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Giuliano M, Tiple D, Agostoni P, Armocida B, Biardi L, Bonfigli AR, Campana A, Ciardi M, Di Marco F, Floridia M, Gnerre P, Grassi T, Grattagliano I, Kruger P, Leonardi M, Liguori R, Pagani E, Perger E, Pricci F, Ruggeri M, Silenzi A, Spannella F, Tascini C, Teté G, Tosato M, Vecchi S, Villa M, Onder G. Italian good practice recommendations on management of persons with Long-COVID. Front Public Health 2023; 11:1122141. [PMID: 37151592 PMCID: PMC10157646 DOI: 10.3389/fpubh.2023.1122141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 03/27/2023] [Indexed: 05/09/2023] Open
Abstract
A significant number of people, following acute SARS-CoV-2 infection, report persistent symptoms or new symptoms that are sustained over time, often affecting different body systems. This condition, commonly referred to as Long-COVID, requires a complex clinical management. In Italy new health facilities specifically dedicated to the diagnosis and care of Long-COVID were implemented. However, the activity of these clinical centers is highly heterogeneous, with wide variation in the type of services provided, specialistic expertise and, ultimately, in the clinical care provided. Recommendations for a uniform management of Long-COVID were therefore needed. Professionals from different disciplines (including general practitioners, specialists in respiratory diseases, infectious diseases, internal medicine, geriatrics, cardiology, neurology, pediatrics, and odontostomatology) were invited to participate, together with a patient representative, in a multidisciplinary Panel appointed to draft Good Practices on clinical management of Long-COVID. The Panel, after extensive literature review, issued recommendations on 3 thematic areas: access to Long-COVID services, clinical evaluation, and organization of the services. The Panel highlighted the importance of providing integrated multidisciplinary care in the management of patients after SARS-CoV-2 infection, and agreed that a multidisciplinary service, one-stop clinic approach could avoid multiple referrals and reduce the number of appointments. In areas where multidisciplinary services are not available, services may be provided through integrated and coordinated primary, community, rehabilitation and mental health services. Management should be adapted according to the patient's needs and should promptly address possible life-threatening complications. The present recommendations could provide guidance and support in standardizing the care provided to Long-COVID patients.
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Affiliation(s)
- Marina Giuliano
- National Center for Global Health, Istituto Superiore di Sanità, Rome, Italy
- *Correspondence: Marina Giuliano,
| | - Dorina Tiple
- Department of Neuroscience, Istituto Superiore di Sanità, Rome, Italy
| | - Piergiuseppe Agostoni
- Heart Failure Unit, Centro Cardiologico Monzino IRCCS, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Benedetta Armocida
- Department of Cardiovascular, Endocrine-Metabolic Diseases, and Aging, Istituto Superiore di Sanità, Rome, Italy
| | | | | | | | - Maria Ciardi
- Department of Public Health and Infectious Diseases, University “La Sapienza”, Rome, Italy
| | - Fabiano Di Marco
- Department of Health Sciences and Pneumology, University of Milan, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Marco Floridia
- National Center for Global Health, Istituto Superiore di Sanità, Rome, Italy
| | - Paola Gnerre
- Department of Internal Medicine, ASL AL, Acqui Terme, Italy
| | - Tiziana Grassi
- Department of Cardiovascular, Endocrine-Metabolic Diseases, and Aging, Istituto Superiore di Sanità, Rome, Italy
| | - Ignazio Grattagliano
- SIMG, Italian College of General Practitioners and Primary Care, Florence, Italy
| | - Paola Kruger
- European Patients Academy for Therapeutic Innovation (EUPATI), Rome, Italy
| | - Matilde Leonardi
- Neurology, Public Health and Disability Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Rocco Liguori
- UOC Clinica Neurologica, IRCCS Istituto delle Scienze Neurologiche, Bologna, Italy
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Elisabetta Pagani
- Department of Internal Medicine, Fondazione IRCCS, Policlinico San Matteo, Pavia, Italy
| | - Elisa Perger
- Department of Cardiovascular, Neural and Metabolic Sciences, Sleep Disorders Center, Istituto Auxologico Italiano IRCCS, Milan, Italy
| | - Flavia Pricci
- Department of Cardiovascular, Endocrine-Metabolic Diseases, and Aging, Istituto Superiore di Sanità, Rome, Italy
| | | | - Andrea Silenzi
- General Directorate for Health Prevention, Ministry of Health, Rome, Italy
| | - Francesco Spannella
- Internal Medicine and Geriatrics, IRCCS INRCA, Ancona, Italy
- Department of Clinical and Molecular Sciences, Università Politecnica delle Marche, Ancona, Italy
| | - Carlo Tascini
- Infectious Diseases Division, Department of Medicine, University of Udine and Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Giulia Teté
- Department of Dentistry, IRCCS San Raffaele Hospital, Milan, Italy
| | - Matteo Tosato
- Department of Geriatrics and Othopedic Sciences, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy
| | - Simona Vecchi
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | - Marika Villa
- Department of Cardiovascular, Endocrine-Metabolic Diseases, and Aging, Istituto Superiore di Sanità, Rome, Italy
| | - Graziano Onder
- Department of Geriatrics and Othopedic Sciences, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy
- Department of Geriatrics, Università Cattolica del Sacro Cuore, Rome, Italy
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Birtolo LI, Silvia P, Monosilio S, Cimino S, Filomena D, D'Antoni L, Francavilla S, Francone M, Galea N, Severino P, Pasculli P, Colaiacomo MC, Petroianni A, Chimenti C, Lavalle C, Badagliacca R, Palange P, Mastroianni CM, Catalano C, Pugliese F, Ciardi M, Maestrini V, Mancone M, Fedele F. FOLLOW-UP OF HOSPITALIZED COVID-19 SURVIVORS: ASSESSMENT OF SHORT AND LONG-TERM CARDIOVASCULAR SEQUELAE AFTER SARS-COV-2 INFECTION. J Am Coll Cardiol 2022. [PMCID: PMC8972617 DOI: 10.1016/s0735-1097(22)03148-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Vitarelli A, Capotosto L, Nguyen BL, Tanzilli G, Viceconte N, Mancone M, Mangieri E, Ciardi M, Mastroianni C, Miraldi F. SIMPLE AND COMPLEX MITRAL VALVE PROLAPSE: ASSESSMENT BY THREE-DIMENSIONAL TRANSESOPHAGEAL ECHOCARDIOGRAPHY. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)02272-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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4
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Neron B, Zingaropoli M, Radocchia G, Ciardi M, Mosca L, Pantanella F, Schippa S. Evaluation of the anti‑proliferative activity of violacein, a natural pigment of bacterial origin, in urinary bladder cancer cell lines. Oncol Lett 2022; 23:132. [DOI: 10.3892/ol.2022.13252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 12/06/2021] [Indexed: 11/06/2022] Open
Affiliation(s)
- Bruna Neron
- Department of Public Health and Infectious Diseases, Microbiology Section, Sapienza University of Rome, I-00185 Rome, Italy
| | - Maria Zingaropoli
- Department of Public Health and Infectious Diseases, Microbiology Section, Sapienza University of Rome, I-00185 Rome, Italy
| | - Giulia Radocchia
- Department of Public Health and Infectious Diseases, Microbiology Section, Sapienza University of Rome, I-00185 Rome, Italy
| | - Maria Ciardi
- Department of Public Health and Infectious Diseases, Microbiology Section, Sapienza University of Rome, I-00185 Rome, Italy
| | - Luciana Mosca
- Department of Biochemical Sciences, Sapienza University of Rome, I-00185 Rome, Italy
| | - Fabrizio Pantanella
- Department of Public Health and Infectious Diseases, Microbiology Section, Sapienza University of Rome, I-00185 Rome, Italy
| | - Serena Schippa
- Department of Public Health and Infectious Diseases, Microbiology Section, Sapienza University of Rome, I-00185 Rome, Italy
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5
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Birtolo LI, Prosperi S, Monosilio S, Cimino S, Filomena D, Alfarano M, Manzi G, Neccia M, Papa S, Passarelli I, De Persis F, Luca AD, Mei M, Di Iorio M, D’Antoni L, Di Pietro G, Francavilla S, Improta R, Marcon S, Mariani MV, Agnes G, Piro A, Rizzo M, Rachele ES, Straito M, Tocci M, Francone M, Galea N, Severino P, Pasculli P, Colaiacomo MC, Petroianni A, Chimenti C, Lavalle C, Badagliacca R, Palange P, Mastroianni C, Catalano C, Pugliese F, Ciardi M, Maestrini V, Mancone M, Fedele F. 282 Follow-up of hospitalized COVID-19 survivors: assessment of short- and long-term cardiovascular sequelae after SARS-CoV-2 infection. Eur Heart J Suppl 2021. [PMCID: PMC8689752 DOI: 10.1093/eurheartj/suab135.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Aims Cardiovascular sequelae in COVID-19 survivors remain largely unclear and can potentially go unrecognized. Reports on follow-up focused on cardiovascular evaluation after hospital discharge are currently scarce. Aim of this prospective study was to assess cardiovascular sequelae in previously hospitalized COVID-19 survivors. Methods and results The study was conducted at ‘Sapienza’ University of Rome—Policlinico ‘Umberto I’. After 2 months from discharge, n = 230 COVID-19 survivors underwent a follow-up visit at a dedicated ‘post-COVID Outpatient Clinic’. A cardiovascular evaluation including electrocardiogram (ECG), Troponin and echocardiography was performed. Further tests were requested when clinically indicated. Medical history, symptoms, arterial-blood gas, blood tests, chest computed tomography, and treatment of both in-hospital and follow-up evaluation were recorded. A 1-year telephone follow-up was performed. A total of 36 (16%) COVID-19 survivors showed persistence or delayed onset of cardiovascular disease at 2-months follow-up visit. Persistent condition was recorded in 62% of survivors who experienced an in-hospital cardiovascular disease. Delayed cardiovascular involvement included: myocarditis, pericarditis, ventricular disfunction, new onset of systemic hypertension and arrhythmias. At 1-year telephone follow-up, 105 (45%) survivors reported persistent symptoms, with dyspnoea and fatigue being the most frequent. 60% of survivors showed persistent chest CT abnormalities and among those 28% complained of persistent cardiopulmonary symptoms at long term follow-up. Conclusions Our preliminary data showed persistent or delayed onset of cardiovascular involvement (16%) at short-term follow-up and persistent symptoms (45%) at long-term follow-up. These findings suggest the need for monitoring COVID-19 survivors.
