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Nomah DK, Jamarkattel S, Bruguera A, Moreno-Fornés S, Díaz Y, Alonso L, Aceitón J, Llibre JM, Domingo P, Saumoy M, Homar F, Fanjul F, Navarro J, de la Mora L, Knobel H, Orti A, Martin-Iguacel R, Miró JM, Casabona J, Reyes-Urueña J. Evolving AIDS- and non-AIDS Mortality and Predictors in the PISCIS Cohort of People Living With HIV in Catalonia and the Balearic Islands (Spain), 1998-2020. Open Forum Infect Dis 2024; 11:ofae132. [PMID: 38560603 PMCID: PMC10977910 DOI: 10.1093/ofid/ofae132] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 03/05/2024] [Indexed: 04/04/2024] Open
Abstract
Background Effective antiretroviral therapy (ART) has substantially reduced acquired immunodeficiency syndrome (AIDS)-related deaths, shifting the focus to non-AIDS conditions in people living with human immunodeficiency virus (HIV) (PLWH). We examined mortality trends and predictors of AIDS- and non-AIDS mortality in the Population HIV Cohort from Catalonia and Balearic Islands (PISCIS) cohort of PLWH from 1998 to 2020. Methods We used a modified Coding Causes of Death in HIV protocol, which has been widely adopted by various HIV cohorts to classify mortality causes. We applied standardized mortality rates (SMR) to compare with the general population and used competing risks models to determine AIDS-related and non-AIDS-related mortality predictors. Results Among 30 394 PLWH (81.5% male, median age at death 47.3), crude mortality was 14.2 per 1000 person-years. All-cause standardized mortality rates dropped from 9.6 (95% confidence interval [CI], 8.45-10.90) in 1998 through 2003 to 3.33 (95% CI, 3.14-3.53) in 2015 through 2020, P for trend = .0001. Major causes were AIDS, non-AIDS cancers, cardiovascular disease, AIDS-defining cancers, viral hepatitis, and nonhepatitis liver disease. Predictors for AIDS-related mortality included being aged ≥40 years, not being a man who have sex with men, history of AIDS-defining illnesses, CD4 < 200 cells/µL, ≥2 comorbidities, and nonreceipt of ART. Non-AIDS mortality increased with age, injection drug use, heterosexual men, socioeconomic deprivation, CD4 200 to 349 cells/µL, nonreceipt of ART, and comorbidities, but migrants had lower risk (adjusted hazard risk, 0.69 [95% CI, .57-.83]). Conclusions Mortality rates among PLWH have significantly decreased over the past 2 decades, with a notable shift toward non-AIDS-related causes. Continuous monitoring and effective management of these non-AIDS conditions are essential to enhance overall health outcomes.
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Affiliation(s)
- Daniel K Nomah
- Departament de Salut, Centre d’Estudis Epidemiològics sobre les Infeccions de Transmissió Sexual i Sida de Catalunya (CEEISCAT), Barcelona, Spain
- Institut d'Investigació Germans Trias i Pujol (IGTP), Barcelona, Spain
| | - Suju Jamarkattel
- Departament de Salut, Centre d’Estudis Epidemiològics sobre les Infeccions de Transmissió Sexual i Sida de Catalunya (CEEISCAT), Barcelona, Spain
| | - Andreu Bruguera
- Departament de Salut, Centre d’Estudis Epidemiològics sobre les Infeccions de Transmissió Sexual i Sida de Catalunya (CEEISCAT), Barcelona, Spain
- Institut d'Investigació Germans Trias i Pujol (IGTP), Barcelona, Spain
- CIBER Epidemiologia y Salud Pública (CIBERESP), Barcelona, Spain
- Departament de Pediatria, d’Obstetrícia i Ginecologia i de Medicina Preventiva i de Salut Publica, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Sergio Moreno-Fornés
- Departament de Salut, Centre d’Estudis Epidemiològics sobre les Infeccions de Transmissió Sexual i Sida de Catalunya (CEEISCAT), Barcelona, Spain
- Institut d'Investigació Germans Trias i Pujol (IGTP), Barcelona, Spain
- CIBER Epidemiologia y Salud Pública (CIBERESP), Barcelona, Spain
| | - Yesika Díaz
- Departament de Salut, Centre d’Estudis Epidemiològics sobre les Infeccions de Transmissió Sexual i Sida de Catalunya (CEEISCAT), Barcelona, Spain
- Institut d'Investigació Germans Trias i Pujol (IGTP), Barcelona, Spain
- CIBER Epidemiologia y Salud Pública (CIBERESP), Barcelona, Spain
| | - Lucía Alonso
- Departament de Salut, Centre d’Estudis Epidemiològics sobre les Infeccions de Transmissió Sexual i Sida de Catalunya (CEEISCAT), Barcelona, Spain
- Institut d'Investigació Germans Trias i Pujol (IGTP), Barcelona, Spain
| | - Jordi Aceitón
- Departament de Salut, Centre d’Estudis Epidemiològics sobre les Infeccions de Transmissió Sexual i Sida de Catalunya (CEEISCAT), Barcelona, Spain
- Institut d'Investigació Germans Trias i Pujol (IGTP), Barcelona, Spain
| | - Josep M Llibre
- Infectious Disease Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Pere Domingo
- Department of Infectious Diseases, HIV Infection Unit, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Maria Saumoy
- Department of Infectious Diseases, Hospital Universitari de Bellvitge, Institute of Biomedical Research of Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Spain
| | - Francesc Homar
- Department of Internal Medicine, Hospital de Son Llàtzer, Palma, Spain
| | - Francisco Fanjul
- Hospital Universitario Son Espases, Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain
| | - Jordi Navarro
- Department of Infectious Diseases, Hospital Universitari Vall d’Hebron, Vall d'Hebron Research Institute (VHIR), Barcelona, Spain
| | - Lorena de la Mora
- Hospital Clínic-Institut d’Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
| | - Hernando Knobel
- Department of Internal Medicine-Infectious Diseases, Hospital del Mar, Barcelona, Spain
| | - Amat Orti
- Internal Medicine and Infectious Disease Service, Hospital Verge de la Cinta, Tortosa, Spain
| | - Raquel Martin-Iguacel
- Departament de Salut, Centre d’Estudis Epidemiològics sobre les Infeccions de Transmissió Sexual i Sida de Catalunya (CEEISCAT), Barcelona, Spain
- Department of Infectious Diseases, Odense University Hospital, Odense, Denmark
| | - José M Miró
- Hospital Clínic-Institut d’Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
- CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain
| | - Jordi Casabona
- Departament de Salut, Centre d’Estudis Epidemiològics sobre les Infeccions de Transmissió Sexual i Sida de Catalunya (CEEISCAT), Barcelona, Spain
- Institut d'Investigació Germans Trias i Pujol (IGTP), Barcelona, Spain
- CIBER Epidemiologia y Salud Pública (CIBERESP), Barcelona, Spain
- Departament de Pediatria, d’Obstetrícia i Ginecologia i de Medicina Preventiva i de Salut Publica, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Juliana Reyes-Urueña
- Departament de Salut, Centre d’Estudis Epidemiològics sobre les Infeccions de Transmissió Sexual i Sida de Catalunya (CEEISCAT), Barcelona, Spain
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Derby N, Biswas S, Yusova S, Luevano-Santos C, Pacheco MC, Meyer KA, Johnson BI, Fischer M, Fancher KA, Fisher C, Abraham YM, McMahon CJ, Lutz SS, Smedley JV, Burwitz BJ, Sodora DL. SIV Infection Is Associated with Transient Acute-Phase Steatosis in Hepatocytes In Vivo. Viruses 2024; 16:296. [PMID: 38400071 PMCID: PMC10892327 DOI: 10.3390/v16020296] [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: 11/01/2023] [Revised: 02/06/2024] [Accepted: 02/09/2024] [Indexed: 02/25/2024] Open
Abstract
Metabolic-dysfunction-associated fatty liver disease (MAFLD) is a major cause of morbidity and mortality in HIV-infected individuals, even those receiving optimal antiretroviral therapy. Here, we utilized the SIV rhesus macaque model and advanced laparoscopic techniques for longitudinal collection of liver tissue to elucidate the timing of pathologic changes. The livers of both SIV-infected (N = 9) and SIV-naïve uninfected (N = 8) macaques were biopsied and evaluated at four time points (weeks -4, 2, 6, and 16-20 post-infection) and at necropsy (week 32). SIV DNA within the macaques' livers varied by over 4 logs at necropsy, and liver SIV DNA significantly correlated with SIV RNA in the plasma throughout the study. Acute phase liver pathology (2 weeks post-infection) was characterized by evidence for fat accumulation (microvesicular steatosis), a transient elevation in both AST and cholesterol levels within the serum, and increased hepatic expression of the PPARA gene associated with cholesterol metabolism and beta oxidation. By contrast, the chronic phase of the SIV infection (32 weeks post-infection) was associated with sinusoidal dilatation, while steatosis resolved and concentrations of AST and cholesterol remained similar to those in uninfected macaques. These findings suggest differential liver pathologies associated with the acute and chronic phases of infection and the possibility that therapeutic interventions targeting metabolic function may benefit liver health in people newly diagnosed with HIV.
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Affiliation(s)
- Nina Derby
- Center for Global Infectious Disease Research, Seattle Children’s Research Institute, Seattle, WA 98109, USA
| | - Sreya Biswas
- Vaccine and Gene Therapy Institute, Oregon Health and Science University, Beaverton, OR 97006, USA
- Oregon National Primate Research Center, Beaverton, OR 97006, USA
| | - Sofiya Yusova
- Vaccine and Gene Therapy Institute, Oregon Health and Science University, Beaverton, OR 97006, USA
- Oregon National Primate Research Center, Beaverton, OR 97006, USA
| | - Cristina Luevano-Santos
- Center for Global Infectious Disease Research, Seattle Children’s Research Institute, Seattle, WA 98109, USA
| | | | - Kimberly A. Meyer
- Center for Global Infectious Disease Research, Seattle Children’s Research Institute, Seattle, WA 98109, USA
| | - Brooke I. Johnson
- Center for Global Infectious Disease Research, Seattle Children’s Research Institute, Seattle, WA 98109, USA
| | - Miranda Fischer
- Vaccine and Gene Therapy Institute, Oregon Health and Science University, Beaverton, OR 97006, USA
- Oregon National Primate Research Center, Beaverton, OR 97006, USA
| | - Katherine A. Fancher
- Center for Global Infectious Disease Research, Seattle Children’s Research Institute, Seattle, WA 98109, USA
| | - Cole Fisher
- Center for Global Infectious Disease Research, Seattle Children’s Research Institute, Seattle, WA 98109, USA
| | - Yohannes M. Abraham
- Center for Global Infectious Disease Research, Seattle Children’s Research Institute, Seattle, WA 98109, USA
| | - Conor J. McMahon
- Vaccine and Gene Therapy Institute, Oregon Health and Science University, Beaverton, OR 97006, USA
- Oregon National Primate Research Center, Beaverton, OR 97006, USA
| | - Savannah S. Lutz
- Vaccine and Gene Therapy Institute, Oregon Health and Science University, Beaverton, OR 97006, USA
- Oregon National Primate Research Center, Beaverton, OR 97006, USA
| | - Jeremy V. Smedley
- Vaccine and Gene Therapy Institute, Oregon Health and Science University, Beaverton, OR 97006, USA
- Oregon National Primate Research Center, Beaverton, OR 97006, USA
| | - Benjamin J. Burwitz
- Vaccine and Gene Therapy Institute, Oregon Health and Science University, Beaverton, OR 97006, USA
- Oregon National Primate Research Center, Beaverton, OR 97006, USA
| | - Donald L. Sodora
- Center for Global Infectious Disease Research, Seattle Children’s Research Institute, Seattle, WA 98109, USA
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Mendez Valdez MJ, Lu VM, Kim E, Rivas SR, Govindarajan V, Ivan M, Komotar R, Nath A, Heiss JD, Shah AH. Glioblastoma multiforme in patients with human immunodeficiency virus: an integrated review and analysis. J Neurooncol 2022; 159:571-579. [PMID: 35857248 DOI: 10.1007/s11060-022-04095-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 06/14/2022] [Accepted: 07/09/2022] [Indexed: 11/24/2022]
Abstract
INTRODUCTION As lifespans for persons living with HIV (PLWH) have improved over the last decade, there has been a simultaneous increase in non-AIDS-related cancer in that group. However, there is a paucity of data regarding the incidence of glioblastoma multiforme (GBM) in PLWH. Better understanding of the oncogenesis, natural history, and treatment outcomes of GBM in PLWH should lead to improved treatment strategies. METHODS We performed a comprehensive literature search of six electronic databases to identify eligible cases of GBM among PLWH. Kaplan-Meier estimates, Fisher's exact test, and logistic regression were used to interrogate the data. Epidemiologic data on global HIV prevalence was obtained from the 2016 UNAIDS incidence report, and CNS cancer incidence was obtained from the GDB 2016 Brain and Other CNS Cancer Collaborators. RESULTS There is an inverse relationship between the incidence of HIV and CNS cancer globally. Median overall survival (OS) from GBM diagnosis was 8 months. Estimates for survival at 1 and 2 years were 28 and 5%, respectively. There were no statistically significant predictors of OS in this setting. There was a significant difference (p < 0.01) in OS in PLWH and GBM when compared to TCGA age matched cohorts. CONCLUSION The diagnosis of GBM in PLWH is severely underreported in the literature. Despite maximal treatment, OS in this patient population is significantly less than in HIV-negative people. There was a poor prognosis of GBM in PLWH, which is inconsistent with previous reports. Further investigation is required for PLWH and concomitant GBM. Analyses must consider if HAART is maintained in PLWH during GBM treatment.
