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Stella G, Volpicelli L, Carlo DD, Vicenti I, Celani L, Maggiolo F, Callegaro AP, Gennari W, Francisci D, Lombardi F, Piermatteo L, Bezenchek A, Micheli V, Rossetti B, Santoro MM. Impact of pre-existent drug resistance on virological efficacy of single tablet regimens in people living with HIV. Int J Antimicrob Agents 2022; 60:106636. [PMID: 35820534 DOI: 10.1016/j.ijantimicag.2022.106636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 06/21/2022] [Accepted: 07/05/2022] [Indexed: 11/18/2022]
Abstract
Despite the broad use of single tablet regimens (STRs), few real-life data are available regarding the impact of pre-existent drug resistance on virological failure (VF). Through this study we aimed to fill this gap, by analyzing a large cohort of individuals selected from the ARCA database. The impact on VF of pre-existent resistance associated mutations (RAMs) and cumulative genotypic susceptibility score (cGSS) before STR start was evaluated through survival analysis. Potential emergence of resistance at VF was also evaluated. Overall, 3916 individuals were included: 678 treatment-naïve (G1), 2309 treatment-experienced aviremic (G2), and 929 viremic (G3); 65.2% of them was treated with an STR based on efavirenz (35.2%) or rilpivirine (30%). At two years after starting STR, the overall probability of VF was 5.9% in G1, 8.7% in G2, and 20.8% in G3. No impact of pre-existent resistance on VF was found in G1. The probability of VF was higher in patients with cGSS<3 (reduced susceptibility to at least one drug) than in those with cGSS=3 (full susceptibility to STR drugs) in both G2 and G3. A higher probability of VF was also found in presence of pre-existent M184V (alone or in combination with pre-existent thymidine analogue mutations). Among patients who failed STR, a significant emergence of RAMs was found only in those exposed to EFV/FTC/TDF in G3 (specifically K103N and M184V). Our results confirm a high efficacy of STRs in clinical settings. Pre-existent resistance seems to influence virological efficacy of STR in treatment-experienced individuals (both aviremic and viremic).
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Affiliation(s)
- Giulia Stella
- Department of Medical Biotechnologies, University of Siena, Siena, Italy; Department of Medical Sciences, Infectious and Tropical Diseases Unit, AOU Senese, Siena, Italy
| | - Lorenzo Volpicelli
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Domenico Di Carlo
- CRC Pediatric "Romeo and Enrica Invernizzi", Department of Biomedical and Clinical Sciences "L. Sacco", University of Milan, Milan, Italy
| | - Ilaria Vicenti
- Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Luigi Celani
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Franco Maggiolo
- Department of Infectious Diseases, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy
| | | | - William Gennari
- Unit of Virology and Molecular Microbiology, University Hospital, Modena, Italy
| | | | - Francesca Lombardi
- Department of Safety and Bioethics, Infectious Diseases Section, Catholic University of the Sacred Heart, Rome, Italy
| | - Lorenzo Piermatteo
- Department of Experimental Medicine, University of Rome 'Tor Vergata', Via Montpellier 1, 00133 Rome, Italy
| | - Antonia Bezenchek
- IPRO-InformaPRO S.r.l., Rome, Italy; EuResist Network GEIE, Rome, Italy
| | - Valeria Micheli
- Laboratory of Clinical Microbiology, Virology and Bioemergencies, ASST Fatebenefratelli Sacco, L. Sacco University Hospital, Milan, Italy
| | - Barbara Rossetti
- Department of Medical Sciences, Infectious and Tropical Diseases Unit, AOU Senese, Siena, Italy
| | - Maria Mercedes Santoro
- Department of Experimental Medicine, University of Rome 'Tor Vergata', Via Montpellier 1, 00133 Rome, Italy.
