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Biomedical subjects

Giuseppe Barbaro

Publications and source records attributed to Giuseppe Barbaro.

15 recordsLinked to original sources
PubMed2003

Pathogenesis of HIV-associated heart disease.

As longevity increases in HIV-infected individuals after the introduction of highly active antiretroviral therapy regimens, long-term effects such as cardiovascular disease and, more specifically, symptomatic heart failure are emerging as leading health issues. In the present review article, we discuss HIV-associated cardiovascular disease, focusing on etiopathogenetic mechanisms that may play a role in diagnosis, management, and therapy of HIV-associated heart failure in the highly active antiretroviral therapy era.

Antiretroviral Therapy, Highly Active↗
PubMed2003

Kawasaki-like syndromes and other vasculitic syndromes in HIV-infected patients.

Excluding drug-related hypersensitivity reactions, vasculitic syndromes are not common in HIV-positive patients. Review of the existing literature suggests that HIV positive patients may be predisposed to polyarteritis nodosa, microscopic polyarteritis, Kawasaki-like syndromes, acute occlusion syndromes, primary angiitis of the central nervous system and erythema elevatum diutinum. With the exception of erythema elevatum diutinum, these vasculitic syndromes have significant morbidities and mortality if they are not treated. It is therefore important to make these diagnoses and to initiate appropriate therapy in a timely fashion. Because fevers, malaise, weakness, rashes, headaches and neurologic symptoms are common in HIV-positive patients, it is probable that some cases of vasculitis go undiagnosed. In this report, we review vasculitic syndromes seen in HIV-positive patients. We also re-examine a previously published case of a young HIV-positive male who died of an acute myocardial infarction without atherosclerotic disease. Immunohistopathology of the affected arteries suggests that he died of a Kawasaki-like syndrome.

AIDS-Related Opportunistic Infections↗
PubMed2003

Highly active antiretroviral therapy and cardiovascular complications in HIV-infected patients.

Highly active antiretroviral therapy (HAART) has prolonged many patients' lives, but many cardiac sequelae of HIV are not affected by HAART and continue to develop even with treatment. In addition, HAART itself causes in a high proportion of patients a metabolic syndrome, characterized by lipodystrophy/ lipoatrophy, dyslipidemia and insulin resistance that may be associated with an increase in peripheral artery and coronary artery diseases. Careful cardiovascular evaluation in the course of HIV disease can identify cardiac complications early enough to treat. All HIV-infected patients who are either candidates to antiretroviral therapy or who are already under treatment should undergo an assessment that includes the evaluation of the cardiovascular risk with the available guidelines and the interactions between antiretrovirals and drugs commonly used to treat cardiovascular disease.

Acquired Immunodeficiency Syndrome↗
PubMed2003

Incidence of the involvement of the cardiovascular system in HIV infection.

The epidemiology of cardiac complications related to HIV, including cardiomyopathy, increased left ventricular mass, myocarditis, pericardial effusion, endocarditis, and malignancy, are discussed. An increased number of HIV-infected individuals may present with cardiac complications in the next decade as chronic viral infection, co-infections, drug therapy, and immunosuppression affect the heart. Understanding the nature and course of cardiac illness related to HIV infection may allow appropriate monitoring, early intervention and therapy, and will provide a baseline to evaluate the effects of new therapeutic regimens such as highly active antiretroviral therapy on the cardiovascular system.

AIDS-Related Opportunistic Infections↗
PubMed2002

Consensus interferon for chronic hepatitis C patients with genotype 1 who failed to respond to, or relapsed after, interferon alpha-2b and ribavirin in combination: an Italian pilot study.

