Comorbidity and Aging With HIV

HIV-1-infection Clinical Trial

— agehIV  

Official title:

Comorbidity and Aging With HIV, the agehIV Cohort Study

Clinical Trial Details — Status: Active, not recruiting

Administrative data

• NCT number: NCT01466582
• Other study ID #: NL30802.018.09
• Status: Active, not recruiting
• Start date: October 2010
• Est. completion date: October 2024

Study information

• Verified date: July 2023
• Source: Academisch Medisch Centrum - Universiteit van Amsterdam (AMC-UvA)
• Contact: n/a
• Is FDA regulated: No
• Study type: Observational

Clinical Trial Summary

In this prospective cohort study the investigators will assess the prevalence and incidence of a broad range of age-related co-morbidities and their (known) risk factor among HIV-patients and HIV-negative controls. HIV might cause premature onset or accelerated aging and could therefore result in an increase of age-related comorbidities when compared with controls.

Description:

The standard use of combination antiretroviral therapy (cART) has resulted in major and sustained declines in HIV-associated morbidity and mortality. Nonetheless, the life expectancy of patients with HIV on cART still remains 10 or more years shorter than that of uninfected persons of the same age, especially in patients starting cART at the time infection is already advanced. A greater risk of a broad range of co-morbidities, experienced by as many as 60% of patients, even after adjustment for age, may contribute to this discrepancy. Several studies have demonstrated an increased incidence of heart disease, diabetes mellitus, kidney disease, liver disease, osteoporosis, malignancies (other than Kaposi's sarcoma and non-Hodgkin's lymphoma traditionally associated with HIV), cognitive disorders and possibly chronic obstructive pulmonary disease in HIV-infected individuals when compared to age matched HIV-uninfected controls. Of note, the incidence of each of the mentioned co-morbidities is also higher after adjustment for age and other traditional risk factors. Most studies were conducted in the United States where prevalence of and risk factors for the various co-morbidities may be different than in Europe, in particular the Netherlands.

HIV-related factors and adverse effects of cART each may independently contribute to the observed increased risk of several of the earlier mentioned co-morbidities. Interestingly, HIV-infected men in the absence of cART have increased frailty (a clinical syndrome associated with aging that identifies a subset of older adults at high risk of mortality and other adverse outcomes) when compared to uninfected men of similar age. Middle aged HIV-infected men despite cART use also show reduction in exercise capacity, functional performance, physical activity, and grip strength.

The multidisciplinary expertise regarding co-morbidities which is present within the AMC in close collaboration with the existing data collection structures of the HIV Monitoring Foundation (HMF) and the Cluster of Infectious Diseases of the Public Health Service Amsterdam (PHSA), offers a unique opportunity to systematically identify the burden of co-morbidity, their (known) risk factors and their effect on quality of life among HIV-infected individuals and in a comparable group of uninfected individuals.

As of August 2020, the study was amended to include a substudy, the main aim of which is to determine and compare the rate of SARS-CoV-2 infection, the extent of the SARS-CoV-2-specific adaptive immune response, and the incidence and severity of COVID-19 disease between PWH and HIV-negative cohort participants who remain in active follow-up.

Furthermore, if disease prevalence is sufficiently high, another aim will be to determine and compare risk factors for the development of severe COVID-19 between PWH and HIV-negative controls. Furthermore, an attempt will be made to compare the impact of nationally imposed social distancing measures on substance use, medication adherence, sexual behavior, quality of life and depressive symptoms in study participants.

Specific aims

1. To assess the SARS-CoV-2 infection rate in HIV-positive and -negative participants over 24 months by combined testing for in vivo SARS-CoV-2 specific antibodies, and in vitro SARS-CoV-2 specific memory B-cell and T-cell responses.