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Nozza S, Galli L, Gianotti N, Parisi M, Poli A, Cinque P, Spagnuolo V, Bruzzesi E, Mastrangelo A, Castagna A. HIV-DNA undetectability during chronic HIV infection: frequency and predictive factors. J Antimicrob Chemother 2021; 75:2994-2997. [PMID: 32585684 DOI: 10.1093/jac/dkaa235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 04/30/2020] [Accepted: 05/03/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND HIV-DNA is a marker of HIV reservoirs. Objectives of the study were to determine prevalence of HIV-DNA < 100 copies/106 PBMCs in blood and to identify factors associated with this in a cohort of HIV-1-infected subjects treated with ART and with undetectable viral load (VL). METHODS This was a cross-sectional study on chronic HIV-1-infected people living with HIV (PLWH) followed up at the Department of Infectious Diseases of San Raffaele Scientific Institute on current ART without change for 12 months, with available pre-ART HIV-RNA and with undetectable VL for ≥12 months. HIV-DNA was amplified and quantified by real-time PCR (ABI Prism 7900); limit of detectability was 100 copies/106 PBMCs. Logistic regression was used to identify predictive factors for HIV-DNA < 100 copies/106 PBMCs. RESULTS Four hundred and sixty-eight PLWH were considered in the analyses, 119 (25%) with HIV-DNA < 100 copies/106 PBMCs. At multivariate analysis, we found that PLWH with lower zenith HIV-RNA, higher nadir CD4 and a shorter time between HIV diagnosis and ART start were more likely to have HIV-DNA < 100 copies/106 PBMCs, after adjustment for age, gender, calendar year of ART start, type of current ART regimen, percentage time spent with undetectable VL since ART start, current CD4 and CD4/CD8 ratio. CONCLUSIONS In our chronic PLWH on virological suppression for 4 years, the prevalence of HIV-DNA < 100 copies/106 PBMCs was found to be 25%. Lower zenith HIV-RNA, shorter time between HIV diagnosis and starting ART and higher CD4 nadir were independently associated with low HIV-DNA.
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Affiliation(s)
- Silvia Nozza
- Department of Infectious Diseases, San Raffaele Scientific Institute, Milan, Italy
| | - Laura Galli
- Department of Infectious Diseases, San Raffaele Scientific Institute, Milan, Italy
| | - Nicola Gianotti
- Department of Infectious Diseases, San Raffaele Scientific Institute, Milan, Italy
| | | | - Andrea Poli
- Department of Infectious Diseases, San Raffaele Scientific Institute, Milan, Italy
| | - Paola Cinque
- Department of Infectious Diseases, San Raffaele Scientific Institute, Milan, Italy
| | - Vincenzo Spagnuolo
- Department of Infectious Diseases, San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
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Madeddu G, De Vito A, Cozzi-Lepri A, Cingolani A, Maggiolo F, Perno CF, Gagliardini R, Marchetti G, Saracino A, Monforte AD, Antinori A, Girardi E. Time spent with HIV-RNA ≤ 200 copies/ml in a cohort of people with HIV during the U=U era. AIDS 2021; 35:1103-1112. [PMID: 33534204 PMCID: PMC9904439 DOI: 10.1097/qad.0000000000002825] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 01/02/2021] [Accepted: 01/11/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Zero risk of linked HIV transmission in serodiscordant couples when the HIV-infected partner had viral load less than 200 copies/ml ('U status') was found in observational studies. We aimed at estimating the proportion of time in which 'U status' was maintained and identifying factors associated with the risk of losing it. DESIGN Observational cohort study. METHODS We included participants in the ICONA cohort who had reached an established 'U status' (viral load ≤200 copies/ml for >6 months) as of December 2010. The outcome was the number of person-days of follow-up (PDFU) above a viral load greater than 200 copies/ml, relative to the total number of PDFU observed. A logistic regression model was used to identify factors independently associated with the risk of losing 'U status'. RESULTS Eight thousand, two hundred and forty-one persons living with HIV were included in the analysis who contributed 2 670 888 PDFU. Of these, 1648 (20%) were women, 768 (9%) were people who inject drugs (PWID), and 2066 (25%) were foreign-born. The median of viral load measurements was 9 (IQR: 4-15). Overall, only 3.1% of PDFU were observed when viral load was above 200 copies/ml. The proportion of PDFU with viral load more than 200 copies/ml was higher than average in women (5.3%), unemployed (5.4%), PWID (4.7%), and in people with more than three previous virologic failures (6.3%). These variables were significant predictors of losing 'U status' in the multivariable logistic regression. CONCLUSION Our results reinforce the validity of the U=U message in real-world setting. However, we identified subsets of our study population at higher risk of losing the 'U status' for whom additional efforts are needed.
