scholarly journals Inflammatory pathways amongst people living with HIV in Malawi differ according to socioeconomic status

PLoS ONE ◽  
2021 ◽  
Vol 16 (8) ◽  
pp. e0256576
Author(s):  
Christine Kelly ◽  
Willard Tinago ◽  
Dagmar Alber ◽  
Patricia Hunter ◽  
Natasha Luckhurst ◽  
...  
Keyword(s):  
Risk Factors ◽  
Socioeconomic Status ◽  
Arterial Stiffness ◽  
Immune Activation ◽  
Tertiary Education ◽  
Sub Saharan Africa ◽  
People Living With Hiv ◽  
Living With Hiv ◽  
Socioeconomic Risk ◽  
Socioeconomic Risk Factors

Background Non-communicable diseases (NCDs) are increased amongst people living with HIV (PLWH) and are driven by persistent immune activation. The role of socioeconomic status (SES) in immune activation amongst PLWH is unknown, especially in low-income sub-Saharan Africa (SSA), where such impacts may be particularly severe. Methods We recruited Malawian adults with CD4<100 cells/ul two weeks after starting ART in the REALITY trial (NCT01825031), as well as volunteers without HIV infection. Clinical assessment, socioeconomic evaluation, blood draw for immune activation markers and carotid femoral pulse wave velocity (cfPWV) were carried out at 2- and 42-weeks post-ART initiation. Socioeconomic risk factors for immune activation and arterial stiffness were assessed using linear regression models. Results Of 279 PLWH, the median (IQR) age was 36 (31–43) years and 122 (44%) were female. Activated CD8 T-cells increased from 70% amongst those with no education to 88% amongst those with a tertiary education (p = 0.002); and from 71% amongst those earning less than 10 USD/month to 87% amongst those earning between 100–150 USD/month (p = 0.0001). Arterial stiffness was also associated with higher SES (car ownership p = 0.003, television ownership p = 0.012 and electricity access p = 0.029). Conversely, intermediate monocytes were higher amongst those with no education compared to a tertiary education (12.6% versus 7.3%; p = 0.01) and trended towards being higher amongst those earning less than 10 USD/month compared to 100–150 USD/month (10.5% versus 8.0%; p = 0.08). Water kiosk use showed a protective association against T cell activation (p = 0.007), as well as endothelial damage (MIP1β, sICAM1 and sVCAM1 p = 0.047, 0.026 and 0.031 respectively). Conclusions Socioeconomic risk factors for persistent inflammation amongst PLWH in SSA differ depending on the type of inflammatory pathway. Understanding these pathways and their socioeconomic drivers will help identify those at risk and target interventions for NCDs. Future studies assessing drivers of inflammation in HIV should include an SES assessment.

scholarly journals Inflammatory pathways amongst people living with HIV in Malawi differ according to socioeconomic status

2020 ◽  
Author(s):  
Christine Kelly ◽  
Willard Tinago ◽  
Dagmar Alber ◽  
Patricia Hunter ◽  
Natasha Luckhurst ◽  
...  
Keyword(s):  
Socioeconomic Status ◽  
Arterial Stiffness ◽  
Socioeconomic Factors ◽  
Low Income ◽  
Immune Activation ◽  
Communicable Diseases ◽  
Sub Saharan Africa ◽  
People Living With Hiv ◽  
Non Communicable Diseases ◽  
Living With Hiv

