Metabolic changes associated with antiretroviral therapy in HIV-positive patients

Overweight and obesity and associated factors among adult ART patients at Hawassa University Comprehensive Specialized Hospital, Southern Ethiopia

BACKGROUND

Overweight and obesity complicates the care and treatment of ART patients and predispose them to chronic non-communicable diseases. However, there is a shortage of research evidence on overweight and obesity and its associated factors among adult ART patients in our setting. Therefore, this study aimed to asses overweight and obesity and associated factors among adult ART patients at Hawassa University Comprehensive Specialized Hospital, Southern Ethiopia.

METHODS

A facility-based cross-sectional study design was conducted by using systematic sampling technique. Primary and secondary data were collected from 369 adult ART patients from February to May 2017. Structured interviewer-administered questionnaire and laboratory outputs were used as primary data. The patient's baseline medical records were used as secondary data. Ethiopian Ministry of Health ART patient's follow-up tool was used to collect the required information. The standard laboratory and well-calibrated digital Seca Scale and portable Stadio-meter were used to collect medical and anthropometric data. Data were entered into Epi- data version 3.1 and exported to SPSS version 20 for analysis. Descriptive statistics were calculated and presented by tables, graphs and texts. Binary and multivariable logistic regression analyses were computed and the level of statistical significance was declared at p-value < 0.05.

RESULTS

The prevalence of overweight and obesity (BMI ≥ 25 kg/m2) was 43.4% (95% CI = 43.35, 43.45). The difference in the overweight and obesity between the study period and initial commencement of ART was 35%. The course of HIV chronic care since the commencement of ART and during the study was 35%. Higher recent CD4 counts (200-499cells/mm3) (AOR = 3.15, 95%CI = 1.04-9.49) and (≥ 500 cells/mm3) (AOR = 7.58, 95%CI = 2.49-23.08), hypertension (AOR = 2.57, 95%CI = 1.24-5.35), higher baseline BMI status (AOR = 5.93, 95%CI = 2.62-13.40) and abdominal obesity (AOR = 1.82, 95%CI = 1.07-3.10) were significantly associated with overweight and obesity.

CONCLUSION

In this study, a high prevalence of overweight and obesity among adult ART patients was reported compared to general adult population in Ethiopia. Overweight and obesity were significantly higher among hypertensive, with higher recent CD4 counts and abdominal obese ART patients. Thus, screening of overweight and obesity, incorporating nutritionist/dietician into the routine chronic care, and regular monitoring of the nutritional status of ART patients is recommended.

Management of infection among Medicare beneficiaries with HIV/AIDS: risk of diabetes with protease inhibitors and associated racial disparities using big data approach

Association between protease inhibitors (PI) and Type II diabetes mellitus (T2DM) in human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) patients is largely debated. This study examined the odds of developing T2DM among HIV/AIDS Medicare beneficiaries treated with PI and possible racial disparities in the odds. We performed a nested casecontrol study of Medicare database 2013-2017. We included HIV/AIDS positive beneficiaries who were enrolled continuously in Medicare Part A/B with no previous history of T2DM. PI-users were matched to non-PI users and non-anti-retroviral therapies (ART) users using a1:1 greedy propensity score (PS) matching . Multivariablee logistic regressions were performed to assess the odds of developing T2DM. The analysis included 2,353 HIV/AIDS beneficiaries. Matched samples were generated for PI vs. non-PI groups (n = 484) and PI vs. non-ART groups (n = 490). Compared to the non-PI group, the odds of developing T2DM were higher in PI-users (AOR: 1.76; 95% CI: 1.17-2.64), in Caucasian PI-users (AOR: 1.81; 95% CI: 1.02-3.22) and in African-American PI-users (AOR: 1.86; 95% CI: 1.03-3.36). Compared to the non-ART group, the odds of developing T2DM were higher in PI-users (AOR: 1.87; 95% CI: 1.25-2.81), in Caucasian PI-users (AOR: 1.96; 95% CI: 1.14-3.39) and in African-American PI-users (AOR: 2.05; 95% CI: 1.03-4.09). The use of PI is associated with higher odds of T2DM; odds were higher among African-Americans than Caucasians.

