Multimorbidity Among Persons Living with Human Immunodeficiency Virus in the United States

Wong, Chung F.; Gange, Stephen J.; Moore, Richard D.; Justice, Amy C.; Buchacz, Kate; Abraham, Alison G.; Rebeiro, Peter F; Koethe, John R.; Martin, Jeffrey N.; Horberg, Michael A.; Boyd, Cynthia M.; Kitahata, Mari M.; Crane, Heidi M.; Gebo, Kelly A.; Gill, M John; Silverberg, Michael J.; Palella, Frank J.; Patel, Pragna; Samji, Hasina; Thorne, Jennifer E.; Rabkin, Charles S.; Mayor, Angel M.; Althoff, Keri N.; Freeman, Aimee; Cescon, Angela; Rachlis, Anita; Rogers, Ben; Rodríguez, Benigno; Grasso, Chris; Benson, Constance A.; Drozd, Daniel R.; Fiellin, David A.; Haas, David W.; Kirk, Gregory D.; Willig, James H.; Globerman, Jason; Brooks, John T.; Eron, Joseph J.; Montaner, Julio S. G.; Gabler, Karyn; Anastos, Kathryn; Mayer, Kenneth H.; Jacobson, Lisa P.; Kopansky-Giles, Madison; Klein, Marina B.; Turner, Megan; Mugavero, Michael J.; Saag, Michael S.; Harrigan, P. Richard; Dubrow, Robert; Hunter-Mellado, Robert F.; Hogg, Robert S.; Bosch, Ronald J.; McKaig, Rosemary G.; Bebawy, Sally; Rourke, Sean B.; Napravnik, Sonia; Boswell, Stephen L.; Sterling, Timothy R.

doi:10.1093/cid/cix998

Cited by 136 publications

(101 citation statements)

References 35 publications

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“…In line with previous studies, smoking increased the risk for low‐ to high‐level AIN significantly ( P = 0.001) in our cohort . The increased incidence of cardiovascular diseases in PLWH has been clearly demonstrated . As smoking is also a considerable risk factor for cardiovascular problems, preventive strategies for PLWH should include programmes to quit smoking.…”

Section: Discussionmentioning

confidence: 99%

“…During the last twenty years, the main prevention and treatment focus of concomitant diseases has shifted from AIDS‐defining diseases to non‐AIDS‐defining diseases. Most common among them are cardiovascular diseases and non‐AIDS‐defining malignancies such as lymphomas, squamous epithelial carcinomas, and lung and liver cancer . Lymphomas and squamous epithelial carcinomas have been described as diseases with higher prevalence among PLWH .…”

Section: Introductionmentioning

confidence: 99%

“…Most common among them are cardiovascular diseases and non-AIDS-defining malignancies such as lymphomas, squamous epithelial carcinomas, and lung and liver cancer. [3][4][5][6][7] Lymphomas and squamous epithelial carcinomas have been described as diseases with higher prevalence among PLWH. 6,7 While squamous epithelial anal carcinoma shows with 0.3-1/ 100 000 cases per year a relative low incidence in the general population, the incidence is 40-to 50-fold higher in patients with HIV including an accelerated course of disease and earlier manifestation.…”

Section: Introductionmentioning

confidence: 99%

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Evaluation of anal carcinoma screening in male and female HIV patients at an interdisciplinary HIV therapy centre

Todorova

Schwierzeck

Turek

et al. 2019

Acad Dermatol Venereol

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Background Incidence of anal carcinoma is increased in people living with HIV (PLWH). Due to the improved life expectancy in PLWH, identifying appropriate prevention strategies for non‐AIDS‐defining cancer types such as anal carcinoma has become a priority in managing PLWH today. Objective We aimed to evaluate anal cytology assessment as screening tool for anal dysplasia and/or carcinoma in PLWH, regardless of gender or sexual orientation. Additionally, we investigated the correlation between cancer risk factors and abnormal screening results in our patient cohort. Methods People living with HIV from the Interdisciplinary HIV Centre of the University Hospital rechts der Isar in Munich, Germany (IZAR), were screened for anal carcinoma by single cytobrush examination and anal Papanicolaou (PAP) smear assessment from 2013 to 2015. Patients with abnormal PAP smear result were offered a follow‐up examination after 12 months. Differences between two groups were tested for statistical significance using Student's t‐test and Mann–Whitney U‐test, as appropriate. Results In total, 101 PLWH were included. 26.7% of subjects (n = 27) were PAP IIID, and 9.9% (n = 10) were PAP IVa. Seven female subjects had an abnormal finding at screening. Smoking was significantly associated with abnormal findings at screening (P = 0.005). In addition, our study found an association between sexually transmitted infections (STI) and anal dysplasia. Condylomata acuminata were increased in subjects with PAP IIID/PAP IVa (P = 0.045). Reactive syphilis serology was found to be significantly associated with abnormal screening results (P = 0.016), respectively. Conclusion Our results demonstrate that smoking and two common STIs, condylomata acuminata and syphilis, are risk factors associated with advanced anal intraepithelial neoplasia (AIN) stages in our PLWH cohort. While further analysis is needed to determine diagnostic guidelines concerning AIN in PLWH, these results suggest that interdisciplinary lifestyle prevention strategies are required to reduce the risk factors for AIN in PLWH in an outpatient setting.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Evaluation of anal carcinoma screening in male and female HIV patients at an interdisciplinary HIV therapy centre

