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Trunfio M, Pinnetti C, Arsuffi S, Bai F, Celani L, D'Ettorre G, Vera JH, D'Arminio Monforte A, Focà E, Ghisetti V, Bonora S, Antinori A, Calcagno A. The presence of resistance‐associated mutations in reverse transcriptase gene is associated with cerebrospinal fluid HIV‐1 escape: A multicentric retrospective analysis. J Med Virol 2023; 95:e28704. [PMID: 36967541 DOI: 10.1002/jmv.28704] [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: 12/28/2022] [Revised: 02/07/2023] [Accepted: 03/23/2023] [Indexed: 04/05/2023]
Abstract
Higher risk of cerebrospinal fluid escape (CVE) has been associated with the use of specific antiretroviral (ARV) classes, such as protease inhibitors. We assessed whether archived resistance-associated mutations (RAMs) can mediate this relationship by identifying patients treated with incompletely active antiretroviral regimens. A retrospective multicentric study on 282 adult people with HIV on antiretroviral therapy (ART) and available historical plasma genotype resistance testing (HGRT) for reverse transcriptase (RT) and protease genes between 2001 and 2021. The odds ratio for demographic, clinic-, and ART-related variables and CVE was estimated by multivariable modeling. HGRT-adjusted central nervous system effectiveness penetration (CPE) score was computed in modeling the risk. Median age, plasma VL, and CD4 count were 49 years, <50 copies/mL, and 310 cells/μL. CVE was detected in 51 participants (17.0%). No difference in CVE prevalence was observed according to ART type, number of ARVs or ARV classes. Participants with CVE had more frequently plasma (52.9% vs. 32.1%, p = 0.005) and CSF RAMs in RT (n = 63, 57.1% vs. 28.6%, p = 0.029), but not in protease gene. The presence of plasma RAMs in RT associated with increased odds of CVE in adjusted analyses (aOR 3.9, p < 0.001) and in models restricted to plasma viral load ≤50 copies/mL (n = 202; aOR 4.3, p = 0.003). CVE risk decreased by 40% per each point increase in HGRT-adjusted CPE score in multivariable models (p < 0.001). Rather than the type of ARV classes or of ART regimens, functional mono or dual regimens caused by the presence of RAMs affecting ART components may explain the majority of cases of CVE.
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Affiliation(s)
- Mattia Trunfio
- Unit of Infectious Diseases, Amedeo di Savoia Hospital at Department of Medical Sciences University of Turin Turin Italy
| | - Carmela Pinnetti
- Clinical and Research Infectious Diseases Department, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS Rome Italy
| | - Stefania Arsuffi
- Department of Clinical and Experimental Sciences, Division of Infectious and Tropical Diseases, Spedali Civili General Hospital University of Brescia Brescia Italy
| | - Francesca Bai
- Department of Health Sciences, Clinic of Infectious Diseases and Tropical Medicine, S.Paolo Hospital, ASST Santi Paolo e Carlo University of Milan Milan Italy
| | - Luigi Celani
- Department of Public Health and Infectious Diseases Azienda Policlinico Umberto I Rome Italy
| | - Gabriella D'Ettorre
- Department of Public Health and Infectious Diseases Azienda Policlinico Umberto I Rome Italy
| | - Jaime H. Vera
- Department of Global Health and Infection Brighton and Sussex Medical School Brighton UK
| | - Antonella D'Arminio Monforte
- Department of Health Sciences, Clinic of Infectious Diseases and Tropical Medicine, S.Paolo Hospital, ASST Santi Paolo e Carlo University of Milan Milan Italy
| | - Emanuele Focà
- Department of Clinical and Experimental Sciences, Division of Infectious and Tropical Diseases, Spedali Civili General Hospital University of Brescia Brescia Italy
| | - Valeria Ghisetti
- Molecular Biology and Microbiology Unit, Amedeo di Savoia Hospital ASL Città di Torino Turin Italy
| | - Stefano Bonora
- Unit of Infectious Diseases, Amedeo di Savoia Hospital at Department of Medical Sciences University of Turin Turin Italy
| | - Andrea Antinori
- Clinical and Research Infectious Diseases Department, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS Rome Italy
| | - Andrea Calcagno
- Unit of Infectious Diseases, Amedeo di Savoia Hospital at Department of Medical Sciences University of Turin Turin Italy
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2
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Stella G, Volpicelli L, Carlo DD, Vicenti I, Celani L, Maggiolo F, Callegaro AP, Gennari W, Francisci D, Lombardi F, Piermatteo L, Bezenchek A, Micheli V, Rossetti B, Santoro MM. Impact of pre-existent drug resistance on virological efficacy of single tablet regimens in people living with HIV. Int J Antimicrob Agents 2022; 60:106636. [PMID: 35820534 DOI: 10.1016/j.ijantimicag.2022.106636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 06/21/2022] [Accepted: 07/05/2022] [Indexed: 11/18/2022]
Abstract
Despite the broad use of single tablet regimens (STRs), few real-life data are available regarding the impact of pre-existent drug resistance on virological failure (VF). Through this study we aimed to fill this gap, by analyzing a large cohort of individuals selected from the ARCA database. The impact on VF of pre-existent resistance associated mutations (RAMs) and cumulative genotypic susceptibility score (cGSS) before STR start was evaluated through survival analysis. Potential emergence of resistance at VF was also evaluated. Overall, 3916 individuals were included: 678 treatment-naïve (G1), 2309 treatment-experienced aviremic (G2), and 929 viremic (G3); 65.2% of them was treated with an STR based on efavirenz (35.2%) or rilpivirine (30%). At two years after starting STR, the overall probability of VF was 5.9% in G1, 8.7% in G2, and 20.8% in G3. No impact of pre-existent resistance on VF was found in G1. The probability of VF was higher in patients with cGSS<3 (reduced susceptibility to at least one drug) than in those with cGSS=3 (full susceptibility to STR drugs) in both G2 and G3. A higher probability of VF was also found in presence of pre-existent M184V (alone or in combination with pre-existent thymidine analogue mutations). Among patients who failed STR, a significant emergence of RAMs was found only in those exposed to EFV/FTC/TDF in G3 (specifically K103N and M184V). Our results confirm a high efficacy of STRs in clinical settings. Pre-existent resistance seems to influence virological efficacy of STR in treatment-experienced individuals (both aviremic and viremic).
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Affiliation(s)
- Giulia Stella
- Department of Medical Biotechnologies, University of Siena, Siena, Italy; Department of Medical Sciences, Infectious and Tropical Diseases Unit, AOU Senese, Siena, Italy
| | - Lorenzo Volpicelli
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Domenico Di Carlo
- CRC Pediatric "Romeo and Enrica Invernizzi", Department of Biomedical and Clinical Sciences "L. Sacco", University of Milan, Milan, Italy
| | - Ilaria Vicenti
- Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Luigi Celani
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Franco Maggiolo
- Department of Infectious Diseases, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy
| | | | - William Gennari
- Unit of Virology and Molecular Microbiology, University Hospital, Modena, Italy
| | | | - Francesca Lombardi
- Department of Safety and Bioethics, Infectious Diseases Section, Catholic University of the Sacred Heart, Rome, Italy
| | - Lorenzo Piermatteo
- Department of Experimental Medicine, University of Rome 'Tor Vergata', Via Montpellier 1, 00133 Rome, Italy
| | - Antonia Bezenchek
- IPRO-InformaPRO S.r.l., Rome, Italy; EuResist Network GEIE, Rome, Italy
| | - Valeria Micheli
- Laboratory of Clinical Microbiology, Virology and Bioemergencies, ASST Fatebenefratelli Sacco, L. Sacco University Hospital, Milan, Italy
| | - Barbara Rossetti
- Department of Medical Sciences, Infectious and Tropical Diseases Unit, AOU Senese, Siena, Italy
| | - Maria Mercedes Santoro
- Department of Experimental Medicine, University of Rome 'Tor Vergata', Via Montpellier 1, 00133 Rome, Italy.
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3
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Pinacchio C, Scordio M, Santinelli L, Frasca F, Sorrentino L, Bitossi C, Oliveto G, Viscido A, Ceci FM, Celani L, Ceccarelli G, Antonelli G, Mastroianni CM, d’Ettorre G, Scagnolari C. Analysis of serum microRNAs and rs2910164 GC single-nucleotide polymorphism of miRNA-146a in COVID-19 patients. J Immunoassay Immunochem 2022; 43:347-364. [DOI: 10.1080/15321819.2022.2035394] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
- Claudia Pinacchio
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Mirko Scordio
- Department of Molecular Medicine, Laboratory of Virology, Sapienza University, Rome, Italy
| | - Letizia Santinelli
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Federica Frasca
- Department of Molecular Medicine, Laboratory of Virology, Sapienza University, Rome, Italy
| | - Leonardo Sorrentino
- Department of Molecular Medicine, Laboratory of Virology, Sapienza University, Rome, Italy
| | - Camilla Bitossi
- Department of Molecular Medicine, Laboratory of Virology, Sapienza University, Rome, Italy
| | - Giuseppe Oliveto
- Department of Molecular Medicine, Laboratory of Virology, Sapienza University, Rome, Italy
| | - Agnese Viscido
- Department of Molecular Medicine, Laboratory of Virology, Sapienza University, Rome, Italy
| | - Flavio Maria Ceci
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Luigi Celani
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Giancarlo Ceccarelli
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Guido Antonelli
- Department of Molecular Medicine, Laboratory of Virology, Sapienza University, Rome, Italy
- Microbiology and Virology Unit, Sapienza University, Hospital Policlinico Umberto I, Rome, Italy
- Department of Molecular Medicine, Pasteur Institute Italy, Cenci Bolognetti Foundation, Rome, Italy
| | | | - Gabriella d’Ettorre
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Carolina Scagnolari
- Department of Molecular Medicine, Laboratory of Virology, Sapienza University, Rome, Italy
- Department of Molecular Medicine, Pasteur Institute Italy, Cenci Bolognetti Foundation, Rome, Italy
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4
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Santinelli L, Laghi L, Innocenti GP, Pinacchio C, Vassalini P, Celani L, Lazzaro A, Borrazzo C, Marazzato M, Tarsitani L, Koukopoulos AE, Mastroianni CM, d'Ettorre G, Ceccarelli G. Oral Bacteriotherapy Reduces the Occurrence of Chronic Fatigue in COVID-19 Patients. Front Nutr 2022; 8:756177. [PMID: 35096923 PMCID: PMC8790565 DOI: 10.3389/fnut.2021.756177] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 08/10/2021] [Accepted: 11/29/2021] [Indexed: 12/22/2022] Open
Abstract
Long COVID refers to patients with symptoms as fatigue, “brain fog,” pain, suggesting the chronic involvement of the central nervous system (CNS) in COVID-19. The supplementation with probiotic (OB) would have a positive effect on metabolic homeostasis, negatively impacting the occurrence of symptoms related to the CNS after hospital discharge. On a total of 58 patients hospitalized for COVID-19, 24 (41.4%) received OB during hospitalization (OB+) while 34 (58.6%) taken only the standard treatment (OB–). Serum metabolomic profiling of patients has been performed at both hospital acceptance (T0) and discharge (T1). Six months after discharge, fatigue perceived by participants was assessed by administrating the Fatigue Assessment Scale. 70.7% of participants reported fatigue while 29.3% were negative for such condition. The OB+ group showed a significantly lower proportion of subjects reporting fatigue than the OB– one (p < 0.01). Furthermore, OB+ subjects were characterized by significantly increased concentrations of serum Arginine, Asparagine, Lactate opposite to lower levels of 3-Hydroxyisobutirate than those not treated with probiotics. Our results strongly suggest that in COVID-19, the administration of probiotics during hospitalization may prevent the development of chronic fatigue by impacting key metabolites involved in the utilization of glucose as well as in energy pathways.
