Rates of cardiovascular disease following smoking cessation in patients with HIV infection: results from the D:A:D study(*)

Objectives

The aim of the study was to estimate the rates of cardiovascular disease (CVD) events after stopping smoking in patients with HIV infection.

Methods

Patients who reported smoking status and no previous CVD prior to enrolment in the Data Collection on Adverse Events of Anti‐HIV Drugs (D:A:D) study were included in this study. Smoking status is collected at each visit as current smoker (yes/no) and ever smoker (yes/no). Time since stopping smoking was calculated for persons who had reported current smoking during follow‐up and no current smoking subsequently. Endpoints were: myocardial infarction (MI); coronary heart disease (CHD: MI plus invasive coronary artery procedure or death from other CHD); CVD (CHD plus carotid artery endarterectomy or stroke); and all‐cause mortality. Event rates were calculated for never, previous and current smokers, and smokers who stopped during follow‐up. Incidence rate ratios (IRRs) were determined using Poisson regression adjusted for age, sex, cohort, calendar year, family history of CVD, diabetes, lipids, blood pressure and antiretroviral treatment.

Results

A total of 27 136 patients had smoking status reported, with totals of 432, 600, 746 and 1902 MI, CHD, CVD and mortality events, respectively. The adjusted IRR of CVD in patients who stopped smoking during follow‐up decreased from 2.32 within the first year of stopping to 1.49 after >3 years compared with those who never smoked. Similar trends were observed for the MI and CHD endpoints. Reductions in risk were less pronounced for all‐cause mortality.

Conclusion

The risk of CVD events in HIV‐positive patients decreased with increasing time since stopping smoking. Smoking cessation efforts should be a priority in the management of HIV‐positive patients.     

Utility of interferon-γ ELISPOT assay responses in highly tuberculosis-exposed patients with advanced HIV infection in South Africa

Background  

Interferon-gamma (IFN-γ) ELISPOT assays incorporating Mycobacterium tuberculosis-specific antigens are useful in the diagnosis of tuberculosis (TB) or latent infection. However, their utility in patients with advanced HIV is unknown. We studied determinants of ELISPOT responses among patients with advanced HIV infection (but without active TB) living in a South African community with very high TB notification rates.     

Fetal lung volume and pulmonary artery changes in congenital heart disease with decreased pulmonary blood flow: Quantitative ultrasound analysis

Background

It has been reported that congenital heart disease with decreased pulmonary blood flow (CHD‐DPBF) may affect postnatal lung morphogenesis and function. However, there has been a lack of information regarding the impact of CHD‐DPBF on prenatal fetal lung development.

Methods

Fifty‐four fetuses with CHD‐DPBF were compared with 110 controls. Fetal lung volume (FLV) was estimated using three‐dimensional ultrasonography (3D‐US). Estimated fetal weight (EFW) and McGoon index (MGI) were estimated using two‐dimensional ultrasonography (2D‐US).

Results

FLV/EFW and MGI values measured using sonography for the CHD‐DPBF group were significantly reduced compared to those of the control group (P < .05). Pearson correlation analysis indicated that the summed diameter of the right pulmonary artery and left pulmonary artery (RPA + LPA) measured by 2D‐US correlated well with FLV measured by 3D‐US.

Conclusions

In our study, FLV/EFW and MGI values for fetuses with CHD‐DPBF tended to be decreased and FLV was associated with RPA + LPA. We concluded that CHD‐DPBF might delay fetal lung development. The summed diameter of the RPA + LPA measurement could be used as an alternative to FLV for assessing fetal lung development.     

Common mental disorders in TB/HIV co-infected patients in Ethiopia

Background-  

The relationship between TB/HIV co-infection and common mental disorders (CMD) has been scarcely investigated. In this study, we compared the occurrence of CMD in TB/HIV co-infected and non-co-infected HIV patients in Ethiopia.     

Cardiovascular risk assessment in persons with HIV infection in the developing world: comparing three risk equations in a cohort of HIV-infected Thais

Objective

There is growing concern regarding cardiovascular disease in HIV‐infected individuals in developing countries such as Thailand. We evaluated the 10‐year risk of coronary heart disease (CHD) in a Thai HIV‐infected cohort using three cardiovascular risk equations, and assessed the level of agreement among their predictions.

