1
|
Suárez I, Rauschning D, Schüller C, Hagemeier A, Stecher M, Lehmann C, Schommers P, Schlabe S, Vehreschild JJ, Koll C, Schwarze-Zander C, Wasmuth JC, Klingmüller A, Rockstroh JK, Fätkenheuer G, Boesecke C, Rybniker J. Incidence and risk factors for HIV-tuberculosis coinfection in the Cologne-Bonn region: a retrospective cohort study. Infection 2024:10.1007/s15010-024-02215-y. [PMID: 38492196 DOI: 10.1007/s15010-024-02215-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Accepted: 02/13/2024] [Indexed: 03/18/2024]
Abstract
PURPOSE The risk of developing active tuberculosis (TB) is considerably increased in people living with HIV/AIDS (PLWH). However, incidence of HIV/TB coinfection is difficult to assess as surveillance data are lacking in many countries. Here, we aimed to perform a quantitative analysis of HIV/TB coinfections within the Cologne/Bonn HIV cohort and to determine risk factors for active TB. METHODS We systematically evaluated data of patients with HIV/TB coinfection between 2006 and 2017. In this retrospective analysis, we compared HIV/TB-coinfected patients with a cohort of HIV-positive patients. The incidence density rate (IDR) was calculated for active TB cases at different time points. RESULTS During 2006-2017, 60 out of 4673 PLWH were diagnosed with active TB. Overall IDR was 0.181 cases/100 patient-years and ranged from 0.266 in 2006-2009 to 0.133 in 2014-2017. Patients originating from Sub-Saharan Africa had a significantly (p < 0.001) higher IDR (0.694/100 patient-years of observation, 95% CI [0.435-1.050]) in comparison to patients of German origin (0.053/100 patient-years of observation, 95% CI [0.028-0.091]). In terms of TB-free survival, individuals originating from countries with a TB incidence higher than 10/100,000 exhibited a markedly reduced TB-free survival compared to those originating from regions with lower incidence (p < 0.001). In 22 patients, TB and HIV infection were diagnosed simultaneously. CONCLUSION Overall, we observed a decline in the incidence density rate (IDR) of HIV/TB coinfections between 2006 and 2017. Patients originating from regions with high incidence bear a higher risk of falling ill with active TB. For PLWH born in Germany, the observed risk of active TB appears to be lower compared to other groups within the cohort. These findings should be considered when developing TB containment and screening strategies for PLWH in low-incidence countries.
Collapse
Affiliation(s)
- Isabelle Suárez
- Department I of Internal Medicine, Medical Faculty and University Hospital of Cologne, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
- German Center for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne/Bonn, Germany
| | - Dominic Rauschning
- Department I of Internal Medicine, Medical Faculty and University Hospital of Cologne, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
- Department IB of Internal Medicine, Bundeswehrzentralkrankenhaus Koblenz, Koblenz, Germany
| | - Cora Schüller
- Department I of Internal Medicine, Medical Faculty and University Hospital of Cologne, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Anna Hagemeier
- Medical Faculty and University Hospital Cologne, Institute of Medical Statistics and Computational Biology, University of Cologne, Cologne, Germany
| | - Melanie Stecher
- Department I of Internal Medicine, Medical Faculty and University Hospital of Cologne, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
- German Center for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne/Bonn, Germany
| | - Clara Lehmann
- Department I of Internal Medicine, Medical Faculty and University Hospital of Cologne, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
- German Center for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne/Bonn, Germany
- Center for Molecular Medicine Cologne, University of Cologne, Cologne, Germany
| | - Philipp Schommers
- Department I of Internal Medicine, Medical Faculty and University Hospital of Cologne, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
- German Center for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne/Bonn, Germany
- Center for Molecular Medicine Cologne, University of Cologne, Cologne, Germany
| | - Stefan Schlabe
- Department of Medicine I, University Hospital Bonn, Bonn, Germany
| | - Jörg-Janne Vehreschild
- Department I of Internal Medicine, Medical Faculty and University Hospital of Cologne, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
- German Center for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne/Bonn, Germany
- Medical Department 2 (Hematology/Oncology and Infectious Diseases), Center for Internal Medicine, University Hospital, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Carolin Koll
- Department I of Internal Medicine, Medical Faculty and University Hospital of Cologne, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Carolynne Schwarze-Zander
- German Center for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne/Bonn, Germany
- Department of Medicine I, University Hospital Bonn, Bonn, Germany
- Gemeinschaftspraxis am Kaiserplatz, Bonn, Germany
| | - Jan-Christian Wasmuth
- German Center for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne/Bonn, Germany
- Department of Medicine I, University Hospital Bonn, Bonn, Germany
| | - Angela Klingmüller
- Department I of Internal Medicine, Medical Faculty and University Hospital of Cologne, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Jürgen Kurt Rockstroh
- German Center for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne/Bonn, Germany
- Department of Medicine I, University Hospital Bonn, Bonn, Germany
| | - Gerd Fätkenheuer
- Department I of Internal Medicine, Medical Faculty and University Hospital of Cologne, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
- German Center for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne/Bonn, Germany
| | - Christoph Boesecke
- German Center for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne/Bonn, Germany
- Department of Medicine I, University Hospital Bonn, Bonn, Germany
| | - Jan Rybniker
- Department I of Internal Medicine, Medical Faculty and University Hospital of Cologne, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany.
- German Center for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne/Bonn, Germany.
- Center for Molecular Medicine Cologne, University of Cologne, Cologne, Germany.
| |
Collapse
|
2
|
Loosli T, Hossmann S, Ingle SM, Okhai H, Kusejko K, Mouton J, Bellecave P, van Sighem A, Stecher M, d’Arminio Monforte A, Gill MJ, Sabin CA, Maartens G, Günthard HF, Sterne JAC, Lessells R, Egger M, Kouyos R. sHIV-1 drug resistance in people on dolutegravir-based ART: Collaborative analysis of cohort studies. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.04.05.23288183. [PMID: 37066200 PMCID: PMC10104228 DOI: 10.1101/2023.04.05.23288183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
Background The widespread use of the integrase strand transfer inhibitor (INSTI) dolutegravir (DTG) in first- and second-line antiretroviral therapy (ART) may facilitate emerging resistance. We combined data from HIV cohorts to examine patterns of drug resistance mutations (DRMs) and identify risk factors for DTG resistance. Methods Eight cohorts from Canada, Europe, and South Africa contributed data on individuals with genotypic resistance testing on DTG-based ART. Resistance levels were categorised using the Stanford algorithm. We identified risk factors for resistance using mixed-effects ordinal logistic regression models. Results We included 750 people with genotypic resistance testing on DTG-based ART between 2013 and 2022. Most had HIV subtype B (N=444, 59·2%) and were treatment-experienced; 134 (17.9%) were on DTG dual and 19 (2.5%) on DTG monotherapy. INSTI DRMs were detected in 100 (13·3%) individuals; 21 (2·8%) had more than one mutation. Most (N=713, 95·1%) were susceptible to DTG, 8 (1·1%) had potential-low, 5 (0·7%) low, 18 (2·4%) intermediate and 6 (0·8%) high-level DTG resistance. The risk of DTG resistance was higher on DTG monotherapy (adjusted odds ratio (aOR) 37·25, 95% CI 11·17 to 124·2) and DTG lamivudine dual therapy (aOR 6·59, 95% CI 1·70 to 25·55) compared to combination ART, and higher in the presence of potential-low/low (aOR 4.62, 95% CI 1.24 to 17.2) or intermediate/high-level (aOR 7·01, 95% CI 2·52 to 19·48) nucleoside reverse transcriptase inhibitors (NRTI) resistance. Viral load on DTG showed a trend towards increased DTG resistance (aOR 1·42, 95% CI 0·92 to 2·19 per standard deviation of log10 area under the viral load curve). Interpretation Among people experiencing virological failure on DTG-based ART, INSTI DRMs were uncommon, and DTG resistance was rare. DTG monotherapy and NRTI resistance substantially increased the risk for DTG resistance, which is of concern, notably in resource-limited settings.
