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Castriotta L, Onder G, Rosolen V, Beorchia Y, Fanizza C, Bellini B, Floridia M, Giuliano M, Silenzi A, Pricci F, Grisetti T, Grassi T, Tiple D, Villa M, Profili F, Francesconi P, Barbone F, Bisceglia L, Brusaferro S. Examining potential Long COVID effects through utilization of healthcare resources: a retrospective, population-based, matched cohort study comparing individuals with and without prior SARS-CoV-2 infection. Eur J Public Health 2024:ckae001. [PMID: 38243748 DOI: 10.1093/eurpub/ckae001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2024] Open
Abstract
BACKGROUND A significant proportion of individuals reports persistent clinical manifestations following SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) acute infection. Nevertheless, knowledge of the burden of this condition-often referred to as 'Long COVID'-on the health care system remains limited. This study aimed to evaluate healthcare utilization potentially related to Long COVID. METHODS Population-based, retrospective, multi-center cohort study that analyzed hospital admissions and utilization of outpatient visits and diagnostic tests between adults aged 40 years and older recovered from SARS-CoV-2 infection occurred between February 2020 and December 2021 and matched unexposed individuals during a 6-month observation period. Healthcare utilization was analyzed by considering the setting of care for acute SARS-CoV-2 infection [non-hospitalized, hospitalized and intensive care unit (ICU)-admitted] as a proxy for the severity of acute infection and epidemic phases characterized by different SARS-CoV-2 variants. Data were retrieved from regional health administrative databases of three Italian Regions. RESULTS The final cohort consisted of 307 994 previously SARS-CoV-2 infected matched with 307 994 uninfected individuals. Among exposed individuals, 92.2% were not hospitalized during the acute infection, 7.3% were hospitalized in a non-ICU ward and 0.5% were admitted to ICU. Individuals previously infected with SARS-CoV-2 (vs. unexposed), especially those hospitalized or admitted to ICU, reported higher utilization of outpatient visits (range of pooled Incidence Rate Ratios across phases; non-hospitalized: 1.11-1.33, hospitalized: 1.93-2.19, ICU-admitted: 3.01-3.40), diagnostic tests (non-hospitalized: 1.35-1.84, hospitalized: 2.86-3.43, ICU-admitted: 4.72-7.03) and hospitalizations (non-hospitalized: 1.00-1.52, hospitalized: 1.87-2.36, ICU-admitted: 4.69-5.38). CONCLUSIONS This study found that SARS-CoV-2 infection was associated with increased use of health care in the 6 months following infection, and association was mainly driven by acute infection severity.
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Affiliation(s)
- Luigi Castriotta
- Institute of Hygiene and Evaluative Epidemiology, Friuli Centrale University Health Authority, Udine, Italy
- Central Directorate for Health, Social Policies and Disability, Friuli Venezia Giulia Region, Trieste, Italy
| | - Graziano Onder
- Istituto Superiore di Sanità-Italian National Institute of Health, Rome, Italy
- Fondazione Policlinico Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Valentina Rosolen
- Central Directorate for Health, Social Policies and Disability, Friuli Venezia Giulia Region, Trieste, Italy
| | - Yvonne Beorchia
- Institute of Hygiene and Evaluative Epidemiology, Friuli Centrale University Health Authority, Udine, Italy
| | - Caterina Fanizza
- Agenzia Regionale Strategica per la Salute e il Sociale, Regione Puglia, Bari, Italy
| | - Benedetta Bellini
- Agenzia Regionale di Sanità, Regione Toscana, Firenze, Italy
- Agenzia Italiana del Farmaco-Italian Medicines Agency, Rome, Italy
| | - Marco Floridia
- Istituto Superiore di Sanità-Italian National Institute of Health, Rome, Italy
| | - Marina Giuliano
- Istituto Superiore di Sanità-Italian National Institute of Health, Rome, Italy
| | | | - Flavia Pricci
- Istituto Superiore di Sanità-Italian National Institute of Health, Rome, Italy
| | - Tiziana Grisetti
- Istituto Superiore di Sanità-Italian National Institute of Health, Rome, Italy
| | - Tiziana Grassi
- Istituto Superiore di Sanità-Italian National Institute of Health, Rome, Italy
| | - Dorina Tiple
- Istituto Superiore di Sanità-Italian National Institute of Health, Rome, Italy
| | - Marika Villa
- Istituto Superiore di Sanità-Italian National Institute of Health, Rome, Italy
| | | | | | - Fabio Barbone
- Central Directorate for Health, Social Policies and Disability, Friuli Venezia Giulia Region, Trieste, Italy
- Dipartimento Universitario Clinico di Scienze Mediche Chirurgiche e della Salute, Università degli Studi di Trieste, Trieste, Italy
| | - Lucia Bisceglia
- Agenzia Regionale Strategica per la Salute e il Sociale, Regione Puglia, Bari, Italy
| | - Silvio Brusaferro
- Istituto Superiore di Sanità-Italian National Institute of Health, Rome, Italy
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2
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Ciprandi G, Giuliano M, Schiavetti I, Miraglia Del Giudice M, Tosca MA. Factors associated with asthma exacerbations in schoolchildren: an experience in clinical practice. Eur Ann Allergy Clin Immunol 2024; 56:45-48. [PMID: 35620992 DOI: 10.23822/eurannaci.1764-1489.255] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- G Ciprandi
- Allergy Clinic, Casa di Cura Villa Montallegro, Genoa, Italy
| | - M Giuliano
- Pediatric Primary Care ASL Napoli 2, Naples, Italy
| | - I Schiavetti
- Department of Health, University of Genoa, Genoa, Italy
| | - M Miraglia Del Giudice
- Department of Woman, Child, and General and Specialized Surgery, University of Campania Luigi Vanvitelli, Naples, Italy
| | - M A Tosca
- Allergy Center, Istituto Giannina Gaslini, Genoa, Italy
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Rizzo A, Schipilliti FM, Di Costanzo F, Acquafredda S, Arpino G, Puglisi F, Del Mastro L, Montemurro F, De Laurentiis M, Giuliano M. Discontinuation rate and serious adverse events of chemoimmunotherapy as neoadjuvant treatment for triple-negative breast cancer: a systematic review and meta-analysis. ESMO Open 2023; 8:102198. [PMID: 38100933 PMCID: PMC10774952 DOI: 10.1016/j.esmoop.2023.102198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 10/30/2023] [Accepted: 10/31/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND The use of combination of chemotherapy with immune checkpoint inhibitors (ICIs) has shown efficacy in triple-negative breast cancer (TNBC), and chemoimmunotherapy has been introduced in clinical practice. However, limited data are available on the discontinuation rate and serious adverse events of these treatments, particularly in the neoadjuvant setting. Herein, we carried out a comprehensive systematic review and meta-analysis to assess discontinuation rate and serious adverse events of chemoimmunotherapy compared to chemotherapy alone in phase II and III neoadjuvant clinical trials in TNBC. MATERIALS AND METHODS Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, EMBASE, Cochrane Library, and PubMed/Medline were searched for articles published from June 2008 to May 2023. The outcomes of interest were the discontinuation rate, serious adverse events, and grade 3-4 adverse events. RESULTS Four studies were included in the analysis. The pooled odds ratios (ORs) for discontinuation rate and serious adverse events were 1.26 [95% confidence interval (CI) 0.78-2.06] and 1.79 (95% CI 1.4-2.28), respectively, in patients receiving chemoimmunotherapy compared to chemotherapy alone as neoadjuvant treatment for TNBC. The chemoimmunotherapy group had a higher risk of grade 3-4 adverse events (OR 1.30, 95% CI 1.07-1.59). The analysis showed substantial heterogeneity, and the risk of discontinuation rate was heavily influenced by the KEYNOTE-522 trial. CONCLUSIONS Our findings highlight the need for clinical trials specifically focused on safety, quality of life, and treatment adherence in TNBC patients receiving neoadjuvant treatment. Close monitoring of tolerability remains crucial in this clinical setting.
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Affiliation(s)
- A Rizzo
- IRCCS Istituto Tumori "Giovanni Paolo II", Bari
| | - F M Schipilliti
- Oncological Department, Sant'Andrea Hospital, University Sapienza in Rome, Rome
| | - F Di Costanzo
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples
| | | | - G Arpino
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples
| | - F Puglisi
- Department of Medicine, University of Udine, Udine; Department of Medical Oncology-CRO Aviano, National Cancer Institute, IRCCS, Aviano
| | - L Del Mastro
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genova; Medical Oncology Department, U.O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova
| | | | - M De Laurentiis
- Istituto Nazionale Tumori IRCCS "Fondazione Pascale", Napoli, Italy
| | - M Giuliano
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples.
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Giuliano M, Pirillo MF, Orlando S, Luhanga R, Mphwere R, Kavalo T, Andreotti M, Amici R, Ciccacci F, Marazzi MC, Floridia M. Cytomegalovirus viremia in HIV-exposed and HIV-unexposed infants in Malawi. Acta Trop 2023; 246:106987. [PMID: 37454709 DOI: 10.1016/j.actatropica.2023.106987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 06/15/2023] [Accepted: 07/13/2023] [Indexed: 07/18/2023]
Abstract
In sub-Saharan Africa the great majority of infants acquire Cytomegalovirus (CMV) infection within the first year of life. Maternal long-term antiretroviral therapy (ART) has been suggested to reduce the rate of CMV acquisition in HIV-exposed infants. In the present study serum samples collected at 6 months of age from HIV-exposed and HIV-unexposed infants were analyzed for the presence of CMV DNA (with CMV positivity defined by levels of CMV DNA > 1000 UI/ml). Twenty out of 58 (34.5%) infants had CMV DNA > 1000 UI/ml. There was no difference in the prevalence of CMV viremia between HIV-exposed and -unexposed infants [33.3% (15/45) vs 38.5% (5/13), respectively, P = 0.488]. In the HIV-exposed group, mothers of CMV-negative infants had received a longer antiretroviral treatment before delivery in comparison to mothers of CMV-positive infants (28 vs 3 months, P = 0.187). No differences in weights and lengths at birth, and at 1, 6 and 12 months were observed between CMV-positive and CMV-negative infants. In this study, the prevalence of CMV viremia at six months of age was high in infants born to HIV-positive mothers receiving long-term ART, similar to that of HIV-unexposed infants. Considering the possible relevant impact of CMV on infant health, strategies for containment of the infection should be explored.