Methods

We carried out a cross‐sectional analysis of data on 785 Thai subjects followed prospectively in the HIV Netherlands Australia Thailand Collaboration (HIV‐NAT) cohort study from 1996 to 2009. Cardiovascular risk factor history, along with relevant laboratory and clinical data, was collected at follow‐up clinic visits. Ten‐year risks of CHD were calculated using the Framingham, Ramathibodi–Electricity Generating Authority of Thailand (Rama‐EGAT) and Data Collection on Adverse Effects of Anti‐HIV Drugs (D:A:D) risk equations.

Results

The mean age of the patients was 41.0 years; 55% of the subjects were male. The mean duration of antiretroviral therapy was 7.7 years. The prevalence of cardiovascular risk factors was low, with the most common risk factor being low high‐density lipoprotein (HDL) (36.3%). The prevalence of high cardiovascular risk scores (defined as 10‐year risk of CHD≥10%) was also low: 9.9, 2.1 and 0.8%, by the Framingham, Rama‐EGAT and D:A:D scoring systems, respectively. Only eight subjects (1.0%) had a history of CHD. Bland–Altman plots showed that the Framingham equation predicted a higher risk of CVD compared with the Rama‐EGAT and D:A:D equations, which agreed relatively well.

Conclusion

The predicted cardiovascular risk in this HIV‐infected Thai cohort was relatively low. The agreement among the Rama‐EGAT and D:A:D risk scores suggests that both equations may be appropriate estimators of cardiovascular risk in this population.     

Normalisation of cerebrospinal fluid biomarkers parallels improvement of neurological symptoms following HAART in HIV dementia – case report

Background  

Since the introduction of HAART the incidence of HIV dementia has declined and HAART seems to improve neurocognitive function in patients with HIV dementia. Currently, HIV dementia develops mainly in patients without effective treatment, though it has also been described in patients on HAART and milder HIV-associated neuropsychological impairment is still frequent among HIV-1 infected patients regardless of HAART. Elevated cerebrospinal fluid (CSF) levels of markers of neural injury and immune activation have been found in HIV dementia, but neither of those, nor CSF HIV-1 RNA levels have been proven useful as diagnostic or prognostic pseudomarkers in HIV dementia.     

Effects of continuous positive airway pressure on blood pressure and daytime sleepiness in obstructive sleep apnea patients with coronary heart diseases under optimal medications

Background  

Continuous positive airway pressure (CPAP) is an effective therapy for obstructive sleep apnea (OSA). However, for patients who already have OSA and coronary heart diseases (CHD) with optimal medications, whether CPAP can reduce the blood pressure (BP) is not clear. This is a controlled study to evaluate the effects of CPAP on BP in Chinese cohorts with CHD under optimal medications.     

A novel method for the evaluation and treatment of obstructive sleep apnea in four adults with complex congenital heart disease and Fontan repairs

Introduction  

Advances in cardiac diagnosis, medical therapy, and surgery have resulted in greater survival for patients with congenital heart disease (CHD). As a result, increasing numbers of CHD patients are surviving to adulthood with little knowledge regarding the consequences of comorbid medical conditions. Obstructive sleep apnea (OSA) is common and associated with hypertension, heart failure, and arrhythmias. Adults with certain types of CHD are at a higher risk for these and other cardiovascular complications than the general population. Therefore, OSA in adults with CHD may have a greater adverse impact on cardiovascular health than in the general population.     

Epicardial versus endocardial permanent pacing in adults with congenital heart disease

Background  

Permanent pacing (PM) in patients with congenital heart disease (CHD) presents unique challenges—with little known about the long-term outcomes.     

Accumulation of oxidative stress-related gene polymorphisms and the risk of coronary heart disease events in patients with type 2 diabetes – An 8-year prospective study

Objective

Oxidative stress, which is provoked in patients with diabetes, plays critical roles in the pathogenesis of coronary heart disease (CHD). We simultaneously determined 5 relatively common genetic variants related to oxidative stress and evaluated the combined effect on CHD.

