Sorin Ștefan Aramă

Correlation between inflammatory biomarkers and metabolic disorders in HIV infected patients undergoing antiretroviral therapy

Correlation between inflammatory biomarkers and metabolic disorders in HIV infected patients undergoing antiretroviral therapy Raluca Mihăilescu, Victoria Aramă, Cătălin Tiliscan, Daniela Munteanu, Viorica Leoveanu, Mihaela Rădulescu, Adriana Hristea, Cristina Popescu, Ruxandra Moroti, Violeta Molagic, Raluca Năstase, Loredana Benea, Ana Maria Tudor, Mihai Lazăr, Anca-Ruxandra Negru, Irina Lăpădat, Ligia Ionescu, Mirela Cernat, Georgeta Jugănaru, Doina Cristea, Adriana Manea, Adrian Streinu-Cercel, Daniela Adriana Ion, Sorin Ștefan Aramă

Metabolic syndrome, insulin resistance and the risk of cardiovascular disease in HIV patients undergoing antiretroviral therapy

We enrolled 103 patients, including 60 males (58.3%) and 43 females (41.7%). The mean age was 32.3±13.3 years (range: 13-65 years). The median Framingham score was 1.2% (IQR=5.8%). Most patients (81.63%) had a low CVR (below 10%) and 18.37% had Framingham score values above 10%. MS and IR prevalences were 16.9% and 61.2%, respectively. CVR in the general population is primarily dependent on age. This observation was valid for our group: the median age was 24 years in people with low CVR, compared with 50 years for those with Framingham score above 10% (p=0.000). None of the antiretroviral drug classes significantly influenced CVR.

Evaluation of adipose tissue changes with bioimpedance and dual-energy X-ray absorptiometry in treatment of multi-experienced HIV-infected patients

Multi-experienced HIV-infected patients bear the burden of treatment-related toxicities over the years. This study evaluated the correlation between bioimpedance- and DXA-quantified changes of adipose tissue with duration of infection and duration of combined antiretroviral therapy (cART) in HIV-seropositive patients. A cross-sectional study, belonging to prospective grant PNCDI2 no.62077/2008, was conducted in a national reference hospital in 2011-2012. DXA whole-body adipose tissue analysis and bioimpedance analysis revealed fat and lean tissue (% and grams), android/gynoid distribution, arm+legs/trunk ratio and waist/hip ratio (WHR). There were 78 patients enrolled, including the control seronegative group. HIV-seropositive patients had equal sex distribution, median age of 33 years with mode of 20 years and body mass index of 23.6 kg/sqm [21;25.7]. Duration of diagnosed infection, duration of cART and number of previous therapeutic regimens had medians of 69 months [36;113], 57 months [27;111] and 2 [1;3], respectively. Among all variables, WHR correlated with duration of infection (rho= -0.36, p=0.05), duration of cART (rho= -0.36, p=0.05) and duration of number of therapeutic regimens (rho= -0.48, p=0,007). Also fat and lean tissue, as grams, correlated with duration of cART - rho= -0.26, p=0.048 for both. In this young treatment-experienced HIV-infected population undergoing antiretroviral therapy, the waist/hip ratio correlated best with the number of previous therapeutic regimens, inversely proportional. Adipose changes, measured by bioimpedance and DXA, were rather correlated with treatment duration than with time from diagnosis. Patients experiencing the history of antiretrovirals still present adverse effects on long term, which could influence their adherence to antiretrovirals.

Resistin, insulin sensitivity and markers of inflammation in a cohort of Romanian patients under combined antiretroviral therapy

Methods We performed a transversal study that used the following inclusion criteria: non-diabetic patients with documented HIV infection, undergoing stable cART for at least 6 months. Clinical, metabolic, inflammatory and immuno-virological patterns were assessed (age, sex, body mass index, HIV load, actual and nadir CD4, duration of HIV infection and antiretroviral therapy, lipid panel, C-reactive protein CRP). Resistin levels were evaluated using KAPME Biosource EASIA. In order to test the sensitivity to insulin we used the QUICKI index, the best surrogate marker after glucose clamp index. Parametric and non-parametric variables were described using means (±Standard Deviation SD) and medians (Interquartile Ratio IQR), respectively.

