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Giron LB, Liu Q, Adeniji OS, Yin X, Kannan T, Ding J, Lu DY, Langan S, Zhang J, Azevedo JLLC, Li SH, Shalygin S, Azadi P, Hanna DB, Ofotokun I, Lazar J, Fischl MA, Haberlen S, Macatangay B, Adimora AA, Jamieson BD, Rinaldo C, Merenstein D, Roan NR, Kutsch O, Gange S, Wolinsky SM, Witt MD, Post WS, Kossenkov A, Landay AL, Frank I, Tien PC, Gross R, Brown TT, Abdel-Mohsen M. Immunoglobulin G N-glycan markers of accelerated biological aging during chronic HIV infection. Nat Commun 2024; 15:3035. [PMID: 38600088 PMCID: PMC11006954 DOI: 10.1038/s41467-024-47279-4] [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: 09/01/2023] [Accepted: 03/25/2024] [Indexed: 04/12/2024] Open
Abstract
People living with HIV (PLWH) experience increased vulnerability to premature aging and inflammation-associated comorbidities, even when HIV replication is suppressed by antiretroviral therapy (ART). However, the factors associated with this vulnerability remain uncertain. In the general population, alterations in the N-glycans on IgGs trigger inflammation and precede the onset of aging-associated diseases. Here, we investigate the IgG N-glycans in cross-sectional and longitudinal samples from 1214 women and men, living with and without HIV. PLWH exhibit an accelerated accumulation of pro-aging-associated glycan alterations and heightened expression of senescence-associated glycan-degrading enzymes compared to controls. These alterations correlate with elevated markers of inflammation and the severity of comorbidities, potentially preceding the development of such comorbidities. Mechanistically, HIV-specific antibodies glycoengineered with these alterations exhibit a reduced ability to elicit anti-HIV Fc-mediated immune activities. These findings hold potential for the development of biomarkers and tools to identify and prevent premature aging and comorbidities in PLWH.
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Affiliation(s)
| | - Qin Liu
- The Wistar Institute, Philadelphia, PA, USA
| | | | | | | | | | - David Y Lu
- The Wistar Institute, Philadelphia, PA, USA
- Cornell University, New York, NY, USA
| | | | | | | | - Shuk Hang Li
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | | | | | | | - Igho Ofotokun
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Jason Lazar
- SUNY Downstate Health Sciences University, New York, NY, USA
| | - Margaret A Fischl
- Division of Infectious Disease, Department of Medicine, University of Miami, Miami, FL, USA
| | | | | | | | | | | | | | - Nadia R Roan
- Gladstone Institutes, San Francisco, CA, USA
- University of California San Francisco, San Francisco, CA, USA
| | - Olaf Kutsch
- University of Alabama at Birmingham, Birmingham, AL, USA
| | | | | | - Mallory D Witt
- Lundquist Institute of Biomedical Research at Harbor-UCLA Medical Center, Torrance, CA, USA
| | | | | | | | - Ian Frank
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Phyllis C Tien
- University of California San Francisco, San Francisco, CA, USA
| | - Robert Gross
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
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Price JC, Springer G, Seaberg EC, Budoff MJ, Koletar SL, Hawkins CA, Witt MD, Post WS, Thio CL. High Incidence Rate of Computed Tomography-Measured Steatotic Liver Disease in Men With and Without HIV Infection. Am J Gastroenterol 2024; 119:768-773. [PMID: 38131623 PMCID: PMC10994731 DOI: 10.14309/ajg.0000000000002633] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 11/30/2023] [Indexed: 12/23/2023]
Abstract
INTRODUCTION We determined steatotic liver disease (SLD) incidence in a prospective cohort of men with HIV (MWH) and men without HIV (MWOH). METHODS Incident SLD was defined using paired noncontrast computed tomography scans performed during 2010-2013 and repeated during 2015-2017. RESULTS Of 268 men, 173 MWH and 95 MWOH, 33 had incident SLD (11.1%, incidence rate 2.4 and 2.7/100 person-years for MWH and MWOH, respectively). Overall, higher abdominal visceral adipose tissue was independently associated with increased SLD risk. In MWH, increased visceral adipose tissue, insulin resistance, chronic hepatitis B, and cumulative etravirine use were associated with SLD. DISCUSSION Metabolic factors, but not HIV, were associated with incident SLD. The high incidence rate suggests that SLD will continue to increase in PWH.
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Affiliation(s)
- Jennifer C Price
- Division of Gastroenterology and Hepatology, Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Gayle Springer
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Eric C Seaberg
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Matthew J Budoff
- Division of Cardiology, Department of Medicine, Lundquist Institute, Torrance, California, USA
| | - Susan L Koletar
- Division of Infectious Diseases, Department of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Claudia A Hawkins
- Division of Infectious Diseases, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Mallory D Witt
- Division of HIV Medicine, Department of Medicine, Lundquist Institute at Harbor-UCLA Medical Center, Torrance, California, USA
| | - Wendy S Post
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Chloe L Thio
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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3
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Lai M, Madden E, Shlipak MG, Scherzer R, Post WS, Vittinghoff E, Haberlen S, Brown TT, Wolinsky SM, Witt MD, Ho K, Abraham AG, Parikh CR, Budoff M, Estrella MM. Association of urine biomarkers of kidney health with subclinical cardiovascular disease among men with and without HIV. AIDS 2024; 38:465-475. [PMID: 37861689 PMCID: PMC10922264 DOI: 10.1097/qad.0000000000003761] [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: 10/21/2023]
Abstract
OBJECTIVE The aim of this study was to determine whether urine biomarkers of kidney health are associated with subclinical cardiovascular disease among men with and without HIV. DESIGN A cross-sectional study within the Multicenter AIDS Cohort Study (MACS) among 504 men with and without HIV infection who underwent cardiac computed tomography scans and had urine biomarkers measured within the preceding 2 years. METHODS Our primary predictors were four urine biomarkers of endothelial (albuminuria), proximal tubule dysfunction (alpha-1-microglobulin [A1 M] and injury (kidney injury molecule-1 [KIM-1]) and tubulointerstitial fibrosis (pro-collagen-III N-terminal peptide [PIIINP]). These were evaluated for association with coronary artery calcium (CAC) prevalence, CAC extent, total plaque score, and total segment stenosis using multivariable regression. RESULTS Of the 504 participants, 384 were men with HIV (MWH) and 120 were men without HIV. In models adjusted for sociodemographic factors, cardiovascular disease risk factors, eGFR, and HIV-related factors, each two-fold higher concentration of albuminuria was associated with a greater extent of CAC (1.35-fold higher, 95% confidence interval 1.11-1.65), and segment stenosis (1.08-fold greater, 95% confidence interval 1.01-1.16). Associations were similar between MWH and men without HIV in stratified analyses. The third quartile of A1 M showed an association with greater CAC extent, total plaque score, and total segment stenosis, compared with the lowest quartile. CONCLUSION Worse endothelial and proximal tubule dysfunction, as reflected by higher urine albumin and A1 M, were associated with greater CAC extent and coronary artery stenosis.
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Affiliation(s)
- Mason Lai
- Kidney Health Research Collaborative, Department of Medicine, University of California San Francisco
- Department of Medicine, University of California San Francisco
| | - Erin Madden
- Kidney Health Research Collaborative, Department of Medicine, University of California San Francisco
- San Francisco VA Healthcare System, San Francisco, California
| | - Michael G Shlipak
- Kidney Health Research Collaborative, Department of Medicine, University of California San Francisco
- Department of Medicine, University of California San Francisco
- San Francisco VA Healthcare System, San Francisco, California
| | - Rebecca Scherzer
- Kidney Health Research Collaborative, Department of Medicine, University of California San Francisco
- San Francisco VA Healthcare System, San Francisco, California
| | - Wendy S Post
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health
| | - Eric Vittinghoff
- Kidney Health Research Collaborative, Department of Medicine, University of California San Francisco
| | - Sabina Haberlen
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health
| | - Todd T Brown
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Steven M Wolinsky
- Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Mallory D Witt
- Lundquist Institute of Biomedical Research at Harbor-UCLA Medical Center, Torrance, California
| | - Ken Ho
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Alison G Abraham
- Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado
| | - Chirag R Parikh
- Department of Medicine, Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Matthew Budoff
- Lundquist Institute of Biomedical Research at Harbor-UCLA Medical Center, Torrance, California
| | - Michelle M Estrella
- Kidney Health Research Collaborative, Department of Medicine, University of California San Francisco
- San Francisco VA Healthcare System, San Francisco, California
- Department of Medicine, Division of Nephrology, University of California San Francisco, San Francisco, California, USA
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Bravo CA, Moon JY, Davy K, Kaplan RC, Anastos K, Rodriguez CJ, Post WS, Gange SJ, Kassaye SG, Kingsley LA, Lazar JM, Mack WJ, Pyslar N, Tien PC, Witt MD, Palella FJ, Li Y, Yan M, Hodis HN, Hanna DB. Association of HIV and HCV Infection With Carotid Artery Plaque Echomorphology in the MACS/WIHS Combined Cohort Study. Stroke 2024; 55:651-659. [PMID: 38333992 PMCID: PMC10940210 DOI: 10.1161/strokeaha.123.043922] [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: 05/17/2023] [Accepted: 12/19/2023] [Indexed: 02/10/2024]
Abstract
BACKGROUND HIV and hepatitis C virus (HCV) are associated with increased risk of carotid artery atherosclerotic plaque and stroke. We examined associations of HIV- and HCV-related factors with echomorphologic features of carotid artery plaque. METHODS This cross-sectional study included participants from the MACS (Multicenter AIDS Cohort Study)/WIHS (Women's Interagency HIV Study) Combined Cohort Study who underwent high-resolution B-mode carotid artery ultrasound. Plaques were characterized from 6 areas of the right carotid artery. Poisson regression controlling for demographic and cardiometabolic risk factors determined adjusted prevalence ratios (aPRs) and 95% CIs for associations of HIV- and HCV-related factors with echomorphologic features. RESULTS Of 2655 participants (65% women, median age 44 [interquartile range, 37-50] years), 1845 (70%) were living with HIV, 600 (23%) were living with HCV, and 425 (16%) had carotid plaque. There were 191 plaques identified in 129 (11%) women with HIV, 51 plaques in 32 (7%) women without HIV, 248 plaques in 171 (28%) men with HIV, and 139 plaques in 93 (29%) men without HIV. Adjusted analyses showed that people with HIV and current CD4+ count <200 cells/µL had a significantly higher prevalence of predominantly echolucent plaque (aPR, 1.86 [95% CI, 1.08-3.21]) than those without HIV. HCV infection alone (aPR, 1.86 [95% CI, 1.08-3.19]) and HIV-HCV coinfection (aPR, 1.75 [95% CI, 1.10-2.78]) were each associated with higher prevalence of predominantly echogenic plaque. HIV-HCV coinfection was also associated with higher prevalence of smooth surface plaque (aPR, 2.75 [95% CI, 1.03-7.32]) compared with people without HIV and HCV. CONCLUSIONS HIV with poor immunologic control, as well as HCV infection, either alone or in the presence of HIV, were associated with different echomorphologic phenotypes of carotid artery plaque.
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Affiliation(s)
| | | | | | - Robert C. Kaplan
- Albert Einstein College of Medicine, Bronx, NY, USA
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | | | | | - Wendy S. Post
- Johns Hopkins University, School of Medicine, Baltimore, MD, USA
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Stephen J. Gange
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | | | - Jason M. Lazar
- State University of New York Downstate Medical Center, Brooklyn, NY, USA
| | - Wendy J. Mack
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | | | - Phyllis C. Tien
- University of California-San Francisco and Department of Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Mallory D. Witt
- Lundquist Institute for Biomedical Research at Harbor-UCLA Medical Center, Los Angeles, CA, USA
| | - Frank J. Palella
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Yanjie Li
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Mingzhu Yan
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Howard N. Hodis
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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Fisher MC, Hoover DR, Shi Q, Sharma A, Estrella MM, Adimora A, Alcaide M, Collins LF, French A, Gao W, Koletar SL, Mcfarlane SI, Mckay H, Dionne JA, Palella F, Sarkar S, Spence A, Witt MD, Ross MJ. Association of marijuana, tobacco and alcohol use with estimated glomerular filtration rate in women living with HIV and women without HIV. AIDS 2023; 37:1555-1564. [PMID: 37352493 PMCID: PMC10859004 DOI: 10.1097/qad.0000000000003625] [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: 06/25/2023]
Abstract
OBJECTIVE Marijuana, tobacco and alcohol use are prevalent among people with HIV and may adversely affect kidney function in this population. We determined the association of use of these substances with estimated glomerular filtration rate (eGFR) among women with HIV (WWH) and women without HIV. DESIGN We undertook a repeated measures study of 1043 WWH and 469 women without HIV within the United States Women's Interagency HIV Study, a multicenter, prospective cohort of HIV-seropositive and HIV-seronegative women. METHODS We quantified substance exposures using semi-annual questionnaires. Using pooled eGFR data from 2009 to 2019, we used linear regression models with multivariable generalized estimating equations to ascertain associations between current and cumulative substance use exposures with eGFR, adjusting for sociodemographics, chronic kidney disease risk factors and HIV-related factors. RESULTS Marijuana use of 1-14 days/month versus 0 days/month was associated with 3.34 ml/min per 1.73 m 2 [95% confidence interval (CI) -6.63, -0.06] lower eGFR and marijuana use of >0.02-1.6 marijuana-years versus 0-0.2 marijuana-years was associated with 3.61 ml/min per 1.73 m 2 (95% CI -5.97, -1.24) lower eGFR. Tobacco use was not independently associated with eGFR. Alcohol use of seven or more drinks/week versus no drinks/week was associated with 5.41 ml/min per 1.73 m 2 (95% CI 2.34, 8.48) higher eGFR and alcohol use of >0.7-4.27 drink-years and >4.27 drink-years versus 0-0.7 drink-years were associated with 2.85 ml/min per 1.73 m 2 (95% CI 0.55, 5.15) and 2.26 ml/min per 1.73 m 2 (95% CI 0.33, 4.20) higher eGFR, respectively. CONCLUSION Among a large cohort of WWH and women without HIV, marijuana use was associated with a lower eGFR while alcohol use was associated with a higher eGFR.
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Affiliation(s)
- Molly C. Fisher
- Division of Nephrology, Albert Einstein College of Medicine, Bronx, New York
| | - Donald R. Hoover
- Department of Statistics and Institute for Health, Healthcare Policy and Aging Research, Rutgers University, Piscataway, New Jersey
| | - Qiuhu Shi
- Department of Public Health, New York Medical College, Valhalla
| | - Anjali Sharma
- Division of Infectious Diseases, Albert Einstein College of Medicine, Bronx, New York
| | - Michelle M. Estrella
- Division of Nephrology and Kidney Health Research Collaborative, Department of Medicine, San Francisco VA Medical Center and University of California, San Francisco, California
| | - Adaora Adimora
- Division of Infectious Diseases, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Maria Alcaide
- University of Miami Miller School of Medicine, Miami, Florida
| | - Lauren F. Collins
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia
| | | | | | - Susan L. Koletar
- Division of Infectious Diseases, College of Medicine, The Ohio State University, Columbus, Ohio
| | - Samy I. Mcfarlane
- State University of New York, Downstate Health Science University, Brooklyn, New York
| | - Heather Mckay
- Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Jodie A. Dionne
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Frank Palella
- Department of Medicine, Northwestern University, Chicago, Illinois
| | - Sudipa Sarkar
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Amanda Spence
- Department of Medicine, Division of Infectious Disease and Tropical Medicine, Georgetown University, Washington, DC
| | - Mallory D. Witt
- Lundquist Research Institute at Harbor, UCLA Medical Center, Torrance, California, USA
| | - Michael J. Ross
- Division of Nephrology, Albert Einstein College of Medicine, Bronx, New York
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Etzkorn LH, Liu F, Urbanek JK, Heravi AS, Magnani JW, Plankey MW, Margolich JB, Witt MD, Palella FJ, Haberlen SA, Wu KC, Post WS, Schrack JA, Crainiceanu CM. Patterns of objectively measured physical activity differ between men living with and without HIV. AIDS 2022; 36:1553-1562. [PMID: 35979829 PMCID: PMC9395149 DOI: 10.1097/qad.0000000000003274] [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: 01/26/2023]
Abstract
OBJECTIVE To use accelerometers to quantify differences in physical activity (PA) by HIV serostatus and HIV viral load (VL) in the Multicenter AIDS Cohort Study (MACS). METHODS MACS participants living with (PLWH, n = 631) and without (PWOH, n = 578) HIV wore an ambulatory electrocardiogram monitor containing an accelerometer for 1-14 days. PA was summarized as cumulative mean absolute deviation (MAD) during the 10 most active consecutive hours (M10), cumulative MAD during the six least active consecutive hours (L6), and daily time recumbent (DTR). PA summaries were compared by HIV serostatus and by detectability of VL (>20 vs. ≤20 copies/ml) using linear mixed models adjusted for sociodemographics, weight, height, substance use, physical function, and clinical factors. RESULTS In sociodemographic-adjusted models, PLWH with a detectable VL had higher L6 (β = 0.58 mg, P = 0.027) and spent more time recumbent (β = 53 min/day, P = 0.003) than PWOH. PLWH had lower M10 than PWOH (undetectable VL β = -1.62 mg, P = 0.027; detectable VL β = -1.93 mg, P = 0.12). A joint test indicated differences in average PA measurements by HIV serostatus and VL (P = 0.001). However, differences by HIV serostatus in M10 and DTR were attenuated and no longer significant after adjustment for renal function, serum lipids, and depressive symptoms. CONCLUSIONS Physical activity measures differed significantly by HIV serostatus and VL. Higher L6 among PLWH with detectable VL may indicate reduced amount or quality of sleep compared to PLWH without detectable VL and PWOH. Lower M10 among PLWH indicates lower amounts of physical activity compared to PWOH.
