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The high risk persists if CD4 nadir was low (Worm 2012). This correlation between non-ADM and severe immune deficiency is from the EuroSIDA study (Reekie 2010). In a US databank analysis which included 300,000 AIDS patients (Frisch 2001), some malignomas cases were associated with immunodeficiency: Hodgkin’s lymphoma, lung cancer, penile carcinoma, soft tissue sarcomas, testical and lip cancer. Apart from immunodeficiency, other factors certainly play a role. Mainly smoking but also life-style (alcohol, UV exposure) or coinfections (HPV, HBV, HCV) contribute to the risk. In the absence of smoking, however, the increase in risk is confined to cancers related to viral infections, whereas the risk of other cancers is not elevated and does not seem to be associated with immune deficiency (Helleberg 2014). Given the fact that HIV+ patients are aging, an increase of incidences of malignancies is to be expected (Shiels 2011). ART seems to have little influence on the occurrence of non-ADMs since therapy interruption does not increase the risk for non-ADMs, in contrast to ADMs (Silverberg 2007). Early diagnosis and prevention It remains unclear whether HIV+ patients require cancer screening and preventive medical checkups more frequently than negative patients. There are some indica- tions for a benefit regarding anal carcinomas (see below). Regarding colon carcinoma the situation is not clear; however, there is evidence that neoplastic changes are found more frequently in colorectal cancer screening with HIV+ patients (Bini 2009, Boesecke 2012). This examination, however, is not so popular with HIV+ patients or with treating physicians. Compared to the HIV-negative population, colorectal cancer screening is utilized to a lesser degree (Reinhold 2005). With respect to PSA screening, which is discussed controversially in general, there is no specific recom- mendation for HIV+ patients (Tyerman 2012). Gynaecological examinations are dis- cussed in the chapter HIV and Gynaecology.

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The study authors caution, however, that documentation of heart failure was poor and that the data may be unreliable. Weight gain Seven comparative observational studies reported weight gain in follow-up periods ranging from 244, 246, 250-255 8 weeks to 1 year (Table 64). There was no difference in the amount of weight gain in patients taking pioglitazone compared with rosiglitazone in any study. Range of weight gain reported in comparative observational studies Weight gain with Weight gain with a Study Duration pioglitazone (kg) rosiglitazone (kg) 255 King 2000 16 weeks 0. Evidence comparing pioglitazone or rosiglitazone to active controls: Harms Ten observational studies reported adverse events associated with thiazolidinediones compared 243, 256-264 with other active drugs (Table 65, Evidence Table 21). The adverse events they examined included mortality, coronary heart disease events, heart failure, cancer or adenoma incidence, edema, weight gain and progression to insulin use. Because these studies did not report results separately for pioglitazone and rosiglitazone or they included only 1 of the thiazolidinediones, they do not provide information about the comparative safety of the thiazolidinediones. They do provide information about thiazolidinediones as a class compared with other antidiabetic agents. In 2 studies, thiazolidinediones were not associated with increased mortality compared 258, 261 with other oral hypoglycemic agents. In 1 study, pioglitazone was associated with reduced 243 all-cause mortality compared with other oral antidiabetic medications. In older patients with heart failure thiazolidinediones, either alone or combined with metformin, were associated with a lower risk of death over a 15-month period compared with patients not treated with an insulin 261 sensitizer. Two studies reported the incidence of coronary heart disease events (myocardial infarction or revascularization) with thiazolidinediones compared with metformin or sulfonylureas. A good-quality study using United States health insurance data found no increased risk of coronary heart disease events in patients initiating thiazolidinedione monotherapy 257 compared with those initiating metformin plus sulfonylurea combination therapy. The other found similar risks with rosiglitazone compared with sulfonylureas, metformin, or insulin, either 262 alone or in combination. Both studies also found no increased risk in the individual components of the composite outcome with thiazolidinedione use. Observational studies comparing adverse events associated with thiazolidinediones to adverse events associated with active controls Author, Year Data source, Sample Size Population (Quality) Comparison description Main outcomes Main results Adjusted odds ratio (95% CI) TZD vs. HR with propensity 243 2009 Rosiglitazone integrated All-cause adjustment, each compared to 19,717 vs.

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Lisk, 41 years: Sleepiness: no significantbetweengroupdifferences sleepiness) Sleepmeasurements: no significantbetweengroupdifferences O verallincidence: notreported F requentadverse events: notreported Salvini F A IR.

Mortis, 32 years: Less common opportunistic infections In HIV+ children, CMV pneumonia is more often seen than PCP (Zampoli 2011), while in adults it is less frequent.

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