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Introduction: Advancements in and accessibility to effective antiretroviral therapy has improved the life expectancy of people living with HIV, increasing the proportion of people living with HIV reaching older age (≥60 years), making this population's health‐related quality of life (HRQoL) more relevant. Our aim was to identify the determinants of poor HRQoL in people living with HIV aged ≥60 years and compare them with those of their younger counterparts. Methods: We used data from the 'Vive+' study, a cross‐sectional survey conducted between October 2019 and March 2020, nested within the PISCIS cohort of people living with HIV in Catalonia and the Balearic Islands, Spain. We used the 12‐item short‐form survey (SF‐12), divided into a physical component summary (PCS) and a mental component summary (MCS), to evaluate HRQoL. We used the least absolute shrinkage and selection operator for variable selection and used multivariable regression models to identify predictors. Results: Of the 1060 people living with HIV (78.6% males) who participated in the study, 209 (19.7%) were aged ≥60 years. When comparing older people living with HIV (≥60 years) and their younger counterparts, older people exhibited a worse PCS (median 51.3 [interquartile range {IQR} 46.0–58.1] vs. 46.43 [IQR 42.5–52.7], p < 0.001) but a similar MCS (median 56.0 [IQR 49.34–64.7] vs. 57.0 [IQR 48.9–66.3], p = 0.476). In the multivariable analysis, cognitive function correlated with a PCS (β correlation factor [β] −0.18, p = 0.014), and depressive symptoms and satisfaction with social role correlated with an MCS (β 0.61 and β −0.97, respectively, p < 0.001) in people living with HIV aged ≥60 years. Conclusion: Depressive symptoms, poor cognitive function, and lower satisfaction with social roles predict poorer HRQoL in older people living with HIV. These factors need to be considered when designing targeted interventions. [ABSTRACT FROM AUTHOR]

Objectives: To compare the prevalence of carotid atherosclerosis in virologically suppressed HIV patients with that of a community sample, and to evaluate the capacity of various cardiovascular risk (CVR) equations for predicting carotid atherosclerosis. Methods: This was a cross‐sectional study with two randomly selected groups: HIV patients from an HIV unit and a control group drawn from the community. Participants were matched by age (30–80 years) and sex without history of cardiovascular disease. Carotid plaque, common carotid intima–media thickness (cc‐IMT) and subclinical atherosclerosis (carotid plaque and/or cc‐IMT > 75th percentile) were assessed by carotid ultrasound. The Systematic Coronary Risk Evaluation (SCORE), Framingham, REGICOR, reduced Data Collection on Adverse Effects of Anti‐HIV Drugs (D:A:D), and COMVIH equations were applied, and their abilities to predict carotid plaque were compared using the area under the curve (AUC). Results: Each group included 379 subjects (77.8% men, age 49.7 years). Duration of antiretroviral therapy was 15.5 years. There were no differences between the groups for carotid plaque (HIV, 33.2%; control, 31.3%), mean cc‐IMT (HIV, 0.63 mm; control, 0.61 mm) or subclinical atherosclerosis (HIV, 42.9%; control, 47.9%). Thymidine analogues were independently associated with subclinical atherosclerosis in HIV‐infected patients. CVR equations revealed AUCs between 0.715 and 0.807 for prediction of carotid plaque; prediction was better in the control group and did not improve when HIV‐adapted scales were used. Conclusions: The features of carotid atherosclerosis did not differ between the HIV‐infected and the control group, although CVR equations were more predictive for carotid plaque in controls than in HIV‐infected patients. HIV‐specific equations did not improve prediction. [ABSTRACT FROM AUTHOR]

