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Calza L, Giglia M, Colangeli V, Bon I, Vitale S, Viale P. Improvement in insulin sensitivity after switching from an integrase inhibitor-based regimen to doravirine/tenofovir disoproxil fumarate/lamivudine in people with significant weight gain. HIV Med 2024. [PMID: 38570897 DOI: 10.1111/hiv.13644] [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: 01/25/2024] [Accepted: 03/25/2024] [Indexed: 04/05/2024]
Abstract
OBJECTIVES We performed an observational, retrospective, cohort study to assess changes in insulin sensitivity after a switch from dolutegravir/lamivudine (DOL/3TC) or bictegravir/emtricitabine/tenofovir alafenamide (BIC/F/TAF) to doravirine/tenofovir disoproxil fumarate/3TC (DOR/TDF/3TC) in virologically suppressed people living with HIV with recent significant weight gain. METHODS All non-diabetic patients with HIV treated with DOL/3TC or BIC/F/TAF for ≥12 months, with HIV RNA <20 copies/mL, and with a weight increase ≥3 kg in the last year, who underwent a switch to DOR/TDF/3TC were enrolled into the study. Serum levels of glucose, insulin, and homeostasis model assessment of insulin resistance (HOMA-IR) index were evaluated every 6 months during a 12-month follow-up. RESULTS Overall, 81 patients were enrolled: 41 were treated with DOL/3TC and 40 with BIC/F/TAF. At baseline, median HOMA-IR index was 3.18 and insulin resistance (HOMA-IR index >2.5) was present in 49 subjects (60%). At 12 months after the switch to DOR/TDF/3TC, change in mean serum glucose concentration was not significant, but the reduction in median concentration of insulin was significant (-3.54 mcrUI/L [interquartile range -4.22 to -2.87]; p = 0.012), associated with a significant reduction in mean HOMA-IR index (-0.54 [interquartile range -0.91 to -0.18]; p = 0.021). A significant reduction in total and low-density lipoprotein cholesterol was also reported, whereas decreases in mean body weight and mean body mass index were not significant. CONCLUSIONS In our retrospective study in virologically suppressed people living with HIV treated with DOL/3TC or BIC/F/TAF and with recent weight gain, the switch to DOR/TDF/3TC led to a significant improvement in insulin sensitivity and plasma lipids, with a trend to decreased body weight.
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Affiliation(s)
- Leonardo Calza
- Infectious Diseases Unit, IRCCS Policlinico di Sant'Orsola, University of Bologna, Bologna, Italy
| | - Maddalena Giglia
- Infectious Diseases Unit, IRCCS Policlinico di Sant'Orsola, University of Bologna, Bologna, Italy
| | - Vincenzo Colangeli
- Infectious Diseases Unit, IRCCS Policlinico di Sant'Orsola, University of Bologna, Bologna, Italy
| | - Isabella Bon
- Microbiology Unit, IRCCS Policlinico di Sant'Orsola, University of Bologna, Bologna, Italy
| | - Salvatore Vitale
- Hospital Pharmacy, IRCCS Policlinico di Sant'Orsola, University of Bologna, Bologna, Italy
| | - Pierluigi Viale
- Infectious Diseases Unit, IRCCS Policlinico di Sant'Orsola, University of Bologna, Bologna, Italy
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2
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Jin D, Jin S, Zhou T, Cui Z, Guo B, Li G, Zhang C. Regional variation in NAFLD prevalence and risk factors among people living with HIV in Europe: a meta-analysis. Front Public Health 2024; 11:1295165. [PMID: 38259755 PMCID: PMC10802187 DOI: 10.3389/fpubh.2023.1295165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 12/08/2023] [Indexed: 01/24/2024] Open
Abstract
Background and Aim Europe faces an elevated risk of nonalcoholic fatty liver disease (NAFLD) among people living with HIV (PLWH), contributing to the region's highest global burden of NAFLD. However, the prevalence of NAFLD across various European countries and regions remains unclear. This study aims to investigate the prevalence and risk factors associated with NAFLD among PLWH across European countries. Methods A systematic search was conducted across four databases: PubMed, Embase, Web of Science, and Cochrane Library. Data on the prevalence of NAFLD, nonalcoholic steatohepatitis (NASH), and fibrosis, as well as the associated risk factors, were collected among PLWH in Europe. Results Thirty-six studies from 13 European nations were included. The prevalence of NAFLD, NASH, and fibrosis were 42% (95%CI 37-48), 35% (95%CI 21-50) and 13% (95%CI 10-15), respectively. Male gender, BMI, waist circumference, Diabetes, hypertension, metabolic syndrome, dyslipidemia, triglycerides, HDL, LDL, ALT, AST, and years on antiretroviral therapy (ART) were found to be risk factors for NAFLD. High BMI and triglycerides were associated with NASH. Patients with high BMI and triglycerides are at increased risk of significant liver fibrosis. Conclusion The high prevalence of NAFLD, NASH, and fibrosis among PLWH in Europe highlights the need for early screening, intervention, and increased research focus on adolescents living with HIV. Furthermore, the significant variations observed between countries and regions underscore the influence of related risk factors.
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Affiliation(s)
- Dachuan Jin
- Clinical Laboratory, Sixth People’s Hospital of Zhengzhou, Zhengzhou, China
| | - Shunqin Jin
- Department of Radiology, Hebei Medical University, Shijiazhuang, China
| | - Tao Zhou
- Department of Geriatric Medicine, Qilu Hospital of Shandong University, Jinan, China
- Key Laboratory of Cardiovascular Proteomics of Shandong Province, Qilu Hospital of Shandong University, Jinan, China
| | - Zhongfeng Cui
- Clinical Laboratory, Sixth People’s Hospital of Zhengzhou, Zhengzhou, China
| | - Baoqiang Guo
- Department of Life Sciences, Faculty of Science and Engineering, Manchester Metropolitan University, Manchester, United Kingdom
| | - Guangming Li
- Department of Liver Disease, Sixth People’s Hospital of Zhengzhou, Zhengzhou, China
| | - Chunming Zhang
- Department of General Surgery, Sixth People’s Hospital of Zhengzhou, Zhengzhou, China
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Santos M, Corma-Gómez A, Martin-Carmona J, Pérez-García M, Martín-Sierra C, Rincón-Mayo P, González-Serna A, Pineda JA, Real LM, Macías J. Hepatic Steatosis and Weight Gain During the Coronavirus Disease 2019 Pandemic Among People With Human Immunodeficiency Virus: Impact of Therapy With Tenofovir Alafenamide. Open Forum Infect Dis 2023; 10:ofad532. [PMID: 37965642 PMCID: PMC10642731 DOI: 10.1093/ofid/ofad532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 10/27/2023] [Indexed: 11/16/2023] Open
Abstract
Background Lockdown due to the coronavirus disease 2019 (COVID-19) pandemic led to increases in weight in part of the population. Weight gain leads to hepatic steatosis (HS). Antiretroviral treatment could also influence HS in people with human immunodeficiency virus (PWH). The impact of lockdown on HS in PWH is unknown. The aim of this study was to analyze the changes in HS, as measured by the controlled attenuation parameter (CAP), during the COVID-19 pandemic in PWH. Methods This was a cohort study that included PWH who attended a tertiary care center in southern Spain from January 2018 to December 2021. The CAP was evaluated by transient elastography. Only those who had a valid CAP before and after March 2020 were included. HS was defined as CAP ≥248 dB/m. Results Six hundred eighty PWH were attended and 488 (71.8%) were included. Two hundred and fourteen (43.9%) had HS at baseline and 239 (49%) at the end of the follow-up (P = .036). The median change in CAP among PWH taking tenofovir alafenamide (TAF) was 8.5 (interquartile range [IQR], -24 to 46.3) dB/m versus -4 (IQR, -35 to 27) dB/m among PWH receiving TAF-free regimens (P = .003). After multivariate analysis, adjusted by sex and age, weight gain (adjusted odds ratio [AOR], 1.09 [95% confidence interval {CI}, 1.05-1.14]; P < .001), TAF therapy (AOR, 1.59 [95% CI, 1.07-2.35]; P = .021), plasma triglycerides (AOR, 1.01 [95% CI, 1-1.01]; P < .001), and fasting blood glucose (AOR, 1.01 [95% CI, 1-1.02]; P = .027) were associated with HS at the end of follow-up. Conclusions The frequency of HS increased during the COVID-19 pandemic among PWH. TAF is associated with HS development, regardless of metabolic factors.
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Affiliation(s)
- Marta Santos
- Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen de Valme, Sevilla, Spain
- Instituto de Biomedicina de Sevilla, Sevilla, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Madrid, Spain
| | - Anais Corma-Gómez
- Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen de Valme, Sevilla, Spain
- Instituto de Biomedicina de Sevilla, Sevilla, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Madrid, Spain
| | - Jesica Martin-Carmona
- Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen de Valme, Sevilla, Spain
- Instituto de Biomedicina de Sevilla, Sevilla, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Madrid, Spain
| | - Margarita Pérez-García
- Instituto de Biomedicina de Sevilla, Sevilla, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Madrid, Spain
| | - Carmen Martín-Sierra
- Instituto de Biomedicina de Sevilla, Sevilla, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Madrid, Spain
| | - Pilar Rincón-Mayo
- Instituto de Biomedicina de Sevilla, Sevilla, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Madrid, Spain
| | - Alejandro González-Serna
- Instituto de Biomedicina de Sevilla, Sevilla, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Madrid, Spain
- Department of Physiology, University of Sevilla, Sevilla, Spain
| | | | - Luis Miguel Real
- Instituto de Biomedicina de Sevilla, Sevilla, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Madrid, Spain
- Department of Medical Biochemistry, Molecular Biology and Immunology, University of Sevilla, Sevilla, Spain
| | - Juan Macías
- Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen de Valme, Sevilla, Spain
- Instituto de Biomedicina de Sevilla, Sevilla, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Madrid, Spain
- Department of Medicine, University of Sevilla, Sevilla, Spain
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Gawrieh S, Lake JE, Debroy P, Sjoquist JA, Robison M, Tann M, Akisik F, Bhamidipalli SS, Saha CK, Zachary K, Robbins GK, Gupta SK, Chung RT, Chalasani N, Corey KE. Burden of fatty liver and hepatic fibrosis in persons with HIV: A diverse cross-sectional US multicenter study. Hepatology 2023; 78:578-591. [PMID: 36805976 PMCID: PMC10496090 DOI: 10.1097/hep.0000000000000313] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 01/02/2023] [Indexed: 02/23/2023]
Abstract
BACKGROUND AIMS The current prevalence of fatty liver disease (FLD) due to alcohol-associated (AFLD) and nonalcoholic (NAFLD) origins in US persons with HIV (PWH) is not well defined. We prospectively evaluated the burden of FLD and hepatic fibrosis in a diverse cohort of PWH. APPROACH RESULTS Consenting participants in outpatient HIV clinics in 3 centers in the US underwent detailed phenotyping, including liver ultrasound and vibration-controlled transient elastography for controlled attenuation parameter and liver stiffness measurement. The prevalence of AFLD, NAFLD, and clinically significant and advanced fibrosis was determined. Univariate and multivariate logistic regression models were used to evaluate factors associated with the risk of NAFLD. Of 342 participants, 95.6% were on antiretroviral therapy, 93.9% had adequate viral suppression, 48.7% (95% CI 43%-54%) had steatosis by ultrasound, and 50.6% (95% CI 45%-56%) had steatosis by controlled attenuation parameter ≥263 dB/m. NAFLD accounted for 90% of FLD. In multivariable analysis, old age, higher body mass index, diabetes, and higher alanine aminotransferase, but not antiretroviral therapy or CD4 + cell count, were independently associated with increased NAFLD risk. In all PWH with fatty liver, the frequency of liver stiffness measurement 8-12 kPa was 13.9% (95% CI 9%-20%) and ≥12 kPa 6.4% (95% CI 3%-11%), with a similar frequency of these liver stiffness measurement cutoffs in NAFLD. CONCLUSIONS Nearly half of the virally-suppressed PWH have FLD, 90% of which is due to NAFLD. A fifth of the PWH with FLD has clinically significant fibrosis, and 6% have advanced fibrosis. These data lend support to systematic screening for high-risk NAFLD in PWH.
