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Dragović G, Srdić D, Al Musalhi K, Soldatović I, Kušić J, Jevtović D, Nair D. Higher Levels of Cystatin C in HIV/AIDS Patients with Metabolic Syndrome. Basic Clin Pharmacol Toxicol 2017; 122:396-401. [PMID: 29024496 DOI: 10.1111/bcpt.12919] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 10/04/2017] [Indexed: 01/01/2023]
Abstract
Data about Cystatin-C levels in HIV-infected patients with metabolic syndrome (MetS) are still limited. Therefore, the aim of this study was to evaluate the possible correlations of serum levels of Cystatin-C in HIV/AIDS patients treated with combined antiretroviral therapy (cART) with or without MetS. This cross-sectional study included 89 HIV/AIDS Caucasian patients receiving cART at the HIV/AIDS Centre Belgrade, Serbia, divided into two groups according to the presence of MetS. Cystatin-C and other biochemical parameters were measured using Cytokine-Array-I, Metabolic-Array-I and Metabolic-Array-II, at the Department of Clinical Biochemistry, Royal Free Hospital and University College London, UK. A linear regression model was performed to evaluate which clinical and laboratory variables had an independent effect on Cystatin-C levels in HIV/AIDS patients. There were 33 (37%) patients with MetS and 56 (63%) without MetS. Patients with and without MetS were homogenous for age, duration of cART, number of cART combinations and CD4+ T cell count. Statistically increased Cystatin-C levels were observed in HIV/AIDS patients with MetS (p = 0.017), when compared to patients without MetS. Data showed a positive correlation of Cystatin-C and C-reactive protein (r = 0.349, p = 0.001). Using linear regression modelling, significant correlations were obtained between Cystatin-C and MetS in univariate analysis (p < 0.001). Cystatin-C levels were significantly higher in HIV/AIDS patients with MetS versus without MetS. Early assessment of MetS using Cystatin-C as a marker may ultimately help increase the lifespan of HIV/AIDS patients, as these patients appear to be at high risk of cardiovascular diseases.
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Affiliation(s)
- Gordana Dragović
- Department of Pharmacology, Clinical Pharmacology and Toxicology, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Danica Srdić
- Department of Pharmacology, Clinical Pharmacology and Toxicology, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Khawla Al Musalhi
- Department of Clinical Biochemistry, Royal Free Hospital and University College London, London, UK
| | - Ivan Soldatović
- Institute for Biomedical Statistics, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Jovana Kušić
- Infectious and Tropical Diseases Hospital, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Djordje Jevtović
- Infectious and Tropical Diseases Hospital, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Devaki Nair
- Department of Clinical Biochemistry, Royal Free Hospital and University College London, London, UK
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Srdic D, Khawla AM, Soldatovic I, Nikolic J, Jevtovic D, Nair D, Dragovic G. Correlation of Leptin, Adiponectin, and Resistin Levels in Different Types of Lipodystrophy in HIV/AIDS Patients. Metab Syndr Relat Disord 2017; 15:153-159. [PMID: 28339344 DOI: 10.1089/met.2016.0068] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Leptin, adiponectin, and resistin may play an important role in the development of lipodystrophy (LD) in HIV/AIDS patients. The aim of this study was to correlate levels of leptin, adiponectin, and resistin between HIV/AIDS patients with LD and without lipodystrophy (non-LD), as well as between subgroups of LD [lipoatrophy (LA), lipohypertrophy (LH), and mixed fat redistribution (MFR)] and non-LD patients. METHODS Cross-sectional study of 66 HIV/AIDS patients. Serum levels of leptin, adiponectin, and resistin were measured. The associations between adipocytokine levels and metabolic variables were estimated by Spearman correlation. Analysis of covariance with bootstrapping method was used to examine the relationship between adiponectin and leptin and lipodystrophy categories. RESULTS The LD was observed in 29 (44%) patients, while 15 (52%) of them had LA, 4 (14%) had LH, and 10 (34%) patients had MFR. No significant differences regarding leptin, adiponectin, and resistin levels, between LD and non-LD patients, were observed. LH patients had significantly higher levels of leptin and adiponectin in comparison with non-LD patients (P = 0.039, P = 0.011, respectively). Within the LD group, LA patients had significantly lower levels of leptin (LA vs. LH, P = 0.020; LA vs. MFR, P = 0.027), while LH patients had significantly higher levels of adiponectin (LH vs. LA, P = 0.027; LH vs. MFR, P = 0.028). Correlation of adiponectin with LD remains significant in the LH subgroup after adjustment for age, body mass index, cystatin-C, plasminogen activator inhibitor-1 (PAI-1), and interferon gamma (IFN-γ) (P = 0.001). CONCLUSIONS Adiponectin and leptin levels differ significantly between LH patients and non-LD patients, as well as between the LD subgroups. Adiponectin may be a more useful marker of LD in HIV/AIDS patients.