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Affiliation(s)
- Marina Giuliano
- National Center for Global Health, Istituto Superiore di Sanità, Viale Regina Elena 299, Rome 00161, Italy.
| | - Maria Franca Pirillo
- National Center for Global Health, Istituto Superiore di Sanità, Viale Regina Elena 299, Rome 00161, Italy
| | - Stefano Orlando
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | | | | | - Thom Kavalo
- DREAM Program, Community of S. Egidio, Blantyre, Malawi
| | - Mauro Andreotti
- National Center for Global Health, Istituto Superiore di Sanità, Viale Regina Elena 299, Rome 00161, Italy
| | - Roberta Amici
- National Center for Global Health, Istituto Superiore di Sanità, Viale Regina Elena 299, Rome 00161, Italy
| | - Fausto Ciccacci
- UniCamillus, Saint Camillus International University of Health Sciences, Rome, Italy
| | | | - Marco Floridia
- National Center for Global Health, Istituto Superiore di Sanità, Viale Regina Elena 299, Rome 00161, Italy
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Baroncelli S, Galluzzo CM, Orlando S, Luhanga R, Mphwere R, Kavalo T, Amici R, Floridia M, Andreotti M, Ciccacci F, Marazzi MC, Giuliano M. Insufficient measles antibody protection in 6-month-old Malawian infants: Reconsider vaccination schedule? Trop Med Int Health 2023; 28:731-735. [PMID: 37533039 DOI: 10.1111/tmi.13920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/04/2023]
Abstract
Measles vaccination is currently recommended at 9 months, since maternal antibodies are supposed to protect infants until that age. In this study of 6-month-old Malawian infants 98.3% (58/59) had non-protective IgG levels against measles, irrespective of HIV exposure. Anticipating the first dose at 6 months could be considered.
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Affiliation(s)
- Silvia Baroncelli
- National Center for Global Health, Istituto Superiore di Sanità, Rome, Italy
| | | | - Stefano Orlando
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | | | | | - Thom Kavalo
- DREAM Program, Community of S. Egidio, Blantyre, Malawi
| | - Roberta Amici
- National Center for Global Health, Istituto Superiore di Sanità, Rome, Italy
| | - Marco Floridia
- National Center for Global Health, Istituto Superiore di Sanità, Rome, Italy
| | - Mauro Andreotti
- National Center for Global Health, Istituto Superiore di Sanità, Rome, Italy
| | - Fausto Ciccacci
- Saint Camillus International, University of Health Sciences, Rome, Italy
| | | | - Marina Giuliano
- National Center for Global Health, Istituto Superiore di Sanità, Rome, Italy
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Floridia M, Galluzzo CM, Orlando S, Luhanga R, Mphwere R, Kavalo T, Andreotti M, Amici R, Ciccacci F, Marazzi MC, Giuliano M. Micronutrient and Nutritional Status of HIV-Exposed and HIV-Unexposed Malawian Infants in the First Year of Life: Assessment of Ferritin, Vitamin A, and D Status and Its Association with Growth. Nutrients 2023; 15:3282. [PMID: 37513701 PMCID: PMC10386663 DOI: 10.3390/nu15143282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 07/19/2023] [Accepted: 07/21/2023] [Indexed: 07/30/2023] Open
Abstract
Breastfed Malawian infants from Human Immunodeficiency Virus (HIV)-uninfected and HIV-infected women who received antiretroviral therapy were followed until 12 months of age, allowing us to evaluate plasma levels of ferritin, vitamin A (as retinol-binding protein, RBP), and vitamin D (25(OH)D) at six months, as well as nutritional status and growth between six and 12 months. Ferritin and RBP levels were adjusted for inflammation. The study included 88 infants, 63 of whom were part of a recent cohort (2019-2021) that included 49 HIV-exposed but uninfected (HEU) and 14 HIV-unexposed and uninfected (HUU) infants, as well as 25 infants (all HEU) from an earlier cohort (2008-2011). No differences were observed between HEU and HUU infants regarding micronutrient levels, anthropometric indexes, growth, and rates of stunting, being underweight, or wasting. HEU infants from the earlier cohort, when compared to more recent HEU infants, had significantly worse anthropometric measures at six months and inferior growth between six and twelve months. Overall, ferritin deficiency involved 68.6% of infants, while vitamin A and vitamin D deficiency involved 8% and 1.2% of infants, respectively. Micronutrient deficiencies were not associated with HIV exposure, cohort, stunting, being underweight, or wasting. At six months, stunting, being underweight, and wasting involved 25.0%, 2.7% and 2.8% of infants, respectively, with no differences related to HIV exposure. Ferritin deficiency at six months was associated with inferior subsequent growth. In this small observational study conducted in Malawian infants, no major nutritional gap was observed between HIV-exposed and HIV-unexposed infants, though the study highlighted specific nutritional deficiencies that deserve attention. High rates of stunting and ferritin deficiency were observed in the first year of life in Malawian infants, irrespective of maternal HIV status; a significant association between ferritin deficiency and worse subsequent growth was found. Vitamin A and vitamin D deficiencies were much less frequent. Based on the data observed, nutritional interventions should give priority to the correction of ferritin deficiency and chronic undernutrition.
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Affiliation(s)
- Marco Floridia
- National Center for Global Health, Istituto Superiore di Sanità, 00161 Rome, Italy
| | | | - Stefano Orlando
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Richard Luhanga
- DREAM Program, Community of S. Egidio, Blantyre P.O. Box 30355, Malawi
| | - Robert Mphwere
- DREAM Program, Community of S. Egidio, Blantyre P.O. Box 30355, Malawi
| | - Thom Kavalo
- DREAM Program, Community of S. Egidio, Blantyre P.O. Box 30355, Malawi
| | - Mauro Andreotti
- National Center for Global Health, Istituto Superiore di Sanità, 00161 Rome, Italy
| | - Roberta Amici
- National Center for Global Health, Istituto Superiore di Sanità, 00161 Rome, Italy
| | - Fausto Ciccacci
- UniCamillus, Department of Medicine, Saint Camillus International University of Health Sciences, 00131 Rome, Italy
| | | | - Marina Giuliano
- National Center for Global Health, Istituto Superiore di Sanità, 00161 Rome, Italy
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Baroncelli S, Galluzzo CM, Orlando S, Pirillo MF, Luhanga R, Mphwere R, Kavalo T, Amici R, Floridia M, Andreotti M, Ciccacci F, Scarcella P, Marazzi MC, Giuliano M. Rates of Seroprotection against Vaccine-Preventable Infectious Diseases in HIV-Exposed and -Unexposed Malawian Infants. Pathogens 2023; 12:938. [PMID: 37513785 PMCID: PMC10383556 DOI: 10.3390/pathogens12070938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 07/11/2023] [Accepted: 07/13/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND The evaluation of seroprotection rates against vaccine-preventable infectious diseases allows for the identification of risk populations. HIV-exposed infants, even if not infected with HIV, have higher morbidity and mortality in comparison to unexposed counterparts. The aim of this study was to compare the specific IgG levels against Haemophilus influenzae type-B (HiB), Hepatitis-B (HBV), and Streptococcus pneumoniae (Spn) in two groups of infants (HIV-exposed and HIV-unexposed) living in Malawi. METHODS Blood samples from 62 infants, 49 HIV-exposed, uninfected (HEU), and born to women living with HIV and 13 HIV-unexposed and uninfected (HUU), were collected at 6 months, and specific IgG levels were determined using ELISA tests. RESULTS The antibody levels against HiB, HBV, and Spn were similar in the two groups. At six months, all HUU infants and 81.6% of HEU infants showed seroprotective levels against HiB, while a percentage of protection varying from 80.6 to 84.6% was observed for HBV and Spn regardless of HIV exposure. Only 59.2% of HEU and 69.2% of HUU infants showed antibody protection against all three pathogens. CONCLUSIONS These results indicate similar rates of seroprotection among HEU and HUU infants but also suggest that a consistent fraction of infants received incomplete vaccinations. Strategies to enforce participation in immunization programs in Malawi should be a health priority.
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Affiliation(s)
- Silvia Baroncelli
- National Center for Global Health, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Rome, Italy
| | - Clementina Maria Galluzzo
- National Center for Global Health, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Rome, Italy
| | - Stefano Orlando
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy
| | - Maria Franca Pirillo
- National Center for Global Health, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Rome, Italy
| | - Richard Luhanga
- DREAM Program, Community of S. Egidio, P.O. Box 30355, Blantyre 312200, Malawi
| | - Robert Mphwere
- DREAM Program, Community of S. Egidio, P.O. Box 30355, Blantyre 312200, Malawi
| | - Thom Kavalo
- DREAM Program, Community of S. Egidio, P.O. Box 30355, Blantyre 312200, Malawi
| | - Roberta Amici
- National Center for Global Health, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Rome, Italy
| | - Marco Floridia
- National Center for Global Health, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Rome, Italy
| | - Mauro Andreotti
- National Center for Global Health, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Rome, Italy
| | - Fausto Ciccacci
- UniCamillus, Saint Camillus International University of Health Sciences, Via di Sant'Alessandro 8, 00131 Rome, Italy
| | - Paola Scarcella
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy
| | | | - Marina Giuliano
- National Center for Global Health, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Rome, Italy
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8
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Floridia M, Orlando S, Andreotti M, Mphwere R, Kavalo T, Ciccacci F, Scarcella P, Marazzi MC, Giuliano M. A 12-month Prospective Study of HIV-infected and HIV-uninfected Women and Their Infants in Malawi: Comparative Analysis of Clinical Events and Infant Growth. Am J Trop Med Hyg 2023; 108:394-402. [PMID: 36535249 PMCID: PMC9896343 DOI: 10.4269/ajtmh.22-0482] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 09/16/2022] [Indexed: 12/23/2022] Open
Abstract
Few studies have compared clinical outcomes in HIV-exposed uninfected (HEU) and HIV-unexposed uninfected (HUU) infants in the current scenario of universal and lifelong maternal antiretroviral therapy (ART). HIV-uninfected and HIV-infected Malawian women receiving ART and their breastfed infants were followed for 12 months postpartum, analyzing the rates of infectious and noninfectious events and assessing infant growth at 6 weeks, 6 months, and 12 months. The cohorts included 227 mothers (70 HIV-negative, 157 HIV-positive) and 235 infants (72 HUU, 163 HEU). No maternal or infant deaths occurred during follow-up. HIV-negative women were less likely to complete follow-up (48.6% versus 91.1%). Mothers with and without HIV had similar rates of both infectious and noninfectious events per person-month. Infants who were HEU, compared with HUU, had higher rates of events of any type, lower respiratory tract infections (LRTI), and noninfectious events. HEU had lower body mass index (BMI) at 6 weeks but did not differ from HUU in all anthropometric measures at 6 and 12 months; in growth between 6 weeks and 12 months; and in occurrence of stunting, underweight, and wasting at 6 weeks, 6 months, and 12 months. During the first year of life, infants who were HEU, compared with HUU, showed a transiently lower BMI and an increased risk of LRTI.
