Risultati per: Linee guida su HIV, epatite e malattie sessualmente trasmissibili.

Circulation, Volume 150, Issue Suppl_1, Page A4141238-A4141238, November 12, 2024. Background:Longitudinal blood pressure (BP) trajectories are associated with cardiovascular disease (CVD) but have not been characterized in a sub-Saharan African (SSA) cohort. We identified distinct BP trajectories and evaluated their association with HIV and preclinical CVD.Research question:Is HIV associated with lower or higher BP trajectory in SSA? Is BP trajectory associated with preclinical CVD, and does HIV change the association?Methods:Our longitudinal cohort study included 437 people with HIV (PWH) and 473 HIV-uninfected adults recruited from public HIV clinics in Mwanza, Tanzania. Echocardiography was performed in 772 participants. Group-based multi-trajectory modeling identified trajectories based jointly on systolic and diastolic BP. Multivariable multinomial logistic regression determined the association between HIV and BP trajectory group. Multivariable linear regression evaluated the association between BP trajectory group and echocardiographic measurements, including average E/e’, left atrial volume index (LAVI), and left ventricular mass index (LVMI).Results:The mean age was 36 years and 68% (N = 623) were female. Four BP trajectories were identified (Figure 1), numbered from group 1 (lowest BP) to group 4 (highest BP). Compared to BP trajectory group 2, PWH had higher odds of being classified to group 1 (aOR: 1.71; 95% CI: 0.97-3.02) and lower odds of being classified to group 3 (aOR: 0.51, 95% CI: 0.36-0.71) and group 4 (aOR: 0.45, 95% CI: 0.29-0.71). Participants in group 4 had significantly higher average E/e’, LAVI, and LVMI compared to group 2 (Figure 2). The association between BP trajectory and preclinical CVD did not differ by HIV status. HIV was associated with higher LAVI and LVMI after adjusting for age, sex, traditional CVD risk factors, and BP trajectory.Conclusion:BP trajectory and HIV were independently associated with preclinical CVD. Integrating CVD prevention with routine HIV care is urgently needed in HIV clinics across SSA.

Circulation, Volume 150, Issue Suppl_1, Page A4138220-A4138220, November 12, 2024. Introduction:With effective antiretroviral therapy (ART), HIV can now be managed as a chronic disease. Chronic disease and cardiovascular risk factor management is especially important for underrepresented racial and ethnic minority groups (UREG). Non-valvular atrial fibrillation and atrial flutter (NVAF) have not been adequately studied in UREG with HIV.Research Questions:Among UREG with HIV, what is the incidence of NVAF? What factors are associated with incident NVAF?Aims:To narrow an evidence gap among UREG with HIV by 1) describing the incidence of NVAF and 2) identifying factors associated with incident NVAF.Methods:This is an ancillary study of the Pathways to Cardiovascular Disease Prevention and Impact of Specialty Referral in Underrepresented Racial and Ethnic Minorities with HIV (PATHWAYS) study, a retrospective population-based study of HIV care patterns among UREG with HIV. Patients without a known history of NVAF entered our study cohort at the date of their first documented HIV diagnosis. We computed the cumulative incidence of NVAF over five years of follow-up (mean 3.4, SD 1.6), handling death as a competing risk. Cox regression analysis was used to examine the univariate associations between characteristics at HIV diagnosis and incident NVAF, adjusting for site and date of HIV diagnosis.Results:From 2015-2019, 10,945 UREG meeting entry criteria were identified. On average, patients were 67.1% male, 94.4% Black, and 8.5% Hispanic. Average CHA2DS2VASc score was 0.92 (SD 1.1) and 63.4% were on ART. Cumulative incidence of NVAF at one and five years after HIV diagnosis were 0.48% (95% CI 0.36-0.63) and 2.16% (95% CI 1.85-2.51), respectively. HIV-related factors associated with incident NVAF included baseline CD4 count

Circulation, Volume 150, Issue Suppl_1, Page A4147410-A4147410, November 12, 2024. Introduction:Advancements in antiretroviral therapy (ART) have significantly increased the lifespan of patients living with HIV over the past decade. Studies have shown higher mortality and morbidity rates following acute coronary syndrome (ACS) in HIV patients, attributed to traditional cardiac risk factors, psychosomatic illness, metabolic effects of ART, and chronic immune activation caused by HIV.Hypothesis:We hypothesized that HIV patients presenting with ACS in the form of STEMI would have poorer in-hospital clinical outcomes compared to patients without HIV.Aims:We hypothesized that HIV patients presenting with ACS in the form of STEMI would have poorer in-hospital clinical outcomes compared to patients without HIV.Methods:We queried the National Inpatient Sample (NIS) Database from 2015-2019 using ICD-10 codes to identify STEMI patients with and without HIV. Propensity matching adjusted for confounders. The primary outcome was in-hospital mortality; secondary outcomes included major bleeding, the need for mechanical circulatory support (MCS), and net adverse clinical events (NACE). STATA was used for statistical analysis.Results:A total of 581,859 patients were included in the analysis. Baseline comorbidities are listed in Table 1. STEMI patients with HIV were younger (54±12 vs 63±18 years) and had higher rates of liver disease, renal failure, depression, polysubstance abuse, and a history of MI. After propensity matching, in-hospital mortality was similar between both subgroups (Table 2). No significant differences were found between the subgroups in NACE, need for MCS, and major bleeding.Conclusion:Despite being a strong risk factor for CAD, the presence of HIV did not influence in-hospital clinical outcomes in patients presenting with STEMI. This may reflect improved ACS protocols, advancements in ART, and a younger patient cohort. Additional studies are needed to further validate these findings.

