Sonographic assessment of severity in the body fat changes related to the lipoatrophic findings of HIV associated Adipose Redistribution Syndrome (HARS)


ABSTRACT
Objective: To investigate the diagnostic accuracy of ultrasound (US) to identify the severity of body fat changes due to HIV-related lipoatrophy (LA) by US grading scale (US GS. Methods: US diagnoses based on measurements of the thickness of subcutaneous fat at representative reference points (RPs) for LA were compared to clinical diagnoses based on the HIV Outpatient Study Grading Scale (HOPS-GS). A sample size of 115 patients was required for statistical power of 80%. Results: 73 males [HOPS-GS-0: 31.5%, 41.2%, and 50.5%; HOPS-GS-1 42.5%, 32.5%, and 29%, and HOPS-GS-2/3 26%, 26.2% and 20.5%, for facial, brachial, and crural RPs, respectively] and 42 females [HOPS-GS-0 26%, 43%, and 28.6%; HOPS-GS-1 38%, 38% and 33.3%; and HOPS-GS-2/3 36, 19% and 38.1%, for facial, brachial, and crural RPs, respectively] were recruited. Significant differences were found in US assessments for each corresponding HOPS-GS (p<.003–.0001). Diagnostic thresholds were identified for each degree of LA severity (US-GS 0 vs. US-GS 1 and US-GS2-3) for facial, brachial, and crural LA, with related sensitivity (range: 83–99%), specificity (range: 85–99%), positive predictive values (range: 73–98%) and negative predictive values (range: 82–98%). Compared with clinical LA diagnoses, US-GS correctly diagnosed 80.9% of cases (OR: 8.1; 95%CI: 2.8–23.5, p<.0001). US identified 33% of cases with initial LA (fat loss <1.5mm from diagnostic thresholds) not recognizable by the clinical assessments. Conclusions: US shows good diagnostic accuracy in the assessment of early HIV related LA. US-GS may be valuable in routine management of HIV outpatients to objectively assess lipoatrophic findings. Keywords: Lipodystrophy; Sonography; HIV; Lipoatrohy; Antiretrovirals.


Articolo presente in – HAART and correlated pathologies n. 4

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Genotypic Resistance to Tipranavir/Ritonavir (TPV/R): Correlation with a -1 Log HIV-RNA Decline at 12 and 24 Weeks in PI-Experienced Patients Enrolled in the Italian Expanded Access Program for Tipranavir


ABSTRACT
To validate the clinical utility of the current TPV genotypic score and describe the role of additional protease mutations in determining the virological response to tipranavir/ritonavir, 176 pluri-experienced HIV-infected patients with a baseline genotypic profile were evaluated. Univariate and multivariate analyses, using a stepwise estimation model with backward procedure, were performed to identify variables associated with virological response to a new regimen including tipranavir after 12 and 24 weeks. Results relative to the subanalysis of data using the achievement of a viral load decrease of at least 1 log as primary endpoint are presented herein.
At week 24, 62.6% of patients had a ≥1 log HIV-RNA decrease. The following variables were significantly (p<0.05) associated with response in multivariate analysis: CD4 nadir, number of previous protease inhibitors and CDC stage C. TPV score was predictive of outcome with univariate, but not multivariate, analysis. Among mutations, Q58E (p=0.040) and Q92K (p=0.027) were associated with failure, while L76V (OR p=0.002) was associated with success. This study suggests that the current TPV-associated mutation list does not fully reflect the genotypic profile of TPV resistance in our clinical cohort, and the role of additional mutations needs to be considered. Of note, the L76V mutation appeared to have a beneficial impact on the virological response to TPV.
Keywords: Tipranavir; Genotypic resistance; Antiretrovirals.


Articolo presente in – HAART and correlated pathologies n. 1

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