Impact of HIV-1 tropism on the emergence of non-AIDS events in HIV-infected patients receiving fully suppressive antiretroviral therapy

Abstract

Objective:The impact of HIV-1 tropism on the emergence of non-AIDS events was evaluated in a cohort of 116 antiretroviral therapy (ART) responder patients.Methods:The patients were followed for the emergence of hypertension, renal impairment, metabolic and bone disorders (defined as non-AIDS events) each 8 weeks at standard visits. A V3 plasma sequence genotype analysis was performed at the time of ART initiation and the geno2pheno algorithm with the results that defines the false-positive rate (FPR) was used to infer HIV tropism. The associations between the non-AIDS events and the FPR at baseline were evaluated using the χ2 test for trend. A Cox-regression analysis using the counting process formulation of Andersen and Gill was performed to define whether the emergence of non-AIDS events was correlated to FPR.Results:The prevalence of at least one non-AIDS event resulted higher in patients with a FPR below 10% than in patients with a R5 virus (P = 0.033). Patients with a FPR below 5.0% most frequently developed non-AIDS events during ART (P = 0.01). A higher prevalence of patients with at least two AIDS events was found in the group of patients with a FPR below 5.0% with respect to the others (P < 0.001). At multivariate Cox-regression analysis, having an X4 virus and age were independently associated with a higher probability of non-AIDS event development.Conclusion:This study shows that an X4 virus, particularly a FPR less than 5%, is related to non-AIDS events development. Further studies are warranted to understand the mechanisms underlying this phenomenon.

Prevention of cardiovascular disease among people living with HIV in sub-Saharan Africa

“…26 The complex interplay between traditional risk factors, HIV viral tropism, ART, HIV-related chronic inflammation, rapid changes in adiposity and other factors leading to HTN in PLWH may require new strategies for HTN prevention and treatment in this population. [27][28][29] Despite the growing knowledge of HTN among PLWH, the HIV health system in SSA is illequipped to handle the rising tide of HTN in PLWH with most HIV clinical care services lacking basic equipment such as BP cuffs and sphygmomanometers and front-line healthcare workers with limited basic knowledge about HTN. 30 This is compounded by fragmented clinical care for HIV and for HTN, frequent stock outs of BP lowering drugs, as such PLWH with HTN often face severe physical and financial barriers to obtaining treatment for both HIV and HTN.…”

Hypertension in HIV-Infected Adults

“…66 The HIV virus seems to induce premature telomeric shortening through mitochondrial dysfunction. 25 While immune senescence, through telomere shortening, has been proposed to explain the increased cardiovascular risk in HIV-infected adults, 25 its specific relationship to hypertension has not yet been evaluated.…”

“…14,19,20 A number of virologic- and treatment-related factors have been implicated, among them chronic inflammation, immune reconstitution, and lipodystrophy, all of which uniquely influence common downstream pathways such as the sympathetic and renin-angiotensin-aldosterone systems. 21–25…”

A Lower Baseline CD4/CD8 T-Cell Ratio Is Independently Associated with Immunodiscordant Response to Antiretroviral Therapy in HIV-Infected Subjects

“…Traditional associated risk factors for such anomalous immune responses to cART include age, male sex, low CD4 nadir, injection drug use, and hepatitis C virus (HCV) coinfection (reviewed in references 3 and 4). More recently, a predictive value for baseline CXCR4-tropic HIV variants has also been proposed for both the low CD4 recovery (5) and the emergence of non-AIDSrelated events (6).…”