Circulation, Volume 150, Issue Suppl_1, Page A4143505-A4143505, November 12, 2024. Introduction:Uncontrolled hypertension substantially increases the risk for cardiovascular disease and is a major cause of mortality among people living with HIV in many countries in sub-Saharan Africa, including Malawi. Despite previous studies showing low rates of blood pressure (BP) control among individuals with comorbid HIV and hypertension in these settings, few have focused on identifying potentially modifiable factors for improving BP control. This study examined contextual and self-management behaviors associated with BP control.Methods:This is a cross-sectional analysis of baseline data from participants in Healthy Hearts, a cohort study of persons with HIV and cardiometabolic conditions in Malawi. Participants were adults aged ≥18 years with HIV and hypertension (n=202), recruited from HIV care clinics at 3 hospitals. Multiple logistic regression was used to examine factors associated with BP control, defined as mean systolic BP

Background
Pre-exposure prophylaxis (PrEP) is a highly effective, safe and acceptable intervention for preventing HIV infection. However, identifying individuals who could best benefit from PrEP remains a significant challenge. Existing HIV risk assessment tools vary in performance depending on context. This systematic review aims to synthesise evidence on their diagnostic performances to predict incident HIV infection.

Methods and analysis
This protocol is informed and reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) Protocols. We will search MEDLINE (Ovid), Embase (Ovid) and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases (January 1998–May 2024) for observational and relevant interventional studies assessing the diagnostic performance of HIV risk tools to predict incident HIV for PrEP eligibility. There will be no restrictions on study language or location. Two reviewers will conduct the search, data extraction and risk of bias assessment using the Johanna Briggs Institute Critical Appraisal Checklist for Diagnostic Studies. Standardised templates will be used in Covidence for data extraction. We will conduct a meta-analysis if appropriate, otherwise, a narrative review. We will use the PRISMA guidelines to guide reporting.

Ethics and dissemination of research
Ethical approval is not required as data is publicly available. This review will inform updates to Canadian HIV PrEP guidelines and guide healthcare professionals in using HIV risk assessment tools for identifying PrEP candidates. Findings will be presented at guideline panel meetings and submitted for publication in a peer-reviewed journal and conferences.

PROSPERO registration number
CRD42024543975.

Background
With the ageing of people living with HIV/AIDS (PLWHA), the prevalence of chronic comorbidities, especially hyperglycaemia, is increasing among elderly PLWHA. Antiretroviral therapy (ART) is associated with fasting plasma glucose (FPG) levels. This study aimed to investigate both short-term and long-term FPG characteristics and trends across different ART regimens in elderly Chinese PLWHA.

Methods
This retrospective cohort study, based on hospital treatment information, classified ART regimens as this retrospective cohort study used hospital treatment data. ART regimens are classified into three categories: non-nucleoside reverse transcriptase inhibitors (NNRTIs) based, protease inhibitors (PIs) based and integrase strand transfer inhibitor (INSTIs) based. Propensity score matching was applied to control for confounding factors. Follow-up FPG characteristics were then described, and a generalised linear mixed model was employed to estimate FPG trends under different regimens within 1-year and 5-year periods following ART initiation.

Results
Participants had an average age of 58.28 years, with 75.02% male. FPG increased following ART initiation, with the most significant rise within 1 year of ART, followed by stabilisation. The FPG increase within 1 year was slower in the PIs-based group compared with the NNRTIs-based group (β=–0.08, 95% CI –0.15 to –0.01), while there was a higher prevalence of diabetes within 5 years of ART (31.55% vs 22.33%, standardised difference=0.357). The FPG increase within 1 year of ART did not differ between NNRTIs-based and INSTIs-based groups (β=–0.01, 95% CI –0.20, 0.18).

Conclusion
Our study highlights that elderly Chinese PLWHA experience an increase in FPG levels, particularly during the first year of ART, with variations observed across different ART regimens. The higher long-term prevalence of diabetes in the PIs-based regimen group emphasises the need for tailored glucose management strategies. Routine glucose monitoring and proactive management are crucial for preventing and controlling diabetes in this population, particularly given the long-term metabolic risks associated with ART.

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