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Affiliation(s)
| | - Fangyu Liu
- Johns Hopkins Bloomberg School of Public Health
| | | | | | | | | | - Joseph B Margolich
- Johns Hopkins Bloomberg School of Public Health
- Johns Hopkins School of Medicine, Baltimore, MD
| | | | - Frank J Palella
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | | | - Wendy S Post
- Johns Hopkins Bloomberg School of Public Health
- Johns Hopkins School of Medicine, Baltimore, MD
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Sarkar S, Haberlen S, Metkus TS, Kingsley L, Budoff M, Witt MD, Palella FJ, Post WS, Brown TT. HIV serostatus and incident coronary artery stenosis in men with a baseline zero coronary artery calcium. AIDS 2021; 35:2061-2063. [PMID: 34471076 PMCID: PMC8496999 DOI: 10.1097/qad.0000000000002991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
| | - Sabina Haberlen
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | | | - Lawrence Kingsley
- Department of Infectious Diseases and Microbiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA
| | | | | | - Frank J. Palella
- Division of Infectious Diseases, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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Sarkar S, Haberlen S, Post WS, Kelesidis T, Wiley D, Kingsley L, Kim EY, Palella FJ, Witt MD, Budoff MJ, Rodriguez A, Brown TT. Short Communication: Plasma Lymphocyte Activation Gene 3 and Subclinical Coronary Artery Disease in the Multicenter AIDS Cohort Study. AIDS Res Hum Retroviruses 2021; 37:842-845. [PMID: 34542321 PMCID: PMC8817687 DOI: 10.1089/aid.2021.0035] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Chronic inflammation, including among people with HIV (PWH), elevates immune cell expression of lymphocyte activation gene 3 (LAG3); however, low plasma LAG3 predicts cardiovascular disease (CVD) events in the general population. The associations among LAG3 plasma levels, subclinical atherosclerosis, inflammation, and HIV infection have not been well described. We measured plasma LAG3 in 704 men with and without HIV from the multicenter AIDS cohort study, who underwent coronary computed tomography angiography. HIV serostatus was not independently associated with LAG3 after adjustment for sociodemographic and CVD risk factors. Current smoking status and African American race were associated with lower LAG3, and age and sTNFαRI concentration were associated with greater LAG3. LAG3 was not associated with coronary artery stenosis. Thus, no difference was found in plasma LAG3 concentration by HIV serostatus, and no association between LAG3 and subclinical coronary atherosclerosis in men with and without HIV was observed.
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Affiliation(s)
- Sudipa Sarkar
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Sabina Haberlen
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Wendy S. Post
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
- Division of Cardiology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Theodoros Kelesidis
- Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Dorothy Wiley
- School of Nursing, University of California, Los Angeles, California, USA
| | - Lawrence Kingsley
- Department of Infectious Diseases and Microbiology and Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Eun-Young Kim
- Division of Infectious Diseases, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Frank J. Palella
- Division of Infectious Diseases, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Mallory D. Witt
- The Lundquist Research Institute at Harbor-UCLA Medical Center, Torrance, California, USA
| | - Matthew J. Budoff
- The Lundquist Research Institute at Harbor-UCLA Medical Center, Torrance, California, USA
| | - Annabelle Rodriguez
- Center for Vascular Biology, University of Connecticut Health Center, Farmington, Connecticut, USA
| | - Todd T. Brown
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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D’Souza G, Benning L, Stosor V, Witt MD, Johnson J, Friedman M, Abraham AG. The shifting picture of HIV treatment, comorbidity and substance use among US MSM living with HIV. HIV Med 2021; 22:538-546. [PMID: 33751813 PMCID: PMC8295172 DOI: 10.1111/hiv.13082] [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: 04/15/2020] [Revised: 01/07/2021] [Accepted: 01/08/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES People living with HIV (PLWH) have increased risk of chronic disease and poor mental health. We aimed to explore HIV disease indicators, comorbidity, and risk behavior of recent antiretroviral therapy (ART) initiators to inform current needs of PLWH. METHODS Men who have sex with men (MSM) in the Multicenter AIDS Cohort Study (MACS) who initiated ART between 2010 and 2018 (recent initiators) were compared with age-, race- and geographic location-matched men who initiated ART during 2000-2009 (early initiators). Measures of HIV disease, behavior, comorbidity and mental health were collected prospectively every 6 months using standardized forms. RESULTS Recent initiators had higher current CD4 (median CD4 451 vs. 307 cells/μL, P < 0.0001) and nadir CD4 (451 vs. 300 cells/μL, P < 0.0001) than earlier initiators. The proportion achieving viral suppression within a year of starting ART was significantly higher in recent compared with earlier initiators (92% vs. 74%, P < 0.0001). Median [interquartile range (IQR)] time from HIV diagnosis to ART initiation was 5.4 (1.7-23.1) months in recent initiators. Comorbidity prevalence was high in recent initiators, including obesity (24%), hypertension (25%) and kidney disease (15%). Substance use continues to be common, including cigarette use (40%), daily alcohol use (88%) and marijuana use (46%). CONCLUSIONS Improvements in getting individuals onto ART at an early stage have led to substantially higher CD4 cell counts at initiation. However, the high burden of comorbidity, substance use and poor mental health affecting MSM living with HIV in the US underscore ongoing challenges and our need to adapt and coordinate care.
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Affiliation(s)
- Gypsyamber D’Souza
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, USA
| | - Lorie Benning
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, USA
| | - Valentina Stosor
- Department of Medicine, Northwestern University Feinberg School of Medicine, USA
| | - Mallory D. Witt
- Department of Medicine, The Lundquist Institute at Harbor-UCLA, USA
| | - Jacquett Johnson
- Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, USA
| | - Mackey Friedman
- Department of Infectious Diseases and Microbiology, University of Pittsburgh, USA
| | - Alison G Abraham
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, USA
- Department of Ophthalmology, Johns Hopkins School of Medicine
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Osuji N, Haberlen SA, Ashikaga H, Brown TT, Feinstein MJ, Witt MD, Magnani JW, Soliman EZ, Wu KC, Post WS. Association between human immunodeficiency virus serostatus and the prevalence of atrial fibrillation. Medicine (Baltimore) 2021; 100:e26663. [PMID: 34398028 PMCID: PMC8294896 DOI: 10.1097/md.0000000000026663] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 06/24/2021] [Accepted: 06/28/2021] [Indexed: 11/25/2022] Open
Abstract
ABSTRACT Atrial fibrillation (AF) leads to increased risk for stroke. Human immunodeficiency virus (HIV) is associated with cardiovascular disease (CVD), although it is unclear if HIV is associated with AF. The purpose of this study was to evaluate the association between HIV serostatus and the prevalence of AF in the Multicenter AIDS Cohort Study.A cross sectional study was conducted among 1674 HIV-infected (HIV+) and uninfected (HIV-) men who completed resting 12-lead electrocardiograms, and/or ambulatory electrocardiogram monitoring. Multivariable logistic regression was used to evaluate the association between AF, defined as the presence of either AF or atrial flutter, and HIV+ serostatus. Associations were adjusted for demographic variables, and then also for CVD risk factors.HIV+ men were younger than HIV- men (median 55.5 vs 61.7 years, P < .001) and were more frequently African-American (30.5% vs 17.8%, P < .001). Most HIV+ men (81%) had undetectable viral load. The age and race adjusted prevalence of AF was 3.0% in HIV+ and 3.3% in HIV- men. There was only 1 case of AF among African-American men. There were no associations between AF and HIV serostatus after adjusting for demographic factors (odds ratio 0.76; 95% CI 0.37 to -1.58; P = .47) or after further adjustment for CVD risk factors (odds ratio 0.84; 95% CI 0.39 to -1.81; P = .66).We found no association between HIV and AF in this cohort in which viral replication among the HIV+ men is generally suppressed. The overall prevalence of AF was low and was rare in African-American men.
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Affiliation(s)
- Ngozi Osuji
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - Sabina A. Haberlen
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - Hiroshi Ashikaga
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Todd T. Brown
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Matthew J. Feinstein
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Mallory D. Witt
- The Lundquist Institute at Harbor-University of California Los Angeles, Torrance, CA
| | | | | | - Katherine C. Wu
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Wendy S. Post
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
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11
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Haley DF, Edmonds A, Ramirez C, French AL, Tien P, Thio CL, Witt MD, Seaberg EC, Plankey MW, Cohen MH, Adimora AA. Direct-Acting Antiviral Hepatitis C Treatment Cascade and Barriers to Treatment Initiation Among US Men and Women With and Without HIV. J Infect Dis 2021; 223:2136-2144. [PMID: 33141170 PMCID: PMC8205633 DOI: 10.1093/infdis/jiaa686] [Citation(s) in RCA: 3] [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] [Received: 01/13/2020] [Accepted: 10/27/2020] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND People with HIV are disproportionately coinfected with hepatitis C virus (HCV) and experience accelerated liver-related mortality. Direct-acting antivirals (DAAs) yield high sustained virologic response (SVR) rates, but uptake is suboptimal. This study characterizes the DAA-era HCV treatment cascade and barriers among US men and women with or at risk for HIV. METHODS We constructed HCV treatment cascades using the Women's Interagency HIV Study (women, 6 visits, 2015-2018, n = 2447) and Multicenter AIDS Cohort Study (men, 1 visit, 2015-2018, n = 2221). Cascades included treatment-eligible individuals (ie, HCV RNA-positive or reported DAAs). Surveys captured self-reported clinical (eg, CD4), patient (eg, missed visits), system (eg, appointment access), and financial/insurance barriers. RESULTS Of 323/92 (women/men) treatment eligible, most had HIV (77%/70%); 69%/63% were black. HIV-positive women were more likely to attain cascade outcomes than HIV-negative women (39% vs 23% initiated, 21% vs 12% SVR); similar discrepancies were noted for men. Black men and substance users were treated less often. Women initiating treatment (vs not) reported fewer patient barriers (14%/33%). Among men not treated, clinical barriers were prevalent (53%). CONCLUSIONS HIV care may facilitate HCV treatment linkage and barrier navigation. HIV-negative individuals, black men, and substance users may need additional support. CLINICAL TRIALS REGISTRATION NCT00000797 (Women's Interagency HIV Study); NCT00046280 (Multicenter AIDS Cohort Study).
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Affiliation(s)
- Danielle F Haley
- Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Andrew Edmonds
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Catalina Ramirez
- Divison of Infectious Diseases, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Audrey L French
- Division of Infectious Diseases, Stroger (Cook County) Hospital, Chicago, Illinois, 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
| | - Chloe L Thio
- Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Mallory D Witt
- Department of Medicine, Lundquist Institute, Harbor-University of California Los Angeles, Torrance, California, USA
| | - Eric C Seaberg
- Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Michael W Plankey
- Department of Medicine, Georgetown University Medical Center, Washington, District of Columbia, USA
| | - Mardge H Cohen
- Department of Medicine, Stroger (Cook County) Hospital, Chicago, Illinois, USA
| | - Adaora A Adimora
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Divison of Infectious Diseases, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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12
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Brusca RM, Hanna DB, Wada NI, Blankson JN, Witt MD, Jacobson LP, Kingsley L, Palella FJ, Budoff M, Brown TT, Anastos K, Lazar JM, Mack WJ, Bacchetti P, Tien PC, Golzar Y, Plankey M, Golub E, Kaplan RC, Post WS. Subclinical cardiovascular disease in HIV controller and long-term nonprogressor populations. HIV Med 2020; 21:217-227. [PMID: 31729142 PMCID: PMC7069771 DOI: 10.1111/hiv.12820] [Citation(s) in RCA: 9] [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] [Accepted: 10/11/2019] [Indexed: 01/09/2023]
Abstract
OBJECTIVES Elite controllers (ECs), viraemic controllers (VCs), and long-term nonprogressors (LTNPs) control HIV viral replication or maintain CD4 T-cell counts without antiretroviral therapy, but may have increased cardiovascular disease (CVD) risk compared to HIV-uninfected persons. We evaluated subclinical carotid and coronary atherosclerosis and inflammatory biomarker levels among HIV controllers, LTNPs and noncontrollers and HIV-uninfected individuals in the Multicenter AIDS Cohort Study (MACS) and the Women's Interagency HIV Study (WIHS). METHODS We measured carotid plaque presence and common carotid artery intima-media thickness (IMT) in 1729 women and 1308 men, and the presence of coronary artery calcium and plaque in a subgroup of men. Associations between HIV control category and carotid and coronary plaque prevalences were assessed by multivariable regression analyses adjusting for demographics and CVD risk factors. Serum inflammatory biomarker concentrations [soluble CD163 (sCD163), soluble CD14 (sCD14), galectin-3 (Gal-3), galectin-3 binding protein (Gal-3BP) and interleukin (IL)-6] were measured and associations with HIV control category assessed. RESULTS We included 135 HIV controllers (30 ECs) and 135 LTNPs in the study. Carotid plaque prevalence and carotid IMT were similar in HIV controllers, LTNPs and HIV-uninfected individuals. HIV controllers and LTNPs had lower prevalences of carotid plaque compared to viraemic HIV-infected individuals. The prevalence of coronary atherosclerosis was similar in HIV controllers/LTNPs compared to HIV-uninfected and viraemic HIV-infected men. Controllers and LTNPs had higher concentrations of sCD163 and sCD14 compared to HIV-uninfected persons. CONCLUSIONS Subclinical CVD was similar in HIV controllers, LTNPs and HIV-uninfected individuals despite elevated levels of some inflammatory biomarkers. Future studies of HIV controllers and LTNPs are needed to characterize the risk of CVD among HIV-infected persons.
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Affiliation(s)
| | - David B. Hanna
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY
| | - Nikolas I. Wada
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | | | - Mallory D. Witt
- Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA
| | | | | | | | - Matthew Budoff
- Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA
| | - Todd T. Brown
- Johns Hopkins University School of Medicine, Baltimore MD
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Kathryn Anastos
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY
- Department of Medicine, Montefiore Medical Center, Bronx, NY
| | - Jason M. Lazar
- Department of Medicine, SUNY-Downstate Medical Center, Brooklyn, NY
| | - Wendy J. Mack
- Preventive Medicine, University of Southern California, Los Angeles, CA
| | - Peter Bacchetti
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA
| | - Phyllis C. Tien
- Department of Medicine and Clinical Pharmacy, University of California, San Francisco, CA and Department of Veterans Affairs Medical Center, San Francisco, CA
| | | | - Michael Plankey
- Department of Medicine, Division of Infectious Diseases, Georgetown University Medical Center, Washington, DC
| | - Elizabeth Golub
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Robert C. Kaplan
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Wendy S. Post
- Johns Hopkins University School of Medicine, Baltimore MD
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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13
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Sarkar S, Haberlen S, Whelton S, E Schneider E, Kingsley L, Palella F, Witt MD, Kelesidis T, Rodriguez A, Post WS, Brown TT. Greater IL-6, D-dimer, and ICAM-1 Levels Are Associated With Lower Small HDL Particle Concentration in the Multicenter AIDS Cohort Study. Open Forum Infect Dis 2019; 6:ofz474. [PMID: 32128324 PMCID: PMC7047959 DOI: 10.1093/ofid/ofz474] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 11/11/2019] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE Low HDL cholesterol (HDL-C) is common in people living with HIV infection, which is associated with inflammation, and correlates with greater cardiovascular disease (CVD) risk. Particles of HDL are HDL subfractions, and in some general population studies, higher small HDL particle number (HDL-P) has been associated with lower CVD risk. The objective of this study was to determine whether HIV serostatus and systemic inflammation were associated with small HDL-P in the Multicenter AIDS Cohort Study (MACS). METHOD The MACS is composed of HIV-infected and HIV-uninfected men. Separate linear regression analyses were conducted to evaluate the associations between outcomes (small HDL-P, large HDL-P, total HDL-P, and HDL size) and variables of interest (interleukin-6 [IL-6], D-dimer, and intercellular adhesion molecule-1 [ICAM-1] levels), with adjustment for other CVD risk factors. RESULTS The study population included 553 HIV-infected (88.1% on current ART) and 319 HIV-uninfected men. The mean age was 52.7 years for HIV-infected men and 55.3 years for HIV-uninfected men. In separate models of the study population, higher log IL-6 was associated with lower total and small HDL-P (P < .01 for both), independent of HIV serostatus and CVD risk factors. Similar results were seen with ICAM-1. Positive HIV serostatus was associated with lower small and total HDL-P, adjusted for inflammatory markers. CONCLUSIONS Greater systemic inflammation and HIV infection both were associated with lower atheroprotective small HDL-P. This may be a potential mechanism contributing to increased cardiovascular risk among HIV-infected people.
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Affiliation(s)
- Sudipa Sarkar
- Department of Medicine, Division of Endocrinology, Diabetes, and Metabolism, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Sabina Haberlen
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Seamus Whelton
- Department of Medicine, Division of Cardiology, Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Edward E Schneider
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Lawrence Kingsley
- Department of Infectious Diseases and Microbiology, University of Pittsburgh, Pittsburgh, Pennsylvania
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Frank Palella
- Department of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Mallory D Witt
- Division of HIV Medicine, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California
| | - Theodoros Kelesidis
- Department of Medicine, Division of Infectious Diseases, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Annabelle Rodriguez
- Center for Vascular Biology, University of Connecticut Health Center, Farmington, Connecticut
| | - Wendy S Post
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
- Department of Medicine, Division of Cardiology, Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Todd T Brown
- Department of Medicine, Division of Endocrinology, Diabetes, and Metabolism, Johns Hopkins School of Medicine, Baltimore, Maryland
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
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14
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Price JC, Wang R, Seaberg EC, Brown TT, Budoff MJ, Kingsley LA, Palella FJ, Witt MD, Post WS, Lake JE, Thio CL. Sex Hormone-Binding Globulin Levels Are Inversely Associated With Nonalcoholic Fatty Liver Disease in HIV-Infected and -Uninfected Men. Open Forum Infect Dis 2019; 6:ofz468. [PMID: 32128321 PMCID: PMC7047947 DOI: 10.1093/ofid/ofz468] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 10/30/2019] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Nonalcoholic fatty liver disease (NAFLD) is a leading cause of liver disease worldwide. Elevated sex hormone-binding globulin (SHBG) levels have been observed in the setting of HIV and may protect against some metabolic disorders. We aimed to investigate whether higher SHBG levels may protect against NAFLD in men with/without HIV. METHODS NAFLD was assessed using noncontrast computed tomography in 530 men in the Multicenter AIDS Cohort Study (MACS) who drank <3 alcoholic drinks/d and were uninfected with chronic hepatitis C or B (340HIV+, 190HIV-). Morning serum samples were tested for SHBG, total testosterone (TT), and adiponectin. Multivariable logistic regression was used to assess associations between HIV, SHBG, TT, adiponectin, and NAFLD. RESULTS Median SHBG was highest among HIV+/NAFLD- men and lowest among HIV-/NAFLD+ men. Adjusted for demographics, HIV, visceral adiposity, HOMA-IR, TT, and PNPLA3 genotype, higher SHBG was associated with lower odds of NAFLD (odds ratio [OR], 0.52 per doubling; 95% confidence interval [CI], 0.34-0.80). In separate multivariable models without SHBG, HIV (OR, 0.46; 95% CI, 0.26-0.79) and higher adiponectin (OR, 0.66 per doubling; 95% CI, 0.49-0.89) were associated with lower NAFLD odds, whereas TT was not significantly associated (OR, 0.74 per doubling; 95% CI, 0.53-1.04). Adjusting for SHBG attenuated the associations of HIV (OR, 0.61; 95% CI, 0.34-1.08) and adiponectin (OR, 0.74; 95% CI, 0.54-1.02) with NAFLD. CONCLUSIONS SHBG levels were higher among HIV+ men, were independently associated with lower NAFLD, and could partially explain the associations of HIV and higher adiponectin with lower NAFLD in our cohort. These findings suggest that SHBG may protect against NAFLD, supporting further prospective and mechanistic studies.
