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Keshani P, Sarihi S, Parsaie N, Joulaei H. Dietary pattern association with CD4 cells count in patients living with human immunodeficiency virus: A cross-sectional study. J Public Health Res 2023; 12:22799036231181200. [PMID: 37434871 PMCID: PMC10331780 DOI: 10.1177/22799036231181200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 04/28/2023] [Indexed: 07/13/2023] Open
Abstract
Background Considering contradictory reports about the impact of dietary pattern on CD4 cell count in previous studies and the potential importance of diet on the immune system, this study aimed to assess the association between dietary patterns and CD4 count among HIV-infected patients. Methods This cross-sectional study was conducted among HIV-infected patients aged 18-60 who registered in the referral Voluntary Counseling and Testing Center of Shiraz, Iran. The principal component analysis identified nutritional patterns and factors. The association between the score of the dietary patterns and CD4 count was considered in two categories of CD4 more/less than 500 and using backward logistic regression after adjusting for confounders. Results A total of 226 participants were included in the analysis. CD4 was significantly lower in males (p < 0.001). Participants with illegal drug use (p < 0.001), HCV (p = 0.001), and HBV (p < 0.001) had lower serum CD4. Four extracted dietary patterns were a Plant-rich diet, Healthy animal-based proteins, a Western diet, and Affordable calorie and protein patterns. There was an association between CD4 and Western diet patterns in the best model in which age, gender, weight, and HBV were included. Each unit increase in Western diet score increased the odds of CD4 less than 500 by 57% (OR = 1.57; CI 95% 1.06-2.34, p = 0.02). Conclusion Among the four dietary patterns, the Western diet comprising a high intake of refined sugar and grain, saturated and trans fats, and animal protein sources, especially high-fat red meat, had a statistically significant relationship with a decrease in CD4 cell count.
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Affiliation(s)
- Parisa Keshani
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sorour Sarihi
- Department of Human Nutrition and Hospitality Management, College of Human Environmental Sciences, The University of Alabama, Tuscaloosa, AL, USA
- Alabama Research Institute on Aging(ARIA), The University of Alabama, Tuscaloosa, AL, USA
| | - Narges Parsaie
- HIV/AIDS Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hassan Joulaei
- HIV/AIDS Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
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Ozcan SN, Sevgi DY, Oncul A, Gunduz A, Pehlivan O, Terlemez R, Kuran B, Dokmetas L. The prevalence and associated factors of reduced bone mineral density (BMD) among men with suppressed viral load taking antiretroviral therapy. Curr HIV Res 2021; 20:74-81. [PMID: 34856908 DOI: 10.2174/1570162x19666211202100308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 09/02/2021] [Accepted: 10/21/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Reduced bone mineral density (BMD) is a frequent comorbidity observed in people living with HIV (PLHIV). OBJECTIVE The aim of the study is to determine the prevalence and associated factors of reduced bone mineral density (BMD) among men with suppressed viral load taking antiretroviral therapy. METHOD The study was conducted as a cross-sectional study design between January to April 2019. 211 patients were included in the study. Z-score at either body site between -1.0 and -2.0 or -2 or less were defined as osteopenia or osteoporosis, respectively. Multivariate logistic regression analysis was used to evaluate the factors affecting the development of reduced BMD. RESULTS The mean age of the patients involved in the study was 34.8 ± 7.6. Osteoporosis was detected in 21.4% and osteopenia in 44.5% of the patients. There was a significant relationship between HIV diagnosis time, ART usage duration, tenofovir disoproxil fumarate (TDF) use, TDF use in the past, total TDF usage time and decreased BMD. Multivariate logistic regression analysis showed that the likelihood of reduced bone marrow density was 67% lower among those with regular milk or dairy product intake compared to those without (OR=0.330; 95% CI = 0.12-0.92, p=0.033 ) Conclusion: There is a high prevalence of reduced BMD among PLHIV aged under 50 which is mainly confounded by HIV diagnosis time, ART usage duration and TDF usage. Although virological control has been achieved, these patients should be followed up, considering that they may have decreased BMD.
