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Ripamonti D, Rusconi S, Zazzi M. A cautionary note on entry and exit strategies with long-acting cabotegravir and rilpivirine. AIDS 2024; 38:263-265. [PMID: 38116723 DOI: 10.1097/qad.0000000000003760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Affiliation(s)
| | - Stefano Rusconi
- Infectious Diseases Unit, ASST Ovest Milanese, Legnano General Hospital and DIBIC 'Luigi, Sacco', University of Milan, Milan
| | - Maurizio Zazzi
- Department of Medical Biotechnology, University of Siena, Siena, Italy
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2
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Gachanja G, Burkholder GJ, Ferraro A, Ripamonti D. Editorial: Exploring HIV disclosure challenges and approaches around the globe. Front Public Health 2024; 11:1357915. [PMID: 38264248 PMCID: PMC10803535 DOI: 10.3389/fpubh.2023.1357915] [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: 12/18/2023] [Accepted: 12/20/2023] [Indexed: 01/25/2024] Open
Affiliation(s)
- Grace Gachanja
- School of Health Sciences, Walden University, Minneapolis, MN, United States
| | - Gary J. Burkholder
- School of Psychology, College of Psychology and Community Services, Walden University, Minneapolis, MN, United States
| | - Aimee Ferraro
- School of Health Sciences, College of Health Sciences and Public Policy, Walden University, Minneapolis, MN, United States
| | - Diego Ripamonti
- Infectious Diseases Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
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Antinori A, Vergori A, Ripamonti D, Valenti D, Esposito V, Carleo MA, Rusconi S, Cascio A, Manzillo E, Andreoni M, Orofino G, Cappuccio A, Reale L, Marini MG, Mancusi D, Termini R, Uglietti A, Portaro M. Investigating coping and stigma in people living with HIV through narrative medicine in the Italian multicentre non-interventional study DIAMANTE. Sci Rep 2023; 13:17624. [PMID: 37848464 PMCID: PMC10582167 DOI: 10.1038/s41598-023-44768-2] [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: 04/05/2023] [Accepted: 10/12/2023] [Indexed: 10/19/2023] Open
Abstract
Antiretroviral therapy (ART) significantly reduced Human Immunodeficiency Virus (HIV) morbidity and mortality; nevertheless, stigma still characterises the living with this condition. This study explored patients' coping experience by integrating narrative medicine (NM) in a non-interventional clinical trial. From June 2018 to September 2020 the study involved 18 centres across Italy; enrolled patients were both D/C/F/TAF naïve and previously ART-treated. Narratives were collected at enrolment (V1) and last visit (V4) and then independently analysed by three NM specialist researchers through content analysis. One-hundred and fourteen patients completed both V1 and V4 narratives. Supportive relationships with clinicians and undetectable viral load facilitated coping. Conversely, lack of disclosure of HIV-positive status, HIV metaphors, and unwillingness to narrate the life before the diagnosis indicated internalised stigma. This is the first non-interventional study to include narratives as patient reported outcomes (PROs). Improving HIV awareness and reducing the sense of guilt experienced by patients helps to overcome stigma and foster coping.
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Affiliation(s)
- A Antinori
- HIV/AIDS Unit, National Institute for Infectious Diseases "Lazzaro Spallanzani" IRCCS, Rome, Italy
| | - A Vergori
- HIV/AIDS Unit, National Institute for Infectious Diseases "Lazzaro Spallanzani" IRCCS, Rome, Italy
| | - D Ripamonti
- Infectious Diseases Clinic, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - D Valenti
- Infectious Diseases Clinic, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - V Esposito
- General Infectious Diseases Unit, Department of Infectious Disease and Infectious Emergencies, Cotugno Hospital, Naples, Italy
| | - M A Carleo
- General Infectious Diseases Unit, Department of Infectious Disease and Infectious Emergencies, Cotugno Hospital, Naples, Italy
| | - S Rusconi
- DIBIC Luigi Sacco, University of Milan, Milan, Italy
- Infectious Diseases Unit, Legnano Hospital ASST Ovest Milanese, Legnano, Italy
| | - A Cascio
- Infectious Diseases Clinic, AOU Policlinico "P.Giaccone", Palermo, Italy
| | - E Manzillo
- Infectious Disease and Infectious Emergencies, Azienda Ospedaliera dei Colli, Naples, Italy
| | - M Andreoni
- Infectious Diseases Clinic, Foundation Policlinico Tor Vergata University Hospital, Rome, Italy
| | - G Orofino
- Amedeo di Savoia Hospital Unit of Infectious Diseases Torino, Turin, Italy
| | | | - L Reale
- Healthcare Area, ISTUD Srl, Milan, Italy
| | - M G Marini
- Healthcare Area, ISTUD Srl, Milan, Italy
| | - D Mancusi
- Medical Affairs Department, Infectious Diseases and Vaccines, Janssen-Cilag SpA, Via Michelangelo Buonarroti, 23, 20093, Cologno Monzese, MI, Italy
| | - R Termini
- Medical Affairs Department, Infectious Diseases and Vaccines, Janssen-Cilag SpA, Via Michelangelo Buonarroti, 23, 20093, Cologno Monzese, MI, Italy
| | - A Uglietti
- Medical Affairs Department, Infectious Diseases and Vaccines, Janssen-Cilag SpA, Via Michelangelo Buonarroti, 23, 20093, Cologno Monzese, MI, Italy
| | - M Portaro
- Medical Affairs Department, Infectious Diseases and Vaccines, Janssen-Cilag SpA, Via Michelangelo Buonarroti, 23, 20093, Cologno Monzese, MI, Italy.
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4
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Ripamonti D, Zazzi M. Emergent HIV drug resistance in non-inferiority trials. Lancet HIV 2023; 10:e632-e634. [PMID: 37714175 DOI: 10.1016/s2352-3018(23)00203-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 07/21/2023] [Accepted: 08/08/2023] [Indexed: 09/17/2023]
Affiliation(s)
- Diego Ripamonti
- Infectious Diseases Unit, ASST Papa Giovanni XXIII Hospital, Bergamo 24127, Italy.
| | - Maurizio Zazzi
- Department of Medical Biotechnology, University of Siena, Siena, Italy
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5
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Bruzzesi E, Gabrieli A, Bernasconi D, Marchetti G, Calcagno A, Ripamonti D, Antinori A, Squillace N, Cingolani A, Muscatello A, Bandera A, Gori A, Rusconi S, Nozza S. HIV-DNA decrease during treatment in primary HIV-1 infection with three different drug regimens: Italian Network of Acute HIV Infection (INACTION) clinical trial. J Med Virol 2023; 95:e29114. [PMID: 37752816 DOI: 10.1002/jmv.29114] [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: 04/17/2023] [Revised: 09/06/2023] [Accepted: 09/10/2023] [Indexed: 09/28/2023]
Abstract
As the introduction of antiretroviral therapy (ART) during primary HIV-1 infection (PHI) could restrict the establishment of HIV reservoirs, we aimed to assess the effect of three different ART regimens on HIV-DNA load in people living with HIV (PLWH), who started ART in PHI. Randomized, open-label, multicentric study, including subjects in PHI (defined as an incomplete HIV-1 Western blot and detectable plasma HIV-RNA) in the Italian Network of Acute HIV Infection cohort. Participants were randomly assigned (10:10:8) to a fixed-dose combination of tenofovir alafenamide fumarate (TAF) 10 mg plus emtricitabine (FTC) 200 mg, darunavir 800 mg, and cobicistat 150 mg once daily (group A), or TAF 25 mg plus FTC 200 mg, dolutegravir 50 mg once daily (group B), or an intensified four-drug regimen (TAF 10 mg plus FTC 200 mg, dolutegravir 50 mg, darunavir 800 mg, and cobicistat 150 mg once daily) (group C). The primary endpoint was the decrease of HIV-DNA copies/106 peripheral blood mononuclear cells (PBMCs) at weeks (W) 12 and 48. Secondary endpoints were increased in CD4+ cells and in CD4+/CD8+ ratio and percentage of PLWH reaching undetectable HIV-RNA. HIV-DNA was quantified by Droplet Digital PCR (Biorad QX100) and normalized to RPP30 reference gene. This study was registered in ClinicalTrials.gov (number NCT04225325). Among 78 participants enrolled, 30 were randomized to group 1, 28 to group 2, and 20 to group 3. At baseline, median CD4+ count was 658/µL (476-790), HIV-RNA 5.37 (4.38, 6.12) log10 copies/mL, without statistical difference in their change among groups at weeks 12 and 48 (p = 0.432 and 0.234, respectively). The trial was prematurely discontinued for slow accrual and for COVID-19 pandemic-associated restrictions. In the per-protocol analysis, PLWH (n = 72) with undetectable viral load was 54.3% at W12 and 86.4% at W48. Interestingly, the CD4/CD8 ratio progressively increased over time, up to normalization in almost half of the cohort by week 48, despite a deflection in group 3; no difference was observed by the Fiebig stage (I-III vs. IV-VI). HIV-DNA decreased from 4.46 (4.08, 4.81) log10 copies/106 PBMCs to 4.22 (3.79, 4.49) at week 12, and 3.87 (3.46, 4.34) at week 48, without difference among groups. At multivariable analysis, HIV-DNA delta at W48 was associated only with the increase of CD4+ count by 100 cells/mm3 but not with the Fiebig stage, the CD4+/CD8+ ratio, and treatment arm, despite a higher decrease in group 3. Six adverse events were recorded during our study, which did not cause any withdrawal from the study. We observed a decrease in HIV-DNA from baseline to W48 in PLWH treated during PHI, associated with an increase in CD4+ count, unrelated to the treatment arm.
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Affiliation(s)
| | - Arianna Gabrieli
- Dipartimento di Scienze Biomediche e Cliniche (DIBIC), Milan, Italy
| | - Davide Bernasconi
- Bicocca Bioinformatics Biostatistics and Bioimaging Centre - B4 School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Giulia Marchetti
- Clinic of Infectious Diseases, Department of Health Sciences, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
- School of Medicine and Surgery, University of Milan, Milan, Italy
| | - Andrea Calcagno
- Unit of Infectious Diseases, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Diego Ripamonti
- Infectious Disease Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Andrea Antinori
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Nicola Squillace
- Infectious Disease Unit, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Antonella Cingolani
- Istituto Clinica di Malattie Infettive, Università Cattolica del Sacro Cuore, Rome, Italy
- UOC Malattie Infettive, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Antonio Muscatello
- Infectious Diseases Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan
| | - Alessandra Bandera
- School of Medicine and Surgery, University of Milan, Milan, Italy
- Infectious Diseases Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan
| | - Andrea Gori
- School of Medicine and Surgery, University of Milan, Milan, Italy
| | - Stefano Rusconi
- School of Medicine and Surgery, University of Milan, Milan, Italy
- SC Malattie Infettive, Ospedale di Legnano, ASST Ovest Milanese, Legnano, Italy
| | - Silvia Nozza
- Vita-Salute San Raffaele University, Milan, Italy
- Infectious Diseases Unit, IRCCS Ospedale San Raffaele, Milan, Italy
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Arsuffi S, Cambianica A, Di Filippo E, Ripamonti D, Tebaldi A, Arosio MEG, Farina CF, Rizzi M. Vascular graft infections caused by Mycobacterium bovis BCG after BCG immunotherapy for non-muscle-invasive bladder cancer: Case report and review of literature. J Clin Tuberc Other Mycobact Dis 2023; 31:100360. [PMID: 36941969 PMCID: PMC10023866 DOI: 10.1016/j.jctube.2023.100360] [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: 03/12/2023] Open
Abstract
Bacillus Calmette-Guerin (BCG) immunotherapy (i.e., intravesical instillation of live attenuated strain of Mycobacterium bovis) is a standard of care for non-muscle-invasive bladder cancer (NMIBC). The risk of infective adverse events is generally low as studies have reported an incidence of systemic BCG infections between 3% and 7%. In the majority of cases, BCG infections are disseminated (34.4%), genitourinary (23.4%), osteomuscular (19.9%), or vascular (6.7%). Regarding vascular involvement, mycotic aortic aneurysm, aorto-enteric fistula and vascular bypass graft infections have been described. A 73-year-old man with a prosthetic femoral-popliteal bypass was treated with BCG immunotherapy for a relapsed NMIBC. Two months later, the patient developed fever and hyporexia. PET-CT and CT scans of the abdomen showed an abscess surrounding the superficial femoral artery, while blood cultures yielded M. bovis BCG, and antitubercular therapy (with RMP + EMB + INH) was started. The prosthetic graft was removed and its cultures tested positive for M. bovis as well. A total of 14 cases of vascular prosthesis infections caused by M. bovis BCG following BCG instillation are so far reported. All the cases occurred in adult symptomatic men. Abdominal aorta was involved in the majority of cases. CT scan played a pivotal role in the diagnostic process. Mycobacterium bovis BCG was isolated from several different sources. Treatment required surgery and medical therapy, the latter showing wide variability. Previous BCG immunotherapy must be considered in the differential diagnosis in patients with infected vascular grafts. These infectious complications are rare and, while the infected grafts should be removed, there are no definite recommendations regarding the type of regimen and duration of treatment.
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Affiliation(s)
- Stefania Arsuffi
- Department of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili di Brescia, Piazzale Spedali Civili 1, 25123 Brescia, Italy
| | - Anna Cambianica
- Department of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili di Brescia, Piazzale Spedali Civili 1, 25123 Brescia, Italy
- Corresponding author.
| | - Elisa Di Filippo
- Infectious Diseases Unit, ASST Papa Giovanni XXIII, Piazza OMS 1, 24127 Bergamo, Italy
| | - Diego Ripamonti
- Infectious Diseases Unit, ASST Papa Giovanni XXIII, Piazza OMS 1, 24127 Bergamo, Italy
| | - Alessandra Tebaldi
- Infectious Diseases Unit, ASST Papa Giovanni XXIII, Piazza OMS 1, 24127 Bergamo, Italy
| | | | | | - Marco Rizzi
- Infectious Diseases Unit, ASST Papa Giovanni XXIII, Piazza OMS 1, 24127 Bergamo, Italy
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Bozzi G, Fabeni L, Abbate I, Berno G, Muscatello A, Taramasso L, Fabbiani M, Nozza S, Tambussi G, Rusconi S, Giacomelli A, Focà E, Pinnetti C, d'Ettorre G, Mussini C, Borghi V, Celesia BM, Madeddu G, Di Biagio A, Ripamonti D, Squillace N, Antinori A, Gori A, Capobianchi MR, Bandera A. Non-B subtypes account for a large proportion of clustered primary HIV-1 infections in Italy. Sex Transm Infect 2023; 99:53-56. [PMID: 35443987 DOI: 10.1136/sextrans-2021-055289] [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: 09/27/2021] [Accepted: 04/01/2022] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVES AND DESIGN Using pol sequences obtained for routine resistance testing, we characterised the molecular patterns of HIV-1 transmission and factors associated with being part of a transmission cluster among individuals who in 2008-2014 presented with primary HIV-1 infection (PHI) at 11 urban centres across Italy. METHODS Pol sequences were obtained by Sanger sequencing. Transmission clusters were identified by phylogenetic analysis (maximum likelihood method, confirmed by Bayesian analysis). Multivariable logistic regression explored factors associated with a participant being part of a transmission cluster. RESULTS The PHI cohort comprised 186 participants (159/186, 85.5% males) with median age 44 years, median CD4 count 464 cells/mm3 and median plasma HIV-1 RNA 5.6 log10 copies/mL. Drug resistance associated mutations were found in 16/186 (8.6%). A diversity of non-B subtypes accounted for 60/186 (32.3%) of all infections. A total of 17 transmission clusters were identified, including 44/186 (23.7%) participants. Each cluster comprised 2-6 sequences. Non-B subtypes accounted for seven clusters and 22/44 (50%) of clustered sequences. In multivariable logistic regression analysis, factors associated with being part of a transmission cluster comprised harbouring a non-B subtype (adjusted OR (adjOR) 2.28; 95% CI 1.03 to 5.05; p=0.04) and showing a lower plasma HIV-1 RNA (adjOR 0.80, 95% CI 0.64 to 0.99; p=0.04). CONCLUSIONS There was a large contribution of diverse non-B subtypes to transmission clusters among people presenting with acute or recent HIV-1 infection in this cohort, illustrating the evolving dynamics of the HIV-1 epidemic in Italy, where subtype B previously dominated.
