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Barbara BEGHETTO

Personale tecnico amministrativo
Dipartimento di Scienze Mediche e Chirurgiche Materno-Infantili e dell'Adulto

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Pubblicazioni

2023 - Evaluating immunological and inflammatory changes of treatment-experienced people living with HIV switching from first-line triple cART regimens to DTG/3TC vs. B/F/TAF: the DEBATE trial [Articolo su rivista]
Cossarizza, A.; Cozzi-Lepri, A.; Mattioli, M.; Paolini, A.; Neroni, A.; De Biasi, S.; Tartaro, D. L.; Borella, R.; Fidanza, L.; Gibellini, L.; Beghetto, B.; Roncaglia, E.; Nardini, G.; Milic, J.; Menozzi, M.; Cuomo, G.; Digaetano, M.; Orlando, G.; Borghi, V.; Guaraldi, G.; Mussini, C.
abstract

Background: The aim of this randomized clinical trial (RCT) was to compare immunological changes in virally suppressed people living with HIV (PLWH) switching from a three-drug regimen (3DR) to a two-drug regimen (2DR).Methods: An open-label, prospective RCT enrolling PLWH receiving a 3DR who switched to bictegravir/emtricitabine/tenofovir alafenamide (B/F/TAF) or dolutegravir/lamivudine (DTG/3TC) was performed. Blood was taken at baseline and months 6 and 12. The primary outcome was the change in CD4+ or CD8+ T-cell counts and CD4/CD8 ratio over time points. The secondary outcomes were the changes in immunological and inflammatory parameters. Parametric mixed-linear models with random intercepts and slopes were fitted separately for each marker after controlling for potential confounders.Results: Between the two arms (33 PLWH each), there was no difference in CD4+ or CD8+ T cells, CD4/CD8 ratio, and IL-6 trajectories. PLWH switching to DTG/3TC had increased levels of both transitional memory and terminally differentiated CD4+ T cells (arm-time interaction p-value = 0.02) and to a lesser extent for the corresponding CD8+ T-cell subsets (p = 0.09). Significantly lower levels of non-classical monocytes were detected in the B/F/TAF arm at T6 (diff = -6.7 cells/mm(3); 95% CI; -16, +2.6; p-value for interaction between arm and time = 0.03). All differences were attenuated at T12.Conclusion: No evidence for a difference in absolute CD4+ and CD8+ T-cell counts, CD4/CD8 ratio, and IL-6 trajectories by study arm over 12 months was found. PLWH on DTG/3TC showed higher levels of terminally differentiated and exhausted CD4+ and CD8+ T lymphocytes and non-classical monocytes at T6. Further studies are warranted to better understand the clinical impact of our results.

2020 - 18Fluoride-based molecular imaging of coronary atherosclerosis in HIV infected patients [Articolo su rivista]
Guaraldi, G.; Milic, J.; Prandini, N.; Ligabue, G.; Esposito, F.; Ciusa, G.; Malagoli, A.; Scaglioni, R.; Besutti, G.; Beghetto, B.; Nardini, G.; Roncaglia, E.; Mussini, C.; Raggi, P.
abstract

Background and aims: Molecular imaging with 18Fluorodeoxyglucose (FDG) and 18F-sodium-fluoride (NaF) captures arterial inflammation and micro-calcification and can reveal potentially unstable atherosclerotic plaques. Methods: We performed FDG and NaF PET/CT imaging in two clinically similar cohorts of patients living with HIV (PLWH) with no symptomatic cardiovascular disease. The prevalence and intensity of coronary artery uptake of each tracer, measured as target-to-background ratio (TBR), were assessed in patients at low and high cardiovascular risk. Results: Ninety-three PLWH were submitted to PET/CT imaging with FDG (N = 43) and NaF (N = 50); 42% were at low and 58% at high cardiovascular risk. The intensity of uptake and multivessel coronary artery uptake were significantly higher with NaF than FDG both in low and high-risk patients. When each 18F-tracer was tested in low and high-risk patients, an equal proportion of subjects showed no vessel, single and multivessel NaF uptake; the same was true for no and single vessel uptake of FDG (no multivessel FDG uptake was noted). Waist circumference, CRP, D-dimer, HIV duration and treatment with nucleoside reverse transcriptase inhibitors were associated with high NaF uptake in univariable analyses; D-dimer remained significant in multivariable analyses (OR = 1.05; p=0.02). There were no significant associations with FDG uptake. Conclusions: The prevalence of coronary artery uptake was higher with NaF compared to FDG both in high and low risk patients, hence microcalcification imaging may be a more sensitive tool to detect coronary atherosclerosis than inflammation imaging. However, the uptake of each 18Fluoride tracer was similar between low and high-risk subjects, and this underscores the discordance between clinical and imaging based risk assessment. Future investigation should address the prognostic significance of NaF coronary artery uptake.

2020 - Effects of atazanavir, darunavir, and raltegravir on fat and muscle among persons living with HIV [Articolo su rivista]
Adrian, S.; Miao, H.; Feng, H.; Scherzinger, A.; Nardini, G.; Beghetto, B.; Roncaglia, E.; Ligabue, G.; Milic, J.; Guaraldi, G.; Lake, J. E.; Erlandson, K. M.
abstract

Background: Antiretroviral therapy (ART) is associated with gain in quantity of fat and muscle, but the impact on quality is less understood. The objective of this study was to compare fat and muscle density among people with HIV (PWH) on stable raltegravir (RAL), atazanavir with ritonavir (ATV/r), or darunavir with ritonavir (DRV/r), and explore implications on muscle function. Methods: Participants from the Modena HIV Metabolic Clinic taking RAL, ATV/r, or DRV/r with at least 1 computed tomography (CT) scan were included. CT scans were reanalyzed for area and density of truncal fat and musculature. Multivariate models explored the effect of ART on fat and muscle density. Results: One hundred six participants were receiving ATV/r, 48 DRV/r, and 141 RAL. In multivariate models (reference ATV/r), only DRV/r was associated with greater subcutaneous (SAT) and visceral adipose tissue (VAT) area, lower lateralis muscle density (more fat), and greater lateralis intermuscular fat area. Compared to ATV/r, RAL was independently associated with less psoas intermuscular fat area. Among all, greater paraspinal muscle density correlated with better physical function. No associations between ART group and physical function were seen among men; DRV/r was associated with stronger grip strength among women. Conclusion: DRV/r was associated with greater fat area and lower density of both fat and muscle, and RAL with less intermuscular psoas fat. Higher density psoas and paraspinal musculature were associated with better physical function, suggesting potential clinical relevance of these findings.

2019 - Molecular Imaging of Vascular Calcification with 18 F-Sodium-Fluoride in Patients Infected with Human Immunodeficiency Virus [Articolo su rivista]
Raggi, Paolo; Prandini, Napoleone; Ligabue, Guido; Braglia, Giovanni; Esposito, Francesco; Milic, Jovana; Malagoli, Andrea; Scaglioni, Riccardo; Besutti, Giulia; Beghetto, Barbara; Nardini, Giulia; Roncaglia, Enrica; Mussini, Cristina; Guaraldi, Giovanni
abstract

18F-Sodium Fluoride (NaF) accumulates in areas of active hydroxyapatite deposition and potentially unstable atherosclerotic plaques. We assessed the presence of atherosclerotic plaques in 50 adult patients with HIV (HIV+) who had undergone two cardiac computed tomography scans to measure coronary artery calcium (CAC) progression. CAC and its progression are predictive of an unfavorable prognosis. Tracer uptake was quantified in six arterial territories: aortic arch, innominate carotid artery, right and left internal carotid arteries, left coronary (anterior descending and circumflex) and right coronary artery. Thirty-one patients showed CAC progression and 19 did not. At least one territory with high NaF uptake was observed in 150 (50%) of 300 arterial territories. High NaF uptake was detected more often in non-calcified than calcified areas (68% vs. 32%), and in patients without than in those with prior CAC progression (68% vs. 32%). There was no correlation between clinical and demographic variables and NaF uptake. In clinically stable HIV+ patients, half of the arterial territories showed a high NaF uptake, often in the absence of macroscopic calcification. NaF uptake at one time point did not correlate with prior progression of CAC. Prospective studies will demonstrate the prognostic significance of high NaF uptake in HIV+ patients.

2017 - Successful Pre- and Posttransplant Sofosbuvir-Based Anti-Hepatitis C Virus Treatment in Persons Living With Human Immunodeficiency Virus Infection [Articolo su rivista]
Guaraldi, Giovanni; Rossotti, Roberto; Verucchi, Gabriella; Tavio, Marcello; Pasulo, Luisa; Beghetto, Barbara; Dolci, Giovanni; Nardini, Giulia; Badia, Lorenzo; Magliano, Anna; Moioli, Maria Cristina; Puoti, Massimo
abstract

This retrospective study reports the data of sofosbuvir-based anti-hepatitis C virus treatment in 24 candidates and 24 recipients of liver transplantation coinfected with human immunodeficiency virus. Sustained virologic response was cumulatively 85% (90% and 100% in those treated with optimal schedules pre- and posttransplant, respectively).

