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da Silva NM, Leite NPDM, Carvalho AE, Almeida VDD, Santos ÍKD, Cavalcanti JRLDP, Fernandes TAADM, Nascimento EGCD, Andrade MFD. The Role of Extracellular Traps in HIV Infection. AIDS Res Hum Retroviruses 2024; 40:308-316. [PMID: 37772695 DOI: 10.1089/aid.2022.0178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2023] Open
Abstract
Human immunodeficiency virus (HIV) infection is still an important public health problem, which justifies the research of new therapies to combat it. Recent studies show that Extracellular Traps (ETs) are cellular mechanisms useful in the capture and destruction of some viruses, such as the HIV. Here, we show that neutrophils from peripheral blood, genital tissues, and placenta are activated when exposed to human immunodeficiency virus type 1 (HIV-1) and release Neutrophil Extracellular Traps (NETs). The NETs can capture, neutralize, and inactivate the virus and, also, protect other target cells from HIV infection, as long as the DNA and other constituents of the NETs remain intact. Further, the review indicates that the immunoprotective role of NETs in the context of HIV-1 infection is a promising finding for the development of new antiviral therapies. It is necessary, however, the development of studies that evaluate the tissue injury that NETs can cause and the biological relationships with other cells to improve them as therapeutic targets.
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Affiliation(s)
- Natanias Macson da Silva
- Graduate Program in Health and Society, School of Health Sciences, University of Rio Grande do Norte State, Mossoro, Brazil
- Department of Biomedical Sciences, School of Health Sciences, University of Rio Grande do Norte State, Mossoro, Brazil
| | | | - Amanda Estevam Carvalho
- Multicenter Graduate Program in Biochemistry and Molecular Biology, School of Health Sciences, University of Rio Grande do Norte State, Mossoro, Brazil
| | - Valéria Duarte de Almeida
- Multicenter Graduate Program in Physiological Sciences, School of Health Sciences, University of Rio Grande do Norte State, Mossoro, Brazil
| | - Ísis Kelly Dos Santos
- Department of Physical Education, School of Physical Education, University of Rio Grande do Norte State, Mossoro, Brazil
| | - José Rodolfo Lopes de Paiva Cavalcanti
- Graduate Program in Health and Society, School of Health Sciences, University of Rio Grande do Norte State, Mossoro, Brazil
- Department of Biomedical Sciences, School of Health Sciences, University of Rio Grande do Norte State, Mossoro, Brazil
- Multicenter Graduate Program in Biochemistry and Molecular Biology, School of Health Sciences, University of Rio Grande do Norte State, Mossoro, Brazil
- Multicenter Graduate Program in Physiological Sciences, School of Health Sciences, University of Rio Grande do Norte State, Mossoro, Brazil
| | - Thales Allyrio Araújo de Medeiros Fernandes
- Graduate Program in Health and Society, School of Health Sciences, University of Rio Grande do Norte State, Mossoro, Brazil
- Department of Biomedical Sciences, School of Health Sciences, University of Rio Grande do Norte State, Mossoro, Brazil
- Multicenter Graduate Program in Biochemistry and Molecular Biology, School of Health Sciences, University of Rio Grande do Norte State, Mossoro, Brazil
- Multicenter Graduate Program in Physiological Sciences, School of Health Sciences, University of Rio Grande do Norte State, Mossoro, Brazil
| | - Ellany Gurgel Cosme do Nascimento
- Graduate Program in Health and Society, School of Health Sciences, University of Rio Grande do Norte State, Mossoro, Brazil
- Department of Biomedical Sciences, School of Health Sciences, University of Rio Grande do Norte State, Mossoro, Brazil
| | - Micássio Fernandes de Andrade
- Graduate Program in Health and Society, School of Health Sciences, University of Rio Grande do Norte State, Mossoro, Brazil
- Multicenter Graduate Program in Biochemistry and Molecular Biology, School of Health Sciences, University of Rio Grande do Norte State, Mossoro, Brazil
- Department of Health Sciences, School of Biological and Health Sciences, Federal Rural University of the Semi-arid, Mossoro, Brazil
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Liu Z, Meng Z, Wei D, Qin Y, Lv Y, Xie L, Qiu H, Xie B, Li L, Wei X, Zhang D, Liang B, Li W, Qin S, Yan T, Meng Q, Wei H, Jiang G, Su L, Jiang N, Zhang K, Lv J, Hu Y. Predictive model and risk analysis for coronary heart disease in people living with HIV using machine learning. BMC Med Inform Decis Mak 2024; 24:110. [PMID: 38664736 PMCID: PMC11046885 DOI: 10.1186/s12911-024-02511-5] [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: 07/27/2023] [Accepted: 04/15/2024] [Indexed: 04/28/2024] Open
Abstract
OBJECTIVE This study aimed to construct a coronary heart disease (CHD) risk-prediction model in people living with human immunodeficiency virus (PLHIV) with the help of machine learning (ML) per electronic medical records (EMRs). METHODS Sixty-one medical characteristics (including demography information, laboratory measurements, and complicating disease) readily available from EMRs were retained for clinical analysis. These characteristics further aided the development of prediction models by using seven ML algorithms [light gradient-boosting machine (LightGBM), support vector machine (SVM), eXtreme gradient boosting (XGBoost), adaptive boosting (AdaBoost), decision tree, multilayer perceptron (MLP), and logistic regression]. The performance of this model was assessed using the area under the receiver operating characteristic curve (AUC). Shapley additive explanation (SHAP) was further applied to interpret the findings of the best-performing model. RESULTS The LightGBM model exhibited the highest AUC (0.849; 95% CI, 0.814-0.883). Additionally, the SHAP plot per the LightGBM depicted that age, heart failure, hypertension, glucose, serum creatinine, indirect bilirubin, serum uric acid, and amylase can help identify PLHIV who were at a high or low risk of developing CHD. CONCLUSION This study developed a CHD risk prediction model for PLHIV utilizing ML techniques and EMR data. The LightGBM model exhibited improved comprehensive performance and thus had higher reliability in assessing the risk predictors of CHD. Hence, it can potentially facilitate the development of clinical management techniques for PLHIV care in the era of EMRs.
