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Love M, Behrens-Bradley N, Ahmad A, Wertheimer A, Klotz S, Ahmad N. Plasma Levels of Secreted Cytokines in Virologically Controlled HIV-Infected Aging Adult Individuals on Long-Term Antiretroviral Therapy. Viral Immunol 2024; 37:202-215. [PMID: 38717822 DOI: 10.1089/vim.2023.0123] [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: 05/14/2024] Open
Abstract
HIV-infected (HIV+) aging adult individuals who have achieved undetectable viral load and improved CD4 T cell counts due to long-term antiretroviral therapy (ART) may continue to experience inflammation and immunosenescence. Therefore, we evaluated the plasma levels of proinflammatory and anti-inflammatory cytokines in 173 HIV+ aging adult individuals with age ranging from 22 to 81 years on long-term ART with viral load mostly <20 HIV RNA copies/mL and compared with 92 HIV-uninfected (HIV- or healthy controls) aging individuals. We found that the median levels of TNF-α, IFN-γ, IL-1β, IL-6, and IL-10 were higher (p < 0.001 to <0.0001) and IL-17 trended lower in HIV+ individuals than healthy controls. Increasing CD4 T cell counts in the HIV+ cohort did not significantly change the circulating cytokine levels, although levels of IL-1β increased. However, IL-17 levels significantly decreased with increasing CD4 counts in the healthy controls and yet unchanged in the HIV+ cohort. Of note, the levels of circulating IL-17 were significantly reduced comparatively in the healthy controls where the CD4 count was below 500, yet once above 500 the levels of CD4, IL-17 levels were comparable with the HIV+ cohort. With increasing CD8 T cell counts, the levels of these cytokines were not significantly altered, although levels of TNF-α, IFN-γ, and IL-6 declined, whereas IL-1β and IL-17 were slightly elevated. Furthermore, increasing age of the HIV+ cohort did not significantly impact the cytokine levels although a slight increase in TNF-α, IL-6, IL-10, and IL-17 was observed. Similarly, these cytokines were not significantly modulated with increasing levels of undetectable viral loads, whereas some of the HIV+ individuals had higher levels of TNF-α, IFN-γ, and IL-1β. In summary, our findings show that HIV+ aging adult individuals with undetectable viral load and restored CD4 T cell counts due to long-term ART still produce higher levels of both proinflammatory and anti-inflammatory cytokines compared with healthy controls, suggesting some level of inflammation.
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Affiliation(s)
- Maria Love
- Department of Immunobiology, University of Arizona, Tucson, Arizona, USA
| | | | - Aasim Ahmad
- Department of Immunobiology, University of Arizona, Tucson, Arizona, USA
| | - Anne Wertheimer
- Department of Medicine, College of Medicine, University of Arizona, Tucson, Arizona, USA
- Department of BIO5 Institute, University of Arizona, Tucson, Arizona, USA
| | - Stephen Klotz
- Department of Medicine, College of Medicine, University of Arizona, Tucson, Arizona, USA
| | - Nafees Ahmad
- Department of Immunobiology, University of Arizona, Tucson, Arizona, USA
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Suleman M, Khan SU, Hussain T, Khan MU, Shamsul Hassan S, Majid M, Khan SU, Shehzad Khan M, Shan Ahmad RU, Arif M, Ahmad Z, Crovella S, Anthony S. Cardiovascular challenges in the era of antiretroviral therapy for AIDS/ HIV: A comprehensive review of research advancements, pathophysiological insights, and future directions. Curr Probl Cardiol 2024; 49:102353. [PMID: 38128638 DOI: 10.1016/j.cpcardiol.2023.102353] [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] [Received: 12/14/2023] [Accepted: 12/18/2023] [Indexed: 12/23/2023]
Abstract
Cardiovascular disease, particularly coronary heart disease, is becoming more common among those living with HIV. Individuals with HIV face an increased susceptibility to myocardial infarction, also known as a heart attack, as compared to the general population in developed countries. This heightened risk can be attributed mainly to the presence of effective antiretroviral drugs and the resulting longer lifespan. Some cardiac issues linked to non-antiretroviral medications, including myocarditis, endocarditis, cardiomyopathy with dilation, pulmonary hypertension, and oedema of the heart, may affect those not undergoing highly active antiretroviral therapy (ART). Impaired immune function and systemic inflammation are significant contributors to this phenomenon after initiating highly aggressive antiretroviral treatment ART. It is becoming more challenging to determine the best course of treatment for HIV-associated cardiomyopathy due to new research suggesting that protease inhibitors might have a negative impact on the development of HF. Currently, the primary focus of research on ART medications is centered on the cardiovascular adverse effects of nucleoside reverse transcriptase inhibitors and protease inhibitors. This review paper thoroughly evaluates the advancements achieved in cardiovascular disease research and explores the potential implications for prospects. Additionally, it considers the field's future prospects while examining how ART might be altered and its clinical applications.
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Affiliation(s)
- Muhammad Suleman
- Laboratory of Animal Research Center (LARC), Qatar University, Doha, Qatar; Center for Biotechnology and Microbiology, University of Swat, Swat, Pakistan
| | - Shahid Ullah Khan
- Integrative Science Center of Germplasm Creation in Western China (CHONGQING) Science City and Southwest University, College of Agronomy and Biotechnology, Southwest University, Chongqing 400715, PR China; Department of Biochemistry, Women Medical and Dental College, Khyber Medical University, Abbottabad, Khyber Pakhtunkhwa 22080, Pakistan
| | - Talib Hussain
- Women Dental College Abbottabad, KPK 22020, Pakistan
| | - Munir Ullah Khan
- MOE Key Laboratory of Macromolecular Synthesis and Functionalization, International Research Center for X Polymers, Department of Polymer Science and Engineering, Zhejiang University, Hangzhou 310027 PR China
| | - Syed Shamsul Hassan
- Chinese Academy of Sciences, Institute of Basic Medicine and Cancer (IBMC),Hangzhou 310002, PR China
| | - Muhammad Majid
- Faculty of Pharmacy, Hamdard University, Islamabad 45550, Pakistan
| | - Safir Ullah Khan
- Hefei National Laboratory for Physical Sciences at the Microscale, School of Life Sciences, University of Science and Technology of China, Hefei 230027, PR China
| | - Muhammad Shehzad Khan
- Hong Kong Centre for Cerebro-Cardiovascular Health Engineering (COCHE), Shatin city, HKSAR, Hong Kong
| | - Rafi U Shan Ahmad
- Department of Biomedical Engineering, City university of Hong Kong, Kowloon City, HKSAR, Hong Kong
| | - Muhammad Arif
- College of Agriculture, Guizhou University, Guiyang, Guizhou, China
| | - Zubair Ahmad
- Applied College, Center of Bee Research and its Products, Unit of Bee Research and Honey Production, and Research Center for Advanced Materials Science (RCAMS), King Khalid University, P.O. Box 9004, Abha 61413, Saudi Arabia
| | - Sergio Crovella
- Center for Biotechnology and Microbiology, University of Swat, Swat, Pakistan
| | - Stefan Anthony
- Chinese Academy of Sciences, Institute of Basic Medicine and Cancer (IBMC),Hangzhou 310002, PR China.
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Elias Junior E, Gubert VT, Bonin-Jacob CM, Puga MAM, Gouveia CG, Sichinel AH, Tozetti IA. CD57 T cells associated with immunosenescence in adults living with HIV or AIDS. Immunology 2024; 171:146-153. [PMID: 37880915 DOI: 10.1111/imm.13707] [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: 04/21/2023] [Accepted: 10/04/2023] [Indexed: 10/27/2023] Open
Abstract
Despite the advancement of human immunodeficiency virus (HIV)-related discoveries, new HIV infections still persist. With the advent of antiretroviral therapy, prognosis has migrated from acute to chronic HIV infection and inflammation, with the possibility of increased immune aging. We aimed to assess such immunosenescence by analysing CD27 and CD57 expression on the surface of T cells. This cross-sectional study was conducted between 2017 and 2018 on people living with HIV/AIDS (PLWHA) who attended an outpatient clinic of the Infectious Diseases Service of a university hospital and a geriatric reference service in Brazil. A standardized interview was conducted, and venous peripheral blood was collected for flow cytometry analysis. To assess immunosenescence, we compared CD27 and CD57 expression on the surface of T cells between adult and elderly individuals without HIV and adult PLWHA. All results for cells in terminal senescent stages in adult PLWHA more closely resembled those of elderly than adult participants without HIV (p > 0.05). The presence of CD27+ cells did not differ statistically among the three study groups when comparing immunological responders (IR) and immunological non-responders (INR); for the entire CD4+ T-cell population (including CD4 + CD8+ and CD4 + CD8- cells), the median count (25-75th) was higher in the INR (79.6%) than the IR (68.0%) group. HIV-infected individuals possessed a higher number of T lymphocytes with a molecular phenotype associated with immunosenescence, a lower proportion of T cells in the early stages of senescence (median 25-75th: 27.0%), and a higher proportion of T cells in the intermediate and final stages of senescence (median 25-75th: 16.1%) than adults without HIV (median 25-75th: 42.0% and 18.4%, respectively). Considering the higher number of senescent T lymphocytes, we observed in our PLWHA population-especially in the INR group (CD8CD57+ cells: 39.3% INR vs. 23.4% IR; CD4CD57+ cells: 44.0% INR vs. 27.7% IR)-may indicate a similar mortality risk phenotype from immune-preventable diseases.
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Affiliation(s)
- Erivaldo Elias Junior
- Postgraduate Program in Infectious and Parasitic Diseases, School of Medicine, Federal University of Mato Grosso do Sul, Campo Grande, Campo Grande, Mato Grosso do Sul, Brazil
- São Julião Hospital, Campo Grande, Mato Grosso do Sul, Brazil
| | - Vanessa T Gubert
- School of Pharmaceutical Sciences, Food and Nutrition, Federal University of Mato Grosso do Sul, Campo Grande, Mato Grosso do Sul, Brazil
| | - Camila M Bonin-Jacob
- Postgraduate Program in Infectious and Parasitic Diseases, School of Medicine, Federal University of Mato Grosso do Sul, Campo Grande, Campo Grande, Mato Grosso do Sul, Brazil
| | - Marco Antonio M Puga
- Postgraduate Program in Infectious and Parasitic Diseases, School of Medicine, Federal University of Mato Grosso do Sul, Campo Grande, Campo Grande, Mato Grosso do Sul, Brazil
| | | | | | - Inês A Tozetti
- Postgraduate Program in Infectious and Parasitic Diseases, School of Medicine, Federal University of Mato Grosso do Sul, Campo Grande, Campo Grande, Mato Grosso do Sul, Brazil
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Jankowski CM, Konigsberg IR, Wilson MP, Sun J, Brown TT, Julian CG, Erlandson KM. Skeletal muscle DNA methylation: Effects of exercise and HIV. Aging Cell 2024; 23:e14025. [PMID: 37920126 PMCID: PMC10776118 DOI: 10.1111/acel.14025] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 10/13/2023] [Accepted: 10/15/2023] [Indexed: 11/04/2023] Open
Abstract
Aging, human immunodeficiency virus (HIV) infection, and antiretroviral therapy modify the epigenetic profile and function of cells and tissues, including skeletal muscle (SkM). In some cells, accelerated epigenetic aging begins very soon after the initial HIV infection, potentially setting the stage for the early onset of frailty. Exercise imparts epigenetic modifications in SkM that may underpin some health benefits, including delayed frailty, in people living with HIV (PWH). In this first report of exercise-related changes in SkM DNA methylation among PWH, we investigated the impact of 24 weeks of aerobic and resistance exercise training on SkM (vastus lateralis) DNA methylation profiles and epigenetic age acceleration (EAA) in older, virally suppressed PWH (n = 12) and uninfected controls (n = 18), and associations of EAA with physical function at baseline. We identified 983 differentially methylated positions (DMPs) in PWH and controls at baseline and 237 DMPs after training. The influence of HIV serostatus on SkM methylation was more pronounced than that of exercise training. There was little overlap in the genes associated with the probes most significantly differentiated by exercise training within each group. Baseline EAA (mean ± SD) was similar between PWH (-0.4 ± 2.5 years) and controls (0.2 ± 2.6 years), and the exercise effect was not significant (p = 0.79). EAA and physical function at baseline were not significantly correlated (all p ≥ 0.10). This preliminary investigation suggests HIV-specific epigenetic adaptations in SkM with exercise training but confirmation in a larger study that includes transcriptomic analysis is warranted.
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Affiliation(s)
| | - Iain R. Konigsberg
- Department of Biomedical InformaticsUniversity of Colorado Anschutz Medical CampusColoradoAuroraUSA
| | - Melissa P. Wilson
- Division of Infectious Diseases, Department of MedicineUniversity of Colorado Anschutz Medical CampusColoradoAuroraUSA
| | - Jing Sun
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthMarylandBaltimoreUSA
| | - Todd T. Brown
- Division of Endocrinology, Diabetes, & Metabolism, Department of MedicineJohns Hopkins UniversityMarylandBaltimoreUSA
| | - Colleen G. Julian
- Department of Biomedical InformaticsUniversity of Colorado Anschutz Medical CampusColoradoAuroraUSA
| | - Kristine M. Erlandson
- Division of Infectious Diseases, Department of MedicineUniversity of Colorado Anschutz Medical CampusColoradoAuroraUSA
- Division of Geriatric Medicine, Department of MedicineUniversity of Colorado Anschutz Medical CampusColoradoAuroraUSA
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O’Shea JG, Cholli P, Heil EL, Buchacz K. Considerations for long-acting antiretroviral therapy in older persons with HIV. AIDS 2023; 37:2271-2286. [PMID: 37965737 PMCID: PMC10993170 DOI: 10.1097/qad.0000000000003704] [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] [Indexed: 11/16/2023]
Abstract
People with HIV (PWH) can now enjoy longer, healthier lives due to safe and highly effective antiretroviral therapy (ART), and improved care and prevention strategies. New drug formulations such as long-acting injectables (LAI) may overcome some limitations and issues with oral antiretroviral therapy and strengthen medication adherence. However, challenges and questions remain regarding their use in aging populations. Here, we review unique considerations for LAI-ART for the treatment of HIV in older PWH, including benefits, risks, pharmacological considerations, implementation challenges, knowledge gaps, and identify factors that may facilitate uptake of LA-ART in this population.
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Affiliation(s)
- Jesse G. O’Shea
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Preetam Cholli
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Emily L. Heil
- Department of Practice, Sciences, and Health Outcomes Research, University of Maryland School of Pharmacy, Baltimore, Maryland, USA
| | - Kate Buchacz
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
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Tang Y, Zhu X, Lu W, Song Y, Tao X, Cheng H. Transcriptional analysis reveals distinct gene expression profiles of three bowenoid papulosis patients. Exp Dermatol 2023; 32:1439-1450. [PMID: 37293825 DOI: 10.1111/exd.14847] [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] [Received: 01/03/2023] [Revised: 05/17/2023] [Accepted: 05/24/2023] [Indexed: 06/10/2023]
Abstract
Bowenoid papulosis (BP) is a benign and possibly carcinogenic disease associated with human papillomavirus (HPV) infection, which has been increasingly recognised and paid attention to in recent years, but the potential mechanisms still remain unclear. In our study, three patients who were diagnosed with BP were enrolled into our research. Skin biopsies were taken and were separated into two parts, one part was for HE staining and the others were for RNA-sequencing (RNA-seq). All the three patents were human papillomavirus (HPV) positive and HE staining revealed typical skin histopathological changes in BP, including dyskeratosis, hyperplasia and hypertrophy of the granular and spinous layers, atypical keratinocytes. RNA-seq analysis demonstrated that a total of 486 differentially expressed genes (DEGs) were detected between the skin tissues from BP and the controls, among which, 320 genes were significantly upregulated and 166 genes were dramatically downregulated. GO enrichment revealed that antigen binding, cell cycle, immune response and keratinisation to be the most notably altered pathways, whereas KEGG analysis indicated that cell cycle cytokine-cytokine receptor interaction, ECM receptor interaction and p53 signalling pathway to be the most significantly changed signalling pathways in BP. Furthermore, metabolism-associated enrichment analysis showed that cholesterol metabolism, metabolism of xenobiotics by cytochrome p450 and pyrimidine metabolism to be the most dramatically dysregulated metabolic pathways in BP as compared to normal controls. Our study revealed that inflammation, metabolism and cell proliferation signalling pathways might be the most important pathways for BP disease, targeted inhibiting of these signals might be a potential method for BP treatment.
