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Iriarte E, Smyth HL, Schmiege S, Tassiopoulos K, Jankowski CM, Erlandson KM. Predictors of frailty trajectories among people with HIV. AIDS 2025; 39:373-380. [PMID: 39630590 PMCID: PMC11864888 DOI: 10.1097/qad.0000000000004086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2024] [Accepted: 11/27/2024] [Indexed: 12/07/2024]
Abstract
OBJECTIVE This study aimed to estimate the latent frailty trajectories and identify corresponding predictors (sociodemographic, HIV-related, comorbidities, and behavioral) among a cohort of people with HIV (PWH). DESIGN Longitudinal observational study using latent class growth modeling. METHODS Nine hundred and seventy-six PWH aged 40 years and older with frailty measured from at least two visits within the ACTG HAILO cohort were included. Frailty components included weakness, physical activity, weight loss, exhaustion, and slowness. Latent class growth models were estimated to capture change in frailty over time; multinomial logistic regression was used to estimate associations between predictors and frailty trajectory class. RESULTS At baseline, participants were M = 51.5 years old ( SD = 7.5), 81% male ( n = 783), 48% White non-Hispanic ( n = 461), and 20% Hispanic ( n = 195). Latent class growth models identified three frailty trajectories: sustained robustness ( n = 811; 83%), worsening frailty ( n = 79; 8%), and frailty improvement ( n = 86; 9%). Older age, race, sex at birth, select comorbidities (cardiovascular disease, depression, type 2 diabetes), and behavioral characteristics (physical activity, smoking, and alcohol) were associated with fluctuations in frailty trajectories over time ( P < 0.05). CONCLUSION Modifiable factors such as managing comorbidities and promoting physical activity present ideal opportunities for future interventions to prevent or slow the progression of frailty.
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Affiliation(s)
- Evelyn Iriarte
- University of Colorado Anschutz Medical Campus, College of Nursing, Aurora
| | - Heather L. Smyth
- University of Colorado Anschutz Medical Campus, Colorado School of Public Health - Center for Innovative Design and Analysis, Aurora
| | - Sarah Schmiege
- University of Colorado Anschutz Medical Campus, Colorado School of Public Health -Biostatistics and Informatics, Aurora
| | | | | | - Kristine M. Erlandson
- University of Colorado Anschutz Medical Campus, Department of Medicine, Division of Infectious Diseases, Aurora
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Serrano-Villar S, Moreno S. Predicting neurocognitive decline in older persons living with VIH: a spotlight on the T-CD4 + /CD8 + ratio. Eur Geriatr Med 2025; 16:315-316. [PMID: 39954033 DOI: 10.1007/s41999-024-01144-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2025]
Affiliation(s)
- Sergio Serrano-Villar
- Servicio de Enfermedades Infecciosas, Hospital Universitario Ramón y Cajal, IRYCIS, Universidad de Alcalá, Ctra. Colmenar, Km. 9,100, 28034, Madrid, Spain
| | - Santiago Moreno
- Servicio de Enfermedades Infecciosas, Hospital Universitario Ramón y Cajal, IRYCIS, Universidad de Alcalá, Ctra. Colmenar, Km. 9,100, 28034, Madrid, Spain.
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Ruiz-Manríquez CA, Avila-Funes JA, Brañas F, Crabtree-Ramírez B, Amieva H, Hernández-Ruiz V. Association between a lower T-CD4+ /CD8+ lymphocyte ratio and cognitive impairment in older persons with HIV. Eur Geriatr Med 2025; 16:305-313. [PMID: 39476100 DOI: 10.1007/s41999-024-01079-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2024] [Accepted: 10/01/2024] [Indexed: 02/25/2025]
Abstract
PURPOSE To ascertain the association between the LT-CD4 + /CD8 + ratio and cognitive impairment in older people living with HIV. METHODS A cross-sectional study was conducted, including 207 adults aged > 50 years with HIV, receiving care at a tertiary-care hospital in Mexico City. Participants underwent a standardized geriatric and neuropsychological assessment to establish the presence of HIV-associated neurocognitive disorder according to the validated Antinori criteria. Multivariate logistic regression models were performed to determine the association between T-CD4 + /CD8 + lymphocyte ratio tercile values (0.57-0.91, and < 0.56; with > 0.91 being the reference category) and cognitive impairment. RESULTS Participants' median age was 56 (IQR 53-62) years and 173 (83.6%) were men. The prevalence of any kind of cognitive impairment according to the Antinori criteria was 66.2% (n = 137), the highest proportion being asymptomatic neurocognitive impairment (n = 114, 83.2%). Adjusted logistic regression analyses showed that the lowest LT-CD4 + /CD8 + ratio tercile values (< 0.56) were independently associated with the presence of cognitive impairment (OR 3.16; 95% CI 1.22-8.16, p = 0.017). CONCLUSION Lower LT-CD4 + /CD8 + ratios are independently associated with cognitively impaired older persons with HIV, which represents another factor that could be addressed to identify individuals at risk and focus on cognitive screening as well as correction of other modifiable risk factors.
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Affiliation(s)
- Carlos Alberto Ruiz-Manríquez
- Geriatric Medicine Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15, 14080, Tlalpan, Mexico City, Mexico
| | - José Alberto Avila-Funes
- Department of Medical Education, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Fátima Brañas
- Sección de Geriatría, Hospital Universitario Infanta Leonor, Madrid, Spain
| | - Brenda Crabtree-Ramírez
- Infectious Diseases Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Hélène Amieva
- INSERM, Bordeaux Population Health Research Center, UMR 1219, Univ. Bordeaux, 33000, Bordeaux, France
| | - Virgilio Hernández-Ruiz
- Geriatric Medicine Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15, 14080, Tlalpan, Mexico City, Mexico.
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Clair-Sullivan NS, Bristowe K, Khan I, Maddocks M, Harding R, Bremner S, Levett T, Roberts J, Adler Z, Yi D, Vera JH. Implementation of frailty screening for older people living with HIV in Brighton, UK. HIV Med 2024; 25:484-490. [PMID: 38062917 DOI: 10.1111/hiv.13598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 11/20/2023] [Indexed: 04/05/2024]
Abstract
OBJECTIVES To evaluate the implementation of frailty screening in people living with HIV (PLWH) in a large urban cohort of patients in Brighton, UK. METHODS Focus group discussions with HIV professionals and PLWH interviews helped inform the design and implementation of the frailty screening pathway in the clinic. Data were collected from PLWH aged over 60 years attending their HIV annual health check from July 2021 to January 2023 (n = 590), who were screened for frailty by nurses using the FRAIL scale. We assessed the proportions of PLWH who screened as frail, prefrail or robust and compared patient characteristics across groups. All PLWH identified as frail were offered a comprehensive geriatric assessment delivered by a combined HIV geriatric clinic, and uptake was recorded. RESULTS A total of 456/590 (77.3%) PLWH aged over 60 years were screened for frailty. Median age and time since HIV diagnosis (range) for those screened were 66 (60-99) years and 21 (0-32) years, respectively. In total, 56 (12.1%) of those screened were identified as frail, 118 (25.9%) as prefrail and 282 (61.8%) as robust. A total of 10/56 (18%) people identified as frail declined an appointment in the geriatric clinic. Compared with non-frail individuals, frail PLWH had been living with HIV for longer and had a greater number of comorbidities and comedications but were not chronologically older. CONCLUSIONS Implementing frailty screening in PLWH over 60 years old is feasible in a large cohort of PLWH, as recommended by the European AIDS Clinical Society. More research is needed to determine if frailty screening can improve clinical outcomes of older PLWH and the use of the comprehensive geriatric assessment within HIV services.
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Affiliation(s)
- Natalie St Clair-Sullivan
- King's College London, Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, London, UK
| | - Katherine Bristowe
- King's College London, Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, London, UK
| | - Inayat Khan
- University Hospitals Sussex NHS Trust, Brighton, UK
| | - Matthew Maddocks
- King's College London, Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, London, UK
| | - Richard Harding
- King's College London, Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, London, UK
| | | | - Thomas Levett
- University Hospitals Sussex NHS Trust, Brighton, UK
- Brighton and Sussex Medical School, Brighton, UK
| | | | - Zoe Adler
- University Hospitals Sussex NHS Trust, Brighton, UK
| | - Deokhee Yi
- King's College London, Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, London, UK
| | - Jaime H Vera
- University Hospitals Sussex NHS Trust, Brighton, UK
- Brighton and Sussex Medical School, Brighton, UK
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5
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Holden CJ, Lampe FC, Burns FM, Chaloner C, Johnson M, Kinloch-De Loes S, Smith CJ. Association of age at antiretroviral therapy initiation with CD4 + : CD8 + ratio recovery among virally suppressed people with HIV. AIDS 2024; 38:703-711. [PMID: 38016172 PMCID: PMC10942155 DOI: 10.1097/qad.0000000000003801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 11/16/2023] [Accepted: 11/23/2023] [Indexed: 11/30/2023]
Abstract
OBJECTIVE To investigate the association of age at antiretroviral therapy (ART) initiation with CD4 + : CD8 + T-cell ratio in virally suppressed people with HIV on long-term ART, and to characterize potential CD4 + : CD8 + ratio recovery in this population by age. DESIGN A longitudinal study of people attending an HIV clinic at the Royal Free Hospital NHS Trust, London, who initiated ART between 2001 and 2015, and achieved and maintained HIV-1 viral suppression (viral load <1,000 copies/ml). The association of age group at ART initiation with CD4 + : CD8 + ratio at 5 and 10 years was assessed. METHODS Multivariable linear regression was used to investigate the relationship between age at ART initiation and log CD4 + : CD8 + ratio, adjusting for demographic factors (gender/HIV transmission route, ethnicity), baseline CD4 + count and calendar year. RESULTS The sample included 1859 people aged 20-78 (75% men, 56% white ethnicity). Overall, median CD4 + : CD8 + T-cell ratio increased from 0.24 at baseline to 0.77 at year 5 and 0.88 at year 10. Ratios increased among all age groups in unadjusted and adjusted models but increased less among older ages (baseline ages 60-69 and 70-79). Median ratios at year 5 were 0.85, 0.80, 0.72, 0.76, 0.6, and 0.44, respectively, among people aged 20-29, 30-39, 40-49, 50-59, 60-69 and 70-79 years at baseline. CONCLUSION In a virally suppressed London population, age had a substantial impact on CD4 + : CD8 + ratio recovery, especially for those starting ART after age 60 years. Results may indicate the level of CD4 + : CD8 + ratio recovery possible in an HIV-positive, virally suppressed, aging population.