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Affiliation(s)
- Zengjing Liu
- Information and Management College of Guangxi Medical University, Nanning, Guangxi, 530021, China
| | - Zhihao Meng
- Guangxi Clinical Center for AIDS Prevention and Treatment, Chest Hospital of Guangxi Zhuang Autonomous Region, No. 8 Yangjiaoshan Road, Liuzhou, Guangxi, 545005, China
| | - Di Wei
- Guangxi Clinical Center for AIDS Prevention and Treatment, Chest Hospital of Guangxi Zhuang Autonomous Region, No. 8 Yangjiaoshan Road, Liuzhou, Guangxi, 545005, China
| | - Yuan Qin
- Guangxi Clinical Center for AIDS Prevention and Treatment, Chest Hospital of Guangxi Zhuang Autonomous Region, No. 8 Yangjiaoshan Road, Liuzhou, Guangxi, 545005, China
| | - Yu Lv
- Guangxi Clinical Center for AIDS Prevention and Treatment, Chest Hospital of Guangxi Zhuang Autonomous Region, No. 8 Yangjiaoshan Road, Liuzhou, Guangxi, 545005, China
| | - Luman Xie
- Guangxi Clinical Center for AIDS Prevention and Treatment, Chest Hospital of Guangxi Zhuang Autonomous Region, No. 8 Yangjiaoshan Road, Liuzhou, Guangxi, 545005, China
| | - Hong Qiu
- Life Sciences College of Guangxi Medical University, Nanning, Guangxi, 530021, China
| | - Bo Xie
- Information and Management College of Guangxi Medical University, Nanning, Guangxi, 530021, China
| | - Lanxiang Li
- Basic Medical College of Guangxi Medical University, Nanning, Guangxi, 530021, China
| | - Xihua Wei
- Life Sciences College of Guangxi Medical University, Nanning, Guangxi, 530021, China
| | - Die Zhang
- Collaborative Innovation Centre of Regenerative Medicine and Medical BioResource Development and Application Co- constructed by the Province, Ministry of Guangxi Medical University, Nanning, Guangxi, 530021, China
| | - Boying Liang
- Basic Medical College of Guangxi Medical University, Nanning, Guangxi, 530021, China
| | - Wen Li
- Life Sciences College of Guangxi Medical University, Nanning, Guangxi, 530021, China
| | - Shanfang Qin
- Guangxi Clinical Center for AIDS Prevention and Treatment, Chest Hospital of Guangxi Zhuang Autonomous Region, No. 8 Yangjiaoshan Road, Liuzhou, Guangxi, 545005, China
| | - Tengyue Yan
- Collaborative Innovation Centre of Regenerative Medicine and Medical BioResource Development and Application Co- constructed by the Province, Ministry of Guangxi Medical University, Nanning, Guangxi, 530021, China
| | - Qiuxia Meng
- Information and Management College of Guangxi Medical University, Nanning, Guangxi, 530021, China
| | - Huilin Wei
- Life Sciences College of Guangxi Medical University, Nanning, Guangxi, 530021, China
| | - Guiyang Jiang
- Department of rehabilitation medicine, Department of the First affliated hospital of Guangxi Medical University, Nanning, Guangxi, 530021, China
| | - Lingsong Su
- Guangxi Clinical Center for AIDS Prevention and Treatment, Chest Hospital of Guangxi Zhuang Autonomous Region, No. 8 Yangjiaoshan Road, Liuzhou, Guangxi, 545005, China
| | - Nili Jiang
- Life Sciences College of Guangxi Medical University, Nanning, Guangxi, 530021, China
| | - Kai Zhang
- Guangxi Clinical Center for AIDS Prevention and Treatment, Chest Hospital of Guangxi Zhuang Autonomous Region, No. 8 Yangjiaoshan Road, Liuzhou, Guangxi, 545005, China.
| | - Jiannan Lv
- Affiliate Hospital of Youjiang Medical University for Nationalities, Baise, Guangxi, 533000, China.
| | - Yanling Hu
- Information and Management College of Guangxi Medical University, Nanning, Guangxi, 530021, China.
- Life Sciences College of Guangxi Medical University, Nanning, Guangxi, 530021, China.
- Collaborative Innovation Centre of Regenerative Medicine and Medical BioResource Development and Application Co- constructed by the Province, Ministry of Guangxi Medical University, Nanning, Guangxi, 530021, China.
- Faculty of Data science, City University of Macau, 999078, Macau, China.
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Guha D, Misra V, Yin J, Horiguchi M, Uno H, Gabuzda D. Vascular injury markers associated with cognitive impairment in people with HIV on suppressive antiretroviral therapy. AIDS 2023; 37:2137-2147. [PMID: 37503603 PMCID: PMC10615701 DOI: 10.1097/qad.0000000000003675] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
OBJECTIVE Human immunodeficiency virus (HIV)-associated neurocognitive disorders (HAND) remain prevalent despite viral suppression on antiretroviral therapy (ART). Vascular disease contributes to HAND, but peripheral markers that distinguish vascular cognitive impairment (VCI) from HIV-related etiologies remain unclear. DESIGN Cross-sectional study of vascular injury, inflammation, and central nervous system (CNS) injury markers in relation to HAND. METHODS Vascular injury (VCAM-1, ICAM-1, CRP), inflammation (IFN-γ, IL-1β, IL-6, IL-8, IL-15, IP-10, MCP-1, VEGF-A), and CNS injury (NFL, total Tau, GFAP, YKL-40) markers were measured in plasma and CSF from 248 individuals (143 HIV+ on suppressive ART and 105 HIV- controls). RESULTS Median age was 53 years, median CD4 + cell count, and duration of HIV infection were 505 cells/μl and 16 years, respectively. Vascular injury, inflammation, and CNS injury markers were increased in HIV+ compared with HIV- individuals ( P < 0.05). HAND was associated with increased plasma VCAM-1, ICAM-1, and YKL-40 ( P < 0.01) and vascular disease ( P = 0.004). In contrast, inflammation markers had no significant association with HAND. Vascular injury markers were associated with lower neurocognitive T scores in age-adjusted models ( P < 0.01). Furthermore, plasma VCAM-1 correlated with NFL ( r = 0.29, P = 0.003). Biomarker clustering separated HAND into three clusters: two clusters with high prevalence of vascular disease, elevated VCAM-1 and NFL, and distinctive inflammation profiles (CRP/ICAM-1/YKL-40 or IL-6/IL-8/IL-15/MCP-1), and one cluster with no distinctive biomarker elevations. CONCLUSIONS Vascular injury markers are more closely related to HAND and CNS injury in PWH on suppressive ART than inflammation markers and may help to distinguish relative contributions of VCI to HAND.