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Affiliation(s)
- Yi Tang
- Center for Plastic & Reconstructive Surgery, Department of Dermatology, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China
- Department of Dermatology and Venereology, Zhejiang University School of Medicine Sir Run Run Shaw Hospital, Hangzhou, China
| | - Xiaoxia Zhu
- Department of Dermatology, The Affiliated Hospital of Medical School, Ningbo University, Ningbo, China
| | - Wei Lu
- Center for Plastic & Reconstructive Surgery, Department of Dermatology, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Yinjing Song
- Department of Dermatology and Venereology, Zhejiang University School of Medicine Sir Run Run Shaw Hospital, Hangzhou, China
| | - Xiaohua Tao
- Center for Plastic & Reconstructive Surgery, Department of Dermatology, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Hao Cheng
- Department of Dermatology and Venereology, Zhejiang University School of Medicine Sir Run Run Shaw Hospital, Hangzhou, China
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Ma H, Zhang Q, Liang W, Han A, Xie N, Xiang H, Wang X. Short-Term Exposure to PM 2.5 and O 3 Impairs Liver Function in HIV/AIDS Patients: Evidence from a Repeated Measurements Study. TOXICS 2023; 11:729. [PMID: 37755740 PMCID: PMC10537338 DOI: 10.3390/toxics11090729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 08/11/2023] [Accepted: 08/23/2023] [Indexed: 09/28/2023]
Abstract
Studies investigating the relationship between ambient air pollutants and liver function are scarce. Our objective was to examine the associations of acute exposure to PM2.5 and O3 with levels of hepatic enzymes in people living with HIV/AIDS (PWHA). Our study involved 163 PWHA, who were evaluated for serum hepatic enzymes up to four times within a year. We extracted daily average concentrations of PM2.5, PM2.5 components, and O3 for each participant, based on their residential address, using the Tracking of Air Pollution in China database. Linear mixed-effect models were utilized to assess the associations of acute exposure to PM2.5 and O3 with hepatic enzymes. Weighted quantile sum regression models were employed to identify the major constituents of PM2.5 that affect hepatic enzymes. The percent change of aspartate aminotransferase (AST) concentration was positively correlated with a 10 µg/m3 increase in PM2.5, ranging from 1.92 (95% CI: 3.13 to 4.38) to 6.09 (95% CI: 9.25 to 12.38), with the largest effect observed at lag06. Additionally, acute O3 exposure was related to increased levels of alanine aminotransferase (ALT), AST, and alkaline phosphatase (ALP) concentrations. Co-exposure to high levels of PM2.5 and O3 had an antagonistic effect on the elevation of AST. Further analysis revealed that SO42- and BC were major contributors to elevated AST concentration due to PM2.5 constituents. A stronger association was found between O3 exposure and ALT concentration in female PWHA. Our study found that short-term exposure to PM2.5 and O3 was associated with increased levels of hepatic enzymes, indicating that PM2.5 and O3 exposure may contribute to hepatocellular injury in PWHA. Our study also found that PWHA may be more vulnerable to air pollution than the general population. These findings highlight the relationship between air pollutants and liver function in PWHA, providing a scientific basis for the implementation of measures to protect susceptible populations from the adverse effects of air pollution. A reduction in the burning of fossil fuels and reduced exposure to air pollutants may be effective hazard reduction approaches.
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Affiliation(s)
- Hongfei Ma
- Wuhan Center for Disease Control and Prevention, 288# Machang Road, Wuhan 430024, China
| | - Qian Zhang
- Qingshan District Center for Disease Control and Prevention, 4# Yangang Road, Wuhan 430070, China
| | - Wei Liang
- Department of Global Health, School of Public Health, Wuhan University, 115# Donghu Road, Wuhan 430071, China
| | - Aojing Han
- Department of Global Health, School of Public Health, Wuhan University, 115# Donghu Road, Wuhan 430071, China
| | - Nianhua Xie
- Wuhan Center for Disease Control and Prevention, 288# Machang Road, Wuhan 430024, China
| | - Hao Xiang
- Department of Global Health, School of Public Health, Wuhan University, 115# Donghu Road, Wuhan 430071, China
| | - Xia Wang
- Wuhan Center for Disease Control and Prevention, 288# Machang Road, Wuhan 430024, China
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Simon L, Primeaux SD, Levitt DE, Bourgeois B, Johannsen NM, Peters A, Ahmed J, Marshall RH, Fairchild AH, Ferguson TF, Molina PE. An aerobic exercise intervention to improve metabolic health among people living with HIV with at-risk alcohol use: the ALIVE-Ex research study protocol. AIDS Res Ther 2023; 20:35. [PMID: 37296413 PMCID: PMC10251573 DOI: 10.1186/s12981-023-00530-2] [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: 02/25/2023] [Accepted: 05/25/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND Effective antiretroviral therapy (ART) in people living with HIV (PLWH) has improved life expectancy and increased risk of age-associated cardiometabolic comorbidities. At-risk alcohol use is more frequent among PLWH and increases the risk of health challenges. PLWH with at-risk alcohol use are more likely to meet criteria for prediabetes/diabetes and this is associated with impaired whole-body glucose-insulin dynamics. METHODS The Alcohol & Metabolic Comorbidities in PLWH: Evidence Driven Interventions Study (ALIVE-Ex Study, NCT03299205) is a longitudinal, prospective, interventional study to determine the effects of an aerobic exercise protocol on improving dysglycemia among PLWH with at-risk alcohol use. The intervention is a moderate intensity aerobic exercise protocol implemented 3 days per week for 10 weeks at the Louisiana State University Health Sciences Center-New Orleans. Participants who have a fasting blood glucose level between 94 and 125 mg/dl will be enrolled in the study. Oral glucose tolerance tests, fitness assessments, and skeletal muscle biopsies will be performed pre- and post-exercise intervention. The primary outcome is to determine whether the exercise protocol improves measures of whole-body glucose-insulin dynamics, cardiorespiratory fitness, and skeletal muscle metabolic and bioenergetic function. Secondary outcomes are to determine whether the exercise intervention improves cognitive function and overall quality of life. Results generated will demonstrate the effect of exercise on glycemic measures in PLWH with subclinical dysglycemia and at-risk alcohol use. CONCLUSIONS The proposed intervention will also have the potential to be scalable to promote lifestyle changes among PLWH, particularly in underserved communities.
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Affiliation(s)
- Liz Simon
- Department of Physiology, LSU Health Sciences Center, 1901 Perdido Street, MEB/7205, New Orleans, LA, 70112, USA
- Comprehensive Alcohol HIV/AIDS Research Center, LSU Health Sciences Center, New Orleans, LA, 70112, USA
| | - Stefany D Primeaux
- Department of Physiology, LSU Health Sciences Center, 1901 Perdido Street, MEB/7205, New Orleans, LA, 70112, USA
- Joint Diabetes, Endocrinology & Metabolism Program, Pennington Biomedical Research Center, Baton Rouge, LA, 70808, USA
| | - Danielle E Levitt
- Department of Physiology, LSU Health Sciences Center, 1901 Perdido Street, MEB/7205, New Orleans, LA, 70112, USA
- Comprehensive Alcohol HIV/AIDS Research Center, LSU Health Sciences Center, New Orleans, LA, 70112, USA
- Department of Kinesiology & Sport Management, Texas Tech University, Lubbock, TX, 79409, USA
| | - Brianna Bourgeois
- Department of Physiology, LSU Health Sciences Center, 1901 Perdido Street, MEB/7205, New Orleans, LA, 70112, USA
- Comprehensive Alcohol HIV/AIDS Research Center, LSU Health Sciences Center, New Orleans, LA, 70112, USA
| | - Neil M Johannsen
- School of Kinesiology, Louisiana State University, Baton Rouge, LA, 70803, USA
| | - Adrianna Peters
- Department of Physiology, LSU Health Sciences Center, 1901 Perdido Street, MEB/7205, New Orleans, LA, 70112, USA
- Comprehensive Alcohol HIV/AIDS Research Center, LSU Health Sciences Center, New Orleans, LA, 70112, USA
| | - Jameel Ahmed
- Department of Medicine, LSU Health Sciences Center, New Orleans, LA, 70112, USA
| | - Richard H Marshall
- Department of Radiology, Tulane University School of Medicine, New Orleans, LA, 70112, USA
| | | | - Tekeda F Ferguson
- Joint Diabetes, Endocrinology & Metabolism Program, Pennington Biomedical Research Center, Baton Rouge, LA, 70808, USA
- Department of Epidemiology, LSU Health Sciences Center, New Orleans, LA, 70112, USA
| | - Patricia E Molina
- Department of Physiology, LSU Health Sciences Center, 1901 Perdido Street, MEB/7205, New Orleans, LA, 70112, USA.
- Comprehensive Alcohol HIV/AIDS Research Center, LSU Health Sciences Center, New Orleans, LA, 70112, USA.
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Sahel-Gozin N, Loutfy M, O'Brien KK. Exploring experiences engaging in exercise from the perspectives of women living with HIV: A qualitative study. PLoS One 2023; 18:e0286542. [PMID: 37267270 DOI: 10.1371/journal.pone.0286542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 05/18/2023] [Indexed: 06/04/2023] Open
Abstract
OBJECTIVES To explore experiences engaging in exercise from the perspectives of women living with HIV, specifically, i) nature and extent of exercise, ii) components that characterize exercise experiences, iii) facilitators and barriers, and iv) strategies for uptake and sustainability of exercise. DESIGN Qualitative descriptive study involving online semi-structured interviews. RECRUITMENT We recruited women living with HIV from a specialty hospital, community-based organization, and medical clinic in Toronto, Canada. PARTICIPANTS Ten women living with HIV who may or may not have engaged in exercise. DATA COLLECTION Using a semi-structured interview guide, we asked participants to describe their experiences with, facilitators and barriers to, and strategies to facilitate uptake of exercise. We electronically administered a demographic questionnaire to describe personal, HIV and physical activity characteristics of participants. We conducted a descriptive thematic analysis with the interview data, and descriptive analysis (medians, frequencies, percentages) of questionnaire responses. RESULTS Women characterized their experiences with exercise with six intersecting components: (1) culture, (2) gender, (3) HIV-related stigma, (4) episodic nature of HIV, (5) sense of belonging, and (6) perceptions of exercise. Facilitators to exercise included: aspirations to achieve a healthy lifestyle, using exercise as a mental diversion, having an exercise companion, and receiving financial support from community-based organizations to facilitate engagement. Barriers to exercise included: limited resources (lack of mental-health support and fitness resources in the community), financial limitations, time and gym restrictions, and cold winter weather conditions. Strategies to facilitate uptake of exercise included: creating social interactions, provision of online exercise classes, raising awareness and education about exercise, and offering practical support. CONCLUSIONS Experiences with exercise among women living with HIV were characterized by intersecting personal and environmental contextual components. Results may help inform tailored implementation of exercise rehabilitation programs to enhance uptake of exercise and health outcomes among women living with HIV.
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Affiliation(s)
- Nora Sahel-Gozin
- Institute of Health Policy, Management and Evaluation (IHPME), Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Mona Loutfy
- Institute of Health Policy, Management and Evaluation (IHPME), Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Kelly K O'Brien
- Institute of Health Policy, Management and Evaluation (IHPME), Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Rehabilitation Sciences Institute (RSI), University of Toronto, Toronto, ON, Canada
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Chen C, Cao X, Xu J, Jiang Z, Liu Z, McGoogan J, Wu Z. Comparison of healthspan-related indicators between adults with and without HIV infection aged 18-59 in the United States: a secondary analysis of NAHNES 1999-March 2020. BMC Public Health 2023; 23:814. [PMID: 37142969 PMCID: PMC10157932 DOI: 10.1186/s12889-023-15538-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 03/27/2023] [Indexed: 05/06/2023] Open
Abstract
BACKGROUND As persons with HIV (PWH) live longer they may experience a heightened burden of poor health. However, few studies have characterized the multi-dimentional health of PWH. Thus, we aimed to identify the extent and pattern of health disparities, both within HIV infection status and across age (or sex) specific groups. METHODS We used cross-sectional data from the US National Health and Nutrition Examination Survey, 1999-March 2020. The adjusted prevalence of six healthspan-related indicators-physical frailty, activities of daily living (ADL) disability, mobility disability, depression, multimorbidity, and all-cause death-was evaluated. Logistic regression and Cox proportional hazards analyses were used to investigate associations between HIV status and healthspan-related indicators, with adjustment for individual-level demographic characteristics and risk behaviors. RESULTS The analytic sample consisted of 33 200 adults (170 (0.51%) were PWH) aged 18-59 years in the United States. The mean (interquartile range) age was 35.1 (25.0-44.0) years, and 49.4% were male. PWH had higher adjusted prevalences for all of the 6 healthspan-related indicators, as compared to those without HIV, ranged from 17.4% (95% CI: 17.4%, 17.5%) vs. 2.7% (95%CI: 2.7%, 2.7%) for all-cause mortality, to 84.3% (95% CI: 84.0%, 84.5%) vs. 69.8% (95%CI: 69.7%, 69.8%) for mobility disability. While the prevalence difference was largest in ADL disability (23.4% (95% CI: 23.2%, 23.7%); P < 0.001), and least in multimorbidity (6.9% (95% CI: 6.8%, 7.0%); P < 0.001). Generally, the differences in prevalence by HIV status were greater in 50-59 years group than those in 18-29 group. Males with HIV suffered higher prevalence of depression and multimorbidity, while females with HIV were more vulnerable to functional limitation and disabilities. HIV infection was associated with higher odds for 3 of the 6 healthspan-related indicators after fully adjusted, such as physical frailty and depression. Sensitivity analyses did not change the health differences between adults with and without HIV infection. CONCLUSIONS In a large sample of U.S. community-dwelling adults, by identifying the extent and pattern of health disparities, we characterized the multi-dimentional health of PWHs, providing important public health implications for public policy that aims to improve health of persons with HIV and further reduce these disparities.
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Affiliation(s)
- Chen Chen
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, 155 Changbai Road, Changping District, Beijing, 102206, China
- National Institute of Environmental and Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Xingqi Cao
- Department of Big Data in Health Science, School of Public Health, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Jie Xu
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, 155 Changbai Road, Changping District, Beijing, 102206, China
| | - Zhen Jiang
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, 155 Changbai Road, Changping District, Beijing, 102206, China
| | - Zuyun Liu
- Department of Big Data in Health Science, School of Public Health, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | | | - Zunyou Wu
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, 155 Changbai Road, Changping District, Beijing, 102206, China.
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11
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Massawe AT, Shayo GA, Mugusi SF. Polypharmacy and health related quality of life among older adults on antiretroviral therapy in a tertiary hospital in Tanzania: a hospital-based cross-sectional study. BMC Infect Dis 2023; 23:179. [PMID: 36973690 PMCID: PMC10041806 DOI: 10.1186/s12879-023-08150-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Accepted: 03/10/2023] [Indexed: 03/29/2023] Open
Abstract
BACKGROUND Human immunodeficiency virus (HIV) chronicity in the midst of old age multiplies the risk for chronic non communicable diseases. The old are predisposed to drug-drug interactions, overlapping toxicities and impairment of the quality of life (QoL) due to age-related physiological changes. We investigated polypharmacy, QoL and associated factors among older HIV-infected adults at Muhimbili National hospitals in Dar es Salaam Tanzania. METHODS A hospital-based cross sectional study enrolled adults aged 50 years or older who were on antiretroviral therapy (ART) for ≥ 6 months. Participants' Information including the number and type of medications used in the previous one week were recorded. Polypharmacy was defined as concurrent use of five or more non-HIV medications. A World Health Organization QoL questionnaire for people living with HIV on ART (WHOQoL HIV BREF) was used to assess QoL. A score of ≤ 50 meant poor QoLwhile > 50 meant good QoL. Polypharmacy and QoL are presented as proportions and compared using Chi-square test. Association between various factors and polypharmacy or QoL was assessed using modified Poisson regression. A p-value of < 0.05 was considered significant. RESULTS A total of 285 patients were enrolled. The mean (SD) age was 57(± 6.88) years. Females were the majority (62.5%), and 42.5% were married. Polypharmacy was seen in 52 (18.2%) of participants. Presence of co-morbidities was independently associated with polypharmacy (p < 0.001). The mean(SD) score QoL for the study participants was 67.37 ± 11.Poor QoL was seen in 40 (14%) participants.All domains' mean score were above 50, however social domain had a relatively lowmean scoreof 68 (± 10.10). Having no formal or primary education was independently associated with poor QoL (p = 0.021). CONCLUSION The prevalence of polypharmacy was modestly high and was linked to the presence of co-morbidities. No formal and/or primary education was associated with poor QoL, where by social domain of QoL was the most affected.
