Background: It is unclear whether the risk of cardiovascular disease (CVD) is increasing more rapidly with age in HIV positive (HIV+) patients. We hypothesize that accelerated ageing in HIV+ patients would mean an accelerating risk of CVD with older age, and that the increased risk per year older would be higher in D:A:D relative to the general population. In this analysis we model the risk of CVD by age in D:A:D, and compare with the aging effects seen in conventional CVD risk equations.
Methods: We included all male D:A:D participants without prior CVD and with all conventional CVD risk factors available. We analysed three endpoints: myocardial infarction (MI), coronary heart disease (CHD: MI+invasive coronary procedure), and CVD (CVD: CHD+ stroke). We fitted a number of parametric age effects, adjusting for known risk factors and ART use. The best fitting age effect was determined using the Akaike Information Criteria. We compared the relative risk increase of CVD per year older from 40 years old in the D:A:D data to the general population risk equations – the Framingham Heart Study, CUORE and ASSIGN.
Results: 24,323 men were included in analyses, with median age 41 years at baseline. Crude MI, CHD and CVD event rates increased from 2.29, 3.11 and 3.65 in those aged 40-45 years to 6.53, 11.91 and 15.89 in those aged 60-65 years. In D:A:D there was a slowly accelerating risk of CHD and CVD per year older, which was somewhat raised compared to the general population based equations for CHD and CVD. The relative risk of MI with age was not different between D:A:D and the general population.
Conclusion: We found limited evidence of accelerating risk of CVD with age in D:A:D. The absolute risk of CVD associated with HIV infection remains unknown.
HIV disease is associated with chronic inflammation and activation of the innate immune system. This state, as measured using plasma markers of inflammation, persists following suppression of HIV viremia using antiretroviral therapy, and may increase risk of non-AIDS co-morbidities. The causes of innate immune activation in the setting of virological suppression are unclear. Natural killer (NK) cells are innate immune cells that kill virus-infected and transformed cells without prior sensitization. We have shown that NK cells are activated both phenotypically (elevated expression of HLA-DR) and functionally (increased spontaneous degranulation measured by CD107a surface expression) in virologically suppressed (VS) HIV+ individuals. NK cells also lose expression of CD16, the receptor which mediates antibody-dependent cellular cytotoxicity.
Regular HIV testing is recommended in men who take sexual risks. We assessed the relationship between perceived barriers to HIV testing, and frequency of testing among men who engaged in unprotected anal intercourse with casual partners (UAIC), to inform HIV testing strategies.
The majority of HIV diagnoses including delayed diagnoses in Australia occur among men who report homosexual contact – hereafter called gay and bisexual men (GBM). Delayed diagnosis is strongly associated with increased HIV-related mortality and morbidity. People who are unaware of their HIV-positive status may also be unwittingly transmitting HIV. We assessed trends in delayed HIV diagnoses among GBM in Australia.
HIV-associated leishmaniasis, endemic in the Mediterranean basin is a growing problem in India, Brazil and East Africa. Despite surviving for than 20 years, the clinical course of our visceral-leishmania (VL)-HIV co-infected patient illustrates several management challenges including diagnosis, speciation and drug resistance; monitoring burden of disease; access to and use of VL-treatments; end-organ toxicity and the combined immunosuppressive effects of HIV-VL.
Adherence to combination antiretroviral therapy (cART ) plays an important role on treatment outcomes. The TREAT Asia Studies to Evaluate Resistance – Monitoring Cohort Study (TASER-M) collects patients’ adherence based on a Visual Analogue Scale. The aim of this analysis was to assess the rates of, and factors associated with, suboptimal adherence in the first 24 months of initial cART in Asian patients.
REACH was a collaborative research and practice initiative to develop evidence building frameworks, capacity, tools and resources with the Victorian HIV community partnership.
Early first sexual intercourse has been proposed as an important marker of later sexual and reproductive health. Discussions of what constitutes early sexual debut in this context, however, have been limited.