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Hudson JA, Ferrand RA, Gitau SN, Mureithi MW, Maffia P, Alam SR, Shah ASV. HIV-Associated Cardiovascular Disease Pathogenesis: An Emerging Understanding Through Imaging and Immunology. Circ Res 2024; 134:1546-1565. [PMID: 38781300 DOI: 10.1161/circresaha.124.323890] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
Cardiac abnormalities were identified early in the epidemic of AIDS, predating the isolation and characterization of the etiologic agent, HIV. Several decades later, the causation and pathogenesis of cardiovascular disease (CVD) linked to HIV infection continue to be the focus of intense speculation. Before the widespread use of antiretroviral therapy, HIV-associated CVD was primarily characterized by HIV-associated cardiomyopathy linked to profound immunodeficiency. With increasing antiretroviral therapy use, viral load suppression, and establishment of immune competency, the effects of HIV on the cardiovascular system are more subtle. Yet, people living with HIV still face an increased incidence of cardiovascular pathology. Advances in cardiac imaging modalities and immunology have deepened our understanding of the pathogenesis of HIV-associated CVD. This review provides an overview of the pathogenesis of HIV-associated CVD integrating data from imaging and immunologic studies with particular relevance to the HIV population originating from high-endemic regions, such as sub-Saharan Africa. The review highlights key evidence gaps in the field and suggests future directions for research to better understand the complex HIV-CVD interactions.
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Affiliation(s)
- Jonathan A Hudson
- Kings College London BHF Centre, School of Cardiovascular and Metabolic Medicine & Sciences, United Kingdom (J.A.H.)
| | - Rashida A Ferrand
- Department of Clinical Research (R.A.F.), London School of Hygiene and Tropical Medicine, United Kingdom
- Biomedical Research and Training Institute, Harare, Zimbabwe (R.A.F.)
| | - Samuel N Gitau
- Department of Radiology, Aga Khan University Nairobi, Kenya (S.N.G.)
| | - Marianne Wanjiru Mureithi
- Department of Medical Microbiology and Immunology, Faculty of Health Sciences (M.W.M.), University of Nairobi, Kenya
| | - Pasquale Maffia
- School of Infection and Immunity, College of Medical, Veterinary and Life Sciences, University of Glasgow, United Kingdom (P.M.)
- Department of Pharmacy, School of Medicine and Surgery, University of Naples Federico II, Italy (P.M.)
- Africa-Europe Cluster of Research Excellence in Non-Communicable Diseases and Multimorbidity, African Research Universities Alliance and The Guild of European Research-Intensive Universities, Glasgow, United Kingdom (P.M.)
| | - Shirjel R Alam
- Department of Cardiology, North Bristol NHS Trust, United Kingdom (S.R.A.)
| | - Anoop S V Shah
- Department of Non-Communicable Disease Epidemiology (A.S.V.S.), London School of Hygiene and Tropical Medicine, United Kingdom
- Department of Cardiology, Imperial College NHS Trust, London, United Kingdom (A.S.V.S.)
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Moshomo T, Molefe-Baikai OJ, Bennett K, Gaolathe T, Moyo S, Gaseitsewe S, Mohammed T, Lockman S, Mosepele M. Cytomegalovirus Immunoglobulin G Levels and Subclinical Arterial Disease among People Living with HIV in Botswana: A Cross-Sectional Study. Biomedicines 2024; 12:935. [PMID: 38790897 PMCID: PMC11118051 DOI: 10.3390/biomedicines12050935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 03/08/2024] [Accepted: 03/20/2024] [Indexed: 05/26/2024] Open
Abstract
Cytomegalovirus (CMV) has been linked with increased cardiovascular risk and monocyte activation in people living with HIV (PLWH). This cross-sectional study aimed to compare CMV immunoglobulin G (IgG) levels between combined antiretroviral therapy (cART)-treated PLWH versus ART-naïve PLWH and those without HIV, and to investigate their associations with biomarkers of endothelial injury and carotid atherosclerosis, in Gaborone, Botswana. All participants were between 30 and 50 years old. Carotid intimal media thickness (cIMT) and biomarkers of endothelial injury and monocyte activation were also assessed. The association between quantitative CMV IgG and cardiovascular disease risk was assessed in multivariate logistic regression analysis. The results showed that the mean CMV IgG level among ART-naïve participants was significantly higher than both the cART group and controls. However, CMV IgG levels did not differ significantly between the controls and cART groups. Among PLWH, CMV IgG levels were associated with ICAM-1 levels and cIMT. Increases in CMV IgG among ART-naïve participants were significantly associated with increases in log VCAM-1. In conclusion, CMV IgG levels are elevated among PLWH in sub-Saharan Africa, and higher levels are associated with biomarkers of endothelial injury and cIMT. Future research should investigate the long-term impact of elevated CMV IgG among PLWH.
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Affiliation(s)
- Thato Moshomo
- Department of Internal Medicine, Faculty of Medicine, University of Botswana, Gaborone Private Bag 00713, Botswana; (O.J.M.-B.); (M.M.)
| | - Onkabetse Julia Molefe-Baikai
- Department of Internal Medicine, Faculty of Medicine, University of Botswana, Gaborone Private Bag 00713, Botswana; (O.J.M.-B.); (M.M.)
| | - Kara Bennett
- Bennett Statistical Consulting, Inc., Ballston Lake, NY 12019, USA
| | - Tendani Gaolathe
- Department of Internal Medicine, Faculty of Medicine, University of Botswana, Gaborone Private Bag 00713, Botswana; (O.J.M.-B.); (M.M.)
- Botswana-Harvard Health Partnership, Gaborone Private Bag BO 320, Botswana
| | - Sikhulile Moyo
- Botswana-Harvard Health Partnership, Gaborone Private Bag BO 320, Botswana
| | - Simani Gaseitsewe
- Botswana-Harvard Health Partnership, Gaborone Private Bag BO 320, Botswana
| | - Terence Mohammed
- Botswana-Harvard Health Partnership, Gaborone Private Bag BO 320, Botswana
| | - Shahin Lockman
- Botswana-Harvard Health Partnership, Gaborone Private Bag BO 320, Botswana
- Department of Immunology & Infectious Diseases, Harvard T. H. Chan School of Public Health, Boston, MA 02115, USA
- Division of Infectious Diseases, Brigham & Women’s Hospital, Boston, MA 02115, USA
| | - Mosepele Mosepele
- Department of Internal Medicine, Faculty of Medicine, University of Botswana, Gaborone Private Bag 00713, Botswana; (O.J.M.-B.); (M.M.)