Methods

We enrolled 1977 Japanese type 2 diabetic subjects without history of CVD (males 66.1%, 59.5 ± 10.0 years old), determined their genotypes regarding glutamate-cysteine ligase modifier subunit (GCLM) C-588T, manganese superoxide dismutase (SOD2) Val16Ala, endothelial nitric oxide synthase (NOS3) G894T, NAD(P)H oxidase p22phox (CYBA) C242T, and myeloperoxidase (MPO) G-463A polymorphisms, and prospectively evaluated the association between these polymorphisms and CHD events.

Results

The median follow-up period was 7.5 years and there were 85 new CHD events. The single association analysis revealed that there were no statistically significant associations between each polymorphism and the prevalence of CHD. Interestingly, the risk of CHD event was higher with the increase of the total number of 10 concomitant unfavorable “pro-oxidant alleles” in each subject (p for trend = 0.018, log-rank test). Especially, the carriers of ≥8 pro-oxidant alleles had a significantly increased risk as compared to the carriers of <8 pro-oxidant alleles, whether the other clinical variables were adjusted (HR 2.92 with 95%CI 1.50–5.67, p = 0.002) or not (HR 2.89 with 95%CI 1.49–5.59, p = 0.002)..

Conclusions

Accumulation of gene polymorphisms related to oxidative stress is likely associated with the development of CHD in patients with type 2 diabetes, suggesting that the combined information about these variants is useful to assess the risk of CHD.     

Association between leukocyte mitochondrial DNA content and risk of coronary heart disease: A case-control study

Objective

Compelling epidemiological evidence indicates that alterations of mitochondrial DNA (mtDNA), including mutations and abnormal content of mtDNA, are associated with the initiation and development of cardiovascular disease. This study was undertaken to investigate whether mtDNA content in peripheral blood leukocytes (PBLs) could be used as a risk predictor for coronary heart disease (CHD).

Methods

The mtDNA content of PBLs from 378 CHD patients and 378 matched healthy controls was measured using quantitative real-time PCR-based method in a case-control study. An unconditional multivariate logistic regression model was applied to estimate the association between leukocyte mtDNA content and CHD risk.

Results

CHD patients exhibited notably lower mtDNA content than matched healthy controls (median, 0.65 vs. 0.86; P < 0.001). Compared with individuals who had high mtDNA content, individuals who had low mtDNA content had a significantly increased risk of CHD (adjusted OR, 2.38; 95% confidence interval, 1.33–4.69). A significant dose–response relation was observed between increased CHD risk and lower mtDNA content (P_trend < 0.001). Furthermore, there was a significantly positive mtDNA content correlation between PBLs and atherosclerotic plaque tissue (ρ = 0.627, P = 0.039). In addition, a significant joint effect on the risk of CHD was noted between mtDNA content and cigarette smoking or plasma LDL-C concentration.

Conclusions

This present study provide the first epidemiologic evidence linking low mtDNA content in PBLs to an increased CHD risk, which warrants further investigation in other populations.     

Decision-Making Role Preferences Among Patients with HIV: Associations with Patient and Provider Characteristics and Communication Behaviors

BACKGROUND  

A preference for shared decision-making among patients with HIV has been associated with better health outcomes. One possible explanation for this association is that patients who prefer a more active role in decision-making are more engaged in the communication process during encounters with their providers. Little is known, however, about patient and provider characteristics or communication behaviors associated with patient decision-making preferences in HIV settings.     

Oncogenic HPV among HIV infected female population in West Bengal,India

Background  

Prevalence of both cervical cancer and Human Immunodeficiency Virus (HIV) infection are very high in India. Natural history of Human Papilloma Virus (HPV) infection is known to be altered in HIV positive women and there is an increased possibility of persistence of HPV infections in this population. Therefore, this study was conducted to understand the epidemiology and circulating genotypes of oncogenic HPV among HIV positive and negative female population in West Bengal, India.     

The 745.5 issue in code‐based,adult congenital heart disease population studies: Relevance to current and future ICD‐9‐CM and ICD‐10‐CM studies

Objective

Although the ICD‐9‐CM code 745.5 is widely used to indicate the presence of a secundum atrial septal defect (ASD), it is also used for patent foramen ovale (PFO) which is a normal variant and for “rule‐out” congenital heart disease (CHD). The ICD‐10‐CM code Q21.1 perpetuates this issue. The objective of this study was to assess whether code 745.5 in isolation or in combination with unspecified CHD codes 746.9 or 746.89 miscodes for CHD, and if true CHD positives decrease with age.

