Comorbidities in Persons With HIV

Lerner, Andrea M; Eisinger, Robert W.; Fauci, Anthony S.

doi:10.1001/jama.2019.19775

Cited by 112 publications

(94 citation statements)

References 8 publications

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“…7 The difference in survival by HIV status may have narrowed in more recent years, but few studies 8 have included data after 2011. Moreover, despite many studies 9 documenting an excess risk of major chronic comorbidities among individuals with HIV infection, such as cancer 10 and cardiovascular disease, 11 few have compared the number of healthy life years by HIV status. One study 12 found that individuals with HIV infection in Canada lived substantially fewer comorbidity-free years compared with the general population from 1996 to 2012, but the study did not examine trends over time or whether ART initiation at high CD4 cell counts was associated with more healthy years.…”

Section: Introductionmentioning

confidence: 99%

Comparison of Overall and Comorbidity-Free Life Expectancy Between Insured Adults With and Without HIV Infection, 2000-2016

et al. 2020

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Section: Introductionmentioning

confidence: 99%

Comparison of Overall and Comorbidity-Free Life Expectancy Between Insured Adults With and Without HIV Infection, 2000-2016

et al. 2020

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“…The long-term outlook for patients infected with human immunodeficiency virus (HIV) has been transformed over the past decades, following the introduction of combined antiretroviral therapy (cART) in the mid-1990s, from a consistently rapidly fatal disease to a chronic, manageable illness. As a result, people living with HIV can reach near-normal long-term survival in developed countries [1]. Concurrently, the rates of hospitalization [2,3] and hospital mortality [4] have progressively decreased over time among HIV-infected patients.…”

Section: Introductionmentioning

confidence: 99%

In-Hospital Cardiopulmonary Resuscitation of Patients With Human Immunodeficiency Virus Infection: A Population-Based Cohort Study of Epidemiology and Outcomes

Oud

2020

J Clin Med Res

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Background: Marked improvements were realized in both shortterm and long-term outcomes of human immunodeficiency virus (HIV)-infected patients following the introduction of combination antiretroviral therapy. However, the contemporary population-level patterns of in-hospital cardiopulmonary resuscitation (CPR) and the outcomes of HIV-infected patients were not systematically examined. Methods:We used the Texas Inpatient Public Use Data File to identify hospitalizations aged ≥ 18 years with and without HIV during 2009 -2014, and those in each group who have undergone in-hospital CPR. Short-term survival (defined as absence of hospital mortality or discharge to hospice) following in-hospital CPR was examined. Multivariate logistic regression modeling was used to assess the prognostic impact of HIV infection following in-hospital CPR and predictors of short-term survival among HIV hospitalizations. Results:In-hospital CPR was reported in 437 and 54,135 hospitalizations with and without HIV, respectively. The rates of in-hospital CPR (per 1,000 hospitalizations) were 4.4 and 4.1 among hospitalizations with and without HIV, respectively (P = 0.1659). The corresponding rates of in-hospital CPR among decedents were 11% and 11.8%, respectively (P = 0.1531). Crude short-term survival following in-hospital CPR among hospitalizations with and without HIV was 19% and 26.8%, respectively (P = 0.0003). The corresponding adjusted short-term survival between 2009 and 2014 rose from 14.2% to 27% (P = 0.0009 for trend) and from 25.5% to 28% (P < 0.0001 for trend). HIV infection was associated with lower odds of shortterm survival following in-hospital CPR (adjusted odds ratio (aOR): 0.50, 95% confidence interval (95% CI): 0.39 -0.65). Select comorbid conditions (congestive heart failure, aOR: 2.03, 95% CI: 1.20 -2.46; cerebrovascular disease, aOR: 2.08, 95% CI: 1.15 -3.75; and diabetes, aOR: 1.53, 95% CI 1.31 -4.71) were the only independent predictors of short-term survival following in-hospital CPR among HIV hospitalizations. Conclusions:The rates of in-hospital CPR were similar among hospitalizations with and without HIV infection, with similar level of selectivity among decedents. Although HIV infection was associated with lower short-term survival following in-hospital CPR for the whole cohort, a dramatic improvement was observed during the study period among affected patients, with short-term survival rates becoming near-similar to those without HIV. Further studies are needed to identify modifiable factors to further improve the outcomes following in-hospital CPR among patients with HIV infection.

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“…Despite highly active antiretroviral treatment (ART), persons living with HIV (PLWH) are more likely than HIV-uninfected individuals to experience non-AIDS related morbidities, such as non-AIDS defining cancers, cardiovascular disease, osteoporosis, frailty and other conditions associated with aging 1 . This increased morbidity appears to be associated, at least in part, with low-level immune activation persisting even in the face of complete suppression of plasma viremia 2 .…”

Section: Introductionmentioning

confidence: 99%

Treatment with commonly used antiretroviral drugs induces a type I/III interferon signature in the gut in the absence of HIV infection

Hughes

Levy

Calienes

et al. 2019

Preprint

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Tenofovir disoproxil fumarate and emtricitabine are used for HIV treatment and pre-exposure prophylaxis. Previously, we found that topical rectal application of tenofovir 1% gel caused many gene expression changes. Here, we measured RNA and protein expression in several clinical trials of oral administration in HIVuninfected individuals (using microarrays, RNAseq, droplet digital PCR, mass spectrometry, and microscopy). We found tens to hundreds of differentially expressed genes in the gastrointestinal tract, but none in the blood or female reproductive tract. In rectal samples from one trial, most of the 13 upregulated genes were related to type I/III interferon signaling. Similar changes were seen at the protein level in the same trial and in the duodenum and rectum in another trial. We conclude that tenofovir disoproxil fumarate and emtricitabine have little effect on gene expression in the blood or female reproductive tract but increase type I/III interferon signaling in the gut. This effect may enhance their anti-viral efficacy when used as pre-exposure prophylaxis, in particular to prevent rectal HIV transmission. However, it may also contribute to chronic immune activation and HIV reservoir maintenance in chronically treated people living with HIV.

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Comorbidities in Persons With HIV

Cited by 112 publications

References 8 publications

Comparison of Overall and Comorbidity-Free Life Expectancy Between Insured Adults With and Without HIV Infection, 2000-2016

Comparison of Overall and Comorbidity-Free Life Expectancy Between Insured Adults With and Without HIV Infection, 2000-2016

In-Hospital Cardiopulmonary Resuscitation of Patients With Human Immunodeficiency Virus Infection: A Population-Based Cohort Study of Epidemiology and Outcomes

Treatment with commonly used antiretroviral drugs induces a type I/III interferon signature in the gut in the absence of HIV infection

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