Foto personale

Giovanni GUARALDI

Department of Medical and Surgical Sciences for Children and Adults

Floridia, Marco; Pinnetti, Carmela; Ravizza, Marina; Masuelli, Giulia; Personeni, Carlo; Sansone, Matilde; Antoni, Anna Degli; Guaraldi, Giovanni; Spinillo, Arsenio; Tassis, Beatrice; Dalzero, Serena; Liuzzi, Giuseppina; Tamburrini, Enrica ( 2018 ) - Abacavir/Lamivudine and Tenofovir/Emtricitabine in Pregnant Women with Hiv: Laboratory and Clinical Outcomes in an Observational National Study - JOURNAL OF ACQUIRED IMMUNE DEFICIENCY SYNDROMES - pp. da 1 a 12 ISSN: 1525-4135 [Articolo in rivista (262) - Articolo su rivista]
Abstract

Abacavir-lamivudine (ABC/3TC) and tenofovir-emtricitabine (TDF/FTC) represent in the guidelines of several countries, including Italy and United States, the preferred nucleoside/nucleotide backbones of antiretroviral regimens. We assessed their profile in pregnancy using data from a national observational study.

Alfano, G.; Fontana, F.; Francesca, D.; Assirati, G.; Magistri, P.; Tarantino, G.; Ballarin, R.; Rossi, G.; Franceschini, E.; Codeluppi, M.; Guaraldi, G.; Mussini, C.; Di Benedetto, F.; Cappelli, G. ( 2018 ) - Gastric Mucormycosis in a Liver and Kidney Transplant Recipient: Case Report and Concise Review of Literature - TRANSPLANTATION PROCEEDINGS - n. volume 50 [Articolo in rivista (262) - Articolo su rivista]
Abstract

Mucormycosis is an uncommonly encountered fungal infection in solid organ transplantation. The infection is severe and often results in a fatal outcome. The most common presentations are rhino-sino-orbital and pulmonary disease. We describe a rare case of gastric mucormycosis in a patient with a combined liver-kidney transplant affected by glycogen storage disease type Ia. A 42-year-old female patient presented with gastric pain and melena 26 days after transplantation. Evaluation with upper endoscopy showed two bleeding gastric ulcers. Histological examination of gastric specimens revealed fungal hyphae with evidence of Mucormycetes at subsequent molecular analysis. Immunosuppressive therapy was reduced and antifungal therapy consisting of liposomal amphotericin B and posaconazole was promptly introduced. Gastrointestinal side effects of posaconazole and acute T-cell rejection of renal graft complicated further management of the case. A prolonged course of daily injections of amphotericin B together with a slight increase of immunosuppression favored successful treatment of mucormycosis as well as of graft rejection. After 2-year follow-up examination, the woman was found to have maintained normal renal and liver function tests. We conclude that judicious personalization of antimicrobial and antirejection therapy should be considered to resolve every life-threatening case of mucormycosis in solid organ transplantation.

De Vincentis, S.; Decaroli, M. C.; Diazzi, C.; Santi, D.; Menozzi, M.; Zona, S.; Guaraldi, G.; Rochira, V. ( 2018 ) - IL SODIO SIERICO È INVERSAMENTE CORRELATO ALLA FRAILTY E ALLA DENSITÀ MINERALE OSSEA (BMD) NEI PAZIENTI CON INFEZIONE DA HUMAN IMMUNODEFICIENCY VIRUS (HIV) - Abstract Book - SIE ITA) - n. volume 0 - pp. da 2 a 2 ISSN: - [Abstract in Atti di convegno (274) - Abstract in Atti di Convegno]
Abstract

L'iponatriemia si associa alla frailty nei pazienti con infezione da HIV

De Francesco, Davide; Wit, Ferdinand W.; Cole, James H.; Kootstra, Neeltje A.; Winston, Alan; Sabin, Caroline A.; Underwood, Jonathan; Van Zoest, Rosan A.; Schouten, Judith; Kooij, Katherine W.; Prins, Maria; Guaraldi, Giovanni; Caan, Matthan W. A.; Burger, David; Franceschi, Claudio; Libert, Claude; Bürkle, Alexander; Reiss, Peter ( 2018 ) - The ‘COmorBidity in Relation to AIDS’ (COBRA) cohort: Design, methods and participant characteristics - PLOS ONE - n. volume 13 [Articolo in rivista (262) - Articolo su rivista]
Abstract

Background Persons living with HIV on combination antiretroviral therapy (cART) may be at increased risk of the development of age-associated non-communicable comorbidities (AANCC) at relatively young age. It has therefore been hypothesised that such individuals, despite effective cART, may be prone to accelerated aging. Objective The COmorBidity in Relation to AIDS (COBRA) cohort study was designed to investigate the potential causal link between HIV and AANCC, amongst others, in a cohort of middle-aged individuals with HIV with sustained viral suppression on cART and otherwise comparable HIV-negative controls. Methods Longitudinal cohort study of HIV-positive subjects 45 years of age, with sustained HIV suppression on cART recruited from two large European HIV treatment centres and similarly-aged HIV-negative controls recruited from sexual health centres and targeted community groups. Both HIV-positive and HIV-negative subjects were assessed at study entry and again at follow-up after 2 years. Results Of the 134 HIV-positive individuals with a median (IQR) age of 56 (51, 62) years recruited, 93% were male, 88% of white ethnicity and 86% were men who have sex with men (MSM). Similarly, the 79 HIV-negative subjects had a median (IQR) age of 57 (52, 64) and 92% were male, 97% of white ethnicity and 80% were MSM. Conclusions The results from the COBRA study will be a significant resource to understand the link between HIV and AANCC and the pathogenic mechanisms underlying this link. COBRA will inform future development of novel prognostic tools for earlier diagnosis of AANCC and of novel interventions which, as an adjunct to cART, may prevent AANCC.

Guaraldi, G; Malagoli, A; Calcagno, A; Mussi, C; Celesia, B M; Carli, F; Piconi, S; De Socio, G V; Cattelan, A M; Orofino, G; Riva, A; Focà, E; Nozza, S; Di Perri, G ( 2018 ) - The increasing burden and complexity of multi-morbidity and polypharmacy in geriatric HIV patients: a cross sectional study of people aged 65 - 74 years and more than 75 years - BMC GERIATRICS - n. volume 18 - pp. da 99 a 109 ISSN: 1471-2318 [Articolo in rivista (262) - Articolo su rivista]
Abstract

Geriatric Patients Living with HIV/AIDS (GEPPO) is a new prospective observational multicentre cohort consisting of all the HIV-positive geriatric patients being treated at 10 clinics in Italy, and HIV-negative controls attending a single geriatric clinic. The aim of this analysis of the GEPPO cohort was to compare prevalence and risk factors of individual non-communicable diseases (NCD), multi-morbidity (MM) and polypharmacy (PP) amongst HIV positive and HIV negative controls at enrolment into the GEPPO cohort.

Cuomo, Gianluca; Puzzolante, Cinzia; Lazzaretti, Claudia; Guaraldi, Giovanni; Borghi, Vanni; Mussini, Cristina ( 2018 ) - Treatment rate for HCV in the direct acting antivirals era in HIV co-infected patients: data from an italian cohort - MINERVA MEDICA - pp. da 1 a 10 ISSN: 0026-4806 [Articolo in rivista (262) - Articolo su rivista]
Abstract

New Direct Antiviral Agents (DAA) are now effective in HCV infection; persons living with HIV (PLWH) were undertreated. Aim of this study was to describe the management of HCV treatment in a HIV/HCV cohort during a 16 years period.

Guaraldi, Giovanni; Dolci, Giovanni; Zona, Stefano; Tarantino, Giuseppe; Serra, Valentina; Ballarin, Roberto; Franceschini, Erica; Codeluppi, Mauro; Brothers, Thomas D.; Mussini, Cristina; Di Benedetto, Fabrizio ( 2017 ) - A frailty index predicts post-liver transplant morbidity and mortality in HIV-positive patients - AIDS RESEARCH AND THERAPY - n. volume 14 - pp. da 37 a 45 ISSN: 1742-6405 [Articolo in rivista (262) - Articolo su rivista]
Abstract

Background: We hypothesized that frailty acts as a measure of health outcomes in the context of LT. The aim of this study was to explore frailty index across LT, as a measure of morbidity and mortality. This was a retrospective observational study including all consecutive 47 HIV+patients who received LT in Modena, Italy from 2003 to June 2015. Methods: frailty index (FI) was constructed from 30 health variables. It was used both as a continuous score and as a categorical variable, defining 'most frail' a FI > 0.45. FI change across transplant (deltaFI, ΔFI) was calculated as the difference between year 1 FI (FI-Y1) and pre-transplant FI (FI-t0). The outcomes measures were mortality and "otpimal LT" (defined as being alive without multi-morbidity). Results: Median value of FI-t0 was 0.48 (IQR 0.42-0.52), FI-Y1 was 0.31 (IQR 0.26-0.41). At year five mortality rate was 45%, "optimal transplant" rate at year 1 was 38%. All the patients who died in the post-LT were most frail in the pre-LT. ΔFI was a predictor of mortality after correction for age and MELD (HR = 1.10, p = 0.006) and was inversely associated with optimal transplant after correction for age (HR = 1.04, p = 0.01). Conclusions: We validated FI as a valuable health measure in HIV transplant. In particular, we found a relevant correlation between FI strata at baseline and mortality and a statistically significant correlation between, ΔFI and survival rate.

De Luca, A; Lorenzini, P; Castagna, A; Puoti, M; Gianotti, N; Castelli, F; Mastroianni, C; Maggiolo, F; Antinori, A; Guaraldi, Giovanni; Lichtner, M; Monforte, Ad ( 2017 ) - Active HCV Replication but Not HCV or CMV Seropositive Status Is Associated With Incident and Prevalent Type 2 Diabetes in Persons Living With HIV - JOURNAL OF ACQUIRED IMMUNE DEFICIENCY SYNDROMES - n. volume 75 - pp. da 465 a 471 ISSN: 1525-4135 [Articolo in rivista (262) - Articolo su rivista]
Abstract

Objective: To analyze the association between chronic hepatitis C virus (HCV) and cytomegalovirus (CMV) infections with type 2 diabetes in HIV-infected patients.Methods: HIV-1-infected patients enrolled in ICONA, a prospective cohort study involving 42 tertiary care centers in Italy, were selected with the following characteristics: for the diabetes incidence analysis, all patients with available CMV IgG results (first available test = baseline) and without type 2 diabetes were followed until onset of type 2 diabetes, last available clinical follow-up, death or September 30, 2014, whichever occurred first; for the prevalence analysis, all ICONA patients were analyzed at their last follow-up visit. Main outcome measures were the new onset of type 2 diabetes (incidence analysis) and the prevalence of type 2 diabetes at last follow-up.Results: During 38,062 person-years of follow-up (PYFU) in 6505 individuals, we observed 140 cases of incident type 2 diabetes (Incidence rate 3.7, 95% CI: 3.1 to 4.3, per 1000 PYFU). In a multivariable Poisson regression model, HCV-antibody (Ab) +/HCV RNA+ patients [adjusted relative rate versus HCV-Ab negative 1.73 (95% CI: 1.08 to 2.78)] but not HCV Ab+RNA- or CMV IgG+ patients, had a higher risk of diabetes. Among 12,001 patients, 306 (2.5%) prevalent cases of type 2 diabetes were detected. HCV Ab+RNA+ status was independently associated with prevalent diabetes (adjusted Odds Ratio vs HCV Ab- 2.49; 95% CI: 1.08 to 5.74), whereas HCV-Ab+/HCV RNA- and CMV IgG+ status were not.Conclusion: In HIV-infected individuals, active HCV replication but not prior HCV exposure or latent CMV infection is associated with incident and prevalent type 2 diabetes.

Negredo, Eugenia; Back, David; Blanco, José-Ramón; Blanco, Julià; Erlandson, Kristine M; Garolera, Maite; Guaraldi, Giovanni; Mallon, Patrick; Moltó, José; Serra, José Antonio; Clotet, Bonaventura ( 2017 ) - Aging in HIV-Infected Subjects: A New Scenario and a New View - BIOMED RESEARCH INTERNATIONAL - n. volume 2017 - pp. da 1 a 9 ISSN: 2314-6133 [Articolo in rivista (262) - Articolo su rivista]
Abstract

The prevalence of HIV-infected people aged 50 years or older is increasing rapidly; the proportion will increase from 28% to 73% in 2030. In addition, HIV-infected individuals may be more vulnerable to age-related condition. There is growing evidence that the prevalence of comorbidities and other age-related conditions (geriatric syndromes, functional or neurocognitive/mental problems, polypharmacy, and social difficulties) is higher in the HIV-infected population than in their uninfected counterparts. However, despite the potential impact of this situation on health care, little information exists about the optimal clinical management of older HIV-infected people. Here we examine the age-related conditions in older HIV-infected persons and address clinical management according to author expertise and published literature. Our aim is to advance the debate about the most appropriate management of this population, including less well-studied aspects, such as frequency of screening for psychological/mental and social and functional capabilities.

Guaraldi, Giovanni; Raggi, Paolo ( 2017 ) - Antiretroviral therapies and cardiovascular risk: True or false? - ATHEROSCLEROSIS - pp. da 313 a 314 ISSN: 0021-9150 [Articolo in rivista (262) - Articolo su rivista]
Abstract

not available

Nozza, Silvia; Malagoli, Andrea; Maia, Lilian; Calcagno, Andrea; Focà, Emanuele; De Socio, Giuseppe; Piconi, Stefania; Orofino, Giancarlo; Cattelan, Anna Maria; Celesia, Benedetto Maurizio; Gervasi, Elena; Guaraldi, Giovanni ( 2017 ) - Antiretroviral therapy in geriatric HIV patients: the GEPPO cohort study - JOURNAL OF ANTIMICROBIAL CHEMOTHERAPY - n. volume 72 - pp. da 2879 a 2886 ISSN: 0305-7453 [Articolo in rivista (262) - Articolo su rivista]
Abstract

GEPPO is a prospective observational multi-centric cohort including HIV-infected geriatric patients. We hypothesized that the GEPPO cohort may help characterize antiretroviral (ARV) prescribing criteria used in real life by Italian infectious disease (ID) physicians.

Guaraldi, Giovanni; Raggi, Paolo ( 2017 ) - Atherosclerosis in frailty: Not frailty in atherosclerosis - ATHEROSCLEROSIS - n. volume 266 - pp. da 226 a 227 ISSN: 0021-9150 [Articolo in rivista (262) - Articolo su rivista]
Abstract

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Erlandson, Kristine M; Lake, Jordan E; Sim, Myung; Falutz, Julian; Prado, Carla M; Domingues Da Silva, Ana Rita; Brown, Todd T; Guaraldi, Giovanni ( 2017 ) - Bone Mineral Density Declines Twice as Quickly Among HIV-Infected Women Compared to Men - JOURNAL OF ACQUIRED IMMUNE DEFICIENCY SYNDROMES - pp. da 1 a 24 ISSN: 1525-4135 [Articolo in rivista (262) - Articolo su rivista]
Abstract

Initial declines in bone mineral density (BMD) following antiretroviral therapy (ART) initiation in HIV are well described, but data on long-term changes and risk factors for decline, particularly among women, are limited.

Raggi, Paolo; De Francesco, Davide; Guaraldi, Giovanni ( 2017 ) - Cardiovascular Risk Prediction in Patients With Human Immunodeficiency Virus - JAMA CARDIOLOGY - n. volume 2 - pp. da 1048 a 1048 ISSN: 2380-6583 [Articolo in rivista (262) - Articolo su rivista]
Abstract

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Guaraldi, Giovanni; Palella, Frank J ( 2017 ) - Clinical implications of aging with HIV infection: perspectives and the future medical care agenda - AIDS - n. volume 31 [Articolo in rivista (262) - Articolo su rivista]
Abstract

The increasing number of aging HIV-infected (HIV+) persons comprises a unique population at risk for illnesses and syndromes traditionally associated with the elderly. As a result, similar to the current need for primary care providers to manage chronic noninfectious comorbidities among aging persons with well controlled HIV infection, HIV clinical care will need to routinely involve geriatric medicine in a new HIV-geriatric discipline. The objective of this article is to provide a conceptual framework in which HIV and geriatric management considerations for healthcare professionals caring for HIV+ persons are integrated. The provision of contemporary HIV clinical care extends well beyond the achievement of HIV virologic suppression and antiretroviral therapy management and includes a need for careful characterization of geriatric syndromes based upon functional capacity and extent of disability. Screening for geriatric syndromes is both a multidisciplinary and multidimensional process, designed to evaluate an older person's functional ability, physical health, cognition, overall mental health, and socio-environmental circumstances. Although routine incorporation of geriatric assessment into clinical trials involving HIV+ persons is feasible, a current challenge is the availability of a consensus clinical definition of frailty or vulnerability. To maximize the efficiency, value, and convenience of outpatient care visits for older HIV+ persons, these visits should include encounters with multiple providers, including primary care clinicians, social workers, and geriatricians. Challenges may exist in the routine provision of these assessments to older HIV+ persons, but clearly such cross-disciplinary collaboration will not only markedly enhance the care of aging HIV+ persons but may also constitute a model of successful healthcare management that can be applied to all aging persons with changing healthcare needs.

Franceschini, Erica; Plessi, Jessica; Zona, Stefano; Santoro, Antonella; Digaetano, Margherita; Fontana, Francesco; Alfano, Gaetano; Guaraldi, Giovanni; Comoli, Patrizia; Facchini, Francesca; Potenza, Leonardo; Gennari, William; Codeluppi, Mauro; Luppi, Mario; Cappelli, Gianni; Gyssens, Inge C.; Mussini, Cristina ( 2017 ) - Clinical Utility of Epstein-Barr Virus Viral Load Monitoring and Risk Factors for Posttransplant Lymphoproliferative Disorders After Kidney Transplantation - TRANSPLANTATION DIRECT - n. volume 3 [Articolo in rivista (262) - Articolo su rivista]
Abstract

Background. Posttransplant lymphoproliferative disease (PTLD) is an important cause of morbidity and mortality in solid organ transplants. Epstein Barr virus (EBV) plays a major role in PTLD development. Guidelines recommend EBV viral load (VL) monitoring in high-risk populations in the first year. Methods. Retrospective observational study in all adult patients who had at least 1 EBV-VL performed in the postkidney transplant (KT) period from January 2005 to December 2014 at the Policlinico Modena Hospital. We compared patients with negative EBV-DNA to patients with positive EBV-DNA and we described PTLD developed in the study period. Results.One hundred ninety (36.3%) KT patients of 523 were screened for EBV-DNA with 796 samples. One hundred twenty-eight (67.4%) of 190 tested patients presented at least 1 positive sample for EBV. Older age, the use of sirolimus, everolimus, and steroids were associated with EBV-DNA positivity in the univariate analysis. Nine (1.7%) of 523 patients had PTLD. Incidence rate of PTLD in the KT cohort was 0.19/100 person year follow-up (95% confidence interval, 0.09-0.37). One of 9 patients developed early PTLD and was a high-risk patient. Only this PTLD case was positive for EBV. No PTLD case had an EBV-VL superior to 4000 copies/mL. Conclusions. Our results suggest that the keystone of PTLD diagnosis is the clinical suspicion. Our study suggests that, in line with guidelines, EBV-VL assays may be avoided in low-risk patients in the absence of a strong clinical PTLD suspicion without increasing patients' risk of developing PTLD. This represents a safe and cost-saving clinical strategy for our center

Guaraldi, Giovanni; Malagoli, Andrea; Theou, O; Brothers, T. D; Wallace, Lmk; Torelli, Riccardo; Mussini, Cristina; Sartini, Silvana; Kirkland, S. A; Rockwood, K. ( 2017 ) - Correlates of frailty phenotype and frailty index and their associations with clinical outcomes - HIV MEDICINE - pp. da 764 a 771 ISSN: 1464-2662 [Articolo in rivista (262) - Articolo su rivista]
Abstract

Frailty is a predictor of adverse health outcomes and can be measured across the life course, including among people living with HIV. The purpose of this study was to examine two commonly used measures of frailty - the frailty index (FI) and frailty phenotype - to assess common characteristics and to describe associations with multimorbidity, falls, and disability in people aging with HIV.

Guaraldi, Giovanni; Cossarizza, Andrea ( 2017 ) - Geriatric-HIV medicine: A science in its infancy - VIRULENCE - n. volume 8 - pp. da 504 a 507 ISSN: 2150-5594 [Articolo in rivista (262) - Articolo su rivista]
Abstract

not available

Guaraldi, Giovanni; Rockwood, Kenneth ( 2017 ) - Geriatric-HIV medicine is born - CLINICAL INFECTIOUS DISEASES - n. volume 65 - pp. da 507 a 509 ISSN: 1058-4838 [Articolo in rivista (262) - Articolo su rivista]
Abstract

not available

Rochira, Vincenzo; Guaraldi, Giovanni ( 2017 ) - Growth hormone deficiency and human immunodeficiency virus - BAILLIERE'S BEST PRACTICE & RESEARCH. CLINICAL ENDOCRINOLOGY & METABOLISM - n. volume 31 - pp. da 91 a 111 ISSN: 1521-690X [Articolo in rivista (262) - Articolo su rivista]
Abstract

Treatment with highly active antiretroviral drugs (HAART) is associated with several endocrine and metabolic comorbidities. Pituitary growth hormone (GH) secretion seems to be altered in human immunodeficiency virus (HIV) infection, and about one-third of patients have biochemical GH deficiency (GHD). We undertake a historical review of the functioning of the GH/insulin-like growth factor-1 (IGF-1) axis in patients with acquired immunodeficiency syndrome, and provide an overview of the main changes of the GH/IGF-1 axis occurring today in patients with HIV. Both spontaneous GH secretion and GH response to provocative stimuli are reduced in patients with HIV infection, especially in those with HIV-related lipodystrophy. The role of fat accumulation on flattened GH secretion is discussed, together with all factors able to potentially interfere with the pituitary secretion of GH. Several factors contribute to the development of GHD, but the pathophysiologic mechanisms involved in the genesis of GHD are complex and not yet fully elucidated owing to the difficulty in separating the effects of HIV infection from those of HAART, comorbidities and body changes. An update on the putative mechanisms involved in the pathogenesis of altered GH secretion in these patients is provided, together with an overview on the therapeutic strategies targeting the GH/IGF-1 axis to counteract fat redistribution associated with HIV-related lipodystrophy. The clinical significance of GHD in the context of HIV infection is discussed. The administration of tesamorelin, a GH releasing hormone analogue, is effective in reducing visceral fat in HIV-infected patients with lipodystrophy. This treatment is promising and safer than treatment with high doses of recombinant human growth hormone, which has several side-effects.

Floridia, Marco; Masuelli, Giulia; Tamburrini, Enrica; Spinillo, Arsenio; Simonazzi, Giuliana; Guaraldi, Giovanni; Degli Antoni, Anna Maria; Martinelli, Pasquale; Portelli, Vincenzo; Dalzero, Serena; Ravizza, Marina ( 2017 ) - HBV coinfection is associated with reduced CD4 response to antiretroviral treatment in pregnancy - HIV CLINICAL TRIALS - n. volume 18(2) - pp. da 54 a 59 ISSN: 1528-4336 [Articolo in rivista (262) - Articolo su rivista]
Abstract

To evaluate the impact of Hepatitis B virus (HBV) coinfection on response to antiretroviral treatment in pregnant women with HIV.

Gibellini, Lara; Pecorini, Simone; De Biasi, Sara; Bianchini, Elena; Digaetano, Margherita; Pinti, Marcello; Carnevale, Gianluca; Borghi, Vanni; Guaraldi, Giovanni; Mussini, Cristina; Cossarizza, Andrea; Nasi, Milena ( 2017 ) - HIV-DNA content in different CD4+ T-cell subsets correlates with CD4+ cell : CD8+ cell ratio or length of efficient treatment - AIDS - n. volume 31 - pp. da 1387 a 1392 ISSN: 0269-9370 [Articolo in rivista (262) - Articolo su rivista]
Abstract

Objectives: HIV establishes a latent infection at different degrees within naïve (TN) or central (TCM) and effector memory (TEM) CD4+ T cell. Studying patients in whom HIV production was suppressed by combined antiretroviral therapy, our main aim was to find which factors are related or can influence intracellular viral reservoir in different CD4+ T-cell subsets. Methods: We enrolled 32 HIV+ patients successfully treated for more than 2 years, with a CD4+ T-cell count more than 500 cells/μl and plasma viremia undetectable from at least 1 year. Proviral HIV-DNA, the amount of cells expressing signal-joint T-cell receptor rearrangement excision circles and telomere length were quantified by droplet digital PCR in highly purified, sorted CD4+ T-cell subsets; plasma IL-7 and IL-15 were measured by ELISA. Results: HIV-DNA was significantly lower in TN cells compared with TCM or to TEM. Conversely, TN cells contained more signal-joint T-cell receptor rearrangement excision circles compared with TCM or to TEM; no appreciable changes were observed in telomere length. HIV-DNA content was significantly higher in TN and TCM cells, but not in TEM, from patients with shorter time of treatment, or in those with lower CD4+ : CD8+ ratio. Conclusion: Length of treatment or recovery of CD4+ : CD8+ ratio significantly influences viral reservoir in both TN and TCM. Measuring HIV-DNA in purified lymphocyte populations allows a better monitoring of HIV reservoir and could be useful for designing future eradication strategies.

Guaraldi, Giovanni; Menozzi, Marianna; Zona, Stefano; Calcagno, Andrea; Domingues Da Silva, Ana R; Santoro, Antonella; Malagoli, Andrea; Dolci, Giovanni; Mussi, Chiara; Mussini, Cristina; Cesari, Matteo; Khoo Saye, H. ( 2017 ) - Impact of polypharmacy on antiretroviral prescription in people living with HIV. - JOURNAL OF ANTIMICROBIAL CHEMOTHERAPY - n. volume 72 - pp. da 511 a 514 ISSN: 0305-7453 [Articolo in rivista (262) - Articolo su rivista]
Abstract

OBJECTIVES: To evaluate the relationship between polypharmacy and ART, delivered as conventional multi-tablet three-drug regimens, single-tablet regimens or less-drug regimens (simplified mono or dual regimens). METHODS: We conducted a cross-sectional analysis of electronic data from the prospective Modena HIV Metabolic Clinic Cohort Study. We included the last clinical observation for each patient from January 2006 to December 2015. Polypharmacy was defined as the use of five or more medications (excluding ART). Multi-morbidity was classified as the presence of two or more non-infectious comorbidities. Factors associated with different ART regimens were analysed using multivariable multinomial logistic regression analyses with multi-tablet three-drug regimens as the reference. RESULTS: A total of 2944 patients (33.7% females) were included in the analysis. Multinomial logistic regression analysis identified polypharmacy to be negatively associated with single-tablet regimens [relative risk reduction (RRR) = 0.48, 95% CI = 0.28-0.81] independently from frailty (RRR = 0.68, 95% CI = 0.59-0.78), after correction for age, gender, HIV infection duration, current and nadir CD4 and calendar year. This association was not found comparing multi-tablet three-drug regimens and less-drug regimens. CONCLUSIONS: Single-tablet regimens are less likely to be prescribed in patients with polypharmacy. Single-tablet regimens are perceived to be less flexible in patients with multi-morbidity and at higher risk of drug-drug interaction.

Guaraldi, Giovanni; Zona, Stefano; Menozzi, Marianna; Brothers, Thomas D.; Carli, Federica; Stentarelli, Chiara; Dolci, Giovanni; Santoro, Antonella; Da Silva, Ana Rita Domingues; Rossi, Elisa; Falutz, Julian; Mussini, Cristina ( 2017 ) - Late presentation increases risk and costs of non-infectious comorbidities in people with HIV: An Italian cost impact study - AIDS RESEARCH AND THERAPY - n. volume 14 - pp. da 8 a 15 ISSN: 1742-6405 [Articolo in rivista (262) - Articolo su rivista]
Abstract

Background: Late presentation (LP) at the time of HIV diagnosis is defined as presentation with AIDS whatever the CD4 cell count or with CD4 <350 cells/mm. The objective of our study was to assess the prevalence of non-infectious comorbidities (NICM) and multimorbidity among HIV-positive individuals with and without a history of LP (HIV + LP and HIV + EP, respectively), and compare them to matched HIV-negative control participants from a community-based cohort. The secondary objective was to provide estimates and determinants of direct cost of medical care in HIV patients. Methods: We performed a matched cohort study including HIV + LP and HIV + EP among people attending the Modena HIV Metabolic Clinic (MHMC) in 2014. HIV-positive participants were matched in a 1:3 ratio with HIV-negative participants from the CINECA ARNO database. Multimorbidity was defined as the concurrent presence of ≥2 NICM. Logistic regression models were constructed to evaluate associated predictors of NICM and multimorbidity. Results: We analyzed 452 HIV + LP and 73 HIV + EP participants in comparison to 1575 HIV-negative controls. The mean age was 46 ± 9 years, 27.5% were women. Prevalence of NICM and multimorbidity were fourfold higher in the HIV + LP compared to the general population (p < 0.001), while HIV + EP present an intermediate risk. LP was associated with increased total costs in all age strata, but appear particularly relevant in patients above 50 years of age, after adjusting for age, multimorbidity, and antiretroviral costs. Conclusions: LP with HIV infection is still very frequent in Italy, is associated with higher prevalence of NICM and multimorbidity, and contributes to higher total care costs. Encouraging early testing and access to care is still urgently needed.

Wallace, Lindsay M K; Ferrara, Maria; Brothers, Thomas D; Garlassi, Sara; Kirkland, Susan A; Theou, Olga; Zona, Stefano; Mussini, Cristina; Moore, David; Rockwood, Kenneth; Guaraldi, Giovanni ( 2017 ) - Lower Frailty Is Associated with Successful Cognitive Aging Among Older Adults with HIV - AIDS RESEARCH AND HUMAN RETROVIRUSES - n. volume 33 - pp. da 157 a 163 ISSN: 0889-2229 [Articolo in rivista (262) - Articolo su rivista]
Abstract

Aging 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.

Guaraldi, Giovanni; Lonardo, Amedeo; Maia, Liliana; Palella, Frank J. ( 2017 ) - Metabolic concerns in aging HIV-infected persons: from serum lipid phenotype to fatty liver - AIDS - n. volume 31 Suppl 2 [Articolo in rivista (262) - Articolo su rivista]
Abstract

: Among HIV-infected persons, the assessment of nonalcoholic fatty liver disease (NAFLD) provides a window through which overall metabolic health can be evaluated. In this review, we summarize clinical data that support the roles of aging and metabolic dysregulation as factors contributing to fatty liver/NAFLD among HIV-infected persons.Age-related metabolic alterations include hepatic anatomic and functional changes, altered homeostasis of gastrointestinal microbiota and anthropometric changes (such as a shift of body fat depots from the subcutaneous to the visceral compartment) that are often associated with the development of insulin resistance and increased cardiovascular risk.Fatty changes in the liver occur not only with metabolic disruption but also with virus-induced injury. Chronic hepatitis C virus infection is commonly associated with fatty liver, and can be related to both hepatitis C virus genotype and host metabolic features. Similarly, HIV infection is associated with fatty liver as a result of multiple viral and host factors. Clearly, lipodystrophy, dysregulation of the gut-liver axis and HIV infection itself may each contribute simultaneously to NAFLD pathogenesis. Although lifestyle changes are the mainstay of treatment, to date no drug has specifically been approved for use in persons with NAFLD. Moreover, current guidelines provide no specific therapeutic recommendations for persons with NAFLD older than 65 years.Well-designed studies characterizing the epidemiology, pathogenesis, clinical outcomes and potential therapeutic interventions for liver disease and associated metabolic comorbidities in older HIV-infected patients are urgently needed.

Orsini, Mirko; Pacchioni, Marco; Malagoli, Andrea; Guaraldi, Giovanni ( 2017 ) - My smart age with HIV: An innovative mobile and IoMT framework for patient's empowerment - International Forum on Research and Technologies for Society and Industry - pp. da 1 a 6 ISBN: 978-1-5386-3906-1 ISSN: - [Abstract in Atti di convegno (274) - Abstract in Atti di Convegno]
Abstract

In the My Smart Age with HIV (MySAwH) project1, an innovative mobile and IoMT framework has been developed to empower patients via health promotion, assessing reduction in health deficit and improvement in quality of life. The MySAwH IoMT framework has been designed to expand the traditional healthcare infrastructure providing patient monitoring and support outside the hospitals. It allows the collection of patient's data from smartphone and wearable devices, the integration and analysis of the collected data, and provide real-time insights of patient's health status. Health coaches can monitor the patient's care path and establish a direct communication channel through an integrated secure chat system. This paper describes the MySAwH IoMT framework features and demonstrate how the IoMT, mobile and wearable technologies have been successfully exploited to provide: i) physicians with a continuous patient monitoring to measure the response to illness and the life quality improvement; ii) patients with an up to date insight of health conditions and a constant support via a direct communication with the health coaches.

Diazzi, C.; Brigante, G.; Ferrannini, G.; Ansaloni, A.; Zirilli, L.; De Santis, M.C.; Zona, S.; Guaraldi, G.; Rochira, V. ( 2017 ) - Pituitary growth hormone (GH) secretion is partially rescued in HIV-infected patients with GH deficiency (GHD) compared to hypopituitary patients - ENDOCRINE - n. volume 55 - pp. da 885 a 898 ISSN: 1355-008X [Articolo in rivista (262) - Articolo su rivista]
Abstract

Biochemical growth hormone deficiency is prevalent among human immunodeficiency virus-infected patients, but if this condition is clinically relevant remains challenging. The aim is to prospectively compare the growth hormone deficiency/insulin-like growth factor-1 status of 71 human immunodeficiency virus-infected patients with impaired growth hormone response to growth hormone releasing hormone + Arginine with that of 65 hypopituitary patients affected by a true growth hormone deficiency secondary to pituitary disease. The main outcomes were: basal serum growth hormone, insulin-like growth factor-1, insulin-like growth factor binding protein 3, growth hormone peak and area under the curve after growth hormone response to growth hormone releasing hormone + Arginine test, body mass index, waist and hip circumference, and body composition by dual energy X-ray absorptiometry. Insulin-like growth factor-1 binding protein 3, basal growth hormone (p < 0.005), growth hormone peak and area under the curve after growth hormone response to growth hormone releasing hormone + Arginine, waist to hip ratio, insulin-like growth factor-1, fasting glucose, insulin, and triglycerides (p < 0.0001) were lower in hypopituitary than human immunodeficiency virus-infected patients. Total and trunk fat mass by dual energy X-ray absorptiometry were higher in hypopituitary than in human immunodeficiency virus-infected patients (p < 0.0001). In all the patients total body fat was associated with both growth hormone peak and area under the curve at stepwise linear regression analysis. The degree of growth hormone deficiency is more severe in hypopituitary than in human immunodeficiency virus-infected patients, suggesting that the function of growth hormone/insulin-like growth factor-1 axis is partially rescued in the latter thanks to a preserved pituitary secretory reserve. Data from the current study suggest that human immunodeficiency virus-infected patients with peak growth hormone < 9 mg/L may have partial growth hormone deficiency and clinicians should be cautious before prescribing recombinant human growth hormone replacement treatment to patients living with human immunodeficiency virus.

Lake, Jordan E; Stanley, Takara; Apovian, Caroline; Bhasin, Shalendar; Brown, Todd T; Capeau, Jaqueline; Currier, Judith S; Dube, Michael P; Falutz, Julian; Grinspoon, Steven K; Guaraldi, Giovanni; Martinez, Esteban; Mccomsey, Grace A; Sattler, Fred R; Erlandson, Kristine M ( 2017 ) - Practical Review of Recognition and Management of Obesity and Lipohypertrophy in HIV Infection - CLINICAL INFECTIOUS DISEASES - pp. da 1422 a 1429 ISSN: 1058-4838 [Articolo in rivista (262) - Articolo su rivista]
Abstract

Obesity and lipohypertrophy are common in treated HIV infection and contribute to morbidity and mortality among HIV-infected adults on antiretroviral therapy (ART).

Brothers, Thomas D.; Kirkland, Susan; Theou, Olga; Zona, Stefano; Malagoli, Andrea; Wallace, Lindsay M. K.; Stentarelli, Chiara; Mussini, Cristina; Falutz, Julian; Guaraldi, Giovanni; Rockwood, Kenneth ( 2017 ) - Predictors of transitions in frailty severity and mortality among people aging with HIV - PLOS ONE - n. volume 12 - pp. da 1 a 13 ISSN: 1932-6203 [Articolo in rivista (262) - Articolo su rivista]
Abstract

Background: People aging with HIV show variable health trajectories. Our objective was to identify longitudinal predictors of frailty severity and mortality among a group aging with HIV. Methods: Exploratory analyses employing a multistate transition model, with data from the prospective Modena HIV Metabolic Clinic Cohort Study, based in Northern Italy, begun in 2004. Participants were followed over four years from their first available visit. We included all 963 participants (mean age 46.8±7.1; 29% female; 89% undetectable HIV viral load; median current CD4 count 549, IQR 405–720; nadir CD4 count 180, 81–280) with four-year data. Frailty was quantified using a 31-item frailty index. Outcomes were frailty index score or mortality at four-year follow-up. Candidate predictor variables were baseline frailty index score, demographic (age, sex), HIV-disease related (undetectable HIV viral load, current CD4+ T-cell count, nadir CD4 count, duration of HIV infection, and duration of antiretroviral therapy [ARV] exposure), and behavioral factors (smoking, injection drug use (IDU), and hepatitis C virus co-infection). Results: Four-year mortality was 3.0% (n = 29). In multivariable analyses, independent predictors of frailty index at follow-up were baseline frailty index (RR 1.06, 95% CI 1.05–1.07), female sex (RR 0.93, 95% CI 0.87–0.98), nadir CD4 cell count (RR 0.96, 95% CI 0.93–0.99), duration of HIV infection (RR 1.06, 95% CI 1.01–1.12), duration of ARV exposure (RR 1.08, 95% CI 1.02–1.14), and smoking pack-years (1.03, 1.01–1.05). Independent predictors of mortality were baseline frailty index (OR 1.19, 1.02–1.38), current CD4 count (0.34, 0.20–0.60), and IDU (2.89, 1.30–6.42). Conclusions: Demographic, HIV-disease related, and social and behavioral factors appear to confer risk for changes in frailty severity and mortality among people aging with HIV.

Floridia, M; Masuelli, G; Tamburrini, E; Cetin, I; Liuzzi, G; Martinelli, P; Guaraldi, G; Spinillo, A; Vimercati, A; Maso, G; Pinnetti, C; Frisina, V; Dalzero, S; Ravizza, M ( 2017 ) - Pregnant with HIV before age 25: data from a large national study in Italy, 2001-2016 - EPIDEMIOLOGY AND INFECTION - n. volume 145 - pp. da 2360 a 2365 ISSN: 0950-2688 [Articolo in rivista (262) - Articolo su rivista]
Abstract

Young pregnant women with HIV may be at significant risk of unplanned pregnancy, lower treatment coverage, and other adverse pregnancy outcomes. In a large cohort of pregnant women with HIV in Italy, among 2979 pregnancies followed in 2001-2016, 9·0% were in women <25 years, with a significant increase over time (2001-2005: 7·0%; 2006-2010: 9·1%; 2011-2016: 12·2%, P < 0·001). Younger women had a lower rate of planned pregnancy (23·2% vs. 37·7%, odds ratio (OR) 0·50, 95% confidence interval (CI) 0·36-0·69), were more frequently diagnosed with HIV in pregnancy (46·5% vs. 20·9%, OR 3·29, 95% CI 2·54-4·25), and, if already diagnosed with HIV before pregnancy, were less frequently on antiretroviral treatment at conception (<25 years: 56·3%; ⩾25 years: 69·0%, OR 0·58, 95% CI 0·41-0·81). During pregnancy, treatment coverage was almost universal in both age groups (98·5% vs. 99·3%), with no differences in rate of HIV viral suppression at third trimester and adverse pregnancy outcomes. The data show that young women represent a growing proportion of pregnant women with HIV, and are significantly more likely to have unplanned pregnancy, undiagnosed HIV infection, and lower treatment coverage at conception. During pregnancy, antiretroviral treatment, HIV suppression, and pregnancy outcomes are similar compared with older women. Earlier intervention strategies may provide additional benefits in the quality of care for women with HIV.

Decaroli, M.C.; De Vincentis, S.; Diazzi, C.; Zona, S.; Guaraldi, G.; Santi, D.; Rochira, V. ( 2017 ) - Psychological rather than organic and/or relational components are involved in sexual dysfunction in Young/Middle aged human immunodeficiency virus (HIV)-Infected Men. - ENDOCRINE ABSTRACTS - n. volume 49 - pp. da 146 a 146 ISSN: 1479-6848 [Abstract in rivista (266) - Abstract in Rivista]
Abstract

Background HIV-infection is associated to an increased prevalence of erectile dysfunction (ED). In HIV-infected men ED seems to be less related to serum Testosterone (T), depending from other factors. Aim To investigate the role of different components (organic, relational, psycho- logical) of erectile function by using validate questionnaires in HIV-infected men with normal serum T. Methodology Prospective, cross-sectional, observational study on eugonadal HIV-infected male patients with ongoing Highly Active Antiretroviral Therapy (HAART) attending the Clinic of Infectious Diseases. The International Index of Erectile Function (IIEF)-15, IIEF-5 and Structured Interview for Erectile Dysfunction (SIEDY) were used to assess sexual function. Sexual desire was further evaluated through a direct question during the visit. LC-MS/MS was used to assess gonadal status. Results 225 HIV-infected patients were enrolled (mean age 45.19G5.36 years). SIEDY scores at appendix and scale 3 were significantly higher in patients with ED at IIEF- 15 (nZ136, 60.4%) compared with those without ED (P!0.001 and PZ0.015, respectively). Conversely, scale 1 (PZ0.448) and 2 (PZ0.503) of SIEDY did not differ between patients with or without ED, suggesting a predominance of the psychological basis of ED in our cohort. The erectile function domain at IIEF-15 was directly correlated with IIEF-5 score (0.778, P!0.001). Similarly, the score at SIEDY appendix was significantly different among ED degrees at IIEF-15 (P!0.001). In particular, lower score was found in HIV-infected men without ED compared to those with mild, moderate and severe ED (P!0.001, PZ0.001, and P!0.001, respectively), confirming the reliability of these tools. Sexual desire was impaired in 73 patients (31.33%) at interview with a good correlation with the specific item of IIEF-15 (P!0.001). Conclusions The psychological component impacts in a significant manner on ED in HIV- infection context. Despite the high prevalence of comorbidities in these patients, the organic component does not affect erectile function. All the three validated questionnaires seem to be trustworthy in the diagnosis of ED in this setting.

Decaroli, M.C.; De Vincentis, S.; Diazzi, C.; Zona, S.; Guaraldi, G.; Santi, D.; Rochira, V. . ( 2017 ) - Psychological rather than organic and/or relational components are involved in sexual dysfunction in young/middle aged human immunodeficiency virus (HIV)-infected men. - Abstract Book 39° Congresso Società Italiana di Endocrinologia - Endocrinologia 2.0 - SIE Roma, Italia ITA) - n. volume 0 - pp. da 49 a 50 ISSN: - [Abstract in Atti di convegno (274) - Abstract in Atti di Convegno]
Abstract

BACKGROUND: HIV-infection is associated to an increased prevalence of erectile dysfunction (ED). In HIV-infected men ED seems to be less related to serum Testosterone (T), depending from other factors. AIM: To investigate the role of different components (organic, relational, psychological) of erectile function by using validate questionnaires in HIV-infected men with normal serum T. METHODOLOGY: Prospective, cross-sectional, observational study on eugonadal HIV-infected male patients with ongoing Highly Active Antiretroviral Therapy (HAART) attending the Clinic of Infectious Diseases. The International Index of Erectile Function (IIEF)-15, IIEF-5 and Structured Interview for Erectile Dysfunction (SIEDY) were used to assess sexual function. Sexual desire was further evaluated through a direct question during the visit. LC-MS/MS was used to assess gonadal status. RESULTS: 225 HIV-infected patients were enrolled (mean age 45.19±5.36years). SIEDY scores at appendix and scale 3 were significantly higher in patients with ED at IIEF-15 (n=136, 60.4%) compared with those without ED (p<0.001 and p=0.015, respectively). Conversely, scale 1 (p=0.448) and 2 (p=0.503) of SIEDY did not differ between patients with or without ED, suggesting a predominance of the psychological basis of ED in our cohort. The erectile function domain at IIEF-15 was directly correlated with IIEF-5 score (0.778, p<0.001). Similarly, the score at SIEDY appendix was significantly different among ED degrees at IIEF-15 (p<0.001). In particular, lower score was found in HIV-infected men without ED compared to those with mild, moderate and severe ED (p<0.001, p=0.001, and p<0.001, respectively), confirming the reliability of these tools. Sexual desire was impaired in 73 patients (31.33%) at interview with a good correlation with the specific item of IIEF-15 (p<0.001). CONCLUSIONS: The psychological component impacts in a significant manner on ED in HIV-infection context. Despite the high prevalence of comorbidities in these patients, the organic component does not affect erectile function. All the three validated questionnaires seem to be trustworthy in the diagnosis of ED in this setting.

Calcagno, A; Piconi, S; Focà, E; Nozza, S; Carli, Federica; Montrucchio, C; Cattelan, A. M; Orofino, G; Celesia, B. M; Morena, V; De Socio, G. V; Guaraldi, Giovanni ( 2017 ) - Role of Normalized T-Cell Subsets in Predicting Comorbidities in a Large Cohort of Geriatric HIV-infected Patient - JOURNAL OF ACQUIRED IMMUNE DEFICIENCY SYNDROMES - n. volume 76 - pp. da 338 a 342 ISSN: 1525-4135 [Articolo in rivista (262) - Articolo su rivista]
Abstract

Adults aging with HIV are at greater risk for several comorbidities. The CD4+ cell count and CD4+/CD8+ ratio often fail to normalize in elderly patients despite prolonged antiretroviral therapy; this has been associated with concomitant diseases and poor prognosis.

Guaraldi, Giovanni ( 2017 ) - Role of tenofovir alafenamide in the jungle of antiretroviral prescription - JOURNAL OF ANTIMICROBIAL CHEMOTHERAPY - pp. da 1 a 2 ISSN: 0305-7453 [Articolo in rivista (262) - Articolo su rivista]
Abstract

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Lionetti, Raffaella; Calvaruso, Vincenza; Piccolo, Paola; Mancusi, Rossella Letizia; Mazzarelli, Chiara; Fagiuoli, Stefano; Montalbano, Marzia; Lenci, Ilaria; Carrai, Paola; Guaraldi, Giovanni; Visco-Comandini, Ubaldo; Milana, Martina; Biolato, Marco; Loiacono, Laura; Valente, Giovanna; Craxì, Antonio; Angelico, Mario; D'Offizi, Gianpiero ( 2017 ) - Sofosbuvir plus daclatasvir with or without ribavirin is safe and effective for post-transplant hepatitis C recurrence and severe fibrosis and cirrhosis: A prospective study - CLINICAL TRANSPLANTATION [Articolo in rivista (262) - Articolo su rivista]
Abstract

In 2012, an Italian Named Patient Program began for hepatitis C virus (HCV)-infected liver transplant (LT) recipients with advanced fibrosis, before approval of direct antiviral agents (DAA), to benefit severely ill patients. The aim of this "real-life" study was to assess treatment efficacy and safety with an extended course of daclatasvir (DCV) plus sofosbuvir (SOF) with or without ribavirin (RBV).

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 ( 2017 ) - Successful Pre- and Posttransplant Sofosbuvir-Based Anti-Hepatitis C Virus Treatment in Persons Living With Human Immunodeficiency Virus Infection - OPEN FORUM INFECTIOUS DISEASES - n. volume 4 - pp. da 1 a 5 ISSN: 2328-8957 [Articolo in rivista (262) - Articolo su rivista]
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).

Gatell, José M; Assoumou, Lambert; Moyle, Graeme; Waters, Laura; Johnson, Margaret; Domingo, Pere; Fox, Julie; Martinez, Esteban; Stellbrink, Hans-Jürgen; Guaraldi, Giovanni; Masia, Mar; Gompels, Mark; De Wit, Stephane; Florence, Eric; Esser, Stefan; Raffi, François; Pozniak, Anton L ( 2017 ) - Switching from a ritonavir-boosted protease inhibitor to a dolutegravir-based regimen for maintenance of HIV viral suppression in patients with high cardiovascular risk - AIDS - n. volume 31 - pp. da 2503 a 2514 ISSN: 1473-5571 [Articolo in rivista (262) - Articolo su rivista]
Abstract

To compare the efficacy, safety, and impact on lipid fractions of switching from a ritonavir-boosted protease inhibitor (PI/r) to a dolutegravir (DTG) regimen.

De Vincentis, S.; Santi, D.; Decaroli, M.C.; Fanelli, F.; Mezzullo, M.; Fazzini, A.; Ansaloni, A.; Pagotto, U.; Guaraldi, G.; Rochira, V. ( 2017 ) - Testosterone is poorly related to erectile dysfunction in young/middle aged human immunodeficiency virus-infected men. - ENDOCRINE ABSTRACTS - n. volume 49 - pp. da 1166 a 1166 ISSN: 1479-6848 [Abstract in rivista (266) - Abstract in Rivista]
Abstract

Background human immunodeficiency virus (HIV)-infection is strongly associated to erectile dysfunction (ED) in men. Preliminary data suggests that ED is poorly associated with serum T in HIVC men. Aim To investigate in HIV-infected men the relationship between sexual function as assessed by the validated International Index of Erectile Function (IIEF-15) and T deficiency using Liquid Chromatography-tandem Mass Spectrometry (LC-MS/MS). Methodology Prospective, cross-sectional, observational study on HIV-infected male patients with ongoing Highly Active Antiretroviral Therapy (HAART), attending the Clinic of Infectious Diseases. IIEF-15 and IIEF-5 questionnaires were used to define ED, while LC-MS/MS was used for hormonal assays. Results 233 consecutive HIV-infected patients were enrolled (mean age 45.29G5.33 years). Eight patients (3.4%) had total T !300 ng/dl, while 142 patients (61.5%) had ED (score %25). Age, hormonal data and duration of HIV-infection and HAART did not differ among groups of patients according to the degree of ED. The direct comparison of each ED cluster showed that months of infection were significantly higher in men with severe ED compared to mild ED (PZ0.037). The erectile function domain at IIEF-15 was directly correlated with IIEF-5 score (0.778, P!0.001), as expected. Moreover, the IIEF-15 score was inversely related to months of infection (K0.147, PZ0.026), but not to months of HAART therapy (K0.121, PZ0.071). Conclusions To the best of our knowledge, this is the first, properly-designed prospective study aiming to investigate the relationship between erectile function and serum T, assessed by LC-MS/MS in HIV-infected men. In our cohort, i) IIEF-5 is reliable as IIEF-15 for ED diagnosis, ii) ED is not associated with serum T, iii) erectilef unction is not influenced by T and HAART, but only by HIV-infection duration. In conclusion, several specific factors, such as the duration of HIV infection, are involved in erectile function in HIV-infected men and should be carefully considered in this setting, while hormonal status seems to be less important. DOI: 10.1530/endoabs.49.EP1166

De Vincentis, S.; Santi, D.; Decaroli, M.C.; Fanelli, F.; Mezzullo, M.; Fazzini, A.; Ansaloni, A.; Pagotto, U.; Guaraldi, G.; Rochira, V. ( 2017 ) - Testosterone (T) is poorly related to erectile dysfunction (ED) in young/middle aged human immunodeficiency virus (HIV)-infected men. - Abstract Book 39° Congresso Società Italiana di Endocrinologia - Endocrinologia 2.0 - SIE Roma ITA) - n. volume 0 - pp. da 35 a 35 ISSN: - [Abstract in Atti di convegno (274) - Abstract in Atti di Convegno]
Abstract

BACKGROUND: HIV-infection is strongly associated to ED in men. Preliminary data suggests that ED is poorly associated with serum T in HIV+ men. AIM: To investigate in HIV-infected men the relationship between sexual function as assessed by the validated International Index of Erectile Function (IIEF-15) and T deficiency using Liquid Chromatography-tandem Mass Spectrometry (LC-MS/MS). METHODOLOGY: Prospective, cross-sectional, observational study on HIV-infected male patients with ongoing Highly Active Antiretroviral Therapy (HAART), attending the Clinic of Infectious Diseases. IIEF-15 and IIEF-5 questionnaires were used to define ED, while LC-MS/MS was used for hormonal assays. RESULTS: 233 consecutive HIV-infected patients were enrolled (mean age 45.29±5.33years). Eight patients (3.4%) had total T <300ng/dL, while 142 patients (61.5%) had ED (score ≤25). Age, hormonal data and duration of HIV-infection and HAART did not differ among groups of patients according to the degree of ED. The direct comparison of each ED cluster showed that months of infection were significantly higher in men with severe ED compared to mild ED (p=0.037). The erectile function domain at IIEF-15 was directly correlated with IIEF-5 score (0.778, p<0.001), as expected. Moreover, the IIEF-15 score was inversely related to months of infection (-0.147, p=0.026), but not to months of HAART therapy (-0.121, p=0.071). CONCLUSIONS: To the best of our knowledge, this is the first, properly-designed prospective study aiming to investigate the relationship between erectile function and serum T, assessed by LC-MS/MS in HIV-infected men. In our cohort, a) IIEF-5 is reliable as IIEF-15 for ED diagnosis, b) ED is not associated with serum T, c) erectile function is not influenced by T and HAART, but only by HIV-infection duration. In conclusion, several specific factors, such as the duration of HIV infection, are involved in erectile function in HIV-infected men and should be carefully considered in this setting, while hormonal status seems to be less important

Nasi, M.; De Biasi, S.; Gibellini, L.; Bianchini, E.; Pecorini, S.; Bacca, V.; Guaraldi, G.; Mussini, C.; Pinti, M.; Cossarizza, A ( 2016 ) - Ageing and inflammation in patients with HIV infection - CLINICAL AND EXPERIMENTAL IMMUNOLOGY - pp. da 1 a 9 ISSN: 0009-9104 [Articolo in rivista (262) - Articolo su rivista]
Abstract

Nowadays, HIV+ patients have an expected lifespan that is only slightly shorter than healthy individuals. For this reason, along with the fact that infection can be acquired at a relatively advanced age, the effects of ageing on HIV+ people have begun to be evident. Successful anti-viral treatment is, on one hand, responsible for the development of side effects related to drug toxicity; on the other hand, it is not able to inhibit the onset of several complications caused by persistent immune activation and chronic inflammation. Therefore, patients with a relatively advanced age, i.e. aged more than 50 years, can experience pathologies that affect much older citizens. HIV+ individuals with non-AIDS-related complications can thus come to the attention of clinicians because of the presence of neurocognitive disorders, cardiovascular diseases, metabolic syndrome, bone abnormalities and non-HIV-associated cancers. Chronic inflammation and immune activation, observed typically in elderly people and defined as 'inflammaging', can be present in HIV+ patients who experience a type of premature ageing, which affects the quality of life significantly. This relatively new condition is extremely complex, and important factors have been identified as well as the traditional behavioural risk factors, e.g. the toxicity of anti-retroviral treatments and the above-mentioned chronic inflammation leading to a functional decline and a vulnerability to injury or pathologies. Here, we discuss the role of inflammation and immune activation on the most important non-AIDS-related complications of chronic HIV infection, and the contribution of aging per se to this scenario.

Agüero, F.; Castel, M.A.; Cocchi, S.; Moreno, A.; Mestres, C.A.; Cervera, C.; Pérez-Villa, F.; Tuset, M.; Cartañà, R.; Manzardo, C.; Guaraldi, G.; Gatell, J.M.; Miró, J.M. ( 2016 ) - An update on heart transplantation in human immunodeficiency virus–infected patients - AMERICAN JOURNAL OF TRANSPLANTATION - n. volume 16 - pp. da 21 a 28 ISSN: 1600-6135 [Articolo in rivista (262) - Articolo su rivista]
Abstract

Cardiovascular diseases have become a significant cause of morbidity in patients with human immunodeficiency virus (HIV) infection. Heart transplantation (HT) is a well-established treatment of end-stage heart failure (ESHF) and is performed in selected HIV-infected patients in developed countries. Few data are available on the prognosis of HIV-infected patients undergoing HT in the era of combined antiretroviral therapy (cART) because current evidence is limited to small retrospective cohorts, case series, and case reports. Many HT centers consider HIV infection to be a contraindication for HT; however, in the era of cART, HT recipients with HIV infection seem to achieve satisfactory outcomes without developing HIV-related events. Consequently, selected HIV-infected patients with ESHF who are taking effective cART should be considered candidates for HT. The present review provides epidemiological data on ESHF in HIV-infected patients from all published experience on HT in HIV-infected patients since the beginning of the epidemic. The practical management of these patients is discussed, with emphasis on the challenging issues that must be addressed in the pretransplant (including HIV criteria) and posttransplant periods. Finally, proposals are made for future management and research priorities.

Galli, Laura; Spagnuolo, Vincenzo; Bigoloni, Alba; D'Arminio Monforte, Antonella; Montella, Francesco; Antinori, Andrea; Di Biagio, Antonio; Rusconi, Stefano; Guaraldi, Giovanni; Di Giambenedetto, Simona; Borderi, Marco; Gibellini, Davide; Caramatti, Giada; Lazzarin, Adriano; Castagna, Antonella ( 2016 ) - Atazanavir/ritonavir monotherapy: 96 week efficacy, safety and bone mineral density from the MODAt randomized trial - JOURNAL OF ANTIMICROBIAL CHEMOTHERAPY - n. volume 71 - pp. da 1637 a 1642 ISSN: 0305-7453 [Articolo in rivista (262) - Articolo su rivista]
Abstract

To report the 96 week results on efficacy, safety and bone mineral density (BMD) in subjects with HIV-1 that were virologically suppressed and treated with atazanavir/ritonavir monotherapy versus atazanavir/ritonavir triple therapy.

Caselgrandi, Agnese; Guaraldi, Giovanni; Cottafavi, Katiuscia; Artioli, Giovanna; Ferri, Paola ( 2016 ) - Clinical Research Nurse involvement to foster a community based transcultural research in RODAM European study - ACTA BIO-MEDICA DE L'ATENEO PARMENSE - n. volume 87, Suppl. 2 - pp. da 80 a 87 ISSN: 0392-4203 [Articolo in rivista (262) - Articolo su rivista]
Abstract

Background and aim of the work: The Clinical Research Nurse (CRN) can be considered the fulcrum of clinical studies, being a vital link between patient, principal investigator, study sponsor and administrative staff. The clinical research’s way is still long and the contribution that CRNs can provide is crucial. In Italy, a CRN was employed in the study: Research on Obesity & Type 2 Diabetes among African Migrants (RODAM). The aim of the paper is to explore and describe the experience of this involvement. Methods: The CRN managed the project in order to gain a complete collaboration from the Ghanaian population. From the first contact, the CRN decided to adopt a transcultural approach with the aim to create a relationship of understanding, mutual trust respect for each other’s cultural diversity. The CRN also used organizational, technical and linguistic skills. Results: The day-to-day trial management from CRN included the following activities: obtaining local Ethics Committee study approval; recruiting the study staff; planning the study activities; identifying potential study participants; collaborating with the mediators; managing contacts with other RODAM centers; conducting a follow-up of patients. The most important results of CRN involvement have been the empowerment of Ghanaian community and the effective healthcare promotion. Conclusions: The project encouraged the Ghanaian community to increase their healthcare awareness and encouraged the Ghanaian population to create new strategies to face the hard health challenges. The CRN is the most versatile and appropriate health professional to deal the entire study.

GIRARDI, ENRICO; D’ARMINIO MONFORTE, ANTONELLA; CAMONI, LAURA; PEZZOTTI, PATRIZIO; GUARALDI, GIOVANNI; AMMASSARI, ADRIANA; ANTINORI, ANDREA; BONORA, STEFANO; MUSSINI, CRISTINA; CINGOLANI, ANTONELLA; CORBELLI, GIULIO MARIA; ADAMI, SILVIA; DEGLI ESPOSTI, LUCA; ANDRETTA, MARGHERITA ( 2016 ) - Curare la malattia da HIV: ritorno al paziente? - RECENTI PROGRESSI IN MEDICINA - n. volume 107 - pp. da 1 a 26 ISSN: 2038-1840 [Articolo in rivista (262) - Articolo su rivista]
Abstract

Negli ultimi 20 anni la malattia da HIV è an-data progressivamente trasformandosi da una patologia invariabilmente letale a una condizione cronica trattabi-le, grazie alla disponibilità di terapie antiretrovirali sempre più efficaci. Un uso diffuso di queste terapie ha inoltre la potenzialità di contribuire al controllo della diffusione del contagio. È significativamente diminuita nelle persone con HIV l’incidenza di manifestazioni opportunistiche favorite dalla immunodepressione, mentre sono divenute molto più comuni patologie cronico-degenerative, come patolo-gie cardio- e cerebrovascolari, metaboliche, ossee, renali ed epatiche, legate allo stato di infiammazione cronica e all’invecchiamento della popolazione di queste persone. Nel 2030, si prevede che oltre l’80% delle persone con HIV più anziani avrà almeno una patologia cronico-degenerati-va, rispetto al 19% delle persone HIV-negative, e oltre un quarto di essi avrà tre o più patologie. Tra le persone con HIV va incrementandosi la prevalenza di una condizione di fragilità. La scelta delle strategie terapeutiche per la malat-tia da HIV quindi deve oggi essere basata non più soltanto sulla capacità dei farmaci di indurre una completa soppres-sione della replicazione virale nel breve/medio termine. Le scelte terapeutiche devono favorire l’aderenza e l’assenza di tossicità sul lungo termine, avere la capacità di ripristina-re l’omeostasi immunitaria e ridurre quindi l’infiammazione cronica e il rischio di patologie correlate, avere un impatto positivo nel tempo sulle condizioni complessive di vita del-la persona con HIV, misurato anche con indicatori quali i patient related oucomes.

Leung, Janice M.; Malagoli, Andrea; Santoro, Antonella; Besutti, Giulia; Ligabue, Guido; Scaglioni, Riccardo; Dai, Darlene; Hague, Cameron; Leipsic, Jonathon; Sin, Don D.; Man, S.F. Paul; Guaraldi, Giovanni ( 2016 ) - Emphysema distribution and diffusion capacity predict emphysema progression in human immunodeficiency virus infection - PLOS ONE - n. volume 11 - pp. da 1 a 12 ISSN: 1932-6203 [Articolo in rivista (262) - Articolo su rivista]
Abstract

Background Chronic obstructive pulmonary disease (COPD) and emphysema are common amongst patients with human immunodeficiency virus (HIV). We sought to determine the clinical factors that are associated with emphysema progression in HIV. Methods 345 HIV-infected patients enrolled in an outpatient HIV metabolic clinic with ô2 chest computed tomography scans made up the study cohort. Images were qualitatively scored for emphysema based on percentage involvement of the lung. Emphysema progression was defined as any increase in emphysema score over the study period. Univariate analyses of clinical, respiratory, and laboratory data, as well as multivariable logistic regression models, were performed to determine clinical features significantly associated with emphysema progression. Results 17.4% of the cohort were emphysema progressors. Emphysema progression was most strongly associated with having a low baseline diffusion capacity of carbon monoxide (DLCO) and having combination centrilobular and paraseptal emphysema distribution. In adjusted models, the odds ratio (OR) for emphysema progression for every 10% increase in DLCO percent predicted was 0.58 (95% confidence interval [CI] 0.41-0.81). The equivalent OR (95% CI) for centrilobular and paraseptal emphysema distribution was 10.60 (2.93-48.98). Together, these variables had an area under the curve (AUC) statistic of 0.85 for predicting emphysema progression. This was an improvement over the performance of spirometry (forced expiratory volume in 1 second to forced vital capacity ratio), which predicted emphysema progression with an AUC of only 0.65. Conclusion Combined paraseptal and centrilobular emphysema distribution and low DLCO could identify HIV patients who may experience emphysema progression.

Lonardo, Amedeo; Ballestri, Stefano; Guaraldi, Giovanni; Nascimbeni, Fabio; Romagnoli, Dante; Zona, Stefano; Targher, Giovanni ( 2016 ) - Fatty liver is associated with an increased risk of diabetes and cardiovascular disease-Evidence from three different disease models: NAFLD, HCV and HIV - WORLD JOURNAL OF GASTROENTEROLOGY - n. volume 22 - pp. da 9674 a 9693 ISSN: 1007-9327 [Articolo in rivista (262) - Articolo su rivista]
Abstract

Fatty liver, which frequently coexists with necroinflammatory and fibrotic changes, may occur in the setting of nonalcoholic fatty liver disease (NAFLD) and chronic infections due to either hepatitis C virus (HCV) or human immunodeficiency virus (HIV). These three pathologic conditions are associated with an increased prevalence and incidence of cardiovascular disease (CVD) and type 2 diabetes (T2D). In this multidisciplinary clinical review, we aim to discuss the ever-expanding wealth of clinical and epidemiological evidence supporting a key role of fatty liver in the development of T2D and CVD in patients with NAFLD and in those with HCV or HIV infections. For each of these three common diseases, the epidemiological features, pathophysiologic mechanisms and clinical implications of the presence of fatty liver in predicting the risk of incident T2D and CVD are examined in depth. Collectively, the data discussed in this updated review, which follows an innovative comparative approach, further reinforce the conclusion that the presence of fatty/inflamed/fibrotic liver might be a shared important determinant for the development of T2D and CVD in patients with NAFLD, HCV or HIV. This review may also open new avenues in the clinical and research arenas and paves the way for the planning of future, well-designed prospective and intervention studies.

Cesari, Matteo; Marzetti, Emanuele; Canevelli, Marco; Guaraldi, Giovanni ( 2016 ) - Geriatric syndromes: How to treat - VIRULENCE - n. volume 8 - pp. da 577 a 585 ISSN: 2150-5594 [Articolo in rivista (262) - Articolo su rivista]
Abstract

The survival of HIV-infected persons has been increasing over the last years, thanks to the implementation of more effective pharmacological and non-pharmacological interventions. Nevertheless, HIV-infected persons are often “biologically” older than their “chronological” age due to multiple clinical, social, and behavioral conditions of risk. The detection in this population of specific biological features and syndromic conditions typical of advanced age has made the HIV infection an interesting research model of accelerated and accentuated aging. Given such commonalities, it is possible that “biologically aged” HIV-positive persons might benefit from models of adapted and integrated care developed over the years by geriatricians for the management of their frail and complex patients. In this article, possible strategies to face the increasingly prevalent geriatric syndromes in HIV-infected persons are discussed. In particular, it is explained the importance of shifting from the traditional disease-oriented approach into models of care facilitating a multidisciplinary management of frailty.

Baroncelli, S.; Pirillo, M.F.; Amici, R.; Tamburrini, E.; Genovese, O.; Ravizza, M.; Maccabruni, A.; Masuelli, G.; Guaraldi, G.; Liuzzi, G.; Pinnetti, C.; Giacomet, V.; Degli Antoni, A.; Vimercati, A.; Dalzero, S.; Sacchi, V.; Floridia, M. ( 2016 ) - HCV-HIV coinfected pregnant women: data from a multicentre study in Italy - INFECTION - n. volume 44 - pp. da 235 a 242 ISSN: 0300-8126 [Articolo in rivista (262) - Articolo su rivista]
Abstract

PURPOSE: To provide information about main pregnancy outcomes in HIV-HCV coinfected women and about the possible interactions between HIV and HCV in this particular population. METHODS: Data from a multicenter observational study of pregnant women with HIV, conducted in Italian University and Hospital Clinics between 2001 and 2015, were used. Eligibility criteria for analysis were HCV coinfection and at least one detectable plasma HCV-RNA viral load measured during pregnancy. Qualitative variables were compared using the Chi-square or the Fisher test and quantitative variables using the Mann-Whitney U test. The Spearman's coefficient was used to evaluate correlations between quantitative variables. RESULTS: Among 105 women with positive HCV-RNA, median HCV viral load was substantially identical at the three trimesters (5.68, 5.45, and 5.86 log IU/ml, respectively), and 85.7 % of the women had at least one HCV-RNA value >5 log IU/ml. Rate of preterm delivery was 28.6 % with HCV-RNA <5 log IU/ml and 43.2 % with HCV-RNA >5log (p = 0.309). Compared to women with term delivery, women with preterm delivery had higher median HCV-RNA levels (third trimester: 6.00 vs. 5.62 log IU/ml, p = 0.037). Third trimester HIV-RNA levels were below 50 copies/ml in 47.7 % of the cases. No cases of vertical HIV transmission occurred. Rate of HCV transmission was 9.0 % and occurred only with HCV-RNA levels >5 log IU/ml. CONCLUSIONS: Coinfection with HIV and HCV has relevant consequences in pregnancy: HIV coinfection is associated with high HCV-RNA levels that might favour HCV transmission, and HCV infection might further increase the risk of preterm delivery in women with HIV. HCV/HIV coinfected women should be considered a population at high risk of adverse outcomes.

Besutti, G.; Raggi, P.; Zona, S.; Scaglioni, R.; Santoro, A.; Orlando, G.; Ligabue, G.; Leipsic, J.; Sin, D.D.; Man, S.F.P.; Guaraldi, G. ( 2016 ) - Independent association of subclinical coronary artery disease and emphysema in HIV-infected patients - HIV MEDICINE - n. volume 17 - pp. da 178 a 187 ISSN: 1464-2662 [Articolo in rivista (262) - Articolo su rivista]
Abstract

Chronic obstructive pulmonary disease (COPD) and coronary artery disease are inflammatory states with a significant clinical impact. The relationship between them has not been investigated in patients with HIV infection. We assessed the presence of subclinical emphysema and coronary artery disease using chest computed tomography (CT) imaging in a cohort of HIV-infected patients receiving antiretroviral therapy.

Santi, Daniele; Guaraldi, Giovanni; Corona, Giovanni; Rochira, Vincenzo ( 2016 ) - Is Testosterone (T) treatment safe and effective in men with HIV infection? A meta-analysis - ENDOCRINE ABSTRACTS - n. volume 41 - pp. da 718 a 718 ISSN: 1479-6848 [Abstract in rivista (266) - Abstract in Rivista]
Abstract

Background Prevalence of hypogonadism is high (30%) in men with HIV. In these patients T treatment (TT) is currently used mainly to counteract wasting syndrome and/or HIV-related lipodystrophy, irrespective of patients’ serum T. However, its effect and safety in HIV-infected men is still not completely known. Aim To investigate both beneficial and adverse effects related to TT in HIV-infected men using a meta-analytic approach. Methods An extensive MEDLINE search was performed using ‘PubMed’ with the following key-words: ‘HIV’ and: ’hypogonadism’, ‘TT’, ‘T’, ’androgens’ or ‘sex steroids’ from 1946 to April 2015. Meta-analysis included 19 placebo-controlled- clinical trials evaluating TT in HIV patients and was conducted according to PRISMA statement using RevMan. Results All 19 trials evaluated the effect of TT on body weight on a total of 952 subjects (TT group: 557; placebo group: 395). Patients’ gonadal status was often not reported and most of patients were presumably eugonadal. All data are shown as standardized mean and Confidence Interval (CI). TT significantly improved total lean body mass (1.44 [0.82–2.07], P!0.001), total body weight (0.99 [0.25–1.72], PZ0.008) and fat free mass (1.48 [0.85–2.12], P!0.001). This improvement is characterized by higher heterogeneity (I 2Z84%, 88%, and 60%, respectively). Conversely, no beneficial effects were seen on total fat mass (K0.17 [K1.58–1.25], PZ0.820). TT was associated with an increased incidence of minor adverse events (ORZ1.50[1.11–2.01], PZ0.008) and increased mean serum PSA (0.10 ng/mL, [0.03–0.17], PZ0.007). No change in hemoglobin (0.39 g/dL, [K0.29–1.07], PZ0.260) was seen. Conclusions Our study suggests that TT in HIV-infected men is effective in improving body composition (increase in lean body mass), although the incidence of general adverse events is higher than in the placebo group. However, studies show a highest variability and the real benefits of TT in HIV-infected men remains still to be established.

Baisi, A; Nava, F.; Baisi, B.; Rubbiani, E.; Guaraldi, G.; Di Benedetto, F.; Giovannoni, M.; Solazzo, A.; Bonucchi, D.; Cappelli, G. ( 2016 ) - Kidney Transplantation in HIV-Infected Recipients: Therapeutic Strategy and Outcomes in Monocentric Experience - TRANSPLANTATION PROCEEDINGS - n. volume 48 - pp. da 333 a 336 ISSN: 0041-1345 [Articolo in rivista (262) - Articolo su rivista]
Abstract

Background In Human immunodeficiency virus (HIV)-positive patients undergoing kidney transplantation, outcomes and immunosuppression (IS) protocol are not yet established due to infectious and neoplastic risks as well as to pharmacokinetic interactions with antiretroviral therapy (TARV). Methods We report a retrospective, 1-center study on 18 HIV+ patients undergoing, between October 2007 and September 2015, kidney transplantation (13 cases) or combined kidney-liver transplant (5 cases). Inclusion criteria for transplant were based on the Italian National Transplant Center protocol. IS regimen was based on quick tapering of steroids and the use of mTOR inhibitors (mTORi) with low dose of calcineurin inhibitors (CNI). In the early post-transplant period, TARV was based on enfuvirtide, raltegravir, plus 1 or more nucleoside analogues. Results In a mean follow-up of 3.1 years, patient survival rate at 1 and 3 years was, respectively, 86.6% and 84.6%, whereas graft survival was 81.2% and 78.6%. Cumulative rejection rate was 20.0% and 26.6% (1- and 3-year results). Median eGFR (MDRD) was 58.8 mL/min and 51.9 mL/min at 1 and 3 years. We had 9 cases of clinically relevant infections (2 Pneumocystis jirovecii pneumonia, 1 pulmonary aspergillosis, 2 severe sepsis, and 4 HCV reactivation) as well as 1 case (5.5%) of HIV reactivation. Conclusions IS therapy based on mTORi and low CNI dose ensures good graft survival, low rate of acute rejection, limited drug toxicity, and control of HIV disease. TARV has no significant interaction with IS therapy.

Erlandson, Kristine M; Guaraldi, Giovanni; Falutz, Julian ( 2016 ) - More than osteoporosis: Age-specific issues in bone health - CURRENT OPINION IN HIV AND AIDS - n. volume 11 - pp. da 343 a 350 ISSN: 1746-630X [Articolo in rivista (262) - Articolo su rivista]
Abstract

Purpose of review The interaction between fall and fracture risk factors is an area of increasing clinical relevance, but little information is known about the age-specific issues in bone health unique to HIV-infected adults. The present review will focus on what is known about falls and fall risk factors among HIV-infected adults, and then review the association between decreased muscle, increased adiposity, and frailty with both low bone mineral density (BMD) and falls. Recent findings The rate of falls among middle-aged HIV-infected adults is similar to that of HIV-uninfected adults 65 years and older. Many of the clinical factors that contribute to low BMD overlap with risk factors for falls, resulting in a high risk of a serious fall among older adults with the greatest risk for a fracture. Low muscle mass, increased adiposity and metabolic syndrome, physical function impairment and frailty, common among older HIV-infected adults, contribute to an increased risk for low BMD and falls, and subsequently, may increase the risk of fracture among HIV-infected older adults. Summary Interventions with dual benefit on reducing fall risk and improving BMD are likely to have the greatest impact on fracture prevention in the older, HIV-infected adult.

Guaraldi, Giovanni ( 2016 ) - Multimorbidity and burden of disease - HIV and Aging: PartII Multimorbidity and Geriatric Care of HIV - Kager Basilea CHE) - pp. da 59 a 73 ISBN: 9783318059458 ISSN: - [Contributo in volume (Capitolo o Saggio) (268) - Capitolo/Saggio]
Abstract

With effective antiretroviral therapy, HIV has become a chronic disease, and life expectancy among HIV-infected persons is approaching that of HIV-uninfected persons. Despite this success, epidemiologic evidence suggests that the burden of multiple aging-related diseases, including cardiovascular disease, liver disease, metabolic abnormalities, chronic kidney disease, cognitive dysfunction, and osteoporosis, is higher in HIV-infected persons compared to their HIV-uninfected peers. These comorbid diseases tend to cluster in a single person, leading to multimorbidity and polypharmacy. Emerging evidence suggests that multimorbidity among HIV-infected persons results in functional decline, reduced quality of life, and increased mortality. In this review, we examine the epidemiology, risk factors, etiologies, and potential consequences of multimorbidity in aging HIV-infected persons. With aggressive risk factor management for comorbidities and less toxic antiretroviral medications, the burden of multimorbidity in HIV-infected persons can be reduced

Ballestri, Stefano; Zona, Stefano; Targher, Giovanni; Romagnoli, Dante; Baldelli, Enrica; Nascimbeni, Fabio; Roverato, Alberto; Guaraldi, Giovanni; Lonardo, Amedeo ( 2016 ) - Nonalcoholic fatty liver disease is associated with an almost twofold increased risk of incident type 2 diabetes and metabolic syndrome. Evidence from a systematic review and meta-analysis - JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY - n. volume 31 - pp. da 936 a 944 ISSN: 0815-9319 [Articolo in rivista (262) - Articolo su rivista]
Abstract

Background and Aim:: The magnitude of the risk of incident type 2 diabetes (T2D) and metabolic syndrome (MetS) among patients with nonalcoholic fatty liver disease (NAFLD) is poorly known. We gauged the risk of developing T2D and MetS in patients with NAFLD diagnosed by either serum liver enzymes (aminotransferases or gamma-glutamyltransferase [GGT]) or ultrasonography. Methods:: Pertinent prospective studies were identified through extensive electronic database research, and studies fulfilling enrolment criteria were included in the meta-analysis. Results: Overall, in a pooled population of 117020 patients (from 20 studies), who were followed-up for a median period of 5years (range: 3-14.7years), NAFLD was associated with an increased risk of incident T2D with a pooled relative risk of 1.97 (95% confidence interval [CI], 1.80-2.15) for alanine aminotransferase, 1.58 (95% CI, 1.43-1.74) for aspartate aminotransferase, 1.86 (95% CI, 1.71-2.03) for GGT (last vs first quartile or quintile), and 1.86 (95% CI, 1.76-1.95) for ultrasonography, respectively. Overall, in a pooled population of 81411 patients (from eight studies) who were followed-up for a median period of 4.5years (range: 3-11years), NAFLD was associated with an increased risk of incident MetS with a pooled relative risk of 1.80 (95% CI, 1.72-1.89) for alanine aminotransferase (last vs first quartile or quintile), 1.98 (95% CI, 1.89-2.07) for GGT, and 3.22 (95% CI, 3.05-3.41) for ultrasonography, respectively. Conclusions:: Nonalcoholic fatty liver disease, as diagnosed by either liver enzymes or ultrasonography, significantly increases the risk of incident T2D and MetS over a median 5-year follow-up.