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Affiliation(s)
- Antimon Tibursi Massawe
- Department of Internal Medicine, Muhimbili University of Health and Allied Sciences, P.O.BOX 65001, Dar Es Salaam, Tanzania.
| | - Grace Ambrose Shayo
- Department of Internal Medicine, Muhimbili University of Health and Allied Sciences, P.O.BOX 65001, Dar Es Salaam, Tanzania
| | - Sabina Ferdinand Mugusi
- Department of Clinical Pharmacology, Muhimbili University of Health and Allied Sciences, P.O.BOX 65001, Dar Es Salaam, Tanzania
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12
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Petroll AE, Quinn KG, John SA, Nigogosyan Z, Walsh JL. Factors associated with lack of care engagement among older, rural-dwelling adults living with HIV in the United States. J Rural Health 2023; 39:477-487. [PMID: 36482508 PMCID: PMC10038837 DOI: 10.1111/jrh.12732] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE Most people living with HIV (PLH) in the United States are over age 50 and this sector of PLH continues to grow. Aging with HIV can be challenging due to comorbid medical conditions, mental health disorders, substance use, and lack of social and practical support. Additional challenges are faced by older PLH living in the rural United States, such as longer distances to health care, concerns over privacy and stigma, and social isolation. PLH in rural areas have higher mortality rates than urban PLH. We aimed to understand factors associated with HIV care engagement and quality of life in rural US adults over age 50. METHODS We conducted a cross-sectional study to evaluate the association between patient-level factors and a combined outcome variable encompassing multiple aspects of care engagement. FINDINGS Either online or on paper, 446 participants completed our survey. One-third of the participants (33%) were from the southern United States; one-third were women; one-third were non-White; and 24% completed the survey on paper. In multiple regression analysis, lower income, residing in the southern United States, lacking internet access at home, not having an HIV specialist provider, higher levels of stress, living alone, and longer distance to an HIV provider were all associated with lower engagement in HIV care. CONCLUSIONS Our findings demonstrated multiple potential options for interventions that could improve care engagement, such as providing and enhancing access to technology for health care engagement and remotely delivering social support and mental health services. Research on such potential interventions is needed for older, rural PLH.
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Affiliation(s)
- Andrew E. Petroll
- Health Intervention Sciences Group/Center for AIDS Intervention Research (CAIR), Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Division of Infectious Diseases, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Katherine G. Quinn
- Health Intervention Sciences Group/Center for AIDS Intervention Research (CAIR), Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Steven A. John
- Health Intervention Sciences Group/Center for AIDS Intervention Research (CAIR), Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Zack Nigogosyan
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Jennifer L. Walsh
- Health Intervention Sciences Group/Center for AIDS Intervention Research (CAIR), Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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13
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Plascencia-Cruz M, Plascencia-Hernández A, De Armas-Rodríguez Y, Cervantes-Guevara G, Cervantes-Cardona GA, Ramírez-Ochoa S, González-Ojeda A, Fuentes-Orozco C, Hernández-Mora FJ, González-Valencia CM, Pérez de Acha-Chávez A, Cervantes-Pérez E. Pneumocystis jirovecii Colonization in Mexican Patients with Chronic Obstructive Pulmonary Disease. Trop Med Infect Dis 2023; 8:tropicalmed8030137. [PMID: 36977138 PMCID: PMC10055963 DOI: 10.3390/tropicalmed8030137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 02/20/2023] [Accepted: 02/21/2023] [Indexed: 03/02/2023] Open
Abstract
The prevalence of colonization by Pneumocystis jirovecii (P. jirovecii) has not been studied in Mexico. We aimed to determine the prevalence of colonization by P. jirovecii using molecular detection in a population of Mexican patients with chronic obstructive pulmonary disease (COPD) and describe their clinical and sociodemographic profiles. We enrolled patients discharged from our hospital diagnosed with COPD and without pneumonia (n = 15). The primary outcome of this study was P. jirovecii colonization at the time of discharge, as detected by nested polymerase chain reaction (PCR) of oropharyngeal wash samples. The calculated prevalence of colonization for our study group was 26.66%. There were no statistically significant differences between COPD patients with and without colonization in our groups. Colonization of P. jirovecii in patients with COPD is frequent in the Mexican population; the clinical significance, if any, remains to be determined. Oropharyngeal wash and nested PCR are excellent cost-effective options to simplify sample collection and detection in developing countries and can be used for further studies.
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Affiliation(s)
- Marcela Plascencia-Cruz
- Department of Internal Medicine, Hospital Civil de Guadalajara “Fray Antonio Alcalde”, Guadalajara 44280, Jalisco, Mexico
- Health Sciences University Center, Universidad de Guadalajara, Guadalajara 44100, Jalisco, Mexico
| | - Arturo Plascencia-Hernández
- Health Sciences University Center, Universidad de Guadalajara, Guadalajara 44100, Jalisco, Mexico
- Department of Pediatric Infectious Diseases, Hospital Civil de Guadalajara “Fray Antonio Alcalde”, Guadalajara 44280, Jalisco, Mexico
| | | | - Gabino Cervantes-Guevara
- Department of Welfare and Sustainable Development, Centro Universitario del Norte, Universidad de Guadalajara, Colotlán 46200, Jalisco, Mexico
- Department of Gastroenterology, Hospital Civil de Guadalajara “Fray Antonio Alcalde”, Guadalajara 44280, Jalisco, Mexico
| | | | - Sol Ramírez-Ochoa
- Department of Internal Medicine, Hospital Civil de Guadalajara “Fray Antonio Alcalde”, Guadalajara 44280, Jalisco, Mexico
| | - Alejandro González-Ojeda
- Biomedical Research Unit 02, Specialties Hospital of the Western National Medical Center, Mexican Institute of Social Security, Guadalajara 44329, Jalisco, Mexico
| | - Clotilde Fuentes-Orozco
- Biomedical Research Unit 02, Specialties Hospital of the Western National Medical Center, Mexican Institute of Social Security, Guadalajara 44329, Jalisco, Mexico
| | - Francisco Javier Hernández-Mora
- Human Reproduction, Growth and Child Development Clinic, Health Sciences University Center, Universidad de Guadalajara, Guadalajara 44100, Jalisco, Mexico
| | | | - Andrea Pérez de Acha-Chávez
- Department of Geriatrics, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14080, Mexico
| | - Enrique Cervantes-Pérez
- Department of Internal Medicine, Hospital Civil de Guadalajara “Fray Antonio Alcalde”, Guadalajara 44280, Jalisco, Mexico
- Health Sciences University Center, Universidad de Guadalajara, Guadalajara 44100, Jalisco, Mexico
- Correspondence:
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Involvement of lncRNA TUG1 in HIV-1 Tat-Induced Astrocyte Senescence. Int J Mol Sci 2023; 24:ijms24054330. [PMID: 36901763 PMCID: PMC10002460 DOI: 10.3390/ijms24054330] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 02/19/2023] [Accepted: 02/20/2023] [Indexed: 02/25/2023] Open
Abstract
HIV-1 infection in the era of combined antiretroviral therapy has been associated with premature aging. Among the various features of HIV-1 associated neurocognitive disorders, astrocyte senescence has been surmised as a potential cause contributing to HIV-1-induced brain aging and neurocognitive impairments. Recently, lncRNAs have also been implicated to play essential roles in the onset of cellular senescence. Herein, using human primary astrocytes (HPAs), we investigated the role of lncRNA TUG1 in HIV-1 Tat-mediated onset of astrocyte senescence. We found that HPAs exposed to HIV-1 Tat resulted in significant upregulation of lncRNA TUG1 expression that was accompanied by elevated expression of p16 and p21, respectively. Additionally, HIV-1 Tat-exposed HPAs demonstrated increased expression of senescence-associated (SA) markers-SA-β-galactosidase (SA-β-gal) activity and SA-heterochromatin foci-cell-cycle arrest, and increased production of reactive oxygen species and proinflammatory cytokines. Intriguingly, gene silencing of lncRNA TUG1 in HPAs also reversed HIV-1 Tat-induced upregulation of p21, p16, SA-β gal activity, cellular activation, and proinflammatory cytokines. Furthermore, increased expression of astrocytic p16 and p21, lncRNA TUG1, and proinflammatory cytokines were observed in the prefrontal cortices of HIV-1 transgenic rats, thereby suggesting the occurrence of senescence activation in vivo. Overall, our data indicate that HIV-1 Tat-induced astrocyte senescence involves the lncRNA TUG1 and could serve as a potential therapeutic target for dampening accelerated aging associated with HIV-1/HIV-1 proteins.
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Njie-Carr VPS, Zhu S, Stafford KA, Tong W, Plankey M, Sharma A, Milam J, Cohen M, Diaz MM, Rubtsova AA, Fischl MA, Konkle-Parker D, Gustafson D, Rubin LH. Intersectionality of Socioecological Factors Associated With Cognitive Function Among Older Women With HIV in the United States: A Structural Equation Model Analysis Using Data From the Women's Interagency HIV Study. J Assoc Nurses AIDS Care 2023; 34:83-95. [PMID: 36656093 PMCID: PMC10079306 DOI: 10.1097/jnc.0000000000000376] [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] [Indexed: 01/20/2023]
Abstract
ABSTRACT Increased life expectancy of people with HIV has health implications including the intersection of the long-term use of antiretroviral treatment, inflammatory events, and age-related immunosenescence. In a cross-sectional study utilizing using the Socio-Eecological Model, we identified pathways of cognitive function (CF) among 448 women with HIV, 50 years and older. A structural equation model showed the direct effects of mood (β = -0.25, p < .01), comorbidities (β = --0.13, p < .05), race (β = --0.13, p < .05), and abuse (β = 0.27, p < .001) on the latent variable CF. Substance and alcohol use, depressive symptoms, cigarette smoking, and the number of comorbidities are important considerations when designing interventions utilizing using a multi-level and intersectional lens to maximize positive CF outcomes.
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Affiliation(s)
| | - Shijun Zhu
- School of Nursing, University of Maryland, Baltimore, Maryland, USA
| | | | - Weiqun Tong
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Michael Plankey
- Division of Infectious Diseases, School of Medicine, Georgetown University, Washington, District of Columbia, USA
| | - Anjali Sharma
- Department of Medicine, College of Medicine, Albert Einstein University Bronx, New York, USA
| | - Joel Milam
- Department of Epidemiology and Biostatistics, Program in Public Health, Susan & Henry Samueli College of Health Sciences, University of California Irvine, Irvine, California, USA
| | - Mardge Cohen
- Boston Health Care for the Homeless Program, Chicago, Illinois, USA
| | - Monica M. Diaz
- Department of Neurology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Anna A. Rubtsova
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Margaret A. Fischl
- School of Medicine, University of Miami Health Systems, Miami, Florida, USA
| | - Deborah Konkle-Parker
- Schools of Nursing, Medicine, and Population Health Sciences, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Deborah Gustafson
- Department of Neurology, SUNY Downstate Health Sciences University, Brooklyn, New York, USA
| | - Leah H. Rubin
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
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16
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Alterations of gray and white matter volumes and cortical thickness in treated HIV-positive patients. Magn Reson Imaging 2023; 95:27-38. [PMID: 36265696 DOI: 10.1016/j.mri.2022.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 10/03/2022] [Accepted: 10/11/2022] [Indexed: 11/19/2022]
Abstract
Brain structural changes in HIV identified by voxel-based morphometry (VBM) alone could arise from a variety of causes that are difficult to distinguish without further information, such as cortical thickness (CT), gyrification index (GI) or sulcal depth (SD). Hence, our goal was to assess these additional metrics in HIV using high-resolution 3D T1-weighted images and investigate if surface-based morphometric (SBM) analysis would reveal significant changes in the gray matter (GM) and white matter (WM) volumes combined with alterations in cortical thickness (CT), gyrification index (GI), sulcal depth (SD). T1-w magnetization-prepared-rapid-acquisition gradient-echo (MP-RAGE) scans were acquired in 27 HIV-infected individuals on antiretroviral therapy (ART) and 15 HIV-uninfected healthy controls using a 3T MRI scanner equipped with a 16-channel head "receive" and a quadrature body "transmit" coil. Voxel-based and surface-based morphometric analyses were performed using the MATLAB based SPM Computational Anatomy Toolbox (CAT12.7(1700)). HIV-infected patients showed significantly altered GM and WM volumes, CT, GI, and SD, in multiple brain regions. This study showed the association of altered GM and WM volumes in local brain regions with the changes in region-wise CT, GI and SD measures of HIV-infected patients, especially in the parahippocampal and middle frontal regions as compared to uninfected healthy controls. The outcome of this study suggests that the findings of VBM may not necessarily indicate the volumetric shrinkage or increase alone, but might also be due to altered CT, GI, or SD. Correlation analysis showed a significantly accelerated gray matter loss with age in HIV-infected individuals compared to uninfected healthy controls.
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17
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Chetty L, Cobbing S, Chetty V. The perceptions of older people living with hiv/aids towards physical activity and exercise. AIDS Res Ther 2022; 19:67. [PMID: 36575436 PMCID: PMC9795653 DOI: 10.1186/s12981-022-00500-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 12/19/2022] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Older people living with HIV (OPLWH) require significant levels of support, including healthcare and rehabilitation interventions. People living with HIV are living longer, but still experience health-related impairments that affect functional activity, participation in day-to-day interactions, livelihoods and overall quality of life. Physical activity and exercise should be included as part of the comprehensive medical management for OPLWH but the investigation of prior studies reveal a gap in understanding and prescription. Our study aimed to explore the perceptions of OPLWH about physical activity and exercise. METHODS The study adopted a phenomenological, qualitative design, using in-depth interviews, to understand OPLWH perceptions of physical activity and exercise, and their need for, and access to, physical activity and exercise programmes in a community in South Africa. Nine [9] males and seven [7] females participated in the study. RESULTS Sixteen individuals voluntarily participated in face-to-face, semi-structured interviews which took place at the healthcare facility where they received regular treatment. All participants were 50 years and older. Personal gratification and the ability to perform activities of daily living as well as participate in community activities were believed to be strong motivators for exercise participation, while barriers to exercise were attributed to physical health issues; lack of proper instruction as well as stigma associated with HIV status within their communities. Participants also favored a combination of aerobic, flexibility and strength activities, as well as proper supervision and instruction within a group exercise setting. CONCLUSION The qualitative nature of our study provided an in-depth understanding of the perceptions of OPLWH towards physical activity and exercise. Our study highlighted the factors that hinder adherence to physical activity and exercise in this population. Many indicated that they would love to engage in structured physical activity programmes, but did not know where, when or how to begin. Creating a suitable environment with proper supervision and instruction by suitably qualified health professionals are essential when developing a community-based exercise programme for OPLWH.
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Affiliation(s)
- Levin Chetty
- grid.16463.360000 0001 0723 4123Discipline of Physiotherapy, School of Health Sciences, University of KwaZulu-Natal, Westville Campus, Private Bag X54001, Durban, 4000 Westville South Africa
| | - Saul Cobbing
- grid.16463.360000 0001 0723 4123Discipline of Physiotherapy, School of Health Sciences, University of KwaZulu-Natal, Westville Campus, Private Bag X54001, Durban, 4000 Westville South Africa
| | - Verusia Chetty
- grid.16463.360000 0001 0723 4123Discipline of Physiotherapy, School of Health Sciences, University of KwaZulu-Natal, Westville Campus, Private Bag X54001, Durban, 4000 Westville South Africa
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Jung SH, Lee KT. Atherosclerosis by Virus Infection—A Short Review. Biomedicines 2022; 10:biomedicines10102634. [PMID: 36289895 PMCID: PMC9599298 DOI: 10.3390/biomedicines10102634] [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: 09/13/2022] [Revised: 10/14/2022] [Accepted: 10/17/2022] [Indexed: 11/21/2022] Open
Abstract
Atherosclerosis manifests by the thickening of artery walls and their narrowed channels through the accumulation of plaque. It is one of the most important indicators of cardiovascular disease. It can be caused by various factors, such as smoking, a high cholesterol diet, hypertension, hyperglycemia, and genetic factors. However, atherosclerosis can also develop due to infection. It has been reported that some bacteria and viruses can cause the development of atherosclerosis. Examples of these viruses are influenza viruses, herpes viruses, hepatitis viruses, or papillomaviruses, which are all prevalent and eminent globally for infecting the population worldwide. Moreover, many patients with coronavirus disease 2019 (COVID-19) showed symptoms of cardiovascular disease. In this review paper, the viruses linked to the development of atherosclerosis are introduced, and their viral characteristics, the mechanisms of the development of atherosclerosis, and the current vaccines and antiviral treatment methods are summarized.
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Affiliation(s)
- Seang-Hwan Jung
- Department of Biomedical and Pharmaceutical Sciences, College of Pharmacy, Kyung Hee University, Seoul 02247, Korea
- Correspondence: (S.-H.J.); (K.-T.L.)
| | - Kyung-Tae Lee
- Department of Biomedical and Pharmaceutical Sciences, College of Pharmacy, Kyung Hee University, Seoul 02247, Korea
- Department of Pharmaceutical Biochemistry, College of Pharmacy, Kyung Hee University, Seoul 02247, Korea
- Correspondence: (S.-H.J.); (K.-T.L.)
