27 results on '"Hatleberg, Camilla Ingrid"'
Search Results
2. Serious clinical events in HIV-positive persons with chronic kidney disease
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Ryom, Lene, Lundgren, Jens D., Law, Matthew, Kirk, Ole, El-Sadr, Wafaa, Bonnet, Fabrice, Weber, Rainer, Fontas, Eric, Monforte, Antonella d’Arminio, Phillips, Andrew, Reiss, Peter, de Wit, Stephane, Hatleberg, Camilla Ingrid, Sabin, Caroline, and Mocroft, Amanda
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- 2019
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3. Improvements over time in short-term mortality following myocardial infarction in HIV-positive individuals
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Hatleberg, Camilla Ingrid, Ryom, Lene, El-Sadr, Wafaa, Smith, Colette, Weber, Rainer, Reiss, Peter, Fontas, Eric, Dabis, Francois, Law, Matthew, Monforte, Antonella d’Arminio, De Wit, Stephane, Mocroft, Amanda, Phillips, Andrew, Lundgren, Jens D., and Sabin, Caroline
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- 2016
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4. Cardiovascular disease (CVD) and chronic kidney disease (CKD) event rates in HIV-positive persons at high predicted CVD and CKD risk: A prospective analysis of the D:A:D observational study
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Boyd, Mark A., Mocroft, Amanda, Ryom, Lene, Monforte, Antonella d'Arminio, Sabin, Caroline, El-Sadr, Wafaa M., Hatleberg, Camilla Ingrid, De Wit, Stephane, Weber, Rainer, Fontas, Eric, Phillips, Andrew, Bonnet, Fabrice, Reiss, Peter, Lundgren, Jens, and Law, Matthew
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HIV infections -- Drug therapy ,Antiretroviral agents -- Complications and side effects ,Kidney diseases -- Risk factors ,Cardiovascular diseases -- Risk factors ,Biological sciences - Abstract
Background The Data Collection on Adverse Events of Anti-HIV Drugs (D:A:D) study has developed predictive risk scores for cardiovascular disease (CVD) and chronic kidney disease (CKD, defined as confirmed estimated glomerular filtration rate [eGFR] [less than or equal to] 60 ml/min/1.73 m.sup.2) events in HIV-positive people. We hypothesized that participants in D:A:D at high (>5%) predicted risk for both CVD and CKD would be at even greater risk for CVD and CKD events. Methods and findings We included all participants with complete risk factor (covariate) data, baseline eGFR > 60 ml/min/1.73 m.sup.2, and a confirmed (>3 months apart) eGFR 1%-5%, >5%) and fitted Poisson models to assess whether CVD and CKD risk group effects were multiplicative. A total of 27,215 participants contributed 202,034 person-years of follow-up: 74% male, median (IQR) age 42 (36, 49) years, median (IQR) baseline year of follow-up 2005 (2004, 2008). D:A:D risk equations predicted 3,560 (13.1%) participants at high CVD risk, 4,996 (18.4%) participants at high CKD risk, and 1,585 (5.8%) participants at both high CKD and high CVD risk. CVD and CKD event rates by predicted risk group were multiplicative. Participants at high CVD risk had a 5.63-fold (95% CI 4.47, 7.09, p < 0.001) increase in CKD events compared to those at low risk; participants at high CKD risk had a 1.31-fold (95% CI 1.09, 1.56, p = 0.005) increase in CVD events compared to those at low risk. Participants' CVD and CKD risk groups had multiplicative predictive effects, with no evidence of an interaction (p = 0.329 and p = 0.291 for CKD and CVD, respectively). The main study limitation is the difference in the ascertainment of the clinically defined CVD endpoints and the laboratory-defined CKD endpoints. Conclusions We found that people at high predicted risk for both CVD and CKD have substantially greater risks for both CVD and CKD events compared with those at low predicted risk for both outcomes, and compared to those at high predicted risk for only CVD or CKD events. This suggests that CVD and CKD risk in HIV-positive persons should be assessed together. The results further encourage clinicians to prioritise addressing modifiable risks for CVD and CKD in HIV-positive people., Author(s): Mark A. Boyd 1,2,*, Amanda Mocroft 3, Lene Ryom 4, Antonella d'Arminio Monforte 5, Caroline Sabin 3, Wafaa M. El-Sadr 6, Camilla Ingrid Hatleberg 4, Stephane De Wit 7, [...]
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- 2017
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5. Cardiovascular risks associated with protease inhibitors for the treatment of HIV
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Hatleberg, Camilla Ingrid, primary, Ryom, Lene, additional, and Sabin, Caroline, additional
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- 2021
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6. Cessation of Cigarette Smoking and the Impact on Cancer Incidence in HIV-positive Persons: The D:A:D Study
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Shepherd, Leah, Ryom, Lene, Law, Matthew, Petoumenos, Kathy, Hatleberg, Camilla Ingrid, d'Arminio Monforte, Antonella, Sabin, Caroline, Bower, Mark, Bonnet, Fabrice, Reiss, Peter, de Wit, Stephane, Pradier, Christian, Weber, Rainer, El-Sadr, Wafaa, Lundgren, Jens, Mocroft, Amanda, University of Zurich, and Mocroft, Amanda
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10234 Clinic for Infectious Diseases ,610 Medicine & health ,2725 Infectious Diseases ,2726 Microbiology (medical) - Published
- 2019
7. Gender differences in HIV‐positive persons in use of cardiovascular disease‐related interventions: D:A:D study
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Hatleberg, Camilla Ingrid, Ryom, Lene, El?Sadr, Wafaa, Mocroft, Amanda, Reiss, Peter, Wit, Stephan, Dabis, Francois, Pradier, Christian, Monforte, Antonella D'Arminio, Rickenbach, Martin, Law, Matthew, Lundgren, Jens, and Sabin, Caroline
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Cardiovascular diseases -- Diagnosis -- Care and treatment ,HIV infection -- Complications and side effects -- Care and treatment ,Health - Abstract
Introduction: There is a lack of data on potential gender differences in the use of interventions to prevent and treat cardiovascular disease (CVD) in HIV‐positive individuals. We investigated whether such differences exist in the D:A:D study. Materials and Methods: Follow‐up was from 01/02/99 until the earliest of death, 6 months after last visit or 01/02/13. Rates of initiation of lipid‐lowering drugs (LLDs), angiotensin‐converting enzyme inhibitors (ACEIs), anti‐hypertensives and receipt of invasive cardiovascular procedures (ICPs; bypass, angioplasty, endarterectomy) were calculated in those without a myocardial infarction (MI) or stroke at baseline, overall and in groups known to be at higher CVD risk: (i) age >50, (ii) total cholesterol >6.2 mmol/l, (iii) triglyceride >2.3 mmol/l, (iv) hypertension, (v) previous MI, (vi) diabetes, or (vii) predicted 10‐year CVD risk >10%. Poisson regression was used to assess whether rates of initiation were higher in men than women, after adjustment for these factors. Results: At enrolment, women (n=13,039; median (interquartile range) 34 (29–40) years) were younger than men (n=36,664, 39 (33–46) years, p=0.001), and were less likely to be current smokers (29% vs. 39%, p=0.0001), to have diabetes (2% vs. 3%, p=0.0001) or to have hypertension (7% vs. 11%, p=0.0001). Of 49,071 individuals without a MI/stroke at enrolment, 0.6% women vs. 2.1% men experienced a MI while 0.8% vs. 1.3% experienced a stroke. Overall, women received ICPs at a rate of 0.07/100 person‐years (PYRS) compared to 0.29/100 PYRS in men. Similarly, the rates of initiation of LLDs (1.28 vs. 2.46), anti‐hypertensives (1.11 vs. 1.38) and ACEIs (0.82 vs. 1.37) were all significantly lower in women than men (Table 1). As expected, initiation rates of each intervention were higher in the groups determined to be at moderate/high CVD risk; however, within each high‐risk group, initiation rates of most interventions (with the exception of anti‐hypertensives) were generally lower in women than men. These gender differences persisted after adjustment for potential confounders (Table 1). Conclusion: Use of most CVD interventions was lower among women than men in the D:A:D study. Our findings suggest that actions should be taken to ensure that both men and women are monitored for CVD and, if eligible, receive appropriate CVD interventions., Table 1: Relative rate (RR) of receipt of each of the four interventions in women versus men, before and after adjustment for potential confounders (age, year, BMI, high cholesterol, high [...]