Dolci, Marco; Nascimbeni, Fabio; Romagnoli, Dante; Reggiani Bonetti, Luca; Guaraldi, Giovanni; Mascia, Maria Teresa; Lonardo, Amedeo ( 2016 ) - Nonalcoholic steatohepatitis heralding olmesartan-induced sprue-like enteropathy - DIGESTIVE AND LIVER DISEASE - n. volume 48 - pp. da 1399 a 1401 ISSN: 1590-8658 [Articolo in rivista (262) - Articolo su rivista]
Abstract

not available

Raggi, Paolo; De Francesco, Davide; Manicardi, Marcella; Zona, Stefano; Bellasi, Antonio; Stentarelli, Chiara; Carli, Federica; Beghetto, Barbara; Mussini, Cristina; Malagoli, Andrea; Guaraldi, Giovanni ( 2016 ) - Prediction of hard cardiovascular events in HIV patients - JOURNAL OF ANTIMICROBIAL CHEMOTHERAPY - n. volume 71 - pp. da 3515 a 3518 ISSN: 0305-7453 [Articolo in rivista (262) - Articolo su rivista]
Abstract

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

Floridia, Marco; Pirillo, Maria F; Antoni, Anna Degli; Molinari, Atim; Tamburrini, Enrica; Pinnetti, Carmela; Guaraldi, Giovanni; Nardini, Giulia; Masuelli, Giulia; Dalzero, Serena; Cetin, Irene; Sansone, Matilde; Amici, Roberta; Ravizza, Marina ( 2016 ) - Pregnancy outcomes and cytomegalovirus DNAemia in HIV-infected pregnant women with CMV - CLINICAL MICROBIOLOGY AND INFECTION - n. volume 22 - pp. da 818 a 820 ISSN: 1198-743X [Articolo in rivista (262) - Articolo su rivista]
Abstract

not available

Decaroli, M.C.; De Vincentis, S.; Diazzi, C.; Zona, S.; Guaraldi, G.; Santi, D.; Rochira, V. ( 2016 ) - Psychological, rather than organic and/or relational components are involved in sexual dysfunction in Young/Middle Aged Human immunodeficiency virus (HIV)-Infected Men. - Abstract-MiniPoster Book, 1, 2, 3 ...Sex - SIAMS Roma ITA) - n. volume 0 - pp. da 29 a 29 ISSN: - [Abstract in Atti di convegno (274) - Abstract in Atti di Convegno]
Abstract

BACKGROUND: HIV-infection is associated to an increased prevalence of erectile dysfunction (ED)1,2. In HIV- infected men ED seems to be less related to serum Testosterone (T)2-4, ED and sexual dysfunction mainly depending from other factors1,2. However, data on other components of sexual dysfunction in HIV are scanty2. AIM: To investigate the role of different components (organic, relational, psychological) of erectile function by using different validate questionnaire in HIV-infected men with normal serum T who are mainly homosexual (70%). METHODOLOGY: Prospective, cross-sectional, observational study on 225 eugonadal, HIV-infected male patients with ongoing Highly Active Antiretroviral Therapy (HAART) attending the Clinic of Infectious Diseases. The International Index of Erectile Function (IIEF)-15, IIEF-5 and Structured Interview for Erectile Dysfunction (SIEDY) were used for the evaluation of sexual function. Moreover, the sexual desire was further evaluated using a direct question during the visit. Statistical analysis: comparison of continue variables among groups was performed using Kruskal-Wallis test and Dunnet test for post-hoc analyses. RESULTS: 225 HIV-infected patients were enrolled (mean age 45.19±5.36 years) with average duration of HIV- infection and of HAART treatment of 187.62±101.71 and 156.38+89.81 months, respectively. Table 1 summarizes the score obtained in each item evaluated by questionnaires.The SIEDY scores obtained at appendix and scale 3 were significantly higher in patients with ED at IIEF-15 (n=136, 60.4%) compared with those without ED (appendix: 7.64+4.39 vs 4.35+3-14, p<0.001) (scale 3: 2.72+4.39 vs 2.07+1.86, p=0.015). Conversely, scale 1 (2.76+2.16 vs 2.46+2.10, p=0.448) and 2 (0.53+1.02 vs 0.61+1.47, p=0.503) of SIEDY did not differ between patients with or without ED. This suggests that the psychological basis of ED was predominant in HIV-infected men. However, when patients were grouped according to the severity of ED at IIEF-15 all SIEDY items did not differ among the 3 groups (p>0.05). The erectile function domain at IIEF-15 was directly correlated with IIEF-5 score (0.778, p<0.001). Similarly, the score at SIEDY appendix was significantly different among the ED degree found at IIEF-15 (p<0.001). In particular, lower score was found in HIV-infected men without ED compared to those with mild, moderate and severe ED (p<0.001, p=0.001, and p<0.001, respectively), confirming the reliability of these tools. Sexual desire was evaluated using IIEF-15 appropriate domain and during the interview through direct question performed by the clinician. Sexual desire was impaired in 73 patients (31.33%) at interview with a good correlation with the item of IIEF-15 on sexual desire (p<0.001). CONCLUSIONS: The psychological component of ED impacts in a significant manner on ED in men with HIV. Despite the high prevalence of comorbidities in these patients the organic component does not affect erectile function. Similarly, the relational component seems to play a not significant role probably because of the high percentage of men not in a stable relationship. All the three validated questionnaires well describe the degree of erectile dysfunction, with a good correlation index, suggesting that they are all reliable and accurate for the diagnosis of ED in this peculiar population. REFERENCES 1Zona S et al. Erectile dysfunction is more common in young to middle-aged HIV-infected men than in HIV-uninfected men. J Sex Med. 2012 Jul;9(7):1923-30. 2Santi D et al. Male sexual dysfunction and HIV--a clinical perspective. Nat Rev Urol. 2014 Feb;11(2):99-109. 3Rochira V et al. Premature decline of serum total testosterone in HIV-infected men in the HAART-era. PLoS One. 2011;6(12):e28512. 4Rochira V & Guaraldi G. Hypogonadism in the HIV-infected man. Endocrinol Metab Clin North Am. 2014 Sep;43(3):709-30.

Calcagno, A.; Montrucchio, C.; Capetti, A.; Guaraldi, G.; Cenderello, G.; Calza, L.; Lanzafame, M.; Marinaro, L.; Tettoni, M.C.; Trentini, L.; D'Avolio, A.; Di Perri, G.; Bonora, S. ( 2016 ) - Raltegravir Plus Nevirapine as Maintenance Antiretroviral Therapy in HIV-Positive Patients: Safety, Efficacy and Pharmacokinetics - CURRENT HIV RESEARCH - n. volume 14 - pp. da 54 a 60 ISSN: 1570-162X [Articolo in rivista (262) - Articolo su rivista]
Abstract

BACKGROUND: Tolerability, long-term toxicities and selection of resistant variants limit the use and efficacy of antiretroviral drugs in HIV-positive patients. Novel combinations are needed for mantaining long-term control of HIV replication; nevertheless scarse data are available on protease inhibitor-free dual antiretroviral therapies. METHODS: A multi-centric retrospective study was conducted including HIV-1-positive patients on raltegravir/nevirapine dual regimens. Plasma concentrations were measured as therapeutic drug monitoring while a subset of patients underwent intensive 12-hour pharmacokinetic evaluation. RESULTS: A total of 77 patients switching from successful regimens (76.6% male, median age 52 years) was included; 10 patients on raltegravir plus nevirapine once-daily while 67 subjects on twice-daily schedule. After a median follow-up of 32 months 69 patients (89.6%) were still successfully on treatment. Three patients discontinued for side effects (skin rash or hepatoxicity). Virological failure was observed in five patients (6.5%, 3 on once-daily schedule): in 4 patients (80%) resistance-associated mutations were observed (4 reverse transcriptase, 2 integrase). Triglycerides decreased in patients switching with lipid abnormalities (n=52) and estimated creatinine clearance increased in those with less than 60 ml/min (n=13). Median trough raltegravir and nevirapine concentrations were 83 ng/ml (32-227) and 5460 ng/ml (4037-7221); intensive 12-hours pharmacokinetic parameters (n=7) were similar to published data. CONCLUSION: Dual therapy with raltegravir/nevirapine in selected patients was highly effective over a 32-month follow up: virological failure was infrequent (6.5%), most common with once-daily schedule (60%) and often associated with the selection of resistance-associated mutations (80%). Twice-daily raltegravir plus nevirapine deserves further clinical evaluation as an NRTI- and PI-sparing strategy in selected patients.

Santi, D.; Madeo, B.; Carli, F.; Zona, S.; Brigante, G.; Vescini, F.; Guaraldi, G.; Rochira, V. ( 2016 ) - Serum total estradiol, but not testosterone is associated with reduced bone mineral density (BMD) in HIV-infected men: a cross-sectional, observational study - OSTEOPOROSIS INTERNATIONAL - n. volume 27 - pp. da 1103 a 1114 ISSN: 0937-941X [Articolo in rivista (262) - Articolo su rivista]
Abstract

By investigating the relationship between serum testosterone, estradiol, and bone mineral density (BMD) in a large cohort of HIV-infected men, estradiol was associated with BMD, relative estrogen deficiency being involved in bone loss in men with hypogonadism, in addition to all HIV-related factors. Increased aromatization in adipose tissue does not counteract HIV-related bone loss. INTRODUCTION: The purpose of this study is to evaluate the relationship between serum testosterone, estradiol, and BMD in a large cohort of HIV-infected men. METHODS: We investigated biochemical, hormonal parameters, and BMD in 1204 HIV-infected men (age 45.64 ± 7.33 years) participating in a cross-sectional, observational study. Among other parameters, the main outcome measures were serum total testosterone and estradiol, gonadotropins, 25-hydroxyvitamin D [25(OH)D], parathormone (PTH), calcium, phosphorous, femoral, and lumbar BMD. RESULTS: In men with HIV, the prevalence of osteoporosis and osteopenia is 15.1 and 63.2 % with 25(OH)D insufficiency being very common (60.1 %). After age adjustment, BMD is positively associated with estradiol, but not testosterone, at linear (p < 0.001) and stepwise (p < 0.05) multiple regression. Lumbar BMD significantly increases across the estradiol quartiles but not among testosterone quartiles. Femoral and lumbar BMD are significantly higher in men with estradiol ≥ 27 pg/mL than in those with estradiol <27 pg/mL. Apart from estradiol, only age, calcium, and BMI predict BMD at stepwise linear multiple regression, but the strength of this association is weak. CONCLUSIONS: Estradiol, but not testosterone, is associated with BMD in HIV-infected men and exerts a protective role on bone especially when it is above 27 pg/mL. Relative estrogen deficiency is a potential mechanism involved in bone loss in hypogonadal HIV-infected men, in addition to all HIV-related factors. Increased aromatization in adipose tissue does not counteract HIV-related bone loss. Finally, reduced BMD in young-to-middle-aged HIV-infected men might be considered a peculiar hallmark of HIV infection due to its relevant prevalence, representing one of the several pieces composing the complicated puzzle of premature aging related to HIV infection.

De Vincentis, S.; Santi, D.; Decaroli, M.C.; Fanelli, F.; Mezzullo, M.; Ansaloni, A.; Pagotto, U.; Guaraldi, G.; Rochira, V. ( 2016 ) - Testosterone (T) is poorly related to Erectile Dysfunction (ED) in Young/Middle Aged Human immunodeficiency virus (HIV)-Infected Men. - Abstract-MiniPoster Book, 1, 2, 3 ...Sex - SIAMS Roma ITA) - n. volume 0 - pp. da 4 a 4 ISSN: - [Abstract in Atti di convegno (274) - Abstract in Atti di Convegno]
Abstract

BACKGROUND: HIV infection is strongly associated to ED in men1,2. Preliminary data suggests that ED is poorly associated with serum T in HIV+ men1,3-4. AIM: To investigate the relationship between sexual function as assessed by the validated International Index of Erectile Function (IIEF-15) and T deficiency in HIV-infected men by assessing circulating T by Liquid Chromatography tandem Mass Spectrometry (LC-MS/MS). METHODOLOGY: Prospective, cross-sectional, observational study on 233 consecutive HIV-infected male patients with ongoing Highly Active Antiretroviral Therapy (HAART), attending the Clinic of Infectious Diseases. IIEF-15 questionnaire was used to define patients having ED (score <25), IIEF-5 was performed to check if it is reliable as IIEF-15 in this setting, while LC-MS/MS was used for hormonal assays. Statistical analysis: Continuous and categorical variables were compared using ANOVA univariate and Chi-Square test, respectively. Correlations were performed using Spearman’s Rho coefficient. RESULTS: 233 HIV-infected patients were enrolled (mean age 45.29±5.33 years) with average duration of HIV-infection of 195.98±129.54 months. Eight patients (3.4%) had hypogonadism, defined as total T serum levels below 300 ng/dL. 142 patients (61.5%) had ED (EF score ≤25) (Table 1). Age, hormonal data and duration of HIV infection and HAART did not differ among groups of patients according to the degree of ED (Table 1). Although no differences were seen among categories, the direct comparison of each ED cluster showed that months of infection were significantly higher in men with severe ED compared to mild ED (p=0.037); moreover, men with severe ED had lower T levels than men with mild form (p=0.029). All hypogonadal men had erectile dysfunction (p=0.020). However, no differences were found among ED degree for hypogonadal men (p=0.151). The erectile function domain at IIEF-15 was directly correlated with IIEF-5 score (0.778, p<0.001), as expected. Moreover, the IIEF-15 score was inversely related to months of infection (-0.147, p=0.026) (Figure 1), but not to months of HAART therapy (-0.121, p=0.071). Total T showed an inverse relation with months of infection (-0.172, p=0.009) (Figure 1) and months of HAART (-0.173, p=0.010), but not with IIEF-15 score (0.039; p=0.559). CONCLUSIONS: To the best of our knowledge, this is the first, properly-designed prospective study aiming to investigate the relationship between erectile function and serum T, assessed using the LC-MS/MS in HIV-infected men. Similarly to the IIEF-15, the IIEF-5 recognize ED patients and the scores of both correlates each other. In our cohort, the prevalence of ED and hypogonadism was 61% and 3.4%, respectively. Thus, ED evaluated by IIEF-15 seems to be not directly related to serum total T, but it correlates with age and months of infection. In conclusion, in HIV-infected patients a) IIEF-5 is reliable as IIEF- 15 for ED diagnosis, b) ED is not associated with serum T, c) erectile function is not influenced by T and HAART, but only by HIV-infection duration. In conclusion, several specific factors, such as the duration of HIV infection, are involved in erectile function in HIV-infected men and should be carefully considered in this setting, while hormonal status seems to be less important.

Núñez-Torres, Rocío; Macías, Juan; Mancebo, María; Frías, Mario; Dolci, Giovanni; Téllez, Francisco; Merino, Dolores; Merchante, Nicolás; Gómez-Mateos, Jesús; Guaraldi, Giovanni; Rivero-Juárez, Antonio; Pineda, Juan A; Real, Luis M ( 2016 ) - The PNPLA3 Genetic Variant rs738409 Influences the Progression to Cirrhosis in HIV/Hepatitis C Virus Coinfected Patients - PLOS ONE - n. volume 11 - pp. da 1 a 13 ISSN: 1932-6203 [Articolo in rivista (262) - Articolo su rivista]
Abstract

Contradictory data about the impact of the rs738409 steatosis-related polymorphism within PNPLA3 gene on liver fibrosis progression in HIV/hepatitis C virus (HIV/HCV)-coinfected patients have been reported. Our objective was to test whether this, and other polymorphisms previously related to fatty liver disease in HIV infection linked to SAMM50 or LPPR4 genes, influence liver fibrosis progression in HIV/HCV-coinfected individuals. Three hundred and thirty two HIV/HCV-coinfected patients who consecutively attended four Spanish university hospitals from November 2011 to July 2013 were included. A liver stiffness cut-off of 14.6 kPa, as determined by transient elastography, was used to diagnose cirrhosis. Liver stiffness progression was studied in 171 individuals who had two available LS determinations without anti-HCV treatment between them. Moreover, 28 HIV/HCV-coinfected patients who underwent liver transplant, as well as 19 non-cirrhotic coinfected individuals used as controls, were included in an additional study. Only rs738409 was associated with cirrhosis: 45 (29.6%) of 152 G allele carriers versus 36 (20.0%) of 180 CC carriers showed cirrhosis (multivariate p = 0.018; adjusted odds ratio = 1.98; 95% confidence interval = 1.12-3.50). Also, 21 (30.4%) of 69 G allele carriers versus 16 (15.7%) of 102 CC patients showed significant liver stiffness progression (adjusted p-value = 0.015; adjusted odds ratio = 2.89; 95% confidence interval = 1.23-6.83). Finally, the proportion of rs738409 G allele carriers was significantly higher in transplanted individuals than in controls (p = 0.044, odds ratio = 3.43; 95% confidence interval = 1.01-11.70). Our results strongly suggest that the rs738409 polymorphism is associated with liver fibrosis progression in HIV/HCV-coinfected patients.

Guaraldi, Giovanni ( 2016 ) - The transition from co-morbidities to geriatric syndromes in HIV. - GERMS - n. volume 6(3) - pp. da 79 a 81 ISSN: 2248-2997 [Articolo in rivista (262) - Articolo su rivista]
Abstract

Several recent cohort studies have suggested that life expectancy of HIV-infected individuals is currently comparable to that of the general population, particularly when antiretroviral therapy (ART) was initiated at earlier disease stages.1 Simultaneously, HIV seroconversion among older age persons is increasingly recognized, in part as the result of lower perceptions of sexual risk in older people.2 The overall effect is one of advancing age among HIV-infected persons, with a recognition that persons who age with HIV infection have an increased burden of age-related comorbid illnesses compared to persons of a similar age who were more recently HIV-infected.

De Biasi, Sara; Bianchini, Elena; Nasi, Milena; Digaetano, Margherita; Gibellini, Lara; Carnevale, Gianluca; Borghi, Vanni; Guaraldi, Giovanni; Pinti, Marcello; Mussini, Cristina; Cossarizza, Andrea ( 2016 ) - Th1 and Th17 pro-inflammatory profile characterizes iNKT cells in virologically suppressed HIV+ patients with low CD4/CD8 ratio - AIDS - n. volume 30(17) - pp. da 2599 a 2610 ISSN: 0269-9370 [Articolo in rivista (262) - Articolo su rivista]
Abstract

INTRODUCTION:: Scanty data exist on the phenotype and functionality of invariant natural killer T (iNKT) cells in HIV+ patients (pts). METHODS:: By flow cytometry, we studied iNKT cells from 54 HIV+ pts who started combined antiretroviral therapy (cART) and had undetectable viral load for >1 year. Twenty-five maintained a CD4/CD8 ratio <0.4, while 29 reached a ratio >1.1; 32 age- and sex-matched subjects were healthy controls (CTR). RESULTS:: Pts with low ratio had lower percentage of CD4+ iNKT cells compared to pts with high ratio, and higher CD8+ iNKT cell percentage; double negative (DN) iNKT cells were lower in HIV+ pts compared to CTR. Pts with low ratio had higher percentage of CD4+ and DN iNKT cells expressing CD38 and HLA-DR compared to pts with high ratio. CD4+ iNKT cells expressing PD-1 were higher in pts with CD4/CD8 ratio <0.4, while DN iNKT cells expressing PD-1 were lower compared to pts with ratio >1.1. Pts with low ratio had higher CD4+ iNKT cells producing IL-17, CD8+ iNKT cells producing IFN-γ, TNF-α or IFN-γ plus TNF-α, and DN iNKT cells producing IL-17 or IL-17 plus IFN-γ compared to CTR. Activated CD4+ (or CD8+) T cells correlated with activated CD4+ (or CD8+) iNKT cells, as well as the percentages of CD4+ (or CD8+) T cells expressing PD-1 was correlated to that of CD4+ (or CD8+) iNKT cells expressing PD-1. CONCLUSIONS:: Low CD4/CD8 ratio despite effective cART is associated with altered iNKT cell subsets, enhanced activation and prominent Th1/Th17 pro-inflammatory profile.

Campos-Varela, I.; Moreno, A.; Morbey, A.; Guaraldi, G.; Hasson, H.; Bhamidimarri, K.R.; Castells, L.; Grewal, P.; Baños, I.; Bellot, P.; Brainard, D.M.; Mchutchison, J.G.; Terrault, N.A ( 2016 ) - Treatment of severe recurrent hepatitis C after liver transplantation in HIV infected patients using sofosbuvir-based therapy - ALIMENTARY PHARMACOLOGY & THERAPEUTICS - n. volume 43 - pp. da 1319 a 1329 ISSN: 0269-2813 [Articolo in rivista (262) - Articolo su rivista]
Abstract

Background For liver transplant recipients with hepatitis C virus (HCV) and human immunodeficiency virus (HIV) co-infection, recurrence after LT is associated with a higher risk of graft loss than for HCV mono-infected patients. Prior HCV treatment options were limited by side effects and drug-drug interactions. Aim To evaluate treatment outcomes with sofosbuvir (SOF)-based therapy among HIV/HCV coinfected liver transplant recipients. Methods Access to SOF and ribavirin (RBV) prior to regulatory approval was attained via an international compassionate access program for transplant recipients with a life expectancy of 1 year or less in the absence of HCV treatment. This report focuses on the short and longer term outcomes in HCV-HIV co-infected liver transplant recipients. Results Twenty patients were treated, nine with early severe recurrence and 11 with cirrhosis. Eleven patients received SOF and RBV, one SOF, RBV and Peg-interferon, three SOF, RBV and simeprevir and five SOF, RBV and daclatasvir. Of the 18 patients who completed treatment, 16 (89%) achieved sustained virological response 12 weeks after the end of treatment (SVR12). Liver function tests (including bilirubin and albumin) improved significantly over time. Nineteen serious adverse events occurred in eight (40%) patients, none of them related to SOF. Two patients died during treatment and another, 1 year after the end of therapy, due to progressive end-stage liver disease. Importantly, HIV suppression was not compromised. No significant drug-drug interactions were reported. Conclusions Sofosbuvir-based regimens are safe, well-tolerated and provide high rates of SVR in HCV-HIV co-infected patients with severe recurrence after-liver transplant.

Guaraldi, Giovanni; Brothers, Thomas D.; Zona, Stefano; Stentarelli, Chiara; Carli, Federica; Malagoli, Andrea; Santoro, Antonella; Menozzi, Marianna; Mussi, Chiara; Mussini, Cristina; Kirkland, Susan; Falutz, Julian; Rockwood, Kenneth ( 2015 ) - A frailty index predicts survival and incident multimorbidity independent of markers of HIV disease severity - AIDS - n. volume 29 - pp. da 1633 a 1641 ISSN: 0269-9370 [Articolo in rivista (262) - Articolo su rivista]
Abstract

Objectives: Aging with HIV is associated with multisystem vulnerability that might be well characterized by frailty. We sought to construct a frailty index based on health deficit accumulation in a large HIV clinical cohort and evaluate its validity including the ability to predict mortality and incident multimorbidity. Design and methods: This is an analysis of data from the prospective Modena HIV Metabolic Clinic cohort, 2004–2014. Routine health variables were screened for potential inclusion in a frailty index. Content, construct, and criterion validity of the frailty index were assessed. Multivariable regression models were built to investigate the ability of the frailty index to predict survival and incident multimorbidity (at least two chronic disease diagnoses) after adjusting for known HIV-related and behavioral factors. Results: Two thousand, seven hundred and twenty participants (mean age 46!8; 32% women) provided 9784 study visits; 37 non-HIV-related variables were included in a frailty index. The frailty index exhibited expected characteristics and met validation criteria. Predictors of survival were frailty index (0.1 increment, adjusted hazard ratio 1.63, 95% confidence interval 1.05–2.52), current CD4þ cell count (0.48, 0.32–0.72), and injection drug use (2.51, 1.16–5.44). Predictors of incident multimorbidity were frailty index (adjusted incident rate ratio 1.98, 1.65–2.36), age (1.07, 1.05–1.09), female sex (0.61, 0.40–0.91), and current CD4þ cell count (0.71, 0.59–0.85). Conclusion: Among people aging with HIV in northern Italy, a frailty index based on deficit accumulation predicted survival and incident multimorbidity independently of HIV-related and behavioral risk factors. The frailty index holds potential value in quantifying vulnerability among people aging with HIV.

Guaraldi, Giovanni ( 2015 ) - Active HCV replication is associated with incident and prevalent type 2 diabetes in persons living with HIV. - ANTIVIRAL THERAPY - n. volume 20 - pp. da 3 a 3 ISSN: 1359-6535 [Abstract in rivista (266) - Abstract in Rivista]
Abstract

In HIV-infected individuals metabolic alterations are more prevalent and some antiretroviral drugs may favour type 2 diabetes (T2D). HCV and CMV infections have been associated with T2D in the HIV-negative population. It is not clear whether HCV replication or other factor associated with HCV-antibody + status play a role in determing T2D. We investigated whether HCV and CMV co-infections were associated with incident and prevalent T2D in HIV+ patients from the ICONA cohort

Guaraldi, Giovanni; Zona, Stefano; Brothers, Thomas D; Carli, Federica; Stentarelli, Chiara; Dolci, Giovanni; Santoro, Antonella; Beghetto, Barbara; Menozzi, Marianna; Mussini, Cristina; Falutz, Julian ( 2015 ) - Aging with HIV vs. HIV Seroconversion at Older Age: A Diverse Population with Distinct Comorbidity Profiles - PLOS ONE - n. volume 10 - pp. da 1 a 11 ISSN: 1932-6203 [Articolo in rivista (262) - Articolo su rivista]
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.

Guaraldi, Giovanni; De Francesco, D; Malagoli, Andrea; Manicardi, Marcella; Zona, Stefano; Stentarelli, Chiara; Carli, Federica; Santoro, Antonella; Raggi, P. ( 2015 ) - American College of Cardiology pooled equations and DAD algorithm to predict freedom from cardiovascular events in HIV patients - ANTIVIRAL THERAPY - n. volume 20 - pp. da 55 a 55 ISSN: 1359-6535 [Abstract in rivista (266) - Abstract in Rivista]
Abstract

A 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.

Andreoni, Massimo; Marcotullio, Simone; Puro, Vincenzo; De Carli, Gabriella; Tambussi, Giuseppe; Nozza, Silvia; Gori, Andrea; Rusconi, Stefano; Santoro, Maria Mercedes; Clementi, Massimo; Perno, Carlo Federico; d’Arminio Monforte, Antonella; Maggiolo, Franco; Castagna, Antonella; De Luca, Andrea; Galli, Massimo; Giacomelli, Andrea; Borderi, Marco; Guaraldi, Giovanni; Calcagno, Andrea; Di Perri, Giovanni; Bonora, Stefano; Mussini, Cristina; Di Biagio, Antonio; Puoti, Massimo; Bruno, Raffaele; Zuccaro, Valentina; Antinori, Andrea; Cinque, Paola; Croce, Davide; Restelli,Umberto; Rizzardini, Giuliano; Lazzarin, Adriano ( 2015 ) - An update on integrase inhibitors: new opportunities for a personalized therapy? The NEXTaim Project - NEW MICROBIOLOGICA - n. volume 38 - pp. da 443 a 490 ISSN: 1121-7138 [Articolo in rivista (262) - Articolo su rivista]
Abstract

Thanks to the development of antiretroviral agents to control HIV replication, HIV infection has turned from a fatal disease into a treatable chronic infection. The present work collects the opinions of several experts on the efficacy and safety of recently approved second generation of integrase inhibitors and, in particular, on the role of this new class of drugs in antiretroviral therapy. The availability of new therapeutic options represents an opportunity to ameliorate the efficacy of cART in controlling HIV replication also within viral reservoirs. The personalization of the treatment driven mainly by the management of comorbidities, HIV-HCV co-infections and aging, will be easier with antiretroviral drugs without drug-drug interactions and with a better toxicity and tolerability profile. Future assessment of economic impact for the introduction of new innovative drugs in the field of antiretroviral therapy will likely need some degree of adjustment of the evaluation criteria of costs and benefit which are currently based almost exclusively on morbidity and mortality.

Nasi, Milena; De Biasi, Sara; Bianchini, Elena; Digaetano, Margherita; Pinti, Marcello; Gibellini, Lara; Pecorini, Simone; Carnevale, Gianluca; Guaraldi, Giovanni; Borghi, Vanni; Mussini, Cristina; Cossarizza, Andrea ( 2015 ) - Analysis of inflammasomes and antiviral sensing components reveals decreased expression of NLRX1 in HIV-positive patients assuming efficient antiretroviral therapy - AIDS - n. volume 29(15) - pp. da 1937 a 1941 ISSN: 0269-9370 [Articolo in rivista (262) - Articolo su rivista]
Abstract

Objective: Few studies have investigated the importance of different components of the inflammasome system and of innate mitochondrial sensing (IMS) pathways in HIV infection and its treatment. We analysed the expression of several components of the inflammasome and of the IMS in HIV-positive patients taking successful combination antiretroviral therapy (cART). Methods: We enrolled 20 HIV-positive patients under cART, who achieved viral suppression since at least 10 months and 20 age and sex-matched healthy donors. By RT-PCR, using peripheral blood mononuclear cells (PBMCs), we quantified the mRNA expression of 16 genes involved in inflammasome activation and regulation (AIM2, NAIP, PYCARD, CASP1, CASP5, NLRP6, NLRP1, NLRP3, TXNIP, BCL2, NLRC4, PANX1, P2RX7, IL-18, IL-1β, SUGT1) and eight genes involved in IMS (MFN2, MFN1, cGAS, RIG-I, MAVS, NLRX1, RAB32, STING). Results: Compared with controls, HIV-positive patients showed significantly lower mRNA levels of the mitochondrial protein NLRX1, which plays a key role in regulating apoptotic cell death; main PBMC subpopulations behave in a similar manner. No differences were observed in the expression of inflammasome components, which however showed complex correlations. Conclusion: The decreased level of NLRX1 in HIV infection could suggest that the virus is able to downregulate mechanisms linked to triggering of cell death in several immune cell types. The fact that HIV-positive patients did not show altered expression of inflammasome components, nor of most genes involved in IMS, suggests that the infection and/or the chronic immune activation does not influence the transcriptional machinery of innate mechanisms able to trigger inflammation at different levels.

Manicardi, M; Guaraldi, P; Santoro, A; Lattanzi, A; Malagoli, A; Salvi, P; Grillo, A; Rossi, R; Mussini, C; Raggi, P; Cortelli, P; Guaraldi, G. ( 2015 ) - Automic Function Tests and Pulse wave velocity in HIV Disease: correlation to vascular ageing. - REVIEWS IN ANTIVIRAL EDUCATION - n. volume 9 - pp. da 29 a 29 ISSN: 1872-437X [Abstract in rivista (266) - Abstract in Rivista]
Abstract

Autonomic dysfunction is related to increased cardiovascular disease and mortality, being responsible of both subclinical coronary artery disease and cardiac arhythmias. In addition augmented sympathetic activity arises vascular constriction contributing to parietal arterial stiffness. Arterial stiffness can be assessed by measuring the velocity of the initial pulse wave propagation between two sites measured with PulsePen tonometer. We assessed whether subclinical autonomic dysfunction, as evaluated by a complete battery of autonomic function tests, correlates with pulse wave velocity change over 10 year follow up.

Shahbaz, Shima; Manicardi, Marcella; Guaraldi, Giovanni; Raggi, Paolo ( 2015 ) - Cardiovascular disease in human immunodeficiency virus infected patients: A true or perceived risk? - WORLD JOURNAL OF CARDIOLOGY - n. volume 7 - pp. da 633 a 644 ISSN: 1949-8462 [Articolo in rivista (262) - Articolo su rivista]
Abstract

After the successful introduction of highly active antiretroviral agents the survival of patients infected with the human immunodeficiency virus (HIV) in developed countries has increased substantially. This has allowed the surfacing of several chronic diseases among which cardiovascular disease (CVD) is prominent. The pathogenesis of CVD in HIV is complex and involves a combination of traditional and HIV related factors. An accurate assessment of risk of CVD in these patients is still elusive and as a consequence the most appropriate preventive and therapeutic interventions remain controversial.

Mussini, Cristina; Lorenzini, Patrizia; Cozzi-Lepri, Alessandro; Lapadula, Giuseppe; Marchetti, Giulia; Nicastri, Emanuele; Cingolani, Antonella; Lichtner, Miriam; Antinori, Andrea; Gori, Andrea; Monforte, Antonella d'Arminio; Moroni, M.; Andreoni, M.; Angarano, G.; Antinori, A.; d'Arminio Monforte, A.; Castelli, F.; Cauda, R.; Di Perri, G.; Galli, M.; Iardino, R.; Ippolito, G.; Lazzarin, A.; Perno, C. F.; von Schloesser, F.; Viale, P.; d'Arminio Monforte, A.; Antinori, A.; Castagna, A.; Ceccherini-Silberstein, F.; Cozzi-Lepri, A.; Girardi, E.; Lo Caputo, S.; Mussini, C.; Puoti, M.; Ammassari, A.; Antinori, A.; d'Arminio Monforte, A.; Balotta, C.; Bonfanti, P.; Bonora, S.; Borderi, M.; Capobianchi, M. R.; Castagna, A.; Ceccherini-Silberstein, F.; Cingolani, A.; Cinque, P.; Cozzi-Lepri, A.; d'Arminio Monforte, A.; De Luca, A.; Di Biagio, A.; Girardi, E.; Gianotti, N.; Gori, A.; Guaraldi, G.; Lapadula, G.; Lichtner, M.; Lo Caputo, S.; Madeddu, Giordano; Maggiolo, F.; Marchetti, G.; Marcotullio, S.; Monno, L.; Mussini, C.; Puoti, M.; Quiros Roldan, E.; Rusconi, S.; Saracino, A.; Cozzi-Lepri, A.; Cicconi, P.; Fanti Galli, I.; Lorenzini, P.; Tavelli, A.; Giacometti, A.; Costantini, A.; Mazzoccato, S.; Angarano, G.; Monno, L.; Santoro, C.; Maggiolo, F.; Suardi, C.; Viale, P.; Vanino, E.; Verucchi, G.; Castelli, F.; Minardi, C.; Quirino, T.; Abeli, C.; E Manconi, P.; Piano, P.; Vecchiet, J.; Falasca, K.; Sighinolfi, L.; Segala, D.; Mazzotta, F.; Lo Caputo, S.; Cassola, G.; Viscoli, C.; Alessandrini, A.; Piscopo, R.; Mazzarello, G.; Mastroianni, C.; Belvisi, V.; Caramma, I.; Chiodera, A.; Castelli, A. P.; Galli, M.; Lazzarin, A.; Rizzardini, G.; Puoti, M.; d'Arminio Monforte, A.; Ridolfo, A. L.; Piolini, R.; Castagna, A.; Salpietro, S.; Carenzi, L.; Moioli, M. C.; Tincati, C.; Marchetti, G.; Mussini, C.; Puzzolante, C.; Gori, A.; Lapadula, G.; Abrescia, N.; Chirianni, A.; Guida, M. G.; Gargiulo, M.; Baldelli, F.; Francisci, D.; Parruti, G.; Ursini, T.; Magnani, G.; Ursitti, M. A.; Andreoni, M.; Antinori, A.; Vullo, V.; Cingolani, A.; D'Avino, A.; Gallo, L.; Nicastri, E.; Acinapura, R.; Capozzi, M.; Libertone, R.; Tebano, G.; Cattelan, A.; Sasset, L.; Mura, M. S.; De Luca, A.; Rossetti, B.; Caramello, P.; Di Perri, G.; Orofino, G. C.; Bonora, S.; Sciandra, M.; Bassetti, M.; Londero, A.; Pellizzer, G.; Manfrin, V. ( 2015 ) - CD4/CD8 ratio normalisation and non-AIDS-related events in individuals with HIV who achieve viral load suppression with antiretroviral therapy: An observational cohort study - THE LANCET. HIV - n. volume 2 - pp. da 98 a 106 ISSN: 2352-3018 [Articolo in rivista (262) - Articolo su rivista]
Abstract

Background: In patients with HIV, immune reconstitution after antiretroviral therapy (ART) is often incomplete. We assessed the probability of patients reaching a CD4/CD8 ratio of 1 or more after the start of ART and its association with the onset of non-AIDS-defining events and death. Methods: We did an analysis of the ICONA cohort, which recruited treatment-naive patients with HIV in Italy. We included participants in the cohort who started ART, reached an undetectable viral load (≤80 copies per mL), and had a CD4/CD8 ratio of less than 0·8 at the time of an undetectable viral load. We defined ratio normalisation in patients as two consecutive values of 1 or more. We used Kaplan-Meier curves to estimate the cumulative probability of ratio normalisation. We then used Poisson regression models to identify factors independently associated with normalisation and with progression to non-AIDS-defining events or death. Findings: We included 3236 participants, enrolled between Jan 22, 1997, and Feb 25, 2013. At the start of ART, median CD4/CD8 ratio in our population was 0·39 (IQR 0·26-0·55). 458 (14%) patients reached a CD4/CD8 ratio of 1 or more; the estimated probability of normalisation was 4·4% (95% CI 3·7-5·2) by 1 year from baseline, 11·5% (10·2-13·0) by 2 years, and 29·4% (26·7-32·4) by 5 years. Factors associated with normalisation were high pre-ART CD4 cell counts, a high CD4/CD8 ratio at baseline, and negative cytomegalovirus serological findings. The incidence rate of non-AIDS-defining events for patients with a CD4/CD8 ratio of less than 0·30 (4·2 per 100 patient-years, 95% CI 3·4-5·3) was double that for those with a ratio of 0·30-0·45 (2·3, 2·1-2·5) or more than 0·45 (2·2, 1·7-2·9). A ratio of less than 0·30 was independently associated with an increased risk of non-AIDS-defining events or death compared with one of more than 0·45. Interpretation: Few patients had normalised CD4/CD8 ratios, even though they had viral suppression. Low ratios were associated with increased risk of serious events and deaths. The CD4/CD8 ratio could be used by clinicians to identity patients at risk of non-AIDS-related events. Funding: AbbVie, Bristol-Myers Squibb, Gilead, Janssen, Merck Sharp & Dohme, ViiV Italy.

Zona, S; Brothers, T; Malagoli, A; Menozzi, M; Carli, F; Stentarelli, C; Wallace L; Theou, O; Kirkland, S; Mussini,C; Rockwood, K; Guaraldi, G ( 2015 ) - Changes with menopause in the distribution of frailty index (FI) in HIV infected women. - REVIEWS IN ANTIVIRAL EDUCATION - n. volume 9 - pp. da 26 a 27 ISSN: 1872-437X [Abstract in rivista (266) - Abstract in Rivista]
Abstract

Menopause is a physiological aging transition associated with rapid metabolic and physical changes. The aim of this study was to describe changes with menopause in the longitudinal distributions of a frailty index in HIV infected women.

Floridia, Marco; Tamburrini, Enrica; Masuelli, Giulia; Guaraldi, Giovanni; Molinari, Atim; Cetin, Irene; Dalzero, Serena; Spinillo, Arsenio; Liuzzi, Giuseppina; Pinnetti, Carmela; Vicini, Ilaria; Castelli, Paula; Sacchi, Valentina; Ravizza, Marina ( 2015 ) - Consequences of presentation with advanced HIV disease in pregnancy: data from a national study in Italy - JOURNAL OF ACQUIRED IMMUNE DEFICIENCY SYNDROMES - n. volume 70 - pp. da 452 a 455 ISSN: 1525-4135 [Articolo in rivista (262) - Articolo su rivista]
Abstract

Among 469 women with a diagnosis of HIV in pregnancy, 74 (15.8%) presented with less than 200 CD4 cells per cubic millimeter. The only variable significantly associated with this occurrence was African origin (odds ratio: 2.22, 95% confidence intervals: 1.32 to 3.75, P = 0.003). Four women with low CD4 (5.6%), compared with none with higher CD4 counts, had severe AIDS-defining conditions (P < 0.001) during pregnancy or soon after delivery, and one transmitted HIV to the newborn. Early preterm delivery (<32 weeks) was significantly more frequent with low CD4 (6.2% vs. 1.4%, P = 0.015). An earlier access to HIV testing, particularly among immigrants of African origin, can prevent severe HIV-related morbidity.

Guaraldi, Giovanni; Malagoli, Andrea; Manicardi, Marcella; Grillo, A; Santoro, Antonella; Lattanzi, A; Rossi, Rosario; Mussini, Cristina; Raggi, P; Salvi, P. ( 2015 ) - Dissociation of aortic pulse wave velocity from risk factors for cardiovascular disease other than hypertension and age: a prospective study on frailty in HIV-infected patients. - ANTIVIRAL THERAPY - n. volume 20 - pp. da 56 a 57 ISSN: 1359-6535 [Abstract in rivista (266) - Abstract in Rivista]
Abstract

Pulse Wave Velocity (PWV) is a measure of arterial stiffness (arteriosclerosis) and vascular ageing. Both in cross-sectional and prospective studies it was a predictor of cardiovascular disease (CVD)events independent of traditional risk factors for artherosclerosis. CVD is an increasing cause of morbidity and mortality among HIV-infected patients: traditional and non-traditional risk factors are involved. We hypothesized that factors influencing PWV may measure biological ageing in these patients. Therefore we aimed to identify predictors of PWV change over time in HIV-infected patients on stable antiretroviral therapy.

Raggi, Paolo; Zona, Stefano; Scaglioni, Riccardo; Stentarelli, Chiara; Ligabue, Guido; Besutti, Giulia; Menozzi, Marianna; Santoro, Antonella; Malagoli, Andrea; Bellasi, Antonio; Guaraldi, Giovanni ( 2015 ) - Epicardial adipose tissue and coronary artery calcium predict incident myocardial infarction and death in HIV-infected patients - JOURNAL CARDIOVASCULAR COMPUTED TOMOGRAPHY - n. volume 9 - pp. da 553 a 558 ISSN: 1934-5925 [Articolo in rivista (262) - Articolo su rivista]
Abstract

Epicardial adipose tissue (EAT) and coronary artery calcium (CAC) have been associated with incident coronary artery disease (CAD) and all-cause mortality in the general population. Their prognostic impact in HIV is unknown.

Baroncelli, Silvia; Pirillo, Maria F.; Tamburrini, Enrica; Guaraldi, Giovanni; Pinnetti, Carmela; Degli Antoni, Anna; Galluzzo, Clementina M.; Stentarelli, Chiara; Amici, Roberta; Floridia, Marco ( 2015 ) - Full Viral Suppression, Low-Level Viremia, and Quantifiable Plasma HIV-RNA at the End of Pregnancy in HIV-Infected Women on Antiretroviral Treatment - AIDS RESEARCH AND HUMAN RETROVIRUSES - n. volume 31 - pp. da 673 a 678 ISSN: 0889-2229 [Articolo in rivista (262) - Articolo su rivista]
Abstract

There is limited information on full viral suppression and low-level HIV-RNA viremia in HIV-infected women at the end of pregnancy. We investigated HIV-RNA levels close to delivery in women on antiretroviral treatment in order to define rates of complete suppression, low-level viremia, and quantifiable HIV-RNA, exploring as potential determinants some clinical and viroimmunological variables. Plasma samples from a national study in Italy, collected between 2003 and 2012, were used. According to plasma HIV-RNA levels, three groups were defined: full suppression (target not detected), low-level viremia (target detected but <37 copies/ml), and quantifiable HIV-RNA (≥37 copies/ml). Multivariable logistic regression was used to define determinants of full viral suppression and of quantifiable HIV-RNA. Among 107 women evaluated at a median gestational age of 35 weeks, 90 (84.1%) had HIV-RNA <37 copies/ml. Most of them (59/90, 65.6%) had full suppression, with the remaining (31/90, 34.4%) showing low-level viremia (median: 11.9 copies/ml; IQR 7.4-16.3). Among the 17 women with quantifiable viral load, median HIV-RNA was 109 copies/ml (IQR 46-251), with only one case showing resistance (mutation M184V; rate: 9.1%). In multivariable analyses, women with higher baseline HIV-RNA levels and with hepatitis C virus (HCV) coinfection were significantly more likely to have quantifiable HIV-RNA in late pregnancy. Full viral suppression was significantly more likely with nonnucleoside reverse transcriptase inhibitor (NNRTI)-based regimens and significantly less likely with higher HIV-RNA in early pregnancy. No cases of HIV transmission occurred. In conclusion, HIV-infected pregnant women showed a high rate of viral suppression and a low resistance rate before delivery. In most cases no target HIV-RNA was detected in plasma, suggesting a low risk of subsequent virological rebound and development of resistance. Women with high levels of HIV-RNA in early pregnancy and those who have concomitant HCV infection should be considered at higher risk of having quantifiable HIV-RNA at the end of pregnancy.

Zona, S; Malagoli, A; Stentarelli, C; Mussini, C; Guaraldi, G ( 2015 ) - Health transitions in HIV-seropositive individulas undergoing NRTI-based and NRTI-sparing treatment strategies. - ANTIVIRAL THERAPY - n. volume 20 - pp. da 36 a 37 ISSN: 1359-6535 [Abstract in rivista (266) - Abstract in Rivista]
Abstract

NRTI-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.

Malagoli, Andrea; Santoro, Antonella; Besutti, Giulia; Ligabue, Guido; Guaraldi, Giovanni ( 2015 ) - HIV patients exhibit similar rates of emphysema progression observed in older HIV-uninfected patients with higher cumulative smoke exposure. - ANTIVIRAL THERAPY - n. volume 20 - pp. da 35 a 35 ISSN: 1359-6535 [Abstract in rivista (266) - Abstract in Rivista]
Abstract

HIV patients face the burden of chronic obstructive pulmonary disease (COPD). How quickly COPD phenotypes such as emphysema progress, what risk factors are associated with COPD progression in an HIV-infected population, and whether this risk of progression is in excess compared to HIV-uninfected patients are unknown.

Leung, J; Malagoli, A; Santoro, A; Besutti, G; Ligabue, G; Dai, D; Mayo, J; Lam, S; Sin, D; Man, S; Guaraldi, G ( 2015 ) - HIV patients exhibit similar rates of emphysema progression observed in older HIV-uninfected patients with higher cumulative smoke exposure. - REVIEWS IN ANTIVIRAL EDUCATION - n. volume 9 - pp. da 13 a 14 ISSN: 1872-437X [Abstract in rivista (266) - Abstract in Rivista]
Abstract

HIV patients face the burden of chronic obstructive pulmonary disease (COPD). How quickly COPD phenotypes such as emphysema progress, what risk factors are associated with COPD progression in an HIV-infected population, and whether this risk of progression is in excess compared to HIV-uninfected patients are unknown.

Ferrara, M; Malagoli, A; Garlassi, S; Stentarelli, C; Zona, S; Carli, F; Menozzi, M; Santoro, A; Raggi, P; Starace, F; Mussini, C; Guaraldi, G ( 2015 ) - HIV patients undergoing second generation antipsychotics show high cardiovascular disease burden - ANTIVIRAL THERAPY - n. volume 20 - pp. da 53 a 54 ISSN: 1359-6535 [Abstract in rivista (266) - Abstract in Rivista]
Abstract

Cardiovascular disease is highly prevalent in HIV-positive patients and can be explored with coronary artery calcium score as a biomarker of preclinical coronary disease. Antiretroviral drugs and concomitant treatment including second generation anti-psychotics may contribute to metabolic derangement with potential impact on traditional cardiovascular risk factors associated with the metabolic syndrome phenotype. The objective of the study was to assess the impact of second generation anti-psychotics on subclinical cardiovascular disease in HIV positive patients.

Malagoli, Andrea; Garlassi, Sara; Stentarelli, Chiara; Carli, Federica; Menozzi, Marianna; Santoro, Antonella; Beghetto, Barbara; Nardini, Giulia; Mussini, Cristina; Guaraldi, Giovanni ( 2015 ) - How do frailty mediate pathway leading to disability - ANTIVIRAL THERAPY - n. volume 20 - pp. da 37 a 38 ISSN: 1359-6535 [Abstract in rivista (266) - Abstract in Rivista]
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.

Cingolani, A.; Zona, S.; Girardi, E.; Cozzi-Lepri, A.; Monno, L.; Quiros Roldan, E.; Guaraldi, G.; Antinori, A.; D'Arminio Monforte, A.; Marcotullio, S. ( 2015 ) - Incidence and factors associated with the risk of sexually transmitted diseases in HIV-infected people seen for care in Italy: data from the Icona Foundation cohort - HIV MEDICINE - n. volume 16 - pp. da 412 a 420 ISSN: 1464-2662 [Articolo in rivista (262) - Articolo su rivista]
Abstract

The aims of this study were to identify temporal trends in the incidence of sexually transmitted diseases (STDs) in a cohort of HIV-infected people and to evaluate factors associated with the risk of a new STD diagnosis.

Rochira, Vincenzo; Diazzi, Chiara; Santi, Daniele; Brigante, Giulia; Ansaloni, Anna; Decaroli, Maria Chiara; De Vincentis, Sara; Stentarelli, Chiara; Zona, Stefano; Guaraldi, Giovanni ( 2015 ) - Low testosterone is associated with poor health status in men with human immunodeficiency virus infection: a retrospective study - ANDROLOGY - n. volume 3 - pp. da 298 a 308 ISSN: 2047-2919 [Articolo in rivista (262) - Articolo su rivista]
Abstract

Men with human immunodeficiency virus (HIV) infection are often hypogonadal and develop several HIV-associated non-acquired immunodeficiency syndrome (AIDS) (HANA) conditions that impair overall health status. No studies explored the relationship between health status and serum testosterone (T) in HIV-infected men. This study aims to investigate the association between total serum T and HANA, multimorbidity, and frailty in a large cohort of 1359 HIV-infected men and to explore the relationship between patients' overall health status and serum T. Among biochemical and hormonal measurement performed the main are serum total T, free triiodothyronine (fT3), and luteinizing hormone. Other outcome measurements include anthropometry, assessment of comorbidities and disabilities, overall health status defined as the number of HANA and by the 38-item multimorbidity frailty index, anthropometry, and bone mineral density. The cumulative relative risk of comorbidities is increased in HIV-infected men with hypogonadism (p < 0.001) and hypogonadism is associated with several comorbidities. The prevalence of hypogonadism increases progressively with the increase of the number of comorbidities. Frailty index is inversely related to serum total T (age-adjusted r = 0.298, r(2) = 0.089, p < 0.0001). Serum fT3 levels are significantly lower in hypogonadal than eugonadal men (p = 0.022). This suggests that low serum T could be considered a sensitive marker of frailty and poor health status and that the latter might induce hypogonadism. The more HIV-infected men are frail the more they are hypogonadal. This suggests that hypogonadism might be a naturally occurring condition in unhealthy HIV-infected men and raises concern about the safety of T treatment. In conclusion, low serum T is associated with multimorbidity, HANA, and frailty in HIV-infected men and this association seems to be bidirectional. Given the wide attitude to offer T treatment to HIV-infected men, caution is needed when prescribing T to HIV-infected male patients, especially if the patient is unhealthy or frail.

Guaraldi, Giovanni; Raggi, Paolo; Gomes, André; Zona, Stefano; Marchi, Enrico; Santoro, Antonella; Besutti, Giulia; Scaglioni, Riccardo; Ligabue, Guido; Leipsic, Jonathon; Man, Paul; Sin, Don ( 2015 ) - Lung and Heart Diseases Are Better Predicted by Pack-Years than by Smoking Status or Duration of Smoking Cessation in HIV Patients - PLOS ONE - n. volume 10 - pp. da 1 a 14 ISSN: 1932-6203 [Articolo in rivista (262) - Articolo su rivista]
Abstract

BACKGROUND: The objective of this study was to assess the relationship of pack-years smoking and time since smoking cessation with risk of lung and heart disease. METHODS: We investigated the history of lung and heart disease in 903 HIV-infected patients who had undergone thoracic computed tomography (CT) imaging stratified by smoking history. Multimorbidity lung and heart disease (MLHD) was defined as the presence of ≥ 2 clinical or subclinical lung abnormalities and at least one heart abnormality. RESULTS: Among 903 patients, 23.7% had never smoked, 28.7% were former smokers and 47.6% were current smokers. Spirometry indicated chronic obstructive pulmonary disease in 11.4% of patients and MLHD was present in 53.6%. Age, male sex, greater pack-years smoking history and smoking cessation less than 5 years earlier vs. more than 10 years earlier (OR 2.59, 95% CI 1.27-5.29, p = 0.009) were independently associated with CT detected subclinical lung and heart disease. Pack-years smoking history was more strongly associated with MLHD than smoking status (p<0.001). CONCLUSIONS: MLHD is common even among HIV-infected patients who never smoked and pack- years smoking history is a stronger predictor than current smoking status of MLHD. A detailed pack-years smoking history should be routinely obtained and smoking cessation strategies implemented

Brothers, TD; Wallace LMK; Malagoli, A; Rossi, Rosario; Manicardi, M; Santoro, A; Theou, O; Kirkland, S, Rockwood, K; Guaraldi, G ( 2015 ) - Number of Cardiometabolic disorders is associated with degree of frailty among people aging with HIV. - REVIEWS IN ANTIVIRAL EDUCATION - n. volume 9 - pp. da 3 a 4 ISSN: 1872-437X [Abstract in rivista (266) - Abstract in Rivista]
Abstract

Inflammatory cardiometabolic disorders become more common and can accumulate with age. Frailty also worsens with age and is associated with pro-inflammatory states. We sought to assess the burden of cardiometabolic disorders in a large ongoing HIV-positive cohort study, the relationship between cardiometaolic disorders and frailty, and whether they independently contribute to mortality.

Brown, Todd T.; Hoy, Jennifer; Borderi, Marco; Guaraldi, Giovanni; Renjifo, Boris; Vescini, Fabio; Yin, Michael T.; Powderly, William G. ( 2015 ) - Recommendations for evaluation and management of bone disease in HIV - CLINICAL INFECTIOUS DISEASES - n. volume 60 - pp. da 1242 a 1251 ISSN: 1058-4838 [Articolo in rivista (262) - Articolo su rivista]
Abstract

Thirty-four human immunodeficiency virus (HIV) specialists from 16 countries contributed to this project, whose primary aim was to provide guidance on the screening, diagnosis, and monitoring of bone disease in HIV-infected patients. Four clinically important questions in bone disease management were identified, and recommendations, based on literature review and expert opinion, were agreed upon. Risk of fragility fracture should be assessed primarily using the Fracture Risk Assessment Tool (FRAX), without dual-energy X-ray absorptiometry (DXA), in all HIV-infected men aged 40-49 years and HIV-infected premenopausal women aged ≥40 years. DXA should be performed in men aged ≥50 years, postmenopausal women, patients with a history of fragility fracture, patients receiving chronic glucocorticoid treatment, and patients at high risk of falls. In resource-limited settings, FRAX without bone mineral density can be substituted for DXA. Guidelines for antiretroviral therapy should be followed; adjustment should avoid tenofovir disoproxil fumarate or boosted protease inhibitors in at-risk patients. Dietary and lifestyle management strategies for high-risk patients should be employed and antiosteoporosis treatment initiated.

Bellasi, A; Ascione, E; Malagoli, Andrea; Zona, Stefano; Rubbiani, E; Carli, Federica; Stentarelli, Chiara; Mussini, Cristina; Cappelli, Gianni; Guaraldi, Giovanni ( 2015 ) - Renal hyperfiltration and outcome in HIV-infected subjects. - ANTIVIRAL THERAPY - n. volume 20 - pp. da 73 a 73 ISSN: 1359-6535 [Abstract in rivista (266) - Abstract in Rivista]
Abstract

Evidence 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.

Diazzi, C.; Brigante, G.; Guaraldi, G.; Simoni, M.; Rochira, V. ( 2015 ) - Serum gonadotropins secretion is not reduced with advancing age in HIV-infected females: results of a case–control study in menopausal women. - 17th European Congress of Endocrinology - Bioscientifica Bristol, UK GBR) - ENDOCRINE ABSTRACTS - n. volume 37 [Abstract in rivista (266) - Abstract in Rivista]
Abstract

Introduction HIV infection treated with highly active antiretroviral therapy (HAART) seems to be associated with hypogonadism in men. Less is known in HIV-infected women gonadal status. The aim of this study is to investigate gonadal function, in menopausal HIV-infected women compared sex- and age-matched healthy subjects (HS). Methods We retrospectively compared 188 HIV-infected women with 192 HS selected reviewing record charts and laboratory database respectively. We considered only women older than 50 years and we grouped them according to their age (50–54; 55–59; and O60 years). Basal serum LH, FSH, estradiol, and testosterone were measured. The FSH cut-off of 40 UI/l for establishing menopausal status. Results The percentage of subjects with FSH levels O40 UI/l was higher in HIV-infected women (67.5%) than in healthy controls (59.4%). This difference was found also in the younger subgroup (38% vs 27%). FSH serum levels in HIV-infected women (54.08G31.47 mUI/ml) did not differ (PZ0.27) from HS (50.87G 31 mUI/ml). Accordingly, no significant differences were found in LH, estradiol, and testosterone levels. Conclusions Menopause seems to occur at a younger age than HS in HIV-infected women. Moreover, differently from what was documented in HIV-infected male counterpart, HIV-infected women seem to not develop hypogonadotropic hypogonadism, but have a tendency to higher serum FSH at a younger age (!54 years) suggesting premature hypergonadotropic hypogonadism. With this in view menopause may be considered an element of the process of premature aging associated with HIV infection and its comorbidities.

Guaraldi, G; Malagoli, A; Stentarelli, C; Manicardi, M; Zona, S; Carli, F; Menozzi, M; Santoro, A; Franceschini, E; Mussini, C ( 2015 ) - Should we screen for NAFLD/NASH in HIV patients? - ANTIVIRAL THERAPY - n. volume 20 - pp. da 65 a 66 ISSN: 1359-6535 [Abstract in rivista (266) - Abstract in Rivista]
Abstract

NAFLD is expected to be the most prevalent liver disease in the post-HCV era. The clinical impact of NAFLD and the benefit of screening with biochemical based algorithms is a metter of concern.

Guaraldi, G; Torelli, R; Malagoli, A; Brothers, TL; Wallace, L; Garlassi, S; Santoro, A; Stentarelli, C; Carli, F; Sartini, S; Theou, O; Kirkland, S; Zona, S; Rockwood, K ( 2015 ) - Two methods of measuring frailty among people aging with HIV - REVIEWS IN ANTIVIRAL EDUCATION - n. volume 9 - pp. da 5 a 5 ISSN: 1872-437X [Abstract in rivista (266) - Abstract in Rivista]
Abstract

The 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.

B Di Iorio; A Bellasi; G Guaraldi ( 2014 ) - ARE ARBS THE PREFERRED AGENTS TO TREAT HYPERTENSION IN PATIENTS WITH HIVNEPHROPATHY WITH ALBUMINURIA - ACE Inhibitors - Macaulay Amechi Onuigbo Hauppauge NY USA) - n. volume 2 - pp. da 161 a 170 ISBN: 9781629484228 ISSN: - [Contributo in volume (Capitolo o Saggio) (268) - Capitolo/Saggio]
Abstract

Numerous signs of renal dysfunction such as proteinuria, crystalluria and microhematuria as well as a variety of other renal syndromes may characterize the course of HIV infection and lead to renal failure. It is estimated that approximately 1% to 2% of patients starting dialysis suffer from HIV-associated renal disease. HIV-associated nephropathy (HIVAN) occurs in about 10% of HIV-infected subjects with a distinct predilection for Blacks and Hispanic individuals. This nephropathy is characterized by glomerular basement membrane thickening, wrinkling and folding, segmental or global collapse of the glomerular tufts, increase in the Bowman space, and podocytes abnormalities. Large podocytes filled with protein droplets often accumulate in layers around the collapsed areas forming the pseudocrescents. Tubular atrophy, interstitial inflammation and different degree of fibrosis are generally associated with the glomerular damage. Until antiretroviral therapy (ART) became available, HIVAN was characterized by a rapid renal function decline and progression to end-stage renal disease. Aside from the HIV direct injury to the nephron, numerous experimental observations lend support to the notion that Angiotensin II contributes to podocytes damage and treatment with angiotensin-converting enzyme inhibitors (ACE-Is) as well as angiotensin receptor

Spagnuolo, Vincenzo; Galli, Laura; Bigoloni, Alba; Nozza, Silvia; Monforte, Antonella d'Arminio; Antinori, Andrea; Di Biagio, Antonio; Rusconi, Stefano; Guaraldi, Giovanni; Di Giambenedetto, Simona; Lazzarin, Adriano; Castagna, Antonella ( 2014 ) - Atazanavir/ritonavir monotherapy as maintenance strategy in HIV-1 treated subjects with viral suppression: 96-week analysis results of the MODAT study - JOURNAL OF THE INTERNATIONAL AIDS SOCIETY - n. volume 17 - pp. da 19806 a 19806 ISSN: 1758-2652 [Abstract in rivista (266) - Abstract in Rivista]
Abstract

The 48-week interim analysis of the MODAT study showed that confirmed virologic failure (CVF) was more frequent in patients simplifying to ATV/r monotherapy compared to maintaining ATV/r-based triple therapy. The DSMB recommended stopping study enrollment but continuing follow-up of enrolled patients. We present the 96-week efficacy analysis.

G. Sulis; I. El Hamad; M. Fabiani; S. Rusconi; F. Maggiolo; G. Guaraldi; G. Bozzi; C. Bernardini; M. Lichtner; C. Stentarelli; L. Carenzi; D. Francisci; A. Saracino; F. Castelli; The HIV/Migrants Study Group ( 2014 ) - Clinical and epidemiological features of HIV/AIDS infection among migrants at first access to healthcare services as compared to Italian patients in Italy: a retrospective multicentre study, 2000-2010. - INFECTION - n. volume 42(5) - pp. da 859 a 867 ISSN: 0300-8126 [Articolo in rivista (262) - Articolo su rivista]
Abstract

Migrants account for approximately 8.7 % of the resident population in Italy. The immigration status deeply influences access to prevention and care, thus contributing to increase the burden of HIV/AIDS among such a fragile category. The aim of this study was to investigate socio-demographic and baseline clinical and immunological features of HIV-infected migrants, as compared to Italians. We retrospectively analysed data for all the 1,611 HIV-infected migrant patients and a random sample of 4,230 HIV-infected Italian patients aged 18 or older who first accessed nine Italian clinical centres in 2000-2010 and were followed up at least 1 year. Differences in baseline characteristics between migrants and Italians were evaluated in univariate analysis, while factors associated with late presentation were evaluated in multivariate analysis using logistic regression models. The baseline profile differs between the HIV-infected migrant and Italian patients, substantially reflecting what reported by current statistics in terms of gender, age, risk category as well as clinical features. Late presenters were more frequent among migrants as compared to Italians (53.0 vs 45.8 %; adjusted odds ratio [(AOR) = 1.55, 95 % confidence interval (CI) 1.34-1.78]. Other factors associated with late presentation included increasing age, as well as undocumented legal status among foreign-born subjects (AOR = 1.41, 95 % CI 0.97-2.04), though of borderline significance. Late presentation still represents a relevant problem despite the advances in the management of HIV infection. More efforts are needed to allow early diagnosis and access to care among the most vulnerable, such as undocumented foreign-born subjects in a country where migration flows are on the rise.

TD. Brothers; S. Kirkland; G. Guaraldi; J. Falutz; O. Theou; BL. Johnston; K. Rockwood ( 2014 ) - Frailty in People Aging With Human Immunodeficiency Virus (HIV) Infection. - THE JOURNAL OF INFECTIOUS DISEASES - n. volume 210 (8) - pp. da 1170 a 1179 ISSN: 0022-1899 [Articolo in rivista (262) - Articolo su rivista]
Abstract

The increasing life spans of people infected with human immunodeficiency virus (HIV) reflect enormous treatment successes and present new challenges related to aging. Even with suppression of viral loads and immune reconstitution, HIV-positive individuals exhibit excess vulnerability to multiple health problems that are not AIDS-defining. With the accumulation of multiple health problems, it is likely that many people aging with treated HIV infection may be identified as frail. Studies of frailty in people with HIV are currently limited but suggest that frailty might be feasible and useful as an integrative marker of multisystem vulnerability, for organizing care and for comprehensively measuring the impact of illness and treatment on overall health status. This review explains how frailty has been conceptualized and measured in the general population, critically reviews emerging data on frailty in people with HIV infection, and explores how the concept of frailty might inform HIV research and care.

D. Santi; G. Brigante; C. Diazzi; S. De Vincentis; S. Zona; G. Guaraldi; M. Simoni; V. Rochira ( 2014 ) - Funzione gonadica e sessuale in uomini giovani/adulti con infezione da Human Immunodeficiency Virus (HIV) - 37° Congresso Società Italiana di Endocrinologia, XXXI Giornate Endocrinologiche Pisane Abstract Book - Società Italiana di Endocrinologia Pisa, Italy ITA) - n. volume 0 - pp. da 75 a 75 ISBN: 0000000000 ISSN: - [Abstract in Atti di convegno (274) - Abstract in Atti di Convegno]
Abstract

This study investigates male sexual function in men with HIV infection according with their gonadal status and circulating androgens

Brigante G; Diazzi C; Ansaloni A; Zirilli L; Orlando G; Guaraldi G; Rochira V. ( 2014 ) - Gender differences in GH response to GHRH+ARG in lipodystrophic patients with HIV: a key role for body fat distribution - EUROPEAN JOURNAL OF ENDOCRINOLOGY - n. volume 170 - pp. da 685 a 696 ISSN: 1479-683X [Articolo in rivista (262) - Articolo su rivista]
Abstract

OBJECTIVE: Gender influence on GH secretion in human immunodeficiency virus (HIV)-infected patients is poorly known. DESIGN AND METHODS: To determine the effect of gender, we compared GH response to GH-releasing hormone plus arginine (GHRH+Arg), and body composition in 103 men and 97 women with HIV and lipodystrophy. The main outcomes were IGF1, basal GH, GH peak and area under the curve (AUC) after GHRH+Arg, body composition, visceral adipose tissue (VAT), and subcutaneous adipose tissue (SAT). RESULTS: Men had lower GH peak and AUC than women (P<0.001). Of the study population, 21% of women and 37% of men had biochemical GH deficiency (GHD; GH peak <7.5 μg/l). VAT-to-SAT ratio was higher in men than in women with GHD (P<0.05). Unlike women, VAT, SAT, and trunk fat were greater in men with GHD than in men without GHD. IGF1 was significantly lower in women with GHD than in women without GHD, but not in men. At univariate analysis, BMI, trunk fat mass, VAT, and total adipose tissue were associated with GH peak and AUC in both sexes (P<0.05). BMI was the most significant predictive factor of GH peak, and AUC at multiregression analysis. Overall, abdominal fat had a less pronounced effect on GH in females than in males. CONCLUSIONS: These data demonstrate that GH response to GHRH+Arg is significantly lower in HIV-infected males than females, resulting in a higher percentage of GHD in men. Adipose tissue distribution more than fat mass per se seems to account for GH gender differences and for the alteration of GH-IGF1 status in these patients.

C. Diazzi; G. Brigante; G. Ferrannini; G. Guaraldi; A. Ansaloni; M. Simoni; V. Rochira ( 2014 ) - GH deficiency in HIV-infected patients compared to hypoopituitary patients - 16th European Congress of Endocrinology Endocrine Abstracts - Bioscientifica Limited:22 Apex Court, Woodlands, Bradley, Bristol BS32 4JT United Kingdom:011 44 1454 619036, EMAIL: sales@endocrinology.org, INTERNET: http://www.endocrinology.org, Fax: 011 44 1454 616071 Bristol, UK GBR) - ENDOCRINE ABSTRACTS - n. volume 35 [Abstract in rivista (266) - Abstract in Rivista]
Abstract

The difference between HIV-infected patients with growth hormone deficiency (GHD) and GHD patients with hypopituitarism is in higher values go GH peak after GHRH+Arginine and IGF-1 in men with HIV.

Brigante, Giulia; Diazzi, Chiara; Ferrannini, G.; De Vincentis, S.; Guaraldi, Giovanni; Ansaloni, Anna; Simoni, Manuela; Rochira, Vincenzo ( 2014 ) - GH deficiency in HIV-infected patients compared to hypopituitary patients - The 96th Annual Meeting of the Endocrine Society Abstracts - Bioscientifica Limited:22 Apex Court, Woodlands, Bradley, Bristol BS32 4JT United Kingdom:011 44 1454 619036, EMAIL: sales@endocrinology.org, INTERNET: http://www.endocrinology.org, Fax: 011 44 1454 616071 Bethesda GBR) - ENDOCRINE REVIEWS - n. volume 35 (03) [Abstract in rivista (266) - Abstract in Rivista]
Abstract

Gh peak after GHR+Arginine and IGF-1 are lower in HIV-infected patients with biochemical growth hormone deficiency than in patients with hypopituitarism and GHD.

D. Santi; G. Brigante; C. Diazzi; S. De Vincentis; S. Zona; G. Guaraldi; M. Simoni; V. Rochira. ( 2014 ) - Gonadal and sexual function in young/middle aged human immunodeficiency virus (HIV)-infected men - 16th European Congress of Endocrinology Endocrine Abstracts - Bioscientifica Limited:22 Apex Court, Woodlands, Bradley, Bristol BS32 4JT United Kingdom:011 44 1454 619036, EMAIL: sales@endocrinology.org, INTERNET: http://www.endocrinology.org, Fax: 011 44 1454 616071 Bristol, UK GBR) - ENDOCRINE ABSTRACTS - n. volume 35 [Abstract in rivista (266) - Abstract in Rivista]
Abstract

The study investigated male sexual function in men with HIV infection according with their gonadal status.

V. Rochira; G. Guaraldi ( 2014 ) - Hypogonadism in the HIV-infected man - ENDOCRINOLOGY AND METABOLISM CLINICS OF NORTH AMERICA - n. volume 43 - pp. da 709 a 730 ISSN: 0889-8529 [Articolo in rivista (262) - Articolo su rivista]
Abstract

Androgen deficiency occurs frequently in men with human immunodeficiency virus (HIV) infection. Antiretroviral treatments had reduced the prevalence of male hypogonadism. The pathogenesis of testosterone (T) deficiency in HIV is multifactorial. Several mechanisms have been proposed; among them, drugs, fat redistribution, and a poor health status could explain the mechanism leading to gonadotropins inhibition and hypogonadotropic hypogonadism. The diagnosis of hypogonadism in HIV-infected men should be made based on clinical symptoms and a specific workup including T measurement. The interpretation of the results of biochemical testing is more difficult in men with HIV due to several confounding factors. T treatment should be offered to HIV-infected men with documented clinical hypogonadism and symptoms, especially if they are losing lean mass.

G. Brigante; C. Diazzi; G. Ferrannini; G. Guaraldi; A. Ansaloni; M. Simoni; V. Rochira ( 2014 ) - I pazienti con infezione da HIV hanno un reale deficit di GH (GHD) ? Confronto tra pazienti HIV positivi con documentato GHD biochimico e pazienti ipopituitarici HIV negativi con GHD - 37° Congresso Società Italiana di Endocrinologia, XXXI Giornate Endocrinologiche Pisane Abstract Book - Società Italiana di Endocrinologia Pisa, Italy ITA) - n. volume 0 - pp. da 221 a 221 ISBN: 0000000000 ISSN: - [Abstract in Atti di convegno (274) - Abstract in Atti di Convegno]
Abstract

The response to GHRH+Arginine is higher in HIV-infected patients with GHD when compared to patients with GHD and hypopituitarism

G. Guaraldi; A. Santoro; C. Stentarelli; K. Luzi ( 2014 ) - Impact of Antiretroviral Medications on Fasting Lipid Parameters - REVIEWS IN CARDIOVASCULAR MEDICINE - n. volume 15 [Articolo in rivista (262) - Articolo su rivista]
Abstract

It 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.

Guaraldi G; Dolci G; Bellasi A; Di Iorio B ( 2014 ) - Inhibition of the Renin-Angiotensin System in HIV nephropathy - GIORNALE ITALIANO DI NEFROLOGIA - n. volume Jan-Feb;31(1) [Articolo in rivista (262) - Articolo su rivista]
Abstract

It is estimated that 1-2 % of patients starting dialysis suffers from kidney disease associated with HIV infection. HIV-associated nephropathy ( HIVAN ) develops in about 10% of people living with HIV , with different preference for Blacks and Hispanics . Since the beginning of large-scale use of antiretroviral therapy (ART), the HIVAN has been characterized by a rapid decline in renal function , with progression to ESRD ( End - Stage Renal Disease ). Aside from HIV direct damage to the nephron, numerous experimental observations support the argument that the agiotensina II contributes to the podocytes damage. Treatment with ACE - inhibitors (ACE - Is) , as well as the one with angiotensin receptor blockers ( ARBs), may attenuate the decline in renal function in HIVAN . However, clinical data on the effects of these antihypertensive agents in HIV-infected individuals are still scarce and doubts have yet to be adequately addressed. In the following, we analyze the studies that have investigated the use of ACE -Is and ARBs in the treatment of hypertension and albuminuria in patients with HIVAN.

Antonio Bellasi; Paolo Raggi; Rosario Rossi; Vincenzo Rochira; Chiara Stentarelli; Stefano Zona; Antonella Lattanzi; Federica Carli; Cristina Mussini; Giovanni Guaraldi ( 2014 ) - Intact parathyroid hormone levels are associated with increased carotid intima media thickness in HIV infected patients - ATHEROSCLEROSIS - n. volume 237 - pp. da 618 a 622 ISSN: 0021-9150 [Articolo in rivista (262) - Articolo su rivista]
Abstract

Aim. Preliminary evidence suggests that intact parathyroid hormone (iPTH) and bone mineral abnormalities may contribute to the development of vascular disease and are associated with reduced survival in the general population. Whether iPTH is associated with subclinical atherosclerosis in HIV-infected individuals has not been elucidated. Methods. Cross-sectional study of 470 consecutive HIV-infected patients in whom we measured carotid intima-media thickness (cIMT), and collected demographical, clinical and laboratory data. High-cIMT was defined as a mean IMT above the 75th percentile for the study cohort. Parametric, non-parametric tests and logistic regression analyses were used to compare patients' characteristics between low- and high-cIMT and to test the association between high-cIMT and log-transformed iPTH. Results. Of the 470 patients, 130 had high-cIMT. High-cIMT subjects were older and more likely to be male and have a history of cardiovascular disease. Glucose, lipid and iPTH levels were lower among low-cIMT subjects (p < 0.05). Unadjusted and multivariable adjusted analyses demonstrated an independent association between high-cIMT and iPTH (fully adjusted OR: 1.74; 95%CI: 1.08–2.79; p = 0.021). Bootstrap and sensitivity analyses confirmed these findings. Conclusions. Elevated iPTH was associated with subclinical atherosclerosis in HIV-infected subjects. Of note this association was statistically significant even for iPTH values within the range of normality. The existence of a causal relationship between iPTH and atherosclerosis needs to be fully explored in future investigations.

Floridia M; Guaraldi G; Ravizza M; Tibaldi C; Pinnetti C; Maccabruni A; Molinari A; Liuzzi G; Alberico S; Meloni A; Rizzi L; Dalzero S; Tamburrini E. ( 2014 ) - Is "Option B+" Also Being Adopted in Pregnant Women in High-Income Countries? Temporal Trends From a National Study in Italy. - CLINICAL INFECTIOUS DISEASES - n. volume 60 - pp. da 159 a 161 ISSN: 1058-4838 [Articolo in rivista (262) - Articolo su rivista]
Abstract

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G. Guaraldi; A. Cossarizza; C. Franceschi; A. Roverato; E. Vaccher; G. Tambussi; E. Garlassi; M. Menozzi; C. Mussini; A. DʼArminio Monforte ( 2014 ) - Life Expectancy in the Immune Recovery Era - JOURNAL OF ACQUIRED IMMUNE DEFICIENCY SYNDROMES - n. volume 65 (2) - pp. da 175 a 181 ISSN: 1525-4135 [Articolo in rivista (262) - Articolo su rivista]
Abstract

INTRODUCTION: National cohort and intercohort studies have been set to describe the differences of life expectancy (LE) of HIV-infected individuals. OBJECTIVE: The aim of this study was to assess the impact of immune recovery (IR) on LE of patients with HIV undergoing combination antiretroviral therapy. METHODS: In this retrospective observational study, outcome measure was LE of patients with HIV compared with LE of northern Italian population. Group categorizations were as follows: patients with no immune recovery (nIR), patients with IR, patients who are immune maintained, and pre-highly active antiretroviral therapy (HAART) and post-HAART. Abridged life tables were constructed from age-specific mortality rates (per 1000 person years) to estimate LE from the age of 20-55 years. RESULTS: A total of 9671 patients, 71% men, were included. After 2005, we assisted to a rapid increase in the overall rate of patients attaining IR in the community coupled with a progressive decrease of AIDS death, but not of non-AIDS deaths. In a 40-year-old patient, LE was 38.10 years [standard error (SE) = 2.60], 30.08 years (SE = 0.98), and 22.9 (SE = 0.69) in the IR, post-HAART group and nIR, respectively, compared with 41.38 years of the general Italian population. An approximately 5-year gap in LE was observed in IR patients. DISCUSSION: We describe IR at a "community" level, related to calendar year and apparent 10 years after HAART introduction. HAART community IR is significantly influencing LE and is associated with the changing clinical picture of HIV disease. An increasing gradient of LE exists between nIR, post-HAART, and IR groups, with the latter, above the age of 40 years only, reaching LE of general population.

Santi D; Brigante G; Zona S; Guaraldi G; Rochira V ( 2014 ) - Male sexual dysfunction and HIV--a clinical perspective. - NATURE REVIEWS. UROLOGY - n. volume 11 - pp. da 99 a 109 ISSN: 1759-4812 [Articolo in rivista (262) - Articolo su rivista]
Abstract

Sexual dysfunction in men with HIV is often overlooked by clinicians owing to many factors, including the taboo of sexuality. The improved life expectancy of patients with HIV requires physicians to consider their general wellbeing and sexual health with a renewed interest. However, data on sexual dysfunction in those with HIV are scarce. Erectile dysfunction (ED) is the most common sexual dysfunction in men, with a prevalence of ∼30-50% and is frequent even in men <40 years of age. HIV infection itself is the strongest predictor of ED, and many factors related to the infection-fear of virus transmission, changes in body image, HIV-related comorbidities, infection stigma, obligatory condom use-all impair erectile function. The diagnosis and treatment of sexual dysfunction is based on a multidisciplinary approach, which involves specialists in both infectious diseases and sexual medicine. Particular attention should be paid to the promotion of safer sex in these patients. This Review, describes the issues surrounding sexual dysfunction in men with HIV and aims to provide clinical advice for the physician treating these patients.