2. To assess the course over time of SARS-CoV-2 specific antibody levels, the quantity of SARS-CoV-2-specific memory B-cell, as well as CD4 and CD8 T-cell responses, and the functionality of the overall T cell response in vitro in HIV-positive and -negative participants with demonstrated SARS-CoV-2 infection, as well as the presence of SARS-CoV-2 cross-reactive common cold coronavirus (HKU1, OC43, NL63 and 229E) specific CD4 and CD8 T-cell responses in selected participants.

3. To assess the proportion of HIV-positive and -negative participants who carried broadly recognizing coronavirus (HKU1, OC43, NL63 and 229E) antibodies, prior to demonstrated SARS-CoV-2 infection.

4. To assess the rate and severity of COVID-19 disease in HIV-positive and -negative participants.

5. To assess factors associated with SARS-CoV-2 infection, development of COVID-19 and severe disease (i.e. requiring hospitalization and/or ICU-admission) in HIV-positive and HIV-negative participants.

6. To assess associations between nationally imposed social distancing measures and substance use, medication adherence, social behavior, quality of life and depression in study participants.

Recruitment information / eligibility

• Status: Active, not recruiting
• Enrollment: 1148
• Est. completion date: October 2024
• Est. primary completion date: October 2024
• Accepts healthy volunteers: Accepts Healthy Volunteers
• Gender: All
• Age group: 45 Years and older

Eligibility

Inclusion Criteria:

• For the HIV-positive patients: HIV-1 infection and aged 45 years and above

• For the HIV-negative controls: HIV-uninfected and aged 45 years and above

Exclusion Criteria:

• None

Related Conditions & MeSH terms

• Ageing
• Comorbidity
• HIV-1-infection
• Infections

Locations

Country	Name	City	State
Netherlands	Academic Medical Center	Amsterdam
Netherlands	Public Health Service Amsterdam	Amsterdam

Sponsors (2)

Lead Sponsor	Collaborator
Academisch Medisch Centrum - Universiteit van Amsterdam (AMC-UvA)	Public Health Service of Amsterdam

Country where clinical trial is conducted

Netherlands, 

References & Publications (18)

Cobos Jimenez V, Wit FW, Joerink M, Maurer I, Harskamp AM, Schouten J, Prins M, van Leeuwen EM, Booiman T, Deeks SG, Reiss P, Kootstra NA; AGEhIV Study Group. T-Cell Activation Independently Associates With Immune Senescence in HIV-Infected Recipients of Long-term Antiretroviral Treatment. J Infect Dis. 2016 Jul 15;214(2):216-25. doi: 10.1093/infdis/jiw146. Epub 2016 Apr 12. — View Citation

Demirkaya N, Wit FW, van Den Berg TJ, Kooij KW, Prins M, Schlingemann RO, Abramoff MD, Reiss P, Verbraak FD; AGEhIV Cohort Study Group. HIV-Associated Neuroretinal Disorder in Patients With Well-Suppressed HIV-Infection: A Comparative Cohort Study. Invest Ophthalmol Vis Sci. 2016 Mar;57(3):1388-97. doi: 10.1167/iovs.15-18537. — View Citation

Kooij KW, Schouten J, Wit FW, van der Valk M, Kootstra NA, Stolte IG, van der Meer JT, Prins M, Grobbee DE, van den Born BJ, Reiss P. Difference in Aortic Stiffness Between Treated Middle-Aged HIV Type 1-Infected and Uninfected Individuals Largely Explained by Traditional Cardiovascular Risk Factors, With an Additional Contribution of Prior Advanced Immunodeficiency. J Acquir Immune Defic Syndr. 2016 Sep 1;73(1):55-62. doi: 10.1097/QAI.0000000000001024. — View Citation

