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Mesic A, Decroo T, Florence E, Ritmeijer K, van Olmen J, Lynen L. Systematic review on cumulative HIV viraemia among people living with HIV receiving antiretroviral treatment and its association with mortality and morbidity. Int Health 2024; 16:261-278. [PMID: 37823452 PMCID: PMC11062202 DOI: 10.1093/inthealth/ihad093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 08/30/2023] [Accepted: 09/22/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND We performed a systematic review to generate evidence on the association between cumulative human immunodeficiency virus (HIV) viraemia and health outcomes. METHODS Quantitative studies reporting on HIV cumulative viraemia (CV) and its association with health outcomes among people living with HIV (PLHIV) on antiretroviral treatment (ART) were included. We searched MEDLINE via PubMed, Embase, Scopus and Web of Science and conference abstracts from 1 January 2008 to 1 August 2022. RESULTS The systematic review included 26 studies. The association between CV and mortality depended on the study population, methods used to calculate CV and its level. Higher CV was not consistently associated with greater risk of acquire immunodeficiency syndrome-defining clinical conditions. However, four studies present a strong relationship between CV and cardiovascular disease. The risk was not confirmed in relation of increased hazards of stroke. Studies that assessed the effect of CV on the risk of cancer reported a positive association between CV and malignancy, although the effect may differ for different types of cancer. CONCLUSIONS CV is associated with adverse health outcomes in PLHIV on ART, especially at higher levels. However, its role in clinical and programmatic monitoring and management of PLHIV on ART is yet to be established.
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Affiliation(s)
- Anita Mesic
- Institute of Tropical Medicine, Department of Clinical Sciences, Kronenburgstraat 43, 2000, Antwerpen, Belgium
- Médecins Sans Frontières, Public Health Department, Plantage Middenlaan 14, 1018DD Amsterdam, The Netherlands
- University of Antwerp, Faculty of Medicine and Health Sciences, Family Medicine and Population Health, Doornstraat 331, 2610 Antwerpen, Belgium
| | - Tom Decroo
- Institute of Tropical Medicine, Department of Clinical Sciences, Kronenburgstraat 43, 2000, Antwerpen, Belgium
| | - Eric Florence
- Institute of Tropical Medicine, Department of Clinical Sciences, Kronenburgstraat 43, 2000, Antwerpen, Belgium
- Department of General Internal Medicine, Infectious Diseases and Tropical Medicine, University Hospital of Antwerp, Drie Eikenstraat 655, 2650, Edegem, Belgium
| | - Koert Ritmeijer
- Médecins Sans Frontières, Public Health Department, Plantage Middenlaan 14, 1018DD Amsterdam, The Netherlands
| | - Josefien van Olmen
- Institute of Tropical Medicine, Department of Clinical Sciences, Kronenburgstraat 43, 2000, Antwerpen, Belgium
- University of Antwerp, Faculty of Medicine and Health Sciences, Family Medicine and Population Health, Doornstraat 331, 2610 Antwerpen, Belgium
| | - Lutgarde Lynen
- Institute of Tropical Medicine, Department of Clinical Sciences, Kronenburgstraat 43, 2000, Antwerpen, Belgium
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Stammler R, Guillaume J, Mazighi M, Denier C, Raynouard I, Lapergue B, De Broucker T, Meseguer E, Hosseini H, Leger A, Smadja D, Lamy C, Obadia M, Moulignier A. First-ever acute ischemic strokes in HIV-infected persons: A case-control study from stroke units. Ann Clin Transl Neurol 2024; 11:916-925. [PMID: 38287505 PMCID: PMC11021677 DOI: 10.1002/acn3.52008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 12/05/2023] [Accepted: 01/09/2024] [Indexed: 01/31/2024] Open
Abstract
OBJECTIVE The stroke risk for persons living with human immunodeficiency virus (PLHIVs) doubled compared to uninfected individuals. Stroke-unit (SU)-access, acute reperfusion therapy-use and outcome data on PLHIVs admitted for acute ischemic stroke (AIS) are scarce. METHODS AIS patients admitted (01 January 2017 to 31 January 2021) to 10 representative Paris-area SUs were screened retrospectively from the National Hospitalization Database. PLHIVs were compared to age-, initial NIHSS- and sex-matched HIV-uninfected controls (HUCs). Outcome was the 90-day modified Rankin Scale score. RESULTS Among 126 PLHIVs with confirmed first-ever AIS, ~80% were admitted outside the thrombolysis-administration window. Despite antiretrovirals, uncontrolled plasma HIV loads exceeded 50 copies/mL (26% of all PLHIVs; 38% of those ≤55 years). PLHIVs' stroke causes by decreasing frequency were large artery atherosclerosis (LAA), undetermined, other cause, cerebral small-vessel disease (CSVD) or cardioembolism. No stroke etiology was associated with HIV duration or detectable HIVemia. MRI revealed previously unknown AIS in one in three PLHIVs, twice the HUC rate (p = 0.006). Neither group had optimally controlled modifiable cardiovascular risk factors (CVRFs): 20%-30% without specific hypertension, diabetes, and/or dyslipidemia treatments. Their stroke outcomes were comparable. Multivariable analyses retained good prognosis associated solely with initial NIHSS or reperfusion therapy. Older age and hypertension were associated with CSVD/LAA for all PLHIVs. Standard neurovascular care and reperfusion therapy were well-tolerated. INTERPRETATION The high uncontrolled HIV-infection rate and suboptimal CVRF treatment support heightened vigilance to counter suboptimal HIV suppression and antiretroviral adherence, and improve CVRF prevention, mainly for younger PLHIVs. Those preventive, routine measures could lower PLHIVs' AIS risk.
