26. Grund, B., et al., Continuous antiretroviral therapy decreases bone mineral density. AIDS, 2009. 23(12): p.1519-29.27. Negredo, E., et al., Reconstructive treatment for antiretroviral-associated facial lipoatrophy: a prospectivestudy comparing autologous fat and synthetic substances. AIDS Patient Care STDS, 2006. 20(12): p. 829-37.28. Bischoff-Ferrari, H.A., et al., Estimation of optimal serum concentrations of 25-hydroxyvitamin D for multiplehealth outcomes. Am J Clin Nutr, 2006. 84(1): p. 18-28.29. Mueller, N.J., et al., High prevalence of severe vitamin D deficiency in combined antiretroviral therapy-naiveand successfully treated Swiss <strong>HIV</strong> patients. AIDS.30. Cozzolino, M., et al., <strong>HIV</strong>-protease inhibitors impair vitamin D bioactivation to 1,25-dihydroxyvitamin D.AIDS, 2003. 17(4): p. 513-20.31. Paccou, J., et al., Bone loss in patients with <strong>HIV</strong> infection. Joint Bone Spine, 2009. 76(6): p. 637-41.32. Borderi, M., et al., Metabolic bone disease in <strong>HIV</strong> infection. AIDS, 2009. 23(11): p. 1297-310.33. Labarga, P., et al., Kidney tubular abnormalities in the absence of impaired glomerular function in <strong>HIV</strong>patients treated with tenofovir. AIDS, 2009. 23(6): p. 689-96.34. Worm, S.W., et al., Risk of myocardial infarction in patients with <strong>HIV</strong> infection exposed to specific individualantiretroviral drugs from the 3 major drug classes: the data collection on adverse events of anti-<strong>HIV</strong> drugs(D:A:D) study. J Infect Dis. 201(3): p. 318-30.35. Hughes, C.A., et al., New antiretroviral drugs: a review of the efficacy, safety, pharmacokinetics, andresistance profile of tipranavir, darunavir, etravirine, rilpivirine, maraviroc, and raltegravir. Expert OpinPharmacother, 2009. 10(15): p. 2445-66.36. Chowers, M., et al., Nucleoside reverse transcriptase inhibitors in combination therapy for <strong>HIV</strong> patients:systematic review and meta-analysis. Eur J Clin Microbiol Infect Dis, 2010. 29(7): p. 779-86.37. Mallal, S., et al., HLA-B*5701 screening for hypersensitivity to abacavir. N Engl J Med, 2008. 358(6): p. 568-79.38. Saag, M., et al., High sensitivity of human leukocyte antigen-b*5701 as a marker for immunologicallyconfirmed abacavir hypersensitivity in white and black patients. Clin Infect Dis, 2008. 46(7): p. 1111-8.39. Escaut, L., et al., Abacavir rechallenge has to be avoided in case of hypersensitivity reaction. AIDS, 1999.13(11): p. 1419-20.40. Malan, D.R., et al., Efficacy and safety of atazanavir, with or without ritonavir, as part of once-daily highlyactive antiretroviral therapy regimens in antiretroviral-naive patients. J Acquir Immune Defic Syndr, 2008.47(2): p. 161-7.41. Molina, J.M., et al., Once-daily atazanavir/ritonavir versus twice-daily lopinavir/ritonavir, each incombination with tenofovir and emtricitabine, for management of antiretroviral-naive <strong>HIV</strong>-1-infected patients:48 week efficacy and safety results of the CASTLE study. Lancet, 2008. 372(9639): p. 646-55.42. Rodriguez-Novoa, S., et al., Genetic factors influencing atazanavir plasma concentrations and the risk ofsevere hyperbilirubinemia. AIDS, 2007. 21(1): p. 41-6.43. Munoz-Moreno, J.A., et al., Neuropsychiatric symptoms associated with efavirenz: prevalence, correlates, andmanagement. A neurobehavioral review. AIDS Rev, 2009. 11(2): p. 103-9.44. Haas, D.W., et al., Pharmacogenetics of efavirenz and central nervous system side effects: an Adult AIDSClinical Trials Group study. AIDS, 2004. 18(18): p. 2391-400.45. El-Sadr, W.M., et al., Effects of <strong>HIV</strong> disease on lipid, glucose and insulin levels: results from a largeantiretroviral-naive cohort. <strong>HIV</strong> Med, 2005. 6(2): p. 114-21.46. Law, M.G., et al., The use of the Framingham equation to predict myocardial infarctions in <strong>HIV</strong>-infectedpatients: comparison with observed events in the D:A:D Study. <strong>HIV</strong> Med, 2006. 7(4): p. 218-30.47. Rossi, R., et al., The role of the Framingham risk score to predict the presence of subclinical coronaryatherosclerosis in patients with <strong>HIV</strong> infection. J Acquir Immune Defic Syndr, 2009. 52(2): p. 303-4.48. Greenland, P., et al., ACCF/AHA 2007 clinical expert consensus document on coronary artery calcium scoringby computed tomography in global cardiovascular risk assessment and in evaluation of patients with chestpain: a report of the American College of Cardiology Foundation Clinical Expert Consensus Task Force(ACCF/AHA Writing Committee to Update the 2000 Expert Consensus Document on Electron BeamComputed Tomography) developed in collaboration with the Society of Atherosclerosis Imaging andPrevention and the Society of Cardiovascular Computed Tomography. J Am Coll Cardiol, 2007. 49(3): p. 378-402.49. De Socio, G.V., et al., Relations between cardiovascular risk estimates and subclinical atherosclerosis innaive <strong>HIV</strong> patients: results from the HERMES study. Int J STD AIDS. 21(4): p. 267-272.