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Affiliation(s)
- Giorgio Bozzi
- Infectious Diseases Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico - Milan, Milan, Lombardia, Italy
| | - Lavinia Fabeni
- Virology and Biosafety Laboratories Unit and HIV/AIDS Clinical Unit, National Institute for Infectious Diseases, "Lazzaro Spallanzani"- IRCCS Rome, Rome, Italy
| | - Isabella Abbate
- Virology and Biosafety Laboratories Unit and HIV/AIDS Clinical Unit, National Institute for Infectious Diseases, "Lazzaro Spallanzani"- IRCCS Rome, Rome, Italy
| | - Giulia Berno
- Virology and Biosafety Laboratories Unit and HIV/AIDS Clinical Unit, National Institute for Infectious Diseases, "Lazzaro Spallanzani"- IRCCS Rome, Rome, Italy
| | - Antonio Muscatello
- Infectious Diseases Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico - Milan, Milan, Lombardia, Italy
| | - Lucia Taramasso
- Infectious Diseases Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico - Milan, Milan, Lombardia, Italy.,Infection Diseases Unit, IRCCS Policlinico San Martino Hospital, Genoa, Italy
| | - Massimiliano Fabbiani
- Infectious and Tropical Diseases Unit, Azienda Ospedaliero-Universitaria Senese, Siena, Italy
| | - Silvia Nozza
- Clinic of Infectious Diseases, San Raffaele Hospital, University Vita Salute, Milan, Italy
| | - Giuseppe Tambussi
- Clinic of Infectious Diseases, San Raffaele Hospital, University Vita Salute, Milan, Italy
| | - Stefano Rusconi
- Infectious Diseases Unit, Department of Biomedical and Clinical Sciences "Luigi Sacco" Hospital, University of Milan, Milan, Italy.,Infectious Diseases Unit, Ospedale Civile di Legnano, ASST Ovest Milanese, Legnano, Italy
| | - Andrea Giacomelli
- Infectious Diseases Unit, Department of Biomedical and Clinical Sciences "Luigi Sacco" Hospital, University of Milan, Milan, Italy
| | - Emanuele Focà
- Division of Infectious and Tropical Diseases, University of Brescia, ASST Spedali Civili Hospital, Brescia, Italy
| | - Carmela Pinnetti
- Virology and Biosafety Laboratories Unit and HIV/AIDS Clinical Unit, National Institute for Infectious Diseases, "Lazzaro Spallanzani"- IRCCS Rome, Rome, Italy
| | - Gabriella d'Ettorre
- Infectious Diseases Unit, Umberto I Hospital, La Sapienza University, Rome, Rome, Italy
| | - Cristina Mussini
- Clinic of Infectious Diseases, University of Modena and Reggio Emilia, Modena Hospital, Modena, Italy
| | - Vanni Borghi
- Clinic of Infectious Diseases, University of Modena and Reggio Emilia, Modena Hospital, Modena, Italy
| | | | - Giordano Madeddu
- Department of Medical, Surgical and Experimental Sciences, Unit of Infectious Diseases, University of Sassari, Sassari, Italy
| | - Antonio Di Biagio
- Department of Health Sciences (DiSSal), University of Genoa, Italy, Genoa, Italy
| | - Diego Ripamonti
- Division of Infectious Diseases, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Nicola Squillace
- Infectious Diseases Unit, Department of Internal Medicine, ASST San Gerardo, Monza, Italy
| | - Andrea Antinori
- Virology and Biosafety Laboratories Unit and HIV/AIDS Clinical Unit, National Institute for Infectious Diseases, "Lazzaro Spallanzani"- IRCCS Rome, Rome, Italy
| | - Andrea Gori
- Infectious Diseases Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico - Milan, Milan, Lombardia, Italy.,Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Maria Rosaria Capobianchi
- Virology and Biosafety Laboratories Unit and HIV/AIDS Clinical Unit, National Institute for Infectious Diseases, "Lazzaro Spallanzani"- IRCCS Rome, Rome, Italy
| | - Alessandra Bandera
- Infectious Diseases Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico - Milan, Milan, Lombardia, Italy.,Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
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8
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Ripamonti D, Poliseno M, Mazzola G, Colletti P, Di Biagio A, Celesia BM, Gori A, Bellagamba R, Madeddu G, Nozza S, Rusconi S, Cascio A, Lo Caputo S. Perceptions of U = U Among Italian Infectious Diseases Specialists: A Nationwide Survey on Providers' Attitudes Toward the Risk of HIV Transmission in Virologically Suppressed Patients. AIDS Res Hum Retroviruses 2022; 38:847-855. [PMID: 36097757 DOI: 10.1089/aid.2022.0056] [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: 01/25/2023] Open
Abstract
This survey aimed to understand how far the Italian infectious diseases (ID) specialists are confident in the "Undetectable = Untransmittable" (U = U) message and translate this concept into clinical practice. An anonymous survey was distributed by e-mail to 286 clinicians to collect their opinions regarding six situations potentially at risk of HIV transmission between virologically suppressed patients and seronegative individuals who possibly require postexposure prophylaxis (PEP). Overall, 51% of ID specialists deemed zero risk of HIV transmission through condomless sex for undetectable patients. This answer was more frequent among HIV specialists (30% vs. 21%, p = .01) and clinicians working in teaching hospitals (35% vs. 16%, p = .03). Remarkably, 61% of participants would advise taking PEP for the HIV-negative partner in case of sexual intercourse with a seropositive person with a recent blip occurrence or absence of an HIV RNA test performed within the last 6 months (63%). Seventy-three percent of respondents deemed it essential to know patients' history of adherence to interpreting an HIV RNA test, regardless of its timing. When applying the U = U concept to daily clinical decisions, we observed an overall cautious attitude among physicians. Concerns mainly regarded the timing of the last HIV RNA test to the exposure event, especially in the absence of details on the patient's adherence. Wider diffusion and application of the U = U message are needed.
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Affiliation(s)
- Diego Ripamonti
- Division of Infectious Diseases, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Mariacristina Poliseno
- Infectious Diseases Unit, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Giovanni Mazzola
- Department of Sciences for Health Promotion "G. D'Alessandro," University of Palermo, Palermo, Italy
| | - Pietro Colletti
- Department of Medicinal Clinics and Emerging Diseases, "Paolo Giaccone" Policlinic University Hospital, Palermo, Italy
| | - Antonio Di Biagio
- Unit of Infectious Diseases, Department of Health Sciences, San Martino Policlinico Hospital, University of Genoa, Genoa, Italy
| | - Benedetto Maurizio Celesia
- Department of Clinical and Molecular Biomedicine, Division of Infectious Diseases, University of Catania, Catania, Italy
| | - Andrea Gori
- Clinic of Infectious Diseases, San Gerardo Hospital, University of Milano-Bicocca, Milan, Italy
| | - Rita Bellagamba
- Infectious and Tropical Diseases Unit, National Institute for Infectious Disease "L. Spallanzani," Roma, Italy
| | - Giordano Madeddu
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, University of Sassarim Sassari, Italy
| | - Silvia Nozza
- Department of Infectious Diseases, San Raffaele Scientific Institute, Milano, Italy
| | - Stefano Rusconi
- Divisione Clinicizzata di Malattie Infettive, DIBIC L. Sacco, Università degli Studi di Milano, Milan, Italy
| | - Antonio Cascio
- Infectious Disease Unit, Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE), Policlinico "P. Giaccone," University of Palermo, Palermo, Italy
| | - Sergio Lo Caputo
- Infectious Diseases Unit, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
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9
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Pathak GA, Karjalainen J, Stevens C, Neale BM, Daly M, Ganna A, Andrews SJ, Kanai M, Cordioli M, Polimanti R, Harerimana N, Pirinen M, Liao RG, Chwialkowska K, Trankiem A, Balaconis MK, Nguyen H, Solomonson M, Veerapen K, Wolford B, Roberts G, Park D, Ball CA, Coignet M, McCurdy S, Knight S, Partha R, Rhead B, Zhang M, Berkowitz N, Gaddis M, Noto K, Ruiz L, Pavlovic M, Hong EL, Rand K, Girshick A, Guturu H, Baltzell AH, Niemi MEK, Rahmouni S, Guntz J, Beguin Y, Cordioli M, Pigazzini S, Nkambule L, Georges M, Moutschen M, Misset B, Darcis G, Guiot J, Azarzar S, Gofflot S, Claassen S, Malaise O, Huynen P, Meuris C, Thys M, Jacques J, Léonard P, Frippiat F, Giot JB, Sauvage AS, Frenckell CV, Belhaj Y, Lambermont B, Nakanishi T, Morrison DR, Mooser V, Richards JB, Butler-Laporte G, Forgetta V, Li R, Ghosh B, Laurent L, Belisle A, Henry D, Abdullah T, Adeleye O, Mamlouk N, Kimchi N, Afrasiabi Z, Rezk N, Vulesevic B, Bouab M, Guzman C, Petitjean L, Tselios C, Xue X, Afilalo J, Afilalo M, Oliveira M, Brenner B, Brassard N, Durand M, Schurr E, Lepage P, Ragoussis J, Auld D, Chassé M, Kaufmann DE, Lathrop GM, Adra D, Hayward C, Glessner JT, Shaw DM, Campbell A, Morris M, Hakonarson H, Porteous DJ, Below J, Richmond A, Chang X, Polikowski H, Lauren PE, Chen HH, Wanying Z, Fawns-Ritchie C, North K, McCormick JB, Chang X, Glessner JR, Hakonarson H, Gignoux CR, Wicks SJ, Crooks K, Barnes KC, Daya M, Shortt J, Rafaels N, Chavan S, Timmers PRHJ, Wilson JF, Tenesa A, Kerr SM, D’Mellow K, Shahin D, El-Sherbiny YM, von Hohenstaufen KA, Sobh A, Eltoukhy MM, Nkambul L, Elhadidy TA, Abd Elghafar MS, El-Jawhari JJ, Mohamed AAS, Elnagdy MH, Samir A, Abdel-Aziz M, Khafaga WT, El-Lawaty WM, Torky MS, El-shanshory MR, Yassen AM, Hegazy MAF, Okasha K, Eid MA, Moahmed HS, Medina-Gomez C, Ikram MA, Uitterlinden AG, Mägi R, Milani L, Metspalu A, Laisk T, Läll K, Lepamets M, Esko T, Reimann E, Naaber P, Laane E, Pesukova J, Peterson P, Kisand K, Tabri J, Allos R, Hensen K, Starkopf J, Ringmets I, Tamm A, Kallaste A, Alavere H, Metsalu K, Puusepp M, Batini C, Tobin MD, Venn LD, Lee PH, Shrine N, Williams AT, Guyatt AL, John C, Packer RJ, Ali A, Free RC, Wang X, Wain LV, Hollox EJ, Bee CE, Adams EL, Palotie A, Ripatti S, Ruotsalainen S, Kristiansson K, Koskelainen S, Perola M, Donner K, Kivinen K, Palotie A, Kaunisto M, Rivolta C, Bochud PY, Bibert S, Boillat N, Nussle SG, Albrich W, Quinodoz M, Kamdar D, Suh N, Neofytos D, Erard V, Voide C, Bochud PY, Rivolta C, Bibert S, Quinodoz M, Kamdar D, Neofytos D, Erard V, Voide C, Friolet R, Vollenweider P, Pagani JL, Oddo M, zu Bentrup FM, Conen A, Clerc O, Marchetti O, Guillet A, Guyat-Jacques C, Foucras S, Rime M, Chassot J, Jaquet M, Viollet RM, Lannepoudenx Y, Portopena L, Bochud PY, Vollenweider P, Pagani JL, Desgranges F, Filippidis P, Guéry B, Haefliger D, Kampouri EE, Manuel O, Munting A, Papadimitriou-Olivgeris M, Regina J, Rochat-Stettler L, Suttels V, Tadini E, Tschopp J, Van Singer M, Viala B, Boillat-Blanco N, Brahier T, Hügli O, Meuwly JY, Pantet O, Gonseth Nussle S, Bochud M, D’Acremont V, Estoppey Younes S, Albrich WC, Suh N, Cerny A, O’Mahony L, von Mering C, Bochud PY, Frischknecht M, Kleger GR, Filipovic M, Kahlert CR, Wozniak H, Negro TR, Pugin J, Bouras K, Knapp C, Egger T, Perret A, Montillier P, di Bartolomeo C, Barda B, de Cid R, Carreras A, Moreno V, Kogevinas M, Galván-Femenía I, Blay N, Farré X, Sumoy L, Cortés B, Mercader JM, Guindo-Martinez M, Torrents D, Garcia-Aymerich J, Castaño-Vinyals G, Dobaño C, Gori M, Renieri A, Mari F, Mondelli MU, Castelli F, Vaghi M, Rusconi S, Montagnani F, Bargagli E, Franchi F, Mazzei MA, Cantarini L, Tacconi D, Feri M, Scala R, Spargi G, Nencioni C, Bandini M, Caldarelli GP, Canaccini A, Ognibene A, D’Arminio Monforte A, Girardis M, Antinori A, Francisci D, Schiaroli E, Scotton PG, Panese S, Scaggiante R, Monica MD, Capasso M, Fiorentino G, Castori M, Aucella F, Biagio AD, Masucci L, Valente S, Mandalà M, Zucchi P, Giannattasio F, Coviello DA, Mussini C, Tavecchia L, Crotti L, Rizzi M, Rovere MTL, Sarzi-Braga S, Bussotti M, Ravaglia S, Artuso R, Perrella A, Romani D, Bergomi P, Catena E, Vincenti A, Ferri C, Grassi D, Pessina G, Tumbarello M, Pietro MD, Sabrina R, Luchi S, Furini S, Dei S, Benetti E, Picchiotti N, Sanarico M, Ceri S, Pinoli P, Raimondi F, Biscarini F, Stella A, Zguro K, Capitani K, Nkambule L, Tanfoni M, Fallerini C, Daga S, Baldassarri M, Fava F, Frullanti E, Valentino F, Doddato G, Giliberti A, Tita R, Amitrano S, Bruttini M, Croci S, Meloni I, Mencarelli MA, Rizzo CL, Pinto AM, Beligni G, Tommasi A, Sarno LD, Palmieri M, Carriero ML, Alaverdian D, Busani S, Bruno R, Vecchia M, Belli MA, Mantovani S, Ludovisi S, Quiros-Roldan E, Antoni MD, Zanella I, Siano M, Emiliozzi A, Fabbiani M, Rossetti B, Bergantini L, D’Alessandro M, Cameli P, Bennett D, Anedda F, Marcantonio S, Scolletta S, Guerrini S, Conticini E, Frediani B, Spertilli C, Donati A, Guidelli L, Corridi M, Croci L, Piacentini P, Desanctis E, Cappelli S, Verzuri A, Anemoli V, Pancrazzi A, Lorubbio M, Miraglia FG, Venturelli