Kristine M Erlandson1, Kathleen V Fitch2, Sara A McCallum2, Heather J Ribaudo3, Edgar T Overton4, Markella V Zanni2, Gerald S Bloomfield5, Todd T Brown6, Carl J Fichtenbaum7, Sara Bares8, Judith A Aberg9, Pamela S Douglas10, Evelynne S Fulda2, Jorge L Santana-Bagur11, Jose G Castro12, Laura E Moran13, Vidya Mave14, Khuanchai Supparatpinyo15, Ponego L Ponatshego16, Mauro Schechter17, Steven K Grinspoon2. 1. University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA. 2. Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA. 3. Center for Biostatistics in AIDS Research, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA. 4. University of Alabama at Birmingham, Birmingham, Alabama, USA. 5. Duke Global Health Institute, Durham, North Carolina, USA. 6. Johns Hopkins University School of Medicine, Baltimore, Maryland, USA. 7. University of Cincinnati, Cincinnati, Ohio, USA. 8. Specialty Care Center, Nebraska Medical Center, Omaha, Nebraska, USA. 9. Icahn School of Medicine at Mount Sinai, New York, New York, USA. 10. Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA. 11. Proyecto ACTU, San Juan, Puerto Rico. 12. University of Miami Infectious Disease Research Unit At Jackson Memorial Hospital, Miami, Florida, USA. 13. Social & Scientific Systems, a DLH Company, Silver Spring, Maryland, USA. 14. Byramjee Jeejeebhoy Medical College, Johns Hopkins University Clinical Research Site, Pune, Maharashtra, India. 15. Chiang Mai University HIV Treatment, Chiang Mai, Thailand. 16. Gaborone Prevention/Treatment Trials, Princess Marina Hospital, Gaborone, Botswana. 17. Projeto Praça Onze Pesquisa Em Saúde, Cidade Nova, Rio de Janeiro, Brazil.
Abstract
BACKGROUND: We sought to explore multinational differences in functional status by global burden of disease (GBD) regions in the REPRIEVE cohort. METHODS: REPRIEVE is a prospective, double-blind, randomized, placebo-controlled, multicenter, phase III primary cardiovascular prevention study of pitavastatin calcium vs placebo among people with human immunodeficiency virus (HIV, PWH) ages 40-75 on antiretroviral therapy (ART). GBD super regions were defined using World Health Organization classifications. Participants were categorized by impairment on the Duke Activity Status Instrument (DASI: none, some, moderate, severe). Logistic regression models examined risk factors and GBD regions associated with functional impairment. The association between functional impairment and cardiometabolic risk was also explored. RESULTS: Of 7736 participants, the majority were from high-income countries (n = 4065), were male (65%), and had received ART for ≥ 10 years. The median DASI score was 58.2 (interquartile range [IQR] 50.2, 58.2); 36% reported at least some impairment. In adjusted analyses, functional impairment was significantly more frequent among participants from Southeast/East Asia. Other factors associated with greater impairment included female sex, Black race, older age, current/former smoking, higher body mass index, use of ART for ≥ 10 years, and select ART regimens; differences were seen in risks across GBD regions. Functional impairment was associated with increased cardiometabolic risk. CONCLUSIONS: Over 1/3 of middle-aged and older PWH in a global cohort across diverse GBD regions demonstrate functional impairments. The associations between DASI and cardiometabolic risk suggest that a measure of functional status may improve risk prediction; these longitudinal associations will be further investigated over REPRIEVE trial follow-up.
BACKGROUND: We sought to explore multinational differences in functional status by global burden of disease (GBD) regions in the REPRIEVE cohort. METHODS: REPRIEVE is a prospective, double-blind, randomized, placebo-controlled, multicenter, phase III primary cardiovascular prevention study of pitavastatin calcium vs placebo among people with human immunodeficiency virus (HIV, PWH) ages 40-75 on antiretroviral therapy (ART). GBD super regions were defined using World Health Organization classifications. Participants were categorized by impairment on the Duke Activity Status Instrument (DASI: none, some, moderate, severe). Logistic regression models examined risk factors and GBD regions associated with functional impairment. The association between functional impairment and cardiometabolic risk was also explored. RESULTS: Of 7736 participants, the majority were from high-income countries (n = 4065), were male (65%), and had received ART for ≥ 10 years. The median DASI score was 58.2 (interquartile range [IQR] 50.2, 58.2); 36% reported at least some impairment. In adjusted analyses, functional impairment was significantly more frequent among participants from Southeast/East Asia. Other factors associated with greater impairment included female sex, Black race, older age, current/former smoking, higher body mass index, use of ART for ≥ 10 years, and select ART regimens; differences were seen in risks across GBD regions. Functional impairment was associated with increased cardiometabolic risk. CONCLUSIONS: Over 1/3 of middle-aged and older PWH in a global cohort across diverse GBD regions demonstrate functional impairments. The associations between DASI and cardiometabolic risk suggest that a measure of functional status may improve risk prediction; these longitudinal associations will be further investigated over REPRIEVE trial follow-up.
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