Association between mild chronic kidney disease and coronary artery disease in persons living with and without HIV in Uganda.

Thesis (Master's)--University of Washington, 2023BackgroundSevere chronic kidney disease (CKD), associated with HIV, is a risk factor for coronary artery disease (CAD). However, the impact of the more common, subclinical form of kidney disease in people living with HIV (PLWH) on CAD risk is less understood. Using non-invasive computed tomography angiography, we aim to determine if an association exists between mild CKD and plaque parameters indicative of CAD in persons living with and without HIV, in a sub-Saharan African population. Methods This cross-sectional analysis stems from the Ugandan sTudy of HIV effects on the Myocardium and Atherosclerosis (mUTIMA) study. mUTIMA compared 100 PLWH on stable antiretroviral therapy (ART) and 100 matched non-HIV participants, all aged over 45 with ≥1 cardiovascular disease risk factor. For 165 of these participants with available computer tomography angiography data, we performed multivariable Tobit regression to examine the association between the mild CKD parameters, estimated glomerular filtration rate (eGFR) (0), segment stenosis score (SSS) (≥3), or coronary artery calcium (CAC) (>0). Results Our findings indicate that in PLWH, lower eGFR values are associated with increased SIS (coefficient: 3.31, 95% CI: 0.41 to 6.21, p = 0.03), and increased SSS (coefficient: 5.95, 95% CI: 0.54 to 11.36, p = 0.03). The association with SIS, but not SSS, remained significant after adjusting for age, gender, and 10-year ASCVD score (coefficient: 2.58, 95% CI: 0.10 to 5.06, p = 0.04). There was no association among people not living with HIV. Conclusion Mild to moderately low eGFR is associated with increased CAD plaque parameters. Estimation of renal function by relatively simple methods like eGFR monitoring therefore may be a valuable tool for cardiovascular risk assessment among PLWH in addition to that provided by traditional risk factors. The observed association also highlights the need for early integrated cardiovascular and renal care in this population

A Rare Case of an Ectopic Liver Presenting as Right Atrial Mass

Ectopic liver tissue is commonly observed in the abdominal cavity in adjacent organs. Extension of hepatic tissue into the intrathoracic cavity is rarely reported. We present the case of a 46-year-old woman with a 2.1×1.8 cm mass confirmed by transesophageal echocardiogram to be at the right atrial and inferior vena cava junction that was initially thought to be a myxoma which prompted surgical excision but subsequently identified as ectopic liver by histology

SARS-CoV-2 antibody prevalence, correlates, and access to harm reduction services among people who inject drugs living with and without HIV and their partners in Kenya

Abstract Background In sub-Saharan Africa many people who inject drugs (PWID) are living with undiagnosed or untreated HIV and experience high levels of poverty and conditions that can contribute to worse outcomes from SARS-CoV-2 infection. Identifying the burden of SARS-CoV-2 infection in marginalized populations like PWID may contribute to controlling the pandemic. Methods This is a nested cross-sectional study within an ongoing cohort study that recruits PWID living with HIV and their injecting and/or sexual partners at needle and syringe program sites and methadone clinics in Kenya. Blood samples were collected from consenting participants at enrollment to determine SARS-CoV-2 antibodies using a Platellia BioRad SARS-CoV-2 total antibody enzyme-linked immunosorbent assay. Baseline data were collected on HIV status, antiretroviral therapy and methadone adherence. We used logistic regression to identify factors associated with antibody positivity and descriptive statistics to report SARS-CoV-2 antibody prevalence. Results One thousand participants were enrolled between April and July 2021, of whom 323 (32.3%) were women and 677 (67.7%) were men. Median age of participants was 36 years (interquartile range: 30, 42). SARS-CoV-2 antibody positivity was found in 309 (30.9%) participants. Disruption in obtaining methadone service was reported by 106 (24.3%) of the participants. Men were significantly less likely than women to have SARS-CoV-2 antibodies (adjusted odds ratio [aOR] = 0.68, 95% confidence interval [CI] 0.51, 0.95; p < 0.01) Participants who reported a sexual or injecting partner diagnosed with SARS-CoV-2 were twofold more likely to have SARS-CoV-2 antibodies detected (aOR = 2.21, 95% CI 1.06, 4.58; p < 0.032). Living with HIV was not associated with presence of SARS-CoV-2 antibodies. Conclusion The seroprevalence of SARS-CoV-2 of 30.9% in this cohort suggests high transmission rates within this population. SARS-CoV-2 seroprevalence was similar for people living with and without HIV. A large portion of this population was noted to have had disruption in access to harm reduction services