Depression, lifestyle factors and cognitive function in people living with HIV and comparable HIV-negative controls

ObjectivesAs people living with HIV (PLWH) live longer, morbidity and mortality from non-AIDS comorbidities have emerged as major concerns. Our objective was to compare prevalence trends and age at diagnosis of nine chronic age-associated comorbidities between individuals living with and without HIV.Design and settingThis population-based cohort study used longitudinal cohort data from all diagnosed antiretroviral-treated PLWH and 1:4 age-sex-matched HIV-negative individuals in British Columbia, Canada.ParticipantsThe study included 8031 antiretroviral-treated PLWH and 32 124 HIV-negative controls (median age 40 years, 82% men). Eligible participants were ≥19 years old and followed for ≥1 year during 2000 to 2012.Primary and secondary outcome measuresThe presence of non-AIDS-defining cancers, diabetes, osteoarthritis, hypertension, Alzheimer’s and/or non-HIV-related dementia, cardiovascular, kidney, liver and lung diseases were identified from provincial administrative databases. Beta regression assessed annual age-sex-standardised prevalence trends and Kruskal-Wallis tests compared the age at diagnosis of comorbidities stratified by rate of healthcare encounters.ResultsAcross study period, the prevalence of all chronic age-associated comorbidities, except hypertension, were higher among PLWH compared with their community-based HIV-negative counterparts; as much as 10 times higher for liver diseases (25.3% vs 2.1%, p value<0.0001). On stratification by healthcare encounter rates, PLWH experienced most chronic age-associated significantly earlier than HIV-negative controls, as early as 21 years earlier for Alzheimer’s and/or dementia.ConclusionsPLWH experienced higher prevalence and earlier age at diagnosis of non-AIDS comorbidities than their HIV-negative controls. These results stress the need for optimised screening for comorbidities at earlier ages among PLWH, and a comprehensive HIV care model that integrates prevention and treatment of chronic age-associated conditions. Additionally, the robust methodology developed in this study, which addresses concerns on the use of administrative health data to measure prevalence and incidence, is reproducible to other settings.

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Cognitive function, depressive symptoms and syphilis in HIV-positive and HIV-negative individuals

International Journal of STD & AIDS ◽

10.1177/0956462418817612 ◽

2019 ◽

Vol 30 (5) ◽

pp. 440-446 ◽

Cited By ~ 2

Author(s):

Davide De Francesco ◽

Alan Winston ◽

Jonathan Underwood ◽

Fiona V Cresswell ◽

Jane Anderson ◽

...

Keyword(s):

Depressive Symptoms ◽

Cognitive Function ◽

Cognitive Test ◽

People Living With Hiv ◽

Serological Tests ◽

Syphilis Infection ◽

Patient Health ◽

History Of ◽

Negative Controls ◽

Hiv Negative

We evaluated associations between history of syphilis infection and both cognitive function and depressive symptoms in people living with HIV (PLHIV) and comparable HIV-negative controls. Syphilis serological tests, cognitive function and depression were assessed in PLHIV and controls participating in the Pharmacokinetic and Clinical Observations in People Over Fifty study. Cognitive test scores were converted to demographically adjusted T-scores (mean = 50, SD = 10) and then averaged to obtain a global T-score. Severity of depressive symptoms was assessed via the Patient Health Questionnaire-9. Associations of syphilis with global T-scores and depression were assessed using median regression. The 623 PLHIV and 246 HIV-negative controls were predominantly male (89.3% and 66.5%) with median age (interquartile range [IQR]) of 57 (53–63) and 58 (53–63) years, respectively. PLHIV had lower global cognitive T-scores (median [IQR] 48.7 [45.1, 52.1] versus 50.5 [47.0, 53.9], p < 0.001), more severe depressive symptoms (median [IQR] 4 [1, 10] versus 1 [0, 3], p < 0.001) and were more likely to report history of syphilis infection (22.0% versus 8.1%) than controls. There was no significant association between history of syphilis and global cognitive function in either PLHIV (p = 0.69) or controls (p = 0.10). Participants with a history of syphilis had more severe depressive symptoms (median [IQR] 4 [1, 9] versus 2 [0, 8], p = 0.03); however, the association became non-significant (p = 0.62) after adjusting for HIV status and potential confounders. Despite the higher prevalence of syphilis infection in PLHIV, there was no evidence of an association between history of syphilis infection and impaired cognitive function nor depressive symptoms after accounting for potential confounders.