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Affiliation(s)
| | - Victor M Lu
- Miller School of Medicine, University of Miami, Miami, USA
| | - Enoch Kim
- College of Osteopathic Medicine, Nova Southeastern University, Davie, USA
| | - Sarah R Rivas
- National Institutes of Health/National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA
| | | | - Michael Ivan
- Miller School of Medicine, University of Miami, Miami, USA
| | | | - Avindra Nath
- National Institutes of Health/National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA
| | - John D Heiss
- National Institutes of Health/National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA
| | - Ashish H Shah
- Miller School of Medicine, University of Miami, Miami, USA
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Muñoz Hornero C, Muriel A, Montero M, Iribarren JA, Masía M, Muñoz L, Sampériz G, Navarro G, Moreno S, Pérez-Elías MJ. Differences in epidemiology and mortality between men and women with HIV infection in the CoRIS cohort from 2004 to 2014. ACTA ACUST UNITED AC 2021; 39:372-382. [PMID: 34373227 DOI: 10.1016/j.eimce.2021.07.003] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 05/19/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION This study sought to analyse differences in epidemiology and survival between women and men living with HIV (WLHIV and MLHIV) in the CoRIS cohort and the course of their disease over a 10-year period. METHODS Variables of interest between WLHIV and MLHIV were compared. A trend analysis was performed using the Mantel-Haenszel test. Kaplan-Meier survival curves and a Cox regression analysis were used to study survival. RESULTS A total of 10,469 people were enrolled; of them, 1,742 (16.6%) were women. At the time of enrolment in the cohort, WLHIV, compared to MLHIV, had higher rates of transmission due to intravenous drug use (IDU), hepatitis C virus (HCV) coinfection, AIDS-stage disease and foreign origin. They also had a worse immunovirological status and a lower educational level. These differences were maintained in the trend study. Regarding age, the women included in the cohort were older whereas the men were younger. In the comparative analysis between women according to place of origin, we found that the group of Spanish WLHIV featured older women with higher rates of IDU transmission and HCV coinfection, whereas the group of WLHIV born outside of Spain featured women with higher rates of syphilis infection. There were no major differences in relation to other characteristics such as educational level or disease status. Although sex was not a determinant of survival, conditions more prevalent in women were determinants of survival. CONCLUSIONS HIV-infected women presented at diagnosis with certain epidemiological and HIV-associated characteristics that made them more vulnerable. These trends became more marked or did not improve during the years of observation.
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Affiliation(s)
| | - Alfonso Muriel
- Unidad de Bioestadística Clínica, Hospital Ramón y Cajal, YRICIS, CIBERESP, Madrid, Spain
| | - Marta Montero
- Servicio de Enfermedades Infecciosas, Hospital La Fe, Valencia, Spain
| | - José Antonio Iribarren
- Servicio de Enfermedades Infecciosas, Hospital Universitario Donostia, San Sebastián, Spain
| | - Mar Masía
- Servicio de Enfermedades Infecciosas, Hospital de Elche, Elche, Alicante, Spain
| | - Leopoldo Muñoz
- Servicio de Enfermedades Infecciosas, Hospital San Cecilio, Granada, Spain
| | - Gloria Sampériz
- Servicio de Enfermedades Infecciosas, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Gemma Navarro
- Servicio de Enfermedades Infecciosas, Hospital Parc Taulí, Sabadell, Barcelona, Spain
| | - Santiago Moreno
- Servicio de Enfermedades Infecciosas, Hospital Ramón y Cajal, Madrid, Spain
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Muñoz Hornero C, Muriel A, Montero M, Iribarren JA, Masía M, Muñoz L, Sampériz G, Navarro G, Moreno S, Pérez-Elías MJ. Differences in epidemiology and mortality between men and women with HIV infection in the CoRIS cohort from 2004 to 2014. Enferm Infecc Microbiol Clin 2020; 39:S0213-005X(20)30220-2. [PMID: 32680794 DOI: 10.1016/j.eimc.2020.05.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 05/14/2020] [Accepted: 05/19/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION This study sought to analyse differences in epidemiology and survival between women and men living with HIV in the CoRIS cohort and the course of their disease over a 10-year period. METHODS Variables of interest between women living with HIV and men living with HIV were compared. A trend analysis was performed using the Mantel-Haenszel test. Kaplan-Meier survival curves and a Cox regression analysis were used to study survival. RESULTS A total of 10,469 people were enrolled; of them, 1,742 (16.6%) were women. At the time of enrolment in the cohort, women living with HIV, compared to men living with HIV, had higher rates of transmission due to intravenous drug use (IDU), hepatitisC virus (HCV) coinfection, AIDS-stage disease and foreign origin. They also had a worse immunovirological status and a lower educational level. These differences were maintained in the trend study. Regarding age, the women included in the cohort were older whereas the men were younger. In the comparative analysis between women according to place of origin, we found that the group of Spanish women living with HIV featured older women with higher rates of IDU transmission and HCV coinfection, whereas the group of women living with HIV born outside of Spain featured women with higher rates of syphilis infection. There were no major differences in relation to other characteristics such as educational level or disease status. Although sex was not a determinant of survival, conditions more prevalent in women were determinants of survival. CONCLUSIONS HIV-infected women presented at diagnosis with certain epidemiological and HIV-associated characteristics that made them more vulnerable. These trends became more marked or did not improve during the years of observation.
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Affiliation(s)
| | - Alfonso Muriel
- Unidad de Bioestadística Clínica, Hospital Ramón y Cajal. YRICIS. CIBERESP, Madrid, España
| | - Marta Montero
- Servicio de Enfermedades Infecciosas, Hospital La Fe, Valencia, España
| | - José Antonio Iribarren
- Servicio de Enfermedades Infecciosas, Hospital Universitario Donostia, San Sebastián, España
| | - Mar Masía
- Servicio de Enfermedades Infecciosas, Hospital de Elche, Elche, Alicante, España
| | - Leopoldo Muñoz
- Servicio de Enfermedades Infecciosas, Hospital San Cecilio, Granada, España
| | - Gloria Sampériz
- Servicio de Enfermedades Infecciosas, Hospital Universitario Miguel Servet, Zaragoza, España
| | - Gemma Navarro
- Servicio de Enfermedades Infecciosas, Hospital Parc Taulí, Sabadell, Barcelona, España
| | - Santiago Moreno
- Servicio de Enfermedades Infecciosas, Hospital Ramón y Cajal, Madrid, España
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Abstract
While the interactions between HIV and various liver cell populations have been explored, the relevance of these interactions when patients are well-controlled on ART is less clear. Therefore, we focus this perspective on HIV-related alterations that may drive hepatic inflammation and fibrosis in aviremic patients, with a focus on Kupffer cells and Hepatic Stellate Cells. Persistent CD4+ T cell depletion in the gut resulting in increased gut permeability has been postulated to play a role in systemic immune activation in HIV patients. The liver, with its unique location, remains the gatekeeper between the gut and the systemic circulation. The resident liver macrophage, Kupffer cell, is responsible for clearing and responding to these products. We propose that changes in Kupffer cell biology, in the context of HIV infection, creates a mileu that drives hepatic inflammation and fibrosis in response to microbial translocation. Targeting these pathways may be helpful in improving liver-related outcomes in HIV patients.
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Affiliation(s)
- Lumin Zhang
- Divison of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Meena B Bansal
- Divison of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, NY, United States
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Sellier P, Hamet G, Brun A, Ponscarme D, De Castro N, Alexandre G, Rozenbaum W, Molina JM, Abgrall S. Mortality of People Living with HIV in Paris Area from 2011 to 2015. AIDS Res Hum Retroviruses 2020; 36:373-380. [PMID: 31565958 DOI: 10.1089/aid.2019.0143] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
In high-income countries, causes of death in people living with HIV (PLHIV) have changed. Three French national surveys from 2000 to 2010 showed a decrease in AIDS-related and an increase in non-AIDS-related deaths. Deaths notified in PLHIV followed between January 1, 2011 and December 31, 2015 in 1 of 13 participating hospitals northeast of Paris area were described. Risk factors for death were assessed, using a multivariable logistic regression model. Of 14,403 individuals, 295 died. Median age at death was 52 years (interquartile range = 47-60) and 77% were men. Sixty-seven individuals (23%) died from non-AIDS-defining nonviral hepatitis-related (NaNH) malignancy, 40 (14%) from AIDS, 34 (12%) from cardiovascular disease (CVD), 33 (11%) from non-AIDS infection, 21 (7%) from liver disease, and 12 (4%) from suicide. Men and women born in sub-Saharan Africa had a lower adjusted odds ratio (aOR) of dying than men having sex with men (MSM) born in France (0.70, 95% confidence interval = 0.45-1.09; and 0.45, 0.28-0.73, respectively). Risk factors for death were older age (aOR = 2.26, 1.36-3.77 for 40-49 years and 2.91, 1.75-4.84 for >50 years vs. 18-39 years), male intravenous drug users (IVDU) transmission (2.24, 1.42-3.54 vs. MSM born in France), AIDS (2.75, 2.10-3.59), antiretroviral therapy initiation in earlier periods, time since HIV diagnosis <1 year, low CD4 cell count nadir, hepatitis B virus and/or hepatitis C virus coinfection (1.69, 1.23-2.30), and psychiatric disorders (1.73, 1.27-2.38). Our study confirms the increasing frequency of non-AIDS-related deaths, mainly NaNH malignancies and CVD, in PLHIV, justifying overall and in some specific populations (psychiatric and IVDU) prevention and screening.