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Affiliation(s)
- Letizia Santinelli
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Luca Laghi
- Department of Agricultural and Food Sciences, University of Bologna, Bologna, Italy.,Interdepartmental Centre for Agri-Food Industrial Research, University of Bologna, Bologna, Italy
| | | | - Claudia Pinacchio
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Paolo Vassalini
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Luigi Celani
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Alessandro Lazzaro
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Cristian Borrazzo
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Massimiliano Marazzato
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Lorenzo Tarsitani
- Department of Human Neurosciences, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Alexia E Koukopoulos
- Department of Human Neurosciences, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Claudio M Mastroianni
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Gabriella d'Ettorre
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Giancarlo Ceccarelli
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
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Fabris S, d'Ettorre G, Spagnolello O, Russo A, Lopalco M, D'Agostino F, Vassalini P, Celani L, Aronica R, Gabrielli S, d'Ettorre G, Angeletti S, Mastroianni CM, Ciccozzi M, Ceccarelli G. SARS-CoV-2 Among Migrants Recently Arrived in Europe From Low- and Middle-Income Countries: Containment Strategies and Special Features of Management in Reception Centers. Front Public Health 2021; 9:735601. [PMID: 34917571 PMCID: PMC8669389 DOI: 10.3389/fpubh.2021.735601] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 10/18/2021] [Indexed: 12/19/2022] Open
Abstract
Despite the “migrants and COVID-19” topic has been neglected since felt marginal concerning other aspects of the SARS-CoV-2 pandemic, it represents a relevant public health issue in the European countries. This report describes COVID-19 containment strategies adopted in a large Italian reception center hosting recently arrived asylum-seeker migrants. Risk assessment and prevention measures adopted were described. Geo-spatial epidemiological analysis of the outbreak was reported. Significant gaps in the knowledge of self-protection measures from contagious diseases and in the perception of the pandemic risk were observed in migrants; health promotion activities, targeted to remove cultural barriers and improve behaviors appropriate to individual protection, were able to fulfill this gap. In low-resource settings, especially in closed communities, the implementation of social distancing strategies, the systematic use of individual protection devices, and active syndromic surveillance are essential tools to limit the risk of outbreaks. In the event of an outbreak, it is relevant to rapidly activate containment procedures based on systematic screening, isolation, and quarantine, taking into consideration the limits of tracing contacts within a closed community. Not being able to trace certain contacts, the geo-spatial epidemiological analysis of cases distribution could be key in the management of the outbreak. Interestingly, positive cases identified in our facility were all clinically pauci-symptomatic or asymptomatic. Dedicated strategies are needed to minimize the chance of SARS-CoV-2 transmission in a limited space such as reception centers and a vulnerable population such as migrants.
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Affiliation(s)
- Silvia Fabris
- National Center for Control and Emergency Against Animal Diseases and Central Crisis Unit - Office III, Directorate General for Animal Health and Veterinary Drugs, Italian Ministry of Health, Rome, Italy.,Medical Statistics and Epidemiology Unit, Campus Bio-Medico University, Rome, Italy
| | - Gabriella d'Ettorre
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy.,Infectious Diseases Unit, Azienda Ospedaliero-Universitaria Policlinico Umberto I, Rome, Italy
| | - Ornella Spagnolello
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Alessandro Russo
- Department of Medical and Surgical Sciences, "Magna Græcia" University, Catanzaro, Italy
| | - Maurizio Lopalco
- Medical Center, Extraordinary Reception Center "Mondo Migliore", Rocca di Papa, Italy
| | - Fausto D'Agostino
- Italian Ministry of Health, Rome, Italy.,Anesthesia and Resuscitation Unit, Campus Bio-Medico University, Rome, Italy
| | - Paolo Vassalini
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy.,Infectious Diseases Unit, Belcolle Hospital, Viterbo, Italy
| | - Luigi Celani
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Raissa Aronica
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Simona Gabrielli
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy.,Unit of Parasitology, Azienda Ospedaliero-Universitaria Policlinico Umberto I, Rome, Italy
| | - Gabriele d'Ettorre
- Unit of Occupational Prevention and Protection, Azienda Sanitaria Locale Lecce, Lecce, Italy
| | - Silvia Angeletti
- Unit of Clinical Laboratory Science, University Campus Bio-Medico of Rome, Rome, Italy
| | - Claudio M Mastroianni
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy.,Infectious Diseases Unit, Azienda Ospedaliero-Universitaria Policlinico Umberto I, Rome, Italy
| | - Massimo Ciccozzi
- Medical Statistics and Epidemiology Unit, Campus Bio-Medico University, Rome, Italy
| | - Giancarlo Ceccarelli
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy.,Infectious Diseases Unit, Azienda Ospedaliero-Universitaria Policlinico Umberto I, Rome, Italy.,Medical Center, Extraordinary Reception Center "Mondo Migliore", Rocca di Papa, Italy.,Migrants and Global Health Research Organization, Rome, Italy
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6
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Calcagno A, Celani L, Trunfio M, Orofino G, Imperiale D, Atzori C, Arena V, d'Ettorre G, Guaraldi G, Gisslen M, Di Perri G. Alzheimer Dementia in People Living With HIV. Neurol Clin Pract 2021; 11:e627-e633. [PMID: 34840876 DOI: 10.1212/cpj.0000000000001060] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 01/06/2021] [Indexed: 12/19/2022]
Abstract
Objective Given the aging of people living with HIV (PLWH) and the high prevalence of HIV-associated neurocognitive disorders, we aimed at describing the clinical, instrumental, and CSF features of PLWH diagnosed with Alzheimer dementia (AD). Methods The databases of 3 large Italian outpatient clinics taking care of more than 9,000 PLWH were searched for the diagnosis of AD. After obtaining patients' or their next of kin's consent for publication, anonymous data were collected in an excel spreadsheet and described. Routinely collected CSF biomarkers and radiologic imaging results were recorded whether available. Results Four patients were included in this case series who were diagnosed with AD aged between 60 and 74 years. All participants were on highly active antiretroviral therapy and showed nondetectable serum HIV RNA. Memory impairment was the most prominent cognitive feature. The diagnosis was obtained considering the exclusion of other potential causes, MRI and fluorodeoxyglucose-PET features, and, in (in 2/4), CSF AD biomarkers levels. In 1 patient, longitudinal CSF tau/p-tau increased, and beta-amyloid1-42 decreased over time despite antiretroviral therapy containing nucleotide reverse transcriptase inhibitors. Conclusions In older PLWH cognitive symptoms may represent the onset of AD: a multidisciplinary team may be needed for reaching a likely in vivo diagnosis.
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Affiliation(s)
- Andrea Calcagno
- Unit of Infectious Diseases (C. Andrea, MT, GDP), Department of Medical Sciences, University of Torino, Italy; Department of Public Health and Infectious Diseases (LC, GE), Sapienza University of Rome, Italy; "Divisione A" Unit of Infectious Diseases (GO), Ospedale Amedeo di Savoia, ASL Città di Torino, Italy; Unit of Neurology (DI, C. Atzori), Ospedale Maria Vittoria, ASL Città di Torino, Italy; AFFIDEA Irmet PET/CT Center (VA), Torino, Italy; Department of Surgical (GG), Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, Italy; Department of Infectious Diseases (MG), Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Sweden; and Region Västra Götaland (MG), Sahlgrenska University Hospital, Department of Infectious Diseases, Gothenburg, Sweden
| | - Luigi Celani
- Unit of Infectious Diseases (C. Andrea, MT, GDP), Department of Medical Sciences, University of Torino, Italy; Department of Public Health and Infectious Diseases (LC, GE), Sapienza University of Rome, Italy; "Divisione A" Unit of Infectious Diseases (GO), Ospedale Amedeo di Savoia, ASL Città di Torino, Italy; Unit of Neurology (DI, C. Atzori), Ospedale Maria Vittoria, ASL Città di Torino, Italy; AFFIDEA Irmet PET/CT Center (VA), Torino, Italy; Department of Surgical (GG), Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, Italy; Department of Infectious Diseases (MG), Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Sweden; and Region Västra Götaland (MG), Sahlgrenska University Hospital, Department of Infectious Diseases, Gothenburg, Sweden
| | - Mattia Trunfio
- Unit of Infectious Diseases (C. Andrea, MT, GDP), Department of Medical Sciences, University of Torino, Italy; Department of Public Health and Infectious Diseases (LC, GE), Sapienza University of Rome, Italy; "Divisione A" Unit of Infectious Diseases (GO), Ospedale Amedeo di Savoia, ASL Città di Torino, Italy; Unit of Neurology (DI, C. Atzori), Ospedale Maria Vittoria, ASL Città di Torino, Italy; AFFIDEA Irmet PET/CT Center (VA), Torino, Italy; Department of Surgical (GG), Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, Italy; Department of Infectious Diseases (MG), Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Sweden; and Region Västra Götaland (MG), Sahlgrenska University Hospital, Department of Infectious Diseases, Gothenburg, Sweden
| | - Giancarlo Orofino
- Unit of Infectious Diseases (C. Andrea, MT, GDP), Department of Medical Sciences, University of Torino, Italy; Department of Public Health and Infectious Diseases (LC, GE), Sapienza University of Rome, Italy; "Divisione A" Unit of Infectious Diseases (GO), Ospedale Amedeo di Savoia, ASL Città di Torino, Italy; Unit of Neurology (DI, C. Atzori), Ospedale Maria Vittoria, ASL Città di Torino, Italy; AFFIDEA Irmet PET/CT Center (VA), Torino, Italy; Department of Surgical (GG), Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, Italy; Department of Infectious Diseases (MG), Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Sweden; and Region Västra Götaland (MG), Sahlgrenska University Hospital, Department of Infectious Diseases, Gothenburg, Sweden
| | - Daniele Imperiale