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Affiliation(s)
- Jennifer C Price
- Division of Gastroenterology and Hepatology, Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Ruibin Wang
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Eric C Seaberg
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Todd T Brown
- Division of Endocrinology, Diabetes, & Metabolism, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Matthew J Budoff
- Division of Cardiology, Department of Medicine, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California, USA
| | - Lawrence A Kingsley
- Departments of Infectious Diseases and Microbiology and Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania, USA
| | - Frank J Palella
- Division of Infectious Diseases, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Mallory D Witt
- Division of HIV Medicine, Department of Medicine, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California, USA
| | - Wendy S Post
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jordan E Lake
- Division of Infectious Diseases, Department of Medicine, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Chloe L Thio
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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15
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Rahman F, Zhang Z, Zhao D, Budoff MJ, Palella FJ, Witt MD, Evans RW, Jacobson LP, Korley FK, Guallar E, Post WS, McEvoy JW. Association of High-Sensitivity Troponin with Cardiac CT Angiography Evidence of Myocardial and Coronary Disease in a Primary Prevention Cohort of Men: Results from MACS. J Appl Lab Med 2019; 4:355-369. [PMID: 31659073 PMCID: PMC7085121 DOI: 10.1373/jalm.2018.028860] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 03/12/2019] [Indexed: 12/27/2022]
Abstract
BACKGROUND High-sensitivity cardiac troponin (hs-cTn) elevations are associated with incident cardiovascular disease events in primary prevention samples. However, the mechanisms underlying this association remain unclear. METHODS We studied 458 men without known cardiovascular disease who participated in the cardiovascular disease substudy of the Multicenter AIDS Cohort Study and had cardiac CT angiography. We used multivariable linear and logistic regression models to examine the cross-sectional associations between coronary artery stenosis, coronary artery plaque, indexed left ventricular mass (LVMi), and the outcome of hs-cTnI. We also evaluated the associations between HIV serostatus or use of highly active antiretroviral therapy (HAART) and hs-cTnI. RESULTS The mean age was 54 years, 54% were white, and 61% were HIV infected. In multivariable-adjusted logistic models, comparing the highest quartile of LVMi with the lowest quartile, the odds ratio (OR) of hs-cTnI ≥75th percentile was 2.59 (95% CI, 1.20-5.75). There was no significant association between coronary stenosis severity or plaque type and hs-cTnI in linear models; however, in logistic regression models, coronary artery stenosis ≥70% (8% of sample) was marginally associated with a higher likelihood (OR, 2.75 [95% CI, 1.03, 7.27]) of having hs-cTnI ≥75th percentile. There were no associations between HIV serostatus or HAART use and hs-cTnI in either linear or logistic models. CONCLUSION Among primary prevention men with or at risk for HIV, hs-cTnI concentrations were strongly associated with LVMi but were not associated with HIV infection or treatment status or with coronary plaque type or stenosis until the extremes of severity (≥70% stenosis).
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Affiliation(s)
- Faisal Rahman
- Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD;
- Department of Medicine, Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Zhenyu Zhang
- Department of Epidemiology and the Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Di Zhao
- Department of Epidemiology and the Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Matthew J Budoff
- Division of Cardiology, Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, CA
| | - Frank J Palella
- Division of Infectious Diseases, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Mallory D Witt
- Division of HIV Medicine, Department of Medicine, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA
| | - Rhobert W Evans
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA
| | - Lisa P Jacobson
- Department of Epidemiology and the Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Frederick K Korley
- Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, MI
| | - Eliseo Guallar
- Department of Epidemiology and the Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Wendy S Post
- Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Medicine, Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Epidemiology and the Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - John W McEvoy
- Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD;
- Department of Medicine, Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Epidemiology and the Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- National University of Ireland and National Institute for Prevention and Cardiovascular Health, Galway, Ireland
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16
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Ascher SB, Scherzer R, Estrella MM, Shlipak MG, Ng DK, Palella FJ, Witt MD, Ho K, Bennett MR, Parikh CR, Ix JH, Jotwani V. Associations of Urine Biomarkers with Kidney Function Decline in HIV-Infected and Uninfected Men. Am J Nephrol 2019; 50:401-410. [PMID: 31553981 DOI: 10.1159/000502898] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 05/24/2019] [Accepted: 08/15/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND HIV-infected (HIV+) persons are at increased risk of chronic kidney disease, but serum creatinine does not detect early losses in kidney function. We hypothesized that urine biomarkers of kidney damage would be associated with subsequent changes in kidney function in a contemporary cohort of HIV+ and HIV-uninfected (HIV-) men. METHODS In the Multicenter AIDS Cohort Study, we measured baseline urine concentrations of 5 biomarkers from 2009 to 2011 in 860 HIV+ and 337 HIV- men: albumin, alpha-1-microglobulin (α1m), interleukin-18 (IL-18), kidney injury molecule-1 (KIM-1), and procollagen type III N-terminal propeptide (PIIINP). We evaluated associations of urine biomarker concentrations with annual changes in estimated glomerular filtration rate (eGFR) using multivariable linear mixed models adjusted for demographics, traditional kidney disease risk factors, HIV-related risk factors, and baseline eGFR. RESULTS Over a median follow-up of 4.8 years, the average annual eGFR decline was 1.42 mL/min/1.73 m2/year in HIV+ men and 1.22 mL/min/1.73 m2/year in HIV- men. Among HIV+ men, the highest vs. lowest tertiles of albumin (-1.78 mL/min/1.73 m2/year, 95% CI -3.47 to -0.09) and α1m (-2.43 mL/min/1.73 m2/year, 95% CI -4.14 to -0.73) were each associated with faster annual eGFR declines after multivariable adjustment. Among HIV- men, the highest vs. lowest tertile of α1m (-2.49 mL/min/1.73 m2/year, 95% CI -4.48 to -0.50) was independently associated with faster annual eGFR decline. Urine IL-18, KIM-1, and PIIINP showed no independent associations with eGFR decline, regardless of HIV serostatus. CONCLUSIONS Among HIV+ men, higher urine albumin and α1m are associated with subsequent declines in kidney function, independent of eGFR.
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Affiliation(s)
- Simon B Ascher
- Kidney Health Research Collaborative, Department of Medicine, San Francisco Veterans Affairs Medical Center and University of California, San Francisco, California, USA
- Department of Medicine, University of California, Los Angeles, California, USA
| | - Rebecca Scherzer
- Kidney Health Research Collaborative, Department of Medicine, San Francisco Veterans Affairs Medical Center and University of California, San Francisco, California, USA
| | - Michelle M Estrella
- Kidney Health Research Collaborative, Department of Medicine, San Francisco Veterans Affairs Medical Center and University of California, San Francisco, California, USA
| | - Michael G Shlipak
- Kidney Health Research Collaborative, Department of Medicine, San Francisco Veterans Affairs Medical Center and University of California, San Francisco, California, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
| | - Derek K Ng
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Frank J Palella
- Division of Infectious Disease, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Mallory D Witt
- Department of Medicine, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California, USA
| | - Ken Ho
- Division of Infectious Diseases, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Michael R Bennett
- Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Chirag R Parikh
- Division of Nephrology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Joachim H Ix
- Division of Nephrology-Hypertension, University of California, San Diego, California, USA
- Nephrology Section, Department of Medicine, Veterans Affairs San Diego Healthcare System, San Diego, California, USA
| | - Vasantha Jotwani
- Kidney Health Research Collaborative, Department of Medicine, San Francisco Veterans Affairs Medical Center and University of California, San Francisco, California, USA,
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17
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Li X, Brown TT, Ho KS, Witt MD, Phair J, Jacobson LP. Recent Trends and Effectiveness of Antiretroviral Regimens Among Men Who Have Sex With Men Living With HIV in the United States: The Multicenter AIDS Cohort Study (MACS) 2008-2017. Open Forum Infect Dis 2019; 6:ofz333. [PMID: 31660409 PMCID: PMC6798255 DOI: 10.1093/ofid/ofz333] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 07/15/2019] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE We evaluated trends and population effectiveness (tolerability, HIV suppression) of current combination antiretroviral therapy (cART) regimens mindful of treatment guidelines. METHOD Trend analyses included 18 017 person-visits (1457 men) on cART during 2008-2017 in the Multicenter AIDS Cohort Study. Effectiveness analyses of current regimens used 3598 person-visit-pairs (745 men) on cART in 2014-2017. Inverse-probability-of-treatment-and-censoring weighted Poisson regression with robust variances was used to evaluate the association between regimens and switching, adherence and HIV RNA <20 copies/mL. RESULTS Integrase strand transfer inhibitor (INSTI)-based regimen usage has increased since 2008. Almost 90% of cART initiators started with INSTI-cART in 2016-2017; cART adherence was stable around 90% and 83%-85% suppressed virus (<20 cp/mL). Commonly used regimens in 2014-2017 contained disoproxil fumarate/emtricitabine (TDF/FTC) backbone with efavirenz (EFV, n = 1161 person-visits), elvitegravir/cobicistat (EVG/c, n = 551), rilpivirine (RPV, n = 492), darunavir/ritonavir (DRV/r, n = 351), or atazanavir (ATV)/r (n = 333). Others were dolutegravir/abacavir/lamivudine (DTG/ABC/3TC, n = 401) and EVG/c/tenofovir alafenamide/FTC (EVG/c/TAF/FTC, n = 309). Compared to EFV/TDF/FTC users, ATV/r+TDF/FTC users switched more (rate ratio [RR] = 1.80, 95% confidence interval (CI), 1.17-2.76), while those on DTG/ABC/3TC (RR [95% CI] = 0.16 [0.08-0.31]) or EVG/c/TAF/FTC (RR [95% CI] = 0.12 [0.06-0.27]) switched less. The rate of suppressed HIV RNA was 15% (95% CI, 2%-26%) lower among younger EVG/c/TDF/FTC users and 18% (95% CI, 3%-34%) higher in older DRV/r+TDF/FTC users; adherence did not differ by regimen. CONCLUSIONS Consistent with guidelines, recent cART initiators started with INSTI-cART, which was associated with less switching early after initiation. Factors beyond those studied here, such as need for salvage therapy, unique personal characteristics, drug interactions, and cost may influence treatment decisions.
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Affiliation(s)
- Xiuhong Li
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Todd T Brown
- Division of Endocrinology, Diabetes, and Metabolism, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Kenneth S Ho
- Department of Medicine, Division of Infectious Diseases, University of Pittsburgh School of Medicine, Pennsylvania
| | - Mallory D Witt
- Division of HIV Medicine, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California
| | - John Phair
- Department of Medicine, Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Lisa P Jacobson
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Hutchins E, Wang R, Rahmani S, Nakanishi R, Haberlen S, Kingsley L, Witt MD, Palella FJ, Jacobson L, Budoff MJ, Post WS. HIV Infection Is Associated with Greater Left Ventricular Mass in the Multicenter AIDS Cohort Study. AIDS Res Hum Retroviruses 2019; 35:755-761. [PMID: 31044604 PMCID: PMC6688109 DOI: 10.1089/aid.2019.0014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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] Open
Abstract
HIV infection has been associated with diastolic heart failure and atrial fibrillation. The purpose of this study is to determine whether HIV infection is associated with differences in left ventricular mass (LVM), left ventricular end-diastolic volume (LVEDV), and left atrial volume (LAV) indexed to body surface area (left ventricular mass index, left ventricular end-diastolic volume index [LVEDVI], and left atrial volume index [LAVI], respectively). Cross-sectional study of 721 men [425 HIV-infected (HIV+), 296 HIV-uninfected (HIV-) enrolled in the cardiovascular substudy of the Multicenter AIDS Cohort Study (MACS). Participants underwent cardiac computed tomography imaging. A blinded reader measured LVM, LVEDV, and LAV. We used multivariable linear regression models to evaluate whether LVEDVI, left ventricular mass index (LVMI), and LAVI differed by HIV serostatus, adjusting for demographics and cardiovascular disease risk factors. LVMI was significantly greater in HIV+ compared with HIV- men, with adjusted difference of 2.65 g/m2 (95% confidence interval 0.53-4.77, p < .001). Left ventricular end-diastolic index and LAVI did not differ significantly between the two groups. HIV-related factors (nadir CD4 count, clinical AIDS diagnosis, cumulative antiretroviral therapy use, and cumulative protease inhibitor use) were not significantly associated with LVMI, LVEDVI, or LAVI. LVM was significantly higher in HIV+ than HIV- men, which may contribute to the observed increased risk for diastolic heart failure associated with HIV infection. Although HIV infection has been associated with an increased risk for atrial fibrillation, we did not find any difference in LAV by HIV serostatus.
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Affiliation(s)
| | - Ruibin Wang
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Sina Rahmani
- Los Angeles Biomedical Research Institute, Torrance, California
| | - Rine Nakanishi
- Los Angeles Biomedical Research Institute, Torrance, California
| | - Sabina Haberlen
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Lawrence Kingsley
- Department of Infectious Diseases and Microbiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania
| | - Mallory D. Witt
- Los Angeles Biomedical Research Institute, Torrance, California
| | - Frank Joseph Palella
- Feinberg School of Medicine, Division of Infectious Diseases, Northwestern University, Chicago, Illinois
| | - Lisa Jacobson
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | | | - Wendy S. Post
- Division of Cardiology, Johns Hopkins School of Medicine, Baltimore, Maryland
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Whelton SP, Deal JA, Zikusoka M, Jacobson LP, Sarkar S, Palella FJ, Kingsley L, Budoff M, Witt MD, Brown TT, Post WS. Associations between lipids and subclinical coronary atherosclerosis. AIDS 2019; 33:1053-1061. [PMID: 30946159 PMCID: PMC6457132 DOI: 10.1097/qad.0000000000002151] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Whether HIV modifies the relationship of serum lipids with coronary atherosclerosis and coronary plaque subtypes is uncertain. We examined the associations between traditional lipids and coronary atherosclerosis among HIV-infected (HIV+) and HIV-uninfected (HIV-) men. DESIGN The Multicenter AIDS Cohort Study is an observational cohort with a total of 429 HIV+ and 303 HIV- men who had non-contrast cardiac computed tomography performed to measure coronary artery calcium and coronary computed tomography angiography to measure coronary stenosis, coronary plaque presence, and composition. METHODS We used multivariable adjusted prevalence ratios to examine the relationship between the SD difference in each lipid parameter and coronary atherosclerosis. RESULTS Total cholesterol (TC)/HDL-cholesterol had the strongest associations with coronary atherosclerosis regardless of HIV status. Overall, lipid parameters were most strongly associated with the presence of mixed plaque, stenosis more than 50%, and coronary artery calcium for both HIV+ and HIV- men. HIV+ men had similar, but weaker associations, between lipid parameters and coronary atherosclerosis compared with HIV- men. The strongest association was between the TC/HDL-cholesterol and stenosis more than 50% for both HIV+ [prevalence ratios 1.25 per SD (95% confidence interval 1.07-1.43)] and HIV- men [prevalence ratios 1.46 per SD (95% confidence interval 1.08-1.85)]. CONCLUSION The associations between lipids and coronary atherosclerosis tended to be weaker for HIV+ compared with HIV- men, although TC/HDL had the strongest association for both HIV+ and HIV- men. A weaker association between lipid levels and coronary atherosclerosis for HIV+ men may contribute to the decreased discrimination of cardiovascular disease risk observed in HIV+ individuals.
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Affiliation(s)
- Seamus P. Whelton
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine. 600 North Wolfe Street, Baltimore, MD 21287
| | - Jennifer A. Deal
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health 2024 E. Monument St, Suite 2-700, Baltimore, MD 21205
| | - Michelle Zikusoka
- MedStar Health System, 5601 Lock Raven Boulevard, Baltimore, MD 21239
| | - Lisa P. Jacobson
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health 2024 E. Monument St, Suite 2-700, Baltimore, MD 21205
| | - Sudipa Sarkar
- Division of Endocrinology, Department of Medicine, Johns Hopkins University School of Medicine. 600 North Wolfe Street, Baltimore, MD 21287
| | - Frank J. Palella
- Division of Infectious Diseases, Feinberg School of Medicine of Northwestern University. 645 N. Michigan Ave, Chicago, IL 60611
| | - Lawrence Kingsley
- Department of Infectious Diseases and Microbiology, University of Pittsburgh Graduate School of Public Health. 130 De Soto Street, Pittsburgh, PA 15261
| | - Matthew Budoff
- Division of HIV Medicine, Los Angeles Biomedical Research Institute at Harbor UCLA Medical Center. 1124 West Carson St. Torrance, CA 90502
| | - Mallory D. Witt
- Division of HIV Medicine, Los Angeles Biomedical Research Institute at Harbor UCLA Medical Center. 1124 West Carson St. Torrance, CA 90502
| | - Todd T. Brown
- Division of Endocrinology, Department of Medicine, Johns Hopkins University School of Medicine. 600 North Wolfe Street, Baltimore, MD 21287
| | - Wendy S. Post
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine. 600 North Wolfe Street, Baltimore, MD 21287
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health 2024 E. Monument St, Suite 2-700, Baltimore, MD 21205
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Subramanya V, McKay HS, Brusca RM, Palella FJ, Kingsley LA, Witt MD, Hodis HN, Tracy RP, Post WS, Haberlen SA. Inflammatory biomarkers and subclinical carotid atherosclerosis in HIV-infected and HIV-uninfected men in the Multicenter AIDS Cohort Study. PLoS One 2019; 14:e0214735. [PMID: 30946765 PMCID: PMC6448851 DOI: 10.1371/journal.pone.0214735] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [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: 10/24/2018] [Accepted: 03/19/2019] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND HIV-infected persons have an increased risk of atherosclerosis relative to uninfected individuals. Inflammatory processes may contribute to this risk. We evaluated the associations of 10 biomarkers of systemic inflammation (CRP, IL-6, sTNF-αR1 and 2), monocyte activation (CCL2, sCD163, sCD14), coagulation (fibrinogen, D-dimer), and endothelial dysfunction (ICAM-1) with subclinical carotid atherosclerosis among participants in the Multicenter AIDS Cohort Study (MACS). METHODS Carotid plaque and intima media thickness (IMT) in the common carotid (CCA-IMT) and bifurcation region were assessed by B mode ultrasound among 452 HIV-infected and 276 HIV-uninfected men from 2010-2013. Associations between levels of each biomarker and presence of focal plaque and IMT were assessed by logistic and linear regression models, adjusting for demographics, risk behaviors, traditional cardiovascular disease (CVD) risk factors, and HIV disease characteristics. RESULTS Compared to HIV-uninfected men, HIV-infected men had significantly higher levels of 8 of the 10 biomarkers. Overall, men with sCD163, CCL2, IL-6, and CRP levels in the highest quintile had approximately 2 times the odds of carotid plaque relative to those with levels in the lowest quintile, independent of demographic and CVD risk factors. Fibrinogen levels were positively associated with CCA-IMT while ICAM-1, CCL2, and sTNF-αR1 levels were positively associated with bifurcation-IMT. Among HIV-uninfected men, higher levels of sTNF-αR2 were positively associated with CCA-IMT, fibrinogen with bifurcation-IMT and carotid plaque, and ICAM-1 with carotid plaque. CONCLUSION In addition to greater levels of systemic inflammation, heightened monocyte activation (sCD163, CCL2) may contribute to the burden of atherosclerosis among HIV-infected persons.
