HIV not associated with higher risk for coronary artery disease in Uganda, challenging prior notions of health risks among regional populations with HIV
Below please find a summary of a new article that has published in Annals of Internal Medicine following an oral presentation at the Conference on Retroviruses and Opportunistic Infections (CROI) in San Francisco, CA. The summary is not intended to substitute for the full article as a source of information.
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HIV not associated with higher risk for coronary artery disease in Uganda, challenging prior notions of health risks among regional populations with HIV
Abstract: https://www.acpjournals.org/doi/10.7326/ANNALS-24-02233
Editorial: https://www.acpjournals.org/doi/10.7326/ANNALS-24-03940
A cross-sectional study of adults in Uganda with and without HIV was conducted to estimate the prevalence of coronary atherosclerosis disease (CAD) in Uganda and determine whether well-controlled HIV infection is associated with increased presence or severity of CAD. The study found the prevalence of CAD among people with and without HIV in Uganda is much lower than in similar populations in the Global North. The results challenge the notion that CAD is a major cause of morbidity in Uganda. The study is published in Annals of Internal Medicine following an oral presentation at the Conference on Retroviruses and Opportunistic Infections (CROI) in San Francisco, CA.
Researchers from Massachusetts General Hospital and colleagues studied data from 586 adults older than age 40 with and without HIV in Southwestern Uganda. People living with HIV (PWH) were eligible to participate if they were receiving clinical care at a nearby Immune Suppression Syndrome Clinic or HIV Clinic and were taking antiretroviral therapy (ART) for at least three years. People without HIV (PWoH) included in the study had to live within 20 km of the HIV clinics and were age and sex similar to PWH. Coronary CT angiography (CCTA) scans were performed on the participants and a radiologist and three CV imaging fellows who were blinded to HV serostatus analyzed the CCTA results. The primary outcome was the presence of CAD, defined by any plaque on CCTA in at least one of the major coronary arteries, or an Agatston CAC score greater than zero. Additionally, this research was done at a time and place in Uganda when HIV medicines were available and nearly all participants in the study had achieved virologic suppression.
The researchers found that among PWH taking ART in public-sector clinical care in Uganda, prevalence of CAD was low. For both PWH and PWoH, prevalence of CAD was less than 10% and the prevalence of a CAC score greater than one was three percent. The findings suggest the prevalence of CAD among PWH in Uganda is much lower than high-income regions like the United States and Europe. The findings refute notions that HIV is associated with higher CAD risk in Uganda and emphasize the need to ensure that the necessary work and research can be done to understand the greatest health threats for people with HIV regionally instead of relying on data from the Global North to make inferences about health priorities elsewhere.
Media contacts: For a PDF, please contact Angela Collom at acollom@acponline.org. To speak with corresponding author Mark J. Siedner, MD, MPH, please contact Noah Brown at nbrown9@partners.org, or Michael Morrison at mdmorrison@partners.org.
Journal
Annals of Internal Medicine
Method of Research
News article
Subject of Research
People
Article Title
Epidemiology of Coronary Atherosclerosis among People Living with HIV in Uganda: A Cross-Sectional Study
Article Publication Date
12-Mar-2025
People with HIV in Malawi face greater risk for dementia
As treatments improve and people with HIV live longer, many face a double burden of HIV and dementia later in life
New York University
Adults living with HIV in Malawi are more than twice as likely to also have dementia compared to those without HIV, according to a new study by a team of US and Malawian researchers.
Their findings, published in the journal Alzheimer’s and Dementia, shed light on the significant burden of dementia among people living with HIV in Malawi and the importance of studying dementia in resource-poor settings with limited access to health care.
Thanks to advances in the treatment of HIV with antiretroviral therapy, people with HIV are living longer lives. Yet aging with HIV comes with challenges, as the virus increases the chances of prematurely developing other age-related diseases, including diabetes, heart disease, and cancer. Due to inflammation and other changes in the brain, HIV also raises the risk for dementia.
In the southeastern African country of Malawi, 8 to 12 percent of adults are living with HIV and it remains the leading cause of death. However, life expectancy has dramatically improved in recent decades: according to the World Health Organization, a child born in 2000 is expected to live only to 45, while a child born in 2021 is likely to live to 63. With sub-Saharan Africa’s aging population, experts are predicting a surge of dementia cases in the coming decades.
“Most of what we know about dementia and Alzheimer’s disease comes from research studies in high-income countries, but less is known about dementia prevalence and risk in low- and middle-income countries,” said Haeok Lee, a professor at NYU Rory Meyers College of Nursing and the study’s lead author.
To better understand the prevalence of dementia among people in Malawi with and without HIV, the researchers reviewed medical records from 400 adult patients 30 years and older seen at an outpatient clinic in Lilongwe, the capital city of Malawi. Half of the participants were living with HIV and taking antiretroviral therapy, while the other half did not have HIV.
The researchers found that 22 percent of people with HIV had dementia, compared with 10 percent of those without HIV. Although the prevalence of dementia increased with age in both groups, the increase was more rapid in those with HIV, who also tended to be diagnosed with dementia at a younger age.
In addition to older age, depression was a significant risk factor for dementia for both people with and without HIV. For people living with HIV, unstable employment also increased the chances of developing dementia.