Association between the use of protease inhibitors in highly active antiretroviral therapy and incidence of diabetes mellitus and/or metabolic syndrome in HIV-infected patients: A systematic review and meta-analysis

This systematic review and meta-analysis tries to determine whether there is an association between the use of protease inhibitors (PIs) and the incidence of diabetes mellitus (DM) and/or metabolic syndrome (MS) in HIV-infected patients. A systematic literature search was performed using MEDLINE/PubMed, CENTRAL, LILACS, and EMBASE. Included articles were observational studies published on or prior to November 2015 that met specific inclusion criteria. Pooled relative risks (RRs) and hazard ratios (HRs) were calculated. Nine articles met the inclusion criteria, describing 13,742 HIV patients. Use of PIs was associated with the development of MS (RR: 2.11; 95% CI 1.28-3.48; p-value 0.003). No association between the use of PIs and development of DM was found: the HR for the incidence of DM among patients using PIs was 1.23 (95% CI 0.66-2.30; p-value: 0.51) and the RR was 1.25 (95% CI 0.99-1.58; p-value 0.06). Use of PIs in HIV-infected patients is associated with an increased risk of MS. No evidence of an increased risk of DM was found. However, because MS is a precursor to DM, it is possible that studies with a longer follow-up duration are needed in order to detect an association between PI use and onset of DM.

Metabolic Status and Hypogonadism in Human Immunodeficiency Virus-infected Males

AIMS AND OBJECTIVES

The aim of this study is to determine the prevalence of hypogonadism in human immunodeficiency virus (HIV)-infected males and to study its relation to age, CD4 count, body mass index (BMI), duration of highly active antiretroviral therapy (HAART), and metabolic status.

METHODOLOGY

Eighty-one HIV positive cases and 82 healthy controls were included in this case-control study. Each case underwent a complete physical examination and serum fasting plasma glucose, A1c, lipid profile, total testosterone (TT), follicle-stimulating hormone (FSH), and luteinizing hormone (LH) levels were estimated. Serum TT level <300 ng/dl, or TT >300 ng/dl with high LH and FSH (compensatory hypogonadism) were taken as markers for hypogonadism, and it was correlated with age, CD4 count, duration of HAART, and metabolic status of the patient.

RESULTS

Out of 81 cases, 21 (25.9%) were found to have hypogonadism as compared to 4 (4.9%) out of 82 controls. Of these 21, 14 cases had secondary hypogonadism, five had primary, and the remaining two had compensatory hypogonadism. The mean serum TT value among cases (371.7 ± 102.9 ng/dl) was significantly lower than that among controls (419.7 ± 71.5 ng/dl) (P = 0.007). Hypogonadism was found to be significantly associated with the age of the patient (P = 0.007), CD4 count (P = 0.002), and duration of HAART (P = 0.04) and was independent of the BMI (P = 0.9) and the waist circumference (P = 0.8). Dyslipidemia and dysglycemia were significantly more common among cases as compared to controls (P < 0.05) but were not associated with hypogonadism.

CONCLUSION

The prevalence of hypogonadism is higher among HIV-infected males as compared to healthy individuals. Hypogonadism was significantly associated with age, CD4 count, and duration of HAART and was independent of BMI, glycemic status, and dyslipidemia.

[Obesity, high blood pressure, hypercholesterolaemia, and untreated diabetes in HIV-infected and HIV-uninfected Adults in Mbuji-Mayi (Democratic republic of congo)]