G. Guaraldi; C. Stentarelli; A.D. Da Silva; K. Luzi; I. Neri; M. Cellini; E. Petrella; E. Garlassi; M. Menozzi; F. Facchinetti; C. Mussini ( 2014 ) - Metabolic alterations in HIV-infected pregnant women: moving to metabolic tailoring of antiretroviral drugs. - AIDS REVIEWS - n. volume Jan-Mar;16(1) - pp. da 14 a 22 ISSN: 1139-6121 [Articolo in rivista (262) - Articolo su rivista]
Abstract

The 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.

G. Guaraldi; M. Prakash; C. Moecklinghoff; HJ. Stellbrink ( 2014 ) - Morbidity in Older HIV-Infected Patients: Impact of Long-Term Antiretroviral Use. - AIDS REVIEWS - n. volume 16(2) - pp. da 75 a 89 ISSN: 1139-6121 [Articolo in rivista (262) - Articolo su rivista]
Abstract

The introduction of HAART has represented a major advance in the care of people with HIV. By markedly increasing life expectancy, HAART has significantly changed the pattern of HIV infection in developed countries, the "graying" of the HIV-infected population being a powerful testament to its success. However, this has presented physicians with new challenges relating to the care of older patients with HIV, many of whom exhibit a "frailty syndrome" associated with increased comorbidity and chronic low-grade inflammation in a process which has recently been termed "inflammaging". This paper reviews the pattern of morbidity seen in older HIV-infected patients and examines the effects, both beneficial and deleterious, of antiretroviral therapy. The efficacy and tolerability of antiretroviral therapy is of particular importance in older patients, given the likelihood that increased frailty may magnify the consequences both of suboptimal viral suppression and of toxicity, and in view of the complications that may arise from the presence of comorbidities and resultant polypharmacy. The challenge is to maximize antiviral efficacy and minimize toxicity, while taking into account the often complex web of comorbidities that may be present in these patients. This challenge is being met through the refinement of existing antiretroviral therapy regimens, the development of new agents, and a growing focus on a more holistic approach to care, which acknowledges the importance of the overall "health picture" and of good communication and cooperation between treating physicians and patients.

G. Guaraldi; A.R. Silva; C. Stentarelli ( 2014 ) - Multimorbidity and functional status assessment - CURRENT OPINION IN HIV AND AIDS - n. volume 9(4) - pp. da 386 a 397 ISSN: 1746-630X [Articolo in rivista (262) - Articolo su rivista]
Abstract

Purpose 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.

M. Floridia;C. Pinnetti;M. Ravizza;V. Frisina;I. Cetin;M. Fiscon;M. Sansone;A. Degli Antoni;G. Guaraldi;A. Vimercati;B. Guerra;G. Placido;S. Dalzero;E. Tamburrini ( 2014 ) - Rate, Predictors, and Consequences of Late Antenatal Booking in a National Cohort Study of Pregnant Women With HIV in Italy - HIV CLINICAL TRIALS - n. volume 15 - pp. da 104 a 115 ISSN: 1528-4336 [Articolo in rivista (262) - Articolo su rivista]
Abstract

To evaluate the prevalence and consequences of late antenatal booking (13 or more weeks gestation) in a national observational study of pregnant women with HIV. Methods: The clinical and demographic characteristics associated with late booking were evaluated in univariate analyses using the Mann-Whitney U test for quantitative data and the chi-square test for categorical data. The associations that were found were re-evaluated in multivariable logistic regression models. Main outcomes were preterm delivery, low birthweight, nonelective cesarean section, birth defects, undetectable (<50 copies/mL) HIV plasma viral load at third trimester, delivery complications, and gender-adjusted and gestational age-adjusted Z scores for birthweight. Results: Rate of late booking among 1,643 pregnancies was 32.9%. This condition was associated with younger age, African provenance, diagnosis of HIV during pregnancy, and less antiretroviral exposure. Undetectable HIV RNA at third trimester and preterm delivery were significantly more prevalent with earlier booking (67.1% vs 46.3%, P < .001, and 23.2% vs 17.6, P = .010, respectively), whereas complications of delivery were more common with late booking (8.2% vs 5.0%, P = .013). Multivariable analyses confirmed an independent role of late booking in predicting detectable HIV RNA at third trimester (adjusted odds ratio [AOR], 1.7; 95% CI, 1.3-2.3; P < .001) and delivery complications (AOR, 1.8; 95% CI, 1.2-2.8; P = .005). Conclusions: Late antenatal booking was associated with detectable HIV RNA in late pregnancy and with complications of delivery. Measures should be taken to ensure an earlier entry into antenatal care, particularly for African women, and to facilitate access to counselling and antenatal services. These measures can significantly improve pregnancy management and reduce morbidity and complications in pregnant women with HIV.

Armignacco, Orlando; Andreoni, Massimo; Sagnelli, Evangelista; Puoti, Massimo; Bruno, Raffaele; Gaeta, Giovanni Battista; Perno, Carlo F; Santantonio, Teresa A; Bonfanti, Paolo; Bonora, Stefano; Borderi, Marco; Castagna, Antonella; d'Arminio Monforte, Antonella; De Luca, Andrea; Grossi, Paolo; Guaraldi, Giovanni; Maggiolo, Franco; Mussini, Cristina; Sagnelli, Caterina; Tavio, Marcello; Torti, Carlo; Uberti Foppa, Caterina; Andreoni, Massimo; Angarano, Gioacchino; Antinori, Andrea; Armignacco, Orlando; Carosi, Giampiero; Chirianni, Antonio; Di Perri, Giovanni; Galli, Massimo; Lazzarin, Adriano; Rizzardini, Giuliano; Sagnelli, Evangelista; Taliani, Gloria ( 2014 ) - Recommendations for the use of hepatitis C virus protease inhibitors for the treatment of chronic hepatitis C in HIV-infected persons. A position paper of the Italian Association for the Study of Infectious and Tropical Disease - NEW MICROBIOLOGICA - n. volume 37 - pp. da 423 a 438 ISSN: 1121-7138 [Articolo in rivista (262) - Articolo su rivista]
Abstract

The efficacy data obtained with boceprevir and telaprevir for persons with hepatitis C virus (HCV) genotype 1 infection raise the question of whether HCV protease inhibitors should be used in human immunodeficiency virus (HIV)/HCV co-infected persons. The Italian Association for the Study of Infectious and Tropical Diseases has made these recommendations to provide the rationale and practical indications for the use of triple anti-HCV therapy in persons living with HIV (PLWHIV). A Writing Committee of experts indicated by the President of the Association and a Consulting Committee con- tributed to the document. The final draft was submitted to the evaluation of external experts and the text modified according to their suggestions and comments. Treatment of HCV co-infection should be considered for all HCV RNA positive PLWHIV. Response-guided therapy with pegylated interferon and ribavirin is the standard treatment of PLWHIV with infection by HCV genotype 2, 3, 4, 5 and 6. Boceprevir and telaprevir should be used to treat HCV genotype 1 infection in HIV/HCV co-infected patients for 48 weeks on an individual basis, with close monitoring of their efficacy and tolerability with concur- rent antiretroviral therapy, taking into account potential drug-drug interactions. The decision to treat a patient or to wait for better treatment options, or to discontinue treatment should be made on an individual basis taking into account pre-treatment variables and the on-treatment HCV RNA kinetics.

R. Bucciardini; K. Pugliese; L. Weimer; M. Digregorio; V. Fragola; M. Mancini; Z. Maroccia; N. Ladisa; D. Francisci; R. Bellagamba; A. Degli Antoni; G. Guaraldi; O. Cirioni; F. Ortu; G. Parruti; M. Mannazzu; R. Libertone; S. Donnini; M. Floridia ( 2014 ) - Relationship Between Health-Related Quality of Life Measures and High HIV Viral Load in HIV-Infected Triple-Class-Experienced Patients - HIV CLINICAL TRIALS - n. volume 15 - pp. da 176 a 183 ISSN: 1528-4336 [Articolo in rivista (262) - Articolo su rivista]
Abstract

BACKGROUND: Health-related quality of life (HRQoL) has been recognized as a central measure of the overall health status in HIV patients. With the availability of different highly effective drug combinations, maximizing quality-adjusted survival has become a major target of HIV treatment. Although the association of HIV RNA and CD4 cell count with clinical HIV progression has been well established, the relation between these markers and HRQoL measures is still unclear. METHOD: This cross-sectional study investigated the relationship linking HIV RNA and CD4 to HRQoL measures in 181 triple-class-experienced patients with advanced HIV disease. The instrument used was the ISSQoL, a self-administered and HIV-specific HRQoL questionnaire. RESULTS: Data showed no correlation between HRQoL measures and CD4 counts. Higher HIV RNA levels were, however, associated with poor HRQoL scores in 3 out of 9 scales of social functioning, depression and anxiety, and satisfaction with quality of life. In multivariable analyses, only the satisfaction with quality of life mean score remained significantly lower for the HIV RNA ≯100,000 copies/mL group compared to the HIV RNA 50 to 10,000 copies/mL group. CONCLUSIONS: Although other determinants of HRQoL in people with HIV should also be considered, this finding suggests a negative impact of high viral load on perceived HRQoL that adds to other described determinants of lower quality of life in people with HIV, such as lower social support and self-reported symptoms.

Vincenzo Rochira; Chiara Diazzi; Giulia Brigante; Daniele Santi; Maria Chiara De Caroli; Sara De Vincentis; Manuela Simoni; Cesare Carani; Giovanni Guaraldi ( 2014 ) - Relationship between testosterone and HIV-related comorbidities: secondary hypogonadism is associated with a poor health status in HIV-infected men - Abstract Book - XI Congresso Nazionale della Società Italiana di Andrologia e Medicina della Sessualità - FASI Roma ITA) - n. volume 0 - pp. da 0 a 0 ISBN: 0000000000 ISSN: - [Abstract in Atti di convegno (274) - Abstract in Atti di Convegno]
Abstract

ABSTRACT INTRODUCTION: Testosterone (T) deficiency is very common in men with Human Immunodeficiency Virus (HIV), and it is more often associated with inappropriately low/normal luteinizing hormone (LH). However, the underlying causes remain poorly understood. Moreover, the role of HIV and/or HIV infection treatments, as well as the role of the general health status on the gonadal axis have been rarely investigated. AIM: The aim of this study is to evaluate the association between gonadal function and health status in men with HIV infection. METHODS: We performed a cross-sectional, observational study on 1359 consecutive HIV male outpatients. Morning serum Total T (TT), LH, estradiol, HIV parameters were measured. Frailty Index and number of comorbidities were extracted from the Clinical Database in which all patients data are recorded. TT<300 ng/dL was used as the threshold for biochemical T deficiency. RESULTS: T deficiency was found in 212 subjects (15.6%), and most of them (n=183; 13.4%) had secondary hypogonadism. TT resulted inversely related to Frailty Index in all patients (r=0.302, r2=0.091), this correlation being strengthened in HIV- infected men with secondary hypogonadism (r=0.403, r2=0.162). The percentage of HIVinfected men with TT <300 ng/dL increased progressively in accordance with the increase in the number of comorbidities (0.5%, 2.8%, 8.5%, 22.7%, 25.5%, 40% in men with 0, 1, 2, 3, 4, and >5 comorbidities, respectively). CONCLUSION: Poor health status in HIV-infected men might be involved in the pathogenesis of hypogonadism. This mechanism could reflect an adaptive response to illness in unhealthy patients similarly to what happens in other clinical conditions such as anorexia nervosa. Thus, low TT could be considered a biomarker of frailty and might confer an advantage for both the sick patients (in terms of sparing energy) and the species (preventing fatherhood). Furthermore, frailty related hypogonadism could be part of the process of premature aging already demonstrated in HIVinfected patients.

G. Guaraldi; S. Zona; A. Cossarizza; L. Vernacotola; F. Carli; A. Lattanzi; G. Nardini; G. Orlando; E. Garlassi; R. Termini; M. Garau ( 2014 ) - Switching to darunavir/ritonavir monotherapy vs. triple-therapy on body fat redistribution and bone mass in HIV-infected adults: Monarch randomized controlled trial - INTERNATIONAL JOURNAL OF STD & AIDS - n. volume Mar;25(3) - pp. da 207 a 212 ISSN: 0956-4624 [Articolo in rivista (262) - Articolo su rivista]
Abstract

BackgroundChanges in body fat distribution and bone mass in HIV-infected patients may be associated with long-term use of nucleoside analogues.MethodsThe Monarch trial recruited 30 patients receiving non-nucleoside reverse transcriptase inhibitor or protease inhibitor-based highly active antiretroviral therapy, with HIV RNA <40 copies/mL. Patients were randomized to either darunavir/ritonavir 800/100 mg once daily monotherapy or darunavir/ritonavir 800/100 mg once daily + 2NRTIs. Bone mass, peripheral lipoatrophy and central fat accumulation were assessed using dual-energy X-ray absorptiometry scanning, supplemented by computed tomography scans.ResultsMedian age was 43 years, 77% were males. Visceral adipose tissue remained stable from baseline to Week 48 in the whole group (p = 0.261) with no significant difference between arms (p = 0.56). There was a significant reduction in insulin resistance (HOMA-IR, p = 0.013) over 48 weeks in the whole group, but not of body mass index (p = 0.24). In the darunavir/ritonavir monotherapy arm, there was a small but significant increase in both lumbar and femur bone mineral density at 48 weeks and was observed after correction for baseline values. The absolute change in lumbar bone mineral density at 48 weeks was more pronounced in the darunavir/ritonavir arm compared with the darunavir/ritonavir + 2NRTIs arm.ConclusionsIn this study, discontinuing nucleoside analogues and switching to darunavir/ritonavir monotherapy was associated with a small but statistically significant increase in bone mineral density, but stable levels of limb fat and visceral adipose tissue.

G. Guaraldi; G. Besutti; R. Scaglioni; A. Santoro; S. Zona; G.Ligabue; A. Marchioni; G. Orlando; F. Carli; B. Beghe; L. Fabbri; J. Leipsic;D. Don Sin; S. F. P. Man ( 2014 ) - The Burden of Image Based Emphysema and Bronchiolitis in HIV-Infected Individuals on Antiretroviral Therapy - PLOS ONE - n. volume 9 [Articolo in rivista (262) - Articolo su rivista]
Abstract

Abstract Background: With the widespread use of anti-retroviral therapy (ART), individuals infected with human immune deficiency virus (HIV) are increasingly experiencing morbidity and mortality from respiratory disorders. However, the prevalence or the risk factors associated with emphysema and bronchiolitis are largely unknown. Methods: Thoracic computed tomography (CT) scans were performed in 1,446 patients infected with HIV who were on ART and who attended a tertiary care metabolic clinic (average age 48 years and 29% females). Detailed history and physical examination including anthropometric measurements were performed. Complete pulmonary function tests were performed in a subset of these patients (n = 364). No subjects were acutely ill with a respiratory condition at the time of CT scanning. Findings: Nearly 50% of the subjects had CT evidence for emphysema, bronchiolitis or both with 13% (n = 195) showing bronchiolitis, 19% (n = 274) showing emphysema and 16% (n = 238) revealing both. These phenotypes were synergistically associated with reduced regular physical activity (p for interaction ,.0001). The most significant risk factors for both phenotypes were cigarette smoking, intravenous drug use and peripheral leucocytosis. Together, the area-under-the curve statistics was 0.713 (p = 0.0037) for discriminating those with and without these phenotypes. There were no significant changes in lung volumes or flow rates related to these phenotypes, though the carbon monoxide diffusion capacity was reduced for the emphysema phenotype. Interpretation: Emphysema and bronchiolitis are extremely common in HIV-infected patients who are treated with ART and can be identified by use of thoracic CT scanning.

G. Guaraldi; C. Stentarelli; S. Zona; A. Santoro; B. Beghetto; F. Carli; G. Orlando; A. Franceschetto; A. Casolo; C. Mussini ( 2014 ) - The natural history of HIV-associated lipodystrophy in the changing scenario of HIV infection - HIV MEDICINE - n. volume 15(10) - pp. da 587 a 594 ISSN: 1464-2662 [Articolo in rivista (262) - Articolo su rivista]
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.

G. Guaraldi; R. Scaglioni; S. Zona; G. Orlando; F. Carli; G. Ligabue; G. Besutti; M. Menozzi; A. Santoro; B. Beghetto; C. Mussini; P. Raggi ( 2013 ) - Associatioin of epicardial adipose tissue with incident coronary heart disease and death in HIV infected patients. - Programme & Abstracts - International Mediacl Press London GBR) - ANTIVIRAL THERAPY - n. volume 18 [Abstract in rivista (266) - Abstract in Rivista]
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.

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;G. Guaraldi;G. Nardini;C. Stentarelli;B. Beghetto;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 ( 2013 ) - Atazanavir and lopinavir profile in pregnant women with HIV: tolerability, activity and pregnancy outcomes in an observational national study - JOURNAL OF ANTIMICROBIAL CHEMOTHERAPY - n. volume 69 (5) - pp. da 1377 a 1384 ISSN: 0305-7453 [Articolo in rivista (262) - Articolo su rivista]
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.

M., Floridia; M., Ravizza; G., Masuelli; S., Dalzero; C., Pinnetti; I., Cetin; A., Meloni; A., Spinillo; E., Rubino; D., Francisci; E., Tamburrini; M., Floridia; 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; 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; K., Luzi; Nardini, Giulia; Stentarelli, Chiara; 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; S., Alberico; G., Maso; M., Tropea; A., Meloni; M., Dedoni; C., Cuboni; F., Ortu; P., Piano; A., Citernesi; I., Vicini; 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; S., Garetto; I., Cetin; T., Brambilla; V., Savasi; A., Crepaldi; 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; M., Anceschi; 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; P., Villani; M., Cusato; A., Cerioli; M., De Martino; P., Mastroiacovo; M., Moroni; F., Parazzini; E., Tamburrini; S., Vella; P., Martinelli ( 2013 ) - Body Mass Index and Weight Gain in Pregnant Women With HIV: A National Study in Italy - CLINICAL INFECTIOUS DISEASES - n. volume 56 - pp. da 1190 a 1193 ISSN: 1058-4838 [Articolo in rivista (262) - Articolo su rivista]
Abstract

not available

Giovanni Guaraldi;Kety Luzi;Giusi Maria Bellistrì;Stefano Zona;Ana Rita Domingues da Silva;Francesca Bai;Elisa Garlassi;Giulia Marchetti;Jacqueline Capeau;Antonella d’Arminio Monforte ( 2013 ) - CD8 T-Cell Activation Is Associated With Lipodystrophy and Visceral Fat Accumulation in Antiretroviral Therapy–Treated Virologically Suppressed HIV-Infected Patients - JOURNAL OF ACQUIRED IMMUNE DEFICIENCY SYNDROMES - n. volume 64 - pp. da 360 a 366 ISSN: 1525-4135 [Articolo in rivista (262) - Articolo su rivista]
Abstract

OBJECTIVE.: 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.

G. Guaraldi; C. Puzzolante; C. Lazzaretti; A. Santoro; F. Guaraldi ( 2013 ) - Changing scenarios of HIV treatment in Southern Africa - HIV/AIDS in Souther Africa: challenges, policies, actors - Lapieve Poligrafica Editore Villa Verucchio ITA) - pp. da 178 a 192 ISBN: 9788890616860 ISSN: - [Contributo in volume (Capitolo o Saggio) (268) - Capitolo/Saggio]
Abstract

In this paper we will analyse the assesment criteria for road map to control the HIV pandemic in SSA within the context of the changing scenarios of HIV disease in the third millennium. They include: effective medical interventions; political will; community participation

E. Franceschini; S. Zona; V. Borghi; T. Bini; P. Cicconi; G. Guaraldi; A. D’Arminio Monforte; C. Mussini. ( 2013 ) - Characteristics of HIV-infected patients not retained in care of two cohorts of northern Italy. - ICAR - Divisione EDIMES - Edizioni medico Scientifiche Pavia ITA) - NEW MICROBIOLOGICA - n. volume 36 (suppl 1) - pp. da 167 a 168 ISSN: 1121-7138 [Abstract in rivista (266) - Abstract in Rivista]
Abstract

The aim of the study was to assess the proportion of patients not-retained in care after HIV diagnosis in two cohorts of Northern Italy.

Potenza, Leonardo; Vallerini, Daniela; Barozzi, Patrizia; Riva, Giovanni; Forghieri, Fabio; Beauvais, Anne; Beau, Remi; Candoni, Anna; Maertens, Johan; Rossi, Giulio; Morselli, Monica; Zanetti, Eleonora; Quadrelli, Chiara; Codeluppi, Mauro; Guaraldi, Giovanni; Pagano, Livio; Caira, Morena; DEL GIOVANE, Cinzia; Maccaferri, Monica; Stefani, Alessandro; Morandi, Uliano; Tazzioli, Giovanni; Girardis, Massimo; Delia, Mario; Specchia, Giorgina; Longo, Giuseppe; Marasca, Roberto; Narni, Franco; Merli, Francesco; Imovilli, Annalisa; Apolone, Giovanni; Carvalho, Agostinho; Comoli, Patrizia; Romani, Luigina; Latgè, Jean Paul; Luppi, Mario ( 2013 ) - Characterization of Specific Immune Responses to Different Aspergillus Antigens during the Course of Invasive Aspergillosis in Hematologic Patients - PLOS ONE - n. volume 8 - pp. da 1 a 11 ISSN: 1932-6203 [Articolo in rivista (262) - Articolo su rivista]
Abstract

Several studies in mouse model of invasive aspergillosis (IA) and in healthy donors have shown that different Aspergillus antigens may stimulate different adaptive immune responses. However, the occurrence of Aspergillus-specific T cells have not yet been reported in patients with the disease. In patients with IA, we have investigated during the infection: a) whether and how specific T-cell responses to different Aspergillus antigens occur and develop; b) which antigens elicit the highest frequencies of protective immune responses and, c) whether such protective T cells could be expanded ex-vivo. Forty hematologic patients have been studied, including 22 patients with IA and 18 controls. Specific T cells producing IL-10, IFN-γ, IL-4 and IL-17A have been characterized through enzyme linked immunospot and cytokine secretion assays on 88 peripheral blood (PB) samples, by using the following recombinant antigens: GEL1p, CRF1p, PEP1p, SOD1p, α1-3glucan, β1-3glucan, galactomannan. Specific T cells were expanded through short term culture. Aspergillus-specific T cells producing non-protective interleukin-10 (IL-10) and protective interferon-gamma (IFN-γ) have been detected to all the antigens only in IA patients. Lower numbers of specific T cells producing IL-4 and IL-17A have also been shown. Protective T cells targeted predominantly Aspergillus cell wall antigens, tended to increase during the IA course and to be associated with a better clinical outcome. Aspergillus-specific T cells could be successfully generated from the PB of 8 out of 8 patients with IA and included cytotoxic subsets able to lyse Aspergillus hyphae. Aspergillus specific T-cell responses contribute to the clearance of the pathogen in immunosuppressed patients with IA and Aspergillus cell wall antigens are those mainly targeted by protective immune responses. Cytotoxic specific T cells can be expanded from immunosuppressed patients even during the infection by using the above mentioned antigens. These findings may be exploited for immunotherapeutic purposes in patients with IA. © 2013 Potenza et al.

Trevor, O’Neill; Guaraldi, Giovanni; Orlando, Gabriella; Carli, Federica; Garlassi, Elisa; Zona, Stefano; Jean Pierre, Després; Robert, Ross ( 2013 ) - Combined Use of Waist and Hip Circumference to Identify Abdominally Obese HIV-Infected Patients at Increased Health Risk - PLOS ONE - n. volume 8 [Articolo in rivista (262) - Articolo su rivista]
Abstract

OBJECTIVES: To determine whether for a given waist circumference (WC), a larger hip circumference (HC) was associated with a reduced risk of insulin resistance, type 2 diabetes (T2D), hypertension and cardiovascular disease (CVD) in HIV-infected patients. A second objective was to determine whether, for a given WC, the addition of HC improved upon estimates of abdominal adiposity, in particular visceral adipose tissue (VAT), compared to those obtained by WC alone. METHODS: HIV-infected men (N = 1481) and women (N = 841) were recruited between 2005 and 2009. WC and HC were obtained using standard techniques and abdominal adiposity was measured using computed tomography. RESULTS: After control for WC and covariates, HC was negatively associated with risk of insulin resistance (p<0.05) and T2D [Men: OR = 0.91 (95% CI: 0.86-0.96); Women: OR = 0.91 (95% CI: 0.84-0.98)]. For a given WC, HC was also negatively associated with a lower risk of hypertension (p<0.05) and CVD [OR = 0.94 (95% CI: 0.88-0.99)] in men, but not women. Although HC was negatively associated with VAT in men and women after control for WC (p<0.05), the addition of HC did not substantially improve upon the prediction of VAT compared to WC alone. CONCLUSIONS: The identification of HIV-infected individuals at increased health risk by WC alone is substantially improved by the addition of HC. Estimates of visceral adipose tissue by WC are not substantially improved by the addition of HC and thus variation in visceral adiposity may not be the conduit by which HC identifies increased health risk.

M., Rotger; T. R., Glass; T., Junier; J., Lundgren; J. D., Neaton; E. S., Poloni; A. B., van 't Wout; R., Lubomirov; S., Colombo; R., Martinez; A., Rauch; H. F., Gunthard; J., Neuhaus; D., Wentworth; D., van Manen; L. A., Gras; H., Schuitemaker; L., Albini; C., Torti; L. P., Jacobson; X., Li; L. A., Kingsley; Carli, Federica; Guaraldi, Giovanni; E. S., Ford; I., Sereti; C., Hadigan; E., Martinez; M., Arnedo; L., Egana Gorrono; J. M., Gatell; M., Law; C., Bendall; K., Petoumenos; J., Rockstroh; J. C., Wasmuth; K., Kabamba; M., Delforge; S., De Wit; F., Berger; S., Mauss; M., de Paz Sierra; M., Losso; W. H., Belloso; M., Leyes; A., Campins; A., Mondi; A., De Luca; I., Bernardino; M., Barriuso Iglesias; A., Torrecilla Rodriguez; J., Gonzalez Garcia; J. R., Arribas; I., Fanti; S., Gel; J., Puig; E., Negredo; M., Gutierrez; P., Domingo; J., Fischer; G., Fatkenheuer; C., Alonso Villaverde; A., Macken; J., Woo; T., Mcginty; P., Mallon; A., Mangili; S., Skinner; C. A., Wanke; P., Reiss; R., Weber; H. C., Bucher; J., Fellay; A., Telenti; P. E., Tarr ( 2013 ) - Contribution of Genetic Background, Traditional Risk Factors, and HIV-Related Factors to Coronary Artery Disease Events in HIV-Positive Persons - CLINICAL INFECTIOUS DISEASES - n. volume 57 - pp. da 112 a 121 ISSN: 1058-4838 [Articolo in rivista (262) - Articolo su rivista]
Abstract

BACKGROUND: Persons infected with human immunodeficiency virus (HIV) have increased rates of coronary artery disease (CAD). The relative contribution of genetic background, HIV-related factors, antiretroviral medications, and traditional risk factors to CAD has not been fully evaluated in the setting of HIV infection. METHODS: In the general population, 23 common single-nucleotide polymorphisms (SNPs) were shown to be associated with CAD through genome-wide association analysis. Using the Metabochip, we genotyped 1875 HIV-positive, white individuals enrolled in 24 HIV observational studies, including 571 participants with a first CAD event during the 9-year study period and 1304 controls matched on sex and cohort. RESULTS: A genetic risk score built from 23 CAD-associated SNPs contributed significantly to CAD (P = 2.9 × 10(-4)). In the final multivariable model, participants with an unfavorable genetic background (top genetic score quartile) had a CAD odds ratio (OR) of 1.47 (95% confidence interval [CI], 1.05-2.04). This effect was similar to hypertension (OR = 1.36; 95% CI, 1.06-1.73), hypercholesterolemia (OR = 1.51; 95% CI, 1.16-1.96), diabetes (OR = 1.66; 95% CI, 1.10-2.49), ≥ 1 year lopinavir exposure (OR = 1.36; 95% CI, 1.06-1.73), and current abacavir treatment (OR = 1.56; 95% CI, 1.17-2.07). The effect of the genetic risk score was additive to the effect of nongenetic CAD risk factors, and did not change after adjustment for family history of CAD. CONCLUSIONS: In the setting of HIV infection, the effect of an unfavorable genetic background was similar to traditional CAD risk factors and certain adverse antiretroviral exposures. Genetic testing may provide prognostic information complementary to family history of CAD.

Guaraldi G; Zona S; Menozzi M; Carli F; Bagni P; Berti A; Rossi E; Orlando G; Zoboli G; Palella F ( 2013 ) - Cost of noninfectious comorbidities in patients with HIV - CLINICOECONOMICS AND OUTCOMES RESEARCH - n. volume 5 - pp. da 481 a 488 ISSN: 1178-6981 [Articolo in rivista (262) - Articolo su rivista]
Abstract

OBJECTIVES: We hypothesized that the increased prevalence of noninfectious comorbidities (NICMs) observed among HIV-infected patients may result in increased direct costs of medical care compared to the general population. Our objective was to provide estimates of and describe factors contributing to direct costs for medical care among HIV-infected patients, focusing on NICM care expenditure. METHODS: A case-control study analyzing direct medical care costs in 2009. Antiretroviral therapy (ART)-experienced HIV-infected patients (cases) were compared to age, sex, and race-matched adults from the general population, included in the CINECA ARNO database (controls). NICMs evaluated included cardiovascular disease, hypertension, diabetes mellitus, bone fractures, and renal failure. Medical care cost information evaluated included pharmacy, outpatient, and inpatient hospital expenditures. Linear regression models were constructed to evaluate predictors of total care cost for the controls and cases. RESULTS: There were 2854 cases and 8562 controls. Mean age was 46 years and 37% were women. We analyzed data from 29,275 drug prescription records. Positive predictors of health care cost in the overall population: HIV infection (β = 2878; confidence interval (CI) = 2001-3755); polypathology (β = 8911; CI = 8356-9466); age (β = 62; CI = 45-79); and ART exposure (β = 18,773; CI = 17,873-19,672). Predictors of health care cost among cases: Center for Disease Control group C (β = 1548; CI = 330-2766); polypathology (β = 11,081; CI = 9447-12,716); age < 50 years (β = 1903; CI = 542-3264); protease inhibitor exposure (per month of use; β = 69; CI = 53-85); CD4 count < 200 cells/mm3 (β = 5438; CI = 3082-7795); and ART drug change (per change; β = 911; CI = 716-1106). CONCLUSION: Total cost of medical care is higher in cases than controls. Lower medical costs associated with higher CD4 strata are offset by increases in the care costs needed for advancing age, particularly for NICMs.

G.Guaraldi ( 2013 ) - Does lipohypertrophy increase cardiovascular risk? Assessing patients for metabolic disordes - Living with HIV-Associated Lipodystrophy:Assessment, diagnosis, and management in the HAART Era - n. volume Mar 2013 - pp. da 7 a 10 ISSN: - [Contributo in volume (Capitolo o Saggio) (268) - Capitolo/Saggio]
Abstract

not available

G. Brigante; C. Diazzi; G. Ferrannini; A. Ansaloni; L. Zirilli; G. Guaraldi; V. Rochira ( 2013 ) - Effects of gender and body composition on GH response to GHRH plus Arginine (GHRH+ARG) in HIV-lipodystrophic patients - XXXVI National Congress of the Italian Society of Endocrinology - Editrice Kurtis Srl:via Luigi Zoja 30, Milan 20153 Italy:011 39 02 48202740, EMAIL: info@kurtis.it, INTERNET: http://www.kurtis.it, Fax: 011 39 02 48201219 Milano ITA) - JOURNAL OF ENDOCRINOLOGICAL INVESTIGATION - n. volume 36 - pp. da 62 a 62 ISSN: 0391-4097 [Abstract in rivista (266) - Abstract in Rivista]
Abstract

GH-deficiency is more frequent in men with HIV than in HIV-infected women.

G. Brigante; C. Diazzi; G. Ferrannini; A. Ansaloni; L. Zirilli; C. Carani; G. Guaraldi; V. Rochira ( 2013 ) - Effects of gender and body composition on GH response to GHRH plus Arginine (GHRH+Arg) in HIV-lipodystrophic patients: higher rate of GH deficiency in men. - Abstracts of The 95th Annual Meeting of the Endocrine Society ENDO2013 - Endocrine Society / Maryland:8401 Connecticut Avenue, Suite 900:Chevy Chase, MD 20815:(301)941-0200, (301)941-0200, (301)941-0232, EMAIL: journals@endo-society.org, INTERNET: http://www.endo.society.org, Fax: (301)941-0259 Maryland USA) - ENDOCRINE REVIEWS - n. volume 34 [Abstract in rivista (266) - Abstract in Rivista]
Abstract

The study investigates gender differences in the rate of GH-deficiency among hIV-infected men.

Giulia Brigante; Chiara Diazzi; Giulia Ferrannini; Anna Ansaloni; Lucia Zirilli; Giovanni Guaraldi; Vincenzo Rochira ( 2013 ) - Effects of gender and body composition on GH response to GHRH+Arg in HIV-lipodystrophic patients: higher rate of GH deficiency in men - 15th European Congress of Endocrinology - Bioscientifica Limited:22 Apex Court, Woodlands, Bradley, Bristol BS32 4JT United Kingdom:011 44 1454 619036, EMAIL: sales@endocrinology.org, INTERNET: http://www.endocrinology.org, Fax: 011 44 1454 616071 Bristol, UK GBR) - ENDOCRINE ABSTRACTS - n. volume 32 [Abstract in rivista (266) - Abstract in Rivista]
Abstract

The study investigated the gender difference in GH secretion after GHRH+Arg in patients with HIV-related lipodystrophy showing hoe men are at higher risk to fail to respond copmared to females. In this group of patients with HIV that are at higher risk of GH deficiency, men have higher risk of GH deficiency than women.

C. Montrucchio; A. Calcagno; A. Capetti; G. Guaraldi; G. Cenderello; L. Calza; M. Lanzafame; L. Marinaro; M.C. Tettoni; L. Trentini; G. Di Perri; S. Bonora ( 2013 ) - Efficacy and safety of Nevirapine plus raltegravir as dual regimen in the clinical setting - ICAR - Divisione EDIMES - Edizioni medico Scientifiche Pavia ITA) - NEW MICROBIOLOGICA - n. volume 36 (suppl 1) - pp. da 15 a 15 ISSN: 1121-7138 [Abstract in rivista (266) - Abstract in Rivista]
Abstract

Dual therapy based on raltegravir and nevirapine has been recently proposed as a possible switching strategy in selected patients, due to attractive tolerability and safety profile. We recently reported the pharmacokinetic compatibility of these drugs when administered twice-daily, but data on efficacy and safety of this combination in the clinical setting are scarce.

G. Guaraldi; G. Besutti; R. Scaglioni; A. Santoro; S. Zona; G. Ligabue; G. Orlando; F. Carli; C. Mussini; J. Leipsic D.D. Sin; S.F.P. Man ( 2013 ) - Emphysema is an independent predictor of coronary artery calcium score in a large cohort of HIV infected patients - Abstract & Program - SIMIT Milano ITA) - n. volume na [Abstract in Atti di convegno (274) - Abstract in Atti di Convegno]
Abstract

The objective of this study was to evaluate the association between emphysema and CAC in a large cohort of HIV infected patients undergoing ART

Guaraldi, Giovanni; Besutti, Giulia; Scaglioni, Riccardo; Santoro, Antonella; Zona, Stefano; Ligabue, Guido; Mussini, Cristina; Orlando, Gabriella; Carli, Federica; Lipsic, J.; Sin, D. D.; Man, S. F. P. ( 2013 ) - Emphysema is an independent predictor of coronary artery calcium score in a large cohort of HIV-infected patients. - Programme & Abstracts - International Medical Press London GBR) - ANTIVIRAL THERAPY - n. volume 18 (suppl 3) [Abstract in rivista (266) - Abstract in Rivista]
Abstract

The complex relationship between chronic obstructive pulmonary disease and cardiovascular disease has not been investigated in patients chronically infected with HIV. The objective of this study was to evaluate the association between emphysema and coronary artery calcium score as surrogate for coronary artery diasease in a large cohort of HIV-infected patients on antiretroviral treatment.

C. Stentarelli; S. Zona; E. Garlassi; M. Menozzi; T. Trenti; S. Baroncelli; C. Pinnetti; A. Degli Antoni; M. Floridia; G. Guaraldi ( 2013 ) - HIGH PREVALENCE OF VITAMIN D DEFICIENCY IN A COHORT OF HIV INFECTED PREGNANT AND NON-PREGNANT WOMEN OF CHILDBEARING AGE - 7th international symposium Diabetes, Hypertension, Metabolic Syndrome & Pregnancy. - na na ITA) [Poster (275) - Poster]
Abstract

Aims: To analyze prevalence and risk factors for 25(OH) VitaminD [25(OH)D] plasma levels < 20ng/mL among HIV-infected pregnant and non-pregnant women. Methods: Cross-sectional, case-control study comparing HIV-infected pregnant women at third trimester enrolled between 2003 and 2010 in the Italian National Program on Surveillance on Antiretroviral Treatment in Pregnancy and HIV-infected non-pregnant women followed within the Modena Metabolic Clinic. The two groups were matched for age, seasonality of 25(OH)D measurement and body mass index. Quantitative determinations of 25(OH)D were measured using chemiluminescent immunoassay (CLIA) technology. Results: Two hundred twelve HIV-infected women were studied. African ethnicity was more common in the group of pregnant women (37.6% vs.10.5%). Two groups had similar prevalence of 25(OH)D levels < 20ng/mL (64.1% vs. 54.7%, respectively; p=0.166). At univariate logistic regression analysis, only black ethnicity was found to be different in two study groups (0.015). Multivariate analysis is shown in table1. Conclusion: This study shows a high prevalence of vitaminD deficiency in both groups. Pregnancy per se didn't result an independent risk factor for vitamin D deficiency. Both groups recognized traditional risk factors for vitaminD deficiency

C. Stentarelli; S. Zona; E. Garlassi; M. Menozzi; T. Trenti; S. Baroncelli; C. Pinnetti; A. Degli Antoni; M. Floridia; G. Guaraldi ( 2013 ) - HIGH PREVALENCE OF VITAMIN D DEFICIENCY IN A COHORT OF HIV INFECTED PREGNANT WOMEN AND ITS IMPACT ON PREGNANCY OUTCOME - 7th international symposium Diabetes, Hypertension, Metabolic Syndrome & Pregnancy. [Poster (275) - Poster]
Abstract

Background and aims: To assess out the clinical impact of 25(OH)D plasma levels < 20ng/mL in HIV-infected pregnant women and their newborns. Methods: Cross-sectional study. Quantitative determinations of 25(OH)D were measured using chemiluminescent immunoassay technology in HIV-infected pregnant women at third trimester, participating between 2003 and 2010 to the Italian National Program on Surveillance on Antiretroviral Treatment in Pregnancy. Results: One hundred seventeen HIV-infected pregnant women were studied. 25(OH)D mean value(±SD) was 19.89(±11.36)ng/mL. Prevalence of 25(OH)D levels < 20ng/mL was 64.1%. Preterm delivery (< 37weeks) occurred in 15.38% of the women. There was no statistically significant association between low 25(OH)D and pregnancy outcomes at multivariate analysis (Table1). Conclusion: This study shows a high prevalence of 25(OH)D deficiency. Future studies are needed to verify potential role of low 25(OH)D in determining birth weight in HIV-infected pregnant women.

Giovanni Guaraldi;Chiara Stentarelli;Stefano Zona;Antonella Santoro ( 2013 ) - HIV-Associated Lipodystrophy: Impact of Antiretroviral Therapy - DRUGS - n. volume 73(13) - pp. da 1431 a 1450 ISSN: 0012-6667 [Articolo in rivista (262) - Articolo su rivista]
Abstract

In 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.

G Guaraldi ( 2013 ) - Il ruolo dell’ageing, delle interazioni farmacologiche e comorbidità nella gestione a lungo termine del paziente HIV positivo. L’invecchiamento come variabile sempre più frequente nella gestione del paziente HIV positivo - READ FILES - n. volume Anno I vol3 - pp. da 3 a 4 ISSN: - [Articolo in rivista (262) - Articolo su rivista]
Abstract

na

Antonio Bellasi; S. Zona; G. Orlando; F. Carli; G. Ligabue; V. Rochira; Antonello Santoro; C. Mussini; G. Guaraldi; Paolo Raggi ( 2013 ) - Inverse correlation between vascular calcification and bone mineral density in human immunodeficiency virus-infected patients - CALCIFIED TISSUE INTERNATIONAL - n. volume 93 - pp. da 413 a 418 ISSN: 0171-967X [Articolo in rivista (262) - Articolo su rivista]
Abstract

HIV-infected individuals suffer from acceler- ated aging, which manifests as premature cardiovascular and bone disease. However, little is known of the association of these two disorders in the HIV population. Our objective was to investigate the association between a marker of ath- erosclerosis (coronary artery calcium [CAC]) and low bone mineral density (BMD) in a cross-sectional cohort of HIV- infected patients. The study was conducted at the University of Modena and Reggio Emilia, Italy. A total of 636 con- secutive middle-aged, HIV-infected subjects were recruited between January 2006 and December 2010. All patients underwent CAC and BMD assessment. Patients were cate- gorized according to a CAC score\100 or[100 units based on previous literature that identified this cut-point as a marker of increased risk. Low femoral and lumbar spine BMD was defined as \25th percentile value for the study cohort. Logistic regression and bootstrap analysis were used to assess the independent association between CAC and BMD. The main outcome measure was a CAC score[100. Patients with CAC [ 100 were older and more likely to be men, diabetic, and overweight. Patients with CAC \ 100 had better renal function and a lower cardiovascular risk profile. After adjusting for age, sex, traditional and HIV- specific risk factors, vitamin D level, and PTH level, there was a significant association between CAC [ 100 and low BMD for the femur (OR = 2.33, 95 % CI 1.09–4.99; p = 0.02) but not for the spine. Bootstrap analyses con- firmed these findings. In summary, CAC was independently associated with low femoral BMD in HIV-infected patients. Future studies should test whether therapies that attenuate cardiovascular risk in HIV favorably impact bone health.

G. Guaraldi ( 2013 ) - La malattia cardiovascolare in HIV:l'attenzione al paziente - READ FILES - n. volume 2/2013 - pp. da 6 a 9 ISSN: - [Articolo in rivista (262) - Articolo su rivista]
Abstract

not available

G. Guaraldi ( 2013 ) - La sindrome Lipodistrofica - Principi di Malattie Infettive - ESCULAPIO - Bologna Bologna ITA) - pp. da 302 a 308 ISBN: 9788874885930 ISSN: - [Contributo in volume (Capitolo o Saggio) (268) - Capitolo/Saggio]
Abstract

not available

G. Guaraldi; E. Garlassi; A. Santoro ( 2013 ) - L’evoluzione della terapia per il controllo dell’HIV.” Le comorbidità - HAART 2.0 - pp. da 5 a 39 ISSN: - [Contributo in volume (Capitolo o Saggio) (268) - Capitolo/Saggio]
Abstract

non disponibile

G. Guaraldi; A. Cossarizza; C. Franceschi; A. Roverato; E. Vaccher; G. Tambussi; E. Garlassi; M. Menozzi; C. Mussini; A. D’Arminio Monforte. ( 2013 ) - Life expectancy in the immune-recovery era: the evolving scenario of HIV epidemic in Northern Italy - ICAR - Divisione EDIMES - Edizioni medico Scientifiche Pavia ITA) - NEW MICROBIOLOGICA - n. volume 36 (suppl 1) - pp. da 122 a 123 ISSN: 1121-7138 [Abstract in rivista (266) - Abstract in Rivista]
Abstract

National cohort and inter-cohort studies have been set to describe differences of Life Expectancy (LE) of HIV-infected individuals. the aim of this study was to assess the impact of immune-recovery on LE of HIV-patients undergoing cART.

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; G. Guaraldi; G. Nardini; C. Stentarelli; B. Beghetto ( 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 - ICAR 2013 - EDMES Pavia ITA) - NEW MICROBIOLOGICA - n. volume 36(1) - pp. da 131 a 132 ISSN: 1121-7138 [Abstract in rivista (266) - Abstract in Rivista]
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

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; ML. Di Martino; P. Viale; G. Verucchi; S. Tedeschi; MS. 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; D. Francisci; E. Schiaroli; S. Bastianelli; G. Guaraldi; G. Nardini; C. Stentarelli; B. Beghetto. ( 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. - ICAR - Divisione EDIMES - Edizioni medico Scientifiche Pavia ITA) - NEW MICROBIOLOGICA - n. volume 36 (suppl 1) - pp. da 131 a 132 ISSN: 1121-7138 [Abstract in rivista (266) - Abstract in Rivista]
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.

G. Meini;B. Rossetti;C. Bianco;F. Ceccherini-Silberstein;S. Di Giambenedetto;L. Sighinolfi;L. Monno;A. Castagna;G. Rozera;A. D'Arminio Monforte;M. Zazzi;A. De Luca;M. Moroni;G. Angarano;A. Antinori;O. Armignacco;A. d'Arminio Monforte;F. Castelli;R. Cauda;G. Di Perri;M. Galli;R. Iardino;G. Ippolito;A. Lazzarin;C. F. Perno;F. von Schloesser;P. Viale;A. Castagna;F. Ceccherini-Silberstein;A. Cozzi-Lepri;E. Girardi;S. Lo Caputo;C. Mussini;M. Puoti;M. Andreoni;A. Ammassari;C. Balotta;P. Bonfanti;S. Bonora;M. Borderi;M. R. Capobianchi;A. Cingolani;P. Cinque;A. De Luca;A. Di Biagio;N. Gianotti;A. Gori;G. Guaraldi;G. Lapadula;M. Lichtner;G. Madeddu;F. Maggiolo;G. Marchetti;S. Marcotullio;L. Monno;E. Quiros Roldan;S. Rusconi;P. Cicconi;I. Fanti;T. Formenti;L. Galli;P. Lorenzini;A. Giacometti;A. Costantini;C. Santoro;C. Suardi;E. Vanino;G. Verucchi;C. Minardi;T. Quirino;C. Abeli;P. E. Manconi;P. Piano;J. Vecchiet;K. Falasca;L. Sighinolfi;D. Segala;F. Mazzotta;G. Cassola;G. Viscoli;A. Alessandrini;R. Piscopo;G. Mazzarello;C. Mastroianni;V. Belvisi;I. Caramma;A. P. Castelli;G. Rizzardini;A. L. Ridolfo;R. Piolini;S. Salpietro;L. Carenzi;M. C. Moioli;C. Puzzolante;N. Abrescia;A. Chirianni;M. G. Guida;M. Gargiulo;F. Baldelli;D. Francisci;G. Parruti;T. Ursini;G. Magnani;M. A. Ursitti;V. Vullo;A. d'Avino;L. Gallo;E. Nicastri;R. Acinapura;M. Capozzi;R. Libertone;G. Tebano;A. Cattelan;M. S. Mura;P. Caramello;G. C. Orofino;M. Sciandra;G. Pellizzer;V. Manfrin ( 2013 ) - Longitudinal analysis of HIV-1 coreceptor tropism by single and triplicate HIV-1 RNA and DNA sequencing in patients undergoing successful first-line antiretroviral therapy - JOURNAL OF ANTIMICROBIAL CHEMOTHERAPY - n. volume 69 - pp. da 735 a 741 ISSN: 0305-7453 [Articolo in rivista (262) - Articolo su rivista]
Abstract

OBJECTIVES: Maraviroc has been shown to be effective in patients harbouring CCR5-tropic HIV-1. While this CCR5 antagonist has initially been used in salvage therapy, its excellent safety profile makes it ideal for antiretroviral treatment simplification strategies in patients with suppressed plasma viraemia. The aim of this study was to compare HIV-1 tropism as detected in baseline plasma RNA and peripheral blood mononuclear cell (PBMC) DNA prior to first-line therapy and to analyse tropism evolution while on successful treatment. METHODS: HIV-1 tropism was determined using triplicate genotypic testing combined with geno2pheno[coreceptor] analysis at a 10% false positive rate in 42 patients. Paired pre-treatment plasma RNA and PBMC DNA and two subsequent PBMC DNA samples (the first obtained after reaching undetectable plasma HIV-1 RNA and the second after at least 2 years of suppression of plasma viraemia) were evaluated. RESULTS: Coreceptor tropism was completely concordant in paired pre-treatment RNA and DNA, with 26.2% of HIV-1 sequences predicted to be non-CCR5-tropic. During follow-up, coreceptor tropism switches were detected in 4 (9.5%) patients without any preferential direction. Although false positive rate discrepancies within triplicates were common, the rate of discordance of coreceptor tropism assignment among triplicate results in this mostly CCR5-tropic dataset was only 2.1%, questioning the added value of triplicate testing compared with single testing. CONCLUSIONS: HIV-1 coreceptor tropism changes during virologically successful first-line treatment are infrequent. HIV-1 DNA analysis may thus support the choice of a CCR5 antagonist in treatment switch strategies; however, maraviroc treatment outcome data are required to confirm this option.

Guido Ligabue; Giulia Besutti; Riccardo Scaglioni; Chiara Stentarelli; Giovanni Guaraldi ( 2013 ) - MR quantitative biomarkers of non-alcoholic fatty liver disease: technical evolutions and future trends - QUANTITATIVE IMAGING IN MEDICINE AND SURGERY - n. volume 3(4) - pp. da 192 a 195 ISSN: 2223-4292 [Articolo in rivista (262) - Articolo su rivista]
Abstract

Non-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.

F. Di Benedetto;G. Tarantino;G. Ercolani;U. Baccarani;R. Montalti;N. De Ruvo;M. Berretta;G. L. Adani;M. Zanello;M. Tavio;N. Cautero;U. Tirelli;A. D. Pinna;G. E. Gerunda;G. Guaraldi ( 2013 ) - Multicenter Italian Experience in Liver Transplantation for Hepatocellular Carcinoma in HIV-Infected Patients - THE ONCOLOGIST - n. volume 18 - pp. da 592 a 599 ISSN: 1083-7159 [Articolo in rivista (262) - Articolo su rivista]
Abstract

Abstract: Background. The aim of our work is to assess the clinical outcomes of liver transplantation (LT) for hepatocellular carcinoma (HCC) in HIV-coinfected patients. This is a multicenter study involving three Italian transplant centers in northern Italy: University of Modena, University of Bologna, and University of Udine. Patients and Methods. We compared 30 HIV-positive pants affected by HCC who underwent LT with 125 HIV-uninfected patients who received the same treatment from September 2004 to June 2009. At listing, there were no differences between HIV-infected and -uninfected patients regarding HCC features. Patients outside the University of California, San Francisco criteria (UCSF) were considered eligible for LT if a down-staging program permitted a reduction of tumor burden. Results. HIV-infected patients were younger, they were more frequently anti-HCV positive, and a higher number of HIV-infected patients presented a coinfection HBV-HCV. Pre-LT treatments (liver resection and or locoregional treatments) were similar between the two groups. Histological characteristics of the tumor were similar in patients with and without HIV infection. No differences were observed in terms of overall survival and HCC recurrence rates. Conclusion. LT for HCC is a feasible procedure and the presence of HIV does not particularly affect the post-LT outcome.

P. Loria; G. Guaraldi ( 2013 ) - Obesità e diabete nei migranti africani - Subcontractor del 7° progetto quadro "Research on Obesity and Diabetes among African Migrants – RODAM” [Altro (298) - Partecipazione a progetti di ricerca]
Abstract

Gazzola, L; Guaraldi, G; De Luca, A; Antinori, A; Nicastri E; Castagna A; Di Perri,G; Pellizzer, G; Angarano, G; Viale, P; Cozzi Lepri, A; d'Arminio Monforte, A . ( 2013 ) - Predictive Accuracy of VACS Index for all cause Mortality in HIV-infected People enrolled in a large cohort in Italy - Abstract Book - EACS Brussels BEL) [Abstract in Atti di convegno (274) - Abstract in Atti di Convegno]
Abstract

Objective: To determine the Accuracy of VACS index to predict 5-years all-cause mortality and to compare it with thet of other prognostic indices in the ICONA cohort. Conclusion: The VACS index mortality risk demonstrated a very good predictive accuracy in cART-treated HIV infected patients seen for care in Italy, overall and in specific subgroups under-represented in cohorts used to derive and previously validate the index. Overall its predictive value was similar to other more parsimonious indices. Late presentation of HIV and virological response to cART were independent predictors of having a high VACS score.

Giuseppina Liuzzi;Carmela Pinnetti;Marco Floridia;Enrica Tamburrini;Giulia Masuelli;Serena Dalzero;Matilde Sansone;Vania Giacomet;Anna Maria Degli Antoni;Giovanni Guaraldi;Alessandra Meloni;Anna Maccabruni;Salvatore Alberico;Vincenzo Portelli;Marina Ravizza ( 2013 ) - Pregnancy Outcomes in HIV-Infected Women of Advanced Maternal Age - HIV CLINICAL TRIALS - n. volume 14 - pp. da 110 a 119 ISSN: 1528-4336 [Articolo in rivista (262) - Articolo su rivista]
Abstract

BACKGROUND: There is limited information on pregnancy outcomes in women with HIV who are of a more advanced maternal age. METHODS: Data from a national observational study in Italy were used to evaluate the risk of nonelective cesarean section, preterm delivery, low birthweight, major birth defects, and small gestational age-adjusted birthweight according to maternal age (<35 and ≥35 years, respectively). RESULTS: Among 1,375 pregnancies with live births, 82.4% of deliveries were elective cesarean sections, 15.8% were nonelective cesarean sections, and 1.8% were vaginal deliveries. Rates of nonelective cesarean section were similar among mothers ≥35 and <35 years (odds ratio [OR], 1.22; 95% CI, 0.90-1.65;P = .19). Preterm delivery and low birthweight were significantly more common among women ≥35 years in univariate but not in multivariate analyses. Newborns from women ≥35 and <35 years showed no differences inZ scores of birthweight, with a similar occurrence of birthweight <10th percentile (12.1% vs 12.0%; OR, 1.02; 95% CI, 0.71-1.46;P = .93). The overall rate of birth defects was 3.4% (95% CI, 2.4-4.4), with no differences by maternal age (≥35 years, 3.5%; <35 years, 3.3%; OR, 1.05; 95% CI, 0.56-1.98;P = .88). DISCUSSION: In this study of pregnant women with HIV, older women were at higher risk of some adverse pregnancy outcomes, such as preterm delivery and low birthweight. The association, however, did not persist in multivariable analyses, suggesting a role of some predisposing factors associated with older age.

Guaraldi, Giovanni; Zona, Stefano; Besutti, Giulia; Scaglioni, Riccardo; Stentarelli, Chiara; Menozzi, Marianna; Garlassi, Elisa; Ligabue, Guido; Mussini, Cristina; Raggi, P. ( 2013 ) - Prevalence and predictors of preclinical coronary heart disease in post-menopause period - Programme & Abstracts - International Medical Press London GBR) - ANTIVIRAL THERAPY - n. volume 18 (Suppl3) [Abstract in rivista (266) - Abstract in Rivista]
Abstract

There are very few longitudinal studies of change in coronary artery calcium (CAC) across the menopause period, when it is expected there would be a significant increase in coronary heart disease. CAC>0 identifies preclinical coronary artery disease. We aimed to evaluate risk factors for detectable CAC among HIV-infected women across the menopause period.

Guaraldi, Giovanni; Zona, Stefano; Cossarizza, Andrea; L., Vernacotola; Carli, Federica; A., Lattanzi; Beghetto, Barbara; Orlando, Gabriella; DE BIASI, Sara; R., Termini; M., Garau ( 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 - HIV CLINICAL TRIALS - n. volume 14 - pp. da 140 a 148 ISSN: 1528-4336 [Articolo in rivista (262) - Articolo su rivista]
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.

J Falutz;L Rosenthall;D Kotler;S Zona;G Guaraldi ( 2013 ) - Surrogate markers of visceral adipose tissue in treated HIV-infected patients: accuracy of waist circumference determination - HIV MEDICINE - n. volume 15 - pp. da 98 a 107 ISSN: 1464-2662 [Articolo in rivista (262) - Articolo su rivista]
Abstract

Objectives: The accuracy of the use of anthropometrics to quantify visceral adipose tissue (VAT) in treated HIV-infected patients is unknown. We evaluated the predictive accuracy of waist circumference (WC) with and without dual-energy X-ray absorptiometry (DXA)-derived trunk:limb fat ratio [fat mass ratio (FMR)] as surrogates for VAT determined using computerized axial tomography (CT-determined VAT). Methods: We performed a retrospective cohort analysis of treated HIV-infected male patients followed at the Modena HIV Clinic. We developed prediction equations for VAT using linear regression analysis and Spearman correlations. Receiver operating characteristic (ROC) analysis evaluated the accuracy of WC alone or with FMR at discrete VAT thresholds. Results: The 1500 Caucasian male patients had a median age of 45 years, body mass index (BMI) of 24, WC of 87cm, VAT area of 127cm2 and body fat percentage of 14%. The correlation between WC-predicted VAT and CT-VAT was 0.613, and this increased significantly if FMR was added. The WC-associated R2 of 0.35 increased to 0.51 if the prediction equation included WC plus FMR. The area under the ROC curve (AUC) using WC was 0.795-0.820 at all VAT thresholds. The positive predictive value (PPV) and negative predictive value (NPV) changed reciprocally at CT-VAT thresholds from 75 to 200cm2 and ranged from 0.72 to 0.74, respectively, at a representative VAT of 125cm2. Adding the FMR to the predictive equations increased the AUC in the range of 0.854-0.889 with the PPV and NPV increasing minimally, ranging from 0.780 to 0.821. Limits of precision were wide, especially at the highest CT-VAT levels, and varied from 24 to 68cm2. Conclusions: WC is a limited surrogate for CT-VAT in this population and DXA-derived parameters do not improve performance indices to a clinically relevant level. These findings should inform the applicability of WC to predict VAT in treated HIV-infected male patients. © 2013 British HIV Association.

Guaraldi, Giovanni; Stentarelli, Chiara ( 2013 ) - Tesamorelin for the treatment of excess abdominal fat in HIV-infected individuals with lipodistrophy - CLINICAL INVESTIGATION - n. volume 3 - pp. da 763 a 775 ISSN: 2041-6792 [Articolo in rivista (262) - Articolo su rivista]
Abstract

Metabolic 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.

Guaraldi, Giovanni; Dolci, G; Bellasi, A. ( 2013 ) - Urolithiasis associated with atazanavir may mask a metabolic 'channelling' bias. - JOURNAL OF ANTIMICROBIAL CHEMOTHERAPY - n. volume 69 - pp. da 284 a 285 ISSN: 1460-2091 [Articolo in rivista (262) - Articolo su rivista]
Abstract

n/a

Guaraldi, Giovanni; Dolci, Giovanni; Bellasi, Antonio ( 2013 ) - Urolitiasi in corso di infezione da HIV: revisione della letteratura. - READ FILES - n. volume 2 - pp. da 1 a 3 ISSN: - [Articolo in rivista (262) - Articolo su rivista]
Abstract

L'eccesso di pazienti in condizioni dismetaboliche trattati con ATV/r può rappresentare un challenging bias che comporta un maggior rischio di urolitiasi.

Guaraldi G; Zona S; Roverato A; Orlando G; Carli F; Lattanzi A; Manzini L; Bisi L; Cicognani A; Rossi R ( 2012 ) - Abacavir and Tenofovir impact on endothelial. - Abstracts - INFECTION - n. volume 39 [Abstract in rivista (266) - Abstract in Rivista]
Abstract

Flow mediated dilation (FMD) of the brachial artery is an endothelial function test, that has been used to assess the impact of cardiovascular induced drug toxicity. The objective of the study was to analyse the impact of abacavir and tenofovir on endothelial function.

Guaraldi G; Santoro A; Santamaria G; Mantovani V; Notarianni L; Alessandrini A; Zona S; Garlassi E; Man P; Pederzoli P; Mgaya O ( 2012 ) - Aging with HIV in Tanzania. - Reviews in Antiviral Therapy & Infectious Diseases - Virology Education Utrecht NLD) - n. volume 9 - pp. da 23 a 24 ISBN: 9780000000002 ISSN: - [Abstract in Atti di convegno (274) - Abstract in Atti di Convegno]
Abstract

The increase in life expectancy of HIV infected patients, following the scale-up of ART, raises concern of a potential overlap between HIV and non-communicable diseases (NCD) epidemics in Sub-Saharan Africa. Population will age, unmasking the burden of NCD, previously hidden due to high rates of HIV-related mortality. NCD are becoming more important in low- and middle incoming settings, where prevalence of risk factors is high and prevention efforts are limited.

Cocchi, S; Franceschini, E; Meschiari, M; Codeluppi, M; Rompianesi, G; Di Benedetto, F; Gerunda, Ge; Mussini, C; Guaraldi, G ( 2012 ) - Aseptic Osteonecrosis: A Newly Diagnosed Complication in HIV-Infected Patients Undergoing Liver Transplantation. - TRANSPLANTATION - n. volume 94(3) [Articolo in rivista (262) - Articolo su rivista]
Abstract

Aseptic osteonecrosis: a newly diagnosed complication in HIV-infected patients undergoing liver transplantation

G. Guaraldi; S Zona; E Garlassi; G Orlando; F Carli; C Stentarelli; AR Domingues da Silva; M Menozzi; A Santoro; C Mussini ( 2012 ) - Body Composition changes in ageing HIV infected patients: the complex interplay between low muscle mass, lipodystrophy and osteopenia. - Programme & Abstracts - ANTIVIRAL THERAPY - n. volume 17 [Abstract in rivista (266) - Abstract in Rivista]
Abstract

Body composition is a key determinant of ageing phenotype. HIV patients on ART are frequently affected by lipodystrophy and osteopenia/osteoporosis (O/O), and in the aging process they experience a decline in fat free mass index (FFMi) similar to uninfected individuals. In an ageing HIV-infected cohort we aimed to describe the interaction between anthropometric changes of FFMi, leg fat % (surrogate of lipoatrophy), VAT/TAT (surrogate of lipohypertrophy) and lumbar BMD (surrogate for (O/O).

O’Neil, T; Ross, R; Zona, Stefano; Orlando, Gabriella; Carli, Federica; Garlassi, Elisa; Stentarelli, Chiara; Mussini, Cristina; Guaraldi, Giovanni ( 2012 ) - Combined use of waist and thigh circumference to identify high-risk,, abdominally obese HIV+ patients. - Abstract Supllement - International AIDS Society Geneve CHE) - JOURNAL OF THE INTERNATIONAL AIDS SOCIETY - n. volume 15(4) - pp. da 43 a 43 ISSN: 1758-2652 [Abstract in rivista (266) - Abstract in Rivista]
Abstract

We examined vhether the combination of waist (WC) and thigh (ThC) circumference improves the prediction of visceral adipose tissue (VAT) over WC and ThC independently in HIV-infected men and women after correction for age. We also examined the independent associations between VAT, and the combination of WC and ThC with metabolic risk facters, metabolic syndrome, type 2 diabetes mellitus and prior cardiovascular events in HIV-infected individuals.

G Guaraldi ( 2012 ) - Co-morbidity in relation to HIV-AIDS /COBRA [Altro (298) - Partecipazione a progetti di ricerca]
Abstract

G Orlando;G Guaraldi;S Zona;F Carli;P Bagni;M Meschiari;S Cocchi;R Scaglioni ;G Ligabue;P Raggi ( 2012 ) - Ectopic fat is linked to prior cardiovascular events in men with HIV. - JOURNAL OF ACQUIRED IMMUNE DEFICIENCY SYNDROMES - n. volume 59(5) - pp. da 494 a 497 ISSN: 1525-4135 [Articolo in rivista (262) - Articolo su rivista]
Abstract

Epicardial Adipose Tissue (EAT) has been associated with adverse cardiovascular events in the general population. We studied the association of general adiposity measures (body mass index, waist circumference) and ectopic adipose tissue [visceral adipose tissue (VAT); liver fat (LF); EAT) with prevalent cardiovascular disease (CVD) (prior myocardial infarction, coronary revascularization, stroke, peripheral vascular disease] in 583 HIV-infected men. VAT, EAT, and LF (liver/spleen attenuation ratio < 1.1) were measured by computed tomography. Patients' mean age was 48.5 ± 8.1 years, prior CVD was present in 33 (5.7%) patients. Factors independently associated with CVD on multivariable analyses were age [incidence-rate ratio (IRR) = 1.07, 95% confidence interval (CI): 1.02 to 1.12], smoking (IRR = 2.70, 95% CI: 1.22 to 6.01), Center for Disease Control group C (IRR = 3.09, 95% CI: 1.41 to 6.76), EAT (IRR = 1.13, 95% CI: 1.04 to 1.24, per 10 cm), LF (IRR = 1.17, 95% CI: 1.04 to 1.32), and VAT (IRR = 1.05, 95% CI: 1.00 to 1.10, per 10 cm). Ectopic fat but not general adiposity measures were associated with prevalent CVD in men with HIV.

M Ferrara; A Umlauf; C Fitzsimons; JM Meyer; NA Duarte; G Guaraldi; JH Atkinson; I Grant; RJ Ellis; Charter Study Group ( 2012 ) - Effect of second generation antipsychotics on metabolic variables in HIV-infected adults on long-term antiretroviral therapy. - Programme & Abstracts - ANTIVIRAL THERAPY - n. volume 17 [Abstract in rivista (266) - Abstract in Rivista]
Abstract

Psychiatric disorders are common among HIV-infected adults, but there are no published data on the metabolic side effects of concurrent use of second generation antipsychotics with antiretroviral therapy.

Lazzaretti C; Borghi V; Franceschini E; Guaraldi G; Mussini C ( 2012 ) - Engagement and retention in care of patients diagnosed with HIV infection and enrolled in the Modena HIV surveillance cohort. - Abstract Supplement - International AIDS Society Geneve CHE) - JOURNAL OF THE INTERNATIONAL AIDS SOCIETY - n. volume 15 (4) - pp. da 73 a 74 ISSN: 1758-2652 [Abstract in rivista (266) - Abstract in Rivista]
Abstract

Engagement and retention in care is one of the main aspects not only for the prognosis of the single patient, but also for the treatment as prevention strategy. Aim of our study was to evaluatethe engagement in care after diagnosis and the percentage of viral load suppression in an Italian Public Health System.

S. Zona; G. Guaraldi; K. Luzi; M. Beggi; D. Santi; C. Stentarelli; B. Madeo; V. Rochira ( 2012 ) - Erectile dysfunction is more common in young to middle-aged HIV-infected men than in HIV-uninfected men. - JOURNAL OF SEXUAL MEDICINE - n. volume 9 - pp. da 1923 a 1930 ISSN: 1743-6095 [Articolo in rivista (262) - Articolo su rivista]
Abstract

Introduction. The penis has been compared to a barometer of endothelial health, erectile dysfunction (ED) being an early sign of endothelial dysfunction. Aim. The aim of the study was to investigate the extent of the association between ED and endothelial dysfunction in patients with human immunodeficiency virus (HIV) infection on antiretroviral therapy. Methods. In this observational cross-sectional study, we evaluated the prevalence and factors associated with ED in a cohort of 133 HIV-infected men. Main Outcome Measures. The International Index of Erectile Function, ultrasound assessment of brachial artery flow mediated dilatation (FMD), and multi-slice computed tomography for coronary artery calcifications (CAC) as surrogates of endothelial dysfunction, the Adult Treatment Panel III criteria to diagnose metabolic syndrome (MS), plasma total testosterone (hypogonadism), and a visual analogue scale (VAS) of aesthetic satisfaction of the face and of the body (psychological distress associated with lipodystrophy). Results. Thirty-nine (29.32%) patients had mild ED, 14 (10.52%) patients had moderate ED, and 26 (19.55%) patients had severe ED. Prevalence of ED ranged from 45% to 65%, respectively, in patients less than 40 and more than 60 years old. MS was present in 20 (25%) patients with ED and 13 (24%) patients without ED (P value = 0.87). Prevalence of ED neither appeared to be associated with MS as a single clinical pathological entity nor with the numbers of its diagnostic components. FMD < 7% was present in 25 (32%) patients with ED and 18 (33%) patients without ED (P value = 0.83), and CAC > 100 was present in 8 (10%) patients with ED and 5 (9%) patients without ED (P value = 0.87). A stepwise multivariable logistic regression analysis was used to find predictors of ED. Independent predictors were VAS face (odds ratio [OR] = 0.85, 95% confidence interval [CI] 0.73–0.99, P = 0.049) and age per 10 years of increase (OR = 1.73, 95% CI 1.02–2.94, P = 0.04). Conclusions. Age constituted the most important risk factor for ED, which was related to aesthetic dissatisfaction of the face leading to negative body image perception.

Guaraldi G; Beggi M; Zona S; Luzi K; Orlando G; Carli F; Ligabue G; Rochira V; Rossi R; Modena MG; Bouloux P. ( 2012 ) - Erectile Dysfunction Is Not a Mirror of Endothelial Dysfunction in HIV-Infected Patients. - JOURNAL OF SEXUAL MEDICINE - n. volume 9 - pp. da 1114 a 1121 ISSN: 1743-6095 [Articolo in rivista (262) - Articolo su rivista]
Abstract

Introduction.  The penis has been compared to a barometer of endothelial health, erectile dysfunction (ED) being an early sign of endothelial dysfunction. Aim.  The aim of the study was to investigate the extent of the association between ED and endothelial dysfunction in patients with human immunodeficiency virus (HIV) infection on antiretroviral therapy. Methods.  In this observational cross-sectional study, we evaluated the prevalence and factors associated with ED in a cohort of 133 HIV-infected men. Main Outcome Measures.  The International Index of Erectile Function, ultrasound assessment of brachial artery flow mediated dilatation (FMD), and multi-slice computed tomography for coronary artery calcifications (CAC) as surrogates of endothelial dysfunction, the Adult Treatment Panel III criteria to diagnose metabolic syndrome (MS), plasma total testosterone (hypogonadism), and a visual analogue scale (VAS) of aesthetic satisfaction of the face and of the body (psychological distress associated with lipodystrophy). Results.  Thirty-nine (29.32%) patients had mild ED, 14 (10.52%) patients had moderate ED, and 26 (19.55%) patients had severe ED. Prevalence of ED ranged from 45% to 65%, respectively, in patients less than 40 and more than 60 years old. MS was present in 20 (25%) patients with ED and 13 (24%) patients without ED (P value = 0.87). Prevalence of ED neither appeared to be associated with MS as a single clinical pathological entity nor with the numbers of its diagnostic components. FMD < 7% was present in 25 (32%) patients with ED and 18 (33%) patients without ED (P value = 0.83), and CAC > 100 was present in 8 (10%) patients with ED and 5 (9%) patients without ED (P value = 0.87). A stepwise multivariable logistic regression analysis was used to find predictors of ED. Independent predictors were VAS face (odds ratio [OR] = 0.85, 95% confidence interval [CI] 0.73-0.99, P = 0.049) and age per 10 years of increase (OR = 1.73, 95% CI 1.02-2.94, P = 0.04). Conclusions.  Age constituted the most important risk factor for ED, which was related to aesthetic dissatisfaction of the face leading to negative body image perception. Guaraldi G, Beggi M, Zona S, Luzi K, Orlando G, Carli F, Ligabue G, Rochira V, Rossi R, Modena MG, and Bouloux P. Erectile dysfunction is not a mirror of endothelial dysfunction in HIV-infected patients.

D Gotti; B M Cesana; L Albini; A Calabresi; D Motta; R Bellagamba; L Sighinolfi; P Maggi; G Guaraldi; C Torti ( 2012 ) - Evolution of Serum Lipids and High-density Lipoprotein Particle Subclasses in HIV+ Patients during Tenofovir in Combination with Atazanavir/ritonavir or Efavirenz - Program and Abstracts - Conference on Retroviruses and Opportunistic Infections(CROI) Alexandria USA) - n. volume na - pp. da 403 a 403 ISBN: 0985284811 ISSN: - [Abstract in Atti di convegno (274) - Abstract in Atti di Convegno]
Abstract

Cardiovascular diseases are partially related to serum lipid alterations over the course of ART. Moreover, lipoprotein-particle subclasses may exert an additional effect and this may be correlated with inflammatory status and endothelial damage.

G. Brigante; C. Diazzi; G. Guaraldi; M. De Santis; L. Roli; V. Rochira; E. Baraldi ( 2012 ) - GH response to GHRH plus Arginine in lipodistrophic patients with human immunodeficiency virus: gender differences - Ligand Assay 2012, Relazioni e Poster - Biomedia Milano, Italia ITA) - LIGANDASSAY - n. volume 17(2) - pp. da 200 a 200 ISSN: - [Abstract in rivista (266) - Abstract in Rivista]
Abstract

GH deficiency is more frequent in men with HIV than in HIV-infected women

L. Zirilli; G. Orlando; F. Carli; B. Madeo; S.Cocchi; C. Diazzi; C. Carani; G. Guaraldi; V. Rochira ( 2012 ) - GH response to GHRH plus arginine is impaired in lipoatrophic women with human immunodeficiency virus compared with controls - EUROPEAN JOURNAL OF ENDOCRINOLOGY - n. volume 166 - pp. da 415 a 424 ISSN: 0804-4643 [Articolo in rivista (262) - Articolo su rivista]
Abstract

Objective: GH secretion is impaired in lipodystrophic human immunodeficiency virus (HIV) patients and inversely related to lipodystrophy-related fat redistribution in men. Less is known about the underlying mechanisms involved in reduced GH secretion in HIV-infected women.Design: A case–control, cross-sectional study comparing GH/IGF1 status, body composition, and metabolic parameters in 92 nonobese women with HIV-related lipodystrophy and 63 healthy controls matched for age, ethnicity, sex, and body mass index (BMI).Methods: GH, IGF1, IGF binding protein 3 (IGFBP3), GH after GHRH plus arginine (GHRHCArg), several metabolic variables, and body composition were evaluated.Results: GH response to GHRHCArg was lower in HIV-infected females than in controls. Using a cutoff of peak GH %7.5 mg/l, 20.6% of HIV-infected females demonstrated reduced peak GH response after GHRHCArg. In contrast, none of the control subjects demonstrated a peak GH response %7.5 mg/l. Bone mineral density (BMD), quality of life, IGF1, and IGFBP3 were lowest in the HIV-infected females with a GH peak %7.5 mg/l. BMI was the main predictive factor of GH peak in stepwise multiregression analysis followed by age, with a less significant effect of visceral fat in the HIV-infected females. Conclusions: This study establishes that i) GH response to GHRHCArg is lower in lipoatrophic HIV- infected women than in healthy matched controls, ii) BMI more than visceral adipose tissue or trunk fat influences GH peak in this population, and iii) HIV-infected women with a GH peak below or equal to 7.5 mg/l demonstrate reduced IGF1, IGFBP3, BMD, and quality of life.

M. Pignatti; A. Pedone; A. Baccarani; G. Guaraldi; G. Orlando; M. Lombardi; G. De Santis ( 2012 ) - High-density hyaluronic acid for the treatment of HIV-related facial lipoatrophy - AESTHETIC PLASTIC SURGERY - n. volume 36 - pp. da 180 a 185 ISSN: 0364-216X [Articolo in rivista (262) - Articolo su rivista]
Abstract

BACKGROUND: Facial lipoatrophy is a stigmatizing hallmark of HIV. The injection of facial fillers has an essential role in the treatment of this condition. The objective of our study was to verify the safety and efficacy of a new formulation of high-density hyaluronic acid for the injectable treatment of HIV-related facial lipoatrophy.METHODS: We treated with high-density hyaluronic acid injections HIV patients affected by moderate to severe facial lipoatrophy and evaluated them at last follow-up, at a minimum of 36 weeks. Physician-related outcomes included pre-and post-treatment ultrasound measurement of the soft-tissue thickness of the cheeks and qualitative assessment of aesthetic results by means of the Global Aesthetic Improvement Scale using pre- and post-treatment photos of the patients. Patient satisfaction outcomes were evaluated with the VAS-face scale and Freiburg test.RESULTS: Fifty-four patients were studied. The median number of treatment sessions was 3 and the median length of treatment was 5.5 months. The thickness of the soft tissues of the cheek increased significantly from 9.45 to 13.12 mm (p < 0.0001). On the basis of the Global Aesthetic Improvement Scale, 87.5% of the patients were judged as "much improved" or "improved." Patient satisfaction at 1 year from the end of treatment was proven (VAS-face: 77.9; Freiburg questionnaire: 93.6% of patients were satisfied or very satisfied). Complications were limited to mild redness and swelling in the early postoperative period.CONCLUSION: Long-term improvement of facial contour and excellent patient satisfaction, in the absence of severe side effects, were obtained by the injection of high-density hyaluronic acid (STYLAGE(®) XL) in HIV patients with facial lipoatrophy.

M. Pignatti;A. Pedone;A. Baccarani;G. Guaraldi;G. Orlando;M. Lombardi; De Santis G. ( 2012 ) - High-density hyaluronic acid for the treatment of HIV-related facial lipoatrophy. - AESTHETIC PLASTIC SURGERY - n. volume 36 - pp. da 180 a 185 ISSN: 0364-216X [Articolo in rivista (262) - Articolo su rivista]
Abstract

Facial lipoatrophy is a stigmatizing hallmark of HIV. The injection of facial fillers has an essential role in the treatment of this condition. The objective of our study was to verify the safety and efficacy of a new formulation of high-density hyaluronic acid for the injectable treatment of HIV-related facial lipoatrophy.We treated with high-density hyaluronic acid injections HIV patients affected by moderate to severe facial lipoatrophy and evaluated them at last follow-up, at a minimum of 36 weeks. Physician-related outcomes included pre-and post-treatment ultrasound measurement of the soft-tissue thickness of the cheeks and qualitative assessment of aesthetic results by means of the Global Aesthetic Improvement Scale using pre- and post-treatment photos of the patients. Patient satisfaction outcomes were evaluated with the VAS-face scale and Freiburg test.Fifty-four patients were studied. The median number of treatment sessions was 3 and the median length of treatment was 5.5 months. The thickness of the soft tissues of the cheek increased significantly from 9.45 to 13.12 mm (p<0.0001). On the basis of the Global Aesthetic Improvement Scale, 87.5\% of the patients were judged as "much improved" or "improved." Patient satisfaction at 1 year from the end of treatment was proven (VAS-face: 77.9; Freiburg questionnaire: 93.6\% of patients were satisfied or very satisfied). Complications were limited to mild redness and swelling in the early postoperative period.Long-term improvement of facial contour and excellent patient satisfaction, in the absence of severe side effects, were obtained by the injection of high-density hyaluronic acid (STYLAGE® XL) in HIV patients with facial lipoatrophy.