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Milic J, Renzetti S, Morini D, Motta F, Carli F, Menozzi M, Cuomo G, Mancini G, Simion M, Romani F, Spadoni A, Baldisserotto I, Barp N, Diazzi C, Mussi C, Mussini C, Rochira V, Calza S, Guaraldi G. Bone Mineral Density and Trabecular Bone Score Changes throughout Menopause in Women with HIV. Viruses 2023; 15:2375. [PMID: 38140615 PMCID: PMC10747369 DOI: 10.3390/v15122375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 10/03/2023] [Accepted: 10/06/2023] [Indexed: 12/24/2023] Open
Abstract
OBJECTIVE The objectives of this study were to describe the trajectories of bone mineral density (BMD) and trabecular bone score (TBS) changes throughout pre-menopause (reproductive phase and menopausal transition) and post-menopause (early and late menopause) in women with HIV (WWH) undergoing different antiretroviral therapies (ARTs) and explore the risk factors associated with those changes. METHODS This was an observational longitudinal retrospective study in WWH with a minimum of two DEXA evaluations comprising BMD and TBS measurements, both in the pre-menopausal and post-menopausal periods. Menopause was determined according to the STRAW+10 criteria, comprising four periods: the reproductive period, menopausal transition, and early- and late-menopausal periods. Mixed-effects models were fitted to estimate the trajectories of the two outcomes (BMD and TBS) over time. Annualized lumbar BMD and TBS absolute and percentage changes were calculated in each STRAW+10 time window. A backward elimination procedure was applied to obtain the final model, including the predictors that affected the trajectories of BMD or TBS over time. RESULTS A total of 202 WWH, all Caucasian, were included. In detail, 1954 BMD and 195 TBS data were analyzed. The median number of DEXA evaluations per woman was 10 (IQR: 7, 12). The median observation periods per patient were 12.0 years (IQR = 8.9-14.4) for BMD and 6.0 years (IQR: 4.3, 7.9) for TBS. The prevalence of osteopenia (63% vs. 76%; p < 0.001) and osteoporosis (16% vs. 36%; p < 0.001) increased significantly between the pre-menopausal and post-menopausal periods. Both BMD (1.03 (±0.14) vs. 0.92 (±0.12) g/cm2; p < 0.001) and TBS (1.41 (IQR: 1.35, 1.45) vs. 1.32 (IQR: 1.28, 1.39); p < 0.001) decreased significantly between the two periods. The trend in BMD decreased across the four STRAW+10 periods, with a slight attenuation only in the late-menopausal period when compared with the other intervals. The TBS slope did not significantly change throughout menopause. The delta mean values of TBS in WWH were lower between the menopausal transition and reproductive period compared with the difference between menopause and menopausal transition. CONCLUSIONS Both BMD and TBS significantly decreased over time. The slope of the change in BMD and TBS significantly decreased in the menopausal transition, suggesting that this period should be considered by clinicians as a key time during which to assess bone health and modifiable risk factors in WWH.
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Affiliation(s)
- Jovana Milic
- Modena HIV Metabolic Clinic, University of Modena and Reggio Emilia, 41121 Modena, Italy;
- Department of Surgical, Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, 41121 Modena, Italy; (F.M.); (C.M.)
| | - Stefano Renzetti
- Department of Medical-Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, 25121 Brescia, Italy;
| | - Denise Morini
- Hematology and Transplant Center, University Hospital “San Giovanni di Dio e Ruggi d’Aragona”, 84121 Salerno, Italy;
| | - Federico Motta
- Department of Surgical, Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, 41121 Modena, Italy; (F.M.); (C.M.)
| | - Federica Carli
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria, Policlinico of Modena, 41121 Modena, Italy; (F.C.); (M.M.); (G.C.); (G.M.); (M.S.); (F.R.); (A.S.); (I.B.); (N.B.)
| | - Marianna Menozzi
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria, Policlinico of Modena, 41121 Modena, Italy; (F.C.); (M.M.); (G.C.); (G.M.); (M.S.); (F.R.); (A.S.); (I.B.); (N.B.)
| | - Gianluca Cuomo
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria, Policlinico of Modena, 41121 Modena, Italy; (F.C.); (M.M.); (G.C.); (G.M.); (M.S.); (F.R.); (A.S.); (I.B.); (N.B.)
| | - Giuseppe Mancini
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria, Policlinico of Modena, 41121 Modena, Italy; (F.C.); (M.M.); (G.C.); (G.M.); (M.S.); (F.R.); (A.S.); (I.B.); (N.B.)
| | - Mattia Simion
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria, Policlinico of Modena, 41121 Modena, Italy; (F.C.); (M.M.); (G.C.); (G.M.); (M.S.); (F.R.); (A.S.); (I.B.); (N.B.)
| | - Federico Romani
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria, Policlinico of Modena, 41121 Modena, Italy; (F.C.); (M.M.); (G.C.); (G.M.); (M.S.); (F.R.); (A.S.); (I.B.); (N.B.)
| | - Anna Spadoni
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria, Policlinico of Modena, 41121 Modena, Italy; (F.C.); (M.M.); (G.C.); (G.M.); (M.S.); (F.R.); (A.S.); (I.B.); (N.B.)
| | - Irene Baldisserotto
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria, Policlinico of Modena, 41121 Modena, Italy; (F.C.); (M.M.); (G.C.); (G.M.); (M.S.); (F.R.); (A.S.); (I.B.); (N.B.)
| | - Nicole Barp
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria, Policlinico of Modena, 41121 Modena, Italy; (F.C.); (M.M.); (G.C.); (G.M.); (M.S.); (F.R.); (A.S.); (I.B.); (N.B.)
| | - Chiara Diazzi
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41126 Modena, Italy; (C.D.); (V.R.)
| | - Chiara Mussi
- Department of Biomedical and Metabolic Sciences and Neuroscience, University of Modena and Reggio Emilia, 41126 Modena, Italy;
| | - Cristina Mussini
- Department of Surgical, Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, 41121 Modena, Italy; (F.M.); (C.M.)
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria, Policlinico of Modena, 41121 Modena, Italy; (F.C.); (M.M.); (G.C.); (G.M.); (M.S.); (F.R.); (A.S.); (I.B.); (N.B.)
| | - Vincenzo Rochira
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41126 Modena, Italy; (C.D.); (V.R.)
- Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria of Modena, Ospedale Civile of Baggiovara, 41126 Modena, Italy
| | - Stefano Calza
- Department of Molecular and Translational Medicine, University of Brescia, 25121 Brescia, Italy;
| | - Giovanni Guaraldi
- Modena HIV Metabolic Clinic, University of Modena and Reggio Emilia, 41121 Modena, Italy;
- Department of Surgical, Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, 41121 Modena, Italy; (F.M.); (C.M.)
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria, Policlinico of Modena, 41121 Modena, Italy; (F.C.); (M.M.); (G.C.); (G.M.); (M.S.); (F.R.); (A.S.); (I.B.); (N.B.)
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Mansour M, Augustine M, Kumar M, Butt AN, Thugu TR, Kaur P, Patel NJ, Gaudani A, Jahania MB, Jami E, Sharifa M, Raj R, Mehmood D. Frailty in Aging HIV-Positive Individuals: An Evolving Healthcare Landscape. Cureus 2023; 15:e50539. [PMID: 38222136 PMCID: PMC10787848 DOI: 10.7759/cureus.50539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2023] [Indexed: 01/16/2024] Open
Abstract
The life expectancy of people living with HIV (PLWH) has greatly increased due to advancements in combination antiretroviral treatment (cART). However, this longer life has also increased the prevalence of age-related comorbidities, such as frailty, which now manifest sooner in this group. Frailty, a term coined by the insurance industry, has been broadened to include physical, cognitive, and emotional elements and has been recognized as a critical predictor of negative health outcomes. With the median age of PLWH now in the mid-50s, treating frailty is critical given its link to chronic diseases, cognitive decline, and even death. Frailty assessment tools, such as the Frailty Phenotype (FP) and the Frailty Index (FI), are used to identify vulnerable people. Understanding the pathophysiology of frailty in PLWH indicates the role of immunological mechanisms. Frailty screening and management in this group have progressed, with specialized clinics and programs concentrating on multidisciplinary care. Potential pharmacotherapeutic solutions, as well as novel e-health programs and sensors, are in the future of frailty treatment, but it is critical to ensure that frailty evaluation is not exploited to perpetuate ageist healthcare practices. This narrative review investigates the changing healthcare environment for older people living with HIV (OPLWH), notably in high-income countries. It emphasizes the significance of identifying and managing frailty as a crucial feature of OPLWH's holistic care and well-being.
