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Guaraldi G, Malagoli A, Milic J, Pintassilgo I, Rossi E, Riva N, Franconi I, Santoro A, Sorin P, Streinu-Cercel A, De Rosa M, Mussini C. Age of HIV Acquisition Affects the Risk of Multi-Morbidity after 25 Years of Infection Exposure. J Frailty Aging 2019; 8:88-92. [PMID: 30997922 DOI: 10.14283/jfa.2019.6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
INTRODUCTION Understanding the intersection of HIV, aging and health is crucial due to the increasing number of people aging with HIV. OBJECTIVE The objective of the study was to assess the prevalence of, and risk factors for individual comorbidities and multi-morbidity in people living with HIV with similar duration of HIV infection, notwithstanding a 25-year difference at the time of HIV acquisition. METHODS In a cross-sectional multicentre retrospective study, we compared three match-control age groups. The "Young" were selected from Romania and included HIV-positive patients prenatally infected and assessed at the age of 25-30 years. The "Old" and the "Geriatric" were selected from Italy. These respectively included subjects infected with HIV at the age of 25 years and assessed at the age of 50-55 years, and those infected at the age of 50 years and assessed at the age of 75-80 years. Each group was sex and age matched in a 1:5 ratio with controls selected from the CINECA ARNO database from Italy. We described non-infectious comorbidities (NICM), including cardiovascular disease, hypertension, dyslipidaemia, diabetes, chronic kidney disease, and multi-morbidity (MM≥ 3 NICM). RESULTS MM prevalence in the "Young" group compared to controls was 6.2% vs 0%, while in the "Geriatric" was "68.2% vs 3.6%. Using "Young" as a reference, in multivariate analyses, predictors for MM were as follows: HIV serostatus (OR=47.75, IQR 14.78-154.25, p<0.01) and "Geriatric" vs "Young" (OR=30.32, IQR 5.89-155.98, p<0.01). CONCLUSION These data suggest that age at acquisition of HIV should be considered as a risk factor for NICM and MM.
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Affiliation(s)
- G Guaraldi
- Giovanni Guaraldi, Universita degli Studi di Modena e Reggio Emilia, Italy,
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Marcellusi A, Viti R, Sciattella P, Sarmati L, Streinu-Cercel A, Pana A, Espin J, Horcajada JP, Favato G, Andretta D, Soro M, Andreoni M, Mennini FS. Economic evaluation of the treatment of Acute Bacterial Skin and Skin Structure Infections (ABSSSIs) from the national payer perspective: introduction of a new treatment to the patient journey. A simulation of three European countries. Expert Rev Pharmacoecon Outcomes Res 2019; 19:581-599. [PMID: 30714834 DOI: 10.1080/14737167.2019.1569516] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background: The aim of this study was to develop a spending predictor model to evaluate the direct costs associated with the management of ABSSSIs from the National health-care provider's perspective of Italy, Romania, and Spain. Methodology: A decision-analytic model was developed to evaluate the diagnostic and clinical pathways of hospitalized ABSSSI patients based on scientific guidelines and real-world data. A Standard of Care (SoC) scenario was compared with a dalbavancin scenario in which the patients could be discharged early. The epidemiological and cost parameters were extrapolated from national administrative databases (i.e., hospital information system). A probabilistic sensitivity analysis (PSA) and one-way sensitivity analysis (OWA) were performed. Results: Overall, the model estimated an average annual number of patients with ABSSSIs of approximately 50,000 in Italy, Spain, and Romania. On average, the introduction of dalbavancin reduced the length of stay by 3.3 days per ABSSSI patient. From an economic perspective, dalbavancin did not incur any additional cost from the National Healthcare perspective, and the results were consistent among the countries. The PSA and OWA demonstrated the robustness of these results. Conclusion: This model represents a useful tool for policymakers by providing information regarding the economic and organizational consequences of an early discharge approach in ABSSSI management.
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Affiliation(s)
- A Marcellusi
- Economic Evaluation and HTA (CEIS- EEHTA) - IGF Department, Faculty of Economics, University of Rome "Tor Vergata" , Rome , Italy.,Institute for Leadership and Management in Health, Kingston University London , London , UK.,National Research Council (CNR), Institute for Research on Population and Social Policies (IRPPS) , Rome , Italy
| | - R Viti
- Economic Evaluation and HTA (CEIS- EEHTA) - IGF Department, Faculty of Economics, University of Rome "Tor Vergata" , Rome , Italy
| | - P Sciattella
- Department of Statistical Sciences, "Sapienza" University of Rome , Rome , Italy
| | - L Sarmati
- Clinical Infectious Diseases, Department of Systems Medicine, University of Rome "Tor Vergata" , Rome , Italy
| | - A Streinu-Cercel
- National Institute for Infectious Diseases "Prof. Dr. Matei Balș" , Bucharest , Romania
| | - A Pana
- Bucharest University of Economic Studies , Bucharest , Romania
| | - J Espin
- Andalusian School of Public Health , Granada , Spain
| | - J P Horcajada
- Department of Infectious Diseases Hospital Del Mar, Institut Hospital del Mar d'Investigacions Mèdiques (IPAR-IMIM) , Barcelona , Spain
| | - G Favato
- Department of Accounting, Finance & Informatics, Kingston Business School, Kingston University London , London , United Kingdom of Great Britain and Northern Ireland
| | | | - M Soro
- Global HEOR Angelini Spa , Rome , Italy
| | - M Andreoni
- Clinical Infectious Diseases, Department of Systems Medicine, University of Rome "Tor Vergata" , Rome , Italy
| | - F S Mennini
- Economic Evaluation and HTA (CEIS- EEHTA) - IGF Department, Faculty of Economics, University of Rome "Tor Vergata" , Rome , Italy.,Institute for Leadership and Management in Health, Kingston University London , London , UK
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Negru AR, Tiliscan C, Tudor AM, Munteanu DI, Popescu C, Lazar M, Streinu-Cercel A, Arama V, Arama SS. BONE QUALITY IN A YOUNG COHORT OF HIV-POSITIVE PATIENTS. Acta Endocrinol (Buchar) 2019; 15:447-453. [PMID: 32377241 DOI: 10.4183/aeb.2019.447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Context In HIV+ patients, several factors related to patient and antiretroviral therapy (ART) could determine early onset of bone mineral density (BMD) disturbances. Objective Evaluation of bone quality according to gender in patients from the HIV Romanian cohort. Design A cross-sectional study in "Prof. Dr. Matei Balş" National Institute for Infectious Diseases, Bucharest between 2016-2018. Subject and Methods We collected data regarding HIV infection, ART history, viral hepatitis co-infections and we calculated patients body mass index (BMI). CD4 cell count, HIV viral load (VL), vitamin-D levels were determined. Dual-energy X-ray absorptiometry (DXA) scans were used to evaluate BMD. Results We enrolled 97 patients with the median age of 26 years. According to the DXA T-scores, 10 males and 8 females had osteopenia and 4 males and 4 females had osteoporosis. According to Z-scores 2 males and 1 female had osteoporosis. Hip DXA T-scores revealed osteopenia in 6 males and 9 females, whereas T and Z-scores showed osteoporosis in 2 males and 3 females. Lumbar spine (LS) T-score diagnosed osteopenia in 9 males and 6 females, while T and Z-scores revealed osteoporosis in 3 males and females. In males, low T-scores were associated with decreased BMI; low LS DXA Z-scores with low vitamin-D levels; low T and Z-scores and LS-BMD with high VL. Conclusions Evaluating bone quality in patients with a long history of HIV infection, multiple factors should be taken into account.
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Affiliation(s)
- A R Negru
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,"Prof. Dr. Matei Balş" National Institute of Infectious Diseases, Bucharest, Romania
| | - C Tiliscan
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,"Prof. Dr. Matei Balş" National Institute of Infectious Diseases, Bucharest, Romania
| | - A M Tudor
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,"Prof. Dr. Matei Balş" National Institute of Infectious Diseases, Bucharest, Romania
| | - D I Munteanu
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,"Prof. Dr. Matei Balş" National Institute of Infectious Diseases, Bucharest, Romania
| | - C Popescu
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,"Prof. Dr. Matei Balş" National Institute of Infectious Diseases, Bucharest, Romania
| | - M Lazar
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,"Prof. Dr. Matei Balş" National Institute of Infectious Diseases, Bucharest, Romania
| | - A Streinu-Cercel
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,"Prof. Dr. Matei Balş" National Institute of Infectious Diseases, Bucharest, Romania
| | - V Arama
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,"Prof. Dr. Matei Balş" National Institute of Infectious Diseases, Bucharest, Romania
| | - S S Arama
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,"Prof. Dr. Matei Balş" National Institute of Infectious Diseases, Bucharest, Romania
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Piţigoi D, Săndulescu O, Ionescu T, Niţescu B, Niţescu M, Streinu-Cercel A, Streinu-Cercel A. Assessment of knowledge, attitudes and perceptions regarding Ebola disease in healthcare workers from a tertiary care hospital in Romania. Public Health 2018; 164:7-15. [PMID: 30149186 PMCID: PMC7111886 DOI: 10.1016/j.puhe.2018.07.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Revised: 10/19/2017] [Accepted: 07/02/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVES The National Institute for Infectious Diseases 'Prof. Dr. Matei Balș' was the designated centre for managing Ebola alerts in Romania during the 2014 African outbreak. We surveyed Ebola knowledge, attitudes and perceptions (KAP) among the institute's healthcare workers. STUDY DESIGN This was a cross-sectional survey. METHODS The study consisted of a self-administered paper-based anonymous questionnaire that included 24 closed-item questions and two scales of personal concern. RESULTS Respondents were generally well informed; compared to nurses, doctors recorded a 1.9-fold higher rate of correct responses regarding Ebola transmission (P < 0.001), but both nurses and doctors correctly identified Ebola's aetiological agent. Nurses perceived higher personal (P = 0.008) and family (P < 0.001) risk than doctors. Respondents reporting high perceived risks were more likely to be less informed about Ebola (P = 0.019) and its prevention options (P = 0.033). Males were 6.7-fold more likely to volunteer than females (P = 0.001) and so were graduates of higher rather than lower education (1.5-fold more likely, P = 0.017) and doctors than nurses (1.7-fold more likely, P = 0.018). The institute ranked first among sources of information on Ebola; respondents who had received Ebola training in the institute 2 years previously were 1.2-1.3 times more likely to correctly identify transmission routes. CONCLUSIONS We have characterised KAP on Ebola disease among Romanian healthcare workers from a tertiary care hospital in Bucharest. Nurses, specialist physicians and laboratory personnel may need more frequent retraining than residents and senior physicians.
