Article

Rate of co-morbidities not related to HIV infection or AIDS among HIV-infected patients, by CD4 count and HAART use status

Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Clinical Infectious Diseases (Impact Factor: 8.89). 10/2008; 47(8):1102-4. DOI: 10.1086/592115
Source: PubMed

ABSTRACT

The rate of comorbidities not related to human immunodeficiency virus (HIV) infection or acquired immunodeficiency syndrome
(AIDS) among HIV-infected patients may be higher than expected. We assessed the incidence of comorbidities not related to
HIV infection or AIDS by CD4 cell count and highly active antiretroviral therapy (HAART) use status in an HIV clinical practice.
A total of 2824 patients contributed 9172 person-years of longitudinal data during the period 1997–2006. Among patients with
a CD4 cell count <350 cells/mm3, receipt of HAART was associated with a significantly decreased incidence of comorbidities not related to HIV infection or
AIDS.

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    • "Research has shown that the features of chronic, treated HIV infection that mirror the immunologic changes observed with aging are also associated with NCD outcomes, including T-lymphocyte activation and replicative senescence, alteration in CD8 þ lymphocyte populations, and elevated systemic measures of innate immune activation [3,4,10]. However, studies that have examined the association between CD4 þ lymphocyte counts and NCDs have demonstrated inconsistent results, and a clinically applicable measure of immune senescence as a predictor of NCDs has not yet been identified11121314. In HIV-uninfected adults, CD4 þ /CD8 þ ratio increases over the lifespan, and inversion of the CD4 þ /CD8 þ ratio in the elderly has been associated with risk of frailty and chronic viral infections, such as cytomegalovirus1516171819. In HIV-infected adults with virologic suppression, CD4 þ /CD8 þ ratio inversely correlates with measures of innate and adaptive immune senescence202122 . "
    [Show abstract] [Hide abstract] ABSTRACT: Objective: In virologically suppressed HIV-infected adults, non-communicable diseases (NCDs) have been associated with immune senescence and low CD4/CD8 lymphocyte ratio. Age differences in the relationship between CD4/CD8 ratio and NCDs have not been described. Design: Observational cohort study. Methods: We assessed CD4/CD8 ratio and incident NCDs (cardiovascular, cancer, liver, and renal diseases) in HIV-infected adults started on antiretroviral therapy between 1998-2012. Study inclusion began once patients maintained virologic suppression for 12 months (defined as baseline). We examined age and baseline CD4/CD8 ratio and used Cox proportional hazard models to assess baseline CD4/CD8 ratio and NCDs. Results: This study included 2,006 patients. Low baseline CD4/CD8 ratio was associated with older age, male sex, and low CD4 lymphocyte counts. In models adjusting for CD4 lymphocyte count, CD4/CD8 ratio was inversely associated with age (p < 0.01). Among all patients, 182 had incident NCDs, including 46 with coronary artery disease (CAD) events. CD4/CD8 ratio was inversely associated with risk of CAD events (adjusted HR per 0.1 increase in CD4/CD8 ratio = 0.87, 95% CI: 0.76-0.99, p=0.03). This association was driven by those under age 50 years (adjusted HR 0.83 [0.70-0.97], p = 0.02) versus those over age 50 years (adjusted HR = 0.96 [0.79-1.18], p = 0.71). CD4/CD8 ratio was not significantly associated with incident non-cardiac NCDs. Conclusions: Higher CD4/CD8 ratio after one year of HIV virologic suppression was independently predictive of decreased CAD risk, particularly among younger adults. Advanced immune senescence may contribute to CAD events in younger HIV patients on antiretroviral therapy. Copyright (C) 2016 Wolters Kluwer Health, Inc.
    No preview · Article · Dec 2015 · AIDS
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    • "Consequently , patterns of morbidity and mortality among HIVinfected subjects receiving ART are changing, with an increase in the proportion of deaths due to non–HIV-related disorders, including cardiovascular disease, liver disease, and non–AIDSdefining cancers [22, 23]. Lower CD4 + T-cell count, anemia, and uncontrolled viral load, along with the classical potentially modifiable risk factors, such as cigarette smoking, diabetes, and hypertension, seem to play a driving role in developing severe non–AIDS-defining events, although available data are partially contrasting [24, 25] . Studies on modifiable and nonmodifiable risk factors for non–AIDS-defining events in HIVinfected persons are still an important unmet research issue. "
    [Show abstract] [Hide abstract] ABSTRACT: Background: Chronic cytomegalovirus (CMV) infection has been associated with immunosenescence and immunoactivation in the general population. In human immunodeficiency virus type 1 (HIV-1)-infected people, CMV coinfection, in addition to residual HIV replication and microbial translocation, has been proposed as a key factor in sustaining immune activation, even in individuals with a controlled HIV load. Methods: Patients from the ICONA Study with at least 1 CMV immunoglobulin G (IgG) test available without active CMV disease were included in the analysis. AIDS-defining event or AIDS-related death and severe non-AIDS-defining event or non-AIDS-related death were taken as clinical progression end points. Independent predictors of CMV were identified by multivariable logistic regression. Probabilities of reaching the end points were estimated by survival analyses. Results: A total of 6111 subjects were included, of whom 5119 (83.3%) were CMV IgG positive at baseline. Patients with CMV IgG positivity at baseline were more likely to develop a severe non-AIDS-defining event/non-AIDS-related death (adjusted hazard ratio [HR], 1.53 [95% confidence interval {CI}, 1.08-2.16]. In particular, CMV seropositivity was an independent risk factor for cardiovascular and cerebrovascular diseases (adjusted HR, 2.27 [95% CI, .97-5.32]). Conclusions: In our study population, CMV/HIV coinfection was associated with the risk of severe non-AIDS-defining events/non-AIDS-related death, especially with cardiovascular and cerebrovascular events, independently of other prognostic factors. This finding supports a potential independent role of CMV coinfection in vascular/degenerative organ disorders in HIV-infected subjects.
    Full-text · Article · Jan 2015 · The Journal of Infectious Diseases
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    • "Consequently , patterns of morbidity and mortality among HIVinfected subjects receiving ART are changing, with an increase in the proportion of deaths due to non–HIV-related disorders, including cardiovascular disease, liver disease, and non–AIDSdefining cancers [22, 23]. Lower CD4 + T-cell count, anemia, and uncontrolled viral load, along with the classical potentially modifiable risk factors, such as cigarette smoking, diabetes, and hypertension, seem to play a driving role in developing severe non–AIDS-defining events, although available data are partially contrasting [24, 25] . Studies on modifiable and nonmodifiable risk factors for non–AIDS-defining events in HIVinfected persons are still an important unmet research issue. "
    Full-text · Article · Jul 2014
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