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Affiliation(s)
- Samer Gawrieh
- Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN
| | - Jordan E. Lake
- Division of Infectious Diseases, Department of Medicine, University of Texas Health Science Center at Houston, Houston, TX
| | - Paula Debroy
- Division of Infectious Diseases, Department of Medicine, University of Texas Health Science Center at Houston, Houston, TX
| | - Julia A. Sjoquist
- Liver Center, Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Montreca Robison
- Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN
| | - Mark Tann
- Department of Radiology, Indiana University School of Medicine, Indianapolis, IN
| | - Fatih Akisik
- Department of Radiology, Indiana University School of Medicine, Indianapolis, IN
| | - Surya S. Bhamidipalli
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, IN
| | - Chandan K. Saha
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, IN
| | - Kimon Zachary
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Gregory K. Robbins
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Samir K. Gupta
- Division of Infectious Diseases, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN
| | - Raymond T. Chung
- Liver Center, Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Naga Chalasani
- Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN
| | - Kathleen E. Corey
- Liver Center, Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
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5
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Circulating levels of endotrophin and cross-linked type III collagen reflect liver fibrosis in people with HIV. BMC Infect Dis 2023; 23:52. [PMID: 36694115 PMCID: PMC9872428 DOI: 10.1186/s12879-023-08000-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 01/10/2023] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND AND AIMS Liver-associated complications still frequently lead to mortality in people with HIV (PWH), even though combined antiretroviral treatment (cART) has significantly improved overall survival. The quantification of circulating collagen fragments released during collagen formation and degradation correlate with the turnover of extracellular matrix (ECM) in liver disease. Here, we analysed the levels of ECM turnover markers PC3X, PRO-C5, and PRO-C6 in PWH and correlated these with hepatic fibrosis and steatosis. METHODS This monocentre, retrospective study included 141 PWH. Liver stiffness and liver fat content were determined using transient elastography (Fibroscan) with integrated CAP function. Serum levels of formation of cross-linked type III collagen (PC3X), formation of type V collagen (PRO-C5) and formation type VI collagen (PRO-C6), also known as the hormone endotrophin, were measured with ELISA. RESULTS Twenty-five (17.7%) of 141 PWH had clinical significant fibrosis with liver stiffness ≥ 7.1 kPa, and 62 PWH (44.0%) had steatosis with a CAP value > 238 dB/m. Study participants with fibrosis were older (p = 0.004) and had higher levels of AST (p = 0.037) and lower number of thrombocytes compared to individuals without fibrosis (p = 0.0001). PC3X and PRO-C6 were markedly elevated in PWH with fibrosis. Multivariable cox regression analysis confirmed PC3X as independently associated with hepatic fibrosis. PRO-C5 was significantly elevated in participants with presence of hepatic steatosis. CONCLUSION Serological levels of cross-linked type III collagen formation and endotrophin were significantly associated with liver fibrosis in PWH receiving cART and thus may be suitable as a non-invasive evaluation of liver fibrosis in HIV disease.
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Michel M, Labenz C, Wahl A, Anders M, Armandi A, Huber Y, Galle PR, Sprinzl M, Schattenberg JM. Prevalence and risk factors of nonalcoholic steatohepatitis with significant fibrosis in people with HIV. AIDS 2022; 36:1665-1674. [PMID: 35849074 PMCID: PMC9451864 DOI: 10.1097/qad.0000000000003312] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Metabolic risk factors and nonalcoholic fatty liver disease (NAFLD) in people with HIV (PWH) have been increasing. Patients exhibiting the inflammatory subtype nonalcoholic steatohepatitis (NASH) are at increased risk of liver-related complications. Therefore, the aim was to investigate the prevalence of NASH with significant fibrosis in PWH using noninvasive tests (NITs). DESIGN In this prospectively enrolling cohort study, 282 PWH were explored for hepatic steatosis, fibrosis and steatohepatitis using vibration-controlled transient elastography (VCTE) and the Fibroscan-AST (FAST) score. METHODS On the basis of controlled attenuation parameter (CAP; dB/m) and liver stiffness measurement (LSM; kPa), patients were categorized according to the presence of steatosis (≥275 dB/m) and significant fibrosis (≥8.2 kPa). The FAST score was calculated according to established cut-offs. RESULTS The prevalence of hepatic steatosis in this cohort was 35.5% ( n = 100) with 75 (75%) of these patients fulfilling the criteria of NAFLD. The prevalence of significant fibrosis (≥ F2) was 6.7% ( n = 19). The FAST score identified a total of 32 (12.3%) patients with a cut-off greater than 0.35, of whom 28 (87.5%) PWH qualified as NASH. On multivariable analysis, waist circumference was a predictor of hepatic steatosis and type 2 diabetes was a predictor of significant fibrosis. Type 2 diabetes and ALT remained independent predictors of a FAST score greater than 0.35. CONCLUSION NASH with significant fibrosis is highly prevalent among PWH. The FAST score may be helpful to identify patients at risk for significant liver disease.
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Affiliation(s)
- Maurice Michel
- Metabolic Liver Research Program,I. Department of Medicine, University Medical Centre Mainz, Germany
| | - Christian Labenz
- Metabolic Liver Research Program,I. Department of Medicine, University Medical Centre Mainz, Germany
| | - Alisha Wahl
- Metabolic Liver Research Program,I. Department of Medicine, University Medical Centre Mainz, Germany
| | - Malena Anders
- Metabolic Liver Research Program,I. Department of Medicine, University Medical Centre Mainz, Germany
| | - Angelo Armandi
- Metabolic Liver Research Program,I. Department of Medicine, University Medical Centre Mainz, Germany
| | - Yvonne Huber
- Metabolic Liver Research Program,I. Department of Medicine, University Medical Centre Mainz, Germany
| | - Peter R. Galle
- Metabolic Liver Research Program,I. Department of Medicine, University Medical Centre Mainz, Germany
| | - Martin Sprinzl
- Metabolic Liver Research Program,I. Department of Medicine, University Medical Centre Mainz, Germany
| | - Jörn M. Schattenberg
- Metabolic Liver Research Program,I. Department of Medicine, University Medical Centre Mainz, Germany
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Cervo A, Sebastiani G, Milic J, Krahn T, Mazzola S, Petta S, Cascio A, Guaraldi G, Mazzola G. "Dangerous liaisons: NAFLD and liver fibrosis increase cardiovascular risk in HIV". HIV Med 2022; 23:911-921. [PMID: 35199429 DOI: 10.1111/hiv.13274] [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: 11/21/2021] [Revised: 01/24/2022] [Accepted: 02/03/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Non-alcoholic fatty liver disease (NAFLD) is strongly associated with cardiovascular disease in the general population. We aimed to assess the impact of NAFLD and liver fibrosis on intermediate-high cardiovascular risk in people living with HIV. METHODS We included people living with HIV from three cohorts. NAFLD and significant liver fibrosis were defined using transient elastography: controlled attenuation parameter ≥288 dB/m and liver stiffness measurement ≥7.1 kPa, respectively. Cardiovascular risk was assessed with the atherosclerotic cardiovascular disease (ASCVD) risk estimator in patients aged between 40 and 75 years and categorised as low if <5%, borderline if 5%-7.4%, intermediate if 7.5%-19.9% and high if ≥20% or with the presence of a previous cardiovascular event. Patients with hepatitis B and/or hepatitis C virus co-infection, alcohol abuse and unreliable transient elastography measurements were excluded. Predictors of intermediate-high cardiovascular risk were investigated in multivariable analysis by logistic regression and also by stratifying according to body mass index (BMI; cut-offs of 25 and 30 kg/m2 ) and age (cut-off of 60 years). RESULTS Of 941 patients with HIV alone included, 423 (45%), 128 (13.6%), 260 (27.6%) and 130 (13.8%) were categorised as at low, borderline, intermediate and high ASCVD risk, respectively. Predictors of intermediate-high ASCVD risk were NAFLD (adjusted odds ratio [aOR] 2.11; 95% confidence interval [CI] 1.40-3.18; p < 0.001), liver fibrosis (aOR 1.64; 95% CI 1.03-2.59; p = 0.034), duration of HIV (aOR 1.04; 95% CI 1.02-1.06; p < 0.001), and previous exposure to thymidine analogues and/or didanosine (aOR 1.54; 95% CI 1.09-2.18; p = 0.014). NAFLD was also associated with higher cardiovascular risk in normoweight patients (aOR 2.97; 95% CI 1.43-6.16; p = 0.003), in those with BMI <30 kg/m2 (aOR 2.30; 95% CI 1.46-3.61; p < 0.001) and in those aged <60 years (aOR 2.19; 95% CI 1.36-3.54; p = 0.001). CONCLUSION Assessment of cardiovascular disease should be targeted in people living with HIV with NAFLD and/or significant liver fibrosis, even if they are normoweight and young.
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Affiliation(s)
- Adriana Cervo
- Infectious Diseases Unit, PROMISE, University Hospital of Palermo, Palermo, Italy
| | - Giada Sebastiani
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, Canada
| | - Jovana Milic
- University of Modena and Reggio Emilia, Modena, Italy.,Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Thomas Krahn
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, Canada
| | - Sergio Mazzola
- Clinical Epidemiology and Cancer Register Unit, University Hospital of Palermo, Palermo, Italy
| | - Salvatore Petta
- Service of Gastroenterology and Hepatology, PROMISE, University Hospital of Palermo, Palermo, Italy
| | - Antonio Cascio
- Infectious Diseases Unit, PROMISE, University Hospital of Palermo, Palermo, Italy
| | - Giovanni Guaraldi
- University of Modena and Reggio Emilia, Modena, Italy.,Infectious Diseases Unit, University Hospital of Modena, Modena, Italy
| | - Giovanni Mazzola
- Infectious Diseases Unit, PROMISE, University Hospital of Palermo, Palermo, Italy
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Huang Y, Zhang K, Zhang L, Qiu J, Fu L, Yin T, Wang J, Qin R, Zhang J, Dong X, Wang G. Dosage of Dual-Protein Nutrition Differentially Impacts the Formation of Atherosclerosis in ApoE-/- Mice. Nutrients 2022; 14:nu14040855. [PMID: 35215505 PMCID: PMC8879330 DOI: 10.3390/nu14040855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 02/14/2022] [Accepted: 02/15/2022] [Indexed: 11/23/2022] Open
Abstract
Atherosclerosis (AS) is recognized as the original cause of most cardiovascular and cerebrovascular diseases. The dual-protein (DP) nutrition that consists of soy protein and whey protein is reported to be associated with a reduction in AS; however, the relationship between DP and AS remains ambiguous. Therefore, this study aimed to verify the effect of DP on AS and explore the optimal DP intake to improve AS. ApoE−/− mice were administrated with low- (LDP), middle- (MDP), and high-dose (HDP) DP. The MDP group exhibited significant improvements in AS. In terms of lipid metabolism, the levels of plasma total triglyceride and LDL-C and the mRNA expression levels of Cyp7a1 and PCSK9 were markedly tuned in the MDP group. In addition, the MDP treatment group had a substantially lower inflammatory response and better intestinal barrier function than LDP and HDP groups. The species richness demonstrated by the Chao1 index was distinctly increased in the MDP group, and the relative abundance of intestinal-permeability-protective microbes Blautia and Akkermansia was significantly elevated. In summary, an adequate intake of DP was able to counteract atherosclerosis development in ApoE−/− mice, and this study provides a scientific theoretical basis for the application of DP in the food and pharmaceutical fields.