G.Guaraldi; R. Montalti ( 2012 ) - Il Follow Up post trapianto di fegato nelle persone con HIV. - READ FILES - n. volume 13 - pp. da 10 a 16 ISSN: - [Articolo in rivista (262) - Articolo su rivista]
Abstract

Esiste una specificità relativa al paziente con infezione da HIV nella gestione del follow up post trapianto di fegato? Per rispondere a questa domanda viene presentata l'esperienza italiana raccolta dal Centro Nazionale Trapianti e, più in dettaglio, gli outcome trapiantologici dei pazienti con infezione da HIV seguiti dal Centro Trapianti dell'Azienda Policlinico di Modena.

Gotti D; Cesana BM; Albini L; Calabresi A; Izzo I; Focà E; Motta D; Bellagamba R; Fezza R; Narciso P; Sidhinolfi L; Maggi P; Brianese N; Quiros-Roldan E; Guaraldi G; Torti C. ( 2012 ) - Increase in Standard Cholesterol and Large HDL Particle Subclasses in Antiretroviral-Naïve Patients Prescribed Efavirenz Compared to Atazanavir/Ritonavir. - HIV CLINICAL TRIALS - n. volume 13(5) - pp. da 245 a 255 ISSN: 1528-4336 [Articolo in rivista (262) - Articolo su rivista]
Abstract

Background: Cardiovascular risk in HIV-infected patients is related, at least in part, to serum lipid alterations before and after HAART. Lipoprotein-particle subclasses may also have an effect, but comparative data after standard HAART regimens are limited.Methods: This was a substudy of a trial in 91 antiretroviral-naïve patients randomized to tenofovir + emtricitabine + atazanavir/ritonavir (ATV/r) or efavirenz (EFV). Over-time trends from baseline to week 48 in total cholesterol (TC), triglycerides (TG), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), HDL particles (HDLp), and TC:HDL-C and TG:HDL-C ratios were analyzed by analysis of covariance (ANCOVA). Furthermore, confidence intervals for differences between the 2 groups at week 48 were calculated. Indications for lipid-lowering interventions and low HDL-C were also studied.Results: ANCOVA showed that, with respect to patients receiving ATV/r, those prescribed efavirenz (EFV) had greater increases reported as mean differences in lipid values at week 48: 14 mg/dL (95% CI, 0.2 to 27) for TC, 14 mg/dL (95% CI, 4 to 25) for LDL-C, 5 mg/dL (95% CI, 2 to 9) for HDL-C, and 2.2 mg/dL (95% CI, 0.4 to 4) for large HDLp. Proportions of subjects with indications for lipid-lowering interventions and with HDL-C <40 mg/dL did not differ significantly.Conclusions: Patients prescribed EFV had greater increases in TC, LDL-C, and HDL-C. Although no significant differences were detected between the 2 groups for the TC:HDL ratio and for indications to start lipid-lowering interventions, large HDLp increased more in the EFV group compared to the ATV/r group, suggesting a protective effect associated with EFV use.

K Luzi; GM Bellistri; S Zona; AR Domingues da Silva; F Bai; G Orlando; F Carli; A d’Arminio Monforte; G Marchetti; G. Guaraldi ( 2012 ) - Lipodistrophy and ectopic adipose tissue are associated with activated immune phenotype in HIV-infected patients on virologically suppressive ART. - 14th International Workshop on Adverse Drug Reactions and Co-morbidities in HIV - ANTIVIRAL THERAPY - n. volume 17 [Abstract in rivista (266) - Abstract in Rivista]
Abstract

The aim of the study was to describe the association between clinical lipodystrophy and ectopic fat measurements with peripheral activated/differentiated T-cell phenotype and IL-7/IL-7R system. Visceral and epicardial fat measurements were explored in the association to T2DM and CVD risk

G. De Santis; M. Pignatti; A. Baccarani; A. Pedone; A. Spaggiari; G. Orlando; G. Guaraldi ( 2012 ) - Long-term efficacy and safety of polyacrylamide hydrogel injection in the treatment of human immunodeficiency virus-related facial lipoatrophy: a 5-year follow-up. - PLASTIC AND RECONSTRUCTIVE SURGERY - n. volume 129(1) - pp. da 101 a 109 ISSN: 0032-1052 [Articolo in rivista (262) - Articolo su rivista]
Abstract

BACKGROUND: Facial lipoatrophy, a human immunodeficiency virus-related wasting of the facial soft tissues, can compromise patients' quality of life. Injection of different materials in the cheeks can improve this condition. Concern regarding potential long-term complications of nonbiodegradable fillers remains. The authors investigated the long-term efficacy and safety of polyacrylamide gel injections.METHODS: Human immunodeficiency virus-infected patients treated with polyacrylamide gel for moderate to severe facial lipoatrophy with a minimum of 5 years' follow-up were included. Aquamid (1 ml) was injected monthly into each cheek until adequate correction was obtained. Outcome measures were ultrasound measurement of cheek soft-tissues thickness, evaluation of aesthetic improvement, and self-evaluation of satisfaction and psychological consequences of treatment (visual analogue scale for the face, Assessment of Body Change and Distress questionnaire, and Beck Depression Inventory score). Adverse events were classified as acute (<1 week), early (1 week to 1 month), midterm (1 month to 1 year), or late (>1 year).RESULTS: One hundred forty-one patients completed the treatment as of June of 2005; 38 (32 men; mean age, 42 years) were available for follow-up of more than 5 years (mean, 62 months). The mean number of treatment sessions was seven over a mean period of 8 months. Significant improvement of cheek thickness and aesthetic result and highly significant satisfaction and psychological improvement were obtained. No serious adverse events occurred during the follow-up period.CONCLUSION:The long-term efficacy and safety of polyacrylamide gel injection for the treatment of human immunodeficiency virus-related facial lipoatrophy were shown over a period of 5 years. CLINICAL QUESTION/LEVEL OF EVIDENCE:: Therapeutic, IV.

G Guaraldi; S Zona; A Silva; G Orlando; F Carli; A Santoro; N Crupi; G Ligabue; C Mussi; L Ferruci ( 2012 ) - Low Muscle Mass in HIV+ Patients: Prevalence, Predictors, and Clinical Implication. - Program & Abstracts - Conference on Retroviruses and Opportunistic Infections(CROI) Alexandria USA) - n. volume na - pp. da 409 a 409 ISBN: 0985284811 ISSN: - [Abstract in Atti di convegno (274) - Abstract in Atti di Convegno]
Abstract

In HIV+ patients, muscle mass measured as fat free mass index (FFMi = FFM/h2) in DXA has never been characterized in large epidemiological cohorts. We aimed: to describe the prevalence of low muscle mass using t- and z-score, per age decades, defined as <–2 SD from the mean FFMi for an Italian Caucasian population, respectively, for the same age or in the age strata 30 to 39 years; to identify predictors of FFMi change; and to assess the association between FFMi and all-cause mortality in a large HIV+ cohort.

Guaraldi G;Besutti G;Stentarelli C;Zona S;Nocetti L;Loria P;Ballestri S;Losi L;Torricelli P;Ligabue G ( 2012 ) - Magnetic resonance for quantitative assessment of liver steatosis: a new potential tool to monitor antiretroviral-drug-related toxicities. - ANTIVIRAL THERAPY - n. volume 17 - pp. da 965 a 971 ISSN: 1359-6535 [Articolo in rivista (262) - Articolo su rivista]
Abstract

BACKGROUND: There is an increasing need for new diagnostic tools to monitor antiretroviral drug-related toxicities. Magnetic resonance (MR) imaging and MR spectroscopy are non-invasive diagnostic methods used in the detection and quantification of liver fat. The aim of this study was to compare sensitivity and specificity of different MR techniques in the quantitative assessment of liver steatosis, using liver biopsy as the reference standard, in patients with and without HIV infection.METHODS: Sequentially evaluated patients with suspected steatosis who were referred for liver biopsy at our tertiary care site were eligible. MR liver fat content (LFC) was estimated by T2-weighted and fat-suppressed T2-weighted spin-echo, dual-phase T1-weighted gradient-echo, multiecho gradient-echo and (1)H spectroscopy. Association between LFC and histological steatosis percentage was calculated by using univariate linear regressions and Pearson's coefficient. Respective receiver operating characteristic (ROC) curves were used to compare specificity and sensitivity of MR methods in diagnosis (cutoff 5%) and in quantitative evaluation (cutoff 33%) of steatosis.RESULTS: A total of 28 patients were identified: 12 refused or had contraindications for liver biopsy and 16 had biopsies plus MR. LFC and histological steatosis percentage were strongly associated (fat-suppressed r=0.86 [P<0.001], dual-phase r=0.88 [P<0.001], multiecho r=0.95 [P<0,001] and spectroscopy r=0.84 [P=0.01]). MR techniques had high sensitivity and specificity in diagnosis and quantitative assessment of steatosis (areas under ROC curves ranging from 0.88 to 0.98).CONCLUSIONS: This pilot study confirms that MR may be a sensitive non-invasive alternative to biopsy for the quantitative assessment of liver fat and a potential end point to monitor antiretroviral-drug-related toxicities.

Guaraldi G; Garlassi E; Stentarelli C; Menozzi M; Zona S; Santoro A; Borderi M; Madeddu G; Vescini F; Mussini C. ( 2012 ) - Menopause in HIV-infected women: somewhat different? - Reviews in Antiviral Therapy & Infectious Diseases - Virology Education Utrecht NLD) - n. volume 9 - pp. da 27 a 28 ISBN: 9780000000002 ISSN: - [Abstract in Atti di convegno (274) - Abstract in Atti di Convegno]
Abstract

Menopause is a physiological aging, process. This complex biological process, involving both physical and psychological health, appears to be an appropriate setting where to study aging in people living with HIV. Some studies have found that HIV was independently associated with earlier onset of menopause. Little is known on menopausal symptoms in HIV infected women. The objective was to describe prevalence of clinical diagnosed comorbidities, polypathology, and patient related outcomes domains in HIV infected patients on menopause.

S. Zona; P. Raggi; P. Bagni; G. Orlando; F. Carli; G. Ligabue; R. Scaglioni; R. Rossi; M.G. Modena; G. Guaraldi. ( 2012 ) - Parallel increase of subclinical atherosclerosis and epicardial adipose tissue in patients with HIV. - AMERICAN HEART JOURNAL - n. volume 2012 Jun;163(6) - pp. da 1024 a 1030 ISSN: 0002-8703 [Articolo in rivista (262) - Articolo su rivista]
Abstract

BACKGROUND: Epicardial adipose tissue (EAT) may contribute to the development of coronary atherosclerosis via paracrine secretion of inflammatory cytokines.METHODS: This is a prospective, observational study of 240 consecutive HIV-infected patients receiving antiretroviral therapy. All patients underwent 2 sequential chest computed tomographic scans to assess the change in coronary artery calcium (CAC), a marker of subclinical atherosclerosis, and EAT volume. Patients with known cardiovascular disease were excluded. Factors independently associated with EAT change were explored using multivariable linear regression analyses. The association between EAT increase and CAC progression was explored using logistic regression analyses.RESULTS: Two hundred forty patients were included. Patients' mean age was 47.5 ± 8 years, and 68% were men. The median interval between computed tomographic scans was 18.7 months (interquartile range 10-27 months). Men showed a larger increase in EAT (5 ± 14.2 cm(3)) than did women (-0.45 ± 8.8 cm(3), P = .007). Factors independently associated with change in EAT were CD4(+) recovery (β = 0.43, CI 0.05-0.82) and male gender (β = 5.65, CI, 1.05-10.26). Change in EAT was independently associated with CAC progression (odds ratio 1.04, 95% CI 1.004-1.88, P = .030) after adjusting for traditional cardiovascular risk factors.CONCLUSIONS: In this cohort of patients with HIV receiving antiretroviral therapy, male gender and CD4(+) were independent predictors of EAT increase, and there was a parallel progression of CAC and EAT. Abnormal immunoreactivity associated with T-lymphocyte recovery should be further studied as a determinant of atherosclerosis progression in HIV-infected patients.

B. Madeo; D. Santi; S. Zona; G. Guaraldi; A. Granata; C. Carani; V. Rochira. ( 2012 ) - Prevalence of Erectile Dysfunction Is Greater in Young Middle-Aged HIV-Infected Men Than in HIV-Uninfected Men - The 94th Annual Meeting of the Endocrine Society ENDO2012 - Endocrine Society / Maryland:8401 Connecticut Avenue, Suite 900:Chevy Chase, MD 20815:(301)941-0200, (301)941-0200, (301)941-0232, EMAIL: journals@endo-society.org, INTERNET: http://www.endo.society.org, Fax: (301)941-0259 Bethesda, MAryland USA USA) - ENDOCRINE REVIEWS - n. volume 33 [Abstract in rivista (266) - Abstract in Rivista]
Abstract

Erectile dysfunction is more frequent in men living with HIV than in HIV-uninfected men. Erectile function is impaired in men with HIV even at a young age.

Bruno Madeo; Daniele Santi; Stefano Zona; Giovanni Guaraldi; Vincenzo Rochira ( 2012 ) - Prevalence of Erectile Dysfunction is greater in young middle-aged HIV-infected Men than in HIV-uninfected Men - 15th International Congress of Endocrinology and 14th European Congress of Endocrinology (ICE/ECE 2012) - Bioscientifica Limited:22 Apex Court, Woodlands, Bradley, Bristol BS32 4JT United Kingdom:011 44 1454 619036, EMAIL: sales@endocrinology.org, INTERNET: http://www.endocrinology.org, Fax: 011 44 1454 616071 Bristol, UK GBR) - ENDOCRINOLOGY ABSTRACTS - n. volume 29 [Abstract in rivista (266) - Abstract in Rivista]
Abstract

The study investigates the prevalence of erectile dysfunction in men with HIV infection in comparison with normal healthy men. Erectile dysfunction seems to be more prevalent in HIV and seems to occur at a younger age.

G. Guaraldi; S. Zona; G. Orlando; F. Carli; G. Ligabue; F. Fiocchi; R. Rossi; M.G. Modena; P. Raggi ( 2012 ) - Progression of coronary artery calcium in men affected by human immunodeficiency virus infection. - INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING - n. volume 28(4) - pp. da 935 a 941 ISSN: 1569-5794 [Articolo in rivista (262) - Articolo su rivista]
Abstract

Cardiovascular risk is increased in HIV infected patients. We assessed progression of coronary artery calcium (CAC) in patients with HIV infection to identify factors that may help explain progression of atherosclerosis. Prospective, observational study of 132 HIV-infected men receiving chronic antiretroviral therapy (ART); we measured traditional atherosclerosis risk factors and assessed progression of CAC on sequential 64-slice CT scans at an average interval of 11 months (range 6–36). CAC score progression was defined as absolute and percentage change from baseline. During follow-up 45 patients (34%) showed absolute progression of CAC and 34 of them showed >15% yearly progression, a threshold previously associated with a high risk of myocardial infarction. Age, LDL cholesterol, visceral abdominal fat and current T-helper (CD4+) cell count were significantly associated with absolute CAC progression. Progression of subclinical atherosclerosis in HIV patients is associated with traditional coronary risk factors as well as HIV related factors such as the CD4+ cell count. Therefore, immunologic perturbations secondary to HIV infection may contribute to atherosclerosis progression.

L. E. Weimer;V. Fragola;M. Floridia;G. Guaraldi;N. Ladisa;D. Francisci;R. Bellagamba;A. Degli Antoni;G. Parruti;A. Giacometti;P. E. Manconi;A. Vivarelli;G. D'Ettorre;M. S. Mura;S. Cicalini;R. Preziosi;L. Sighinolfi;G. Verucchi;R. Libertone;M. Tavio;L. Sarmati;R. Bucciardini ( 2012 ) - Response to raltegravir-based salvage therapy in HIV-infected patients with hepatitis C virus or hepatitis B virus coinfection - JOURNAL OF ANTIMICROBIAL CHEMOTHERAPY - n. volume 68(1) - pp. da 193 a 199 ISSN: 0305-7453 [Articolo in rivista (262) - Articolo su rivista]
Abstract

OBJECTIVES: To define the impact of coinfection with hepatitis B virus (HBV) or hepatitis C virus (HCV) on viroimmunological response to raltegravir-based salvage regimens that also include new HIV inhibitors such as maraviroc, darunavir and etravirine. METHODS: We used data from a national observational study of patients starting raltegravir-based regimens to compare virological suppression and CD4 cell change from baseline in patients with and without concomitant HBV or HCV infection. RESULTS: Overall, 275 patients (107 coinfected and 168 non-coinfected) were evaluated. Coinfected patients were more commonly former intravenous drug users and had a longer history of HIV infection and higher baseline aminotransferase levels. Both HIV-RNA and CD4 response were similar in the two groups. Mean time to first HIV-RNA copy number <50 copies/mL was 4.1 months (95% CI 3.5-4.6) in non-coinfected patients and 3.9 months (95% CI 3.3-4.5) in coinfected patients (hazard ratio 1.039, 95% CI 0.761-1.418, P = 0.766, log-rank test). The risk of developing new grade 3-4 hepatic adverse events was significantly higher in coinfected patients (hazard ratio 1.779, 95% CI 1.123-2.817, P = 0.009). The two groups of coinfected and non-coinfected patients had similar rates of interruption of any baseline drug (hazard ratio 1.075, 95% CI 0.649-1.781, P = 0.776) and of raltegravir (hazard ratio 1.520, 95% CI 0.671-3.447, P = 0.311). Few AIDS-defining events and deaths occurred. CONCLUSIONS: Viroimmunological response to regimens based on raltegravir and other recent anti-HIV inhibitors is not negatively affected by coinfection with HBV or HCV. Liver toxicity, either pre-existing or new, is more common in coinfected patients, but with no increased risk of treatment interruption.

G Guaraldi ( 2012 ) - Soft tissue fillers in the treatment of HIV-associated facial lipoatrphy - EUROPEAN INFECTIOUS DISEASE - n. volume 5 - pp. da 80 a 82 ISSN: 1755-1137 [Articolo in rivista (262) - Articolo su rivista]
Abstract

HIV-associated facial lipoatrophy is a stigmatising side effect to the use of the thymidine analogue drugs and affects more than 50% of HIV infected individuals on HAART. At present the most successful treatment options consist of aesthetic procedures; either autologous fat transfer or injection of soft tissue gel fillers, which can be biodegradable or permanent. In this article we summarise the advantages and disadvantages of different treatment strategies with special focus on the soft tissue fillers. Several clinical studies ahve recently published in-depth data on the long-term safety and aesthetic durability of using the permanent gel filler Aquamid. They demonstratethat Aquamid is a safe, durable and fully biocompatible product with very high patient satisfaction, a convincing option in the treatment of HIV-associated lipoatrophy.

Cossarizza, A; Bertoncelli, L; Nemes, E; Lugli, E; Pinti, M; Nasi, M; De Biasi, S; Gibellini, L; Montagna, Jp; Vecchia, M; Manzini, L; Meschiari, M; Borghi, V; Guaraldi, G; Mussini, C. ( 2012 ) - T cell activation but not polyfunctionality after primary HIV infection predicts control of viral load and length of the time without therapy. - PloS one - PLOS ONE - n. volume 7 - pp. da 1 a 10 ISSN: 1932-6203 [Articolo in rivista (262) - Articolo su rivista]
Abstract

Immune changes occurring after primary HIV infection (PHI) have a pivotal relevance. Our objective was to characterize the polyfunctionality of immune response triggered by PHI, and to characterize immune activation and regulatory T cells, correlating such features to disease progression. PATIENTS AND METHODS: We followed 11 patients experiencing PHI for 4 years. By polychromatic flow cytometry, we studied every month, for the first 6 months, T lymphocyte polyfunctionality after cell stimulation with peptides derived from HIV-1 gag and nef. Tregs were identified by flow cytometry, and T cell activation studied by CD38 and HLA-DR expression. RESULTS: An increase of anti-gag and anti-nef CD8+ specific T cells was observed 3 months after PHI; however, truly polyfunctional T cells, also able to produce IL-2, were never found. No gross changes in Tregs were present. T lymphocyte activation was maximal 1 and 2 months after PHI, and significantly decreased in the following period. The level of activation two months after PHI was strictly correlated to the plasma viral load 1 year after infection, and significantly influenced the length of period without therapy. Indeed, 80% of patients with less than the median value of activated CD8+ (15.5%) or CD4+ (0.9%) T cells remained free of therapy for >46 months, while all patients over the median value had to start treatment within 26 months. CONCLUSIONS: T cell activation after PHI, more than T cell polyfunctionality or Tregs, is a predictive marker for the control of viral load and for the time required to start treatment.

S Zona; F Vescini; A Silva; C Berardi; G Orlando; F Carli; M Menozzi; A Santoro; C Mussini; G Guaraldi ( 2012 ) - Tenofovir accelerates bone mass loss of the lumbar spine in the first year of menopause in HIV infected women. - Programme & Abstracts - EuroCoord Bordeaux FRA) - n. volume na - pp. da 70 a 70 ISBN: 0985284811 ISSN: - [Abstract in Atti di convegno (274) - Abstract in Atti di Convegno]
Abstract

Menopause is a paradigm of physiological aging involving an impairement in bone metabolism. We hypothesized that in menopausal HIV infected women, Tenofovir exposure may contribute to a progressive Bone Mass Loss (BML). The aim of the study was to identify predictors of bone mineral density in HIV infected women entering menopause and to evaluate the bone mass loss after menopause.

Garlassi E; Zona S; Vescini F; Domingues da Silva A; Berardi C; Orlando G; Carli F; Menozzi M; Santoro A; Mussini C; Guaraldi G ( 2012 ) - Tenofovir accelerates bone mass loss of the lumbar spine in the first years of menopause in HIV infected women - Abstract Supplement - International AIDS Society Geneve CHE) - JOURNAL OF THE INTERNATIONAL AIDS SOCIETY - n. volume 15 (4) - pp. da 48 a 49 ISSN: 1758-2652 [Abstract in rivista (266) - Abstract in Rivista]
Abstract

HIV-infected postmenopausal women have higer rates of bone loss than HIV negative women. We aimed to identify predictors of body mass density (BMD) in HIV infected women entering menopause and to evaluate the pre- and post- menopausal BMD change, with regard to tenofovir use.

Guaraldi G; Garlassi E; Stentarelli C; Zona S; Vescini F; Mussi C; Orlando G; Carli F; Menozzi M; Santoro A; Mussini C ( 2012 ) - Tenofovir accelerates bone mass loss of the lumbar spine in the first years of menopause in HIV infected women. - Reviews in Antiviral Therapy & Infectious Diseases - Virology Education Utrecht NLD) - n. volume 9 - pp. da 9 a 9 ISBN: 9780000000002 ISSN: - [Abstract in Atti di convegno (274) - Abstract in Atti di Convegno]
Abstract

Previous studies haveshown that HIV-infected postmenopausal women have higer rates of bone loss than HIV negative women. No studies so far have analyzed the slope of bone loss across the menopausal transition period. We hypothesized that in HIV infected women BMD decreases in the postmenopausal period and Tenofovir exposure may contribute to this impairment. The aim of the study was to identify predictors of BMD in HIV infected women entering menopause and to evaluate the pre- and post- menopausal BMD change.

Guaraldi, Giovanni; Santoro, Antonella ( 2012 ) - The Aging Skeleton: Differences Between HIV-Infected Patients and the Uninfected Aging Population - CLINICAL REVIEWS IN BONE AND MINERAL METABOLISM - n. volume 10 (4) - pp. da 257 a 265 ISSN: 1534-8644 [Articolo in rivista (262) - Articolo su rivista]
Abstract

Osteoporosis is defined as a reduction in bone mass and disruption of bone architecture, resulting in reduced bone strength and increased fracture risk. Fractures show a steep age-related increase and have a major impact on the health of elderly. The objective of this review is to describe the aging skeleton as a paradigm of the biological aging process affecting patients with HIV infection. We will focus on the comparison between HIV infected and uninfected individuals with regards to risk factors for bone disease, fractures events and the association between bone diseases and other age related conditions. We will critically discuss the assessment for fracture risk in HIV infected patients and some management issue regarding this condition.

M. Floridia; M. Ravizza; G. Guaraldi; C. Pinnetti; P. Martinelli; E. Tamburrini ( 2012 ) - Use of Specific Antiretroviral Regimens Among HIV-Infected Women in Italy at Time of Conception: 2001-2011 - AIDS PATIENT CARE AND STDS - n. volume 26 (8) - pp. da 439 a 443 ISSN: 1087-2914 [Articolo in rivista (262) - Articolo su rivista]
Abstract

not available

Bucciardini R;D'Ettorre G;Baroncelli S;Ceccarelli G;Parruti G;Weimer LE;Fragola V;Galluzzo CM;Pirillo MF;Lucattini S;Bellagamba R;Francisci D;Ladisa N;Antoni AD;Guaraldi G;Manconi PE;Vullo V;Preziosi R;Cirioni O;Verucchi G;Floridia M;for the ISS-NIA study group ( 2012 ) - Virological failure at one year in triple-class experienced patients switching to raltegravir-based regimens is not predicted by baseline factors - INTERNATIONAL JOURNAL OF STD & AIDS - n. volume 23 (7) - pp. da 459 a 463 ISSN: 0956-4624 [Articolo in rivista (262) - Articolo su rivista]
Abstract

We evaluated rates and determinants of virological failure in triple-class experienced patients receiving raltegravir-based regimens from a national observational study over 48 weeks, defined by any one of the following: (1) no HIV-RNA suppression to undetectable levels (<50 copies/mL) during follow-up; (2) detectable viral load after obtaining undetectable levels; and (3) leaving the study before 48 weeks. Among 101 eligible patients, 26 (25.7%; 95% CI 17.2-34.2) had virological failure. No significant differences between patients with and without virological failure were observed for gender, age, route of transmission, baseline CD4/HIV-RNA, CDC group, hepatitis B or C co-infections, resistance (based on the last genotype available), type and number of concomitant drug classes, concomitant use of darunavir, atazanavir, etravirine, enfuvirtide or maraviroc, and health-related quality-of-life measures. A high rate of treatment response was observed. The analyses did not identify any baseline factor associated with failure, including resistance status. Even if we cannot exclude the presence of pre-existing minority resistant variants not captured by genotypic tests, the lack of baseline predictors of failure suggests the need to monitor patients closely during follow up for other factors, such as potential drug interactions and reduced levels of adherence, which may favour virological failure.

Guaraldi, Giovanni; Zona, Stefano; Cossarizza, Andrea; Vernacotola, L.; Carli, Federica; Lattanzi, A.; Beghetto, Barbara; Orlando, Gabriella; Termini, R.; Garau, M. ( 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. - Abstracts - ANTIVIRAL THERAPY - n. volume 16 [Abstract in rivista (266) - Abstract in Rivista]
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.

L. Albini; B.M. Cesana; D. Motta; E. Focà; D. Gotti; A. Calabresi; I. Izzo; R. Bellagamba; R. Fezza; P. Narciso; L. Sighinolfi; P. Maggi; E. Quiros-Roldan; L. Manili; G. Guaraldi; G. Lapadula; C. Torti ( 2011 ) - A randomized, pilot trial to evaluate glomerular filtration rate by creatinine or cystatin C in naïve HIV-infected patients after tenofovir/emtricitabine in combination with atazanavir/ritonavir or efavirenz. - JOURNAL OF ACQUIRED IMMUNE DEFICIENCY SYNDROMES - n. volume 59 - pp. da 18 a 30 ISSN: 1525-4135 [Articolo in rivista (262) - Articolo su rivista]
Abstract

BACKGROUND: Glomerular filtration rate (GFR) estimated by Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation based on creatinine or cystatine C may be more accurate methods especially in patients without chronic kidney disease. There is lack of data on GFR estimated by these methods in patients on HAART.METHODS: Antiretroviral-naïve HIV-infected patients were randomized to TDF/emtricitabine (FTC) in association with ATV/r or EFV. Patients had to have an actual creatinine clearance >50 ml/min (24 hour urine collection) and were followed for 48 weeks.RESULTS: Ninety-one patients (48 ATV/r, 43 EFV) were recruited. Using the CKD-EPI creatinine formula, there was a significant decrease in GFR up to week 48 in patients receiving ATV/r (4.9 mL/min/m; P =0.02) compared to a not statistically significant increment in patients prescribed EFV. Using the cystatin C-based equation, we found greater decrease in GFR in both arms, although, in the EFV arm, the decrease was not statistically significant (5.8 mL/min/m, P=0.92). At multivariable analysis, ATV/r was a significant predictor of greater decrease in eGFR (P=0.0046) only with CKD-EPI creatinine.CONCLUSIONS: ATV/r plus TDF caused greater GFR decreases compared to EFV. The evaluation of eGFR by cystatin C confirmed this result but this method appeared to be more stringent, probably precluding the possibility to detect a significant difference in the pattern of eGFR evolution between the two arms over time. More studies are needed to understand the clinical relevance of these alterations and whether cystatin C is a more appropriate method for monitoring GFR in clinical practice.

V.A. Triant; F. Josephson; C.G. Rochester; K.N. Althoff; K. Marcus; R. Munk; C. Cooper; R.B. D'Agostino; D. Costagliola; C.A. Sabin; P.L. Williams; S. Hughes; W.S.Post; N. Chandra-Strobos; G. Guaraldi; S.S. Young; R. Obenchain; R. Bedimo; V. Miller; J. Strobos ( 2011 ) - Adverse Outcome Analyses of Observational Data: Assessing Cardiovascular Risk in HIV Disease. - CLINICAL INFECTIOUS DISEASES - n. volume 54(3) - pp. da 408 a 413 ISSN: 1058-4838 [Articolo in rivista (262) - Articolo su rivista]
Abstract

Clinical decisions are ideally based on randomized trials but must often rely on observational data analyses, which are less straightforward and more influenced by methodology. The authors, from a series of expert roundtables convened by the Forum for Collaborative HIV Research on the use of observational studies to assess cardiovascular disease risk in human immunodeficiency virus infection, recommend that clinicians who review or interpret epidemiological publications consider 7 key statistical issues: (1) clear explanation of confounding and adjustment; (2) handling and impact of missing data; (3) consistency and clinical relevance of outcome measurements and covariate risk factors; (4) multivariate modeling techniques including time-dependent variables; (5) how multiple testing is addressed; (6) distinction between statistical and clinical significance; and (7) need for confirmation from independent databases. Recommendations to permit better understanding of potential methodological limitations include both responsible public access to de-identified source data, where permitted, and exploration of novel statistical methods.

G. Guaraldi; P. Bagni ( 2011 ) - Antiretroviral drugs and cardiovascular risk - FBCommunication S.r.l. Modena ITA) - pp. da 13 a 19 ISBN: 9788864500966 ISSN: - [Curatela (284) - Curatela]
Abstract

Cardiovascular diseases (CVD) in human immunodeficiency virus (HIV)-infected patients are the result of amultifactorial interplay between the host, virus, and drug-related risk factors. Historically, first-generationantiretroviral therapy (ART) and particularly protease inhibitors (PIs) were blamed for a potential impact on CVrisk due to their implication in metabolic and body composition abnormalities. More recently, lopinavir andIndinavir cumulative exposure was associated with increased CV risk with a toxicity only partially explained bytheir metabolic impact. Concerns have also been raised regarding the potential CV risk associated withnucleoside reverse transcriptase inhibitors (NRTIs) and, particularly, with abacavir, but the potential mechanismsof this signal are not conclusive to provide a final answer. It is important to recognize that the magnitude ofincreased CV risk observed with these drugs is not high, especially as compared with the effect of other CVrisk factors and smoking, in particular. A tailoring approach to antiretroviral drug prescription must include theevaluation of patient global CV risk.

B. Madeo; D. Santi; G. Orlando; G. Guaraldi; Fabio Vescini; M. Simoni; C. Carani; V.Rochira ( 2011 ) - Bone mineral density and sex hormones in HIV-infected men - XI Congresso Nazionale SIOMMMS - Dynamicon edizioni Milano ITA) - OSTEOPOROSI.IT - n. volume 11(3-4) - pp. da 107 a 107 ISSN: - [Abstract in rivista (266) - Abstract in Rivista]
Abstract

In men with HIV bone mineral density depends on estrogens and not from testosterone as in non HIV-infected men.

C. Pinnetti; S. Baroncelli; A. Molinari; G. Nardini; O. Genovese; B.M. Ricerca; A.F. Cavaliere; G. Guaraldi; A.D. Antoni; E. Tamburrini; M. Floridia ( 2011 ) - Common occurrence of anaemia at the end of pregnancy following exposure to zidovudine-free regimens. - JOURNAL OF INFECTION - n. volume 63 - pp. da 144 a 150 ISSN: 0163-4453 [Articolo in rivista (262) - Articolo su rivista]
Abstract

OBJECTIVE: Although zidovudine-free regimens are increasingly used in pregnancy, their haematological effects in mothers and newborns are incompletely defined.METHODS: The haematological profiles of 119 HIV-infected women and their neonates with highly active antiretroviral regimens (HAART) in pregnancy including or not zidovudine (ZDV) were investigated. Three groups were compared: 1) women who started ZDV-lamivudine (3TC)-based HAART during pregnancy (ZDVs, n = 60); 2) women on ZDV-3TC-based HAART from conception (ZDVc, n = 18); 3) women on ZDV-free HAART from conception (ZDVf, n = 41).RESULTS: At the beginning of pregnancy, haemoglobin levels were similar in the three groups. By week 36 compared to baseline, haemoglobin levels had a significantly greater decrease in ZDVf women compared to ZDVs women (ZDVf: -2.03 g/dl; ZDVs: -1.36 g/dl, p = 0.036). A similar trend was observed for occurrence of maternal anaemia at 36 weeks. Newborns with no prenatal ZDV exposure had significantly higher haemoglobin levels at birth (ZDVf: 16.1 ± 1.4 g/dl, ZDVs: 14.3 ± 2.0 g/dl; ZDVc: 14.6 ± 2.4 g/dl, p = 0.044 and 0.003, respectively).CONCLUSIONS: Half of ZDV-unexposed mothers had anaemia at the end of pregnancy, but their neonates had normal haemoglobin levels. ZDV initiation was associated with a lower occurrence of maternal anaemia during the third trimester and decreased haemoglobin levels in the newborns. We hypothesize that foetal iron requirements could represent a major determinant of maternal anaemia at the end of pregnancy.

G. Guaraldi; P.L. Bonucci; D. De Fazio ( 2011 ) - Comparison of three different methods for correction of HIV-Associated facial Lipodystrophy. - Advanced Surgical Facial Rejuvenation - Springer_Verlag Berlin Heidelberg Berlin DEU) - pp. da 1 a 6 ISBN: 9780000000002 ISSN: - [Contributo in volume (Capitolo o Saggio) (268) - Capitolo/Saggio]
Abstract

HIV-1 infected patients have peripheral fat loss or lipoatrophy of the face, limbs, and buttocks and central fat accumulation within the adbomen, breast, and the dorso-cervical spine both of which may be present in the same individual. Lipoatrophy causes negative psychosocial impact and an impairment of quality of life because of erosio of self-image and self-esteem, demoralization and depression, problems in social and sexual relations, and threats to locus of control. Surgical treatments for facial lipoatrophy include autologous fat transplant from a subcutaneous abdominal graft or injection of biodegradable or non biodegradable fillers into the lipoatrophic areas of the face. The authors discuss how to choose from the different surgical procedures to treat HIV-related facial lipoatrophy.

Antonio Bellasi; S. Zona; G. Orlando; F. Carli; S. Cocchi; G. Ligabue; V. Rochira; Pietro Bagni; Paolo Raggi; G. Guaraldi ( 2011 ) - Coronary artery calcification is associated with femoral but not with lumbar spine mineral density - 6th IAS Conference on HIV Pathogenesis, Treatment and Prevention - International AIDS Society Ginevra CHE) - n. volume n.a. risorsa online [Abstract in Atti di convegno (274) - Abstract in Atti di Convegno]
Abstract

Coronary artery calcification is associated with reduced BMD in HIV-infected patients.

Antonio Bellasi; S. Zona; G. Orlando; F. Carli; S. Cocchi; G. Ligabue; V. Rochira**; Pietro Bagni; Paolo Raggi; G. Guaraldi ( 2011 ) - Coronary artery calcification is associated with femoral but not with lumbar spine mineral density - Abstracts presented at the 13th International Workshop on Adverse Drug Reactions and Co-morbidities in HIV - International Medical Press London, UK GBR) - ANTIVIRAL THERAPY - n. volume 16 (Suppl 2) [Abstract in rivista (266) - Abstract in Rivista]
Abstract

Calcium within the coronary is associated with low BMD

Guaraldi, Giovanni; Zona, Stefano; Menozzi, Marianna; Carli, Federica; Bagni, P; Berti, A; Rossi, E; Orlando, Gabriella; Zoboli, G; Palella, F. ( 2011 ) - Cost of non-infectious co-morbidities in patients with HIV - 16 - ANTIVIRAL THERAPY - n. volume 16 [Abstract in rivista (266) - Abstract in Rivista]
Abstract

We hypothesize that the increased prevalence of non-infectious co-morbidities (NICM) observed among HIV-infected pts may will result in increased direct financial costs of medical care in compared to general population. Our objective was to provide estimates of and describe factors contributing to direct costs for medical care among HIV-infected patients, with a focus on financial costs related to NICM management.

G. Guaraldi; S. Zona; M. Menozzi; F. Carli; P. Bagni; S. Cocchi; A. Berti; E. Rossi; E. Ciconze; G. Orlando ( 2011 ) - Costs of Non-Infectious co-morbidities in patients with HIV. - Programma - Fondazione A.S.I.A. Milano ITA) - n. volume not applicable - pp. da 29 a 29 ISBN: 9780000000002 ISSN: - [Abstract in Atti di convegno (274) - Abstract in Atti di Convegno]
Abstract

We hypothesized that the increased prevalence of Non-Infectious Co-Morbidities observed among HIV-related patients, when compared to the general population, may result in an increased direct cost of medical care. The objective was to provide estimates and determinants of direct cost of medical care.

Guaraldi, Giovanni; Zona, Stefano; Raggi, P; Orlando, Gabriella; Carli, Federica; Ligabue, Guido; Scaglioni, R; Besutti, G; Rossi, Rosario; Modena, Maria Grazia ( 2011 ) - EAT volume is an independent risk factor of cardiovascular disease in HIV-infected patients - Abstracts - INFECTION - n. volume 39 [Abstract in rivista (266) - Abstract in Rivista]
Abstract

Epicardial adipose tissue volume (EAT) is increased in HIV infected patients. EAT may contribute to coronary artery atherosclerosis via paracrine secretion of proinflammatory cytokines, plying a role in the development of cardiovascular disease (CVD). The aim of the study was to evaluate EAT associated factors and the relationship between EAT and occult CVD and predictors of EAT change over time.

G. Orlando; S. Zona; F. Carli; P. Bagni; M. Menozzi; S. Cocchi; R. Scaglioni; G. Ligabue; P. Raggi; G. Guaraldi ( 2011 ) - Ectopic fat is a surrogate marker of CVD in patients with HIV. - Programma - Fondazione A.S.I.A. Milano ITA) - n. volume non applicabile - pp. da 17 a 17 ISBN: 9780000000002 ISSN: - [Abstract in Atti di convegno (274) - Abstract in Atti di Convegno]
Abstract

The aim of this study was to evaluate the association between general adiposity and ectopic fat measurements; Epicardial adipose tissue with prevalent cardiovascular disease defined as prior myocardial infarction, coronary revascularization, stroke, peripheral vascular disease in male patients with HIV infection with or without klipodystrophy.

Giovanni Guaraldi;Stefano Zona;Paolo Raggi ( 2011 ) - Epicardial adipose tissue in HIV-infected patients - AIDS - n. volume 25 - pp. da 2189 a 2190 ISSN: 0269-9370 [Articolo in rivista (262) - Articolo su rivista]
Abstract

not available

Guaraldi, Giovanni; Scaglioni, R.; Zona, Stefano; Orlando, Gabriella; Carli, Federica; Ligabue, Guido; Besutti, G.; Bagni, P.; Rossi, Rosario; Modena, Maria Grazia; Raggi, P. ( 2011 ) - Epicardial adipose tissue is an independent marker of cardiovascular risk in HIV-infected patients. - AIDS - n. volume 25(9) - pp. da 1199 a 1205 ISSN: 0269-9370 [Articolo in rivista (262) - Articolo su rivista]
Abstract

BACKGROUND: Epicardial adipose tissue (EAT) is increased in HIV-infected patients. The aim of this study was to evaluate the association between EAT and coronary artery calcium (CAC) a marker of atherosclerosis; furthermore, we investigated the association of EAT with HIV infection, antiretroviral treatment (ART), and lipodystrophy.METHODS: This was a cross-sectional study of 876 consecutive HIV-infected ART experienced patients. Patients underwent CAC imaging with multidetector computed tomography (CT) for atherosclerosis screening and risk of cardiovascular events (CAC score >100); EAT was measured in the same CT images. Factors independently associated with EAT were explored in a multivariable backward stepwise linear regression analysis. Multivariable logistic regression was used to evaluate the association of EAT and CAC score greater than 100.RESULTS: Patients' mean age was 47.2 ± 8 years, 68% were men. EAT was associated with central fat accumulation and mixed lipodystrophy phenotypes. Factors independently associated with EAT were: age [β = 0.6, confidence interval (CI) 0.2-1.0], male sex (β = 6.6, CI 0.5-12.7), visceral adipose tissue (β = 0.12, CI 0.08-0.17), waist circumference (β = 0.7, CI 0.04-1.3), current CD4 (β = 0.6, CI 0.1-1.2, per 50 cells), total cholesterol (β = 0.1, CI 0.02-0.15), and cumulative exposure to ART (months) (β = 0.05, CI 0.00-0.11). EAT (per 10 cm) was associated with CAC greater than 100 (odds ratio = 1.10, CI 1.02-1.19) after adjustment for age, male sex, and diabetes.CONCLUSION: We showed an association between EAT and central fat accumulation and mixed form lipodystrophy phenotypes as well as traditional risk factors for atherosclerosis. EAT may be a useful marker of cardiovascular risk as shown by its association with CAC greater than 100.

S. Zona; P. Raggi; G. Orlando; F. Carli; G. Ligabue; R. Scaglioni; G. Besutti; R. Rossi; M.G. Modena; G. Guaraldi ( 2011 ) - Epicardial Adipose Tissue Volume is an Independent Risk Factor of CVD in HIV-infected Patients - Program & Abstracts - CROI Alexandria VA, USA USA) - n. volume not applicable - pp. da 395 a 395 ISBN: 9780979319198 ISSN: - [Abstract in Atti di convegno (274) - Abstract in Atti di Convegno]
Abstract

Epicardial adipose tissue (EAT) volume is increased in HIV-infected patients. EAT may contribute to coronary artery atherosclerosis via paracrine secretion of proinflammatory cytokines, playing a role in the development of cardiovascular disease (CVD). The aim of the study was to evaluate EAT-associated factors and the relationship between EAT and occult CVD and predictors of EAT change over time.

D. Santi; Mattia Beggi; G. Brigante; S. Zona; Kety Luzy; G. Orlando; R. Rossi; Pierre Bouloux; G. Guaraldi; V. Rochira ( 2011 ) - Erectile Dysfunction Does Not Mirror Endothelial Dysfunction in HIV-Infected Patients - Abstracts of the 93rd Annual Meeting of the Endocrine Society ENDO2011 - Endocrine Society / Maryland:8401 Connecticut Avenue, Suite 900:Chevy Chase, MD 20815:(301)941-0200, (301)941-0200, (301)941-0232, EMAIL: journals@endo-society.org, INTERNET: http://www.endo.society.org, Fax: (301)941-0259 Bethesda USA) - ENDOCRINE REVIEWS - n. volume 32 [Abstract in rivista (266) - Abstract in Rivista]
Abstract

Non classical risk factors are associated with HIV-related erectile dysfunction

D. Santi; Mattia Beggi; G. Brigante; S. Zona; K. Luzi; G. Orlando; R. Rossi; Pierre Bouloux; G. Guaraldi; V. Rochira ( 2011 ) - Erectile dysfunction does not mirror endothelial dysfunction in hiv-infected patients - 13th European Congress of Endocrinology - Bioscientifica Limited:22 Apex Court, Woodlands, Bradley, Bristol BS32 4JT United Kingdom:011 44 1454 619036, EMAIL: sales@endocrinology.org, INTERNET: http://www.endocrinology.org, Fax: 011 44 1454 616071 Bristol, UK GBR) - ENDOCRINOLOGY ABSTRACTS - n. volume 26 [Abstract in rivista (266) - Abstract in Rivista]
Abstract

This study confirms that the classical predictors of erectile dysfunction are not associated to impaired erectile function, probably since other factor are more important in HIV , the latter mask the role of classic risk factors

Guaraldi, Giovanni ( 2011 ) - Evolving approaches and resources for clinical practice in the management of HIV infection in the HAART era - GERMS - n. volume 1 - pp. da 6 a 8 ISSN: 2248-2997 [Articolo in rivista (262) - Articolo su rivista]
Abstract

Physicians treating HIV infection concentrate not only on the viral management but they also have to take into account the potential age and lifestyle-related conditions likely to influence long-term morbidity, correlated with patients' survival. Hypertension, diabetes, cardiovascular, bone, kidney and liver disease, better than opportunistic infection, depict the changing spectrum of HIV disease in the HAART era. These conditions, the so called non infectious co-morbidities, are age-related diseases affecting the general population. However, their prevalence in HIV-infected individuals is higher, with earlier onset, probably as a result of the complex inter-relationship between HIV infection, co-infection and antiretroviral therapy. Regular screening for non infectious co-morbidities helps identify those asymptomatic HIV-infected individuals who are most at risk of developing comorbidities; this means that appropriate intervention, either by lifestyle changes to reduce modifiable risk factors or by the use of pharmacological management, can be initiated. © GERMS 2011.

S. Cocchi; M. Codeluppi; C. Venturelli; A. Bedini; A. Grottola; W. Gennari; F. Cavrini; F. Di Benedetto; N. De Ruvo; F. Rumpianesi; G.E. Gerunda; G. Guaraldi ( 2011 ) - Fusarium verticillioides fungemia in a liver transplantation patient: successful treatment with voriconazole - DIAGNOSTIC MICROBIOLOGY AND INFECTIOUS DISEASE - n. volume 71 (4) - pp. da 438 a 441 ISSN: 0732-8893 [Articolo in rivista (262) - Articolo su rivista]
Abstract

Fusarium is an opportunistic fungal pathogen which is emerging as a significant cause of morbidity and mortality in immunocompromised hosts. We present a rare case of F. verticillioides fungemia that occurred in a patient who underwent a second orthotopic liver transplantation for chronic rejection and completely responded to treatment with voriconazole.

A. Meloni; M. Floridia; S. Alberico; E. Tamburrini; C. Pinnetti; A. Bucceri; G. Masuelli; A. Viganò; G. Liuzzi; A. Degli Antoni; G. Guaraldi; A. Spinillo; R. Marocco; S. Dalzero; M. Ravizza. ( 2011 ) - Glucose Plasma Levels and Pregnancy Outcomes in Women with HIV - HIV CLINICAL TRIALS - n. volume 12(6) - pp. da 299 a 312 ISSN: 1528-4336 [Articolo in rivista (262) - Articolo su rivista]
Abstract

Background: There is limited information on the relation between glucose levels in pregnancy and adverse perinatal outcomes in HIV-infected pregnant women. Objective: To evaluate the potential impact of fasting glucose levels on pregnancy outcomesin a large sample of pregnant women with HIV from a national study, adjusting for potential confounders. Methods: Data from the Italian National Program on Surveillance on Antiretroviral Treatment in Pregnancy were used. The main outcomes evaluatedin univariate and multivariable analyses were birthweight for gestational age >90th percentile (large for gestational age [LGA]), nonelective cesarean delivery, and preterm delivery. Glucose measurements were considered both as continuous and as categorical variables, following the HAPO study defi nition. Results: Overall, 1,032 cases were eligible for the analysis. In multivariable analyses, a birthweight >90th percentilewas associated with increasing fasting plasma glucose levels (adjusted odds ratio [AOR] per unitary (mg/dL) increase, 1.04; 95% CI, 1.01–1.06; P = .005), a higher body mass index, and parity of 1 or higher. A lower risk of LGA was associated with smoking and African ethnicity. A higher fasting plasma glucose category was signifi cantly associated with LGA occurrence, and AORs for the glucose categories of 90–94 mg/ dL and 95–99 mg/dL were 3.34 (95% CI, 1.09–10.22) and 6.26 (95% CI, 1.82–21.58), respectively. Fasting plasma glucose showed no association with nonelective cesarean section [OR per unitary increase, 1.00; 95% CI, 0.98–1.02] or preterm delivery [ORper unitary increase, 1.00; 95% CI, 0.99–1.02]. Conclusions: In pregnant women with HIV, glucose values below the threshold usually defi ning hyperglycemia are associated with an increased risk of delivering LGA infants. Other conditions may independentlycontribute to adverse perinatal outcomes in women with HIV and should be considered to identify pregnancies at risk.

G. Guaraldi; A. Santoro; A.R. Domingues da Silva ( 2011 ) - HAART e complicanze metaboliche a lungo termine. - CLINICAL PRACTICE - n. volume VIII n.6 - pp. da 12 a 18 ISSN: - [Articolo in rivista (262) - Articolo su rivista]
Abstract

La malattia da HIV sempre più si qualifica come un paradigma di relazione stretta tra malattie infettive e malattie non trasmissibili e in ultima analisi come modello di invecchiamento accelerato sostenuto da fenomeni infiammatori cronici.

M. Berretta; E. Garlassi; B. Cacopardo; A. Cappellani; G. Guaraldi; S. Cocchi; P. de Paoli; A. Lleshi; I. Izzi; A. Torresin; P. Di Gangi; A. Pietrangelo; M.C. Ferrari; A. Beraz; S. Berretta; G. Nasti; F. DI Benedetto; L. Balestreri; U. Tirelli; P. Ventura ( 2011 ) - Hepatocellular Carcinoma in HIV-infected Patients: Check Ealy, Treat Hard - THE ONCOLOGIST - n. volume 16 - pp. da 1258 a 1269 ISSN: 1083-7159 [Articolo in rivista (262) - Articolo su rivista]
Abstract

Purpose. Hepatocellular carcinoma (HCC) is an increasingcause of mortality in HIV-infected patients inthe highly active antiretroviral therapy (HAART) era.The aims of this study were to describe HCC tumorcharacteristics and different therapeutic approaches, toevaluate patient survival time from HCC diagnosis, andto identify clinical prognostic predictors in patients withand without HIV infection.Patients and Methods. A multicenter observationalretrospective comparison of 104 HIV-infected patientsand 484 uninfected patients was performed in four Italiancenters. HCC was staged according to the BarcelonaClinic Liver Cancer (BCLC) criteria.Results. Tumor characteristics of patients with andwithout HIV were significantly different for age, EasternCooperative Oncology Group performance status(PS) score <1, and etiology of chronic liver disease. Despitethe similar potentially curative option rate and better BCLC stage at diagnosis, the median survivaltime was significantly shorter in HIV patients. HIVpatients were less frequently retreated at relapse.Independent predictors of survival were: BCLC stage,potentially effective HCC therapy, tumor dimension <3cm, HCC diagnosis under a screening program, HCC recurrence,and portal vein thrombosis. Restricting the analysisto HIV patients only, all positive prognostic factorswere confirmed together with HAART exposure.Conclusion. This study confirms a significantlyshorter survival time in HIV HCC patients. The lessaggressive retreatment at recurrence approach does notbalance the benefit of younger age and better BCLCstage and PS score of HIV patients. Thus, consideringthe prognosis of HIV HCC patients, effective screeningtechniques, programs, and specific managementguidelines are urgently needed.

G. Angarano; A. Antinori; M. Galli; G. Guaraldi; F. Maggiolo; G. Rizzardini ( 2011 ) - HIV Connect – strategie terapeutiche nell’infezione da HIV: il paziente early presenter, il paziente late presenter, il paziente ageing. - CLINICAL PRACTICE - n. volume 4 - pp. da 22 a 28 ISSN: - [Articolo in rivista (262) - Articolo su rivista]
Abstract

Il cambiamento epidemiologico più rilevante nell'epidemia da HIV negli ultimi anni è l'incremento dell'età media dei pazienti con infezione da HIV, da attribuirsi in primo luogo all'incremento dell'aspettativa di vita dei pazienti, grazie all'avvento della terapia antiretrovirale, ma anche all'aumento dell'età media dei soggetti con nuova diagnosi di infezione da HIV/AIDS. Il paziente anziano con inf. da HIV richiede una gestione assistenziale attenta, con uno stretto monitoraggio del rischio di sviluppare patologie, attraverso la valutazione dei fattori di rischio, la stima del rischio, la valutazione individuale di vulnerabilità.

Valeria Righi; Chiara Stentarelli; Giovanni Guaraldi; Stefano Zona; Guido Ligabue; Giulia Besutti; Paola Loria; Luisa Losi; Luca Nocetti; Vitaliano Tugnoli; Luisa Schenetti; Adele Mucci ( 2011 ) - HR-MAS NMR SPECTROSCOPY FOR CHARACTERIZATION OF STEATOSIC LIVER: FAT QUANTIFICATION FOR A SPECTROSCOPIC DIFFERENTIATION BETWEEN STEATOSIS AND STEATOHEPATITIS - XL National Congress on Magnetic Resonance - GIDRM Parma ITA) - n. volume unico - pp. da 27 a 27 ISBN: 9780000000002 ISSN: - [Abstract in Atti di convegno (274) - Abstract in Atti di Convegno]
Abstract

Non-alcoholic fatty liver disease (NAFLD) is a common cause of chronic liver disease. The NAFLD includes non-alcoholic fatty liver (NAFL) and non-alcoholic steatohepatitis (NASH) [1]. The mechanisms of NAFL to NASH transition remain to be clarified [2]. NAFLD appears to originate from the dysregulation of hepatic lipid metabolism as a part of the metabolic syndrome accompanied by visceral obesity, dyslipidemia, atherosclerosis and insulin resistance. A recent study has also demonstrate that high prevalence of steatosis is correlated to HCV-related chronic hepatitis [3]. High Resolution Magic Angle Spinning (HR-MAS) NMR is a useful tool for the metabolic characterization of intact tissues [4] and can be used to support the clinical diagnosis. The first aim of this study is to characterize the NAFL and NASH metabolism using HR-MAS NMR Spectroscopy. The second one is to evaluate the possible transition from NAFLD to NASH quantifying the liver fat content (LFC), both in ex-vivo and in-vivo NMR Spectroscopy. Patients with indication for steatosis underwent in-vivo 1H MR Spectroscopy analysis and liver biopsy. Histopathological analysis provided steatosis percentage, steatosis grade and fibrosis. A fragment of biopsy specimen was used for HR-MAS analysis, to obtain metabolic tissue characterization. Univariate linear regression analysis and Pearson r coefficient were used to study the relationship between histological steatosis percentage and LFC, estimated through HR-MAS analysis and in-vivo Spectroscopy. Similar high associations were found between LFC estimated by HR-MAS and histological steatosis percentage (r=0,71; p=0,006) and between LFC estimated by in-vivo Spectroscopy and histological steatosis percentage (r=0,79; p=0,002). HR-MAS spectra showed a high tissue metabolic heterogeneity, with particular regard to the content of free glucose, alanine, glutamine/glutamate and phospholipids. Fibrotic liver showed a higher presence of small metabolites such as choline. HR-MAS NMR Spectroscopy, well estimates the fatty infiltration of the liver. Future research on HR-MAS spectral heterogeneity may allow to find biochemical metabolic indicators of steatosis progression to be used in the differentiation between steatohepatitis and steatosis through in-vivo MR Spectroscopy.[1] Contos M. J. and Sanyal A. J., The clinicopathologic spectrum an management of nonalcoholic fatty liver disease. Adv Anat Pathol, 9, 37-51 (2002).[2] Reid A. E., Nonalcoholic steatohepatitis . Gastroenterol, 121, 710-23 (2001).[3] Scheuer P. J., Ashrafzaddeh P., Sherlock S., Brown D., Disheiko G. M., the pathology of hepatitis C. Hepatology, 25, 567-71. (1992).[4] Righi V., Durante C., Cocchi M., Calabrese C., Di Febo G., Lecce F., Pisi A., Tugnoli V., Mucci A. and Schenetti L., Discrimination of healthy and neoplastic human colon tissues by ex vivo HR-MAS NMR spectroscopy and chemometric analyses. J of Proteome Res, 8, 1859-69 (2009).

G. Guaraldi; S. Zona; G. Orlando; F. Carli; G. Ligabue; F. Fiocchi; M. Menozzi; R. Rossi; M.G. Modena; P. Raggi ( 2011 ) - Human immunodeficiency virus infection is associated with accelerated atherosclerosis. - JOURNAL OF ANTIMICROBIAL CHEMOTHERAPY - n. volume 66 - pp. da 1857 a 1860 ISSN: 0305-7453 [Articolo in rivista (262) - Articolo su rivista]
Abstract

Objectives Cardiovascular risk is increased in HIV-infected individuals compared with the general population, making HIV disease an ideal model to investigate the pathogenesis and natural history of atherosclerosis. In this pilot study, we compared the progression of coronary artery calcium (CAC) between HIV-infected and uninfected patients. Methods Atherosclerosis progression was assessed in 25 HIV-infected men and 13 HIV-negative controls by means of sequential CAC scans using CT. A CAC score progression ≥15%/year was used as a surrogate marker of increased risk of cardiovascular events. Results During a median follow-up of 11 months, a CAC score increase ≥15%/year was detected in 14 HIV-infected patients (56%) and 4 HIV-negative individuals (31%). HIV infection, age and hypercholesterolaemia were independently associated with a CAC score increase ≥15%/year in an adjusted Cox regression model. Conclusions HIV infection, age and hypercholesterolaemia were independently associated with CAC progression. HIV as well as traditional risk factors contribute to accelerate atherosclerosis in HIV-infected patients.

Guaraldi G; Lonardo A; Ballestri S; Zona S; Stentarelli C; Orlando G; Carli F; Carulli L; Roverato A; Loria P. ( 2011 ) - Human Immunodeficiency Virus Is the Major Determinant of Steatosis and Hepatitis C Virus of Insulin Resistance in Virus-associated Fatty Liver Disease. - ARCHIVES OF MEDICAL RESEARCH - n. volume 42 - pp. da 690 a 697 ISSN: 0188-4409 [Articolo in rivista (262) - Articolo su rivista]
Abstract

BACKGROUND AND AIMS: To promote our understanding of the relative contribution of metabolic and viral factors, the independent predictors of fatty liver and insulin resistance (IR) were assessed by comparing patients with nonalcoholic fatty liver disease (NAFLD) to individuals with virus-associated fatty liver disease (VAFLD): human immunodeficiency virus (HIV)-VAFLD, hepatitis C virus (HCV)-VAFLD and HIV-HCV-VAFLD.METHODS: One hundred eighty eight consecutive patients with viral infections (103 HIV, 85 patients with HCV genotype 1 infection: 45 mono-infected and 40 HIV/HCV co-infected) with or without steatosis and 126 NAFLD patients were analyzed. Steatosis was diagnosed by ultrasonography. To assess the odds ratio (OR) of steatosis and IR, HCV and NAFLD, respectively, were used as the reference values. IR was evaluated through homeostasis model (HOMA) and the metabolic syndrome (MetS) using standard criteria.RESULTS: The prevalence of VAFLD was 47%. Multivariate logistic regression analysis was carried out using HCV as the reference. VAFLD was predicted by HIV, HIV/HCV, female gender, waist circumference (WC) and HOMA (OR = 3.99, 3.76, 2.80, 1.08 and 1.18). According to multiple linear regression using NAFLD as a reference, IR was predicted by HCV, HIV and HIV/HCV, WC, triglycerides (coefficient beta = 2.25, 0.99, 1.86, 0.08, 0.05, respectively). In linear models, for any given number of components of MetS, HCV and HCV/HIV-associated fatty liver disease had greater HOMA compared to NAFLD (p <0.001).CONCLUSIONS: Whereas HIV confers a higher risk of steatosis, VAFLD is associated with higher IR than NAFLD and such an effect is specifically linked to HCV rather than to HIV infection.

P.M. Janiszewski; R. Ross; J.P. Despres; I. Lemieux; G. Orlando; F. Carli; P. Bagni; M. Menozzi; S. Zona; G. Guaraldi ( 2011 ) - Hypertriglyceridemia and Waist Circumference Predict Cardiovascular Risk among HIV Patients: A Cross-Sectional Study - PLOS ONE - n. volume 6(9) [Articolo in rivista (262) - Articolo su rivista]
Abstract

BACKGROUND: Although half of HIV-infected patients develop lipodystrophy and metabolic complications, there exists no simple clinical screening tool to discern the high from the low-risk HIV-infected patient. Thus, we evaluated the associations between waist circumference (WC) combined with triglyceride (TG) levels and the severity of lipodystrophy and cardiovascular risk among HIV-infected men and women.METHODS: 1481 HIV-infected men and 841 HIV-infected women were recruited between 2005 and 2009 at the metabolic clinic of the University of Modena and Reggio Emilia in Italy. Within each gender, patients were categorized into 4 groups according to WC and TG levels. Total and regional fat and fat-free mass were assessed by duel-energy x-ray absorptiometry, and visceral adipose tissue (VAT) and abdominal subcutaneous AT (SAT) were quantified by computed tomography. Various cardiovascular risk factors were assessed in clinic after an overnight fast.RESULTS: The high TG/high WC men had the most VAT (208.0±94.4 cm(2)), as well as the highest prevalence of metabolic syndrome (42.2%) and type-2 diabetes (16.2%), and the highest Framingham risk score (10.3±6.5) in comparison to other groups (p<0.05 for all). High TG/high WC women also had elevated VAT (150.0±97.9 cm(2)) and a higher prevalence of metabolic syndrome (53.3%), hypertension (30.5%) and type-2 diabetes (12.0%), and Framingham risk score(2.9±2.8) by comparison to low TG/low WC women (p<0.05 for all).CONCLUSIONS: A simple tool combining WC and TG levels can discriminate high- from low-risk HIV-infected patients.

Di Benedetto F; Tarantino G; D'Amico G; De Ruvo N; Cautero N; Montalti R; Guerrini GP; Ballarin R; Spaggiari M; Guaraldi G; Gerunda GE ( 2011 ) - Immunosuppressive strategies in liver transplantation in hiv co-infected patients: university of modena experience. Transplant international - Abstracts - TRANSPLANT INTERNATIONAL - n. volume 24 - pp. da 121 a 121 ISSN: 0934-0874 [Abstract in rivista (266) - Abstract in Rivista]
Abstract

Highly active antiretroviral therapy in the last decade increased the survival rates in HIV positive patients, determing at the same time a higer number of HIV patients suffering from liver-related disease. Liver tranplantation is the only curative treatment for end-stage liver disease associated or not associated with HCC.

L.R. Tomasonia; M. Galli; S. Declichd; V. Pietra; F. Crocec; S. Pignatelli; M. Fabiani; J. Simporé; M. Mabilia; E.O. Ayella; C. Caracciolo; G. Russo; G. Guaraldi; M.N. Gambirasio; V. Vullo; F. Castelli ( 2011 ) - Knowledge, attitudes and practice (KAP) regarding newborn feeding modalities in HIV-infected and HIV-uninfected pregnant women in sub-Saharan Africa: a multicentre study. - INTERNATIONAL HEALTH - n. volume 3 (1) - pp. da 56 a 65 ISSN: 1876-3413 [Articolo in rivista (262) - Articolo su rivista]
Abstract

Exclusive formula feeding, exclusive breastfeeding (EBF) with early weaning or the administration of antiretroviral therapy to lactating mothers and/or to breastfed newborns may lower postnatal HIV transmission. The aim of this study was to assess mothers’ knowledge, attitudes and practice (KAP) on lactation in various real-life settings in sub-Saharan Africa. A questionnaire survey investigating KAP with regard to breastfeeding in pregnant women of unknown status (Questionnaire A, 16 items) or HIV-infected women (Questionnaire B, 37 items) was administered. Associations between newborn feeding KAP and demographic, socioeconomic, cultural and obstetric variables were investigated. From January 2007 to January 2008, 2112 pregnant women answered Questionnaire A in Burkina Faso, Cameroon, Chad, Tanzania, Uganda and Zambia. Most women (53.0%) declared EBF as the preferred feeding modality. The practice of strictly defined EBF in previous pregnancies was only 11.4%, which was inversely correlated with education and parity. Questionnaire B was answered by 225 HIV-infected pregnant women in Burkina Faso, Tanzania and Uganda. Knowledge about the lactation-associated risk was associated with previous dead children. Significant variability was observed among collaborating sites. The introduction of fluids other than maternal milk within 6 months of age is common practice in sub-Saharan Africa, requiring intensive health education efforts if strictly defined EBF is to be adopted to decrease HIV postnatal transmission. Significant variation in newborn feeding determinants was observed.

Di Benedetto F; Tarantino G; De Ruvo N; Cautero N; Montalti R; Guerrini GP; Ballarin R; Spaggiari M; Serra V; Guaraldi G; Gerunda GE ( 2011 ) - Liver Transplantation for Hepatocellular Carcinoma in HIV Co-Infected Patients: A Single Centre Experience. - Abstracts - LIVER TRANSPLANTATION - n. volume 17 [Abstract in rivista (266) - Abstract in Rivista]
Abstract

HCC is the leading cause of death aong patients with cirrhosis. HIV positive patients are likely to have hepatitis B and/or C virus co-infection because of wxposure to common risk factors. There are several reports that oulined a more aggressive course in HIV positive patients with respect to HCC. The aim of our study was to assess the outcome of liver tranplantation in this setting of patients.

Berardi, C; Rossi, Rosario; Zona, Stefano; Orlando, Gabriella; Carli, Federica; Casalgrandi, C; Bedini, A; Cocchi, S; Modena, Maria Grazia; Guaraldi, Giovanni ( 2011 ) - Menopause In Hiv Infected Patients: Women In A Midlife Polypathology Crisis - Programme & Abstracts - INFECTION - n. volume 39 [Abstract in rivista (266) - Abstract in Rivista]
Abstract

Menopause can be considered a paradigm of physiological ageing. The aim of this study was to compare the physical and psychological health profile of postmenopausal women with and without HIV. Secondary objective was to assess polypathology prevalence and risk factors as surrogate of ageing phenotype.

Guaraldi, Giovanni; Zona, Stefano; Orlando, Gabriella; Carli, Federica; Stentarelli, C.; Luzi, K.; Garlassi, E.; Menozzi, M.; Bagni, P.; Adorni, F. ( 2011 ) - Morphological and metabolic components of lipodystrophy in various nevirapine-based highly active antiretroviral therapy (HAART) regimens: a cross-sectional, observational study. - CLINICAL DRUG INVESTIGATION - n. volume 31 - pp. da 759 a 767 ISSN: 1173-2563 [Articolo in rivista (262) - Articolo su rivista]
Abstract

Background: 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.

G. Besutti; G. Ligabue; L. Nocetti; F. Fiocchi; C. Stentarelli; A. Mucci; P. Loria;G. Guaraldi; P. Torricelli ( 2011 ) - Multiecho MR sequences and high-resolution magic angle spinning (HRMAS)ex-vivo spectroscopy in the qualitative analysis and differentiationbetween steatohepatitis and steatosis - ECR 2011 Book of Abstracts - B - Scientific Sessions - Springer Berlino DEU) - INSIGHTS INTO IMAGING - n. volume B [Abstract in rivista (266) - Abstract in Rivista]
Abstract

Purpose: 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.

G. Guaraldi; E. Garlassi; P. Maggi ( 2011 ) - Nuove frontiere diagnostiche nel controllo della tossicità cardiovascolare. - READ FILES - n. volume 2 - pp. da 26 a 31 ISSN: - [Articolo in rivista (262) - Articolo su rivista]
Abstract

In questo articolo verrà proposto quanto viene proposto nella cardiologia moderna per la valutazione del rischio cardiovascolare globale nella popolazione generale asintomatica e quanto di ciò è stato valutato e trasferito nel contesto della malattia da HIV.

R. Maserati; M. Brandolini; A. Cattelan; A. Orani; L. Sighinolfi; M. Andreoni; A. Uglietti; G. Guaraldi; G. Sotgiu ( 2011 ) - Once-a-day (QD) vs. Twice-daily (BID) Nevirapine as Simplification in PI-Treated Patients after 2 mos. of BID Induction. - CURRENT HIV RESEARCH - n. volume 9(3) - pp. da 166 a 173 ISSN: 1570-162X [Articolo in rivista (262) - Articolo su rivista]
Abstract

To assess the efficacy and the tolerability of once-daily (QD) versus twice-daily (BID) nevirapine (NVP)-based highly active antiretroviral therapy (HAART) in virologically suppressed, HIV-positive patients switched from protease inhibitor (PI)-based HAART. Eligible patients were enrolled in the multicenter trial if HIV RNA levels were <50 copies/mL for ³6 months prior. Patients were switched from a PI to NVP 200 mg BID for 2 months, and then randomized to continue with that regimen (group A) or NVP 400 mg QD (group B) for a further 10 months. Virological efficacy (primary endpoint) and tolerability/toxicity were evaluated according to an intention-to-treat analysis. A total of 126 patients (63 per group) were enrolled. Withdrawals from the study (any reason) numbered 15 in group A and 14 in B, virological failures numbered 5 and 2, respectively, and there were 4 cases of adverse events in each group (all p = NS). Mean alanine aminotransaminase (ALT) and gamma-glutamyl transpeptidase (γ-GT) level increases were significant for the whole cohort (33.2±22.9 to 43.3±29.1, p < 0.001; 57.3±72 to 109±131 U/L, p < 0.0002, respectively), but there were no differences between the two groups. Apparently, no significant differences between the QD and BID NVP groups were found, in terms of virological failures or tolerability/toxicity. The switch to NVP may be safely pursued with a QD schedule.

G. Guaraldi; G. Orlando; S. Zona; M. Menozzi; F. Carli; E. Garlassi; A. Berti; E. Rossi; A. Roverato; F. Palella ( 2011 ) - Premature Age-Related Comorbidities Among HIV-Infected Persons Compared With the General Population. - CLINICAL INFECTIOUS DISEASES - n. volume 53(11) - pp. da 1120 a 1126 ISSN: 1058-4838 [Articolo in rivista (262) - Articolo su rivista]
Abstract

Background. Human immunodeficiency virus (HIV)-infected patients may have a greater risk of noninfectious comorbidities (NICMs) compared with the general population. We assessed the prevalence and risk factors for NICMs in a large cohort of HIV-infected adults and compared these findings with data from matched control subjects.Methods. We performed a case-control study involving antiretroviral therapy (ART)-experienced HIV-infected patients treated at Modena University, Italy, from 2002 through 2009. These patients were compared with age-, sex-, and race-matched adults (control subjects) from the general population included in the CINECA ARNO database. NICMs included cardiovascular disease, hypertension, diabetes mellitus, bone fractures, and renal failure. Polypathology (Pp) was defined as the concurrent presence of ≥2 NICMs. Logistic regression models were constructed to evaluate associated predictors of NICMs and Pp.Results. There were 2854 patients and 8562 control subjects. The mean age was 46 years, and 37% were women. Individual NICM and Pp prevalences in each age stratum were higher among patients than among controls (all P <.001). Pp prevalence among patients aged 41-50 years was similar to that among controls aged 51-60 years (P value was not statistically significant); diabetes mellitus, cardiovascular disease, bone fractures, and renal failure were statistically independent after adjustment for sex, age, and hypertension. Logistic regression models showed that independent predictors of Pp in the overall cohort were (all P < .001) age (odds ratio [OR], 1.11), male sex (OR, 1.77), nadir CD4 cell count <200 cells/μL (OR, 4.46), and ART exposure (OR, 1.01).Conclusions. Specific age-related NICMs and Pp were more common among HIV-infected patients than in the general population. The prevalence of Pp in HIV-infected persons anticipated Pp prevalence observed in the general population among persons who were 10 years older, and HIV-specific cofactors (lower nadir CD4 cell count and more prolonged ART exposure) were identified as risk factors. These data support the need for earlier screening for NICMs in HIV-infected patients.

V. Rochira; L. Zirilli; G. Orlando; D. Santi; G. Brigante; C. DIazzi; F. Carli; C. Carani; G. Guaraldi ( 2011 ) - Premature Decline of Serum Total Testosterone in HIV-Infected Men in the HAART-Era - PLOS ONE - n. volume 6(12) [Articolo in rivista (262) - Articolo su rivista]
Abstract

BackgroundTestosterone (T) deficiency remains a poorly understood issue in men with Human Immunodeficiency Virus (HIV). We investigated the gonadal status in HIV-infected men in order to characterize T deficiency and to identify predictive factors for low serum T.Methodology/Principal FindingsWe performed a cross-sectional, observational study on 1325 consecutive HIV male outpatients, most of them having lipodystrophy. Serum total T<300 ng/dL was used as the threshold for biochemical T deficiency. Morning serum total T, luteinizing hormone (LH), estradiol, HIV parameters, and body composition parameters by CT-scan and Dual-Energy-X-ray-Absorptiometry were measured in each case. Sexual behavior was evaluated in a subset of 247 patients. T deficiency was found in 212 subjects, especially in the age range 40–59, but was frequent even in younger patients. T deficiency occurred mainly in association with low/normal serum LH. Adiposity was higher in subjects with T deficiency (p<0.0001) and both visceral adipose tissue and body mass index were the main negative predictors of serum total T. Osteoporosis and erectile dysfunction were present in a similar percentage in men with or without T deficiency.Conclusions/SignificancePremature decline of serum T is common (16%) among young/middle-aged HIV-infected men and is associated with inappropriately low/normal LH and increased visceral fat. T deficiency occurs at a young age and may be considered an element of the process of premature or accelerated aging known to be associated with HIV infection. The role of HIV and/or HIV infection treatments, as well as the role of the general health state on the gonadal axis, remains, in fact, to be elucidated. Due to the low specificity of signs and symptoms of hypogonadism in the context of HIV, caution is needed in the diagnosis of hypogonadism in HIV-infected men with biochemical low serum T levels.

V. Rochira; L. Zirilli; G. Orlando; D. Santi; G. Brigante; C. Diazzi; F. Carli; S. Zona; C. Carani; G. Guaraldi ( 2011 ) - Premature decline of serum total testosterone in human immunodeficiency virus (HIV) infected men with HIV-related lipodystrophy in the highly active antiretroviral therapy (HAART) era: a cross-sectional observational study - Abstracts presented at the 13th International Workshop on Adverse Drug Reactions and Co-morbidities in HIV - International Medical Press London, UK GBR) - ANTIVIRAL THERAPY - n. volume 16(Suppl. 2) [Abstract in rivista (266) - Abstract in Rivista]
Abstract

Hypogonadism is common in HIV-infected men with HAART. The causes are both testicular failure and pituitary insufficiency, these two cause often coexist in a mixed form of hypogonadism.

G. Brigante; D. Santi; L. Zirilli; C. Diazzi; G. Orlando; M. Simoni; C. Carani; G. Guaraldi; V. Rochira ( 2011 ) - Prevalence of secondary, primary, and compensated hypogonadism in HIV infected men in HAART era: a cross-sectional observational study - Abstract of the XXXV National Congress of the Italian Society of Endocrinology - Editrice Kurtis Srl:via Luigi Zoja 30, Milan 20153 Italy:011 39 02 48202740, EMAIL: info@kurtis.it, INTERNET: http://www.kurtis.it, Fax: 011 39 02 48201219 Milano ITA) - JOURNAL OF ENDOCRINOLOGICAL INVESTIGATION - n. volume 34 - pp. da 4 a 4 ISSN: 0391-4097 [Abstract in rivista (266) - Abstract in Rivista]
Abstract

The study investigates the prevalence of male hypogonadism among patients with HIV infection paying particular attention to the different types of hypogonadism

M. Floridia; C. Pinnetti; M. Ravizza; C. Tibaldi; M. Sansone; M. Fiscon; G. Guaraldi; B. Guerra; S. Alberico; A. Spinillo; P. Castelli; S. Dalzero; A. F. Cavaliere; E. Tamburrini ( 2011 ) - Rubella Susceptibility Profile in Pregnant Women with HIV - CLINICAL INFECTIOUS DISEASES - n. volume 52 - pp. da 960 a 962 ISSN: 1058-4838 [Articolo in rivista (262) - Articolo su rivista]
Abstract

Rubella infection usually has a limited clinical relevance in children and young adults. However, its acquisition during pregnancy may lead to severe fetal or neonatal complications, such as miscarriage, fetal death, or an association of birth defects represented by the congenital rubella syndrome (CRS)There are very limited data on the rubella susceptibility status of human immunodeficiency virus (HIV)-infected pregnant women, and it is still unknown whether this population may be at higher risk of acquiring rubella because of a higher susceptibility prevalence.We used data from a national study to investigate the prevalence of rubella susceptibility in a large series of pregnant women with HIV.

Guaraldi, Giovanni; Zona, Stefano; Orlando, Gabriella; Carli, Federica; Ligabue, Guido; Bagni, Pietro; Rossi, Rosario; Modena, Maria Grazia; Falutz, J; Raggi, P. ( 2011 ) - Sensitivity and specificity of visceral and epicardial adipose tissue values in the prediction of occult cardiovascular disease in HIV-infected patients. - Abstracts - ANTIVIRAL THERAPY - n. volume 16 [Abstract in rivista (266) - Abstract in Rivista]
Abstract

Visceral adipose tissue and epicardial adipose tissue have been shown to be associated with the presence of occult cardiovascular disease identified with coronary artery calcium >100. The clinical relevance of VAT and EAT values are not known. The aim of this study was to identify sensitivity and specificity of different VAt and EAT values associated with occult CVD.