Little is known about the major cardiovascular risk factors in HIV-infected as compared to the HIV-uninfected patients in the Democratic Republic of Congo (DR Congo). We determined the prevalence of hypertension, obesity (BMI ≥ 30 kg/m²), total cholesterol > 200 mg/dl, HDLcholesterol &≤ 40 mg/dl, and glycemia > 126 mg/dl. We also calculated the average and/or median of total cholesterol, HDL-cholesterol, and glycemia among HIV-infected and HIV-uninfected patients.We conducted a cross-sectional study that enrolled 592 HIV-uninfected and 445 HIV-infected patients of whom 425 (95.5%) were on first-line antiretroviral therapy based on stavudine-lamivudine-nevirapine. Clinical and laboratory data of the patients were collected. The results were analyzed by chi-square, t-student, and Wilcoxon rank sum tests. 11.5% of HIV-infected patients had an average blood pressure suggesting hypertension versus 10.6% of HIV-uninfected (P = 0.751). But in absolute value, HIVinfected patients had a median of diastolic blood pressure of 90 mmHg versus 85 mmHg of HIV-uninfected (P < 0.001). 4.04% of HIV-infected patients had a BMI suggesting obesity versus 6.08% of HIV-uninfected patients (P = 0.187). For fasting glucose: 2.50% of HIV-infected patients versus 4.20% of HIV-uninfected patients had a serum fasting glucose suggesting diabetes (P<0.176). 11.9% of HIV-infected patients had a total cholesterol greater than 200 mg/dl versus 7.4% of HIVuninfected patients (P=0.019). For HDL-cholesterol: 36.40% of HIV-infected patients had a serum fasting ≤ 40 mg/dl versus 15.70% of HIV-uninfected patients (P < 0.001). HIV-infected patients had a median fasting total cholesterol higher (140 mg/ dl) thanHIV-uninfected patients (133mg/dl) [P=0.015].HIVuninfected patients had a median fasting HDL-cholesterol higher (58.5 mg/dl) than HIV-infected patients (49 mg/dl) [P < 0.001]. HIV-infected women were more likely to have a higher mean of total cholesterol: 147.70 #x00B1; 52.09 mg/dl versus 135.72 &#x00B1; 48.23 mg/dl for the HIV-infected men (P = 0.014) and of HDL-cholesterol: 55.80 ± 30.77 mg/dl versus 48.24 ± 28.57mg/dl for the HIV-infected men (P = 0.008). In this study population, prevalence of hypertension was elevated in HIVinfected versus HIV-uninfected patients. Being HIV positive on first-line antiretroviral therapy based on stavudine-lamivudine-nevirapine was associated with high prevalence of total cholesterol > 200 mg/dl and HDL-cholesterol ≤ 40 mg/dl. Proactive screening and prompt management of dyslipidemia and hypertension in this population should be a priority.

Path of infectious diseases in Brazil in the last 50 years: an ongoing challenge

In this article, we comment on the main features of infectious diseases in Brazil in the last 50 years, highlighting how much of this path Revista de Saúde Pública could portray. From 1967 to 2016, 1,335 articles focusing on infectious diseases were published in Revista de Saúde Pública. Although the proportion of articles on the topic have decreased from about 50.0% to 15.0%, its notability remained and reflected the growing complexity of the research required for its control. It is noteworthy that studies design and analysis strategies progressively became more sophisticated, following the great development of epidemiology in Brazil in the recent decades. Thus, the journal has followed the success of public health interventions that permitted to control or eliminate numerous infectious diseases - which were responsible, in the past, for high rates of morbidity and mortality -, and also followed the reemergence of diseases already controlled and the emergence of until then unknown diseases, with a strong impact on the Brazilian population, establishing a little predictable and very challenging path. RESUMO Neste artigo, comentamos as principais características das doenças infecciosas no Brasil, nos últimos 50 anos, destacando o quanto a Revista de Saúde Pública conseguiu capturar essa trajetória. De 1967 a 2016, foram publicados 1.335 artigos na Revista de Saúde Pública com foco em doenças infecciosas. Ainda que a proporção de artigos sobre esse tema tenha declinado de cerca de 50,0% para 15,0%, seu destaque se manteve e refletiu a crescente complexidade das pesquisas necessárias para o seu controle. Nota-se que os desenhos dos estudos e as estratégias de análise ganharam progressivamente maior sofisticação, acompanhando o grande desenvolvimento da epidemiologia no Brasil, nas últimas décadas. Assim, foi registrado não apenas o sucesso de intervenções de saúde pública que permitiram o controle ou a eliminação de inúmeras doenças infecciosas responsáveis, no passado, por elevadas taxas de morbimortalidade, como também a reemergência de males já controlados e o surgimento de doenças até então desconhecidas, com forte impacto na população brasileira, desenhando uma trajetória pouco previsível e muito desafiadora.

