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Mariotti S, Venturi G, Chiantore MV, Teloni R, De Santis R, Amendola A, Fortuna C, Marsili G, Grilli G, Lia MS, Kiros ST, Lagi F, Bartoloni A, Iacobino A, Cresta R, Lastilla M, Biselli R, Di Bonito P, Lista F, Nisini R. Antibodies Induced by Smallpox Vaccination after at Least 45 Years Cross-React with and In Vitro Neutralize Mpox Virus: A Role for Polyclonal B Cell Activation? Viruses 2024; 16:620. [PMID: 38675961 PMCID: PMC11054675 DOI: 10.3390/v16040620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 04/04/2024] [Accepted: 04/15/2024] [Indexed: 04/28/2024] Open
Abstract
AIMS To evaluate whether antibodies specific for the vaccinia virus (VV) are still detectable after at least 45 years from immunization. To confirm that VV-specific antibodies are endowed with the capacity to neutralize Mpox virus (MPXV) in vitro. To test a possible role of polyclonal non-specific activation in the maintenance of immunologic memory. METHODS Sera were collected from the following groups: smallpox-vaccinated individuals with or without latent tuberculosis infection (LTBI), unvaccinated donors, and convalescent individuals after MPXV infection. Supernatant of VV- or MPXV-infected Vero cells were inactivated and used as antigens in ELISA or in Western blot (WB) analyses. An MPXV plaque reduction neutralization test (PRNT) was optimized and performed on study samples. VV- and PPD-specific memory T cells were measured by flow cytometry. RESULTS None of the smallpox unvaccinated donors tested positive in ELISA or WB analysis and their sera were unable to neutralize MPXV in vitro. Sera from all the individuals convalescing from an MPXV infection tested positive for anti-VV or MPXV IgG with high titers and showed MPXV in vitro neutralization capacity. Sera from most of the vaccinated individuals showed IgG anti-VV and anti-MPXV at high titers. WB analyses showed that positive sera from vaccinated or convalescent individuals recognized both VV and MPXV antigens. Higher VV-specific IgG titer and specific T cells were observed in LTBI individuals. CONCLUSIONS ELISA and WB performed using supernatant of VV- or MPXV-infected cells are suitable to identify individuals vaccinated against smallpox at more than 45 years from immunization and individuals convalescing from a recent MPXV infection. ELISA and WB results show a good correlation with PRNT. Data confirm that a smallpox vaccination induces a long-lasting memory in terms of specific IgG and that antibodies raised against VV may neutralize MPXV in vitro. Finally, higher titers of VV-specific antibodies and higher frequency of VV-specific memory T cells in LTBI individuals suggest a role of polyclonal non-specific activation in the maintenance of immunologic memory.
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Affiliation(s)
- Sabrina Mariotti
- Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Roma, Italy; (S.M.); (G.V.); (M.V.C.); (R.T.); (A.A.); (C.F.); (G.M.); (A.I.); (P.D.B.)
| | - Giulietta Venturi
- Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Roma, Italy; (S.M.); (G.V.); (M.V.C.); (R.T.); (A.A.); (C.F.); (G.M.); (A.I.); (P.D.B.)
| | - Maria Vincenza Chiantore
- Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Roma, Italy; (S.M.); (G.V.); (M.V.C.); (R.T.); (A.A.); (C.F.); (G.M.); (A.I.); (P.D.B.)
| | - Raffaela Teloni
- Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Roma, Italy; (S.M.); (G.V.); (M.V.C.); (R.T.); (A.A.); (C.F.); (G.M.); (A.I.); (P.D.B.)
| | - Riccardo De Santis
- Defense Institute for Biomedical Sciences, 00184 Roma, Italy; (R.D.S.); (G.G.); (M.S.L.); (F.L.)
| | - Antonello Amendola
- Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Roma, Italy; (S.M.); (G.V.); (M.V.C.); (R.T.); (A.A.); (C.F.); (G.M.); (A.I.); (P.D.B.)
| | - Claudia Fortuna
- Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Roma, Italy; (S.M.); (G.V.); (M.V.C.); (R.T.); (A.A.); (C.F.); (G.M.); (A.I.); (P.D.B.)
| | - Giulia Marsili
- Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Roma, Italy; (S.M.); (G.V.); (M.V.C.); (R.T.); (A.A.); (C.F.); (G.M.); (A.I.); (P.D.B.)
| | - Giorgia Grilli
- Defense Institute for Biomedical Sciences, 00184 Roma, Italy; (R.D.S.); (G.G.); (M.S.L.); (F.L.)
| | - Maria Stella Lia
- Defense Institute for Biomedical Sciences, 00184 Roma, Italy; (R.D.S.); (G.G.); (M.S.L.); (F.L.)
| | - Seble Tekle Kiros
- University Hospital Careggi, 50134 Firenze, Italy; (S.T.K.); (F.L.); (A.B.)
| | - Filippo Lagi
- University Hospital Careggi, 50134 Firenze, Italy; (S.T.K.); (F.L.); (A.B.)
| | | | - Angelo Iacobino
- Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Roma, Italy; (S.M.); (G.V.); (M.V.C.); (R.T.); (A.A.); (C.F.); (G.M.); (A.I.); (P.D.B.)
| | - Raffaele Cresta
- Aeronautica Militare, Comando Logistico, Servizio Sanitario, 00185 Roma, Italy; (R.C.); (M.L.); (R.B.)
| | - Marco Lastilla
- Aeronautica Militare, Comando Logistico, Servizio Sanitario, 00185 Roma, Italy; (R.C.); (M.L.); (R.B.)
| | - Roberto Biselli
- Aeronautica Militare, Comando Logistico, Servizio Sanitario, 00185 Roma, Italy; (R.C.); (M.L.); (R.B.)
| | - Paola Di Bonito
- Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Roma, Italy; (S.M.); (G.V.); (M.V.C.); (R.T.); (A.A.); (C.F.); (G.M.); (A.I.); (P.D.B.)
| | - Florigio Lista
- Defense Institute for Biomedical Sciences, 00184 Roma, Italy; (R.D.S.); (G.G.); (M.S.L.); (F.L.)
| | - Roberto Nisini
- Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Roma, Italy; (S.M.); (G.V.); (M.V.C.); (R.T.); (A.A.); (C.F.); (G.M.); (A.I.); (P.D.B.)
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2
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Nannini G, Di Gloria L, Russo E, Sterrantino G, Kiros ST, Coppi M, Niccolai E, Baldi S, Ramazzotti M, Di Pilato V, Lagi F, Bartolucci G, Rossolini GM, Bartoloni A, Amedei A. Oral microbiota signatures associated with viremia and CD4 recovery in treatment-naïve HIV-1-infected patients. Microbes Infect 2024:105339. [PMID: 38636822 DOI: 10.1016/j.micinf.2024.105339] [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: 01/07/2024] [Revised: 04/11/2024] [Accepted: 04/11/2024] [Indexed: 04/20/2024]
Abstract
PURPOSE Few reports focused on the role of oral microbiome diversity in HIV infection. We characterized the microbiota-immunity axis in a cohort of treatment-naïve HIV-1-infected patients undergoing antiretroviral therapy (ART) focusing on the oral microbiome (OM) and immunological responsivity. METHODS The sequencing of 16S rRNA V3-V4 hypervariable region was performed on salivary samples of 15 healthy control (HC) and 12 HIV+ patients before starting ART and after reaching virological suppression. Then, we correlated the OM composition with serum cytokines and the Short Chain Fatty acids (SCFAs). RESULTS The comparison between HIV patients and HC oral microbiota showed differences in the bacterial α-diversity and richness. We documented a negative correlation between oral Prevotella and intestinal valeric acid at before starting ART and a positive correlation between oral Veillonella and gut acetic acid after reaching virological suppression. Finally, an increase in the phylum Proteobacteria was observed comparing saliva samples of immunological responders (IRs) patients against immunological non-responders (INRs). CONCLUSIONS For the first time, we described an increase in the oral pro-inflammatory Proteobacteria phylum in INRs compared to IRs. We provided more evidence that saliva could be a non-invasive and less expensive approach for research involving the oral cavity microbiome in HIV patients.
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Affiliation(s)
- Giulia Nannini
- Department of Experimental and Clinical Medicine, University of Florence, Florence 50134, Italy
| | - Leandro Di Gloria
- Department of Biomedical, Experimental and Clinical "Mario Serio", University of Florence, Florence 50134, Italy
| | - Edda Russo
- Department of Experimental and Clinical Medicine, University of Florence, Florence 50134, Italy
| | - Gaetana Sterrantino
- Department of Experimental and Clinical Medicine, University of Florence, Florence 50134, Italy
| | - Seble Tekle Kiros
- Department of Experimental and Clinical Medicine, University of Florence, Florence 50134, Italy; Clinical Microbiology and Virology Unit, Careggi University Hospital, Florence, Italy
| | - Marco Coppi
- Department of Experimental and Clinical Medicine, University of Florence, Florence 50134, Italy
| | - Elena Niccolai
- Department of Experimental and Clinical Medicine, University of Florence, Florence 50134, Italy
| | - Simone Baldi
- Department of Experimental and Clinical Medicine, University of Florence, Florence 50134, Italy
| | - Matteo Ramazzotti
- Department of Biomedical, Experimental and Clinical "Mario Serio", University of Florence, Florence 50134, Italy
| | - Vincenzo Di Pilato
- Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy
| | - Filippo Lagi
- Department of Experimental and Clinical Medicine, University of Florence, Florence 50134, Italy
| | - Gianluca Bartolucci
- Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence, Florence 50019, Italy
| | - Gian Maria Rossolini
- Department of Experimental and Clinical Medicine, University of Florence, Florence 50134, Italy; Clinical Microbiology and Virology Unit, Careggi University Hospital, Florence, Italy
| | - Alessandro Bartoloni
- Department of Experimental and Clinical Medicine, University of Florence, Florence 50134, Italy; Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy
| | - Amedeo Amedei
- Department of Experimental and Clinical Medicine, University of Florence, Florence 50134, Italy.
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Corti N, Menzaghi B, Orofino G, Guastavigna M, Lagi F, Di Biagio A, Taramasso L, De Socio GV, Molteni C, Madeddu G, Salomoni E, Pellicanò GF, Pontali E, Bellagamba R, Celesia BM, Cascio A, Sarchi E, Gulminetti R, Calza L, Maggi P, Cenderello G, Bandera A, Carleo MA, Falasca K, Ferrara S, Martini S, Guadagnino G, Angioni G, Bargiacchi O, Ricci ED, Squillace N, Bonfanti P. Risk of Cardiovascular Events in People with HIV (PWH) Treated with Integrase Strand-Transfer Inhibitors: The Debate Is Not Over; Results of the SCOLTA Study. Viruses 2024; 16:613. [PMID: 38675955 PMCID: PMC11054557 DOI: 10.3390/v16040613] [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: 03/07/2024] [Revised: 04/09/2024] [Accepted: 04/12/2024] [Indexed: 04/28/2024] Open
Abstract
Cardiovascular disease (CVD) is common in people with HIV (PWH), and has great impact in terms of morbidity and mortality. Several intertwined mechanisms are believed to play a role in determining the increased risk of CVD, including the effect of certain antiretrovirals; among these, the role of integrase strand-transfer inhibitors (INSTIs) is yet to be fully elucidated. We conducted a multicenter, observational study comprising 4984 PWH evaluating the antiretroviral therapy (ART)-related nature of CVD in real life settings, both in naïve vs. treatment-experienced people. A comparison was conducted between INSTIs vs. either protease inhibitors (PIs) or non-nucleoside reverse transcriptase inhibitors (NNRTIs) considering demographic, baseline clinical characteristics, incidence of CVD in both 2-year and complete follow-up periods. Among 2357 PWH exposed to INSTIs, 24 people experienced CVD; the corresponding figure was 12 cases out of 2599 PWH exposed to other ART classes. At univariate and multivariate analysis, a tendency towards an increased risk of CVD was observed in the 2-year follow-up period in PWH exposed to INSTIs in the absence, however, of statistical significance. These findings leave open the hypothesis that INSTIs may play a role, albeit minimal, in determining an increased risk of CVD in PWH.
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Affiliation(s)
- Nicolò Corti
- Infectious Diseases Unit, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy; (N.C.); (N.S.); (P.B.)
- School of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy
| | - Barbara Menzaghi
- Unit of Infectious Diseases, ASST della Valle Olona, 21052 Busto Arsizio, Italy;
| | - Giancarlo Orofino
- Division I of Infectious and Tropical Diseases, ASL Città di Torino, 10149 Turin, Italy; (G.O.); (M.G.)
| | - Marta Guastavigna
- Division I of Infectious and Tropical Diseases, ASL Città di Torino, 10149 Turin, Italy; (G.O.); (M.G.)
| | - Filippo Lagi
- AOU Infectious and Tropical Diseases, Careggi Hospital, 50134 Florence, Italy;
| | - Antonio Di Biagio
- Infectious Diseases Clinic, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy; (A.D.B.); (L.T.)
- Department of Health’s Sciences (DISSAL), University of Genoa, 16132 Genoa, Italy
| | - Lucia Taramasso
- Infectious Diseases Clinic, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy; (A.D.B.); (L.T.)
| | | | - Chiara Molteni
- Unit of Infectious Diseases, A. Manzoni Hospital, 23900 Lecco, Italy;
| | - Giordano Madeddu
- Unit of Infectious Diseases, Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy;
| | - Elena Salomoni
- Unit of Infectious Diseases, Santa Maria Annunziata Hospital, 50012 Florence, Italy;
| | - Giovanni Francesco Pellicanò
- Unit of Infectious Diseases, Department of Human Pathology of the Adult and the Developmental Age “G. Barresi”, University of Messina, 98125 Messina, Italy;
| | - Emanuele Pontali
- Department of Infectious Diseases, Galliera Hospital, 16128 Genoa, Italy;
| | - Rita Bellagamba
- National Institute for Infectious Diseases, Lazzaro Spallanzani Institute for Hospitalization and Care Scientific, 00149 Rome, Italy;
| | | | - Antonio Cascio
- Unit of Infectious Diseases, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, 90127 Palermo, Italy;
| | - Eleonora Sarchi
- Infectious Diseases Unit, S. Antonio e Biagio e Cesare Arrigo Hospital, 15121 Alessandria, Italy;
| | - Roberto Gulminetti
- Fondazione IRCCS Policlinico S. Matteo, Infectious Diseases, University of Pavia, 27100 Pavia, Italy;
| | - Leonardo Calza
- Department of Medical and Surgical Sciences, Clinics of Infectious Diseases, S. Orsola-Malpighi Hospital, “Alma Mater Studiorum”, University of Bologna, 40128 Bologna, Italy;
| | - Paolo Maggi
- Infectious Diseases Unit, AORN Sant’Anna e San Sebastiano, 81100 Caserta, Italy;
| | | | - Alessandra Bandera
- Infectious Disease Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy;
| | - Maria Aurora Carleo
- Infectious Diseases and Gender Medicine Unit, Cotugno Hospital, AO dei Colli, 80131 Naples, Italy;
| | - Katia Falasca
- Clinic of Infectious Diseases, Department of Medicine and Science of Aging, G. D’Annunzio University, Chieti-Pescara, 66100 Chieti, Italy;
| | - Sergio Ferrara
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, University of Foggia, 71122 Foggia, Italy;
| | - Salvatore Martini
- Infectious Disease Unit, University Hospital Luigi Vanvitelli, 80138 Naples, Italy;
| | - Giuliana Guadagnino
- Department of Infectious and Tropical Diseases, St. Annunziata Hospital, 87100 Cosenza, Italy;
| | - Goffredo Angioni
- Infectious Diseases Unit, SS Trinità Hospital, 09121 Cagliari, Italy;
| | - Olivia Bargiacchi
- Unit of Infectious Diseases, Ospedale Maggiore della Carità, 28100 Novara, Italy;
| | | | - Nicola Squillace
- Infectious Diseases Unit, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy; (N.C.); (N.S.); (P.B.)
| | - Paolo Bonfanti
- Infectious Diseases Unit, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy; (N.C.); (N.S.); (P.B.)
- School of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy
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Papaioannu Borjesson R, Galli L, Lolatto R, Menzaghi B, Feasi M, Gulminetti R, Fornabaio C, Cattelan AM, Bonora S, Lagi F, Zazzi M, Castagna A, Spagnuolo V. Lower aids-related hospitalizations in women living with HIV multidrug resistance. AIDS 2024; 38:435-438. [PMID: 38300163 DOI: 10.1097/qad.0000000000003781] [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: 02/02/2024]
Affiliation(s)
| | - Laura Galli
- Infectious Diseases Department, San Raffaele Scientific Institute, Milan
| | - Riccardo Lolatto
- Infectious Diseases Department, San Raffaele Scientific Institute, Milan
| | - Barbara Menzaghi
- Unit of Infectious Diseases, ASST della Valle Olona, Busto Arsizio
| | | | - Roberto Gulminetti
- Department of Medical Sciences and Infectious Diseases, Fondazione IRCCS Policlinico San Matteo, Pavia
| | | | | | - Stefano Bonora
- Unit of Infectious Diseases, Department of Medical Sciences, University of Turin, Torino
| | - Filippo Lagi
- Infectious and Tropical diseases Unit, Azienda Ospedaliero Universitaria Careggi, Florence
| | - Maurizio Zazzi
- Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Antonella Castagna
- San Raffaele Vita-Salute University
- Infectious Diseases Department, San Raffaele Scientific Institute, Milan
| | - Vincenzo Spagnuolo
- Infectious Diseases Department, San Raffaele Scientific Institute, Milan
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Pisano L, Magliulo M, Turco M, Farini J, Rapaccini AL, Lagi F, Bartoloni A, Pimpinelli N. The never-ending story of mpox epidemic: Tracing a new cluster in Florence, Italy. Travel Med Infect Dis 2024:102704. [PMID: 38432283 DOI: 10.1016/j.tmaid.2024.102704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 02/29/2024] [Indexed: 03/05/2024]
Affiliation(s)
- Luigi Pisano
- Section of Dermatology, Health Sciences Department, University of Florence, Florence, Italy
| | - Manfredi Magliulo
- Section of Dermatology, Health Sciences Department, University of Florence, Florence, Italy
| | - Martina Turco
- Section of Dermatology, Health Sciences Department, University of Florence, Florence, Italy.
| | - Jacopo Farini
- Section of Dermatology, Health Sciences Department, University of Florence, Florence, Italy
| | - Anna Lisa Rapaccini
- Section of Dermatology, Health Sciences Department, University of Florence, Florence, Italy
| | - Filippo Lagi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Alessandro Bartoloni
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Nicola Pimpinelli
- Section of Dermatology, Health Sciences Department, University of Florence, Florence, Italy
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6
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Clemente T, Galli L, Lolatto R, Gagliardini R, Lagi F, Ferrara M, Cattelan AM, Focà E, Di Biagio A, Cervo A, Calza L, Maggiolo F, Marchetti G, Cenderello G, Rusconi S, Zazzi M, Santoro MM, Spagnuolo V, Castagna A. Cohort profile: PRESTIGIO, an Italian prospective registry-based cohort of people with HIV-1 resistant to reverse transcriptase, protease and integrase inhibitors. BMJ Open 2024; 14:e080606. [PMID: 38341206 PMCID: PMC10862296 DOI: 10.1136/bmjopen-2023-080606] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 01/04/2024] [Indexed: 02/12/2024] Open
Abstract
PURPOSE The PRESTIGIO Registry was established in 2017 to collect clinical, virological and immunological monitoring data from people living with HIV (PLWH) with documented four-class drug resistance (4DR). Key research purposes include the evaluation of residual susceptibility to specific antiretrovirals and the validation of treatment and monitoring strategies in this population. PARTICIPANTS The PRESTIGIO Registry collects annual plasma and peripheral blood mononuclear cell samples and demographic, clinical, virological, treatment and laboratory data from PLWH followed at 39 Italian clinical centres and characterised by intermediate-to-high genotypic resistance to ≥1 nucleoside reverse transcriptase inhibitors, ≥1 non-nucleoside reverse transcriptase inhibitors, ≥1 protease inhibitors, plus either intermediate-to-high genotypic resistance to ≥1 integrase strand transfer inhibitors (INSTIs) or history of virological failure to an INSTI-containing regimen. To date, 229 people have been recorded in the cohort. Most of the data are collected from the date of the first evidence of 4DR (baseline), with some prebaseline information obtained retrospectively. Samples are collected from the date of enrollment in the registry. FINDINGS TO DATE The open-ended cohort has been used to assess (1) prognosis in terms of survival or development of AIDS-related or non-AIDS-related clinical events; (2) long-term efficacy and safety of different antiretroviral regimens and (3) virological and immunological factors predictive of clinical outcome and treatment efficacy, especially through analysis of plasma and cell samples. FUTURE PLANS The registry can provide new knowledge on how to implement an integrated approach to study PLWH with documented resistance to the four main antiretroviral classes, a population with a limited number of individuals characterised by a high degree of frailty and complexity in therapeutic management. Given the scheduled annual updates of PLWH data, the researchers who collaborate in the registry can send study proposals at any time to the steering committee of the registry, which evaluates every 3 months whether the research studies can be conducted on data and biosamples from the registry and whether they are aimed at a better understanding of a specific health condition, the emergence of comorbidities or the effect of potential treatments or experimental drugs that may have an impact on disease progression and quality of life. Finally, the research studies should aim to be inclusive, innovative and in touch with the communities and society as a whole. TRIAL REGISTRATION NUMBER NCT04098315.
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Affiliation(s)
- Tommaso Clemente
- Vita-Salute San Raffaele University, Milan, Italy
- Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Laura Galli
- Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Riccardo Lolatto
- Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Roberta Gagliardini
- National Institute for Infectious Diseases "L. Spallanzani" IRCCS, Rome, Italy
| | - Filippo Lagi
- Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy
| | - Micol Ferrara
- Unit of Infectious Diseases, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Anna Maria Cattelan
- Infectious Diseases Unit, Department of Molecular Medicine, Padua University Hospital, Padua, Italy
| | - Emanuele Focà
- Unit of Infectious and Tropical Diseases, Department of Clinical and Experimental Sciences, ASST Spedali di Brescia, Brescia, Italy
| | - Antonio Di Biagio
- Clinic of Infectious Diseases, IRCCS Policlinico San Martino Hospital, University of Genoa, Genoa, Italy
| | - Adriana Cervo
- Infectious Diseases Unit, Policlinico di Modena, Università Degli Studi di Modena e Reggio Emilia, Modena, Italy
| | - Leonardo Calza
- Unit of Infectious Diseases, Department of Medical and Surgical Sciences, S. Orsola Hospital, "Alma Mater Studiorum" University of Bologna, Bologna, Italy
| | - Franco Maggiolo
- Unit of HIV-related Diseases and Experimental Therapies, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy
| | - Giulia Marchetti
- Clinic of Infectious Diseases, Department of Health Sciences, San Paolo Hospital, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
| | | | - Stefano Rusconi
- Infectious Diseases Unit, ASST Ovest Milanese, Legnano General Hospital, Legnano, Italy
- DIBIC, University of Milan, Milan, Italy
| | - Maurizio Zazzi
- Department of Medical Biotechnology, University of Siena, Siena, Italy
| | | | - Vincenzo Spagnuolo
- Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Antonella Castagna
- Vita-Salute San Raffaele University, Milan, Italy
- Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
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Lagi F, Formica G, Rostagno A, Milia A, Pradella S, Guazzini G, Tekle Kiros S, Corsi P, Bartoloni A, Zammarchi L, Pieralli F. When it rains, it pours: Early treatment with tecovirimat of cardiac complications associated with monkeypox infection in a person with HIV and previously undiagnosed Lyme disease. A case report. Heliyon 2024; 10:e23965. [PMID: 38226256 PMCID: PMC10788526 DOI: 10.1016/j.heliyon.2023.e23965] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 12/11/2023] [Accepted: 12/20/2023] [Indexed: 01/17/2024] Open
Abstract
Cardiac involvement, such as myocarditis and pericarditis, can be a severe complication of monkeypox virus (mpox) infection and could be related to other co-infections with cardiac involvement. Tecovirimat is an antiviral specifically designed to inhibit smallpox infection diffusion and approved by the FDA for other Orthopoxvirus infections; its efficacy in mpox-infected patients is not well established. We present the case of a cardiac complication during mpox infection in a previously undiagnosed Lyme disease in a 42-year-old man living with HIV. Two days after the typical maculopapular rash, the patient reported a rise in body temperature up to 39 °C, chest pain without irradiation, and shortness of breath. We found an increase in troponin level, a slight reduction in ejection fraction, and grade 2 AV block (Mobitz 1 and 2) with frequent sinus pauses (the longest of 10.1 s). Given the suspicion of myopericarditis with cardiac conduction system involvement, the patient was admitted to the Intermediate Care Unit for continuous monitoring and further evaluation. Treatment included Ibuprofen 600 mg every 12 hours (bid) and colchicine 1 mg once daily for anti-inflammatory purposes. Concomitantly, treatment with tecovirimat was started at 600 mg bid for a total of 14 days. Cardiac MRI with gadolinium showed mild interstitial edema and pericardial enhancement. However, despite the clinical and laboratory resolution of the acute phase, bradycardia with episodes of AV block persisted at follow-up, suggesting the possibility of an additional etiology. Thus, the patient was investigated for Lyme disease because high-degree AV block is the most common presentation of Lyme carditis. Serological results evidenced a previous Borrelia burgdorferi senso latu. We decided to start treatment with doxycycline 100 mg every 12h, even pending the uncertainty of the role of a previous Lyme disease in determining the cardiac rhythm disturbances. At the evaluation on day 44, the patient was systemically well, and after cardiologist consultation, pace-maker implantation was not deemed indicated. This case underscores the importance of considering alternative causes of carditis when the clinical picture remains unclear or persists after the acute phase.