M. Ferrara; G. Solignani; S. Ferrari; M. Rigatelli; G. Guaraldi ( 2011 ) - Severe mental illness is an HIV indicator disease - Abstracts of the 19th European Congress of Psychiatry - EUROPEAN PSYCHIATRY - n. volume 26 - pp. da 1983 a 1983 ISSN: 0924-9338 [Abstract in rivista (266) - Abstract in Rivista]
Abstract

Abstracts of the 19th European Congress of Psychiatry

D. Santi; G. Brigante; G. Orlando; Michela Ciccarese; C. Diazzi; G. Guaraldi; C. Carani; V. Rochira; B. Madeo ( 2011 ) - Sex steroids and HIV-related osteoporosis in men: low circulating estrogens are associated with impaired bone mineral density (BMD) - Abstract of the XXXV National Congress of the Italian Society of Endocrinology - Editrice Kurtis Srl:via Luigi Zoja 30, Milan 20153 Italy:011 39 02 48202740, EMAIL: info@kurtis.it, INTERNET: http://www.kurtis.it, Fax: 011 39 02 48201219 Milano ITA) - JOURNAL OF ENDOCRINOLOGICAL INVESTIGATION - n. volume 34 - pp. da 26 a 26 ISSN: 0391-4097 [Abstract in rivista (266) - Abstract in Rivista]
Abstract

The study investigates the role of sex steroids on HIV-related osteoporosis, suggesting that relative estrogen deficiency might play a role even in this particular type of bone demineralization.

G. Guaraldi; J. Fontdevila; L.H. Christensen; G. Orlando; C. Stentarelli; F. Carli; S. Zona; G. de Santis; A. Pedone; D. De Fazio; P. Bonucci; E. Martínez ( 2011 ) - Surgical correction of HIV-associated facial lipoatrophy. - AIDS - n. volume 25(1) - pp. da 1 a 12 ISSN: 0269-9370 [Articolo in rivista (262) - Articolo su rivista]
Abstract

not available

Falutz J; Rosenthall L; Kotler D; Zona S; Guaraldi G ( 2011 ) - Surrogate markers of visceral adipose tissue (VAT) in HIV-infected males: how accurate are they? - Abstracts - ANTIVIRAL THERAPY - n. volume 16 [Abstract in rivista (266) - Abstract in Rivista]
Abstract

VAT determination by CT and MRI identifies HIV patients who may benefit from interventions to reduce VAT, although these are not screening tools. Surrogate markers are therefore required and waist circumference (WC), which correlates with VAT, is commonly used, although its predictive accuracy in HIV is unknown. We evaluated the ability of WC, alone or with DXA-derived trunk fat, to predict VAT.

G. Brigante; D. Santi; L. Zirilli; C. Diazzi; G. Orlando; V. Gnarini; C. Carani; G. Guaraldi; V. Rochira ( 2011 ) - Testosterone Changes over Time in Men with Human Immunodeficiency Virus Infection: Preliminary Results - Abstracts of the 93rd Annual Meeting of the Endocrine Society ENDO2011 - Endocrine Society / Maryland:8401 Connecticut Avenue, Suite 900:Chevy Chase, MD 20815:(301)941-0200, (301)941-0200, (301)941-0232, EMAIL: journals@endo-society.org, INTERNET: http://www.endo.society.org, Fax: (301)941-0259 Bethesda USA) - ENDOCRINE REVIEWS - n. volume 32 [Abstract in rivista (266) - Abstract in Rivista]
Abstract

The study explored the changes overtime of circulating testosterone

G. Brigante; D. Santi; L. Zirilli; C. Diazzi; G. Orlando; V. Gnarini; C. Carani; G. Guaraldi; V. Rochira ( 2011 ) - Testosterone changes over time in men with human immunodeficiency virus infection: preliminary results - 13th European Congress of Endocrinology - Bioscientifica Limited:22 Apex Court, Woodlands, Bradley, Bristol BS32 4JT United Kingdom:011 44 1454 619036, EMAIL: sales@endocrinology.org, INTERNET: http://www.endocrinology.org, Fax: 011 44 1454 616071 Bristol, UK GBR) - ENDOCRINOLOGY ABSTRACTS - n. volume 26 [Abstract in rivista (266) - Abstract in Rivista]
Abstract

The study investigates the changes in circulating testosterone overtime in order to establish if hypogonadism in men with HIV is a reversal condition or not

F. Di Benedetto; G. Tarantino; N. De Ruvo; N. Cautero; R. Montalti; G.P. Guerrini; R. Ballarin; M. Spaggiari; N. Smerieri; V. Serra; G. Rompianesi; G. D'Amico; A. Mimmo; R.M. Iemmolo; M. Codeluppi; S. Cocchi; G. Guaraldi; G.E. Gerunda ( 2011 ) - University of Modena Experience in HIV-Positive Patients Undergoing Liver Transplantation. - TRANSPLANTATION PROCEEDINGS - n. volume 43 - pp. da 1114 a 1118 ISSN: 0041-1345 [Articolo in rivista (262) - Articolo su rivista]
Abstract

IntroductionHighly effective antiretroviral therapy in the last decade has increased the survival rates of HIV-positive patients, yielding a greater number of HIV patients suffering from liver-related disease. Liver transplantation (LT) is the only curative treatment for end-stage liver disease (ESLD) associated or not with hepatocellular carcinoma (HCC).Patients and methodsFrom June 2003 to September 2010, 23 patients underwent cadaveric donor LT for ESLD at our institution. Inclusion criteria followed the Italian Protocol for LT in HIV-positive patients. Immunosuppressive regimens were based on cyclosporine or tacrolimus, eventually switched to Rapamycin.ResultsThe median CD4 T-cell count was 275/mmc (range = 119–924). All patients were affected by ESLD, which was associated with HCC in 14 cases. Ten patients were within the Milan criteria and four patients exceeded them but were within the San Francisco criteria. Conversion from calcineurin inhibitors (CNI) to rapamycin occurred in ten cases. Hepatitis C virus (HCV) recurrence occurred in 13/21 HCV-positive patients. Acute cellular rejection occurred in eight patients with one developing chronic cellular rejection. Overall patient and graft survivals at 80 months were 50% and 45% respectively.DiscussionLT in HIV-positive patients is a feasible procedure, even if in our experience was burdened by a greater incidence of complications including HCV recurrence and infection compared with HIV-negative patients.

Nizzi, Mc; Ravera, F; Bonucchi, D; Genovese, Elisabetta; Griffo, G; Guaraldi, Giovanni; Guaraldi, Giacomo ( 2011 ) - Validation Of Current International Legislation On Organ Allocation With Actual Practice In Persons With Disability. - Abstracts - TRANSPLANT INTERNATIONAL - n. volume 24 - pp. da 216 a 217 ISSN: 0934-0874 [Abstract in rivista (266) - Abstract in Rivista]
Abstract

There is increasing concern that persons with disability are being marginalized and discriminated against for their disability status in the organ allocation process despite legislation which guarantees transparency and equity. This is due to perceived infeasibility of organ allocation in this subset of patients with end-stage organ failure.

Szep Z;Guaraldi G;Shah SS;Lo Re V 3rd;Ratcliffe SJ;Orlando G;Carli F;Rossi R;Rochira V;Tebas P ( 2011 ) - Vitamin D deficiency is associated with type 2 diabetes mellitus in HIV infection. - AIDS - n. volume 25 - pp. da 525 a 529 ISSN: 0269-9370 [Articolo in rivista (262) - Articolo su rivista]
Abstract

BACKGROUND: Metabolic complications, including type 2 diabetes mellitus and metabolic syndrome, are increasingly recognized among HIV-infected individuals. Low vitamin D levels increase the risk of type 2 diabetes mellitus, and vitamin D supplementation has been shown to decrease the risk of type 2 diabetes mellitus in patients without HIV infection.OBJECTIVES: The primary objective was to determine whether vitamin D deficiency (serum 25-hyrdoxyvitamin D <20 ng/ml) was associated with type 2 diabetes mellitus among HIV-infected patients. Our secondary objective was to determine whether vitamin D deficiency was associated with metabolic syndrome in HIV.METHODS: We conducted a cross-sectional study among participants enrolled in the prospective Modena (Italy) HIV Metabolic Clinic Cohort. Clinical and laboratory data, including history of type 2 diabetes mellitus, fasting blood glucose, components of metabolic syndrome, and 25-hydroxyvitamin D levels, were obtained for all participants.RESULTS: After adjusting for vitamin D supplementation, sex, age, body mass index, and hepatitis C virus co-infection, vitamin D deficiency was associated with type 2 diabetes mellitus [adjusted odds ratio (OR) 1.85; 95% confidence interval (CI) 1.03-3.32; P = 0.038]. The association between vitamin D deficiency and metabolic syndrome was not significant after adjusting for vitamin D supplementation, sex, age and body mass index (adjusted OR 1.32; 95% CI 1.00-1.75; P = 0.053).CONCLUSIONS: Our study demonstrates an association between vitamin D deficiency and type 2 diabetes mellitus. Clinical trials are needed to better characterize the association between vitamin D deficiency and type 2 diabetes mellitus in HIV infection and to evaluate whether vitamin D is able to prevent or delay the onset of type 2 diabetes mellitus.

G. Guaraldi; S. Zona; G. Orlando; F. Carli; G. Ligabue; C. Stentarelli; M. Menozzi; E. Garlassi; C. Giovanardi; P. Tebas ( 2011 ) - Vitamin D3 Supplementation Decreases the Risk of Diabetes Mellitus among Patients with HIV Infection - Program & Abstracts - CROI Alexandria, USA USA) - n. volume not applicable - pp. da 405 a 405 ISBN: 9780979319198 ISSN: - [Abstract in Atti di convegno (274) - Abstract in Atti di Convegno]
Abstract

Type 2 diabetes mellitus (DM), insulin resistance, and hypovitaminosis D are common among individuals living with HIV. Low vitamin D has been associated with insulin resistance and DM in the general population and more recently in the HIV-infected population. Our objective was to examine whether use of vitamin D3 (Cholecalciferol) supplementation could prevent the development of DM among patients with HIV infection.

Guaraldi, Giovanni; Zona, Stefano; Orlando, Gabriella; Carli, Federica; Ligabue, Guido; Stentarelli, Chiara; Menozzi, Marianna; Garlassi, Elisa; Giovanardi, C; Tebas, P. ( 2011 ) - Vitamin D3 supplementation decreases the risk of diabetes mellitus among patients with HIV infection. - Abstracts - INFECTION - n. volume 39 [Abstract in rivista (266) - Abstract in Rivista]
Abstract

Type 2 diabetes mellitus (DM), insulin resistance and hypovitaminosis D are common among individuals living with HIV. Low vitamin D (VitD) has been associated with insulin resistance and DM in the general population and more recently in the HIV infected population. Our objective was to examine if the use of VitD3 supplementation could prevent the development of DM among patients with HIV infection.

Pinetti, C.; Baroncelli, S.; Molinari, A.; Luzi, K.; Degli Antoni, A.; Guaraldi, Giovanni; Tamburrini, E.; Floridia, M. ( 2010 ) - Anaemia in HIV pregnant women and their neonates exposed to non-ZDV-based HAART. - INFECTION - n. volume Vol 38 Suppl.I - pp. da 20 a 20 ISSN: 0300-8126 [Abstract in rivista (266) - Abstract in Rivista]
Abstract

In countries with adequate resources, an increasing number of HIV positive women become pregnant while taking non ZDV-based HAART regimens, and meet the criteria to maintain such regimens during pregnancy. Although some studies have reported some data on the tolerability and side effects of TDF, FTC and ABC, there are limited data on the effects of these NRTIs on maternal and neonatal haemoglobin levels.

Guaraldi, Giovanni; Kalolo, L.; Zona, Stefano; Bianchi, A.; Sola, C.; Calmieri, M.; Broglia, C.; Bettonte, S.; Salvi, P.; Raggi, P. ( 2010 ) - Arterial stiffness assessment in Tanzania by pulse wave velocity: a case-control study of HIV-infected cohort. - INFECTION - n. volume 38 Suppl.I - pp. da 36 a 37 ISSN: 0300-8126 [Abstract in rivista (266) - Abstract in Rivista]
Abstract

The expansion of HIV epidemic and scaling up of antiretroviral therapy in developing countries raise a concern for the development of cardiovascular disease in HIV-infected patients living in those areas. Aortic pulse wave velocity (PWV) is a non-invasive and objective measure of arterial wall elasticity. Arterial stiffness measures vascular damage secondary to ageing, hypertension and inflammation of the vascular wall. An elevated PWV has been established as an indicator of CVD.

S. Cocchi;L. Bisi;M. Codeluppi;C. Venturelli;F. Di Benedetto;R. Ballarin;G. E. Gerunda;F. Rumpianesi;R. Esposito;G. Guaraldi ( 2010 ) - Brucellosis in a patient with end-stage liver disease undergoing liver transplantation: successful treatment with tigecycline. - LIVER TRANSPLANTATION - n. volume 16 - pp. da 1215 a 1216 ISSN: 1527-6465 [Articolo in rivista (262) - Articolo su rivista]
Abstract

No abstract available.

G. Guaraldi; M. Menozzi; S. Zona; E. Garlassi; A. Berti; E. Rossi; G. Orlando; F. Carli; A. Roverato; S. Cocchi; FJ Palella ( 2010 ) - CD4 nadir and antiretroviral exposure predict premature polypathology onset - Abstracts - ANTIVIRAL THERAPY - n. volume 15 [Abstract in rivista (266) - Abstract in Rivista]
Abstract

It has been hypothesized that the increased prevalence of non-infectious comorbidities observed in HIV-related patients when compared to general population is the result of premature ageing effect of HIV infection. The objective was to compare age-related comorbidities prevalence and risk factors between HIV-infected patients and matched controls.

Murphy R.L.; Berzins B.; Zala C.; Fichtenbaum C.; Dube M.P.; Guaraldi G.; Torriani F.; Belsey E.; Mitchell C.; Stein J.H.; SABAR Study Team ( 2010 ) - Change to atazanavir/ritonavir treatment improves lipids but not endothelial function in patients on stable antiretroviral therapy. - AIDS - n. volume Mar 27;24(6) - pp. da 885 a 890 ISSN: 0269-9370 [Articolo in rivista (262) - Articolo su rivista]
Abstract

OBJECTIVE: Protease inhibitors and other antiretroviral drugs have been associated with dyslipidemia, endothelial dysfunction, and increased cardiovascular disease risk. The protease inhibitor atazanavir has an advantageous lipid profile; we studied its effects on arterial function and other metabolic and inflammatory cardiovascular disease risk factors. DESIGN: Prospective, randomized, multinational trial in HIV-infected patients receiving stable protease inhibitor-based therapy with plasma HIV RNA less than 500 copies/ml and fasting low-density lipoprotein cholesterol more than 130 mg/dl, or triglycerides more than 200 mg/dl. METHODS: Patients were randomized to continue their current protease inhibitor or switch the protease inhibitor to atazanavir and continue ritonavir if given as a protease inhibitor booster for 24 weeks. Brachial artery flow-mediated dilation, lipoproteins, and inflammatory and metabolic markers were measured at baseline, week 12, and week 24. Median changes within (signed rank test) and between (Wilcoxon test) arms were calculated. RESULTS: Twenty-six patients switched to atazanavir (all continued on ritonavir); 24 remained on their protease inhibitor regimen. Median CD4 cell count was 499 cells/mul, total cholesterol 204 mg/dl, low-density lipoprotein cholesterol 122 mg/dl, and triglycerides 244 mg/dl. There were no significant changes in flow-mediated dilation after 12 and 24 weeks. At 24 weeks, significant changes in the atazanavir vs. continued protease inhibitor group were observed for total cholesterol (-25 vs. +1.5 mg/dl, P = 0.009), triglycerides (-58 vs. +3.5 mg/dl, P = 0.013), and nonhigh-density lipoprotein cholesterol (-27 vs. -0.5 mg/dl, P = 0.014). CONCLUSION: In dyslipidemic individuals with suppressed HIV RNA on stable therapy, changing the protease inhibitor to atazanavir/ritonavir for 24 weeks improved lipids; however, endothelial function, inflammatory, and metabolic markers did not change.

Guaraldi G; Cossarizza A; Pinti M; Modena M G ( 2010 ) - Circulating endothelial cells and their precursors as biomarkers of endothelial dysfunction in HAART-treated HIV + patients who experienced a myocardial infarction [Altro (298) - Partecipazione a progetti di ricerca]
Abstract

Berretta M; Garlassi E; Ventura P; Cacopardo B; Lleshi A; Cocchi S; Guaraldi G; Pietrangelo A; Tirelli U ( 2010 ) - CLINICAL OUTCOMES AND SURVIVAL IN PATIENTS WITH HEPATOCELLULAR CARCINOMA AND HIV INFECTION - ANNALS OF ONCOLOGY - n. volume 21(6) - pp. da 95 a 96 ISSN: 0923-7534 [Abstract in rivista (266) - Abstract in Rivista]
Abstract

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Floridia, M.; Tamburrini, E.; Anzidei, G.; Tibaldi, C.; Muggiasca, M. L.; Guaraldi, Giovanni; Fiscon, M.; Vimercati, A.; Martinelli, P.; Donisi, A.; Dalzero, S.; Ravizza, M.; for the Italian Group on Surveillance on Antiretroviral Treatment in Pregnancy, ( 2010 ) - Declining HCV seroprevalence in pregnant women with HIV. - EPIDEMIOLOGY AND INFECTION - n. volume 138(9) - pp. da 1317 a 1321 ISSN: 0950-2688 [Articolo in rivista (262) - Articolo su rivista]
Abstract

We assessed recent trends in hepatitis C virus (HCV) prevalence in pregnant women with HIV using data from a large national study. Based on 1240 pregnancies, we observed a 3.4-fold decline in HCV seroprevalence in pregnant women with HIV between 2001 (29.3%) and 2008 (8.6%). This decline was the net result of two components: a progressively declining HCV seroprevalence in non-African women (from 35.7% in 2001 to 16.7% in 2008), sustained by a parallel reduction in history of injecting drug use (IDU) in this population, and a significantly growing presence (from 21.2% in 2001 to 48.6% in 2008) of women of African origin, at very low risk of being HCV-infected [average HCV prevalence 1%, adjusted odds ratio (aOR) for HCV 0.09, 95% CI 0.03-0.29]. Previous IDU was the stronger determinant of HCV co-infection in pregnant women with HIV (aOR 30.9, 95% CI 18.8-51.1). The observed trend is expected to translate into a reduced number of cases of vertical HCV transmission.

Guaraldi, Giovanni; Luzi, Kety; Zona, Stefano; Orlando, Gabriella; Carli, Federica; Becci, M.; Rochira, Vincenzo; Amadeo, B.; Esposito, Roberto; Raggi, P. ( 2010 ) - Determinants of erectile dysfunction changes in HIV infected men: a prospective study. - Abstracts. Italian Conference on AIDS and Retroviruses-ICAR 2010 - Attuale:ELSEVIER SCIENCE BV, PO BOX 211, AMSTERDAM, NETHERLANDS, 1000 AE Springer Verlag Germany:Tiergartenstrasse 17, D 69121 Heidelberg Germany:011 49 6221 3450, EMAIL: g.braun@springer.de, INTERNET: http://www.springer.de, Fax: 011 49 6221 345229 Heidelberg DEU) - INFECTION - n. volume 38 Suppl.I - pp. da 77 a 77 ISSN: 0300-8126 [Abstract in rivista (266) - Abstract in Rivista]
Abstract

A high prevalence of erectile dysfunction /ED) has been reported in HIV-infected men. However factors associated with ED are poorly understood and the role of antiretroviral therapy, especially PIs, is unclear. The aims of this study were to evaluate prevalence of ED and identify factors associated with improvement in ED during a mean follow up of 1.5years among 67 HIV infected men.

Moyle G.; Moutschen M.; Martínez E.; Domingo P.; Guaraldi G.; Raffi F.; Behrens G.; Reiss P. ( 2010 ) - Epidemiology, Assessment, and Management of Excess Abdominal Fat in Persons with HIV Infection. - AIDS REVIEWS - n. volume Jan-Mar;12(1) - pp. da 3 a 14 ISSN: 1139-6121 [Articolo in rivista (262) - Articolo su rivista]
Abstract

Metabolic 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 and metformin, both of which have shown benefit for insulin-resistant individuals with isolated fat accumulation. Testosterone supplements may also have benefits in a subset of individuals. Supra-physiological doses of recombinant human growth hormone and the growth hormone releasing hormone analog tesamorelin both significantly and selectively reduce visceral fat over 12-24 weeks; however, the benefits are only maintained if doping is continued. In summary, the prevention and management of visceral adiposity remains a substancial challenge in clinical practice.

G. Guaraldi; K. Luzi; S. Zona; G. Orlando; F. Carli; G. Ligabue; V. Rochira; R. Rossi; R. Esposito; P. Raggi ( 2010 ) - Erectile dysfunction does not mirror sub-clinical atherosclerosis in HIV infected males. - Abstracts of ICAR 2010, Italian Conference on AIDS and Retroviruses - Editori indicati: SPRINGER, 233 SPRING STREET, NEW YORK, USA, NY, 10013 Springer Verlag Germany:Tiergartenstrasse 17, D 69121 Heidelberg Germany:011 49 6221 3450, EMAIL: g.braun@springer.de, INTERNET: http://www.springer.de, Fax: 011 49 6221 345229 Heidelberg DEU) - INFECTION - n. volume 38 Suppl.I - pp. da 79 a 80 ISSN: 0300-8126 [Abstract in rivista (266) - Abstract in Rivista]
Abstract

In the general population erectile dysfunction (ED) and coronary artery disease share the same risk factors and endothelial dysfunction appear to be the common denominator. ED appears to be one of the earliest signs of systemic vascular disease and might be considered as an early marker for subclinical cardiovascular disease. We hypothesised ED as a nirror of sub-clinical atherosclerosis in HIV infected patients.

Borsari, Lucia; Ferrara, M.; Barbanti Silva, V.; Pingani, Luca; Cocchi, S.; Guaraldi, Giovanni; Gerunda, Giorgio Enrico; Rigatelli, Marco; Ferrari, Silvia ( 2010 ) - Evaluation of HIV positive recipients of orthotopic liver transplant (OLT): an observational study in the modena consultation liaison psychiatric service - 18th European Congress of Psychiatry - EUROPEAN PSYCHIATRY - n. volume 25 - pp. da 484 a 484 ISSN: 0924-9338 [Abstract in rivista (266) - Abstract in Rivista]
Abstract

18th European Congress of Psychiatry

M. Ferrara; R. Murri; E. Bertaccini; G. Orlando; M. Vandelli; M. De Paola; R. Bucciardini; M. Rigatelli; R. Esposito; G. Guaraldi; S. Ferrari ( 2010 ) - Evaluation of psychological impact of facial lipoatrophy in HIV: the “assessment of face & body change and distress” questionnaire - 18th European Congress of Psychiatry - EUROPEAN PSYCHIATRY - n. volume 25 - pp. da 752 a 752 ISSN: 0924-9338 [Abstract in rivista (266) - Abstract in Rivista]
Abstract

18th European Congress of Psychiatry

F. D. Benedetto;S. D. Sandro;N. D. Ruvo;R. Montalti;R. Ballarin;G. P. Guerrini;M. Spaggiari;G. Guaraldi;G. Gerunda ( 2010 ) - First report on a series of HIV patients undergoing rapamycin monotherapy after liver transplantation. - TRANSPLANTATION - n. volume 89 - pp. da 733 a 738 ISSN: 0041-1337 [Articolo in rivista (262) - Articolo su rivista]
Abstract

Some experimental trials have demonstrated that rapamycin (RAPA) is able to inhibit HIV-1 progression in three different ways: (1) reducing CCR5-gene transcription, (2) blocking interleukin-2 intracellular secondary messenger (mammalian target of rapamycin), and (3) up-regulating the beta-chemokine macrophage inflammatory protein (MIP; MIP-1alpha and MIP-1beta). We present the preliminary results of a prospective nonrandomized trial concerning the first HIV patient series receiving RAPA monotherapy after liver transplantation (LT).Since June 2003, 14 HIV patients have received cadaveric donor LT due to end-stage liver disease (ESLD) associated or not associated with hepatocellular carcinoma, scored by the model for ESLD system. Patients were assessed using the following criteria for HIV characterization: CD4 T-cell count more than 100/mL and HIV-RNA levels less than 50 copies/mL. Primary immunosuppression was based on calcineurin inhibitors (CI), whereas switch to RAPA monotherapy occurred in cases of CI complications or Kaposi's sarcoma.Mean overall post-LT follow-up was 14.8 months (range: 0.5-52.6). Six of 14 patients were administered RAPA monotherapy. Mean preswitch period from CI to RAPA was 67 days (range: 10-225 days). Mean postswitch follow-up was 11.9 months (range: 2-31 months). All patients were affected by ESLD, which was associated with hepatocellular carcinoma in seven patients. ESLD occurred due to hepatitis C virus (HCV)-related hepatopathy for nine patients, hepatitis B virus-related hepatopathy for one patient, and hepatitis B virus-HCV hepatopathy for four patients. Significantly better control of HIV and HCV replication was found among patients taking RAPA monotherapy (P=0.0001 and 0.03, respectively).After in vitro and in vivo experimental evidence of RAPA antiviral proprieties, to our knowledge, this is the first clinical report of several significant benefits in long-term immunosuppression maintenance and HIV-1 control among HIV positive patients who underwent LT.

Guaraldi, Giovanni; Zona, Stefano ( 2010 ) - From lipodystrophy to cardiovascular disease: new insight into the management of HIV infection. - CLINICAL LIPIDOLOGY - n. volume 5 - pp. da 583 a 593 ISSN: 1758-4299 [Articolo in rivista (262) - Articolo su rivista]
Abstract

In this era of highly active antiretroviral therapy (ART), body habitus changes among HIV-infected patients, including face and peripheral lipoatrophy, visceral abdomen fat accumulation, together with lipid and glucose metabolism abnormalities, have been widely described under the name of lipodystrophy. Lipodystrophy contributes to cardiovascular disease risk in HIV infection through a complex interplay of host, virus and ART factors. Given that both HIV and ART are indipendent risk factors for cardiovascular disease, aggressive preventive care should be considered in all infected patients. The time has come to proceed beyond lipodystrophy studies based on blood concentretations of lipids and glucose and body fat evaluation. Surrogate markers of organ disease associates with lipodystrophy identify patients vulnerable to cardiovascular events better than statistical risk algorithms. Management of lipodystrophy needs to be considered as being part of a multidisciplinary appoach focusing on the reduction of cardiovascular diseases. For now, the mainstays of cardiovascular disease prevention of HIV-infected persons at high risk include, appropriate lifestyle changes, use of lipid-lowering and anti-aggregant medications and judicious selection of highly active ART agents.

Garlassi, E.; Ventura, Paolo; Beretta, M.; Cocchi, S.; Cacopardo, B.; Stentarelli, C.; Di Gangi, P.; Pietrangelo, Antonello; Tirelli, U.; Guaraldi, Giovanni ( 2010 ) - Hepatocellular carcinoma in HIV infected patients: check early, treat hard. - INFECTION - n. volume 38 Suppl.I - pp. da 82 a 82 ISSN: 0300-8126 [Abstract in rivista (266) - Abstract in Rivista]
Abstract

Hepatocellular carcinoma (HCC) is an emerging problem for HIV patients, particularly if HCV and/or HBV co-infected. The aim of the study was to evaluate the impact of early diagnosis and effective treatment on survival of HIV infected patients with HCC.

Rockstroh, J.; Guaraldi, Giovanni; Deray, G. ( 2010 ) - HIV and the body: a review of multidisciplinary management. - HIV MEDICINE - n. volume 11, Suppl 2 - pp. da 1 a 8 ISSN: 1464-2662 [Articolo in rivista (262) - Articolo su rivista]
Abstract

The increase in the life expectancy achieved following the introduction of more effective antiretroviral therapy (ART) in recent years now means that the HIV-infected population are for the first time being exposed to the age-related diseases that affect the general population. Nevertheless, the prevalence of these diseases (which include cardiovascular disease, dyslipidaemia, glucose intolerance and diabetes) is higher, and their onset earlier in the HIV population, probably due to the complex interplay between HIV infection, coinfection with hepatitis B and C, and ART. As a result, HIV physicians are now required to adopt a new approach to the management of HIV, which involves screening and regular monitoring of all HIV-infected individuals for the presence of comorbidities and prompt referral to other clinical specialties when required. If this challenge to patient management is to be overcome, it is clear that educating physicians in the diagnosis and treatment of age-associated comorbidities is essential, either through ongoing programmes such as the HIV and the Body initiative, an overarching independent medical education programme established in 2007 and overseen by an independent Steering Committee, organized and funded by Gilead, and/or through internal training. To assist in this process, this article provides an overview of common comorbidities affecting HIV-infected persons and provides practical guidance on their management.

Guaraldi G ( 2010 ) - HIV clinical spectrum, HAART adherence, efficacy and tolerability in migrants in Italy. [Altro (298) - Partecipazione a progetti di ricerca]
Abstract

P. Ventura; E. Garlassi; B. Cacopardo; P. Di Gangi; M.C. Ferrari;G. Venturelli; U. Tirelli; G. Guaraldi; A. Pietrangelo; M. Berretta ( 2010 ) - HIV INFECTION AND SURVIVAL IN PATIENTS WITH HCCAND LIVER CIRRHOSIS - Abstracts of the 43th A.I.S.F. - Italian Association for the - Elsevier Roma NLD) - DIGESTIVE AND LIVER DISEASE - n. volume 42S [Abstract in rivista (266) - Abstract in Rivista]
Abstract

Background and Aims: HCC is an emerging problem for HIVpatients, particularly if HCV and/or HBV co-infected. At the present,few data are available on the effect of HCC treatment receipt in HIV+patients. Our data aim to retrospectively compare survival rates inpatients with and without HIV infection affected by liver cirrhosisand HCC (HCC-LC).Materials and Methods: 65 HIV positive (HIV+) (54 on HAART;34 A1-A3, 17 B1-B3 and 9 C1-C3 stage; 12 with CD4 lowerthan 200) and 267 HIV negative (HIV−) HCC-LC subjects werecompared in terms of survival rates considering age, tumor andliver disease characteristics at the diagnosis (etiology, BCLC stage,number of lesions, vascular invasion, progression), treatment receipt(no treatment, palliative or curative, treatment at the progression),HIV status. All subjects were male and had at least three-months ofdisease follow up.Results: The Table resumes median survival rates according todifferent treatment strategies in the considered groups.Median survival (months) pHIV+ HIV−Overall 31.3±4.91 (n = 65) 59.7±7.07 (n = 267) .010Untreated 4.52±1.83 (n = 6) 36.1±15.2 (n = 48) .000Treated (all treatment) 35.0±11.3 (n = 59) 65.0±7.23 (n = 219) .042Treated (curative) 35.1±11.9 (n = 25) 67.8±14.7 (n = 75) .000Treated (palliative) 31.1±10.2 (n = 34) 53.1±11.1 (n = 144) .052Factors independently related to survival (Cox regression) were:HIVab pos (HR = .567, 95% CI 0.317–0.912, p = 0.046), HCCTreatment (HR = 1.506, 95%–CI 1.154–2.549, p = 0.035), tumor size>5 cm (HR = 1.257, 95% CI 1.106–1.636, p = 0.025) BCLC 0−1(HR = 1.247, 95% CI 1.100–1.576, P = 0.034), such as HAARTtherapy (HR = 2.25, 95% CI 1.01–5.048, p = .048) and treatment atprogression (TaP) (HR = 2.801, 95% CI 1.78–4.56, p = 0.000). HIV−patients had a higher frequency of TaP (88.6% vs. 67.3%, p = 0.001).Conclusions: HIV infection negatively influences HCC outcome,even in treated patients. The role of reduced re-treatment rate in caseof HCC progression in these patients needs be evaluated.

G. Guaraldi; S. Zona; G. Orlando; F. Carli; C. Stentarelli; JP Despres; R. Ross ( 2010 ) - Hypertriglyceridemic waist identifies HIV men and women at increased cardiometabolic risk - ANTIVIRAL THERAPY - n. volume 15 [Abstract in rivista (266) - Abstract in Rivista]
Abstract

Screening for increased waist circumference and hypertriglyceridemia (the hypertriglyceridemic-waist phenotype) is an inexpensive approach to identify patients at risk of coronary artery disease in apparently healthy individuals who may be at increased risk of type 2 diabetes and coronary heart disease because of an excess of intra-abdominal (visceral) fat. We examined the ralationship between the hypertriglyceridemic-waist and selected cardiometabolic risk factors in HIV individuals.

G. Guaraldi ( 2010 ) - Invecchiare con – per HIV - READ FILES - n. volume 2 - pp. da 1 a 3 ISSN: - [Articolo in rivista (262) - Articolo su rivista]
Abstract

non disponibile

Guaraldi, Giovanni; Stentarelli, C.; Zona, S.; Orlando, G.; Carli, F.; Ligabue, Guido; Lattanzi, A.; Zaccherini, G.; Rossi, Rosario; Modena, Maria Grazia; Alexopoulos, N.; Palella, F.; Raggi, P. ( 2010 ) - Lipodystrophy and anti-retroviral therapy as predictors of sub-clinical atherosclerosis in human immunodeficiency virus infected subjects. - ATHEROSCLEROSIS - n. volume Jan;208(1) (Epub 2009 Jun 18) - pp. da 222 a 227 ISSN: 0021-9150 [Articolo in rivista (262) - Articolo su rivista]
Abstract

Although anti-retroviral therapy (ART) prolonged survival in HIV-infected persons, an increase in cardiovascular disease has also been observed. A frequent complication of ART is the development of lipodystrophy (LD) with its multiple phenotypes that may be associated with cardiovascular disease. We assessed the contribution of chronic HIV infection, ART use and LD to the presence of sub-clinical atherosclerosis as evaluated by coronary artery calcium (CAC) imaging. METHODS: Observational cross-sectional study of 372 HIV-infected patients receiving ART who attended a cardiometabolic clinic (48.2+/-8-year old; 74% men). All patients underwent CAC surveillance with computed tomography and the Agatston score was used to quantitate CAC. Presence of CAC was defined as a score >10. Multivariable logistic regression was used to evaluate associations between HIV clinical factors, ART and LD with the presence of CAC. FINDINGS: CAC was found in 134 patients (36%) with a median CAC score of 50 (range 10; 1243). Lipoatrophy alone (OR 3.82, 95% CI: 1.11; 13.1), fat accumulation alone (OR 7.65, 95% CI: 1.71; 37.17) and mixed lipodystrophy phenotypes (OR 4.36, 95% CI: 1.26; 15.01) were strongly associated with presence of CAC after adjusting for age, sex, hypertension and cumulative exposure to ART. CONCLUSION: CAC is common among long-term ART users. The association between CAC and LD underscores the potential atherosclerosis risk inherent with ART and the need to undertake routine cardiovascular surveillance in patients treated with these drugs.

Cocchi, S.; Zona, Stefano; Montalti, R.; DI BENEDETTO, Fabrizio; Codeluppi, M.; Gerunda, Giorgio Enrico; Esposito, Roberto; Guaraldi, Giovanni ( 2010 ) - Longitudinal assessment of pre-transplant mortality risk among HIV-infected and uninfected patients with end-stage liver disease: the role of delta-meld score - INFECTION - n. volume Vol 38 Suppl.I - pp. da 33 a 33 ISSN: 0300-8126 [Abstract in rivista (266) - Abstract in Rivista]
Abstract

The need for liver transplantation (LTx) has recently increased due to higher rates of end-stage liver disease (ESLD) associated with hepatitis C virus co-infection. Hence, LTx is now considered a definitive therapeutic option for selected HIV-positive patients. The model for ESLD (MELD) scoring system is the prevailing criterion for organ allocation, but its reliability has not been fully established in HIV-infected patients. Moreover, the change in MELDscore over time (Delta-MELD) may be a more accurate predictor of adverse outcomes in this population. The primary objective was to assess the role of Delta-MELD score as indipendent predictor of pre-transplant mortality in HIV-infected LTx candidates. The secondary objective was to determine factors associated with predictors of pre-transplant mortality in this population.

K. Luzi; S. Zona; A. Lattanzi; R. Bruno; F. Facchinetti; R. Esposito; G. Guaraldi ( 2010 ) - Measurement of endothelial function in HIV-infected pregnant women:case-control study. - INFECTION - n. volume 38 Suppl.I - pp. da 33 a 34 ISSN: 0300-8126 [Abstract in rivista (266) - Abstract in Rivista]
Abstract

Endothelial function play a significant role in cardiovascular adaptation of physiological changes occurring during pregnancy. Hypertension in a pregnant women may be considered an endothelial dysfunction secondary disease. No studies have explored functional integrity of vasculature by mean of brachial artery diameter and flow mediated dilation in HIV infected women during pregnancy so far. Our objective was to describe endothelial function chenges and predictors in pregnant women with and without HIV infection.

G. Besutti; L. Nocetti; G. Ligabue; R. Scaglioni; C. Stentarelli; S. Zona; P. Loria; S. Ballestri; L. Losi; P. Torricelli; G. Guaraldi ( 2010 ) - MR techiniques in the quantitative assessment of liver steatosis - Abstracts - ANTIVIRAL THERAPY - n. volume 15 [Abstract in rivista (266) - Abstract in Rivista]
Abstract

To compare sensitivity and specificity of different magnetic resonance (MR) techiniques in the quantitative assessment of liver steatosis, using liver biopsy as the reference standard, in patients with and without HIV infection.

G. Besutti; L. Nocetti; C. Stentarelli; S. Zona; R. Scaglioni; P. Loria; S. Ballestri; V. Righi; A. Mucci; L. Losi; P. Torricelli; G. Guaraldi; G. Ligabue ( 2010 ) - MR techniques in the qualitative analysis of liver steatosis: the potential in the differentiation between steatohepatatis and steatosis - Abstracts - ANTIVIRAL THERAPY - n. volume 15 [Abstract in rivista (266) - Abstract in Rivista]
Abstract

To evaluate multiecho MR techniques in the differentiation between steatohepatitis and steatosis, using liver biopsy as the reference standard, in patients with and without HIV infection.

F. Filace; V. Righi; C. Stentarelli; G. Guaraldi; V. Borghi; S. Zona; G. Ligabue; G. Busetti; P. Loria; S. Ballestri; L. Losi; L. Nocetti; L. Schenetti; A. Mucci ( 2010 ) - Non-alcoholic Fatty Liver Disease: a HR-MAS analysis - Book of Abstracts - WWMR2010 Firenze ITA) - n. volume Unico - pp. da 177 a 177 ISBN: .. ISSN: - [Abstract in Atti di convegno (274) - Abstract in Atti di Convegno]
Abstract

Non-alcoholic fatty liver disease (NAFLD) is a common cause of chronicliver disease. The NAFLD includes non-alcoholic fatty liver (NAFL) andnon-alcoholic steatohepatitis (NASH). The mechanisms of NAFLD to NASH transition remain to be clarified. NAFLD appears to originate from the dysregulation of hepatic lipid metabolism as a part of the metabolicsyndrome accompanied by visceral obesity dyslipidemia, atherosclerosis, and insulin resistance. High Resolution Magic Angle Spinning (HR-MAS) NMR is a useful tool for the metabolic characterization of intact tissues and can be used to support the clinical diagnosis. The aim of this study is to characterized the NAFLD and NASH metabolism using HR-MAS NMR Spectroscopy, and to evaluate the possible transition from NAFLD to NASH. Liver needle biopsies were collected for the HR-MAS and histological analyses. Preliminary HR-MAS NMR results show a higher amount of lipids in the biopsies from patients with 30-50% of steatosis, whereas lipids and of small metabolites are present when the liver is affected from a market fibrosis.

Guaraldi, Giovanni; Stentarelli, C; Orlando, G; Zona, S; Carli, F; Ballestri, S; Lonardo, A; Squillace, N; Loria, Paola ( 2010 ) - Nonalcoholic fatty liver disease in HIV-infected persons: epidemiology and the role of nucleoside reverse transcriptase inhibitors. - JOURNAL OF ACQUIRED IMMUNE DEFICIENCY SYNDROMES - n. volume 53 - pp. da 278 a 278 ISSN: 1525-4135 [Articolo in rivista (262) - Articolo su rivista]
Abstract

No abstract available

G. Guaraldi; M. Menozzi; S. Zona; E. Garlassi; A. Berti; E. Rossi; G. Orlando; F. Carli; A. Roverato; S. Cocchi; FJ Palella ( 2010 ) - Polypharmacology for polypathology in HIV infected patients. - ANTIVIRAL THERAPY - n. volume 15 [Abstract in rivista (266) - Abstract in Rivista]
Abstract

We hypothesized that age-related non-infectious comorbidities (cardiovascular disease, hypertension, diabetes, osteoporosis and renal failure), aggregating in polypathology, need a polypharmacology approach in HIV-infected patients. The objective was to compare, in HIV-infected patients and matched controls, the distribution of drug groups and daily pill burden in different age strata.

G. Brigante; D. Santi; L. Zirilli; C. Diazzi; G. Orlando; M. Simoni; G. Guaraldi; C. Carani; V. Rochira ( 2010 ) - Prevalence and characterization of hypogonadism among men with human immunodeficiency virus infection: preliminary results - Abstracts of the IX National Congress of the Italian Society of Medical Andrology and Sexual Medicine - Editrice Kurtis Srl:via Luigi Zoja 30, Milan 20153 Italy:011 39 02 48202740, EMAIL: info@kurtis.it, INTERNET: http://www.kurtis.it, Fax: 011 39 02 48201219 Milano ITA) - JOURNAL OF ENDOCRINOLOGICAL INVESTIGATION. SUPPLEMENT - n. volume 33 - pp. da 5 a 5 ISSN: 1121-1369 [Abstract in rivista (266) - Abstract in Rivista]
Abstract

Preliminary data on the prevalence and type of male hypogonadism in men with HIV infection

Rochira, Vincenzo; Santi, Daniele; Brigante, Giulia; Zirilli, Lucia; Diazzi, Chiara; Orlando, Gabriella; Carani, Cesare; Guaraldi, Giovanni ( 2010 ) - Prevalence and characterization of hypogonadism among men with human immunodeficiency virus infection: preliminary results - Abstracts of the The 92nd Annual Meeting of the Endocrine Society ENDO2010 - Endocrine Society / Maryland:8401 Connecticut Avenue, Suite 900:Chevy Chase, MD 20815:(301)941-0200, (301)941-0200, (301)941-0232, EMAIL: journals@endo-society.org, INTERNET: http://www.endo.society.org, Fax: (301)941-0259 Maryland USA) - ENDOCRINE REVIEWS - n. volume 31(3) [Abstract in rivista (266) - Abstract in Rivista]
Abstract

Preliminary results on the prevalence of male hypogonadism in HIV-infected men

V. Rochira; G. Brigante; D. Santi; L. Zirilli; C. Diazzi; G. Orlando; C. Carani; G. Guaraldi. ( 2010 ) - Prevalence and characterization of hypogonadism among men with human immunodeficiency virus infection: preliminary results. - Abstracts of the 12th European Congress of Endocrinology - Bioscientifica Limited:22 Apex Court, Woodlands, Bradley, Bristol BS32 4JT United Kingdom:011 44 1454 619036, EMAIL: sales@endocrinology.org, INTERNET: http://www.endocrinology.org, Fax: 011 44 1454 616071 Bristol GBR) - ENDOCRINE ABSTRACTS - n. volume 22 [Abstract in rivista (266) - Abstract in Rivista]
Abstract

According to the preliminary results of the study HIV-infected men present a higher prevalence of hypogonadism, at a younger age than general population

S. Cocchi; D. Bonucchi; R. Pulizzi; G. Ghiandai; G. Mori; C. Americo; S. Zona; M. Codeluppi; R. Esposito; G. Cappelli; G. Guaraldi ( 2010 ) - Raltegravir and enfuvirtide as a “bridge” antiretroviral therapy in kidney-tranplanted patients with HIV infection receiving everolimus and low-dose cyclosporine: a case-control study - INFECTION - n. volume 38 Suppl.I - pp. da 41 a 42 ISSN: 0300-8126 [Abstract in rivista (266) - Abstract in Rivista]
Abstract

Pharmacokinetic interactions between antiretrovirals and immunosuppressants are critical elements in the management of HIV-infected patients who undergo kidney tranplantation (KTX) thus most transplant centres discontinue antiretrovirals until IS steady state is reached. The objective of the study was to assess the impact of an antiretroviral regimen based on enfuvirtide+raltegravir+NRTI on everolimus and cyclosporin pharmacokinetics in the early post-KTx period.

Fabrizio Di Benedetto; Stefano Di Sandro; Roberto Ballarin; Giovanni Guaraldi; Giorgio E. Gerunda ( 2010 ) - Rapamycin and HIV Replication in Liver Transplant Recipients - TRANSPLANTATION - n. volume 90 - pp. da 1040 a 1040 ISSN: 0041-1337 [Articolo in rivista (262) - Articolo su rivista]
Abstract

not available

G. Guaraldi; S. Zona; G. Orlando; F. Carli; C. Stenterelli; J.P. Despres; R. Ross ( 2010 ) - Regional fat changes in the pre, early and late ART eras. - ANTIVIRAL THERAPY - n. volume 15 [Abstract in rivista (266) - Abstract in Rivista]
Abstract

Antiretroviral strategies and drugs are changing, and this may affect the evolution of regional fat distribution over time. We examined the changes in visceral adipose tissue (VAT) and leg fat (LF) as surrogate measures of lipohypertrophy and lipoatrophy in relation to the time period when antiretroviral treatment (ART) was started and to the use of specific antiretroviral drugs.

Dal Maso, L.; Franceschi, S.; Lise, M.; De' Bianchi, P. S.; Polesel, J.; Ghinelli, F.; Falcini, F.; Droghini, A. C. FinarelliCollaborators: L.; Serraino, D.; Alberici, F.; Antoni, A. D.; Magnani, G.; Guaraldi, Giovanni; Chiodo, F.; Sighinolfi, L.; Ballardini, G.; Cancellieri, C.; Stagno, A.; Arlotti, M.; Govoni, A. ( 2010 ) - Self-reported history of Pap-smear in HIV-positive women in Northern Italy: a cross-sectional study - BMC CANCER - n. volume 10 - pp. da 310 a 310 ISSN: 1471-2407 [Articolo in rivista (262) - Articolo su rivista]
Abstract

BACKGROUND: The incidence of invasive cervical cancer in HIV-positive women is higher than in the general population. There is evidence that HIV-positive women do not participate sufficiently in cervical cancer screening in Italy, where cervical cancer is more than 10-fold higher in women with AIDS than in the general population. The aim of the present study was to evaluate the history of Pap-smear in HIV-positive women in Italy in recent years. We also examined the sociodemographic, clinical, and organizational factors associated with adherence to cervical cancer screening.METHODS: A cross-sectional study was conducted between July 2006 and June 2007 in Emilia-Romagna region (Northern Italy). All HIV-positive women who received a follow-up visit in one of the 10 regional infectivology units were invited to participate. History of Pap-smear, including abnormal smears and subsequent treatment, was investigated through a self-administered anonymous questionnaire. The association between lack of Pap-smear in the year preceding the interview and selected characteristics was assessed by means of odds ratios (OR) and 95% confidence intervals adjusted for study centre and age.RESULTS: A total of 1,002 HIV-positive women were interviewed. Nine percent reported no history of Pap-smear, and 39% had no Pap-smear in the year prior to the date of questionnaire (last year). The lack of Pap-smear in the last year was significantly associated with age <35 years (OR = 1.4, compared to age > or =45 years), lower education level (OR = 1.3), first HIV-positive test in the last 2 years (OR = 1.4), and CD4 count <200 cells/microl (OR = 1.6). Conversely, when women were advised by a gynecologist rather than other health workers to undergo screening, it significantly increased adherence. Non-significantly higher proportions of lack of Pap-smear in the last year were found in women born in Central-Eastern Europe (OR = 1.8) and Africa (OR = 1.3). No difference in history of Pap-smear emerged by mode of HIV-acquisition or AIDS status.Three hundred five (34%) women reported a previous abnormal Pap-smear, and of the 178 (58%) referred for treatment, 97% complied.CONCLUSIONS: In recent years the self-reported history of Pap-smear in HIV-positive women, in some public clinics in Italy, is higher than previously reported, but further efforts are required to make sure cervical cancer screening is accessible to all HIV-positive women.

D. Santi; G. Brigante; G. Orlando; M. Ciccarese; C. Diazzi; G. Guaraldi; C. Carani; V. Rochira; B. Madeo ( 2010 ) - Sex steroids and HIV-related osteoporosis in men: low circulating estrogens are associated with impaired bone mineral density (BMD) - Abstracts of the IX National Congress of the Italian Society of Medical Andrology and Sexual Medicine - Editrice Kurtis Srl:via Luigi Zoja 30, Milan 20153 Italy:011 39 02 48202740, EMAIL: info@kurtis.it, INTERNET: http://www.kurtis.it, Fax: 011 39 02 48201219 Milano ITA) - JOURNAL OF ENDOCRINOLOGICAL INVESTIGATION. SUPPLEMENT - n. volume 33 - pp. da 10 a 10 ISSN: 1121-1369 [Abstract in rivista (266) - Abstract in Rivista]
Abstract

Preliminary data on the effects of sex steroids on bone max in men with HIV

Pinti, Marcello; Gibellini, Lara; Guaraldi, Giovanni; Orlando, Gabriella; Gant, T. W.; Morselli, Eugenia; Nasi, Milena; Salomoni, P.; Mussini, Cristina; Cossarizza, Andrea ( 2010 ) - Upregulation of nuclear-encoded mitochondrial LON protease in HAART-treated HIV+ patients with lipodystrophy: implications for the pathogenesis of the disease - AIDS - n. volume 24 - pp. da 841 a 850 ISSN: 0269-9370 [Articolo in rivista (262) - Articolo su rivista]
Abstract

BACKGROUND: HAART can provoke metabolic changes and body fat redistribution, resulting in lipodystrophy, a side effect significantly involving mitochondrial function. Mitochondrial DNA (mtDNA) depletion caused by nucleosidic reverse transcription inhibitors is supposed to be a crucial mechanism in the pathogenesis of mitochondrial damages. METHODS: In adipose tissue from 22 HIV-positive patients with lipodystrophy and 20 healthy controls, we analyzed gene expression by microarray analysis and real-time PCR. The most upregulated gene was further studied in the human adipocytic cell line SW872 by real-time PCR, western blot, transient transfection assays and flow cytometry. RESULTS: We identified 18 genes differently expressed between lipodystrophy patients and controls, and focused our attention on the nuclear-encoded mitochondrial protease LON, essential in mtDNA maintenance. In SW872 cells, treatment with stavudine (d4T) doubled LON levels, in parallel with mtDNA depletion. As d4T increased reactive oxygen species (ROS) intracellular content, we measured LON in presence of deoxyribose, which causes oxidative stress but not mtDNA depletion, and observed LON upregulation. Ethidium bromide, which markedly depletes mtDNA, did not alter LON levels. The antioxidant glutathione inhibited the increase of intracellular ROS and the increase in LON caused by d4T or deoxyribose. CONCLUSION: LON upregulation was due to d4T-induced ROS production, rather than due to mtDNA depletion, and represents a response to an oxidative stress. Other mechanisms than mtDNA depletion thus exist that explain nucleosidic reverse transcription inhibitors toxicity. This observation provides a rationale for possible therapeutic interventions aimed at reducing intracellular ROS content in patients assuming HAART.

Pinti, Marcello; Gibellini, Lara; Guaraldi, Giovanni; Orlando, Gabriella; Gant, Tw; Morselli, Eugenia; Nasi, Milena; Salomoni, Paolo; Mussini, Cristina; Cossarizza, Andrea ( 2010 ) - Upregulation of nuclear-encoded mitochondrial LON protease in HAART-treated HIV-positive patients with lipodystrophy: implications for the pathogenesis of the disease - AIDS - n. volume 24 - pp. da 841 a 850 ISSN: 0269-9370 [Articolo in rivista (262) - Articolo su rivista]
Abstract

BACKGROUND: HAART can provoke metabolic changes and body fat redistribution, resulting in lipodystrophy, a side effect significantly involving mitochondrial function. Mitochondrial DNA (mtDNA) depletion caused by nucleosidic reverse transcription inhibitors is supposed to be a crucial mechanism in the pathogenesis of mitochondrial damages. METHODS: In adipose tissue from 22 HIV-positive patients with lipodystrophy and 20 healthy controls, we analyzed gene expression by microarray analysis and real-time PCR. The most upregulated gene was further studied in the human adipocytic cell line SW872 by real-time PCR, western blot, transient transfection assays and flow cytometry. RESULTS: We identified 18 genes differently expressed between lipodystrophy patients and controls, and focused our attention on the nuclear-encoded mitochondrial protease LON, essential in mtDNA maintenance. In SW872 cells, treatment with stavudine (d4T) doubled LON levels, in parallel with mtDNA depletion. As d4T increased reactive oxygen species (ROS) intracellular content, we measured LON in presence of deoxyribose, which causes oxidative stress but not mtDNA depletion, and observed LON upregulation. Ethidium bromide, which markedly depletes mtDNA, did not alter LON levels. The antioxidant glutathione inhibited the increase of intracellular ROS and the increase in LON caused by d4T or deoxyribose. CONCLUSION: LON upregulation was due to d4T-induced ROS production, rather than due to mtDNA depletion, and represents a response to an oxidative stress. Other mechanisms than mtDNA depletion thus exist that explain nucleosidic reverse transcription inhibitors toxicity. This observation provides a rationale for possible therapeutic interventions aimed at reducing intracellular ROS content in patients assuming HAART.

G Guaraldi;N Alexopoulos;C Stentarelli;S Zona;G Orlando;F Carli;G Ligabue;A Lattanzi;R Rossi;MC Modena;F Palella;P Raggi ( 2009 ) - Abstract: P784 ANTIRETROVIRAL THERAPY AND LIPODYSTROPHY AS PREDICTORS OF SUB-CLINICAL ATHEROSCLEROSIS - Atherosclerosis Supplements - ATHEROSCLEROSIS SUPPLEMENTS - n. volume 10 [Abstract in rivista (266) - Abstract in Rivista]
Abstract

Although antiretroviral therapy (ART) has prolonged survival in HIV-infected persons, an increase in cardiovascular disease (CVD) has been observed. A frequent complication of ART is the development of lipodystrophy (LD) that may be associated with CVD. We assessed the contribution of chronic HIV infection, ART use and LD to the presence and extent of subclinical atherosclerosis as evaluated by coronary artery calcium imaging.

G. Guaraldi; A. Leonardo; S. Ballestri; S. Zona; C. Stenterelli; G. Orlando; F. Carli; L. Carulli; A. Roverato ( 2009 ) - Antiretroviral drugs induced metabolic diseases in HIV infected patients. - Programme and Abstracts - EASL (European Association for the Study of the Liver) Geneva CHE) - n. volume 1 - pp. da 37 a 37 ISBN: 9780000000002 ISSN: - [Abstract in Atti di convegno (274) - Abstract in Atti di Convegno]
Abstract

The aim of the first study was to describe prevalence and predictors of HIV virus associated fatty liver disease that in HIV-infected HAART- experienced patients are unknown.The aim of the second study was to ascertain a) the determinants of steatosis and insulin resistance in virus-associated fatty liver disease and b) the role of HIV, HCV and HIV/HCV as modulators of the relationship between MS and IR.

G. Guaraldi; N. Alexopoulos; C. Stentarelli; S. Zona; G. Orlando; F. Carli; G. Ligabue; A. Lattanzi; R. Rossi; M.G. Modena; F. Palella; P. Raggi. ( 2009 ) - ANTIRETROVIRAL THERAPY AND LIPODYSTROPHY AS PREDICTORS OF SUB-CLINICAL ATHEROSCLEROSIS - Abstracts - INFECTION - n. volume 37 - pp. da 73 a 74 ISSN: 0300-8126 [Abstract in rivista (266) - Abstract in Rivista]
Abstract

Although anti-retroviral therapy (ART) has prolonged survival in human immunodeficiency virus (HIV)-infected persons, an increase in cardiovascular disease (CVD) has been observed. A frequent complication of ART is the development of lipodystrophy (LD) that may be associated with CVD. We assessed the contribution of chronic HIV infection, ART use and LD to the presence and extent of sub-clinical atherosclerosis as evaluated by coronary artery calcium (CAC) imaging.

S. Baroncelli, E. Tamburrini, M. Ravizza, S. Dalzero, C. Tibaldi, E. Ferrazzi, G. Anzidei, M. Fiscon, S. Alberico, P. Martinelli, G. Placido, G. Guaraldi, C. Pinnetti, M. Floridia; Italian Group on Surveillance on Antiretroviral Treatment in Pregnancy. ( 2009 ) - Antiretroviral treatment in pregnancy: a six-year perspective on recent trends in prescription patterns, viral load suppression, and pregnancy outcomes. - AIDS PATIENT CARE AND STDS - n. volume 23 Issue 7 - pp. da 513 a 520 ISSN: 1087-2914 [Articolo in rivista (262) - Articolo su rivista]
Abstract

The aim of the study was to describe the recent trends in antiretroviral treatment in late pregnancy and the sociodemographic changes among pregnant women with HIV over the last 6 years. Data from the National Program on Surveillance on Antiretroviral Treatment in Pregnancy in Italy were grouped per calendar year, and changes in antiretroviral treatment, population characteristics, maternal immunovirologic status and newborn clinical parameters were analyzed. A total of 981 HIV-infected mothers who delivered between 2002 and 2008 were evaluated. The proportion of women receiving at least three antiretroviral drugs at delivery increased significantly from 63.0% in 2002 to 95.5% in 2007-2008, paralleled by a similar upward trend in the proportion of women who achieved complete viral suppression at third trimester (from 37.3 in 2002 to 80.9 in 2007-2008; p < 0.001). The co-formulation of zidovudine plus lamivudine remained the most common nucleoside backbone in pregnancy, even if a significant increase in the use of tenofovir plus emtricitabine was observed in more recent years. Starting from 2003, nevirapine prescription declined, paralleled by a significant rise in the use of protease inhibitors (PI), which were present in more than 60% of regimens administered in 2007-2008. Nelfinavir was progressively replaced by ritonavir-boosted PIs, mainly lopinavir. No significant changes in preterm delivery, Apgar score, birth weight, and birth defects were observed during the study period, and the rate of HIV transmission remained below 2%. These data demonstrate a significant evolution in the treatment of HIV in pregnancy. Constant improvements in the rates of HIV suppression were observed, probably driven by the adoption of stronger and more effective regimens and by the increasing options available for combination treatment.

G. Guaraldi; S. Zona; F. Vescini; G. Orlando; F. Carli; A. Roverato; R. Esposito; H. Johansson; J. Compston; J. Kanis. ( 2009 ) - Assessment of 10-year probability of a major osteoporotic fracture in HIV-infected patients using FRAX® tool algorithms. - HIV MEDICINE - n. volume 10 Suppl. 2 - pp. da 141 a 142 ISSN: 1464-2662 [Abstract in rivista (266) - Abstract in Rivista]
Abstract

The FRAX® tool is an individual patient model that integrates clinical risk factors for fracture as well as bone mineral density at femoral neck. The objective of the present study was to assess fracture risk with the FRAX tool in HIV infected population to identify patients at increased absolute fracture risk and determine those patients who would be advantaged by further testing with bone mineral density.

Kety Luzi; Guaraldi G; Rita Murri; Maria De Paola; Orlando G; Squillace N; Esposito R; Rochira V; Zirilli L; Esteban Martinez ( 2009 ) - Body image is a major determinant of sexual dysfunction in stable HIV-infected women. - ANTIVIRAL THERAPY - n. volume 14 - pp. da 85 a 92 ISSN: 1359-6535 [Articolo in rivista (262) - Articolo su rivista]
Abstract

BACKGROUND: Prevalence and factors associated with sexual dysfunction in HIV-positive women are poorly known. METHODS: This was a cross-sectional study in a cohort of HIV-infected women. Clinically stable women were invited to participate in a female sexual dysfunction (FSD) evaluation with Female Sexual Function Index (FSFI) exploring desire, arousal, lubrication, orgasm, pain and satisfaction. An FSFI score <23 was used for defining FSD. Variables evaluated included body appearance satisfaction, interference of body changes with habits, social life and attitudinal aspects of body image, health-related quality of life, hormonal assessment, menopause, cumulative exposure to antiretroviral drug classes and immune-virological parameters. Lipodystrophy was defined according to the HIV Outpatient Study definition. RESULTS: A total of 185 women completed the FSFI. The mean (+/-SD) age was 42 years (+/-5), 27% had CDC stage C, the mean (+/-SD) CD4+ T-cell count was 508 cells/microl (+/-251) and median HIV RNA was 1.7 log10 copies/ml (interquartile range 1.7-2.6). Among 161 evaluable patients, 59 (32%) reported FSD. In a multiple linear regression analysis, desire, arousal and satisfaction domains were associated with interference of body changes with habits, social life and attitudinal aspects of body image (beta = 0.22, 95% confidence interval [CI] 0.06-0.37; beta = 0.29, 95% CI 0.10-0.48; and beta = 0.20, 95% CI 0.02-0.38, respectively). Lubrication and orgasm domains were associated with body image satisfaction (beta = -0.49, 95% CI -0.88 - -0.10 and beta = -0.58, 95% CI -1.00 - -0.16, respectively). No significant associations with sex hormones, CDC stage, CD4+ T-cell count, HIV RNA viral load and cumulative exposure to antiretroviral drug classes were found. In women with FSD, severity of self-perceived abdominal fat accumulation showed a trend towards lower FSFI scores (ANOVA P = 0.02). CONCLUSIONS: FSD was highly prevalent in this cohort. Self-perceived body changes was identified as its major determinant.

G. Guaraldi ( 2009 ) - Community based system in HIV Treatment, ACP S&T PROGRAMME [Altro (298) - Partecipazione a progetti di ricerca]
Abstract

Guaraldi, Giovanni; Zona, Stefano; Orlando, Gabriella; Carli, Federica; Alexopoulos, N.; Ligabue, Guido; Fiocchi, F.; Rossi, Rosario; Modena, Maria Grazia; Palella, F.; Raggi, P. ( 2009 ) - CORONARY AGEING IN HIV INFECTED PATIENTS - Abstracts - INFECTION - n. volume 37 - pp. da 24 a 24 ISSN: 0300-8126 [Abstract in rivista (266) - Abstract in Rivista]
Abstract

The objectives of this study were to assess the coronaryage (CA) of a cohort of HIV infected patients based on the extent of coronary artery calcium (CAC) and to iden-tify the variables associated with it.

Alexopoulos N; Guaraldi G; Zona S; Orlando G; Carli F; Ligabue G; Fiocchi F; Rossi R; Modena MC; Palella F; Raggi P ( 2009 ) - Coronary ageing in hiv-infected patients - Abstracts - ATHEROSCLEROSIS SUPPLEMENTS - n. volume 10 [Abstract in rivista (266) - Abstract in Rivista]
Abstract

The objectives of this study were to assess the coronary age of a cohort of HIV infected patients based on the extent of coronary artery calcium and to identify the variables associated with it.

Guaraldi G.; Zona S.; Alexopoulos N.; Orlando G.; Carli F.; Ligabue G.; Fiocchi F.; Lattanzi A.; Rossi R.; Modena M.G.; Esposito R.; Palella F.; Raggi P. ( 2009 ) - Coronary aging in HIV-infected patients. - CLINICAL INFECTIOUS DISEASES - n. volume Dec 1;49(11) - pp. da 1756 a 1762 ISSN: 1058-4838 [Articolo in rivista (262) - Articolo su rivista]
Abstract

BACKGROUND: Human immunodeficiency virus (HIV)-infected patients often demonstrate accelerated aging processes. We investigated whether the vascular age of a cohort of stable HIV-infected patients receiving antiretroviral therapy (ART) was increased and sought out predictors of increased vascular age. METHODS: In this cross-sectional study, 400 HIV-infected patients (mean age, 48 years) attending a cardiometabolic clinic underwent cardiac computed tomography imaging to identify coronary artery calcium (CAC). Vascular age was estimated on the basis of the extent of CAC by means of previously published equations. RESULTS: Increased vascular age was observed in 162 patients (40.5%), with an average increase of 15 years (range, 1-43 years) over the chronological age. In univariable analyses, chronological age, male sex, systolic blood pressure, duration of ART, fasting glucose level, fasting serum triglyceride level, total cholesterol level, low-density and high-density lipoprotein cholesterol levels, hypertension, and the presence of the metabolic syndrome were associated with increased vascular age. In multivariable linear regression analyses, current CD4+ cell count was the only predictor of increased vascular age (beta = 0.51; P = .005). CONCLUSIONS: Increased vascular age is frequent among HIV-infected patients and appears to be associated with CD4+ cell count. If these findings were to be confirmed in prospective trials, a positive response to ART with an increase in CD4+ cell count may become a marker of increased risk of atherosclerosis development.

C. Diazzi; G. Brigante; G. Orlando; N. Squillace; G. Guaraldi; C. Carani; V. Rochira; M. Simoni; L. Zirilli ( 2009 ) - Deficit di GH in pazienti affetti da lipodistrofia HIV-correlata: dati preliminari sugli effetti del trattamento con r-hGH sulla composizione corporea - Libro degli Abstract del 4° Incontro Italiano sulle Malattie Ipotalamo-Ipofisarie - CSR Congressi Bologna ITA) - n. volume 0 - pp. da 122 a 122 ISBN: 0000000000 ISSN: - [Abstract in Atti di convegno (274) - Abstract in Atti di Convegno]
Abstract

r-hGH treatment in HIV-infected patients with documented GH deficiency seems to improve fat distribution

Squillace N.; Zona S.; Stentarelli C.; Orlando G.; Beghetto B.; Nardini G.; Esposito R.; Guaraldi G. ( 2009 ) - Detectable HIV viral load is associated with metabolic syndrome. - JOURNAL OF ACQUIRED IMMUNE DEFICIENCY SYNDROMES - n. volume Dec 1;52(4) - pp. da 459 a 464 ISSN: 1525-4135 [Articolo in rivista (262) - Articolo su rivista]
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.

Guaraldi G.; Cocchi S.; Motta A.; Ciaffi S.; Conti C.; Codeluppi M.; Bonora S.; Zona S.; Di Benedetto F.; Pinetti D.; D'Avolio A.; Bertolini A.; Esposito R. ( 2009 ) - Differential Dose Adjustments of Immunosuppressants after Resuming Boosted versus Unboosted HIV-Protease Inhibitors Postliver Transplant. - AMERICAN JOURNAL OF TRANSPLANTATION - n. volume 2009 Oct;9(10) (Epub 2009 Jul 28) - pp. da 2429 a 2434 ISSN: 1600-6135 [Articolo in rivista (262) - Articolo su rivista]
Abstract

Pharmacokinetic (PK) interactions between protease inhibitors (PI(s)) and immunosuppressive agents (IS) are critical elements in the management of HIV-infected patients who undergo liver transplantation (LT(x)). The primary objective of this study was to evaluate the decreases in IS dosages necessary to maintain an appropriate therapeutic window (TW) after initiating PI-based antiretroviral therapy regimens post-LT(x). Single-center, PK cross-sectional study of consecutive HIV-infected adult patients who underwent LT(x) was done. Blood trough concentrations (C(t)) of IS were obtained using a commercial MEIA test; plasma C(t) of PI(s) were measured using HPLC. Twelve consecutive HIV-infected adult patients (11 males, 1 female) were enrolled. More rapid increases in IS plasma C(t) were observed 48 h after initiating ritonavir (RTV)-boosted PI therapy post-LT(x) than when using unboosted PI(s). Seven patients developed acute renal failure. The median fold decrease in IS dosages required to regain IS concentrations that were in the TW was 7.5 (range 6-14) after resuming boosted PI(s) and 2.9 (range 2-4) after unboosted PI(s). The overall median time necessary to reach IS TW after dose adjustment was 3.5 days (range 0-15). Unboosted PI(s) exhibited lesser PK interactions with IS than did RTV-boosted PI(s) and were thus more amenable to use in the post-LT(x) setting.

G. Guaraldi; S. Cocchi; A. Motta; S. Ciaffi; M. Codeluppi; S. Bonora; F. Di Benedetto; M. Masetti; M. Floridia; S. Baroncelli; D. Pinetti; A. Bertolini; G.E. Gerunda; R. Esposito ( 2009 ) - Efficacy and safety of atazanavir in patients with end-stage liver disease. - INFECTION - n. volume Jun;37(3) - pp. da 250 a 255 ISSN: 0300-8126 [Articolo in rivista (262) - Articolo su rivista]
Abstract

BACKGROUND: No data are available on the use of atazanavir (ATV) in patients with end-stage liver disease (ESLD), and guidelines discourage its use in this setting. The objective of our study was to evaluate the efficacy and safety of unboosted ATV in patients infected with HIV and suffering from ESLD who had been screened for orthotopic liver transplantation (OLT(x)). PATIENTS AND METHODS: This was a single-arm, 24-week pilot study. Atazanavir-naïve patients undergoing a highly active antiretroviral therapy were switched to ATV 400 mg daily plus two non-thymidine nucleoside reverse transcriptase inhibitors. RESULTS: Fifteen patients (ten males and five females, age range 36-59 years) were enrolled in the study. Of these, 11 (73%) had a baseline CD4 cell count > 200 microl(-1), and 12 had undetectable plasma HIV-RNA. 12 subjects (80%) were able to remain on ATV until week 24 (n = 10) or transplantation (n = 2). At the end of the study, the median CD4 cell count was 340 microl(-1) , and nine of the ten patients had undetectable RNA. During the study period, two patients received a transplant, two died of intracerebral hemorrhage and lactic acidosis, respectively, and one discontinued ATV. Among the ten patients completing the 24-week study, no significant changes from baseline were observed for most of the liver function markers, with the exception of unconjugated bilirubin (from 1.15 mg/dl to 1.32 mg/dl, p = 0.047). CONCLUSIONS: Unboosted ATV treatment did not worsen liver disease and was able to maintain or gain immunovirological eligibility for OLT(x) in all patients, with a limited effect on unconjugated bilirubin. These results suggest that ATV is an easy-to-use drug in patients with ESLD.

R. Murphy; C. Zala; B. Berzins; C. Fichtenbaum; M. Dube; G. Guaraldi; F. Torriani; E. Belsey; C. Mitchell; J. Stein; and SABAR Study Team ( 2009 ) - Endothelial Function, Lipoproteins,and Cardiovascular Inflammatory Markers in Treated HIV-infected Patients with Hyperlipidemia Who Were Switched to an Atazanavir-containing Regimen or Continued on Other Protease Inhibitor-based Therapy: Switch to Atazanavir and Brachial Artery Reactivity Study - Program & Abstracts - CROI Alexandria, VA USA) - n. volume not applicable [Abstract in Atti di convegno (274) - Abstract in Atti di Convegno]
Abstract

PI use has been associated with adverse changes in lipoproteins, endothelial dysfunction, and increased cardiovascular disease risk. This study evaluated changes in endothelial function, lipoproteins, and cardiovascular inflammatory markers in hyperlipidemic, atazanavir (ATV) -naive PI-experienced patients who switched their PI to ATV, a PI with a favorable lipid profile.

G. Guaraldi; I.G. Baraboutis ( 2009 ) - Evolving perspectives on HIV-associated lipodystrophy syndrome: moving from lipodystrophy to non-infectious HIV co-morbidities. - JOURNAL OF ANTIMICROBIAL CHEMOTHERAPY - n. volume Sep;64(3) - pp. da 437 a 440 ISSN: 0305-7453 [Articolo in rivista (262) - Articolo su rivista]
Abstract

This article will provide insight into the evolving perspectives on HIV-related lipodystrophy syndrome: recent changes in epidemiology, a shifting focus from individual component assessment towards a more comprehensive risk evaluation for organ dysfunction and disease, the impact of patient-related outcomes in heath-related quality of life and the integration of this syndrome into a wider scenario of a premature ageing process in HIV-infected people will be discussed. The time has come to proceed beyond lipodystrophy studies based on blood concentrations of lipids and glucose and body fat evaluation. Surrogate markers of organ disease associated with lipodystrophy better identify patients vulnerable to non-infectious co-morbidities (NICMs) rather than statistical risk algorithms. In this evolving perspective NICMs take the place of lipodystrophy in the description of the clinical spectrum of HIV disease and allow integration of this syndrome into the wider scenario of a premature ageing process in HIV-infected people. Management of NICMs needs to be considered as part of a multi-disciplinary holistic approach that accommodates the increasing number of factors influencing non-infectious HIV-related outcomes.

G. Guaraldi; A. Lonardo; S. Ballestri; S. Zona; C. Stentarelli; G. Orlando; F. Carli; L. Carulli; A. Roverato; P. Loria. . ( 2009 ) - Fatty liver disease associated with epatiti C and/or human immunodeficiency virus: characterization of the link between hepatic steatosis, insulin resistance and metabolic syndrome. - HIV MEDICINE - HIV MEDICINE - n. volume 10 - pp. da 29 a 30 ISSN: 1464-2662 [Abstract in rivista (266) - Abstract in Rivista]
Abstract

Little is known about the relationship between steatosis, insulin resistance (IR) and metabolic syndrome (MS) in patients with hepatitis C (HCV) and/or human immunodeficiency virus (HIV) infections. The aim of this study was to ascertain the determinants of steatosis and of insulin resistance in virus-associated fatty liver disease and the role of HIV, HCV and HIV/HCV as modulators of the relationship between MS and IR

G. Guaraldi; S. Zona; Fabio Vescini; Alberto Roverato; G. Orlando; N. Squillace; E. Garlassi; K. Luzi; V. Rochira; L. Zirilli ( 2009 ) - Gender and gonadal function differences in the prevalence of bone mass reduction - Abstracts of the 16th Conference on Retroviruses and Opportunistic Infections (CROI 2009) - Conference on Retroviruses and Opportunistic Infections(CROI) New York USA) - n. volume 0 - pp. da 754 a 754 ISBN: 0000000000 ISSN: - [Abstract in Atti di convegno (274) - Abstract in Atti di Convegno]
Abstract

The role of gender and gonadal steroids in the genesis of bone loss in HIV-infected patients has been investigated. Apart from a role of estradiol end lean mass, no other gender related variables resulted associated to bone loss in both men and women with HIV.

L. Zirilli; G. Orlando; G. Brigante; N. Squillace; C. Diazzi; C. Carani; G. Guaraldi; V. Rochira ( 2009 ) - GH deficiency in HIV-infected patients with lipodystrophy: preliminary data on the effects of r-hGH treatment on body composition - Endocrine Abstracts - Bioscientifica Limited:22 Apex Court, Woodlands, Bradley, Bristol BS32 4JT United Kingdom:011 44 1454 619036, EMAIL: sales@endocrinology.org, INTERNET: http://www.endocrinology.org, Fax: 011 44 1454 616071 Bristol GBR) - ENDOCRINE ABSTRACTS - n. volume 20 [Abstract in rivista (266) - Abstract in Rivista]
Abstract

Evaluation of GH deficiency in HIV-infected patients with lipodystrophy,with particular concern to preliminary data on the effects of r-hGH treatment on body composition

Guaraldi G.; Roverato A.; Giovanardi C.; Ravera F.; Squillace N.; Orlando G.; Cappelli G.; Esposito R.; Palella F. ( 2009 ) - Glomerular filtration rates in HIV-infected patients treated with and without tenofovir: a prospective, observational study. - JOURNAL OF ANTIMICROBIAL CHEMOTHERAPY - n. volume 63 (2) - pp. da 374 a 379 ISSN: 0305-7453 [Articolo in rivista (262) - Articolo su rivista]
Abstract

Objectives The aim of our study was to assess the impact of plasma HIV-1 RNA level [viral load (VL)] variation and tenofovir exposure on kidney functions by analysing changes in calculated glomerular filtration rates (GFRs) over a 48 week period in patients with mild renal impairment. Patients and methods A prospective observational study that included data from all consecutive HIV-infected patients who attended a metabolic clinic was conducted. Included were adult, antiretroviral (ARV)-experienced, tenofovir-naive patients, whose kidney functions were evaluated by calculated GFR using the simplified Modification of Diet in Renal Disease study equation (MDRD). Tenofovir-exposed patients were patients who initiated tenofovir therapy at baseline and tenofovir-unexposed patients were patients whose ARV therapy did not include tenofovir. Participants were stratified into three sub-groups according to the plasma HIV-1 RNA (VL) changes observed: sub-groups 1, 2 and 3 were patients with stable VL </=50 copies/mL, >0.5 log(10) VL increases and >0.5 VL log(10) decreases, respectively. Results Ninety-nine patients were enrolled and included in the analysis. Within the tenofovir-unexposed group, GFRs remained stable (ANOVA, P = 0.94) over the follow-up period. Within the tenofovir-exposed group, mean GFR changes varied significantly by sub-group (ANOVA, P < 0.01). In particular, GFR changes in sub-group 3 (+8.4 +/- 12.4 mL/min) were different from those seen in sub-group 1 (-1.0 +/- 8.8 mL/min) (P < 0.05) and sub-group 2 (-4.6 +/- 8.8 mL/min) (P < 0.01). Conclusions Observed improvements in GFR that occurred as a consequence of highly active ARV therapy-induced viral suppression may have more than offset any potential negative effects of tenofovir on renal function.

Guaraldi G.; Squillace N.; De Fazio D.; Prestileo T.; Palella F. ( 2009 ) - Heterologous fat transplantation for the treatment of HIV-related facial lipoatrophy. - ANNALS OF INTERNAL MEDICINE - n. volume 2009 Jan 6;150(1) - pp. da 61 a 63 ISSN: 0003-4819 [Articolo in rivista (262) - Articolo su rivista]
Abstract

not available

L.R. Tomasoni; M. Galli; V. Vullo; S. Declich; M. Giuliano; V. Pietra; M. Fabiani; J. Simporé; E. Gianelli; S. Rusconi; A. Riva; G. Guaraldi; K. Luzi; G. Russo; M. Lichtner; F. Castelli. ( 2009 ) - HIV NOTIFICATION TO THE PARTNER AMONG PUERPERAS IN SUB-SAHARAN AFRICA - Abstracts - INFECTION - n. volume 37 - pp. da 99 a 100 ISSN: 0300-8126 [Abstract in rivista (266) - Abstract in Rivista]
Abstract

HIV serostatus disclosure to sexual partner may lead to clear public health benefits (motivation for partner testing, behavior changes, earlier access to medical care), but it may also lead to women rejection, loss of economic support, physical and emotional abuse. Studies from developing countries suggest that a larger proportion of women compared to industrialized countries do not share HIV test result with anyone

Guaraldi G.; Ventura P.; Garlassi E.; Orlando G.; Squillace N.; Nardini G.; Stentarelli C.; Zona S.; Marchini S.; Moriondo V.; Tebas P. ( 2009 ) - Hyperhomocysteinaemia in HIV-infected patients: determinants of variability and correlations with predictors of cardiovascular disease. - HIV MEDICINE - n. volume 10 (1) - pp. da 28 a 34 ISSN: 1464-2662 [Articolo in rivista (262) - Articolo su rivista]
Abstract

OBJECTIVE: We evaluated hyperhomocysteinaemia (HHcy) in a cohort of HIV-infected patients in order to assess its relation to cardiovascular risk (CVR) and identify determinants of HHcy variability. METHODS: Cross-sectional observational study. HIV-infected patients on stable highly active antiretroviral therapy (ART) were evaluated for the presence of the metabolic syndrome, lipodystrophy and traditional CVR factors. Plasma homocysteine levels were measured using high-performance liquid chromatography. RESULTS: Five hundred and sixty-seven patients (38% female) with a median age of 44 years were included in the study. Homocysteine (Hcy) was significantly higher in patients with the metabolic syndrome and lipodystrophy. No significant association was found between Hcy levels and the use of ART. However, Hcy was associated with higher blood pressure, waist circumference and waist-to-hip ratio, total lean body mass, visceral adipose tissue (VAT), VAT/total adipose tissue, homeostasis model assessment of insulin resistance (HOMA-IR), triglycerides, high-density lipoprotein cholesterol, apolipoprotein A1, B, and creatinine. All 10-year CVR assessment scores were significantly associated with Hcy. In a multivariate regression model, systolic blood pressure, vitamin supplementation and HOMA-IR were significantly and independently related to Hcy. CONCLUSIONS: Hcy is elevated in HIV-infected patients and is significantly associated with increased CVR. Measurement of Hcy might be useful in identifying particularly high-risk populations at whom therapeutic interventions could be targeted.