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Affiliation(s)
- Danica Srdic
- 1 Department of Pharmacology, Clinical Pharmacology and Toxicology, School of Medicine, University of Belgrade , Belgrade, Serbia
| | - Al Musalhi Khawla
- 2 Department of Clinical Biochemistry, Royal Free Hospital, University College London , London, United Kingdom
| | - Ivan Soldatovic
- 3 Institute for Biomedical Statistics, School of Medicine, University of Belgrade , Belgrade, Serbia
| | - Jelena Nikolic
- 4 Infectious and Tropical Diseases Hospital, School of Medicine, University of Belgrade , Belgrade, Serbia
| | - Djordje Jevtovic
- 4 Infectious and Tropical Diseases Hospital, School of Medicine, University of Belgrade , Belgrade, Serbia
| | - Devaki Nair
- 2 Department of Clinical Biochemistry, Royal Free Hospital, University College London , London, United Kingdom
| | - Gordana Dragovic
- 1 Department of Pharmacology, Clinical Pharmacology and Toxicology, School of Medicine, University of Belgrade , Belgrade, Serbia
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Dragović G, Dimitrijević B, Khawla AM, Soldatović I, Andjić M, Jevtović D, Nair D. Lower levels of IL-4 and IL-10 influence lipodystrophy in HIV/AIDS patients under antiretroviral therapy. Exp Mol Pathol 2017; 102:210-214. [PMID: 28189545 DOI: 10.1016/j.yexmp.2017.02.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 02/04/2017] [Accepted: 02/07/2017] [Indexed: 10/20/2022]
Abstract
BACKGROUND The role of interleukins in the pathogenesis of lipodystrophy in HIV/AIDS-patients is still not understood. The aim of this study was to evaluate the relationship between serum levels of interleukins between HIV/AIDS-patients with or without lipodystrophy, as well as between different subgroups of lipodystrophy (lipoatrophy, lipohypertrophy, mixed-fat-redistribution) and patients without lipodystrophy. METHODS Cross-sectional study of 66 HIV/AIDS patients, all Caucasians. Serum levels of interleukins (IL-1α, IL-1β, IL-2, IL-4, IL-6, IL-8, IL-10) were measured using Cytokine-Array-1 on Evidence Investigator, Biochip Array Technology. The associations between interleukins and anthropometric and metabolic variables were estimated by Spearman-correlation. Analysis of covariance with bootstrapping method (ACBM) was used to examine relationship between interleukins and lipodystrophy categories adjusted for confounding variables. RESULTS The lipodystrophy was observed in 29 (44%) patients, while 15 (52%) had lipoatrophy, 4 (14%) lipohypertrophy and 10 (34%) patients had mixed fat redistribution. There were 37 (56%) patients without lipodystrophy. Significantly lower levels of IL-4 and IL-10 were observed in lipodystrophy vs. non-lipodystrophy (p=0.008; p=0.027, respectively). No differences were found relating IL-1α, IL-1β, IL-2, IL-6 and IL-8 levels in lipodystrophy vs. non-lipodystrophy. In patient subgroup with lipoatrophy, significantly lower levels of IL-4 and IL-10 were found when compared to non-lipodystrophy (p=0.043; p=0.031, respectively). In lipohypertrophy subgroup significantly lower levels of IL-4 were found when compared to non-lipodystrophy (p=0.003). In order to estimate the correlation of IL-4 and IL-10 and the presence of lipodystrophy, ACBM showed that correlation of IL-4 levels in patients with lipodystrophy remains statistically significant (p=0.004) in all types of lipodystrophy: lipoatrophy, lipohypertrophy and mix-fat-redistribution (p=0.027; p=0.009; p=0.017, respectively) after adjustment for age, BMI. CONCLUSIONS IL-4 and IL-10 levels were significantly lower in lipodystrophy vs. non-lipodystrophy. According to our knowledge, we showed for the first time significant correlation between IL-4 levels and lipodystrophy development in HIV/AIDS patients.