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Affiliation(s)
- Yingchun Huang
- Key Laboratory for Biorheological Science and Technology of Ministry of Education, State and Local Joint Engineering Laboratory for Vascular Implants, College of Bioengineering, Chongqing University, Chongqing 400044, China; (Y.H.); (K.Z.); (J.Q.); (T.Y.)
| | - Kun Zhang
- Key Laboratory for Biorheological Science and Technology of Ministry of Education, State and Local Joint Engineering Laboratory for Vascular Implants, College of Bioengineering, Chongqing University, Chongqing 400044, China; (Y.H.); (K.Z.); (J.Q.); (T.Y.)
| | - Li Zhang
- Chongqing Academy of Animal Sciences, Chongqing 402493, China; (L.Z.); (L.F.)
| | - Juhui Qiu
- Key Laboratory for Biorheological Science and Technology of Ministry of Education, State and Local Joint Engineering Laboratory for Vascular Implants, College of Bioengineering, Chongqing University, Chongqing 400044, China; (Y.H.); (K.Z.); (J.Q.); (T.Y.)
| | - Lin Fu
- Chongqing Academy of Animal Sciences, Chongqing 402493, China; (L.Z.); (L.F.)
| | - Tieying Yin
- Key Laboratory for Biorheological Science and Technology of Ministry of Education, State and Local Joint Engineering Laboratory for Vascular Implants, College of Bioengineering, Chongqing University, Chongqing 400044, China; (Y.H.); (K.Z.); (J.Q.); (T.Y.)
| | - Jing Wang
- Institute of Food and Nutrition Development, Ministry of Agriculture and Rural Affairs, Beijing 100086, China;
- Correspondence: (J.W.); (X.D.); (G.W.)
| | - Rui Qin
- College of Life Sciences, South-Central University for Nationalities, Wuhan 430079, China;
| | - Jingjie Zhang
- Institute of Food and Nutrition Development, Ministry of Agriculture and Rural Affairs, Beijing 100086, China;
| | - Xianwen Dong
- Key Laboratory for Biorheological Science and Technology of Ministry of Education, State and Local Joint Engineering Laboratory for Vascular Implants, College of Bioengineering, Chongqing University, Chongqing 400044, China; (Y.H.); (K.Z.); (J.Q.); (T.Y.)
- Chongqing Academy of Animal Sciences, Chongqing 402493, China; (L.Z.); (L.F.)
- Correspondence: (J.W.); (X.D.); (G.W.)
| | - Guixue Wang
- Key Laboratory for Biorheological Science and Technology of Ministry of Education, State and Local Joint Engineering Laboratory for Vascular Implants, College of Bioengineering, Chongqing University, Chongqing 400044, China; (Y.H.); (K.Z.); (J.Q.); (T.Y.)
- Correspondence: (J.W.); (X.D.); (G.W.)
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Lake JE, Overton T, Naggie S, Sulkowski M, Loomba R, Kleiner DE, Price JC, Chew KW, Chung RT, Corey KE. Expert Panel Review on Nonalcoholic Fatty Liver Disease in Persons With Human Immunodeficiency Virus. Clin Gastroenterol Hepatol 2022; 20:256-268. [PMID: 33069882 PMCID: PMC9069630 DOI: 10.1016/j.cgh.2020.10.018] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 10/07/2020] [Accepted: 10/12/2020] [Indexed: 02/07/2023]
Abstract
Nonalcoholic fatty liver disease (NAFLD) affects 25% of adults in the general population and is a disease spectrum ranging from steatosis to nonalcoholic steatohepatitis (NASH) to end-stage liver disease. NAFLD is an independent risk factor for cardiovascular disease, diabetes mellitus, and all-cause mortality, and NASH cirrhosis is a frequent indication for liver transplantation. In persons with human immunodeficiency virus (PWH), chronic liver disease is the second leading cause of non-human immunodeficiency virus-related mortality. Between 20% and 63% of PWH have NASH, and 14% to 63% have NASH with fibrosis. However, little is known about the optimal diagnostic strategies, risk factors for, and treatment of NAFLD in PWH. Here, we review current data on and identify knowledge gaps in the epidemiology, pathophysiology, diagnosis, and management of NAFLD in PWH and highlight priorities for research.
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Affiliation(s)
- Jordan E Lake
- Division of Infectious Disease, University of Texas Health Sciences Center at Houston, Houston, Texas.
| | - Turner Overton
- Division of Infectious Disease, University of Alabama School of Medicine, Birmingham, Alabama
| | - Susanna Naggie
- Division of Infections Disease, Duke University School of Medicine, Durham, North Carolina
| | - Mark Sulkowski
- Division of Infectious Disease, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Rohit Loomba
- Division of Gastroenterology, University of California San Diego School of Medicine, San Diego, California
| | - David E Kleiner
- Center for Cancer Research, National Cancer Institute, Bethesda, Maryland
| | - Jennifer C Price
- Division of Gastroenterology, University of California San Francisco School of Medicine, San Francisco, California
| | - Kara W Chew
- Division of Infectious Diseases, University of California Los Angeles School of Medicine, Los Angeles, California
| | - Raymond T Chung
- Division of Gastroenterology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Kathleen E Corey
- Division of Gastroenterology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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10
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Yanavich C, Perazzo H, Li F, Tobin N, Lee D, Zabih S, Morata M, Almeida C, Veloso VG, Grinsztejn B, Aldrovandi GM. A pilot study of microbial signatures of liver disease in those with HIV mono-infection in Rio de Janeiro, Brazil. AIDS 2022; 36:49-58. [PMID: 34873092 PMCID: PMC8667204 DOI: 10.1097/qad.0000000000003084] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE The rectal microbiome was examined to assess the relationship between the microbiome and liver disease in HIV-infection. DESIGN Eighty-two HIV-1 mono-infected individuals from the PROSPEC-HIV-study (NCT02542020) were grouped into three liver health categories based on results of controlled attenuation parameter (CAP) and liver stiffness measurement (LSM) of transient elastography: normal (n = 30), steatosis (n = 30), or fibrosis (n = 22). METHODS Liver steatosis and fibrosis were defined by CAP at least 248 dB/m and LSM at least 8.0 kPa, respectively. 16S rRNA gene and whole genome shotgun metagenomic sequencing were performed on rectal swabs. Bacterial differences were assessed using zero-inflated negative binomial regression and random forests modeling; taxonomic drivers of functional shifts were identified using FishTaco. RESULTS Liver health status explained four percentage of the overall variation (r2 = 0.04, P = 0.003) in bacterial composition. Participants with steatosis had depletions of Akkermansia muciniphila and Bacteroides dorei and enrichment of Prevotella copri, Finegoldia magna, and Ruminococcus bromii. Participants with fibrosis had depletions of Bacteroides stercoris and Parabacteroides distasonis and enrichment of Sneathia sanguinegens. In steatosis, functional analysis revealed increases in primary and secondary bile acid synthesis encoded by increased Eubacterium rectale, F. magna, and Faecalibacterium prausnitzii and decreased A. muciniphila, Bacteroides fragilis and B. dorei. Decreased folate biosynthesis was driven by similar changes in microbial composition. CONCLUSION HIV mono-infection with steatosis or fibrosis had distinct microbial profiles. Some taxa are similar to those associated with non-alcoholic fatty liver disease in HIV-negative populations. Further studies are needed to define the role of the gut microbiota in the pathogenesis of liver disease in HIV-infected persons.
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Affiliation(s)
- Carolyn Yanavich
- Laboratory of Clinical Research in STD/AIDS (LAPCLIN-AIDS), Evandro Chagas National Institute of Infectious Diseases-Oswaldo Cruz Foundation (INI/FIOCRUZ), Rio de Janeiro, Brazil
- Department of Pediatrics, University of California, Los Angeles (UCLA), Los Angeles, California, USA
| | - Hugo Perazzo
- Laboratory of Clinical Research in STD/AIDS (LAPCLIN-AIDS), Evandro Chagas National Institute of Infectious Diseases-Oswaldo Cruz Foundation (INI/FIOCRUZ), Rio de Janeiro, Brazil
| | - Fan Li
- Department of Pediatrics, University of California, Los Angeles (UCLA), Los Angeles, California, USA
| | - Nicole Tobin
- Department of Pediatrics, University of California, Los Angeles (UCLA), Los Angeles, California, USA
| | - David Lee
- Department of Pediatrics, University of California, Los Angeles (UCLA), Los Angeles, California, USA
| | - Sara Zabih
- Department of Pediatrics, University of California, Los Angeles (UCLA), Los Angeles, California, USA
| | - Michelle Morata
- Laboratory of Clinical Research in STD/AIDS (LAPCLIN-AIDS), Evandro Chagas National Institute of Infectious Diseases-Oswaldo Cruz Foundation (INI/FIOCRUZ), Rio de Janeiro, Brazil
| | - Cristiane Almeida
- Laboratory of Clinical Research in STD/AIDS (LAPCLIN-AIDS), Evandro Chagas National Institute of Infectious Diseases-Oswaldo Cruz Foundation (INI/FIOCRUZ), Rio de Janeiro, Brazil
| | - Valdilea G Veloso
- Laboratory of Clinical Research in STD/AIDS (LAPCLIN-AIDS), Evandro Chagas National Institute of Infectious Diseases-Oswaldo Cruz Foundation (INI/FIOCRUZ), Rio de Janeiro, Brazil
| | - Beatriz Grinsztejn
- Laboratory of Clinical Research in STD/AIDS (LAPCLIN-AIDS), Evandro Chagas National Institute of Infectious Diseases-Oswaldo Cruz Foundation (INI/FIOCRUZ), Rio de Janeiro, Brazil
| | - Grace M Aldrovandi
- Department of Pediatrics, University of California, Los Angeles (UCLA), Los Angeles, California, USA
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11
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Kamkwalala AR, Garg A, Roy U, Matthews A, Castillo-Mancilla J, Lake JE, Sebastiani G, Yin M, Brown TT, Kamer AR, Jabs DA, Ellis RJ, Boffito M, Greene M, Schmalzle S, Siegler E, Erlandson KM, Moore DJ. Current Considerations for Clinical Management and Care of People with HIV: Findings from the 11th Annual International HIV and Aging Workshop. AIDS Res Hum Retroviruses 2021; 37:807-820. [PMID: 34405689 DOI: 10.1089/aid.2021.0059] [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: 11/12/2022] Open
Abstract
The number of people with HIV (PWH) aged 50 years or older continues to steadily increase. The convergence of age- and HIV-related complications in these individuals presents a challenge for both patients and clinicians alike. New findings continue to emerge, as numerous researchers evaluate the combined impact of these two factors on quality of life, physiological systems, and mental health in PWH. Since its first occurrence in 2009, the International Workshop on HIV and Aging has served as a multidisciplinary meeting to share basic biomedical data, clinical trial results, treatment strategies, and epidemiological recommendations, toward better understanding and outcomes among like-minded scientific professionals. In this article, we share a selection of key findings presented in plenary talks at the 11th Annual International Workshop on HIV and Aging, held virtually from September 30, 2020 to October 2, 2020. We will also address the future directions of HIV and aging research, to further assess how the aging process intersects with chronic HIV.