L.R. Tomasoni; M. Galli; V. Vullo; B. Pedruzzi; V. Pietra; J. Simporé; E. Gianelli; S. Rusconi; A. Riva; G. Guaraldi; K. Luzi; G. Russo; M. Lichtner; G. Carosi; F. Castelli. ( 2009 ) - INFANT FEEDING MODALITIES AND MORBIDITY IN HIV INFECTED WOMEN IN RESOURCE-POOR COUNTRIES. A MULTICENTER STUDY IN SUBSAHARAN AFRICA - Abstracts - INFECTION - n. volume 37 - pp. da 99 a 99 ISSN: 0300-8126 [Abstract in rivista (266) - Abstract in Rivista]
Abstract

The optimal feeding modality of infants born to HIV infected mothers in resource-limited settings is still the subject for debate. WHO guidelines recommends exclusive formula feeding wherever it is available, feasible, affordable, safe and sustainable (AFASS). In all other instances, exclusive breastfeeding and early weaning is recommended. However, formula feeding has been reported to be associated to a higher incidence of infant morbidity in previous studies. Aim of our study was to assess factors associated to (i) feeding practices and (ii) infant morbidity

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 G; Beghetto B. ( 2009 ) - ISS-NIA ITALIAN COHORT: NEW ANTI-HIV INHIBITORS IN PATIENTS EXPERIENCED TO IP, NRTI, NNRTI. - Abstracts - INFECTION - n. volume 37 - pp. da 63 a 64 ISSN: 0300-8126 [Abstract in rivista (266) - Abstract in Rivista]
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.

Guaraldi G.; Garlassi E.; Rossi R. ( 2009 ) - La valutazione del rischio cardiovascolare nel paziente con infezione da HIV. - Tumori ed Infezione da HIV - Biomedia Milano ITA) - pp. da 67 a 80 ISBN: 9788886154512 ISSN: - [Contributo in volume (Capitolo o Saggio) (268) - Capitolo/Saggio]
Abstract

Il trattamento dell'infezione da HIV con farmaci antiretrovirali appare oggi più complesso rispetto al passato. Ai determinanti viro-immunologici e di resistenza bisogna necessariamente affiancare i determinanti relativi alle comorbosità presenti nel paziente, prime fra tutte le malattie cardiovascolari. In quest'ambito, la prevenzione rimane il cardine degli interventi, imponendo una gestione oculata e saggia dei farmaci da utilizzare, ma soprattutto la contestualizzazione della terapia antiretrovirale nell'ambito della stima della vulnerabilità del soggetto a rischio.

G. Guaraldi ( 2009 ) - L’AIDS in Africa: tendenze e prospettive. - AFRICHE E ORIENTI - n. volume N. speciale I - pp. da 15 a 28 ISSN: 1592-6753 [Articolo in rivista (262) - Articolo su rivista]
Abstract

Alla fine del 2007 è stato stimato che il n. di persone che vivono con l'infezione da HIV/AIDS a livello modiale sia di 33.2 mil. Si tratta di un secondo rapporto in cui le stime di prevalenza dell'infezione si sono abbassate. La principale causa di questa correzione epidemiologica è da attribuirsi a miglioramenti metodologici nella raccolta dei dati. Possiamo ritenere che una lenta ma significativa riduzione nell'incidenza dell'HIV sia reale non solo nel sud-est asiatico, ma anche in alcuni paesi africani che costituiscono l'epicentro dell'epidemia di AIDS. E' importante descrivere questi cambiamenti epidemiologici per comprendere in quale direzione si stia muovendo l'epidemia e per avere efficaci sistemi di monitoraggio dell'impatto degli interventi di prevenzione.

R. Rossi; A. Nuzzo; G. Guaraldi; N. Squillace; G. Orlando; R. Esposito; A. Lattanzi; M.G. Modena ( 2009 ) - Metabolic disorders induced by highly active antiretroviral therapy and their relationship with vascular remodeling of the brachial artery in a population of HIV-infected patients. - METABOLISM, CLINICAL AND EXPERIMENTAL - n. volume 58(7) - pp. da 927 a 933 ISSN: 0026-0495 [Articolo in rivista (262) - Articolo su rivista]
Abstract

Antiretroviral therapy has positively modified the natural history of HIV infection; but this treatment can induce metabolic abnormalities, including dyslipidemia, fat redistribution, high blood pressure, and insulin resistance. The metabolic syndrome, a clustering of the metabolic disorders, is frequently detected among HIV patients, especially those on antiretroviral treatment. All the arteries can modify their diameter in response to a chronic injury. This process, defined vascular remodeling, was demonstrated for the brachial artery. It is well known that the diameter of the brachial artery was correlated with the number of the elements of the metabolic syndrome and was associated with the severity of coronary artery disease. On this basis, we postulate that brachial arterial enlargement may be a process potentially correlated with the metabolic disorders induced by antiretroviral therapy. We tested this hypothesis in a large population of HIV-infected patients in which we measured brachial artery diameter, as an indicator of artery remodeling, by noninvasive, ultrasonographic technique. Our population consisted of 570 patients, with a mean age of 46.3 +/- 7.1 years. All the patients were chronically treated with highly active antiretroviral therapy. Brachial artery diameter was correlated with insulin resistance, evaluated by the homeostasis model assessment of insulin resistance index (r = 0.18, P < .0001). There was a significant linear increase in brachial artery diameter as the number of components of the metabolic syndrome increased: brachial artery diameter for those with 0, 1, 2, 3, or + characteristics was 39.3 +/- 7.2, 41.0 +/- 6.8, 42.0 +/- 7.3, and 43.8 +/- 7.9 mm, respectively (P < .001 for trend). In multivariable logistic regression analysis, brachial artery diameter was independently correlated with the presence of metabolic syndrome. Our results are in line with the hypothesis that, among HIV-infected patients chronically treated with antiretroviral therapy, those with a larger brachial artery diameter are at high risk for metabolic disorders, including a more severe insulin resistance and the presence of metabolic syndrome.

G. Guaraldi; S. Zona; A. Roverato; G. Orlando; F. Carli; G. Ligabue; R. Rossi; M.G. Modena; P. Raggi ( 2009 ) - Moving from risk factor assessment to atherosclerosis imaging to select the most appropriate patient for primary prevention - HIV MEDICINE - n. volume 10 Suppl 2 - pp. da 41 a 42 ISSN: 1464-2662 [Abstract in rivista (266) - Abstract in Rivista]
Abstract

All HIV-infected adults should undergo coronary heart disease risk assessment with Framingham Risk Score /FRS) to guide preventive treatment intensity. The European Hypertension Guidelines (ESH-ESC) and the FRS are examples of algorithms used to identify people who qualify for primary prevention: clinical decision making is usually most uncertain in the intermediate risk category (10-20% 10year-risk of events) an in this group imaging for sub-clinical atherosclerosis has been shown to improve risk prediction. The purpose of this study was to identify people who qualify and not qualify for primary prevention for CVD according to ESH-ESC, NCEP.FRS and CAC-FRS across coronary calcium score strata in all HIV infected patients and in the subset of female and young patients (<55 yrs males and <65 if females)

Floridia M.; Tamburrini E.; Anzidei G.; Tibaldi C.; Guaraldi G.; Guerra B.; Meloni A.; Vimercati A.; Molinari A.; Pinnetti C.; Dalzero S.; Ravizza M. ( 2009 ) - Plasma Lipid Profile in Pregnant Women with HIV Receiving Nevirapine. - AIDS PATIENT CARE AND STDS - n. volume 14 (3) - pp. da 147 a 152 ISSN: 1087-2914 [Articolo in rivista (262) - Articolo su rivista]
Abstract

Abstract Limited information is currently available on the metabolic profile of nevirapine in pregnancy. We used data from a national observational study to evaluate plasma lipid profile in pregnant women receiving nevirapine. Lipid values were collected during routine clinical visits. Midpregnancy (second trimester) lipid values were analyzed according to use of nevirapine, calculating differences and 95% confidence intervals (CI) between women taking and not taking this drug. In order to adjust for possible confounders, multivariable models were constructed using as dependent variables levels of total cholesterol (TC), high-density lipoprotein-cholesterol (HDL-C), low-density lipoprotein-cholesterol (LDL-C), triglyceride (TG) levels and TC/HDL-C ratio, and as independent variables age, body weight, previous treatment history, CD4 count, and presence of any antiretroviral therapy, use or nonuse of protease inhibitors, stavudine, and nevirapine at the time of blood sampling. Overall, 375 women had available data for analysis. Pregnant women on nevirapine, compared to women not taking this drug, had in univariate analyses higher levels of HDL-C (difference: +13.0 mg/dL [95%CI 7.4-18.6], p < 0.001), lower values of TC/HDL-C ratio (difference: -0.51 [0.23-0.80], p < 0.001) and a trend for lower levels of triglycerides (difference: -17.6 mg/dL [0.7-35.9], p = 0.06). Higher HDL-C levels were also associated with use of protease inhibitors and with no previous antiretroviral experience before pregnancy. The associations with higher HDL-C levels were confirmed in multivariable analyses. Our study indicates in pregnant women an association between nevirapine use and higher HDL-C levels. Further studies should assess whether this effect is due to an intrinsic activity of nevirapine and define the potential mechanisms involved.

Guaraldi G; Zona S; Orlando G; Carli F; Ligabue G; Luzi K; Esposito R; Raggi P ( 2009 ) - Progression of subclinical atherosclerosis in HIV-infected patients - Abstracts - ANTIVIRAL THERAPY - n. volume 14 [Abstract in rivista (266) - Abstract in Rivista]
Abstract

Progression of subclinical atherosclerosis can accurately be assessed by sequential coronary artery calcium imaging on multidirector CT. Advancing atherosclerosis is associated with a high risk of cardiovascular events.

Murri, Rita; Guaraldi, Giovanni; Lupoli, Piergiorgio; Crisafulli, Raffaella; Marcotullio, Simone; Von Schloesser, Filippo; Wu, Albert W. ( 2009 ) - Rate and predictors of self-chosen drug discontinuations in highly active antiretroviral therapy-treated HIV-positive individuals - AIDS PATIENT CARE AND STDS - n. volume 23 - pp. da 35 a 39 ISSN: 1087-2914 [Articolo in rivista (262) - Articolo su rivista]
Abstract

Despite the clinical benefits of highly active antiretroviral therapy (HAART), sustained treatment remains a great challenge for HIV-infected people. The rate, consequences, and correlates of self-elected treatment interruptions (TI) are not known. The objectives of the study were to assess the rate of patient-elected TI in a cohort of HIV-infected people taking HAART, to evaluate whether patient-elected TI is correlated with suboptimal nonadherence, and to identify the predictors of self-chosen HAART interruptions. Using a Web-based cross-sectional survey beginning in January 2006 primary outcomes were: (1) reports of having asked their physician to interrupt the current regimen (AskDisc) and (2) reports of at least one interruption of a minimum of 1 day of any of the drugs included in the regimen (INTERR). Three hundred fifty-nine people were enrolled; 296 were taking HAART. Twenty-three percent self-reported suboptimal adherence, 45% reported AskDisc, and 25% INTERR. Forty percent of people reporting INTERR self-reported suboptimal adherence. As expected, AskDisc and INTERR were correlated with suboptimal adherence. The AskDisc group had higher CD4 cell counts and HIV RNA, more symptoms, and took more convenient regimens. The INTERR group had higher HIV RNA, were more likely to smoke, seek more information on HIV/AIDS, and less likely to take non-nucleoside reverse transcriptase inhibitors (NNRTIs). The rate of self-chosen TI was high and often related to suboptimal adherence. These findings may help clinicians to better monitor patients, and identify patients for targeted counseling. © Copyright 2009, Mary Ann Liebert, Inc.

Murri R.; Guaraldi G.; Lupoli P.; Crisafulli R.; Marcotullio S.; von Schloesser F.; Wu AW. ( 2009 ) - Rate and predictors of self-chosen drug discontinuations in people living with hiv/aids taking haart - AIDS PATIENT CARE AND STDS - n. volume 2009 Jan;23(1) - pp. da 35 a 39 ISSN: 1087-2914 [Articolo in rivista (262) - Articolo su rivista]
Abstract

Despite the clinical benefits of highly active antiretroviral therapy (HAART), sustained treatment remains a great challenge for HIV-infected people. The rate, consequences, and correlates of self-elected treatment interruptions (TI) are not known. The objectives of the study were to assess the rate of patient-elected TI in a cohort of HIV-infected people taking HAART, to evaluate whether patient-elected TI is correlated with suboptimal nonadherence, and to identify the predictors of self-chosen HAART interruptions. Using a Web-based cross-sectional survey beginning in January 2006 primary outcomes were: (1) reports of having asked their physician to interrupt the current regimen (AskDisc) and (2) reports of at least one interruption of a minimum of 1 day of any of the drugs included in the regimen (INTERR). Three hundred fifty-nine people were enrolled; 296 were taking HAART. Twenty-three percent self-reported suboptimal adherence, 45% reported AskDisc, and 25% INTERR. Forty percent of people reporting INTERR self-reported suboptimal adherence. As expected, AskDisc and INTERR were correlated with suboptimal adherence. The AskDisc group had higher CD4 cell counts and HIV RNA, more symptoms, and took more convenient regimens. The INTERR group had higher HIV RNA, were more likely to smoke, seek more information on HIV/AIDS, and less likely to take non-nucleoside reverse transcriptase inhibitors (NNRTIs). The rate of self-chosen TI was high and often related to suboptimal adherence. These findings may help clinicians to better monitor patients, and identify patients for targeted counseling.

V. Rochira; G. Orlando; M. Ciccarese; N. Squillace; C. Diazzi; G. Guaraldi; C. Carani; L. Zirilli ( 2009 ) - Sex steroids and HIV-related osteoporosis in men: low circulating estrogens are associated with impaired bone mineral density - Abstract Book (CD-ROM) of The 91st Annual Meeting of the Endocrine Society ENDO09 - Endocrine Society / Maryland:8401 Connecticut Avenue, Suite 900:Chevy Chase, MD 20815:(301)941-0200, (301)941-0200, (301)941-0232, EMAIL: journals@endo-society.org, INTERNET: http://www.endo.society.org, Fax: (301)941-0259 Maryland USA) - n. volume 0 [Abstract in Atti di convegno (274) - Abstract in Atti di Convegno]
Abstract

Low circulating estrogens, but not testosterone are associated with impaired bone mineral density in HIV-related osteoporosis in men, especially when serum estradiol falls below a threshold of about 15-20 pg/mL

G. Guaraldi ( 2009 ) - Solidarietà contro l'AIDS nei paesi in via di sviluppo: "Solidarietà contro l'AIDS in Tanzania" Ministero del lavoro e della salute e delle politiche sociali. [Altro (298) - Partecipazione a progetti di ricerca]
Abstract

Rossi R.; Nuzzo A.; Guaraldi G.; Orlando G.; Squillace N.; Ligabue G.; Fiocchi F.; Di Girolamo A.; Romagnoli R.; Modena M.G. ( 2009 ) - The Role of the Framingham Risk Score to Predict the Presence of Subclinical Coronary Atherosclerosis in Patients with HIV Infection - JOURNAL OF ACQUIRED IMMUNE DEFICIENCY SYNDROMES - n. volume 52(2) - pp. da 303 a 304 ISSN: 1525-4135 [Articolo in rivista (262) - Articolo su rivista]
Abstract

Patients with HIV infection have an increased mortality, largely attributable to coronary artery disease (CAD),1-3 and there is increasing evidence that these patients have more extensive coronary calcification than age-matched control subjects.4,5 The assessment of the risk to develop CAD is a challenge in patients with HIV infection because there are many aspects that contribute to generate it. It is well known that smoking habit is more frequent in patients with HIV infection; however, a citotoxic direct effect on myocardial cells (mediated by HIV) and the inflammatory reaction associated with HIV infection may play a role in the atherosclerotic process. In addition, the treatment with combination antiretroviral therapy (cART), despite the positive modification of the natural history of HIV infection, is associated with a variety of metabolic abnormalities that determine an increase of CAD risk. Therefore, there is the need to stratify the risk of coronary events in HIV patients, taking into account all the components cited above.

Guaraldi, G; Alexopoulos, N; Zona, S; Orlando, G; Carli, F; Ligabue, G; Rossi, R; Modena, Mg; Palella, F; Raggi, P. ( 2009 ) - Vascular age as a marker of premature biological ageing in HIV-infected patients - EUROPEAN HEART JOURNAL - OXFORD UNIV PRESS GREAT CLARENDON ST, OXFORD OX2 6DP, ENGLAND ) - EUROPEAN HEART JOURNAL - n. volume 30 - pp. da 751 a 751 ISSN: 0195-668X [Abstract in Atti di convegno (274) - Abstract in Atti di Convegno]
Abstract

Vascular age as a marker of premature biological ageing in HIV-infected patients

Vincent Lo Re; G. Guaraldi; Mary B. Leonard; Jennifer Lin; G. Orlando; N. Squillace; V. Rochira; C. Giovanni; Jay R. Kostman; Pablo Tebas ( 2009 ) - Viral hepatitis co-infection is associated with reduced bone mineral density in HIV-infected women but not men - Abstracts of the 16th Conference on Retroviruses and Opportunistic Infections (CROI 2009) - Conference on Retroviruses and Opportunistic Infections(CROI) New York USA) - n. volume 0 - pp. da 820 a 820 ISBN: 0000000000 ISSN: - [Abstract in Atti di convegno (274) - Abstract in Atti di Convegno]
Abstract

Cross-sectional study among HIV-infected subjects with viral hepatitis showing that viral hepatitis was associated with a higher risk of low BMD among HIV-infected women but not men.

Lo Re V 3rd; Guaraldi G; Leonard MB; Localio AR; Lin J; Orlando G; Zirilli L; Rochira V; Kostman JR; Tebas P. ( 2009 ) - Viral hepatitis is associated with reduced bone mineral density in HIV-infected women but not men. - AIDS - n. volume 23 - pp. da 2191 a 2198 ISSN: 0269-9370 [Articolo in rivista (262) - Articolo su rivista]
Abstract

OBJECTIVE:: Few studies have examined the impact of viral hepatitis on bone mineral density (BMD), and none have done so among HIV-infected patients. Our objective was to determine whether viral hepatitis was associated with low BMD in HIV. DESIGN:: A cross-sectional study among 1237 HIV-infected patients (625 with viral hepatitis). METHODS:: Dual-energy X-ray absorptiometry scans of the lumbar spine and femoral neck were obtained. Clinical data, hepatitis B and C status, and markers of bone metabolism were determined at dual-energy X-ray absorptiometry scanning. Multivariable logistic regression examined the association between hepatitis and low BMD (Z-score </=-2.0 at the lumbar spine, femoral neck, or both). RESULTS:: Mean BMD Z-scores were lower among hepatitis-coinfected women at the lumbar spine {-0.15 versus +0.29; difference = -0.44 [95% confidence Interval (CI) -0.65 to -0.23]; P < 0.001} and femoral neck [-0.64 versus -0.39; difference = -0.25 (95% CI -0.44 to -0.06); P = 0.009] compared with HIV-monoinfected women. No differences in mean BMD Z-scores were observed between coinfected and monoinfected men. After adjustment for age, BMI, duration of HIV, antiretroviral use, physical activity, and smoking, viral hepatitis was associated with low BMD among women (adjusted odds ratio 2.87, 95% CI 1.31-6.29) but not men (adjusted odds ratio 1.19, 95% CI 0.74-1.91). Coinfected women had lower mean parathyroid hormone (60.1 versus 68.1 pg/ml; P = 0.02) but similar mean 25-hydroxyvitamin D (19.1 versus 19.6 ng/ml; P = 0.6) and osteocalcin (3.0 versus 3.2 ng/ml; P = 0.8) concentrations than HIV-monoinfected women. CONCLUSION:: Viral hepatitis was associated with a higher risk of low BMD among HIV-infected women but not men.

G. Guaraldi; S. Zona; A. Roverato; G. Orlando; F. Carli; G. Ligabue; R. Rossi; M.G. Modena; F. J. Palella; P. Raggi ( 2009 ) - Visceral fat but not general adiposity is a predictor of sub-clinical atherosclerosis in HIV-infected patients with lipodystrophy. - HIV MEDICINE - n. volume 10 Supl 2 - pp. da 132 a 132 ISSN: 1464-2662 [Abstract in rivista (266) - Abstract in Rivista]
Abstract

General and visceral adiposity are associated with risk of cardiovascular disease. HIV lipodystrophy offers a unique patho-physiological model to study visceral adiposity, best described in the abdominal fat accumulation or mixed phenotypes, not necessarily associated with general adiposity. The object of this study was to evaluate the association of general adiposity and visceral adiposity with presence and extent of subclinical atherosclerosis as evaluated by coronary artery calcium imaging in HIV infected patients.

G. Guaraldi;S. Cocchi;A. Motta;S. Ciaffi;M. Codeluppi;S. Bonora;F. D. Benedetto;M. Masetti;M. Floridia;S. Baroncelli;D. Pinetti;A. D'Avolio;A. Bertolini;R. Esposito ( 2008 ) - A pilot study on the efficacy, pharmacokinetics and safety of atazanavir in patients with end-stage liver disease. - JOURNAL OF ANTIMICROBIAL CHEMOTHERAPY - n. volume 62 - pp. da 1356 a 1364 ISSN: 0305-7453 [Articolo in rivista (262) - Articolo su rivista]
Abstract

OBJECTIVES: Antiretroviral combinations including atazanavir are currently not recommended in HIV-infected patients with end-stage liver disease (ESLD). The objective of our study was to evaluate efficacy, pharmacokinetics and safety of unboosted atazanavir in HIV-infected patients with ESLD screened for orthotopic liver transplantation (OLT(x)). Patients and methods Single-arm, 24 week pilot study. Atazanavir-naive patients undergoing highly active antiretroviral therapy were switched to atazanavir 400 mg/day plus two non-thymidine nucleoside reverse transcriptase inhibitors. Results Fifteen patients (10 males and 5 females) were included. In the study period, 2 patients were transplanted and 10 completed 24 weeks of atazanavir treatment. Median area under the concentration-time curve at week 4 was 19 211 ng.h/mL (IQR = 8959-27 500). At week 24, median atazanavir trough concentrations (C(trough)) per patient calculated across the study were above the minimum effective concentration (MEC = 100 ng/mL) in 8 of 10 subjects. Atazanavir C(trough) time-point values were always above the MEC in five patients. The other three subjects experienced only one determination below the MEC, with median atazanavir C(trough) levels across the study being above the MEC in two of them. At 8 of 11 time-points when atazanavir and proton pump inhibitors (PPIs) were co-administered and at 16 of 19 time-points in which patients had a concomitant tenofovir association, atazanavir C(trough) was above the MEC. Conclusions Unboosted atazanavir showed a favourable pharmacokinetic profile and was able to maintain or gain immuno-virological eligibility for OLT(x) in all patients. Limited biochemical toxicities (including unconjugated hyperbilirubinaemia) and allowance of concomitant administration of tenofovir and PPIs were observed.

A. Tomasini; R. Murri; G. Guaraldi; N. Squillace; G. Orlando; S. Zona; I. Mazeu; M.S. Aloisi; M. Bossola ( 2008 ) - Adherence to antiretroviral therapies in people with HIV infection: a qualitative approach from a narrative-based medicine study - Abstracts2View™. - Marathon Multimedia Amsterdam NLD) - n. volume not applicable [Abstract in Atti di convegno (274) - Abstract in Atti di Convegno]
Abstract

Antiretroviral therapies significantly improved morbidity and mortality of HIV-infected people. However, regimens are complex to be taken and in the last years adherence to drugs has been raised as a crucial factor for therapeutical efficacy. The narrative medicine is a developing approach to complement information obtained by traditional measures on health status. Our objective has been to investigate through the narrative-based medicine approach patterns of non-adherence and reasons for suboptimal adherence. This information may help to design intervention strategies aimed to improve adherence to antiretroviral drugs.

Guaraldi G.; Zona S.; Orlando G.; Squillace N.; Stentarelli C.; Nardini G.; Beghetto B.; Esposito R.; Palella F. ( 2008 ) - Age-related comorbidities in people living with HIV - ANTIVIRAL THERAPY - n. volume 13 (4) [Abstract in rivista (266) - Abstract in Rivista]
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.

G. Guaraldi ( 2008 ) - Alterazioni metaboliche e rischio cardio-vascolare in pazienti HIV in trattamento con terapia antivirale - libro degli abstract - Not available Modnea ITA) - n. volume Not available - pp. da 1 a 1 ISBN: Not available ISSN: - [Abstract in Atti di convegno (274) - Abstract in Atti di Convegno]
Abstract

The evaluation of cardiovascular risk in patients with HIV hinges upon a complex interplay of direct and indirect vascular effects of HIV infection, antiretroviral therapy, aging, and exposure to cardiovascular risk factors.

Zsofia Szep; G. Guaraldi; Samir S. Shah; G. Orlando; N. Squillace; V. Rochira; B. Madeo; C. Diazzi; E. Baraldi; C. Carani; R. Esposito; Pablo Tebas ( 2008 ) - Association of serum vitamin D levels nd type 2 diabetes in HIV infection in the Modena cohort - Abstracts of the 10th International Workshop on Adverse Drug Reactions and lipodystrophy in HIV - International Medical Press:2-4 Idol Lane, London EC3R 5DD United Kingdom:011 44 207 3980700, EMAIL: imp@intmedpress.com, INTERNET: http://www.intmedpress.com, Fax: 011 44 207 3980701 London GBR) - ANTIVIRAL THERAPY - n. volume 13 [Abstract in rivista (266) - Abstract in Rivista]
Abstract

Metabolic complications, including type 2 diabetes mellitus and metabolic syndrome, are increasingly recognized among HIV-infected individuals. Low vitamin D levels increase the risk of type 2 diabetes mellitus. Our study demonstrates an association between vitamin D deficiency and type 2 diabetes mellitus.

Kety Luzi; G. Guaraldi; Rita Murri; Maria De Paola; G. Orlando; N. Squillace; R. Esposito; V. Rochira; L. Zirilli; Esteban Martinez. ( 2008 ) - Body Image is a major determinant of sexual dysfunction in stable HIV-infected women. - Abstracts of the 10th International Workshop on Adverse Drug Reactions and lipodystrophy in HIV - International Medical Press:2-4 Idol Lane, London EC3R 5DD United Kingdom:011 44 207 3980700, EMAIL: imp@intmedpress.com, INTERNET: http://www.intmedpress.com, Fax: 011 44 207 3980701 London GBR) - ANTIVIRAL THERAPY - n. volume 13 [Abstract in rivista (266) - Abstract in Rivista]
Abstract

Female sexual dysfunction was highly prevalent in this cohort of HIV-infected women. Self-perceived body changes was identified as its major determinant.

R. Ballarin;F. D. Benedetto;M. Masetti;M. Spaggiari;N. D. Ruvo;R. Montalti;A. Romano;S. Cocchi;G. Guaraldi;G. E. Gerunda ( 2008 ) - Combined liver-kidney transplantation in an HIV-HCV-coinfected patient with haemophilia. - AIDS - n. volume 22 - pp. da 2047 a 2049 ISSN: 1473-5571 [Articolo in rivista (262) - Articolo su rivista]
Abstract

No abstract available

Guaraldi G.; Adorni F.; Sconiamilio C.; Zona S.; Squillace N.; Orlando G.; Stentarelli C; Esposito R. ( 2008 ) - Different metabolic and anthropometric characteristics of TVD, CBV or KVX associated with nevirapine. Results from the “NEVIRAPINE COMPANION” cross-sectional cohort - ANTIVIRAL THERAPY - n. volume 13 (4) [Abstract in rivista (266) - Abstract in Rivista]
Abstract

to assess metabolic, anthropometric and cardiovascular risk profile of a cohort undergoing stable nevirapine therapy associated with TDF+FTC (TVD), AZT+3TC (CBV) or ABC+3TC (KVX)

C. Stentarelli; S. Zona; V. Rochira; G. Caffagni; L. Zirilli; S. Ballestri; A. Lonardo; R. D'Amico; N. Squillace; G. Orlando; P. Loria; G. Guaraldi ( 2008 ) - "Endocrine NAFLD": a hormonocentric perspective of Non-Alcoholic Liver Disease (NAFLD) pathogenesis in HIV-infected patients - Abstracts2View™. - Marathon Multimedia Amsterdam. NLD) - n. volume not applicable [Abstract in Atti di convegno (274) - Abstract in Atti di Convegno]
Abstract

We assessed endocrine system involvement in a multifactorial pathogenesis hypothesis of NAFLD in HIV-infected patients.

G. Guaraldi ( 2008 ) - Ensemble pour une Solidarietà Therapeutique Hospitaliere En Reseau contre la SIDA (ESTHER). [Altro (298) - Partecipazione a progetti di ricerca]
Abstract

J. D. Lundgren; M. Battegay; G. Behrens; S. De Wit; G. Guaraldi; C. Katlama; E. Martinez; D. Nair; W. G. Powderly; P. Reiss; J. Sutinen; A. Vigano; EACS Executive Committee. ( 2008 ) - European AIDS Clinical Society (EACS) guidelines on the prevention and management of metabolic diseases in HIV. - HIV MEDICINE - n. volume 2008 Feb;9(2) - pp. da 72 a 81 ISSN: 1464-2662 [Articolo in rivista (262) - Articolo su rivista]
Abstract

BACKGROUND: Metabolic diseases are frequently observed in HIV-infected persons and, as the risk of contracting these diseases is age-related, their prevalence will increase in the future as a consequence of the benefits of antiretroviral therapy (ART). SUMMARY OF GUIDELINES: All HIV-infected persons should be screened at regular intervals for a history of metabolic disease, dyslipidaemia, diabetes mellitus, hypertension and alteration of body composition; cardiovascular risk and renal function should also be assessed. Efforts to prevent cardiovascular disease will vary in intensity depending on an individual's absolute risk of ischaemic heart disease and should be comprehensive in nature. Lifestyle interventions should focus on counselling to stop smoking, modify diet and take regular exercise. A healthy diet, exercise and maintaining normal body weight tend to reduce dyslipidaemia; if not effective, a change of ART should be considered, followed by use of lipid-lowering medication in high-risk patients. A pre-emptive switch from thymidine analogues is recommended to reduce the risk of development or progression of lipoatrophy. Intra-abdominal fat accumulation is best managed by exercise and diet. Prevention and management of type 2 diabetes mellitus and hypertension follow guidelines used in the general population. When using medical interventions to prevent and/or treat metabolic disease(s), impairment of the efficacy of ART should be avoided by considering the possibility of pharmacokinetic interactions and compromised adherence. Specialists in HIV and specialists in metabolic diseases should consult each other, in particular in difficult-to-treat cases. CONCLUSION: Multiple and relatively simple approaches exist to prevent metabolic diseases in HIV-infected persons; priority should be given to patients at high risk of contracting these diseases.

G. Guaraldi; N. Squillace; C. Stentarelli; G. Orlando; R. D’Amico; G. Ligabue; F. Fiocchi; S. Zona; R. Esposito; F. Palella ( 2008 ) - Evolution of Non-alcoholic Fatty Liver Disease in HIV-infected Patients: Incidence, Characteristics, and Predictors - Program & abstracts - Conference on Retroviruses and Opportunistic Infections Alexandria, VA USA) - n. volume not applicable [Abstract in Atti di convegno (274) - Abstract in Atti di Convegno]
Abstract

Non-alcoholic fatty liver disease (NAFLD) occurs among persons without chronic viral hepatitis or significant alcohol consumption. It presents often in the context of cardiovascular risk factors. Our objectives were to assess the incidence and predictors of NAFLD in HIV-infected HAART-experienced patients.

M. Floridia; M. Ravizza; A. Bucceri; L. Lazier; A. Viganò; S. Alberico; G. Guaraldi; G. Anzidei; B. Guerra; A. Citernesi; M. Sansone; S. Baroncelli; E. Tamburrini; Italian Group on Surveillance on Antiretroviral Treatment in Pregnancy. ( 2008 ) - Factors influencing gestational age-adjusted birthweight in a national series of 600 newborns from mothers with HIV. - HIV CLINICAL TRIALS - n. volume 2008 Sep-Oct;9(5) - pp. da 287 a 297 ISSN: 1528-4336 [Articolo in rivista (262) - Articolo su rivista]
Abstract

BACKGROUND: Few studies have assessed the determinants of birthweight in newborns from HIV-positive mothers in analyses that adjusted for different gestational age at delivery. METHOD: We calculated gestational age-adjusted birthweight Z-score values in a national series of 600 newborns from women with HIV and in 600 newborns from HIV-negative women matched for gender and gestational age. The determinants of Z-score values in newborns from HIV-positive mothers were assessed in univariate and multivariate regression analyses. RESULTS: Compared to newborns from HIV-negative women, newborns from HIV-positive women had significantly lower absolute birthweight (2799 vs. 2887 g; p = .007) and birthweight Z score (-0.430 vs. -0.222; p < .001). Among newborns from mothers with HIV, the maternal characteristics associated with significantly lower Z-score values in univariate analyses were recent substance use (Z-score difference [ZSD] 0.612, 95% CI 0.359-0.864, p < .001), smoking >10 cigarettes/day (ZSD 0.323, 95% CI 0.129-0.518, p = .001), absence of pregnancies in the past (ZSD 0.200, 95% CI 0.050-0.349, p = .009), no antiretroviral treatment in the past (ZSD 0.186, 95% CI 0.044-0.327, p = .010), and Caucasian ethnicity compared to Hispanic (ZSD 0.248, 95% CI 0.022-0.475, p = .032). Body mass index (BMI) at conception and maternal glycemia levels during pregnancy were also significantly related to birthweight Z scores. Glycemia, BMI, and recent substance use maintained a significant association with Z-score values in multivariate analyses. In the multivariate analysis, the only factors significantly associated with Z-score values below the 10th percentile were recent substance use (adjusted odds ratio [AOR] 3.17, 95% CI 1.15-8.74) and smoking (AOR 2.26, 95% CI 1.13-4.49). DISCUSSION: We identified several factors associated with gestational age-adjusted birthweight in newborns from women with HIV. Smoking and substance use have a significant negative impact on intrauterine growth, which adds to an independent HIV-related effect on birthweight. Prevention and information on this issue should be reinforced in women with HIV of childbearing age to reduce the risk of negative outcomes in their offspring.

Orlando G.; Squillace N.; Beghetto B.; Nardini G.; Mazeu I.; Guaraldi G. ( 2008 ) - Gender differences in depression evolution in a cohort of patients attendine a metabolic clinic for lipodystrophy management - ANTIVIRAL THERAPY - n. volume 13 (4) [Abstract in rivista (266) - Abstract in Rivista]
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.

N. Squillace; G. Lapadula; C. Torti; G. Orlando; S. Mandalia; G. Nardini; B. Beghetto; S. Costarelli; G. Guaraldi ( 2008 ) - Hepatitis C virus antibody-positive patients with HIV infection have a high risk of insulin resistance: a cross-sectional study. - HIV MEDICINE - n. volume 2008 Mar;9(3) - pp. da 151 a 159 ISSN: 1464-2662 [Articolo in rivista (262) - Articolo su rivista]
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.

Di Benedetto F.; De Ruvo N.; Berretta M.; Masetti M.; Montalti R.; Di Sandro S.; Ballarin R.; Codeluppi M.; Guaraldi G.; Gerunda GE. ( 2008 ) - Hepatocellular carcinoma in HIV patients treated by liver transplantation. - EUROPEAN JOURNAL OF SURGICAL ONCOLOGY - n. volume 34(4) - pp. da 422 a 427 ISSN: 0748-7983 [Articolo in rivista (262) - Articolo su rivista]
Abstract

Several reports have shown the effectiveness of liver transplantation (LT) as a therapeutic option in HIV-patients affected by end-stage liver disease. HCC on cirrhosis is another major indication for LT. However, no reports, to our knowledge, have been published as yet addressing the important questions of indications and outcome of LT in HIV-patients with HCC, mainly because of concerns regarding a more aggressive course of HCC with respect to HCC seen in HIV-negative individuals. METHODS: The aim of this report is to focus on indications, preliminary results and complications of LT in a group of 7 HIV-patients who underwent LT at our department for HCC on cirrhosis. RESULTS: Indications to listing HIV-patients were HCC using the internationally accepted Milan criteria. All patients were HBV-and/or HCV-infected. The mean CD4+ cell-count was 249 (range 144-353), and the HIV-RNA load was undetectable in all but one case. After a mean follow-up period of 232days (range 33-774), no recurrence of HCC was seen; one patient died. CONCLUSION: Characteristics of the study protocol, the patients, virological and immunological features, tumor stage and pre-transplantation treatment, complications and survival are herein described in an effort to provide new insights into methodology for an aggressive management of HCC in HIV patients, and possibly give a greater chance of cure.

Potenza, Leonardo; Luppi, Mario; Barozzi, Patrizia; Rossi, Giulio; Cocchi, Stefania; Codeluppi, Mauro; Pecorari, Monica; Masetti, Michele; Di Benedetto, Fabrizio; Gennari, William; Portolani, Marinella; Gerunda, Giorgio Enrico; Lazzarotto, Tiziana; Landini, Maria Paola; Schulz, Thomas F.; Torelli, Giuseppe; Guaraldi, Giovanni ( 2008 ) - HHV-6A in syncytial giant-cell hepatitis - NEW ENGLAND JOURNAL OF MEDICINE - n. volume 359 - pp. da 593 a 602 ISSN: 0028-4793 [Articolo in rivista (262) - Articolo su rivista]
Abstract

Syncytial giant-cell hepatitis is a rare but severe form of hepatitis that is associated with autoimmune diseases, drug reactions, and viral infections. We used serologic, molecular, and immunohistochemical methods to search for an infectious cause in a case of syncytial giant-cell hepatitis that developed in a liver-transplant recipient who had latent infection with variant B of human herpesvirus 6 (HHV-6B) and who had received the organ from a donor with variant A latent infection (HHV-6A). At the onset of the disease, the detection of HHV-6A (but not HHV-6B) DNA in plasma, in affected liver tissue, and in single micromanipulated syncytial giant cells with the use of two different polymerase-chain-reaction (PCR) assays indicated the presence of active HHV-6A infection in the patient. Expression of the HHV-6A-specific early protein, p41/38, but not of the HHV-6B-specific late protein, p101, was demonstrated only in liver syncytial giant cells in the absence of other infectious pathogens. The same markers of HHV-6A active infection were documented in serial follow-up samples from the patient and disappeared only at the resolution of syncytial giant-cell hepatitis. Neither HHV-6B DNA nor late protein was identified in the same follow-up samples from the patient. Thus, HHV-6A may be a cause of syncytial giant-cell hepatitis.

F. Di Benedetto; S. Di Sandro; N. De Ruvo; M. Berretta; R. Montalti; G. P. Guerrini; R. Ballarin; M. G. De Blasiis; M. Spaggiari; N. Smerieri; R. M. Iemmolo; G. Guaraldi; G. E. Gerunda ( 2008 ) - Human immunodeficiency virus and liver transplantation: our point of view. - TRANSPLANTATION PROCEEDINGS - n. volume 40 (6) - pp. da 1965 a 1971 ISSN: 0041-1345 [Articolo in rivista (262) - Articolo su rivista]
Abstract

INTRODUCTION: Highly active antiretroviral therapy (HAART) has been able to improve the immune system function and survival of HIV patients with a consequent increase in the number of HIV patients affected by end-stage liver disease (ESLD). Between June 2003 and October 2006, 10 HIV-positive patients underwent liver transplantations in our center. METHODS: All patients were treated with HAART before transplantation; treatment was interrupted on transplantation day and was restarted once the patients' conditions stabilized. Five patients were hepatitis C virus (HCV)-positive, 3 were hepatitis B virus (HBV)-positive, and 2 were HBV-HCV coinfected. HIV viral load before transplantation was <50 copies/mL in all cases. CD4+ cell count before transplantation ranged between 144 and 530 c/microL. Immunosuppression was based on Cyclosporine (CyA) and steroid weaning for 8 patients, and on Tacrolimus and steroid weaning for 2 patients. RESULTS: Five patients were cytomegalovirus (CMV)-positive pp65 antigenemia posttransplantation, and 1 patient was EBV-positive; 2 patients had a coinfection with HHV6. Four patients suffered from a cholestatic HCV recurrent hepatitis treated with antiviral therapy (peginterferon and Ribavirin). Three patients died after transplantation. DISCUSSION: The outcome of liver transplantation in HIV patients was influenced by infections (HCV, CMV, and EBV) and Kaposi's Sarcoma. HCV recurrence was more aggressive, showing a faster progression in this patient population. Drug interaction between HAART and immunosuppressants occurs; longer follow-up and better experience may improve the management of these drug interactions.

L. Zirilli; G. Orlando; C. Diazzi; N. Squillace; C. Carani; G. Guaraldi; V. Rochira ( 2008 ) - Hypopituitarism and HIV-infection: a new comorbidity in the HAART era? - JOURNAL OF ENDOCRINOLOGICAL INVESTIGATION - n. volume 31 (Suppl 9) - pp. da 33 a 38 ISSN: 0391-4097 [Articolo in rivista (262) - Articolo su rivista]
Abstract

Several comorbidities are associatedwith the HIV infection and may involvealso the endocrine-metabolic system. Consistently,the recent development of the therapeuticregimen highly active antiretroviraltherapy (HAART) ruled out a significant improvementboth in the prognosis and life expectancyof HIV-infected patients, but disclosedalso new serious drug-related toxicity.Of these, the lipodystrophy syndrome isthe most frequent, occurring in up to 83% ofHIV-infected patients under HAART. The HIVrelatedlipodystrophy is associated with alterationsin GH dynamics, affecting bothbasal and stimulated GH secretion. This GHIGF-I secretive pattern resembles that of severeGH deficiency in adulthood due to pituitarydiseases, but without leading to IGF-Iserum levels below the normal range. The impairmentof pituitary GH secretion has beenascribed to the hormonal and metabolic inhibitoryeffect due to adipose tissue redistributionin HIV-infected males, since in thesepatients pituitary GH secretion appeared tobe inversely related to visceral adipose tissueaccumulation and waist to-hip-ratio. However,whether these patients suffer from a true GHdeficiency due to an intrinsic pituitary failureor display only a functional reduction of GHsecretion due to visceral adiposity remainsstill a matter of debate, especially in HIV-infectedfemales.

S. Zona; A. Lattanzi; N. Squillace; G. Orlando; C. Stentarelli; R. Rossi; A.C. Nuzzo; M.G. Modena; G. Guaraldi ( 2008 ) - Impairment of functional integrity of the vasculature is not changed in patients starting abacavir - Abstracts2View™ - Marathon Multimedia Amsterdam NLD) - n. volume not applicable [Abstract in Atti di convegno (274) - Abstract in Atti di Convegno]
Abstract

In order to explore a possible pathogenetic mechanism of abacavir (ABC) cardiovascular toxicity, we assess the impact of beginning the drug on endothelial function via assessment of brachial artery diameter (BAD) and flow-mediated dilation (FMD).

G. Di Perri; S. Bonora; G. Guaraldi; A. Antinori; G. Carosi; J. Vingerhoets; C. Corbett; S. Bollen; G. De Smedt; R. Termini; M. Risi ( 2008 ) - Impatto del regime background sulla risposta virologica ad etravirina (TMC125;ETR), NNRTI di ultima generazione: analisi combinata a 48 settimane degli studi DUET-1 e DUET-2 - Abstracts - not available Milano ITA) - n. volume Non applicabile [Abstract in Atti di convegno (274) - Abstract in Atti di Convegno]
Abstract

DUET-1 e –2, studi di fase III, randomizzati, in doppio cieco, controllati verso placebo per valutare efficacia, sicurezza e tollerabilità di etravirina in pazienti HIV+ pretrattati.

G. Guaraldi; R. Murri; G. Orlando; N. Squillace; C. Stentarelli; S. Zona; E. Garlassi; E. Martínez ( 2008 ) - Lipodystrophy and quality of life of HIV-infected persons. - AIDS REVIEWS - n. volume 2008 Jul-Sep;10(3) - pp. da 152 a 161 ISSN: 1139-6121 [Articolo in rivista (262) - Articolo su rivista]
Abstract

Morphological changes induced by HIV-related lipodystrophy profoundly affect body image and influence health-related quality of life. Measurements of health-related quality of life in patients with lipodystrophy are complex due to a lack of consensus on the definition of lipodystrophy, a lack of appropriate methods to capture the impact of body fat changes, and the subjective perception of those changes by patients. This review describes the different tools that have been used to assess quality of life in patients with lipodystrophy, and critically analyzes published papers on health-related quality of life. With regard to facial lipoatrophy, the most stigmatizing condition of lipodystrophy, we have analyzed the impact of reconstructive plastic surgery on patient-related outcomes and health-related quality of life. A better knowledge of the associations between lipodystrophy and health-related quality of life will allow us to understand the burden of long-term toxicities of antiretroviral therapies as well as to identify novel patient-related endpoints useful in assessing the efficacy of lipodystrophy treating programs.

Guaraldi G.; Zona S.; Sconiamilio C.; Squillace N.; Orlando G.; Stenterelli C.; Esposito R. ( 2008 ) - Metabolic and athropometric characteristics of TVD, CBV or KVX associated with nevirapine. Results from the “NEVIRAPINE COMPANION” prospective cohort - ANTIVIRAL THERAPY - n. volume 13 (4) [Abstract in rivista (266) - Abstract in Rivista]
Abstract

To assess anthropometric and metabolic profile of a prospective cohort undergoing stable nevirapine therapy associated with TDF+FTC (TVD), AZT+3TC (CBV) OR ABC+3TC (KVX)

M. NASI; GIOVANNI GUARALDI; GABRIELLA ORLANDO; CATERINA DURANTE; MARCELLO PINTI; ELISA NEMES; GIULIA NARDINI; GIUSEPPE PASSARINO; M. COCCHI; ROBERTO ESPOSITO; CRISTINA MUSSINI; ANDREA COSSARIZZA ( 2008 ) - Mitochondrial DNA Haplogroups and Highly Active Antiretroviral Therapy–Related Lipodystrophy - Clinical infectious diseases : an official publication of the Infectious Diseases Society of America - University of Chicago Press:PO Box 37005, Journals Division:Chicago, IL 60637:(877)705-1878, (877)705-1878, (773)753-2247, EMAIL: subscriptions@press.uchicago.edu, INTERNET: http://www.press.uchicago.edu, Fax: (877)705-1879, (773)753-0811 ) - CLINICAL INFECTIOUS DISEASES - n. volume 47 - pp. da 962 a 968 ISSN: 1058-4838 [Articolo in rivista (262) - Articolo su rivista]
Abstract

Background. The combination of different point mutations in mitochondrial DNA (mtDNA), which are defined as haplogroups, may cause modification in organelle function and may be involved in several pathologies. We analyzed the distribution of mtDNA polymorphisms in human immunodeficiency virus (HIV)–infected patients with lipodystrophy, a relevant adverse event caused by highly active antiretroviral therapy, and their correlation with metabolic and viroimmunologic parameters. Methods. The frequency of the 9 most common European haplogroups was investigated in 346 white, HIV- infected patients with lipodystrophy. Haplogroups were identified on the basis of classic methods. Statistical analysis was performed with use of 1-way analysis of variance, the x2 test, and principal-components analysis. Results. The distribution of mtDNA haplogroups among patients with lipodystrophy was similar to that among the general European population. We found no differences between patients with different haplogroups with regard to viroimmunologic results (plasma HIV load, CD4+ T cell count, and nadir CD4+ T cell count), glucose data (glucose, insulin, C-peptide, and glycosylated hemoglobin concentrations and insulin resistance), lipid data (levels of triglycerides, total cholesterol, high- and low-density lipoproteins, and apolipoprotein A1 and B), acid-base balance parameters (lactate level and anion gap), or anthropometric measures (weight, body mass index, and waist- to-hip ratio). No differences were observed in trunk fat levels, leg-fat ratio (which was determined by dual-energy X-ray absorptiometry), or exposure to different drug classes. Principal-components analysis confirmed that the spatial distribution of patients belonging to a given haplogroup was not influenced by different clinical parameters. Conclusions. Our study indicates that, in HIV-infected patients with lipodystrophy, mtDNA haplogroups are not related to major metabolic changes or to particular viroimmunologic features.

Guaraldi G.; Squillace N.; Stentarelli C.; Orlando G.; D'Amico R.; Ligabue G.; Fiocchi F.; Zona S.; Loria P.; Esposito R.; Palella F. ( 2008 ) - Nonalcoholic Fatty Liver Disease in HIV-Infected Patients Referred to a Metabolic Clinic: Prevalence, Characteristics, and Predictors - CLINICAL INFECTIOUS DISEASES - n. volume 47 - pp. da 250 a 257 ISSN: 1058-4838 [Articolo in rivista (262) - Articolo su rivista]
Abstract

BACKGROUND: The prevalence and predictors of nonalcoholic fatty liver disease (NAFLD) in human immunodeficiency virus (HIV)-infected highly active antiretroviral therapy-experienced patients and the association of NAFLD with risk of cardiovascular disease and subclinical atherosclerosis are unknown. METHODS: We performed a cross-sectional observational study. NAFLD was defined by liver-spleen attenuation values of <1.1 on computed tomography in persons who had neither evidence of chronic viral hepatitis nor a significant history of alcohol consumption. RESULTS: We enrolled 225 patients; 163 (72.4%) were men. Mean (+/-SD) HIV infection duration was 145 +/- 60 months, and mean (+/-SD) body mass index (calculated as weight in kilograms divided by the square of height in meters) was 23.75 +/- 3.59. NAFLD was diagnosed in 83 patients (36.9% of the total cohort). The following variables were significantly associated with NAFLD in univariate analyses: sex, waist circumference, body mass index, cumulative exposure to nucleoside reverse-transcriptase inhibitors, visceral adipose tissue, homeostasis model assessment of insulin resistance index, serum alanine and aspartate aminotransferase levels, and ratios of total serum cholesterol to high-density lipoprotein cholesterol. Coronary artery calcium scores and a diagnosis of diabetes were not associated with NAFLD. In multivariable logistic regression analyses, factors associated (P<0.001) with NAFLD were higher serum alanine to aspartate ratio (odds ratio, 4.59; 95% confidence interval, 2.09-10.08), male sex (odds ratio, 2.49; 95% confidence interval, 1.07-5.81), greater waist circumference (odds ratio, 1.07; 95% confidence interval, 1.03-1.11), and longer nucleoside reverse-transcriptase inhibitor exposure (odds ratio, 1.12 per year of exposure; 95% confidence interval, 1.03-1.22). CONCLUSIONS: NAFLD is common among HIV-infected persons who have the traditional risk factors for NAFLD (elevations in serum alanine level, male sex, and increased waist circumference) apparent. Exposure to nucleoside reverse-transcriptase inhibitors was an independent risk factor for NAFLD, with an 11% increase in the odds ratio for each year of use.

Giovanni Guaraldi;Nicola Squillace;Chiara Stentarelli;Gabriella Orlando;Stefano Zona;Paola Loria; Frank Palella ( 2008 ) - Nucleoside reverse-transcriptase inhibitor use, cirrhosis, and end-stage liver disease in HIV-infected patients - Reply to Remtulla and Decker - CLINICAL INFECTIOUS DISEASES - n. volume 47 - pp. da 1234 a 1234 ISSN: 1058-4838 [Articolo in rivista (262) - Articolo su rivista]
Abstract

not available

G. De Santis; V. Jacob; A. Baccarani; A. Pedone; M. Pinelli; A. Spaggiari; G. Guaraldi ( 2008 ) - Polyacrylamide hydrogel injection in the management of human immunodeficiency virus-related facial lipoatrophy: a 2-year clinical experience. - PLASTIC AND RECONSTRUCTIVE SURGERY - n. volume 2008 Feb;121(2) - pp. da 644 a 653 ISSN: 0032-1052 [Articolo in rivista (262) - Articolo su rivista]
Abstract

BACKGROUND: Facial lipoatrophy is defined as the reduction in buccal and orbital fat pads along with a more global loss of fat within the subcutaneous tissue. It is the most common and distressing sign of human immunodeficiency virus-associated lipodystrophy. Injectable polyacrylamide hydrogel (Aquamid) is a synthetic nonbiodegradable polymer consisting of a minor backbone of 2.5 percent cross-linked polyacrylamide and 97.5 percent nonpyrogenic water and is used for cosmetic facial contour correction. Favorable results with maximum aesthetic gains with the use of polyacrylamide hydrogel for reconstruction of facial lipoatrophy on the face in significantly immunocompromised individuals are being reported. These results are attributable to its use in limited volume injected at multiple sites and in multiple sittings. METHODS: Aquamid has been used for the correction of severe nasolabial folds and mid and lower facial volume loss in patients affected by human immunodeficiency virus-associated lipodystrophy. Fifty patients were enrolled and treated, with a mean follow-up of 13.1 months. Results were evaluated clinically, by standardized ultrasonography, and by psychological tests (visual analogue scale, Beck Depression Inventory, and Assessment of Body Change and Distress questionnaire) to quantify patient satisfaction. RESULTS: No significant side effects or issues such as swelling, infections, allergies, or nodule formation were noted over the follow-up period. CONCLUSION: Aquamid has provided a minimally invasive, effective, long-lasting facial contour correction that significantly improves the quality of life in human immunodeficiency virus-infected patients.

Guaraldi G.; Murri R.; Orlando R.; Squillace N.; De Paola M.; Beghetto B.; Nardini G.; Luzi K.; Ciaffi S.; Esposito R. ( 2008 ) - Prospective, 48 weeks follow up, multidisciplinary interventionalstudy to assess improvement of adherence in people with lipodistrophy. - Program and abstracts - NIMH and IAPAC Chicago USA) - n. volume not applicable [Abstract in Atti di convegno (274) - Abstract in Atti di Convegno]
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.

Guaraldi G.; Murri R.; Orlando G.; Giovanardi C.; Squillace N.; Vandelli M.; Beghetto B.; Nardini G.; De Paola M.; Esposito R.; Wu AW. ( 2008 ) - Severity of lipodystrophy is associated with decreased health-related quality of life. - AIDS PATIENT CARE AND STDS - n. volume 2008 Jul;22(7) - pp. da 577 a 585 ISSN: 1087-2914 [Articolo in rivista (262) - Articolo su rivista]
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.

Guaraldi G.; Marcotullio S.; von Schloesser F.; Ciaffi S.; Mazeu I.; Pellicanò G.; Scavello G.; Orofino G.; Sighinolfi L.; Murri R. ( 2008 ) - Simplification to TDF+FTC fixed dose combination shows improved immunological response, adherence and patient-related outcomes while maintaining virological efficacy (the MULTIFACTORS Back Study) - Program and abstracts - NIMH and IAPAC Chicago USA) - n. volume 104 - pp. da 40 a 40 ISBN: not applicable ISSN: - [Abstract in Atti di convegno (274) - Abstract in Atti di Convegno]
Abstract

Aim of this study was to assess the efficacy, adherence and patient-related outcomes of a simplification strategy in patients switching from a stable regimen containing tenofovir and lamivudine to fixed dose combination with tenofovir + emtricitabine.

G. Guaraldi; S. Zona; R. D'Amico; N. Squillace; G. Orlando; C. Stentarelli; R. Esposito ( 2008 ) - Statistical agreement between ATPIII, IDF, EGIR, AACE metabolic syndrome classifications in HIV-infected patients and association with lipodystrophy - Abstract book - Marathon Multimedia Amsterdam NLD) - n. volume 11(Suppl 1) [Abstract in Atti di convegno (274) - Abstract in Atti di Convegno]
Abstract

Purpose of the studyTo assess statistical agreement of metabolic syndrome (MS) ATPIII, IDF, EGIR and AACE classification in HIV-infected patients and association with body fat redistribution.MethodsCross-sectional observational study that included all consecutive HIV-infected patients seen at a metabolic clinic who were screened for MS and had a clinical and radiological lipodystrophy (LD) evaluation. Cohen's Kappa statistic was calculated to assess statistical agreement between different MS classifications. Logistic regression models were performed to identify factors associated with different MS classifications. (Tables 1 and 2.)Table 1. K of Cohen shows a low level of agreement between MS classifications.Summary of results1,348 pts were included in the analysis.Figure 1 depicts prevalence of metabolic syndrome according to different definition.ConclusionConcordance between MS classification is less than ideal. After adjusting for BMI strata, lipodystrophy phenotypes and central fat accumulation are associated with for MS diagnosis.

Squillace N.; Zona S.; Guaraldi G.; Stentarelli C.; D’amico R.; Mazeu I.; Esposito R. ( 2008 ) - Statistical agreement between metabolic syndrome ATP-III, IDF, EGIR and ACE classification in HIV-infected patients and association with body fat redistribution - ANTIVIRAL THERAPY - n. volume 13(4) [Abstract in rivista (266) - Abstract in Rivista]
Abstract

The aim of our study is to assess K statistic of Metabolic Syndrome (MS) Adult Treatment Panel III (ATP-III), International Diabetic Federation (IDF), European Group for the study of Insulin Resistance (EGIR) and America College of Endocrinology (ACE) classificationin in HIV-infected patients and association with body fat reditribution.

Stentarelli C.; Ballestri S.; Zona S.; Amedeo L.; D’amico R.; Squillace N.; Orlando G.; Loria P.; Guaraldi G. ( 2008 ) - Statistical agreement between ultrasound (US) and computerized tomography (CT) for non-alcoholic liver disease (NAFLD) diagnosis - ANTIVIRAL THERAPY - n. volume 13 (4) [Abstract in rivista (266) - Abstract in Rivista]
Abstract

To assess the Cohen's Kappa statistic of non invasive imaging evaluations to diagnose non-alcoholic liver disease (NAFLD) by means of ultrasound (US) fatty liver index score and liver-to-spleen attenuation ratio (L/S) by computerized tomography (CT)

Zona S.; Luzi K.; Murri R.; Granata A.; Orlando G.; Squillace N.; Ligabue G.; Rochira V.; Rossi R.; Guaraldi G. ( 2008 ) - Subclinical coronary artery atherosclerosis and endothelial dysfunction are not predictors of erectile dysfunction in HIV-infected males - Abstracts of the 10th International Workshop on Adverse Drug Reactions and lipodystrophy in HIV - International Medical Press:2-4 Idol Lane, London EC3R 5DD United Kingdom:011 44 207 3980700, EMAIL: imp@intmedpress.com, INTERNET: http://www.intmedpress.com, Fax: 011 44 207 3980701 London GBR) - ANTIVIRAL THERAPY - n. volume 13 [Abstract in rivista (266) - Abstract in Rivista]
Abstract

To evaluate the association between erectile dysfunction and subclinical coronary artery atherosclerosis to endothelial dysfunction in HIV-infected people.

Squillace N.; Zona S.; Orlando G.; Stentarelli C.; Beghetto B.; Nardini G.; Guaraldi G. ( 2008 ) - Virologic failure and metabolic syndrome in patients with HIV infection - Abstracts2View™ - Marathon Multimedia Amsterdam NLD) - n. volume not applicable [Abstract in Atti di convegno (274) - Abstract in Atti di Convegno]
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

Squillace N.; Zona S.; Orlando G.; Stentarelli C.; Beghetto B.; Nardini G.; Guaraldi G. ( 2008 ) - Virologic failure and metabolic syndrome in patients with HIV infection - ANTIVIRAL THERAPY - n. volume 13 (4) [Abstract in rivista (266) - Abstract in Rivista]
Abstract

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

Barbanti Silva V; Ferrara M; Mazzi F; Pingani L; Cocchi S; Romano A; Masetti M; Gerunda G; Guaraldi G; Rigatelli M. ( 2008 ) - What is the biopsychosocial role of human immunodeficiency virus positivity in patients with end-stage liver disease who undergo orthotopic liver transplantation? - TRANSPLANTATION PROCEEDINGS - n. volume 40 - pp. da 1910 a 1912 ISSN: 0041-1345 [Articolo in rivista (262) - Articolo su rivista]
Abstract

INTRODUCTION: Since 2003 the National Research Program for Solid Organ Transplantation in patients with human immunodeficiency virus (HIV) is active at our liver transplantation center. Patients with HIV who enter this protocol are assessed by the Consultation Liaison Psychiatry Service. The aim of the present study was to evaluate their psychiatric comorbidity. METHODS: An observational prospective study was conducted comparing end-stage liver disease (ESLD) patients with and without HIV. After the assessment, the psychiatrist compiled the Transplant Evaluation Rating Scale (TERS) and the Montgomery Asberg Depression Rating Scale (MADRS). Baseline evaluation was made before inclusion on the OLT waiting list and the follow-up evaluation was made 12 months later. RESULTS: From January 2003 to December 2006 we assessed 553 patients: 39 (6%) with HIV and 361 (94%) without HIV. The 2 groups were homogeneous for gender (75% of male patients; P=not significant [NS]) but not for age (46+/-5 vs 56+/-9; P=NS). Psychiatric history was negative in 176 (49%) patients without HIV and in 6 (15%) patients with HIV (P< .001). At baseline psychiatric comorbidity was present in 33 HIV patients (85%) and in 148 non-HIV patients (41%; P< .001). At follow-up MADRS highlighted an improvement in all of the items for HIV patients. In the non-HIV group, the variation was as follows: baseline, 7.10; follow-up, 8.15. In the HIV group, the variation was as follows: baseline, 10.20; follow-up, 4.09 (P< .001). The average score at TERS was higher among patients with HIV (43+/-9 vs 35+/-9; P=NS). CONCLUSIONS: At baseline HIV patients with ESLD showed a higher rate of psychopathology, but they improved at follow-up; the contrary happened in the non-HIV group.

Barbanti SV; Ferrara M; Mazzi F; Pingani L; Cocchi S; Guaraldi G; Gerunda GE; Rigatelli M ( 2008 ) - What is the role of HIV positivity in patients with ESLD who undergo Oltxiter? - XXVII European Conference on Psychosomatic Research (ECPR) XI Annual Scientific Meeting of the European Association for Consultation-Liaison Psychiatry and Psychosomatics XLII Congreso de la Sociedad Española de Medicina Psicosomática - JOURNAL OF PSYCHOSOMATIC RESEARCH - n. volume 64 - pp. da 338 a 338 ISSN: 0022-3999 [Abstract in rivista (266) - Abstract in Rivista]
Abstract

Not available

V. Barbanti Silva;M. Ferrara;L. Pingani;F. Mazzi;S. Cocchi;G. Guaraldi;A. Romano;M. Masetti;G.E. Gerunda;M. Rigatelli ( 2008 ) - What is the role of HIV positivity in patients with ESLD who undergo to OLTx Iter? - European Psychiatry - EUROPEAN PSYCHIATRY - n. volume 23 [Abstract in rivista (266) - Abstract in Rivista]
Abstract

Not available

Masetti M; Guaraldi G; Romano A; Di Benedetto F; Cocchi S; De Ruvo N; Codeluppi M; De Blasiis MG; Lemmolo RM; Montalti R; Gerunda GE ( 2007 ) - Adult liver transplantation in HIV-infected patients - Abstracts - AMERICAN JOURNAL OF TRANSPLANTATION - n. volume 7 - pp. da 477 a 477 ISSN: 1600-6135 [Abstract in rivista (266) - Abstract in Rivista]
Abstract

Report of a retrospective analysis of the results of adult liver transplantation in HIV-infected patients performed between Jun 2003 and October 2006.

Masetti M; Guaraldi G; Romano A; Di Benedetto F; De Ruvo N; Cocchi S; Codeluppi M; Guerrini GP; Montalti R; Iemmolo R; Gerunda GE ( 2007 ) - Adult liver transplantation in HIV-infected patients: Single center experience. - Abstracts - LIVER TRANSPLANTATION - n. volume 13 [Abstract in rivista (266) - Abstract in Rivista]
Abstract

Report of a retrospective analysis of the results of adult liver transplantation in HIV-infected pts performed between 6-2003 and 10-2006.

A. Bedini;C. Venturelli;M. Codeluppi;S. Cocchi;F. Prati;F. Di Benedetto;M. Masetti;C. Mussini;G. Guaraldi;V. Borghi;F. Rumpianesi;G.E. Gerunda;R. Esposito ( 2007 ) - Bloodstream infections complicating orthotopic liver transplant: comparison between the recipients from cadaver and living donors - International Journal of Antimicrobial Agents - INTERNATIONAL JOURNAL OF ANTIMICROBIAL AGENTS - n. volume 29 [Abstract in rivista (266) - Abstract in Rivista]
Abstract

We evaluated the incidence, the prevalence of the microorganisms isolated and the impact on the survival of the bloodstream infections in two groups of patients: recipients of orthotopic liver transplant from cadaveric donor and from living donor.

Guaraldi G.; Cocchi S.; Ciaffi S.; Motta A.; Pinetti D.; Codeluppi M.; Bonora S.; Di Benedetto F.; Masetti M.; Di Sandro S.; Nardini G.; Bertolini A.; Gerunda G.E.; Esposito R. ( 2007 ) - Different dose adjustments of immunosuppresants are necessary after initiating boosted or unboosted first protease inhibitors regimen post-liver transplantation - Abstract book - not available Madrid ESP) - n. volume # P4.2/04 [Abstract in Atti di convegno (274) - Abstract in Atti di Convegno]
Abstract

Antiretroviral (ARV) drug interactions in HIV-infected liver transplant (LTx) recipients can lead to increased levels of immunosuppressive agents (Is) which are responsible to induce acute renal failure and other major toxicities.

Cocchi S.; Guaraldi G.; Ciaffi S.; Motta A.; Pinetti D.; Codeluppi M.; Bonora S.; Di Benedetto F.; Masetti M.; Di Sandro S.; Nardini G.; Zona S.; Bertolini A.; Gerunda G.E.; Esposito R. ( 2007 ) - Does change of the liver change the metabolism? Assessment of atazanavir pharmacokinetic profile in 7 HIV-infected patients pre- and post-liver transplantation - Abstract book - not available Madrid ESP) - n. volume # P4.2/03 [Abstract in Atti di convegno (274) - Abstract in Atti di Convegno]
Abstract

Liver Transplantation (LTx) is a rational therapeutic option for selected HIV-infected patients who have concomitant end-stage liver disease (ESLD). In particular, the use of atazanavir (ATV) in the setting of patients with HIV infection suffering from ESLD is actually controindicated.

Orlando G; Guaraldi G; Squillace N; De Fazio D; Rottino A; Bonucci P; Padalino E; Grisotti A; Nardini G; Beghetto B; Esposito R ( 2007 ) - Effectiveness and long-term durability of autologous fat transplant for HIV-related face lipoatrophy. - Abstracts - ANTIVIRAL THERAPY - n. volume 12 [Abstract in rivista (266) - Abstract in Rivista]
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.

Carosi G.; Quiros-Roldan E.; Torti C.; Antinori A.; Bevilacqua M.; Bonadonna R.C.; Bonfanti P.; Castagna A.; Cauda R.; d'Arminio-Monforte A.; Di Gregorio P.; Di Perri G.; Esposito R.; Fatuzzo F.; Gervasoni C.; Giannattasio C.; Guaraldi G.; Lazzarin A.; Lo Caputo S.; Maggi P.; Mazzotta F.; Moroni M.; Prestileo T.; Ranieri R.; Rizzardini G.; Russo R.; Galli M.; Members of the Italian Cardiovascular Risk Guidelines Working Group ( 2007 ) - First Italian consensus statement on diagnosis, prevention and treatment of cardiovascular complications in HIV-infected patients in the HAART era (2006). - INFECTION - n. volume Jun;35(3) - pp. da 134 a 142 ISSN: 0300-8126 [Articolo in rivista (262) - Articolo su rivista]
Abstract

The present document contains recommendations for assessment, prevention and treatment of cardiovascular risk for HIV-infected patients. All recommendations were graded according to the strength and quality of the evidence and were voted on by 73 members of the Italian Cardiovascular Risk Guidelines Working Group which includes both experts in HIV/AIDS care and in cardiovascular and metabolic medicine. Since antiretroviral drug exposure represents only one risk factor, continued emphasis on an integrated management is given. This should include prevention and treatment of known cardiovascular risk factors (such as dyslipidaemia, diabetes, insulin resistance, healthy diet, physical activity, avoidance of smoking), but also rational switch of antiretroviral drugs. A rational switch strategy should consider both metabolic and anthropometric disturbances and effectiveness of antiretroviral regimens.

A. Bedini; M. Codeluppi; S. Cocchi; G. Guaraldi ; F. Di Benedetto; C. Venturelli; M. Masetti; F. Prati; C. Mussini; V. Borghi; M. Girardis; G.E. Gerunda; F. Rumpianesi; R. Esposito ( 2007 ) - Gram-positive bloodstream infections in liver transplant recipients: incidence, risk factors, and impact on survival. - TRANSPLANTATION PROCEEDINGS - n. volume 39 - pp. da 1947 a 1949 ISSN: 0041-1345 [Articolo in rivista (262) - Articolo su rivista]
Abstract

The objective of the study was to assess the incidence, risk factors, and survival of gram-positive bloodstream infections (GP-BSIs) among liver transplant recipients during the first year after transplantation. Between October 2000 and September 2006, 42 episodes of GP-BSIs occurred in 205 patients with an overall incidence of 0.20 episodes/patient. Coagulase-negative staphylococci were detected in 45.2% of cases, Enterococcus species in 42.9% (E faecalis, eight; E faecium, seven; E avium, two; E gallinarum, one) and Staphylococcus aureus in 11.9%. Retransplantation was the only independent risk factor for GP-BSI (odds ratio [OR], 0.253; 95% confidence interval (CI), 0.089 to 0.715; P = .009). Thirty-day mortality rate was 28.5% and S aureus infections were related to a poorer outcome. It is noteworthy that all the isolates of S aureus were methicillin-resistant. Ampicillin was inactive against all the strains of E faecium and 50% of E avium isolates, but active against all E faecalis and E gallinarum strains. All the isolates were glycopeptide-susceptible. No significant differences in mortality rate were observed in relation to sex, etiologies of end-stage liver disease, cytomegalovirus infection/reinfection, type of donor, rejection, or retransplantation. GP-BSI, the only independent risk factor for death (OR, 0.262; 95% CI, 0.106 to 0.643; P = .003), reduced the survival rate by 26% in the first year posttransplant. In conclusion, GP-BSIs impact significantly on morbidity and mortality posttransplant, particularly among retransplantations. Control measures are required to reduce the incidence of GP-BSIs in liver transplant recipients. These findings must be considered when empirical antimicrobial therapy is indicated while awaiting blood-culture results.

Dominici M.; Sternieri R.; De Fazio D.; Cafarelli L.; Guaraldi G.; Spano C.; Rasini V.; Paolucci P.; Cilli M.; Piccardi F.; Astori G.; Hofmann T.J.; Horwitz E.; Conte P.F. ( 2007 ) - Grams of Sub-Cutaneous Adipose Tissue (SCAT) as Source of Adult Multipotent Mesenchymal Stromal Cells (MSC) for Cell-Based Therapies - BLOOD - n. volume 110 (N. 11, part 2) [Abstract in rivista (266) - Abstract in Rivista]
Abstract

The purification of multipotent mesenchymal stromal cell (MSC) from sub-cutaneous adipose tissue (SCAT) represents a promising approach for several clinical applications. We here report a novel and safe approach to isolate multipotent cells from small SCAT specimens to be used as platform for cell based therapies with minimal donor's discomfort.

Guaraldi G; Roverato A; Giovanardi C; Ravera F; Squillace N; Orlando G; Cappelli G; Esposito R; Palella F ( 2007 ) - HAART-induced viral suppression compensates potential negative effects of TDF on renal function - Abstracts - ANTIVIRAL THERAPY - n. volume 12 [Abstract in rivista (266) - Abstract in Rivista]
Abstract

The aim of our study was to assess the impact of HIV-1 viral load variation and TDF exposure on kidney function evaluated by means of delta glomerular filtration rate over 48-week period in patients with mild renal impairement.

V. Rochira; L. Zirilli; G. Orlando; G. Caffagni; N. Squillace; C. Diazzi; B. Madeo; G. Guaraldi; C. Carani ( 2007 ) - Impairment of GH response to GHRH+Arginine in women affected by HIV-related adipose tissue redistribution syndrome (HARS) - Abstracts of the XXXII National Congress of the Italian Society of Endocrinology - Editrice Kurtis Srl:via Luigi Zoja 30, Milan 20153 Italy:011 39 02 48202740, EMAIL: info@kurtis.it, INTERNET: http://www.kurtis.it, Fax: 011 39 02 48201219 Milan ITA) - JOURNAL OF ENDOCRINOLOGICAL INVESTIGATION - n. volume 30 - pp. da 68 a 68 ISSN: 0391-4097 [Abstract in rivista (266) - Abstract in Rivista]
Abstract

This study suggests that relative GH deficiency is common among females with HIV-related lipodystrophy if compared with matched controls.

M. Masetti;S. Cocchi;R. Montalti;G. Guaraldi;A. Romano;M. Codeluppi;M. Girardis;N. De Ruvo;S. Busani;R. Ballarin;F. Di Benedetto;G.P. Guerrini;R.M. Iemmolo;G. Rompianesi;G.E. Gerunda ( 2007 ) - Liver transplantation in HIV patients - Digestive and Liver Disease - DIGESTIVE AND LIVER DISEASE - n. volume 39 [Abstract in rivista (266) - Abstract in Rivista]
Abstract

not available

Orlando G.; Guaraldi G.; De Fazio D.; Rottino A.; Grisotti A.; Blini M.; De Santis G.; Pedone A.; Spaggiari A.; Baccarani A.; Vandelli M.; De Paola M.; Comelli D.; Nardini G.; Beghetto B.; Squillace N.; Esposito R. ( 2007 ) - Long-term psychometric outcomes of facial lipoatrophy therapy: forty-eight-week observational, nonrandomized study. - AIDS PATIENT CARE AND STDS - n. volume 2007 Nov;21(11) - pp. da 833 a 842 ISSN: 1087-2914 [Articolo in rivista (262) - Articolo su rivista]
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 < 0.0001), of body image satisfaction (ABCD question 7 from 3.8 +/- 1 to 3.1 +/- 1 p < 0.0001 and ABCD question 8 from 70.7 +/- 16.7 to 77.2 +/- 17.2 p < 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 < 0.0001, left cheek from 4.4 +/- 2 mm to 9.6 +/- 3.1 mm, p < 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.

P. Cortelli; J. Mandrioli; M. Zeviani; R. Lodi; C. Prata; M. Pecorari; G. Orlando; G. Guaraldi ( 2007 ) - Mitochondrial complex III deficiency in a case of HCV related noninflammatory myopathy. - JOURNAL OF NEUROLOGY - n. volume 254 (10) - pp. da 1450 a 1452 ISSN: 0340-5354 [Articolo in rivista (262) - Articolo su rivista]
Abstract

not available

FLORIDIA M.; TAMBURRINI E.; BUCCERI A.; TIBALDI C.; ANZIDEI G.; GUARALDI G.; MELONI A.; GUERRA B.; FERRAZZI E.; MOLINARI A.; PINNETTI C.; SALERIO B.; RAVIZZA M.; THE ITALIAN GROUP ON SURVEILLANCE ON ANTIRETROVIRAL TREATMENT IN PREGNANCY ( 2007 ) - Pregnancy outcomes and antiretroviral treatment in a national cohort of pregnant women with HIV: overall rates and differences according to nationality. - Elsevier BV:PO Box 211, 1000 AE Amsterdam Netherlands:011 31 20 4853757, 011 31 20 4853642, 011 31 20 4853641, EMAIL: nlinfo-f@elsevier.nl, INTERNET: http://www.elsevier.nl, Fax: 011 31 20 4853598 ) - BJOG-AN INTERNATIONAL JOURNAL OF OBSTETRICS AND GYNAECOLOGY - n. volume 2007 Jul;114(7) - pp. da 896 a 900 ISSN: 1470-0328 [Articolo in rivista (262) - Articolo su rivista]
Abstract

We used data from the main surveillance study of HIV and pregnancy in Italy to evaluate possible differences in pregnancy care and outcomes according to nationality. Among 960 women followed in 2001-06, 33.5% were of foreign nationality, mostly from African countries. Foreign women had lower rates of preconception counselling and planning of pregnancy. They had more frequently HIV diagnosed during pregnancy, with a later start of antiretroviral treatment and lower treatment rates at all trimesters but not when the entire pregnancy, including delivery, was considered. No differences were observed between the two groups in ultrasonography assessments, hospitalisations, AIDS events, intrauterine or neonatal deaths, and mode and complications of delivery. Foreign women had a slightly lower occurrence of preterm delivery and infants with low birthweight. The results indicate good standards of care and low rates of adverse outcomes in pregnant women with HIV in Italy, irrespective of nationality. Specific interventions, however, are needed to increase the rates of counselling and HIV testing before pregnancy in foreign women.

Guaraldi G.; Orlando G.; Squillace N.; Roverato A.; De Fazio D.; Vandelli M.; Nardini G.; Beghetto B.; De Paola M.; Esposito R.; Palella F. ( 2007 ) - Prevalence of and risk factors for pubic lipoma development in HIV-infected persons. - JOURNAL OF ACQUIRED IMMUNE DEFICIENCY SYNDROMES - n. volume 2007 May 1;45(1) - pp. da 72 a 76 ISSN: 1525-4135 [Articolo in rivista (262) - Articolo su rivista]
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.

