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Alberton F, Galli L, Lolatto R, Candela C, Gianotti N, Chiurlo M, Ranzenigo M, Strano M, Uglietti A, Castagna A. Outcome of Darunavir-Cobicistat-Based Regimens in HIV-Infected People Who Have Experienced Virological Failure. Drug Des Devel Ther 2024; 18:1153-1163. [PMID: 38618279 PMCID: PMC11016266 DOI: 10.2147/dddt.s443775] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 03/09/2024] [Indexed: 04/16/2024] Open
Abstract
Objective To evaluate the virological outcome of darunavir-cobicistat (DRVc)-based regimens in adults living with HIV who had experienced virological failure (VF) on any previous drug combination. Methods This was a retrospective cohort study (CSLHIV Cohort) of adults living with HIV who started a DRVc-based regimen with HIV-RNA >50 copies/mL after VF on any previous drug combination. Data on demographics, antiretroviral treatment since HIV diagnosis, and immunological and metabolic parameters from baseline (start of DRVc) to 48 weeks were analyzed in order to assess the cumulative proportion of those who achieved virological success (VS), defined as at least one instance of HIV-RNA <50 copies/mL within 12 months from baseline. Follow-up lasted from the start of the DRVc-based regimen (baseline) to the first instance of HIV-RNA <50 copies/mL, last available visit, or loss to follow-up or death, whichever occurred first. Univariate and multivariate Cox proportional-hazard regression models were used to identify baseline factors associated with VS. Results A total of 176 individuals were included, and 120 (68.2%) achieved <50 HIV-RNA copies/mL within 12 months since baseline. On multivariate analysis, baseline HDL cholesterol was independently associated with the occurrence of VS (adjusted HR 1.021, 95% CI 1.004-1.038; p=0.014). Among the 120 subjects with VS, 27 (22.5%) had had VF during a median follow-up of 20.8 months since the first undetectable HIV-RNA. Resistance testing after VF was available in two cases, which harboured the HIV variant-bearing protease inhibitor-resistance mutations D30N, I50V, and N88D. During a median follow-up of 38.4 months, 65 of 176 (36.9%) individuals discontinued DRVc for any reason (37 of 120, 30.8%) and achieved VS vs. 28 of 56 (50%) without VS (p=0.019). Time to discontinuation was longer in people with VS (41.5 vs. 23.0 months, p=0.0007). No statistically significant changes were observed in immunological or lipid profiles during follow-up. Conclusion Most individuals in this study achieved VS within 12 months from the beginning of a DRVc-based regimen; therefore, this treatment represent a viable option for people who have experienced VF on other regimens.
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Affiliation(s)
- Francesca Alberton
- Infectious Diseases Unit, Vita Salute San Raffaele University, Milan, Italy
| | - Laura Galli
- Infectious Diseases Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Riccardo Lolatto
- Infectious Diseases Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Caterina Candela
- Infectious Diseases Unit, Vita Salute San Raffaele University, Milan, Italy
| | - Nicola Gianotti
- Infectious Diseases Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Matteo Chiurlo
- Infectious Diseases Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Martina Ranzenigo
- Infectious Diseases Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Martina Strano
- Infectious Diseases Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Alessia Uglietti
- Medical Affairs Department, Infectious Diseases and Vaccines & Rare Diseases, Johnson&Johnson, Milan, Italy
| | - Antonella Castagna
- Infectious Diseases Unit, Vita Salute San Raffaele University, Milan, Italy
- Infectious Diseases Unit, San Raffaele Scientific Institute, Milan, Italy
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Raccagni AR, Galli L, Lucente MF, Candela C, Lolatto R, Trentacapilli B, Ponta G, Messina E, Gianotti N, Castagna A, Nozza S. High Propensity to Switch to Long-acting Injectable HIV PrEP with Cabotegravir in a Cohort of Oral PrEP Experienced Men who Have Sex with Men in Italy. AIDS Behav 2024; 28:907-911. [PMID: 37792228 DOI: 10.1007/s10461-023-04197-8] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2023] [Indexed: 10/05/2023]
Abstract
Aim was to investigate the propensity to switch to long-acting injectable HIV pre-exposure prophylaxis (PrEP) with cabotegravir among oral PrEP-experienced men who have sex with men. Out of 377 PrEP users, 325 (86.2%) were interested (would like = 210) or considering (would consider = 115) switch to long-acting PrEP. At multivariable analysis, the odds ratio of interest in long-acting PrEP in non-adherent vs. adherent individuals to oral PrEP was 5.03 (95%CI = 1.73-14.61,p = 0.003) and of consideration 1.63 (95%CI = 0.51-5.23,p = 0.410). We observed very high propensity to switch to long-acting PrEP, particularly among non-adherent users. Rapid availability of long-acting PrEP might address unmet needs of PrEP users in Italy.
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Affiliation(s)
| | - Laura Galli
- Infectious Diseases Unit, San Raffaele Scientific Institute, Milan, Italy
| | | | - Caterina Candela
- Vita-Salute San Raffaele University, Via Stamira D'Ancona 20, Milano, 20127, Italy
| | - Riccardo Lolatto
- Infectious Diseases Unit, San Raffaele Scientific Institute, Milan, Italy
| | | | - Giacomo Ponta
- Vita-Salute San Raffaele University, Via Stamira D'Ancona 20, Milano, 20127, Italy
| | - Emanuela Messina
- Infectious Diseases Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Nicola Gianotti
- Infectious Diseases Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Antonella Castagna
- Vita-Salute San Raffaele University, Via Stamira D'Ancona 20, Milano, 20127, Italy
- Infectious Diseases Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Silvia Nozza
- Vita-Salute San Raffaele University, Via Stamira D'Ancona 20, Milano, 20127, Italy
- Infectious Diseases Unit, San Raffaele Scientific Institute, Milan, Italy
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Senkoro E, Varadarajan M, Candela C, Gebreselassie A, Antoniadi C, Boffito M. Anastrozole as a therapeutic option for gynecomastia in a person receiving antiretroviral therapy: Case report. Br J Clin Pharmacol 2024; 90:350-353. [PMID: 37917870 DOI: 10.1111/bcp.15951] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 10/23/2023] [Accepted: 10/25/2023] [Indexed: 11/04/2023] Open
Abstract
A middle-aged Caucasian man living with HIV, clinically stable (viral load <20 copies/mL) on injectable antiretroviral cabotegravir plus rilpivirine every 2 months presented with a 6-month history of bilateral enlargement of the breasts associated with pain. His hormonal profile was normal, and no other underlying cause was identified. He was diagnosed with idiopathic gynecomastia. Tamoxifen is an anti-oestrogen recommended for gynecomastia and has been described in people living with HIV but can potentially induce the activity of cytochrome P450 3A4 (CYP3A4), reducing rilpivirine concentrations, which consequently may cause virological failure and resistance. This is the same for other antiretroviral agents majorly induced by CYP3A4. To date, there have been no reported cases of using anastrozole as a treatment for gynecomastia in people living with HIV or of its co-administration with antiretroviral. We describe the use of an aromatase inhibitor instead of tamoxifen in a person living with HIV, diagnosed with gynecomastia.