Metabolic risk factors for liver inflammation in a cohort of chronic hepatitis C patients

Methods We conducted a cross-sectional non-interventional study on CHC patients evaluated in a tertiary hospital in Bucharest between December 2012-August 2013. We measured fasting serum lipids, glucose, liver transaminases, inflammatory proteins, and viral load. We calculated body-mass index (BMI) and waist-to-hip ratio (WTH). Cardiovascular risk was assessed with Framingham risk score, metabolic syndrome was defined with ATPIII criteria. Liver histology was assessed with noninvasive Fibromax tests (Biopredictive, France). For statistical analysis we used SPSS (version 12.0).

Leptin dysfunction and the risk of dyslipidemia and metabolic syndrome in Romanian HIV-infected patients undergoing antiretroviral therapy

Leptin is a hormone secreted by the adipose tissue that may be associated in the general population with components of the metabolic syndrome (MS). Our objective was to test the association between dyslipidemia, MS presence and circulating leptin dysfunction in a cohort of HIV-infected non-diabetic patients undergoing combinant antiretroviral therapy (cART). We included HIV-infected non-diabetic consecutive patients undergoing cART, admitted to the National Institute for Infectious Diseases “Prof. Dr. Matei Bals”, between 2008-2011. The diagnosis of MS was made using the International Diabetes and American Heart Association harmonized criteria from 2009. Circulating levels of leptin (BioSource EASIA) were measured. We enrolled 95 patients: 53 (55.8%) males (mean age=33.1±13.4 years) and 42 (44.2%) females (mean age=30.5±13.6 years). Most patients (72.5%) had undetectable HIV viral load; median CD4 count was 493.5 (IQR=422)/cmm. The median time from HIV diagnosis was 60 (IQR=73) months. The median time on cART was 58.5 (IQR=70) months, 53.8% of patients had experienced more than one cART regimen. The prevalence of MS was 17.1%. Elevated blood pressure, elevated waist circumference and abnormal fasting glucose prevalences were 30.3%, 17.1% and 6.5%, respectively. Median serum leptin was 1.89 (IQR=3.57) ng/mL. Circulating leptin dysfunction was present in almost half of patients, hypoleptinemia being more frequent (42.%) than hyperleptinemia (8.5%). Hypoleptinemia was more frequent in men (62.3%) comparative to women (17.1%), p=0.000. The prevalence of MS in patients with hypoleptinemia was 25.8% vs 10.8% in persons with normal leptin values (p=0.261). Hypoleptinemia was associated with elevated waist circumference (p=0.004) and abnormal fasting glucose (p=0.05) in women. More than half (65.6%) of men with hypoleptinemia had reduced HDL-cholesterol levels vs 29.4% in men with normal levels of leptin. As expected, hyperleptinemia was associated with the increase of body mass index, both in men (p=0.000) and women (p=0.05). In our cohort of young cART multiexperienced HIV patients leptin dysfunction was not significantly associated with MS presence. Leptin was correlated with several MS components (HDL-dyslipidemia, elevated circumference, abnormal fasting glucose) with significant gender differences, that suggests that leptin may play different roles in the regulation of glucose and lipid metabolism according to the sex.

Inflammatory patterns in patients with chronic hepatitis C

Methods We performed a cross-sectional study on patients with CHC, in a tertiary-care hospital in November 2011 – April 2012. We staged liver fibrosis using FibroMax (BioPredictive) and we used CobasTaqman (Roche) for HCV-RNA quantification. Patients were also evaluated by ALT, platelets, erythrocyte sedimentation rate (ESR), fibrinogen, C-reactive protein (CRP) and tumor necrosis factor alpha (TNFa) plasma levels. For TNFa quantification we used Kamiya Biomedical Company ELISA kits.