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Affiliation(s)
- Marco Floridia
- Istituto Superiore di Sanità, National Center for Global Health, Rome, Italy
| | - Stefano Orlando
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Mauro Andreotti
- Istituto Superiore di Sanità, National Center for Global Health, Rome, Italy
| | | | - Thom Kavalo
- DREAM Program, Community of S. Egidio, Blantyre, Malawi
| | - Fausto Ciccacci
- Saint Camillus International University of Health Sciences, Rome, Italy
| | - Paola Scarcella
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | | | - Marina Giuliano
- Istituto Superiore di Sanità, National Center for Global Health, Rome, Italy
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9
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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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10
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Giuliano M, Orlando S, Andreotti M, Mthiko B, Mphwere R, Kavalo T, Ciccacci F, Marazzi MC, Floridia M. Maternal retention and early infant HIV diagnosis in a prospective cohort study of HIV-positive women and their children in Malawi. Int J STD AIDS 2023; 34:54-61. [PMID: 36285600 PMCID: PMC10658750 DOI: 10.1177/09564624221136647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 10/14/2022] [Accepted: 10/17/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND Post-partum loss to follow-up and lack of early HIV infant diagnosis (EID) can significantly affect the efficiency of programs for the prevention of mother-to-child transmission. METHODS In a prospective observational study 167 women were enrolled at week 36 of gestation and followed with their infants up to one year after delivery. Retention was defined as the proportion of women who attended the 12 months visit and EID as an HIV PCR test performed within 2 months. Determinants for retention and EID were assessed in univariate analyses and in multivariable logistic regression models. RESULTS Women lost to follow-up (24/167 or 14.4%) had a shorter duration of antiretroviral therapy (ART) at enrolment in comparison to women retained in care (p = 0.025). Lack of EID (occurring in 18.9% of the cases) was directly correlated, although not significantly, with a history of child death (p = 0.071), a higher educational level (p = 0.083), and female infant gender (p = 0.064). CONCLUSIONS Longer duration of ART at enrolment significantly predicted a better post-partum retention, suggesting that specific counselling interventions should be targeted to recent ART initiators. A low proportion of infants did not receive an EID, but predictive factors were difficult to identify.
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Affiliation(s)
- Marina Giuliano
- National Center for Global Health, Istituto Superiore di Sanità, Rome, Italy
| | - Stefano Orlando
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Mauro Andreotti
- National Center for Global Health, Istituto Superiore di Sanità, Rome, Italy
| | - Bryan Mthiko
- DREAM Program, Community of S. Egidio, Blantyre, Malawi
| | | | - Thom Kavalo
- DREAM Program, Community of S. Egidio, Blantyre, Malawi
| | - Fausto Ciccacci
- UniCamillus, Saint Camillus International University of Health Sciences, Rome, Italy
| | | | - Marco Floridia
- National Center for Global Health, Istituto Superiore di Sanità, Rome, Italy
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11
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Floridia M, Giuliano M, Monaco M, Palmieri L, Lo Noce C, Palamara AT, Pantosti A, Brusaferro S, Onder G, Palmieri L, Agazio E, Barbariol P, Bella A, Benelli E, Bertinato L, Bocci M, Boros S, Bressi M, Calcagnini G, Canevelli M, Censi F, Ciervo A, Colaizzo E, Da Cas R, Del Manso M, Di Benedetto C, Donfrancesco C, Fabiani M, Facchiano F, Floridia M, Galati F, Giuliano M, Grisetti T, Guastadisegni C, Lega I, Lo Noce C, Maiozzi P, Manno V, Martini M, Massari M, Urdiales AM, Mattei E, Meduri C, Meli P, Menniti Ippolito F, Minelli G, Onder G, Petrone D, Pezzotti P, Pricci F, Punzo O, Quarata F, Raparelli V, Riccardo F, Rocchetto S, Sacco C, Salerno P, Sarti G, Serra D, Spila Alegiani S, Spuri M, Tallon M, Tamburo De Bella M, Tiple D, Toccaceli Blasi M, Trentin F, Unim B, Vaianella L, Vanacore N, Vescio MF, Villani ER, Weimer LE, Brusaferro S. Microbiologically confirmed infections and antibiotic-resistance in a national surveillance study of hospitalised patients who died with COVID-19, Italy 2020–2021. Antimicrob Resist Infect Control 2022; 11:74. [PMID: 35598032 PMCID: PMC9123740 DOI: 10.1186/s13756-022-01113-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 05/07/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Patients hospitalised for COVID-19 may present with or acquire bacterial or fungal infections that can affect the course of the disease. The aim of this study was to describe the microbiological characteristics of laboratory-confirmed infections in hospitalised patients with severe COVID-19.
Methods
We reviewed the hospital charts of a sample of patients deceased with COVID-19 from the Italian National COVID-19 Surveillance, who had laboratory-confirmed bacterial or fungal bloodstream infections (BSI) or lower respiratory tract infections (LRTI), evaluating the pathogens responsible for the infections and their antimicrobial susceptibility.
Results
Among 157 patients with infections hospitalised from February 2020 to April 2021, 28 (17.8%) had co-infections (≤ 48 h from admission) and 138 (87.9%) had secondary infections (> 48 h). Most infections were bacterial; LRTI were more frequent than BSI. The most common co-infection was pneumococcal LRTI. In secondary infections, Enterococci were the most frequently recovered pathogens in BSI (21.7% of patients), followed by Enterobacterales, mainly K. pneumoniae, while LRTI were mostly associated with Gram-negative bacteria, firstly Enterobacterales (27.4% of patients, K. pneumoniae 15.3%), followed by A. baumannii (19.1%). Fungal infections, both BSI and LRTI, were mostly due to C. albicans. Antibiotic resistance rates were extremely high in Gram-negative bacteria, with almost all A. baumannii isolates resistant to carbapenems (95.5%), and K. pneumoniae and P. aeruginosa showing carbapenem resistance rates of 59.5% and 34.6%, respectively.
Conclusions
In hospitalised patients with severe COVID-19, secondary infections are considerably more common than co-infections, and are mostly due to Gram-negative bacterial pathogens showing a very high rate of antibiotic resistance.
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12
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Monaco M, Floridia M, Giuliano M, Palmieri L, Lo Noce C, Pantosti A, Palamara AT, Brusaferro S, Onder G. Hospital-acquired bloodstream infections in patients deceased with COVID-19 in Italy (2020-2021). Front Med (Lausanne) 2022; 9:1041668. [PMID: 36465906 PMCID: PMC9713028 DOI: 10.3389/fmed.2022.1041668] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Accepted: 10/31/2022] [Indexed: 10/06/2023] Open
Abstract
INTRODUCTION In hospitalized patients with COVID-19, bloodstream infections (BSI) are associated with high mortality and high antibiotic resistance rates. The aim of this study was to describe BSI etiology, antimicrobial resistance profile and risk factors in a sample of patients deceased with COVID-19 from the Italian National COVID-19 surveillance. METHODS Hospital charts of patients who developed BSI during hospitalization were reviewed to describe the causative microorganisms and their antimicrobial susceptibility profiles. Risk factors were analyzed in univariate and multivariate analyses. RESULTS The study included 73 patients (71.2% male, median age 70): 40 of them (54.8%) received antibiotics and 30 (41.1%) systemic steroids within 48 h after admission; 53 (72.6%) were admitted to intensive care unit. Early steroid use was associated with a significantly shorter interval between admission and BSI occurrence. Among 107 isolated microorganisms, the most frequent were Enterococcus spp., Candida spp., Acinetobacter baumannii, and Klebsiella pneumoniae. Median time from admission to BSI was shorter for Staphylococcus aureus compared to all other bacteria (8 vs. 24 days, p = 0.003), and longer for Enterococcus spp., compared to all other bacteria (26 vs. 18 days, p = 0.009). Susceptibility tests showed a high rate of resistance, with 37.6% of the bacterial isolates resistant to key antibiotics. Resistance was associated with geographical area [adjusted odds ratio (AOR) for Central/South Italy compared to North Italy: 6.775, p = 0.002], and with early use of systemic steroids (AOR 6.971, p = 0.018). CONCLUSIONS In patients deceased with COVID-19, a large proportion of BSI are caused by antibiotic-resistant bacteria. Early steroid use may facilitate this occurrence.
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Affiliation(s)
- Monica Monaco
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Marco Floridia
- National Center for Global Health, Istituto Superiore di Sanità, Rome, Italy
| | - Marina Giuliano
- National Center for Global Health, Istituto Superiore di Sanità, Rome, Italy
| | - Luigi Palmieri
- Department of Cardiovascular, Endocrine-Metabolic Diseases and Aging, Istituto Superiore di Sanità, Rome, Italy
| | - Cinzia Lo Noce
- Department of Cardiovascular, Endocrine-Metabolic Diseases and Aging, Istituto Superiore di Sanità, Rome, Italy
| | - Annalisa Pantosti
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | | | | | - Graziano Onder
- Department of Cardiovascular, Endocrine-Metabolic Diseases and Aging, Istituto Superiore di Sanità, Rome, Italy
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13
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Baroncelli S, Galluzzo CM, Orlando S, Mphwere R, Kavalo T, Luhanga R, Amici R, Floridia M, Andreotti M, Scarcella P, Marazzi MC, Giuliano M. Dynamics of SARS-CoV-2 exposure in Malawian infants between February 2020 and May 2021. J Clin Virol Plus 2022; 2:100110. [PMID: 36128323 PMCID: PMC9477783 DOI: 10.1016/j.jcvp.2022.100110] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 09/12/2022] [Accepted: 09/15/2022] [Indexed: 11/21/2022] Open
Abstract
Background Very limited information is available on SARS-CoV-2 seroprevalence in infants in sub-Saharan countries. Objective In this study, we aimed to determine the rate and the temporal evolution of SARS CoV-2 seropositivity in breastfed Malawian infants. Study design Blood samples (n = 250) from 158 infants, born to HIV-negative women and women living with HIV, collected from February 2020 to May 2021, were first tested using an Anti-IgG/A/M SARS CoV 2 ELISA assay against trimeric spike protein, and then, if positive, confirmed using a second ELISA assay detecting IgG against Receptor Binding Domain. Results The confirmed prevalence of anti-SARS CoV-2 antibodies was 31.0% (95% CI: 23.7%-38.3%) with no significant difference between HIV-exposed and HIV-unexposed infants (29.3% and 37.1% respectively, P = 0.410). The presence of anti-SARS-CoV-2 IgG was not associated with maternal socioeconomic or demographic indices. Conclusions Our data underline the wide spread of the SARS-CoV-2 infection in the pediatric population in sub-Saharan Africa. Design of more specific serological tests for African samples and improvements in serosurveillance programs are needed for more rigorous monitoring of the dynamics of SARS-CoV-2 infection in Africa.