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Affiliation(s)
- Lucia Ilaria Birtolo
- Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, ‘Policlinico Umberto I’ Hospital, Sapienza University of Rome, Rome, Italy
| | - Silvia Prosperi
- Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, ‘Policlinico Umberto I’ Hospital, Sapienza University of Rome, Rome, Italy
| | - Sara Monosilio
- Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, ‘Policlinico Umberto I’ Hospital, Sapienza University of Rome, Rome, Italy
| | - Sara Cimino
- Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, ‘Policlinico Umberto I’ Hospital, Sapienza University of Rome, Rome, Italy
| | - Domenico Filomena
- Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, ‘Policlinico Umberto I’ Hospital, Sapienza University of Rome, Rome, Italy
| | - Maria Alfarano
- Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, ‘Policlinico Umberto I’ Hospital, Sapienza University of Rome, Rome, Italy
| | - Giovanna Manzi
- Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, ‘Policlinico Umberto I’ Hospital, Sapienza University of Rome, Rome, Italy
| | - Matteo Neccia
- Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, ‘Policlinico Umberto I’ Hospital, Sapienza University of Rome, Rome, Italy
| | - Silvia Papa
- Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, ‘Policlinico Umberto I’ Hospital, Sapienza University of Rome, Rome, Italy
| | - Ilaria Passarelli
- Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, ‘Policlinico Umberto I’ Hospital, Sapienza University of Rome, Rome, Italy
| | - Francesca De Persis
- Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, ‘Policlinico Umberto I’ Hospital, Sapienza University of Rome, Rome, Italy
| | - Alessandra De Luca
- Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, ‘Policlinico Umberto I’ Hospital, Sapienza University of Rome, Rome, Italy
| | - Mariachiara Mei
- Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, ‘Policlinico Umberto I’ Hospital, Sapienza University of Rome, Rome, Italy
| | - Martina Di Iorio
- Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, ‘Policlinico Umberto I’ Hospital, Sapienza University of Rome, Rome, Italy
| | - Letizia D’Antoni
- Department of Public Health and Infectious Diseases, ‘Policlinico Umberto I’ Hospital, Sapienza University of Rome, Rome, Italy
| | - Gianluca Di Pietro
- Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, ‘Policlinico Umberto I’ Hospital, Sapienza University of Rome, Rome, Italy
| | - Santi Francavilla
- Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, ‘Policlinico Umberto I’ Hospital, Sapienza University of Rome, Rome, Italy
| | - Riccardo Improta
- Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, ‘Policlinico Umberto I’ Hospital, Sapienza University of Rome, Rome, Italy
| | - Serena Marcon
- Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, ‘Policlinico Umberto I’ Hospital, Sapienza University of Rome, Rome, Italy
| | - Marco Valerio Mariani
- Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, ‘Policlinico Umberto I’ Hospital, Sapienza University of Rome, Rome, Italy
| | - Gianluca Agnes
- Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, ‘Policlinico Umberto I’ Hospital, Sapienza University of Rome, Rome, Italy
| | - Agostino Piro
- Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, ‘Policlinico Umberto I’ Hospital, Sapienza University of Rome, Rome, Italy
| | - Massimiliano Rizzo
- Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, ‘Policlinico Umberto I’ Hospital, Sapienza University of Rome, Rome, Italy
| | - Edoardo Sebastian Rachele
- Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, ‘Policlinico Umberto I’ Hospital, Sapienza University of Rome, Rome, Italy
| | - Martina Straito
- Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, ‘Policlinico Umberto I’ Hospital, Sapienza University of Rome, Rome, Italy
| | - Marco Tocci
- Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, ‘Policlinico Umberto I’ Hospital, Sapienza University of Rome, Rome, Italy
| | - Marco Francone
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Nicola Galea
- Department of Radiological, Oncological and Pathological Sciences, ‘Policlinico Umberto I’ Hospital, Sapienza University of Rome, Rome, Italy
| | - Paolo Severino
- Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, ‘Policlinico Umberto I’ Hospital, Sapienza University of Rome, Rome, Italy
| | - Patrizia Pasculli
- Department of Public Health and Infectious Diseases, ‘Policlinico Umberto I’ Hospital, Sapienza University of Rome, Rome, Italy
| | - Maria Chiara Colaiacomo
- RadiologyDepartment, ‘Policlinico Umberto I’ Hospital, Sapienza University of Rome, Rome, Italy
| | - Angelo Petroianni
- Department of Public Health and Infectious Diseases, Division of Pulmonary Medicine, ‘Policlinico Umberto I’ Hospital, Sapienza University of Rome, Rome, Italy
| | - Cristina Chimenti
- Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, ‘Policlinico Umberto I’ Hospital, Sapienza University of Rome, Rome, Italy
| | - Carlo Lavalle
- Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, ‘Policlinico Umberto I’ Hospital, Sapienza University of Rome, Rome, Italy
| | - Roberto Badagliacca
- Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, ‘Policlinico Umberto I’ Hospital, Sapienza University of Rome, Rome, Italy
| | - Paolo Palange
- Department of Public Health and Infectious Diseases, Division of Pulmonary Medicine, ‘Policlinico Umberto I’ Hospital, Sapienza University of Rome, Rome, Italy
| | - Claudio Mastroianni
- Department of Public Health and Infectious Diseases, ‘Policlinico Umberto I’ Hospital, Sapienza University of Rome, Rome, Italy
| | - Carlo Catalano
- Department of Radiological, Oncological and Pathological Sciences, ‘Policlinico Umberto I’ Hospital, Sapienza University of Rome, Rome, Italy
| | - Francesco Pugliese
- Department of Anaesthesia and Intensive Care Medicine, ‘Policlinico Umberto I’ Hospital, Sapienza University of Rome, Rome, Italy
| | - Maria Ciardi
- Department of Public Health and Infectious Diseases, ‘Policlinico Umberto I’ Hospital, Sapienza University of Rome, Rome, Italy
| | - Viviana Maestrini
- Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, ‘Policlinico Umberto I’ Hospital, Sapienza University of Rome, Rome, Italy
| | - Massimo Mancone
- Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, ‘Policlinico Umberto I’ Hospital, Sapienza University of Rome, Rome, Italy
| | - Francesco Fedele
- Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, ‘Policlinico Umberto I’ Hospital, Sapienza University of Rome, Rome, Italy
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Luca AD, Cozzi-Lepri A, Antinori A, Zaccarelli M, Bongiovanni M, Giambenedetto SD, Marconi P, Cicconi P, Resta F, Grisorio B, Ciardi M, Cauda R, Monforte AD. Lopinavir/Ritonavir or Efavirenz plus two Nucleoside Analogues as First-Line Antiretroviral Therapy: A Non-Randomized Comparison. Antivir Ther 2006. [DOI: 10.1177/135965350601100507] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Although efavirenz (EFV) and lopinavir/ritonavir (LPV/r) are both recommended antiretroviral agents for combination therapy in drug-naive HIV-infected patients, no randomized comparison of their efficacy and tolerability is available yet. A multi-cohort prospective observational comparative study was performed. Methods Efficacy was examined comparing time to virological failure, CD4 recovery and clinical progression. Tolerability was examined comparing time to treatment discontinuation for any reason and for toxicity and time to liver enzymes or lipid alterations. Survival analysis was conducted by an intent-to-treat principle using the Kaplan–Meier method, and standard and weighted Cox regression models. Results A total of 674 antiretroviral-naive patients starting a two nucleoside reverse transcriptase inhibitor regimen plus either EFV ( n=481) or LPV/r ( n=193) were examined. At baseline, patients starting LPV/r had higher HIV RNA and lower CD4+ T-cell counts. There was no difference in the adjusted hazards of virological failure (LPV/r versus EFV relative hazard [RH] 1.16, 95% confidence intervals [CI]: 0.58–2.32, P=0.67), CD4 recovery (RH=0.93, 95% CI: 0.66–1.30, P=0.66), clinical progression (RH=1.64, 95% CI: 0.70–3.84, P=0.25), drug discontinuation for toxicity (RH=0.92, 95% CI: 0.51–1.64, P=0.76) and for any reason, and rates of liver enzyme and total/low density lipoprotein (LDL) cholesterol elevation. In contrast, the rate of triglycerides elevations (>1 NCEP Adult Treatment Panel III category increase) was higher in the LPV/r group (RH=1.69, 95% CI: 1.14–2.50; P=0.01). Models weighted for the inverse of conditional probability of receiving either drug applied to the efficacy endpoints yielded similar results. CD4 recovery with both drugs was also similar in the lowest CD4 strata. Conclusions Our analysis suggests similar efficacy and tolerability for EFV- or LPV/r-based first-line antiretroviral regimens. LPV/r was associated with higher rates of hypertriglyceridaemia.
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Affiliation(s)
| | - Andrea De Luca
- Institute of Clinical Infectious Diseases, Catholic University of the Sacred Heart, Rome, Italy
| | | | - Andrea Antinori
- National Institute for Infectious Diseases ‘Lazzaro Spallanzani’, Rome, Italy
| | - Mauro Zaccarelli
- National Institute for Infectious Diseases ‘Lazzaro Spallanzani’, Rome, Italy
| | - Marco Bongiovanni
- Institute of Infectious and Tropical Diseases, University of Milan, Milan, Italy
| | - Simona Di Giambenedetto
- Institute of Clinical Infectious Diseases, Catholic University of the Sacred Heart, Rome, Italy
| | - Patrizia Marconi
- National Institute for Infectious Diseases ‘Lazzaro Spallanzani’, Rome, Italy
| | - Paola Cicconi
- Institute of Infectious and Tropical Diseases, University of Milan, Milan, Italy
| | | | | | | | - Roberto Cauda
- Institute of Clinical Infectious Diseases, Catholic University of the Sacred Heart, Rome, Italy
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De Luca A, Cozzi-Lepri A, Antinori A, Zaccarelli M, Bongiovanni M, Di Giambenedetto S, Marconi P, Cicconi P, Resta F, Grisorio B, Ciardi M, Cauda R, Monforte AD. Lopinavir/ritonavir or efavirenz plus two nucleoside analogues as first-line antiretroviral therapy: a non-randomized comparison. Antivir Ther 2006; 11:609-18. [PMID: 16964829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
BACKGROUND Although efavirenz (EFV) and lopinavir/ ritonavir (LPV/r) are both recommended antiretroviral agents for combination therapy in drug-naive HIV-infected patients, no randomized comparison of their efficacy and tolerability is available yet. A multi-cohort prospective observational comparative study was performed. METHODS Efficacy was examined comparing time to virological failure, CD4 recovery and clinical progression. Tolerability was examined comparing time to treatment discontinuation for any reason and for toxicity and time to liver enzymes or lipid alterations. Survival analysis was conducted by an intent-to-treat principle using the Kaplan-Meier method, and standard and weighted Cox regression models. RESULTS A total of 674 antiretroviral-naive patients starting a two nucleoside reverse transcriptase inhibitor regimen plus either EFV (n = 481) or LPV/r (n = 193) were examined. At baseline, patients starting LPV/r had higher HIV RNA and lower CD4+ T-cell counts. There was no difference in the adjusted hazards of virological failure (LPV/r versus EFV relative hazard [RH] 1.16, 95% confidence intervals [CI]: 0.58-2.32, P = 0.67), CD4 recovery (RH = 0.93, 95% CI: 0.66-1.30, P = 0.66), clinical progression (RH = 1.64, 95% CI: 0.70-3.84, P = 0.25), drug discontinuation for toxicity (RH = 0.92, 95% CI: 0.51-1.64, P = 0.76) and for any reason, and rates of liver enzyme and total/low density lipoprotein (LDL) cholesterol elevation. In contrast, the rate of triglycerides elevations (> 1 NCEP Adult Treatment Panel III category increase) was higher in the LPV/r group (RH = 1.69, 95% CI: 1.14-2.50; P = 0.01). Models weighted for the inverse of conditional probability of receiving either drug applied to the efficacy endpoints yielded similar results. CD4 recovery with both drugs was also similar in the lowest CD4 strata. CONCLUSIONS Our analysis suggests similar efficacy and tolerability for EFV- or LPV/r-based first-line antiretroviral regimens. LPV/r was associated with higher rates of hypertriglyceridaemia.