- Unit of Infectious Diseases (C. Andrea, MT, GDP), Department of Medical Sciences, University of Torino, Italy; Department of Public Health and Infectious Diseases (LC, GE), Sapienza University of Rome, Italy; "Divisione A" Unit of Infectious Diseases (GO), Ospedale Amedeo di Savoia, ASL Città di Torino, Italy; Unit of Neurology (DI, C. Atzori), Ospedale Maria Vittoria, ASL Città di Torino, Italy; AFFIDEA Irmet PET/CT Center (VA), Torino, Italy; Department of Surgical (GG), Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, Italy; Department of Infectious Diseases (MG), Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Sweden; and Region Västra Götaland (MG), Sahlgrenska University Hospital, Department of Infectious Diseases, Gothenburg, Sweden
| | - Cristiana Atzori
- Unit of Infectious Diseases (C. Andrea, MT, GDP), Department of Medical Sciences, University of Torino, Italy; Department of Public Health and Infectious Diseases (LC, GE), Sapienza University of Rome, Italy; "Divisione A" Unit of Infectious Diseases (GO), Ospedale Amedeo di Savoia, ASL Città di Torino, Italy; Unit of Neurology (DI, C. Atzori), Ospedale Maria Vittoria, ASL Città di Torino, Italy; AFFIDEA Irmet PET/CT Center (VA), Torino, Italy; Department of Surgical (GG), Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, Italy; Department of Infectious Diseases (MG), Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Sweden; and Region Västra Götaland (MG), Sahlgrenska University Hospital, Department of Infectious Diseases, Gothenburg, Sweden
| | - Vincenzo Arena
- Unit of Infectious Diseases (C. Andrea, MT, GDP), Department of Medical Sciences, University of Torino, Italy; Department of Public Health and Infectious Diseases (LC, GE), Sapienza University of Rome, Italy; "Divisione A" Unit of Infectious Diseases (GO), Ospedale Amedeo di Savoia, ASL Città di Torino, Italy; Unit of Neurology (DI, C. Atzori), Ospedale Maria Vittoria, ASL Città di Torino, Italy; AFFIDEA Irmet PET/CT Center (VA), Torino, Italy; Department of Surgical (GG), Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, Italy; Department of Infectious Diseases (MG), Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Sweden; and Region Västra Götaland (MG), Sahlgrenska University Hospital, Department of Infectious Diseases, Gothenburg, Sweden
| | - Gabriella d'Ettorre
- Unit of Infectious Diseases (C. Andrea, MT, GDP), Department of Medical Sciences, University of Torino, Italy; Department of Public Health and Infectious Diseases (LC, GE), Sapienza University of Rome, Italy; "Divisione A" Unit of Infectious Diseases (GO), Ospedale Amedeo di Savoia, ASL Città di Torino, Italy; Unit of Neurology (DI, C. Atzori), Ospedale Maria Vittoria, ASL Città di Torino, Italy; AFFIDEA Irmet PET/CT Center (VA), Torino, Italy; Department of Surgical (GG), Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, Italy; Department of Infectious Diseases (MG), Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Sweden; and Region Västra Götaland (MG), Sahlgrenska University Hospital, Department of Infectious Diseases, Gothenburg, Sweden
| | - Giovanni Guaraldi
- Unit of Infectious Diseases (C. Andrea, MT, GDP), Department of Medical Sciences, University of Torino, Italy; Department of Public Health and Infectious Diseases (LC, GE), Sapienza University of Rome, Italy; "Divisione A" Unit of Infectious Diseases (GO), Ospedale Amedeo di Savoia, ASL Città di Torino, Italy; Unit of Neurology (DI, C. Atzori), Ospedale Maria Vittoria, ASL Città di Torino, Italy; AFFIDEA Irmet PET/CT Center (VA), Torino, Italy; Department of Surgical (GG), Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, Italy; Department of Infectious Diseases (MG), Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Sweden; and Region Västra Götaland (MG), Sahlgrenska University Hospital, Department of Infectious Diseases, Gothenburg, Sweden
| | - Magnus Gisslen
- Unit of Infectious Diseases (C. Andrea, MT, GDP), Department of Medical Sciences, University of Torino, Italy; Department of Public Health and Infectious Diseases (LC, GE), Sapienza University of Rome, Italy; "Divisione A" Unit of Infectious Diseases (GO), Ospedale Amedeo di Savoia, ASL Città di Torino, Italy; Unit of Neurology (DI, C. Atzori), Ospedale Maria Vittoria, ASL Città di Torino, Italy; AFFIDEA Irmet PET/CT Center (VA), Torino, Italy; Department of Surgical (GG), Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, Italy; Department of Infectious Diseases (MG), Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Sweden; and Region Västra Götaland (MG), Sahlgrenska University Hospital, Department of Infectious Diseases, Gothenburg, Sweden
| | - Giovanni Di Perri
- Unit of Infectious Diseases (C. Andrea, MT, GDP), Department of Medical Sciences, University of Torino, Italy; Department of Public Health and Infectious Diseases (LC, GE), Sapienza University of Rome, Italy; "Divisione A" Unit of Infectious Diseases (GO), Ospedale Amedeo di Savoia, ASL Città di Torino, Italy; Unit of Neurology (DI, C. Atzori), Ospedale Maria Vittoria, ASL Città di Torino, Italy; AFFIDEA Irmet PET/CT Center (VA), Torino, Italy; Department of Surgical (GG), Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, Italy; Department of Infectious Diseases (MG), Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Sweden; and Region Västra Götaland (MG), Sahlgrenska University Hospital, Department of Infectious Diseases, Gothenburg, Sweden
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7
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Russo A, Gentilini Cacciola E, Borrazzo C, Filippi V, Bucci T, Vullo F, Celani L, Binetti E, Battistini L, Ceccarelli G, Alessandroni M, Galardo G, Mastroianni CM, d’Ettorre G. Clinical Characteristics and Outcome of Patients with Suspected COVID-19 in Emergency Department (RESILIENCY Study II). Diagnostics (Basel) 2021; 11:diagnostics11081368. [PMID: 34441304 PMCID: PMC8393530 DOI: 10.3390/diagnostics11081368] [Citation(s) in RCA: 3] [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: 05/30/2021] [Revised: 07/25/2021] [Accepted: 07/28/2021] [Indexed: 01/08/2023] Open
Abstract
Objectives: COVID-19 may show no peculiar signs and symptoms that may differentiate it from other infective or non-infective etiologies; thus, early recognition and prompt management are crucial to improve survival. The aim of this study was to describe clinical, laboratory, and radiological characteristics and outcomes of hospitalized COVID-19 patients compared to those with other infective or non-infective etiologies. Methods: We performed a prospective study from March 2020 to February 2021. All patients hospitalized for suspected or confirmed COVID-19 were prospectively recruited. All patients were evaluated according to a predefined protocol for diagnosis of suspected SARS-CoV-2 infection. The primary endpoint was evaluation of clinical, laboratory, and radiological characteristics associated or not with COVID-19 etiology at time of hospitalization in an emergency department. Results: A total of 1036 patients were included in the study: 717 (69%) patients with confirmed COVID-19 and 319 (31%) without COVID-19, hospitalized for other causes. The main causes of hospitalization among non-COVID-19 patients were acute heart failure (44%) and bacterial pneumonia (45.8%). Overall, 30-day mortality was 9% among the COVID-19 group and 35% in the non-COVID-19 group. Multivariate analysis showed variables (fever > 3 days, dry cough, acute dyspnea, lymphocytes < 1000 × 103/µL, and ferritin > 250 ng/mL) independently associated with COVID-19 etiology. A decision tree was elaborated to early detect COVID-19 patients in the emergency department. Finally, Kaplan–Meier curves on 30-day survival in COVID-19 patients during the first wave (March–May 2020, n = 289 patients) and the second wave (October–February 2021, n = 428 patients) showed differences between the two study periods (p = 0.021). Conclusions: Patients with confirmed diagnosis of COVID-19 may show peculiar characteristics at time of hospitalization that could help physicians to distinguish from other infective or non-infective etiologies. Finally, a different 30-day mortality rate was observed during different periods of the pandemic.
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Affiliation(s)
- Alessandro Russo
- Department of Medical and Surgical Sciences, Infectious and Tropical Disease Unit, “Magna Graecia” University of Catanzaro, 88100 Catanzaro, Italy
- Correspondence:
| | - Elio Gentilini Cacciola
- Policlinico “Umberto I”, Department of Public Health and Infectious Diseases, “Sapienza” University of Rome, 00185 Rome, Italy; (E.G.C.); (C.B.); (V.F.); (L.C.); (E.B.); (L.B.); (G.C.); (C.M.M.); (G.d.)
| | - Cristian Borrazzo
- Policlinico “Umberto I”, Department of Public Health and Infectious Diseases, “Sapienza” University of Rome, 00185 Rome, Italy; (E.G.C.); (C.B.); (V.F.); (L.C.); (E.B.); (L.B.); (G.C.); (C.M.M.); (G.d.)
| | - Valeria Filippi
- Policlinico “Umberto I”, Department of Public Health and Infectious Diseases, “Sapienza” University of Rome, 00185 Rome, Italy; (E.G.C.); (C.B.); (V.F.); (L.C.); (E.B.); (L.B.); (G.C.); (C.M.M.); (G.d.)
| | - Tommaso Bucci
- Department of General Surgery, Surgical Specialties and Organ Transplantation “Paride Stefanini”, Sapienza University of Rome, 00185 Rome, Italy;
| | - Francesco Vullo
- Department of Radiological, Oncological and Pathological Sciences, “Sapienza” University of Rome, 00185 Rome, Italy;
| | - Luigi Celani
- Policlinico “Umberto I”, Department of Public Health and Infectious Diseases, “Sapienza” University of Rome, 00185 Rome, Italy; (E.G.C.); (C.B.); (V.F.); (L.C.); (E.B.); (L.B.); (G.C.); (C.M.M.); (G.d.)
| | - Erica Binetti
- Policlinico “Umberto I”, Department of Public Health and Infectious Diseases, “Sapienza” University of Rome, 00185 Rome, Italy; (E.G.C.); (C.B.); (V.F.); (L.C.); (E.B.); (L.B.); (G.C.); (C.M.M.); (G.d.)
| | - Luigi Battistini
- Policlinico “Umberto I”, Department of Public Health and Infectious Diseases, “Sapienza” University of Rome, 00185 Rome, Italy; (E.G.C.); (C.B.); (V.F.); (L.C.); (E.B.); (L.B.); (G.C.); (C.M.M.); (G.d.)
| | - Giancarlo Ceccarelli
- Policlinico “Umberto I”, Department of Public Health and Infectious Diseases, “Sapienza” University of Rome, 00185 Rome, Italy; (E.G.C.); (C.B.); (V.F.); (L.C.); (E.B.); (L.B.); (G.C.); (C.M.M.); (G.d.)
| | - Maria Alessandroni
- Medical Emergency Unit, Sapienza University of Rome, Policlinico Umberto I, 00185 Rome, Italy; (M.A.); (G.G.)
| | - Gioacchino Galardo
- Medical Emergency Unit, Sapienza University of Rome, Policlinico Umberto I, 00185 Rome, Italy; (M.A.); (G.G.)
| | - Claudio Maria Mastroianni
- Policlinico “Umberto I”, Department of Public Health and Infectious Diseases, “Sapienza” University of Rome, 00185 Rome, Italy; (E.G.C.); (C.B.); (V.F.); (L.C.); (E.B.); (L.B.); (G.C.); (C.M.M.); (G.d.)
| | - Gabriella d’Ettorre
- Policlinico “Umberto I”, Department of Public Health and Infectious Diseases, “Sapienza” University of Rome, 00185 Rome, Italy; (E.G.C.); (C.B.); (V.F.); (L.C.); (E.B.); (L.B.); (G.C.); (C.M.M.); (G.d.)
