HIV Medicine最新文献_第7页

Cardiovascular disease risk in people of African ancestry with HIV in the United Kingdom 英国非洲裔艾滋病毒感染者的心血管疾病风险。

IF 2.8 3区医学 Q2 INFECTIOUS DISEASES

HIV Medicine

Pub Date : 2024-08-29 DOI: 10.1111/hiv.13706

Stephanie Ko, Lourdes Dominguez-Dominguez, Zoe Ottaway, Lucy Campbell, Julie Fox, Fiona Burns, Lisa Hamzah, Andrew Ustianowski, Amanda Clarke, Stephen Kegg, Sarah Schoeman, Rachael Jones, Sarah L. Pett, Jonathan Hudson, Frank A. Post

Objectives

Our objective was to describe the prevalence of cardiovascular disease (CVD) risk factors in people of African ancestry with HIV in the UK.

Methods

We conducted a cross-sectional analysis of CVD risk factors in Black people with HIV aged ≥40 years and estimated the 10-year CVD risk using QRISK®3-2018. Correlations between body mass index (BMI) and CVD risk factors were described using Pearson correlation coefficients, and factors associated with 10-year CVD risk ≥5% were described using logistic regression.

Results

We included 833 Black people with HIV and a median age of 54 years; 54% were female, 50% were living with obesity (BMI ≥30 kg/m²), 61% had hypertension, and 19% had diabetes mellitus. CVD risk >5% ranged from 2% in female participants aged 40–49 years to 99% in men aged ≥60 years, and use of statins ranged from 7% in those with CVD risk <2.5% to 64% in those with CVD risk ≥20%. BMI was correlated (R² 0.1–0.2) with triglycerides and diastolic blood pressure in women and with glycated haemoglobin, systolic and diastolic blood pressure, and total:high-density lipoprotein (HDL) cholesterol ratio in men. In both female and male participants, older age, blood pressure, diabetes mellitus, and kidney disease were strongly associated with CVD risk ≥5%, whereas obesity, total:HDL cholesterol, triglycerides, and smoking status were variably associated with CVD risk ≥5%.

Conclusions

We report a high burden of CVD risk factors, including obesity, hypertension, and diabetes mellitus, in people of African ancestry with HIV in the UK. BMI-focused interventions in these populations may improve CVD risk while also addressing other important health issues.

目的我们的目的是描述英国感染艾滋病毒的非洲裔人群中心血管疾病（CVD）风险因素的流行情况：我们对年龄≥40 岁的黑人 HIV 感染者的心血管疾病风险因素进行了横断面分析，并使用 QRISK®3-2018 估算了 10 年的心血管疾病风险。使用皮尔逊相关系数描述了身体质量指数（BMI）与心血管疾病风险因素之间的相关性，使用逻辑回归描述了与 10 年心血管疾病风险≥5% 相关的因素：我们纳入了 833 名感染艾滋病毒的黑人，中位年龄为 54 岁；54% 为女性，50% 患有肥胖症（体重指数≥30 kg/m2），61% 患有高血压，19% 患有糖尿病。心血管疾病风险大于 5% 的女性参与者占 40-49 岁的 2%，而年龄≥60 岁的男性参与者占 99%，使用他汀类药物的女性参与者占心血管疾病风险为 2 0.1-0.2% 的 7%，使用他汀类药物的男性参与者占甘油三酯和舒张压的 7%，使用他汀类药物的男性参与者占糖化血红蛋白、收缩压和舒张压以及总胆固醇：高密度脂蛋白胆固醇比率的 7%。在女性和男性参与者中，年龄较大、血压、糖尿病和肾脏疾病与心血管疾病风险≥5%密切相关，而肥胖、总胆固醇：高密度脂蛋白胆固醇、甘油三酯和吸烟状况与心血管疾病风险≥5%有不同程度的相关性：我们报告了英国非洲裔艾滋病感染者心血管疾病风险因素的高负担，包括肥胖、高血压和糖尿病。在这些人群中开展以 BMI 为重点的干预措施可在改善心血管疾病风险的同时解决其他重要的健康问题。