S, Cossarizza A, Vergori A, Gabrieli A, Riva A, Paciosi F, Andretta F, Gatti F, Parisi SG, Baratti S, Piscopo C, Russo R, Andolfo I, Iolascon A, Carella M, Merla G, Squeo GM, Raggi P, Marciano C, Perna R, Bassetti M, Sanguinetti M, Giorli A, Salerni L, Parravicini P, Menatti E, Trotta T, Coiro G, Lena F, Martinelli E, Mancarella S, Gabbi C, Maggiolo F, Ripamonti D, Bachetti T, Suardi C, Parati G, Bottà G, Domenico PD, Rancan I, Bianchi F, Colombo R, Barbieri C, Acquilini D, Andreucci E, Segala FV, Tiseo G, Falcone M, Lista M, Poscente M, Vivo OD, Petrocelli P, Guarnaccia A, Baroni S, Hayward C, Porteous DJ, Fawns-Ritchie C, Richmond A, Campbell A, van Heel DA, Hunt KA, Trembath RC, Huang QQ, Martin HC, Mason D, Trivedi B, Wright J, Finer S, Akhtar S, Anwar M, Arciero E, Ashraf S, Breen G, Chung R, Curtis CJ, Chowdhury M, Colligan G, Deloukas P, Durham C, Finer S, Griffiths C, Huang QQ, Hurles M, Hunt KA, Hussain S, Islam K, Khan A, Khan A, Lavery C, Lee SH, Lerner R, MacArthur D, MacLaughlin B, Martin H, Mason D, Miah S, Newman B, Safa N, Tahmasebi F, Trembath RC, Trivedi B, van Heel DA, Wright J, Griffiths CJ, Smith AV, Boughton AP, Li KW, LeFaive J, Annis A, Niavarani A, Aliannejad R, Sharififard B, Amirsavadkouhi A, Naderpour Z, Tadi HA, Aleagha AE, Ahmadi S, Moghaddam SBM, Adamsara A, Saeedi M, Abdollahi H, Hosseini A, Chariyavilaskul P, Jantarabenjakul W, Hirankarn N, Chamnanphon M, Suttichet TB, Shotelersuk V, Pongpanich M, Phokaew C, Chetruengchai W, Putchareon O, Torvorapanit P, Puthanakit T, Suchartlikitwong P, Nilaratanakul V, Sodsai P, Brumpton BM, Hveem K, Willer C, Wolford B, Zhou W, Rogne T, Solligard E, Åsvold BO, Franke L, Boezen M, Deelen P, Claringbould A, Lopera E, Warmerdam R, Vonk JM, van Blokland I, Lanting P, Ori APS, Feng YCA, Mercader J, Weiss ST, Karlson EW, Smoller JW, Murphy SN, Meigs JB, Woolley AE, Green RC, Perez EF, Wolford B, Zöllner S, Wang J, Beck A, Sloofman LG, Ascolillo S, Sebra RP, Collins BL, Levy T, Buxbaum JD, Sealfon SC, Jordan DM, Thompson RC, Gettler K, Chaudhary K, Belbin GM, Preuss M, Hoggart C, Choi S, Underwood SJ, Salib I, Britvan B, Keller K, Tang L, Peruggia M, Hiester LL, Niblo K, Aksentijevich A, Labkowsky A, Karp A, Zlatopolsky M, Zyndorf M, Charney AW, Beckmann ND, Schadt EE, Abul-Husn NS, Cho JH, Itan Y, Kenny EE, Loos RJF, Nadkarni GN, Do R, O’Reilly P, Huckins LM, Ferreira MAR, Abecasis GR, Leader JB, Cantor MN, Justice AE, Carey DJ, Chittoor G, Josyula NS, Kosmicki JA, Horowitz JE, Baras A, Gass MC, Yadav A, Mirshahi T, Hottenga JJ, Bartels M, de geus EEJC, Nivard MMG, Verma A, Ritchie MD, Rader D, Li B, Verma SS, Lucas A, Bradford Y, Abedalthagafi M, Alaamery M, Alshareef A, Sawaji M, Massadeh S, AlMalik A, Alqahtani S, Baraka D, Harthi FA, Alsolm E, Safieh LA, Alowayn AM, Alqubaishi F, Mutairi AA, Mangul S, Almutairi M, Aljawini N, Albesher N, Arabi YM, Mahmoud ES, Khattab AK, Halawani RT, Alahmadey ZZ, Albakri JK, Felemban WA, Suliman BA, Hasanato R, Al-Awdah L, Alghamdi J, AlZahrani D, AlJohani S, Al-Afghani H, AlDhawi N, AlBardis H, Alkwai S, Alswailm M, Almalki F, Albeladi M, Almohammed I, Barhoush E, Albader A, Alotaibi S, Alghamdi B, Jung J, fawzy MS, Alrashed M, Zeberg H, Nkambul L, Frithiof R, Hultström M, Lipcsey M, Tardif N, Rooyackers O, Grip J, Maricic T, Helgeland Ø, Magnus P, Trogstad LIS, Lee Y, Harris JR, Mangino M, Spector TD, Emma D, Moutsianas L, Caulfield MJ, Scott RH, Kousathanas A, Pasko D, Walker S, Stuckey A, Odhams CA, Rhodes D, Fowler T, Rendon A, Chan G, Arumugam P, Karczewski KJ, Martin AR, Wilson DJ, Spencer CCA, Crook DW, Wyllie DH, O’Connell AM, Atkinson EG, Kanai M, Tsuo K, Baya N, Turley P, Gupta R, Walters RK, Palmer DS, Sarma G, Solomonson M, Cheng N, Lu W, Churchhouse C, Goldstein JI, King D, Zhou W, Seed C, Daly MJ, Neale BM, Finucane H, Bryant S, Satterstrom FK, Band G, Earle SG, Lin SK, Arning N, Koelling N, Armstrong J, Rudkin JK, Callier S, Bryant S, Cusick C, Soranzo N, Zhao JH, Danesh J, Angelantonio ED, Butterworth AS, Sun YV, Huffman JE, Cho K, O’Donnell CJ, Tsao P, Gaziano JM, Peloso G, Ho YL, Smieszek SP, Polymeropoulos C, Polymeropoulos V, Polymeropoulos MH, Przychodzen BP, Fernandez-Cadenas I, Planas AM, Perez-Tur J, Llucià-Carol L, Cullell N, Muiño E, Cárcel-Márquez J, DeDiego ML, Iglesias LL, Soriano A, Rico V, Agüero D, Bedini JL, Lozano F, Domingo C, Robles V, Ruiz-Jaén F, Márquez L, Gomez J, Coto E, Albaiceta GM, García-Clemente M, Dalmau D, Arranz MJ, Dietl B, Serra-Llovich A, Soler P, Colobrán R, Martín-Nalda A, Martínez AP, Bernardo D, Rojo S, Fiz-López A, Arribas E, de la Cal-Sabater P, Segura T, González-Villa E, Serrano-Heras G, Martí-Fàbregas J, Jiménez-Xarrié E, de Felipe Mimbrera A, Masjuan J, García-Madrona S, Domínguez-Mayoral A, Villalonga JM, Menéndez-Valladares P, Chasman DI, Sesso HD, Manson JE, Buring JE, Ridker PM, Franco G, Davis L, Lee S, Priest J, Sankaran VG, van Heel D, Biesecker L, Kerchberger VE, Baillie JK. A first update on mapping the human genetic architecture of COVID-19. Nature 2022; 608:E1-E10. [PMID: 35922517 PMCID: PMC9352569 DOI: 10.1038/s41586-022-04826-7] [Citation(s) in RCA: 52] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 04/29/2022] [Indexed: 01/04/2023]
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Mazzitelli M, Antoni MD, Castelli F, Ripamonti D, Zuglian G, Lapadula G, Fabbiani M, Ferraresi A, Putaggio C, Cattelan AM, Quiros-Roldan E. Real-life use of Doravirine in treatment-experienced people living with HIV: A multicenter Italian study. Medicine (Baltimore) 2022; 101:e29855. [PMID: 35905209 PMCID: PMC9333545 DOI: 10.1097/md.0000000000029855] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Use of doravirine (DOR), a new nonnucleoside reverse-transcriptase inhibitors recently approved for HIV treatment, is still unclear in clinical practice and real-life data are scarce. We retrospectively investigated the rationale for switching people with HIV to DOR-containing/-based regimens in a real-life cohort. Among 132 patients (68.9% males, median age 56 years), the main reasons to start DOR were prevention of toxicities (39.4%) and dyslipidemia (18.2%). DOR was combined with integrase inhibitors in 40.9% cases, and in 25.7% of patients, DOR was prescribed without availability of a genotypic resistance test. Twenty-four weeks after the switch to DOR-containing/-based regimens, no significant changes in CD4+ T-cell count, CD4/CD8 ratio, detectable HIV-RNA, serum creatinine levels, and body weight were detected. By contrast, a significant reduction in lipids (both cholesterol and triglycerides) was observed in 52 patients for whom a follow-up assessment was available (P = .008 and .01, respectively). Our data confirmed that switching to DOR-containing/-based regimens may have a favorable impact on lipid profile and a neutral impact on weight gain. However, more data are needed to support its use in patients who do not have a genotypic test available or have an extensive nonnucleoside reverse-transcriptase inhibitors-associated resistance, as well as its use in a dual regimen, especially in combination with second-generation integrase inhibitors.
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Affiliation(s)
- Maria Mazzitelli
- Infectious and Tropical Diseases Unit, Padua University Hospital, Padua, Italy
| | - Melania Degli Antoni
- Department of Infectious and Tropical Diseases, ASST Spedali Civili General Hospital and University of Brescia, Brescia, Italy
| | - Francesco Castelli
- Department of Infectious and Tropical Diseases, ASST Spedali Civili General Hospital and University of Brescia, Brescia, Italy
| | - Diego Ripamonti
- Infectious Diseases Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Gianluca Zuglian
- Infectious Diseases Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | | | - Massimiliano Fabbiani
- Infectious and Tropical Diseases Unit, Azienda Ospedaliero-Universitaria Senese, Siena, Italy
| | - Alice Ferraresi
- Division of Infectious Diseases, Cremona Hospital, Cremona, Italy
| | - Cristina Putaggio
- Infectious and Tropical Diseases Unit, Padua University Hospital, Padua, Italy
| | - Anna Maria Cattelan
- Infectious and Tropical Diseases Unit, Padua University Hospital, Padua, Italy
| | - Eugenia Quiros-Roldan
- Department of Infectious and Tropical Diseases, ASST Spedali Civili General Hospital and University of Brescia, Brescia, Italy
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Zuglian G, Ripamonti D, Tebaldi A, Cuntrò M, Riva I, Farina C, Rizzi M. The changing pattern of bacterial and fungal respiratory isolates in patients with and without COVID-19 admitted to intensive care unit. BMC Infect Dis 2022; 22:185. [PMID: 35196993 PMCID: PMC8865172 DOI: 10.1186/s12879-022-07176-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 02/10/2022] [Indexed: 11/18/2022] Open
Abstract
Objectives Severe acute respiratory syndrome 2 (SARS-CoV-2) pandemic has had a heavy impact on national health system, especially in the first wave. That impact hit principally the intensive care units (ICUs). The large number of patients requiring hospitalization in ICUs lead to a complete upheaval of intensive wards. The increase in bed, the fewer number of nurses per patient, the constant use of personal protective equipment, the new antimicrobial surveillance protocols could have had deeply effects on microbiological flora of these wards. Moreover, the overconsumption of antimicrobial therapy in COVID-19 patients, like several studies report, could have impact of this aspect. Aim of this study is to evaluate the changing pattern of microbiological respiratory isolates during and before COVID-19 pandemic in a tertiary hospital ICUs. Methods A retrospective, observational study was conducted in ICUs of “ASST Papa Giovanni XXIII”, a large tertiary referral hospital in Northern Italy. We have retrospectively collected the microbiological data from bronchoalveolar lavage (BAL) and tracheal aspirate (TA) of patients with COVID-19, hospitalized in ICUs from 22nd February 2020 to 31st May 2020 (Period 1), and without COVID-19, from 22nd February 2019 to 31st May 2019 (Period 2). We compared the prevalence and the antibiotic profile of bacterial and fungal species in the two time periods. Results The prevalence of Pseudomonas spp. shows a statistically significant increase from patients without COVID-19 compared to COVID-19 positive as well as the prevalence of Enterococcus spp. On the contrary, the prevalence of Gram negative non fermenting bacteria (GN-NFB), Haemophilus influenzae and Streptococcus pneumoniae showed a significant reduction between two periods. There was a statistically significant increase in resistance of Pseudomonas spp. to carbapenems and piperacillin/tazobactam and Enterobacterales spp. for piperacillin/tazobactam, in COVID-19 positive patients compared to patients without COVID-19. We did not observe significant changing in fungal respiratory isolates. Conclusions A changing pattern in prevalence and resistance profiles of bacterial and fungal species was observed during COVID-19 pandemic.
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Affiliation(s)
- Gianluca Zuglian
- Infectious Diseases Unit, ASST "Papa Giovanni XXIII", Piazza OMS, 1, 24127, Bergamo, Italy.
| | - Diego Ripamonti
- Infectious Diseases Unit, ASST "Papa Giovanni XXIII", Piazza OMS, 1, 24127, Bergamo, Italy
| | - Alessandra Tebaldi
- Infectious Diseases Unit, ASST "Papa Giovanni XXIII", Piazza OMS, 1, 24127, Bergamo, Italy
| | - Marina Cuntrò
- Microbiology and Virology Laboratory, ASST "Papa Giovanni XXIII", Bergamo, Italy
| | - Ivano Riva
- Intensive Care Unit, ASST "Papa Giovanni XXIII", Bergamo, Italy
| | - Claudio Farina
- Microbiology and Virology Laboratory, ASST "Papa Giovanni XXIII", Bergamo, Italy
| | - Marco Rizzi
- Infectious Diseases Unit, ASST "Papa Giovanni XXIII", Piazza OMS, 1, 24127, Bergamo, Italy
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Perrone F, Piccirillo MC, Ascierto PA, Salvarani C, Parrella R, Marata AM, Popoli P, Ferraris L, Marrocco-Trischitta MM, Ripamonti D, Binda F, Bonfanti P, Squillace N, Castelli F, Muiesan ML, Lichtner M, Calzetti C, Salerno ND, Atripaldi L, Cascella M, Costantini M, Dolci G, Facciolongo NC, Fraganza F, Massari M, Montesarchio V, Mussini C, Negri EA, Botti G, Cardone C, Gargiulo P, Gravina A, Schettino C, Arenare L, Chiodini P, Gallo C. Correction to: Tocilizumab for patients with COVID-19 pneumonia. The single-arm TOCIVID-19 prospective trial. J Transl Med 2021; 19:442. [PMID: 34674735 PMCID: PMC8529863 DOI: 10.1186/s12967-021-03094-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Francesco Perrone
- Clinical Trial Unit, Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Napoli, Italy.