2016 - Prediction of hard cardiovascular events in HIV patients [Articolo su rivista]
Raggi, Paolo; De Francesco, Davide; Manicardi, Marcella; Zona, Stefano; Bellasi, Antonio; Stentarelli, Chiara; Carli, Federica; Beghetto, Barbara; Mussini, Cristina; Malagoli, Andrea; Guaraldi, Giovanni
abstract

To assess the accuracy of risk prediction algorithms used in the general population and an HIV-specific algorithm to predict hard cardiovascular events.

2015 - Aging with HIV vs. HIV Seroconversion at Older Age: A Diverse Population with Distinct Comorbidity Profiles [Articolo su rivista]
Guaraldi, Giovanni; Zona, Stefano; Brothers, Thomas D; Carli, Federica; Stentarelli, Chiara; Dolci, Giovanni; Santoro, Antonella; Beghetto, Barbara; Menozzi, Marianna; Mussini, Cristina; Falutz, Julian
abstract

People aging with HIV might have different health conditions compared with people who seroconverted at older ages. The study objective was to assess the prevalence of, and risk factors for, individual co-morbidities and multimorbidity (MM) between HIV-positive patients with a longer duration of HIV infection, and patients who seroconverted at an older age. We compared estimates across both groups to a matched community-based cohort sampled from the general population.

2015 - How do frailty mediate pathway leading to disability [Abstract in Rivista]
Malagoli, Andrea; Garlassi, Sara; Stentarelli, Chiara; Carli, Federica; Menozzi, Marianna; Santoro, Antonella; Beghetto, Barbara; Nardini, Giulia; Mussini, Cristina; Guaraldi, Giovanni
abstract

HIV infection increases the risk of multimorbidity (MM) and disability but factors influencing the association between the two are still poorly understood. We hypothesized that frailty mediate pathway leading to disability.

2014 - Atazanavir and lopinavir profile in pregnant women with HIV: tolerability, activity and pregnancy outcomes in an observational national study [Articolo su rivista]
M., Floridia; M., Ravizza; G., Masuelli; V., Giacomet; P., Martinelli; A., Degli Antoni; A., Spinillo; M., Fiscon; D., Francisci; G., Liuzzi; C., Pinnetti; A. M., Marconi; E., Tamburrini; M., Floridia; M., Ravizza; E., Tamburrini; M., Ravizza; E., Tamburrini; F., Mori; P., Ortolani; E. R., dalle Nogare; F., Di Lorenzo; G., Sterrantino; M., Meli; S., Polemi; J., Nocentini; M., Baldini; G., Montorzi; M., Mazzetti; P., Rogasi; B., Borchi; F., Vichi; B., Del Pin; E., Pinter; E., Anzalone; R., Marocco; C., Mastroianni; V. S., Mercurio; A., Carocci; E., Grilli; A., Maccabruni; M., Zaramella; B., Mariani; G., Natalini Raponi; Guaraldi, Giovanni; Nardini, Giulia; Stentarelli, Chiara; Beghetto, Barbara; A. M., Degli Antoni; A., Molinari; M. P., Crisalli; A., Donisi; M., Piepoli; V., Cerri; G., Zuccotti; V., Giacomet; V., Fabiano; G., Placido; A., Vivarelli; P., Castelli; F., Savalli; V., Portelli; F., Sabbatini; D., Francisci; L., Bernini; P., Grossi; L., Rizzi; S., Alberico; G., Maso; M., Airoud; G., Soppelsa; A., Meloni; M., Dedoni; C., Cuboni; F., Ortu; P., Piano; A., Citernesi; I., Bordoni Vicini; K., Luzi; A., Spinillo; M., Roccio; A., Vimercati; A., Miccolis; E., Bassi; B., Guerra; F., Cervi; C., Puccetti; P., Murano; M., Contoli; M. G., Capretti; C., Marsico; G., Faldella; M., Sansone; P., Martinelli; A., Agangi; C., Tibaldi; L., Trentini; T., Todros; G., Masuelli; V., Frisina; I., Cetin; T., Brambilla; V., Savasi; C., Personeni; C., Giaquinto; M., Fiscon; R., Rinaldi; E., Rubino; A., Bucceri; R., Matrone; G., Scaravelli; C., Fundaro; O., Genovese; C., Cafforio; C., Pinnetti; G., Liuzzi; V., Tozzi; P., Massetti; A. M., Casadei; A. F., Cavaliere; V., Finelli; M., Cellini; G., Castelli Gattinara; A. M., Marconi; S., Dalzero; V., Sacchi; A., De Pirro; C., Polizzi; A., Mattei; M. F., Pirillo; R., Amici; C. M., Galluzzo; S., Donnini; S., Baroncelli; M., Floridia; M., Regazzi; P., Villani; M., Cusato; A., Cerioli; M., De Martino; P., Mastroiacovo; M., Moroni; F., Parazzini; E., Tamburrini; S., Vella; P., Martinelli; M., Ravizza
abstract

CKGROUND: Atazanavir and lopinavir represent the main HIV protease inhibitors recommended in pregnancy, but comparative data in pregnant women are limited. METHODS: Women from a national observational study, exposed in pregnancy to either atazanavir or lopinavir, were compared for glucose and lipid profiles, liver function tests, CD4 count, HIV RNA and main pregnancy outcomes. Statistical methods included univariate and multivariable analyses. RESULTS: The study population included 428 pregnancies (lopinavir, 322; atazanavir, 106). The lopinavir group was characterized by higher rates of HIV diagnosis in pregnancy and treatment indication for maternal health, lower CD4 counts, higher HIV RNA levels, less frequent antiretroviral treatment at conception and shorter duration of drug exposure during pregnancy. No differences in pregnancy outcomes, glucose metabolism and weight gain were observed. The two groups also showed in a multivariable analysis similar odds for detectable HIV RNA in the third trimester (adjusted OR 0.85, 95% CI 0.35-2.10, P = 0.730). Total lipid levels were significantly higher in the lopinavir group (median values in the third trimester 239 versus 221 mg/dL for total cholesterol and 226 versus 181 mg/dL for triglycerides; P < 0.001 for both comparisons) and bilirubin levels were significantly higher in the atazanavir group (1.53 versus 0.46 mg/dL, P < 0.001). CONCLUSIONS: In this observational study atazanavir and lopinavir showed similar safety and activity in pregnancy, with no differences in the main pregnancy outcomes. Atazanavir use was associated with a better lipid profile and with higher bilirubin levels. Overall, the study findings confirm that these two HIV protease inhibitors represent equally valid alternative options.

2014 - The natural history of HIV-associated lipodystrophy in the changing scenario of HIV infection [Articolo su rivista]
Guaraldi, Giovanni; Stentarelli, Chiara; Zona, Stefano; A., Santoro; Beghetto, Barbara; Carli, Federica; Orlando, Gabriella; Franceschetto, Antonella; A., Casolo; Mussini, Cristina
abstract

Objectives: In long-term HIV-infected patients, peripheral lipoatrophy (LA) and central lipohypertrophy (LH) appear to be related to the same insults (virus and antiretroviral drugs), but are likely to be associated with different fat depot physiologies. The objective of this study was to describe the natural history of lipodystrophy assessed using dual energy X-ray absorptiometry (DEXA) and computed tomography (CT) in a large HIV out-patients metabolic clinic. Methods: An observational retrospective study was carried out including HIV-infected patients recruited at the Metabolic Clinic of Modena, Modena, Italy, who were assessed for lipodystrophy and had at least two anthropometric evaluations using DEXA for leg fat per cent mass and abdominal CT for visceral adipose tissue (VAT). Factors associated with leg fat per cent and VAT changes were analysed using multivariable generalized estimating equation (GEE) regression models. Results: A total of 6789 DEXAs and 7566 CT scans were evaluated in the observation period. A total of 1840 patients were included; the mean age was 45.2±7.2 (standard deviation) years, 621 (34%) were women, and the median HIV infection duration was 176 (interquartile range 121-232) years. According to the GEE multivariable regression analysis, leg fat per cent evaluated with DEXA appeared to increase over calendar years (ß=0.92; P<0.001); moreover, a progressive increase in VAT was observed in the cohort (ß=5.69; P<0.001). No association with antiretroviral drugs was found. Conclusions: In our study, neither LA nor LH appeared to be associated with antiretroviral drug exposure. We observed a progressive increase in LH in HIV-infected patients over calendar years. This anthropometric change, together with loss of appendicular lean mass, could describe a physiological aging process in HIV-infected patients.

2013 - Associatioin of epicardial adipose tissue with incident coronary heart disease and death in HIV infected patients. [Abstract in Rivista]
Guaraldi, Giovanni; Scaglioni, Riccardo; Zona, Stefano; Orlando, Gabriella; Carli, Federica; Ligabue, Guido; Besutti, Giulia; Menozzi, Marianna; Santoro, Antonella; Beghetto, Barbara; Mussini, Cristina; P., Raggi
abstract

Epicardial adipose tissue has been reported to be highly inflamed and to be associated with incident coronary artery disease and all cause mortality in the general population. Its association with adverse events in HIV is unknown.