- Botswana-Harvard Health Partnership, Gaborone Private Bag BO 320, Botswana
- Department of Immunology & Infectious Diseases, Harvard T. H. Chan School of Public Health, Boston, MA 02115, USA
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Peters BA, Hanna DB, Sharma A, Anastos K, Hoover DR, Shi Q, Moran CA, Jackson EA, Alcaide ML, Ofotokun I, Adimora AA, Haberlen SA, Cohen M, Tien PC, Michel KG, Levine SR, Hodis HN, Kaplan RC, Yin MT. Menopausal Hormone Therapy and Subclinical Cardiovascular Disease in Women With and Without Human Immunodeficiency Virus. Clin Infect Dis 2023; 76:e661-e670. [PMID: 35903868 PMCID: PMC10169435 DOI: 10.1093/cid/ciac620] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 06/20/2022] [Accepted: 07/26/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Estrogen-based hormone therapy (HT) may have beneficial cardiovascular effects when initiated in early menopause. This has not been examined in women with human immunodeficiency virus (HIV), who have heightened immune activation and cardiovascular risks. METHODS Among 609 postmenopausal women (1234 person-visits) in the Women's Interagency HIV Study, we examined the relationship of ever HT use (oral, patch, or vaginal) with subclinical atherosclerosis: carotid artery intima-media thickness (CIMT), distensibility, and plaque assessed via repeated B-mode ultrasound imaging (2004-2013). We also examined associations of HT with cross-sectional biomarkers of immune activation and D-dimer. Statistical models were adjusted for sociodemographic, behavioral, and cardiometabolic factors. RESULTS Women (mean age, 51 years; 80% HIV positive) who ever used HT at baseline were older, and more likely to be non-Hispanic White and report higher income, than never-users. Women who ever used HT had 43% lower prevalence of plaque (prevalence ratio, 0.57 [95% confidence interval {CI}, .40-.80]; P < .01), 2.51 µm less progression of CIMT per year (95% CI, -4.60, to -.41; P = .02), and marginally lower incidence of plaque over approximately 7 years (risk ratio, 0.38 [95% CI, .14-1.03; P = .06), compared with never-users, adjusting for covariates; ever HT use was not associated with distensibility. These findings were similar for women with and without HIV. Ever HT use was associated with lower serum D-dimer, but not with biomarkers of immune activation after covariate adjustment. CONCLUSIONS HT may confer a subclinical cardiovascular benefit in women with HIV. These results begin to fill a knowledge gap in menopausal care for women with HIV, in whom uptake of HT is very low.
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Affiliation(s)
- Brandilyn A Peters
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - David B Hanna
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Anjali Sharma
- Department of Medicine, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Kathryn Anastos
- Department of Medicine, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Donald R Hoover
- Department of Statistics and Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, New Jersey, USA
| | - Qiuhu Shi
- School of Health Sciences and Practice, New York Medical College, Valhalla, New York, USA
| | - Caitlin A Moran
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Elizabeth A Jackson
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Maria L Alcaide
- Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Igho Ofotokun
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Adaora A Adimora
- Department of Medicine, UNC School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Sabina A Haberlen
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Mardge Cohen
- Department of Medicine, Stroger Hospital, Cook County Health and Hospital System, Chicago, Illinois, USA
| | - Phyllis C Tien
- Department of Medicine, University of California, San Francisco, San Francisco, California, USA
- Department of Veterans Affairs Medical Center, San Francisco, California, USA
| | - Katherine G Michel
- Department of Medicine, Georgetown University, Washington, District of Columbia, USA
| | - Steven R Levine
- Departments of Neurology and Emergency Medicine, State University of New York Downstate Health Sciences University, Brooklyn, New York, USA
| | - Howard N Hodis
- Departments of Medicine and Population and Public Health Sciences, Atherosclerosis Research Unit, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Robert C Kaplan
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
- Fred Hutchinson Cancer Research Center, Division of Public Health Sciences, Seattle, Washington, USA
| | - Michael T Yin
- Department of Medicine, College of Physicians and Surgeons, Columbia University Medical Center, New York, New York, USA
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4
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Dirajlal-Fargo S, Zhao C, Labbato D, Sattar A, Karungi C, Longenecker CT, Nazzinda R, Funderburg N, Kityo C, Musiime V, McComsey GA. Longitudinal Changes in Subclinical Vascular Disease in Ugandan Youth With Human Immunodeficiency Virus. Clin Infect Dis 2023; 76:e599-e606. [PMID: 36004575 PMCID: PMC10169397 DOI: 10.1093/cid/ciac686] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 07/29/2022] [Accepted: 08/22/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Prospective investigations on the risk of cardiovascular disease among youth with perinatally acquired human immunodeficiency virus (PHIV) in sub-Saharan Africa are lacking. METHODS A prospective observational cohort study was performed in 101 youth (aged 10-18 years) with PHIV and 97 who were human immunodeficiency virus (HIV) uninfected (HIV-), from 2017 to 2021 at the Joint Clinical Research Center in Uganda. Participants with PHIV were receiving antiretroviral therapy (ART) and had HIV-1 RNA levels ≤400 copies/mL. The common carotid artery intima-media thickness (IMT) and pulse wave velocity (PWV) were evaluated at baseline and at 96 weeks. Groups were compared using unpaired t-test, and potential predictors of IMT and PWV were assessed using quantile regression. RESULTS Of the 198 participants recruited at baseline, 168 (89 with PHIV, 79 HIV-) had measurements at 96 weeks. The median age (interquartile range) age was 13 (11-15) years; 52% were female, and 85% had viral loads <50 copies/mL that remained undetectable at week 96. The baseline mean common carotid artery IMT was slightly higher in participants with PHIV compared with controls (P < .01), and PWV did not differ between groups (P = .08). At week 96, IMT decreased and PWV increased in the PHIV group (P ≤ .03); IMT increased in the HIV- group (P = .03), with no change in PWV (P = .92). In longitudinal analyses in those with PHIV, longer ART duration was associated with lower PWV (β = .008 [95% confidence interval, -.008 to .003]), and abacavir use with greater IMT (β = .043 [.012-.074]). CONCLUSIONS In healthy Ugandan youth with PHIV, virally suppressed by ART, the common carotid artery IMT did not progress over 2 years. Prolonged and early ART may prevent progression of subclinical vascular disease, while prolonged use of abacavir may increase it.