| | | | - Paolo Antonio Ascierto
- Melanoma, Cancer Immunotherapy and Development Therapeutics Unit, Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Napoli, Italy
| | - Carlo Salvarani
- Rheumathology, Università degli Studi di Modena e Reggio Emilia and Azienda USL-IRCCS di Reggio Emilia, Modena, Italy
| | | | | | - Patrizia Popoli
- Center for Drug Research and Evaluation, Istituto Superiore di Sanità, Roma, Italy
| | - Laurenzia Ferraris
- Infectious Diseases Unit, Hospital Health Direction, IRCCS - Policlinico San Donato, Milano, Milano, Italy
| | | | - Diego Ripamonti
- Infectious Diseases Unit - ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Francesca Binda
- Infectious Diseases Unit - ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Paolo Bonfanti
- Infectious Diseases Unit, ASST Monza and University Milano Bicocca, Milan, Italy
| | - Nicola Squillace
- Infectious Diseases Unit, ASST Monza and University Milano Bicocca, Milan, Italy
| | | | | | - Miriam Lichtner
- Sapienza University of Rome, Santa Maria Goretti Hospital, Latina, Italy
| | - Carlo Calzetti
- Infectious Diseases and Hepatology Unit AOU, Parma, Italy
| | | | | | - Marco Cascella
- Anesthesia and Resuscitation Unit, Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Napoli, Italy
| | | | - Giovanni Dolci
- Rheumathology, Università degli Studi di Modena e Reggio Emilia and Azienda USL-IRCCS di Reggio Emilia, Modena, Italy
| | | | | | - Marco Massari
- Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | | | | | | | - Gerardo Botti
- Clinical Trial Unit, Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Napoli, Italy
| | - Claudia Cardone
- Clinical Trial Unit, Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Napoli, Italy
| | - Piera Gargiulo
- Clinical Trial Unit, Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Napoli, Italy
| | - Adriano Gravina
- Clinical Trial Unit, Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Napoli, Italy
| | - Clorinda Schettino
- Clinical Trial Unit, Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Napoli, Italy
| | - Laura Arenare
- Clinical Trial Unit, Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Napoli, Italy
| | - Paolo Chiodini
- Department of Mental Health and Preventive Medicine, Università degli Studi della Campania Luigi Vanvitelli, Caserta, Italy
| | - Ciro Gallo
- Department of Mental Health and Preventive Medicine, Università degli Studi della Campania Luigi Vanvitelli, Caserta, Italy
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Olender SA, Walunas TL, Martinez E, Perez KK, Castagna A, Wang S, Kurbegov D, Goyal P, Ripamonti D, Balani B, De Rosa FG, De Wit S, Kim SW, Diaz G, Bruno R, Mullane KM, Lye DC, Gottlieb RL, Haubrich RH, Chokkalingam AP, Wu G, Diaz-Cuervo H, Brainard DM, Lee IH, Hu H, Lin L, Osinusi AO, Bernardino JI, Boffito M. Remdesivir Versus Standard-of-Care for Severe Coronavirus Disease 2019 Infection: An Analysis of 28-Day Mortality. Open Forum Infect Dis 2021; 8:ofab278. [PMID: 34282406 PMCID: PMC8244650 DOI: 10.1093/ofid/ofab278] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 05/24/2021] [Indexed: 12/15/2022] Open
Abstract
Background Remdesivir is approved by the US Food and Drug Administration for the treatment of patients hospitalized with coronavirus disease 2019 (COVID-19) and has been shown to shorten time to recovery and improve clinical outcomes in randomized trials. Methods This was the final day 28 comparative analysis of data from a phase 3, randomized, open-label study comparing 2 remdesivir regimens (5 vs 10 days, combined for this analysis [remdesivir cohort]) and a real-world retrospective longitudinal cohort study of patients receiving standard-of-care treatment (nonremdesivir cohort). Eligible patients, aged ≥18 years, had confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), oxygen saturation ≤94% on room air or required supplemental oxygen, with pulmonary infiltrates. Propensity score matching (up to 1:10 ratio) was used to ensure comparable populations. We assessed day 14 clinical recovery (determined using a 7-point ordinal scale) and day 28 all-cause mortality (coprimary endpoints). Results A total of 368 (remdesivir) and 1399 (nonremdesivir) patients were included in the matched analysis. The day 14 clinical recovery rate was significantly higher among the remdesivir versus the nonremdesivir cohort (65.2% vs 57.1%; odds ratio [OR], 1.49; 95% confidence interval [CI], 1.16–1.90; P = 0.002). The day 28 mortality rate was significantly lower in the remdesivir cohort versus the nonremdesivir cohort (12.0% vs 16.2%; OR, 0.67; 95% CI, 0.47–.95; P = .03). Conclusions Remdesivir was associated with significantly higher rates of day 14 clinical recovery, and lower day 28 mortality, compared with standard-of-care treatment in hospitalized patients with COVID-19. These data, taken together, support the use of remdesivir to improve clinical recovery and decrease mortality from SARS-CoV-2 infection.
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Affiliation(s)
- Susan A Olender
- Division of Infectious Diseases, Department of Internal Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Theresa L Walunas
- Northwestern University Feinberg School of Medicine, Illinois, Chicago, USA
| | - Esteban Martinez
- Hospital Clínic-IDIBAPS and University of Barcelona, Barcelona, Spain
| | | | | | - Su Wang
- Saint Barnabas Medical Center, RWJBarnabas Health Medical Group, Livingston, New Jersey, USA
| | - Dax Kurbegov
- Sarah Cannon Research Institute, Nashville, Tennessee, USA
| | - Parag Goyal
- Weill Cornell Medicine, New York, New York, USA
| | | | - Bindu Balani
- Hackensack University Medical Center, Hackensack, New Jersey, USA
| | - Francesco G De Rosa
- Department of Medical Sciences, University of Turin, Turin, Italy.,City of Health and Sciences, Turin, Italy.,Cardinal Massaia Hospital, Asti, Italy
| | - Stéphane De Wit
- NEAT ID Foundation, CHU Saint Pierre, Université Libre de Bruxelles, Brussels, Belgium
| | - Shin-Woo Kim
- Kyungpook National University Hospital, Republic of Korea
| | - George Diaz
- Providence Regional Medical Center Everett, Everett, Washington, USA
| | - Raffaele Bruno
- Fondazione IRCCS S. Matteo Hospital - University of Pavia, Pavia, Italy
| | | | - David Chien Lye
- National Centre for Infectious Diseases, Tan Tock Seng Hospital, Singapore.,Yong Loo Lin School of Medicine, Singapore.,Lee Kong Chian School of Medicine, Singapore
| | - Robert L Gottlieb
- Baylor University Medical Center Dallas, Dallas, Texas, USA.,Baylor Scott & White Research Institute, Dallas, Texas, USA
| | | | | | - George Wu
- Gilead Sciences Inc., Foster City, California, USA
| | | | | | - I-Heng Lee
- Gilead Sciences Inc., Foster City, California, USA
| | - Hao Hu
- Gilead Sciences, Ltd, Causeway Bay, Hong Kong
| | - Lanjia Lin
- Gilead Sciences Inc., Foster City, California, USA
| | | | - Jose I Bernardino
- Hospital La Paz Institute for Health Research (IdiPAZ) Madrid, Spain
| | - Marta Boffito
- Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom
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14
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Gritti G, Raimondi F, Bottazzi B, Ripamonti D, Riva I, Landi F, Alborghetti L, Frigeni M, Damiani M, Micò C, Fagiuoli S, Lorini FL, Gandini L, Novelli L, Morgan JP, Owens BMJ, Kanhai KJK, Reljanovic GT, Rizzi M, Di Marco F, Mantovani A, Rambaldi A. Siltuximab downregulates interleukin-8 and pentraxin 3 to improve ventilatory status and survival in severe COVID-19. Leukemia 2021; 35:2710-2714. [PMID: 34031531 PMCID: PMC8142063 DOI: 10.1038/s41375-021-01299-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 05/12/2021] [Indexed: 12/16/2022]
Affiliation(s)
- Giuseppe Gritti
- Hematology Unit, Azienda Socio Sanitario Territoriale Papa Giovanni XXIII, Bergamo, Italy.
| | - Federico Raimondi
- Pneumology Unit, Azienda Socio Sanitario Territoriale Papa Giovanni XXIII, Bergamo, Italy.,Postgraduate School of Respiratory Medicine, University of Milan, Milan, Italy
| | | | - Diego Ripamonti
- Infectious Diseases Unit, Azienda Socio Sanitario Territoriale Papa Giovanni XXIII, Bergamo, Italy
| | - Ivano Riva
- Intensive Care Unit, Azienda Socio Sanitario Territoriale Papa Giovanni XXIII, Bergamo, Italy
| | - Francesco Landi
- Hematology Unit, Azienda Socio Sanitario Territoriale Papa Giovanni XXIII, Bergamo, Italy.,Postgraduate School of Hematology, University of Milan, Milan, Italy
| | - Leonardo Alborghetti
- Infectious Diseases Unit, Azienda Socio Sanitario Territoriale Papa Giovanni XXIII, Bergamo, Italy
| | - Marco Frigeni
- Hematology Unit, Azienda Socio Sanitario Territoriale Papa Giovanni XXIII, Bergamo, Italy
| | - Marianna Damiani
- Intensive Care Unit, Azienda Socio Sanitario Territoriale Papa Giovanni XXIII, Bergamo, Italy.,Postgraduate School of Anesthesiology and Intensive Care, University of Milan, Milan, Italy
| | - Caterina Micò
- Hematology Unit, Azienda Socio Sanitario Territoriale Papa Giovanni XXIII, Bergamo, Italy
| | - Stefano Fagiuoli
- Gastroenterology Unit, Azienda Socio Sanitario Territoriale Papa Giovanni XXIII, Bergamo, Italy
| | - Ferdinando Luca Lorini
- Intensive Care Unit, Azienda Socio Sanitario Territoriale Papa Giovanni XXIII, Bergamo, Italy
| | - Lucia Gandini
- Intensive Care Unit, Azienda Socio Sanitario Territoriale Papa Giovanni XXIII, Bergamo, Italy.,Postgraduate School of Anesthesiology and Intensive Care, University of Milan, Milan, Italy
| | - Luca Novelli
- Pneumology Unit, Azienda Socio Sanitario Territoriale Papa Giovanni XXIII, Bergamo, Italy
| | | | | | | | | | - Marco Rizzi
- Infectious Diseases Unit, Azienda Socio Sanitario Territoriale Papa Giovanni XXIII, Bergamo, Italy
| | - Fabiano Di Marco
- Pneumology Unit, Azienda Socio Sanitario Territoriale Papa Giovanni XXIII, Bergamo, Italy.,Department of Health Sciences, University of Milan, Milan, Italy
| | - Alberto Mantovani
- Postgraduate School of Respiratory Medicine, University of Milan, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Milan, Italy.,The William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Alessandro Rambaldi
- Hematology Unit, Azienda Socio Sanitario Territoriale Papa Giovanni XXIII, Bergamo, Italy.,Department of Oncology-Hematology, University of Milan, Milan, Italy
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15
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De Angeli M, Ripamonti D, Ghezzi F, Tolias P, Conti C, Arnas C, Jerab M, Rudakov D, Chrobak C, Irby J, LaBombard B, Lipschultz B, Maddaluno G. Cross machine investigation of magnetic tokamak dust: Morphological and elemental analysis. Fusion Engineering and Design 2021. [DOI: 10.1016/j.fusengdes.2021.112315] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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16
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Perrone F, Piccirillo MC, Ascierto PA, Salvarani C, Parrella R, Marata AM, Popoli P, Ferraris L, Marrocco-Trischitta MM, Ripamonti D, Binda F, Bonfanti P, Squillace N, Castelli F, Muiesan ML, Lichtner M, Calzetti C, Salerno ND, Atripaldi L, Cascella M, Costantini M, Dolci G, Facciolongo NC, Fraganza F, Massari M, Montesarchio V, Mussini C, Negri EA, Botti G, Cardone C, Gargiulo P, Gravina A, Schettino C, Arenare L, Chiodini P, Gallo C. Tocilizumab for patients with COVID-19 pneumonia. The single-arm TOCIVID-19 prospective trial. J Transl Med 2020; 18:405. [PMID: 33087150 PMCID: PMC7576974 DOI: 10.1186/s12967-020-02573-9] [Citation(s) in RCA: 79] [Impact Index Per Article: 19.8] [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: 09/28/2020] [Accepted: 10/13/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Tocilizumab blocks pro-inflammatory activity of interleukin-6 (IL-6), involved in pathogenesis of pneumonia the most frequent cause of death in COVID-19 patients. METHODS A multicenter, single-arm, hypothesis-driven trial was planned, according to a phase 2 design, to study the effect of tocilizumab on lethality rates at 14 and 30 days (co-primary endpoints, a priori expected rates being 20 and 35%, respectively). A further prospective cohort of patients, consecutively enrolled after the first cohort was accomplished, was used as a secondary validation dataset. The two cohorts were evaluated jointly in an exploratory multivariable logistic regression model to assess prognostic variables on survival. RESULTS In the primary intention-to-treat (ITT) phase 2 population, 180/301 (59.8%) subjects received tocilizumab, and 67 deaths were observed overall. Lethality rates were equal to 18.4% (97.5% CI: 13.6-24.0, P = 0.52) and 22.4% (97.5% CI: 17.2-28.3, P < 0.001) at 14 and 30 days, respectively. Lethality rates were lower in the validation dataset, that included 920 patients. No signal of specific drug toxicity was reported. In the exploratory multivariable logistic regression analysis, older age and lower PaO2/FiO2 ratio negatively affected survival, while the concurrent use of steroids was associated with greater survival. A statistically significant interaction was found between tocilizumab and respiratory support, suggesting that tocilizumab might be more effective in patients not requiring mechanical respiratory support at baseline. CONCLUSIONS Tocilizumab reduced lethality rate at 30 days compared with null hypothesis, without significant toxicity. Possibly, this effect could be limited to patients not requiring mechanical respiratory support at baseline. Registration EudraCT (2020-001110-38); clinicaltrials.gov (NCT04317092).
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Affiliation(s)
- Francesco Perrone
- grid.508451.d0000 0004 1760 8805Clinical Trial Unit, Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Napoli, Italy
| | - Maria Carmela Piccirillo
- grid.508451.d0000 0004 1760 8805Clinical Trial Unit, Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Napoli, Italy
| | - Paolo Antonio Ascierto
- grid.508451.d0000 0004 1760 8805Melanoma, Cancer Immunotherapy and Development Therapeutics Unit, Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Napoli, Italy
| | - Carlo Salvarani
- grid.7548.e0000000121697570Rheumathology, Università degli Studi di Modena e Reggio Emilia and Azienda USL-IRCCS di Reggio Emilia, Modena, Italy
| | | | | | - Patrizia Popoli
- grid.416651.10000 0000 9120 6856Center for Drug Research and Evaluation, Istituto Superiore di Sanità, Roma, Italy
| | - Laurenzia Ferraris
- grid.419557.b0000 0004 1766 7370Infectious Diseases Unit, Hospital Health Direction, IRCCS - Policlinico San Donato, Milano Milano, Italy
| | | | - Diego Ripamonti
- grid.460094.f0000 0004 1757 8431Infectious Diseases Unit - ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Francesca Binda
- grid.460094.f0000 0004 1757 8431Infectious Diseases Unit - ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Paolo Bonfanti
- grid.7563.70000 0001 2174 1754Infectious Diseases Unit, ASST Monza and University Milano Bicocca, Milan, Italy
| | - Nicola Squillace
- grid.7563.70000 0001 2174 1754Infectious Diseases Unit, ASST Monza and University Milano Bicocca, Milan, Italy
| | - Francesco Castelli
- grid.7637.50000000417571846University of Brescia and ASST Spedali Civili, Brescia, Italy
| | - Maria Lorenza Muiesan
- grid.7637.50000000417571846University of Brescia and ASST Spedali Civili, Brescia, Italy
| | - Miriam Lichtner
- grid.7841.aSapienza University of Rome, Santa Maria Goretti Hospital, Latina, Italy
| | - Carlo Calzetti
- Infectious Diseases and Hepatology Unit AOU, Parma, Italy
| | - Nicola Duccio Salerno
- grid.411475.20000 0004 1756 948XUOC Malattie Infettive e Tropicali, AOUI, Verona, Italy
| | | | - Marco Cascella
- grid.508451.d0000 0004 1760 8805Anesthesia and Resuscitation Unit, Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Napoli, Italy
| | | | - Giovanni Dolci
- grid.7548.e0000000121697570Rheumathology, Università degli Studi di Modena e Reggio Emilia and Azienda USL-IRCCS di Reggio Emilia, Modena, Italy
| | | | | | - Marco Massari
- Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | | | - Cristina Mussini
- grid.7548.e0000000121697570Università degli Studi di Modena e Reggio Emilia, Modena, Italy
| | | | - Gerardo Botti
- grid.508451.d0000 0004 1760 8805Clinical Trial Unit, Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Napoli, Italy
| | - Claudia Cardone
- grid.508451.d0000 0004 1760 8805Clinical Trial Unit, Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Napoli, Italy
| | - Piera Gargiulo
- grid.508451.d0000 0004 1760 8805Clinical Trial Unit, Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Napoli, Italy
| | - Adriano Gravina
- grid.508451.d0000 0004 1760 8805Clinical Trial Unit, Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Napoli, Italy
| | - Clorinda Schettino
- grid.508451.d0000 0004 1760 8805Clinical Trial Unit, Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Napoli, Italy
| | - Laura Arenare
- grid.508451.d0000 0004 1760 8805Clinical Trial Unit, Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Napoli, Italy
| | - Paolo Chiodini
- grid.9841.40000 0001 2200 8888Department of Mental Health and Preventive Medicine, Università degli Studi della Campania Luigi Vanvitelli, Caserta, Italy
| | - Ciro Gallo
- grid.9841.40000 0001 2200 8888Department of Mental Health and Preventive Medicine, Università degli Studi della Campania Luigi Vanvitelli, Caserta, Italy
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17
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Maggiolo F, Zoboli F, Arosio M, Valenti D, Guarneri D, Sangiorgio L, Ripamonti D, Callegaro A. SARS-CoV-2 infection in persons living with HIV: A single center prospective cohort. J Med Virol 2020; 93:1145-1149. [PMID: 32706409 PMCID: PMC7404443 DOI: 10.1002/jmv.26352] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [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: 07/14/2020] [Revised: 07/20/2020] [Accepted: 07/21/2020] [Indexed: 11/16/2022]
Abstract
Information about severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection in HIV‐infected individuals is scarce. In this prospective study, we included HIV (human immunodefeciency virus)‐infected individuals (people living with HIV [PLWHIV]) with confirmed SARS‐CoV‐2 infection and compared them with PLWHIV negative for SARS‐CoV‐2. We compared 55 cases of SARS‐CoV‐2 infection with 69 asymptomatic PLWHIV negative for SARS‐CoV‐2 reverse transcription‐polymerase chain reaction and/or serology. There was no significant difference between SARS‐CoV‐2 positive or negative patients for age distribution, gender, time with HIV infection, nadir CD4‐cell counts, type and number of co‐morbidities, current CD4 and CD8 counts and type of anti‐HIV therapy. Positive patients presented with a median of three symptoms (interquartile range, 1‐3). Most common symptoms were fever (76%), dyspnea (35%), anosmia (29%) non‐productive cough (27%), fatigue 22%), and ageusia (20%). Ten patients (18%) were completely asymptomatic. Four (7.2%) subjects died of coronavirus disease 2019. Factors significantly (P < .05) associated with death included age and number of co‐morbidities, while time from HIV infection and lower current CD4 counts were significant only in univariate analysis. HIV‐infected individuals are not protected from SARS‐CoV‐2 infection or have a lower risk of severe disease. Indeed, those with low CD4 cell counts might have worse outcomes. Infection is asymptomatic in a large proportion of subjects and this is relevant for epidemiological studies. This study addresses the question if specific characteristics of HIV infection may raise the risk of SARS‐CoV‐2 infection by comparing infected persons living with HIV (PLWHIV), either symptomatic or not, with other PLWHIV who tested negative for SARS‐CoV‐2 infection. None of the parameters classically used to define immune suppression or risk of immune impairment in HIV positive subjects does correlate with the risk of acquiring SARS‐CoV‐2 infection. Although low CD4 counts were not associated with the positivity for SARS‐CoV‐2, relative immunosuppression did seem to affect disease severity, and it might be associated with adverse outcomes. By contrast, there was no evidence that any specific antiretroviral drug affected SARS‐CoV‐2 infection or COVID‐19 severity. The disease may cover a vast range of clinical pictures, being almost one fifth of infected individuals asymptomatic and variables already described for the general population as risk factors for a more severe disease such as advanced age and the presence of multiple co‐morbidities do apply to PLWHIV, too. HIV‐infected individuals should not be considered protected from SARS‐CoV‐2 infection or as having lower risk of severe disease. Indeed, those with low CD4 cell counts might have worse outcomes than individuals with restored immunity. Infection may be asymptomatic in a large proportion of subjects and this variable must be counted when epidemiological studies are implemented in PLWHIV.