Collapse
Affiliation(s)
- Tom Loosli
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland
- Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - Stefanie Hossmann
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Switzerland
| | - Suzanne M. Ingle
- Population Health Sciences, Bristol Medical School, University of Bristol, UK
| | - Hajra Okhai
- Institute for Global Health, University College London, UK
| | - Katharina Kusejko
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland
- Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - Johannes Mouton
- Department of Medicine, University of Cape Town, Cape Town, South Africa
| | | | | | - Melanie Stecher
- German Center for Infection Research (DZIF), Partner-Site Cologne-Bonn, Cologne, Germany
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf
| | - Antonella d’Arminio Monforte
- Italian Cohort Naive Antiretrovirals, (ICONA) L’Azienda Socio Sanitaria Territoriale (ASST) Santi Paolo e Carlo, Milano, Italy
| | - M. John Gill
- Southern Alberta Clinic, Calgary, AB, Canada
- Department of Medicine, University of Calgary, Calgary, AB, Canada
| | | | - Gary Maartens
- Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Huldrych F. Günthard
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland
- Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | | | - Richard Lessells
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa
- Centre for Infectious Disease Epidemiology and Research, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Matthias Egger
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Switzerland
- Population Health Sciences, Bristol Medical School, University of Bristol, UK
- Centre for Infectious Disease Epidemiology and Research, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Roger Kouyos
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland
- Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| |
Collapse
|
3
|
Tsai YT, K. M. SP, Ku HC, Wu YL, Ko NY. Global overview of suicidal behavior and associated risk factors among people living with human immunodeficiency virus: A scoping review. PLoS One 2023; 18:e0269489. [PMID: 36940193 PMCID: PMC10029973 DOI: 10.1371/journal.pone.0269489] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Accepted: 05/22/2022] [Indexed: 03/21/2023] Open
Abstract
Death by suicide is a major public health problem. People living with human immunodeficiency virus (PLHIV) have higher risk of suicidal behavior than the general population. The aim of this review is to summarize suicidal behavior, associated risk factors, and risk populations among PLHIV. Research studies in six databases from January 1, 1988, to July 8, 2021, were searched using keywords that included "HIV," "suicide," and "risk factors." The study design, suicide measurement techniques, risk factors, and study findings were extracted. A total of 193 studies were included. We found that the Americas, Europe, and Asia have the highest rates of suicidal behavior. Suicide risk factors include demographic factors, mental illness, and physiological, psychological, and social support. Depression is the most common risk factor for PLHIV, with suicidal ideation and attempt risk. Drug overdosage is the main cause of suicide death. In conclusion, the current study found that PLHIV had experienced a high level of suicidal status. This review provides an overview of suicidal behavior and its risk factors in PLHIV with the goal of better managing these factors and thus preventing death due to suicide.
Collapse
Affiliation(s)
- Yi-Tseng Tsai
- Department of Nursing, An Nan Hospital, China Medical University, Tainan,
Taiwan
- Department of Nursing, College of Medicine, National Cheng Kung
University, Tainan, Taiwan
| | - Sriyani Padmalatha K. M.
- Department of Nursing, College of Medicine, National Cheng Kung
University, Tainan, Taiwan
- Operating Room Department, National Hospital of Sri Lanka, Colombo, Sri
Lanka
| | - Han-Chang Ku
- Department of Nursing, An Nan Hospital, China Medical University, Tainan,
Taiwan
- Department of Nursing, College of Medicine, National Cheng Kung
University, Tainan, Taiwan
| | - Yi-Lin Wu
- Department of Nursing, College of Medicine, National Cheng Kung
University, Tainan, Taiwan
| | - Nai-Ying Ko
- Department of Nursing, College of Medicine, National Cheng Kung
University, Tainan, Taiwan
- Department of Public Health, College of Medicine, National Cheng Kung
University, Tainan, Taiwan
| |
Collapse
|
4
|
Wang J, Zhang R, Ding X, Jin Y, Qin R, Xia B, Liao Q, Hu H, Song W, Wang Z, Zhang X, Xu J. Pathologically complete remission to combination of invariant NK T cells and anti-CD20 antibody in a refractory HIV+ diffuse large B-cell lymphoma patient. Immunotherapy 2022; 14:599-607. [PMID: 35443802 DOI: 10.2217/imt-2021-0247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Although there is a high curability rate with rituximab chemotherapy, approximately 40% of patients with diffuse large B-cell lymphoma (DLBCL) develop disease relapse or primary-refractory lymphoma. The prognosis of HIV+ DLBCL patients is even worse with limited therapeutic options. The case is presented of a 28-year-old man who was diagnosed with HIV-DLBCL, refractory to rituximab-based chemo-immunotherapies and radiotherapy before and maintained a pathologically complete regression with the infusion of haplotype-matched invariant NK T cells and anti-CD20 antibody. His abdominal mass kept shrinking during the period of follow-up without relapse to date. A combination of haplotype-matched invariant NK T cells was likely to reinvigorate the efficacy of anti-CD20 antibody and may offer a viable treatment option for refractory DLBCL patients.
Collapse
Affiliation(s)
- Jing Wang
- Shanghai Public Health Clinical Center, Fudan University, Shanghai, 201508, China
| | - Renfang Zhang
- Shanghai Public Health Clinical Center, Fudan University, Shanghai, 201508, China
| | - Xiangqing Ding
- Shanghai Public Health Clinical Center, Fudan University, Shanghai, 201508, China
| | - Yanling Jin
- Shanghai Public Health Clinical Center, Fudan University, Shanghai, 201508, China
| | - Ran Qin
- Shanghai Public Health Clinical Center, Fudan University, Shanghai, 201508, China
| | - Bili Xia
- Shanghai Public Health Clinical Center, Fudan University, Shanghai, 201508, China
| | - Qibin Liao
- Shanghai Public Health Clinical Center, Fudan University, Shanghai, 201508, China
| | - Huiliang Hu
- Shanghai Public Health Clinical Center, Fudan University, Shanghai, 201508, China
| | - Wei Song
- Shanghai Public Health Clinical Center, Fudan University, Shanghai, 201508, China
| | - Zhenyan Wang
- Shanghai Public Health Clinical Center, Fudan University, Shanghai, 201508, China
| | - Xiaoyan Zhang
- Zhongshan Hospital and Institutes of Biomedical Sciences, Fudan University, Shanghai, 201508, China
| | - Jianqing Xu
- Zhongshan Hospital and Institutes of Biomedical Sciences, Fudan University, Shanghai, 201508, China
| |
Collapse
|
5
|
Cioe PA, Pinkston M, Tashima KT, Kahler CW. Peer navigation for smoking cessation in smokers with HIV: Protocol for a randomized clinical trial. Contemp Clin Trials 2021; 110:106435. [PMID: 33992767 PMCID: PMC8590703 DOI: 10.1016/j.cct.2021.106435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 05/07/2021] [Accepted: 05/10/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Smoking prevalence in persons with HIV (PWH) is high (40%) and cessation rates remain low. Lack of social support and poor adherence to nicotine replacement therapy (NRT) are related to poor cessation outcomes; thus, both factors represent possible targets for smoking cessation interventions. Peer navigators (PNs) have been integrated into HIV care with great success to improve engagement and adherence to antiretroviral therapy. However, no clinical trial has evaluated the potential for PNs to provide social support and improve NRT adherence for smoking cessation. We developed a treatment protocol that targets social support, adherence, and self-efficacy for quitting by incorporating PNs into a smoking cessation program. This randomized trial will test whether this approach results in higher rates of 7-day point prevalence abstinence at 12- and 24-weeks, compared to standard treatment. METHODS Seventy-two smokers with HIV will be randomized to either Peer Navigation Social Support for smoking cessation (PNSS-S) or standard cessation counseling. All participants will meet with a nurse for a smoking cessation counseling session, which will include discussion of FDA-approved cessation pharmacotherapy. Participants assigned to PNSS-S will receive weekly phone calls from the PN for 12 weeks. The PN will address readiness to quit, using medication to quit, common barriers to cessation, high risk situations, slip management, and maintaining abstinence. Smoking cessation outcomes will be measured at 4, 12, and 24 weeks following the baseline appointment. CONCLUSION Results from this study will provide preliminary evidence of whether incorporating a peer navigator-based intervention into smoking cessation treatment can improve smoking cessation outcomes in PWH.