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Affiliation(s)
- Silvia Baroncelli
- National Center for Global Health, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Rome, Italy
| | - Clementina Maria Galluzzo
- National Center for Global Health, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Rome, Italy
| | - Stefano Orlando
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy
| | - Robert Mphwere
- DREAM Program, Community of S. Egidio, P.O. Box 30355, Blantyre, Malawi
| | - Thom Kavalo
- DREAM Program, Community of S. Egidio, P.O. Box 30355, Blantyre, Malawi
| | - Richard Luhanga
- DREAM Program, Community of S. Egidio, P.O. Box 30355, Blantyre, Malawi
| | - Roberta Amici
- National Center for Global Health, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Rome, Italy
| | - Marco Floridia
- National Center for Global Health, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Rome, Italy
| | - Mauro Andreotti
- National Center for Global Health, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Rome, Italy
| | - Paola Scarcella
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy
| | | | - Marina Giuliano
- National Center for Global Health, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Rome, Italy
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14
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Del Mastro L, Poggio F, Blondeaux E, de Placido S, Giuliano M, De Laurentiis M, Bisagni G, Cantore M, Turletti A, Nisticò C, Urracci Y, Garrone O, Bighin C, Mansutti M, Montemurro F, Colantuoni G, Lambertini M, Boni L. 134O Dose-dense adjuvant chemotherapy in early-stage breast cancer patients: End-of-study results from a randomised, phase III trial of the Gruppo Italiano Mammella (GIM). Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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15
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Floridia M, Grassi T, Giuliano M, Tiple D, Pricci F, Villa M, Silenzi A, Onder G. Characteristics of Long-COVID care centers in Italy. A national survey of 124 clinical sites. Front Public Health 2022; 10:975527. [PMID: 36062113 PMCID: PMC9437305 DOI: 10.3389/fpubh.2022.975527] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 08/05/2022] [Indexed: 01/25/2023] Open
Abstract
Background Despite the growing clinical relevance of Long-COVID, there is minimal information available on the organizational response of health services to this condition. Methods A national online survey of centers providing assistance for Long-COVID was implemented. Information collected included date of start of activity, target population, mode of assistance and of referral, type and number of specialists available, diagnostic and instrumental tests, use of telemedicine and of specific questionnaires. Results Between February and May 2022, 124 centers completed the survey. Half of them were situated in northern Italy. Most (88.9%) provided assistance through either outpatient visits or day hospital services. Eleven (8.9%) assisted pediatric patients. Access to centers included scheduled visits for previously hospitalized patients (67.7%), referral from primary care (62.1%), from other specialists (46.8%), and, less commonly, from other services. Almost half of the centers (46.3%) started their activity early in the pandemics (March-September 2020). Almost all (93.5%) communicated with primary care physicians, and 21.8% used telemedicine tools. The mean number of patients followed was 40 per month (median 20, IQR 10-40). In most cases, the center coordinator was a specialist in respiratory diseases (30.6%), infectious diseases (28.2%), or internal medicine (25.0%). At least half of the centers had specialistic support in cardiology, respiratory diseases, radiology, infectious diseases, neurology and psychology, but roughly one quarter of centers had just only one (14.5%) or two (9.7%) specialists available. The clinical assessment was usually supported by a wide range of laboratory and instrumental diagnostics and by multidimensional evaluations. Conclusions Most of the centers had an articulate and multidisciplinary approach to diagnosis and care of Long-COVID. However, a minority of centers provided only single or dual specialistic support. These findings may be of help in defining common standards, interventions and guidelines that can reduce gaps and heterogeneity in assistance to patients with Long-COVID.
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Affiliation(s)
- Marco Floridia
- National Center for Global Health, Istituto Superiore di Sanità, Rome, Italy,*Correspondence: Marco Floridia
| | - Tiziana Grassi
- Department of Cardiovascular, Endocrine-Metabolic Diseases and Aging, Istituto Superiore di Sanità, Rome, Italy
| | - Marina Giuliano
- National Center for Global Health, Istituto Superiore di Sanità, Rome, Italy
| | - Dorina Tiple
- Department of Neuroscience, Istituto Superiore di Sanità, Rome, Italy
| | - Flavia Pricci
- Department of Cardiovascular, Endocrine-Metabolic Diseases and Aging, Istituto Superiore di Sanità, Rome, Italy
| | - Marika Villa
- Department of Cardiovascular, Endocrine-Metabolic Diseases and Aging, Istituto Superiore di Sanità, Rome, Italy
| | - Andrea Silenzi
- Ministry of Health, General Directorate for Health Prevention, Rome, Italy
| | - Graziano Onder
- Department of Cardiovascular, Endocrine-Metabolic Diseases and Aging, Istituto Superiore di Sanità, Rome, Italy
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16
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Baroncelli S, Galluzzo CM, Orlando S, Mphwere R, Kavalo T, Luhanga R, Amici R, Floridia M, Andreotti M, Ciccacci F, Marazzi MC, Giuliano M. Immunoglobulin G passive transfer from mothers to infants: total IgG, IgG subclasses and specific antipneumococcal IgG in 6-week Malawian infants exposed or unexposed to HIV. BMC Infect Dis 2022; 22:342. [PMID: 35382749 PMCID: PMC8985312 DOI: 10.1186/s12879-022-07335-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 04/01/2022] [Indexed: 12/17/2022] Open
Abstract
Background The impaired transplacental passage of IgG from mothers living with HIV to their infants could be one of the causes of the high vulnerability to infections of HIV-exposed uninfected (HEU) infants, but controversial results have been obtained in different settings. The aim of this study was to assess in 6-week old HEU and HIV-unexposed, uninfected (HUU) Malawian infants the total IgG levels, the subclasses profile and the concentrations of global anti-pneumococcal capsular polysaccharide (anti-PCP) IgG and IgG2. Methods Dried blood spots were collected from 80 infants (40 HEU, 40 HUU) and antibodies concentrations determined by nephelometric method (total IgG and subclasses), or using ELISA (anti-PCP total IgG and IgG2). Results are expressed as median levels with IQR, while the proportions of each subclass out of the total IgG are used to describe the subclasses profile. Results At 6 weeks HEU infants had higher median levels of total IgG and IgG1 and a significantly lower level of IgG2 [0.376 (0.344–0.523) g/l vs 0.485 (0.374–0.781) g/l, p = 0.037] compared to the HUU counterparts. The IgG subclasses distribution confirmed the underrepresentation of IgG2 (IgG2 represented 5.82% of total IgG in HEU and 8.87% in HUU). The anti-PCP IgG and IgG2 levels were significantly lower in HEU infants [8.9 (5.4–15.1) mg/l vs 16.2 (9.61–25.8) mg/l in HUU, p < 0.001, and 2.69 (1.90–4.29) mg/l vs 4.47 (2.96–5.71) mg/l in HUU, p = 0.001, respectively]. Conclusion Compared to HUU infants, HEU infants have IgG abnormalities mainly represented by low IgG2 levels, suggesting that despite maternal antiretroviral therapy, the mechanisms of IgG transplacental passage continue to be impaired in women living with HIV. HEU infants also showed a significantly lower level of specific anti-PCP IgG, possibly favouring a high vulnerability to S. pneumoniae infection at an age when protection is mostly depending on maternal IgG.
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Affiliation(s)
- Silvia Baroncelli
- National Center for Global Health, Istituto Superiore di Sanità, Viale Regina Elena, 299, 00161, Rome, Italy
| | - Clementina M Galluzzo
- National Center for Global Health, Istituto Superiore di Sanità, Viale Regina Elena, 299, 00161, Rome, Italy
| | - Stefano Orlando
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Robert Mphwere
- DREAM Program, Community of S. Egidio, P.O. Box 30355, Blantyre, Malawi
| | - Thom Kavalo
- DREAM Program, Community of S. Egidio, P.O. Box 30355, Blantyre, Malawi
| | - Richard Luhanga
- DREAM Program, Community of S. Egidio, P.O. Box 30355, Blantyre, Malawi
| | - Roberta Amici
- National Center for Global Health, Istituto Superiore di Sanità, Viale Regina Elena, 299, 00161, Rome, Italy
| | - Marco Floridia
- National Center for Global Health, Istituto Superiore di Sanità, Viale Regina Elena, 299, 00161, Rome, Italy
| | - Mauro Andreotti
- National Center for Global Health, Istituto Superiore di Sanità, Viale Regina Elena, 299, 00161, Rome, Italy
| | - Fausto Ciccacci
- Saint Camillus International, University of Health Sciences, Rome, Italy
| | | | - Marina Giuliano
- National Center for Global Health, Istituto Superiore di Sanità, Viale Regina Elena, 299, 00161, Rome, Italy.
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17
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Baroncelli S, Tarantino M, Galluzzo CM, Liotta G, Orlando S, Sagno JB, Luhanga R, Andreotti M, Petrucci P, Amici R, Marazzi MC, Adone R, Giuliano M. Seroprevalence of Brucella Infection in a Cohort of HIV-Positive Malawian Pregnant Women Living in Urban Areas. Vector Borne Zoonotic Dis 2022; 22:263-266. [PMID: 35333643 DOI: 10.1089/vbz.2021.0088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: The seroprevalence of Brucella infection in sub-Saharan regions is high, and no recent data are available for Malawi, a country in which >60% of the population is involved in agropastoral activity. Aim: To evaluated the seroprevalence of Brucella in a cohort of HIV-positive pregnant women, living in an urban setting in Malawi. Methods: Sera of 201 pregnant women were tested for Brucella IgG. The Rose Bengal Plate Test and Serum Agglutination Tube test were used to determine antibody titer. Results: Five out of 201 (2.48%) women show positivity to Brucella, consistent with a past exposition to the infection. All five women delivered healthy infants, but two of them reported previous abortion/stillbirths, with a higher rate than those of the rest of the cohort (40% vs. 21.5%). Conclusions: This is one of the first reports of exposure of pregnant women to Brucella infection in Malawi, providing evidence of Brucella occurrence in an urban setting. Control programs should be introduced to reduce its impact on animal and human health.
