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Castellani F, Galletti M, Charavgis F, Cingolani A, Renzi S, Nucci M, Protano C, Vitali M. Perfluorinated Compounds (PFCs) in River Waters of Central Italy: Monthly Variation and Ecological Risk Assessment (ERA). Arch Environ Contam Toxicol 2023; 84:332-346. [PMID: 37022436 PMCID: PMC10130131 DOI: 10.1007/s00244-023-00993-4] [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] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 03/22/2023] [Indexed: 06/19/2023]
Abstract
Perfluorinated compounds (PFCs) are a wide class of emerging pollutants. In this study, we applied the US EPA method 533 for the determination of 21 PFCs in river water samples. In particular, this method was used to investigate the presence of the target PFCs in six rivers in central Italy during a 4-month-long monitoring campaign. In 73% of the analyzed samples, at least some of the target PFCs were detected at concentrations higher than the limit of detection (LOD). The sum of the 21 target analytes (∑21PFCs) ranged from 4.3 to 68.5 ng L-1, with the highest concentrations measured in the month of June, probably due to a minor river streamflow occurring in the warmer summer months. Considering the individual congeners, PFBA and PFPeA, followed by PFHxA and PFOA, were the predominantly detected compounds. Short- and medium-chain PFCs (C4-C9) prevail over the long-chain PFCs (C10-C18), likely due to the increased industrial use and the higher solubility of short-chain PFCs compared to long-chain PFCs. The ecological risk assessment, conducted by using the risk quotient method, highlighted that the risk for aquatic environments associated with PFBA, PFPeA, PFBS, PFHxA and PFOA was low or negligible. Only for PFOA, there was a medium level of risk in two rivers in the month of June. With regard to PFOS, 54% of the river water samples were classified as "high risk" for the aquatic environment. The remaining 46% of the samples were classified as "medium risk."
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Affiliation(s)
- Federica Castellani
- Department of Public Health and Infectious Diseases, University of Rome la Sapienza, P.le Aldo Moro, 5, 00185, Rome, Italy
- Department of Ecological and Biological Sciences, Tuscia University, Largo dell'Università snc, 01100, Viterbo, Italy
| | - Mara Galletti
- ARPA Umbria, Via Carlo Alberto Dalla Chiesa, 23, 05100, Terni, Italy
| | | | | | - Sonia Renzi
- ARPA Umbria, Via Pievaiola 207/B-3, 06132, Perugia, Italy
| | - Mirko Nucci
- ARPA Umbria, Via Pievaiola 207/B-3, 06132, Perugia, Italy
| | - Carmela Protano
- Department of Public Health and Infectious Diseases, University of Rome la Sapienza, P.le Aldo Moro, 5, 00185, Rome, Italy
| | - Matteo Vitali
- Department of Public Health and Infectious Diseases, University of Rome la Sapienza, P.le Aldo Moro, 5, 00185, Rome, Italy.
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Donati G, Gasperoni L, Napoli M, Scrivo A, Zappulo F, Abenavoli C, Hu L, Angelini A, Di Nunzio M, Tringali E, Cingolani A, Marchegiani BC, Rigotti A, La Manna G. Anti-Inflammatory Approach in Chronic Dialysis Patients with SARS-CoV-2: ATA or PMMA Dialyzers? Blood Purif 2022; 52:210-218. [PMID: 36323242 PMCID: PMC9782266 DOI: 10.1159/000526319] [Citation(s) in RCA: 1] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 07/21/2022] [Indexed: 12/23/2022]
Abstract
INTRODUCTION High-flux hemodialysis membranes may modulate the cytokine storm of SARS-CoV-2, but their impact on chronic hemodialysis (CHD) patients is unknown. The aim of the study was the evaluation of asymmetric cellulose triacetate (ATA) and polymethylmethacrylate (PMMA) dialyzers on inflammatory markers and clinical outcomes in CHD patients with SARS-CoV-2. METHODS A prospective, observational study on CHD patients with SARS-CoV-2 was carried out. Patients were enrolled from March 2020 to May 2021. Pre- and postdialysis C-reactive protein (CRP), procalcitonin (PCT), and interleukin-6 (IL-6) were determined at each session. Patients who underwent on-line hemodiafiltration (OLHDF) with a PMMA dialyzer were compared with those treated with OLHDF with a ATA dialyzer. The primary endpoint was the differences in the reduction ratio per session (RR) of CRP, PCT, IL-6, and IL-6 RR >25%. RESULTS We consecutively enrolled 74 CHD patients with COVID-19, 48 were treated with ATA membrane, and 26 with PMMA. Median IL-6 RR was higher in the ATA group compared to PMMA (17.08%, IQR -9.0 to 40.0 vs. 2.95%, IQR -34.63 to 27.32). Median CRP RR was 7.77% (IQR 2.47-13.77) in the ATA group versus 4.8% (IQR -2.65 to 11.38) in the PMMA group (p = 0.0017). Median PCT-RR% was 77.38% (IQR 70.92-82.97) in ATA group versus 54.59% (IQR 42.62-63.16) in the PMMA group (p < 0.0001). A multiple logistic regression analysis with IL-6 RR >25% as the outcome including the membrane employed, pre-dialysis IL-6, CRP, PCT, and ferritin showed that ATA led to a higher probability to reach the outcome (OR 1.891, 95% CI 1.273-2.840, p = 0.0018) while higher CRP favors the risk of lower IL-6 RR values (OR 0.910, 95% CI 0.868-0.949, p ≤ 0.0001). CONCLUSIONS In SARS-CoV-2 CHD patients treated with OLHDF, ATA showed a better anti-inflammatory profile, regarding IL-6 RR, compared to PMMA.
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Affiliation(s)
- Gabriele Donati
- Nephrology, Dialysis and Renal Transplantation Unit, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy,Surgical, Medical, Dental and Morphological Sciences Department (CHIMOMO), University of Modena and Reggio Emilia, Modena, Italy
| | - Lorenzo Gasperoni
- Nephrology and Dialysis Unit, Azienda USL della Romagna, Infermi Hospital, Rimini, Italy
| | - Marianna Napoli
- Nephrology Dialysis and Renal Transplantation Unit, S. Orsola University Hospital, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy,Department of Experimental Diagnostic and Specialty Medicine (DIMES), University of Bologna, Bologna, Italy
| | - Anna Scrivo
- Nephrology Dialysis and Renal Transplantation Unit, S. Orsola University Hospital, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy,Department of Experimental Diagnostic and Specialty Medicine (DIMES), University of Bologna, Bologna, Italy
| | - Fulvia Zappulo
- Nephrology Dialysis and Renal Transplantation Unit, S. Orsola University Hospital, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy,Department of Experimental Diagnostic and Specialty Medicine (DIMES), University of Bologna, Bologna, Italy
| | - Chiara Abenavoli
- Nephrology Dialysis and Renal Transplantation Unit, S. Orsola University Hospital, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy,Department of Experimental Diagnostic and Specialty Medicine (DIMES), University of Bologna, Bologna, Italy
| | - Lilio Hu
- Nephrology Dialysis and Renal Transplantation Unit, S. Orsola University Hospital, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy,Department of Experimental Diagnostic and Specialty Medicine (DIMES), University of Bologna, Bologna, Italy
| | - Andrea Angelini
- Nephrology Dialysis and Renal Transplantation Unit, S. Orsola University Hospital, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy,Department of Experimental Diagnostic and Specialty Medicine (DIMES), University of Bologna, Bologna, Italy
| | - Miriam Di Nunzio
- Nephrology Dialysis and Renal Transplantation Unit, S. Orsola University Hospital, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy,Department of Experimental Diagnostic and Specialty Medicine (DIMES), University of Bologna, Bologna, Italy
| | - Edoardo Tringali
- Nephrology Dialysis and Renal Transplantation Unit, S. Orsola University Hospital, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy,Department of Experimental Diagnostic and Specialty Medicine (DIMES), University of Bologna, Bologna, Italy
| | - Alessandra Cingolani
- Nephrology Dialysis and Renal Transplantation Unit, S. Orsola University Hospital, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy,Department of Experimental Diagnostic and Specialty Medicine (DIMES), University of Bologna, Bologna, Italy
| | - Beatrice Claudia Marchegiani
- Nephrology Dialysis and Renal Transplantation Unit, S. Orsola University Hospital, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy,Department of Experimental Diagnostic and Specialty Medicine (DIMES), University of Bologna, Bologna, Italy
| | - Angelo Rigotti
- Nephrology and Dialysis Unit, Azienda USL della Romagna, Infermi Hospital, Rimini, Italy
| | - Gaetano La Manna
- Nephrology Dialysis and Renal Transplantation Unit, S. Orsola University Hospital, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy,Department of Experimental Diagnostic and Specialty Medicine (DIMES), University of Bologna, Bologna, Italy,*Gaetano La Manna,
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Cingolani A, Tavelli A, Calvino GV, Maggiolo F, Girardi E, Cozzi-Lepri A, Perziano A, Meli P, Camposeragna A, Mattioli S, Calzavara D, Gagliardini R, Nozza S, Antinori A, d'Arminio Monforte A. Awareness and perception of accuracy of the Undetectable=Untransmittable message (U=U) in Italy: results from a survey among PLWHA, infectious-diseases physicians and people having unprotected sex. AIDS Care 2022; 35:923-933. [PMID: 35579404 DOI: 10.1080/09540121.2022.2074960] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Evidences on the absence of risk of sexual transmission of HIV by persons living with HIV/AIDS (PLWHA) with undetectable plasma HIV-RNA (HIV-RNA <200 copies/ml) led to the worldwide campaign "U = U" (undetectable = untransmittable). The purpose of this study was to evaluate the perceived accuracy of this message among PLWHA, HIV-negative people having unprotected sex (PHUS) and infectious diseases' (ID) physicians in Italy. A nationwide survey has been conducted using three different anonymous questionnaires (for ID physicians, PLWHA and PHUS). A total of 1121 participants filled the questionnaires: 397 PLWHA; 90 physicians; 634 PHUS. Awareness of U = U message has been reported in 74%, 92% and 47% of PLWHA, ID physicians and PHUS, respectively. The perception of accuracy of the U = U message among those aware was reported as high in 80.4%, 79.5% and 67.3% of PLWHA, ID physicians and PHUS, respectively. Physicians perceived that 11% of PLWHA have a high rate of perception of U = U, whereas among PLWHA, only 34% reported definitive positive messages from physicians. Discrepancies between awareness and perception of accuracy of the message U = U in PLWHA and physicians have been found, suggesting still low confidence in the community regarding the message itself.
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Affiliation(s)
- A Cingolani
- Fondazione Policlinico A. Gemelli IRCCS, Catholic University of the Sacred Heart, Infectious Diseases Unit, Rome, Italy
| | | | | | - F Maggiolo
- Division of Infectious Diseases, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - E Girardi
- National Institute for Infectious Diseases "Lazzaro Spallanzani" IRCCS, Epidemiology Unit, Rome, Italy
| | | | - A Perziano
- Associazione Arcobaleno AIDS, Torino, Italy
| | - P Meli
- Associazione Comunità Emmaus, Bergamo Fast Track City, Italy
| | - A Camposeragna
- Coordinamento Nazionale Comunita' di Accoglienza (CNCA), Roma, Italy
| | | | | | - R Gagliardini
- HIV/AIDS Department, National Institute for Infectious Diseases "Lazzaro Spallanzani" IRCCS, Rome, Italy
| | - S Nozza
- Department of Infectious Diseases, San Raffaele Scientific Institute IRCCS, Milan, Italy
| | - A Antinori
- HIV/AIDS Department, National Institute for Infectious Diseases "Lazzaro Spallanzani" IRCCS, Rome, Italy
| | - A d'Arminio Monforte
- ASST Santi Paolo e Carlo, University of Milan, Infectious Diseases Unit, Milan, Italy for ICONA Fundation Study Group
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- Fondazione Policlinico A. Gemelli IRCCS, Catholic University of the Sacred Heart, Infectious Diseases Unit, Rome, Italy
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Cingolani A, Scrivo A, Mattiotti M, Zappulo F, Laura Croci Chiocchini A, Gasperoni L, Hu L, Abenavoli C, DI Nunzio M, Marchegiani B, Tringali E, Cristina Galaverni M, Cappelli A, Mosconi C, Renzulli M, Golfieri R, Donati G, LA Manna G. MO775: Vacuum-Assisted Thromboaspiration with Indigo System After Acute Arteriovenous Fistula Thrombosis: Monocentric Experience of an Innovative Interventional Approach. Nephrol Dial Transplant 2022. [DOI: 10.1093/ndt/gfac080.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
BACKGROUND AND AIMS
Arteriovenous fistula (AVF) must be the first choice where eligible and a prompt approach within 48–72 h should be performed in case of acute AVF failure in order to maintain the patency of the vascular access. Evaluation of the most appropriate de-clotting technique must be made considering the patient's comorbidity, AVF characteristics and absolute, relative and temporary contraindications to each kind of corrective intervention. The outcome is different between the multiple methods and nowadays mechanical thromboaspiration (MT) seems to be an innovative and promising approach.