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Reynolds Z, Gilbert R, Sentongo R, Meyer AC, Saylor D, Okello S, Nakasujja N, Greene M, Seeley J, Tsai AC, Asiimwe S, Quach L, Olivieri-Mui B, Siedner MJ. Priorities for health and wellbeing for older people with and without HIV in Uganda: a qualitative methods study. J Int AIDS Soc 2022; 25 Suppl 4:e26000. [PMID: 36176017 PMCID: PMC9523001 DOI: 10.1002/jia2.26000] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 08/01/2022] [Indexed: 12/20/2022] Open
Abstract
Introduction With improved HIV treatment availability in sub‐Saharan Africa, the population of older people with HIV (PWH) is growing. In this qualitative study, we intended to understand (1) the lived experiences of ageing people in rural Uganda, with and without HIV, (2) their fears and health priorities as they grow older. Methods We conducted 36 semi‐structured interviews with individuals with and without HIV in Mbarara, Uganda from October 2019 to February 2020. Interview guide topics included priorities in older age, physical functioning in daily activities, social functioning, HIV‐related stigma and the impact of multimorbidity on health and independence. Interviews were conducted in Runyankole, transcribed, translated and inductively coded thematically by two researchers with tests for inter‐coder reliability. Results The respondents were purposively sampled to be evenly divided by sex and HIV serostatus. The median age of respondents was 57 (49–73). Two‐thirds were married or cohabitating, 94% had biological children and 75% cited farming as their primary livelihood. Overall, PWH considered themselves as healthy or healthier than people without HIV (PWOH). PWH rarely considered their HIV status a barrier to a healthy life, but some reported a constant sense of anxiety as it relates to their long‐term health. Irrespective of HIV status, nearly all respondents noted concerns about memory loss, physical pain, reductions in energy and the effect of these changes on their ability to complete physical tasks like small‐scale farming, and activities of daily living important to the quality of life, such as participating in community groups. Increasing reliance on others for social, physical and financial support was also a common theme. The most prevalent health concern among participants involved the threat of non‐communicable diseases and perceptions that physical functioning may diminish. Conclusions In rural Uganda, we found that PWH consider themselves to be healthy and do not anticipate a different ageing experience from PWOH. Common priorities shared by both groups included the desire for physical and financial independence, health maintenance and social support for daily functioning and social needs. Entities supporting geriatric care in Uganda would benefit from attention to concerns about functional limitations and reported needs as people age with and without HIV.
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Affiliation(s)
- Zahra Reynolds
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Rebecca Gilbert
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Ruth Sentongo
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Ana-Claire Meyer
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Deanna Saylor
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,University Teaching Hospital, Lusaka, Zambia
| | - Samson Okello
- Mbarara University of Science and Technology, Mbarara, Uganda.,Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | | | | | - Janet Seeley
- London School of Hygiene and Tropical Medicine, London, UK
| | - Alexander C Tsai
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts, USA.,Mbarara University of Science and Technology, Mbarara, Uganda.,Harvard Medical School, Boston, Massachusetts, USA
| | - Stephen Asiimwe
- Mbarara University of Science and Technology, Mbarara, Uganda.,Kabwohe Clinical Research Centre, Kabwohe, Uganda
| | - Lien Quach
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts, USA.,University of Massachusetts, Boston, Massachusetts, USA
| | | | - Mark J Siedner
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts, USA.,Mbarara University of Science and Technology, Mbarara, Uganda.,Harvard Medical School, Boston, Massachusetts, USA
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20
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Mitra P, Jain A, Kim K. HIV and AIDS in Older Adults: Neuropsychiatric Changes. Curr Psychiatry Rep 2022; 24:463-468. [PMID: 35809165 DOI: 10.1007/s11920-022-01354-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/08/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Patients diagnosed with HIV can now survive well into their old age. Aging with HIV is not only associated with comorbid medical illnesses but also with neuropsychiatric conditions that can range from cognitive changes to severe behavioral manifestations. This paper reviews mood, anxiety, and cognitive changes in older patients with HIV, as well as some of the treatment challenges in this population. RECENT FINDINGS Most recent findings show that untreated HIV illness over a long period of time may further worsen both preexisting neuropsychiatric illness and may cause new onset behavioral and cognitive symptoms. HIV induces immune phenotypic changes that have been compared to accelerated aging Low CD 4 counts and high viral counts are indicative of poor prognosis. Evaluation for potential HIV infections may be overlooked in older adults and require screening. Older adults experience accelerated CD4 cell loss. Older adults endorsing new onset mood or cognitive changes must be screened for HIV infection. New onset neurobehavioral symptoms should be carefully screened for and treated simultaneously in patients with HIV infection.
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Affiliation(s)
- Paroma Mitra
- New York University Grossman School of Medicine, New York City, NY, USA.
- Bellevue Hospital Center, New York City, NY, USA.
| | - Ankit Jain
- Penn State College of Medicine, Hershey, USA
| | - Katherine Kim
- New York University Grossman School of Medicine, New York City, NY, USA
- Bellevue Hospital Center, New York City, NY, USA
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Olivieri-Mui B, Shi S, McCarthy EP, Montano M, Wilson I, Oh G, Manjourides J, Kim DH. Categorizing Comorbid Risk for People Living With HIV: A Latent Profile Analysis. J Acquir Immune Defic Syndr 2022; 90:449-455. [PMID: 35413021 PMCID: PMC9248847 DOI: 10.1097/qai.0000000000002999] [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: 12/28/2021] [Accepted: 03/01/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Categorizing clinical risk amidst heterogeneous multimorbidity in older people living with HIV/AIDS (PLWH) may help prioritize and optimize health care engagements. METHODS PLWH and their prevalent conditions in 8 health domains diagnosed before January 1, 2015 were identified using 2014-2016 Medicare claims and the Chronic Conditions Data Warehouse. Latent profile analysis identified 4 distinct clinical subgroups based on the likelihood of conditions occurring together [G1: healthy, G2: substance use (SU), G3: pulmonary (PULM), G4: cardiovascular conditions (CV)]. Restricted mean survival time regression estimated the association of each subgroup with the 365 day mean event-free days until death, first hospitalization, and nursing home admission. Zero-inflated Poisson regression estimated hospitalization frequency in 2-year follow-up. RESULTS Of 11,196 older PLWH, 71% were male, and the average age was 61 (SD 9.2) years. Compared with healthy group, SU group had a mean of 30 [95% confidence interval: (19.0 to 40.5)], PULM group had a mean of 28 (22.1 to 34.5), and CV group had a mean of 22 (15.0 to 22.0) fewer hospitalization-free days over 1 year. Compared with healthy group (2.8 deaths/100 person-years), CV group (8.4) had a mean of 4 (3.8 to 6.8) and PULM group (7.9) had a mean of 3 (0.7 to 5.5) fewer days alive; SU group (6.0) was not different. There was no difference in restricted mean survival time for nursing home admission. Compared with healthy group, SU group had 1.42-fold [95% confidence interval: (1.32 to 1.54)], PULM group had 1.71-fold (1.61 to 1.81), and CV group had 1.28-fold (1.20 to 1.37) higher rates of hospitalization. CONCLUSION Identifying clinically distinct subgroups with latent profile analysis may be useful to identify targets for interventions and health care optimization in older PLWH.
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Affiliation(s)
- Brianne Olivieri-Mui
- The Roux Inst and Department of Health Sciences, Northeastern University
- The Marcus Institute for Aging Research, Hebrew SeniorLife, Harvard Medical School
| | - Sandra Shi
- The Marcus Institute for Aging Research, Hebrew SeniorLife, Harvard Medical School
| | - Ellen P. McCarthy
- The Marcus Institute for Aging Research, Hebrew SeniorLife, Harvard Medical School
| | - Monty Montano
- Brigham and Women’s Hospital, Harvard Medical School
| | - Ira Wilson
- Department of Health Services, Policy and Practice, Brown University School of Public Health
| | - Gahee Oh
- The Marcus Institute for Aging Research, Hebrew SeniorLife, Harvard Medical School
| | - Justin Manjourides
- The Roux Inst and Department of Health Sciences, Northeastern University
| | - Dae Hyun Kim
- The Marcus Institute for Aging Research, Hebrew SeniorLife, Harvard Medical School
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Abdo M, Wu X, Sharma A, Tassiopoulos KK, Brown TT, Koletar SL, Yin MT, Erlandson KM. Regional Differences in Risk of Recurrent Falls Among Older U.S. Women and Men with HIV in the HIV Infection, Aging, and Immune Function Long-Term Observational Study. AIDS Res Hum Retroviruses 2022; 38:530-537. [PMID: 35018800 PMCID: PMC9297325 DOI: 10.1089/aid.2021.0162] [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: 01/31/2023] Open
Abstract
Geographic location was a strong predictor of falls among women with and without HIV in the Women's Interagency HIV Study. We examined regional variation in falls in a more geographically diverse cohort of older people with HIV (PWH) and explored whether physical activity, sex, or body-mass index modified these associations. PWH enrolled in the A5322 HAILO (HIV Infection, Aging, and Immune Function Long-Term Observational Study). Participants who reported falls in the 6 months before each semiannual visit and had ≥1 consecutive pair of fall assessments were included. We examined associations of geographic region [Northeast, Midwest, South, and West] with recurrent falls (≥2) over each 12-month period using repeated measures multinomial logistic regression models and assessed effect modification by adding an interaction term between geographic region and each potential effect modifier. A total of 788 men and 192 women with median age of 51 years at study entry contributed up to 240 weeks of data. U.S. regions included Northeast (22%), Midwest (29%), South (20%), and West (28%). In multivariable analyses, compared with the Western region, greater risk was seen among Midwestern (odds ratio [OR] = 2.35 [95% confidence interval (CI) = 1.29-4.28]) and Southern regions (OR = 2.09 [95% CI = 1.09-4.01]). Among those with higher physical activity, the Midwestern region had higher odds of recurrent falls than the Western region. Among obese individuals, the Southern region had higher odds of recurrent falls than the Western region. Sex did not modify the association between region and recurrent falls. Among older PWH, fall risk varied by geographic region. Associations between geographic region and recurrent falls appeared to be modified by physical activity and obesity. This may help identify subgroups of older PWH for targeted fall screening/interventions.
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Affiliation(s)
- Mona Abdo
- Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado, USA
| | - Xingye Wu
- Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Anjali Sharma
- Department of Medicine, Albert Einstein College of Medicine, Bronx, New York, USA
| | | | - Todd T. Brown
- Division of Endocrinology, Diabetes, and Metabolism, Johns Hopkins University, Baltimore, Maryland, USA
| | - Susan L. Koletar
- Division of Infectious Diseases, Department of Medicine, Ohio State University, Columbus, Ohio, USA
| | - Michael T. Yin
- Division of Infectious Diseases, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, New York, USA
| | - Kristine M. Erlandson
- Division of Infectious Diseases, School of Medicine, University of Colorado Anschutz Medical Center, Aurora, Colorado, USA.,Address correspondence to: Kristine M. Erlandson, Division of Infectious Diseases, School of Medicine, University of Colorado-Anschutz Medical Center, 12700 East 19th Avenue, Mail Stop B168, Aurora, CO 80045, USA
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Love M, Samora L, Barker D, Zukosky P, Kummet N, Ahmad A, Bernhardt D, Tripathi M, Klotz S, Ahmad N. Genetic Analysis of HIV-1 vpr Sequences from HIV-Infected Older Patients on Long-Term Antiretroviral Therapy. Curr HIV Res 2022; 20:309-320. [PMID: 35792120 DOI: 10.2174/1570162x20666220705124341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 04/20/2022] [Accepted: 04/28/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND Many HIV-infected individuals have achieved undetectable viral load and increased CD4 T cell counts due to the success of Antiretroviral Therapy (ART). However, HIV persists in resting T cells, monocytes/macrophages and other quiescent cells. Furthermore, the HIV- 1 vpr accessory gene may play an important role in the persistence of HIV in these infected patients. OBJECTIVES Therefore, we characterized the HIV-1 vpr gene from PBMC DNA of 14 HIV-infected older patients on long-term ART with mostly undetectable viral load and increased CD4 T cell counts. METHODS Peripheral Blood Mononuclear Cells (PBMC) were isolated from 14 HIV-infected individuals, followed by extraction of genomic DNA, amplification of HIV-1 vpr gene by polymerase chain reaction (PCR), cloning of vpr gene in TOPO vector and characterization of correct size recombinant inserts containing vpr genes. An average of 13 clones were sequenced from each patient, followed by sequence analysis by bioinformatic tools. RESULTS Phylogenetic analysis of 182 vpr sequences demonstrated that the vpr sequences of each patient were well separated and discriminated from other patients' sequences and formed distinct clusters. The vpr sequences showed a low degree of viral heterogeneity, lower estimates of genetic diversity and about half of the patients' sequences were under positive selection pressure. While the majority of the vpr deduced amino acid sequences from most patients contained intact open reading frames, several sequences, mostly from two patients, had stop codons. Numerous patient-specific and common amino acid motifs were found in deduced vpr sequences. The functional domains required for vpr activity, including virion incorporation, nuclear import of pre-integration complex and cell cycle arrest, were generally conserved in most vpr sequences. Several of the known Cytotoxic T-lymphocytes (CTL) epitopes in vpr showed variation in our patients' sequences. CONCLUSION In summary, a low degree of genetic variability, conservation of functional domains and variations in CTL epitopes were the features of vpr sequences from the 14 HIV-infected older patients with controlled viremia on long-term ART.
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Affiliation(s)
- Maria Love
- Department of Immunobiology, College of Medicine, University of Arizona, Tucson, AZ 85721, Arizona, USA
| | - Luiza Samora
- Department of Immunobiology, College of Medicine, University of Arizona, Tucson, AZ 85721, Arizona, USA
| | - Danae Barker
- Department of Immunobiology, College of Medicine, University of Arizona, Tucson, AZ 85721, Arizona, USA
| | - Priya Zukosky
- Department of Immunobiology, College of Medicine, University of Arizona, Tucson, AZ 85721, Arizona, USA
| | - Nathan Kummet
- Department of Immunobiology, College of Medicine, University of Arizona, Tucson, AZ 85721, Arizona, USA
| | - Aasim Ahmad
- Department of Immunobiology, College of Medicine, University of Arizona, Tucson, AZ 85721, Arizona, USA
| | - Dana Bernhardt
- Department of Immunobiology, College of Medicine, University of Arizona, Tucson, AZ 85721, Arizona, USA
| | - Meghna Tripathi
- Department of Immunobiology, College of Medicine, University of Arizona, Tucson, AZ 85721, Arizona, USA
| | - Stephen Klotz
- Department of Medicine, College of Medicine, University of Arizona, Tucson, AZ 85721, Arizona, USA
| | - Nafees Ahmad
- Department of Immunobiology, College of Medicine, University of Arizona, Tucson, AZ 85721, Arizona, USA
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Dias JP, Piggott DA, Sun J, Wehbeh L, Garza J, Abraham A, Astemborski J, Moseley KF, Basaria S, Varadhan R, Brown TT. SHBG, Bone Mineral Density, and Physical Function Among Injection Drug Users With and Without HIV and HCV. J Clin Endocrinol Metab 2022; 107:e2971-e2981. [PMID: 35293996 PMCID: PMC9202730 DOI: 10.1210/clinem/dgac144] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Indexed: 11/19/2022]
Abstract
CONTEXT Sex hormone-binding globulin (SHBG) is a glycoprotein that regulates the bioavailability of sex hormones and is higher in people with HIV (PWH) and hepatitis C virus (HCV). SHBG is associated with aging-related diseases, including osteoporosis and frailty in the general population. However, the relationship between SHBG concentration and bone mineral density (BMD) and physical function among PWH and HCV is unclear. OBJECTIVE This study aimed to evaluate the association between chronic infection with HIV and HCV and SHBG, and to assess the relationship of circulating SHBG concentrations with low BMD, physical function impairment, and frailty. METHODS A cross-sectional study was conducted of 278 HCV-exposed (HCV antibody positive) adults enrolled with and without HIV and HCV from the AIDS Linked to the IntraVenous Experience cohort study into 4 groups: HCV-/HIV-, HCV-/HIV+, HCV+/HIV-, and HCV+/HIV+. We evaluated the association between SHBG concentrations and grip strength, gait speed, Short Physical Performance Battery score, frailty (Fried Frailty Phenotype), and BMD (lumbar spine, total hip, and femoral neck T-score) by using adjusted multivariable regression stratified by sex. RESULTS SHBG concentrations were higher in women, in those with HIV RNA greater than 400 copies/mL (P = .02) and HCV RNA greater than 15 IU/mL (P < .001). In adjusted models, higher SHBG concentrations among women were statistically significantly associated with lower grip strength (-0.43 [95% CI, -0.77 to -0.081] kg/10 nmol/L, P < .05), higher odds of frailty (odds ratio, 1.49 [95% CI, 1.07 to 2.08], P < .05), and lower T-scores at the lumbar spine (-0.070 [95% CI, -0.15 to -0.001] SD/10 nmol/L T-score BMD, P < .05). Similar associations were not observed among men. CONCLUSION Higher SHBG concentrations are associated with the presence of HIV and HCV viremia. Among women, but not men, higher SHBG concentrations were associated with lower grip strength, higher odds of frailty, and lower lumbar spine BMD. The underlying mechanisms of these associations require further investigation.
