Alterazioni del grasso corporeo:

Il ritorno di antichi fantasmi?

Antonella Castagna

David Lowery, 2017

Diagnosis and treatment of lipodistrophy: a step-by-step

approach

D. Araujo-Vilar

ENDOCRINOL METABOL CLIN N AM 2016

Potential causes of inflammageing

Ferrucci F, NrC, 2018

Inflammageing is a risk factor for multiple chronic diseases

Ferrucci F, NrC, 2018

Heart Fat in HIV: marker or mediator of risk?

Curr Opin HIV AIDS, 2017

WHAT ABOUT TAF ?

Fletcher C, CROI 2019

What is LDL Cholesterol?

Holmes MV, NrC , 2019

Mills A, et al. JAIDS 2015

Switch study (TANGO)

Phase III, randomised, multicentre, parallel-group, non-inferiority study

• Objective: To demonstrate the non-inferior antiviral activity of switching to DTG/3TC QD

compared with continuation of current ARV regimen over 48 weeks in HIV-1-infected

ART-experienced subjects

• Primary endpoint: The proportion of participants who meet the snapshot virological failure

criteria at week 48 using the ITT-E population

– Non-inferiority margin = 4%; week 48 primary endpoint

TAF-based

regimens

TAF-based

regimens

Randomisation

1:1N=600

Randomisation

1:1N=600

DTG/3TC

Primary

endpoints

Secondary

endpoints

Baseline Week 24 Week 48 Week 96 Week 144

TAF-based regimensTAF-based regimens

North America + EU + international

JA LAKE, CROI 2019

Bernardino J, 2019

Homeostatic model assessment for insulin resistance (HOMA-IR) index trajectories in HIV-infected patients treated with first-line

antiretroviral regimens based on non-nucleoside reverse transcriptase inhibitors (NNRTIs), ritonavir-boosted protease

inhibitors (PIs/r) or on integrase strand transfer inhibitors (InSTIs)

Muccini Camilla1, Gianotti Nicola2, Galli Laura2, Poli Andrea2, Galizzi Nadia1, Dell’Acqua

Raffaele3, Mastrangelo Andrea1, Messina Emanuela2, Piatti Pier Marco4, Lazzarin

Adriano2, Castagna Antonella1,2

1Vita-Salute San Raffaele University, Milan, Italy;

2IRCCS San Raffaele Scientific Institute, Milan, Italy;

3University Hospital Policlinico, Bari, Italy;

4Cardiometabolic Clinical Trials Unit, Internal Medicine Department, IRCCS San Raffaele Scientific Institute, Milan, Italy

ICAR 10° congresso nazionale, Roma 22-24 maggio 2018

OC64

Submitted, JMV

• Retrospective analysis on a cohort of HIV-1 infected patients followed at the Infectious Diseases Unit of the San Raffaele Hospital of Milan:

• who started antiretroviral therapy (ART) since 2007;

• with 2 NRTIs (tenofovir, abacavir, lamivudine or emtricitabine) and 1 anchor drug [ritonavir-boosted PI, non-NRTI or integrase strand transfer inhibitor (InSTI)];

• with 1 HOMA-IR determination before starting ART and ≥1 determination after starting ART;

• Patients with known diabetes were excluded;

• Follow-up accrued from the start of ART (=baseline, BL) up to the stop of any drug of the regimen or lost to follow-up or data freezing (January, 22, 2018);

• Univariate and multivariate mixed linear models with random slope and intercept for each patient were fitted to estimate HOMA-IR changes according to the anchor drug.

Material and methods

Changes from baseline in HOMA-IR index according to the type of the initial ART regimen

Type of ART regimen

Univariate mixed linear model

Crude mean (95%CI) change in

HOMA-IR, units per yearP-value

INSTI 0.149 (0.012, 0.287) 0.034

NNRTI -0.071 (-0.174, 0.031) 0.174

PI/r 0.041 (-0.052, 0.134) 0.387

Inflammageing induces a catabolic state.

L Ferrucci, NrC 2019

LT Fourman, AIDS

2017

Ogni difficoltà su cui si sorvola diventa un fantasma che

turba il nostro sonnoF. Chopin

Tom’s Selfies

15

368

586

757

680

598 609635

660

588

101

15

145

207

253 261

215 203 215 218203

89

0

100

200

300

400

500

600

700

800

2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019

N° VISITE N° pazienti

Accessi al servizio di chirurgia plastica _ Data on File_ 180319_OSR

Normale

100 mg/dL

126 mg/dL 7,0 mmol/L

5,6 mmol/L

Normale

140 mg/dL

200 mg/dL 11,1 mmol/L

7,8 mmol/L

Adattamento dal rapporto di follow-up di The Expert Committee on the Diagnosis and Classification of

Diabetes Mellitus. Diabetes Care 2003;26:3160–3167

IFG IGT

Diabetemellito

Diabetemellito

Glicemiaa digiuno

Glicemia 2 ore dopoil carico di glucosio all’OGTT

PRE-DIABETE

About 50% of cases convert from NFG/NGT to diabetes

in less than 5 years