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Affiliation(s)
- Silvia Baroncelli
- National Center for Global Health, Istituto Superiore di Sanità, Rome, Rome, Italy
| | - Michela Tarantino
- Department of Veterinary Public Health and Food Safety, Istituto Superiore di Sanità, Rome, Rome, Italy
| | | | - Giuseppe Liotta
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Stefano Orlando
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | | | | | - Mauro Andreotti
- National Center for Global Health, Istituto Superiore di Sanità, Rome, Rome, Italy
| | - Paola Petrucci
- Department of Veterinary Public Health and Food Safety, Istituto Superiore di Sanità, Rome, Rome, Italy
| | - Roberta Amici
- National Center for Global Health, Istituto Superiore di Sanità, Rome, Rome, Italy
| | | | - Rosanna Adone
- Department of Veterinary Public Health and Food Safety, Istituto Superiore di Sanità, Rome, Rome, Italy
| | - Marina Giuliano
- National Center for Global Health, Istituto Superiore di Sanità, Rome, Rome, Italy
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18
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Morganti S, Bianchini G, Giordano A, Giuliano M, Curigliano G, Criscitiello C. How I treat HER2-positive early breast cancer: how long adjuvant trastuzumab is needed? ESMO Open 2022; 7:100428. [PMID: 35272131 PMCID: PMC8908056 DOI: 10.1016/j.esmoop.2022.100428] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 02/07/2022] [Accepted: 02/09/2022] [Indexed: 01/03/2023] Open
Abstract
Since its first approval in 2006, 1 year of adjuvant trastuzumab has been the standard of care for early-stage HER2-positive breast cancer. Nevertheless, the optimal duration of adjuvant trastuzumab was uncertain, and the standard 12-month duration has been questioned by a number of different trials. Although most of these studies were formally negative, a patient-level meta-analysis presented at the 2021 European Society for Medical Oncology (ESMO) meeting first showed the non-inferiority of 6-month trastuzumab. Through this review, we sought to take a closer look at the meta-analysis and the included trials to explain why we believe that non-inferiority should be interpreted with caution. Indeed, here we underline how the meta-analysis’ results were mainly driven by the PERSEPHONE study, an old trial that tested non-standard chemo-trastuzumab regimens in a relatively low-risk population with doubtful endpoints. In summary, considering all the limitations of this analysis and the increasing use of effective anthracycline-free de-escalation strategies, we are convinced that 1-year trastuzumab should remain the standard of care. The standard 1-year duration of adjuvant trastuzumab has been questioned by a number of trials. At ESMO 2021, the meta-analysis by Earl et al. showed that 6-month adjuvant trastuzumab is not inferior to 12-month. The PERSEPHONE trial was the main driver of the meta-analysis’ results, but it has several limitations. Alternative anthracycline-free de-escalation strategies proved to be effective for HER2+ early breast cancer patients. 12-month adjuvant trastuzumab should remain the standard of care.
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Affiliation(s)
- S Morganti
- Division of Early Drug Development, European Institute of Oncology IRCCS, Milan, Italy; Department of Oncology and Hematology, University of Milan, Milan, Italy; Dana-Farber Cancer Institute, Boston, USA
| | - G Bianchini
- Department of Medical Oncology, IRCCS Ospedale San Raffaele, Milan, Italy. https://twitter.com/BianchiniGP
| | - A Giordano
- Dana-Farber Cancer Institute, Boston, USA. https://twitter.com/antgiorda
| | - M Giuliano
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - G Curigliano
- Division of Early Drug Development, European Institute of Oncology IRCCS, Milan, Italy; Department of Oncology and Hematology, University of Milan, Milan, Italy. https://twitter.com/curijoey
| | - C Criscitiello
- Division of Early Drug Development, European Institute of Oncology IRCCS, Milan, Italy; Department of Oncology and Hematology, University of Milan, Milan, Italy.
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Palmieri L, Floridia M, Giuliano M, Tiple D, Lo Noce C, Meli P, Onder G. Clinical characteristics of SARS-CoV-2 fully-vaccinated patients dying with COVID-19 in Italy. Clin Microbiol Infect 2022; 28:890-892. [PMID: 35181537 PMCID: PMC8843808 DOI: 10.1016/j.cmi.2022.01.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 12/28/2021] [Accepted: 01/27/2022] [Indexed: 11/20/2022]
Affiliation(s)
- Luigi Palmieri
- Department of Cardiovascular, Endocrine-metabolic Diseases and Aging, Istituto Superiore di Sanità, Rome, Italy.
| | - Marco Floridia
- National Center for Global Health, Istituto Superiore di Sanità, Rome, Italy.
| | - Marina Giuliano
- National Center for Global Health, Istituto Superiore di Sanità, Rome, Italy.
| | - Dorina Tiple
- Department of Neuroscience, Istituto Superiore di Sanità, Rome, Italy.
| | - Cinzia Lo Noce
- Department of Cardiovascular, Endocrine-metabolic Diseases and Aging, Istituto Superiore di Sanità, Rome, Italy.
| | - Paola Meli
- National Center for Innovative Technologies in Public Health, Istituto Superiore di Sanità, Rome, Italy.
| | - Graziano Onder
- Department of Cardiovascular, Endocrine-metabolic Diseases and Aging, Istituto Superiore di Sanità, Rome, Italy.
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Baroncelli S, Galluzzo CM, Liotta G, Andreotti M, Orlando S, Ciccacci F, Mphwere R, Luhanga R, Sagno JB, Amici R, Marazzi MC, Giuliano M. HIV-exposed infants with EBV infection have a reduced persistence of the immune response to the HBV vaccine. AIDS Res Ther 2021; 18:48. [PMID: 34348748 PMCID: PMC8336389 DOI: 10.1186/s12981-021-00375-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 07/28/2021] [Indexed: 11/29/2022] Open
Abstract
Background In sub-Saharan African countries Epstein Barr virus (EBV) infection occurs in early childhood. We aim to investigate the factors associated with EBV acquisition and the impact of EBV infection on the humoral response to HBV vaccination in infants born from HIV-positive, antiretroviral-treated mothers in Malawi. Methods A total of 149 HIV-exposed infants were included in this longitudinal study. EBV anti-VCA IgG were measured using an ELISA assay. The EBV seroconversion was correlated with the maternal viro-immunological conditions, with infant growth and immunological vulnerability, and with the humoral response to the HBV vaccine. Results No infant was EBV-positive at 6 months (n. 52 tested). More than a third of infants (49/115 or 42.6 %) on study beyond 6 months seroconverted at 12 months. At 24 months, out of 66 tested infants, only 13 remained EBV-uninfected, while 53 (80.3 %) acquired EBV infection, rising the total proportion of EBV seroconversion to 88.7 % (102/115 infants). EBV seroconversion was significantly associated with a low maternal educational status but had no impact on infant growth or vulnerability to infections. Reduced HBsAb levels and accelerated waning of antibodies were associated with early EBV seroconversion. Conclusions We found a heterogeneous timing of acquisition of EBV with the majority of infants born from HIV + mothers acquiring infection after 6 months. Anti-HBs levels were lower and appeared to wane faster in infants acquiring EBV infection.
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21
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Schettini F, Conte B, Buono G, De Placido P, Parola S, Griguolo G, Fabi A, Bighin C, Riccardi F, Cianniello D, De Laurentiis M, Puglisi F, Pelizzari G, Bonotto M, Russo S, Frassoldati A, Pazzola A, Montemurro F, Lambertini M, Guarneri V, Cognetti F, Locci M, Generali D, Conte P, De Placido S, Giuliano M, Arpino G, Del Mastro L. T-DM1 versus pertuzumab, trastuzumab and a taxane as first-line therapy of early-relapsed HER2-positive metastatic breast cancer: an Italian multicenter observational study. ESMO Open 2021; 6:100099. [PMID: 33819752 PMCID: PMC8047485 DOI: 10.1016/j.esmoop.2021.100099] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 02/06/2021] [Accepted: 02/27/2021] [Indexed: 02/06/2023] Open
Abstract
Background The current standard first-line treatment of human epidermal growth factor receptor 2 (HER2)-positive (+) metastatic breast cancer is the combination of pertuzumab, trastuzumab and a taxane (P + T + taxane), while standard second-line is ado-trastuzumab-emtansine (T-DM1). The registration trial of pertuzumab, however, did not include early-relapsing patients, defined as patients experiencing tumor relapse ≤12 months from the end of (neo)adjuvant anti-HER2 therapy. Conversely, the pivotal trial of T-DM1 included some patients relapsing ≤6 months after the end of (neo)adjuvant trastuzumab. Thus, a proportion of early-relapsing patients are currently eligible to receive T-DM1 as first-line treatment. Nevertheless, no direct comparison exists between the two regimens in this clinical setting. Patients and methods We retrospectively compared T-DM1 versus P + T + taxane as first-line treatment in two cohorts of early-relapsing patients in an Italian ‘real-world’ setting, involving 14 public health care institutions. The primary endpoint was progression-free survival. Secondary endpoints included patients' characterization, overall survival and post-progression survival. Univariate and multivariate analyses were carried out. All tests were two-sided and a P ≤ 0.05 was considered statistically significant. Results Among 1252 screened patients, 75 met the inclusion criteria. Forty-four (58.7%) received P + T + taxane and 31 (41.3%) received T-DM1. The two cohorts showed similar characteristics of aggressiveness and no significant differences in treatment history. T-DM1, compared with P + T + taxane was associated with worse progression-free survival (adjusted hazard ratio: 2.26, 95% confidence interval: 1.13-4.52, P = 0.021) and overall survival (adjusted hazard ratio: 3.95, 95% confidence interval: 1.38-11.32, P = 0.010), irrespective of previous (neo)adjuvant treatment, age, hormone receptors status, time-to-relapse (≤6 months or within 6-12 months) and presence of visceral/brain metastases. No differences were observed in post-progression survival (P = 0.095). Conclusions Our study suggests superiority for P + T + taxane over T-DM1 as up-front treatment of early-relapsing HER2+ metastatic breast cancer, which merits further assessment in larger and prospective trials. This is the first study comparing pertuzumab + trastuzumab + taxane (P + T + taxane) with T-DM1 in early-relapsing HER2+ MBC. The majority of early-relapsing HER2+ MBC have high-grade, node-positive, large primary tumors. First-line T-DM1 compared with P + T + taxane is associated with worse progression-free survival. First-line T-DM1 compared with P + T + taxane is associated with worse overall survival. Post-progression survival does not differ between the two treatments cohorts.