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Affiliation(s)
- Romain Stammler
- Department of Neurology and Stroke UnitRothschild Foundation HospitalParisFrance
| | | | - Mikael Mazighi
- APHP, Department of Neurology and Stroke Unit, Lariboisière Hospital, and Department of Interventional NeuroradiologyRothschild Foundation HospitalParisFrance
| | - Christian Denier
- APHP, Department of Neurology and Stroke UnitHôpital Bicêtre, Paris Saclay UniversityLe Kremlin–BicêtreFrance
| | - Igor Raynouard
- Department of Neurology and Stroke UnitRothschild Foundation HospitalParisFrance
| | - Bertrand Lapergue
- Department of Neurology and Stroke Unit, Foch HospitalVersailles Saint‐Quentin‐en‐Yvelines UniversitySuresnesFrance
| | - Thomas De Broucker
- Department of Neurology and Stroke UnitDelafontaine HospitalSaint‐DenisFrance
| | - Elena Meseguer
- APHP, Department of Neurology and Stroke Unit, Bichat–Claude‐Bernard Hospital, INSERM LVTS‐U1148, DHU FIREUniversity of ParisParisFrance
| | - Hassan Hosseini
- APHP, Department of Neurology and Stroke Unit, Henri‐Mondor HospitalUniversity of Paris XIICréteilFrance
| | - Anne Leger
- APHP, Stroke Unit, Pitié–Salpêtrière HospitalSorbonne UniversityParisFrance
| | - Didier Smadja
- Department of Neurology and Stroke Unit, Centre Hospitalier Sud‐FrancilienParis Saclay UniversityCorbeil‐EssonnesFrance
| | - Catherine Lamy
- Neurology Department and Stroke UnitGHU Paris Psychiatrie et Neurosciences, Sainte‐Anne HospitalParisFrance
| | - Michael Obadia
- Department of Neurology and Stroke UnitRothschild Foundation HospitalParisFrance
| | - Antoine Moulignier
- Department of Neurology and Stroke UnitRothschild Foundation HospitalParisFrance
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Swilley-Martinez ME, Coles SA, Miller VE, Alam IZ, Fitch KV, Cruz TH, Hohl B, Murray R, Ranapurwala SI. "We adjusted for race": now what? A systematic review of utilization and reporting of race in American Journal of Epidemiology and Epidemiology, 2020-2021. Epidemiol Rev 2023; 45:15-31. [PMID: 37789703 DOI: 10.1093/epirev/mxad010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 07/31/2023] [Accepted: 09/28/2023] [Indexed: 10/05/2023] Open
Abstract
Race is a social construct, commonly used in epidemiologic research to adjust for confounding. However, adjustment of race may mask racial disparities, thereby perpetuating structural racism. We conducted a systematic review of articles published in Epidemiology and American Journal of Epidemiology between 2020 and 2021 to (1) understand how race, ethnicity, and similar social constructs were operationalized, used, and reported; and (2) characterize good and poor practices of utilization and reporting of race data on the basis of the extent to which they reveal or mask systemic racism. Original research articles were considered for full review and data extraction if race data were used in the study analysis. We extracted how race was categorized, used-as a descriptor, confounder, or for effect measure modification (EMM)-and reported if the authors discussed racial disparities and systemic bias-related mechanisms responsible for perpetuating the disparities. Of the 561 articles, 299 had race data available and 192 (34.2%) used race data in analyses. Among the 160 US-based studies, 81 different racial categorizations were used. Race was most often used as a confounder (52%), followed by effect measure modifier (33%), and descriptive variable (12%). Fewer than 1 in 4 articles (22.9%) exhibited good practices (EMM along with discussing disparities and mechanisms), 63.5% of the articles exhibited poor practices (confounding only or not discussing mechanisms), and 13.5% were considered neither poor nor good practices. We discuss implications and provide 13 recommendations for operationalization, utilization, and reporting of race in epidemiologic and public health research.