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Affiliation(s)
| | - Ankita Garg
- Department of Infectious Diseases, University of Georgia, Athens, Georgia, USA
| | - Upal Roy
- Department of Health and Biomedical Sciences, The University of Texas Rio Grande Valley, Brownsville, Texas, USA
| | - Avery Matthews
- Department of Psychiatry, South Texas Veteran Health Care System, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Jose Castillo-Mancilla
- Department of Medicine, Division of Infectious Disease, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Jordan E. Lake
- Department of Internal Medicine, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Giada Sebastiani
- Department of Medicine, McGill University Health Centre, Montreal, Canada
| | - Michael Yin
- Department of Infectious Disease, Columbia University, New York, New York, USA
| | - Todd T. Brown
- Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Angela R. Kamer
- Department of Periodontology and Implant Dentistry, New York University College of Dentistry, New York, New York, USA
| | - Douglas A. Jabs
- Department of Epidemiology, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Ophthalmology, The Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Ronald J. Ellis
- Department of Neurosciences, University of California San Diego, La Jolla, California, USA
- Department of Psychiatry, University of California San Diego, La Jolla, California, USA
| | - Marta Boffito
- Department of HIV Services, Chelsea and Westminster Hospital, London, United Kingdom
| | - Meredith Greene
- Division of Geriatrics, Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Sarah Schmalzle
- Department of Infectious Disease, University of Maryland, Baltimore, Maryland, USA
| | - Eugenia Siegler
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Kristine M. Erlandson
- Department of Medicine, Division of Infectious Disease, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - David J. Moore
- Department of Psychiatry, University of California San Diego, La Jolla, California, USA
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12
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Bischoff J, Gu W, Schwarze-Zander C, Boesecke C, Wasmuth JC, van Bremen K, Dold L, Rockstroh JK, Trebicka J. Stratifying the risk of NAFLD in patients with HIV under combination antiretroviral therapy (cART). EClinicalMedicine 2021; 40:101116. [PMID: 34522873 PMCID: PMC8427211 DOI: 10.1016/j.eclinm.2021.101116] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 08/14/2021] [Accepted: 08/16/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND De novo steatosis is the main criteria for non-alcoholic fatty liver disease (NAFLD), which is becoming a clinically relevant comorbidity in HIV-infected patients. This may be due to the HIV virus itself, as well as long-term toxicities deriving from antiretroviral therapy. Therefore, HIV infected patients require prevention and monitoring regarding NAFLD. METHODS This study investigated the differential role of body mass index (BMI) and combination antiretroviral treatment (cART) drugs on NAFLD progression. This single center prospective longitudinal observational study enrolled HIV monoinfected individuals between August 2013 to December 2018 with yearly visits. Each visit included liver stiffness and steatosis [defined as controlled attenuation parameter (CAP)>237 dB/m] assessment by annually transient elastography using an M- or XL-probe of FibroScan, and calculation of the novel FibroScan-AST (FAST) score. Risk factors for denovo/progressed steatosis and tripling of FAST-score increase were investigated using Cox regression model with time-dependent covariates. FINDINGS 319 monoinfected HIV positive patients with at least two visits were included into the study, of which 301 patients had at least two valid CAP measurements. 51·5%(155) patients did not have steatosis at first assessment, of which 45%(69) developed steatosis during follow-up. A BMI>23 kg/m2 (OR: 4·238, 95% CI: 2·078-8·938; p < 0·0001), tenofovir-alafenamid (TAF) (OR: 5·073, 95% CI: 2·362-10·899); p < 0·0001) and integrase strand transfer inhibitors (INSTI) (OR: 2·354, 95% CI: 1·370-4·048; p = 0·002), as well as type 2 diabetes mellitus (OR: 7·605, 95% CI: 2·315-24·981; p < 0·0001) were independent predictors of de novo steatosis in multivariable analysis. Tenofovir disoproxilfumarate (TDF) was associated with a lower risk for weight gain and steatosis progression/onset using CAP value (HR: 0·28, 95% CI: 0·12-0·64; p = 0·003) and FAST scores (HR: 0·31, 95% CI: 0·101-0·945; p = 0·04). INTERPRETATION Steatosis can develop despite non-obese BMI in patients with HIV monoinfection under cART, especially in male patients with BMI over 23 kg/m2. While TAF and INSTI increase the risk of progression of steatosis, TDF was found to be independently associated with a lower risk of a clinically significant weight gain and thereby, might slow down development and progression of steatosis. FUNDING There was no additional funding received for this project. All funders mentioned in the 'declaration of interests' section had no influence on study design, data collection and analysis, decision to publish, or preparation of the manuscript.
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Key Words
- APRI, AST to platelet ratio index
- ART, antiretroviral treatment
- AST, aspartate aminotransferase
- BMI, body mass index
- CAP, controlled attenuation parameter
- Cap
- DAA, direct-acting antiviral
- FAST, FibroScan-AST
- FIB4, fibrosis-4
- HCV, chronic hepatitis C
- Hiv
- INSTI, integrase strand transfer inhibitors
- NAFLD, Non-alcoholic fatty liver disease
- NASH, non-alcoholic steatohepatitis
- Nafld
- PLHIV, people living with HIV
- PrEP, pre-exposure prophylaxis
- Steatosis
- TAF, tenofovir-alafenamid
- TDF, Tenofovir disoproxilfumarate
- TE, transient elastography
- cART
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Affiliation(s)
- Jenny Bischoff
- Department of Internal Medicine I, Venusberg Campus 1, University Hospital Bonn, 53127 Bonn Germany,
| | - Wenyi Gu
- Department of Internal Medicine I, University Hospital Frankfurt, Germany
| | - Carolynne Schwarze-Zander
- Department of Internal Medicine I, Venusberg Campus 1, University Hospital Bonn, 53127 Bonn Germany,
- German Center for Infection Research (DZIF), partner site Cologne-Bonn, Bonn, Germany
| | - Christoph Boesecke
- Department of Internal Medicine I, Venusberg Campus 1, University Hospital Bonn, 53127 Bonn Germany,
- German Center for Infection Research (DZIF), partner site Cologne-Bonn, Bonn, Germany
| | - Jan-Christian Wasmuth
- Department of Internal Medicine I, Venusberg Campus 1, University Hospital Bonn, 53127 Bonn Germany,
- German Center for Infection Research (DZIF), partner site Cologne-Bonn, Bonn, Germany
| | - Kathrin van Bremen
- Department of Internal Medicine I, Venusberg Campus 1, University Hospital Bonn, 53127 Bonn Germany,
| | - Leona Dold
- Department of Internal Medicine I, Venusberg Campus 1, University Hospital Bonn, 53127 Bonn Germany,
- German Center for Infection Research (DZIF), partner site Cologne-Bonn, Bonn, Germany
| | - Jürgen K Rockstroh
- Department of Internal Medicine I, Venusberg Campus 1, University Hospital Bonn, 53127 Bonn Germany,
- German Center for Infection Research (DZIF), partner site Cologne-Bonn, Bonn, Germany
| | - Jonel Trebicka
- Department of Internal Medicine I, University Hospital Frankfurt, Germany
- Corresponding author.
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13
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Williams C, Kamau FM, Everson F, Kgokane B, De Boever P, Goswami N, Webster I, Strijdom H. HIV and Antiretroviral Therapy Are Independently Associated with Cardiometabolic Variables and Cardiac Electrical Activity in Adults from the Western Cape Region of South Africa. J Clin Med 2021; 10:4112. [PMID: 34575223 PMCID: PMC8466610 DOI: 10.3390/jcm10184112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 09/07/2021] [Accepted: 09/08/2021] [Indexed: 01/15/2023] Open
Abstract
Cardiovascular-related complications are on the rise in people with HIV/AIDS (PWH); however, the relationship among HIV and antiretroviral therapy (ART)-related parameters, cardiovascular risk, and cardiac electrical activity in PWH remain poorly studied, especially in sub-Saharan African populations. We investigated whether HIV and ART are associated with cardiometabolic and cardiac electrical activity in PWH from Worcester in the Western Cape Province, South Africa. This was a cross-sectional study with HIV-negative (HIV-, n = 24) and HIV-positive on ART (HIV+/ART+, n = 63) participants. We obtained demographic, lifestyle, and medical history data and performed anthropometric, clinical assessments, and blood/urine biochemistry. We performed multiple stepwise linear regression analyses to determine independent associations among HIV, ART, cardiometabolic, and electrocardiographic (ECG) variables. HIV+/ART+ independently associated with a lower body mass index (p = 0.004), elevated gamma-glutamyl transferase levels (β: 0.333 (0.130-0.573); p = 0.002), and elevated alanine aminotransferase levels (β: 0.427 (0.224-0.629); p < 0.001) compared to HIV-. Use of second-line ART was positively associated with high-sensitivity C-reactive protein (p = 0.002). Although ECG parameters did not differ between HIV- and HIV+/ART+, viral load positively associated with p-wave duration (0.306 (0.018-0.594); p = 0.038), and longer HIV duration (≥5 years) with ST-interval (0.270 (0.003-0.537); p = 0.047) after adjusting for confounding factors. Our findings suggest that HIV and ART are associated with mixed effects on this population's cardiometabolic profile and cardiac electrical activity, underpinning the importance of cardiovascular risk monitoring in PWH.
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Affiliation(s)
- Cassidy Williams
- Centre for Cardio-Metabolic Research in Africa, Division of Medical Physiology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town 8000, South Africa; (C.W.); (F.E.); (B.K.); (I.W.); (H.S.)
| | - Festus M. Kamau
- Centre for Cardio-Metabolic Research in Africa, Division of Medical Physiology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town 8000, South Africa; (C.W.); (F.E.); (B.K.); (I.W.); (H.S.)
| | - Frans Everson
- Centre for Cardio-Metabolic Research in Africa, Division of Medical Physiology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town 8000, South Africa; (C.W.); (F.E.); (B.K.); (I.W.); (H.S.)
| | - Boipelo Kgokane
- Centre for Cardio-Metabolic Research in Africa, Division of Medical Physiology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town 8000, South Africa; (C.W.); (F.E.); (B.K.); (I.W.); (H.S.)
| | - Patrick De Boever
- Department of Biology, University of Antwerp, 2610 Wilrijk, Belgium;
- Centre for Environmental Sciences, Hasselt University, 3590 Diepenbeek, Belgium
| | - Nandu Goswami
- Division of Physiology, Otto Loewi Research Center of Vascular Biology, Immunity and Inflammation, Medical University of Graz, 8036 Graz, Austria;
| | - Ingrid Webster
- Centre for Cardio-Metabolic Research in Africa, Division of Medical Physiology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town 8000, South Africa; (C.W.); (F.E.); (B.K.); (I.W.); (H.S.)
| | - Hans Strijdom
- Centre for Cardio-Metabolic Research in Africa, Division of Medical Physiology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town 8000, South Africa; (C.W.); (F.E.); (B.K.); (I.W.); (H.S.)