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Affiliation(s)
- Filippo Lagi
- Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy
| | - Giuseppe Formica
- Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
| | - Andrea Rostagno
- Intermediate Care Unit, Careggi University Hospital, Florence, Italy
| | - Alessandro Milia
- Intermediate Care Unit, Careggi University Hospital, Florence, Italy
| | - Silvia Pradella
- Department of Radiology, Careggi University Hospital, Florence, Italy
| | - Giulia Guazzini
- Intermediate Care Unit, Careggi University Hospital, Florence, Italy
| | - Seble Tekle Kiros
- Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
| | - Paola Corsi
- Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy
| | - Alessandro Bartoloni
- Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy
- Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
| | - Lorenzo Zammarchi
- Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy
- Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
| | - Filippo Pieralli
- Intermediate Care Unit, Careggi University Hospital, Florence, Italy
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Ciccullo A, Baldin G, Borghi V, Oreni L, Lagi F, Fusco P, Giacomelli A, Torti C, Sterrantino G, Mussini C, Antinori S, Di Giambenedetto S. Comparing the efficacy and safety of a first-line regimen with emtricitabine/tenofovir alafenamide fumarate plus either bictegravir or dolutegravir: Results from clinical practice. Int J Antimicrob Agents 2024; 63:107040. [PMID: 37981074 DOI: 10.1016/j.ijantimicag.2023.107040] [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: 02/13/2023] [Revised: 10/29/2023] [Accepted: 11/14/2023] [Indexed: 11/21/2023]
Abstract
BACKGROUND First-line integrase strand transfer inhibitor-based regimens have become commonly used in clinical practice over the last decade. This study aimed to analyse and compare the efficacy and safety of bictegravir (BIC) and dolutegravir (DTG) when prescribed in association with emtricitabine/tenofovir alafenamide (FTC/TAF) as part of a first-line regimen for the treatment of human immunodeficiency-1 (HIV-1) infection. METHODS Treatment-naïve people living with HIV (PLWHIV) starting a first-line regimen with either BIC/FTC/TAF (BIC group) or FTC/TAF+DTG (DTG group) were analysed. Snapshot analyses were performed after 24 and 48 weeks to evaluate virological efficacy. In addition, differences in the rate of treatment discontinuation (TD) between the two groups were evaluated using the Kaplan-Meier method and the log rank test. RESULTS Data from 327 PLWHIV were analysed: 140 in the DTG group and 187 in the BIC group. At 48 weeks, 90.0% of individuals in the DTG group and 86.7% of those in the BIC group achieved HIV-RNA <50 copies/mL. In total, 88 and 38 cases of TD were observed in the DTG group and BIC group, respectively. The estimated probability of maintaining the study regimen at week 48 was 59.5% in the DTG group and 84.2% in the BIC group. Analysing changes in immunological parameters after 48 weeks, median improvements of +169 cell/mm3 (P<0.001) and +233 cell/mm3 (P<0.001) were observed in the DTG group and the BIC group, respectively. CONCLUSIONS Both BIC and DTG, in combination with FTC/TAF, show promising efficacy and safety as first-line strategies in clinical practice, with favourable immunological recovery even in the short term.
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Affiliation(s)
- Arturo Ciccullo
- Infectious Diseases Unit, San Salvatore Hospital, L'Aquila, Italy.
| | - Gianmaria Baldin
- Unit of Infectious Diseases, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Mater Olbia Hospital, Olbia, Italy
| | - Vanni Borghi
- Azienda Ospedaliero Universitaria di Modena, Clinica Malattie Infettive e Tropicali, Modena, Italy
| | - Letizia Oreni
- UOC Malattie Infettive III, DIBIC Luigi Sacco, University of Milan, Milan, Italy
| | - Filippo Lagi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Paolo Fusco
- Infectious and Tropical Disease Unit, Department of Medical and Surgical Sciences, "Magna Graecia" University of Catanzaro, Catanzaro, Italy
| | - Andrea Giacomelli
- UOC Malattie Infettive III, DIBIC Luigi Sacco, University of Milan, Milan, Italy
| | - Carlo Torti
- Infectious and Tropical Disease Unit, Department of Medical and Surgical Sciences, "Magna Graecia" University of Catanzaro, Catanzaro, Italy
| | - Gaetana Sterrantino
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Cristina Mussini
- Azienda Ospedaliero Universitaria di Modena, Clinica Malattie Infettive e Tropicali, Modena, Italy
| | - Spinello Antinori
- UOC Malattie Infettive III, DIBIC Luigi Sacco, University of Milan, Milan, Italy
| | - Simona Di Giambenedetto
- Unit of Infectious Diseases, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Catholic University of the Sacred Heart, Rome, Italy
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Mariotti F, Sponchiado F, Lagi F, Moroni C, Paggi R, Kiros ST, Miele V, Bartoloni A, Mencarini J. Latent Tuberculosis Infection and COVID-19: Analysis of a Cohort of Patients from Careggi University Hospital (Florence, Italy). Infect Dis Rep 2023; 15:758-765. [PMID: 38131881 PMCID: PMC10742684 DOI: 10.3390/idr15060068] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Revised: 11/29/2023] [Accepted: 12/07/2023] [Indexed: 12/23/2023] Open
Abstract
Data regarding the relationship between coronavirus disease (COVID-19) and active or latent tuberculosis (TB) are discordant. We conducted a retrospective study examining the impact of latent tuberculosis infection (LTBI) on the clinical progression of COVID-19 patients. We selected 213 patients admitted with COVID-19 in a tertiary-level Italian hospital (February-December 2020), who underwent a QuantiFERON-TB test (QFT) and/or chest radiological exam. The population was divided into three groups: (i) QFT negative and without radiological TB sequelae (Neg); (ii) QFT positive and without radiological TB sequelae (Pos); (iii) radiological TB sequelae regardless of QFT result (Seq). In-hospital mortality and oro-tracheal intubation (OTI) showed significantly higher results in the Seq group (Seq 50% vs. Pos 13.3% vs. Neg 9.3%, p < 0.001; Seq 16.7% vs. Pos 6.7% vs. Neg 4.9%, p = 0.045). Considering the Pos and Seq groups' patients as the population with defined LTBI, in-hospital mortality (20/51, 39.2%) and OTI risk (7/51, 13.7%) were statistically higher with respect to patients without LTBI (in-hospital mortality: 15/162, 9.3%, p < 0.001; OTI risk: 8/162, 4.9%, p = 0.023), respectively. Multivariate analysis showed that radiological sequelae and the Charlson Comorbidity Index (CCI) were significantly associated with higher mortality rate; despite the higher CCI of Seq population, we cannot exclude the correlation between COVID-19 in-hospital mortality and the presence of radiological TB sequelae.
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Affiliation(s)
- Francesca Mariotti
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy (R.P.); (S.T.K.)
| | - Francesco Sponchiado
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy (R.P.); (S.T.K.)
| | - Filippo Lagi
- Infectious and Tropical Diseases Unit, Careggi University Hospital, 50134 Florence, Italy (J.M.)
| | - Chiara Moroni
- Emergency Radiology Unit, Careggi University Hospital, 50134 Florence, Italy
| | - Riccardo Paggi
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy (R.P.); (S.T.K.)
| | - Seble Tekle Kiros
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy (R.P.); (S.T.K.)
| | - Vittorio Miele
- Emergency Radiology Unit, Careggi University Hospital, 50134 Florence, Italy
| | - Alessandro Bartoloni
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy (R.P.); (S.T.K.)
- Infectious and Tropical Diseases Unit, Careggi University Hospital, 50134 Florence, Italy (J.M.)
| | - Jessica Mencarini
- Infectious and Tropical Diseases Unit, Careggi University Hospital, 50134 Florence, Italy (J.M.)
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Piccica M, Spinicci M, Botta A, Bianco V, Lagi F, Graziani L, Faragona A, Parrella R, Giani T, Bartolini A, Morroni G, Bernardo M, Rossolini GM, Tavio M, Giacometti A, Bartoloni A. Cefiderocol use for the treatment of infections by carbapenem-resistant Gram-negative bacteria: an Italian multicentre real-life experience. J Antimicrob Chemother 2023; 78:2752-2761. [PMID: 37807834 PMCID: PMC10631827 DOI: 10.1093/jac/dkad298] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 09/14/2023] [Indexed: 10/10/2023] Open
Abstract
BACKGROUND Cefiderocol is a novel siderophore cephalosporin with promising activity against most carbapenem-resistant Gram-negative bacteria (CRGNB). However, extensive postmarketing experiences are lacking. This study aimed to analyse the early experience on cefiderocol postmarketing use at three tertiary care hospitals in Italy. METHODS We retrospectively included patients with infections caused by CRGNB treated with cefiderocol at three Italian tertiary care hospitals from 1 March 2021 to 30 June 2022. A multivariate Cox model was used to identify predictors of 30 day mortality. A propensity score (PS) analysis with inverse probability weighting (IPW) was also performed to compare the treatment effect of cefiderocol monotherapy (CM) versus combination regimens (CCRs). RESULTS The cohort included 142 patients (72% male, median age 67 years, with 89 cases of Acinetobacter baumannii infection, 22 cases of Klebsiella pneumoniae, 27 cases of Pseudomonas aeruginosa and 4 of other pathogens). The 30 day all-cause mortality was 37% (52/142). We found no association between bacterial species and mortality. In multivariate analysis, a Charlson Comorbidity Index >3 was an independent predictor of mortality (HR 5.02, 95% CI 2.37-10.66, P < 0.001). In contrast, polymicrobial infection (HR 0.41, 95% CI 0.21-0.82, P < 0.05) was associated with lower mortality. There was no significant difference in mortality between patients receiving CM (n = 70) and those receiving a CCR (n = 72) (33% versus 40%, respectively), even when adjusted for IPW-PS (HR 1.11, 95% CI 0.63-1.96, P = 0.71). CONCLUSIONS Real-life data confirm that cefiderocol is a promising option against carbapenem-resistant Gram-negative infections, even as monotherapy.
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Affiliation(s)
- Matteo Piccica
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Michele Spinicci
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Infectious and Tropical Diseases Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Annarita Botta
- Department of Infectious Disease and Infectious Emergencies, AORN dei Colli, Cotugno Hospital, Naples, Italy
| | - Vincenzo Bianco
- Department of Infectious Disease and Infectious Emergencies, AORN dei Colli, Cotugno Hospital, Naples, Italy
| | - Filippo Lagi
- Infectious and Tropical Diseases Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Lucia Graziani
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Alessandro Faragona
- Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, Ancona, Italy
| | - Roberto Parrella
- Department of Infectious Disease and Infectious Emergencies, AORN dei Colli, Cotugno Hospital, Naples, Italy
| | - Tommaso Giani
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Clinical Microbiology and Virology Unit, Florence Careggi University Hospital, Florence, Italy
| | - Andrea Bartolini
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Gianluca Morroni
- Clinic of Infectious Diseases, Azienda Ospedaliero-Universitaria delle Marche, Ancona, Italy
| | - Mariano Bernardo
- Microbiology Unit, AORN Ospedali dei Colli-Monaldi Hospital, Naples, Italy
| | - Gian Maria Rossolini
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Clinical Microbiology and Virology Unit, Florence Careggi University Hospital, Florence, Italy
| | - Marcello Tavio
- Unit of Emerging and Immunosuppressed Infectious Diseases, Department of Gastroenterology and Transplantation, Azienda Ospedaliero-Universitaria ‘Ospedali Riuniti’, Ancona, Italy
| | - Andrea Giacometti
- Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, Ancona, Italy
- Clinic of Infectious Diseases, Azienda Ospedaliero-Universitaria delle Marche, Ancona, Italy
| | - Alessandro Bartoloni
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Infectious and Tropical Diseases Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
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Lagi F, Giacomelli A, Borghi V, Ciccullo A, Taramasso L, Madeddu G, D'Ettorre G, Giacometti A, Ducci F, De Vito A, Pincino R, Di Giambenedetto S, Mussini C, Antinori S, Sterrantino G. Efficacy and tolerability of dolutegravir/lamivudine versus dolutegravir/rilpivirine in switching from a three-drug regimen based on nonnucleoside reverse transcriptase inhibitors: A retrospective cohort study. J Med Virol 2023; 95:e29149. [PMID: 37805832 DOI: 10.1002/jmv.29149] [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: 05/16/2023] [Revised: 09/17/2023] [Accepted: 09/26/2023] [Indexed: 10/09/2023]
Abstract
Real-life comparisons of dolutegravir/rilpivirine (DTG/RPV) and DTG/lamivudine (3TC) regimens in people living with human immunodeficiency virus (PLWHIV) who switched from a standard three-drug regimen based on nonnucleoside reverse transcriptase inhibitors (NNRTIs) are missing. This study aimed to compare DTG/3TC and DTG/RPV in virologically suppressed patients (HIV-RNA < 50 copies/mL) coming from any NNRTI-based regimen in terms of discontinuation due to virologic failure (VF) discontinuation rates due to all causes, and adverse events. As a secondary outcome, we evaluated the difference in creatinine, total cholesterol, CD4, and triglycerides from baseline to weeks 48 after the switch. Of the 415 PLWHs included in the study, 278 (66.9%) switched to DTG/3TC, and 137 (33.1%) switched to DTG/RPV. Overall, 48 PLWHs (11.6%) discontinued the treatment:38 with DTG/3TC and 10 with DTG/RPV with similar discontinuation rates: 5.01 × 100 py (95% confidence interval [CI] 3.64-6.94) and 4.66 × 100 py (95% CI 2.51-8.67), respectively. The most common reason for discontinuation was toxicity (26 patients, 22/278 [7.9%] in the DTG/3TC group and 4/137 [2.9%] in the DTG/RPV group), mainly neurologic toxicity (never above grade 2). We found no differences in discontinuation rates due to treatment adverse events. Two study participants experienced virological failure in the DTG/3TC arm. We observed no significant difference in CD4 cell counts, lipid parameters, or renal function between the two groups at 48 weeks. This study demonstrated that, in clinical practice, a two-drug regimen with DTG/3TC or DTG/RPV is characterized by a low discontinuation rate and VF in virologically suppressed PLWHs switched from an NNRTI-based three antiretroviral drugs regimen.
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Affiliation(s)
- Filippo Lagi
- Infectious and Tropical Diseases Unit, Emergency Department, Careggi University Hospital, Florence, Italy
| | - Andrea Giacomelli
- Department of Infectious Diseases, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Vanni Borghi
- Department of Infectious Diseases, Azienda Ospedaliero, Universitaria Policlinico of Modena, Modena, Italy
| | - Arturo Ciccullo
- Section of Infectious Diseases, Department of Safety and Bioethics, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Lucia Taramasso
- Infectious Diseases Unit, Department of Internal Medicine, Ospedale Policlinico San Martino - IRCCS, Genoa, Italy
| | - Giordano Madeddu
- Department of Medicine, Surgery and Pharmacy, Unit of Infectious Disease, University of Sassari, Sassari, Italy
| | - Gabriella D'Ettorre
- Department of Public Health and Infectious Diseases, Policlinico Umberto I, Sapienza University, Rome, Italy
| | - Andrea Giacometti
- Institute of Infectious Diseases and Public Health, Department of Biological Sciences and Public Health, Università Politecnica delle Marche, Ancona, Italy
| | - Filippo Ducci
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Andrea De Vito
- Department of Medicine, Surgery and Pharmacy, Unit of Infectious Disease, University of Sassari, Sassari, Italy
| | - Rachele Pincino
- Department of Health Sciences (DISSAL), Infectious Diseases Unit, University of Genoa, Genoa, Italy
| | - Simona Di Giambenedetto
- Section of Infectious Diseases, Department of Safety and Bioethics, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Cristina Mussini
- Department of Infectious Diseases, Azienda Ospedaliero, Universitaria Policlinico of Modena, Modena, Italy
| | - Spinello Antinori
- Department of Infectious Diseases, ASST Fatebenefratelli-Sacco, Milan, Italy
- Luigi Sacco Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Gaetana Sterrantino
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
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Fei L, Santarelli G, D'Anna G, Moretti S, Mirossi G, Patti A, Sanfilippo G, Almerigogna F, Berni A, Caldini E, Lagi F, Para O, Vaudo M, Vultaggio A. Can selective serotonin reuptake inhibitors/serotonin and norepinephrine reuptake inhibitor antidepressants decrease the "cytokine storm" in the course of COVID-19 pneumonia? Panminerva Med 2023; 65:321-326. [PMID: 34240839 DOI: 10.23736/s0031-0808.21.04436-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Lots of research has been conducted to fight COVID-19 since the outbreak of the pandemic in 2020. The role of "cytokine storm" in the pathogenesis of COVID-19 pneumonia is well known. Relationship between interleukins and depression is still subject matter of the research, but a correlation between interleukin-6 and depressive disorders is proven by now. The aim of this study is to verify differences among interleukin-6 blood levels of inpatients treated with selective serotonin reuptake inhibitors and/or serotonin and norepinephrine reuptake inhibitor before and during hospitalization and of inpatients not treated with these drugs. METHODS This is an observational study performed during the first wave of SARS Cov-2 pandemic in Italy for three months. The hospitalized patients of Internal Medicine wards and Infectious and Tropical Diseases ward of Azienda Ospedaliero-Universitaria Careggi of Florence for COVID-19 pneumonia have been divided into two subgroups (treated / not treated with antidepressants). Patients admitted to Intensive Care Unit previously have been excluded. Each patient has been evaluated concerning demographic, clinical and therapeutic features. The first dosage of interleukin-6 detected during hospitalization has been noticed. RESULTS The entire sample included 402 patients and 8.5% (N.=34) had been treated with an antidepressant of the two considered categories before admission until discharge from hospital. Significant lower levels of interleukin-6 of recovered patients of the treated subgroup have been highlighted as compared to recovered patients of not-treated subgroup (12.1 vs. 25.4 P<0.001). These results have been pointed out in spite of higher mean age and more serious comorbidities of the treated subgroup. Nevertheless, the incidence of severe acute respiratory distress syndrome is significantly lower in the subgroup of patients with antidepressant treatment (20.6% vs. 43.2% P<0.02) as well as endotracheal intubation employment (0.0% vs. 11.7% P<0.04). The rate of deceased patients of treated-subgroup is not significantly lower than the rate of not-treated subgroup (23.5% vs. 26.4% P=0.13). CONCLUSIONS During COVID-19 pneumonia, the production of interleukin-6 seems to be modulated in presence of antidepressant therapy. Further proofs and broader surveys are necessary.
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Affiliation(s)
| | | | - Giulio D'Anna
- School of Psychiatry, University of Florence, Florence, Italy
| | | | - Giulia Mirossi
- School of Psychiatry, University of Florence, Florence, Italy
| | - Andrea Patti
- School of Psychiatry, University of Florence, Florence, Italy
| | | | | | | | | | | | | | - Micol Vaudo
- University Hospital of Careggi, Florence, Italy
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13
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Lagi F, Gatteschi C, Tilli M, Zocco N, Avarello A, Bellini S, Contanessi S, Zigliani MR, Stagnitta M, Mariano L, Gazzarri E, Belloni L, Fisher AD, Bartoloni A, Sterrantino G, Ierardi F. Facilitators and barriers in HIV testing and continuum of care among migrant transgender women who are sex workers residing in Florence, Italy. Int J Transgend Health 2023; 25:268-282. [PMID: 38681492 PMCID: PMC11044723 DOI: 10.1080/26895269.2023.2209072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/01/2024]
Abstract
Background An increased risk of contracting HIV infection, suboptimal adherence, and a loss to follow-up have been observed in migrants, particularly if those individuals are transgender or sex workers. A clear picture of the HIV epidemic among migrants is complex due to the lack of specific national data. Aims We developed a qualitative study that describes the barriers and facilitators (cultural, social, and personal) in HIV testing and the continuum of care for a group of migrant transgender women who are sex workers. Methods A semi-structured interview was conducted with a group of migrant transgender women who are sex workers living with HIV or with unknown HIV serostatus residing in the Florentine metropolitan area. Results We included 12 participants: 3 had unknown HIV serostatus and 9 were living with HIV in follow-up at the Clinic of Infectious and Tropical Diseases, Careggi University hospiral, Florence, Italy. Among barriers, the perceived stigma due to their identity as migrants and transgender people, the language lack of ability and the legal position in the host country played a significant role. Moreover, the interviewees claimed having no alternative to sex work: for those individuals, changing their lifestyle condition is perceived as difficult or impossible due to social prejudices. Conversely, the interviewees considered support services, such as cultural mediators/interpreters and street units, as facilitators to HIV testing, access to care, and continuum of care. Having regular and accessible ART and the availability of a more consistent health care system, represent reasons for HIV-positive migrants living with HIV to move to Italy. Conclusions Knowledge of this population's personal experience regarding the barriers and factors that facilitate access to the HIV care system is essential for planning public health interventions capable of responding to the real needs of patients.
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Affiliation(s)
- Filippo Lagi
- Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy
| | | | - Marta Tilli
- Department of experimental and clinical medicine, University of Florence, Florence, Italy
| | | | - Angelo Avarello
- Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy
| | - Sabrina Bellini
- Lega Italiana per la Lotta contro l’AIDS, LILA Toscana, Florence, Italy
| | | | | | | | | | | | - Laura Belloni
- Regional Center for Critical Relationships, Careggi University Hospital, Florence, Italy
| | - Alessandra Daphne Fisher
- Andrology, Women’s Endocrinology and Gender Incongruence Unit, Careggi University Hospital, Florence, Italy
| | - Alessandro Bartoloni
- Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy
- Department of experimental and clinical medicine, University of Florence, Florence, Italy
| | - Gaetana Sterrantino
- Department of experimental and clinical medicine, University of Florence, Florence, Italy
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14
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Fabbiani M, Masini M, Rossetti B, Ciccullo A, Borghi V, Lagi F, Capetti A, Colafigli M, Panza F, Baldin G, Mussini C, Sterrantino G, Farinacci D, Montagnani F, Tumbarello M, Di Giambenedetto S. Efficacy and Durability of Dolutegravir- or Darunavir-Based Regimens in ART-Naïve AIDS- or Late-Presenting HIV-Infected Patients. Viruses 2023; 15:v15051123. [PMID: 37243208 DOI: 10.3390/v15051123] [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: 04/07/2023] [Revised: 05/01/2023] [Accepted: 05/05/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND Since limited data are available, we aimed to compare the efficacy and durability of dolutegravir and darunavir in advanced naïve patients. METHODS Retrospective multicenter study including AIDS- or late-presenting (def. CD4 ≤ 200/µL) HIV-infected patients starting dolutegravir or ritonavir/cobicistat-boosted darunavir+2NRTIs. Patients were followed from the date of first-line therapy initiation (baseline, BL) to the discontinuation of darunavir or dolutegravir, or for a maximum of 36 months of follow-up. RESULTS Overall 308 patients (79.2% males, median age 43 years, 40.3% AIDS-presenters, median CD4 66 cells/µL) were enrolled; 181 (58.8%) and 127 (41.2%) were treated with dolutegravir and darunavir, respectively. Incidence of treatment discontinuation (TD), virological failure (VF, defined as a single HIV-RNA > 1000 cp/mL or two consecutive HIV-RNA > 50 cp/mL after 6 months of therapy or after virological suppression had been achieved), treatment failure (the first of TD or VF), and optimal immunological recovery (defined as CD4 ≥ 500/µL + CD4 ≥ 30% + CD4/CD8 ≥ 1) were 21.9, 5.2, 25.6 and 1.4 per 100 person-years of follow-up, respectively, without significant differences between dolutegravir and darunavir (p > 0.05 for all outcomes). However, a higher estimated probability of TD for central nervous system (CNS) toxicity (at 36 months: 11.7% vs. 0%, p = 0.002) was observed for dolutegravir, whereas darunavir showed a higher probability of TD for simplification (at 36 months: 21.3% vs. 5.7%, p = 0.046). CONCLUSIONS Dolutegravir and darunavir showed similar efficacy in AIDS- and late-presenting patients. A higher risk of TD due to CNS toxicity was observed with dolutegravir, and a higher probability of treatment simplification with darunavir.
