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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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Ekali LG, Johnstone LK, Echouffo-Tcheugui JB, Kouanfack C, Dehayem MY, Fezeu L, Nouthe B, Hayes L, Unwin NC, Sobngwi E. Fasting blood glucose and insulin sensitivity are unaffected by HAART duration in Cameroonians receiving first-line antiretroviral treatment. DIABETES & METABOLISM 2012; 39:71-7. [PMID: 23153435 DOI: 10.1016/j.diabet.2012.08.012] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2012] [Revised: 08/20/2012] [Accepted: 08/21/2012] [Indexed: 10/27/2022]
Abstract
AIMS This study assessed the relationship between highly active antiretroviral therapy (HAART) duration and cardiometabolic disorders in HIV-infected Cameroonians. METHODS HIV-infected Cameroonians aged 21 years or above were cross-sectionally recruited at the Yaoundé Central Hospital, a certified HIV care centre, and their anthropometry, body composition (impedancemetry), fasting blood glucose (FBG) and lipid levels, and insulin sensitivity (IS; short insulin tolerance test) were measured. RESULTS A total of 143 participants with various durations of HAART [treatment-naïve (n=28), 1-13 months (n=44), 14-33 months (n=35) and 34-86 months (n=36)] were recruited. They were mostly women (72%), and had a mean age of 39.5 (SD: 9.8) years. Half (52%) were using a stavudine-containing regimen. There was a significant trend towards a positive change in body mass index and waist-to-hip ratio with increasing duration of HAART (all P=0.02). Systolic (P=0.04) and diastolic (P=0.03) blood pressure, total cholesterol (P=0.01), prevalence of hypertension (P=0.04) and hypercholesterolaemia (P=0.007) were also significantly increased with HAART duration, whereas triglycerides, FBG and IS were unaffected. Clustering of metabolic disorders increased (P=0.02 for ≥1 component of the metabolic syndrome and P=0.09 for ≥2 components) with HAART duration. CONCLUSION HAART duration is associated with obesity, fat distribution, blood pressure and cholesterol levels in HIV-infected Cameroonians, but does not appear to significantly affect glucose metabolism.
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Affiliation(s)
- L G Ekali
- Department of Internal Medicine, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
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Marcel AK, Ekali LG, Eugene S, Arnold OE, Sandrine ED, von der Weid D, Gbaguidi E, Ngogang J, Mbanya JC. The effect of Spirulina platensis versus soybean on insulin resistance in HIV-infected patients: a randomized pilot study. Nutrients 2011; 3:712-24. [PMID: 22254118 PMCID: PMC3257696 DOI: 10.3390/nu3070712] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2011] [Revised: 06/23/2011] [Accepted: 06/27/2011] [Indexed: 01/12/2023] Open
Abstract
UNLABELLED HIV-infected patients develop abnormalities of glucose metabolism due to the virus and antiretroviral drugs. Spirulina and soybean are nutritional supplements that are cheap, accessible in our community and affect glucose metabolism. We carried out a randomized study to assess the effect of Spirulina platensis versus soybean as a food supplement on HIV/HAART-associated insulin resistance (IR) in 33 insulin-resistant HIV-infected patients. The study lasted for two months at the National Obesity Centre of Cameroon. Insulin resistance was measured using the short insulin tolerance test. Physical activity and diet did not change over the study duration. On-treatment analysis was used to analyze data. The Mann-Whitney U test, the Students T test and the Chi square test were used as appropriate. Curve gradients were analyzed using ANCOVA. Seventeen subjects were randomized to spirulina and 16 to soybean. Each received 19 g of supplement daily. The follow up rate was 65% vs. 100% for spirulina and soybean groups, respectively, and both groups were comparable at baseline. After eight weeks, insulin sensitivity (IS) increased by 224.7% vs. 60% in the spirulina and soybean groups respectively (p < 0.001). One hundred per cent vs. 69% of subjects on spirulina versus soybean, respectively, improved their IS (p = 0.049) with a 1.45 (1.05-2.02) chance of improving insulin sensitivity on spirulina. This pilot study suggests that insulin sensitivity in HIV patients improves more when spirulina rather than soybean is used as a nutritional supplement. TRIAL REGISTRATION ClinicalTrials.gov identifier NCT01141777.
