Lene Ryom MD PhD CHIP Center of Excellence for Health Immunity amp Infections Rigshospitalet Copenhagen Denmark Lene Ryom Comorbidities in PLWH Host or HIV Associated Nothing to disclose ID: 1044042
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1. Co-morbidities In People Living With HIV: Host- Or HIV-AssociatedLene RyomMD PhDCHIP, Center of Excellence for Health, Immunity & Infections, Rigshospitalet, Copenhagen, Denmark
2. Lene RyomCo-morbidities in PLWH: Host or HIV Associated Nothing to disclose
3. Co-morbidities & Ageing Schouten J for Age in HIV CID 2014
4. Disease Clusters Suggesting Common Underlying Pathogenesis Francesco DD for Age in HIV and Poppy Open Forum Infect Dis 2018.
5. Mechanisms?Factors Associated with Co-morbidities in PLWH Traditional/Lifestyle Risk factorsHIV-relatedfactorsART/ Other drugs?Host/Lifestyle Related factors- Smoking- Substance use- Risk taking - Education- Financial issues- Genetic predisposition- Age- Diet/Exercise- Obesity- Dyslipidaemiaetc.- Adverse drug effects e.g. DTG & weight change/TDF & renal disease - Polypharmacy - Drug-drug interactionsetc.- Low CD4 count- Immune & Coagulation activation- Inflammation- Microbial translocation- Viremia- Opportunistic infections- HCV/HBVetc.Access to care
6. Life Years LostPopulation Attributable Fraction (PAF)Numbers Needed to Treat to Harm (NNTH)Risk/Prediction ScoresImpact of Individual Risk Factors
7. Smoking, Loss of Life Years, Cancer & CVD Risks in PLWH Helleberg M for The Danish HIV Cohort AIDS 2015Petoumenos K for D:A:D HIV Med 2014Shepherd L for D:A:D CID 2019.Loss of Life YearsCVD Risk ModificationCancer Risk
8. Althoff K for NA-ACCORD Lancet HIV 2019 Impact of Risk Factors for Cardiovascular DiseaseFriis-Moeller N for D:A:D Eur J Prev Cardiology 2016 Rotger M for Magnificient/INSIGHT/SWISS HIV CohortCID 2013
9. Rasmussen LD for The Danish HIV Cohort BMC Infect Dis 2010Comorbidities in Parents of PLWH & of HIV-negative ControlsEnsig F for The Danish HIV Cohort BMC cancer 2011Myocardial Infarction Lung Cancer
10. Althoff K for NA-ACCORD Lancet HIV 2019 Impact of Risk Factors for Renal DiseaseMocroft A for D:A:D PLOS Med 2015Dietrich LG forThe Swiss HIV Cohort CID 2020b
11. Interaction Between CD4 count & Other Renal Risk FactorsRyom L for D:A:D JID 2021Percentage of follow-up time with CD4 count < 200 cells/µLChronic kidney disease IRR
12. Myocardial Infarction in PLWH With Access To Optimal Care vs. HIV-negative ControlsKlein D for Kaiser Permanente CID 2015
13. EACS Co-morbidity Management Guidelines V10.1 2020https://www.eacsociety.org/guidelines/eacs-guidelines.html
14. Conclusions - Irrespectively of the underlying cause(s) ageing PLWH experience disproportionally high rates of non-AIDS co-morbidities - CVD studies show risk may be overcome w/optimal management- other co-morbidities?- Closely related risk profiles, suggest effective interventions against common factors incl smoking, dyslipidemia & hypertension may have wide-ranging multimorbidity impact- Multidisciplinary efforts focusing on systematic risk assessments & management are required, recommendations are available e.g. in the EACS Guidelines- Need studies to assess which interventions are most effective for different co-morbidities, when to initiate & impacts of moderating HIV-related inflammation/coagulation activation- Lifestyle/host factors are key drivers for several co-morbidities, however contribution of HIV-related factors & ART should not be overlooked - Impact differs for individual co-morbidities/presence of other factors/cumulative nature - The more risk factors the more likely incident disease