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Biomedical subjects

F Chiodo

Publications and source records attributed to F Chiodo.

At least 19 recordsLinked to original sources
PubMed2002

Use of fibrates in the management of hyperlipidemia in HIV-infected patients receiving HAART.

BACKGROUND: Despite potent antiretroviral activity, protease inhibitor-based pharmacological treatment of HIV disease has recently been associated with lipid and glucose metabolism abnormalities (more frequently hypertriglyceridemia and hypercholesterolemia). The aim of our open-label, randomized, prospective study was to evaluate the role of fibrates in the management of HIV-associated hyperlipidemia. PATIENTS AND METHODS: Plasma lipid levels of 635 HIV-infected patients referred to our tertiary care center and who had been receiving protease inhibitor-based antiretroviral therapy for at least 12 months were evaluated. All patients presenting hypertriglyceridemia (> 300 mg/dl) of at least 6-month duration and unresponsive to a hypolipidemic diet and physical exercise were treated with bezafibrate (400 mg once daily), gemfibrozil (600 mg twice daily) or fenofibrate (200 mg once daily) for 12 months. RESULTS: 69 (10.9%) of the 635 observed patients received fibrate therapy: bezafibrate was employed in 25 cases, gemfibrozil in 22 and fenofibrate in 22. Hypolipidemic drugs led to a reduction of 41.2% and 23.3% vs baseline triglyceridemia and cholesterolemia, respectively, with a favorable tolerability profile. CONCLUSION: All used fibrates showed a similar, significant efficacy in the treatment of diet-resistant hyperlipidemia, but further studies seem necessary in order to establish the most appropriate guidelines for the management of dyslipidemia associated with highly active antiretroviral therapy (HAART).

Antiretroviral Therapy, Highly Active↗
PubMed2002

Gabexate mesilate and/or octreotide in human immunodeficiency virus-associated pancreatic abnormalities.

BACKGROUND: Human immunodeficiency virus (HIV)-associated pancreatic alterations are frequent, but poorly investigated, notwithstanding their potential consequences on the course and management of HIV infection. No epidemiological or clinical data on pancreatic alterations have been published since the introduction of highly active antiretroviral therapy, and no indications of the pharmacological management of symptomatic or prolonged laboratory pancreatic abnormalities have been reported. AIM: To investigate the therapeutic role of gabexate mesilate and octreotide in HIV-infected patients with elevated, symptomatic or instrumentally confirmed pancreatic anomalies persisting for more than 3 months. METHODS AND RESULTS: An open-label, prospective, 5-year case-control study was conducted involving 185 consecutive patients with pancreatic alterations. Treatment of patients with severe laboratory and/or clinical involvement with low-dose gabexate mesilate and/or somatostatin was effective and safe and led to a lower recurrence rate and a better tolerability of concomitant drug regimens compared with supportive therapy taken by control patients. Combined gabexate-octreotide proved to be more active than single drug administration. CONCLUSIONS: Epidemiological and therapeutic data on the frequency, risk factors and clinical significance of pancreatic abnormalities during HIV infection are required, as are studies investigating the need for and choice of antisecretory and/or antiprotease compounds.

Adult↗
PubMed2002

Merkel cell carcinoma in a human immunodeficiency virus-infected patient.

In the general population, Merkel cell carcinoma (MCC) is a very rare neuroendocrine primary skin cancer, known for its high propensity for local recurrence and distant metastases. Treatment for this neoplasm is individualized on the grounds of clinical staging at presentation, and may include surgical excision, radiotherapy and chemotherapy. Several studies suggest that MCC occurs more frequently and with a more aggressive course in immunocompromised patients such as organ transplant recipients and those infected with human immunodeficiency virus (HIV). A case of this cutaneous malignancy, characterized by a short-term local recurrence and systemic fatal spread in spite of surgical treatment, radiotherapy and chemotherapy, is described in a patient with advanced HIV infection.

Carcinoma, Merkel Cell↗
PubMed2002

Doxycycline and chloroquine as treatment for chronic Q fever endocarditis.