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Electrocardiographic and echocardiographic abnormalities in urban African people living with HIV in South Africa

PLoS ONE ◽

10.1371/journal.pone.0244742 ◽

2021 ◽

Vol 16 (2) ◽

pp. e0244742

Author(s):

Geert V. T. Roozen ◽

Ruchika Meel ◽

Joyce Peper ◽

William D. F. Venter ◽

Roos E. Barth ◽

...

Keyword(s):

South Africa ◽

Viral Load ◽

Left Ventricular Mass ◽

Qt Interval ◽

Left Ventricular ◽

Hiv Positive ◽

People Living With Hiv ◽

Living With Hiv ◽

Negative Controls ◽

Hiv Negative

Background Studies from high income countries report that HIV-positive people have an impaired systolic and diastolic cardiac function compared to HIV-negative people. It is unclear if results can be translated directly to the Sub-Saharan Africa context. This study assesses electro- and echocardiographic characteristics in an urban African population, comparing HIV-positive people (treated and not yet treated) with HIV-negative controls. Methods We conducted a cross-sectional study in Johannesburg, South Africa. We enrolled HIV-positive participants from three randomized controlled trials that had recruited participants from routine HIV testing programs. HIV-negative controls were recruited from the community. Data were collected on demographics, cardiovascular risk factors, medical history and electrocardiographic and echocardiographic characteristics. Results In total, 394 HIV-positive participants and 153 controls were enrolled. The mean age of HIV-positive participants was 40±9 years (controls: 35±10 years), and 34% were male (controls: 50%). Of HIV-positive participants 36% were overweight or obese (controls: 44%), 23% had hypertension (controls: 28%) and 12% were current smoker (controls: 37%). Median time since HIV diagnosis was 6.0 years (IQR 2.3–10.0) and median treatment duration was 4.0 years (IQR 0.0–8.0), 50% had undetectable viral load. The frequency of anatomical cardiac abnormalities was low and did not differ between people with and without HIV. We observed no relation between HIV or anti-retroviral therapy (ART) and systolic or diastolic heart function. There was an association between ART use and corrected QT interval: +11.8 ms compared to HIV-negative controls (p<0.01) and +18.9 ms compared to ART-naïve participants (p = 0.01). We also observed a higher left ventricular mass index in participants on ART (+7.8 g/m2, p<0.01), but this association disappeared after adjusting for CD4 cell count, viral load and HIV-duration. Conclusion The low number of major cardiac abnormalities in this relatively young, well managed urban African HIV-positive population is reassuring. The increase in corrected QT interval and left ventricular mass may contribute to higher cardiac mortality and morbidity in people living with HIV in the long term.

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CTN 328: immunogenicity outcomes in people living with HIV in Canada following vaccination for COVID-19 (HIV-COV): protocol for an observational cohort study

BMJ Open ◽

10.1136/bmjopen-2021-054208 ◽

2021 ◽

Vol 11 (12) ◽

pp. e054208

Author(s):

Cecilia T Costiniuk ◽

Joel Singer ◽

Marc-André Langlois ◽

Iva Kulic ◽

Judy Needham ◽

...

Keyword(s):

