15 research outputs found
Morphological and metabolic components of lipodystrophy in various nevirapine-based highly active antiretroviral therapy (HAART) regimens: a cross-sectional, observational study.
No full textBackground: Morphological abnormalities (lipoatrophy and central fat accumulation) and metabolic changes (dyslipidaemia and glucose regulation impairment) have emerged as components of lipodystrophy and as major tolerability issues with long-term use of highly active antiretroviral therapy (HAART) in HIV-positive patients. Protease inhibitors (PIs) are recognized as having the greatest impact in terms of metabolic complications, followed by nucleoside reverse transcriptase inhibitors, while the non-nucleoside reverse transcriptase inhibitors (NNRTIs) have the least impact. In particular, regimens based on the NNRTI nevirapine have been shown to achieve significant metabolic benefits and may help to improve dyslipidaemia. Improvements in body shape changes associated with lipodystrophy have also been reported when nevirapine replaced a PI in long-term triple therapy. Objective: The objective of this cross-sectional observational ('real-world') study was to investigate the effect of three HAART regimens plus stable nevirapine therapy on morphological and metabolic components of lipodystrophy in HIV-infected patients. Methods: Consecutive patients (aged >18 years) with serologically documented HIV infection, who had received HAART for at least 2 years and who had been diagnosed with lipodystrophy, were followed up as outpatients at the metabolic clinic of the University of Modena and Reggio Emilia, Modena, Italy. Patients received stable nevirapine therapy plus fixed-dose combinations of tenofovir disoproxil fumarate plus emtricitabine (Truvada®; TVD), zidovudine plus lamivudine (3TC) [Combivir®; CBV], or abacavir plus lamivudine (Kivexa®; KVX). Multivariate regression analyses were performed to analyse predictors of four components of lipodystrophy: lipoatrophy using leg fat mass measured by dual-emission x-ray absorptiometry (DXA), fat accumulation using waist circumference, dyslipidaemia using apolipoprotein (Apo)B/ApoA1 ratio, and glucose intolerance using the Homeostasis Model Assessment for Insulin Resistance (HOMA-IR). Results: Overall, 101 patients were enrolled (TVD group = 61, CBV group = 20, KVX group = 20); 191 observations were analysed. Male sex was associated with reduced leg fat mass, while age and body mass index (BMI) were associated with increased leg fat mass (all p < 0.05). Leg fat mass and male sex were associated with increased waist circumference (p < 0.001 for both). Leg fat mass predicted reduced ApoB/ApoA1 ratio, while age and BMI predicted increased ApoB/ApoA1 ratio (all p < 0.05). BMI predicted HOMA-IR increase (p = 0.0017). No differences in lipoatrophy, central fat accumulation, dyslipidaemia or glucose metabolism were observed among any of the three different nevirapine plus nucleoside backbone groups (TVD, CBV or KVX). Conclusion: HAART including nevirapine has a limited impact on components of lipodystrophy in patients with HIV infection. Further studies are needed to verify if nevirapine overcomes the expected distinct lipodystrophy risk profile associated with different nucleoside backbone therapies
Screening for psychosis risk among help-seeking adolescents: application of the Italian version of the 16-item prodromal questionnaire (iPQ-16) in child and adolescent neuropsychiatry services
No full textAIM:
The 16-item Prodromal Questionnaire (PQ-16) is a versatile screen tool for routine screening of at-risk individuals. We wished to evaluate the psychometric properties of the Italian version of the PQ-16 (iPQ-16) in a sample of 72 help-seeking adolescents (age range 13-17 years) referred to child and adolescent neuropsychiatry services for diagnostic assessment.
METHODS:
Participants who completed iPQ-16 were subsequently interviewed with the Comprehensive Assessment of At-Risk Mental States (CAARMS) to confirm the psychosis high risk state. We then examined the diagnostic accuracy (sensitivity, specificity, positive and negative predictive values [PPV e NPV]) and concurrent validity between iPQ-16 and CAARMS using Cronbach's alpha and Cohen's kappa. We also tested the validity of the adopted iPQ-16 cut-offs through Receiver Operating Characteristic (ROC) curves plotted against CAARMS diagnoses and the 1-year predictive validity of the iPQ-16.
RESULTS:
Overall, the psychometric properties of the iPQ-16 were satisfactory. The iPQ-16 showed high internal consistency (Cronbach's alpha = .827) and acceptable diagnostic accuracy (77% sensitivity, 72% PPV) and concurrent validity (Cohen's k = 0.309). ROC analyses pointed to iPQ-16 total distress score of ≥10 as best cut-off.