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引用次数: 0

Optimizing statin prescriptions for people living with HIV: Evidence for improved communication and shared care between primary care and specialist HIV services 优化艾滋病毒感染者的他汀类药物处方：改善初级保健和艾滋病专科服务之间的沟通和共同护理的证据。

IF 2.8 3区医学 Q2 INFECTIOUS DISEASES

HIV Medicine

Pub Date : 2024-08-26 DOI: 10.1111/hiv.13704

N. Li, L. Thomas, A. Allan, B. John, S. Creighton

Objectives

Our objective was to assess the numbers of eligible people living with HIV attending one HIV clinic and receiving statins, the factors increasing the likelihood of statin prescription, the knowledge and involvement of primary care in cardiovascular risk prevention in people living with HIV, and the barriers to and drivers of shared care between general practitioners (GPs) and an HIV centre.

Methods

This was a retrospective case note review identifying cardiovascular risk, medications, and communication between the HIV clinic and GPs via an electronic survey of GPs identifying their knowledge about statin indications in people living with HIV.

Results

In total, 62% of GPs were unaware of the indication for statins in people living with HIV aged >40 years. A total of 33% of patients received statins, rising to 61% of patients with independent indications for statins. 92% of all statin prescriptions were provided by the GP. Statins were recommended in 25% of clinic letters but were not prescribed in 72% of these cases. There was discordance between antiretrovirals prescribed by the HIV clinic and those documented on the GP record in 60% of cases and in 40% of non-antiretroviral medications.

Conclusions

Our results indicate that GPs can engage people living with HIV in cardiovascular risk reduction measures but may not consider HIV a cardiovascular risk. Written communication alone is insufficient to improve safe patient care. Shared HIV care needs bidirectional shared medical records. Ongoing work needs to ensure that HIV is recognized as an independent cardiovascular risk factor.

目标：我们的目的是评估在一家艾滋病诊所就诊并接受他汀类药物治疗的合格艾滋病病毒感染者人数、增加开具他汀类药物处方可能性的因素、初级保健对艾滋病病毒感染者心血管风险预防的了解和参与程度，以及全科医生（GPs）和艾滋病中心之间共享护理的障碍和驱动因素：这是一项回顾性病例回顾，通过对全科医生进行电子调查，了解他们对他汀类药物在艾滋病病毒感染者中的适应症的认识，从而确定心血管风险、用药以及艾滋病诊所与全科医生之间的沟通：结果：总共有 62% 的全科医生不了解他汀类药物在年龄大于 40 岁的 HIV 感染者中的适应症。共有 33% 的患者接受了他汀类药物治疗，其中 61% 的患者有他汀类药物的独立适应症。92%的他汀类药物处方由全科医生开具。25%的门诊信中推荐使用他汀类药物，但其中72%的病例并未开具他汀类药物处方。艾滋病诊所开具的抗逆转录病毒药物处方与全科医生记录不一致的情况占 60%，非抗逆转录病毒药物处方与全科医生记录不一致的情况占 40%：我们的研究结果表明，全科医生可以让艾滋病病毒感染者参与降低心血管风险的措施，但他们可能并不认为艾滋病是一种心血管风险。仅靠书面交流不足以改善对患者的安全护理。共同的艾滋病护理需要双向共享医疗记录。需要持续开展工作，确保艾滋病被视为一个独立的心血管风险因素。

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引用次数: 0

What have we learned from the REPRIEVE trial and where do we go from here? 我们从 REPRIEVE 试验中学到了什么？

IF 2.8 3区医学 Q2 INFECTIOUS DISEASES

HIV Medicine

Pub Date : 2024-08-25 DOI: 10.1111/hiv.13703

Steven K. Grinspoon, Michael T. Lu, Markella V. Zanni, Marissa R. Diggs, Sarah M. Chu, Heather J. Ribaudo, Pamela S. Douglas

引用次数: 0

Impact of omission of routine blood monitoring of stable patients living with HIV during the coronavirus pandemic 冠状病毒大流行期间对病情稳定的艾滋病病毒感染者不进行常规血液监测的影响。

IF 2.8 3区医学 Q2 INFECTIOUS DISEASES

HIV Medicine

Pub Date : 2024-08-18 DOI: 10.1111/hiv.13696

Eleanor Swift, George Upton, Colin Fitzpatrick, Jonathan Roberts, Yvonne Gilleece, Amanda Clarke

Introduction

The British HIV Association (BHIVA) guidelines were amended during the coronavirus (COVID-19) pandemic, allowing for less frequent monitoring of routine bloods. We assessed the impact of this on patient outcomes.