Design

Echocardiograms of patients with an ICD‐9‐CM code of 745.5 in isolation or in combination with unspecified CHD codes 746.9 or 746.89 were reviewed to validate the true incidence of an ASD. This observational, cross‐sectional record review included patients between 11 and 64 years of age.

Results

Medical charts and echocardiograms of 190 patients (47.9% males) were reviewed. The number of falsely coded patients with 745.5 (no ASD) was high (76.3%). Forty‐five (23.7%) patients had a true ASD. Among the 145 patients without an ASD, 100 (52.6%) were classified as having a PFO, 37 (19.5%) had a normal non‐CHD echocardiogram, and 8 (4.2%) had some other CHD anomaly. The likelihood that 745.5 coded for a true ASD was higher in children aged 11‐20 (64.3%) than adults aged 21‐64 years (20.6%).

Conclusions

This validation study demonstrates that 745.5 performed poorly across all ages. As 745.5 is widely used in population‐level investigations and ICD‐10‐CM perpetuates the problem, future analyses utilizing CHD codes should consider separate analysis of those identified only through code 745.5.     

Psychosocial stress and major cardiovascular events in patients with stable coronary heart disease

Objectives

Assess the risk of ischaemic events associated with psychosocial stress in patients with stable coronary heart disease (CHD).

Methods

Psychosocial stress was assessed by a questionnaire in 14 577 patients (median age 65.0, IQR 59, 71; 81.6% males) with stable CHD on optimal secondary preventive therapy in the prospective randomized STABILITY clinical trial. Adjusted Cox regression models were used to assess associations between individual stressors, baseline cardiovascular risk factors and outcomes.

Results

After 3.7 years of follow‐up, depressive symptoms, loss of interest and financial stress were associated with increased risk (hazard ratio, 95% confidence interval) of CV death (1.21, 1.09–1.34; 1.15, 1.05–1.27; and 1.19, 1.08–1.30, respectively) and the primary composite end‐point of CV death, nonfatal MI or nonfatal stroke (1.21, 1.13–1.30; 1.19, 1.11–1.27; and 1.17, 1.10–1.24, respectively). Living alone was related to higher risk of CV death (1.68, 1.38–2.05) and the primary composite end‐point (1.28, 1.11–1.48), whereas being married as compared with being widowed, was associated with lower risk of CV death (0.64, 0.49–0.82) and the primary composite end‐point (0.81, 0.67–0.97).

Conclusions

Psychosocial stress, such as depressive symptoms, loss of interest, living alone and financial stress, were associated with increased CV mortality in patients with stable CHD despite optimal medical secondary prevention treatment. Secondary prevention of CHD should therefore focus also on psychosocial issues both in clinical management and in future clinical trials.     

Transforming Growth Factor β1 and Coronary Intimal Hyperplasia in Pediatric Patients With Congenital Heart Disease

Background

Congenital heart defects or the process of their repair leads to an increased risk for adult cardiovascular disease compared with the general population. Intimal hyperplasia is a preatherosclerotic lesion that may be produced as a consequence of transforming growth factor β1 (TGF-β1) pathway activation. We studied the presence of intimal hyperplasia in arteries from a pediatric population with congenital heart disease (CHD) and TGF-β1 expression to enlighten its possible role in the genesis of these lesions.

Methods

Coronary arteries from 10 controls and 98 CHD patients (54% cyanotic type, 32% surgically repaired) were stained, and the presence and degree of intimal thickening were analyzed. The expression of TGF-β1 was studied by immunohistochemistry.

Results

The difference between the presence of coronary intimal hyperplasia in patients with cyanotic (35; 66.1%) and noncyanotic CHD (29; 64.3%) was not significant. However, surgically repaired CHD presented a higher rate of coronary intimal hyperplasia (80%) than did the group without surgical intervention (47.3%), P = 0.0002. The immunostaining for TGF-β1 analyzed in samples of patients with cyanotic and noncyanotic CHD showed no significant differences. However, TGF-β1 expression was more intense on the intimal layer of patients with surgically repaired CHD than on that of those without surgery (intimal area positive for TGF-β1, 50.43% vs 15.91%, respectively; Mann-Whitney U test P = 0.0005).

