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Mabhida SE, Mchiza ZJ, Mokgalaboni K, Hanser S, Choshi J, Mokoena H, Ziqubu K, Masilela C, Nkambule BB, Ndwandwe DE, Kengne AP, Dludla PV. High-sensitivity C-reactive protein among people living with HIV on highly active antiretroviral therapy: a systemic review and meta-analysis. BMC Infect Dis 2024; 24:160. [PMID: 38308222 PMCID: PMC10838000 DOI: 10.1186/s12879-024-09050-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 01/23/2024] [Indexed: 02/04/2024] Open
Abstract
The pathological consequences of inflammation persist in people living with the human immunodeficiency virus (PLWH), regardless of the positive outcomes of highly active antiretroviral therapy (HAART). The current systematic review and meta-analysis aims to understand and explore the levels of high-sensitivity C-reactive protein (hs-CRP) and other cardiovascular disease (CVD)-risk factors including lipid profiles among PLWH on HAART. Major electronic databases including PubMed, Scopus, and Web of Science were searched to retrieve relevant global literature reporting on hs-CRP levels in PLWH on HAART. A total of twenty-two studies with an average participant age of 40 years were eligible for this systematic review and meta-analysis. Majority of the included studies were from Africa (n = 11), the United States (n = 6), and Europe (n = 5). Our systemic review showed that most studies reported increased levels of hs-CRP among PLWH on HAART when compared to controls (PLWH not on HAART or those without HIV), especially in studies from Africa. This was supported by a meta-analysis showing significantly elevated levels of hs-CRP in PLWH on HAART when compared to PLWH not on HAART (standardised mean difference [SMD] = 0.56; 95% CI = 0.10‑1.01, z = 2.41; p = 0.02) or those without HIV (SMD = 1.19; 95% CI = 0.76‑1.63, z = 5.35; p < 0.001). Where lipid profiles, as a major predictor for CVD risk, were also impaired in PLWH on HAART when compared to PLWH not on HAART and HIV-negative participants. In conclusion, elevated levels of hs-CRP and lipid levels are prevalent in PLWH on HAART, this may increase the risk of CVD complications, especially for those people living in Africa. However, more evidence in larger population studies is required to confirm these outcomes and unveil any possible clinical implications of HAART-induced modulation of hs-CRP levels in PLWH.
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Affiliation(s)
- Sihle E Mabhida
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Tygerberg, 7505, South Africa.
| | - Zandile J Mchiza
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Tygerberg, 7505, South Africa
- School of Public Health, University of the Western Cape, Bellville, 7535, South Africa
| | - Kabelo Mokgalaboni
- Department of Life and Consumer Sciences, University of South Africa, Roodepoort, 1709, South Africa
| | - Sidney Hanser
- Department of Physiology and Environmental Health, University of Limpopo, Sovenga, 0727, South Africa
| | - Joel Choshi
- Department of Physiology and Environmental Health, University of Limpopo, Sovenga, 0727, South Africa
| | - Haskly Mokoena
- Department of Physiology and Environmental Health, University of Limpopo, Sovenga, 0727, South Africa
| | - Khanyisani Ziqubu
- Department of Biochemistry, North-West University, Mmabatho, 2745, South Africa
| | - Charity Masilela
- Department of Biochemistry and Microbiology, University of Zululand, KwaDlangezwa, Richards Bay, 3880, South Africa
| | - Bongani B Nkambule
- School of Laboratory Medicine and Medical Sciences, University of KwaZulu-Natal, Durban, 4000, South Africa
| | - Duduzile E Ndwandwe
- Cochrane South Africa, South African Medical Research Council, Tygerberg, 7505, South Africa
| | - André P Kengne
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Tygerberg, 7505, South Africa
- Department of Medicine, University of Cape Town, Cape Town, 7700, South Africa
| | - Phiwayinkosi V Dludla
- Cochrane South Africa, South African Medical Research Council, Tygerberg, 7505, South Africa
- Department of Biochemistry and Microbiology, University of Zululand, KwaDlangezwa, Richards Bay, 3880, South Africa
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Akinosoglou K, Kolosaka M, Schinas G, Delastic AL, Antonopoulou S, Perperis A, Marangos M, Mouzaki A, Gogos C. Association of Antiretroviral Therapy with Platelet Function and Systemic Inflammatory Response in People Living with HIV: A Cross-Sectional Study. Microorganisms 2023; 11:microorganisms11040958. [PMID: 37110381 PMCID: PMC10144397 DOI: 10.3390/microorganisms11040958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 04/03/2023] [Accepted: 04/04/2023] [Indexed: 04/29/2023] Open