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Affiliation(s)
- Elizabeth Senkoro
- Chelsea and Westminster Hospital, London, UK
- Chronic Disease Clinic, Ifakara Health Institute, Morogoro, Tanzania
| | | | - Caterina Candela
- Chelsea and Westminster Hospital, London, UK
- Infectious Disease Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Department of Infectious DIseases, Vita-Salute San Raffaele University, Milan, Italy
| | | | | | - Marta Boffito
- Chelsea and Westminster Hospital, London, UK
- Imperial College London, London, UK
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Candela C, Galli L, Rizzo A, Mileto D, Canetti D, Gianotti N, Raccagni AR, Bertoni C, Lucente MF, Gismondo MR, Castagna A, Nozza S. Mpox DNA clearance in semen over 6-month follow-up. J Med Virol 2023; 95:e29259. [PMID: 38037499 DOI: 10.1002/jmv.29259] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 09/29/2023] [Accepted: 11/11/2023] [Indexed: 12/02/2023]
Abstract
Sexual intercourse is a well-established way of transmission of mpox infection. However, it is still uncertain whether semen may represent a viral reservoir. The aim of the study was to evaluate the clearance of viral DNA in semen samples from individuals diagnosed with mpox infection over 6-month follow-up. This prospective, observational, single-center study was conducted at IRCCS San Raffaele Scientific Institute, Milan, Italy, between May and October 2022 in 140 individuals who attended Sexual Health Clinic and diagnosed with mpox infection. Semen samples were collected and analyzed by real-time polymerase chain reaction assays. The baseline collection was performed in 64 (46%) of 140 men diagnosed with mpox infection. The viral DNA was detected in 43 (67%) with median cycle threshold (Ct) 34 (interquartile range [IQR] 31-36). The research was repeated in 32 (74%) and viral DNA clearance was observed in all within 6 months in a median time of 10.5 days (IQR 7-33). Viral clearance occurred in all tested individuals, mostly within 2 weeks since the first positive test. These findings suggest a transient presence of viral DNA in semen and do not support the hypothesis of reservoir. More studies on mpox DNA detection in semen with viral culture and extended follow-up are needed.
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Affiliation(s)
| | - Laura Galli
- Infectious Diseases Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alberto Rizzo
- Laboratory of Clinical Microbiology, Virology and Bioemergencies, Sacco Hospital, Milan, Italy
| | - Davide Mileto
- Laboratory of Clinical Microbiology, Virology and Bioemergencies, Sacco Hospital, Milan, Italy
| | - Diana Canetti
- Infectious Diseases Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Nicola Gianotti
- Infectious Diseases Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | | | | | - Maria Rita Gismondo
- Laboratory of Clinical Microbiology, Virology and Bioemergencies, Sacco Hospital, Milan, Italy
| | - Antonella Castagna
- Vita-Salute San Raffaele University, Milan, Italy
- Infectious Diseases Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Silvia Nozza
- Vita-Salute San Raffaele University, Milan, Italy
- Infectious Diseases Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
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Raccagni AR, Diotallevi S, Lolatto R, Lucente MF, Candela C, Gianotti N, Trentacapilli B, Canetti D, Castagna A, Nozza S. Viral blips and virologic failures following mpox vaccination with MVA-BN among people with HIV. AIDS 2023; 37:2365-2369. [PMID: 37773029 DOI: 10.1097/qad.0000000000003733] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2023]
Abstract
OBJECTIVES The study aim was to evaluate whether mpox vaccination with modified vaccinia Ankara-Bavarian Nordic (MVA-BN) may be associated with viral blips or confirmed virologic failures (CVF) in people with HIV (PWH) receiving antiretroviral therapy and the associated factors. DESIGN PWH who received MVA-BN, with HIV-RNA less than 50 copies/ml, and CD4 + lymphocytes at least 200 cells/μl in the 6 months prior to vaccination and at least 1 HIV-RNA determination within 3 months from vaccination. METHODS The primary outcome was occurrence of viral blips (1 HIV-RNA ≥50 copies/ml) and CVF (1 HIV-RNA ≥1000 copies/ml or ≥2 consecutive HIV-RNA ≥50 copies/ml) following MVA-BN. Changes in CD4 + and CD4 + /CD8 + were secondary outcomes. Residual viremia was defined as detectable HIV-RNA less than 50 copies/ml. PWH already vaccinated against smallpox received single-dose MVA-BN. Mann--Whitney rank-sum test or chi-square/Fisher's test applied. RESULTS Overall, 187 PWH were included: 147 received two doses of MVA-BN, 40 single-dose. Six viral blips [incidence rate = 1.59/100-person months of follow-up (PMFU), 95% confidence interval (95% CI) = 0.58-3.47], and three CVFs [incidence rate = 0.80/100-PMFU (95% CI = 0.16-2.33)] were observed. Two CVFs occurred at second dose with presence of detectable HIV-RNA following first one, with high compliance to antiretroviral therapy (ART). PWH with viral blips or CVFs had, prior to first vaccination, more frequently residual viremia [77% ( n = 7) versus 35% ( n = 62), P = 0.01]. No differences in ART ( P = 0.42) and number of MBA-BN doses ( P = 0.40) was found. In two cases of CVFs, ART was changed; all VBs resolved within 1 month. CONCLUSION Although rare, viral blips and CVFs following MVA-BN vaccination among PWH receiving ART were identified. Close monitoring of HIV-RNA during mpox vaccination should be encouraged.
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Affiliation(s)
| | - Sara Diotallevi
- Infectious Diseases Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Riccardo Lolatto
- Infectious Diseases Unit, San Raffaele Scientific Institute, Milan, Italy
| | | | | | - Nicola Gianotti
- Infectious Diseases Unit, San Raffaele Scientific Institute, Milan, Italy
| | | | - Diana Canetti
- Infectious Diseases Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Antonella Castagna
- Vita-Salute San Raffaele University
- Infectious Diseases Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Silvia Nozza
- Vita-Salute San Raffaele University
- Infectious Diseases Unit, San Raffaele Scientific Institute, Milan, Italy
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Moschetta N, Raccagni AR, Bianchi M, Diotallevi S, Lolatto R, Candela C, Uberti Foppa C, Gismondo MR, Castagna A, Nozza S, Mileto D. Mpox neutralising antibodies at 6 months from mpox infection or MVA-BN vaccination: a comparative analysis. Lancet Infect Dis 2023; 23:e455-e456. [PMID: 37837982 DOI: 10.1016/s1473-3099(23)00571-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 09/07/2023] [Accepted: 09/07/2023] [Indexed: 10/16/2023]
Affiliation(s)
| | | | - Micol Bianchi
- Laboratory of Clinical Microbiology, Virology and Bioemergencies, Ospedale Sacco, Milan, Italy
| | - Sara Diotallevi
- Infectious Diseases Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Riccardo Lolatto
- Infectious Diseases Unit, San Raffaele Scientific Institute, Milan, Italy
| | | | - Caterina Uberti Foppa
- Vita-Salute San Raffaele University, 20132 Milan, Italy; Department of Biomedical and Clinical Sciences "L Sacco", University of Milan, Italy
| | - Maria Rita Gismondo
- Laboratory of Clinical Microbiology, Virology and Bioemergencies, Ospedale Sacco, Milan, Italy; Infectious Diseases Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Antonella Castagna
- Vita-Salute San Raffaele University, 20132 Milan, Italy; Department of Biomedical and Clinical Sciences "L Sacco", University of Milan, Italy
| | - Silvia Nozza
- Vita-Salute San Raffaele University, 20132 Milan, Italy; Department of Biomedical and Clinical Sciences "L Sacco", University of Milan, Italy
| | - Davide Mileto
- Laboratory of Clinical Microbiology, Virology and Bioemergencies, Ospedale Sacco, Milan, Italy
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Bruzzesi E, Raccagni AR, Mileto D, Candela C, Canetti D, Castagna A, Nozza S, Tamburini AM. Isolated monkeypox proctitis among men who have sex with men. Infection 2023; 51:1597-1598. [PMID: 37273166 DOI: 10.1007/s15010-023-02051-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 05/12/2023] [Indexed: 06/06/2023]
Affiliation(s)
| | | | - Davide Mileto
- Clinical Microbiology, Virology and Bioemergency Diagnostics, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milan, Italy
| | | | - Diana Canetti
- Infectious Diseases Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Antonella Castagna
- Vita-Salute San Raffaele University, Milan, Italy
- Infectious Diseases Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Silvia Nozza
- Vita-Salute San Raffaele University, Milan, Italy
| | - Andrea Marco Tamburini
- Vita-Salute San Raffaele University, Milan, Italy.