Cohort Study ◽

Immune Responses ◽

Guideline Development ◽

Vaccine Dose ◽

People Living With Hiv ◽

Similar Time ◽

Dosing Strategies ◽

Living With Hiv ◽

Negative Controls ◽

Hiv Negative

IntroductionMost existing vaccines require higher or additional doses or adjuvants to provide similar protection for people living with HIV (PLWH) compared with HIV-uninfected individuals. Additional research is necessary to inform COVID-19 vaccine use in PLWH.Methods and analysisThis multicentred observational Canadian cohort study will enrol 400 PLWH aged >16 years from Montreal, Ottawa, Toronto and Vancouver. Subpopulations of PLWH of interest will include individuals: (1) >55 years of age; (2) with CD4 counts <350 cells/mm3; (3) with multimorbidity (>2 comorbidities) and (4) ‘stable’ or ‘reference’ PLWH (CD4 T cells >350 cells/mm3, suppressed viral load for >6 months and <1 comorbidity). Data for 1000 HIV-negative controls will be obtained via a parallel cohort study (Stop the Spread Ottawa), using similar time points and methods. Participants receiving >1 COVID-19 vaccine will attend five visits: prevaccination; 1 month following the first vaccine dose; and at 3, 6 and 12 months following the second vaccine dose. The primary end point will be the percentage of PLWH with COVID-19-specific antibodies at 6 months following the second vaccine dose. Humoral and cell-mediated immune responses, and the interplay between T cell phenotypes and inflammatory markers, will be described. Regression techniques will be used to compare COVID-19-specific immune responses to determine whether there are differences between the ‘unstable’ PLWH group (CD4 <350 cells/mm3), the stable PLWH cohort and the HIV-negative controls, adjusting for factors believed to be associated with immune response. Unadjusted analyses will reveal whether there are differences in driving factors associated with group membership.Ethics and disseminationResearch ethics boards at all participating institutions have granted ethics approval for this study. Written informed consent will be obtained from all study participants prior to enrolment. The findings will inform the design of future COVID-19 clinical trials, dosing strategies aimed to improve immune responses and guideline development for PLWH.Trial registration numberNCT04894448.

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Depressive symptoms and level of physical activity mediate the associations between HIV sero-status and neurocognitive functions among individuals aged at least 50 years in China (Preprint)

10.2196/preprints.32968 ◽

2021 ◽

Author(s):

Pei Qin ◽

Jianmei He ◽

Xue Yang ◽

Siyu Chen ◽

Xi Chen ◽

...

Keyword(s):

Physical Activity ◽

Depressive Symptoms ◽

Older People ◽

Processing Speed ◽

Neurocognitive Impairment ◽

People Living With Hiv ◽

Neurocognitive Performance ◽

Living With Hiv ◽

Negative Controls ◽

Hiv Negative

BACKGROUND Neurocognitive impairment are prevalent among older people. It is more problematic among older people living with HIV (PLWH). This study was to explore whether the association between HIV sero-status and neurocognitive performance was mediated by depressive symptoms and/or level of physical activity. OBJECTIVE Neurocognitive impairment are prevalent among older people in China. It is more problematic among older people living with HIV (PLWH). This study was to compare neurocognitive performance between older PLWH and HIV-negative controls, and to explore whether the association between HIV sero-status and neurocognitive performance was mediated by depressive symptoms and/or level of physical activity. METHODS A cross-sectional study was conducted in Yongzhou, China. All PLWH aged ≥50 years listed in the registry were invited. Frequency matching was used to sample HIV-negative controls according to the distribution of age, sex, and years of formal education of older PLWH. A total of 315 older PLWH and 350 HIV-negative controls completed the face-to-face interview and comprehensive neuropsychological assessment of seven domains (learning, memory, working memory, verbal fluency, processing speed, executive function and motor skills). RESULTS As compared to HIV-negative controls, older PLWH performed worse in global score and all seven domains (P<.05). Positive HIV sero-status was associated with higher depressive symptoms (P<.001) and lower level of physical activity (P<.001). Depressive symptoms and physical activity were negatively correlated (P<.001). Depressive symptoms and/or level of physical activity mediated the association between HIV sero-status and global score and four domain-specific neurocognitive performance (learning, memory, verbal fluency, and processing speed). CONCLUSIONS Change in mental health and physical activity after HIV infection may partially explain why older PLWH are more susceptible to neurocognitive impairment. Promoting mental health and physical activity are potential entry points to slow down the progress of neurocognitive impairment among older PLWH.

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Exploring the Factors Considered by People Living with HIV and Their Partners during Preconception

Journal of the International Association of Providers of AIDS Care (JIAPAC) ◽

10.1177/2325957416682089 ◽

2016 ◽

Vol 16 (3) ◽

pp. 239-246 ◽

Cited By ~ 3

Author(s):

V. Logan Kennedy ◽

Micaela Collins ◽

Mark H. Yudin ◽

Lena Serghides ◽

Sharon Walmsley ◽

...