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Affiliation(s)
- Jenny Pena Dias
- Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Damani A Piggott
- Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Jing Sun
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Leen Wehbeh
- Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Joshua Garza
- Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Alison Abraham
- Department of Epidemiology Johns Hopkins Bloomberg School of Public Health; Department of Epidemiology, School of Public Health and Department of Ophthalmology, School of Medicine, University of Colorado Anschutz Medical Campus, Colorado, USA
| | - Jacquie Astemborski
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Kendall F Moseley
- Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Shehzad Basaria
- Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Ravi Varadhan
- Department of Oncology; Biostatistics and Bioinformatics, Johns Hopkins University, Baltimore, Maryland, USA
| | - Todd T Brown
- Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
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25
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Klotz SA, Egurrola C, Love M, Miller MN, Bradley N, Smith SN, Najafi B, Ahmad N. Phenotypic frailty in people living with HIV is not correlated with age or immunosenescence. Int J STD AIDS 2022; 33:597-603. [PMID: 35377254 PMCID: PMC9024027 DOI: 10.1177/09564624221091455] [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: 11/20/2022]
Abstract
Background It has been hypothesized that HIV-1 infection prematurely “ages” individuals phenotypically and immunologically. We measured phenotypic frailty and immune “aging” markers on T-cells of people living with HIV on long term, suppressive anti-retroviral therapy (ART) to determine if there is an association between frailty and immunosenescence. Methods Thirty-seven (37) community-dwelling people living with HIV were measured for frailty using a sensor-based frailty meter that quantifies weakness, slowness, rigidity, and exhaustion. An immunological profile of the patients’ CD4+ and CD8+ T-cell expression of cell surface proteins and cytokines was performed (n = 20). Results Phenotypic frailty prevalence was 19% (7/37) and correlated weakly with the number of past medical events accrued by the patient (r = 0.34, p = .04). There was no correlation of frailty with age, sex, prior AIDS diagnosis or HIV-1 viral load, or IFN-γ expression by CD4+ or CD8+ T-cells. There were more immune competent (CD28+ CD57−) cells than exhausted/senescent (CD28− CD57+) T cells. Conclusion Frailty in people living with HIV on long term, suppressive ART did not correlate with aging or T cell markers of exhaustion or immunosenescence.
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Affiliation(s)
- Stephen A Klotz
- Department of Medicine, 22165University of Arizona Medical Center - University Campus, Tucson, AZ, USA
| | - Cesar Egurrola
- Department of Medicine, 22165University of Arizona Medical Center - University Campus, Tucson, AZ, USA
| | - Maria Love
- Department of Immunology, College of Medicine, 242724University of Arizona, Tucson, AZ, USA
| | - Mary N Miller
- Department of Medicine, 22165University of Arizona Medical Center - University Campus, Tucson, AZ, USA
| | - Nicole Bradley
- Department of Immunology, College of Medicine, 242724University of Arizona, Tucson, AZ, USA
| | - Shannon N Smith
- Department of Medicine, 22165University of Arizona Medical Center - University Campus, Tucson, AZ, USA
| | - Bijan Najafi
- AZ and Department of Surgery, 3989Baylor College of Medicine, Houston, TX, USA
| | - Nafees Ahmad
- Department of Immunology, College of Medicine, 242724University of Arizona, Tucson, AZ, USA
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Akerele T, Rivera YP, Rwegerera GM. Duration of Tenofovir Use and Diabetes Mellitus Predict Microalbuminuria among Well-controlled Human Immunodeficiency Virus-infected Patients Attending a Tertiary Clinic in Gaborone, Botswana. SAUDI JOURNAL OF KIDNEY DISEASES AND TRANSPLANTATION 2022; 33:393-403. [PMID: 37843140 DOI: 10.4103/1319-2442.385962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2023] Open
Abstract
The study aimed to determine the prevalence and associated factors of microalbuminuria among patients infected with human immunodeficiency virus (HIV). A cross-sectional study was conducted at the Infectious Disease Control Center of Princess Marina Hospital, a Tertiary Clinic in Gaborone, Botswana. The risk factors of microalbuminuria were determined by comparing the sociodemographic and clinical characteristics of patients with the presence of microalbuminuria or normoalbuminuria. In total, 297 randomly selected HIV-infected patients were included in the analysis. The mean age of the study participants was 48.6 years, with the majority of patients (60.9%) being females. The study participants were largely well-controlled both immunologically and virologically, with 283/297 (95.3%) and 280/297 (94.3%), having CD4 counts of more than 200 cells/mm3 and undetected viral load (<400 copies/mL), respectively. The prevalence of microalbuminuria was found to be 46.5%. Microalbuminuria was associated with the duration of exposure to a regimen containing tenofovir [P <0.001, odds ratio = 1.137, 95% confidence interval (CI) = 1.073-1.205] and a history of diabetes mellitus (P = 0.044, odds ratio = 9.260, 95% CI = 1.058-81.06). Sociodemographic characteristics and other clinical factors were not associated with microalbuminuria. There is a need to carry out prospective studies among HIV- infected patients with microalbuminuria to determine the short- and long-term cardiovascular morbidity and mortality outcomes.
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Affiliation(s)
- Tolatilewa Akerele
- Department of Medicine, Princess Marina Hospital, University of Botswana, Gaborone, Botswana
| | - Yordanka Pina Rivera
- Department of Medicine, Princess Marina Hospital; Department of Internal Medicine, Faculty of Medicine, University of Botswana, Gaborone, Botswana
| | - Godfrey Mutashambara Rwegerera
- Department of Medicine, Princess Marina Hospital; Department of Internal Medicine, Faculty of Medicine, University of Botswana, Gaborone, Botswana
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Ahmed S, Algarin AB, Thadar H, Zhou Z, Taskin T, Vaddiparti K, Villalba K, Wang Y, Ennis N, Morano JP, Somboonwit C, Cook RL, Ibañez GE. Comorbidities among persons living with HIV (PLWH) in Florida: a network analysis. AIDS Care 2022; 35:1055-1063. [PMID: 35172664 PMCID: PMC9378751 DOI: 10.1080/09540121.2022.2038363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
ABSTRACTPeople living with HIV (PLWH) experience a higher rate of age-related comorbidities at younger ages. Understanding common comorbidities among PLWH and their relationship to one another could be significant in improving aging for PLWH. The goal of the present study is to identify the most common comorbidities among PLWH and the relationship between them using network analysis. We used abstracted electronic medical record (EMR) data of PLWH from the Florida Cohort study, a prospective cohort study conducted in eight cities in Florida, USA. We used International Classification of Diseases (10th revision, ICD-10) code to classify comorbidities and organ systems. Network analysis was conducted to determine the degree and betweenness centrality among comorbidities. We included 756 PLWH with an average age of 46.4 years (SD 11.3) in the analysis. Infectious diseases (A00-B99, 50.8%), mental and behavioural (F01-F99, 47.0%), endocrine, nutritional and metabolic (E00-E88, 45.2%), and circulatory (I00-I99, 39%) disorders were the most prevalent system comorbidities among PLWH. Hypertensive disorder (I10-I1635.8%), dyslipidaemia (E78, 25.7%) and major depressive disorder (F32-F33, 23.9%) were the most common non-infectious conditions affecting PLWH. Viral hepatitis (B15-B19, 17.1%) and syphilis (A15-A53, 12%) were the most common coinfections among PLWH. Hypertension, dyslipidaemia and major depressive disorder were the most central of the comorbidities among PLWH. Comorbidities among PLWH were most prevalent for chronic disease and mental illness. Targeting shared disease risk factors in addition to monitoring known pathological pathways may prevent comorbidities among PLWH.
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Affiliation(s)
- Shyfuddin Ahmed
- Department of Epidemiology, Robert Stempel College of Public Health & Social Work, Florida International University, Miami, FL, USA
| | - Angel B Algarin
- Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, CA, USA
| | - Hsu Thadar
- Department of Epidemiology, Robert Stempel College of Public Health & Social Work, Florida International University, Miami, FL, USA
| | - Zhi Zhou
- Department of Epidemiology, College of Public Health and Health Professions, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Tanjila Taskin
- Department of Epidemiology, Robert Stempel College of Public Health & Social Work, Florida International University, Miami, FL, USA
| | - Krishna Vaddiparti
- Department of Epidemiology, College of Public Health and Health Professions, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Karina Villalba
- Department of Population Health, College of Medicine, University of Central Florida, Orlando, FL, USA
| | - Yan Wang
- Department of Epidemiology, College of Public Health and Health Professions, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Nicole Ennis
- Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA
| | - Jamie P Morano
- Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | | | - Robert L Cook
- Department of Epidemiology, College of Public Health and Health Professions, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Gladys E Ibañez
- Department of Epidemiology, Robert Stempel College of Public Health & Social Work, Florida International University, Miami, FL, USA
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Chetty L, Cobbing S, Chetty V. Physical Activity and Exercise for Older People Living with HIV: A Scoping Review. HIV AIDS (Auckl) 2021; 13:1079-1090. [PMID: 34984030 PMCID: PMC8702781 DOI: 10.2147/hiv.s336886] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 11/12/2021] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION Improvements in physical, mental, and overall quality of life are well documented in younger HIV populations who exercise. Exercise guidelines exist for younger HIV populations, but none for older people living with HIV (OPLWH), especially 50 years of age and older. Our aim was to map the existing literature on the effects of exercise and physical activity prescriptions for OPLWH. METHODS We conducted a scoping review using the methodological framework proposed by the Joanna Briggs Institute. Online searches on five research databases yielded 503 published articles. Fifteen studies met the study's inclusion criteria. RESULTS The most commonly used parameters of exercise included aerobic and strength training, as well as a combination of both. The physical, psychological and Quality of Life (QoL) impact of physical activity and its effect on OPLWH is evidently beneficial. Overall, a positive correlation between exercise and physical, mental and functional status was observed. No adverse side effects, or safety and efficacy concerns, during the use of exercise were reported. CONCLUSION This review confirms the dearth of evidence on physical activity and exercise in the context of OPLWH. Of greater concern is the fact that there were no studies conducted in sub-Saharan Africa, the global region with by far the highest HIV burden.
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Affiliation(s)
- Levin Chetty
- School of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Saul Cobbing
- School of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Verusia Chetty
- School of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
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Gnoni M, Beas R, Raghuram A, Díaz-Pardavé C, Riva-Moscoso A, Príncipe-Meneses FS, Vásquez-Garagatti R. Potential role of intermittent fasting on decreasing cardiovascular disease in human immunodeficiency virus patients receiving antiretroviral therapy. World J Exp Med 2021; 11:66-78. [PMID: 34877266 PMCID: PMC8611195 DOI: 10.5493/wjem.v11.i5.66] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 08/18/2021] [Accepted: 09/23/2021] [Indexed: 02/06/2023] Open
Abstract
Cardiovascular disease (CVD) has become one of the commonest causes of comorbidity and mortality among People living with human immunodeficiency virus (HIV) (PLWH) on antiretroviral therapy (ART). Nearly 50% of PLWH are likely to have an increased risk of developing CVD, including coronary heart disease, cerebrovascular disease, peripheral artery disease and aortic atherosclerosis. Aside from the common risk factors, HIV infection itself and side effects of antiretroviral therapy contribute to the pathophysiology of this entity. Potential non-pharmacological therapies are currently being tested worldwide for this purpose, including eating patterns such as Intermittent fasting (IF). IF is a widespread practice gaining high level of interest in the scientific community due to its potential benefits such as improvement in serum lipids and lipoproteins, blood pressure (BP), platelet-derived growth factor AB, systemic inflammation, and carotid artery intima-media thickness among others cardiovascular benefits. This review will focus on exploring the potential role of intermittent fasting as a non-pharmacological and cost-effective strategy in decreasing the burden of cardiovascular diseases among HIV patients on ART due to its intrinsic properties improving the main cardiovascular risk factors and modulating inflammatory pathways related to endothelial dysfunction, lipid peroxidation and aging. Intermittent fasting regimens need to be tested in clinical trials as an important, cost-effective, and revolutionary coadjutant of ART in the fight against the increased prevalence of cardiovascular disease in PLWH.
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Affiliation(s)
- Martin Gnoni
- Department of Internal Medicine, Good Samaritan Hospital, Cincinnati, OH 45220, United States
- Division of Infectious Diseases, Department of Medicine, University of Louisville Health Sciences Center, Louisville, KY 40202, United States
| | - Renato Beas
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, United States
| | - Anupama Raghuram
- Division of Infectious Diseases, Department of Medicine, University of Louisville Health Sciences Center, Louisville, KY 40202, United States
- US Medical Affairs, Merck Research Laboratories, Kenilworth, NJ 07033, United States
| | - Celeste Díaz-Pardavé
- Division of Research and Academic Affairs, Larkin Health System, South Miami, FL 33143, United States
- School of Medicine, Universidad Científica del Sur, Lima 15837, Peru
| | - Adrian Riva-Moscoso
- Division of Research and Academic Affairs, Larkin Health System, South Miami, FL 33143, United States
- Escuela de Medicina, Universidad Peruana de Ciencias Aplicadas (UPC), Lima 15067, Peru
- Sociedad Científica de Estudiantes de Medicina, Universidad Peruana de Ciencias Aplicadas (UPC), Lima 15067, Peru
| | - Fortunato S Príncipe-Meneses
- Division of Research and Academic Affairs, Larkin Health System, South Miami, FL 33143, United States
- Escuela de Medicina, Universidad Peruana de Ciencias Aplicadas (UPC), Lima 15067, Peru
- Sociedad Científica de Estudiantes de Medicina, Universidad Peruana de Ciencias Aplicadas (UPC), Lima 15067, Peru
| | - Raúl Vásquez-Garagatti
- Hospital Medicine Department and Infectious Diseases, University of Tennessee Medical Center at Knoxville, Knoxville, TN 37920, United States
- Department of Internal Medicine, Cherokee Health, Knoxville, TN 37921, United States
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30
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Knox C, Leak Date H, Lim SS, Shaw M, Flynn B, Kendall L, Vera J. Facilitating primary care non-antiretroviral drug prescribing in people living with HIV: The 'THINK ARV' initiative. Int J STD AIDS 2021; 33:88-93. [PMID: 34632879 DOI: 10.1177/09564624211047380] [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: 11/16/2022]
Abstract
OBJECTIVES Older people living with HIV (PLWH) have higher rates of multimorbidity, polypharmacy and an associated increased risk of potential drug-drug interactions (DDIs). We describe the development, implementation and evaluation of an intervention to increase community prescribers' access to specialist prescribing advice. METHODS Phase One: a survey evaluating General Practitioners' (GPs') knowledge of, and confidence detecting DDIs affecting PLWH, was circulated to eight General Practices in one UK city. Phase Two: co-production was used to develop the THINK ARV intervention for prescribers in city-wide General Practices: a dedicated mobile phone and e-mail advice service staffed by HIV specialist pharmacists. Queries were audited for 6 months pre- and post-intervention. A user-satisfaction survey was emailed to enquirers. RESULTS Phase One: 42 GPs responded, of whom 62% requested further support identifying DDIs among PLWH. Phase Two: the number of queries received increased from 25 (6 months before 'THINK ARV' launch) to 63 in the following 6 months (152% increase). 94% of the queries were specifically about DDIs. CONCLUSIONS Increasing community prescribers' access to specialist telephone and e-mail advice resulted in increased awareness and detection of DDIs. Similar interventions could be embedded within different healthcare settings to optimise medicines and avoid potential patient harm.