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Affiliation(s)
- Monica E Swilley-Martinez
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599-7435, United States
- Injury Prevention Research Center, University of North Carolina, Chapel Hill, NC 27599, United States
| | - Serita A Coles
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599-7440, United States
| | - Vanessa E Miller
- Injury Prevention Research Center, University of North Carolina, Chapel Hill, NC 27599, United States
| | - Ishrat Z Alam
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599-7435, United States
- Injury Prevention Research Center, University of North Carolina, Chapel Hill, NC 27599, United States
| | - Kate Vinita Fitch
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599-7435, United States
- Injury Prevention Research Center, University of North Carolina, Chapel Hill, NC 27599, United States
| | - Theresa H Cruz
- Prevention Research Center, Department of Pediatrics, Health Sciences Center, University of New Mexico, Albuquerque, NM 87131, United States
| | - Bernadette Hohl
- Penn Injury Science Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104-6021, United States
| | - Regan Murray
- Center for Public Health and Technology, Department of Health, Human Performance and Recreation, University of Arkansas, Fayetteville, AR 72701, United States
| | - Shabbar I Ranapurwala
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599-7435, United States
- Injury Prevention Research Center, University of North Carolina, Chapel Hill, NC 27599, United States
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Mbonde AA, Chang J, Musubire AK, Okello S, Kayanja A, Moses A, Butterfield RJ, Chow FC, Saylor DR, O'Carroll CB, Siedner M. HIV Infection and 90-Day Stroke Outcomes in Uganda: A Prospective Observational Cohort Study. Neurol Clin Pract 2023; 13:e200198. [PMID: 38495078 PMCID: PMC10942001 DOI: 10.1212/cpj.0000000000200198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 09/21/2023] [Indexed: 03/19/2024]
Abstract
Background and Objectives Little is known about the impact of HIV infection on the clinical presentation and outcomes after stroke in the modern antiretroviral therapy (ART) era. We aimed to compare stroke characteristics and outcomes between persons with HIV (PWH) and without HIV (PWOH) presenting with stroke in Uganda. Methods We conducted a matched cohort study at Mulago National Referral Hospital and Mbarara Regional Referral Hospital between January 2018 and November 2020. We enrolled consecutive PWH presenting with CT-confirmed acute or subacute stroke (symptom onset ≤14 days) and matched them by sex and stroke type to 2 consecutive available PWOH admitted to the same hospital. We obtained baseline clinical data and followed participants for 90 days from the day of clinical presentation. We compared stroke severity (defined by the NIH stroke scale [NIHSS]) and 90-day all-cause mortality and morbidity (using the modified Rankin Scale [mRS]) by HIV serostatus with and without adjustment for confounders. Results We enrolled 105 PWH and 157 PWOH with stroke. PWH were younger (mean [SD] age 49 [14] vs 59 [16] years, p < 0.001), and nearly 80% (82/105) were on ART for a median of 5 years and a median CD4 count of 214 cells/uL (interquartile range 140, 337). Compared with PWOH, PWH presented with a 3-point lower median NIHSS (16 vs 19, p = 0.011), a 20% lower proportion of all-cause mortality at 90 days (p = 0.001), and had less disability at 90 days (median mRS 4 vs 5, p = 0.004). Age and NIHSS-adjusted odds ratio of 90-day all-cause mortality in PWH compared with PWOH was 0.45 (95% CI 0.22-0.96, p = 0.037). Discussion In the modern ART era, PWH with acute stroke in Uganda present with modest stroke and are significantly less likely to die within 90 days than PWOH. This potentially reflects the protective effects of ART, enhanced health care access, and their younger age at stroke presentation.
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Affiliation(s)
- Amir A Mbonde
- Department of Medicine (AAM, AK, MS), Mbarara University of Science and Technology, Uganda; Harvard Medical School (AAM, MS); Department of Medicine (JC), Boston Medical Center, MA; Department of Medicine (Neurology) (AKM), Makerere University, Kampala, Uganda; Department of Epidemiology (SO), Gillings School of Global Public Health, University of North Carolina at Chapel Hill; Department of Radiology (AM), Mbarara University of Science and Technology, Uganda; Department of Quantitative Health Sciences (RJB), Mayo Clinic Arizona, Phoenix, AZ; Departments of Neurology and Medicine (Infectious Diseases) (FCC), University of California San Francisco; Department of Neurology (DRS), John Hopkins University School of Medicine, Baltimore, MD; Department of Internal Medicine (DRS), University Teaching Hospital, Lusaka, Zambia; Department of Neurology (CBOC), Mayo Clinic Arizona, Scottsdale; and Department of Medicine and Medical Practice Evaluation Center (MS), Massachusetts General Hospital, Boston
| | - Jonathan Chang
- Department of Medicine (AAM, AK, MS), Mbarara University of Science and Technology, Uganda; Harvard Medical School (AAM, MS); Department of Medicine (JC), Boston Medical Center, MA; Department of Medicine (Neurology) (AKM), Makerere University, Kampala, Uganda; Department of Epidemiology (SO), Gillings School of Global Public Health, University of North Carolina at Chapel Hill; Department of Radiology (AM), Mbarara University of Science and Technology, Uganda; Department of Quantitative Health Sciences (RJB), Mayo Clinic Arizona, Phoenix, AZ; Departments of Neurology and Medicine (Infectious Diseases) (FCC), University of California San Francisco; Department of Neurology (DRS), John Hopkins University School of Medicine, Baltimore, MD; Department of Internal Medicine (DRS), University Teaching Hospital, Lusaka, Zambia; Department of Neurology (CBOC), Mayo Clinic Arizona, Scottsdale; and Department of Medicine and Medical Practice Evaluation Center (MS), Massachusetts General Hospital, Boston