OBJECTIVE: To evaluate the long-term efficacy of consensus interferon in the treatment of chronic hepatitis C patients with genotype 1 who failed to respond to, or relapsed after, combination therapy with interferon alpha-2b and ribavirin. DESIGN: Open label pilot study. METHODS: Twenty-four chronic hepatitis C outpatient non-responders to (12 cases), or relapsers after (12 cases), standard combination therapy were treated with consensus interferon (9 microg five times per week) for 36 weeks. The patients were followed up for a further 24 weeks. The primary end-point of the study was the rate of sustained virological response. RESULTS: Sustained virological response was observed in 33% of previous non-responders and in 42% of previous relapsers. Improvement of the histological score was documented in 80% of previous non-responders and in all previous relapsers who showed undetectable levels of hepatitis C virus RNA at the end of treatment. Logistic regression analysis showed that sustained virological response was associated with a hepatitis C viral load of 2 x 106 copies/ml or less, with an inflammation score of 7 or less and with an estimated duration of disease of 10 years or less. The treatment was well tolerated with an 83% compliance. CONCLUSIONS: Consensus interferon given at a dose of 9 microg five times per week for 36 weeks may offer a good chance of sustained virological response in a subset of patients who failed to respond to, or relapsed after, standard combination therapy. However, a larger randomized trial is required to assess the efficacy of consensus interferon before its use can be advocated for the treatment of such patients.

Adult↗
PubMed2002

HIV infection, antiretroviral therapy and cardiovascular risk.

Vascular complications in the course of human immunodeficiency virus (HIV) infection are multifactorial and may be caused by the virus itself or by the related opportunistic infections and neoplasms. Highly active antiretroviral therapy (HAART), which dramatically modifies the natural history of HIV disease, causes in a high proportion of patients a metabolic syndrome that includes body fat redistribution, hypercholesterolaemia, hypertriglyceridaemia and insulin resistance. These effects are particularly evident in patients treated with protease inhibitors (PIs). However, studies on the cardiovascular risk among HIV-infected individuals receiving PIs have not shown a consistent association. The pathogenesis of the HAART-associated metabolic syndrome has not been completely elucidated, but there is growing evidence that a synergistic effect between PIs and nucleoside reverse transcriptase inhibitors might play a significant role. All HIV-infected patients candidate to antiretroviral therapy and patients already under treatment should undergo an assessment that includes the evaluation of the cardiovascular risk with the available guidelines.

AIDS-Related Opportunistic Infections↗
PubMed2002

Metabolic disorders and cardiovascular risk in HIV-infected patients treated with antiretroviral agents.

The clinical management of HIV-infected individuals is based on highly active antiretroviral combination therapy, which provides significant clinical benefit in most patients, but causes in a high proportion of them a metabolic syndrome that includes body fat redistribution, hypercholesterolemia, hypertriglyceridemia, and insulin resistance. These effects are particularly evident in patients treated with protease inhibitors. It is likely that the metabolic disorders related to anti-HIV treatment will eventually translate into an increased cardiovascular risk in patients submitted to such regimens.

Antiretroviral Therapy, Highly Active↗
PubMedDate not supplied

HIV infection and the cardiovascular system.

Better treatment and supportive care are prolonging the lives of patients with HIV, which is resulting in a higher prevalence of long-term effects of HIV. Autopsy and echocardiography studies support frequent involvement of the heart in advanced stages of HIV infection. The most common cardiac manifestations of HIV are dilated cardiomyopathy, myocarditis, pulmonary hypertension, pericardial effusion, endocarditis, HIV-associated malignant neoplasms, and drug-related cardiotoxicity. Highly active antiretroviral therapy (HAART) has prolonged many patients' lives, but many cardiac sequelae of HIV are not affected by HAART and continue to develop even with treatment. In addition, HAART itself may be associated with an increase in peripheral artery and coronary artery diseases. This review focuses on the most recent knowledge about HIV-associated cardiovascular disease. Careful cardiovascular evaluation in the course of HIV disease can identify cardiac complications early enough to treat. In addition, the study of HIV-related cardiovascular disease may shed light on the mechanisms of non-HIV-related cardiovascular disease.

Antiretroviral Therapy, Highly Active↗