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Affiliation(s)
- Safiye Nur Ozcan
- University of Health Sciences Sisli Hamidiye Etfal Training and Research Hospital, İnfectious Diseases and Clinical Microbiology, Istanbul. Turkey
| | - Dilek Yıldız Sevgi
- University of Health Sciences Sisli Hamidiye Etfal Training and Research Hospital, İnfectious Diseases and Clinical Microbiology, Istanbul. Turkey
| | - Ahsen Oncul
- University of Health Sciences Sisli Hamidiye Etfal Training and Research Hospital, İnfectious Diseases and Clinical Microbiology, Istanbul. Turkey
| | - Alper Gunduz
- University of Health Sciences Sisli Hamidiye Etfal Training and Research Hospital, İnfectious Diseases and Clinical Microbiology, Istanbul. Turkey
| | - Ozgun Pehlivan
- University of Abant Izzet Baysal , Department of Public Health, Bolu. Turkey
| | - Rana Terlemez
- Department of Physical Medicine and Rehabilitation, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul. Turkey
| | - Banu Kuran
- Department of Physical Medicine and Rehabilitation, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul. Turkey
| | - Llyas Dokmetas
- University of Health Sciences Sisli Hamidiye Etfal Training and Research Hospital, İnfectious Diseases and Clinical Microbiology, Istanbul. Turkey
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Wang Y, Huang X, Wu Y, Li A, Tian Y, Ren M, Li Z, Zhang T, Wu H, Wang W. Increased Risk of Vitamin D Deficiency Among HIV-Infected Individuals: A Systematic Review and Meta-Analysis. Front Nutr 2021; 8:722032. [PMID: 34490331 PMCID: PMC8418196 DOI: 10.3389/fnut.2021.722032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 07/26/2021] [Indexed: 12/11/2022] Open
Abstract
Background: Human immunodeficiency virus (HIV) infection is a heavy burden worldwide. Observational studies have reported a high prevalence of vitamin D deficiency (VDD) among people living with HIV (PLWH). However, its deficiency is also a global health problem. Therefore, we conducted a meta-analysis and systemic review to compare differences between HIV-infected subjects and non-HIV-infected subjects. Methods: We searched PubMed, Web of Science, Embase, and Cochrane library. We extracted data, including demographic information, study type, vitamin D-related values, and HIV-related values, ultimately including 15 studies after removing duplicates and screening titles, abstracts, and full texts and finally performing a meta-analysis in terms of vitamin D level and vitamin D deficiency prevalence. Results: Regarding VDD prevalence, the HIV vs. the non-HIV group had an odds ratio of 1.502 (95% CI, 1.023–2.205; P = 0.038). In the subgroup analysis, the odds ratios were 1.647 (95% CI, 1.020–2.659; P = 0.041; I2 = 94.568) from 7 studies (age over 40), 2.120 (95% CI, 1.122–4.008; P = 0.021; I2 = 0.000) from 2 studies (BMI less than or equal to 25), 1.805 (95% CI, 1.373–2.372; P = 0.042; I2 = 74.576) from 7 studies (latitude <40), 2.120 (95% CI, 1.122–4.088; P = 0.021; I2 = 0.000) from 2 studies (only included male participants), and 2.296 (95% CI, 1.287–4.097; P = 0.005; I2 = 19.927) from 3 studies (only included ART-experienced participants). Thirteen studies were deemed to have moderate quality, while two had high quality. Conclusions: HIV infected subjects are prone to have VDD compared with general population. ART, older age, lower BMI, lower latitude and male sex may present risk factors for VDD in PLWH. Systematic Review Registration:https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=228096.