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Affiliation(s)
- D Piţigoi
- Carol Davila University of Medicine and Pharmacy, No. 37 Dionisie Lupu Street, Bucharest, 030167, Romania; National Institute for Infectious Diseases 'Prof. Dr. Matei Balş', No. 1 Dr. Calistrat Grozovici Street, Bucharest, 021105, Romania.
| | - O Săndulescu
- Carol Davila University of Medicine and Pharmacy, No. 37 Dionisie Lupu Street, Bucharest, 030167, Romania; National Institute for Infectious Diseases 'Prof. Dr. Matei Balş', No. 1 Dr. Calistrat Grozovici Street, Bucharest, 021105, Romania.
| | - T Ionescu
- National Institute of Endocrinology C. I. Parhon, No. 34-36 Aviatorilor Street, Bucharest, 011863, Romania.
| | - B Niţescu
- Carol Davila University of Medicine and Pharmacy, No. 37 Dionisie Lupu Street, Bucharest, 030167, Romania.
| | - M Niţescu
- Carol Davila University of Medicine and Pharmacy, No. 37 Dionisie Lupu Street, Bucharest, 030167, Romania; National Institute for Infectious Diseases 'Prof. Dr. Matei Balş', No. 1 Dr. Calistrat Grozovici Street, Bucharest, 021105, Romania.
| | - A Streinu-Cercel
- Carol Davila University of Medicine and Pharmacy, No. 37 Dionisie Lupu Street, Bucharest, 030167, Romania; National Institute for Infectious Diseases 'Prof. Dr. Matei Balş', No. 1 Dr. Calistrat Grozovici Street, Bucharest, 021105, Romania.
| | - A Streinu-Cercel
- Carol Davila University of Medicine and Pharmacy, No. 37 Dionisie Lupu Street, Bucharest, 030167, Romania; National Institute for Infectious Diseases 'Prof. Dr. Matei Balş', No. 1 Dr. Calistrat Grozovici Street, Bucharest, 021105, Romania.
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Brouwer WP, Sonneveld MJ, Xie Q, Guo S, Zhang N, Zeuzem S, Tabak F, Zhang Q, Simon K, Akarca US, Streinu-Cercel A, Hansen BE, Janssen HLA. Peginterferon add-on results in more HBsAg decline compared to monotherapy in HBeAg-positive chronic hepatitis B patients. J Viral Hepat 2016; 23:419-26. [PMID: 26403919 DOI: 10.1111/jvh.12468] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Accepted: 08/25/2015] [Indexed: 01/04/2023]
Abstract
It is unknown whether peginterferon (PEG-IFN) add-on to entecavir (ETV) leads to more HBsAg decline compared to PEG-IFN monotherapy or combination therapy, and whether ETV therapy may prevent HBsAg increase after PEG-IFN cessation. We performed a post hoc analysis of 396 HBeAg-positive patients treated for 72 weeks with ETV + 24 weeks PEG-IFN add-on from week 24 to 48 (add-on, n = 85), 72 weeks with ETV monotherapy (n = 90), 52 weeks with PEG-IFN monotherapy (n = 111) and 52 weeks PEG-IFN + lamivudine (combination, n = 110) within 2 randomized trials. HBsAg decline was assessed at the end of PEG-IFN (EOP) and 6 months after PEG-IFN (EOF) discontinuation. Differences in baseline characteristics were accounted for using inversed probability of treatment weights. At EOP, a HBsAg reduction of ≥1log10 IU/mL was more frequently achieved for patients in the add-on or combination therapy arms (both 36%), compared to PEG-IFN mono (20%) or ETV (8%) (add-on vs PEG-IFN mono P = 0.050). At EOF, the HBsAg reduction ≥1log10 IU/mL was only sustained in patients treated with ETV consolidation (add-on vs combination and PEG-IFN mono: 40% vs 23% and 18%, P = 0.029 and P = 0.003, respectively). For add-on, combination, PEG-IFN mono and ETV, the mean HBsAg-level change at EOF was -0.84, -0.81, -0.68 and -0.33 log10 IU/mL, respectively (P > 0.05 for PEG-IFN arms). HBeAg loss at EOF was 36%, 31%, 33% and 20%, respectively (P > 0.05). PEG-IFN add-on for 24 weeks results in more on-treatment HBsAg decline than does 52 weeks of PEG-IFN monotherapy. ETV therapy may maintain the HBsAg reduction achieved with PEG-IFN.
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Affiliation(s)
- W P Brouwer
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - M J Sonneveld
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Q Xie
- Infectious Diseases, Ruijin Hospital, Jiaotong University, Shanghai, China
| | - S Guo
- Infectious Diseases, Ruijin Hospital, Jiaotong University, Shanghai, China
| | - N Zhang
- Gastroenterology and Hepatology, Zhong Shan Hospital, Fu Dan University, Shanghai, China
| | - S Zeuzem
- Medizinische Klinik 1, Klinikum der Johann Wolfgang Goethe-Universität, Frankfurt am Main, Germany
| | - F Tabak
- Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Q Zhang
- Gastroenterology and Hepatology, Shanghai Public Health Center, Fu Dan University, Shanghai, China
| | - K Simon
- Division of Infectious Diseases and Hepatology, Wroclaw Medical University, Wroclaw, Poland
| | - U S Akarca
- Ege Üniversitesi Tip Fakultesi, Bornova, Turkey
| | - A Streinu-Cercel
- Department of Gastroenterology, Fundeni Cinical Institute, Bucharest, Romania
| | - B E Hansen
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands.,Department of Public Health, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - H L A Janssen
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands.,Toronto Center for Liver Disease, Toronto Western and General Hospital, University Health Network, Toronto, ON, Canada
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Streinu-Cercel A, Sandulescu O, Stefan M, Streinu-Cercel A. Treatment with lamivudine and entecavir in severe acute hepatitis B. Indian J Med Microbiol 2016; 34:166-72. [DOI: 10.4103/0255-0857.176837] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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van Campenhout MJH, Brouwer WP, van Oord GW, Xie Q, Zhang Q, Zhang N, Guo S, Tabak F, Streinu-Cercel A, Wang J, Pas SD, Sonneveld MJ, de Knegt RJ, Boonstra A, Hansen BE, Janssen HLA. Hepatitis B core-related antigen levels are associated with response to entecavir and peginterferon add-on therapy in hepatitis B e antigen-positive chronic hepatitis B patients. Clin Microbiol Infect 2016; 22:571.e5-9. [PMID: 26898481 DOI: 10.1016/j.cmi.2016.02.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Revised: 02/01/2016] [Accepted: 02/05/2016] [Indexed: 01/21/2023]
Abstract
Hepatitis B core-related antigen (HBcrAg), a new serum marker, may be useful in monitoring chronic hepatitis B infection. HBcrAg was measured in 175 hepatitis B e antigen-positive patients treated with entecavir (ETV) with or without peginterferon (PEG-IFN) add-on therapy. Decline in HBcrAg was stronger in patients with vs. without combined response (ETV: -3.22 vs. -1.71 log U/mL, p <0.001; PEG-IFN add-on: -3.16 vs. -1.83 IU/mL, p <0.001) and in patients with vs. without hepatitis B surface antigen (HBsAg) response (ETV: -2.60 vs. -1.74 log U/mL, p <0.001; PEG-IFN add-on: -2.38 vs. -2.15 log U/mL, p = 0.31). HBcrAg was associated with combined response (adjusted odds ratio 0.3, 95% confidence interval 0.2-0.5, p <0.001), but was not superior to quantitative HBsAg (qHBsAg).
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Affiliation(s)
- M J H van Campenhout
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - W P Brouwer
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - G W van Oord
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Q Xie
- Infectious Diseases, Ruijin Hospital, Jiaotong University, Shanghai, China
| | - Q Zhang
- Gastroenterology and Hepatology, Shanghai Public Health Center, Fu Dan University, Shanghai, China
| | - N Zhang
- Gastroenterology and Hepatology, Zhong Shan Hospital, Fu Dan University, Shanghai, China
| | - S Guo
- Infectious Diseases, Ruijin Hospital, Jiaotong University, Shanghai, China
| | - F Tabak
- Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - A Streinu-Cercel
- Carol Davila University of Medicine and Pharmacy, National Institute for Infectious Diseases "Prof. Dr Matei Balş", Bucharest, Romania
| | - J Wang
- Gastroenterology and Hepatology, Zhong Shan Hospital, Fu Dan University, Shanghai, China
| | - S D Pas
- Department of Virology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - M J Sonneveld
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - R J de Knegt
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - A Boonstra
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - B E Hansen
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands; Department of Public Health, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - H L A Janssen
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands; Toronto Center for Liver Disease, Toronto Western and General Hospital, University Health Network, Toronto, Canada.