METHOD
A total of 9 AVF of 9 chronic haemodialysis patients with acute AVF failure were treated with MT between January 2019 and January 2022 and were retrospectively evaluated. MT was carried out via Indigo catheter (Penumbra Inc.), an aspiration system intended for the removal of emboli and thrombi from vessels through venipuncture of AVF/AVG: the continuous aspiration helps distinguish clots from normal blood flow; in case of resistant clots, separators of many sizes can be used at the tip of the catheter to facilitate their fragmentation and aspiration. Adjunctive procedures such as balloon angioplasty (used at all sites), local fibrinolysis, heparin infusion, or stents placement were considered. Technical success was defined by clot removal from AVF or AVG. Clinical success was defined by the restoration of thrill and bruit together with AVF usability after the procedure. Vascular access survival defined as AVF/AVG usability at 3 and 6 months was assessed.
RESULTS
Average age was 71.2 years; dialysis vintage was 93.4 months. Medium follow-up was 13.1 months. All patients needed placement of a temporary central venous catheter (CVC) and dialysis before the MT. Technical success was achieved in 100% of the procedures, clinical success was achieved in 88.9% of the MT (despite the technical success, in 1/9 patients AVF could not be used due to a severe residual venous stenosis). None reported peri-/intraprocedural complications. In 2/9 MT there was no use of anticoagulation; in 5/9 patients, a single unfractionated heparin bolus was used (2500 UI) during the manoeuvre; in 2/9 patients, a single 2500 UI bolus plus continuous intravenous infusion of unfractionated heparin was administered combined with local thrombolysis with urokinase: both patients needed blood transfusions after the manoeuvre, one of them reporting severe haemorrhage from AVF. As adjunctive procedures, 9/9 patients underwent balloon angioplasty; one of them needed stent placement over the venous stenosis. CVC was removed less than 48 h from the procedure in 5/9 patients (55.6%), in 3/9 patients it was removed after 48 h, while 1/9 patients maintained the temporary vascular access due to the lack of clinical success after MT. Double-needle puncture occurred after a medium time of 3.5 days. AVF survival at 3 months and 6 months was 66.6% (6/9 patients), while 3/9 patients faced AVF failure (1/3 patients deceased 2 months after the procedure with a functioning AVF, in 1/3 patients a relapse of AVG thrombosis occurred 2 months after the procedure, 1/3 never reached clinical success due to severe residual venous stenosis). At the time of study design, 3/9 patients resulted to be deceased due to causes unrelated to the procedure. (1/3 due to complications of abdominal surgery, 1/3 due to sepsis, 1/3 due to subarachnoid haemorrhage).
CONCLUSION
MT is an innovative yet functional and safe procedure that allows declotting of the thrombosed AVF while reducing or avoiding anticoagulation and/or surgery.
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Affiliation(s)
- Alessandra Cingolani
- IRCCS Policlinico di Sant'Orsola, Nephrology, Dialysis and Transplant Unit, Bologna, Italy
| | - Anna Scrivo
- IRCCS Policlinico di Sant'Orsola, Nephrology, Dialysis and Transplant Unit, Bologna, Italy
| | - Maria Mattiotti
- IRCCS Policlinico di Sant'Orsola, Nephrology, Dialysis and Transplant Unit, Bologna, Italy
| | - Fulvia Zappulo
- IRCCS Policlinico di Sant'Orsola, Nephrology, Dialysis and Transplant Unit, Bologna, Italy
| | | | - Lorenzo Gasperoni
- IRCCS Policlinico di Sant'Orsola, Nephrology, Dialysis and Transplant Unit, Bologna, Italy
| | - Lilio Hu
- IRCCS Policlinico di Sant'Orsola, Nephrology, Dialysis and Transplant Unit, Bologna, Italy
| | - Chiara Abenavoli
- IRCCS Policlinico di Sant'Orsola, Nephrology, Dialysis and Transplant Unit, Bologna, Italy
| | - Miriam DI Nunzio
- IRCCS Policlinico di Sant'Orsola, Nephrology, Dialysis and Transplant Unit, Bologna, Italy
| | - Beatrice Marchegiani
- IRCCS Policlinico di Sant'Orsola, Nephrology, Dialysis and Transplant Unit, Bologna, Italy
| | - Edoardo Tringali
- IRCCS Policlinico di Sant'Orsola, Nephrology, Dialysis and Transplant Unit, Bologna, Italy
| | - Maria Cristina Galaverni
- IRCCS Policlinico di Sant'Orsola, Radiology Unit, Department of Diagnostic & Preventive Medicine, Bologna, Italy
| | - Alberta Cappelli
- IRCCS Policlinico di Sant'Orsola, Radiology Unit, Department of Diagnostic & Preventive Medicine, Bologna, Italy
| | - Cristina Mosconi
- IRCCS Policlinico di Sant'Orsola, Radiology Unit, Department of Diagnostic & Preventive Medicine, Bologna, Italy
| | - Matteo Renzulli
- IRCCS Policlinico di Sant'Orsola, Radiology Unit, Department of Diagnostic & Preventive Medicine, Bologna, Italy
| | - Rita Golfieri
- IRCCS Policlinico di Sant'Orsola, Radiology Unit, Department of Diagnostic & Preventive Medicine, Bologna, Italy
| | - Gabriele Donati
- Nephrology, Dialysis and Renal Transplantation Unit, Azienda Ospedaliero-Universitaria di Modena, Surgical, Medical, Dental and Morphological Sciences Department (CHIMOMO), University of Modena and Reggio Emilia, Modena, Italy
| | - Gaetano LA Manna
- IRCCS Policlinico di Sant'Orsola, Nephrology, Dialysis and Transplant Unit, Bologna, Italy
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Gasperoni L, Donati G, Scrivo A, Zappulo F, Abenavoli C, Hu L, Napoli M, Angelini A, Nunzio MDI, Tringali E, Cingolani A, Marchegiani B, Rigotti A, Manna GLA. MO655: Anti-Inflammatory Approach in Chronic Dialysis Patients with SARS-CoV-2: ATA or PMMA Dialyzers? Nephrol Dial Transplant 2022. [PMCID: PMC9383853 DOI: 10.1093/ndt/gfac077.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND AND AIMS High flux haemodialysis membranes may modulate the cytokine storm of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), but their impact in chronic haemodialysis (CHD) patients is not assessed [1, 2]. The aim of the study was the evaluation of asymmetric cellulose triacetate (ATA) and polymethylmethacrylate (PMMA) dialyzers on inflammatory markers in CHD patients with SARS-CoV-2. METHOD A prospective, observational study on CHD patients (age ≥18 years) affected by SARS-CoV-2 was carried out. Patients were enrolled from March 2020 to May 2021 and dialysis was performed at S. Orsola University Hospital (Bologna, Italy) Dialysis Unit. Mechanical ventilation at diagnosis was exclusion criteria. Pre- and post-dialysis C-reactive protein (CRP), procalcitonin (PCT) and interleukin-6 (IL-6) were determined at each session and corrected for haemoconcentration during the complete SARS-CoV-2 period. Patients who underwent online haemodiafiltration (OLHDF) with PMMA dialyzer (Filtryzer BG-U™, Toray, surface area 2.1 m2 cut-off 20 kDa, KUF 43 mL/h/mmHg) were compared with those who underwent OLHDF with ATA dialyzer (SolaceaTM Nipro, surface area 2.1 m2 cut-off 45 kDa, KUF 72 mL/h/mmHg). The primary endpoint was to assess the differences in the reduction ratio/session (RR) of CRP, PCT and IL-6. RESULTS A total of 74 patients were enrolled, 48 were treated with ATA and 26 were with PMMA (420 versus 191 dialysis sessions). The main results are shown in Table 1. Median IL-6RR% was higher for ATA [17.08%, interquartile range (IQR) −9.0 to 40.0 versus 2.95%, IQR −34.63 to 27.32]. CRP and PCT showed higher RR with ATA in comparison to PMMA. When IL-6RR > 25% was the dependent variable in the multiple logistic regression analysis only ATA showed a significant correlation [odds ratio (OR) 1.891, 95% confidence interval (95% CI) 1.273–2.840, P = .0018) while higher CRP favoured the risk of lower IL6RR (OR 0.9101, 95% CI 0.868–0.949, P < 0.0001) (Table 2). CONCLUSION In SARS-CoV-2 CHD patients treated with OLHDF, ATA showed a better anti-inflammatory profile than PMMA, in particular regarding IL-6 RR.
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Affiliation(s)
- Lorenzo Gasperoni
- Nephrology and Dialysis Unit, AUSL Romagna Infermi Hospital, 47 923 Rimini, Italy
| | - Gabriele Donati
- Nephrology, Dialysis and Renal Transplantation Unit, Azienda Ospedaliero-Universitaria di Modena, Surgical, Medical, Dental and Morphological Sciences Department (CHIMOMO), University of Modena and Reggio Emilia, Modena, Italy
| | - Anna Scrivo
- Nephrology Dialysis and Renal Transplantation Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, S.Orsola University Hospital, Department of Experimental Diagnostic and Specialty Medicine (DIMES); University of Bologna, Bologna, Italy
| | - Fulvia Zappulo
- Nephrology Dialysis and Renal Transplantation Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, S.Orsola University Hospital, Department of Experimental Diagnostic and Specialty Medicine (DIMES); University of Bologna, Bologna, Italy
| | - Chiara Abenavoli
- Nephrology Dialysis and Renal Transplantation Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, S.Orsola University Hospital, Department of Experimental Diagnostic and Specialty Medicine (DIMES); University of Bologna, Bologna, Italy
| | - Lilio Hu
- Nephrology Dialysis and Renal Transplantation Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, S.Orsola University Hospital, Department of Experimental Diagnostic and Specialty Medicine (DIMES); University of Bologna, Bologna, Italy
| | - Marianna Napoli
- Nephrology Dialysis and Renal Transplantation Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, S.Orsola University Hospital, Department of Experimental Diagnostic and Specialty Medicine (DIMES); University of Bologna, Bologna, Italy
| | - Andrea Angelini
- Nephrology Dialysis and Renal Transplantation Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, S.Orsola University Hospital, Department of Experimental Diagnostic and Specialty Medicine (DIMES); University of Bologna, Bologna, Italy
| | - Miriam D I Nunzio
- Nephrology Dialysis and Renal Transplantation Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, S.Orsola University Hospital, Department of Experimental Diagnostic and Specialty Medicine (DIMES); University of Bologna, Bologna, Italy
| | - Edoardo Tringali
- Nephrology Dialysis and Renal Transplantation Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, S.Orsola University Hospital, Department of Experimental Diagnostic and Specialty Medicine (DIMES); University of Bologna, Bologna, Italy
| | - Alessandra Cingolani
- Nephrology Dialysis and Renal Transplantation Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, S.Orsola University Hospital, Department of Experimental Diagnostic and Specialty Medicine (DIMES); University of Bologna, Bologna, Italy
| | - Beatrice Marchegiani
- Nephrology Dialysis and Renal Transplantation Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, S.Orsola University Hospital, Department of Experimental Diagnostic and Specialty Medicine (DIMES); University of Bologna, Bologna, Italy
| | - Angelo Rigotti
- Nephrology and Dialysis Unit, AUSL Romagna Infermi Hospital, 47 923 Rimini, Italy
| | - Gaetano L A Manna
- Nephrology Dialysis and Renal Transplantation Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, S.Orsola University Hospital, Department of Experimental Diagnostic and Specialty Medicine (DIMES); University of Bologna, Bologna, Italy
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Seguiti C, Salvo PF, Di Stasio E, Lamonica S, Fedele AL, Manfrida S, Ciccarelli N, Corvari B, De Luca C, Tartaglione L, Pitocco D, Cauda R, Cingolani A. Health-related quality of life (HRQoL) from HIV patients' perspective: comparison of patient-reported outcome (PRO) measures among people living with hiv (PLWH) and other chronic clinical conditions. J Patient Rep Outcomes 2022; 6:27. [PMID: 35347476 PMCID: PMC8960483 DOI: 10.1186/s41687-022-00423-4] [Citation(s) in RCA: 1] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 02/13/2022] [Indexed: 11/25/2022] Open
Abstract
Background People living with HIV (PLWH) are generally known to suffer from a lower quality of life compared to the one of general population, but still very few is known about the self-perception of quality of life when comparing HIV to non-communicable diseases. We performed a comprehensive assessment of patient’s reported outcomes measures (PROMs) among PLWH and patients affected by other chronic conditions (OC) such as diabetes mellitus type 1, rheumatoid arthritis, breast cancer in hormonal therapy, in order to investigate differences in PROMs outcomes between PLWH and other pathologies. Methods A cross-sectional observational study was performed by using questionnaires investigating health-related quality of life (Medical Outcomes Study Short Form 36-item Health Survey), work productivity (WPI), and global health status (EQ-5D-3L). They were administered to patients affected by chronic diseases consecutively observed at a single University Hospital during a 10 months period, with comparable disease related aspects. Logistic regression analysis was used to analyze the association between disease group (HIV vs OC) and PROMs. Results 230 patients were enrolled (89 PLWH, 143 OC). Mean age: 49 years (SD 10), mean time of disease 12 years (10), 96% were Caucasian, 35% assumed polypharmacy, 42% of male were PLWH versus 16% OC (p < 0.001), 19% PLWH versus 6% OC had clinical complications (p < 0.001). HIV infection was independently associated to a better health-related quality of life in several domains compared with the other conditions, except in mental health, whereas a worst health-related quality of life in most domains was reported by older patients and those experiencing polypharmacy. Conclusions In this cohort of patients with chronic conditions followed within the same health setting, PLWH showed better self-reported health outcomes compared to other chronic conditions with comparable characteristics of chronicity. The potential detrimental role of older age and polypharmacy in most outcomes suggests the need of longitudinal assessment of PROMs in clinical practice.
