Daniela Marić

Background/Aim. At the beginning of the coronavirus disease 2019 (COVID-19) pandemic, human immunodeficiency virus (HIV)-infected persons (HIP) were considered to be at an increased risk of more severe forms of the disease. Although vaccination of HIP is deemed essential, data on the humoral response to both infection and vaccination in this population are inconsistent, particularly when comparing different vaccine types. The aim of this study was to examine factors that could influence severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) anti-spike protein antibody titers in HIP after vaccination and/or exposure to the virus. Methods. The study included all HIP who came for routine check-ups to the Center for HIV/AIDS of the University Clinical Center of Vojvodina, Serbia, from April to December 2022 and who had received at least two doses of the vaccine or had a positive history of COVID-19. Data on age, duration of antiretroviral therapy (ART), nadir and current CD4+ and CD8+ T-cell counts, and type of vaccine were collected from medical records and the national data-base. Immunoglobulin G (IgG) antibodies against SARS-CoV-2 spike protein were determined in the sera of HIP using the AdviseDx SARS-CoV-2 IgG II assay. Results. The research included 226 HIP with undetectable viremia, in 96.3% of cases, the CD4 T-lymphocyte count was over 350 cells/mm3. Out of 171 HIP who received at least two doses of a vaccine, 64 (37.4%) were both vaccinated and had COVID-19 and 107 (62.6%) were vaccinated and had no evidence of COVID-19. Among the vaccinated participants, 62% received three doses and 38% received two vaccine doses. Regarding the type of vaccine, 59.6% of participants received a messenger ribonucleic acid (mRNA) vaccine, 25.1% an inactivated vaccine, and 15.3% received a vector vaccine. A better humoral response was observed in the mRNA compared to the inactivated vaccines and in three compared to two doses in the case of mRNA vaccines. Age and duration of ART negatively correlated with antibody titers, while the number of CD8 T-cells had a positive correlation. Conclusion. The study showed the immunogenicity and safety of full vaccination against COVID-19 in HIP with any of the available vaccines.

With people living with HIV (PLWH) reaching the senium, the importance of aging-related comorbidities such as metabolic syndrome (MS) becomes increasingly important. This study aimed to determine the additive effect of MS on brain atrophy in PLWH. This prospective study included 43 PLWH, average age of 43.02 ± 10.93 years, and 24 healthy controls, average age of 36.87 ± 8.89 years. PLWH were divided into two subgroups: without MS and with MS, according to NCEP ATP III criteria. All patients underwent brain magnetic resonance imaging (MRI) on a 3T clinical scanner with MR volumetry, used for defining volumes of cerebrospinal fluid (CSF) spaces and white and grey matter structures, including basal ganglia. A Student’s t-test was used to determine differences in brain volumes between subject subgroups. The binary classification was performed to determine the sensitivity and specificity of volumetry findings and cut-off values. Statistical significance was set at p < 0.05. PLWH presented with significantly lower volumes of gray matter, putamen, thalamus, globus pallidus, and nc. accumbens compared to healthy controls; cut-off values were: for gray matter 738.130 cm³, putamen 8.535 cm³, thalamus 11.895 cm³, globus pallidus 2.252 cm³, and nc. accumbens 0.715 cm³. The volumes of CSF and left lateral ventricles were found to be higher in PLWH with MS compared to those without MS, where, with a specificity of 0.310 and sensitivity of 0.714, it can be assumed that PLWH with a CSF volume exceeding 212.83 cm³ are likely to also have MS. This suggests that PLWH with metabolic syndrome may exhibit increased CSF volume above 212.83 cm³ as a consequence of brain atrophy. There seems to be an important connection between MS and brain volume reduction in PLWH with MS, which may add to the accurate identification of persons at risk of developing HIV-associated cognitive impairment.

Background: The interaction of human immunodeficiency virus (HIV), host and antiretroviral therapy (ART) causes a range of metabolic disorders that can be characterized as a metabolic syndrome (MetS) that increases the cardiovascular risk. MetS involves central obesity, which can be detected using different anthropometric parameters. Objective: To assess the abilities of different anthropometric parameters in the prediction of MetS in HIV-infected men on ART. Method: The study involved 92 male participants (mean age 44.46±10.38 years), divided into two groups: with and without MetS. All subjects underwent biochemical evaluation (triglycerides, HDL-cholesterol, fasting glucose), blood pressure measurement and anthropometric assessment: body mass, body height, body mass index (BMI), body fat mass, body circumferences (chest, upper arm, forearm, waist, hip, proximal and middle thigh and calf), sagittal abdominal diameter (SAD), skinfold thicknesses (subscapular, anterior and posterior upper arm, anterior and lateral forearm, abdominal, supraspinal, thigh and calf), waist-to-hip ratio (WHR), waist-to-height ratio (WHtR), waist-to-thigh ratio (WTR), sagittal abdominal diameter–to-body height ratio (SADH), body adiposity index (BAI) and conicity index. MetS was specified according to IDF criteria. Results: Subjects with MetS had statistically significant higher values of all anthropometric parameters except middle thigh circumference, calf skinfold and body height. According to ROC analysis and Binary Logistic Regression, SAD has been shown as the best predictor of MetS with a predictive value of 21.40 cm (AUC:0.91), followed by WHR with a predictive value of 0.93. Conclusion: Sagittal abdominal diameter is the strongest anthropometric indicator of MetS in HIV-infected patients on ART.