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Affiliation(s)
- Pierre Sellier
- Department of Internal Medicine, Saint-Louis-Lariboisière-Fernand Widal Hospital, AP-HP, Paris, France
| | - Gwenn Hamet
- COREVIH Ile de France Est, Saint-Louis Hospital, Paris, France
| | - Alexandre Brun
- COREVIH Ile de France Est, Saint-Louis Hospital, Paris, France
| | - Diane Ponscarme
- Department of Infectious Diseases, Saint-Louis-Lariboisière-Fernand Widal Hospital, AP-HP, Paris, France
| | - Nathalie De Castro
- Department of Infectious Diseases, Saint-Louis-Lariboisière-Fernand Widal Hospital, AP-HP, Paris, France
| | | | - Willy Rozenbaum
- COREVIH Ile de France Est, Saint-Louis Hospital, Paris, France
- Department of Infectious Diseases, Saint-Louis-Lariboisière-Fernand Widal Hospital, AP-HP, Paris, France
| | - Jean-Michel Molina
- Department of Infectious Diseases, Saint-Louis-Lariboisière-Fernand Widal Hospital, AP-HP, Paris, France
- University Paris Diderot, Paris, France
| | - Sophie Abgrall
- Department of Infectious Diseases, Avicenne Hospital, AP-HP, Bobigny, France
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Toegel F, Holtyn AF, Pollock S, Rodewald AM, Leoutsakos JM, Fingerhood M, Silverman K. Effects of incentivizing viral suppression in previously incarcerated adults living with HIV. HIV Res Clin Pract 2020; 21:1-10. [PMID: 32133931 DOI: 10.1080/25787489.2020.1735816] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 12/21/2022]
Abstract
Background: The amount of HIV in a person's blood can be suppressed to an undetectable level through antiretroviral therapy medications (ART). Adhering to an ART regimen can improve a person's health and reduce HIV transmission. Despite these benefits, many people with HIV do not maintain the level of adherence required to achieve an undetectable viral load. This problem is particularly common among people who have been incarcerated.Objective: To determine effects of incentivizing viral suppression in previously incarcerated adults with HIV.Methods: Adults with HIV (N = 102) and detectable viral load (>200 copies/mL) were randomly assigned to a Usual Care or Incentive group. Usual Care participants did not earn incentives for viral suppression. Incentive participants earned incentives ($10/day maximum) for providing blood samples with a reduced or undetectable (<200 copies/mL) viral load. Assessments were conducted every 3 months. Results collected during the first year were aggregated and compared based on group assignment and incarceration history.Results: Previously incarcerated participants in the Incentive group provided more (OR: 2.9; CI: 1.3-6.8; p <.05) blood samples with an undetectable viral load (69%) than those in the Usual Care group (41%). Never-incarcerated participants in the Incentive group provided more (OR: 6.8; CI: 2.2-21.0; p <.01) blood samples with an undetectable viral load (78%) than those in the Usual Care group (36%). Effects of incentives did not differ by incarceration history.Conclusions: Incentivizing viral suppression can increase viral suppression (undetectable viral load) in people who have been incarcerated.
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Affiliation(s)
- Forrest Toegel
- Department of Psychiatry and Behavioral Sciences, Center for Learning and Health, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - August F Holtyn
- Department of Psychiatry and Behavioral Sciences, Center for Learning and Health, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sarah Pollock
- Department of Psychiatry and Behavioral Sciences, Center for Learning and Health, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Andrew M Rodewald
- Department of Psychiatry and Behavioral Sciences, Center for Learning and Health, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jeannie-Marie Leoutsakos
- Department of Psychiatry and Behavioral Sciences, Center for Learning and Health, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Michael Fingerhood
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kenneth Silverman
- Department of Psychiatry and Behavioral Sciences, Center for Learning and Health, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Subramaniam S, Getty CA, Holtyn AF, Rodewald A, Katz B, Jarvis BP, Leoutsakos JS, Fingerhood M, Silverman K. Evaluation of a Computer-Based HIV Education Program for Adults Living with HIV. AIDS Behav 2019; 23:3152-64. [PMID: 30929150 DOI: 10.1007/s10461-019-02474-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
This study evaluated a computer-delivered HIV and antiretroviral treatment education program in adults (N = 102) living with detectable HIV viral loads (> 200 copies/mL). The self-paced program provided immediate feedback for responses and financial incentives for responding correctly. The program was divided into three courses and a test of content from all three courses was delivered before and after participants completed each course. Test scores on the content delivered in Courses 1, 2 and 3 improved only after participants completed training on the relevant course. Initial test scores were positively correlated with health literacy and academic achievement; were negatively correlated with viral load; and were lowest for participants living in poverty. Education, academic achievement, and health literacy were related to how much participants learned following each course. Computer-based education is a convenient, effective approach to promoting an understanding of HIV and its treatment.
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10
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Leone S, Lorenzini P, Cozzi-Lepri A, Orofino G, Bernacchia D, Castagna A, Menozzi M, Guaraldi G, Madeddu G, Di Biagio A, Puoti M, Gori A, d'Arminio Monforte A. Impact of diabetes on the risk of serious liver events and liver-related deaths in people living with HIV and hepatitis C co-infection: data from the ICONA Foundation Cohort Study. Eur J Clin Microbiol Infect Dis 2019; 38:1857-1865. [PMID: 31230205 DOI: 10.1007/s10096-019-03618-8] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 06/14/2019] [Indexed: 12/29/2022]
Abstract
To investigate the association between diabetes and HCV infection in persons living with HIV and to determine the impact of diabetes on the occurrence of serious liver events (SLEs) and liver-related deaths (LRDs) among HIV/HCV-co-infected patients. Patients were included if they had at least one follow-up visit. In a cross-sectional analysis among all HIV patients, we have investigated the association between diabetes and HCV infection. A further longitudinal analysis was performed in the population of HIV/HCV-co-infected free from SLE with FIB-4 index < 3.25 at baseline, using the following endpoints: (A) first event between SLE and LRD; (B) liver fibrosis progression defined as the first of two consecutive FIB-4 > 3.25; (C) first event between SLE, LRD, and liver fibrosis progression. Data from 15,571 HIV patients were analyzed: 2944 (18.9%) were HCV-Ab positive, and 739 (4.7%) presented a diagnosis of diabetes at their last follow-up. Among HIV/HCV-co-infected population, 107 patients had a diagnosis of diabetes. Viremic HCV-co-infected patients had 3-fold risk of diabetes onset than HCV-uninfected patients. On HIV/HCV-co-infected population, 85 SLEs/LRDs occurred over 20,410 person-years of follow-up (PYFU), for an incidence rate of 4.2/1000 PYFU (95%CI 3.4-5.2). Diabetic patients had 3-fold risk of pooled SLE and LRD than patients without diabetes. Furthermore, viremic HCV infection was independently associated with a higher risk of SLE/LRD (aIRR 3.35 [95%CI 1.14-9.83]). In HIV-infected patients, viremic HCV co-infection is a strong predictor of diabetes. Among HIV/HCV-co-infected population, diabetic patients showed an increased risk of SLE/LRD compared with those without diabetes.
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Affiliation(s)
- Sebastiano Leone
- Division of Infectious Diseases, Department of Internal Medicine, San Giuseppe Moscati Hospital, Contrada Amoretta, 83100, Avellino, Italy.
| | | | | | | | - Dario Bernacchia
- Infectious Diseases Unit, ASST Fatebenefratelli-Sacco, DIBIC 'L. Sacco', University of Milan, Milan, Italy
| | - Antonella Castagna
- Infectious Diseases Department, IRCCS San Raffaele Scientific Institute & Vita-Salute University, Milan, Italy
| | - Marianna Menozzi
- Clinic of Infectious Diseases, University of Modena and Reggio Emilia, Modena, Italy
| | - Giovanni Guaraldi
- Clinic of Infectious Diseases, University of Modena and Reggio Emilia, Modena, Italy
| | - Giordano Madeddu
- Infectious Diseases Unit, Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy
| | - Antonio Di Biagio
- Infectious Diseases Unit, Policlinico San Martino Hospital, Genoa, Italy
| | - Massimo Puoti
- Infectious Diseases Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Andrea Gori
- Infectious Diseases Unit, Department of Internal Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Pathophysiology and Transplantation, School of Medicine and Surgery, University of Milan, Milan, Italy
| | - Antonella d'Arminio Monforte
- Clinic of Infectious and Tropical Diseases, Department of Health Sciences, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
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11
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Fisher BS, Green RR, Brown RR, Wood MP, Hensley-McBain T, Fisher C, Chang J, Miller AD, Bosche WJ, Lifson JD, Mavigner M, Miller CJ, Gale M, Silvestri G, Chahroudi A, Klatt NR, Sodora DL. Liver macrophage-associated inflammation correlates with SIV burden and is substantially reduced following cART. PLoS Pathog 2018; 14:e1006871. [PMID: 29466439 PMCID: PMC5837102 DOI: 10.1371/journal.ppat.1006871] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [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: 06/29/2017] [Revised: 03/05/2018] [Accepted: 01/09/2018] [Indexed: 12/19/2022] Open
Abstract
Liver disease is a leading contributor to morbidity and mortality during HIV infection, despite the use of combination antiretroviral therapy (cART). The precise mechanisms of liver disease during HIV infection are poorly understood partially due to the difficulty in obtaining human liver samples as well as the presence of confounding factors (e.g. hepatitis co-infection, alcohol use). Utilizing the simian immunodeficiency virus (SIV) macaque model, a controlled study was conducted to evaluate the factors associated with liver inflammation and the impact of cART. We observed an increase in hepatic macrophages during untreated SIV infection that was associated with a number of inflammatory and fibrosis mediators (TNFα, CCL3, TGFβ). Moreover, an upregulation in the macrophage chemoattractant factor CCL2 was detected in the livers of SIV-infected macaques that coincided with an increase in the number of activated CD16+ monocyte/macrophages and T cells expressing the cognate receptor CCR2. Expression of Mac387 on monocyte/macrophages further indicated that these cells recently migrated to the liver. The hepatic macrophage and T cell levels strongly correlated with liver SIV DNA levels, and were not associated with the levels of 16S bacterial DNA. Utilizing in situ hybridization, SIV-infected cells were found primarily within portal triads, and were identified as T cells. Microarray analysis identified a strong antiviral transcriptomic signature in the liver during SIV infection. In contrast, macaques treated with cART exhibited lower levels of liver macrophages and had a substantial, but not complete, reduction in their inflammatory profile. In addition, residual SIV DNA and bacteria 16S DNA were detected in the livers during cART, implicating the liver as a site on-going immune activation during antiretroviral therapy. These findings provide mechanistic insights regarding how SIV infection promotes liver inflammation through macrophage recruitment, with implications for in HIV-infected individuals.
