HIV

A Haemophilia, HIV and osteoporosis: an emerging problem in clinical practice

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ABSTRACT
HIV infection is an important co-morbidity in haemophilia. Some evidences suggest that both these pathologies are related to a reduction in bone mineral density. We describe the complexity in management of a femoral fracture in a patient with severe haemophilia and a long history of treatment for HIV infection.

Articolo presente in – HAART and correlated pathologies n. 14 –

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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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Towards a decline in hepatitis related mortality in persons living with HIV?

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ABSTRACT
Liver related mortality is the second cause of death in persons living with HIV (PLHIV) in developed countries; it has showed a stable trend since from 2000, but a decline of HBV related mortality has been observed during this time period probably because of the large usage of anti HIV drugs with dual anti HBV and anti HIV activity. Hepatitis C coinfection is the main cause of liver related death, but its prevalence in PLHIV in Italy is declining. HIV worsens the course of HCV, but this effect could be reduced by early HAART. The negative effect of HAART in the short term (hepatotoxicity) and long term (steatosis, insulin resistance) could be reduced by the usage of new antiretrovirals. Optimization of anti HCV treatment by: response and human genotype guided therapy, usage of higher doses of Ribavirin, selection of concurrent HAART and pre-treatment management of metabolic side effects of HAART might increase the rate of SVR and patients survival. Screening of cirrhotics for HCC, aggressive treatment of decompensated cirrhosis and liver transplantation might increase survival in patients with advanced liver disease. In the next future the implementation of new anti HCV drugs in clinical practice, by increasing the rate of response to treatment, could additionally improve the prognosis of HIV/HCV coinfected patients.
Keywords: HCV; HBV; HIV; Cirrhosis; Hepatocellular Carcinoma; Interferon; Ribavirin.

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

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Do we still need CD4 T cell count?

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ABSTRACT
The relevance of CD4 T cell count as pivotal marker of HIV disease progression and response to HAART is well established. The authors explore the potential role of immunological markers other than CD4 count in the management of HIV-infected individuals, and consider their usefulness and convenience in clinical practice.
Keywords: HIV; CD4 T cells; Immune reconstitution; T cell phenotype and function.

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

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Bone Mass Density disorders and HIV infection: a prospective evaluation of BMD and its predictors in the HIV cohort at Pescara General Hospital.

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ABSTRACT
Introduction HAART increased patients’ survival, but dismetabolic events increased in parallel. Bone disorders like osteopenia/osteoporosis are on the rise. We designed a prospective study to evaluate bone mass density (BMD) and risk factors for BMD disorders in all consecutive HIV infected patients attending our Institution. Methods All consecutive HIV infected patients in follow up at our Institution are being enrolled. Clinical and behavioral evaluations are considered at enrollment and will be reconsidered 24 months apart. HAART, Nadir and current CD4 T-cell counts, current HIV viremia are being retrieved with other metabolic and hormonal parameters. BMD is measured by dual X-ray absorptiometry (DXA) of femur and lumbar spine and by Quantitative UltraSound (QUS) of the heel. Stata Software package 9 has been used for statistical analyses. Results Main outcomes were: DXA T-Scores and Z-Scores for lumbar spine and femur; QUS T-Scores, Z-Scores and QUS stiffness for heel. All major outcomes were significantly related to BMI and length of HAART. Gainful employment, taking other drugs in addition to HAART, presence of ACL, hypertension and occurrence of any type of bone fracture emerged as possibly related additional risk or protective factors for BMD reduction. Discussion Our observation seems to confirm the importance of studying bone metabolism in a HIV infected patients. Lower BMIs and longer duration of HAART were confirmed associated to a lower BMDs. A link between BMD reduction and working activity may have emerged. Our final analysis on data from the whole sample will provide a more significant contribution.
Keywords: Osteopenia/osteoporosis; HIV; Bone mass density (BMD).

Articolo presente in – HAART and correlated pathologies n. 4 –

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

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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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Type 2 diabetes: impending doom for the HIV+ patient?