| | - Abdu K Musubire
- Department of Medicine (AAM, AK, MS), Mbarara University of Science and Technology, Uganda; Harvard Medical School (AAM, MS); Department of Medicine (JC), Boston Medical Center, MA; Department of Medicine (Neurology) (AKM), Makerere University, Kampala, Uganda; Department of Epidemiology (SO), Gillings School of Global Public Health, University of North Carolina at Chapel Hill; Department of Radiology (AM), Mbarara University of Science and Technology, Uganda; Department of Quantitative Health Sciences (RJB), Mayo Clinic Arizona, Phoenix, AZ; Departments of Neurology and Medicine (Infectious Diseases) (FCC), University of California San Francisco; Department of Neurology (DRS), John Hopkins University School of Medicine, Baltimore, MD; Department of Internal Medicine (DRS), University Teaching Hospital, Lusaka, Zambia; Department of Neurology (CBOC), Mayo Clinic Arizona, Scottsdale; and Department of Medicine and Medical Practice Evaluation Center (MS), Massachusetts General Hospital, Boston
| | - Samson Okello
- Department of Medicine (AAM, AK, MS), Mbarara University of Science and Technology, Uganda; Harvard Medical School (AAM, MS); Department of Medicine (JC), Boston Medical Center, MA; Department of Medicine (Neurology) (AKM), Makerere University, Kampala, Uganda; Department of Epidemiology (SO), Gillings School of Global Public Health, University of North Carolina at Chapel Hill; Department of Radiology (AM), Mbarara University of Science and Technology, Uganda; Department of Quantitative Health Sciences (RJB), Mayo Clinic Arizona, Phoenix, AZ; Departments of Neurology and Medicine (Infectious Diseases) (FCC), University of California San Francisco; Department of Neurology (DRS), John Hopkins University School of Medicine, Baltimore, MD; Department of Internal Medicine (DRS), University Teaching Hospital, Lusaka, Zambia; Department of Neurology (CBOC), Mayo Clinic Arizona, Scottsdale; and Department of Medicine and Medical Practice Evaluation Center (MS), Massachusetts General Hospital, Boston
| | - Adrian Kayanja
- Department of Medicine (AAM, AK, MS), Mbarara University of Science and Technology, Uganda; Harvard Medical School (AAM, MS); Department of Medicine (JC), Boston Medical Center, MA; Department of Medicine (Neurology) (AKM), Makerere University, Kampala, Uganda; Department of Epidemiology (SO), Gillings School of Global Public Health, University of North Carolina at Chapel Hill; Department of Radiology (AM), Mbarara University of Science and Technology, Uganda; Department of Quantitative Health Sciences (RJB), Mayo Clinic Arizona, Phoenix, AZ; Departments of Neurology and Medicine (Infectious Diseases) (FCC), University of California San Francisco; Department of Neurology (DRS), John Hopkins University School of Medicine, Baltimore, MD; Department of Internal Medicine (DRS), University Teaching Hospital, Lusaka, Zambia; Department of Neurology (CBOC), Mayo Clinic Arizona, Scottsdale; and Department of Medicine and Medical Practice Evaluation Center (MS), Massachusetts General Hospital, Boston
| | - Acan Moses
- Department of Medicine (AAM, AK, MS), Mbarara University of Science and Technology, Uganda; Harvard Medical School (AAM, MS); Department of Medicine (JC), Boston Medical Center, MA; Department of Medicine (Neurology) (AKM), Makerere University, Kampala, Uganda; Department of Epidemiology (SO), Gillings School of Global Public Health, University of North Carolina at Chapel Hill; Department of Radiology (AM), Mbarara University of Science and Technology, Uganda; Department of Quantitative Health Sciences (RJB), Mayo Clinic Arizona, Phoenix, AZ; Departments of Neurology and Medicine (Infectious Diseases) (FCC), University of California San Francisco; Department of Neurology (DRS), John Hopkins University School of Medicine, Baltimore, MD; Department of Internal Medicine (DRS), University Teaching Hospital, Lusaka, Zambia; Department of Neurology (CBOC), Mayo Clinic Arizona, Scottsdale; and Department of Medicine and Medical Practice Evaluation Center (MS), Massachusetts General Hospital, Boston
| | - Richard J Butterfield
- Department of Medicine (AAM, AK, MS), Mbarara University of Science and Technology, Uganda; Harvard Medical School (AAM, MS); Department of Medicine (JC), Boston Medical Center, MA; Department of Medicine (Neurology) (AKM), Makerere University, Kampala, Uganda; Department of Epidemiology (SO), Gillings School of Global Public Health, University of North Carolina at Chapel Hill; Department of Radiology (AM), Mbarara University of Science and Technology, Uganda; Department of Quantitative Health Sciences (RJB), Mayo Clinic Arizona, Phoenix, AZ; Departments of Neurology and Medicine (Infectious Diseases) (FCC), University of California San Francisco; Department of Neurology (DRS), John Hopkins University School of Medicine, Baltimore, MD; Department of Internal Medicine (DRS), University Teaching Hospital, Lusaka, Zambia; Department of Neurology (CBOC), Mayo Clinic Arizona, Scottsdale; and Department of Medicine and Medical Practice Evaluation Center (MS), Massachusetts General Hospital, Boston
| | - Felicia C Chow
