Incidence of Hypertension among Persons Living with HIV in China A Multicenter Study

Abstract Objectives Life expectancy among persons living with HIV (PLWH) has improved with increasing access to antiretroviral therapy (ART), however incidence of chronic comorbidities has simultaneously increased. No data are available regarding the incidence of hypertension among Chinese PLWH.Methods We analyzed data collected from patients enrolled in two prospective longitudinal multicenter studies of PLWH initiating ART in China. Incidence rate of hypertension per 100 person-years (PYs) among PLWH was calculated, and Cox proportional hazards models was used to evaluate the association between incident hypertension and traditional and HIV-associated risk factors.Results Of 1078 patients included in this analysis, 984 ART-naïve patients were hypertension-free at baseline, and contributed 2337.7 PYs of follow up, with a median follow-up period of 1.8 years (range: 1.2-3.2) after initiation of ART. Incidence of hypertension was 7.6 [95% confidence interval (CI): 6.5-8.7] per 100 PYs. In the Cox regression analysis, incidence of hypertension was positively associated with BMI [adjusted hazard ratio (aHR) 1.07 (1.01,1.13), p=0.02] and recent viral load (aHR 1.28, 95% CI:1.08-1.51, p=0), and negatively associated with recent CD4+/CD8+ ratio (aHR 0.14, 95% CI:0.06-0.31, p<0.001), zidovudine exposure (aHR 0.15, 95% CI: 0.10-0.24, p<0.001) and tenofovir exposure (aHR 0.13, 95% CI: 0.08-0.21, p<0.001).Conclusions The incidence of hypertension was relatively high among Chinese PLWH initiating ART. Independent risk factors for incident hypertension included recent low CD4+/CD8+ ratio and detectable HIV viremia, whereas receipt of ART was associated with reduced risk. Hypertension may be mitigated, in part, by excellent HIV care, including viral suppression with ART.

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Incidence of Hypertension among Persons Living with HIV in China: A Multicenter Cohort Study

10.21203/rs.2.20649/v2 ◽

2020 ◽

Author(s):

Hongwei Fan ◽

fuping guo ◽

Evelyn Hsieh ◽

Wei-Ti Chen ◽

Wei Lv ◽

...

Keyword(s):

Cox Regression ◽

Cox Proportional Hazards ◽

Hiv Care ◽

Multicenter Cohort Study ◽

Cox Regression Analysis ◽

Incident Hypertension ◽

Persons Living With Hiv ◽

Living With Hiv ◽

Prospective Longitudinal

Abstract Background Life expectancy among persons living with HIV (PLWH) has improved with increasing access to antiretroviral therapy (ART), however incidence of chronic comorbidities has simultaneously increased. No data are available regarding the incidence of hypertension among Chinese PLWH. Methods We analyzed data collected from patients enrolled in two prospective longitudinal multicenter studies of PLWH initiating ART in China. Incidence rate of hypertension per 100 person-years (PYs) among PLWH was calculated, and Cox proportional hazards models was used to evaluate the association between incident hypertension and traditional and HIV-associated risk factors. Results Of 1078 patients included in this analysis, 984 ART-naïve patients were hypertension-free at baseline, and contributed 2337.7 PYs of follow up, with a median follow-up period of 1.8 years (range: 1.2-3.2) after initiation of ART. Incidence of hypertension was 7.6 [95% confidence interval (CI): 6.5-8.7] per 100 PYs. In the Cox regression analysis, incidence of hypertension was positively associated with body mass index [adjusted hazard ratio (aHR) 1.07 (1.01,1.13), p=0.02] and recent viral load (aHR 1.28, 95% CI:1.08-1.51, p=0), and negatively associated with recent CD4+/CD8+ ratio (aHR 0.14, 95% CI:0.06-0.31, p<0.001), zidovudine exposure (aHR 0.15, 95% CI: 0.10-0.24, p<0.001) and tenofovir disoproxil fumarate exposure (aHR 0.13, 95% CI: 0.08-0.21, p<0.001). Conclusions The incidence of hypertension was relatively high among Chinese PLWH initiating ART. Recent low CD4+/CD8+ ratio and detectable HIV viremia were associated with incident hypertension, whereas receipt of ART was associated with reduced risk . Hypertension may be mitigated, in part, by excellent HIV care, including viral suppression with ART.