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Niţescu M, Streinu-Cercel A, Tusaliu M, Piţigoi D, Oţelea M. CORRELATION BETWEEN THE WAIST CIRCUMFERENCE, DIASTOLIC BLOOD PRESSURE AND INSULIN RESISTANCE IN NON-OBESE YOUNG ADULTS. Acta Endocrinol (Buchar) 2016; 12:493-499. [PMID: 31149139 DOI: 10.4183/aeb.2016.493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Context The metabolic syndrome is a profound, systemic impairment of the metabolism of lipids, carbohydrates and branched amino-acids, affecting specially obese people. Recently, many studies outlined the presence of the metabolic syndrome, also in non obese persons. Objective and design To assess the relationship between insulin resistance and the cardiovascular component of the metabolic syndrome in a group of young, non obese subjects using a cross sectional study. Subjects and methods We enrolled 103 subjects with body mass index < 30 Kg/m2, without metabolic syndrome to whom fasting glucose, triglycerides, high density lipoprotein cholesterol, insulinemia, waist circumference and arterial pressure were recorded in a cross-sectional approach. Insulin resistance was evaluated using the homeostasis model assessment for insulin (HOMA-IR) index. Statistic data processing included Pearson relation and multiple regression (backward method), using the SPSS version 21 software. Results A significant relationship between waist circumference, diastolic blood pressure and HOMA-IR is found. High value of HOMA-IR (>2.6) was more frequently in men (p=0.011). The incidence of the 2 metabolic components mentioned above was higher in the high value HOMA-IR group: 33% vs. 7% in women and 50% vs. 4% in men. Multiple regression showed a strong correlation between HOMA-IR and waist circumference (p<0.001) and diastolic blood pressure (p=0.008) that was maintained inside the women group (p=0.016 and p=0.032, respectively). In men, HOMA-IR correlated with waist circumference (p=0.031). Conclusion We found a significant interdepen-dence between waist circumference, diastolic blood pressure and HOMA-IR. Based on our results, we consider that lifestyle intervention should start as soon as abnormal waist circumference is recorded.
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Affiliation(s)
- M Niţescu
- "Carol Davila" University of Medicine and Pharmacy, 3 Preclinic, Bucharest, Romania.,"Carol Davila" University of Medicine and Pharmacy, "Matei Balŝ" National Institute for Infectious Diseases, Bucharest, Romania
| | - A Streinu-Cercel
- "Carol Davila" University of Medicine and Pharmacy, 2 Clinic, Bucharest, Romania.,"Carol Davila" University of Medicine and Pharmacy, "Matei Balŝ" National Institute for Infectious Diseases, Bucharest, Romania
| | - M Tusaliu
- "Carol Davila" University of Medicine and Pharmacy, Otorhinolaryngology and Ophthalmology Dept., Bucharest, Romania
| | - D Piţigoi
- "Carol Davila" University of Medicine and Pharmacy, 2 Clinic, Bucharest, Romania
| | - M Oţelea
- "Carol Davila" University of Medicine and Pharmacy, 2 Clinic, Bucharest, Romania
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Buti M, Flisiak R, Kao JH, Chuang WL, Streinu-Cercel A, Tabak F, Calistru P, Goeser T, Rasenack J, Horban A, Davis GL, Alberti A, Mazzella G, Pol S, Orsenigo R, Brass C. Alisporivir with peginterferon/ribavirin in patients with chronic hepatitis C genotype 1 infection who failed to respond to or relapsed after prior interferon-based therapy: FUNDAMENTAL, a Phase II trial. J Viral Hepat 2015; 22:596-606. [PMID: 25412795 DOI: 10.1111/jvh.12360] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Accepted: 09/18/2014] [Indexed: 02/02/2023]
Abstract
Alisporivir (ALV) is an oral, investigational host-targeting agent, with pangenotypic activity against hepatitis C virus (HCV). This randomized, double-blind, placebo-controlled, Phase II study explored the efficacy and safety of ALV with peginterferon-α2a/ribavirin (PR) in patients with chronic HCV genotype 1 infection in whom prior PR had failed (43% relapsers, 34% null responders and 23% partial responders). Four-hundred-and-fifty-nine patients were randomized (1:1:1:1) to ALV 600 mg once daily (QD), ALV 800 mg QD, ALV 400 twice daily (BID) or placebo plus PR for 48 weeks. When the global ALV trial programme was put on clinical hold, all patients in this study had received ≥31 weeks of randomized treatment; patients completed 48 weeks on PR alone. All ALV groups demonstrated superior rates of complete early virologic response (cEVR; primary endpoint) vs PR alone (P ≤ 0.0131), with highest cEVR rate seen with ALV 400 mg BID (74% vs 36% with PR alone; P < 0.0001). Respective SVR12 rates (key secondary endpoint) were 65% vs 26% in prior relapsers, 63% vs 5% in partial responders and 68% vs 3% in null responders. In patients who received >40 weeks of randomized treatment, the SVR12 rate was 89% for ALV 400 mg BID vs 30% for PR alone (P = 0.0053). Rates of viral breakthrough and relapse were lowest with ALV 400 mg BID. One case of pancreatitis (fully recovered) occurred with ALV/PR. Common AEs were headache, fatigue, anaemia, neutropenia and nausea. Hypertension was infrequent, but more common with ALV. ALV merits further investigation in interferon-free regimens in combination with direct-acting antiviral agents.
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Affiliation(s)
- M Buti
- Liver Unit, Hospital Universitario Valle Hebron and Ciberehd del Instituto Carlos III, Barcelona, Spain
| | - R Flisiak
- Department of Infectious Diseases and Hepatology, Medical University of Bialystok, Bialystok, Poland
| | - J-H Kao
- National Taiwan University Hospital, Taipei, Taiwan
| | - W-L Chuang
- Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - A Streinu-Cercel
- Carol Davila University of Medicine and Pharmacy, and National Institute for Infectious Diseases 'Prof. Dr. Matei Balş', Bucharest, Romania
| | - F Tabak
- Istanbul University Cerrahpasa Medical School, Istanbul, Turkey
| | - P Calistru
- Centrul de Diagnostic si Tratament Dr. Viktor Babeş, Bucharest, Romania
| | - T Goeser
- Klinik für Gastroenterologie und Hepatologie Universitätsklinik Köln, Köln, Germany
| | - J Rasenack
- Universitätsklinik Albert-Ludwigs Universität Freiburg, Freiburg, Germany
| | - A Horban
- Warsaw Medical University and Hospital of Infectious Disease, Warsaw, Poland
| | - G L Davis
- Baylor University Medical Center, Dallas, TX, USA
| | - A Alberti
- Department of Molecular Medicine, University of Padova, Padova, Italy
| | - G Mazzella
- Azienda Ospedaliera di Bologna Policl, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - S Pol
- Hôpital Cochin, Paris, France
| | | | - C Brass
- Novartis Pharma AG, Basel, Switzerland
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10
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Daia-Iliescu S, Opris D, Streinu-Cercel A, Sandulescu O, Daia T, Streinu-Cercel A, Ionescu R. THU0259 Rheumatic Diseases and Immunologic Features in a Group of Patients with HCV Infection and Concomitant Rheumatic Complaints. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.6410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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11
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Colombo M, Fernández I, Abdurakhmanov D, Ferreira PA, Strasser SI, Urbanek P, Moreno C, Streinu-Cercel A, Verheyen A, Iraqi W, DeMasi R, Hill A, Läuffer JM, Lonjon-Domanec I, Wedemeyer H. Safety and on-treatment efficacy of telaprevir: the early access programme for patients with advanced hepatitis C. Gut 2014; 63:1150-8. [PMID: 24201995 PMCID: PMC4078754 DOI: 10.1136/gutjnl-2013-305667] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIM Severe adverse events (AEs) compromise the outcome of direct antiviral agent-based treatment in patients with advanced liver fibrosis due to HCV infection. HEP3002 is an ongoing multinational programme to evaluate safety and efficacy of telaprevir (TVR) plus pegylated-interferon-α (PEG-IFNα) and ribavirin (RBV) in patients with advanced liver fibrosis caused by HCV genotype 1 (HCV-1). METHODS 1782 patients with HCV-1 and bridging fibrosis or compensated cirrhosis were prospectively recruited from 16 countries worldwide, and treated with 12 weeks of TVR plus PEG-IFN/RBV, followed by 12 or 36 weeks of PEG-IFN and RBV (PR) alone dependent on virological response to treatment and previous response type. RESULTS 1587 patients completed 12 weeks of triple therapy and 4 weeks of PR tail (53% cirrhosis, 22% HCV-1a). By week 12, HCV RNA was undetectable in 85% of naives, 88% of relapsers, 80% of partial responders and 72% of null responders. Overall, 931 patients (59%) developed grade 1-4 anaemia (grade 3/4 in 31%), 630 (40%) dose reduced RBV, 332 (21%) received erythropoietin and 157 (10%) were transfused. Age and female gender were the strongest predictors of anaemia. 64 patients (4%) developed a grade 3/4 rash. Discontinuation of TVR due to AEs was necessary in 193 patients (12%). Seven patients died (0.4%, six had cirrhosis). CONCLUSIONS In compensated patients with advanced fibrosis due to HCV-1, triple therapy with TVR led to satisfactory rates of safety, tolerability and on-treatment virological response with adequate managements of AEs.