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Affiliation(s)
- Bridget S. Fisher
- Center for Infectious Disease Research, formally Seattle Biomedical Research Institute, Seattle, Washington, United States of America
| | - Richard R. Green
- Center for Innate Immunity and Immune Disease, Department of Immunology, University of Washington, Seattle, Washington, United States of America
| | - Rachel R. Brown
- Center for Infectious Disease Research, formally Seattle Biomedical Research Institute, Seattle, Washington, United States of America
| | - Matthew P. Wood
- Center for Infectious Disease Research, formally Seattle Biomedical Research Institute, Seattle, Washington, United States of America
| | - Tiffany Hensley-McBain
- Department of Pharmaceutics, Washington National Primate Research Center, University of Washington, Seattle, Washington, United States of America
| | - Cole Fisher
- Center for Infectious Disease Research, formally Seattle Biomedical Research Institute, Seattle, Washington, United States of America
| | - Jean Chang
- Center for Innate Immunity and Immune Disease, Department of Immunology, University of Washington, Seattle, Washington, United States of America
| | - Andrew D. Miller
- Cornell University College of Veterinary Medicine, Department of Biomedical Sciences, Section of Anatomic Pathology, Ithaca, New York, United States of America
| | - William J. Bosche
- AIDS and Cancer Virus Program, Leidos Biomedical Research, Inc., Frederick National Laboratory for Cancer Research, Frederick, Maryland, United States of America
| | - Jeffrey D. Lifson
- AIDS and Cancer Virus Program, Leidos Biomedical Research, Inc., Frederick National Laboratory for Cancer Research, Frederick, Maryland, United States of America
| | - Maud Mavigner
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia, United States of America
| | - Charlene J. Miller
- Department of Pharmaceutics, Washington National Primate Research Center, University of Washington, Seattle, Washington, United States of America
| | - Michael Gale
- Center for Innate Immunity and Immune Disease, Department of Immunology, University of Washington, Seattle, Washington, United States of America
| | - Guido Silvestri
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia, United States of America
- Emory Vaccine Research Center and, Yerkes National Primate Research Center, Atlanta, Georgia, United States of America
| | - Ann Chahroudi
- Emory Vaccine Research Center and, Yerkes National Primate Research Center, Atlanta, Georgia, United States of America
- Emory University School of Medicine, Department of Pediatrics, Atlanta, Georgia, United States of America
| | - Nichole R. Klatt
- Department of Pharmaceutics, Washington National Primate Research Center, University of Washington, Seattle, Washington, United States of America
| | - Donald L. Sodora
- Center for Infectious Disease Research, formally Seattle Biomedical Research Institute, Seattle, Washington, United States of America
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12
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Fiore M, Cascella M, Bimonte S, Maraolo AE, Gentile I, Schiavone V, Pace MC. Liver fungal infections: an overview of the etiology and epidemiology in patients affected or not affected by oncohematologic malignancies. Infect Drug Resist 2018; 11:177-186. [PMID: 29416363 PMCID: PMC5790101 DOI: 10.2147/idr.s152473] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Fungal infections of the liver, most commonly caused by Candida spp., often occur in patients with hematologic malignancies treated with chemotherapy. Colonization of the gastrointestinal tract is thought to be the main origin of dissemination of Candida; mucositis and neutropenia facilitate the spread of Candida from the gastrointestinal tract to the liver. Hepatic involvement due to other fungi is a less common infectious complication in this setting. Fungal infections represent a less common cause of hepatic abscesses in non-oncohematologic population and the trend appears to be decreasing in recent years. Understanding of the etiology and epidemiology of fungal infections of the liver is indicated for an appropriate antimicrobial therapy and an overall optimal management of fungal liver infections.
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Affiliation(s)
- Marco Fiore
- Department of Anaesthesiological, Surgical and Emergency Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Marco Cascella
- Department of Support for Clinical Activities and Critical Area, Division of Anesthesia and Pain Medicine, Istituto Nazionale Tumori - IRCCS "Fondazione G. Pascale", Via Mariano Semmola, Naples, Italy
| | - Sabrina Bimonte
- Department of Support for Clinical Activities and Critical Area, Division of Anesthesia and Pain Medicine, Istituto Nazionale Tumori - IRCCS "Fondazione G. Pascale", Via Mariano Semmola, Naples, Italy
| | - Alberto Enrico Maraolo
- Department of Clinical Medicine and Surgery, Section of Infectious Diseases, University of Naples Federico II, Naples, Italy
| | - Ivan Gentile
- Department of Clinical Medicine and Surgery, Section of Infectious Diseases, University of Naples Federico II, Naples, Italy
| | - Vincenzo Schiavone
- Division of Anesthesia and Intensive Care, Hospital "Pineta Grande", Castel Volturno, Italy
| | - Maria Caterina Pace
- Department of Anaesthesiological, Surgical and Emergency Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
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13
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Leone S, Shanyinde M, Cozzi Lepri A, Lampe FC, Caramello P, Costantini A, Giacometti A, De Luca A, Cingolani A, Ceccherini Silberstein F, Puoti M, Gori A, d'Arminio Monforte A; ICONA Foundation Cohort Study. Incidence and predictors of single drug discontinuation according to the presence of HCV coinfection in HIV patients from the ICONA Foundation Cohort Study. Eur J Clin Microbiol Infect Dis 2018; 37:871-81. [PMID: 29318459 DOI: 10.1007/s10096-017-3180-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 12/25/2017] [Indexed: 10/18/2022]
Abstract
To evaluate incidence rates of and predictors for any antiretroviral (ART) drug discontinuation by HCV infection status in a large Italian cohort of HIV infected patients. All patients enrolled in ICONA who started combination antiretroviral therapy (cART) containing abacavir or tenofovir or emtricitabine or lamivudine plus efavirenz or rilpivirine or atazanavir/r or darunavir/r (DRV/r) or lopinavir/r or dolutegravir or elvitegravir or raltegravir were included. Multivariate Poisson regression models were used to determine factors independently associated with single ART drug discontinuation. Inverse probability weighting method to control for potential informative censoring was applied. Data from 10,637 patients were analyzed and 1,030 (9.7%) were HCV-Ab positive. Overall, there were 15,464 ART discontinuations due to any reason in 82,415.9 person-years of follow-up (PYFU) for an incidence rate (IR) of 18.8 (95% confidence interval [95%CI] 18.5-19.1) per 100 PYFU. No difference in IR of ART discontinuation due to any reason between HCV-infected and -uninfected patients was found. In a multivariable Poisson regression model, HCV-infected participants were at higher risk of darunavir/r discontinuation due to any reason (adjusted incidence rate ratio = 1.5, 95%CI 1.01-2.22, p value = 0.045) independently of demographics, HIV-related, ART and life-style factors. Among DRV/r treated patients, we found that HCV-viremic patients had twice the risk of ART discontinuation due to any reason than HCV-aviremic patients. In conclusion, HIV/HCV coinfected patients had a marginal risk increase of DRV/r discontinuation due to any reason compared with those without coinfection.
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14
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Brandt CP, Paulus DJ, Jardin C, Heggeness L, Lemaire C, Zvolensky MJ. Examining anxiety sensitivity as an explanatory construct underlying HIV-related stigma: Relations to anxious arousal, social anxiety, and HIV symptoms among persons living with HIV. J Anxiety Disord 2017; 48:95-101. [PMID: 27527687 PMCID: PMC5293677 DOI: 10.1016/j.janxdis.2016.08.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [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: 07/04/2016] [Revised: 08/04/2016] [Accepted: 08/05/2016] [Indexed: 12/01/2022]
Abstract
Persons living with HIV (PLHIV) are a health disparity subgroup of the overall population for mental and physical health problems. HIV-related stigma has been shown to increase anxiety symptoms and HIV symptoms among PLHIV. However, little is known about factors that may impact the relations between HIV-related stigma and anxiety symptoms and HIV symptoms among PLHIV. To address this gap in the literature, the current study examined anxiety sensitivity (i.e., the extent to which individuals believe anxiety and anxiety-related sensations) in the relation between HIV-related stigma, social anxiety, anxious arousal, and HIV symptoms among a sample of 87 PLHIV (60.9% cis gender male, 52.9% Black, non-Hispanic). Results indicated that anxiety sensitivity mediated the relations between HIV-related stigma and the dependent variables, with effect sizes indicating moderate to large effects of anxiety sensitivity on these relations. Findings suggest that anxiety sensitivity be a mechanistic factor in the relations between HIV-related stigma and social anxiety, anxious arousal, and HIV symptoms, and therefore, be important element in efforts to reduce mental/physical health disparity among this population.
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Affiliation(s)
- Charles P. Brandt
- University of Houston, Department of Psychology. 3695 Cullen Blvd. Room 126, Houston, Texas 77204,Baylor College of Medicine. 1 Baylor Plaza, Houston, Texas 77030,Corresponding author may be reached at
| | - Daniel J. Paulus
- University of Houston, Department of Psychology. 3695 Cullen Blvd. Room 126, Houston, Texas 77204
| | - Charles Jardin
- University of Houston, Department of Psychology. 3695 Cullen Blvd. Room 126, Houston, Texas 77204
| | - Luke Heggeness
- Kent State University, Department of Psychology. 144 Kent Hall, Kent, Ohio 44242
| | - Chad Lemaire
- Legacy Community Health. 1415 California St, Houston, Texas 77006
| | - Michael J. Zvolensky
- University of Houston, Department of Psychology. 3695 Cullen Blvd. Room 126, Houston, Texas 77204,The University of Texas MD Anderson Cancer Center, Department of Behavioral Science. 1515 Holcombe Blvd, Houston, Texas 77030
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15
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Eyawo O, Franco-Villalobos C, Hull MW, Nohpal A, Samji H, Sereda P, Lima VD, Shoveller J, Moore D, Montaner JSG, Hogg RS. Changes in mortality rates and causes of death in a population-based cohort of persons living with and without HIV from 1996 to 2012. BMC Infect Dis 2017; 17:174. [PMID: 28241797 PMCID: PMC5329918 DOI: 10.1186/s12879-017-2254-7] [Citation(s) in RCA: 73] [Impact Index Per Article: 10.4] [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: 08/30/2016] [Accepted: 02/08/2017] [Indexed: 12/22/2022] Open
Abstract
Background Non-HIV/AIDS-related diseases are gaining prominence as important causes of morbidity and mortality among people living with HIV. The purpose of this study was to characterize and compare changes over time in mortality rates and causes of death among a population-based cohort of persons living with and without HIV in British Columbia (BC), Canada. Methods We analysed data from the Comparative Outcomes And Service Utilization Trends (COAST) study; a retrospective population-based study created via linkage between the BC Centre for Excellence in HIV/AIDS and Population Data BC, and containing data for HIV-infected individuals and the general population of BC, respectively. Our analysis included all known HIV-infected adults (≥ 20 years) in BC and a random 10% sample of uninfected BC adults followed from 1996 to 2012. Deaths were identified through Population Data BC – which contains information on all registered deaths in BC (BC Vital Statistics Agency dataset) and classified into cause of death categories using International Classification of Diseases (ICD) 9/10 codes. Age-standardized mortality rates (ASMR) and mortality rate ratios were calculated. Trend test were performed. Results 3401 (25%), and 47,647 (9%) individuals died during the 5,620,150 person-years of follow-up among 13,729 HIV-infected and 510,313 uninfected individuals, respectively. All-cause and cause-specific mortality rates were consistently higher among HIV-infected compared to HIV-negative individuals, except for neurological disorders. All-cause ASMR decreased from 126.75 (95% CI: 84.92-168.57) per 1000 population in 1996 to 21.29 (95% CI: 17.79-24.79) in 2011-2012 (83% decline; p < 0.001 for trend), compared to a change from 7.97 (95% CI: 7.61-8.33) to 6.87 (95% CI: 6.70-7.04) among uninfected individuals (14% decline; p < 0.001). Mortality rates from HIV/AIDS-related causes decreased by 94% from 103.85 per 1000 population in 1996 to 6.72 by the 2011–2012 era (p < 0.001). Significant ASMR reductions were also observed for hepatic/liver disease and drug abuse/overdose deaths. ASMRs for neurological disorders increased significantly over time. Non-AIDS-defining cancers are currently the leading non-HIV/AIDS-related cause of death in both HIV-infected and uninfected individuals. Conclusions Despite the significant mortality rate reductions observed among HIV-infected individuals from 1996 to 2012, they still have excess mortality risk compared to uninfected individuals. Additional efforts are needed to promote effective risk factor management and appropriate screening measures among people living with HIV.
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Affiliation(s)
- Oghenowede Eyawo
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, Canada.,Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Conrado Franco-Villalobos
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, Canada
| | - Mark W Hull
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, Canada
| | | | - Hasina Samji
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
| | - Paul Sereda
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, Canada
| | - Viviane D Lima
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, Canada
| | - Jeannie Shoveller
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - David Moore
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, Canada
| | - Julio S G Montaner
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, Canada.,Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Robert S Hogg
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, Canada. .,Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada.