- Department of Medicine (AAM, AK, MS), Mbarara University of Science and Technology, Uganda; Harvard Medical School (AAM, MS); Department of Medicine (JC), Boston Medical Center, MA; Department of Medicine (Neurology) (AKM), Makerere University, Kampala, Uganda; Department of Epidemiology (SO), Gillings School of Global Public Health, University of North Carolina at Chapel Hill; Department of Radiology (AM), Mbarara University of Science and Technology, Uganda; Department of Quantitative Health Sciences (RJB), Mayo Clinic Arizona, Phoenix, AZ; Departments of Neurology and Medicine (Infectious Diseases) (FCC), University of California San Francisco; Department of Neurology (DRS), John Hopkins University School of Medicine, Baltimore, MD; Department of Internal Medicine (DRS), University Teaching Hospital, Lusaka, Zambia; Department of Neurology (CBOC), Mayo Clinic Arizona, Scottsdale; and Department of Medicine and Medical Practice Evaluation Center (MS), Massachusetts General Hospital, Boston
| | - Deanna R Saylor
- Department of Medicine (AAM, AK, MS), Mbarara University of Science and Technology, Uganda; Harvard Medical School (AAM, MS); Department of Medicine (JC), Boston Medical Center, MA; Department of Medicine (Neurology) (AKM), Makerere University, Kampala, Uganda; Department of Epidemiology (SO), Gillings School of Global Public Health, University of North Carolina at Chapel Hill; Department of Radiology (AM), Mbarara University of Science and Technology, Uganda; Department of Quantitative Health Sciences (RJB), Mayo Clinic Arizona, Phoenix, AZ; Departments of Neurology and Medicine (Infectious Diseases) (FCC), University of California San Francisco; Department of Neurology (DRS), John Hopkins University School of Medicine, Baltimore, MD; Department of Internal Medicine (DRS), University Teaching Hospital, Lusaka, Zambia; Department of Neurology (CBOC), Mayo Clinic Arizona, Scottsdale; and Department of Medicine and Medical Practice Evaluation Center (MS), Massachusetts General Hospital, Boston
| | - Cumara B O'Carroll
- Department of Medicine (AAM, AK, MS), Mbarara University of Science and Technology, Uganda; Harvard Medical School (AAM, MS); Department of Medicine (JC), Boston Medical Center, MA; Department of Medicine (Neurology) (AKM), Makerere University, Kampala, Uganda; Department of Epidemiology (SO), Gillings School of Global Public Health, University of North Carolina at Chapel Hill; Department of Radiology (AM), Mbarara University of Science and Technology, Uganda; Department of Quantitative Health Sciences (RJB), Mayo Clinic Arizona, Phoenix, AZ; Departments of Neurology and Medicine (Infectious Diseases) (FCC), University of California San Francisco; Department of Neurology (DRS), John Hopkins University School of Medicine, Baltimore, MD; Department of Internal Medicine (DRS), University Teaching Hospital, Lusaka, Zambia; Department of Neurology (CBOC), Mayo Clinic Arizona, Scottsdale; and Department of Medicine and Medical Practice Evaluation Center (MS), Massachusetts General Hospital, Boston
| | - Mark Siedner
- Department of Medicine (AAM, AK, MS), Mbarara University of Science and Technology, Uganda; Harvard Medical School (AAM, MS); Department of Medicine (JC), Boston Medical Center, MA; Department of Medicine (Neurology) (AKM), Makerere University, Kampala, Uganda; Department of Epidemiology (SO), Gillings School of Global Public Health, University of North Carolina at Chapel Hill; Department of Radiology (AM), Mbarara University of Science and Technology, Uganda; Department of Quantitative Health Sciences (RJB), Mayo Clinic Arizona, Phoenix, AZ; Departments of Neurology and Medicine (Infectious Diseases) (FCC), University of California San Francisco; Department of Neurology (DRS), John Hopkins University School of Medicine, Baltimore, MD; Department of Internal Medicine (DRS), University Teaching Hospital, Lusaka, Zambia; Department of Neurology (CBOC), Mayo Clinic Arizona, Scottsdale; and Department of Medicine and Medical Practice Evaluation Center (MS), Massachusetts General Hospital, Boston
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Du M, Wang Y, Qin C, Mi D, Liu M, Liu J. Prevalence and incidence of stroke among people with HIV. AIDS 2023; 37:1747-1756. [PMID: 37352496 PMCID: PMC10399939 DOI: 10.1097/qad.0000000000003632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 06/12/2023] [Accepted: 06/19/2023] [Indexed: 06/25/2023]
Abstract
OBJECTIVE We aimed to obtain more precise estimates of stroke to address the wide variation of stroke burden among people with HIV (PWH) in different clinical settings. DESIGN Systematic review and meta-analysis. METHODS We systematically searched PubMed, EMBASE, and Web of Science for original articles reporting the prevalence and incidence of stroke among PWH up to November 23, 2022. Der Simonian-Laird random effects were used to obtain pooled estimates and 95% confidence intervals (CIs). RESULTS We included 17 observational studies covering 1 749 003 PWH on estimation of prevalence, and 17 cohort studies covering 249 606 PWH on estimation of incidence. The pooled prevalence of stroke was 1.30% (95% CI: 1.01%, 1.59%) for PWH aged at least 15 years, and 3.98% (95% CI: 2.45%, 5.51%) for PWH aged at least 50 years. The pooled incidence of stroke was 17.86 per 10 000 person-years (95% CI: 15.96, 19.76), meanwhile, the pooled incidence of ischemic stroke (31.50 per 10 000 person-years; 95% CI: 11.11, 51.89) was higher than hemorrhagic stroke (4.43 per 10 000 person-years; 95% CI: 1.95, 6.91) among PWH aged at least 15 years. CONCLUSION The prevalence of stroke was nearly one per hundred among PWH aged ≥15 years, and reached four per hundred for those aged ≥50 years. The occurrence of stroke is common during HIV progression, particularly ischemic stroke. Therefore, more efforts should be made on implementing policies, strategies, and programs aimed at identifying the risk factors, improving treatment, and facilitating rehabilitation for stroke to reduce the disease burden among PWH.
