Alterazioni del grasso corporeo: Il ritorno di antichi fantasmi? - Antonella Castagna
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Alterazioni del grasso corporeo:
Il ritorno di antichi fantasmi?
Antonella Castagna
David Lowery, 2017
Diagnosis and treatment of lipodistrophy: a step-by-step
approach
D. Araujo-Vilar
ENDOCRINOL METABOL CLIN N AM 2016
Potential causes of inflammageing
Ferrucci F, NrC, 2018
Inflammageing is a risk factor for multiple chronic diseases
Ferrucci F, NrC, 2018
Heart Fat in HIV: marker or mediator of risk?
Curr Opin HIV AIDS, 2017
WHAT ABOUT TAF ?
Fletcher C, CROI 2019
What is LDL Cholesterol? Holmes MV, NrC , 2019
Mills A, et al. JAIDS 2015
Switch study (TANGO)
Phase III, randomised, multicentre, parallel-group, non-inferiority study
• Objective: To demonstrate the non-inferior antiviral activity of switching to DTG/3TC QD
compared with continuation of current ARV regimen over 48 weeks in HIV-1-infected
ART-experienced subjects
• Primary endpoint: The proportion of participants who meet the snapshot virological failure
criteria at week 48 using the ITT-E population
– Non-inferiority margin = 4%; week 48 primary endpoint
TAF-based regimens
Randomisation
TAF-based
regimens
1:1
N=600
DTG/3TC
Baseline Week 24 Week 48 Week 96 Week 144
Primary
endpoints
North America + EU + international Secondary
endpointsJA LAKE, CROI 2019
Bernardino J, 2019
OC64
Homeostatic model assessment for insulin resistance (HOMA-IR)
index trajectories in HIV-infected patients treated with first-line
antiretroviral regimens based on non-nucleoside reverse
transcriptase inhibitors (NNRTIs), ritonavir-boosted protease
inhibitors (PIs/r) or on integrase strand transfer inhibitors (InSTIs)
Muccini Camilla1, Gianotti Nicola2, Galli Laura2, Poli Andrea2, Galizzi Nadia1, Dell’Acqua
Raffaele3, Mastrangelo Andrea1, Messina Emanuela2, Piatti Pier Marco4, Lazzarin
Adriano2, Castagna Antonella1,2
1Vita-Salute San Raffaele University, Milan, Italy;
2IRCCS San Raffaele Scientific Institute, Milan, Italy;
3University Hospital Policlinico, Bari, Italy;
4Cardiometabolic Clinical Trials Unit, Internal Medicine Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
ICAR 10° congresso nazionale, Roma 22-24 maggio 2018
Submitted, JMVMaterial and methods • Retrospective analysis on a cohort of HIV-1 infected patients followed at the Infectious Diseases Unit of the San Raffaele Hospital of Milan: • who started antiretroviral therapy (ART) since 2007; • with 2 NRTIs (tenofovir, abacavir, lamivudine or emtricitabine) and 1 anchor drug [ritonavir-boosted PI, non-NRTI or integrase strand transfer inhibitor (InSTI)]; • with 1 HOMA-IR determination before starting ART and ≥1 determination after starting ART; • Patients with known diabetes were excluded; • Follow-up accrued from the start of ART (=baseline, BL) up to the stop of any drug of the regimen or lost to follow-up or data freezing (January, 22, 2018); • Univariate and multivariate mixed linear models with random slope and intercept for each patient were fitted to estimate HOMA-IR changes according to the anchor drug.
Changes from baseline in HOMA-IR index according to the
type of the initial ART regimen
Univariate mixed linear model
Type of ART
regimen Crude mean (95%CI) change in
P-value
HOMA-IR, units per year
INSTI 0.149 (0.012, 0.287) 0.034
NNRTI -0.071 (-0.174, 0.031) 0.174
PI/r 0.041 (-0.052, 0.134) 0.387Inflammageing induces a catabolic state.
L Ferrucci, NrC 2019LT Fourman, AIDS 2017
Ogni difficoltà su cui si sorvola diventa un fantasma che turba il nostro sonno F. Chopin
Tom’s Selfies
Accessi al servizio di chirurgia plastica _ Data on File_ 180319_OSR
800
757
700 680
660
635
598 609
600 586 588
500
400 368
300 261
253
207 215 215 218
203 203
200
145
10189
100
15 15
0
2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019
N° VISITE N° pazientiPRE-DIABETE
Glicemia Glicemia 2 ore dopo
a digiuno il carico di glucosio all’OGTT
Diabete Diabete
mellito mellito
126 mg/dL 7,0 mmol/L 200 mg/dL 11,1 mmol/L
IFG IGT
100 mg/dL 5,6 mmol/L 140 mg/dL 7,8 mmol/L
Normale Normale
About 50% of cases convert from NFG/NGT to diabetes
in less than 5 years
Adattamento dal rapporto di follow-up di The Expert Committee on the Diagnosis and Classification of
Diabetes Mellitus. Diabetes Care 2003;26:3160–3167You can also read