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Affiliation(s)
- Giordano Madeddu
- Unit of Infectious Diseases, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Andrea De Vito
- Unit of Infectious Diseases, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Alessandro Cozzi-Lepri
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation (CREME) Institute for Global Health UCL, London, UK
| | - Antonella Cingolani
- Institute of Clinical Infectious Diseases, Catholic University of the Sacred Heart, Rome
| | - Franco Maggiolo
- Division of Infectious Diseases, ASST Papa Giovanni XXIII, Bergamo
| | - Carlo Federico Perno
- Department of Laboratory Medicine, Unit of Microbiology and Immunology, IRCCS Children Hospital Bambino Gesù
| | - Roberta Gagliardini
- HIV/AIDS Clinical Unit, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome
| | - Giulia Marchetti
- ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, Clinic of Infectious and Tropical Diseases, Milan
| | - Annalisa Saracino
- Clinic of Infectious Diseases, Department of Biomedical Sciences and Human Oncology, University of Bari “Aldo Moro”, Bari
| | - Antonella d’Arminio Monforte
- ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, Clinic of Infectious and Tropical Diseases, Milan
| | - Andrea Antinori
- HIV/AIDS Clinical Unit, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome
| | - Enrico Girardi
- Clinical Epidemiology Unit, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
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Taramasso L, Fabbiani M, Nozza S, De Benedetto I, Bruzzesi E, Mastrangelo A, Pinnetti C, Calcagno A, Ferrara M, Bozzi G, Focà E, Quiros-Roldan E, Ripamonti D, Campus M, Celesia BM, Torti C, Cosco L, Di Biagio A, Rusconi S, Marchetti G, Mussini C, Gulminetti R, Cingolani A, d'Ettorre G, Madeddu G, Franco A, Orofino G, Squillace N, Muscatello A, Gori A, Antinori A, Tambussi G, Bandera A. Predictors of incomplete viral response and virologic failure in patients with acute and early HIV infection. Results of Italian Network of ACuTe HIV InfectiON (INACTION) cohort. HIV Med 2020; 21:523-535. [PMID: 32578947 DOI: 10.1111/hiv.12885] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/13/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate the factors that can influence an incomplete viral response (IVR) after acute and early HIV infection (AEHI). METHODS This was a retrospective, observational study including patients with AEHI (Fiebig stages I-V) diagnosed between January 2008 and December 2014 at 20 Italian centres. IVR was defined by: (1) viral blip (51-1000 HIV-1 RNA copies/mL after achievement of < 50 HIV-1 RNA copies/mL); (2) virologic failure [> 1000 copies/mL after achievement of < 200 copies/mL, or ≥ 200 copies/mL after 24 weeks on an antiretroviral therapy (ART)]; (3) suboptimal viral response (> 50 copies/mL after 48 weeks on ART or two consecutive HIV-1 RNA levels with ascending trend during ART). Cox regression analysis was used to calculate the hazard ratios (HRs) and 95% confidence intervals (95% CIs) for IVR. RESULTS In all, 263 patients were studied, 227 (86%) males, with a median [interquartile range (IQR)] age of 38 (30-46) years. During a median follow-up of 13.0 (5.7-31.1) months, 38 (14.4%) had IVR. The presence of central nervous system (CNS) symptoms was linked to a higher risk of IVR (HR = 4.70, 95% CI: 1.56-14.17), while a higher CD4/CD8 cell count ratio (HR = 0.13, 95% CI: 0.03-0.51 for each point increase) and first-line ART with three-drug regimens recommended by current guidelines (HR = 0.40, 95% CI: 0.18-0.91 compared with other regimens including four or five drugs, older drugs or non-standard backbones) were protective against IVR. CONCLUSIONS Patients with lower CD4/CD8 ratio and CNS symptoms could be at a higher risk of IVR after AEHI. The use of recommended ART may be relevant for improving short-term viral efficacy in this group of patients.