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Affiliation(s)
- M Colombo
- Department of Medicine, Division of Gastroenterology, Fondazione IRCCS Ca` Granda Ospedale Maggiore Policlinico, Universita` degli Studi di Milano, Milan, Italy
| | - I Fernández
- Hospital Universitario 12 de Octubre, Sección de Aparato Digestivo, Madrid, Spain
| | - D Abdurakhmanov
- I.M. Sechenov First Moscow State Medical University, E. M. Tareev Clinic for Nephrology, Internal and Occupational Medicine, Moscow, Russia
| | - P A Ferreira
- Viral Hepatitis Division of Infectious Disease, Outpatient Clinic to HIV, Federal University of São Paulo, São Paulo, Brazil
| | - S I Strasser
- AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, University of Sydney, Sydney, Australia
| | - P Urbanek
- Department of Internal Medicine, First Medical Faculty, Charles University, and Central Military Hospital Prague, Prague, Czech Republic
| | - C Moreno
- Liver Unit, Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - A Streinu-Cercel
- Carol Davila University of Medicine and Pharmacy, National Institute for Infectious Diseases, "Prof. Dr. Matei Bals", Bucharest, Romania
| | | | - W Iraqi
- Janssen Pharmaceuticals, Paris, France
| | - R DeMasi
- Janssen Research and Development, Titusville, New Jersey, USA
| | - A Hill
- Janssen Research and Development, High Wycombe, UK
| | | | | | - H Wedemeyer
- Medizinische Hochschule Hannover, Hannover, Germany
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12
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Revell AD, Wang D, Wood R, Morrow C, Tempelman H, Hamers RL, Alvarez-Uria G, Streinu-Cercel A, Ene L, Wensing AMJ, DeWolf F, Nelson M, Montaner JS, Lane HC, Larder BA. Computational models can predict response to HIV therapy without a genotype and may reduce treatment failure in different resource-limited settings. J Antimicrob Chemother 2013; 68:1406-14. [PMID: 23485767 DOI: 10.1093/jac/dkt041] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES Genotypic HIV drug-resistance testing is typically 60%-65% predictive of response to combination antiretroviral therapy (ART) and is valuable for guiding treatment changes. Genotyping is unavailable in many resource-limited settings (RLSs). We aimed to develop models that can predict response to ART without a genotype and evaluated their potential as a treatment support tool in RLSs. METHODS Random forest models were trained to predict the probability of response to ART (≤400 copies HIV RNA/mL) using the following data from 14 891 treatment change episodes (TCEs) after virological failure, from well-resourced countries: viral load and CD4 count prior to treatment change, treatment history, drugs in the new regimen, time to follow-up and follow-up viral load. Models were assessed by cross-validation during development, with an independent set of 800 cases from well-resourced countries, plus 231 cases from Southern Africa, 206 from India and 375 from Romania. The area under the receiver operating characteristic curve (AUC) was the main outcome measure. RESULTS The models achieved an AUC of 0.74-0.81 during cross-validation and 0.76-0.77 with the 800 test TCEs. They achieved AUCs of 0.58-0.65 (Southern Africa), 0.63 (India) and 0.70 (Romania). Models were more accurate for data from the well-resourced countries than for cases from Southern Africa and India (P < 0.001), but not Romania. The models identified alternative, available drug regimens predicted to result in virological response for 94% of virological failures in Southern Africa, 99% of those in India and 93% of those in Romania. CONCLUSIONS We developed computational models that predict virological response to ART without a genotype with comparable accuracy to genotyping with rule-based interpretation. These models have the potential to help optimize antiretroviral therapy for patients in RLSs where genotyping is not generally available.
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Affiliation(s)
- A D Revell
- The HIV Resistance Response Database Initiative (RDI), London, UK
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13
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Merisescu M, Luminos M, Jugulete G, Florea D, Streinu-Cercel A. Molecular diagnosis of severe bacterial sepsis in children. Crit Care 2012. [PMCID: PMC3504868 DOI: 10.1186/cc11754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- M Merisescu
- National Institute of Infectious Diseases, Bucharest, Romania
| | - M Luminos
- National Institute of Infectious Diseases, Bucharest, Romania
| | - G Jugulete
- National Institute of Infectious Diseases, Bucharest, Romania
| | - D Florea
- National Institute of Infectious Diseases, Bucharest, Romania
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14
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Bumbea H, Vladareanu AM, Vintilescu A, Radesi S, Ciufu C, Onisai M, Baluta C, Begu M, Dobrea C, Arama V, Streinu-Cercel A, Arama S. The lymphocyte immunophenotypical pattern in chronic lymphocytic leukemia associated with hepatitis viral infections. J Med Life 2011; 4:256-63. [PMID: 22567048 PMCID: PMC3168828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2011] [Accepted: 06/04/2011] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Chronic lymphoproliferative disorders (CLD) are frequently found in patients with hepatitis viral infections, which can lead to changes in pathogenesis. Hepatitis viruses are hepatotrope viruses, potentially lymphotrope and also potentially oncogenic (hepatocellular carcinoma) viruses. HBV and HCV are involved in autoimmune disorders and in the ethiopathogeny of chronic lymphoproliferative disorders. AIM Detection of immunophenotype changes of malignant lymphocytes in CLD--especially CLL--associated with hepatitis viral infections. MATERIALS AND METHODS Bone marrow aspirate, peripheral blood samples on EDTA were available for analysis from 58 patients from a follow-up schedule of the Department of Hematology SUUB from March 2008 until June 2009. The patients were diagnosed with chronic lymphoproliferative disorders associated with hepatitis virus B/C/D infections. A group of 28 consecutive unselected patients with CLL who met the diagnostic criteria of the National Cancer Institute-Working Group (NCI NCIWG), and associated hepatitis viral infection (v-CLL) were studied for the expression of several immunophenotypical markers, in comparison to CLL patients without viral infection (control group). Immunophenotyping analysis was performed on a FACS Calibur flowcytometer with a large panel according to EGIL/WHO recommendations. The diagnosis was completed after the histological and immunochemical analysis from tumoral lesions. RESULTS Demographics characteristics--male/female ratio 1/2, average age 64 years. Disease type: 90% B-CLD, 5% T-CLD, 5% Hodgkin's disease. The viral infections: 58.53% HCV, 34.41% HBV, 2.43% HBV+HDV, 2.43% HCV+HDV, 2.43% HBV+HCV+HDV. We found in CLL with viral coinfection (v-CLL) cases an elevated expression of B-cell markers--CD19 (Md95/92), CD20 (Md 90/39), CD79b (Md58/31), CD23 (Md67/37). Poor prognosis markers have a higher expression in v-CLL: CD38 (Md49/24), Bcl2 (Md 46/5), cyclin D19 (Md 11/0.5). No change in ZAP-70 expression was observed: Md 59.5/59.1. DISCUSSIONS Hepatitis viruses could be involved in the pathogenesis of CLD, but as a trigger for a more aggressive outcome. Higher expression of B-cell markers CD19, CD20 in CLL with viral infection suggests a change to atypical CLL, sustained by elevated expression of known poor prognosis markers bcl-2, cyclin D1 and CD38. Lack of ZAP-70 expression could be explained by a strong correlation with a basic unmutated IgVH status, not related to the viral infection. We found a higher frequency of HCV infection in patients with CLD and especially in CLL patients, which were analyzed extensively for immunophenotypical changes. In the present study, we demonstrated that this CD5+ B cell population with clonal expansion, defining CLL patients, has a different immunophenotype, probably related to the hepatitis viral infection.
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MESH Headings
- Antigens, Neoplasm/immunology
- Biomarkers, Tumor/immunology
- Female
- Hepatitis/complications
- Hepatitis/epidemiology
- Hepatitis/immunology
- Hepatitis/virology
- Humans
- Immunophenotyping
- Incidence
- Leukemia, Lymphocytic, Chronic, B-Cell/complications
- Leukemia, Lymphocytic, Chronic, B-Cell/epidemiology
- Leukemia, Lymphocytic, Chronic, B-Cell/immunology
- Leukemia, Lymphocytic, Chronic, B-Cell/virology
- Lymphocytes/immunology
- Male
- Middle Aged
- Prevalence
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Affiliation(s)
- H Bumbea
- Hematology Department, Universitary Emergency Hospital, Bucharest, Romania
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15
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Rusu MC, Pop F, Hostiuc S, Curcă GC, Streinu-Cercel A. Extrahepatic and intrahepatic human portal interstitial Cajal cells. Anat Rec (Hoboken) 2011; 294:1382-92. [PMID: 21714117 DOI: 10.1002/ar.21441] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2010] [Accepted: 05/16/2011] [Indexed: 01/18/2023]
Abstract
Portal interstitial cells of Cajal (PICCs), acting as vascular pacemakers, were previously only identified in nonhumans. Moreover, there is no evidence available about the presence of such cells within the liver. The objective of the study is to evaluate whether or not PICCs are identifiable in humans and, if they are, whether or not they are following the scaffold of portal vein (PV) branches within the liver. We obtained extrahepatic PVs and liver samples from six adult human cadavers, negative for liver disease, in accordance with ethical rules. They were stained with hematoxylin-eosin (HE) and Giemsa, and then we performed immunohistochemistry on formalin-fixed paraffin-embedded specimens for CD117/c-kit, a marker of the Cajal's cells. Immune labeling was also performed for S-100 protein, desmin, glial fibrillary acidic protein (GFAP), neurofilaments, α-smooth muscle actin (α-SMA), and CD34. c-kit-Positive PICCs were identified within the extrahepatic PV, in portal spaces, and septa. On adjacent sections, these PICCs were negative for all the other antibodies used. In conclusion, our study confirms the presence of extrahepatic PICCs on humans, which may act as a possible intrinsic pacemaker in the human PV. However, the intrahepatic PICCs, which were evidenced here for the first time, are in need for further experimental studies to evaluate their functional role. A promising further direction of the study is the PICCs role in the idiopathic portal hypertension.