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Affiliation(s)
| | - Vikas Misra
- Department of Cancer Immunology and Virology
| | - Jun Yin
- Department of Cancer Immunology and Virology
| | - Miki Horiguchi
- Department of Data Science, Dana-Farber Cancer Institute
| | - Hajime Uno
- Department of Data Science, Dana-Farber Cancer Institute
| | - Dana Gabuzda
- Department of Cancer Immunology and Virology
- Department of Neurology, Harvard Medical School, Boston, Massachusetts, USA
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Guha D, Misra V, Yin J, Horiguchi M, Uno H, Gabuzda D. Vascular injury markers associated with cognitive impairment in people with HIV on suppressive antiretroviral therapy. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.07.23.23293053. [PMID: 37546734 PMCID: PMC10402231 DOI: 10.1101/2023.07.23.23293053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/08/2023]
Abstract
Objective Human immunodeficiency virus (HIV)-associated neurocognitive disorders (HAND) remain prevalent despite viral suppression on antiretroviral therapy (ART). Vascular disease contributes to HAND, but peripheral markers that distinguish vascular cognitive impairment (VCI) from HIV-related etiologies remain unclear. Design Cross-sectional study of vascular injury, inflammation, and central nervous system (CNS) injury markers in relation to HAND. Methods Vascular injury (VCAM-1, ICAM-1, CRP), inflammation (IFN-γ, IL-1β, IL-6, IL-8, IL-15, IP-10, MCP-1, VEGF-A), and CNS injury (NFL, total Tau, GFAP, YKL-40) markers were measured in plasma and CSF from 248 individuals (143 HIV+ on suppressive ART and 105 HIV- controls). Results Median age was 53 years, median CD4 count, and duration of HIV infection were 505 cells/μl and 16 years, respectively. Vascular injury, inflammation, and CNS injury markers were increased in HIV+ compared with HIV- individuals (p<0.05). HAND was associated with increased plasma VCAM-1, ICAM-1, and YKL-40 (p<0.01) and vascular disease (p=0.004). In contrast, inflammation markers had no significant association with HAND. Vascular injury markers were associated with lower neurocognitive T scores in age-adjusted models (p<0.01). Furthermore, plasma VCAM-1 correlated with NFL (r=0.29, p=0.003). Biomarker clustering separated HAND into three clusters: two clusters with high prevalence of vascular disease, elevated VCAM-1 and NFL, and distinctive inflammation profiles (CRP/ICAM-1/YKL-40 or IL-6/IL-8/IL-15/MCP-1), and one cluster with no distinctive biomarker elevations. Conclusions Vascular injury markers are more closely related to HAND and CNS injury in PWH on suppressive ART than inflammation markers and may help to distinguish relative contributions of VCI to HAND.
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Affiliation(s)
- Debjani Guha
- Department of Cancer Immunology and Virology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Vikas Misra
- Department of Cancer Immunology and Virology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Jun Yin
- Department of Cancer Immunology and Virology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Miki Horiguchi
- Department of Data Science, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Hajime Uno
- Department of Data Science, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Dana Gabuzda
- Department of Cancer Immunology and Virology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
- Department of Neurology, Harvard Medical School, Boston, MA, USA
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Bayowa JR, Kalyango JN, Baluku JB, Katuramu R, Ssendikwanawa E, Zalwango JF, Akunzirwe R, Nanyonga SM, Amutuhaire JS, Muganga RK, Cherop A. Mortality rate and associated factors among patients co-infected with drug resistant tuberculosis/HIV at Mulago National Referral Hospital, Uganda, a retrospective cohort study. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001020. [PMID: 37410761 DOI: 10.1371/journal.pgph.0001020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 06/06/2023] [Indexed: 07/08/2023]
Abstract
Drug resistant tuberculosis (DR-TB)/HIV co-infection remains a growing threat to public health and threatens global TB and HIV prevention and care programs. HIV is likely to worsen the outcomes of DR-TB and DR-TB is likely to worsen the outcomes of HIV despite the scale up of TB and HIV services and advances in treatment and diagnosis. This study determined the mortality rate and factors associated with mortality among persons on treatment co-infected with drug resistant TB and HIV at Mulago National Referral Hospital. We retrospectively reviewed data of 390 persons on treatment that had a DR-TB/HIV co-infection in Mulago National Referral Hospital from January 2014 to December 2019.Modified poisson regression with robust standard errors was used to determine relationships between the independent variables and the dependent variable (mortality) at bivariate and multivariate analysis. Of the 390 participants enrolled, 201(53.9%) were males with a mean age of 34.6 (±10.6) and 129 (33.2%,95% CI = 28.7-38.1%) died. Antiretroviral therapy(ART) initiation (aIRR 0.74, 95% CI = 0.69-0.79), having a body mass index (BMI)≥18.5Kg/m2 (aIRR 1.01, 95% CI = 1.03-1.17), having a documented client phone contact (aIRR 0.85, 95% CI = 0.76-0.97), having a mid-upper arm circumference,(MUAC) ≥18.5cm (aIRR 0.90, 95% CI = 0.82-0.99), being on first and second line ART regimen (aIRR 0.83, 95% CI = 0.77-0.89),having a known viral load (aIRR 1.09, 95% CI = 1.00-1.21) and having an adverse event during the course of treatment (aIRR 0.88, 95% CI = 0.83-0.93) were protective against mortality. There was a significantly high mortality rate due to DR-TB/HIV co-infection. These results suggest that initiation of all persons living with HIV/AIDS (PLWHA) with DR-TB on ART and frequent monitoring of adverse drug events highly reduces mortality.