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Affiliation(s)
- Franco Maggiolo
- Department of Medicine, Division of Infectious Diseases, ASST Papa Giovanni XXIII, Bergamo, Italy.,Department of Medicine, Unit of HIV related diseases and experimental therapies, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Fabio Zoboli
- Department of Medicine, Division of Infectious Diseases, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Marco Arosio
- Department of Laboratory, Biobanking Unit, ASST Papa Giovanni XXIII, Bergamo, Italy.,Department of Laboratory, Microbiology and Virology Laboratory, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Daniela Valenti
- Department of Medicine, Unit of HIV related diseases and experimental therapies, ASST Papa Giovanni XXIII, Bergamo, Italy.,FROM Foundation, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Davide Guarneri
- Department of Laboratory, Biobanking Unit, ASST Papa Giovanni XXIII, Bergamo, Italy.,Department of Laboratory, Microbiology and Virology Laboratory, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Lorena Sangiorgio
- Department of Laboratory, Biobanking Unit, ASST Papa Giovanni XXIII, Bergamo, Italy.,Department of Laboratory, Microbiology and Virology Laboratory, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Diego Ripamonti
- Department of Medicine, Division of Infectious Diseases, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Annapaola Callegaro
- Department of Laboratory, Biobanking Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
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18
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Greco G, Ripamonti D, Binda F, Fabretti F, Grazioli L, Rizzi M. Potential role of subcutaneous tocilizumab injections in patients with COVID-19 associated pneumonia. J Med Virol 2020; 93:686-688. [PMID: 32897539 DOI: 10.1002/jmv.26494] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 08/31/2020] [Accepted: 09/01/2020] [Indexed: 11/08/2022]
Affiliation(s)
- Giuseppe Greco
- Division of Infectious Diseases, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Diego Ripamonti
- Division of Infectious Diseases, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Francesca Binda
- Division of Infectious Diseases, ASST Papa Giovanni XXIII, Bergamo, Italy
| | | | - Lorenzo Grazioli
- Anesthesiology Department, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Marco Rizzi
- Division of Infectious Diseases, ASST Papa Giovanni XXIII, Bergamo, Italy
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19
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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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Guerrini G, Franzetti F, Giacomelli R, Meroni L, Riva A, Scirè CA, Scrivo R, Tavio M, Agostinone A, Airò P, Atzeni F, Bartalesi F, Bazzichi L, Berardicurti O, Cassola G, Castagna A, Castelli F, Cattelan A, Citriniti G, Cristini F, De Rosa F, Fracassi E, Galloway J, La Paglia GMC, Moioli MC, Ripamonti D, Saracino A, Tani C, Tascini C, Tieghi T, Tinelli M, Zabotti A, Sarzi-Puttini P, Galli M. Italian recommendations for influenza and pneumococcal vaccination in adult patients with autoimmune rheumatic diseases. Clin Exp Rheumatol 2020. [DOI: 10.55563/clinexprheumatol/hj69ne] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Giulio Guerrini
- Department of Medical Sciences, Section of Rheumatology, University of Ferrara, Italy
| | - Fabio Franzetti
- Infectious Disease Unit, Department of Biomedical and Clinical Sciences L. Sacco, University of Milano, Italy
| | - Roberto Giacomelli
- Rheumatology Unit, Department of Biotechnological and Applied Clinical Science, School of Medicine, University of L'Aquila, Italy
| | - Luca Meroni
- Infectious Disease Unit, Department of Biomedical and Clinical Sciences L. Sacco, University of Milano, Italy
| | - Agostino Riva
- Infectious Disease Unit, Department of Biomedical and Clinical Sciences L. Sacco, University of Milano, Italy
| | - Carlo Alberto Scirè
- Department of Medical Sciences, Section of Rheumatology, University of Ferrara, Italy
| | - Rossana Scrivo
- Rheumatology Unit, Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Italy
| | - Marcello Tavio
- Division of Infectious Diseases, Azienda Ospedaliero Universitaria Ospedali Riuniti, Ancona, Italy
| | - Adriana Agostinone
- Unità di Malattie Infettive, Ospedale Civile Spirito Santo, Pescara, Italy
| | - Paolo Airò
- Rheumatology and Clinical Immunology Unit, Spedali Civili of Brescia, Italy
| | - Fabiola Atzeni
- Department of Internal Medicine and Medical Therapy, Section of Rheumatology, University of Messina, Italy
| | - Filippo Bartalesi
- Department of Experimental and Clinical Medicine, University of Florence, and Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy
| | - Laura Bazzichi
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - Onorina Berardicurti
- Rheumatology Unit, Department of Biotechnological and Applied Clinical Science, School of Medicine, University of L'Aquila, Italy
| | | | - Antonella Castagna
- Clinic of Infectious Diseases, Vita-Salute San Raffaele University, Milano, Italy
| | - Francesco Castelli
- University Department of Infectious and Tropical Diseases, University of Brescia and Spedali Civili General Hospital, Brescia, Italy
| | - Annamaria Cattelan
- Division of Infectious and Tropical Diseases, Azienda Ospedaliera and University of Padova, Italy
| | - Giorgia Citriniti
- Rheumatology Unit, Department of Medical and Surgical Science, University of Modena, Azienda Policlinico of Modena, Italy
| | - Francesco Cristini
- Infectious Diseases Unit, Teaching Hospital S. Orsola-Malpighi, Alma Mater Studiorum University of Bologna, Italy
| | - Francesco De Rosa
- Department of Medical Science, University of Turin, Infectious Diseases Amedeo di Savoia Hospital, Turin, Italy
| | - Elena Fracassi
- Rheumatology Section, Department of Medicine, University of Verona, Italy
| | - James Galloway
- Academic Department of Rheumatology, King’s College London, UK
| | | | | | - Diego Ripamonti
- Division of Infectious Diseases, ASST Papa Giovanni XIII, Bergamo, Italy
| | | | - Chiara Tani
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - Carlo Tascini
- First Division of Infectious Diseases, Cotugno Hospital, Azienda Ospedaliera dei Colli, Napoli, Italy
| | - Tiziana Tieghi
- Infectious Diseases Unit, Sapienza University, S.M. Goretti Hospital, Latina, Italy
| | - Marco Tinelli
- Division of Infectious and Tropical Diseases, Hospital of Lodi, Italy
| | - Alen Zabotti
- Rheumatology Clinic, Department of Medical and Biological Sciences, University Hospital Santa Maria della Misericordia, Udine, Italy
| | | | - Massimo Galli
- Infectious Disease Unit, Department of Biomedical and Clinical Sciences L. Sacco, University of Milano, Italy.
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21
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Muscatello A, Nozza S, Fabbiani M, De Benedetto I, Ripa M, Dell'acqua R, Antinori A, Pinnetti C, Calcagno A, Ferrara M, Focà E, Quiros-Roldan E, Ripamonti D, Campus M, Maurizio Celesia B, 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, Gori A, Tambussi G, Bandera A. Enhanced Immunological Recovery With Early Start of Antiretroviral Therapy During Acute or Early HIV Infection-Results of Italian Network of ACuTe HIV InfectiON (INACTION) Retrospective Study. Pathog Immun 2020; 5:8-33. [PMID: 32258852 PMCID: PMC7104556 DOI: 10.20411/pai.v5i1.341] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Accepted: 01/20/2020] [Indexed: 01/13/2023] Open
Abstract
Background Viral load peak and immune activation occur shortly after exposure during acute or early HIV infection (AEHI). We aimed to define the benefit of early start of antiretroviral treatment (ART) during AEHI in terms of immunological recovery, virological suppression, and treatment discontinuation. Setting Patients diagnosed with AEHI (Fiebig stages I-V) during 2008-2014 from an analysis of 20 Italian centers. Methods This was an observational, retrospective, and multicenter study. We investigated the effect of early ART (defined as initiation within 3 months from AEHI diagnosis) on time to virological suppression, optimal immunological recovery (defined as CD4 count ≥500/µL, CD4 ≥30%, and CD4/CD8 ≥1), and first-line ART regimen discontinuation by Cox regression analysis. Results There were 321 patients with AEHI included in the study (82.9% in Fiebig stage III-V). At diagnosis, the median viral load was 5.67 log10 copies/mL and the median CD4 count was 456 cells/µL. Overall, 70.6% of patients started early ART (median time from HIV diagnosis to ART initiation 12 days, IQR 6-27). Higher baseline viral load and AEHI diagnosis during 2012-2014 were independently associated with early ART. HBV co-infection, baseline CD4/CD8 ≥1, lower baseline HIV-RNA, and AEHI diagnosis in recent years (2012-2014) were independently associated with a shorter time to virological suppression. Early ART emerged as an independent predictor of optimal immunological recovery after adjustment for baseline CD4 (absolute and percentage count) and CD4/CD8 ratio. The only independent predictor of first-line ART discontinuation was an initial ART regimen including > 3 drugs. Conclusions In a large cohort of well-characterized patients with AEHI, we confirmed the beneficial role of early ART on CD4+ T-cell recovery and on rates of CD4/CD8 ratio normalization. Moreover, we recognized baseline CD4/CD8 ratio as an independent factor influencing time to virological response in the setting of AEHI, thus giving new insights into research of immunological markers associated with virological control.
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Affiliation(s)
- Antonio Muscatello
- Infectious Diseases Unit; Department of Internal Medicine; IRCCS Ca' Granda Foundation Maggiore Hospital; Milan, Italy
| | - Silvia Nozza
- Clinic of Infectious Diseases; San Raffaele Hospital; University Vita Salute; Milan, Italy
| | - Massimiliano Fabbiani
- Infectious and Tropical Diseases Unit; Azienda Ospedaliero-Universitaria Senese; Siena, Italy
| | - Ilaria De Benedetto
- Department of Medical Sciences; Unit of Infectious Diseases; University of Turin; Amedeo di Savoia Hospital; Turin, Italy
| | - Marco Ripa
- Clinic of Infectious Diseases; San Raffaele Hospital; University Vita Salute; Milan, Italy
| | - Raffaele Dell'acqua
- Clinic of Infectious Diseases; San Raffaele Hospital; University Vita Salute; Milan, Italy
| | - Andrea Antinori
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS; Rome, Italy
| | - Carmela Pinnetti
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS; Rome, Italy
| | - Andrea Calcagno
- Department of Medical Sciences; Unit of Infectious Diseases; University of Turin; Amedeo di Savoia Hospital; Turin, Italy
| | - Micol Ferrara
- Department of Medical Sciences; Unit of Infectious Diseases; University of Turin; Amedeo di Savoia Hospital; Turin, Italy
| | - Emanuele Focà
- Division of Infectious and Tropical Diseases; University of Brescia; ASST Spedali Civili Hospital; Brescia, Italy
| | - Eugenia Quiros-Roldan
- Division of Infectious and Tropical Diseases; University of Brescia; ASST Spedali Civili Hospital; Brescia, Italy
| | - Diego Ripamonti
- Infectious Disease Unit; ASST Papa Giovanni XXIII; Bergamo, Italy
| | - Marco Campus
- Infectious Diseases Unit; SS Trinità Hospital; ASSL Cagliari, Italy
| | | | - Carlo Torti
- Unit of Infectious Diseases; Department of Medical and Surgical Sciences; University "Magna Graecia;" Catanzaro, Italy
| | - Lucio Cosco
- Infectious Diseases Unit; "Pugliese-Ciaccio" Hospital; Catanzaro, Italy
| | - Antonio Di Biagio
- Department of Infectious Diseases; IRCCS AOU San Martino IST; (DISSAL); University of Genoa; Genoa, Italy
| | - Stefano Rusconi
- Infectious Diseases Unit; Department of Biomedical and Clinical Sciences "Luigi Sacco" Hospital; University of Milan, Italy
| | - Giulia Marchetti
- Clinic of Infectious Diseases; Department of Health Sciences; University of Milan; ASST Santi Paolo e Carlo; Milan, Italy
| | - Cristina Mussini
- Clinic of Infectious Diseases; University of Modena and Reggio Emilia; Modena Hospital; Italy
| | - Roberto Gulminetti
- Department of Medical Sciences; Unit of Infectious Diseases; University of Turin; Amedeo di Savoia Hospital; Turin, Italy
| | - Antonella Cingolani
- Institute of Clinical Infectious Diseases; Agostino Gemelli Hospital; Catholic University of Sacred Heart; Rome, Italy
| | - Gabriella D'ettorre
- Infectious Diseases Unit; Umberto I Hospital; La Sapienza University; Rome, Italy
| | - Giordano Madeddu
- Department of Clinical and Experimental Medicine; Unit of Infectious Diseases; University of Sassari, Italy
| | | | - Giancarlo Orofino
- Unit of Infectious Diseases; Divisione A; Amedeo di Savoia Hospital; Turin, Italy
| | - Nicola Squillace
- Infectious Diseases Unit; Department of Internal Medicine; ASST San Gerardo; Monza, Italy, University of Milano-Bicocca; Milan, Italy
| | - Andrea Gori
- Infectious Diseases Unit; Department of Internal Medicine; IRCCS Ca' Granda Foundation Maggiore Hospital; Milan, Italy.,School of Medicine and Surger; University of Milan, Italy
| | - Giuseppe Tambussi
- Clinic of Infectious Diseases; San Raffaele Hospital; University Vita Salute; Milan, Italy
| | - Alessandra Bandera
- Infectious Diseases Unit; Department of Internal Medicine; IRCCS Ca' Granda Foundation Maggiore Hospital; Milan, Italy.,School of Medicine and Surger; University of Milan, Italy
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22
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Zuglian G, Ripamonti D, Tebaldi A, Rizzi M. Cutaneous mucormycosis by Rhizopus arrhizus treated with isavuconazole as first line therapy: A case report. Med Mycol Case Rep 2019; 26:42-43. [PMID: 31667060 PMCID: PMC6812037 DOI: 10.1016/j.mmcr.2019.10.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Revised: 09/22/2019] [Accepted: 10/02/2019] [Indexed: 11/17/2022] Open
Abstract
Mucormycosis are a group of infections that affect principally immunocompromised host and have a high mortality. Liposomal amphotericin B is the first-line treatment with combined surgical removal of the infectious focus. We report the case of 67-year-old man with idiopathic granulocytic aplasia and a cutaneous lesion caused by Rhizopus arrhizus treated with isavuconazole. Its safety profile and spectrum of activity make it an important therapeutic option.