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Affiliation(s)
- Sahera Dirajlal-Fargo
- Department of Pediatrics, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
- Rainbow Babies and Children’s Hospital, Cleveland, Ohio, USA
- Case Western Reserve University, Cleveland, Ohio, USA
| | - Chenya Zhao
- Case Western Reserve University, Cleveland, Ohio, USA
| | - Danielle Labbato
- Department of Pediatrics, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Abdus Sattar
- Case Western Reserve University, Cleveland, Ohio, USA
| | | | | | | | - Nicholas Funderburg
- Ohio State University School of Health and Rehabilitation Sciences, Columbus, Ohio, USA
| | - Cissy Kityo
- Joint Clinical Research Centre, Kampala, Uganda
| | - Victor Musiime
- Joint Clinical Research Centre, Kampala, Uganda
- Makerere University, Kampala, Uganda
| | - Grace A McComsey
- Department of Pediatrics, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
- Rainbow Babies and Children’s Hospital, Cleveland, Ohio, USA
- Case Western Reserve University, Cleveland, Ohio, USA
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Farrant MT, Masyuko SJ, Kinuthia J, Osoti AO, Mogaka JN, Temu TM, Zifodya JS, Nakanjako D, Ameda F, Farquhar C, Page ST. Association of HIV, cardiovascular risk factors, and carotid intimal media thickness: A cross-sectional study in Western Kenya. Medicine (Baltimore) 2022; 101:e31366. [PMID: 36451447 PMCID: PMC9704953 DOI: 10.1097/md.0000000000031366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
The carotid intimal media thickness (CIMT) is a validated measure of subclinical atherosclerosis. Human immunodeficiency virus (HIV) is a risk factor for cardiovascular disease (CVD) and has been associated with CIMT in North America and Europe; however, there are limited data from Sub-Saharan Africa (SSA). In this cross-sectional study, we measured CIMT in a cohort of 262 people living with HIV (PLHIV) on antiretroviral therapy (ART) for ≥6 months and HIV-negative adults in western Kenya. Using linear regression, we examined the associations between CVD risk factors and CIMT, both overall and stratified according to the HIV status. Among the PLHIV, we examined the association between CIMT and HIV-related factors. Of 262 participants, approximately half were women. The HIV-negative group had a higher prevalence of age ≥55 years (P = .002), previously diagnosed hypertension (P = .02), treatment for hypertension (P = .03), and elevated blood pressure (BP) (P = .01). Overall prevalence of carotid plaques was low (15/262 [6.0%]). HIV-positive status was not significantly associated with a greater mean CIMT (P = .19). In multivariable regression models, PLHIV with elevated blood pressure or treatment for hypertension had a greater mean CIMT (P = .002). However, the CD4 count, viral load, and ART regimen were not associated with differences in CIMT. In the HIV-negative group, older age (P = .006), high total cholesterol levels (P = .01), and diabetes (P = .02) were associated with a greater mean CIMT. In this cross-sectional study of Kenyan adults, traditional CVD risk factors were found to be more prevalent among HIV-negative participants. After multivariable regression analysis, we found no association between HIV status and CIMT, and PLHIV had fewer CVD risk factors associated with CIMT than HIV-negative participants did. HIV-specific factors were not associated with the CIMT.
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Affiliation(s)
- Maritza T. Farrant
- Department of Global Health, University of Washington, Seattle, WA, USA
- * Correspondence: Maritza T. Farrant, Department of Global Health, University of Washington, Seattle, WA 98195, USA (e-mail: )
| | - Sarah J. Masyuko
- Department of Global Health, University of Washington, Seattle, WA, USA
- Ministry of Health, Nairobi, Kenya
| | - John Kinuthia
- Department of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya
| | - Alfred O. Osoti
- Department of Global Health, University of Washington, Seattle, WA, USA
- Department of Obstetrics and Gynaecology, University of Nairobi, Nairobi, Kenya, Tulane University, New Orleans, LA, USA
| | - Jerusha N. Mogaka
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Tecla M. Temu
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Jerry S. Zifodya
- Department of Medicine, Section of Pulmonary, Critical Care & Environmental Medicine, Tulane University, New Orleans, LA, USA
| | - Damalie Nakanjako
- Department of Medicine, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Faith Ameda
- Department of Radiology, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Carey Farquhar
- Department of Global Health, University of Washington, Seattle, WA, USA
- Department of Medicine, University of Washington, Seattle, WA, USA
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Stephanie T. Page
- Department of Global Health, University of Washington, Seattle, WA, USA
- Department of Medicine, University of Washington, Seattle, WA, USA
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Kausalya B, Saravanan S, Pallikkuth S, Pahwa R, Saini SR, Iqbal S, Solomon S, Murugavel KG, Poongulali S, Kumarasamy N, Pahwa S. Immune correlates of cardiovascular co-morbidity in HIV infected participants from South India. BMC Immunol 2022; 23:24. [PMID: 35581554 PMCID: PMC9115939 DOI: 10.1186/s12865-022-00498-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 02/07/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Understanding the immune correlates of cardiovascular disease (CVD) risk in HIV infection is an important area of investigation in the current era of aging with HIV infection. Less is known about CVD risk and HIV infection in developing nations where additional risk factors may be playing a role in the CVD development. In this study, we assessed the effects of systemic inflammation, microbial translocation (MT), T cell immune activation (IA), and nadir CD4 counts on cardiac function and arterial stiffness as markers of subclinical atherosclerosis in HIV-infected individuals. METHODS People with HIV (PWH) who were ART naïve (n = 102) or virally suppressed on ART (n = 172) were stratified on nadir CD4 counts and compared to HIV-uninfected controls (n = 64). Determination was made of cardiac function via radial pulse wave and carotid intima thickness (C-IMT) measurements. Plasma biomarkers of inflammation and MT by ELISA or multiplex assays, and immune activation (IA) of T cells based HLA-DR and CD38 expression were investigated by flow cytometry. T-test, Mann-Whitney U test, and Spearman correlation were used to analyze study parameters. RESULTS Reduction in cardiac function with lower cardiac ejection time (p < 0.001), stroke volume (p < 0.001), cardiac output (p = 0.007), higher arterial stiffness (p < 0.05) were identified in ART-naïve participants, compared to PWH on ART (p < 0.05). No significant difference in C-IMT values were noted. Higher inflammatory and MT markers were found in the ART-naïve group compared to treated group who were comparable to uninfected participants, except for having higher TNF-α (p < 0.001) and sCD14 (p < 0.001). Immune activation of CD4 and CD8 T-cells was greater in ART-naïve participants compared to ART-treated and uninfected controls (p < 0.05). Lower nadir CD4 counts, higher inflammation, and higher MT predicted poor cardiac measures in the ART-naïve with nadir CD4 < 200cells/mm3 manifesting the highest arterial stiffness, and lowest cardiac function, whereas ART-treated, even with nadir < 200 cells/mm3 were similar to uninfected in these measures. CONCLUSIONS In HIV-infected individuals, initiation of ART even at nadir of < 200 cells/mm3 may prevent or reverse cardiovascular disease outcomes that are easily measurable in low income countries.