Collapse
Affiliation(s)
- Patricia A Cioe
- Center for Alcohol and Addiction Studies, Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, United States of America.
| | - Megan Pinkston
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, United States of America; Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI, United States of America
| | - Karen T Tashima
- Division of Infectious Diseases, Alpert Medical School of Brown University, Providence, RI, United States of America
| | - Christopher W Kahler
- Center for Alcohol and Addiction Studies, Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, United States of America
| |
Collapse
|
6
|
Webel AR, Schexnayder J, Cioe PA, Zuñiga JA. A Review of Chronic Comorbidities in Adults Living With HIV: State of the Science. J Assoc Nurses AIDS Care 2021; 32:322-346. [PMID: 33595986 PMCID: PMC8815414 DOI: 10.1097/jnc.0000000000000240] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
ABSTRACT People living with HIV are living longer, high-quality lives; however, as they age, this population is at increased risk for developing chronic comorbidities, including cardiovascular disease, certain types of cancer (e.g., lung, anal, and liver), and diabetes mellitus. The purpose of this state-of-the-science review is to provide an evidence-based summary on common physical comorbidities experienced by people living and aging with HIV. We focus on those chronic conditions that are prevalent and growing and share behavioral risk factors that are common in people living with HIV. We will discuss the current evidence on the epidemiology, physiology, prevention strategies, screening, and treatment options for people living with HIV across resource settings.
Collapse
Affiliation(s)
- Allison R Webel
- Allison R. Webel, PhD, RN, FAAN, is Associate Professor of Nursing, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA, and Associate Editor, Journal of the Association of Nurses in AIDS Care
- Julie Schexnayder, DNP, MPH, ACNP-BC, is a PhD Candidate, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA
- Patricia A. Cioe, PhD, RN, is Associate Professor of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, Rhode Island, USA
- Julie A. Zuñiga, RN, PhD, FAAN, is Assistant Professor of Nursing, School of Nursing, University of Texas at Austin, Austin, Texas, USA
| | - Julie Schexnayder
- Allison R. Webel, PhD, RN, FAAN, is Associate Professor of Nursing, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA, and Associate Editor, Journal of the Association of Nurses in AIDS Care
- Julie Schexnayder, DNP, MPH, ACNP-BC, is a PhD Candidate, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA
- Patricia A. Cioe, PhD, RN, is Associate Professor of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, Rhode Island, USA
- Julie A. Zuñiga, RN, PhD, FAAN, is Assistant Professor of Nursing, School of Nursing, University of Texas at Austin, Austin, Texas, USA
| | - Patricia A Cioe
- Allison R. Webel, PhD, RN, FAAN, is Associate Professor of Nursing, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA, and Associate Editor, Journal of the Association of Nurses in AIDS Care
- Julie Schexnayder, DNP, MPH, ACNP-BC, is a PhD Candidate, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA
- Patricia A. Cioe, PhD, RN, is Associate Professor of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, Rhode Island, USA
- Julie A. Zuñiga, RN, PhD, FAAN, is Assistant Professor of Nursing, School of Nursing, University of Texas at Austin, Austin, Texas, USA
| | - Julie A Zuñiga
- Allison R. Webel, PhD, RN, FAAN, is Associate Professor of Nursing, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA, and Associate Editor, Journal of the Association of Nurses in AIDS Care
- Julie Schexnayder, DNP, MPH, ACNP-BC, is a PhD Candidate, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA
- Patricia A. Cioe, PhD, RN, is Associate Professor of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, Rhode Island, USA
- Julie A. Zuñiga, RN, PhD, FAAN, is Assistant Professor of Nursing, School of Nursing, University of Texas at Austin, Austin, Texas, USA
| |
Collapse
|
7
|
Pacek LR, Holloway AD, Cropsey KL, Meade CS, Sweitzer MM, Davis JM, Joseph McClernon F. Experiences With Smoking Cessation Attempts and Prior Use of Cessation Aids in Smokers With HIV: Findings From a Focus Group Study Conducted in Durham, North Carolina. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2021; 33:158-168. [PMID: 33821680 PMCID: PMC8158019 DOI: 10.1521/aeap.2021.33.2.158] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Cigarette smoking remains disproportionately prevalent and is increasingly a cause of death and disability among people with HIV (PWH). Many PWH are interested in quitting, but interest in and uptake of first-line smoking cessation pharmacotherapies are varied in this population. To provide current data regarding experiences with and perceptions of smoking cessation and cessation aids among PWH living in Durham, North Carolina, the authors conducted five focus group interviews (total n = 24; 96% African American) using semistructured interviews. Interviews were recorded, transcribed, coded, and thematically analyzed. Major themes included ambivalence and/or lack of interest in cessation; presence of cessation barriers; perceived perceptions of ineffectiveness of cessation aids; perceived medication side effects; and conflation of the harms resulting from use of tobacco products and nicotine replacement therapy. Innovative and effective interventions must account for the aforementioned multiple barriers to cessation as well as prior experiences with and misperceptions regarding cessation aids.
Collapse
Affiliation(s)
- Lauren R Pacek
- Duke University School of Medicine, Department of Psychiatry and Behavioral Sciences, Durham, North Carolina
| | - Alicia D Holloway
- Duke University School of Medicine, Department of Psychiatry and Behavioral Sciences, Durham, North Carolina
| | - Karen L Cropsey
- University of Alabama at Birmingham, Department of Psychiatry and Behavioral Neurobiology, Birmingham, Alabama
| | - Christina S Meade
- Duke University School of Medicine, Department of Psychiatry and Behavioral Sciences, Durham, North Carolina
| | - Maggie M Sweitzer
- Duke University School of Medicine, Department of Psychiatry and Behavioral Sciences, Durham, North Carolina
| | - James M Davis
- Duke University School of Medicine, General Internal Medicine, and the Duke Cancer Institute, Durham, North Carolina
| | - F Joseph McClernon
- Duke University School of Medicine, Department of Psychiatry and Behavioral Sciences, Durham, North Carolina
| |
Collapse
|
8
|
Poudel KC, Poudel-Tandukar K, Bertone-Johnson ER, Pekow P, Vidrine DJ. Inflammation in Relation to Intensity and Duration of Cigarette Smoking Among People Living with HIV. AIDS Behav 2021; 25:856-865. [PMID: 32986190 DOI: 10.1007/s10461-020-03048-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2020] [Indexed: 02/07/2023]
Abstract
Both inflammation and smoking are independent predictors of morbidity and mortality among people living with HIV (PLHIV). As smoking burden is likely to exacerbate inflammation, we tested the hypothesis that higher intensity and longer duration of smoking are positively associated with C-reactive protein (CRP, an inflammatory marker) among 284 PLHIV in Kathmandu, Nepal. We measured smoking status, intensity of smoking, smoking duration, and CRP concentrations. In total, 22.9% of never smokers, 24.3% former smokers, and 34.1% current smokers had high CRP (> 3 mg/l). The median intensity and duration of smoking were 12 (cigarettes/day) and 19 years, respectively. Intensity of smoking (beta for increase in number of cigarettes/day: β = 0.245; p = 0.017), smoking duration (beta for 1-year increase in smoking: β = 0.341; p = 0.013), and pack-years of smoking (beta for 1-pack-years of smoking increase: β = 0.351; p = 0.002) were each positively associated with CRP concentrations. While quitting is important, reducing the intensity and duration of smoking until quitting might be helpful in reducing the levels of inflammation, thereby in mitigating HIV-related harms.