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Affiliation(s)
- G. Zuglian
- University Department of Infectious and Tropical Diseases, University of Brescia and Spedali Civili General Hospital, Brescia, 25123, Italy
- Corresponding author.
| | - D. Ripamonti
- Unit of Infectious Diseases, ASST Papa Giovanni XXIII, Piazza OMS 1, Bergamo, 24129, Italy
| | - A. Tebaldi
- Unit of Infectious Diseases, ASST Papa Giovanni XXIII, Piazza OMS 1, Bergamo, 24129, Italy
| | - M. Rizzi
- Unit of Infectious Diseases, ASST Papa Giovanni XXIII, Piazza OMS 1, Bergamo, 24129, Italy
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23
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Tolias P, De Angeli M, Riva G, Ratynskaia S, Daminelli G, Laguardia L, Pedroni M, Ripamonti D, Uccello A, Vassallo E. The adhesion of tungsten dust on plasma-exposed tungsten surfaces. Nuclear Materials and Energy 2019. [DOI: 10.1016/j.nme.2018.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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24
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Ratynskaia S, Tolias P, De Angeli M, Ripamonti D, Riva G, Aussems D, Morgan T. Interaction of adhered beryllium proxy dust with transient and stationary plasmas. Nuclear Materials and Energy 2018. [DOI: 10.1016/j.nme.2018.11.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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25
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Taramasso L, Riccardi N, Del Puente F, Bruzzone B, Ripamonti D, D'Ambrosio B, Viscoli C, Di Biagio A. Short Communication: Tenofovir Disoproxil Fumarate/Emtricitabine Fits for All as Appropriate HIV-1 Pre-Exposure Prophylaxis? AIDS Res Hum Retroviruses 2018; 34:168-170. [PMID: 29166777 DOI: 10.1089/aid.2017.0112] [Citation(s) in RCA: 1] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Pre-exposure prophylaxis (PrEP) with TDF/FTC significantly reduces the risk for HIV-1 transmission, but, to date, nobody knows if PrEP can still be useful in case of viruses harboring resistances to TDF/FTC or if alternative antiretroviral drugs might be rather proposed in selected cases. We promote the debate by describing a case of an acute infection with multiresistant HIV that occurred in a young girl who started a relationship with an HIV-infected partner who had a known multiresistant HIV.
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Affiliation(s)
- Lucia Taramasso
- Infectious Diseases Unit, Policlinico Ospedale San Martino, University of Genoa, Genoa, Italy
| | - Niccolò Riccardi
- Infectious Diseases Unit, Policlinico Ospedale San Martino, University of Genoa, Genoa, Italy
| | - Filippo Del Puente
- Infectious Diseases Unit, Policlinico Ospedale San Martino, University of Genoa, Genoa, Italy
| | - Bianca Bruzzone
- Hygiene Unit, Policlinico Ospedale San Martino, University of Genoa, Genoa, Italy
| | - Diego Ripamonti
- Infectious Diseases Unit, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy
| | - Beatrice D'Ambrosio
- Hygiene Unit, Policlinico Ospedale San Martino, University of Genoa, Genoa, Italy
| | - Claudio Viscoli
- Infectious Diseases Unit, Policlinico Ospedale San Martino, University of Genoa, Genoa, Italy
| | - Antonio Di Biagio
- Infectious Diseases Unit, Policlinico Ospedale San Martino, University of Genoa, Genoa, Italy
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26
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Thomas M, Hopkins C, Duffy E, Lee D, Loulergue P, Ripamonti D, Ostrov DA, Phillips E. Association of the HLA-B*53:01 Allele With Drug Reaction With Eosinophilia and Systemic Symptoms (DRESS) Syndrome During Treatment of HIV Infection With Raltegravir. Clin Infect Dis 2018; 64:1198-1203. [PMID: 28369189 DOI: 10.1093/cid/cix096] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Accepted: 02/11/2017] [Indexed: 12/16/2022] Open
Abstract
Background Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a rare, severe adverse event during treatment with raltegravir. The occurrence of DRESS syndrome during treatment with other drugs is strongly associated with particular HLA alleles. Methods We performed HLA testing in 3 of the 5 patients previously reported to have developed raltegravir-induced DRESS syndrome and in 1 previously unreported patient. We then used virtual modeling to visualize interactions between raltegravir and the imputed HLA molecule. Results Five of the 6 patients who developed raltegravir-induced DRESS syndrome were African, and 1 was Hispanic. HLA typing was performed in 4 patients, all of whom carried both the HLA-B*53 allele and the HLA-C*04 allele to which it is commonly haplotypic. No other HLA alleles were shared by all of the tested patients. Given the approximate prevalence of HLA-B*53 carriage in African (20%) and Hispanic (6%) populations, the probability of all 4 patients being HLA-B*53 carriers, and 2 of 3 African patients being homozygous for HLA-B*53:01, is approximately 0.00002. Conclusions These data implicate the prevalent African allele HLA-B*53:01 in the immunopathogenesis of raltegravir-induced DRESS syndrome. Although the immunopathogenic mechanisms are currently unknown, virtual modeling suggests that raltegravir may bind within the antigen binding cleft of the HLA-B*53:01 molecule, but not within the closely related HLA-B*35:01 molecule. Further studies are necessary to confirm the strength of the association between carriage of the HLA-B*53:01 allele and raltegravir-induced DRESS syndrome, and the potential utility of HLA screening before raltegravir treatment.
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Affiliation(s)
- Mark Thomas
- Department of Molecular Medicine and Pathology, Faculty of Medical and Health Sciences, University of Auckland, New Zealand.,Infectious Diseases Department, Auckland City Hospital, New Zealand
| | - Chris Hopkins
- Infectious Diseases Department, Auckland City Hospital, New Zealand
| | - Eamon Duffy
- Infectious Diseases Department, Auckland City Hospital, New Zealand
| | - Daniel Lee
- Department of Internal Medicine, University of California San Diego, California, USA
| | - Pierre Loulergue
- Centre d'Investigation Clinique Cochin-Pasteur de Vaccinologie Cochin-Pasteur, Hôpital Cochin, Paris, France
| | - Diego Ripamonti
- Department of Infectious Diseases, Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | - David A Ostrov
- Department of Pathology, Immunology and Laboratory Medicine, University of Florida College of Medicine, Gainesville, FL, USA
| | - Elizabeth Phillips
- Department of Pharmacology, Oates Institute for Experimental Therapeutics, Vanderbilt University Medical School, Nashville, Tennessee, USA.,Department of Medicine, Vanderbilt University, Nashville, Tennessee, USA.,Institute for Immunology and Infectious Diseases, Murdoch University, Murdoch, Western Australia
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27
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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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28
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Ratynskaia S, Tolias P, De Angeli M, Weinzettl V, Matejicek J, Bykov I, Rudakov D, Vignitchouk L, Thorén E, Riva G, Ripamonti D, Morgan T, Panek R, De Temmerman G. Tungsten dust remobilization under steady-state and transient plasma conditions. Nuclear Materials and Energy 2017. [DOI: 10.1016/j.nme.2016.10.021] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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29
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De Angeli M, Tolias P, Ratynskaia S, Ripamonti D, Riva G, Bardin S, Morgan T, De Temmerman G. Remobilization of tungsten dust from castellated plasma-facing components. Nuclear Materials and Energy 2017. [DOI: 10.1016/j.nme.2017.01.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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30
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Di Biagio A, Riccardi N, Signori A, Maserati R, Nozza S, Gori A, Bonora S, Borderi M, Ripamonti D, Rossi MC, Orofino G, Quirino T, Nunnari G, Celesia BM, Martini S, Sagnelli C, Mazzola G, Colletti P, Bartolozzi D, Bini T, Ladisa N, Castelnuovo F, Saracino A, Lo Caputo S. PrEP in Italy: The time may be ripe but who's paying the bill? A nationwide survey on physicians' attitudes towards using antiretrovirals to prevent HIV infection. PLoS One 2017; 12:e0181433. [PMID: 28727818 PMCID: PMC5519091 DOI: 10.1371/journal.pone.0181433] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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: 11/22/2016] [Accepted: 07/02/2017] [Indexed: 11/18/2022] Open
Abstract
Several studies have demonstrated the efficacy of the oral pre-exposure prophylaxis (PrEP) with tenofovir (with or without emtricitabine) on preventing HIV-negative partners of HIV infected patients to become infected through sexual contacts. PrEP is already available in the United States and now is approved by European Medicine Agency. In this setting we would like to gauge physicians' knowledge, acquaintance with and attitude to include PrEP in their clinical practice. A cross sectional survey was conducted among Italian physicians expert on antiretroviral therapy. Out of 146 physicians, 35% of participants declared to be familiar with PrEP but only 46% of them believed that, currently, there are not enough reasons to make it available in Italy. 51% of physicians have already been attracted to prescribe it and 63.4% have been openly asked about PrEP. The main concerns noticed were: the risk of acquire other sexual transmitted diseases (STDs) (70% of physicians feared that PrEP could favor STDs spread), the potential harmful of PrEP if not adequately implemented and, especially the risk of possible side effects if not properly used. Nevertheless, 55.9% of participants believed that Health Authorities face an ethical obligation to make PrEP available as part of the strategies to protect from HIV transmission and half of the respondents asked for further researches to better define the role for PrEP. Attitudes regarding PrEP impact on Italian National Health Organization were also very interesting: 57.5% of participants did not believe that investing in PrEP would be an appropriate use of healthcare resources, while 70.6% affirmed that PrEP's financial coverage should not be funded by the Italian National System of Health (SSN). This survey showed a high awareness of PrEP potential among Italian physicians coupled with a great deal of skepticism about how and if implementing it in clinical practice.
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Affiliation(s)
- Antonio Di Biagio
- Infectious Diseases Clinic, Department of Internal Medicine, Ospedale Policlinico San Martino, Genoa, Italy
| | - Niccolò Riccardi
- Infectious Diseases Clinic, Department of Internal Medicine, Ospedale Policlinico San Martino, Genoa, Italy
- * E-mail:
| | - Alessio Signori
- Department of Health Science, Biostatistics, University of Genoa, Genoa, Italy
| | - Renato Maserati
- Malattie Infettive, Fondazione IRCCS Policlinico San Matteo di Pavia, Pavia, Italy
| | - Silvia Nozza
- Department of Infectious Diseases, IRCCS San Raffaele, Milan, Italy
| | - Andrea Gori
- Clinic of Infectious Diseases, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - Stefano Bonora
- Unit of Infectious Diseases, Department of Medical Sciences, University of Torino, Torino, Italy
| | - Marco Borderi
- Infection Diseases Unit, Sant’Orsola Hospital, University of Bologna, Bologna, Italy
| | - Diego Ripamonti
- Infectious Diseases Unit, AO Papa Giovanni XXIII, Bergamo, Italy
| | | | - Giancarlo Orofino
- Unit of Infectious Diseases, "Divisione A", Ospedale Amedeo di Savoia, Torino, Italy
| | - Tiziana Quirino
- Infectious Diseases Unit, Ospedali di Busto Arsizio, Varese, Italy
| | - Giuseppe Nunnari
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Benedetto Maurizio Celesia
- Department of Clinical and Molecular Biomedicine, Division of Infectious Diseases, University of Catania, ARNAS Garibaldi, Catania, Italy
| | - Salvatore Martini
- Department of Clinical and Experimental Medicine and Surgery "F. Magrassi e A. Lanzara, Second University of Naples, Naples, Italy
| | - Caterina Sagnelli
- Department of Clinical and Experimental Medicine and Surgery "F. Magrassi e A. Lanzara, Second University of Naples, Naples, Italy
| | - Giovanni Mazzola
- Department of Medicinal Clinics and Emerging Diseases, "Paolo Giaccone" Polyclinic University Hospital, Palermo, Italy
| | - Pietro Colletti
- Department of Medicinal Clinics and Emerging Diseases, "Paolo Giaccone" Polyclinic University Hospital, Palermo, Italy
| | - Dario Bartolozzi
- Infectious Disease Unit, Careggi University Hospital, Florence, Italy
| | - Teresa Bini
- Clinical of Infectious Disease, San Paolo Hospital, Milan, Italy
| | - Nicoletta Ladisa
- Institute of Infectious Disease, University of Bari, Bari, Italy
| | | | | | - Sergio Lo Caputo
- Institute of Infectious Disease, University of Bari, Bari, Italy
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Maggiolo F, Gulminetti R, Pagnucco L, Digaetano M, Benatti S, Valenti D, Callegaro A, Ripamonti D, Mussini C. Lamivudine/dolutegravir dual therapy in HIV-infected, virologically suppressed patients. BMC Infect Dis 2017; 17:215. [PMID: 28302065 PMCID: PMC5356275 DOI: 10.1186/s12879-017-2311-2] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [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: 02/03/2017] [Accepted: 03/08/2017] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Little is known about the applicability of dual treatments based on integrase inhibitors. We explored the combination of lamivudine + dolutegravir as an option when switching from standard cART in virologically suppressed patients. METHODS In this prospective cohort we enrolled patients previously switched to 3TC + DTG who were 18 years or older, with no previous resistance mutations to the used drugs, having a HIV-RNA <50 copies/ml for 6 months or longer, negative for HBsAg and on a stable (>6 months) cART. RESULTS Ninety-four individuals were included. They were mostly men (77.7%) with a mean age of 53 years. They presented 159 co-morbidities including cardiovascular, bone, hepatic, kidney, and CNS diseases. Because of these pathologies, they took 207 non-ARV drugs (mean 2.2 per patient). Median duration of viral suppression was 77.5 months (IQR 61). All subjects were prospectively followed up to week 24 and all remained on dual therapy during the whole period. Neither virological failure, nor viral blip was detected. The median CD4 count rose from 658 cells/mcl (IQR 403) to 724 cells/mcl (IQR 401) (P = 0.006) without a significant (P = 0.44) change in the CD4/CD8 ratio. A significant (P < 0.0001) increment of median creatinine from 0.87 mg/dl (IQR 0.34) to 0.95 mg/dl (IQR 0.29) was observed in the first 2 months but thereafter leveled on these values (1.00 mg/dl; IQR 0.35) (P = 0.111 compared to 2 months). The lipid profile slightly improved. The daily cost of cART was significantly (P < 0.0001) reduced of 6.89 euros (SD 6.10). DISCUSSION Switching to a dual cART regimen based on lamivudine + dolutegravir maintains virological efficacy up to week 24, and is associated to slight improvements of the immunologic and metabolic status. The strategy allows to freely using concomitant medications for associated pathologies. The dual therapy is less expensive in economic terms. CONCLUSION Although still limited evidence exists, a dolutegravir-based dual therapy in combination with lamivudine shows promising results to be confirmed in larger controlled trials.