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- 2014
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8. Association between exposure to antiretroviral drugs and the incidence of hypertension in HIV-positive persons: the D:A:D Study
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Hatleberg, Camilla Ingrid, Ryom, DR Lene, Monforte, Antonella d’Arminio, Fontas, Eric, Reiss, Peter, Kirk, Ole, Sadr, Wafaa El, Phillips, Andrew, de Wit, Stephane, Dabis, Francois, Weber, Rainer, Law, Matthew, Lundgren, Jens Dilling, and Sabin, Caroline
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Adult ,Male ,Anti-HIV Agents ,Risk Factors ,Incidence ,Hypertension ,Humans ,Regression Analysis ,Female ,HIV Infections ,Article - Abstract
This article presents findings indicating that cumulative exposure to antiretroviral drugs is not associated with a clinically relevant increased risk of hypertension in HIV-positive individuals. Increased risk of hypertension is mainly linked to traditional cardiovascular disease risk factors. OBJECTIVES: Previous studies have suggested that hypertension in HIV-positive individuals is associated primarily with traditional risk factors such as older age, diabetes and dyslipidemia. However, controversy remains as to whether exposure to antiretroviral (ARV) drugs poses additional risk, and we investigated this question in the D:A:D cohort. METHODS: The incidence of hypertension (systolic blood pressure (BP) >140 and/or diastolic BP >90 mmHg and/or initiation of antihypertensive treatment) was determined overall and in strata defined by demographic, metabolic- and HIV-related factors, including cumulative exposure to each individual ARV drug. Predictors of hypertension were identified using uni- and multivariable Poisson regression models. RESULTS: Of 33,278 included persons, 7636 (22.9%) developed hypertension over 223,149 person years (Incidence rate: 3.42 [95% CI 3.35–3.50]/100 PYRS). In univariable analyses, cumulative exposure to most ARV drugs was associated with an increased risk of hypertension. After adjustment for demographic, metabolic and HIV-related factors, only associations for nevirapine (rate ratio 1.07 [95% CI 1.04–1.13]/5 years) and indinavir/ritonavir (1.12 [1.04–1.20]/5 years) remained statistically significant, although effects were small. The strongest independent predictors of hypertension were male gender, older age, black African ethnicity, diabetes, dyslipidemia, use of lipid-lowering drugs, high BMI, renal impairment and a low CD4 count. CONCLUSION: We did not find evidence for any strong independent association between exposure to any of the individual ARV drugs and the risk of hypertension. Findings provide reassurance that screening policies and preventative measures for hypertension in HIV-positive persons should follow algorithms used for the general population.
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- 2018
9. Associations between serum albumin and serious non-AIDS events among people living with HIV
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Ronit, Andreas, Hatleberg, Camilla Ingrid, Ryom, Lene, Bonnet, Fabrice, El-Sadr, Wafaa, Reiss, Peter, Weber, Rainer, Pradier, Christian, De Wit, Stephane, Law, Matthew, d'Arminio Monforte, Antonella; https://orcid.org/0000-0003-0073-1789, Lundgren, Jens, Mocroft, Amanda, Phillips, Andrew N, Sabin, Caroline A, Ronit, Andreas, Hatleberg, Camilla Ingrid, Ryom, Lene, Bonnet, Fabrice, El-Sadr, Wafaa, Reiss, Peter, Weber, Rainer, Pradier, Christian, De Wit, Stephane, Law, Matthew, d'Arminio Monforte, Antonella; https://orcid.org/0000-0003-0073-1789, Lundgren, Jens, Mocroft, Amanda, Phillips, Andrew N, and Sabin, Caroline A
- Abstract
OBJECTIVE Lower serum albumin (sAlb) has been associated with an increased risk of mortality and AIDS among people living with HIV and may be associated with the development of serious non-AIDS events (SNAEs). We evaluated the long-term association between sAlb and the risk of SNAEs. DESIGN Prospective multinational cohort study. METHODS D:A:D participants without SNAEs were followed from first routine sAlb value to the first of a new SNAE [cardiovascular disease (CVD), end-stage liver disease (ESLD), end-stage renal disease (ESRD), non-AIDS malignancy (NADM), death from non-AIDS cause], AIDS-death, 6 months after last visit or 01/02/2016. Poisson regression was used to determine associations between sAlb and a new i) SNAE, ii) CVD or iii) NADM event, with adjustment for potential confounders. Models additionally tested whether the associations were modified by age, follow-up time, smoking status, CD4 and viral load. RESULTS Of 16,350 participants (71.8% male, median age 44 years) 1,463 developed a SNAE (371 CVD, 200 ESLD, 40 ESRD, 553 NADM, 299 deaths from other non-AIDS causes) over 80,264 person-years. Increased sAlb was associated with a decreased risk of an SNAE (adjusted rate ratio (aRR) per 5 g/L: SNAE 0.79 [95%CI: 0.76, 0.83]; CVD 0.87 [0.80, 0.94]; NADM 0.88 [0.82, 0.95]). The association did not appear to wane with additional years of follow-up (p-interaction = 0.79) but was stronger for current smokers than for never smokers (p-interaction<0.01). CONCLUSIONS sAlb is a durable risk factor for SNAE. Future studies are needed to determine the mechanism underlying this association and to evaluate the value of sAlb in predictive tools.