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Affiliation(s)
- Vinita Subramanya
- Division of Cardiology, Johns Hopkins School of Medicine, Baltimore, Maryland, United States of America
| | - Heather S. McKay
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Rebeccah M. Brusca
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, United States of America
| | - Frank J. Palella
- Division of Infectious Diseases, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, United States of America
| | - Lawrence A. Kingsley
- Department of Epidemiology, University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania, United States of America
| | - Mallory D. Witt
- Department of Medicine, Los Angeles Biomedical Research Institute at Harbor-University of California Los Angeles, Torrance, California, United States of America
| | - Howard N. Hodis
- Atherosclerosis Research Unit, Keck School of Medicine at University of Southern California, Los Angeles, California, United States of America
| | - Russell P. Tracy
- Departments of Pathology & Laboratory Medicine, and Biochemistry, University of Vermont, Larner College of Medicine, Colchester, Vermont, United States of America
| | - Wendy S. Post
- Division of Cardiology, Johns Hopkins School of Medicine, Baltimore, Maryland, United States of America
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Sabina A. Haberlen
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- * E-mail:
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21
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Zhang L, Brown TT, Margolick JB, Witt MD, Palella FJ, Kingsley LA, Hoofnagle AN, Tin A, Jacobson LP, Abraham AG. Vitamin D Metabolites in Aging HIV-Infected Men: Does Inflammation Play a Role? AIDS Res Hum Retroviruses 2018; 34:1067-1074. [PMID: 30251872 PMCID: PMC6306657 DOI: 10.1089/aid.2018.0101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
The inflammatory context of HIV infection has been posited to contribute to the higher comorbidity risk noted in HIV-infected populations. One possible pathway may involve 1,25-dihydroxyvitamin D [1,25(OH)2D], which plays a wide biologic role in many tissues. We sought to investigate whether inflammation was associated with vitamin D metabolites in a cohort of HIV-infected (HIV+) men receiving treatment and HIV-uninfected (HIV-) men. Vitamin D metabolites, including 25-hydroxyvitamin D [25(OH)D] and 1,25(OH)2D, were measured along with 24 inflammatory markers among Multicenter AIDS Cohort Study participants. Exploratory factor analysis reduced inflammatory marker data to a smaller set of inflammatory processes (IPs). Multivariate linear regression was used to evaluate associations between vitamin D metabolites and IPs. There were 466 HIV+ and 100 HIV- men, who contributed 658 stored samples from 1998 to 2008. We found three IPs with IP 1 characterized by sTNF-R2, sIL-2Rα, sCD27, BAFF, sgp130, sCD14, CXCL10 (IP-10), and sIL-6R. While none of the three IPs was associated with 25(OH)D levels in either HIV+ or HIV-, higher levels of IP 1 were significantly associated with the reduced levels of 1,25(OH)2D in HIV+, and a similar although nonsignificant trend was seen in HIV-. The association between 1,25(OH)2D and inflammation found among HIV-infected men suggests a possible mechanism whereby inflammation leads to the increased comorbidity risk noted among HIV-infected individuals.
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Affiliation(s)
- Long Zhang
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Todd T. Brown
- Division of Endocrinology, Diabetes and Metabolism, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Joseph B. Margolick
- Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Mallory D. Witt
- Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California
| | - Frank J. Palella
- Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Lawrence A. Kingsley
- Department of Infectious Diseases and Microbiology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Andrew N. Hoofnagle
- Departments of Laboratory Medicine and Medicine, University of Washington, Seattle, Washington
| | - Adrienne Tin
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Lisa P. Jacobson
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Alison G. Abraham
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of Ophthalmology, Johns Hopkins School of Medicine, Baltimore, Maryland
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22
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Hanna DB, Moon JY, Haberlen SA, French AL, Palella FJ, Gange SJ, Witt MD, Kassaye S, Lazar JM, Tien PC, Feinstein MJ, Kingsley LA, Post WS, Kaplan RC, Hodis HN, Anastos K. Carotid artery atherosclerosis is associated with mortality in HIV-positive women and men. AIDS 2018; 32:2393-2403. [PMID: 30102657 PMCID: PMC6170701 DOI: 10.1097/qad.0000000000001972] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Among people with HIV, there are few long-term studies of noninvasive ultrasound-based measurements of the carotid artery predicting major health events. We hypothesized that such measurements are associated with 10-year mortality in the Women's Interagency HIV Study (WIHS) and Multicenter AIDS Cohort Study (MACS), and that associations differ by HIV serostatus. DESIGN Nested cohort study. METHODS Participants without coronary heart disease underwent B-mode carotid artery ultrasound, with measurement of common carotid artery intima-media thickness (IMT); carotid artery plaque (focal IMT > 1.5 mm) at six locations; and Young's modulus of elasticity, a measure of arterial stiffness. We examined all-cause mortality using Cox models, controlling for demographic, behavioral, cardiometabolic, and HIV-related factors. RESULTS Among 1722 women (median age 40 years, 90% nonwhite, 71% HIV-positive) and 1304 men (median age 50, 39% nonwhite, 62% HIV-positive), 11% died during follow-up. Mortality was higher among HIV-positive women [19.9 deaths/1000 person-years, 95% confidence interval (CI) 14.7-28.8] than HIV-positive men (15.1/1000, 95% CI 8.3-26.8). In adjusted analyses, plaque was associated with mortality (hazard ratio 1.44, 95% CI 1.10-1.88) regardless of HIV serostatus, and varied by sex (among women, hazard ratio 1.06, 95% CI 0.74-1.52; among men; hazard ratio 2.19, 95% CI 1.41-3.43). The association of plaque with mortality was more pronounced among HIV-negative (hazard ratio 3.87, 95% 1.95-7.66) than HIV-positive participants (hazard ratio 1.35, 95% CI 1.00-1.84). Arterial stiffness was also associated with mortality (hazard ratio 1.43 for highest versus lowest quartile, 95% CI 1.02-2.01). Greater common carotid artery-IMT was not associated with mortality. CONCLUSION Carotid artery plaque was predictive of mortality, with differences observed by sex and HIV serostatus.
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Affiliation(s)
- David B Hanna
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York
| | - Jee-Young Moon
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York
| | - Sabina A Haberlen
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Audrey L French
- Department of Infectious Diseases, John H. Stroger, Jr. Hospital of Cook County
| | - Frank J Palella
- Department of Medicine, Northwestern University Medical Center, Chicago, Illinois
| | - Stephen J Gange
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Mallory D Witt
- Department of Medicine, Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, California
| | - Seble Kassaye
- Department of Medicine, Georgetown University Medical Center, Washington, District of Columbia
| | - Jason M Lazar
- Department of Medicine, SUNY-Downstate Medical Center, Brooklyn, New York
| | - Phyllis C Tien
- Department of Medicine
- Department of Veterans Affairs, University of California, San Francisco, San Francisco, California
| | - Matthew J Feinstein
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Lawrence A Kingsley
- Department of Epidemiology
- Department of Infectious Diseases and Microbiology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Wendy S Post
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Robert C Kaplan
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Howard N Hodis
- Atherosclerosis Research Unit, University of Southern California, Los Angeles, California
| | - Kathryn Anastos
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York
- Department of Medicine, Montefiore Medical Center, Bronx, New York, USA
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23
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Ascher SB, Scherzer R, Estrella MM, Zhang WR, Muiru AN, Jotwani V, Grunfeld C, Parikh CR, Gustafson D, Young M, Sharma A, Cohen MH, Ng DK, Palella FJ, Witt MD, Ho K, Shlipak MG. Association of Urinary Biomarkers of Kidney Injury with Estimated GFR Decline in HIV-Infected Individuals following Tenofovir Disoproxil Fumarate Initiation. Clin J Am Soc Nephrol 2018; 13:1321-1329. [PMID: 30154221 PMCID: PMC6140559 DOI: 10.2215/cjn.01700218] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [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] [Received: 02/06/2018] [Accepted: 06/22/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND OBJECTIVES Tenofovir disoproxil fumarate (tenofovir) is associated with elevated concentrations of biomarkers of kidney damage and dysfunction in individuals with HIV. The relationship of these kidney biomarkers with longitudinal kidney function decline is unknown. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS We evaluated associations of 14 urinary biomarkers of kidney injury with changes in eGFR among 198 men and women with HIV who initiated tenofovir between 2009 and 2015 in the Multicenter AIDS Cohort Study and Women's Interagency HIV Study. Urinary biomarkers included albumin-to-creatinine ratio, α-1-microglobulin, β-2-microglobulin, cystatin C, kidney injury molecule-1 (KIM-1), IL-18, neutrophil gelatinase-associated lipocalin (NGAL), clusterin, osteopontin, uromodulin, monocyte chemoattractant protein-1, EGF, trefoil factor 3, and chitinase 3-like protein 1. We used multivariable linear mixed-effect models controlling for demographics, traditional kidney disease risk factors, and HIV-related risk factors to evaluate associations of baseline biomarkers with first-year changes in eGFR, and associations of year 1 and first-year change in biomarkers with changes in eGFR from year 1 to year 3. We used the least absolute shrinkage and selection operator method to identify a parsimonious set of biomarkers jointly associated with changes in eGFR. RESULTS Median eGFR before tenofovir initiation was 103 (interquartile range, 88-116) ml/min per 1.73 m2. During the first year of tenofovir use, eGFR decreased on average by 9.2 (95% confidence interval, 6.5 to 11.9) ml/min per 1.73 m2 and was stable afterward (decrease of 0.62; 95% confidence interval, -0.85 to 2.1 ml/min per 1.73 m2 per year). After multivariable adjustment, higher baseline β-2-microglobulin, KIM-1, and clusterin were associated with larger first-year eGFR declines, whereas higher baseline uromodulin was associated with a smaller eGFR decline. First-year increase in urinary cystatin C and higher year 1 IL-18 were associated with larger annual eGFR declines from year 1 to year 3. The parsimonious models identified higher pre-tenofovir clusterin and KIM-1, lower pre-tenofovir uromodulin, and higher year 1 IL-18 as jointly associated with larger eGFR declines. CONCLUSIONS Urinary biomarkers of kidney injury measured before and after tenofovir initiation are associated with subsequent changes in eGFR in individuals with HIV. PODCAST This article contains a podcast at https://www.asn-online.org/media/podcast/CJASN/2018_08_28_CJASNPodcast_18_9_S.mp3.
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Affiliation(s)
- Simon B. Ascher
- Department of Medicine, Kidney Health Research Collaborative, San Francisco Veterans Affairs Medical Center, San Francisco, California
- Department of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Rebecca Scherzer
- Department of Medicine, Kidney Health Research Collaborative, San Francisco Veterans Affairs Medical Center, San Francisco, California
| | - Michelle M. Estrella
- Department of Medicine, Kidney Health Research Collaborative, San Francisco Veterans Affairs Medical Center, San Francisco, California
| | - William R. Zhang
- Department of Medicine, Kidney Health Research Collaborative, San Francisco Veterans Affairs Medical Center, San Francisco, California
| | - Anthony N. Muiru
- Department of Medicine, Kidney Health Research Collaborative, San Francisco Veterans Affairs Medical Center, San Francisco, California
| | - Vasantha Jotwani
- Department of Medicine, Kidney Health Research Collaborative, San Francisco Veterans Affairs Medical Center, San Francisco, California
| | - Carl Grunfeld
- Department of Medicine, Kidney Health Research Collaborative, San Francisco Veterans Affairs Medical Center, San Francisco, California
- Department Epidemiology, and Biostatistics, University of California, San Francisco, San Francisco, California
| | - Chirag R. Parikh
- Section of Nephrology, Department of Medicine, Yale University, New Haven, Connecticut
| | - Deborah Gustafson
- Department of Neurology, The State University of New York (SUNY) Downstate Medical Center, Brooklyn, New York
| | - Mary Young
- Division of Infectious Diseases, Department of Medicine, Georgetown University Medical Center, Washington, DC
| | - Anjali Sharma
- Department of Medicine, Albert Einstein College of Medicine, Bronx, New York
| | - Mardge H. Cohen
- Department of Medicine, Stroger Hospital and Rush University, Chicago, Illinois
| | - Derek K. Ng
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Frank J. Palella
- Division of Infectious Diseases, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Mallory D. Witt
- Department of Medicine, Los Angeles Biomedical Research Institute at Harbor–University of California Los Angeles Medical Center, Torrance, California; and
| | - Ken Ho
- Division of Infectious Diseases, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Michael G. Shlipak
- Department of Medicine, Kidney Health Research Collaborative, San Francisco Veterans Affairs Medical Center, San Francisco, California
- Department Epidemiology, and Biostatistics, University of California, San Francisco, San Francisco, California
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Tibuakuu M, Zhao D, Saxena A, Brown TT, Jacobson LP, Palella FJ, Witt MD, Koletar SL, Margolick JB, Guallar E, Korada SKC, Budoff MJ, Post WS, Michos ED. Low thigh muscle mass is associated with coronary artery stenosis among HIV-infected and HIV-uninfected men: The Multicenter AIDS Cohort Study (MACS). J Cardiovasc Comput Tomogr 2018; 12:131-138. [PMID: 29396194 DOI: 10.1016/j.jcct.2018.01.007] [Citation(s) in RCA: 4] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 01/16/2018] [Accepted: 01/22/2018] [Indexed: 01/06/2023]
Abstract
BACKGROUND HIV-infected individuals are at increased risk for both sarcopenia and cardiovascular disease. Whether an association between low muscle mass and subclinical coronary artery disease (CAD) exists, and if it is modified by HIV serostatus, are unknown. METHODS We performed cross-sectional analysis of 513 male MACS participants (72% HIV-infected) who underwent mid-thigh computed tomography (CT) and non-contrast cardiac CT for coronary artery calcium (CAC) during 2010-2013. Of these, 379 also underwent coronary CT angiography for non-calcified coronary plaque (NCP) and obstructive coronary stenosis ≥50%. Multivariable-adjusted Poisson regression was used to estimate prevalence risk ratios of associations between low muscle mass (<20th percentile of the HIV-uninfected individuals in the sample) and CAC, NCP and obstructive stenosis. RESULTS The prevalence of low thigh muscle mass was similar by HIV serostatus (20%). There was no association of low muscle mass with CAC or NCP. However, low thigh muscle mass was significantly associated with a 2.5-fold higher prevalence of obstructive coronary stenosis, after adjustment for demographics and traditional CAD risk factors [PR 2.46 (95% CI 1.51, 4.01)]. This association remained significant after adjustment for adiposity, inflammation, and physical activity. There was no significant interaction by HIV serostatus (p-interaction = 0.90). CONCLUSIONS In this exploratory analysis, low thigh muscle mass was significantly associated with subclinical obstructive coronary stenosis. Additional studies involving larger sample sizes and prospective analyses are needed to confirm the potential utility of measuring mid-thigh muscle mass for identifying individuals at increased risk for obstructive CAD who might benefit from more aggressive risk factor management.
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Affiliation(s)
- Martin Tibuakuu
- Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Medicine, St. Luke's Hospital, Chesterfield, MO, USA
| | - Di Zhao
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Ankita Saxena
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Todd T Brown
- Division of Endocrinology, Diabetes, and Metabolism, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Lisa P Jacobson
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Frank J Palella
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Mallory D Witt
- Department of Medicine, Harbor-UCLA Medical Center, Torrance, CA, USA; Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, USA
| | - Susan L Koletar
- Division of Infectious Diseases, Ohio State University, Columbus, OH, USA
| | - Joseph B Margolick
- Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Eliseo Guallar
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Matthew J Budoff
- Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, USA
| | - Wendy S Post
- Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Erin D Michos
- Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
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Tin A, Zhang L, Estrella MM, Hoofnagle A, Rebholz CM, Brown TT, Palella FJ, Witt MD, Jacobson LP, Kingsley LA, Abraham AG. Vitamin D Status and Kidney Function Decline in HIV-Infected Men: A Longitudinal Study in the Multicenter AIDS Cohort Study. AIDS Res Hum Retroviruses 2017; 33:1140-1148. [PMID: 28756682 DOI: 10.1089/aid.2017.0009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 12/20/2022] Open
Abstract
Vitamin D may play an important role in a range of disease processes. In the general population, lower vitamin D levels have been associated with kidney dysfunction. HIV-infected populations have a higher risk of chronic kidney disease. Few studies have examined the link between lower vitamin D levels and kidney function decline among HIV-infected persons. We investigated the associations of serum 25-hydroxyvitamin D [25(OH)D] and 1,25-dihydroxyvitamin D [1,25(OH)2D] with kidney function decline in a cohort of HIV-infected white and black men under highly active antiretroviral therapy treatment in the vitamin D ancillary study of the Multicenter AIDS Cohort Study. The associations of 25(OH)D and 1,25(OH)2D with annual change in estimated glomerular filtration rate (eGFR) were evaluated using linear mixed effects models. This study included 187 whites and 86 blacks with vitamin D measures and eGFR ≥60 ml/min/1.73 m2 at baseline. Over a median follow-up of 8.0 years, lower 25(OH)D levels were significantly associated with faster eGFR decline in whites (adjusted annual change in eGFR, tertile 1: -2.06 ml/min/1.73 m2 vs. tertile 3: -1.23 ml/min/1.73 m2, p trend .03), while no significant association was detected in blacks. Lower 1,25(OH)2D was associated with faster kidney function decline in both whites and blacks, although the estimates were not statistically significant. In conclusion, lower 25(OH)D levels were significantly associated with faster eGFR decline in a cohort of HIV-infected white men, but not in those with black ancestry. Further research is warranted to investigate the association of 25(OH)D and 1,25(OH)2D with kidney function decline in larger and ethnically diverse populations.