50. Calmy, A., et al., <strong>HIV</strong> increases markers of cardiovascular risk: results from a randomized, treatmentinterruption trial. AIDS, 2009. 23(8): p. 929-39.51. Moyle, G.J., et al., A randomized comparative trial of tenofovir DF or abacavir as replacement for athymidine analogue in persons with lipoatrophy. AIDS, 2006. 20(16): p. 2043-50.52. Martin, A., et al., Reversibility of lipoatrophy in <strong>HIV</strong>-infected patients 2 years after switching from a thymidineanalogue to abacavir: the MITOX Extension Study. AIDS, 2004. 18(7): p. 1029-36.53. Mocroft, A., et al., Serious fatal and nonfatal non-AIDS-defining illnesses in Europe. J Acquir Immune DeficSyndr, 2010. 55(2): p. 262-70.54. Smith, C., et al., Factors associated with specific causes of death amongst <strong>HIV</strong>-positive individuals in theD:A:D Study. AIDS, 2010. 24(10): p. 1537-48.55. Currier, J.S., et al., Coronary heart disease in <strong>HIV</strong>-infected individuals. J Acquir Immune Defic Syndr, 2003.33(4): p. 506-12.56. Mary-Krause, M., et al., Increased risk of myocardial infarction with duration of protease inhibitor therapy in<strong>HIV</strong>-infected men. AIDS, 2003. 17(17): p. 2479-86.57. Triant, V.A., et al., Increased acute myocardial infarction rates and cardiovascular risk factors amongpatients with human immunodeficiency virus disease. J Clin Endocrinol Metab, 2007. 92(7): p. 2506-12.58. Durand, M., et al., Association between <strong>HIV</strong> infection, antiretroviral therapy, and risk of acute myocardialinfarction: a cohort and nested case-control study using Quebec's public health insurance database. J AcquirImmune Defic Syndr, 2011. 57(3): p. 245-53.59. Klein, D., et al., Do protease inhibitors increase the risk for coronary heart disease in patients with <strong>HIV</strong>-1infection? J Acquir Immune Defic Syndr, 2002. 30(5): p. 471-7.60. Rasmussen, L.D., et al., Risk of cerebrovascular events in persons with and without <strong>HIV</strong>: a Danish nationwidepopulation-based cohort study. AIDS, 2011. 25(13): p. 1637-46.61. Ovbiagele, B. and A. Nath, Increasing incidence of ischemic stroke in patients with <strong>HIV</strong> infection. Neurology,2011. 76(5): p. 444-50.62. Sabin, C.a.t.D.A.D.S.G., Associations between Markers of Immunosuppression and the Risk of CVD, in 19thConference on Retroviruses and Opportunistic Infections (CROI 2012), poster n.822. 2012: Seattle.63. Masia, M., et al., Endothelial function is impaired in <strong>HIV</strong>-infected patients with lipodystrophy. Antivir Ther.15(1): p. 101-10.64. Petoumenos, K., et al. Rates of Cardiovascular Disease following Smoking Cessation in Patients with <strong>HIV</strong>Infection: Results from the D:A:D Study. in 17th Conference on Retroviruses and Opportunist Infections.2010. San Francisco, CA, USA.65. Fitch, K.V., et al., Effects of a lifestyle modification program in <strong>HIV</strong>-infected patients with the metabolicsyndrome. AIDS, 2006. 20(14): p. 1843-50.66. Smith, K.Y., et al., Randomized, double-blind, placebo-matched, multicenter trial of abacavir/lamivudine ortenofovir/emtricitabine with lopinavir/ritonavir for initial <strong>HIV</strong> treatment. AIDS, 2009. 23(12): p. 1547-56.67. Madruga, J.V., et al., Efficacy and safety of darunavir-ritonavir compared with that of lopinavir-ritonavir at48 weeks in treatment-experienced, <strong>HIV</strong>-infected patients in TITAN: a randomised controlled phase III trial.Lancet, 2007. 370(9581): p. 49-58.68. Eron, J.J., et al., Switch to a raltegravir-based regimen versus continuation of a lopinavir-ritonavir-basedregimen in stable <strong>HIV</strong>-infected patients with suppressed viraemia (SWITCHMRK 1 and 2): two multicentre,double-blind, randomised controlled trials. Lancet, 2010. 375(9712): p. 396-407.69. Podzamczer D, S.V., Andrade-Villanueva J, Clotet B, Taylor S, Rockstroh J, et al., Comparison of lipid profilewith nevirapine versus atazanavir/ritonavir, both combined with tenofovir DF and emtricitabine (TDF/FTC),in treatment-naive <strong>HIV</strong>-1-infected patients: ARTEN study week 48 results., in 12th European AIDSConference/EACS. 2009: 11-14 November 2009 - Cologne, Germany.70. EACS Guidelines. 29/07/2011]; Available from: www.europeanaidsclinicalsociety.org/Guidelines.71. Monforte A, R.P., Ryom L, El-Sadr W, Dabis F, De Wit S, Worm S, Phillips A, Lundgren J, Sabin C, ATVcontainingART Is Not Associated with an Increased Risk of Cardio- or Cerebro-vascular Events in the D:A:DStudy, in 19th Conference on Retroviruses and Opportunistic Infections (CROI 2012), poster n.823. 2012:Seattle.72. Abgrall, S., et al., Switch from a first virologically effective protease inhibitor-containing regimen to a regimencontaining efavirenz, nevirapine or abacavir. AIDS, 2006. 20(16): p. 2099-106.73. Fichtenbaum, C.J. and J.G. Gerber, Interactions between antiretroviral drugs and drugs used for the therapy ofthe metabolic complications encountered during <strong>HIV</strong> infection. Clin Pharmacokinet, 2002. 41(14): p. 1195-211.
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PIANO DELL’OPERALinee Guida Itali
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VALUTAZIONE E PREPARAZIONE DEL PAZI