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Affiliation(s)
- Yingying Wang
- Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Xiaojie Huang
- Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Yaxin Wu
- Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Aixin Li
- Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Yakun Tian
- Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Meixin Ren
- Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Zhen Li
- Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Tong Zhang
- Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Hao Wu
- Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Wen Wang
- Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China
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Atencio P, Conesa-Buendía FM, Cabello-Ubeda A, Llamas-Granda P, Pérez-Tanoira R, Prieto-Pérez L, Álvarez BÁ, Acosta IC, Arboiro-Pinel R, Díaz-Curiel M, Largo R, Herrero-Beaumont G, Górgolas M, Mediero A. Bone deleterious effects of different nrtis in treatment-naïve HIV patients after 12 and 48 weeks of treatment. Curr HIV Res 2021; 19:434-447. [PMID: 34353266 PMCID: PMC9175084 DOI: 10.2174/1570162x19666210805094434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 06/21/2021] [Accepted: 06/22/2021] [Indexed: 11/22/2022]
Abstract
Background Bone alterations have been observed in the course of HIV infection, characterized by a marked decrease in bone mineral density (BMD) and an increase in the frequency of fractures as a result of fragility. We aim to evaluate early changes in bone metabolic profile and the possible association with tenofovir and other nucleoside and nucleotide reverse transcriptase inhibitors (NRTIs) in treatment-naïve HIV patients. Methods We conducted a prospective study in naïve HIV-infected adults (under 50 years), separated into three groups according to NRTI therapy: tenofovir disoproxil fumarate (TDF); tenofovir alafenamide (TAF) and abacavir (ABC). BMD and epidemiological, immunological and metabolic bone parameters were evaluated. Bone markers were analyzed in plasma at baseline, 12 and 48 weeks after initiating treatment. Results Average age of patients was 34.8 years (± 9.6). 92.4% of them with CD4 count > 200 cel/μL. At week 12 after starting treatment, both TDF [increase in PN1P (31.7%, p = 0.004), TRAP (11.1%, p = 0.003), OPN (19.3%, p = 0.045) and OC (38.6%, p = 0.001); decrease in OPG (-23.4%, p = 0.003)] and TAF [increase in 42.6% for CTX (p = 0.011), 27.3% for OC (p = 0.001) and 21% for TRAP (p = 0.008); decrease in OPG (-28.8%, p = 0.049)] presented a deep resorption profile compared to ABC, these differences in bone molecular markers, a tendency to equalize at week 48, where no significant differences were observed. Patients treated with TDF showed the greatest decrease in Z-score in both lumbar spine (LS) and femoral neck (FN) at week 48 without statistically significant differences. Conclusion Treatment-naïve HIV patients have a high prevalence of low bone density. Treatment with TDF is associated with greater bone deterioration at 12 and 48 weeks. TAF seems to present similar early bone deterioration at 12 weeks which disappears at 48 weeks.
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Affiliation(s)
- Patricia Atencio
- Division of Infectious Diseases. Fundación Jiménez Díaz University Hospital. Research Health Institute, Autónoma de Madrid University (IIS-FJD, UAM). Madrid 28040. Spain
| | | | - Alfonso Cabello-Ubeda
- Division of Infectious Diseases. Fundación Jiménez Díaz University Hospital. Research Health Institute, Autónoma de Madrid University (IIS-FJD, UAM). Madrid 28040. Spain
| | - Patricia Llamas-Granda
- Bone and Joint Research Unit. Research Health Institute, Autónoma de Madrid University (IIS-FJD, UAM). Madrid 28040. Spain
| | - Ramón Pérez-Tanoira
- Division of Infectious Diseases. Fundación Jiménez Díaz University Hospital. Research Health Institute, Autónoma de Madrid University (IIS-FJD, UAM). Madrid 28040. Spain
| | - Laura Prieto-Pérez
- Division of Infectious Diseases. Fundación Jiménez Díaz University Hospital. Research Health Institute, Autónoma de Madrid University (IIS-FJD, UAM). Madrid 28040. Spain
| | - Beatriz Álvarez Álvarez