Methods

Between April 2020 and March 2021, routine blood appointments at our HIV clinic were replaced by virtual consultations in ‘stable’ people living with HIV (PLWH), defined using standard operating procedure (SOP) criteria. All had an undetectable HIV viral load (VL) (<50 copies/mL). Demographic, HIV clinical information, and antiretroviral treatment (ART) data were collated using the electronic patient record (EPR). Blood results from before (baseline) and after (follow-up) the omitted appointment were analysed for each parameter.

Results

In all, 791/2395 PLWH were scheduled to have blood tests omitted; 381 were excluded for reasons including not fitting the SOP criteria or presenting to clinic early, and 410 were included in analysis. The demographics of the group were consistent with our whole HIV cohort. HIV VL became detectable in 8/410 individuals (1.95%, range 51–730 copies/mL). VL resuppressed in 6/8 after a median of 29 days. VL remained detectable in two individuals, both of whom remain in care. Routine blood monitoring revealed baseline and follow-up blood parameters that were largely within normal range. Four out of 12 parameters had statistically significant changes but were not considered clinically significant; 59/410 (14.4%) changed ART, most commonly for simplification.

Conclusion

For the majority of stable PLWH included in our evaluation, the omission of routine blood monitoring during the pandemic did not have a negative impact on HIV suppression or blood monitoring outcomes. ART switch was uncommon.

导言：英国艾滋病协会（BHIVA）指南在冠状病毒（COVID-19）大流行期间进行了修订，允许减少常规血液监测的频率。我们评估了这对患者治疗效果的影响：在 2020 年 4 月至 2021 年 3 月期间，我们艾滋病诊所的常规血检预约被虚拟会诊取代，虚拟会诊的对象是 "稳定 "的艾滋病病毒感染者（PLWH），定义采用标准操作程序（SOP）标准。所有患者均检测不到 HIV 病毒载量（VL）（结果：共有 791/2395 名艾滋病病毒感染者被排除在血液检测计划之外；其中 381 人因不符合标准操作程序标准或过早就诊等原因被排除，410 人被纳入分析。这组人群的人口统计学特征与我们的整个 HIV 群体一致。8/410（1.95%，范围 51-730拷贝/毫升）人检测到艾滋病毒 VL。中位 29 天后，6/8 的人 VL 恢复。有两人仍能检测到 VL，他们都仍在接受护理。常规血液监测显示，基线和随访血液参数基本在正常范围内。在 12 项参数中，有 4 项参数在统计学上有显著变化，但不被认为有临床意义；59/410（14.4%）人更换了抗逆转录病毒疗法，最常见的原因是为了简化治疗：结论：对于我们评估中的大多数病情稳定的 PLWH 来说，大流行期间省略常规血液监测并不会对 HIV 抑制或血液监测结果产生负面影响。抗逆转录病毒疗法的转换并不常见。

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引用次数: 0

No increased risk of tuberculosis-related immune reconstitution inflammatory syndrome with integrase inhibitor-based antiretroviral therapy in people with HIV with profound immunosuppression 使用整合酶抑制剂类抗逆转录病毒疗法不会增加免疫抑制严重的艾滋病病毒感染者罹患结核病相关免疫重建炎症综合征的风险。

IF 2.8 3区医学 Q2 INFECTIOUS DISEASES

HIV Medicine

Pub Date : 2024-08-12 DOI: 10.1111/hiv.13695

Chi Kuen Chan, Shan Shan Huang, Ka Hing Wong, Chi Chiu Leung, Man Po Lee, Tak Yin Tsang, Chun Kwan Bonnie Wong, Shuk Nor Lee, Wing Sze Law, Lai Bun Tai

Introduction

The issue of whether integrase inhibitors (INSTIs) may confer a higher risk of paradoxical tuberculosis-related immune reconstitution inflammatory syndrome (TB-IRIS) compared with other classes of antiretroviral in people with HIV with a profound level of immunosuppression remains insufficiently explored. We aimed to assess whether such a higher risk exists by examining a cohort of patients with TB-HIV initiating antiretroviral therapy (ART) in Hong Kong.