Keyword(s):

Logit Model ◽

Hiv Transmission ◽

Horizontal Transmission ◽

People Living With Hiv ◽

Relative Importance ◽

Hiv Status ◽

Ordered Logit Model ◽

Living With Hiv ◽

Shed Light ◽

Hiv Negative

Data are lacking on factors that may impact conception-related decision-making among individuals living with HIV. This study’s aim was to shed light on these considerations. Participants were invited to complete a survey on preconception considerations. A rank-ordered logit model was fit to estimate the relative importance of listed consideration factors; the interaction of HIV status and the factors was assessed. Fifty-nine participants living with HIV and 18 partners (11 HIV-negative participants and 7 living with HIV) were included. Risk of vertical and horizontal HIV transmission and the effect of antiretroviral therapy on the fetus were the top considerations. However, individuals living with HIV prioritized vertical transmission, whereas HIV-negative participants prioritized horizontal transmission. Other factors of importance were probability of conception, stress of trying to conceive, cost associated with fertility clinics, and stigma associated with certain conception methods. This study builds our understanding of the preconception considerations for people living with HIV.

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HIV status alters disease severity and immune cell responses in beta variant SARS-CoV-2 infection wave

eLife ◽

10.7554/elife.67397 ◽

2021 ◽

Vol 10 ◽

Author(s):

Farina Karim ◽

Inbal Gazy ◽

Sandile Cele ◽

Yenzekile Zungu ◽

Robert Krause ◽

...

Keyword(s):

Hiv Infection ◽

Disease Severity ◽

Immune Cell ◽

Supplemental Oxygen ◽

People Living With Hiv ◽

Cell Counts ◽

Cell Changes ◽

Living With Hiv ◽

Second Wave ◽

Hiv Negative

There are conflicting reports on the effects of HIV on COVID-19. Here we analyzed disease severity and immune cell changes during and after SARS-CoV-2 infection in 236 participants from South Africa, of which 39% were people living with HIV (PLWH), during the first and second (beta dominated) infection waves. The second wave had more PLWH requiring supplemental oxygen relative to HIV negative participants. Higher disease severity was associated with low CD4 T cell counts and higher neutrophil to lymphocyte ratios (NLR). Yet, CD4 counts recovered and NLR stabilized after SARS-CoV-2 clearance in wave 2 infected PLWH, arguing for an interaction between SARS-CoV-2 and HIV infection leading to low CD4 and high NLR. The first infection wave, where severity in HIV negative and PLWH was similar, still showed some HIV modulation of SARS-CoV-2 immune responses. Therefore, HIV infection can synergize with the SARS-CoV-2 variant to change COVID-19 outcomes.

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Loco-Regional Treatments for Hepatocellular Carcinoma in People Living with HIV

Infectious Disease Reports ◽

10.3390/idr14010006 ◽

2022 ◽

Vol 14 (1) ◽

pp. 43-55

Author(s):

Cristina Micali ◽

Ylenia Russotto ◽

Grazia Caci ◽

Manuela Ceccarelli ◽

Andrea Marino ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Overall Survival ◽

Cancer Staging ◽

Hiv Positive ◽

People Living With Hiv ◽

Liver Cancers ◽

Significant Difference ◽

Cancer Specific Mortality ◽

Living With Hiv ◽

Hiv Negative

Hepatocellular carcinoma (HCC) accounts for approximately 75–90% of primary liver cancers and is the sixth most common cancer and the third leading cause of cancer-related deaths worldwide. In the HIV-positive population, the risk of HCC is approximately four times higher than in the general population, with higher cancer-specific mortality than in HIV-negative patients. In most cases, HCC diagnosis is made in patients younger than the HIV-negative population and in the intermediate-advanced stage, thus limiting the therapeutic possibilities. Treatment choice in HIV-positive patients with HCC is subject to cancer staging, liver function and health status, as for HIV-negative and non-HIV-negative HCC patients. There are relatively few studies on the efficacy and safety in HIV-positive patients to date in loco-regional treatments for HCC. So far, literature shows that curative treatments such as radiofrequency ablation (RFA) have no significant differences in overall survival between HIV-positive and HIV-negative patients, as opposed to palliative treatments such as TACE, where there is a significant difference in overall survival. Although it can be assumed that the most recently discovered loco-regional therapies are applicable to HIV-positive patients with HCC in the same way as HIV-negative patients, further studies are needed to confirm this hypothesis. The purpose of our review is to evaluate these treatments, their efficacy, effectiveness, safety and their applicability to HIV-positive patients.