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Affiliation(s)
- M C Rusu
- Discipline of Anatomy, Faculty of Dental Medicine, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.
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16
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Nichita L, Zurac S, Popp C, Micu G, Bastian A, Stăniceanu F, Streinu-Cercel A. Dendritic cells--immunodeficiency virus (HIV): early interactions. Rom J Intern Med 2011; 49:251-255. [PMID: 22568269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Since 1973, when Steinman and Cohn highlighted the importance of dendritic cells as mediators of immunity, a large series of subsequent researches have been registered concerning these amazing cells and their implications in different pathologies. Although in small number, they are widely distributed and represent crucial elements in immune responses against pathogens. Data gathered in the last period, mostly based on in vitro studies, helped us understand the early events of HIV-host interactions, the important roles of dendritic cells in this phase, but fails to fully explain the complex mechanisms underlying these interactions, such as the ways developed by HIV to evade the immune system and to facilitate viral dissemination. Improved knowledge of these mechanisms may provide a basis in the attempt to find new therapeutic targets and elaborate immunologic therapies.
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Affiliation(s)
- Luciana Nichita
- Colentina Clinical Hospital, Department of Pathology, Bucharest, Romania.
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17
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Hristea A, Otelea D, Paraschiv S, Macri A, Baicus C, Moldovan O, Tinischi M, Arama V, Streinu-Cercel A. Detection of Mycobacterium tuberculosis resistance mutations to rifampin and isoniazid by real-time PCR. Indian J Med Microbiol 2010; 28:211-6. [DOI: 10.4103/0255-0857.66474] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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18
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Hristea A, Luka AI, Oancea I, Bica F, Stăniceanu F, Arama V, Streinu-Cercel A, Moroti R. Isolated tuberculous tenosynovitis of the forearm in an immunocompetent patient. Chirurgia (Bucur) 2010; 105:427-430. [PMID: 20726315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Primary tuberculous tenosynovitis is a rare manifestation of extraspinal musculoskeletal tuberculosis. The diagnosis may be easily delayed because of its nonspecific clinical signs. We report a case of culture-proven tuberculous tenosynovitis of the extensor carpi ulnaris tendon and common extensor tendon in a 68-year-old female without concomitant pulmonary tuberculosis, nor documented immunodeficiency. The diagnosis was initially overlooked due to the lack of appropriate histological and bacteriological analyses and the lesion recurred after surgery. MR imaging represents the most accurate method in making the diagnosis, but has no diagnostic specificity in regard to tuberculosis, therefore surgical biopsy is strongly recommended. The patient had a favorable clinical response after a combination of excision and appropriate antituberculous therapy for sensitive Mycobacterium tuberculosis. We emphasize the need for an increased awareness and high index of suspicion of tuberculosis in all cases of a chronic orrecurrent abscess in the extremities, not only in patients living in endemic areas but also in those who have emigrated from regions with a high prevalence of tuberculosis.
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Affiliation(s)
- A Hristea
- Prof. Dr. Matei Balş National Institute for Infectious Diseases, Department of Infectious Diseases, UMF Carol Davila, Bucharest.
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19
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Preotescu L, Popa GL, Motoi M, Streinu-Cercel A, Popa MI. Aspergillus fumigatus meningitis in immunosuppressed patients; diagnosis, management, prevention and control. Roum Arch Microbiol Immunol 2009; 68:95-99. [PMID: 20361528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Aspergillosis is a fungal disease that may be expressed by a diversity of clinical syndromes being produced by several of more than 170 Aspergillus species. The "Matei Balş" National Institute for Infectious Diseases has a long experience in diagnostic procedures and treatment of the immunosuppressed patients. Irrespective of the place of their residence, most patients with HIV infection and AIDS were investigated in the Institute in the last two decades. The first case of double central nervous infection (Mycobacterium tuberculosis and Aspergillus fumigatus) in a HIV positive patient is discussed.
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20
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Lazăr M, Ion DA, Streinu-Cercel A, Bădărău AI. Fahr's syndrome: diagnosis issues in patients with unknown family history of disease. Rom J Morphol Embryol 2009; 50:425-428. [PMID: 19690769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Fahr's disease (FD) is a rare clinical neurodegenerative entity, occurring in fourth or fifth decade or elderly patients, consisting in symmetric polytopic calcifications, in one ore more of the following areas: basal ganglia, cerebral white matter, thalami, internal capsulae, cerebellum, which can lead to pyramidal, extrapyramidal, cerebellar symptoms, alteration of sensitive perception and psychiatric manifestations. The purpose of this paper is to present the FD-diagnosis with unknown family history of disease, based on calcification pattern, symptomatology and lab tests. A three years retrospective study was effectuated on 1942 patients, aged between 20 and 96-year-old, presenting neurological and psychiatric symptoms, which required differential diagnosis with FD. All the patients were evaluated by CT-scans and levels of serum calcium and alkaline phosphatase were measured in cases with cerebral calcification, in order to exclude abnormal calcium-phosphorus metabolism. Cerebral and cerebellar calcification were found in 176 cases, seven cases presenting a calcification pattern suggestive for FD and in six from the seven cases a positive diagnosis of FD was established.
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Affiliation(s)
- M Lazăr
- Department of Radiology and Medical Imaging, Prof. Dr. Matei Bals National Institute for Infectious Disease, Bucharest, Romania.
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21
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Mihăilescu R, Arama V, Paraschiv S, Streinu-Cercel A, Oţelea D, Munteanu D, Iosipenco M, Chiotan C, Benea OE, Mărdărescu M, Rădulescu M, Hristea A, Ungurianu R, Aramă SS, Cercel AS, Călin R, Băicuş C. Impact of highly active antiretroviral therapy on cytomegalovirus viraemia in the absence of specific anti-cytomegalovirus therapy. Rom J Intern Med 2008; 46:305-311. [PMID: 19480296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
OBJECTIVES (1) to evaluate the effect of HAART on CMV viraemia in co-infected patients, in the absence of specific anti-CMV therapy; (2) to compare 2 molecular biology techniques for the detection and quantification of CMV-DNA in these patients. METHODS We present the preliminary data of an ongoing prospective research grant on newly diagnosed HIV seropositives, in a tertiary care hospital, during June 2006- June 2008. Clinical, virological (HIV and CMV viraemia) and immunological (CD4) screening was performed every 3 months. The CMV viraemia was performed by RoboGene Human Cytomegalovirus Quantification kit (aj Roboscreen). We retested all undetectable CMV viremia found in patients with CD4 <50/mmc, by CMV PCR kit (Qiagen Diagnostics). Both PCR reactions were performed on ABI Prism 7000 (Applied Biosystems). RESULTS Up to date, our study has included 105 HIV-infected subjects, who were seropositive for anti-CMV IgG antibodies. Average follow-up was 18 months. CMV viraemia was found detectable in 21 cases at first visit and in other 5 at the second visit. 22 cases had CD4 <50/mmc, among which 14 had undetectable CMV viraemia. The results of both molecular biology techniques were widely the same. HAART was prescribed to 86% of the patients; all the patients having detectable CMV viraemia received HAART, but not any specific anti-CMV therapy. Under HAART, all the detectable CMV loads which were retested in time became undetectable at next visits, after a median of 16.5 weeks from the introduction of therapy. CONCLUSIONS CMV viraemia detection was useful in early diagnosis of asymptomatic CMV infection. As opposed to transplant cases, molecular biology techniques for the detection and quantification of CMV-DNA in HIV-patients have not been standardized yet. In our study, the two kits RoboGene Human Cytomegalovirus (HCMV) Quantification kit (aj Roboscreen) and CMV PCR kit (Qiagen Diagnostics) were comparable. HAART made the reduction of CMV viral load, without any specific anti-CMV therapy. As in the case of other opportunistic infections, undetectable natural history of CMV infection seemed to have been improved by controlling HIV infection.
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Affiliation(s)
- Raluca Mihăilescu
- Prof. Dr. Matei Balş National Institute of Infectious Diseases, Bucharest, Romania
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22
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Mihailescu R, Paraschiv S, Arama V, Streinu-Cercel A, Otelea D, Benea OE, Iosipenco M, Mardarescu M, Luminos M, Munteanu D, Radulescu M, Chiotan C, Hristea A, Ungurianu R. Impact of highly active antiretroviral therapy on cytomegalovirus viraemia, in the absence of specific anti-cytomegalovirus therapy. J Int AIDS Soc 2008. [DOI: 10.1186/1758-2652-11-s1-p255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Streinu-Cercel A, Ion DA, Chivu LI, Chivu RD. [Lipodystrophy syndrome in HIV-infected patients. Clinical and diagnostic features]. Rev Med Chir Soc Med Nat Iasi 2006; 110:521-5. [PMID: 17571539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
After the introduction of HAART (Highly Active Anti-Retroviral Therapy) in patients infected with HIV, a new syndrome--Lipodystrophy syndrome--has been described, in 1998. Lipodystrophy syndrome in patients with HIV infection comprises several conditions: lipoatrophy, lipohypertrophy, mixed syndrome (lipoatrophy and lipohypertrophy), often associated with dyslipidemia and insulin resistance. Lipoatrophy and lipohypertrophy can occur independently, being associated with different constellations of host, disease and drug risk factors. Until a working clinical definition on HIV-related lipodystrophy syndrome is developed, it will be difficult to monitor patients and compare studies, because, at present, investigators, clinicians and patients have different working definitions.