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Affiliation(s)
- Chloe Knox
- 1949Brighton and Sussex University Hospitals with University Hospitals Sussex NHS Foundation Trust.,Department of Global Health and Infection, Brighton and Sussex Medical School, University of Sussex NHS Foundation Trust, Brighton, UK
| | - Heather Leak Date
- 1949Brighton and Sussex University Hospitals with University Hospitals Sussex NHS Foundation Trust
| | - Su S Lim
- 1949Brighton and Sussex University Hospitals with University Hospitals Sussex NHS Foundation Trust
| | - Mark Shaw
- 1949Brighton and Sussex University Hospitals with University Hospitals Sussex NHS Foundation Trust
| | | | | | - Jaime Vera
- 1949Brighton and Sussex University Hospitals with University Hospitals Sussex NHS Foundation Trust.,Department of Global Health and Infection, Brighton and Sussex Medical School, University of Sussex NHS Foundation Trust, Brighton, UK
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31
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Hixson EA, Borker PV, Jackson EK, Macatangay BJ. The Adenosine Pathway and Human Immunodeficiency Virus-Associated Inflammation. Open Forum Infect Dis 2021; 8:ofab396. [PMID: 34557556 PMCID: PMC8454523 DOI: 10.1093/ofid/ofab396] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 07/23/2021] [Indexed: 12/15/2022] Open
Abstract
Human immunodeficiency virus (HIV) is associated with an increased risk of age-associated comorbidities and mortality compared to people without HIV. This has been attributed to HIV-associated chronic inflammation and immune activation despite viral suppression. The adenosine pathway is an established mechanism by which the body regulates persistent inflammation to limit tissue damage associated with inflammatory conditions. However, HIV infection is associated with derangements in the adenosine pathway that limits its ability to control HIV-associated inflammation. This article reviews the function of purinergic signaling and the role of the adenosine signaling pathway in HIV-associated chronic inflammation. This review also discusses the beneficial and potential detrimental effects of pharmacotherapeutic strategies targeting this pathway among people with HIV.
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Affiliation(s)
- Emily A Hixson
- Department of Infectious Disease and Microbiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania, USA
| | - Priya V Borker
- Division of Pulmonary Allergy and Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Edwin K Jackson
- Department of Pharmacology and Chemical Biology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Bernard J Macatangay
- Department of Infectious Disease and Microbiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania, USA.,Division of Infectious Diseases, University of Pittsburgh School of Medicine, Pennsylvania, USA
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Dias JP, Haberlen SA, Dobs AS, Lake JE, Palella FJ, Kingsley LA, Price JC, Basaria S, Varadhan R, Margolick JB, Thio CL, Brown TT. Longitudinal Changes in Sex Hormone-Binding Globulin in Men With HIV. J Acquir Immune Defic Syndr 2021; 87:1178-1186. [PMID: 33990494 PMCID: PMC8263509 DOI: 10.1097/qai.0000000000002723] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 03/29/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Sex hormone-binding globulin (SHBG) is a glycoprotein that regulates sex hormone bioavailability and increases with age in the general population. SHBG concentrations are higher in people with HIV, a population in whom accelerated aging has been hypothesized. It is unclear whether longitudinal changes in SHBG increase over time and differ by HIV serostatus. METHODS In a longitudinal study, SHBG was measured in 182 men with HIV (MWH) and 267 men without HIV (seronegative) from the Multicenter AIDS Cohort Study and matched for age, race, site, and time, with ≥2 SHBG serum samples over the 10 years after HAART initiation. Multivariable linear mixed-effects regression models were used to evaluate whether log-transformed SHBG [ln(SHBG)] and its rate of change differed by HIV serostatus. RESULTS At baseline, the mean age in MWH was similar to that in HIV-seronegative men (51 ± 5 vs 49 ± 6 years). However, SHBG mean values were higher in MWH compared with those in HIV-seronegative men (65.6 ± 48.8 vs. 45.4 ± 22 nmol/L, P < 0.001). In a fully adjusted model, SHBG increased over time and at a faster rate in MWH compared with that in HIV-seronegative men: [2.0%/year (95% CI: 1.4 to 2.7) vs 1.3%/year (95% CI: 0.8 to 1.8), respectively, P = 0.038]. Among MWH, higher SHBG concentrations were significantly associated with lower CD4+ T-cell count [β= -0.02 (95% CI: -0.03 to -0.0002), P < 0.05], fewer cumulative years on zidovudine [β = -0.027 (95% CI: -0.045 to -0.009), P < 0.001], and greater cumulative years on nonnucleoside reverse transcriptase inhibitors drugs [β = 0.022 (95% CI: 0.0006 to 0.04), P < 0.05]. CONCLUSIONS Aging-related increases in SHBG were faster in MWH compared with those in HIV-seronegative men and were related to poorer immunologic status and antiretroviral medication exposure. The mechanisms and consequences of these findings require further investigation.
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Affiliation(s)
- Jenny Pena Dias
- Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - Sabina A Haberlen
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - Adrian S. Dobs
- Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - Jordan E Lake
- Division of Infectious Diseases, McGovern School of Medicine, Houston, TX, USA
| | - Frank J. Palella
- Division of Infectious Disease, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States
| | - Lawrence A. Kingsley
- Department of Infectious Diseases and Microbiology, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | - Jennifer C. Price
- Division of Gastroenterology and Hepatology, Department of Medicine, University of California, San Francisco, San Francisco, California
| | - Shehzad Basaria
- Section on Men’s Health, Aging and Metabolism, Brigham and Women’s Hospital Harvard Medical School, Boston, MA, United States
| | - Ravi Varadhan
- Department of Oncology; Biostatistics and Bioinformatics, Johns Hopkins University, Baltimore, MD, United States
| | - Joseph B. Margolick
- Department of Molecular Microbiology and Immunology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - Chloe L Thio
- Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - Todd T. Brown
- Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, United States
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Chaudhary NS, Kind T, Willig AL, Saag MS, Shrestha S, Funderburg N, Wiener HW, Overton ET, Irvin MR. Changes in lipidomic profile by anti-retroviral treatment regimen: An ACTG 5257 ancillary study. Medicine (Baltimore) 2021; 100:e26588. [PMID: 34397689 PMCID: PMC8322553 DOI: 10.1097/md.0000000000026588] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 06/21/2021] [Indexed: 02/07/2023] Open
Abstract
High cardiovascular disease risk in people living with HIV is partly attributed to antiretroviral therapy (ART). Lipid response to ART has been extensively studied, yet, little is known how small molecule lipids respond to Integrase inhibitor-based (INSTI-based) compared to Protease inhibitor-based (PI-based) ART regimens.Ancillary study to a phase 3, randomized, open-label trial [AIDS Clinical Trial Group A5257 Study] in treatment-naive HIV-infected patients randomized in a 1:1:1 ratio to receive ritonavir-boosted atazanavir (ATV/r), ritonavir-boosted darunavir (DRV/r) (both PI-based), or raltegravir with Tenofovir Disoproxil Fumarate-TDF plus emtricitabine (RAL, INSTI-based).We examined small molecule lipid response in a subcohort of 75 participants. Lipidomic assays of plasma samples collected pre- and post-ART treatment (48 weeks) were conducted using ultra-performance liquid chromatography coupled to time-of-flight mass spectrometry. The effect of ART regimens was regressed on lipid species response adjusting for the baseline covariates (lipids, age, sex, race, CD4 level, BMI, and smoking). Results were validated in the Centers for AIDS Research Network of Integrated Clinical Systems study (N = 16).Out of 417 annotated lipids, glycerophospholipids (P = .007) and sphingolipids (P = .028) had a higher response to ATV/r and DRV/r compared to RAL. The lysophosphatidylcholine (LPCs(16:1),(17:1),(20:3)) and phosphophatidylcholine species (PCs(40:7),(38:4)) had an opposite response to RAL versus ATV/r in the discovery and validation cohort. The INSTI-based regimen had an opposite response of ceramide species ((d38:1), (d42:2)), PCs((35:2), (38:4)), phosphatidylethanolamines (PEs(38:4), (38:6)), and sphingomyelin(SMd38:1) species compared with the PI-based regimens. There were no differences observed between 2 PI-based regimens.We observed differences in response of small molecule lipid species by ART regimens in treatment-naive people living with HIV.
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Affiliation(s)
- Ninad S. Chaudhary
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL
| | - Tobias Kind
- NIH West Coast Metabolomics Center, UC Davis Genome Center, University of California, Davis, CA
| | - Amanda L. Willig
- Division of Infectious Diseases, University of Alabama School of Medicine, Birmingham, AL
| | - Michael S. Saag
- Division of Infectious Diseases, University of Alabama School of Medicine, Birmingham, AL
| | - Sadeep Shrestha
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL
| | - Nicholas Funderburg
- School of Health and Rehabilitation Sciences, Division of Medical Laboratory Science, Ohio State University, Columbus, OH
| | - Howard W. Wiener
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL
| | - E. Turner Overton
- Division of Infectious Diseases, University of Alabama School of Medicine, Birmingham, AL
| | - Marguerite R. Irvin
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL
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Phalane E, Fourie C, Schutte AE, Kruger IM, Mels C. Arterial structure and function in Africans with HIV for > 5 years: longitudinal relationship with endothelial activation and cardiovascular risk markers. HIV Med 2021; 22:650-661. [PMID: 33949073 DOI: 10.1111/hiv.13111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 02/27/2021] [Accepted: 03/22/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES We aimed to determine whether people with human immunodeficiency virus (PWHIV) have increased measures of arterial injury [carotid intima-media thickness (cIMT)] and large artery stiffness [carotid-femoral pulse wave velocity (cfPWV)] when compared with their counterparts without HIV, and whether baseline markers of endothelial activation and cardiovascular risk are associated with cIMT and cfPWV after 5 years. METHODS We matched 126 PWHIV from North West Province, South Africa, to 126 without HIV according to age, sex and locality. Cardiovascular risk and endothelial function markers [soluble intracellular adhesion molecule (ICAM-1) and soluble vascular cell adhesion molecule (VCAM-1)] were measured at baseline and cIMT and cfPWV at follow-up. RESULTS This study included 21.4% men. The use of antiretroviral therapy (ART) increased from 44.1% at baseline to 81.4% at follow-up. At follow-up, cIMT (P = 0.90) and cfPWV (P = 0.35) were similar in the groups. Despite elevated ICAM-1 and VCAM-1 in the PWHIV (all P < 0.001) at baseline, these markers did not associate with cIMT and cfPWV after 5 years. In multivariable-adjusted regression analysis, cIMT associated positively with age (β = 0.31, P = 0.002) and triglyceride: high-density lipoprotein-cholesterol (β = 0.23, P = 0.016) in PWHIV. Mean arterial pressure (MAP) (β = 0.28, P = 0.010) associated positively with cfPWV in the PWHIV. In the people without HIV, sex (β = 0.31, P = 0.004) and glycated haemoglobin (HbA1c) (β = 0.24, P = 0.026) associated with cIMT while age (β = 0.17, P = 0.049), sex (β = 0.29, P = 0.003), MAP (β = 0.31, P = 0.001) and HbA1c (β = 0.21, P = 0.041) associated positively with cfPWV. CONCLUSIONS Measures of arterial structure and function were similar in Africans with HIV and their age, sex and locality matched controls. Traditional cardiovascular risk markers rather than elevated endothelial activation at baseline were independently associated with cIMT and cfPWV over 5 years.
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Affiliation(s)
- E Phalane
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa
| | - Cmt Fourie
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa.,Medical Research Council Unit for Hypertension and Cardiovascular Disease, Faculty of Health Sciences, North-West University, Potchefstroom, South Africa
| | - A E Schutte
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa.,Medical Research Council Unit for Hypertension and Cardiovascular Disease, Faculty of Health Sciences, North-West University, Potchefstroom, South Africa.,School of Population Health, University of New South Wales, The George Institute for Global Health, Sydney, NSW, Australia
| | - I M Kruger
- Africa Unit for Transdisciplinary Health Research (AUTHeR), North-West University, Potchefstroom, South Africa
| | - Cmc Mels
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa.,Medical Research Council Unit for Hypertension and Cardiovascular Disease, Faculty of Health Sciences, North-West University, Potchefstroom, South Africa
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35
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Baer SL, Colombo RE, Johnson MH, Wakade S, Pacholczyk G, Newman-Whitlow C, Thompson SA, Saag MS, Martin JN, Floris-Moore M, Huang L, Mellor AL. Indoleamine 2,3 dioxygenase, age, and immune activation in people living with HIV. J Investig Med 2021; 69:1238-1244. [PMID: 33875612 DOI: 10.1136/jim-2021-001794] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2021] [Indexed: 11/03/2022]
Abstract
Immune activation complicates HIV despite antiretroviral therapy (ART). Indoleamine 2,3 dioxygenase (IDO) catabolizes tryptophan (T) to kynurenine (K), regulating immune activity, and IDO activity increases with age. This study examines the relationship of IDO activity, bacterial translocation, and aging in people living with HIV (PLWH) on ART. Samples and data from PLWH on ART from the Centers for AIDS Research Network of Integrated Clinical Systems and from matched HIV-uninfected patients (controls) from the Multicenter AIDS Cohort Study and the Women's Interagency HIV Study were analyzed. The ratio of K to T (K:T) and neopterin were indicators of inflammation; 16S ribosomal DNA (16S rDNA) and lipopolysaccharide (LPS) were markers of bacterial translocation. Samples and data from 205 PLWH and 99 controls were analyzed. PLWH had higher K:T values across all ages, with a significant relationship between age and K:T for both groups. CD4 count or CD4 nadir had no association with K:T. There was no positive association between level of 16S rDNA or LPS detection and K:T. K:T and neopterin were associated. PLWH had elevated IDO activity, at younger ages, despite ART. This study suggests K:T ratio increases with age in both groups and is elevated in PLWH at all ages compared with age-matched controls.
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Affiliation(s)
- Stephanie L Baer
- Infection Control, Charlie Norwood VA Medical Center, Augusta, Georgia, USA .,Department of Medicine, Augusta University, Augusta, Georgia, USA
| | - Rhonda E Colombo
- Department of Medicine, Augusta University, Augusta, Georgia, USA.,Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, Bethesda, Maryland, USA
| | - Maribeth H Johnson
- Department of Neuroscience and Regenerative Medicine, Augusta University, Augusta, Georgia, USA
| | - Sushama Wakade
- Department of Medicine, Augusta University, Augusta, Georgia, USA
| | | | | | | | - Michael S Saag
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jeffrey N Martin
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
| | - Michelle Floris-Moore
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Lei Huang
- Institute of Cellular Medicine, Faculty of Medical Science, Newcastle University, Newcastle upon Tyne, UK.,Immunotherapy Discovery Institute, Augusta University, Augusta, Georgia, USA
| | - Andrew L Mellor
- Institute of Cellular Medicine, Faculty of Medical Science, Newcastle University, Newcastle upon Tyne, UK.,Immunotherapy Discovery Institute, Augusta University, Augusta, Georgia, USA
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Behrens NE, Love M, Bandlamuri M, Bernhardt D, Wertheimer A, Klotz SA, Ahmad N. Characterization of HIV-1 Envelope V3 Region Sequences from Virologically Controlled HIV-Infected Older Patients on Long Term Antiretroviral Therapy. AIDS Res Hum Retroviruses 2021; 37:233-245. [PMID: 33287636 DOI: 10.1089/aid.2020.0139] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Although many HIV-infected patients have attained older age owing to the success of antiretroviral therapy (ART) in controlling viremia and increasing CD4 T cell counts, HIV continues to persist in several target cells. We have characterized 514 HIV-1 envelope V3 region sequences (94-96 amino acids [aa]) from 25 HIV-infected older patients' peripheral blood mononuclear cell DNA on long-term ART with controlled viremia (undetectable viral load) and improved CD4 T cell counts. Phylogenetic analysis revealed that the V3 region sequences of each patient formed distinct clusters that were well separated and discriminated from other patients' sequences. The coding potential of the V3 region, including several patient-specific amino acid motifs and functional domains, including the two cysteines sandwiching the V3 loop, the central GPGR motif with variation at one position in some sequences, the base GDIR motif, and the N-glycosylation sites were generally conserved. The patients' V3 region sequences contained amino acid motifs conferring affinity mostly for CCR5 coreceptor, suggesting R5 phenotype. There was a low degree of heterogeneity and lower estimates of genetic diversity in all 25 patients' V3 region sequences. Twelve of 25 patients' V3 region sequences were found to be under positive selection pressure. Analysis of the several cytotoxic T lymphocytes (CTL) epitopes showed variation, whereas some of known neutralizing antibodies (nAbs) epitopes showed conservation in patients' V3 region sequences. In conclusion, a low degree of genetic variability and maintenance of functional domains with R5 phenotypes, and variation in CTL and conservation of nAb epitopes were the hallmarks of V3 region sequences from our 25 virologically controlled HIV-infected older patients on long-term ART.
