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Aging & Comorbidities CROI 2016
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from Jules: There is no doubt for me that HIV causes premature & accelerated aging phenomena in HIV+ meaning at least some if not many patients experience comorbidities sooner/at earlier ages & that in general HIV+ get more comoebidities vs HIV-, and when HIV+ reach into their early 60s the decline in immunity all older people get is accelerated in HIV. The study at CROI estimating survival difference between HIV+ vs HIV-negs from Kaiser does not look at the numbers of comorbidities HIV+ have vs HIV-negs and as such may underestimate gap in survival or overestimate HIV+ survival; regardless, here are some CROI Aging & Comorbidity Reports highlighting excessive cancers in HIV+, excessive heart disease & subclinical heart disease i.e. heart disease in HIV+ not reflected in blood tests like lipids, Blacks & Women suffer higher risks for heart disease; bone disease is a much more serious problem in HIV vs HIV-neg. Immune deficiency & immune senescence, mitochondrial toxicity, inflammation & immune activation & depletion in HIV+ are some of the reasons for the problem, apparently the gut is a major source for inflammation & immune activation & immune senescence, HIV inhabits & damages the immune system in the gut shortly after infection causing a "leaky gut" allowing "gut derived bacterial products translocation to systemic circulation" leading to ongoing inflammation & activation...this discusses the leaky gut -
CROI: Immunopathogenesis of Metabolic Complications in Treated HIV Infection
CROI / Bone - Bone & HIV...3-4 Fold increased osteoporosis & fractures, a worrisome bone future - (04/13/16)
The Kidney Report - CROI 2016 - Christina Wyatt MD Associate Professor, Medicine/ Nephrology Icahn School of Medicine at Mount Sinai New York, NY (02/26/16)
CROI: Cardiovascular Disease in HIV Patients: An Emerging Paradigm and Call to Action - (03/02/15)....risk for CVD goes beyond traditional risk factors in HIV+ and inflammation & immune activation appear a contributing cause....duration of immune suppression & nadir CD4 increase risk
note this problem highlighted by Dr Grinspoon is particularly concerning because the disease is "subclinical" meaning these cardiovascular abnormalities are not detectable by normal lab testing, are below the surface, "subclinical".
CROI: Hepatitis C and the Risk of Non-Liver-Related Morbidity and Mortality in HIV+ Persons....kidney, bone, cardiovascular - (04/4/16)
CROI: HIV and Cardiovascular Disease: Report back from 2016 Conference on Retroviruses and Opportunistic Infections - by Priscilla Hsue MD Professor of Medicine, UCSF - (04/04/16)
CROI 2016 Co-morbidities in HIV: Stroke, Cancer, Liver Disease David H Shepp, MD Associate Professor of Medicine Hofstra-Northwell School of Medicine Manhasset, NY - (03/05/16)
CROI: Factors Associated with Limitations in Daily Activity Among Older HIV+ Adults - (02/29/16)
CROI: Excess Mortality Among HIV-Infected Cancer Patients in the United States ....excessive breast cancer mortality found in young non-White females 30-49 & 50-69 years old Table 1) - (03/08/16)
CROI: Aging/HIV IGNORED....The aging survivors left behind by AIDS
CROI: Belly Fat (lipodystophy) May be Caused by Metabolic Abnormalities: immune activation/inflammation/senescence
CROI: Aging with HIV: Emerging importance of chronic comorbidities in patients over 75 - (02/29/16)
.....First Look at Big 75-and-Older HIV Group--Diagnosed at Age 62.....much higher rates of comorbidities among older HIV+ - 40% with 2 or more, 14% with 4 or more comorbidities
CROI: Mitochondrial DNA Copy Number and Neurocognitive Impairment in HIV-Infected Persons....."mtDNA associated with worse cognitive outcomes".....both HIV & ART duration associated with mtDNA damage
CROI: Vitamin D Supplementation Decreases Immune Activation and Exhaustion in HIV+ Youth...high dose did best & increased Vit D levels best too
CROI: Trends in Comorbid Conditions Mentioned with HIV Disease on Death Certificates, United States, 2000-2010 ...Comorbidities' Deaths Sharply Increasing/Leaders Ignore Problem - (02/29/16)
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CROI: Frailty is associated with NNRTI-based Initial ART and Modifiable Risks in ACTG 5322 - (02/29/16)
CROI: Incidental Carotid Plaque in HIV and an increase in subsequent Cerebrovascular Events.....Carotid Plaque Develops More Often With HIV and Triples Stroke Risk
CROI: STROKE INCIDENCE HIGHEST IN WOMEN AND BLACK HIV-INFECTED PARTICIPANTS IN ALLRT COHORT - (02/26/16)
CROI: HCV/HICV coinfection & Stroke in HIV-infected patients in the combination antiretroviral therapy era - (04/4/16)....increased among HCV/HIV coinfected while decreased among HIV+
CROI: Persistently Increased Ischemic Stroke Risk in HIV-Infected Women - (03/29/16)
CROI: Reduced Ovarian Reserve Relates to Monocyte Activation and Subclinical Coronary Atherosclerotic Plaque in Women with HIV - (04/4/16)
HIV+ had significantly higher incidence for MI
CROI: Myocardial Infarction Risk in the NA-ACCORD Compared to MESA and ARIC - (03/29/16)
CROI: Persistently Increased Ischemic Stroke Risk in HIV-Infected Women
Fat Around the Heart Increases Inflammation & CVD risk in HIV+
CROI: Diastolic Function Correlates With Pericardial Fat [fat around the heart] and Vascular Remodeling in HIV - (03/29/16)
CROI: 9-YEAR TRENDS IN NON-LIPID CARDIOVASCULAR DISEASE PREVENTION STRATEGIES IN HIV+ WOMEN in WIHS-women have poor control of diabetes & hypertension - (02/25/16)
Depression Increases Comorbidities & Mortality & Impacts Viral suppression
CROI: Impact of Depression on Mortality, Viral Load, and Adherence: Three CROI Studies
CROI: Depression and Social Isolation Mediate Effect of HIV Stigma on Women's ART Adherence - (02/26/16)
CROI: Liver Fibrosis Linked to Cognition in HIV and HCV: The Women's Interagency HIV Study
CROI: Effects of Vitamin D Supplementation on BMD and Bone Markers in HIV+ Youth
CROI: Neurotoxicity Screening of Antiretroviral Drugs With Human iPSC-Derived Neurons
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