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Affiliation(s)
- F Schettini
- Department of Clinical Medicine and Surgery, University of Naples 'Federico II', Naples, Italy; Translational Genomics and Targeted Therapies in Solid Tumors Group, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain; SOLTI Breast Cancer Research Group, Barcelona, Spain.
| | - B Conte
- SOLTI Breast Cancer Research Group, Barcelona, Spain; Medical Oncology Unit 2, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - G Buono
- Oncology Unit, San Rocco Hospital, Sessa Aurunca, Italy
| | - P De Placido
- Department of Clinical Medicine and Surgery, University of Naples 'Federico II', Naples, Italy
| | - S Parola
- Department of Clinical Medicine and Surgery, University of Naples 'Federico II', Naples, Italy
| | - G Griguolo
- Division of Oncology 2, Istituto Oncologico Veneto IRCCS, Padua, Italy; Department of Surgery, Oncology and Gastroenterology, University of Padova, Padua, Italy
| | - A Fabi
- Division of Medical Oncology 1, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - C Bighin
- Medical Oncology Unit 2, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - F Riccardi
- Medical Oncology, 'A. Cardarelli' Hospital, Naples, Italy
| | - D Cianniello
- National Cancer Institute Fondazione 'G. Pascale', Naples, Italy
| | - M De Laurentiis
- National Cancer Institute Fondazione 'G. Pascale', Naples, Italy
| | - F Puglisi
- Department of Medicine (DAME), University of Udine, Udine, Italy; Department of Clinical Oncology, CRO Aviano National Cancer Institute, Aviano, Italy
| | - G Pelizzari
- Department of Clinical Oncology, CRO Aviano National Cancer Institute, Aviano, Italy
| | - M Bonotto
- Department of Oncology, ASUFC University Hospital, Udine, Italy
| | - S Russo
- Department of Oncology, ASUFC University Hospital, Udine, Italy
| | - A Frassoldati
- Oncology Unit, University Hospital St. Anna, Ferrara, Italy
| | - A Pazzola
- Division of Medical Oncology, AOU Sassari, Sassari, Italy
| | - F Montemurro
- Depertment of Medical Oncology, Candiolo Cancer Institute, Candiolo, Italy
| | - M Lambertini
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genoa, Italy; Department of Medical Oncology, U.O.C. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - V Guarneri
- Division of Oncology 2, Istituto Oncologico Veneto IRCCS, Padua, Italy; Department of Surgery, Oncology and Gastroenterology, University of Padova, Padua, Italy
| | - F Cognetti
- Department of Clinic and Molecular Medicine, 'La Sapienza' University of Rome, Rome, Italy
| | - M Locci
- Department of Neuroscience, Reproductive Medicine, Odontostomatology, University of Naples 'Federico II', Naples, Italy
| | - D Generali
- Breast Cancer Unit, Azienda Socio Sanitaria Territoriale di Cremona, Cremona, Italy; Department of Medical, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - P Conte
- Division of Oncology 2, Istituto Oncologico Veneto IRCCS, Padua, Italy; Department of Surgery, Oncology and Gastroenterology, University of Padova, Padua, Italy
| | - S De Placido
- Department of Clinical Medicine and Surgery, University of Naples 'Federico II', Naples, Italy
| | - M Giuliano
- Department of Clinical Medicine and Surgery, University of Naples 'Federico II', Naples, Italy
| | - G Arpino
- Department of Clinical Medicine and Surgery, University of Naples 'Federico II', Naples, Italy
| | - L Del Mastro
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genoa, Italy; U.O.S.D. Breast Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
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22
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De Angelis C, Bruzzese D, Bernardo A, Baldini E, Leo L, Fabi A, Gamucci T, De Placido P, Poggio F, Russo S, Forestieri V, Lauria R, De Santo I, Caputo R, Cianniello D, Michelotti A, Del Mastro L, De Laurentiis M, Giuliano M, De Placido S, Arpino G. Corrigendum to 'Eribulin in combination with bevacizumab as second-line treatment for HER2-negative metastatic breast cancer progressing after first-line therapy with paclitaxel and bevacizumab: a multicenter, phase II, single arm trial (GIM11-BERGI)': [ESMO Open Volume 6, Issue 2, April 2021, 100054]. ESMO Open 2021; 6:100097. [PMID: 33926709 PMCID: PMC8103531 DOI: 10.1016/j.esmoop.2021.100097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Affiliation(s)
- C De Angelis
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy
| | - D Bruzzese
- Department of Public Health, University of Naples "Federico II", Naples, Italy
| | - A Bernardo
- Oncologia Medica, Fondazione S. Maugeri IRCCS, Pavia, Italy
| | - E Baldini
- Department of Oncology, S. Luca Hospital, Lucca, Italy
| | - L Leo
- Unit of Oncology, A.O.R.N. dei Colli, Napoli, Naples, Italy
| | - A Fabi
- Medical Oncology 1, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - T Gamucci
- Medical Oncology Unit, ASL Frosinone, Frosinone, Italy
| | - P De Placido
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy
| | - F Poggio
- UO Breast Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - S Russo
- Department of Oncology, Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy
| | - V Forestieri
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy
| | - R Lauria
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy
| | - I De Santo
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy
| | - R Caputo
- Breast Oncology Department, Istituto Nazionale Tumori Fondazione G. Pascale, Naples, Italy
| | - D Cianniello
- Breast Oncology Department, Istituto Nazionale Tumori Fondazione G. Pascale, Naples, Italy
| | - A Michelotti
- Azienda Ospedaliera Universitaria Pisana, Ospedale Santa Chiara, Pisa, Italy
| | - L Del Mastro
- UO Breast Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy; University of Genova, Dipartimento di Medicina Interna e Specialità Mediche (DIMI), Genova, Italy
| | - M De Laurentiis
- Breast Oncology Department, Istituto Nazionale Tumori Fondazione G. Pascale, Naples, Italy
| | - M Giuliano
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy.
| | - S De Placido
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy
| | - G Arpino
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy
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Ottaviano M, Giuliano M, Tortora M, La Civita E, Liotti A, Longo M, Bruzzese D, Cennamo M, Riccio V, De Placido P, Picozzi F, Parola S, Daniele B, Botti G, Formisano P, Beguinot F, De Placido S, Terracciano D, Palmieri G. MA06.10 A New Horizon of Liquid Biopsy in Thymic Epithelial Tumors: The Potential Utility of Circulating Cell-Free DNA. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.01.180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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De Angelis C, Bruzzese D, Bernardo A, Baldini E, Leo L, Fabi A, Gamucci T, De Placido P, Poggio F, Russo S, Forestieri V, Lauria R, De Santo I, Michelotti A, Del Mastro L, De Laurentiis M, Giuliano M, De Placido S, Arpino G. Eribulin in combination with bevacizumab as second-line treatment for HER2-negative metastatic breast cancer progressing after first-line therapy with paclitaxel and bevacizumab: a multicenter, phase II, single arm trial (GIM11-BERGI). ESMO Open 2021; 6:100054. [PMID: 33601296 PMCID: PMC7900694 DOI: 10.1016/j.esmoop.2021.100054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 01/03/2021] [Accepted: 01/12/2021] [Indexed: 12/12/2022] Open
Abstract
Background We evaluated the efficacy and safety of the nontaxane microtubule dynamics inhibitor eribulin plus the humanized anti-VEGF monoclonal antibody bevacizumab in a novel second-line chemotherapy scheme in HER2-negative metastatic breast cancer (MBC) patients progressing after first-line paclitaxel and bevacizumab. Patients and methods This is a multicenter, single-arm, Simon's two-stage, phase II study. The primary endpoint was the overall response rate, considered as the sum of partial and complete response based on the best overall response rate (BORR). The secondary endpoints were progression-free survival (PFS), overall survival (OS), and clinical benefit rate. Results A total of 58 of the 61 patients enrolled in the study were evaluable for efficacy. The BORR was 24.6% (95% CI 14.5-37.3). The clinical benefit rate was 32.8% (95% CI 21.3-46.0). The median PFS was 6.2 months (95% CI 4.0-7.8), and median OS was 14.8 months (95% CI 12.6-22.8). Overall, adverse events (AEs) were clinically manageable and the most common AEs were fatigue, paresthesia, and neutropenia. Quality of life was well preserved in most patients. Conclusions The results of this study suggest that second-line therapy with bevacizumab in combination with eribulin has a meaningful clinical activity and may represent a potential therapeutic option for patients with HER2-negative MBC. Bevacizumab + chemotherapy improved progression-free survival in HER2-negative metastatic breast cancer (MBC) patients. Eribulin monotherapy improved overall survival in patients with anthracycline- and taxane-pretreated MBC. The GIM11-BERGI trial assessed the efficacy and safety of eribulin + bevacizumab as second-line treatment for HER2-MBC. Eribulin + bevacizumab showed to be a safe and active treatment after progression to first-line paclitaxel + bevacizumab.
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Affiliation(s)
- C De Angelis
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy
| | - D Bruzzese
- Department of Public Health, University of Naples "Federico II", Naples, Italy
| | - A Bernardo
- Oncologia Medica, Fondazione S. Maugeri IRCCS, Pavia, Italy
| | - E Baldini
- Department of Oncology, S. Luca Hospital, Lucca, Italy
| | - L Leo
- Unit of Oncology, A.O.R.N. dei Colli, Napoli, Naples, Italy
| | - A Fabi
- Medical Oncology 1, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - T Gamucci
- Medical Oncology Unit, ASL Frosinone, Frosinone, Italy
| | - P De Placido
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy
| | - F Poggio
- UO Breast Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - S Russo
- Department of Oncology, Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy
| | - V Forestieri
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy
| | - R Lauria
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy
| | - I De Santo
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy
| | - A Michelotti
- Azienda Ospedaliera Universitaria Pisana, Ospedale Santa Chiara, Pisa, Italy
| | - L Del Mastro
- UO Breast Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy; University of Genova, Dipartimento di Medicina Interna e Specialità Mediche (DIMI), Genova, Italy
| | - M De Laurentiis
- Breast Oncology Department, Istituto Nazionale Tumori Fondazione G. Pascale, Naples, Italy
| | - M Giuliano
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy.
| | - S De Placido
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy
| | - G Arpino
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy
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Santoro C, Soloperto R, Casciano O, Esposito R, Lembo M, Canonico M, Arpino G, Giuliano M, De Placido S, Esposito G. Right ventricular dysfunction parallels left ventricular functional involvement in women with breast cancer experiencing subclinical cardiotoxicity. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeaa356.187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Cancer therapy related cardiac toxicity disease (CRCTD) of the left ventricle (LV)can influence the outcome of oncologic patients. Little is known on CRCTD related right ventricular (RV)dysfunction even though RV involvement has been proven to be a remarkable prognosticator in heart failure.
Purpose
To analyse parallel changes in LV and RV function occurring during the course of cancer therapy in women affected by breast cancer by using both standard and speckle tracking echocardiography.
Methods
Fifty Her-2 positive breast cancer women (age = 53.6 ± 11.7 years) underwent sequential cancer therapy protocol including anthracycline (ANT) epirubicine + cyclophosphamide (4 cycles) followed by a total amount of 18 cycles with trastuzumab (TRZ) + paclitaxel. A complete echo-Doppler exam, including LV and RV global longitudinal strain (GLS)as well as RV septal and free wall longitudinal strain (SLS and FWLS respectively) assessment, was performed at baseline, after ANT end and after TRZ completion. Patients with overt heart failure and LV ejection fraction < 50%, coronary artery disease,atrial fibrillation, hemodinamically significant valve disease and inadequate echo were excluded. Overt CRCTD was defined according guidelines and both subclinical LV and RV CRCTD as a LV and RV GLS drop from baseline >15%.
