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Zanuzzi MG, López SM, Cattaneo MJ, Pérez-Maure MA, Lahiri CD, Romero CA. Isolated Nocturnal Hypertension in People Living With Human Immunodeficiency Virus: A Cross-Sectional Study. Am J Hypertens 2024; 37:127-133. [PMID: 37777195 DOI: 10.1093/ajh/hpad087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 08/04/2023] [Accepted: 09/20/2023] [Indexed: 10/02/2023] Open
Abstract
BACKGROUND Nocturnal hypertension (NH) is a potent cardiovascular risk factor described frequently in people with HIV (PWH). Isolated NH (INH) is less well reported in PWH because of the need for ambulatory blood pressure monitoring (ABPM) in office normotensive patients. We aim to document the prevalence of NH and INH and the clinical factors associated with these phenotypes. METHODS Cross-sectional study from an HIV program in Argentina. Office and ABPM measurements, as well as clinical and laboratory exploration, were performed. We defined INH as NH with daytime normotension in patients with office normotension. RESULTS We obtained ABPM in 66 PWH, 60% male, aged 44.7 (IQR 27-69) years; 87% receiving antiretroviral therapy, and 86.2% virologically suppressed. ABPM-based hypertension prevalence was 54.7% (95% CI: 42.5-66.3). The prevalence of NH was 48.5% (32/66), while the INH prevalence was 19.7% (95% CI: 11.7-30.9). No differences were found regarding sex, HIV viral load, CD4+ T lymphocytes count, or years of infection between normotensive and INH patients. Multiple linear regression model adjusted for sex and age determined that body mass index (β = 0.93, P < 0.01), plasma uric acid (β = 0.25, P = 0.04), plasma potassium (β = -10.1, P = 0.01), and high-sensitivity C-reactive protein (hs-CRP) (β = 0.78, P = 0.02) independently predicted nocturnal systolic blood pressure (BP) in PWH. In a multiple logistic regression model adjusted for age and sex, the presence of sedentariness, plasma potassium <4 mEq/L, BMI, and hs-CRP levels were predictors of INH. CONCLUSION INH is highly prevalent in PWH. Metabolic and inflammatory markers predict nocturnal SBP in PWH.
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Affiliation(s)
- Matias G Zanuzzi
- Servicio de Clínica Médica, Hospital Privado de Córdoba, Córdoba, Argentina
| | - Silvina M López
- Servicio de Clínica Médica, Hospital Rawson de Córdoba, Córdoba, Argentina
| | - Máximo J Cattaneo
- Servicio de Clínica Médica, Hospital Rawson de Córdoba, Córdoba, Argentina
| | | | - Cecile D Lahiri
- Division of Infectious Diseases, Department of Medicine, Emory University, Atlanta, Georgia, USA
| | - Cesar A Romero
- Renal Division, Department of Medicine, Emory University, Atlanta, Georgia, USA
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Liu Y, Ramos SD, Hanna DB, Jones DL, Lazar JM, Kizer JR, Cohen MH, Haberlen SA, Adimora AA, Lahiri CD, Wise JM, Friedman MR, Plankey M, Chichetto NE. Psychosocial Syndemic Classes and Longitudinal Transition Patterns Among Sexual Minority men Living with or Without HIV in the Multicenter AIDS Cohort Study (MACS). AIDS Behav 2023; 27:4094-4105. [PMID: 37418062 PMCID: PMC10615787 DOI: 10.1007/s10461-023-04123-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2023] [Indexed: 07/08/2023]
Abstract
Mental health and substance use epidemics interact to create psychosocial syndemics, accelerating poor health outcomes. Using latent class and latent transition analyses, we identified psychosocial syndemic phenotypes and their longitudinal transition pathways among sexual minority men (SMM) in the Multicenter AIDS Cohort Study (MACS, n = 3,384, mean age 44, 29% non-Hispanic Black, 51% with HIV). Self-reported depressive symptoms and substance use indices (i.e., smoking, hazardous drinking, marijuana, stimulant, and popper use) at the index visit, 3-year and 6-year follow-up were used to model psychosocial syndemics. Four latent classes were identified: "poly-behavioral" (19.4%), "smoking and depression" (21.7%), "illicit drug use" (13.8%), and "no conditions" (45.1%). Across all classes, over 80% of SMM remained in that same class over the follow-ups. SMM who experienced certain psychosocial clusters (e.g., illicit drug use) were less likely to transition to a less complex class. These people could benefit from targeted public health intervention and greater access to treatment resources.
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Affiliation(s)
- Yiyang Liu
- University of Florida, Gainesville, FL, USA
| | - Stephen D Ramos
- University of California - San Diego, San Diego, La Jolla, CA, USA
| | | | - Deborah L Jones
- University of Miami Miller School of Medicine, Miami, FL, USA
| | | | - Jorge R Kizer
- San Francisco Veterans Affairs Health Care System, University of California, San Francisco, CA, USA
| | - Mardge H Cohen
- Stroger Hospital, Cook County Health and Hospitals System, Chicago, IL, USA
| | | | | | - Cecile D Lahiri
- Department of Medicine, Division of Infectious Diseases, Emory University, Atlanta, GA, USA
| | - Jenni M Wise
- University of Alabama at Birmingham, Birmingham, AL, England
| | - Mackey R Friedman
- School of Public Health. Newark, Rutgers, the State University of New Jersey, New Brunswick, NJ, Canada
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3
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Lahiri CD, Mehta CC, Sykes C, Weiser SD, Palella F, Lake JE, Mellors JW, Gustafson D, French AL, Adimora AA, Konkle-Parker D, Sharma A, Bolivar H, Kassaye SG, Rubin LH, Alvarez JA, Golub ET, Ofotokun I, Sheth AN. Obesity Modifies the Relationship Between Raltegravir and Dolutegravir Hair Concentrations and Body Weight Gain in Women Living with HIV. AIDS Res Hum Retroviruses 2023; 39:644-651. [PMID: 37140468 PMCID: PMC10712367 DOI: 10.1089/aid.2022.0185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023] Open
Abstract
Integrase strand-transfer inhibitors (INSTIs) are associated with weight gain in women living with HIV (WLH). Relationships between drug exposure, baseline obesity, and INSTI-associated weight gain remain unclear. Data from 2006 to 2016 were analyzed from virally suppressed WLH enrolled in the Women's Interagency HIV Study, who switched/added an INSTI to antiretroviral therapy: [raltegravir (RAL), dolutegravir (DTG), or elvitegravir (EVG)]. Percent body weight change was calculated from weights obtained a median 6 months pre-INSTI and 14 months post-INSTI initiation. Hair concentrations were measured with validated liquid chromatography-mass spectrometry (MS)/MS assays. Baseline (preswitch) weight status evaluated obese (body mass index, BMI, ≥30 kg/m2) versus nonobese (BMI <30 kg/m2). Mixed models examined the drug hair concentration*baseline obesity status interaction for each INSTI. There were 169 WLH included: 53 (31%) switched to RAL, 72 (43%) to DTG, and 44 (26%) to EVG. Women were median age 47-52 years, predominantly Non-Hispanic Black, median CD4 counts >500 cells/mm3, >75% with undetectable HIV-1 RNA. Over ∼1 year, women experienced median increases in body weight: 1.71% (-1.78, 5.00) with RAL; 2.40% (-2.82, 6.50) with EVG; and 2.48% (-3.60, 7.88) with DTG. Baseline obesity status modified the relationship between hair concentrations and percent weight change for DTG and RAL (p's < 0.05): higher DTG, yet lower RAL concentrations were associated with greater weight gain among nonobese women. Additional pharmacologic assessments are needed to understand the role of drug exposure in INSTI-associated weight gain.
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Affiliation(s)
- Cecile D. Lahiri
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - C. Christina Mehta
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Craig Sykes
- Clinical Pharmacology and Analytical Chemistry Core, Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Sheri D. Weiser
- Division of HIV, Infectious Diseases, and Global Medicine, Department of Medicine, University of California San Francisco School of Medicine, San Francisco, California, USA
| | - Frank Palella
- Division of Infectious Diseases, Department of Medicine, Feinberg School of Medicine, Chicago, Illinois, USA
| | - Jordan E. Lake
- Division of Infectious Diseases, Department of Medicine, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - John W. Mellors
- Division of Infectious Diseases, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Deborah Gustafson
- Department of Neurology, State University of New York Downstate Health Sciences University, Brooklyn, New York, USA
| | - Audrey L. French
- Division of Infectious Diseases, CORE Center/Stroger (Cook County) Hospital, Chicago, Illinois, USA
| | - Adaora A. Adimora
- Division of Infectious Diseases, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Deborah Konkle-Parker
- Division of Infectious Diseases, Department of Medicine, University of Mississippi School of Medicine, Jackson, Mississippi, USA
| | - Anjali Sharma
- Department of Medicine, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Hector Bolivar
- Division of Infectious Diseases, Department of Medicine, University of Miami Health System, Miami, Florida, USA
| | - Seble G. Kassaye
- Division of Infectious Diseases, Department of Medicine, Georgetown University Medical Center, Washington, District of Columbia, USA
| | - Leah H. Rubin
- Departments of Neurology, Psychiatry and Behavioral Sciences, and Molecular and Comparative Pathobiology, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Jessica A. Alvarez
- Division of Endocrinology, Metabolism, and Lipids, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Elizabeth T. Golub
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Igho Ofotokun
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Anandi N. Sheth
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
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Herbertson EC, Lahiri CD, Olugbake OA, Soremekun RO, Spinelli MA, Gandhi M. Adherence determination using urine-tenofovir point-of-care testing and pharmacy refill records: A cross-sectional study. Medicine (Baltimore) 2023; 102:e36321. [PMID: 38013290 PMCID: PMC10681504 DOI: 10.1097/md.0000000000036321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 11/03/2023] [Indexed: 11/29/2023] Open
Abstract
Pharmacy refill records (PRR), are an accessible strategy for estimating adherence in low- and middle-income countries (LMICs). However, the low-cost urine-tenofovir point-of-care test opens up the possibility of an objective metric of adherence that is scalable to LMICs. This study compared adherence to tenofovir-based regimens using urine-tenofovir point-of-care (POC) test with pharmacy refill records in a Nigerian population of HIV-positive persons. This was a cross-sectional study among 94 HIV-positive adults, which was conducted from June to August 2021, in a large outpatient clinic in Lagos, Nigeria. Adherence to pharmacy appointments was automatically calculated using a computerized pharmacy appointment system (FileMaker Pro™). Urine drops on the urine-tenofovir POC test strip developed 2 lines for a negative test (tenofovir absent) and one line for a positive test. Fisher's exact test was used to examine the association between pharmacy refill record and urine-tenofovir point-of-care test. Logistic regression was performed to predict viral suppression (<1000 copies/mL, based on WHO recommendations) using both methods of adherence determination. A Receiver Operating Characteristic (ROC) curve of the association between specificity and sensitivity was generated to evaluate the predictive value of adherence determined using pharmacy-refill record and urine-tenofovir point-of-care test in forecasting viral suppression. The statistical significance level was set at 0.05. Fisher's exact test showed no statistically significant difference in adherence using urine-tenofovir point-of-care test or pharmacy refill record. The logistic regression model showed that an increase in pharmacy-refill record of ≥ 95% was associated with viral suppression (P = .019). From the ROC curve, the sensitivity was same at 95.5% for both methods, but the specificity of the urine-tenofovir point-of-care test was greater (96.6% vs 95.5%) than pharmacy refill record (P = .837). Urine-tenofovir point-of-care test provided equivalent adherence data to pharmacy refill data.