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Affiliation(s)
- A Streinu-Cercel
- Institutul de Boli Infecţioase Prof. Dr. Matei Balş, Catedra de Boli Infecţioase Universitatea de Medicină Si Farmacie Carol Davila Bucureşti Facultatea de Medicină
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Mocroft A, Rockstroh J, Soriano V, Ledergerber B, Kirk O, Vinogradova E, Reiss P, Katlama C, Phillips AN, Lundgren JD, Losso M, Duran A, Vetter N, Karpov I, Vassilenko A, Clumeck N, De Wit S, Poll B, Machala L, Rozsypal H, Sedlacek D, Nielsen J, Lundgren J, Benfield T, Kirk O, Gerstoft J, Katzenstein T, Hansen ABE, Skinhøj P, Pedersen C, Zilmer K, Katlama C, Viard JP, Girard PM, Marc TS, Vanhems P, Pradier C, Dabis F, Dietrich M, Manegold C, Van Lunzen J, Stellbrink HJ, Staszewski S, Bickel M, Goebel FD, Fätkenheuer G, Rockstroh J, Schmidt R, Kosmidis J, Gargalianos P, Sambatakou H, Perdios J, Panos G, Banhegyi D, Mulcahy F, Yust I, Turner D, Burke M, Pollack S, Hassoun G, Sthoeger Z, Maayan S, Vella S, Chiesi A, Arici C, Pristerá R, Mazzotta F, Gabbuti A, Esposito R, Bedini A, Chirianni A, Montesarchio E, Vullo V, Santopadre P, Narciso P, Antinori A, Franci P, Zaccarelli M, Lazzarin A, Finazzi R, Monforte AD, Viksna L, Chaplinskas S, Hemmer R, Staub T, Reiss P, Bruun J, Maeland A, Ormaasen V, Knysz B, Gasiorowski J, Horban A, Prokopowicz D, Wiercinska-Drapalo A, Boron-Kaczmarska A, Pynka M, Beniowski M, Mularska E, Trocha H, Antunes F, Valadas E, Mansinho K, Matez F, Duiculescu D, Streinu-Cercel A, Vinogradova E, Rakhmanova A, Jevtovic D, Mokrás M, Staneková D, González-Lahoz J, Sánchez-Conde M, García-Benayas T, Martin-Carbonero L, Soriano V, Clotet B, Jou A, Conejero J, Tural C, Gatell JM, Miró JM, Blaxhult A, Karlsson A, Pehrson P, Ledergerber B, Weber R, Francioli P, Telenti A, Hirschel B, Soravia-Dunand V, Furrer H, Chentsova N, Barton S, Johnson AM, Mercey D, Phillips A, Johnson MA, Mocroft A, Murphy M, Weber J, Scullard G, Fisher M, Brettle R, Loveday C, Clotet B, Antunes F, Blaxhult A, Clumeck N, Gatell J, Horban A, Johnson A, Katlama C, Ledergerber B, Loveday C, Phillips A, Reiss P, Vella S, Lundgren J, Gjørup I, Kirk O, Friis-Moeller N, Mocroft A, Cozzi-Lepri A, Bannister W, Mollerup D, Podlevkareva D, Olsen CH, Kjær J. Are Specific Antiretrovirals associated with an Increased Risk of Discontinuation due to Toxicities or Patient/Physician Choice in patients with Hepatitis C Virus Coinfection? Antivir Ther 2005. [DOI: 10.1177/135965350501000704] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Background Liver damage associated with hepatitis C (HCV) may influence the likelihood of experiencing discontinuation due to toxicities or patient/physician choice (TOXPC) in patients taking combination antiretroviral therapy (cART). Little information to address this concern is available from clinical trials as patients with HCV are often excluded. Aims To compare incidence rates of discontinuation due to TOXPC associated with specific antiretrovial drugs in patients with or without HCV. Patients/methods A total of 4929 patients from EuroSIDA under follow-up from January 1999 on a specific nucleoside pair (zidovudine/lamivudine, didanosine/stavudine, stavudine/lamivudine, or other) with a third drug (abacavir, nelfinavir, indinavir, nevirapine, efavirenz, lopinavir/ ritonavir or other boosted-protease inhibitor (PI)-containing regimen) and with known HCV serostatus were studied for the incidence of discontinuation of any nucleoside pair or third drug due to TOXPC. Incidence rate ratios were derived from Poisson regression models. Results In total 1358 patients had HCV (27.5%). During 12 799 person-years of follow-up there were 2141 discontinuations due to TOXPC for nucleoside pairs and 2501 for third drugs. The incidence of discontinuation due to TOXPC was consistently higher in patients with HCV after stratification by nucleoside pair or third drug. After adjustment for CD4+ count, gender, exposure group, time on HAART, region and treatment regimen, there were few differences in the rate of discontinuation due to TOXPC in those with HCV compared with those without for any nucleoside pairs or third drugs. Similar results were seen when concentrating on discontinuation due to toxicities alone. Conclusions Although patients with HCV generally had higher rates of discontinuation due to TOXPC compared with patients without HCV, there was little evidence to suggest that this was associated with any specific nucleoside pair or third drug used as part of cART. Our results do not suggest that any specific component of cART is more poorly tolerated in patients with HCV or that the presence of HCV should influence the choice between antiretrovirals used as part of a cART regimen.
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Affiliation(s)
- Amanda Mocroft
- Royal Free Centre for HIV Medicine and Department of Primary Care and Population Sciences, Royal Free and University College Medical School, London, UK
| | | | | | | | - Ole Kirk
- Copenhagen HIV Program, Hvidovre Hospital, Copenhagen, Denmark
| | | | - Peter Reiss
- Academisch Medisch Centrum bij de Universiteit van Amsterdam, Amsterdam, the Netherlands
| | | | - Andrew N Phillips
- Royal Free Centre for HIV Medicine and Department of Primary Care and Population Sciences, Royal Free and University College Medical School, London, UK
| | - Jens D Lundgren
- Copenhagen HIV Program, Hvidovre Hospital, Copenhagen, Denmark
| | - M Losso
- Hospital JM Ramos Mejia, Buenos Aires
| | - A Duran
- Hospital JM Ramos Mejia, Buenos Aires
| | - N Vetter
- Pulmologisches Zentrum der Stadt Wien, Vienna
| | - I Karpov
- Belarus State Medical University, Minsk
| | | | - N Clumeck
- Saint-Pierre Hospital, Brussels; R Colebunders, Institute of Tropical Medicine, Antwerp
| | - S De Wit
- Saint-Pierre Hospital, Brussels; R Colebunders, Institute of Tropical Medicine, Antwerp
| | - B Poll
- Saint-Pierre Hospital, Brussels; R Colebunders, Institute of Tropical Medicine, Antwerp
| | | | | | | | | | | | | | - O Kirk
- Hvidovre Hospital, Copenhagen
| | | | | | | | | | | | - K Zilmer
- West-Tallinn Central Hospital, Tallinn
| | - C Katlama
- Hôpital de la Pitié-Salpétière, Paris
| | - J-P Viard
- Hôpital Necker-Enfants Malades, Paris
| | | | | | | | | | | | - M Dietrich
- Bernhard-Nocht-Institut for Tropical Medicine, Hamburg
| | - C Manegold
- Bernhard-Nocht-Institut for Tropical Medicine, Hamburg
| | | | | | | | - M Bickel
- JW Goethe University Hospital, Frankfurt
| | | | | | | | | | | | | | | | | | - G Panos
- A Filandras and E Karabatsaki, 1st IKA Hospital, Athens
| | | | | | - I Yust
- Ichilov Hospital, Tel Aviv
| | | | | | | | | | | | - S Maayan
- Hadassah University Hospital, Jerusalem
| | - S Vella
- Istituto Superiore di Sanita, Rome
| | - A Chiesi
- Istituto Superiore di Sanita, Rome
| | | | | | | | - A Gabbuti
- Ospedale S. Maria Annunziata, Florence
| | | | | | | | | | - V Vullo
- Università di Roma La Sapienza, Rome
| | | | | | | | | | | | | | | | | | - L Viksna
- Infectology Centre of Latvia, Riga
| | | | | | - T Staub
- Centre Hospitalier, Luxembourg
| | - P Reiss
- Academisch Medisch Centrum bij de Universiteit van Amsterdam, Amsterdam
| | | | | | | | | | | | - A Horban
- Centrum Diagnostyki i Terapii AIDS, Warsaw
| | | | | | | | | | | | - E Mularska
- Osrodek Diagnostyki i Terapii AIDS, Chorzow
| | | | | | | | | | - F Matez
- Hospital Curry Cabral, Lisbon
| | - D Duiculescu
- Spitalul de Boli Infectioase si Tropicale: Dr. Victor Babes, Bucarest
| | | | | | | | - D Jevtovic
- The Institute for Infectious and Tropical Diseases, Belgrade
| | | | | | | | | | | | | | | | - B Clotet
- Hospital Germans Trias i Pujol, Badalona
| | - A Jou
- Hospital Germans Trias i Pujol, Badalona
| | - J Conejero
- Hospital Germans Trias i Pujol, Badalona
| | - C Tural
- Hospital Germans Trias i Pujol, Badalona
| | - JM Gatell
- Hospital Clinic i Provincial, Barcelona
| | - JM Miró
- Hospital Clinic i Provincial, Barcelona
| | | | - A Karlsson
- Karolinska University Hospital, Stockholm
| | - P Pehrson
- Karolinska University Hospital, Huddinge
| | | | | | - P Francioli
- Centre Hospitalier Universitaire Vaudois, Lausanne
| | - A Telenti
- Centre Hospitalier Universitaire Vaudois, Lausanne
| | - B Hirschel
- Hospital Cantonal Universitaire de Geneve, Geneve
| | | | | | | | - S Barton
- St. Stephen's Clinic, Chelsea and Westminster Hospital, London
| | - AM Johnson
- Royal Free and University College London Medical School, London (University College Campus)
| | - D Mercey
- Royal Free and University College London Medical School, London (University College Campus)
| | - A Phillips
- Royal Free and University College Medical School, London (Royal Free Campus)
| | - MA Johnson
- Royal Free and University College Medical School, London (Royal Free Campus)
| | - A Mocroft
- Royal Free and University College Medical School, London (Royal Free Campus)
| | - M Murphy
- Medical College of Saint Bartholomew's Hospital, London
