RESUMEN
OBJECTIVES: Facial lipoatrophy can be a stigmatizing side effect of antiretroviral (AVR) treatment for HIV-infected patients. We sought to evaluate the long-term efficacy and safety of a new formulation of hyaluronic acid that can be injected in larger amounts and into deeper skin layers during 3 years of follow-up. METHODS: Twenty patients received injections of Restylane SubQ(). Refill treatment was offered at 12 and 24 months. Treatment effects were evaluated using ultrasound, the Global Aesthetic Improvement Scale, visual analogue scale (VAS) and the Rosenberg self-esteem scale. RESULTS: Seventeen patients remained at 36 months. Mean (+/- standard deviation) total cutaneous thickness increased from 6 +/- 1 mm at baseline to 12 +/- 1 mm (P<0.001) at 36 months. Response rate (total cutaneous thickness >10 mm) was 70%. Fifteen patients classified their facial appearance as very much or moderately improved. VAS increased from 39 +/- 25 to 70 +/- 20 (P<0.05) and higher self-esteem scores were reported. Local swelling and tenderness after treatment was common. Persistent papules found in several patients after treatment were removed effectively with hyaluronidase injections. Three patients, treated only at baseline, still had higher total cutaneous thickness scores at 36 months. CONCLUSIONS: Our results indicate that a large particle hyaluronic acid formulation is a durable and well-tolerated dermal filler for treating HIV-positive patients with facial lipoatrophy.
Asunto(s)
Adyuvantes Inmunológicos/uso terapéutico , Antirretrovirales/efectos adversos , Cara , Infecciones por VIH/tratamiento farmacológico , Síndrome de Lipodistrofia Asociada a VIH/tratamiento farmacológico , Ácido Hialurónico/análogos & derivados , Adyuvantes Inmunológicos/efectos adversos , Antirretrovirales/uso terapéutico , Materiales Biocompatibles/efectos adversos , Materiales Biocompatibles/uso terapéutico , Dermatosis Facial/inducido químicamente , Dermatosis Facial/tratamiento farmacológico , Femenino , Estudios de Seguimiento , Síndrome de Lipodistrofia Asociada a VIH/inducido químicamente , Humanos , Ácido Hialurónico/efectos adversos , Ácido Hialurónico/química , Ácido Hialurónico/uso terapéutico , Hialuronoglucosaminidasa/uso terapéutico , Inyecciones Intradérmicas/métodos , Masculino , Persona de Mediana Edad , Tamaño de la Partícula , Satisfacción del Paciente , Procedimientos de Cirugía Plástica/métodos , Autoimagen , Resultado del TratamientoRESUMEN
OBJECTIVES: Facial lipoatrophy can be devastating for HIV-infected patients, with negative effects on self-esteem. In this study, we treated facial fat atrophy in the nasogenian area with hyaluronic acid (Restylane SubQ; Q-Med AB, Uppsala, Sweden). METHODS: Twenty patients were included in the study. Treatment effects were evaluated at baseline, and at weeks 6, 24 and 52 using ultrasound, the Global Aesthetic Improvement Scale, the Visual Analogue Scale and the Rosenberg Self-Esteem Scale. RESULTS: Mean (+/-standard deviation) total cutaneous thickness increased from 6+/-1 mm at baseline to 15+/-3 mm at week 6 (P<0.001), and declined to 10+/-2 mm at week 52 (P<0.001 vs baseline). The response rate (total cutaneous thickness >10 mm) was 100% at week 6, 85% at week 24 and 60% at week 52. At week 6, all of the patients classified their facial appearance as very much improved or moderately improved. They also reported increased satisfaction with their facial appearance and had higher self-esteem scores. At week 52, 15 of 19 patients still classified their facial appearance as very much improved or moderately improved, although the mean total cutaneous thickness had gradually declined. CONCLUSIONS: Our results indicate that Restylane SubQ is a useful and well-tolerated dermal filler for treating HIV-positive patients with facial lipoatrophy.