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Affiliation(s)
| | - Cecile D. Lahiri
- Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA
| | - Olubusola A. Olugbake
- Department of Clinical Pharmacy and Biopharmacy, University of Lagos, Lagos, Nigeria
| | - Rebecca O. Soremekun
- Department of Clinical Pharmacy and Biopharmacy, University of Lagos, Lagos, Nigeria
| | | | - Monica Gandhi
- University of California at San Francisco (UCSF), San Francisco, CA
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5
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Chichetto NE, Gebru NM, Plankey MW, Tindle HA, Koethe JR, Hanna DB, Shoptaw S, Jones DL, Lazar JM, Kizer JR, Cohen MH, Haberlen SA, Adimora AA, Lahiri CD, Wise JM, Freiberg MS. Syndemic trajectories of heavy drinking, smoking, and depressive symptoms are associated with mortality in women living with HIV in the United States from 1994 to 2017. Drug Alcohol Depend 2023; 249:110838. [PMID: 37352734 PMCID: PMC10726291 DOI: 10.1016/j.drugalcdep.2023.110838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 05/25/2023] [Accepted: 06/13/2023] [Indexed: 06/25/2023]
Abstract
BACKGROUND Heavy drinking, smoking, and depression are common among people with HIV. Little is known about the co-occurring, synergistic effect of having two or more of these conditions long-term -a sustained syndemic - on mortality among women with HIV (WWH). METHODS Data from 3282 WWH of the Women's Interagency HIV Study from 1994 to 2017 were utilized. National Death Index review identified cause of death (n=616). Sustained syndemic phenotypes were based on membership in high-risk groups defined by group-based trajectory models of repeated self-reported alcohol use, smoking, and depressive symptoms and their co-occurrence. Cox proportional hazard models estimated associations of sustained syndemic phenotypes with all-cause, non-AIDS, and non-overdose mortality, adjusting for age, race/ethnicity, education, enrollment wave, illicit drug use, and time-varying HIV viral load and CD4+ T-cell count. RESULTS WWH were 58% Black and 26% Hispanic, with a mean baseline age of 36.7 years. Syndemic phenotypes included zero (45%, n=1463), heavy drinking only (1%, n=35), smoking only (28%, n=928), depressive symptoms only (9%, n=282), and 2+ trajectories (17%, n=574). Compared to zero trajectories, having 2+ trajectories was associated with 3.93 times greater all-cause mortality risk (95% CI 3.07, 5.04) after controlling for confounders and each high-risk trajectory alone. These findings persisted in sensitivity analyses, removing AIDS- and overdose-related mortalities. CONCLUSIONS Clustering of 2+ conditions of heavy drinking, smoking, and depression affected nearly one in five WWH and was associated with higher mortality than zero or one condition. Our findings underscore the need for coordinated screening and parsimonious treatment strategies for these co-occurring conditions.
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Affiliation(s)
| | | | | | - Hilary A Tindle
- Vanderbilt University Medical CenterNashville, TN37232, USA; Geriatric Research Education and Clinical Centers (GRECC), Veterans Affairs Tennessee Valley Healthcare SystemNashville, TN37212USA
| | - John R Koethe
- Vanderbilt University Medical CenterNashville, TN37232, USA
| | - David B Hanna
- Albert Einstein College of MedicineBronx, NY10461, USA
| | - Steven Shoptaw
- David Geffen School of Medicine at UCLA, Los Angeles, CA90095USA
| | - Deborah L Jones
- University of Miami Miller School of MedicineMiami, FL33136, USA
| | | | - Jorge R Kizer
- San Francisco Veterans Affairs Health Care System, University of California, San Francisco, CA94121USA
| | - Mardge H Cohen
- Stroger Hospital/Cook County Health and Hospitals SystemChicago, IL60612, USA
| | - Sabina A Haberlen
- Johns Hopkins Bloomberg School of Public HealthBaltimore, MD21205, USA
| | | | - Cecile D Lahiri
- Department of Medicine, Division of Infectious Diseases, Emory UniversityAtlanta, GA30322, USA
| | - Jenni M Wise
- University of Alabama at BirminghamBirmingham, AL35294, USA
| | - Matthew S Freiberg
- Vanderbilt University Medical CenterNashville, TN37232, USA; Geriatric Research Education and Clinical Centers (GRECC), Veterans Affairs Tennessee Valley Healthcare SystemNashville, TN37212USA
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Moran CA, Oliver NT, Szabo B, Collins LF, Nguyen MLT, Shah NS, Moanna A, Colasanti JA, Cantos VD, Armstrong WS, Sheth AN, Ofotokun I, Kelley CF, Marconi VC, Lahiri CD. The association between comorbidities and coronavirus disease 2019 hospitalization among people with HIV differs by age. AIDS 2023; 37:71-81. [PMID: 36111530 PMCID: PMC9742289 DOI: 10.1097/qad.0000000000003386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVES To determine whether factors associated with coronavirus disease 2019 (COVID-19) hospitalization among people with HIV (PWH) differ by age stratum. DESIGN Retrospective cohort study. METHODS All adult PWH with a positive SARS-CoV-2 PCR in a public safety-net health system between 1 March 2020 and 28 February 2021 and a Veterans Affairs Medical Center between 1 1 March 2020 and 15 November 2020 in Atlanta, Georgia were included. We performed multivariable logistic regression to determine demographic and clinical factors associated with COVID-19 hospitalization overall and stratified by age less than 50 and at least 50 years. RESULTS Three hundred and sixty-five PWH (mean age 49 years, 74% cisgender male, 82% black) were included. Ninety-six percent were on antiretroviral therapy (ART), 87% had CD4 + T-cell count at least 200 cells/μl, and 89% had HIV-1 RNA less than 200 copies/ml. Overall, age [adjusted odds ratio (aOR) 95% confidence interval (CI) 1.07 (1.04-1.10)], later date of SARS-CoV-2 infection [aOR 0.997 (0.995-1.00)], heart disease [aOR 2.27 (1.06-4.85)], and history of hepatitis C virus (HCV) [aOR 2.59 (1.13-5.89)] were associated with COVID-19 hospitalization. Age-adjusted comorbidity burden was associated with 30% increased risk of hospitalization [aOR 1.30 (1.11-1.54)]. Among 168 PWH less than 50 years old, older age [aOR 1.09 (1.01-1.18)] and no ART use [aOR 40.26 (4.12-393.62)] were associated with hospitalization; age-adjusted comorbidity burden was not ( P = 0.25). Among 197 PWH at least 50, older age [aOR 1.10 (1.04-1.16)], heart disease [aOR 2.45 (1.04-5.77)], history of HCV [aOR 3.52 (1.29-9.60)], and age-adjusted comorbidity burden [aOR 1.36 (1.12-1.66)] were associated with hospitalization. CONCLUSION Comorbidity burden is more strongly associated with COVID-19 hospitalization among older, rather than younger, PWH. These findings may have important implications for risk-stratifying COVID-19 therapies and booster recommendations in PWH.
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Affiliation(s)
- Caitlin A Moran
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine
- Grady Health System, Atlanta
| | - Nora T Oliver
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine
- Atlanta Veterans Affairs Medical Center, Decatur
| | | | - Lauren F Collins
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine
- Grady Health System, Atlanta
| | - Minh Ly T Nguyen
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine
- Grady Health System, Atlanta
| | - N Sarita Shah
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine
- Atlanta Veterans Affairs Medical Center, Decatur
- Department of Epidemiology
- Hubert Department of Global Health, Emory University Rollins School of Public Health, Atlanta, Georgia, USA
| | - Abeer Moanna
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine
- Atlanta Veterans Affairs Medical Center, Decatur
| | - Jonathan A Colasanti
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine
- Grady Health System, Atlanta
- Hubert Department of Global Health, Emory University Rollins School of Public Health, Atlanta, Georgia, USA
| | - Valeria D Cantos
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine
- Grady Health System, Atlanta
| | - Wendy S Armstrong
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine
- Grady Health System, Atlanta
| | - Anandi N Sheth
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine
- Grady Health System, Atlanta
| | - Ighovwerha Ofotokun
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine
- Grady Health System, Atlanta
| | - Colleen F Kelley
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine
- Grady Health System, Atlanta
| | - Vincent C Marconi
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine
- Grady Health System, Atlanta
- Atlanta Veterans Affairs Medical Center, Decatur
- Hubert Department of Global Health, Emory University Rollins School of Public Health, Atlanta, Georgia, USA
| | - Cecile D Lahiri
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine
- Grady Health System, Atlanta
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Yu MA, Gerig L, Mehta CC, Yusef O, Musonge-Effoe J, Alvarez J, Spence AB, Albrecht S, Alcaide MLL, Adimora AA, Abraham AG, French AL, Augenbraun M, Anastos K, Price JC, Tien PC, Lahiri CD. 1276. Noninvasive Assessment of Change in Hepatic Fibrosis Following Initiation of Integrase Inhibitors in Women Living with HIV. Open Forum Infect Dis 2022. [DOI: 10.1093/ofid/ofac492.1107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Abstract
Background
Nonalcoholic fatty liver disease (NAFLD) is highly prevalent in persons with HIV and can lead to hepatic fibrosis. Integrase strand-transfer inhibitors (INSTIs), first-line agents in antiretroviral therapy (ART), are associated with increased body mass index (BMI), particularly in women living with HIV (WLWH). We evaluated change in hepatic fibrosis risk following INSTI initiation in WLWH. Table 1.Change over time in hepatic fibrosis scores among group switching to INSTI-regimens versus group staying on non-INSTI regimens
INSTI=integrase strand-transfer inhibitor; SD=standard deviation; FIB-4=Fibrosis-4 Score (calculated by Age*AST/[platelet count*ALT1/2]; APRI=AST to Platelet Ratio Index (calculated by [AST/AST upper limit of normal]/platelet count); NFS = Non Alcoholic Fatty Liver Disease Fibrosis Score (calculated by -1.675+(0.037*age) + (0.094*body mass index)+(1.13*hyperglycemia or diabetes [yes=1, no=0])+ (0.99*AST/ALT)-(0.013*platelet count)-(0.66*albumin)); CI=Confidence Interval. Linear regression model with unstructured covariance matrix for repeated observations with a person. Adjusted models for all outcomes included the following covariates: age, race/ethnicity, education, baseline CD4 lymphocyte count, baseline antiretroviral anchor drug, and abacavir, tenofovir disoproxil fumarate, and tenofovir alafenamide use. Body mass index was included in models for FIB-4 and APRI only. Age was included for APRI only.
Methods
Data from 2007-2020 were analyzed from virologically-suppressed WLWH enrolled in the Women’s Interagency HIV Study (WIHS). We excluded WLWH with untreated viral hepatitis, heavy alcohol use and autoimmune or metabolic chronic liver disease. WLWH who switched to or added an INSTI to ART were compared to women who remained on non-INSTI ART. Outcomes included change in noninvasive markers of hepatic fibrosis: Fibrosis-4 (FIB4), AST to Platelet Ratio Index (APRI), and NAFLD fibrosis score (NFS), measured 4-12 months before and 4-19 months post INSTI switch/add. Longitudinal linear regression models compared change over time in each outcome by group, adjusted for covariates.
Results
872 WIHS participants (323 INSTI, 549 non-INSTI) were followed for a median 3.0 years (Q1 2.0, Q3 4.5). Mean age was 47.2 years (SD 9.0), 61% were Non-Hispanic Black, and mean BMI was 31.4 (8.8) kg/m2. Absolute mean changes in FIB4, APRI, and NFS scores were +0.021, -0.005, +0.194, respectively, in the INSTI group compared to +0.003, -0.011, +0.016, respectively, in the non-INSTI group (Table 1). No significant differences in mean AST and ALT change between the INSTI and non-INSTI groups were noted. There was a significant increase in NFS score in the INSTI group (p< 0.0001) and this difference remained in adjusted models (p=0.0135). Compared to the non-INSTI group, a larger proportion of participants in the INSTI group changed to a higher NFS risk category: 15.7% vs 9.0%, p=0.014.
Conclusion
Starting INSTIs was associated with minimal change in FIB4 and APRI scores but increased NFS score in WLWH. The increase in NFS score likely reflects BMI gain with INSTI use, as BMI is not factored into FIB4 or APRI calculators and AST and ALT did not change significantly. Nonetheless, patients starting INSTIs need close monitoring of metabolic changes and low thresholds for additional noninvasive liver fibrosis testing.
Disclosures
Michael A. Yu, MD, Ligera: Advisor/Consultant Maria L L. Alcaide, MD, Gilead: Advisor/Consultant Adaora A. Adimora, MD, MPH, Gilead: Advisor/Consultant|Gilead: Grant/Research Support|Merck: Advisor/Consultant|Merck: Grant/Research Support Jennifer C. Price, MD, PhD, Abbvie: Grant/Research Support|Gilead: Grant/Research Support|Merck: Grant/Research Support Phyllis C. Tien, MD, MSc, Gilead: Grant/Research Support|Merck: Grant/Research Support Cecile D. Lahiri, MD, MS, Theratechnologies: Advisor/Consultant.