Methods

This was a retrospective review of 133 patients registered in the TB-HIV Registry of the Department of Health during the period 2014–2021.

Results

Sixteen of 70 patients (22.9%; 95% confidence interval [CI] 13.0–32.7) and 14 of 63 patients (22.2%; 95% CI 12.0–32.5) from the INSTI and non-INSTI groups experienced TB-IRIS (p = 0.920). The median intervals between ART initiation and IRIS among patients from the two groups were similar (3 weeks [interquartile range IQR 2.0–7.8] vs. 4 weeks [IQR 2.0–5.1], p = 0.620). The proportion of patients requiring steroid therapy were similar, as were the hospitalization rates. There was no IRIS-related death in either group. The risk of TB-IRIS with INSTI versus non-INSTI was also similar in a stratified analysis in a subgroup of patients with a baseline CD4 count of <50 μL (10/33 [30.3%; 95% CI 14.6–46.0] vs. 10/22 [45.5%; 95% CI 24.7–66.3], p = 0.252) and another subgroup of patients with ART initiated within 4 weeks of anti-TB treatment (10/26 [38.5%; 95% CI 19.8–57.2] vs. 10/23 [43.5%; 95% CI 23.2–63.7], p = 0.721).

Conclusion

Our cohort study did not offer support for an increased risk of TB-IRIS with INSTIs compared with non-INSTIs, even in severely immunocompromised people with HIV.

导言：与其他类型的抗逆转录病毒药物相比，整合酶抑制剂（INSTIs）是否会使免疫抑制程度极高的艾滋病病毒感染者患上与结核病相关的免疫重建炎症综合征（TB-IRIS）的风险更高，这一问题仍未得到充分探讨。我们的目的是通过研究香港一组开始接受抗逆转录病毒疗法（ART）的 TB-HIV 患者，评估是否存在这种更高的风险：这是一项回顾性研究，研究对象是2014-2021年间在卫生署结核病-艾滋病毒登记处登记的133名患者：70名患者中有16名（22.9%；95%置信区间[CI]13.0-32.7）和63名患者中有14名（22.2%；95%置信区间[CI]12.0-32.5）分别来自INSTI组和非INSTI组（P = 0.920）。两组患者开始接受抗逆转录病毒疗法到出现 IRIS 的中位间隔时间相似（3 周 [四分位数间距 IQR 2.0-7.8] vs. 4 周 [IQR 2.0-5.1], p = 0.620）。需要接受类固醇治疗的患者比例和住院率相似。两组患者均未发生与 IRIS 相关的死亡。在对基线 CD4 细胞数为结论的患者亚组进行的分层分析中，INSTI 与非 INSTI 的结核病 IRIS 风险也相似：我们的队列研究并未证明 INSTI 与非 INSTI 相比会增加 TB-IRIS 风险，即使在免疫力严重低下的 HIV 感染者中也是如此。

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引用次数: 0

Network analysis to prioritize issues for intervention to improve the health-related quality of life of people with HIV in Spain 通过网络分析确定干预问题的优先次序，以改善西班牙艾滋病毒感染者与健康相关的生活质量。

IF 2.8 3区医学 Q2 INFECTIOUS DISEASES

HIV Medicine

Pub Date : 2024-08-10 DOI: 10.1111/hiv.13693

Trenton M. White, María José Fuster-RuizdeApodaca, Carlos Iniesta, Carlos Prats-Silvestre, Jeffrey V. Lazarus, Rebeca Izquierdo, Inmaculada Jarrín

Objectives

The objective is to assess the interconnectedness of a network of health-related quality of life (HRQoL) variables among people with HIV (PHIV) to identify key areas for which clinical interventions could improve HRQoL for this population.

