Co-morbidities associated with HIV

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1. Santoro N, et al. Maturitas 2009;64:160-4
2. Fumaz C, et al. First International Workshop on HIV and Aging. October 4-5, 2010. Baltimore. Abstract O_13
3. McComsey G, et al. CID 2009;48:1323
4. Maki PM, et al. Neuropsychol Rev 2009;19:204–14
5. Grulich AE, et al. Lancet 2007;370:59–67


Lipodystrophy in women with HIV

1. Galli M, et al. JAIDS 2003;34:58
2. Jacobson D, et al. CID 2005;40:1837
3. McComsey G, et al. CID 2009;48:1323
4. Wells J, et al. Best Pract Res Clin Endocrinol Metab 2007;21:415


CV risk factors increased in HIV-infected women

1. Floris-Moore M, et al. HIV Med 2006;7:421–30
2. Lang S, et al. AIDS 2010; 24:1228–30


Less favourable changes in lipids with LPV/r vs NVP

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Shaffer D, et al. 18th CROI 2011. Poster 818


CASTLE: Mean percentage changes in fasting lipids over 96 weeks generally greater in women and men receiving LPV/r than in those receiving ATV/r

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Squires KE et al. J Antimicrob Chemother 2011; 66: 363–370


Quebec Cohort: MI risk by PI

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Adjusted for use of anti-diabetic drugs, anti-hypertensive drugs, lipid-lowering drugs, and anti-platelet drugs or warfarin Time of follow up (pts/yrs)=1577.4+1191.3 (cases [N=125]); 1582.6+1219.5 (controls [n=1084])
Durand M, et al. IAS 2009; Poster# TUPEB175


Increased rates of diabetes in HIV+ women

Diabetes amoung HAART-experienced HIV-infected women, HOPS and SUN studies, 2003-2006

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Buchacz K, et al. 18th CROI 2011. Abstract 786


Improved glucose tolerance with ATV/r vs LPV/r

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Stanley TL, et al. AIDS 2009;23:1349–57


Co-morbidities associated with HIV

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1. Santoro N, et al. Maturitas 2009;64:160-4
2. Fumaz C, et al. First International Workshop on HIV and Aging. October 4-5, 2010. Baltimore. Abstract O_13
3. McComsey G, et al. CID 2009;48:1323
4. Maki PM, et al. Neuropsychol Rev 2009;19:204–14
5. Grulich AE, et al. Lancet 2007;370:59–67


Risk of osteoporosis (T-score ≤–2.5) in HIV-infected patients and controls: A meta-analysis

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Figure adapted from Brown TT, et al. AIDS 2006:20;2165–74

1. Duvivier C, et al. AIDS 2009; 27:817–24
2. Woodward CL, et al. HIV Medicine 2009;10:482–7


Risk factors for fracture in patients with HIV

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*Risk ratio: 1.95 for a BMI of 20 vs 25

Amorosa V, et al. Clin Infect Dis 2006;42:108–14


Probability of fracture higher in HIV+ patients vs matched controls

  • Cross-sectional case-control comparison of 223 randomly selected HIV patients (40% women, 48% whites, 33% people with an AIDS diagnosis, 85% taking HAART) and age- and gender-matched controls in UK
  • DEXA scans of the lumbar spine, femoral neck and total hip revealed:
    • Osteopaenia rate 3.0 times higher and osteoporosis rate 2.4 times higher in HIV patients than in age-matched controls
    • Spine fracture probability higher in the HIV group (adjusted OR 1.22, 95% CI 1.07–1.40, p=0.003)
    • Factors associated with low BMD included ART (adjusted OR 3.61, 95% CI 1.38–9.42, p=0.01)
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Peters B, et al. Tenth International Congress on Drug Therapy in HIV Infection 2010. Abstract P099


Reduced BMD in HIV-infected women in the USA

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Adapted from Arnsten J, et al. CID 2006;42:1014–20 1. Santoro N, et al. Maturitas 2009;64:160-4


Fracture prevalence according to HIV status in women

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Triant VA, et al. J Clin Endocrinol Metab 2008;93:3499-04


Managing bone disease

  • Consider:
    • Traditional risk factors
    • Exclude vitamin D deficiency
    • FRAX scoring
    • DEXA every 2–5 years
    • Bisphosphonates
    • Consultation with endocrinologist or rheumatologist
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McComsey GA, et al. Clin Infect Dis 2010;51:937–46