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Affiliation(s)
| | | | - Suresh Pallikkuth
- University of Miami Miller School of Medicine, 1580 NW 10th Avenue; BCRI 712, Miami, FL, 33136, USA
| | - Rajendra Pahwa
- University of Miami Miller School of Medicine, 1580 NW 10th Avenue; BCRI 712, Miami, FL, 33136, USA
| | - Shelly Rani Saini
- University of Miami Miller School of Medicine, 1580 NW 10th Avenue; BCRI 712, Miami, FL, 33136, USA
| | - Syed Iqbal
- YRG Centre for AIDS Research and Education (YRG CARE), Chennai, India
| | - Sunil Solomon
- YRG Centre for AIDS Research and Education (YRG CARE), Chennai, India.,Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | | | - Nagalingeswaran Kumarasamy
- YRG Centre for AIDS Research and Education (YRG CARE), Chennai, India.,Johns Hopkins University School of Medicine, Baltimore, MD, USA.,VHS-Infectious Diseases Medical Centre, Chennai, India
| | - Savita Pahwa
- University of Miami Miller School of Medicine, 1580 NW 10th Avenue; BCRI 712, Miami, FL, 33136, USA.
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Codjo HL, Attinsounon CA, Mele R, Dohou SHM, Rouga KD, Amegan HN, Biaou COA, Sylvestri V, Caronna R, Houenassi M. Frequency and factors associated with arterial remodeling in persons living with human immunodeficiency virus in Parakou in 2019. JOURNAL DE MEDECINE VASCULAIRE 2022; 47:71-81. [PMID: 35691666 DOI: 10.1016/j.jdmv.2022.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Accepted: 04/16/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND The side effects of antiretroviral drugs and the chronic inflammation induced by human immunodeficiency virus (HIV) infection contribute to the development of atherosclerotic arterial remodeling in people living with HIV (PLWH). OBJECTIVES To determine the frequency and factors associated with arterial remodeling in PLWH treated at the university hospital of Parakou. METHODS It was a cross-sectional, descriptive, and analytic study. Data were collected from March to August 2019 at the university hospital of Parakou in Benin. PLWH aged at least 18years and consenting were included. The diagnosis of arterial remodeling was retained in the presence of at least one of the following criteria: carotid intima-media thickness≥1mm, anteroposterior diameter of the abdominal aorta≥25mm, ankle brachial index<0.9, presence of atheromatous plaque. Data were recorded and analyzed with R 3.5.1 software, and the threshold of significance was 5%. RESULTS A total of 114 patients have undergone arterial Doppler ultrasound. The majority were women (71.9%). The patients' mean age was 43.2±10.2years with extremes of 18 and 67years. The frequency of arterial remodeling was 24.6%. The most common atherosclerotic lesion found was atheromatous overload (IMT≥1mm). Age≥50y (p=0.003; ORa=4.9[1.5-15.6]), male sex (p=0.037; ORa=4.1[1.3-13.4]), and a family history of hypertension and/or diabetes (p=0.027; ORa=3.6[1.1-12.8]) were significantly associated with atherosclerosis in PLWH. CONCLUSION Arterial remodeling was frequent among PLWH in Parakou in 2019. The associated factors were the classic cardiovascular risk factors that should be systematically taken into account in the follow-up of these patients.
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Affiliation(s)
- H L Codjo
- UER Cardiologie, Faculté de Médecine, Université de Parakou, BP 123, Parakou, Benin.
| | - C A Attinsounon
- UER Maladies infectieuses et tropicales, Faculté de Médecine, Université de Parakou, Parakou, Benin
| | - R Mele
- Département des sciences chirurgicales, Université de Rome, La Sapienza, Italy
| | - S H M Dohou
- UER Cardiologie, Faculté de Médecine, Université de Parakou, BP 123, Parakou, Benin
| | - K D Rouga
- UER Cardiologie, Faculté de Médecine, Université de Parakou, BP 123, Parakou, Benin
| | - H N Amegan
- École Doctorale des Sciences de la Santé, Université d'Abomey-Calavi, Cotonou, Benin
| | - C O A Biaou
- Institut Régional de Santé Publique, Université d'Abomey-Calavi, Ouidah, Benin
| | - V Sylvestri
- Département des sciences chirurgicales, Université de Rome, La Sapienza, Italy
| | - R Caronna
- Département des sciences chirurgicales, Université de Rome, La Sapienza, Italy
| | - M Houenassi
- Clinique Universitaire de Cardiologie, Faculté des Sciences de la Santé, Université d'Abomey-Calavi, Cotonou, Benin
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8
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Ransley G, Zimba S, Gadama Y, Saylor D, Benjamin L. Trends and Clinical Characteristics of HIV and Cerebrovascular Disease in Low- and Middle-Income Countries (LMICs) Between 1990 and 2021. Curr HIV/AIDS Rep 2022; 19:548-565. [PMID: 36264482 PMCID: PMC9759508 DOI: 10.1007/s11904-022-00627-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2022] [Indexed: 01/31/2023]
Abstract
PURPOSE OF THE REVIEW To describe trends and clinical characteristics of HIV and cerebrovascular disease between 1990 and 2021 in LMICs and identify the gaps in our understanding. RECENT FINDINGS In the era of antiretroviral therapy (ART), people living with HIV (PLWH) live longer and risk excess cerebrovascular events due to ageing and HIV-driven factors. Despite the highest burden of HIV infection in low-to-middle income countries, there is underreporting in the literature of cerebrovascular events in this population. We systematically reviewed published literature for primary clinical studies in adult PLWH and cerebrovascular disease in LMICs. The clinical phenotype of cerebrovascular disease among PLWH over the last three decades in LMICs has evolved and transitioned to an older group with overlapping cerebrovascular risk factors. There is an important need to increase research in this population and standardise reporting to facilitate understanding, guide development of appropriate interventions, and evaluate their impact.
