Persistent low-level viraemia is associated with non-infectious comorbidities in an observational cohort in four African countries.
HIV
cohort studies
low‐level viraemia
multimorbidity
non‐communicable diseases
sub‐Saharan Africa
Journal
Journal of the International AIDS Society
ISSN: 1758-2652
Titre abrégé: J Int AIDS Soc
Pays: Switzerland
ID NLM: 101478566
Informations de publication
Date de publication:
Aug 2024
Aug 2024
Historique:
received:
01
12
2023
accepted:
04
06
2024
medline:
27
8
2024
pubmed:
27
8
2024
entrez:
27
8
2024
Statut:
ppublish
Résumé
People living with HIV (PLWH) have higher rates of non-infectious comorbid diseases (NCDs) than individuals without HIV. We characterized the risk of NCDs among PLWH with undetectable viral load and persistent low-level viraemia (pLLV) in the African Cohort Study (AFRICOS). We secondarily quantified the role of immune activation in the association between LLV and NCDs. AFRICOS enrols participants in 12 clinics in Uganda, Kenya, Tanzania and Nigeria. Participants on antiretroviral therapy ≥ 6 months without an NCD at enrolment were included. PLLV was defined as at least two consecutive visits with a detectable viral load <1000 copies/ml. We examined elevated blood pressure, hypercholesterolemia, hyperglycaemia, renal insufficiency and a composite variable of any NCD. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using Cox proportional hazard modelling. Among a subset of participants with biomarker data, we assessed the interaction between viral load and 13 biomarkers in the association with any NCD. From 23 January 2013 to 1 December 2022, 1755 participants met the inclusion criteria for these analyses. At the first eligible visit, the majority of participants had an undetectable viral load (n = 1375, 78.35%). Participants with pLLV had an increased rate of developing any NCD (aHR: 1.22, 95% CI: 1.02-1.47) compared to participants with an undetectable viral load. There was a statistically significant interaction between LLV and TNF-α, CCL2/MCP-1 and TNF-RII in the association with any NCD. PLLV was significantly associated with NCDs and immune inflammation in this population. Aggressive management of LLV may positively impact NCDs in PLWH.
Types de publication
Journal Article
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
e26316Subventions
Organisme : U.S. Department of Defense
ID : W81XWH-11-2-0174
Organisme : U.S. Department of Defense
ID : W81XWH-18-2-0040
Informations de copyright
© 2024 The Author(s). Journal of the International AIDS Society published by John Wiley & Sons Ltd on behalf of International AIDS Society.
Références
Jespersen NA, Axelsen F, Dollerup J, Nørgaard M, Larsen CS. The burden of non‐communicable diseases and mortality in people living with HIV (PLHIV) in the pre‐, early‐ and late‐HAART era. HIV Med. 2021;22(6):478–490.
Hopkins KL, Hlongwane KE, Otwombe K, Dietrich J, Cheyip M, Olivier J, et al. The substantial burden of non‐communicable diseases and HIV‐comorbidity amongst adults: screening results from an integrated HIV testing services clinic for adults in Soweto, South Africa. EClinicalMedicine. 2021;38:101015.
Ake JA, Polyak CS, Crowell TA, Kiweewa F, Semwogerere M, Maganga L, et al. Noninfectious comorbidity in the African Cohort Study. Clin Infect Dis. 2019;69(4):639–647.
Chang D, Esber AL, Dear NF, Iroezindu M, Bahemana E, Kibuuka H, et al. Non‐communicable diseases by age strata in people living with and without HIV in four African countries. J Int AIDS Soc. 2022;25(S4):31–37.
Todowede OO, Mianda SZ, Sartorius B. Prevalence of metabolic syndrome among HIV‐positive and HIV‐negative populations in sub‐Saharan Africa—a systematic review and meta‐analysis. Syst Rev. 2019;8(1):4.
Esber AL, Chang D, Iroezindu M, Bahemana E, Kibuuka H, Owuoth J. Weight gain during the dolutegravir transition in the African Cohort Study. J Int AIDS Soc. 2022;25(4):e25899.
Lubega G, Mayanja B, Lutaakome J, Abaasa A, Thomson R, Lindan C, et al. Prevalence and factors associated with hypertension among people living with HIV/AIDS on antiretroviral therapy in Uganda. Pan Afr Med J. 2021;38:216.
Elvstam O, Medstrand P, Jansson M, Isberg PE, Gisslén M, Björkman P. Is low‐level HIV‐1 viraemia associated with elevated levels of markers of immune activation, coagulation and cardiovascular disease? HIV Med. 2019;20(9):571–580.
The Antiretroviral Therapy Cohort Collaboration. Impact of low‐level viremia on clinical and virological outcomes in treated HIV‐1‐infected patients. AIDS. 2015;29:373–383.