- Gastrointestinal Surgery Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy.
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Passini F, Raccagni AR, Diotallevi S, Lolatto R, Bruzzesi E, Candela C, Bertoni C, Trentacapilli B, Lucente MF, Castagna A, Nozza S. Mpox Outbreak 2022: A Comparative Analysis of the Characteristics of Individuals Receiving MVA-BN Vaccination and People Diagnosed with Mpox Infection in Milan, Italy. Pathogens 2023; 12:1079. [PMID: 37764887 PMCID: PMC10537006 DOI: 10.3390/pathogens12091079] [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] [Received: 07/13/2023] [Revised: 08/10/2023] [Accepted: 08/23/2023] [Indexed: 09/29/2023] Open
Abstract
Mpox caused a worldwide outbreak in 2022, disproportionately affecting MSM reporting high-risk sexual behaviors. The aim of this study was to compare the characteristics of people receiving MVA-BN vaccination with those of individuals diagnosed with mpox to guide future vaccination policies. This was a retrospective study on people with mpox infection or vaccination at San Raffaele Scientific Institute, Milan, Italy, from May to November 2022. Characteristics were compared using Mann-Whitney or chi-square/Fisher's exact tests; multivariable logistic regression and classification tree analysis were applied. Overall, 473 vaccinated individuals and 135 with mpox were included; 472/473 and 134/135 were MSM. People with mpox were more frequently living with HIV (48.9% vs. 22.4%, p < 0.001), had ≥1 previous STI (75.6% vs. 35.7%, p < 0.001), were chemsex users (37.8% vs. 6.34%, p < 0.001), were with a higher number of partners (23.0% vs. 1.69%, p < 0.001), and had engaged in group sex (55.6% vs. 24.1%, p < 0.001). At multivariable analysis, PLWH (aOR = 2.86, 95%CI = 1.59-5.19, p < 0.001), chemsex users (aOR = 2.96, 95%CI = 1.52-5.79, p = 0.001), those with previous syphilis (aOR = 4.11, 95%CI = 2.22-7.72, p < 0.001), and those with >10 partners (aOR = 11.56, 95%CI = 6.60-21.09, p < 0.001) had a higher risk of infection. This study underscores the importance of prioritizing MSM with prior STIs and multiple partners as well as chemsex users in vaccination policies to curb mpox spread. A destigmatized assessment of sexual history is vital for comprehensive sexual health strategies.
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Affiliation(s)
- Flavia Passini
- Infectious Diseases Unit, Vita-Salute San Raffaele University, 20132 Milan, Italy; (F.P.); (E.B.); (C.C.); (C.B.); (B.T.); (M.F.L.); (A.C.); (S.N.)
| | - Angelo Roberto Raccagni
- Infectious Diseases Unit, Vita-Salute San Raffaele University, 20132 Milan, Italy; (F.P.); (E.B.); (C.C.); (C.B.); (B.T.); (M.F.L.); (A.C.); (S.N.)
| | - Sara Diotallevi
- Infectious Diseases Unit, San Raffaele Scientific Institute, 20132 Milan, Italy; (S.D.); (R.L.)
| | - Riccardo Lolatto
- Infectious Diseases Unit, San Raffaele Scientific Institute, 20132 Milan, Italy; (S.D.); (R.L.)
| | - Elena Bruzzesi
- Infectious Diseases Unit, Vita-Salute San Raffaele University, 20132 Milan, Italy; (F.P.); (E.B.); (C.C.); (C.B.); (B.T.); (M.F.L.); (A.C.); (S.N.)
| | - Caterina Candela
- Infectious Diseases Unit, Vita-Salute San Raffaele University, 20132 Milan, Italy; (F.P.); (E.B.); (C.C.); (C.B.); (B.T.); (M.F.L.); (A.C.); (S.N.)
| | - Costanza Bertoni
- Infectious Diseases Unit, Vita-Salute San Raffaele University, 20132 Milan, Italy; (F.P.); (E.B.); (C.C.); (C.B.); (B.T.); (M.F.L.); (A.C.); (S.N.)
| | - Benedetta Trentacapilli
- Infectious Diseases Unit, Vita-Salute San Raffaele University, 20132 Milan, Italy; (F.P.); (E.B.); (C.C.); (C.B.); (B.T.); (M.F.L.); (A.C.); (S.N.)
| | - Maria Francesca Lucente
- Infectious Diseases Unit, Vita-Salute San Raffaele University, 20132 Milan, Italy; (F.P.); (E.B.); (C.C.); (C.B.); (B.T.); (M.F.L.); (A.C.); (S.N.)
| | - Antonella Castagna
- Infectious Diseases Unit, Vita-Salute San Raffaele University, 20132 Milan, Italy; (F.P.); (E.B.); (C.C.); (C.B.); (B.T.); (M.F.L.); (A.C.); (S.N.)
- Infectious Diseases Unit, San Raffaele Scientific Institute, 20132 Milan, Italy; (S.D.); (R.L.)
| | - Silvia Nozza
- Infectious Diseases Unit, Vita-Salute San Raffaele University, 20132 Milan, Italy; (F.P.); (E.B.); (C.C.); (C.B.); (B.T.); (M.F.L.); (A.C.); (S.N.)
- Infectious Diseases Unit, San Raffaele Scientific Institute, 20132 Milan, Italy; (S.D.); (R.L.)
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Clemente T, Galli L, Poli A, Borjesson RP, Bresciani L, Muccini C, Canetti D, Candela C, Bossolasco S, Hasson H, Castagna A, Spagnuolo V. Treatment success of rescue regimens after dual therapy failure in people living with HIV in a real-life setting. Int J Antimicrob Agents 2023:106897. [PMID: 37343809 DOI: 10.1016/j.ijantimicag.2023.106897] [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] [Received: 12/27/2022] [Revised: 06/06/2023] [Accepted: 06/16/2023] [Indexed: 06/23/2023]
Abstract
BACKGROUND Few data on the management of two-drug regimen (2DR) failure in people living with human immunodeficiency virus (PLWH) are available. METHODS Retrospective study on treatment-experienced PLWH on a 2DR, who underwent virological failure [(VF) two consecutive viral loads (VLs) ≥50 copies/mL, a single VL ≥1000 copies/mL, or an antiretroviral therapy (ART) switch after a single VL ≥50 copies/mL with previous blips] or discontinuation for toxicity (baseline). We included integrase strand transfer inhibitor (INSTI)-based [one INSTI plus one nucleoside reverse transcriptase inhibitor (NRTI) (n=78) or one non-NRTI (n=20)] or boosted protease inhibitor (PI/b)-based [one PI/b plus one NRTI (n=116) or one INSTI (n=12)] 2DRs. Probabilities of treatment success (TS), VF, and discontinuation for any other cause of rescue regimens were estimated by Kaplan-Meier curves. A stepwise Cox model was performed to assess predictors of TS. RESULTS Overall, 226 PLWH were evaluated: at baseline, 144 individuals discontinued 2DR for toxicity and 82 had VF [median viremia 81 (63-212) copies/mL]; 171 switched therapy (49.7% to a triple-regimen, 40.9% to a different 2DR), while 55 (exclusively among those with VF) maintained their failing regimens. The probabilities of 12- and 24-month TS were 75.6% and 64.7%, respectively. Higher TS probabilities were observed in individuals who switched ART at 2DR failure (p=0.003) and in PLWH who discontinued 2DR for toxicity (p=0.008). A therapy switch was the only predictor of TS (p=0.002). CONCLUSIONS Overall probability of success of rescue regimens introduced after 2DR failure is good; an immediate ART switch is associated with higher efficacy, so this approach should be encouraged.