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DIAGNOSTICA VIROLOGICALa diagnosi d
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ResistenzeLa prevalenza di farmaco-
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avvalersi, nella valutazione del te
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con tropismo X4) della metodica di
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QUANDO INIZIAREInfezione acutaSi st
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seguito alla terapia antiretroviral
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Nota: La valutazione della conta as
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- Pazienti con leucoencefalopatia m
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IntroduzioneCOME INIZIAREIl princip
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farmaci diversi da EFV, ATV/r e LPV
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Tabella 2 - Regimi alternativi per
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ddI+TDF (come backbone) Ridotta eff
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1. La riduzione del numero di farma
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controllo (stesso regime + 2NRTI) s
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opzione complessivamente vantaggios
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studio randomizzato e a disegno cro
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GESTIONE DEL FALLIMENTO TERAPEUTICO
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Gestione fallimento virologico con
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caratterizzati da una tollerabilit
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valutazione attenta nella composizi
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evidenziato un rischio significativ
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ADERENZA E QUALITÀ DELLA VITAADERE
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comportamenti salutari (potenziando
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Algoritimo gestionale per l’adere
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Per l’uso dei questionari per la
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- Parimenti ENF, non viene suggerit
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Le benzodiazepine come alprazolam,
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glucoronosyl-transferase 1A1 (UGT1A
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SEZIONE 2Patologie associate all’
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MALATTIA CARDIOVASCOLARE, EPATICA,
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Screening per patologie non infetti
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Dosaggio Vitamina D + + -Annuale, p
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assenza di screening, il farmaco no
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INTERVENTISmettere di fumarePRINCIP
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MALATTIA CARDIOVASCOLARELe malattie
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- Terapie complementari:1. Le terap
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3. L’esposizione cumulativa a ini
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- Switch di terapia antiretrovirale
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LIPODISTROFIALa lipodistrofia ha un
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Il fenotipo lipodistrofico di tipo
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2. In caso di Sindrome di Fanconi
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DISFUNZIONI SESSUALIPer Disfunzione
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DEFICIT DI VITAMINA DL’insufficie
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Di seguito alcune abbreviazioni uti
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- Depressione;- Disturbi d’ansia;
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Figura 1- Algoritmo per la diagnosi
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approccio veloce e semplice, potend
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indipendentemente dalla presenza di
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I benefici di cART in pazienti con
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TUMORILa terapia dei tumori associa
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SARCOMA DI KAPOSI (SK)La scelta del
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SEZIONE 2bPatologie infettive assoc
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malattia da HIV instabile (indicati
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significative interferenze farmacol
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Tabella 1 - Classificazione della f
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Figura 1 - Criteri di gestione dell
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antitubercolare, entrambi hanno dim
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farmacologico, sono preferibili, qu