Kooij KW, Vogt L, Wit FWNM, van der Valk M, van Zoest RA, Goorhuis A, Prins M, Post FA, Reiss P; AGEhIV Cohort Study. Higher Prevalence and Faster Progression of Chronic Kidney Disease in Human Immunodeficiency Virus-Infected Middle-Aged Individuals Compared With Human Immunodeficiency Virus-Uninfected Controls. J Infect Dis. 2017 Sep 15;216(6):622-631. doi: 10.1093/infdis/jix202. Erratum In: J Infect Dis. 2018 Apr 23;217(10):1673. — View Citation

Kooij KW, Wit FW, Bisschop PH, Schouten J, Stolte IG, Prins M, van der Valk M, Prins JM, van Eck-Smit BL, Lips P, Reiss P; AGEhIV Cohort Study group. Low bone mineral density in patients with well-suppressed HIV infection: association with body weight, sm — View Citation

Kooij KW, Wit FW, Booiman T, van der Valk M, Schim van der Loeff MF, Kootstra NA, Reiss P; AGEhIV Cohort Study Group. Cigarette Smoking and Inflammation, Monocyte Activation, and Coagulation in HIV-Infected Individuals Receiving Antiretroviral Therapy, Compared With Uninfected Individuals. J Infect Dis. 2016 Dec 15;214(12):1817-1821. doi: 10.1093/infdis/jiw459. Epub 2016 Sep 28. — View Citation

Kooij KW, Wit FW, Schouten J, van der Valk M, Godfried MH, Stolte IG, Prins M, Falutz J, Reiss P; AGEhIV Cohort Study Group. HIV infection is independently associated with frailty in middle-aged HIV type 1-infected individuals compared with similar but uninfected controls. AIDS. 2016 Jan;30(2):241-50. doi: 10.1097/QAD.0000000000000910. Erratum In: AIDS. 2016 Jul 17;30(11):1863. — View Citation

Kooij KW, Wit FW, van Zoest RA, Schouten J, Kootstra NA, van Vugt M, Prins M, Reiss P, van der Valk M; AGEhIV Cohort Study Group. Liver fibrosis in HIV-infected individuals on long-term antiretroviral therapy: associated with immune activation, immunodeficiency and prior use of didanosine. AIDS. 2016 Jul 17;30(11):1771-80. doi: 10.1097/QAD.0000000000001119. — View Citation

Langebeek N, Kooij KW, Wit FW, Stolte IG, Sprangers MAG, Reiss P, Nieuwkerk PT; AGEhIV Cohort Study Group. Impact of comorbidity and ageing on health-related quality of life in HIV-positive and HIV-negative individuals. AIDS. 2017 Jun 19;31(10):1471-1481. doi: 10.1097/QAD.0000000000001511. — View Citation

Moller LM, Brands R, Sluiter JK, Schouten J, Wit FW, Reiss P, Prins M, Stolte IG. Prevalence and determinants of insufficient work ability in older HIV-positive and HIV-negative workers. Int Arch Occup Environ Health. 2016 May;89(4):699-709. doi: 10.1007/s00420-015-1108-0. Epub 2016 Jan 8. — View Citation

Schouten J, Su T, Wit FW, Kootstra NA, Caan MW, Geurtsen GJ, Schmand BA, Stolte IG, Prins M, Majoie CB, Portegies P, Reiss P; AGEhIV Study Group. Determinants of reduced cognitive performance in HIV-1-infected middle-aged men on combination antiretroviral therapy. AIDS. 2016 Apr 24;30(7):1027-38. doi: 10.1097/QAD.0000000000001017. — View Citation

Schouten J, Wit FW, Stolte IG, Kootstra NA, van der Valk M, Geerlings SE, Prins M, Reiss P; AGEhIV Cohort Study Group. Cross-sectional comparison of the prevalence of age-associated comorbidities and their risk factors between HIV-infected and uninfected — View Citation

Su T, Caan MW, Wit FW, Schouten J, Geurtsen GJ, Cole JH, Sharp DJ, Vos FM, Prins M, Portegies P, Reiss P, Majoie CB; AGEhIV Cohort Study. White matter structure alterations in HIV-1-infected men with sustained suppression of viraemia on treatment. AIDS. 2016 Jan;30(2):311-22. doi: 10.1097/QAD.0000000000000945. — View Citation