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Affiliation(s)
- Min Du
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University
| | - Yaping Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University
| | - Chenyuan Qin
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University
| | - Donghua Mi
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University
| | - Min Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University
| | - Jue Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University
- Institute for Global Health and Development, Peking University
- Global Center for Infectious Disease and Policy Research & Global Health and Infectious Diseases Group, Peking University
- Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education, Beijing, China
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Abstract
Widespread use of contemporary antiretroviral therapy globally has transformed HIV disease into a chronic illness associated with excess risk for disorders of the heart and circulatory system. Current clinical care and research has focused on improving HIV-related cardiovascular disease outcomes, survival, and quality of life. In high-income countries, emphasis on prevention of atherosclerotic coronary artery disease over the past decade, including aggressive management of traditional risk factors and earlier initiation of antiretroviral therapy, has reduced risk for myocardial infarction among persons living with human immunodeficiency virus-1 infection. Still, across the globe, persons living with human immunodeficiency virus-1 infection on effective antiretroviral therapy treatment remain at increased risk for ischemic outcomes such as myocardial infarction and stroke relative to the persons without HIV. Unique features of HIV-related cardiovascular disease, in part, include the pathogenesis of coronary disease characterized by remodeling ectasia and unusual plaque morphology, the relative high proportion of type 2 myocardial infarction events, abnormalities of the aorta such as aneurysms and diffuse aortic inflammation, and HIV cerebrovasculopathy as a contributor to stroke risk. Literature over the past decade has also reflected a shift in the profile and prevalence of HIV-associated heart failure, with a reduced but persistent risk of heart failure with reduced ejection fraction and a growing risk of heart failure with preserved ejection fraction. Cardiac magnetic resonance imaging and autopsy data have emphasized the central importance of intramyocardial fibrosis for the pathogenesis of both heart failure with preserved ejection fraction and the increase in risk of sudden cardiac death. Still, more research is needed to better characterize the underlying mechanisms and clinical phenotype of HIV-associated myocardial disease in the current era. Across the different cardiovascular disease manifestations, a common pathogenic feature is that HIV-associated inflammation working through different mechanisms may amplify underlying pathology because of traditional risk and other host factors. The prevalence and phenotype of individual cardiovascular disease manifestations is ultimately influenced by the degree of injury from HIV disease combined with the profile of underlying cardiometabolic factors, both of which may differ substantially by region globally.
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Affiliation(s)
- Mpiko Ntsekhe
- Division of Cardiology, Institute of Infectious Diseases and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa (M.N.)
| | - Jason V Baker
- Division of Infectious Diseases, Hennepin Healthcare Research Institute, Minneapolis, MN (J.V.B.).,Department of Medicine, University of Minnesota, Minneapolis (J.V.B.)
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Elvstam O, Marrone G, Engström G, Nilsson PM, Carlander C, Treutiger CJ, Gisslén M, Björkman P. Associations between HIV viremia during antiretroviral therapy and cardiovascular disease. AIDS 2022; 36:1829-34. [PMID: 35730359 DOI: 10.1097/QAD.0000000000003240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To investigate the association between HIV viremia exposure during antiretroviral therapy (ART) and cardiovascular disease (CVD) risk. DESIGN Nationwide observational cohort. METHODS Participants (age >15 years) from the Swedish nationwide InfCareHIV register initiating ART 1996-2017 were categorized in a time-updated manner into four viremia categories, starting from 12 months after ART initiation: suppression (<50 copies/ml), low-level viremia (50-199 copies/ml and 200-999 copies/ml, respectively), and high-level viremia (≥1000 copies/ml). In addition, cumulative viremia was estimated as the area under the log viral load (VL) curve. Proportional subhazard models adjusted for sex, age, pre-ART CD4 and VL, injection drug use, and country of birth were used to analyze the association between viremia exposure and CVD risk (ischemic heart disease, stroke, and heart failure; data obtained by linkage to national registers), accounting for the competing risk of non-CVD death. RESULTS In all, 337 cases of CVD were observed during 44 937 person-years of follow-up ( n = 6562). Higher viremia exposure was associated with CVD, both when parameterized as cumulative viremia (adjusted subhazard ratio [aSHR] per 1 log 10 copy × year/ml, 1.03; 95% confidence interval [CI], 1.01-1.05) and as viremia category (aSHR for high-level viremia versus suppression, 1.45; 95% CI, 1.03-2.05). We observed no association between CVD and low-level viremia compared with those with suppression. CONCLUSIONS Higher exposure to HIV viremia was linked to CVD in ART recipients, whereas no increased risk was detected for people with low-level viremia compared with viral suppression. Causal inference is limited by the observational nature of this study.