Guaraldi G.; Luzi K.; Murri R.; Granata A.; De Paola M.; Orlando G.; Squillace N.; Malmusi D.; Carani C.; Comelli D.; Esposito R.; Martinez E. ( 2007 ) - Sexual dysfunction in HIV-infected men: role of antiretroviral therapy, hypogonadism and lipodystrophy. - ANTIVIRAL THERAPY - n. volume 12(7) - pp. da 1059 a 1065 ISSN: 1359-6535 [Articolo in rivista (262) - Articolo su rivista]
Abstract

BACKGROUND: Both psychological and organic factors have been recognized to be associated with sexual dysfunction in HIV-infected individuals. METHODS: In this cross-sectional study we evaluated the prevalence and factors associated with sexual dysfunction in a cohort of HIV-infected adult men. Evaluation tools included: the International Index of Erectile Function (erectile dysfunction [ED], desire, orgasm, intercourse satisfaction, overall satisfaction), the Assessment of Body Change and Distress (body image satisfaction), the Medical Outcomes Study HIV Health Survey (mental and physical health-related quality of life), and plasma free and total testosterone level (hypogonadism). RESULTS: Three-hundred and fifty-seven men were enrolled. Among 336 patients reporting sexual activities in the 4 weeks before, 94 (29.6%) had mild, 30 (9.4%) moderate and 34 (10.1%) severe dysfunction. The Mental Health Summary score was 2.28 units (95% confidence interval [CI] 1.51, 3.06) lower for each unit higher of body image dissatisfaction and 0.31 units (95% CI 0.27, 0.36) higher for each unit higher of the score for body change interference with habits. At regression analysis, ED was independently related to the body mass index (B = 0.31, 95% CI 0.08, 0.62). Desire, orgasm and overall satisfaction domains were associated with mental health score (B = 0.87, 95% CI 0.47, 1.27; B = 0.75, 95% CI 0.23, 1.26; B = 0.86, 95% CI 0.45, 1.28, respectively). An improved intercourse satisfaction domain was associated with a lower interference of body changes with habits and social life (B = 0.39, 95% CI 0.05, 0.73). Testosterone, metabolic alterations and HAART were not associated with sexual function domains. CONCLUSIONS: Body image and mental health but not HAART or hypogonadism were associated with sexual function domains.

Squillace N.; Guaraldi G.; Orlando G.; Roverato A.; Nardini G.; Beghetto B.; Esposito R. ( 2007 ) - The role of virological and immunological parameters on the diagnosis of metabolic syndrome in HIV-associated lipodystrophy - ANTIVIRAL THERAPY - n. volume 12(2) [Abstract in rivista (266) - Abstract in Rivista]
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.

Ravizza M.; Martinelli P.; Bucceri A.; Fiore S.; Alberico .S; Tamburrini E.; Tibaldi C.; Guaraldi G.; Anzidei G.; Maccabruni A.; Crisalli M.P.; Floridia M. ( 2007 ) - Treatment with protease inhibitors and coinfection with hepatitis C virus are independent predictors of preterm delivery in HIV-infected pregnant women. - THE JOURNAL OF INFECTIOUS DISEASES - n. volume 2007 Mar 15;195(6) - pp. da 913 a 914 ISSN: 0022-1899 [Articolo in rivista (262) - Articolo su rivista]
Abstract

In a recent study, Cotter et al analyzed a cohort of HIV-infected pregnant women followed at a single site, to examine the risk of preterm delivery and other pregnancy outcomes. Their results indicated that combination therapy with protease inhibitors (PI), compared with monotherapy and combination therapy without PI, is indipendently associated with preterm delivery. We analyzed data from the largest surveillance study currently being conducted in Italy of the use of antiretroviral drugs in pregnancy, to establish the role of PIs in preterm delivery after controlling for important prognostic cofactors.

Floridia M.; Tamburrini E.; Ravizza M.; Anzidei G.; Tibaldi C.; Bucceri A.; Maccabruni A.; Guaraldi G.; Meloni A.; Probizer M.F.R.; Guerra B.; Martinelli P. ( 2006 ) - Antiretroviral therapy at conception in pregnant women with HIV in Italy: Wide range of variability and frequent exposure to contraindicated drugs - ANTIVIRAL THERAPY - n. volume 11 (7) - pp. da 941 a 946 ISSN: 1359-6535 [Articolo in rivista (262) - Articolo su rivista]
Abstract

Methods: Data from a large national surveillance study was used to describe antiretroviral regimens in pregnant women with HIV, with particular reference to the presence at conception of antiretroviral treatments contraindicated in pregnancy. Therapeutic changes during pregnancy were also analysed. Results: Among 334 women on antiretroviral treatment at conception, less than half (42.4%) reported current pregnancy as planned. A large number of different regimens (80) was observed. All the regimens included at least one nucleoside or nucleotide reverse transcriptase inhibitor. Non-nucleoside reverse transcriptase inhibitors and protease inhibitors were present in similar proportions (39.2% and 40.7%, respectively). The most commonly used drugs were lamivudine (83.2% of regimens), zidovudine (50.0%), stavudine (d4T; 38.0%), nevirapine (25.7%), didanosine (ddl; 17.7%) and nelfinavir (17.7%). Treament with efavirenz (13.5% of regimens) and ddI+d4T (9.6%) was markedly frequent. Use of efavirenz at conception was associated with a subsequent treatment change during pregnancy (odds ratio [OR]: 13.2.; 95% confidence interval [CI]: 3.2-53.8, P < 0.001). A similar but less strong association was found for ddI (OR: 1.8; 95% CI: 1.03-3.25, P=0.033), whereas being on nevirapine was associated with a lower risk (OR: 0.58; 95% CI: 0.38-0.81, P=0.013). Conclusions: Our data show that treatment at conception frequently represents the regimen previously selected for the treatment of the non-pregnant woman. The observed rates of exposure to contraindicated treatment should lead prescribing physicians to consider in HIV-positive women therapeutic choices that take into account the likelihood of an unplanned pregnancy. Such an approach is likely to reduce not only unintended exposures to contraindicated drugs, but also therapeutic changes during pregnancy.

Bedini A.; Cocchi S.; Di Benedetto F.; Codeluppi M.; Guaraldi G.; Venturelli C.; Mussini C.; Prati F.; Masetti M.; Rumpianesi F.; Gerunda G.E.; Esposito R. ( 2006 ) - Bloodstream infections (BSIs) in Liver Transplant Recipients: Analisys at an Italian Tertiary-Care Hospital - Abstract - American Society for Microbiology Washington USA) - n. volume not applicable [Abstract in Atti di convegno (274) - Abstract in Atti di Convegno]
Abstract

After liver transplantation, bacteriemia has been documented in 24% to 35%.We evaluated the incidence of BSIs and the impact on the survival in 205 consecutive liver-transplant recipients at the University Hospital of Modena-Italy

G. Guaraldi ( 2006 ) - Cardiovascular complications in HIV-infected individuals. - CURRENT OPINION IN HIV AND AIDS - n. volume 1(6) - pp. da 507 a 513 ISSN: 1746-630X [Articolo in rivista (262) - Articolo su rivista]
Abstract

PURPOSE OF REVIEW: This review updates the relationship between HIV and cardiovascular abnormalities in the context of the pathophysiology of coronary artery disease.RECENT FINDINGS: The evaluation of cardiovascular risk in patients with HIV hinges upon a complex interplay of direct and indirect vascular effects of HIV infection, antiretroviral therapy, aging, and exposure to cardiovascular risk factors. Carotid artery intima-media thickness and endothelial-dependent flow-mediated vasodilatation of the brachial artery, which gives an indication of the structural and functional aspect of the endothelium as well as soluble biomarkers, can help to assess the potential harm and benefits of antiretroviral drugs and address the residual burden of cardiovascular risk in the HIV population.SUMMARY: Given the complex pathophysiology of cardiovascular disease, no single biomarker is likely to be able to provide a universal surrogate whereby change observed independently predicts benefit, increased risk, or no effect across all drugs and mechanistic targets. Investigations and treatments must be tailored in the single patient according to non-modifiable and modifiable risk factors, including exposure to highly active antiretroviral therapy. With proper risk stratification altering the approach to highly active antiretroviral therapy, lifestyle changes, and lipid-lowering medications are the basis for reducing cardiovascular risk in HIV-infected patients.

N. Gianotti; V. Mondino; M.C. Rossi; E. Chiesa; I. Mezzaroma; N. Ladisa; G. Guaraldi; C. Torti; P. Tarquini; P. Castelli; A. Di Carlo; E. Boeri; W. Keulen; P. Mc Kenna; A. Lazzarin ( 2006 ) - Comparison of a rule-based algorithm with a phenotype-based algorithm for the interpretation of HIV genotypes in guiding salvage regimens in HIV-infected patients by a randomized clinical trial: The mutations and salvage study - CLINICAL INFECTIOUS DISEASES - n. volume 42(10) - pp. da 1470 a 1480 ISSN: 1058-4838 [Articolo in rivista (262) - Articolo su rivista]
Abstract

Background. There is still considerable uncertainty as to the best algorithm for interpreting humanimmunodeficiency virus (HIV) genotyping results. Methods. A total of 318 subjects with HIV RNA levels of > 1000 copies/mL were enrolled in 41 centers throughout Italy from 2001 through 2003, stratified on the basis of their drug history, randomized (1:1) to 2 arms to have their treatments modified on the basis of the results of HIV genotyping (as interpreted by virtual phenotype analysis or with use of a rule-based interpretation system), and followed up for 48 weeks. At least 1 nucleoside reverse-transcriptase inhibitor and 1 protease inhibitor had to be included in any new regimen; nonnucleoside reverse-transcriptase inhibitor naive patients were also prescribed a nonnucleoside reverse-transcriptase inhibitor. Only drugs licensed in Italy were allowed. The primary end point was a decrease in HIV RNA level to < 400 copies/mL by week 12 according to on-treatment analysis. Results. The mean (+/- standard deviation) values at baseline were as follows: HIV RNA level, log(10) copies/mL; CD4(+) T lymphocyte count, cells/mu L; reverse-transcriptase mutations,4.8 +/- 2.9; and protease mutationa, mutations, 2.8 +/- 2.5. There were 133 patients (41.8%) who were nonnucleoside reverse-transcriptase inhibitor naive and protease inhibitor experienced, 63 patients (19.8%) who were nonnucleoside reverse- transcriptase inhibitor experienced and protease inhibitor naive, and 122 patients (38.4%) who were 3-class experienced. A total of 192 patients completed 12 weeks of the treatment regimen assigned at baseline; at 12 weeks, 66.3% of patients in the virtual phenotype arm and 71.3% of patients in the rule-based interpretation arm had HIV RNA levels of ! 400 copies/ mL (P = .46). No statistically significant difference between arms was observed by intention-to-treat analysis. Conclusion. Both the virtual phenotype and rule-based interpretation methods of HIV genotyping can guide the selection of effective antiretroviral drugs for a salvage regimen.

Floridia M.; Ravizza M.; Tamburrini E.; Anzidei G.; Tibaldi C.; Maccabruni A.; Guaraldi G.; Alberico S.; Vimercati A.; Degli Antoni A.; Ferrazzi E. ( 2006 ) - Diagnosis of HIV infection in pregnancy: data from a national cohort of pregnant women with HIV in Italy - EPIDEMIOLOGY AND INFECTION - n. volume 2006 Oct;134(5) - pp. da 1120 a 1127 ISSN: 0950-2688 [Articolo in rivista (262) - Articolo su rivista]
Abstract

We analysed the characteristics of the pregnancies with a previously undetected HIV infection in a national observational study of pregnant women with HIV in Italy. In a total of 443 pregnancies with available date of HIV diagnosis, 118 were characterized by a previously undetected HIV infection (26(.)6 %, 95 % CI 22(.)5-30(.)8). The following factors were independently associated with this occurrence in a multivariate analysis (adjusted odds ratios; 95 % CIs): foreign nationality (5(.)1, 2(.)8-9(.)3); no pre-conception counselling (35(.)9, 4(.)8-266(.)1); first pregnancy (2(.)1, 1(.)2-4(.)0); asymptomatic status (6(.)8, 1(.)5-30(.)6). Women with previously undetected infection started antiretroviral treatment significantly later during pregnancy (P < 0(.)001). Missed diagnosis was responsible for one case of transmission. A high rate of previously undetected HIV infection was observed. This suggests a good HIV detection during pregnancy, but also the need to reinforce HIV testing strategies among women of childbearing age. We identified some determinants which may be considered for intervention measures.

A. Bedini; C. Venturelli; C. Mussini; G. Guaraldi; M. Codeluppi; V. Borghi; F. Rumpianesi; F. Barchiesi; R. Esposito ( 2006 ) - Epidemiology of candidaemia and antifungal susceptibility patterns in an Italian tertiary-care hospital - Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases - CLINICAL MICROBIOLOGY AND INFECTION - n. volume Jan;12(1) - pp. da 75 a 80 ISSN: 1198-743X [Articolo in rivista (262) - Articolo su rivista]
Abstract

The epidemiological and antifungal susceptibility data for 94 episodes of candidaemia in an Italian tertiary-care hospital between January 2000 and August 2003 were evaluated by prospective laboratory-based surveillance. The incidence of fungaemia was 0.90 episodes/10 000 patient-days, and the most common species isolated were Candida albicans (40.4%), Candida parapsilosis (22.3%), Candida tropicalis (16.0%) and Candida glabrata (12.8%). Among 24 patients who received antifungal prophylaxis, non-albicans Candida spp. were more prevalent than C. albicans (p 0.012). The 30-day mortality rate was high (38.2%), particularly for haematological (71.4%) and solid-organ transplant patients (50.0%), and in individuals with C. tropicalis and C. glabrata bloodstream infections (60.0% and 50.0%, respectively). In-vitro susceptibility tests demonstrated that 95% of the isolates were susceptible to amphotericin B (MIC < 2 mg/L), 98.1% to posaconazole (MIC < 1 mg/L), 95.8% to flucytosine (MIC < 32 mg/L) and fluconazole (MIC < 64 mg/L), and 94.7% to itraconazole (MIC < 1 mg/L). Posaconazole was active (MIC 0.5 mg/L) against all three isolates of Candida krusei, which had reduced susceptibility to both fluconazole and itraconazole. Overall, non-albicans Candida spp. accounted for 60% of the episodes of candidaemia, which could be related to the use of antifungal prophylaxis. Resistance is still uncommon in Candida spp. recovered from blood cultures. The in-vitro activity of posaconazole is encouraging, and this agent could play an important role in the management of invasive candidiasis, including episodes caused by inherently less susceptible species such as C. krusei.

S. Cocchi; F. Di Benedetto; M. Codeluppi; G. Guaraldi; A. Lauro; A. Bagni; M. Pecorari; W. Gennari; C. Quintini; R. Esposito; AD Pinna ( 2006 ) - Fatal cytomegalovirus necrotising enteritis in a small bowel transplantation adult recipient with low pp65 antigenaemia levels - DIGESTIVE AND LIVER DISEASE - n. volume 38 - pp. da 429 a 433 ISSN: 1590-8658 [Articolo in rivista (262) - Articolo su rivista]
Abstract

Although advances in immunosuppressive therapy have led to increased survival of solid organ transplantation recipients, it is well established that current protocols have been associated with an increased risk of developing tissue-invasive infections. In particular, cytomegalovirus still represents an important cause of morbidity. We report a case of cytomegalovirus infection involving the graft ileum with documented necrotising enteritis that developed after small bowel transplantation. The patient, a 56-year-old Caucasian female with a postsurgery short bowel syndrome, underwent a small bowel transplantation. Immunosuppression was maintained by combination of tacrolimus, steroids and daclizumab. Both the donor and the recipient were serologically negative for cytomegalovirus IgG. Nevertheless, ganciclovir prophylaxis was given for 21 days after surgery, as standard procedure. On hospital day 174, routine pp65 antigenaemia resulted positive (14/200,000 peripheral blood leukocytes). The patient was asymptomatic and preemptive ganciclovir therapy was instituted. In the following 3 days, due to a cytomegalovirus antigenaemia increase, ganciclovir was changed to foscarnet with subsequent virological response (7/200,000 peripheral blood leukocytes, on day 18 1). Two days later, the patient complained of acute abdominal pain and she underwent surgery for the diagnosis. Since the intraoperative findings consisted of a diffuse acute purulent peritonitis, the intestinal graft, together with native rectum, was removed. Biopsy specimens showed evidence of tissue-invasive cytomegalovirus infection. Postsurgery, the patient developed septic shock and died on day 198 as a consequence of multiple organ failure.

Guaraldi G; Cocchi S; Codeluppi M; Pecorari M; Barozzi P; Gennari W; Bagni A; Bosco R; Vallerini D; Di Benedetto F; Masetti M; Portolani M; Torelli G; Luppi M ( 2006 ) - Giant cell hepatitis following primary infection with HHV-6 variant A, transmitted from the donor, in a liver transplant recipient latently infected with HHV-6 variant B - Abstracts - JOURNAL OF CLINICAL VIROLOGY - n. volume 37 [Abstract in rivista (266) - Abstract in Rivista]
Abstract

Syncytial giant-cell hepatitis is a rare but severe form of hepatitis that is associated with autoimmune diseases, drug reactions, and viral infections. We used serologic, molecular, and immunohistochemical methods to search for an infectious cause in a case of syncytial giant-cell hepatitis that developed in a liver-transplant recipient who had latent infection with variant B of human herpesvirus 6 (HHV-6B) and who had received the organ from a donor with variant A latent infection (HHV-6A).

V. Rochira; L. Zirilli; C. Diazzi; G. Caffagni; Antonio Balestrieri; Antonio R.M. Granata; Maria C. De Santis; G. Orlando; N. Squillace; G. Guaraldi; C. Carani ( 2006 ) - Impaired GH secretion in women with HIV-related lipodystrophy - Abstract of the XXVI Giornate Endocrinologiche Pisane - Editrice Kurtis Srl:via Luigi Zoja 30, Milan 20153 Italy:011 39 02 48202740, EMAIL: info@kurtis.it, INTERNET: http://www.kurtis.it, Fax: 011 39 02 48201219 Milan ITA) - JOURNAL OF ENDOCRINOLOGICAL INVESTIGATION - n. volume 29 (Suppl 4) - pp. da 48 a 48 ISSN: 0391-4097 [Abstract in rivista (266) - Abstract in Rivista]
Abstract

Women with HIV-related lipodystrophy show impaired GH after GHRH+Arginine

V. Rochira; L. Zirilli; B. Madeo; G. Caffagni; A. Sanguanini; Antonio R.M. Granata; Maria C. De Santis; G. Orlando; N. Squillace; G. Guaraldi; C. Carani ( 2006 ) - Impaired GH secretion in women with HIV-related lipodystrophy - ENEA 2006 Abstracts Hormones, International Journal of Endocrinology and Metabolism - Athēna: Tehnogramma. Athens GRC) - HORMONES - n. volume 5 (Suppl 1) - pp. da 79 a 79 ISSN: 1109-3099 [Abstract in rivista (266) - Abstract in Rivista]
Abstract

Women with HIV-related lipodystrophy present an impaired GH secretion at the stimulation test with GHRH+Arginine

G. Guaraldi; G. Orlando; N. Squillace; V. Rochira; L. Zirilli; C. Diazzi; G. Caffagni; Antonio Balestrieri; Antonio R.M. Granata; Maria C. De Santis; C. Carani ( 2006 ) - Impaired growth hormone secretion in women with HIV-related lipodystrophy - Abstracts of the 8th International Workshop on Adverse Drug Reactions and Lipodystrophy in HIV - International Medical Press:2-4 Idol Lane, London EC3R 5DD United Kingdom:011 44 207 3980700, EMAIL: imp@intmedpress.com, INTERNET: http://www.intmedpress.com, Fax: 011 44 207 3980701 London GBR) - ANTIVIRAL THERAPY - n. volume 11 (Suppl 3) [Abstract in rivista (266) - Abstract in Rivista]
Abstract

Women with HIV-related lipodystrophy show impaired GH secretion at the stimulation test with GHRH+Arginine

P. Barozzi; R. Bosco; D. Vallerini; L. Potenza; G. Torelli; M. Luppi; F. Facchetti; G. Guaraldi; T.F. Schulz ( 2006 ) - KSHV/HHV-8 infection of tubular epithelial cells in transplantation kidney - TRANSPLANTATION - n. volume 82 (6) - pp. da 851 a 852 ISSN: 0041-1337 [Articolo in rivista (262) - Articolo su rivista]
Abstract

n.d.

G. Guaraldi ( 2006 ) - La sindrome lipodistrofica - Principi di Malattie Infettive - Società Editrice Esculapio Bologna ITA) - pp. da 326 a 332 ISBN: 9788874882724 ISSN: - [Contributo in volume (Capitolo o Saggio) (268) - Capitolo/Saggio]
Abstract

La sindrome lipodistrofica o lipodistrofia (LD) identifica l'insieme delle alterazioni metaboliche e morfologiche che si verificano in corso di infezione da HIV. Descritta per la prima volta nel 1988, ovvero un paio d'anni dopo la disponibilità dei regimi antiretrovirali altamente efficaci (HAART), era stata inizialmente considerata una tossicità associata ai farmaci antiretrovirali. Indubbiamente i farmaci giocano un ruolo catalizzante le manifestazioni cliniche ad essa associate, tuttavia la LD va intesa piuttosto come l'esito di una complessa relazione di eventi genetici, metabolici e immunovirologici in cui i farmaci assumono solo un ruolo scatenante.

M. Floridia; E. Tamburrini; M. Ravizza; C. Tibaldi; M.F. Ravizza Probizer; G. Anzidei; M. Sansone; F. Mori; E. Rubino; M. Meli; S. Dalzero; G. Guaraldi; Italian Group on Surveillance on Antiretroviral Treatment in Pregnancy. ( 2006 ) - Lipid profile during pregnancy in HIV-infected women - HIV CLINICAL TRIALS - n. volume 2006 Jul-Aug;7(4) - pp. da 184 a 193 ISSN: 1528-4336 [Articolo in rivista (262) - Articolo su rivista]
Abstract

Purpose: We investigated the evolution of serum lipid levels in HIV-infected pregnant women and the potential effect of antiretroviral treatment during pregnancy using data from a national surveillance study. Method: Fasting lipid measurements collected during routine care in pregnancy were used, analyzing longitudinal changes and differences in lipid values at each trimester by protease inhibitors (Pls) and stavudine use. Multivariate analyses were used to control for simultaneous factors potentially leading to hyperlipidemia. Study population included 248 women. Results: Lipid values increased progressively and significantly during pregnancy: mean increases between the first and third trimesters were 141.6 mg/dL for triglycerides (p <.001), 60.8 mg/dL for total cholesterol (p <.001), 13.7 mg/dL for HDL cholesterol (p <.001), and 17.8 mg/dL for LDL cholesterol (p =.001). At all trimesters, women on PIs had significantly higher triglyceride values compared to women not on Pis. The effect of Pls on cholesterol levels was less consistent. Stavudine showed a dyslipidemic effect at first trimester only. Multivariate analyses confirmed these observations and suggested a potential role of other cofactors in the development of hyperlipidemia during pregnancy. Conclusion: The changes observed point to the need to further explore the causes and the clinical correlates of hyperlipidemia during pregnancy in women with HIV.

M. Floridia; Guaraldi G.; E. Tamburrini; M. Ravizza; C. Tibaldi; A. Bucceri; G. Anzidei; A. Meloni; A. Vimercati; E. Dalle Nogare; and for The Italian Group on Surveillance on Antiretroviral Treatment in Pregnancy. ( 2006 ) - Lipodistrophy before Pregnancy Is a Protease Inhibitor-independent Predictor of Hypertriglyceridemia during Pregnancy in HIV-infected Pregnant Women - Abstract book - Foundation for Retrovirology and Human Health. Alexandria USA) - n. volume not applicable [Abstract in Atti di convegno (274) - Abstract in Atti di Convegno]
Abstract

Little is known about serum lipid changes during pregnancy in HIV-infected women with a previous history of lipodistrophy (LD).

M. Floridia; G. Guaraldi; E. Tamburrini; C. Tibaldi; A. Bucceri; G. Anzidei; A. Meloni; A. Vimercati; C. Polizzi; E.R. Dalle Nogare; S. Albericoi; M. Ravizza ( 2006 ) - Lipodystrophy is an independent predictor of hypertriglyceridemia during pregnancy in HIV-infected women - AIDS - n. volume 20 (6) - pp. da 944 a 947 ISSN: 0269-9370 [Articolo in rivista (262) - Articolo su rivista]
Abstract

Lipid values were measured during pregnancy in HIV-infected, treatment-experienced women. A previous history of lipodystrophy was associated with significantly higher triglyceride values at all pregnancy trimesters. In multivariate analyses lipodystrophy independently increased the risk of hypertriglyceridemia by threefold at the first trimester, and by eightfold at the second and third trimesters. Protease inhibitor treatment was also independently associated with hypertriglyceridemia.

Di Benedetto F; De Ruvo N; Masetti M; Cautero N; Quintim C; Montalti R; Gerunda GE; Guaraldi G; Tirelli U; Berretta M ( 2006 ) - Liver resection of metastasis by colorectal cancer in a HIV patient - DIGESTIVE AND LIVER DISEASE - n. volume 38 - pp. da 149 a 150 ISSN: 1590-8658 [Articolo in rivista (262) - Articolo su rivista]
Abstract

Liver resection has become the treatment of choice for liver metastasis after colorectal cancer. However, HIV patients have been long denied this chance of cure. The increase in survival of patients with HIV infection is attributed to the use of highly active antiretroviral therapy (HAART). The changes in natural history have prompted the medical community to consider therapeutic strategies including the possibility of major surgery and solid organ transplantation to contrast the clinical picture of end-organ failure or malignancies with a poor prognosis.As results in long-term outcome have not been encouraging, surgeons are not willing to get involved in their management, and both oncologists and infectivologists do not often refer these patients to surgeons. From the advent of HAART to the present, we have treated nine HIV patients of which eight were with major surgery (five orthotopic liver transplants, two liver resections and one head pancreatico-duodenectomy) and one was with a large wound hernia repair.

Orlando G.; Guaraldi G.; Squillace N.; Vandelli M.; De Paola M.; Cardinali L.; Comelli D.; De Santis G.; Pedone A.; Spaggiari A.; Baccarani A.; Pinelli M.; Nardini G.; Beghetto B.; Esposito R. ( 2006 ) - Long lasting psycho-social benefits of polyacrylamide injections for the treatment of facial lipoatrophy - 8th International Workshops on adverse drug reactions and lipodystrophy in HIV - ANTIVIRAL THERAPY - n. volume 11 [Abstract in rivista (266) - Abstract in Rivista]
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.

Squillace N.; Lapadula G.; Orlando G; Nardini G.; Beghetto B.; Torti C.; Guaraldi G. ( 2006 ) - Metabolic and anthropometric alterations in a population of HIV infected patients with a high prevalence of lipodystrophy: associations with HCV coinfection - ANTIVIRAL THERAPY - n. volume 11 [Abstract in rivista (266) - Abstract in Rivista]
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.

G. Guaraldi; G. Orlando; N. Squillace; G. De Santis; A. Pedone; A. Spaggiari; D. De Fazio; M. Vandelli; M. De Paola; C. Bertucelli; C. Aldrovandi; G. Nardini; B. Beghetto; V. Borghi; M. Bertolotti; B. Bagni; M.G. Amorico; A. Roverato; R. Esposito ( 2006 ) - Multidisciplinary approach to the treatment of metabolic and morphologic alterations of HIV-related lipodystrophy - HIV CLINICAL TRIALS - n. volume May-Jun;7(3) - pp. da 97 a 106 ISSN: 1528-4336 [Articolo in rivista (262) - Articolo su rivista]
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.

G. Guaraldi; S. Cocchi; M. Codeluppi; F. Di Benedetto; S. Bonora; A. Motta; K. Luzi; M. Pecorari; W. Gennari; M. Masetti; G.E. Gerunda; R. Esposito ( 2006 ) - Pharmacokinetic interaction between amprenavir/ritonavir and FosAmprenavir on cyclosporine in two patients with human immunodeficiency virus infection undergoing orthotopic liver transplantation - TRANSPLANTATION PROCEEDINGS - n. volume 38(4) - pp. da 1138 a 1140 ISSN: 0041-1345 [Articolo in rivista (262) - Articolo su rivista]
Abstract

The pharmacokinetic interaction between highly active antiretroviral therapy (HAART) and immunosuppressive drugs is a critical element in the management of patients with human immunodeficiency virus infection who undergo orthotopic liver transplantation (OLT). We describe the effect of the coadministration of Amprenavir/Ritonavir (APV/r) and FosAmprenavir (FosAPV) on cyclosporine (CsA) concentrations in two patients receiving OLT for end-stage liver disease due to hepatitis C Virus. Patient 1, who was maintained on 300 mg CsA twice a day with a trough concentration (C-trough) around 250 ng/mL, restarted HAART 12 days after transplantation with 300 mg APV/r twice a day with corresponding APV C-trough of 5293 ng/mL and RTV C-tough of 186 ng/mL. Forty-eight hours after initiation of HAART, C-trogh of CsA was 1200 mg/mL, so it was necessary to reduce the CsA dosage 12-fold (50 mg every day) to achieve a therapeutic effect. In Patient 2, who was maintained on 300 mg CsA twice a day and a corresponding C-trough of 400 ng/mL, HAART was restarted 12 days post-OLT with FosAPV 1400 mg twice a day. After 48 hours C-trough of CsA was around 600 ng/mL and C-trough of FosAPV, 1221 ng/mL. In this case it was necessary to reduce the CsA administration 3.5-fold (175 mg every day). In conclusion, therapeutic drug monitoring was necessary to monitor HAART and CsA post-OLT to prevent toxicity due to both therapies. The use of FosAPV without ritonavir boostering is sufficient to maintain adequate CsA blood concentrations, avoiding any event of toxicity.

Villani P.; Floridia M.; Pirillo M.F.; Cusato M.; Tamburrini E.; Cavaliere A.F.; Guaraldi G.; Vanzini C.; Molinari A.; degli Antoni A.; Regazzi M. ( 2006 ) - Pharmacokinetics of nelfinavir in HIV-1-infected pregnant and nonpregnant women. - Blackwell Science Limited:PO Box 88, Oxford OX2 0NE United Kingdom:011 44 1865 776868, 011 44 1865 206038, EMAIL: journals.cs@blacksci.co.uk, INTERNET: http://www.blackwell-science.com, Fax: 011 44 1865 721205 ) - BRITISH JOURNAL OF CLINICAL PHARMACOLOGY - n. volume 62(3) - pp. da 309 a 315 ISSN: 0306-5251 [Articolo in rivista (262) - Articolo su rivista]
Abstract

To compare steady-state nelfinavir (NFV) pharmacokinetics in pregnant and nonpregnant HIV-infected women. METHODS: Twenty-five pregnant HIV-infected women were selected from an ongoing observational study evaluating the pharmacokinetics of antiretroviral agents during pregnancy. Twenty of them were in the third and five in the second trimester. Data for the control group of 21 HIV-infected nonpregnant women were taken from a previous multicentre pharmacokinetic trial. All the participating women achieved steady-state plasma concentrations while on a highly active antiretroviral therapy (HAART) regimen including NFV (1250 mg bid) and two nucleoside reverse transcriptase inhibitors (NRTIs). Blood samples for NFV measurement were collected predose (C(trough)) and at 0.5, 1, 2, 3, 4, 5, 6, 8 and 12 h post dose. RESULTS: During the third trimester of pregnancy NFV AUC(0-12 h) median (range) values were 25.76 (12.61-42.74) microg h(-1) ml(-1), and were 32.49 (19.16-63.81) microg h(-1) ml(-1) in the control group [mean difference - 9.30 microg h(-1) ml(-1); 95% confidence interval (CI) -15.76, -2.83; P < 0.05). Median oral clearance (CL/F) was significantly higher in pregnant women than in the control group (48.5 l h(-1), range 29.3-99.1 l h(-1) vs. 38.5 l h(-1), range 19.6-65.2 l h(-1); mean difference 12.6 l h(-1); 95% CI 3.3, 21.9) but the difference disappeared when CL/F was adjusted for body weight. C(trough) was significantly (P < 0.01) lower in pregnant compared with nonpregnant women (median 0.8 microg ml(-1), range 0-2.6 microg ml(-1) vs. 1.5 microg ml(-1), range 0.5-4.9 microg ml(-1); mean difference -1.0 microg ml(-1); 95% CI -1.7, -0.31). The median elimination half-life of NFV observed during pregnancy was 3.7 h (range 1.4-6.6 h), compared with 5.2 (range 3.1-10.1 h) in the control group (mean difference -1.7; 95% CI -2.8, -0.51). CONCLUSIONS: Our results indicate that women in the later stages of pregnancy may be exposed to subtherapeutic concentrations of NFV. Thus, adjustments in drug dosage or frequency of administration may be required.

M. Codeluppi; S. Cocchi; G. Guaraldi; F. Di Benedetto; N. De Ruvo; M. Meacci; B. Meccugni; R. Esposito; G.E. Gerunda ( 2006 ) - Posttransplant Mycobacterium tuberculosis disease following liver transplantation and the need for cautious evaluation of quantiferon TB GOLD results in the transplant setting: A case report - TRANSPLANTATION PROCEEDINGS - n. volume 38 (4) - pp. da 1083 a 1085 ISSN: 0041-1345 [Articolo in rivista (262) - Articolo su rivista]
Abstract

This report describes a case of pulmonary tuberculosis in a liver transplant patient without a history of previous exposure to Mycobacterium tuberculosis (MTB) complex. Prior to transplantation, the tuberculin skin test was negative and the QuantiFERON-TB Gold (QFT Gold), an, interferon gamma-based blood test, was negative before and after transplant including a period beginning on postoperative day 55 when the patient developed a febrile illness with an interstitial infiltrate and pleural effusion that was unresponsive to broad-spectrum antibiotic therapy. Empiric treatment with isoniazid, ethambutol, and levofloxacin resulted in resolution of the clinical symptoms. A sputum culture grew MTB on postoperative day 87. This case illustrates the need for caution when QFT Gold is used as diagnostic tool for latent tuberculosis during the pretransplant assessment. Further studies evaluating the usefulness of QFT Gold and other interferon gamma tests in posttransplantation active infection are warranted.

Guaraldi G.; Orlando G.; Squillace N.; Roverato A.; De Fazio D.; Vandelli M.; Nardini G.; Beghetto B.; De Paola M.; Esposito R. ( 2006 ) - Prevalence and risk factors of pubic lipomas in HIV-infected patients - ANTIVIRAL THERAPY - n. volume 11 [Abstract in rivista (266) - Abstract in Rivista]
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.

G. Guaraldi; G. Orlando; N. Squillace; V. Rochira; B. Madeo; L. Zirilli; C. Diazzi; G. Caffagni; Enrica Baraldi; C. Carani; R. Esposito; Pablo Tebas ( 2006 ) - Prevalence of secondary causes of osteoporosis among HIV infected individuals - Abstracts of the 8th International Workshop on Adverse Drug Reactions and Lipodystrophy in HIV - International Medical Press:2-4 Idol Lane, London EC3R 5DD United Kingdom:011 44 207 3980700, EMAIL: imp@intmedpress.com, INTERNET: http://www.intmedpress.com, Fax: 011 44 207 3980701 London GBR) - ANTIVIRAL THERAPY - n. volume 11 (Suppl 3) [Abstract in rivista (266) - Abstract in Rivista]
Abstract

Although osteopenia/osteoporosis is very frequent among HIV infected individuals. Vitamin D deficiency is frequent in this Italian population and might be a contrib- utor to this problem.

G. Guaraldi ( 2006 ) - Programma Nazionale di Ricerca sull’AIDS: “Ricerca Clinica e terapia della malattia da HIV: Azione concertata nei paesi in via di sviluppo. Uno studio multicentrico di accettabilità e fattibilità di differenti strategie preventive della trasmissione postpartum di HIV in 6 paesi dell’Africa sub-sahariana.” [Altro (298) - Partecipazione a progetti di ricerca]
Abstract

G. Guaraldi ( 2006 ) - Programma Nazionale di Ricerca sull’AIDS: “Ricerca Clinica e terapia della malattia da HIV: Azione concertata per lo studio degli effetti indesiderati della terapia antiretrovirale.” [Altro (298) - Partecipazione a progetti di ricerca]
Abstract

G. Guaraldi; G. Orlando; R. Murri; M. Vandelli; M. De Paola; B. Beghetto; G. Nardini; S. Ciaffi; F. Vichi; Esposito; A.W. Wu ( 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 - QUALITY OF LIFE RESEARCH - n. volume Feb 15(1) - pp. da 173 a 178 ISSN: 0962-9343 [Articolo in rivista (262) - Articolo su rivista]
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.

Bedini A.; Borghi R.; Guaraldi G.; Venturelli C.; Mussini C.; Baldini T.; Codeluppi M.; Prati F.; Cocchi S.; Rumpianesi F.; Esposito R. ( 2006 ) - Sthapylococcus aureus Bacteremia: Incidence, survival and antimicrobial susceptibility patterns of the isoltes - Abstracts - American society of microbiology Washington USA) - n. volume not applicable [Abstract in Atti di convegno (274) - Abstract in Atti di Convegno]
Abstract

S. aureus bacteriemia is a common cause of nosocomial infection and contributes significantly to morbidity and mortality in critically ill patients. During the past two decades, the frequency of methicillin-resistant S. aureus infections has dramatically increased, particularly in patients admitted in emergency wards.

G. Guaraldi; G. Orlando; A. Roverato; G. De Santis; A. Pedone; A. Spaggiari; A. Baccarani; D. De Fazio; M. Vandelli; C. Bertucelli; B. Beghetto; G. Nardini; V. Borghi; C. Grisendi; M. Bertolotti; F. Carubbi; I. Zini; R. Esposito ( 2006 ) - Tenofovir treatment in HIV-related lipodystrophy syndrome. Retrospective observational forty-eight weeks follow-up study - TRENDS IN MEDICINE - n. volume 6 - pp. da 77 a 85 ISSN: 1594-2848 [Articolo in rivista (262) - Articolo su rivista]
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

C. Casolari; G. Guaraldi; M. Pecorari; G. Tamassia; C. Cappi; G. Fabio; A.M. Cesinaro; R. Piolini; F. Rumpianesi; L. Presutti ( 2005 ) - A rare case of localized mucosal leishmaniasis due to Leishmania infantum in an immunocompetent Italian host - EUROPEAN JOURNAL OF EPIDEMIOLOGY - n. volume 20 (6) - pp. da 559 a 561 ISSN: 0393-2990 [Articolo in rivista (262) - Articolo su rivista]
Abstract

The case of authoctonous isolated laryngeal leishmaniasis due to L. infantum in an italian immunocompetent host is reported. It is highlighed the need to consider mucosal leishmaniasis in the differential diagnosis of laryngeal tumors. Rapid nested-PCR technique and enzyme restriction analysis were useful for diagnosis and species identification directly from bioptic samples.

L.Galluzzi; M. Pinti; G. Guaraldi; C. Mussini; L. Troiano; E. Roat; C. Giovenzana; E. Nemes; M. Nasi; G. Orlando; P. Salomoni; A. Cossarizza ( 2005 ) - Altered mithocondrial RNA production in adipocytes from HIV-infected individuals with lipodystrophy - ANTIVIRAL THERAPY - n. volume 10 (2) [Abstract in rivista (266) - Abstract in Rivista]
Abstract

Damage to mitochondria (mt) is a major side effect of highly active antiretroviral therapy (HAART) tha includes a nucleoside reverse transcriptase inhibitor (NRTI).Such damage is associated with the onset of lipodystrophy in HAART-treated HIV+ patients. To further investigate mt changes during this syndrome, we analysed the expression of mtRNA in adipocytes from lipodystrophic HIV+ patients taking NRTI-containing HAART and compared it with similar cells from healthy individuals.

Galluzzi L;Pinti M;Guaraldi G;Mussini C;Troiano L;Roat E;Giovenzana C;Nemes E;Nasi M;Orlando G;Salomoni P;Cossarizza A ( 2005 ) - Altered mitochondrial RNA production in adipocytes from HIV-infected individuals with lipodystrophy - Antiviral therapy - ANTIVIRAL THERAPY - n. volume 10 suppl2 [Articolo in rivista (262) - Articolo su rivista]
Abstract

Background: Damage to mitochondria (mt) is a major side effect of highly active antiretroviral therapy (HAART) that includes a nucleoside reverse transcriptase inhibitor (NRTI). Such damage is associated with the onset of lipodystrophy in HAART-treated HIV+ patients. To further investigate mt changes during this syndrome, we analysed the expression of mtRNA in adipocytes from lipodystrophic HIV+ patients taking NIRTI-containing HAART and compared it with similar cells from healthy individuals. Materials and methods: Total RNA was extracted from adipocytes collected from different anatomical locations of 11 HIV+ lipodystrophic patients and seven healthy control individuals. RNA was reverse transcribed and Taqman-based real-time PCR was used to quantify three different mt transcripts (ND1, CYTB and ND6 gene products). mtRNA content was normalized versus the housekeeping transcript L13. Results: ND1, CYTB and ND6 expression was significantly reduced in HIV+ lipodystrophic patients. HIV+ men and women did not differ in a statistically significant way regarding the levels of ND1 and ND6, whereas the opposite occurred for CYTB. Conclusions: Lipodystrophy following treatment with NRTI-containing HAART is associated with a decrease in adipose tissue mtRNAs.

Guaraldi G.; Orlando G.; De Fazio D.; Rottino A.; Grisotti A.; Blini M.; Borghi V.; Nardini G.; Esposito R. ( 2005 ) - Autologous fat transfer for the treatment of HIV-related face lipoatrophy: 1-year follow-up - ANTIVIRAL THERAPY - n. volume 10(8) [Abstract in rivista (266) - Abstract in Rivista]
Abstract

The aim of this study was to analyse the long-term subjective efficacy and durability of autologous fat transfer for the treatment of HIV-related facial atrophy in a sample of people reaching 48 to 96 weeks of follow up.

Mussini, Cristina; Bedini, Andrea; V., Borghi; Guaraldi, Giovanni; Esposito, Roberto; E., Barchi; R., Emilia; A., Cozzi Lepri; A. N., Phillips; P., Ortolani; Cossarizza, Andrea; G., Bratt; L. E., Eriksson; L., Sighinolfi; A. D., Monforte; A., De Luca; S., Di Giambenedetto; A., Antinori ( 2005 ) - CD4 cell-monitored treatment interruption in patients with a CD4 cell count > 500 x 10(6) cells/I - AIDS (London, England) - AIDS - n. volume 19(3) - pp. da 287 a 294 ISSN: 0269-9370 [Articolo in rivista (262) - Articolo su rivista]
Abstract

Background: Little is known about CD4 cell count changes in patients with high CD4 cell counts who interrupt antiretroviral therapy, especially in those with a nadir of 250350 x 10(6) cells/I. Methods: Data derived from 139 patients from seven prospective cohorts who had > 12 months highly active antiretroviral therapy (HAART), CD4 cell count nadir of > 250 x 10(6) cells/I and at pre-interruption of > 500 x 106 cells/I. Endpoint was time to CD4 cell count < 350 x 10(6) cells/I or reinitiation of treatment. Results: At interruption, the median CD4 cell count was 800 x 106 cells/I, median viral load was 1.7 log(10) copies/ml. At the time of analysis, 63 (45.3%) had resumed therapy or experienced < 350 x 10(6) cells/I CD4 cells over a median interruption of 75 weeks. Of these, 33 (52.4%) experienced a decline to < 350 x 10(6) cells/I and 30 (47.6%) restarted therapy before their CD4 cell count had fallen below this level. In 43 patients with CD4 cell nadir of 251-350 x 10(6) cells/I, median time to therapy resumption or CD4 cell count < 350 x 10(6) cells/I was 61 weeks. Higher CD4 cell count nadir, longer duration of viral load suppression on therapy, and higher viral load level at interruption were independently associated with longer time to restart therapy. The risk of clinical events was 5 per 1000 person-years of follow-up. Conclusions: Patients who started therapy with CD4 cell count of 250-350 x 10(6) cells/I and who later interrupted therapy appear able to remain off therapy with a CD4 cell count > 350 x 10(6) cells/I for a substantial period of time.

Giannotti N.; Mondino V.; Rossi M.C.; Chiesa E.; Mezzaroma I.; Ladisa N.; Guaraldi G.; Torti C.; Fanconi Di Francesco L.; Castelli P.; Di Carlo A.; Boeri E.; Keulen W.; Mc Kenna P.; Lazzarin A. ( 2005 ) - Comparison of a rule-based with a phenotype-based algorithm for interpretation of HIV-genotype in guiding salvage regimens in HIV-infected, failing patients, by a randomized clinical trial - Abstract book - EACS Dublino IRL) - n. volume not applicable [Abstract in Atti di convegno (274) - Abstract in Atti di Convegno]
Abstract

To compare the efficacy of two algorithms of interpretation of HIV-genotype in guiding salvage regimens, without the assistance of experts.

G. Guaraldi; G. Orlando; D. De Fazio; I. De Lorenzi; A. Rottino; G. De Santis; A. Pedone; A. Spaggiari; A. Baccarani; V. Borghi; R. Esposito ( 2005 ) - Comparison of three different interventions for the correction of HIV-associated facial lipoatrophy: a prospective study - ANTIVIRAL THERAPY - n. volume 10 (6) - pp. da 753 a 759 ISSN: 1359-6535 [Articolo in rivista (262) - Articolo su rivista]
Abstract

Objective: To compare autologous fat transfer (AFT), injections of reabsorbable [polylactic acid (PLA)] and non-reabsorbable [polyacrylamide hydrogel (PAAG)] filler materials for the treatment of HIV-related facial lipoatrophy. Design and methods: Eligible individuals with enough residual subcutaneous fat in the abdomen or in the dorso-cervical region were offered AFT surgery. Other individuals were blindly assigned to two different surgical teams, who administered a set of PLA or PAAG injections every 4 weeks. The primary endpoint was the measurement of Bichat's fat pad region, determined by the result of dermal plus subcutaneous thickness. Secondary endpoints included body image evaluation (determined by ABCD questionnaire), facial aesthetic satisfaction (determined by Visual Analogue Scale), and aesthetic pre- and post-picture comparisons by independent reviewers. All variables were measured at baseline and at 24 weeks after the last treatment session. Results: Twenty-four individuals received AFT and 35 were selectively randomized to PLA (20) or PAAG (15) infiltrations. PLA and Ill groups received a mean of 5 and 6 injections respectively (P=NS). The mean change in dermal and subcutaneous thickness was 3.3 +/- 4.1 mm, 3.5 +/- 4.0 mm; 2.1 +/- 3.0 mm (P=0.687), respectively. The mean change in ABCD score result was poorer in the AFT arm, but there were no other differences in other measured factors. Four serious adverse events were documented in the AFT arm only. Conclusions: All three interventional techniques were highly effective in improving the aesthetic satisfaction of the patients. Longer follow-up is necessary to determine the most durable and suitable treatment.

Giannotti N.; Mondino V.; Rossi M.C.; Chiesa E.; Mezzaroma I.; Ladisa N.; Guaraldi G.; Torti C.; Falconi Di Francesco L.; Castelli P.; Di Carlo A.; Boeri E.; Keulen W.; Mc Kenna P.; Lazzarin A. ( 2005 ) - Confronto randomizzato fra un algoritmo d’interpretazione del genotipo di HIV basato sulle regole e uno basato sul fenotipo nel guidare una terapia di salvataggio - GIORNALE ITALIANO DI MALATTIE INFETTIVE - n. volume 1 suppl.1 [Abstract in rivista (266) - Abstract in Rivista]
Abstract

In 41 centri italiani, 318 paz. con infezione da HIV e HIV-RNA > 1000 copie/ml in corso di HAART, sono stati randomizzati a modificare la HAART in base al risultato del test di resistenza genotipico interpretato mediante VirtualPhenotypeTM e l'algoritmo basato sulle regole RetroGramTM.

Luzi K.; Guaraldi G.; Malmusi D.; De Paola M.; Vandelli M.; Martinez E.; De Lazzari E.; Granata A.; Blanco J.L.; Orlando G.; Murri R.; Gatell J.M. ( 2005 ) - Disfunzioni sessuali in maschi HIV: prevalenza e fattori associati - GIORNALE ITALIANO DI MALATTIE INFETTIVE - n. volume 1 Suppl 1 [Abstract in rivista (266) - Abstract in Rivista]
Abstract

Valutare prevalenza e fattori di rischio delle disfunzioni sessuali in maschi HIV positivi.

C. Mussini; M. Pinti; R. Bugarini; V. Borghi; M. Nasi; E. Nemes; L. Troiano; G. Guaraldi; A. Bedini; C. Sabin; R. Esposito; A. Cossarizza ( 2005 ) - Effect of treatment interruption monitored by CD4 cell count on mitochondrial DNA content in HIV-infected patients: a prospective study - AIDS (London, England) - AIDS - n. volume 19 (15) - pp. da 1627 a 1633 ISSN: 0269-9370 [Articolo in rivista (262) - Articolo su rivista]
Abstract

Background: HIV infection per se and HAART can alter mitochondrial functionality, leading to a decrease in mitochondrial DNA content. Objective: To evaluate whether treatment interruption monitored by CD4 cell count can restore mitochondrial DNA content in peripheral blood lymphocytes. Methods: Mitochondrial DNA content was measured in platelet-free CD4 and CD8 T cells by real-time polymerase chain reaction; flow cytometry was used to identify and quantify activated CD4 and CD8 T lymphocytes. Results: The 30 patients had been treated for a mean of 107 months (range, 27-197). Median CD4 cell count at discontinuation was 702 cells/mu l (range, 547-798). Median observational time from HAART discontinuation was 11.3 months (range, 4-26). Discontinuation of treatment provoked significant increases in mitochondrial DNA in CD8 T cells, which started only 6 months after therapy cliscontinuation [5.12 copies/ cell per month from 0 to 6 months (P = 0.3 7) and 2 6.96 copies/cel I per month from 6 to 12 months (P < 0.0001)]. Conclusions: This study is the first showing that mitochondrial DNA content can increase in peripheral blood lymphocytes during treatment interruption, but only after at least 6 months of interruption. Consequently, interruptions of shorter periods, whether by clinician or patient decision, are unlikely to allow restoration of mitochondrial DNA and so decrease HAART-related toxicity.

Orlando G.; Guaraldi G.; Pedone A.; Spaggiari A.; Baccarani A.; Borghi V.; Nardini G.; Beghetto B.; Cappi C.; De Santis G. ( 2005 ) - Effectiveness and durability of polyacrylamide hydrogel injections for treating HIV-related facial lipoatrophy - ANTIVIRAL THERAPY - n. volume 10(8) [Abstract in rivista (266) - Abstract in Rivista]
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.

Cocchi S.; Codeluppi M.; Guaraldi G.; Di Benedetto F.; Venturelli C.; Masetti M.; Esposito R.; Gerunda G.E. ( 2005 ) - Efficacia di voriconazolo nel trattamento dell’infezione disseminata da Fusarium verticilloides in una paziente sottoposta a ritrapianto di fegato - GIORNALE ITALIANO DI MALATTIE INFETTIVE - n. volume 1 Suppl 1 [Abstract in rivista (266) - Abstract in Rivista]
Abstract

Fusarium species sono responsabili di severe infezioni fungine in pazienti affetti da patologie onco-ematologiche e sottoposti a trapianto di midollo. Tuttavia, solo di rado tali infezioni sono state riportate in altre condizioni di immunodepressione. Descriviamo il caso di una fusariosi disseminata in una paziente sottoposta a ritrapianto di fegato, con revisione dei casi di infezione da Fusarium spp. in soggetti trapiantati di organo solido.

Orlando G.; Guaraldi G.; Cavuto S.; Borghi V.; Nardini G.; Beghetto B.; Cappi C.; Esposito R. ( 2005 ) - Efficacy and safety of medical and surgical interventions for treating HIV-related lipodystrophy in women - ANTIVIRAL THERAPY - n. volume 10(8) [Abstract in rivista (266) - Abstract in Rivista]
Abstract

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

Guaraldi G.; De Fazio D.; Orlando G.; Murri R.; Wu A.; Guaraldi P.; Esposito R. ( 2005 ) - Facial lipohypertrophy in HIV-infected subjects who underwent autologous fat tissue transplantation. - CLINICAL INFECTIOUS DISEASES - n. volume 40(2) - pp. da 13 a 15 ISSN: 1058-4838 [Articolo in rivista (262) - Articolo su rivista]
Abstract

Of 41 HIV-infected patients with facial lipoatrophy who underwent autologous fat transplantation, disfiguring facial lipohypertrophy at the graft site occurred at the same time as recurrent fat accumulation at the tissue harvest site in 4 patients who had had fat transferred from the dorsocervical fat pad or from subcutaneous abdominal tissue.

Ferrari A.; Luppi M.; Potenza L.; Riva G.; Morselli M.; Imovilli A.; Volzone F.; Rossi G.; Codeluppi M.; Guaraldi G.; Torelli G. ( 2005 ) - Herpes simplex virus pneumonia during standard induction chemotherapy for acute leukemia: case report and review of literature. - LEUKEMIA - n. volume 19(11) - pp. da 2019 a 2021 ISSN: 0887-6924 [Articolo in rivista (262) - Articolo su rivista]
Abstract

Reactivation of latent HSV is the most common viral infection in patients during the profound neutropenia that occurs during remission induction in patients with lymphoma and acute leukemia and during the conditioning phase of bone marrow transplantation. We report here the occurrence of HSV-1 pneumonia in a patient with B-cell common ALL.

Floridia M.; Tamburrini E.; Ravizza M.; Tibaldi C.; Ravagni Probizer M.F.; Anzidei G.; Sansone M.; Mori F.; Rubino E.; Meli M.; Dalzero S.; Guaraldi G. ( 2005 ) - Impact of antiretroviral treatment on lipid profile during pregnancy in HIV-infected women - Abstract book - EACS Dublino IRL) - n. volume not applicable [Abstract in Atti di convegno (274) - Abstract in Atti di Convegno]
Abstract

To define serum lipid changes in HIV-infected pregnant women undergoing antiretroviral treatment, clarifyning the independent effects of pregnancy, HIV infection and antiretroviral tratment on cholesterol and triglycerides values.

S. Cocchi; M. Codeluppi; G. Guaraldi; N. Squillace; A. Bedini; C. Venturelli; R. Esposito ( 2005 ) - Invasive pulmonary and cerebral aspergillosis in a patient with Weil's disease - SCANDINAVIAN JOURNAL OF INFECTIOUS DISEASES - n. volume 37 (5) - pp. da 396 a 398 ISSN: 0036-5548 [Articolo in rivista (262) - Articolo su rivista]
Abstract

We describe the successful medical treatment of invasive aspergillosis in a patient suffering from Weil's disease with a combined therapy based on amphotericin B lipid complex and voriconazole

Vichi F.; Dini M.; Guaraldi G.; De Fazio D.; Di Pietro M.; Lo Caputo S.; Mori A.; Mazzotta F. ( 2005 ) - La chirurgia plastica nel trattamento della lipodistrofia in pazienti in HAART - Libro riassunti - ANLAIDS Roma ITA) - n. volume not applicable - pp. da 140 a 140 ISBN: not available ISSN: - [Abstract in Atti di convegno (274) - Abstract in Atti di Convegno]
Abstract

La lipodistrofia correlata alla terapia anti HIV ha nel trattamento chirurgico l'unico intervento significativo. 48 pazienti HIV positivi in terapia HAART seguiti presso il nostro centro sono stati valutati dal chirurgo plastico nel periodo febbraio 2004/giugno 2005.

Vichi F.; Dini M.; Guaraldi G.; De Fazio D.; Di Pietro M.; Lo Caputo S.; Mori A.; Mazzotta F. ( 2005 ) - La chirurgia plastica nel trattamento della lipodistrofia: outcome di maggiore produttività sociale - GIORNALE ITALIANO DI MALATTIE INFETTIVE - n. volume Vol1 Suppl 1 [Abstract in rivista (266) - Abstract in Rivista]
Abstract

48 pazienti HIV positivi in terapia HAART seguiti presso il nostro centro sono stati valutati dal chirurgo plastico nel periodo febbraio 2004/giugno2005.

G. Guaraldi; S. Cocchi; M. Codeluppi; F. Di Benedetto; N. De Ruvo; M. Masetti; C. Venturelli; M. Pecorari; A.D. Pinna; R. Esposito ( 2005 ) - Outcome, incidence, and timing of infectious complications in small bowel and multivisceral organ transplantation patients - TRANSPLANTATION - n. volume 80 (12) - pp. da 1742 a 1748 ISSN: 0041-1337 [Articolo in rivista (262) - Articolo su rivista]
Abstract

Background. Infectious complications still represent a major cause of morbidity and mortality in patients with organ transplantation. In particular, small bowel or multivisceral transplantation is complicated to a greater extent than other grafts as a consequence of infectious complications including sepsis. Methods. This prospective study assessed outcome, incidence, and timing of infections in sequential patients undergoing small bowel or multivisceral transplantation (SB/MVTx) performed at a university transplant center between January 2001 and October 2003. Nineteen patients underwent transplantation during this period, 13 of whom (68%) undergoing isolated SB and 6 (32%) MV grafts with or without liver. Results. The median follow up was 524 days (interquartile range=252-730) with an overall 24.4 person/year of observation. Postoperative mortality rate was 0.1 death/person/year; all patients, except one who died intraoperatively, were alive 6 months postsurgery. There were 100 documented infections including: 59 bacterial (2.4 events/person/year), 35 viral (1.4 events/person/year) and 6 fungal (0.2 events/person/year). Patients developed at least one episode of bacterial infection in 94% of the cases, viral infection in 67%, and fungal infection in 28%. Conclusions. This cohort describes the very common and complex nature of infectious complications in this challenging group of transplantation patients. Larger cohorts are needed to specifically address infection risk factors and longer term outcomes.

Guaraldi G.; Orlando G.; Vandelli M.; De Paola M.; Comelli D.; De Santis G.; Pedone A.; Spaggiari A.; Baccarani A.; Pinelli M.; De Fazio D.; Blini M.; Borghi V.; Nardini G.; Beghetto B.; Esposito R. ( 2005 ) - Psychometric evaluation in patients undergoing fillers injections for the treatment of HIV-related facial lipoatrophy: polylactic acid versus polyacrylamide - ANTIVIRAL THERAPY - n. volume 10(8) [Abstract in rivista (266) - Abstract in Rivista]
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.

M. Codeluppi; S. Cocchi; G. Guaraldi; F. Di Benedetto; A. Bagni; M. Pecorari; W. Gennari; A.D. Pinna; G.E. Gerunda; R. Esposito ( 2005 ) - Rituximab as treatment of posttransplant lymphoproliferative disorder in patients who underwent small bowel/multivisceral transplantation: Report of three cases - TRANSPLANTATION PROCEEDINGS - n. volume 37 (6) - pp. da 2634 a 2635 ISSN: 0041-1345 [Articolo in rivista (262) - Articolo su rivista]
Abstract

This report describes three cases of posttransplant lymphoproliferative disorder (PTLD) in multivisceral/small bowel transplant patients treated with rituximab (anti-CD20 monoclonal antibodies). In two cases (one of which was a B-cell lymphoma) a good response to therapy was achieved. A third case (with polymorphic PTLD with low CD20 expression) developed a refractory rejection and PTLD was still documented on graftectomy. Rituximab was well tolerated, and a reduction of Epstein-Barr virus (EBV) viral load was documented by quantitive competitive-EBV polymerase chain reaction. Efficacy of therapy needs to be assessed in controlled studies.

G. Guaraldi; S. Cocchi; M. Codeluppi; F. Di Benedetto; S. Bonora; M. Pecorari; W. Gennari; N. Cautero; A.D. Pinna; G.E. Gerunda; R. Esposito ( 2005 ) - Role of therapeutic drug monitoring in a patient with human immunodeficiency virus infection and end-stage liver disease undergoing orthotopic liver transplantation - TRANSPLANTATION PROCEEDINGS - n. volume 37 (6) - pp. da 2609 a 2610 ISSN: 0041-1345 [Articolo in rivista (262) - Articolo su rivista]
Abstract

Pharmacological interactions between protease inhibitors and tacrolimus require careful monitoring to prevent toxicity in the posttransplantation period. A 42-year-old man with human immunodeficiency virus (HIV) infection and end-stage liver disease due to hepatitis C virus (HCV) received an orthotopic liver transplant. At the time of surgery the patient was on triple antiretroviral therapy (tenofovir, lamivudine, and lopinavir/ritonavir) with a stable CD4+ count (> 500 celIS/mm(3)) and HIV-1 RNA (< 50 copies/mL). Immunosuppression was maintained with tacrolimus (0.5 mg at a single dose once per week). One month after surgery HCV recurrence was documented. Pharmacokinetic evaluation of lopinavir/ritonavir showed a rapid increase in the area under the curve. Drug concentrations returned to normal levels, with reduction in liver enzymes. At the same time, tacrolimus dosages were reduced to a maintenance dose of 0.5 mg every 2 weeks. The patient, at 17 months postoperatively, is alive in good health with normal liver function and HCV RNA load levels. This is the first case in which a profound change in the pharmacokinetics of a protease inhibitor caused by a drug-drug interaction was observed during transient liver damage. Because this clinical event is particularly common in HIV-infected patients, our findings suggest that therapeutic drug monitoring should be performed to determine the impact of potential drug interactions in the early posttransplantation period, at the time of resumption of therapy or introduction of new antiretroviral therapy and during HCV recurrence in order to optimize both tacrolimus and protease inhibitor treatment.

Malmusi D.; Guaraldi G.; Martinez E.; de Lazzari E.; Luzi K.; Granata A.; Blanco J.L.; Orlando G.; Murri R.; Gatell J.M. ( 2005 ) - Sexual dysfunction in HIV-infected men: prevalence and associated factors - ANTIVIRAL THERAPY - n. volume 10(8) [Abstract in rivista (266) - Abstract in Rivista]
Abstract

In the HAART era, few clinical studies evaluated prevalence and risk factors of sexual dysfunctions (SD) in HIV-positive men. SD prevalence has been described in up to 74% of this population, but no standardised and validated methods for detection of SD have ever been used. Protease inhibitors and hypogonadism have been inconsistently associated with SD. This is a cross-sectional study to evaluate the prevalence and risk factors of sexual dysfunctions in HIV-infected men.

Ciuffedra D.; Rizzardi G.P.; Tassan-Din C.; Travi G.; Guaraldi G.; Lazzarin A.; Pantaleo G.; Tambussi G. ( 2005 ) - Single supervised treatment interruption coupled with mycophenolate mofetil therapy induces control of HIV-1 RNA replication in patients treated with ART since primary HIV-1 Infection - Program & abstracts - Foundation for Retrovirology and Human Health Alexandria, VA USA) - n. volume not applicable [Abstract in Atti di convegno (274) - Abstract in Atti di Convegno]
Abstract

Mycophenolate mofetil (MMF) reduces the pool of dividing and activated CD4+Tcells contributing to control virus load. A single supervised treatment interruption coupled with MMF might highly reduce the overall need of ART

M. DOMINICI; L. CAFFARELLI; G.GUARALDI; S.KORDOWICH; R.STERNIERI; D. CAMPIONI; P.PAOLUCCI; G.CERVO; C.SPANO; I.MARIOTTI; T. HOFMAN; E.HORWITZ; P.CONTE ( 2005 ) - SMALL VOLUMES OF SUBCUTANEOUS ADIPOSE TISSUE AS SOURCE OF ADULT MESENCHIMAL STEM CELLS FOR REGENERATIVE MEDICINE AND CANCER CELL-THERAPIES - CYTOTHERAPY - CYTOTHERAPY - n. volume 7 - pp. da 165 a 165 ISSN: 1465-3249 [Abstract in rivista (266) - Abstract in Rivista]
Abstract

THE POSSIBILITY OF GENERATING MESENCHIMAL STEM CELLS FROM SMALL VOLUMES OF ADIPOSE TISSUE OPENS NEW PERSPECTIVES TO CLINICAL APPLICATIONS OF REGENERATIVE MEDICINE AND CANCER CELL-THERAPIES

Guaraldi G ( 2005 ) - Solidarietà contro l'AIDS nei Paesi in via di sviluppo" - Esther [Altro (298) - Partecipazione a progetti di ricerca]
Abstract

Codeluppi M.; Cocchi S.; Guaraldi G.; Di Benedetto F.; Meacci M.; Mecugni B.; Esposito R.; Gerunda G.E. ( 2005 ) - Un caso di tubercolosi post-trapianto ortotopico di fegato: limiti dell’impiego del quantiferon-TB gold nella diagnosi della infezione tubercolare latente ed attiva - GIORNALE ITALIANO DI MALATTIE INFETTIVE - n. volume 1 Suppl 1 [Abstract in rivista (266) - Abstract in Rivista]
Abstract

Il QuantiFERON-TB Gold è entrato recentemente in uso per la diagnosi dell'infezione tubercolare latente. Essi rileva la risposta di g interferon a due diversi antigeni tubercolari (ESAT6 e CFO10). La sua efficacia è sata considerata almeno paragonabile a quella del test cutaneo, ma nella diagnosi di infezione latente ed attiva in condizioni di immunodepressione non è mai stata estesamente studiata.

G. Guaraldi; G. Orlando; G. Madeddu; F. Vescini; P. Ventura; S. Campostrini; M.S. Mura; N. Parise; R. Caudarella; R. Esposito ( 2004 ) - Alendronate reduces bone resorption in HIV-associated osteopenia/osteoporosis - HIV CLINICAL TRIALS - n. volume 5 (5) - pp. da 269 a 277 ISSN: 1528-4336 [Articolo in rivista (262) - Articolo su rivista]
Abstract

Purpose: To evaluate the effects of alendronate, vitamin D, and calcium supplementation on bone metabolism and bone mineral density (BMD) in both HIV-infected men and women treated with highly active antiretroviral therapy (HAART). Method: We performed a 52-week prospective, multicenter, randomized, open-label clinical trial. Eligible participants were on stable HAART and had BMD values at the femoral neck or lumbar spine that corresponded to a t score less than -1. Patients were randomized to receive alendronate 70 mg weekly or no alendronate; calcium 1000 mg daily and vitamin D 500 IU daily were provided to all study recipients. Primary endpoint of the study was the change in bone metabolism evaluated by N-telopeptide of type 1 collagen and bone-specific alkaline phosphatase; the secondary endpoint was BMD variation. Results: 18 patients were randomized to the alendronate and 23 to the no-alendronate group (controls). The alendronate-treatment group compared to controls had a significant decrease in serum N-telopeptides, 1914 +/- 1433.4 vs. 3967 +/- 1650.5 pM/L (p = .005) after 1 year. Lumbar spine BMD increased by 4% in the alendronate group (p = .004) vs. 3.7% (p = .062) in controls, compared to baseline values. Femoral neck BMD decreased by 0.5% in the alendronate group (p = .05) and by 3.5% in the control group (p = .04). No between-groups differences for BMD were found (Delta lumbar-BMD 0.0351 +/- 0.0406 in cases and 0.0356 +/- 0.073 in controls [p = .9771, Delta femoral-BMD -0.085 +/- 0.160 in cases and -0.100 +/- 0.165 in controls [p = .795]). Conclusion: Alendronate plus vitamin D and calcium was effective in reducing bone resorption. Alendronate improved lumbar BMD and minimized femoral BMD decrease after 52 weeks compared to treatment with vitamin D and calcium alone in patients on HAART with osteopenia/osteoporosis.

Guaraldi G.; Orlando G.; Maddeddu G.; Vescini F.; Ventura P.; Campostrini S.; Corradini E.; Parise N.; Solinas P.; Calia G.M.; Mura M.S.; Nardini G.; Beghetto B.; Caudarella R.; Esposito R. ( 2004 ) - Alendronate reduces bone turnover in HIV-associated Osteopenia and Osteoporosis - Program & Abstracts 11th Conference on Retroviruses and Opportunistic Infections - Foundation for Retrovirology and Human Health Alexandria, VA USA) - n. volume not applicable [Abstract in Atti di convegno (274) - Abstract in Atti di Convegno]
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.

Guaraldi G.; Orlando G.; De Fazio D.; Vigo M.; De Lorenzi I.; Rottino A.; Grisotti A.; Borghi V.; Nardini G.; Esposito R. ( 2004 ) - Autologous fat transfer for the treatment of HIV-related face lipoatrophy: A long follow-up experience - ANTIVIRAL THERAPY - n. volume 9 (6) [Abstract in rivista (266) - Abstract in Rivista]
Abstract

The aim of this open, prospective study was to assess subjective efficacy and durability of autologous fat transfer (AFT) in HIV+ people with facial atrophy.

Guaraldi G; Bonucci PL; De Fazio D ( 2004 ) - Comparison of Three Different Methods for Correction of HIV-Associated Facial Lipodystrophy - Advanced Surgical Facial Rejuvenation - Springer Berlin DEU) - pp. da 723 a 728 ISBN: 9783642178375 ISSN: - [Contributo in volume (Capitolo o Saggio) (268) - Capitolo/Saggio]
Abstract

HIV-1-infected patients can have peripheral fat loss or lipoatrophy of the face, limbs, and buttocks and central fat accumulation within the abdomen, breast, and the dorso-cervical spine both of which may be present in the same individual. Lipoatrophy causes negative psychosocial impact and an impairment of quality of life because of erosion of self-image and self-esteem, demoralization and depression, problems in social and sexual relations, and threats to locus of control. Surgical treatments for facial lipoatrophy include autologous fat transplant (AFT) from a subcutaneous abdominal graft or injections of biodegradable or nonbiodegradable fillers into the lipoatrophic areas of the face. The authors discuss how to choose from the different surgical procedures to treat HIV-related facial lipoatrophy.

Pinelli, M.; Baccarani, A.; Pedone, A.; Spaggiari, A.; Guaraldi, Giovanni; DE SANTIS, Giorgio ( 2004 ) - Correzione della lipodistrofia facciale HIV correlata: esperienza con l’uso di poliacrilammide nell’ambito di uno studio multicentrico comparativo - 53° Congresso Nazionale della Società Italiana di Chirurgia Plastica, Ricostruttiva ed Estetica (SICPRE). Pisa (Italy), 16-18 September 2004. - not available Pisa ITA) [Abstract in Atti di convegno (274) - Abstract in Atti di Convegno]
Abstract

Il trattamento dell'infezione da HIV negli ultimi anni è stato profondamente modificato a seguito del miglioramento delle conoscenze teoriche sulla patogenesi dell'infezione e grazie alla disponibilità di nuovi agenti antiretrovirali. La comunità scientifica ha tuttavia recentemente messo in luce pesanti effetti collaterali a lungo termine associate all'uso di questi farmaci, fra questi la lipodistrofia.

ORLANDO G; GUARALDI G; GIURICIN F; GRISENDI G; CARUBBI F; I. ZINI; BORGHI V; ESPOSITO R ( 2004 ) - Dietary evaluation and metabolic alterations in HIV-related lipodystrophy - Abstract & Programme - ANTIVIRAL THERAPY - n. volume 9 [Abstract in rivista (266) - Abstract in Rivista]
Abstract

not available

De Fazio D.; De Lorenzi I.; Rottino A.; Callegari M.; Blini M.; Vigo M.; Guaraldi G.; Orlando G.; Grisotti A. ( 2004 ) - Efficacia e durabilità degli interventi ricostruttivi per il trattamento della lipoatrofia al volto HIV correlata - Abstract book - not available Pisa ITA) - n. volume not available [Abstract in Atti di convegno (274) - Abstract in Atti di Convegno]
Abstract

La sindrome da ridistribuzione del tessuto adiposo corporeo ed in particolare la lipoatrofia del volto rivestono un importante ruolo psicologico sulla qualità di vita dei pazienti HIV+. I trattamenti terapeutici farmacologici finora adottati, non sono riusciti a correggere con successo questa patologia. L'innesto di tessuto adiposo autologo e l'impianto di acido polilattico sono stati utilizzati per il trattamento della lipoatrofia del volto.

Cinque P.; Lorenzini P.; Larussa D.; Cingolani A.; Grisetti S.; Bossolasco S.; Dongiovanni M.; Finazzi M.G.; Vigo B.; Moretti F.; De Marco M.; Loiacono L.; Foresti S.; Egidi M.S.; Guaraldi G.; Monno L.; Ammassari A.; d’Arminio Manforte A.; Antinori A.per il Registro Italiano Neuro AIDS ( 2004 ) - Encefalopatie di origine non determinata in pazienti HIV positivi: aspetti clinico- epidemiologici, fattori predittivi e sopravvivenza - Libro riassunti - Anlaids Milano ITA) - n. volume not applicable [Abstract in Atti di convegno (274) - Abstract in Atti di Convegno]
Abstract

Descrivere all'interno di un'ampia sorveglianza epidemiologica: prevalenza, principali caratteristiche, associazione con la HAART e markers di risposta alla terapia di quadri atipici di patologie neurologiche, comparsi in seguito all'introduzione della HAART

Bedini A.; Venturelli C.; Mussini C.; Guaraldi G.; Codeluppi M.; Borghi V.; Rumpianesi F.; Esposito R. ( 2004 ) - Epidemiology and Antifungal Susceptibility of Candida spp Isolates Causing Bloodstream Infections - Abstracts - American Society for Microbiology Washington, DC USA) - n. volume not applicable [Abstract in Atti di convegno (274) - Abstract in Atti di Convegno]
Abstract

During the past decade invasive fungal infections and antifungal resistance have dramatically increased in hospitalized patients.

Rizzardi G.P.; Guaraldi G.; Lazzarin A.; Pantaleo G.; Tambussi G. ( 2004 ) - Long term control of HIV-1 RNA Replication following a Unique Supervized Treatment Interruption and Mycophenolate Mofetil Therapy in patients treated with HAART since Primary HIV-1 Infection - Program & Abstracts 11th Conference on Retroviruses and Opportunistic Infections - Foundation for Retrovirology and Human Health Alexandria, VA USA) - n. volume not applicable [Abstract in Atti di convegno (274) - Abstract in Atti di Convegno]
Abstract

Mycophenolate mofetil (MMF) reduces the pool of dividing and activated CD4+ T cells, contributing to control virus load. Impact on VIRUS LOAD and CD4+ T cell counts of a unique supervised treatment interruption coupled with MMF is assessed in a non-randomized controlled study.

Guaraldi G.; Orlando G.; De Fazio D.; Grisotti A.; Borghi V.; Nardini G.; Beghetto B.; Esposito R. ( 2004 ) - Long-term follow-up of graft hypertrophy after autologous fat transfer for HIV-related face lipoatrophy (hamster syndrome 1 year later) - ANTIVIRAL THERAPY - n. volume 9 (6) [Abstract in rivista (266) - Abstract in Rivista]
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.

G. Guaraldi; S. Cocchi; N. De Ruvo; M. Codeluppi; M. Masetti; C. Venturelli; R. D'Amico; M. Pecorari; R. Esposito; A.D. Pinna ( 2004 ) - Outcome, incidence, and timing of infections in small bowel/multivisceral transplantation - TRANSPLANTATION PROCEEDINGS - n. volume 36 (2) - pp. da 383 a 385 ISSN: 0041-1345 [Articolo in rivista (262) - Articolo su rivista]
Abstract

The objective of this study was to assess the timing, incidence, and outcome of infections in patients with small bowel/multivisceral transplants (SB/MV Tx). A 180-day follow-up was obtained on 13 SB/MV patients transplanted from January 2001 to June 2002. Fifty-six documented infections were observed. By Kaplan-Meier analysis for time to infection, most of which were of bacterial origin (more than 86%), revealed most events to have occurred within the first month post-Tx. Viral infections were equally distributed after the 30th postoperative day.

A. Antinori; D. Larussa; A. Cingolani; P. Lorenzini; S. Bossolasco; M.G. Finazzi; M. Bongiovanni; G. Guaraldi; S. Grisetti; B. Vigo; B. Gigli; A. Mariano; E.R. Dalle Nogare; M. De Marco; F. Moretti; P. Corsi; N. Abrescia; P. Rellecati; A. Castagna; Mussini C.; A. Ammassari; P. Cinque; A. D' Arminio Monforte. ( 2004 ) - Prevalence, associated factors, and prognostic determinants of AIDS-related toxoplasmic encephalitis in the era of advanced highly active antiretroviral therapy - Clinical infectious diseases : an official publication of the Infectious Diseases Society of America - CLINICAL INFECTIOUS DISEASES - n. volume 39 (11) - pp. da 1681 a 1691 ISSN: 1058-4838 [Articolo in rivista (262) - Articolo su rivista]
Abstract

Background. Characteristics, associated factors, and survival probability of toxoplasmic encephalitis (TE) in the era of advanced highly active antiretroviral therapy ( HAART) have not been fully clarified. Methods. Data for 205 individuals with acquired immunodeficiency syndrome ( AIDS)-related TE were derived from the Italian Registry Investigative NeuroAIDS database, and the cases were studied longitudinally to evaluate prevalence, clinical characteristics, and survival. Moreover, the relationship between the occurrence of TE and exposure to antiretroviral therapy and to TE prophylaxis was evaluated. Results. With an overall prevalence of 26%, TE represented the most frequent neurological disorder in the cohort. Female sex, severe immunodeficiency, and absence of primary TE prophylaxis significantly increased the risk of TE, and previous exposure to antiretroviral therapy reduced the probability of disease occurrence. Thirty-six percent of patients who had received antiretroviral therapy developed TE, although in most of these cases, the patient experienced failure of antiretroviral therapy. Of note, 66% of patients who had experienced antiretroviral therapy did not receive prophylaxis for TE at TE diagnosis. The 1-year probability of that infection with human immunodeficiency virus (HIV) would progress or that death would occur after TE was 40% and 23%, respectively. Cognitive symptoms, low CD4(+) cell count, not receiving HAART after TE, and initiating HAART 12 months after TE diagnosis were all significantly associated with an increased probability of progression of HIV infection. Not receiving HAART after diagnosis negatively affected survival. Conclusions. TE remains a highly prevalent disorder of the central nervous system, even in the late HAART era, particularly among severely immunosuppressed patients and in absence of prophylaxis. Considering that persons with TE have a high probability of early death, prophylaxis should be maintained in immunosuppressed patients who experience failure of antiretroviral therapy, and HAART should be initiated as soon as possible after TE diagnosis.