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Affiliation(s)
- Tommaso Clemente
- Vita-Salute San Raffaele University, via Stamira D'Ancona, 20, 20127, Milan, Italy; Infectious Diseases, IRCCS San Raffaele Scientific Institute, via Stamira D'Ancona, 20, 20127, Milan, Italy.
| | - Laura Galli
- Infectious Diseases, IRCCS San Raffaele Scientific Institute, via Stamira D'Ancona, 20, 20127, Milan, Italy
| | - Andrea Poli
- Infectious Diseases, IRCCS San Raffaele Scientific Institute, via Stamira D'Ancona, 20, 20127, Milan, Italy
| | - Rebecka Papaioannu Borjesson
- Vita-Salute San Raffaele University, via Stamira D'Ancona, 20, 20127, Milan, Italy; Infectious Diseases, IRCCS San Raffaele Scientific Institute, via Stamira D'Ancona, 20, 20127, Milan, Italy
| | - Livia Bresciani
- Vita-Salute San Raffaele University, via Stamira D'Ancona, 20, 20127, Milan, Italy
| | - Camilla Muccini
- Vita-Salute San Raffaele University, via Stamira D'Ancona, 20, 20127, Milan, Italy; Infectious Diseases, IRCCS San Raffaele Scientific Institute, via Stamira D'Ancona, 20, 20127, Milan, Italy
| | - Diana Canetti
- Infectious Diseases, IRCCS San Raffaele Scientific Institute, via Stamira D'Ancona, 20, 20127, Milan, Italy
| | - Caterina Candela
- Vita-Salute San Raffaele University, via Stamira D'Ancona, 20, 20127, Milan, Italy; Infectious Diseases, IRCCS San Raffaele Scientific Institute, via Stamira D'Ancona, 20, 20127, Milan, Italy
| | - Simona Bossolasco
- Infectious Diseases, IRCCS San Raffaele Scientific Institute, via Stamira D'Ancona, 20, 20127, Milan, Italy
| | - Hamid Hasson
- Infectious Diseases, IRCCS San Raffaele Scientific Institute, via Stamira D'Ancona, 20, 20127, Milan, Italy
| | - Antonella Castagna
- Vita-Salute San Raffaele University, via Stamira D'Ancona, 20, 20127, Milan, Italy; Infectious Diseases, IRCCS San Raffaele Scientific Institute, via Stamira D'Ancona, 20, 20127, Milan, Italy
| | - Vincenzo Spagnuolo
- Infectious Diseases, IRCCS San Raffaele Scientific Institute, via Stamira D'Ancona, 20, 20127, Milan, Italy
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10
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Raccagni AR, Ceccarelli D, Trentacapilli B, Galli L, Lolatto R, Canetti D, Bruzzesi E, Candela C, Castagna A, Nozza S. Viral Hepatitis and Human Papillomavirus Vaccination during HIV Pre-exposure Prophylaxis: Factors Associated with Missed Vaccination. J Acquir Immune Defic Syndr 2023; Publish Ahead of Print:00126334-990000000-00239. [PMID: 37220020 DOI: 10.1097/qai.0000000000003216] [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: 05/25/2023]
Abstract
BACKGROUND We evaluated factors associated with lack of triple vaccination (hepatitis A (HAV), hepatitis B (HBV), human papilloma virus (HPV)] among men who have sex with men (MSM) using pre-exposure prophylaxis (PrEP). SETTING PrEP users at San Raffaele Scientific Institute, Italy, with ≥1 follow-up visit (May 2017-2022). METHODS Participants were considered protected if: i) prior to PrEP access: positive serology (IgG-HAV+, HbsAb>10mUI/ml) or vaccination history were recorded; ii) after starting PrEP: ≥1 dose of each vaccination was administered. Individuals were considered fully protected if they received before/during PrEP access: HAV vaccination/infection, HBV vaccination/infection and HPV vaccination. Chi-square and Kruskal-Wallis tests were used to compare characteristics of those fully, partially and not protected. Factors associated with lack of triple vaccination were assessed by multivariable logistic regression and classification tree analysis. RESULTS Overall, 473 MSM were considered: 146 (31%) were fully protected, 231 (48%) partially and 96 (20%) not. Daily-based PrEP users (fully:93, 63.7%; partially:107, 46.3%; not protected:40, 41.7%; p=0.001) and those with a sexually transmitted infection (STI) at first visit (43, 29.5%; 55, 23.8%; 15, 15.6%; p=0.048) were more frequently fully protected. At multivariable analysis, the odds of lack of triple vaccination was lower among daily-based users (adjusted odds ratio=0.47, 95%CI=0.31-0.70, p<0.001). Classification tree analysis showed that among daily-based users, with an STI prior and at first PrEP visit, there was lower chance of lack of triple vaccination (probability=44%). CONCLUSION Strategies targeting PrEP users at risk of missing HAV, HBV, HPV vaccinations need to be implemented, focusing mostly on event-based users.
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Affiliation(s)
| | - Daniele Ceccarelli
- Infectious Diseases Unit, San Raffaele Scientific Institute, Milan, Italy
| | | | - Laura Galli
- Infectious Diseases Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Riccardo Lolatto
- Infectious Diseases Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Diana Canetti
- Infectious Diseases Unit, San Raffaele Scientific Institute, Milan, Italy
| | | | | | - Antonella Castagna
- Vita-Salute San Raffaele University, Milan, Italy
- Infectious Diseases Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Silvia Nozza
- Infectious Diseases Unit, San Raffaele Scientific Institute, Milan, Italy
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11
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Raccagni AR, Canetti D, Mileto D, Tamburini AM, Candela C, Albarello L, Bracchitta F, Mancon A, Micheli V, Gismondo MR, Castagna A, Nozza S. Two individuals with potential monkeypox virus reinfection. Lancet Infect Dis 2023; 23:522-524. [PMID: 37031694 PMCID: PMC10079276 DOI: 10.1016/s1473-3099(23)00185-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Revised: 02/28/2023] [Accepted: 03/02/2023] [Indexed: 04/11/2023]
Affiliation(s)
| | - Diana Canetti
- Infectious Diseases Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Davide Mileto
- Laboratory of Clinical Microbiology, Virology and Bioemergencies, Ospedale Sacco, Milan, Italy
| | - Andrea Marco Tamburini
- Gastrointestinal Surgery Unit, Vita Salute San Raffaele University, Milan, Italy; Gastrointestinal Surgery Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Caterina Candela
- Infectious Diseases Unit, Vita Salute San Raffaele University, Milan, Italy
| | - Luca Albarello
- Department of Pathology, Vita Salute San Raffaele University, Milan, Italy; Department of Pathology, San Raffaele Scientific Institute, Milan, Italy
| | - Fiorenza Bracchitta
- Laboratory of Clinical Microbiology, Virology and Bioemergencies, Ospedale Sacco, Milan, Italy
| | - Alessandro Mancon
- Laboratory of Clinical Microbiology, Virology and Bioemergencies, Ospedale Sacco, Milan, Italy
| | - Valeria Micheli