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- 2018
10. Differences in Virological and Immunological Risk Factors for Non-Hodgkin and Hodgkin Lymphoma
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Shepherd, Leah, Ryom, Lene, Law, Matthew, Hatleberg, Camilla Ingrid, de Wit, Stephane, Monforte, Antonella d'Arminio, Battegay, Manuel, Phillips, Andrew, Bonnet, Fabrice, Reiss, Peter, Pradier, Christian, Grulich, Andrew, Sabin, Caroline, Lundgren, Jens, Mocroft, Amanda, Shepherd, Leah, Ryom, Lene, Law, Matthew, Hatleberg, Camilla Ingrid, de Wit, Stephane, Monforte, Antonella d'Arminio, Battegay, Manuel, Phillips, Andrew, Bonnet, Fabrice, Reiss, Peter, Pradier, Christian, Grulich, Andrew, Sabin, Caroline, Lundgren, Jens, and Mocroft, Amanda
- Abstract
Background: Non-Hodgkin lymphoma (NHL) and Hodgkin lymphoma (HL) are increased in populations with immune dysfunction, including people living with HIV; however, there is little evidence for to what degree immunological and virological factors differently affect NHL and HL risk.Methods: Data from the Data Collection on Adverse events of Anti-HIV Drugs Study cohort were analyzed to identify independent risk factors for NHL and HL using hazard ratios (HRs), focusing on current and cumulative area under the curve (AUC) measures of immunological and virological status. Variables with different associations with NHL and HL were identified using marginal Cox models. All statistical tests were two-sided.Results: Among 41 420 people followed for 337 020 person-years, 392 developed NHL (incidence rate = 1.17/1000 person-years of follow-up [PYFU], 95% confidence interval [CI] = 1.06 to 1.30) and 149 developed HL (incidence rate = 0.44/1000 PYFU, 95% CI = 0.38 to 0.52). Higher risk of both NHL and HL was associated with lower current CD4 cell count (adjusted HR [aHR] of NHL for CD4 <100 vs > 599 cells/mm3 = 8.08, 95% CI = 5.63 to 11.61; HL = 4.58, 95% CI = 2.22 to 9.45), whereas higher current HIV viral load (aHR of NHL for HIV-VL >1000 vs < 50 copies/mL = 1.97, 95% CI = 1.50 to 2.59) and higher AUC of HIV-VL (aHR of NHL for highest vs lowest quintile = 2.91, 95% CI = 1.92 to 4.41) were associated with NHL only. Both current and AUC of HIV-VL were factors that had different associations with NHL and HL, where the hazard ratio for NHL was progressively higher than for HL with increasing HIV-VL category. Lower current CD4 cell count had a strong but similar association with both NHL and HL.Conclusions: CD4 depletion increased risk of both types of lymphomas while current and accumulated HIV-VL was associated with NHL only. This suggests that NHL development is related to both CD4 cell depletion and added immune dysfunction derived from ongoing
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- 2018
11. Abacavir use and risk of recurrent myocardial infarction
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Sabin, Caroline, Mocroft, Amanda, Bonnet, Fabrice, Law, Matthew, De Wit, Stéphane, Reiss, Peter, Lundgren, Jens J.D., Ryom, Lene, d'Arminio Monforte, Antonella, Hatleberg, Camilla Ingrid, Pradier, Christian, El-Sadr, W.M., Kirk, Ole, Weber, Rainer, Phillips, Andrew A.N., Sabin, Caroline, Mocroft, Amanda, Bonnet, Fabrice, Law, Matthew, De Wit, Stéphane, Reiss, Peter, Lundgren, Jens J.D., Ryom, Lene, d'Arminio Monforte, Antonella, Hatleberg, Camilla Ingrid, Pradier, Christian, El-Sadr, W.M., Kirk, Ole, Weber, Rainer, and Phillips, Andrew A.N.
- Abstract
Objective: To investigate the association between abacavir (ABC) use and recurrent myocardial infarction (MI) among HIV-positive people with a prior MI. Design: International multicohort collaboration with follow-up from 1999 to 2016. Methods: The rate of recurrent MI was described among D:A:D participants who experienced an index MI whilst in the study, and who remained under follow-up beyond 28 days after this MI. Follow-up was considered to the date of next MI, death, 1 February 2016 or 6 months after last clinic visit. Poisson regression models considered associations between recurrent MI and exposure to ABC (use at index MI, current post-MI exposure and cumulative exposure), before and after adjusting for calendar year. Results: The 984 individuals who experienced an index MI during the study (91.3% male, median age 51 at index MI) were followed for 5312 person-years, over which time there were 136 recurrent MIs (rate 2.56/100 person-years, 95% confidence interval 2.13-2.99). Rates were 2.40 (1.71-3.09) and 2.65 (2.10-3.21)/100 person-years in those who were and were not on ABC, respectively, at the index MI, and 2.90 (2.01-3.78) and 2.44 (1.95-2.93)/100 person-years in those who were and were not currently receiving ABC, respectively, post-MI. No association was seen with recurrent MI and either cumulative exposure to ABC [relative rate 0.86 (0.68-1.10)/5 years], receipt of ABC at index MI [0.90 (0.63-1.29)] nor recent post-MI exposure to ABC [1.19 (0.82-1.71)]. Conclusion: Among people with a previous MI, there was no evidence for an association between use of ABC post-MI and an elevated risk of a recurrent MI., SCOPUS: ar.j, info:eu-repo/semantics/published
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- 2018
12. Use of Contemporary Protease Inhibitors and Risk of Incident Chronic Kidney Disease in Persons With Human Immunodeficiency Virus: the Data Collection on Adverse Events of Anti-HIV Drugs (D:A:D) Study.