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Affiliation(s)
- Mohammad Mansour
- General Medicine, University of Debrecen, Debrecen, HUN
- General Medicine, Jordan University Hospital, Amman, JOR
| | | | - Mahendra Kumar
- Medicine, Sardar Patel Medical College, Bikaner, Bikaner, IND
| | - Amna Naveed Butt
- Medicine/Internal Medicine, Allama Iqbal Medical College, Lahore, PAK
| | - Thanmai Reddy Thugu
- Internal Medicine, Sri Padmavathi Medical College for Women, Sri Venkateswara Institute of Medical Sciences (SVIMS), Tirupati, IND
| | - Parvinder Kaur
- Internal Medicine, Crimean State Medical University, Simferopol, UKR
| | | | - Ankit Gaudani
- Graduate Medical Education, Jiangsu University, Zhenjiang, CHN
| | - M Bilal Jahania
- Internal Medicine, Combined Military Hospital (CMH) Lahore Medical College and Institute of Dentistry, Lahore, PAK
| | - Elhama Jami
- Internal Medicine, Herat Regional Hospital, Herat, AFG
| | | | - Rohan Raj
- Internal Medicine, Nalanda Medical College and Hospital, Patna, IND
| | - Dalia Mehmood
- Community Medicine, Fatima Jinnah Medical University, Lahore, PAK
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Doctor J, Winston A, Vera JH, Post FA, Boffito M, Mallon PWG, Anderson J, Prechtl C, Williams I, Johnson M, Bagkeris E, Sachikonye M, Sabin CA. Anticholinergic medications associated with falls and frailty in people with HIV. HIV Med 2023; 24:1198-1209. [PMID: 37644705 DOI: 10.1111/hiv.13532] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 08/01/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND Anticholinergic medications (ACMs) are associated with poorer age-related outcomes, including falls and frailty. We investigate associations between ACM use and recurrent falls and frailty among older (aged ≥50 years) people with HIV in the POPPY study. METHODS Anticholinergic potential of co-medications at study entry was coded using the anticholinergic burden score, anticholinergic risk score, and Scottish Intercollegiate Guidelines Network score; drugs scoring ≥1 on any scale were defined as ACM. Associations with recurrent falls (two or more falls in the previous 28 days) and frailty (modified Fried's) were assessed using logistic regression adjusting for (1) possible demographic/lifestyle confounders and (2) clinical factors and depressive symptoms (Patient Health Questionnaire-9). RESULTS ACM use was reported by 193 (28%) of 699 participants, with 64 (9%) receiving two or more ACM; commonly prescribed ACMs were codeine (12%), citalopram (12%), loperamide (9%), and amitriptyline (7%). Falls were reported in 63/673 (9%), and 126/609 (21%) met the frailty criteria. Both recurrent falls and frailty were more common in ACM users than in non-users (recurrent falls: 17% in users vs. 6% in non-users, p < 0.001; frailty: 32% vs. 17%, respectively, p < 0.001). Use of two or more ACMs was associated with increased odds of falls after adjustment for demographic/lifestyle factors (odds ratio [OR] 4.53; 95% confidence interval [CI] 2.06-9.98) and for clinical factors (OR 3.58; 95% CI 1.37-9.38). Similar albeit weaker associations were seen with frailty (OR 2.26; 95% CI 1.09-4.70 and OR 2.12; 95% CI 0.89-5.0, respectively). CONCLUSIONS ACM are commonly prescribed for people living with HIV, and evidence exists for an association with recurrent falls and frailty. Clinicians should be alert to this and reduce ACM exposure where possible.
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Affiliation(s)
| | | | - Jaime H Vera
- Brighton and Sussex Medical School, Brighton, UK
| | - Frank A Post
- King's College Hospital NHS Foundation Trust, London, UK
| | - Marta Boffito
- Chelsea and Westminster Healthcare NHS Foundation Trust, London, UK
| | | | | | | | - Ian Williams
- Institute for Global Health, University College London, London, UK
| | | | | | | | - Caroline A Sabin
- Institute for Global Health, University College London, London, UK
- National Institute for Health Research (NIHR) Health Protection Research Unit (HPRU) in Blood-borne and Sexually Transmitted Infections at University College, London, UK
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9
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de Morais IRB, Barbosa DDO, de Almeida GB, da Costa RR, da Silva BO, de Oliveira LA, Arantes JP, Leite LOC, Rossato L, Ribeiro MB, Marchioro SB, Freire SM, Nascimento RJM, Simionatto S, Torres AJL. Determining reference ranges for immunological cells of healthy indigenous individuals from a region in Brazil. EINSTEIN-SAO PAULO 2023; 21:eAO0291. [PMID: 37878969 PMCID: PMC10567104 DOI: 10.31744/einstein_journal/2023ao0291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 04/16/2023] [Indexed: 10/27/2023] Open
Abstract
Morais et al. conducted a pioneering study with Brazilian indigenous populations to determine reference values for immunologic cells from healthy adult individuals. The main findings included a higher relative median for T lymphocyte subsets in females than males, and T CD3+, T CD4+, and T CD8+ relative values were statistically different when compared with Brazilian populations from other Brazilian regions. The relative medians of CD3+, CD4+, and CD8+ T cells were significantly higher in women than in men in a healthy indigenous population. Demographic and ethnic diversity of the Brazilian population can be associated with quantitative modifications in the immunologic cells of healthy individuals. OBJECTIVE The establishment of reference values for a subset of leukocytes is common in clinical practice, and ethnic variations are strongly associated with disease development. In Brazil, indigenous people are vulnerable to infections, and few studies have described the health and disease conditions of this population. This study aimed to provide reference values for immunological cell subsets in indigenous Brazilians living in the state of Mato Grosso do Sul. METHODS Flow cytometry and 4-color combinations of monoclonal antibodies were used to characterize cells. A total of 115 healthy adults, mostly females (72%), were included in the study. The results are presented as mean and median (2.5%-97.5% percentiles) for T and B lymphocytes, CD4+ T cells, CD8+ T cells, Natural Killer cells, monocytes, and dendritic cells, providing an average immunological profile for the population in question. RESULTS The relative medians of CD3+, CD4+, and CD8+ T cells were significantly higher in women than in men in a healthy indigenous population. CONCLUSION To our knowledge, cell reference data from indigenous Brazilians are unknown in the literature. The immune cell results presented in this pioneering study will contribute to the clinical and laboratory evaluation of the Brazilian indigenous population, especially given the important differences when compared with other Brazilian ethnic groups.
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Affiliation(s)
- Isa Rita Brito de Morais
- Universidade Federal da BahiaSalvadorBABrazil Universidade Federal da Bahia , Salvador , BA , Brazil .
| | | | | | - Regina Rossoni da Costa
- Universidade Federal da Grande DouradosDouradosMSBrazil Universidade Federal da Grande Dourados , Dourados , MS , Brazil .
| | - Bruna Oliveira da Silva
- Universidade Federal da Grande DouradosDouradosMSBrazil Universidade Federal da Grande Dourados , Dourados , MS , Brazil .
| | - Laís Albuquerque de Oliveira
- Universidade Federal da Grande DouradosDouradosMSBrazil Universidade Federal da Grande Dourados , Dourados , MS , Brazil .
| | - Julia Pimentel Arantes
- Universidade Federal da Grande DouradosDouradosMSBrazil Universidade Federal da Grande Dourados , Dourados , MS , Brazil .
| | - Layla Oliveira Campos Leite
- Universidade Federal da Grande DouradosDouradosMSBrazil Universidade Federal da Grande Dourados , Dourados , MS , Brazil .
| | - Luana Rossato
- Universidade Federal da Grande DouradosDouradosMSBrazil Universidade Federal da Grande Dourados , Dourados , MS , Brazil .
| | - Marcos Borges Ribeiro
- Universidade Federal da BahiaSalvadorBABrazil Universidade Federal da Bahia , Salvador , BA , Brazil .
| | | | - Songelí Menezes Freire
- Universidade Federal da BahiaSalvadorBABrazil Universidade Federal da Bahia , Salvador , BA , Brazil .
| | | | - Simone Simionatto
- Universidade Federal da BahiaSalvadorBABrazil Universidade Federal da Bahia , Salvador , BA , Brazil .
| | - Alex José Leite Torres
- Universidade Federal da BahiaSalvadorBABrazil Universidade Federal da Bahia , Salvador , BA , Brazil .
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10
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Magatti M, Pischiutta F, Ortolano F, Pasotti A, Caruso E, Cargnoni A, Papait A, Capuzzi F, Zoerle T, Carbonara M, Stocchetti N, Borsa S, Locatelli M, Erba E, Prati D, Silini AR, Zanier ER, Parolini O. Systemic immune response in young and elderly patients after traumatic brain injury. Immun Ageing 2023; 20:41. [PMID: 37573338 PMCID: PMC10422735 DOI: 10.1186/s12979-023-00369-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 08/07/2023] [Indexed: 08/14/2023]
Abstract
BACKGROUND Traumatic brain injury (TBI) is a leading cause of death and long-term disability worldwide. In addition to primary brain damage, systemic immune alterations occur, with evidence for dysregulated immune responses in aggravating TBI outcome and complications. However, immune dysfunction following TBI has been only partially understood, especially in the elderly who represent a substantial proportion of TBI patients and worst outcome. Therefore, we aimed to conduct an in-depth immunological characterization of TBI patients, by evaluating both adaptive (T and B lymphocytes) and innate (NK and monocytes) immune cells of peripheral blood mononuclear cells (PBMC) collected acutely (< 48 h) after TBI in young (18-45 yo) and elderly (> 65 yo) patients, compared to age-matched controls, and also the levels of inflammatory biomarkers. RESULTS Our data show that young respond differently than elderly to TBI, highlighting the immune unfavourable status of elderly compared to young patients. While in young only CD4 T lymphocytes are activated by TBI, in elderly both CD4 and CD8 T cells are affected, and are induced to differentiate into subtypes with low cytotoxic activity, such as central memory CD4 T cells and memory precursor effector CD8 T cells. Moreover, TBI enhances the frequency of subsets that have not been previously investigated in TBI, namely the double negative CD27- IgD- and CD38-CD24- B lymphocytes, and CD56dim CD16- NK cells, both in young and elderly patients. TBI reduces the production of pro-inflammatory cytokines TNF-α and IL-6, and the expression of HLA-DM, HLA-DR, CD86/B7-2 in monocytes, suggesting a compromised ability to drive a pro-inflammatory response and to efficiently act as antigen presenting cells. CONCLUSIONS We described the acute immunological response induced by TBI and its relation with injury severity, which could contribute to pathologic evolution and possibly outcome. The focus on age-related immunological differences could help design specific therapeutic interventions based on patients' characteristics.