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Affiliation(s)
- Nicole E. Behrens
- Department of Immunobiology, College of Medicine, University of Arizona, Tucson, Arizona, USA
| | - Maria Love
- Department of Immunobiology, College of Medicine, University of Arizona, Tucson, Arizona, USA
| | - Meghana Bandlamuri
- Department of Immunobiology, College of Medicine, University of Arizona, Tucson, Arizona, USA
| | - Dana Bernhardt
- Department of Immunobiology, College of Medicine, University of Arizona, Tucson, Arizona, USA
| | - Anne Wertheimer
- Department of Medicine, College of Medicine, University of Arizona, Tucson, Arizona, USA
- BIO5 Institute, University of Arizona, Tucson, Arizona, USA
| | - Stephen A. Klotz
- Department of Medicine, College of Medicine, University of Arizona, Tucson, Arizona, USA
| | - Nafees Ahmad
- Department of Immunobiology, College of Medicine, University of Arizona, Tucson, Arizona, 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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Abudan AA, Vaidya VR, Tripathi B, Noseworthy PA, DeSimone DC, Egbe A, Arora S, Sridhar H, DeSimone CV, Mulpuru S, Deshmukh AJ. Burden of arrhythmia in hospitalized HIV patients. Clin Cardiol 2020; 44:66-77. [PMID: 33295667 PMCID: PMC7803370 DOI: 10.1002/clc.23506] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Revised: 10/19/2020] [Accepted: 10/29/2020] [Indexed: 02/02/2023] Open
Abstract
Background The improved life expectancy observed in patients living with human immunodeficiency virus (HIV) infection has made age‐related cardiovascular complications, including arrhythmias, a growing health concern. Hypothesis We describe the temporal trends in frequency of various arrhythmias and assess impact of arrhythmias on hospitalized HIV patients using the Nationwide Inpatient Sample (NIS). Methods Data on HIV‐related hospitalizations from 2005 to 2014 were obtained from the NIS database using International Classification of Diseases, 9th Revision (ICD‐9) codes. Data was further subclassified into hospitalizations with associated arrhythmias and those without. Baseline demographics and comorbidities were determined. Outcomes including in‐hospital mortality, cost of care, and length of stay were extracted. SAS 9.4 (SAS Institute Inc., Cary, NC) was utilized for analysis. A multivariable analysis was performed to identify predictors of arrhythmias among hospitalized HIV patients. Results Among 2 370 751 HIV‐related hospitalizations identified, the overall frequency of any arrhythmia was 3.01%. Atrial fibrillation (AF) was the most frequent arrhythmia (2110 per 100 000). The overall frequency of arrhythmias increased over time by 108%, primarily due to a 132% increase in AF. Arrhythmias are more frequent among older males, lowest income quartile, and nonelective admissions. Patients with arrhythmias had a higher in‐hospital mortality rate (9.6%). In‐hospital mortality among patients with arrhythmias decreased over time by 43.8%. The cost of care and length of stay associated with arrhythmia‐related hospitalizations were mostly unchanged. Conclusions Arrhythmias are associated with significant morbidity and mortality in hospitalized HIV patients. AF is the most frequent arrhythmia in hospitalized HIV patients.
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Affiliation(s)
- Anas A Abudan
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, United States.,Department of Internal Medicine, University of Kansas School of Medicine, Kansas City, Kansas, United States
| | - Vaibhav R Vaidya
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, United States
| | - Byomesh Tripathi
- Department of Medicine, Mount Sinai St Luke's-Roosevelt Hospital, New York, New York, United States
| | - Peter A Noseworthy
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, United States
| | - Daniel C DeSimone
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, United States.,Division of Infectious Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Alexander Egbe
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, United States
| | - Shilpkumar Arora
- Department of Medicine, Mount Sinai St Luke's-Roosevelt Hospital, New York, New York, United States
| | - Haarini Sridhar
- University of California, Berkeley, California, United States
| | | | - Siva Mulpuru
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, United States
| | - Abhishek J Deshmukh
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, United States
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Yeşilbağ Z, Şengül Eİ, Şenoğlu S, Aydın ÖA, Karaosmanoğlu HK. Co-medications and Drug-Drug Interactions in People Living with HIV in Turkey in the Era of Integrase Inhibitors. Curr HIV Res 2020; 18:415-425. [PMID: 32787762 DOI: 10.2174/1574885515666200812215140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 06/25/2020] [Accepted: 07/17/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Long life expectancy in people living with human immunodeficiency virus (PLWH) caused an increase in comorbidities and co-medications. We aimed to analyse comedications and drug-drug interactions (DDIs) in antiretroviral therapy (ART)-naive PLWH in the era of integrase inhibitors. METHODS A retrospective observational study was conducted between January 2016-August 2019. Patients' characteristics and chronic co-medications were recorded. The University of Liverpool HIV drug interaction database was used for DDIs. RESULTS Among 745 patients, the chronic co-medication rate was 30.9%. Older age (p<0.001, OR:6.66, 95% CI: 3.86-11.49) and female gender (p=002, OR:2.25, 95%:1.14-4.44) were independently associated with co-medication. Cardiovascular system (CVS) and central nervous system (CNS) drugs were the most common co-medications. Older age patients (p<0.001, OR:12.04, 95% CI:4.63-36.71), having heterosexual (HS) contact (p=0.003, OR:3.8, 95% CI:1.57-9.22) were independently associated with CVS drugs use, while being men who have sex with men (MSM) (p=0.03, OR:2.59, 95% CI:1.11-6.03) were associated with CNS drugs use. DDIs were seen in 37.4% of patients with co-medications. Antidiabetics (23.3%), CNS (22.1%) and CVS drugs (19.8%) most commonly had DDIs. Contraindication was most commonly seen between inhaled corticosteroids and elvitegravir/cobicistat. A number of non-ART drugs, elvitegravir/cobicistat, antidiabetics, vitamins were independently associated with the presence of DDIs. CONCLUSION Results suggested the need for attention about co-medication in PLWH regardless of whether they are young or older. CNS drugs should be questioned more detailed in MSM, as well as CVS drugs in older HS patients. Elvitegravir/cobicistat is significantly associated with DDIs and switching to an unboosted INSTI should be considered in patients with multiple comorbidities.
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Affiliation(s)
- Zuhal Yeşilbağ
- Department of Infectious Diseases and Clinical Microbiology, University of Health Sciences, Bakirkoy Dr. Sadi Konuk Education and Research Hospital, Istanbul, Turkey
| | - Emine İlay Şengül
- Department of Infectious Diseases and Clinical Microbiology, University of Health Sciences, Bakirkoy Dr. Sadi Konuk Education and Research Hospital, Istanbul, Turkey
| | - Sevtap Şenoğlu
- Department of Infectious Diseases and Clinical Microbiology, University of Health Sciences, Bakirkoy Dr. Sadi Konuk Education and Research Hospital, Istanbul, Turkey
| | - Özlem Altuntaş Aydın
- Department of Infectious Diseases and Clinical Microbiology, University of Health Sciences, Bakirkoy Dr. Sadi Konuk Education and Research Hospital, Istanbul, Turkey
| | - Hayat Kumbasar Karaosmanoğlu
- Department of Infectious Diseases and Clinical Microbiology, University of Health Sciences, Bakirkoy Dr. Sadi Konuk Education and Research Hospital, Istanbul, Turkey
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Bloch M, John M, Smith D, Rasmussen TA, Wright E. Managing HIV-associated inflammation and ageing in the era of modern ART. HIV Med 2020; 21 Suppl 3:2-16. [PMID: 33022087 DOI: 10.1111/hiv.12952] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVES This paper aims to address the concerns around ongoing immune activation, inflammation, and resistance in those ageing with HIV that represent current challenges for clinicians. METHODS Presentations at a symposium addressing issues of ageing with HIV infection were reviewed and synthesised. RESULTS The changing natural history and demographics of human immunodeficiency virus (HIV)-infected individuals means new challenges in contemporary management. In the early years of the epidemic,management was focussed on acute, potentially life-threatening AIDS-related complications. From initial monotherapy with first-generation antiretroviral therapy (ART), the development of combination highly active ART (HAART) allowed HIV control but ART toxicities, treatment adherence and drug resistance emerged as major issues. Today, the availability of potent and tolerable ART has made viral suppression achievable in most people living with HIV (PLHIV), and clinicians are confronted with managing a chronic condition among an ageing population. The combination of diseases of ageing and the co-morbidities associated with HIV-infection, even when well controlled, results in a complex set of challenges for many older PLHIV. There is a growing appreciation that many non-AIDS-related co-morbidities are caused, at least in part, by persistent, low-grade immune activation, inflammation, and hypercoagulability, despite suppressive ART. CONCLUSIONS In order to further improve HIV management, it is important to understand the enduring effects of chronically suppressed HIV infection, the potential contribution of these factors to the ageing process, the possibility of drug resistance, and the impact of different treatment strategies, including early ART initiation.
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Affiliation(s)
- M Bloch
- Holdsworth House Medical Practice, Sydney, NSW, Australia.,Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - M John
- Kirby Institute, University of New South Wales, Sydney, NSW, Australia.,Royal Perth Hospital, Perth, WA, Australia.,Institute of Immunology and Infectious Disease, Perth, WA, Australia
| | - D Smith
- School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, Australia.,The Albion Centre, Sydney, NSW, Australia
| | - T A Rasmussen
- Doherty Institute for Infection and Immunity, Melbourne, Vic., Australia.,University of Melbourne, Melbourne, Vic., Australia
| | - E Wright
- The Alfred Hospital, Melbourne, Vic., Australia.,Centre for Inflammatory Diseases, Monash University, Melbourne, Vic., Australia.,The Burnett Institute, Melbourne, Vic., Australia
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De Francesco D, Sabin CA, Reiss P, Kootstra NA. Monocyte and T Cell Immune Phenotypic Profiles Associated With Age Advancement Differ Between People With HIV, Lifestyle-Comparable Controls and Blood Donors. Front Immunol 2020; 11:581616. [PMID: 33123168 PMCID: PMC7573236 DOI: 10.3389/fimmu.2020.581616] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 09/21/2020] [Indexed: 12/11/2022] Open
Abstract
Motivation People with HIV on successful antiretroviral therapy show signs of premature aging and are reported to have higher rates of age-associated comorbidities. HIV-associated immune dysfunction and inflammation have been suggested to contribute to this age advancement and increased risk of comorbidities. Method Partial least squares regression (PLSR) was used to explore associations between biological age advancement and immunological changes in the T cell and monocyte compartment in people with HIV (n=40), comparable HIV-negative individuals (n=40) participating in the Comorbidity in Relation to AIDS (COBRA) cohort, and blood donors (n=35). Results We observed that age advancement in all three groups combined was associated with a monocyte immune phenotypic profile related to inflammation and a T cell immune phenotypic associated with immune senescence and chronic antigen exposure. Interestingly, a unique monocyte and T cell immune phenotypic profile predictive for age advancement was found within each group. An inflammatory monocyte immune phenotypic profile associated with age advancement in HIV-negative individuals, while the monocyte profile in blood donors and people with HIV was more reflective of loss of function. The T cell immune phenotypic profile in blood donors was related to loss of T cell function, whereas the same set of markers were related to chronic antigen stimulation and immune senescence in HIV-negative individuals. In people with HIV, age advancement was related to changes in the CD4+ T cell compartment and more reflective of immune recovery after cART treatment. Impact The identified monocyte and T cell immune phenotypic profiles that were associated with age advancement, were strongly related to inflammation, chronic antigen exposure and immune senescence. While the monocyte and T cell immune phenotypic profile within the HIV-negative individuals reflected those observed in the combined three groups, a distinct profile related to immune dysfunction, was observed within blood donors and people with HIV. These data suggest that varying exposures to lifestyle and infection-related factors may be associated with specific changes in the innate and adaptive immune system, that all contribute to age advancement.
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Affiliation(s)
- Davide De Francesco
- Institute for Global Health, University College London, London, United Kingdom
| | - Caroline A Sabin
- Institute for Global Health, University College London, London, United Kingdom
| | - Peter Reiss
- Amsterdam institute for Global Health and Development, Amsterdam, Netherlands.,Department of Global Health & Division of Infectious Disease, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands.,HIV Monitoring Foundation, Amsterdam, Netherlands
| | - Neeltje A Kootstra
- Department of Experimental Immunology, Amsterdam Infection and Immunity Institute, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
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A randomized pilot trial to evaluate the benefit of the concomitant use of atorvastatin and Raltegravir on immunological markers in protease-inhibitor-treated subjects living with HIV. PLoS One 2020; 15:e0238575. [PMID: 32941476 PMCID: PMC7498036 DOI: 10.1371/journal.pone.0238575] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 08/18/2020] [Indexed: 01/19/2023] Open
Abstract
Objective Optimization of antiretroviral therapy and anti-inflammatory treatments, such as statins, are among the strategies aimed at reducing metabolic disorders, inflammation and immune activation in people living with HIV (PLWH). We evaluated the potential benefit of combining both strategies. Design Forty-two PLWH aged ≥40 years receiving a protease inhibitor (PI)-based regimen were randomized (1:1) to switch from PI to Raltegravir (n = 20), or to remain on PI (n = 22). After 24 weeks, all patients received atorvastatin 20mg/day for 48 weeks. Methods We analyzed plasma inflammatory as well as T-cell maturation, activation, exhaustion and senescence markers at baseline, 24 and 72 weeks, Results Plasma inflammatory markers remained unchanged. Furthermore, no major changes on T-cell maturation subsets, immunoactivation, exhaustion or immunosenescence markers in both CD4 and CD8 T cell compartments were observed. Only a modest decrease in the frequency of CD38+ CD8 T cells and an increase in the frequency of CD28-CD57+ in both CD4 and CD8 T-cell compartments were noticed in the Raltegravir-switched group. Conclusions The study combined antiretroviral switch to Raltegravir and Statin-based anti-inflammatory strategies to reduce inflammation and chronic immune activation in PLWH. Although this combination was safe and well tolerated, it had minimal impact on inflammatory and immunological markers. Clinical Trials Registration NCT02577042.
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Ziada AS, Smith MSR, Côté HCF. Updating the Free Radical Theory of Aging. Front Cell Dev Biol 2020; 8:575645. [PMID: 33043009 PMCID: PMC7525146 DOI: 10.3389/fcell.2020.575645] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 08/18/2020] [Indexed: 11/13/2022] Open
Affiliation(s)
- Adam S Ziada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada.,Centre for Blood Research, University of British Columbia, Vancouver, BC, Canada
| | - Marie-Soleil R Smith
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada.,Centre for Blood Research, University of British Columbia, Vancouver, BC, Canada
| | - Hélène C F Côté
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada.,Centre for Blood Research, University of British Columbia, Vancouver, BC, Canada.,Women's Health Research Institute, Vancouver, BC, Canada
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44
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Njie-Carr VPS, Zhu S, Williams GC, Corless IB, Himelhoch S. Evaluation of a technology-enhanced intervention for older women with HIV infection: a proof of concept study. AIDS Care 2020; 33:983-992. [PMID: 32835493 DOI: 10.1080/09540121.2020.1810617] [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: 10/23/2022]
Abstract
The syndemic effects of HIV infection, side effects of highly active antiretroviral medications, and age-related changes lead to increased risk for comorbidities and functional decline for older people with HIV. This proof of concept (PoC) study evaluated perceived usefulness, satisfaction, acceptability, intervention processes, resource management, and outcome effect variances of ThE CARE Intervention guided by the Self-Determination Theory. To test the utility of ThE CARE, we conducted a one-group pre/posttest intervention design with a convenience sample of 20 women, 50 years and older. The mean age was 56 years (SD = 11) and years since HIV diagnosis was 23.7 (SD = 8.6). ThE CARE intervention was found useful and participants "felt empowered" utilizing the app. Fourteen participants (70%) reported high-intensity distress and negative impact on life from neuropathic pain, anxiety (55%), fatigue (50%), and depressive symptoms (35%). Self-awareness and self-regulation also improved. Modest results of acceptability, usability, and positive trends in the outcome measures suggest possible effects. The interactivity and cultural relevance of ThE CARE would enhance women's autonomous motivation and perceived competence to actively engage in self-care. The PoC study provides important foundational information to advance science in mHealth interventions for older women with HIV.