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Affiliation(s)
- Massimiliano Fabbiani
- UOC Malattie Infettive e Tropicali, Azienda Ospedaliero-Universitaria Senese, 53100 Siena, Italy
| | - Melissa Masini
- UOC Malattie Infettive, Azienda USL Toscana Sud Est, PO San Donato, 52100 Arezzo, Italy
| | - Barbara Rossetti
- Division of Infectious Diseases, AUSL Toscana Sud Est, Grosseto Hospital, 58100 Grosseto, Italy
| | - Arturo Ciccullo
- Dipartimento di Sicurezza e Bioetica Sezione Malattie Infettive, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- UOC Malattie Infettive, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Vanni Borghi
- Clinica Malattie Infettive e Tropicali, Azienda Ospedaliero Universitaria di Modena, 41100 Modena, Italy
| | - Filippo Lagi
- SOD Malattie Infettive e Tropicali, Azienda Ospedaliero-Universitaria Careggi, 50134 Firenze, Italy
| | - Amedeo Capetti
- Divisione di Malattie Infettive, Dipartimento di Malattie Infettive, Ospedale Universitario Luigi Sacco, 20157 Milano, Italy
| | - Manuela Colafigli
- Unità di Dermatologia Infettiva e Allergologia, Istituto S. Gallicano IRCCS, 00144 Rome, Italy
| | - Francesca Panza
- UOC Malattie Infettive e Tropicali, Azienda Ospedaliero-Universitaria Senese, 53100 Siena, Italy
- Dipartimento di Biotecnologie Mediche, Università degli Studi di Siena, 53100 Siena, Italy
| | - Gianmaria Baldin
- Dipartimento di Sicurezza e Bioetica Sezione Malattie Infettive, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- UOC Malattie Infettive, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Cristina Mussini
- Clinica Malattie Infettive e Tropicali, Azienda Ospedaliero Universitaria di Modena, 41100 Modena, Italy
| | - Gaetana Sterrantino
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy
| | - Damiano Farinacci
- Dipartimento di Sicurezza e Bioetica Sezione Malattie Infettive, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- UOC Malattie Infettive, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Francesca Montagnani
- UOC Malattie Infettive e Tropicali, Azienda Ospedaliero-Universitaria Senese, 53100 Siena, Italy
- Dipartimento di Biotecnologie Mediche, Università degli Studi di Siena, 53100 Siena, Italy
| | - Mario Tumbarello
- UOC Malattie Infettive e Tropicali, Azienda Ospedaliero-Universitaria Senese, 53100 Siena, Italy
- Dipartimento di Biotecnologie Mediche, Università degli Studi di Siena, 53100 Siena, Italy
| | - Simona Di Giambenedetto
- Dipartimento di Sicurezza e Bioetica Sezione Malattie Infettive, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- UOC Malattie Infettive, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
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15
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Paggi R, Barbiero A, Manciulli T, Miftode A, Tilli M, Lagi F, Mencarini J, Borchi B, Pozzi M, Bartalesi F, Spinicci M, Martini L, Coppola A, Nozzoli C, Peris A, Bonizzoli M, Pieralli F, Bartoloni A, Zammarchi L. Characteristics of COVID-19 vaccinated and unvaccinated patients admitted to Careggi University Hospital, Florence, Italy. Intern Emerg Med 2023; 18:821-830. [PMID: 36853393 PMCID: PMC9972322 DOI: 10.1007/s11739-023-03231-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 02/14/2023] [Indexed: 03/01/2023]
Abstract
More than 11.5 billion COVID-19 vaccine doses have been administered around the world. Although vaccine effectiveness for severe infections is reported to be 89.0%, breakthrough infections are common and may lead to severe outcome in fragile population. We conducted a real-world observational study on 420 COVID-19 admitted patients from July 2021 to January 2022 in a tertiary level Italian hospital. We collected patient's vaccination and SARS-CoV-2 serological status, SARS-CoV-2 treatments, oxygen supports, intensive (ICU) and subintensive (sub-ICU) care unit admissions, length of staying (LoS) and in-hospital mortality. One-hundred-seventy-two vaccinated and 248 unvaccinated patients were admitted during the study period. Vaccinated group (Vg) had a significantly more elevated Charlson Comorbidity Index than Unvaccinated group (UVg), and no statistical differences were found in terms of in-hospital mortality, LoS or ICU and sub-ICU admissions. Among Vg, anti-S antibodies were detected in 86.18% of patients (seropositives). Vaccinated seronegative patients' in-hospital mortality was significantly higher than vaccinated seropositive patients (33.33% vs 10.69%, p = 0.0055): in particular, mortality rate in 45-69 years old population was higher in vaccinated seronegative group, and comparable in patients ≥ 70 years old. No differences in terms of outcome were registered between Vg and UVg, taking into account that Vg was considerably older and with more comorbidities. In line with other recent observations, higher mortality rate was evidenced for seronegative vaccinated patients. Primary prophylaxis and early treatments result to be necessary, especially for older and immunosuppressed populations.
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Affiliation(s)
- Riccardo Paggi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Anna Barbiero
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Tommaso Manciulli
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Andreea Miftode
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Marta Tilli
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Filippo Lagi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy
| | - Jessica Mencarini
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy
| | - Beatrice Borchi
- Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy
| | - Marco Pozzi
- Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy
| | - Filippo Bartalesi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy
| | - Michele Spinicci
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy
| | - Lorenzo Martini
- Internal Medicine Unit 2, Careggi University Hospital, Florence, Italy
| | | | - Carlo Nozzoli
- Internal Medicine Unit 1, Careggi University Hospital, Florence, Italy
| | - Adriano Peris
- Intensive Care Unit and Regional ECMO Referral Centre, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Manuela Bonizzoli
- Intensive Care Unit and Regional ECMO Referral Centre, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Filippo Pieralli
- High-Intensity Internal Medicine Unit, Careggi University Hospital, Florence, Italy
| | - Alessandro Bartoloni
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy
| | - Lorenzo Zammarchi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.
- Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy.
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16
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Papavramidis T, Gentile I, Cattelan AM, Magnasco L, Viale P, Francisci D, Kofteridis DP, Tiseo G, Giamarellos-Bourboulis EJ, Lagi F, Pinna SM, D'Amico F, La Ferla L, Panagopoulos P, Gattuso G, Sipsas NV, Ruggieri A, Cattaneo A, Corio L, Comandini A, Mascagni P, Bassetti M. REDS study: Retrospective effectiveness study of dalbavancin and other standard of care of the same IV antibiotic class in patients with ABSSSI. Int J Antimicrob Agents 2023; 61:106746. [PMID: 36758778 DOI: 10.1016/j.ijantimicag.2023.106746] [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: 06/17/2022] [Revised: 10/24/2022] [Accepted: 02/01/2023] [Indexed: 02/11/2023]
Abstract
OBJECTIVES Acute bacterial skin and skin-structure infections (ABSSSIs) are a common source of morbidity in both the community and hospital settings. The current standard of care (SoC) requires multiple-dose intravenous (IV) regimens, which are associated with high hospitalisation rates, concomitant event risks and costs. Dalbavancin is a lipoglycopeptide, long-acting antibiotic that is effective against Gram-positive microorganisms, including methicillin-resistant Staphylococcus aureus (MRSA). Dalbavancin allows treatment of ABSSSIs with a single-shot IV administration or once weekly for 2 weeks, enabling clinicians to treat patients in an outpatient setting or to shorten the length of hospital stay. METHODS This multicentre, observational, retrospective study compared hospitalised patients who received dalbavancin and patients treated with the three most used IV antibiotics of the same or similar class: vancomycin, teicoplanin and daptomycin. The primary outcome was the time to discharge after starting the study antibiotics. RESULTS The primary endpoint, time to discharge from the study therapy start, was measured for both groups: the median number of days was 6.5 in the dalbavancin group vs. 11.0 days in the SoC group. Moreover, in subpopulations of patients receiving one or more concomitant antibiotics active for Gram-positives, MRSA and patients with the most prevalent comorbidity (i.e., diabetes), the advantage of dalbavancin in terms of length of stay was confirmed, with a halved time to discharge or more. Safety data on dalbavancin were consistent with data collected in clinical trials. No serious adverse drug reactions related to dalbavancin were reported and most of them were classified as skin and subcutaneous tissue disorders. One serious ADR was reported for daptomycin. CONCLUSIONS Although the analysis was only descriptive, it can be concluded that dalbavancin may enable a remarkable reduction in length of hospital stay, also confirming the clinical effectiveness and good safety profile demonstrated in clinical trials in a real-world setting.
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Affiliation(s)
- Theodossis Papavramidis
- 1st Propaedeutic Department of Surgery, University General Hospital of Thessaloniki AHEPA, Thessaloniki, Greece
| | - Ivan Gentile
- Department of Clinical Medicine and Surgery, Section of Infectious Diseases, University of Naples Federico II - Naples, Italy
| | - Anna Maria Cattelan
- Clinic of Infectious Diseases, Department of Internal Medicine, University Hospital of Padua, Padua, Italy
| | - Laura Magnasco
- Infectious Diseases Clinic, Department of Health Sciences, University of Genoa and Hospital Policlinico San Martino - IRCCS, Genoa, Italy
| | - Pierluigi Viale
- Infectious Diseases Unit - Department of Medical and Surgical Sciences, University of Bologna, Teaching Hospital S. Orsola-Malpighi, Bologna, Italy
| | - Daniela Francisci
- Infectious Diseases Clinic, University Hospital "S. Maria della Misericordia", University of Perugia, Perugia, Italy
| | - Diamantis P Kofteridis
- University Hospital of Heraklion, Department of Internal Medicine, Heraklion, Crete, Greece
| | - Giusy Tiseo
- Infectious Disease Unit, Azienda Ospedaliera Universitaria Pisana, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | | | - Filippo Lagi
- Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy
| | | | - Federico D'Amico
- Clinic of Infectious Diseases, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Lucia La Ferla
- Infectious Diseases Unit, Cannizzaro Hospital, Catania, Italy
| | - Periklis Panagopoulos
- Department of Internal Medicine, University Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - Gianni Gattuso
- Department of Infectious Diseases, Carlo Poma Hospital, Mantua, Italy
| | - Nikolaos V Sipsas
- Infectious Diseases Unit, Pathophysiology Department, Laikon General Hospital and National and Kapodistrian University of Athens, Athens, Greece
| | | | | | | | | | | | - Matteo Bassetti
- Infectious Diseases Clinic, Department of Health Sciences, University of Genoa and Hospital Policlinico San Martino - IRCCS, Genoa, Italy
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17
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Manciulli T, Spinicci M, Rossetti B, Antonello RM, Lagi F, Barbiero A, Chechi F, Formica G, Francalanci E, Alesi M, Gaggioli S, Modi G, Modica S, Paggi R, Costa C, Morea A, Paglicci L, Rancan I, Amadori F, Tamborrino A, Tilli M, Bandini G, Pignone AM, Valoriani B, Montagnani F, Tumbarello M, Blanc P, Di Pietro M, Galli L, Aquilini D, Vincenti A, Sani S, Nencioni C, Luchi S, Tacconi D, Zammarchi L, Bartoloni A. Safety and Efficacy of Outpatient Treatments for COVID-19: Real-Life Data from a Regionwide Cohort of High-Risk Patients in Tuscany, Italy (the FEDERATE Cohort). Viruses 2023; 15:v15020438. [PMID: 36851654 PMCID: PMC9967010 DOI: 10.3390/v15020438] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 01/28/2023] [Accepted: 01/28/2023] [Indexed: 02/09/2023] Open
Abstract
Early COVID-19 treatments can prevent progression to severe disease. However, real-life data are still limited, and studies are warranted to monitor the efficacy and tolerability of these drugs. We retrospectively enrolled outpatients receiving early treatment for COVID-19 in 11 infectious diseases units in the Tuscany region of Italy between 1 January and 31 March 2022, when Omicron sublineages BA.1 and BA.2 were circulating. Eligible COVID-19 patients were treated with sotrovimab (SOT), remdesivir (RMD), nirmatrelvir/ritonavir (NRM/r), or molnupiravir (MOL). We gathered demographic and clinical features, 28-day outcomes (hospitalization or death), and drugs tolerability. A total of 781 patients (median age 69.9, 66% boosted for SARS-CoV-2) met the inclusion criteria, of whom 314 were treated with SOT (40.2%), 205 with MOL (26.3%), 142 with RMD (18.2%), and 120 with NRM/r (15.4%). Overall, 28-day hospitalization and death occurred in 18/781 (2.3%) and 3/781 (0.3%), respectively. Multivariable Cox regression showed that patients receiving SOT had a reduced risk of meeting the composite outcome (28-day hospitalization and/or death) in comparison to the RMD cohort, while no significant differences were evidenced for the MOL and NRM/r groups in comparison to the RMD group. Other predictors of negative outcomes included cancer, chronic kidney disease, and a time between symptoms onset and treatment administration > 3 days. All treatments showed good safety and tolerability, with only eight patients (1%) whose treatment was interrupted due to intolerance. In the first Italian multicenter study presenting real-life data on COVID-19 early treatments, all regimens demonstrated good safety and efficacy. SOT showed a reduced risk of progression versus RMD. No significant differences of outcome were observed in preventing 28-day hospitalization and death among patients treated with RMD, MOL, and NRM/r.
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Affiliation(s)
- Tommaso Manciulli
- Dipartimento di Medicina Sperimentale e Clinica, Università degli Studi di Firenze, 50121 Firenze, Italy
| | - Michele Spinicci
- Dipartimento di Medicina Sperimentale e Clinica, Università degli Studi di Firenze, 50121 Firenze, Italy
- SOD Malattie Infettive e Tropicali, Azienda Ospedaliero-Universitaria Careggi, 50134 Firenze, Italy
| | - Barbara Rossetti
- UOC Malattie Infettive, Ospedale Misericordia, 58100 Grosseto, Italy
| | - Roberta Maria Antonello
- Dipartimento di Medicina Sperimentale e Clinica, Università degli Studi di Firenze, 50121 Firenze, Italy
| | - Filippo Lagi
- Dipartimento di Medicina Sperimentale e Clinica, Università degli Studi di Firenze, 50121 Firenze, Italy
- SOD Malattie Infettive e Tropicali, Azienda Ospedaliero-Universitaria Careggi, 50134 Firenze, Italy
| | - Anna Barbiero
- Dipartimento di Medicina Sperimentale e Clinica, Università degli Studi di Firenze, 50121 Firenze, Italy
| | - Flavia Chechi
- Dipartimento di Medicina Sperimentale e Clinica, Università degli Studi di Firenze, 50121 Firenze, Italy
- SOC Malattie Infettive, Ospedale San Jacopo, 51100 Pistoia, Italy
| | - Giuseppe Formica
- Dipartimento di Medicina Sperimentale e Clinica, Università degli Studi di Firenze, 50121 Firenze, Italy
| | - Emanuela Francalanci
- Dipartimento di Medicina Sperimentale e Clinica, Università degli Studi di Firenze, 50121 Firenze, Italy
- UO Malattie Infettive, Ospedale Santo Stefano, 59100 Prato, Italy
| | - Mirco Alesi
- Dipartimento di Medicina Sperimentale e Clinica, Università degli Studi di Firenze, 50121 Firenze, Italy
- UO Malattie Infettive, Ospedale Santo Stefano, 59100 Prato, Italy
| | - Samuele Gaggioli
- Dipartimento di Medicina Sperimentale e Clinica, Università degli Studi di Firenze, 50121 Firenze, Italy
| | - Giulia Modi
- Dipartimento di Medicina Sperimentale e Clinica, Università degli Studi di Firenze, 50121 Firenze, Italy
- UO Malattie Infettive, Ospedale Santa Maria Annunziata, 50012 Firenze, Italy
| | - Sara Modica
- SOC Malattie Infettive ed Epatologia, Ospedale San Luca, 55100 Lucca, Italy
| | - Riccardo Paggi
- Dipartimento di Medicina Sperimentale e Clinica, Università degli Studi di Firenze, 50121 Firenze, Italy
- SOC Malattie Infettive, Ospedale San Jacopo, 51100 Pistoia, Italy
| | - Cecilia Costa
- UO Malattie Infettive, Ospedale Santa Maria Annunziata, 50012 Firenze, Italy
| | - Alessandra Morea
- UO Malattie Infettive, Ospedali Riuniti di Livorno, 57124 Livorno, Italy
| | | | - Ilaria Rancan
- Dipartimento di Medicina Sperimentale e Clinica, Università degli Studi di Firenze, 50121 Firenze, Italy
- Dipartimento di Biotecnologie Mediche, Università degli Studi di Siena, 53100 Siena, Italy
| | | | - Agnese Tamborrino
- Dipartimento Scienze della Salute, Università degli Studi di Firenze, 50139 Firenze, Italy
| | - Marta Tilli
- Dipartimento di Medicina Sperimentale e Clinica, Università degli Studi di Firenze, 50121 Firenze, Italy
- UO Malattie Infettive, Ospedale Santa Maria Annunziata, 50012 Firenze, Italy
| | - Giulia Bandini
- Dipartimento di Medicina Sperimentale e Clinica, Università degli Studi di Firenze, 50121 Firenze, Italy
| | - Alberto Moggi Pignone
- Dipartimento di Medicina Sperimentale e Clinica, Università degli Studi di Firenze, 50121 Firenze, Italy
| | | | - Francesca Montagnani
- Dipartimento di Biotecnologie Mediche, Università degli Studi di Siena, 53100 Siena, Italy
- UOC Malattie Infettive e Tropicali, Azienda Ospedaliero Universitaria Senese, 53100 Siena, Italy
| | - Mario Tumbarello
- Dipartimento di Biotecnologie Mediche, Università degli Studi di Siena, 53100 Siena, Italy
- UOC Malattie Infettive e Tropicali, Azienda Ospedaliero Universitaria Senese, 53100 Siena, Italy
| | - Pierluigi Blanc
- SOC Malattie Infettive, Ospedale San Jacopo, 51100 Pistoia, Italy
| | - Massimo Di Pietro
- UO Malattie Infettive, Ospedale Santa Maria Annunziata, 50012 Firenze, Italy
| | - Luisa Galli
- Dipartimento Scienze della Salute, Università degli Studi di Firenze, 50139 Firenze, Italy
- UO Malattie Infettive, Azienda Ospedaliero-Universitaria “Meyer”, 50139 Firenze, Italy
| | | | | | - Spartaco Sani
- UO Malattie Infettive, Ospedali Riuniti di Livorno, 57124 Livorno, Italy
| | - Cesira Nencioni
- UOC Malattie Infettive, Ospedale Misericordia, 58100 Grosseto, Italy
| | - Sauro Luchi
- SOC Malattie Infettive ed Epatologia, Ospedale San Luca, 55100 Lucca, Italy
| | - Danilo Tacconi
- UO Malattie Infettive, Ospedale San Donato, 52100 Arezzo, Italy
| | - Lorenzo Zammarchi
- Dipartimento di Medicina Sperimentale e Clinica, Università degli Studi di Firenze, 50121 Firenze, Italy
- SOD Malattie Infettive e Tropicali, Azienda Ospedaliero-Universitaria Careggi, 50134 Firenze, Italy
| | - Alessandro Bartoloni
- Dipartimento di Medicina Sperimentale e Clinica, Università degli Studi di Firenze, 50121 Firenze, Italy
- SOD Malattie Infettive e Tropicali, Azienda Ospedaliero-Universitaria Careggi, 50134 Firenze, Italy
- Correspondence:
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18
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Ciccullo A, Baldin G, Borghi V, Cossu MV, Giacomelli A, Lagi F, Farinacci D, Iannone V, Passerotto RA, Capetti A, Sterrantino G, Mussini C, Antinori S, Di Giambenedetto S. Analysing the efficacy and tolerability of dolutegravir plus either rilpivirine or lamivudine in a multicentre cohort of virologically suppressed PLWHIV. J Antimicrob Chemother 2022; 78:117-121. [PMID: 36272137 DOI: 10.1093/jac/dkac362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 10/05/2022] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVES We aimed to investigate and compare the efficacy and safety of two dolutegravir-based two-drug regimens: dolutegravir + lamivudine versus dolutegravir + rilpivirine. METHODS We analysed a cohort of people living with HIV (PLWHIV) switching to dolutegravir + lamivudine or dolutegravir + rilpivirine. We excluded from the analysis PLWHIV with no available pre-switch genotypic test or with a known resistance mutation to one of the study drugs. We evaluated incidence of virological failure (VF) and treatment discontinuation (TD), as well as changes in immunological and metabolic parameters. RESULTS We enrolled 592 PLWHIV: 306 in the lamivudine group and 286 in the rilpivirine group. We observed nine VFs in the lamivudine group [1.4 VF per 100 patient-years of follow-up (PYFU)] and four VFs in the rilpivirine group (0.6 VF per 100 PYFU). Subsequent genotypic analysis showed no acquired resistance-associated mutations in those experiencing VF. Estimated probability of maintaining virological suppression at 144 and 240 weeks were 96.6% and 92.7%, respectively, in the lamivudine group and 98.7% and 98.7%, respectively, in the rilpivirine group (log-rank P = 0.172). The estimated probability of maintaining study regimen at Week 240 was 82.3% in the lamivudine group and 85.9% in the rilpivirine group (log-rank P = 0.018). We observed a significant improvement in CD4+ cell count at Week 240 in the lamivudine group (P = 0.012); in the rilpivirine group we registered a significant increase in CD4/CD8 ratio (P = 0.014). CONCLUSIONS Both analysed strategies are effective and safe as switch strategies in clinical practice, with a low incidence of VF and a favourable immunological recovery, even in the long term.
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Affiliation(s)
- A Ciccullo
- Unit of Infectious Diseases, San Salvatore Hospital, L'Aquila, Italy
| | - G Baldin
- Unit of Infectious Diseases, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Mater Olbia Hospital, Olbia, Italy
| | - V Borghi
- Azienda Ospedaliero Universitaria di Modena, Clinica Malattie Infettive e Tropicali, Modena, Italy
| | - M V Cossu
- Division of Infectious Diseases, Department of Infectious Diseases, Luigi Sacco University Hospital, Milan, Italy
| | - A Giacomelli
- UOC Malattie Infettive III, DIBIC Luigi Sacco, University of Milan, Milan, Italy
| | - F Lagi
- Division of Tropical and Infectious Diseases, 'Careggi' Hospital, Florence, Italy
| | - D Farinacci
- Catholic University of the Sacred Heart, Rome, Italy
| | - V Iannone
- Catholic University of the Sacred Heart, Rome, Italy
| | | | - A Capetti
- Division of Infectious Diseases, Department of Infectious Diseases, Luigi Sacco University Hospital, Milan, Italy
| | - G Sterrantino
- Division of Tropical and Infectious Diseases, 'Careggi' Hospital, Florence, Italy
| | - C Mussini
- Azienda Ospedaliero Universitaria di Modena, Clinica Malattie Infettive e Tropicali, Modena, Italy
| | - S Antinori
- UOC Malattie Infettive III, DIBIC Luigi Sacco, University of Milan, Milan, Italy
| | - S Di Giambenedetto
- Unit of Infectious Diseases, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Catholic University of the Sacred Heart, Rome, Italy
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19
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Lamacchia G, Salvati L, Kiros ST, Mazzoni A, Vanni A, Capone M, Carnasciali A, Farahvachi P, Lagi F, Di Lauria N, Rocca A, Colao MG, Liotta F, Cosmi L, Rossolini GM, Bartoloni A, Maggi L, Annunziato F. Fourth Dose of mRNA COVID-19 Vaccine Transiently Reactivates Spike-Specific Immunological Memory in People Living with HIV (PLWH). Biomedicines 2022; 10:3261. [PMID: 36552017 PMCID: PMC9775459 DOI: 10.3390/biomedicines10123261] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 12/06/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022] Open
Abstract
Background: People Living With HIV (PLWH), with advanced disease, lower CD4+ T cell counts or an unsuppressed HIV viral load can have a suboptimal vaccine response. For this reason, in the current COVID-19 pandemic, they represent a prioritized population for the SARS-CoV-2 fourth (or second booster) vaccine dose. This work aims to investigate the effects of a second booster on the reactivation of the spike-specific humoral and cell-mediated immune responses in PLWH. Methods: A total of eight PLWH, who received a fourth dose of the original mRNA vaccines were enrolled. They were evaluated before and then 7 days, 1 month and 2 months after the injection. The humoral response was assessed via a chemiluminescent immunoassay. Immunophenotyping and the functional evaluation of the SARS-CoV-2-specific cellular immune responses were performed via flow cytometry. Results: Anti-spike IgG levels were above the cut-off value for all subjects at all timepoints. The spike-specific CD4+ T cell response was reactivated one week after the fourth vaccine dose, and on average declined at two months post-vaccination. A similar trend was observed for the spike-specific B cells. A low percentage of spike-specific CD4+ T cells was activated by the B.1.1.529 BA.1 Omicron-spike mutated peptides, and the majority of these cells were reactive to the conserved portions of the spike protein. Similarly, the majority of the spike-specific memory B cells were able to bind both Wuhan and Omicron-spike entire protein. Conclusions: Spike-specific adaptive immune responses are transiently reactivated in PLWH following the fourth mRNA vaccine dose. The breadth of the immune responses to the mutated spike protein provides insight on the possible cross-reactivity for the SARS-CoV-2 variants of concern (VOCs).
