Lyons, Alexandra Rachel Campbell;
(2020)
The association between HIV infection duration/biomarkers of HIV infection and serious non-AIDS events (SNAEs).
Doctoral thesis (Ph.D), UCL (University College London).
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Abstract
Life-long combination antiretroviral therapy (cART) has markedly increased life-expectancy in people living with HIV (PLHIV). Once largely AIDS-related, morbidity and mortality is now dominated by non-AIDS conditions including: cardiovascular, endocrine, renal and liver disease and non-AIDS defining cancers. These conditions, called Serious non-AIDS events (SNAEs), occur at higher rates in PLHIV than in the general population. This could be due to the effects of HIV infection, cART, other risk factors, or some combination of these. My study aimed to disentangle, as far as is possible using regression modelling of observational data, the relative contribution of each components to several SNAEs. I explored whether HIV-related exposures were independently associated with fractures, diabetes mellitus (DM) and myocardial infarction (MI). I analysed data from the Concerted Action on Seroconversion to AIDS and Death in Europe (CASCADE) cohort collaboration. All individuals had well-estimated HIV-seroconversion dates. Exposures of interest comprised: duration of HIV infection, current and nadir CD4 cell count, current HIV viral load and duration of immune-suppression (≤200/100/50 cells/µL). During 128 654 person-years of follow-up, 266 fractures, 103 MI and 109 DM (all first known events) occurred. I found evidence of an independent association between duration of HIV infection and MI, and between prior AIDS and fractures/MI, but evidence for other associations was lacking. After adjustment, each additional 10 years of HIV infection was associated with an approximate doubling in MI rate. Initiation of cardiovascular disease risk reduction strategies at lower traditional risk thresholds may be warranted in PLHIV. This is the first study to examine these associations in a large sample of individuals with well-estimated HIV-seroconversion dates, enabling accurate estimation of nadir CD4 and duration of both HIV infection and immune-suppression.
| Type: | Thesis (Doctoral) |
|---|---|
| Qualification: | Ph.D |
| Title: | The association between HIV infection duration/biomarkers of HIV infection and serious non-AIDS events (SNAEs) |
| Event: | UCL |
| Open access status: | An open access version is available from UCL Discovery |
| Language: | English |
| Additional information: | Copyright © The Author 2020. Original content in this thesis is licensed under the terms of the Creative Commons Attribution 4.0 International (CC BY 4.0) Licence (https://creativecommons.org/licenses/by/4.0/). Any third-party copyright material present remains the property of its respective owner(s) and is licensed under its existing terms. Access may initially be restricted at the author’s request. |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Epidemiology and Health UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Epidemiology and Health > Behavioural Science and Health |
| URI: | https://discovery.ucl.ac.uk/id/eprint/10109429 |
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