Todorova

Schwierzeck

Turek

et al. 2019

Acad Dermatol Venereol

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“…In recent years, NCDs have emerged as the leading cause of morbidity and mortality among PWH on ART . Although certain behavioural risk factors, such as obesity, smoking and nutrition, may contribute to a higher prevalence of NCDs in PWH, people on ART also experience immune activation that is associated with higher risk of NCDs .…”

Section: Introductionmentioning

confidence: 99%

“…Although certain behavioural risk factors, such as obesity, smoking and nutrition, may contribute to a higher prevalence of NCDs in PWH, people on ART also experience immune activation that is associated with higher risk of NCDs . As more PWH are on ART and live near‐normal life spans, NCDs are likely to cause proportionally greater morbidity and mortality .…”

Section: Introductionmentioning

confidence: 99%

Cardiovascular risk factors among ART‐experienced people with HIV in South Africa

et al. 2019

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Introduction People with HIV ( PWH ) are at increased risk for atherosclerotic cardiovascular disease ( CVD ). Screening for CVD risk factors is recommended but not routine in South African HIV clinics. We sought to describe the prevalence of CVD risk factors among antiretroviral treatment ( ART )‐experienced patients in South Africa. Methods We performed a prospective, observational cross‐sectional study of PWH (>21 years, excluding pregnant women) on ART in South Africa. We interviewed patients regarding CVD risk factors, and obtained two blood pressure ( BP ) measurements and random/fasting glucose via a point‐of‐care glucometer. Standardized chart reviews provided individuals' HIV ‐specific data. We defined hypertension as: self‐reported use of antihypertensives or mean systolic BP ( SBP ) ≥140 mmHg or diastolic BP ( DBP ) ≥90 mmHg (Stage 1) or SBP ≥160 mmHg or DBP ≥100 mmHg (Stage 2). We defined diabetes as self‐reported use of insulin/oral hypoglycaemics or fasting (random) glucose ≥7.0 (≥11.1) mmol. We obtained risk ratios ( RR ) for hypertension from a multivariable log‐binomial regression model, adjusting for age, sex and diabetes. Results From March 2015 to February 2016, 458 participants enrolled with median age 38 years (interquartile range ( IQR ) 33 to 44 years) and median CD 4 466/μL ( IQR 317 to 638/μL); 78% were women. Participants were on ART for a median of four years, with 33% on ART ≥6 years. Almost a quarter (106/458) met the study definition for hypertension, of whom 45/106 (42%) were previously diagnosed, 23/45 (51%) were on medication and 4/23 (17%) were controlled. Eight participants had asymptomatic hypertensive urgency ( BP ≥180/110 mmHg). Of the 458 participants, 26 (6%) met the study definition for diabetes, half of whom (13/26) were already diagnosed; 11/13 (85%) were on treatment, of whom 4/11 (36%) had normal glucose. Age was the only significant predictor of hypertension ( RR , 1.04; 95% CI , 1.03 to 1.06, p < 0.0001) in the multivariable model. Conclusions Hypertension and diabetes were prevalent among PWH prescribed ART in South Africa with less than half diagn...

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Evaluation of the Pharmacokinetics of Metformin Following Coadministration With Doravirine in Healthy Volunteers

Sánchez

Yee

et al. 2019

Clinical Pharm in Drug Dev

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Doravirine is a novel nonnucleoside reverse transcriptase inhibitor for the treatment of human immunodeficiency virus type-1 (HIV-1) infection. In vitro and clinical data suggest that doravirine is unlikely to cause significant drug-drug interactions via major drug-metabolizing enzymes or transporters. As a common HIV-1 infection comorbidity, type 2 diabetes mellitus is often treated with metformin. Perturbations of metformin absorption or elimination may affect its safety and efficacy profile; therefore, understanding potential drug-drug interactions between doravirine and metformin is important. An open-label, fixed-sequence, 2-period trial in healthy adults was conducted. Single-dose metformin 1000 mg was administered in period 1; in period 2, doravirine 100 mg was administered once daily on days 1 to 7, and single-dose metformin 1000 mg was administered on day 5. Plasma pharmacokinetics for metformin alone and coadministered with doravirine were assessed. Fourteen participants enrolled and completed the trial. Least-squares geometric mean ratios and 90% confidence intervals of metformin AUC 0-Ý , and C max following coadministration of metformin and doravirine compared with metformin alone were 0.94 (0.88-1.00) and 0.94 (0.86-1.03), respectively; metformin T max and half-life were also minimally impacted. These data indicate that doravirine did not have a clinically relevant effect on the pharmacokinetics of metformin. Metformin alone and coadministered with doravirine was generally well tolerated. These data support coadministration of doravirine 100 mg and metformin 1000 mg without dose adjustment.Keywords antiretroviral therapy, doravirine, drug interaction, human immunodeficiency virus (HIV), metformin, type 2 diabetes, nonnucleoside reverse transcriptase inhibitor (NNRTI), pharmacokinetics

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Multimorbidity Among Persons Living with Human Immunodeficiency Virus in the United States

Abstract: Multimorbidity prevalence has increased among PLWH. Comorbidity prevention and multisubspecialty management of increasingly complex healthcare needs will be vital to ensuring that they receive needed care.

Cited by 136 publications

References 35 publications

Evaluation of anal carcinoma screening in male and female HIV patients at an interdisciplinary HIV therapy centre

Evaluation of anal carcinoma screening in male and female HIV patients at an interdisciplinary HIV therapy centre

Cardiovascular risk factors among ART‐experienced people with HIV in South Africa

Evaluation of the Pharmacokinetics of Metformin Following Coadministration With Doravirine in Healthy Volunteers

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