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Affiliation(s)
- Adrienne Tin
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Long Zhang
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Michelle M. Estrella
- Kidney Health Research Collaborative, University of California, San Francisco, California
| | - Andy Hoofnagle
- Department of Laboratory Medicine, University of Washington, Seattle, Washington
| | - Casey M. Rebholz
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Todd T. Brown
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Frank J. Palella
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Mallory D. Witt
- Los Angeles Biomedical Research Institute at Harbor-UCLA and David Geffen School of Medicine at University of California, Los Angeles, California
| | - Lisa P. Jacobson
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Lawrence A. Kingsley
- Department of Infectious Diseases and Microbiology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Alison G. Abraham
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Hanna DB, Lin J, Post WS, Hodis HN, Xue X, Anastos K, Cohen MH, Gange SJ, Haberlen SA, Heath SL, Lazar JM, Liu C, Mack WJ, Ofotokun I, Palella FJ, Tien PC, Witt MD, Landay AL, Kingsley LA, Tracy RP, Kaplan RC. Association of Macrophage Inflammation Biomarkers With Progression of Subclinical Carotid Artery Atherosclerosis in HIV-Infected Women and Men. J Infect Dis 2017; 215:1352-1361. [PMID: 28199691 DOI: 10.1093/infdis/jix082] [Citation(s) in RCA: 82] [Impact Index Per Article: 11.7] [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: 09/26/2016] [Accepted: 02/08/2017] [Indexed: 12/30/2022] Open
Abstract
Background Monocytes and monocyte-derived macrophages promote atherosclerosis through increased inflammation and vascular remodeling. This may be especially true in chronic human immunodeficiency virus (HIV) infection. Methods We examined 778 women (74% HIV+) in the Women's Interagency HIV Study and 503 men (65% HIV+) in the Multicenter AIDS Cohort Study who underwent repeated B-mode carotid artery ultrasound imaging in 2004-2013. We assessed baseline associations of the serum macrophage inflammation markers soluble (s)CD163, sCD14, galectin-3 (Gal-3), and Gal-3 binding protein (Gal-3BP) with carotid plaque formation (focal intima-media thickness >1.5 mm) over 7 years. Results Marker levels were higher in HIV+ persons versus HIV- persons. Presence of focal plaque increased over time: from 8% to 15% in women, and 24% to 34% in men. After adjustment for demographic, behavioral, and cardiometabolic factors, and CRP and interleukin-6, each standard deviation increase in sCD14 was associated with increased plaque formation (risk ratio [RR] 1.24, 95% confidence interval [CI] 1.07-1.43). This pattern was consistentby sex. sCD163 was associated with plaque formation in virally suppressed HIV+ men (RR 1.52, 95% CI 1.04-2.22); Gal-3BP and Gal-3 were not associated with increased plaque. Conclusions sCD14 and sCD163 may play important roles in atherogenesis among HIV+ persons.
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Affiliation(s)
- David B Hanna
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York
| | - Juan Lin
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York
| | - Wendy S Post
- Department of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Howard N Hodis
- Department of Medicine, University of Southern California, Los Angeles
| | - Xiaonan Xue
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York
| | - Kathryn Anastos
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York
| | - Mardge H Cohen
- Department of Medicine, John H. Stroger, Jr Hospital of Cook County, Chicago, Illinois
| | - Stephen J Gange
- Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland
| | - Sabina A Haberlen
- Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland
| | - Sonya L Heath
- Department of Medicine, University of Alabama at Birmingham
| | - Jason M Lazar
- Department of Medicine, SUNY-Downstate Medical Center, Brooklyn, New York
| | - Chenglong Liu
- Department of Medicine, Georgetown University Medical Center, Washington, DC
| | - Wendy J Mack
- Department of Preventive Medicine, University of Southern California, Los Angeles
| | - Igho Ofotokun
- Department of Medicine, Emory University and Grady Healthcare System, Atlanta, Georgia
| | - Frank J Palella
- Department of Medicine, Northwestern University Medical Center, Chicago, Illinois
| | - Phyllis C Tien
- Department of Medicine, University of California-San Francisco and the Department of Veterans Affairs
| | - Mallory D Witt
- Department of Medicine, Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, California
| | - Alan L Landay
- Department of Immunology and Microbiology, Rush University Medical Center, Chicago, Illinois
| | - Lawrence A Kingsley
- Departments of Epidemiology and Infectious Diseases and Microbiology, University of Pittsburgh, Pennsylvania; and
| | - Russell P Tracy
- Department of Pathology and Laboratory Medicine, University of Vermont, Colchester
| | - Robert C Kaplan
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York
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27
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Price JC, Wang R, Seaberg EC, Budoff MJ, Kingsley LA, Palella FJ, Witt MD, Post WS, Thio CL. The Association of Inflammatory Markers With Nonalcoholic Fatty Liver Disease Differs by Human Immunodeficiency Virus Serostatus. Open Forum Infect Dis 2017; 4:ofx153. [PMID: 28929125 PMCID: PMC5601080 DOI: 10.1093/ofid/ofx153] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [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] [Received: 05/30/2017] [Accepted: 07/15/2017] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND We aimed to determine the relationship of circulating adipokines and inflammatory biomarkers with fatty liver among men in the Multicenter AIDS Cohort Study. METHODS Noncontrast computed tomography was used to assess fatty liver and measure abdominal visceral adipose tissue (VAT) area in 526 participants without history of cardiovascular disease, heavy alcohol use, or viral hepatitis infection. Multivariable logistic regression was used to assess associations of circulating biomarker levels with fatty liver. RESULTS Three hundred twenty-nine human immunodeficiency virus (HIV)-infected men had higher levels of several inflammatory biomarkers compared with 197 HIV-uninfected men. Among HIV-uninfected men, increased adiponectin was associated with lower odds of fatty liver (odds ratio [OR] = 0.51 per doubling, P = .02), whereas higher odds of fatty liver was observed with increased levels of the proinflammatory markers intercellular adhesion molecule (ICAM)-1 (OR = 5.30, P = .004), C-reactive protein (OR = 1.66, P = .002), interleukin (IL)-6 (OR = 1.67, P = .03), and tumor necrosis factor α receptor 2 (OR = 6.55, P = .003). Among HIV-infected men, ICAM-1 was the only proinflammatory marker associated with greater odds of fatty liver (OR = 2.67, P = .02), whereas higher adiponectin (OR = 0.57, P = .003), and osteoprotegerin levels (OR = 0.48, P = .03) were associated with lower odds. These associations were all independent of VAT. CONCLUSIONS Fatty liver is associated with a heightened inflammatory state independent of visceral adiposity in HIV-uninfected men but not in HIV-infected men. However, a heightened anti-inflammatory state may protect against fatty liver regardless of HIV serostatus.
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Affiliation(s)
- Jennifer C Price
- Division of Gastroenterology and Hepatology, Department of Medicine, University of California San Francisco
| | - Ruibin Wang
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Divisions of
| | - Eric C Seaberg
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Divisions of
| | | | - Lawrence A Kingsley
- Departments of Infectious Diseases and Microbiology and Epidemiology, University of Pittsburgh Graduate School of Public Health, Pennsylvania
| | - Frank J Palella
- Division of Infectious Diseases, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Divisions of
| | - Mallory D Witt
- HIV Medicine, Department of Medicine, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California
| | | | - Chloe L Thio
- Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
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28
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Zhang L, Tin A, Brown TT, Margolick JB, Witt MD, Palella FJ, Kingsley LA, Hoofnagle AN, Jacobson LP, Abraham AG. Vitamin D Deficiency and Metabolism in HIV-Infected and HIV-Uninfected Men in the Multicenter AIDS Cohort Study. AIDS Res Hum Retroviruses 2017; 33:261-270. [PMID: 27700140 PMCID: PMC5333563 DOI: 10.1089/aid.2016.0144] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [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: 01/02/2023] Open
Abstract
We evaluated associations of serum 25-hydroxyvitamin D (25[OH]D) and 1,25-dihydroxyvitamin D (1,25[OH]2D) levels in a cohort of HIV-infected and HIV-uninfected men at risk for infection in the United States. Stored samples collected between 1999 and 2008 were tested for vitamin D metabolites between 2014 and 2015. Vitamin D deficiency was defined as a serum concentration of 25[OH]D <20 ng/ml. Multivariate models were used to assess associations of various demographic and clinical factors with vitamin D status. HIV-infected men on effective antiretroviral therapy (n = 640) and HIV-uninfected men (n = 99) had comparable levels of 25[OH]D and 1,25[OH]2D, and prevalences of vitamin D deficiency were 41% in HIV-infected and 44% in HIV-uninfected men, respectively. Self-reported black or other non-white race, obesity, and normal kidney function were significant predictors of vitamin D deficiency regardless of HIV serostatus. Lower CD4+ T cell count was associated with vitamin D deficiency in HIV-infected men, while current ritonavir use was protective. Self-reported black race was the only factor significantly associated with higher levels of 1,25[OH]2D (vs. whites; β = 4.85 pg/ml, p = .003). Levels of 1,25[OH]2D and 25[OH]D were positively correlated in HIV-infected men (β = 0.32 pg/ml, p < .001), but not in uninfected men (β = -0.09 pg/ml, p = .623; p < .05 for interaction). Vitamin D deficiency was prevalent regardless of HIV serostatus in this cohort, suggesting that HIV infection did not confer additional risk of deficiency in this cohort of well-treated HIV-infected men. However, HIV infection and race may have implications for vitamin D metabolism and 1,25[OH]2D levels.
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Affiliation(s)
- Long Zhang
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Adrienne Tin
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Todd T. Brown
- Division of Endocrinology, Diabetes and Metabolism, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Joseph B. Margolick
- Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Mallory D. Witt
- Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California
| | - Frank J. Palella
- Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Lawrence A. Kingsley
- Department of Infectious Diseases and Microbiology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Andrew N. Hoofnagle
- Department of Laboratory Medicine, University of Washington, Seattle, Washington
- Department of Medicine, University of Washington, Seattle, Washington
| | - Lisa P. Jacobson
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Alison G. Abraham
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of Ophthalmology, Johns Hopkins School of Medicine, Baltimore, Maryland
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29
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Jotwani V, Scherzer R, Estrella MM, Jacobson LP, Witt MD, Palella F, Ho K, Bennett M, Parikh CR, Ix JH, Shlipak M. Association of HIV infection with biomarkers of kidney injury and fibrosis in the Multicenter AIDS Cohort Study. Antivir Ther 2017; 22:421-429. [PMID: 28054933 PMCID: PMC5498264 DOI: 10.3851/imp3124] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2016] [Indexed: 12/20/2022]
Abstract
BACKGROUND Chronic kidney disease (CKD) is common among HIV-infected individuals but serum creatinine is insensitive for detecting kidney damage at early stages. We hypothesized that HIV infection would be associated with elevations in subclinical markers of kidney injury and fibrosis in a contemporary cohort of men. METHODS In this cross-sectional study, we measured urine levels of interleukin-18 (IL-18), kidney injury molecule-1 (KIM-1), pro-collagen type III N-terminal pro-peptide (PIIINP) and albumin-creatinine ratio (ACR) in 813 HIV-infected and 331 uninfected men enrolled in the Multicenter AIDS Cohort Study. RESULTS Median eGFR was 95 ml/min/1.73 m2 among African-Americans (n=376) and 87 ml/min/1.73 m2 among Caucasians (n=768). Among HIV-infected men, the median CD4 lymphocyte count was 572 cells/mm3 and 76% of men had undetectable HIV RNA levels. After multivariable adjustment for traditional CKD risk factors including eGFR, HIV infection was associated with 52% higher urine IL-18 (95% CI, 33%, 73%), 44% higher KIM-1 (27%, 64%), 30% higher PIIINP (15%, 47%) and 84% higher ACR (54%, 120%), with similar effect sizes among African-Americans and Caucasians (P>0.2 for tests of interaction by race). These associations remained statistically significant in analyses that excluded persons with detectable HIV RNA levels and in models that adjusted for cumulative exposure to tenofovir disoproxil fumarate. CONCLUSIONS Compared with uninfected men, HIV-infected men had more extensive glomerular and tubulointerstitial damage, as assessed by urine biomarkers. Future studies should evaluate whether combinations of biomarkers can be used to monitor stages of kidney injury and to predict CKD risk in HIV-infected individuals.
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Affiliation(s)
- Vasantha Jotwani
- Department of Medicine, San Francisco VA Medical Center, San Francisco, CA, USA
- Kidney Health Research Collaborative, San Francisco VA Medical Center and University of California, San Francisco, CA, USA
| | - Rebecca Scherzer
- Department of Medicine, San Francisco VA Medical Center, San Francisco, CA, USA
- Kidney Health Research Collaborative, San Francisco VA Medical Center and University of California, San Francisco, CA, USA
| | - Michelle M Estrella
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Lisa P Jacobson
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Mallory D Witt
- Division of HIV Medicine, Department of Medicine, Harbor-UCLA Medical Center and the Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, CA, USA
| | - Frank Palella
- Division of Infectious Diseases, Department of Medicine, Northwestern University, Chicago, IL, USA
| | - Ken Ho
- Division of Infectious Diseases, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Michael Bennett
- Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Chirag R Parikh
- Section of Nephrology, Department of Medicine, Yale University, New Haven, CT, USA
- Program of Applied Translational Research, Yale University, New Haven, CT, USA
| | - Joachim H Ix
- Division of Nephrology-Hypertension, Department of Medicine, University of California, San Diego, CA, USA
- Nephrology Section, Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
| | - Michael Shlipak
- Department of Medicine, San Francisco VA Medical Center, San Francisco, CA, USA
- Kidney Health Research Collaborative, San Francisco VA Medical Center and University of California, San Francisco, CA, USA
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30
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Thomas GP, Li X, Post WS, Jacobson LP, Witt MD, Brown TT, Kingsley L, Phair JP, Palella FJ. Associations between antiretroviral use and subclinical coronary atherosclerosis. AIDS 2016; 30:2477-2486. [PMID: 27490639 PMCID: PMC5173385 DOI: 10.1097/qad.0000000000001220] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [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: 12/21/2022]
Abstract
OBJECTIVES HIV infection is associated with increased prevalence of subclinical coronary plaque. The extent to which such plaque reflects effects of HIV infection or effects of long-term antiretroviral therapy (ART) use remains unclear and was the goal of this analysis. DESIGN AND METHODS We compared the prevalence and extent of coronary plaque and stenosis between users of specific ART drugs or drug classes using coronary computed tomography (CT) among HIV-infected men in the Multicenter AIDS Cohort Study. To account for time-dependent confounders, including cardiovascular disease risk factors and time-varying reasons for using specific treatments, we conducted fully adjusted logistic and linear models with inverse probability of treatment weighting. RESULTS There were 618 men who underwent noncontrast coronary CT; 450 also underwent coronary CT angiography. At the time of scanning, 81% had undetectable plasma HIV RNA. In fully adjusted models, cumulative use of zidovudine, abacavir, darunavir, and protease inhibitors as a drug class were inconsistently associated with specific forms of plaque presence or extent. CONCLUSION Among virally suppressed HIV-infected men with extensive ART exposure, no consistent associations between use of specific ART drugs and both subclinical coronary plaque presence and extent were apparent. Our findings support the hypothesis that, among virally suppressed persons, type of ART used is not in general a major determinant of subclinical coronary plaque risk.
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Affiliation(s)
- Guajira P. Thomas
- Division of Infectious Diseases, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Xiuhong Li
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Wendy S. Post
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Lisa P. Jacobson
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Mallory D. Witt
- Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California
| | - Todd T. Brown
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Lawrence Kingsley
- Department of Infectious Diseases and Microbiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania
| | - John P. Phair
- Division of Infectious Diseases, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Frank J. Palella
- Division of Infectious Diseases, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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Bahrami H, Budoff M, Haberlen SA, Rezaeian P, Ketlogetswe K, Tracy R, Palella F, Witt MD, McConnell MV, Kingsley L, Post WS. Inflammatory Markers Associated With Subclinical Coronary Artery Disease: The Multicenter AIDS Cohort Study. J Am Heart Assoc 2016; 5:JAHA.116.003371. [PMID: 27353609 PMCID: PMC4937277 DOI: 10.1161/jaha.116.003371] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Background Despite evidence for higher risk of coronary artery disease among HIV+ individuals, the underlying mechanisms are not well understood. We investigated associations of inflammatory markers with subclinical coronary artery disease in 923 participants of the Multicenter AIDS Cohort Study (575 HIV+ and 348 HIV− men) who underwent noncontrast computed tomography scans for coronary artery calcification, the majority (n=692) also undergoing coronary computed tomography angiography. Methods and Results Outcomes included presence and extent of coronary artery calcification, plus computed tomography angiography analysis of presence, composition, and extent of coronary plaques and severity of coronary stenosis. HIV+ men had significantly higher levels of interleukin‐6 (IL‐6), intercellular adhesion molecule‐1, C‐reactive protein, and soluble‐tumor necrosis factor‐α receptor (sTNFαR) I and II (all P<0.01) and a higher prevalence of noncalcified plaque (63% versus 54%, P=0.02) on computed tomography angiography. Among HIV+ men, for every SD increase in log‐interleukin‐6 and log intercellular adhesion molecule‐1, there was a 30% and 60% increase, respectively, in the prevalence of coronary stenosis ≥50% (all P<0.05). Similarly, sTNFαR I and II in HIV+ participants were associated with an increase in prevalence of coronary stenosis ≥70% (P<0.05). Higher levels of interleukin‐6, sTNFαR I, and sTNFαR II were also associated with greater coronary artery calcification score in HIV+ men (P<0.01). Conclusions Higher inflammatory marker levels are associated with greater prevalence of coronary stenosis in HIV+ men. Our findings underscore the need for further study to elucidate the relationships of inflammatory pathways with coronary artery disease in HIV+ individuals.