2013 - Limited occurence of new grade 3-4 toxicity events with salvage regimens based on raltegravir and /or maraviroc: 96 weeks data from the ISS NIA cohort study [Abstract in Rivista]
Le, Weimer; M., Floridia; R., Bucciardini; S., Baroncelli; C. M., Galluzzo; M. F., Pirillo; V., Fragola; S., Donnini; M., Mirra; M., di Gregorio; S., Lucattini; L., Fucili; G., Angarano; N., Ladisa; A., Volpe; V., Vullo; G., D'Ettorre; G., Ceccarelli; M., Andreoni; L., Sarmati; D., Delle Rose; V., Tozzi; N., Petrosillo; R., Bellagamba; R., Libertone; S., Cicalini; L., Sighinolfi; D., Segala; O., Armignacco; R., Preziosi; C., Ferrari; A., Degli Antoni; A., Cavalli; G., Parruti; F., Sozio; L., Cosentino; A., Vivarelli; P. E., Manconi; F., Ort; M. L., Di Martino; P., Viale; G., Verrucchi; S., Tedeschi; M. S., Mura; M., Mannazzu; G., Cattari; M., Tavio; R., del Gobbo; A., Mataloni Paggi; A., Giacometti; O., Cirioni; E., Marchionni; C., Silvestri; S., Sebastianelli; L., Brescini; F., Baldelli; Guaraldi, Giovanni; Nardini, Giulia; Stentarelli, Chiara; Beghetto, Barbara
abstract

Limited occurence of new grade 3-4 toxicity events with salvage regimens based on raltegravir and /or maraviroc: 96 weeks data from the ISS NIA cohort study

2013 - Limited occurrence of new grade 3-4 toxicity events with salvage regimens based on raltegravir and /or maraviroc: 96 weeks data from the ISS NIA cohort study. [Abstract in Rivista]
L. E., Weimer; M., Floridia; R., Bucciardini; S., Baroncelli; C. M., Galluzzo; M. F., Pirillo; V., Fragola; S., Donnini; M., Mirra; M., Di Gragorio; S., Lucattini; L., Fucili; G., Angarano; N., Ladisa; A., Volpe; V., Vullo; G., D’Ettorre; G., Ceccarelli; M., Andreoni; L., Sarmati; D., Delle Rose; V., Tozzi; N., Petrosillo; R., Bellagamba; R., Libertone; S., Cicalini; L., Sighinolfi; D., Segala; O., Armignacco; R., Preziosi; C., Ferrari; A., Degli Antoni; A., Cavalli; G., Parruti; F., Sozio; L., Cosentino; A., Vivarelli; Pe, Manconi; F., Ort; Di Martino, M. L.; P., Viale; G., Verucchi; S., Tedeschi; Mura, M. S.; M., Mannazzu; G., Cattari; M., Tavio; R., Del Gobbo; A., Mataloni Paggi; A., Giacometti; O., Cirioni; E., Marchionni; C., Silvestri; S., Sebastianelli; L., Brescini; F., Baldelli; D., Francisci; E., Schiaroli; S., Bastianelli; Guaraldi, Giovanni; Nardini, Giulia; Stentarelli, Chiara; Beghetto, Barbara
abstract

Most of the available information on long-term toxicity of regimens based on raltegravir and/or maraviroc comes from controlled trials, and there is limited information on the occurrence and characteristics af adverse events in a setting of common clinical practice with frequent concomitant use of darunavir, enfuvirtide and etravirine. We anlyzed the number and characteristics of new adverse events grade 3-4 occurring in the first 96 weeks of treatment with salvage regimens based on raltegravir and /or maraviroc in an observational study.

2013 - Randomized Trial to Evaluate Cardiometabolic and Endothelial Function in Patients with Plasma HIV-1 RNA Suppression Switching to Darunavir/Ritonavir with or without Nucleoside Analogues [Articolo su rivista]
Guaraldi, Giovanni; Zona, Stefano; Cossarizza, Andrea; L., Vernacotola; Carli, Federica; A., Lattanzi; Beghetto, Barbara; Orlando, Gabriella; DE BIASI, Sara; R., Termini; M., Garau
abstract

Background: We performed a study to evaluate change in cardiometabolic and endothelial function in HIV-infected patients switching to darunavir/ritonavir (DRV/r) monotherapy versus triple therapy. Methods: The MONARCH trial recruited 30 patients who were taking triple combination therapy and with HIV RNA<40 copies/ mL. Patients were randomized to either DRV/r 800/100 mg once daily (OD) monotherapy or DRV/r 800/100 mg OD plus 2 nucleoside reverse transcriptase inhibitors (NRTIs). The primary objective was to assess endothelial function change from baseline to 24 and 48 weeks in brachial artery flow-mediated dilation (FMD) test; changes in endothelial precursor cells (EPCs) and circulating endothelial cells (CECs) were secondary objectives. Results: At baseline, the median age of participants was 43 years, 77% were men, and median CD4 cell count was 585 cells/μL. The median FMD (%) decreased in both arms in the study period (P ≯ .05), with no statistically significant difference between arms (10.7% at baseline and 6.7% at week 48 in the DRV/r + 2 NRTIs arm; 11.1% at baseline and 8.8% at week 48 in the DRV/r arm). The changes at week 48 were similar in the 2 arms for EPCs and CECs. Total cholesterol and low-density lipoprotein (LDL) cholesterol showed larger rises to week 48 in the DRV/r arm monotherapy group than in the triple-therapy group (+26 vs +9 mg/dL for total cholesterol and +14 vs +5 mg/dL for LDL cholesterol). Conclusions: In the MONARCH trial, switching from triple combination treatment to DRV/r, with or without nucleoside analogues, did not translate into clinically meaningful reductions in endothelial function as measured by FMD.

2011 - A randomized, controlled trial to evaluate change in cardiometabolic and endothelial function in HIV-infected patients with optimal viral suppression on Darunavir/ritonavir monotherapy vs. triple-therapy. [Abstract in Rivista]
Guaraldi, Giovanni; Zona, Stefano; Cossarizza, Andrea; L., Vernacotola; Carli, Federica; A., Lattanzi; Beghetto, Barbara; Orlando, Gabriella; R., Termini; M., Garau
abstract

MONET and MONOI have shown a small rise in cholesterol after stopping tenofovir in darunavir/ritonavir arm, without providing any information regarding endothelial function. We performed a study to compare the change in brachial artery flow mediated vasodilatation in patients receiving darunavir/ritonavir monotherapy versus triple therapy.

2009 - Detectable HIV viral load is associated with metabolic syndrome. [Articolo su rivista]
Squillace, N.; Zona, S.; Stentarelli, C.; Orlando, G.; Beghetto, Barbara; Nardini, Giulia; Esposito, Roberto; Guaraldi, Giovanni
abstract

BACKGROUND: The aim of our study was to assess the association between HIV viral load (HIV-VL) and metabolic syndrome (MS) in a cohort of HIV-infected patients. METHODS: This is a cross-sectional study including 1324 consecutive HIV-infected patients on stable antiretroviral therapy regimens. RESULTS: Variables significantly associated with MS in univariate analysis were: age [mean +/- SD: 47.04 +/- 7.41 vs 44.07 +/- 6.82, (P < 0.0001)]; male sex [224 (69.35%) vs 614 (61.34%) (P = 0.009)]; Apo B (mg/dL) [111.51 +/- 29.64 vs 100.57 +/- 31.22, (P < 0.0001)]; homeostasis model assessment equation [median (interquartile range), 5.14 (3.00-8.15) vs 2.95 (1.93-4.57), (P < 0.0001)]; body mass index [25.17 +/- 4.40 vs 22.80 +/- 3.38, (P < 0.0001)]; protease inhibitor current use (%) [199 (61.61) vs 529 (52.85), (P = 0.006)]; and log10 HIV-VL [2.17 +/- 0.94 vs 2.02 +/- 0.79, (P = 0.0048)]. MS associated variables in multivariable analysis were: log10 HIV-VL [odds ratio (OR): 1.25; P = 0.003], age (per 10-year increment) [OR: 1.60; P < 0.0001], homeostasis model assessment equation > or =3.8 [OR: 2.77; P < 0.0001]. CONCLUSIONS: Persistent viremia is a significant predictor for the development of MS. Viral control through effective antiretroviral therapy is paramount not only for the control of HIV disease progression but also for the prevention of MS and associated cardiovascular disease.

2009 - ISS-NIA ITALIAN COHORT: NEW ANTI-HIV INHIBITORS IN PATIENTS EXPERIENCED TO IP, NRTI, NNRTI. [Abstract in Rivista]
Bucciardini, R; Floridia, M; Weimer L., E; Fragola, V; Massella, M; Baroncelli, S; Pirillo, Mf; Galluzzo, Cm; Donnini, S; Mirra, M; Di Gregorio, M; Lucattini, S; Fucili, L; Baldelli, F; Francisci, D; Martinelli, L; Bastianelli, S; Pastore, G; Ladisa, N; Volpe, A; Vullo, V; D'Ettore, G; Ceccarelli, G; Andreoni, M; Sarmati, L; Delle Rose, D; Montano, M; Tozzi, V; Libertone, R; Pucillo, L; Narciso, P; Bellagamba, R; Tommasi, C; Petrosillo, N; Cicalini, S; Sighinolfi, L; Segala, D; Armignacco, O; Preziosi, R; Ferrari, C; Antoni, A; Cavalli, A; Parruti, G; Sozio, F; Cosentino, L; Dionisio, D; Vivarelli, A; Manconi, Pe; Ortu, F; Di Martino, Ml; Chiodo, F; Biagelti, C; Borderi, M; Boni, P; Del Gobbo, R; Paggi, A; Silvestri, C; Scalise, G; Giacometti, A; Cirioni, O; Mura, Ms; Mannazzu, M; Coinu, G; Bellissima, P; Bonfante, S; Neri, D; Guaraldi, Giovanni; Beghetto, Barbara
abstract

Management of HIV infection can now rely on new classes of antiretroviral drugs (CCR5 antagonists, integrase inhibitors,fusion inhibitors) which represent innovative options compared to the three main drug classes targeting HIV protease or reverse transcriptase (PI, NRTI, NNRTI). Although there is evidence that these new antiretroviral drugs can be effective and relatively safe in patients resistant to the other anti-HIV drugs who have limited treatment options, available data have only been collected for a short period of time and within controlled trials.Thus, collecting long-term safety and efficacy information as well as patient-reported outcomes in a setting of clinical practice is a necessary step to better define the profile of these drugs.