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1036. Persistence of Guideline-Recommended Antiretroviral Therapy Regimens among Persons Living with HIV Newly Initiating Treatment in the US

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.1222 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S548-S549

Author(s):

Joshua P Cohen ◽

Xingzhi Wang ◽

Rolin L Wade ◽

Helena Diaz Cuervo ◽

Dionne M Dionne

Keyword(s):

Antiretroviral Therapy ◽

Proportional Hazards ◽

Cox Proportional Hazards ◽

Treatment Discontinuation ◽

Forest Plot ◽

Current Guideline ◽

First Line ◽

Persons Living With Hiv ◽

Living With Hiv

Abstract Background Discontinuation of first-line antiretroviral therapy (ART) may lead to poor outcomes for persons living with HIV (PLWH). While single-tablet regimens (STRs) have been associated with greater persistence compared to multi-tablet regimens (MTRs), few real-world studies have assessed persistence with current guideline-recommended ART regimens. The study aims to assess persistence among treatment-naïve PLWH initiating guideline-recommended ART regimens Methods Longitudinal pharmacy claims were extracted from IQVIA’s US LRx database for PLWH initiating ART between Jan 1, 2016 - Jul 31, 2019 (index period), with the observational period up to Jan 31, 2020. Index date was defined as the date of the first ART claim for STRs, or the date of the last filled drug of 1st set of claims for MTRs. Persistence was measured as the number of days until treatment discontinuation (≥ 90-day gap in therapy) and presented via Kaplan-Meier curves. Risk of discontinuation was assessed via Cox proportional hazards models, with BIC/FTC/TAF used as the reference ART regimen. Results Overall, 90,949 PLWH initiated STRs and 20,737 initiated MTRs. Average (SD) age was 43 (14) years, 75% were male, and 75% had commercial insurance. At 6 months of follow-up, 71% of PLWH initiating STRs and 56% initiating MTRs remained on their ART regimen. The proportion remaining on their index regimen at 6 months of follow-up was 79% for BIC/FTC/TAF, 73% for EVG/COBI/FTC/TAF, 71% for DTG/ABC/3TC, 69% for DTG + FTC/TAF, 67% for EFV/FTC/TDF, 62% for EVG/COBI/FTC/TDF, and 38% for DTG + FTC/TDF. Risk of discontinuation was higher for MTRs compared to STRs (hazard ratio [HR]: 1.63, 95% CI: 1.61 - 1.66). Compared to the referent BIC/FTC/TAF, risk of discontinuation was higher for EVG/COBI/FTC/TAF (HR: 1.54, 95% CI: 1.48 - 1.60), DTG/ABC/3TC (HR: 1.58, 95% CI: 1.52, 1.65), DTG + FTC/TAF (HR: 1.83, 95% CI: 1.74 - 1.93), EFV/FTC/TDF (HR: 2.31, 95% CI: 2.21 - 2.41), EVG/COBI/FTC/TDF (HR: 2.58, 95% CI: 2.47 - 2.70), and DTG + FTC/TDF (HR: 6.20, 95% CI: 5.83 - 6.59). Table 1. Persistence with ART by regimen for STR and MTR Figure 1. Forest Plot of Hazard Ratios for Treatment Discontinuation Conclusion Among US adult PLWH, STRs were associated with longer persistence on first-line therapy compared to MTRs. Among STRs, persistence was highest for BIC/FTC/TAF. Disclosures All Authors: No reported disclosures

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Trajectories of Mediterranean Diet Adherence and Risk of Hypertension in China: Results from the CHNS Study, 1997–2011

Nutrients ◽

10.3390/nu10122014 ◽

2018 ◽

Vol 10 (12) ◽

pp. 2014 ◽

Cited By ~ 3

Author(s):

Min Gao ◽

Fengbin Wang ◽

Ying Shen ◽

Xiaorou Zhu ◽

Xing Zhang ◽

...