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Affiliation(s)
- Marta Magatti
- Centro di Ricerca E. Menni, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy.
| | - Francesca Pischiutta
- Department of Acute Brain Injury, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
| | - Fabrizio Ortolano
- Dipartimento di Anestesia-Rianimazione e Emergenza Urgenza, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Anna Pasotti
- Centro di Ricerca E. Menni, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy
| | - Enrico Caruso
- Department of Acute Brain Injury, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
- Dipartimento di Anestesia-Rianimazione e Emergenza Urgenza, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Anna Cargnoni
- Centro di Ricerca E. Menni, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy
| | - Andrea Papait
- Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore Facoltà di Medicina e Chirurgia, Roma, Italy
| | - Franco Capuzzi
- Dipartimento Medicina di Laboratorio, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy
| | - Tommaso Zoerle
- Dipartimento di Anestesia-Rianimazione e Emergenza Urgenza, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milano, Italy
| | - Marco Carbonara
- Dipartimento di Anestesia-Rianimazione e Emergenza Urgenza, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Nino Stocchetti
- Dipartimento di Anestesia-Rianimazione e Emergenza Urgenza, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milano, Italy
| | - Stefano Borsa
- Unit of Neurosurgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Marco Locatelli
- Department of Pathophysiology and Transplantation, University of Milan, Milano, Italy
- Unit of Neurosurgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Elisa Erba
- Department of Transfusion Medicine and Hematology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Daniele Prati
- Department of Transfusion Medicine and Hematology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Antonietta R Silini
- Centro di Ricerca E. Menni, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy
| | - Elisa R Zanier
- Department of Acute Brain Injury, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
| | - Ornella Parolini
- Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore Facoltà di Medicina e Chirurgia, Roma, Italy
- Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Roma, Italy
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11
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Premeaux TA, Ndhlovu LC. Decrypting biological hallmarks of aging in people with HIV. Curr Opin HIV AIDS 2023:01222929-990000000-00054. [PMID: 37421383 DOI: 10.1097/coh.0000000000000810] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/10/2023]
Abstract
PURPOSE OF REVIEW HIV infection adds further complexity to the heterogenous process of aging. In this focused review, we examine and discuss recent advances to better elucidate mechanisms of biological aging perturbed and accelerated in the context of HIV, particularly among those with viral suppression through the benefits of antiretroviral therapy (ART). New hypotheses from these studies are poised to provide an improved understanding of multifaceted pathways that converge and likely form the basis for effective interventions toward successful aging. RECENT FINDINGS Evidence to date suggests multiple mechanisms of biological aging impact people living with HIV (PLWH). Recent literature delves and expands on how epigenetic alterations, telomere attrition, mitochondrial perturbations, and intercellular communications may underpin accelerated or accentuated aging phenotypes and the disproportionate prevalence of age-related complications among PLWH. Although most hallmarks of aging are likely exacerbated in the setting of HIV, ongoing research efforts are providing new insight on the collective impact these conserved pathways may have in the aging disease processes. SUMMARY New knowledge on underlying molecular disease mechanisms impacting people aging with HIV are reviewed. Also examined are studies that may facilitate the development and implementation of effective therapeutics and guidance on improving geriatric HIV clinical care.
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Affiliation(s)
- Thomas A Premeaux
- Division of Infectious Diseases, Department of Medicine, Weill Cornell Medicine, New York, New York, USA
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12
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Pennati F, Calza S, Di Biagio A, Mussini C, Rusconi S, Bonora S, Borghetti A, Quiros‐Roldan E, Sarteschi G, Menozzi M, Ferrara M, Celotti A, Ciccullo A, Giacomet V, Izzo I, Dotta L, Badolato R, Castelli F, Focà E. Reduced probability of improving viro-immunological state in subjects with vertical transmission of HIV reaching adult age: A multicenter retrospective cohort study. Immun Inflamm Dis 2023; 11:e778. [PMID: 36840488 PMCID: PMC9910169 DOI: 10.1002/iid3.778] [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: 09/30/2022] [Revised: 01/18/2023] [Accepted: 01/19/2023] [Indexed: 02/11/2023] Open
Abstract
INTRODUCTION Young adults with vertical transmission (VT) of human immunodeficiency virus (HIV) represent a fragile population. This study evaluates factors associated with viro-immunological outcome of these patients. METHODS We performed a multicenter study including HIV-infected subjects with VT ≥ 18 years old from six Italian clinics. Subjects were observed from birth to death, lost to follow-up, or last visit until December 31, 2019. Condition of "optimal viro-immunological status" (OS) was defined as the simultaneous presence of HIV ribonucleic acid (RNA) < 50 copies/mL, CD4+ > 500 cells/mm3 , and CD4+/CD8+ ratio ≥ 1. RESULTS A total of 126 subjects were enrolled. At 18 years of age, 52/126 (44.4%) had HIV-RNA > 50 copies/mL, 47/126 (38.2%) had CD4+ < 500/mm3 , and 78/126 (67.2%) had CD4+/CD8+ < 1; 28 subjects (23.7%) presented in the condition of OS. Having a CD4+/CD8+ ratio ≥ 1 at 18 years of age was related with an increased probability of shift from suboptimal viro-immunological status (SOS) to OS (HR: 7.7, 95% confidence interval [CI]: 4.23-14.04), and a reduced risk of shift from the OS to the SOS (HR: 0.49, 95% CI: 0.26-0.92). Acquired immunodeficiency syndrome (AIDS) diagnosis significantly reduced the probability of shift from a viro-immunological SOS to OS (HR: 0.09, 95% CI: 0.03-0.30). Subjects who had not achieved an OS at 18 years of age had an increased risk of discontinuation of combination antiretroviral therapy (cART, p = .019). CONCLUSIONS Only a small proportion of subjects with VT of HIV reached the adult age with "OS". Transition to the adult care with a compromised viro-immunological condition represents a negative driver for future optimal infection control, with a higher risk of discontinuation of cART and a reduced probability to improve the immunological status later in the years.
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Affiliation(s)
- Francesca Pennati
- Unit of Infectious and Tropical DiseasesUniversity of Brescia and ASST Spedali Civili HospitalBresciaItaly
| | - Stefano Calza
- Unit of Biostatistics, Department of Molecular and Translational MedicineUniversity of BresciaBresciaItaly
| | - Antonio Di Biagio
- Clinic of Infectious and Tropical DiseasesUniversity of Genova and “San Martino” HospitalGenoaItaly
| | - Cristina Mussini
- Department of Infectious DiseasesUniversity of Modena and Reggio Emilia and Modena PolyclinicModenaItaly
| | - Stefano Rusconi
- Unit of Infectious DiseasesUniversity of Milano and ASST Fatebenefratelli “L. Sacco” HospitalMilanItaly
| | - Stefano Bonora
- Department of Infectious DiseasesUniversity of Torino and “Amedeo di Savoia” HospitalTurinItaly
| | - Alberto Borghetti
- Infectious Diseases UnitFondazione Policlinico Universitario Agostino Gemelli IRCCSRomeItaly
| | - Eugenia Quiros‐Roldan
- Unit of Infectious and Tropical DiseasesUniversity of Brescia and ASST Spedali Civili HospitalBresciaItaly
| | - Giovanni Sarteschi
- Clinic of Infectious and Tropical DiseasesUniversity of Genova and “San Martino” HospitalGenoaItaly
| | - Marianna Menozzi
- Department of Infectious DiseasesUniversity of Modena and Reggio Emilia and Modena PolyclinicModenaItaly
| | - Micol Ferrara
- Department of Infectious DiseasesUniversity of Torino and “Amedeo di Savoia” HospitalTurinItaly
| | - Anna Celotti
- Unit of Infectious and Tropical DiseasesUniversity of Brescia and ASST Spedali Civili HospitalBresciaItaly
| | - Arturo Ciccullo
- Department of Safety and Bioethics, Section of Infectious DiseasesCatholic University of the Sacred HeartRomeItaly
| | - Vania Giacomet
- Unit of PediatricsUniversity of Milano and ASST Fatebenefratelli “L. Sacco” HospitalMilanItaly
| | - Ilaria Izzo
- Unit of Infectious and Tropical DiseasesUniversity of Brescia and ASST Spedali Civili HospitalBresciaItaly
| | - Laura Dotta
- Unit of PediatricsUniversity of Brescia and ASST Spedali Civili HospitalBresciaItaly
| | - Raffaele Badolato
- Unit of PediatricsUniversity of Brescia and ASST Spedali Civili HospitalBresciaItaly
| | - Francesco Castelli
- Unit of Infectious and Tropical DiseasesUniversity of Brescia and ASST Spedali Civili HospitalBresciaItaly
| | - Emanuele Focà
- Unit of Infectious and Tropical DiseasesUniversity of Brescia and ASST Spedali Civili HospitalBresciaItaly
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13
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Kehler DS, Milic J, Guaraldi G, Fulop T, Falutz J. Frailty in older people living with HIV: current status and clinical management. BMC Geriatr 2022; 22:919. [PMID: 36447144 PMCID: PMC9708514 DOI: 10.1186/s12877-022-03477-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 09/23/2022] [Indexed: 12/05/2022] Open
Abstract
This paper will update care providers on the clinical and scientific aspects of frailty which affects an increasing proportion of older people living with HIV (PLWH). The successful use of combination antiretroviral therapy has improved long-term survival in PLWH. This has increased the proportion of PLWH older than 50 to more than 50% of the HIV population. Concurrently, there has been an increase in the premature development of age-related comorbidities as well as geriatric syndromes, especially frailty, which affects an important minority of older PLWH. As the number of frail older PLWH increases, this will have an important impact on their health care delivery. Frailty negatively affects a PLWH's clinical status, and increases their risk of adverse outcomes, impacting quality of life and health-span. The biologic constructs underlying the development of frailty integrate interrelated pathways which are affected by the process of aging and those factors which accelerate aging. The negative impact of sarcopenia in maintaining musculoskeletal integrity and thereby functional status may represent a bidirectional interaction with frailty in PLWH. Furthermore, there is a growing body of literature that frailty states may be transitional. The recognition and management of related risk factors will help to mitigate the development of frailty. The application of interdisciplinary geriatric management principles to the care of older PLWH allows reliable screening and care practices for frailty. Insight into frailty, increasingly recognized as an important marker of biologic age, will help to understand the diversity of clinical status occurring in PLWH, which therefore represents a fundamentally new and important aspect to be evaluated in their health care.