2008 - Age-related comorbidities in people living with HIV [Abstract in Rivista]
Guaraldi, Giovanni; Zona, S.; Orlando, G.; Squillace, N.; Stentarelli, C.; Nardini, Giulia; Beghetto, Barbara; Esposito, Roberto; Palella, F.
abstract

To describe prevalence of age-related morbidities across age groups in people living with HIV/AIDS and to analyse care needs in the elderly people.

2008 - Gender differences in depression evolution in a cohort of patients attendine a metabolic clinic for lipodystrophy management [Abstract in Rivista]
Orlando, G.; Squillace, N.; Beghetto, Barbara; Nardini, Giulia; Mazeu, I.; Guaraldi, Giovanni
abstract

The purpose of our study was to evaluate gender differences in the evolution of depression among patients attending a metabolic clinic for lipodystrophy diagnosis and treatment.

2008 - Hepatitis C virus antibody-positive patients with HIV infection have a high risk of insulin resistance: A cross-sectional study [Articolo su rivista]
N., Squillace; G., Lapadula; C., Torti; G., Orlando; S., Mandalia; Nardini, Giulia; Beghetto, Barbara; S., Costarelli; Guaraldi, Giovanni
abstract

OBJECTIVE: The aim of the study was to characterize and compare insulin resistance (IR) in hepatitis C virus (HCV)-antibody (Ab)-positive and HCV-Ab-negative patients with HIV infection. METHODS: This was a single-centre cross-sectional study of 1041 HIV-infected patients (373 HCV-Ab-positive; 167 with detectable plasma HCV RNA). Metabolic and anthropometric assessments were performed, including measurement of IR using the homeostasis model for assessment of insulin resistance (HOMA-IR). RESULTS: The prevalence of IR (i.e. a HOMA-IR score >or=3.8) was significantly higher in HCV-Ab-positive than in HCV-Ab-negative patients (47.7 vs. 32.7\%; P<0.0001). On multivariable linear regression analysis, the following variables were associated with HOMA-IR score, expressed as an estimate of the percentage variation (Est.): high-density lipoprotein cholesterol (per 0.3 mmol/L increase: Est.-4.1; P=0.01), triglycerides (per 0.1 mmol/L increase: Est. 0.6; P<0.001), alcohol intake (Est. -12.4; P=0.002), sedentary lifestyle (Est. 14.7; P<0.001), CD4 T-cell count in the highest quartile, i.e. >or=690 cells/microL (Est. 20.7; P=0.002), body mass index in the highest quartiles, i.e. >or=22.54 kg/m2 (Est. 30.5-44.7; P<0.001), waist-to-hip ratio in the highest quartile, i.e. >1 (Est. 30.2; P<0.001) and HCV-Ab positivity (Est. 24.4; P<0.001). CONCLUSIONS: Our data confirm that HCV-Ab positivity is an independent risk factor for IR. Management aimed at correcting known risk factors for IR should be implemented.

2008 - Prospective, 48 weeks follow up, multidisciplinary interventionalstudy to assess improvement of adherence in people with lipodistrophy. [Abstract in Atti di Convegno]
Guaraldi, Giovanni; Murri, R.; Orlando, R.; Squillace, N.; De Paola, M.; Beghetto, Barbara; Nardini, Giulia; Luzi, K.; Ciaffi, S.; Esposito, Roberto
abstract

Body image alteration observed in HIV people with lipodystrophy (LD) may impair antiretrovirals adherence. The objective of this study was to assess the improvement of adherence in people undergoing a multidisciplinary intervention to treat LD.

2008 - Severity of lipodystrophy is associated with decreased health-related quality of life [Articolo su rivista]
Guaraldi, Giovanni; Murri, R.; Orlando, G.; Giovanardi, C.; Squillace, N.; Vandelli, M.; Beghetto, Barbara; Nardini, Giulia; De Paola, M.; Esposito, Roberto; Wu, A. W.
abstract

The impact of lipodystrophy (LD) on quality of life is high, but it has not been demonstrated in literature. The objective of the study was to assess the impact of LD on the health-related quality of life (HRQOL) in HIV-infected people on highly active antiretroviral therapy (HAART). Patients with LD phenotype defined by the Multicenter AIDS Cohort Study (MACS) were included. Three different methods were used to define LD severity: both patient and physician evaluation using the HIV Outpatient Study (HOPS) severity scales and the Lipodystrophy Case Definition (LDCD). The HRQOL was evaluated by MOS-HIV Health Survey. Four hundred one patients on HAART for a mean of 108 +/- 52 months were evaluated for LD at the Metabolic Clinic of Modena and Reggio Emilia University were enrolled from January 2003 to July 2006. According to self-perceived or physician-based HOPS, 106 (26.5%) and 122 (30.4%) patients had severe LD. Females had significantly more severe LD. Few HRQOL scores correlated to LD severity using the physician-based score (both HOPSph and LDCD), while all the HRQOL scores correlated with LD severity when a patient-based score was used (HOPSpt). In multiple linear regression analysis, Mental Health HRQOL score, gender, body mass index, age, body image satisfaction were independent predictors of patient-based (HOPSpt) LD, while none of the HRQOL scores, but female gender, age, waist-to-hip ratio, limb fat, and body image satisfaction were correlated with physician-estimated HOPSph LD severity. HRQOL was strongly correlated with LD severity when a patient-based score was used. For an overall assessment of the impact of LD on HIV-infected people, both patient-based and physician-based measures are required.

2008 - Virologic failure and metabolic syndrome in patients with HIV infection [Abstract in Atti di Convegno]
Squillace, N.; Zona, S.; Orlando, G.; Stentarelli, C.; Beghetto, Barbara; Nardini, Giulia; Guaraldi, Giovanni
abstract

The objective of our study was to assess the association between HIV-RNA viral load and metabolic syndrome prevalence in a cohort of HIV patients experienced to ART with lipodystrophy

2008 - Virologic failure and metabolic syndrome in patients with HIV infection [Abstract in Rivista]
Squillace, N.; Zona, S.; Orlando, G.; Stentarelli, C.; Beghetto, Barbara; Nardini, Giulia; Guaraldi, Giovanni
abstract

The objective was to assess the association between HIV RNA viral load and metabolic syndrome in antiretroviral therapy-experienced HIV patients with lipodystrophy.

2007 - Determinants of virologic and immunologic outcomes in chronically HIV-infected subjects undergoing repeated treatment interruptions: The Istituto Superiore di Sanità-Pulsed Antiretroviral Therapy (ISS-PART) study [Articolo su rivista]
Palmisano, L.; Giuliano, M.; Bucciardini, R.; Fragola, V.; Andreotti, M.; Galluzzo, C. M.; Pirillo, M. F.; Weimer, L. E.; Arcieri, R.; Germinario, E. A. P.; Amici, R.; Mancini, M. G.; D'Arminio Monforte, A.; Castelli, F.; Caramello, P.; Vella, S.; Abrescia, N.; Figoni, M.; Viglietti, R.; Angarano, G.; Saracino, A.; Anselmo, M.; Antinori, A.; Sette, P.; Zaccarelli, M.; Liuzzi, G.; Arlotti, M.; Martelli, L. T.; Ortolani, P.; Bassetti, D.; Di Biagio, A.; Bisio, F.; Bellissima, P.; Branz, F.; Dorigoni, N.; Cadeo, G.; Vangi, D.; Bertelli, D.; Bergamasco, A.; Caggese, L.; Volonterio, A.; Orofino, G. C.; Carosella, S.; Gennero, L.; Caremani, M.; Tacconi, D.; Carosi, G.; Tomasoni, L.; Patroni, A.; Chiodo, F.; Borderi, M.; Calza, L.; Gritti, F.; Fasulo, G.; Chirianni, A.; Gargiulo, M.; Colomba, A.; Dalle Nogare, E. R.; Di Lorenzo, F.; Prestileo, T.; Bini, T.; Cicconi, P.; De Lalla, F.; Giordani, M. T.; De Stefano, C.; De Stefano, G.; Delia, S.; Ciardi, M.; Di Perri, G.; Sinicco, A.; Sales, P.; Dini, M.; Simeone, M.; Esposito, R.; Guaraldi, G.; Beghetto, B.; Fatuzzo, F.; La Rosa, R.; Ferrari, C.; Calzetti, C.; Ferraro, T.; Cosco, L.; Ghinelli, F.; Sighinolfi, L.; Guadagnino, V.; Caroleo, B.; Izzi, A.; Izzo, C.; Franco, A.; Lazzarin, A.; Castagna, A.; Fusetti, G.; Leoncini, F.; Pozzi, M.; Sbaragli, S.; Marzetti, M.; Magnani, G.; Bonazzi, L.; Barchi, E.; Zoboli, G.; Pintus, A.; Mandas, A.; Soddu, M. L.; Zucca, F.; Mannucci, P. M.; Gringeri, A.; Marani Toro, G.; Graziani, R. V.; Consorti, A.; Mazzotta, F.; Di Pietro, M.; Ble, C.; Meneghetti, F.; Sasset, L.; Cattelan, A. M.; Menichetti, F.; Savalli, E.; Mian, P.; Pristera, R.; Mignani, E.; Artioli, S.; Mura, M. S.; Mannazzu, M.; Narciso, P.; Bellagamba, R.; Orani, A.; Perini, P.; Ortona, L.; De Luca, A.; Murri, R.; Pagano, G.; Alessandrini, A.; Paladini, A.; Vinattieri, M. A.; Carbonai, S.; Pastore, G.; Ladina, N.; Tateo, M.; Piersantelli, N.; Penco, G.; Petrelli, E.; Balducci, M.; Pippi, L.; Gonnelli, A.; Puppo, F.; Murdaca, G.; Raise, E.; Pasquirucci, A.; Riccio, G.; Bartolacci, V.; Carrega, G.; Rizzardini, G.; Migliorino, G.; Russo, R.; Casentino, S.; Celesia, M.; Soranzo, M. L.; Macor, A.; Salassa, B.; Soscia, F.; Roberti, L.; Di Toro, M. T.; Stagno, A.; Beltrami, C.; Suter, F.; Maggiolo, F.; Ripamonti, D.; Tantimonaco, G.; Grisorio, B.; Tassara, A.; Rossi, P.; Tinelli, M.; Regazzetti, A.; Tirelli, U.; Voltaggio, G.; Cinelli, R.; Toti, M.; Baldari, M.; Carli, T.; Ricciardi, B.; Trezzi, M.; Vigevani, G. M.; Capetti, A.; Landonio, S.; Vullo, V.; Massetti, P.; Zauli, T.; Casolari, S.
abstract

