||A Review of Cardiovascular Disease and HIV: Highlights From CROI 2009|
How big a problem is heart disease for people with HIV? Just as important is what's causing it: HIV meds, the virus itself, or both? Read or listen as David Wohl, M.D., walks us through some of the most important research on heart disease presented at a recent HIV medical conference. The conference included a few studies that may change the landscape of HIV care: One study, for instance, suggests that HIV poses a danger similar to that of traditional heart disease risk factors, while other studies highlighted new ways that doctors may be able to assess an HIVer's heart risk.
||Jens Lundgren, M.D., Discusses New Findings Regarding MI Risk of Specific Antiretrovirals
The latest data from D:A:D indicate that lopinavir/ritonavir does increase myocardial infarction risk, but efavirenz, nevirapine and tenofovir do not. In this interview, Jens Lundgren, M.D., and HIV advocate Jeff Berry take part in a fascinating discussion on the new findings and their possible underlying causes.
More Top Stories:
- Untreated HIV Infection Is Associated With Impaired Arterial Elasticity
An interview with Jason Baker, M.D.
- Hepatitis C Transmission Among HIV-Infected Men Who Have Sex With Men Is Occurring Primarily in Men Older Than 35
An interview with Sarah Fishman.
- HIV-Infected Patients Who Have the ApoE4 Allele Are More Vulnerable to the Effects of Low CD4 Counts
An interview with Kalpana Kallianpur.
- Bone Mineral Density Loss Accelerated in HIV-Infected Males
An interview with Julian Falutz, M.D.
- High Prevalence of Obesity, Dyslipidemia and Inflammation Seen in Behaviorally Infected Adolescent Women
An interview with Kathleen Mulligan, Ph.D.
- High-Dose Vitamin D Supplementation in HIV-Infected Men Safe in Small Study
An interview with Kathryn Childs.
- HPV, Anal Cancer and Cervical Cancer: An Update on Pathogenesis, Treatment and Prevention
Joel Palefsky, M.D., discusses an important study he presented at CROI 2009 regarding the link between anal intraepithelial neoplasia and anal cancer, and also brings us up to speed on the methods by which these lesions can be prevented and treated.
- HIV on Par With Smoking, Diabetes as Risk Factor for Atherosclerosis, Large Study Finds
Carl Grunfeld, M.D., Ph.D., and Colette Smith present new findings from a pair of massive studies that explore factors associated with cardiovascular risk in HIV-infected patients. Dr. Grunfeld's data suggest that HIV itself is a major risk factor for atherosclerosis -- a far greater risk, in fact, than any that may be posed by the use of antiretrovirals.
- Up to Half of HIV-Infected Patients on Effective HAART Still Ultimately Develop Neurocognitive Impairment, Study Finds
Igor Grant, M.D. presents new data from the CHARTER study indicating that, although the prevalence of dementia is significantly down in the modern treatment era, 40 percent to 50 percent of HIV-infected patients on effective HAART will still eventually develop some form of neurological impairment -- and in most cases, the impairment will impact their day-to-day lives.
- Peripheral Neuropathy Still Common Among HIV-Infected Patients on HAART; Risk May Increase With Age
A metastudy of ACTG trial participants finds peripheral neuropathy prevalence of greater than 20% among patients initiating HAART -- a proportion that increases as patients age, despite maintaining a CD4+ cell count above 350 and a viral load below 400, and despite declining use of didanosine and stavudine. Study presenter Scott Evans, Ph.D., also notes that neuropathy usually occurred without patients experiencing any pain whatsoever.
- Many HIV-Infected Women Do Not Receive Cervical Cancer Screenings Nearly Often Enough, U.S. Study Suggests
Despite the importance of annual cervical cancer screenings for HIV-infected women, 23% of a 2,400-woman nationwide sample reported no pap smear within the past year, according to data presented by Alexandra Oster, M.D. Three factors were associated with an increased risk of missing a screening: age; CD4 count below 200; and receiving a pelvic exam from someone other than their HIV care provider.
- Antidepressants Can Significantly Reduce Viral Load by Improving Adherence Among Homeless or Marginally Housed Patients, Study Says
Antidepressant use had a small (.8 log) but statistically significant effect on viral load reduction among 418 homeless and marginally housed adults who had initiated HAART, found Alexander Tsai, M.D., Ph.D., et al. However, that benefit vanished after adjusting for adherence, suggesting that improved adherence was the reason behind the viral load reduction, not a biological effect of antidepressant use.
- Hormonal Contraception Use Has No Impact on HIV Disease Progression, Large Cohort Analysis Finds
In an analysis of a cohort of more than 4,000 HIV-infected, antiretroviral-naive women in Africa and Thailand, Elizabeth Stringer, M.D., et al found that use of any type of contraceptive appeared to have no impact on the risk of death or the likelihood of becoming eligible for antiretroviral therapy.
- Language Impairment May Be More Common Than Previously Thought in Perinatally HIV-Infected Children, Study Suggests
One-third of 178 perinatally HIV-infected children scored low on language assessments in the 12-site prospective cohort study, explained Mabel Rice, Ph.D. There appeared to be a relationship between risk of secondary language impairment and any of three factors at study enrollment: CDC Class C; viral load >400 copies/mL; and CD4+ percentage <25%.
- Risk for Invasive Anal Cancer High Among HIV-Positive People
- During First 45 Days Post HAART Initiation Patients Hospitalized Most Often for Non-AIDS-Defining Infections
- Hospitalization and Disability Are Higher Amongst HIV Patients With Hepatitis C Coinfection
- Half of HIV/HCV Co-Infected Early Responders Are Cured of HCV With 72-Week Treatment
- Risk of Cancers With Infectious Cause Going Down in People With HIV
- Test Can Predict Non-Hodgkin's Lymphoma in People With HIV
- Corticosteroid Therapy Improves Outcomes in People With TB-IRIS in Placebo-Controlled Trial -- Without Excess Side Effects or Infections
- Ugandan Study Supports the Use of Fluconazole to Prevent Cryptococcal Meningitis
Please note: Knowledge about HIV changes rapidly. Note the date of this summary's publication, and before treating patients or employing any therapies described in these materials, verify all information independently. If you are a patient, please consult a doctor or other medical professional before acting on any of the information presented in this summary. For a complete listing of our most recent conference coverage, click here.