Abstract
People living with HIV (PLWHIV) present an increased risk of adverse cardiovascular events. We aimed to assess whether antiretroviral therapy (ART) pharmacologically enhances platelet reactivity and platelet activation intensity, and explore the potential association with underlying inflammatory status. This was a cross-sectional cohort study carried out among PLWHIV on diverse ART regimens. Platelet reactivity and activation intensity were assessed using the bedside point-of-care VerifyNow assay, in P2Y12 reaction units (PRU), measurements of monocyte-platelet complexes, and P-selectin and GPIIb/IIIa expression increase, following activation with ADP, respectively. Levels of major inflammatory markers and whole blood parameters were also evaluated. In total, 71 PLWHIV, 59 on ART and 22 healthy controls, were included in this study. PRU values were significantly elevated in PLWHIV compared to controls [Mean; 257.85 vs. 196.67, p < 0.0001], but no significant differences were noted between ART-naïve or ART-experienced PLWHIV, or between TAF/TDF and ABC based regimens, similar to systemic inflammatory response. However, within-group analysis showed that PRUs were significantly higher in ABC/PI vs ABC/INSTI or TAF/TDF + PI patients, in line with levels of IL-2. PRU values did not correlate strongly with CD4 counts, viral load, or cytokine values. P-selectin and GPIIb/IIIa expression increased following ADP activation and were significantly more prominent in PLWHIV (p < 0.005). Platelet reactivity and platelet activation intensity were shown to be increased in PLWHIV, but they did not appear to be related to ART initiation, similar to the underlying systemic inflammatory response.
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Affiliation(s)
- Karolina Akinosoglou
- Department of Internal Medicine, University General Hospital of Patras, 26504 Patras, Greece
- Medical School, University of Patras, 26504 Patras, Greece
- Division of Infectious Diseases, Department of Internal Medicine, University of Patras, 26504, Patras, Greece
| | - Martha Kolosaka
- Department of Internal Medicine, University General Hospital of Patras, 26504 Patras, Greece
| | - George Schinas
- Medical School, University of Patras, 26504 Patras, Greece
| | - Anne-Lise Delastic
- Laboratory of Immuno-Hematology, Medical School, University of Patras, 26504 Patras, Greece
| | - Stefania Antonopoulou
- Laboratory of Immuno-Hematology, Medical School, University of Patras, 26504 Patras, Greece
| | - Angelos Perperis
- Department of Cardiology, University General Hospital of Patras, 26504 Patras, Greece
| | - Markos Marangos
- Department of Internal Medicine, University General Hospital of Patras, 26504 Patras, Greece
- Medical School, University of Patras, 26504 Patras, Greece
- Division of Infectious Diseases, Department of Internal Medicine, University of Patras, 26504, Patras, Greece
| | - Athanasia Mouzaki
- Medical School, University of Patras, 26504 Patras, Greece
- Laboratory of Immuno-Hematology, Medical School, University of Patras, 26504 Patras, Greece
| | - Charalambos Gogos
- Department of Internal Medicine, University General Hospital of Patras, 26504 Patras, Greece
- Medical School, University of Patras, 26504 Patras, Greece
- Division of Infectious Diseases, Department of Internal Medicine, University of Patras, 26504, Patras, Greece
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Abstract
PURPOSE OF REVIEW HIV treatment has evolved since the introduction of antiretroviral therapy (ART) in the 1990s. Earlier treatment strategies, and the introduction of integrase inhibitors in preferred first-line ART have fundamentally changed cardiovascular side effects due to HIV infection and ART. This review provides an update on cardiovascular toxicity of contemporary ART. RECENT FINDINGS Cardiovascular disease (CVD) risk, including heart failure, is still increased in people living with HIV (PLWH). Exposure to older antiretrovirals, including stavudine and zidovudine, still impact on CVD risk through persistent changes in body fat distribution years after discontinuation. Protease inhibitors (PI) and efavirenz have associated metabolic disturbances and increased risk of CVD, although use is decreasing worldwide. Integrase inhibitors and CCR5 antagonists seem to have negligible immediate CVD toxicity. Weight gain on newer antiretrovirals including integrase inhibitors is a reason for concern. SUMMARY CVD risk should be monitored carefully in PLWH who were exposed to first generation ART, efavirenz or to PIs. Registries should capture ART use and CVD events to stay informed on actual clinical risk in the current era of rapid initiation on integrase inhibitor-based ART.