BACKGROUND: Factors influencing the outcome of structured treatment interruptions (STIs) in HIV chronic infection are not fully elucidated. METHODS: In ISS-PART, 273 subjects were randomly assigned to arm A (137 assigned to continuous highly active antiretroviral therapy [HAART]) and arm B (136 assigned to 5 STIs of 1, 1, 2, 2, and 3 months' duration, each followed by 3 months of therapy). Main outcome measures were the proportion of subjects with a CD4 count &gt;500 cells/mm, the rate of virologic failure, and the emergence of resistance at 24 months. RESULTS: The proportion of subjects with a CD4 count &gt;500 cells/mm was higher in arm A than in arm B (86.5% vs. 69.1%; P = 0.0075). Pre-HAART CD4 cell count and male gender were independent predictors of a CD4 count &gt;500 cells/mm in arm B. The overall risk of virologic failure was not increased in arm B; however, it was higher in the 38 subjects who had resistance mutations in the rebounding virus. Archived mutations at baseline and the use of a regimen that included an unboosted protease inhibitor (PI), compared with nonnucleoside reverse transcriptase inhibitor-based HAART, independently predicted the emergence of plasma mutations during STI (P = 0.002 for DNA mutations and P = 0.048 for PI-based HAART). CONCLUSIONS: Our results suggest that patients with preexisting mutations and treated with unboosted PI-based HAART should not be enrolled in studies of time-fixed treatment interruptions, being at higher risk of developing plasma mutations during STI and virologic failure at therapy reinstitution. © 2007 Lippincott Williams &amp; Wilkins, Inc.

2007 - Effectiveness and long-term durability of autologous fat transplant for HIV-related face lipoatrophy. [Abstract in Rivista]
Orlando, Gabriella; Guaraldi, Giovanni; Squillace, N; De Fazio, D; Rottino, A; Bonucci, P; Padalino, E; Grisotti, A; Nardini, Giulia; Beghetto, Barbara; Esposito, R.
abstract

Autologous Fat Transplat (AFT) according to Coleman tachnique is an effective option for surgical treatment of HIV-related facial lipoatrophy; nevertheless, both patients and surgeons are often concerned about durability of this procedure in the fear of early fat reabsorption in the recipient area. The purpose of this study was to evaluate effectiveness and log-term durability of AFT with a 104 - week follow up in patients who were treated with single surgical procedure and in those who needed lipofilling reintervention or aesthetic correction with subcutaneous filler.

2007 - Long-term psychometric outcomes of facial lipoatrophy therapy: forty-eight-week observational, nonrandomized study. [Articolo su rivista]
Orlando, G.; Guaraldi, Giovanni; De Fazio, D.; Rottino, A.; Grisotti, A.; Blini, M.; Pedone, A.; Spaggiari, A.; Baccarani, A.; Vandelli, M.; De Paola, M.; Comelli, D.; Nardini, Giulia; Beghetto, Barbara; Squillace, N.; Esposito, Roberto; DE SANTIS, Giorgio
abstract

The aim of this observational, prospective, nonrandomized study was to assess long-term psychometric outcomes of surgical treatment of HIV-related facial lipoatrophy. Two hundred ninety-nine participants (70.8% male) consecutively attending the Metabolic Clinic of Modena and Reggio Emilia University from November 2005 to July 2006, undergoing surgical interventions for HIV-related facial lipoatrophy were enrolled. Fifty-four (18.1%) underwent facial lipofilling, which consists of the harvesting of a small, intact parcel of fatty tissue with processing that removes the nonviable components and of the transport of fatty parcels through a small cannula to implant the graft in a manner that provides nutrition and anchors the fat to the host tissue. After an initial lipofilling, 24 (8%) needed polylactic acid injections to correct cheek asymmetry, 91 (30.4%) received only polylactic acid infiltrations, and 130 (43.5%) polyacrylamide infiltrations only. Subjective outcome measures were face aesthetic satisfaction, body image perception, depression evaluated by a visual analogue scale (VAS), the Assessment of Body Change and Distress questionnaire (ABCD), and by the Beck Depression Inventory questionnaire, respectively. Objective measure was cheek thickness evaluated by a 7.5-MHz frequency ultrasound probe perpendicular to the skin surface at the nasolabial fold, the corner of the mouth, the zygomatic arch, and centrally between these points in the buccal fat pad area. Both subjective and objective variables were evaluated at baseline and 48 weeks after end of surgical treatment. All 299 participants had significant improvement of the aesthetic satisfaction for the face (VAS from 2.9 +/- 2.1 to 6.2 +/- 2.1, p &lt; 0.0001), of body image satisfaction (ABCD question 7 from 3.8 +/- 1 to 3.1 +/- 1 p &lt; 0.0001 and ABCD question 8 from 70.7 +/- 16.7 to 77.2 +/- 17.2 p &lt; 0.0001), of depression score (Beck score from 11.4 +/- 8.3 to 9.4 +/- 7.8 p = 0.001). Participants experienced a significant augmentation of both cheeks' thickness (right cheek from 4.3 +/- 1.9 mm to 9.5 +/- 3 mm p &lt; 0.0001, left cheek from 4.4 +/- 2 mm to 9.6 +/- 3.1 mm, p &lt; 0.0001). Our data suggest that facial surgery is an important option in the treatment of HIV-related lipoatrophy as an integral part of the management of HIV infection, because of the important and lasting psychological benefits.

2007 - Prevalence of and risk factors for pubic lipoma development in HIV-infected persons [Articolo su rivista]
Guaraldi, Giovanni; Orlando, G.; Squillace, N.; Roverato, A.; De Fazio, D.; Vandelli, M.; Nardini, Giulia; Beghetto, Barbara; De Paola, M.; Esposito, Roberto; Palella, F.
abstract

BACKGROUND: The natural history of HIV-associated body habitus changes is unclear. In this report, we describe a novel manifestation of HIV-associated lipoaccumulation. METHODS: We noted the presence of suprapubic fat pads (pubic lipomas [PLs]) in several patients with preexisting HIV-associated body habitus abnormalities. Subsequently, we evaluated the prevalence of and associated risk factors for development of PLs by undertaking an observational cross-sectional study among patients with known lipodystrophy who attended a metabolic clinic in northern Italy. Inclusion criteria were a physician-confirmed diagnosis of lipodystrophy according to the Multicenter AIDS Cohort Study definition and, for those affected with PL, a readily noticeable PL on physical examination. RESULTS: We evaluated 582 patients with lipodystrophy: 214 female (36.7%) and 368 male (63.3%). The overall PL prevalence was 9.4% (95% confidence interval [CI]: 7.2% to 12.1%; P < 0.0001). PLs were more common among obese than nonobese individuals (34.5%, 95% CI: 17.9% to 5l.3% vs. 8%, 95% CI: 5.9% to 10.6%, respectively; P < 0.0001) and those with preexisting dorsocervical fat pads, commonly called "buffalo humps" (BHs) (18.5%, 95% CI: 12.7% to 25.4% vs. 6.1%, 95% CI: 4.03% to 8.83%, respectively, P < 0.0001; relative risk = 3.02, 95% CI: 1.84% to 4.96%, P < 0.0001). The PL prevalence in the nonobese HIV-infected population (body mass index [BMI] <30, n = 550) was 8.0% (95% CI: 5.9% to 10.6%; P < 0.0001). Logistic regression analyses identified the following factors as associated with a greater likelihood for PL: BMI >30 (beta = 0.18, SE = 0.04; P < 0.001), female gender (beta = 1.06, SE = 0.31; P < 0.001), and shorter duration of HIV infection (beta = -0.005, SE = 0.003; P = 0.04). We used a chain graph model to evaluate risk factors for BH and PL simultaneously. A nonnull interaction between these entities was evident, and this association seemed to be independent of factors positively associated with both (BMI and gender). CONCLUSIONS: PL is a newly recognized manifestation of HIV-associated lipoaccumulation that is more likely to occur among those with coexisting dorsocervical fat pads, suggesting the possibility of a common pathogenesis between the 2 entities. Likewise, PLs are more common among women, obese individuals, and those with a shorter duration of HIV infection. We suggest that PL should be considered part of the HIV-associated lipodystrophy syndrome.