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Affiliation(s)
- Giulia Lamacchia
- Department of Experimental and Clinical Medicine, University of Florence, 50121 Florence, Italy
| | - Lorenzo Salvati
- Department of Experimental and Clinical Medicine, University of Florence, 50121 Florence, Italy
| | - Seble Tekle Kiros
- Infectious and Tropical Diseases Unit, Careggi University Hospital, 50134 Florence, Italy
| | - Alessio Mazzoni
- Department of Experimental and Clinical Medicine, University of Florence, 50121 Florence, Italy
- Flow Cytometry Diagnostic Center and Immunotherapy, Careggi University Hospital, 50134 Florence, Italy
| | - Anna Vanni
- Department of Experimental and Clinical Medicine, University of Florence, 50121 Florence, Italy
| | - Manuela Capone
- Department of Experimental and Clinical Medicine, University of Florence, 50121 Florence, Italy
- Flow Cytometry Diagnostic Center and Immunotherapy, Careggi University Hospital, 50134 Florence, Italy
| | - Alberto Carnasciali
- Department of Experimental and Clinical Medicine, University of Florence, 50121 Florence, Italy
| | - Parham Farahvachi
- Department of Experimental and Clinical Medicine, University of Florence, 50121 Florence, Italy
| | - Filippo Lagi
- Infectious and Tropical Diseases Unit, Careggi University Hospital, 50134 Florence, Italy
| | - Nicoletta Di Lauria
- Infectious and Tropical Diseases Unit, Careggi University Hospital, 50134 Florence, Italy
| | - Arianna Rocca
- Microbiology and Virology Unit, Careggi University Hospital, 50134 Florence, Italy
| | - Maria Grazia Colao
- Microbiology and Virology Unit, Careggi University Hospital, 50134 Florence, Italy
| | - Francesco Liotta
- Department of Experimental and Clinical Medicine, University of Florence, 50121 Florence, Italy
- Flow Cytometry Diagnostic Center and Immunotherapy, Careggi University Hospital, 50134 Florence, Italy
- Immunology and Cell Therapy Unit, Careggi University Hospital, 50134 Florence, Italy
| | - Lorenzo Cosmi
- Department of Experimental and Clinical Medicine, University of Florence, 50121 Florence, Italy
- Immunoallergology Unit, Careggi University Hospital, 50134 Florence, Italy
| | - Gian Maria Rossolini
- Department of Experimental and Clinical Medicine, University of Florence, 50121 Florence, Italy
- Microbiology and Virology Unit, Careggi University Hospital, 50134 Florence, Italy
| | - Alessandro Bartoloni
- Department of Experimental and Clinical Medicine, University of Florence, 50121 Florence, Italy
- Infectious and Tropical Diseases Unit, Careggi University Hospital, 50134 Florence, Italy
| | - Laura Maggi
- Department of Experimental and Clinical Medicine, University of Florence, 50121 Florence, Italy
| | - Francesco Annunziato
- Department of Experimental and Clinical Medicine, University of Florence, 50121 Florence, Italy
- Flow Cytometry Diagnostic Center and Immunotherapy, Careggi University Hospital, 50134 Florence, Italy
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20
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Gacci M, Coppi M, Baldi E, Sebastianelli A, Zaccaro C, Morselli S, Pecoraro A, Manera A, Nicoletti R, Liaci A, Bisegna C, Gemma L, Giancane S, Pollini S, Antonelli A, Lagi F, Marchiani S, Dabizzi S, Degl'Innocenti S, Annunziato F, Maggi M, Vignozzi L, Bartoloni A, Rossolini GM, Serni S. O-001 Semen impairment and occurrence of SARS-CoV-2 virus in semen after recovery from COVID-19. Hum Reprod 2022. [PMCID: PMC9384383 DOI: 10.1093/humrep/deac104.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background The presence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in human semen and its role in virus contagion and semen quality after recovery from coronavirus disease 2019 (COVID-19) is still unclear. Recent reports evidence that, after SARS-CoV-2 infection, male reproductive function and semen quality may be damaged. Aim To evaluate the semen parameters and inflammation of sexually active men following recovery from SARS-CoV-2 infection at 1 month and 3 months follow-up after the second negative nasopharyngeal swab. Materials and methods A prospective cross-sectional study on sexually active men recovered from SARS-CoV-2 infection was performed. For previously hospitalized COVID-19 patients, data on serum inflammatory markers were retrospectively collected. One month after the second SARS-CoV-2 negative nasopharyngeal swab and 3 months later, four biological fluid samples, namely saliva, pre-ejaculation urine, semen, and post-ejaculation urine, were collected. The occurrence of SARS-CoV-2 RNA in the specimen was evaluated in all the biological fluids collected by RT-PCR. Female partners were retested if any specimen was found to be SARS-CoV-2 positive. Semen parameters were evaluated according to the World Health Organization manual edition V. Furthermore, semen inflammation was assessed by quantification of semen leukocytes and interleukin-8 (IL-8) levels and evaluation of a panel of sperm cytokine levels by a two-step ELISA method. Results A total of 43 men were enrolled in the study. Three patients (7%) tested positive for at least one sample (one saliva; one pre-ejaculation urine; one semen and one post-ejaculation urine), so the next day new nasopharyngeal swabs were collected. The results from these 3 patients and their partners were all negative for SARS-CoV-2. At 1-month follow-up, 25% of the men with recent SARS-Cov-2 infections and proven healing were oligo-cryptoazoospermic, despite the absence of virus RNA in semen. Of the 11 men with semen impairment, 8 were azoospermic and 3 were oligospermic. Serum inflammatory markers (procalcitonin and C-reactive protein) were analyzed in previously hospitalized patients both at admission and at peak of infection. Levels at admission were statistically significantly higher in patients resulting in crypto-azoospermic with respect to those resulting in normozoospermic (p = 0.05; p = 0.03 and p = 0.02, respectively) after healing. Oligo-crypto-azoospermia was significantly related to COVID-19 severity (P < 0.001). A total of 33 patients (76.7%) showed pathological levels of IL-8 in semen. Interleukin-1β and tumor necrosis factor-α levels were significantly negatively related to sperm total number and concentration, whereas interleukin-4 was correlated with sperm motility. At 3-months follow-up, 8/10 men with semen impairment showed an overall increase of semen parameters compared to levels assessed after 1 month. Of the 4 crypto-/azoo-spermic men 1 month after healing, 2 resulted oligozoospermic, 1 normozoospermic and only 1 remained azoospermic. Two of the 3 oligozoospermic men turned normozoozpermic. Semen cytokine levels remained elevated after 3 months, except for IL-6. Discussion and conclusion SARS-CoV-2 can be detected in saliva, urine, and semen in a small percentage of men who recovered from COVID-19. 25% of men who recovered from COVID-19 demonstrated oligo-crypto-azoospermia. Negative correlations between interleukin-1β and tumor necrosis factor-α and sperm number and the overall high levels of semen cytokines indicate a potential detrimental role of SARS-CoV-2 driven inflammation on spermatogenesis. An overall tendency to an improvement of semen parameters was found although a genital tract inflammatory condition appears to persist at least 3 months after COVID-19 recovery. Despite the low number of enrolled patients may limit the statistical power of study and the fact that the previous semen quality of these men was unknown, our results indicate that male of reproductive age recovering from COVID-19 deserve accurate follow-up for their fertility status.
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Affiliation(s)
- M Gacci
- Department of Minimally Invasive and Robotic Urologic Surgery and Kidney Transplantation, Careggi University Hospital (AOUC) University of Florence, 50134 Florence , Italy
| | - M Coppi
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence , Italy
- Clinical Microbiology and Virology Unit, Florence Careggi University Hospital, 50134 Florence , Italy
| | - E Baldi
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence , Italy
- Unit of Andrology, Female Endocrinology and Gender Incongruence, AOUC and Center of Excellence DeNothe
| | - A Sebastianelli
- Department of Minimally Invasive and Robotic Urologic Surgery and Kidney Transplantation, Careggi University Hospital (AOUC) University of Florence, 50134 Florence , Italy
| | - C Zaccaro
- Department of Minimally Invasive and Robotic Urologic Surgery and Kidney Transplantation, Careggi University Hospital (AOUC) University of Florence, 50134 Florence , Italy
| | - S Morselli
- Department of Minimally Invasive and Robotic Urologic Surgery and Kidney Transplantation, Careggi University Hospital (AOUC) University of Florence, 50134 Florence , Italy
| | - A Pecoraro
- Department of Minimally Invasive and Robotic Urologic Surgery and Kidney Transplantation, Careggi University Hospital (AOUC) University of Florence, 50134 Florence , Italy
| | - A Manera
- Department of Minimally Invasive and Robotic Urologic Surgery and Kidney Transplantation, Careggi University Hospital (AOUC) University of Florence, 50134 Florence , Italy
| | - R Nicoletti
- Department of Minimally Invasive and Robotic Urologic Surgery and Kidney Transplantation, Careggi University Hospital (AOUC) University of Florence, 50134 Florence , Italy
| | - A Liaci
- Department of Minimally Invasive and Robotic Urologic Surgery and Kidney Transplantation, Careggi University Hospital (AOUC) University of Florence, 50134 Florence , Italy
| | - C Bisegna
- Department of Minimally Invasive and Robotic Urologic Surgery and Kidney Transplantation, Careggi University Hospital (AOUC) University of Florence, 50134 Florence , Italy
| | - L Gemma
- Department of Minimally Invasive and Robotic Urologic Surgery and Kidney Transplantation, Careggi University Hospital (AOUC) University of Florence, 50134 Florence , Italy
| | - S Giancane
- Department of Minimally Invasive and Robotic Urologic Surgery and Kidney Transplantation, Careggi University Hospital (AOUC) University of Florence, 50134 Florence , Italy
| | - S Pollini
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence , Italy
- Clinical Microbiology and Virology Unit, Florence Careggi University Hospital, 50134 Florence , Italy
| | - A Antonelli
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence , Italy
- Clinical Microbiology and Virology Unit, Florence Careggi University Hospital, 50134 Florence , Italy
| | - F Lagi
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence , Italy
- Infectious and Tropical Diseases Unit, Careggi University Hospital, 50134 Florence , Italy
| | - S Marchiani
- Unit of Andrology, Female Endocrinology and Gender Incongruence, AOUC and Center of Excellence DeNothe
| | - S Dabizzi
- Unit of Andrology, Female Endocrinology and Gender Incongruence, AOUC and Center of Excellence DeNothe
| | | | - F Annunziato
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence , Italy
| | - M Maggi
- Endocrinology Unit and Department of Experimental, Clinical and Biomedical Sciences, University of Florence
| | - L Vignozzi
- Unit of Andrology, Female Endocrinology and Gender Incongruence, AOUC and Center of Excellence DeNothe
| | - A Bartoloni
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence , Italy
- Infectious and Tropical Diseases Unit, Careggi University Hospital, 50134 Florence , Italy
| | - G M Rossolini
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence , Italy
- Clinical Microbiology and Virology Unit, Florence Careggi University Hospital, 50134 Florence , Italy
| | - S Serni
- Department of Minimally Invasive and Robotic Urologic Surgery and Kidney Transplantation, Careggi University Hospital (AOUC) University of Florence, 50134 Florence , Italy
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence , Italy
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21
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Manciulli T, Modi G, Campolmi I, Borchi B, Trotta M, Spinicci M, Lagi F, Bartoloni A, Zammarchi L. Treatment with anti-SARS-CoV-2 monoclonal antibodies in pregnant and postpartum women: first experiences in Florence, Italy. Infection 2022; 50:1139-1145. [PMID: 35257291 PMCID: PMC8900641 DOI: 10.1007/s15010-022-01777-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 02/05/2022] [Indexed: 12/16/2022]
Abstract
Purpose Pregnant and postpartum women are at increased risk of developing severe COVID-19. Monoclonal antibodies (mAbs) are now widely used in high-income countries to treat mild to moderate COVID-19 outpatients at risk for developing severe disease. Very few data are available on the use of mAbs in special populations, including pregnant and postpartum women. Here we present our early experience with mAbs in these two populations. Methods Electronic records of pregnant and postpartum women treated with mAbs at Careggi University Hospital, Florence, were retrieved. Relevant data were extracted (age, presence of risk factors for COVID-19, oxygen support, mAb type, gestational age, and pregnancy status). When available, outcomes at 28 days after administration were also included. Results From March 1st to September 30th 2021, eight pregnant and two postpartum women have been treated with mAbs at our center. The median age was 31 years (IQR 30–33.5, range 29–38), median gestational age was 24 weeks. Seven patients had additional risk factors. According to the Italian disposition, all patients received casirivimab/imdevimab, with five receiving a 2.4 mg dose and five receiving a 8 g dose. Eight patients improved. One developed myocarditis, considered a COVID-19 complication. Another required a transient increase of low flow oxygen support before improving and being discharged. At a 28 days follow-up, all patients were clinically recovered. We did not observe mAbs related adverse events. Conclusion Although preliminary data should be interpreted with caution, it is remarkable how mAbs were well tolerated by pregnant women with COVID-19. Further data on mAbs in this special population should be collected but the use of mAbs in pregnant and postpartum patients should be considered. Even thus oral antivirals are becoming available, they are not recommended in pregnant and postpartum women. This population may specifically benefit from treatment with last generation mAbs.
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Affiliation(s)
- Tommaso Manciulli
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla 3, Largo Giovanni Alessandro Brambilla, 3, 50134, Florence, FI, Italy
| | - Giulia Modi
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla 3, Largo Giovanni Alessandro Brambilla, 3, 50134, Florence, FI, Italy
| | - Irene Campolmi
- Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy
- Referral Centre for Infectious Diseases in Pregnancy, Careggi University Hospital, Florence, Italy
| | - Beatrice Borchi
- Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy
- Referral Centre for Infectious Diseases in Pregnancy, Careggi University Hospital, Florence, Italy
| | - Michele Trotta
- Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy
- Referral Centre for Infectious Diseases in Pregnancy, Careggi University Hospital, Florence, Italy
| | - Michele Spinicci
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla 3, Largo Giovanni Alessandro Brambilla, 3, 50134, Florence, FI, Italy
- Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy
| | - Filippo Lagi
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla 3, Largo Giovanni Alessandro Brambilla, 3, 50134, Florence, FI, Italy
- Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy
| | - Alessandro Bartoloni
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla 3, Largo Giovanni Alessandro Brambilla, 3, 50134, Florence, FI, Italy
- Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy
| | - Lorenzo Zammarchi
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla 3, Largo Giovanni Alessandro Brambilla, 3, 50134, Florence, FI, Italy.
- Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy.
- Referral Centre for Infectious Diseases in Pregnancy, Careggi University Hospital, Florence, Italy.
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22
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Russo E, Nannini G, Sterrantino G, Kiros ST, Di Pilato V, Coppi M, Baldi S, Niccolai E, Ricci F, Ramazzotti M, Pallecchi M, Lagi F, Rossolini GM, Bartoloni A, Bartolucci G, Amedei A. Effects of viremia and CD4 recovery on gut “microbiome-immunity” axis in treatment-naïve HIV-1-infected patients undergoing antiretroviral therapy. World J Gastroenterol 2022; 28:635-652. [PMID: 35317423 PMCID: PMC8900548 DOI: 10.3748/wjg.v28.i6.635] [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] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 07/30/2021] [Accepted: 01/12/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Human immunodeficiency virus type 1 (HIV-1) infection is characterized by persistent systemic inflammation and immune activation, even in patients receiving effective antiretroviral therapy (ART). Converging data from many cross-sectional studies suggest that gut microbiota (GM) changes can occur throughout including human immunodeficiency virus (HIV) infection, treated by ART; however, the results are contrasting. For the first time, we compared the fecal microbial composition, serum and fecal microbial metabolites, and serum cytokine profile of treatment-naïve patients before starting ART and after reaching virological suppression, after 24 wk of ART therapy. In addition, we compared the microbiota composition, microbial metabolites, and cytokine profile of patients with CD4/CD8 ratio < 1 (immunological non-responders [INRs]) and CD4/CD8 > 1 (immunological responders [IRs]), after 24 wk of ART therapy.
AIM To compare for the first time the fecal microbial composition, serum and fecal microbial metabolites, and serum cytokine profile of treatment-naïve patients before starting ART and after reaching virological suppression (HIV RNA < 50 copies/mL) after 24 wk of ART.
METHODS We enrolled 12 treatment-naïve HIV-infected patients receiving ART (mainly based on integrase inhibitors). Fecal microbiota composition was assessed through next generation sequencing. In addition, a comprehensive analysis of a blood broad-spectrum cytokine panel was performed through a multiplex approach. At the same time, serum free fatty acid (FFA) and fecal short chain fatty acid levels were obtained through gas chromatography-mass spectrometry.
RESULTS We first compared microbiota signatures, FFA levels, and cytokine profile before starting ART and after reaching virological suppression. Modest alterations were observed in microbiota composition, in particular in the viral suppression condition, we detected an increase of Ruminococcus and Succinivibrio and a decrease of Intestinibacter. Moreover, in the same condition, we also observed augmented levels of serum propionic and butyric acids. Contemporarily, a reduction of serum IP-10 and an increase of IL-8 levels were detected in the viral suppression condition. In addition, the same components were compared between IRs and INRs. Concerning the microflora population, we detected a reduction of Faecalibacterium and an increase of Alistipes in INRs. Simultaneously, fecal isobutyric, isovaleric, and 2-methylbutyric acids were also increased in INRs.
CONCLUSION Our results provided an additional perspective about the impact of HIV infection, ART, and immune recovery on the “microbiome-immunity axis” at the metabolism level. These factors can act as indicators of the active processes occurring in the gastrointestinal tract. Individuals with HIV-1 infection, before ART and after reaching virological suppression with 24 wk of ART, displayed a microbiota with unchanged overall bacterial diversity; moreover, their systemic inflammatory status seems not to be completely restored. In addition, we confirmed the role of the GM metabolites in immune reconstitution.
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Affiliation(s)
- Edda Russo
- Department of Clinical and Experimental Medicine, University of Florence, Florence 50134, Italy
| | - Giulia Nannini
- Department of Clinical and Experimental Medicine, University of Florence, Florence 50134, Italy
| | - Gaetana Sterrantino
- Department of Clinical and Experimental Medicine, University of Florence, Florence 50134, Italy
| | - Seble Tekle Kiros
- Department of Clinical and Experimental Medicine, University of Florence, Florence 50134, Italy
| | - Vincenzo Di Pilato
- Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa 16126, Italy
| | - Marco Coppi
- Department of Clinical and Experimental Medicine, University of Florence, Florence 50134, Italy
| | - Simone Baldi
- Department of Clinical and Experimental Medicine, University of Florence, Florence 50134, Italy
| | - Elena Niccolai
- Department of Clinical and Experimental Medicine, University of Florence, Florence 50134, Italy
| | - Federica Ricci
- Department of Clinical and Experimental Medicine, University of Florence, Florence 50134, Italy
| | - Matteo Ramazzotti
- Department of Biomedical, Experimental and Clinical "Mario Serio", University of Florence, Florence 50134, Italy
| | - Marco Pallecchi
- Department of Biomedical, Experimental and Clinical "Mario Serio", University of Florence, Florence 50134, Italy
| | - Filippo Lagi
- Department of Clinical and Experimental Medicine, University of Florence, Florence 50134, Italy
| | - Gian Maria Rossolini
- Microbiology and Virology Unit, Florence Careggi University Hospital, University of Florence, Florence 50134, Italy
| | - Alessandro Bartoloni
- Department of Clinical and Experimental Medicine, University of Florence, Florence 50134, Italy
| | - Gianluca Bartolucci
- Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence, Florence 50019, Italy
| | - Amedeo Amedei
- Department of Clinical and Experimental Medicine, University of Florence, Florence 50134, Italy
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23
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Mazzoni A, Vanni A, Spinicci M, Lamacchia G, Kiros ST, Rocca A, Capone M, Di Lauria N, Salvati L, Carnasciali A, Mantengoli E, Farahvachi P, Zammarchi L, Lagi F, Colao MG, Liotta F, Cosmi L, Maggi L, Bartoloni A, Rossolini GM, Annunziato F. SARS-CoV-2 infection and vaccination trigger long-lived B and CD4+ T lymphocytes: implications for booster strategies. J Clin Invest 2022; 132:157990. [PMID: 35139036 PMCID: PMC8920339 DOI: 10.1172/jci157990] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 02/03/2022] [Indexed: 11/17/2022] Open
Affiliation(s)
- Alessio Mazzoni
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Anna Vanni
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Michele Spinicci
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Infectious and Tropical Diseases Unit
| | - Giulia Lamacchia
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Seble Tekle Kiros
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Infectious and Tropical Diseases Unit
| | - Arianna Rocca
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Manuela Capone
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | | | - Lorenzo Salvati
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Alberto Carnasciali
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | | | - Parham Farahvachi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Lorenzo Zammarchi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Infectious and Tropical Diseases Unit
| | | | | | - Francesco Liotta
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Immunology and Cell Therapy Unit, and
- Flow Cytometry Diagnostic Center and Immunotherapy, Careggi University Hospital, Florence, Italy
| | - Lorenzo Cosmi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Immunology and Cell Therapy Unit, and
| | - Laura Maggi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Alessandro Bartoloni
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Infectious and Tropical Diseases Unit
| | - Gian Maria Rossolini
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Microbiology and Virology Unit
| | - Francesco Annunziato
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Flow Cytometry Diagnostic Center and Immunotherapy, Careggi University Hospital, Florence, Italy
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24
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Ciccullo A, Baldin G, Borghi V, Lagi F, Latini A, d’Ettorre G, Oreni L, Fusco P, Capetti A, Fabbiani M, Giacomelli A, Grimaldi A, Madeddu G, Sterrantino G, Mussini C, Di Giambenedetto S. Real-Life Impact of Drug Toxicity on Dolutegravir Tolerability: Clinical Practice Data from a Multicenter Italian Cohort. Viruses 2022; 14:v14010163. [PMID: 35062367 PMCID: PMC8778073 DOI: 10.3390/v14010163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 01/08/2022] [Accepted: 01/11/2022] [Indexed: 11/23/2022] Open
Abstract
Dolutegravir (DTG) is currently one of the most used Integrase inhibitors (INI) in antiretroviral therapies (ARV) in both naïve and experienced people living with HIV (PLWHIV). We analyzed a multicenter cohort of PLWHIV, both naïve and experienced, starting an ARV including DTG. We enrolled 3775 PLWHIV: 2763 (73.2%) were males, with a median age of 50 years. During 9890.7 PYFU, we observed 930 discontinuations (9.4 per 100 PYFU). Estimated probabilities of maintaining DTG at three and five years were 75.1% and 67.2%, respectively. Treatment-naïve pts showed a lower probability of maintaining DTG at three and five years compared to treatment-experienced PLWHIV (log-rank p < 0.001). At a multivariate analysis, a longer time of virological suppression (aHR 0.994, p < 0.001) and having experienced a previous virological failure (aHR 0.788, p = 0.016) resulted protective against DTG discontinuation. Most discontinuations (84.0%) happened within the first 12 months of DTG initiation, in particular, 92.2% of discontinuations due to neuropsychiatric toxicity were observed in the first year. Our data confirm the overall good tolerability of DTG in clinical practice, with a low rate of discontinuations. CNS toxicity resulted the main reason for DTG discontinuation, with most related interruptions happening in the first year from DTG introduction.