Keyword(s):

Mediterranean Diet ◽

Proportional Hazards Model ◽

Cox Regression ◽

Cox Proportional Hazards ◽

Cox Proportional Hazards Model ◽

Nutrition Survey ◽

Cox Regression Analysis ◽

Incident Hypertension ◽

Diet Adherence ◽

Mediterranean Diet Adherence

Evidence indicates that longitudinal changes in dietary patterns may predict variations in blood pressure (BP) and risk of incident hypertension. We aimed to identify distinct trajectories in the levels of Mediterranean diet adherence (MDA) in China and explore their association with BP levels and hypertension risk using the China Health and Nutrition Survey 1997–2011 data. Three levels of MDA were constructed. The trajectories in these levels were constructed using group-based trajectory modeling. A Cox proportional hazards model was used to measure the association between MDA trajectory groups and the risk of incident hypertension after adjusting for covariates. Finally, 6586 individuals were included. Six distinct MDA trajectory groups were identified: persistently low and gradual decline; rapidly increasing and stabilized; persistently moderate; slightly increasing, steady, and acutely descending; slightly decreasing and acutely elevated; and persistently high. The systolic BP and diastolic BP were significantly lower in trajectory groups with rapidly increasing and stabilized MDA; slightly increasing, steady, and acutely descending MDA; and persistently high MDA. Cox regression analysis showed that the risks of developing hypertension were relatively lower in the group with slightly increasing, steady, and acutely descending MDA (hazard ratio (HR) = 0.17, 95% confidence interval (CI): 0.09–0.32) and the group with rapidly increasing and stabilized MDA (HR = 0.32, 95% CI: 0.23–0.42), but the risk was the highest in the trajectory with persistently moderate MDA (HR = 0.96, 95% CI: 0.84–1.08). In conclusion, MDA in China was categorized into six distinct trajectory groups. BP was relatively lower in trajectory groups with initially high or increasing MDA levels. Greater MDA was significantly associated with a lower risk of developing hypertension.

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1309. Effects of a Pharmacist-Driven Antiretroviral Stewardship and Transitions of Care Service in Persons Living with HIV/AIDS

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.1172 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S471-S472

Author(s):

Marisa B Brizzi ◽

Rodrigo M Burgos ◽

Thomas D Chiampas ◽

Sarah M Michienzi ◽

Renata Smith ◽

...

Keyword(s):

Care Service ◽

Transitions Of Care ◽

Hiv Care ◽

Outpatient Clinics ◽

Readmission Rates ◽

Implementation Phase ◽

Persons Living With Hiv ◽

Living With Hiv ◽

Hiv Aids

Abstract Background Historical data demonstrate that PLWHA experience higher rates of medication-related errors when admitted to the inpatient setting. Prior to initiation of this program, rapid-start initiation of antiretroviral therapy (ART) was not implemented prior to discharge. The purpose of this study was to evaluate the impact of a pharmacist-driven antiretroviral stewardship and transitions of care service in persons living with HIV/AIDS (PLWHA). Methods This was a retrospective pre- and post-analysis of PLWHA hospitalized at University of Illinois Hospital (UIH). Patients included were adults following at UIH outpatient clinics for HIV care admitted to UIH for acute care. Data were collected between April 19, 2017 and October 19, 2017 for the pre-implementation phase, and between July 1, 2018 and December 31, 2018 for the post-implementation phase. The post-implementation phase included an HIV-trained clinical pharmacist (Figure 1). Primary and secondary endpoints included follow-up rates at UIH outpatient HIV clinics, 30-day readmission rates, and access to medications at hospital discharge. Statistical analysis included descriptive statistics and Fisher’s Exact test. Results A total of 119 patients were included in the analysis, 66 in the pre-implementation phase and 53 in the post-implementation phase. Patients included were mostly black males with median age of 48. In the pre-implementation phase 50 out of 65 (77%) patients attended follow-up visits for HIV care at UIH outpatient clinics, vs. 42 out of 47 (89%) patients in the post-implementation phase (P = 0.1329). Thirty-day readmission occurred in 17 of 62 (27%) patients in the pre-implementation phase vs. 5 of 52 (10%) of patients in the post-implementation phase (P = 0.0183). During the post-implementation phase, the HIV pharmacist secured access of ART and opportunistic infection medications prior to discharge for 22 patients (42%), 2 of which were new diagnoses. Conclusion A pharmacist-led antiretroviral stewardship and TOC program led to a decrease in 30-day readmission rates in PLWHA. Although not significant, the HIV-pharmacist led to higher rates of clinic follow-up. Finally, the HIV-pharmacist helped secure access to ART and initiate rapid-start therapy in newly diagnosed patients prior to leaving the hospital. Disclosures All authors: No reported disclosures.