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Affiliation(s)
- Joan Rokani Bayowa
- Clinical Epidemiology Unit, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Joan N Kalyango
- Clinical Epidemiology Unit, College of Health Sciences, Makerere University, Kampala, Uganda
| | | | - Richard Katuramu
- Ministry of Health, Tuberculosis Control Program, Kampala, Uganda
| | - Emmanuel Ssendikwanawa
- Clinical Epidemiology Unit, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Jane Frances Zalwango
- Clinical Epidemiology Unit, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Rebecca Akunzirwe
- Clinical Epidemiology Unit, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Stella Maris Nanyonga
- Clinical Epidemiology Unit, College of Health Sciences, Makerere University, Kampala, Uganda
| | | | - Ronald Kivumbi Muganga
- Clinical Epidemiology Unit, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Adolphus Cherop
- Clinical Epidemiology Unit, College of Health Sciences, Makerere University, Kampala, Uganda
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Masenga SK, Muchaili L, Hamooya BM. Cardiovascular Outcomes Among Persons with HIV and Nonalcoholic Fatty Liver Disease. AIDS 2023; 37:1329-1331. [PMID: 37822712 PMCID: PMC10564394 DOI: 10.1097/qad.0000000000003562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/13/2023]
Affiliation(s)
- Sepiso K. Masenga
- HAND Research group, School of Medicine and Health Sciences, Mulungushi University, Livingstone, Zambia
- School of Public Health, University of Zambia, Lusaka, Zambia
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Lweendo Muchaili
- HAND Research group, School of Medicine and Health Sciences, Mulungushi University, Livingstone, Zambia
| | - Benson M. Hamooya
- HAND Research group, School of Medicine and Health Sciences, Mulungushi University, Livingstone, Zambia
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Saloner R, Sun-Suslow N, Morgan EE, Lobo J, Cherner M, Ellis RJ, Heaton RK, Grant I, Letendre SL, Iudicello JE. Plasma biomarkers of vascular dysfunction uniquely relate to a vascular-risk profile of neurocognitive deficits in virally-suppressed adults with HIV. Brain Behav Immun Health 2022; 26:100560. [DOI: 10.1016/j.bbih.2022.100560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 11/11/2022] [Indexed: 11/16/2022] Open
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Prevalence and Correlates of Ischemic ECG Findings among Adults With and Without HIV in Tanzania. Glob Heart 2022; 17:38. [PMID: 35837355 PMCID: PMC9187247 DOI: 10.5334/gh.1127] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 05/18/2022] [Indexed: 11/24/2022] Open
Abstract
Introduction: HIV confers increased risk of myocardial infarction (MI), but there has been little study of ischemic electrocardiogram (ECG) findings among people with HIV in sub-Saharan Africa. Objectives: To compare the prevalence of ischemic ECG findings among Tanzanians with and without HIV and to identify correlates of ischemic ECG changes among Tanzanians with HIV. Methods: Consecutive adults presenting for routine HIV care at a Tanzanian clinic were enrolled. Age- and sex-matched HIV-uninfected controls were enrolled from a nearby general clinic. All participants completed a standardized health questionnaire and underwent 12-lead resting ECG testing, which was adjudicated by independent physicians. Prior MI was defined as pathologic Q-waves in contiguous leads, and myocardial ischemia was defined as ST-segment depression or T-wave inversion in contiguous leads. Pearson’s chi-squared test was used to compare the prevalence of ECG findings among those with and without HIV and multivariate logistic regression was performed to identify correlates of prior MI among all participants. Results: Of 497 participants with HIV and 497 without HIV, 272 (27.8%) were males and mean (sd) age was 45.2(12.0) years. ECG findings suggestive of prior MI (11.1% vs 2.4%, OR 4.97, 95% CI: 2.71–9.89, p < 0.001), and myocardial ischemia (18.7% vs 12.1% OR 1.67, 95% CI: 1.18–2.39, p = 0.004) were significantly more common among participants with HIV. On multivariate analysis, ECG findings suggestive of prior MI among all participants were associated with HIV infection (OR 4.73, 95% CI: 2.51–9.63, p = 0.030) and self-reported family history of MI or stroke (OR 1.96, 95% CI: 1.08–3.46, p = 0.023). Conclusions: There may be a large burden of ischemic heart disease among adults with HIV in Tanzania, and ECG findings suggestive of coronary artery disease are significantly more common among Tanzanians with HIV than those without HIV.
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Thames AD, Nunez R, Slavich GM, Irwin MR, Senturk D. Racial differences in health and cognition as a function of HIV among older adults. Clin Neuropsychol 2021; 36:367-387. [PMID: 34429015 DOI: 10.1080/13854046.2021.1967449] [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: 10/20/2022]
Abstract
The present study investigated the contribution of health risk factors (using the Charlson Comorbidity Index [CCI]) on cognitive outcomes in a sample of 380 HIV-positive (HIV+; n = 221) and HIV-seronegative (HIV-; n = 159) African American and European American adults aged 50+. Participants were recruited from HIV clinics and community advertisements. HIV status was confirmed by serological testing. Self-report and chart history review was used to gather information about medical ssscomorbidities. The Charlson Comorbidity Index (CCI) was used to create a comorbidity score. Participants were administered a brief cognitive test battery. As expected, health risks were greater among those with HIV. There was a HIV × Race interaction on CCI scores, such that in the HIV + group, European Americans had significantly higher CCI scores (M = 3.74; SD = 2.1) than African American HIV + participants (M = 2.70; SD = 1.9). However, in the HIV - group, African Americans had significantly higher CCI scores (M = 2.20; SD = 1.1) than HIV - European American participants (M = 1.80; SD = 1.2). Also, consistent with hypotheses, across the entire sample CCI score was significantly associated with global cognition (β = -.24, p = .02). Study results underscore the importance of considering HIV serostatus in studies examining racial disparities in health, and how multiple medical risks relate to cognitive outcomes. Neuropsychologists evaluating patients living with HIV should consider how the presence of multiple medical comorbidities may contribute to the course of cognitive decline as people age.
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Affiliation(s)
- April D Thames
- Department of Psychology, University of Southern California, Los Angeles, CA, USA.,Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, USA
| | - Rodolfo Nunez
- Department of Psychology, University of Southern California, Los Angeles, CA, USA
| | - George M Slavich
- Cousins Center for Psychoneuroimmunology and Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, USA
| | - Michael R Irwin
- Cousins Center for Psychoneuroimmunology and Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, USA
| | - Damla Senturk
- Department of Biostatistics, University of California Los Angeles, Los Angeles, CA, USA
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Homayouni TS, Ruth A, Abbott-Tate Z, Burger H, Rahim S, Murray C, Wannamaker R, Chan Carusone S, O'Brien KK. Experiences engaging in a group-based physiotherapist-led exercise programme for adults living with HIV and complex multimorbidity: a qualitative study. BMJ Open 2021; 11:e045158. [PMID: 34315789 PMCID: PMC8317082 DOI: 10.1136/bmjopen-2020-045158] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE To explore experiences participating in a group-based physiotherapist (PT)-led exercise programme among people living with HIV and complex multimorbidity. DESIGN We conducted a qualitative descriptive study using semistructured interviews. RECRUITMENT AND SETTING We recruited community-dwelling adults living with HIV who engaged in a group-based PT-led exercise programme within an HIV-specialty hospital in Toronto, Canada. Interviews were conducted in-person or by telephone. PARTICIPANTS Eight men and two women with a median age of 58 years and median of six concurrent conditions in addition to HIV, who had attended ≥2 classes of the exercise programme. DATA COLLECTION Interviews explored (1) reasons for engaging in the programme, (2) experiences with exercise prior to and after joining the programme, (3) facilitators and barriers to engagement and (4) perceived impacts of participation on health and disability. We administered the HIV Disability Questionnaire and a demographic questionnaire. RESULTS Experiences spanned perspectives prior to, during and after the PT-led exercise programme. Reasons for engaging in the programme included addressing health-related goals. Participants identified accessibility, the flexible schedule, interprofessional staff and the HIV-specific, group-based environment as facilitators to engagement. Participants reported high attendance rates, but identified episodic health challenges and overcrowded space as potential barriers to attending exercise classes. Perceived impacts on health and disability outcomes included improved physical, mental, social and cognitive health, and activities of daily living. Anticipated or actual experiences transitioning to independent exercise included facilitators (supportive programme leaders) and barriers (challenges motivatiing self to exercise alone). CONCLUSIONS Features of the programme that facilitated engagement included the interprofessional, group-based environment that offered tailored exercise in an HIV-specific facility, whereby participants perceived benefits in domains of health and disability. However, challenges transitioning to independent exercise remain. Group-based PT-led exercise programmes may facilitate engagement in exercise among adults living with HIV and complex multimorbidity.