Results
None of the patients experienced overt CTCRD but 6 patients (14%) showed subclinical LV dysfunction and 33 (66%) had a significant drop of RV longitudinal function.The comparison of standard echo-Doppler exam at baseline and after ANT and TRZ completion did not show significant changes of LV and RV systolic and diastolic parameters. Conversely, a progressive significant reduction of RV GLS (p < 0.002 after TRZ), SLS and FWLS and, with a lower extent, of LV GLS (p < 0.02 after TRZ) was observed after ANT and TRZ completion (Figure). Percentage reduction in RV GLS (DRV GLS) from baseline to ANT end correlated with LV GLS both at EC end (r=-0.40, p = 0.006) and after TRZ completion (r=-0.62, p < 0.0001).
Conclusions
Detrimental cardiac effects of cancer therapy involve both LV and RV systolic longitudinal function. Progressive RV dysfunction is evident through ANT and TRZ treatment. Early RV dysfunction parallels LV involvement and predicts subsequent LV subclinical dysfunction. A comprehensive LV and RV longitudinal function assessment might better predict the onset of CRCTD in breast cancer patients.
Abstract Figure.
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Affiliation(s)
- C Santoro
- Federico II University of Naples, Naples, Italy
| | - R Soloperto
- Federico II University Hospital, Advanced biomedical science, Naples, Italy
| | - O Casciano
- Federico II University Hospital, Advanced biomedical science, Naples, Italy
| | - R Esposito
- Federico II University Hospital, Advanced biomedical science, Naples, Italy
| | - M Lembo
- Federico II University Hospital, Advanced biomedical science, Naples, Italy
| | - M Canonico
- Federico II University Hospital, Advanced biomedical science, Naples, Italy
| | - G Arpino
- Federico II University Hospital, Advanced biomedical science, Naples, Italy
| | - M Giuliano
- Federico II University of Naples, Naples, Italy
| | | | - G Esposito
- Federico II University of Naples, Naples, Italy
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Punzo O, Bellino S, Palmieri L, Lo Noce C, Giuliano M, Meli P, Boros S, Bella A, Riccardo F, Pezzotti P, Onder G. Clinical characteristics of individuals under 40 years of age who died with COVID-19 in Italy. J Med Virol 2021; 93:1932-1936. [PMID: 33482014 PMCID: PMC8013661 DOI: 10.1002/jmv.26788] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 12/24/2020] [Accepted: 01/05/2021] [Indexed: 12/17/2022]
Affiliation(s)
- Ornella Punzo
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Stefania Bellino
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Luigi Palmieri
- Department of Cardiovascular, Endocrine-Metabolic Diseases and Aging, Istituto Superiore di Sanità, Rome, Italy
| | - Cinzia Lo Noce
- Department of Cardiovascular, Endocrine-Metabolic Diseases and Aging, Istituto Superiore di Sanità, Rome, Italy
| | - Marina Giuliano
- National Center for Global Health, Istituto Superiore di Sanità, Rome, Italy
| | - Paola Meli
- National Center for Innovative Technologies in Public Health, Istituto Superiore di Sanità, Rome, Italy
| | - Stefano Boros
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Antonino Bella
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Flavia Riccardo
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Patrizio Pezzotti
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Graziano Onder
- Department of Cardiovascular, Endocrine-Metabolic Diseases and Aging, Istituto Superiore di Sanità, Rome, Italy
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27
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Onder G, Palmieri L, Vanacore N, Giuliano M, Brusaferro S. Nonrespiratory Complications and Obesity in Patients Dying with COVID-19 in Italy. Obesity (Silver Spring) 2021; 29:20-23. [PMID: 32812383 DOI: 10.1002/oby.23007] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 08/08/2020] [Accepted: 08/11/2020] [Indexed: 01/02/2023]
Abstract
OBJECTIVE This study aimed to assess the impact of obesity on nonrespiratory complications in patients dying with coronavirus disease (COVID-19). METHODS Medical charts of 3,694 of patients dying with COVID-19 in Italy were reviewed to extract information on demographics, preexisting comorbidities, and in-hospital complications leading to death. Multivariate logistic regressions were performed to assess the association of obesity with nonrespiratory complications. These analyses were adjusted for age, gender, and number of preexisting comorbidities. RESULTS Obesity was present in 411/3,694 (11.1%) patients dying with COVID-19. Obesity was significantly associated with increased probability of experiencing acute renal failure (adjusted odds ratio [OR], 1.33; 95% CI: 1.04-1.71) and shock (adjusted OR, 1.54; 95% CI: 1.19-1.99). The associations of obesity with acute renal failure and shock were stronger in patients aged < 60 years (adjusted OR, 2.00; 95% CI: 1.09-3.67 and OR, 2.37; 95% CI 1.29-4.36) than in those aged 60 years or older (adjusted OR, 1.20; 95% CI: 0.90-1.60 and OR, 1.22; 95% CI: 0.91-1.65). CONCLUSIONS In patients dying with COVID-19 in Italy, obesity is associated with an increased probability of nonrespiratory complications, particularly shock and acute renal failure. These associations seem stronger in younger than in older adults. Strategies should be put in place in patients with COVID-19 with obesity to prevent these complications.
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Affiliation(s)
- Graziano Onder
- Department of Cardiovascular, Endocrine-metabolic Diseases and Aging, Istituto Superiore di Sanità, Rome, Italy
| | - Luigi Palmieri
- Department of Cardiovascular, Endocrine-metabolic Diseases and Aging, Istituto Superiore di Sanità, Rome, Italy
| | - Nicola Vanacore
- National Center for Disease Prevention and Health Promotion, Istituto Superiore di Sanità, Rome, Italy
| | - Marina Giuliano
- National Center for Global Health, Istituto Superiore di Sanità, Rome, Italy
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Palmieri L, Palmer K, Lo Noce C, Meli P, Giuliano M, Floridia M, Tamburo de Bella M, Piccioli A, Brusaferro S, Onder G. Differences in the clinical characteristics of COVID-19 patients who died in hospital during different phases of the pandemic: national data from Italy. Aging Clin Exp Res 2021; 33:193-199. [PMID: 33345291 PMCID: PMC7750107 DOI: 10.1007/s40520-020-01764-0] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Accepted: 11/24/2020] [Indexed: 01/16/2023]
Abstract
Background Epidemiological data obtained during the initial wave of the COVID-19 epidemic showed that persons dying with COVID-19 were typically older men with multiple chronic conditions. No studies have assessed if the characteristics of patients dying with COVID-19 have changed in the second phase of the epidemic, when the initial wave subsided. The aim of the present study was to compare characteristics of patients dying with COVID-19 in Italy in the first ‘peak’ phase of the epidemic and in its second phase. Methods Medical charts of patients with COVID-19 who died while in hospital in Italy were reviewed to extract information on pre-existing comorbidities, in-hospital complications, and disease trajectories. The course of the epidemic was classified in two 3-month periods: March–May 2020 and June–August 2020. Findings Overall, in the Italian population, 34,191 COVID-19 deaths occurred in March–May 2020 and 1,404 in June–August 2020. Patients dying in March–May were significantly younger (80.1 ± 10.6 vs. 82.8 ± 11.1 years, p < 0.001) and less frequently female (41.9% vs. 61.8%, p < 0.001) than those dying in June–August. The medical charts of 3533 patients who died with PCR-confirmed SARS-CoV-2 infection in March–May 2020 (10.3% of all deaths occurring in this period) and 203 patients who died in June–August 2020 (14.5% of all deaths occurring in this period) were analysed. Patients who died in March–May 2020, compared to those who died in June–August 2020, had significantly lower rates of multiple comorbidities (3 or more comorbidities: 61.8% vs 74.5%, p = 0.001) and superinfections (15.2% vs. 52.5%, p < 0.001). Treatment patterns also substantially differed in the two study periods, with patients dying in March–May 2020 being less likely to be treated with steroids (41.7% vs. 69.3%, p < 0.001) and more likely to receive antivirals (59.3% vs. 41.4%, p < 0.001). Survival time also largely differed, with patients dying in March–May 2020 showing a shorter time from symptoms onset to death (mean interval: 15.0 vs. 46.6 days, p < 0.001). The differences observed between the two periods remained significant in a multivariate analysis. Interpretation The clinical characteristics of patients dying with COVID-19 in Italy, their treatment and symptom-to-death survival time have significantly changed overtime. This is probably due to an improved organization and delivery of care and to a better knowledge of disease treatment. Supplementary Information The online version contains supplementary material available at 10.1007/s40520-020-01764-0.
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Affiliation(s)
- Luigi Palmieri
- Department of Cardiovascular, Endocrine-Metabolic Diseases and Aging, Istituto Superiore di Sanità, Rome, Italy
| | - Katie Palmer
- Department of Geriatrics, Centro Medicina dell'Invecchiamento, Fondazione Policlinico A. Gemelli IRCCS, Rome, Italy
| | - Cinzia Lo Noce
- Department of Cardiovascular, Endocrine-Metabolic Diseases and Aging, Istituto Superiore di Sanità, Rome, Italy
| | - Paola Meli
- National Center for Innovative Technologies in Public Health, Istituto Superiore di Sanità, Rome, Italy
| | - Marina Giuliano
- National Center for Global Health, Istituto Superiore di Sanità, Rome, Italy
| | - Marco Floridia
- National Center for Global Health, Istituto Superiore di Sanità, Rome, Italy
| | | | - Andrea Piccioli
- Office of the Director General, Istituto Superiore di Sanità, Rome, Italy
| | | | - Graziano Onder
- Department of Cardiovascular, Endocrine-Metabolic Diseases and Aging, Istituto Superiore di Sanità, Rome, Italy.
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Di Pietro Martínez M, Giuliano M, Hoyuelos M. Out-of-equilibrium Monte Carlo simulations of a classical gas with Bose-Einstein statistics. Phys Rev E 2020; 102:062125. [PMID: 33466070 DOI: 10.1103/physreve.102.062125] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 11/04/2020] [Indexed: 06/12/2023]
Abstract
Algorithms to determine transition probabilities in Monte Carlo simulations are tested using a system of classical particles with effective interactions which reproduce Bose-Einstein statistics. The system is appropriate for testing different Monte Carlo simulation methods in out-of-equilibrium situations since nonequivalent results are produced. We compare mobility numerical results obtained with transition probabilities derived from Glauber and Metropolis algorithms. Then, we compare these with a recent method, the interpolation algorithm, appropriate for nonequilibrium systems in homogeneous substrata and without phase transitions. The results of mobility obtained from the interpolation algorithm are qualitatively verified with molecular dynamics simulations for low concentrations.