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Affiliation(s)
- Gordana Dragović
- Department of Pharmacology, Clinical Pharmacology and Toxicology, School of Medicine, University of Belgrade, Belgrade, Serbia.
| | - Božana Dimitrijević
- Department of Pharmacology, Clinical Pharmacology and Toxicology, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Al Musalhi Khawla
- Department of Clinical Biochemistry, Royal Free Hospital, London, United Kingdom; University College London, London, United Kingdom
| | - Ivan Soldatović
- Institute for Biomedical Statistics, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Mladen Andjić
- Department of Pharmacology, Clinical Pharmacology and Toxicology, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Djordje Jevtović
- Infectious and Tropical Diseases Hospital, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Devaki Nair
- Department of Clinical Biochemistry, Royal Free Hospital, London, United Kingdom; University College London, London, United Kingdom
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Dragovic G, Smith CJ, Jevtovic D, Dimitrijevic B, Kusic J, Youle M, Johnson MA. Choice of first-line antiretroviral therapy regimen and treatment outcomes for HIV in a middle income compared to a high income country: a cohort study. BMC Infect Dis 2016; 16:106. [PMID: 26939611 PMCID: PMC4778345 DOI: 10.1186/s12879-016-1443-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Accepted: 02/23/2016] [Indexed: 11/10/2022] Open
Abstract
Background The range of combination antiretroviral therapy (cART) regimens available in many middle-income countries differs from those suggested in international HIV treatment guidelines. We compared first-line cART regimens, timing of initiation and treatment outcomes in a middle income setting (HIV Centre, Belgrade, Serbia - HCB) with a high-income country (Royal Free London Hospital, UK - RFH). Methods All antiretroviral-naïve HIV-positive individuals from HCB and RFH starting cART between 2003 and 2012 were included. 12-month viral load and CD4 count responses were compared, considering the first available measurement 12-24 months post-cART. The percentage that had made an antiretroviral switch for any reason, or for toxicity and the percentage that had died by 36 months (the latest time at which sufficient numbers remained under follow-up) were investigated using standard survival methods. Results 361/597 (61 %) of individuals initiating cART at HCB had a prior AIDS diagnosis, compared to 337/1763 (19 %) at RFH. Median pre-ART CD4 counts were 177 and 238 cells/mm3 respectively (p < 0.0001). The most frequently prescribed antiretrovirals were zidovudine with lamivudine (149; 25 %) and efavirenz [329, 55 %] at HCB and emtricitabine with tenofovir (899; 51 %) and efavirenz [681, 39 %] at RFH. At HCB, a median of 2 CD4 count measurements in the first year of cART were taken, compared to 5 at RFH (p < 0.0001). Median (IQR) CD4 cell increase after 12 months was +211 (+86, +359) and +212 (+105, +318) respectively. 287 (48 %) individuals from HCB and 1452 (82 %) from RFH had an available viral load measurement, of which 271 (94 %) and 1280 (88 %) were <400 copies/mL (p < 0.0001). After 36 months, comparable percentages had made at least one antiretroviral switch (77 % HCB vs. 78 % RFH; p = 0.23). However, switches for toxicity/patient choice were more common at RFH. After 12 and 36 months of cART 3 % and 8 % of individuals died at HCB, versus 2 % and 4 % at RFH (p < 0.0001). Conclusion In middle-income countries, cART is usually started at an advanced stage of HIV disease, resulting in higher mortality rates than in high income countries, supporting improved testing campaigns for early detection of HIV infection and early introduction of newer cART regimens.