- Laboratory of Clinical Microbiology, Virology and Bioemergencies, Ospedale Sacco, Milan, Italy
| | - Maria Rita Gismondo
- Laboratory of Clinical Microbiology, Virology and Bioemergencies, Ospedale Sacco, Milan, Italy; Department of Biomedical and Clinical Sciences Luigi Sacco University Hospital, University of Milan, Italy
| | - Antonella Castagna
- Infectious Diseases Unit, Vita Salute San Raffaele University, Milan, Italy; Infectious Diseases Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Silvia Nozza
- Infectious Diseases Unit, Vita Salute San Raffaele University, Milan, Italy; Infectious Diseases Unit, San Raffaele Scientific Institute, Milan, Italy
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12
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Raccagni AR, Mileto D, Candela C, Bruzzesi E, Bracchitta F, Marcatti M, Curreli D, Ciceri F, Gismondo MR, Castagna A, Nozza S. Monkeypox infection in a hemopoietic stem cell and heart transplant recipient. J Med Virol 2023; 95:e28304. [PMID: 36372449 DOI: 10.1002/jmv.28304] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 11/10/2022] [Indexed: 11/15/2022]
Affiliation(s)
| | - Davide Mileto
- Laboratory of Clinical Microbiology, Virology and Bioemergencies, Ospedale Sacco, Milan, Italy
| | - Caterina Candela
- Infectious Diseases Unit, Vita-Salute San Raffaele University, Milan, Italy
| | - Elena Bruzzesi
- Infectious Diseases Unit, Vita-Salute San Raffaele University, Milan, Italy
| | - Fiorenza Bracchitta
- Laboratory of Clinical Microbiology, Virology and Bioemergencies, Ospedale Sacco, Milan, Italy.,Department of Biomedical and Clinical Sciences "L.Sacco", University of Milan, Milan, Italy
| | - Magda Marcatti
- Hematology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Daniele Curreli
- Laboratory of Clinical Microbiology, Virology and Bioemergencies, Ospedale Sacco, Milan, Italy.,Department of Biomedical and Clinical Sciences "L.Sacco", University of Milan, Milan, Italy
| | - Fabio Ciceri
- Infectious Diseases Unit, Vita-Salute San Raffaele University, Milan, Italy.,Hematology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Maria Rita Gismondo
- Laboratory of Clinical Microbiology, Virology and Bioemergencies, Ospedale Sacco, Milan, Italy.,Department of Biomedical and Clinical Sciences "L.Sacco", University of Milan, Milan, Italy
| | - Antonella Castagna
- Infectious Diseases Unit, Vita-Salute San Raffaele University, Milan, Italy.,Infectious Diseases Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Silvia Nozza
- Infectious Diseases Unit, San Raffaele Scientific Institute, Milan, Italy
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13
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Bertoni C, Raccagni AR, Candela C, Bruzzesi E, Mileto D, Canetti D, Rizzo A, Morsica G, Castagna A, Nozza S. Beyond stigma: Monkeypox infection in a 27-year-old woman. J Med Virol 2023; 95:e28421. [PMID: 36546405 DOI: 10.1002/jmv.28421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 12/10/2022] [Accepted: 12/16/2022] [Indexed: 12/24/2022]
Affiliation(s)
- Costanza Bertoni
- Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, Milan, Italy.,Infectious Diseases Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Angelo Roberto Raccagni
- Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, Milan, Italy.,Infectious Diseases Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Caterina Candela
- Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, Milan, Italy.,Infectious Diseases Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Elena Bruzzesi
- Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, Milan, Italy.,Infectious Diseases Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Davide Mileto
- Laboratory of Clinical Microbiology, Virology and Bioemergencies, Sacco Hospital, Milan, Italy
| | - Diana Canetti
- Infectious Diseases Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Alberto Rizzo
- Laboratory of Clinical Microbiology, Virology and Bioemergencies, Sacco Hospital, Milan, Italy.,University of Milan, Milan, Italy
| | - Giulia Morsica
- Infectious Diseases Unit, San Raffaele Scientific Institute, Milan, Italy.,Laboratory of Clinical Microbiology, Virology and Bioemergencies, Sacco Hospital, Milan, Italy
| | - Antonella Castagna
- Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, Milan, Italy.,Infectious Diseases Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Silvia Nozza
- Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, Milan, Italy.,Infectious Diseases Unit, San Raffaele Scientific Institute, Milan, Italy
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14
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Raccagni AR, Candela C, Bruzzesi E, Mileto D, Canetti D, Rizzo A, Castagna A, Nozza S. Real-life use of cidofovir for the treatment of severe monkeypox cases. J Med Virol 2023; 95:e28218. [PMID: 36229902 DOI: 10.1002/jmv.28218] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 10/11/2022] [Accepted: 10/12/2022] [Indexed: 01/11/2023]
Affiliation(s)
| | - Caterina Candela
- Infectious Diseases Unit, Vita-Salute San Raffaele University, Milan, Italy
| | - Elena Bruzzesi
- Infectious Diseases Unit, Vita-Salute San Raffaele University, Milan, Italy
| | - Davide Mileto
- Laboratory of Clinical Microbiology, Virology and Bioemergencies, Ospedale Sacco, Milan, Italy
| | - Diana Canetti
- Infectious Diseases Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Alberto Rizzo
- Laboratory of Clinical Microbiology, Virology and Bioemergencies, Ospedale Sacco, Milan, Italy.,Laboratory of Clinical Microbiology, Virology and Bioemergencies, University of Milan, Milan, Italy
| | - Antonella Castagna
- Infectious Diseases Unit, Vita-Salute San Raffaele University, Milan, Italy.,Infectious Diseases Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Silvia Nozza
- Infectious Diseases Unit, San Raffaele Scientific Institute, Milan, Italy
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15
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Rizzo A, Mileto D, Moschese D, Candela C, Mancon A, Giacomelli A, Raccagni AR, Salari F, Cossu MV, Micheli V, Castagna A, Rizzardini G, Lombardi A, Nozza S, Gismondo MR. Role of multi-site sampling in the diagnosis of human Monkeypox. J Infect 2022; 86:154-225. [PMID: 36521564 PMCID: PMC9743791 DOI: 10.1016/j.jinf.2022.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 12/09/2022] [Indexed: 12/14/2022]
Affiliation(s)
- Alberto Rizzo
- Laboratory of Clinical Microbiology, Virology and Bioemergencies, "Luigi Sacco" Hospital, ASST Fatebenefratelli Sacco, Via G.B. Grassi 74, Milan 20157, Italy.