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Affiliation(s)
- Hossein Bahrami
- Division of Cardiovascular Medicine, Keck School of Medicine of University of Southern California, Los Angeles, CA Cardiovascular Institute and Division of Cardiovascular Medicine, Stanford University, Stanford, CA
| | - Matthew Budoff
- Division of Cardiology, Harbor-UCLA Medical Center, Torrance, CA
| | - Sabina A Haberlen
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Pantea Rezaeian
- Division of Cardiology, Harbor-UCLA Medical Center, Torrance, CA
| | - Kerunne Ketlogetswe
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Russell Tracy
- Departments of Pathology & Laboratory Medicine, and Biochemistry, University of Vermont College of Medicine, Colchester, VT
| | | | | | - Michael V McConnell
- Cardiovascular Institute and Division of Cardiovascular Medicine, Stanford University, Stanford, CA
| | | | - Wendy S Post
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD Division of Cardiology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD
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32
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Palella FJ, McKibben R, Post WS, Li X, Budoff M, Kingsley L, Witt MD, Jacobson LP, Brown TT. Anatomic Fat Depots and Coronary Plaque Among Human Immunodeficiency Virus-Infected and Uninfected Men in the Multicenter AIDS Cohort Study. Open Forum Infect Dis 2016; 3:ofw098. [PMID: 27419170 PMCID: PMC4943560 DOI: 10.1093/ofid/ofw098] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [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] [Received: 01/16/2016] [Accepted: 05/10/2016] [Indexed: 11/13/2022] Open
Abstract
Methods. In a cross-sectional substudy of the Multicenter AIDS Cohort Study, noncontrast cardiac computed tomography (CT) scanning for coronary artery calcium (CAC) scoring was performed on all men, and, for men with normal renal function, coronary CT angiography (CTA) was performed. Associations between fat depots (visceral adipose tissue [VAT], abdominal subcutaneous adipose tissue [aSAT], and thigh subcutaneous adipose tissue [tSAT]) with coronary plaque presence and extent were assessed with logistic and linear regression adjusted for age, race, cardiovascular disease (CVD) risk factors, body mass index (BMI), and human immunodeficiency virus (HIV) parameters. Results. Among HIV-infected men (n = 597) but not HIV-uninfected men (n = 343), having greater VAT was positively associated with noncalcified plaque presence (odds ratio [OR] = 1.04, P < .05), with a significant interaction (P < .05) by HIV serostatus. Human immunodeficiency virus-infected men had lower median aSAT and tSAT and greater median VAT among men with BMI <25 and 25–29.9 kg/m2. Among HIV-infected men, VAT was positively associated with presence of coronary plaque on CTA after adjustment for CVD risk factors (OR = 1.04, P < .05), but not after additional adjustment for BMI. There was an inverse association between aSAT and extent of total plaque among HIV-infected men, but not among HIV-uninfected men. Lower tSAT was associated with greater CAC and total plaque score extent regardless of HIV serostatus. Conclusions. The presence of greater amounts of VAT and lower SAT may contribute to increased risk for coronary artery disease among HIV-infected persons.
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Affiliation(s)
| | | | | | - Xiuhong Li
- Johns Hopkins University , Baltimore, Maryland
| | - Matthew Budoff
- Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center , Torrance, California
| | | | - Mallory D Witt
- Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center , Torrance, California
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Jotwani V, Scherzer R, Estrella MM, Jacobson LP, Witt MD, Palella FJ, Macatangay B, Bennett M, Parikh CR, Ix JH, Shlipak MG. HIV Infection, Tenofovir, and Urine α1-Microglobulin: A Cross-sectional Analysis in the Multicenter AIDS Cohort Study. Am J Kidney Dis 2016; 68:571-581. [PMID: 27287300 DOI: 10.1053/j.ajkd.2016.03.430] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [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: 11/04/2015] [Accepted: 03/29/2016] [Indexed: 12/26/2022]
Abstract
BACKGROUND Tenofovir disoproxil fumarate (TDF) can cause proximal tubular damage and chronic kidney disease in human immunodeficiency virus (HIV)-infected individuals. Urine α1-microglobulin (A1M), a low-molecular-weight protein indicative of proximal tubular dysfunction, may enable earlier detection of TDF-associated tubular toxicity. STUDY DESIGN Cross-sectional. SETTING & PARTICIPANTS 883 HIV-infected and 350 -uninfected men enrolled in the Multicenter AIDS Cohort Study. PREDICTORS HIV infection and TDF exposure. OUTCOME Urine A1M level. RESULTS Urine A1M was detectable in 737 (83%) HIV-infected and 202 (58%) -uninfected men (P<0.001). Among HIV-infected participants, 573 (65%) were current TDF users and 112 (13%) were past TDF users. After multivariable adjustment including demographics, traditional kidney disease risk factors, and estimated glomerular filtration rate, HIV infection was associated with 136% (95% CI, 104%-173%) higher urine A1M levels and 1.5-fold (95% CI, 1.3- to 1.6-fold) prevalence of detectable A1M. When participants were stratified by TDF exposure, HIV infection was associated with higher adjusted A1M levels, by 164% (95% CI, 127%-208%) among current users, 124% (95% CI, 78%-183%) among past users, and 76% (95% CI, 45%-115%) among never users. Among HIV-infected participants, each year of cumulative TDF exposure was associated with 7.6% (95% CI, 5.4%-9.9%) higher A1M levels in fully adjusted models, a 4-fold effect size relative to advancing age (1.8% [95% CI, 0.9%-2.7%] per year). Each year since TDF treatment discontinuation was associated with 4.9% (95% CI, -9.4%--0.2%) lower A1M levels among past users. LIMITATIONS Results may not be generalizable to women. CONCLUSIONS HIV-infected men had higher urine A1M levels compared with HIV-uninfected men. Among HIV-infected men, cumulative TDF exposure was associated with incrementally higher A1M levels, whereas time since TDF treatment discontinuation was associated with progressively lower A1M levels. Urine A1M appears to be a promising biomarker for detecting and monitoring TDF-associated tubular toxicity.
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Affiliation(s)
- Vasantha Jotwani
- Department of Medicine, San Francisco VA Medical Center, San Francisco, CA; Department of Epidemiology and Biostatistics, University of California, San Francisco, CA.
| | - Rebecca Scherzer
- Department of Medicine, San Francisco VA Medical Center, San Francisco, CA; Department of Epidemiology and Biostatistics, University of California, San Francisco, CA
| | | | - Lisa P Jacobson
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Mallory D Witt
- Division of HIV Medicine, Department of Medicine, Harbor-UCLA Medical Center and the Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, CA
| | - Frank J Palella
- Division of Infectious Diseases, Department of Medicine, Northwestern University, Chicago, IL
| | - Bernard Macatangay
- Division of Infectious Diseases, Department of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Michael Bennett
- Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Chirag R Parikh
- Section of Nephrology, Department of Medicine, Yale University, New Haven, CT; Program of Applied Translational Research, Yale University, New Haven, CT
| | - Joachim H Ix
- Division of Nephrology-Hypertension, Department of Medicine, University of California, San Diego, CA; Nephrology Section, Veterans Affairs San Diego Healthcare System, San Diego, CA
| | - Michael G Shlipak
- Department of Medicine, San Francisco VA Medical Center, San Francisco, CA; Kidney Health Research Collaborative, San Francisco VA Medical Center and University of California, San Francisco, CA
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Rezaeian P, Miller PE, Haberlen SA, Razipour A, Bahrami H, Castillo R, Witt MD, Kingsley L, Palella FJ, Nakanishi R, Matsumoto S, Alani A, Jacobson LP, Post WS, Budoff MJ. Extra-coronary calcification (aortic valve calcification, mitral annular calcification, aortic valve ring calcification and thoracic aortic calcification) in HIV seropositive and seronegative men: Multicenter AIDS Cohort Study. J Cardiovasc Comput Tomogr 2016; 10:229-236. [PMID: 26949197 DOI: 10.1016/j.jcct.2016.02.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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] [Received: 09/08/2015] [Revised: 02/08/2016] [Accepted: 02/22/2016] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Previous studies have demonstrated an association between HIV infection and coronary artery disease (CAD); little is known about potential associations between HIV infection and extra-coronary calcification (ECC). METHODS We analyzed 621 HIV infected (HIV+) and 384 HIV uninfected (HIV-) men from the Multicenter AIDS Cohort Study who underwent non-contrast computed tomography (CT) from 2010-2013. Agatston scores were calculated for mitral annular calcification (MAC), aortic valve calcification (AVC), aortic valve ring calcification (AVRC), and thoracic aortic calcification (TAC). The associations between HIV infection and the presence of each type of ECC (score > 0) were evaluated by multivariable logistic regression. We also evaluated the association of ECC with inflammatory biomarker levels and coronary plaque morphology. RESULTS Among HIV+ and HIV- men, the age-standardized prevalences were 15% for TAC (HIV+ 14%/HIV- 16%), 10% for AVC (HIV+ 11%/HIV- 8%), 24% for AVRC (HIV+ 23% HIV- 24%), and 5% for MAC (HIV+ 7%/HIV- 3%). After adjustment, HIV+ men had 3-fold greater odds of MAC compared to HIV- men (OR = 3.2, 95% CI: 1.5-6.7), and almost twice the odds of AVC (1.8, 1.1-2.9). HIV serostatus was not associated with TAC or AVRC. AVRC was associated with higher Il-6 and sCD163 levels. TAC was associated with higher ICAM-1, TNF-α RII, and Il-6 levels. AVC and AVRC calcification were associated with presence of non-calcified plaque in HIV+ but not HIV- men. CONCLUSION HIV infection is an independent predictor of MAC and AVC. Whether these calcifications predict mortality in HIV+ patients deserves further investigation.
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Affiliation(s)
- Panteha Rezaeian
- Department of Family Medicine, Loma Linda University School of Medicine; Loma Linda, CA.,Division of Cardiology- Los Angeles Biomedical Institute at Harbor UCLA Medical Center; Torrance, CA
| | - P Elliott Miller
- Department of Medicine, Johns Hopkins University School of Medicine; Baltimore, MD
| | - Sabina A Haberlen
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health; Baltimore, MD
| | - Aryabod Razipour
- Division of Cardiology- Los Angeles Biomedical Institute at Harbor UCLA Medical Center; Torrance, CA
| | - Hossein Bahrami
- Division of Cardiology and Stanford Cardiovascular Institute, Stanford University; Stanford, CA
| | - Romeo Castillo
- Department of Family Medicine, Loma Linda University School of Medicine; Loma Linda, CA
| | - Mallory D Witt
- Division of HIV Medicine- Los Angeles Biomedical Institute at Harbor UCLA Medical Center; Torrance, CA
| | | | - Frank J Palella
- Northwestern University Feinberg School of Medicine; Chicago, IL
| | - Rine Nakanishi
- Division of Cardiology- Los Angeles Biomedical Institute at Harbor UCLA Medical Center; Torrance, CA
| | - Suguru Matsumoto
- Division of Cardiology- Los Angeles Biomedical Institute at Harbor UCLA Medical Center; Torrance, CA
| | - Anas Alani
- Division of Cardiology, University of Florida; Gainesville, FL
| | - Lisa P Jacobson
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health; Baltimore, MD
| | - Wendy S Post
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health; Baltimore, MD.,Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine; Baltimore, MD
| | - Matthew J Budoff
- Division of Cardiology- Los Angeles Biomedical Institute at Harbor UCLA Medical Center; Torrance, CA
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Falade-Nwulia O, Seaberg EC, Snider AE, Rinaldo CR, Phair J, Witt MD, Thio CL. Incident Hepatitis B Virus Infection in HIV-Infected and HIV-Uninfected Men Who Have Sex With Men From Pre-HAART to HAART Periods: A Cohort Study. Ann Intern Med 2015; 163:673-80. [PMID: 26457744 PMCID: PMC4630157 DOI: 10.7326/m15-0547] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Men who have sex with men (MSM) are at high risk for hepatitis B virus (HBV) infection. Data on the effect of highly active antiretroviral therapy (HAART) on incident HBV infection in HIV-infected and HIV-uninfected MSM are limited. OBJECTIVE To determine predictors of incident HBV infection in MSM during pre-HAART and HAART periods. DESIGN Observational cohort study. SETTING Cohort of MSM who have, or are at risk for, HIV infection. PATIENTS 2375 HBV-uninfected MSM in the Multicenter AIDS Cohort Study. MEASUREMENTS Poisson regression was used to compare incidence rates of HBV infection in the pre-HAART and HAART eras and to identify factors associated with incidence of HBV infection. RESULTS In 25,322 person-years of follow-up, 244 incident HBV infections occurred. The unadjusted incidence rate was higher in HIV-infected MSM than in HIV-uninfected MSM (incidence rate ratio [IRR], 1.9 [95% CI, 1.5 to 2.4]) and was significantly lower in the HAART era than in the pre-HAART era among HIV-infected (IRR, 0.2 [CI, 0.1 to 0.4]) and HIV-uninfected (IRR, 0.3 [CI, 0.2 to 0.4]) MSM. Age younger than 40 years (IRR, 2.3 [CI, 1.7 to 3.0]), more than 1 recent sexual partner (IRR, 3.1 [CI, 2.3 to 4.2]), and HIV infection (IRR, 2.4 [CI, 1.8 to 3.1]) were independently associated with higher incidence of HBV infection, whereas HBV vaccination was protective (IRR, 0.3 [CI, 0.2 to 0.4]). Highly active antiretroviral therapy with HIV RNA levels less than 400 copies/mL was associated with protection (IRR, 0.2 [CI, 0.1 to 0.5]), but HAART in those with HIV RNA levels of 400 copies/mL or greater was not. LIMITATION The observational nature limits inferences about causality. CONCLUSION Effective HAART is associated with lower incidence of HBV infection; however, even in the HAART era, incidence of HBV infection remains high among MSM. PRIMARY FUNDING SOURCE National Institute of Allergy and Infectious Diseases.
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Affiliation(s)
- Oluwaseun Falade-Nwulia
- From Johns Hopkins University, Baltimore, Maryland; University of Pittsburgh, Pittsburgh, Pennsylvania; Feinberg School of Medicine, Northwestern University, Chicago, Illinois; and Los Angeles Biomedical Research Institute at Harbor–University of California, Los Angeles Medical Center, Torrance, California
| | - Eric C. Seaberg
- From Johns Hopkins University, Baltimore, Maryland; University of Pittsburgh, Pittsburgh, Pennsylvania; Feinberg School of Medicine, Northwestern University, Chicago, Illinois; and Los Angeles Biomedical Research Institute at Harbor–University of California, Los Angeles Medical Center, Torrance, California
| | - Anna E. Snider
- From Johns Hopkins University, Baltimore, Maryland; University of Pittsburgh, Pittsburgh, Pennsylvania; Feinberg School of Medicine, Northwestern University, Chicago, Illinois; and Los Angeles Biomedical Research Institute at Harbor–University of California, Los Angeles Medical Center, Torrance, California
| | - Charles R. Rinaldo
- From Johns Hopkins University, Baltimore, Maryland; University of Pittsburgh, Pittsburgh, Pennsylvania; Feinberg School of Medicine, Northwestern University, Chicago, Illinois; and Los Angeles Biomedical Research Institute at Harbor–University of California, Los Angeles Medical Center, Torrance, California
| | - John Phair
- From Johns Hopkins University, Baltimore, Maryland; University of Pittsburgh, Pittsburgh, Pennsylvania; Feinberg School of Medicine, Northwestern University, Chicago, Illinois; and Los Angeles Biomedical Research Institute at Harbor–University of California, Los Angeles Medical Center, Torrance, California
| | - Mallory D. Witt
- From Johns Hopkins University, Baltimore, Maryland; University of Pittsburgh, Pittsburgh, Pennsylvania; Feinberg School of Medicine, Northwestern University, Chicago, Illinois; and Los Angeles Biomedical Research Institute at Harbor–University of California, Los Angeles Medical Center, Torrance, California
| | - Chloe L. Thio
- From Johns Hopkins University, Baltimore, Maryland; University of Pittsburgh, Pittsburgh, Pennsylvania; Feinberg School of Medicine, Northwestern University, Chicago, Illinois; and Los Angeles Biomedical Research Institute at Harbor–University of California, Los Angeles Medical Center, Torrance, California
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McKibben RA, Haberlen SA, Post WS, Brown TT, Budoff M, Witt MD, Kingsley LA, Palella FJ, Thio CL, Seaberg EC. A Cross-sectional Study of the Association Between Chronic Hepatitis C Virus Infection and Subclinical Coronary Atherosclerosis Among Participants in the Multicenter AIDS Cohort Study. J Infect Dis 2015. [PMID: 26216904 DOI: 10.1093/infdis/jiv396] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [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: 12/15/2022] Open
Abstract
BACKGROUND Hepatitis C virus (HCV) infection may increase the risk of cardiovascular disease (CVD). We evaluated the association of chronic HCV infection and coronary atherosclerosis among participants in the Multicenter AIDS Cohort Study. METHODS We assessed 994 men with or without human immunodeficiency virus (HIV) infection (87 of whom had chronic HCV infection) for coronary plaque, using noncontrast coronary computed tomography (CT); 755 also underwent CT angiography. We then evaluated the associations of chronic HCV infection and HIV infection with measures of plaque prevalence, extent, and stenosis. RESULTS After adjustment for demographic characteristics, HIV serostatus, behaviors, and CVD risk factors, chronic HCV infection was significantly associated with a higher prevalence of coronary artery calcium (prevalence ratio, 1.29; 95% confidence interval [CI], 1.02-1.63), any plaque (prevalence ratio, 1.26; 95% CI, 1.09-1.45), and noncalcified plaque (prevalence ratio, 1.42; 95% CI, 1.16-1.75). Chronic HCV infection and HIV infection were independently associated with the prevalence of any plaque and of noncalcified plaque, but there was no evidence of a synergistic effect due to HIV/HCV coinfection. The prevalences of coronary artery calcium, any plaque, noncalcified plaque, a mixture of noncalcified and calcified plaque, and calcified plaque were significantly higher among men with an HCV RNA load of ≥2 × 10(6) IU/mL, compared with findings among men without chronic HCV infection. CONCLUSIONS Chronic HCV infection is associated with subclinical CVD, suggesting that vigilant assessments of cardiovascular risk are warranted for HCV-infected individuals. Future research should determine whether HCV infection duration or HCV treatment influence coronary plaque development.
