Many countries have seen a two-wave pattern in reported cases of coronavirus disease-19 during the 2020 pandemic, with a first wave during spring followed by the current second wave in late summer and autumn. Empirical data show that the characteristics of the effects of the virus do vary between the two periods. Differences in age range and severity of the disease have been reported, although the comparative characteristics of the two waves still remain largely unknown. Those characteristics are compared in this study using data from two equal periods of 3 and a half months. The first period, between 15th March and 30th June, corresponding to the entire first wave, and the second, between 1st July and 15th October, corresponding to part of the second wave, still present at the time of writing this article. Two hundred and four patients were hospitalized during the first period, and 264 during the second period. Patients in the second wave were younger and the duration of hospitalization and case fatality rate were lower than those in the first wave. In the second wave, there were more children, and pregnant and post-partum women. The most frequent signs and symptoms in both waves were fever, dyspnea, pneumonia, and cough, and the most relevant comorbidities were cardiovascular diseases, type 2 diabetes mellitus, and chronic neurological diseases. Patients from the second wave more frequently presented renal and gastrointestinal symptoms, were more often treated with non-invasive mechanical ventilation and corticoids, and less often with invasive mechanical ventilation, conventional oxygen therapy and anticoagulants. Several differences in mortality risk factors were also observed. These results might help to understand the characteristics of the second wave and the behaviour and danger of SARS-CoV-2 in the Mediterranean area and in Western Europe. Further studies are needed to confirm our findings.

Background— Patients infected with HIV present with premature atherosclerosis, and the 2 diseases share common pathogenic pathways. We investigated mutations in the monocyte chemoattractant protein-1 (MCP-1) and CCR-2 genes, which are known to control aspects of these pathways, to ascertain whether they are involved in atherogenesis in these patients. Methods and Results— We performed carotid and femoral artery ultrasonography to detect subclinical atherosclerosis in patients infected with HIV (n=183). MCP-1–2518G and CCR-2 64I polymorphisms were determined in the HIV group and in a population-based control group (n=348). We also determined MCP-1 circulating levels in the HIV group. The presence of MCP-1–2518G in the group of patients with subclinical atherosclerosis was significantly higher than in patients without atherosclerotic lesions (47.5% versus 18.2%, respectively; P <0.001). Furthermore, the patients with atherosclerotic lesions had higher MCP-1 plasma concentrations than did patients without lesions (74.15 [4.03] versus 57.81 [3.67] pg/mL, respectively; P =0.03). When adjusted for known cardiovascular risk factors, the MCP-1–2518G allele was associated with subclinical atherosclerosis (OR 5.72, 95% CI 1.74 to 18.80, P =0.004). Compared with measurements conducted ≈2.5 years earlier in a subset of 40 patients, intima-media thickness (IMT) in the carotid artery progressed at a mean rate of 0.06 mm/y more rapidly in patients bearing the MCP-1-mutated allele ( P =0.08). Conclusions— HIV-infected patients with the MCP-1–2518G allele have a 5-fold increased risk for atherosclerosis, as assessed by ultrasonography.

ObjectivesHIV-infected patients show an increased cardiovascular disease (CVD) risk resulting, essentially, from metabolic disturbances related to chronic infection and antiretroviral treatments. The aims of this study were: (1) to evaluate the agreement between the CVD risk estimated using the Framingham risk score (FRS) and the observed presence of subclinical atherosclerosis in HIV-infected patients; (2) to investigate the relationships between CVD and plasma biomarkers of oxidation and inflammation. MethodsAtherosclerosis was evaluated in 187 HIV-infected patients by measuring the carotid intima-media thickness (CIMT). CVD risk was estimated using the FRS. We also measured the circulating levels of interleukin-6, monocyte chemoattractant protein-1 (MCP-1) and oxidized low-density lipoprotein (LDL), and paraoxonase-1 activity and concentration. ResultsThere was a weak, albeit statistically significant, agreement between FRS and CIMT (k 5 0.229, Po0.001). A high proportion of patients with an estimated low risk had subclinical atherosclerosis (n 5 66; 56.4%). In a multivariate analysis, the presence of subclinical atherosclerosis in this subgroup of patients was associated with age [odds ratio (OR) 1.285; 95% confidence interval (CI) 1.084-1.524; P 5 0.004], body mass index (OR 0.799; 95% CI 0.642-0.994; P 5 0.044), MCP-1 (OR 1.027; 95% CI 1.004-1.050; P 5 0.020) and oxidized LDL (OR 1.026; 95% CI 1.001-1.051; P 5 0.041). ConclusionFRS underestimated the presence of subclinical atherosclerosis in HIV-infected patients. The increased CVD risk was related, in part, to the chronic oxidative stress and inflammatory status associated with this patient population. IntroductionSince the advent of effective antiretroviral therapy, HIV infection has become a chronic disease [1]. The life expectancy of HIV-infected patients is progressively improving, but undesirable secondary effects of these treatments and the infection itself are associated with metabolic complications, including dyslipidaemia, insulin resistance, altered body fat distribution and hypertension [2,3]. An increase in atherosclerosis at a relatively young age becomes evident in these patients, probably secondary to the pro-inflammatory and pro-oxidative status of chronic infection exacerbating classical cardiovascular disease (CVD) risk factors, including dyslipidaemia [4][5][6][7].The decision to initiate a treatment to prevent CVD is commonly based on the individual's risk estimation The measurement of carotid intima-media thickness (CIMT) has been proposed as a surrogate marker of atherosclerosis and a valuable index of the future appearance of adverse vascular events in the at-risk patient within the general population [16]. We and others have demonstrated an increase in CIMT in HIV-infected patients; these patients also have a faster rate of progression of atherosclerosis [17,18]. This indicates that CIMT is a realistic reflection of arterial lesion status in these patients. Together with CIMT, several biochemical markers of inflammation and oxida...