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8
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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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9
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Di Carlo D, Falasca F, Palermo E, Mezzaroma I, Fimiani C, Siccardi G, Celani L, Di Campli FM, d'Ettorre G, Antonelli G, Turriziani O. Dolutegravir-Based Regimen for Maintenance of Viral Suppression in People Living with HIV: 48-Week Results in Real-Life Setting. AIDS Res Hum Retroviruses 2021; 37:478-485. [PMID: 33487130 DOI: 10.1089/aid.2020.0196] [Citation(s) in RCA: 3] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
To evaluate the efficacy, safety, and tolerability of switching to a dolutegravir (DTG)-based regimen in a cohort of virological suppressed HIV-infected patients who have previously been treated with different antiretroviral combination. The dynamics of total HIV-DNA and levels of high-sensitivity c-reactive protein, interleukin-6, soluble-CD14, and D-Dimer were also analyzed. Ninety-six individuals who switched to a DTG-containing regimen were followed up for 48 weeks. HIV RNA, CD4+ T cell count, weight, and levels of laboratory parameters were recorded at baseline, after 24 and 48 weeks of treatment for all study participants. In a subgroup of patients, HIV DNA and inflammation/coagulation marker levels were also analyzed until week 24. Ninety-three out of 96 patients maintained virological suppression, including patients who switched to dual-therapy from triple-drug combination. Eighteen out of 96 patients had residual viremia at baseline, of which 13 reached the maximal viral suppression at W48. Serum creatinine levels showed a significant increase at weeks 24 and 48. A progressive reduction of total cholesterol was observed from week 24 and up to week 48. No variation in body mass index was detected. HIV DNA, inflammation, and coagulation marker levels did not significantly change during follow-up. Switching to a DTG-based regimen may be a key option for achieving and maintaining maximal virological suppression, even in patients showing residual viremia at baseline. Furthermore, the improvement in blood lipid profile and the overall tolerability observed in this study strongly support the use of these regimens in the aging HIV population.
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Affiliation(s)
- Daniele Di Carlo
- Department of Molecular Medicine, University of Rome Sapienza, Rome, Italy
| | - Francesca Falasca
- Department of Molecular Medicine, University of Rome Sapienza, Rome, Italy
| | - Enrico Palermo
- Istituto Pasteur-Fondazione Cenci Bolognetti, Rome, Italy
| | - Ivano Mezzaroma
- Department of Translational and Precision Medicine, University of Rome Sapienza, Rome, Italy
| | - Caterina Fimiani
- Department of Infectious Diseases, Umberto I University Hospital, Rome, Italy
| | - Guido Siccardi
- Department of Public Health and Infectious Diseases, University of Rome Sapienza, Rome, Italy
| | - Luigi Celani
- Department of Public Health and Infectious Diseases, University of Rome Sapienza, Rome, Italy
| | | | - Gabriella d'Ettorre
- Department of Public Health and Infectious Diseases, University of Rome Sapienza, Rome, Italy
| | - Guido Antonelli
- Department of Molecular Medicine, University of Rome Sapienza, Rome, Italy
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10
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Vita S, Gabrielli S, Fontanelli Sulekova L, De Angelis M, Alessandri F, Pugliese F, Ruberto F, Spagnolello O, Mazzocato V, Celani L, Lopalco M, Mattiucci S, Bazzardi R, Angeletti S, Ciccozzi M, D'Ettorre G, Ceccarelli G. Malaria in an asylum seeker paediatric liver transplant recipient: diagnostic challenges for migrant population. J Infect Dev Ctries 2021; 15:172-178. [PMID: 33571161 DOI: 10.3855/jidc.12541] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 05/03/2020] [Indexed: 10/31/2022] Open
Abstract
Transplanted patients are particularly exposed to a major risk of infectious diseases due to prolonged immunosuppressive treatment. Over the last decade, the growing migration flows and the transplant tourism have led to increasing infections caused by geographically restricted organisms. Malaria is an unusual event in organ transplant recipients than can be acquired primarily or reactivation following immunosuppression, by transfusion of blood products or through the transplanted organ. We report a rare case of Plasmodium falciparum infection in a liver transplanted two years-old African boy who presented to one Italian Asylum Seeker Center on May 2019. We outlined hereby diagnostic challenges, possible aetiologies of post-transplantation malaria and finally we summarized potential drug interactions between immunosuppressive agents and antimalarials. This report aims to increase the attention to newly arrived migrants, carefully evaluating patients coming from tropical areas and taking into consideration also rare tropical infections not endemic in final destination countries.
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Affiliation(s)
- Serena Vita
- Migrant and global Health Research Organization (Mi-HeRO) Rome, Italy
| | - Simona Gabrielli
- Department of Public Health and Infectious Diseases, University of Rome "Sapienza", Rome, Italy
| | | | - Maurizio De Angelis
- Department of Clinical Medicine, Clinic of Tropical Medicine, Sapienza University of Rome, Rome, Italy
| | - Francesco Alessandri
- Department of Anaesthesia and Critical Care Medicine, University of Rome "Sapienza", Rome, Italy
| | - Francesco Pugliese
- Department of Anaesthesia and Critical Care Medicine, University of Rome "Sapienza", Rome
| | - Franco Ruberto
- Department of Anaesthesia and Critical Care Medicine, University of Rome "Sapienza", Rome, Italy
| | | | | | - Luigi Celani
- Department of Public Health and Infectious Diseases, University of Rome "Sapienza", Rome, Italy
| | - Maurizio Lopalco
- Reception Center for Migrants Mondo Migliore. Rocca di Papa, Italy
| | - Simonetta Mattiucci
- Department of Public Health and Infectious Diseases, University of Rome "Sapienza", Rome, Italy
| | - Riccardo Bazzardi
- Controllo Microbiologico e Ispezione degli Alimenti, Istituto Zooprofilattico Sperimentale della Sardegna "G. Pegreffi", Sassari, Italy
| | - Silvia Angeletti
- Unit of Clinical Laboratory Science, University Campus Bio-Medico of Rome, Rome, Italy
| | - Massimo Ciccozzi
- Unit of Medical Statistics and Molecular Epidemiology, University Campus Bio-Medico of Rome, Rome, Italy
| | - Gabriella D'Ettorre
- Department of Public Health and Infectious Diseases, University of Rome "Sapienza", Rome, Italy
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11
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Ceccarelli G, Borrazzo C, Pinacchio C, Santinelli L, Innocenti GP, Cavallari EN, Celani L, Marazzato M, Alessandri F, Ruberto F, Pugliese F, Venditti M, Mastroianni CM, d'Ettorre G. Oral Bacteriotherapy in Patients With COVID-19: A Retrospective Cohort Study. Front Nutr 2021; 7:613928. [PMID: 33505983 PMCID: PMC7829198 DOI: 10.3389/fnut.2020.613928] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [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: 10/04/2020] [Accepted: 12/09/2020] [Indexed: 12/16/2022] Open
Abstract
Background: Mounting evidence suggests SARS-CoV-2 may impact on host microbiota and gut inflammation, infecting intestinal epithelial cells. This possible link and its implications can be investigated by observing the effects of modulation of the microbial flora in patients with COVID-19. The aim of this study was to compare the rate of mortality, the need of ICU hospitalization and the length of hospitalization in patients with severe COVID-19 pneumonia who received the best available therapy (BAT) vs. patients treated with BAT and supplemented with oral bacteriotherapy. Methods: This retrospective, observational cohort study included 200 adults with severe COVID-19 pneumonia. All patients received therapeutic regimens including low molecular weight heparin plus one or more between hydroxychloroquine, azithromycin, antivirals, and Tocilizumab. Oral bacteriotherapy was used as complementary treatment. Results: Out of the 200 patients, 112 received BAT without oral bacteriotherapy, and 88 BAT with oral bacteriotherapy. Crude mortality was 22%. Eleven percent died in the group of patients treated with BAT plus oral bacteriotherapy vs. 30% subjects in the group of patients managed only with BAT (p < 0.001). By multivariate analysis, the age >65 years, CRP >41.8 mg/L, Platelets <150.000 mmc, and cardiovascular events were associated with the increased risk of mortality. Oral bacteriotherapy was an independent variable associated with a reduced risk for death. Despite large prospective trials are needed, this study highlights a possible role for oral bacteriotherapy in the management of patients hospitalized for COVID-19 pneumonia.
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Affiliation(s)
- Giancarlo Ceccarelli
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy.,Azienda Ospedaliero-Universitaria Policlinico Umberto I, Rome, Italy
| | - Cristian Borrazzo
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy.,Azienda Ospedaliero-Universitaria Policlinico Umberto I, Rome, Italy.,Medical Statistics Unit, Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Claudia Pinacchio
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Letizia Santinelli
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | | | - Eugenio Nelson Cavallari
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy.,Azienda Ospedaliero-Universitaria Policlinico Umberto I, Rome, Italy
| | - Luigi Celani
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy.,Azienda Ospedaliero-Universitaria Policlinico Umberto I, Rome, Italy
| | - Massimiliano Marazzato
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Francesco Alessandri
- Department of Anaesthesia and Intensive Care, Sapienza University of Rome, Rome, Italy
| | - Franco Ruberto
- Department of Anaesthesia and Intensive Care, Sapienza University of Rome, Rome, Italy
| | - Francesco Pugliese
- Department of Anaesthesia and Intensive Care, Sapienza University of Rome, Rome, Italy
| | - Mario Venditti
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy.,Azienda Ospedaliero-Universitaria Policlinico Umberto I, Rome, Italy
| | - Claudio M Mastroianni
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy.,Azienda Ospedaliero-Universitaria Policlinico Umberto I, Rome, Italy
| | - Gabriella d'Ettorre
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy.,Azienda Ospedaliero-Universitaria Policlinico Umberto I, Rome, Italy
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12
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Spagnolello O, Ceccarelli G, Borrazzo C, Macrì A, Suppa M, Baldini E, Garramone A, Alessandri F, Celani L, Vullo F, Angeletti S, Ciccozzi M, Mastroianni C, Bertazzoni G, D'Ettorre G. qSOFA as a new community-acquired pneumonia severity score in the emergency setting. Emerg Med J 2020; 38:906-912. [PMID: 33023921 DOI: 10.1136/emermed-2019-208789] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 12/31/2019] [Accepted: 08/23/2020] [Indexed: 11/03/2022]
Abstract
BACKGROUND Quick Sequential Organ Failure Assessment (qSOFA) score is a bedside prognostic tool for patients with suspected infection outside the intensive care unit (ICU), which is particularly useful when laboratory analyses are not readily available. However, its performance in potentially septic patients with community-acquired pneumonia (CAP) needs to be examined further, especially in relation to early outcomes affecting acute management. OBJECTIVE First, to compare the performance of qSOFA and CURB-65 in the prediction of mortality in the emergency department in patients presenting with CAP. Second, to study patients who required critical care support (CCS) and ICU admission. METHODS Between January and December 2017, a 1-year retrospective observational study was carried out of adult (≥18 years old) patients presenting to the emergency department (ED) of our hospital (Rome, Italy) with CAP. The accuracy of qSOFA, qSOFA-65 and CURB-65 was compared in predicting mortality in the ED, CCS requirement and ICU admission. The concordance among scores ≥2 was then assessed for 30-day estimated mortality prediction. RESULTS 505 patients with CAP were enrolled. Median age was 71.0 years and mortality rate in the ED was 4.7%. The areas under the curve (AUCs) of qSOFA-65, CURB-65 and qSOFA in predicting mortality rate in the ED were 0.949 (95% CI 0.873 to 0.976), 0.923 (0.867 to 0.980) and 0.909 (0.847 to 0.971), respectively. The likelihood ratio of a patient having a qSOFA score ≥2 points was higher than for qSOFA-65 or CURB-65 (11 vs 7 vs 6.7). The AUCs of qSOFA, qSOFA-65 and CURB-65 in predicting CCS requirement were 0.862 (95% CI 0.802 to 0.923), 0.824 (0.758 to 0.890) and 0.821 (0.754 to 0.888), respectively. The AUCs of qSOFA-65, qSOFA and CURB-65 in predicting ICU admission were 0.593 (95% CI 0.511 to 0.676), 0.585 (0.503 to 0.667) and 0.570 (0.488 to 0.653), respectively. The concordance between qSOFA-65 and CURB-65 in 30-day estimated mortality prediction was 93%. CONCLUSION qSOFA is a valuable score for predicting mortality in the ED and for the prompt identification of patients with CAP requiring CCS. qSOFA-65 may further improve the performance of this useful score, showing also good concordance with CURB-65 in 30-day estimated mortality prediction.
