1,721,004 research outputs found
Tesamorelin for the treatment of excess abdominal fat in HIV-infected individuals with lipodistrophy
No full textMetabolic and morphologic abnormalities in persons with HIV remain common contributors to stigma and morbidity. Increased abdominal circumference and visceral adiposity were first recognized in the late 1990s, soon after the advent of effective combination antiretroviral therapy. Visceral adiposity is commonly associated with metabolic abnormalities including low HDL- cholesterol, raised triglycerides, insulin resistance and hypertension, a constellation of risk factors for cardiovascular disease and diabetes mellitus known as the metabolic syndrome. Medline and conference abstracts were searched to identify clinical research on factors associated with visceral adiposity and randomized studies of management approaches. Data were critically reviewed by physicians familiar with the field. A range of host and lifestyle factors, as well as antiretroviral drug choice, were associated with increased visceral adiposity. Management approaches included treatment switching. Supraphysiological doses of recombinant HGH and the hGHRH tesamorelin both significantly and selectively reduce visceral fat over 12-24 weeks; however, the benefits are only maintained if dosing is continued. In summary, the prevention and management of visceral adiposity remains a substantial challenge in clinical practice
Multimorbidity and functional status assessment
No full textPurpose of review: This review conceptualizes multimorbidity and functional status impairment in people living with HIV and their implication in clinical and research fields.
Recent findings: Multimorbidity is an increasing age-related condition whose prevalence is higher in HIV-infected patients compared with the general population. It portrays the contemporary clinical complexity of HIV care. Whether multimorbidity describes an accelerated or accentuated aging process is the matter of discussion, although some HIV variables depicting immune activation and chronic inflammation are associated with multimorbidity. Multimorbidity coupled with functional status impairment are determinants of a frailty phenotype and in the frailty research setting, multimorbidity can be explored as an endpoint for clinical studies.
Summary: The success of highly active antiretroviral therapy has significantly changed the clinical pattern of HIV infection, with the 'greying' of the HIV-infected population testament to its success. This has provided new challenges relating to the care of older patients, particularly with regard to the management of multimorbidity functional status impairment
Impact of Antiretroviral Medications on Fasting Lipid Parameters
Full text linkIt is widely accepted that metabolic disease in human immunodeficiency virus (HIV) develops at the intersection of traditional risk factors and HIV-specific contributors, but in observational studies it is difficult to dissect the contribution of the two. This review describes the metabolic impact of antiretroviral medications recommended in the first-line treatment in HIV-infected naive patients. At a clinical level, coronary heart disease screening and management will continue to be of paramount importance in the long-term management of HIV-positive patients on antiretroviral therapy
MR quantitative biomarkers of non-alcoholic fatty liver disease: technical evolutions and future trends
No full textNon-alcoholic fatty liver disease (NAFLD) is characterized by hepatic steatosis as the earliest manifestation and hallmark, and ranges from benign fatty liver to non-alcoholic steatohepatitis (NASH). Liver biopsy (LB) is considered the reference standard for NAFLD diagnosis, grading and characterization, but it is limited by its invasiveness and observer-dependence. Among imaging surrogates for the assessment of hepatic steatosis, MR is the most accurate. (1)H MR spectroscopy (MRS) provides a quantitative biomarker of liver fat content (LFC) called proton density fat fraction (PDFF), but it is time-consuming, not widely available and limited in sample size. Several MR imaging (MRI) techniques, in particular fat suppression and in-opposed phase techniques, have been used to quantify hepatic steatosis, mainly estimating LFC from water and fat signal intensities rather than proton densities. Several technical measures have been introduced to minimize the effect of confounding factors, in particular a low flip angle, a multiecho acquisition and a spectral modeling of fat with multipeak reconstruction to address respectively T1 effect, T2* effect, and the multifrequency interference effects of fat protons, allowing to use MRI to estimate LFC based on PDFF. Tang et al. evaluated MRI-estimated PDFF, obtained by applying the above-mentioned technical improvements, in the assessment of hepatic steatosis, using histopathology as the reference standard. The identification of PDFF thresholds, even though to be further explored and validated in larger and more diverse cohorts, is useful to identify steatosis categories based on MRI-based steatosis percentages. MRI, with the new refined techniques which provide a robust quantitative biomarker of hepatic steatosis (PDFF) evaluated on the whole liver parenchyma, is a promising non-invasive alternative to LB as the gold standard for steatosis diagnosis and quantification
Health transitions in HIV-seropositive individulas undergoing NRTI-based and NRTI-sparing treatment strategies.