- Division of Infectious Diseases. Fundación Jiménez Díaz University Hospital. Research Health Institute, Autónoma de Madrid University (IIS-FJD, UAM). Madrid 28040. Spain
| | - Irene Carrillo Acosta
- Division of Infectious Diseases. Fundación Jiménez Díaz University Hospital. Research Health Institute, Autónoma de Madrid University (IIS-FJD, UAM). Madrid 28040. Spain
| | - Rosa Arboiro-Pinel
- Internal Medicine, Bone Disease Department. Fundación Jiménez Díaz University Hospital. Research Health Institute, Autónoma de Madrid University (IIS-FJD, UAM). Madrid 28040. Spain
| | - Manuel Díaz-Curiel
- Internal Medicine, Bone Disease Department. Fundación Jiménez Díaz University Hospital. Research Health Institute, Autónoma de Madrid University (IIS-FJD, UAM). Madrid 28040. Spain
| | - Raquel Largo
- Bone and Joint Research Unit. Research Health Institute, Autónoma de Madrid University (IIS-FJD, UAM). Madrid 28040. Spain
| | - Gabriel Herrero-Beaumont
- Bone and Joint Research Unit. Research Health Institute, Autónoma de Madrid University (IIS-FJD, UAM). Madrid 28040. Spain
| | - Miguel Górgolas
- Internal Medicine, Bone Disease Department. Fundación Jiménez Díaz University Hospital. Research Health Institute, Autónoma de Madrid University (IIS-FJD, UAM). Madrid 28040. Spain
| | - Aránzazu Mediero
- Bone and Joint Research Unit. Research Health Institute, Autónoma de Madrid University (IIS-FJD, UAM). Madrid 28040. Spain
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Atencio P, Cabello A, Conesa-Buendía FM, Pérez-Tanoira R, Prieto-Pérez L, Carrillo I, Álvarez B, Arboiro-Pinel R, Díaz-Curiel M, Herrero-Beaumont G, Mediero A, Górgolas M. Increased risk factors associated with lower BMD in antiretroviral-therapy-naïve HIV-infected adult male. BMC Infect Dis 2021; 21:542. [PMID: 34107907 PMCID: PMC8188666 DOI: 10.1186/s12879-021-06263-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 05/26/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Low BMD (bone mineral density) has been described as a non-AIDS (Acquired Immune Deficiency Syndrome)-related event in HIV (human immunodeficiency virus)-patients but it is poorly studied in young HIV-infected men who have received no previous antiretroviral therapy. METHODS A cross-sectional study of 245 naïve-HIV-infected men over 21 and under 50 years old who voluntary attended the Infectious Disease Division appointment in Hospital Fundación Jimenez Díaz in Madrid, from January 1st, 2014 to September 30th, 2017. All subjects underwent a baseline DXA scan (dual energy x-ray absorptiometry) performed prior to start antiretroviral treatment. Further, all patients who started treatment between May 1st and September 30th, 2017 were invited to participate in a substudy on bone mineral metabolism. All the information was collected through clinical history and complementary questionnaire. RESULTS The mean age was 36.4 years, been 68% Caucasian, 29.3% Latin American and 2.7% African race. At the time of diagnosis, 91% of patients had stage-A (median CD4+ T-cell 481cells/μL, IQR, 320-659). 10% had a count below 200 CD4 cells/μL, and 40% had a CD4/CD8 cell-count-ratio below 0.4. Regarding lifestyle and risk factors, 14.1% presented underweight, 36.1% were not engage in any regular exercise, 51.9% were active smokers and 35.3% reported drug use. Low levels of vitamin D were seen in 87.6% of the study participants. Low BMD (Z-score <- 2.0) was found in 22.8% of the patients. It was only observed a significant association of Z-score in lumbar spine (LS) with CD8 and the CD4/CD8 ratio, and with alcohol for femoral neck (FN) measurement. CONCLUSIONS We find prevalence of increased bone involvement among naïve HIV-infected men under 50 years old. Further studies are necessary to evaluate if changes in actual guidelines are needed to assess BMD measurements in HIV-infected adult male patients under 50.
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Affiliation(s)
- Patricia Atencio
- Infectious Diseases Division, Fundación Jiménez Díaz University Hospital, Universidad Autónoma de Madrid, 28040, Madrid, Spain
| | - Alfonso Cabello
- Infectious Diseases Division, Fundación Jiménez Díaz University Hospital, Universidad Autónoma de Madrid, 28040, Madrid, Spain.