CONCLUSION:
The iPQ-16 is a reliable and valid instrument for routine screening of at-risk individuals in Italian neuropsychiatry services
Metabolic alterations in HIV-infected pregnant women: moving to metabolic tailoring of antiretroviral drugs.
No full textThe most striking effect of increased survival and improved quality of life in HIV-infected women undergoing antiretroviral therapy is the feasibility of motherhood-desire satisfaction. However, such advantages are often associated with drug-related metabolic toxicities, particularly relevant in the pregnancy context. Recent guidelines provide recommendations and trends for the use of antiretroviral therapy in pregnant women, but current literature falls short of providing specific insights on the need for metabolic monitoring and treatment in HIV-infected pregnant women. In this review we provide specific insight into the state-of-the-art of: detection, evaluation, and management of metabolic alterations in this special population. Pregnancy is in fact a metabolic transition process, potentially associated with specific diseases in the mother, in the newborn, and in the adulthood of the child. We will not simply discuss antiretroviral therapy metabolic toxicities, but rather their interaction with the physiological metabolic changes occurring during pregnancy. Close monitoring is needed to diagnose metabolic alterations that can lead to adverse outcomes in the mother, in the newborn, and potentially in adulthood. Lifestyle interventions and an appropriate metabolic tailoring of antiretroviral therapy drugs need to be considered in the prevention and treatment of metabolic alteration during pregnancy
Two methods of measuring frailty among people aging with HIV
No full textThe two most common methods of assessing frailty are via the frailty phenotype and the frailty index. We assessed and compared their cross-sectional characteristics in the same sample of people aging with HIV in northern Italy
Reliability of the italian version of the 16-item Prodromal Questionnaire (iPQ-16) for psychosis risk screening in a young help-seeking community sample
No full textObjective:
Among current early screeners for psychosis-risk states, the Prodromal Questionnaire-16 items (PQ-16) is used. We aimed to assess reliability of the Italian version of the PQ-16 in a young help-seeking sample.
Methods:
We included 151 individuals, aged 13-35 years, seeking help at the Reggio Emilia outpatient mental health services in a large semirural catchment area (550.000 inhabitants). Participants completed the Italian version of the PQ-16 (iPQ-16) and were subsequently evaluated with the Comprehensive Assessment of At-Risk Mental States (CAARMS). We examined test-retest reliability, internal consistency and diagnostic accuracy (i.e. sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios) between PQ-16 and CAARMS UHR-defined criteria using coefficient of stability (k), Cronbach’s alpha
and Cohen’s kappa, respectively.
Results:
The iPQ-16 showed excellent short term test-retest reliability (k = 0.898), high internal consistency (α = 0.810) and acceptable diagnostic accuracy (sensitivity = 73.5% and specificity = 75.9% at the proposed cut-off of ≥ 6 on symptom total score).
Conclusions:
Psychometric properties of the iPQ-16 were satisfactory. The iPQ-16 is a suitable screening tool for routine use in mental health care services. Indeed, it is short and therefore easy to implement in routine assessment
Lower Frailty Is Associated with Successful Cognitive Aging Among Older Adults with HIV
No full textAging with HIV poses unique and complex challenges, including avoidance of neurocognitive disorder. Our objective here is to identify the prevalence and predictors of successful cognitive aging (SCA) in a sample of older adults with HIV. One hundred three HIV-infected individuals aged 50 and older were recruited from the Modena HIV Metabolic Clinic in Italy. Participants were treated with combination antiretroviral therapy for at least 1 year and had suppressed plasma HIV viral load. SCA was defined as the absence of neurocognitive impairment (as defined by deficits in tasks of episodic learning, information processing speed, executive function, and motor skills) depression, and functional impairment (instrumental activities of daily living). In cross-sectional analyses, odds of SCA were assessed in relation to HIV-related clinical data, HIV-Associated Non-AIDS (HANA) conditions, multimorbidity (≥2HANA conditions), and frailty. A frailty index was calculated as the number of deficits present out of 37 health variables. SCA was identified in 38.8% of participants. Despite no differences in average chronologic age between groups, SCA participants had significantly fewer HANA conditions, a lower frailty index, and were less likely to have hypertension. In addition, hypertension (odds ratio [OR] = 0.40, p = .04), multimorbidity (OR = 0.35, p = .05), and frailty (OR = 0.64, p = .04) were significantly associated with odds of SCA. Frailty is associated with the likelihood of SCA in people living with HIV. This defines an opportunity to apply knowledge from geriatric population research to people aging with HIV to better appreciate the complexity of their health status
CD8 T-Cell Activation Is Associated With Lipodystrophy and Visceral Fat Accumulation in Antiretroviral Therapy–Treated Virologically Suppressed HIV-Infected Patients
No full textOBJECTIVE.: HIV-infected patients receiving antiretroviral treatment frequently accumulate fat at the abdominal level. It is unknown whether T-cell activation and immune phenotypes are associated with fat accumulation. Thus, the aim of the study was to search for an association between the presence of clinical lipodystrophy (LD), visceral and subcutaneous abdominal adipose tissue amount (VAT and SAT) and peripheral T-cell immune phenotypes.