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Affiliation(s)
- Andrea De Luca
- Institute of Clinical Infectious Diseases, Catholic University of the Sacred Heart, Rome, Italy.
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Ancarani F, Angeli E, Antinori A, Antonucci G, Bonasso M, Bruno R, Capobianchi MR, Cargnel A, Cozzi-Lepri A, Monforte AD, Cingolani A, Galli M, Orofino GC, Girardi E, Marino N, Bongiovanni M, Morsica G, Narciso P, Pastecchia C, Pizzaferri P, Puoti M, Santantonio T, Verucchi G, Montroni M, Scalise G, Braschi MC, Maracci M, Tirelli U, Cinelli R, Pastore G, Ladisa N, Minafra G, Suter F, Arici C, Chiodo F, Colangeli V, Fiorini C, Coronado O, Carosi G, Cadeo GP, Torti C, Minardi C, Bertelli D, Rizzardini G, Migliorino G, Manconi PE, Piano P, Ferraro T, Scerbo A, Pizzigallo E, D'Alessandro M, Santoro D, Pusterla L, Carnevale G, Galloni D, Viganò P, Mena M, Ghinelli F, Sighinolfi L, Leoncini F, Mazzotta F, Pozzi M, Caputo SL, Angarano G, Grisorio B, Saracino A, Ferrara S, Grima P, Tundo P, Pagano G, Cassola G, Alessandrini A, Piscopo R, Toti M, Chigiotti S, Soscia F, Tacconi L, Orani A, Perini P, Scasso A, Vincenti A, Chiodera F, Castelli P, Scalzini A, Fibbia G, Moroni M, Lazzarin A, Cargnel A, Vigevani GM, Caggese L, Monforte AD, Repetto D, Novati R, Galli A, Merli S, Pastecchia C, Moioli MC, Esposito R, Mussini C, Abrescia N, Chirianni A, Izzo CM, Piazza M, De Marco M, Viglietti R, Manzillo E, Graf M, Colomba A, Abbadessa V, Prestileo T, Mancuso S, Ferrari C, Pizzaferri P, Filice G, Minoli L, Bruno R, Novati S, Baldelli F, Tinca M, Petrelli E, Cioppi A, Alberici F, Ruggieri A, Menichetti F, Martinelli C, De Stefano C, La Gala A, Ballardini G, Briganti E, Magnani G, Ursitti MA, Arlotti M, Ortolani P, Cauda R, Dianzani F, Ippolito G, Antinori A, Antonucci G, D'Elia S, Narciso P, Petrosillo N, Vullo V, De Luca A, Di Giambenedetti S, Zaccarelli M, Acinapura R, De Longis P, Ciardi M, D'Offizi G, Trotta MP, Noto P, Lichtner M, Capobianchi MR, Girardi E, Pezzotti P, Rezza G, Mura MS, Mannazzu M, Resta F, Loso K, Caramello P, Sinicco A, Soranzo ML, Orofino G, Sciandra M, Bonasso M, Grossi PA, Basilico C, Poggio A, Bottari G, Raise E, Pasquinucci S, De Lalla F, Tositti G, Lepri AC, Solmone M, Girardi E, Lalle E, Abbate I, Monforte AD, Cozzi-Lepri A, Alessandrini A, Piscopo R, Ebo F, Cosco L, Antonucci G, Ippolito G, Capobianchi MR. Evolution of HVR-1 Quasispecies after 1-Year Treatment in HIV/HCV-Coinfected Patients According to the Pattern of Response to Highly Active Antiretroviral Therapy. Antivir Ther 2006. [DOI: 10.1177/135965350601100102] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Hepatitis C virus (HCV) variability is mainly attributed to the ability of the virus to respond to host immune pressure, acting as a driving force for the evolution of quasispecies. This study was aimed at studying the changes in HVR-1 heterogeneity and the evolution of HCV quasispecies in HIV/HCV-coinfected patients according to the pattern of response to highly active antiretroviral therapy (HAART). Sixteen HIV/HCV-coinfected patients harbouring HCV genotype 1 and who had been on HAART for at least 1 year, 8 showing increasing CD4+T-cell counts (immunological responders) and 8 showing a stable or decreasing CD4+ T-cell counts (immunological non-responders), were selected from a prospective cohort study. After 1 year of HAART, 11 patients showed HIV viral load <2.6 log10 cp/ml (virological responders), and 5 showed HIV viral load above this value (virological non-responders). Plasma samples, collected before starting therapy and after 1 year of HAART, underwent clonal sequence analysis for HVR-1 region of HCV. Non-synonymous/synonymous substitutions ratio (Ka/Ks), aminoacidic complexity (normalized Shannon entropy) and diversity (p-distance), were considered as parameters of quasispecies heterogeneity. After 1 year of HAART, heterogeneity of HVR-1 quasispecies significantly decreased in virological non-responders, whereas the heterogeneity tended to increase in virological responders. The differences in the evolution were less stringent, when considering immunological response. On the other hand, profound qualitative modifications of HVR-1 quasispecies were observed only in patients with both immunological and virological HAART response. On the whole, these findings suggest that, in patients undergoing HAART, the extent of HCV variability and the evolution of HVR-1 quasispecies is influenced by the pattern of response to antiretroviral therapy.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Enrico Girardi
- National Institute of Infectious Diseases “L. Spallanzani”, Rome
| | - Eleonora Lalle
- National Institute of Infectious Diseases “L. Spallanzani”, Rome
| | - Isabella Abbate
- National Institute of Infectious Diseases “L. Spallanzani”, Rome
| | | | - Alessandro Cozzi-Lepri
- Department of Primary Care and Population Sciences, Royal Free and University College Medical School, London
| | | | - Rita Piscopo
- Department of Infectious Diseases, Galliera Hospital, Genova
| | - Francesca Ebo
- Department of Infectious Diseases, Hosp Civile San Giovanni e Paolo, Venezia
| | - Lucio Cosco
- Department of Infectious Diseases, A. Pugliesi Catanzaro
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Antonucci G, Girardi E, Cozzi-Lepri A, Capobianchi MR, Morsica G, Pizzaferri P, Ladisa N, Sighinolfi L, Chiodera A, Solmone M, Lalle E, Ippolito G, Monforte AD, Ancarani F, Antinori A, Antonucci G, Bonasso M, Bruno R, Capobianchi MR, Cargnel A, Cozzi-Lepri A, d'Arminio Monforte A, Luca AD, Galli M, Gennero L, Girardi E, Lipani F, Marino N, Milazzo L, Morsica G, Narciso P, Pizzaferri P, Puoti M, Santantonio T, Verucchi G, Montroni M, Scalise G, Braschi MC, Prete MSD, Tirelli U, Cinelli R, Pastore G, Ladisa N, Suter GMBF, Arici C, Chiodo F, Colangeli V, Fiorini C, Coronado O, Carosi G, Cadeo GP, Torti C, Minardi C, Bertelli D, Rizzardini G, Migliorino G, Manconi PE, Piano P, Ferraro T, Scerbo A, Pizzigallo E, D'Alessandro M, Santoro D, Pusterla L, Carnevale G, Galloni D, Viganò P, Mena M, Ghinelli F, Sighinolfi L, Leoncini F, Mazzotta F, Pozzi M, Caputo SL, Angarano G, Grisorio B, Saracino A, Ferrara S, Grima P, Tundo P, Pagano G, Cassola G, Alessandrini A, Piscopo R, Toti M, Chigiotti S, Soscia F, Tacconi L, Orani A, Perini P, Scasso A, Vincenti A, Chiodera F, Castelli P, Scalzini A, Fibbia G, Moroni M, Lazzarin A, Cargnel A, Vigevani GM, Caggese L, Monforte AD, Repetto D, Novati R, Galli A, Merli S, Pastecchia C, Moioli MC, Esposito R, Mussini C, Abrescia N, Chirianni A, Izzo CM, Piazza M, Marco MD, Viglietti R, Manzillo E, Graf M, Colomba A, Abbadessa V, Prestileo T, Mancuso S, Ferrari C, Pizzaferri P, Filice G, Minoli L, Bruno R, Novati S, Baldelli F, Tinca M, Petrelli E, Cioppi A, Alberici F, Ruggieri A, Menichetti F, Martinelli C, Stefano CD, Gala AL, Ballardini G, Briganti E, Magnani G, Ursitti MA, Arlotti M, Ortolani P, Cauda R, Dianzani F, Ippolito G, Antinori A, Antonucci G, D'Elia S, Narciso P, Petrosillo N, Vullo V, Luca AD, Giambenedetti SD, Zaccarelli M, Acinapura R, Longis PD, Ciardi M, D'Offizi G, Trotta MP, Noto P, Lichtner M, Capobianchi MR, Girardi E, Pezzotti P, Rezza G, Mura MS, Mannazzu M, Resta F, Loso K, Caramello P, Sinicco A, Soranzo ML, Orofino G, Sciandra M, Bonasso M, Grossi PA, Basilico C, Poggio A, Bottari G, Raise E, Pasquinucci S, Lalla FD, Tositti G, Lepri AC. Response to Haart and Gb Virus Type C Coinfection in a Cohort of Antiretroviral-Naive HIV-Infected Individuals. Antivir Ther 2005. [DOI: 10.1177/135965350501000108] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The prognostic role of GB virus type C (GBV-C) viraemia in HIV-infected subjects treated with highly active antiretroviral therapy (HAART) is still undefined, The aim of this analysis is to assess the relationship between GBV-C infection and response to antiretroviral therapy among HIV-infected subjects initiating HAART when antiretroviral-naive. A prospective, observational study of 400 HIV-infected patients with measurements of GBV-C RNA, hepatitis C virus (HCV) antibodies and HCV RNA determined from plasma stored prior to HAART initiation, Time to virological (achieving HIV RNA ≤500 copies/ml) and immunological success (a CD4+ count increase of ≥200cells/μl), and the time to virological relapse (confirmed HIV RNA >500 copies/ml) were assessed by Kaplan-Meier methods and Cox proportional hazard regression model. Of the subjects, 117 (29.3%) were GBV-C positive and, overall, 351 (87.8%) patients achieved virological success, After controlling for a number of confounders including HCV RNA, GBV-C viraemic patients experienced a significantly lower risk of HIV rebound than those who were GBV-C negative [relative hazard (RH)=0.56, 95% CI: 0.34–0.93, P=0.03], Conversely, the probability of achieving initial virological success or CD4+ count response after HAART did not differ between GBV-C-negative and -positive subjects, These results suggest that GBV-C coinfection may play a role in determining the rate of HIV rebound possibly by competing with HIV replication after HIV load has been successfully suppressed by HAART.