Methods

Between 2021 and 2023, we carried out a cross-sectional study within the Spanish CoRIS cohort. We conducted a weighted and undirected network analysis, which examines complex patterns of relationships and interconnections between variables, to assess a network of eight HRQoL dimensions from the validated Clinic Screening Tool for HIV (CST-HIV): anticipated stigma, psychological distress, sexuality, social support, material deprivation, sleep and fatigue, cognitive problems and physical symptoms.

Results

A total of 347 participants, predominantly male (93.1%), currently working (79.0%), self-reported homosexual (72.6%) and college-educated (53.9%), were included in the study. Psychological distress showed the highest centrality in the network, indicating its strong connections with sleep and fatigue, cognitive problems and social support within the HRQoL network.

Conclusions

Psychological distress, sleep and fatigue, cognitive issues and social support were identified as key factors in an HRQoL network, indicating that interventions focused on these areas could significantly enhance overall well-being.

目标：目的是评估艾滋病病毒感染者（PHIV）中与健康相关的生活质量（HRQoL）变量网络的相互关联性，以确定临床干预措施可改善该人群 HRQoL 的关键领域：2021 年至 2023 年期间，我们在西班牙 CoRIS 队列中开展了一项横断面研究。我们进行了加权和非定向网络分析，研究变量之间复杂的关系模式和相互联系，以评估有效的艾滋病临床筛查工具（CST-HIV）中八个 HRQoL 维度的网络：预期污名化、心理困扰、性、社会支持、物质匮乏、睡眠和疲劳、认知问题和身体症状：共有 347 名参与者参与了研究，其中男性居多（93.1%），目前有工作（79.0%），自述为同性恋（72.6%），受过大学教育（53.9%）。心理困扰在网络中显示出最高的中心性，表明它与睡眠和疲劳、认知问题和社会支持在 HRQoL 网络中有着紧密的联系：结论：心理困扰、睡眠和疲劳、认知问题和社会支持被确定为 HRQoL 网络中的关键因素，表明针对这些领域的干预措施可显著提高整体福祉。

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引用次数: 0

Incidence and predictors of attrition from HIV treatment among adults living with HIV in high-caseload facilities following implementation of universal test and treat strategy in Ethiopia: A prospective cohort study 埃塞俄比亚实施普遍检测和治疗战略后，高案例量设施中感染艾滋病毒的成人中自然退出艾滋病毒治疗的发生率和预测因素：前瞻性队列研究。

IF 2.8 3区医学 Q2 INFECTIOUS DISEASES

HIV Medicine

Pub Date : 2024-08-06 DOI: 10.1111/hiv.13691

Alemayehu Bekele, Ismael Ahmed, Fana Tefera, Jemal Ayalew Yimam, Fasil Tessema Woldeselassie, Getinet Abera, Jelaludin Ahmed, Alemayehu Mekonnen, Ashenafi Haile, Fikerte Yohannes, Mirtie Getachew, Saro Abdella, Minesh Shah