No full textNRTI-sparing strategies are often prescribed to reduce the impact of drug toxicities on age related co-morbidities, particularly relevant in frail individuals. The objective of this study was to assess the impact of NRTI-sparing strategies on health transitions in HIV-infected patients with well-controlled HIV infection using a multi-item frailty index
HIV-Associated Lipodystrophy: Impact of Antiretroviral Therapy
No full textIn the late 1990s, reports of unusual changes in
body fat distribution named ‘lipodystrophy’ (LD) began to
appear in HIV patients mitigating the enormous enthusiasm about improvement of survival and quality of life provided by the combinations of antiretroviral (ARV) drug classes, the so-called highly active antiretroviral therapy (HAART), which had just become available at that time. The objective of this paper is to critically review the literature on LD and to discuss the impact of newer ARV agents, namely atazanavir, darunavir and raltegravir, as well as strategies of the late HAART era, including single-tablet regimens and nucleoside-sparing regimens. Studies in which LD was measured by dual-energy x-ray absorptiometry or by abdominal computed tomography or magnetic resonance
imaging scan only, were included. We were unable to
identify studies depicting a negative impact of drugs or
ARV regimens on limb fat loss. On the contrary, a few
studies identified a negative impact of atazanavir/ritonavir
or darunavir/ritonavir on trunk fat increase. It should be
noted that this anthropometric measure is a poor instrument since it cannot distinguish between subcutaneous and visceral fat. We conclude that presumably the body fat changes currently observed in HIV-infected patients is the net result of competing phenomena: on one side the natural history of lipohypertrophy as a result of HIV and HAART impact, and on the other side the physiological body fat
changes observed in the aging population
Nucleoside reverse-transcriptase inhibitor use, cirrhosis, and end-stage liver disease in HIV-infected patients - Reply to Remtulla and Decker
No full textnot availabl
Multiecho MR sequences and high-resolution magic angle spinning (HRMAS)ex-vivo spectroscopy in the qualitative analysis and differentiationbetween steatohepatitis and steatosis
No full textPurpose: To compare multiecho gradient-echo MR (magnetic resonance) sequencesin the differentiation between steatohepatitis and steatosis and to describeHR-MAS spectra of liver biopsy showing steatohepatitis or steatosis.Methods and Materials: Fourteen patients with indication for biopsy assessmentof steatosis underwent liver biopsy (reference standard) and MR imaging. Liverbiopsy of both viral and metabolic steatosis were classified using NAFLD activityscore (NAS) which depicts the degree of necro-inflammatrory activity allowing todifferentiate between steatohepatitis and steatosis. Besides liver fat content (LFC),multiecho sequences were also used to calculate water and fat relaxation times(T2*), which are influenced by microenvironmental characteristics, so potentiallyassociated with necro-inflammatory activity. Relation between each multiechoparameter (LFC/T2*water/T2*fat) and NAS was estimated using univariate linearregression and Pearson coefficient. A fragment of biopsy specimen was analysedthrough HR-MAS to obtain metabolic tissue characterisation.Results: Association was found between: NAS and LFCmulti (r = 0.7; p = 0.006),NAS and T2*fat (r = -0.73, p = 0.063, ns, T2*fat was available for 7 patients only).No correlation was found between NAS and T2*water. HR-MAS spectra showedtissue metabolic heterogeneity, with particular regard to the contents of free glucose,alanine, glutamine/glutamate and phospholipids.Conclusion: This pilot study describes multiecho parameters associated withhistological necro-inflammatory activity, allowing to study the potential capability ofMR to differentiate between steatohepatitis and steatosis. Description of HR-MASspectral heterogeneity in NAFLD and NASH may allow to find biochemical indicatorsof steatosis progression to be used in differentiating between steatohepatitisand steatosis in spectra acquired with in vivo MR Spectroscopy too
Renal hyperfiltration and outcome in HIV-infected subjects.
No full textEvidence from the general population suggests that renal hyperfiltration portends poor prognosis in the general population. No data in HIV-infected subjects is available. Hence, we investigated prevalence, associations with traditional and HIV-related risk factors as well as the prognostic significance of renal hyperfiltration in a large cohort of HIV-infected subjects
American College of Cardiology pooled equations and DAD algorithm to predict freedom from cardiovascular events in HIV patients
No full textA predicted low cardiovascular (CV) risk may be informative in choosing antiretroviral therapy. We compared the 10-year and the 5-year CV risk prediction of the Frammingham Risk Score with the new pooled equations and the new DAD risk score, respectively, to identify patients with low probability of CV disease
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