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Affiliation(s)
- D. Scott Kehler
- grid.55602.340000 0004 1936 8200Division of Geriatric Medicine, Department of Medicine, Dalhousie University, Halifax, NS Canada ,grid.55602.340000 0004 1936 8200School of Physiotherapy, Faculty of Health, Dalhousie University, Room 402 Forrest Building 5869 University Ave, B3H 4R2, PO Box 15000 Halifax, NS Canada
| | - Jovana Milic
- grid.7548.e0000000121697570Department of Surgical, Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Giovanni Guaraldi
- grid.7548.e0000000121697570Department of Surgical, Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Tamas Fulop
- grid.86715.3d0000 0000 9064 6198Department of Medicine, Geriatric Division, Research Center On Aging, Université de Sherbrooke, Sherbrooke, QC Canada
| | - Julian Falutz
- grid.63984.300000 0000 9064 4811Division of Geriatric Medicine, Division of Infectious Diseases, Comprehensive HIV Aging Initiative, McGill University Health Center, Montreal, QC Canada
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14
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Ruiz-Manriquez CA, Hernández-Ruiz V, Crabtree-Ramírez BE, Amieva H, Avila-Funes JA. A Lower CD4 +/CD8 + Ratio Predicts Activities of Daily Living Decline Among Older Adults with HIV. AIDS Res Hum Retroviruses 2022; 38:863-868. [PMID: 36136908 DOI: 10.1089/aid.2022.0080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Aging of people with human immunodeficiency virus (HIV) is a worldwide reality, and age-related conditions, including disability, have also increased. Efforts are being made to search for more specific markers of immune system malfunction, which serve as good predictors of adverse health-related outcomes. Therefore, this study aimed to determine the relationship between the CD4+/CD8+ ratio and functional decline in activities of daily living (ADL). Participants in this longitudinal study underwent a standardized comprehensive geriatric assessment by trained staff, using validated tools. Functional decline in ADL was established by the delta resulting from the subtraction of the score on the Barthel index at T1 minus the score at T0 (baseline). Multivariate linear regression analyses were used to determine the independent relationship between the CD4+/CD8+ ratio and ADL decline. Mean age was 57.9 (standard deviation 6.6; range 50-84 years), and 82.7% were men. Eleven of the 209 participants had disability for ADL at baseline. Multivariate linear regression analysis showed an inverse relationship between the log of CD4+/CD8+ ratio at baseline and the delta of Barthel index even after adjustment for multiple confounders (β = -1.68, 95% confidence interval -3.02 to -0.33; p = .01). A CD4+/CD8+ ratio of <1 predicts the development of functional decline in ADL. This ratio can be a useful marker to identify people at risk of disability and should be considered for the tailored management of older adults with HIV.
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Affiliation(s)
| | - Virgilio Hernández-Ruiz
- INSERM, Bordeaux Population Health Research Center, UMR 1219, University of Bordeaux, Bordeaux, France
| | - Brenda E Crabtree-Ramírez
- Department of Infectious Diseases, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Hélène Amieva
- INSERM, Bordeaux Population Health Research Center, UMR 1219, University of Bordeaux, Bordeaux, France
| | - Jose Alberto Avila-Funes
- Department of Geriatrics, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.,INSERM, Bordeaux Population Health Research Center, UMR 1219, University of Bordeaux, Bordeaux, France
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15
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Bristow C, Barber T. Managing frailty in people with human immunodeficiency virus. Br J Hosp Med (Lond) 2022; 83:1-7. [DOI: 10.12968/hmed.2021.0474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The population of people living with human immunodeficiency virus (HIV) is ageing and has an increasing burden of non-acquired immune deficiency syndrome (AIDS)-related morbidity and mortality, including frailty. Frailty is prevalent at a younger age in this population and is associated with multimorbidity, disability and death. This article examines the key interventions to ameliorate the advancement of frailty in people living with HIV. It explores methods of successfully delivering a multidisciplinary holistic approach to this complex patient group, using three case studies. The most effective frailty intervention is exercise. Group-based physiotherapy classes protect against functional decline and frailty symptomatology. Optimisation of medical and psychiatric comorbidities, including deprescribing when appropriate, is also essential. Addressing the social determinants of frailty, such as social isolation and loneliness, are beneficial, but are dependent on local charities and resources. More research is required to assess pharmacological and nutritional interventions in frailty. This requires a greater understanding of the exact pathophysiology of frailty, which remains poorly understood.
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Affiliation(s)
- Clare Bristow
- Department of HIV Medicine, Royal Free London NHS Foundation Trust, London, UK
| | - Tristan Barber
- Institute for Global Health, University College London, London, UK
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16
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Lazzaro A, Cacciola EG, Borrazzo C, Innocenti GP, Cavallari EN, Mezzaroma I, Falciano M, Fimiani C, Mastroianni CM, Ceccarelli G, d’Ettorre G. Switching to a Bictegravir Single Tablet Regimen in Elderly People Living with HIV-1: Data Analysis from the BICTEL Cohort. Diagnostics (Basel) 2021; 12:diagnostics12010076. [PMID: 35054243 PMCID: PMC8774414 DOI: 10.3390/diagnostics12010076] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 12/19/2021] [Accepted: 12/22/2021] [Indexed: 12/05/2022] Open
Abstract
Bictegravir/emtricitabine/tenofovir alafenamide fumarate (BIC/FTC/TAF) is a recommended once-daily single tablet regimen for the treatment of people living with HIV-1 (PLWH). We aimed to assess efficacy, safety and tolerability of BIC/FTC/TAF among PLWH, with a specific focus on people older than 55 years. Thus, we recruited an observational retrospective real-life cohort including all PLWH who underwent a therapeutic switch to BIC/FTC/TAF, independently from the provenience treatment regimen. After 48 weeks of follow-up, 147 PLWH were included and 93 were older than 55 years. PLWH with HIV-RNA < 37 copies/mL increased from 140 to 146 (p < 0.033). Among the overall population, we observed an increase in CD4+ T cells count by 30.1% (p-value < 0.001), in CD8+ T cells count by 7.1% (p-value = 0.004) and in CD4+/CD8+ ratio by 21.5% (p-value < 0.001). Lipidic profile was characterized by decreasing total cholesterol/HDL ratio by 8% (p-value < 0.001) and LDL by 6.8% (p-value = 0.007). Total body weight increased by 1.8% (p-value = 0.014) and BMI by 4.2% (p-value < 0.001), even remaining within the healthy range. Hepatic and renal profile were not altered by the switch, nor were adverse events and/or discontinuations events detected. In conclusion, BIC/FTC/TAF is effective, safe and well tolerated in real life and among PLWH older than 55.
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Affiliation(s)
- Alessandro Lazzaro
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Policlinico Umberto I of Rome, 00185 Rome, Italy; (A.L.); (E.G.C.); (C.B.); (G.P.I.); (E.N.C.); (M.F.); (C.F.); (C.M.M.); (G.C.)
| | - Elio Gentilini Cacciola
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Policlinico Umberto I of Rome, 00185 Rome, Italy; (A.L.); (E.G.C.); (C.B.); (G.P.I.); (E.N.C.); (M.F.); (C.F.); (C.M.M.); (G.C.)
| | - Cristian Borrazzo
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Policlinico Umberto I of Rome, 00185 Rome, Italy; (A.L.); (E.G.C.); (C.B.); (G.P.I.); (E.N.C.); (M.F.); (C.F.); (C.M.M.); (G.C.)
| | - Giuseppe Pietro Innocenti
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Policlinico Umberto I of Rome, 00185 Rome, Italy; (A.L.); (E.G.C.); (C.B.); (G.P.I.); (E.N.C.); (M.F.); (C.F.); (C.M.M.); (G.C.)
| | - Eugenio Nelson Cavallari
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Policlinico Umberto I of Rome, 00185 Rome, Italy; (A.L.); (E.G.C.); (C.B.); (G.P.I.); (E.N.C.); (M.F.); (C.F.); (C.M.M.); (G.C.)
| | - Ivano Mezzaroma
- Department of Translational and Precision Medicine, Sapienza University of Rome, AOU Policlinico Umberto I of Rome, 00185 Rome, Italy;
| | - Mario Falciano
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Policlinico Umberto I of Rome, 00185 Rome, Italy; (A.L.); (E.G.C.); (C.B.); (G.P.I.); (E.N.C.); (M.F.); (C.F.); (C.M.M.); (G.C.)
| | - Caterina Fimiani
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Policlinico Umberto I of Rome, 00185 Rome, Italy; (A.L.); (E.G.C.); (C.B.); (G.P.I.); (E.N.C.); (M.F.); (C.F.); (C.M.M.); (G.C.)
| | - Claudio Maria Mastroianni
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Policlinico Umberto I of Rome, 00185 Rome, Italy; (A.L.); (E.G.C.); (C.B.); (G.P.I.); (E.N.C.); (M.F.); (C.F.); (C.M.M.); (G.C.)
| | - Giancarlo Ceccarelli
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Policlinico Umberto I of Rome, 00185 Rome, Italy; (A.L.); (E.G.C.); (C.B.); (G.P.I.); (E.N.C.); (M.F.); (C.F.); (C.M.M.); (G.C.)
| | - Gabriella d’Ettorre
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Policlinico Umberto I of Rome, 00185 Rome, Italy; (A.L.); (E.G.C.); (C.B.); (G.P.I.); (E.N.C.); (M.F.); (C.F.); (C.M.M.); (G.C.)
