Penta HIV guidelines

19

Apr, 2012

Italian guidelines for the use of antiretroviral agents and the diagnostic-clinical management of HIV-1 infected persons. Update 2011

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Authors: Antinori A., Marcotullio S., Ammassari A., Andreoni M., Angarano G., Armignacco O., Carosi G., Cinque P., d’Arminio Monforte A., Di Perri G., Ensoli B., Florida M., Galli M., Mastroianni C., Matteelli A., Mazzotta F., Moroni M., Pal G., Puoti M., Puro V., Rizzardini G., Sagnelli E., Vella S., Vullo V., Lazzarin A., Italian HIV Guidelines Working Group (Giaquinto C.  member of Study Group)

Published inNew Microbiol 2012, 35: 113 – 59

Abstract: This short version complies with the intention expressed in the methodological introduction to the full text Italian Guidelines for the use of antiretroviral drugs and the diagnostic-clinical management of people with HIV-1 infection. By definition, this version should not be considered completely exhaustive with respect to the full text version of the Guidelines available at the website: http://www.salute.gov.it/imgs/C_17_pubblicazioni_1301_allegato.pdf.

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4

Apr, 2012

Antiretroviral use in Italian children with perinatal HIV infection over a 14 – year period

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Authors:  Chiappini E., Galli L., Tovo P.A., Gabiano C., Lisi C., Giacomet V., Bernardi S., Esposito S., Rosso R., Giaquinto C ., Badolato R., Guarino A., Maccabruni A., Masi M., Cellini M., Salvini F., Di Bari C., Dedoni M., Dodi I., De Martino M for the Italian Register for HIV infection in children

Published in: Acta Paediatr, 2012, 101: 287-295

Background:  Information on the use of new antiretroviral drugs in children in the real setting of clinical fields is largely unknown.

Methods:  Data from 2554 combined antiretroviral therapy (cART) regimens administered to 911 children enrolled in the Italian Register for HIV infection in children, between 1996 and 2009, were analysed. Factors potentially associated with undetectable viral load and immunological response to cART were explored by Cox regression analysis.

Results:  Proportion of protease inhibitor (PI)-based regimens significantly decreased from 88.0% to 51.2% and 54.9%, while proportion on non-nucleoside reverse transcriptase inhibitor (NNRTI)-based regimens increased from 4.5% to 38.8% and 40.2% in 1996–1999, 2000–2004 and 2005–2009, respectively (p < 0.0001). Significant change in the use of each antiretroviral drug occurred over the time periods (p < 0.0001). Factors independently associated with virological and immunological success were as follows: later calendar periods, younger age at regimen (only for virological success) and higher CD4+ T-lymphocyte percentage at baseline. Use of unboosted PI was associated with lower adjusted hazard ratio (aHR) of virological or immunological success with respect to NNRTI- and boosted PI-based regimens, with no difference among these two latter types.

Conclusion:  Use of new generation antiretroviral drugs in Italian HIV-infected children is increasing. No different viro-immunological outcomes between NNRTI- and boosted PI-based cART were observed.

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19

Mar, 2012

Body Fat Abnormality in HIV-infected children and adoloscents living in Europe: prevalence and risk factors

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Authors: Alam N., Cortina – Borja M., Goetghebuer T., et al. European Paediatr HIV & Lipodystrop (Giaquinto C.  member of the Study Group)

Published in: JAIDS, 2012, 59: 314 – 32

Objectives: To estimate the prevalence of and identify risk factors for lipodystrophy syndrome (LS) and body fat abnormality in a population of HIV-infected children and adolescents.

Design: Cross-sectional observational study.

Methods: HIV-infected subjects aged 2-18 years were recruited from 15 HIV centers in Belgium, Italy, and Poland between January 2007 and December 2008. Standardized assessments by the patient’s long-term clinician were performed to establish the presence of abnormality. Risk factors were explored in logistic regression models for fat abnormality outcomes and LS (abnormality plus dyslipidemia).

Results: Among 426 subjects (70% white), median age was 12.2 years (interquartile range: 9.0-15.0 years) and median duration of antiretroviral therapy was 5.2 years (interquartile range: 2.2-8.8 years). Prevalence was 57% (n = 235) for LS and 42% (n = 176) for fat abnormality; 90 subjects with abnormality were affected in ≥3 locations. Lipoatrophy occurred in 28% (n = 117) of subjects and lipohypertrophy in 27% (n = 115), most commonly in the face and trunk, respectively. In multivariable analysis, white ethnicity, body mass index, ritonavir/lopinavir, and nonnucleoside reverse transcriptase inhibitors were each associated with an increased risk of LS (P < 0.05). White ethnicity, history of Centers for Disease Control and Prevention-defined disease, and stavudine were associated with risk of lipoatrophy (P < 0.05). Increased risk of lipohypertrophy was associated with body mass index and prior HIV disease.

Conclusions: Fat abnormality was prevalent in close to half of children and adolescents, who had accumulated long treatment durations. Risk of fat abnormality was associated with specific drugs, including stavudine and ritonavir, and other variables. Our results underline the importance of continued surveillance of children treated with antiretroviral therapy.

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