Collapse
Affiliation(s)
- Krishna C Poudel
- Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts Amherst, 715 North Pleasant St., 301 Arnold House, Amherst, MA, 01003-9304, USA.
- Institute for Global Health, University of Massachusetts Amherst, Amherst, MA, USA.
| | | | - Elizabeth R Bertone-Johnson
- Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, MA, USA
- Department of Biostatistics & Epidemiology, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, MA, USA
| | - Penelope Pekow
- Department of Biostatistics & Epidemiology, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, MA, USA
| | - Damon J Vidrine
- Department of Health Outcomes and Behavior, Moffit Cancer Center, Tampa, FL, USA
| |
Collapse
|
9
|
Pacek LR, Holloway AD. Cigarette Smoking and Cessation-Related Interactions With Health Care Providers in the Context of Living With HIV: Focus Group Study Findings. J Assoc Nurses AIDS Care 2021; 32:e14-e19. [PMID: 32639266 PMCID: PMC8211397 DOI: 10.1097/jnc.0000000000000185] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT Smoking is disproportionately prevalent among people living with HIV (PLWH) compared with the general population. We conducted five focus groups (n = 24) using semi-structured interview guides to explore perceptions and experiences of smoking and cessation-related interactions with health care providers among smokers with HIV. Major themes included a limited understanding of how smoking affects illness among PLWH and minimal discussion about cessation with providers. Findings highlight the need to educate smokers with HIV about the known impacts of smoking on illness among PLWH and to facilitate greater discussion of cessation between providers and smokers with HIV. Prior experiences with smoking cessation medications and desire for additional information regarding these medications should be considered when implementing medication regimens in research and clinical settings.
Collapse
Affiliation(s)
- Lauren R. Pacek
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Alicia D. Holloway
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| |
Collapse
|
10
|
Mor Z, Sheffer R, Chemtob D. Causes of death and mortality trends of all individuals reported with HIV/AIDS in Israel, 1985-2010. J Public Health (Oxf) 2019. [PMID: 28633458 PMCID: PMC5896593 DOI: 10.1093/pubmed/fdx039] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Background Highly active antiretroviral therapy (HAART) has changed life-expectancy and mortality trends among people living with HIV/AIDS (PLWHA) since 1996. This retrospective cohort study aimed to assess the mortality epidemiology of PLWHA in Israel and analyze the causes of death. Methods This cohort study included all adult Israeli-citizens PLWHA between 1985 and 2010 and crossed matched with the Civil Registry to identify those who died. Death certificates were classified into AIDS or non-AIDS deaths related-causes. Standardized mortality-ratio (SMR) represented mortality excess. Results Of all 5140 PLWHA who were followed-up for 36 955 person-years, 1066 (20.7%) died. The ratio of AIDS-related deaths to non-AIDS related deaths reduced from 1.2:1 before 1996 to 0.6:1 after 1997, and case-fatality rates reduced from 12.0 to 0.9%, respectively (P < 0.001). SMR were 3.0 (95% CI: 2.3–3.5) for males and 3.9 (95% CI: 3.3–4.5) for females. Fatality cases were more likely older Israeli-born males, co-infected with tuberculosis, reported before 1996 and acquired HIV by drug-injection or infected-blood products. Deaths of AIDS-related causes were common among Israeli-born gay men, while non-AIDS deaths were common among those reported after 1997 and drug users. Conclusions Death rates declined since HAART introduction. Yet, SMR remained high, and PLWHA infected by drug-use or blood-products have not enjoyed relative longevity.
Collapse
Affiliation(s)
- Zohar Mor
- Department of Tuberculosis and AIDS, P.O. Box 1176, Jerusalem 9101002, Israel.,Tel Aviv Department of Health, Ministry of Health, P.O. Box 6120101, Tel Aviv 6473912, Israel.,School of Public Health, Sackler Faculty of Medicine, P.O. Box 39040, Tel Aviv 6997801, Israel
| | - Rivka Sheffer
- Tel Aviv Department of Health, Ministry of Health, P.O. Box 6120101, Tel Aviv 6473912, Israel
| | - Daniel Chemtob
- Department of Tuberculosis and AIDS, P.O. Box 1176, Jerusalem 9101002, Israel
| |
Collapse
|
11
|
Smoking and Accelerated Lung Function Decline in HIV-Positive Individuals: A Secondary Analysis of the START Pulmonary Substudy. J Acquir Immune Defic Syndr 2019; 79:e85-e92. [PMID: 29985804 DOI: 10.1097/qai.0000000000001797] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is a leading cause of death and disability globally. Both cigarette smoking and HIV have been identified as independent risk factors for COPD. We used data from the strategic timing of antiretroviral treatment (START) Pulmonary Substudy to quantify the impact of smoking on rate of lung function decline in HIV. METHODS We included START Pulmonary Substudy participants who contributed at least 2 good quality spirometry measures during the study. Slope of forced expiratory volume in 1 second (FEV1) was estimated using a repeated-measures model adjusted for the treatment group (immediate vs deferred treatment arm of START), age, sex, race, baseline COPD, and region. RESULTS Of 1026 START Pulmonary Substudy participants, 915 (89%) were included in this analysis. Median follow-up time was 3.9 years. Smokers and nonsmokers were similar in baseline age (median 36 years), but smokers were more likely to be white, male, and from Europe/Israel/Australia. Smokers had faster average FEV1 decline compared with nonsmokers [-38.3 mL/yr vs -25.1 mL/yr; difference of -13.2 mL/yr (95% confidence interval: -23.6 to -2.7); P = 0.013], were more likely to meet criteria for rapid FEV1 decline [7.2%-11.7% more likely (P = 0.09-P = 0.002), depending on the definition of rapid decline], and had borderline, but not statistically significant, higher incident COPD during follow-up (9.7% vs 5.8%, P = 0.06). CONCLUSIONS Compared to nonsmokers, HIV-positive smokers experience faster decline in lung function. These results underscore the need for a better understanding of how to best support smoking cessation among HIV-positive populations.
Collapse
|
12
|
Eman P, Chacon E, Gupta M, Berger JC, Shah MB, El Haddad HE, El-Husseini A, Dela Cruz AC, Grigorian A, Mei X, Gedaly R. Long term outcomes of patients transplanted for hepatocellular carcinoma with human immunodeficiency virus infection. HPB (Oxford) 2019; 21:1009-1016. [PMID: 30765199 DOI: 10.1016/j.hpb.2019.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 12/18/2018] [Accepted: 01/03/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND We aimed to study outcomes in HIV + patients with HCC in the US following Liver Transplantation (LT) using the UNOS dataset. METHODS The database was queried from 2003 to 2016 for patients undergoing LT with HCC, HIV+, and HCC/HIV+. RESULTS Out of 17,397 LT performed for HCC during the study period, 113 were transplanted for HCC with HIV infection (91 isolated livers). Patients transplanted for HCC/HIV+ were younger (55.54 ± 5.89 vs 58.80 ± 7.37, p < 0.001), had lower total bilirubin (1.20 vs 1.60, p = 0.042) significantly lower BMI (25.35 ± 4.43 vs 28.39 ± 5.17, p < 0.001) and were more likely to be co-infected with HBV (25.3% vs 8.2% p < 0.001) than those transplanted for HCC alone. HCC/HIV + patients were found to have a 3.8 fold increased risk of peri-operative mortality at 90 days after matching. HCC/HIV + recipients had 54% decreased long-term survival within the HCC cohort. Our initial analysis of overall graft and patient survival found significant differences between HCC/HIV and HCC/HIV + recipients. However, these variances were lost after case-matching. Recurrence and disease free survival were similar in HCC alone vs HCC/HIV + recipients. CONCLUSIONS Our analysis suggests that excellent outcomes can be achieved in selected patients with HCC/HIV+.