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Corbett C, Brey N, Pitcher RD, O'Hagan S, Esterhuizen TM, Chow FC, Decloedt EH. Prevalence and Characteristics of HIV-Associated Stroke in a Tertiary Hospital Setting in South Africa. Neurology 2022; 99:e904-e915. [PMID: 36038281 PMCID: PMC9502736 DOI: 10.1212/wnl.0000000000200780] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 04/11/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Antiretroviral treatment (ART) era HIV-associated stroke data from sub-Saharan Africa are limited. We determined the prevalence of HIV in patients presenting with acute symptomatic stroke and compared risk factors, clinical characteristics, and brain imaging with age-matched stroke patients without HIV. METHODS We conducted a retrospective study of adults presenting with any type of stroke to Tygerberg Hospital in a 12-month period. Patients living with HIV (PLWH) and HIV-uninfected (HIV-) patients were matched based on age group (1:2 ratio). Patients were identified by keyword search, while HIV status was ascertained from laboratory data. Clinical and imaging data were extracted from medical records. RESULTS Among 884 patients presenting with acute strokes, the minimum prevalence of HIV infection was 9.3% (95% CI: 7.4%-11.2%), with 496 patients (56.1%) with negative HIV status and 306 patients with unknown HIV status (34.6%). The mean age at presentation in PLWH was 46 (±11) years compared with 55 (±14) years in HIV- patients (p < 0.001). Smoking was less prevalent in PLWH with an adjusted relative risk ratio of RR = 0.58 (95% CI: 0.39-0.86). Concurrent infection was more prevalent in PLWH (25.6% vs 4.9%, p ≤ 0.001) with an adjusted relative risk ratio of RR = 2.07 (95% CI: 1.49-2.84), largely in patients with a CD4 count <200 cells/μL. PLWH with higher CD4 counts (≥200 cells/μL, 51.3%) had more traditional risk factors and less concurrent infection. Among PLWH, 68.3% were on ART, and 39.3% of them had been started or restarted on ART within the past 6 months. Basal ganglia infarcts (35.6% vs 18.3%, p = 0.014) and multiple vascular territory involvement (25.4% vs 7.7%, p = 0.002) were more common in PLWH. Clinical presentation, ischemic stroke type, and in-hospital outcomes did not differ between the groups. DISCUSSION Stroke patients with HIV were younger, had less traditional cardiovascular risk factors, and more concurrent infections than patients without HIV, especially those with a lower CD4 count. Recent ART initiation or reinitiation rates were high. Significant differences in CT brain imaging findings were seen. Understanding the multifactorial mechanisms underlying increased stroke risk, including associated infections and potential ART-associated immune reconstitution, is crucial and needs further study.
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Affiliation(s)
- Craig Corbett
- From the Divisions of Clinical Pharmacology (C.C., E.H.D., F.C.C.) and Neurology (N.B.), Department of Medicine, Division of Radiodiagnosis (R.D.P., S.O.H.), Department of Medical Imaging and Clinical Oncology, and Biostatistics Unit (T.M.E.), Division of Epidemiology and Biostatistics, Stellenbosch University, Cape Town Western Cape, South Africa; and Departments of Neurology and Medicine (Infectious Diseases) (F.C.C.), University of California, San Francisco
| | - Naeem Brey
- From the Divisions of Clinical Pharmacology (C.C., E.H.D., F.C.C.) and Neurology (N.B.), Department of Medicine, Division of Radiodiagnosis (R.D.P., S.O.H.), Department of Medical Imaging and Clinical Oncology, and Biostatistics Unit (T.M.E.), Division of Epidemiology and Biostatistics, Stellenbosch University, Cape Town Western Cape, South Africa; and Departments of Neurology and Medicine (Infectious Diseases) (F.C.C.), University of California, San Francisco
| | - Richard D Pitcher
- From the Divisions of Clinical Pharmacology (C.C., E.H.D., F.C.C.) and Neurology (N.B.), Department of Medicine, Division of Radiodiagnosis (R.D.P., S.O.H.), Department of Medical Imaging and Clinical Oncology, and Biostatistics Unit (T.M.E.), Division of Epidemiology and Biostatistics, Stellenbosch University, Cape Town Western Cape, South Africa; and Departments of Neurology and Medicine (Infectious Diseases) (F.C.C.), University of California, San Francisco
| | - Suzanne O'Hagan
- From the Divisions of Clinical Pharmacology (C.C., E.H.D., F.C.C.) and Neurology (N.B.), Department of Medicine, Division of Radiodiagnosis (R.D.P., S.O.H.), Department of Medical Imaging and Clinical Oncology, and Biostatistics Unit (T.M.E.), Division of Epidemiology and Biostatistics, Stellenbosch University, Cape Town Western Cape, South Africa; and Departments of Neurology and Medicine (Infectious Diseases) (F.C.C.), University of California, San Francisco