BackgroundNon-communicable diseases (NCDs) are increased amongst people living with HIV (PLWH) and are driven by persistent immune activation. The role of socioeconomic status (SES) in immune activation amongst PLWH is unknown, especially in low income sub Saharan Africa (SSA), where such impacts may be particularly severe.MethodsWe recruited Malawian adults with CD4<100 cells/ul two weeks after starting ART in the REALITY trial (NCT01825031), as well as volunteers without HIV infection. Clinical assessment, socioeconomic evaluation, blood draw for immune activation markers and carotid femoral pulse wave velocity (cfPWV) were carried out at 2 and 42 weeks post-ART initiation. Socioeconomic risk factors for immune activation and arterial stiffness were assessed using linear regression models.ResultsOf 279 PLWH, the median (IQR) age was 36 (31-43) years and 122 (44%) female. Activated CD8 T-cells increased from 70% amongst those with no education to 88% amongst those with a tertiary education (p=0.002); and from 71% amongst those earning less than 10 USD/month to 87% amongst those earning between 100-150 USD/month (p=0.0001). Arterial stiffness was also associated with higher SES (car ownership p=0.003, television ownership p=0.012 and electricity access p=0.029). Conversely, intermediate monocytes were higher amongst those with no education compared to a tertiary education (12.6% versus 7.3%; p=0.01) and amongst those earning less than 10 USD/month compared to 100-150 USD/month (10.5% versus 8.0%; p=0.08). Water kiosk use was protective against T cell activation (p=0.007), as well as endothelial damage (MIP1β, sICAM1 and sVCAM1 p=0.047, 0.026 and 0.031 respectively).ConclusionsSocioeconomic risk factors for persistent inflammation amongst PLWH in SSA differ depending on the type of inflammatory pathway. Understanding these pathways and their socioeconomic drivers will help identify those at risk and target interventions for NCDs. Future studies assessing drivers of inflammation amongst PLWH should include an SES assessment.Key pointsWhat is already known?Persistent immune activation drives an increased risk of non-communicable diseases amongst people living with HIV. The aetiology of persistent immune activation amongst PLWH is complex and includes microbial translocation, subclinical co-infection and continued low level HIV viral replication. However, the contribution of socioeconomic factors has not previously been investigated, and may be especially relevant amongst those living in low income settings.What are the new findings?The contribution of socioeconomic factors to persistent inflammation differs according to the type of inflammatory pathway. PLWH with higher socioeconomic status are at increased risk of T cell activation and arterial stiffness, perhaps as a result of more sedentary lifestyles. Conversely, evidence of innate immune activation is seen amongst those with lower socioeconomic status. Water kiosk use is associated with a favourable inflammatory profile.What do the findings imply?The phenotype of chronic immune activation amongst PLWH in a low-income sub-Saharan Africa setting differs according to socioeconomic status. We recommend incorporation of socioeconomic factors into future studies assessing the relationship between chronic inflammation and non-communicable diseases amongst HIV populations.

scholarly journals Falls in people living with HIV: a scoping review

BMJ Open ◽  
2020 ◽  
Vol 10 (11) ◽  
pp. e034872
Author(s):  
Maria Yvonne Charumbira ◽  
Karina Berner ◽  
Quinette Abegail Louw
Keyword(s):  
Risk Factors ◽  
Scoping Review ◽  
Descriptive Analysis ◽  
Falls Prevention ◽  
Assessment Tools ◽  
Sub Saharan Africa ◽  
People Living With Hiv ◽  
Potential Risk Factors ◽  
Risk Factors For Falls ◽  
Living With Hiv

ObjectivesRecent research has indicated seemingly increased propensity for falls and accelerated bone demineralisation in people living with HIV (PLWH). We aim to map out the extent and nature of existing research relating to falls in PLWH and describe the relationship between bone demineralisation and falls in PLWH.MethodsA scoping review was done following Arksey & O’Malley’s methodological framework and recommendations from Joanna Briggs Institute. Four databases were searched until October 2019 for peer-reviewed studies available in English reporting on the definition, prevalence, assessment, risk factors and interventions for falls in PLWH as well as information on bone demineralisation linked to falls in PLWH. Narrative reviews were excluded. Two reviewers independently performed the extraction using a predesigned Excel sheet. A descriptive analysis of extracted information was done.ResultsFourteen studies on falls in older PLWH were identified, with all but one study conducted in high-income countries. Prevalence of falls in PLWH ranged from 12% to 41%. Variable assessment tools/tests were used to assess potential risk factors, but it remains to be determined which are more predictive and appropriate for use among PLWH. Considerable agreement existed for risk factors regarding use of medications while evidence regarding functional and cognitive impairments were variable. Few studies compared risk factors for falls in PLWH with those in age-matched and sex-matched seronegative population. There is currently no evidence for interventions to prevent or reduce falls risk in PLWH.ConclusionMore research is needed on falls in younger cohorts of PLWH and in sub-Saharan Africa where HIV is most prevalent and more robust clades exist. More studies need to report on data in seronegative controls to determine risk factors unique to PLWH. More intervention studies targeted at falls prevention and promotion of bone health are required. Quality clinical practice guidelines highlighting validated assessment tools and outcome measures need to be developed.