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Affiliation(s)
- George Ransley
- grid.83440.3b0000000121901201National Hospital for Neurology and Neurosurgery, University College London Foundation Trust, London, UK
| | - Stanley Zimba
- grid.79746.3b0000 0004 0588 4220Department of Internal Medicine, University Teaching Hospital, Lusaka, Zambia
| | - Yohane Gadama
- grid.11956.3a0000 0001 2214 904XDivision of Neurology, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa ,grid.419393.50000 0004 8340 2442Malawi-Liverpool Wellcome Trust Clinical Research Program, Kamuzu University of Health Sciences (KUHeS), Blantyre, Malawi
| | - Deanna Saylor
- grid.79746.3b0000 0004 0588 4220Department of Internal Medicine, University Teaching Hospital, Lusaka, Zambia ,grid.21107.350000 0001 2171 9311Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD USA
| | - Laura Benjamin
- grid.83440.3b0000000121901201National Hospital for Neurology and Neurosurgery, University College London Foundation Trust, London, UK ,grid.83440.3b0000000121901201MRC LMCB, University College London, Gower Street, London, WC1E 6BT UK
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Bibangambah P, Hemphill LC, Acan M, Tsai AC, Sentongo RN, Kim JH, Yang IT, Siedner MJ, Okello S. Prevalence and correlates of carotid plaque in a mixed HIV-serostatus cohort in Uganda. BMC Cardiovasc Disord 2021; 21:593. [PMID: 34911457 PMCID: PMC8672630 DOI: 10.1186/s12872-021-02416-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 12/07/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The extent to which the risk of atherosclerotic cardiovascular disease (ACVD) is increased among people living with HIV (PLWH) in sub-Saharan Africa remains unknown. SETTING Cross-sectional analysis nested within the Ugandan Noncommunicable Diseases and Aging Cohort, including PLWH in rural Uganda > 40 years taking antiretroviral therapy (ART) for at least 3 years, and a population-based control group of HIV-uninfected age- and sex-matched persons. METHODS We conducted carotid ultrasonography and collected ACVD risk factor data. Our outcome of interest was carotid plaque, defined as > 1.5 mm thickness from the intima-lumen interface to the media-adventitia interface. We fit multivariable logistic regression models to estimate correlates of carotid plaque including HIV-specific and traditional cardiovascular risk factors. RESULTS We enrolled 155 (50.2%) PLWH and 154 (49.8%) HIV-uninfected comparators, with a mean age of 51.4 years. Among PLWH, the median CD4 count was 433 cells/mm3 and 97.4% were virologically suppressed. Carotid plaque prevalence was higher among PLWH (8.4% vs 3.3%). HIV infection (aOR 3.90; 95% CI 1.12-13.60) and current smokers (aOR 6.60; 95% CI 1.22-35.80) had higher odds of carotid plaque, whereas moderate (aOR 0.13, 95% CI 0.01-1.55) and vigorous intensity of physical activity (aOR 0.34, 95% CI 0.07-1.52) were associated with decreased odds of carotid plaque. CONCLUSION In rural Uganda, PLWH have higher prevalence of carotid plaque compared to age- and sex-matched HIV-uninfected comparators. Future work should explore how biomedical and lifestyle modifications might reduce atherosclerotic burden among PLWH in the region.
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Affiliation(s)
- Prossy Bibangambah
- Department of Radiology, Mbarara University of Science and Technology, P.O. Box, 1410, Mbarara, Uganda.
| | - Linda C. Hemphill
- grid.32224.350000 0004 0386 9924Massachusetts General Hospital, Boston, MA USA ,grid.38142.3c000000041936754XHarvard Medical School, Boston, MA USA
| | - Moses Acan
- grid.33440.300000 0001 0232 6272Department of Radiology, Mbarara University of Science and Technology, P.O. Box, 1410 Mbarara, Uganda
| | - Alexander C. Tsai
- grid.32224.350000 0004 0386 9924Massachusetts General Hospital, Boston, MA USA
| | - Ruth N. Sentongo
- grid.33440.300000 0001 0232 6272Department of Radiology, Mbarara University of Science and Technology, P.O. Box, 1410 Mbarara, Uganda
| | - June-Ho Kim
- grid.32224.350000 0004 0386 9924Massachusetts General Hospital, Boston, MA USA
| | - Isabelle T. Yang
- grid.254880.30000 0001 2179 2404Geisel School of Medicine at Dartmouth, Hanover, NH USA
| | - Mark J. Siedner
- grid.33440.300000 0001 0232 6272Department of Radiology, Mbarara University of Science and Technology, P.O. Box, 1410 Mbarara, Uganda ,grid.32224.350000 0004 0386 9924Massachusetts General Hospital, Boston, MA USA ,grid.38142.3c000000041936754XHarvard Medical School, Boston, MA USA
| | - Samson Okello
- grid.33440.300000 0001 0232 6272Department of Radiology, Mbarara University of Science and Technology, P.O. Box, 1410 Mbarara, Uganda
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10
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Siedner MJ, Bibangambah P, Kim J, Lankowski A, Chang JL, Yang IT, Kwon DS, North CM, Triant VA, Longenecker C, Ghoshhajra B, Peck RN, Sentongo RN, Gilbert R, Kakuhikire B, Boum Y, Haberer JE, Martin JN, Tracy R, Hunt PW, Bangsberg DR, Tsai AC, Hemphill LC, Okello S. Treated HIV Infection and Progression of Carotid Atherosclerosis in Rural Uganda: A Prospective Observational Cohort Study. J Am Heart Assoc 2021; 10:e019994. [PMID: 34096320 PMCID: PMC8477876 DOI: 10.1161/jaha.120.019994] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Background Although ≈70% of the world's population of people living with HIV reside in sub-Saharan Africa, there are minimal prospective data on the contributions of HIV infection to atherosclerosis in the region. Methods and Results We conducted a prospective observational cohort study of people living with HIV on antiretroviral therapy >40 years of age in rural Uganda, along with population-based comparators not infected with HIV. We collected data on cardiovascular disease risk factors and carotid ultrasound measurements annually. We fitted linear mixed effects models, adjusted for cardiovascular disease risk factors, to estimate the association between HIV serostatus and progression of carotid intima media thickness (cIMT). We enrolled 155 people living with HIV and 154 individuals not infected with HIV and collected cIMT images at 1045 visits during a median of 4 annual visits per participant (interquartile range 3-4, range 1-5). Age (median 50.9 years) and sex (49% female) were similar by HIV serostatus. At enrollment, there was no difference in mean cIMT by HIV serostatus (0.665 versus 0.680 mm, P=0.15). In multivariable models, increasing age, blood pressure, and non-high-density lipoprotein cholesterol were associated with greater cIMT (P<0.05), however change in cIMT per year was also no different by HIV serostatus (0.004 mm/year for HIV negative [95% CI, 0.001-0.007 mm], 0.006 mm/year for people living with HIV [95% CI, 0.003-0.008 mm], HIV×time interaction P=0.25). Conclusions In rural Uganda, treated HIV infection was not associated with faster cIMT progression. These results do not support classification of treated HIV infection as a risk factor for subclinical atherosclerosis progression in rural sub-Saharan Africa. Registration URL: https://www.ClinicalTrials.gov; Unique identifier: NCT02445079.