Endocarditis is a rare but severe complication of Q fever, an infectious disease caused by the intracellular pathogen Coxiella burnetii. Heart involvement is the most common clinical presentation of chronic Q fever, and it occurs almost invariably in patients with previous valvular disease or artificial valves, and in the immunocompromised host. The optimal treatment of Q fever endocarditis is still today debated, and recommended duration of treatment varies from one year to one's lifespan. A case of chronic Q fever endocarditis is described in a patient with biological prosthetic aortic valve and aortic homograft, successfully treated with doxycycline and chloroquine for 2 years.

Anti-Bacterial Agents↗
PubMed2002

Community-acquired Pseudomonas aeruginosa sacro-iliitis in a previously healthy patient.

Pyogenic sacro-iliitis is an uncommon osteo-articular infection that occurs usually in immunocompromised patients and is associated with gram-positive cocci. It is very rarely linked with a gram-negative aetiology. The first case of Pseudomonas aeruginosa sacro-iliitis is described, which occurred in a previously healthy young man, without history of prior traumatic events, hospitalisation or chronic underlying disease.

Adult↗
PubMed2002

Frequency, epidemiology, risk factors, clinical and bacteriological features of enterococcal disease in patients with HIV infection in a decade survey.

In order to assess the frequency and clinical significance of Enterococcus spp. infection during HIV disease, the epidemiological features, risk factors, microbiological issues, and therapeutic perspectives of all the 148 consecutive episodes observed in the past decade were analyzed. The overall frequency of these complications (which involved the genito-urinary tract in over 75% of cases) regarded 5.3% of all admission for HIV disease, with a clear prevalence of Enterococcus faecalis as the causative agent (86.5% of episodes), and a proportionally elevated frequency of polymicrobial infection (45.9% of cases). Among the 148 cultured bacterial strains, a complete susceptibility to glycopeptide antibiotics was documented, together with favorable sensitivity levels against semisynthetic penicillins, followed by chloramphenicol, macrolides, and clindamycin. An advanced underlying HIV disease characterized by a concurrent, severe immunodeficiency, concomitant, prolonged neurological complications, hospitalization itself (with prevalence of nosocomial infection), recourse to invasive diagnostic and/or therapeutic procedures, and prior administration of broad spectrum antimicrobial agents, all seem to support HIV-associated enterococcal disease (mostly involving the genito-urinary tract). The adjunct of neutropenia, a very low CD4+ lymphocyte count, and severe AIDS-defining illnesses represented significant risk factors for hematogenous dissemination of this bacterial infection with potentially life-threatening consequences (16.1% of lethal cases among our septic patients).

AIDS-Related Opportunistic Infections↗
PubMed2002

HIV-1, HAART and bone metabolism.

Much attention has been paid to the emerging complications of HIV infection in patients receiving HAART. Recently, there emerged a potentially increased risk of bone problems like osteopenia, osteoporosis and osteonecrosis as patients live longer. It could be a drug side effect, a consequence of prolonged exposure to HIV and/or activated immune cells characteristic of HIV infection, or a consequence of immune system changes that accompany suppression of virus by the drugs. Future research should focus on the etiologic mechanisms, define the incidence and prevalence prospectively, determine the relationship with HAART (especially the rule of protease inhibitors), and help to guide management. Only when the mechanism for HIV-related versus HAART-related changes can be defined, will we be much closer to designing specific interventions.

Anti-HIV Agents↗
PubMed2001

Carpal tunnel syndrome in HIV-infected patients treated with highly active antiretroviral therapy: other case reports.

A possible association between carpal tunnel syndrome and HIV infection has been suggested only once until now. Two patients with HIV infection are described who presented confirmed carpal tunnel syndrome while on prolonged protease inhibitor-containing highly active antiretroviral therapy (HAART). Their disease course and long-term outcome after medical and/or surgical interventions is presented and discussed according to available evidence from the literature. In our patients, carpal tunnel syndrome occurred in apparent absence of all presumed risk factors of this disease and metabolic abnormalities potentially related to HIV protease inhibitor administration.

Adult↗
PubMed2001

Lack of change in the distribution of AIDS-defining opportunistic diseases and the related degree of immunodeficiency during the periods before and after the introduction of highly active antiretroviral therapy.