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Affiliation(s)
- C Seguiti
- Malattie Infettive, Università Cattolica del Sacro Cuore, Rome, Italy.,UOC Malattie Infettive, Infectious Disease Department, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Francesco Vito 1, 00168, Rome, Italy
| | - P F Salvo
- Malattie Infettive, Università Cattolica del Sacro Cuore, Rome, Italy
| | - E Di Stasio
- UOC Chimica, Biochimica e Biologia Molecolare Clinica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie, Università Cattolica del Sacro Cuore, Rome, Italy
| | - S Lamonica
- UOC Malattie Infettive, Infectious Disease Department, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Francesco Vito 1, 00168, Rome, Italy
| | - A L Fedele
- Divisione Reumatologia, Fondazione Policlinico A. Gemelli IRCCS, Rome, Italy
| | - S Manfrida
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico A. Gemelli IRCCS, Rome, Italy
| | - N Ciccarelli
- Dipartimento di Psicologia, Università Cattolica, Milan, Italy
| | - B Corvari
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico A. Gemelli IRCCS, Rome, Italy
| | - C De Luca
- UOC Chimica, Biochimica e Biologia Molecolare Clinica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - L Tartaglione
- UOS Diabetologia, Fondazione Policlinico A. Gemelli IRCCS, Rome, Italy
| | - D Pitocco
- UOS Diabetologia, Fondazione Policlinico A. Gemelli IRCCS, Rome, Italy
| | - R Cauda
- Malattie Infettive, Università Cattolica del Sacro Cuore, Rome, Italy.,UOC Malattie Infettive, Infectious Disease Department, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Francesco Vito 1, 00168, Rome, Italy
| | - A Cingolani
- Malattie Infettive, Università Cattolica del Sacro Cuore, Rome, Italy. .,UOC Malattie Infettive, Infectious Disease Department, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Francesco Vito 1, 00168, Rome, Italy.
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7
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Busutti M, Cingolani A, Natali F, Mattiotti M, Grandinetti V, Baraldi O, Comai G, Candoli P, La Manna G. Everolimus-associated alveolar hemorrage relapse after drug discontinuation in a kidney transplant recipient. J Nephrol 2022; 35:1275-1278. [PMID: 35286598 PMCID: PMC8919162 DOI: 10.1007/s40620-022-01298-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 02/26/2022] [Indexed: 11/01/2022]
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8
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Gasperoni L, Abenavoli C, Donati G, Scrivo A, Zappulo F, Cingolani A, Hu L, La Manna G. Safety of Intradialytic Bamlanivimab/Etesevimab Administration in Two COVID-19 Dialysis Outpatients. Blood Purif 2022; 51:875-878. [PMID: 35108709 PMCID: PMC9059059 DOI: 10.1159/000521637] [Citation(s) in RCA: 1] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 12/14/2021] [Indexed: 11/24/2022]
Abstract
Chronic hemodialysis patients are at high risk of severe COVID-19 disease and death related to the infection. Anti-spike monoclonal antibodies administration reduces risk of disease progression and hospitalization in high-risk subjects but no clear data on end-stage renal disease are available. We report 2 cases of Bamlanivimab/Etesevimab administration to two not hospitalized chronic hemodialysis patients with SARS-CoV2 infection. Since they are large molecules (human immunoglobulin G1) with molecular weight of 146,000 Da, administration was conducted during the second hour of the dialysis session with no adverse reaction.
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Affiliation(s)
- Lorenzo Gasperoni
- Nephrology Dialysis and Renal Transplantation Unit, IRCCS Azienda Ospedaliero Universitaria di Bologna, Department of Experimental, Diagnostic and Speciality Medicine (DIMES), University of Bologna, Bologna, Italy
| | - Chiara Abenavoli
- Nephrology Dialysis and Renal Transplantation Unit, IRCCS Azienda Ospedaliero Universitaria di Bologna, Department of Experimental, Diagnostic and Speciality Medicine (DIMES), University of Bologna, Bologna, Italy
| | - Gabriele Donati
- Nephrology Dialysis and Renal Transplantation Unit, IRCCS Azienda Ospedaliero Universitaria di Bologna, Department of Experimental, Diagnostic and Speciality Medicine (DIMES), University of Bologna, Bologna, Italy
| | - Anna Scrivo
- Nephrology Dialysis and Renal Transplantation Unit, IRCCS Azienda Ospedaliero Universitaria di Bologna, Department of Experimental, Diagnostic and Speciality Medicine (DIMES), University of Bologna, Bologna, Italy
| | - Fulvia Zappulo
- Nephrology Dialysis and Renal Transplantation Unit, IRCCS Azienda Ospedaliero Universitaria di Bologna, Department of Experimental, Diagnostic and Speciality Medicine (DIMES), University of Bologna, Bologna, Italy
| | - Alessandra Cingolani
- Nephrology Dialysis and Renal Transplantation Unit, IRCCS Azienda Ospedaliero Universitaria di Bologna, Department of Experimental, Diagnostic and Speciality Medicine (DIMES), University of Bologna, Bologna, Italy
| | - Lilio Hu
- Nephrology Dialysis and Renal Transplantation Unit, IRCCS Azienda Ospedaliero Universitaria di Bologna, Department of Experimental, Diagnostic and Speciality Medicine (DIMES), University of Bologna, Bologna, Italy
| | - Gaetano La Manna
- Nephrology Dialysis and Renal Transplantation Unit, IRCCS Azienda Ospedaliero Universitaria di Bologna, Department of Experimental, Diagnostic and Speciality Medicine (DIMES), University of Bologna, Bologna, Italy
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9
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Cingolani A, Tummolo AM, Montemurro G, Gremese E, Larosa L, Cipriani MC, Pasciuto G, Liperoti R, Murri R, Pirronti T, Cauda R, Fantoni M. Baricitinib as rescue therapy in a patient with COVID-19 with no complete response to sarilumab. Infection 2020; 48:767-771. [PMID: 32642806 PMCID: PMC7340855 DOI: 10.1007/s15010-020-01476-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 06/28/2020] [Indexed: 01/20/2023]
Abstract
A patient with COVID-19-related severe respiratory failure, with insufficient response to an antiretroviral therapy, hydroxychloroquine and Interleukin-6 (IL-6) antagonist therapy, presented a prompt resolution of the respiratory function and improvement in the radiological picture after baricitinib at an oral dose of 4 mg per day for 2 weeks.
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Affiliation(s)
- A Cingolani
- Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Gemelli IRCCS, Rome, Italy
- Dipartimento di Sicurezza e Bioetica, Università Cattolica S. Cuore, Milan, Italy
| | - A M Tummolo
- Dipartimento di Scienze dell'invecchiamento, Fondazione Policlinico Gemelli IRCCS, Rome, Italy.
- Division of Infectious Diseases, Covid 2 Columbus, Fondazione Policlinico Gemelli, IRCCS, Università Cattolica S. Cuore, L.go A. Gemelli 8, 00167, Rome, Italy.
| | - G Montemurro
- Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Gemelli IRCCS, Rome, Italy
| | - E Gremese
- Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Gemelli IRCCS, Rome, Italy
- Dipartimento di Scienze Geriatriche e Ortopediche, Università Cattolica S. Cuore, Milan, Italy
| | - L Larosa
- Dipartimento di Diagnostica per immagini, Fondazione Policlinico Gemelli IRCCS, Rome, Italy
| | - M C Cipriani
- Dipartimento di Scienze dell'invecchiamento, Fondazione Policlinico Gemelli IRCCS, Rome, Italy
| | - G Pasciuto
- Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Gemelli IRCCS, Rome, Italy
| | - R Liperoti
- Dipartimento di Scienze dell'invecchiamento, Fondazione Policlinico Gemelli IRCCS, Rome, Italy
- Dipartimento di Scienze Geriatriche e Ortopediche, Università Cattolica S. Cuore, Milan, Italy
| | - R Murri
- Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Gemelli IRCCS, Rome, Italy
- Dipartimento di Sicurezza e Bioetica, Università Cattolica S. Cuore, Milan, Italy
| | - T Pirronti
- Dipartimento di Diagnostica per immagini, Fondazione Policlinico Gemelli IRCCS, Rome, Italy
- Dipartimento di Scienze Radiologiche e Ematologiche, Università Cattolica S. Cuore, Milan, Italy
| | - R Cauda
- Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Gemelli IRCCS, Rome, Italy
- Dipartimento di Sicurezza e Bioetica, Università Cattolica S. Cuore, Milan, Italy
| | - M Fantoni
- Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Gemelli IRCCS, Rome, Italy
- Dipartimento di Sicurezza e Bioetica, Università Cattolica S. Cuore, Milan, Italy
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10
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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11
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Borghetti A, Moschese D, Cingolani A, Baldin G, Speziale D, Ciccullo A, Lombardi F, Emiliozzi A, Belmonti S, Antinori A, Cauda R, Di Giambenedetto S. Lamivudine-based maintenance antiretroviral therapies in patients living with HIV-1 with suppressed HIV RNA: derivation of a predictive score for virological failure. HIV Med 2019; 20:624-627. [PMID: 31240860 DOI: 10.1111/hiv.12759] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/18/2019] [Indexed: 01/04/2023]
Abstract
OBJECTIVES Two-drug antiretroviral regimens based on lamivudine (3TC) plus either a protease inhibitor (PI) or dolutegravir (DTG) are becoming increasingly popular in switch strategies. Our goal was to derive a predictive score for virological failure (VF). METHODS We retrospectively analysed data for a cohort of 587 virologically suppressed (HIV RNA < 37 HIV-1 RNA copies/mL), adult (≥ 18 years old) patients starting lamivudine plus either a boosted PI or dolutegravir. Predictors of VF (defined as a single HIV RNA measurement ≥ 1000 copies/mL or two consecutive HIV RNA measurements ≥ 50 copies/mL) were identified using a multivariate Cox regression model. A 'weighted' score was assigned to each variable associated with VF; the discriminative power of the score obtained was expressed as the area under the receiver-operator characteristic curve (ROC-AUC). RESULTS During a median 2 years of follow-up time, 35 VFs occurred; predictors of VF were baseline residual HIV RNA between 20 and 36 copies/mL, African ethnicity, ≥ 10 therapeutic lines, the presence of at least one resistance-associated mutation (RAM) for resistance to current drugs (excluding M184V), a non-B viral subtype and a baseline CD4 count < 200 cells/μL. A score of 2 was assigned to non-B viral subtype, 3 to residual viraemia ≥ 20 copies/mL, ≥ 10 previous therapeutic lines and African ethnicity, 4 to baseline CD4 count < 200 cells/μL, and 7 to the presence of at least one RAM (excluding M184V). The ROC-AUC was 0.67 (95% confidence interval 0.57-0.77). CONCLUSIONS The presence of at least one RAM, higher residual viraemia and African ethnicity were among the major predictors of VF in our cohort. Studies with larger sample sizes are warranted to improve the predictive value of the derived score.