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16
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Choy W, Lagman C, Lee SJ, Bui TT, Safaee M, Yang I. Impact of Human Immunodeficiency Virus in the Pathogenesis and Outcome of Patients with Glioblastoma Multiforme. Brain Tumor Res Treat 2016; 4:77-86. [PMID: 27867916 PMCID: PMC5114196 DOI: 10.14791/btrt.2016.4.2.77] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [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: 07/01/2016] [Revised: 07/10/2016] [Accepted: 07/18/2016] [Indexed: 12/25/2022] Open
Abstract
Background Improvement in antiviral therapies have been accompanied by an increased frequency of non-Acquired Immune Deficiency Syndrome (AIDS) defining malignancies, such as glioblastoma multiforme. Here, we investigated all reported cases of human immunodeficiency virus (HIV)-positive patients with glioblastoma and evaluated their clinical outcomes. A comprehensive review of the molecular pathogenetic mechanisms underlying glioblastoma development in the setting of HIV/AIDS is provided. Methods We performed a PubMed search using keywords “HIV glioma” AND “glioblastoma,” and “AIDS glioma” AND “glioblastoma.” Case reports and series describing HIV-positive patients with glioblastoma (histologically-proven World Health Organization grade IV astrocytoma) and reporting on HAART treatment status, clinical follow-up, and overall survival (OS), were included for the purposes of quantitative synthesis. Patients without clinical follow-up data or OS were excluded. Remaining articles were assessed for data extraction eligibility. Results A total of 17 patients met our inclusion criteria. Of these patients, 14 (82.4%) were male and 3 (17.6%) were female, with a mean age of 39.5±9.2 years (range 19–60 years). Average CD4 count at diagnosis of glioblastoma was 358.9±193.4 cells/mm3. Tumor progression rather than AIDS-associated complications dictated patient survival. There was a trend towards increased median survival with HAART treatment (12.0 vs 7.5 months, p=0.10) Conclusion Our data suggests that HAART is associated with improved survival in patients with HIV-associated glioblastoma, although the precise mechanisms underlying this improvement remain unclear.
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Affiliation(s)
- Winward Choy
- Department of Neurosurgery, University of California, Los Angeles, Los Angeles, CA, USA
| | - Carlito Lagman
- Department of Neurosurgery, University of California, Los Angeles, Los Angeles, CA, USA
| | - Seung J Lee
- Department of Neurosurgery, University of California, Los Angeles, Los Angeles, CA, USA
| | - Timothy T Bui
- Department of Neurosurgery, University of California, Los Angeles, Los Angeles, CA, USA
| | - Michael Safaee
- Department of Neurosurgery, University of California, Los Angeles, Los Angeles, CA, USA
| | - Isaac Yang
- Department of Neurosurgery, University of California, Los Angeles, Los Angeles, CA, USA.; Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles, CA, USA
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17
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Trickey A, May MT, Vehreschild J, Obel N, Gill MJ, Crane H, Boesecke C, Samji H, Grabar S, Cazanave C, Cavassini M, Shepherd L, d’Arminio Monforte A, Smit C, Saag M, Lampe F, Hernando V, Montero M, Zangerle R, Justice AC, Sterling T, Miro J, Ingle S, Sterne JAC. Cause-Specific Mortality in HIV-Positive Patients Who Survived Ten Years after Starting Antiretroviral Therapy. PLoS One 2016; 11:e0160460. [PMID: 27525413 PMCID: PMC4985160 DOI: 10.1371/journal.pone.0160460] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [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: 04/28/2016] [Accepted: 07/19/2016] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVES To estimate mortality rates and prognostic factors in HIV-positive patients who started combination antiretroviral therapy between 1996-1999 and survived for more than ten years. METHODS We used data from 18 European and North American HIV cohort studies contributing to the Antiretroviral Therapy Cohort Collaboration. We followed up patients from ten years after start of combination antiretroviral therapy. We estimated overall and cause-specific mortality rate ratios for age, sex, transmission through injection drug use, AIDS, CD4 count and HIV-1 RNA. RESULTS During 50,593 person years 656/13,011 (5%) patients died. Older age, male sex, injecting drug use transmission, AIDS, and low CD4 count and detectable viral replication ten years after starting combination antiretroviral therapy were associated with higher subsequent mortality. CD4 count at ART start did not predict mortality in models adjusted for patient characteristics ten years after start of antiretroviral therapy. The most frequent causes of death (among 340 classified) were non-AIDS cancer, AIDS, cardiovascular, and liver-related disease. Older age was strongly associated with cardiovascular mortality, injecting drug use transmission with non-AIDS infection and liver-related mortality, and low CD4 and detectable viral replication ten years after starting antiretroviral therapy with AIDS mortality. Five-year mortality risk was <5% in 60% of all patients, and in 30% of those aged over 60 years. CONCLUSIONS Viral replication, lower CD4 count, prior AIDS, and transmission via injecting drug use continue to predict higher all-cause and AIDS-related mortality in patients treated with combination antiretroviral therapy for over a decade. Deaths from AIDS and non-AIDS infection are less frequent than deaths from other non-AIDS causes.
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Affiliation(s)
- Adam Trickey
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
| | - Margaret T. May
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
| | - Janne Vehreschild
- German Centre for Infection Research, partner site Bonn-Cologne, Cologne, Germany
- Department I for Internal Medicine, University Hospital of Cologne, Cologne, Germany
| | - Niels Obel
- Department of Infectious Diseases, Copenhagen University Hospital, Copenhagen, Denmark
| | - Michael John Gill
- Division of Infectious Diseases, University of Calgary, Calgary, Canada
| | - Heidi Crane
- Center for AIDS Research, University of Washington, Seattle, WA, United States of America
| | | | - Hasina Samji
- Epidemiology and Population Health Program, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada, and Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Sophie Grabar
- Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1136, Institut Pierre Louis d’Epidémiologie et de Santé Publique, F-75013, Paris, France
- INSERM, UMR_S 1136, Institut Pierre Louis d’Epidémiologie et de Santé Publique, F-75013, Paris, France
- Université Paris Descartes et Assistance Publique-Hôpitaux de Paris, Groupe hospitalier Cochin Hôtel-Dieu, Paris, France
| | - Charles Cazanave
- Centre Hospitalier Universitaire de Bordeaux, Hôpital Pellegrin, Bordeaux, F-33000, France
| | - Matthias Cavassini
- Service of Infectious Diseases, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Leah Shepherd
- Research Department of Infection and Population Health, UCL Medical School, London, United Kingdom
| | | | - Colette Smit
- Stichting HIV Monitoring, Amsterdam, the Netherlands
| | - Michael Saag
- Division of Infectious Disease, Department of Medicine, University of Alabama, Birmingham, United States of America
| | - Fiona Lampe
- Research Department of Infection and Population Health, UCL Medical School, London, United Kingdom
| | - Vicky Hernando
- Red de Investigación en Sida, Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Avda. Monforte de Lemos, 5 28029, Madrid, Spain
| | | | | | - Amy C. Justice
- Yale University School of Medicine, New Haven, CT, United States of America, and VA Connecticut Healthcare System, West Haven, CT, United States of America
| | - Timothy Sterling
- Vanderbilt University School of Medicine, Nashville, TN, United States of America
| | - Jose Miro
- Hospital Clínic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Suzanne Ingle
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
| | - Jonathan A. C. Sterne
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
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Leone S, Prosperi M, Costarelli S, Nasta P, Maggiolo F, Di Giambenedetto S, Saracino A, Di Pietro M, Gori A. Incidence and predictors of cardiovascular disease, chronic kidney disease, and diabetes in HIV/HCV-coinfected patients who achieved sustained virological response. Eur J Clin Microbiol Infect Dis 2016; 35:1511-20. [PMID: 27272121 DOI: 10.1007/s10096-016-2692-y] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Accepted: 05/20/2016] [Indexed: 12/19/2022]
Abstract
Data on the effects of sustained virologic response (SVR) to hepatitis C virus (HCV) therapy on the outcome of extrahepatic complications are scarce. We conducted this study to assess the impact of SVR on the occurrence of chronic kidney disease (CKD), diabetes mellitus (DM), and cardiovascular disease (CVD) in a cohort of human immunodeficiency virus (HIV)-infected patients. We analyzed coinfected HIV/HCV patients in the Management of Standardized Evaluation of Retroviral HIV Infection (MASTER) cohort. Only event-free patients with a serum HCV-RNA determination at baseline were included. Patients were divided into four groups: INF-exposed with SVR; INF-exposed without SVR; spontaneous HCV clearance; untreated viremic patients. We estimated the incidence of extrahepatic complications and employed Kaplan-Meier curves and Cox regression to assess the association of SVR/INF strata adjusted for a series of confounders. Data from 1676 patients were analyzed (20.29 % started an INF-based regimen). Overall, the incidence of CKD, DM, CVD, and death was 5.32 [95 % confidence interval (CI) 3.99-6.98], 10.13 (95 % CI 8.20-12.37), 6.79 (95 % CI 5.26-8.65), and 13.49 (95 % CI 11.29-16.0) per 1000 person-years of follow-up, respectively. In the Cox model for treated patients, SVR was not associated with a lower risk of CKD, DM, CVD, and death compared to non-SVR. Cirrhosis was significantly associated with a higher risk of CKD [hazard ratio (HR) 2.13; 95 % CI 1.06-4.31], DM (HR 3.48; 95 % CI 2.18-5.57), and death (HR 6.18; 95 % CI 4.1-9.31), but not of CVD (HR 1.14; 95 % CI 0.57-2.3). There are still many unknowns regarding the impact of SVR on the occurrence of extrahepatic complications in coinfected HIV/HCV patients. Further investigations are needed in order to elucidate the role of SVR as an independent prognostic factor for extrahepatic events.
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Affiliation(s)
- S Leone
- Infectious Diseases Division, "San Gerardo" Hospital, University of Milano-Bicocca, Monza, Italy. .,Infectious Diseases Division, "San Giuseppe Moscati" Hospital, Avellino, Italy.
| | - M Prosperi
- Department of Epidemiology, University of Florida, Gainesville, FL, USA
| | - S Costarelli
- Infectious Diseases Division, "San Gerardo" Hospital, University of Milano-Bicocca, Monza, Italy
| | - P Nasta
- University Department of Infectious and Tropical Diseases, University of Brescia and Brescia Spedali Civili General Hospital, Brescia, Italy
| | - F Maggiolo
- Infectious Diseases Division, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy
| | | | - A Saracino
- Clinic of Infectious Diseases, Policlinico Hospital, University of Bari, Bari, Italy
| | - M Di Pietro
- Infectious Diseases Division, "Santa Maria Annunziata" Hospital, Florence, Italy
| | - A Gori
- Infectious Diseases Division, "San Gerardo" Hospital, University of Milano-Bicocca, Monza, Italy
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Farahani M, Mulinder H, Farahani A, Marlink R. Prevalence and distribution of non-AIDS causes of death among HIV-infected individuals receiving antiretroviral therapy: a systematic review and meta-analysis. Int J STD AIDS 2016; 28:636-650. [DOI: 10.1177/0956462416632428] [Citation(s) in RCA: 89] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
The advent of antiretroviral therapy has significantly improved AIDS-related morbidity and mortality. Yet, among people living with HIV, deaths due to non-AIDS-defining illnesses have been on the rise. The objective of this study was to provide information about the global prevalence and distribution of non-AIDS causes of death in the last ten years among people living with HIV receiving antiretroviral therapy, by income levels of countries. We used broad search terms in Google Scholar, PubMed, and EMBASE to identify all studies that investigated the cause of death among people living with HIV receiving antiretroviral therapy, published after January 1, 2005. References were also identified from review articles and reference lists. Inclusion criteria were English language, the study’s end date was after 2005, all patients were HIV-positive, at least two-thirds of the patients were receiving antiretroviral therapy, at least one patient died of non-AIDS causes of death. Titles, abstracts, and articles were reviewed by at least two independent readers. Of 2951 titles identified in our original search, 151 articles were selected for further screening. We identified 19 studies meeting our full criteria, with patients from 55 different nations. Pooled non-AIDS causes of death prevalence estimates in high-income countries were 53.0% (95% confidence interval, 43.6–62.3), in developing countries 34.0% (95% confidence interval, 20.3–49.1), and in sub-Saharan countries 18.5% (95% confidence interval, 13.8–23.7). Statistically significant variation was noted within and between categories. Our findings show that a significant number of people living with HIV across the world die from cardiovascular disease, non-AIDS malignancies, and liver disease. There is a global need for further scrutiny in all regions to improve preventive measures and early detection according to distinct causes of death patterns.