| | - Davide Mileto
- Laboratory of Clinical Microbiology, Virology and Bioemergencies, "Luigi Sacco" Hospital, ASST Fatebenefratelli Sacco, Via G.B. Grassi 74, Milan 20157, Italy
| | - Davide Moschese
- I Division of Infectious Diseases, "Luigi Sacco" Hospital, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Caterina Candela
- Infectious Diseases Unit, Vita-Salute San Raffaele University, Milan, Italy
| | - Alessandro Mancon
- Laboratory of Clinical Microbiology, Virology and Bioemergencies, "Luigi Sacco" Hospital, ASST Fatebenefratelli Sacco, Via G.B. Grassi 74, Milan 20157, Italy
| | - Andrea Giacomelli
- Division of Infectious Diseases, "Luigi Sacco" Hospital, ASST Fatebenefratelli Sacco, Milan, Italy
| | | | - Federica Salari
- Laboratory of Clinical Microbiology, Virology and Bioemergencies, "Luigi Sacco" Hospital, ASST Fatebenefratelli Sacco, Via G.B. Grassi 74, Milan 20157, Italy
| | - Maria Vittoria Cossu
- I Division of Infectious Diseases, "Luigi Sacco" Hospital, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Valeria Micheli
- Laboratory of Clinical Microbiology, Virology and Bioemergencies, "Luigi Sacco" Hospital, ASST Fatebenefratelli Sacco, Via G.B. Grassi 74, Milan 20157, Italy
| | - Antonella Castagna
- Infectious Diseases Unit, Vita-Salute San Raffaele University, Milan, Italy,Infectious Diseases Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Giuliano Rizzardini
- I Division of Infectious Diseases, "Luigi Sacco" Hospital, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Alessandra Lombardi
- Laboratory of Clinical Microbiology, Virology and Bioemergencies, "Luigi Sacco" Hospital, ASST Fatebenefratelli Sacco, Via G.B. Grassi 74, Milan 20157, Italy
| | - Silvia Nozza
- Infectious Diseases Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Maria Rita Gismondo
- Laboratory of Clinical Microbiology, Virology and Bioemergencies, "Luigi Sacco" Hospital, ASST Fatebenefratelli Sacco, Via G.B. Grassi 74, Milan 20157, Italy,Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milan, Italy
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16
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Raccagni AR, Candela C, Mileto D, Bruzzesi E, Canetti D, Bertoni C, Castagna A, Nozza S. Breakthrough monkeypox infection among individuals previously immunized with smallpox or monkeypox vaccination. J Infect 2022; 86:154-225. [PMID: 36481365 PMCID: PMC9721380 DOI: 10.1016/j.jinf.2022.12.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 12/01/2022] [Indexed: 12/12/2022]
Affiliation(s)
| | | | - Davide Mileto
- Laboratory of Clinical Microbiology, Virology and Bioemergencies, Ospedale Sacco, Milan, Italy
| | | | - Diana Canetti
- Infectious Diseases Unit, San Raffaele Scientific Institute, Milan, Italy
| | | | - Antonella Castagna
- Vita-Salute San Raffaele University, Milan, Italy,Infectious Diseases Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Silvia Nozza
- Infectious Diseases Unit, San Raffaele Scientific Institute, Milan, Italy
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17
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Raccagni AR, Candela C, Mileto D, Canetti D, Bruzzesi E, Rizzo A, Castagna A, Nozza S. Monkeypox infection among men who have sex with men: PCR testing on seminal fluids. J Infect 2022; 85:573-607. [PMID: 35914609 PMCID: PMC9556608 DOI: 10.1016/j.jinf.2022.07.022] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 07/26/2022] [Indexed: 11/20/2022]
Affiliation(s)
| | - Caterina Candela
- Vita-Salute San Raffaele University, Via Stamira D'Ancona 20, Milano, Milan 20127, Italy
| | - Davide Mileto
- Laboratory of Clinical Microbiology, Virology and Bioemergencies, Ospedale Sacco, Milan, Italy
| | - Diana Canetti
- Infectious Diseases Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Elena Bruzzesi
- Vita-Salute San Raffaele University, Via Stamira D'Ancona 20, Milano, Milan 20127, Italy
| | - Alberto Rizzo
- Laboratory of Clinical Microbiology, Virology and Bioemergencies, Ospedale Sacco, Milan, Italy; University of Milan, Milan, Italy
| | - Antonella Castagna
- Vita-Salute San Raffaele University, Via Stamira D'Ancona 20, Milano, Milan 20127, Italy; Infectious Diseases Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Silvia Nozza
- Infectious Diseases Unit, San Raffaele Scientific Institute, Milan, Italy
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18
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Pinnetti C, Cimini E, Vergori A, Mazzotta V, Grassi G, Mondi A, Forbici F, Amendola A, Grisetti S, Baldini F, Candela C, Casetti R, Campioni P, Capobianchi MR, Agrati C, Antinori A. Use of Pembrolizumab for Treatment of Progressive Multifocal Leukoencephalopathy in People Living with HIV. Viruses 2022; 14:v14050970. [PMID: 35632711 PMCID: PMC9146231 DOI: 10.3390/v14050970] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 04/28/2022] [Accepted: 05/02/2022] [Indexed: 02/04/2023] Open
Abstract
Progressive Multifocal Leukoencephalopathy (PML) is a demyelinating disease occurring in advanced HIV infection, caused by the reactivation of poliomavirus JC (JCV). The use of pembrolizumab for treatment is based on the inhibition of programmed cell death protein 1 (PD-1), potentially improving the anti JCV-specific response. We used pembrolizumab with combined antiretroviral treatment (cART) on a compassionate-use basis. At each administration, clinical evaluation, MRI and laboratory testing, including CD3, CD4, CD8, PD-1 markers, HIV-RNA and JCV-DNA in cerebrospinal fluid (CSF)/plasma pairs, were performed. The JCV-specific T cell response was analysed by Elispot assay. This study included five HIV patients: four male, median age 43 years (29–52), median CD4 and CD8 count 150 (15–158) and 973 (354–1250) cell/mm3, respectively; median JCV-DNA and HIV-RNA in CSF/plasma pairs 9.540/1.503 cps/mL and 2.230/619 cp/mL, respectively. Overall, patients received between two and seven doses of pembrolizumab. After treatment, we observed JCV-DNA reduction and PD-1 down-regulation both in CSF and in plasma (high in circulating CD4 and CD8 at baseline), which remained stable at low levels in all patients. Three out of five patients showed stability of clinical picture and neuroimaging, while two others died. More data are needed in order to identify predictors of response to therapy.
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Affiliation(s)
- Carmela Pinnetti
- HIV/AIDS Unit, National Institute for Infectious Diseases, Lazzaro Spallanzani IRCCS, 00149 Rome, Italy; (V.M.); (A.M.); (S.G.); (F.B.); (C.C.); (A.A.)
- Correspondence: (C.P.); (A.V.); Tel.: +39-0655170482 (C.P. & A.V.); Fax: +39-0655170477 (C.P. & A.V.)
| | - Eleonora Cimini
- Cellular Immunology and Pharmacology Laboratory, National Institute for Infectious Diseases, Lazzaro Spallanzani IRCCS, 00149 Rome, Italy; (E.C.); (G.G.); (R.C.); (C.A.)
| | - Alessandra Vergori
- HIV/AIDS Unit, National Institute for Infectious Diseases, Lazzaro Spallanzani IRCCS, 00149 Rome, Italy; (V.M.); (A.M.); (S.G.); (F.B.); (C.C.); (A.A.)
- Correspondence: (C.P.); (A.V.); Tel.: +39-0655170482 (C.P. & A.V.); Fax: +39-0655170477 (C.P. & A.V.)
| | - Valentina Mazzotta
- HIV/AIDS Unit, National Institute for Infectious Diseases, Lazzaro Spallanzani IRCCS, 00149 Rome, Italy; (V.M.); (A.M.); (S.G.); (F.B.); (C.C.); (A.A.)
| | - Germana Grassi
- Cellular Immunology and Pharmacology Laboratory, National Institute for Infectious Diseases, Lazzaro Spallanzani IRCCS, 00149 Rome, Italy; (E.C.); (G.G.); (R.C.); (C.A.)
| | - Annalisa Mondi
- HIV/AIDS Unit, National Institute for Infectious Diseases, Lazzaro Spallanzani IRCCS, 00149 Rome, Italy; (V.M.); (A.M.); (S.G.); (F.B.); (C.C.); (A.A.)
| | - Federica Forbici
- Laboratory of Virology, National Institute for Infectious Diseases, Lazzaro Spallanzani IRCCS, 00149 Rome, Italy; (F.F.); (A.A.); (M.R.C.)
| | - Alessandra Amendola
- Laboratory of Virology, National Institute for Infectious Diseases, Lazzaro Spallanzani IRCCS, 00149 Rome, Italy; (F.F.); (A.A.); (M.R.C.)
| | - Susanna Grisetti
- HIV/AIDS Unit, National Institute for Infectious Diseases, Lazzaro Spallanzani IRCCS, 00149 Rome, Italy; (V.M.); (A.M.); (S.G.); (F.B.); (C.C.); (A.A.)
| | - Francesco Baldini
- HIV/AIDS Unit, National Institute for Infectious Diseases, Lazzaro Spallanzani IRCCS, 00149 Rome, Italy; (V.M.); (A.M.); (S.G.); (F.B.); (C.C.); (A.A.)