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Affiliation(s)
- A Borghetti
- Fondazione Policlinico Agostino Gemelli IRCCS, Infectious Diseases Unit, Rome, Italy
| | - D Moschese
- Institute of Clinical Infectious Diseases, Catholic University of the Sacred Heart, Rome, Italy
| | - A Cingolani
- Fondazione Policlinico Agostino Gemelli IRCCS, Infectious Diseases Unit, Rome, Italy.,Institute of Clinical Infectious Diseases, Catholic University of the Sacred Heart, Rome, Italy
| | - G Baldin
- Institute of Clinical Infectious Diseases, Catholic University of the Sacred Heart, Rome, Italy
| | - D Speziale
- Institute of Microbiology, Catholic University of the Sacred Heart, Rome, Italy
| | - A Ciccullo
- Institute of Clinical Infectious Diseases, Catholic University of the Sacred Heart, Rome, Italy
| | - F Lombardi
- Institute of Clinical Infectious Diseases, Catholic University of the Sacred Heart, Rome, Italy
| | - A Emiliozzi
- Institute of Clinical Infectious Diseases, Catholic University of the Sacred Heart, Rome, Italy
| | - S Belmonti
- Institute of Clinical Infectious Diseases, Catholic University of the Sacred Heart, Rome, Italy
| | - A Antinori
- UOC Immunodeficienze Virali, Istituto Nazionale per le Malattie Infettive Lazzaro Spallanzani-IRCCS, Rome, Italy
| | - R Cauda
- Fondazione Policlinico Agostino Gemelli IRCCS, Infectious Diseases Unit, Rome, Italy.,Institute of Clinical Infectious Diseases, Catholic University of the Sacred Heart, Rome, Italy
| | - S Di Giambenedetto
- Fondazione Policlinico Agostino Gemelli IRCCS, Infectious Diseases Unit, Rome, Italy.,Institute of Clinical Infectious Diseases, Catholic University of the Sacred Heart, Rome, Italy
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12
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d'Arminio Monforte A, Diaz-Cuervo H, De Luca A, Maggiolo F, Cingolani A, Bonora S, Castagna A, Girardi E, Antinori A, Lo Caputo S, Guaraldi G, Cozzi-Lepri A. Evolution of major non-HIV-related comorbidities in HIV-infected patients in the Italian Cohort of Individuals, Naïve for Antiretrovirals (ICONA) Foundation Study cohort in the period 2004-2014. HIV Med 2018; 20:99-109. [PMID: 30461158 DOI: 10.1111/hiv.12683] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The management of HIV disease is complicated by the incidence of a new spectrum of comorbid noncommunicable diseases (NCDs). It is important to document changes in the prevalence of NCDs over time. The aim of the study was to describe the impact of ageing on HIV markers and on the prevalence of NCDs in people living with HIV (PLWHIV) in the Italian Cohort of Individuals, Naïve for Antiretrovirals (ICONA) seen for care in 2004-2014. METHODS Analyses were conducted separately for a closed cohort (same people seen at both times) and an open cohort (all people under follow-up). We used the χ2 test for categorical factors and the Wilcoxon test for quantitative factors to compare profiles over time. RESULTS The closed cohort included 1517 participants and the open cohort 3668 under follow-up in 2004 and 6679 in 2014. The median age of the open cohort was 41 [interquartile range (IQR) 37-46] years in 2004 and 44 (IQR 36-52) years in 2014. Analysis of the closed cohort showed an increase in the prevalence of some NCDs [the prevalence of dyslipidaemia increased from 75% in 2004 to 91% in 2014, that of hypertension from 67 to 84%, and that of cardiovascular disease (CVD) from 18 to 32%] and a decrease in renal function (5% with eGFR < 60 mL/min per 1.73 m2 in 2004 versus 30% in 2014); the percentage of people in the high-risk group for the Framingham CHD score more than tripled (from 13 to 45%). Results in the open cohort were similar. CONCLUSIONS The burden of NCDs in our PLWHIV population markedly worsened over a 10-year time-span, which is likely to be a result of the effects of both ageing and HIV infection as well as their interaction. Special attention must be given to the management and prevention of NCDs.
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Affiliation(s)
- A d'Arminio Monforte
- Department of Health Sciences, ASST Santi Paolo e Carlo, Institute of Infectious Diseases, University of Milan, Milan, Italy
| | | | - A De Luca
- Division of Infectious Diseases, Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - F Maggiolo
- Department of Infectious Diseases, Giovanni XXIII Hospital, Bergamo, Italy
| | - A Cingolani
- Institute of Infectious Diseases, Cattolica University, Rome, Italy
| | - S Bonora
- Institute of Infectious Diseases, University of Torino, Torino, Italy
| | - A Castagna
- Institute of Infectious Diseases, University vita E. Salute, Milan, Italy
| | - E Girardi
- INMI Lazzaro Spallanzani, Rome, Italy
| | | | - S Lo Caputo
- Department of Infectious Diseases, Bagno A. Ripoli Hospital, Firenze, Italy
| | - G Guaraldi
- University of Modena and Reggio Emilia, Modena, Italy
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13
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Muscatello A, Bandera A, Fabbiani M, De Benedetto I, Ammassari A, Antinori A, Calcagno A, Celesia B, Cingolani A, d'Ettorre G, Di Biagio A, Focà E, Girardi E, Gulminetti R, Madeddu G, Marchetti G, Mussini C, Nozza S, Orofino G, Ripamonti D, Rusconi S, Tambussi G, Gori A. O4 Early start of antiretroviral therapy (ART) during primary HIV infection (PHI) is associated with faster optimal immunological recovery: results of Italian Network of ACuTe HIV InfectiON (INACTION) retrospective study. J Virus Erad 2017. [DOI: 10.1016/s2055-6640(20)30820-7] [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: 10/23/2022] Open
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14
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Attanasi M, Rapino D, Marcovecchio ML, Consilvio NP, Scaparrotta A, Cingolani A, Di Pillo S, Chiarelli F. Airway hyper-responsiveness to mannitol provides a good evaluation of atopy in childhood asthma. Acta Paediatr 2015; 104:718-23. [PMID: 25661794 DOI: 10.1111/apa.12968] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Revised: 12/11/2014] [Accepted: 02/02/2015] [Indexed: 01/27/2023]
Abstract
AIM The relationship between airway hyper-responsiveness (AHR) and atopy has been previously investigated, but there are still some issues to be clarified. The aim of this study was to assess the link between AHR and mannitol and atopy in asthmatic children. METHODS We evaluated 44 children with asthma, aged 6-16 years of age, using skin prick tests (SPTs), serum total and specific immunoglobulin E (IgE) levels and the mannitol challenge test (MCT). RESULTS We found a good correlation between AHR to mannitol and specific IgE against Dermatophagoides pteronissinus (r = -0.66, p < 0.001) and a weak correlation with specific IgE against dog dander (r = -0.33, p = 0.01) and Aspergillus fumigatus (r = -0.23, p = 0.02). Furthermore, we found a weak correlation between AHR to mannitol and serum total IgE (r = -0.30; p = 0.03), the sum of specific IgE to aeroallergens (r = -0.37, p = 0.01) and the number of positive SPTs (r = -0.31, p = 0.02). CONCLUSION Measuring AHR with MCT might provide an accurate evaluation of the degree of atopy in children. The patients with a higher degree of atopy were significantly more reactive to mannitol. In clinical practice, these results indicate that children with asthma who are more atopic may require more intensive treatment strategies to reduce AHR.
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Affiliation(s)
- M Attanasi
- Allergy and Respiratory Diseases Clinic; Department of Paediatrics; University of Chieti; Chieti Italy
| | - D Rapino
- Allergy and Respiratory Diseases Clinic; Department of Paediatrics; University of Chieti; Chieti Italy
| | | | - N P Consilvio
- Allergy and Respiratory Diseases Clinic; Department of Paediatrics; University of Chieti; Chieti Italy
| | - A Scaparrotta
- Allergy and Respiratory Diseases Clinic; Department of Paediatrics; University of Chieti; Chieti Italy
| | - A Cingolani
- Allergy and Respiratory Diseases Clinic; Department of Paediatrics; University of Chieti; Chieti Italy
| | - S Di Pillo
- Allergy and Respiratory Diseases Clinic; Department of Paediatrics; University of Chieti; Chieti Italy
| | - F Chiarelli
- Department of Paediatrics; University of Chieti; Chieti Italy
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Cingolani A, Zona S, Girardi E, Cozzi-Lepri A, Monno L, Quiros Roldan E, Guaraldi G, Antinori A, D'Arminio Monforte A, Marcotullio S. Incidence and factors associated with the risk of sexually transmitted diseases in HIV-infected people seen for care in Italy: data from the Icona Foundation cohort. HIV Med 2015; 16:412-20. [PMID: 25959419 PMCID: PMC4682467 DOI: 10.1111/hiv.12226] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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] [Accepted: 11/16/2014] [Indexed: 11/28/2022]
Abstract
Objectives The aims of this study were to identify temporal trends in the incidence of sexually transmitted diseases (STDs) in a cohort of HIV-infected people and to evaluate factors associated with the risk of a new STD diagnosis. Methods All HIV-infected patients in the Icona Foundation Study cohort enrolled after 1998 were included in this study. STD incidence rates (IRs) were calculated and stratified by calendar period. Predictors of STDs were identified using a Poisson regression model with sandwich estimates for standard errors. Results Data for 9168 participants were analysed [median age 37.3 (range 18–81) years; 74% male; 30% men who have sex with men (MSM)]. Over 46 736 person-years of follow-up (PYFU), 996 episodes of STDs were observed [crude IR 21.3/1000 PYFU; 95% confidence interval (CI) 20.0–22.6/1000 PYFU]. In multivariable Poisson regression analysis, MSM [rate ratio (RR) 3.03; 95% CI 2.52–3.64 versus heterosexuals], calendar period (RR 1.67; 95% CI 1.42–1.97 for 2008–2012 versus 1998–2002), HIV RNA > 50 HIV-1 RNA copies/mL (RR 1.44; 95% CI 1.19–1.74 versus HIV RNA ≤ 50 copies/mL) and a current CD4 count < 100 cells/μL (RR 4.66; 95% CI 3.69–5.89; P < 0.001 versus CD4 count > 500 cells/μL) were associated with an increased risk of STDs. In contrast, older age (RR 0.82 per 10 years older; 95% CI 0.77–0.89) and being currently on ART (RR 0.38; 95% CI 0.33–0.45) compared with being ART-naïve or on a treatment interruption were associated with a lower risk of developing STDs. Conclusions An increase in the incidence of STDs was observed in more recent years. Interventions to prevent STDs and potential spread of HIV should target the younger population, MSM and people currently not receiving ART.
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Affiliation(s)
- A Cingolani
- Department of Public Health, Infectious Diseases, Catholic University, Rome, Italy
| | - S Zona
- Clinic of Infectious Diseases, Univeristy of Modena and Reggio Emilia, Modena, Italy
| | - E Girardi
- Department of Epidemiology, National Institute for Infectious Diseases 'L. Spallanzani', Rome, Italy
| | - A Cozzi-Lepri
- Department of Infection and Population Health, Division of Population Health, University College London Medical School, Royal Free Campus, London, UK
| | - L Monno
- Institute of Infectious Diseases, University of Bari, Bari, Italy
| | - E Quiros Roldan
- Institute of Infectious Diseases, University of Brescia, Brescia, Italy
| | - G Guaraldi
- Clinic of Infectious Diseases, Univeristy of Modena and Reggio Emilia, Modena, Italy
| | - A Antinori
- Clinical Department, National Institute for Infectious Diseases 'L. Spallanzani', Rome, Italy
| | - A D'Arminio Monforte
- Clinic of Infectious and Tropical Diseases, Department of Health Sciences, San Paolo University Hospital, Milan, Italy
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Abstract
A DSC study, supplemented by X-ray diffraction measurements, was carried out on potassium soaps from n.tridecanoate to n.eicosanoate in the range between room temperature and the isotropic liquid region. The present results are combined with earlier ones for the shorter homologues down to methanoate to draw a rather comprehensive picture of the phase relationships concerned. The significant features shown for a number of transition series by plots ΔS vs the number of carbon atoms, as well as the dimorphism exhibited by tridecanoate at room temperature are also discussed.
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Affiliation(s)
- A. Cingolani
- Centro di Studio per la Termodinamica ed Elettrochimica dei Sistemi Salini Fusi e Solidi del CNR c/o Institute of Physical Chemistry and Electrochemistry of the University, Pavia (Italy)
| | - G. Spinolo
- Centro di Studio per la Termodinamica ed Elettrochimica dei Sistemi Salini Fusi e Solidi del CNR c/o Institute of Physical Chemistry and Electrochemistry of the University, Pavia (Italy)
| | - M. Sanesi
- Centro di Studio per la Termodinamica ed Elettrochimica dei Sistemi Salini Fusi e Solidi del CNR c/o Institute of Physical Chemistry and Electrochemistry of the University, Pavia (Italy)
| | - P. Franzosini
- Centro di Studio per la Termodinamica ed Elettrochimica dei Sistemi Salini Fusi e Solidi del CNR c/o Institute of Physical Chemistry and Electrochemistry of the University, Pavia (Italy)
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Scaparrotta A, Di Pillo S, Consilvio NP, Attanasi M, Cingolani A, Rapino D, Cerasa M, Pucci N, Di Gioacchino M, Chiarelli F. Usefulness of Atopy Patch Test on a child with milk protein-induced enterocolitis syndrome: a case report. Int J Immunopathol Pharmacol 2014; 26:795-800. [PMID: 24067480 DOI: 10.1177/039463201302600327] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
We describe the case of a child affected by milk-protein induced enterocolitis, in which oral challenge with corn was performed without symptoms after a negative specific Atopy Patch Test. Food protein-induced enterocolitis syndrome (FPIES) is an uncommon nonIgE-mediated gastrointestinal food hypersensitivity of infancy, characterized by severe vomiting and diarrhea arising within 1 to 3 hours after ingestion of the causative food. Little is known about the pathophysiology of FPIES. The absence of food-specific IgE as demonstrated by negative skin prick tests suggests that the disease is not caused by an early onset IgE-mediated reaction. Atopy Patch Test has been described as sensitive and predictive in this syndrome. The hypothesis on the immunological pathogenesis has been discussed on the basis of literature data.