Conclusion

The high incidence of intimal hyperplasia in patients with surgically repaired CHD is correlated with TGF-β1 expression and may contribute to the development of atherosclerotic coronary artery disease in CHD patients.     

Lack of causal relationship between leukocyte telomere length and coronary heart disease

Objective

To investigate the association between genetic variation in telomerase RNA component (TERC) and leukocyte telomere length (LTL) with risk of coronary heart disease (CHD).

Methods and results

An analysis of LTL was conducted, focusing on two SNPs in 2 community-based cohort populations comprising 3500 Chinese Han individuals. In addition, LTL ratio was determined in a case–control setting involving 4351 participants: 2211 healthy individuals and 2140 CHD patients. The association between LTL and the presence and extent of cardiovascular and cerebrovascular lesions were tested. Results confirmed the association of rs12696304 and rs16847897 with LTL in the Chinese Han population (P = 1.63 × 10⁻⁶ and P = 1.44 × 10⁻⁷, respectively). However, these SNPs confer a moderate risk for CHD but did not achieve significant threshold after multiple corrections. Decreased LTL ratio was associated with CHD (odds ratio [OR], 1.13; 95% confidence interval [CI], 1.02–1.34; P < 0.01). In addition, the LTL ratio in CHD patients was related to numbers of vascular disease lesions.

Conclusions

Our results do not support a causal role of LTL for the development of CHD. However, LTL may be related to complex conditions associated with cardiovascular and cerebrovascular disease manifestations.     

Beta-Blocker Therapy and Cardiac Events Among Patients With Newly Diagnosed Coronary Heart Disease

Background

The effectiveness of beta-blockers for preventing cardiac events has been questioned for patients who have coronary heart disease (CHD) without a prior myocardial infarction (MI).

Objectives

The purpose of this study was to assess the association of beta-blockers with outcomes among patients with new-onset CHD.

Methods

We studied consecutive patients discharged after the first CHD event (acute coronary syndrome or coronary revascularization) between 2000 and 2008 in an integrated healthcare delivery system who did not use beta-blockers in the year before entry. We used time-varying Cox regression models to determine the hazard ratio (HR) associated with beta-blocker treatment and used treatment-by-covariate interaction tests (p_int) to determine whether the association differed for patients with or without a recent MI.

Results

A total of 26,793 patients were included, 19,843 of whom initiated beta-blocker treatment within 7 days of discharge from their initial CHD event. Over an average of 3.7 years of follow-up, 6,968 patients had an MI or died. Use of beta-blockers was associated with an adjusted HR for mortality of 0.90 (95% confidence limits [CL]: 0.84 to 0.96), and an adjusted HR for death or MI of 0.92 (CL: 0.87 to 0.97). The association between beta-blockers and outcomes differed significantly between patients with and without a recent MI (HR for death: 0.85 vs. 1.02, p_int = 0.007; and HR for death or MI: 0.87 vs. 1.03, p_int = 0.005).

Conclusions

Use of beta-blockers among patients with new-onset CHD was associated with a lower risk of cardiac events only among patients with a recent MI.     

Factors influencing cerebrospinal fluid and plasma HIV-1 RNA detection rate in patients with and without opportunistic neurological disease during the HAART era

Background  

In the central nervous system, HIV replication can occur relatively independent of systemic infection, and intrathecal replication of HIV-1 has been observed in patients with HIV-related and opportunistic neurological diseases. The clinical usefulness of HIV-1 RNA detection in the cerebrospinal fluid (CSF) of patients with opportunistic neurological diseases, or the effect of opportunistic diseases on CSF HIV levels in patients under HAART has not been well defined. We quantified CSF and plasma viral load in HIV-infected patients with and without different active opportunistic neurological diseases, determined the characteristics that led to a higher detection rate of HIV RNA in CSF, and compared these two compartments.     

Association between amebic liver abscess and Human Immunodeficiency Virus infection in Taiwanese subjects

Purpose  

Invasive amebiasis is an emerging parasitic disorder in Taiwan, especially in patients diagnosed with human immunodeficiency virus (HIV) infection. Thirty-three Taiwanese subjects with amebic liver abscess (ALA) were examined and a possible correlation between ALA and HIV infection was investigated.