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 Marcadores subclínicos Eventos clínicos

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.”

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

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

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

# 122. Microbial translocation and progression of atherosclerosis # 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.

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

# 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).

“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).

# 822. Inmunosupression and CVD (D:A:D) - Cohorts I and II of the D:A:D Study (n=33,301) - Followed from study entry to the earliest of an endpoint, death, 1st February 2010 or 6 months after the last clinic visit. Unadjusted analyseslatest or nadir CD4 counts <350 cells/mm3 tended to experience higher rates of all four endpoints. - Controlling for potential covariates no strong evidence that this higher risk remained. Stroke and CVD rates remain substantially higher in those with a latest CD4 <100 cells/mm3.

# 822. Inmunosupression and CVD (D:A:D)

# 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

Factores predisponentes METABOLISMO ÓSEO Factores predisponentes Intervención

# 875. Body Composition (ACTG Study A5260s) Todd Brown N=331 pacientes naive DMO baja asociada a: más adiponectina, menos OPG, menos “lean mass”

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

# 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…

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

TOXICIDAD RENAL Métodos diagnósticos Riñón y TDF

# 862. Validation of eGFR equations compared with isotopic GFR # 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.

# 866. Baseline Creatinine-based eGFR and CC as Predictors of Clinical Events (SMART). Gregory Lucas N=4613 pacientes (SMART con creatinina y cistatina C). Asociación eGFR con EKD-EPI con: - Mortalidad (n=92) - RCV (n=111) - Infec. oportunistas (n=118) Cistatina C tiene mejor asociación con mortalidad, evento Cv y IO que ecuación eGFR.

# 865. Exposure to ARV and the Risk of Renal Impairment ( D:A:D) # 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.

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

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