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Affiliation(s)
- A Scaparrotta
- Allergy and Respiratory Unit, Department of Pediatrics, University of Chieti, Italy
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Di Giambenedetto S, Fabbiani M, Colafigli M, Ciccarelli N, Farina S, Sidella L, D'Avino A, Mondi A, Cingolani A, Tamburrini E, Murri R, Navarra P, Cauda R, De Luca A. Safety and feasibility of treatment simplification to atazanavir/ritonavir + lamivudine in HIV-infected patients on stable treatment with two nucleos(t)ide reverse transcriptase inhibitors + atazanavir/ritonavir with virological suppression (Atazanavir and Lamivudine for treatment Simplification, AtLaS pilot study). J Antimicrob Chemother 2013; 68:1364-72. [DOI: 10.1093/jac/dkt007] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
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Cingolani A, Cozzi Lepri A, Castagna A, Goletti D, De Luca A, Scarpellini P, Fanti I, Antinori A, d'Arminio Monforte A, Girardi E. Impaired CD4 T-Cell Count Response to Combined Antiretroviral Therapy in Antiretroviral-Naive HIV-Infected Patients Presenting With Tuberculosis as AIDS-Defining Condition. Clin Infect Dis 2011; 54:853-61. [DOI: 10.1093/cid/cir900] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
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20
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Scaparrotta A, Verrotti A, Consilvio N, Cingolani A, Di Pillo S, Di Gioacchino M, Verini M, Chiarelli F. Pathogenesis and Clinical Approaches to Anticonvulsant Hypersensitivity Syndrome: Current State of Knowledge. Int J Immunopathol Pharmacol 2011; 24:277-84. [DOI: 10.1177/039463201102400201] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Anticonvulsant hypersensitivity syndrome (AHS) is a rare, but severe and potentially fatal, adverse reaction that occurs in patients who are treated with commonly used older anticonvulsant drugs (phenytoin, carbamazepine and phenobarbital) and/or with some newer agents (lamotrigine). Paediatric patients are at an increased risk for the development of AHS for the higher incidence of seizure disorder in the first decade of life. Hypersensitivity reactions range from simple maculopapular skin eruptions to a severe life-threatening disorder. AHS is typically associated with the development of skin rash, fever and internal organ dysfunctions. Recent evidence suggests that AHS is the result of a chemotoxic and immunologically-mediated injury, characterized by skin and mucosal bioactivation of antiepileptic drugs and by major histocompatibility complex-dependent clonal expansion of T cells. Early recognition of AHS and withdrawal of anticonvulsant therapy are essential for a successful outcome. In vivo and vitro tests can be helpful for the diagnosis that actually depends essentially on clinical recognition.
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Affiliation(s)
- A. Scaparrotta
- Department of Paediatrics, “G. d'Annunzio” University, Chieti, Italy
| | - A. Verrotti
- Department of Paediatrics, “G. d'Annunzio” University, Chieti, Italy
| | - N.P. Consilvio
- Department of Paediatrics, “G. d'Annunzio” University, Chieti, Italy
| | - A. Cingolani
- Department of Paediatrics, “G. d'Annunzio” University, Chieti, Italy
| | - S. Di Pillo
- Department of Paediatrics, “G. d'Annunzio” University, Chieti, Italy
| | - M. Di Gioacchino
- Allergy Related Disease Unit, “G. d'Annunzio” University, Chieti, Italy
| | - M. Verini
- Department of Paediatrics, “G. d'Annunzio” University, Chieti, Italy
| | - F. Chiarelli
- Department of Paediatrics, “G. d'Annunzio” University, Chieti, Italy
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Affiliation(s)
- I.M. Catalano
- a Istituto di Fisica, Università degli Studi, Bari, Italy
| | - A. Cingolani
- a Istituto di Fisica, Università degli Studi, Bari, Italy
| | - M. Ferrara
- a Istituto di Fisica, Università degli Studi, Bari, Italy
| | - M. Lugarà
- a Istituto di Fisica, Università degli Studi, Bari, Italy
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Affiliation(s)
- I.M. Catalano
- a Unità di Bari del G.N.E.Q.P., C.N.R., Istituto di Fisica, via Amendola 173, 70126 Bari, Italy
| | - A. Cingolani
- a Unità di Bari del G.N.E.Q.P., C.N.R., Istituto di Fisica, via Amendola 173, 70126 Bari, Italy
| | - M. Ferrara
- a Unità di Bari del G.N.E.Q.P., C.N.R., Istituto di Fisica, via Amendola 173, 70126 Bari, Italy
| | - M. Lugarà
- a Unità di Bari del G.N.E.Q.P., C.N.R., Istituto di Fisica, via Amendola 173, 70126 Bari, Italy
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Cingolani A, Torti L, Pinnetti C, de Gaetano Donati K, Murri R, Tacconelli E, Larocca LM, Teofili L. Detrimental clinical interaction between ritonavir-boosted protease inhibitors and vinblastin in HIV-infected patients with Hodgkin lymphoma. J Int AIDS Soc 2010. [PMCID: PMC3113000 DOI: 10.1186/1758-2652-13-s4-p215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Donato C, Cingolani A, Pinnetti C, De Luca A. Insulin resistance and HCV virologic response to peg-interferons (Peg-IFN) with ribavirin (RBV) in HIV/HCV co-infected patients. J Hepatol 2010; 52:306-7. [PMID: 20006404 DOI: 10.1016/j.jhep.2009.10.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2009] [Revised: 10/19/2009] [Accepted: 10/24/2009] [Indexed: 12/04/2022]
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Di Giambenedetto S, Colafigli M, Pinnetti C, Bacarelli A, Cingolani A, Tamburrini E, Cauda R, de Luca A. Genotypic resistance profile and clinical progression of treatment-experienced HIV type 1-infected patients with virological failure. AIDS Res Hum Retroviruses 2008; 24:149-54. [PMID: 18240962 DOI: 10.1089/aid.2007.0070] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
We explored the relationship between HIV-1 drug resistance in treatment-experienced patients and disease progression in a cohort of patients undergoing resistance testing to guide treatment decisions. A total of 601 treatment-failing individuals tested for genotypic HIV-1 drug resistance between 1998 and 2004 were selected. At genotypic testing, median HIV-1 RNA levels and CD4 counts were 3.8 log copies/ml and 293 cells/mul, respectively; 84% had resistance mutations to nucleoside reverse transcriptase inhibitors (NRTIs), 42% had resistance mutations to non-NRTIs, 51% had major resistance mutations to protease inhibitors (PI), 12% had no major resistance mutations to any drug class, 22% had mutations to one class, 42% had mutations to two classes, and 23% had mutations to three classes. During a follow-up of 714.7 patients/year, 80 patients showed an AIDS-defining event or died. In multivariable models adjusting for prior AIDS, baseline CD4 counts, HIV-1 RNA, and calendar year, viral resistance variables associated with increased hazards of clinical progression were the presence of reverse transcriptase substitution T215F (p = 0.002) and the presence of three or more protease substitutions among L33F/I/V, V82A/F/L/T, I84V, and L90M (p = 0.003). Resistance to three drug classes remained independently predictive of clinical progression only when calendar year was not used as an adjustment factor. Prevention and treatment of multiple drug class resistance are clinical priorities for HIV-infected patients. In recent years, improved treatment options may have helped in reducing part of the resistance-associated clinical progression.
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Affiliation(s)
- S. Di Giambenedetto
- Department of Clinical Infectious Diseases, Catholic University, Rome, Italy
| | - M. Colafigli
- Department of Clinical Infectious Diseases, Catholic University, Rome, Italy
| | - C. Pinnetti
- Department of Clinical Infectious Diseases, Catholic University, Rome, Italy
| | - A. Bacarelli
- Institute of Pharmacology, Catholic University, Rome, Italy
| | - A. Cingolani
- Department of Clinical Infectious Diseases, Catholic University, Rome, Italy
| | - E. Tamburrini
- Department of Clinical Infectious Diseases, Catholic University, Rome, Italy
| | - R. Cauda
- Department of Clinical Infectious Diseases, Catholic University, Rome, Italy
| | - A. de Luca
- Department of Clinical Infectious Diseases, Catholic University, Rome, Italy
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Murri R, Cingolani A, De Luca A, Di Giambenedetto S, Marasca G, Muscatello A, Mazzocato V, Bracciale L, Tamburrini E. Once-daily regimens were associated with a higher rate of self-chosen discontinuations. J Int AIDS Soc 2008. [DOI: 10.1186/1758-2652-11-s1-p168] [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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Ancarani F, Angeli E, Antinori A, Antonucci G, Bonasso M, Bruno R, Capobianchi MR, Cargnel A, Cozzi-Lepri A, Monforte AD, Cingolani A, Galli M, Orofino GC, Girardi E, Marino N, Bongiovanni M, Morsica G, Narciso P, Pastecchia C, Pizzaferri P, Puoti M, Santantonio T, Verucchi G, Montroni M, Scalise G, Braschi MC, Maracci M, Tirelli U, Cinelli R, Pastore G, Ladisa N, Minafra G, Suter F, Arici C, Chiodo F, Colangeli V, Fiorini C, Coronado O, Carosi G, Cadeo GP, Torti C, Minardi C, Bertelli D, Rizzardini G, Migliorino G, Manconi PE, Piano P, Ferraro T, Scerbo A, Pizzigallo E, D'Alessandro M, Santoro D, Pusterla L, Carnevale G, Galloni D, Viganò P, Mena M, Ghinelli F, Sighinolfi L, Leoncini F, Mazzotta F, Pozzi M, Caputo SL, Angarano G, Grisorio B, Saracino A, Ferrara S, Grima P, Tundo P, Pagano G, Cassola G, Alessandrini A, Piscopo R, Toti M, Chigiotti S, Soscia F, Tacconi L, Orani A, Perini P, Scasso A, Vincenti A, Chiodera F, Castelli P, Scalzini A, Fibbia G, Moroni M, Lazzarin A, Cargnel A, Vigevani GM, Caggese L, Monforte AD, Repetto D, Novati R, Galli A, Merli S, Pastecchia C, Moioli MC, Esposito R, Mussini C, Abrescia N, Chirianni A, Izzo CM, Piazza M, De Marco M, Viglietti R, Manzillo E, Graf M, Colomba A, Abbadessa V, Prestileo T, Mancuso S, Ferrari C, Pizzaferri P, Filice G, Minoli L, Bruno R, Novati S, Baldelli F, Tinca M, Petrelli E, Cioppi A, Alberici F, Ruggieri A, Menichetti F, Martinelli C, De Stefano C, La Gala A, Ballardini G, Briganti E, Magnani G, Ursitti MA, Arlotti M, Ortolani P, Cauda R, Dianzani F, Ippolito G, Antinori A, Antonucci G, D'Elia S, Narciso P, Petrosillo N, Vullo V, De Luca A, Di Giambenedetti S, Zaccarelli M, Acinapura R, De Longis P, Ciardi M, D'Offizi G, Trotta MP, Noto P, Lichtner M, Capobianchi MR, Girardi E, Pezzotti P, Rezza G, Mura MS, Mannazzu M, Resta F, Loso K, Caramello P, Sinicco A, Soranzo ML, Orofino G, Sciandra M, Bonasso M, Grossi PA, Basilico C, Poggio A, Bottari G, Raise E, Pasquinucci S, De Lalla F, Tositti G, Lepri AC, Solmone M, Girardi E, Lalle E, Abbate I, Monforte AD, Cozzi-Lepri A, Alessandrini A, Piscopo R, Ebo F, Cosco L, Antonucci G, Ippolito G, Capobianchi MR. Evolution of HVR-1 Quasispecies after 1-Year Treatment in HIV/HCV-Coinfected Patients According to the Pattern of Response to Highly Active Antiretroviral Therapy. Antivir Ther 2006. [DOI: 10.1177/135965350601100102] [Citation(s) in RCA: 2] [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: 11/16/2022]
Abstract
Hepatitis C virus (HCV) variability is mainly attributed to the ability of the virus to respond to host immune pressure, acting as a driving force for the evolution of quasispecies. This study was aimed at studying the changes in HVR-1 heterogeneity and the evolution of HCV quasispecies in HIV/HCV-coinfected patients according to the pattern of response to highly active antiretroviral therapy (HAART). Sixteen HIV/HCV-coinfected patients harbouring HCV genotype 1 and who had been on HAART for at least 1 year, 8 showing increasing CD4+T-cell counts (immunological responders) and 8 showing a stable or decreasing CD4+ T-cell counts (immunological non-responders), were selected from a prospective cohort study. After 1 year of HAART, 11 patients showed HIV viral load <2.6 log10 cp/ml (virological responders), and 5 showed HIV viral load above this value (virological non-responders). Plasma samples, collected before starting therapy and after 1 year of HAART, underwent clonal sequence analysis for HVR-1 region of HCV. Non-synonymous/synonymous substitutions ratio (Ka/Ks), aminoacidic complexity (normalized Shannon entropy) and diversity (p-distance), were considered as parameters of quasispecies heterogeneity. After 1 year of HAART, heterogeneity of HVR-1 quasispecies significantly decreased in virological non-responders, whereas the heterogeneity tended to increase in virological responders. The differences in the evolution were less stringent, when considering immunological response. On the other hand, profound qualitative modifications of HVR-1 quasispecies were observed only in patients with both immunological and virological HAART response. On the whole, these findings suggest that, in patients undergoing HAART, the extent of HCV variability and the evolution of HVR-1 quasispecies is influenced by the pattern of response to antiretroviral therapy.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Enrico Girardi
- National Institute of Infectious Diseases “L. Spallanzani”, Rome
| | - Eleonora Lalle
- National Institute of Infectious Diseases “L. Spallanzani”, Rome
| | - Isabella Abbate
- National Institute of Infectious Diseases “L. Spallanzani”, Rome
| | | | - Alessandro Cozzi-Lepri
- Department of Primary Care and Population Sciences, Royal Free and University College Medical School, London
| | | | - Rita Piscopo
- Department of Infectious Diseases, Galliera Hospital, Genova
| | - Francesca Ebo
- Department of Infectious Diseases, Hosp Civile San Giovanni e Paolo, Venezia
| | - Lucio Cosco
- Department of Infectious Diseases, A. Pugliesi Catanzaro
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Di Giambenedetto S, Vago G, Pompucci A, Scoppettuolo G, Cingolani A, Marzocchetti A, Tumbarello M, Cauda R, De Luca A. Fatal inflammatory AIDS-associated PML with high CD4 counts on HAART: A new clinical entity? Neurology 2004; 63:2452-3. [PMID: 15623736 DOI: 10.1212/01.wnl.0000148585.41802.6c] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- S Di Giambenedetto
- Istituto di Clinica delle Malattie Infettive, Università Cattolica del Sacro Cuore, Largo Gemelli 8, 00168 Rome, Italy.