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Hodgkin Lymphoma in People Living with HIV

Cancers ◽

10.3390/cancers13174366 ◽

2021 ◽

Vol 13 (17) ◽

pp. 4366

Author(s):

Jose-Tomas Navarro ◽

José Moltó ◽

Gustavo Tapia ◽

Josep-Maria Ribera

Keyword(s):

Hodgkin Lymphoma ◽

Interdisciplinary Collaboration ◽

Survival Rates ◽

People Living With Hiv ◽

Barr Virus ◽

Non Hodgkin Lymphoma ◽

Combined Antiretroviral Therapy ◽

Epstein Barr ◽

Living With Hiv ◽

Hiv Negative

Despite widespread use of combined antiretroviral therapy (cART) and increased life expectancy in people living with HIV (PLWH), HIV-related lymphomas (HRL) remain a leading cause of cancer morbidity and mortality for PLWH, even in patients optimally treated with cART. While the incidence of aggressive forms of non-Hodgkin lymphoma decreased after the advent of cART, incidence of Hodgkin lymphoma (HL) has increased among PLWH in recent decades. The coinfection of Epstein–Barr virus plays a crucial role in the pathogenesis of HL in the HIV setting. Currently, PLWH with HRL, including HL, are treated similarly to HIV-negative patients and, importantly, the prognosis of HL in PLWH is approaching that of the general population. In this regard, effective cART during chemotherapy is strongly recommended since it has been shown to improve survival rates in all lymphoma subtypes, including HL. As a consequence, interdisciplinary collaboration between HIV specialists and hemato-oncologists for the management of potential drug–drug interactions and overlapping toxicities between antiretroviral and antineoplastic drugs is crucial for the optimal treatment of PLWH with HL. In this article the authors review and update the epidemiological, clinical and biological aspects of HL presenting in PLWH with special emphasis on advances in prognosis and the factors that have contributed to it.

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Malaria and intestinal parasite co-infection and its association with anaemia among people living with HIV in Buea, Southwest Cameroon: A community-based retrospective cohort study

PLoS ONE ◽

10.1371/journal.pone.0245743 ◽

2021 ◽

Vol 16 (1) ◽

pp. e0245743

Author(s):

Sorelle Mekachie Sandie ◽

Irene Ule Ngole Sumbele ◽

Martin Mih Tasah ◽

Helen Kuokuo Kimbi

Keyword(s):

Cohort Study ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Intestinal Parasites ◽

Significant Risk ◽

People Living With Hiv ◽

Viral Load Suppression ◽

Community Based ◽

Living With Hiv ◽

Hiv Negative

Background Both malaria and intestinal parasites are endemic in Cameroon, and their co-infection can be of great impact on anaemia among people living with HIV (PLWH). This community-based retrospective cohort study determined the prevalence and association of infections with anaemia in PLWH and HIV-negative individuals in Buea, Cameroon from March to August 2019. Methods The study population comprised of 190 PLWH and 216 consenting HIV-negative individuals from the Buea community. Participants were examined clinically, the collected blood sample was used for malaria parasite (MP) detection, HIV diagnosis and haemoglobin (Hb) measurement while stool samples were examined for the detection of intestinal parasites (IPs). Proportions were compared using Pearson’s Chi-square test and association of anaemia with independent variables was evaluated using logistic regression analysis. Results Out of the 406 participants, MP, IPs and MP/IP co-infection prevalences were 15.5%, 13.0% and 3.0% respectively. PLWH had a higher prevalence of MP (16.3%, P = 0.17), IPs (23.7%, P ˂ 0.001) and MP/IPs co-infection (3.7%, P = 0.04) when compared with HIV-negative participants. Similarly, PLWH had significantly lower mean haemoglobin value (11.10 ± 1.54 g/dL) than their HIV-negative counterparts (12.45 ± 2.06 g/dL). Also, PLWH co-infected with MP and IPs were observed to have a significantly lower mean haemoglobin value (10.6 ± 1.21 g/dL). PLWH had a significantly (P ˂ 0.001) higher prevalence of mild (56.8%), moderate (18.4%) and severe (1.6%) anaemia when compared with HIV-negative counterparts. The significant risk factors associated with anaemia included being febrile (P = 0.03), MP-infected only (P = 0.001), HIV-infected only (P < 0.001), having dual (P < 0.001) or triple-infections (P = 0.03). Conclusion Malaria and intestinal parasites remain public health concerns among PLWH and anaemia as a serious haematological abnormality gets exacerbated even with the viral load suppression. Hence, routine medical check-ups among PLWH are recommended.

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