Esber A, Polyak C, Kiweewa F, Maswai J, Owuoth J, Maganga L, et al. Persistent low‐level viremia predicts subsequent virologic failure: is it time to change the third 90? Clin Infect Dis. 2019;69(5):805–812.
Elvstam O, Marrone G, Medstrand P, Treutiger CJ, Sönnerborg A, Gisslén M, et al. All‐cause mortality and serious non‐AIDS events in adults with low‐level human immunodeficiency virus viremia during combination antiretroviral therapy: results from a Swedish Nationwide Observational Study. Clin Infect Dis. 2021;72(12):2079–2086.
Soldado‐Folgado J, Chillarón JJ, Cañas‐Ruano E, Arrieta‐Aldea I, González‐Mena A, Blasco‐Hernando F, et al. An abnormal inflammatory pattern associated with long‐term non‐progression of HIV infection impacts negatively on bone quality. J Clin Med. 2022;11(10):2927‐2938.
Grauer OM, Reichelt D, Grüneberg U, Lohmann H, Schneider‐Hohendorf T, Schulte‐Mecklenbeck A, et al. Neurocognitive decline in HIV patients is associated with ongoing T‐cell activation in the cerebrospinal fluid. Ann Clin Transl Neurol. 2015;2(9):906–919.
Gibellini D, Borderi M, Clò A, Morini S, Miserocchi A, Bon I, et al. HIV‐related mechanisms in atherosclerosis and cardiovascular diseases. J Cardiovasc Med. 2013;14(11):780–790.
Streeck H, Maestri A, Habermann D, Crowell TA, Esber A, Son G, et al. Dissecting drivers of immune activation in chronic HIV‐1 infection. SSRN Electron J. 2022;83:104182.
Popa C, Netea MG, Van Riel PLCM, Van Der Meer JWM, Stalenhoef AFH. The role of TNF‐α in chronic inflammatory conditions, intermediary metabolism, and cardiovascular risk. J Lipid Res. 2007;48(4):751–752.
Hunt PW, Lee SA, Siedner MJ. Immunologic biomarkers, morbidity, and mortality in treated HIV infection. J Infect Dis. 2016;214(Suppl 2):S44–S50.
Kibuuka H, Musingye E, Mwesigwa B, Iroezindu M, Bahemana E. Predictors of all‐cause mortality among people with HIV in a prospective cohort study in East Africa and Nigeria. Clin Infect Dis. 2021;75(4):657‐664.
Elvstam O, Marrone G, Engström G, Nilsson PM, Carlander C, Treutiger CJ, et al. Associations between HIV viremia during antiretroviral therapy and cardiovascular disease. AIDS. 2022;36(13):1829–1834.
Roux SB, Elvstam O, De Boever P, Goswami N, Magnusson M, Nilsson PM, et al. Cardiovascular profile of South African adults with low‐level viremia during antiretroviral therapy. J Clin Med. 2022;11(10):2812‐2823.
Xu Y, Chen X, Wijayabahu A, Zhou Z, Yu B, Emma C, et al. Cumulative HIV viremia copy‐years and hypertension in people living with HIV. Curr HIV Res. 2021;18(3):143–153.
Sinxadi PZ, Pharm MC, Mcilleron HM, Dave JA, Sa FCP, Smith PJ, et al. Plasma efavirenz concentrations are associated with lipid and glucose concentrations. Medicine (Baltimore). 2016;95(2):1–7.
Chu Y, Wang Y. HIV protease inhibitors: a review of molecular selectivity and toxicity. HIV AIDS (Auckl). 2015;7:95–104.
Brennan AT, Nattey C, Kileel EM, Rosen S, Maskew M, Stokes AC, et al. Change in body weight and risk of hypertension after switching from efavirenz to dolutegravir in adults living with HIV: evidence from routine care in Johannesburg, South Africa. EClinicalMedicine. 2023;57:1–12.
Esber A, Dear N, Shah N. Virologic impact of the dolutegravir transition: prospective results from the multinational African Cohort Study. J Acquir Immune Defic Syndr. 2022;91(3):285–289.
Ryscavage P, Kelly S, Li JZ, Harrigan PR, Taiwo B. Significance and clinical management of persistent low‐level viremia and very‐low‐level viremia in HIV‐1‐infected patients. Antimicrob Agents Chemother. 2014;58(7):3585–3598.
Sauce D, Ferry T, Boddaert J, Slama L, Allavena C. Immune activation and chronic inflammation. Medicine (Baltimore). 2021;100(17):e25678.
Buch S. Roles of MCP‐1 in development of HIV‐dementia. Front Biosci. 2009;13:3913–3918.
Domingo P, Ceausu A, Yeregui E, Vilad C, Pacheco YM, Veloso S, et al. High circulating SDF‐1 and MCP‐1 levels and genetic variations in CXCL12, CCL2 and CCR5: prognostic signature of immune recovery status in treated HIV‐positive patients. EBioMedicine. 2020;62:103077.