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Affiliation(s)
- Arturo Ciccullo
- Infectious Diseases Unit, San Salvatore Hospital, 67100 L’Aquila, Italy;
- Correspondence:
| | - Gianmaria Baldin
- Mater Olbia Hospital, 07026 Olbia, Italy;
- Infectious Diseases Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy;
| | - Vanni Borghi
- Infectious and Tropical Diseases Unit, Azienda Ospedaliero Universitaria di Modena, 41125 Modena, Italy; (V.B.); (C.M.)
| | - Filippo Lagi
- Infectious and Tropical Diseases Unit, Careggi University Hospital, 50134 Florence, Italy; (F.L.); (G.S.)
| | - Alessandra Latini
- Infectious Dermatology and Allergology Unit, IFO S. Gallicano Institute (IRCCS), 00144 Rome, Italy;
| | - Gabriella d’Ettorre
- Department of Public Health and Infectious Diseases, Azienda Policlinico Umberto I, 00185 Rome, Italy;
| | - Letizia Oreni
- Infectious Diseases Unit, DIBIC Luigi Sacco, University of Milan, 20157 Milan, Italy; (L.O.); (A.G.)
| | - Paolo Fusco
- Infectious and Tropical Diseases Unit, Department of Medical and Surgical Sciences, “Magna Graecia” University of Catanzaro, 88100 Catanzaro, Italy;
| | - Amedeo Capetti
- 1st Division of Infectious Diseases, Luigi Sacco University Hospital, 20157 Milan, Italy;
| | - Massimiliano Fabbiani
- Infectious Diseases Unit, Azienda Ospedaliero-Universitaria Senese, 53100 Siena, Italy;
| | - Andrea Giacomelli
- Infectious Diseases Unit, DIBIC Luigi Sacco, University of Milan, 20157 Milan, Italy; (L.O.); (A.G.)
| | | | - Giordano Madeddu
- Unit of Infectious Diseases, Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100 Sassari, Italy;
| | - Gaetana Sterrantino
- Infectious and Tropical Diseases Unit, Careggi University Hospital, 50134 Florence, Italy; (F.L.); (G.S.)
| | - Cristina Mussini
- Infectious and Tropical Diseases Unit, Azienda Ospedaliero Universitaria di Modena, 41125 Modena, Italy; (V.B.); (C.M.)
| | - Simona Di Giambenedetto
- Infectious Diseases Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy;
- Department of Safety and Bioethics, Catholic University of the Sacred Heart, 00168 Rome, Italy
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25
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Morselli S, Sebastianelli A, Liaci A, Zaccaro C, Pecoraro A, Nicoletti R, Manera A, Bisegna C, Campi R, Pollini S, Antonelli A, Lagi F, Coppi M, Baldi E, Marchiani S, Nicolò S, Torcia M, Annunziato F, Maggi M, Vignozzi L, Bartoloni A, Rossolini GM, Serni S, Gacci M. Male reproductive system inflammation after healing from coronavirus disease 2019. Andrology 2021; 10:1030-1037. [PMID: 34889528 DOI: 10.1111/andr.13138] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 12/01/2021] [Accepted: 12/06/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND There is evidence that, after severe acute respiratory syndrome coronavirus 2 infection, male reproductive function and semen quality may be damaged OBJECTIVES: To evaluate a panel of inflammatory mediators in semen in patients recovered from coronavirus disease 2019. MATERIAL AND METHODS Sexually active men with previous severe acute respiratory syndrome coronavirus 2 infection and proven recovery from coronavirus disease 2019 were enrolled in a prospective cohort study. Clinical, uro-andrological data and semen specimens were prospectively collected. For previously hospitalized coronavirus disease 2019 patients, data on serum inflammatory markers were retrospectively collected. RESULTS A total of 43 men were enrolled in the study. Of these, 32 men were normozoospermic, three were oligozoospermic, and eight were crypto-azoospermic. Serum inflammatory markers (procalcitonin and C-reactive protein) were analyzed in previously hospitalized patients both at admission and at peak of infection. Levels at admission were statistically significantly higher in patients resulting in crypto-azoospermic with respect to those resulting in normozoospermic (p = 0.05; p = 0.03 and p = 0.02, respectively) after healing. Seminal cytokine levels were similar among all groups. Interleukin-1β and tumor necrosis factor-α levels were significantly negatively related to sperm total number and concentration, whereas interleukin-4 was correlated with sperm motility. DISCUSSION AND CONCLUSION Negative correlations between interleukin-1β and tumor necrosis factor-α and sperm number and the overall high levels of semen cytokines indicate a potential detrimental role of severe acute respiratory syndrome coronavirus 2 driven inflammation on spermatogenesis. Overall, our results indicate that male patients recovering from coronavirus disease 2019 deserve accurate follow-up for their fertility status.
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Affiliation(s)
- Simone Morselli
- Department of Minimally Invasive and Robotic Urologic Surgery and Kidney Transplantation, Careggi University Hospital (AOUC), University of Florence, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, University of Florence, Florence, Italy
| | - Arcangelo Sebastianelli
- Department of Minimally Invasive and Robotic Urologic Surgery and Kidney Transplantation, Careggi University Hospital (AOUC), University of Florence, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, University of Florence, Florence, Italy
| | - Andrea Liaci
- Department of Minimally Invasive and Robotic Urologic Surgery and Kidney Transplantation, Careggi University Hospital (AOUC), University of Florence, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, University of Florence, Florence, Italy
| | - Claudia Zaccaro
- Department of Minimally Invasive and Robotic Urologic Surgery and Kidney Transplantation, Careggi University Hospital (AOUC), University of Florence, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, University of Florence, Florence, Italy
| | - Alessio Pecoraro
- Department of Minimally Invasive and Robotic Urologic Surgery and Kidney Transplantation, Careggi University Hospital (AOUC), University of Florence, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, University of Florence, Florence, Italy
| | - Rossella Nicoletti
- Department of Minimally Invasive and Robotic Urologic Surgery and Kidney Transplantation, Careggi University Hospital (AOUC), University of Florence, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, University of Florence, Florence, Italy
| | - Alekseja Manera
- Department of Minimally Invasive and Robotic Urologic Surgery and Kidney Transplantation, Careggi University Hospital (AOUC), University of Florence, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, University of Florence, Florence, Italy
| | - Claudio Bisegna
- Department of Minimally Invasive and Robotic Urologic Surgery and Kidney Transplantation, Careggi University Hospital (AOUC), University of Florence, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, University of Florence, Florence, Italy
| | - Riccardo Campi
- Department of Minimally Invasive and Robotic Urologic Surgery and Kidney Transplantation, Careggi University Hospital (AOUC), University of Florence, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, University of Florence, Florence, Italy
| | - Simona Pollini
- Department of Experimental and Clinical Medicine, University of Florence, University of Florence, Florence, Italy.,Clinical Microbiology and Virology Unit, Florence Careggi University Hospital, University of Florence, Florence, Italy
| | - Alberto Antonelli
- Department of Experimental and Clinical Medicine, University of Florence, University of Florence, Florence, Italy.,Clinical Microbiology and Virology Unit, Florence Careggi University Hospital, University of Florence, Florence, Italy
| | - Filippo Lagi
- Department of Experimental and Clinical Medicine, University of Florence, University of Florence, Florence, Italy.,Infectious and Tropical Diseases Unit, Careggi University Hospital, University of Florence, Florence, Italy
| | - Marco Coppi
- Department of Experimental and Clinical Medicine, University of Florence, University of Florence, Florence, Italy.,Clinical Microbiology and Virology Unit, Florence Careggi University Hospital, University of Florence, Florence, Italy
| | - Elisabetta Baldi
- Department of Experimental and Clinical Medicine, University of Florence, University of Florence, Florence, Italy.,Unit of Sexual Medicine and Andrology, Center of Excellence DeNothe, University of Florence, Florence, Italy
| | - Sara Marchiani
- Department of Experimental and Clinical Biomedical Sciences Mario Serio University of Florence, Florence, Italy
| | - Sabrina Nicolò
- Department of Experimental and Clinical Biomedical Sciences Mario Serio University of Florence, Florence, Italy
| | - Maria Torcia
- Department of Experimental and Clinical Medicine, University of Florence, University of Florence, Florence, Italy.,Clinical Microbiology and Virology Unit, Florence Careggi University Hospital, University of Florence, Florence, Italy
| | - Francesco Annunziato
- Department of Experimental and Clinical Medicine, University of Florence, University of Florence, Florence, Italy
| | - Mario Maggi
- Department of Experimental and Clinical Biomedical Sciences Mario Serio University of Florence, Florence, Italy.,Sexual Medicine & Andrology Unit - Department of Experimental and Clinical Biomedical Sciences Mario Serio University of Florence, Florence, Italy
| | - Linda Vignozzi
- Department of Experimental and Clinical Biomedical Sciences Mario Serio University of Florence, Florence, Italy.,Sexual Medicine & Andrology Unit - Department of Experimental and Clinical Biomedical Sciences Mario Serio University of Florence, Florence, Italy
| | - Alessandro Bartoloni
- Department of Experimental and Clinical Medicine, University of Florence, University of Florence, Florence, Italy.,Infectious and Tropical Diseases Unit, Careggi University Hospital, University of Florence, Florence, Italy
| | - Gian Maria Rossolini
- Department of Experimental and Clinical Medicine, University of Florence, University of Florence, Florence, Italy.,Clinical Microbiology and Virology Unit, Florence Careggi University Hospital, University of Florence, Florence, Italy
| | - Sergio Serni
- Department of Minimally Invasive and Robotic Urologic Surgery and Kidney Transplantation, Careggi University Hospital (AOUC), University of Florence, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, University of Florence, Florence, Italy
| | - Mauro Gacci
- Department of Minimally Invasive and Robotic Urologic Surgery and Kidney Transplantation, Careggi University Hospital (AOUC), University of Florence, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, University of Florence, Florence, Italy
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26
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Lagi F, Bartoloni A, Suarez-Cuervo C. 1034. FebriDx use in Immunocompromised Patients in a Real-World Hospital Setting during the second (COVID-19) wave in Italy. Open Forum Infect Dis 2021. [PMCID: PMC8690834 DOI: 10.1093/ofid/ofab466.1228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
The diagnosis of acute respiratory infection (ARI) in patients with immunosuppression secondary to disease or medications is often unclear. Symptoms may be absent or blunted, and acute phase reactants, like procalcitonin (PCT) and C-reactive protein (CRP) may not elevate. For these patients, minor signs or symptoms could lead to hospitalization and antibiotic prescriptions to prevent complications or death. FebriDx® is a rapid, qualitative immunoassay test designed to distinguish between viral or bacterial respiratory infection through simultaneous detection of both CRP and Myxovirus resistance protein A (MxA) from a fingerstick blood sample.
Methods
FebriDx was evaluated as part of a real-world prospective, observational study in hospitalized patients with symptoms of ARI and suspected COVID-19 in a single tertiary care center in Italy (August, 2020 - January, 2021). A sub analysis of patients with expected reduced host immune responses secondary to immunosuppression by disease or medication was performed. (Classified by treating clinician; patient on high dose steroids/ immunosuppressive therapy, or underlying condition like cancer or autoimmune disease). Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and likelihood ratios were calculated for FebriDx with respect to the final diagnosis.
Results
We included 28 patients from 200 in the study, 16 patients had a final diagnosis of bacterial infection and 12 had viral infection. FebriDx showed a sensitivity of 91.7% to accurately diagnose viral infection and 93.8% for bacterial infection (see tables). Serum CRP was not available for 4 of the patients included (14%) and elevated in the remaining patients. PCT was not available for one patient with viral infection and was elevated in 50.0%.
FebriDx Performance when compared to Clinical Diagnosis
Conclusion
FebriDx demonstrated a higher accuracy for differentiating bacterial vs. viral infection in an immunocompromised cohort than single biomarkers CRP and PCT. FebriDx demonstrated a high diagnostic accuracy to differentiate viral from bacterial infection in patients with chronic immunosuppressive conditions in a real-world setting and had better performance than standalone CRP and PCT to distinguish viral and bacterial ARI in immunocompromised patients.
Disclosures
Catalina Suarez-Cuervo, MD, Lumos Diagnostics (Employee)
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Affiliation(s)
- Filippo Lagi
- Department of experimental and clinical medicine, Florence, Toscana, Italy
| | - Alessandro Bartoloni
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy, Florence, Toscana, Italy
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27
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Lagi F, Botta A, Kiros ST, Meli M, Borchi B, Cavallo A, Pozzi M, Bartoloni A, Sterrantino G. Comparison of the efficacy, safety and durability of a switch to co-formulated RPV/TDF-TAF/FTC or DTG/ABC/3TC in virologically-suppressed HIV-1-infected patients in a single Italian centre: a cohort data analysis. Int J Antimicrob Agents 2021; 59:106465. [PMID: 34699933 DOI: 10.1016/j.ijantimicag.2021.106465] [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: 01/22/2021] [Revised: 10/01/2021] [Accepted: 10/09/2021] [Indexed: 11/17/2022]
Abstract
This study evaluated the efficacy, safety and durability of a switch to co-formulated RPV/TDF-TAF/FTC (RPV-STR) or DTG/ABC/3TC (DTG-STR) in virologically-suppressed HIV-positive patients in a single Italian centre. All HIV-infected ART-experienced patients switching to RPV-STR or DTG-STR with HIV-RNA <50 copies/mL were included. Outcomes were incidence rate and rate ratios for discontinuation due to all causes (DAC), to adverse events (DAE) and to virological failure (VF) after 4 years of follow-up. We included 402 patients (244 on RPV-STR, 158 on DTG-STR). At Year 4 of follow-up, 124 patients (30.8%) discontinued for any cause (71 on RPV-STR, 53 on DTG-STR). Fifteen patients experienced VF [13 (5.3%) on RPV-STR and 2 (1.3%) on DTG-STR; log-rank, P = 0.4413]. Overall, 46 patients (11.4%) had AEs (23 on RPV-STR, 23 on DTG-STR). Nausea/diarrhoea was more frequent with DTG-STR (4.4% vs. 0%) and neurological toxicity with RPV-STR (4.5% vs. 2.5%). The rate of DAC within the first 3 months was significantly higher with DTG-STR (aRR = 5.88, 95% CI 3.20-10.81; P < 0.001); similarly, the discontinuation rate due to AEs was significantly higher with DTG-STR compared with RPV-STR (aRR = 12.89, 95% CI 5.48-30.32; P < 0.001). No difference in VF was observed between the two groups (RR = 0.47, 95% CI 0.10-2.14; P = 0.335). Patients with undetectable viral load who switched to DTG-STR or RPV-STR maintained virological suppression with a low risk of VF. A higher discontinuation rate was observed with DTG-STR compared with RPV-STR, particularly within 3 months from switch.
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Affiliation(s)
- Filippo Lagi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy
| | - Annarita Botta
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Seble Tekle Kiros
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Massimo Meli
- Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy
| | - Beatrice Borchi
- Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy
| | - Annalisa Cavallo
- Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy
| | - Marco Pozzi
- Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy
| | - Alessandro Bartoloni
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy
| | - Gaetana Sterrantino
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.
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Mazzitelli M, Ciccullo A, Baldin G, Cauda R, Rusconi S, Giacomelli A, Oreni L, Borghi V, Mussini C, Guaraldi G, Sterrantino G, Lagi F, Candelaresi B, Cirioni O, De Vito A, Rossetti B, Torti C, Di Giambenedetto S. Has COVID-19 changed the approach to HIV diagnosis?: A multicentric Italian experience. Medicine (Baltimore) 2021; 100:e27418. [PMID: 34731116 PMCID: PMC8519218 DOI: 10.1097/md.0000000000027418] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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] [Received: 03/26/2021] [Accepted: 09/14/2021] [Indexed: 01/05/2023] Open
Abstract
The occurrence of COVID-19 pandemic had a significant negative effect on health care systems over the last year. Health care providers were forced to focus mainly on COVID-19 patients, neglecting in many cases equally important diseases, both acute and chronic. Therefore, also screening and diagnostic strategies for HIV could have been significantly impaired.This retrospective, multicenter, observational study aimed at assessing the number and characteristics of new HIV/AIDS diagnoses during COVID-19 pandemic in Italy and compared characteristics of people living with HIV at diagnosis between pre- and post-COVID-19 era (2019 vs 2020).Our results showed a significant reduction of HIV diagnoses during pandemic. By contrast, people living with HIV during pandemic were older and were diagnosed in earlier stage of disease (considering CD4+ T cell count) compared to those who were diagnosed the year before. Moreover, there was a significant decrease of new HIV diagnoses among men who have sex with men, probably for the impact of social distancing and restriction applied by the Italian Government. Late presentation incidence, if numbers in 2020 were lower than those in 2019, is still an issue.Routinely performing HIV testing in patients with suspected SARS-CoV-2 infection is identifying and linking to care underdiagnosed people living with HIV earlier. Thus, combined tests (HIV and SARS-CoV-2) should be implemented in patients with SARS-CoV-2 symptoms overlapping HIV's ones. Lastly, our results lastly showed how urgent implementation of a national policy for HIV screening is necessary.
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Affiliation(s)
- Maria Mazzitelli
- Infectious and Tropical Diseases Unit, Department of Medical and Surgical Sciences, “Magna Graecia” University of Catanzaro, Catanzaro, Italy
| | | | | | - Roberto Cauda
- Catholic University of the Sacred Heart, Rome, Italy
- Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, Rome, Italy
| | - Stefano Rusconi
- III Infectious Diseases Unit, ASST FBF-Sacco, Milan, Italy
- UOC Malattie Infettive, Ospedale di Legnano, ASST Ovest Milanese, Italy
| | - Andrea Giacomelli
- III Infectious Diseases Unit, ASST FBF-Sacco, Milan, Italy
- DIBIC Luigi Sacco, Università degli Studi di Milano, Milan, Italy
| | - Letizia Oreni
- III Infectious Diseases Unit, ASST FBF-Sacco, Milan, Italy
- DIBIC Luigi Sacco, Università degli Studi di Milano, Milan, Italy
| | - Vanni Borghi
- Clinica Malattia Infettive, Università di Modena e Reggio Emilia
| | - Cristina Mussini
- Clinica Malattia Infettive, Università di Modena e Reggio Emilia
| | | | - Gaetana Sterrantino
- Dipartimento di Medicina clinica e Sperimentale presso l’Università degli studi di Firenze
| | - Filippo Lagi
- Dipartimento di Medicina clinica e Sperimentale presso l’Università degli studi di Firenze
| | - Bianca Candelaresi
- Clinica Malattie Infettive, Azienda Ospedaliero-Universitaria Ospedali Riuniti di Ancona, Ancona, Italy
| | - Oscar Cirioni
- Clinica Malattie Infettive, Azienda Ospedaliero-Universitaria Ospedali Riuniti di Ancona, Ancona, Italy
| | - Andrea De Vito
- Unit of Infectious Diseases, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Barbara Rossetti
- UOC Malattie Infettive e Tropicali, Azienda Ospedaliero-Universitaria Senese, Siena, Italy
| | - Carlo Torti
- Infectious and Tropical Diseases Unit, Department of Medical and Surgical Sciences, “Magna Graecia” University of Catanzaro, Catanzaro, Italy
| | - Simona Di Giambenedetto
- Catholic University of the Sacred Heart, Rome, Italy
- Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, Rome, Italy
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29
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Piccica M, Lagi F, Bartoloni A, Zammarchi L. Efficacy and safety of pentamidine isethionate for tegumentary and visceral human leishmaniasis: a systematic review. J Travel Med 2021; 28:6246322. [PMID: 33890115 DOI: 10.1093/jtm/taab065] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 03/23/2021] [Accepted: 04/14/2021] [Indexed: 11/14/2022]
Abstract
RATIONALE FOR REVIEW We performed a systematic review of the literature to investigate the efficacy and safety of pentamidine isethionate for the treatment of human tegumentary and visceral leishmaniasis. KEY FINDINGS A total of 616 papers were evaluated, and 88 studies reporting data on 3108 cases of leishmaniasis (2082 patients with tegumentary leishmaniasis and 1026 with visceral leishmaniasis) were finally included. The majority of available studies were on New World cutaneous leishmaniasis and visceral leishmaniasis caused by Leishmania donovani. At the same time, few data are available for Old World cutaneous leishmaniasis, mucosal leishmaniasis, and visceral leishmaniasis caused by L. infantum. Pooled cure rate for tegumentary leishmaniasis was 78.8% (CI 95%, 76.9-80.6%) and 92.7% (CI 95%, 88.3-97.1%) according to controlled randomized trial and observational studies and case report and case series respectively. Pooled cure rate for visceral leishmaniasis was 84.8% (CI 95%, 82.6-87.1%) and 90.7% (CI 95%, 84.1-97.3%) according to controlled randomized trial and observational studies and case report and case series, respectively. Comparable cure rate was observed in recurrent and refractory cases of visceral leishmaniasis. Concerning the safety profile, among about 2000 treated subjects with some available information, the most relevant side effects were six cases of arrhythmia (including four cases of fatal ventricular fibrillation), 20 cases of irreversible diabetes, 26 cases of muscular aseptic abscess following intramuscular administration. CONCLUSIONS/RECOMMENDATIONS Pentamidine isethionate is associated with a similar cure rate of the first-line anti-leishmanial drugs. Severe and irreversible adverse effect appear to be rare. The drug may still have a role in the treatment of any form of human leishmaniasis when the first-line option has failed or in patients who cannot tolerate other drugs also in the setting of travel medicine. In difficult cases, the drug can also be considered as a component of a combination treatment regimen.
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Affiliation(s)
- Matteo Piccica
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Filippo Lagi
- Infectious and Tropical Diseases Unit, Azienda Ospedaliero-Universitaria Careggi, largo Brambilla 3, Firenze (FI), Florence 50134, Italy
| | - Alessandro Bartoloni
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.,Infectious and Tropical Diseases Unit, Azienda Ospedaliero-Universitaria Careggi, largo Brambilla 3, Firenze (FI), Florence 50134, Italy
| | - Lorenzo Zammarchi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.,Infectious and Tropical Diseases Unit, Azienda Ospedaliero-Universitaria Careggi, largo Brambilla 3, Firenze (FI), Florence 50134, Italy
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30
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Lagi F, Botta A, Ciccullo A, Picarelli C, Fabbiani M, di Giambenedetto S, Borghi V, Mussini C, Bartoloni A, Sterrantino G. Early discontinuation of DTG/ABC/3TC and BIC/TAF/FTC single-tablet regimens: a real-life multicenter cohort study. HIV Res Clin Pract 2021; 22:96-101. [PMID: 34437817] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Background: Data regarding the efficacy and tolerability of DTG/ABC/3TC/and BIC/TAF/FTC in switching strategies are still scarce. The rates and reasons of early discontinuation within 24 weeks from the switch to dolutegravir (DTG) or bictegravir (BIC) single-tablet regimens (STRs) were compared.Methods: This is a multicenter cohort study. Persons living with HIV (PLWH) with HIV-1 RNA <50 copies/mL switching to BIC-STR or DTG-STR were included and followed-up 24 weeks. Major outcome was the analysis of (quantitative assessment of) discontinuation due to adverse events and self-suspension (EDAEs). Second, we assessed virologic failure (VF), and all-cause discontinuation (EDAC). Cox model for regression analysis was employed.Results: We included 786 PLWH: 524 with DTG, 262 with BIC. At week 24, we observed 70 EDAC: 5 for VF (1 with BIC and 4 with DTG; p = 0.6276), 10 simplifications, more frequently with BIC than DTG (n = 5, 1.9% and n = 5, 0.9%; p = 0.072) and 55 EDAEs, 7 (2.7%) with BIC, 48 (9.2%) with DTG (p = 0.0323). EDAEs due to neurological and gastrointestinal toxicity were similar (p = 0.2398 and p = 0.1160, respectively). There were no significant differences in the rates of VF and EDAC. EDAEs rate was significantly higher for DTG than for BIC. The adjusted HR for EDAEs in DTG group was 3.28 (95% CI: 1.34-8.00; p = 0.009). We identified an association between EDAE in the DTG group and having an age >60 and having switched from a regimen without ABC.Conclusions: PLWH who received DTG or BIC do not show differences in VF or EDAC rates. However, EDAEs is more frequent with DTG especially in the over-sixties and in those who come from regimens without abacavir.