<div> <section> <h3> Background</h3> <p>The introduction of universal test and treat (UTT) strategy has demonstrated a reduction in attrition in some low-resource settings. UTT was introduced in Ethiopia in 2016. However, there is a paucity of information regarding the magnitude and predictors of attrition from HIV treatment in Ethiopia. This study aims to assess the incidence and predictors of attrition from HIV treatment among adults living with HIV (PLHIV) in high-caseload facilities following the implementation of universal test and treat strategy in Ethiopia from March 2019 to June 2020.</p> </section> <section> <h3> Methods</h3> <p>A prospective cohort of individuals in HIV care from 39 high-caseload facilities in Oromia, Amhara, Tigray, Addis Ababa and Dire Dawa regions of Ethiopia was conducted for 12 months. Participants were adults aged 15 year and older who were first testers recruited for 3 months from March to June 2019. Subsequent follow-up was for 12 months, with data collected on sociodemographic and clinical conditions at baseline, 6 and 12 months and attrition at 6 and 12 months. We defined attrition as discontinuation from follow-up care due to loss to follow-up, dropout or death. Data were collected using Open Data Kit at field level and aggregated centrally. Kaplan–Meier survival analysis was employed to assess survival probability to the time of attrition from treatment. The Cox proportional hazards regression model was used to measure association of baseline predictor variables with the proportion of antiretroviral therapy (ART) patients retained in ART during the follow up period.</p> </section> <section> <h3> Results</h3> <p>The overall incidence rate for attrition from HIV treatment among the study participants during 12 months of follow-up was 5.02 cases per 1000 person-weeks [95% confidence interval (CI): 4.44–5.68 per 1000 person-weeks]. Study participants from health facilities in Oromia and Addis Ababa/Dire Dawa had 68% and 51% higher risk of attrition from HIV treatment compared with participants from the Amhara region, respectively [adjusted hazard ratio (AHR) = 1.68, 95% CI: 1.22–2.32 and AHR = 1.51, 95% CI: 1.05–2.17, respectively]. Participants who did not have a child had a 44% higher risk of attrition compared with those who had a child (AHR = 1.44, 95% CI: 1.12–1.85). Individuals who did not own mobile phone had a 37% higher risk of attrition than those who owned a mobile phone (AHR = 1.37, 95% CI: 1.02–1.83). Ambulatory/bedridden functional status at the time of diagnosis had a 44% higher risk of attrition compared with participants with a working functional status (AHR = 1.44, 95% CI: 1.08–1.92) at any time during the follow-up period.</p> </section>

背景：在一些低资源环境中，普遍检测和治疗（UTT）战略的引入已证明减少了自然减员。埃塞俄比亚于 2016 年引入了 UTT。然而，有关埃塞俄比亚艾滋病治疗自然减员的规模和预测因素的信息却很少。本研究旨在评估埃塞俄比亚于 2019 年 3 月至 2020 年 6 月实施普遍检测和治疗策略后，高案例量设施中成年 HIV 感染者（PLHIV）从 HIV 治疗中流失的发生率和预测因素：对埃塞俄比亚奥罗米亚、阿姆哈拉、提格雷、亚的斯亚贝巴和德雷达瓦地区 39 家高负荷设施中接受 HIV 护理的个人进行了为期 12 个月的前瞻性队列研究。参与者为 15 岁及以上的成年人，他们是 2019 年 3 月至 6 月招募的首次检测者，为期 3 个月。随后进行了为期 12 个月的随访，收集了基线、6 个月和 12 个月的社会人口学和临床情况数据，以及 6 个月和 12 个月的自然减员数据。我们将自然减员定义为因失去随访、辍学或死亡而中断随访护理。我们使用开放数据工具包在实地收集数据，然后集中汇总。我们采用卡普兰-米尔生存分析法来评估从治疗中断时起的生存概率。采用 Cox 比例危险回归模型测量基线预测变量与随访期间继续接受抗逆转录病毒疗法（ART）的患者比例之间的关系：在 12 个月的随访期间，研究参与者中艾滋病治疗的总流失率为每千人周 5.02 例[95% 置信区间 (CI)：每千人周 4.44-5.68 例]。与阿姆哈拉地区的参与者相比，来自奥罗米亚和亚的斯亚贝巴/德雷达瓦卫生机构的研究参与者从艾滋病治疗中流失的风险分别高出 68% 和 51%[调整后危险比 (AHR) = 1.68，95% 置信区间 (CI)：1.22-2.32 和 AHR = 1.51，95% 置信区间 (CI)：1.05-2.17]。与有孩子的参与者相比，没有孩子的参与者流失风险高出 44%（AHR = 1.44，95% CI：1.12-1.85）。与拥有手机的人相比，没有手机的人流失风险高出 37%（AHR = 1.37，95% CI：1.02-1.83）。与随访期间任何时候都处于工作状态的参与者相比，诊断时处于非卧床/卧床功能状态的参与者流失风险高出44%（AHR = 1.44，95% CI：1.08-1.92）：结论：接受艾滋病治疗的艾滋病病毒感染者的总体流失率并没有其他研究报告的那么高。预测自然减员的独立因素包括：医疗机构所在的埃塞俄比亚行政区域、无子女、无手机以及确诊时的行动/卧床功能状况。应齐心协力降低艾滋病毒治疗的自然减员率，并解决其驱动因素。