2007 - The role of virological and immunological parameters on the diagnosis of metabolic syndrome in HIV-associated lipodystrophy [Abstract in Rivista]
Squillace, N.; Guaraldi, Giovanni; Orlando, G.; Roverato, A.; Nardini, Giulia; Beghetto, Barbara; Esposito, Roberto
abstract

The aim of our study is to analyse metabolic syndrome (MS) prevalence in a cohort of HIV patients and to apply a statistical model to HIV viro-immunological and MS parameters to explore relations among variables.

2006 - Long lasting psycho-social benefits of polyacrylamide injections for the treatment of facial lipoatrophy [Abstract in Rivista]
Orlando, G.; Guaraldi, Giovanni; Squillace, N.; Vandelli, M.; De Paola, M.; Cardinali, L.; Comelli, D.; DE SANTIS, Giorgio; Pedone, A.; Spaggiari, A.; Baccarani, A.; Pinelli, M.; Nardini, Giulia; Beghetto, Barbara; Esposito, Roberto
abstract

Polyacrylamide (PAL) injections are an effective surgical option for the treatment of HIV-related face lipoatrophy. The aim of this study was to analyse the psycho-social benefits of thissurgical intervention one year after the end of the treatment.

2006 - Metabolic and anthropometric alterations in a population of HIV infected patients with a high prevalence of lipodystrophy: associations with HCV coinfection [Abstract in Rivista]
Squillace, N.; Lapadula, G.; Orlando, G; Nardini, Giulia; Beghetto, Barbara; Torti, C.; Guaraldi, Giovanni
abstract

Data are still fragmentary so as to characterized the wide range of metabolic alterations in HIV-HCV co-infected patients in relation with their behavioural and anthropometric peculiarities.

2006 - Multidisciplinary approach to the treatment of metabolic and morphologic alterations of HIV-related lipodystrophy [Articolo su rivista]
Guaraldi, Giovanni; G., Orlando; N., Squillace; DE SANTIS, Giorgio; A., Pedone; A., Spaggiari; D., De Fazio; Vandelli, Maria Angela; M., De Paola; C., Bertucelli; C., Aldrovandi; Nardini, Giulia; Beghetto, Barbara; V., Borghi; Bertolotti, Marco; Bagni, Bruno; M. G., Amorico; A., Roverato; Esposito, Roberto
abstract

Background: Treatment for metabolic and morphologic alterations in HIV-related lipodystrophy include medical therapy, physical exercise, and surgical interventions. Method: We assessed the efficacy and safety of a comprehensive multidisciplinary approach for treating morphological and metabolic alterations of the lipodystrophy syndrome in consecutive patients attending the Metabolic Clinic (MC) of the University of Modena and Reggio Emilia who had at least 2 evaluations over a 48-week period. 245 patients were evaluated: 143 (62.4%) were men, 74 (36.1%) presented with lipoatrophy, 10 (4.9%) with fat accumulation, 93 (45%) with mixed forms, 24 (11.3%) had hypercholesterolemia (LDL >1 60 mg/dL), 87 (38%) had hypertriglyceridemia (TG >1 50 mg/dL), 13 (5.7%) had diabetes (glucose >1 26 mg/ dL), and 78 (44%) had insulin resistance (HOMA-IR >4). Results: At follow-up, a significant improvement was observed in both objective and subjective variables. Anthropometric improvement was observed in waist to hip ratio, waist circumference, and right and left cheek dermal thickness measurements. A nonsignificant improvement was observed in fat and lean regional mass by DEXA; CT showed improvement in visceral and subcutaneous adipose tissue. Glucose, HOMA-IR, total cholesterol, and APO B improved. Subjective variables improved in aesthetic satisfaction. Conclusion: We conclude that the medical and surgical interventions proposed in this multidisciplinary therapeutic approach are efficacious and safe in the management of lipodystrophy.

2006 - Prevalence and risk factors of pubic lipomas in HIV-infected patients [Abstract in Rivista]
Guaraldi, Giovanni; Orlando, G.; Squillace, N.; Roverato, A.; De Fazio, D.; Vandelli, M.; Nardini, Giulia; Beghetto, Barbara; De Paola, M.; Esposito, Roberto
abstract

The natural history of lipodystrophy (LD) and body fat changes is not known. The object of this study was to describe a new clinical picture apparently associated with LD characterized by the emergence of a subcutaneous lipoma in the pubic region. Prevalence and risk factors of pubic lipomas (PL) were analysed in a observational cross sectional study in patients with lipodystrophy attending a metabolic clinic. in northern Italy.

2006 - Quality of life and body image in the assessment of psychological impact of lipodystrophy: validation of the italian version of assessment of body change and distress questionnaire [Articolo su rivista]
Guaraldi, Giovanni; G., Orlando; R., Murri; Vandelli, Maria Angela; M., De Paola; Beghetto, Barbara; Nardini, Giulia; S., Ciaffi; F., Vichi; Esposito, ; A. W., Wu
abstract

Lipodystrophy (LD) includes morphologic changes that are distressing to patients with HIV. We tested the validity of an Italian version of the Assessment of Body Change and Distress (ABCD) questionnaire and analysed its relationship to physical and mental aspects of Health-Related Quality of Life. Two hundred and fifty-two patients completed the questionnaires. Construct validity of the ABCD was tested against the MOS-HIV Health Survey, body mass-index (BMI) and CD4+ T-lymphocyte counts. Cronbach's alpha for the ABCD total score was 0.94. The ABCD showed the hypothesized moderate correlations to MOS-HIV scales and clinical variables. Preliminary evidence supports the reliability and validity of the Italian version of the ABCD in people with HIV and LD. This questionnaire may be useful to identify people experiencing greater impact of LD, or to evaluate the impact of interventions to treat LD such as plastic surgery.

2006 - Tenofovir treatment in HIV-related lipodystrophy syndrome. Retrospective observational forty-eight weeks follow-up study [Articolo su rivista]
Guaraldi, Giovanni; Orlando, Gabriella; Roverato, A.; DE SANTIS, Giorgio; Pedone, A.; Spaggiari, A.; Baccarani, A.; De Fazio, D.; Vandelli, M.; Bertucelli, C.; Beghetto, Barbara; Nardini, Giulia; Borghi, V.; Grisendi, C.; Bertolotti, Marco; Carubbi, Francesca; Zini, I.; Esposito, Roberto
abstract

Efficacy and safety of morphological and metabolic alterations treatment in HIV related lipodystrophy syndrome have never been evaluated outside clinical trials and progression of lipodystrophy remains uncertain. This is a 48 weeks follow up observational retrospective study over consecutive patients attending the Metabolic Clinic of the University of Modena and Reggio Emilia in whom a biochemical, antropometric with DEXA and psychometric evaluation was available. The aim of this research was to assess efficacy and safety of switching to tenofovir (TDF) in the context of the multidisciplinary interventions offered in the Metabolic Clinic comprehensive of: dietary counseling, physical activities, surgical treatment for facial lipoatrophy or fat hypertrophy and psychological support. In a cohort of 189 people with lipodystrophy, TDF was part of the antiretroviral regimen in 125 individuals (82 males e 43 females). TDF-control group was made of 64 individuals (38 males e 26 females). The two study groups were homogeneous for metabolic, morphologic and psychometric profile at baseline. In the follow up period a significant improvement was observed in TDF+ group with regard of blood glucose, insuline, triglyceride. Non significant change in morphologic alterations evaluated with DEXA was observed in the two study groups. With regards of psychometric evaluations, a striking improvement was observed in aesthetic satisfaction of the face, of the body, of body image and depression. In the cohort, no progressions of HIV disease nor serious adverse events were observed. We conclude that switching to tenofovir in the context of the multidisciplinary interventions offered in the Metabolic Clinic is efficacious and safe in the management of LD

2005 - Effectiveness and durability of polyacrylamide hydrogel injections for treating HIV-related facial lipoatrophy [Abstract in Rivista]
Orlando, G.; Guaraldi, Giovanni; Pedone, A.; Spaggiari, A.; Baccarani, A.; Borghi, V.; Nardini, Giulia; Beghetto, Barbara; Cappi, C.; DE SANTIS, Giorgio
abstract

Polyacrylamide hydrogel injections implant (PHI) is stable, pH neutral, insoluble, non toxic injectable implant used for facial and body contour correction and reconstruction. The aim of our study was to assess objective and subjective effectiveness and durability of PHI in HIV-infected individuals with facial lipoatrophy.