Asunto(s)
Adyuvantes Inmunológicos/uso terapéutico , Antirretrovirales/efectos adversos , Hemiatrofia Facial/tratamiento farmacológico , Infecciones por VIH/complicaciones , Ácido Hialurónico/análogos & derivados , Ácido Hialurónico/uso terapéutico , Hemiatrofia Facial/psicología , Hemiatrofia Facial/virología , Femenino , Infecciones por VIH/psicología , Humanos , Masculino , Persona de Mediana Edad , Satisfacción del Paciente , Autoimagen , Resultado del TratamientoRESUMEN
OBJECTIVES: To identify clinical factors associated with HIV-associated lipoatrophy and to evaluate body composition changes, blood pressure and lipid levels in lipoatrophic subjects 3-4 years after the atrophy diagnosis. METHODS: Clinical signs of lipoatrophy were assessed in 308 ambulant HIV-positive patients in 2000-2001. Possible clinical risk factors, such as age, gender, race, wasting, duration of HIV infection, presence or absence of AIDS diagnosis, viral load and CD4 count, and detailed information about drug treatment were analysed and explored in a multivariate model. Lipoatrophic white males with triceps skin fold <10 mm were re-examined after 44 months. Signs of lipoatrophy and associated factors, blood pressure, lipid levels, diet and level of exercise at first and second visits were compared. RESULTS: In the multivariate analysis, significant clinical risk factors for lipoatrophy were weight loss >7 kg compared to normal weight [odds ratio (OR) 3.76; 95% confidence interval (CI) 1.80-7.82; P<0.001], current and/or previous use of stavudine (OR 3.72; 95% CI 1.57-8.83; P=0.003) and duration of HIV infection >80 months (OR 2.28; 95% CI 1.13-4.59; P=0.021). Forty of 47 lipoatrophic white males with skin fold < 10 mm were available for re-examination. Of these, 15 (38%) no longer fulfilled the atrophy diagnosis (P<0.001). The prevalence of arm atrophy fell from 63 to 28% (P=0.001) and facial atrophy from 55 to 43% (P=0.23). Use of stavudine for < 36 months was significantly associated with lipoatrophy reversal (OR 5.00; 95% CI 1.15-21.80; P=0.032), but weight gain and increased CD4 count were not. Prevalence of hypertension increased from 28 to 50% (P=0.035), mean systolic blood pressure from 130+/-14 to 136+/-19 mmHg (P=0.021) and diastolic blood pressure from 82+/-10 to 87+/-12 mmHg (P<0.001). In spite of increased use of lipid-lowering drugs (from two to nine patients), levels of total cholesterol, high-density lipoprotein (HDL) cholesterol and triglycerides were unchanged. CONCLUSIONS: In this study, we found that weight loss >7 kg, use of stavudine and long duration of HIV infection were significant risk factors for clinical lipoatrophy. Clinical lipoatrophy was partly reversible, and <36 months on stavudine was significantly associated with atrophy reversal. The prevalence of hypertension and the yearly increase of mean blood pressure were disturbingly high in these patients. However, the number of patients in this study was limited, and prospective studies in larger cohorts are required to confirm these findings.