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Affiliation(s)
- Tina S Homayouni
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Alex Ruth
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Zoe Abbott-Tate
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Helen Burger
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Shaera Rahim
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | | | - Soo Chan Carusone
- Casey House, Toronto, Ontario, Canada
- Department of Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Kelly K O'Brien
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute (RSI), University of Toronto, Toronto, Ontario, Canada
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Mueller MC, Kern WV, Usadel S, Pauly MC, Cathomen T, Salzer U. Assessing the differential impact of chronic CMV and treated HIV infection on CD8+ T-cell differentiation in a matched cohort study: is CMV the key? AIDS Res Ther 2021; 18:37. [PMID: 34193181 PMCID: PMC8247205 DOI: 10.1186/s12981-021-00361-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Accepted: 06/18/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cytomegalovirus (CMV) infection is one of the main driving forces of T-cell senescence in the general population, whereas its differential impact in people living with HIV (PLWH) is less well characterized. The study explores the effect of latent CMV infection on T-cell subsets, monocyte/macrophages activation markers, and CRP in PLWH on long-term ART. METHODS Cross-sectional cohort study including PLWH on long-term suppressive ART. Individuals of 4 groups (HIV+CMV-, HIV+CMV+, HIV-CMV+, and HIV-CMV-) were matched 1:1:1:1 for age and sex. Immunophenotyping of lymphocyte and T-cell subsets by multicolor flow cytometry was performed in fresh blood samples collected from patients and healthy donors. RESULTS Both, latent CMV and treated HIV infection were associated with an expansion of CD8 T cells, a reduced CD4/CD8 ratio, and with CD8 T-cell activation with a cumulative effect in CMV/HIV-coinfected individuals. CMV was associated with elevated numbers of late effector and terminally differentiated CD8 T-cells. Compared to CMV monoinfection, CMV/HIV coinfection showed to be associated with lower proportion of CD28-CD8+ T cells expressing CD57 suggesting that HIV preferentially expands CD28-CD57-CD8+ T cells and impedes terminal differentiation of CD28-CD8+ T cells. We could not show any association between HIV or CMV infection status and concentration of CRP and CD163. CONCLUSIONS CMV infection is associated with phenotypic signs of T-cell senescence, promoting exacerbation and persistence of alterations of the T-cell compartment in PLWH on effective ART, which are associated with adverse clinical outcomes and may be an attractive target for therapeutic interventions.
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HIV, Vascular Risk Factors, and Cognition in the Combination Antiretroviral Therapy Era: A Systematic Review and Meta-Analysis. J Int Neuropsychol Soc 2021; 27:365-381. [PMID: 33161930 PMCID: PMC9618305 DOI: 10.1017/s1355617720001022] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES Mounting evidence indicates that vascular risk factors (VRFs) are elevated in HIV and play a significant role in the development and persistence of HIV-associated neurocognitive disorder. Given the increased longevity of people living with HIV (PLWH), there is a great need to better elucidate vascular contributions to neurocognitive impairment in HIV. This systematic review and meta-analysis examine relationships between traditional VRFs, cardiovascular disease (CVD), and cognition in PLWH in the combination antiretroviral therapy era. METHODS For the systematic review, 44 studies met inclusion criteria and included data from 14,376 PLWH and 6,043 HIV-seronegative controls. To better quantify the contribution of VRFs to cognitive impairment in HIV, a robust variance estimation meta-analysis (N = 11 studies) was performed and included data from 2139 PLWH. RESULTS In the systematic review, cross-sectional and longitudinal studies supported relationships between VRFs, cognitive dysfunction, and decline, particularly in the domains of attention/processing speed, executive functioning, and fine motor skills. The meta-analysis demonstrated VRFs were associated with increased odds of global neurocognitive impairment (odds ratio [OR ]= 2.059, p = .010), which remained significant after adjustment for clinical HIV variables (p = .017). Analyses of individual VRFs demonstrated type 2 diabetes (p = .004), hyperlipidemia (p = .043), current smoking (p = .037), and previous CVD (p = .0005) were significantly associated with global neurocognitive impairment. CONCLUSIONS VRFs and CVD are associated with worse cognitive performance and decline, and neurocognitive impairment in PLWH. Future studies are needed to examine these relationships in older adults with HIV, and investigate how race/ethnicity, gender, medical comorbidities, and psychosocial factors contribute to VRF-associated cognitive dysfunction in HIV.
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Additive and Synergistic Cardiovascular Disease Risk Factors and HIV Disease Markers' Effects on White Matter Microstructure in Virally Suppressed HIV. J Acquir Immune Defic Syndr 2021; 84:543-551. [PMID: 32692114 DOI: 10.1097/qai.0000000000002390] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND It is unclear whether intermediate to high cardiovascular disease (CVD) risk and HIV disease status may have additive (ie, independent statistical effects concomitantly tested) or synergistic effects on white matter microstructure and cognition in virally suppressed HIV-infected (HIV+) men relative to sex and age-matched controls. SETTING Tertiary health care observational cohort. METHODS Eighty-two HIV+ men (mean age 55 ± 6 years, 10%-30% on various CVD drugs; 20% with previous CVD) and 40 HIV-uninfected (HIV-) men (none with previous CVD; 10%-20% on various CVD drugs) underwent diffusion tensor imaging and neuropsychological testing. A standard classification of intermediate to high CVD risk (CVD+ group) was based on the Framingham score ≥15% cutoff and/or a history of CVD. Fractional anisotropy (FA) and mean diffusivity (MD) were quantified in 11 white matter tracts. RESULTS Within the HIV- group, the CVD+ group had lower FA (P = 0.03) and higher MD (P = 0.003) in the corona radiata and higher MD in the corpus callosum (P = 0.02) and superior fasciculi (P = 0.03) than the CVD- group. Within the HIV+ group, the CVD+ group had lower FA in the superior fasciculi (P = 0.04) and higher MD in the uncinate fasciculus (P = 0.04), and lower FA (P = 0.01) and higher MD (P = 0.03) in the fornix than the CVD- group. The fornix alterations were also abnormal compared with the HIV- groups. The HIV+ CVD+ was more likely to have HIV-associated dementia. Older age, antihypertensive use, longer HIV duration, and higher C-reactive protein associated with lower FA and higher MD. Higher blood CD4 lymphocyte count and CD4/CD8 ratio associated with higher FA and lower MD. CONCLUSIONS In virally suppressed HIV, CVD risk factors have a mostly additive contribution to white matter microstructural alterations, leading to a different distribution of injury in HIV- and HIV+ persons with CVD. There was also evidence of a synergistic effect of CVD and HIV factors on the fornix white matter injury.
