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Prevalence of Silent Atherosclerosis
and Other Comorbidities in an Outpatient
Cohort of Adults Living with HIV
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• primary end point was the prevalence of subclinical carotid/ coronary
atherosclerosis, Among 790 participants (median age: 49.8 years [IQR: 44.5–55.6], 77.1% males, median CD4: 536/mm3 [IQR: 390–754], 83.6% with undetectable viral load), asymptomatic atherosclerosis was found in 26%, multimorbidity found in 42%, 19.4% had diabetes! 14.6% renal failure!
• Conclusions: Asymptomatic atherosclerosis and multimorbidity were frequent in a cohort of middle- aged, well-controlled, PLWH and were associated with traditional and HIV-specific factors. Associations between morbidities and inflammatory/immune activation biomarkers were diverse.
Virtual 2020 International Workshop on Comorbidities & Adverse Drug Reactions in HIV
Reported by Jules Levin
Jade Ghosn, Hendy Abdoul, Soraya Fellahi, Audrey Merlet, Dominique Salmon,
Jean-Pierre Morini, Jean Deleuze, Jacques Blacher, Jacqueline Capeau,
Jean-Philippe Bastard, Jean-Paul Viard
Hotel-Dieu
Assistance Publique-Hopitaux de Paris.Centre
Université de Paris
Abstract
Prevalence of silent atherosclerosis and other comorbidities in an outpatient cohort of adults living with HIV: associations with HIV parameters and biomarkers
J Ghosn1, H Abdoul1, S Fellahi2, A Merler1,
D Salmon1, JP Morini1, J Deleuze1, J Blacher1, J Capeau2, JP Bastard2, JP Viard1
1Assistance Publique-Hôpitaux de Paris. Centre-Université de Paris; 2Assistance Publique-Hôpitaux de Paris. Sorbonne Université, Paris, France
Background: People living with HIV (PLWH) are at risk of non-infectious comorbidities. It is important to individualize those at higher risk.
Methods: In a single-centre cohort of PLWH, we performed a cross-sectional analysis of comorbidities, diagnosed according to standard procedures. The primary end point was the prevalence of subclinical carotid/ coronary atherosclerosis. Secondary end points were its association with selected inflammatory/immune activation biomarkers and with other comorbidities. Associations were examined using Chi-2 or Fisher’s exact test for categorical variables and Student or Wilcoxon tests for quantitative variables, and a stepwise multivariate logistical model was performed for further exploration.
Results: Among 790 participants (median age: 49.8 years [IQR: 44.5–55.6], 77.1% males, median CD4: 536/mm3 [IQR: 390–754], 83.6% with undetectable viral load), asymptomatic atherosclerosis was found in 26% and was associated in multivariate analysis with older age, longer known duration of infection, longer exposure to antiretroviral drugs and ever exposure to stavudine, higher sCD14 and lower adiponectin levels. Hypertension was found in 33.5% of participants, diabetes in 19.4%, renal impairment in 14.6%, elevated LDL-cholesterol in 13.3%, elevated triglyceride/HDL- cholesterol ratio in 6.6% and osteoporosis in 7.9%. The presence of two or more comorbidities was found in 42.1% of participants and was associated in multivariate analysis with older age, longer exposure to antiretrovirals, ever exposure to stavudine and higher sCD14 levels. Comorbidities were diversely associated with biomarkers: osteoporosis with higher IL-6, renal impairment with higher sCD14, hypertension with higher D-dimer, diabetes and elevated triglyceride/ HDL-cholesterol ratio both with lower adiponectin and lower 25hydroxy-vitamin D.
Conclusions: Asymptomatic atherosclerosis and multimorbidity were frequent in a cohort of middle- aged, well-controlled, PLWH and were associated with traditional and HIV-specific factors. Associations between morbidities and inflammatory/immune activation biomarkers were diverse.
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