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14
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Cervo A, Milic J, Mazzola G, Schepis F, Petta S, Krahn T, Lebouche B, Deschenes M, Cascio A, Guaraldi G, Sebastiani G. Prevalence, Predictors, and Severity of Lean Nonalcoholic Fatty Liver Disease in Patients Living With Human Immunodeficiency Virus. Clin Infect Dis 2021; 71:e694-e701. [PMID: 32280969 DOI: 10.1093/cid/ciaa430] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 04/10/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The burden of nonalcoholic fatty liver disease (NAFLD) is growing in people living with human immunodeficiency virus (HIV). NAFLD is associated with obesity; however, it can occur in normoweight (lean) patients. We aimed to investigate lean NAFLD in patients living with HIV. METHODS We included patients living with HIV mono-infection from 3 prospective cohorts. NAFLD was diagnosed by transient elastography (TE) and defined as controlled attenuation parameter ≥248 dB/m, in absence of alcohol abuse. Lean NAFLD was defined when a body mass index was <25 kg/m2. Significant liver fibrosis was defined as TE ≥7.1 kPa. The presence of diabetes, hypertension, or hyperlipidemia defined metabolically abnormal patients. RESULTS We included 1511 patients, of whom 57.4% were lean. The prevalence of lean NAFLD patients in the whole cohort was 13.9%. NAFLD affected 24.2% of lean patients. The proportions of lean NAFLD patients who were metabolically abnormal or had elevated alanine aminotransferase (ALT) were higher than among those who were lean patients without NAFLD (61.9% vs 48.9% and 36.7% vs 24.2%, respectively). Lean NAFLD patients had a higher prevalence of significant liver fibrosis than lean patients without NAFLD (15.7% vs 7.6%, respectively). After adjusting for sex, ethnicity, hypertension, CD4 cell count, nadir CD4 <200µ/L, and time since HIV diagnosis, predictors of NAFLD in lean patients were age (adjusted OR [aOR], 1.29; 95% confidence interval [CI], 1.04-1.59), high triglycerides (aOR, 1.34; 95% CI, 1.11-1.63), and high ALT (aOR, 1.15; 95% CI, 1.05-1.26), while a high level of high-density lipoprotein cholesterol was protective (aOR, 0.45; 95% CI, .26-.77). CONCLUSIONS NAFLD affects 1 in 4 lean patients living with HIV mono-infection. Investigations for NAFLD should be proposed in older patients with dyslipidemia and elevated ALT, even if normoweight.
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Affiliation(s)
- Adriana Cervo
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, Canada.,Infectious Diseases Unit, Department of Health Promotion Sciences and Mother and Child Care "Giuseppe D'Alessandro" (PROMISE), University of Palermo, Palermo, Italy
| | - Jovana Milic
- Infectious Diseases Clinic, University of Modena and Reggio Emilia, University of Modena and Reggio Emilia, Modena, Italy.,Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Giovanni Mazzola
- Infectious Diseases Unit, Department of Health Promotion Sciences and Mother and Child Care "Giuseppe D'Alessandro" (PROMISE), University of Palermo, Palermo, Italy
| | - Filippo Schepis
- Hepatology Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - Salvatore Petta
- Gastroenterology and Hepatology Service, Department of Health Promotion Sciences and Mother and Child Care "Giuseppe D'Alessandro" (PROMISE), University of Palermo, Palermo, Italy
| | - Thomas Krahn
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, Canada
| | - Bertrand Lebouche
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, Canada.,Department of Family Medicine, McGill University, Montreal, Canada
| | - Marc Deschenes
- Division of Gastroenterology and Hepatology, McGill University Health Centre, Montreal, Canada
| | - Antonio Cascio
- Infectious Diseases Unit, Department of Health Promotion Sciences and Mother and Child Care "Giuseppe D'Alessandro" (PROMISE), University of Palermo, Palermo, Italy
| | - Giovanni Guaraldi
- Infectious Diseases Clinic, University of Modena and Reggio Emilia, University of Modena and Reggio Emilia, Modena, Italy
| | - Giada Sebastiani
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, Canada.,Division of Gastroenterology and Hepatology, McGill University Health Centre, Montreal, Canada
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15
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Abstract
PURPOSE OF REVIEW Aging-related comorbidities, including liver disease, represent the main drivers of morbidity and mortality in people with HIV (PWH). Nonalcoholic fatty liver disease (NAFLD) seems a frequent comorbidity in aging PWH nowadays. NAFLD results from a fat deposition into the liver parenchyma that may evolve to nonalcoholic steatohepatitis (NASH), a state of hepatocellular inflammation and injury in response to the accumulated fat leading to liver fibrosis and cirrhosis. We here review the current status of knowledge regarding this emerging comorbidity in PWH. RECENT FINDINGS Recent studies suggest that PWH are at higher risk for both NASH and NASH-related liver fibrosis. Several hypothesized pathogenic mechanisms may account for this finding, including increased metabolic comorbidities, hepatotoxic effect of lifelong antiretroviral therapy, and chronic HIV infection. In clinical practice, non-invasive diagnostic tests, such as serum biomarkers and elastography, may help identify patients with NASH-related fibrosis, thus improving risk stratification, and enhancing clinical management decisions, including early initiation of interventions such as lifestyle changes and potential pharmacologic interventions. Clinicians should remain informed of the frequency, significance, and diagnostic and management approach to NASH in PWH.
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Affiliation(s)
- Adriana Cervo
- Division of Infectious Diseases, Chronic Viral Illness Service, McGill University Health Centre, Montreal, Canada
- Department of Health Promotion Sciences and Mother and Child Care "Giuseppe D'Alessandro", University of Palermo, Palermo, Italy
| | - Mohamed Shengir
- Division of Experimental Medicine, McGill University, Montreal, Canada
| | - Keyur Patel
- Division of Gastroenterology, University Health Network Toronto, Toronto General Hospital, Toronto, Canada
| | - Giada Sebastiani
- Division of Gastroenterology and Hepatology, Chronic Viral Illness Service Royal Victoria Hospital, McGill University Health Centre, 1001 Blvd. Décarie, Montreal, QC H4A 3J1, Canada.
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16
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Yanavich C, Pacheco AG, Cardoso SW, Nunes EP, Chaves U, Freitas G, Santos R, Morata M, Veloso VG, Grinsztejn B, Perazzo H. Diagnostic value of serological biomarkers for detection of non-alcoholic fatty liver disease (NAFLD) and/or advanced liver fibrosis in people living with HIV. HIV Med 2021; 22:445-456. [PMID: 33529485 DOI: 10.1111/hiv.13060] [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] [Accepted: 12/12/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVES We aimed to evaluate the accuracy of serological biomarkers for non-alcoholic fatty liver disease (NAFLD) and advanced fibrosis (METAVIR-F3F4) in HIV mono-infected individuals. METHODS In all, 674 participants from the PROSPEC-HIV study (NCT02542020), who had blood sample tests and transient elastography (TE) performed on the same day, were eligible. Exclusion criteria were viral hepatitis co-infection (n = 90), abusive alcohol intake (n = 61), missing data (n = 47) or unreliable TE (n = 39). NAFLD was defined by controlled attenuation parameter ≥ 248 dB/m and advanced fibrosis by liver stiffness measurement ≥ 8.7 kPa with M probe or ≥ 7.2 kPa with XL probe. Biomarkers for NAFLD [Steato-ELSA, Fatty Liver Index (FLI), Hepatic Steatosis Index (HSI), NAFLD-Liver Fat Score (NAFLD-LFS)] and fibrosis [Fibrosis-4 score (FIB-4), Aspartate-to-Platelet Ratio Index (APRI) and NAFLD Fibrosis Score (NFS)] were calculated. RESULTS A total of 437 patients [57% female, age = 44 (interquartile range: 35-52) years, body mass index (BMI) = 26.1 (23.4-29.3) kg/m2 , CD4 = 660 (427-901) cells/μL] were included. The prevalence [95% confidence interval (CI)] of NAFLD and advanced fibrosis were 38.2% (33.8-42.9) and 10.5% (8.0-13.8), respectively. The areas (95% CI) under the receiver operator curve (AUROCs) for diagnosis of NAFLD were 0.854 (0.818-0.889), 0.840 (0.804-0.877), 0.805 (0.762-0.847) and 0.793 (0.750-0.836) for Steato-ELSA, FLI, HSI and NAFLD-LFS (P < 0.001), respectively. All tests yielded satisfactory sensitivities, specificities and negative predictive values (NPVs). The AUROCs (95% CI) for diagnosis of advanced fibrosis were 0.736 (0.659-0.814), 0.700 (0.614-0.7851) and 0.795 (0.726-0.864) for FIB-4, APRI and NFS (P = 0.077), respectively. These tests yielded high specificities and negative predictive values (NPVs) > 90%. CONCLUSION Biomarkers for NAFLD had a good accuracy and those for fibrosis had high specificities and NPVs. These tests should be integrated to HIV care to detect NAFLD and to exclude advanced liver fibrosis.
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Affiliation(s)
- C Yanavich
- Laboratory of Clinical Research in STD/AIDS (LAPCLIN-AIDS), National Institute of Infectious Diseases Evandro Chagas (INI), Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil.,Department of Pediatrics, University of California Los Angeles, Los Angeles, CA, USA
| | - A G Pacheco
- Scientific Computation Program (PROCC), Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil
| | - S W Cardoso
- Laboratory of Clinical Research in STD/AIDS (LAPCLIN-AIDS), National Institute of Infectious Diseases Evandro Chagas (INI), Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil
| | - E P Nunes
- Laboratory of Clinical Research in STD/AIDS (LAPCLIN-AIDS), National Institute of Infectious Diseases Evandro Chagas (INI), Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil
| | - Usb Chaves
- Laboratory of Clinical Research in STD/AIDS (LAPCLIN-AIDS), National Institute of Infectious Diseases Evandro Chagas (INI), Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil
| | - G Freitas
- Laboratory of Clinical Research in STD/AIDS (LAPCLIN-AIDS), National Institute of Infectious Diseases Evandro Chagas (INI), Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil
| | - R Santos
- Laboratory of Clinical Research in STD/AIDS (LAPCLIN-AIDS), National Institute of Infectious Diseases Evandro Chagas (INI), Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil
| | - M Morata
- Laboratory of Clinical Research in STD/AIDS (LAPCLIN-AIDS), National Institute of Infectious Diseases Evandro Chagas (INI), Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil
| | - V G Veloso
- Laboratory of Clinical Research in STD/AIDS (LAPCLIN-AIDS), National Institute of Infectious Diseases Evandro Chagas (INI), Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil
| | - B Grinsztejn
- Laboratory of Clinical Research in STD/AIDS (LAPCLIN-AIDS), National Institute of Infectious Diseases Evandro Chagas (INI), Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil
| | - H Perazzo
- Laboratory of Clinical Research in STD/AIDS (LAPCLIN-AIDS), National Institute of Infectious Diseases Evandro Chagas (INI), Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil
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17
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Orkin C, Elion R, Thompson M, Rockstroh JK, Alvarez Bognar F, Xu ZJ, Hwang C, Sklar P, Martin EA. Changes in weight and BMI with first-line doravirine-based therapy. AIDS 2021; 35:91-99. [PMID: 33048879 PMCID: PMC7752237 DOI: 10.1097/qad.0000000000002725] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 09/23/2020] [Accepted: 09/27/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To evaluate changes in weight and BMI in adults with HIV-1 at 1 and 2 years after starting an antiretroviral regimen that included doravirine, ritonavir-boosted darunavir, or efavirenz. DESIGN Post-hoc analysis of pooled data from three randomized controlled trials. METHODS We evaluated weight change from baseline, weight gain at least 10%, and increase in BMI after 48 and 96 weeks of treatment with doravirine, ritonavir-boosted darunavir, or efavirenz-based regimens. Risk factors for weight gain and metabolic outcomes associated with weight gain were also examined. RESULTS Mean (and median) weight changes were similar for doravirine [1.7 (1.0) kg] and ritonavir-boosted darunavir [1.4 (0.6) kg] and were lower for efavirenz [0.6 (0.0) kg] at week 48 but were similar across all treatment groups at week 96 [2.4 (1.5), 1.8 (0.7), and 1.6 (1.0) kg, respectively]. No significant differences between treatment groups were found in the proportion of participants with at least 10% weight gain or the proportion with BMI class increase at either time point. Low CD4 T-cell count and high HIV-1 RNA at baseline were associated with at least 10% weight gain and BMI class increase at both timepoints, but treatment group, age, sex, and race were not. CONCLUSION Weight gains over 96 weeks were low in all treatment groups and were similar to the average yearly change in adults without HIV-1. Significant weight gain and BMI class increase were similar across the treatment groups and were predicted by low baseline CD4 T-cell count and high baseline HIV-1 RNA.