2005 - Efficacy and safety of medical and surgical interventions for treating HIV-related lipodystrophy in women [Abstract in Rivista]
Orlando, G.; Guaraldi, Giovanni; Cavuto, S.; Borghi, V.; Nardini, Giulia; Beghetto, Barbara; Cappi, C.; Esposito, Roberto
abstract

HIV-related lipodistrophy syndrome in women is rarely described, and its progression is not well characterized.

2005 - Psychometric evaluation in patients undergoing fillers injections for the treatment of HIV-related facial lipoatrophy: polylactic acid versus polyacrylamide [Abstract in Rivista]
Guaraldi, Giovanni; Orlando, G.; Vandelli, M.; De Paola, M.; Comelli, D.; DE SANTIS, Giorgio; Pedone, A.; Spaggiari, A.; Baccarani, A.; Pinelli, M.; De Fazio, D.; Blini, M.; Borghi, V.; Nardini, Giulia; Beghetto, Barbara; Esposito, Roberto
abstract

Filler injections can represent an effective treatment for HIV-related face lipoatrophy. The aim of this study was to analyse quality of life (QoL), depression and body image perception in a cohort of patients udergoing polylactic acid or polyacrylamide injections for face lipoatrophy using a set of questionnaires.

2004 - Alendronate reduces bone turnover in HIV-associated Osteopenia and Osteoporosis [Abstract in Atti di Convegno]
Guaraldi, Giovanni; Orlando, G.; Maddeddu, G.; Vescini, F.; Ventura, Paolo; Campostrini, S.; Corradini, E.; Parise, N.; Solinas, P.; Calia, G. M.; Mura, M. S.; Nardini, Giulia; Beghetto, Barbara; Caudarella, R.; Esposito, Roberto
abstract

OOsteopenia and Osteoporosis are frequent complications of HIV infection and may be related with low trauma fractures. Gender differences, with an increased prevalence of osteoporosis in male patients, have been observed. We conducted a 104-week prospective, randomized, open-label study to evaluate the effects of alendronate, vitamin D, and calcium supplementation on bone metabolism and bone mineral density in patients with HIV infection. Interim analysis at 52 weeks is presented.

2004 - Long-term follow-up of graft hypertrophy after autologous fat transfer for HIV-related face lipoatrophy (hamster syndrome 1 year later) [Abstract in Rivista]
Guaraldi, Giovanni; Orlando, G.; De Fazio, D.; Grisotti, A.; Borghi, V.; Nardini, Giulia; Beghetto, Barbara; Esposito, Roberto
abstract

At the 5th International Workshop on Adverse Drug Reactions and Lipodystrophy in HIV we presented four patients with facial lipoatrophy who underwent autologous fat transplantation and had a disfiguring fat graft hypertrophy of the face occurring at the same time as recurrent fat accumulation in the tissue harvest site. This report focuses on the clinical and surgical follow up of these cases.

2004 - Prospective, partially randomized, 24-week study to compare the efficacy and durability of different surgical techniques and interventions for the treatment of HIV-related facial lipoatrophy [Abstract in Rivista]
Guaraldi, Giovanni; Orlando, G.; De Fazio, D.; Callegari, M.; DE SANTIS, Giorgio; Pedone, A.; Spaggiari, A.; Baccarani, A.; Pinelli, M.; Borghi, V.; Nardini, Giulia; Beghetto, Barbara; Esposito, Roberto
abstract

Autologous fat transfer (AFT) surgery and injection of reabsorbable or non-reabsorbable material into the lipoatrophic areas of the face are the only availabletreatment for HIV-related facial lipoatrophy. Comparisons between treatment approacheshave been limited.

2004 - Psychometric evaluation of patients undergoing surgical treatment of HIV-related facial lipoatrophy [Abstract in Rivista]
Orlando, G.; Guaraldi, Giovanni; Vandelli, M.; De Palma, M.; Comelli, D.; DE SANTIS, Giorgio; Pedoni, A.; Spaggiari, A.; Baccarani, A.; Pinelli, M.; De Fazio, D.; Borghi, V.; Nardini, Giulia; Beghetto, Barbara; Esposito, Roberto
abstract

Surgery seems to be the only effective treatment for HIV-related face lipoatrophy. The aim of this study was to analyse the role of available psychometric questionnaires to valuate quality of life, depression and body image perception in a cohort of patients undergoing surgical treatment for face lipoatrophy.

2004 - Relapse of HIV-related buffalo hump after liposuction [Abstract in Rivista]
Orlando, G.; Guaraldi, Giovanni; De Fazio, D.; Grisotti, A.; Borghi, V.; Nardini, Giulia; Beghetto, Barbara; Esposito, Roberto
abstract

Traditional and ultrasound assisted liposuction and lipectomy are potential surgical treatments for buffalo hump. The primary objective of this retrospective study was to analyse the durability of the surgical result 1 year after the treatment and the mean time to reintervention due to buffalo hump relapse.

2003 - Autologous fat transfer for treating facial waisting in HIV body fat redistribution Syndrome [Abstract in Atti di Convegno]
Guaraldi, Giovanni; De Fazio, D.; Orlando, G.; Murri, R.; Grisotti, A.; Nardini, Giulia; Callegari, M.; De Lorenzi, I.; Prinzivalli, G.; Pecorari, M.; Beghetto, Barbara; Covezzi, R.; Amorico, G.; Esposito, Roberto; Wu, A.
abstract

Autologous fat transfer has been used only rarely to treat facial lipoatrophy for fear of rapid graft loss. We assessed the objective and subjective and durability of this intervention in people with HIV and body fat redistribution.

2003 - Autologous fat transfer for treating facial wasting in HIV-related lipodystrophy: experience of 53 treated patients [Abstract in Rivista]
Guaraldi, Giovanni; De Fazio, D.; Rondina, R.; Orlando, G.; Murri, R.; Grisotti, A.; Nardini, Giulia; Callegari, M.; De Lorenzi, I.; Blini, M.; Pecorari, M.; Beghetto, Barbara; Covezzi, R.; Esposito, Roberto; Wu, A.
abstract

the aim of our study was to assess subjective and objective efficacy and durability of autologous fat transfer in HIV-positive people with facial wasting in lipodystrophy.

2003 - HIV counselling and prevention on the WEB [Abstract in Atti di Convegno]
Guaraldi, Giovanni; Galli, C.; Artioli, F.; Vanzini, C.; Miselli, S.; Bertani, D.; Pinto, G.; Orlando, G.; Nardini, Giulia; Beghetto, Barbara; Florini, C.; Ascari, A.; Gandolfi, G.; Ranellucci, M.; Orlandi, L.; Esposito, Roberto
abstract

The aim of our study is to describe target, methods, and characteristics of a three years experience of a web counselling service.

2003 - HIV counselling looks for new target and methods web versus face to face counselling [Abstract in Atti di Convegno]
Guaraldi, Giovanni; Vanzini, C.; Mazeu, I.; Galli, C.; Orlando, G.; Bertani, D.; Miselli, S.; Nardini, Giulia; Beghetto, Barbara; Esposito, Roberto
abstract

First objective was to descibe three years experience of a wab counselling service and a three month prospective case control study of web versus face to face counselling.

2003 - Lipodystrophy and quality of life: a prospective study [Abstract in Atti di Convegno]
Orlando, G.; Guaraldi, Giovanni; Murri, R.; Nardini, Giulia; Beghetto, Barbara; Sterrantino, G.; Cattelan, A. M.; Borderi, M.; Esposito, Roberto; Wu, A. W.
abstract

Antiretrovirals related lipodystrophy may have a negative impact on quality of life due to disfiguring body changes.

2003 - Mechanical and ultrasound-assisted liposuction for treating subcutaneous fat accumulations in HIV-related lipodystrophy: experience of 33 treated patients [Abstract in Rivista]
Guaraldi, Giovanni; De Fazio, D.; Orlando, G.; Murri, R.; Grisotti, A.; Nardini, Giulia; Callegari, M.; De Lorenzi, I.; Blini, M.; Pecorari, M.; Beghetto, Barbara; Covezzi, R.; Esposito, Roberto; Wu, A.
abstract

The aim of our study was to assess subjective and objective efficacy and durability of mechenical and ultrasound-assisted liposuction in HIV-positive people with subcutaneous fat accumulations in HIV-related lipodystrophy

2003 - Morphologic alterations in HIV infected people with lipodystropy are associated with good adherence to HAART. [Articolo su rivista]
Guaraldi, Giovanni; R., Murri; G., Orlando; E., Orlandi; G., Sterrantino; M., Borderi; C., Grosso; A. M., Cattelan; Nardini, Giulia; Beghetto, Barbara; A., Antinori; Esposito, Roberto; A. W., Wu
abstract

Objective: To evaluate the association between adherence to drugs and morphologic alterations (MOA) in a cohort of HIV-Infected patients on HAART. Method: This was a cross-sectional multicenter cohort study in eight tertiary Clinical Centers of Northern and Central Italy. Consecutive outpatients taking HAART were enrolled from August 2000 to March 2001. They completed a self-administered questionnaire for the evaluation of signs of MOA and the self-reported adherence to drugs. Main outcome measures were MOA according to the Multicenter AIDS Cohort Study (MACS) definition and adherence to drugs. Results: One hundred seventy-five persons were enrolled into the study. Median CD4 cell count was 522 (interquartile range [IQR] 306-720); 35% of people had undetectable HIV RNA. Patients had been taking HAART for a median of 53 months (IQR 33-62). Among enrolled patients, 83 (47%) had a diagnosis of self-reported MOA; 57 of them reported body changes of more than 12 months duration. Forty persons (23%) self-reported nonadherence in the previous week. Mean time on HAART was 48.7 months (SD = 19.7) for people with MOA and 42.1 months (SD = 21.8) for those without MOA (p =.043). The odds of adherence for people with MOA was 2.36 times (95% Cl 1.11-5.00) higher than for people without MOA. On multivariate analysis, being older and female, having an undetectable HIV RNA, longer duration on HAART, and self-reported adherence were independently associated with the presence of MOA. In people with MOA, adherence seems to decrease over time. Conclusion: Longer time on HAART and self-reported adherence were correlated to MOA. MOA was also associated with older age and female gender.