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Affiliation(s)
- Gordana Dragovic
- Department of Pharmacology, Clinical Pharmacology and Toxicology, School of Medicine, University of Belgrade, Belgrade, Serbia.
| | - Colette J Smith
- UCL Research Department of Infection and Population Health, Royal Free Campus, 1st Floor, Rowland Hill Street, London, NW3 2PF, UK.
| | - Djordje Jevtovic
- Infectious and Tropical Diseases Hospital, School of Medicine, University of Belgrade, Belgrade, Serbia.
| | - Bozana Dimitrijevic
- Department of Pharmacology, Clinical Pharmacology and Toxicology, School of Medicine, University of Belgrade, Belgrade, Serbia.
| | - Jovana Kusic
- Infectious and Tropical Diseases Hospital, School of Medicine, University of Belgrade, Belgrade, Serbia.
| | - Mike Youle
- Department of HIV Medicine, Royal Free London Hospital, London, UK.
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Kušić J, Mladenović M, Dimitrijević B, Aleksić B, Zec S, Jevtović D, Dragović Lukić G. Treatment outcomes of first-line antiretroviral therapy in HIV-1-positive patients in Serbia. J Virus Erad 2016. [DOI: 10.1016/s2055-6640(20)30690-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Dragovic G. Acute pancreatitis in HIV/AIDS patients: an issue of concern. Asian Pac J Trop Biomed 2013; 3:422-5. [PMID: 23730553 PMCID: PMC3644568 DOI: 10.1016/s2221-1691(13)60091-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2013] [Accepted: 05/26/2013] [Indexed: 12/20/2022] Open
Abstract
Pancreatitis is a well-described complication of human immunodeficiency virus (HIV) itself and its combination antiretroviral therapy. Historically, this has been predominantly associated with the usage of nucleoside reverse transcriptase inhibitors such as didanosine and stavudine, but only rarely with the usage of protease inhibitors via the induction of hypertriglyceridemia. Pancreatitis rates in HIV/AIDS population may have been exceedingly high because of the comorbid conditions prevalent in HIV/AIDS patients (e.g. ethanol use and biliary disease), and the use of non-combination antiretroviral therapy medications such as pentamidine, corticosteroids, ketoconazole, sulphonamides, metronidazole, isoniazid and opportunistic infections (e.g. cytomegalovirus, cryptosporidiosis, mycobacterial disease). In resource limited settings, where didanosine and stavudine are widely available in cheaper generic fixed dose combinations it is likely that their usage will remain in the first line HIV treatment in common. In such settings management or estimation of a patient's risk of pancreatitis still remains an issue of concern.
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Affiliation(s)
- Gordana Dragovic
- Institute of Pharmacology, Clinical Pharmacology and Toxicology, School of Medicine, University of Belgrade, Belgrade, Serbia
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Dragovic G, Jevtovic D. The role of nucleoside reverse transcriptase inhibitors usage in the incidence of hyperlactatemia and lactic acidosis in HIV/AIDS patients. Biomed Pharmacother 2012; 66:308-11. [PMID: 22658063 DOI: 10.1016/j.biopha.2011.09.016] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2011] [Accepted: 09/28/2011] [Indexed: 12/25/2022] Open
Abstract
Hyperlactatemia and lactic acidosis (LA) are among the most dangerous and life-threatening side effect that occurs during therapy with some nucleoside reverse transcriptase inhibitors (NRTIs), mainly didanosine (ddI) and stavudine (d4T), also known as d-drugs. Therefore, we performed a prospective, follow-up study and aimed to examine the incidence rates (IR) and rate ratios (RR) of hyperlactatemia and LA for each NRTI. Three hundred and ninety-six HIV-patients were included in final analysis comprising 783.8 person-years of follow-up. Between 1st January 2000 and 1st January 2008, 19 cases of hyperlactatemia and 15 cases of LA were recorded. Between regimens with the significant impact for developing hyperlactatemia and LA the lowest IR was for didanosine (IR=2.87 per 100 person-years, 95%CI=0.45-9.25 and IR=4.31 per 100 person-years, 95%CI=1.07-13.91, respectively), and the highest for didanosine+stavudine (IR=10.17 per 100 person-years, 95%CI=1.02-19.76 and IR=7.39 per 100 person-years, 95%CI=1.02-13.05, respectively). Compared to didanosine alone the RR of hyperlactatemia was 2.67 (95%CI=1.11-12.52) for stavudine, and 4.06 (95%CI=1.31-15.48) for didanosine+stavudine. The RR of LA was 3.12 (95%CI=1.13-10.65) for stavudine, and 5.13 (95%CI=1.54-13.37) for didanosine+stavudine in comparison with didanosine alone. Other risk factors for AP were CD4 cell count less than 200 cells/mm³ and female sex. Our results suggest that the use of stavudine alone or in combination with didanosine should not be used as first-line therapy, especially in patients with CD4 cell count less than 200 cells/mm³ and females if other treatment options are available.
