Objective To determine whether HIV-infected men have either higher incidence or more rapid progression of coronary artery calcium (CAC) compared to HIV-uninfected controls. Design Prospective observational study. Setting Multicenter study in four USA academic research centers; University of Pittsburgh, Johns Hopkins University, University of California Los Angeles and Northwestern University. Participants 825 men (541 HIV-infected and 284 HIV-uninfected) enrolled in the cardiovascular sub-study of the Multicenter AIDS Cohort Study who underwent serial cardiac CT imaging during a mean follow-up of 5 years (range, 2–8 years). Main Outcome Measures Incidence and progression of CAC assessed by cardiac computed tomography (CT). Results During follow-up, 21% of HIV-infected men developed incident CAC as compared to 16% of HIV-uninfected men. This association persisted after adjustment for traditional and HIV-associated risk factors: HR 1.64 [1.13–3.14]. However, there was no association between HIV serostatus and CAC progression among men with CAC present at baseline. Current smoking and increased insulin resistance, both modifiable risk factors, were independently associated with increased incidence of CAC. No evidence supporting an elevated risk for either CAC progression or incidence was found for either dyslipidemia or long-term usage of antiretroviral therapy. Conclusions In this large study of HIV-infected and HIV-uninfected men who underwent serial cardiac CT scan imaging, HIV-infected men were at significantly higher risk for development of CAC: HR 1.64 [1.13–3.14]. In addition, two important and modifiable risk factors were identified for increased incidence of CAC. Taken together these findings underscore the potential importance for smoking cessation and interventions to improve insulin resistance among HIV-infected men.
To determine whether men are able to self-diagnose external genital warts (EGWs), we studied data from 1115 men with and without human immunodeficiency virus infection. Men were largely unable to accurately assess the presence of EGWs. Self-reporting of EGWs was not a sensitive tool; only 38% of men who had EGWs diagnosed by a trained examiner who used bright light and visual inspection also reported having them. When we controlled for other covariates in a multivariate model, men who had EGWs diagnosed by an examiner were 14 times less likely to show concordance between examiner findings and self-report than were men who did not have EGWs diagnosed by an examiner (odds ratio, 0.07; 95% confidence interval, 0.06-0.09). Self-diagnosis and self-assessment may not accurately reflect the presence of EGWs, and self-diagnosis should not be used in place of an examiner's findings for epidemiologic studies that seek to determine the cause of disease.
The aim of the study was a prospective assessment of the possible consequences of a diagnosis of lipodystrophy on health-related quality of life (HRQL) and depressive symptomatology in HIV-seropositive men who have sex with men. A standardized physical assessment for lipodystrophy was introduced within a prospective study in April 1999. Over a 2-year follow- up, 37 HIV-seropositive men who met the criteria for lipodystrophy were longitudinally compared to 92 HIV-seropositive men without lipodystrophy and 88 HIV-seronegative men on measures of HRQL and depression. A series of questionnaires, which included the Medical Outcomes Study Short-Form 36 (SF-36) and the Center for Epidemiological Studies-Depression (CES-D), were administered to assess HRQL and depression, respectively. SF-36 scores were summarized using the mental and physical components; CES-D results were reported as both dichotomous (with or with clinical depression) and continuous scores. Neither the mental nor physical components of the SF-36 showed any significant differences between patients with lipodystrophy versus HIV-seropositive patients without lipodystrophy. Similarly, lipodystrophy status was not significantly associated with either continuous depression scores or presence of clinical depression. However, consistent with previous results, HIV-seropositive men without lipodystrophy (compared to HIV-seronegative men) reported higher scores on both components of the SF-36 scales and both categorizations of the CES-D. The results of this study suggest that lipodystrophy does not negatively affect HRQL or depression, above and beyond, the diagnosis of HIV infection, although the impact of the severity of lipodystrophy on these conditions will require further study.
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