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Eugènia Negredo Fundació Lluita contra la Sida Hospital Germans Trias i Pujol Badalona

TOXICIDAD SECUNDARIA AL TRATAMIENTO ANTIRRETROVIRAL Y VIH. Eugènia Negredo Fundació Lluita contra la Sida Hospital Germans Trias i Pujol Badalona. 13 Marzo 2012. # 1130. Causas de muerte. 90 centros en Francia. N=82.000 pacientes. Cardiovascular Biomarcadores inflamatorios

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Eugènia Negredo Fundació Lluita contra la Sida Hospital Germans Trias i Pujol Badalona

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  1. TOXICIDAD SECUNDARIA AL TRATAMIENTO ANTIRRETROVIRAL Y VIH Eugènia Negredo Fundació Lluita contra la Sida Hospital Germans Trias i Pujol Badalona 13 Marzo 2012

  2. # 1130. Causas de muerte 90 centros en Francia. N=82.000 pacientes

  3. Cardiovascular • Biomarcadores inflamatorios • Marcadores subclínicos • Eventos clínicos

  4. Biomarcadores de inflamación Abstracts  829-843, 1052-1057 Jason Baker #177. James Stein (cardiólogo) The value of biomarker research • VIH e inflamación: • Tamaño muestral pequeño • Observacionales • Seguimiento corto • “Inconsistent results but promising. • Treat the HIV and CVRF.”

  5. Asymmetric Dimethylarginine (ADMA) Nuevo marcador de inflamación. Marcador de disfunción arterial. Inhibidor competitivo de oxido nitroso endotelial. Consecuenciasdilatación arterial / aterosclerosis / eventos CV y muerte

  6. Asymmetric Dimethylarginine (ADMA) # 831. J Baker # 832. K Kurz # 833. R Parikh, P Shue 48sem ADMA 10,3%(p=0.003) 12sem ADMA (p<0.001) neopterina (p<0.001) VIH+  ADMA vs VIH-  CD4   ADMA  CV VIH   ADMA? VIH disfunción arterial por  ADMA (producción o eliminación?) ARV  mejora función endotelial mediada por ON a través ADMA

  7. Marcadores subclínicos Abstracts: 801-816  Ultrasonidos (cIMT)  RM (CAC)  Disfunción endotelial

  8. # 122. Microbial translocation and progression of atherosclerosis.T Kelesidis. Objective: RANKL, LPS, sCD14, dys-HDL progression of CIMT Stored samples from a prospective 3-year study (ACTG 5078) of carotid intima-media thickness (CIMT) Study population: - HIV+ (HIV RNA <500 copies/mL) n=55: - PI, n = 29; - NNRTI, n = 26 - HIV– (n = 36) matched for age, smoking status, and race.

  9. Multivariate analysis (HIV+): the yearly rate of change in cIMT - Every 10 mg/mL increase in sCD14 15.2 mm/y (95%CI 0.66 to 29.8, p = 0.04) - Every 100 pg/mL increase in LPS  0.49 mm/y (CI 0.18 to 0.81, p = 0.003). -No significant association with dys-HDL and RANKL levels

  10. # 124. Statin and Risk of Serious Non-AIDS-Defining Events (ACTG ALLRT Cohort). Edgar Overton. N= 3601 subjects who initiated ART, not on a statin at ALLRT entry. Primary endpoint: time to first major clinical event (CV event, renal or hepatic disease, incident diabetes, thrombotic or embolic event, non-traumatic fracture, non-AIDS-defining malignancy, serious bacterial infection, or non-accidental death).

  11. “Estatinas” “No-estatinas” - Reducción del 18% en el tiempo a primer evento (p=ns). - Reducción del 55% en neoplasias (aHR 0.45 (0.21 to 0.97).

  12. # 823.ATV Is Not Associated with an Increased Risk of CV Events (D:A:D). A d’Arminio Monforte 27.125 pers/año con ATV // 274.728 pers/año sin ATV

  13. METABOLISMO ÓSEO Factores predisponentes Intervención

  14. #125LB. Switching from AZT/3TC to TVD on Bone Mineral Density (Sub-study of PREPARE Study) Aoife Cotter

  15. # 878.Switch from Tenofovir to Raltegravir (TROP Study). Mark Bloch Estudio multicéntrico, no-randomizado. N= 37 pacientes con t-score <-1 SD en lumbar o femur. IP/r + TDF…  IP/r + RAL…

  16. # 886. Vitamin D Insufficiency Is Associated with HIV Disease Progression and Death.Fiona Havers

  17. TOXICIDAD RENAL Métodos diagnósticos Riñón y TDF

  18. # 862. Validation of eGFR equations compared with isotopic GFR. Eiam-Ong. 99mTc DTPA plasma clearence GFR N=196 naive; N=186 ARV eGFR infraestima el GFR Cistatina C y MDRD  metodos más aproximados.

  19. # 865. Exposure to ARV and the Risk of Renal Impairment ( D:A:D). Lene Ryom 22.603 pacientes con FGR normal en basal  2,1% progresaron a FGR<70.  0,6% a IRC (FGR<60) Pacientes con TDF, ATV i LPV progresaron más a “descenso de FGR”, como los factores riesgo tradicionales. Cambios de TDF, pero no de ATV o LPV. Monotorizar a éstos.

  20. # 870.Immune Status Plays a Key Role in Renal Recovery in Patients with Tenofovir-related Nephrotoxicity. Anna Bonjoch.

  21. Muchas gracias

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