Body mass index and early CD4 T-cell recovery among adults initiating antiretroviral therapy in North America, 1998-2010

OBJECTIVES

Adipose tissue affects several aspects of the cellular immune system, but prior epidemiological studies have differed on whether a higher body mass index (BMI) promotes CD4 T-cell recovery on antiretroviral therapy (ART). The objective of this analysis was to assess the relationship between BMI at ART initiation and early changes in CD4 T-cell count.

METHODS

We used the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD) data set to analyse the relationship between pre-treatment BMI and 12-month CD4 T-cell recovery among adults who started ART between 1998 and 2010 and maintained HIV-1 RNA levels < 400 copies/mL for at least 6 months. Multivariable regression models were adjusted for age, race, sex, baseline CD4 count and HIV RNA level, year of ART initiation, ART regimen and clinical site.

RESULTS

A total of 8381 participants from 13 cohorts contributed data; 85% were male, 52% were nonwhite, 32% were overweight (BMI 25-29.9 kg/m(2) ) and 15% were obese (BMI > 30 kg/m(2) ). Pretreatment BMI was associated with 12-month CD4 T-cell change (P < 0.001), but the relationship was nonlinear (P < 0.001). Compared with a reference of 22 kg/m(2) , a BMI of 30 kg/m(2) was associated with a 36 cells/μL [95% confidence interval (CI) 14, 59 cells/μL] greater CD4 T-cell count recovery among women and a 19 cells/μL (95% CI 9, 30 cells/μL) greater recovery among men at 12 months. At a BMI > 30 kg/m(2) , the observed benefit was attenuated among men to a greater degree than among women, although this difference was not statistically significant.

CONCLUSIONS

A BMI of approximately 30 kg/m(2) at ART initiation was associated with greater CD4 T-cell recovery at 12 months compared with higher or lower BMI values, suggesting that body composition may affect peripheral CD4 T-cell recovery.

Relationship of chronic hepatitis C infection to rates of AIDS-defining illnesses in a Canadian cohort of HIV seropositive individuals receiving highly active antiretroviral therapy

BACKGROUND

The influence of chronic hepatitis C virus (HCV) infection on the risk, timing, and type of AIDS-defining illnesses (ADIs) is not well described. To this end, rates of ADIs were evaluated in a Canadian cohort of HIV seropositive individuals receiving highly active antiretroviral therapy (HAART).

METHODS

ADIs were classified into 6 Centers for Disease Control and Prevention (CDC)-defined etiological subgroups: non-Hodgkin lymphoma, viral infection, bacterial infection, HIV-related disease, protozoal infection, and mycotic infection. Generalized estimating equation (GEE) Poisson regression models were used to estimate the effect of HCV on rates of ADIs after adjusting for covariates.

RESULTS

Among 2,706 HAART recipients, 768 (28%) were HCV coinfected. Rates of all ADIs combined and of bacterial infection, HIV-related disease, and mycotic infection were increased in HCV-coinfected persons and among those with CD4 counts <200 cells/mm3 HCV was associated with an increased risk of ADIs (rate ratio [RR], 1.38; 95% CI, 1.01-1.88) and a 2-fold increased risk of mycotic infections (RR, 2.21; 95% CI, 1.35-3.62) in univariate analyses and after adjusting for age, baseline viral load, baseline CD4 count, and region of Canada. However, after further adjustment for HAART interruptions, HCV was no longer associated with an increased rate of ADIs overall (RR, 1.13; 95% CI, 0.80-1.59), but remained associated with an increased rate of mycotic infections (RR, 1.97, 95% CI, 1.08-3.61).

CONCLUSION

Although HCV coin-fected individuals are at increased risk of developing ADIs overall, our analysis suggests that behavioral variables associated with HCV (including rates of retention on HAART), and not biological interactions with HCV itself, are primarily responsible.

High prevalence of food insecurity among HIV-infected individuals receiving HAART in a resource-rich setting

This study aimed to assess the prevalence and correlates of food insecurity in a cohort of HIV-infected individuals on highly active antiretroviral therapy (HAART) in British Columbia (BC), Canada. Adults receiving HAART voluntarily enrolled into the Longitudinal Investigations into Supportive and Ancillary Health Services (LISA) cohort. Individual food insecurity was measured using a modified version of the Radimer/Cornell Questionnaire. We performed bivariate analyses to determine differences between explanatory variables for individuals who were food secure and food insecure. We performed logistic regression to determine independent predictors of food insecurity. Of the 457 individuals enrolled in the LISA cohort, 324 (71.0%) were found to be food insecure. Multivariate analysis indicated that individuals who had an annual incomes less than $15,000 (odds ratio [OR] 3.15, 95% confidence interval [CI] 1.83, 5.44), used illicit drugs (OR 1.85, 95% CI 1.03, 3.33), smoked tobacco (OR 2.30, 95% CI 1.30, 4.07), had depressive symptoms (OR 2.34, 95% CI 1.38, 3.96), and were younger (OR 0.95, 95% CI, 0.92, 0.98) were more likely to be food insecure. Our results demonstrated a high (71%) prevalence of food insecurity among HIV-infected individuals receiving HAART in this resource-rich setting, and that food insecurity is associated with a compendium of environmental and behavioral factors. More research is needed to understand the biological and social pathways linking food insecurity to these variables in order to identify program strategies that can effectively improve food security among HIV-infected populations.

