Cardiovascular disease in women living with HIV: A narrative review

Advances in the treatment of HIV have led to increasing numbers of people living with HIV reaching older age. Age-related comorbid conditions, such as cardiovascular disease (CVD), are therefore of increasing importance in HIV clinical practice. Over half the global population of people living with HIV are female. We present a narrative literature review of 39 studies exploring CVD in women living with HIV (WLHIV), with particular reference to coronary heart disease, and focusing on: (1) epidemiology, (2) pathophysiology, (3) risk factors (including traditional risk factors and HIV-related risk factors), and (4) management. Although we found significant gaps in the literature on CVD in WLHIV, data suggest that: HIV increases the risk of CVD in women even more than it does in men; certain cardiometabolic risk factors (such as obesity and metabolic syndrome) are more prevalent in WLHIV than their male counterparts; and risk factors such as hyperlipidaemia and hypertension are not optimally managed in this population. Clinicians working with WLHIV therefore need to be aware that this is a patient group at elevated cardiovascular risk, and should be familiar with relevant guidelines

Comorbidity indices in people with HIV and considerations for coronavirus disease 2019 outcomes

OBJECTIVE: To determine comorbidity indices in persons-with-HIV (PWH) and lifestyle-similar HIV-negative controls. DESIGN: Cross-sectional analysis of the Pharmacokinetic and clinical Observations in PeoPle over fifty (POPPY) cohort study in UK and Ireland. METHODS: The Elixhauser Comorbidity Index (ECI), Charlson Comorbidity Index (CCI) and the Comorbidity Burden Index (CBI) were compared between older PWH and HIV-negative controls using the Mann-Whitney U test; the magnitude of the difference between groups was quantified using the r effect size. RESULTS: The 699 PWH and 304 HIV-negative controls were predominantly male (87.5% vs. 64.0%), white (86.3% vs. 90.0%) and had median ages of 57 and 58 years, respectively. Among PWH, the median (interquartile range (IQR)) CD4+ T-cell count was 624 (475, 811) cells/μl; 98.7% were on antiretroviral therapy. The median (IQR) ECI was 0 (0, 8) and 0 (-3, 1), CCI was 2 (1, 5) and 1 (0, 1) and CBI 8.6 (2.2, 16.8) and 5.9 (0.6, 10.8), respectively. Whilst all three indices were significantly higher in PWH than in controls (p < 0.001 for each), the magnitude of the differences between the two groups were small to medium, with effect sizes (95% confidence interval) of 0.21 (0.16, 0.27), 0.38 (0.32, 0.42) and 0.18 (0.11, 0.23), respectively. CONCLUSIONS: These three comorbidity indices are higher in PWH compared to HIV-negative controls, although the magnitude of differences between groups were small. Differences in the ECI, reportedly associated with poorer COVID-19 outcomes, were driven by more individuals with HIV being within the higher end of the range

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

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

Assessment of trabecular bone score, an index of bone microarchitecture, in HIV positive and HIV negative persons within the HIV UPBEAT cohort

Introduction Increased prevalence of low bone mineral density (BMD) and increased fracture incidence are observed in persons living with HIV (PLWH). The trabecular bone score (TBS) is a novel index of bone microarchitecture which improves fracture prediction independent of BMD. Methods The HIV UPBEAT study is a single centre, prospective cohort study that enrolled subjects with and without HIV from similar sociodemographic backgrounds for annual assessments of bone health. TBS was derived from lumbar spine (LS) dual-energy X-ray absorptiometry images. Univariate and multivariable linear regression was used to assess relationships between baseline TBS, BMD, sociodemographic and clinical factors. Results 463 subjects (201 HIV positive) were included; PLWH were younger and more likely male, of non-African ethnicity and current smokers. HIV was associated with a mean reduction of 0.037 [-0.060, -0.013] (p = 0.002) in TBS. Lower TBS was also associated with male gender, non-African ethnicity, current smoking status and lower LS BMD. HIV remained associated with lower TBS after adjustment for LS BMD, age, gender and ethnicity. However, adjustment for current smoking significantly attenuated the association between HIV and TBS, with further adjustment for higher bone turnover markers largely explaining any residual association. Among the sub-group of PLWH, exposure to protease inhibitors and lower nadir CD4+ T-cell counts were both predictors of lower TBS. Conclusions PLWH have lower TBS independent of LS BMD. However, this is largely explained by higher current smoking rates and higher bone turnover in those with HIV. Exposure to PI, but not tenofovir disproxil fumarate, also contributed to lower TBS in those with HIV

Response to: ‘How helpful are the European AIDS Clinical Society cognitive screening questions in predicting cognitive impairment in an aging, well‐treated HIV‐positive population?’

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