Hypertension and obesity among HIV patients in a care programme in Nairobi

Objective: To determine the prevalence of hypertension and obesity among HIV patients enrolled in the Sex Worker Outreach Programme (SWOP), Nairobi, Kenya.Design: A retrospective astudy.Setting: SWOP managed by the University of Manitoba, Nairobi team.Subjects: We selected clinic visit records from HIV patients seen between 2011 and 2014, which had valid blood pressure and age entries.Interventions: We analysed data to determine prevalence and correlates of hypertension and obesity in the study population. Associations were tested using chi-square for categorical variables and t-test for continuous variables.Main outcome measures: Hypertension and obesity.Results: Three thousand one hundred ninty seven subjects were included in the study. All were HIV-positive and most (97.8%) were on ART. The mean age was 39.7 years (standard deviation = 8.8) and 72.4% of the subjects were female. The prevalence of hypertension was 7.7% (246/3197) and 31% of the study cases (798/2590) were either overweight or obese. Males were more likely to have hypertension (p < 0.001) while females were more predisposed to obesity (p < 0.001).Conclusion: Hypertension and obesity are important co-morbidities among HIV patients. Preventive and management strategies should be adopted as part of the comprehensive packages on offer at all existing HIV care and ART centres targeting those enrolled for services as well as their relatives and the community at large

Hypertension and obesity among HIV patients in a care programme in Nairobi

Objective: To determine the prevalence of hypertension and obesity among HIV patients enrolled in the Sex Worker Outreach Programme (SWOP), Nairobi, Kenya.Design: A retrospective a study.Setting: SWOP managed by the University of Manitoba, Nairobi team.Subjects: We selected clinic visit records from HIV patients seen between 2011 and 2014, which had valid blood pressure and age entries.Interventions: We analysed data to determine prevalence and correlates of hypertension and obesity in the study population. Associations were tested using chi-square for categorical variables and t-test for continuous variables.Main outcome measures: Hypertension and obesity.Results: Three thousand one hundred ninety seven subjects were included in the study. All were HIV-positive and most (97.8%) were on ART. The mean age was 39.7 years (standard deviation = 8.8) and 72.4% of the subjects were female. The prevalence of hypertension was 7.7% (246/3197) and 31% of the study cases (798/2590) were either overweight or obese. Males were more likely to have hypertension (p < 0.001) while females were more predisposed to obesity (p < 0.001).Conclusion: Hypertension and obesity are important co-morbidities among HIV patients. Preventive and management strategies should be adopted as part of the comprehensive packages on offer at all existing HIV care and ART centres targeting those enrolled for services as well as their relatives and the community at large

HIV-1 Clade D Is Associated with Increased Rates of CD4 Decline in a Kenyan Cohort

HIV-1 is grouped phylogenetically into clades, which may impact rates of HIV-1 disease progression. Clade D infection in particular has been shown to be more pathogenic. Here we confirm in a Nairobi-based prospective female sex worker cohort (1985-2004) that Clade D (n = 54) is associated with a more rapid CD4 decline than clade A1 (n = 150, 20.6% vs 13.4% decline per year, 1.53-fold increase, p = 0.015). This was independent of "protective" HLA and country of origin (p = 0.053), which in turn were also independent predictors of the rate of CD4 decline (p = 0.026 and 0.005, respectively). These data confirm that clade D is more pathogenic than clade A1. The precise reason for this difference is currently unclear, and requires further study. This is first study to demonstrate difference in HIV-1 disease progression between clades while controlling for protective HLA alleles

Epitope Mapping of HIV-Specific CD8+ T cells in a Cohort Dominated by Clade A1 Infection

CD8+ T cell responses are often detected at large magnitudes in HIV-infected subjects, and eliciting these responses is the central aim of many HIV-1 vaccine strategies. Population differences in CD8+ T cell epitope specificity will need to be understood if vaccines are to be effective in multiple geographic regions.In a large Kenyan cohort, we compared responsive CD8+ T cell HIV-1 Env overlapping peptides (OLPs) to Best Defined Epitopes (BDEs), many of which have been defined in clade B infection. While the majority of BDEs (69%) were recognized in this population, nearly half of responsive OLPs (47%) did not contain described epitopes. Recognition frequencies of BDEs were inversely correlated to epitopic sequence differences between clade A1 and BDE (P = 0.019), and positively selected residues were more frequent in "new" OLPs (without BDEs). We assessed the impact of HLA and TAP binding on epitope recognition frequencies, focusing on predicted and actual epitopes in the HLA B7 supertype.Although many previously described CD8 epitopes were recognized, several novel CD8 epitopes were defined in this population, implying that epitope mapping efforts have not been completely exhausted. Expansion of these studies will be critical to understand population differences in CD8 epitope recognition

CD26/dipeptidyl peptidase IV (CD26/DPPIV) is highly expressed in peripheral blood of HIV-1 exposed uninfected Female sex workers

<p>Abstract</p> <p>Background</p> <p>Design of effective vaccines against the human immunodeficiency virus (HIV-1) continues to present formidable challenges. However, individuals who are exposed HIV-1 but do not get infected may reveal correlates of protection that may inform on effective vaccine design. A preliminary gene expression analysis of HIV resistant female sex workers (HIV-R) suggested a high expression CD26/DPPIV gene. Previous studies have indicated an anti-HIV effect of high CD26/DPPIV expressing cells in vitro. Similarly, high CD26/DPPIV protein levels in vivo have been shown to be a risk factor for type 2 diabetes. We carried out a study to confirm if the high CD26/DPPIV gene expression among the HIV-R were concordant with high blood protein levels and its correlation with clinical type 2 diabetes and other perturbations in the insulin signaling pathway.</p> <p>Results</p> <p>A quantitative CD26/DPPIV plasma analysis from 100 HIV-R, 100 HIV infected (HIV +) and 100 HIV negative controls (HIV Neg) showed a significantly elevated CD26/DPPIV concentration among the HIV-R group (mean 1315 ng/ml) than the HIV Neg (910 ng/ml) and HIV + (870 ng/ml, p < 0.001). Similarly a FACs analysis of cell associated DPPIV (CD26) revealed a higher CD26/DPPIV expression on CD4+ T-cells derived from HIV-R than from the HIV+ (90.30% vs 80.90 p = 0.002) and HIV Neg controls (90.30% vs 82.30 p < 0.001) respectively. A further comparison of the mean fluorescent intensity (MFI) of CD26/DPPIV expression showed a higher DPP4 MFI on HIV-R CD4+ T cells (median 118 vs 91 for HIV-Neg, p = 0.0003). An evaluation for hyperglycemia, did not confirm Type 2 diabetes but an impaired fasting glucose condition (5.775 mmol/L). A follow-up quantitative PCR analysis of the insulin signaling pathway genes showed a down expression of NFκB, a central mediator of the immune response and activator of HIV-1 transcription.</p> <p>Conclusion</p> <p>HIV resistant sex workers have a high expression of CD26/DPPIV in tandem with lowered immune activation markers. This may suggest a novel role for CD26/DPPIV in protection against HIV infection in vivo.</p

Track A Basic Science

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/138319/1/jia218438.pd