| | - J Weber
- Imperial College School of Medicine at St. Mary's, London
| | - G Scullard
- Imperial College School of Medicine at St. Mary's, London
| | - M Fisher
- Royal Sussex County Hospital, Brighton
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Cabrera C, Cozzi-Lepri A, Phillips AN, Loveday C, Kirk O, Ait-Khaled M, Reiss P, Kjær J, Ledergerber B, Lundgren JD, Clotet B, Ruiz L, Losso M, Duran A, Vetter N, Clumeck N, Hermans P, Sommereijns B, Colebunders R, Machala L, Rozsypal H, Nielsen J, Lundgren J, Benfield T, Kirk O, Gerstoft J, Katzenstein T, Røge B, Skinhøj P, Pedersen C, Zilmer K, Katlama C, De Sa M, Viard JP, Saint-Marc T, Vanhems P, Pradier C, Dietrich M, Manegold C, van Lunzen J, Stellbrink HJ, Miller V, Staszewski S, Goebel FD, Salzberger B, Rockstroh J, Kosmidis J, Gargalianos P, Sambatakou H, Perdios J, Panos G, Karydis I, Filandras A, Banhegyi D, Mulcahy F, Yust I, Burke M, Pollack S, Ben-Ishai Z, Bentwich Z, Maayan S, Vella S, Chiesi A, Arici C, Pristerá R, Mazzotta F, Gabbuti A, Esposito R, Bedini A, Chirianni A, Montesarchio E, Vullo V, Santopadre P, Narciso P, Antinori A, Franci P, Zaccarelli M, Lazzarin A, Finazzi R, D'Arminio Monforte A, Viksna L, Chaplinskas S, Hemmer R, Staub T, Reiss P, Bruun J, Maeland A, Ormaasen V, Knysz B, Gasiorowski J, Horban A, Prokopowicz D, Wiercinska-Drapalo A, Boron-Kaczmarska A, Pynka M, Beniowski M, Trocha H, Antunes F, Mansinho K, Proenca R, Duiculescu D, Streinu-Cercel A, Mikras M, González-Lahoz J, Diaz B, García-Benayas T, Martin-Carbonero L, Soriano V, Clotet B, Jou A, Conejero J, Tural C, Gatell JM, Miró JM, Blaxhult A, Karlsson A, Pehrson P, Ledergerber B, Weber R, Francioli P, Telenti A, Hirschel B, Soravia-Dunand V, Furrer H, Chentsova N, Barton S, Johnson AM, Mercey D, Phillips A, Loveday C, Johnson MA, Mocroft A, Pinching A, Parkin J, Weber J, Scullard G, Fisher M, Brettle R. Baseline Resistance and Virological Outcome in Patients with Virological Failure who Start a Regimen Containing Abacavir: Eurosida Study. Antivir Ther 2004. [DOI: 10.1177/135965350400900509] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives To investigate the ability of several HIV-1 drug-resistance interpretation systems, as well as the number of pre-specified combinations of abacavir-related mutations, to predict virological response to abacavir-containing regimens in antiretroviral therapy-experienced, abacavir-naive patients starting an abacavir-containing regimen in the EuroSIDA cohort. Patients and methods A total of 100 HIV-infected patients with viral load (VL) >500 copies/ml who had a plasma sample available at the time of starting abacavir (baseline) were included. Resistance to abacavir was interpreted by using eight different commonly used systems that consisted of rules-based algorithms or tables of mutations. Correlation between baseline abacavir-resistance mutations and month 6 virological response was performed on this population using a multivariable linear regression model accounting for censored data. Results The baseline VL was 4.36 log10 RNA copies/ml [interquartile range (IQR): 3.65–4.99 log10 RNA copies/ml] and the median CD4 cell count was 210 cells/μl (IQR: 67–305 cells/μl). Our patients were pre-exposed to a median of seven antiretrovirals (2–12) before starting abacavir therapy. The median (range) number of abacavir mutations (according to the International AIDS Society-USA) detected at baseline was 3.5 (0–8). Overall, the Kaplan–Meier estimate of the median month 6 VL decline was 0.86 log10 RNA copies/ml [95% confidence intervals (95% CI): 0.45–1.24]. The VL in those patients ( n=31) who intensified treatment by adding only abacavir decreased by a median 0.20 log10 RNA copies/ml (95% CI: -0.18; +0.94). The proportion of patients who harboured viruses fully resistant to abacavir among the eight genotypic resistance interpretation algorithms ranged from 12% [Agence Nationale de Recherches sur le SIDA (ANRS)] to 79% [Stanford HIV RT and PR Sequence Database (HIVdb)]. Some interpretation systems showed statistically significant associations between the predicted resistance status and the virological response while others showed no consistent association. The number of active drugs in the regimen was associated with greater virological suppression (additional month 6 VL reduction per additional sensitive drug=0.51, 95% CI: 0.15–0.88, P=0.006); baseline VL was also weakly associated (additional month 6 VL reduction per log10 higher=0.30, 95% CI: -0.02; +0.62, P=0.06). In contrast, the number of drugs previously received was associated with diminished viral reduction (additional month 6 VL reduction per additional drug=-0.14, 95% CI: -0.28; 0.00, P=0.05). Conclusions Our results revealed a high degree of variability among several genotypic resistance interpretation algorithms currently in use for abacavir. Therefore, the interpretation of genotypic resistance for predicting response to regimens containing abacavir remains a major challenge.
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Affiliation(s)
| | - Cecilia Cabrera
- IrsiCaixa Foundation & Lluita contra la SIDA Foundation, Badalona, Spain
| | | | | | - Clive Loveday
- International Clinical Virology Centre (ICVC), Buckinghamshire, UK
| | - Ole Kirk
- EuroSIDA Coordinating Centre, Hvidovre University Hospital, Hvidovre, Denmark
| | | | - Peter Reiss
- Academisch Medisch Centrum bij de Universiteit van Amsterdam, Amsterdam, the Netherlands
| | - Jesper Kjær
- EuroSIDA Coordinating Centre, Hvidovre University Hospital, Hvidovre, Denmark
| | | | - Jens D Lundgren
- EuroSIDA Coordinating Centre, Hvidovre University Hospital, Hvidovre, Denmark
| | - Bonaventura Clotet
- IrsiCaixa Foundation & Lluita contra la SIDA Foundation, Badalona, Spain
| | - Lidia Ruiz
- IrsiCaixa Foundation & Lluita contra la SIDA Foundation, Badalona, Spain
| | - M Losso
- Hospital JM Ramos Mejia, Buenos Aires. Argentina
| | - A Duran
- Hospital JM Ramos Mejia, Buenos Aires. Argentina
| | - N Vetter
- Pulmologisches Zentrum der Stadt Wien, Vienna. Austria
| | - N Clumeck
- Saint-Pierre Hospital, Brussels; Belgium
| | - P Hermans
- Saint-Pierre Hospital, Brussels; Belgium
| | | | | | - L Machala
- Faculty Hospital Bulovka, Prague. Czech Republic
| | - H Rozsypal
- Faculty Hospital Bulovka, Prague. Czech Republic
| | - J Nielsen
- Hvidovre Hospital, Copenhagen; Denmark
| | | | | | - O Kirk
- Hvidovre Hospital, Copenhagen; Denmark
| | | | | | - B Røge
- Rigshospitalet, Copenhagen
| | | | | | - K Zilmer
- Tallinn Merimetsa Hospital, Tallinn. Estonia
| | - C Katlama
- Hôpital de la Pitié-Salpêtière, Paris; France
| | - M De Sa
- Hôpital de la Pitié-Salpêtière, Paris; France
| | - J-P Viard
- Hôpital Necker-Enfants Malades, Paris
| | | | | | | | - M Dietrich
- Bernhard-Nocht-Institut for Tropical Medicine, Hamburg; Germany
| | - C Manegold
- Bernhard-Nocht-Institut for Tropical Medicine, Hamburg; Germany
| | | | | | - V Miller
- JW Goethe University Hospital, Frankfurt
| | | | | | | | | | | | | | | | - J Perdios
- Athens General Hospital, Athens; Greece
| | | | | | | | | | - F Mulcahy
- St James's Hospital, Dublin. Ireland
| | - I Yust
- Ichilov Hospital, Tel Aviv; Israel
| | - M Burke
- Ichilov Hospital, Tel Aviv; Israel
| | | | | | | | - S Maayan
- Hadassah University Hospital, Jerusalem
| | - S Vella
- Istituto Superiore di Sanita, Rome; Italy
| | - A Chiesi
- Istituto Superiore di Sanita, Rome; Italy
| | | | | | | | - A Gabbuti
- Ospedale S Maria Annunziata, Florence
| | | | | | | | | | - V Vullo
- Università di Roma La Sapienza, Rome
| | | | | | | | | | | | | | | | | | - L Viksna
- Infectology Centre of Latvia, Riga. Latvia
| | | | - R Hemmer
- Centre Hospitalier, Luxembourg. Luxembourg
| | - T Staub
- Centre Hospitalier, Luxembourg. Luxembourg
| | - P Reiss
- Academisch Medisch Centrum bij de Universiteit van Amsterdam, Amsterdam. Netherlands
| | - J Bruun
- Ullevål Hospital, Oslo. Norway
| | | | | | - B Knysz
- Medical University, Wroclaw; Poland
| | | | - A Horban
- Centrum Diagnostyki i Terapii AIDS, Warsaw
| | | | | | | | | | | | | | - F Antunes
- Hospital Santa Maria, Lisbon; Portugal
| | | | | | - D Duiculescu
- Spitalul de Boli Infectioase si Tropicale Dr Victor Babes, Bucharest; Romania
| | | | - M Mikras
- Derrer Hospital, Bratislava. Slovakia
| | | | - B Diaz
- Hospital Carlos III, Madrid; Spain
| | | | | | | | - B Clotet
- Hospital Germans Trias i Pujol, Barcelona
| | - A Jou
- Hospital Germans Trias i Pujol, Barcelona
| | - J Conejero
- Hospital Germans Trias i Pujol, Barcelona
| | - C Tural
- Hospital Germans Trias i Pujol, Barcelona
| | - JM Gatell
- Hospital Clinic i Provincial, Barcelona
| | - JM Miró
- Hospital Clinic i Provincial, Barcelona
| | | | | | | | | | | | - P Francioli
- Centre Hospitalier Universitaire Vaudois, Lausanne; Switzerland
| | - A Telenti
- Centre Hospitalier Universitaire Vaudois, Lausanne; Switzerland
| | - B Hirschel
- Hospital Cantonal Universitaire de Geneve, Geneve