| | - Francisco M Conesa-Buendía
- Bone and Joint Research Unit, IIS-Fundación Jiménez Díaz, Universidad Autónoma de Madrid, 28040, Madrid, Spain
| | - Ramón Pérez-Tanoira
- Infectious Diseases Division, Fundación Jiménez Díaz University Hospital, Universidad Autónoma de Madrid, 28040, Madrid, Spain
| | - Laura Prieto-Pérez
- Infectious Diseases Division, Fundación Jiménez Díaz University Hospital, Universidad Autónoma de Madrid, 28040, Madrid, Spain
| | - Irene Carrillo
- Infectious Diseases Division, Fundación Jiménez Díaz University Hospital, Universidad Autónoma de Madrid, 28040, Madrid, Spain
| | - Beatriz Álvarez
- Infectious Diseases Division, Fundación Jiménez Díaz University Hospital, Universidad Autónoma de Madrid, 28040, Madrid, Spain
| | - Rosa Arboiro-Pinel
- Internal Medicine, Metabolic Bone Diseases Unit, Fundación Jiménez Díaz University Hospital, Universidad Autónoma de Madrid, 28040, Madrid, Spain
| | - Manuel Díaz-Curiel
- Internal Medicine, Metabolic Bone Diseases Unit, Fundación Jiménez Díaz University Hospital, Universidad Autónoma de Madrid, 28040, Madrid, Spain
| | - Gabriel Herrero-Beaumont
- Bone and Joint Research Unit, IIS-Fundación Jiménez Díaz, Universidad Autónoma de Madrid, 28040, Madrid, Spain
| | - Aránzazu Mediero
- Bone and Joint Research Unit, IIS-Fundación Jiménez Díaz, Universidad Autónoma de Madrid, 28040, Madrid, Spain
| | - Miguel Górgolas
- Infectious Diseases Division, Fundación Jiménez Díaz University Hospital, Universidad Autónoma de Madrid, 28040, Madrid, Spain
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Dalla Grana E, Rigo F, Lanzafame M, Lattuada E, Suardi S, Mottes M, Valenti MT, Dalle Carbonare L. Relationship Between Vertebral Fractures, Bone Mineral Density, and Osteometabolic Profile in HIV and Hepatitis B and C-Infected Patients Treated With ART. Front Endocrinol (Lausanne) 2019; 10:302. [PMID: 31139152 PMCID: PMC6527878 DOI: 10.3389/fendo.2019.00302] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 04/26/2019] [Indexed: 01/08/2023] Open
Abstract
Objective: The purpose of our study was to evaluate the alterations of bone metabolism and the prevalence of vertebral fractures in the population with HIV and hepatitis B and C seropositivity in treatment with antiretroviral drugs (HAART). Methods: We selected 83 patients with diagnosis of HIV, HBV, HCV infection. In all these patients biochemical examinations of phospho-calcium metabolism and a densitometry of lumbar spine were performed. We also evaluated lateral spine X-rays in order to analyze the presence of vertebral deformities and to define their severity. As a control group we analyzed the prevalence of vertebral fractures in a group of 40 non-infectious patients. Results: We selected 82 seropositive patients, 46 males and 37 females, with a median age of 55 ± 10 years. Out of these patients, 55 were infected by HIV, 12 were infected by HBV, 11 presented HIV and HCV co-infection and 4 were HCV+. The prevalence of hypovitaminosis D in the studied population was 53%, while the prevalence of osteoporosis and osteopenia was 14 and 48%, respectively. The average T-score in the fractured population was -1.9 SD. The viral load and the CD4+ cell count were respectively, directly, and inversely correlated with the number and severity of vertebral fractures. Antiretroviral therapy regimen containing TDF and PI was a significant determinant of the presence of vertebral deformities. The use of these drugs was also associated with lower levels of vitamin D and higher bone turnover levels compared to other antiretroviral drugs. Conclusions: HIV patients suffer from bone fragility, particularly at spine, independently by the level of bone mineral density. In this population, the T-score threshold for the risk of fracture is higher than that usually used in general population. For this reason, it would be indicated to perform an X-ray of the spine in order to detect vertebral deformities even in patients with a normal or slighlty reduced bone mineral density.
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Affiliation(s)
- Elisa Dalla Grana
- Internal Medicine Section D, Department of Medicine, University of Verona, Verona, Italy
| | - Fabio Rigo
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | | | - Emanuela Lattuada
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Silvia Suardi
- Internal Medicine Section D, Department of Medicine, University of Verona, Verona, Italy
| | - Monica Mottes
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Maria Teresa Valenti
- Internal Medicine Section D, Department of Medicine, University of Verona, Verona, Italy
| | - Luca Dalle Carbonare
- Internal Medicine Section D, Department of Medicine, University of Verona, Verona, Italy
- *Correspondence: Luca Dalle Carbonare
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