In a retrospective study of 86 patients with AIDS-defining diseases diagnosed from 1997 to June 2000, i.e. following consolidated and large-scale introduction of highly active antiretroviral therapy (HAART), and 342 control patients diagnosed with AIDS from 1985 to 1995, i.e. the decade preceding the HAART era, the etiological spectrum and the related level of immunodeficiency of each individual AIDS-defining opportunistic infection were compared. The results show that, despite the progress attained in the management of HIV infection since the introduction of HAART, clinicians facing newly diagnosed cases of AIDS will likely encounter a spectrum of opportunistic diseases and a level of underlying immunodeficiency similar to those observed during the decade preceding the introduction of HAART. Even in recent years, the large majority of patients newly diagnosed with AIDS have not been able to take advantage of HAART prior to diagnosis of their disease.

AIDS-Related Opportunistic Infections↗
PubMed2001

Limits of deep salvage antiretroviral therapy with nelfinavir plus either efavirenz or nevirapine, in highly pre-treated patients with HIV disease.

The virological and immunological response to an efavirenz-containing rescue regimen was compared with that of a nevirapine-containing one in a prospective, open-label 12-month study performed in patients previously treated with > or = 12 months of nucleoside analogue monotherapy, and > or = 15 months of indinavir- or ritonavir-containing HAART. Pooled laboratory data were assessed according to change or continuation of nucleoside analogues, at the time of start of salvage treatment. An improvement of markers of HIV disease progression occurred in all 59 evaluable patients (with a higher viral load decrease in the efavirenz over the nevirapine group at the third month), but the virological response was neither complete nor sustained at the end of study, irrespective of efavirenz or nevirapine adjunct, and complete viral suppression was attained in only 16.9% of subjects. A progressively increasing mean CD4+ lymphocyte count characterized the immunological response of all patients. The 35 patients who changed at least one nucleoside analogue when introducing salvage therapy had a better outcome, irrespective of the non-nucleoside reverse transcriptase inhibitor chosen. Rescue strategies are increasingly needed in HIV-infected patients treated for a long time with HAART. The association of nelfinavir, a non-nucleoside reverse transcriptase inhibitor, and dual nucleoside analogues, is popular among patients who fail first-line HAART. When prolonged prior treatment with nucleoside analogue monotherapy and HAART are of concern, and a quite elevated viral load is present, this salvage regimen may not allow a complete and sustained virological response in a 1-year period, while a more favourable immunological recovery can be expected. However, the concurrent change of nucleoside analogues significantly improves treatment outcome.

Adult↗
PubMed2001

Prevalence of multiple dideoxynucleoside analogue resistance (MddNR) in a cohort of Italian HIV-1 seropositive patients extensively treated with antiretroviral drugs.

As the emergence of highly resistant virus might compromise antiretroviral regimens in HIV-1 infected patients, a constant analysis of genotypic mutations should be performed to establish the magnitude of mutation prevalence and gauge their impact in patients treated extensively with combination therapy. The frequency of multiple dideoxynucleoside analogue resistance (MddNR) was evaluated in a group of Italian HIV-1 seropositive patients who failed to respond to therapy despite a long-lasting drug treatment. Results showed the presence of one or more mutations (A62V, V75I, F77L, F116Y and Q151M) able to confer resistance to all NRTIs in a relatively high percentage (7.9%) of patients enrolled in the study. Moreover, a significantly lower HIV-1 viral replication in patients with MddNR, suggested the importance of monitoring HIV-1 subjects not only by viral load, but also by drug resistance testing, so that a correct drug regimen may be chosen.

Adult↗
PubMed2001

HIV disease among immigrants coming to Italy from outside of the European Union: a case-control study of epidemiological and clinical features.

The epidemiological, clinical and therapeutic features of HIV disease diagnosed in 41 immigrants from outside of the European Union (EU), were compared with those of 123 Italian and EU patients, in a cross-sectional case-control study, with individuals matched according to age and gender. In total 4.15% of our patients came from outside of the EU (51.2% of them from subsaharan Africa), with a proportional predominance of females, and heterosexual and perinatal transmission of HIV disease (P < 0.0001 and P < 0.02, respectively). Compared with Italian and EU subjects, patients coming from abroad had a shorter duration of known HIV infection (P < 0.001), but only some subjects were aware of their HIV disease prior to immigration, or acquired HIV infection only after coming to Italy (14.6% and 12.2%, respectively). No cases of HIV-2 infection or co-infection were detected in either study group. Compared with controls, patients coming from outside of the EU had a comparable clinical and immunological status, and had similar antiretroviral therapy, which was administered earlier (P < 0.0001), and proved better tolerated (P < 0.04), than in Italian and EU subjects. The apparently more limited virological response (as expressed by a higher mean plasma viral load, and a lower rate of viral suppression at the last visit; P < 0.001 and P < 0.05, respectively), was probably a bias due to the shorter mean overall follow-up time (P < 0.0001), and the shorter mean duration of antiretroviral treatment (11.1 +/- 2.2 months of immigrants vs. 16.2 +/- 6.7 months of controls; P < 0.0001).