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Affiliation(s)
- Franco Maggiolo
- Division of Infectious Diseases, ASST Papa Giovanni XXIII, Piazza OMS 1, 24127 Bergamo, Italy
| | - Roberto Gulminetti
- Division of Infectious Diseases, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Layla Pagnucco
- Division of Infectious Diseases, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | - Simone Benatti
- Division of Infectious Diseases, ASST Papa Giovanni XXIII, Piazza OMS 1, 24127 Bergamo, Italy
| | - Daniela Valenti
- Division of Infectious Diseases, ASST Papa Giovanni XXIII, Piazza OMS 1, 24127 Bergamo, Italy
| | - Annapaola Callegaro
- Microbiology and Virology Laboratory, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Diego Ripamonti
- Division of Infectious Diseases, ASST Papa Giovanni XXIII, Piazza OMS 1, 24127 Bergamo, Italy
| | - Cristina Mussini
- Division of Infectious Diseases, University of Modena, Modena, Italy
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Ripamonti D, Tatarelli P, Mangili G, Gotta C, Benatti SV, Bruzzone B, Callegaro A, Viscoli C, Ruggeri M, Di Biagio A. Potential role of raltegravir-based therapy to induce rapid viral decay in highly viraemic HIV-infected neonates. J Chemother 2017; 28:337-40. [PMID: 25248795 DOI: 10.1179/1973947814y.0000000217] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 10/31/2022]
Abstract
We report safety and tolerability of raltegravir (RAL) as a forth HIV agent in two highly viraemic newborns. Raltegravir (6 mg/kg) was given orally twice daily. The other antiretrovirals were assumed according to standard dose for newborns. The first baby was born at week 36. An antiretroviral therapy consisting of zidovudine, lamivudine, and lopinavir/ritonavir was started 96 hour after delivery. Raltegravir was added at hour 120, being plasma HIV-1 RNA above 10×10(6) copies/ml. HIV RNA declined to 5·000 copies/ml at day 30. The second baby was born at week 40. He was started on zidovudine, lamivudine, and nevirapine at day 0, while RAL was added at day 3. Plasma HIV-1 RNA declined from 6·6×10(6) at birth to 52 copies/ml at day 28. RAL tolerability was good in both patients, one with gamma-glutamyltransferase increase, which normalized after RAL discontinuation. Raltegravir-based four drug regimen may be effective and well tolerated in highly viraemic HIV neonates up to 4 weeks.
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Affiliation(s)
- Diego Ripamonti
- a Infectious Diseases Unit, AO Papa Giovanni XXIII , Bergamo , Italy
| | - Paola Tatarelli
- b Infectious Diseases Unit, University of Genoa, IRCCS San Martino , IST Genoa , Italy
| | - Giovanna Mangili
- a Infectious Diseases Unit, AO Papa Giovanni XXIII , Bergamo , Italy
| | - Cristina Gotta
- b Infectious Diseases Unit, University of Genoa, IRCCS San Martino , IST Genoa , Italy
| | - Simone V Benatti
- a Infectious Diseases Unit, AO Papa Giovanni XXIII , Bergamo , Italy
| | - Bianca Bruzzone
- b Infectious Diseases Unit, University of Genoa, IRCCS San Martino , IST Genoa , Italy
| | - Anna Callegaro
- a Infectious Diseases Unit, AO Papa Giovanni XXIII , Bergamo , Italy
| | - Claudio Viscoli
- b Infectious Diseases Unit, University of Genoa, IRCCS San Martino , IST Genoa , Italy
| | - Maurizio Ruggeri
- a Infectious Diseases Unit, AO Papa Giovanni XXIII , Bergamo , Italy
| | - Antonio Di Biagio
- b Infectious Diseases Unit, University of Genoa, IRCCS San Martino , IST Genoa , Italy
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Thomas M, Hopkins C, Duffy E, Loulergue P, Ripamonti D, Lee D. The HLA-B*53 / HLA-C*04 Haplotype is Strongly Associated with DRESS Syndrome during Treatment with Raltegravir. Open Forum Infect Dis 2016. [DOI: 10.1093/ofid/ofw172.1212] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Mark Thomas
- Molecular Medicine and Pathology, University of Auckland, Auckland, New Zealand
| | | | - Eamon Duffy
- Infectious Diseases, Auckland City Hospital, Auckland, New Zealand
| | - Pierre Loulergue
- CIC De Vaccinologie Cochin-Pasteur, Hopital Cochin, Paris, France
| | - Diego Ripamonti
- Infectious Diseases, Ospedale Papa Giovanni XXIII, Bergamo, Italy
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Marinaro L, Calcagno A, Ripamonti D, Cenderello G, Pirriatore V, Trentini L, Salassa B, Bramato C, Orofino G, D'Avolio A, Rizzi M, Di Perri G, Rusconi S, Bonora S. Efficacy, safety and pharmacokinetics of atazanavir (200mg twice daily) plus raltegravir (400mg twice daily) dual regimen in the clinical setting. J Clin Virol 2016; 87:30-36. [PMID: 27992788 DOI: 10.1016/j.jcv.2016.11.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Revised: 09/07/2016] [Accepted: 11/29/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Unboosted atazanavir with raltegravir has been investigated at 300mg twice daily showing frequent hyperbilirubinemia and selection of resistance-associated mutations. OBJECTIVES Atazanavir 200mg twice daily could increase tolerability and plasma exposure. STUDY DESIGN Patients on atazanavir/raltegravir (200/400 twice daily), with self-reported adherence >95% and no concomitant interacting drugs were retrospectively evaluated. RESULTS 102 patients [72.5% male, age 46.4 years (42-54), BMI 24kg/m2 (22-26)] were included. CD4+ T lymphocytes were 417 cell/μL (302-704) and 76 patients (74.5%) had HIV-RNA <50 copies/ml. After 123 weeks 18.6% patients showed virological failure and 3.9% discontinued for intolerance. Available genotypes showed selection of major integrase (7/10 patients) and protease resistance-associated mutations (5/13 patients). In patients switching with dyslipidemia (n=67) total, LDL cholesterol and triglycerides significantly decreased. Patients switching with eCRCL<60ml/min (n=27) had no significant changes while patients with eCRCL >60ml/min showed significant decrease (-9.8ml/min, p=0.003) at 96-weeks. Atazanavir and raltegravir trough concentrations were 321ng/mL (147-720) and 412ng/mL (225-695). Self-reported non-adherence (n=4) was significantly associated with virological failure (p=0.02); patients with virological success had borderline longer previous virological control (33 vs. 18 months, p=0.07). DISCUSSION Switch to atazanavir/raltegravir was safe and well tolerated allowing optimal drugs' plasma exposure. However, a concerning rate (18.6%) failed with newly selected mutations and stopped ATV/RAL because of DDI and intolerance issues or were lost to follow-up. This regimen might be considered in selected patients, without history of protease inhibitors failure or HBV infection, showing optimal adherence and prolonged suppression.
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Affiliation(s)
- Letizia Marinaro
- Unit of Infectious Diseases, Department of Medical Sciences, University of Torino, Ospedale Amedeo di Savoia, Torino, Italy.
| | - Andrea Calcagno
- Unit of Infectious Diseases, Department of Medical Sciences, University of Torino, Ospedale Amedeo di Savoia, Torino, Italy.
| | - Diego Ripamonti
- Infectious Diseases Unit, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy.
| | - Giovanni Cenderello
- Department of Infectious Diseases, Ente Ospedaliero Ospedali Galliera, Genova, Italy.
| | - Veronica Pirriatore
- Unit of Infectious Diseases, Department of Medical Sciences, University of Torino, Ospedale Amedeo di Savoia, Torino, Italy.
| | - Laura Trentini
- Unit of Infectious Diseases, Department of Medical Sciences, University of Torino, Ospedale Amedeo di Savoia, Torino, Italy.
| | - Bernardino Salassa
- Unit of Infectious Diseases, Department of Medical Sciences, University of Torino, Ospedale Amedeo di Savoia, Torino, Italy.
| | - Caterina Bramato
- Unit of Infectious Diseases, Department of Medical Sciences, University of Torino, Ospedale Amedeo di Savoia, Torino, Italy.
| | - Giancarlo Orofino
- Department of Infectious Diseases, "Divisione A", Ospedale Amedeo di Savoia, Torino, Italy.
| | - Antonio D'Avolio
- Unit of Infectious Diseases, Department of Medical Sciences, University of Torino, Ospedale Amedeo di Savoia, Torino, Italy.
| | - Marco Rizzi
- Infectious Diseases Unit, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy.
| | - Giovanni Di Perri
- Unit of Infectious Diseases, Department of Medical Sciences, University of Torino, Ospedale Amedeo di Savoia, Torino, Italy.
| | - Stefano Rusconi
- Unit of Infectious Diseases, University of Milano, Ospedale Luigi Sacco, Milano, Italy.
| | - Stefano Bonora
- Unit of Infectious Diseases, Department of Medical Sciences, University of Torino, Ospedale Amedeo di Savoia, Torino, Italy.
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Gianotti N, Galli L, Maserati R, Sighinolfi L, Ripamonti D, Palvarini L, Lo Caputo S, Focà E, Celesia BM, Baldelli F, Sterrantino G, Lazzarin A. Monotherapy with darunavir/ritonavir or lopinavir/ritonavir versus standard antiretroviral therapy: a randomized clinical trial (2pm Study). New Microbiol 2016; 39:290-294. [PMID: 27551725] [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] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 12/19/2016] [Indexed: 06/06/2023]
Abstract
In a multicentre, open-label, clinical trial, 43 patients virologically suppressed while receiving a standard triple antiretroviral therapy were randomized (1:1:1) to switch to monotherapy with darunavir/ritonavir (DRV/r-MT arm), monotherapy with lopinavir/ritonavir (LPV/r-MT arm) or to continue on the ongoing regimen (cART arm). The proportion (95% CI) of patients with virological success (Snapshot analysis) at week 48 was 73% (48%-90%) in the DRV/r-MT arm, 69% (42%-88%) in the LPV/r-MT arm and 87% (61%-98%) in the cART arm. Virological failure was detected in only one patient receiving LPV/r-MT. The LPV/r-MT arm showed a modest worsening in lipid profile.
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Affiliation(s)
- Nicola Gianotti
- Malattie Infettive, IRCCS Ospedale San Raffaele, Milano, Italy
| | - Laura Galli
- Malattie Infettive, IRCCS Ospedale San Raffaele, Milano, Italy
| | - Renato Maserati
- Malattie Infettive, Fondazione IRCCS Policlinico San Matteo di Pavia, Italy
| | - Laura Sighinolfi
- U.O. Malattie Infettive, Azienda Ospedaliero Universitaria, Ferrara, Italy
| | - Diego Ripamonti
- Malattie Infettive, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy
| | | | - Sergio Lo Caputo
- Malattie Infettive, Ospedale Santa Maria Annunziata, Firenze, Italy
| | - Emanuele Focà
- Dipartimento di Malattie Infettive e Tropicali, Università di Brescia, Spedali Civili, Brescia, Italy
| | | | - Franco Baldelli
- Malattie Infettive, Azienda Ospedaliera di Perugia, Perugia, Italy
| | - Gaetana Sterrantino
- SOD di Malattie Infettive e Tropicali, Azienda Ospedaliero-Universitaria Careggi, Firenze, Italy
| | - Adriano Lazzarin
- Malattie Infettive, IRCCS Ospedale San Raffaele, Milano, Italy
- Università Vita-Salute San Raffaele, Milano, Italy
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Maggiolo F, Airoldi M, Callegaro A, Ripamonti D, Gregis G, Quinzan G, Bombana E, Ravasio V, Suter F. Prediction of Virologic Outcome of Salvage Antiretroviral Treatment by Different Systems for Interpreting Genotypic HIV Drug Resistance. ACTA ACUST UNITED AC 2016; 6:87-93. [PMID: 17537998 DOI: 10.1177/1545109707299632] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [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: 11/16/2022]
Abstract
The authors assessed the predictive capacity of 3 rule-based algorithms (Bergamo, Stanford University, Rega Institute) for HIV genotypic interpretation. A total of 1132 postgenotypic regimens in 533 patients were considered. The genotypic sensitivity score (GSS) was strongly associated ( P < .0001) with the virologic outcome (1 log HIV-RNA reduction). The 3 algorithms had a highly significant prediction efficiency. The Bergamo algorithm receiver-operating characteristic curve area under the curve (AUC) for the prediction of ≥1 log HIV-RNA reduction was 0.753 (95% confidence interval, 0.725-0.781), testifying that the prediction was significantly different ( P < .0001) from simple chance. The AUCs obtained by the 2 other systems were similar (0.752 Stanford; 0.741 Rega). The predictive capacity of the algorithms was not influenced by the type of antiviral drugs used. The 3 considered rule-based algorithms for the interpretation of HIV genotypic resistance yield congruent results and may effectively predict the virologic outcome of rescue therapy. Their use may help clinicians in interpreting mutational patterns and in making therapeutic choices.
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Affiliation(s)
- Franco Maggiolo
- Divisione di Malattie Infettive, Ospedali Riuniti, Bergamo, Italy.
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Ripamonti D. Protease inhibitor monotherapy was non-inferior and cost-effective as maintenance therapy compared to triple therapy in viral load suppressed patients with HIV-1 infection. ACTA ACUST UNITED AC 2016; 21:184. [PMID: 27565944 DOI: 10.1136/ebmed-2016-110464] [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] [Indexed: 11/03/2022]
Affiliation(s)
- Diego Ripamonti
- Infectious Diseases Unit, Azienda Ospedaliera Papa Giovanni XXIII, Piazza, Italy
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Arici C, Tebaldi A, Quinzan GP, Maggiolo F, Ripamonti D, Suter F. Severe lactic acidosis and thiamine administration in an HIV-infected patient on HAART. Int J STD AIDS 2016; 12:407-9. [PMID: 11368826 DOI: 10.1258/0956462011923228] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Severe lactic acidosis has been increasingly reported as a potentially fatal complication of HIV treatment. We report on an asymptomatic HIV-infected woman treated with stavudine, lamivudine and indinavir for one year. She was hospitalized because of progressive dispnoea, oedema, cyanosis and severe lactic acidosis. Arterial blood pH was 6.98, bicarbonate 4.4 mmol/l (normal value 22-26), blood lactate: 29.7 mmol/l (normal value <2.2). Hepatic function was normal. She had an impressively rapid response (within a few hours) to empirical treatment with thiamine (100 mg i.v.). No evidence of sepsis or malabsorption were identified and vitamin B1 level was not tested before thiamine infusion. Three months later she was re-started successfully on nelfinavir plus nevirapine. The rapid response to thiamine infusion deserves a careful attention and such an approach should be considered in similar cases as a support treatment of this potentially life-threatening complication of HIV therapy.
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Affiliation(s)
- C Arici
- Unità Operativa Perativa di Malattie Infettive, Ospedali Riuniti di Bergamo, Italy.
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Girard PM, Antinori A, Arribas JR, Ripamonti D, Bicer C, Netzle-Sveine B, Hadacek B, Moecklinghoff C. Week 96 efficacy and safety of darunavir/ritonavir monotherapy vs. darunavir/ritonavir with two nucleoside reverse transcriptase inhibitors in the PROTEA trial. HIV Med 2016; 18:5-12. [PMID: 27279571 DOI: 10.1111/hiv.12386] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2016] [Indexed: 11/27/2022]
Abstract
OBJECTIVES PROTEA is a randomized controlled trial to assess the efficacy and safety of darunavir/ritonavir (DRV/r) monotherapy as an alternative to triple therapy. METHODS Patients fully suppressed on first-line antiretrovirals (viral load < 50 HIV-1 RNA copies/mL) were switched to DRV/r 800/100 mg once daily, either as monotherapy (n = 137) or with two nucleoside reverse transcriptase inhibitors (NRTIs) (n = 136). Treatment failure was HIV-1 RNA level ≥ 50 copies/mL at week 96 or discontinuation of study treatment [Food and Drug Administration (FDA) snapshot algorithm]. RESULTS Patients were mainly male and white, with mean age 44 years. In the primary efficacy analysis, the percentage of patients with HIV-1 RNA < 50 copies/mL by week 96 [intent to treat (ITT)] was lower in the DRV/r monotherapy arm (103 of 137 patients; 75%) than in the triple therapy arm (116 of 136 patients; 85%) [difference -10.1%; 95% confidence interval (CI) -19.5, -0.7%]. In the switch-included analysis, monotherapy was noninferior to triple therapy. In a post hoc analysis, for patients with nadir CD4 count ≥ 200 cells/μL, rates of HIV-1 RNA suppression were 82 of 96 patients (85%) in the DRV/r monotherapy arm and 88 of 106 patients (83%) in the triple therapy arm. No treatment-emergent primary protease inhibitor mutations were detected in either arm. The frequency of adverse events was similar in the two arms; however, one patient in the monotherapy arm was hospitalized with HIV encephalitis and elevated cerebrospinal fluid HIV-1 RNA. CONCLUSIONS In this study, in patients with HIV-1 RNA < 50 copies/mL at baseline, switching to DRV/r monotherapy showed lower efficacy vs. triple therapy at week 96 in the primary ITT switch-equals-failure analysis, particularly in patients with CD4 counts < 200 cells/μL.