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Sex specific trajectories of central adiposity, lipid indices, and glucose level with incident hypertension: 12 years Follow-up in Tehran lipid and glucose study

Journal of Translational Medicine ◽

10.1186/s12967-021-02749-x ◽

2021 ◽

Vol 19 (1) ◽

Author(s):

Noushin Sadat Ahanchi ◽

Seyed Saeed Tamehri Zadeh ◽

Davood Khalili ◽

Fereidoun Azizi ◽

Farzad Hadaegh

Keyword(s):

Latent Class ◽

Cox Regression ◽

Density Lipoprotein ◽

Multivariate Model ◽

Central Adiposity ◽

Growth Mixture Model ◽

Cox Regression Analysis ◽

Incident Hypertension ◽

Growth Mixture

Abstract Aims To identify sex specific trajectories of waist circumference (WC),triglyceride (TG), total cholesterol (TC), high density lipoprotein cholesterol (HDL-C) and fasting plasma glucose (FPG) during adulthood and examine their associations with incident hypertension. Methods The cohort consisted of 5030 participants (2051 males) with at least 2 repeated measurement during a median of 12 years follow up. We identified trajectory groups using latent class growth mixture model, their association with hypertension was examined using multivariate Cox-regression analysis. Results We found 997 cases of hypertension (483 male). For both exposures, three distinct trajectory groups were identified in both genders. For WC, in women: low-increasing, 82.4%; high-stable, 13.4%; high-increasing, 4.2% and in men: stable, 94.6%; low-increasing, 3.6% and for high- increasing, 1.7%. For TG, in women: stable, 91.3%; decreasing, 5.9%; inverse U-shape, 2.8%; in men: stable, 89.7%; inverse U- shape, 6.2% and for decreasing, 4.1%. Regarding WC, high stable and high-increasing trajectories were associated with hypertension in the multivariate model [(hazard ratio (HR) = 1.66 (95% CI 1.26–2.20) and 2.78(1.79–3.60), respectively]. Among men, this association was shown only for the low-increasing trajectory [2.76: 1.49–5.10]. For TG, among women decreasing and inverse U-shape trajectories were significantly associated with hypertension in the multivariate model [1.32:1.01–1.76] and [2.23:1.58–3.23, respectively]. We did not find any impact of increasing trajectories of FPG and HDL-C on incident hypertension. Considering TC, all individuals followed a stable trajectory. Conclusion WC dynamic changes in both gender and TG trajectory among women were significantly associated with incident hypertension.

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Follow-Up Survey of the Impact of COVID-19 on People Living with HIV during the Second Semester of the Pandemic

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18094635 ◽

2021 ◽

Vol 18 (9) ◽

pp. 4635

Author(s):

Joseph Nelson Siewe Fodjo ◽

Edlaine Faria de Moura Villela ◽

Stijn Van Hees ◽

Pieter Vanholder ◽

Patrick Reyntiens ◽

...

