NUOVI STRUMENTI GESTIONALI: CALCOLATORI ONLINE, PUNTEGGI ED APPLICAZIONI INFORMATICHE - Sergio Lo Caputo U.O. Malattie Infettive A.O.U ...

Preconference advanced course

La gestione della terapia antiretrovirale: nuove opzioni diagnostiche

  NUOVI STRUMENTI GESTIONALI:
  CALCOLATORI ONLINE, PUNTEGGI
  ED APPLICAZIONI INFORMATICHE
                                     Sergio Lo Caputo

                                     U.O. Malattie Infettive
                                     A.O.U. Policlinico Bari

HIV e strumenti
    informatici

In quali contesti possono essere utili

Quale aiuto può avere l’infettivologo

Siamo nell’era dell’infettivologo 2.0

Calcolatori online per i
pazienti

Calcolatori online e comorbilità

VACS Index: mortality risk prediction
             … and much more
     The Veterans Aging Cohort Study
     Risk Index (VACS Index) is an index
     composed of routinely collected
     laboratory values that accurately predicts
     all cause mortality among those with HIV
     infection
     Uses lab tests currently part of routine care

     Identifies modifiable risk at lower test thresholds

     Incorporates age, and effects of HANA and toxicity

     Computation easy, can be included in lab reports and available through websites/apps

     Offers approach that incorporates multifaceted HIV effects, multimorbidity, and toxicity

Justice, AC. et. al, HIV Med. 2010 Feb;11(2):143-51. Epub 2009 Sep 14.

All-cause,five-year mortality rates by risk score

              VACS cohorts                     ART-CC cohorts
Conclusions: Among HIV-infected patients treated with ART, the VACS
Index more accurately discriminates mortality risk than traditional HIV
markers and age alone.
By accounting for multi-organ system injury, the VACS Index may prove a
useful tool in clinical care and research.

VACS INDEX

PRO                      CONS

Molto utile per studi   Management clinico
 di coorte               Centri clinici non di
Ricerche cliniche        ricerca
Studi translazionali

RISCHIO DI MALATTIA
CARDIOVASCOLARE

Risk score results:
Age:                       52
Gender:                    male
Total Cholesterol:         180 mg/dL
HDL Cholesterol:           43 mg/dL
Smoker:                    Yes
Systolic Blood Pressure:   175 mm/Hg
On medication for HBP:     No
Risk Score*                16%
                           * The risk score shown was
                           derived on the basis of an
                           equation. Other NCEP
                           materials, such as ATP III print
                           products, use a point-based
                           system to calculate a risk
                           score that approximates the
                           equation-based one.

Risk score results:
Age:                       52
Gender:                    male
Total Cholesterol:         180 mg/dL
HDL Cholesterol:           43 mg/dL
Smoker:                    No
Systolic Blood Pressure:   175 mm/Hg
On medication for HBP:     No
Risk Score*                7%
                           * The risk score shown was
                           derived on the basis of an
                           equation. Other NCEP
                           materials, such as ATP III print
                           products, use a point-based
                           system to calculate a risk
                           score that approximates the
                           equation-based one

FATTORI DI RISCHIO PER EVENTI
ISCHEMICI
                          Non modificabili
                           Età
Modificabili               Sesso
Ipertensione              Etnia
                           Ereditarietà
Diabete
Iperlipidemia
Fumo di sigarette       Correlati ad HIV
Obesità                 • Uso di stupefacenti
Inattività fisica       • Durata HAART
Fibrillazione atriale   • Tipo di HAART
Alcoolismo              • Immunodeficit
Stenosi carotidea       • Immunoricostituzione

•   Quanto sono realmente utilizzati nella pratica clinica
•   Score alti seguono un percorso cardiologico differente
•   I fattori noti di rischio CV non sono sufficienti
•   Ci sono dati sull’aspetto positivo dell’utilizzo di questi score

RISCHIO DI MALATTIA RENALE

RISCHIO DI MALATTIA OSSEA

 • Semplice da utilizzare
 • Quanto viene realmente utilizzato nella pratica clinica ?
 • Il paziente con Frax elevato viene indirizzato ad altro specialista?

RISCHIO DI MALATTIA EPATICA

Interpretation:
In a meta-analysis of 40 studies, investigators concluded that an APRI score greater than 1.0
had a sensitivity of 76% and specificity of 72% for predicting cirrhosis. In addition, they
concluded that APRI score greater than 0.7 had a sensitivity of 77% and specificity of 72% for
predicting significant hepatic fibrosis.1
For detection of cirrhosis, using an APRI cutoff score of 2.0 was more specific (91%) but less
sensitive (46%)

Interpretation:
Using a lower cutoff value of 1.45, a FIB-4 score 3.25 would have a 97%
specificity and a positive predictive value of 65% for advanced fibrosis. In the
patient cohort in which this formula was first validated, at least 70% patients had
values 3.25

FRAILTY-RELATED PHENOTYPE (FRP)
 • At least 3 components out of the following 5:

 1.       weakness (grip strength)
 2.       slowness (time to walk 15 feet)
 3.       exhaustion (self- reported)
      ✓      During the past 4 weeks, have you had difficulty performing your work or other activities
             (for example, it took extra effort)?

 4.       low physical activity level (SF-36)
      ✓      Does your health now limit you in vigorous activities, such as running, lifting heavy objects,
             participating in strenuous sports?

 5.       Unintentional weight loss (self-reported)
      ✓      During the past 4 weeks have you had difficulty performing your work or other activities (for
             example, it took extra effort)?

                                             Desquilbet L et al, J Gerontol A Biol Sci Med Sci 2007; 62:1279-86

 In elderly populations, frailty is associated with higher mortality risk.
 Many frailty scores (FS) have been proposed, no single score is
  considered the gold standard.
 We aimed to evaluate the agreement between a wide range of FS in
  the English Longitudinal Study of Ageing (ELSA).
 Through a literature search, we identified 35 FS
 Different FS are based on different concepts of frailty, and most
  pairs cannot be assumed to be interchangeable.
 Research results based on different FS cannot be compared or
  pooled.

FRAILTY SCORE ?

Quale è il reale utilizzo nei centri clinici
Utilità solo per ricerca
Interventi di solito generici e indirizzati agli stili di vita
Difficile valutare reale efficacia

Over 1200 apps were
identified.
We applied several
exclusion criteria to
identify adult/pediatric
apps
A comprehensive list
of 24 ID apps to
assist healthcare
professionals at the
point of care.

TOP APP IN HIV

TOP APP IN HIV

TOP APP IN HIV

TOP APP IN HIV

Objective:The aim of this study was to develop an immersive, action-oriented
iPhone gaming intervention to improve adherence to antiretroviral medication and
treatment

 Conclusions: We utilized youth feedback, social learning theory (information-
motivation-behavioral skills), and agile software development to create a
multilevel, immersive, action-oriented iPhone gaming intervention to measure and
improve treatment adherence for adolescents and young adults living with HIV.

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