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De Luca A, Ciancio BC, Larussa D, Murri R, Cingolani A, Rizzo MG, Giancola ML, Ammassari A, Ortona L. Correlates of independent HIV-1 replication in the CNS and of its control by antiretrovirals. Neurology 2002; 59:342-7. [PMID: 12177366 DOI: 10.1212/wnl.59.3.342] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To investigate in detail factors associated with independent replication of HIV-1 in CNS, and to predict its therapeutic control. METHODS HIV RNA concentration was measured by PCR in 134 cross-sectional paired plasma and CSF samples from 95 patients infected with HIV-1 with various conditions, and in longitudinal CSF samples from 50 patients on antiretroviral treatment. Monocyte chemotactic protein (MCP)-1 was quantified in CSF by ELISA. RESULTS High HIV RNA levels either in plasma or in CSF did not correlate with HIV RNA concentration in the paired biologic sample. A high CSF-to-plasma HIV RNA ratio, suggesting independent viral replication in the CNS, was associated with higher CSF viral load and higher CSF MCP-1 levels. Higher MCP-1 levels in the CSF were also associated with neurologic disorders and were not influenced by the use of highly active antiretroviral therapy (HAART). A higher number of antiretroviral drugs with CSF penetration correlated with a more profound CSF HIV-1 load reduction, independently from the use of HAART alone. Virologic suppression in CSF was predicted by a higher number of CSF-penetrating antiretrovirals and by the baseline CSF viral load, whereas lower baseline CD4 counts and higher MCP-1 levels were associated with increased risk of virologic failure. CONCLUSIONS Quantification of HIV RNA in CSF is clinically useful, particularly in patients with neurologic disorders. CSF penetration of antiretrovirals must be considered when choosing treatments, mainly in patients with higher CSF viral loads, advanced disease, and CNS disorders associated with significant macrophage activation.
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Affiliation(s)
- Andrea De Luca
- Istituto di Clinica delle Malattie Infettive, Università Cattolica del S Cuore, Largo Francesco Vito, I-00168 Rome, Italy.
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Antinori A, Liuzzi G, Cingolani A, Bertoli A, Di Giambenedetto S, Trotta MP, Rizzo MG, Girardi E, De Luca A, Perno CF. Drug-resistant mutants of HIV-1 in patients exhibiting increasing CD4 cell count despite virological failure of highly active antiretroviral therapy. AIDS 2001; 15:2325-7. [PMID: 11698709 DOI: 10.1097/00002030-200111230-00017] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- A Antinori
- Lazzaro Spallanzani National Institute for Infectious Diseases, IRCCS, Rome, Italy
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Quiroga PA, Yuln GV, Palummo M, Cingolani A, Dall LL, Volonté MG. Comparative bioavailability of diltiazem in prolonged-release oral preparations. Drug Dev Ind Pharm 2001; 27:1099-106. [PMID: 11794812 DOI: 10.1081/ddc-100108372] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
This study was conducted to compare the bioavailability of two prolonged-release pharmaceutical forms containing 300 mg of diltiazem. The test formulation is a new design of tablets with a hydrophilic matrix, and the reference formulation is capsules containing prolonged liberation microgranules, in the same dose, that are commercially available in the pharmaceutical market. Diltiazem plasma concentrations were analyzed by high-performance liquid chromatography (HPLC), which involves solid-phase extraction for plasma sample preparation. Twelve healthy volunteers participated in the study, which had a single-dose, two-treatment, two-sequence-crossover, randomized design. The preparations were compared using pharmacokinetic parameters such as the area under the plasma concentration-time curve AUC(0-36), peak plasma concentration Cmax, and Cmax/AUC(0-36) ratio as a measure for the absorption rate. No statistically significant difference was observed for any of the parameters, and the 90% confidence intervals calculated for the ratio of the logarithmically transformed AUC(0-36) and Cmax/AUC(0-36) values of both formulations were within the bioequivalence limit of 0.80-1.25. Moreover, an in vitro study of dissolution according to USP 23 was conducted, and the in vitro parameters were calculated.
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Affiliation(s)
- P A Quiroga
- Departamento Ciencias Biológicas, Facultad Ciencias Exactas, Universidad Nacional de La Plata, Argentina
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Volonté MG, Yuln G, Mandrile A, Longo R, Cingolani A. Stability of ranitidine tablets subjected to stress and environmental conditions, by HPLC. Boll Chim Farm 2001; 140:316-21. [PMID: 11680085] [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: 02/22/2023]
Abstract
High Performance Liquid Chromatographic (HPLC) method was applied in this study to comparatively evaluate the stability of tablets in their original package which 150 mg of Ranitidine from six different pharmaceutical laboratories in the market, according to ICH conditions for accelerated testing: 40 degrees C, 75% RH with and without light for six months. The stability at environmental conditions was evaluated for a twelve-month period, with and without light, with the same purpose. Ranitidine is widely used to treat peptic ulcer diseases. Ranitidine is susceptible to degradation under the influence of light, humidity and temperature. The chromatographic conditions were: RP-18 column of 250 mm yen 4 mm ID and a particle size of 5 mm; mobile phase of Acetonitrile-Ammonium acetate solution (0.2 M) (70:30; v/v) (pH*6) adjusted with glacial acetic acid; flow rate of 1 ml min-1; 25 degrees C of temperature; detection at 322 nm; injection volume of 20 ml, using height peak as the integration parameter. The results obtained at six months indicate that the stability of Ranitidine depends on the correct formulation and the primary container. The remaining content of Ranitidine, dissolved percentage in vitro and total impurity percentage were determined by HPLC. Organoleptic characteristics were visually examined. The proposed analytical method was validated and linearity, precision and selectivity were determined. Degradation products were detected.
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Affiliation(s)
- M G Volonté
- Cátedra de Ensayo y Valoración de Medicamentos, División Farmacia, Departamento de Ciencias Biológicas, Facultad de Ciencias Exactas, Universidad Nacional de La Plata, La Plata, Argentina
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Antinori A, Cingolani A, Alba L, Ammassari A, Serraino D, Ciancio BC, Palmieri F, De Luca A, Larocca LM, Ruco L, Ippolito G, Cauda R. Better response to chemotherapy and prolonged survival in AIDS-related lymphomas responding to highly active antiretroviral therapy. AIDS 2001; 15:1483-91. [PMID: 11504980 DOI: 10.1097/00002030-200108170-00005] [Citation(s) in RCA: 164] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To evaluate the impact of response to highly active antiretroviral therapy (HAART) on the natural history of AIDS non-Hodgkin's lymphoma (NHL) and to analyse the feasibility, efficacy and toxicity of HAART in combination with chemotherapy. DESIGN Prospective observational study in two AIDS clinical centres in Italy. METHODS All consecutive HIV-infected patients with NHL were included (n = 44; 48% high-risk group) and prospectively followed for 27 months. HAART was administered concomitantly with chemotherapy. The association between response to HAART and clinical presentation, response to chemotherapy and toxicity was analysed by univariate and multivariate models. Survival analysis was performed by Kaplan-Meier estimates and the Cox proportional hazards regression model. RESULTS A complete response (CR) to chemotherapy was achieved in 71% of HAART responders and 30% of non-responders. Virological response to HAART was the only variable associated with tumour response on multivariate analysis. A higher relative dose intensity (RDI) of chemotherapy was administered in patients with virological response compared with those without. The probability of 1 year survival was higher in patients with virological or immunological response. At Cox regression analysis, immunological response, a higher RDI and a CR to chemotherapy were all associated with a reduced risk of death. CONCLUSION In HIV-infected patients with NHL, response to HAART was strongly associated with a better response to chemotherapy and prolonged survival. Concurrent treatments were well tolerated, and HAART-responder patients could receive a higher RDI of chemotherapy. In patients with AIDS lymphomas, combining HAART with chemotherapy could be a feasible and effective approach.
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Affiliation(s)
- A Antinori
- National Institute for Infectious Diseases Lazzaro Spallanzani, IRCCS, Rome, Italy.
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Antinori A, Baldini F, Girardi E, Cingolani A, Zaccarelli M, Di Giambenedetto S, Barracchini A, De Longis P, Murri R, Tozzi V, Ammassari A, Rizzo MG, Ippolito G, De Luca A. Female sex and the use of anti-allergic agents increase the risk of developing cutaneous rash associated with nevirapine therapy. AIDS 2001; 15:1579-81. [PMID: 11504993 DOI: 10.1097/00002030-200108170-00018] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
To identify factors associated with cutaneous rash, we performed a retrospective multicentre analysis of HIV outpatients starting a highly active antiretroviral therapy regimen containing nevirapine. A total of 62 cutaneous adverse events were observed in 429 patients. Rash hazard was increased in women, by the prophylactic use of glucocorticoids or antihistaminics, and was reduced by escalating the initial dose of nevirapine. Women receiving glucocorticoids had a 3 month cumulative probability of rash of 0.41.
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Affiliation(s)
- A Antinori
- National Institute for Infectious Diseases Lazzaro Spallanzani, IRCCS, Rome, Italy
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Antinori A, Ammassari A, Giancola ML, Cingolani A, Grisetti S, Murri R, Alba L, Ciancio B, Soldani F, Larussa D, Ippolito G, De Luca A. Epidemiology and prognosis of AIDS-associated progressive multifocal leukoencephalopathy in the HAART era. J Neurovirol 2001; 7:323-8. [PMID: 11517411 DOI: 10.1080/13550280152537184] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Whereas most AIDS-related neurologic disorders have reduced incidence since HAART therapy was introduced, we find that the incidence of progressive multifocal leukoencephalopathy (PML) did not significantly differ between the pre-HAART and the HAART period (OR 0.78; 95% CI 0.41-1.50). These findings were confirmed by the preliminary results of the Italian Register Investigative Neuro AIDS (IRINA) Study, a prospective multicenter study started in January 2000, which showed that PML was the second most frequently diagnosed neurologic disorder after TE. A similar proportion of cases were found in HAART-naïve and HAART-experienced patients in our experience. PML was more common in the presence of HIV RNA > 500 copies/ml. Most of the cases occurring in HAART-exposed patients developed within the first 6 months of therapy. As others have reported, we find a prolonged survival in PML subjects prescribed HAART (245 days in the group treated with HAART versus 66 days in the group not treated with HAART; P at log rank = 0.001). However despite the survival benefit, AIDS-associated PML still has a serious prognosis. In fact, PML had the lowest 1-year survival probability of any cerebral disorder in our study (P = 0.0005). Our findings also confirm that CSF JCV DNA burden at baseline is a useful prognostic indicator with a threshold of 4.7 log(10) JCV copies/ml (P at log rank = 0.01) in our experience. CSF JCV DNA load at 4 weeks of follow-up and clearance of JCV-DNA from CSF are associated with a better neurologic outcome and a longer survival.
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Affiliation(s)
- A Antinori
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy.
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De Luca A, Giancola ML, Ammassari A, Grisetti S, Cingolani A, Larussa D, Alba L, Murri R, Ippolito G, Cauda R, Monforte A, Antinori A. Potent anti-retroviral therapy with or without cidofovir for AIDS-associated progressive multifocal leukoencephalopathy: extended follow-up of an observational study. J Neurovirol 2001; 7:364-8. [PMID: 11517418 DOI: 10.1080/13550280152537256] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
To analyze the clinical efficacy of cidofovir combined with highly active anti-retroviral therapy (HAART) in AIDS-related progressive multifocal leukoencepalopathy (PML), a multicenter observational study was performed. Consecutive HIV-positive patients with histologically or virologically proven PML and at least 4 weeks of treatment after diagnosis were examined: 27 patients were treated with HAART, whereas 16 patients were treated with HAART plus cidofovir 5 mg/kg intravenously per week for the first 2 weeks and every other week thereafter. JC virus DNA was quantified in cerebrospinal fluid (CSF) by PCR. Baseline virologic, immunologic, and clinical characteristics as well as HIV RNA and CD4 responses to HAART were homogeneous between the groups. The median follow-up was 132 weeks. In one case (6%), cidofovir was permanently discontinued because of severe proteinuria. One-year cumulative probability of survival was 0.61 with cidofovir and 0.29 without (log rank test P = 0.02). After adjusting for baseline CD4 counts, JC viral load in CSF, Karnofsky, and use of HAART prior to the onset of PML, the use of cidofovir was independently associated with a reduced risk of death (hazard ratio, 0.21, 95% confidence interval, 0.07-0.65; P = 0.005). A randomized study will definitively establish whether cidofovir confers significant advantage over HAART alone in AIDS-related PML.