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Affiliation(s)
| | - Holly Mulinder
- Texas Tech University Health Sciences Center, School of Medicine, Lubbock, TX, USA
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20
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Brandt CP, Sheppard DP, Zvolensky MJ, Morgan EE, Atkinson JH, Woods SP. Does Age Influence the Frequency of Anxiety Symptoms and Disorders in HIV Disease? J HIV AIDS Soc Serv 2016; 15:380-403. [PMID: 28070173 PMCID: PMC5218542 DOI: 10.1080/15381501.2016.1189865] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Affiliation(s)
- Charles P Brandt
- Department of Psychology, University of Houston, 126 Heyne Building, Houston, Texas, 77004, United States
| | - David P Sheppard
- Department of Psychology, University of Houston, 126 Heyne Building, Houston, Texas, 77004, United States
| | - Michael J Zvolensky
- Department of Psychology, University of Houston, 126 Heyne Building, Houston, Texas, 77004, United States; Department of Behavioral Sciences, University of Texas MD Anderson Cancer Center, 1515 Holcomb Blvd. Houston, Texas, 77030, United States
| | - Erin E Morgan
- Department of Psychiatry, 220 Dickinson Street, Suite B, University of California, San Diego, San Diego, California 92103, United States
| | - J Hampton Atkinson
- Department of Psychiatry, 220 Dickinson Street, Suite B, University of California, San Diego, San Diego, California 92103, United States
| | - Steven Paul Woods
- Department of Psychology, University of Houston, 126 Heyne Building, Houston, Texas, 77004, United States; Department of Psychiatry, 220 Dickinson Street, Suite B, University of California, San Diego, San Diego, California 92103, United States
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Kim SK, Choi JA, Kim MH, Kim MS, Lee KC. Gender Reassignment Surgery in Human Immunodeficiency Virus-Positive Patients: A Report of Two Cases. Arch Plast Surg 2015; 42:776-82. [PMID: 26618127 DOI: 10.5999/aps.2015.42.6.776] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Revised: 08/04/2015] [Accepted: 09/07/2015] [Indexed: 11/08/2022] Open
Abstract
It is believed that surgery on human immunodeficiency virus (HIV)-positive patients is dangerous and should be avoided due to the possibility of postoperative infection of the patients or HIV occupational transmission to the medical staff. We discuss here the preparations and measures needed to conduct surgery safely on HIV-positive patients, based on our experience. We performed sex reassignment surgery on two HIV-positive patients from January 2013 to January 2015. Both of them were receiving highly active antiretroviral therapy and were asymptomatic, with a normal CD4 count (>500 cells/µL). The HIV-RNA was undetectable within the bloodstream. All the staff wore protective clothing, glasses, and three pairs of protective gloves in the operating room because of the possibility of transmission. Prophylactic antibiotics were administered to the patients, and antiviral therapy was performed during their perioperative course. Neither of the patients had postoperative complications, and none of the medical staff experienced accidental exposure. Both patients had satisfactory surgery outcomes without complications. HIV-positive patients can undergo surgery safely without increased risk of postoperative complications or HIV transmission to the staff through the proper use of antibiotics, active antiretroviral therapy, and supplemental protective measures with post-exposure prophylaxis for the staff in case of HIV exposure.
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Stenkvist J, Weiland O, Sönnerborg A, Blaxhult A, Falconer K. High HCV treatment uptake in the Swedish HIV/HCV co-infected cohort. ACTA ACUST UNITED AC 2014; 46:624-32. [DOI: 10.3109/00365548.2014.921932] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Ingle SM, May MT, Gill MJ, Mugavero MJ, Lewden C, Abgrall S, Fätkenheuer G, Reiss P, Saag MS, Manzardo C, Grabar S, Bruyand M, Moore D, Mocroft A, Sterling TR, D'Arminio Monforte A, Hernando V, Teira R, Guest J, Cavassini M, Crane HM, Sterne JAC. Impact of risk factors for specific causes of death in the first and subsequent years of antiretroviral therapy among HIV-infected patients. Clin Infect Dis 2014; 59:287-97. [PMID: 24771333 PMCID: PMC4073781 DOI: 10.1093/cid/ciu261] [Citation(s) in RCA: 106] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Among HIV-infected patients who initiated antiretroviral therapy (ART), patterns of cause-specific death varied by ART duration and were strongly related to age, sex, and transmission risk group. Deaths from non-AIDS malignancies were much more frequent than those from cardiovascular disease. Background. Patterns of cause-specific mortality in individuals infected with human immunodeficiency virus type 1 (HIV-1) are changing dramatically in the era of antiretroviral therapy (ART). Methods. Sixteen cohorts from Europe and North America contributed data on adult patients followed from the start of ART. Procedures for coding causes of death were standardized. Estimated hazard ratios (HRs) were adjusted for transmission risk group, sex, age, year of ART initiation, baseline CD4 count, viral load, and AIDS status, before and after the first year of ART. Results. A total of 4237 of 65 121 (6.5%) patients died (median, 4.5 years follow-up). Rates of AIDS death decreased substantially with time since starting ART, but mortality from non-AIDS malignancy increased (rate ratio, 1.04 per year; 95% confidence interval [CI], 1.0–1.1). Higher mortality in men than women during the first year of ART was mostly due to non-AIDS malignancy and liver-related deaths. Associations with age were strongest for cardiovascular disease, heart/vascular, and malignancy deaths. Patients with presumed transmission through injection drug use had higher rates of all causes of death, particularly for liver-related causes (HRs compared with men who have sex with men: 18.1 [95% CI, 6.2–52.7] during the first year of ART and 9.1 [95% CI, 5.8–14.2] thereafter). There was a persistent role of CD4 count at baseline and at 12 months in predicting AIDS, non-AIDS infection, and non-AIDS malignancy deaths. Lack of viral suppression on ART was associated with AIDS, non-AIDS infection, and other causes of death. Conclusions. Better understanding of patterns of and risk factors for cause-specific mortality in the ART era can aid in development of appropriate care for HIV-infected individuals and inform guidelines for risk factor management.
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Affiliation(s)
- Suzanne M Ingle
- School of Social and Community Medicine, University of Bristol, United Kingdom
| | - Margaret T May
- School of Social and Community Medicine, University of Bristol, United Kingdom
| | - M John Gill
- Division of Infectious Diseases, University of Calgary, Canada
| | - Michael J Mugavero
- Division of Infectious Disease, Department of Medicine, University of Alabama, Birmingham
| | - Charlotte Lewden
- INSERM, Centre INSERM U897-Epidemiologie-Biostatistique, Bordeaux Université Bordeaux, Institut de Santé Publique, d'Epidémiologie et de Developpement (ISPED)
| | - Sophie Abgrall
- UPMC Université Paris 06, UMR_S 943 INSERM, UMR_S 943, Paris Service des maladies infectieuses et tropicales, AP-HP, Hôpital Avicenne, Bobigny, France
| | | | - Peter Reiss
- Stichting HIV Monitoring, and Division of Infectious Diseases and Department of Global Health, Amsterdam Institute for Global Health and Development, Academic Medical Center, University of Amsterdam, The Netherlands
| | - Michael S Saag
- Division of Infectious Disease, Department of Medicine, University of Alabama, Birmingham
| | | | - Sophie Grabar
- INSERM, UMR_S 943, Paris AP-HP, Hôpital Cochin, Unité de Biostatistique et Epidémiologie, Paris Université Paris Descartes
| | - Mathias Bruyand
- INSERM, ISPED, Centre Inserm U897-Epidemiologie-Biostatistique, Bordeaux, France
| | - David Moore
- BC Centre for Excellence in HIV/AIDS, Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Amanda Mocroft
- Research Department of Infection and Population Health, University College London, United Kingdom
| | | | | | - Victoria Hernando
- Red de Investigación en Sida, Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid CIBER de Epidemiología y Salud Pública, Madrid
| | - Ramon Teira
- Unit of Infectious Diseases, Hospital Sierrallana, Torrelavega, Spain
| | - Jodie Guest
- HIV Atlanta VA Cohort Study, Atlanta Veterans Affairs Medical Center, Decatur, Georgia
| | - Matthias Cavassini
- Service of Infectious Diseases, Lausanne University Hospital and University of Lausanne, Switzerland
| | - Heidi M Crane
- Clinical Epidemiology and Health Services Research Core, Center for AIDS Research, University of Washington, Seattle
| | - Jonathan A C Sterne
- School of Social and Community Medicine, University of Bristol, United Kingdom
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Althoff KN, Jacobson LP, Cranston RD, Detels R, Phair JP, Li X, Margolick JB. Age, comorbidities, and AIDS predict a frailty phenotype in men who have sex with men. J Gerontol A Biol Sci Med Sci 2014; 69:189-98. [PMID: 24127428 PMCID: PMC4038242 DOI: 10.1093/gerona/glt148] [Citation(s) in RCA: 157] [Impact Index Per Article: 15.7] [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: 05/14/2013] [Accepted: 07/24/2013] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Adults aging with HIV infection are at risk for age-related comorbidities and syndromes, such as frailty. The objective of this study was to evaluate the expression and predictors of the frailty phenotype (FP) among HIV-infected (HIV+) and HIV-uninfected (HIV-) men who have sex with men. METHODS A prospective, observational cohort study was nested in the Multicenter AIDS Cohort Study from October 2007-September 2011. FP conversion was defined as the onset of FP over two consecutive study visits. Adjusted odds ratios and 95% confidence intervals ([,]) for FP conversion were estimated using logistic regression models with generalized estimating equations. RESULTS Of 10,571 completed study visits from 1,946 men who have sex with men, 12% and 9% were FP+ among HIV+ and HIV- men, respectively (p = .002). The proportion of FP+ visits increased with age regardless of HIV status, but was significantly greater in HIV+ compared to HIV- men aged 50-64 years. Of the 10,276 consecutive visit pairs contributed by participants, 5% (537) were classified as FP conversion, and 45% of the men with FP conversion had only one FP+ study visit. FP conversion was significantly associated with a history of AIDS (adjusted odds ratios = 2.26 [1.50, 3.39], but not with HIV+ alone (adjusted odds ratios = 1.26 [0.98, 1.64]). Among men who had one or more FP+ visits, 34% of HIV+ and 38% of HIV- men had less than two comorbidities. CONCLUSIONS These findings suggest that expression of the FP can be measured in men who have sex with men with and without HIV infection and reflects multisystem dysfunction in this population; further investigations are needed to better understand clinical utility.
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Affiliation(s)
- Keri N Althoff
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St., Rm E7142, Baltimore, MD 21205.
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25
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Abstract
Combination antiretroviral therapy has resulted in longer life expectancies in persons living with HIV; however, end organ disease and death from organ failure have become growing issues for this population. With effective therapies for viral suppression, HIV is no longer considered an absolute contraindication to organ transplantation. Over the past decade, studies of transplantation in patients with HIV have had encouraging results such that patients with organ failure are pursuing transplantation. This review focuses on the current status of organ transplantation for HIV-infected persons.