- Correspondence:
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17
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Geppert J, Walth AA, Expósito RT, Kaltenecker D, Morigny P, Machado J, Becker M, Simoes E, Lima JDCC, Daniel C, Berriel Diaz M, Herzig S, Seelaender M, Rohm M. Aging Aggravates Cachexia in Tumor-Bearing Mice. Cancers (Basel) 2021; 14:cancers14010090. [PMID: 35008253 PMCID: PMC8750471 DOI: 10.3390/cancers14010090] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 12/17/2021] [Accepted: 12/20/2021] [Indexed: 12/15/2022] Open
Abstract
Simple Summary Cachexia is a deadly disease that accompanies many different types of cancers. Animal studies on cachexia have so far mostly been conducted using young mice, while cancer in humans is a disease of high age. Mouse models used to date may therefore not be suitable to study cachexia with relevance to patients. By comparing young and old mice of three different strains and two different tumor types, we here show that the age of mice has a substantial effect on cachexia progression (specifically body weight, tissue weight, fiber size, molecular markers) that is dependent on the mouse strain studied. This is independent of glucose tolerance. The cachexia markers IL6 and GDF15 differ between ages in both mice and patients. Future studies on cachexia should consider the age and strain of mice. Abstract Background: Cancer is primarily a disease of high age in humans, yet most mouse studies on cancer cachexia are conducted using young adolescent mice. Given that metabolism and muscle function change with age, we hypothesized that aging may affect cachexia progression in mouse models. Methods: We compare tumor and cachexia development in young and old mice of three different strains (C57BL/6J, C57BL/6N, BALB/c) and with two different tumor cell lines (Lewis Lung Cancer, Colon26). Tumor size, body and organ weights, fiber cross-sectional area, circulating cachexia biomarkers, and molecular markers of muscle atrophy and adipose tissue wasting are shown. We correlate inflammatory markers and body weight dependent on age in patients with cancer. Results: We note fundamental differences between mouse strains. Aging aggravates weight loss in LLC-injected C57BL/6J mice, drives it in C57BL/6N mice, and does not influence weight loss in C26-injected BALB/c mice. Glucose tolerance is unchanged in cachectic young and old mice. The stress marker GDF15 is elevated in cachectic BALB/c mice independent of age and increased in old C57BL/6N and J mice. Inflammatory markers correlate significantly with weight loss only in young mice and patients. Conclusions: Aging affects cachexia development and progression in mice in a strain-dependent manner and influences the inflammatory profile in both mice and patients. Age is an important factor to consider for future cachexia studies.
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Affiliation(s)
- Julia Geppert
- Institute for Diabetes and Cancer, Helmholtz Center Munich, 85764 Neuherberg, Germany; (J.G.); (A.A.W.); (R.T.E.); (D.K.); (P.M.); (J.M.); (E.S.); (M.B.D.); (S.H.)
- Joint Heidelberg-IDC Translational Diabetes Program, Inner Medicine 1, Heidelberg University Hospital, 69120 Heidelberg, Germany
- German Center for Diabetes Research (DZD), 85764 Neuherberg, Germany; (M.B.); (C.D.)
| | - Alina A. Walth
- Institute for Diabetes and Cancer, Helmholtz Center Munich, 85764 Neuherberg, Germany; (J.G.); (A.A.W.); (R.T.E.); (D.K.); (P.M.); (J.M.); (E.S.); (M.B.D.); (S.H.)
- Joint Heidelberg-IDC Translational Diabetes Program, Inner Medicine 1, Heidelberg University Hospital, 69120 Heidelberg, Germany
- German Center for Diabetes Research (DZD), 85764 Neuherberg, Germany; (M.B.); (C.D.)
| | - Raúl Terrón Expósito
- Institute for Diabetes and Cancer, Helmholtz Center Munich, 85764 Neuherberg, Germany; (J.G.); (A.A.W.); (R.T.E.); (D.K.); (P.M.); (J.M.); (E.S.); (M.B.D.); (S.H.)
- Joint Heidelberg-IDC Translational Diabetes Program, Inner Medicine 1, Heidelberg University Hospital, 69120 Heidelberg, Germany
- German Center for Diabetes Research (DZD), 85764 Neuherberg, Germany; (M.B.); (C.D.)
| | - Doris Kaltenecker
- Institute for Diabetes and Cancer, Helmholtz Center Munich, 85764 Neuherberg, Germany; (J.G.); (A.A.W.); (R.T.E.); (D.K.); (P.M.); (J.M.); (E.S.); (M.B.D.); (S.H.)
- Joint Heidelberg-IDC Translational Diabetes Program, Inner Medicine 1, Heidelberg University Hospital, 69120 Heidelberg, Germany
- German Center for Diabetes Research (DZD), 85764 Neuherberg, Germany; (M.B.); (C.D.)
| | - Pauline Morigny
- Institute for Diabetes and Cancer, Helmholtz Center Munich, 85764 Neuherberg, Germany; (J.G.); (A.A.W.); (R.T.E.); (D.K.); (P.M.); (J.M.); (E.S.); (M.B.D.); (S.H.)
- Joint Heidelberg-IDC Translational Diabetes Program, Inner Medicine 1, Heidelberg University Hospital, 69120 Heidelberg, Germany
- German Center for Diabetes Research (DZD), 85764 Neuherberg, Germany; (M.B.); (C.D.)
| | - Juliano Machado
- Institute for Diabetes and Cancer, Helmholtz Center Munich, 85764 Neuherberg, Germany; (J.G.); (A.A.W.); (R.T.E.); (D.K.); (P.M.); (J.M.); (E.S.); (M.B.D.); (S.H.)
- Joint Heidelberg-IDC Translational Diabetes Program, Inner Medicine 1, Heidelberg University Hospital, 69120 Heidelberg, Germany
- German Center for Diabetes Research (DZD), 85764 Neuherberg, Germany; (M.B.); (C.D.)
| | - Maike Becker
- German Center for Diabetes Research (DZD), 85764 Neuherberg, Germany; (M.B.); (C.D.)
- Institute for Diabetes Research, Research Group Immune Tolerance in Diabetes, Helmholtz Diabetes Center at Helmholtz Center Munich, 85764 Neuherberg, Germany
| | - Estefania Simoes
- Institute for Diabetes and Cancer, Helmholtz Center Munich, 85764 Neuherberg, Germany; (J.G.); (A.A.W.); (R.T.E.); (D.K.); (P.M.); (J.M.); (E.S.); (M.B.D.); (S.H.)
- Joint Heidelberg-IDC Translational Diabetes Program, Inner Medicine 1, Heidelberg University Hospital, 69120 Heidelberg, Germany
- German Center for Diabetes Research (DZD), 85764 Neuherberg, Germany; (M.B.); (C.D.)
- Department of Surgery and LIM 26, Faculdade de Medicina, University of Sao Paulo, Sao Paulo 01246-903, Brazil; (J.D.C.C.L.); (M.S.)
| | - Joanna D. C. C. Lima
- Department of Surgery and LIM 26, Faculdade de Medicina, University of Sao Paulo, Sao Paulo 01246-903, Brazil; (J.D.C.C.L.); (M.S.)
| | - Carolin Daniel
- German Center for Diabetes Research (DZD), 85764 Neuherberg, Germany; (M.B.); (C.D.)
- Institute for Diabetes Research, Research Group Immune Tolerance in Diabetes, Helmholtz Diabetes Center at Helmholtz Center Munich, 85764 Neuherberg, Germany
- Division of Clinical Pharmacology, Department of Medicine IV, Ludwig-Maximilians-Universität, 80539 Munich, Germany
| | - Mauricio Berriel Diaz
- Institute for Diabetes and Cancer, Helmholtz Center Munich, 85764 Neuherberg, Germany; (J.G.); (A.A.W.); (R.T.E.); (D.K.); (P.M.); (J.M.); (E.S.); (M.B.D.); (S.H.)
- Joint Heidelberg-IDC Translational Diabetes Program, Inner Medicine 1, Heidelberg University Hospital, 69120 Heidelberg, Germany
- German Center for Diabetes Research (DZD), 85764 Neuherberg, Germany; (M.B.); (C.D.)
| | - Stephan Herzig
- Institute for Diabetes and Cancer, Helmholtz Center Munich, 85764 Neuherberg, Germany; (J.G.); (A.A.W.); (R.T.E.); (D.K.); (P.M.); (J.M.); (E.S.); (M.B.D.); (S.H.)
