Cardiovascular disease risk in an aging HIV population

So‐Armah, Kaku; Freiberg, Matthew S.

doi:10.1097/coh.0000000000000065

Cited by 42 publications

(25 citation statements)

References 110 publications

(117 reference statements)

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“…However, as life expectancy for PLWH has increased, many teams have turned to focus on the widening spectrum of non-AIDS-defining diseases, from higher cardiovascular morbidity to metabolic disorders and emergence of tumors (Bathia, Ryscavage, & Taiwo, 2012;Brothers et al, 2014;Clifford, 2008;Islam, Wu, Jansson, & Wilson, 2012;Justice, 2010;Nardkani, Konstantinidis, & Wyatt 2014;Pinzone, Moreno, Cacopardo, & Nunnari, 2014;So-Armah & Freiberg, 2014;Vigouroux, Bastard, & Capeau, 2014). It is now entirely justified for PLWH, coordinated by GPs, to consult regular organ specialists and health-care professionals on their chronic conditions.…”

Section: Introductionmentioning

confidence: 96%

Impact of age on care pathways of people living with HIV followed up in hospital

et al. 2016

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The aging population of people living with human immunodeficiency virus (HIV) (PLWH) is exposed to a widening spectrum of non-AIDS-defining diseases. Thus, our objective was to compare the health care offered to PLWH according to age. We conducted a multicenter cross-sectional study on PLWH who consulted at one of 59 French HIV reference centers from 15th to 19th October 2012. Using our survey questionnaires, PLWH self-reported the medical care they received, whether or not tied to HIV infection monitoring, during the previous year. A total of 650 PLWH participated in the survey (median age 48 years, Interquartile range (IQR) 40-54), of which 95 were aged 60 years or over (14.5%). Compared to younger PLWH, 60-and-over PLWH were more often under complementary health insurance cover and less socially deprived based on the French EPICES (Evaluation of Precarity and Inequalities in Health Examination Centers) score. The elderly PLWH presented more comorbidities and less coinfections with hepatitis viruses. During health care, therapeutic education was less often offered to older PLWH (14% vs. 26%, p = .01), but this difference was mainly explained by sociodemographic factors and clinical status. Over the previous 6 months, 74% of PLWH who were followed up in hospital had also consulted another doctor, with a mean of 3.75 consultations (±4.18) without difference between age groups. After adjustment for sociodemographic factors and comorbidities, PLWH over 60 years were more likely to have consulted medical specialists as outpatients in the last 6 months (odds ratio [OR] = 2.63 [1.11-6.20]). Whatever their age, 13% of PLWH had been refused care on disclosure of their HIV status, and 27% of PLWH still did not disclose their HIV status to some caregivers. Coordinated health care throughout patients' lives is crucial, as health-care pathways evolve toward outpatient care as the patients get older. ARTICLE HISTORY

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Section: Introductionmentioning

confidence: 96%

Impact of age on care pathways of people living with HIV followed up in hospital

et al. 2016

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“…In the nearly two decades since, we have developed a greater understanding of the epidemiology and mechanisms of cardiovascular disease (CVD) among those with HIV infection. Recent reviews in this journal have summarized this evolving field in terms of the epidemiology and risk factors for CVD in HIV[2] and whether early ART might reduce CVD risk[3]. …”

Section: Introductionmentioning

confidence: 99%

“…Some reports have even described event rates that approach HIV-negative cohorts, possibly due to heightened awareness and more aggressive risk factor modification[14, 15]. Ultimately, CVD event rates are likely to increase, potentially more rapidly, as the treated HIV-infected population continues to age[2]. …”

Section: Introductionmentioning

confidence: 99%

Immune activation and cardiovascular disease in chronic HIV infection

Longenecker

Sullivan

Baker³

2016

Current Opinion in HIV and AIDS

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Purpose of review To describe the potential contribution of immune activation in the pathogenesis of HIV-associated cardiovascular disease (CVD)—a leading cause of morbidity and mortality among HIV positive persons with access to antiretroviral therapy (ART). Recent findings We review recent literature that suggests abnormalities in both adaptive and innate immunity contributes to CVD risk among persons with HIV infection. In particular, potentially atherogenic T-cell mechanisms include persistent high-level T-cell activation (and associated pro-inflammatory mechanisms), as well as the presence of co-pathogens (e.g., CMV) providing an ongoing stimulus for cytotoxic T-cell responses. More recent data has then emphasized the potential impact of monocyte/macrophage-mediated inflammation and injury within atherosclerotic lesions. The pathology driving innate immune activation many not fully reverse with ART treatment, highlighting the need for interventions that target inflammation as a CVD prevention strategy. Summary Premature CVD among persons with HIV infection is due, in part, to persistent abnormalities in immune activation and systemic inflammation despite viral suppression. Prevention strategies for persons with HIV infection include those that target traditional CVD risk factors as well as newer candidate treatments with potential immunomodulatory benefits.

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“…HIV infection has been shown to increase the risk of CVD, independent of established risk factors, by 50% to 100% 2, 3, 4. The mechanisms underlying this increased risk may be mediated by inflammation, immune activation, and oxidative stress 5. Thus, the search for better methods of identifying those PLWH at highest risk and discovering novel ways to address the cause of CVD has been of crucial importance for the past several years 6…”

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confidence: 99%

Bilirubin Is Inversely Associated With Cardiovascular Disease Among HIV‐Positive and HIV‐Negative Individuals in VACS (Veterans Aging Cohort Study)

Marconi

Duncan

So‐Armah

et al. 2018

JAHA

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BackgroundBilirubin may protect against cardiovascular disease (CVD) by reducing oxidative stress. Whether elevated bilirubin reduces the risk of CVD events among HIV + individuals and if this differs from uninfected individuals remain unclear. We assessed whether bilirubin independently predicted the risk of CVD events among HIV + and uninfected participants in VACS (Veterans Aging Cohort Study).Methods and ResultsWe conducted a prospective cohort study using VACS participants free of baseline CVD. Total bilirubin was categorized by quartiles. CVD as well as acute myocardial infarction, heart failure, and ischemic stroke events were assessed. Cox regression was used to evaluate hazard ratios of outcomes associated with quartiles of total bilirubin in HIV + and uninfected people after adjusting for multiple risk factors. There were 96 381 participants (30 427 HIV +); mean age was 48 years, 48% were black, and 97% were men. There were 6603 total incident CVD events over a mean of 5.7 years. In adjusted models, increasing quartiles of baseline total bilirubin were associated with decreased hazards of all outcomes (hazard ratio, 0.86; 95% confidence interval, 0.80–0.91). Among HIV + participants, results persisted for heart failure, ischemic stroke, and total CVD, but nonsignificant associations were observed for acute myocardial infarction.Conclusions VACS participants (regardless of HIV status) with elevated bilirubin levels had a lower risk of incident total CVD, acute myocardial infarction, heart failure, and ischemic stroke events after adjusting for known risk factors. Future studies should investigate how this apparently protective effect of elevated bilirubin could be harnessed to reduce CVD risk or improve risk estimation among HIV + individuals.

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Cardiovascular disease risk in an aging HIV population

Cited by 42 publications

References 110 publications

Impact of age on care pathways of people living with HIV followed up in hospital

Impact of age on care pathways of people living with HIV followed up in hospital

Immune activation and cardiovascular disease in chronic HIV infection

Bilirubin Is Inversely Associated With Cardiovascular Disease Among HIV‐Positive and HIV‐Negative Individuals in VACS (Veterans Aging Cohort Study)

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