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Affiliation(s)
- Ornella Spagnolello
- Department of Emergency Medicine, University of Rome La Sapienza, Roma, Lazio, Italy .,Department of Public Health and Infectious Diseases, University of Rome La Sapienza, Roma, Lazio, Italy
| | - Giancarlo Ceccarelli
- Department of Public Health and Infectious Diseases, University of Rome La Sapienza, Roma, Lazio, Italy
| | - Cristian Borrazzo
- Statistical Unit, Department of Public Health and Infectious Diseases, University of Rome La Sapienza, Roma, Lazio, Italy
| | - Angela Macrì
- Department of Emergency Medicine, University of Rome La Sapienza, Roma, Lazio, Italy
| | - Marianna Suppa
- Department of Emergency Medicine, University of Rome La Sapienza, Roma, Lazio, Italy
| | - Enrico Baldini
- Department of Emergency Medicine, University of Rome La Sapienza, Roma, Lazio, Italy
| | - Alessia Garramone
- Department of Emergency Medicine, University of Rome La Sapienza, Roma, Lazio, Italy
| | - Francesco Alessandri
- Department of Anesthesia and Intensive Care Medicine, University of Rome La Sapienza, Roma, Lazio, Italy
| | - Luigi Celani
- Department of Public Health and Infectious Diseases, University of Rome La Sapienza, Roma, Lazio, Italy
| | - Francesco Vullo
- Department of Radiological, Oncological and Anatomo Pathological Sciences, University of Rome La Sapienza, Roma, Lazio, Italy
| | - Silvia Angeletti
- Unit of Clinical Laboratory Science, University Campus Bio-Medico University of Rome Faculty of Medicine and Surgery, Roma, Lazio, Italy
| | - Massimo Ciccozzi
- Unit of Medical Statistics and Molecular Epidemiology, University Campus Bio-Medico University of Rome Faculty of Medicine and Surgery, Roma, Lazio, Italy
| | - Claudio Mastroianni
- Department of Public Health and Infectious Diseases, University of Rome La Sapienza, Roma, Lazio, Italy
| | - Giuliano Bertazzoni
- Department of Emergency Medicine, University of Rome La Sapienza, Roma, Lazio, Italy
| | - Gabriella D'Ettorre
- Department of Public Health and Infectious Diseases, University of Rome La Sapienza, Roma, Lazio, Italy
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d'Ettorre G, Ceccarelli G, Marazzato M, Campagna G, Pinacchio C, Alessandri F, Ruberto F, Rossi G, Celani L, Scagnolari C, Mastropietro C, Trinchieri V, Recchia GE, Mauro V, Antonelli G, Pugliese F, Mastroianni CM. Challenges in the Management of SARS-CoV2 Infection: The Role of Oral Bacteriotherapy as Complementary Therapeutic Strategy to Avoid the Progression of COVID-19. Front Med (Lausanne) 2020; 7:389. [PMID: 32733907 PMCID: PMC7358304 DOI: 10.3389/fmed.2020.00389] [Citation(s) in RCA: 124] [Impact Index Per Article: 31.0] [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: 05/09/2020] [Accepted: 06/22/2020] [Indexed: 12/17/2022] Open
Abstract
Background: Gastrointestinal disorders are frequent in COVID-19 and SARS-CoV-2 has been hypothesized to impact on host microbial flora and gut inflammation, infecting intestinal epithelial cells. Since there are currently no coded therapies or guidelines for treatment of COVID-19, this study aimed to evaluate the possible role of a specific oral bacteriotherapy as complementary therapeutic strategy to avoid the progression of COVID-19. Methods: We provide a report of 70 patients positive for COVID-19, hospitalized between March 9th and April 4th, 2020. All the patients had fever, required non-invasive oxygen therapy and presented a CT lung involvement on imaging more than 50%. Forty-two patients received hydroxychloroquine, antibiotics, and tocilizumab, alone or in combination. A second group of 28 subjects received the same therapy added with oral bacteriotherapy, using a multistrain formulation. Results: The two cohorts of patients were comparable for age, sex, laboratory values, concomitant pathologies, and the modality of oxygen support. Within 72 h, nearly all patients treated with bacteriotherapy showed remission of diarrhea and other symptoms as compared to less than half of the not supplemented group. The estimated risk of developing respiratory failure was eight-fold lower in patients receiving oral bacteriotherapy. Both the prevalence of patients transferred to ICU and mortality were higher among the patients not treated with oral bacteriotherapy. Conclusions: A specific bacterial formulation showed a significant ameliorating impact on the clinical conditions of patients positive for SARS-CoV-2 infection. These results also stress the importance of the gut-lung axis in controlling the COVID-19 disease.
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Affiliation(s)
- Gabriella d'Ettorre
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Giancarlo Ceccarelli
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Massimiliano Marazzato
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Giuseppe Campagna
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Claudia Pinacchio
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Francesco Alessandri
- Department of Anesthesia and Intensive Care Medicine, Sapienza University of Rome, Rome, Italy
| | - Franco Ruberto
- Department of Anesthesia and Intensive Care Medicine, Sapienza University of Rome, Rome, Italy
| | - Giacomo Rossi
- School of Biosciences, Veterinary Medicine University of Camerino, Camerino, Italy
| | - Luigi Celani
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Carolina Scagnolari
- Laboratory of Virology, Department of Molecular Medicine, Affiliated to Istituto Pasteur Italia - Cenci Bolognetti Foundation, Sapienza University, Rome, Italy
| | - Cristina Mastropietro
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Vito Trinchieri
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Gregorio Egidio Recchia
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Vera Mauro
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Guido Antonelli
- Laboratory of Virology, Department of Molecular Medicine, Affiliated to Istituto Pasteur Italia - Cenci Bolognetti Foundation, Sapienza University, Rome, Italy
| | - Francesco Pugliese
- Department of Anesthesia and Intensive Care Medicine, Sapienza University of Rome, Rome, Italy
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14
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Santinelli L, Ceccarelli G, Borrazzo C, Innocenti GP, Frasca F, Cavallari EN, Celani L, Nonne C, Mastroianni CM, d'Ettorre G. Sex-related differences in markers of immune activation in virologically suppressed HIV-infected patients. Biol Sex Differ 2020; 11:23. [PMID: 32357901 PMCID: PMC7195770 DOI: 10.1186/s13293-020-00302-x] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Accepted: 04/16/2020] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES Gender-specific studies remain a neglected area of biomedical research. Recent reports have emphasized that sex-related biological factors may affect disease progression during HIV-1 infection. The aim of this study was to investigate the influence of sex on the levels of immune activation in the gut and in peripheral blood of individuals with HIV treated with fully suppressive antiretroviral therapy (ART). METHODS Thirty individuals with HIV undergoing long-term fully suppressive ART were enrolled in this study. Lamina propria lymphocytes (LPL) and peripheral blood mononuclear cells (PBMCs) were isolated from gut biopsies collected by pancolonoscopy and peripheral blood samples. The expression of markers of immune activation was evaluated by multi-parametric flow cytometry. This is a sub analysis of ClinicalTrials.gov Identifier: NCT02276326 RESULTS: We observed differences in the levels of immune activation in the gut and in PBMCs, with values higher in the gut compartment compared to PBMCs. In addition, we found that the mean value of the levels of immune activation was higher in the women than in the men. Finally, we measured the markers of immune activation by mean relative difference (MRD) and confirmed the higher value in the women. CONCLUSION A significant sex-related difference in the level of immune activation was observed in a population of individuals with HIV on long-term ART. A more complete characterization of these differences may support the introduction of sex-specific approaches in the clinical management of individuals with HIV.
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Affiliation(s)
- Letizia Santinelli
- Department of Molecular Medicine, Sapienza University of Rome, Rome, Italy
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Giancarlo Ceccarelli
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy.
| | - Cristian Borrazzo
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | | | - Federica Frasca
- Department of Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | | | - Luigi Celani
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Chiara Nonne
- Department of Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | | | - Gabriella d'Ettorre
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
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15
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Santinelli L, Ceccarelli G, Borrazzo C, Celani L, Pavone P, Innocenti GP, Spagnolello O, Fimiani C, Ceci F, Di Sora F, Mezzaroma I, Mastroianni CM, d'Ettorre G. Real word outcomes associated with use of raltegravir in older people living with HIV: results from the 60 months follow-up of the RAL-age cohort. Expert Rev Anti Infect Ther 2020; 18:485-492. [PMID: 32096433 DOI: 10.1080/14787210.2020.1733415] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Objective: In people living with HIV (PLWH), antiretroviral treatments have increased the median life expectancy. Raltegravir (RAL) represents a long-term safe regimen used both in the first-line antiretroviral treatments and in the optimization strategies. Aim of the study was to evaluate the real-life efficacy, tolerability, and safety of the long-term RAL use in a multicenter cohort of elderly PLWH.Methods: A 60-month follow-up observational study was carried out in the RAL-AGE Cohort including aged PLWH (≥60 years old) treated with RAL-based regimens (n = 96). The control group was a cohort of PLWH aged less than 60 years (n = 50).Results: RAL treated aged HIV population experiences an increase of CD4+ cells and a stable control of viral load at 60 months of follow-up. A significant improvement in lipid metabolism profile, a decrease of platelet count and a reduction in cardiovascular risk levels were observed in the older population. Immune activation markers expressed on CD4+ T cells decreased compared to baseline, but this difference was greater in the control group.Conclusion: A 60-month treatment with RAL-containing regimens is safe and highly effective in the older PLWH and these data give new insights on the elderly population.Clinical trial registration: NCT02765776 and NCT03579485.