2003 - Nuovi obiettivi e strumenti di lavoro nel counselling HIV: studio prospettico osservazionale del counselling informatico versus il counselling vis a vis [Abstract in Rivista]
Guaraldi, Giovanni; Mazeu, I.; Cappi, C.; Vazini, C.; Galli, C.; Piselli, S.; Pinelli, M.; Orlando, G.; Nardini, Giulia; Beghetto, Barbara; Orlandi, L.; Esposito, Roberto
abstract

www.helpaids.it è un sito internet attivo da oltre tre anni dedicato alla prevenzione dell'infezione da HIV tramite un servizio di counselling informatico. Ci si è proposti di descrivere in maniera comparativa e prospettica le caratteristiche epidemiologiche e i fattori di rischio per infezione da HIV degli utenti del counselling informatico e di quello vis a vis eseguito presso l'ambulatorio della Clinica di Malattie Infettive di Modena. I counsellor erano in psicologi attivamente coinvolti nei programmi di prevenzione dell'infezione da HIV nella provincia di Modena.

2002 - Autologous fat transfer for treating facial wasting in HIV body fat redistribution syndrome. [Abstract in Atti di Convegno]
Guaraldi, Giovanni; De Fazio, D.; Orlando, G.; Beghetto, Barbara; Nardini, Giulia; Amorico, G.; Esposito, Roberto; Grisotti, A.; Callegari, M.; De Lorenzi, I.; Prinzivalli, G.
abstract

Body fat redistribution syndrome and in particular facial wasting, play a tremendous burden on psychological aspect of living with HIV disease, stigmatising this condition. Any medical intervention was proven unsuccessful to revert these alterations. Autologous fat tranfer for treating facial wasting has been rarely used to treat this condition in the fear of rapid loss of the fat transfer. The aim of our study wasto access afficacy and durability of this intevention.

2002 - Body Image perception in HIV infected women with body fat redistribution. [Abstract in Atti di Convegno]
Guaraldi, Giovanni; Orlando, G.; Murri, R.; Orlandi, E.; Covezzi, R.; Nardini, Giulia; Beghetto, Barbara; Bedini, A.; Esposito, Roberto; Wu, A. W.
abstract

The aim of this study was to examine, in HIV positive women with body fat redistribution syndrome, body image perception.

2002 - Candidemia nosocomiale: quattro anni di esperienza in un'ospedale universitario italiano [Abstract in Atti di Convegno]
Bedini, A.; Venturelli, C.; Mussini, Cristina; Guaraldi, Giovanni; Della Loggia, P.; Codeluppi, M.; Beghetto, Barbara; Nardini, Giulia; Rumpianesi, F.; Esposito, Roberto
abstract

Lo scopo del presente studio era di valutare, in un Ospedale Universitario Italiano, l'incidenza della candidemia nosocomiale, gli agenti patogeni responsabili, il trattamento e i fattori di rischio per la letalità

2002 - Does lipodistrophy affect quality of life? [Abstract in Atti di Convegno]
Orlando, G.; Guaraldi, Giovanni; Murri, R.; Wu, A.; Nardini, Giulia; Beghetto, Barbara; Sterrantino, Gk; Sbaragli, S.; Borderi, M.; Talò, S.; Grosso, C.; Erba, C.; Cattelan, Am; Antinori, A.; Esposito, Roberto
abstract

Increases in life expectancy of people with HIV makes it important to consider quality of life (QOL) as an outcome of HAART. Lipodystrophy (LD) has the potential to affect patients' QOL, but little is known about this impact. We examined the QOL of HIV+ patients with and without lipodystrophy.

2002 - Lipodistrophy is related to adherence to antiretroviral therapy (ARV) [Abstract in Atti di Convegno]
Guaraldi, Giovanni; Orlando, G.; Murri, R.; Orlandi, E.; Covezzi, R.; Sterrantino, G. K.; Sbaragli, S.; Borderi, M.; Talò, S.; Grosso, C.; Erba, C.; Catellan, A. M.; Antinori, A.; Nardini, Giulia; Beghetto, Barbara; Esposito, Roberto; Wu, A.
abstract

It is not known whether lipodystrophy is related to adherence to ART. GRAAL is a prospective observational study to examine lipodystrophy and its relationship to medication adherence.

2002 - Qual è il rapporto tra qualità di vita e lipodistrofia [Abstract in Atti di Convegno]
Guaraldi, Giovanni; Orlando, G.; Murri, R.; Talia, K.; Nardini, Giulia; Beghetto, Barbara; Sterrantino, K. G.; Sbaragli, S.; Borderi, M.; Talò, S.; Catellan, A. M.; Antinori, A.; Esposito, Roberto; Wu, A. W.
abstract

Molto si è discusso a proposito della lipodistrofia e delle potenziali conseguenze legate alle alterazioni metaboliche associate, ma non abbastanza si è riflettuto sulle sue conseguenze psicologiche e il suo impatto sulla qualità della vita delle persone con infezione da HIV. Nel presente lavoro si è cercato di individuare i rapporti tra queste due entità.

2002 - Ruolo della chirurgia plastica nel trattamento della sindrome da ridistribuzione del tessuto adiposo [Abstract in Atti di Convegno]
Guaraldi, Giovanni; De Fazio, D.; Orlando, G.; Grisotti, A.; Callegari, M.; De Lorenzi, I.; Prinzivalli, G.; Beghetto, Barbara; Nardini, Giulia; Amorico, G.; Marcotullio, S.; Murri, R.; Esposito, Roberto
abstract

La sindrome da ridistribuzione del tessuto adiposo ha un impatto psicologico grave nelle persone con infezione da HIV. Nessun trattamento medico si è dimostrato in grado di correggere questa condizione. La chirurgia plastica, al contrario, permette un risultato estetico delle lipoatrofie al volto e dei lipoaccumuli sottocutanei correlati a questa condizione morbosa. Non esistono studi di confronto tra le diverse tecniche chirurgiche e la durabilità di questi interventi non è nota.

2002 - Un raro caso di prostatite da Candida albicans, Candida krusei ed Enterococcus fecium [Abstract in Atti di Convegno]
Bedini, A.; Venturelli, C.; Mussini, Cristina; Guaraldi, Giovanni; Pellegrino, F.; Codeluppi, M.; Beghetto, Barbara; Nardini, Giulia; Rumpianesi, F.; Esposito, Roberto
abstract

Le infezioni micotiche dell'apparato urogenitale sono un evento relativamente frequente nei pazienti ospedalizzati e non. I principali fattori di rischio sono rappresentati da condizioni che alterano la flora microbica della mucosa urogenitale, stati di immunosoppressione locale e generale, e, sopprattutto, nei soggetti ospedalizzati, l'utilizzo del cateterismo vescicale. Le infezioni micotiche più frequenti sono la vaginite, l'uretrite, la cistite, la balanite.

2002 - Validity of body image perception in women with HIV. [Abstract in Atti di Convegno]
Guaraldi, Giovanni; Orlando, G.; Murri, R.; Orlandi, E.; Covezzi, R.; Nardini, Giulia; Beghetto, Barbara; Bedini, A.; Esposito, Roberto; Wu, A.
abstract

Tests are needed to study fat redistribution in HIV/AIDS. The aim of this study was to assess the validity of tests of perceived body image and related attitudes, originally designed for eating disorders, for use in HIV+ women.

2002 - È possibile un counselling HIV su internet? [Abstract in Atti di Convegno]
Guaraldi, Giovanni; Galli, C.; Artioli, F.; Vanzini, C.; Miselli, S.; Bertani, D.; Pinto, G.; Orlando, G.; Nardini, Giulia; Beghetto, Barbara; Florini, C.; Ascari, A.; Gandolfi, G.; Ranellucci, M.; Orlandi, L.; Esposito, Roberto
abstract

www.helpadis.it è un sito internet sviluppato per la prevenzione primaria e secondaria dell'infezione da HIV, attivo da oltre tre anni. All'interno del sito è stata costruita una sezione dedicata al counselling HIV dove operano medici infettivologi e psicologi direttamente coinvolti nel counselling vis a vis attivi presso i servizi sanitari della provincia di Modena. Questo sito consente alle persone che abitualmente non accedono ai servizi sanitari di richiedere una relazione di aiuto attraverso lo strumento telematico.