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

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

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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

Rapamycin and HIV Replication in Liver Transplant Recipients

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Clinical recrudescence of chronic untreated P. malariae infection after BNT162b2 CoVID-19 vaccine

We described a case of clinical reactivation of chronic P. malariae infection following CoVID-19 vaccination with BNT162b2 (Pifzer-Biontech CoVID-19 vaccine) in a 48-year old Italian man.The patient came to our attention for fever of unknown origin show a quartan pattern (every third day) associated to splenomegaly, the onset of the fever occurred one month after CoVID-19 vaccination with BNT162b2. P. malariae was diagnosed using Carestart™ malaria rapid test and Polymerase-Chain Reaction. Post-vaccine transient reduction of immune reactivity is described in literature, although the mechanism is unknown

Rituximab in people living with HIV affected by immune-mediated renal diseases: a case-series

Over the last two decades, rituximab (RTX) has played an important role in the treatment of some lymphoproliferative malignancies and immune-mediated diseases. RTX administration is generally safe and well-tolerated, but side effects including late-onset neutropenia, hypogammaglobulinemia, hepatitis B reactivation and rare cases of progressive multifocal leukoencephalopathy have been observed after its administration. Although there are no absolute contraindications regarding its use in people living with HIV (PLWH), the prescription of this drug has been principally limited in patients with oncohematological diseases. In this report, we described the outcome of four PLWH who underwent RTX therapy after the diagnosis of immune-mediated renal disease. The main RTX-associated adverse effects were leukopenia, late-onset neutropenia and decline of CD4+ and CD8+ T-cell counts. In addition, two of the four patients experienced pneumonia requiring hospitalization within six months from the last RTX infusion. We suggest that RTX should be used with caution in PLWH until further evidence emerges on its safety profile in this vulnerable population

High-density hyaluronic acid for the treatment of HIV-related facial lipoatrophy

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&lt;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\uae XL) in HIV patients with facial lipoatrophy

Hypertriglyceridemic waist identifies HIV+ men and women at increased cardiometabolic risk

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