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Affiliation(s)
- Letizia Santinelli
- Department of Public Health and Infectious Diseases, University of Rome "Sapienza", Rome, Italy
| | - Giancarlo Ceccarelli
- Department of Public Health and Infectious Diseases, University of Rome "Sapienza", Rome, Italy.,Infectious Diseases Clinic, Azienda Policlinico Umberto I, Rome, Italy
| | - Cristian Borrazzo
- Department of Public Health and Infectious Diseases, University of Rome "Sapienza", Rome, Italy
| | - Luigi Celani
- Department of Public Health and Infectious Diseases, University of Rome "Sapienza", Rome, Italy
| | - Paolo Pavone
- Department of Public Health and Infectious Diseases, University of Rome "Sapienza", Rome, Italy
| | | | - Ornella Spagnolello
- Department of Public Health and Infectious Diseases, University of Rome "Sapienza", Rome, Italy.,Infectious Diseases Clinic, Azienda Policlinico Umberto I, Rome, Italy.,Emergency Department, Royal Infirmary of Edinburgh, EMERGE - Emergency Medicine Research Group Edinburgh, Edinburgh, UK
| | - Caterina Fimiani
- Department of Public Health and Infectious Diseases, University of Rome "Sapienza", Rome, Italy
| | - Fabrizio Ceci
- Department of Experimental Medicine, University of Rome "Sapienza", Rome, Italy
| | - Fiorella Di Sora
- Emergency Department, Royal Infirmary of Edinburgh, EMERGE - Emergency Medicine Research Group Edinburgh, Edinburgh, UK.,Unit of Clinical Immunology, Azienda Ospedaliera San Giovanni-Addolorata, Rome, Italy
| | - Ivano Mezzaroma
- Department of Translational and Precision Medicine, University of Rome "Sapienza", Rome, Italy
| | | | - Gabriella d'Ettorre
- Department of Public Health and Infectious Diseases, University of Rome "Sapienza", Rome, Italy
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Ciccullo A, Baldin G, Capetti A, Borghi V, Sterrantino G, Latini A, Madeddu G, Celani L, Vignale F, Rossetti B, Dusina A, Cossu MV, Restelli S, Gennari W, Lagi F, Giacomelli A, Colafigli M, Brescini L, Borghetti A, Mussini C, Rusconi S, Di Giambenedetto S. Cohort profile: The Observational cohort for the study of DOlutegravir in Antiretroviral Combination REgimens (ODOACRE). BMJ Open 2019; 9:e029960. [PMID: 31796476 PMCID: PMC7003384 DOI: 10.1136/bmjopen-2019-029960] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE The Observational cohort for the study of DOlutegravir in Antiretroviral Combination REgimens (ODOACRE) cohort was established in Italy in 2016 to evaluate the overall efficacy and tolerability of dolutegravir (DTG)-based antiretroviral (ARV) regimens in clinical practice. PARTICIPANTS The ODOACRE cohort enrols all adult HIV-1-infected patients, both treatment-naïve and treatment-experienced, starting a DTG-based ARV regimen, in 11 clinical centres in Italy from 2014. FINDINGS TO DATE In recent years, various works by the ODOACRE cohort have been produced, demonstrating the high efficacy and tolerability of DTG-based ARV regimens in clinical practice, both in ART-naïve (in the setting of acute HIV-1 infection and late presenters patient) and experienced patients. We confirmed the virological efficacy of DTG-based regimens and we evaluated predictors of virological failure. We investigated cause of discontinuation and evaluated tolerability and metabolic profile of the regimens. Within these investigations, we explored particularly the use of DTG in simplification in two-drug regimen with either rilpivirine or lamivudine. We also compared DTG-based regimens with other integrase inhibitors in clinical practice. FUTURE PLANS To continue to study long-term efficacy and tolerability of DTG-based regimens is the purpose of the ODOACRE cohort.
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Affiliation(s)
- Arturo Ciccullo
- Università Cattolica del Sacro Cuore, Facoltà di Medicina e Chirurgia, Roma, Italy
| | - Gianmaria Baldin
- Università Cattolica del Sacro Cuore, Facoltà di Medicina e Chirurgia, Roma, Italy
| | - Amedeo Capetti
- Università degli Studi di Milano Dipartimento di Scienze Cliniche Luigi Sacco, Milano, Lombardia, Italy
| | - Vanni Borghi
- Università degli Studi di Modena e Reggio Emilia Facoltà di Medicina e Chirurgia, Modena, Emilia-Romagna, Italy
| | - Gaetana Sterrantino
- Division of Tropical and Infectious Diseases, Azienda Ospedaliera Careggi, Firenze, Italy
| | - Alessandra Latini
- Infectious Dermatology and Allergology Unit, IFO, Roma, Lazio, Italy
| | - Giordano Madeddu
- Department of Clinical, Surgical and Experimental Sciences, Sassari University Hospital, Sassari, Sardegna, Italy
| | - Luigi Celani
- Department of Public Health and Infectious Diseases, Universita degli Studi di Roma La Sapienza, Roma, Lazio, Italy
| | - Francesca Vignale
- Infectious Disease Clinic- Department of Medicine and Science of Aging, School of Medicine, "G. d'Annunzio" University, Chieti, Italy
| | - Barbara Rossetti
- Università degli Studi di Siena Facoltà di Medicina e Chirurgia, Siena, Toscana, Italy
| | - Alex Dusina
- Università Cattolica del Sacro Cuore, Facoltà di Medicina e Chirurgia, Roma, Italy
| | - Maria Vittoria Cossu
- Università degli Studi di Milano Dipartimento di Scienze Cliniche Luigi Sacco, Milano, Lombardia, Italy
| | - Sibilla Restelli
- Università degli Studi di Milano Dipartimento di Scienze Cliniche Luigi Sacco, Milano, Lombardia, Italy
| | - William Gennari
- Università degli Studi di Modena e Reggio Emilia Facoltà di Medicina e Chirurgia, Modena, Emilia-Romagna, Italy
| | - Filippo Lagi
- Division of Tropical and Infectious Diseases, Azienda Ospedaliera Careggi, Firenze, Italy
| | - Andrea Giacomelli
- Università degli Studi di Milano Dipartimento di Scienze Cliniche Luigi Sacco, Milano, Lombardia, Italy
| | - Manuela Colafigli
- Infectious Dermatology and Allergology Unit, IFO, Roma, Lazio, Italy
| | - Lucia Brescini
- Università Politecnica delle Marche Facoltà di Medicina e Chirurgia, Ancona, Marche, Italy
| | - Alberto Borghetti
- UOC Malattie Infettive, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | - Cristina Mussini
- Università degli Studi di Modena e Reggio Emilia Facoltà di Medicina e Chirurgia, Modena, Emilia-Romagna, Italy
| | - Stefano Rusconi
- Università degli Studi di Milano Dipartimento di Scienze Cliniche Luigi Sacco, Milano, Lombardia, Italy
| | - Simona Di Giambenedetto
- Università Cattolica del Sacro Cuore, Facoltà di Medicina e Chirurgia, Roma, Italy
- UOC Malattie Infettive, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
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17
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Baldin G, Ciccullo A, Rusconi S, Madeddu G, Sterrantino G, Freedman A, Giacometti A, Celani L, Latini A, Rossetti B, Cossu MV, Giacomelli A, Lagi F, Capetti A, Di Giambenedetto S. Single tablet regimen with abacavir/lamivudine/dolutegravir compared with two-drug regimen with lamivudine and dolutegravir as different strategies of simplification from a multicenter HIV cohort study. Infez Med 2019; 27:410-414. [PMID: 31846991] [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: 06/10/2023]
Abstract
We investigated the effectiveness and safety of a dual therapy (DT) with lamivudine plus dolutegravir versus a single tablet regimen (STR) with abacavir/lamivudine/dolutegravir. We performed a retrospective analysis in a cohort of virologically suppressed HIV+ patients switching to lamivudine-dolutegravir or abacavir/lamivudine/dolutegravir. We evaluated the incidence of virological failure and treatment discontinuation, as well as their predictors. Non-parametric tests were applied to assess changes in immunological and metabolic parameters. In all, 616 patients were analyzed: 380 began STR and 236 DT. In the STR group three patients experienced VF; in the DT group seven patients experienced VF. No differences in cause of treatment discontinuation were found. The estimated probability of continuing therapy at 48 weeks were 88.5 % in DT and 90.3% in STR, without a statistically significant difference (Log-rank 0.338). Regarding the metabolic profile, in the STR group there was a reduction in LDL cholesterol levels at week 48 (p=0.008), whereas in the lamivudine group there was a significant reduction in total cholesterol level at week 48 (p=0.044). Regarding the renal function, in both groups we registered a reduction in estimated glomerular filtration rate (eGFR), with a median reduction of 8.4 ml/min in the STR group (p<0.001) and 10.2 mL/min in DT (p<0.001). We found a difference in strategy option: in a context of side effect and comorbidities, dual therapy strategy was preferred. Conversely, simplification and compliance improvement more frequently translated into a DTG-STR strategy.
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Affiliation(s)
- Gianmaria Baldin
- Institute of Clinical Infectious Diseases, Catholic University of the Sacred Heart, Rome, Italy; Mater Olbia Hospital, Olbia, Italy
| | - Arturo Ciccullo
- Institute of Clinical Infectious Diseases, Catholic University of the Sacred Heart, Rome, Italy
| | - Stefano Rusconi
- Infectious Diseases Unit, DIBIC Luigi Sacco, University of Milan, Milan, Italy
| | - Giordano Madeddu
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy
| | - Gaetana Sterrantino
- Infectious Diseases Unit, Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
| | - Andrew Freedman
- Department of Infectious Diseases, University Hospital of Wales, Cardiff, UK
| | - Andrea Giacometti
- Infectious Diseases Clinic, Department of Biomedical Sciences and Public Health, Polytechnic University of Marche, Ancona, Italy
| | - Luigi Celani
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Alessandra Latini
- Infectious Dermatology and Allergology Unit, IFO S. Gallicano Institute (IRCCS), Rome, Italy
| | - Barbara Rossetti
- Infectious Diseases Unit, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Maria Vittoria Cossu
- Division of Infectious Diseases, Department of Infectious Diseases, Luigi Sacco University Hospital, Milan, Italy
| | - Andrea Giacomelli
- Infectious Diseases Unit, DIBIC Luigi Sacco, University of Milan, Milan, Italy
| | - Filippo Lagi
- Infectious Diseases Unit, Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
| | - Amedeo Capetti
- Division of Infectious Diseases, Department of Infectious Diseases, Luigi Sacco University Hospital, Milan, Italy
| | - Simona Di Giambenedetto
- Institute of Clinical Infectious Diseases, Catholic University of the Sacred Heart, Rome, Italy; Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
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Bellelli V, d'Ettorre G, Celani L, Borrazzo C, Ceccarelli G, Venditti M. Clinical significance of lymphocytopenia in patients hospitalized with pneumonia caused by influenza virus. Crit Care 2019; 23:330. [PMID: 31665060 PMCID: PMC6819578 DOI: 10.1186/s13054-019-2608-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 09/13/2019] [Indexed: 11/24/2022]
Affiliation(s)
- Valeria Bellelli
- Department of Public Health and Infectious Diseases, University of Rome Sapienza, Viale del Policlinico 155, Rome, Italy
| | - Gabriella d'Ettorre
- Department of Public Health and Infectious Diseases, University of Rome Sapienza, Viale del Policlinico 155, Rome, Italy
| | - Luigi Celani
- Department of Public Health and Infectious Diseases, University of Rome Sapienza, Viale del Policlinico 155, Rome, Italy
| | - Cristian Borrazzo
- Department of Public Health and Infectious Diseases, University of Rome Sapienza, Viale del Policlinico 155, Rome, Italy
| | - Giancarlo Ceccarelli
- Department of Public Health and Infectious Diseases, University of Rome Sapienza, Viale del Policlinico 155, Rome, Italy
| | - Mario Venditti
- Department of Public Health and Infectious Diseases, University of Rome Sapienza, Viale del Policlinico 155, Rome, Italy.