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Affiliation(s)
| | - Giorgio Antonucci
- National Institute of Infectious Diseases, L Spallanzani, Roma, Italy
| | - Enrico Girardi
- National Institute of Infectious Diseases, L Spallanzani, Roma, Italy
| | - Alessandro Cozzi-Lepri
- Department of Primary Care and Population Sciences, Royal Free and University College Medical School, London, UK
| | | | - Giulia Morsica
- Institute of Infectious Diseases, Ateneo Vita e Salute, S Raffaele Hospital, Milano, Italy
| | - Paolo Pizzaferri
- Department of Infectious Diseases and Hepatology, Azienda Ospedaliera, Parma, Italy
| | - Nicoletta Ladisa
- Institute of Infectious and Tropical Diseases, University of Bari, Bari, Italy
| | - Laura Sighinolfi
- Department of Infectious Diseases, Arcispedale S Anna, Ferrara, Italy
| | | | | | - Eleonora Lalle
- National Institute of Infectious Diseases, L Spallanzani, Roma, Italy
| | - Giuseppe Ippolito
- National Institute of Infectious Diseases, L Spallanzani, Roma, Italy
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10
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Murri R, Ammassari A, Trotta MP, De Luca A, Melzi S, Minardi C, Zaccarelli M, Rellecati P, Santopadre P, Soscia F, Scasso A, Tozzi V, Ciardi M, Orofino GC, Noto P, Monforte AD, Antinori A, Wu AW. Patient-reported and physician-estimated adherence to HAART: social and clinic center-related factors are associated with discordance. J Gen Intern Med 2004; 19:1104-10. [PMID: 15566439 PMCID: PMC1494787 DOI: 10.1111/j.1525-1497.2004.30248.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To evaluate the rate of discordance between patients and physicians on adherence to highly active antiretroviral therapy (HAART) and identify factors related to discordance in these two assessments. DESIGN Prospective, multicenter, cohort study (AdICONA) nested within the Italian Cohort Naive Antiretrovirals (ICONA) study. SETTING Tertiary clinical centers. PARTICIPANTS The patients filled out a 16-item self-administered questionnaire on adherence to HAART. At the same time, physicians estimated the current HAART adherence of their patient. MAIN OUTCOME MEASURE Discordance between patient and physician on adherence to antiretroviral therapy. RESULTS From May 1999 to March 2000, 320 paired patient-physician assessments were obtained. Patients had a mean plasma HIV RNA of 315 copies/ml (64% had undetectable HIV RNA) and a mean CD4+ cell count of 577 cells x 10(6)/L. Nonadherence was reported by 30.9% of patients and estimated by physicians in 45.0% cases. In 111 cases (34.7%), patients and physicians were discordant on adherence to HAART. Kappa statistics was 0.27. Using patient-assessed adherence as reference, sensitivity, specificity, positive predictive value, and negative predictive value of physician-estimated adherence were 64.7%, 66.6%, 81.2%, and 45.8%, respectively. On multivariable analysis, low education level, unemployment, absence of a social worker in the clinical center, and unavailability of afternoon visits were significantly correlated with patient-physician discordance on adherence to antiretrovirals. CONCLUSIONS Physicians did not correctly estimate patient-reported adherence to HAART in more than one third of patients. Both social variables and factors related to the clinical center were important predictors of discordance between patients and physicians. Interventions to enhance adherence should include strategies addressed to improve patient-physician relationship.
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Affiliation(s)
- Rita Murri
- Clinica delle Malattie Infettive, Università Cattolica del S. Cuore, 00168 Rome, Italy.
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11
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Luca AD, Cozzi-Lepri A, Perno CF, Balotta C, Giambenedetto SD, Poggio A, Pagano G, Tositti G, Piscopo R, Forno AD, Chiodo F, Magnani G, Monforte AD, Angarano G, Antinori A, Balotta C, Cozzi-Lepri A, Monforte AD, De Luca A, Monno L, Perno CF, Rusconi S, Montroni M, Scalise G, Zoli A, Del Prete MS, Tirelli U, Di Gennaro G, Pastore G, Ladisa N, Minafra G, Suter F, Arici C, Chiodo F, Colangeli V, Fiorini C, Coronado O, Carosi G, Cadeo GP, Castelli F, Minardi C, Vangi D, Rizzardini G, Migliorino G, Manconi PE, Piano P, Ferraro T, Scerbo A, Pizzigallo E, D'Alessandro M, Santoro D, Pusterla L, Carnevale G, Galloni D, Viganò P, Mena M, Ghinelli F, Sighinolfi L, Leoncini F, Mazzotta F, Pozzi M, Caputo SL, Angarano G, Grisorio B, Ferrara S, Grima P, Tundo P, Pagano G, Piersantelli N, Alessandrini A, Piscopo R, Toti M, Chigiotti S, Soscia F, Tacconi L, Orani A, Perini P, Scasso A, Vincenti A, Chiodera F, Castelli P, Scalzini A, Fibbia G, Moroni M, Lazzarin A, Cargnel A, Vigevani GM, Caggese L, d'Arminio Monforte A, Repetto D, Novati R, Galli A, Merli S, Pastecchia C, Moioli MC, Esposito R, Mussini C, Abrescia N, Chirianni A, Izzo C, Piazza M, De Marco M, Montesarchio V, Manzillo E, Graf M, Colomba A, Abbadessa V, Prestileo T, Mancuso S, Ferrari C, Pizzaferri P, Filice G, Minoli L, Bruno R, Novati S, Balzelli F, Loso K, Petrelli E, Cioppi A, Alberici F, Ruggieri A, Menichetti F, Martinelli C, De Stefano C, Gala AL, Ballardini G, Briganti E, Magnani G, Ursitti MA, Arlotti M, Ortolani P, Cauda R, Dianzani F, Ippolito G, Antinori A, Antonucci G, D'Elia S, Narciso P, Petrosillo N, Vullo V, De Luca A, Di Giambenedetto S, Zaccarelli M, Acinapura R, De Longis P, Ciardi M, D'Offizi G, Trotta MP, Noto P, Lichtner M, Capobianchi MR, Girardi E, Pezzotti P, Rezza G, Mura MS, Mannazzu M, Caramello P, Sinicco A, Soranzo ML, Gennero L, Sciandra M, Bonasso M, Grossi PA, Basilico C, Poggio A, Bottari G, Raise E, Pasquinucci S, De Lalla F, Tositti G, Resta F, Chimienti A, Lepri AC. Variability in the Interpretation of Transmitted Genotypic HIV-1 Drug Resistance and Prediction of Virological Outcomes of the Initial Haart by Distinct Systems. Antivir Ther 2004. [DOI: 10.1177/135965350400900505] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
High level HIV-1 drug resistance in recently infected treatment-naive individuals correlates with sub-optimal virological responses to highly active antiretroviral therapy (HAART). To determine whether genotypic HIV-1 drug resistance in chronic naive patients, as interpreted by various systems, could predict the virological outcomes of HAART, isolates from patients enrolled in a prospective observational cohort (ICoNA) prior to treatment start were genotyped. Genotypic susceptibility scores (GSS) assigned to the initial HAART regimens using the interpretations of pre-therapy resistance mutations by 13 systems were related to virological outcomes. Of 415 patients, 42 (10%) had at least one major resistance mutation. According to the different interpretations, 1.9–20.5% of patients had some level of resistance to at least one drug in the initial regimen. In multivariable analysis, GSS from two systems significantly predicted the time to virological success: Rega 5.5, for each unit increase in GSS adjusted relative hazard (RH) 1.86 [95% confidence intervals (95% CI): 1.15–3.02] and hivresistanceWeb v3, RH 1.87 (95% CI: 1.00–3.48). With three other systems, GSS showed a trend towards a significant prediction of success: Retrogram 1.6, RH 2.33 (95% CI: 0.98–5.53), Menéndez 2002, RH 2.36 (95% CI: 0.97–5.72) and Stanford hivdb, RH 2.06 (95% CI: 0.94–4.49). Genotypic resistance testing coupled with adequate interpretation in chronic naive patients can usefully identify those at risk of sub-optimal virological response to HAART.