Asunto(s)
Síndrome de Lipodistrofia Asociada a VIH/fisiopatología , Hipertensión/fisiopatología , Tejido Adiposo/fisiopatología , Fármacos Anti-VIH/uso terapéutico , Presión Sanguínea/fisiología , Composición Corporal/fisiología , Recuento de Linfocito CD4 , Colesterol/sangre , HDL-Colesterol/sangre , Estudios de Cohortes , Dieta , Ejercicio Físico/fisiología , Síndrome de Lipodistrofia Asociada a VIH/complicaciones , Síndrome de Lipodistrofia Asociada a VIH/tratamiento farmacológico , Humanos , Hipertensión/complicaciones , Hipolipemiantes/uso terapéutico , Masculino , Factores de Riesgo , Factores Sexuales , Estavudina/uso terapéutico , Factores de Tiempo , Triglicéridos/sangre , Pérdida de Peso/fisiologíaRESUMEN
Highly active antiretroviral therapy (HAART) may induce dyslipidemia and thus increase the risk of future cardiovascular heart disease (CHD). In this cross-sectional study performed in 2000-2001, the prevalence of a Framingham CHD risk score of >20% in HIV-positive individuals treated or not treated with HAART was compared with that in age- and gender-matched controls. The study included 721 subjects: 219 HIV-positive individuals on HAART, 64 HIV-positive, HAART-naïve individuals, and 438 age- and gender-matched controls randomly selected from a simultaneous health survey. The prevalence of a 10-year estimated CHD risk of >20% was 11.9% in patients on HAART compared to 5.3% in controls ( P=0.004). The main contributors to the increased CHD risk in patients on HAART were increased prevalence of daily smoking (54.5% vs 30.1%; P<0.001), total cholesterol of >6.2 mmol/l (36.1% vs 21.7%; P<0.001), and HDL cholesterol of < 0.9 mmol/l (20.9% vs 8.0%; P<0.001). In HAART-naïve patients, the prevalence of a 10-year estimated CHD risk of >20% was 6.3% ( P=0.25 vs HAART patients, P=0.76 vs controls), the prevalence of daily smoking was 56.3% ( P=0.89 vs HAART patients, P<0.001 vs controls), the prevalence of total cholesterol >6.2 mmol/l was 9.4% ( P<0.001 vs HAART patients, P=0.019 vs controls), and the prevalence of HDL cholesterol of <0.9 mmol/l was 30.9% ( P=0.16 vs HAART patients, P<0.001 vs controls). The results show that, compared to controls, twice as many patients on HAART have an estimated 10-year CHD risk above 20%. These patients are candidates for intensive interventions. HAART patients should be encouraged to permanently stop smoking, make healthy food choices, and increase physical activity. In patients with elevated lipid levels, a change in the HAART regimen or treatment with lipid-lowering drugs should be considered.
Asunto(s)
Terapia Antirretroviral Altamente Activa/efectos adversos , Enfermedades Cardiovasculares/inducido químicamente , Infecciones por VIH/tratamiento farmacológico , Indicadores de Salud , Hiperlipidemias/inducido químicamente , Adulto , Terapia Antirretroviral Altamente Activa/métodos , Enfermedades Cardiovasculares/epidemiología , Estudios de Casos y Controles , Estudios Transversales , Femenino , Infecciones por VIH/diagnóstico , Infecciones por VIH/mortalidad , Humanos , Hiperlipidemias/epidemiología , Masculino , Persona de Mediana Edad , Noruega/epidemiología , Prevalencia , Probabilidad , Valores de Referencia , Medición de Riesgo , Sensibilidad y Especificidad , Análisis de SupervivenciaRESUMEN
Highly active antiretroviral therapy (HAART) may induce dyslipidemia, insulin resistance and body fat distribution similar to that seen in the metabolic syndrome. Hypertension is often a part of the classic metabolic syndrome, but few studies are published about hypertension in HIV-positive patients on HAART. The aim of this study was to compare the prevalence of hypertension in HIV-positive patients on HAART with that in HIV-positive/HAART-naïve patients and HIV-negative controls. The cross-sectional study included 283 unselected HIV-positive ambulatory patients, 219 who were on HAART and 64 who were HAART-naïve. Age- and gender-matched controls (n=438) were randomly selected from a simultaneous health survey of the general population. The prevalence of hypertension was 21% in patients on HAART, 13% in HAART-naïve patients (P=0.20), and 24% in HIV-negative controls (P=0.28). Among several possible risk factors for hypertension, only body mass index (BMI) was found to be a confounder. BMI was similar in HAART-treated and HAART-naïve patients but elevated in controls compared to HAART-treated patients. After adjustment for BMI, the prevalence of hypertension in HIV-negative controls was slightly lower than that in patients on HAART (P=0.29). The results demonstrated a prevalence of hypertension in patients on HAART similar to that in HIV-negative controls. The prevalence of hypertension was somewhat higher in patients on HAART compared to HAART-naïve patients, but the difference was not statistically significant. Considering the marked drop in mortality following antiretroviral therapy, we conclude that the possible influence of HAART on the prevalence of hypertension appears to be a minor problem.