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Affiliation(s)
- P M Girard
- Department of Infectious and Tropical Diseases, Hôpital Saint-Antoine, AP-HP, INSERM UMR S 1136, Paris, France
| | - A Antinori
- National Institute for Infectious Diseases, L. Spallanzani IRCCS, Rome, Italy
| | - J R Arribas
- Hospital University La Paz, IdiPAZ, Madrid, Spain
| | | | - C Bicer
- Biostatistics, Janssen R&D, Beerse, Belgium
| | | | - B Hadacek
- Janssen EMEA, Issy-les-Moulineaux, France
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Abstract
A randomized controlled study exploring an induction-maintenance strategy was performed with a quadruple-drug regimen: zidovudine/lamivudine/abacavir/nevirapine. The study was prematurely interrupted due to the high proportion of adverse events. The median time on protocol-defined therapy was 110 days; 13/28 (46%) patients interrupted therapy and 2/6 tested patients selected praecox viral mutants. Despite this, we observed a significant (p </= .001) increment of CD4. The theoretical advantages of induction-maintenance strategies are tempered by an increased risk of adverse experiences.
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Affiliation(s)
- Franco Maggiolo
- Division of Infectious Diseases, Antiviral Therapy Unit, Ospedali Riuniti di Bergamo, Italy.
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Gazzola L, Cicconi P, Ripamonti D, Di Filippo E, Gustinetti G, Di Biagio A, Marchetti G, Bini T, d'Arminio Monforte A. Efficacy and safety of darunavir/ritonavir plus etravirine dual regimen in antiretroviral therapy-experienced patients: a multicenter clinical experience. HIV Clin Trials 2014; 15:140-50. [PMID: 25143023 DOI: 10.1310/hct1504-140] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVES To assess the outcome of a dual regimen combining darunavir/ritonavir plus etravirine in a cohort of antiretroviral therapy (ART)-experienced patients. METHODS A retrospective analysis was performed on all ART-experienced patients starting a darunavir/ritonavir plus etravirine regimen at the 3 clinics. Patients were stratified according to HIV RNA detectability (≥ 40 copies/mL) at baseline. Two efficacy endpoints were evaluated by Kaplan-Meier and Cox multivariable models: virological failure (confirmed HIV RNA ≥ 40 copies/mL after 6 months) and therapeutic failure (including virological failure and treatment discontinuation for any reason). RESULTS Sixty-eight patients were included in the study. They had a median of 10.8 years on ART and 5 previous ART regimens; 61.3% showed primary protease inhibitor (PI) mutations and 70% showed previous non-nucleoside reverse transcriptase inhibitor (NNRTI) exposure. HIV RNA was detectable in 34 (50%) patients. The median observation period was 21 (interquartile range [IQR], 11.9-25.1) months. After 24 months, 75.1% of the patients were still on the study regimen and 88.8% remained free from virological failure. Although a higher therapeutic failure rate was reported in patients with detectable viremia at baseline, only the immunological status revealed an independent predictive role. No differences in virological failure were observed according to HIV RNA detectability at baseline; a higher number of previous ART regimens was the only predictor. Discontinuation due to adverse events occurred in 5.9%. CONCLUSIONS Darunavir/ritonavir plus etravirine regimen proved virological efficacy and safety in heavily pretreated patients with a high rate of virological success, even in patients who switched during virological failure.
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Affiliation(s)
- Lidia Gazzola
- Department of Health Sciences, Clinic of Infectious Diseases, "San Paolo" Hospital, University of Milan, Milan, Italy
| | - Paola Cicconi
- Department of Health Sciences, Clinic of Infectious Diseases, "San Paolo" Hospital, University of Milan, Milan, Italy
| | - Diego Ripamonti
- Unit of Infectious Diseases, Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | - Elisa Di Filippo
- Unit of Infectious Diseases, Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | - Giulia Gustinetti
- Clinic of Infectious Diseases, "San Martino" Hospital, University of Genova, Genova, Italy
| | - Antonio Di Biagio
- Clinic of Infectious Diseases, "San Martino" Hospital, University of Genova, Genova, Italy
| | - Giulia Marchetti
- Department of Health Sciences, Clinic of Infectious Diseases, "San Paolo" Hospital, University of Milan, Milan, Italy
| | - Teresa Bini
- Department of Health Sciences, Clinic of Infectious Diseases, "San Paolo" Hospital, University of Milan, Milan, Italy
| | - Antonella d'Arminio Monforte
- Department of Health Sciences, Clinic of Infectious Diseases, "San Paolo" Hospital, University of Milan, Milan, Italy
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Ripamonti D, Benatti SV, Di Filippo E, Ravasio V, Rizzi M. Drug reaction with eosinophilia and systemic symptoms associated with raltegravir use: case report and review of the literature. AIDS 2014; 28:1077-9. [PMID: 24685746 DOI: 10.1097/qad.0000000000000204] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Ripamonti D, Bombana E, Rizzi M. Rilpivirine: drug profile of a second-generation non-nucleoside reverse transcriptase HIV-inhibitor. Expert Rev Anti Infect Ther 2013; 12:13-29. [DOI: 10.1586/14787210.2014.863708] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Ripamonti D, Hill A, Lauthouwers E, van Delft Y, Moecklinghoff C. Time to HIV-1 RNA suppression below 5 copies/ml during first-line protease inhibitor-based antiretroviral treatment - any impact of residual viremia on treatment success? AIDS Rev 2013; 15:230-236. [PMID: 24322383] [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: 06/03/2023]
Abstract
When antiretroviral treatment suppresses HIV RNA levels to below 50 copies/ml, traces of viremia may still be detected with more sensitive assays. In the ARTEMIS trial, 689 antiretroviral treatment-naive patients were randomized to tenofovir/emtricitabine plus either darunavir/ritonavir (n = 343) or lopinavir/ritonavir (n = 346). HIV-1 RNA was evaluated using the Roche Amplicor® Ultrasensitive assay: plasma samples with HIV RNA < 50 copies/ml were classified as either "No HIV RNA detected" (< 5 HIV RNA copies/ml, optical density = background) or HIV RNA detected (5-50 copies/ml). The percentage of patients in each arm with HIV RNA < 5 copies/ml rose progressively from week 2 to week 192. For patients with baseline HIV RNA ≥ 100,000, the percentage with HIV RNA < 5 copies/ml at week 192 was 66% for darunavir/ritonavir and 63% for lopinavir/ritonavir. For patients with baseline HIV RNA < 100,000 copies/ml, the percentage with HIV RNA < 5 copies/ml at week 192 was 79% for darunavir/ritonavir versus 77% for lopinavir/ritonavir. Of the patients on darunavir/ritonavir with HIV RNA < 50 copies/ml, 63% had levels < 5 copies/ml at week 48, versus 80% at week 192. In summary, HIV-1 RNA suppression to < 5 copies/ml is dependent on baseline HIV RNA levels. The HIV RNA levels can remain under quantification limits but still detectable after 2-4 years of antiretroviral treatment.
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Abstract
Atazanavir (Reyataz®) is a protease inhibitor (PI) for the treatment of HIV infection. Several trials have demonstrated the good efficacy and toxicity profile of atazanavir boosted by ritonavir (atazanavir/r). However, several toxicity events and pharmacokinetic issues due to drug-to-drug interactions (partly related to ritonavir) may complicate atazanavir/r therapy. This is why regimens with unboosted atazanavir have been experimented with and are used in clinical practice. The aim of this article is to identify the clinical settings in which unboosted atazanavir may be a safe and effective option for the long-term control of HIV replication. Despite the fact that a favourable lipid profile and good gastrointestinal tolerability have been reported in comparative trials, unboosted atazanavir should not be considered an optimal choice for treatment-naive patients. In fact, boosting with ritonavir produces higher atazanavir plasma levels, which are beneficial in terms of efficacy, especially in untreated patients with high plasma HIV RNA. Clinical data indicate that, in patients with sustained undetectable HIV RNA and without previous virological failure or HIV drug resistance-associated mutations, a switch to unboosted atazanavir-based regimens is a feasible option to control and prevent toxicity events, especially in patients who cannot tolerate ritonavir and in those with severe hyperbilirubinaemia on atazanavir/r. Moreover, while unboosted atazanavir must not be used in pregnant women, it is a recommended option in special populations, such as patients with moderate liver insufficiency. Lastly, unboosted atazanavir in combination with raltegravir may allow the construction of a well tolerated and effective regimen without nucleoside reverse transcriptase inhibitors in patients for whom these drugs are contraindicated. In conclusion, there is a good rationale, significant clinical interest and accumulating clinical experience with unboosted atazanavir-based regimens, although this formulation should be used only in specific situations and as a maintenance strategy. Moreover, therapeutic drug monitoring could be useful in specific circumstances (such as in patients with liver impairment or in case of potential drug-drug interactions).
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Affiliation(s)
- Emanuele Focà
- Department for Infectious and Tropical Diseases, University of Brescia, Brescia, Italy
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Andreoni M, Giacometti A, Maida I, Meraviglia P, Ripamonti D, Sarmati L. HIV-HCV co-infection: epidemiology, pathogenesis and therapeutic implications. Eur Rev Med Pharmacol Sci 2012; 16:1473-1483. [PMID: 23111959] [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: 06/01/2023]
Abstract
Hepatitis C virus (HCV) is the cause of more than three-quarters of liver-related deaths in HIV-seropositive individuals and it is remarkable that today approximately one-quarter of HIV-infected individuals in Europe and the USA have a HCV coinfection. HIV/HCV coinfected patients were more likely to develop cirrhosis, had an increased risk of developing AIDS, of HIV-related disease and of overall mortality. How HCV may affect the course of HIV infection is not well known even if it was suggested that HCV co-infection is able to increase immune activation and to sensitize CD4+ T-cells towards apoptosis in the absence of HIV therapy. There are many evidences that the simultaneous presence of HIV infection accelerates the liver damage from HCV favouring the evolution to cirrhosis in co-infected patients. HIV increasing of TNF alpha liver production and of HCV replication in peripheral blood lymphomonocytes are the mechanisms at the basis of this phenomenon. HAART had a positive effect on HIV/HCV co-infection, otherwise it does not appear to fully correct the adverse effect of HIV infection on HCV-related outcomes. Traditional treatment with pegilated Interferon plus ribavirin have low rates of sustained virological response in co-infected patients especially if infected with HCV genotype 1, and better results were often obtained in patients in which the use of antiretroviral treatment was avoided to reduce the occurrence of adverse effects. The recent preliminary results on the use of anti-HCV protease inhibitor drugs, boceprevir and telapravir, in co-infected people seems to demonstrate an enhanced antiviral efficacy in the HIV/HCV co-infected population of triple anti-HCV treatment even is some important limitation as interactions with antiretroviral agents and selection of HCV drug resistance, lead to consider the need for further studies designed to assess the best therapeutic strategies.
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Affiliation(s)
- M Andreoni
- Clinical Infectious Diseases, Tor Vergata University, Rome, Italy.
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Cattaneo D, Ripamonti D, Gervasoni C, Landonio S, Meraviglia P, Baldelli S, Cozzi V, Fucile S, Clementi E. Limited Sampling Strategies for the Estimation of Raltegravir Daily Exposure in HIV-Infected Patients. J Clin Pharmacol 2012; 52:440-445. [DOI: 10.1177/0091270010395939] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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Cattaneo D, Ripamonti D, Baldelli S, Cozzi V, Fucile S, Clementi E. Limited sampling strategies for the estimation of atazanavir daily exposure in HIV-infected patients. Fundam Clin Pharmacol 2011; 27:216-22. [DOI: 10.1111/j.1472-8206.2011.01005.x] [Citation(s) in RCA: 4] [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: 01/11/2023]
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Torti C, Prosperi M, Motta D, Digiambenedetto S, Maggiolo F, Paraninfo G, Ripamonti D, Cologni G, Fabbiani M, Caputo SL, Sighinolfi L, Ladisa N, El-Hamad I, Quiros-Roldan E, Frank I. Factors influencing the normalization of CD4+ T-cell count, percentage and CD4+/CD8+ T-cell ratio in HIV-infected patients on long-term suppressive antiretroviral therapy. Clin Microbiol Infect 2011; 18:449-58. [PMID: 21919996 DOI: 10.1111/j.1469-0691.2011.03650.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
We evaluated factors associated with normalization of the absolute CD4+ T-cell counts, per cent CD4+ T cells and CD4+/CD8+ T-cell ratio. A multicentre observational study was carried out in patients with sustained HIV-RNA <50 copies/mL. Outcomes were: CD4-count >500/mm(3) and multiple T-cell marker recovery (MTMR), defined as CD4+ T cells >500/mm(3) plus%CD4 T cells >29%plus CD4+/CD8+ T-cell ratio >1. Kaplan-Meier survival analysis and Cox regression analyses to predict odds for achieving outcomes were performed. Three hundred and fifty-two patients were included and followed-up for a median of 4.1 (IQR 2.1-5.9) years, 270 (76.7%) achieving a CD4+ T-cell count >500 cells/mm(3) and 197 (56%) achieving MTMR. Using three separate Cox models for both outcomes we demonstrated that independent predictors were: both absolute CD4+ and CD8+ T-cell counts, %CD4+ T cells, a higher CD4+/CD8+ T-cell ratio, and age. A likelihood-ratio test showed significant improvements in fitness for the prediction of either CD4+ >500/mm(3) or MTMR by multivariable analysis when the other immune markers at baseline, besides the absolute CD4+ count alone, were considered. In addition to baseline absolute CD4+ T-cell counts, pretreatment %CD4+ T cells and the CD4+/CD8+ T-cell ratio influence recovery of T-cell markers, and their consideration should influence the decision to start antiretroviral therapy. However, owing to the small sample size, further studies are needed to confirm these results in relation to clinical endpoints.
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Affiliation(s)
- C Torti
- Institute of Infectious and Tropical Diseases, University of Brescia, Brescia, Italy.
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Leone S, Gregis G, Quinzan G, Velenti D, Cologni G, Soavi L, Ravasio V, Ripamonti D, Suter F, Maggiolo F. Causes of death and risk factors among HIV-infected persons in the HAART era: analysis of a large urban cohort. Infection 2011; 39:13-20. [PMID: 21246246 DOI: 10.1007/s15010-010-0079-z] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2010] [Accepted: 12/21/2010] [Indexed: 12/25/2022]
Abstract
OBJECTIVE We aimed to examine the clinical outcome in HIV-1-infected patients after more than 10 years of highly active antiretroviral therapy (HAART). METHODS We analyzed data from 1,236 treatment-naïve adults who had started HAART. The primary endpoint was the yearly prevalence of death for AIDS-related causes (ARC) or for non-AIDS related causes (non-ARC). The data from our cohort were compared with that of the general population (GP) of our region. RESULTS We observed that 116 patients died, and 58.6% of deaths were non-ARC. The death incidence decreased from 18.8% in 1998-1999 to 1.2% in 2008-2009. The leading causes of death were malignancies (35.3%), infections (21.6%), end-stage liver diseases (18.1%), and cardiovascular diseases (CVD) (6.9%). Yearly death rates were similar in the HIV-infected cohort and in the crude GP (odds ratio [OR] 1.1, 95% confidence interval [CI] 0.5-2.5), but when adjusted for age, HIV-infected patients showed a greater risk (OR 7.4, 95% CI 4.1-13.4). The difference was still highly significant when the analysis was restricted to non-ARCs (OR 4.3, 95% CI 2.07-9.2). Overall, malignancies (OR 5.7, 95% CI 2.6-12.8) and end-stage liver diseases (OR 35.0, 95% CI 15.5-78.8) were significantly more frequent than in the age-adjusted GP. CONCLUSIONS Despite HAART, HIV-infected patients are at greater risk of death compared to a reference uninfected population.
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Affiliation(s)
- S Leone
- Division of Infectious Diseases, Ospedali Riuniti, Largo Barozzi 1, Bergamo, Italy.
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