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Abstract
Even after more than 30 years since its discovery, there is no cure for HIV-1 infection. Combination antiretroviral therapy (cART) is currently the only HIV-1 infection management option in clinics. Despite its success in suppressing viral replication and converting HIV-1 from a lethal infection to a chronic and manageable disease, cART treatment is life long and long-term use can result in major drawbacks such as high cost, multiple side effects, and an increase in the development of multidrug-resistant escape mutants. Recently, antibody-based anti-HIV-1 treatment has emerged as a potential alternative therapeutic modality for HIV-1 treatment and cure strategies. These antibody-based anti-HIV-1 treatments comprising either receptor-targeting antibodies or broad neutralizing antibodies (bNAbs) are currently being developed and evaluated in clinical trials. These antibodies have demonstrated potent antiviral effects against multiple strains of HIV-1, and shown promise for prevention, maintenance, and prolonged remission of HIV-1 infection. This review gives an update on the current status of these antibody-based treatments for HIV-1, discusses their mechanism of action and the challenges in developing them, providing insight for their development as novel clinical therapies against HIV-1 infection.
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Affiliation(s)
- Wanwisa Promsote
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Megan E DeMouth
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Cassandra G Almasri
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Amarendra Pegu
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA.
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Comorbidities in people living with HIV: An epidemiologic and economic analysis using a claims database in France. PLoS One 2020; 15:e0243529. [PMID: 33332394 PMCID: PMC7746269 DOI: 10.1371/journal.pone.0243529] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 11/24/2020] [Indexed: 01/24/2023] Open
Abstract
OBJECTIVES As people living with HIV (PLHIV) age, the burden of non-HIV related comorbidities increases resulting in additional healthcare costs. The present study aimed to describe the profile, the prevalence and the incremental costs of non-HIV related comorbidities in PLHIV compared to non-HIV matched controls (1:2 ratio) in France. METHODS The French permanent sample of health beneficiaries (Echantillon généraliste de bénéficiaires [EGB]), a claims database representative of the national population, was used to assess comorbidities in PLHIV which were identified by the ICD-10 diagnosis codes of hospitalization, full healthcare coverage, and drug reimbursements between 2011 and 2014. The control group was matched by year of birth, gender, region of residence, and economic status. Total costs of outpatient care and hospitalizations were analysed from a societal perspective. A general linear model was used to assess the incremental cost per patient in PLHIV. RESULTS A total of 1,091 PLHIV and 2,181 matched controls were identified with a mean ± standard deviation age of 46.7 ± 11.5 years. The prevalence of alcohol abuse (5.8% vs 3.1%; p<0.001), chronic renal disease (1.2% vs 0.3%; p = 0.003), cardiovascular disease (7.4% vs 5.1%; p = 0.009), dyslipidaemia (22% vs 15.9%; p<0.001), hepatitis B (3.8% vs 0.1%; p<0.001) and hepatitis C (12.5% vs 0.6%; p<0.001) was significantly higher in PLHIV compared with non-HIV controls. Other comorbidities such as anaemia, malnutrition, psychiatric diseases, and neoplasms were also more prevalent in PLHIV. Hospitalizations were significantly increased in PLHIV compared to controls (33.2% vs 16%; p<0.001). Mean total cost was 6 times higher for PLHIV compared to controls and 4 times higher after excluding antiretroviral drugs (9,952€ vs. 2,593€; p<0.001). Higher costs per person in PLHIV were significantly associated to aging (42€ per patient/year), chronic cardiovascular disease (3,003€), hepatitis C (6,705€), metastatic carcinoma (6,880€) and moderate or severe liver disease (6,299€). CONCLUSION Our results demonstrated an increase in non-HIV related comorbidities among PLHIV compared to matched controls. This study contributes to raise awareness on the burden of chronic comorbidities.
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O'Brien KK, Kietrys D, Galantino ML, Parrott JS, Davis T, Tran Q, Aubry R, Solomon P. Reliability and Validity of the HIV Disability Questionnaire (HDQ) with Adults Living with HIV in the United States. J Int Assoc Provid AIDS Care 2020; 18:2325958219888461. [PMID: 31769326 PMCID: PMC6880031 DOI: 10.1177/2325958219888461] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES To assess measurement properties of the HIV Disability Questionnaire (HDQ) among adults with HIV in the United States. METHODS We administered the HDQ, World Health Organization Disability Assessment Schedule II (WHODAS 2.0), and a demographic questionnaire. For internal consistency reliability, we calculated Cronbach α and Kuder-Richardson-20 (KR-20) statistics for disability and episodic scores, respectively (≥0.80 acceptable). For test-retest reliability, we calculated intraclass correlation coefficients (>0.8 acceptable). For construct validity, we tested 15 a priori hypotheses assessing correlations between HDQ and WHODAS 2.0 scores. RESULTS Of the 128 participants, the majority were males (68%), median age 51 years, taking antiretroviral therapy (96%). Cronbach α ranged from 0.88 (social inclusion) to 0.93 (uncertainty). The KR-20 ranged from 0.86 (cognitive) to 0.96 (uncertainty). Intraclass correlation coefficients ranged from 0.88 (physical, cognitive, social inclusion) to 0.92 (mental-emotional). Of the 15 hypotheses, 13 (87%) were confirmed. CONCLUSIONS The HDQ demonstrates internal consistency reliability, test-retest reliability, and construct validity when administered to a sample of adults with HIV in the United States.