Asunto(s)
Terapia Antirretroviral Altamente Activa/efectos adversos , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/epidemiología , Hipertensión/epidemiología , Adulto , Distribución por Edad , Determinación de la Presión Sanguínea , Estudios de Casos y Controles , Estudios de Cohortes , Comorbilidad , Femenino , Estudios de Seguimiento , Infecciones por VIH/diagnóstico , Seronegatividad para VIH , Seropositividad para VIH , Humanos , Hipertensión/diagnóstico , Hipertensión/tratamiento farmacológico , Modelos Logísticos , Masculino , Persona de Mediana Edad , Noruega/epidemiología , Prevalencia , Probabilidad , Valores de Referencia , Medición de Riesgo , Índice de Severidad de la Enfermedad , Distribución por Sexo , Estadísticas no ParamétricasRESUMEN
We study the ABC model ( A + B mapsto 2 B, B + C mapsto 2 C, C + A mapsto 2 A), and its counterpart: the three-component neutral drift model ( A + B mapsto 2 A or 2 B, B + C mapsto 2 B or 2 C, C + A mapsto 2 C or 2 A.) In the former case, the mean-field approximation exhibits cyclic behaviour with an amplitude determined by the initial condition. When stochastic phenomena are taken into account the amplitude of oscillations will drift and eventually one and then two of the three species will become extinct. The second model remains stationary for all initial conditions in the mean-field approximation, and drifts when stochastic phenomena are considered. We analyzed the distribution of first extinction times of both models by simulations of the master equation, and from the point of view of the Fokker-Planck equation. Survival probability vs. time plots suggest an exponential decay. For the neutral model the extinction rate is inversely proportional to the system size, while the cyclic model exhibits anomalous behaviour for small system sizes. In the large system size limit the extinction times for both models will be the same. This result is compatible with the smallest eigenvalue obtained from the numerical solution of the Fokker-Planck equation. We also studied the behaviour of the probability distribution. The exponential decay is found to be robust against certain changes, such as the three reactions having different rates.
RESUMEN
Most bacteria in the ocean can be motile. Chemotaxis allows bacteria to detect nutrient gradients, and hence motility is believed to serve as a method of approaching sources of food. This picture is well established in a stagnant environment. In the ocean a shear microenvironment is associated with turbulence. This shear flow prevents clustering of bacteria around local nutrient sources if they swim in the commonly assumed "run-and-tumble" strategy. Recent observations, however, indicate a "back-and-forth" swimming behavior for marine bacteria. In a theoretical study we compare the two bacterial swimming strategies in a realistic ocean environment. The "back-and-forth" strategy is found to enable the bacteria to stay close to a nutrient source even under high shear. Furthermore, rotational diffusion driven by thermal noise can significantly enhance the efficiency of this strategy. The superiority of the "back-and-forth" strategy suggests that bacterial motility has a control function rather than an approach function under turbulent conditions.
Asunto(s)
Bacterias , Modelos Biológicos , Movimiento , Bacterias/citología , Fenómenos Biomecánicos , Difusión , Alimentos , Océanos y Mares , Rotación , Resistencia al CorteRESUMEN
The stimulus for secretion of the atrial peptides from the heart is a mechanical distension of the atria. We studied the changes in plasma levels of immunoreactive ANF (1-98) and ANF (99-126) after volume loading (NaCl 0.9%, 50 ml/kg in 10 min) in pigs that had their pericardium opened (peric-, n = 8) and compared these changes to those of pigs subjected to sham operation (peric+, n = 8). For irANF (99-126), the maximum increase was achieved 10 min after the start of loading: 18.6 +/- 5.5 pmol/l to 31.4 +/- 15.6 pmol/l. (P < 0.05) in peric+ and 23.9 +/- 6.5 pmol/l to 110.2 +/- 46.2 pmol/l (P < 0.05) in peric-. The maximum increase in irANF (1-98) took place after 15 min: 658.8 +/- 223.9 pmol/l to 791.0 +/- 229.4 pmol/l (P < 0.05) in peric+ and 769.9 +/- 228.5 pmol/l to 1136.7 +/- 348.6 pmol/l (P < 0.05) in peric-. For both peptides the maximal increase after loading was significantly greater when the pericardium had been removed. The results demonstrate that the intact pericardium restricts peptide release secondary to volume infusion in closed-chest pigs.