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19
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Ceccarelli G, Borrazzo C, Lazzaro A, Innocenti GP, Celani L, Cavallari EN, Pinacchio C, Santinelli L, Mastroianni CM, d'Ettorre G. Diagnostic Issues of Asymptomatic Neurosyphilis in HIV-Positive Patients: A Retrospective Study. Brain Sci 2019; 9:brainsci9100278. [PMID: 31627294 PMCID: PMC6826495 DOI: 10.3390/brainsci9100278] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Revised: 10/13/2019] [Accepted: 10/15/2019] [Indexed: 11/16/2022] Open
Abstract
Introduction: Asymptomatic neurosyphilis (ANS) is a disease that is difficult to diagnose in people living with HIV (PLWH). The European Guidelines on the management of syphilis suggest that ANS should be suspected and thus the lumbar puncture (LP) should be performed in cases of (1) late syphilis (acquired >2 years previously), (2) CD4+ cells ≤ 350/mm3 and/or a serum Venereal Disease Research Laboratory/Rapid Plasma Reagin (VDRL/RPR) title > 1:32, (3) “serological failure” after syphilis therapy, and (4) the use of alternative treatment for syphilis. In the present study, we aimed to verify the accuracy of the guideline’s criteria for the indication of LP in the suspicion of ANS in a cohort of PLWH. Methods: This retrospective study was carried out in a cohort of PLWH referred at a single medical center of a large academic hospital in Italy. Clinical and laboratory data of patients diagnosed with late syphilis were extracted from the cohort and analyzed. The European Guidelines of syphilis were adopted for patient management. Results: Out of a cohort of 713 PLWH, only 51 (7%) had a diagnosis of late syphilis and were therefore included in the study. Thirty-one subjects (61%) met one or more diagnostic criteria to perform LP: 39% (12/31) of patients undergoing LP had a diagnosis of ANS. The accuracy of predictive criteria for ANS, suggested by the guidelines, was 62% for RPR > 1:32 and 74% for CD4+ ≤ 350 cc/µL. The simultaneous occurrence of both criteria (RPR > 1:32 plus CD4+ ≤ 350 cc/µL) achieved a diagnostic accuracy of 59%. Interestingly, only 17% of patients who underwent LP for serological failure were eventually diagnosed positive for ANS. Conclusion: Asymptomatic neurosyphilis represents a challenging, but not uncommon, diagnosis. Therefore, it requires a careful investigation. Low CD4+ cell count and RPR > 1:32 remain excellent predictors of neurosyphilis, but have become the only acceptable predictors of ANS in PLWH. “Serologic failure” should be regarded with caution as a criterion to perform LP in order to investigate possible ANS in HIV-syphilis coinfected patients asymptomatic for neurological disorders. The retrospective nature of this single-site study may represent a limit to the interpretation of the data. Thus, larger clinical studies on the topic are warranted.
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Affiliation(s)
- Giancarlo Ceccarelli
- Department of Public Health and Infectious Diseases, Azienda Ospedaliero-Universitaria Policlinico Umberto I, Sapienza University, 00161 Rome, Italy.
| | - Cristian Borrazzo
- Department of Public Health and Infectious Diseases, Azienda Ospedaliero-Universitaria Policlinico Umberto I, Sapienza University, 00161 Rome, Italy.
| | - Alessandro Lazzaro
- Department of Public Health and Infectious Diseases, Azienda Ospedaliero-Universitaria Policlinico Umberto I, Sapienza University, 00161 Rome, Italy.
- Department of Medical Sciences, Infectious Diseases, University of Turin, 10124 Turin, Italy.
| | - Giuseppe Pietro Innocenti
- Department of Public Health and Infectious Diseases, Azienda Ospedaliero-Universitaria Policlinico Umberto I, Sapienza University, 00161 Rome, Italy.
| | - Luigi Celani
- Department of Public Health and Infectious Diseases, Azienda Ospedaliero-Universitaria Policlinico Umberto I, Sapienza University, 00161 Rome, Italy.
| | - Eugenio Nelson Cavallari
- Department of Public Health and Infectious Diseases, Azienda Ospedaliero-Universitaria Policlinico Umberto I, Sapienza University, 00161 Rome, Italy.
| | - Claudia Pinacchio
- Department of Public Health and Infectious Diseases, Azienda Ospedaliero-Universitaria Policlinico Umberto I, Sapienza University, 00161 Rome, Italy.
| | - Letizia Santinelli
- Department of Public Health and Infectious Diseases, Azienda Ospedaliero-Universitaria Policlinico Umberto I, Sapienza University, 00161 Rome, Italy.
| | - Claudio Maria Mastroianni
- Department of Public Health and Infectious Diseases, Azienda Ospedaliero-Universitaria Policlinico Umberto I, Sapienza University, 00161 Rome, Italy.
| | - Gabriella d'Ettorre
- Department of Public Health and Infectious Diseases, Azienda Ospedaliero-Universitaria Policlinico Umberto I, Sapienza University, 00161 Rome, Italy.
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Rossetti B, Baldin G, Sterrantino G, Rusconi S, De Vito A, Giacometti A, Gagliardini R, Colafigli M, Capetti A, d'Ettorre G, Celani L, Lagi F, Ciccullo A, De Luca A, Di Giambenedetto S, Madeddu G. Efficacy and safety of dolutegravir-based regimens in advanced HIV-infected naïve patients: results from a multicenter cohort study. Antiviral Res 2019; 169:104552. [PMID: 31283942 DOI: 10.1016/j.antiviral.2019.104552] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [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: 03/11/2019] [Revised: 06/21/2019] [Accepted: 07/04/2019] [Indexed: 10/26/2022]
Abstract
The aims were to describe efficacy and tolerability of regimens containing dolutegravir (DTG) in advanced ART-naïve people living with HIV (PLHIV) from the clinical practice. The frequency of Immune Reconstitution Inflammatory Syndrome (IRIS), the estimated time of discontinuation of the first ART regimen and the time to reach virological suppression in a multicenter cohort of AIDS-presenters or late-presenters with CD4 <350/μL were assessed. We included 272 PLHIV: 120 (44%) AIDS-presenters and 152 (56%) late-presenters. The most frequent AIDS-defining event was Pneumocystis jirovecii pneumonia in 41 (34%). One hundred-thirty-two PLHIV (48%) started first-line cART regimens including DTG and 140 PLHIV (52%) were treated with cART regimens without DTG. One-hundred-eighty-two (67%) individuals discontinued their first-line regimen: 109 (60%) for simplification, 32 (18%) for toxicities, 4 (2%) for drug-drug interactions, 37 (20%) for other reasons. DTG was interrupted in 19/132 (14%) PLHIV: 13 (68%) for adverse events (5 intolerance, 4 gastrointestinal disorders and 4 neurological symptoms), 2 (11%) for proactive switch and 4 (21%) for medical/individual choice. IRIS was reported in 13 (5%) AIDS-presenters without differences between arms. During a median observation time of 16 months (IQR 5-24), HIV-1 RNA<50 copies/mL was achieved in 95/132 (72%) individuals on DTG-based regimen and in 92/140 (66%) individuals with other regimens. The 12-month estimated probability of DTG interruption was 14% (95% CI 11-17). The results demonstrated the low risk for IRIS and the high potency, good tolerability and safety of DTG in our population of advanced naïve PLHIV.
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Affiliation(s)
- Barbara Rossetti
- Infectious Diseases Unit, Azienda Ospedaliera Universitaria Senese, Viale Bracci 16, 53100, Siena, Italy.
| | - Gianmaria Baldin
- Institute of Clinical Infectious Diseases, Catholic University of Sacred Heart, Largo Agostino Gemelli, 8, 00168, Rome, Italy.
| | - Gaetana Sterrantino
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla 3, 50134, Florence, Italy.
| | - Stefano Rusconi
- Infectious Diseases Unit, DIBIC Luigi Sacco, University of Milan, Via G.B. Grassi 74, 20157, Milan, Italy.
| | - Andrea De Vito
- Unit of Infectious Diseases, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Viale San Pietro 43, 07100, Sassari, Italy.
| | - Andrea Giacometti
- Infectious Diseases, Department of Biological Sciences and Public Health, Marche Polytechnic University, Via Conca, 71, 60200, Ancona, Italy.
| | - Roberta Gagliardini
- Department of Medical Biotechnologies, University of Siena, Viale Bracci 16, 53100, Siena, Italy.
| | - Manuela Colafigli
- Infectious Dermatology and Allergology Unit, IFO S. Gallicano Institute (IRCCS), via Elio Chianesi, 53, 00144, Rome, Italy.
| | - Amedeo Capetti
- First Division of Infectious Diseases, Department of Infectious Diseases, Luigi Sacco University Hospital, Via G.B. Grassi 74, 20157, Milan, Italy.
| | - Gabriella d'Ettorre
- Department of Infectious Diseases and Public Health, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185, Rome, Italy.
| | - Luigi Celani
- Department of Infectious Diseases and Public Health, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185, Rome, Italy.
| | - Filippo Lagi
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla 3, 50134, Florence, Italy.
| | - Arturo Ciccullo
- Institute of Clinical Infectious Diseases, Catholic University of Sacred Heart, Largo Agostino Gemelli, 8, 00168, Rome, Italy.
| | - Andrea De Luca
- Infectious Diseases Unit, Azienda Ospedaliera Universitaria Senese, Viale Bracci 16, 53100, Siena, Italy; Department of Medical Biotechnologies, University of Siena, Viale Bracci 16, 53100, Siena, Italy.
| | - Simona Di Giambenedetto
- Institute of Clinical Infectious Diseases, Catholic University of Sacred Heart, Largo Agostino Gemelli, 8, 00168, Rome, Italy; IRCCS Fondazione Policlinico Universitario Agostino Gemelli,Largo Agostino Gemelli, 8, 00168, Rome, Italy.
| | - Giordano Madeddu
- Unit of Infectious Diseases, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Viale San Pietro 43, 07100, Sassari, Italy.
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De Angelis M, Scagnolari C, Oliva A, Cavallari EN, Celani L, Santinelli L, Innocenti GP, Borrazzo C, Ceccarelli G, Vullo V, d'Ettorre G. Short-Term Probiotic Administration Increases Fecal-Anti Candida Activity in Healthy Subjects. Microorganisms 2019; 7:E162. [PMID: 31163660 PMCID: PMC6616593 DOI: 10.3390/microorganisms7060162] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Revised: 05/20/2019] [Accepted: 05/27/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Candida albicans' ability to evade host immune responses represents a serious threat for vulnerable patients. OBJECTIVES To investigate if (1) feces from healthy subjects exert anti-Candida activity; (2) fecal anti-Candida activity is modified by probiotic administration and (3) different probiotic differently modulate anti-Candida activity. PATIENTS AND METHODS Feces from healthy donors were analyzed before and after seven days of dietary supplementation with two different probiotic formulations (VSL#3®; Vivomixx®). Candida albicans was cultured with decreasing concentrations of diluted feces, obtained before and after the treatment period. The relationship between anti-Candida activity of feces, interferon-α, anti-interferon-α antibodies and the expression of MxA, ISG15 and IFNAR1 was also evaluated. RESULTS Feces obtained prior to probiotic intake and feces collected after supplementation with VSL#3® did not affect Candida albicans growth. On the contrary, a 3log10 inhibition of Candida development was observed after Vivomixx® intake. Interferon-α played a role in the inhibition of Candida growth. CONCLUSION Fecal anti-Candida activity was not observed prior to probiotic supplementation. Seven days of administration of Vivomixx® increased fecal anti-Candida activity, the same effect was not observed after intake of VSL#3®. The probiotic-induced anti-Candida activity seems to be related to an increased local production and release of interferon-α. Clinical trials are needed to determine if a short pretreatment with specific probiotic formulations may increase anti-Candida defenses in patients at risk.