Adult↗
PubMed2001

American cutaneous leishmaniasis as a rare imported disease in Europe: a case report favourably treated with antimonial derivatives.

A rare case report of American leishmaniasis imported to Italy after a prolonged journey in Brazil is described, and discussed according to the recent epidemiologic, diagnostic, and clinical literature evidence. Since a delayed diagnosis and treatment of American leishmaniasis outside endemic areas is common (due to a low clinical suspicion), careful and timely consideration of tropical infections is warranted in the differential diagnosis of cutaneous lesions found in a European traveller.

Adolescent↗
PubMed2001

Disorders of lipid metabolism in patients with HIV disease treated with antiretroviral agents: frequency, relationship with administered drugs, and role of hypolipidaemic therapy with bezafibrate.

OBJECTIVES: To assess the correlation between antiretroviral treatment and dyslipidaemia in HIV-infected patients, and the role of bezafibrate as a lipid-lowering agent. METHODS: We retrospectively compared serum lipid levels of five groups of 40 patients, each of them treated with either saquinavir hard gel, indinavir, or ritonavir (associated with two nucleoside analogues), or dual nucleoside reverse transcriptase inhibitors (NRTI) with or without a non-nucleoside reverse transcriptase inhibitor (NNRTI), or not treated with antiretrovirals, randomly selected from nearly 1000 HIV-infected patients followed-up for >or= 12 months, while on the relevant therapy. Hypertriglyceridaemia was defined by triglyceride levels >or= 172 mg/dl, and hypercholesterolaemia by cholesterol levels >or= 200 mg/dl. All patients with triglyceridaemia > 300 mg/dl and cholesterolaemia > 220 mg/dl for at least 6 months, and unresponsive to a >or= 3-month diet, started bezafibrate (400 mg/day), and were prospectively followed-up at a <or= 3-month interval, evaluating both efficacy and tolerability of the hypolipidaemic treatment, provided that they did not change their protease inhibitor treatment for reasons other than metabolic abnormalities. RESULTS: Hypertrygliceridaemia occurred in 75 patients out of 200 (37.5%), but was significantly more frequent and severe with ritonavir vs. indinavir (P<0.001), and in subjects given indinavir vs. all remaining patients (either treated or not) (P<0.001), while isolated saquinavir use was associated with higher tri glyceride levels than NRTI-NNRTI treatment alone, or no antiretroviral therapy (P<0.03). Hypercholesterolaemia was found in 27 subjects (13.5%), and a significantly higher frequency and severity was shown in patients treated with indinavir and ritonavir vs. saquinavir, NRTI-NNRTI, and no anti-HIV therapy (P<0.05 to P<0.001). No appreciable difference was found between patients undergoing NRTI-NNRTI and untreated controls, for all evaluated variables. Bezafibrate was administered once daily for 6-18 months to 49 patients with elevated and diet-resistant hyperlipidaemia due to ritonavir or indinavir (27 and 22 subjects, respectively), and reduced triglyceride and cholesterol levels by 35% and 25%, respectively over 6 months, without differences between the underlying protease inhibitor regimen. Thirty-three patients (67.3%) reached a normal triglyceridaemia after 6-9 months, and normal cholesterol levels were obtained in all subjects. Bezafibrate proved safe and well tolerated. CONCLUSIONS: Careful monitoring of the serum lipid profile is needed during antiretroviral therapy, including protease inhibitors, to identify the need for a diet and/or an hypolipidaemic treatment, and to prevent clinical sequelae related to long-term dyslipidaemia. Specific guidelines for the management of disorders of lipid metabolism in HIV-infected patients are needed.

Bezafibrate↗