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Ryom, Lene, Lundgren, Jens Dilling, Reiss, Peter, Kirk, Ole, Law, Matthew, Ross, Mike, Morlat, Phillip, Fux, Christoph Andreas, Fontas, Eric, Wit, Stephane De, Monforte, Antonella D'Arminio, El-Sadr, Wafaa, Phillips, Andrew, Hatleberg, Camilla Ingrid, Sabin, Caroline, Mocroft, Amanda, Group, Data Collection on Adverse Events of Anti-HIV Drugs (D:A:D) Study, Dilling Lundgren, Jens, Andreas Fux, Christoph, and De Wit, Stephane
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ANTI-HIV agents ,CHRONIC kidney failure ,HIV ,PROTEASE inhibitors ,ACQUISITION of data ,HIV infection complications ,COMPARATIVE studies ,HIV infections ,LONGITUDINAL method ,RESEARCH methodology ,MEDICAL cooperation ,RESEARCH ,RISK assessment ,EVALUATION research ,DISEASE incidence ,HIV protease inhibitors - Abstract
Background: It is unclear whether use of contemporary protease inhibitors pose a similar risk of chronic kidney disease (CKD) as use of older protease inhibitors.Methods: Participants in the Data Collection on Adverse Events of Anti-HIV Drugs (D:A:D) study were followed up until the earliest occurrence of CKD, the last visit plus 6 months, or 1 February 2016. Adjusted Poisson regression was used to assess associations between CKD and the use of ritonavir-boosted atazanavir (ATV/r) or ritonavir-boosted darunavir (DRV/r).Results: The incidence of CKD (10.0/1000 person-years of follow-up; 95% confidence interval, 9.5-10.4/1000 person-years of follow-up) increased gradually with increasing exposure to ATV/r, but the relation was less clear for DRV/r. After adjustment, only exposure to ATV/r (adjusted incidence rate ratio, 1.4; 95% confidence interval, 1.2-1.6), but not exposure to DRV/r (1.0; .8-1.3), remained significantly associated with CKD.Conclusion: While DRV/r use was not significantly associated with CKD an increasing incidence with longer ATV/r use was confirmed. [ABSTRACT FROM AUTHOR]- Published
- 2019
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13. Role of pre-stroke immunity in ischemic stroke mechanism among patients with HIV
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Gutierrez, Jose, primary, Hatleberg, Camilla Ingrid, additional, Evans, Henry, additional, and Yin, Michael T., additional
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- 2018
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14. Differences in Virological and Immunological Risk Factors for Non-Hodgkin and Hodgkin Lymphoma
- Author
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Shepherd, Leah, primary, Ryom, Lene, additional, Law, Matthew, additional, Hatleberg, Camilla Ingrid, additional, de Wit, Stephane, additional, Monforte, Antonella d'Arminio, additional, Battegay, Manuel, additional, Phillips, Andrew, additional, Bonnet, Fabrice, additional, Reiss, Peter, additional, Pradier, Christian, additional, Grulich, Andrew, additional, Sabin, Caroline, additional, Lundgren, Jens, additional, and Mocroft, Amanda, additional
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- 2017
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15. Cardiovascular disease (CVD) and chronic kidney disease (CKD) event rates in HIV-positive persons at high predicted CVD and CKD risk:A prospective analysis of the D:A:D observational study
- Author
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Boyd, Mark A, Mocroft, Amanda, Ryom, Lene, Monforte, Antonella d'Arminio, Sabin, Caroline, El-Sadr, Wafaa M, Hatleberg, Camilla Ingrid, De Wit, Stephane, Weber, Rainer, Fontas, Eric, Phillips, Andrew, Bonnet, Fabrice, Reiss, Peter, Lundgren, Jens, Law, Matthew, Boyd, Mark A, Mocroft, Amanda, Ryom, Lene, Monforte, Antonella d'Arminio, Sabin, Caroline, El-Sadr, Wafaa M, Hatleberg, Camilla Ingrid, De Wit, Stephane, Weber, Rainer, Fontas, Eric, Phillips, Andrew, Bonnet, Fabrice, Reiss, Peter, Lundgren, Jens, and Law, Matthew
- Abstract
BACKGROUND: The Data Collection on Adverse Events of Anti-HIV Drugs (D:A:D) study has developed predictive risk scores for cardiovascular disease (CVD) and chronic kidney disease (CKD, defined as confirmed estimated glomerular filtration rate [eGFR] ≤ 60 ml/min/1.73 m2) events in HIV-positive people. We hypothesized that participants in D:A:D at high (>5%) predicted risk for both CVD and CKD would be at even greater risk for CVD and CKD events.METHODS AND FINDINGS: We included all participants with complete risk factor (covariate) data, baseline eGFR > 60 ml/min/1.73 m2, and a confirmed (>3 months apart) eGFR < 60 ml/min/1.73 m2 thereafter to calculate CVD and CKD risk scores. We calculated CVD and CKD event rates by predicted 5-year CVD and CKD risk groups (≤1%, >1%-5%, >5%) and fitted Poisson models to assess whether CVD and CKD risk group effects were multiplicative. A total of 27,215 participants contributed 202,034 person-years of follow-up: 74% male, median (IQR) age 42 (36, 49) years, median (IQR) baseline year of follow-up 2005 (2004, 2008). D:A:D risk equations predicted 3,560 (13.1%) participants at high CVD risk, 4,996 (18.4%) participants at high CKD risk, and 1,585 (5.8%) participants at both high CKD and high CVD risk. CVD and CKD event rates by predicted risk group were multiplicative. Participants at high CVD risk had a 5.63-fold (95% CI 4.47, 7.09, p < 0.001) increase in CKD events compared to those at low risk; participants at high CKD risk had a 1.31-fold (95% CI 1.09, 1.56, p = 0.005) increase in CVD events compared to those at low risk. Participants' CVD and CKD risk groups had multiplicative predictive effects, with no evidence of an interaction (p = 0.329 and p = 0.291 for CKD and CVD, respectively). The main study limitation is the difference in the ascertainment of the clinically defined CVD endpoints and the laboratory-defined CKD endpoints.CONCLUSIONS: We found that people at high predicted risk for bo
- Published
- 2017
16. Cardiovascular disease (CVD) and chronic kidney disease (CKD) event rates in HIV-positive persons at high predicted CVD and CKD risk: a prospective analysis of the D:A:D observational study
- Author
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Boyd, Mark A; https://orcid.org/0000-0002-6848-3307, Mocroft, Amanda, Ryom, Lene, Monforte, Antonella d'Arminio; https://orcid.org/0000-0003-0073-1789, Sabin, Caroline; https://orcid.org/0000-0001-5173-2760, El-Sadr, Wafaa M; https://orcid.org/0000-0003-3735-9781, Hatleberg, Camilla Ingrid, De Wit, Stephane; https://orcid.org/0000-0002-8079-6170, Weber, Rainer, Fontas, Eric, Phillips, Andrew; https://orcid.org/0000-0003-2384-4807, Bonnet, Fabrice, Reiss, Peter, Lundgren, Jens, Law, Matthew, Boyd, Mark A; https://orcid.org/0000-0002-6848-3307, Mocroft, Amanda, Ryom, Lene, Monforte, Antonella d'Arminio; https://orcid.org/0000-0003-0073-1789, Sabin, Caroline; https://orcid.org/0000-0001-5173-2760, El-Sadr, Wafaa M; https://orcid.org/0000-0003-3735-9781, Hatleberg, Camilla Ingrid, De Wit, Stephane; https://orcid.org/0000-0002-8079-6170, Weber, Rainer, Fontas, Eric, Phillips, Andrew; https://orcid.org/0000-0003-2384-4807, Bonnet, Fabrice, Reiss, Peter, Lundgren, Jens, and Law, Matthew