Collapse
Affiliation(s)
- Pedro Eman
- Department of Surgery - Transplant Division, University of Kentucky, College of Medicine, Lexington, KY, USA
| | - Eduardo Chacon
- Department of Surgery - Transplant Division, University of Kentucky, College of Medicine, Lexington, KY, USA
| | - Meera Gupta
- Department of Surgery - Transplant Division, University of Kentucky, College of Medicine, Lexington, KY, USA
| | - Jonathan C Berger
- Department of Surgery - Transplant Division, University of Kentucky, College of Medicine, Lexington, KY, USA
| | - Malay B Shah
- Department of Surgery - Transplant Division, University of Kentucky, College of Medicine, Lexington, KY, USA
| | - Hanine E El Haddad
- Department of Medicine, Division of Infectious Diseases, University of Kentucky College of Medicine, Lexington, KY, USA
| | - Amr El-Husseini
- Department of Medicine, Division of Nephrology, University of Kentucky College of Medicine, Lexington, KY, USA
| | - Anna C Dela Cruz
- Department of Medicine, Division of Gastroenterology, University of Kentucky College of Medicine, Lexington, KY, USA
| | - Alla Grigorian
- Department of Medicine, Division of Gastroenterology, University of Kentucky College of Medicine, Lexington, KY, USA
| | - Xiaonan Mei
- Department of Surgery - Transplant Division, University of Kentucky, College of Medicine, Lexington, KY, USA
| | - Roberto Gedaly
- Department of Surgery - Transplant Division, University of Kentucky, College of Medicine, Lexington, KY, USA.
| |
Collapse
|
13
|
Abstract
OBJECTIVE With combination-antiretroviral therapy, HIV-infected individuals live longer with an elevated burden of cancer. Given the high prevalence of smoking among HIV-infected populations, we examined the risk of incident cancers attributable to ever smoking cigarettes. DESIGN Observational cohort of HIV-infected participants with 270 136 person-years of follow-up in the North American AIDS Cohort Collaboration on Research and Design consortium. Among 52 441 participants, 2306 were diagnosed with cancer during 2000-2015. MAIN OUTCOME MEASURES Estimated hazard ratios and population-attributable fractions (PAF) associated with ever cigarette smoking for all cancers combined, smoking-related cancers, and cancers that were not attributed to smoking. RESULTS People with cancer were more frequently ever smokers (79%) compared with people without cancer (73%). Adjusting for demographic and clinical factors, cigarette smoking was associated with increased risk of cancer overall [hazard ratios = 1.33 (95% confidence interval: 1.18-1.49)]; smoking-related cancers [hazard ratios = 2.31 (1.80-2.98)]; lung cancer [hazard ratios = 17.80 (5.60-56.63)]; but not nonsmoking-related cancers [hazard ratios = 1.12 (0.98-1.28)]. Adjusted PAFs associated with ever cigarette smoking were as follows: all cancers combined, PAF = 19% (95% confidence interval: 13-25%); smoking-related cancers, PAF = 50% (39-59%); lung cancer, PAF = 94% (82-98%); and nonsmoking-related cancers, PAF = 9% (1-16%). CONCLUSION Among HIV-infected persons, approximately one-fifth of all incident cancer, including half of smoking-related cancer, and 94% of lung cancer diagnoses could potentially be prevented by eliminating cigarette smoking. Cigarette smoking could contribute to some cancers that were classified as nonsmoking-related cancers in this report. Enhanced smoking cessation efforts targeted to HIV-infected individuals are needed.
Collapse
|
14
|
Hoffmann C. [In Process Citation]. MMW Fortschr Med 2018; 157 Suppl 2:23-6. [PMID: 26048116 DOI: 10.1007/s15006-015-3162-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Christian Hoffmann
- Infektionsmedizinisches Centrum Hamburg, Glockengiesserwall 1, D-20095, Hamburg, Deutschland,
| |
Collapse
|
15
|
Bogner J. [In Process Citation]. MMW Fortschr Med 2018; 157 Suppl 2:13-9. [PMID: 26048114 DOI: 10.1007/s15006-015-2726-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Johannes Bogner
- Sektion Klinische Infektiologie, Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Campus Innenstadt, Pettenkoferstr. 8a, D-80336, München, Deutschland,
| |
Collapse
|
16
|
Hessol NA, Schwarcz SK, Hsu LC, Shumway M, Machtinger EL. Gender differences in causes of death among persons with HIV/AIDS in San Francisco, California, 1996-2013. Int J STD AIDS 2017; 29:135-146. [PMID: 28728525 DOI: 10.1177/0956462417720370] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The objective was to examine gender differences in causes of death using the San Francisco HIV/AIDS and death registries. Data from San Francisco residents diagnosed with HIV/AIDS who died from 1996 to 2013 were analyzed. Age, race/ethnicity, year, and gender-adjusted standardized mortality ratios and Poisson 95% confidence intervals were calculated for underlying causes of death. Among the 6268 deaths, deaths attributed to drug use, mental disorders due to substance use, cerebrovascular disease, chronic obstructive pulmonary disease, renal disease, and septicemia were more likely among women than among men. Compared to the California population, women had elevated standardized mortality ratios for drug overdose (25.37), mental disorders due to substance abuse (27.21), cerebrovascular disease (2.83), chronic obstructive pulmonary disease (7.37), heart disease (2.37), and liver disease (5.54), and these were higher than the standardized mortality ratios for the men in our study. Men, but not women, had elevated standardized mortality ratios for suicide (2.70), undetermined intent (3.88), renal disease (2.29), and non-AIDS cancer (1.68) compared to population rates. Continued efforts to reduce HIV-related illnesses and an increased emphasis on diagnosing and treating preventable causes of death, including substance use, heart disease, and mental health disorders, are needed as part of comprehensive HIV care.
Collapse
Affiliation(s)
- Nancy A Hessol
- 1 Department of Clinical Pharmacy, University of California, San Francisco, CA, USA.,2 Department of Medicine, University of California, San Francisco, CA, USA
| | - Sandra K Schwarcz
- 3 San Francisco Department of Public Health, San Francisco, CA, USA.,4 Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Ling Chin Hsu
- 3 San Francisco Department of Public Health, San Francisco, CA, USA
| | - Martha Shumway
- 5 Department of Psychiatry, University of California, San Francisco, CA, USA
| | | |
Collapse
|
17
|
Suicidal Behavior Among People Living with HIV (PLHIV) in Medical Care in Estonia and Factors Associated with Receiving Psychological Treatment. AIDS Behav 2017; 21:1709-1716. [PMID: 27664013 DOI: 10.1007/s10461-016-1561-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
People living with HIV (PLHIV) have higher rates of suicidal behavior than the general population. This study assessed suicidal behavior (ideation and/or attempts, ever and in the past 12 months) among PLHIV receiving outpatient HIV medical care in Estonia and associations between suicidal behavior and psychological treatment. The cross-sectional study collected data from January to November 2013 using a self-report questionnaire. Eight hundred PLHIV participated, 39 % (n = 306) of whom had been suicidal. Lifetime prevalence was 36 % for suicidal ideation and 20 % for attempts. Younger age, incarceration, having ever abused alcohol and also injected drugs, having lived with HIV for more than 10 years, and being depressed were associated with lifetime suicidal behavior. Suicidal behavior within the past 12 months was reported by 20 % (n = 156) of respondents. Of these, 27 % received psychological treatment (counseling and/or psychotherapy), 20 % had taken antidepressants, and 49 % sedatives. Individuals perceiving a need for treatment were significantly more likely to receive psychological treatment when experiencing suicidal behavior (OR 25.65, 95 % CI 2.92-225.47). In conclusion, suicidal behavior is frequent among PLHIV but psychological treatment is not often received. One of the barriers to treatment is patients' lack of perceived need for help.