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Affiliation(s)
- Azabji-Kenfack Marcel
- Department of Physiological Sciences and Biochemistry, Faculty of Medicine and Biomedical Sciences, University of Yaounde 1, Melen Street, Cameroon; (E.D.S.); (J.N.)
| | - Loni G. Ekali
- Department of Internal Medicine, Faculty of Medicine and Biomedical Sciences, University of Yaounde 1, Melen Street, Cameroon; (L.G.E.); (S.E.); (O.E.A.); (J.C.M.)
| | - Sobngwi Eugene
- Department of Internal Medicine, Faculty of Medicine and Biomedical Sciences, University of Yaounde 1, Melen Street, Cameroon; (L.G.E.); (S.E.); (O.E.A.); (J.C.M.)
| | - Onana E. Arnold
- Department of Internal Medicine, Faculty of Medicine and Biomedical Sciences, University of Yaounde 1, Melen Street, Cameroon; (L.G.E.); (S.E.); (O.E.A.); (J.C.M.)
| | - Edie D. Sandrine
- Department of Physiological Sciences and Biochemistry, Faculty of Medicine and Biomedical Sciences, University of Yaounde 1, Melen Street, Cameroon; (E.D.S.); (J.N.)
| | - Denis von der Weid
- Antenna Technologies Foundation, Rue de Neuchâtel 29 1201 Geneva, Switzerland;
| | | | - Jeanne Ngogang
- Department of Physiological Sciences and Biochemistry, Faculty of Medicine and Biomedical Sciences, University of Yaounde 1, Melen Street, Cameroon; (E.D.S.); (J.N.)
| | - Jean C. Mbanya
- Department of Internal Medicine, Faculty of Medicine and Biomedical Sciences, University of Yaounde 1, Melen Street, Cameroon; (L.G.E.); (S.E.); (O.E.A.); (J.C.M.)
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Andrade ASA, Hendrix C, Parsons TL, Caballero B, Yuan CS, Flexner CW, Dobs AS, Brown TT. Pharmacokinetic and metabolic effects of American ginseng (Panax quinquefolius) in healthy volunteers receiving the HIV protease inhibitor indinavir. BMC COMPLEMENTARY AND ALTERNATIVE MEDICINE 2008; 8:50. [PMID: 18713456 PMCID: PMC2542349 DOI: 10.1186/1472-6882-8-50] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/08/2008] [Accepted: 08/19/2008] [Indexed: 02/07/2023]
Abstract
BACKGROUND Complementary and alternative medicine (CAM) use is prevalent among HIV-infected patients to reduce the toxicity of antiretroviral therapy. Ginseng has been used for treatment of hyperglycemia and insulin resistance, a common side effect of some HIV-1 protease inhibitors (PI). However, it is unknown whether American ginseng (AG) can reverse insulin resistance induced by the PI indinavir (IDV), and whether these two agents interact pharmacologically. We evaluated potential pharmacokinetic interactions between IDV and AG, and assessed whether AG improves IDV-induced insulin resistance. METHODS After baseline assessment of insulin sensitivity using the insulin clamp technique, healthy volunteers received IDV 800 mg q8 h for 3 days and then IDV and AG 1g q8h for 14 days. IDV pharmacokinetics and insulin sensitivity were assessed before and after AG co-administration. RESULTS There was no difference in the area-under the plasma-concentration-time curve after the co-administration of AG, compared to IDV alone (n = 13). Although insulin-stimulated glucose disposal per unit of insulin (M/I) decreased by an average of 14.8 +/- 5.9% after 3 days of IDV (from 0.113 +/- 0.012 to 0.096 +/- 0.014 mg/kgFFM/min per muU/ml of insulin, p = 0.03, n = 11), M/I remained unchanged after co-administration of IDV and AG. CONCLUSION IDV decreases insulin sensitivity, which is unaltered by AG co-administration. AG does not significantly affect IDV pharmacokinetics.