- Abstract
BACKGROUND: The Data Collection on Adverse Events of Anti-HIV Drugs (D:A:D) study has developed predictive risk scores for cardiovascular disease (CVD) and chronic kidney disease (CKD, defined as confirmed estimated glomerular filtration rate [eGFR] ≤ 60 ml/min/1.73 m2) events in HIV-positive people. We hypothesized that participants in D:A:D at high (>5%) predicted risk for both CVD and CKD would be at even greater risk for CVD and CKD events. METHODS AND FINDINGS: We included all participants with complete risk factor (covariate) data, baseline eGFR > 60 ml/min/1.73 m2, and a confirmed (>3 months apart) eGFR < 60 ml/min/1.73 m2 thereafter to calculate CVD and CKD risk scores. We calculated CVD and CKD event rates by predicted 5-year CVD and CKD risk groups (≤1%, >1%-5%, >5%) and fitted Poisson models to assess whether CVD and CKD risk group effects were multiplicative. A total of 27,215 participants contributed 202,034 person-years of follow-up: 74% male, median (IQR) age 42 (36, 49) years, median (IQR) baseline year of follow-up 2005 (2004, 2008). D:A:D risk equations predicted 3,560 (13.1%) participants at high CVD risk, 4,996 (18.4%) participants at high CKD risk, and 1,585 (5.8%) participants at both high CKD and high CVD risk. CVD and CKD event rates by predicted risk group were multiplicative. Participants at high CVD risk had a 5.63-fold (95% CI 4.47, 7.09, p < 0.001) increase in CKD events compared to those at low risk; participants at high CKD risk had a 1.31-fold (95% CI 1.09, 1.56, p = 0.005) increase in CVD events compared to those at low risk. Participants' CVD and CKD risk groups had multiplicative predictive effects, with no evidence of an interaction (p = 0.329 and p = 0.291 for CKD and CVD, respectively). The main study limitation is the difference in the ascertainment of the clinically defined CVD endpoints and the laboratory-defined CKD endpoints. CONCLUSIONS: We found that people at high predicted risk for both CVD and CKD have substantially gr
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- 2017
17. Cardiovascular disease (CVD) and chronic kidney disease (CKD) event rates in HIV-positive persons at high predicted CVD and CKD risk: A prospective analysis of the D:A:D observational study
- Author
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Boyd, Mark M.A., Fontas, Eric, Phillips, Andrew N., Bonnet, Fabrice, Reiss, Peter, Lundgren, Jens D D J., Law, Matthew, Mocroft, Amanda, Ryom, Lene, d'Arminio Monforte, Antonella, Sabin, Caroline, El-Sadr, W.M., Hatleberg, Camilla Ingrid, De Wit, Stéphane, Weber, Rainer, Boyd, Mark M.A., Fontas, Eric, Phillips, Andrew N., Bonnet, Fabrice, Reiss, Peter, Lundgren, Jens D D J., Law, Matthew, Mocroft, Amanda, Ryom, Lene, d'Arminio Monforte, Antonella, Sabin, Caroline, El-Sadr, W.M., Hatleberg, Camilla Ingrid, De Wit, Stéphane, and Weber, Rainer
- Abstract
BACKGROUND: The Data Collection on Adverse Events of Anti-HIV Drugs (D:A:D) study has developed predictive risk scores for cardiovascular disease (CVD) and chronic kidney disease (CKD, defined as confirmed estimated glomerular filtration rate [eGFR] ≤ 60 ml/min/1.73 m2) events in HIV-positive people. We hypothesized that participants in D:A:D at high (>5%) predicted risk for both CVD and CKD would be at even greater risk for CVD and CKD events., SCOPUS: ar.j, info:eu-repo/semantics/published
- Published
- 2017
18. Cessation of Cigarette Smoking and the Impact on Cancer Incidence in Human Immunodeficiency Virus–infected Persons: The Data Collection on Adverse Events of Anti-HIV Drugs Study.
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Shepherd, Leah, Ryom, Lene, Law, Matthew, Petoumenos, Kathy, Hatleberg, Camilla Ingrid, Monforte, Antonella d'Arminio, Sabin, Caroline, Bower, Mark, Bonnet, Fabrice, Reiss, Peter, Wit, Stephane de, Pradier, Christian, Weber, Rainer, el-Sadr, Wafaa, Lundgren, Jens, Mocroft, Amanda, and Group, Data Collection on Adverse Events of Anti-HIV Drugs (D:A:D) Study
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CONFIDENCE intervals ,HIV-positive persons ,REGRESSION analysis ,LUNG tumors ,SMOKING cessation ,DISEASE incidence ,ODDS ratio ,DIAGNOSIS ,PREVENTION - Abstract
Background Cancers are a major source of morbidity and mortality for human immunodeficiency virus (HIV)–infected persons, but the clinical benefits of smoking cessation are unknown. Methods Participants were followed from 1 January 2004 until first cancer diagnosis, death, or 1 February 2016. Smoking status was defined as ex-smoker, current smoker, and never smoker. Adjusted incidence rate ratios (aIRRs) were calculated using Poisson regression, adjusting for demographic and clinical factors. Results In total 35442 persons from the Data Collection on Adverse Events of Anti-HIV Drugs (D:A:D) study contributed 309803 person-years of follow-up. At baseline, 49% were current smokers, 21% were ex-smokers, and 30% had never smoked. Incidence of all cancers combined (n = 2183) was highest <1 year after smoking cessation compared to never smokers (aIRR, 1.66 [95% confidence interval {CI}, 1.37–2.02]) and not significantly different from never smokers 1–1.9 years after cessation. Lung cancer incidence (n = 271) was elevated <1 year after cessation (aIRR, 19.08 [95% CI, 8.10–44.95]) and remained 8-fold higher 5 years after smoking cessation (aIRR, 8.69 [95% CI, 3.40–22.18]). Incidence of other smoking-related cancers (n = 622) was elevated in the first year after cessation (aIRR, 2.06 [95% CI, 1.42–2.99]) and declined to a level similar to nonsmokers thereafter. Conclusions Lung cancer incidence in HIV-infected individuals remained elevated >5 years after smoking cessation. Deterring uptake of smoking and smoking cessation efforts should be prioritised to reduce future cancer risk. [ABSTRACT FROM AUTHOR]
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- 2019
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19. Role of pre-stroke immunity in ischemic stroke mechanism among patients with HIV.
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Gutierrez, Jose, Hatleberg, Camilla Ingrid, Evans, Henry, and Yin, Michael T.
