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

Risultati su 500 test di screening: per 0,4% necessario ricovero

This study examines the prescribing trends of 3 oral preexposure prophylaxis medications and a long-acting injectable option from 2013 to 2023.

This JAMA Insights discusses the expanding PrEP options for preventing HIV, including the considerations for initiation and follow-up and implementation challenges of these medications.

Circulation, Volume 150, Issue Suppl_1, Page A4120480-A4120480, November 12, 2024. Background:People living with HIV (PLWH) on anti-retroviral therapy remain at risk for cardiovascular diseases, including atherosclerosis. We hypothesized that persistent viral protein (HIV-Nef) in extracellular vesicles (EVs) modulate macrophage heterogeneity to impair atheroprotective efferocytosis to accelerate cardiovascular disease.Methods and Results:Macrophage heterogeneity was characterized in human primary macrophages (50,931 cells; 4 donors) stimulated with EVs engineered to contain HIV-Nef by simultaneous scRNAseq and scATACseq. Among 16 clusters (Fig.1A), two inflammatory Nef dominant clusters were characterized using gene set enrichment analysis. Gene regulatory network analysis of scRNAseq (pySCENIC) and transcription factor footprinting analysis of sc-ATACseq (ChromVar) suggest elevated NFκB activation in these clusters. Whole cell and sub-cellular compartmentalized proteomics of nucleus, cytosol, cell surface and secreted EVs indicate changes in immune response related biological pathways. Network analysis of our multi-omics data predicts Bruton Tyrosine Kinase (Btk) signaling as a potential contributor to Nef induced macrophage dysregulation. Pathway enrichment analysis of these multiomics dataset suggest Nef influences atheroprotective efferocytosis through the Btk-NFκB signaling axis. Spectral flow cytometry, high content imaging and multiplexed qPCR showed reduction in key effector of efferocytosis, MerTK. Btk inhibition using siRNA, reversible and irreversible Btk inhibitors restored MerTK expression and rescued efferocytosis. Importantly, CRISPRa based overexpression of MerTK in human primary macrophages rescued Nef impaired efferocytosis. Injection of HIV-Nef EVs into male and female C57BL6/J mice impaired efferocytosis of peritoneal and bone marrow derived macrophages which was rescued with Btk inhibitionin vivo. Critically, injection of HIV-Nef EV into male and female Ldlr-/-enhanced atherogenesis with larger aortic wall thickness and necrotic core (Fig.1B).Conclusion:Persistent Nef in EV in PLWH may modulate macrophage heterogeneity to impair efferocytosis. These findings may help develop novel atheroprotective therapies by restoring macrophage efferocytosis.

Circulation, Volume 150, Issue Suppl_1, Page A4119611-A4119611, November 12, 2024. Background:Catheter ablation has emerged as an effective treatment option for atrial fibrillation (AF) in the general population. However, limited data exist on the outcomes of catheter ablation in patients infected with the Human Immunodeficiency Virus (HIV+) with concomitant AF.Objectives:This systematic review and single arm meta-analysis aims to comprehensively evaluate the literature on catheter ablation approach and outcome in HIV+ patients with AF.Methods:A systematic search of PubMed, Embase, and Cochrane Central Register of Controlled Trials was conducted following PRISMA guidelines.Studies meeting the intervention of catheter ablation for AF in HIV+ patients, using radiofrequency, cryoballoon, or pulsed field ablation techniques, were included and data were collected and synthesized using proportion meta-analysis techniques. Statistical analysis was carried out using R software.Results:Three studies met the inclusion criteria, involving 89 HIV+ patients, with an average age of 51.5 years, of whom 83.1% were men, undergoing catheter ablation. Two studies performed received isolation of the pulmonary vein (PV) + posterior wall and superior vena cava. And one study evaluated only the isolation of the pulmonary veins. Of these patients, 43.8% had paroxysmal AF and 56.1% had persistent AF. In two studies reporting freedom from atrial arrhythmias, all patients (62) experienced recurrence of atrial arrhythmias within 5 years of follow-up. Freedom from repeat ablation was 6.26% (Figure 1A). The rate of Pulmonary Vein Trigger was 31.28% (Figure 1B), while the rate of Non-Pulmonary Vein Trigger (non-PV) was 76.64% (Figure 1C).Conclusion:In this systematic review and meta-analysis assessing outcomes of ablation in HIV patients with AF, we observed a similar prevalence of paroxysmal and persistent AF. Furthermore, contrary to the non-HIV+ patients, a high incidence of non-pulmonary vein triggers of AF was noted in this population.

