Showing papers by "Elena Ricci published in 2011"

The burden of metabolic diseases amongst HIV positive patients on HAART attending The Johannesburg Hospital.

Abstract: South Africa has the highest prevalence of human immunodeficiency virus (HIV) infection in the world. The improved life expectancy, due to the recent introduction of highly active antiretroviral therapy (HAART), may lead to an increased health burden related to metabolic disorders, resulting in an increased pressure on health-care services. The main objective of this study was to determine the prevalence of hypertension, diabetes, obesity and dyslipidemia in a sample of HAART-treated HIV infected patients, attending an HIV clinic in the Gauteng province. This was a cross-sectional study of 304 HIV positive patients enrolled between January 2009 and March 2009, including patients aged 18 to 45 years, on HAART for more than one year. Hypertension prevalence was 19.1% (95% confidence interval (CI) 14.7-23.5): 23.9% in men and 17.7% in women (P=0.10). Diabetes was diagnosed in 4 women. Hypercholesterolemia (total cholesterol >5.00 mmol/mL) was found in 32.2% (95% CI 27.0-37.5), low HDL cholesterol ( 4.10 mmol/mL) in 9.5% (95% CI 6.2-12.8); these prevalences were not different between sexes, whereas hypertriglyceridemia (>2.25 mmol(mL) (15.8%, 95% CI 11.7-19.9) was significantly more frequent in men (28.4% versus 12.2%, P=0.002). TC and LDL-C were positively correlated with CD4+ cell count (r=0.13, P=0.03 and r=0.12, P=0.03). In this sample, the traditional risk factors for cardiovascular disease had a high prevalence, despite the young age of our patients. Women seemed to be at higher risk than man, unlike other HIV populations where these comparisons were made (Uganda, Italy and Norway). Obesity and lipid abnormalities, highly prevalent in the general population, also appeared related to HIV-infection and CD4+ cell count, presumably as a consequence of ART exposure. Further studies are needed in order to survey a population where HIV infection is turning into a chronic disease, with its complications.

The cost of HIV disease in Northern Italy: The payer's perspective

Abstract: Background: Healthcare expenditures incurred by the Health Service for HIV-infected patients have not been reported in Italy. Objective: To present health care costs for HIV-infected patients in the Lombardy Region, in 2004-2007, to determine the clinical characteristics of HIV infection associated with costs. Methods: Retrospective, observational, budget impact study, based on information collected for the period 2004-2007, including hospitalizations, outpatient services, highly active antiretroviral therapy (HAART) and non-HAART drug utilization. Inclusion criteria includes: confirmed HIV infection, age ≥18 years, resident in Lombardy Region, and followed at the "L. Sacco" Hospital in Milan from 2004 to 2007. Results: The mean total cost per year to provide healthcare to HIV-positive patients was rather stable (€9658.36 in 2004 and €9745.65 in 2007 (+0.90%)); HAART represented more than 60% of the total cost. We found that hepatitis C virus coinfection was related to higher costs (€11,003.45 vs. €8896.06), as well as CD4 cell count <200 cells/mm 3 (€12,681.36 vs. €9594.11 and €9450.36 in 200-499 and ≥500 cells/mm 3 , respectively). The mean total cost of HIV health care was higher in patients who initiated antiretroviral treatment before 1997 than in those who started after 1996. Conclusions: The mean total cost per year to provide health care to HIV-positive patients was stable during the period 2004-2007, with an increase of HAART percentage impact on the total cost. Several clinical characteristics of HIV-infected patients were significantly associated with cost variation.

Secondary hyperparathyroidism in HIV patients: is there any responsibility of highly active antiretroviral therapy?

Abstract: Secondary hyperparathyroidism may develop in the presence of hypovitaminosis D in order to maintain calcium homeostasis. We conducted a cross-sectional analysis in a cohort of 371 patients, identifying secondary hyperparathyroidism in 65 patients. This high prevalence (17.5%) was in part justified by the high prevalence of hypovitaminosis D (77.4%) in the whole sample, but we also identified an independent association with the use of tenofovir.

Homocysteine, red cell, and plasma folate concentrations and birth weight in Italian women: results from a prospective study.

Abstract: Objective. A prospective cohort study conducted in Italy on homocysteine and red cell folate levels in pregnancy and pregnancy outcome.Methods. A cohort of pregnant women was identified in 21 Italian obstetric centers. Women were eligible at 8th–10th week of gestation. All women were followed up to delivery in order to collect information on pregnancy outcome and birth weight (BW).Results. Two hundred forty-four women were included in the analysis. In women not reporting current use of folate at study entry, the median homocysteine levels (μmol/l) were 7.9, 8.1, and 8.5 at the 8th–10th, 16th, and 22nd week of gestation, respectively; the median red cells folate levels (nmol/dl) were 3.9, 6.1, and 7.0. The mean BW tended to be lower in the 2nd and 3rd tertile of homocysteine levels in comparison with the 1st tertile (p < 0.05 at the 8th–10th and 22nd week). The mean week of gestation at birth was higher in subjects in the 2nd and 3rd tertile of red cell folate at the 8th–10th and 16th week of gestation.Con...

Eligibility and feasibility of the treatment of chronic hepatitis C in a Cohort of Italian HIV-positive patients at a single HIV reference center.

Abstract: Chronic hepatitis C is frequent and aggressive among HIV-positive patients; evaluation for anti-hepatitis C virus (HCV)-specific therapy is mandatory, but it has many limitations, due to efficacy, tolerability but also applicability. The objective of our retrospective analysis was to evaluate the eligibility and feasibility of anti-HCV therapy in HIV/HCV-coinfected patients followed at the II Department of Infectious Diseases, L. Sacco Hospital, Milan, Italy, from 2000 to March 2010. In our database, 545 HIV/HCV-coinfected patients were present, representing 40% of our whole HIV population, and 421 included in the analysis. One hundred twenty-four patients were excluded because of loss to follow-up (81) or deceased (43). Forty-eight patients spontaneously cleared HCV during follow-up (11%). Ninety-nine patients received anti-HCV therapy (26%), while the majority was excluded for several reasons (mainly concomitant diseases and low CD4+ cell count). Globally, we found that in at least one third of...

Waist circumference and body mass index in HIV infection.

Abstract: GVL De Socio, E Ricci, P Bonfanti, T Quirino and G Schillaci Department of Infectious Diseases, Hospital ‘Santa Maria della Misericordia’, Perugia, Italy, Department of Infectious Diseases, Luigi Sacco Hospital, Milan, Italy, Department of Infectious Diseases, Busto Arsizio Hospital, Busto Arsizio (BM), Italy and Department of Internal Medicine, Angiology Arteriosclerosis, University of Perugia, Perugia, Italy