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ATHEROSCLEROSIS complications , *VASCULAR diseases , *HIV infection complications , *ANTIRETROVIRAL agents , *CEREBRAL ischemia , *CONFIDENCE intervals , *EMBOLISMS , *HIV infections , *HIV-positive persons , *HOSPITAL admission & discharge , *NEUROLOGISTS , *NOSOLOGY , *PATIENTS , *REGRESSION analysis , *STROKE , *LOGISTIC regression analysis , *SYMPTOMS , *MEDICAL records , *RETROSPECTIVE studies , *HIV seroconversion , *CD4 lymphocyte count , *TERTIARY care , *ODDS ratio , *DISEASE complications , *DISEASE risk factors - Abstract
Individuals with HIV are at a higher risk of stroke compared to uninfected populations. The role of HIV-related immunosuppression in stroke mechanism is uncertain. Our aim is to test the hypothesis that stroke mechanisms among HIV+ individuals vary according to preceding CD4 counts. We carried out a retrospective chart review of inpatient admissions for ICD-9 defined ischemic events (TIA or stroke) in HIV+ individuals from 2002 to 2016 at a tertiary care center. Stroke mechanisms were ascertained based on radiographic and clinical presentation, and adjudicated by the treating team and confirmed separately by a vascular neurologist. Vascular risk factors, use of antiretroviral drugs (ARVs), nadir CD4 and current CD4 counts (cells/mm3) were captured to build logistic regressions and generalized linear models to calculate the odds ratios (OR) and beta estimates with their respective 95% confidence intervals. We found that among 115 cases (median age 52, 64% men), stroke mechanisms were 22% due to large artery atherosclerosis (LAA), 17% small artery disease, 16% infectious, 8% cardioembolic, 21% cryptogenic, and 16% other etiologies. The median nadir CD4-count was 153 (IQR 22-274), and 312 (IQR 88-518) at the time of stroke, and 53% were on ARVs. LAA was more common with longer HIV infection (OR 1.1 per year, 1.0-1.2) and nadir CD4 counts <200 (OR 6.7, 1.4-31.9). Stroke due to LAA was associated with higher CD4 count the year prior to stroke (B = 0.009, P = 0.06 for the interaction) independent of CD4 nadir <200 (B = 1.88, P = 0.035). We concluded that in this sample, LAA was the most frequent stroke mechanism among HIV+ individuals with nadir CD4 < 200 but higher CD4 counts near the time of stroke. Determining the association between pre-stroke immune status and stroke mechanisms may allow a targeted approach to stroke prevention. [ABSTRACT FROM AUTHOR]
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- 2019
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20. Renal Impairment and Cardiovascular Disease in HIV-Positive Individuals:The D:A:D Study
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Nielsen, Lene Ryom, Lundgren, Jens D, Ross, Mike, Kirk, Ole, Law, Matthew, Morlat, Philippe, Fontas, Eric, Smit, Colette, Fux, Christoph A, Hatleberg, Camilla Ingrid, De Wit, Stephane, Sabin, Caroline A, Mocroft, Amanda, Nielsen, Lene Ryom, Lundgren, Jens D, Ross, Mike, Kirk, Ole, Law, Matthew, Morlat, Philippe, Fontas, Eric, Smit, Colette, Fux, Christoph A, Hatleberg, Camilla Ingrid, De Wit, Stephane, Sabin, Caroline A, and Mocroft, Amanda
- Abstract
BACKGROUND: While the association between renal impairment and cardiovascular disease (CVD) is well established in the general population, the association remains poorly understood in human immunodeficiency virus (HIV)-positive individuals.METHODS: Individuals with ≥2 estimated glomerular filtration rate (eGFR) measurements after 1 February 2004 were followed until CVD, death, last visit plus 6 months, or 1 February 2015. CVD was defined as the occurrence of centrally validated myocardial infarction, stroke, invasive cardiovascular procedures, or sudden cardiac death.RESULTS: During a median follow-up duration of 8.0 years (interquartile range, 5.4-8.9 years) 1357 of 35 357 individuals developed CVD (incidence rate, 5.2 cases/1000 person-years [95% confidence interval {CI}, 5.0-5.5]). Confirmed baseline eGFR and CVD were closely related with 1.8% of individuals (95% CI, 1.6%-2.0%) with an eGFR > 90 mL/minute/1.73 m(2) estimated to develop CVD at 5 years, increasing to 21.1% (95% CI, 6.6%-35.6%) among those with an eGFR ≤ 30 mL/minute/1.73 m(2) The strong univariate relationship between low current eGFR and CVD was primarily explained by increasing age in adjusted analyses, although all eGFRs ≤ 80 mL/minute/1.73 m(2) remained associated with 30%-40% increased CVD rates, and particularly high CVD rates among individuals with an eGFR ≤ 30 mL/minute/1.73 m(2) (incidence rate ratio, 3.08 [95% CI, 2.04-4.65]).CONCLUSIONS: Among HIV-positive individuals in a large contemporary cohort, a strong relation between confirmed impaired eGFR and CVD was observed. This finding highlights the need for renal preventive measures and intensified monitoring for emerging CVD, particularly in older individuals with continuously low eGFRs.
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- 2016
21. Impact of Antiretroviral Drugs on Hypertension in HIV-positive Persons: D:A:D Study
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Conference on Retroviruses and Opportunistic Infections - CROI 2015 (22: February 23-26, 2015: Seattle, USA), Hatleberg, Camilla Ingrid, Ryom, Lene, d'Arminio Monforte, Antonella, Fontas, Eric, Reiss, Peter, Kirk, Ole, El-Sadr, Wafaa, De Wit, Stéphane, Dabis, François, Weber, Rainer, Law, Mathew M.G., Lundgren, Jens D, Sabin, Caroline, Conference on Retroviruses and Opportunistic Infections - CROI 2015 (22: February 23-26, 2015: Seattle, USA), Hatleberg, Camilla Ingrid, Ryom, Lene, d'Arminio Monforte, Antonella, Fontas, Eric, Reiss, Peter, Kirk, Ole, El-Sadr, Wafaa, De Wit, Stéphane, Dabis, François, Weber, Rainer, Law, Mathew M.G., Lundgren, Jens D, and Sabin, Caroline
- Abstract
On behalf of the D:A:D Study Group, info:eu-repo/semantics/nonPublished
- Published
- 2015
22. Gender differences in HIV-positive persons in use of cardiovascular diseases-related Interventions: D:A:D study
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International Congress on Drug Therapy in HIV infection (12: November 2-6 2014: Glasgow, UK), Hatleberg, Camilla Ingrid, Ryom, Lene, El-Sadr, Wafaa, Mocroft, Amanda, Reiss, Peter, De Wit, Stéphane, Dabis, François, Pradier, Christian, d'Arminio Monforte, Antonella, Rickenbach, Martin, Law, Mathew M.G., Lundgren, Jens D, Sabin, Caroline, International Congress on Drug Therapy in HIV infection (12: November 2-6 2014: Glasgow, UK), Hatleberg, Camilla Ingrid, Ryom, Lene, El-Sadr, Wafaa, Mocroft, Amanda, Reiss, Peter, De Wit, Stéphane, Dabis, François, Pradier, Christian, d'Arminio Monforte, Antonella, Rickenbach, Martin, Law, Mathew M.G., Lundgren, Jens D, and Sabin, Caroline
- Abstract
info:eu-repo/semantics/nonPublished
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- 2014
23. Cardiovascular disease (CVD) and chronic kidney disease (CKD) event rates in HIV-positive persons at high predicted CVD and CKD risk: A prospective analysis of the D:A:D observational study
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Boyd, Mark A., Mocroft, Amanda, Ryom, Lene, Monforte, Antonella D'Arminio, Sabin, Caroline, El-Sadr, Wafaa Mahmoud, Hatleberg, Camilla Ingrid, De Wit, Stephane, Weber, Rainer, Fontas, Eric, Phillips, Andrew, Bonnet, Fabrice, Reiss, Peter, Lundgren, Jens D., and Law, Matthew
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Kidneys--Diseases ,Comorbidity ,HIV-positive persons ,urologic and male genital diseases ,16. Peace & justice ,Cardiovascular system--Diseases--Risk factors ,female genital diseases and pregnancy complications ,3. Good health ,Forecasting - Abstract
Background: The Data Collection on Adverse Events of Anti-HIV Drugs (D:A:D) study has developed predictive risk scores for cardiovascular disease (CVD) and chronic kidney disease (CKD, defined as confirmed estimated glomerular filtration rate [eGFR] ≤ 60 ml/min/1.73 m2) events in HIV-positive people. We hypothesized that participants in D:A:D at high (>5%) predicted risk for both CVD and CKD would be at even greater risk for CVD and CKD events. Methods and findings: We included all participants with complete risk factor (covariate) data, baseline eGFR > 60 ml/min/1.73 m2, and a confirmed (>3 months apart) eGFR < 60 ml/min/1.73 m2 thereafter to calculate CVD and CKD risk scores. We calculated CVD and CKD event rates by predicted 5-year CVD and CKD risk groups (≤1%, >1%–5%, >5%) and fitted Poisson models to assess whether CVD and CKD risk group effects were multiplicative. A total of 27,215 participants contributed 202,034 person-years of follow-up: 74% male, median (IQR) age 42 (36, 49) years, median (IQR) baseline year of follow-up 2005 (2004, 2008). D:A:D risk equations predicted 3,560 (13.1%) participants at high CVD risk, 4,996 (18.4%) participants at high CKD risk, and 1,585 (5.8%) participants at both high CKD and high CVD risk. CVD and CKD event rates by predicted risk group were multiplicative. Participants at high CVD risk had a 5.63-fold (95% CI 4.47, 7.09, p < 0.001) increase in CKD events compared to those at low risk; participants at high CKD risk had a 1.31-fold (95% CI 1.09, 1.56, p = 0.005) increase in CVD events compared to those at low risk. Participants’ CVD and CKD risk groups had multiplicative predictive effects, with no evidence of an interaction (p = 0.329 and p = 0.291 for CKD and CVD, respectively). The main study limitation is the difference in the ascertainment of the clinically defined CVD endpoints and the laboratory-defined CKD endpoints. Conclusions: We found that people at high predicted risk for both CVD and CKD have substantially greater risks for both CVD and CKD events compared with those at low predicted risk for both outcomes, and compared to those at high predicted risk for only CVD or CKD events. This suggests that CVD and CKD risk in HIV-positive persons should be assessed together. The results further encourage clinicians to prioritise addressing modifiable risks for CVD and CKD in HIV-positive people.