Many countries have seen a two-wave pattern in reported cases of coronavirus disease-19 during the 2020 pandemic, with a first wave during spring followed by the current second wave in late summer and autumn. Empirical data show that the characteristics of the effects of the virus do vary between the two periods. Differences in age range and severity of the disease have been reported, although the comparative characteristics of the two waves still remain largely unknown. Those characteristics are compared in this study using data from two equal periods of 3 and a half months. The first period, between 15th March and 30th June, corresponding to the entire first wave, and the second, between 1st July and 15th October, corresponding to part of the second wave, still present at the time of writing this article. Two hundred and four patients were hospitalized during the first period, and 264 during the second period. Patients in the second wave were younger and the duration of hospitalization and case fatality rate were lower than those in the first wave. In the second wave, there were more children, and pregnant and post-partum women. The most frequent signs and symptoms in both waves were fever, dyspnea, pneumonia, and cough, and the most relevant comorbidities were cardiovascular diseases, type 2 diabetes mellitus, and chronic neurological diseases. Patients from the second wave more frequently presented renal and gastrointestinal symptoms, were more often treated with non-invasive mechanical ventilation and corticoids, and less often with invasive mechanical ventilation, conventional oxygen therapy and anticoagulants. Several differences in mortality risk factors were also observed. These results might help to understand the characteristics of the second wave and the behaviour and danger of SARS-CoV-2 in the Mediterranean area and in Western Europe. Further studies are needed to confirm our findings.

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Background and Purpose-The initial steps of atherosclerosis and the entry of HIV into the cell share similar biological mechanisms. Therefore, our hypothesis is that the progression of atherosclerosis in patients with HIV infection can be influenced by variations in genes implicated in both processes. Methods and Results-The progression of atherosclerosis over a 2-year follow-up period was measured as the combined carotid and femoral intima media thickness (IMT) in 141 patients with HIV infection. The ⌬IMT (IMT follow-up ϪIMT baseline ) values were used to segregate patients as minimal progressors or regressors (lowest ⌬IMT tertile), slow progressors (mid ⌬IMT tertile), and rapid progressors (highest ⌬IMT tertile). Mutations CCR-5⌬32, CCR-2 64I, MCP-1-2518G, SDF1-3ЈA, and CX3CR-1 (T280 mol/L and V249I) in the host DNA were determined. Mean age of the patients was 38.96 (SEM: 0.61) and 68.8% were male. The mean ⌬IMT was 0.045 mm (0.01) per year, which represented a significant progression (PϽ0.001) with respect to baseline values. Patients with minimal progression or regression had a significantly (Pϭ0.01) higher CD4 cell count than slow progressors and rapid progressors. Multivariate analyses indicated that age and total cholesterol were positively associated with IMT progression. In contrast, the CD4 cell count, the SDF1-3ЈA, and the CX3CR-1 249 I mutated alleles were associated with lesser IMT progression. Conclusion-The course of atherosclerosis in patients with HIV infection is influenced by polymorphisms in the SDF1 and CX3CR1 genes by metabolic variables and by the CD4 cell count. These data would be of help in assessing therapeutic needs of these patients.

We tested the security and efficacy of ezetimibe in the treatment of HIV-associated dyslipemia. Twenty HIV-infected patients were randomly assigned to receive ezetimibe 10 mg/day or fluvastatin 80 mg/day. Patients receiving ezetimibe experienced a statistically significant (P = 0.003) 20% reduction in the concentration of LDL-cholesterol, similar to that observed with fluvastatin (24%, P between groups 0.70). We concluded that ezetimibe monotherapy effectively decreases LDL-cholesterol in HIV-infected patients.

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