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Affiliation(s)
| | - Andrea De Luca
- Institute of Clinical Infectious Diseases, Catholic University, Rome, Italy
| | - Alessandro Cozzi-Lepri
- Royal Free Centre for HIV Medicine and Department of Primary Care and Population Sciences, Royal Free and University College Medical School, London, UK
| | | | - Claudia Balotta
- Institute of Infectious Diseases and Tropical Medicine, University of Milan, Milan, Italy
| | | | - Antonio Poggio
- Department of Infectious Diseases, Civile Hospital, Verbania, Italy
| | - Gabriella Pagano
- Department of Infectious Diseases, S Martino Hospital, Genova, Italy
| | - Giulia Tositti
- Department of Infectious Diseases, Vicenza Hospital, Vicenza, Italy
| | - Rita Piscopo
- Department of Infectious Diseases, Galliera Hospital, Genova, Italy
| | - Antonio Del Forno
- Institute of Clinical Infectious Diseases, Catholic University, Rome, Italy
| | - Francesco Chiodo
- Institute of Infectious Diseases, University of Bologna, Bologna, Italy
| | - Giacomo Magnani
- Department of Infectious Diseases, Santa Maria Nuova Hospital, Reggio Emilia, Italy
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12
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Puoti M, Cozzi-Lepri A, Ancarani F, Bruno R, Ambu S, Ferraro T, Tundo P, Santantonio T, Toti M, Bonasso M, Monforte AD, Ancarani F, Antonucci G, Bonasso M, Bruno R, Cozzi-Lepri A, Monforte AD, Luca AD, Galli M, Gennero L, Girardi E, Lipani F, Marino N, Milazzo L, Morsica G, Narciso P, Pizzaferri P, Puoti M, Santantonio T, Verucchi G, Montroni M, Scalise G, Zoli A, Prete MSD, Tirelli U, Di Gennaro G, Pastore G, Ladisa N, Minafra G, Suter F, Arici C, Chiodo F, Colangeli V, Fiorini C, Coronado O, Carosi G, Cadeo GP, Castelli F, Minardi C, Vangi D, Rizzardini G, Migliorino G, Manconi PE, Piano P, Ferraro T, Scerbo A, Pizzigallo E, D'Alessandro M, Santoro D, Pusterla L, Carnevale G, Galloni D, Viganò P, Mena M, Ghinelli F, Sighinolfi L, Leoncini F, Mazzotta F, Pozzi M, Lo Caputo S, Angarano G, Grisorio B, Ferrara S, Grima P, Tundo P, Pagano G, Piersantelli N, Alessandrini A, Piscopo R, Toti M, Chigiotti S, Soscia F, Tacconi L, Orani A, Perini P, Scasso A, Vincenti A, Chiodera F, Castelli P, Scalzini A, Fibbia G, Moroni M, Lazzarin A, Cargnel A, Vigevani GM, Caggese L, d'Arminio Monforte A, Repetto D, Novati R, Galli A, Merli S, Pastecchia C, Moioli MC, Esposito R, Mussini C, Abrescia N, Chirianni A, Izzo C, Piazza M, De Marco M, Montesarchio V, Manzillo E, Graf M, Colomba A, Abbadessa V, Prestileo T, Mancuso S, Ferrari C, Pizzaferri P, Filice G, Minoli L, Bruno R, Novati S, Balzelli F, Loso K, Petrelli E, Cioppi A, Alberici F, Ruggieri A, Menichetti F, Martinelli C, De Stefano C, La Gala A, Ballardini G, Briganti E, Magnani G, Ursitti MA, Arlotti M, Ortolani P, Ortona L, Dianzani F, Ippolito G, Antinori A, Antonucci G, D'Elia S, Narciso P, Petrosillo N, Vullo V, De Luca A, Del Forno L, Zaccarelli M, Acinapura R, De Longis P, Ciardi M, D'Offizi G, Trotta MP, Noto P, Lichtner M, Capobianchi MR, Girardi E, Pezzotti P, Rezza G, Mura MS, Mannazzu M, Caramello P, Sinicco A, Soranzo ML, Gennero L, Sciandra M, Bonasso M, Grossi PA, Basilico C, Poggio A, Bottari G, Raise E, Pasquinucci S, De Lalla F, Tositti G, Resta F, Chimienti A, Cozzi-Lepri A. The Management of Hepatitis B Virus/HIV-1 Co-Infected Patients Starting Their First Haart Regimen. Treating Two Infections for the Price of One Drug? Antivir Ther 2004. [DOI: 10.1177/135965350400900506] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We examined the impact of a lamivudine-containing highly active antiretroviral therapy (HAART) regimen on 164 hepatitis B virus/HIV co-infected individuals starting their first HAART. Lamivudine-treated patients (accounting for 73% of the study population) showed a significantly lower level of alanine aminotransferase over follow-up [–81.1 mU/ml mean difference; 95% confidence intervals (95% CI): –30.3; –131.7, P=0.003] and a significantly reduced risk of liver-related morbidity/mortality [Relative hazard (RH)=0.07; 95% CI: 0.01–0.38, P=0.002] than those starting a lamivudine sparing-regimen.
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Affiliation(s)
| | - Massimo Puoti
- Institute of Infectious and Tropical Diseases, Spedali Civili, University of Brescia, Brescia, Italy
| | - Alessandro Cozzi-Lepri
- Department of Primary Care and Population Sciences, Royal Free and University College Medical School, London, UK
| | - Fausto Ancarani
- Institute of Infectious Diseases and Public Health, Umberto I Hospital, University of Ancona, Ancona, Italy
| | - Raffaele Bruno
- Institute of Infectious and Tropical Diseases, IRCCS S Matteo, University of Pavia, Pavia, Italy
| | - Silvia Ambu
- Department of Infectious Diseases, Azienda Ospedaliera Careggi, Firenze, Italy
| | - Teresa Ferraro
- Department of Infectious Diseases, Ospedale A Puglise, Catanzaro, Italy
| | - Paolo Tundo
- Department of Infectious Diseases, Ospedale Santa Caterina Novella, Galatina (Lecce), Italy
| | | | - Mario Toti
- Department of Infectious Diseases, Ospedale di Grosseto, Grosseto, Italy
| | - Marino Bonasso
- Department of Infectious Diseases, Ospedale ‘Amedeo Savoia’, Torino, Italy
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13
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Antinori A, Cozzi-Lepri A, Ammassari A, Trotta MP, Nauwelaers D, Hoetelmans R, Murri R, Melzi S, Narciso P, Nasta P, Zaccarelli M, Santopadre P, Vecchiet J, Izzo CM, Monforte AD, Tirelli U, Nasti G, Carosi G, Nasta P, Manconi PE, Piano P, Pizzigallo E, Dalessandro M, Vecchiet J, Mazzotta F, Caputo SL, Soscia F, Tacconi L, Scasso A, Vincenti A, Scalzini A, Fibbia GC, Moroni M, Manforte AD, Melzi S, Esposito R, Mussini C, Piazza M, Abrescia N, Izzo MC, Marco MD, Manzillo E, Nappa S, Alberici F, Sisti M, Baldelli F, Loso K, Mele P, Acinapura R, Ammassari A, Antinori A, Antonucci G, Ciardi M, Delia S, Longis PD, D'Offizi G, Ippolito G, Lichtner M, Marconi P, Murri R, Narciso P, Noto P, Petrosillo N, Pezzotti P, Santopadre P, Trotta MP, Vullo V, Zaccarelli M, Caramello P, Orofino GC, Cozzi-Lepri A, Baltimore MD, Wu AW. Relative Prognostic Value of Self-Reported Adherence and Plasma Nnrti/Pi Concentrations to Predict Virological Rebound in Patients Initially Responding to Haart. Antivir Ther 2004. [DOI: 10.1177/135965350400900214] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We studied the predictive value of self-reported adherence and plasma drug concentrations on virological rebound to HAART. Among 238 participants in the AdICoNA study who had viral load ≤500 copies/ml, 42 (17.6%) experienced virological rebound by 96 weeks. Both self-reported non-adherence and sub-optimal concentration were independently associated with a higher risk of virological rebound.
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Affiliation(s)
| | - Andrea Antinori
- Istituto Nazionale per le Malattie Infettive, L Spallanzani IRCCS, Roma, Italy
| | | | - Adriana Ammassari
- Istituto di Clinica delle Malattie Infettive, Università Cattolica del S Cuore, Roma, Italy
| | - Maria Paola Trotta
- Istituto Nazionale per le Malattie Infettive, L Spallanzani IRCCS, Roma, Italy
| | | | | | - Rita Murri
- Istituto di Clinica delle Malattie Infettive, Università Cattolica del S Cuore, Roma, Italy
| | - Sara Melzi
- Istituto di Malattie Infettive e Tropicali, Università di Milano, Milano, Italy
| | - Pasquale Narciso
- Istituto Nazionale per le Malattie Infettive, L Spallanzani IRCCS, Roma, Italy
| | - Paola Nasta
- Istituto di Malattie Infettive e Tropicali, Università di Brescia, Brescia, Italy
| | - Mauro Zaccarelli
- Istituto Nazionale per le Malattie Infettive, L Spallanzani IRCCS, Roma, Italy
| | - Paola Santopadre
- Dipartimento di Malattie Infettive e Tropicali, Università ‘La Sapienza’, Roma. Italy
| | - Jacopo Vecchiet
- Clinica delle Malattie Infettive, Università degli Studi di Chieti, Chieti, Italy
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14
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Ciardi M, Giacchetti G, Fedele CG, Tenorio A, Brandi A, Libertone R, Ajassa C, Borgese L, Delia S. Acute cerebellitis caused by herpes simplex virus type 1. Clin Infect Dis 2003; 36:e50-4. [PMID: 12539091 DOI: 10.1086/345781] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2002] [Accepted: 10/14/2002] [Indexed: 01/01/2023] Open
Abstract
Cerebellar disorders due to herpes simplex virus (HSV) infection are rare and always associated with herpes simplex encephalitis. We report 2 cases of severe primary acute cerebellitis caused by HSV type 1 that were identified by nested polymerase chain reaction performed on cerebrospinal fluid samples.
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Affiliation(s)
- Maria Ciardi
- Department of Infectious and Tropical Diseases, University La Sapienza, 00161 Rome, Italy.