scholarly journals Prevalence, Risk Factors, and Pathophysiology of Dysglycemia among People Living with HIV in Sub-Saharan Africa

2018 ◽  
Vol 2018 ◽  
pp. 1-12 ◽  
Author(s):  
Benson Njuguna ◽  
Jepchirchir Kiplagat ◽  
Gerald S. Bloomfield ◽  
Sonak D. Pastakia ◽  
Rajesh Vedanthan ◽  
...  
Keyword(s):  
Risk Factors ◽  
Clinical Outcomes ◽  
Elevated Serum ◽  
Sub Saharan Africa ◽  
People Living With Hiv ◽  
Art Initiation ◽  
Common Risk Factors ◽  
Sub Saharan ◽  
Living With Hiv ◽  
Prevalence Of Diabetes Mellitus

Objective. To review available literature on the prevalence, risk factors, pathophysiology, and clinical outcomes of dysglycemia among people living with HIV (PLHIV) in sub-Saharan Africa (SSA). Methods. Database search on PUBMED for eligible studies describing the prevalence, risk factors, pathophysiology, or clinical outcomes of dysglycemia in SSA PLHIV. Results. Prevalence of diabetes mellitus (DM) and pre-DM among SSA PLHIV ranged from 1% to 26% and 19% to 47%, respectively, in 15 identified studies. Older age and an elevated body mass index (BMI) were common risk factors for dysglycemia. Risk factors potentially more specific to PLHIV in SSA included exposure to older-generation thymidine analogues or protease inhibitors, malnutrition at ART initiation, a failure to gain fat mass on treatment, and elevated serum lipids. There is evidence of higher nephropathy and neuropathy rates among PLHIV in SSA with comorbid DM compared to HIV-negative individuals with DM. Conclusion. There is a need for longitudinal studies to enhance understanding of the risk factors for dysglycemia among PLHIV in SSA, further research into optimal therapies to reduce pre-DM progression to DM among SSA PLHIV, and studies of the burden and phenotype of diabetic complications and other health outcomes among PLHIV with comorbid DM in SSA.

scholarly journals Risk factors for AIDS-defining illnesses among a population of poorly adherent people living with HIV/AIDS in Atlanta, Georgia

AIDS Care ◽  
2015 ◽  
Vol 27 (7) ◽  
pp. 844-848 ◽  
Author(s):  
Jeremy Y. Chow ◽  
Marcella Alsan ◽  
Wendy Armstrong ◽  
Carlos del Rio ◽  
Vincent C. Marconi
Keyword(s):  
Risk Factors ◽  
People Living With Hiv ◽  
Living With Hiv ◽  
Hiv Aids

scholarly journals 947. Stroke demographics and risk factor profile in HIV infected individuals in Florida

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S506-S506
Author(s):  
Folusakin Ayoade ◽  
Dushyantha Jayaweera
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Clinical Research ◽  
Stroke Risk ◽  
Research Network ◽  
Categorical Variables ◽  
People Living With Hiv ◽  
Risk Factor Profile ◽  
Stroke Risk Factors ◽  
Living With Hiv