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Affiliation(s)
- Michael A Yu
- Emory University School of Medicine , Atlanta, GA
| | - Logan Gerig
- Emory University School of Medicine , Atlanta, GA
| | | | | | | | | | - Amanda B Spence
- Georgetown University Medical Center , District of Columbia, District of Columbia
| | | | - Maria L L Alcaide
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine , Miami, Florida
| | | | | | | | | | - Kathryn Anastos
- Department of Medicine, Albert Einstein College of Medicine , Bronx, New York, Bronx, NY
| | - Jennifer C Price
- University of California , San Francisco, San Francisco, California
| | - Phyllis C Tien
- University of California , San Francisco, San Francisco, California
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8
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Janorkar DA, Long DM, Weber KM, Sharma A, Lin GH, D’Souza G, Edmonds A, Kassaye S, Lahiri CD, Konkle-Parker D. Association between BMI and periodontitis in women living with or at risk for HIV. Spec Care Dentist 2022; 42:486-493. [PMID: 35279851 PMCID: PMC9867927 DOI: 10.1111/scd.12711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 08/30/2021] [Accepted: 02/19/2022] [Indexed: 02/03/2023]
Abstract
AIMS Currently, there is no data available assessing the association between body mass index (BMI) and periodontitis among women living with HIV (WLWH). This study aims to investigate this association among WLWH and women at risk for HIV (WRH) in the United States. METHODS AND RESULTS Data from 351 WLWH and 52 WRH participants from the Women's Interagency HIV Study having pocket depths and clinical periodontal attachment loss assessments in 2003-2004 were included. Multinomial logistic regression analyses in the full sample assessed the relationship between BMI (underweight/normal, overweight, or obese) and periodontitis by severity (mild, moderate, severe), adjusting for study sites, age, education, annual household income, smoking, alcohol consumption, and diabetes. Overall, 75.2% women (76.0% WLWH; 69.0% WRH) had periodontitis. Moreover, 75.0% obese and 75.3% overweight women were affected by periodontitis. In the full sample, adjusted odds ratio (aOR) of having mild, moderate, and severe periodontitis in obese women were: 1.14 (95% confidence interval [CI]: 0.51-2.52), 1.02 (95% CI: 0.46-2.29), and 0.24 (95% CI: 0.06-1.07), respectively, and in overweight women: 0.70 (95% CI: 0.31-1.58), 0.85 (95% CI: 0.38-1.90), and 0.31 (95% CI: 0.08-1.15), respectively. CONCLUSIONS Even with high prevalence of periodontitis among women with or without HIV infection in this cohort, this study does not provide evidence of an association between BMI and periodontitis.
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Affiliation(s)
- Deepti A. Janorkar
- Department of Advanced General Dentistry, School of Dentistry, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Dustin M. Long
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Kathleen M. Weber
- Cook County Health/Hektoen Institute of Medicine, Chicago, Illinois, USA
| | - Anjali Sharma
- Department of Medicine I Divisions of General Internal Medicine and Infectious Diseases, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Guo-Hao Lin
- Division of Periodontology, School of Dentistry, University of California San Francisco, San Francisco, California, USA
| | - Gypsyamber D’Souza
- Department of Epidemiology, John Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Andrew Edmonds
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Seble Kassaye
- Department of Medicine I Division of Infectious Diseases, Georgetown University, Washington, DC, USA
| | - Cecile D. Lahiri
- Department of Medicine I Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Deborah Konkle-Parker
- Schools of Nursing, Medicine and Population Health, University of Mississippi Medical Center, Jackson, Mississippi, USA
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9
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Mehta CC, Hagen KS, Rubtsova AA, Lahiri CD, Michopoulos V, Moran CA, Haddad LB, Titanji K, Collins LF, Quyyumi AA, Neigh G, Shaw LJ, Weitzmann MN, Waller L, Ofotokun I. Bone, Brain, Heart study protocol: A resilient nested, tripartite prospective cohort study of the role of estrogen depletion on HIV pathology. PLoS One 2022; 17:e0272608. [PMID: 35921353 PMCID: PMC9348736 DOI: 10.1371/journal.pone.0272608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 07/22/2022] [Indexed: 11/18/2022] Open
Abstract
PURPOSE We describe the rationale for and design of an innovative, nested, tripartite prospective observational cohort study examining whether relative estrogen insufficiency-induced inflammation amplifies HIV-induced inflammation to cause end organ damage and worsen age-related co-morbidities affecting the neuro-hypothalamic-pituitary-adrenal axis (Brain), skeletal (Bone), and cardiovascular (Heart/vessels) organ systems (BBH Study). METHODS The BBH parent study is the Multicenter AIDS Cohort/Women's Interagency HIV Study Combined Cohort Study (MWCCS) with participants drawn from the Atlanta MWCCS site. BBH will enroll a single cohort of n = 120 women living with HIV and n = 60 HIV-negative women, equally distributed by menopausal status. The innovative multipart nested study design of BBH, which draws on data collected by the parent study, efficiently leverages resources for maximum research impact and requires extensive oversight and management in addition to careful implementation. The presence of strong infrastructure minimized BBH study disruptions due to changes in the parent study and the COVID-19 pandemic. CONCLUSION BBH is poised to provide insight into sex and HIV associations with the neuro-hypothalamic-pituitary-adrenal axis, skeletal, and cardiovascular systems despite several major, unexpected challenges.
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Affiliation(s)
- C. Christina Mehta
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, United States of America
| | - Kimberly S. Hagen
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, United States of America
| | - Anna A. Rubtsova
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, United States of America
| | - Cecile D. Lahiri
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, United States of America
- Grady Infectious Diseases Program, Grady Health System, Atlanta, GA, United States of America
| | - Vasiliki Michopoulos
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, United States of America
| | - Caitlin A. Moran
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, United States of America
- Grady Infectious Diseases Program, Grady Health System, Atlanta, GA, United States of America
| | - Lisa B. Haddad
- Center for Biomedical Research, Population Council, New York, NY, United States of America
| | - Kehmia Titanji
- Division of Endocrinology and Metabolism, Department of Medicine, Emory University School of Medicine, Atlanta, GA, United States of America
| | - Lauren F. Collins
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, United States of America
- Grady Infectious Diseases Program, Grady Health System, Atlanta, GA, United States of America
| | - Arshed A. Quyyumi
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, United States of America
| | - Gretchen Neigh
- Department of Anatomy and Neurobiology, Virginia Commonwealth University School of Medicine, Richmond, VA, United States of America
| | - Leslee J. Shaw
- Blavatnik Women’s Health Research Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - M. Neale Weitzmann
- Division of Endocrinology and Metabolism, Department of Medicine, Emory University School of Medicine, Atlanta, GA, United States of America
- Atlanta Veterans Affairs Medical Center, Decatur, GA, United States of America
| | - Lance Waller
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, United States of America
| | - Ighovwerha Ofotokun
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, United States of America
- Grady Infectious Diseases Program, Grady Health System, Atlanta, GA, United States of America
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10
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Galaviz KI, Shah NS, Gutierrez M, Collins LF, Lahiri CD, Moran CA, Szabo B, Sumitani J, Rhodes J, Marconi VC, Nguyen ML, Cantos VD, Armstrong WS, Colasanti JA. Patient Experiences with Telemedicine for HIV Care During the First COVID-19 Wave in Atlanta, Georgia. AIDS Res Hum Retroviruses 2022; 38:415-420. [PMID: 34693726 PMCID: PMC9206466 DOI: 10.1089/aid.2021.0109] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
We explored experiences with telemedicine among persons with HIV (PWH) during the first wave of the coronavirus disease 2019 (COVID-19) pandemic. A convenience sample of adults (>18 years) receiving care in an urban clinic in Atlanta were invited to participate. Patients completed a structured survey that assessed the usefulness, quality, satisfaction, and concerns with telemedicine services (telephone calls) received during the first wave of the COVID-19 pandemic (March-May 2020). Demographic, plasma HIV-1 RNA, and CD4+ T cell count data were obtained through medical chart abstraction. Bootstrapped t-tests and chi-square tests were used to examine differences in patient experiences by age, sex, and race. Of 406 PWH contacted, 101 completed the survey (median age 55 years, 84% men, 77% Black, 98% virally suppressed, median CD4 count 572 cells/μL). The main HIV care disruptions experienced were delays in follow-up visits (40%), difficulty getting viral load measured (35%), and difficulty accessing antiretroviral therapy (21%). Participant ratings for quality (median score 6.5/7), usefulness (median score 6.0/7), and satisfaction (median score 6.3/7) with telemedicine were high. However, 28% of patients expressed concerns about providers' ability to examine them and about the lack of laboratory tests. More women had concerns about providers' ability to examine them (92% vs. 50%, p = .005) and about the safety of their personal information (69% vs. 23%, p = .002) compared with men. No age or race differences were observed. Although PWH are generally satisfied with telephone-based telemedicine, concerns with its use were notable, particularly among women. Future HIV telemedicine models should address these.
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Affiliation(s)
- Karla I. Galaviz
- Indiana University School of Public Health, Bloomington, Indiana, USA
| | - N. Sarita Shah
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, USA
- Emory University Rollins School of Public Health, Atlanta, Georgia, USA
| | - Mariana Gutierrez
- Emory University Rollins School of Public Health, Atlanta, Georgia, USA
| | - Lauren F. Collins
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, USA
- Grady Health System, Atlanta, Georgia, USA
| | - Cecile D. Lahiri
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, USA
- Grady Health System, Atlanta, Georgia, USA
| | - Caitlin A. Moran
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, USA
- Grady Health System, Atlanta, Georgia, USA
| | | | | | - Jeselyn Rhodes
- Emory University, Office of Information Technology, IT Data Solutions, Atlanta, Georgia, USA
| | - Vincent C. Marconi
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, USA
- Emory University Rollins School of Public Health, Atlanta, Georgia, USA
- Grady Health System, Atlanta, Georgia, USA
| | - Minh Ly Nguyen
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, USA
- Grady Health System, Atlanta, Georgia, USA
| | - Valeria D. Cantos
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, USA
- Grady Health System, Atlanta, Georgia, USA
| | - Wendy S. Armstrong
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, USA
- Grady Health System, Atlanta, Georgia, USA
| | - Jonathan A. Colasanti
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, USA
- Emory University Rollins School of Public Health, Atlanta, Georgia, USA
- Grady Health System, Atlanta, Georgia, USA
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11
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Moran CA, Collins LF, Beydoun N, Mehta PK, Fatade Y, Isiadinso I, Lewis TT, Weber B, Goldstein J, Ofotokun I, Quyyumi A, Choi MY, Titanji K, Lahiri CD. Cardiovascular Implications of Immune Disorders in Women. Circ Res 2022; 130:593-610. [PMID: 35175848 PMCID: PMC8869407 DOI: 10.1161/circresaha.121.319877] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Immune responses differ between men and women, with women at higher risk of developing chronic autoimmune diseases and having more robust immune responses to many viruses, including HIV and hepatitis C virus. Although immune dysregulation plays a prominent role in chronic systemic inflammation, a key driver in the development of atherosclerotic cardiovascular disease (ASCVD), standard ASCVD risk prediction scores underestimate risk in populations with immune disorders, particularly women. This review focuses on the ASCVD implications of immune dysregulation due to disorders with varying global prevalence by sex: autoimmune disorders (female predominant), HIV (male-female equivalent), and hepatitis C virus (male predominant). Factors contributing to ASCVD in women with immune disorders, including traditional risk factors, dysregulated innate and adaptive immunity, sex hormones, and treatment modalities, are discussed. Finally, the need to develop new ASCVD risk stratification tools that incorporate variables specific to populations with chronic immune disorders, particularly in women, is emphasized.