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引用次数: 0

Metabolic dysfunction-associated steatohepatitis exhibits sex differences in people with HIV 在艾滋病毒感染者中，代谢功能障碍相关性脂肪性肝炎表现出性别差异。

IF 2.8 3区医学 Q2 INFECTIOUS DISEASES

HIV Medicine

Pub Date : 2024-08-01 DOI: 10.1111/hiv.13697

Dana Kablawi, Jovana Milic, Tyler Thomas, Thierry Fotsing Tadjo, Felice Cinque, Wesal Elgretli, Claudia Gioè, Bertrand Lebouché, Emmanuel Tsochatzis, Jemima Finkel, Sanjay Bhagani, Antonio Cascio, Giovanni Guaraldi, Giovanni Mazzola, Sahar Saeed, Giada Sebastiani

Objectives

People with HIV are at increased risk for metabolic dysfunction-associated steatohepatitis (MASH). Although sex differences are documented in the general population, their role in the context of HIV is less understood.

Methods

This was a multicentre cohort study including people with HIV without viral hepatitis coinfection. A FibroScan-AST (FAST) score >0.35 was used to diagnose MASH with significant liver fibrosis (stage F2–F4). We investigated sex-based differences in MASH trends as a function of age using a segmented linear mixed-effects model. Random effects accounted for clustering by the four sites. Adjusted models included ethnicity, diabetes, hypertension, and detectable HIV viral load.

Results

We included 1472 people with HIV (25% women). At baseline, the prevalence of MASH with fibrosis by FAST score was lower in women than in men (4.8% vs. 9.2%, p = 0.008). Based on the adjusted model, male sex (+0.034; p = 0.04), age per year (+0.003; p = 0.05), detectable HIV viral load (+0.034; p = 0.02), and hypertension (+0.03; p = 0.01) were positively associated with MASH with fibrosis. Although men exhibited generally higher FAST scores, FAST scores increased in women during the critical biological age of presumed perimenopause to menopause (between 40 and 50 years), reaching levels similar to those in men by the age of 55 years.

Conclusion

Despite women with HIV having a lower prevalence of MASH with fibrosis than men, they exhibit an acceleration in FAST score increase around the perimenopausal age. Future studies should target adequate consideration of sex differences in clinical investigation of metabolic dysfunction-associated steatotic liver disease to fill current gaps and implement precision medicine for people with HIV.

目的：艾滋病病毒感染者患代谢功能障碍相关性脂肪性肝炎（MASH）的风险增加。虽然在普通人群中存在性别差异，但人们对性别差异在 HIV 感染中的作用了解较少：这是一项多中心队列研究，研究对象包括未合并病毒性肝炎的 HIV 感染者。FibroScan-AST (FAST) 评分大于 0.35 分可诊断为伴有明显肝纤维化（F2-F4 期）的 MASH。我们使用分段线性混合效应模型研究了MASH趋势随年龄变化的性别差异。随机效应考虑了四个地点的聚类。调整模型包括种族、糖尿病、高血压和可检测到的 HIV 病毒载量：我们纳入了 1472 名艾滋病毒感染者（25% 为女性）。根据 FAST 评分，女性基线 MASH 纤维化患病率低于男性（4.8% 对 9.2%，P = 0.008）。根据调整后的模型，男性性别（+0.034；p = 0.04）、每年的年龄（+0.003；p = 0.05）、可检测到的 HIV 病毒载量（+0.034；p = 0.02）和高血压（+0.03；p = 0.01）与 MASH 伴纤维化呈正相关。尽管男性的 FAST 评分普遍较高，但在推测的围绝经期到绝经期的关键生理年龄段（40 至 50 岁），女性的 FAST 评分有所上升，到 55 岁时达到与男性相似的水平：结论：尽管女性艾滋病毒感染者的 MASH 纤维化发病率低于男性，但她们在围绝经期前后的 FAST 评分会加速上升。未来的研究应在代谢功能障碍相关脂肪性肝病的临床调查中充分考虑性别差异，以填补目前的空白，并为艾滋病病毒感染者实施精准医疗。