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Affiliation(s)
- Mark J. Siedner
- Department of MedicineHarvard Medical SchoolBostonMA,Departments of Medicine and PsychiatryMassachusetts General HospitalBostonMA,Faculty of MedicineMbarara University of Science and TechnologyMbararaUganda
| | - Prossy Bibangambah
- Faculty of MedicineMbarara University of Science and TechnologyMbararaUganda
| | - June‐Ho Kim
- Department of MedicineHarvard Medical SchoolBostonMA,Department of MedicineBrigham and Women's HospitalBostonMA
| | - Alexander Lankowski
- Department of MedicineUniversity of WashingtonSeattleWA,Vaccine and Infectious Disease DivisionFred Hutchinson Cancer Research CenterSeattleWA
| | - Jonathan L. Chang
- Department of MedicineHarvard Medical SchoolBostonMA,Department of MedicineBrigham and Women's HospitalBostonMA
| | - Isabelle T. Yang
- Department of MedicineGeisel School of Medicine at DartmouthHanoverNH
| | - Douglas S. Kwon
- Department of MedicineHarvard Medical SchoolBostonMA,Departments of Medicine and PsychiatryMassachusetts General HospitalBostonMA,Ragon Institute of Massachusetts General Hospital, Massachusetts Institute of Technology, and HarvardCambridgeMA
| | - Crystal M. North
- Department of MedicineHarvard Medical SchoolBostonMA,Departments of Medicine and PsychiatryMassachusetts General HospitalBostonMA
| | - Virginia A. Triant
- Department of MedicineHarvard Medical SchoolBostonMA,Departments of Medicine and PsychiatryMassachusetts General HospitalBostonMA
| | | | - Brian Ghoshhajra
- Department of MedicineHarvard Medical SchoolBostonMA,Departments of Medicine and PsychiatryMassachusetts General HospitalBostonMA
| | - Robert N. Peck
- Center for Global HealthWeill Cornell Medical CollegeNew YorkNY
| | - Ruth N. Sentongo
- Faculty of MedicineMbarara University of Science and TechnologyMbararaUganda
| | - Rebecca Gilbert
- Departments of Medicine and PsychiatryMassachusetts General HospitalBostonMA
| | - Bernard Kakuhikire
- Faculty of MedicineMbarara University of Science and TechnologyMbararaUganda
| | - Yap Boum
- Epicentre Research BaseMbararaUganda
| | - Jessica E. Haberer
- Department of MedicineHarvard Medical SchoolBostonMA,Departments of Medicine and PsychiatryMassachusetts General HospitalBostonMA
| | | | - Russell Tracy
- Department of Pathology and Laboratory MedicineUniversity of VermontBurlingtonVT
| | - Peter W. Hunt
- Department of MedicineUniversity of CaliforniaSan FranciscoCA
| | | | - Alexander C. Tsai
- Department of MedicineHarvard Medical SchoolBostonMA,Departments of Medicine and PsychiatryMassachusetts General HospitalBostonMA,Faculty of MedicineMbarara University of Science and TechnologyMbararaUganda
| | - Linda C. Hemphill
- Department of MedicineHarvard Medical SchoolBostonMA,Departments of Medicine and PsychiatryMassachusetts General HospitalBostonMA
| | - Samson Okello
- Faculty of MedicineMbarara University of Science and TechnologyMbararaUganda
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11
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Phalane E, Fourie C, Schutte AE, Kruger IM, Mels C. Arterial structure and function in Africans with HIV for > 5 years: longitudinal relationship with endothelial activation and cardiovascular risk markers. HIV Med 2021; 22:650-661. [PMID: 33949073 DOI: 10.1111/hiv.13111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 02/27/2021] [Accepted: 03/22/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES We aimed to determine whether people with human immunodeficiency virus (PWHIV) have increased measures of arterial injury [carotid intima-media thickness (cIMT)] and large artery stiffness [carotid-femoral pulse wave velocity (cfPWV)] when compared with their counterparts without HIV, and whether baseline markers of endothelial activation and cardiovascular risk are associated with cIMT and cfPWV after 5 years. METHODS We matched 126 PWHIV from North West Province, South Africa, to 126 without HIV according to age, sex and locality. Cardiovascular risk and endothelial function markers [soluble intracellular adhesion molecule (ICAM-1) and soluble vascular cell adhesion molecule (VCAM-1)] were measured at baseline and cIMT and cfPWV at follow-up. RESULTS This study included 21.4% men. The use of antiretroviral therapy (ART) increased from 44.1% at baseline to 81.4% at follow-up. At follow-up, cIMT (P = 0.90) and cfPWV (P = 0.35) were similar in the groups. Despite elevated ICAM-1 and VCAM-1 in the PWHIV (all P < 0.001) at baseline, these markers did not associate with cIMT and cfPWV after 5 years. In multivariable-adjusted regression analysis, cIMT associated positively with age (β = 0.31, P = 0.002) and triglyceride: high-density lipoprotein-cholesterol (β = 0.23, P = 0.016) in PWHIV. Mean arterial pressure (MAP) (β = 0.28, P = 0.010) associated positively with cfPWV in the PWHIV. In the people without HIV, sex (β = 0.31, P = 0.004) and glycated haemoglobin (HbA1c) (β = 0.24, P = 0.026) associated with cIMT while age (β = 0.17, P = 0.049), sex (β = 0.29, P = 0.003), MAP (β = 0.31, P = 0.001) and HbA1c (β = 0.21, P = 0.041) associated positively with cfPWV. CONCLUSIONS Measures of arterial structure and function were similar in Africans with HIV and their age, sex and locality matched controls. Traditional cardiovascular risk markers rather than elevated endothelial activation at baseline were independently associated with cIMT and cfPWV over 5 years.