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Affiliation(s)
- Kelly Kathleen O'Brien
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada.,School of Rehabilitation Science (RSI), University of Toronto, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, Ontario, Canada
| | - David Kietrys
- School of Health Professions, Rutgers, The State University of New Jersey, Newark, NJ, USA
| | - Mary Lou Galantino
- Physical Therapy Program, School of Health Sciences, Stockton University, Galloway, NJ, USA.,Perelman School of Medicine, Clinical Center for Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA, USA.,Department of Physiotherapy, School of Therapeutic Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - James Scott Parrott
- School of Health Professions, Rutgers, The State University of New Jersey, Newark, NJ, USA
| | - Tracy Davis
- School of Health Professions, Rutgers, The State University of New Jersey, Newark, NJ, USA
| | - Quang Tran
- School of Health Professions, Rutgers, The State University of New Jersey, Newark, NJ, USA
| | - Rachel Aubry
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Patricia Solomon
- School of Rehabilitation Sciences, McMaster University, Hamilton, Ontario, Canada
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Mangona L, Brasil IA, Borges JP, Prista A, Farinatti P. Physical activity among women of low socioeconomic status living with HIV in two major cities of Brazil and Mozambique: A cross-sectional comparative study. Clinics (Sao Paulo) 2020; 75:e1771. [PMID: 32876111 PMCID: PMC7442379 DOI: 10.6061/clinics/2020/e1771] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 06/09/2020] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES Physical activity (PA) may reduce cardiovascular risk and preserve functional capacity of people living with human immunodeficiency virus (HIV). However, only limited research objectively measured PA in patients with low socioeconomic status (SES) in low-income countries, particularly in South America and sub-Saharan Africa. This study compared the PA assessed by accelerometers in women of low SES living with HIV under common antiretroviral therapy (cART) from two major cities in Brazil (Rio de Janeiro, n=33; 40.1±6.1 years) and Mozambique (Maputo, n=50; 38.8±8.7 years). METHODS Eligible women wore triaxial accelerometers during seven consecutive days, to estimate their habitual PA and daily energy expenditure. RESULTS The proportion of participants with overweight/obesity was greater in Rio than Maputo (57% vs. 30%; p=0.021), as well as those classified as sedentary based on steps/day (45% vs. 22%; p=0.02). Sedentary time was prevalent (Median±IQD: Rio-1236±142 vs. Maputo-1192±135 min/day; p=0.15). Time spent in PA was short, but Brazilians exhibited lower amount of light (111±56 vs. 145±51 min/day; p<0.001) and moderate-to-vigorous PA (88±3 vs. 64±36 min/day; p=0.001) vs. Mozambicans. The proportion of patients performing 60 min/day of moderate-to-vigorous PA were 58% (Rio) and 82% (Maputo), respectively. Despite of this, estimated daily energy expenditure was equivalent in both groups (1976±579 vs. 1933±492 kcal; p=0.731). CONCLUSIONS Women with low SES living with HIV in Maputo were more active vs. patients from Rio de Janeiro. Albeit sedentary behavior was prevalent, the proportion of patients complying with the minimum recommended PA for health was higher than values usually reported in developed countries.
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Affiliation(s)
- Lucília Mangona
- Laboratorio de Atividade Fisica e Promocao da Saude (LABSAU), Instituto de Educacao Fisica e Desportos, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, BR
| | - Iedda Almeida Brasil
- Laboratorio de Atividade Fisica e Promocao da Saude (LABSAU), Instituto de Educacao Fisica e Desportos, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, BR
| | - Juliana Pereira Borges
- Laboratorio de Atividade Fisica e Promocao da Saude (LABSAU), Instituto de Educacao Fisica e Desportos, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, BR
| | - Antonio Prista
- Universidade Pedagogica de Mozambique, Maputo, Mozambique
| | - Paulo Farinatti
- Laboratorio de Atividade Fisica e Promocao da Saude (LABSAU), Instituto de Educacao Fisica e Desportos, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, BR
- *Corresponding author. E-mail:
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Liu Y, Dong Y, Wen Y, Peng S, Liao J, Liu Y. Association of Mycoplasma fermentans and the risk of HIV-1 infection: A meta-analysis. Medicine (Baltimore) 2020; 99:e18499. [PMID: 31914019 PMCID: PMC6959946 DOI: 10.1097/md.0000000000018499] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Previous studies have reported the association between Mycoplasma fermentans (M. fermentans) and the risk of human immunodeficiency virus 1 (HIV-1) infection, but the results were inconsistent. The present study aims to systematically review reported studies on M. fermentans and its association with HIV-1 infection, as well as to summarize the findings using a meta-analysis. METHODS Studies meeting the inclusion criteria in the PubMed, Embase, China National Knowledge Infrastructure, WanFang Data, and Chongqing VIP databases up to March 2019 were identified. Cochran Q and I statistics were used to assess heterogeneity. Additionally, pooled odds ratio (OR) with 95% confidence intervals (CI) were calculated and displayed by Forest plots. Also, the funnel plot, Begg test, and Egger test were used to evaluate potential publication bias. In addition, the source of heterogeneity was investigated by subgroup and sensitivity analyses. RESULTS A total of 11 studies comprising 1028 HIV-1-positive patients and 1298 controls were ultimately included in this meta-analysis. Our results indicated that M. fermentans could increase the risk of HIV-1 infection among humans (OR = 3.66, 95%CI 1.26-10.64). Subgroup analysis showed that the risk of HIV-1 infection associated with M. fermentans was, based on the geographical distribution, 1.19 (95%CI 0.33-4.33) in Europe, 2.83 (95%CI 0.94-8.52) in United States, 11.92 (95%CI 3.93-36.15) in Asia; based on the source of the sample, 2.97 (95%CI 0.89-9.95) in blood samples, 4.36 (95%CI 1.63-11.68) in urine samples; based on the detection method, 2.80 (95%CI 0.72-10.96) with the polymerase chain reaction method, 5.54 (95%CI 1.21-25.28) with other detection methods; based on the source of controls, 1.91 (95%CI 0.53-6.89) in sexually transmitted diseases individuals, and 8.25 (95%CI 2.16-31.60) in health individuals. CONCLUSION Our study revealed evidence of the association between M. fermentans and HIV-1 infection. Considering the heterogeneity, further studies are warranted to understand the relationship between M. fermentans and HIV-1 infection.