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Affiliation(s)
- Chloe Orkin
- HIV Medicine, Queen Mary University of London, London, UK
| | - Richard Elion
- George Washington University School of Medicine, Washington, District of Columbia
| | | | | | | | | | - Carey Hwang
- Clinical Research, Merck & Co., Inc., Kenilworth, New Jersey, USA
| | - Peter Sklar
- Clinical Research, Merck & Co., Inc., Kenilworth, New Jersey, USA
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18
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Taborelli M, Suligoi B, Toffolutti F, Frova L, Grande E, Grippo F, Pappagallo M, Pugliese L, Regine V, Serraino D, Zucchetto A. Excess liver-related mortality among people with AIDS compared to the general population: an Italian nationwide cohort study using multiple causes of death. HIV Med 2020; 21:642-649. [PMID: 32876382 DOI: 10.1111/hiv.12937] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/11/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVES Liver diseases have become a leading cause of death among people with AIDS (PWA). This study aimed to investigate whether PWA experienced excess mortality related to liver diseases as compared to the general population (non-PWA), using a multiple cause of death (MCoD; i.e. all conditions reported on death certificates) approach. METHODS A population-based, nationwide, retrospective cohort study was conducted among Italian people, aged 15-74 years, who had been diagnosed with AIDS since 2006. Date of death and MCoD data were retrieved, up to December 2015, by individual record linkage with national mortality data. Sex- and age-standardized mortality ratios (SMRs), with 95% confidence intervals (CIs), were estimated by dividing the observed number of deaths related to a specific condition among PWA to the expected number, based on non-PWA mortality rates. RESULTS Among 7912 PWA (34 184 person-years), 2076 deaths occurred. The number of death certificates reporting liver diseases among MCoDs was 583 (28.1%), including 382 (18.4%) reporting viral hepatitis, 370 (17.8%) reporting nonviral liver diseases, and 41 (2.0%) reporting liver cancers. The corresponding SMRs were 40.4 (95% CI 37.2-43.8) for all liver diseases, 131.1 (95% CI 118.3-145.0) for viral hepatitis, 29.9 (95% CI 27.0-33.1) for nonviral liver diseases, and 11.2 (95% CI 8.1-15.3) for liver cancers. Particularly elevated SMRs emerged among PWA aged 15-49 years and those infected by injecting drug use. CONCLUSIONS The high excess liver-related mortality observed among PWA warrants preventive actions to limit the burden of viral hepatitis coinfections, alcohol abuse, and metabolic disorders, especially among younger PWA and injecting drug users.
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Affiliation(s)
- M Taborelli
- Unit of Cancer Epidemiology, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - B Suligoi
- National AIDS Unit, National Health Institute, Rome, Italy
| | - F Toffolutti
- Unit of Cancer Epidemiology, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - L Frova
- Integrated System for Health, Social Assistance, Welfare and Justice, National Institute of Statistics, Rome, Italy
| | - E Grande
- Integrated System for Health, Social Assistance, Welfare and Justice, National Institute of Statistics, Rome, Italy
| | - F Grippo
- Integrated System for Health, Social Assistance, Welfare and Justice, National Institute of Statistics, Rome, Italy
| | - M Pappagallo
- Integrated System for Health, Social Assistance, Welfare and Justice, National Institute of Statistics, Rome, Italy
| | - L Pugliese
- National AIDS Unit, National Health Institute, Rome, Italy
| | - V Regine
- National AIDS Unit, National Health Institute, Rome, Italy
| | - D Serraino
- Unit of Cancer Epidemiology, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - A Zucchetto
- Unit of Cancer Epidemiology, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
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19
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Guaraldi G, Maurice JB, Marzolini C, Monteith K, Milic J, Tsochatzis E, Bhagani S, Morse CG, Price JC, Ingiliz P, Lemoine M, Sebastiani G. New Drugs for NASH and HIV Infection: Great Expectations for a Great Need. Hepatology 2020; 71:1831-1844. [PMID: 32052857 DOI: 10.1002/hep.31177] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 01/28/2020] [Indexed: 12/14/2022]
Abstract
In recent years, there has been an increasing number of clinical trials for the treatment of nonalcoholic steatohepatitis (NASH). People living with human immunodeficiency virus (PLWH) are commonly excluded from these studies, usually due to concerns over drug-drug interactions associated with antiretroviral therapy. The Steatohepatitis in HIV Emerging Research Network, a group of international experts in hepatology and infectious diseases, discusses our current understanding on the interaction between human immunodeficiency virus and NASH, and the issues related to the inclusion of PLWH in NASH clinical trials. Recent trials addressing NASH treatment in PLWH are discussed. The risk of drug-drug interactions between antiretroviral therapy and aramchol, cenicriviroc, elafibranor, obeticholic acid and resmetirom (MGL-3196), which are currently in phase 3 trials for the treatment of NASH, are reviewed. A model for trial design to include PLWH is proposed, strongly advocating for the scientific community to include this group as a subpopulation within studies.
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Affiliation(s)
- Giovanni Guaraldi
- Department of Surgical, Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - James B Maurice
- Hepatology Unit, Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Catia Marzolini
- Division of Infectious Diseases & Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
| | - Kenneth Monteith
- Coalition des Organismes Communautaires Québécois de Lutte Contre le Sida, Montréal, QC, Canada
| | - Jovana Milic
- Department of Surgical, Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, Modena, Italy.,Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Emmanuel Tsochatzis
- UCL Institute for Liver and Digestive Health, Royal Free Hospital, University College London, London, United Kingdom
| | - Sanjay Bhagani
- Royal Free London, NHS Foundation Trust, London, United Kingdom
| | - Caryn G Morse
- Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC
| | - Jennifer C Price
- Department of Medicine, University of California, San Francisco, CA
| | - Patrick Ingiliz
- Center for Infectiology, Berlin, Germany.,Department of Gastroenterology and Hepatology, Charité University Medical Center, Berlin, Germany
| | - Maud Lemoine
- Department of Surgery and Cancer, Liver Unit, St Mary's Hospital, Imperial College London, London, United Kingdom
| | - Giada Sebastiani
- Division of Gastroenterology and Hepatology, McGill University Health Centre, Royal Victoria Hospital - Site Glen, Montréal, QC, Canada.,Division of Infectious Diseases, McGill University Health Center, Royal Victoria Hospital-Site Glen, Montréal, QC, Canada
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20
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Fernandez-Fuertes M, Macías J, Corma-Gómez A, Rincón P, Merchante N, Gómez-Mateos J, Pineda JA, Real LM. Similar prevalence of hepatic steatosis among patients with chronic hepatitis C with and without HIV coinfection. Sci Rep 2020; 10:6736. [PMID: 32317646 PMCID: PMC7174281 DOI: 10.1038/s41598-020-62671-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 02/17/2020] [Indexed: 12/15/2022] Open
Abstract
Hepatic steatosis (HS) is frequently observed in HIV-infected patients. It is not known whether HIV infection is an independent risk factor for HS development. We aimed to analyze whether HIV coinfection was associated with a higher frequency of HS in patients with chronic hepatitis C. This was a retrospective cross-sectional study. 574 subjects with chronic hepatitis C virus (HCV) infection were included, 246 (43%) of them coinfected with HIV. All of them underwent transient elastography with controlled attenuation parameter (CAP) measurement. HS was defined as CAP ≥ 248 dB/m. 147 individuals (45%) showed HS in the HCV-monoinfected group and 100 (40.7%) in the HIV/HCV-coinfected group (p = 0.318). HS was associated with body mass index (BMI) [<25 Kg/m2 vs. ≥25 Kg/m2, 67 (23.5%) vs. 171 (62.9%); p = 0.001], with plasma HDL-cholesterol [<50 mg/dL vs. ≥50 mg/dL, 122 (48.6%) vs. 95 (37.5%), p = 0.012], with plasma triglycerides [<150 mg/dL vs. ≥150 mg/dL, 168 (40.2%) vs. 65 (52.4%); p = 0.016] and with plasma total cholesterol [<200 mg/dL vs. ≥200 mg/dL, 181 (41%) vs. 53 (52.5%); p = 0.035]. In the multivariate analysis, HS was associated with BMI [adjusted OR (AOR) = 1.264 (1.194–1.339); p = 0.001], age [AOR = 1.029 (1.001–1.058); p = 0.047] and HCV genotype 3 infection [AOR = 1.901 (1.081–2.594); p = 0.026]. HIV coinfection was not associated with HS [AOR = 1.166 (0.719–1.892); p = 0.534]. In conclusion, HIV coinfection is not related with an increased frequency of HS in HCV-infected patients.
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Affiliation(s)
- M Fernandez-Fuertes
- Unit of Infectious Diseases and Microbiology, Hospital Universitario Virgen de Valme, Sevilla, 41014, Spain
| | - J Macías
- Unit of Infectious Diseases and Microbiology, Hospital Universitario Virgen de Valme, Sevilla, 41014, Spain.
| | - A Corma-Gómez
- Unit of Infectious Diseases and Microbiology, Hospital Universitario Virgen de Valme, Sevilla, 41014, Spain
| | - P Rincón
- Unit of Infectious Diseases and Microbiology, Hospital Universitario Virgen de Valme, Sevilla, 41014, Spain
| | - N Merchante
- Unit of Infectious Diseases and Microbiology, Hospital Universitario Virgen de Valme, Sevilla, 41014, Spain
| | - J Gómez-Mateos
- Unit of Infectious Diseases and Microbiology, Hospital Universitario Virgen de Valme, Sevilla, 41014, Spain
| | - J A Pineda
- Unit of Infectious Diseases and Microbiology, Hospital Universitario Virgen de Valme, Sevilla, 41014, Spain
| | - L M Real
- Unit of Infectious Diseases and Microbiology, Hospital Universitario Virgen de Valme, Sevilla, 41014, Spain
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21
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Talal AH, Ding Y, Venuto CS, Chakan LM, McLeod A, Dharia A, Morse GD, Brown LS, Markatou M, Kharasch ED. Toward precision prescribing for methadone: Determinants of methadone deposition. PLoS One 2020; 15:e0231467. [PMID: 32302325 PMCID: PMC7164646 DOI: 10.1371/journal.pone.0231467] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 03/24/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Despite the World Health Organization listing methadone as an essential medication, effective dose selection is challenging, especially in racial and ethnic minority populations. Subtherapeutic doses can result in withdrawal symptoms while supratherapeutic doses can result in overdose and death. Although CYP3A4 was conventionally considered the principal methadone metabolizing enzyme, more recent data have identified CYP2B6 as the principal enzyme. CYP2B6 has ethnically-associated polymorphisms that affect the metabolic rate. Our objective was to investigate the effects of genetic and nongenetic factors on methadone metabolism. METHODS We measured trough plasma methadone levels in 100 participants with opioid use disorder. We assessed methadone metabolism by calculating the metabolite ratio (major metabolite: 2-ethylidene-1,5-dimethyl-3,3-diphenylpyrrolidine [EDDP] divided by methadone concentration). We assessed hepatic fibrosis and steatosis by transient elastography and CYP2B6 alleles, principally responsible for methadone metabolism. Mixed effects models modeled the data in 97 participants. RESULTS Participants were largely male (58%), minority (61% African American) and non-Hispanic (68%). Forty percent were HCV mono-infected, 40% were uninfected, and 20% were HCV/HIV co-infected. Female sex had significant effects on (R)- and (S)-methadone metabolism (p = 0.016 and p = 0.044, respectively). CYP2B6 loss of function (LOF) alleles significantly affected (S)-methadone metabolism (p = 0.012). Body mass index (BMI) significantly affected (R)-methadone metabolism (p = 0.034). Methadone metabolism appeared to be lower in males, in individuals with LOF alleles, and elevated BMI. CONCLUSIONS Genetic analysis, especially in minority populations, is essential to delivering individualized treatments. Although the principal methadone metabolizing enzyme remains controversial, our results suggest that sex, CYP2B6 genotype, and BMI should be incorporated into multivariate models to create methadone dosing algorithms. Methadone dosing algorithms should facilitate medication delivery, improve patient satisfaction, and diminish overdose potential.