Collapse
|
18
|
Measles, mumps, rubella and VZV: importance of serological testing of vaccine-preventable diseases in young adults living with HIV in Germany. Epidemiol Infect 2016; 145:236-244. [PMID: 27780480 DOI: 10.1017/s095026881600217x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Measles, mumps, rubella (MMR) and varicella zoster virus (VZV) infection can cause serious diseases and complications in the HIV-positive population. Due to successful vaccination programmes measles, mumps and congenital rubella syndrome has become neglected in Germany. However, recent outbreaks of measles have occurred from import-associated cases. In this cross-sectional study the serostatus for MMR and VZV in 2013 HIV-positive adults from three different university outpatient clinics in Bonn (n = 544), Cologne (n = 995) and Munich (n = 474) was analysed. Sera were tested for MMR- and VZV-specific immunglobulin G antibodies using commercial immunoassays. Seronegativity was found in 3% for measles, 26% for mumps, 11% for rubella and 2% for VZV. Regarding MMR, 35% of patients lacked seropositivity against at least one infectious agent. In multivariable analysis younger age was strongly associated with seronegativity against all four viruses, measles, mumps, rubella (P < 0·001, P < 0·001 and P = 0·001, respectively) and VZV (P = 0·001). In conclusion, there is high need for MMR and VZV vaccination in people living with HIV in Germany born in 1970 or later. Thus, systematic MMR and VZV antibody screening and vaccination should be implemented in the HIV-positive population to prevent serious disease and complications of vaccine-preventable diseases.
Collapse
|
19
|
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] [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.
Collapse
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
| | | |
Collapse
|
20
|
Pool ERM, Dogar O, Lindsay RP, Weatherburn P, Siddiqi K. Interventions for tobacco use cessation in people living with HIV and AIDS. Cochrane Database Syst Rev 2016; 2016:CD011120. [PMID: 27292836 PMCID: PMC8604206 DOI: 10.1002/14651858.cd011120.pub2] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Tobacco use is highly prevalent amongst people living with HIV/AIDS (PLWHA) and has a substantial impact on morbidity and mortality. OBJECTIVES To assess the effectiveness of interventions to motivate and assist tobacco use cessation for people living with HIV/AIDS (PLWHA), and to evaluate the risks of any harms associated with those interventions. SEARCH METHODS We searched the Cochrane Tobacco Addiction Group's Specialised Register, Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, and PsycINFO in June 2015. We also searched EThOS, ProQuest, four clinical trial registries, reference lists of articles, and searched for conference abstracts using Web of Science and handsearched speciality conference databases. SELECTION CRITERIA Controlled trials of behavioural or pharmacological interventions for tobacco cessation for PLWHA. DATA COLLECTION AND ANALYSIS Two review authors independently extracted all data using a standardised electronic data collection form. They extracted data on the nature of the intervention, participants, and proportion achieving abstinence and they contacted study authors to obtain missing information. We collected data on long-term (greater than or equal to six months) and short-term (less than six months) outcomes. Where appropriate, we performed meta-analysis and estimated the pooled effects using the Mantel-Haenszel fixed-effect method. Two authors independently assessed and reported the risk of bias according to prespecified criteria. MAIN RESULTS We identified 14 studies relevant to this review, of which we included 12 in a meta-analysis (n = 2087). All studies provided an intervention combining behavioural support and pharmacotherapy, and in most studies this was compared to a less intensive control, typically comprising a brief behavioural intervention plus pharmacotherapy.There was moderate quality evidence from six studies for the long-term abstinence outcome, which showed no evidence of effect for more intense cessation interventions: (risk ratio (RR) 1.00, 95% confidence interval (CI) 0.72 to 1.39) with no evidence of heterogeneity (I(2) = 0%). The pooled long-term abstinence was 8% in both intervention and control conditions. There was very low quality evidence from 11 studies that more intense tobacco cessation interventions were effective in achieving short-term abstinence (RR 1.51, 95% CI 1.15 to 2.00); there was moderate heterogeneity (I(2) = 42%). Abstinence in the control group at short-term follow-up was 8% (n = 67/848) and in the intervention group was 13% (n = 118/937). The effect of tailoring the intervention for PLWHA was unclear. We further investigated the effect of intensity of behavioural intervention via number of sessions and total duration of contact. We failed to detect evidence of a difference in effect according to either measure of intensity, although there were few studies in each subgroup. It was not possible to perform the planned analysis of adverse events or HIV outcomes since these were not reported in more than one study. AUTHORS' CONCLUSIONS There is moderate quality evidence that combined tobacco cessation interventions provide similar outcomes to controls in PLWHA in the long-term. There is very low quality evidence that combined tobacco cessation interventions were effective in helping PLWHA achieve short-term abstinence. Despite this, tobacco cessation interventions should be offered to PLWHA, since even non-sustained periods of abstinence have proven benefits. Further large, well designed studies of cessation interventions for PLWHA are needed.
Collapse
Affiliation(s)
- Erica RM Pool
- Brighton and Sussex University Hospitals NHS TrustBrightonUK
| | - Omara Dogar
- University of YorkDepartment of Health SciencesSeebohm Rowntree BuildingHeslingtonYorkUKYO10 5DD
| | - Ryan P Lindsay
- Idaho State UniversityDepartment of Community and Public HealthMeridianIdahoUSA
| | - Peter Weatherburn
- London School of Hygiene and Tropical MedicineSigma Research, Department of Social & Environmental Health ResearchLondonUK
| | - Kamran Siddiqi
- York UniversityDepartment of Health Sciences/Hull York Medical SchoolYorkUKYO10 5DD
| | | |
Collapse
|
21
|
Cheung CC, Ding E, Sereda P, Yip B, Lourenco L, Barrios R, Montaner J, Hogg RS, Lima V, Moore DM. Reductions in all-cause and cause-specific mortality among HIV-infected individuals receiving antiretroviral therapy in British Columbia, Canada: 2001-2012. HIV Med 2016; 17:694-701. [PMID: 27279453 DOI: 10.1111/hiv.12379] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/23/2015] [Indexed: 01/12/2023]
Abstract
OBJECTIVES Since 2006, the British Columbia HIV/AIDS Drug Treatment Program (DTP) has expanded enrolment and dramatically increased its number of participants. We examined the effect this expansion has had on the underlying cause of death in HIV-infected individuals. METHODS We analysed data from participants aged 18 years and older in the DTP to measure 2-year mortality rates and causes of death from 2001 to 2012. We conducted tests of trend for all-cause and cause-specific mortality, and compared demographics and characteristics of individuals. Cox proportional hazard models were used to determine the risk of death. RESULTS A total of 8185 participants received antiretroviral therapy (ART) during the study period. Mortality declined from 3.88 per 100 person-years (PY) in 2001-2002 to 2.15 per 100 PY in 2011-2012 (P = 0.02). There were significant decreases in HIV-related deaths (2.34 to 0.56 per 100 PY; P = 0.02) and deaths attributable to chronic liver disease (0.20 to 0.09 per 100 PY; P = 0.01), cardiovascular disease (0.24 to 0.05 per 100 PY; P = 0.03) and suicides (0.47 to 0 per 100 PY; P = 0.003). Multivariate models, adjusted for age, gender, history of injecting drug use, AIDS diagnoses and baseline CD4 cell counts, demonstrated that initiation of ART in all time periods after 2001-2002 was independently associated with reduced mortality (P < 0.001). CONCLUSIONS We observed declines in HIV-related mortality and certain non-HIV-related causes of death among participants in the BC DTP from 2001 to 2012. These findings suggest that there may be broader benefits to the increasingly liberal HIV treatment guidelines, including reductions in death caused by cardiovascular disease and chronic liver disease.