Keyword(s):

Online Survey ◽

Psychosocial Support ◽

Well Being ◽

Hiv Care ◽

People Living With Hiv ◽

Daily Routines ◽

Persons Living With Hiv ◽

Living With Hiv ◽

The Impact

COVID-19 affects persons living with HIV (PLWH) both directly (via morbidity/mortality) and indirectly (via disruption of HIV care). From July–November 2020, an online survey was conducted to investigate the psychosocial well-being of PLWH and changes in HIV care during the second semester of the COVID-19 outbreak. Data were collected on the socio-demographic characteristics of PLWH, their psychosocial well-being, impact of COVID-19 preventive measures on their daily routines and HIV follow-up. Of the 247 responses analyzed (mean age: 44.5 ± 13.2 years; 73.7% male), 67 (27.1%) and 69 (27.9%) respondents screened positive for anxiety (GAD-2 score ≥ 3) and depression (PHQ-2 score ≥ 3), respectively. HIV care had returned to pre-COVID-19 state for 48.6% PLWH, and 108 (43.7%) had no HIV follow-up during the past month. Over three quarters (76.1%) of respondents expressed willingness to receive the COVID-19 vaccine. Compared to previous findings in April 2020, substance use increased from 58.6% to 67.2% (p < 0.001). Our findings suggest that the well-being and medical follow-up of PLWH are still affected after almost a year into the COVID-19 outbreak. Remote HIV follow-up (telemedicine) with psychosocial support should be envisaged in the medium to long-term. Given that most PLWH accept COVID-19 vaccination, they may be prioritized for this intervention.

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Abstract P025: Perceived Stress and Incidence of Type 2 Diabetes: a 35-Year Follow-up Study of Middle Aged Swedish Men

Circulation ◽

10.1161/circ.125.suppl_10.ap025 ◽

2012 ◽

Vol 125 (suppl_10) ◽

Author(s):

Masuma Novak

Keyword(s):

Type 2 Diabetes ◽

Proportional Hazards ◽

Cox Regression ◽

Cox Proportional Hazards ◽

Prior History ◽

Diabetes Incidence ◽

Middle Aged ◽

Cox Regression Analysis

OBJECTIVE_ To explore the incidence cases of diabetes over 35 years of follow-up in middle-aged Swedish men in relation to their severity of stress at baseline. RESEARCH DESIGHN AND METHODS_ This was a population-based random sample of 7 495 men derived from the Primary Prevention cohort study (Gothenburg) aged 47-55 years and without prior history of diabetes at baseline (1970-1973). Self-perceived psychological stress during the previous years was assessed with a single-item in the questionnaire. Incident diabetes from hospital discharge and death registries was collected during the 35 years follow-up. Cox proportional hazards regression was used to evaluate association of stress with incidence of diabetes. RESULTS_ During the follow up of 35 years, 884 men developed diabetes. The crude incidence rate was 46.32 per 1000 persons-years. At baseline, 15.5% men reported to experience permanent stress. The age-adjusted cumulative incidence of type diabetes in men who had permanent stress was 16%, compared with 12% for those with no or periodic stress. In age-adjusted Cox regression analysis, men with permanent stress had a higher risk of diabetes incident (hazard ratio 1.52 [95% CI 1.26-1.82]) compared with men with periodic or no stress (referent). The excess risk of diabetes incident associated with permanent stress remained significant after adjusting for age, socioeconomic status (SES), smoking, physical inactivity, alcohol abuse, height, BMI, serum-cholesterol, hypertension, systolic and diastolic blood pressure. CONCLUSIONS_ Perceived permanent stress in middle aged Swedish men was an important long-term predictor of diabetes incidence. The association of stress was independent of SES, lifestyle and other conventional type 2 diabetes risk factors. The significant impact of stress on diabetes, as demonstrated in this study, emphasizes need for prevention strategies including intervention programmes for people with permanent stress.

