Racial, ethnic, and gender disparities in hospitalizations among persons with HIV in the United States and Canada, 2005–2015

Davy-Méndez, Thibaut; Napravnik, Sonia; Eron, Joseph J.; Cole, Stephen R.; Duin, David van; Wohl, David A.; Gebo, Kelly A.; Moore, Richard D.; Althoff, Keri N.; Poteat, Tonia; Gill, M. John; Horberg, Michael A.; Silverberg, Michael J.; Nanditha, Ni Gusti Ayu; Thorne, Jennifer E.; Berry, Stephen

doi:10.1097/qad.0000000000002876

Cited by 7 publications

(3 citation statements)

References 46 publications

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“…The lowest hospitalization rates due to CVD have been observed in Asian men living with HIV. Compared to Black men living with HIV, Asians had a three-fold lower rate of hospitalization due to cardiovascular reasons [32]. Those inequalities may result from a lesser number of CVD risk factors among Asians.…”

Section: Racementioning

confidence: 92%

Human Immunodeficiency Virus as a Risk Factor for Cardiovascular Disease

Lembas,

Załęski,

Peller

et al. 2023

Cardiovasc Toxicol

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The developments in HIV treatments have increased the life expectancy of people living with HIV (PLWH), a situation that makes cardiovascular disease (CVD) in that population as relevant as ever. PLWH are at increased risk of CVD, and our understanding of the underlying mechanisms is continually increasing. HIV infection is associated with elevated levels of multiple proinflammatory molecules, including IL-6, IL-1β, VCAM-1, ICAM-1, TNF-α, TGF-β, osteopontin, sCD14, hs-CRP, and D-dimer. Other currently examined mechanisms include CD4 + lymphocyte depletion, increased intestinal permeability, microbial translocation, and altered cholesterol metabolism. Antiretroviral therapy (ART) leads to decreases in the concentrations of the majority of proinflammatory molecules, although most remain higher than in the general population. Moreover, adverse effects of ART also play an important role in increased CVD risk, especially in the era of rapid advancement of new therapeutical options. Nevertheless, it is currently believed that HIV plays a more significant role in the development of metabolic syndromes than treatment-associated factors. PLWH being more prone to develop CVD is also due to the higher prevalence of smoking and chronic coinfections with viruses such as HCV and HBV. For these reasons, it is crucial to consider HIV a possible causal factor in CVD occurrence, especially among young patients or individuals without common CVD risk factors.

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Section: Racementioning

confidence: 92%

Human Immunodeficiency Virus as a Risk Factor for Cardiovascular Disease

Lembas,

Załęski,

Peller

et al. 2023

Cardiovasc Toxicol

View full text Add to dashboard Cite

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“…32 A separate investigation indicated that among cisgender PLWH, Black patients exhibit higher incident rate ratios of cardiovascular hospitalizations compared with similarly aged White patients, irrespective of biological sex. 26 No cardiovascular hospitalization disparities were detected in comparisons of cisgender females to cisgender males or in transgender patients to cisgender male patients. However, additional studies are necessary to better understand the epidemiology of CVD among PLWH by combinations of race/ethnicity, sex, and sexual orientation.…”

Section: Epidemiology Of Hiv and Cardiovascular Diseasementioning

confidence: 93%

“…24 Therefore, given the proportion of PLWH in advanced age has increased over time, it is not surprising that PLWH are increasingly 25 developing chronic comorbid conditions associated with aging, including CVD. 7,26 However, there are disparities in individuals in marginalized identities, such that they experience more aggressive accelerated cardiovascular aging.…”

Section: Epidemiology Of Hiv and Cardiovascular Diseasementioning

confidence: 99%

Exercise to Prevent Accelerated Vascular Aging in People Living With HIV

Jones,

Robinson,

Beach

et al. 2024

Circulation Research

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Given advances in antiretroviral therapy, the mortality rate for HIV infection has dropped considerably over recent decades. However, people living with HIV (PLWH) experience longer life spans coupled with persistent immune activation despite viral suppression and potential toxicity from long-term antiretroviral therapy use. Consequently, PLWH face a cardiovascular disease (CVD) risk more than twice that of the general population, making it the leading cause of death among this group. Here, we briefly review the epidemiology of CVD in PLWH highlighting disparities at the intersections of sex and gender, age, race/ethnicity, and the contributions of social determinants of health and psychosocial stress to increased CVD risk among individuals with marginalized identities. We then overview the pathophysiology of HIV and discuss the primary factors implicated as contributors to CVD risk among PLWH on antiretroviral therapy. Subsequently, we highlight the functional evidence of premature vascular dysfunction as an early pathophysiological determinant of CVD risk among PLWH, discuss several mechanisms underlying premature vascular dysfunction in PLWH, and synthesize current research on the pathophysiological mechanisms underlying accelerated vascular aging in PLWH, focusing on immune activation, chronic inflammation, and oxidative stress. We consider understudied aspects such as HIV-related changes to the gut microbiome and psychosocial stress, which may serve as mechanisms through which exercise can abrogate accelerated vascular aging. Emphasizing the significance of exercise, we review various modalities and their impacts on vascular health, proposing a holistic approach to managing CVD risks in PLWH. The discussion extends to critical future study areas related to vascular aging, CVD, and the efficacy of exercise interventions, with a call for more inclusive research that considers the diversity of the PLWH population.

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