Collapse
Affiliation(s)
- C C Cheung
- Department of Medicine, University of British Columbia, Vancouver, Canada
| | - E Ding
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - P Sereda
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - B Yip
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - L Lourenco
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - R Barrios
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada.,Vancouver Coastal Health, Vancouver, Canada
| | - Jsg Montaner
- Department of Medicine, University of British Columbia, Vancouver, Canada.,British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - R S Hogg
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada.,Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - V Lima
- Department of Medicine, University of British Columbia, Vancouver, Canada.,British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - D M Moore
- Department of Medicine, University of British Columbia, Vancouver, Canada.,British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| |
Collapse
|
22
|
Mocumbi AO. Cardiac Disease and HIV in Africa: A Case for Physical Exercise. Open AIDS J 2015; 9:62-5. [PMID: 26587074 PMCID: PMC4645865 DOI: 10.2174/1874613601509010062] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Revised: 08/08/2015] [Accepted: 08/16/2015] [Indexed: 11/24/2022] Open
Abstract
AIDS-related deaths and new HIV infections have declined globally, but continue to be a major problem in Africa. Prior to the advent of antiretroviral treatment (ART) HIV patients died of immunodeficiency and associated opportunistic infections; Highly Active Antiretroviral Therapy (HAART) has resulted in increased survival of these patients and has transformed this illness into a chronic condition. Cardiovascular, respiratory, neurological and muscular problems interfere with exercise in HIV-infected patients. Particularly cardiovascular disease may be associated with direct damage by the virus, by antiretroviral therapy and by malnutrition and chronic lung disease, resulting in physical and psychological impairment. Recent studies have shown the benefits of exercise training to improvement of physiologic and functional parameters, with the gains being specific to the type of exercise performed. Exercise should be recommended to all HIV patients as an effective prevention and treatment for metabolic and cardiovascular syndromes associated with HIV and HAART exposure in sub-Saharan Africa.
Collapse
Affiliation(s)
- Ana Olga Mocumbi
- Instituto Nacional de Saúde & Universidade Eduardo Mondlane, Av. Eduardo Mondlane 1008, Maputo, Moçambique
| |
Collapse
|
23
|
Cowell A, Shenoi SV, Kyriakides TC, Friedland G, Barakat LA. Trends in hospital deaths among human immunodeficiency virus-infected patients during the antiretroviral therapy era, 1995 to 2011. J Hosp Med 2015; 10:608-14. [PMID: 26130520 PMCID: PMC4560992 DOI: 10.1002/jhm.2409] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Revised: 05/22/2015] [Accepted: 05/27/2015] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Mortality in hospitalized human immunodeficiency virus (HIV)-infected patients is not well described. We sought to characterize in-hospital deaths among HIV-infected patients in the antiretroviral (ART) era and identify factors associated with mortality. METHODS We reviewed the medical records of hospitalized HIV-infected patients who died from January 1, 1995 to December 31, 2011 at an urban teaching hospital. We evaluated trends in early and late ART use and deaths due to acquired immunodeficiency syndrome (AIDS) and non-AIDS, and identified clinical and demographic correlates of non-AIDS deaths. RESULTS In-hospital deaths declined significantly from 1995 to 2011 (P < 0.0001); those attributable to non-AIDS increased (43% to 70.5%, P < 0.0001). Non-AIDS deaths were most commonly caused by non-AIDS infection (20.3%), cardiovascular (11.3%) and liver disease (8.5%), and non-AIDS malignancy (7.8%). Patients with non-AIDS compared to AIDS-related deaths were older (median age 48 vs 40 years, P < 0.0001), more likely to be on ART (74.1% vs 55.8%, P = 0.0001), less likely to have a CD4 count of <200 cells/mm(3) (47.2% vs 97.1%, P < 0.0001), and more likely to have an HIV viral load of ≤400 copies/mL (38.1% vs 4.1%, P < 0.0001). Non-AIDS deaths were associated with 4.5 and 4.2 times greater likelihood of comorbid underlying liver and cardiovascular disease, respectively. CONCLUSIONS Non-AIDS deaths increased significantly during the ART era and are now the most common cause of in-hospital deaths; non-AIDS infection, cardiovascular and liver disease, and malignancies were major contributors to mortality. Higher CD4 cell count, liver, and cardiovascular comorbidities were most strongly associated with non-AIDS deaths. Interventions targeting non-AIDS-associated conditions are needed to reduce inpatient mortality among HIV-infected patients.
Collapse
Affiliation(s)
- Annie Cowell
- Department of Internal Medicine, Section of Infectious Diseases, University of California, San Diego, California
| | - Sheela V Shenoi
- Department of Internal Medicine, Section of Infectious Diseases, AIDS Program, Yale University School of Medicine, New Haven, Connecticut
| | - Tassos C Kyriakides
- Yale Center for Analytical Sciences, Yale School of Public Health, New Haven, Connecticut
| | - Gerald Friedland
- Department of Internal Medicine, Section of Infectious Diseases, AIDS Program, Yale University School of Medicine, New Haven, Connecticut
| | - Lydia Aoun Barakat
- Department of Internal Medicine, Section of Infectious Diseases, AIDS Program, Yale University School of Medicine, New Haven, Connecticut
| |
Collapse
|
24
|
Abstract
INTRODUCTION After the introduction of highly active antiretroviral treatment, the course of HIV infection turned into a chronic disease and most of HIV-positive patients will soon be over 50 years old. MATERIAL AND METHODS This paper reviews the multiple aspects that physicians have to face while taking care of HIV-positive ageing patients including the definitions of frailty and the prevalence and risk factors of concomitant diseases. From a therapeutic point of view pharmacokinetic changes and antiretroviral-specific toxicities associated with ageing are discussed; finally therapeutic approaches to frailty are reviewed both in HIV-positive and negative patients. CONCLUSION AND DISCUSSION We conclude by suggesting that the combined use of drugs with the least toxicity potential and the promotion of healthy behaviours (including appropriate nutrition and exercise) might be the best practice for ageing HIV-positive subjects.
Collapse
|
25
|
Schwarze-Zander C, Pabst S, Hammerstingl C, Ohlig J, Wasmuth JC, Boesecke C, Stoffel-Wagner B, Carstensen A, Nickenig G, Strassburg CP, Rockstroh JK, Skowasch D, Schueler R. Pulmonary hypertension in HIV infection: a prospective echocardiographic study. HIV Med 2015; 16:578-82. [PMID: 25960172 DOI: 10.1111/hiv.12261] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2015] [Indexed: 12/27/2022]
Abstract
OBJECTIVES While idiopathic pulmonary arterial hypertension (PAH) is a rare disease, it is seen more frequently in patients with HIV infection. The aim of this study was to evaluate the prevalence of pulmonary hypertension (PH) in patients with HIV infection by echocardiographic screening. METHODS Echocardiography and N-terminal of the prohormone brain natriuretic peptide measurement were used to examine the prevalence of PH prospectively in HIV-positive patients (n = 374) during routine follow-up visits for HIV disease. RESULTS In echocardiographic screening, PH was detected in a total of 23 of 374 HIV-infected patients (6.1%). Of these, three patients (13%) presented with symptoms of dyspnoea and fatigue, and diagnosis of PAH was confirmed by right heart catheterization. Patients with systolic pulmonary artery pressure (sPAP) > 30 mmHg were more likely to be female, to have a history of injecting drug use and to originate from high-prevalence countries (HPCs). CONCLUSIONS Echocardiographic screening detected PH in a substantial proportion of HIV-positive patients. Female gender, a history of injecting drug use and HPC origin were associated with a higher prevalence of HIV-associated PH. The relevance and long-term outcome of these findings need to be validated in follow-up studies, which are ongoing.