Highly active antiretroviral therapy and dyslipidemia in people living with HIV/AIDS in Fako Division, South West Region of Cameroon

Background

The advent of HAART has been associated with a profound reduction in morbidity and mortality from HIV/AIDS. However, side effects and toxicities associated with HAART may lead to an increased risk for cardiovascular diseases. The aim of this study was to determine the prevalence of dyslipidemia and determining factors of derangements in lipid profile associated with the use of HAART regimens in people living with HIV/AIDS in Fako Division of the South West Region of Cameroon.

Methods

This cross-sectional study was conducted between March and August 2014. Lipid profile was determined after overnight fast and dyslipidemia diagnosed according to the US National Cholesterol Education Program III criteria. Socio-demographic characteristics were also collected using a questionnaire. Data was analyzed using STATA; chi-square test, student’s t-test, ANOVA and logistic regressions were computed.

Results

Two hundred and nine participants were recruited including 157 (75.1 %) on HAART and 52 (24.9 %) HAART-naïve. Antiretrovirals were drugs containing two nucleoside backbones (zidovudine/ /lamivudine/tenofovir) with either a non-nucleoside (nevirapine/efavirenz) or a protease inhibitor (lopinavir). No patient was treated with statins. Their mean age was 43.4 (±11.0) years. The mean CD4⁺ T cell count was 425 (±281) cells/μl after mean duration of HIV infection of 54.8 (±43.9) months and mean duration on ART of 63.7 (±41.4) months. The prevalence of total cholesterol (≥ 200 mg/dL) was 51.0 % in patients on HAART and 9.6 % pre-HAART patients (p < 0.0001), whereas LDL-cholesterol ≥ 130 mg/dL occurred in 36.9 % and in 7.7 % respectively, (p = 0.0001). Receiving HAART (adjusted odds ratio =6.24, 95 % CI: 2.33–17.45, p < 0.0001) and HIV duration of 42 months and more (aOR = 2.26, 95 % CI: 1.16–4.42, p = 0.017) were independently associated with total cholesterol ≥ 200 mg/dL. Receiving HAART (aOR = 5.28, 95 % CI: 1.17–16.32, p = 0.004) was independently associated with raised LDL-cholesterol values. The adjusted odds ratio (95 % CI) of BMI ≥ 25.0 kg/m² versus BMI < 25.0 kg/m² was 3.25 (1.44–7.34) for triglycerides ≥ 150 mg/dL.

Conclusion

HAART regimens were significantly associated with atherogenic lipid profile. Lipid profile should be monitored in HIV/AIDS patients on therapy so that any negative effects of HAART are optimally managed.

Analysis of the prevalence of dyslipidemia in individuals with HIV and its association with antiretroviral therapy

INTRODUCTION

Antiretroviral therapy (ART) has been used to treat large numbers of patients living with human immunodeficiency virus (HIV) infection. Lipid disorders are often observed in these patients, and include elevations in total cholesterol (TC) and triglycerides (TG).

METHODS

A cross-sectional study was performed using 333 patient records from the Regional Hospital of São José Doutor Homero de Miranda Gomes (HRSJHMG). The study population consisted of patients with HIV who were under medical follow up, either on or off drug treatment. The data were entered into Excel and exported to SPSS 16.0 for analysis using chi-square testing. We used prevalence ratios as the measure of association.

RESULTS

Lipid abnormalities were observed in 78.9% of individuals who received ART. Of the 308 subjects on ART, 59.1%, 41.9%, and 33.1% had TG, TC and low-density lipoprotein (LDL) abnormalities, respectively. The prevalence of LDL changes was 2.57-fold higher in individuals who had been using ART for more than 12 months, compared to those using ART for 6 to 12 months.

CONCLUSIONS

HIV patients showed a significant increase in the association between TC and TG levels and the use of ART. In particular, changes in TC, LDL and TG were greater in individuals who had received ART for over more than 12 months.

The effects of a diet formulation with oats, soybeans, and flax on lipid profiles and uricemia in patients with AIDS and dyslipidemia

INTRODUCTION

Although the initiation of highly active antiretroviral therapy (HAART) is accompanied by an attenuation of viral load, metabolic disorders characterized by hyperglycemia, dyslipidemia, and lipodystrophy are often observed in patients under this treatment. Certain foods, such as oat bran, soy protein, and flaxseed, have been shown to improve a patient's lipid profile despite possible increases in uricemia. Thus, a bioactive compound was formulated using these foods to help patients with HIV/AIDS control metabolic disorders resulting from HAART.