Abstract Background The risk of ischemic stroke (IS) is known to be higher in people living with HIV (PLWH) than uninfected controls. However, information about the demographics and risk factors for hemorrhagic stroke (HS) in PLWH is scant. Specifically, very little is known about the differences in the stroke risk factors between HS and IS in PLWH. The goal of this study was to determine the demographics and risk factor differences between HS and IS in PLWH. Methods We retrospectively analyzed the demographic and clinical data of PLWH in OneFlorida (1FL) Clinical Research Consortium from October 2015 to December 2018. 1FL is a large statewide clinical research network and database which contains health information of over 15 million patients, 1240 clinical practices, and 22 hospitals. We compared HS and IS based on documented ICD 9 and 10 diagnostic codes and extracted information about sociodemographic data, traditional stroke risk factors, Charlson comorbidity scores, habits, HIV factors, diagnostic modalities and medications. Statistical significance was determined using 2-sample T-test for continuous variables and adjusted Pearson chi square for categorical variables. Odds ratio (OR) and 95% confidence intervals (CI) between groups were compared. Results Overall, from 1FL sample of 13986 people living with HIV, 574 subjects had strokes during the study period. The rate of any stroke was 18.2/1000 person-years (PYRS). The rate of IS was 10.8/1000 PYRS while the rate of HS was 3.7/1000 PYRS, corresponding to 25.4% HS of all strokes in the study. Table 1 summarizes the pertinent demographic and risk factors for HS and IS in PLWH in the study. Table 1: Summary of pertinent demographic and risk factors for hemorrhagic and ischemic strokes in people living with HIV from One Florida database Conclusion In this large Floridian health database, demographics and risk factor profile differs between HS and IS in PLWH. Younger age group is associated with HS than IS. However, hypertension, hyperlipidemia and coronary artery disease are more likely to contribute to IS than HS in PLWH. Further research is needed to better understand the interplay between known and yet unidentified risk factors that may be contributing to HS and IS in PLWH. Disclosures All Authors: No reported disclosures

scholarly journals Rates and risk factors for suicidal ideation, suicide attempts and suicide deaths in persons with HIV: a systematic review and meta-analysis

2021 ◽  
Vol 34 (2) ◽  
pp. e100247
Author(s):  
Matt Pelton ◽  
Matt Ciarletta ◽  
Holly Wisnousky ◽  
Nicholas Lazzara ◽  
Monica Manglani ◽  
...  
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Suicidal Ideation ◽  
General Population ◽  
Suicide Attempts ◽  
Advanced Disease ◽  
Meta Analysis ◽  
People Living With Hiv ◽  
Meta Regression ◽  
Living With Hiv

BackgroundPeople living with HIV/AIDS (PLWHA) must contend with a significant burden of disease. However, current studies of this demographic have yielded wide variations in the incidence of suicidality (defined as suicidal ideation, suicide attempt and suicide deaths).AimsThis systematic review and meta-analysis aimed to assess the lifetime incidence and prevalence of suicidality in PLWHA.MethodsPublications were identified from PubMed (MEDLINE), SCOPUS, OVID (MEDLINE), Joanna Briggs Institute EBP and Cochrane Library databases (from inception to before 1 February 2020). The search strategy included a combination of Medical Subject Headings associated with suicide and HIV. Researchers independently screened records, extracted outcome measures and assessed study quality. Data were pooled using a random-effects model. Subgroup and meta-regression analyses were conducted to explore the associated risk factors and to identify the sources of heterogeneity. Main outcomes were lifetime incidence of suicide completion and lifetime incidence and prevalence of suicidal ideation and suicide attempt.ResultsA total of 185 199 PLWHA were identified from 40 studies (12 cohorts, 27 cross-sectional and 1 nested case-control). The overall incidence of suicide completion in PLWHA was 10.2/1000 persons (95%CI: 4.5 to 23.1), translating to 100-fold higher suicide deaths than the global general population rate of 0.11/1000 persons. The lifetime prevalence of suicide attempts was 158.3/1000 persons (95%CI: 106.9 to 228.2) and of suicidal ideation was 228.3/1000 persons (95%CI: 150.8 to 330.1). Meta-regression revealed that for every 10-percentage point increase in the proportion of people living with HIV with advanced disease (AIDS), the risk of suicide completion increased by 34 per 1000 persons. The quality of evidence by Grading of Recommendations, Assessment, Development and Evaluations for the suicide deaths was graded as ‘moderate’ quality.ConclusionsThe risk of suicide death is 100-fold higher in people living with HIV than in the general population. Lifetime incidence of suicidal ideation and attempts are substantially high. Suicide risk assessments should be a priority in PLWHA, especially for those with more advanced disease.

Sign in / Sign up

Export Citation Format

Share Document