Collapse
Affiliation(s)
- C Schwarze-Zander
- Department of Internal Medicine I, University Hospital, University of Bonn, Bonn, Germany
| | - S Pabst
- Department of Internal Medicine II, University Hospital, University of Bonn, Bonn, Germany
| | - C Hammerstingl
- Department of Internal Medicine II, University Hospital, University of Bonn, Bonn, Germany
| | - J Ohlig
- Department of Internal Medicine II, University Hospital, University of Bonn, Bonn, Germany
| | - J C Wasmuth
- Department of Internal Medicine I, University Hospital, University of Bonn, Bonn, Germany
| | - C Boesecke
- Department of Internal Medicine I, University Hospital, University of Bonn, Bonn, Germany
| | - B Stoffel-Wagner
- Institute for Clinical Chemistry and Clinical Pharmacology, University Hospital, University of Bonn, Bonn, Germany
| | - A Carstensen
- Institute for Clinical Chemistry and Clinical Pharmacology, University Hospital, University of Bonn, Bonn, Germany
| | - G Nickenig
- Department of Internal Medicine II, University Hospital, University of Bonn, Bonn, Germany
| | - C P Strassburg
- Department of Internal Medicine I, University Hospital, University of Bonn, Bonn, Germany
| | - J K Rockstroh
- Department of Internal Medicine I, University Hospital, University of Bonn, Bonn, Germany
| | - D Skowasch
- Department of Internal Medicine II, University Hospital, University of Bonn, Bonn, Germany
| | - R Schueler
- Department of Internal Medicine II, University Hospital, University of Bonn, Bonn, Germany
| |
Collapse
|
26
|
Abstract
Much of our knowledge about HIV infection has been obtained from cohort studies, including description of the natural history of infection, identification of CD4 count and viral load as good surrogate markers of clinical progression, identification of co-factors [including older age and viral infections (CMV, HCV)] for progression of HIV-related disease and assessment of impact of highly active antiretroviral therapy on clinical outcomes. The Cologne-Bonn cohort was founded by Gerd Fätkenheuer and Bernd Salzberger after introduction of combination antiretroviral therapy in 1996 and has delivered important findings which have helped to improve treatment strategies as well as quality of overall care in HIV infection in these two cities. Indeed, the first pivotal paper from the cohort reported on an unexpectedly high rate of virological treatment failure of protease inhibitor therapy in an unselected cohort of HIV-infected patients. The subsequent analysis of risk factors for virological failure initiated the development of more potent HIV combination therapy. This review summarizes some of the major findings and contributions from the Cologne-Bonn cohort since 1996.
Collapse
|
27
|
Cardiovascular disease risk in an aging HIV population: not just a question of biology. Curr Opin HIV AIDS 2015; 9:346-54. [PMID: 24824885 DOI: 10.1097/coh.0000000000000065] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
PURPOSE OF REVIEW The objective of this review is to appraise recently published literature that describes the relationship between HIV, biologic and environmental risk factors, and cardiovascular disease (CVD) risk with particular emphasis on the aging HIV population and to demonstrate that these biologic and environmental factors may interact to increase the risk of CVD in the HIV population. RECENT FINDINGS The mechanisms linking HIV and CVD are multifactorial and encompass biological and 'environmental' modalities including multimorbid conditions that co-occur with HIV, immunologic alterations associated with HIV, polypharmacy (which affects adherence and increases likelihood of adverse drug-drug interactions) and healthcare disparities in CVD risk reduction by HIV status. SUMMARY Data regarding optimal treatment strategies that balance immunological restoration and CVD risk reduction are needed.
Collapse
|
28
|
Intestinal barrier dysfunction in HIV infection: pathophysiology, clinical implications and potential therapies. Infection 2014; 42:951-9. [PMID: 25070877 DOI: 10.1007/s15010-014-0666-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2014] [Accepted: 07/11/2014] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Current pathogenetic aspects on HIV infection highlight the importance of a chronic immune activation ultimately leading to T lymphocyte homeostasis disruption and immune deregulation associated with disease manifestations and progression. It is widely accepted that this continuous immune activation in HIV infection is principally driven by the phenomenon of pathological microbial translocation (MT). METHODS Review of the literature on the role of intestinal barrier dysfunction in HIV infection, with emphasis on the implicated pathophysiological mechanisms, clinical implications and potentially effective therapeutic interventions. FINDINGS MT in HIV infection is promoted by a multifactorial disruption of all major levels comprising the intestinal barrier defense. Specifically, HIV infection disrupts the integrity of the intestinal biological (quantitative and qualitative alterations of gut microecology, overgrowth of pathogenic bacteria), immune (depletion of CD4(+) T cells, especially Th17 cells, increased CD4+ FoxP3+ Tregs, decreased mucosal macrophages phagocytic capacity, development of intestinal proinflammatory milieu) and mechanical barrier (enterocytes' apoptosis, disruption of tight junctions). Intestinal barrier dysfunction allows the passage of microbes and immunostimulatory bioproducts from the gut lumen first in the lamina propria and thereafter in the systemic circulation, thus continuously promoting a local and systemic inflammatory response. This chronic immune activation is associated with HIV disease progression, suboptimal response to HAART and development of non-AIDS comorbidities. CONCLUSIONS We have reached a point where the effective control of HIV viremia by HAART should be combined with emerging pharmacological approaches aiming at the restoration of the intestinal barrier, targeting its diverse levels of structure and function. Elimination of the MT phenomenon would mitigate its effect on immune homeostasis, which might improve the prognosis of the HIV-infected patient in terms of morbidity and mortality.
Collapse
|
29
|
Pool ERM, Dogar O, Siddiqi K. Interventions for tobacco use cessation in people living with HIV and AIDS. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2014. [DOI: 10.1002/14651858.cd011120] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
|
30
|
Almodovar S. The complexity of HIV persistence and pathogenesis in the lung under antiretroviral therapy: challenges beyond AIDS. Viral Immunol 2014; 27:186-99. [PMID: 24797368 DOI: 10.1089/vim.2013.0130] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Antiretroviral therapy (ART) represents a significant milestone in the battle against AIDS. However, we continue learning about HIV and confronting challenges 30 years after its discovery. HIV has cleverly tricked both the host immune system and ART. First, the many HIV subtypes and recombinant forms have different susceptibilities to antiretroviral drugs, which may represent an issue in countries where ART is just being introduced. Second, even under the suppressive pressures of ART, HIV still increases inflammatory mediators, deregulates apoptosis and proliferation, and induces oxidative stress in the host. Third, the preference of HIV for CXCR4 as a co-receptor may also have noxious outcomes, including potential malignancies. Furthermore, HIV still replicates cryptically in anatomical reservoirs, including the lung. HIV impairs bronchoalveolar T-lymphocyte and macrophage immune responses, rendering the lung susceptible to comorbidities. In addition, HIV-infected individuals are significantly more susceptible to long-term HIV-associated complications. This review focuses on chronic obstructive pulmonary disease (COPD), pulmonary arterial hypertension, and lung cancer. Almost two decades after the advent of highly active ART, we now know that HIV-infected individuals on ART live as long as the uninfected population. Fortunately, its availability is rapidly increasing in low- and middle-income countries. Nevertheless, ART is not risk-free: the developed world is facing issues with antiretroviral drug toxicity, resistance, and drug-drug interactions, while developing countries are confronting issues with immune reconstitution inflammatory syndrome. Several aspects of the complexity of HIV persistence and challenges with ART are discussed, as well as suggestions for new avenues of research.
Collapse
Affiliation(s)
- Sharilyn Almodovar
- Pulmonary Sciences and Critical Care Medicine, University of Colorado Denver Anschutz Medical Campus , Aurora, Colorado
| |
Collapse
|
31
|
ten Freyhaus H, Vogel D, Lehmann C, Kümmerle T, Wyen C, Fätkenheuer G, Rosenkranz S. Echocardiographic screening for pulmonary arterial hypertension in HIV-positive patients. Infection 2014; 42:737-41. [PMID: 24619834 DOI: 10.1007/s15010-014-0610-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2014] [Accepted: 02/28/2014] [Indexed: 12/28/2022]
Abstract
Human immunodeficiency virus (HIV) infection is associated with an increased risk for pulmonary arterial hypertension (PAH). Upon the screening of 220 asymptomatic HIV-positive individuals by echocardiography, we detected and confirmed HIV-associated PAH in 0.45 % of cases. Mild elevations of systolic pulmonary arterial pressure most probably owing to left ventricular diastolic dysfunction were found in 7.7 % of cases, without progress after 2 years. We suggest that the screening of asymptomatic HIV-positive patients for PAH should not be performed.
Collapse
Affiliation(s)
- H ten Freyhaus
- Klinik III für Innere Medizin, Herzzentrum der Universität zu Köln, Kerpener Strasse 62, 50937, Cologne, Germany,
| | | | | | | | | | | | | |
Collapse
|