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New IAS-USA Papers on Heart Disease in PWH,
DoxyPEP, Infant Feeding Updated Guidelines
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The November/December 2023 issue of Topics in Antiviral Medicine™ (TAM) is now available at https://www.iasusa.org/tam/november-december-2023/. This issue offers up to 3.0 CME credits at no charge and includes the 3 invited reviews below:
Invited Reviews
• Prevention and Treatment of Cardiovascular Disease in HIV: Practical Insights in an Evolving Field
Harris Avgousti, BA; Matthew J. Feinstein, MD, MSc
https://www.iasusa.org/wp-content/uploads/2023/12/31-5-559.pdf
Myocardial Infarction
PWH with an HIV RNA level below 500 copies/mL had a 1.39-fold higher risk for MI than PWH without detectable viremia; for PWH with an HIV RNA level above 500 copies/mL, this risk was 1.75-fold higher. Lower current or nadir CD4+ cell counts-markers of immunologic progression and incomplete recovery related to HIV, often in concert with histories of sustained viremia-have likewise been consistently associated with elevated MI risk among PWH.1 In a more recent study, a large cohort of patients with HIV matched with people without HIV was followed up from 2005 to 2020. This study demonstrated that PWH had a 1.6-fold higher risk for MI than people without HIV, and that the cumulative incidence of MI increased from the period of 2005 to 2009 to the period of 2010 to 2017.3
Heart Failure, Arrhythmia, and SuddenCardiac Death
HIV is likewise associated with a 1.5- to 2-fold elevated risk for heart failure, a complex clinical syndrome arising from heterogeneous pathophysiologic mechanisms (Figure 1).4,5 Data are less consistent for HIV and atrial fibrillation. Analyses of data from MACS (Multicenter AIDS Cohort Study) and from within the Northwestern Medicine system observed no association between HIV and atrial fibrillation, whereas a study performed in a University of California San Francisco cohort observed an increased HIV-related risk for atrial fibrillation.6-8
The Role of Immune Dysregulation in HIV-Associated CVD
Innate and adaptive immune dysregulation resulting in persisting inflammation is a hallmark of HIV and is likewise implicated in the pathogenesis of an array of CVDs. In coronary artery disease, these inflammatory responses lead to plaque rupture, erosion, and eventual vasculopathies. In heart failure, they contribute to maladaptive responses to cell injury, microvascular dysfunction, and direct myocardial inflammatory infiltrates, each of which can contribute to systolic and diastolic dysfunction. This complex interplay between comorbidities, underlying immunologic abnormalities, and inflammatory bias can accelerate inflammation
ultimately result in CVD.10-13
• Doxycycline Postexposure Prophylaxis for Prevention of Sexually Transmitted Infections
Chase A. Cannon, MD, MPH; Connie L. Celum, MD, MPH
https://www.iasusa.org/wp-content/uploads/2023/12/31-5-566.pdf
• 2023 Updated Guidelines on Infant Feeding and HIV in the United States: What Are They and Why Have Recommendations Changed?
Lealah Pollock, MD, MS; Judy Levison, MD, MPH
https://www.iasusa.org/wp-content/uploads/2023/12/31-5-576.pdf
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