METHODS

An uncontrolled before and after study was performed. The total cholesterol, HDL-cholesterol, LDL-cholesterol, triglycerides, and uric acid before and after 3 months of consuming the formulation were compared in patients. The compound was formulated such that 40g (the recommended daily intake) contained approximately 10g of flaxseed, 20g of oat bran, and 10g of textured soy protein.

RESULTS

The study population consisted of 139 patients, 31 of whom were included in the final analysis. There were no significant variations between the laboratory results obtained before and after consumption of the compound.

CONCLUSIONS

The regular consumption of the formulation together with individualized dietary guidance did not reduce lipid levels and did not contribute to an increase in uricemia in the study group. However, new studies with higher doses of the foods that compose the formulation should be encouraged to investigate whether these foods can positively influence the lipid profiles of these patients.

N, Herold P, Pimentel GGDA, Pupulin ÁRT. Níveis de atividade física e alterações metabólicas em pessoas vivendo com HIV/AIDS

Com a introdução da highly active antiretroviral therapy (HAART) - terapia antirretroviral fortemente ativa - o curso da infecção pelo HIV sofreu profundas modificações; ocorreu aumento da sobrevida e melhora na qualidade de vida, com restauração parcial do sistema imune. Após cerca de 10 anos do uso da HAART, começaram a aparecer os efeitos da combinação tratamento/vírus. Estes incluem alterações no metabolismo dos lipídios com hipertrigliceridemia, hipercolesterolemia, resistência insulínica, hiperglicemia e redistribuição da gordura corporal que são fatores de risco para doença cardiovascular. Estudos observacionais em pessoas vivendo com HIV/AIDS mostram que o indivíduo, ao se descobrir portador da doença, acaba sentindo medo ou vergonha, reduzindo o círculo social, atividades de trabalho e lazer, e se isolando em casa ou em pequenos grupos os quais tenham em comum a identidade de portadores HIV/AIDS. O objetivo deste trabalho foi avaliar a relação entre o nível de atividade física habitual e de lazer de pessoas vivendo com HIV/AIDS e sua relação com alterações metabólicas. Os pacientes foram classificados em sedentários e ativos, utilizando o questionário de atividade física habitual proposto por Baecke e validado para pacientes HIV/AIDS. Para classificação utilizou-se as recomendações do Colégio Americano de Medicina do Esporte. O metabolismo foi avaliado por meio das dosagens de glicemia de jejum, colesterol total, HDL-colesterol, LDL-colesterol e triglicérides, utilizando-se kits comerciais. A amostra foi composta por 65 pacientes HIV que utilizavam terapia HAART há pelo menos cinco anos. Foram classificados 64,6% como sedentários e 35,4% ativos. O estudo mostra uma relação direta entre nível de atividade física e melhores níveis de HDL-colesterol em pacientes HIV/AIDS. O HDL-colesterol é uma lipoproteína de proteção cardiovascular e, embora outros parâmetros avaliados não tenham mostrado diferença, estes resultados apontam a necessidade de estudos adicionais sobre fatores de risco e atividade física para pacientes HIV/AIDS, possibilitando propostas de intervenções específicas para esses pacientes.

Association of subclinical atherosclerosis with lipid levels amongst antiretroviral-treated and untreated HIV-infected women in the Women's Interagency HIV study

OBJECTIVE

We examined serum lipids in association with carotid artery intima-media thickness (CIMT) in HIV-infected and HIV-uninfected women.

METHODS

In 2003-4, among 1827 Women's Interagency HIV Study participants, we measured CIMT and lipids (high-density lipoprotein cholesterol (HDL-c), low-density lipoprotein cholesterol (LDL-c), total cholesterol (TC), non-HDL-c). A subset of 520 treated HIV-infected women had pre-1997 lipid measures. We used multivariable linear regression to examine associations between lipids and CIMT.

RESULTS

In HIV-uninfected women, higher TC, LDL-c and non-HDL-c were associated with increased CIMT. Among HIV-infected women, associations of lipids with CIMT were observed in treated but not untreated women. Among the HIV-infected women treated in 2003-4, CIMT was associated both with lipids measured a decade earlier in infection, and with late lipid measurements.