N. Carulli; G. Guaraldi ( 2004 ) - PRIN 2004: Sindrome metabolica e metabolismo degli acidi biliari. Interazioni fisiopatologiche e identificazione dei bersagli molecolari per nuovi approcci terapeutici. [Altro (298) - Partecipazione a progetti di ricerca]
Abstract

Guaraldi G.; Orlando G.; De Fazio D.; Callegari M.; De Santis G.; Pedone A.; Spaggiari A.; Baccarani A.; Pinelli M.; Borghi V.; Nardini G.; Beghetto B.; Esposito R. ( 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 - ANTIVIRAL THERAPY - n. volume 9(6) [Abstract in rivista (266) - Abstract in Rivista]
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.

Orlando G.; Guaraldi G.; Vandelli M.; De Palma M.; Comelli D.; De Santis G.; Pedoni A.; Spaggiari A.; Baccarani A.; Pinelli M.; De Fazio D.; Borghi V.; Nardini G.; Beghetto B.; Esposito R. ( 2004 ) - Psychometric evaluation of patients undergoing surgical treatment of HIV-related facial lipoatrophy - ANTIVIRAL THERAPY - n. volume 9 (6) [Abstract in rivista (266) - Abstract in Rivista]
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.

Orlando G.; Guaraldi G.; De Fazio D.; Grisotti A.; Borghi V.; Nardini G.; Beghetto B.; Esposito R. ( 2004 ) - Relapse of HIV-related buffalo hump after liposuction - ANTIVIRAL THERAPY - n. volume 9 (6) [Abstract in rivista (266) - Abstract in Rivista]
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.

G. Guaraldi ( 2004 ) - Solidarietà contro l’AIDS nei paesi in via di sviluppo: Solidarietà contro l’AIDS in Mozambico [Altro (298) - Partecipazione a progetti di ricerca]
Abstract

G. Guaraldi ( 2004 ) - Solidarietà contro l’AIDS nei paesi in via di sviluppo: “Solidarietà contro l’AIDS in Tanzania” [Altro (298) - Partecipazione a progetti di ricerca]
Abstract

MANDRIOLI J.; FRANK G.; SOLA P.; LEONE M.E.; G. GUARALDI; GUARALDI P.; COLLINA G.; RONCAROLI F.; CORTELLI P. ( 2004 ) - Tolosa-Hunt syndrome due to actinomycosis of the cavernous sinus: the infectious hypothesis revisited. - Blackwell Science Incorporated:350 Main Street, Sixth Floor:Malden, MA 02148:(888)661-5800, (781)388-8250, EMAIL: csjournals@blacksci.com, INTERNET: http://www.blackwell-science.com, Fax: (781)388-8232 ) - HEADACHE - n. volume 44(8) - pp. da 806 a 811 ISSN: 0017-8748 [Articolo in rivista (262) - Articolo su rivista]
Abstract

BACKGROUND: The Tolosa-Hunt syndrome is characterized by ophthalmoplegia with unilateral severe retro-orbital pain associated to a granulomatous inflammatory process occupying the cavernous sinus or the superior orbital fissure. The etiology is unknown and diagnosis is based upon a clinical response to steroid treatment and exclusion of neoplasm, trauma, aneurysms, infectious, and inflammatory diseases. CASE DESCRIPTION: A 43-year-old man was admitted because of a 1-week history of acute onset left-sided retro-orbital pain, followed by left sixth cranial nerve palsy. Magnetic resonance imaging was normal and Tolosa-Hunt syndrome was suspected. Steroid treatment controlled pain with recovery of ophthalmoplegia. Four months later, when a good response to treatment was still present, brain magnetic resonance imaging revealed a lesion enlarging the left cavernous sinus, isointense with the gray matter on T1-weighted sequences, hypointense on T2-weighted images, and with homogeneous enhancement after gadolinium injection. Two months later, ocular pain and sixth cranial nerve palsy recurred and new brain magnetic resonance imaging showed an extension of the tissue occupying the left cavernous sinus, over the sella, to the right cavernous sinus, making possible an endoscopic transphenoidal biopsy. RESULTS: Histopathological study revealed a granulomatous aspecific inflammation containing actinomycetes colonies. The patient was treated with intravenous penicillin G followed by amoxicillin per os, with improvement of pain and ophthalmoplegia. A control magnetic resonance imaging 1 month after therapy showed a consistent reduction of the enlarged cavernous sinus, and 3 months later neurological examination and brain magnetic resonance imaging were completely normal. CONCLUSIONS: The present case suggests that the International Classification of Headache Disorders (2nd edition) definition of Tolosa-Hunt syndrome does not reflect the complexity of the syndrome and that some cases of secondary painful ophthalmoplegias can fit the criteria for the primary form. Since the biopsy can only rarely be performed, we agree with other authors that clinical and radiological follow-up should be performed for at least 2 years. Moreover, we propose that in patients with painful ophthalmoplegia having transient response to steroid therapy, a trial with antibiotic therapy should be taken into account.

Casoni F.; Guaraldi G.; Cortelli P.; Merelli E. ( 2003 ) - A case of primery progressive multiple sclerosis like illness in HIV infection: one or two different diseases? - NEUROLOGICAL SCIENCES - n. volume 24 [Abstract in rivista (266) - Abstract in Rivista]
Abstract

Neurological manifestations as onset of HIV infection are reported in about 6% of all the cases. Only few cases of HIV-positive patients with relapsing remitting MS like disease have been reported in the literature up to now. At our knowledge this case of HIV infection presenting with p-p MS like is the first described, but the coincidence of two different diseases may not ruled out.

R. Esposito; S. Antinori; G. Guaraldi ( 2003 ) - Artropodi vettori di agenti infettivi - Malattie Infettive - Elsevier Masson Milano ITA) - pp. da 977 a 984 ISBN: 9788821429804 ISSN: - [Contributo in volume (Capitolo o Saggio) (268) - Capitolo/Saggio]
Abstract

Le malattie infettive i cui microrganismi responsabili vengono trasmessi con la puntura o la morsicatura di artropodi sono numerose. La trasmissione di un agente infettivo da un ospite vertebrato all'altro può essere sia di tipo meccanico, sia di tipo biologico. La prima implica semplicemente il trasferimento del patogeno presente sulle zampe o nell'apparato buccale del vettore o ancora nel suo materiale fecale. Al contrario, nella trasmissione biologica l'agente infettivo si moltiplica all'interno dell'artropode vettore ed è necessario un periodo ben determinato perchè quest'ultimo diventi infettivo per un altro ospite vertebrato. In questo capitolo vengono descritti gli artropodi che rivestono un ruolo importante in medicina, in particolare nella trasmissione delle malattie infettive.

Guaraldi G.; De Fazio D.; Orlando G.; Murri R.; Grisotti A.; Nardini G.; Callegari M.; De Lorenzi I.; Prinzivalli G.; Pecorari M.; Beghetto B.; Covezzi R.; Amorico G.; Esposito R.; Wu A. ( 2003 ) - Autologous fat transfer for treating facial waisting in HIV body fat redistribution Syndrome - Abstracts - Foundation for Retrovirology and Human Health Alexandria, Virginia USA) - n. volume not applicable [Abstract in Atti di convegno (274) - Abstract in Atti di Convegno]
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.

Guaraldi G.; De Fazio D.; Rondina R.; Orlando G.; Murri R.; Grisotti A.; Nardini G.; Callegari M.; De Lorenzi I.; Blini M.; Pecorari M.; Beghetto B.; Covezzi R.; Esposito R.; Wu A. ( 2003 ) - Autologous fat transfer for treating facial wasting in HIV-related lipodystrophy: experience of 53 treated patients - ANTIVIRAL THERAPY - n. volume 8 (4) [Abstract in rivista (266) - Abstract in Rivista]
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.

Mussini C.; Cozzi-Lepri A.; Borghi V.; D’Arminio Monforte A.; De Luca A.; Sighinolfi L.; Ortolani P.; Barchi E.; Guaraldi G.; Bedini A.; Bratt G.; Erikson L.; Antinori A.; Cossarizza A.; Esposito R. ( 2003 ) - CD4-Guided treatment interruptions: a new possibile therapeutic strategy - Abstract book - not available Varsavia POL) - n. volume not available [Abstract in Atti di convegno (274) - Abstract in Atti di Convegno]
Abstract

Aim of this study is to evaluate the safety of CD4 guided treatment interruptions.

A. Antinori; A. Cingolani; P. Lorenzini; M.L. Giancola; I. Uccella; S. Bossolasco; S. Grisetti; F. Moretti; B. Vigo; M. Bongiovanni; B. Del Grosso; M.I. Arcidiacono; G.C. Fibbia; M. Mena; M.G. Finazzi; G. Guaraldi; A. Ammassari; A. D'Arminio Monforte; P. Cinque; A. De Luca ( 2003 ) - Clinical epidemiology and survival of progressive multifocal leukoencephalopathy in the era of highly active antiretroviral therapy: Data from the Italian Registry Investigative Neuro AIDS (IRINA) - JOURNAL OF NEUROVIROLOGY - n. volume 9 Suppl 1 - pp. da 47 a 53 ISSN: 1355-0284 [Articolo in rivista (262) - Articolo su rivista]
Abstract

Human immunodeficiency virus (HIV)-associated progressive multifocal leukoencephalopathy (PML) remains a relevant clinical problem even in the era of highly active antiretroviral therapy (HAART). Aims of the study were to analyze clinical and treatment-related features and the survival probability of PML patients observed within the Italian Registry Investigative Neuro AIDS (IRINA) during a 29-month period of HAART. Intravenous drug use, the presence of focal signs, and the involvement of white matter at neuroradiology increased the risk of having PML. A reduced probability of PML was observed when meningeal signs were reported. Patients starting HAART at PML diagnosis and previously naive for antiretrovirals showed significantly higher 1-year probability of survival (.58), compared to those continuing HAART (.24), or never receiving HAART (.00). Higher CD4 cell count were associated with a higher survival probability (.45). At multivariate analysis, a younger age, higher CD4, starting HAART at PML diagnosis, the absence of previous acquired immunodeficiency syndrome (AIDS)-defining events, and the absence of a severe neurologic impairment were all associated with a reduced hazard of death. The use of cidofovir showed a trend towards a reduced risk of death.

Regazzi M.B.; Villani P.; Zucchi P.; Cusato M.; Sighinolfi L.; Catania A.; Guaraldi G.; Calzetti C.; Giacomazzi D.; Stoppini L.; Rossi M.C.; Castelli P.; Palvarini L.; and Maserati R. ( 2003 ) - Clinical pharmacokinetics of nelfinavir and its metabolites M8 in HIV/HCV coinfected patients with cirrhosis - Programme & Abstracts - not available Cannes FRA) - n. volume not applicable [Abstract in Atti di convegno (274) - Abstract in Atti di Convegno]
Abstract

The objectives of this study were to determine nelfinavir (NFV) and its metabolite M8 pharmacokinetic parameters and their variability in HIV/HCV co-infected patients and in HIV-positive controls with negative hepatitis serology, and to evaluate the opportunity of developing individualizes dosing strategies for HIV/HCV-positive subjects with liver dysfunction.

Guaraldi G.; Cocchi S.; Codeluppi M.; Venturelli C.; De Ruvo N.; Masetti M.; Cautero N.; Pinna A.D.; Esposito R. ( 2003 ) - Complicanze infettive nel trapianto ortotopico di fegato da donatore vivente: incidenza distribuzione temporale ed esiti - GIORNALE ITALIANO DI MALATTIE INFETTIVE - n. volume 9 Suppl 1 [Abstract in rivista (266) - Abstract in Rivista]
Abstract

Valutare l'incidenza, la distribuzione temporale e l'esito delle infezioni nei pazienti sottoposti a trapianto ortotopico di fegato da donatore vivente.

Bedini A.; Mussini C.; Guaraldi G.; Esposito R. ( 2003 ) - Epidemiologia della candidemia nosocomiale: 5 anni di esperienza in un ospedale universitario italiano - GIORNALE ITALIANO DI MALATTIE INFETTIVE - n. volume 9 Suppl1 [Abstract in rivista (266) - Abstract in Rivista]
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.

Larussa D.; Lorenzini P.; Cingolani A.; Bossolasco S.; Finazzi M.G.; Bongiovanni M.; Vigo B.; Grisetti S.; Guaraldi G.; Gigli B.; Mariano A.; Dellenogare E.R.; Ammassari A.; d’Arminio Monforte A.; Cinque P.; and Antinori A. ( 2003 ) - Factors associated and pronostic determinants of toxoplasmic encephalitis in the HAART era - ANTIVIRAL THERAPY - n. volume 8(1) [Abstract in rivista (266) - Abstract in Rivista]
Abstract

to evaluate the effect of HAART exposure on prevalence, predictive factors and prognostic determinants of AIDS-associated toxoplasmic encephalitis.

Guaraldi G.; De Fazio D.; Orlando G.; Murri R.; Wu A.; Esposito R. ( 2003 ) - Fat accumulation of the cheeks after autologous fat transfer for treating facial wasting in HIV-related lipodystrophy - ANTIVIRAL THERAPY - n. volume 8 (4) [Abstract in rivista (266) - Abstract in Rivista]
Abstract

To describe four patients who developed, after at least 1 year from an autologous fat tissue transplant, fat graft hypertrophy, contemporary to the relapse of buffalo hump or abdominal fat accumulation.

Guaraldi G.; Codeluppi M.; Borghi R.; Cocchi S.; Pinna A.D.; Venturelli C.; Esposito R. ( 2003 ) - Gli ascessi epatici nei pazienti sottoposi a trapianto ortotopico di fegato - GIORNALE ITALIANO DI MALATTIE INFETTIVE - n. volume 9 Suppl 1 [Abstract in rivista (266) - Abstract in Rivista]
Abstract

Gli ascessi epatici sono un importante causa di letalità dei pazienti sottoposti a trapianto ortotopico di fegato.

Guaraldi G.; Galli C.; Artioli F.; Vanzini C.; Miselli S.; Bertani D.; Pinto G.; Orlando G.; Nardini G.; Beghetto B.; Florini C.; Ascari A.; Gandolfi G.; Ranellucci M.; Orlandi L.; Esposito R. ( 2003 ) - HIV counselling and prevention on the WEB - VII Congresso internazionale, AIDS e Assistenza domiciliare. Le nuove sfide. - Ospedale Luigi Sacco Milano ITA) - n. volume not applicable - pp. da 92 a 92 ISBN: not applicable ISSN: - [Abstract in Atti di convegno (274) - Abstract in Atti di Convegno]
Abstract

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

Guaraldi G.; Vanzini C.; Mazeu I.; Galli C.; Orlando G.; Bertani D.; Miselli S.; Nardini G.; Beghetto B.; Esposito R. ( 2003 ) - HIV counselling looks for new target and methods web versus face to face counselling - Abstract book - Università Vita-Salute San Raffaele Milano ITA) - n. volume not applicable [Abstract in Atti di convegno (274) - Abstract in Atti di Convegno]
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.

M. Luppi; P. Barozzi; G. Guaraldi; L. Ravazzini; V. Rasini; C. Spano; G. Riva; D. Vallerini; AD Pinna; G. Torelli ( 2003 ) - Human herpesvirus 8-associated diseases in solid-organ transplantation: importance of viral transmission from the donor - CLINICAL INFECTIOUS DISEASES - n. volume 37 - pp. da 606 a 607 ISSN: 1058-4838 [Articolo in rivista (262) - Articolo su rivista]
Abstract

No abstract available

G. Guaraldi ( 2003 ) - Infezione da HIV e Sindrome da Immunodeficienza Acquisita - Testo atlante sulle infezioni sessualmente trasmesse - Poligrafico Artoli Modena ITA) - pp. da 149 a 156 ISBN: 00 ISSN: - [Contributo in volume (Capitolo o Saggio) (268) - Capitolo/Saggio]
Abstract

In questo capitolo verrà trattata l'eziologia, l'epidemiologia, l'immunopatogenesi e la storia naturale dell'infezione da HIV.

Guaraldi G.; Orlando G.; De santis G.; De fazio D.; Giuricin F.; Vandeli M.; Bertolotti M.; Galetti G.; Sartini S.; Murri R.; Covezzi R.; Esposito R.; Wu A. ( 2003 ) - La clinica metabolica per il trattamento della lipodistrofia - GIORNALE ITALIANO DI MALATTIE INFETTIVE - n. volume 9 Suppl 1 [Abstract in rivista (266) - Abstract in Rivista]
Abstract

La presa in carico del paziente con lipodistrofia trascende le competenze infettivologiche e necessita di una rete di specialisti competenti per la diagnosi, il monitoraggio, e il trattamento delle alterazioni metaboliche e morfologiche ad essa associate. L'obiettivo della ricerca è di illustrare la metodologia di lavoro e i risultati di questo approccio multidisciplinare integrato denominato "Clinica Metabolica"

Guaraldi G.; Ikonomou A.; Orlando G.; Borghi R.; Verrocchi G.L.; Neri I.; Facchinetti F.; Cellini M.; Esposito R. ( 2003 ) - La trasmissione verticale di HIV nell’era della HAART - VII Congresso internazionale AIDS e Assistenza domiciliare. Le nuove sfide - Ospedale Luigi Sacco Milano ITA) - n. volume not applicable - pp. da 27 a 27 ISBN: not applicable ISSN: - [Abstract in Atti di convegno (274) - Abstract in Atti di Convegno]
Abstract

L'introduzione della HAART in gravidanza ha ridotto la trasmissione verticale di HIV a una prevalenza attuale minore del 2%.

Guaraldi G.; Cocchi S.; Codeluppi M.; Venturelli C.; De Ruvo N.; Masetti M.; Cautero N.; Pinna A.D.; Esposito R. ( 2003 ) - Le infezioni nel trapianto di intestino isolato e multiviscerale: incidenza, distribuzione temporale ed esiti - GIORNALE ITALIANO DI MALATTIE INFETTIVE - n. volume 9 Suppl 1 [Abstract in rivista (266) - Abstract in Rivista]
Abstract

Valutare l'incidenza, la distribuzione temporale e l'esito delle infezioni nei pazienti sottoposti a trapianto di intestino e multiviscerale.

Orlando G.; Guaraldi G.; Murri R.; Nardini G.; Beghetto B.; Sterrantino G.; Cattelan A.M.; Borderi M.; Esposito R.; Wu A.W. ( 2003 ) - Lipodystrophy and quality of life: a prospective study - Abstract book - Università Vita-Salute San Raffaele Milano ITA) - n. volume not applicable [Abstract in Atti di convegno (274) - Abstract in Atti di Convegno]
Abstract

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

Z. Bisoffi; A. Matteelli; D. Aquilini; G. Guaraldi; G. Magnani; G. Orlando; G. Gaiera; T. Jelinek; R.H. Behrens ( 2003 ) - Malaria clusters among illegal Chinese immigrants to Europe through Africa - EMERGING INFECTIOUS DISEASES - n. volume 9 (9) - pp. da 1177 a 1178 ISSN: 1080-6040 [Articolo in rivista (262) - Articolo su rivista]
Abstract

Between November 2002 and March 2003, 17 cases of malaria (1 fatal) were observed in illegal Chinese immigrants who traveled to Italy through Africa. A further cluster of 12 was reported in August, 2002. Several immigrants traveled by air, making the risk of introducing sudden acute respiratory syndrome a possibility should such illegal immigrations continue.

Guaraldi G.; De Fazio D.; Orlando G.; Murri R.; Grisotti A.; Nardini G.; Callegari M.; De Lorenzi I.; Blini M.; Pecorari M.; Beghetto B.; Covezzi R.; Esposito R.; Wu A. ( 2003 ) - Mechanical and ultrasound-assisted liposuction for treating subcutaneous fat accumulations in HIV-related lipodystrophy: experience of 33 treated patients - ANTIVIRAL THERAPY - n. volume 8 (4) [Abstract in rivista (266) - Abstract in Rivista]
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

G. Guaraldi; R. Murri; G. Orlando; E. Orlandi; G. Sterrantino; M. Borderi; C. Grosso; A.M. Cattelan; G. Nardini; B. Beghetto; A. Antinori; R. Esposito; A.W. Wu ( 2003 ) - Morphologic alterations in HIV infected people with lipodystropy are associated with good adherence to HAART. - HIV CLINICAL TRIALS - n. volume 4 (2) - pp. da 99 a 106 ISSN: 1528-4336 [Articolo in rivista (262) - Articolo su rivista]
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.

Murri R.; Guaraldi G.; Orlando G.; Drapeu C.M.J.; Fantoni M.; De Luca A. ( 2003 ) - Non-structured treatment interruptions are associated to detectable HIV RNA in people taking NNRTI - Abstract book - Università Vita-Salute San Raffaele Milano ITA) - n. volume not applicable [Abstract in Atti di convegno (274) - Abstract in Atti di Convegno]
Abstract

Non-structured treatment interruptions (non STIs, drug discontinuations decided only by pts), could occur often. NON STIs prevalence and their impact on treatment efficacy are not investigated.

Guaraldi G.; Mazeu I.; Cappi C.; Vazini C.; Galli C.; Piselli S.; Pinelli M.; Orlando G.; Nardini G.; Beghetto B.; Orlandi L.; Esposito R. ( 2003 ) - Nuovi obiettivi e strumenti di lavoro nel counselling HIV: studio prospettico osservazionale del counselling informatico versus il counselling vis a vis - GIORNALE ITALIANO DI MALATTIE INFETTIVE - n. volume 9 Suppl 1 [Abstract in rivista (266) - Abstract in Rivista]
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.

R. Esposito; G. Guaraldi ( 2003 ) - Programma nazionale di ricerca sull’AIDS 1999. Progetto Patologia Clinica e Terapia dell’AIDS. Studio ACTG-384 [Altro (298) - Partecipazione a progetti di ricerca]
Abstract

R. Esposito; G. Guaraldi ( 2003 ) - Programma nazionale di ricerca sull’AIDS 1999. Progetto Patologia Clinica e Terapia dell’AIDS. Studio A5116 [Altro (298) - Partecipazione a progetti di ricerca]
Abstract

Bianconi G.; Vandelli M.; Orlando G.; Giuricin F.; Comelli D.; Murri R.; Guaraldi G. ( 2003 ) - Psichological aspects of lipodystrophy sindrome analysed in the perspective of a metabolic clinic - Abstract book - Università Vita-Salute San Raffaele milano ITA) - n. volume not applicable [Abstract in Atti di convegno (274) - Abstract in Atti di Convegno]
Abstract

The study took place in Azienda Ospedaliero Universitaria Policlinico di Modena were a Metabolic clinic is held by a multidisciplinary team of physicians and psychologists providing diagnoses medical intervention and surgical treatment for lipodystrophy

Guaraldi G.; Busi Rizzi E.; Saltini C. ( 2003 ) - Pulmonary complications of HIV infection - Respiratory medicine - Saunders, Elsevier Science Limited Londra GBR) - n. volume 1 - pp. da 900 a 915 ISBN: 0 7020 2613 1 ISSN: - [Contributo in volume (Capitolo o Saggio) (268) - Capitolo/Saggio]
Abstract

The interaction between the human immunodeficiency virus and the host immune system dictates the establishment of chronic HIV infection and the decline of CD4+ cell counts. This, in turn, is the major determinant of the risk of respiratory opportunistic infections. The use of “higly active antiretroviral therapy” (HAART) has changed the natural history of HIV infection and the rate of HIV-associated opportunistic infections, which has declined impressively with 0.5-5.0 fold reduction of rates. Conversely, some new syndromes are now being observed at the inception of HAART, including the paradoxical response to tuberculosis treatment, exacerbation of cryptococcosis and M. avium complex lymphadenitis.

Guaraldi G.; Lodesani C.; Berselli R.; Bolzon R.; Orlando G.; Murri R.; Fantoni M.; Angiolillo E.; Esposito R. ( 2003 ) - The nursing home for people living with AIDS. Changing pattern of people characteristics at admission and care needs in the follow up. A 11 years experience - VII Congresso internazionale, AIDS e Assistenza domiciliare. Le nuove sfide. - Ospedale Luigi Sacco Milano ITA) - n. volume not applicable - pp. da 93 a 94 ISBN: not applicable ISSN: - [Abstract in Atti di convegno (274) - Abstract in Atti di Convegno]
Abstract

Casa San Lazzaro is a Modena's nursing home care unit for AIDS patients since 1991. Leading causes of admission are: homelessness, in particular people coming from correctional facilities, AIDS dementia complex as well as other neurological disabilities, and relevant social and psychiatric disorders in HIV people.

Mandrioli J.; Sola P.; Leone M.; Frank G.; Collina G.; Guaraldi G.; Cortelli P. ( 2003 ) - Tolosa hunt sindrome due to actinomycosis of the cavernous sinus: a case report and review of literature - NEUROLOGICAL SCIENCES - n. volume 24 ottobre 2003 [Abstract in rivista (266) - Abstract in Rivista]
Abstract

Tolosa hunt sindrome is characterized by ophtalmoplegia with unilateral, severe retro-orbital pain associated to a low grade granulomatous inflammatory process occupying the cavernous sinus or the superior orbital fessure. The etiology in unknown and diagnosis is based upon good clinical response to steroid treatment. Differential diagnosis include neoplasm, trauma, aneurysms, infectious and inflammatory diseases. We report a case of painful ophthalmoplegia caused by actinomycosis of the cavernous sinus.

Guaraldi G.; Orlando G.; Murri R.; Sterrantino G.; Cattelan A.M.; Sighinolfi L.; Sbaragli S.; Grosso C.; Rondina R.; Wu A.W. ( 2003 ) - Validation of an italian version of the ACTG assessment of body change and distress (ABCD) questionnaire. - Abstract book - Università Vita-Salute San Raffaele Milano ITA) - n. volume not applicable [Abstract in Atti di convegno (274) - Abstract in Atti di Convegno]
Abstract

No validated questionnaires on the psychological impact of lipodystrophy exists. We validated an italian version of the ACTG assessment of body change and distess (ABCD) questionnaire.

Starace F.; Abrescia N.; Angarano G.; Cafaro L.; Guaraldi G.; Lo Caputo S.; Maserati R.; Massa A.; Tramarin A.; Chirianni A.; Sherr L. ( 2002 ) - Adherence as a gender issue: psychosocial factors influencing antiretroviral adherence in HIV sieropositive women. - Abstract book - not available Barcellona ESP) - n. volume not applicable [Abstract in Atti di convegno (274) - Abstract in Atti di Convegno]
Abstract

In recent years, adherence to antiretroviral (ARV) therapy in HIV-seropositive persons has been explored. However, major gaps still exist in our knowledge of the psychosocial and behavioural aspects of non-adherence (NA) in women.

Guaraldi G.; De Fazio D.; Orlando G.; Beghetto B.; Nardini G.; Amorico G.; Esposito R.; Grisotti A.; Callegari M.; De Lorenzi I.; Prinzivalli G. ( 2002 ) - Autologous fat transfer for treating facial wasting in HIV body fat redistribution syndrome. - Final program and abstract book - Kobe-lipodystrophy Dommartine FRA) - n. volume not applicable [Abstract in Atti di convegno (274) - Abstract in Atti di Convegno]
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.

Guaraldi G.; Orlando G.; Murri R.; Orlandi E.; Covezzi R.; Sterrantino K.; Sbaragli S.; Borderi M.; Talò S.; Grosso C.; Erba C.; Cattelan A.M.; Antinori A.; Esposito R.; Wu A.W. ( 2002 ) - Body fat redistribution syndrome in HIV infected people is associated with good adherence to HAART - Read & see - Momento medico Salerno ITA) - n. volume not applicable - pp. da 6 a 6 ISBN: not available ISSN: - [Abstract in Atti di convegno (274) - Abstract in Atti di Convegno]
Abstract

No studies have investigated body fat redistribution (BFR) as a factor affecting medication adherence. GRAAL is a prospective observational study to examine the impact of BFR on adherence to antiretroviral therapy.

Guaraldi G.; Orlando G.; Murri R.; Orlandi E.; Covezzi R.; Nardini G.; Beghetto B.; Bedini A.; Esposito R.; Wu A. W. ( 2002 ) - Body Image perception in HIV infected women with body fat redistribution. - Final program abstract book - Kobe-lipodystrophy Dommartine. FRA) - n. volume not applicable [Abstract in Atti di convegno (274) - Abstract in Atti di Convegno]
Abstract

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

Bedini A.; Venturelli C.; Mussini C.; Guaraldi G.; Della Loggia P.; Codeluppi M.; Beghetto B.; Nardini G.; Rumpianesi F.; Esposito R. ( 2002 ) - Candidemia nosocomiale: quattro anni di esperienza in un'ospedale universitario italiano - libro dei riassunti - not available Modena ITA) - n. volume not applicable [Abstract in Atti di convegno (274) - Abstract in Atti di Convegno]
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

Orlando G.; Guaraldi G.; Murri R.; Wu A.; Nardini G.; Beghetto B.; Sterrantino Gk; Sbaragli S.; Borderi M.; Talò S.; Grosso C.; Erba C.; Cattelan Am; Antinori A.; Esposito R. ( 2002 ) - Does lipodistrophy affect quality of life? - Abstract book - not available Barcellona ESP) - n. volume not applicable [Abstract in Atti di convegno (274) - Abstract in Atti di Convegno]
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.

Guaraldi G.; Galli C.; Artioli F.; Vanzini C.; Miselli S.; Bertani D.; Pinto G.; Orlando G.; Nardini G.; Beghetto B.; Florini C.; Ascari A.; Gandolfi G.; Ranellucci M.; Orlandi L.; Esposito R. ( 2002 ) - È possibile un counselling HIV su internet? - Libro riassunti - Tip. Ludovici Roma ITA) - n. volume not applicable - pp. da 217 a 217 ISBN: not applicable ISSN: - [Abstract in Atti di convegno (274) - Abstract in Atti di Convegno]
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.

Ammassari A.; Lorenzini P.; Cinque P.; Soldani F.; Granicola M.L.; Cingolani A.; d’Arminio Manforte A.; Grisetti S.; Toma L.; Pierotti C.; Finazzi M.G.; Vigo B.; Dongiovanni M.; Tozzi V.; Fmoretti F.; Guaraldi G.; Cristiano L.; Foresti S.; Monno L.;Corsi P.; Gentile M.; Mena M.; Artioli S.; Fasulo G.; Della Nogare R.; Rezza G.; Ippolito G.. Antinori A. ( 2002 ) - Encephalopaty of unknown origin (EUO): a new picture in the Era of HAART? - Program and Abstracts - Foundation for Retrivirology and Human Health Alexandria USA) - n. volume not applicable [Abstract in Atti di convegno (274) - Abstract in Atti di Convegno]
Abstract

In neurologic manifestations a different distribution of diseases and the emergence of new pictures due to the impact of HAART con be hypothesized.

Ammassari A.; Cinque P.; Lorenzini P.; Cingolati A.; Giancola M.L.; Bossolasco S.; Covoni A.; Finazzi M.G; Del Grosso B.; Dongiovanni M.; Vigo B.; Moretti F.; Gentile M.; Monno L.; Dellenogare E.R.; Corsi P.; Guaraldi G.; Arcidiacono M.I.; Mastrianni A. ( 2002 ) - HAART exposure influences distribution and caracteristics of HIV-associated neurologic disorders: data from Italian Registry Investigation Neuro AIDS (IRINA). - Abstract book - not available Barcellona ESP) - n. volume II [Abstract in Atti di convegno (274) - Abstract in Atti di Convegno]
Abstract

HIV-related CNS diseases may be changed by HAART, though this needs to be studied more in detail. Objective of the study was to evaluate frequency, characteristics, and relationship with antiretrovirals of CNS diseases in the HAART era.

R. Maserati; P. Villani; M. Cusato; M. B Regazzi; P. Zucchi; L. Sighinolfi; A. Catania; G. Guaraldi; C. Calzetti; D. Giacomazzi; L. Stoppini; M. C. Rossi; P. Castelli ( 2002 ) - HCV coinfection with normal or low grade ALT modifies nelfinavir disposition in HIV-positive patients - Abstract book - The Gardiner-Caldwell Group, Ltd. Tytherington GBR) - n. volume not applicable - pp. da 166 a 166 ISBN: not available ISSN: - [Abstract in Atti di convegno (274) - Abstract in Atti di Convegno]
Abstract

Nelfinavir (NFV) pharmacokinetics (PK) was evaluated in a cohort of HIV+/HCV+ pts with different degrees of liver impairment and compared to HIV+/HCV- controls. Group I included 21 HIV+/HCV+pts, while Group II was composed of 42 HIV+/HCV- subjects with normal ALT levels. NFV-PK was determined at steady state. Blood samples for PK analysis were obtained during a dosing interval (≥7 samples per patient). NFV and metabolite M8 plasma concentrations were determined simultaneously by a validated HPLC method.

Guaraldi G.; Borghi R.; Orlando G.; Codeluppi M.; Gennai W.; Tamassia M.G.; Portolani M.; Quintini C.; Masetti M.; Sassi S.; Pinna A.D ( 2002 ) - Human herpesvirus-6 chronic replication is not always associated with clinical disease in small bowel transplant recipients - Abstracts-on-disk - Marathon multimedia Faribault, MN USA) - n. volume not applicable [Abstract in Atti di convegno (274) - Abstract in Atti di Convegno]
Abstract

the objective of this case report is to underline the possibility of a chronic replication of human herpesvirus-6 with no evidence of clinical disease, in immunosuppresed patients undergoing small bowel transplant.

Guaraldi G.; Lodesani C. ( 2002 ) - Il ruolo delle Case alloggio per malati di AIDS nel paziente tossicodipendente HIV positivo (Sezione VI) In: Trattato Completo degli abusi e delle dipendenze. - Trattato Completo degli abusi e delle dipendenze. - Piccin Padova ITA) - pp. da 1539 a 1560 ISBN: 9788829916481 ISSN: - [Contributo in volume (Capitolo o Saggio) (268) - Capitolo/Saggio]
Abstract

not available

Cingolani A.; Lorenzini P.; Pezzetti P.; Ammassari A.; Bossolasco S.; Soldani F.; Granicola M.L.; Uccella I.; Dongiovanni M.; Moretti F.; Finazzi M.G.; Vigo B.; Guaraldi G.; Tozzi V.; Mazzarello G.; Delle Nogare E.R.; Monno L.; Corsi P.; d’Arminio Manforte A.; Cinque P.; Antinori A. ( 2002 ) - Impatto della HAART sulla prevalenza, sui fattori associati e sulla sopravvivenza delle patologie neurologiche HIV relate - Libro riassunti - Tip. Ludovici Roma ITA) - n. volume not applicable - pp. da 58 a 58 ISBN: not applicable ISSN: - [Abstract in Atti di convegno (274) - Abstract in Atti di Convegno]
Abstract

Analizzare la relazione tra esposizione alla HAART, incidenza di patologie neurologiche, fattori predittivi e sopravvivenza delle specifiche malattie.

Alberici F; Bonazzi L; Calleri G; Camma C; Catania A; Craxì A; De Filippi F; Errante D; Fasulo G; Fiorentini G; Giuliani M; Greco G; Guaraldi G; Liuzzi G; Mazzetti M; Nencioni C; Noce S; Pagani L; Paolillo F; Piazza M; Prestileo T; Raise E; Rezza G; Tirelli U; TotiM; Ursitti M A; Vaccher E ( 2002 ) - Infezioni e malattie infettive correlate ai comportamenti di abuso e di dipendenza da eroina e cocaina. (Sezione 4)In: Trattato Completo degli abusi e delle dipendenze. - Trattato Completo degli abusi e delle dipendenze. - Piccin Padova ITA) - pp. da 799 a 845 ISBN: 9788829916481 ISSN: - [Contributo in volume (Capitolo o Saggio) (268) - Capitolo/Saggio]
Abstract

not available

Guaraldi G.; 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 G.; Beghetto B.; Esposito R.; Wu A. ( 2002 ) - Lipodistrophy is related to adherence to antiretroviral therapy (ARV) - Abstract book - not available Barcellona ESP) - n. volume not applicable [Abstract in Atti di convegno (274) - Abstract in Atti di Convegno]
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.

Codeluppi M.; Guaraldi G.; Bedini A.; Borghi R.; De Maria N.; Immolo R. ( 2002 ) - Meningoencefalite criptococcica in paziente HIV negativo con cirrosi postepatitica. Descrizione di un caso. - Libro dei riassunti - not available Modena ITA) - n. volume not applicable [Abstract in Atti di convegno (274) - Abstract in Atti di Convegno]
Abstract

Pur essendo contemplata fra le condizioni cliniche che costituiscano fattore predisponente per la criptococcosi, le segnalazioni di casi in pazienti cirrotici risultano essere poche in letteratura. Inoltre le alterazioni neurologiche che accompagnano l'encefalopatia epatica possono indurre a non considerare adeguatamente la criptococcosi nella diagnosi differenziale di uno stato di coma.

G. Guaraldi ( 2002 ) - MST e HIV: l’esperienza del counselling - Infezioni genitali in ginecologia e ostetricia - Mediacom - Poligrafico Artioli Modena ITA) - n. volume not applicable - pp. da 65 a 67 ISBN: not available ISSN: - [Abstract in Atti di convegno (274) - Abstract in Atti di Convegno]
Abstract

L'evoluzione dell'epidemia da HIV nei paesi industrializzati si caratterizza per una via di trasmissione prevalentemente sessuale. La presenza di malattie trasmissione sessuale sia di tipo ulcerativo, che di tipo suppurativo, è un potente fattore di contagosità e di suscettibilità all'infezione da HIV.

Gatti AM; Guaraldi G; Migliorino G; Manfrin V; Visona G; Savio C; Panebianco R; Galli M ( 2002 ) - Physician-patient concordance on lipodystrophy severity - Abstracts - ANTIVIRAL THERAPY - n. volume 7 [Abstract in rivista (266) - Abstract in Rivista]
Abstract

Measurement and classification criteria for lipodystrophy during antiretroviral therapy (ART) are still under discussion. Theaim of this study was to assess the concordance rate between physician and patient on lipodystrophy signs.

Gatti AM; Guaraldi G; Migliorino G; Manfrin V; Visona G; Savio C; Panebianco R; Galli M ( 2002 ) - Physicians' and patients' perception of adipose tissue alterations changes according to the management strategy - Abstracts - ANTIVIRAL THERAPY - n. volume 7 [Abstract in rivista (266) - Abstract in Rivista]
Abstract

The interventions addressed to improve or revert adipose tissue alterations observed in patients on antiretroviral therapy are still under investigation.The aim of this study was to assess the impact of these interventions on patients and physicians perception of ATA changes.

Codeluppi M.; Guaraldi G.; Bedini A.; Cocchi S.; Jovine E.; Pinna A.D.; Ivagnez Petracca S.; Girardis M. ( 2002 ) - Profilassi delle complicanze micotiche nel trapianto di intestino e multiviscerale con amfotericina B liposomiale (Ambisome). - Libro dei riassunti - not available Modena ITA) - n. volume not applicable [Abstract in Atti di convegno (274) - Abstract in Atti di Convegno]
Abstract

Il trapianto di intestino è gravato da una elevata incidenza di complicanze micotiche, prevalentemente causate da Candida spp. e Aspergillus spp. L'alto grado di immunosoppressione necessario in questo genere di trapianto, la massiccia translocazione batterica intestinale che accompagna l'atto operatorio ed episodi di rigetto ne costituiscono i principali fattori patogenetici. Per tali motivi è indicata una profilassi universale con antimicotici sistemici.

Guaraldi G.; Orlando G.; Murri R.; Talia K.; Nardini G.; Beghetto B.; Sterrantino K.G.; Sbaragli S.; Borderi M.; Talò S.; Catellan A.M.; Antinori A.; Esposito R.; Wu A.W. ( 2002 ) - Qual è il rapporto tra qualità di vita e lipodistrofia - Libro riassunti - Tip. Ludovici Roma ITA) - n. volume not applicable - pp. da 103 a 103 ISBN: not applicable ISSN: - [Abstract in Atti di convegno (274) - Abstract in Atti di Convegno]
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.

Guaraldi G.; De Fazio D.; Orlando G.; Grisotti A.; Callegari M.; De Lorenzi I.; Prinzivalli G.; Beghetto B.; Nardini G.; Amorico G.; Marcotullio S.; Murri R.; Esposito R. ( 2002 ) - Ruolo della chirurgia plastica nel trattamento della sindrome da ridistribuzione del tessuto adiposo - libro riassunti - Tip. Ludovici Roma ITA) - n. volume not applicable - pp. da 102 a 102 ISBN: not applicable ISSN: - [Abstract in Atti di convegno (274) - Abstract in Atti di Convegno]
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.

Guaraldi G.; Bedini A.; Borghi R.; Pomelli I.; Venturelli C.; Codeluppi M.; Orlando G.; Seghetto B.; Cardini G.; Girardis M.; Gelmini R.; Masetti M.; Pinna A.D.; Esposito R. ( 2002 ) - Studio caso-controllo sui fattori di rischio delle infezioni micotiche nei pazienti sottoposti a trapianto ortotopico di fegato (OLT) da donatore cadavere e da donatore vivente. - Libro dei riassunti - not available Modena ITA) - n. volume not applicable [Abstract in Atti di convegno (274) - Abstract in Atti di Convegno]
Abstract

La sopravvivenza e la qualità della vita dei pazienti sottoposti a trapianto di organo solido è notevolmente migliorata grazie a innovative tecniche chirurgiche, a nuove terapie immunosoppressive e a un miglior controllo delle complicanze infettive. Nonostante ciò l'incidenza delle infezioni micotiche profonde nei pazienti sottoposti a OLT, rimane più alta rispetto ad altri tipi di trapianto di organo solido, e determina una mortalità ad esse correlata tutt'ora rilevante. Non è noto se i pazienti sottoposti a trapianto da donatore vivente abbiano un'incidenza minore di infezioni micotiche rispetto a quelli sottoposti da donatore cadavere.

Venturelli C.; Bedini A.; Guaraldi G.; Casolari C.; Codeluppi M.; La Regina A.; Piccinini L.; Mussini C.; Esposito R.; Rumpianesi F. ( 2002 ) - Test di sensibilità antimicotica in vitro su isolati di Candida spp. da emocolture di pazienti ospedalizzati - Libro dei riassunti - not available Modena ITA) - n. volume not applicable [Abstract in Atti di convegno (274) - Abstract in Atti di Convegno]
Abstract

L'obiettivo del presente studio era quello di istituire un programma di sorveglianza prospettica per gli isolati di Candida spp. dalle emocolture di pazienti ricoverati presso il Policlinico di Modena e di valutare la sensibilità in vitro dei ceppi isolati nei confronti di quattro agenti antimicotici

Bedini A.; Venturelli C.; Mussini C.; Guaraldi G.; Pellegrino F.; Codeluppi M.; Beghetto B.; Nardini G.; Rumpianesi F.; Esposito R. ( 2002 ) - Un raro caso di prostatite da Candida albicans, Candida krusei ed Enterococcus fecium - Libro dei riassunti - not applicable Modena ITA) - n. volume not applicable [Abstract in Atti di convegno (274) - Abstract in Atti di Convegno]
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.

Guaraldi G.; Orlando G.; Murri R.; Orlandi E.; Covezzi R.; Nardini G.; Beghetto B.; Bedini A.; Esposito R.; Wu A. ( 2002 ) - Validity of body image perception in women with HIV. - Abstract book - not available Barcellona ESP) - n. volume not applicable [Abstract in Atti di convegno (274) - Abstract in Atti di Convegno]
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.

Guaraldi G.; Ventura P.; Orlando G.; Albuzza M.; Borderi M.; Bedini A.; Della Loggia P.; Esposito R. ( 2001 ) - Alendronate for the treatment of Osteoporosis in HIV-infected patients. - Final program and abstracts - Serono Symposia Roma ITA) - n. volume not applicable [Abstract in Atti di convegno (274) - Abstract in Atti di Convegno]
Abstract

We report on a 51-year old man with AIDS who underwent a cycle of alendronate therapy for pathologic fracture of a lumbar vertebra, induced by antiretroviral therapy. The patient received 10mg of alendronate daily with calcium and vitamin D supplements, for 6 months.

Guaraldi G.; Ventura P.; Albuzza M.; Orlando G.; Bedini A.; Esposito R. ( 2001 ) - Alendronate treatment for osteoporosis in patients infected with human immunodeficiency virus. - CLINICAL INFECTIOUS DISEASES - n. volume 2001 Aug 1;33(3) - pp. da 414 a 415 ISSN: 1058-4838 [Articolo in rivista (262) - Articolo su rivista]
Abstract

Drug-induced osteoporosis is not rare and is mainly caused by treatment with glucocorticoids. Highly active antiretroviral therapy (HAART) has also been shown to accelerate bone mineral loss in HIV-infected patients and has been proven to be a potent inducer of osteoporosis in this (usually young) population [1]. We have recently described pathologic fractures in patients who have osteopenia and osteoporosis induced by antiretroviral therapy [2]. Here we report the result of alendronate therapy in a 51-year-old man with AIDS and severe osteoporosis.In February 2000, this patient suffered a trivial trauma while walking. A radiogram showed a fracture of the body of lumbar vertebra L1; soon thereafter, because of an anterior vertebral collapse, the patient developed severe disability and pain. At the time of the fracture, the patient's CD4 count was 522 cells/μL and virus load (as measured by branched-DNA level) was <50 copies/mL. He had been receiving a stable course of antiretroviral therapy with stavudine, lamivudine, and indinavir for 36 months. The patient was given 10 mg of alendronate daily with calcium (500 mg daily in the form of calcium carbonate) and vitamin D supplements (450 IU daily), for 6 months.Before and at the end of treatment, dual-energy x-ray absorptiometry scanning (DEXA) was performed to determine the bone mineral density (BMD) of the whole body and of the lumbar spine (vertebrae L1 through L5). Before treatment, DEXA documented that the median BMD of the lumbar spine was 0.691 g/cm2 (t score, −3.85; z score, −3.53). At the end of treatment, DEXA showed that the median BMD of the lumbar spine was 0.832 g/cm2 (t score, −2.35; z score, −1.34). A 20.4% increase in lumbar spine BMD was obtained by the end of treatment, and the patient's pain was almost completely relieved. A radiograph did not reveal any new fractures.After 6 months of treatment, the patient developed lactic acidosis and interrupted both antiretroviral therapy and alendronate therapy. Other authors have recently described the association of lactic acidemia with osteoporosis in HIV-infected men, which suggests that this is a real phenomenon and not a spurious association [3].The effect of alendronate on BMD in HIV-infected patients with osteoporosis has not been evaluated yet. On the other hand, no approved treatment exists for osteoporosis that develops secondary to antiretroviral therapy. This case report encourages the development of clinical trials to study the effect of alendronate in HIV-infected patients with metabolic bone disease. Information regarding the safety of this drug in combination with HAART is urgently needed.

Guaraldi G.; Albuzza M.; Lodesani C.; Bedini A.; Della Loggia P.; Bolzon R.; Esposito R. ( 2001 ) - Applicazione della scala di valutazione, Functional indipendence Measure (FIM), per la valutazione dei programmi di riabilitazione per pazienti affetti da AIDS Dementia Complex ospiti di una casa alloggio - Abstract - Meditech Media Italia Milano ITA) - n. volume not applicable - pp. da 40 a 40 ISBN: not available ISSN: - [Abstract in Atti di convegno (274) - Abstract in Atti di Convegno]
Abstract

L'AIDS Dementia Complex è la patologia opportunisticapiù frequentemente riscontrata al momento dell'ingresso nella casa alloggio San Lazzaro di Modena. L'obiettivo del nostro intervento è un programma di riabilitazione personalizzato che permetta di raggiungere il miglior livello di funzionalità del soggetto.

Guaraldi G.; Orlando G.; Orlandi E.; Covezzi R.; Amorico G.; Bedini A.; Murri R.; Esposito R. ( 2001 ) - Body Image perception in HIV-infected women with lipodystrophy syndrome - Final program and abstracts - Serono Symposia Roma ITA) - n. volume not applicable [Abstract in Atti di convegno (274) - Abstract in Atti di Convegno]
Abstract

To identify clinical and personal factors associated with increased depression and decreased quality of life with a focus on the contribution of adverse drug effects and, in particular, the morphologic and metabolic complications associated with lipodystrophy syndrome.

Guaraldi G.; Orlando G.; Murri R.; Orlandi E.; Covezzi R.; Amorico G.; Bedini A.; Esposito R. ( 2001 ) - Body image perception tests for lipodistrophy. - ANTIVIRAL THERAPY - n. volume 6(4) [Abstract in rivista (266) - Abstract in Rivista]
Abstract

Body image is a multidimensional concept, including both perceptive and attitudinal aspects. The psychological impact of lipodystrophy is influenced by the individual body image perception. Instruments for assessment of body image are very useful in identifying people strongly suffering for lipodystrophy.

Amassari A.; Cinque P.; Soldani F.; Lorenzini P.; Toma A.; Govoni A.; Giancola M.L.; Grisetti S.; Pierotti C.; Cingolani A; Finazzi M.G.; Vigo B.; Bini T.; Tozzi V.; Fausti C.; Cristiano L.; Foresti S.; Guaraldi G.; Monno L.; Corsi P.; Mazzarello G.; Gentile M.; Mena M.; Arcidiacono M.I.; Fasulo G.; d’Arminio Monforte A.; Rezza G.; Ippolito G.; Antinori A. ( 2001 ) - Caratteristiche e sopravvivenza delle patologie neurologiche in HIV durante l’era della HAART: Dati del registro Italiano NeuroAIDS - Libro riassunti - ANLAIDS Bari ITA) - n. volume not applicable - pp. da 189 a 189 ISBN: not available ISSN: - [Abstract in Atti di convegno (274) - Abstract in Atti di Convegno]
Abstract

Valutare prevalenza, caratteristiche cliniche, relazione con la HAART, sopravvivenza, di patologie neurologiche HIV-relate in epoca HAART.

M. PORTOLANI; M. PECORARI; MG TAMASSIA; W. GENNARI; F. BERETTI; G. GUARALDI ( 2001 ) - Case of fatal encephalitis by HHV-6 variant A - JOURNAL OF MEDICAL VIROLOGY - n. volume 65 (1) - pp. da 133 a 137 ISSN: 0146-6615 [Articolo in rivista (262) - Articolo su rivista]
Abstract

A fatal case is reported of encephalitis in an 85-year-old man caused by the human herpesvirus 6 variant A. The virological diagnosis was. based on the findings of the virus variant genomic sequences both in the cerebrospinal fluid and serum of the patient. Moreover, virus replication in nervous tissue was suggested by a viral load higher in the cerebrospinal fluid than in the peripheral blood. The association of a central nervous system infection with the A variant of human herpesvirus 6 is interesting because of the difficulty in establishing a pathological role for this virus strain. Epstein-Barr virus DNA was detected in the patient´s cerebrospinal fluid in association with human herpesvirus 6 DNA. The presence of the Epstein-Barr virus genomic sequences in the cerebro-spinal fluid was considered to be unimportant clinically.

Antinori A.; Amassari A.; Cinque P.; Soldani F.; Lorenzini P.; Tona L.; Covoni A.; Giancola Ml; D`Armino Manforte A.; Grisetti S.; Pienotti C.; Cingolati A.; Finazzi Mg; Bini T.; Tozzi V.; Fausti C.; Cristiano L.; Foresti S.; Guaraldi G.; Monno L.; Vigo B ( 2001 ) - Changing patterns in HIV-1 related neurological disorders during HAART era. Data from the Italian Registry Investigative Neuro AIDS (IRINA) - Book of abstracts - Provoli Publicity S.A. Athens GRC) - n. volume not applicable [Abstract in Atti di convegno (274) - Abstract in Atti di Convegno]
Abstract

HIV-1 associated CNS disorders may be reduced as HAART effect, but the exact natural history of these diseases was not conclusively assessd.

Gatti G.; Bonora S.; Liuzzi G.; Guaraldi G.; Bucci B.; De Pascalis C.R.; Sinicco A.; Di Perri G.; Chiarinni A.; Bassetti D. ( 2001 ) - DDI concentrations in seminal plasma - Book of abstracts - Provoli Publicity S.A. Athens GRC) - n. volume not applicable [Abstract in Atti di convegno (274) - Abstract in Atti di Convegno]
Abstract

It has been shown that the concentration of HIV-1 in blood plasma correlates with sexual transmission. Therefore, reducing HIV in semen has potential for limiting sexual transmission. However, penetration of antiretroviral drugs into genital tract may be prevented by epithelial barriers.

Guaraldi G.; Orlando G.; Covezzi R.; Orlandi E.; Sterrantino G. K.; Sbaragli S.; Borderi M.; Talò S.; Grosso C.; Erba C.; Coronada O.; Della Loggia P.; Murri R.; Antinori A.; R. Esposito ( 2001 ) - Does lipodystrophy affect adherence? The cross-sectional GRAAL study - Program and abstracts - Serono Symposia Roma ITA) - n. volume not applicable [Abstract in Atti di convegno (274) - Abstract in Atti di Convegno]
Abstract

Previous studies have shown that patients evaluation of lipodystrophy and measurements of adherence is accurate. The cross sectional GRAAL study aims at analysing the impact of lipodystrophy on drug adherence, measured by self-assessment questionnaires.

Guaraldi G.; Lodesani C.; Righi E.; Bedini A.; Della Loggia P.; Bertani R.; Orlando G.; Esposito R. ( 2001 ) - Incremento della sopravvivenza nei pazienti affetti da AIDS ospiti in una casa alloggio - Abstract - Meditech Media Italia Milano ITA) - n. volume not applicable - pp. da 45 a 45 ISBN: not available ISSN: - [Abstract in Atti di convegno (274) - Abstract in Atti di Convegno]
Abstract

In letteratura vi sono pochi dati relativi al cambiamento della morbilità e mortalità nei pazienti ospiti in case alloggio per malati di AIDS.

Guaraldi G.; Lodesani C.; Righi E.; Bedini A.; Della Loggia P; Bertani R.; Orlando G.; Esposito R. ( 2001 ) - La casa alloggio: ospite, centro riabilitativo o entrambi? - Abstract - Meditech Media Italia Milano ITA) - n. volume not applicable - pp. da 47 a 47 ISBN: not available ISSN: - [Abstract in Atti di convegno (274) - Abstract in Atti di Convegno]
Abstract

La casa alloggio San Lazzaro di Modena ospita pazienti affetti da infezione da HIV dal 1991. Obiettivo: valutare lo stato di salute al momento dell'ingresso e al follow up in un gruppo di 96 pazienti HIV+ assistiti presso la Casa alloggio. Valutare il tasso di ospedalizzazione nel periodo 1991-1999

Guaraldi G. ( 2001 ) - La percezione dell'immagine corporea nelle donne affette da infezione da Hiv con Sindrome lipodistrofica. - Atti del Convegno - Tipolitografia Trabella Peschiera Borromeo ITA) - n. volume not applicable - pp. da 109 a 115 ISBN: not available ISSN: - [Abstract in Atti di convegno (274) - Abstract in Atti di Convegno]
Abstract

L'immagine corporea (IC) si riferisce alle esperienze psicologiche riguardo all'aspetto e al funzionamento del proprio corpo. Un tempo si riteneva, erroneamente, che il costrutto dell'IC fosse unidimensionale. Oggi, invece, si riconosce la necessità di distinguere almeno fra una modalità percettiva e una attitudinale, relativamente indipendenti tra di loro.

Guaraldi G.; Orlando G.; Murri R.; Orlandi E.; Covezzi R.; Sterrantino G.; Sbaragli S.; Borderi M.; Talò S.; Grosso C.; Erba C.; Cattelan A. M.; Della Loggia P.; Antinori A.; Esposito R. ( 2001 ) - Lipodystrophy is related to high level of adherence - Book of abstracts - Provoli Publicity S.A. Athens GRC) - n. volume not applicable [Abstract in Atti di convegno (274) - Abstract in Atti di Convegno]
Abstract

The role of lipodystrophy as a factor affecting adherence has been suggested by several authors, but up to now no clinical trials have been conducted to investigate this relation.

M. Portolani; M. Pecorari; P. Pietrosemoli; A. Bartoletti; AMT Sabbatini; M. Meacci; W. Gennari; E. Bazzani; F. Beretti; G. Guaraldi ( 2001 ) - Outbreak of aseptic meningitis by ECHO 4: Prevalence of clinical cases among adults - NEW MICROBIOLOGICA - n. volume 24 (1) - pp. da 11 a 15 ISSN: 1121-7138 [Articolo in rivista (262) - Articolo su rivista]
Abstract

Twenty five cases of meningitis occurred in urban areas surrounding a city (Modena) in Northern Italy, in the period May-July 1999. When the patients were admitted to the Infectious Diseases Division of the University of Modena and Reggio Emilia Hospital and studied by virological and serological methods, the meningitis proved to have an enteroviral origin and enterovirus ECHO 4 type was responsible for all cases of illness. An epidemiological characteristic of the enteroviral meninigitis outbreak was the adult age in 23 out of the 25 patients (mean age 24.50 +/- 7.84years). The monthly distribution of the aseptic meningitis cases was the following: five cases occurred in May, 13 in June and seven in July. The origin of the spread of the virus infection and the reason for its sudden end remained unknown. The unusual drop in temperature which occurred in the geographic area involved in the aseptic meningitis outbreak at the beginning of August could have interfered with the slowdown in virus circulation.

Guaraldi G.; Orlando G.; Albuzza M.; Della Loggia P.; Lodesani C. Bedini A.; Bolzon R.; Esposito R. ( 2001 ) - Pathologic fracture induced by antiretroviral therapy in an AIDS patients living in a nursing home - Abstract - Meditech Media Italia Milano ITA) - n. volume not applicable - pp. da 46 a 46 ISBN: not available ISSN: - [Abstract in Atti di convegno (274) - Abstract in Atti di Convegno]
Abstract

Osteopenia and osteoporosis have recently been included among the metabolic complications of antiretroviral therapy in HIV-infected patients.

G. Guaraldi; P. Ventura; M. Albuzza; G. Orlando; A. Bedini; G. Amorico; R. Esposito ( 2001 ) - Pathological fractures in AIDS patients with osteopenia and osteoporosis induced by antiretroviral therapy - AIDS - n. volume 15 (1) - pp. da 137 a 138 ISSN: 0269-9370 [Articolo in rivista (262) - Articolo su rivista]
Abstract

Osteopenia and osteoporosis have recently been included among the metabolic complications of antiretroviral therapy in HIV-infected patients. The pathogenesis and particularly the role of each individual medication are currently poorly understood. The prevalence and natural history of these conditions have been evaluated only in cross-sectional studies [1], so that their clinical evolution is still unclear. Avascular osteonecrosis has also been described among AIDS patients receiving or not receiving antiretroviral therapy, suggesting that this is a real phenomenon and not a spurious association [2-6]. However, pathological bone fractures have never been reported in patients with bone alterations induced by antiretroviral therapy.We report on two AIDS patients, one with osteopenia and the other with osteoporosis, who suffered fractures after trivial trauma. Both had moderate central and peripheral lipodystrophy, without any significant alterations in lipid metabolism. A dual energy X-ray absorptiometry (DEXA) scanner was used to determine the bone mineral density of the whole body, lumbar spine (L1-L5) and proximal femur.

G. Guaraldi ( 2001 ) - Pragramma Nazionale AIDS, IV Pogetto per le ricerche sugli aspetti etici, sociali, comportamentali, assistenziali e della prevenzione dell’infezione da HIV/AIDS: Percezione dell'immagine corporea in donne affette da infezione da HIV con sindrome metabolica. [Altro (298) - Partecipazione a progetti di ricerca]
Abstract

G. Guaraldi ( 2001 ) - Programma Nazionale AIDS, IV Pogetto per le ricerche sugli aspetti etici, sociali, comportamentali, assistenziali e della prevenzione dell’infezione da HIV/AIDS:Internet come strumento di informazione e assistenza per i pazienti affetti da infezione da HIV. [Altro (298) - Partecipazione a progetti di ricerca]
Abstract

R. Esposito; G. Guaraldi ( 2001 ) - Programma nazionale di ricerca sull’AIDS 1999. Progetto Patologia Clinica e Terapia dell’AIDS. Studio ISS-PART [Altro (298) - Partecipazione a progetti di ricerca]
Abstract

M. Pizzuto; M. Piazza; D. Senese; C. Scalamogna; S. Calattini; L. Corsico; T. Persico; B. Adriani; C. Magni; G. Guaraldi; G. Gaiera; A. Ludovisi; M. Gramiccia; M. Galli; M. Moroni; M. Corbellino; S. Antinori ( 2001 ) - Role of PCR in diagnosis and prognosis of visceral leishmaniasis in patients coinfected with human immunodeficiency virus type 1 - JOURNAL OF CLINICAL MICROBIOLOGY - n. volume 39 (1) - pp. da 357 a 361 ISSN: 0095-1137 [Articolo in rivista (262) - Articolo su rivista]
Abstract

A group of 76 consecutive human immunodeficiency virus (HIV)-positive patients with fever of unknown origin (n = 52) or fever associated with pulmonary diseases was evaluated in order to assess the usefulness of PCR with peripheral blood in the diagnosis and follow-up of visceral leishmaniasis. We identified 10 cases of visceral leishmaniasis among the 52 patients with fever of unknown origin. At the time of diagnosis, all were parasitemic by PCR with peripheral blood. During follow-up, a progressive decline in parasitemia was observed under therapy, and all patients became PCR negative after a median of 5 weeks (range, 6 to 21 weeks). However, in eight of nine patients monitored for a median period of 88 weeks (range, 33 to 110 weeks), visceral leishmaniasis relapsed, with positive results by PCR with peripheral blood reappearing 1 to 2 weeks before the clinical onset of disease. Eight Leishmania infantum and two Leishmania donovani infections were identified by PCR-restriction fragment length polymorphism analysis. PCR with peripheral blood is a reliable method for diagnosis of visceral leishmaniasis in HIV-infected patients. During follow-up, it substantially reduces the need for traditional invasive tests to assess parasitological response, while a positive PCR result is predictive of clinical relapse.

Guaraldi G.; Lodesani C.; Righi E.; Bedini A.; Della Loggia P.; Bertani R.; Orlando G.; Esposito R. ( 2001 ) - Ruolo della casa alloggio per il miglioramento dell’aderenza alle terapie antiretrovirali, nelle persone con gravi problemi di aderenza - Abstract - Meditech Media Italia Milano ITA) - n. volume not applicable - pp. da 48 a 48 ISBN: not available ISSN: - [Abstract in Atti di convegno (274) - Abstract in Atti di Convegno]
Abstract

La maggior parte degli ospiti afferenti alla casa alloggio presentano, all'anamnesi, gravi problemi di aderenza alla HAART. La casa alloggio ha assunto progressivamente una valenza terapeutica riabilitativa in cui l'assunzione delle terapie antiretrovirali è parte del progetto socio sanitario dell'utente.

Guaraldi G.; Orlando G.; Murri R.; Orlandi E.; Covezzi R.; Amorico G.; Bedini A.; Esposito R. ( 2001 ) - Self-estimate questionnaires are reliable for lipodystrophy diagnosis. - ANTIVIRAL THERAPY - n. volume 6(4) [Abstract in rivista (266) - Abstract in Rivista]
Abstract

No objective variable obtained by anthropometriy or imaging seem to be reliable for lipodystrophy diagnosis and questionnaires are currently used for case definition. Physician's examination of physical features of lipodystrophy is used for diagnosis, but patient self-estimate seems accurate.

Antinori A.; Amassari A.; Cinque P.; Toma L.; Covoni A.; Soldani F.; Giancola Ml; Grisetti S.; Pietrotti C.; Fausti C.; Finazzi M.G; Bini T.; Del Grosso B.; Cristiano L.; Corsi P.; Fasulo G.; Mena M.; Guaraldi G.; Arcidiacono Monno L.; Fibbia G.C.; Gentile M; Mastroianni A; Speranza F.; D'arminio Monforte A.; Rezza G.; Ippolito G. ( 2001 ) - Shift of prevaleces and selected characteristics of HIV-1 related Neurologic disrorders in HAART era: data from Italian Register Investigative Neuro_AIDS (IRINA). - Programs and Abstracts - Foundation for Retrovirology and Human Health Alexandria USA) - n. volume not applicable [Abstract in Atti di convegno (274) - Abstract in Atti di Convegno]
Abstract

This study involved evaluation of the prevalence, clinical characteristics, and relationship with antiretroviral therapy in newly registered HIV-1-related neurologic diseases in Italy.

Guaraldi G.; Lodesani C.; Righi E.; Bedini A.; Agazzotti G.; Esposito R. ( 2000 ) - Declining morbidity and mortality in AIDS patients of an Italian nursing home - Abstract book - Ince Ltd Durban ZAF) - n. volume 1 [Abstract in Atti di convegno (274) - Abstract in Atti di Convegno]
Abstract

The San Lazzaro nursing home in Modena was the first hospice caring for AIDS patients in Emilia Romagna (North of Italy). Since October 1991, 95 patients have been assisted. At present it can assist 14 in-patients and 2 out-patients.

Franchi A.; Amicosante M.; Rovatti E.; Bonini R.; Marchegiano P.; Girardi E.; Guaraldi G.; Franco G.; Saltini C. ( 2000 ) - Evaluation of a western blot test as a potential screening tool for occupational exposure to Mycobacterium tuberculosis in health care workers. - JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL MEDICINE - n. volume 2000 Jan;42(1) - pp. da 64 a 68 ISSN: 1076-2752 [Articolo in rivista (262) - Articolo su rivista]
Abstract

Health care workers (HCWs) have a higher than average risk for contracting Mycobacterium tuberculosis (MTB) infection and tuberculosis (TB). No markers of MTB-exposure are available, and TB risk assessment is performed by tuberculin screening, identifying individuals with acquired MTB infection. This study evaluated a western blot (WB) anti-M. bovis A60 complex antibody as a MTB-exposure marker. WB reactivity was evaluated on 127 exposed and 28 non-exposed HCWs from four divisions of the Policlinico Hospital of Modena, and 140 non-exposed bacille Calmette-Guerin-vaccinated controls. Excess of occupational TB risk according to the Occupational Safety and Health Administration (OSHA) was calculated in each division. WB-positivity (%) was: (1) significantly higher in exposed HCWs compared with non-exposed (72% vs 25%, P < 0.00001), (2) highly related (r = 0.99) to OSHA risk excess in all divisions, (3) higher than non-exposed in HCWs with short (<5 years) MTB-exposure (purified protein derivative [PPD], P > 0.18; WB, P < 0.04). PPD-positivity (%) was higher than controls only in HCWs with longer (>5 years) MTB-exposure. The study suggests that the WB antibody might represent a more sensitive biological marker of MTB contact among exposed HCWs, related to the level of TB risk and detectable earlier than the PPD skin test, thus providing new tools for TB risk assessment in health care facilities.

G. Guaraldi ( 2000 ) - HelpAids, motore di informazione del Servizio Sanitario Regionale [Software (296) - Software]
Abstract

HelpAids, sito di informazione e di servizio, nasce nel 2000 su mandato della rete dei servizi della provincia di Modena per la lotta all'AIDS costituita da: Provincia e Comune di Modena, Azienda USL e Azienda Ospedaliero-Universitaria di Modena, Università degli Studi di Modena e Reggio Emilia, Associazioni Ceis (Centro di solidarietà) e ASA 97 di Modena. Ideato da Giovanni Guaraldi (medico infettivologo dell'Azienda Ospedaliero-Universitaria di Modena e ricercatore presso la locale Università), il suo costante aggiornamento è garantito da un gruppo di lavoro composto da medici, psicologi, ginecologi, giornalisti e volontari. Nel 2004, la Regione, riconoscendo la validità dell'esperienza condotta a livello provinciale, ha deciso di dare una valenza regionale al sito e di prevedere un coinvolgimento di tutto il Servizio sanitario regionale nella sua gestione. Con questo obiettivo ha coinvolto tutti gli attori interessati ed ha costituito un comitato scientifico i cui componenti sono stati indicati dalla Commissione consultiva tecnico-scientifica per la promozione di interventi per la prevenzione e la lotta contro l'AIDS della Regione Emilia-Romagna.

Starace F.; De Gaetano A.; Chirianni A.; Abrescia N.; Angarano G.; Bonadies G.; Guaraldi G.; Lazzarini L.; Lo Caputo S.; Macerati R.; Tramarin A.; D`Onofrio G. ( 2000 ) - Non-adherence in HIV seropositive persons: psycoscial factors and implications for treatment - Abstract book - Ince Ltd Durban ZAF) - n. volume 1 [Abstract in Atti di convegno (274) - Abstract in Atti di Convegno]
Abstract

Patient's adherence to treatment is a crucial issue for the long term success of antiretroviral therapies. Psychosocial factors play an important role as determinants of non-adherence

Guaraldi G.; Ventura P.; Albuzza M.; Bedini A.; Amorico G.; Esposito R. ( 2000 ) - Pathological fractures in patients with osteopenia and osteoporosis induced by antiretroviral therapy - ANTIVIRAL THERAPY - n. volume 5(Suppl. 5) [Abstract in rivista (266) - Abstract in Rivista]
Abstract

Osteopenia and osteoporosis have recently been included among the metabolic complications of antiretroviral therapy. Its pathogenesis and particularly the role of each individual medication are poorly understood. Pathological bone fractureshave never been observed in patients with osteopenia and osteoporosis. Previously described case reports, in fact, refer to fractures due to avascular necrosis or osteonecrosis.

M. Portolani; C. Cermelli; M. Meacci; P. Pietrosemoli; AMT Sabbatini; MC Cerri; G. Guaraldi; B. De Rienzo ( 1999 ) - Epstein-Barr virus DNA in the cerebrospinal fluid of patients with human immunodeficiency virus infection and central nervous system disorders - NEW MICROBIOLOGICA - n. volume 22 (4) - pp. da 369 a 374 ISSN: 1121-7138 [Articolo in rivista (262) - Articolo su rivista]
Abstract

Routine search for herpesvirus types 1-5 by nested polymerase chain reaction revealed Epstein-Barr virus (EBV) DNA in the cerebrospinal fluid (CSF) of ten out of seventy-nine patients with human immunodeficiency virus (HIV) infection and central nervous system (CNS) disorders not associated with the presence of primary CNS lymphomas. One out of the ten CSF samples was positive for EBV DNA only, six were also positive for microbial agents of recognised neurological pathogenicity while the remaining three samples had a high content of HIV p24 Ag. When six available CSF samples out of the ten EBV DNA positive specimens were investigated for an intrathecal EBV antibody response, all six samples proved EBV antibody-free. The concurrent detection of neurotropic infectious agents and the absence of EBV antibodies in the CSF contribute to the uncertainty on the role of EBV in the neurological illness of the patients studied. One hypothesis considered is that the presence of EBV DNA in the CSF of a large fraction of the ten patients under study is an incidental event associated with EBV reactivation in the host's peripheral blood monocytes, but not related to the genesis of neurological disorders.

M. Amicosante; M. Houde; G. Guaraldi; C. Saltini ( 1999 ) - Sensitivity and specificity of a multi-antigen ELISA test for the serological diagnosis of tuberculosis - INTERNATIONAL JOURNAL OF TUBERCULOSIS AND LUNG DISEASE - n. volume 1999 Aug;3(8) - pp. da 736 a 740 ISSN: 1027-3719 [Articolo in rivista (262) - Articolo su rivista]
Abstract

A new serological assay (DETECT-TB, BioChem ImmunoSystems), using three recombinant proteins and two synthetic peptides for the detection of the anti-Mycobacterium tuberculosis IgG, was evaluated using a panel of serum specimens collected from 100 tuberculosis (TB) patients and 270 controls, in comparison with a homemade ELISA test using purified protein derivative (PPD) as antigen. DETECT-TB presented a higher sensitivity (75%) compared to PPD-ELISA (56%; P < 0.01), while the specificity of each assay was similar (DETECT-TB 97%; PPD-ELISA 100%; P > 0.80). Receiver operating characteristics (ROC) analysis obtained with these data confirmed the higher level of performance of DETECT-TB in comparison with PPD-ELISA. Considering the rapidity, cost-effectiveness and simplicity of this assay, its use may provide useful clinical information aiding in the rapid diagnosis of difficult TB cases.

L. GRADONI; G. GUARALDI; M. CODELUPPI; A. SCALONE; F. RIVASI ( 1995 ) - Gastric localization of Leishmania in a patient with acquired immunodeficiency syndrome. A case report - APMIS. ACTA PATHOLOGICA, MICROBIOLOGICA ET IMMUNOLOGICA SCANDINAVICA - n. volume 1995 Jan;103(1) - pp. da 25 a 28 ISSN: 0903-4641 [Articolo in rivista (262) - Articolo su rivista]
Abstract

We report a case of gastric localization of Leishmania in a 29-year old man affected by AIDS. Gastric biopsies revealed macrophages infected with intracytoplasmic organisms attributable to Leishmania amastigotes. The authors emphasize the importance of performing random biopsies in the absence of endoscopic abnormalities.

A. COSSARIZZA; C. ORTOLANI; C. MUSSINI; G. GUARALDI; N. MONGIARDO; V. BORGHI; D. BARBIERI; E. BELLESIA; MG FRANCESCHINI; B. DERIENZO; C. FRANCESCHI ( 1995 ) - Lack of selective V beta deletion in CD4+ or CD8+ T lymphocytes and functional integrity of T-cell repertoire during acute HIV syndrome - AIDS - n. volume 9 - pp. da 547 a 553 ISSN: 0269-9370 [Articolo in rivista (262) - Articolo su rivista]
Abstract

Objective: To study the V beta T-cell repertoire in peripheral blood lymphocytes (PBL) during acute HIV syndrome by using several anti-V beta monoclonal antibodies (MAb) and to analyse its functionality by stimulating PBL with superantigens (SAg) such as Staphylococcus aureus enterotoxins. Methods: Cytofluorimetric analysis of V beta T-cell-receptor expression was performed on PBL from eight patients with symptomatic, acute HIV-1 primary infection, showing a dramatic decrease of CD4+ PBL accompanied by a marked increase in activated/memory CD8+ T cells, and on 12 age- and sex-matched healthy controls. PBL were then isolated, stimulated with different SAg, anti-CD3 MAb or phytohaemagglutinin and cultured for 3 days. PBL capability to progress through cell cycle was studied by the classic cytofluorimetric method of bromodeoxyuridine incorporation and DNA staining with propidium iodide. Results: Despite the presence of a few expansions of some V beta families among CD8+ T lymphocytes, no gross alterations in T-cell repertoire were present in patients with acute HIV syndrome. Its functionality was maintained overall, as PBL responsiveness to SAg was well preserved. Interestingly, all CD8+ T cells, although bearing different V beta T-cell receptors, expressed marked signs of activation, i.e., CD45R0, CD38 and major histocompatibility complex class II molecules, and also high amounts of CD11a and CD18. Conclusions: Our data suggest, at least in the early phases and in the acute form of the infection, that HIV is not likely to act as a SAg. However, further studies are needed to analyse other sites, such as lymph nodes, where HIV could exert other, significant effects, and to study the expression of other V beta families than those investigated here.

A. COSSARIZZA; C. ORTOLANI; C. MUSSINI; V. BORGHI; G. GUARALDI; N. MONGIARDO; E. BELLESIA; MG FRANCESCHINI; B. DERIENZO; C. FRANCESCHI ( 1995 ) - Massive activation of immune cells with an intact T cell repertoire in acute human immunodeficiency virus syndrome - THE JOURNAL OF INFECTIOUS DISEASES - n. volume 172 (1) - pp. da 105 a 112 ISSN: 0022-1899 [Articolo in rivista (262) - Articolo su rivista]
Abstract

In 8 patients with symptomatic, acute primary infection with human immunodeficiency virus (HIV), a dramatic and persistent decrease in CD4(+) lymphocytes was seen, accompanied by a marked increase in activated/memory CD8(+) T cells (CD38(+), CD45R0(+), HLA-DR(+), with high amounts of cell adhesion molecules), which represented most circulating lymphocytes, but no gross alterations in vp T cell repertoire. Extremely high plasma levels of proinflammatory cytokines were observed. Three patients were followed for 2-3 years: The number of CD4(+) cells, extremely low at first, increased significantly in a few months but decreased rapidly after a short stable period. Cytotoxic T lymphocytes bearing markers of immunologic activation/memory could play an important role in the earliest phases of the disease. It remains to be established how such a dramatic onset could determine the rapid progression of the infection that seems characteristic of patients with acute HIV syndrome.

C. MUSSINI; F. TRENTI; G. MANICARDI; N. MONGIARDO; M. CODELUPPI; L. DANDREA; G. GUARALDI; F. SQUADRINI; B. DERIENZO ( 1995 ) - Non-typhoid Salmonella subdural empyema in a patient with AIDS - SCANDINAVIAN JOURNAL OF INFECTIOUS DISEASES - n. volume 27 (2) - pp. da 173 a 174 ISSN: 0036-5548 [Articolo in rivista (262) - Articolo su rivista]
Abstract

In AIDS patients, non-typhoid salmonella metastatic abscesses in lung and brain due to bacteremia have ben described previously, Here we present a case in which a group B Salmonella, serotype Copenhagen, caused right parietal subdural empyema, The etiologic diagnosis was based on culture of pus obtained from the lesion. The patient was treated for bacterial meningitis and made a good recovery. He is at present reasonably well and is taking ciprofloxacin as prophylaxis against salmonella relapse.

SALTINI C; AMICOSANTE M; GIRARDI E; ANTONUCCI G; IPPOLITO G; AMEGLIO F; MONNO L; CONGEDO P; ANGARANO G; BABUDIERI S; GUARALDI G; VISCO G; PICCOLELLA E; PAONE G; PALLOTTA G; BISETTI A ( 1993 ) - EARLY ABNORMALITIES OF THE ANTIBODY-RESPONSE AGAINST MYCOBACTERIUM-TUBERCULOSIS IN HUMAN-IMMUNODEFICIENCY-VIRUS INFECTION - THE JOURNAL OF INFECTIOUS DISEASES - n. volume 168 - pp. da 1409 a 1414 ISSN: 0022-1899 [Articolo in rivista (262) - Articolo su rivista]
Abstract

Among human immunodeficiency virus (HIV)-infected persons, those who react against purified protein derivative (PPD) have higher risk of tuberculosis. Since PPD testing has limited predictive power in HIV-positive populations, new markers of antituberculous immunity were sought by analyzing antibodies to Mycobacterium tuberculosis antigens (PPD and its fraction A60) in 102 HIV-positive subjects, some PPD-positive and some PPD-negative, and in 23 HIV-positive tuberculosis patients. ELISA and Western blotting were used. Forty HIV-negative healthy subjects and 40 HIV-negative tuberculosis patients were evaluated as controls. While all those HIV-negative and PPD-positive had IgG antibodies recognizing the 38-, 28-, and 19-kDa M. tuberculosis antigens, only 26% of those HIV-positive and PPD-positive (all with <400 CD4+ cells/mm3) and none of the HIV-positive tuberculosis patients recognized them, indicating that the lack of IgG against those antigens, in the presence of a specific IgM response, is a marker of immunodeficiency.