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Affiliation(s)
| | - Sabina A Haberlen
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Wendy S Post
- Department of Medicine, Johns Hopkins School of Medicine Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Todd T Brown
- Department of Medicine, Johns Hopkins School of Medicine
| | - Matthew Budoff
- Los Angeles Biomedical Research Institute, Harbor-UCLA Medical Center, Torrance, California
| | - Mallory D Witt
- Los Angeles Biomedical Research Institute, Harbor-UCLA Medical Center, Torrance, California
| | - Lawrence A Kingsley
- Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pennsylvania
| | - Frank J Palella
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Chloe L Thio
- Department of Medicine, Johns Hopkins School of Medicine
| | - Eric C Seaberg
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
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Seaberg EC, Witt MD, Jacobson LP, Detels R, Rinaldo CR, Margolick JB, Young S, Phair JP, Thio CL. Spontaneous Clearance of the Hepatitis C Virus Among Men Who Have Sex With Men. Clin Infect Dis 2015; 61:1381-8. [PMID: 26175521 DOI: 10.1093/cid/civ562] [Citation(s) in RCA: 24] [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: 02/25/2015] [Accepted: 06/28/2015] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The probability of spontaneous hepatitis C virus (HCV) clearance ranges from 11% to 49%. Our previous cross-sectional study suggests that mode of acquisition explains some of this heterogeneity. We performed this prospective study to determine factors associated with spontaneous HCV clearance among men who have sex with men (MSM). METHODS A mixture-cure model was used to evaluate the probability of spontaneous HCV clearance among 101 MSM in the Multicenter AIDS Cohort Study with acute HCV infection between 1984 and 2012. RESULTS Spontaneous HCV clearance occurred in 46% of MSM (49% in non-injection drug users [IDUs] and 23% in IDUs). In the multivariable analysis, age <30 years (clearance ratio [CR] = 2.43; 95% confidence interval [CI], 1.53-3.87) and being human immunodeficiency virus (HIV) uninfected (CR = 2.97; 95% CI, 1.98-4.46) were independently associated with spontaneous clearance. Among men aged ≥30 years, being HIV uninfected, not having unprotected anal intercourse, older age, and being on highly active antiretroviral therapy were independently associated with higher clearance. The interferon lambda rs12979860 single nucleotide polymorphism (SNP) was not associated with spontaneous clearance among the 88 MSM who were not active IDUs (CR = 0.74; 95% CI, .46-1.21 for CC vs CT/TT genotype). CONCLUSIONS The high probability of spontaneous HCV clearance together with the lack of an association between the rs12979860 SNP and spontaneous clearance among MSM who do not use injection drugs suggests that the immune mechanisms involved with a successful response to acute HCV differ by mode of virus acquisition. Understanding potential mechanistic differences could be important for HCV vaccine development.
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Affiliation(s)
- Eric C Seaberg
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Mallory D Witt
- David Geffen School of Medicine, University of California-Los Angeles Los Angeles Biomedical Research Institute at Harbor University of California-Los Angeles, Torrance
| | - Lisa P Jacobson
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Roger Detels
- Department of Epidemiology, University of California-Los Angeles, School of Public Health, California
| | - Charles R Rinaldo
- Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pennsylvania
| | - Joseph B Margolick
- Department of Molecular Microbiology and Immunology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Stephen Young
- Department of Pathology, University of New Mexico HSC, Albuquerque
| | - John P Phair
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Chloe L Thio
- Department of Medicine, Johns Hopkins University, Baltimore, Maryland
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Miller PE, Haberlen SA, Metkus T, Rezaeian P, Palella F, Kingsley LA, Witt MD, George RT, Jacobson LP, Brown TT, Budoff M, Post WS. HIV and coronary arterial remodeling from the Multicenter AIDS Cohort Study (MACS). Atherosclerosis 2015; 241:716-22. [PMID: 26132282 DOI: 10.1016/j.atherosclerosis.2015.06.022] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [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] [Received: 01/30/2015] [Revised: 06/04/2015] [Accepted: 06/12/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Positive remodeling (PR), a coronary artery characteristic associated with risk for myocardial infarction (MI), may be more prevalent in HIV-infected (HIV+) people. We evaluated the prevalence of PR using coronary CT angiography (CCTA) in HIV+ and HIV-uninfected (HIV-) men. METHODS Men enrolled in the Multicenter AIDS Cohort Study underwent CCTA if they were 40-70 years, had normal kidney function and no history of coronary revascularization. Multivariable logistic regression models were used to estimate the odds ratio (OR) of PR by HIV serostatus, adjusting for demographics and coronary artery disease (CAD) risk factors. Analysis of PR among atherosclerotic segments further adjusted for plaque type and stenosis. RESULTS The prevalence of PR was 8.4% versus 12.1% (p = 0.10) for HIV- and HIV + men, respectively. After demographic adjustment, HIV + men had twice the odds of PR [OR 2.01(95% CI 1.20-3.38)], which persisted after CAD risk factor adjustment [1.76(1.00-3.10)]. Higher systolic blood pressure, total cholesterol, diabetes medication use, older age, segment number with plaque present, mixed and non-calcified plaque, and stenosis>50%, were associated with increased odds of PR, while higher HDL cholesterol, higher nadir CD4 count, and black race were associated with lower PR odds. Among atherosclerotic segments, the association between HIV infection and PR persisted, but was not statistically significantly. CONCLUSION HIV+ men have more positively remodeled arterial segments, which may be due to more coronary segments with atherosclerosis or HIV-related immunosuppression. Further studies are needed to evaluate whether PR contributes to higher rates of MI in HIV+ individuals.
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Affiliation(s)
| | | | - Thomas Metkus
- Johns Hopkins University School of Medicine, Baltimore MD, USA
| | | | | | | | | | | | - Lisa P Jacobson
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Todd T Brown
- Johns Hopkins University School of Medicine, Baltimore MD, USA
| | | | - Wendy S Post
- Johns Hopkins University School of Medicine, Baltimore MD, USA; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
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Monroe AK, Fu W, Zikusoka MN, Jacobson LP, Witt MD, Palella FJ, Kingsley LA, Post WS, Brown TT. Low-Density Lipoprotein Cholesterol Levels and Statin Treatment by HIV Status Among Multicenter AIDS Cohort Study Men. AIDS Res Hum Retroviruses 2015; 31:593-602. [PMID: 25664922 DOI: 10.1089/aid.2014.0126] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Treating cardiovascular disease (CVD) risk factors, including dyslipidemia, is important in HIV care. Low-density lipoprotein cholesterol (LDL-c) target achievement is a readily available benchmark for dyslipidemia control, although use of this target is not uniformly endorsed by professional societies. We examined whether HIV serostatus is associated with not achieving LDL-c target. Among Multicenter AIDS Cohort Study (MACS) participants completing visit 56 (10/1/2011-3/31/2012), we categorized each man as on or off statin therapy and used NCEP ATP III guidelines to determine if each man was at LDL-c target or not at target. We compared proportions of men not at target and determined predictors using multivariate logistic regression. Sixty of 543 (11.1%) HIV-infected men and 87 of 585 (14.9%) HIV-uninfected men not receiving statin therapy were not at target (p=0.07), while 31 of 230 (13.5%) HIV-infected and 29 of 204 (14.2%) HIV-uninfected men receiving statin therapy were not at target (p=0.82). Factors associated with not being at target (among men not receiving statin therapy) included current smoking (OR=2.31, 95% CI 1.31, 4.06) and a diagnosis of hypertension (OR=4.69, 95% CI 2.68, 8.21). Factors associated with not being at target (among men receiving statin therapy) included current smoking (OR=2.72, 95% CI 1.30, 5.67) and diabetes (OR=5.31, 95% CI 2.47, 11.42). HIV-infected and HIV-uninfected men receiving statin therapy demonstrated similar nonachievement of LDL-c targets. Comorbidities (e.g., diabetes) lowered targets and may explain why goals were less likely to be met.
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Affiliation(s)
- Anne K. Monroe
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Wei Fu
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Michelle N. Zikusoka
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Lisa P. Jacobson
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Mallory D. Witt
- Division of HIV Medicine, Harbor UCLA Medical Center, Torrence, California
| | - Frank J. Palella
- Division of Infectious Diseases, Feinberg School of Medicine of Northwestern University, Chicago, Illinois
| | - Lawrence A. Kingsley
- Department of Infectious Diseases and Microbiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania
| | - Wendy S. Post
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Todd T. Brown
- Division of Endocrinology, Diabetes & Metabolism, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Metkus TS, Brown T, Budoff M, Kingsley L, Palella FJ, Witt MD, Li X, George RT, Jacobson LP, Post WS. HIV infection is associated with an increased prevalence of coronary noncalcified plaque among participants with a coronary artery calcium score of zero: Multicenter AIDS Cohort Study (MACS). HIV Med 2015; 16:635-9. [PMID: 25968104 DOI: 10.1111/hiv.12262] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2015] [Indexed: 01/10/2023]
Abstract
OBJECTIVES HIV-infected individuals bear increased cardiovascular risk even in the absence of traditional cardiovascular risk factors. In the general population, coronary artery calcium (CAC) scanning is of value for cardiovascular risk stratification, but whether a CAC score of zero implies a low noncalcified coronary plaque burden in HIV-infected persons is unknown. METHODS We assessed the prevalence of noncalcified coronary plaque and compared noncalcified coronary plaque burden between HIV-infected and HIV-uninfected participants who had CAC scores of zero in the Multicenter AIDS Cohort Study (MACS) using coronary computed tomography (CT) angiography. RESULTS HIV infection was associated with the presence of noncalcified coronary plaque among these men with CAC scores of zero. In a model adjusted only for age, race, centre, and pre- or post-2001 cohort, the prevalence ratio for the presence of noncalcified plaque was 1.27 (95% confidence interval 1.04-1.56; P = 0.02). After additionally adjusting for cardiovascular risk factors, HIV infection remained associated with the presence of noncalcified coronary plaque (prevalence ratio 1.31; 95% confidence interval 1.07-1.6; P = 0.01). CONCLUSIONS Among men with CAC scores of zero, HIV infection is associated with an increased prevalence of noncalcified coronary plaque independent of traditional cardiovascular risk factors. This finding suggests that CAC scanning may underestimate plaque burden in HIV-infected men.
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Affiliation(s)
- T S Metkus
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - T Brown
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - M Budoff
- Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - L Kingsley
- University of Pittsburgh, Pittsburgh, PA, USA
| | | | - M D Witt
- Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - X Li
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - R T George
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - L P Jacobson
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - W S Post
- Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Hanna DB, Post WS, Deal JA, Hodis HN, Jacobson LP, Mack WJ, Anastos K, Gange SJ, Landay AL, Lazar JM, Palella FJ, Tien PC, Witt MD, Xue X, Young MA, Kaplan RC, Kingsley LA. HIV Infection Is Associated With Progression of Subclinical Carotid Atherosclerosis. Clin Infect Dis 2015; 61:640-50. [PMID: 25904369 DOI: 10.1093/cid/civ325] [Citation(s) in RCA: 91] [Impact Index Per Article: 10.1] [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: 01/07/2015] [Accepted: 04/08/2015] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Individuals infected with human immunodeficiency virus (HIV) live longer as a result of effective treatment, but long-term consequences of infection, treatment, and immunological dysfunction are poorly understood. METHODS We prospectively examined 1011 women (74% HIV-infected) in the Women's Interagency HIV Study and 811 men (65% HIV-infected) in the Multicenter AIDS Cohort Study who underwent repeated B-mode carotid artery ultrasound imaging in 2004-2013. Outcomes included changes in right common carotid artery intima-media thickness (CCA-IMT) and new focal carotid artery plaque formation (IMT >1.5 mm) over median 7 years. We assessed the association between HIV serostatus and progression of subclinical atherosclerosis, adjusting for demographic, behavioral, and cardiometabolic risk factors. RESULTS Unadjusted mean CCA-IMT increased (725 to 752 µm in women, 757 to 790 µm in men), but CCA-IMT progression did not differ by HIV serostatus, either in combined or sex-specific analyses. Focal plaque prevalence increased from 8% to 15% in women and 25% to 34% in men over 7 years. HIV-infected individuals had 1.6-fold greater risk of new plaque formation compared with HIV-uninfected individuals (relative risk [RR] 1.61, 95% CI, 1.12-2.32), adjusting for cardiometabolic factors; the association was similar by sex. Increased plaque occurred even among persistently virologically suppressed HIV-infected individuals compared with uninfected individuals (RR 1.56, 95% CI, 1.07-2.27). HIV-infected individuals with baseline CD4+ ≥ 500 cells/µL had plaque risk not statistically different from uninfected individuals. CONCLUSIONS HIV infection is associated with greater increases in focal plaque among women and men, potentially mediated by factors associated with immunodeficiency or HIV replication at levels below current limits of detection.
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Affiliation(s)
- David B Hanna
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York
| | - Wendy S Post
- Department of Medicine, Johns Hopkins University School of Medicine Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Jennifer A Deal
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | - Lisa P Jacobson
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Wendy J Mack
- Preventive Medicine, University of Southern California, Los Angeles, California
| | - Kathryn Anastos
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York Department of Medicine, Montefiore Medical Center, Bronx, New York
| | - Stephen J Gange
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Alan L Landay
- Department of Immunology and Microbiology, Rush University Medical Center, Chicago, Illinois
| | - Jason M Lazar
- Department of Medicine, SUNY-Downstate Medical Center, Brooklyn, New York
| | - Frank J Palella
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Phyllis C Tien
- Department of Medicine, University of California-San Francisco
| | - Mallory D Witt
- Department of Medicine, University of California-Los Angeles
| | - Xiaonan Xue
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York
| | - Mary A Young
- Department of Medicine, Georgetown University Medical Center, Washington D.C
| | - Robert C Kaplan
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York
| | - Lawrence A Kingsley
- Departments of Infectious Diseases and Microbiology Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pennsylvania
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Erlandson KM, Reynolds SM, Cox C, Palella FJ, Witt MD, Kingsley LA, Brown TT, Plankey M. Self-reported body fat change in HIV-infected men is a marker of decline in physical health-related quality of life with aging, independent of co-morbidity. PLoS One 2014; 9:e114166. [PMID: 25436612 PMCID: PMC4250188 DOI: 10.1371/journal.pone.0114166] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [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: 08/19/2014] [Accepted: 11/05/2014] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE Self-perception of changes in body fat among HIV+ persons is associated with decreased health related quality of life in cross-sectional studies. The longitudinal impact of body fat changes on health related quality of life, while accounting for comorbidity and anatomic location or severity of body fat changes, is unknown. DESIGN This was a longitudinal analysis of HIV+ and HIV- Multicenter AIDS Cohort Study (MACS) participants who completed questionnaires assessing self-perceived body fat changes (baseline visit) and a health related quality of life (Short Form-36) at baseline and then ≥5 years later. METHODS Relationships between body fat changes and change in Short Form-36 Physical and Mental Component Summary scores were investigated using mixed-model regression. RESULTS We studied 270 HIV+ and 247 HIV- men. At baseline, ≥50% of HIV+ men reported body fat changes; physical component but not mental component summary scores were lower among HIV+ men who reported moderate/severe leg or abdominal fat changes (p<0.05). At follow-up, physical component summary scores were significantly lower among men with face, leg, or abdominal fat changes compared to men without perceived fat changes (p<0.05). No significant changes were seen in mental component scores by fat change location or severity. In the final model, body fat changes at any site or severity were significant predictors of a decline in physical component summary score (p<0.05), independent of demographics or comorbidities. Mental component summary score was not associated with body fat changes, but higher mental component summary score was associated with increasing age and time. CONCLUSIONS Negative self-perceived body fat changes were associated with decline in physical health related quality of life, independent of comorbidities, and may be a marker of an increased risk for physical function decline with aging.
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Affiliation(s)
- Kristine M. Erlandson
- Department of Medicine, Divisions of Infectious Diseases & Geriatric Medicine, University of Colorado, Aurora, Colorado, United States of America
- * E-mail:
| | - Sandra M. Reynolds
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Christopher Cox
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Frank J. Palella
- Department of Medicine, Division of Infectious Diseases, Northwestern University, Chicago, Illinois, United States of America
| | - Mallory D. Witt
- Department of Medicine, Division of HIV Medicine, Los Angeles Biomedical Research Institute at Harbor–University of California Los Angeles (UCLA), Torrance, California, United States of America
| | - Lawrence A. Kingsley
- Department of Infectious Diseases and Microbiology, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Todd T. Brown
- Department of Medicine, Division of Endocrinology, Diabetes, and Metabolism, Johns Hopkins School of Medicine, Baltimore, Maryland, United States of America
| | - Michael Plankey
- Department of Medicine, Division of Infectious Diseases, Georgetown University Medical Center, Washington, District of Columbia, United States of America
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McKibben RA, Margolick JB, Grinspoon S, Li X, Palella FJ, Kingsley LA, Witt MD, George RT, Jacobson LP, Budoff M, Tracy RP, Brown TT, Post WS. Elevated levels of monocyte activation markers are associated with subclinical atherosclerosis in men with and those without HIV infection. J Infect Dis 2014; 211:1219-28. [PMID: 25362192 DOI: 10.1093/infdis/jiu594] [Citation(s) in RCA: 146] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Heightened immune activation among human immunodeficiency virus (HIV)-infected persons may contribute to atherosclerosis. We assessed associations of serologic markers of monocyte activation, soluble CD163 (sCD163) and soluble CD14 (sCD14), and monocyte chemoattractant protein 1 (CCL2) with subclinical atherosclerosis among men with and those without HIV infection in the Multicenter AIDS Cohort Study. METHODS We performed noncontrast computed tomography on 906 men (566 HIV-infected men and 340 HIV-uninfected men), 709 of whom also underwent coronary computed tomographic angiography. Associations between each biomarker and the prevalence of coronary plaque, the prevalence of stenosis of ≥50%, and the extent of plaque were assessed by logistic and linear regression, adjusting for age, race, HIV serostatus, and cardiovascular risk factors. RESULTS Levels of all biomarkers were higher among HIV-infected men, of whom 81% had undetectable HIV RNA, and were associated with lower CD4(+) T-cell counts. In the entire population and among HIV-infected men, higher biomarker levels were associated with a greater prevalence of coronary artery stenosis of ≥50%. Higher sCD163 levels were also associated with greater prevalences of coronary artery calcium, mixed plaque, and calcified plaque; higher CCL2 levels were associated with a greater extent of noncalcified plaque. CONCLUSIONS sCD163, sCD14, and CCL2 levels were elevated in treated HIV-infected men and associated with atherosclerosis. Monocyte activation may increase the risk for cardiovascular disease in individuals with HIV infection.
