Changes in AIDS-Defining Illnesses in a London Clinic, 1987–1998

Mocroft, Amanda; Sabin, Caroline; Youle, Mike; Madge, Sara; Tyrer, Mervyn; Devereux, Helen; Deayton, Jane R; Dykhoff, A.; Lipman, Marc; An, Peng; Ma, Jun

doi:10.1097/00042560-199908150-00007

Cited by 27 publications

(16 citation statements)

References 31 publications

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“…Since the advent of HAART, the incidence of wasting has declined, and now patients are often overweight or obese (6,18,26,27). Studies during the early HAART era found that underweight persons continued to have an increased risk of HIV progression, but researchers did not report a differential impact on CD4 counts among obese compared to normalweight patients (20,38).…”

Section: Discussionmentioning

confidence: 99%

Impact of Weight on Immune Cell Counts among HIV-Infected Persons

Crum-Cianflone

Roediger

Eberly

et al. 2011

Clin. Vaccine Immunol.

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Prior studies have shown that weight may impact immune cell counts. However, few data exist about the relationship of weight and immune cell counts among HIV-infected patients. We examined documented HIV seroconverters (mean window, 15.7 months) in a prospective U.S. Military HIV Natural History Study (1 January 1986 to 20 January 2010). We estimated the association of the time-updated body mass index (BMI) category with changes in immune cell counts from HIV diagnosis across time (mean follow-up of 5.1 years) using multiply adjusted longitudinal linear mixed-effects models. Of 1,097 HIV seroconverters, 448 (41%) were overweight and 93 (8%) were obese at HIV diagnosis. Immune cell counts at HIV diagnosis did not significantly differ by BMI category. In the longitudinal models for those diagnosed before the advent of the highly active antiretroviral therapy (HAART) era, mean postdiagnosis decreases in the white cell count, total lymphocyte count, CD4 count, CD4 percentage, and CD4/CD8 ratio were less as the BMI category increased (all with P values of <0.05). Among HIV seroconverters diagnosed in the HAART era, obese compared to normal-weight patients had significantly smaller increases in CD4 counts, CD4 percentages, and the CD4/CD8 ratio (all with P values of <0.05). Similar findings were also noted among underweight versus normal-weight patients. In conclusion, although BMI was not associated with immune cell levels at the time of HIV diagnosis, weight appears to affect immune cells counts over the course of infection. In the HAART era, being either underweight or obese was associated with smaller increases in several important immune cell levels, including the CD4/CD8 ratio.

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Section: Discussionmentioning

confidence: 99%

Impact of Weight on Immune Cell Counts among HIV-Infected Persons

Crum-Cianflone

Roediger

Eberly

et al. 2011

Clin. Vaccine Immunol.

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“…Their report is the first to show no decrease in PBL incidence since the use of HAART, in contrast to several studies, including the large epidemiologic collaborative study that was reported recently. [18][19][20] The restoration of immunity is probably the key explanation for the lower incidence of PBL since HAART. Restoration of the blood-brain barrier might also explain the lower incidence of PBL.…”

Section: Discussionmentioning

confidence: 99%

“…16,17 The incidence rates of Pneumocystis carinii pneumonia, cytomegalovirus infection, and Candida esophagitis during 1996 and 1997 declined from 27.4 per 100 person-years to 6.9 per 100 personyears. 18 Furthermore, the incidence of PBL has also been shown to decrease in several studies. [18][19][20] The consequences of HAART use on systemic ARL are more controversial.…”

Section: Introductionmentioning

confidence: 98%

“…18 Furthermore, the incidence of PBL has also been shown to decrease in several studies. [18][19][20] The consequences of HAART use on systemic ARL are more controversial. [20][21][22][23][24][25][26] Our goal was to analyze the evolution of the incidence and characteristics of ARL since the use of HAART in a large population of HIV-infected patients in the French Hospital Database on HIV (FHDH; for participants, see "Appendix") and in an exhaustive cohort of patients.…”

Section: Introductionmentioning

confidence: 98%

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Changes in AIDS-related lymphoma since the era of highly active antiretroviral therapy