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Affiliation(s)
- L Taramasso
- Infectious Diseases Unit, Department of Internal Medicine, Fondazione IRCCS Ca' Granda, Policlinico Maggiore Hospital, Milan, Italy
| | - M Fabbiani
- Infectious Diseases Unit, IRCCS San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - S Nozza
- Clinic of Infectious Diseases, San Raffaele Hospital, University Vita Salute, Milan, Italy
| | - I De Benedetto
- Department of Medical Sciences, Unit of Infectious Diseases, Amedeo di Savoia Hospital, University of Turin, Turin, Italy
| | - E Bruzzesi
- Clinic of Infectious Diseases, San Raffaele Hospital, University Vita Salute, Milan, Italy
| | - A Mastrangelo
- Clinic of Infectious Diseases, San Raffaele Hospital, University Vita Salute, Milan, Italy
| | - C Pinnetti
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - A Calcagno
- Department of Medical Sciences, Unit of Infectious Diseases, Amedeo di Savoia Hospital, University of Turin, Turin, Italy
| | - M Ferrara
- Department of Medical Sciences, Unit of Infectious Diseases, Amedeo di Savoia Hospital, University of Turin, Turin, Italy
| | - G Bozzi
- Infectious Diseases Unit, Department of Internal Medicine, Fondazione IRCCS Ca' Granda, Policlinico Maggiore Hospital, Milan, Italy
| | - E Focà
- Division of Infectious and Tropical Diseases, ASST Spedali Civili Hospital, University of Brescia, Brescia, Italy
| | - E Quiros-Roldan
- Division of Infectious and Tropical Diseases, ASST Spedali Civili Hospital, University of Brescia, Brescia, Italy
| | - D Ripamonti
- Infectious Disease Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - M Campus
- Infectious Diseases Unit, SS Trinità Hospital, ASSL Cagliari, Cagliari, Italy
| | - B M Celesia
- Unit of Infectious Diseases, Garibaldi Hospital, Catania, Italy
| | - C Torti
- Unit of Infectious Diseases, Department of Medical and Surgical Sciences, University "Magna Graecia", Catanzaro, Italy
| | - L Cosco
- Infectious Diseases Unit, "Pugliese-Ciaccio" Hospital, Catanzaro, Italy
| | - A Di Biagio
- Department of Infectious Diseases, Policlinico San Martino Hospital, Genoa, Italy
| | - S Rusconi
- Infectious Diseases Unit, Department of Biomedical and Clinical Sciences, "Luigi Sacco" Hospital, University of Milan, Milan, Italy
| | - G Marchetti
- Clinic of Infectious Diseases, Department of Health Sciences, University of Milan, ASST Santi Paolo e Carlo, Milan, Italy
| | - C Mussini
- Clinic of Infectious Diseases, Modena Hospital, University of Modena and Reggio Emilia, Modena, Italy
| | - R Gulminetti
- Infectious Diseases Unit, IRCCS San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - A Cingolani
- Institute of Clinical Infectious Diseases, Agostino Gemelli Hospital, Catholic University of Sacred Heart, Rome, Italy
| | - G d'Ettorre
- Infectious Diseases Unit, Umberto I Hospital, La Sapienza University, Rome, Italy
| | - G Madeddu
- Unit of Infectious Diseases, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - A Franco
- Infectious Diseases Unit, ASP Siracusa, Siracusa, Italy
| | - G Orofino
- Unit of Infectious Diseases, Divisione A, Amedeo di Savoia Hospital, Turin, Italy
| | - N Squillace
- Infectious Diseases Unit, Department of Internal Medicine, ASST San Gerardo, Monza, Italy.,University of Milano-Bicocca, Milan, Italy
| | - A Muscatello
- Infectious Diseases Unit, Department of Internal Medicine, Fondazione IRCCS Ca' Granda, Policlinico Maggiore Hospital, Milan, Italy
| | - A Gori
- Infectious Diseases Unit, Department of Internal Medicine, Fondazione IRCCS Ca' Granda, Policlinico Maggiore Hospital, Milan, Italy.,School of Medicine and Surgery, University of Milan, Milan, Italy
| | - A Antinori
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - G Tambussi
- Clinic of Infectious Diseases, San Raffaele Hospital, University Vita Salute, Milan, Italy
| | - A Bandera
- Infectious Diseases Unit, Department of Internal Medicine, Fondazione IRCCS Ca' Granda, Policlinico Maggiore Hospital, Milan, Italy.,School of Medicine and Surgery, University of Milan, Milan, Italy
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