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Affiliation(s)
- Filippo Lagi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy
| | - Annarita Botta
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Arturo Ciccullo
- Department of Safety and Bioethics, Catholic University of the Sacred Heart, Rome, Italy
- Gemelli Molise Hospital, Campobasso, Italy
| | - Chiara Picarelli
- IFO - Istituto Nazionale Tumori Regina Elena, Dermatologic Institute San Gallicano, Rome, Italy
| | - Massimiliano Fabbiani
- UOC Malattie Infettive e Tropicali, Azienda Ospedaliero-Universitaria Senese, Siena, Italy
| | - Simona di Giambenedetto
- Department of Safety and Bioethics, Catholic University of the Sacred Heart, Rome, Italy
- Institute of Clinical Infectious Diseases, Catholic University of the Sacred Heart, Rome, Italy
| | - Vanni Borghi
- Infectious and Tropical Diseases Unit, Azienda Ospedaliero Universitaria di Modena, Modena, Italy
| | - Cristina Mussini
- Infectious and Tropical Diseases Unit, Azienda Ospedaliero Universitaria di Modena, Modena, Italy
| | - Alessandro Bartoloni
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy
| | - Gaetana Sterrantino
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
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31
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Piccica M, Lagi F, Trotta M, Spinicci M, Zammarchi L, Bartoloni A. High-dose steroids for the treatment of severe COVID-19. Intern Emerg Med 2021; 16:1395-1399. [PMID: 33856664 PMCID: PMC8047517 DOI: 10.1007/s11739-021-02707-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 03/08/2021] [Indexed: 12/27/2022]
Affiliation(s)
- Matteo Piccica
- Department of Experimental and Clinical Medicine, SOD Malattie Infettive eTropicali, University of Florence, Largo Brambilla 3, 50134, Florence, Italy
| | - Filippo Lagi
- Department of Experimental and Clinical Medicine, SOD Malattie Infettive eTropicali, University of Florence, Largo Brambilla 3, 50134, Florence, Italy
- Infectious and Tropical Diseases Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Michele Trotta
- Infectious and Tropical Diseases Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Michele Spinicci
- Department of Experimental and Clinical Medicine, SOD Malattie Infettive eTropicali, University of Florence, Largo Brambilla 3, 50134, Florence, Italy.
- Infectious and Tropical Diseases Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
| | - Lorenzo Zammarchi
- Department of Experimental and Clinical Medicine, SOD Malattie Infettive eTropicali, University of Florence, Largo Brambilla 3, 50134, Florence, Italy
- Infectious and Tropical Diseases Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Alessandro Bartoloni
- Department of Experimental and Clinical Medicine, SOD Malattie Infettive eTropicali, University of Florence, Largo Brambilla 3, 50134, Florence, Italy
- Infectious and Tropical Diseases Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
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32
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Fabbiani M, Rossetti B, Ciccullo A, Oreni L, Lagi F, Celani L, Colafigli M, De Vito A, Mazzitelli M, Dusina A, Durante M, Montagnani F, Rusconi S, Capetti A, Sterrantino G, D'Ettorre G, Di Giambenedetto S. Efficacy and durability of two- vs. three-drug integrase inhibitor-based regimens in virologically suppressed HIV-infected patients: Data from real-life ODOACRE cohort. HIV Med 2021; 22:843-853. [PMID: 34318591 DOI: 10.1111/hiv.13146] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [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: 06/20/2021] [Accepted: 07/05/2021] [Indexed: 01/09/2023]
Abstract
OBJECTIVES The aim of the present study was to compare the efficacy and durability of treatment switch to two-drug (2DR) vs. three-drug (3DR) integrase inhibitor (InSTI)-based regimens in a real-life setting. METHODS Within the ODOACRE cohort, we selected adult patients with HIV RNA < 50 copies/mL switching to an InSTI-based 2DR or 3DR. Survival analyses were performed to estimate the probability of virological failure (VF, defined as one HIV RNA > 1000 copies/mL or two consecutive HIV RNA > 50 copies/mL) and treatment discontinuation (TD, defined as any modification, intensification or interruption of the regimen), and to evaluate their predictors. RESULTS Overall, 1666 patients were included, of whom 1334 (80%) were treated with a 3DR (19.9%, 25.0% and 55.1% elvitegravir-, raltegravir- and dolutegravir-based, respectively) and 332 (20%) with a 2DR (79.2% dolutegravir + lamivudine and 20.8% dolutegravir + rilpivirine). Over a median (interquartile range) follow-up of 100 (52-150) weeks, 52 (3.1%) patients experienced VF with an incidence of 1.5/100 person-year of follow-up (PYFU). The estimated 96-week probability of VF was similar for the 2DR and 3DR groups (2.3% vs. 2.8%, P = 0.53), but it was higher for elvitegravir (4.9%) and raltegravir (5.0%) than for dolutegravir (1.5%) (P = 0.04). Four hundred (24%) patients discontinued their InSTI-based regimen, with an incidence of 11.3/100 PYFU. At 96 weeks, 3DRs showed a higher probability of TD for any reason (20.6% vs. 11.2%, P < 0.001) and TD for toxicity (9.0% vs. 6.6%, P = 0.02) when compared with 2DRs. A higher risk of TD for central nervous system toxicity was observed for dolutegravir than for elvitegravir and raltegravir (4.0% vs. 2.5% vs. 0.6%, P = 0.005). CONCLUSIONS In virologically suppressed HIV-infected patients, 2DRs showed an efficacy similar to 3DRs but with better tolerability.
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Affiliation(s)
- Massimiliano Fabbiani
- UOC Malattie Infettive e Tropicali, Azienda Ospedaliero-Universitaria Senese, Siena, Italy
| | - Barbara Rossetti
- UOC Malattie Infettive e Tropicali, Azienda Ospedaliero-Universitaria Senese, Siena, Italy
| | - Arturo Ciccullo
- UOC Malattie Infettive, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Letizia Oreni
- Infectious Diseases Unit, DIBIC Luigi Sacco, University of Milan, Milan, Italy
| | - Filippo Lagi
- Malattie Infettive e Tropicali, Dipartimento di Medicina Clinica e Sperimentale, Università di Firenze, Firenze, Italy
| | - Luigi Celani
- Department of Public Health and Infectious Diseases - "Sapienza" University of Rome, Rome, Italy
| | - Manuela Colafigli
- Infectious Dermatology and Allergology Unit, IFO S. Gallicano Institute (IRCCS), Rome, Italy
| | - Andrea De Vito
- Unit of Infectious Diseases, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Maria Mazzitelli
- Infectious and Tropical Diseases Unit, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - Alex Dusina
- UOC Malattie Infettive, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Miriam Durante
- Dipartimento di Biotecnologie Mediche, Università degli Studi di Siena, Siena, Italy
| | - Francesca Montagnani
- UOC Malattie Infettive e Tropicali, Azienda Ospedaliero-Universitaria Senese, Siena, Italy.,Dipartimento di Biotecnologie Mediche, Università degli Studi di Siena, Siena, Italy
| | - Stefano Rusconi
- Infectious Diseases Unit, DIBIC Luigi Sacco, University of Milan, Milan, Italy
| | - Amedeo Capetti
- Division of Infectious Diseases, Department of Infectious Diseases, Luigi Sacco University Hospital, Milan, Italy
| | - Gaetana Sterrantino
- Malattie Infettive e Tropicali, Dipartimento di Medicina Clinica e Sperimentale, Università di Firenze, Firenze, Italy
| | - Gabriella D'Ettorre
- Department of Public Health and Infectious Diseases - "Sapienza" University of Rome, Rome, Italy
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33
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Mazzoni A, Di Lauria N, Maggi L, Salvati L, Vanni A, Capone M, Lamacchia G, Mantengoli E, Spinicci M, Zammarchi L, Kiros ST, Rocca A, Lagi F, Colao MG, Parronchi P, Scaletti C, Turco L, Liotta F, Rossolini GM, Cosmi L, Bartoloni A, Annunziato F. First-dose mRNA vaccination is sufficient to reactivate immunological memory to SARS-CoV-2 in subjects who have recovered from COVID-19. J Clin Invest 2021; 131:149150. [PMID: 33939647 DOI: 10.1172/jci149150] [Citation(s) in RCA: 97] [Impact Index Per Article: 32.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 04/26/2021] [Indexed: 12/21/2022] Open
Abstract
The characterization of the adaptive immune response to COVID-19 vaccination in individuals who recovered from SARS-CoV-2 infection may define current and future clinical practice. To determine the effect of the 2-dose BNT162b2 mRNA COVID-19 vaccination schedule in individuals who recovered from COVID-19 (COVID-19-recovered subjects) compared with naive subjects, we evaluated SARS-CoV-2 Spike-specific T and B cell responses, as well as specific IgA, IgG, IgM, and neutralizing antibodies titers in 22 individuals who received the BNT162b2 mRNA COVID-19 vaccine, 11 of whom had a previous history of SARS-CoV-2 infection. Evaluations were performed before vaccination and then weekly until 7 days after second injection. Data obtained clearly showed that one vaccine dose is sufficient to increase both cellular and humoral immune response in COVID-19-recovered subjects without any additional improvement after the second dose. On the contrary, the second dose proved mandatory in naive subjects to further enhance the immune response. These findings were further confirmed at the serological level in a larger cohort of naive (n = 68) and COVID-19-recovered (n = 29) subjects, tested up to 50 days after vaccination. These results question whether a second vaccine injection in COVID-19-recovered subjects is required, and indicate that millions of vaccine doses may be redirected to naive individuals, thus shortening the time to reach herd immunity.
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Affiliation(s)
- Alessio Mazzoni
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | | | - Laura Maggi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Lorenzo Salvati
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Anna Vanni
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Manuela Capone
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Giulia Lamacchia
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | | | - Michele Spinicci
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.,Infectious and Tropical Diseases Unit
| | - Lorenzo Zammarchi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.,Infectious and Tropical Diseases Unit
| | - Seble Tekle Kiros
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.,Infectious and Tropical Diseases Unit
| | - Arianna Rocca
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Filippo Lagi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | | | - Paola Parronchi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.,Immunology and Cell Therapy Unit
| | - Cristina Scaletti
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | | | - Francesco Liotta
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.,Immunology and Cell Therapy Unit
| | - Gian Maria Rossolini
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.,Microbiology and Virology Unit
| | - Lorenzo Cosmi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.,Immunology and Cell Therapy Unit
| | - Alessandro Bartoloni
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.,Infectious and Tropical Diseases Unit
| | - Francesco Annunziato
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.,Flow Cytometry Diagnostic Center and Immunotherapy, Careggi University Hospital, Florence, Italy
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34
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Gacci M, Coppi M, Baldi E, Sebastianelli A, Zaccaro C, Morselli S, Pecoraro A, Manera A, Nicoletti R, Liaci A, Bisegna C, Gemma L, Giancane S, Pollini S, Antonelli A, Lagi F, Marchiani S, Dabizzi S, Nicolò S, Torcia M, Degl'innocenti S, Annunziato F, Maggi M, Vignozzi L, Bartoloni A, Rossolini GM, Serni S. Reply: COVID-19: semen impairment may not be related to the virus. Hum Reprod 2021; 36:2065-2066. [PMID: 33793848 PMCID: PMC8083456 DOI: 10.1093/humrep/deab083] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Affiliation(s)
- Mauro Gacci
- Department of Minimally Invasive, Robotic Urologic Surgery & Kidney Transplantation, Careggi University Hospital (AOUC), University of Florence, Florence, Italy
| | - Marco Coppi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.,Clinical Microbiology and Virology Unit, Florence Careggi University Hospital, Florence, Italy
| | - Elisabetta Baldi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.,Unit of Andrology, Female Endocrinology and Gender Inconsistency, AOUC and Center of Excellence DeNothe, Department of Experimental and Clinical Biomedical Sciences Mario Serio, University of Florence, Florence, Italy
| | - Arcangelo Sebastianelli
- Department of Minimally Invasive, Robotic Urologic Surgery & Kidney Transplantation, Careggi University Hospital (AOUC), University of Florence, Florence, Italy
| | - Claudia Zaccaro
- Department of Minimally Invasive, Robotic Urologic Surgery & Kidney Transplantation, Careggi University Hospital (AOUC), University of Florence, Florence, Italy
| | - Simone Morselli
- Department of Minimally Invasive, Robotic Urologic Surgery & Kidney Transplantation, Careggi University Hospital (AOUC), University of Florence, Florence, Italy
| | - Alessio Pecoraro
- Department of Minimally Invasive, Robotic Urologic Surgery & Kidney Transplantation, Careggi University Hospital (AOUC), University of Florence, Florence, Italy
| | - Alekseja Manera
- Department of Minimally Invasive, Robotic Urologic Surgery & Kidney Transplantation, Careggi University Hospital (AOUC), University of Florence, Florence, Italy
| | - Rossella Nicoletti
- Department of Minimally Invasive, Robotic Urologic Surgery & Kidney Transplantation, Careggi University Hospital (AOUC), University of Florence, Florence, Italy
| | - Andrea Liaci
- Department of Minimally Invasive, Robotic Urologic Surgery & Kidney Transplantation, Careggi University Hospital (AOUC), University of Florence, Florence, Italy
| | - Claudio Bisegna
- Department of Minimally Invasive, Robotic Urologic Surgery & Kidney Transplantation, Careggi University Hospital (AOUC), University of Florence, Florence, Italy
| | - Luca Gemma
- Department of Minimally Invasive, Robotic Urologic Surgery & Kidney Transplantation, Careggi University Hospital (AOUC), University of Florence, Florence, Italy
| | - Saverio Giancane
- Department of Minimally Invasive, Robotic Urologic Surgery & Kidney Transplantation, Careggi University Hospital (AOUC), University of Florence, Florence, Italy
| | - Simona Pollini
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.,Clinical Microbiology and Virology Unit, Florence Careggi University Hospital, Florence, Italy
| | - Alberto Antonelli
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.,Clinical Microbiology and Virology Unit, Florence Careggi University Hospital, Florence, Italy
| | - Filippo Lagi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.,Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy
| | - Sara Marchiani
- Unit of Andrology, Female Endocrinology and Gender Inconsistency, AOUC and Center of Excellence DeNothe, Department of Experimental and Clinical Biomedical Sciences Mario Serio, University of Florence, Florence, Italy
| | - Sara Dabizzi
- Unit of Andrology, Female Endocrinology and Gender Inconsistency, AOUC and Center of Excellence DeNothe, Department of Experimental and Clinical Biomedical Sciences Mario Serio, University of Florence, Florence, Italy
| | - Sabrina Nicolò
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Maria Torcia
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Selene Degl'innocenti
- Unit of Andrology, Female Endocrinology and Gender Inconsistency, AOUC and Center of Excellence DeNothe, Department of Experimental and Clinical Biomedical Sciences Mario Serio, University of Florence, Florence, Italy
| | - Francesco Annunziato
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Mario Maggi
- Unit of Andrology, Female Endocrinology and Gender Inconsistency, AOUC and Center of Excellence DeNothe, Department of Experimental and Clinical Biomedical Sciences Mario Serio, University of Florence, Florence, Italy
| | - Linda Vignozzi
- Unit of Andrology, Female Endocrinology and Gender Inconsistency, AOUC and Center of Excellence DeNothe, Department of Experimental and Clinical Biomedical Sciences Mario Serio, University of Florence, Florence, Italy
| | - Alessandro Bartoloni
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.,Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy
| | - Gian Maria Rossolini
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.,Clinical Microbiology and Virology Unit, Florence Careggi University Hospital, Florence, Italy
| | - Sergio Serni
- Department of Minimally Invasive, Robotic Urologic Surgery & Kidney Transplantation, Careggi University Hospital (AOUC), University of Florence, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
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35
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Gacci M, Coppi M, Baldi E, Sebastianelli A, Zaccaro C, Morselli S, Pecoraro A, Manera A, Nicoletti R, Liaci A, Bisegna C, Gemma L, Giancane S, Pollini S, Antonelli A, Lagi F, Marchiani S, Dabizzi S, Degl’Innocenti S, Annunziato F, Maggi M, Vignozzi L, Bartoloni A, Rossolini GM, Serni S. Semen impairment and occurrence of SARS-CoV-2 virus in semen after recovery from COVID-19. Hum Reprod 2021; 36:1520-1529. [PMID: 33522572 PMCID: PMC7953947 DOI: 10.1093/humrep/deab026] [Citation(s) in RCA: 118] [Impact Index Per Article: 39.3] [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: 10/08/2020] [Revised: 12/28/2020] [Indexed: 12/11/2022] Open
Abstract
STUDY QUESTION How is the semen quality of sexually active men following recovery from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection? SUMMARY ANSWER Twenty-five percent of the men with recent SARS-Cov-2 infections and proven healing were oligo-crypto-azoospermic, despite the absence of virus RNA in semen. WHAT IS KNOWN ALREADY The presence of SARS-CoV-2 in human semen and its role in virus contagion and semen quality after recovery from coronavirus disease 2019 (COVID-19) is still unclear. So far, studies evaluating semen quality and the occurrence of SARS-CoV-2 in semen of infected or proven recovered men are scarce and included a limited number of participants. STUDY DESIGN, SIZE, DURATION A prospective cross-sectional study on 43 sexually active men who were known to have recovered from SARS-CoV2 was performed. Four biological fluid samples, namely saliva, pre-ejaculation urine, semen, and post-ejaculation urine, were tested for the SARS-CoV-2 genome. Female partners were retested if any specimen was found to be SARS-CoV-2 positive. Routine semen analysis and quantification of semen leukocytes and interleukin-8 (IL-8) levels were performed. PARTICIPANTS/MATERIALS, SETTING, METHODS Questionnaires including International Index of Erectile Function and Male Sexual Health Questionnaire Short Form were administered to all subjects. The occurrence of virus RNA was evaluated in all the biological fluids collected by RT-PCR. Semen parameters were evaluated according to the World Health Organization manual edition V. Semen IL-8 levels were evaluated by a two-step ELISA method. MAIN RESULTS AND THE ROLE OF CHANCE After recovery from COVID-19, 25% of the men studied were oligo-crypto-azoospermic. Of the 11 men with semen impairment, 8 were azoospermic and 3 were oligospermic. A total of 33 patients (76.7%) showed pathological levels of IL-8 in semen. Oligo-crypto-azoospermia was significantly related to COVID-19 severity (P < 0.001). Three patients (7%) tested positive for at least one sample (one saliva; one pre-ejaculation urine; one semen and one post-ejaculation urine), so the next day new nasopharyngeal swabs were collected. The results from these three patients and their partners were all negative for SARS-CoV-2. LIMITATIONS, REASONS FOR CAUTION Although crypto-azoospermia was found in a high percentage of men who had recovered from COVID-19, clearly exceeding the percentage found in the general population, the previous semen quality of these men was unknown nor is it known whether a recovery of testicular function was occurring. The low number of enrolled patients may limit the statistical power of study. WIDER IMPLICATIONS OF THE FINDINGS SARS-CoV-2 can be detected in saliva, urine, and semen in a small percentage of men who recovered from COVID-19. One-quarter of men who recovered from COVID-19 demonstrated oligo-crypto-azoospermia indicating that an assessment of semen quality should be recommended for men of reproductive age who are affected by COVID-19. STUDY FUNDING/COMPETING INTEREST(S) None. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- M Gacci
- Department of Minimally Invasive and Robotic Urologic Surgery and Kidney Transplantation, Careggi University Hospital (AOUC), University of Florence, 50134 Florence, Italy
| | - M Coppi
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy
- Clinical Microbiology and Virology Unit, Florence Careggi University Hospital, 50134 Florence, Italy
| | - E Baldi
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy
- Unit of Andrology, Female Endocrinology and Gender Incongruence, AOUC and Center of Excellence DeNothe, University of Florence, 50134 Florence, Italy
| | - A Sebastianelli
- Department of Minimally Invasive and Robotic Urologic Surgery and Kidney Transplantation, Careggi University Hospital (AOUC), University of Florence, 50134 Florence, Italy
| | - C Zaccaro
- Department of Minimally Invasive and Robotic Urologic Surgery and Kidney Transplantation, Careggi University Hospital (AOUC), University of Florence, 50134 Florence, Italy
| | - S Morselli
- Department of Minimally Invasive and Robotic Urologic Surgery and Kidney Transplantation, Careggi University Hospital (AOUC), University of Florence, 50134 Florence, Italy
| | - A Pecoraro
- Department of Minimally Invasive and Robotic Urologic Surgery and Kidney Transplantation, Careggi University Hospital (AOUC), University of Florence, 50134 Florence, Italy
| | - A Manera
- Department of Minimally Invasive and Robotic Urologic Surgery and Kidney Transplantation, Careggi University Hospital (AOUC), University of Florence, 50134 Florence, Italy
| | - R Nicoletti
- Department of Minimally Invasive and Robotic Urologic Surgery and Kidney Transplantation, Careggi University Hospital (AOUC), University of Florence, 50134 Florence, Italy
| | - A Liaci
- Department of Minimally Invasive and Robotic Urologic Surgery and Kidney Transplantation, Careggi University Hospital (AOUC), University of Florence, 50134 Florence, Italy
| | - C Bisegna
- Department of Minimally Invasive and Robotic Urologic Surgery and Kidney Transplantation, Careggi University Hospital (AOUC), University of Florence, 50134 Florence, Italy
| | - L Gemma
- Department of Minimally Invasive and Robotic Urologic Surgery and Kidney Transplantation, Careggi University Hospital (AOUC), University of Florence, 50134 Florence, Italy
| | - S Giancane
- Department of Minimally Invasive and Robotic Urologic Surgery and Kidney Transplantation, Careggi University Hospital (AOUC), University of Florence, 50134 Florence, Italy
| | - S Pollini
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy
- Clinical Microbiology and Virology Unit, Florence Careggi University Hospital, 50134 Florence, Italy
| | - A Antonelli
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy
- Clinical Microbiology and Virology Unit, Florence Careggi University Hospital, 50134 Florence, Italy
| | - F Lagi
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy
- Infectious and Tropical Diseases Unit, Careggi University Hospital, 50134 Florence, Italy
| | - S Marchiani
- Unit of Andrology, Female Endocrinology and Gender Incongruence, AOUC and Center of Excellence DeNothe, University of Florence, 50134 Florence, Italy
| | - S Dabizzi
- Unit of Andrology, Female Endocrinology and Gender Incongruence, AOUC and Center of Excellence DeNothe, University of Florence, 50134 Florence, Italy
| | | | - F Annunziato
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy
| | - M Maggi
- Endocrinology Unit and Department of Experimental, Clinical and Biomedical Sciences, University of Florence, 50134 Florence, Italy
| | - L Vignozzi
- Unit of Andrology, Female Endocrinology and Gender Incongruence, AOUC and Center of Excellence DeNothe, University of Florence, 50134 Florence, Italy
| | - A Bartoloni
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy
- Infectious and Tropical Diseases Unit, Careggi University Hospital, 50134 Florence, Italy
| | - G M Rossolini
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy
- Clinical Microbiology and Virology Unit, Florence Careggi University Hospital, 50134 Florence, Italy
| | - S Serni
- Department of Minimally Invasive and Robotic Urologic Surgery and Kidney Transplantation, Careggi University Hospital (AOUC), University of Florence, 50134 Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy
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36
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Lagi F, Trevisan S, Piccica M, Graziani L, Basile G, Mencarini J, Borchi B, Menicacci L, Vaudo M, Scotti V, Fabbri A, Bandini G, Tozzetti C, Berni A, Aiezza N, Pestelli G, Turchi V, Pignone AM, Poggesi L, Nozzoli C, Morettini A, Rossolini GM, Bartoloni A. Use of the FebriDx point-of-care test for the exclusion of SARS-CoV-2 diagnosis in a population with acute respiratory infection during the second (COVID-19) wave in Italy. Int J Infect Dis 2021; 108:231-236. [PMID: 33901656 PMCID: PMC8064815 DOI: 10.1016/j.ijid.2021.04.065] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 04/17/2021] [Accepted: 04/20/2021] [Indexed: 01/19/2023] Open
Abstract
Objective Evaluate the real-world accuracy of Myxovirus resistance protein A (MxA) detected by the rapid, point-of-care FebriDx test during the second-wave pandemic in Italy in patients with acute respiratory infection (ARI) and a clinical suspicion of COVID-19. Design and methods Prospective, observational, diagnostic accuracy study whereby hospitalized patients with ARI were consecutively enrolled in a single tertiary care center in Italy from August 1, 2020 to January 31, 2021. Results COVID-19 was diagnosed in 136/200 (68.0%) patients and Non-COVID-19 was diagnosed in 64/200 (32.0%) patients. COVID-19 patients were younger and had a lower Charlson comorbidity index compared to Non-COVID-19 patients (p < 0.001). Concordance between FebriDx, MxA and rt-PCR for SARS-CoV-2 (gold standard) was good (k 0.93, 95% CI 0.87–0.99). Overall sensitivity and specificity were 97.8% [95% CI 93.7–99.5] and 95.3% [95% CI 86.9%–99.0%], respectively. FebriDx demonstrated a negative predictive value of 95.3% (95% CI 86.9–99.0) for an observed disease prevalence of 68%. Conclusions FebriDx MxA showed high diagnostic accuracy to identify COVID-19 and could be considered as a real-time triage tool to streamline the management of suspected COVID-19 patients. FebriDx also detected bacterial etiology in Non-COVID-19 patients suggesting good performance to distinguish bacterial from viral respiratory infection.