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Affiliation(s)
- Caitlin A. Moran
- Emory University School of Medicine, Department of Medicine, Division of Infectious Diseases, Atlanta, GA, USA
| | - Lauren F. Collins
- Emory University School of Medicine, Department of Medicine, Division of Infectious Diseases, Atlanta, GA, USA
| | - Nour Beydoun
- Emory University School of Medicine, Department of Medicine, Center for Heart Disease Prevention, Division of Cardiology and Emory Women’s Heart Center, Atlanta, GA, USA
| | - Puja K. Mehta
- Emory University School of Medicine, Department of Medicine, Center for Heart Disease Prevention, Division of Cardiology and Emory Women’s Heart Center, Atlanta, GA, USA
| | - Yetunde Fatade
- Emory University School of Medicine, Department of Medicine, Atlanta, GA, USA
| | - Ijeoma Isiadinso
- Emory University School of Medicine, Department of Medicine, Center for Heart Disease Prevention, Division of Cardiology and Emory Women’s Heart Center, Atlanta, GA, USA
| | - Tené T Lewis
- Emory University, Rollins School of Public Health, Department of Epidemiology, Atlanta, GA, USA
| | - Brittany Weber
- Harvard Medical School, Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women’s Hospital, Boston, MA, USA
| | - Jill Goldstein
- Massachusetts General Hospital, Department of Psychiatry, and Harvard Medical School, Departments of Psychiatry and Medicine, Boston, MA, USA
| | - Igho Ofotokun
- Emory University School of Medicine, Department of Medicine, Division of Infectious Diseases, Atlanta, GA, USA
| | - Arshed Quyyumi
- Emory University School of Medicine, Department of Medicine, Center for Heart Disease Prevention, Division of Cardiology and Emory Women’s Heart Center, Atlanta, GA, USA
| | - May Y. Choi
- Cumming School of Medicine, University of Calgary, Calgary, AB Canada
| | - Kehmia Titanji
- Emory University, Department of Medicine, Division of Endocrinology, Metabolism, and Lipids, Atlanta, GA, USA
| | - Cecile D. Lahiri
- Emory University School of Medicine, Department of Medicine, Division of Infectious Diseases, Atlanta, GA, USA
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12
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D’Souza G, Tong W, Gustafson D, Alcaide ML, Lahiri CD, Sharma A, French AL, Palella FJ, Kempf MC, Mimiaga MJ, Ramirez C, Kassaye S, Rinaldo CR, Brown TT, Tien PC, Adimora AA. SARS-CoV-2 Infection Among People Living With HIV Compared With People Without HIV: Survey Results From the MACS-WIHS Combined Cohort Study. J Acquir Immune Defic Syndr 2022; 89:1-8. [PMID: 34878431 PMCID: PMC8667184 DOI: 10.1097/qai.0000000000002822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 09/08/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and coronavirus disease 2019 (COVID-19) symptoms among people living with HIV (PLWH) are not well described. SETTING Longitudinal survey within the MACS/WIHS Combined Cohort Study (MWCCS) of PLWH compared with similar HIV-seronegative (SN) individuals. METHODS Telephone-administered survey of MWCCS participants at 13 clinical research sites across the United States addressing COVID-19 symptoms, SARS-CoV-2 testing, and pandemic impact on social distancing and antiretroviral therapy (ART) use. Primary data collection occurred during May (wave 1), June-July (wave 2), and August-September, 2020 (wave 3). RESULTS One-third of MWCCS participants were tested for SARS-CoV-2 infection; 10% was tested ≥2 times. Similar proportions of PLWH and SN participants were tested, but SARS-CoV-2 positivity was higher among PLWH than among SN individuals (9.4% vs 4.8%, P = 0.003). Odds of SARS-CoV-2 positivity remained higher among PLWH after adjusting for age, sex, race/ethnicity, and study site (adjusted odds ratio = 2.0, 95% confidence interval = 1.2 to 3.2). SARS-CoV-2 positivity was not associated with CD4 cell counts among PLWH. Among SARS-CoV-2 positive participants, 9% had no symptoms, 7% had 1-2 mild symptoms, and 84% had ≥3 symptoms. Most of the (98%) participants reported physical distancing during all survey waves; self-reported ART adherence among PLWH was not adversely affected during the pandemic compared with the previous year (similar adherence in 89% of participants, improved in 9% of participants, and decreased in 2% of participants). CONCLUSIONS Despite similar SARS-CoV-2 testing and physical distancing profiles by HIV serostatus among MWCCS participants, PLWH who reported SARS-CoV-2 testing were more likely to have a positive test result. Additional studies are needed to determine whether and why PLWH are at increased risk of SARS-CoV-2 infection.
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Affiliation(s)
- Gypsyamber D’Souza
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore MD, USA
| | - Weiqun Tong
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore MD, USA
| | - Deborah Gustafson
- Department of Neurology, State of New York Downstate Health Sciences University, Brooklyn, NY, USA
| | - Maria L. Alcaide
- Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami, Fl, USA
| | - Cecile D. Lahiri
- Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA, USA
| | - Anjali Sharma
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Audrey L. French
- Department of Medicine, CORE Center/Stroger Hospital of Cook County, Chicago IL
| | - Frank J Palella
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Mirjam-Colette Kempf
- Schools of Nursing, Public Health and Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Matthew J. Mimiaga
- Department of Epidemiology, Fielding School of Public Health, UCLA, Los Angeles 90095-1772
| | - Catalina Ramirez
- Department of Medicine, UNC School Division of Medicine, The Infectious Diseases, University of North Carolina School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Seble Kassaye
- Department of Medicine, Division of Infectious Diseases, Georgetown University, Washington DC, USA
| | - Charles R. Rinaldo
- Department of Infectious Diseases and Microbiology, Department of Pathology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Todd T. Brown
- Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Phyllis C. Tien
- Department of Medicine, University of California, San Francisco and Department of Veterans Affairs, San Francisco, CA, USA
| | - Adaora A. Adimora
- Department of Epidemiology, UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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13
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Pond RA, Collins LF, Lahiri CD. Sex Differences in Non-AIDS Comorbidities Among People With Human Immunodeficiency Virus. Open Forum Infect Dis 2021; 8:ofab558. [PMID: 34888399 PMCID: PMC8651163 DOI: 10.1093/ofid/ofab558] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 10/29/2021] [Indexed: 12/12/2022] Open
Abstract
Women are grossly underrepresented in human immunodeficiency virus (HIV) clinical and translational research. This is concerning given that people with HIV (PWH) are living longer, and thus accumulating aging-related non-AIDS comorbidities (NACMs); emerging evidence suggests that women are at higher risk of NACM development and progression compared with men. It is widely recognized that women vs men have greater immune activation in response to many viruses, including HIV-1; this likely influences sex-differential NACM development related to differences in HIV-associated chronic inflammation. Furthermore, many sociobehavioral factors that contribute to aging-related NACMs are known to differ by sex. The objectives of this review were to (1) synthesize sex-stratified data on 4 NACMs among PWH: bone disease, cardiovascular disease, metabolic dysfunction, and neurocognitive impairment; (2) evaluate the characteristics of key studies assessing sex differences in NACMs; and (3) introduce potential biological and psychosocial mechanisms contributing to emerging trends in sex-differential NACM risk and outcomes among PWH.
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Affiliation(s)
- Renee A Pond
- Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Lauren F Collins
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Cecile D Lahiri
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, USA
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14
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Herbertson EC, Lahiri CD, Nwogu JN, Soremekun RO, Olugbake OA, Ezechi OC, Akanmu AS, Gandhi M. High Acceptability of Donating Hair and Other Biological Samples for Research Among People Living with HIV in an Outpatient Clinic in Lagos, Nigeria. AIDS Res Hum Retroviruses 2021; 37:676-682. [PMID: 33687274 PMCID: PMC8501468 DOI: 10.1089/aid.2020.0214] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Willingness to donate hair samples is a rate-limiting step for assaying antiretroviral (ARV) concentrations in hair, an emerging technique for HIV prevention and treatment monitoring. We surveyed ethnically diverse Nigerians to determine their willingness to donate hair for biomedical research. A cross-sectional survey of people living with HIV on ARV therapy (ART) was conducted at the HIV clinic of Nigerian Institute of Medical Research, using systematic sampling. The researcher-administered questionnaire was designed to capture sociodemographic data, length of time on ART, and willingness to donate hair. Univariate analysis was performed on sociodemographic characteristics, and independent-samples t-test and chi-square tests were used for bivariate analysis. Multivariable logistic regression analysis was performed to assess factors associated with willingness to donate hair samples, with a significance level of 0.05. Of the 398 participants enrolled in the study, 258 (64.8%) were female, the average age was 40 years (±9.8), and the average time spent on ART was 7.3 years (±4.2). More than half (64.8%) of the respondents were willing to donate hair samples for biomedical research and they were 1.5 times more likely to donate hair than blood. For one-third of the participants, the anticipated benefit from the eventual research findings was the primary motivation to donate hair samples. Fear of use of hair for rituals was the most common stated reason for unwillingness to donate hair samples (21.2%). In an ethnically diverse, urban-based Nigerian study population, nearly two-thirds of the participants were willing to donate hair samples for biomedical research. These findings support the feasibility of hair sampling for future HIV clinical research conducted within Nigeria.
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Affiliation(s)
- Ebiere C. Herbertson
- Clinical Sciences Department, Nigerian Institute of Medical Research, Lagos, Nigeria
- Emory-Nigeria HIV Research Training Program, Lagos, Nigeria
- Department of Clinical Pharmacy and Biopharmacy, University of Lagos, Lagos, Nigeria
| | - Cecile D. Lahiri
- Emory-Nigeria HIV Research Training Program, Lagos, Nigeria
- Division of Infectious Diseases, Department of Medicine, Emory University, Atlanta, Georgia, USA
| | - Jacinta N. Nwogu
- Department of Pharmaceutical Chemistry, University of Ibadan, Ibadan, Nigeria
| | - Rebecca O. Soremekun
- Department of Clinical Pharmacy and Biopharmacy, University of Lagos, Lagos, Nigeria
| | - Olubusola A. Olugbake
- Department of Clinical Pharmacy and Biopharmacy, University of Lagos, Lagos, Nigeria
| | - Oliver C. Ezechi
- Clinical Sciences Department, Nigerian Institute of Medical Research, Lagos, Nigeria
- Emory-Nigeria HIV Research Training Program, Lagos, Nigeria
| | | | - Monica Gandhi
- Division of HIV, Infectious Diseases, and Global Medicine, University of California, San Francisco, California, USA
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15
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Lahiri CD, Xu Y, Wang K, Alvarez JA, Sheth AN, O'Halloran J, Spence AB, Tien P, Gustafson DR, Milam J, Fischl MA, Konkle-Parker D, Adimora AA, Sharma A, Weber KM, Ofotokun I, Rubin LH. Weight and Body Mass Index Change After Switching to Integrase Inhibitors or Tenofovir Alafenamide Among Women Living with HIV. AIDS Res Hum Retroviruses 2021; 37:461-467. [PMID: 33231474 PMCID: PMC8213005 DOI: 10.1089/aid.2020.0197] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Weight and body mass index (BMI) change was assessed among women after switch to integrase inhibitors (INSTIs) and/or tenofovir alafenamide (TAF). From 2006 to 2019, 1,458 women living with HIV enrolled in the Women's Interagency HIV Study and on antiretroviral therapy (ART) with ≥1 study visit before and after switching to INSTIs and/or TAF were included. Weight and BMI were compared pre- and postswitch to INSTI (by class and type) and/or TAF using multivariable linear mixed effects models; all models were also stratified by preswitch presence or absence of obesity (BMI ≥30 vs. <30 kg/m2). Mean age preswitch was 47 ± 6 years, 64% were black, mean CD4 = 475 ± 201 cells/mm3, 56% had HIV RNA <200 copies/mL, 36% switched to TAF but not INSTI, 60% to INSTI but not TAF, and 3.5% to TAF+INSTI. Time from pre- to postswitch was 12.8 ± 11.8 months. The INSTI-only group but not TAF groups had small but significant increases in weight and BMI: mean 79.2-80.6 kg and 30.2-30.7 kg/m2, p's < .001, respectively, with congruent findings by INSTI type (p's ≤ .01). In stratified (preswitch BMI) analyses, only nonobese subgroups experienced increases in weight and BMI across all ART treatment groups (p's < .05). Significant, although small-to-medium, increases in weight and BMI occurred among nonobese women who switched to INSTIs and/or TAF over short follow-up. Given long-term health consequences of obesity particularly as a low-grade inflammatory condition, identifying women at highest risk of ART-associated weight gain is imperative.