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Affiliation(s)
- Massimiliano De Angelis
- Department of Public Health and Infectious Diseases, University of Rome-Sapienza, Rome 00185, Italy.
| | - Carolina Scagnolari
- Department of Experimental Medicine- Virology section, University of Rome-Sapienza, Rome 00185, Italy.
| | - Alessandra Oliva
- Department of Public Health and Infectious Diseases, University of Rome-Sapienza, Rome 00185, Italy.
| | - Eugenio Nelson Cavallari
- Department of Public Health and Infectious Diseases, University of Rome-Sapienza, Rome 00185, Italy.
| | - Luigi Celani
- Department of Public Health and Infectious Diseases, University of Rome-Sapienza, Rome 00185, Italy.
| | - Letizia Santinelli
- Department of Public Health and Infectious Diseases, University of Rome-Sapienza, Rome 00185, Italy.
| | - Giuseppe Pietro Innocenti
- Department of Public Health and Infectious Diseases, University of Rome-Sapienza, Rome 00185, Italy.
| | - Cristian Borrazzo
- Department of Public Health and Infectious Diseases, University of Rome-Sapienza, Rome 00185, Italy.
| | - Giancarlo Ceccarelli
- Department of Public Health and Infectious Diseases, University of Rome-Sapienza, Rome 00185, Italy.
| | - Vincenzo Vullo
- Department of Public Health and Infectious Diseases, University of Rome-Sapienza, Rome 00185, Italy.
| | - Gabriella d'Ettorre
- Department of Public Health and Infectious Diseases, University of Rome-Sapienza, Rome 00185, Italy.
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Tumbarello M, Trecarichi EM, De Rosa FG, Giannella M, Giacobbe DR, Bassetti M, Losito AR, Bartoletti M, Del Bono V, Corcione S, Maiuro G, Tedeschi S, Celani L, Cardellino CS, Spanu T, Marchese A, Ambretti S, Cauda R, Viscoli C, Viale P. Infections caused by KPC-producing Klebsiella pneumoniae: differences in therapy and mortality in a multicentre study. J Antimicrob Chemother 2015; 70:2133-43. [PMID: 25900159 DOI: 10.1093/jac/dkv086] [Citation(s) in RCA: 360] [Impact Index Per Article: 40.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2014] [Accepted: 03/14/2015] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES Infections caused by Klebsiella pneumoniae (Kp) carbapenemase (KPC)-producing strains of Kp have become a significant threat in recent years. To assess their outcomes and identify risk factors for 14 day mortality, we conducted a 4 year (2010-13) retrospective cohort study in five large Italian teaching hospitals. METHODS The cohort included 661 adults with bloodstream infections (BSIs; n = 447) or non-bacteraemic infections (lower respiratory tract, intra-abdominal structure, urinary tract or other sites) caused by a KPC-Kp isolate. All had received ≥48 h of therapy (empirical and/or non-empirical) with at least one drug to which the isolate was susceptible. RESULTS Most deaths occurred within 2 weeks of infection onset (14 day mortality: 225/661, 34.1%). Logistic regression analysis identified BSI (OR, 2.09; 95% CI, 1.34-3.29), presentation with septic shock (OR, 2.45; 95% CI, 1.47-4.08), inadequate empirical antimicrobial therapy (OR, 1.48; 95% CI, 1.01-2.18), chronic renal failure (OR, 2.27; 95% CI, 1.44-3.58), high APACHE III score (OR, 1.05; 95% CI, 1.04-1.07) and colistin-resistant isolates (OR, 2.18; 95% CI, 1.37-3.46) as independent predictors of 14 day mortality. Combination therapy with at least two drugs displaying in vitro activity against the isolate was associated with lower mortality (OR, 0.52; 95% CI, 0.35-0.77), in particular in patients with BSIs, lung infections or high APACHE III scores and/or septic shock at infection onset. Combinations that included meropenem were associated with significantly higher survival rates when the KPC-Kp isolate had a meropenem MIC of ≤8 mg/L. CONCLUSIONS KPC-Kp infections are associated with high mortality. Treatment with two or more drugs displaying activity against the isolate improves survival, mainly in patients who are critically ill.
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Affiliation(s)
- Mario Tumbarello
- Institute of Infectious Diseases, Catholic University of the Sacred Heart, A. Gemelli Hospital, Roma, Italy
| | - Enrico Maria Trecarichi
- Institute of Infectious Diseases, Catholic University of the Sacred Heart, A. Gemelli Hospital, Roma, Italy
| | - Francesco Giuseppe De Rosa
- Department of Medical Sciences, University of Turin, Torino, Italy Infectious Diseases at Amedeo di Savoia Hospital, Torino, Italy
| | - Maddalena Giannella
- Clinic of Infectious Diseases, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Daniele Roberto Giacobbe
- Infectious Diseases Division, University of Genoa (DISSAL) and IRCCS San Martino-IST, Genoa, Italy
| | - Matteo Bassetti
- Infectious Diseases Division, Santa Maria Misericordia University Hospital, Udine, Italy
| | - Angela Raffaella Losito
- Institute of Infectious Diseases, Catholic University of the Sacred Heart, A. Gemelli Hospital, Roma, Italy
| | - Michele Bartoletti
- Clinic of Infectious Diseases, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Valerio Del Bono
- Infectious Diseases Division, University of Genoa (DISSAL) and IRCCS San Martino-IST, Genoa, Italy
| | - Silvia Corcione
- Department of Medical Sciences, University of Turin, Torino, Italy Infectious Diseases at Amedeo di Savoia Hospital, Torino, Italy
| | - Giuseppe Maiuro
- Institute of Infectious Diseases, Catholic University of the Sacred Heart, A. Gemelli Hospital, Roma, Italy
| | - Sara Tedeschi
- Clinic of Infectious Diseases, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Luigi Celani
- Institute of Infectious Diseases, Catholic University of the Sacred Heart, A. Gemelli Hospital, Roma, Italy
| | - Chiara Simona Cardellino
- Department of Medical Sciences, University of Turin, Torino, Italy Infectious Diseases at Amedeo di Savoia Hospital, Torino, Italy
| | - Teresa Spanu
- Institute of Microbiology, Catholic University of the Sacred Heart, A. Gemelli Hospital, Roma, Italy
| | - Anna Marchese
- Microbiology Unit, University of Genoa (DISC) and IRCCS San Martino-IST, Genoa, Italy
| | - Simone Ambretti
- Operative Unit of Clinical Microbiology, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Roberto Cauda
- Institute of Infectious Diseases, Catholic University of the Sacred Heart, A. Gemelli Hospital, Roma, Italy
| | - Claudio Viscoli
- Infectious Diseases Division, University of Genoa (DISSAL) and IRCCS San Martino-IST, Genoa, Italy
| | - Pierluigi Viale
- Clinic of Infectious Diseases, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
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Mupo A, Celani L, Dovey O, Cooper JL, Grove C, Rad R, Sportoletti P, Falini B, Bradley A, Vassiliou GS. A powerful molecular synergy between mutant Nucleophosmin and Flt3-ITD drives acute myeloid leukemia in mice. Leukemia 2013; 27:1917-20. [PMID: 23478666 PMCID: PMC3768110 DOI: 10.1038/leu.2013.77] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Cevenni E, Celani L, Rea J, Numminen A, Virras O, Broczek K, Sikora E, Franceschi C, Rea M. Do nonagenarian siblings provide mutual support? Insights from the EU GeHA project. Eur Geriatr Med 2012. [DOI: 10.1016/j.eurger.2012.07.158] [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: 11/29/2022]
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Salvioli S, Olivieri F, Marchegiani F, Cardelli M, Santoro A, Bellavista E, Mishto M, Invidia L, Capri M, Valensin S, Sevini F, Cevenini E, Celani L, Lescai F, Gonos E, Caruso C, Paolisso G, De Benedictis G, Monti D, Franceschi C. Genes, ageing and longevity in humans: problems, advantages and perspectives. Free Radic Res 2007; 40:1303-23. [PMID: 17090420 DOI: 10.1080/10715760600917136] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Many epidemiological data indicate the presence of a strong familial component of longevity that is largely determined by genetics, and a number of possible associations between longevity and allelic variants of genes have been described. A breakthrough strategy to get insight into the genetics of longevity is the study of centenarians, the best example of successful ageing. We review the main results regarding nuclear genes as well as the mitochondrial genome, focusing on the investigations performed on Italian centenarians, compared to those from other countries. These studies produced interesting results on many putative "longevity genes". Nevertheless, many discrepancies are reported, likely due to the population-specific interactions between gene pools and environment. New approaches, including large-scale studies using high-throughput techniques, are urgently needed to overcome the limits of traditional association studies performed on a limited number of polymorphisms in order to make substantial progress to disentangle the genetics of a trait as complex as human longevity.
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Affiliation(s)
- S Salvioli
- Department of Experimental Pathology, University of Bologna, Bologna, Italy
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Nobili A, Gebru F, Rossetti A, Schettino F, Zahn RW, Nicolis E, Macario G, Celani L, Acik VO, Farina M, Naldi L. Doctorline: a private toll-free telephone medical information service. Five years of activity: old problems and new perspectives. Ann Pharmacother 1998; 32:120-5. [PMID: 9475832 DOI: 10.1345/aph.16430] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
UNLABELLED Introduction; Healthcare professionals need to continually update their knowledge to provide care based on scientific evidence. In some cases it can be difficult to gain access to the different sources of medical information. In an attempt to overcome these problems, a toll-free telephone medical information service (Doctorline) was established. OBJECTIVE To describe the development, aims, organization, and activities of this private service. METHODS Doctorline is an independent, unbiased, toll-free medical information service that provides information on clinical, pharmacologic, and toxicologic issues; bibliographic searches; full-text articles; public and private clinics; details of forthcoming congresses; and legislative documentation. The service is available Monday through Friday, 1000 to 2000. Staff members are physicians trained in communication techniques, literature evaluation methodologies, and computerized database use. The main on-line facilities are MEDLINE, Micromedex-CCIS, and the Italian Formulary on CD-ROM. Books, bulletins, national and international drug formularies, and property files (i.e., directory of Italian public and private clinics) are also available. RESULTS In 5 years, Doctorline has received 65 258 calls. Nearly 34% of the calls were made by general practitioners, followed by cardiologists (22%), orthopedists (15%), pharmacists (14%), gastroenterologists (13%), and urologists (10%). From 1991 to 1996, nearly 20% of the calls concerned pharmacologic issues, 43% nonpharmacologic issues, while the rest of the calls were for nonclinical requests. Approximately 21% of all questions received an answer during the same phone call (on-line answers); for the other answers (off-line answers) the mean +/- SD waiting time was 7.8 +/- 10.4 days. Although the nature of the questions has been recorded since 1991, data about the exact number of physicians who used the service are available only from 1994. Data from 1994 indicate that of the 52,181 physicians who could access the service, only 8817 (16.9%) called at least once, with a mean number of calls per physician of 3.9 (range 3.0-5.6). CONCLUSIONS The future of Doctorline will depend on the quality and validity of the information provided (i.e., based exclusively on scientific evidence, independent of the source of funds), the promotion of the aims, organization, and clinical utility of the service (especially among physicians who made little or no use of the service), and differentiation of the service activities in relation to the physician's specific needs.
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Affiliation(s)
- A Nobili
- Laboratorio di Neuropsichiatria Geriatrica, Istituto di Ricerche Farmacologiche, Mario Negri, Milan, Italy.
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Aliberti G, D'Erasmo E, Minisola S, Celani L. [Non-hormonal therapy of diabetes insipidus]. Clin Ter 1983; 107:499-505. [PMID: 6661895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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