24. Predictors of Ischemic and Hemorrhagic Strokes Among People Living With HIV: The D:A:D International Prospective Multicohort Study
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Fabrice Bonnet, Jens D Lundgren, Stéphane De Wit, Camilla Ingrid Hatleberg, Helen Kovari, Ole Kirk, Andrew N. Phillips, Lene Ryom, David Kamara, Caroline A. Sabin, Antonella d'Arminio Monforte, Wafaa El-Sadr, Peter Reiss, Matthew Law, Amanda Mocroft, Christian Pradier, University of Copenhagen = Københavns Universitet (KU), Université libre de Bruxelles (ULB), Bordeaux population health (BPH), Université de Bordeaux (UB)-Institut de Santé Publique, d'Épidémiologie et de Développement (ISPED)-Institut National de la Santé et de la Recherche Médicale (INSERM), Infectious diseases, AII - Infectious diseases, APH - Aging & Later Life, Global Health, University of Zurich, and Hatleberg, Camilla Ingrid
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medicine.medical_specialty ,Population ,Renal function ,610 Medicine & health ,2700 General Medicine ,Disease ,01 natural sciences ,10234 Clinic for Infectious Diseases ,03 medical and health sciences ,0302 clinical medicine ,[SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system ,[SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases ,Internal medicine ,Medicine ,030212 general & internal medicine ,0101 mathematics ,education ,Adverse effect ,Cerebrovascular disease ,Stroke ,education.field_of_study ,lcsh:R5-920 ,Ischemic stroke ,business.industry ,010102 general mathematics ,HIV ,Généralités ,General Medicine ,Hepatitis C ,medicine.disease ,Confidence interval ,3. Good health ,Blood pressure ,Risk factors ,Stratified risk prediction ,Cardiology ,[SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie ,business ,lcsh:Medicine (General) ,Hemorrhagic stroke ,Research Paper - Abstract
Background: Hypertension is a stronger predictor of hemorrhagic than ischemic strokes in the general population. We aimed to identify whether hypertension or other risk factors, including HIV-related factors, differ in their associations with stroke subtypes in people living with HIV (PLWHIV). Methods: HIV-1-positive individuals from the Data collection on Adverse events of anti-HIV Drugs (D:A:D) study were followed from the time of first blood pressure (BP) measurement after 1/1/1999 or study entry until the first of a validated stroke, 6 months after last follow-up or 1/2/2014. Stroke events were centrally validated using standardized criteria. Hypertension was defined as one systolic BP ≥ 140 mm Hg and/or diastolic BP ≥ 90 mm Hg. Poisson and Cox proportional hazards regression models determined associations of established cerebro/cardiovascular disease and HIV-related risk factors with stroke and tested whether these differed by stroke subtype. Findings: 590 strokes (83 hemorrhagic, 296 ischemic, 211 unknown) occurred over 339,979 person-years (PYRS) (incidence rate/1000 PYRS 1.74 [95% confidence interval (CI) 1.60–1.88]). Common predictors of both hemorrhagic and ischemic strokes were hypertension (relative hazard 3.55 [95% CI 2.29–5.50] and 2.24 [1.77–2.84] respectively) and older age (1.28 [1.17–1.39] and 1.19 [1.12–1.25]). Male gender (1.62 [1.14–2.31] and 0.60 [0.35–0.91]), previous cardiovascular events (4.03 [2.91–5.57] and 1.44 [0.66–3.16]) and smoking (1.90 [1.41–2.56] and 1.08 [0.68–1.71]) were stronger predictors of ischemic then hemorrhagic strokes, whereas hypertension, hepatitis C (1.32 [0.72–2.40] and 0.46 [0.30–0.70]) and estimated glomerular filtration rate < 60 mL/min/1.72 m3 (4.80 [2.47–9.36] and 1.04 [0.67–1.60]) were stronger predictors of hemorrhagic than ischemic strokes. A CD4 count < 200 cells/μL was associated with an increased risk of hemorrhagic stroke only. Interpretation: Risk factors for stroke may differ by subtype in PLWHIV, emphasizing the importance of further research to increase the precision of stroke risk estimation., SCOPUS: ar.j, info:eu-repo/semantics/published
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- 2019
25. Improvements over time in short-term mortality following myocardial infarction in HIV-positive individuals
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Wafaa El-Sadr, Jens D Lundgren, Camilla Ingrid Hatleberg, Peter Reiss, Matthew Law, Caroline A. Sabin, François Dabis, Antonella d'Arminio Monforte, Lene Ryom, Eric Fontas, Amanda Mocroft, Colette Smith, Stéphane De Wit, Andrew N. Phillips, Rainer Weber, University of Zurich, Hatleberg, Camilla Ingrid, Global Health, and Infectious diseases
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Adult ,Male ,Pediatrics ,medicine.medical_specialty ,Immunology ,Population ,Psychological intervention ,Myocardial Infarction ,610 Medicine & health ,HIV Infections ,030204 cardiovascular system & hematology ,10234 Clinic for Infectious Diseases ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Immunology and Allergy ,Humans ,030212 general & internal medicine ,Myocardial infarction ,Prospective Studies ,education ,Prospective cohort study ,Survival analysis ,education.field_of_study ,2403 Immunology ,business.industry ,Incidence (epidemiology) ,Incidence ,Disease Management ,Odds ratio ,2725 Infectious Diseases ,Middle Aged ,medicine.disease ,Survival Analysis ,Confidence interval ,Infectious Diseases ,2723 Immunology and Allergy ,Female ,business - Abstract
OBJECTIVE Few studies have described mortality and clinical outcomes after myocardial infarction (MI) in the HIV-positive population. This study evaluated changes in short-term mortality after MI in HIV-positive individuals in the D:A:D Study, and investigated possible reasons for any changes seen. DESIGN Prospective cohort study. METHODS Demographic, cardiovascular disease (CVD)/HIV-related characteristics and CVD-related interventions (invasive cardiovascular procedures and drug interventions) were summarized at the time of and following an MI. Associations between calendar year and mortality in the first month after MI were identified using logistic regression with adjustment for confounders, including interventions received in the first month after MI. RESULTS One thousand and eight HIV-positive individuals experiencing an MI over the period 1999-2014 were included. The absolute number of MIs decreased from 214 (1999-2002) to 154 (2011-2014). Whilst the CVD risk profile remained high over time, the HIV status improved. The use of CVD-related interventions after MI appeared to increase over time. The proportion of individuals who died in the first month after MI dropped from 26.6% in 1999-2002 to 8.4% in 2011-2014. Later calendar year was associated with decreased short-term mortality; this effect was attenuated after adjusting for CVD-related interventions received in the first month after MI [odds ratio changed from 0.88 (95% confidence interval 0.83, 0.93) to 0.97 (0.91, 1.02)]. CONCLUSION Improvements in short-term survival after MI appear to be largely driven by improved medical management of CVD risk in HIV-positive individuals after MI. Efforts are still needed to treat CVD risk factors and increase access to CVD-related interventions.