CONCLUSION

Among HIV-infected women, hyperlipidemia is most strongly associated with subclinical atherosclerosis in treated women. Among treated women, the association appeared strongest early in the disease course.

First-line antiretroviral therapy and dyslipidemia in people living with HIV-1 in Cameroon: a cross-sectional study

Background

Data on lipid profile derangements induced by antiretroviral treatment in Africa are scarce. The aim of this study was to determine the prevalence and characteristics of lipid profile derangements associated with first-line highly active antiretroviral therapy (ART) among Cameroonians living with human immunodeficiency virus (HIV) infection.

Methods

This cross-sectional study was conducted between November 2009 and January 2010, and involved 138 HIV patients who had never received ART (ART-naive group) and 138 others treated for at least 12 months with first line triple ART regimens that included nevirapine or efavirenz (ART group). Lipid profile was determined after overnight fast and dyslipidemia diagnosed according to the US National Cholesterol Education Program III criteria. Data comparison used chi-square test, Student t-test and logistic regressions.

Results

The prevalence of total cholesterol ≥ 200 mg/dl was 37.6% and 24.6% respectively in ART group and ART-naive groups (p = 0.019). The equivalents for LDL-cholesterol ≥ 130 mg/dl were 46.4% and 21% (p ≤ 0.001). Proportions of patients with total cholesterol/HDL-cholesterol ratio ≥ 5 was 35.5% in ART group and 18.6% in ART-naive group (p ≤ 0.001). The distribution of HDL-cholesterol and triglycerides was similar between the two groups. In multivariable analysis adjusted for age, sex, body mass index, CD4 count and co-infection with tuberculosis, being on ART was significantly and positively associated with raised total cholesterol, LDL-cholesterol and TC/HDL cholesterol. The adjusted odd ratios (95% confidence interval, p-value) ART-treated vs. ART-naïve was 1.82 (1.06-1.12, p = 0.02) for TC ≥ 200 mg/dl; 2.99 (1.74-5.15), p < 0.0001) for LDL-cholesterol ≥ 130 mg/dl and 1.73 (1.04-2.89, p = 0.03) for TC/HDL-cholesterol ≥ 5.

Conclusions

First-line antiretroviral therapy that includes nonnucleoside reverse transcriptase inhibitors is associated with pro-atherogenic adverse lipid profile in people with HIV-1 infection compared to untreated HIV-infected subjects in Yaounde. Lipid profile and other cardiovascular risk factors should be monitored in patients on such therapy so that any untoward effects of treatments can be optimally managed.

Correlation between HIV disease and lipid metabolism in antiretroviral-naïve HIV-infected patients in Japan

Antiretroviral therapy alters lipid metabolism in HIV-infected patients. However, interpreting the impact of HIV infection on lipid metabolism is difficult because of various associated factors, including antiretroviral drugs and demographic characteristics. A few studies have associated HIV infection with lipid metabolism in antiretroviral-naïve HIV-infected patients. Because there were no data in this regard from Japan, the present study examined the impact of HIV infection, as well as demographic and clinical features, on lipid metabolism in antiretroviral-naïve HIV-infected patients in Japan. We performed a cross-sectional study to examine the impact of HIV disease, demographic and clinical characteristics on lipid metabolism among 168 HIV-infected Japanese men who were antiretroviral naïve and who did not have hemophilia, including patients who took medication for dyslipidemia. The mean age of the patients was 45.7 years; 0.6% of the patients took medication to dyslipidemia. The mean CD4 lymphocyte count was 289/μL, the mean baseline log10 HIV viral load was 4.2 HIV-1 RNA copies/mL, and 22% of the patients had a history of AIDS-defining events. A higher HDL-C concentration was associated with a higher CD4 lymphocyte count (p = 0.043). Also, a higher LDL-C concentration was associated with a higher CD4 lymphocyte count (p = 0.003). Infection with HIV was associated with dyslipidemia in antiretroviral-naïve patients. More advanced HIV disease was associated with less favorable lipid homeostatic profiles. These results are similar to findings from other countries.