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Affiliation(s)
- Gordana Dragovic
- Institute of Pharmacology, Clinical Pharmacology and Toxicology, Dr Subotica 1/III, School of Medicine, University of Belgrade, Belgrade, Serbia.
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Stanojević M, Jevtović D, Dragović G. Predicting HIV treatment response in Romania - Comment. Germs 2012; 2:23-4. [PMID: 24432260 DOI: 10.11599/germs.2012.1010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2011] [Accepted: 02/23/2012] [Indexed: 11/23/2022]
Affiliation(s)
- Maja Stanojević
- MD, PhD, National Retrovirus Reference Laboratory, University of Belgrade Faculty of Medicine, Belgrade, Serbia
| | - Djordje Jevtović
- MD, PhD, Institute of Infective and Tropical Disease 'Dr Kosta Todorović', Professor, School of Medicine, University of Belgrade, Bulevar oslobodjenja 16, 11000 Belgrade, Serbia
| | - Gordana Dragović
- MD, PhD, Institute of Pharmacology, Clinical Pharmacology and Toxicology, Associate Professor, School of Medicine, University of Belgrade, Dr Subotica 1/III, P.O. Box 38; 11000 Belgrade, Serbia
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Jevtović D, Salemović D, Ranin J, Dulović O, Ilić D, Brmbolić B. The prognosis of highly active antiretroviral therapy (HAART) treated HIV infected patients in Serbia, related to the time of treatment initiation. J Clin Virol 2009; 47:131-5. [PMID: 20006540 DOI: 10.1016/j.jcv.2009.11.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2009] [Revised: 11/02/2009] [Accepted: 11/17/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND With the introduction of highly active antiretroviral treatment (HAART) an impressive improvement in patient survival and quality of life has bee observed. However, the optimal timing of initial HAART is still under consideration. OBJECTIVE To investigate the prognosis of HAART treated patients in Serbia, related to the timing of HAART initiation. STUDY DESIGN A series of 563 patients on HAART was retrospectively analyzed to investigate treatment response and survival. RESULTS After a mean of 6 years (range 1-14) of treatment with PI-based and/or NNRTI-based regimens, a favorable response was achieved in 72.4%, treatment failure occurred in 7.9%, while 19.7% had a dissociative immunological/virological response. If treatment was initiated during primary HIV infection it took a shorter time to achieve a favorable response than in patients who began HAART in chronic HIV infection (2.7+/-2.2 years vs. 6.9+/-2.7 years, P<0.01). A higher proportion of patients with primary HIV infection then those treated in the chronic phase achieved a favorable response to HAART (88.4% vs. 71.9%, P=0.045). Patients who initiated HAART when their CD4 cell counts were below 200 cells/microL needed longer treatment for favorable response (8 years vs. 6 years, log rank P<0.01). Forty-seven (8.3%) patients died. The overall estimated survival was 13 years. Patients older then 40 and IVDU were more likely to die during HAART (OR 2.6, 95% CI 1.1-5.9, P=0.016, and OR 2.0, 95% CI 1.0-3.7, P=0.02, respectively). However, reaching and maintaining undetectable viremia was an independent predictor of longer survival (OR 11.3, 95% CI 4.6-27.7, P<0.01). CONCLUSION Reaching and maintaining undetectable viremia during HAART predicted longer survival, even if sub-clinical immunodeficiency remained.
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Affiliation(s)
- Dj Jevtović
- University of Belgrade School of Medicine, Belgrade, Serbia.
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