| | | | | | | | - S Barton
- St Stephen's Clinic, Chelsea and Westminster Hospital, London; United Kingdom
| | - AM Johnson
- Royal Free and University College London Medical School, London University College Campus
| | - D Mercey
- Royal Free and University College London Medical School, London University College Campus
| | - A Phillips
- Royal Free and University College Medical School, London Royal Free Campus
| | - C Loveday
- Royal Free and University College Medical School, London Royal Free Campus
| | - MA Johnson
- Royal Free and University College Medical School, London Royal Free Campus
| | - A Mocroft
- Royal Free and University College Medical School, London Royal Free Campus
| | - A Pinching
- Medical College of Saint Bartholomew's Hospital, London
| | - J Parkin
- Medical College of Saint Bartholomew's Hospital, London
| | - J Weber
- Imperial College School of Medicine at St Mary's, London
| | - G Scullard
- Imperial College School of Medicine at St Mary's, London
| | - M Fisher
- Royal Sussex County Hospital, Brighton
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Piţigoi D, Popa MI, Streinu-Cercel A. [The epidemiological process of West Nile viral infection]. Bacteriol Virusol Parazitol Epidemiol 1998; 43:281-8. [PMID: 10422325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
An important number of arboviruses are known to produce clinical or subclinical infections in humans. Most of these viruses are maintained in zoonotic cycles and are transmitted by mosquitoes or ticks. Viruses believed to be associated with human disease are classified according to the type of vector, the main clinical sign and the geographic distribution. The arboviruses are classified in families and genera, of which Togaviridae, Flaviviridae and Bunyaviridae are the best known. West Nile virus is present in Egypt, Israel, India and is widespread in parts of Africa, the northern Mediterranean area and Western Asia. The first major West Nile fever epidemic in Europe occurred in Romania, in 1996, with a high rate of neurological infections. 393 patients with serologically confirmed or probable West Nile fever infection (352 had acute central-nervous-system infections) were identified. The number of mild cases could not be estimated. WN virus was recovered from Culex pipiens mosquitoes. The virus is not transmitted through direct human contact, probably the infected mosquitoes transmit the virus throughout their life. Viremia is essential for vector infection and occurs during early clinical illness in humans. Susceptibility appears to be general, in both males and females, throughout life. Inapparent infections and mild disease are common.
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Apetrei C, Necula A, Holm-Hansen C, Loussert-Ajaka I, Pandrea I, Cozmei C, Streinu-Cercel A, Pascu FR, Negut E, Molnar G, Duca M, Pecec M, Brun-Vézinet F, Simon F. HIV-1 diversity in Romania. AIDS 1998; 12:1079-85. [PMID: 9662205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVES To evaluate the prevalence and the dynamics of HIV-1 subtypes in Romanian adults and children, and to investigate the origins of the nosocomial epidemic. DESIGN A total of 1000 serum and plasma samples, from adults (n = 579) and children (n = 421) who were diagnosed as being HIV-1-infected during 1990-1997 in 39 of the 41 Romanian districts, were serotyped. Viral DNA was isolated from blood samples of 84 patients and the viruses were genotyped. METHODS Serotyping was performed with a peptide subtype-specific enzyme immunoassay (SSEIA), based on in vitro competition for antibody binding between the representative V3 peptides of the different clades (A-F). Proviral HIV-1 DNA was genotyped by heteroduplex mobility assay or by sequence analysis of the C2-V3 env region. RESULTS SSEIA showed that 93% of the samples from horizontally infected children were serotype F, 1% were serotype B, and the remaining 6% were uninterpretable. In vertically infected children, 74% of strains were serotype F, 10% were serotype A, 3% were serotype B, and 3% were serotype E. Serotype F was also the dominant subtype in adults (68%), but serotypes A, B, C, D and E were also detected. SSEIA gave indeterminate results in 7% of cases. A strong correlation (90%) between serotyping and genotyping for subtype F was found. Analysis of the relative incidence of the different serotypes over a 7-year period (1990-1997) showed a stable distribution. CONCLUSIONS Subtype F largely dominates the epidemiology of HIV-1 infection in both children and adults in Romania, although other major subtypes are present. The predominance of subtype F in Romania may be a future potential source of HIV-1 variability in Europe.
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Affiliation(s)
- C Apetrei
- Laboratoire de Virologie, Hôpital Bichat-Claude Bernard, Paris, France
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Streinu-Cercel A. Therapeutic modalities in severe infections. Theoretic considerations. Rom J Intern Med 1992; 30:297-303. [PMID: 1299422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The advantages of discontinuous versus continuous antibiotherapy are discussed as a therapeutic method in severe infections. The main scientific achievements related to the criteria of discontinuous antibiotherapy are discussed as a therapeutic modality consisting in administration of moderate doses of usual antibiotics every 12th hours. The advantages and disadvantages of the classical continuous and discontinuous antibiotherapies are presented and amply discussed.
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Ioniţă I, Căruntu F, Dragomirescu M, Petraşincu D, Dorobăţ O, Streinu-Cercel A, Antipa C. Interferon detection in patients with neuroinfections: possibilities of clinical use. Arch Roum Pathol Exp Microbiol 1990; 49:177-82. [PMID: 1713761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- I Ioniţă
- National Defense Ministry Military Central Hospital, Bucharest, Romania
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Crăcea E, Constantinescu S, Balaci L, Vizitiu O, Căruntu F, Căruntu V, Angelescu C, Streinu-Cercel A, Bocîrnea C, Pănoiu L. [Etiologic diagnosis of cases of autochthonous Borrelia burgdorferi infection (Lyme disease)]. Rev Ig Bacteriol Virusol Parazitol Epidemiol Pneumoftiziol Bacteriol Virusol Parazitol Epidemiol 1988; 33:239-44. [PMID: 3249895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Crăcea E, Constantinescu S, Balaci L, Vizitiu O, Căruntu F, Angelescu C, Căruntu V, Streinu-Cercel A, Bocîrnea C, Pănoiu L. Lyme borreliosis in Romania. Arch Roum Pathol Exp Microbiol 1988; 47:17-21. [PMID: 3202685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Ciochinaru M, Ispas LT, Ciprut T, Streinu-Cercel A, Vasiliu V. [Serofibrinous pleurisy and angina with beta-hemolytic Streptococcus; intra-infectious glomerulonephritis (presentation of a case)]. Rev Ig Bacteriol Virusol Parazitol Epidemiol Pneumoftiziol Pneumoftiziol 1987; 36:185-8. [PMID: 2825336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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Streinu-Cercel A, Ispas LT. [Current pathogenetic aspects in viral infections of the respiratory system]. Rev Ig Bacteriol Virusol Parazitol Epidemiol Pneumoftiziol Pneumoftiziol 1986; 35:299-311. [PMID: 3031800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Căruntu F, Dogaru D, Stefan D, Căruntu V, Angelescu C, Streinu-Cercel A, Colţan G, Petrescu AL, Tarţă D, Bârnaure F. Value of serological tests in the diagnosis of viral acute respiratory infections in adults. Virologie (Montrouge) 1986; 37:83-7. [PMID: 3727398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The dynamics of the antibody response to influenza viruses A (H1N1), A (H3N2) and B, to parainfluenza viruses 1, 2, 3, to adenoviruses and respiratory syncytial virus was studied in paired serum samples collected from 110 patients hospitalized with acute respiratory infections (ARI) and in 40 patients suffering from other diseases. Rises in serum antibody titers to 1--5 of the above mentioned antigens were detected in many of the patients of both groups. The fact is most likely due to the presence of some epidemiologically and clinically uncharacteristic viral ARI (influenza included); simultaneous or successive infections with influenza virus and different other viruses were very frequent. A greater efficiency of the etiological diagnosis of viral ARI can be achieved only by the association of epidemiological and clinical criteria with serological data, the visualization of viral antigens and virus isolation.
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Ispas LT, Streinu-Cercel A. [Infectious pneumonia in immunocompromised patients]. Rev Ig Bacteriol Virusol Parazitol Epidemiol Pneumoftiziol Pneumoftiziol 1986; 35:113-26. [PMID: 3018903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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