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引用次数: 0

Commentary on ‘Multicentre service evaluation of injectable cabotegravir and rilpivirine delivery and outcomes across 12 UK clinics (SHARE LAI-net)’ 对 "注射用卡博替拉韦和利匹韦林在英国 12 家诊所的交付和结果的多中心服务评估（SHARE LAI-net）"的评论。

IF 2.8 3区医学 Q2 INFECTIOUS DISEASES

HIV Medicine

Pub Date : 2024-08-01 DOI: 10.1111/hiv.13689

Sanjit Sah, Amogh Verma, Quazi Syed Zahiruddin, Sarvesh Rustagi

引用次数: 0

Characterizing heart failure and its subtypes in people living with HIV 艾滋病病毒感染者心力衰竭及其亚型的特征。

IF 2.8 3区医学 Q2 INFECTIOUS DISEASES

HIV Medicine

Pub Date : 2024-07-30 DOI: 10.1111/hiv.13694

Karla Inestroza, Vanessa Hurtado, Michaela E. Larson, Sanjana Satish, Ryan Severdija, Bertrand Ebner, Barbara Lang, Deborah Jones, Maria Alcaide, Claudia Martinez

Objective

People living with HIV have an increased risk of heart failure (HF). There are different subtypes of HF. Knowledge about the factors differentiating HF subtypes in people with HIV is limited but necessary to guide preventive measures and treatment.

Methods

A retrospective review of medical records was undertaken in people with HIV aged ≥18 years who received care at the University of Miami/Jackson Memorial HIV Clinic between January 2017 and November 2019 (N = 1166). Patients with an echocardiogram available for review (n = 305) were included. HF was defined as a documented diagnosis of any HF subtype (n = 52). We stratified those with HF by their ejection fraction (EF) into HF with preserved EF (HFpEF), HF with borderline EF, or HF with reduced EF (HFrEF).

Results

The prevalence of HF was 4.5%. The cohort included 46.2% females and 75% self-identified African Americans. Those with HF had a higher prevalence of hypertension, prior myocardial infarction, angina, coronary artery disease, percutaneous coronary intervention, coronary artery bypass grafting, diastolic dysfunction, and left ventricle hypertrophy. People with HIV with HF with borderline EF exhibited more coronary artery disease than those with HFpEF.

Conclusions

We characterize HF in people with HIV in South Florida and report the prevalence of HF and HF subtypes. Only a small percentage of patients had echocardiograms performed, suggesting an ongoing need for recognition of the increased risk of HF in people living with HIV, and raising the concern about lack of awareness contributing to underdiagnosis and missed treatment opportunities in this population.

目的艾滋病病毒感染者患心力衰竭（HF）的风险增加。心力衰竭有不同的亚型。有关区分艾滋病病毒感染者心力衰竭亚型的因素的知识很有限，但对于指导预防措施和治疗很有必要：对 2017 年 1 月至 2019 年 11 月期间在迈阿密大学/杰克逊纪念医院 HIV 诊所接受治疗的年龄≥18 岁的 HIV 感染者（N = 1166）的病历进行了回顾性分析。纳入了有超声心动图可供复查的患者（n = 305）。心房颤动被定义为任何心房颤动亚型的记录诊断（n = 52）。我们根据射血分数（EF）将心房颤动患者分为射血分数保留型心房颤动（HFpEF）、射血分数边缘型心房颤动或射血分数降低型心房颤动（HFrEF）：心房颤动的发病率为 4.5%。队列中有 46.2% 的女性和 75% 自我认同的非裔美国人。高血压、心肌梗死、心绞痛、冠状动脉疾病、经皮冠状动脉介入治疗、冠状动脉旁路移植术、舒张功能障碍和左心室肥大的发病率较高。与HFpEF患者相比，HF边缘EF的HIV感染者表现出更多的冠状动脉疾病：我们描述了南佛罗里达州艾滋病毒携带者中高血压的特征，并报告了高血压和高血压亚型的发病率。只有一小部分患者进行了超声心动图检查，这表明人们需要不断认识到艾滋病病毒感染者患心房颤动的风险在增加，同时也引起了人们对这一人群因缺乏认识而导致诊断不足和错失治疗机会的担忧。

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引用次数: 0