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Affiliation(s)
- Cecile D. Lahiri
- Division of Infectious Diseases, Department of Medicine, Emory University, Atlanta, Georgia, USA
| | - Yanxun Xu
- Department of Applied Mathematics and Statistics, Johns Hopkins University, Baltimore, Maryland, USA
- Division of Biostatistics and Bioinformatics at the Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Kunbo Wang
- Department of Applied Mathematics and Statistics, Johns Hopkins University, Baltimore, Maryland, USA
| | - Jessica A. Alvarez
- Division of Endocrinology, Department of Medicine, Emory University, Atlanta, Georgia, USA
| | - Anandi N. Sheth
- Division of Infectious Diseases, Department of Medicine, Emory University, Atlanta, Georgia, USA
| | - Jane O'Halloran
- Department of Medicine, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | - Amanda B. Spence
- Division of Infectious Disease and Travel Medicine, Department of Medicine, Georgetown University, Washington, District of Columbia, USA
| | - Phyllis Tien
- Department of Medicine, University of California, San Francisco, San Francisco, California, USA
- Department of Veterans Affairs Medical Center, San Francisco, California, USA
| | - Deborah R. Gustafson
- Department of Neurology, State University of New York Downstate Health Sciences University, New York, New York, USA
| | - Joel Milam
- Institute for Health Promotion & Disease Prevention Research, University of Southern California, Los Angeles, California, USA
| | - Margaret A. Fischl
- Department of Medicine, Division of Infectious Disease, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Deborah Konkle-Parker
- Department of Medicine, Division of Infectious Diseases, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Adaora A. Adimora
- Division of Infectious Diseases, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Anjali Sharma
- Department of Medicine, Albert Einstein College of Medicine, New York, New York, USA
| | - Kathleen M. Weber
- CORE Center, Cook County Health, Chicago, Illinois, USA
- Hektoen Institute of Medicine, Chicago, Illinois, USA
| | - Igho Ofotokun
- Division of Infectious Diseases, Department of Medicine, Emory University, Atlanta, Georgia, USA
| | - Leah H. Rubin
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
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16
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Ofotokun I, Collins LF, Titanji K, Foster A, Moran CA, Sheth AN, Lahiri CD, Lennox JL, Ward L, Easley KA, Weitzmann MN. Antiretroviral Therapy-Induced Bone Loss Is Durably Suppressed by a Single Dose of Zoledronic Acid in Treatment-Naive Persons with Human Immunodeficiency Virus Infection: A Phase IIB Trial. Clin Infect Dis 2021; 71:1655-1663. [PMID: 31621838 DOI: 10.1093/cid/ciz1027] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 10/14/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Human immunodeficiency virus (HIV) infection and antiretroviral therapy (ART) are associated with bone loss leading to increased fracture rate among persons with HIV (PWH). We previously showed long-acting antiresorptive zoledronic acid (ZOL) prevented ART-induced bone loss through 48 weeks of therapy and here investigate whether protection persisted. METHODS We randomized 63 nonosteoporotic, treatment-naive adult PWH initiating ART to ZOL (5 mg) versus placebo in a double-blinded, placebo-controlled, phase IIb trial. Here we analyzed the long-term outcome data (144 weeks). Plasma bone turnover markers and bone mineral density (BMD) were quantified at weeks 0, 12, 24, 48, 96, and 144. Primary outcome was change in bone resorption marker C-terminal telopeptide of collagen (CTx). Repeated-measures analyses using mixed linear models were used to estimate and compare study endpoints. RESULTS At 96 weeks, mean CTx was 62% lower with ZOL relative to placebo (n = 46; CTx = 0.123 vs 0.324 ng/mL; P < .001); at 144 weeks a 25% difference between arms was not statistically significant. At 48 weeks, lumbar spine BMD with ZOL was 11% higher than placebo (n = 60; P < .001) and remained 9-11% higher at 96 (n = 46) and 144 (n = 41; P < .001) weeks. 144 weeks after ZOL infusion, BMD did not change at the lumbar spine (P = .22) but declined at the hip (P = .04) and femoral neck (P = .02). CONCLUSIONS A single dose of ZOL administered at ART initiation blunts bone resorption and BMD loss at key fracture-prone anatomical sites in treatment-naive PWH for 3 years. A multicenter randomized phase III clinical trial validating these results in a larger population is needed. CLINICAL TRIALS REGISTRATION NCT01228318.
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Affiliation(s)
- Ighovwerha Ofotokun
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.,Grady Health System, Atlanta, Georgia, USA
| | - Lauren F Collins
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.,Grady Health System, Atlanta, Georgia, USA
| | - Kehmia Titanji
- Division of Endocrinology and Metabolism and Lipids, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Antonina Foster
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Caitlin A Moran
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.,Grady Health System, Atlanta, Georgia, USA
| | - Anandi N Sheth
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.,Grady Health System, Atlanta, Georgia, USA
| | - Cecile D Lahiri
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.,Grady Health System, Atlanta, Georgia, USA
| | - Jeffrey L Lennox
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.,Grady Health System, Atlanta, Georgia, USA
| | - Laura Ward
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Kirk A Easley
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - M Neale Weitzmann
- Division of Endocrinology and Metabolism and Lipids, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.,Atlanta Department of Veterans Affairs Medical Center, Decatur, Georgia, USA
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17
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O’Halloran JA, Wang K, Spence AB, Williams DW, Dastgheyb R, Fitzgerald KC, Kamkwalala AR, Maki PM, Sharma A, Gustafson DR, Milam J, Weber KM, Adimora AA, Ofotokun I, Fischl MA, Konkle-Parker D, Lahiri CD, Sheth AN, Xu Y, Rubin LH. Integrase Strand Transfer Inhibitor Start or Switch Impacts Learning in Women With HIV. J Acquir Immune Defic Syndr 2021; 86:593-599. [PMID: 33394812 PMCID: PMC8319920 DOI: 10.1097/qai.0000000000002608] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 12/07/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Integrase strand transfer inhibitors (INSTIs) are first-line regimens for HIV treatment. We aimed to examine their impact on cognitive performance and depressive symptoms in women with HIV (WWH). SETTING Women's Interagency HIV Study, a multisite, prospective, cohort study. METHODS WWH who started or switched to INSTI-based antiretroviral therapy (ART) and completed neuropsychological testing and the Center for Epidemiological Studies-Depression (CES-D) scale before and after INSTI start/switch were included in the analyses. Primary outcomes were demographically corrected cognitive domain T-scores. Linear mixed-effects models adjusted for relevant covariates were used to examine effects of start/switch of any INSTI and individual INSTI drugs on cognition and CES-D scores. RESULTS Six hundred thirty-nine WWH, median age 49 (interquartile range 12) years, 66% Black non-Hispanic, had neuropsychological and CES-D scale data before and after INSTI start/switch. Although 14% started INSTI-based ART, the remainder switched to INSTI-based ART from another regimen. Overall, any INSTI use was associated with poorer learning post-INSTI. Specifically, use of dolutegravir and elvitegravir, but not raltegravir, was associated with poorer learning. In analyses restricted to INSTI switch, any INSTI use, and dolutegravir use, was associated with poorer learning. Among those switching from a PI-based regimen, INSTIs overall and dolutegravir remained associated with poorer learning; switching from a nonnucleoside reverse transcriptase inhibitor to dolutegravir was also associated with poorer learning. INSTI start/switch was not related to depressive symptom changes. CONCLUSIONS INSTI use was associated with poorer learning among WWH. These changes were mainly observed in elvitegravir and dolutegravir users, indicating that the impact of INSTI on cognition in WWH may not be a class effect.
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Affiliation(s)
- Jane A O’Halloran
- Department of Medicine, Washington University School of Medicine, St. Louis, MO
| | - Kunbo Wang
- Department of Applied Mathematics and Statistics, Johns Hopkins University, Baltimore, MD
| | - Amanda B. Spence
- Departments of Psychiatry and Psychology, University of Illinois at Chicago, Chicago, IL
| | - Dionna W. Williams
- Department of Molecular and Comparative Pathobiology, Johns Hopkins University School of Medicine, Baltimore, MD
- Division of Clinical Pharmacology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Raha Dastgheyb
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Asante R. Kamkwalala
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Pauline M. Maki
- Departments of Psychiatry and Psychology, University of Illinois at Chicago, Chicago, IL
| | - Anjali Sharma
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY
| | - Deborah R. Gustafson
- Department of Neurology, State University of New York Downstate Health Sciences University, Brooklyn, NY
| | - Joel Milam
- Institute for Health Promotion & Disease Prevention Research, University of Southern California, Los Angeles, California
| | - Kathleen M. Weber
- CORE Center, Cook County Health and Hektoen Institute of Medicine, Chicago, IL
| | - Adaora A. Adimora
- Division of Infectious Diseases, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Igho Ofotokun
- Emory University School of Medicine, Department of Medicine, Infectious Disease Division and Grady Health Care System, Atlanta, GA, USA
| | | | - Deborah Konkle-Parker
- Division of Infectious Diseases, University of Mississippi Medical Center, Jackson, Mississippi
| | - Cecile D. Lahiri
- Emory University School of Medicine, Department of Medicine, Infectious Disease Division and Grady Health Care System, Atlanta, GA, USA
| | - Anandi N. Sheth
- Emory University School of Medicine, Department of Medicine, Infectious Disease Division and Grady Health Care System, Atlanta, GA, USA
| | - Yanxun Xu
- Department of Applied Mathematics and Statistics, Johns Hopkins University, Baltimore, MD
- Division of Biostatistics and Bioinformatics at The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Leah H. Rubin
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
- Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, MD
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18
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Collins LF, Colasanti JA, Nguyen ML, Moran CA, Lahiri CD, Marconi VC, Armstrong WS, Shah NS. The COVID-19 pandemic as a catalyst for differentiated care models to end the HIV epidemic in the United States: applying lessons from high-burden settings. AIDS 2021; 35:337-341. [PMID: 33165032 PMCID: PMC7775326 DOI: 10.1097/qad.0000000000002746] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Lauren F. Collins
- Division of Infectious Diseases, Emory University School of
Medicine, Atlanta, GA, USA
- Grady Healthcare System, Infectious Diseases Program,
Atlanta, GA, USA
| | - Jonathan A. Colasanti
- Division of Infectious Diseases, Emory University School of
Medicine, Atlanta, GA, USA
- Grady Healthcare System, Infectious Diseases Program,
Atlanta, GA, USA
- Rollins School of Public Health, Emory University, Atlanta,
GA, USA
| | - Minh Ly Nguyen
- Division of Infectious Diseases, Emory University School of
Medicine, Atlanta, GA, USA
- Grady Healthcare System, Infectious Diseases Program,
Atlanta, GA, USA
| | - Caitlin A. Moran
- Division of Infectious Diseases, Emory University School of
Medicine, Atlanta, GA, USA
- Grady Healthcare System, Infectious Diseases Program,
Atlanta, GA, USA
| | - Cecile D. Lahiri
- Division of Infectious Diseases, Emory University School of
Medicine, Atlanta, GA, USA
- Grady Healthcare System, Infectious Diseases Program,
Atlanta, GA, USA
| | - Vince C. Marconi
- Division of Infectious Diseases, Emory University School of
Medicine, Atlanta, GA, USA
- Grady Healthcare System, Infectious Diseases Program,
Atlanta, GA, USA
- Rollins School of Public Health, Emory University, Atlanta,
GA, USA
- Atlanta Veterans Affairs Medical Center, Decatur, GA,
USA
| | - Wendy S. Armstrong
- Division of Infectious Diseases, Emory University School of
Medicine, Atlanta, GA, USA
- Grady Healthcare System, Infectious Diseases Program,
Atlanta, GA, USA
| | - N. Sarita Shah
- Division of Infectious Diseases, Emory University School of
Medicine, Atlanta, GA, USA
- Rollins School of Public Health, Emory University, Atlanta,
GA, USA
- Atlanta Veterans Affairs Medical Center, Decatur, GA,
USA
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19
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Lahiri CD, Nguyen ML, Mehta CC, Mosunjac M, Tadros T, Unger ER, Rajeevan MS, Richards J, Ofotokun I, Flowers L. Pilot Study of Markers for High-grade Anal Dysplasia in a Southern Cohort From the Women's Interagency Human Immunodeficiency Virus Study. Clin Infect Dis 2021; 70:1121-1128. [PMID: 31058984 DOI: 10.1093/cid/ciz336] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Accepted: 05/03/2019] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Anal cancer rates have increased, particularly in human immunodeficiency virus (HIV)-infected (HIV+) women. We assessed factors associated with anal precancer in HIV+ and at-risk HIV-negative women from the Atlanta Women's Interagency HIV Study cohort. METHODS All participants underwent high-resolution anoscopy and anal cytology and had anal and cervical samples collected. Specimens were tested for 37 human papillomavirus (HPV) types and for FAM19A4 and microRNA124-2 promoter methylation. Binary logistic regression and multivariate analysis were conducted with histologic anal high-grade squamous intraepithelial lesion (A-HSIL) as the dependent variable. RESULTS Seventy-five women were enrolled: 52 (69%) were HIV+ with three-fourths having undetectable viral load; 64 (86%) were black; mean age was 49 ± 8 years. Forty-nine (65%) anal cytology samples were abnormal, and 38 (51%) of anal samples were positive for at least 1 of 13 high-risk HPV (hrHPV) types. Thirteen (18%) anal biopsies identified A-HSIL. Hypermethylation of FAM19A4 and/or microRNA124-2 was found in 69 (95%) anal samples and 19 (26%) cervical samples. In multivariate analyses, the odds of having A-HSIL were >6 times higher in women with anal hrHPV (adjusted odds ratio [aOR], 6.08 [95% confidence interval {CI}, 1.27-29.18], P = .02) and with positive cervical methylation (aOR, 6.49 [95% CI, 1.66-25.35], P = .007), but not significantly higher in women with positive anal methylation. CONCLUSIONS Anal hrHPV and promoter hypermethylation in the cervix show promise as biomarkers for anal cancer screening in HIV+ and at-risk HIV-negative women. Greater understanding of gene silencing by promoter hypermethylation in anal carcinogenesis is needed.