Su T, Mutsaerts HJ, Caan MW, Wit FW, Schouten J, Geurtsen GJ, Sharp DJ, Prins M, Richard E, Portegies P, Reiss P, Majoie CB; AGEhIV Cohort Study. Cerebral blood flow and cognitive function in HIV-infected men with sustained suppressed viremia on combination antiretroviral therapy. AIDS. 2017 Mar 27;31(6):847-856. doi: 10.1097/QAD.0000000000001414. — View Citation

Su T, Schouten J, Geurtsen GJ, Wit FW, Stolte IG, Prins M, Portegies P, Caan MW, Reiss P, Majoie CB, Schmand BA; AGEhIV Cohort Study Group. Multivariate normative comparison, a novel method for more reliably detecting cognitive impairment in HIV infection — View Citation

Su T, Wit FW, Caan MW, Schouten J, Prins M, Geurtsen GJ, Cole JH, Sharp DJ, Richard E, Reneman L, Portegies P, Reiss P, Majoie CB; AGEhIV Cohort Study. White matter hyperintensities in relation to cognition in HIV-infected men with sustained suppressed viral load on combination antiretroviral therapy. AIDS. 2016 Sep 24;30(15):2329-39. doi: 10.1097/QAD.0000000000001133. — View Citation

van Zoest RA, van der Valk M, Wit FW, Vaartjes I, Kooij KW, Hovius JW, Prins M, Reiss P; AGEhIV Cohort Study Group. Suboptimal primary and secondary cardiovascular disease prevention in HIV-positive individuals on antiretroviral therapy. Eur J Prev Cardiol. 2017 Aug;24(12):1297-1307. doi: 10.1177/2047487317714350. Epub 2017 Jun 5. — View Citation

van Zoest RA, Wit FW, Kooij KW, van der Valk M, Schouten J, Kootstra NA, Wiersinga WJ, Prins M, van den Born BJ, Reiss P; AGEhIV Cohort Study Group. Higher Prevalence of Hypertension in HIV-1-Infected Patients on Combination Antiretroviral Therapy Is Associated With Changes in Body Composition and Prior Stavudine Exposure. Clin Infect Dis. 2016 Jul 15;63(2):205-13. doi: 10.1093/cid/ciw285. Epub 2016 May 3. — View Citation

* Note: There are 18 references in all — Click here to view all references

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	The prevalence of comorbidities, organ system dysfunction and their risk factors at time of enrolment	To assess the prevalence and incidence of comorbidities, organ system dysfunction and their risk factors over two years of follow-up in a cohort of HIV-infected individuals (mostly on antiretroviral therapy) and in a cohort of comparable but uninfected controls	at enrolment and after every 2 years follow up. The Ethics Committee has approved for the study to continue without a set end-date, depending on continued funding.
Primary	The incidence of comorbidities, organ system dysfunction and their risk factors after two years of follow up	To assess the incidence of comorbidities, organ system dysfunction and their risk factors after tow years of follow up in a cohort of HIV-infected individuals (mostly on antiretroviral therapy) in comparison to that of a cohort of comparable but uninfected controls	After every 2 years of follow up.The Ethics Committee has approved for the study to continue without a set end-date, depending on continued funding.
Secondary	Quality of life measured using the Medical Outcomes Study Short Form 36-item health survey (SF-36)	To compare quality of life both at baseline and over time, between patients who are HIV-infected or HIV-uninfected, and with and without co-morbidity.	At baseline and after 2 years
Secondary	Management strategies	To suggest appropriate management strategies for identified co-morbidities in the HIV-infected cohort and their risk factors, if advice is requested by the patient's HIV physician. To assess over time if the prevalence and incidence of co-morbidity burden have changed.	After 4 years