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Affiliation(s)
- Valentina Stosor
- Divisions of Infectious Diseases and Organ Transplantation and Comprehensive Transplant Center, Northwestern University Feinberg School of Medicine, 645 North Michigan Avenue, Suite 900, Chicago, IL, 60611, USA,
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Adeyemi O, Livak B. Higher Veterans Aging Cohort Study (VACS) Index Scores in HIV-Positive Adults With CD4 counts <200 cells/mm3 Despite Viral Suppression. J Acquir Immune Defic Syndr 2013; 63:e78-81. [DOI: 10.1097/qai.0b013e318291854b] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Tate JP, Justice AC, Hughes MD, Bonnet F, Reiss P, Mocroft A, Nattermann J, Lampe FC, Bucher HC, Sterling TR, Crane HM, Kitahata MM, May M, Sterne JAC. An internationally generalizable risk index for mortality after one year of antiretroviral therapy. AIDS 2013; 27:563-72. [PMID: 23095314 PMCID: PMC4283204 DOI: 10.1097/qad.0b013e32835b8c7f] [Citation(s) in RCA: 148] [Impact Index Per Article: 13.5] [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
OBJECTIVE Despite the success of antiretroviral therapy (ART), excess mortality continues for those with HIV infection. A comprehensive approach to risk assessment, addressing multiorgan system injury on ART, is needed. We sought to develop and validate a practical and generalizable mortality risk index for HIV-infected individuals on ART. DESIGN AND METHODS The Veterans Aging Cohort Study (VACS) was used to develop the VACS Index, based on age, CD4 cell count, HIV-1 RNA, hemoglobin, aspartate and alanine transaminase, platelets, creatinine and hepatitis C status, and a Restricted Index based on age, CD4 cell count and HIV-1 RNA with an outcome of death up to 6 years after ART initiation. Validation was in six independent cohorts participating in the ART Cohort Collaboration (ART-CC). RESULTS In both the development (4932 patients, 656 deaths) and validation cohorts (3146 patients, 86 deaths) the VACS Index had better discrimination than the Restricted Index (c-statistics 0.78 and 0.72 in VACS, 0.82 and 0.78 in ART-CC). The VACS Index also demonstrated better discrimination than the Restricted Index for HIV deaths and non-HIV deaths, in men and women, those younger and older than 50 years, with and without detectable HIV-1 RNA, and with or without HCV coinfection. CONCLUSIONS Among HIV-infected patients treated with ART, the VACS Index more accurately discriminates mortality risk than traditional HIV markers and age alone. By accounting for multiorgan system injury, the VACS Index may prove a useful tool in clinical care and research.
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Affiliation(s)
- Janet P Tate
- Yale University School of Medicine, West Haven, CT, USA.
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Borghi V, Bisi L, Manzini L, Cossarizza A, Mussini C. Absence of liver steatosis in HIV-HCV co-infected patients receiving regimens containing tenofovir or abacavir. Infection 2013; 41:425-9. [PMID: 23225268 DOI: 10.1007/s15010-012-0378-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2012] [Accepted: 11/24/2012] [Indexed: 12/31/2022]
Abstract
BACKGROUND In human immunodeficiency virus-hepatitis C virus (HIV-HCV) co-infected patients, steatosis has been independently associated with a number of antiretroviral drugs, including stavudine, especially in patients with non-3 HCV genotypes. We retrospectively investigated the presence of steatosis among HIV-HCV co-infected and HCV mono-infected patients, and the role of tenofovir disoproxil fumarate (TDF) or abacavir (ABC) in determining hepatic steatosis. METHODS Liver steatosis was retrospectively evaluated in all consecutive biopsies performed in the period 2000-2008 in HCV mono-infected and HIV-HCV co-infected patients. A steatosis rate of >5 % was considered to be significant, and a multivariate logistic analysis was performed to evaluate factors associated with steatosis. RESULTS In total, 393 HCV-infected patients underwent liver biopsy during the study period, of whom 205 (52.2 %) were co-infected with HIV. A steatosis rate of >5 % was diagnosed in 33.0 % of HCV mono-infected and in 47.8 % of HIV-HCV co-infected patients (P = 0.003). The rate of steatosis was higher in patients resuming antiretroviral therapy (54.7 %) than in naïve patients (33.3 %; P = 0.006). When the overall population was considered, steatosis was associated to HCV genotype 3 [odds ratio (OR) 4.53, 95 % confidence interval (CI) 2.71-7.58; P < 0.001]. In terms of the use of nucleos(t)ide drugs in HIV co-infected patients, multivariate analysis showed that only in patients with HCV genotypes other than genotype 3 was steatosis related to the use of stavudine (OR 5.38, 95 % CI 1.18-24.53; P = 0.03). The use of TDF (OR 1.07, 95 % CI 0.39-2.88; P = 0.898) or ABC (OR 0.592, 95 % CI 0.09-4.07; P = 0.594) was not associated with steatosis. CONCLUSION In HCV mono-infected and HIV-HCV co-infected patients, steatosis appears to be a virus-mediated effect of HCV genotype 3. In HIV patients infected with HCV genotypes other than genotype 3, the risk of developing steatosis was higher in those patients resuming antiretroviral regimens containing old drugs rather than the new antiretrovirals.
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Weber P, Eberle J, Bogner JR, Schrimpf F, Jansson V, Huber-Wagner S. Is there a benefit to a routine preoperative screening of infectivity for HIV, hepatitis B and C virus before elective orthopaedic operations? Infection 2012; 41:479-83. [PMID: 23225209 DOI: 10.1007/s15010-012-0373-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2012] [Accepted: 11/18/2012] [Indexed: 01/09/2023]
Abstract
PURPOSE Before elective operations, particularly orthopaedic surgery, national guidelines in Germany recommend testing for human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV) to reduce the risk of transmission of the virus through a needlestick or cutting injury. Such testing is expensive. The number of new and unknown diagnoses of viral infections that can be detected by routine screening has not yet been evaluated. METHODS The aim of our department of orthopaedic surgery is to screen every adult patient listed for an operation for HBV, HCV and HIV. We retrospectively analysed the number of operations in this single centre from 2001 to 2010, correlated this number with the total number of screens and calculated the number of newly diagnosed infections. An additional cost:benefit ratio was calculated. RESULTS A total of 20,869 operations were performed by the department between 2001 and 2010. After exclusion of all interventions in children and all patients who had multiple operations, 15,482 patients remained. Test results were found for 10,011 of these patients during this period (screening rate 65 %). Of those screened, in only four cases (0.4 ‰) was a previously unknown infection detected. CONCLUSIONS Two-thirds of the patients included in our study actually underwent screening; this rate was lower than expected. The incidence of newly detected infections was low, putting the benefit of a routine preoperative screening for HBV, HCV and HIV into question. From an economic point of view the low detection rate is a strong argument in favour of omitting routine preoperative screening. Screening only those patients with risk factors may be as safe as screening every patient and would help reduce costs.
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Affiliation(s)
- P Weber
- Department of Orthopedic Surgery, University Hospital, Ludwig-Maximilians-University (LMU), Campus Grosshadern, Marchioninistr. 15, 81377, Munich, Germany.
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Madeddu G, Fois AG, Calia GM, Babudieri S, Soddu V, Becciu F, Fiori ML, Spada V, Lovigu C, Mannazzu M, Caddeo A, Piras B, Pirina P, Mura MS. Chronic obstructive pulmonary disease: an emerging comorbidity in HIV-infected patients in the HAART era? Infection 2013; 41:347-53. [PMID: 22971938 DOI: 10.1007/s15010-012-0330-x] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2012] [Accepted: 08/29/2012] [Indexed: 12/14/2022]
Abstract
PURPOSE The objective of our study was to evaluate the presence of respiratory symptoms and chronic obstructive pulmonary disease (COPD) in a human immunodeficiency virus (HIV)-infected outpatient population and to further investigate the role of highly active antiretroviral therapy (HAART) and other possibly associated risk factors. METHODS We consecutively enrolled in a cross-sectional study HIV-infected patients and HIV-negative age, sex and smoking status matched controls. All participants completed a questionnaire for pulmonary symptoms and underwent a complete spirometry. RESULTS We enrolled 111 HIV-infected patients and 65 HIV-negative age- and sex-matched controls. HIV-infected patients had a significantly higher prevalence of any respiratory symptom (p = 0.002), cough (p = 0.006) and dyspnoea (p = 0.02). HIV-infected patients also had a significantly higher prevalence of COPD in respect of HIV-negative controls (p = 0.008). Furthermore, HIV-infected individuals had significantly (p = 0.002) lower forced expiratory volume at one second (FEV1) and FEV1/forced vital capacity (FVC) ratio (Tiffeneau index) (p = 0.028), whereas the total lung capacity (TLC) was significantly higher (p = 0.018). In the multivariate analysis, significant predictors of respiratory symptoms were current smoking [adjusted odds ratio (AOR) 11.18; 95 % confidence interval (CI) 3.89-32.12] and previous bacterial pneumonia (AOR 4.41; 95 % CI 1.13-17.13), whereas the only significant predictor of COPD was current smoking (AOR 5.94; 95 % CI 1.77-19.96). HAART receipt was not associated with respiratory symptoms nor with COPD. CONCLUSIONS We evidenced a high prevalence of respiratory symptoms and COPD among HIV-infected patients. HIV infection, current cigarette smoking and previous bacterial pneumonia seem to play a significant role in the development of respiratory symptoms and COPD. Thus, our results suggest that the most at-risk HIV-infected patients should be screened for COPD to early identify those who may need specific treatment.
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Althoff KN, Buchacz K, Hall HI, Zhang J, Hanna DB, Rebeiro P, Gange SJ, Moore RD, Kitahata MM, Gebo KA, Martin J, Justice AC, Horberg MA, Hogg RS, Sterling TR, Cescon A, Klein MB, Thorne JE, Crane HM, Mugavero MJ, Napravnik S, Kirk GD, Jacobson LP, Brooks JT. U.S. trends in antiretroviral therapy use, HIV RNA plasma viral loads, and CD4 T-lymphocyte cell counts among HIV-infected persons, 2000 to 2008. Ann Intern Med 2012; 157:325-35. [PMID: 22944874 PMCID: PMC3534765 DOI: 10.7326/0003-4819-157-5-201209040-00005] [Citation(s) in RCA: 102] [Impact Index Per Article: 8.5] [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: 11/22/2022] Open
Abstract
BACKGROUND The U.S. National HIV/AIDS Strategy targets for 2015 include "increasing access to care and improving health outcomes for persons living with HIV in the United States" (PLWH-US). OBJECTIVE To demonstrate the utility of the NA-ACCORD (North American AIDS Cohort Collaboration on Research and Design) for monitoring trends in the HIV epidemic in the United States and to present trends in HIV treatment and related health outcomes. DESIGN Trends from annual cross-sectional analyses comparing patients from pooled, multicenter, prospective, clinical HIV cohort studies with PLWH-US, as reported to national surveillance systems in 40 states. SETTING U.S. HIV outpatient clinics. PATIENTS HIV-infected adults with 1 or more HIV RNA plasma viral load (HIV VL) or CD4 T-lymphocyte (CD4) cell count measured in any calendar year from 1 January 2000 to 31 December 2008. MEASUREMENTS Annual rates of antiretroviral therapy use, HIV VL, and CD4 cell count at death. RESULTS 45 529 HIV-infected persons received care in an NA-ACCORD-participating U.S. clinical cohort from 2000 to 2008. In 2008, the 26 030 NA-ACCORD participants in care and the 655 966 PLWH-US had qualitatively similar demographic characteristics. From 2000 to 2008, the proportion of participants prescribed highly active antiretroviral therapy increased by 9 percentage points to 83% (P < 0.001), whereas the proportion with suppressed HIV VL (≤2.7 log10 copies/mL) increased by 26 percentage points to 72% (P < 0.001). Median CD4 cell count at death more than tripled to 0.209 × 109 cells/L (P < 0.001). LIMITATION The usual limitations of observational data apply. CONCLUSION The NA-ACCORD is the largest cohort of HIV-infected adults in clinical care in the United States that is demographically similar to PLWH-US in 2008. From 2000 to 2008, increases were observed in the percentage of prescribed HAART, the percentage who achieved a suppressed HIV VL, and the median CD4 cell count at death. PRIMARY FUNDING SOURCE National Institutes of Health; Centers for Disease Control and Prevention; Canadian Institutes of Health Research; Canadian HIV Trials Network; and the government of British Columbia, Canada.