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Affiliation(s)
- E Phalane
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa
| | - Cmt Fourie
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa.,Medical Research Council Unit for Hypertension and Cardiovascular Disease, Faculty of Health Sciences, North-West University, Potchefstroom, South Africa
| | - A E Schutte
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa.,Medical Research Council Unit for Hypertension and Cardiovascular Disease, Faculty of Health Sciences, North-West University, Potchefstroom, South Africa.,School of Population Health, University of New South Wales, The George Institute for Global Health, Sydney, NSW, Australia
| | - I M Kruger
- Africa Unit for Transdisciplinary Health Research (AUTHeR), North-West University, Potchefstroom, South Africa
| | - Cmc Mels
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa.,Medical Research Council Unit for Hypertension and Cardiovascular Disease, Faculty of Health Sciences, North-West University, Potchefstroom, South Africa
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12
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Liu X, Sun Y, Zhan Y, Jiang Y. Prevalence and risk of subclinical carotid atherosclerosis in the global population with HIV: a systematic review and meta-analysis. Int J STD AIDS 2021; 32:411-420. [PMID: 33494655 DOI: 10.1177/0956462420972854] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The current evidence regarding the prevalence of subclinical carotid atherosclerosis (SCA) for people living with HIV(PLWH) is inconsistent. In this study, we aimed to synthesize data on the prevalence and association of SCA patients with HIV infection. We searched PubMed, EMBASE, Web of Science, Medline, SinoMed, and CNKI from inception to March 2, 2020. The pooled proportion, odds ratio (OR) with 95% confidence intervals (CIs) were calculated. For inclusion, SCA was measured by carotid intima-media thickness (CIMT), with a B-mode ultrasound machine. Twenty-six studies consisting of 6590 participants were identified. The overall prevalence of SCA was 31.6% (95% CI 13.4-53.3; I2 = 99%; 4 studies) according to CIMT ≥ 0.78 mm criteria, and 32.3% (19.6-46.4; 97%; 10 studies) according to CIMT ≥ 0.90 mm criteria. SCA prevalence was higher in Europe, over 40 years old and male. What's more, PLWH have a higher likelihood of developing SCA comorbidity than HIV-negative controls (pooled OR 2.66, 95% CI 1.57-4.50, I2 = 74%; 9 studies), even after sensitivity analysis (pooled OR 2.58, 1.54-4.31, 73%). This study suggests a high prevalence and risk of SCA in the global population with HIV. As a result, subclinical carotid atherosclerosis deserves more attention from policymakers, HIV health-care providers, researchers, and stakeholders.
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Affiliation(s)
- Xuan Liu
- Department of Epidemiology and Biostatistics, School of Population Medicine and Public Health, 12501Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yang Sun
- The Institute of Medical Information, 12501Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yongle Zhan
- Department of Epidemiology and Biostatistics, School of Population Medicine and Public Health, 12501Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yu Jiang
- Department of Epidemiology and Biostatistics, School of Population Medicine and Public Health, 12501Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
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13
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A comparative analysis of blood pressure in HIV-infected patients versus uninfected controls residing in Sub-Saharan Africa: a narrative review. J Hum Hypertens 2020; 34:692-708. [PMID: 32709885 DOI: 10.1038/s41371-020-0385-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 07/02/2020] [Accepted: 07/16/2020] [Indexed: 12/11/2022]
Abstract
Elevated blood pressure (BP) is an important risk factor for cardiovascular disease and mortality in Sub-Saharan Africa (SSA). We reviewed the literature comparing BP in treated HIV-infected populations against untreated and/or uninfected controls from SSA. We conducted a narrative review through PubMed and EBSCO Discovery Service to determine estimates of raised BP and hypertension in HIV-infected patients versus untreated/uninfected controls (1 January 2005 to 31 July 2019 and 9 May 2020). We included 19 eligible studies that compared treated HIV-infected with untreated and/or uninfected controls. In studies comparing treated HIV-infected patients to uninfected controls, studies including 6882 (56.30%) and 21,819 (79.2%) participants reported lower BP and hypertension prevalence, respectively in HIV-infected patients; whereas studies including 753 (6.16%) and 3553 (12.9%) participants showed a higher BP and hypertension prevalence. Lastly, 4588 (37.54%) and 2180 (7.91%) participants showed no difference in BP and the prevalence of hypertension. When comparing BP of treated versus untreated HIV-infected patients, studies including 5757 (44.2%) patients reported lower BP in treated patients; while studies with 200 (1.53%) patients showed higher BP and 7073 (54.28%) showed no difference in BP. For hypertension status, studies with 4547 (74.5%) patients reported a lower prevalence of hypertension in treated patients; whereas studies with 598 (9.80%) patients showed higher prevalence; and 959 (15.7%) no difference in prevalence between treated versus untreated HIV-infected patients. In studies conducted in Sub-Saharan Africa, the majority of the findings indicate lower blood pressure and/or prevalence of hypertension in treated HIV-infected individuals compared to untreated and uninfected controls.
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14
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Vos AG, Barth RE, Klipstein-Grobusch K, Tempelman HA, Devillé WLJ, Dodd C, Coutinho RA, Grobbee DE. Cardiovascular Disease Burden in Rural Africa: Does HIV and Antiretroviral Treatment Play a Role?: Baseline Analysis of the Ndlovu Cohort Study. J Am Heart Assoc 2020; 9:e013466. [PMID: 32223395 PMCID: PMC7428654 DOI: 10.1161/jaha.119.013466] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background HIV is associated with an increased risk of cardiovascular disease (CVD) in high‐income countries. Little is known about the CVD burden in sub‐Saharan Africa, where 70% of the world's HIV‐positive population lives. This study aims to provide insight into the burden of CVD risk in a rural setting in sub‐Saharan Africa considering HIV infection and antiretroviral therapy (ART). Methods and Results A cross‐sectional analysis was conducted of the baseline of the Ndlovu Cohort study including HIV‐negative and HIV‐positive participants in rural South Africa between 2014 and 2017. Information was collected on demographics, socioeconomic status, and CVD risk factors. Carotid intima‐media thickness measurement was performed. The influence of HIV and ART on the burden of CVD was determined by comparing HIV‐positive participants who were ART naive on first‐line or second‐line ART with HIV‐negative participants. In total, 1927 participants were included, of whom 887 (46%) were HIV positive and 54% women. The median age was 38 years. Overall, 690 participants (79%) were on ART, with 613 (89%) on first‐line and 77 (11%) on second‐line therapy. Participants with HIV had lower values for most of the CVD risk factors but higher C‐reactive protein levels than HIV‐negative participants. ART‐naive, HIV‐positive participants had similar carotid intima‐media thickness compared with HIV‐negative participants but carotid intima‐media thickness was increased for participants on ART aged 30 years and older compared with HIV‐negative participants. Conclusions HIV‐positive participants presented with a favorable CVD risk profile compared with HIV‐negative participants. However, carotid intima‐media thickness was increased in HIV‐positive participants on ART, indicating a higher burden of subclinical CVD for the HIV‐positive population.