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Affiliation(s)
- Andrew H. Talal
- Division of Gastroenterology, Hepatology and Nutrition, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, United States of America
| | - Yuxin Ding
- Department of Biostatistics, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY, United States of America
| | - Charles S. Venuto
- Department of Neurology, University of Rochester, Rochester, NY, United States of America
| | - Lindsay M. Chakan
- Division of Gastroenterology, Hepatology and Nutrition, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, United States of America
| | - Anthony McLeod
- START Treatment & Recovery Centers, Brooklyn, NY, United States of America
| | - Arpan Dharia
- Division of Gastroenterology, Hepatology and Nutrition, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, United States of America
| | - Gene D. Morse
- NYS Center of Excellence in Bioinformatics and Life Sciences, University at Buffalo, Buffalo, NY, United States of America
| | - Lawrence S. Brown
- START Treatment & Recovery Centers, Brooklyn, NY, United States of America
| | - Marianthi Markatou
- Department of Biostatistics, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY, United States of America
| | - Evan D. Kharasch
- Department of Anesthesiology, Duke University School of Medicine, Durham, NC, United States of America
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22
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Fibroblast Growth Factor 21 Is Elevated in HIV and Associated With Interleukin-6. J Acquir Immune Defic Syndr 2020; 83:e30-e33. [PMID: 31913998 DOI: 10.1097/qai.0000000000002285] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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23
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Abstract
PURPOSE OF REVIEW The proportion of overweight and obese persons with HIV (PWH) has increased since the introduction of antiretroviral therapy (ART). We aim to summarize recent literature on risks of weight gain, discuss adipose tissue changes in HIV and obesity, and synthesize current understanding of how excess adiposity and HIV contribute to metabolic complications. RECENT FINDINGS Recent studies have implicated contemporary ART regimens, including use of integrase strand transfer inhibitors and tenofovir alafenamide, as a contributor to weight gain, though the mechanisms are unclear. Metabolic dysregulation is linked to ectopic fat and alterations in adipose immune cell populations that accompany HIV and obesity. These factors contribute to an increasing burden of metabolic diseases in the aging HIV population. Obesity compounds an increasing burden of metabolic disease among PWH, and understanding the role of fat partitioning and HIV- and ART-related adipose tissue dysfunction may guide prevention and treatment strategies.
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Affiliation(s)
- Samuel S Bailin
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, 1161 21st Avenue South, Nashville, TN, 37232-2582, USA
| | - Curtis L Gabriel
- Division of Gastroenterology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Celestine N Wanjalla
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, 1161 21st Avenue South, Nashville, TN, 37232-2582, USA
| | - John R Koethe
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, 1161 21st Avenue South, Nashville, TN, 37232-2582, USA.
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24
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Aepfelbacher JA, Balmaceda J, Purdy J, Mattingly A, Zambell K, Hawkins K, Chairez C, Curl KA, Dee N, Hadigan C. Increased Prevalence of Hepatic Steatosis in Young Adults With Lifelong HIV. J Infect Dis 2020; 220:266-269. [PMID: 30852587 DOI: 10.1093/infdis/jiz096] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 03/05/2019] [Indexed: 02/06/2023] Open
Abstract
Little is known about the effects of lifelong human immunodeficiency virus (HIV) or antiretroviral therapy on hepatic steatosis and fibrosis. Using transient elastography, we evaluated 46 young adults with lifelong HIV and 20 matched HIV-negative controls. Steatosis was present in 33% of persons with HIV and only 10% of controls (P = .04). Hepatic fibrosis scores were not elevated and did not differ between groups. Metabolic parameters, particularly increased waist circumference, and not HIV-specific factors, were significantly associated with steatosis. While this finding should be examined in larger cohorts, modifiable metabolic disturbances may be important targets to optimize liver health in this population.
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Affiliation(s)
- Julia A Aepfelbacher
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Julia Balmaceda
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Julia Purdy
- Departments of Critical Care Medicine, National Institutes of Health Clinical Center, Bethesda, Maryland
| | - Aviva Mattingly
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Kirsten Zambell
- Departments of Nutrition, National Institutes of Health Clinical Center, Bethesda, Maryland
| | - Karyn Hawkins
- Departments of Nursing, National Institutes of Health Clinical Center, Bethesda, Maryland
| | - Cheryl Chairez
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Kara Anne Curl
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Nicola Dee
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Colleen Hadigan
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
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25
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Mansour A, Mohajeri-Tehrani MR, Samadi M, Gerami H, Qorbani M, Bellissimo N, Poustchi H, Hekmatdoost A. Risk factors for non-alcoholic fatty liver disease-associated hepatic fibrosis in type 2 diabetes patients. Acta Diabetol 2019; 56:1199-1207. [PMID: 31197470 DOI: 10.1007/s00592-019-01374-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 05/30/2019] [Indexed: 02/07/2023]
Abstract
AIMS In patients with type 2 diabetes, non-alcoholic fatty liver disease (NAFLD) and liver fibrosis is frequent and presumably associated with increased cardiovascular disease risk and mortality. The objective was to investigate risk factors associated with hepatic fibrosis in patients with type 2 diabetes and NAFLD to provide a basis for the prevention and treatment. METHODS Liver stiffness measurements (LSM) expressed in kilopascals (kPa) and controlled attenuation parameter (CAP) expressed in dB/m were diagnosed by transient elastography. Hepatic steatosis and significant fibrosis were defined as having a CAP score ≥ 260 dB/m and an LSM score ≥ 8 kPa, respectively. Associations between fibrosis categories with anthropometric and metabolic variables were determined; then, variables with statistical significance in the univariate analysis were included in multivariate model. RESULTS A total of 108 participant with type 2 diabetes and NAFLD (mean age: 44.69 ± 5.57 years; mean duration of diabetes 4.68 ± 4.24 years) were recruited. In these patients, body mass index, obesity, fat mass, waist circumferences, resting energy expenditure, CAP score, fasting insulin, C-peptide, HbA1C, hs-CRP as well as liver enzymes and systolic blood pressure and diastolic blood pressure were positively associated with fibrosis (all p < 0.05). Using multivariate logistic regression, serum aspartate aminotransferase (OR 1.12; 95% CI 1.06-1.19), waist circumferences (odds ratio [OR] 1.15; 95% CI 1.05-1.25) and C-peptide (OR 3.81; 95% CI 1.5-9.7) remained as independently associated with liver fibrosis. CONCLUSION For participants with type 2 diabetes with coexisting NAFLD, stratification by independent risk factors for fibrosis could have important prognostic value.
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Affiliation(s)
- Asieh Mansour
- Department of Clinical Nutrition and Dietetics, Faculty of Nutrition and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, 46, West Arghavan St., Farahzadi Blvd., Shahrak Gharb, Tehran, Iran
| | - Mohammad Reza Mohajeri-Tehrani
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Majid Samadi
- Radiology Department, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Hadis Gerami
- Obesity and Eating Habits Research Center, Endocrinology and Metabolism Molecular-Cellular Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mostafa Qorbani
- Non-communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran
- Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Endocrinology and Metabolism Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Nick Bellissimo
- School of Nutrition, Faculty of Community Services, Ryerson University, Toronto, Canada
| | - Hossein Poustchi
- Liver and Pancreatobiliary Diseases Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Azita Hekmatdoost
- Department of Clinical Nutrition and Dietetics, Faculty of Nutrition and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, 46, West Arghavan St., Farahzadi Blvd., Shahrak Gharb, Tehran, Iran.
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26
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Sebastiani G, Cocciolillo S, Mazzola G, Malagoli A, Falutz J, Cervo A, Petta S, Pembroke T, Ghali P, Besutti G, Franconi I, Milic J, Cascio A, Guaraldi G. Application of guidelines for the management of nonalcoholic fatty liver disease in three prospective cohorts of HIV-monoinfected patients. HIV Med 2019; 21:96-108. [PMID: 31642599 DOI: 10.1111/hiv.12799] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/02/2019] [Indexed: 12/19/2022]
Abstract
OBJECTIVES Current guidelines recommend use of a diagnostic algorithm to assess disease severity in cases of suspected nonalcoholic fatty liver disease (NAFLD). We applied this algorithm to HIV-monoinfected patients. METHODS We analysed three prospective screening programmes for NAFLD carried out in the following cohorts: the Liver Disease in HIV (LIVEHIV) cohort in Montreal, the Modena HIV Metabolic Clinic (MHMC) cohort and the Liver Pathologies in HIV in Palermo (LHivPa) cohort. In the LIVEHIV and LHivPa cohorts, NAFLD was diagnosed if the controlled attenuation parameter (CAP) was ≥ 248 dB/m; in the MHMC cohort, it was diagnosed if the liver/spleen Hounsfield unit (HU) ratio on abdominal computerized tomography scan was < 1.1. Medium/high-risk fibrosis category was defined as fibrosis-4 (FIB-4) ≥ 1.30. Patients requiring specialist referral to hepatology were defined as either having NAFLD and being in the medium/high-risk fibrosis category or having elevated alanine aminotransferase (ALT). RESULTS A total of 1534 HIV-infected adults without significant alcohol intake or viral hepatitis coinfection were included in the study. Of these, 313 (20.4%) patients had the metabolic comorbidities (obesity and/or diabetes) required for entry in the diagnostic algorithm. Among these patients, 123 (39.3%) required specialist referral to hepatology, according to guidelines. A total of 1062 patients with extended metabolic comorbidities (any among obesity, diabetes, hypertension and dyslipidaemia) represented most of the cases of NAFLD (79%), elevated ALT (75.9%) and medium/high-risk fibrosis category (75.4%). When the algorithm was extended to these patients, it was found that 341 (32.1%) would require specialist referral to hepatology. CONCLUSIONS According to current guidelines, one in five HIV-monoinfected patients should undergo detailed assessment for NAFLD and disease severity. Moreover, one in ten should be referred to hepatology. Expansion of the algorithm to patients with any metabolic comorbidities may be considered.