DESIGN.: Cross-sectional study including 87 HIV-infected ART-treated, virologically-suppressed and immune-reconstituted patients.
METHODS.: The patients were evaluated for clinical LD, VAT, SAT, insulin resistance (HOMA-IR) and coronary calcium score (CAC>10). T-cell activation (CD8/CD38), differentiation (CD4/CD8/CCR7/CD45RA) and expression/activation of the IL7/IL-7R system (CD4/CD8/CD127; IL-7; CD4/CD8/pStat-5) were assessed by cytometry.
RESULTS.: In multivariable analyses CD8+T-cell activation (CD38+) was associated with lipoatrophy and central fat accumulation (respectively: ß=5.63; p=0.005; and: ß=4.19; p=0.020). This was also the case for IL-7R expressing CD8+T-cells (CD127+): respectively for lipoatrophy ß=12.8; p=0.003 and central fat accumulation ß=9.45; p=0.016. CD8+T-cell activation was also associated with VAT/TAT (ß= 0.01; p=0.002) and SAT/VAT ratios (ß= -0.014; p=0.015).As expected, VAT/TAT was an independent risk factor for insulin resistance (HOMA-IR, r=0.364, p=0.028) and cardiovascular risk (CAC, r=0.406, p=0.002).
CONCLUSIONS.: CD8+T-cell activation was associated with lipodystrophy and the relative amount of VAT in ART-controlled, virologically-suppressed, HIV-infected patients. We propose that CD8 activation may be involved in the accumulation of central fat frequently observed in these patients, with resulting increased cardio-metabolic risk
Reliability of the Italian version of the Brief (21-item) Prodromal Questionnaire (IPQ-B) for psychosis risk screening in a young help-seeking population
No full textObjective Among current screeners for psychosis-risk mental states, the Prodromal Questionnaire- Brief (21 items) (PQ-B) is used. We aimed to assess reliability of the Italian version of the PQ-B in a young help-seeking sample. Methods - We included 151 individuals, aged 13-35 years, seeking help at the Reggio Emilia outpatient mental health services in a large semirural catchment area (550.000 inhabitants). Participants completed the Italian version of the PQ-B (iPQ-B) and were subsequently evaluated with the Comprehensive Assessment of At-Risk Mental States (CAARMS). We examined test-retest reliability, internal consistency and diagnostic accuracy (i.e. sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios) between PQ-B and CAARMS UHR-defined criteria using coefficient of stability (k), Cronbach's alpha and Cohen's kappa, respectively. Results The iPQ-B showed excellent short term test-retest reliability (k = 0.891), high internal consistency (α = 0.876) and acceptable diagnostic accuracy (sensitivity = 91.4% at the proposed cut-off of ≥ 6 on total distress score). Conclusions Psychometric properties of the iPQ-B were satisfactory. The iPQ-B is a suitable screening tool for routine use in mental health care services. Indeed, it is short and therefore easy to implement in routine assessment of early psychosis
Reliability of the Italian version of the Brief (21-item) Prodromal Questionnaire (IPQ-B) for psychosis risk screening in a young help-seeking population
No full textAmong current screeners for psychosis-risk mental states, the Prodromal Questionnaire Brief (21 items) (PQ-B) is used. We aimed to assess reliability of the Italian version of the PQ-B in a young help-seeking sample. Methods – We included 151 individuals, aged 13-35 years, seeking help at the Reggio Emilia outpatient mental health services in a large semirural catchment area (550.000 inhabitants). Participants completed the Italian version of the PQ-B (iPQ-B) and were subsequently evaluated with the Comprehensive Assessment of At-Risk Mental States (CAARMS). We examined test-retest reliability, internal consistency and diagnostic accuracy (i.e. sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios) between PQ-B and CAARMS UHR-defined criteria using coefficient of stability (k), Cronbach’s alpha and Cohen’s kappa, respectively
Neurocognitive profile in first psychotic episode patients
No full textNeurocognitive profile in first psychotic episode patient