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Affiliation(s)
- Cecile D Lahiri
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Georgia.,Atlanta Women's Interagency HIV Study, Rollins School of Public Health, Emory University, Georgia
| | - Minh Ly Nguyen
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Georgia.,Atlanta Women's Interagency HIV Study, Rollins School of Public Health, Emory University, Georgia
| | - C Christina Mehta
- Atlanta Women's Interagency HIV Study, Rollins School of Public Health, Emory University, Georgia.,Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Georgia
| | - Marina Mosunjac
- Department of Pathology, Emory University School of Medicine, Georgia
| | - Talaat Tadros
- Department of Pathology, Emory University School of Medicine, Georgia
| | - Elizabeth R Unger
- Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Georgia
| | - Mangalathu S Rajeevan
- Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Georgia
| | - Jendai Richards
- Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Georgia
| | - Ighovwerha Ofotokun
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Georgia.,Atlanta Women's Interagency HIV Study, Rollins School of Public Health, Emory University, Georgia
| | - Lisa Flowers
- Atlanta Women's Interagency HIV Study, Rollins School of Public Health, Emory University, Georgia.,Department of Gynecology and Obstetrics, Emory University School of Medicine, Georgia
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20
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Kamkwalala AR, Wang K, O’Halloran J, Williams DW, Dastgheyb R, Fitzgerald KC, Spence AB, Maki PM, Gustafson DR, Milam J, Sharma A, Weber KM, Adimora AA, Ofotokun I, Sheth AN, Lahiri CD, Fischl MA, Konkle-Parker D, Xu Y, Rubin LH. Starting or Switching to an Integrase Inhibitor-Based Regimen Affects PTSD Symptoms in Women with HIV. AIDS Behav 2021; 25:225-236. [PMID: 32638219 PMCID: PMC7948485 DOI: 10.1007/s10461-020-02967-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
As the use of Integrase inhibitor (INSTI)-class antiretroviral medications becomes more common to maintain long-term viral suppression, early reports suggest the potential for CNS side-effects when starting or switching to an INSTI-based regimen. In a population already at higher risk for developing mood and anxiety disorders, these drugs may have significant effects on PTSD scale symptom scores, particularly in women with HIV (WWH). A total of 551 participants were included after completing ≥ 1 WIHS study visits before and after starting/switching to an INSTI-based ART regimen. Of these, 14% were ART naïve, the remainder switched from primarily a protease inhibitor (PI) or non-nucleoside reverse transcriptase inhibitor (NNRTI)-based regimen. Using multivariable linear mixed effects models, we compared PTSD Civilian Checklist subscale scores before and after a "start/switch" to dolutegravir (DTG), raltegravir (RAL), or elvitegravir (EVG). Start/switch to EVG improved re-experiencing subscale symptoms (P's < 0.05). Switching to EVG improved symptoms of avoidance (P = 0.01). Starting RAL improved arousal subscale symptoms (P = 0.03); however, switching to RAL worsened re-experiencing subscale symptoms (P < 0.005). Starting DTG worsened avoidance subscale symptoms (P = 0.03), whereas switching to DTG did not change subscale or overall PTSD symptoms (P's > 0.08). In WWH, an EVG-based ART regimen is associated with improved PTSD symptoms, in both treatment naïve patients and those switching from other ART. While a RAL-based regimen was associated with better PTSD symptoms than in treatment naïve patients, switching onto a RAL-based regimen was associated with worse PTSD symptoms. DTG-based regimens either did not affect, or worsened symptoms, in both naïve and switch patients. Further studies are needed to determine mechanisms underlying differential effects of EVG, RAL and DTG on stress symptoms in WWH.
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Affiliation(s)
- Asante R. Kamkwalala
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Kunbo Wang
- Department of Applied Mathematics and Statistics, Johns Hopkins University, Baltimore, MD
| | - Jane O’Halloran
- Department of Medicine, Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Dionna W. Williams
- Department of Molecular and Comparative Pathobiology, Johns Hopkins University School of Medicine, Baltimore, MD,Division of Clinical Pharmacology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Raha Dastgheyb
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Amanda B. Spence
- Department of Medicine, Division of Infectious Disease and Travel Medicine, Georgetown University, Washington, DC
| | - Pauline M. Maki
- Departments of Psychiatry, Psychology and OB/GYN, University of Illinois at Chicago, Chicago, IL
| | - Deborah R. Gustafson
- Department of Neurology, State University of New York Downstate Health Sciences University, Brooklyn, NY
| | - Joel Milam
- Institute for Health Promotion & Disease Prevention Research, University of Southern California, Los Angeles, California
| | | | - Kathleen M. Weber
- CORE Center, Cook County Health and Hektoen Institute of Medicine, Chicago, IL
| | - Adaora A. Adimora
- Division of Infectious Diseases, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Igho Ofotokun
- Department of Medicine, Division of Infectious Diseases, Emory University, Atlanta, GA
| | - Anandi N. Sheth
- Department of Medicine, Division of Infectious Diseases, Emory University, Atlanta, GA
| | - Cecile D. Lahiri
- Department of Medicine, Division of Infectious Diseases, Emory University, Atlanta, GA
| | | | - Deborah Konkle-Parker
- Division of Infectious Diseases, University of Mississippi Medical Center, Jackson, Mississippi
| | - Yanxun Xu
- Department of Medicine, Washington University School of Medicine in St. Louis, St. Louis, MO,Division of Biostatistics and Bioinformatics at The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Leah H. Rubin
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD,Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD,Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, MD
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21
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D'Souza G, Springer G, Gustafson D, Kassaye S, Alcaide ML, Ramirez C, Sharma A, Palella FJ, Tien PC, Detels R, Kempf MC, Lahiri CD, Rinaldo CR, French AL, Margolick JB, Adimora AA. COVID-19 symptoms and SARS-CoV-2 infection among people living with HIV in the US: the MACS/WIHS combined cohort study. HIV Res Clin Pract 2020; 21:130-139. [PMID: 33211636 PMCID: PMC7682380 DOI: 10.1080/25787489.2020.1844521] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND SARS-CoV-2 infection among People Living With HIV (PLWH) is not well-described. OBJECTIVE To study COVID-19 symptoms and SARS-CoV-2 PCR-based swab testing among participants of the Multicenter AIDS Cohort Study (MACS) and Women's Interagency HIV Study (WIHS). METHODS A telephone survey was collected April-June 30, 2020. Symptom and testing prevalence were explored. Multivariable logistic regression was used to examine the factors associated with SARS-CoV-2 positivity. RESULTS The survey was completed by 3411 participants, including 2078 (61%) PLWH and 1333 HIV-seronegative (SN) participants from across the US. Thirteen percent (n = 441) were tested for SARS-CoV-2 infection (13.4% of PLWH vs 12.2% of SN). Among those tested, positivity was higher in PLWH than SN (11.2% vs 6.1%, p = 0.08). Reasons for not being tested included testing not being available (30% of participants) and not knowing where to get tested (16% of participants). Most symptoms reported since January 2020 were similar in PLWH and SN, including headache (23% vs. 24%), myalgias (19% vs 18%), shortness of breath (14% vs 13%), chills (12% vs 10%), fever (6% vs 6%) and loss of taste or smell (6% vs 7%). Among PLWH who tested positive for SARS-CoV-2 DNA, the most common symptoms were headache (71%), myalgia (68%), cough (68%) and chills (65%). In multivariable analysis among those tested, the odds of SARS-CoV-2 positivity were higher among PLWH than SN (aOR = 2.22 95%CI = 01.01-4.85, p = 0.046) and among those living with others versus living alone (aOR = 2.95 95%CI = 1.18-7.40). CONCLUSION Prevalence and type of COVID-19 symptoms were similar in PLWH and SN. SARS-CoV-2 infection may be elevated among PLWH.
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Affiliation(s)
- Gypsyamber D'Souza
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Gayle Springer
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Deborah Gustafson
- Department of Neurology, State of New York Downstate Health Sciences University, Brooklyn, NY, USA
| | - Seble Kassaye
- Department of Medicine, Division of Infectious Diseases, Georgetown University, Washington, DC, USA
| | - Maria L Alcaide
- Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami, Fl, USA
| | - Catalina Ramirez
- Department of Medicine, UNC School Division of Medicine, The Infectious Diseases, University of North Carolina School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Anjali Sharma
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Frank J Palella
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Phyllis C Tien
- Department of Medicine, University of California, San Francisco and Department of Veterans Affairs, San Francisco, CA, USA
| | - Roger Detels
- Department of Epidemiology, Fielding School of Public Health, UCLA, Los Angeles, CA, USA
| | - Mirjam-Colette Kempf
- Schools of Nursing, Public Health and Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Cecile D Lahiri
- Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA, USA
| | - Charles R Rinaldo
- Department of Infectious Diseases and Microbiology, Department of Pathology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Audrey L French
- Department of Medicine, CORE Center/Stroger Hospital of Cook County, Chicago, IL, USA
| | - Joseph B Margolick
- Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Ada A Adimora
- Department of Medicine, UNC School Division of Medicine, The Infectious Diseases, University of North Carolina School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Department of Epidemiology, UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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22
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Summers NA, Lahiri CD, Angert CD, Aldredge A, Mehta CC, Ofotokun I, Kerchberger AM, Gustafson D, Weiser SD, Kassaye S, Konkle-Parker D, Sharma A, Adimora AA, Bolivar H, Cocohoba J, French AL, Golub ET, Sheth AN. Metabolic Changes Associated With the Use of Integrase Strand Transfer Inhibitors Among Virally Controlled Women. J Acquir Immune Defic Syndr 2020; 85:355-362. [PMID: 33060420 PMCID: PMC7577246 DOI: 10.1097/qai.0000000000002447] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Integrase strand transfer inhibitors (INSTIs) have been associated with weight gain among women living with HIV. We aimed to investigate the association between INSTIs and change in cardiometabolic risk indicators. SETTING Retrospective cohort. METHODS Data from 2006 to 2017 were analyzed from women living with HIV enrolled in the longitudinal Women's Interagency HIV Study who were virally controlled on antiretroviral therapy (ART) for ≥5 consecutive semiannual visits. Women who switched/added an INSTI to ART (INSTI group) were compared with women who remained on non-INSTI ART (non-INSTI group). Outcomes included changes in fasting lipids and glucose, hemoglobin A1c (HbA1c), blood pressure (BP), and incident diabetes, hypertension, and insulin resistance. Outcomes were measured 6-12 months before and 6-18 months after INSTI switch/add in the INSTI group with comparable visits in the non-INSTI group. Longitudinal linear regression models compared change over time in each outcome by the study group. RESULTS One thousand one hundred eighteen participants (234 INSTI, 884 non-INSTI) were followed for a median 2.0 (Q1 1.9, Q3 2.0) years. Participants were median age 49 years, 61% Black, and 73% overweight or obese (body mass index ≥25 kg/m). Compared with non-INSTI, the INSTI group experienced greater increases in HbA1c (+0.05 vs. -0.06 mg/dL, P = 0.0318), systolic BP (+3.84 vs. +0.84 mm Hg, P = 0.0191), and diastolic BP (+1.62 vs. -0.14 mm Hg, P = 0.0121), with greatest change in HbA1c among women on INSTIs with ≥5% weight gain. CONCLUSIONS INSTI use was associated with unfavorable changes in HbA1c and systolic and diastolic BP during short-term follow-up. Further research is needed to understand long-term cardiometabolic effects of INSTI use.