| | - Caterina Candela
- HIV/AIDS Unit, National Institute for Infectious Diseases, Lazzaro Spallanzani IRCCS, 00149 Rome, Italy; (V.M.); (A.M.); (S.G.); (F.B.); (C.C.); (A.A.)
| | - Rita Casetti
- Cellular Immunology and Pharmacology Laboratory, National Institute for Infectious Diseases, Lazzaro Spallanzani IRCCS, 00149 Rome, Italy; (E.C.); (G.G.); (R.C.); (C.A.)
| | - Paolo Campioni
- Radiology Unit, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, 00149 Rome, Italy;
| | - Maria Rosaria Capobianchi
- Laboratory of Virology, National Institute for Infectious Diseases, Lazzaro Spallanzani IRCCS, 00149 Rome, Italy; (F.F.); (A.A.); (M.R.C.)
| | - Chiara Agrati
- Cellular Immunology and Pharmacology Laboratory, National Institute for Infectious Diseases, Lazzaro Spallanzani IRCCS, 00149 Rome, Italy; (E.C.); (G.G.); (R.C.); (C.A.)
| | - Andrea Antinori
- HIV/AIDS Unit, National Institute for Infectious Diseases, Lazzaro Spallanzani IRCCS, 00149 Rome, Italy; (V.M.); (A.M.); (S.G.); (F.B.); (C.C.); (A.A.)
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19
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Antinori A, Cicalini S, Meschi S, Bordoni V, Lorenzini P, Vergori A, Lanini S, De Pascale L, Matusali G, Mariotti D, Cozzi Lepri A, Gallì P, Pinnetti C, Gagliardini R, Mazzotta V, Mastrorosa I, Grisetti S, Colavita F, Cimini E, Grilli E, Bellagamba R, Lapa D, Sacchi A, Marani A, Cerini C, Candela C, Fusto M, Puro V, Castilletti C, Agrati C, Girardi E, Vaia F. Humoral and cellular immune response elicited by mRNA vaccination against SARS-CoV-2 in people living with HIV (PLWH) receiving antiretroviral therapy (ART) according with current CD4 T-lymphocyte count. Clin Infect Dis 2022; 75:e552-e563. [PMID: 35366316 PMCID: PMC9047161 DOI: 10.1093/cid/ciac238] [Citation(s) in RCA: 64] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Indexed: 12/14/2022] Open
Abstract
Background Data on SARS-CoV-2 vaccine immunogenicity in PLWH are currently limited. Aim of the study was to investigate immunogenicity according to current CD4 T-cell count Methods PLWH on ART attending a SARS-CoV-2 vaccination program, were included in a prospective immunogenicity evaluation after receiving BNT162b2 or mRNA-1273. Participants were stratified by current CD4 T-cell count (poor CD4 recovery, PCDR: <200/mm3; intermediate CD4 recovery, ICDR: 200–500/mm3; high CD4 recovery, HCDR: >500/mm3). RBD-binding IgG, SARS-CoV-2 neutralizing antibodies (nAbs) and IFN-γ release were measured. As control group, HIV-negative healthcare workers (HCWs) were used Findings Among 166 PLWH, after 1 month from the booster dose, detectable RBD-binding IgG were elicited in 86.7% of PCDR, 100% of ICDR, 98.7% of HCDR, and a neutralizing titre ≥1:10 elicited in 70.0%, 88.2%, and 93.1%, respectively. Compared to HCDR, all immune response parameters were significantly lower in PCDR. After adjusting for confounders, current CD4 T-cell <200/mm3 significantly predicted a poor magnitude of anti-RDB, nAbs and IFN-γ response. As compared with HCWs, PCDR elicited a consistently reduced immunogenicity for all parameters, ICDR only a reduced RBD-binding antibody response, whereas HCDR elicited a comparable immune response for all parameters Conclusion Humoral and cell-mediated immune response against SARS-CoV-2 were elicited in most of PLWH, albeit significantly poorer in those with CD4 T-cell <200/mm3 versus those with >500 cell/mm3 and HIV-negative controls. A lower RBD-binding antibody response than HCWs was also observed in PLWH with CD4 T-cell 200–500/mm3, whereas immune response elicited in PLWH with a CD4 T-cell >500/mm3 was comparable to HIV-negative population
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Affiliation(s)
- Andrea Antinori
- Clinical Department, HIV/AIDS Unit, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Roma, Italy
| | - Stefania Cicalini
- Clinical Department, HIV/AIDS Unit, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Roma, Italy
| | - Silvia Meschi
- Laboratory of Virology, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Roma, Italy
| | - Veronica Bordoni
- Laboratory of Cellular Immunology and Clinical Pharmacology, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Roma, Italy
| | - Patrizia Lorenzini
- Clinical Department, HIV/AIDS Unit, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Roma, Italy
| | - Alessandra Vergori
- Clinical Department, HIV/AIDS Unit, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Roma, Italy
| | - Simone Lanini
- Clinical Department, HIV/AIDS Unit, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Roma, Italy
| | - Lidya De Pascale
- Clinical Department, HIV/AIDS Unit, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Roma, Italy
| | - Giulia Matusali
- Laboratory of Virology, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Roma, Italy
| | - Davide Mariotti
- Laboratory of Cellular Immunology and Clinical Pharmacology, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Roma, Italy
| | - Alessandro Cozzi Lepri
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation (CREME), Institute for Global Health, UCL, London, UK
| | - Paola Gallì
- Health Direction, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Roma, Italy
| | - Carmela Pinnetti
- Clinical Department, HIV/AIDS Unit, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Roma, Italy
| | - Roberta Gagliardini
- Clinical Department, HIV/AIDS Unit, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Roma, Italy
| | - Valentina Mazzotta
- Clinical Department, HIV/AIDS Unit, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Roma, Italy
| | - Ilaria Mastrorosa
- Clinical Department, HIV/AIDS Unit, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Roma, Italy
| | - Susanna Grisetti
- Clinical Department, HIV/AIDS Unit, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Roma, Italy
| | - Francesca Colavita
- Laboratory of Virology, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Roma, Italy
| | - Eleonora Cimini
- Laboratory of Cellular Immunology and Clinical Pharmacology, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Roma, Italy
| | - Elisabetta Grilli
- Clinical Department, HIV/AIDS Unit, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Roma, Italy
| | - Rita Bellagamba
- Clinical Department, HIV/AIDS Unit, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Roma, Italy
| | - Daniele Lapa
- Laboratory of Virology, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Roma, Italy
| | - Alessandra Sacchi
- Laboratory of Cellular Immunology and Clinical Pharmacology, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Roma, Italy
| | - Alessandra Marani
- Health Direction, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Roma, Italy
| | - Carlo Cerini
- Clinical Department, HIV/AIDS Unit, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Roma, Italy
| | - Caterina Candela
- Clinical Department, HIV/AIDS Unit, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Roma, Italy
| | - Marisa Fusto
- Clinical Department, HIV/AIDS Unit, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Roma, Italy
| | - Vincenzo Puro
- Risk Management, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Roma, Italy
| | - Concetta Castilletti
- Laboratory of Virology, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Roma, Italy
| | - Chiara Agrati
- Laboratory of Cellular Immunology and Clinical Pharmacology, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Roma, Italy
| | - Enrico Girardi
- Clinical Epidemiology, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Roma, Italy
| | - Francesco Vaia
- Health Direction, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Roma, Italy
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Campochiaro C, De Luca G, Sartorelli S, Tomelleri A, Esposito A, Candela C, Cavalli G, Dagna L. Efficacy and Safety of Methotrexate for the Treatment of Autoimmune Virus-Negative Myocarditis: A Case Series. J Clin Rheumatol 2021; 27:e143-e146. [PMID: 30234673 DOI: 10.1097/rhu.0000000000000897] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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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21