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Affiliation(s)
- G Sebastiani
- Division of Gastroenterology and Hepatology, Royal Victoria Hospital, McGill University Health Centre, Montreal, QC, Canada.,Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC, Canada
| | - S Cocciolillo
- Division of Gastroenterology and Hepatology, Royal Victoria Hospital, McGill University Health Centre, Montreal, QC, Canada
| | - G Mazzola
- Department of Health Promotion Sciences and Mother and Child Care 'Giuseppe D'Alessandro', University of Palermo, Palermo, Italy
| | - A Malagoli
- University of Modena and Reggio Emilia, Modena, Italy
| | - J Falutz
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC, Canada
| | - A Cervo
- Department of Health Promotion Sciences and Mother and Child Care 'Giuseppe D'Alessandro', University of Palermo, Palermo, Italy
| | - S Petta
- Section of Gastroenterology and Hepatology, Di.Bi.M.I.S., University of Palermo, Palermo, Italy
| | - T Pembroke
- Division of Gastroenterology and Hepatology, Royal Victoria Hospital, McGill University Health Centre, Montreal, QC, Canada.,School of Medicine, Cardiff University, Cardiff, UK
| | - P Ghali
- Division of Gastroenterology and Hepatology, Royal Victoria Hospital, McGill University Health Centre, Montreal, QC, Canada
| | - G Besutti
- Department of Imaging and Laboratory Medicine, AUSL-IRCCS of Reggio Emilia, Reggio Emilia, Italy.,Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - I Franconi
- University of Modena and Reggio Emilia, Modena, Italy
| | - J Milic
- University of Modena and Reggio Emilia, Modena, Italy.,Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - A Cascio
- Department of Health Promotion Sciences and Mother and Child Care 'Giuseppe D'Alessandro', University of Palermo, Palermo, Italy
| | - G Guaraldi
- University of Modena and Reggio Emilia, Modena, Italy.,University Hospital of Modena, Modena, Italy
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27
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Praktiknjo M, Djayadi N, Mohr R, Schierwagen R, Bischoff J, Dold L, Pohlmann A, Schwarze-Zander C, Wasmuth JC, Boesecke C, Rockstroh JK, Trebicka J. Fibroblast growth factor 21 is independently associated with severe hepatic steatosis in non-obese HIV-infected patients. Liver Int 2019; 39:1514-1520. [PMID: 30916873 DOI: 10.1111/liv.14107] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 03/20/2019] [Accepted: 03/21/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Severe hepatic steatosis shows a high prevalence and contributes to morbidity and mortality in human immunodeficiency virus (HIV) infected patients. Known risk factors include obesity, dyslipidaemia and features of metabolic syndrome. Fibroblast growth factor 21 (FGF-21) is involved with hepatic glucose and lipid metabolism. This study aimed to evaluate FGF-21 as a biomarker for severe hepatic steatosis in non-obese HIV-infected patients. METHODS This is a prospective, cross-sectional, monocentric study including HIV-infected out-patients. Hepatic steatosis was measured via controlled attenuation parameter (CAP) using FibroScan 502 touch (ECHOSENS, France). Severe hepatic steatosis was defined at CAP ≥ 253 dB/m. Peripheral blood samples were collected and plasma was analysed for FGF-21. Demographic and clinical characteristics were collected from patient's health records. RESULTS In total, 73 non-obese HIV-monoinfected patients were included in this study. Prevalence of severe hepatic steatosis was 41%. Patients with severe hepatic steatosis showed significantly higher levels of FGF-21. Univariate analysis revealed FGF-21, BMI, hyperlipidaemia, ALT levels and arterial hypertension as significant, while multivariate analysis showed only FGF-21, arterial hypertension and ALT levels as significant independent risk factors for severe hepatic steatosis. CONCLUSION This study presents FGF-21 as an independent and stronger predictor of severe hepatic steatosis than blood lipids in HIV-infected patients. Moreover, arterial hypertension and ALT levels predict severe steatosis even in non-obese HIV-monoinfected patients. Furthermore, this study supports existing metabolic risk factors and expands them to non-obese HIV-infected patients.
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Affiliation(s)
| | | | - Raphael Mohr
- Department of Medicine I, University of Bonn, Bonn, Germany
| | | | - Jenny Bischoff
- Department of Medicine I, University of Bonn, Bonn, Germany
| | - Leona Dold
- Department of Medicine I, University of Bonn, Bonn, Germany
| | | | | | | | | | | | - Jonel Trebicka
- Department of Medicine I, University of Bonn, Bonn, Germany.,Department of Medicine I, University of Frankfurt, Frankfurt, Germany.,Department of Gastroenterology, Odense Hospital, University of Southern Denmark, Odense, Denmark.,European Foundation for the Study of Chronic Liver Failure - EF Clif, Barcelona, Spain.,Institute for Bioengineering of Catalonia, Barcelona, Spain
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28
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Dold L, Nielsen MJ, Praktiknjo M, Schwarze-Zander C, Boesecke C, Schierwagen R, Mohr R, Wasmuth JC, Jansen C, Bischoff J, Rockstroh JK, Karsdal MA, Spengler U, Trebicka J, Leeming DJ. Circulating levels of PRO-C3 reflect liver fibrosis and liver function in HIV positive patients receiving modern cART. PLoS One 2019; 14:e0219526. [PMID: 31295293 PMCID: PMC6622522 DOI: 10.1371/journal.pone.0219526] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Accepted: 06/25/2019] [Indexed: 02/06/2023] Open
Abstract
Background and aims Although combined antiretroviral treatment (cART) has improved overall survival of HIV infected patients, liver fibrosis and liver related-mortality still constitute major challenges in HIV positive patients. Collagen accumulates in the liver during fibrogenesis. Recent studies showed that circulating levels of extracellular matrix (ECM) fragments might reflect degree of portal hypertension and fibrosis stage in liver disease. In this study, we analyzed the correlation between liver fibrosis assessed by Fibroscan and levels of the formation and degradation markers of type III and IV collagen in HIV positive patients receiving cART. Methods 116 HIV positive patients (82.7% male, median age 47 years) were enrolled into the study. Liver stiffness and liver fat content were determined using a Fibroscan with integrated CAP function. We quantified ECM formation and degradation fragments of collagen III and IV: PRO-C3, PRO-C4, C3M and C4M. These fragments were measured in peripheral serum by using specific ELISAs. Results Fifteen (12.9%) out of the 116 HIV positive patients had relevant fibrosis with a liver stiffness ≥ 7.1 kPa, and 79 patients had relevant steatosis with a CAP value > 248 dB/m. Circulating PRO-C3 levels significantly correlated with increasing degree of liver fibrosis assessed by Fibroscan (p = 0.0005), as well as with APRI score (p = 0.015). Interestingly, circulating PRO-C3 levels were significantly correlated with bilirubin (p = 0.022), reduced platelet count (p = 0.0008) and low albumin levels (p = 0.001), suggesting the association of type III collagen deposition with impaired liver function. None of the other measured ECM components significantly correlated with fibrosis or steatosis. Conclusion The formation marker of type III collagen, PRO-C3 not only reflects liver fibrosis, but might also mirror liver dysfunction in HIV positive patients receiving cART. Therefore, the circulating levels of PRO-C3 might be suitable to monitor progression of liver fibrosis and deterioration of liver function in HIV positive patients receiving cART.
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Affiliation(s)
- Leona Dold
- Department of Internal Medicine I, University of Bonn, Bonn, Germany
- German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Bonn, Germany
- * E-mail:
| | - Mette J. Nielsen
- Nordic Bioscience, Fibrosis Biology and Biomarkers, Herlev, Denmark
| | | | - Carolynne Schwarze-Zander
- Department of Internal Medicine I, University of Bonn, Bonn, Germany
- German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Bonn, Germany
| | - Christoph Boesecke
- Department of Internal Medicine I, University of Bonn, Bonn, Germany
- German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Bonn, Germany
| | - Robert Schierwagen
- Department of Internal Medicine I, University of Bonn, Bonn, Germany
- Department of Internal Medicine I, University Hospital of Frankfurt, Frankfurt, Germany
| | - Raphael Mohr
- Department of Internal Medicine I, University of Bonn, Bonn, Germany
| | - Jan-Christian Wasmuth
- Department of Internal Medicine I, University of Bonn, Bonn, Germany
- German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Bonn, Germany
| | - Christian Jansen
- Department of Internal Medicine I, University of Bonn, Bonn, Germany
| | - Jenny Bischoff
- Department of Internal Medicine I, University of Bonn, Bonn, Germany
| | - Jürgen Kurt Rockstroh
- Department of Internal Medicine I, University of Bonn, Bonn, Germany
- German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Bonn, Germany
| | | | - Ulrich Spengler
- Department of Internal Medicine I, University of Bonn, Bonn, Germany
- German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Bonn, Germany
| | - Jonel Trebicka
- Department of Internal Medicine I, University of Bonn, Bonn, Germany
- Department of Internal Medicine I, University Hospital of Frankfurt, Frankfurt, Germany
- European Foundation for the Study of Chronic Liver Failure (EF-CLIF), Barcelona, Spain
- Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Diana J. Leeming
- Nordic Bioscience, Fibrosis Biology and Biomarkers, Herlev, Denmark
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29
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Chromy D, Mandorfer M, Bucsics T, Schwabl P, Bauer D, Scheiner B, Schmidbauer C, Lang GF, Szekeres T, Ferenci P, Trauner M, Reiberger T. Prevalence and Predictors of Hepatic Steatosis in Patients with HIV/HCV Coinfection and the Impact of HCV Eradication. AIDS Patient Care STDS 2019; 33:197-206. [PMID: 31067123 DOI: 10.1089/apc.2018.0333] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Human immunodeficiency virus (HIV)-induced metabolic abnormalities and antiretroviral therapy (ART), genetic factors, most importantly the rs738409 C > G p.I148M variant in the patatin-like phospholipase domain containing 3 (PNPLA3)-gene, as well as hepatitis C virus (HCV) coinfection may all cause hepatic steatosis (HS). However, recent studies suggest a protective effect of HCV infection on HS. Thus, we evaluated HS prior and after HCV eradication in an HIV/HCV-coinfected cohort at the Medical University of Vienna between January 2014 and June 2017. Two hundred forty-seven patients underwent liver stiffness measurement and controlled attenuation parameter (CAP)-based steatosis assessment. A subcohort of 138 patients also had follow-up CAP measurement after HCV eradication by direct-acting antivirals (DAAs). A CAP value ≥248 dB/m defined HS and all CAP values were adapted to compensate for body mass index (BMI) and diabetes mellitus. Among all 247 HIV/HCV-coinfected patients, HS was prevalent in 31%, mean age was 43.3 years, 75% were male, the main ethnicity was Caucasian (96%), and mean BMI was 23.33 kg/m2. Independent risk factors for HS were BMI, years exposed to HIV, PNPLA3 G-alleles, and protease inhibitor (PI) intake. Notably, a significant increase in CAP (from 225 ± 52.9 to 235 ± 50.7 dB/m; p = 0.047) was observed after HCV eradication, whereas patients on PI-containing ART experienced a significant decrease in CAP. Overall, one-third of HIV/HCV-coinfected patients are affected by HS with PI-based ART and PNPLA3 impacting on HS prevalence. While HCV eradication by DAAs increased HS, as assessed by CAP, future studies should account for metabolic syndrome and evaluate whether changes in CAP-based steatosis assessments correspond to a clinically relevant outcome.
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Affiliation(s)
- David Chromy
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
- Vienna HIV & Liver Study Group, Vienna, Austria
| | - Mattias Mandorfer
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
- Vienna HIV & Liver Study Group, Vienna, Austria
| | - Theresa Bucsics
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
- Vienna HIV & Liver Study Group, Vienna, Austria
| | - Philipp Schwabl
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
- Vienna HIV & Liver Study Group, Vienna, Austria
| | - David Bauer
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
- Vienna HIV & Liver Study Group, Vienna, Austria
| | - Bernhard Scheiner
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
- Vienna HIV & Liver Study Group, Vienna, Austria
| | - Caroline Schmidbauer
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
- Vienna HIV & Liver Study Group, Vienna, Austria
| | - Gerold Felician Lang
- Vienna HIV & Liver Study Group, Vienna, Austria
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - Thomas Szekeres
- Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | - Peter Ferenci
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Michael Trauner
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Thomas Reiberger
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
- Vienna HIV & Liver Study Group, Vienna, Austria
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30
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Chung E, Herbert S. Clinical round-up. Br J Vener Dis 2019. [DOI: 10.1136/sextrans-2018-053706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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