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Affiliation(s)
- Nathan A Summers
- Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA
- Department of Medicine, Division of Infectious Diseases, University of Tennessee Health Science Center, Memphis, TN
| | - Cecile D Lahiri
- Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA
| | - Christine D Angert
- Department of Biostatistics and Bioinformatics, Emory University Rollins School of Public Health, Atlanta, GA
| | | | - C Christina Mehta
- Department of Biostatistics and Bioinformatics, Emory University Rollins School of Public Health, Atlanta, GA
| | - Ighovwerha Ofotokun
- Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA
| | | | - Deborah Gustafson
- Department of Neurology, State University of New York Downstate Health Sciences University, Brooklyn, NY
| | - Sheri D Weiser
- Department of Medicine, Division of HIV, Infectious Diseases, and Global Medicine, University of California San Francisco School of Medicine, San Francisco, CA
| | - Seble Kassaye
- Department of Medicine, Division of Infectious Diseases, Georgetown University Medical Center, Washington, DC
| | - Deborah Konkle-Parker
- Department of Medicine, Division of Infectious Diseases, University of Mississippi Medical Center, Jackson, MS
| | - Anjali Sharma
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY
| | - Adaora A Adimora
- Department of Medicine, Division of Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Hector Bolivar
- Department of Medicine, Division of Infectious Diseases, University of Miami Health System, Miami, FL
| | - Jennifer Cocohoba
- Department of Clinical Pharmacy, University of California San Francisco School of Pharmacy, San Francisco, CA
| | - Audrey L French
- Division of Infectious Diseases, CORE Center/Stroger (Cook County) Hospital, Chicago, IL; and
| | - Elizabeth T Golub
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Anandi N Sheth
- Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA
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23
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Kerchberger AM, Sheth AN, Angert CD, Mehta CC, Summers NA, Ofotokun I, Gustafson D, Weiser SD, Sharma A, Adimora AA, French AL, Augenbraun M, Cocohoba J, Kassaye S, Bolivar H, Govindarajulu U, Konkle-Parker D, Golub ET, Lahiri CD. Weight Gain Associated With Integrase Stand Transfer Inhibitor Use in Women. Clin Infect Dis 2020; 71:593-600. [PMID: 31504324 PMCID: PMC7384314 DOI: 10.1093/cid/ciz853] [Citation(s) in RCA: 77] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 08/26/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Integrase strand-transfer inhibitor (INSTI)-based antiretroviral therapy (ART) is recommended for human immunodeficiency virus (HIV) management. Although studies have suggested associations between INSTIs and weight gain, women living with HIV (WLHIV) have been underrepresented in research. We evaluated the effect of switching or adding INSTIs among WLHIV. METHODS Women enrolled in the Women's Interagency HIV Study (WIHS) from 2006-2017 who switched to or added an INSTI to ART (SWAD group) were compared to women on non-INSTI ART (STAY group). Body weight, body mass index (BMI), percentage body fat (PBF), and waist, hip, arm, and thigh circumferences were measured 6-12 months before and 6-18 months after the INSTI switch/add in SWAD participants, with comparable measurement time points in STAY participants. Linear regression models compared changes over time by SWAD/STAY group, adjusted for age, race, WIHS site, education, income, smoking status, and baseline ART regimen. RESULTS We followed 1118 women (234 SWAD and 884 STAY) for a mean of 2.0 years (+/- 0.1 standard deviation [SD]; mean age 48.8 years, SD +/- 8.8); 61% were Black. On average, compared to the STAY group, the SWAD group experienced mean greater increases of 2.1 kg in body weight, 0.8 kg/m2 in BMI, 1.4% in PBF, and 2.0, 1.9, 0.6, and 1.0 cm in waist, hip, arm, and thigh circumference, respectively (all P values < .05). No differences in magnitudes of these changes were observed by INSTI type. CONCLUSIONS In WLHIV, a switch to INSTI was associated with significant increases in body weight, body circumferences, and fat percentages, compared to non-INSTI ART. The metabolic and other health effects of these changes deserve further investigation.
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Affiliation(s)
| | - Anandi N Sheth
- Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Christine D Angert
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Atlanta, Georgia, USA
| | - C Christina Mehta
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Atlanta, Georgia, USA
| | - Nathan A Summers
- Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Ighovwerha Ofotokun
- Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Deborah Gustafson
- Department of Neurology, State University of New York Downstate Medical Center, Brooklyn, New York, USA
| | - Sheri D Weiser
- Department of Medicine, Division of Human Immunodeficiency Virus, Infectious Diseases, and Global Medicine, University of California San Francisco School of Medicine, San Francisco, California, USA
| | - Anjali Sharma
- Department of Medicine, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Adaora A Adimora
- Department of Medicine, Division of Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Audrey L French
- Department of Medicine, Division of Infectious Diseases, Stroger Hospital of Cook County, Chicago, Illinois, USA
| | - Michael Augenbraun
- Department of Medicine, Division of Infectious Diseases, State University of New York Downstate Medical Center, Brooklyn, New York, USA
| | - Jennifer Cocohoba
- Department of Clinical Pharmacy, University of California San Francisco School of Pharmacy, San Francisco, California, USA
| | - Seble Kassaye
- Department of Medicine, Division of Infectious Diseases, Georgetown University Medical Center, Washington, DC, USA
| | - Hector Bolivar
- Department of Medicine, Division of Infectious Diseases, University of Miami Health System, Miami, Florida, USA
| | - Usha Govindarajulu
- Department of Epidemiology and Biostatistics, School of Public Health, State University of New York Downstate Medical Center, Brooklyn, New York, USA
| | - Deborah Konkle-Parker
- Department of Medicine, Division of Infectious Diseases, University of Mississippi Medical Center Jackson, Mississippi, USA
| | - Elizabeth T Golub
- Division of General Epidemiology and Methodology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Cecile D Lahiri
- Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, USA
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24
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Aldredge A, Lahiri CD, Summers NA, Mehta CC, Angert CD, Kerchberger AM, Weiser S, Konkle-Parker D, Sharma A, Adimora AA, Bolivar H, French AL, Golub ET, Kassaye S, Gustafson D, Ofotokun I, Sheth AN. 980. Effects of Integrase Strand-Transfer Inhibitor Use on Lipids, Glycemic Control, and Insulin Resistance in the Women’s Interagency HIV Study (WIHS). Open Forum Infect Dis 2019. [PMCID: PMC6808914 DOI: 10.1093/ofid/ofz359.082] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Abstract
Background
Integrase strand transfer inhibitor (INSTI)-based antiretroviral therapy (ART) is recommended first-line HIV treatment. We recently demonstrated increased weight gain associated with INSTI use among women living with HIV (WLH) enrolled in the Women’s Interagency HIV Study (WIHS), raising concern for cardiometabolic consequences. We, therefore, evaluated the effects of INSTI use on lipids, insulin resistance, and glycemic control in WLH.
Methods
Data from 2008 to 2017 were analyzed from WLH enrolled in WIHS. Women who switched to or added an INSTI to ART (SWAD group) were compared with women who remained on non-INSTI ART (STAY group). Outcomes included changes in fasting total cholesterol (TC), low-density lipoprotein (LDL), high-density lipoprotein (HDL), triglycerides (TG), and glucose; hemoglobin A1c; and incident insulin resistance (defined as homeostatic model assessment of insulin resistance [HOMA] score ≥2). Outcomes were measured 6–12 months before and 6–18 months after INSTI switch/add in the SWAD group with comparable time points in the STAY group. Linear regression models compared change over time in each outcome by SWAD/STAY group, adjusted for age, race, WIHS site, income, smoking status, statin use, and ART regimen at baseline.
Results
In total, 881 WIHS participants (182 SWAD and 699 STAY) were followed for a mean 1.8 (±1.1) years. Mean age was 49 (±8.8) years, BMI was 31 (±8.2) kg/m2, and 49% were Black. At baseline, SWAD vs. STAY was more likely to report NNRTI (vs. PI)-based ART and statin use (both P < 0.0001), but all baseline lipid and glucose variables were similar. Compared with STAY, the SWAD group experienced significantly greater decreases in HDL (−2.4 vs. +0.09 mg/dL, P = 0.03) and trended toward greater decreases in TC (−2.6 vs. −2.4 mg/dL, P = 0.07) at follow-up, without significant differences in TG or LDL. The SWAD group had significantly greater increases in A1c (+0.08% vs. −0.05%, P = 0.01) but trended toward lower incidence of insulin resistance (19% vs. 32%, P = 0.05).
Conclusion
Despite reported increases in weight, INSTI use was associated with only modest changes in lipid measurements and glycemic control during short-term follow-up of WLH compared with non-INSTI ART. Research is needed to elucidate long-term cardiometabolic effects.
Disclosures
Anandi N. Sheth, MD, MS, Gilead Sciences, Inc.: Research Grant.
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Affiliation(s)
- Amalia Aldredge
- Emory University School of Medicine, Department of Medicine, Atlanta, Georgia
| | - Cecile D Lahiri
- Emory University School of Medicine, Department of Medicine, Division of Infectious Diseases, Atlanta, Georgia
- Atlanta Women’s Interagency HIV, Atlanta, Georgia
| | - Nathan A Summers
- Emory University School of Medicine, Department of Medicine, Division of Infectious Diseases, Atlanta, Georgia
| | - C Christina Mehta
- Atlanta Women’s Interagency HIV, Atlanta, Georgia
- Emory University, Rollins School of Public Health, Department of Biostatistics and Bioinformatics, Atlanta, Georgia
| | - Christine D Angert
- Emory University, Rollins School of Public Health, Department of Biostatistics and Bioinformatics, Atlanta, Georgia
| | | | - Sheri Weiser
- University of California San Francisco, San Francisco, California
| | | | - Anjali Sharma
- Albert Einstein College of Medicine, Bronx, New York
| | - Adaora A Adimora
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | | | | | - Elizabeth T Golub
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Seble Kassaye
- Georgetown University Medical Center, Washington, DC
| | | | - Igho Ofotokun
- Emory University School of Medicine, Department of Medicine, Division of Infectious Diseases, Atlanta, Georgia
- Atlanta Women’s Interagency HIV, Atlanta, Georgia
| | - Anandi N Sheth
- Emory University School of Medicine, Department of Medicine, Division of Infectious Diseases, Atlanta, Georgia
- Atlanta Women’s Interagency HIV, Atlanta, Georgia
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25
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Lahiri CD, Brown NL, Ryan KJ, Acosta EP, Sheth AN, Mehta CC, Ingersoll J, Ofotokun I. HIV RNA persists in rectal tissue despite rapid plasma virologic suppression with dolutegravir-based therapy. AIDS 2018; 32:2151-2159. [PMID: 30005011 PMCID: PMC6200454 DOI: 10.1097/qad.0000000000001945] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVES Despite plasma virologic suppression with antiretroviral therapy (ART), HIV persists in gut tissue. The objectives of this study were to compare plasma and rectal tissue HIV RNA dynamics and to assess relationships with dolutegravir (DTG) plasma and tissue concentrations. DESIGN A longitudinal cohort study of HIV-infected treatment-naïve individuals initiating DTG-based ART was conducted over 12 weeks with plasma and rectal tissue sampling (Clinicaltrials.gov:NCT02924389). METHODS HIV RNA and DTG concentrations were quantified in plasma and rectal tissue samples collected pre-ART (baseline) and post-ART at weeks 2, 6, and 12 using Abbott Real-Time HIV-1 assays and high-performance liquid chromatography tandem mass spectroscopy, respectively. Relationships between rectal tissue RNA and DTG concentrations were modeled using binary logistic regression, controlling for repeated measures. RESULTS Twelve participants were enrolled: six (50.0%) women, nine (75.0%) black, median age 42.0 years (Q1 31.2, Q3 52.0). All attained plasma virologic suppression by week 6. 11 of 12 (91.7%) had detectable rectal tissue HIV RNA at baseline, and only three of 11 (27.3%) achieved rectal tissue virologic suppression at any time-point. Compared with rectal tissue nonsuppressors, three of three (100.0%) of rectal tissue suppressors were women, had higher BMI, 35.9 kg/m (range 24.9-38.5) versus 20.6 (17.7-29.9), P = 0.05, and lower baseline log plasma HIV RNA: 3.7 copies/ml (range 3.6-4.4) versus 4.7 (3.8-5.4), P = 0.02. No significant relationships between rectal tissue RNA suppression and DTG concentrations were seen. CONCLUSION Rectal tissue HIV RNA persisted in most participants and was not predicted by DTG concentrations. Impact of host factors, particularly sex, on tissue HIV viral dynamics warrants further exploration.