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Affiliation(s)
- Filippo Lagi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy
| | - Sasha Trevisan
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Matteo Piccica
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Lucia Graziani
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Gregorio Basile
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Jessica Mencarini
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy
| | - Beatrice Borchi
- Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy
| | - Lorenzo Menicacci
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Micol Vaudo
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Valentina Scotti
- Internal Medicine Unit 2, Careggi University Hospital, Florence, Italy
| | - Alessia Fabbri
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Giulia Bandini
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | | | - Andrea Berni
- Internal Medicine Unit 3, AOU Careggi, Florence, Italy
| | - Noemi Aiezza
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Giulia Pestelli
- Internal Medicine Unit 1, Careggi University Hospital, Florence, Italy
| | - Valerio Turchi
- Internal Medicine Unit 1, Careggi University Hospital, Florence, Italy
| | - Alberto Moggi Pignone
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Loredana Poggesi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; Internal Medicine Unit 3, AOU Careggi, Florence, Italy
| | - Carlo Nozzoli
- Internal Medicine Unit 1, Careggi University Hospital, Florence, Italy
| | | | - Gian Maria Rossolini
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; Microbiology and Virology Unit, Careggi University Hospital, Florence, Italy
| | - Alessandro Bartoloni
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy.
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Granata G, Petrosillo N, Adamoli L, Bartoletti M, Bartoloni A, Basile G, Bassetti M, Bonfanti P, Borromeo R, Ceccarelli G, De Luca AM, Di Bella S, Fossati S, Franceschini E, Gentile I, Giacobbe DR, Giacometti E, Ingrassia F, Lagi F, Lobreglio G, Lombardi A, Lupo LI, Luzzati R, Maraolo AE, Mikulska M, Mondelli MU, Mularoni A, Mussini C, Oliva A, Pandolfo A, Rogati C, Trapani FF, Venditti M, Viale P, Caraffa E, Cataldo MA. Prospective Study on Incidence, Risk Factors and Outcome of Recurrent Clostridioides difficile Infections. J Clin Med 2021; 10:jcm10051127. [PMID: 33800334 PMCID: PMC7962640 DOI: 10.3390/jcm10051127] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 12/29/2020] [Revised: 02/03/2021] [Accepted: 02/19/2021] [Indexed: 12/14/2022] Open
Abstract
Background: Limited and wide-ranging data are available on the recurrent Clostridioides difficile infection (rCDI) incidence rate. Methods: We performed a cohort study with the aim to assess the incidence of and risk factors for rCDI. Adult patients with a first CDI, hospitalized in 15 Italian hospitals, were prospectively included and followed-up for 30 d after the end of antimicrobial treatment for their first CDI. A case–control study was performed to identify risk factors associated with 30-day onset rCDI. Results: Three hundred nine patients with a first CDI were included in the study; 32% of the CDI episodes (99/309) were severe/complicated; complete follow-up was available for 288 patients (19 died during the first CDI episode, and 2 were lost during follow-up). At the end of the study, the crude all-cause mortality rate was 10.7% (33 deaths/309 patients). Two hundred seventy-one patients completed the follow-up; rCDI occurred in 21% of patients (56/271) with an incidence rate of 72/10,000 patient-days. Logistic regression analysis identified exposure to cephalosporin as an independent risk factor associated with rCDI (RR: 1.7; 95% CI: 1.1–2.7, p = 0.03). Conclusion: Our study confirms the relevance of rCDI in terms of morbidity and mortality and provides a reliable estimation of its incidence.
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Affiliation(s)
- Guido Granata
- Clinical and Research Department for Infectious Diseases, National Institute for Infectious Diseases L. Spallanzani IRCCS, 00149 Rome, Italy; (G.G.); (E.C.); (M.A.C.)
| | - Nicola Petrosillo
- Clinical and Research Department for Infectious Diseases, National Institute for Infectious Diseases L. Spallanzani IRCCS, 00149 Rome, Italy; (G.G.); (E.C.); (M.A.C.)
- Correspondence: ; Tel.: +39-0655-170-432
| | - Lucia Adamoli
- Infectious Diseases ISMETT IRCCS, 90127 Palermo, Italy; (L.A.); (A.M.D.L.); (A.M.)
| | - Michele Bartoletti
- Department of Medical and Surgical Sciences, “Alma Mater Studiorum”, IRCCS S. Orsola Teaching Hospital, University of Bologna, 40126 Bologna, Italy; (M.B.); (F.F.T.); (P.V.)
| | - Alessandro Bartoloni
- Department of Experimental and Clinical Medicine, University of Florence, 50121 Florence, Italy; (A.B.); (G.B.); (F.L.)
| | - Gregorio Basile
- Department of Experimental and Clinical Medicine, University of Florence, 50121 Florence, Italy; (A.B.); (G.B.); (F.L.)
| | - Matteo Bassetti
- Department of Health Sciences (DISSAL), University of Genoa, 16126 Genoa, Italy; (M.B.); (D.R.G.); (M.M.)
- Infectious Diseases Unit, San Martino Polyclinic Hospital—IRCCS, 16132 Genoa, Italy
- Infectious Diseases Clinic, Department of Medicine University of Udine and Azienda Sanitaria Universitaria Integrata di Udine, 33100 Udine, Italy;
| | - Paolo Bonfanti
- Department of Infectious Diseases, San Gerardo Hospital, Monza—University of Milano-Bicocca, 20126 Milan, Italy;
| | | | - Giancarlo Ceccarelli
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Policlinico Umberto I, 00185 Rome, Italy; (G.C.); (A.O.); (M.V.)
| | - Anna Maria De Luca
- Infectious Diseases ISMETT IRCCS, 90127 Palermo, Italy; (L.A.); (A.M.D.L.); (A.M.)
| | - Stefano Di Bella
- Infectious Diseases Department, Azienda Sanitaria Universitaria Integrata di Trieste, 34128 Trieste, Italy; (S.D.B.); (S.F.); (R.L.)
| | - Sara Fossati
- Infectious Diseases Department, Azienda Sanitaria Universitaria Integrata di Trieste, 34128 Trieste, Italy; (S.D.B.); (S.F.); (R.L.)
| | - Erica Franceschini
- Clinic of Infectious Diseases, University of Modena and Reggio Emilia, 41121 Modena, Italy; (E.F.); (C.M.); (C.R.)
| | - Ivan Gentile
- Section of Infectious Diseases, Department of Clinical Medicine and Surgery, University of Naples “Federico II”, 80138 Naples, Italy; (I.G.); (A.E.M.)
| | - Daniele Roberto Giacobbe
- Department of Health Sciences (DISSAL), University of Genoa, 16126 Genoa, Italy; (M.B.); (D.R.G.); (M.M.)
- Infectious Diseases Unit, San Martino Polyclinic Hospital—IRCCS, 16132 Genoa, Italy
| | - Enrica Giacometti
- Infectious Diseases Clinic, Department of Medicine University of Udine and Azienda Sanitaria Universitaria Integrata di Udine, 33100 Udine, Italy;
| | | | - Filippo Lagi
- Department of Experimental and Clinical Medicine, University of Florence, 50121 Florence, Italy; (A.B.); (G.B.); (F.L.)
| | | | - Andrea Lombardi
- Division of Infectious Diseases and Immunology, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy; (A.L.); (M.U.M.)
| | | | - Roberto Luzzati
- Infectious Diseases Department, Azienda Sanitaria Universitaria Integrata di Trieste, 34128 Trieste, Italy; (S.D.B.); (S.F.); (R.L.)
| | - Alberto Enrico Maraolo
- Section of Infectious Diseases, Department of Clinical Medicine and Surgery, University of Naples “Federico II”, 80138 Naples, Italy; (I.G.); (A.E.M.)
| | - Malgorzata Mikulska
- Department of Health Sciences (DISSAL), University of Genoa, 16126 Genoa, Italy; (M.B.); (D.R.G.); (M.M.)
- Infectious Diseases Unit, San Martino Polyclinic Hospital—IRCCS, 16132 Genoa, Italy
| | - Mario Umberto Mondelli
- Division of Infectious Diseases and Immunology, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy; (A.L.); (M.U.M.)
| | - Alessandra Mularoni
- Infectious Diseases ISMETT IRCCS, 90127 Palermo, Italy; (L.A.); (A.M.D.L.); (A.M.)
| | - Cristina Mussini
- Clinic of Infectious Diseases, University of Modena and Reggio Emilia, 41121 Modena, Italy; (E.F.); (C.M.); (C.R.)
| | - Alessandra Oliva
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Policlinico Umberto I, 00185 Rome, Italy; (G.C.); (A.O.); (M.V.)
| | | | - Carlotta Rogati
- Clinic of Infectious Diseases, University of Modena and Reggio Emilia, 41121 Modena, Italy; (E.F.); (C.M.); (C.R.)
| | - Filippo Fabio Trapani
- Department of Medical and Surgical Sciences, “Alma Mater Studiorum”, IRCCS S. Orsola Teaching Hospital, University of Bologna, 40126 Bologna, Italy; (M.B.); (F.F.T.); (P.V.)
| | - Mario Venditti
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Policlinico Umberto I, 00185 Rome, Italy; (G.C.); (A.O.); (M.V.)
| | - Pierluigi Viale
- Department of Medical and Surgical Sciences, “Alma Mater Studiorum”, IRCCS S. Orsola Teaching Hospital, University of Bologna, 40126 Bologna, Italy; (M.B.); (F.F.T.); (P.V.)
| | - Emanuela Caraffa
- Clinical and Research Department for Infectious Diseases, National Institute for Infectious Diseases L. Spallanzani IRCCS, 00149 Rome, Italy; (G.G.); (E.C.); (M.A.C.)
| | - Maria Adriana Cataldo
- Clinical and Research Department for Infectious Diseases, National Institute for Infectious Diseases L. Spallanzani IRCCS, 00149 Rome, Italy; (G.G.); (E.C.); (M.A.C.)
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Locatello LG, Bruno C, Maggiore G, Cilona M, Orlando P, Fancello G, Piccica M, Vellere I, Lagi F, Trotta M, Gallo O. The prognostic role of IL-10 in non-severe COVID-19 with chemosensory dysfunction. Cytokine 2021; 141:155456. [PMID: 33561690 PMCID: PMC7952472 DOI: 10.1016/j.cyto.2021.155456] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 01/23/2021] [Accepted: 01/24/2021] [Indexed: 12/30/2022]
Abstract
Objectives Olfactory and gustatory dysfunction (OD/GD) are now recognized as typical symptoms of COVID-19 infection. However, their pathogenesis remains unclear and no clear prognostic factors have been identified. We have analyzed a cohort of mild/moderate hospitalized patients to identify possible clinical or immunological predictors of recovery from OD/GD. Methods Clinical and biological parameters were reviewed along with associated comorbidities. Chemosensory Complaint Score was administered on admission and 30 days after the first negative swab. Unpaired Wilcoxon and chi-squared tests were used to compare the variables in the patients who recovered versus those who did not. Results From a cohort of 119 hospitalized patients, 43 (36%) reported OD/GD on admission. 60.6% had a full recovery from OD and 69.2% from GD. Only the concentration of IL-10 on admission emerged as significantly associated with recovery of taste (p = 0.041) while allergic respiratory disease was more prevalent in the group who did not recover from OD (p = 0.049) and GD (p = 0.007). Conclusion These findings suggest that COVID-19 associated OD/GD is an inflammatory-mediated condition and that clinical and immunological parameters could predict the evolution of these symptoms.
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Affiliation(s)
- Luca Giovanni Locatello
- Department of Otorhinolaryngology, Careggi University Hospital, Largo Brambilla 3, 50134 Florence, Italy.
| | - Chiara Bruno
- Department of Otorhinolaryngology, Careggi University Hospital, Largo Brambilla 3, 50134 Florence, Italy
| | - Giandomenico Maggiore
- Department of Otorhinolaryngology, Careggi University Hospital, Largo Brambilla 3, 50134 Florence, Italy
| | - Maria Cilona
- Department of Otorhinolaryngology, Careggi University Hospital, Largo Brambilla 3, 50134 Florence, Italy
| | - Pietro Orlando
- Department of Otorhinolaryngology, Careggi University Hospital, Largo Brambilla 3, 50134 Florence, Italy
| | - Giuseppe Fancello
- Department of Otorhinolaryngology, Careggi University Hospital, Largo Brambilla 3, 50134 Florence, Italy
| | - Matteo Piccica
- Infectious and Tropical Diseases Unit, Careggi University Hospital, Largo Brambilla 3, 50134 Florence, Italy
| | - Iacopo Vellere
- Infectious and Tropical Diseases Unit, Careggi University Hospital, Largo Brambilla 3, 50134 Florence, Italy
| | - Filippo Lagi
- Infectious and Tropical Diseases Unit, Careggi University Hospital, Largo Brambilla 3, 50134 Florence, Italy
| | - Michele Trotta
- Infectious and Tropical Diseases Unit, Careggi University Hospital, Largo Brambilla 3, 50134 Florence, Italy
| | - Oreste Gallo
- Department of Otorhinolaryngology, Careggi University Hospital, Largo Brambilla 3, 50134 Florence, Italy; Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
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Ciccullo A, Baldin G, Borghi V, Sterrantino G, Madeddu G, Latini A, d'Ettorre G, Lanari A, Mazzitelli M, Colafigli M, Capetti AF, Oreni L, Lagi F, Rusconi S, Di Giambenedetto S. Overall Tolerability of Integrase Inhibitors in Clinical Practice: Results from a Multicenter Italian Cohort. AIDS Res Hum Retroviruses 2021; 37:4-10. [PMID: 32998526 DOI: 10.1089/aid.2020.0078] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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
International guidelines recommend the use of integrase strand transfer inhibitor (INI)-based regimens as first-line antiretroviral (ARV) in both naive and experienced HIV-infected patients. We analyzed a multicenter cohort of HIV-infected patients, both naive and experienced, starting an ARV, including an INI. Chi-square test and nonparametric tests were used to assess differences in categorical and continuous variables, respectively. Kaplan-Meier survival analysis was performed to estimate the probability of maintaining the study drug and Cox-regression analysis to evaluate predictors of discontinuation. We enrolled 4,343 patients: 3,143 (72.4%) were males, with a median age of 49 years (interquartile range 41-55). Naive patients were 733 (16.9%), of whom 168 (22.9%) were AIDS presenters. Overall, 2,282 patients (52.5%) started dolutegravir (DTG), 1,426 (32.8%) raltegravir (RAL), and 635 (14.7%) elvitegravir (EVG). During 10,032 patient years of follow-up (PYFU), we observed 1,278 discontinuations (13 per 100 PYFU); 448 of them (35%) due to simplification and 355 (28%) to toxicities (98 for central nervous system toxicity). Reasons of discontinuation were different between INIs. Estimated probability of maintaining DTG at 3 and 4 years were 81.5% [95% confidence interval (CI): 80.5-82.5] and 76.3% (95% CI: 73.9-78.7), respectively; RAL 61.6% (95% CI: 60.2-63.0) and 54.1% (95% CI: 52.7-55.5); EVG 71.6% (95% CI: 69.2-74.0) and 68.3% (95% CI: 65.3-71.3) (p < .001). At a multivariable analysis, being on a RAL-based ARV [vs. DTG, adjusted hazard ratio (aHR) 2.9, 95% CI: 2.3-3.6, p < .001], a EVG-based ARV (vs. DTG, aHR 1.3 95% CI: 1.1-1.7, p = .049), and a peak HIV-RNA >500k cp/mL (aHR 1.3, 95% CI: 1.1-1.6, p = .006) predicted INI discontinuation. Our data confirm the good tolerability of INIs in clinical practice. Differences emerge between the three drugs in reasons for discontinuation.
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Affiliation(s)
- Arturo Ciccullo
- Section of Infectious Diseases, Department of Safety and Bioethics, Catholic University of the Sacred Heart, Rome, Italy
- Infectious Diseases Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Gianmaria Baldin
- Section of Infectious Diseases, Department of Safety and Bioethics, Catholic University of the Sacred Heart, Rome, Italy
- Mater Olbia Hospital, Olbia, Italy
| | - Vanni Borghi
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria Policlinico of Modena, Modena, Italy
| | - Gaetana Sterrantino
- Division of Tropical and Infectious Diseases, ‘Careggi’ Hospital, Florence, Italy
| | - Giordano Madeddu
- Department of Clinical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Alessandra Latini
- Infectious Dermatology and Allergology Unit, IFO S. Gallicano Institute (IRCCS), Rome, Italy
| | - Gabriella d'Ettorre
- Department of Public Health and Infectious Diseases, Azienda Policlinico Umberto I, Rome, Italy
| | - Alessandro Lanari
- Infectious Diseases Unit, AOU Senese, Siena, Italy
- Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Maria Mazzitelli
- Department of Medical and Surgical Sciences, Unit of Infectious and Tropical Diseases, Magna Graecia University, Catanzaro, Italy
| | - Manuela Colafigli
- Infectious Dermatology and Allergology Unit, IFO S. Gallicano Institute (IRCCS), Rome, Italy
| | - Amedeo Ferdinando Capetti
- Division of Infectious Diseases, Department of Infectious Diseases, Luigi Sacco University Hospital, Milan, Italy
| | - Letizia Oreni
- Infectious Diseases Unit, DIBIC Luigi Sacco, University of Milan, Milan, Italy
| | - Filippo Lagi
- Division of Tropical and Infectious Diseases, ‘Careggi’ Hospital, Florence, Italy
| | - Stefano Rusconi
- Infectious Diseases Unit, DIBIC Luigi Sacco, University of Milan, Milan, Italy
| | - Simona Di Giambenedetto
- Section of Infectious Diseases, Department of Safety and Bioethics, Catholic University of the Sacred Heart, Rome, Italy
- Infectious Diseases Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
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40
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Papalini C, Lagi F, Schiaroli E, Sterrantino G, Francisci D. Transgender people living with HIV: characteristics and comparison to homosexual and heterosexual cisgender patients in two Italian teaching hospitals. Int J STD AIDS 2020; 32:194-198. [PMID: 33327898 DOI: 10.1177/0956462420950573] [Citation(s) in RCA: 1] [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: 11/17/2022]
Abstract
Regarding people living with HIV (PLHIV), little is known about the epidemiological characteristics and management decisions for transgender individuals. This retrospective study compared transgender and cisgender (homosexual and heterosexual) PLHIV at both the S. Maria della Misericordia of Perugia and Careggi of Firenze Teaching Hospitals from 2000 to 2018. Multivariate logistic regression was performed to analyse possible relationships between viral suppression (dependent variable) and age, sexually transmitted infections (STIs), and hepatitis diagnosis (independent variables). After analysing and comparing epidemiological and clinical data for 124 transgender, 180 homosexual cisgender and 188 heterosexual cisgender PLHIV, we found that transgender PLHIV, mostly Latin American sex workers, were more likely to have other STIs. Likewise, this subgroup, on average, was younger at the time of HIV diagnosis and more likely to be less adherent to care, consequently jeopardizing the achievement of viral suppression. Finally, the use of hormone therapy and gender confirmation surgery in transgender PLHIV contributed to specific management issues. To date, major attention has focused on studying the epidemiological characteristics of homosexual and heterosexual PLHIV. Our analysis found that transgender PLHIV were the least likely group to be adequately retained in the continuum of care and presented specific issues in part due to social and behavioural realities.
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Affiliation(s)
- Chiara Papalini
- Infectious Diseases Clinic, S. Maria della Misericordia Hospital, University of Perugia, Perugia, Italy
| | - Filippo Lagi
- Departement of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Elisabetta Schiaroli
- Infectious Diseases Clinic, S. Maria della Misericordia Hospital, University of Perugia, Perugia, Italy
| | - Gaetana Sterrantino
- Departement of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Daniela Francisci
- Infectious Diseases Clinic, S. Maria della Misericordia Hospital, University of Perugia, Perugia, Italy
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41
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Cataldo M, Granata G, Caraffa E, Adamoli L, Borromeo R, Fossati S, Franceschini E, Giacobbe D, Giacometti E, Lagi F, Lombardi A, Oliva A, Pandolfo A, Trapani F, Petrosillo N. Recurrence of Clostridioides difficile infection: A multicenter study on incidence and risk factors. Int J Infect Dis 2020. [DOI: 10.1016/j.ijid.2020.09.718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Lagi F, Kiros ST, Di Giambenedetto S, Lombardi F, Pecorari M, Borghi V, Lepore L, Monno L, Setti M, Micheli V, Bagnarelli P, Paolini E, Bai F, Bartoloni A, Sterrantino G. Long-term maintenance of virologic suppression in native and migrant HIV-1 naïve patients: an Italian cohort study. AIDS Care 2020; 33:1159-1166. [PMID: 33172289 DOI: 10.1080/09540121.2020.1839011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Little is known about long-term maintenance of virologic suppression in HIV migrants in Italy. The study aims to compare virologic failure rates and associated factors among antiretroviral therapy (ART)-naïve migrants and natives enrolled in the ARCA database since 2007 who achieved virologic suppression within 18 months from the beginning of the ART. Kaplan-Meier method assessed the probability of virologic suppression and failure. Cox regression model was used for multivariate analysis. Of 2515 patients, 2020 (80.3%) were Italian, 286 (10.6%) migrants from low-income countries, of whom 201 (75.0%) from Africa, and 227 (9.0%) from high-income-countries. The median follow-up was 4.5 years (IQR 2.5-7). No difference was observed in the time of achievement of virological suppression in the three groups (log-rank: p = 0.5687). Higher probability of virologic failure was observed in Africans compared to Italians, to patients from high-income-countries and from low-income-countries other than Africans (Log-rank = p < 0.001). In the adjusted analysis, a higher virologic failure risk was found in Africans only compared to Italians. [HR 4.01; 95% CI 2.44-6.56, p < 0.001]. In Italy, African migrants are less likely to maintain virologic suppression compared to natives and other migrants. Targeted interventions could be needed for foreigners, especially for Africans.