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Affiliation(s)
- Alinda G Vos
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Ezintsha, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - W D F Venter
- Ezintsha, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Abstract
A major challenge encountered by clinicians is differentiating presentations characterized by significant thrombocytopenia due to overlapping clinical symptoms and signs in the setting of ambiguous laboratory results. Immature platelets represent the youngest platelets that can be measured in peripheral blood by current hematology analyzers. These young platelets are larger, with higher RNA content recently released from the bone marrow. Thrombocytopenic presentations caused directly or indirectly by immune responses can lead to compensatory bone marrow responses seeking to normalize the platelet count; thus obtaining absolute immature platelet counts may be informative while triaging patients. Over the last decade, their use has expanded beyond being an early biomarker of bone marrow reconstitution post-hematopoietic stem cell transplantation to being used to establish bone marrow responses to infection and thrombocytopenias due to immune etiologies. Its accessibility as part of more detailed platelet indices obtained with routine laboratories makes it a promising option to understand the bone marrow's real-time response to disease states characterized by thrombocytopenia. This review will look at the immature platelet count as a biomarker, while presenting current attempts trying to understand how it could be used in thrombocytopenias occurring secondary to a given immune etiology.
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Affiliation(s)
- Hollie M Reeves
- Department of Pathology, University Hospitals Cleveland Medical Center and Case Western Reserve University, Cleveland, OH, United States
| | - Robert W Maitta
- Department of Pathology, University Hospitals Cleveland Medical Center and Case Western Reserve University, Cleveland, OH, United States
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Bernlochner I, Klug M, Larasati D, Von Scheidt M, Santovito D, Hristov M, Weber C, Laugwitz KL, Bongiovanni D. Sorting and magnetic-based isolation of reticulated platelets from peripheral blood. Platelets 2020; 32:113-119. [PMID: 32046562 DOI: 10.1080/09537104.2020.1724923] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Reticulated Platelets (RPs) are large, RNA-rich, prothrombotic and hyperactive platelets known to be elevated in high-risk populations such as diabetics and patients with acute coronary syndrome. High levels of RPs correlate with mortality and adverse cardiovascular events in patients with coronary artery disease as well as with an insufficient antiplatelet response to thienopyridines and aspirin after percutaneous coronary interventions, making them an appealing drug target. However, processing of platelets is challenging and no specific marker for RPs exists. Until now, the gold standard laboratory-based method to study them is based on the flow cytometric measurement of their cell size and their RNA-content with the fluorescent dye Thiazole Orange (TO). Nevertheless, standardized protocols for staining and processing of RPs are missing and the existing techniques were not applied for cell sorting. We provide here a structured and reproducible method to detect, isolate and collect RPs from peripheral blood by RNA-specific staining with TO implementing several platelet inhibitors as well as magnetic labeling allowing sufficient cell recovery and deep biological investigation of these platelets.
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Affiliation(s)
- Isabell Bernlochner
- Medical Department 1, Cardiology, Klinikum Rechts Der Isar, Technische Universität , Munich, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance , Munich, Germany
| | - Melissa Klug
- Medical Department 1, Cardiology, Klinikum Rechts Der Isar, Technische Universität , Munich, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance , Munich, Germany
| | - Ditya Larasati
- Medical Department 1, Cardiology, Klinikum Rechts Der Isar, Technische Universität , Munich, Germany
| | - Moritz Von Scheidt
- DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance , Munich, Germany.,Department of Cardiology, Deutsches Herzzentrum München, Technische Universität , Munich, Germany
| | - Donato Santovito
- Institute for Cardiovascular Prevention (IPEK), Ludwig-Maximilians-University Munich , Munich, Germany
| | - Michael Hristov
- Institute for Cardiovascular Prevention (IPEK), Ludwig-Maximilians-University Munich , Munich, Germany
| | - Christian Weber
- DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance , Munich, Germany.,Institute for Cardiovascular Prevention (IPEK), Ludwig-Maximilians-University Munich , Munich, Germany
| | - Karl-Ludwig Laugwitz
- Medical Department 1, Cardiology, Klinikum Rechts Der Isar, Technische Universität , Munich, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance , Munich, Germany
| | - Dario Bongiovanni
- Medical Department 1, Cardiology, Klinikum Rechts Der Isar, Technische Universität , Munich, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance , Munich, Germany.,Department of Cardiovascular Medicine, Humanitas Clinical and Research Center , Rozzano, Milan, Italy
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