- Joint Heidelberg-IDC Translational Diabetes Program, Inner Medicine 1, Heidelberg University Hospital, 69120 Heidelberg, Germany
- German Center for Diabetes Research (DZD), 85764 Neuherberg, Germany; (M.B.); (C.D.)
- Chair Molecular Metabolic Control, TUM School of Medicine, Faculty of Medicine, Technical University Munich, 80333 Munich, Germany
| | - Marilia Seelaender
- Department of Surgery and LIM 26, Faculdade de Medicina, University of Sao Paulo, Sao Paulo 01246-903, Brazil; (J.D.C.C.L.); (M.S.)
| | - Maria Rohm
- Institute for Diabetes and Cancer, Helmholtz Center Munich, 85764 Neuherberg, Germany; (J.G.); (A.A.W.); (R.T.E.); (D.K.); (P.M.); (J.M.); (E.S.); (M.B.D.); (S.H.)
- Joint Heidelberg-IDC Translational Diabetes Program, Inner Medicine 1, Heidelberg University Hospital, 69120 Heidelberg, Germany
- German Center for Diabetes Research (DZD), 85764 Neuherberg, Germany; (M.B.); (C.D.)
- Correspondence:
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Lynch SM, Guo G, Gibson DS, Bjourson AJ, Rai TS. Role of Senescence and Aging in SARS-CoV-2 Infection and COVID-19 Disease. Cells 2021; 10:3367. [PMID: 34943875 PMCID: PMC8699414 DOI: 10.3390/cells10123367] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 11/17/2021] [Accepted: 11/23/2021] [Indexed: 02/07/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has resulted in a global pandemic associated with substantial morbidity and mortality worldwide, with particular risk for severe disease and mortality in the elderly population. SARS-CoV-2 infection is driven by a pathological hyperinflammatory response which results in a dysregulated immune response. Current advancements in aging research indicates that aging pathways have fundamental roles in dictating healthspan in addition to lifespan. Our review discusses the aging immune system and highlights that senescence and aging together, play a central role in COVID-19 pathogenesis. In our review, we primarily focus on the immune system response to SARS-CoV-2 infection, the interconnection between severe COVID-19, immunosenescence, aging, vaccination, and the emerging problem of Long-COVID. We hope to highlight the importance of identifying specific senescent endotypes (or "sendotypes"), which can used as determinants of COVID-19 severity and mortality. Indeed, identified sendotypes could be therapeutically exploited for therapeutic intervention. We highlight that senolytics, which eliminate senescent cells, can target aging-associated pathways and therefore are proving attractive as potential therapeutic options to alleviate symptoms, prevent severe infection, and reduce mortality burden in COVID-19 and thus ultimately enhance healthspan.
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Affiliation(s)
| | | | | | | | - Taranjit Singh Rai
- Northern Ireland Centre for Stratified Medicine, School of Biomedical Sciences, Ulster University, C-TRIC Building, Altnagelvin Area Hospital, Glenshane Road, Derry BT47 6SB, UK; (S.M.L.); (G.G.); (D.S.G.); (A.J.B.)
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19
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Effect of Traditional Chinese Medicine Therapy on the Trend in CD4 + T-Cell Counts among Patients with HIV/AIDS Treated with Antiretroviral Therapy: A Retrospective Cohort Study. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2021; 2021:5576612. [PMID: 34326884 PMCID: PMC8302365 DOI: 10.1155/2021/5576612] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 07/06/2021] [Indexed: 01/05/2023]
Abstract
This retrospective cohort study was conducted to explore the effect of traditional Chinese medicine (TCM) therapy on the long-term trends in CD4+ T-cell count among patients with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) who were treated with combined antiretroviral therapy (cART) over a 14-year period. A total of 721 individuals were treated with cART alone (cART group), and 307 individuals were treated with both cART and TCM (TCM + cART group). Among all enrolled patients with HIV/AIDS, 99.5% were farmers, 71.1% had more than 6 years of education, and 96.8% were infected with HIV via a paid blood donation. For those patients with HIV/AIDS who had a baseline CD4+ T-cell count of <350 cells/mL, the CD4+ T-cell count tended to increase to approximately 350 cells/mL more rapidly in the TCM + cART group than in the cART group, but when the baseline CD4+ T-cell count was ≥350 cells/mL, there was no difference between the cART and TCM + cART groups. For other patients with HIV/AIDS who had a baseline CD4+ T-cell count of 350–500 cells/mL, the CD4+ T-cell counts tended to increase slightly, but there was no difference between the two groups. For patients with HIV/AIDS who had a baseline CD4+ T-cell count of ≥500 cells/mL, the CD4+ T-cell counts tended to be maintained at a particular level, with no difference between the two groups. The results show that the effect of TCM on the CD4+ T-cell counts of patients with HIV/AIDS is related to the CD4+ T-cell level at the time of initial treatment. TCM can increase the CD4+ T-cell count among patients with HIV/AIDS who have a baseline CD4+ T-cell count of <350 cells/mL. Sex and age have a slight influence on the therapeutic effect of TCM.
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20
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Abstract
PURPOSE OF REVIEW Older adults account for the majority of people with HIV (PWH) in high-income countries and have increasingly complex clinical profiles related to premature aging. Frailty is an important geriatric syndrome affecting a minority of PHW. Frailty negatively affects PHW's clinical status and quality of life. This review will update care providers on the current state of frailty that limits the healthspan of PWH. RECENT FINDINGS Ongoing low-level HIV replication in treated PWH leads to immune activation and chronic inflammation contributing to the destabilization of normally autoregulated physiologic systems in response to environmental and biologic challenges characteristic of frailty. Understanding these underlying mechanisms will determine potential intervention options. Potentially reversible risk factors that promote progression to and reversion from the dynamic state of frailty are being studied and will help prevent frailty. Simple assessment tools and treatment strategies for frailty are being adapted for aging PWH. SUMMARY Insight into underlying biologic mechanisms and adapting proven geriatric principles of interdisciplinary care will inform the healthy aging of PWH.
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Affiliation(s)
- Julian Falutz
- Division of Geriatric Medicine, Comprehensive HIV Aging Initiative, Combined Viral Illness Service, Division of Infectious Diseases, McGill University Health Center, Quebec, Canada
| | - Fátima Brañas
- Division of Geriatrics, Hospital Universitario Infanta Leonor, Madrid, Spain
| | - Kristine M Erlandson
- Divisions of Infectious Diseases and Geriatric Medicine, University of Colorado Denver-Anschutz Medical Campus, Aurora, Colorado, USA
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21
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Robinson-Papp J, Gensler G, Navis A, Sherman S, Ellis RJ, Gelman BB, Kolson DL, Letendre SL, Singer EJ, Valdes-Sueiras M, Morgello S. Characteristics of Motor Dysfunction in Longstanding Human Immunodeficiency Virus. Clin Infect Dis 2021; 71:1532-1538. [PMID: 31587032 DOI: 10.1093/cid/ciz986] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 10/03/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Cognitive dysfunction in human immunodeficiency virus (HIV) has decreased, but milder forms of HIV-associated neurocognitive disorders (HAND) persist along with motor dysfunction. The HIV Motor Scale (HMS) is a validated tool that captures motor abnormalities on routine neurologic examination and which is associated with cognitive impairment in HIV. In this study, we applied a modified HMS (MHMS) to a nationwide cohort of people with longstanding HIV to characterize and understand the factors contributing to motor dysfunction. METHODS The National NeuroAIDS Tissue Consortium is a nationwide longitudinal cohort study. Participants undergo regular assessments including neurological examination, neuropsychological testing, and immunovirologic data collection. Data from examinations were used to calculate the MHMS score, which was then correlated with history of AIDS-related central nervous system (CNS) disorders (ARCD; eg, prior CNS opportunistic infection), cerebrovascular disease (CVD), and HAND. RESULTS Sixty-nine percent of participants showed an abnormality on the MHMS, with 27% classified as severe. Results did not vary based on demographic or immunologic variables. The most common abnormalities seen were gait (54%), followed by coordination (39%) and strength (25%), and these commonly co-occurred. CVD (P = .02), history of ARCD (P = .001), and HAND (P = .001) were all associated with higher (ie, worse) HMS in univariate analyses; CVD and ARCD persisted in multivariate analyses. CVD was also marginally associated with symptomatic HAND. CONCLUSIONS Complex motor dysfunction remains common in HIV and is associated with CVD, ARCD, and to a lesser extent, HAND. Future studies are needed to understand the longitudinal trajectory of HIV-associated motor dysfunction, its neural substrates, and impact on quality of life.
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Affiliation(s)
- Jessica Robinson-Papp
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | - Allison Navis
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | - Ronald J Ellis
- Department of Neurosciences, University of California, San Diego, California, USA.,Department of Psychiatry, University of California, San Diego, California, USA
| | - Benjamin B Gelman
- Department of Pathology, University of Texas Medical Branch, Galveston, Texas, USA
| | - Dennis L Kolson
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Scott L Letendre
- Department of Psychiatry, University of California, San Diego, California, USA.,Department of Medicine, University of California, San Diego, California, USA
| | - Elyse J Singer
- Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Miguel Valdes-Sueiras
- Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Susan Morgello
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York.,Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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22
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Abstract
PURPOSE OF REVIEW Different factors contribute to the decreased overall long-term survival in treated people living with HIV (PLWH). This paper will review the state of physical frailty which limits successful aging in PLWH. RECENT FINDINGS Identifiable events on the continuum from clinical normality to heightened risk of adverse health outcomes contribute to frailty. These center on chronic inflammation leading to destabilization of autoregulated physiologic systems challenged by environmental and biologic challenges. Frailty assessment can inform the profile of aging PLWH at increased risk of common age-related disorders and geriatric syndromes. Biologic and psychosocial risk factors promoting progression to and reversion from a dynamic state of frailty are being investigated, allowing for preventative interventions to be considered. Insights gained from studying frail PLWH will help adapt an interdisciplinary geriatric model of health care for selected PLWH. This will improve the health and well-being of aging PLWH.