An assessment of global Internet-based HIV/AIDS media coverage: implications for United Nations Programme on HIV/AIDS' Global Media HIV/AIDS Initiative

No studies to date have assessed the quantity of HIV/AIDS-related media on the Internet. We assessed the quantity of language-specific HIV/AIDS Internet-based news coverage, and the correlation between country-specific HIV/AIDS news coverage and HIV/AIDS prevalence. Internet-based HIV/AIDS news articles were queried from Google News Archives for 168 countries, for the year 2007, in the nine most commonly spoken languages worldwide. English, French and Spanish sources had the greatest number of HIV/AIDS-related articles, representing 134,000 (0.70%), 11,200 (0.65%) and 24,300 (0.49%) of all news articles, respectively. A strong association between country-specific HIV/AIDS news coverage and HIV/AIDS prevalence was found, Spearman's rank correlation: 0.6 ( P < 0.001). Among countries with elevated HIV/AIDS prevalence (≥10%), the volume of HIV/AIDS-specific media was highest in Swaziland (15.9%) and Malawi (13.2%), and lowest in South Africa (4.8%) and Namibia (4.9%). Increased media attention should be placed on countries with high HIV/AIDS prevalence and limited HIV/AIDS-specific news coverage.

Male circumcision for the prevention of heterosexually acquired HIV infection: a meta-analysis of randomized trials involving 11,050 men

OBJECTIVES

Observational studies and a small collection of randomized controlled trials (RCTs) suggest that male circumcision may significantly reduce HIV transmission between sero-discordant contacts. The Joint United Nations Programme on HIV/AIDS (UNAIDS) and World Health Organization have recently announced recommendations to scale up male circumcision in countries with generalized epidemics and low levels of male circumcision. However, no meta-analysis has been conducted to determine the effectiveness of this intervention.

METHODS

We conducted a systematic review of medical literature, and included any RCTs assessing male circumcision to prevent heterosexually acquired HIV infection among males. We used the DerSimonian-Laird random effects method to pool study outcomes. We calculated the relative risk (RR), risk difference, number needed to treat (NNT) and I(2), all with 95% confidence intervals (CIs).

RESULTS

We identified three RCTs that met our inclusion criteria, involving a total of 11 050 men. The pooled RR was 0.44 (95% CI 0.33-0.60, P<0.0001, I(2)=0%, 95% CI 0-35%). The risk difference was 0.014 (95% CI 0.07-0.21), yielding a NNT of 72 (95% CI 50-143).

CONCLUSIONS

Male circumcision is an effective strategy for reducing new male HIV infections. Its impact on a population level will require consistently safe sexual practices to maintain the protective benefit.

Efficacy of influenza vaccination in HIV-positive patients: a systematic review and meta-analysis

BACKGROUND

International treatment guidelines recommend that HIV-positive patients be vaccinated for influenza annually. Evidence supporting this recommendation is limited. We assessed the efficacy of influenza vaccines in preventing influenza in HIV-positive patients through a systematic review and meta-analysis.

METHODS

We searched 10 electronic databases independently, in duplicate (from inception to June 2007). We extracted data on study design, population characteristics and outcomes related to influenza symptoms and antibody titres. We pooled data using a random effects model and conducted sensitivity analyses to evaluate heterogeneity.

RESULTS

We included four studies. Three studies were evaluable for meta-analysis and yielded a pooled relative risk reduction (RRR) of 66% [95% confidence interval (CI) 36-82%; I(2)=73%]. One case-control study yielded an odds ratio of 1.98 (95% CI 0.75-5.20). When we assessed heterogeneity according to study design, we found that the study of the highest quality, a randomized clinical trial (RCT), yielded the most conservative estimate (RRR 41%; 95% CI 2-64%).

INTERPRETATION

Evidence supporting influenza vaccination of HIV-positive individuals is limited, poorly quantified and characterized by substantial methodological shortcomings. A reasonable estimate of influenza vaccination effectiveness in HIV-positive patients cannot be derived from these data. There is an urgent need for randomized trials to guide policy and clinical practice.