Haart

Myalgia and creatine phosphokinase elevations in the HAART era: focus on Raltegravir

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ABSTRACT
Raltegravir is the first HIV integrase inhibitor available in clinical practice for the treatment of HIV-infection in both naive and experienced patients. Randomized clinical trials have evidenced a good safety profile. However, grade III-IV creatine phosphokinase increases have been more frequently observed in patients receiving raltegravir in respect of comparator treatments and cases of rhabdomyolysis has been reported in the literature. In this article, we give an insight into the available data from clinical studies and case reports and possible pathogenetic mechanisms of raltegravir-related muscle toxicity.
Keywords: Raltegravir; Myalgia; Creatine phosphokinase; HAART

Articolo presente in – HAART and correlated pathologies n. 10 –

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HIV-associated pulmonary arterial hypertension

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ABSTRACT
Pulmonary arterial hypertension (PAH) is a rare but severe disease that results from chronic obstruction of small pulmonary arteries, leading to right ventricular failure, and, ultimately, death.
HIV infection is an established risk factor for the development of PAH. In comparison with the incidence of idiopathic PAH in the general population (1-2 per million), HIV-infected patients have a 2500-fold risk of developing PAH.
The presence of PAH is an independent risk factor for mortality in patients with HIV infection, and in most cases death is causally related to PAH rather than to other complications of HIV infection.
HIV-associated PAH (HIV-PAH) occurs at all stages of disease and does not seem to be related to the stage of HIV infection, the degree of immune deficiency or CD4 T-lymphocyte count.
Since highly effective therapies for PAH are now available, allowing an amelioration of symptoms and a better prognosis, clinicians should be aware that the appearance and progression of shortness of breath and other cardiopulmonary symptoms in HIV-infected patients may be suggestive of HIV-PAH.
This paper will focus on HIV-PAH with special considerations to epidemiology, pathogenesis, clinical features and diagnosis, and treatment.
Keywords: Pulmonary arterial hypertension; HIV; Pathogenesis; Diagnosis; Treatment; HAART.

Articolo presente in – HAART and correlated pathologies n. 10 –

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Ocular syphilis in an HIV-infected patient: active disease or immune reconstitution syndrome?

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ABSTRACT
In patients coinfected with HIV the natural history of syphilis may be altered and the immune defect may account for differences in the host immune response to Treponema pallidum. Anyway many questions remain about interactions between HIV and syphilis during the HAART-related restoration of protective pathogen-specific immune responses. We describe the case of a HIV-positive patient with ocular syphilis who presented an unexpected immune response to coinfection.
Keywords: Ocular syphilis; HIV; Immune reconstitution; HAART.

Articolo presente in – HAART and correlated pathologies n. 7 –

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Impaired adipokine profile in HIV positive patients without metabolic syndrome: the role of antiretroviral therapy

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ABSTRACT
Adipose tissue secretes of a range of biologically active proteins called adipokines. Dysregulation of adipokines is implicated in the etiology of insulin resistance and metabolic syndrome, but the relation between adiponectin, leptin and antiretroviral therapy has been poorly studied and subject to controversy. This study investigated the relation between plasma adipokine levels and different antiretroviral drug exposure in HIV positive subjects with similar metabolic and anthropometric parameters and without metabolic syndrome. Our data show that antiretroviral drugs impair the adipokine and osteoprotegerin profiles in HIV positive patients without metabolic syndrome and in the absence of impaired glycemic and lipidic parameters.
Keywords: Adiponectin; Leptin; Osteoprotegerin; HAART.

Articolo presente in – HAART and correlated pathologies n. 1 –

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HIV infection and bone changes

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ABSTRACT

The introduction of highly active antiretroviral therapy (HAART) has radically changed the natural history of HIV infection. The significant reduction of plasma viremia accompanied by the arrested immune deterioration following administration of new therapeutic protocols between 1996 and 1999 generated cautious optimism also based on mathematical models claiming the possibility of a complete eradication of HIV infection. Even if the advent of HAART has significantly extended the life-span of patients living with AIDS, the increased mean life-span has given rise to long-term complications of HIV such as metabolic complication, cardiovascular disease and osteoporosis. Degenerative processes involving the bone compartment are common during the course of HIV-1 infection. Osteopenia and osteoporosis represent a challenge in clinical and therapeutic management. It has yet to be determined whether the cause of this dysfunction is linked to HIV-1-mediated direct and/or indirect effects on osteoblasts/osteoclasts cross-talk regulation. This report analyzes the numerous factors able to favor bone derangement (bone loss and osteopenia/osteoporosis) in HIV-1 infected patients.
Key words: HIV, HAART, Bone changes

Articolo presente in – HAART and correlated pathologies n. 0 –

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