Besson

Goubar

Gabarre

et al. 2001

Blood

331

204

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HIV infection is associated with a high incidence of AIDS-related lymphomas (ARLs). Since the use of highly active antiretroviral therapy (HAART), the incidence of AIDS-defining illnesses has decreased, leading to a significant improvement in survival of HIV-infected patients. The consequences of HAART use on ARL are under debate. This study compared the incidence and the characteristics of ARL before and after the use of HAART in a large population of HIV-infected patients in the French Hospital Database on HIV (FHDH) and particularly in 3 centers including 145 patients with proven lymphoma. Within the FHDH, the incidence of systemic ARL has decreased between 1993-1994 and 1997-1998, from 86.0 per 10 000 to 42.9 per 10 000 person-years (P < 10 ؊30 ). The incidence of primary brain lymphoma has also fallen dramatically between the periods, from 27.8 per 10 000 to 9.7 per 10 000 person-years (P < 10 ؊11 ). The analysis of 145 cases of ARL in 3 hospitals showed that known HIV history was longer in the second period than in the first period among patients with systemic ARL (98 versus 75 months; P < .01).Patients had a higher number of CD4 cells at diagnosis during the second period (191 versus 63/L, P ‫؍‬ 10 ؊3 ). Survival of patients with systemic ARL also increased between the periods (from 6 to 20 months; P ‫؍‬ .004). Therefore, the profile of ARL has changed since the era of HAART, with a lower incidence of systemic and brain ARL.

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“…[1][2][3][4][5][6] People living with HIV (PLWH) in the United States are now diagnosed with a number of age-related chronic conditions including cardiovascular disease, renal disease, and diabetes at rates at least as great as and often greater than those of HIV-uninfected populations. [7][8][9][10][11][12] A striking increase in obesity [body mass index (BMI) ‡30 kg/m is known regarding the associations of race, sex, and obesity with CMD risk.…”

Section: Introductionmentioning

confidence: 99%

Obesity Is Associated with Race/Sex Disparities in Diabetes and Hypertension Prevalence, But Not Cardiovascular Disease, Among HIV-Infected Adults

Willig

Westfall

Overton

et al. 2015

AIDS Research and Human Retroviruses

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Race/sex differences are observed in cardiometabolic disease (CMD) risk and prevalence in the context of treated, chronic HIV infection, and these differences could be exacerbated by disparities in obesity prevalence. We sought to determine the effect of obesity on these disparities among people living with HIV. Prevalence of CMD (dyslipidemia, cardiovascular disorders, hypertension, diabetes, chronic kidney disease) was determined for patients seen at the University of Alabama at Birmingham HIV clinic between 7/2010 and 6/2011. Staged logistic regression was used to examine the impact of race/sex on comorbidities adjusting for key confounders including/ excluding obesity (body mass index ‡30 kg/m 2 ). Of 1,800 participants, 77% were male, 54% were black, and 25% were obese. Obesity prevalence differed by race/sex: black women 49%, black men 24%, white women 24%, white men 15% ( p < 0.01). Compared to white men, other groups had reduced odds for dyslipidemia and cardiovascular disorders ( p < 0.01). Black men had increased odds for hypertension and chronic kidney disease, while black women had a nearly 2-fold increased odds for diabetes and hypertension (all at p < 0.01). The associations of black women with diabetes and hypertension were attenuated when obesity was included in the models. Other group differences remained significant. Disparities in obesity prevalence do not explain race/sex differences in all CMD among people with HIV. Obesity accounted for associations with diabetes/hypertension for black women, who may benefit from weight reduction to decrease disease risk. Further investigations into the etiology and treatment of CMD in people living with HIV should consider unique race/sex treatment issues.

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Changes in AIDS-Defining Illnesses in a London Clinic, 1987–1998

Cited by 27 publications

References 31 publications

Impact of Weight on Immune Cell Counts among HIV-Infected Persons

Impact of Weight on Immune Cell Counts among HIV-Infected Persons

Changes in AIDS-related lymphoma since the era of highly active antiretroviral therapy

Obesity Is Associated with Race/Sex Disparities in Diabetes and Hypertension Prevalence, But Not Cardiovascular Disease, Among HIV-Infected Adults

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