Lipid Metabolism and Cardiovascular Risk in HIV-1 Infection and HAART: Present and Future Problems

Many infections favor or are directly implicated with lipid metabolism perturbations and/or increased risk of coronary heart disease (CHD). HIV itself has been shown to increase lipogenesis in the liver and to alter the lipid profile, while the presence of unsafe habits, addiction, comorbidities, and AIDS-related diseases increases substantially the risk of cardiovascular disease (CVD) in the HIV-infected population. Antiretroviral therapy reduces such stimuli but many drugs have intrinsic toxicity profiles impacting on metabolism or potential direct cardiotoxicity. In a moment when the main guidelines of HIV therapy are predating the point when to start treating, we mean to highlight the contribution of HIV-1 to lipid alteration and inflammation, the impact of antiretroviral therapy, the decisions on what drugs to use to reduce the probability of having a cardiovascular event, the increasing use of statins and fibrates in HIV-1 infected subjects, and finally the switch strategies, that balance effectiveness and toxicity to move the decision to change HIV drugs. Early treatment might reduce the negative effect of HIV on overall cardiovascular risk but may also evidence the impact of drugs, and the final balance (reduction or increase in CHD and lipid abnormalities) is not known up to date

L'approccio patient-based nella determinazione dei comportamenti e dei costi sanitari diretti pubblici

Il presente elaborato ha la finalità di porre il lettore di fronte alla problematica della valutazione dei costi nel contesto sanitario e dei possibili approcci percorribili, in tema di strumenti per la raccolta di dati inerenti il percorso diagnostico e clinico del paziente. Nello specifico si prenderà in considerazione la metodica patient-based come sistema di assoluto interesse, sia per l'applicazione all'interno del contesto del finanziamento dell'offerta sanitaria, sia come strumento di valorizzazione della storia dell'utente-paziente. Differenti applicazioni a livello di sistemi informativi e di database da cui attingere informazioni saranno presi in considerazione. In particolar modo si cercherà di proporre una adeguata applicazione della metodica all'interno del contesto dei pazienti HIV positivi, nel quadro territoriale della Regione Lombardia.The objective of this paper is to deal with cost evaluation within the healthcare sector and the tools which could be used to collect data related to patients' clinical and diagnostic pathways. The patient-based methodology will be considered both for the application within the healthcare supply funding and as a tool to evaluate each patient's clinical history. Alternative information system and database applications will be taken into consideration to collect information. An adequate application of the methodology will be proposed within the HIV+ patients' context, for the Lombardia Region

Health care expenditure for HIV-patients by Health States

20-22 June 201

Tenofovir renal safety in HIV-infected patients: results from the SCOLTA project

Objective: To evaluate the prevalence and incidence of nephrotoxicity in HIV-infected patients enrolled in the SCOLTA Project tenofovir cohort and to identify possible risk factors. Design: The SCOLTA Project is a prospective, observational, multicenter study involving 25 infectious disease departments in Italy created to assess the incidence of severe adverse events in patients receiving new antiretroviral drugs. Patients: The SCOLTA Project tenofovir cohort includes a total of 754 HIV infected patients. Results: Data including grade IIeIV creatinine elevations according to ACTG scale were available in 354 patients, 237 (67%) males with a mean age of 40.1 ± 7.6 years enrolled in the SCOLTA Project tenofovir cohort. During a mean follow up of 19.5 ± 11.5 months creatinine elevations were reported in 9/354 (2.5%) patients, all males. Mean duration of tenofovir therapy at the event was 9.5 ± 5 months. The overall incidence was 1.6 (95% CI 1.5e1.7) per 100 person-years (p-y) and 0.5 (95% CI 0.4e0.6) p-y for grade III. No grade IV creatinine elevations were reported. Patients with nephrotoxicity were older and more frequently male, HCV infected, in CDC stage C and their CD4 cell count was significantly lower than those without nephrotoxicity. No significant difference was found between tenofovir co-administered antiretroviral drugs. Conclusions: Both prevalence and incidence of nephrotoxicity were low in patients receiving tenofovir in a non-selected clinical setting. Renal injury in patients receiving tenofovir seems associated with the presence of co-morbidities and with advanced HIV infection

Next Directions in Measurement of the Home Mathematics Environment

This paper synthesizes findings from an international virtual conference, funded by the National Science Foundation (NSF), focused on the home mathematics environment (HME). In light of inconsistencies and gaps in research investigating relations between the HME and children’s outcomes, the purpose of the conference was to discuss actionable steps and considerations for future work. The conference was composed of international researchers with a wide range of expertise and backgrounds. Presentations and discussions during the conference centered broadly on the need to better operationalize and measure the HME as a construct – focusing on issues related to child, family, and community factors, country and cultural factors, and the cognitive and affective characteristics of caregivers and children. Results of the conference and a subsequent writing workshop include a synthesis of core questions and key considerations for the field of research on the HME. Findings highlight the need for the field at large to use multi-method measurement approaches to capture nuances in the HME, and to do so with increased international and interdisciplinary collaboration, open science practices, and communication among scholars

Adverse events (n) reported during the observation, classified by CTCAE grade.

§<p>Acute hepatitis HBV,</p>*<p>Plus one case of: renal cancer, grade 3 rhabdomyolysis, non-Hodgkin’s lymphoma, coronary heart disease, diabetes, Basedow’s disease, portal hypertension, arterial hypertension, urinary tract infection, fever, acute psychosis, dizziness, flushing, macular rash of skin and glans, gout, cataract, dry skin, asymptomatic hyperuricemia and LDH increase.</p

Metabolic impact of raltegravir-based salvage salvage regimens over 96 weeks.

<p>In both figures values are presented as mean±standard deviation (SD). The dimension of the cohort at each timepoint is reported below (n.). (2A) AST and ALT slope over 96 weeks, all data caught (even 1 acute hepatitis B), (2B) total and fractionated cholesterol slope.</p

Predictors of raltegravir effectiveness.

<p>ITT  =  intention-to-treat analysis, OT  =  on-treatment analysis, IDU  =  intravenous drug user; ARV  =  antiretroviral; ART  =  antiretroviral therapy; HCV  =  Hepatitis C Virus; HBV  =  Hepatitis B Virus.</p>*<p>only including selected variables (P<0.15).</p>§<p>P<0.05.</p