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15
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Perno CF, Cozzi-Lepri A, Balotta C, Forbici F, Violin M, Bertoli A, Facchi G, Pezzotti P, Angarano G, Arici C, Narciso P, Orani A, Raise E, Scalzini A, Poggio A, Ippolito G, Moroni M, Monforte AD, Montroni M, Scalise G, Costantini A, Del Prete MS, Tirelli U, Nasti G, Pastore G, Perulli LM, Suter F, Arici C, Chiodo F, Gritti FM, Colangeli V, Fiorini C, Guerra L, Carosi G, Cadeo GP, Castelli F, Minardi C, Vangi D, Rizzardini G, Migliorino G, Manconi PE, Piano P, Ferraro T, Cosco L, Pizzigallo E, Ricci F, Vigevani GM, Pusterla L, Carnevale G, Pan A, Viganò P, Mena M, Ghinelli F, Sighinolfi L, Leoncini F, Mazzotta F, Ambu S, Lo Caputo S, Angarano G, Grisorio B, Ferrara S, Grima P, Tundo P, Pagano G, Piersantelli N, Alessandrini A, Piscopo R, Toti M, Chigiotti, Soscia F, Tacconi L, Orani A, Castaldo G, Scasso A, Vincenti A, Scalzini A, Alessi F, Moroni M, Lazzarin A, Cargnel A, Milazzo F, Caggese L, Monforte AD, Melzi S, Delfanti F, Carini B, Adriani B, Garavaglia S, Moioli C, Esposito R, Mussini C, Abrescia N, Chirianni A, Perrella O, Piazza M, De Marco M, Montesarchio V, Manzillo E, Nappa S, Cadrobbi P, Scaggiante R, Colomba A, Abbadesse V, Prestileo T, Mancuso S, Filice G, Minoli L, Savino FAP, Maserati R, Pauluzzi S, Baldelli F, Petrelli E, Ciotti A, Alberici F, Sisti M, Menichetti F, Smorfa A, De Stefano C, La Gala A, Zauli T, Ballardini G, Bonazzi L, Ursitti MA, Ciammarughi R, Giordani S, Ortona L, Dianzani F, Ippolito G, Antinori A, Antonucci G, D'Elia S, Narciso P, Petrosillo N, Vullo V, De Luca A, Del Forno A, Zaccarelli M, De Longis P, Ciardi M, D'Offizi G, Palmieri F, Lichter M, Capobianchi MR, Girardi E, Pezzotti P, Rezza G, Mura MS, Mannazzu M, Caramello P, Sinicco A, Soranzo ML, Quaglia S, Sciandra M, Salassa B, Torre D, Basilico C, Poggio A, Bottari G, Raise E, Pasquinucci S, De Lalla F, Tositti G, Resta F, Chimienti A, Lepri AC, Phillips AN. Impact of Mutations Conferring Reduced Susceptibility to Lamivudine on the Response to Antiretroviral Therapy. Antivir Ther 2001. [DOI: 10.1177/135965350100600306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Carlo Federico Perno
- IRCCS L. Spallanzani, Rome, Italy
- Department Experimental Medicine, University of Rome Tor Vergata, Rome, Italy
| | | | - Claudia Balotta
- Institute of Tropical and Infectious Diseases, University of Milan, Milan, Italy
| | | | - Michela Violin
- Institute of Tropical and Infectious Diseases, University of Milan, Milan, Italy
| | | | - Guido Facchi
- Institute of Tropical and Infectious Diseases, University of Milan, Milan, Italy
| | | | | | - Claudio Arici
- Department of Infectious Diseases, Ospedali Riuniti, Bergamo, Italy
| | | | - Anna Orani
- Department of Infectious Diseases, Lecco Hospital, Lecco, Italy
| | - Enzo Raise
- Department of Infectious Diseases, SS Giovanni e Paolo Hospital, Venice, Italy
| | - Alfredo Scalzini
- Department of Infectious Diseases, Mantova Hospital, Mantova, Italy
| | - Antonio Poggio
- Department of Infectious Diseases, Verbania Hospital, Verbania, Italy
| | | | - Mauro Moroni
- Institute of Tropical and Infectious Diseases, University of Milan, Milan, Italy
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16
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Ciardi M. [Forces and molecules: Amedeo Avogadro, electricity, and the hypothesis of 1811]. Rev Hist Sci Paris 2001; 54:85-97. [PMID: 18668987 DOI: 10.3406/rhs.2001.2110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
RÉSUMÉ. — Au cours des premières années de sa carrière scientifique, Amedeo Avogadro (1776-1856) réalisa quelques recherches novatrices sur les phénomènes électriques, en développant des considérations théoriques énoncées par des philosophes naturels tels qu' Alessandro Volta. L'Essai analytique sur l'électricité (1803) ne représente cependant pas seulement le point de départ de la carrière scientifique d'Avogadro : en effet il est étroitement lié, du point de vue tant de la méthode que du contenu, à la formulation de la célèbre hypothèse moléculaire de 1811.
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17
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Abstract
A new method to quantitate small amounts of DNA in clinical specimens is described. The method, a nested competitive polymerase chain reaction (ncPCR), is able to quantitate between 10 and 10(6) copies per tube of polyomavirus DNA and shows good reproducibility when clinical samples are analysed. Throughout the whole procedure, an internal standard (IS) competes for the primers with the target DNA. The internal standard, a heterologous sequence containing the four primer recognition sites, was constructed using a modification of the 'MIMIC' approach that is useful for obtaining competitor sequences for any viral, bacterial or eukaryotic target. The ncPCR method for polyomavirus was applied to cerebrospinal fluids (CSF) from AIDS patients with progressive multifocal leukoencephalopathy (PML) and urine specimens from bone marrow transplant patients affected by haemorrhagic cystitis. The results obtained suggest that the ncPCR method is a sensitive and useful method for quantitating genomic load in clinical samples.
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Affiliation(s)
- C G Fedele
- Diagnostic Microbiology Service, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
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18
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Fedele CG, Ciardi M, Delia S, Echevarria JM, Tenorio A. Multiplex polymerase chain reaction for the simultaneous detection and typing of polyomavirus JC, BK and SV40 DNA in clinical samples. J Virol Methods 1999; 82:137-44. [PMID: 10894630 DOI: 10.1016/s0166-0934(99)00095-6] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
A novel multiplex nested PCR (nPCR) method was developed for detecting and differentiating simultaneously the DNA of polyomaviruses JC, BK and SV40 in a single tube. In the first amplification step the same set of primers were used to amplify a conserved DNA region of the large T antigen gene of JCV, BKV and SV40. The second round of multiplex nPCR was carried out using a set of primers designed to render products of different size for each related virus. The thermocycling parameters and concentration of each reaction component were optimised systematically to achieve optimal specificity and sensitivity for the nPCR assay. The sensitivity of the method ranged between one and 10 copies of polyomavirus genome. Cerebrospinal fluid (CSF) was examined from AIDS patients with clinical and neuroradiological evidence of progressive multifocal leukoencephalopathy (PML) and CSF from AIDS patients with other neurological alterations. Urine specimens from bone marrow transplant recipients affected by haemorrhagic cystitis were also tested. The results obtained suggest that the assay is a good tool for supporting the diagnosis of polyomavirus infection and could be used for epidemiological purposes and in other studies in order to define better the role of polyomaviruses in human disease.
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Affiliation(s)
- C G Fedele
- Diagnostic Microbiology Service, Centro Nacional de Microbiologia, Instituto de Salud Carlos III, Madrid, Spain
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19
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van Vliet KE, Glimâker M, Lebon P, Klapper PE, Taylor CE, Ciardi M, van der Avoort HG, Diepersloot RJ, Kurtz J, Peeters MF, Cleator GM, van Loon AM. Multicenter evaluation of the Amplicor Enterovirus PCR test with cerebrospinal fluid from patients with aseptic meningitis. The European Union Concerted Action on Viral Meningitis and Encephalitis. J Clin Microbiol 1998; 36:2652-7. [PMID: 9705409 PMCID: PMC105179 DOI: 10.1128/jcm.36.9.2652-2657.1998] [Citation(s) in RCA: 48] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The Amplicor Enterovirus PCR test was compared with viral culture for the detection of enteroviruses in cerebrospinal fluid (CSF) specimens. In a multicenter study in which nine laboratories participated, a total of 476 CSF specimens were collected from patients with suspected aseptic meningitis. Sixty-eight samples were positive by PCR (14.4%), whereas 49 samples were positive by culture (10.4%), demonstrating that the Amplicor Enterovirus PCR test was significantly more sensitive than culture (P < 0.001). After discrepancy analysis the sensitivity and specificity of the Amplicor Enterovirus PCR test obtained by using viral culture as the "gold standard" were 85.7 and 93.9%, respectively. Our results with the CSF specimens collected in different countries demonstrate that the Amplicor test is capable of detecting a large variety of enterovirus serotypes and epidemiologically unrelated isolates in CSF specimens from patients with aseptic meningitis. The Amplicor Enterovirus PCR test is a rapid assay which can be routinely performed with CSF samples and is an important improvement for the rapid diagnosis of enteroviral meningitis.
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Affiliation(s)
- K E van Vliet
- University Hospital Utrecht, Utrecht, The Netherlands
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20
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Monteyne P, Albert F, Weissbrich B, Zardini E, Ciardi M, Cleator GM, Sindic CJ. The detection of intrathecal synthesis of anti-herpes simplex IgG antibodies: comparison between an antigen-mediated immunoblotting technique and antibody index calculations. European Union Concerted Action on Virus Meningitis and Encephalitis. J Med Virol 1997; 53:324-31. [PMID: 9407379 DOI: 10.1002/(sici)1096-9071(199712)53:4<324::aid-jmv3>3.0.co;2-9] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The detection of intrathecal antibody synthesis was compared by the calculation of antibody indices (AI) derived from ELISA techniques with the detection of virus-specific oligoclonal IgGs by an antigen-mediated capillary blot technique. Twenty-seven paired serum and cerebrospinal fluid (CSF) samples were examined from 15 immunocompetent patients with herpes simplex virus encephalitis (HSE) diagnosed by PCR on early CSF samples. These techniques were also applied to paired samples from 20 multiple sclerosis (MS) patients, 10 patients with other inflammatory neurological diseases and 10 patients with non inflammatory neurological disorders. There was a good correlation between the results obtained by AI and those obtained by immunoblotting, especially in HSE (2 discordant results out of 27). Discrepancies were more frequent (25%) in MS patients where a "polyspecific" reaction characterized by low affinity antibodies is known to occur. Some of the discrepancies could, in part, be due to serological cross-reaction with varicella zoster virus.
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Affiliation(s)
- P Monteyne
- Laboratory of Neurochemistry, Catholic University of Louvain, Brussels, Belgium
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21
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Weber T, Klapper PE, Cleator GM, Bodemer M, Lüke W, Knowles W, Cinque P, Van Loon AM, Grandien M, Hammarin AL, Ciardi M, Bogdanovic G. Polymerase chain reaction for detection of JC virus DNA in cerebrospinal fluid: a quality control study. European Union Concerted Action on Viral Meningitis and Encephalitis. J Virol Methods 1997; 69:231-7. [PMID: 9504768 DOI: 10.1016/s0166-0934(97)00152-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The sensitivity and specificity of PCR of CSF for the diagnosis of progressive multifocal leuko encephalopathy is estimated at 75 and 98.5%, respectively. However, inter-laboratory and inter-technique variations have been shown to produce wide variations. A 10-fold dilution series of JC virus in cerebrospinal fluid was prepared and circulated for 'blind' evaluation in laboratories participating in a European Union Concerted Action on Virus Meningitis and Encephalitis. Six of seven laboratories returned results with sensitivity of between 10 and 1 JCV DNA copy equivalents per 10 microl of CSF, one laboratory detected 10(5) copies per 10 microl of CSF. These results demonstrate the feasibility of using virus diluted in CSF for comparison of PCR techniques, and that the range of sensitivity of JCV PCR in proficient laboratories is between 10 and 1 copy equivalents per 10 microl of CSF.
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Affiliation(s)
- T Weber
- Neurologische Klinik, Marienkrankenhaus Hamburg, Germany.