Introduction: Decreased physical activity is a major cardiovascular risk factor that is particularly pronounced in people living with HIV (PLHIV), who are more susceptible to endothelial dysfunction and accelerated atherosclerosis than the general population due to multiple mechanisms. The aim of the present study was to analyse whether regular physical activity is capable of improving endothelial function measured by flow‐mediated dilatation (FMD) in PLHIV.Methods: We performed FMD measurement in 38 PLHIV, along with the assessment of their regular physical activity level using the International Physical Activity Questionnaire (IPAQ).Results: Flow‐mediated dilatation results in PLHIV were 0.31 ± 0.06 mm and 7.34% ± 1.41% for absolute and relative FMD, respectively. IPAQ results showed that the average weekly level of physical activity was 3631.1 ± 1526.7 MET‐min/week, whereas the average daily sitting time was 287.3 ± 102.7 min/day. Predictors jointly accounted for 48% (adjusted value 42%) of FMD variance. Bootstrapped confidence levels revealed that physical activity had a statistically significant effect on the outcome [beta = 0.517, 2.5% confidence interval (CI) = 0.205, 97.5% CI = 0.752].Conclusion: Physical activity represents a widely available and uncostly tool that is capable of improving endothelial function and overall cardiovascular health in PLHIV.

Background: In HIV negative population metabolic syndrome and steatosis are related to poorer neurocognitive (NC) performance. We investigated if similar relation exists in people living with HIV (PLWH). Methods:: We included male PLWH aged 20-65, with undetectable viral load for at least 6 months. Data on levels of education, anthropometric measurements, CD4 levels, ART, markers of metabolic syndrome, smoking and concurrent treatment were collected from database. Concentrations of TNF-α and IL-6 were measured. An ultrasound was used to establish the presence of steatosis, visceral fat thickness and carotid intima media thickness. An extensive NC assessment was done by an experienced neuropsychologist. Cognitive domains were defined as executive functions, divergent reasoning, visuo-constructional abilities, delayed recall and working memory and learning and were measured using a battery of 12 tests. Results: 88 PLWH were included (mean age 39,9 years), 51% on PIs, 46% on NNRTI; 20,4% had metabolic syndrome, 42% patients had steatosis. Weak but statistically significant negative correlations were found between the presence of metabolic syndrome, steatosis and VFT and cognitive domains (divergent reasoning, delayed recall and working memory). Poorer perfomrance in the domains of divergent reasoning and in the working memory were found in participants with steatosis (p=0,048 and 0,033 respectively). Conclusion: Although the sample size was relatively small, our results show consistent correlations between the observed neurocognitive variables and metabolic parameters. As central obesity is one of the contributors to NCI, it would be one of the modifiable factors to prevent further neurocognitive decline.

Background: Non-alcoholic fatty liver disease (NAFLD) represents the most common form of chronic liver disease in mono-infected (without concomitant hepatitis B and/or C virus infection) people living with human immunodeficiency virus (HIV). The proper and on time identification of at-risk HIV-positive individuals would be relevant in order to reduce the rate of progression from NAFLD into non-alcoholic steatohepatitis (NASH), cirrhosis and hepatocellular carcinoma.Objectives: The aim of this study was to explore visceral fat thickness (VFT) and anthropometric measurements associated with the development of NAFLD in patients mono-infected with HIV and on long-standing combination antiretroviral therapy (cART).Method: Eighty-eight (n = 88) HIV-positive male patients, average age 39.94 ± 9.91 years, and stable on cART, were included in this prospective study. VFT was measured using ultrasonography. Anthropometric measurements included body mass index (BMI), waist-to-hip ratio (W/H), waist-to-height ratio (WHtR), waist and hip circumference (WC, HC). Differences between variables were determined using the chi-square test. The receiver operating characteristic (ROC) curve and the Youden index were used to determine optimal cut-off values of VFT and hepatic steatosis. The area under the curve (AUC), 95% confidence intervals, sensitivity and specificity are reported for the complete sample. Significance was set at p < 0.05.Results: Patients with steatosis had significantly higher values of BMI, HC, WC, W/H and WHtR. The VFT was higher in patients with steatosis (p < 0.001). Specifically, VFT values above 31.98 mm and age > 38.5 years correlated with steatosis in HIV-positive patients, namely sensitivity 89%, specificity 72%, AUC 0.84 (95% CI, 0.76–0.93, p < 0.001), with the highest Youden index = 0.61. The sensitivity of the age determinant above this cut-off point was 84%, specificity 73% and AUC 0.83 (95% CI, 0.75–0.92, p < 0.001), with the highest Youden index of 0.57.Conclusion: In the absence of more advanced radiographic and histological tools, simple anthropometric measurements and VFT could assist in the early identification of persons at risk of hepatic steatosis in low- and middle-income regions.