The Effects of Thiazolidinediones on Metabolic Complications and Lipodystrophy in HIV-Infected Patients

Highly active antiretroviral therapy (HAART)-associated metabolic complications include lipoatrophy (loss of subcutaneous adipose tissue (SAT)) and insulin resistance. Thiazolidinediones are insulin-sensitizing antidiabetic agents which—as an untoward side effect in obese diabetic patients—increase SAT. Furthermore, troglitazone has improved lipoatrophy and glycemic control in non-HIV patients with various forms of lipodystrophy. These data have led to 14 clinical trials to examine whether thiazolidinediones could be useful in the treatment of HAART-associated metabolic complications. The results of these studies indicate very modest, if any, effect on lipoatrophic SAT, probably due to ongoing HAART negating the beneficial effect. The benefit might be more prominent in patients not taking thymidine analoges. Despite the poor effect on lipoatrophy, thiazolidin-ediones improved insulin sensitivity. However, especially rosiglitazone induced harmful effects on blood lipids. Current data do not provide evidence for the use of thiazolidinediones in the treatment of HAART-associated lipoatrophy, but treatment of lipoatrophy-associated diabetes may be warranted. The role of thiazolidinediones for novel indications, such as hepatosteatosis, should be studied in these patients

HIV-infektio ja syöpä

English summaryPeer reviewe

E85-polttoaineen käyttö henkilöautossa

Tässä opinnäytetyössä selvitettiin ja toteutettiin tarvittavat muutokset alettaessa käyttää E85-biopolttoainetta SI-moottorilla varustetussa henkilöautossa sekä tutkittiin biopolttoaineen tuomia hyötyjä käytettäessä moottorissa suurempaa viritysastetta. Moottorin mittaus- ja säätötyöt tehtiin AMW Dyno Servicen tiloissa Lappeenrannassa ja testiajot suoritettiin Motoparkin moottoriradalla. E85-biopolttoaine toi samalla käytetyllä ahtopaineella enemmän tehoa ja enemmän vääntöä verrattuna 98E5-polttoaineeseen. Testeissä käytetyn moottorin pakopuoli osoittautui hieman ahtaaksi, joten tulokset jäivät arvioitua pienemmiksi. Yksi biopolttoaineen suurimmista haasteista käytössä on sylintereiden täytös. Käytettäessä korkeaseosetanolia tarvitaan sylinteriin jopa 40 % suurempi polttoainemäärä verrattuna 98E5-polttoaineeseen. Lisäksi monet polttoainelinjoissa käytettävät materiaalit eivät sovellu käytettäväksi korkeaseosetanolin kanssa.The purpose of this thesis was to study and implement the necessary changes to start using E85 bio fuel in a car equipped with a SI-engine and to learn the benefits of bio fuel in a high performance engine. The engine tests were ran at AMW Dyno Service in Lappeenranta city. Test drives were held at Motopark race circuit. Measured with identical boost, the E85 –bio fuel gave more horsepower and more torque compared to 98E5- fuel. The test engines exhaust system turned out to be small so the results weren´t as good as expected. Most biggest challenges using bio fuel is filling the cylinders. Using high mixture ethanol the combustion needs even 40 % more fuel compared to 98E5 –fuel. Also many materials common used in fuel systems do not tolerate high mixture ethanol inside

Switching from tenofovir alafenamide to tenofovir disoproxil fumarate improves lipid profile and protects from weight gain

Background: Switching from tenofovir disoproxil fumarate (TDF) to tenofovir alafenamide (TAF) increases low-density lipoprotein cholesterol (LDL-C) and body weight. Metabolic effects of the opposite TAF-to-TDF switch are unknown. Objectives: To investigate the effect of TAF-to-TDF switch on plasma lipids, body weight, and atherosclerotic cardiovascular disease (ASCVD) risk score. Design: A retrospective chart review. Methods: One hundred and forty-six patients with TAF-to-TDF switch (Switch group) were compared with 146 patients matched for sex, age, and third antiretroviral agent class who continued unchanged TAF-containing regimen (Control group). Data were collected at approximately 1 year (follow-up FU-1) and 2 years (follow-up FU-2) after baseline values. Results: In Switch group at FU-1, total cholesterol (TC) and LDL-C decreased 12.1% and 12.4% (P < 0.001 in both), respectively. High-density lipoprotein cholesterol (HDL-C) also decreased 8.2% (P < 0.001) in Switch group, but TC/HDL-C ratio did not change. No statistically significant changes were observed in Control group in any lipid values. TC remained similarly decreased through FU-2 in Switch group, but LDL-C increased from FU-1 to FU-2 in both groups. ASCVD risk score decreased from 6.3% at baseline to 6.0% at FU-2 (P = 0.012) in Switch group but increased from 8.4 to 9.1% (P = 0.162) in Control group. Body weight increased from 83.4 kg at baseline to 84.9 kg at FU-2 (P = 0.025) in Control group but remained stable in Switch group (83.1-83.7 kg, P = 0.978). Conclusions: TAF-to-TDF switch improved plasma lipid profile and ASCVD risk score, as well as prevented weight gain, when compared with ongoing TAF-based antiretroviral therapy.Peer reviewe

HIV ja endokriiniset ongelmat

HIV-potilaiden endokriinisten ongelmien kirjo on vaihtunut taudin muututtua kuolemaan johtavasta ¬immuunivajeesta krooniseksi sairaudeksi. Nykyään suurin osa HIV-potilaiden endokriinisista ongelmista diagnosoidaan ja hoidetaan samalla lailla kuin muidenkin potilaiden. Krooninen infektio ja HIV-lääkitys lisäävät osteoporoosin ja murtumien riskiä. Myös metaboliset haitat ja miesten hypogonadismi ovat yleisiä. HIV-lääkkeiden merkittävät yhteisvaikutukset on muistettava myös endokriinisia sairauksia hoidettaessa. Yhteisvaikutuksia voi ilmaantua esimerkiksi glukokortikoidien, tyroksiinin, kalsiumvalmisteiden ja statiinien kanssa.Peer reviewe

Nonalcoholic Fatty Liver Disease in Human Immunodeficiency Virus : The (Not So) New Kid on the Block? Reply

Non peer reviewe

HIV-Related Self-Stigma and Health-Related Quality of Life of People Living With HIV in Finland

We examined how HIV-related self-stigma was associated with different domains of quality of life (QoL), as measured by the World Health Organization Quality of Life in HIV-infected persons instrument (WHOQOL-HIV-Bref), and health-related quality of life (HRQoL) as measured by the generic 15D (15-dimensional measure of HRQoL), to identify the factors associated with self-stigma of people living with HIV (PLWH). The study sample included 440 patients living with HIV followed at the Infectious Disease Clinic of Helsinki University Hospital. Participants with more severe self-stigma reported significantly lower QoL and HRQoL. Male gender, cohabiting with a partner, and disclosure of HIV status were associated with less self-stigma; high education level and financial difficulties were associated with greater self-stigma. Having lived longer with HIV, being unemployed, and living alone were also predictors of self-stigma via financial difficulties. The findings suggest that self-stigma is a complex and multidimensional phenomenon that impacts the HRQoL of PLWH. Psychosocial interventions to enhance the well-being of PLWH are increasingly needed. Copyright (C) 2017 Association of Nurses in AIDS CarePeer reviewe