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Abstract 131: Cognitive Impairment Predicts Mortality in Patients with Heart Failure

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.9.suppl_2.131 ◽

2016 ◽

Vol 9 (suppl_2) ◽

Author(s):

Howard Lan ◽

Lee Ann Hawkins ◽

Helme Silvet

Keyword(s):

Heart Failure ◽

Cognitive Impairment ◽

Proportional Hazards ◽

Cox Regression ◽

Cox Proportional Hazards ◽

Mortality Data ◽

Cox Regression Analysis ◽

Kaplan Meier ◽

Study Population

Introduction: In our previously published study, we evaluated a Veteran cohort of 250 outpatients with heart failure (HF) and found 58% (144 of 250) incidence of previously undiagnosed cognitive impairment (CI). Previous studies have suggested that HF patients with CI have worse clinical outcomes including higher mortality but this has not been studied in the Veteran population. Methods: Current study was designed to prospectively follow this cohort of 250 patients. Cognitive function was previously evaluated in all patients at baseline using the St. Luis University Mental Status (SLUMS) exam. The primary outcome for this follow-up study was all-cause mortality. Data analysis including Cox regression analysis and Kaplan-Meier curves were generated using SPSS. Results: The study population was predominantly Caucasian (72%, 179 of 250) and male (99%, 247 of 250) with mean age of 69 ± 10 years. Mean follow up was 31 ± 11 months. During follow up, 26% (64 of 250) of patients died. Univariate and multivariate Cox proportional hazards regression analyses were performed and shown in Table 1. Using the SLUMS score, subjects were stratified into three groups: no CI (42%, 106 of 250), mild CI (42%, 104 of 250), and severe CI (16%, 40 of 250). Kaplan-Meier survival curves were generated to compare the three CI groups in Figure 1. Conclusion: Current study demonstrates that CI is an independent risk factor for mortality in outpatient HF patients. This is an important finding because CI is commonly unrecognized in this vulnerable population. Routine CI screening could help to identify those who are at greater risk for worse outcomes. Future studies are needed to derive possible interventions to improve outcomes in these patients.

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Association between Estimated Cardiorespiratory Fitness and All-cause Mortality in Underweight Older Adults

Exercise Science ◽

10.15857/ksep.2020.29.2.146 ◽

2020 ◽

Vol 29 (2) ◽

pp. 146-153

Author(s):

Inhwan Lee ◽

Byungroh Kim

Keyword(s):

Older Adults ◽

Cardiorespiratory Fitness ◽

Proportional Hazards ◽

Cox Regression ◽

Cox Proportional Hazards ◽

National Database ◽

Cox Regression Analysis ◽

All Cause Mortality ◽

Study Participants

PURPOSE: This study investigated the association between estimated cardiorespiratory fitness (eCRF) and all-cause mortality in underweight older adults.METHODS: Data from the 2006 Korean longitudinal study of aging (KLoSA) involving 348 study participants aged 60 years and older (58.0% women) was analyzed in this study. CRF was estimated with sex- and age-specific algorithms developed by the fitness registry and the importance of exercise national database (FRIEND). Participants were classified into lowest 25% (Q1), lower 25% (Q2), middle 25% (Q3), and highest 25% (Q4) on the basis of individual eCRF distributions. Cox proportional hazards regression was used to calculate hazard ratio (HR) and 95% confidence interval (CI) according to eCRF levels.RESULTS: During 7.8±3.2-year follow-up period, a total of 175 deaths occurred from all causes. Cox regression analysis showed that HR of all-cause mortality was 0.686 (95% CI, 0.474-0.991, p=.045) for Q2, 0.382 (95% CI, 0.253-0.575, p<.001) for Q3, and 0.248 (95% CI, 0.155-0.397, p<.001) for Q4 compared to Q1 as reference (HR=1). The HR of Q4 for all-cause mortality remained significant even after adjustments for covariates, including age and marital status.CONCLUSIONS: The current findings suggest that high eCRF is associated with a decreased risk of all-cause mortality in underweight older adults.

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