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Affiliation(s)
- Cecile D Lahiri
- Emory University School of Medicine, Department of Medicine, Division of Infectious Diseases
- Grady Healthcare System Infectious Diseases Program, Atlanta, Georgia
| | - Nakita L Brown
- Emory University School of Medicine, Department of Medicine, Division of Infectious Diseases
| | - Kevin J Ryan
- University of Alabama at Birmingham School of Medicine, Division of Clinical Pharmacology, Birmingham, Alabama
| | - Edward P Acosta
- University of Alabama at Birmingham School of Medicine, Division of Clinical Pharmacology, Birmingham, Alabama
| | - Anandi N Sheth
- Emory University School of Medicine, Department of Medicine, Division of Infectious Diseases
- Grady Healthcare System Infectious Diseases Program, Atlanta, Georgia
| | - Cyra C Mehta
- Emory University, Rollins School of Public Health, Department of Biostatistics and Bioinformatics
| | - Jessica Ingersoll
- Emory Center for AIDS Research, Virology and Molecular Biomarkers Core, Atlanta, Georgia, USA
| | - Ighovwerha Ofotokun
- Emory University School of Medicine, Department of Medicine, Division of Infectious Diseases
- Grady Healthcare System Infectious Diseases Program, Atlanta, Georgia
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26
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Frank M, Lahiri CD, Nguyen ML, Mehta CC, Mosunjac M, Flowers L. Factors Associated with High-Grade Anal Intraepithelial Lesion in HIV-Positive Men in a Southern U.S. City. AIDS Res Hum Retroviruses 2018; 34:598-602. [PMID: 29607650 PMCID: PMC6025845 DOI: 10.1089/aid.2018.0008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
The incidence of anal cancer is increased in HIV-infected patients compared with the general population. Risk factors associated with the anal cancer precursor, high-grade squamous intraepithelial lesion (HSIL), have not been extensively studied in an urban black population with late-stage HIV disease. We performed a retrospective chart review of HIV-infected men at the Grady Ponce de Leon Center HIV Clinic (Atlanta, GA) referred for high-resolution anoscopy (HRA), a procedure where anal tissue is examined under magnification and abnormal areas are biopsied. Between December 2013 and September 2015, 147 men underwent HRA: 72% were black, and 94% were men who have sex with men. CD4 count closest to time of HRA was a median 325 cells/mm3 (interquartile range 203-473), and 69% had an undetectable HIV viral load. Ninety-four percent had abnormal anal cytology [80% atypical squamous cells of undetermined significance/low-grade squamous intraepithelial lesion (LSIL) and 20% atypical squamous cells, cannot exclude HSIL/HSIL], and 97% had abnormal histology (35% LSIL, 65% HSIL). Statistically significant variables associated with HSIL included number of biopsies [odds ratio (OR) 1.55, 95% confidence interval (CI) 1.13-2.14] and having ≥1 high-grade anal cytology in the last 12 months (OR 3.76, 95% CI 1.38-10.23). No significant association was found between HSIL and CD4, HIV viral load, or recent sexually transmitted infection. In this population, the burden of anal HSIL was extremely high, regardless of most recent anal cytology result. In newly diagnosed HIV-infected men with no history of anal cancer screening, performing HRA as primary anal cancer screening instead of cytology appears to be a viable option.
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Affiliation(s)
- Melanie Frank
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Cecile D. Lahiri
- Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia
- Grady Ponce de Leon Center, Atlanta, Georgia
| | - Minh Ly Nguyen
- Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia
- Grady Ponce de Leon Center, Atlanta, Georgia
| | - Cyra Christina Mehta
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Atlanta, Georgia
| | - Marina Mosunjac
- Department of Pathology, Emory University School of Medicine, Atlanta, Georgia
| | - Lisa Flowers
- Grady Ponce de Leon Center, Atlanta, Georgia
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia
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27
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Vergara C, Thio C, Latanich R, Cox AL, Kirk GD, Mehta SH, Busch M, Murphy EL, Villacres MC, Peters MG, French AL, Golub E, Eron J, Lahiri CD, Shrestha S, Gustafson D, Young M, Anastos K, Aouizerat B, Kim AY, Lauer G, Thomas DL, Duggal P. Genetic basis for variation in plasma IL-18 levels in persons with chronic hepatitis C virus and human immunodeficiency virus-1 infections. Genes Immun 2017; 18:82-87. [PMID: 28300059 PMCID: PMC5408324 DOI: 10.1038/gene.2017.2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 11/07/2016] [Accepted: 11/08/2016] [Indexed: 12/27/2022]
Abstract
Inflammasomes are multi-protein complexes integrating pathogen-triggered signaling leading to the generation of pro-inflammatory cytokines, including interleukin-18 (IL-18). Hepatitis C virus (HCV) and human immunodeficiency virus-1 (HIV) infections are associated with elevated IL-18, suggesting inflammasome activation. However, there is marked person-to-person variation in the inflammasome response to HCV and HIV. We hypothesized that host genetics may explain this variation. To test this, we analyzed the associations of plasma IL-18 levels and polymorphisms in 10 genes in the inflammasome cascade. 1538 participants with active HIV and/or HCV infection in 3 ancestry groups are included. Samples were genotyped using the Illumina Omni 1-quad and Omni 2.5 arrays. Linear regression analyses were performed to test the association of variants with logIL-18 including HCV and HIV infection status and HIV-RNA, in each ancestry group and then meta-analyzed. Eleven highly correlated SNPs (r2=0.98-1) in the IL18-BCO2 region were significantly associated with logIL-18; Each T allele of rs80011693 confers a decrease of 0.06 log pg/mL of IL-18 after adjusting for covariates (rs80011693; rs111311302 β=-0.06, P-value=2.7×10-4). In conclusion, genetic variation in IL18 is associated with IL-18 production in response to HIV and HCV infection and may explain variability in the inflammatory outcomes of chronic viral infections.
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Affiliation(s)
- C Vergara
- School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - C Thio
- School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - R Latanich
- School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - A L Cox
- School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - G D Kirk
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - S H Mehta
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - M Busch
- University of California, San Francisco, CA, USA
| | - E L Murphy
- University of California, San Francisco, CA, USA.,Blood Systems Research Institute, San Francisco, CA, USA
| | - M C Villacres
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - M G Peters
- Blood Systems Research Institute, San Francisco, CA, USA
| | - A L French
- CORE Center/Stroger Hospital of Cook County, Chicago, IL, USA
| | - E Golub
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - J Eron
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - C D Lahiri
- School of Medicine, Emory University, Atlanta, GA, USA
| | - S Shrestha
- The University of Alabama at Birmingham, AL, USA
| | - D Gustafson
- State University of New York-Downstate Medical Center, New York, NY, USA
| | - M Young
- Georgetown University Medical Center, Washington, DC, USA
| | - K Anastos
- Albert Einstein College of Medicine and Montefiore Medical Center, New York, NY, USA
| | - B Aouizerat
- Bluestone Center for Clinical Research, New York University, New York, NY, USA.,Department of Oral and Maxillofacial Surgery, New York University, New York, NY, USA
| | - A Y Kim
- Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - G Lauer
- Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - D L Thomas
- School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - P Duggal
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
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28
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Ofotokun I, Titanji K, Lahiri CD, Vunnava A, Foster A, Sanford SE, Sheth AN, Lennox JL, Knezevic A, Ward L, Easley KA, Powers P, Weitzmann MN. A Single-dose Zoledronic Acid Infusion Prevents Antiretroviral Therapy-induced Bone Loss in Treatment-naive HIV-infected Patients: A Phase IIb Trial. Clin Infect Dis 2016; 63:663-671. [PMID: 27193748 DOI: 10.1093/cid/ciw331] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2016] [Accepted: 05/12/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Human immunodeficiency virus (HIV) infection and antiretroviral therapy (ART) are associated with bone loss leading to increased fracture rate among HIV-infected individuals. ART-induced bone loss is most intense within the first 48 weeks of therapy, providing a window for prophylaxis with long-acting antiresorptives. METHODS In a phase 2, double-blind, placebo-controlled trial, we randomized 63 nonosteoporotic, ART-naive adults with HIV initiating ART with atazanavir/ritonavir + tenofovir/emtricitabine to a single zoledronic acid (ZOL) infusion (5 mg) vs placebo to determine the efficacy of ZOL in mitigating ART-induced bone loss. Plasma bone turnover markers and bone mineral density (BMD) were performed at weeks 0, 12, 24, and 48 weeks. Primary outcome was change in C-terminal telopeptide of collagen at 24 weeks. Repeated-measures analyses using mixed linear models were used to estimate and compare study endpoints. RESULTS The ZOL arm had a 65% reduction in bone resorption relative to the placebo arm at 24 weeks (0.117 ng/mL vs 0.338 ng/mL; P < .001). This effect of ZOL occurred as early as 12 weeks (73% reduction; P < .001) and persisted through week 48 (57% reduction; P < .001). The ZOL arm had an 8% higher lumbar spine BMD at 12 weeks relative to the placebo arm (P = .003), and remained 11% higher at 24 and 48 weeks. Similar trends were observed in the hip and femoral neck. CONCLUSIONS A single dose of ZOL administered at ART initiation prevented ART-induced bone loss through the first 48 weeks of ART, the period when ART-induced bone loss is most pronounced. Validation of these results in larger multicenter randomized clinical trials is warranted. CLINICAL TRIALS REGISTRATION NCT01228318.
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Affiliation(s)
- Ighovwerha Ofotokun
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine.,Grady Healthcare System
| | - Kehmia Titanji
- Division of Endocrinology, Metabolism and Lipids, Department of Medicine, Emory University School of Medicine
| | - Cecile D Lahiri
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine.,Grady Healthcare System
| | - Aswani Vunnava
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine
| | - Antonina Foster
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine
| | - Sara E Sanford
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine
| | - Anandi N Sheth
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine.,Grady Healthcare System
| | - Jeffrey L Lennox
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine.,Grady Healthcare System
| | - Andrea Knezevic
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta
| | - Laura Ward
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta
| | - Kirk A Easley
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta
| | | | - M Neale Weitzmann
- Division of Endocrinology, Metabolism and Lipids, Department of Medicine, Emory University School of Medicine.,Atlanta Department of Veterans Affairs Medical Center, Decatur, Georgia
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29
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Lahiri CD, Reed-Walker K, Sheth AN, Acosta EP, Vunnava A, Ofotokun I. Cerebrospinal fluid concentrations of tenofovir and emtricitabine in the setting of HIV-1 protease inhibitor-based regimens. J Clin Pharmacol 2015; 56:492-6. [PMID: 26247878 DOI: 10.1002/jcph.612] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Accepted: 08/03/2015] [Indexed: 11/07/2022]
Affiliation(s)
- Cecile D Lahiri
- Emory University School of Medicine, Department of Medicine, Division of Infectious Diseases, Atlanta, GA, USA
| | - Kedria Reed-Walker
- University of Alabama-Birmingham School of Medicine, Department of Pharmacology and Toxicology, Division of Clinical Pharmacology, Birmingham, AL, USA
| | - Anandi N Sheth
- Emory University School of Medicine, Department of Medicine, Division of Infectious Diseases, Atlanta, GA, USA
| | - Edward P Acosta
- University of Alabama-Birmingham School of Medicine, Department of Pharmacology and Toxicology, Division of Clinical Pharmacology, Birmingham, AL, USA
| | - Aswani Vunnava
- Emory University School of Medicine, Department of Medicine, Division of Infectious Diseases, Atlanta, GA, USA
| | - Ighovwerha Ofotokun
- Emory University School of Medicine, Department of Medicine, Division of Infectious Diseases, Atlanta, GA, USA
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