Vitamin D deficiency

  • Vitamin D deficiencies have been associated with low CD4 cell counts, an activated immune system, HIV disease progression1 and type 2 diabetes mellitus2
  • In a prospective French cohort of 3085 HIV+ patients (27.4% female), Vitamin D levels were <10, 10–30 and >30 ng/mL in 31.1%, 55.4% and 13.5% of patients, respectively3
    • Levels were lower in women (p<0.0001) and in ART-experienced patients (p<0.0001)
    • Levels were lower in AZT- (p=0.0008) and EFV-treated patients (p<0.0001), and higher in TDF-treated patients (p= 0.02)
    • There was no association between Vitamin D level and PIs
  • Even in the Summer, only 26% of Chicago women (120 HIV+ and 42 HIV–) had sufficient Vitamin D levels4
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1. Van Den Bout-Van Den Beukel CJ, et al. AIDS Res Hum Retroviruses. 2008;24:1375–82
2. Szep Z, et al. Antiviral Therapy 2008; 13(Suppl 4):A30
3. Allavena C, et al. 18th CROI 2011. Abstract 826
4. Aziz M, et al. 18th CROI 2011. Abstract 822


Co-morbidities associated with HIV

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1. Santoro N, et al. Maturitas 2009;64:160-4
2. Fumaz C, et al. First International Workshop on HIV and Aging. October 4-5, 2010. Baltimore. Abstract O_13
3. McComsey G, et al. CID 2009;48:1323
4. Maki PM, et al. Neuropsychol Rev 2009;19:204–14
5. Grulich AE, et al. Lancet 2007;370:59–67


Meta-analysis of incidence of non-AIDS cancers in HIV+ patients by gender

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Shiels MS, et al. JAIDS 2009;52:611–22


Incidence of cancer in women with HIV

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1. Hessol N, et al. JAIDs 2004; 36:978–85 2. National Cancer Institute, HIV Infection and Cancer Risk 2010. Available at: http://www.cancer.gov/cancertopics/factsheet/Risk/hiv-infection. Accessed March 2011 3. Grulich AE, et al. Lancet 2007;370:59–67


HIV and the human papillomavirus (HPV)

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1. Chaturvedi AK, et al. J Natl Cancer Inst 2009;101:1120–30
2. Phillips AA, et al. Curr HIV/AIDS Rep 2009;6:83–92
3. Bruni L, et al. J Infect Dis 2010;202:1789–99
4. Arbyn M, et al. Ann Oncol 2010;21:448–58


Cancer screening – EACS

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Regular screening and breast self-examination can reduce the risk of cancer

EACS guidelines 2011. Available at http://www.europeanaidsclinicalsociety.org/guidelinespdf/EACS-EuroGuidelines_FullVersion.pdf . Accessed March 2011.


Co-morbidities associated with HIV

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1. Santoro N, et al. Maturitas 2009;64:160-4 2. Fumaz C, et al. First International Workshop on HIV and Aging. October 4-5, 2010. Baltimore. Abstract O_13
3. McComsey G, et al. CID 2009;48:1323
4. Maki PM, et al. Neuropsychol Rev 2009;19:204–14
5. Grulich AE, et al. Lancet 2007;370:59–67


Kidney function and ageing

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*Hypertension, Diabetes, PCR-HCV+, phosphoremia, PI/r, ATV/r: pNS Age and renal impairment significantly associated with a decrease in creatinine clearance in both sexes. In females, a Ctrough-TDF >90ng/ml significantly associated with a decrease in creatinine clearance3

1. Hallan SI, et al. BMJ, doi:10.1136/bmj.39001.657755.BE
2. Mocroft A, et al. AIDS 2007;21:1119–27
3. Poizot-Martin I, et al. 18th CROI 2011. Poster 842


Co-morbidities associated with HIV

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1. Santoro N, et al. Maturitas 2009;64:160-4
2. Fumaz C, et al. First International Workshop on HIV and Aging. October 4-5, 2010. Baltimore. Abstract O_13
3. McComsey G, et al. CID 2009;48:1323
4. Maki PM, et al. Neuropsychol Rev 2009;19:204–14
5. Grulich AE, et al. Lancet 2007;370:59–67


Cognitive function and women with HIV

1. Fan M, et al. Menopause Int 2008;14:163–8
2. Maki PM, et al. Neuropsychol Rev 2009;19:204–14
3. Martin E, et al. J Clin Exp Neuropsychol 2011;33:112–20