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Affiliation(s)
- Filippo Lagi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.,Infectious and Tropical Diseases Unit, Careggi University and Hospital, Florence, Italy
| | - Seble Tekle Kiros
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Simona Di Giambenedetto
- Institute of Clinical Infectious Diseases, Catholic University of Sacred Heart, Policlinico Gemelli, Rome, Italy
| | - Francesca Lombardi
- Institute of Clinical Infectious Diseases, Catholic University of Sacred Heart, Policlinico Gemelli, Rome, Italy
| | - Monica Pecorari
- Unit of Virology and Molecular Microbiology, University Hospital, Modena, Italy
| | - Vanni Borghi
- Department of Infectious Diseases, University of Modena, Modena, Italy
| | - Luciana Lepore
- Department of Biomedical Sciences and Human Oncology, Clinic of Infectious Diseases, University of Bari, Italy
| | - Laura Monno
- Department of Biomedical Sciences and Human Oncology, Clinic of Infectious Diseases, University of Bari, Italy
| | - Maurizio Setti
- Clinic of Immunology and Internal Medicine, Ospedale Policlinico San Martino, Genoa, Italy
| | - Valeria Micheli
- Microbiology and Virology Laboratory, L. Sacco Hospital, Milano, Italy
| | - Patrizia Bagnarelli
- Virology Unit, Azienda Ospedaliera Universitaria Ospedali Riuniti di Ancona, Ancona, Italy
| | - Elisabetta Paolini
- Immuno-Ematology and Transfusion Medicine Service, Cremona Hospital, Cremona, Italy
| | - Francesca Bai
- Infectious Diseases, San Paolo Hospital, Milan, Italy
| | - Alessandro Bartoloni
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.,Infectious and Tropical Diseases Unit, Careggi University and Hospital, Florence, Italy
| | - Gaetana Sterrantino
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
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Vellere I, Lagi F, Spinicci M, Mantella A, Mantengoli E, Corti G, Colao MG, Gobbi F, Rossolini GM, Bartoloni A, Zammarchi L. Arbo-Score: A Rapid Score for Early Identification of Patients with Imported Arbovirosis Caused by Dengue, Chikungunya and Zika Virus. Microorganisms 2020; 8:microorganisms8111731. [PMID: 33158274 PMCID: PMC7716211 DOI: 10.3390/microorganisms8111731] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 10/31/2020] [Accepted: 11/02/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Chikungunya (CHIKV), Dengue (DENV), and Zika (ZIKV) viruses present significant clinical and epidemiological overlap, making an accurate and rapid diagnosis challenging. Timely activation of preventive vector control measures is crucial to avoid outbreaks in non-endemic settings. Diagnosis is based on combination of serological and molecular assays which could be time consuming and sometimes disappointing. METHODS We report the results of a retrospective case-control study carried out at a tertiary teaching hospital in Italy, including all febrile subjects returning from tropical countries during the period 2014-2019. Controls were travelers with other febrile illnesses who tested negative in laboratory analysis for CHIKV, DENV, ZIKV arbovirosis. A score weighted on the regression coefficients for the independent predictors was generated. RESULTS Ninety patients were identified: 34 cases (22 DENV, 4 CHIKV, and 8 ZIKV) and 56 controls. According to our results, myalgia, cutaneous rash, absence of respiratory symptoms, leukopenia, and hypertransaminasemia showed the strongest association with arbovirosis. Combining these variables, we generated a scoring model that showed an excellent performance (AUC 0.93). The best cut-off (>=2) presented a sensitivity of 82.35% and specificity of 96.43%. CONCLUSION A handy and simple score, based on three clinical data (myalgia, cutaneous rash and absence of respiratory symptoms) and two laboratory results (leukopenia and hypertransaminasemia), provides a useful tool to help diagnose arboviral infections and appropriately activate vector control measures in order to avoid local transmission.
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Affiliation(s)
- Iacopo Vellere
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy; (I.V.); (F.L.); (M.S.); (A.M.); (G.C.); (G.M.R.); (A.B.)
| | - Filippo Lagi
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy; (I.V.); (F.L.); (M.S.); (A.M.); (G.C.); (G.M.R.); (A.B.)
- Infectious and Tropical Diseases Unit, Careggi University Hospital, 50134 Florence, Italy;
| | - Michele Spinicci
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy; (I.V.); (F.L.); (M.S.); (A.M.); (G.C.); (G.M.R.); (A.B.)
- Referral Centre for Tropical Diseases of Tuscany, Infectious and Tropical Diseases Unit, Careggi University Hospital, 50134 Florence, Italy
| | - Antonia Mantella
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy; (I.V.); (F.L.); (M.S.); (A.M.); (G.C.); (G.M.R.); (A.B.)
| | - Elisabetta Mantengoli
- Infectious and Tropical Diseases Unit, Careggi University Hospital, 50134 Florence, Italy;
| | - Giampaolo Corti
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy; (I.V.); (F.L.); (M.S.); (A.M.); (G.C.); (G.M.R.); (A.B.)
- Infectious and Tropical Diseases Unit, Careggi University Hospital, 50134 Florence, Italy;
| | - Maria Grazia Colao
- Clinical Microbiology and Virology Unit, Careggi University Hospital, 50134 Florence, Italy;
| | - Federico Gobbi
- Department of Infectious/Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, 37024 Negrar, Verona, Italy;
| | - Gian Maria Rossolini
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy; (I.V.); (F.L.); (M.S.); (A.M.); (G.C.); (G.M.R.); (A.B.)
- Clinical Microbiology and Virology Unit, Careggi University Hospital, 50134 Florence, Italy;
| | - Alessandro Bartoloni
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy; (I.V.); (F.L.); (M.S.); (A.M.); (G.C.); (G.M.R.); (A.B.)
- Referral Centre for Tropical Diseases of Tuscany, Infectious and Tropical Diseases Unit, Careggi University Hospital, 50134 Florence, Italy
| | - Lorenzo Zammarchi
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy; (I.V.); (F.L.); (M.S.); (A.M.); (G.C.); (G.M.R.); (A.B.)
- Referral Centre for Tropical Diseases of Tuscany, Infectious and Tropical Diseases Unit, Careggi University Hospital, 50134 Florence, Italy
- Correspondence: ; Tel.: +39-0557949431
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Vultaggio A, Vivarelli E, Virgili G, Lucenteforte E, Bartoloni A, Nozzoli C, Morettini A, Berni A, Malandrino D, Rossi O, Nencini F, Pieralli F, Peris A, Lagi F, Scocchera G, Spinicci M, Trotta M, Mazzetti M, Parronchi P, Cosmi L, Liotta F, Fontanari P, Mazzoni A, Salvati L, Maggi E, Annunziato F, Almerigogna F, Matucci A. Prompt Predicting of Early Clinical Deterioration of Moderate-to-Severe COVID-19 Patients: Usefulness of a Combined Score Using IL-6 in a Preliminary Study. J Allergy Clin Immunol Pract 2020; 8:2575-2581.e2. [PMID: 32565226 PMCID: PMC7303032 DOI: 10.1016/j.jaip.2020.06.013] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 05/18/2020] [Accepted: 06/12/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND The early identification of patients at risk of clinical deterioration is of interest considering the timeline of COVID-19 after the onset of symptoms. OBJECTIVE The aim of our study was to evaluate the usefulness of testing serum IL-6 and other serological and clinical biomarkers, to predict a short-term negative clinical course of patients with noncritical COVID-19. METHODS A total of 208 patients with noncritical COVID-19 pneumonia at admission were consecutively enrolled. Clinical and laboratory findings obtained on admission were analyzed by using survival analysis and stepwise logistic regression for variable selection. Three-day worsening as outcome in a logistic model to generate a prognostic score was used. RESULTS Clinical worsening occurred in 63 patients (16 = died; 39 = transferred to intensive care unit; 8 worsening of respiratory failure). Forty-five of them worsened within 3 days after admission. The risk of clinical worsening was progressively enhanced along with increasing quartiles of IL-6 levels. Multivariate analysis showed that IL-6 (P = .005), C-reactive protein (CRP) (P = .003), and SaO2/FiO2 (P = .014) were the best predictors for clinical deterioration in the first 3 days after admission. The combined score yielded an area under the curve = 0.88 (95% confidence interval: 0.83-0.93). A nomogram predicting the probability of 3-day worsening was generated. The score also showed good performance for 7-day and 14- or 21-day worsening and in predicting death occurring during all the follow-up. CONCLUSIONS Combining IL-6, CRP, and SaO2/FiO2 in a score may help clinicians to identify on admission those patients with COVID-19 who are at high risk for a further 3-day clinical deterioration.
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Affiliation(s)
| | | | - Gianni Virgili
- Department of Ophthalmology, Careggi University Hospital, Florence, Italy
| | - Ersilia Lucenteforte
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Alessandro Bartoloni
- Department of Experimental and Clinical Medicine, Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy
| | - Carlo Nozzoli
- Internal Medicine Unit 1, Careggi University Hospital, Florence, Italy
| | | | - Andrea Berni
- Internal Medicine Unit 3, Careggi University Hospital, Florence, Italy
| | - Danilo Malandrino
- Internal Medicine Unit 3, Careggi University Hospital, Florence, Italy
| | - Oliviero Rossi
- Immunoallergology Unit, Careggi University Hospital, Florence, Italy
| | - Francesca Nencini
- Immunoallergology Unit, Careggi University Hospital, Florence, Italy
| | - Filippo Pieralli
- Intermediate Care Unit, Careggi University Hospital, Florence, Italy
| | - Adriano Peris
- Intensive Care Unit and Regional ECMO Referral Centre, Careggi University Hospital, Florence, Italy
| | - Filippo Lagi
- Department of Experimental and Clinical Medicine, Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy
| | - Giulia Scocchera
- Internal Medicine Unit 2, Careggi University Hospital, Florence, Italy
| | - Michele Spinicci
- Department of Experimental and Clinical Medicine, Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy
| | - Michele Trotta
- Department of Experimental and Clinical Medicine, Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy
| | - Marcello Mazzetti
- Department of Experimental and Clinical Medicine, Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy
| | - Paola Parronchi
- Department of Experimental and Clinical Medicine, Immunology and Cell Therapy Unit, Careggi University Hospital, Florence, Italy
| | - Lorenzo Cosmi
- Department of Experimental and Clinical Medicine, Immunology and Cell Therapy Unit, Careggi University Hospital, Florence, Italy
| | - Francesco Liotta
- Department of Experimental and Clinical Medicine, Immunology and Cell Therapy Unit, Careggi University Hospital, Florence, Italy
| | - Paolo Fontanari
- Cardiac Anesthesia and Intensive Care Unit, Careggi University Hospital, Florence, Italy
| | - Alessio Mazzoni
- Department of Experimental and Clinical Medicine, Flow Cytometric Diagnostic Centre and Immunotherapy (CDCI), Careggi University Hospital, Florence, Italy
| | - Lorenzo Salvati
- Department of Experimental and Clinical Medicine, Immunology and Cell Therapy Unit, Careggi University Hospital, Florence, Italy
| | - Enrico Maggi
- Translational Immunology Unit, Immunology Area, Pediatric Hospital Bambino Gesù, IRCCS, Rome, Italy
| | - Francesco Annunziato
- Department of Experimental and Clinical Medicine, Flow Cytometric Diagnostic Centre and Immunotherapy (CDCI), Careggi University Hospital, Florence, Italy
| | - Fabio Almerigogna
- Immunoallergology Unit, Careggi University Hospital, Florence, Italy
| | - Andrea Matucci
- Immunoallergology Unit, Careggi University Hospital, Florence, Italy.
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45
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Pontecorboli G, Lagi F, Bagli M, De Vito E, Millotti G, Botta A, Cappelli F, Mattesini A, Acquafresca M, Barletta G, Del Bene R, Colagrande S, Marcucci R, Bartoloni A, Di Mario C, Martinelli CV. Results of comprehensive cardiovascular diagnostic work-up in HIV positive patients. Infez Med 2020; 28:397-406. [PMID: 32920576] [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: 06/11/2023]
Abstract
Cardiovascular disease (CVD) in the HIV population accounts for a large proportion of morbidity and mortality and, with the increased life expectancy, the burden of CVD is expected to rise. Inflammation, immune dysfunction, side effects of HIV medications, high prevalence of other risk factors are the likely pathogenic mechanisms for accelerated atherosclerosis. We aimed to evaluate the diagnostic yield of a cardiovascular multimodality diagnostic work-up in a contemporary cohort of HIV-infected patients. From November 2017 to October 2019, HIV infected patients were screened in a cardiovascular diagnostic work-up program including clinical history, physical examination, arterial blood pressure measurement, 12-lead ECG, and Transthoracic Echocardiogram (TTE). Advanced non-invasive cardiovascular imaging tests, like Coronary Computed Tomography Angiography (CCTA), stress-echocardiography, Cardiac Magnetic Resonance (CMR), were performed in patients with suspicion of chronic coronary syndrome (CCS) or non-ischemic heart disease (NIHD). 117 HIV-infected consecutive patients underwent this cardiovascular diagnostic work-up and were included in our study. Fifty-two patients (45%) had evidence of CVD. Of them, 22 presented Coronary Artery Disease (CAD), whereas 47 cases showed NIHD. In 17 cases both conditions were present. Among patients with CAD, 8 showed critical coronary stenosis; among them, 5 were treated with percutaneous coronary intervention, 2 with Aorto-Coronary By-Pass Grafting (CABG), and one with medical therapy. Hypertension and diabetes were significantly associated with the development of CVD (respectively p<0.001 and p< 0.05), while current smoking (p<0.02) and hypertension (p<0.007) were positively associated to CAD. A comprehensive cardiovascular diagnostic work-up including advanced multimodality diagnostic imaging modalities led to early detection of CVD in nearly half of an HIV population with immediate interventions required in 6.8% of them, and aggressive prevention treatment started in the remaining HIV patients.
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Affiliation(s)
- Giulia Pontecorboli
- Cardiovascular and Thoracic Department, Careggi University Hospital, Florence, Italy; Department of Experimental and Clinical Biomedical Sciences, University of Florence, Italy
| | - Filippo Lagi
- Department of Experimental and Clinical Biomedical Sciences, University of Florence, Italy
| | - Mauro Bagli
- Cardiovascular and Thoracic Department, Careggi University Hospital, Florence, Italy
| | - Elena De Vito
- Cardiovascular and Thoracic Department, Careggi University Hospital, Florence, Italy
| | - Giovanni Millotti
- Department of Tropical and Infectious disease, Careggi University Hospital, Florence, Italy
| | - Annarita Botta
- Department of Tropical and Infectious disease, Careggi University Hospital, Florence, Italy
| | - Francesco Cappelli
- Cardiovascular and Thoracic Department, Careggi University Hospital, Florence, Italy; Department of Experimental and Clinical Biomedical Sciences, University of Florence, Italy
| | - Alessio Mattesini
- Cardiovascular and Thoracic Department, Careggi University Hospital, Florence, Italy
| | | | - Giuseppe Barletta
- Cardiovascular and Thoracic Department, Careggi University Hospital, Florence, Italy
| | - Riccarda Del Bene
- Cardiovascular and Thoracic Department, Careggi University Hospital, Florence, Italy
| | - Stefano Colagrande
- Department of Experimental and Clinical Biomedical Sciences, University of Florence, Italy; Radiodiagnostic Unit n. 2, Careggi University Hospital, Florence, Italy
| | - Rossella Marcucci
- Department of Experimental and Clinical Biomedical Sciences, University of Florence, Italy: Atherothrombotic Diseases Center, Careggi University Hospital, Florence, Italy
| | - Alessandro Bartoloni
- Department of Experimental and Clinical Biomedical Sciences, University of Florence, Italy; Department of Tropical and Infectious disease, Careggi University Hospital, Florence, Italy
| | - Carlo Di Mario
- Cardiovascular and Thoracic Department, Careggi University Hospital, Florence, Italy; Department of Experimental and Clinical Biomedical Sciences, University of Florence, Italy
| | - Canio Vito Martinelli
- Department of Tropical and Infectious disease, Careggi University Hospital, Florence, Italy
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46
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Gallo O, Locatello LG, Orlando P, Martelli F, Piccica M, Lagi F, Trotta M. Cancer population may be paradoxically protected from severe manifestations of COVID-19. J Infect 2020; 81:e156-e158. [PMID: 32534002 PMCID: PMC7286269 DOI: 10.1016/j.jinf.2020.06.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 06/06/2020] [Indexed: 12/19/2022]
Affiliation(s)
- Oreste Gallo
- Department of Otorhinolaryngology, Careggi University Hospital, Largo Brambilla, 3, 50134 Florence, Italy
| | - Luca Giovanni Locatello
- Department of Otorhinolaryngology, Careggi University Hospital, Largo Brambilla, 3, 50134 Florence, Italy
| | - Pietro Orlando
- Department of Otorhinolaryngology, Careggi University Hospital, Largo Brambilla, 3, 50134 Florence, Italy
| | - Federica Martelli
- Department of Otorhinolaryngology, Careggi University Hospital, Largo Brambilla, 3, 50134 Florence, Italy
| | - Matteo Piccica
- Department of Infectious and Tropical Diseases, Careggi University Hospital, Largo Brambilla, 3, 50134 Florence, Italy
| | - Filippo Lagi
- Department of Infectious and Tropical Diseases, Careggi University Hospital, Largo Brambilla, 3, 50134 Florence, Italy
| | - Michele Trotta
- Department of Infectious and Tropical Diseases, Careggi University Hospital, Largo Brambilla, 3, 50134 Florence, Italy.
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47
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Lagi F, Pollini S, Zammarchi L. Clinical role of viral identification by a polymerase chain reaction-based diagnostic panel in adults hospitalized with community-acquired pneumonia. Intern Emerg Med 2020; 15:563-565. [PMID: 32006218 PMCID: PMC7088805 DOI: 10.1007/s11739-020-02282-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 01/19/2020] [Indexed: 12/18/2022]
Affiliation(s)
- Filippo Lagi
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla 3, 50124, Florence, Italy.
| | - Simona Pollini
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla 3, 50124, Florence, Italy
- Microbiology and Virology Unit, Careggi University Hospital, Florence, Italy
| | - Lorenzo Zammarchi
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla 3, 50124, Florence, Italy
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48
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Lagi F, Piccica M, Graziani L, Vellere I, Botta A, Tilli M, Ottino L, Borchi B, Pozzi M, Bartalesi F, Mencarini J, Spinicci M, Zammarchi L, Pieralli F, Zagli G, Nozzoli C, Romagnoli S, Bartoloni A. Early experience of an infectious and tropical diseases unit during the coronavirus disease (COVID-19) pandemic, Florence, Italy, February to March 2020. ACTA ACUST UNITED AC 2020; 25. [PMID: 32372754 PMCID: PMC7201949 DOI: 10.2807/1560-7917.es.2020.25.17.2000556] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
We analysed the first 84 coronavirus disease (COVID-19) patients hospitalised in an infectious and tropical disease unit in Florence, Italy, over 30 days after the start of the COVID-19 outbreak in Italy. A 12% reduction in the rate of intensive care unit transfer was observed after the implementation of intensity care measures in the regular ward such as increasing the nurse/patient ratio, presence of critical care physicians and using high flow nasal cannulae oxygenation.
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Affiliation(s)
- Filippo Lagi
- Infectious and Tropical Diseases Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Matteo Piccica
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Lucia Graziani
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Iacopo Vellere
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Annarita Botta
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Marta Tilli
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Letizia Ottino
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Beatrice Borchi
- Infectious and Tropical Diseases Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Marco Pozzi
- Infectious and Tropical Diseases Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Filippo Bartalesi
- Infectious and Tropical Diseases Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Jessica Mencarini
- Infectious and Tropical Diseases Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Michele Spinicci
- Infectious and Tropical Diseases Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Lorenzo Zammarchi
- Infectious and Tropical Diseases Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Filippo Pieralli
- Intermediate Care Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Giovanni Zagli
- Department of Anesthesiology and Intensive Care, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Carlo Nozzoli
- Department of Internal Medicine, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Stefano Romagnoli
- Health Sciences Department, Section of Anesthesiology, Intensive Care and Pain Medicine - University of Florence, Florence, Italy.,Department of Anesthesiology and Intensive Care, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Alessandro Bartoloni
- Infectious and Tropical Diseases Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
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49
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Ciccullo A, Baldin G, Capetti A, Rusconi S, Sterrantino G, d'Ettorre G, Colafigli M, Modica S, Lagi F, Giacomelli A, Cossu MV, Restelli S, De Luca A, Di Giambenedetto S. A comparison between two dolutegravir-based two-drug regimens as switch strategies in a multicentre cohort of HIV-1-infected patients. Antivir Ther 2020; 24:63-67. [PMID: 30277466 DOI: 10.3851/imp3270] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/24/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Two-drug regimens are increasingly used in clinical practice as switch strategies. We compared the efficacy and safety of two dolutegravir (DTG)-based dual therapies: DTG plus lamivudine (3TC group) versus DTG plus rilpivirine (RPV group). METHODS In a multicentre cohort of virologically suppressed (HIV RNA <50 copies/ml) HIV+ patients switching to DTG+3TC or DTG+RPV we analysed the incidence of virological failures (VF) and treatment discontinuations (TD), as well as their predictors. RESULTS We analysed 416 patients, 229 in the 3TC group and 187 in the RPV group. The 3TC group, during 344.4 person-years of follow-up (PYFU), had 10 VF without the emergence of resistance mutations, while 30 patients discontinued the regimen. In the RPV group, during 371.0 PYFU, there were 5 VF (1 developed non-nucleoside reverse transcriptase inhibitor mutations Y181C and E138Q) and 13 TD. The estimated probability of remaining free from VF at 48 weeks showed no significant difference between groups (log-rank 0.172). We found a higher risk of VF in patients with peak viral load >500,000 copies/ml in both treatment groups (log-rank P=0.004 in each group). The estimated probability of remaining in the study regimen at week 48 was 89.0% with DTG+3TC and 96.1% with DTG+RPV (log-rank 0.015). After adjusting for potential confounders, treatment group was not associated with TD. A significant decrease in total cholesterol was observed at week 48 in both groups while renal function remained unchanged. CONCLUSIONS DTG+RPV and DTG+3TC were compared in populations with different characteristics in clinical practice: both regimens showed good effectiveness and improved lipid profile.
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Affiliation(s)
- Arturo Ciccullo
- Institute of Clinical Infectious Diseases, Catholic University of the Sacred Heart, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Gianmaria Baldin
- Institute of Clinical Infectious Diseases, Catholic University of the Sacred Heart, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Amedeo Capetti
- Division of Infectious Diseases, Department of Infectious Diseases, Luigi Sacco University Hospital, Milan, Italy
| | - Stefano Rusconi
- Infectious Diseases Unit, DIBIC Luigi Sacco, University of Milan, Milan, Italy
| | - Gaetana Sterrantino
- Division of Tropical and Infectious Diseases, 'Careggi' Hospital, Florence, Italy
| | - Gabriella d'Ettorre
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Manuela Colafigli
- Infectious Dermatology and Allergology Unit, IFO S. Gallicano Institute (IRCCS), Rome, Italy
| | - Sara Modica
- Infectious Diseases Unit, Siena University Hospital, Siena, Italy
| | - Filippo Lagi
- Division of Tropical and Infectious Diseases, 'Careggi' Hospital, Florence, Italy
| | - Andrea Giacomelli
- Infectious Diseases Unit, DIBIC Luigi Sacco, University of Milan, Milan, Italy
| | - Maria Vittoria Cossu
- Division of Infectious Diseases, Department of Infectious Diseases, Luigi Sacco University Hospital, Milan, Italy
| | - Sibilla Restelli
- Division of Infectious Diseases, Department of Infectious Diseases, Luigi Sacco University Hospital, Milan, Italy
| | - Andrea De Luca
- Infectious Diseases Unit, Siena University Hospital, Siena, Italy
| | - Simona Di Giambenedetto
- Institute of Clinical Infectious Diseases, Catholic University of the Sacred Heart, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
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50
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Bruno C, Locatello LG, Cilona M, Fancello G, Vultaggio A, Maltagliati L, Rossi O, Vivarelli E, Almerigogna F, Piccica M, Lagi F, Maggiore G, Matucci A, Trotta M, Gallo O. Seasonal Allergic Rhinitis Symptoms in Relation to COVID-19. Allergy Rhinol (Providence) 2020; 11:2152656720968804. [PMID: 33282450 PMCID: PMC7683838 DOI: 10.1177/2152656720968804] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Chiara Bruno
- Department of Otorhinolaryngology, Careggi University Hospital, Florence, Italy
| | | | - Maria Cilona
- Department of Otorhinolaryngology, Careggi University Hospital, Florence, Italy
| | - Giuseppe Fancello
- Department of Otorhinolaryngology, Careggi University Hospital, Florence, Italy
| | | | - Lucia Maltagliati
- Immunoallergology Unit, Careggi University Hospital, Florence, Italy
| | - Oliviero Rossi
- Immunoallergology Unit, Careggi University Hospital, Florence, Italy
| | | | - Fabio Almerigogna
- Immunoallergology Unit, Careggi University Hospital, Florence, Italy
| | - Matteo Piccica
- Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy
| | - Filippo Lagi
- Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy
| | | | - Andrea Matucci
- Immunoallergology Unit, Careggi University Hospital, Florence, Italy
| | - Michele Trotta
- Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy
| | - Oreste Gallo
- Department of Otorhinolaryngology, Careggi University Hospital, Florence, Italy
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