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Affiliation(s)
- A De Luca
- Department of Clinical Infectious Diseases, Università Cattolica del S Cuore, Rome, Italy.
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Murri R, Ammassari A, De Luca A, Cingolani A, Marconi P, Wu AW, Antinori A. Self-reported nonadherence with antiretroviral drugs predicts persistent condition. HIV Clin Trials 2001; 2:323-9. [PMID: 11590535 DOI: 10.1310/kdm0-ru5w-nvtw-n9mc] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To assess variables predictive of nonadherence persisting over time in HIV-infected people treated with highly active antiretroviral therapy. METHOD Prospective study of consecutive HIV-infected patients who were prescribed ritonavir- or indinavir-containing regimens in a university-based HIV clinic in Rome. A patient questionnaire assessing knowledge of treatment regimen, adherence behavior, reasons for taking and missing therapy, factors influencing adherence, and health behaviors was administered at baseline and 1 year later. A predose protease inhibitor plasma level was measured concurrently. Persistent nonadherence was defined as patient self-reported nonadherence both at enrollment and at follow-up questionnaires. RESULTS From April 1998 to July 1998, 140 patients were enrolled into the study. At follow-up, 10% remained persistently nonadherent, and 15% of the previously adherent patients became nonadherent. On bivariate analysis, being less than 35 years old (odds ratio [OR] 8.9; 95% CI 1.8-43.1; p =.002), self-reporting nonadherence at enrollment (OR 14.5; 95% CI 3.5-5.8; p <.001), and having experienced "a fair amount" or "a lot" of vomiting (OR 11.1;95% CI 1.6-74.7; p =.02) or pruritus (OR 16.4; 95% CI 2.6-102.8; p =.004) during the 4 weeks before enrollment were significantly correlated to persistent nonadherence. CONCLUSION Previous self-reported nonadherence was a strong predictor of persistent nonadherence during follow-up. Moreover, being of younger age and self-reporting vomiting or pruritus were also associated with a higher risk of nonadherence persisting over time.
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Affiliation(s)
- R Murri
- Department of Infectious Diseases, Catholic University of Rome, Italy.
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Romagnoli C, Frezza S, Cingolani A, De Luca A, Puopolo M, De Carolis MP, Vento G, Antinori A, Tortorolo G. Plasma levels of interleukin-6 and interleukin-10 in preterm neonates evaluated for sepsis. Eur J Pediatr 2001; 160:345-50. [PMID: 11421413 DOI: 10.1007/pl00008445] [Citation(s) in RCA: 88] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
UNLABELLED In a prospective study, plasma interleukin-6 (IL-6) and interleukin-10 (IL-10) levels were measured by enzyme-linked immunosorbent assay in 45 premature neonates (25-34 weeks gestational age) with signs and symptoms of suspected sepsis at 0, 12 and 24 h; C-reactive protein (CRP) was measured at 0-24 h after enrolment. Six subjects were excluded due to insufficient blood sampling. The remaining 39 neonates were assigned to one of three groups: 25 newborns with sepsis (blood culture positive), seven with pneumonia (positive results on broncho-alveolar lavage fluid culture and characteristic chest radiography) and seven with necrotising enterocolitis (NEC) (characteristic intestinal and radiological signs according to the criteria of Bell et al.). A group of 20 healthy preterm neonates represented control subjects. On admission, higher levels of IL-6, IL-10 and CRP were observed in neonates with sepsis: IL-6 (median 1500 pg/ml, range 487-10000 pg/ml), IL-10 (median 113 pg/ml, range 70-196 pg/ml), CRP (median 22 mg/l, range 4-80 mg/l); pneumonia: IL-6 (median 1500 pg/ml, range 747-8000 pg/ml, IL-10 (median 84 pg/ml, range 76-92 pg/ml), CRP (median 10 mg/l, range 8-33 mg/l) and NEC: IL-6 (median 6650 pg/ml, range 1595-7950 pg/ml), IL-10 (median 80 pg/ml, range 61-147 pg/ml), CRP (median 3 mg/l, range 2.8-8 mg/l) as compared to controls (IL-6 median 208 pg/ml, range 198-349 pg/ml; IL-10 median 36 pg/ml, range 19-50 pg/ml; CRP median < 2 mg/l) (P < 0.05). In neonates with sepsis, IL-6 levels were significantly correlated with IL-10 levels (r = 0.65; P = 0.04) at the time of the second sample. The highest IL-6 levels were observed at onset, while IL-10 was predominant 12 h later. On admission, IL-10 and CRP levels were significantly higher in non-survivors (IL-10 median 507 pg/ml, range 422-753 pg/ml; CRP median 123 mg/l, range 20-219 mg/l) than in survivors (IL-10 median 76 pg/ml, range 61-143 pg/ml; CRP median 8 mg/l range 3-46 mg/l), while IL-10 levels were significantly higher (P < 0.05) also 12 h after admission (non-survivors: IL-10 median 600 pg/ml, range 538-800 pg/ml; survivors: IL-10 median 74 pg/ml, range 53-161 pg/ml). IL-6 and IL-10 levels were significantly correlated with CRP levels on admission (r = 0.45; P = 0.05). CONCLUSION Preterm neonates with sepsis, pneumonia or necrotising enterocolitis showed increased interleukin-6, interleukin-10 and C-reactive protein levels. High interleukin-10 concentration was associated with mortality and could be an early indicator of prognosis.
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Affiliation(s)
- C Romagnoli
- Department of Neonatology, Catholic University Sacred Heart, Rome, Italy.
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Murri R, Ammassari A, Pezzotti P, Cingolani A, De Luca A, Pallavicini F, Grillo R, Antinori A. Incidence and determinants of bacterial infections in HIV-positive patients receiving anti-Pneumocystis carinii/Toxoplasma gondii primary prophylaxis within a randomized clinical trial. J Acquir Immune Defic Syndr 2001; 27:49-55. [PMID: 11404520 DOI: 10.1097/00126334-200105010-00009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We assessed the incidence and determinants of bacteremia, pneumonia, and sinusitis/otitis in HIV-positive people receiving cotrimoxazole (CTX) or dapsone-pyrimethamine (DP) for primary prophylaxis of Pneumocystis carinii pneumonia (PCP) and toxoplasmic encephalitis (TE) within a randomized clinical trial. In total, 244 patients were randomized: 122 were assigned to CTX and 122 to DP. In the cohort, 22 bacteremia, 63 pneumonia, and 39 sinusitis/otitis cases were observed. Incidence rates of bacteremia, pneumonia, and sinusitis/otitis as well as the 2-year probability of remaining free from any bacterial infection were not significantly different between the two groups. At multivariate analysis, the risks of developing bacteremia and pneumonia were found to be independently increased by the use of a central venous catheter (hazard ratio [HR], 4.48; p <.05 and HR, 4.13; p <.01, respectively) and by hospitalization (HR, 28.82; p <.05 and HR, 10.15; p <.05, respectively). In conclusion, CTX at the dosage employed for primary PCP/TE prophylaxis does not seem to protect against bacterial infections more than second-line DP.
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Affiliation(s)
- R Murri
- Department of Infectious Diseases, Catholic University, Rome, Italy.
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Girardi E, Palmieri F, Cingolani A, Ammassari A, Petrosillo N, Gillini L, Zinzi D, De Luca A, Antinori A, Ippolito G. Changing clinical presentation and survival in HIV-associated tuberculosis after highly active antiretroviral therapy. J Acquir Immune Defic Syndr 2001; 26:326-31. [PMID: 11317073 DOI: 10.1097/00126334-200104010-00006] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To assess changes in clinical presentation and outcome of HIV-associated tuberculosis (TB) before and after widespread implementation of highly active antiretroviral therapy (HAART). METHODS We reviewed clinical charts of HIV-infected patients with culture-confirmed pulmonary TB in two referral clinical centers in Rome, Italy. The 67 patients diagnosed in 1995 to 1996 were compared with 51 patients diagnosed in 1997 to 1998. To analyze factors associated with survival we used a Cox model including antiretroviral therapy as a time-dependent covariate. RESULTS Patients diagnosed in 1997 to 1998 were more likely to have TB as the first AIDS-defining illness (78% versus 58%, p <.05), to have HIV diagnosed <2 months before TB (33% vs. 7%, p <.005) and to have typical chest radiograph pattern (45% vs. 25%, p <.05), and had a higher CD4(+) count (median 105 vs. 43, p <.005). Survival at 1 year was 80% for patients diagnosed in 1997 to 1998 vs. 65% for those diagnosed in 1995 to 1996 (p by log-rank =.02). After adjusting at multivariate analysis, time period of diagnosis was not confirmed as associated with survival (hazard ratio, 1.05; 95% confidence interval, 0.39--2.81). Age, CD4+ cell count <25/mm(3), and AIDS-defining illnesses before TB diagnosis were all associated with an higher risk of death, whereas a decreased risk of death was observed in patients starting a triple combination antiretroviral therapy after TB diagnosis (hazard ratio, 0.14; 95% confidence interval, 0.03--0.57). CONCLUSIONS Cases of HIV-associated TB occurring in patients with advanced immunosuppression and presenting with atypical radiologic appearance tend to be relatively less common in the HAART era. HAART is a major factor in prolonging survival in these patients.
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Affiliation(s)
- E Girardi
- National Institute for Infectious Diseases L. Spallanzani-IRCCS, Rome, Italy.
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Teofili L, Di Febo AL, Pierconti F, Maggiano N, Bendandi M, Rutella S, Cingolani A, Di Renzo N, Musto P, Pileri S, Leone G, Larocca LM. Expression of the c-met proto-oncogene and its ligand, hepatocyte growth factor, in Hodgkin disease. Blood 2001; 97:1063-9. [PMID: 11159538 DOI: 10.1182/blood.v97.4.1063] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
The receptor for hepatocyte growth factor (HGF) is a transmembrane tyrosine kinase that is encoded by the proto-oncogene c-met. Recently, c-MET was detected in Reed-Sternberg (RS) cells from Epstein-Barr virus-positive (EBV(+)) Hodgkin disease (HD). The c-MET, EBER-1, and LMP-1 expression in 45 lymph node biopsies and 12 bone marrow biopsies obtained from patients with HD was analyzed. In addition, HGF levels in serum samples from 80 healthy individuals and 135 HD patients in different phases of disease. In all 45 lymph node and 12 bone marrow samples examined, RS cells expressed c-MET but not HGF(+). These results were independent of the EBV infection. Interestingly, several HGF(+) dendritic-reticulum cells were found scattered around c-MET(+) RS cells. The mean +/- SEM serum HGF levels in HD patients at diagnosis and at the time of relapse were 1403 +/- 91 (95% confidence interval [CI], 1221-1585) and 1497 +/- 242 pg/mL (95% CI, 977-2017), respectively. HGF values were significantly higher than those of healthy individuals (665 +/- 28 pg/mL; 95% CI, 600-721; and P <.001 for both groups of patients) and of HD patients in remission (616 +/- 49 pg/mL; 95% CI, 517-714; and P <.001 for both groups of patients). A significant correlation was found between serum HGF levels and B symptoms at diagnosis (P =.014). In conclusion, this study indicates that HGF and c-MET constitute an additional signaling pathway between RS cells and the reactive cellular background, thereby affecting adhesion, proliferation, and survival of RS cells. Furthermore, the serum concentration of HGF in HD patients may be a useful tool in monitoring the status of disease.
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Affiliation(s)
- L Teofili
- Institutes of Hematology, Infectious Diseases, and Pathology, Università Cattolica del Sacro Cuore, Rome, Italy
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Floridia M, Tomino C, Bucciardini R, Ricciardulli D, Fragola V, Pirillo MF, Amici R, Giannini G, Galluzzo CM, Andreotti M, Seeber AC, Ammassari A, Cingolani A, Lazzarin A, Scalise G, Cargnel A, Suter F, Milazzo F, Pastore G, Moroni M, Ciammarughi R, Pini R, Carosi G, D'Amato C, Contu L, Concia E, Bonazzi L, Aiuti F, Vigevani G, Vella S. A randomized trial comparing the introduction of ritonavir or indinavir in 1251 nucleoside-experienced patients with advanced HIV infection. AIDS Res Hum Retroviruses 2000; 16:1809-20. [PMID: 11118067 DOI: 10.1089/08892220050195775] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
ISS-IP1, a multicenter, randomized, 48-week open trial, was designed to compare the introduction of ritonavir or indinavir in patients with previous nucleoside experience and CD4+ cell counts below 50/mm3. Concomitant antiretroviral treatment with nucleoside analogs was allowed. Primary efficacy measures were survival and time to a new AIDS-defining event or death, analyzed through the whole period of observation by the intention-to-treat approach. Primary toxicity measures were time to treatment discontinuation and adverse events, grade at least 3/serious, analyzed by an on-treatment approach. Evaluation-of efficacy also included CD4+ cell and RNA response. The trial enrolled 1251 patients in 5 months. At baseline, mean CD4+ cell count was about 20 cells/mm3 and mean HIV RNA copy number was 4.9 log10/ml in both groups. Overall, 402 patients in the ritonavir group and 250 patients in the indinavir group permanently discontinued the assigned treatment (relative risk, 1.96; 95% CI, 1.68-2.30; p = 0.0001), with most of this difference dependent on a higher number of discontinuation for adverse events in the ritonavir group. After a mean follow-up of 307 days (ritonavir, 304; indinavir, 309), 124 deaths (ritonavir, 61; indinavir, 63; relative risk, 0.96; 95% CI, 0.67-1.36; p = 0.80) and 330 new AIDS-defining events (ritonavir, 170; indinavir, 160; relative risk, 1.05; 95% CI, 0.85-1.31; p = 0.60) were observed. CD4+ cell counts increased in both groups in patients still receiving treatment, with about 100 cells gained by week 24 and 150 cells gained by week 48. Body weight also increased over time in both groups. Analysis of RNA response showed a decrease of 1.5 log10 or higher in both treatment groups. Overall, 400 patients in the ritonavir group and 338 patients in the indinavir group developed at least one grade 3/serious new adverse event during follow-up (relative risk, 1.48; 95% CI, 1.28-1.72; p = 0.0001). Favorable CD4+ cell and RNA responses at 24 and 48 weeks were observed in both groups of patients remaining on treatment. Indinavir showed slightly better effects in sustaining RNA, CD4+ cell, and body weight responses. Ritonavir and indinavir results were comparable in terms of clinical outcome (survival and AIDS-defining events).