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22
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Linde A, Klapper PE, Monteyne P, Echevarria JM, Cinque P, Rozenberg F, Vestergaard BF, Ciardi M, Lebon P, Cleator GM. Specific diagnostic methods for herpesvirus infections of the central nervous system: a consensus review by the European Union Concerted Action on Virus Meningitis and Encephalitis. Clin Diagn Virol 1997; 8:83-104. [PMID: 9316731 DOI: 10.1016/s0928-0197(97)00015-9] [Citation(s) in RCA: 52] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Herpesvirus infections of the central nervous system are often severe but are fortunately rare. The incidence of these infections has however, increased in recent years as a consequence of an increase in the number of immune-compromised individuals. New diagnostic procedures have improved our ability to diagnose these infections and herpesviruses may yet be implicated as the cause of further neurological diseases with no known aetiology. Methodological standards for selection and evaluation of patient materials are essential to the provision of reliable diagnosis, yet few studies have addressed this important issue. OBJECTIVES To describe and define methodological standards and reference methodology for diagnosis of herpesvirus infections of the CNS. STUDY DESIGN Information gathered by literature review. RESULTS Only for herpes simplex encephalitis is there sufficient data to allow the definition of reference methodology. Good methodological standards exist but few studies have adhered to these standards. As methods for the detection of specific intrathecal antibody synthesis are well established yet under-used in diagnostic virology, the principle of these measurements is reviewed in some detail. CONCLUSIONS Herpesvirus infections of the CNS are of increasing importance. High quality, multi-centre studies are needed to establish the value of the new diagnostic test procedures if further improvement in the diagnostic sensitivity and specificity of these procedures is to be achieved.
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Affiliation(s)
- A Linde
- Manchester Royal Infirmary, UK
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23
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Sorice M, Griggi T, Circella A, Nicodemo G, Ciardi M, Mastroianni CM, Lenti L, Sorice F. Cerebrospinal fluid antiganglioside antibodies in patients with AIDS. Infection 1995; 23:288-91. [PMID: 8557387 DOI: 10.1007/bf01716288] [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: 01/31/2023]
Abstract
In this study the presence of brain antiganglioside antibodies in the cerebrospinal fluid (CSF) of patients with HIV infection was analysed. CSF samples were collected from 45 patients with AIDS and from 45 anti-HIV negative subjects, 15 of whom presented aseptic meningitis. Nineteen AIDS patients had clinically well-documented encephalopathy. Thirteen of these patients had white matter lesions shown by magnetic resonance imaging (MRI). Both IgG and IgM antiganglioside antibodies were detected by immunostaining on thin layer chromatography plates in three CSF samples from AIDS patients with progressive encephalopathy with signs of a diffuse demyelination, as revealed by MRI. Two of these CSF samples reacted specifically with GM3, GM1 and GD1a and one with GD1a. In none of the HIV infected patients without demyelinating encephalopathy, but with opportunistic infections or cerebral lymphoma, nor in the anti-HIV negative control subjects were antiganglioside antibodies detected. No association with JCV DNA, CMV DNA, EBV DNA, detected by nested PCR, nor HIV antigen p24 was found. These findings show the presence of brain antiganglioside antibodies in the CSF of AIDS patients for the first time. However, the findings do not suggest relating the presence of these antibodies to HIV encephalopathy or particular viral agents, but indicate that the antibodies are detectable in subjects with progressive encephalopathy with a diffuse demyelination.
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Affiliation(s)
- M Sorice
- Dip. Malattie Infettive e Tropicali, Università La Sapienza, Rome, Italy
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24
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Mastroianni CM, Ciardi M, Folgori F, Sebastiani G, Vullo V, Delia S, Sorice F. Cytomegalovirus encephalitis in two patients with AIDS receiving ganciclovir for cytomegalovirus retinitis. J Infect 1994; 29:331-7. [PMID: 7884228 DOI: 10.1016/s0163-4453(94)91335-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Cytomegalovirus (CMV) encephalitis has been reported with increasing frequency in patients with AIDS. Nevertheless, the management of CMV-related encephalitis appears to be problematic and data in the literature on the clinical efficacy of ganciclovir therapy is sparse and controversial. We describe two patients with AIDS who developed CMV encephalitis while receiving ganciclovir maintenance therapy for CMV retinitis. Moreover, there was no improvement in neurological status or virological and radiological response during a further induction course of ganciclovir. These observations suggest that the currently recommended therapeutic protocols with ganciclovir are not effective in the prevention and treatment of CMV encephalitis in patients with AIDS.
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Affiliation(s)
- C M Mastroianni
- Department of Infectious and Tropical Diseases, La Sapienza University, Rome, Italy
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25
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Ciardi M, Sharief MK, Thompson EJ, Salotti A, Vullo V, Sorice F, Cirelli A. High cerebrospinal fluid and serum levels of tumor necrosis factor-alpha in asymptomatic HIV-1 seropositive individuals. Correlation with interleukin-2 and soluble IL-2 receptor. J Neurol Sci 1994; 125:175-9. [PMID: 7807163 DOI: 10.1016/0022-510x(94)90031-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The relationship between tumour necrosis factor-alpha (TNF-alpha) and the interleukin-2 (ILL-2) system in HIV-1 infection is important in understanding the dynamics of early immune response before the development of acquired immunodeficiency syndrome. Levels of TNF-alpha, IL-2 and soluble IL-2 receptor (sIL-2R) in serum and cerebrospinal fluid (CSF) samples from 31 asymptomatic HIV-1 seropositive individuals were measured. High levels of TNF-alpha were detected in CSF of 17 (55%) and serum of 22 (71%) subjects, 15 (88%) of whom had elevated CSF IL-2 levels and 16 (94%) had high sIL-2R levels. Moreover, CSF levels of TNF-alpha significantly correlated with CSF levels of IL-2 and sIL-2R. TNF-alpha, IL-2 and sIL-2R seem to be released within the intrathecal compartment early in the course of HIV-1 infection. In view of the known cytotoxic effects of TNF-alpha, an early release may contribute to subsequent development of neurological complications.
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Affiliation(s)
- M Ciardi
- Institute of Infectious Diseases, University of Rome, La Sapienza, Italy
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Cirelli A, Ciardi M, Salotti A, Rossi F. An unusual neurological feature of HIV-1 encephalopathy: Gerstmann's syndrome. Acta Neurol (Napoli) 1994; 16:110-113. [PMID: 7992659] [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: 05/22/2023]
Abstract
The authors describe the first case in literature of Gerstmann's syndrome (agraphia, acalculia, finger agnosia) occurred in HIV correlated encephalopathy developed as the first severe manifestation of HIV infection in a patient with prevalent white matter neuroradiologic alterations. The PDL rapidly extended from the left subcortical parietal-occipital regions to the pre-rolandic one, with subsequent involvement of the corpus calosum splenium and the bilateral temporal lobes white matter. The authors indicate the extent of the lesions and the involvement of the interhemispheric connection fibres as the pathogenetic mechanism of the "Gerstmann syndrome", that until today has not been reported in the literature of the wide variety of AIDS dementia complex. The administration of 1 g of zidovudine for about 9 months did not avoid the establishing of the neurologic damage, but the sudden suspension of the drug could have enhanced the exacerbation of inflammation and the involvement of areas whose lesion is classically believed responsible for cognitive impairment.
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Affiliation(s)
- A Cirelli
- Department of Infectious Diseases, University of Pisa, Italy
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Zeman AZ, Miles K, Ciardi M, Shorvon J, Fox JD. Herpes simplex encephalitis in a patient with complex partial epilepsy: confirmation by the polymerase chain reaction with necropsy studies. J Neurol Neurosurg Psychiatry 1993; 56:937-8. [PMID: 8350121 PMCID: PMC1015161 DOI: 10.1136/jnnp.56.8.937-a] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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Ciardi M, Sharief MK, Noori MA, Thompson EJ, Salotti A, Rossi F, Vullo V, Catania S, Sorice F, Cirelli A. Intrathecal synthesis of interleukin-2 and soluble IL-2 receptor in asymptomatic HIV-1 seropositive individuals. Correlation with local production of specific IgM and IgG antibodies. J Neurol Sci 1993; 115:117-22. [PMID: 8468587 DOI: 10.1016/0022-510x(93)90076-b] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
The relationship between the interleukin-2 (IL-2) system and the humoral response against human immunodeficiency virus type-I (HIV-1) is important in understanding the immune reaction before the development of AIDS. Levels of IL-2 and soluble IL-2 receptor (sIL-2R) in serum and cerebrospinal fluid (CSF) samples from 31 asymptomatic HIV-1 seropositive individuals were measured and correlated with levels of anti-1 IgG and IgM antibodies. High IL-2 levels were detected in the CSF of 20 (65%) subjects, 18 (90%) of whom had evidence of intrathecal synthesis of HIV-1-specific IgM antibodies. Similarly, IgG antibodies were detected in 10 subjects who had elevated IL-2 levels in the CSF. Moreover, intrathecal levels of IL-2 and sIL-2R correlated with intrathecal synthesis of both IgG and IgM antibodies. Local release of IL-2 seems to play an important role in the initiation of the antibody response against HIV-1 in early stages of infection and may be utilised in devising effective therapeutic strategies.
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Affiliation(s)
- M Ciardi
- Institute of Neurology, National Hospital for Neurology and Neurosurgery, London, U.K
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Sharief MK, Noori MA, Ciardi M, Cirelli A, Thompson EJ. Increased levels of circulating ICAM-1 in serum and cerebrospinal fluid of patients with active multiple sclerosis. Correlation with TNF-alpha and blood-brain barrier damage. J Neuroimmunol 1993; 43:15-21. [PMID: 8096220 DOI: 10.1016/0165-5728(93)90070-f] [Citation(s) in RCA: 146] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The mechanism for the initiation of blood-brain barrier damage and intrathecal inflammation in multiple sclerosis (MS) is poorly understood. We have recently reported that levels of tumor necrosis factor-alpha (TNF-alpha) correlate with blood-brain barrier damage in patients with active MS. Stimulation of endothelial cells by TNF-alpha induces the expression of intercellular adhesion molecule-1 (ICAM-1), which is an important early marker of immune activation and response. We report herein for the first time the detection of high levels of free circulating ICAM-1 in serum and cerebrospinal fluid of patients with active MS. Levels of circulating ICAM-1 in these patients correlated with CSF pleocytosis, TNF-alpha levels and blood-brain barrier damage. These findings have important implications for the understanding and investigation of the intrathecal inflammatory response in active MS.