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Griffin AT, Arnold FW. Review of metabolic, immunologic, and virologic consequences of suboptimal vitamin D levels in HIV infection. AIDS Patient Care STDS 2012; 26:516-25. [PMID: 22861070 DOI: 10.1089/apc.2012.0145] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Low 25-hydroxyvitamin D levels are common in the general and HIV-infected populations alike. Defined as levels less than 30 ng/mL, suboptimal vitamin D is known to afflict over 70% of representative samples from each group in resource-rich countries with even greater prevalence in resource-poor regions of the world. In both those with and without HIV, dark skin, low vitamin D intake, exiguous exposure to sunlight, and season act as risk factors for suboptimal vitamin D levels. In those infected with HIV, antiretroviral therapy, particularly non-nucleoside reverse transcriptase inhibitors (NNRTIs), increase risk for low vitamin D as well. Furthermore, metabolic aberrations, including obesity and hyperlipidemia, and miscellaneous risk factors, such as advanced AIDS and substance abuse, have been linked to suboptimal vitamin D in those with HIV. While the skeletal and cardiovascular systems of HIV patients may be adversely impacted as a result of low levels, recent data have also linked low vitamin D to decreased CD4 counts, higher viral loads, and to critical end points including progression to AIDS events and death. More research is needed to confirm these potential consequences of low vitamin D in those with HIV and to discern the benefits of routine screening for and treatment of low vitamin D in this population.
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Affiliation(s)
- Allen T. Griffin
- School of Medicine, Department of Medicine, Division of Infectious Diseases, University of Louisville, Louisville, Kentucky
| | - Forest W. Arnold
- School of Medicine, Department of Medicine, Division of Infectious Diseases, University of Louisville, Louisville, Kentucky
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Jung N, Lehmann C, Rubbert A, Schömig E, Fätkenheuer G, Hartmann P, Taubert D. Organic cation transporters OCT1 and OCT2 determine the accumulation of lamivudine in CD4 cells of HIV-infected patients. Infection 2012; 41:379-85. [PMID: 22875535 DOI: 10.1007/s15010-012-0308-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2012] [Accepted: 07/12/2012] [Indexed: 01/09/2023]
Abstract
PURPOSE Identifying factors that determine concentrations of antiretroviral drugs in CD4 cells are important for improving therapeutic efficacy. Experimental models indicate that the nucleoside reverse transcriptase inhibitor lamivudine is transported by the organic cation transporters 1 and 2 (OCT1 and OCT2, respectively). Here, we tested whether OCT1 and OCT2 contribute to the uptake of lamivudine into native CD4 cells of human immunodeficiency virus (HIV)-infected individuals. METHODS CD4 cells obtained by non-activated cell sorting from 35 individuals with HIV-1 infection were incubated with lamivudine (10 μM, 30 min), and intracellular concentrations of lamivudine and its active metabolite lamivudine triphosphate were determined by liquid chromatography tandem mass spectrometry. The expression of OCT1 and OCT2 mRNA was measured by quantitative real-time polymerase chain reaction (PCR). A model of OCT2-transfected CD4 cells was established for mechanistic investigations. RESULTS Intracellular concentrations of lamivudine and its active metabolite lamivudine triphosphate showed strong linear correlations with each other and with the CD4 mRNA expression of OCT1 and OCT2 (r > 0.80). Coincubation with protease inhibitors (ritonavir, nelfinavir) that inhibit OCT1 and OCT2 yielded decreased intracellular concentrations of lamivudine and lamivudine triphosphate. Incubation of CD4 cells from healthy donors transfected with an OCT2 expression vector yielded increased concentrations of lamivudine and lamivudine triphosphate. CONCLUSION Our studies indicate a role of OCT1 and OCT2 for the cellular accumulation of lamivudine in HIV-infected individuals.
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Affiliation(s)
- N Jung
- First Department of Internal Medicine, Medical Hospital of the University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany.
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Thorsteinsson K, Ladelund S, Jensen-Fangel S, Larsen MV, Johansen IS, Katzenstein TL, Pedersen G, Storgaard M, Obel N, Lebech AM. Impact of gender on the risk of AIDS-defining illnesses and mortality in Danish HIV-1-infected patients: a nationwide cohort study. ACTA ACUST UNITED AC 2012; 44:766-75. [PMID: 22803607 DOI: 10.3109/00365548.2012.684220] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Gender differences in the risk of AIDS-defining illness (ADI) and mortality have been reported in the HIV-1-infected (HIV-positive) population, with conflicting findings. We aimed to assess the impact of gender on the risk of ADI and death in HIV-positive patients infected sexually. METHODS This was a population-based, nationwide cohort study of incident Danish HIV-positive individuals infected by sexual contact. Outcomes were progression to AIDS and death. We used Cox proportional hazards models and Poisson regression analyses to calculate the risk of progression to AIDS and mortality rate ratios (MRR) between risk groups and compared these with the general Danish population. RESULTS We identified 587 heterosexually infected women, 583 men who have sex with women (MSW), and 1089 men who have sex with men (MSM). The total follow-up time was 13,708 person-y. At the time of HIV diagnosis MSM had a lower prevalence of AIDS compared to MSW. Women and MSW presented more often with tuberculosis and less often with AIDS-defining cancers compared to MSM. In the adjusted analyses we observed no differences in progression to AIDS. In the adjusted analyses of risk of death, there were no differences between the 3 risk groups, although we saw a trend towards a higher risk of death in older MSW. MSM had a lower risk of death compared to the background population than women and MSW. CONCLUSIONS In the Danish HIV population, gender has no major impact on progression to AIDS or mortality. Differences in these factors between women, MSW, and MSM are mainly due to confounding from race and CD4 + cell count at diagnosis.
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Erlandson KM, Allshouse AA, Duong S, MaWhinney S, Kohrt WM, Campbell TB. HIV, aging, and advance care planning: are we successfully planning for the future? J Palliat Med 2012; 15:1124-9. [PMID: 22694717 DOI: 10.1089/jpm.2011.0510] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
INTRODUCTION Studies of advance care planning (ACP) completion rates in HIV-infected persons pre-date the "graying" of the HIV epidemic. We sought to examine current ACP completion rates and factors influencing completion among HIV-infected persons. METHODS HIV-1-seropositive persons aged 45-65 years on effective antiretroviral therapy for a minimum of 6 months were enrolled in a cross-sectional survey. Likelihood of ACP was assessed by demographic and clinical characteristics, tested with odds ratios (OR) and 95% Wald confidence intervals (CI), and adjusted for gender. RESULTS Of 238 participants, 112 (47%) completed ACP. Persons ≥55 years of age (OR 2.8; CI 1.6,5.0; p<0.001), males (OR 4.1; CI 1.8,9.3; p=0.004), and persons with higher education (OR 2.2; CI 1.3,4.0; p=0.007) were more likely to have completed ACP. Persons with a cardiac event were more likely to have completed ACP (OR 5.5; CI 1.6,25; p=0.03), although this effect was diminished after adjusting for gender (OR 4.5; CI 0.95,21.4; p=0.06). HIV infection diagnosed for greater than 5 years was not associated with ACP completion (OR 1.3; CI 0.7,2.7; p=0.4). Current CD4(+) cell counts were similar between those completing and not completing documentation (588 cells/μL and 604 cells/μL, respectively; p=0.7). The likelihood of ACP did not significantly differ with other comorbidities. DISCUSSION Less than 50% of middle-aged patients in HIV care had documented ACP. In particular, women and those with lower education were at greatest risk of non-completion and may need interventions to improve ACP.
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Affiliation(s)
- Kristine M Erlandson
- Department of Medicine, Division of Infectious Disease, University of Colorado-Anschutz Medical Campus, Aurora, Colorado 80045, USA.
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Touré A, Khanafer N, Baratin D, Bailly F, Livrozet JM, Trepo C, Peyramond D, Touraine JL, Vanhems P. First presentation for care of HIV-infected patients with low CD4 cell count in Lyon, France: risk factors and consequences for survival. AIDS Care 2012; 24:1272-6. [PMID: 22416893 DOI: 10.1080/09540121.2012.656574] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
To identify the risk factors associated with presentation for care with CD4 cell count ≤ 200 cells/mm(3) and death in HIV-infected patients in Lyon, France. Data were analyzed on participants from mid-1992 to December 2006 in the Lyon section of the French Hospital Database on HIV Infection. Patients were stratified into two categories according to CD4 cell count at first presentation for care in University of Lyon hospitals: Group 1 (Gr1) patients with CD4 ≤ 200 cells/mm(3) and Group 2 (Gr2) patients with CD4 >200 cells/mm(3). Multivariate logistic regression assessed the risk factors associated with first presentation for care with CD4 ≤ 200 cells/mm(3). Survival was analyzed according to the Cox regression model. Among 3569 eligible patients (838 females and 2731 males, mean age: 36.3 ± 10.3 years), 1139 (31.9%) were categorized as Gr1. The factors associated with first presentation for care with CD4 ≤ 200 cells/mm(3) were: older age, male gender, route of HIV transmission, migrant populations, geographical areas other than Rhône-Alpes, and access to care in 1992-1997. Overall mortality was higher in Gr1 than in Gr2 (24.4% [278/1139] vs. 4.1% [101/2430]; p<0.001). The risk of death was 5.81 [4.61-7.32] in Gr1 compared to Gr2. In addition to CD4 cell count, age and enrollment periods for care were factors independently related to death. Despite public health efforts in Lyon, one-third of HIV-infected patients reach the health care system with CD4 cell count ≤ 200 cells/mm(3), which was linked with higher mortality.
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Affiliation(s)
- Abdoulaye Touré
- Laboratory of Epidemiology and Public Health Unit, Lyon, France.
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Sodqi M, Marih L, Lahsen AO, Bensghir R, Chakib A, Himmich H, El Filali KM. [Causes of death among 91 HIV-infected adults in the era of potent antiretroviral therapy]. Presse Med 2012; 41:e386-90. [PMID: 22350063 DOI: 10.1016/j.lpm.2011.12.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [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] [Received: 06/23/2011] [Revised: 10/10/2011] [Accepted: 12/02/2011] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To describe the causes of death occurring during the antiretroviral therapy in Casablanca. METHODS Retrospective study of a cohort of HIV positive patients attending the infectious diseases unit of Casablanca receiving antiretroviral therapy. Files of 91 patients who died were analyzed. RESULTS Since June 1999, 1243 patients were treated and 91 deaths occurred (7, 3%). The mean age at time of death was 36 years. Forty-six patients were male (50, 5%) and 86 were stage C (94, 5%). At the initiation of treatment, mean CD4 count was 96 cells/mL (1-626) and mean plasma HIV- RNA was 5, 65 log10. They have received antiretroviral therapy for a mean of 9 months (1-48 months). At time of death, 37 patients (52, 8%) had a CD4 count greater than 200 cells/mL and 16 patients (23%) had undetectable plasma viral load. In 57 cases (63%), the death occurred within the first year after start of antiretroviral therapy. The main causes of death were: tuberculosis (35%), cryptosporidiosis (19%), cryptococcosis (13%), cerebral toxoplasmosis (9%), Kaposi sarcoma (6%), non Hodgkin's lymphoma (2%), atypical mycobacteriosis (2%), cerebral lymphoma (1%), aspergillosis (1%), HIV wasting syndrome (1%) and cancer of cervix (1%). Non AIDS related deaths were noticed in three cases (3%) and the immune reconstitution inflammatory syndrome in six cases (7%). CONCLUSION In Casablanca, the main cause of death among HIV-infected patients is tuberculosis. Collaboration between the national tuberculosis and AIDS programs has been established to improve the prevention, detection, diagnosis and management of HIV/tuberculosis co infection.
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Affiliation(s)
- Mustapha Sodqi
- Faculté de médecine et de pharmacie de Casablanca, service des maladies infectieuses, CHU Ibn Rochd de Casablanca, Morocco
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Cuong DD, Thorson A, Sönnerborg A, Hoa NP, Chuc NTK, Phuc HD, Larsson M. Survival and causes of death among HIV-infected patients starting antiretroviral therapy in north-eastern Vietnam. ACTA ACUST UNITED AC 2011; 44:201-8. [DOI: 10.3109/00365548.2011.631937] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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