| | - Tonya M Esterhuizen
- From the Divisions of Clinical Pharmacology (C.C., E.H.D., F.C.C.) and Neurology (N.B.), Department of Medicine, Division of Radiodiagnosis (R.D.P., S.O.H.), Department of Medical Imaging and Clinical Oncology, and Biostatistics Unit (T.M.E.), Division of Epidemiology and Biostatistics, Stellenbosch University, Cape Town Western Cape, South Africa; and Departments of Neurology and Medicine (Infectious Diseases) (F.C.C.), University of California, San Francisco
| | - Felicia C Chow
- From the Divisions of Clinical Pharmacology (C.C., E.H.D., F.C.C.) and Neurology (N.B.), Department of Medicine, Division of Radiodiagnosis (R.D.P., S.O.H.), Department of Medical Imaging and Clinical Oncology, and Biostatistics Unit (T.M.E.), Division of Epidemiology and Biostatistics, Stellenbosch University, Cape Town Western Cape, South Africa; and Departments of Neurology and Medicine (Infectious Diseases) (F.C.C.), University of California, San Francisco
| | - Eric H Decloedt
- From the Divisions of Clinical Pharmacology (C.C., E.H.D., F.C.C.) and Neurology (N.B.), Department of Medicine, Division of Radiodiagnosis (R.D.P., S.O.H.), Department of Medical Imaging and Clinical Oncology, and Biostatistics Unit (T.M.E.), Division of Epidemiology and Biostatistics, Stellenbosch University, Cape Town Western Cape, South Africa; and Departments of Neurology and Medicine (Infectious Diseases) (F.C.C.), University of California, San Francisco.
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Eto Y, Saubi N, Ferrer P, Joseph-Munné J. Expression of Chimeric HPV-HIV Protein L1P18 in Pichia pastoris; Purification and Characterization of the Virus-like Particles. Pharmaceutics 2021; 13:pharmaceutics13111967. [PMID: 34834382 PMCID: PMC8622379 DOI: 10.3390/pharmaceutics13111967] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 11/10/2021] [Accepted: 11/12/2021] [Indexed: 11/16/2022] Open
Abstract
Currently, three human papillomavirus (HPV) vaccines are already licensed and all of them are based on virus-like particles (VLPs) of HPV L1 capsid protein but not worldwide accessible. While about 38.0 million people were living with HIV in 2019, only 68% of HIV-infected individuals were accessing antiretroviral therapy as of the end of June 2020 and there is no HIV vaccine yet. Therefore, safe, effective, and affordable vaccines against those two viruses are immediately needed. Both HPV and HIV are sexually transmitted infections and one of the main access routes is the mucosal genital tract. Thus, the development of a combined vaccine that would protect against HPV and HIV infections is a logical effort in the fight against these two major global pathogens. In this study, a recombinant Pichia pastoris producing chimeric HPV-HIV L1P18 protein intracellularly was constructed. After cell disruption, the supernatant was collected, and the VLPs were purified by a combination of ammonium sulfate precipitation, size exclusion chromatography, ultracentrifugation, and ultrafiltration. At the end of purification process, the chimeric VLPs were recovered with 96% purity and 9.23% overall yield, and the morphology of VLPs were confirmed by transmission electron microscopy. This work contributes towards the development of an alternative platform for production of a bivalent vaccine against HPV and HIV in P. pastoris.
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Affiliation(s)
- Yoshiki Eto
- Department of Microbiology, Hospital Universitari Vall d’Hebron, 08035 Barcelona, Spain; (Y.E.); (N.S.)
- Department of Chemical, Biological and Environmental Engineering, School of Engineering, Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain;
- Vall d’Hebron Research Institute, Hospital Universitari Vall d’Hebron, 08035 Barcelona, Spain
- AIDS Research Unit, Infectious Diseases Department, Hospital Clínic/IDIBAPS, School of Medicine, University of Barcelona, 08036 Barcelona, Spain
| | - Narcís Saubi
- Department of Microbiology, Hospital Universitari Vall d’Hebron, 08035 Barcelona, Spain; (Y.E.); (N.S.)
- Vall d’Hebron Research Institute, Hospital Universitari Vall d’Hebron, 08035 Barcelona, Spain
- AIDS Research Unit, Infectious Diseases Department, Hospital Clínic/IDIBAPS, School of Medicine, University of Barcelona, 08036 Barcelona, Spain
| | - Pau Ferrer
- Department of Chemical, Biological and Environmental Engineering, School of Engineering, Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain;
| | - Joan Joseph-Munné
- Department of Microbiology, Hospital Universitari Vall d’Hebron, 08035 Barcelona, Spain; (Y.E.); (N.S.)
- Correspondence:
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