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Affiliation(s)
- Adriana SA Andrade
- Division of Infectious Diseases, The Johns Hopkins University, Baltimore, MD 21287, USA
| | - Craig Hendrix
- Division of Clinical Pharmacology, The Johns Hopkins University, Baltimore, MD 21287, USA
| | - Teresa L Parsons
- Division of Clinical Pharmacology, The Johns Hopkins University, Baltimore, MD 21287, USA
| | - Benjamin Caballero
- Department of Human Nutrition, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Chun-Su Yuan
- Tang Center for Herbal Medicine Research, Department of Anesthesia and Critical Care, Pritzker School of Medicine, University of Chicago, Chicago, IL 60637, USA
| | - Charles W Flexner
- Division of Clinical Pharmacology, The Johns Hopkins University, Baltimore, MD 21287, USA
| | - Adrian S Dobs
- Division of Endocrinology and Metabolism, Department of Medicine, Johns Hopkins University, Baltimore, MD 21287, USA
| | - Todd T Brown
- Division of Endocrinology and Metabolism, Department of Medicine, Johns Hopkins University, Baltimore, MD 21287, USA
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Mayer KH, Bradford JB, Makadon HJ, Stall R, Goldhammer H, Landers S. Sexual and gender minority health: what we know and what needs to be done. Am J Public Health 2008; 98:989-95. [PMID: 18445789 PMCID: PMC2377288 DOI: 10.2105/ajph.2007.127811] [Citation(s) in RCA: 441] [Impact Index Per Article: 27.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/04/2007] [Indexed: 11/04/2022]
Abstract
We describe the emergence of lesbian, gay, bisexual, and transgender (LGBT) health as a key area of study and practice for clinicians and public health professionals. We discuss the specific needs of LGBT populations on the basis of the most recent epidemiological and clinical investigations, methods for defining and measuring LGBT populations, and the barriers they face in obtaining appropriate care and services. We then discuss how clinicians and public health professionals can improve research methods, clinical outcomes, and service delivery for lesbian, gay, bisexual, and transgender people.
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Affiliation(s)
- Kenneth H Mayer
- Infectious Diseases Division, The Miriam Hospital, 164 Summit Avenue, Providence, RI 02906, USA.
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Wierzbicki AS, Purdon SD, Hardman TC, Kulasegaram R, Peters BS. HIV lipodystrophy and its metabolic consequences: implications for clinical practice. Curr Med Res Opin 2008; 24:609-24. [PMID: 18208641 DOI: 10.1185/030079908x272742] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND The introduction of highly active antiretroviral therapy (HAART) around 1996 markedly reduced mortality and morbidity from human immunodeficiency virus (HIV) infection. As life expectancy has improved, the chronic complications of HIV and HAART have become increasingly relevant. SCOPE This article provides an overview of the HIV-associated lipodystrophy, its pathogenesis and its clinical consequences (based on a search strategy in PubMed including literature published to November 2007). FINDINGS Lipodystrophy syndrome is characterized by abnormal fat distribution syndrome associated with metabolic disturbances and includes insulin resistance, deranged glucose and lipid metabolism. It is associated with increased risks of progression to type 2 diabetes and cardiovascular disease. Robust diagnostic criteria are required for lipodystrophy, and subsequent prospective cohort studies and randomized controlled trials are then required to determine the etiology and prognosis of lipodystrophy, and to evaluate therapeutic interventions for this consequence of HAART. Therapies to improve insulin resistance have been tried but they are frequently ineffective, and are limited by potential toxicity in this population. Hence, current management options for HIV associated lipodystrophy are limited and are mostly based on avoidance of risk factors and switching of antiretroviral drugs. CONCLUSION As the '3 by 5 strategy' of providing HIV drugs to the developing world is implemented worldwide, the numbers of patients adhering to antiretroviral medicines is dramatically increasing. One must be aware that in reducing the burden of acute retroviral disease, the treatments proposed might lead to significant rates of metabolic complications and further exacerbation of the epidemic of diabetes and cardiovascular disease.
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