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Affiliation(s)
| | | | | | - Xiuhong Li
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | | | - Mallory D Witt
- Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California
| | | | - Lisa P Jacobson
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Matthew Budoff
- Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California
| | | | | | - Wendy S Post
- Johns Hopkins University School of Medicine Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Seaberg EC, Witt MD, Jacobson LP, Detels R, Rinaldo CR, Young S, Phair JP, Thio CL. Differences in hepatitis C virus prevalence and clearance by mode of acquisition among men who have sex with men. J Viral Hepat 2014; 21:696-705. [PMID: 25280229 PMCID: PMC4187219 DOI: 10.1111/jvh.12198] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [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] [Received: 07/19/2013] [Accepted: 09/21/2013] [Indexed: 01/29/2023]
Abstract
We examined the characteristics associated with hepatitis C virus (HCV) antibody (anti-HCV) prevalence and HCV clearance between injection drug using (IDU) and non-IDU men who have sex with men (MSM). Stored serum and plasma samples were tested for anti-HCV and HCV RNA to determine the HCV status of 6925 MSM at enrolment into the Multicentre AIDS Cohort Study (MACS). Prevalence and clearance ratios were calculated to determine the characteristics associated with HCV prevalence and clearance. Multivariable analyses were performed using Poisson regression methods with robust variance estimation. Anti-HCV prevalence was significantly higher among IDU than among non-IDU MSM (42.9% vs 4.0%), while clearance was significantly lower among IDU MSM (11.5% vs 34.5% among non-IDU MSM). HIV infection, Black race, and older age were independently associated with higher prevalence in both groups, while smoking, transfusion history, and syphilis were significantly associated with prevalence only among non-IDU MSM. The rs12979860-C/C genotype was the only characteristic independently associated with HCV clearance in both groups, but the effects of both rs12979860-C/C genotype [clearance ratio (CR) = 4.16 IDUs vs 1.71 non-IDUs; P = 0.03] and HBsAg positivity (CR = 5.06 IDUs vs 1.62 non-IDUs; P = 0.03) were significantly larger among IDU MSM. HIV infection was independently associated with lower HCV clearance only among non-IDU MSM (CR = 0.59, 95% CI = 0.40-0.87). IDU MSM have higher anti-HCV prevalence and lower HCV clearance than non-IDU MSM. Differences in the factors associated with HCV clearance suggest that the mechanisms driving the response to HCV may differ according to the mode of acquisition.
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Affiliation(s)
- Eric C Seaberg
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, 21205 USA
| | - Mallory D Witt
- David Geffen School of Medicine, University of California, Los Angeles, CA and Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, California, 90509 USA
| | - Lisa P Jacobson
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, 21205 USA
| | - Roger Detels
- Department of Epidemiology, UCLA School of Public Health, Los Angeles, California, 90095 USA
| | - Charles R Rinaldo
- Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, 15261 USA
| | - Steve Young
- TriCore Reference Laboratory, Albuquerque, New Mexico, 87131 USA
| | - John P Phair
- Howard Brown Health Center and Department of Medicine, Northwestern University, Chicago, Illinois, 60611 USA
| | - Chloe L Thio
- Department of Medicine, Johns Hopkins University, Baltimore, Maryland, 21205 USA
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Miller PE, Budoff M, Zikusoka M, Li X, Palella F, Kingsley LA, Witt MD, Sharrett AR, Jacobson LP, Post WS. Comparison of racial differences in plaque composition and stenosis between HIV-positive and HIV-negative men from the Multicenter AIDS Cohort Study. Am J Cardiol 2014; 114:369-75. [PMID: 24929623 DOI: 10.1016/j.amjcard.2014.04.049] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2014] [Revised: 04/30/2014] [Accepted: 04/30/2014] [Indexed: 11/30/2022]
Abstract
Previous studies demonstrated that blacks have less coronary artery calcification (CAC) than whites. We evaluated racial differences in plaque composition and stenosis in the Multicenter AIDS Cohort Study. HIV-positive and HIV-negative men underwent noncontrast cardiac computed tomography (CT) if they were aged 40 to 70 years, weighed <136 kg, and had no history of cardiac surgery or revascularization and, if eligible, coronary CT angiography (CTA). There were 1,001 men who underwent CT scans and 759 men CTA. We measured CAC on noncontrast CT and identified total plaque, noncalcified plaque, calcified plaque, mixed plaque, and coronary stenosis >50% on CTA. The association of presence and extent of plaque with race was determined after adjustment for HIV serostatus, cardiovascular risk factors, and measures of socioeconomic status. The prevalences of any plaque on CTA and noncalcified plaque were not different between black and white men; however, black men had lower prevalences of CAC (prevalence ratio [PR] 0.79, p = 0.01), calcified plaque (PR 0.69, p = 0.002), and stenosis >50% (PR 0.59, p = 0.009). There were no associations between black race and extent of plaque in fully adjusted models. Using log-linear regression, black race was associated with a lower extent of any plaque on CTA in HIV-positive men (estimate = -0.24, p = 0.051) but not in HIV-negative men (0.12, p = 0.50, HIV interaction p = 0.005). In conclusion, a lower prevalence of CAC in black compared with white men appears to reflect less calcification of plaque and stenosis rather than a lower overall prevalence of plaque.
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Affiliation(s)
- P Elliott Miller
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Matthew Budoff
- Department of Medicine, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California
| | - Michelle Zikusoka
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Xiuhong Li
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Frank Palella
- Department of Medicine, Northwestern University, Chicago, Illinois
| | - Lawrence A Kingsley
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Mallory D Witt
- Department of Medicine, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California
| | - A Richey Sharrett
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Lisa P Jacobson
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Wendy S Post
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
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Post WS, Budoff M, Kingsley L, Palella FJ, Witt MD, Li X, George RT, Brown TT, Jacobson LP. Associations between HIV infection and subclinical coronary atherosclerosis. Ann Intern Med 2014; 160:458-67. [PMID: 24687069 PMCID: PMC4143766 DOI: 10.7326/m13-1754] [Citation(s) in RCA: 248] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Coronary artery disease (CAD) has been associated with HIV infection, but data are not consistent. OBJECTIVE To determine whether HIV-infected men have more coronary atherosclerosis than uninfected men. DESIGN Cross-sectional study. SETTING Multicenter AIDS Cohort Study. PARTICIPANTS HIV-infected (n = 618) and uninfected (n = 383) men who have sex with men who were aged 40 to 70 years, weighed less than 136 kg (200 lb), and had no history of coronary revascularization. MEASUREMENTS Presence and extent of coronary artery calcium (CAC) on noncontrast cardiac computed tomography (CT) and of any plaque; noncalcified, mixed, or calcified plaque; or stenosis on coronary CT angiography. RESULTS 1001 men had noncontrast CT, of whom 759 had coronary CT angiography. After adjustment for age, race, CT scanning center, and cohort, HIV-infected men had a greater prevalence of CAC (prevalence ratio [PR], 1.21 [95% CI, 1.08 to 1.35]; P = 0.001) and any plaque (PR, 1.14 [CI, 1.05 to 1.24]; P = 0.001), including noncalcified (PR, 1.28 [CI, 1.13 to 1.45]; P < 0.001) and mixed (PR, 1.35 [CI, 1.10 to 1.65]; P = 0.004) plaque, than uninfected men. Associations between HIV infection and any plaque or noncalcified plaque remained significant (P < 0.005) after CAD risk factor adjustment. HIV-infected men had a greater extent of noncalcified plaque after CAD risk factor adjustment (P = 0.026). They also had a greater prevalence of coronary artery stenosis greater than 50% (PR, 1.48 [CI, 1.06 to 2.07]; P = 0.020), but not after CAD risk factor adjustment. Longer duration of highly active antiretroviral therapy (PR, 1.09 [CI, 1.02 to 1.17]; P = 0.007) and lower nadir CD4+ T-cell count (PR, 0.80 [CI, 0.69 to 0.94]; P = 0.005) were associated with coronary stenosis greater than 50%. LIMITATION Cross-sectional observational study design and inclusion of only men. CONCLUSION Coronary artery plaque, especially noncalcified plaque, is more prevalent and extensive in HIV-infected men, independent of CAD risk factors. PRIMARY FUNDING SOURCE National Heart, Lung, and Blood Institute and National Institute of Allergy and Infectious Diseases.
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Shimizu E, Glaspy K, Witt MD, Poon K, Black S, Schwartz S, Bholat T, Diaz N, Kuo A, Spellberg B. Readmissions at a public safety net hospital. PLoS One 2014; 9:e91244. [PMID: 24618829 PMCID: PMC3949745 DOI: 10.1371/journal.pone.0091244] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Accepted: 02/10/2014] [Indexed: 11/24/2022] Open
Abstract
Objective We aimed to determine factors related to avoidability of 30-day readmissions at our public, safety net hospital in the United States (US). Methods We prospectively reviewed medical records of adult internal medicine patients with scheduled and unscheduled 30-day readmissions. We also interviewed patients if they were available. An independent panel used pre-specified, objective criteria to adjudicate potential avoidability. Results Of 153 readmissions evaluated, 68% were unscheduled. Among these, 67% were unavoidable, primarily due to disease progression and development of new diagnoses. Scheduled readmissions accounted for 32% of readmissions and most (69%) were clinically appropriate and unavoidable. The scheduled but avoidable readmissions (31%) were attributed largely to limited resources in our healthcare system. Conclusions Most readmissions at our public, safety net hospital were unavoidable, even among our unscheduled readmissions. Surprisingly, one-third of our overall readmissions were scheduled, the majority reflecting appropriate management strategies designed to reduce unnecessary hospital days. The scheduled but avoidable readmissions were due to constrained access to non-emergent, expensive procedures that are typically not reimbursed given our system’s payor mix, a problem which likely plague other safety net systems. These findings suggest that readmissions do not necessarily reflect inadequate medical care, may reflect resource constraints that are unlikely to be addressable in systems caring for a large burden of uninsured patients, and merit individualized review.
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Affiliation(s)
- Eri Shimizu
- Division of General Internal Medicine, Los Angeles Biomedical Research Institute at Harbor-University of California at Los Angeles (UCLA) Medical Center, Torrance, California, United States of America
- Department of Medicine, Hawaii Permanente Medical Group, Wailuku, Hawaii, United States of America
- Department of Medicine, Maui Memorial Medical Center, Wailuku, Hawaii, United States of America
- * E-mail:
| | - Kathleen Glaspy
- Division of General Internal Medicine, Los Angeles Biomedical Research Institute at Harbor-University of California at Los Angeles (UCLA) Medical Center, Torrance, California, United States of America
- David Geffen School of Medicine at University of California at Los Angeles (UCLA), Los Angeles, California, United States of America
| | - Mallory D. Witt
- David Geffen School of Medicine at University of California at Los Angeles (UCLA), Los Angeles, California, United States of America
- Division of HIV Medicine, Los Angeles Biomedical Research Institute at Harbor-University of California at Los Angeles (UCLA) Medical Center, Torrance, California, United States of America
| | - Kimble Poon
- Department of Medicine, Maui Memorial Medical Center, Wailuku, Hawaii, United States of America
| | - Susan Black
- Department of Quality, Harbor-University of California at Los Angeles (UCLA) Medical Center, Torrance, California, United States of America
| | - Shelley Schwartz
- Division of General Internal Medicine, Los Angeles Biomedical Research Institute at Harbor-University of California at Los Angeles (UCLA) Medical Center, Torrance, California, United States of America
| | - Tasneem Bholat
- Division of General Internal Medicine, Los Angeles Biomedical Research Institute at Harbor-University of California at Los Angeles (UCLA) Medical Center, Torrance, California, United States of America
| | - Norma Diaz
- Department of Quality, Harbor-University of California at Los Angeles (UCLA) Medical Center, Torrance, California, United States of America
| | - Allen Kuo
- Division of General Internal Medicine, Los Angeles Biomedical Research Institute at Harbor-University of California at Los Angeles (UCLA) Medical Center, Torrance, California, United States of America
| | - Brad Spellberg
- Division of General Internal Medicine, Los Angeles Biomedical Research Institute at Harbor-University of California at Los Angeles (UCLA) Medical Center, Torrance, California, United States of America
- David Geffen School of Medicine at University of California at Los Angeles (UCLA), Los Angeles, California, United States of America
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Margolick JB, Jacobson LP, Schwartz GJ, Abraham AG, Darilay AT, Kingsley LA, Witt MD, Palella FJ. Factors affecting glomerular filtration rate, as measured by iohexol disappearance, in men with or at risk for HIV infection. PLoS One 2014; 9:e86311. [PMID: 24516530 PMCID: PMC3917840 DOI: 10.1371/journal.pone.0086311] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [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: 10/22/2013] [Accepted: 12/11/2013] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE Formulae used to estimate glomerular filtration rate (GFR) underestimate higher GFRs and have not been well-studied in HIV-infected (HIV(+)) people; we evaluated the relationships of HIV infection and known or potential risk factors for kidney disease with directly measured GFR and the presence of chronic kidney disease (CKD). DESIGN Cross-sectional measurement of iohexol-based GFR (iGFR) in HIV(+) men (n = 455) receiving antiretroviral therapy, and HIV-uninfected (HIV(-)) men (n = 258) in the Multicenter AIDS Cohort Study. METHODS iGFR was calculated from disappearance of infused iohexol from plasma. Determinants of GFR and the presence of CKD were compared using iGFR and GFR estimated by the CKD-Epi equation (eGFR). RESULTS Median iGFR was higher among HIV(+) than HIV(-) men (109 vs. 106 ml/min/1.73 m(2), respectively, p = .046), and was 7 ml/min higher than median eGFR. Mean iGFR was lower in men who were older, had chronic hepatitis C virus (HCV) infection, or had a history of AIDS. Low iGFR (≤90 ml/min/1.73 m(2)) was associated with these factors and with black race. Other than age, factors associated with low iGFR were not observed with low eGFR. CKD was more common in HIV(+) than HIV(-) men; predictors of CKD were similar using iGFR and eGFR. CONCLUSIONS iGFR was higher than eGFR in this population of HIV-infected and -uninfected men who have sex with men. Presence of CKD was predicted equally well by iGFR and eGFR, but associations of chronic HCV infection and history of clinically-defined AIDS with mildly decreased GFR were seen only with iGFR.
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Affiliation(s)
- Joseph B. Margolick
- Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Lisa P. Jacobson
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - George J. Schwartz
- Department of Pediatrics, University of Rochester Medical Center, Rochester, New York, United States of America
| | - Alison G. Abraham
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Annie T. Darilay
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Lawrence A. Kingsley
- Department of Infectious Diseases and Microbiology and Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Mallory D. Witt
- Department of Medicine, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California, United States of America
- Los Angeles Biomedical Research Institute at Harbor-UCLA, University of California Los Angeles, Los Angeles, California, United States of America
| | - Frank J. Palella
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America
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Monroe AK, Dobs AS, Palella FJ, Kingsley LA, Witt MD, Brown TT. Morning free and total testosterone in HIV-infected men: implications for the assessment of hypogonadism. AIDS Res Ther 2014; 11:6. [PMID: 24450960 PMCID: PMC3900935 DOI: 10.1186/1742-6405-11-6] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Accepted: 01/09/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Hypogonadism is common among HIV-infected men, even among men receiving antiretroviral therapy (ART). Our objective in this study was to determine the prevalence of biochemical hypogonadism among HIV-infected men compared with HIV-uninfected controls. We also examined the use of free testosterone (FT) and total testosterone (TT) measurements in the assessment of biochemical hypogonadism in HIV-infected and -uninfected men. METHODS This was a cross-sectional analysis from the Multicenter AIDS Cohort Study (MACS). TT levels were measured from archived serum using liquid chromatography-tandem mass spectrometry. FT was calculated from TT and sex hormone-binding globulin (SHBG) (measured by radioimmunoassay) using the Vermeulen equation. Biochemical hypogonadism was defined as having low TT, low FT, or both. RESULTS Of 945 men in the MACS Cardiovascular Substudy, T assays were not performed in 89 because of insufficient/no stored serum (n = 18) or use of T replacement therapy (TRT) (n = 71). 530 men had morning (AM) T measurements; 364 (68.7%) were HIV-infected. The prevalence of biochemical hypogonadism was similar in HIV-infected (34/364 = 9.3%) and HIV-uninfected (12/166 = 7.2%) men. Prevalence of hypogonadism, when men on TRT (n = 71) were included in the group of hypogonadal men, was higher in HIV-infected (104/434 = 24.0%) compared with HIV-uninfected (13/167 = 7.8%) men (p < 0.0001). Of 34 HIV-infected men with biochemical hypogonadism not on TRT, 11 (32.4%) had normal TT, but low FT. Of 12 HIV-uninfected men with biochemical hypogonadism not on TRT, none were in this category (p = 0.04) - all had low TT. CONCLUSIONS The prevalence of biochemical hypogonadism in our sample of HIV-infected men was approximately 10%, with a substantial proportion of these men having a normal TT, but low FT. The measurement of AM FT, rather than TT, in the assessment of hypogonadism in HIV-infected men will likely increase diagnostic sensitivity and should be recommended.
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Abraham AG, Li X, Jacobson LP, Estrella MM, Evans RW, Witt MD, Phair J. Antiretroviral therapy-induced changes in plasma lipids and the risk of kidney dysfunction in HIV-infected men. AIDS Res Hum Retroviruses 2013; 29:1346-52. [PMID: 23758574 DOI: 10.1089/aid.2012.0253] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
In the context of HIV, the initiation of effective antiretroviral therapy (ART) has been found to increase the risk of dyslipidemia in HIV-infected individuals, and dyslipidemia has been found to be a risk factor for kidney disease in the general population. Therefore, we examined changes in lipid profiles in HIV-infected men following ART initiation and the association with future kidney dysfunction. HIV-infected men from the Multicenter AIDS Cohort Study initiating ART between December 31, 1995 and September 30, 2011 with measured lipid and serum creatinine values pre-ART and post-ART were selected. The associations between changes in total cholesterol or high-density lipoprotein following ART initiation and the estimated change in glomerular filtration rate (eGFR) over time were assessed using piecewise linear mixed effects models. There were 365 HIV-infected men who contributed to the analysis. In the adjusted models, at 3 years post-ART, those with changes in total cholesterol >50 mg/dl had an average decrease in eGFR of 2.6 ml/min/1.73 m(2) per year (p<0.001) and at 5 years post-ART, the average decrease was 2.4 ml/min/1.73 m(2) per year (p=0.008). This decline contrasted with the estimates for those with changes in total cholesterol ≤ 50 mg/dl: 1.4 ml/min/1.73 m(2) decrease per year (p<0.001) and 0.1 ml/min/1.73 m(2) decrease per year (p=0.594) for the same time periods, respectively. Large decreases in high-density lipoprotein (a decline of greater than 5 mg/dl) were not associated with declines in eGFR. These results indicate that large ART-related increases in total cholesterol may be a risk factor for kidney function decline in HIV-infected men. Should these results be generalizable to the broader HIV population, monitoring cholesterol changes following the initiation of ART may be important in identifying HIV-infected persons at risk for kidney disease.
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Affiliation(s)
- Alison G. Abraham
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Xiuhong Li
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Lisa P. Jacobson
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Michelle M. Estrella
- Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Rhobert W. Evans
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Mallory D. Witt
- David Geffen School of Medicine at UCLA, Los Angeles Biomedical Research Institute at Harbor-UCLA, Los Angeles, California
| | - John Phair
- Division of Infectious Diseases, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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