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- 2016
26. Differences in Virological and Immunological Risk Factors for Non-Hodgkin and Hodgkin Lymphoma.
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Shepherd L, Ryom L, Law M, Hatleberg CI, de Wit S, Monforte AD, Battegay M, Phillips A, Bonnet F, Reiss P, Pradier C, Grulich A, Sabin C, Lundgren J, and Mocroft A
- Subjects
- Adult, Aged, Aged, 80 and over, Anti-HIV Agents therapeutic use, CD4 Lymphocyte Count, CD4-Positive T-Lymphocytes drug effects, Cohort Studies, Female, Follow-Up Studies, HIV Infections drug therapy, HIV Infections epidemiology, HIV Infections immunology, HIV Infections virology, Hodgkin Disease epidemiology, Humans, Immunocompromised Host immunology, Incidence, Lymphoma, Non-Hodgkin epidemiology, Male, Middle Aged, Risk Factors, Treatment Outcome, Young Adult, CD4-Positive T-Lymphocytes physiology, Hodgkin Disease immunology, Hodgkin Disease virology, Lymphoma, Non-Hodgkin immunology, Lymphoma, Non-Hodgkin virology, Viral Load physiology
- Abstract
Background: Non-Hodgkin lymphoma (NHL) and Hodgkin lymphoma (HL) are increased in populations with immune dysfunction, including people living with HIV; however, there is little evidence for to what degree immunological and virological factors differently affect NHL and HL risk., Methods: Data from the Data Collection on Adverse events of Anti-HIV Drugs Study cohort were analyzed to identify independent risk factors for NHL and HL using hazard ratios (HRs), focusing on current and cumulative area under the curve (AUC) measures of immunological and virological status. Variables with different associations with NHL and HL were identified using marginal Cox models. All statistical tests were two-sided., Results: Among 41 420 people followed for 337 020 person-years, 392 developed NHL (incidence rate = 1.17/1000 person-years of follow-up [PYFU], 95% confidence interval [CI] = 1.06 to 1.30) and 149 developed HL (incidence rate = 0.44/1000 PYFU, 95% CI = 0.38 to 0.52). Higher risk of both NHL and HL was associated with lower current CD4 cell count (adjusted HR [aHR] of NHL for CD4 <100 vs > 599 cells/mm3 = 8.08, 95% CI = 5.63 to 11.61; HL = 4.58, 95% CI = 2.22 to 9.45), whereas higher current HIV viral load (aHR of NHL for HIV-VL >1000 vs < 50 copies/mL = 1.97, 95% CI = 1.50 to 2.59) and higher AUC of HIV-VL (aHR of NHL for highest vs lowest quintile = 2.91, 95% CI = 1.92 to 4.41) were associated with NHL only. Both current and AUC of HIV-VL were factors that had different associations with NHL and HL, where the hazard ratio for NHL was progressively higher than for HL with increasing HIV-VL category. Lower current CD4 cell count had a strong but similar association with both NHL and HL., Conclusions: CD4 depletion increased risk of both types of lymphomas while current and accumulated HIV-VL was associated with NHL only. This suggests that NHL development is related to both CD4 cell depletion and added immune dysfunction derived from ongoing HIV replication. This latter factor was not associated with HL risk.
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- 2018
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27. A review of paediatric tuberculosis in Denmark: 10-year trend, 2000-2009.
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Hatleberg CI, Prahl JB, Rasmussen JN, Andersen PH, Bjerrum S, Thomsen VØ, and Johansen IS
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- Adolescent, Child, Child, Preschool, Communicable Disease Control, Denmark epidemiology, Female, Humans, Incidence, Infant, Infant, Newborn, Male, Recurrence, Registries, Risk, Treatment Outcome, Tuberculosis microbiology, Tuberculosis therapy, Tuberculosis, Pulmonary microbiology, Tuberculosis, Pulmonary therapy, Tuberculosis epidemiology, Tuberculosis, Pulmonary epidemiology
- Abstract
Paediatric tuberculosis (TB) is a key indicator for recent transmission and presents a reservoir for the disease. We describe trends in epidemiology, microbiological characteristics and treatment outcome in Denmark between 2000 and 2009. Data were retrieved from the national TB surveillance system and the International Reference Laboratory of Mycobacteriology. In total, 323 TB cases were reported in children aged <15 years, accounting for 7.6% of all notified cases in Denmark. The overall incidence rate of childhood TB declined from 4.1 per 100,000 to 1.9 per 100,000 in the study period. Immigrant children comprised 79.6% of all cases, with the highest incidence rate of 94.1 per 100,000 children in 2001. In contrast to immigrant children, the majority of Danish children were aged <5 years and had a known exposure to TB. Pulmonary TB was the commonest presentation. Only half of the cases were culture confirmed. We observed an overall decreasing trend in the child to adult notification ratio, but a slight increase in the ratio when calculated specifically for ethnic Danes. Childhood TB needs continuous attention with a special focus on risk groups. Emphasis on improving early TB case detection, contact tracing and further implementation of preventive treatment is necessary.
- Published
- 2014
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