Objective The aim of the study was to investigate changes in plasma biomarkers of cardiovascular risk and lipids in a CD4-guided antiretroviral therapy interruption study. Methods This was a substudy of a prospective, randomized, multicentre treatment interruption study. At months 12, 24 and 36, monocyte chemotactic protein-1 ( MCP-1), soluble vascular cell adhesion molecule-1 ( sVCAM-1), interleukin-6 ( IL-6), interleukin-8 ( IL-8), soluble CD40 ligand ( sCD40L), soluble P-selectin ( sP-selectin), and tissue plasminogen activator (t- PA) were measured using a multiplex cytometric bead-based assay. Total cholesterol (total-c), high-density lipoprotein cholesterol ( HDL-c) and triglycerides ( TG) were determined using standard methods. Results Fifty-four patients were included in the study [34 in the treatment continuation ( TC) arm and 20 in the treatment interruption ( TI) arm]. There were no differences at baseline between the groups, except in CD4 cell count, which was higher in the TI arm ( P = 0.026), and MCP-1, which was higher in the TC arm ( P = 0.039). MCP-1 and sVCAM-1 were increased relative to baseline at the three study time-points in the TI arm, with no changes in the TC arm. Soluble CD40L and sP-selectin were increased at month 36 in both arms, with a greater increase in the TI arm ( P = 0.02). t- PA was increased in both arms at the three time-points. Total-c, HDL-c and low-density lipoprotein cholesterol ( LDL-c) were decreased in the TI arm at the three time-points, with no changes in the total-c/ HDL-c ratio. HIV viral load positively correlated with MCP-1 at months 12 and 24. Regression analysis showed a significant negative association of HDL-c with MCP-1 and sVCAM-1. Conclusions A significant increase in cardiovascular risk biomarkers persisting over the prolonged study period was seen in the TI arm. This factor may contribute to the increased cardiovascular risk observed in previous studies. [ABSTRACT FROM AUTHOR]

Purpose of the study Few clinical trials have compared non-nucleoside reverse transcriptase inhibitors (NNRTI) and ritonavir-boosted protease inhibitors (PI/r) as initial combined antiretroviral therapy (cART) for HIV-1-infected patients with high plasma viral load (pVL), and non-conclusive results have been reported. We compared the effectiveness between NNRTI and PI/r as first-line cART for HIV-1-infected patients with high pVL. Methods Observational retrospective study of 664 consecutive treatment-naïve HIV-1-infected patients with pVL (HIV-1 RNA) >100,000 copies/mL who initiated NNRTI or PI/r-based cART between 2000-2010 in three University hospitals. Only currently preferred or alternative regimens in clinical guidelines were included. Primary endpoint: percentage of therapeutic failures at week 48. Virologic failure was defined as: a) lack of virologic response (<1 log RNA HIV-1 decrease in first 3 months); b) RNA HIV-1 >50 c/mL at week 48; c) confirmed rebound >50 c/ml after a previous value <50 c/mL. Intent-to-treat (ITT noncompleter=failure) and on-treatment (OT) analyses were performed. Results 62% of patients initiated NNRTI-regimens (83% efavirenz) and 38% PI/r-regimens (62% lopinavir/). Baseline characteristics: male 83%; median age 39 yrs; median CD4 count: 212/µL (NNRTI 232 vs PI/r 177, p=0.028); pVL 5.83 log10 c/mL (NNRTI 5.43 vs PI/r 5.55, p=0.007); AIDS 24% (NNRTI 21% vs PI/r 29%, p=0.015). NRTI backbones were tenofovir plus 3TC or FTC in 72%. The percentage of therapeutic failure was higher in the PI/r group (ITT NC=F 26% vs 18%, p=0.012) with no differences in virologic failures (PI/r 5%, NNRTI 6%, p=0.688). The rate of treatment changes due to toxicity and/or voluntary discontinuations was higher in the PI/r group (15% vs 8%, p=0.008). A multivariate analysis adjusted for age, gender, CD4 count, VL and AIDS showed NNRTI vs PI/r as the only variable associated with treatment response (OR 0.61, 95% CI 0.41-0.88). Median pVL and rate of resistance at virologic failure were higher in patients receiving NNRTI (3.97 vs 2.49 log copies/mL, p<0.001 and 62% vs 12%, p=0.004, respectively). Conclusions Initial NNRTI-regimens showed higher effectiveness compared with PI/r-regimens in HIV-1-infected patients with high pVL, although virologic failure rates were low and comparable. Resistance emergence was more frequent and pVL higher in patients failing NNRTI. However, more patients initiating PI/r-based regimens changed or discontinued therapy. [ABSTRACT FROM AUTHOR]