Circulation, Volume 150, Issue Suppl_1, Page A4145119-A4145119, November 12, 2024. Background:The burden of cardiovascular disease (CVD) is increasing among people with HIV (PWH) in sub-Saharan Africa. Integrating CVD screening into routine HIV care represents an opportunity to diagnose CVD at an earlier stage in a potentially high-risk population.Research questionsIs integrating CVD risk factor screening feasible and sustainable in a public HIV clinic in Mwanza, Tanzania? What is the magnitude of CVD risk of the general adult PWH population? What is the unmet need for blood pressure (BP) and diabetes management?Methods:We adapted the AHA Life’s Essential 8 (LE8) into a rapid questionnaire that was administered to every PWH in a large public adult HIV clinic. Questions included demographics; LE8 risk factors (BMI, diet, physical activity, sleep, and smoking); and the hypertension and diabetes continuum of care. Every patient had their BP measured; BP was measured two additional times for those with an initial BP >140/90 mmHg. We administered random blood glucose screening to anyone with a high BP, obese BMI, current smoking, or history of diabetes. Implementation and effectiveness were evaluated using the RE-AIM framework.Results:In 3 months, 1072 PWH were screened at least once. Mean age was 50 years and 72% were female. On average, PWH had a nutritious diet and received adequate physical activity per AHA guidelines. The prevalence of hypertension was 34%; the continuum of care is shown in Figure 1. Of those screened, 21% had diabetes or pre-diabetes. Evaluation via the RE-AIM framework is shown in Table 1. Successes included the reach and effectiveness of screening in only 3 months. Adoption was the biggest challenge due to staffing and supply constraints. The intervention was feasible, implemented with fidelity, and is ongoing.Conclusions:Integrating CVD risk screening into routine HIV care in a busy Tanzanian clinic was feasible and demonstrated a high magnitude of undiagnosed and untreated hypertension among the general PWH population.

Circulation, Volume 150, Issue Suppl_1, Page A4113164-A4113164, November 12, 2024. Intro:Young adults with perinatally acquired HIV (YPHIV) have higher morbidity and mortality than uninfected persons. Antiretroviral therapy (ART) has extended life expectancy making adult CV disease a concern. Perinatal exposure to HIV increases inflammation which is associated with increased arterial stiffness which predicts CV disease.Aims:We compared arterial stiffness between YPHIV and young adults perinatally HIV exposed but uninfected (YPHEU), and evaluated the association of type and duration of ART regimens, HIV disease severity, and cardiac structure and function with arterial stiffness.Methods:In a substudy of the Pediatric HIV/AIDS Cohort Study, 150 participants (95 YPHIV, 55 YPHEU, mean 23.4 yrs, 60% female, 72% Black, 24% Hispanic) had echocardiography and pulse wave velocity (PWV) measured. We compared PWV between YPHIV and YPHEU, adjusting for covariates. Among YPHIV, we fit linear regression models to evaluate the association of current (within 1 year of PWV) and historical measures of HIV disease severity with PWV. We computed correlations between PWV and measures of left ventricular (LV) structure and function, overall and by HIV status.Results:Mean PWV and hemodynamic parameters did not differ between YPHIV and YPHEU (YPHIV 5.63 vs YPHEU 5.39 m/s; p=0.5). HIV control was good (82% with viral load

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 A4137891-A4137891, November 12, 2024. Background:Inflammation and immune dysregulation are thought to drive residual cardiovascular disease risk among persons living with HIV (PLWH) despite effective viral suppression with antiretroviral therapy (ART).Question:We investigated differences in carotid vascular inflammation and atherosclerosis in a longitudinal cohort of virally suppressed PLWH (n = 50; on stable ART with CD4 >250 cells/mm3, viral load 6 months) and HIV-uninfected controls (n = 51) matched for age, sex, hypertension, diabetes, smoking, hyperlipidemia, and family history of premature coronary artery disease.Methods&Results:Participants were >40 years old at enrollment, 8% female, and had a high prevalence of cardiovascular risk factors (Table 1). Measures of carotid inflammation and capillary permeability (Ktrans), neovascularization (Vp), and wall thickness were assessed at baseline, 1 year, and change over 1 year by dynamic contrast-enhanced magnetic resonance imaging. Both PLWH and controls demonstrated a reduction in systolic and diastolic blood pressures and total cholesterol over 1 year; however, the difference was not significant by HIV status. PLWH had a significant reduction in triglycerides compared with controls (-48.8 mg/dL vs 12.8 mg/dL; p = 0.026). HIV was not associated with baseline, follow-up, or change in markers of systemic inflammation assessed by plasma cytokines (C-reactive protein, interleukin-6, interleukin-1ß), nor vascular inflammation or plaque as assessed byKtrans,Vp, carotid wall thickness, or percent wall volume (Tables 2&3).Conclusions:In contrast to other studies of chronically treated and virally suppressed PLWH, HIV infection was not associated with carotid inflammation or plaque.

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 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

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.

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.