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Affiliation(s)
- M K Sharief
- Department of Neurochemistry, National Hospital for Neurology and Neurosurgery, London, UK
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Sharief MK, Hentges R, Ciardi M, Thompson EJ. In vivo relationship of interleukin-2 and soluble IL-2 receptor to blood-brain barrier impairment in patients with active multiple sclerosis. J Neurol 1993; 240:46-50. [PMID: 8423463 DOI: 10.1007/bf00838446] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Interleukin (IL)-2 has well-recognized effects on cerebral endothelial cells and, therefore, may mediate disruption of the blood-brain barrier in patients with multiple sclerosis (MS). To evaluate the in vivo relationship of the IL-2 system to blood-brain barrier impairment in MS, levels of IL-2 and soluble IL-2 receptors (sIL-2R) in cerebrospinal fluid (CSF) and serum samples from 50 patients with active MS and 49 controls were correlated with values of the CSF to serum albumin ratio. Intrathecal levels of IL-2 and sIL-2R were significantly higher in MS compared with the control groups and correlated with albumin ratios in MS patients. Intrathecal levels of IL-2 and sIL-2R also correlated with the degree of barrier damage in these patients. It is suggested that intrathecal levels of IL-2 and sIL-2R are related to barrier impairment in MS and may be important in understanding some of the pathological changes of this condition.
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Affiliation(s)
- M K Sharief
- Department of Clinical Neurochemistry, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
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Sharief MK, Ciardi M, Thompson EJ. Blood-brain barrier damage in patients with bacterial meningitis: association with tumor necrosis factor-alpha but not interleukin-1 beta. J Infect Dis 1992; 166:350-8. [PMID: 1634806 DOI: 10.1093/infdis/166.2.350] [Citation(s) in RCA: 120] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Brain damage after meningeal infection could result from impairment of cerebral endothelial cell functions and disruption of blood-brain barriers. Tumor necrosis factor-alpha (TNF alpha) and interleukin-1 beta (IL-1 beta) produce many of their effects by acting on endothelial cells. This study correlates levels of TNF alpha and IL-1 beta in paired cerebrospinal fluid (CSF) and serum samples with the degree of blood-brain barrier damage, as manifested by CSF to serum albumin quotient, in 48 patients with bacterial meningitis and 66 controls. CSF levels of TNF alpha and IL-1 beta in bacterial meningitis were significantly higher than in controls. Intrathecal levels of TNF alpha, but not IL-1 beta, correlated with albumin quotient (P less than .001), with degree of blood-brain barrier disruption (P less than .001), and with disease severity and indices of meningeal inflammation. Sequential CSF samples demonstrated that IL-1 beta and TNF alpha disappear from the CSF within 24 h of antibiotic treatment. Data presented here suggest that TNF alpha is related to blood-brain barrier damage in bacterial meningitis and that its effect could be dissociated from that of IL-1 beta.
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Affiliation(s)
- M K Sharief
- Department of Clinical Neurochemistry, Institute of Neurology, National Hospital for Neurology and Neurosurgery, London, United Kingdom
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Abstract
BACKGROUND The syndrome of progressive muscular atrophy decades after acute paralytic poliomyelitis (post-polio syndrome) is not well understood. The theory that physiologic changes and aging cause the new weakness does not explain the immunologic abnormalities reported in some patients. An alternative explanation is persistent or recurrent poliovirus infection. METHODS We assessed the intrathecal antibody response to poliovirus and intrathecal production of interleukin-2 and soluble interleukin-2 receptors in 36 patients with the post-polio syndrome and 67 controls (including 13 who had had poliomyelitis but had no new symptoms and 18 with amyotrophic lateral sclerosis). Intrathecal antibody responses to measles, mumps, herpes simplex, and varicella zoster viruses were also determined. RESULTS Oligoclonal IgM bands specific to poliovirus were detected in the cerebrospinal fluid of 21 of the 36 patients with the post-polio syndrome (58 percent) but in none of the control group (P less than 0.0001). In quantitative studies there was evidence of increased intrathecal synthesis of IgM antibodies to poliovirus only among the patients with the post-polio syndrome; there was no increased synthesis of IgM to measles, mumps, herpes simplex, or varicella zoster viruses. The patients with post-polio syndrome had significantly higher mean (+/- SD) (cerebrospinal fluid levels of interleukin-2 and soluble interleukin-2 receptors than the controls (8.1 +/- 5.3 vs. 1.4 +/- 0.8 U per milliliter and 159.6 +/- 102.9 vs. 10.7 +/- 6.2 U per milliliter, respectively). The intrathecal synthesis of IgM antibodies to poliovirus correlated with the cerebrospinal fluid concentrations of interleukin-2 (P less than 0.0005) and soluble interleukin-2 receptors (P less than 0.001). CONCLUSIONS An intrathecal immune response against poliovirus is present in many patients with the post-polio syndrome. In some of these patients the recrudescence of muscle weakness may be caused by persistent or recurrent infection of neural cells with the poliovirus.
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Affiliation(s)
- M K Sharief
- Department of Clinical Neurochemistry, National Hospital for Neurology and Neurosurgery, London, United Kingdom
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Cirelli A, Ciardi M, de Simone C, Sorice F, Giordano R, Ciaralli L, Costantini S. Serum selenium concentration and disease progress in patients with HIV infection. Clin Biochem 1991; 24:211-4. [PMID: 2040094 DOI: 10.1016/0009-9120(91)90601-a] [Citation(s) in RCA: 73] [Impact Index Per Article: 2.2] [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: 12/29/2022]
Abstract
The selenium concentration in the serum of 67 patients with HIV infection was measured to determine whether selenium deficiency occurred in the different stages of the disease. In the first stage of the study, patients were divided into four groups: symptom-free subjects, PGL (persistent generalized lymphadenopathy), ARC (AIDS related complex), and AIDS (acquired immunodeficiency syndrome). Selenium concentrations were normal in HIV antibody positive symptom-free subjects (1.18 +/- 0.27 mumol/L) and lower than normal in the other three groups (p less than 0.001). There was a significant correlation (p less than 0.001) between selenium levels and values of hemoglobin and erythrocyte sedimentation rate. Selenium deficiency was in no case associated with a lack of zinc in serum (also determined in all patients). In the second stage of the study, 12 patients were treated for a period of two months with low doses of selenium to assess whether such supplementation was able to restore their impaired immunological and hematological functions. The therapy increased serum selenium concentrations (from 0.77 +/- 0.23 to 1.44 +/- 0.41 mumol/L) and symptomatic improvements were noted. However, no changes were observed in the immunological and hematological parameters.
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Affiliation(s)
- A Cirelli
- Istituto Malattie Infettive, University La Sapienza, Rome, Italy
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Rossi F, Ciardi M, Cirelli A, Guidetti G, Dazzi M, Guglielmi G. Tc-scan in HIV-infected patients. Neuroradiological aspects and clinical implications. Acta Neurol (Napoli) 1990; 12:28-31. [PMID: 2336991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- F Rossi
- Università La Sapienza, Roma Istituto di Malattie Infettive
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Cirelli A, Ciardi M, Rossi F. Cerebral spinal fluid IgG production in HIV-positive patients. Recenti Prog Med 1989; 80:150-2. [PMID: 2740604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
A brief characterization of 27 neurologic syndromes occurring in 44 AIDS patients during two years is presented. In 4 out of 7, intrathecal Ig synthesis was demonstrated without the CSF cell count and blood brain barrier values being within a normal range. Ig intrathecal formation was also observed in 2 LAS patients without neurological symptoms. Similar changes in CSF findings occur in other subacute encephalitis, particularly in multiple sclerosis. Activation of CSF B-cells or their depression due to impairment of CD8 T-lymphocytes was indicated as the cause of this phenomenon. In the Authors' opinion this explanation is somewhat general. The possibility of an immune response in CNS was clearly demonstrated, but in the CSF neither B-cells nor Ig producing plasma cells are evident. In addition, it should be noted that the reliability of blood brain barrier and Ig intrathecal assessment procedures is doubtful in ADC disease, because of the severe alterations in serum albumin and Ig concentrations seen in these patients.
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Cartoni GP, Ciardi M, Giarrusso A, Rosati F. Detection of β-blocking drugs in urine by capillary column gas chromatography-negative ion chemical ionization mass spectrometry. ACTA ACUST UNITED AC 1988. [DOI: 10.1002/jhrc.1240110707] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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De Simone C, Zanzoglu S, Santini G, Ciardi M, Delia S, Sorice F. Influence of ofloxacin on murine Peyer's patch lymphocytes. Infection 1986; 14 Suppl 4:S256-7. [PMID: 3469157 DOI: 10.1007/bf01661287] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Several factors must be considered before the clinical impact of antimicrobials on the immune function can be determined. No data are available as yet on the influence of ofloxacin, a new fluoro-quinolone, on the lymphocytes of Peyer's patches. The present study offers evidence that murine Peyer's patches are influenced by ofloxacin administered by the oral route for seven days (15 mg/kg). No modifications of the percentage of the Thy 1,2 and SIg positive splenocytes and of the PHA and LPS-induced proliferative responses were observed studying cell suspensions from the spleen of the same animals. An immunotoxic effect of the compound on the cells of Peyer's patches or an impairment of their homing tendency has been postulated.
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Cartoni GP, Giarrusso A, Ciardi M, Rosati F. Capillary gas chromatography and mass spectrometry detection of anabolic steroids II. ACTA ACUST UNITED AC 1985. [DOI: 10.1002/jhrc.1240080912] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Cartoni GP, Ciardi M, Giarrusso A, Rosati F. Detection of phenolalkylamines by capillary column gas chromatography-negative chemical ionization mass spectrometry. J Chromatogr A 1985; 330:315-21. [PMID: 4066825 DOI: 10.1016/s0021-9673(01)81988-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Twelve phenolalkylamines normally used in different pharmaceutical products were determined in urine from volunteers given a therapeutical dose of the drug. The urine extracts were first derivatized with perfluoro propionic or butyric anhydride, then detected by capillary gas chromatography-negative chemical ionization mass spectrometry. The method is highly sensitive and specific in the analysis of biological samples.
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Abstract
A procedure is described for the detection of anabolic steroids in urine by using capillary gas chromatography-mass spectrometry. The method is suitable for doping control and has a sensitivity as low as 1 ppb. The excretion mode and the metabolism of ten commercial anabolic steroids is reported.
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Cirelli A, Triozzi M, Ciardi M. [Effect of antibiotics on blood culture and serodiagnosis in typhoid fever]. Clin Ter 1983; 104:369-73. [PMID: 6851444] [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: 01/22/2023]
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Cartoni GP, Ciardi M, Giarrusso A, Rosati F. Reversed-phase high-performance liquid chromatographic detection of pemoline in doping control. J Chromatogr A 1980; 202:131-3. [PMID: 7217245 DOI: 10.1016/s0021-9673(00)80087-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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