The researchers caution that there are limitations to using medical records to understand dementia prevalence and risk in Malawi, including the challenges of analyzing paper charts (not electronic records), a lack of standardized diagnostic codes, and no records on alcohol and substance use. In addition, because of the shortage of healthcare professionals in the country—there is only one neurologist in the entire adult population—it’s likely that dementia is underdiagnosed due to a lack of screening.
"We need to do more in order for us to look after patients with dementia in low- and middle-income countries,” said study author Jonathan Ngoma of the Kamuzu Central Hospital and Malawi Ministry of Health. "We have embarked on a journey to bring out a lot of information to the world."
“Our findings highlight an urgent need to develop infrastructure for the management of dementia for both people living with HIV and the general population in Malawi, including culturally tested cognitive assessment tools and treatment guidelines that are tailored to Malawians and the local health care system,” added Lee.
The study will appear in a special issue of Alzheimer’s and Dementia focusing on dementia research in Africa. In addition to Lee and Ngoma, study authors include Yohannie Mlombe of Kamuzu University of Health Sciences; Yeunjoo Song of Case Western Reserve University School of Medicine; Hyun-Sik Yang of Brigham and Women’s Hospital and Harvard Medical School; Tiwonge Phiri of the Malawi Ministry of Health and Queen Elizabeth Central Hospital; Joseph Maseke and Esther Bauleni of Daeyang University in Malawi; Gyungah Jun of Boston University; and Yun-Beom Choi of Rutgers Medical School.
Journal
Alzheimer s & Dementia
Article Title
Dementia prevalence and risk factors in people with and without HIV in Malawi: A medical record review
New study in the Lancet HIV highlights gaps in HPV-related cancer prevention for people living with HIV
image:
The figure shows that vaccination should be done before the start of sexual activity. The figure is illustrative and magnitudes (along the y-axis) of the events (eg, incidence) are not to scale.
view moreCredit: Anneli Uusküla And The Lancet HIV
A new study published in The Lancet HIV reveals gaps in knowledge surrounding the prevention of HPV-related cancers in people living with HIV and outlines future research priorities. A literature review, conducted by a team of international experts underscores the need for further research and highlights existing disparities in healthcare for this vulnerable population.
HPV-related cancers are preventable, primarily through vaccination. However, a Professor of Epidemiology at the University of Tartu and one of the study’s authors Anneli Uusküla said that the study found a lack of evidence on the effectiveness of the HPV vaccine in HIV-positive individuals who were vaccinated in childhood before becoming sexually active. “We assume that there is at least a partial effect among HIV-positive individuals similar to that observed in HIV-negative individuals. Though, the weaker immune response to vaccination in people living with HIV compared to the general population warrants further investigation and clinical consideration,” said Uusküla.
While the HPV vaccine is most effective when administered around 11-12 years old, a substantial proportion of people living with HIV acquire the virus later in life, emphasizing the critical role of screening. Cervical cancer is currently the only HPV-related cancer with an effective screening program. While highly effective in the general population, its efficacy in preventing cervical cancer among HIV-positive individuals has not been directly proven. To date, there are no established screening programs for other HPV-related cancers, including vulvar, penile, vaginal, and oral cancers, and no evidence supports their effectiveness in cancer prevention. “One randomized controlled trial has proven the effectiveness of anal cancer screening for cancer prevention in people with HIV,” added Uusküla.
The study also explored potential future prevention strategies. A large number of HPV infections do not lead to cancer and resolve spontaneously. Researchers are working to identify markers that can predict which HPV infections and precancerous lesions are more likely to progress to cancer, allowing for more targeted interventions. How can we identify those who are most at risk of cancer? “Currently, various molecular triage methods are being tested, and a lot of information is coming from those studies.”
People who have had one HPV-related cancer are at higher risk of developing another. Therefore, it makes a lot of sense to screen them for all HPV-related cancers at once. The development of liquid biopsies holds promise for earlier and more accurate detection of HPV-related cancers. Additionally, direct-acting anti-HPV treatments are being developed, offering hope for treating HPV infections before they progress to cancer.
Antiretroviral therapy plays a crucial role for people living with HIV. “When they adhere to antiretroviral therapy, it helps maintain immune system function and may partially mitigate the risk of HPV-related cancers in this population,” explained Uusküla. Evidence suggests that antiretroviral therapy can reduce the risk of cervical, penile, and anal cancers, but further research is needed to determine its effectiveness in preventing vulvar and vaginal cancers.
The study “Prevention and control of HPV-related cancers in people living with HIV” highlights the urgent need for increased research to understand the complexities of HPV-related cancer prevention in people living with HIV. “Healthcare providers need to be aware of the unique challenges faced by this population and advocate for improved access to vaccination, screening, and treatment. Policymakers must allocate resources to develop targeted public health programs and innovative strategies to improve the prevention of HPV-related cancers in people living with HIV. Ultimately, empowering individuals with HIV to make informed decisions about their health and advocate for enhanced access to preventative and care services is crucial,” said Uusküla.
Journal
The Lancet HIV
Method of Research
Literature review
Subject of Research
People
Article Title
Prevention and control of HPV-related cancers in people living with HIV
Article Publication Date
11-Mar-2025