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Affiliation(s)
- M Floridia
- Laboratory of Virology, Istituto Superiore di Sanità, Rome, Italy
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Murri R, Cingolani A, Limongelli P, Visconti E, Maiuro G. Reduction of bronchoscopy performances should be included in the advantages of highly active antiretroviral therapy (HAART). J Acquir Immune Defic Syndr 2000; 25:286-7. [PMID: 11115962 DOI: 10.1097/00126334-200011010-00015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Ammassari A, Cingolani A, Pezzotti P, De Luca DA, Murri R, Giancola ML, Larocca LM, Antinori A. AIDS-related focal brain lesions in the era of highly active antiretroviral therapy. Neurology 2000; 55:1194-200. [PMID: 11071499 DOI: 10.1212/wnl.55.8.1194] [Citation(s) in RCA: 99] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To compare the years since the introduction of highly active antiretroviral therapy (HAART) with the pre-HAART era for trends in the proportions of HIV-related focal brain lesion-causing disorders. METHODS A prospective, single-center study of all consecutive HIV-infected patients with a neurologic presentation and focal brain lesions observed between January 1991 and December 1998 was undertaken. RESULTS The major diagnoses in the 281 patients were toxoplasmic encephalitis (36.4%), primary CNS lymphoma (26.7%), progressive multifocal leukoencephalopathy (18.2%), and focal HIV encephalopathy (5.0%). During the HAART period, patients were less likely to be male, contracted HIV more often through heterosexual exposure, had fewer previous AIDS-defining events, received antiToxoplasma prophylaxis less frequently, had a CD4+ lymphocyte count 2.5 times higher, and had diagnosis based more often on PCR assays from CSF, reducing the need for brain biopsy and enhancing the likelihood of in vivo diagnosis. Using all patients hospitalized per year as reference population, the risk of focal brain lesions strongly increased during the pre-HAART period and declined significantly during the HAART years. In the HAART period a relevant decline of primary CNS lymphoma was found (OR for 1998, 0.25; p for trend = 0.03) and the effect of progressive calendar year was confirmed on multivariable analysis (OR, 0.52; 95% CI, 0.28 to 0.97). The frequency of toxoplasmic encephalitis decreased during the pre-HAART era and was stable afterwards. For progressive multifocal leukoencephalopathy, a slight increase was seen over time. Focal white matter lesions without enhancement or mass effect increased between 1991 and 1998. CONCLUSIONS During the HAART era, AIDS-related primary CNS lymphoma showed a strong decline, toxoplasmic encephalitis remained stable, and progressive multifocal leukoencephalopathy showed a slight increase. Focal white matter lesions without mass effect or contrast enhancement became the most frequently seen focal brain lesion. For differential diagnosis, PCR-based assays from CSF led to a shift from brain biopsy toward a minimally invasive approach with an augmented likelihood of in vivo diagnosis.
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Affiliation(s)
- A Ammassari
- Department of Infectious Diseases, Catholic University, Rome, Italy.
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47
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Caruso F, Rossi M, Tanski J, Sartori R, Sariego R, Moya S, Diez S, Navarrete E, Cingolani A, Marchetti F, Pettinari C. Synthesis, structure, and antitumor activity of a novel tetranuclear titanium complex. J Med Chem 2000; 43:3665-70. [PMID: 11020280 DOI: 10.1021/jm990539b] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The coordination complex cyclo-tetrakis[bis(1-phenyl-3-methyl-4-benzoylpyrazolon-5-ato++ +)mu-o xotitanium(IV)] has been synthesized and characterized with IR and NMR spectroscopies and X-ray diffraction. The core of this species consists of an eight-membered Ti-mu-oxo ring with alternate short-long Ti-O bond lengths. Besides these two O ligands, each metal is bound octahedrally to four O atoms from two chelating 1-phenyl-3-methyl-4-benzoylpyrazolon-5-ato anions. Several sets of Ti-O bond lengths are present: the shortest are the two Ti-O(oxo) (which are cis to each other), the longest are the two Ti-O(acyl) (cis to each other), and the two Ti-O(pyrazolonato) (trans to each other) are intermediate. The beta-diketonate ligand asymmetry, a feature considered essential in other antitumor Ti compounds, induces the short-long Ti-O(oxo) sequence of bond lengths. The antitumor activity of this compound, encapsulated in a dipalmitoylphosphatidylcholine liposome, has been studied in vitro using TA-3 (mouse mammary adenocarcinoma), HEP-2 (human epithelial larynx carcinoma), and VERO (African green monkey kidney) cell lines and in vivo in CF-1 and AJ female mice ip inoculated with TA-3. In vitro cytotoxicity is greater for TA-3 than for HEP-2 and null for VERO cell lines. In vivo results show a marked increase in survival time (T/C = 293% for AJ and 208% for CF-1), whereas tumor weight decrease was observed for CF-1-treated mice. These results suggest the Ti complex-liposome system may be promising as an antitumor drug.
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Affiliation(s)
- F Caruso
- Istituto di Strutturistica Chimica "G. Giacomello", Consiglio Nazionale delle Ricerche (CNR), Box 10, 00016 Monterotondo Stazione, Rome, Italy
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Cingolani A, Gastaldi R, Fassone L, Pierconti F, Giancola ML, Martini M, De Luca A, Ammassari A, Mazzone C, Pescarmona E, Gaidano G, Larocca LM, Antinori A. Epstein-Barr virus infection is predictive of CNS involvement in systemic AIDS-related non-Hodgkin's lymphomas. J Clin Oncol 2000; 18:3325-30. [PMID: 11013271 DOI: 10.1200/jco.2000.18.19.3325] [Citation(s) in RCA: 77] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE This study aimed at correlating Epstein-Barr virus (EBV) infection of systemic AIDS-related non-Hodgkin lymphomas (AIDS-NHL) with the development of a CNS localization of the tumor. PATIENTS AND METHODS Demographic, epidemiologic, clinical, histologic, and virologic features were collected for all systemic AIDS-NHL patients included in the study (n = 50). Pathologic specimens were classified according to the working formulation for NHL and the Revised European-American Lymphoma classification. EBV infection in tumor tissue samples was studied by EBV small encoded RNA in situ hybridization; EBV-DNA detection in CSF was carried out by nested polymerase chain reaction using Epstein-Barr nuclear antigen-1-specific primers. In addition, selected EBV-positive lymphomas were subjected to a detailed characterization of EBV molecular heterogeneity. RESULTS Eleven patients had a CNS involvement at some point during their clinical history (four at diagnosis and seven at relapse). Thirty patients (11 with CNS involvement and 19 without) harbored EBV infection of the tumor. Sensitivity, specificity, and positive and negative predictive values of EBV-DNA detection in CSF for CNS involvement by lymphoma were 90%, 100%, 100%, and 97.6%, respectively. Factors significantly predictive of CNS involvement were EBV infection of the tumor (P=.003), an extranodal disease at diagnosis other than CNS (P=.006), and a non-CNS relapse (P=.01). In four cases of CNS involvement, EBV-DNA in CSF preceded any other sign of disease by a mean of 35 days. CONCLUSION These results show that EBV infection of the tumor clone significantly increases the risk of CNS involvement by systemic AIDS-NHL, without regard of specific molecular features. The detection of EBV-DNA in the CSF of AIDS-NHL patients may select cases with higher risk of CNS involvement and, therefore, may prove useful in the therapeutic stratification of these tumors.
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MESH Headings
- Adult
- Central Nervous System Neoplasms/cerebrospinal fluid
- Central Nervous System Neoplasms/epidemiology
- Central Nervous System Neoplasms/pathology
- Central Nervous System Neoplasms/virology
- DNA, Viral/cerebrospinal fluid
- Epstein-Barr Virus Infections/cerebrospinal fluid
- Epstein-Barr Virus Infections/complications
- Epstein-Barr Virus Infections/epidemiology
- Female
- Herpesvirus 4, Human/classification
- Herpesvirus 4, Human/genetics
- Humans
- Lymphoma, AIDS-Related/cerebrospinal fluid
- Lymphoma, AIDS-Related/epidemiology
- Lymphoma, AIDS-Related/pathology
- Lymphoma, AIDS-Related/virology
- Lymphoma, Non-Hodgkin/cerebrospinal fluid
- Lymphoma, Non-Hodgkin/epidemiology
- Lymphoma, Non-Hodgkin/pathology
- Lymphoma, Non-Hodgkin/virology
- Male
- Predictive Value of Tests
- Risk Factors
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Affiliation(s)
- A Cingolani
- Department of Infectious Diseases, Catholic University
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De Luca A, Giancola ML, Ammassari A, Grisetti S, Paglia MG, Gentile M, Cingolani A, Murri R, Liuzzi G, Monforte AD, Antinori A. The effect of potent antiretroviral therapy and JC virus load in cerebrospinal fluid on clinical outcome of patients with AIDS-associated progressive multifocal leukoencephalopathy. J Infect Dis 2000; 182:1077-83. [PMID: 10979902 DOI: 10.1086/315817] [Citation(s) in RCA: 80] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2000] [Revised: 06/19/2000] [Indexed: 11/03/2022] Open
Abstract
A multicenter analysis of 57 consecutive human immunodeficiency virus-positive patients with progressive multifocal leukoencephalopathy (PML) was performed, to identify correlates of longer survival. JC virus (JCV) DNA was quantified in the cerebrospinal fluid (CSF) by polymerase chain reaction. Two months after therapy, 4% of the patients without highly active antiretroviral therapy (HAART) and 26% with HAART showed neurologic improvement or stability (P=.03), and 8% and 57%, respectively, reached undetectable JCV DNA levels in the CSF (P=.04). One-year probability of survival was.04 without HAART and.46 with HAART. HAART and lack of neurologic progression 2 months after diagnosis were independently associated with longer survival. Among HAART-treated patients, a baseline JCV DNA <4.7 log, and reaching undetectable levels after therapy predicted longer survival. Survival of AIDS-related PML is improved by HAART when JCV replication is controlled.
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Affiliation(s)
- A De Luca
- Istituto di Clinica delle Malattie Infettive, Università Cattolica del S. Cuore, 00168 Rome, Italy.
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De Luca A, Giancola ML, Ammassari A, Grisetti S, Cingolani A, Paglia MG, Govoni A, Murri R, Testa L, Monforte AD, Antinori A. Cidofovir added to HAART improves virological and clinical outcome in AIDS-associated progressive multifocal leukoencephalopathy. AIDS 2000; 14:F117-21. [PMID: 11061646 DOI: 10.1097/00002030-200009290-00001] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To analyse the virological and clinical efficacy of cidofovir combined with highly active antiretroviral therapy (HAART) in AIDS-related progressive multifocal leukoencephalopathy (PML). DESIGN Multicentre observational study of consecutive HIV-positive patients with histologically or virologically-proven PML. Group A, 26 patients treated with HAART; group B, 14 patients treated with HAART plus cidofovir 5 mg/kg intravenously per week for the first 2 weeks and alternate weeks thereafter. JC virus DNA was quantified in cerebrospinal fluid (CSF) by PCR. RESULTS Baseline virological, immunological and clinical characteristics were homogeneous between the groups. In one case cidofovir was discontinued because of severe proteinuria. There was no significant difference in HIV RNA responses and changes in the number of CD4 cells between group A and B. After 2 months of therapy, five out of 12 (42%) patients from group A and seven out of eight (87%) from group B reached undetectable JC virus DNA in the CSF (Chi-square P = 0.04); moreover, 24% of group A and 57% of group B patients showed neurological improvement or stability (P = 0.038). One-year cumulative probability of survival was 0.67 with cidofovir and 0.31 without (log-rank test, P = 0.01). Variables independently associated with longer survival were the use of cidofovir, HAART prior to the onset of PML, a baseline JC virus DNA load in CSF < 4.7 log10 copies/ml, and a baseline Karnofsky performance status > or = 60. CONCLUSIONS In AIDS-related PML, cidofovir added to HAART is associated with a more effective control of JCV replication, with improved neurological outcome and survival compared with HAART alone.
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Affiliation(s)
- A De Luca
- Istituto di Clinica delle Malattie Infettive, Università Cattolica, Roma, Italy
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