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De Luca G, Campochiaro C, Sartorelli S, Peretto G, Sala S, Palmisano A, Esposito A, Candela C, Basso C, Rizzo S, Thiene G, Della Bella P, Dagna L. Efficacy and safety of mycophenolate mofetil in patients with virus-negative lymphocytic myocarditis: A prospective cohort study. J Autoimmun 2020; 106:102330. [DOI: 10.1016/j.jaut.2019.102330] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 08/21/2019] [Accepted: 08/25/2019] [Indexed: 12/12/2022]
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De Luca G, Campochiaro C, Franchini S, Sartorelli S, Candela C, Peretto G, Sala S, Dagna L. Unexpected acute lymphocytic virus-negative myocarditis in a patient with limited cutaneous systemic sclerosis: a case report. Scand J Rheumatol 2018; 48:166-167. [PMID: 30269630 DOI: 10.1080/03009742.2018.1493744] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- G De Luca
- a Unit of Immunology, Rheumatology, Allergy and Rare Disease , IRCCS San Raffaele Hospital , Milan , Italy
| | - C Campochiaro
- a Unit of Immunology, Rheumatology, Allergy and Rare Disease , IRCCS San Raffaele Hospital , Milan , Italy
| | - S Franchini
- a Unit of Immunology, Rheumatology, Allergy and Rare Disease , IRCCS San Raffaele Hospital , Milan , Italy
| | - S Sartorelli
- a Unit of Immunology, Rheumatology, Allergy and Rare Disease , IRCCS San Raffaele Hospital , Milan , Italy
| | - C Candela
- a Unit of Immunology, Rheumatology, Allergy and Rare Disease , IRCCS San Raffaele Hospital , Milan , Italy
| | - G Peretto
- b Arrhythmia Unit and Electrophysiology Laboratories , IRCCS San Raffaele Hospital , Milan , Italy
| | - S Sala
- b Arrhythmia Unit and Electrophysiology Laboratories , IRCCS San Raffaele Hospital , Milan , Italy
| | - L Dagna
- a Unit of Immunology, Rheumatology, Allergy and Rare Disease , IRCCS San Raffaele Hospital , Milan , Italy
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23
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Oliver L, Candela C, Palma J, Pujades M, Soriano A, Alabau J, Martínez J, Mestre V, Ruiz J, Vilar J, Llorca N. Comparison of the dosimetric response of 4-element BeOSL and TLD-100 passive personal dosimeters. Phys Med 2016. [DOI: 10.1016/j.ejmp.2016.07.621] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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24
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Lliso F, Carmona V, Gimeno J, Candela C, Ruiz C, Perez-Calatayud J. EP-1564: TrueBeam RapidArc implementation of radiosurgery for benign lesions: first year experience. Radiother Oncol 2015. [DOI: 10.1016/s0167-8140(15)41556-7] [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: 11/30/2022]
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25
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Celada F, Chicas R, Soler A, Roldan S, Candela C, Gimeno J, Tormo A, Perez-Calatayud J. EP-1256: Salvage iodine-125 brachytherapy for local prostate cancer recurrence after radiotherapy. Radiother Oncol 2015. [DOI: 10.1016/s0167-8140(15)41248-4] [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]
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26
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El Bitar Z, Pino F, Candela C, Ros D, Pavía J, Rannou FR, Ruibal A, Aguiar P. The performance of a hybrid analytical-Monte Carlo system response matrix in pinhole SPECT reconstruction. Phys Med Biol 2014; 59:7573-85. [DOI: 10.1088/0031-9155/59/24/7573] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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27
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Sarubbo S, Latini F, Panajia A, Candela C, Quatrale R, Milani P, Fainardi E, Granieri E, Trapella G, Tugnoli V, Cavallo MA. Awake surgery in low-grade gliomas harboring eloquent areas: 3-year mean follow-up. Neurol Sci 2011; 32:801-10. [DOI: 10.1007/s10072-011-0587-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2010] [Accepted: 04/04/2011] [Indexed: 11/30/2022]
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Abstract
A 51-year-old man presenting with paroxysmal attacks of unilateral sweating for 1 year was studied. Clinical and laboratory findings made the diagnosis of Shapiro or Harlequin syndrome unlikely. The onset of the sweating "crisis" was immediately followed by a progressive decrease in rectal and skin temperature, lasting for about 2 hours. This indicated that hypothermia was related to an abnormal downward shift of the thermoregulatory set point and a delayed effect of mechanisms blocking heat dissipation.
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Affiliation(s)
- F Magnifico
- Institute of Neurology, University of Bologna, Italy
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Magnifico F, Pierangeli G, Barletta G, Candela C, Bonavina G, Contin M, Cortelli P. The cardiovascular effects of metoclopramide in multiple system atrophy and pure autonomic failure. Clin Auton Res 2001; 11:163-8. [PMID: 11605821 DOI: 10.1007/bf02329924] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [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: 10/24/2022]
Abstract
Metoclopramide (MCP), a central and peripheral dopaminergic blocker with cholinergic activity, has been proposed to treat orthostatic hypotension (OH) on the basis that it could antagonize the vasodilator and natriuretic effects of dopamine. The authors evaluated cardiovascular responses to MCP in 11 subjects with OH: 6 with multiple system atrophy (MSA) and 5 with pure autonomic failure (PAF), along with 6 healthy control subjects. Supine blood pressure (BP), heart rate (HR), and breathing were continuously monitored before, during, and after MCP infusion. The pre-MCP head-up tilt test was tolerated at 65 degrees for 10 minutes in all subjects except in one with PAF, who tolerated 30 degrees for only 5 minutes. Tilting confirmed the OH in patients with MSA (change in mean arterial pressure [deltaMAP] = -31 +/- 13 mm Hg) and PAF (AMAP = -34 +/- 8 mm Hg). Infusion of MCP was given in four 5-mg doses every 5 minutes, with the subject in a supine position. Infusion of MCP induced the following effects: (1) A transient hypotensive effect occurred after each infusion in both patients and control subjects, the fall in MAP being counteracted by an increase in HR in control subjects but not in patients; this acute MAP fall was mo resevere in patients. (2) A progressive reduction of MAP occurred during the test,which never returned to preinfusion levels in patients; this effect was so pronounced in two PAF patients as to prevent them from receiving the last dose. Post-MCP tilting was tolerated in control subjects but in only in 5 MSA patients and 4 PAF patients. In those patients who tolerated the test, the MAP fall was similar to, or worse than, that before MCP (MSA: deltaMAP = -28 +/- 16 mm Hg; PAF: deltaMAP = -38 +/- 16 mm Hg). The cardiovascular effect of MCP in normal subjects was a transient hypotension counterbalanced by reflex tachycardia. The lack of an HR increase and the progressive fall in supine BP in MSA and PAF patients, together with worsening orthostatic tolerance after MCP infusion, are effects that should strongly discourage the use of this drug in the treatment of OH.
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Affiliation(s)
- F Magnifico
- Institute of Neurology, University of Bologna, Italy.
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Canella G, Spagnolo S, Di Palo S, Villa G, Candela C, Staudacher C. [General criteria for the organization of an intrahospital emergency plan in Italy]. MINERVA CHIR 1997; 52:1281-5. [PMID: 9471587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The purpose of this work is to provide general criteria to draw up a hospital organization plans for emergencies, in order to efficiently manage the consequences of a massive flow of casualties from a major accident or natural disaster.
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Affiliation(s)
- G Canella
- Servizio di Anestesia e Rianimazione, Chirurgia d'Urgenza, IRCCS S. Raffaele, Milano
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