Evolving approaches and resources for clinical practice in the management of HIV infection in the HAART era

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

The transition from co-morbidities to geriatric syndromes in HIV.

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

Geriatric-HIV medicine: A science in its infancy

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Facial lipohypertrophy in HIV-infected subjects who underwent autologous fat tissue transplantation.

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

The Relationships between Total Body, Lumbar Spine and Femoral Neck Bone Mineral Density T-Scores for Diagnosis of Low Bone Mass in HIVInfected Patients

Background: The total bone mineral density T-score cutoff for low bone mass underestimates the frequency shown by femoral neck and lumbar T-score cutoffs. Objective: To determine whether a total body DXA T-score cutoff can be found that will produce results similar those obtained by local measurements of the femoral neck and lumbar spine. Methodology: Participants were all HIV-infected; 1730 males and 840 females. T-score correlations of the three sites were obtained. ROC analyses were performed to obtain the T-score cutoffs for the total body that would produce results that best matched those of the femoral neck and lumbar spine. Low bone mass was defined as a T-score <-1, which includes both osteopenia and osteoporosis categories as defined by the World Health Organization (WHO). The efficacy of the derived T-score cutoffs were determined by cross tabulation of the modified total body classifications against the femoral neck and lumbar spine classification, and rated by the kappa coefficient of agreement and percent of agreement (concordance). Results: Spearman rank correlations varied from 0.570 to 0.752 between total body, lumbar spine and femoral neck T-scores. Area under the ROC curve varied from 0.777 to 0.874 for the different paired sites. The T-score cutoffs for the total body were selected from the ROC curves at a point where the sum of the sensitivity and specificity is a maximum. Cross tabulation of the binary categories. i.e., normal or abnormal, of the total body using the derived T-score cutoffs against those of the femoral neck and lumbar spine registered a reduction of false negatives, but it was associated with a consistent increase in the number of false positives. The resultant kappa coefficients of agreement varied from 0.429 to 0.564; a moderate rating when perfect agreement is 1.0. Conclusion: The modification of the total body T-score cutoffs for the disclosure of low bone mass at the femoral neck and lumbar spine is not sufficiently accurate for clinical application, in particular fracture risk prediction

Predictors of weight loss and maintenance in patients treated with antiobesity drugs

Federica Guaraldi1, Uberto Pagotto2, Renato Pasquali21Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA; 2Division of Endocrinology, Department of Clinical Medicine, S Orsola-Malpighi Hospital, Alma Mater Studiorum University, Bologna, ItalyBackground: The prevalence of obesity and related diseases has increased enormously in the last few decades, becoming a very important medical and social issue. Because of the increasing number of people who need weight loss therapies and the high costs associated with these, the search for reliable predictors of success for weight loss and weight maintenance treatments has become a priority.Objective: A literature review was undertaken to identify possible predictors of outcome of weight loss and weight maintenance in patients treated with antiobesity drugs.Results: For the majority of variables, published data are not sufficient to define their role on final outcomes. Among all considered factors, only early response to treatment appeared to be a reliable positive predictor, and diabetes a negative predictor of weight loss and maintenance.Conclusion: To date, no definitive results have been obtained. Due to the great benefits of reliable predictors of outcome associated to currently available antiobesity drugs and those under development, identifying these predictors has to be supported and encouraged.Keywords: obesity, weight loss predictors, pharmacological treatmen

Urolithiasis associated with atazanavir may mask a metabolic 'channelling' bias.

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Cardiovascular Risk Prediction in Patients With Human Immunodeficiency Virus

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