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Affiliation(s)
- Yi Liu
- Department of General Practice and Geriatrics, Pingxiang, Jiangxi 337075
| | - Yonghai Dong
- Jiangxi Provincial Center for Disease Control and Prevention, Nanchang, Jiangxi 330029
| | - Yinghao Wen
- Medical Oncology, Pingxiang People's Hospital
| | | | - Jie Liao
- Clinical Laboratory, Pingxiang People's Hospital, Pingxiang, Jiangxi 337075
| | - Yun Liu
- Cadre Wards of Neurology Medicine, Jiangxi Provincial People's Hospital Affiliated to Nanchang University, Nanchang, Jiangxi 330006, China
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Calza L, Colangeli V, Borderi M, Bon I, Borioni A, Volpato F, Re MC, Viale P. Weight gain in antiretroviral therapy-naive HIV-1-infected patients starting a regimen including an integrase strand transfer inhibitor or darunavir/ritonavir. Infection 2019; 48:213-221. [PMID: 31713814 DOI: 10.1007/s15010-019-01376-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 11/05/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND Weight gain after initiation of combination antiretroviral therapy (cART) is a possible side effect of all antiretroviral regimens, but it seems to be more evident in association with integrase strand transfer inhibitors (INSTIs). So, we aimed to evaluate weight change associated with an initial cART including one INSTI or darunavir-ritonavir (DRV/r). METHODS A retrospective, observational, cohort study of antiretroviral therapy-naive adult HIV-positive patients starting an initial cART including raltegravir (RAL), dolutegravir (DTG), elvitegravir-cobicistat (EVG), or DRV/r. We compared changes in weight and body mass index (BMI) across the four groups during a 12-month follow-up. RESULTS As a whole, 680 patients (470 males, mean age 42.1 years) were enrolled: 196 starting RAL, 174 DTG, 158 EVG/c, and 152 DRV/r. Baseline mean CD4 lymphocyte count was 455 cells/mm3 and 7.3% had an AIDS diagnosis. After 12 months, mean increase in body weight was 1.93 kg in the RAL group, 2.38 kg in the DTG group, 2.14 kg in the EVG group, and 1.85 in the DRV/r group. Mean increase in BMI was 0.71, 0.84, 0.77 and 0.63 kg/m2, respectively (p > 0.05 for each comparison). Therefore, no significant increases in weight and BMI were reported in each group, and no significant differences in weight and BMI changes were described across the four treatment groups. CONCLUSIONS In our study, patients starting an initial cART including one INSTI or DRV/r after 12 months showed a small and comparable, but not significant, increase in body weight, whose long-term clinical consequences are unknown.
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Affiliation(s)
- Leonardo Calza
- Department of Medical and Surgical Sciences, Clinics of Infectious Diseases, S. Orsola-Malpighi Hospital, "Alma Mater Studiorum" University of Bologna, Via G. Massarenti 11, 40138, Bologna, Italy.
| | - Vincenzo Colangeli
- Department of Medical and Surgical Sciences, Clinics of Infectious Diseases, S. Orsola-Malpighi Hospital, "Alma Mater Studiorum" University of Bologna, Via G. Massarenti 11, 40138, Bologna, Italy
| | - Marco Borderi
- Department of Medical and Surgical Sciences, Clinics of Infectious Diseases, S. Orsola-Malpighi Hospital, "Alma Mater Studiorum" University of Bologna, Via G. Massarenti 11, 40138, Bologna, Italy
| | - Isabella Bon
- Microbiology Unit, S. Orsola-Malpighi Hospital, "Alma Mater Studiorum" University of Bologna, Bologna, Italy
| | - Aurora Borioni
- Department of Medical and Surgical Sciences, Clinics of Infectious Diseases, S. Orsola-Malpighi Hospital, "Alma Mater Studiorum" University of Bologna, Via G. Massarenti 11, 40138, Bologna, Italy
| | - Francesca Volpato
- Department of Medical and Surgical Sciences, Clinics of Infectious Diseases, S. Orsola-Malpighi Hospital, "Alma Mater Studiorum" University of Bologna, Via G. Massarenti 11, 40138, Bologna, Italy
| | - Maria Carla Re
- Microbiology Unit, S. Orsola-Malpighi Hospital, "Alma Mater Studiorum" University of Bologna, Bologna, Italy
| | - Pierluigi Viale
- Department of Medical and Surgical Sciences, Clinics of Infectious Diseases, S. Orsola-Malpighi Hospital, "Alma Mater Studiorum" University of Bologna, Via G. Massarenti 11, 40138, Bologna, Italy
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Seal LJ. Cardiovascular disease in transgendered people: A review of the literature and discussion of risk. JRSM Cardiovasc Dis 2019; 8:2048004019880745. [PMID: 31620275 PMCID: PMC6775543 DOI: 10.1177/2048004019880745] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 09/04/2019] [Accepted: 09/10/2019] [Indexed: 12/27/2022] Open
Abstract
This review examines the impact of gender affirming hormone therapy used in the transgendered and non-binary populations on cardiovascular outcomes and surrogate markers of cardiovascular health. Current evidence suggests that hormonal therapy for transgendered women decreases or is neutral regarding myocardial infarction risk. There is an increased incidence of venous thromboembolism (VTE), but newer studies suggest that the risk is significantly lower than previously described. For transgendered men, there appears to be an adverse effect on lipid parameters but this does not translate into an increased risk of cardiovascular disease above that of general male population. In all transgendered people, risk factor interventions such as smoking cessation, weight management and treatment of co-morbid conditions are important in optimising cardiovascular health. The effect of gender affirming hormonal therapy in transgendered people is difficult to interpret due to the variety of hormone regimens used, the relative brevity of the periods of observation and the influence of confounding factors such as the historical use of less physiological, oestrogens such as conjugated equine oestrogen and ethinylestradiol which are more pro-thrombotic than the 17β oestradiol that is used in modern practice.
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Affiliation(s)
- Leighton J Seal
- St George's Hospital Medical School, London, UK
- St George's University Hospitals NHS Foundation Trust, London, UK
- Gender Identity Clinic, Tavistock and Portman NHS Foundation Trust, London, UK
- Leighton John Seal, Gender Identity Clinic, Tavistock and Portman NHS Foundation Trust, 179-183 Fulham Palace Road, London W6 8QZ, UK.
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Gender, hormone therapy, and HIV: what should cardiologists know? Neth Heart J 2019; 27:233-236. [PMID: 30671882 PMCID: PMC6470229 DOI: 10.1007/s12471-019-1233-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Transgender individuals represent the fastest growing minority in the United States and are disproportionately affected by HIV. Hormone therapy is the most common treatment for gender dysphoria in transgender individuals. As HIV is an independent risk factor for coronary artery disease, it is critical to further research the influence masculinising and feminising hormone therapies have on cardiovascular disease. There is a clinical need for evidence-based guidelines for cardiologists to follow to effectively care for and treat transgender patients. For this to be done, the interplay between HIV, hormone therapy, and cardiovascular disease must be better understood through collaboration between researchers and clinicians to achieve maximum benefit from recent advancements.
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Aging Gracefully With HIV Disease: Optimizing Wellness Through Models of Care. REHABILITATION ONCOLOGY 2019. [DOI: 10.1097/01.reo.0000000000000163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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What's HIV got to do with cardiovascular disease? Int J Cardiol 2018; 265:210-211. [DOI: 10.1016/j.ijcard.2018.04.127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Revised: 04/25/2018] [Accepted: 04/27/2018] [Indexed: 11/20/2022]
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