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Affiliation(s)
- Veronica P S Njie-Carr
- School of Nursing, Department of Organizational Systems and Adult Health, University of Maryland, Baltimore, MD, USA
| | - Shijun Zhu
- School of Nursing, Department of Organizational Systems and Adult Health, University of Maryland, Baltimore, MD, USA
| | - Geoffrey C Williams
- Department of Medicine, and Center for Community Health and Prevention, University of Rochester, Rochester, NY, USA
| | - Inge B Corless
- School of Nursing, MGH Institute of Health Professions, Boston, MA, USA
| | - Seth Himelhoch
- College of Medicine, University of Kentucky, Lexington, KY, USA
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Thomas A, Hammarlund E, Gao L, Holman S, Michel KG, Glesby M, Villacres MC, Golub ET, Roan NR, French AL, Augenbraun MH, Slifka MK. Loss of Preexisting Immunological Memory Among Human Immunodeficiency Virus-Infected Women Despite Immune Reconstitution With Antiretroviral Therapy. J Infect Dis 2020; 222:243-251. [PMID: 31867597 PMCID: PMC7323495 DOI: 10.1093/infdis/jiz678] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 12/19/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND It is unclear whether human immunodeficiency virus (HIV) infection results in permanent loss of T-cell memory or if it affects preexisting antibodies to childhood vaccinations or infections. METHODS We conducted a matched cohort study involving 50 pairs of HIV-infected and HIV-uninfected women. Total memory T-cell responses were measured after anti-CD3 or vaccinia virus (VV) stimulation to measure T cells elicited after childhood smallpox vaccination. VV-specific antibodies were measured by means of enzyme-linked immunosorbent assay (ELISA). RESULTS There was no difference between HIV-infected and HIV-uninfected study participants in terms of CD4+ T-cell responses after anti-CD3 stimulation (P = .19) although HIV-infected participants had significantly higher CD8+ T-cell responses (P = .03). In contrast, there was a significant loss in VV-specific CD4+ T-cell memory among HIV-infected participants (P = .04) whereas antiviral CD8+ T-cell memory remained intact (P > .99). VV-specific antibodies were maintained indefinitely among HIV-uninfected participants (half-life, infinity; 95% confidence interval, 309 years to infinity) but declined rapidly among HIV-infected participants (half-life; 39 years; 24-108 years; P = .001). CONCLUSIONS Despite antiretroviral therapy-associated improvement in CD4+ T-cell counts (nadir, <200/μL; >350/μL after antiretroviral therapy), antigen-specific CD4+ T-cell memory to vaccinations or infections that occurred before HIV infection did not recover after immune reconstitution, and a previously unrealized decline in preexisting antibody responses was observed.
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Affiliation(s)
- Archana Thomas
- Division of Neuroscience, Oregon National Primate Research Center, Oregon Health & Science University, Beaverton, Oregon, USA
| | - Erika Hammarlund
- Division of Neuroscience, Oregon National Primate Research Center, Oregon Health & Science University, Beaverton, Oregon, USA
| | - Lina Gao
- Biostatistics Shared Resource, Knight Cancer Institute, Biostatistics & Bioinformatics Core, Oregon National Primate Research Center, Oregon Health & Science University, Portland, Oregon, USA
| | - Susan Holman
- Division of Infectious Diseases, Department of Medicine, SUNY Downstate Health Sciences University, Brooklyn, New York, USA
| | - Katherine G Michel
- Department of Medicine, Georgetown University Medical Center, Washington, DC, USA
| | - Marshall Glesby
- Division of Infectious Diseases, Department of Medicine, Weill Cornell Medical College of Cornell University, New York, New York, USA
| | - Maria C Villacres
- Department of Pediatrics, Keck School of Medicine of USC, Los Angeles, California, USA
| | - Elizabeth T Golub
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Nadia R Roan
- Department of Urology, University of California, San Francisco, San Francisco, California, USA
| | - Audrey L French
- Department of Medicine, Cook County Health and Hospitals System, Chicago, Illinois, USA
| | - Michael H Augenbraun
- Division of Infectious Diseases, Department of Medicine, SUNY Downstate Health Sciences University, Brooklyn, New York, USA
| | - Mark K Slifka
- Division of Neuroscience, Oregon National Primate Research Center, Oregon Health & Science University, Beaverton, Oregon, USA
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Bhatta M, Nandi S, Dutta N, Dutta S, Saha MK. HIV Care Among Elderly Population: Systematic Review and Meta-Analysis. AIDS Res Hum Retroviruses 2020; 36:475-489. [PMID: 32027170 DOI: 10.1089/aid.2019.0098] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Elderly people living with HIV are increasing. At present in the United States, nearly half of newly diagnosed HIV-infected people are aged >50 years. Diagnosis and treatment of HIV-infected elderly patients tends to be delayed by several health care factors as several life-threatening diseases are common in elderly people. This study aimed to find the pooled HIV prevalence in elderly population and the present situation of continuum care for the elderly HIV patients through systematic review and meta-analysis. All previously published articles from 2000 to 2018 are retrieved using MEDLINE, PUBMED, Cochrane Library, EMBASE, and Google Scholar. DerSimonian and Laird Random Effects model are used to critically appraise articles. STATA 13.0 is used to perform the meta-analysis and quantum-geographic information system (Q-GIS) is used to prepare desired map. I2 statistics has been used to test heterogeneity and publication biases. Results have been presented using forest plots. A total of 28 studies are included in this meta-analysis. Present analysis revealed pooled prevalence of HIV in elderly population as 15.79% with a lower rate of viral suppression as 11.524% (95% confidence interval, CI: 11.199-11.855), where a moderate number 38.643% (95% CI: 38.289-38.997) of elderly patients received antiretroviral therapy (ART) globally. The ART retention rate was 12.769% (95% CI: 12.540-13.001) with 6.15% (95% CI: 6.089-6.212) mortality. Despite successful administration of ART in developing part of the world that have relatively higher retention rates among HIV-infected elderly patients only a small percentage are virally suppressed, largely due to elderly drugs interact with ART and several comorbidities reduce the life span of the elderly people.
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Affiliation(s)
- Mihir Bhatta
- Divisions of Virology and ICMR-National Institute of Cholera and Enteric Diseases, Kolkata, India
| | - Srijita Nandi
- Divisions of Virology and ICMR-National Institute of Cholera and Enteric Diseases, Kolkata, India
| | - Nalok Dutta
- Divisions of Virology and ICMR-National Institute of Cholera and Enteric Diseases, Kolkata, India
| | - Shanta Dutta
- Divisions of Bacteriology, ICMR-National Institute of Cholera and Enteric Diseases, Kolkata, India
| | - Malay Kumar Saha
- Divisions of Virology and ICMR-National Institute of Cholera and Enteric Diseases, Kolkata, India
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Zuniga JA, García AA, Lee J, Park J. Retention in care in aging adults with a dual diagnosis of HIV infection and type 2 diabetes mellitus: a longitudinal retrospective cross-sectional study. AIDS Res Ther 2020; 17:29. [PMID: 32471484 PMCID: PMC7260810 DOI: 10.1186/s12981-020-00286-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 05/15/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study aimed to investigate the measures of retention in care (RIC) in persons living with HIV (PLWH) and type 2 diabetes mellitus (T2DM) by age group (younger vs. older adults). METHODS This was a longitudinal retrospective cross-sectional study that used secondary data from the Center for AIDS Research Network of Integrated Clinical Systems (CNICS). We examined RIC in 798 adult PLWH + T2DM who visited a CNICS clinic at least once in 2015. Six measures of RIC were examined: missed visits [measured as a continuous variable (total number of missed visits) and dichotomous variable (0 = never missed, 1 = missed)], visit adherence, 6-month visit gap, 4-month visit constancy, and the Health and Resources Services Administration HIV/AIDS Bureau's RIC measure. We calculated Spearman correlation coefficients and conducted logistic regression and multi-group path analysis. RESULTS Most RIC measures were significantly correlated (p < 0.05) with one another; only 4-month visit constancy was not correlated with other measures. Except for the number of missed visits in older adult PLWH + T2DM, we found no significant relationships between RIC measures and CD4 cell count using logistic regression. However, multi-group path analysis demonstrated significant positive relationships between most RIC measures and CD4 cell count in both age groups. In younger adults living with HIV (YALWH) + T2DM, HbA1c level, but not CD4 count, was significantly associated with most RIC measures. CONCLUSIONS RIC is related to disease control (CD4 cell count and HbA1c level) in PLWH + T2DM and notably, HbA1c level was only significantly affected in YALWH + T2DM. A future study is needed to find more accurate reasons for the fact that only HbA1c level had significant relationships in YALWH + T2DM. The findings from this study provide guidance in measuring RIC in PLWH who have comorbidities.
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Dalzini A, Petrara MR, Ballin G, Zanchetta M, Giaquinto C, De Rossi A. Biological Aging and Immune Senescence in Children with Perinatally Acquired HIV. J Immunol Res 2020; 2020:8041616. [PMID: 32509884 PMCID: PMC7246406 DOI: 10.1155/2020/8041616] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 04/22/2020] [Indexed: 12/12/2022] Open
Abstract
Chronic HIV-infected children suffer from premature aging and aging-related diseases. Viral replication induces an ongoing inflammation process, with the release of pathogen-associated molecular patterns (PAMPs) and damage-associated molecular patterns (DAMPs), the activation of the immune system, and the production of proinflammatory cytokines. Although combined highly active antiretroviral therapy (ART) has significantly modified the natural course of HIV infection, normalization of T and B cell phenotype is not completely achievable; thus, many HIV-infected children display several phenotypical alterations, including higher percentages of activated cells, that favor an accelerated telomere attrition, and higher percentages of exhausted and senescent cells. All these features ultimately lead to the clinical manifestations related to premature aging and comorbidities typically observed in older general population, including non-AIDS-related malignancies. Therefore, even under effective treatment, the premature aging process of HIV-infected children negatively impacts their quality and length of life. This review examines the available data on the impact of HIV and ART on immune and biological senescence of HIV-infected children.
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Affiliation(s)
- Annalisa Dalzini
- Section of Oncology and Immunology, Department of Surgery, Oncology and Gastroenterology, Unit of Viral Oncology and AIDS Reference Center, University of Padova, Padova, Italy
| | - Maria Raffaella Petrara
- Section of Oncology and Immunology, Department of Surgery, Oncology and Gastroenterology, Unit of Viral Oncology and AIDS Reference Center, University of Padova, Padova, Italy
| | - Giovanni Ballin
- Section of Oncology and Immunology, Department of Surgery, Oncology and Gastroenterology, Unit of Viral Oncology and AIDS Reference Center, University of Padova, Padova, Italy
| | | | - Carlo Giaquinto
- Department of Mother and Child Health, University of Padova, Padova, Italy
| | - Anita De Rossi
- Section of Oncology and Immunology, Department of Surgery, Oncology and Gastroenterology, Unit of Viral Oncology and AIDS Reference Center, University of Padova, Padova, Italy
- Veneto Institute of Oncology IOV – IRCCS, Padua, Italy
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Sellier P, Hamet G, Brun A, Ponscarme D, De Castro N, Alexandre G, Rozenbaum W, Molina JM, Abgrall S. Mortality of People Living with HIV in Paris Area from 2011 to 2015. AIDS Res Hum Retroviruses 2020; 36:373-380. [PMID: 31565958 DOI: 10.1089/aid.2019.0143] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
In high-income countries, causes of death in people living with HIV (PLHIV) have changed. Three French national surveys from 2000 to 2010 showed a decrease in AIDS-related and an increase in non-AIDS-related deaths. Deaths notified in PLHIV followed between January 1, 2011 and December 31, 2015 in 1 of 13 participating hospitals northeast of Paris area were described. Risk factors for death were assessed, using a multivariable logistic regression model. Of 14,403 individuals, 295 died. Median age at death was 52 years (interquartile range = 47-60) and 77% were men. Sixty-seven individuals (23%) died from non-AIDS-defining nonviral hepatitis-related (NaNH) malignancy, 40 (14%) from AIDS, 34 (12%) from cardiovascular disease (CVD), 33 (11%) from non-AIDS infection, 21 (7%) from liver disease, and 12 (4%) from suicide. Men and women born in sub-Saharan Africa had a lower adjusted odds ratio (aOR) of dying than men having sex with men (MSM) born in France (0.70, 95% confidence interval = 0.45-1.09; and 0.45, 0.28-0.73, respectively). Risk factors for death were older age (aOR = 2.26, 1.36-3.77 for 40-49 years and 2.91, 1.75-4.84 for >50 years vs. 18-39 years), male intravenous drug users (IVDU) transmission (2.24, 1.42-3.54 vs. MSM born in France), AIDS (2.75, 2.10-3.59), antiretroviral therapy initiation in earlier periods, time since HIV diagnosis <1 year, low CD4 cell count nadir, hepatitis B virus and/or hepatitis C virus coinfection (1.69, 1.23-2.30), and psychiatric disorders (1.73, 1.27-2.38). Our study confirms the increasing frequency of non-AIDS-related deaths, mainly NaNH malignancies and CVD, in PLHIV, justifying overall and in some specific populations (psychiatric and IVDU) prevention and screening.
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Affiliation(s)
- Pierre Sellier
- Department of Internal Medicine, Saint-Louis-Lariboisière-Fernand Widal Hospital, AP-HP, Paris, France
| | - Gwenn Hamet
- COREVIH Ile de France Est, Saint-Louis Hospital, Paris, France
| | - Alexandre Brun
- COREVIH Ile de France Est, Saint-Louis Hospital, Paris, France
| | - Diane Ponscarme
- Department of Infectious Diseases, Saint-Louis-Lariboisière-Fernand Widal Hospital, AP-HP, Paris, France
| | - Nathalie De Castro
- Department of Infectious Diseases, Saint-Louis-Lariboisière-Fernand Widal Hospital, AP-HP, Paris, France
| | | | - Willy Rozenbaum
- COREVIH Ile de France Est, Saint-Louis Hospital, Paris, France
- Department of Infectious Diseases, Saint-Louis-Lariboisière-Fernand Widal Hospital, AP-HP, Paris, France
| | - Jean-Michel Molina
- Department of Infectious Diseases, Saint-Louis-Lariboisière-Fernand Widal Hospital, AP-HP, Paris, France
- University Paris Diderot, Paris, France
| | - Sophie Abgrall
- Department of Infectious Diseases, Avicenne Hospital, AP-HP, Bobigny, France
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Pontelo BM, Greco DB, Guimarães NS, Rotsen N, Braga VAR, Pimentel PHN, Barbosa H, Barroso TM, Tupinambás U. Profile of drug-drug interactions and impact on the effectiveness of antiretroviral therapy among patients living with HIV followed at an Infectious Diseases Referral Center in Belo Horizonte, Brazil. Braz J Infect Dis 2020; 24:104-109. [PMID: 32360120 PMCID: PMC9392032 DOI: 10.1016/j.bjid.2020.03.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Revised: 03/12/2020] [Accepted: 03/21/2020] [Indexed: 12/02/2022] Open
Abstract
HIV infection may be considered a chronic condition for people living with HIV with access to antiretrovirals and this has effectively increased survival. Moreover, this has also facilitated the emergence of other comorbidities increasing the risk for drug–drug interactions and polypharmacy. The profile of these interactions as well as their consequences for people living with HIV are still not completely elucidated. The objectives of this study were to describe the profile of these interactions, their prevalence and their classification according to the potential for significant or non-significant drug–drug interactions. From June 2015 to July 2016, people living with HIV on follow-up at an Infectious Diseases Referral Center in Belo Horizonte, Brazil have been investigated for the presence of drug–drug interactions. A total of 304 patients were included and the majority (75%) had less than 50 years of age, male (66.4%), and 37.8% self-defined as brown skinned. Approximately 24% were on five or more medications and half of them presented with drug–drug interactions. Patients older than 50 years had a higher frequency of antiretrovirals drug–drug interactions with other drugs compared to younger patients (p = 0.002). No relationship was found between the number of drug–drug interactions and the effectiveness of antiretrovirals. As expected, the higher the number of non-HIV medications used (OR = 1.129; 95%CI 1.004–1.209; p = 0.04) was associated with an increase in drug–drug interactions. The high prevalence of drug–drug interactions found and the data collected should be useful to establish measures of quaternary prevention and to increase the medication security for people living with HIV.
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Affiliation(s)
- Betânia Maira Pontelo
- Universidade Federal de Minas Gerais (UFMG), Health Sciences: Infectology and Tropical Medicine, Faculdade de Medicina, Belo Horizonte, MG, Brazil
| | - Dirceu Bartolomeu Greco
- Universidade Federal de Minas Gerais (UFMG), Health Sciences: Infectology and Tropical Medicine, Faculdade de Medicina, Belo Horizonte, MG, Brazil; Universidade Federal de Minas Gerais (UFMG), Faculdade de Medicina, Departamento de Medicina Interna, Belo Horizonte, MG, Brazil
| | - Nathalia Sernizon Guimarães
- Universidade Federal de Minas Gerais (UFMG), Health Sciences: Infectology and Tropical Medicine, Faculdade de Medicina, Belo Horizonte, MG, Brazil.
| | - Nina Rotsen
- Universidade Federal de Minas Gerais(UFMG), Faculdade de Medicina, Belo Horizonte, MG, Brazil
| | | | | | - Hugo Barbosa
- Universidade Federal de Minas Gerais(UFMG), Faculdade de Medicina, Belo Horizonte, MG, Brazil
| | - Taciane Miranda Barroso
- Universidade Federal de Minas Gerais(UFMG), Faculdade de Medicina, Belo Horizonte, MG, Brazil
| | - Unaí Tupinambás
- Universidade Federal de Minas Gerais (UFMG), Health Sciences: Infectology and Tropical Medicine, Faculdade de Medicina, Belo Horizonte, MG, Brazil; Universidade Federal de Minas Gerais (UFMG), Faculdade de Medicina, Departamento de Medicina Interna, Belo Horizonte, MG, Brazil
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