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Affiliation(s)
- Alinda G Vos
- Julius Global Health Julius Center for Health Sciences and Primary Care University Medical Center Utrecht the Netherlands.,Department of Internal Medicine & Infectious Diseases University Medical Center Utrecht the Netherlands.,Wits Reproductive Health and HIV Institute Faculty of Health Sciences University of Witwatersrand Johannesburg South Africa
| | - Roos E Barth
- Department of Internal Medicine & Infectious Diseases University Medical Center Utrecht the Netherlands
| | - Kerstin Klipstein-Grobusch
- Julius Global Health Julius Center for Health Sciences and Primary Care University Medical Center Utrecht the Netherlands.,Division of Epidemiology and Biostatistics School of Public Health Faculty of Health Sciences University of the Witwatersrand Johannesburg South Africa
| | | | - Walter L J Devillé
- Julius Global Health Julius Center for Health Sciences and Primary Care University Medical Center Utrecht the Netherlands
| | - Caitlin Dodd
- Julius Global Health Julius Center for Health Sciences and Primary Care University Medical Center Utrecht the Netherlands
| | - Roel A Coutinho
- Julius Global Health Julius Center for Health Sciences and Primary Care University Medical Center Utrecht the Netherlands
| | - Diederick E Grobbee
- Julius Global Health Julius Center for Health Sciences and Primary Care University Medical Center Utrecht the Netherlands
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15
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Vos AG, Hoeve K, Barth RE, Peper J, Moorhouse M, Crowther NJ, Venter WDF, Grobbee DE, Bots ML, Klipstein-Grobusch K. Cardiovascular disease risk in an urban African population: a cross-sectional analysis on the role of HIV and antiretroviral treatment. Retrovirology 2019; 16:37. [PMID: 31796103 PMCID: PMC6889610 DOI: 10.1186/s12977-019-0497-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Accepted: 11/22/2019] [Indexed: 01/19/2023] Open
Abstract
Background Life expectancy is increasing in the HIV-positive population and age-related non-communicable diseases, such as cardiovascular disease, (CVD) are seen more frequently. This study investigated to what extent HIV and antiretroviral therapy (ART) is associated with CVD risk in an urban African population. Methods A cross-sectional study was performed in Johannesburg, South Africa, between July 2016 and November 2017. Both HIV-positive adults (ART-naïve, or on first- or second-line ART), as well as age and sex matched HIV-negative controls who were family or friends of the HIV-positive participants were included. Data were collected on demographics, cardiovascular risk factors, HIV-related characteristics, carotid intima-media thickness (CIMT) and carotid distensibility. The association between HIV, ART and CIMT and distensibility was analysed with linear regression models, adjusting for age, gender and CVD risk factors. Results The study included 548 participants, 337 (62%) females, age 38.3 ± 9.5 years of whom 104 (19.0%) were HIV-positive, ART-naïve; 94 (17.2%) were on first-line ART; 197 (35.9%) were on second-line ART; and 153 (27.9%) were HIV-negative. Participants on second-line ART had higher CIMT and lower distensibility compared to the other groups (p < 0.001). After adjustment for age, these outcomes were similar between groups. Further adjustment for CVD and HIV-related factors did not alter the findings. Conclusion Neither HIV nor ART was associated with CIMT or carotid distensibility in this urban African population. Longitudinal studies are needed to fully understand the relationship between HIV and CVD across different populations.
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Affiliation(s)
- Alinda G Vos
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Universiteitsweg 100, 3584 CG, Utrecht, The Netherlands. .,Department of Internal Medicine & Infectious Diseases, University Medical Center Utrecht, Utrecht, The Netherlands. .,Ezintsha, Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa.
| | - Klariska Hoeve
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Universiteitsweg 100, 3584 CG, Utrecht, The Netherlands
| | - Roos E Barth
- Department of Internal Medicine & Infectious Diseases, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Joyce Peper
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Michelle Moorhouse
- Ezintsha, Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Nigel J Crowther
- Department of Chemical Pathology, National Health Laboratory Service and University of the Witwatersrand, Johannesburg, South Africa
| | - Willem D F Venter
- Ezintsha, Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Diederick E Grobbee
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Universiteitsweg 100, 3584 CG, Utrecht, The Netherlands
| | - Michiel L Bots
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Universiteitsweg 100, 3584 CG, Utrecht, The Netherlands
| | - Kerstin Klipstein-Grobusch
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Universiteitsweg 100, 3584 CG, Utrecht, The Netherlands.,Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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16
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Innes S, Patel K. Noncommunicable diseases in adolescents with perinatally acquired HIV-1 infection in high-income and low-income settings. Curr Opin HIV AIDS 2018; 13:187-195. [PMID: 29432231 PMCID: PMC5934760 DOI: 10.1097/coh.0000000000000458] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE OF REVIEW Perinatally HIV-infected adolescents may be at increased risk of noninfectious comorbidities later in life. This review summarizes recent advances in the understanding of noncommunicable diseases (NCD) among HIV-infected adolescents in high-income and lower middle-income countries, and identifies key questions that remain unanswered. We review atherosclerotic vascular disease (AVD), chronic bone disease (CBD), chronic kidney disease (CKD), and chronic lung disease (CLD). RECENT FINDINGS Persistent immune activation and inflammation underlie the pathogenesis of AVD, highlighting the importance of treatment adherence and maintenance of viral suppression, and the need to evaluate interventions to decrease risk. Tenofovir disoproxil fumarate (TDF) and trials of vitamin D supplementation have been the focus of recent studies of CBD with limited studies to date evaluating tenofovir alafenamide as an alternative to TDF for decreasing risk for bone and renal adverse effects among HIV-infected adolescents. Recent studies of CKD have focused primarily on estimating prevalence in different settings whereas studies of CLD are limited. SUMMARY As perinatally HIV-infected children age into adolescence and adulthood with effective long-term ART, it is necessary to continue to evaluate their risks for noninfectious comorbidities and complications, understand mechanisms underlying their risks, and identify and evaluate interventions specifically in this population.
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Affiliation(s)
- Steve Innes
- Family Infectious Diseases Clinical Research Unit (FAMCRU), Stellenbosch University, and Department of Paediatrics and Child Health, Tygerberg Children’s Hospital, Cape Town, South Africa
| | - Kunjal Patel
- Department of Epidemiology, Harvard T.H. Chan School of Public Health and Center for Biostatistics in AIDS Research (CBAR), Boston, MA, USA
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