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Affiliation(s)
- Julian Falutz
- Division of Geriatrics, Director, Comprehensive HIV and Aging Initiative, McGill University Health Centre, Montreal, Quebec, Canada.
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23
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Immunological and Virological Responses in Older HIV-Infected Adults Receiving Antiretroviral Therapy: An Evidence-Based Meta-Analysis. J Acquir Immune Defic Syndr 2020; 83:323-333. [PMID: 31913990 DOI: 10.1097/qai.0000000000002266] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Millions of people living with the HIV have received antiretroviral therapy (ART). Older adults make up a significant portion of these individuals; however, the immunological and virological responses to ART for older patients still need to be clarified. DESIGN Meta-analysis. METHODS In this article, we systematically reviewed research articles published between 2001 and 2018 that reported immunological and virological responses and AIDS-related mortality among HIV- infected adults (including individuals aged 50 years and older) receiving ART, using meta-analysis. ART efficiency was measured using 3 outcomes: (1) immunological response, (2) virological response, and (3) mortality. RESULTS We identified 4937 citations, and 40 studies were eventually selected to investigate ART efficiency in older HIV-infected patients, comprising more than 888,151 patients initiating ART. We report that older patients showed poor immunological responses, with CD4 counts and the restoration of CD4 counts after ART initiation being significantly lower than seen in younger patients. However, older patients exhibited better viral suppression rates (risk ratio: 1.04; 95% confidence intervals: 1.01 to 1.08) after 36 months following ART initiation. In addition, older adults had a higher risk of AIDS-related death (adjusted hazard ratio: 1.44, 95% confidence interval: 1.30 to 1.60). CONCLUSIONS Older age after ART initiation was associated with a poorer immunological response and a higher risk of mortality, suggesting the need to increase early diagnosis and treatment among older HIV patients.
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Perrotta F, Corbi G, Mazzeo G, Boccia M, Aronne L, D'Agnano V, Komici K, Mazzarella G, Parrella R, Bianco A. COVID-19 and the elderly: insights into pathogenesis and clinical decision-making. Aging Clin Exp Res 2020; 32:1599-1608. [PMID: 32557332 PMCID: PMC7298699 DOI: 10.1007/s40520-020-01631-y] [Citation(s) in RCA: 234] [Impact Index Per Article: 46.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 06/06/2020] [Indexed: 02/06/2023]
Abstract
The elderly may represent a specific cluster of high-risk patients for developing COVID-19 with rapidly progressive clinical deterioration. Indeed, in older individuals, immunosenescence and comorbid disorders are more likely to promote viral-induced cytokine storm resulting in life-threatening respiratory failure and multisystemic involvement. Early diagnosis and individualized therapeutic management should be developed for elderly subjects based on personal medical history and polypharmacotherapy. Our review examines the pathogenesis and clinical implications of ageing in COVID-19 patients; finally, we discuss the evidence and controversies in the management in the long-stay residential care homes and aspects of end-of-life care for elderly patients with COVID-19.
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Affiliation(s)
- Fabio Perrotta
- Department of Medicine and Health Sciences, "Vincenzo Tiberio", University of Molise, Via Francesco De Sanctis, 86100, Campobasso, Italy.
| | - Graziamaria Corbi
- Department of Medicine and Health Sciences, "Vincenzo Tiberio", University of Molise, Via Francesco De Sanctis, 86100, Campobasso, Italy
- Italian Society of Gerontology and Geriatrics (SIGG), Florence, Italy
| | - Grazia Mazzeo
- Department of Translational Medical Sciences, University of Campania "L. Vanvitelli"/Hosp. Monaldi, 80131, Naples, Italy
- COVID-19 Unit, Infectious Disease Department, University of Campania "L. Vanvitelli", 80131, Naples, Italy
| | - Matilde Boccia
- Department of Translational Medical Sciences, University of Campania "L. Vanvitelli"/Hosp. Monaldi, 80131, Naples, Italy
| | - Luigi Aronne
- Department of Translational Medical Sciences, University of Campania "L. Vanvitelli"/Hosp. Monaldi, 80131, Naples, Italy
| | - Vito D'Agnano
- Department of Translational Medical Sciences, University of Campania "L. Vanvitelli"/Hosp. Monaldi, 80131, Naples, Italy
| | - Klara Komici
- Department of Medicine and Health Sciences, "Vincenzo Tiberio", University of Molise, Via Francesco De Sanctis, 86100, Campobasso, Italy
- Italian Society of Gerontology and Geriatrics (SIGG), Florence, Italy
| | - Gennaro Mazzarella
- Department of Translational Medical Sciences, University of Campania "L. Vanvitelli"/Hosp. Monaldi, 80131, Naples, Italy
| | - Roberto Parrella
- COVID Unit D, Department of Infectious Diseases, Cotugno Hospital, A.O.R.N. dei Colli, Naples, Italy
| | - Andrea Bianco
- Department of Translational Medical Sciences, University of Campania "L. Vanvitelli"/Hosp. Monaldi, 80131, Naples, Italy
- COVID-19 Unit, Infectious Disease Department, University of Campania "L. Vanvitelli", 80131, Naples, Italy
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Establishment of reference range of CD4 T-lymphocyte in healthy Nepalese adults. BMC Res Notes 2020; 13:316. [PMID: 32616011 PMCID: PMC7330941 DOI: 10.1186/s13104-020-05156-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 06/25/2020] [Indexed: 11/21/2022] Open
Abstract
Objective CD4 T lymphocytes are the most widely used cellular markers to assess the course of HIV infection, clinical staging and, monitoring the effect of antiretroviral therapy. The regional reference range for Eastern, Central and Western development region of Nepal had already been established whereas the same was still lacking in Mid-western and Far-western development region. The objective of this study was to establish reference range of CD4 T lymphocyte in the remaining two development regions and finally the national reference range using data from previous study. Results The average values (mean ± SD) of CD4 and CD3 T cell in present study was (819 ± 294) cells/μl and (1546 ± 532) cells/μl, respectively. The absolute CD4 T cell (914 ± 303) and CD3 T cell (1671 ± 560) count in female were significantly higher than those from male, CD4 (757 ± 270) and CD3 (1465 ± 499) (p value-0.000). National reference value of CD4 was determined to be (798 ± 335) cells/μl for healthy Nepalese adults.
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26
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Boffito M, Ryom L, Spinner C, Martinez E, Behrens G, Rockstroh J, Hohenauer J, Lacombe K, Psichogyiou M, Voith N, Mallon P, Branco T, Svedhem V, dÁrminio Monforte A. Clinical management of ageing people living with HIV in Europe: the view of the care providers. Infection 2020; 48:497-506. [PMID: 32198726 PMCID: PMC7395037 DOI: 10.1007/s15010-020-01406-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 02/28/2020] [Indexed: 01/01/2023]
Abstract
Background Although guidelines for the management of HIV infection include recommendations for aging people living with HIV (PLWH), clinical practice of European HIV care providers may vary. Method We performed a study using a 3-phase Delphi methodology by involving a panel of clinicians with expertise in HIV infection clinical management. The main aim of the study was to assess the care provider prospective on how HIV clinical care should be delivered to ageing PLWH. The first phase involved ten clinicians to identify HIV comorbidities of interest. The second and third phases recruited clinicians virtually via a web-based questionnaire that included 137 questions focussed on 11 comorbidities (e.g. cardiovascular disease, pulmonary disease, etc.). Results Results were analysed thematically and consensus (or not) among European physicians reported. Ninety-seven and 85 responses were collected in phase 2 and 3, respectively. High levels of agreement were found among clinical care providers across Europe and with the European AIDS Conference Society guidelines regarding key items of clinical management of comorbidities in ageing PLWH. Conclusion However, we identified some important gaps, such as the lack of standardisation or implementation of the assessment of frailty or menopause, which are emerging as important factors to optimise ageing PLWH clinical care. Further studies are warranted to confirm whether intensified screening translates into HIV morbidity advances. Electronic supplementary material The online version of this article (10.1007/s15010-020-01406-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Marta Boffito
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Lene Ryom
- Rigshospitalet University of Copenhagen, Copenhagen, Denmark
| | | | | | | | | | | | | | | | | | | | - Teresa Branco
- Hospital Prof. Doutor Fernando Fonseca, Amadora, Portugal
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Guaraldi G, Milic J. The Interplay Between Frailty and Intrinsic Capacity in Aging and HIV Infection. AIDS Res Hum Retroviruses 2019; 35:1013-1022. [PMID: 31452380 DOI: 10.1089/aid.2019.0157] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
In the context of an emerging aging epidemic affecting people living with HIV (PLWH), we critically discuss existing data regarding two different conceptual models of aging-frailty and intrinsic capacity, respectively, both in a clinical and public health perspective. These constructs have not yet been integrated in the general population. Nevertheless, the holistic HIV care, which goes beyond the viro-immunological success, may offer an ideal setting to test a possible integration of these models in older adults living with HIV. We suggest a new framework to assess health in PLWH, shifting from an infectious disease (ID)/internal medicine approach, which includes quality of life in the definition of healthy living with HIV, to an ID/geriatric medicine approach, focused on the maintenance of functional ability in frail and geriatric PLWH.
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Affiliation(s)
- Giovanni Guaraldi
- Department of Surgical, Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - 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
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