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Persone con infezione da HIV ed ITL
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INFEZIONI OPPORTUNISTICHENonostante
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è subottimale, può essere presa i
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Dal momento che l’aderenza alla p
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PAZIENTE ANZIANOI pazienti anziani
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Tabella 1 - Caratteristiche del paz
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zidovudina [14]. Per quanto riguard
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ispetto alla popolazione sana, si a
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- Si raccomanda l’individuazione
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Tossicità, comorbositàIl rischio
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PAZIENTE PEDIATRICOQuesto documento
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- La combinazione ABC/3TC ha dimost
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L’aderenza alla terapia antiretro
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Tabella 4 - Farmaci antiretrovirali
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Viracept® compresserivestite 250 m
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TOSSICODIPENDENZA E/O ALCOL-DIPENDE
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Oppiacei naturali e HAARTL’eroina
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LSD ? ? ? ? ? ? ? ? ■ ? ?Ketamina
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fosamprenavir■ ▲ verosimilmente
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nuovo sistema nazionale di rilevame
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GRAVIDANZAQuesto documento esamina
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Terapia antiretrovirale in donne ch
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trattamento dell’infezione da HBV
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EtravirinaRilpivirinaunivoche. In d
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TRAPIANTISelezione dei pazienti con
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Riferimento del paziente al centro
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trapiantologico i pazienti competon
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Più recentemente lo studio clinico
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Le evidenze disponibili, incluse qu
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come appropriato; è consigliabile
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Tabella 2 - Rischio di sieroconvers
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Vaccinazioni nell’adultoPNEUMOCOC
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INFLUENZA - Durata e severità clin
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quadrivalente somministrate a dista
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PCV: vaccino antipneumococcico coni
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Tabella 1 - Principali vaccinazioni
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INTERNATIONAL HIV-DEMENTIA SCALE (I
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MINI MENTAL STATE EXAMINATION (MMSE
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Note per la somministrazione del te
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GAD-7Nelle ultime 2 settimane, con
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Attenzione/Working MemorySubtest Me
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QUESTIONARIO IADL (AUTONOMIA NELLE
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Toxoplasmosi cerebraleLa terapia di
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paragonabile assorbimento. In caso
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Altre infezioni erpeticheLe indicaz
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HIV E GRAVIDANZAIntroduzioneIl modi
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sono presenti informazioni e se è
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stabile della carica virale nelle d
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Nella valutazione ostetrico-ginecol
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Analoghi Non Nucleosidici (NNRTI)a
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l’esposizione agli antiretroviral
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quanto possibile e compatibilmente
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35. Molina JM,Chastang C, Coguel J
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BIBLIOGRAFIA DI RIFERIMENTO/NOTA HI
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34. Tuomala RE, Shapiro DE, Mofenso
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BIBLIOGRAFIA DI RIFERIMENTO PAZIENT
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37. Sulkowski MS, Thomas DL, Mehta
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72. Wiener L, Riekert K, Ryder C, W
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Finarelli Alba Carola Nessuna Nessu