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ABSTRACT
Some antiretroviral agentsinduce profound metabolic changes which may result in lipoatrophy/lipodystrophy, metabolic syndrome, type 2 diabetes and related disorders. The evidence linking antiretroviral therapy to enhanced risk of type 2 diabetes in the HIV+ patient on cART is reviewed and the potential relations with cardiovascular risk are highlighted. Current options in diabetes preventative therapy are also examined.
Keywords: Diabetes; HIV.

Articolo presente in – HAART and correlated pathologies n. 3 –

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HIV/AIDS prevention in young migrants across Europe: the AIDS&Mobility Project

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ABSTRACT
The present paper highlights the main aspects of the Community Project AIDS&Mobility, aimed at reducing vulnerability and susceptibility to HIV infection of young migrants (16-25 yy), currently increasing in several E.U. Member states, through communication/information initiatives carried out by transcultural mediators trained for such a task.
The project consists of six different work packages. National Institute for Health, Migrants and Poverty (NIHMP) is the leader of the “Internal Evaluation Package”. As a result more than 2,000 young migrants are expected to be reached by HIV/AIDS prevention campaigns planned in order to meet specific needs of different groups of migrants in each one of the seven participating Countries.
Keywords: HIV; Migrants; Prevention; Transcultural mediator.

Articolo presente in – HAART and correlated pathologies n. 2 –

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Central nervous system immune reconstitution disease presenting with vasculitis-like lesions

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ABSTRACT
The immune reconstitution inflammatory syndrome (IRIS) identifies a spectrum of clinico-pathological entities resulting from either paradoxical worsening or unmasking of previously quiescent disorders following the initiation of combination antiretroviral therapy (cART). The central nervous system (CNS) is a major target tissue for IRIS, and inflammatory forms of cryptococcosis and progressive multifocal leukoencephalopahy (PML) are well known manifestations of CNS-IRIS. We here describe the case of a patient who developed focal neurological disease two months after initiation of cART and one month after successfully treated herpes zoster. Magnetic resonance imaging (MRI) showed vasculitis-like lesions but cerebrospinal fluid analysis failed to reveal the presence of varicella-zoster virus or other opportunistic pathogens. The clinical and radiological picture improved dramatically following treatment with intravenous high dose corticosteroids and remained stable during the subsequent follow-up. CNS-IRIS may present in the form of vasculitis-like inflammatory CNS lesions that respond to anti-inflammatory treatment.
Keywords: HIV; IRIS; Central Nervous System.

Articolo presente in – HAART and correlated pathologies n. 2 –

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Bone turnover markers in clinical practice and their potential use in HIV-related bone disease

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ABSTRACT
Bone metabolism is characterized by two opposing activities coupled in time and space in the so-called ‘bone remodelling units’. Through a continuous remodelling cycle old bone is resorbed by osteoclasts while osteoblasts deposit new bone. Bone loss is due to an imbalance between bone resorption and formation. Biochemical markers provide a dynamic view of the remodelling process, which can improve fracture risk prediction. Furthermore, they can be used to monitor the short-term effects of therapy, treatment efficacy and patient compliance. Markers of bone remodelling can be dosed in plasma and/or urine, as indicators of osteoblast function or osteoclast function. The significance of any bone turnover marker (BTM) depends on two fundamental characteristics: specificity and variability. The biological variability may determine some limitations in the interpretation of the data. Even though some uncertainties on how to interpret a given result are not resolved as yet, it is impossible to ignore the utility of BTM. As they are easy to obtain and inexpensive compared with other not always mandatory examinations, it seems justified to use BTM in our clinical practice.
HIV-related bone disease is characterized by a high turnover state, with an exaggerated osteoclastic bone resorption and delayed osteoblastic bone formation. Few data exist on the relevance of BTM in HIV-infected patient management. Following the considerations drawn for the general population we suggest that, at least in osteoporotic HIV-patients, BTM be used both to increase the ability of fracture prediction and to monitor the response to anti-resorptive therapy.
Keywords: Osteoporosis; HIV; Bone turnover markers.

Articolo presente in – HAART and correlated pathologies n. 2 –

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