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Affiliation(s)
- M Di Pietro Martínez
- Instituto de Investigaciones Físicas de Mar del Plata, CONICET, Facultad de Ciencias Exactas y Naturales, Universidad Nacional de Mar del Plata, Funes 3350, 7600 Mar del Plata, Argentina
| | - M Giuliano
- Instituto de Investigaciones Físicas de Mar del Plata, CONICET, Facultad de Ciencias Exactas y Naturales, Universidad Nacional de Mar del Plata, Funes 3350, 7600 Mar del Plata, Argentina
| | - M Hoyuelos
- Instituto de Investigaciones Físicas de Mar del Plata, CONICET, Facultad de Ciencias Exactas y Naturales, Universidad Nacional de Mar del Plata, Funes 3350, 7600 Mar del Plata, Argentina
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Palmieri G, Giuliano M, Tortora M, Formisano P, Malfitano A, D'Esposito V, Botti G, Marretta A, Margherita V, Di Lauro V, Daniele B, De Placido S, Verde A, Ottaviano M. 1904P Clinical implications of distinct immunoprofiles in patients with thymic epithelial tumours and autoimmunity. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.1447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Ottaviano M, Giuliano M, Tortora M, Picozzi F, Mucci B, Parola S, Riccio V, Pietroluongo E, De Placido P, Vaia A, D'Esposito V, Malfitano A, Di Somma S, Campione S, Staibano S, Botti G, Formisano P, Daniele B, De Placido S, Palmieri G. 1901P Immunomodulatory role of multi-agent therapy in thymic epithelial tumours and severe immunological dysregulation. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.1444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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32
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Margarucci LM, Romano Spica V, Protano C, Gianfranceschi G, Giuliano M, Di Onofrio V, Mucci N, Valeriani F, Vitali M, Romano F. Potential antimicrobial effects of photocatalytic nanothecnologies in hospital settings. Ann Ig 2020; 31:461-473. [PMID: 31304526 DOI: 10.7416/ai.2019.2307] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Recently, several advanced technologies have been considered to reduce the microbial load in hospital environments and control Healthcare Associated Infections (HAIs) incidence. New strategies for preventing HAIs have continuously evolved, including enforcement of hygiene procedures by novel liquid biocides or no-touch technologies, self-disinfecting surfaces coated by heavy metals or light-activated photosensitizers such as Titanium Dioxide (TiO2) nanoparticles. STUDY DESIGN Review publications concerning the use of photocatalytic systems in hospital setting, focusing on products based on TiO2. METHODS Specific keywords combinations were analitically searched in PubMed and Scopus databases. RESULTS Starting 80s-90s, over 2000 papers report "in vitro" studies on antimicrobial activity of TiO2 photocatalysis on several microorganisms including bacteria, viruses, fungi, yeasts, and antibiotic resistant strains. Besides, at least 4 selected papers addressed the potentials of this approach by "in field" studies, showing a widespread pool of applications in hospital and healthcare settings. However, the low number of available experiences and their heterogeneity represent major limitations to achieve a comprehensive final overview on effectiveness and feasibility of these technologies. CONCLUSIONS Photocatalytic systems based on TiO2 represent a promising strategy for hospital hygiene and HAI prevention. Additional "in field" studies are desirable in a next future to further evaluate and exploit this novel and interesting health technology.
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Affiliation(s)
- L M Margarucci
- Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Piazza Lauro De Bosis 6, 00135 Rome, Italy
| | - V Romano Spica
- Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Piazza Lauro De Bosis 6, 00135 Rome, Italy
| | - C Protano
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, P.le Aldo Moro, 5, 00185 Rome, Italy
| | - G Gianfranceschi
- Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Piazza Lauro De Bosis 6, 00135 Rome, Italy
| | - M Giuliano
- Department of Experimental Medicine, Biotechnology and Molecular Biology Section, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - V Di Onofrio
- Department of Sciences and Technologies, University of Naples Parthenope, Naples, Italy
| | - N Mucci
- INAIL, Department of Technological Innovations and Safety of Plants, Products and Anthropic Seattlements, Rome, Italy
| | - F Valeriani
- Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Piazza Lauro De Bosis 6, 00135 Rome, Italy
| | - M Vitali
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, P.le Aldo Moro, 5, 00185 Rome, Italy
| | - F Romano
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, P.le Aldo Moro, 5, 00185 Rome, Italy
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Baroncelli S, Galluzzo CM, Liotta G, Andreotti M, Orlando S, Ciccacci F, Jere H, Luhanga R, Sagno JB, Amici R, Marazzi MC, Giuliano M. Dynamics of immunoglobulin G subclasses during the first two years of life in Malawian infants born to HIV-positive mothers. BMC Pediatr 2020; 20:181. [PMID: 32326903 PMCID: PMC7178742 DOI: 10.1186/s12887-020-02091-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 04/16/2020] [Indexed: 11/24/2022] Open
Abstract
Background Maternal antibodies are key components of the protective responses of infants who are unable to produce their own IgG until 6 months of life. There is evidence that HIV-exposed uninfected children (HEU) have IgG levels abnormalities, that can be partially responsible for the higher vulnerability to infections in the first 2 years of the life of this population. This retrospective study aimed to characterize the dynamics in plasma levels of total IgG and their isotypes during the first 2 years of life in HEU infants exclusively breastfed through 6 months of age. Methods Total IgG, IgG1, IgG2, IgG3 and IgG4 isotypes, and IgM and IgA plasma concentrations were determined by nephelometric methods in 30 Malawian infants born to HIV-positive women at month 1, 6 and 24 of life. Results At 1-month infants had a median concentration of total IgG of 8.48 g/l, (IQR 7.57–9.15), with an overrepresentation of the IgG1 isotype (89.0% of total) and low levels of IgG2 (0.52 g/l, IQR, 0.46–0.65). Total IgG and IgG1 concentrations were lower at 6 months (− 2.1 and − 1.12 g/dl, respectively) reflecting disappearance of maternal antibodies, but at 24 months their levels were higher with respect to the reported reference values for age-matched pairs. Abnormal isotype distribution was still present at 24 months with IgG2 remaining strongly underrepresented (0.87 g/l, 7.5% of total IgG). Conclusion HIV exposure during pregnancy and breastfeeding seems to influence the IgG maturation and isotype distribution that persist in 2-year old infants.
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Affiliation(s)
- Silvia Baroncelli
- National Center for Global Health, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161, Rome, Italy.
| | - Clementina Maria Galluzzo
- National Center for Global Health, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161, Rome, Italy
| | - Giuseppe Liotta
- Department of Biomedicine and Preventio, University of Rome Tor Vergata, Rome, Italy
| | - Mauro Andreotti
- National Center for Global Health, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161, Rome, Italy
| | - Stefano Orlando
- Department of Biomedicine and Preventio, University of Rome Tor Vergata, Rome, Italy
| | - Fausto Ciccacci
- Saint Camillus International University of Health Sciences, Rome, Italy
| | - Haswell Jere
- DREAM Program, Community of S. Egidio, Blantyre, Malawi
| | | | | | - Roberta Amici
- National Center for Global Health, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161, Rome, Italy
| | | | - Marina Giuliano
- National Center for Global Health, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161, Rome, Italy
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Baroncelli S, Galluzzo CM, Liotta G, Andreotti M, Mancinelli S, Mphwere R, Bokola E, Amici R, Marazzi MC, Palombi L, Palmisano L, Giuliano M. Immune Activation and Microbial Translocation Markers in HIV-Exposed Uninfected Malawian Infants in the First Year of Life. J Trop Pediatr 2019; 65:617-625. [PMID: 31006009 DOI: 10.1093/tropej/fmz022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND HIV-exposed uninfected (HEU) infants show a high rate of morbidity. We aimed to investigate on biomarkers of immune activation/microbial translocation in HEU infants, evaluating the impact that infections/malnutrition can have on biomarker levels during the first year of life. METHODS Clinical data of 72 Malawian infants were recorded monthly and correlated with levels of soluble CD14 (sCD14), lipopolysaccharide-binding protein (LBP) and intestinal fatty acid-binding protein (I-FABP), analyzed longitudinally. RESULTS Levels of sCD14 and LBP showed a significant age-related increase. Higher levels of LBP (19.4 vs. 15.2 μg/ml) were associated with stunting, affecting 30% of the infants. The association remained statistically significant after adjusting for cytomegalovirus acquisition, malaria and respiratory infections (p = 0.031). I-FABP levels were significantly increased in infants experiencing gastrointestinal infections (1442.8 vs. 860.0 pg/ml, p = 0.018). CONCLUSION We provide evidence that stunting is associated with an enhanced inflammatory response to microbial products in HEU children, suggesting that malnutrition status should be taken into consideration to better understand the alteration of the immune profile of HEU infants living in poor socioeconomic settings.
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Affiliation(s)
- Silvia Baroncelli
- National Center for Global Health, Istituto Superiore di Sanità, Rome, Italy
| | | | - Giuseppe Liotta
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Mauro Andreotti
- National Center for Global Health, Istituto Superiore di Sanità, Rome, Italy
| | - Sandro Mancinelli
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | | | - Enok Bokola
- DREAM Program, Community of S. Egidio, Blantyre, Malawi
| | - Roberta Amici
- National Center for Global Health, Istituto Superiore di Sanità, Rome, Italy
| | | | - Leonardo Palombi
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Lucia Palmisano
- National Center for Drug Research and Evaluation, Istituto Superiore di Sanità, Rome, Italy
| | - Marina Giuliano
- National Center for Global Health, Istituto Superiore di Sanità, Rome, Italy
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Ciccacci F, Floridia M, Bernardini R, Sidumo Z, Mugunhe RJ, Andreotti M, Passanduca A, Magid NA, Orlando S, Mattei M, Giuliano M, Mancinelli S, Marazzi MC, Palombi L. Plasma levels of CRP, neopterin and IP-10 in HIV-infected individuals with and without pulmonary tuberculosis. J Clin Tuberc Other Mycobact Dis 2019; 16:100107. [PMID: 31720431 PMCID: PMC6830155 DOI: 10.1016/j.jctube.2019.100107] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Introduction Tuberculosis (TB) is a major cause of morbidity and death worldwide, and disproportionally affects people with HIV. Many cases still remain undiagnosed, and rapid and effective screening strategies are needed to control the TB epidemics. Immunological biomarkers may contribute. Methods Plasma samples from healthy individuals (n: 12) and from HIV-infected individuals with (n: 21) and without pulmonary TB (n: 122) were tested for C-reactive protein (CRP), neopterin, and interferon-gamma-inducible protein-10 (IP-10). Increased levels of biomarkers and WHO 4-symptom-screening were compared with the presence of pulmonary TB. Survival status at 12 months was recorded. Associations with CD4 count, BMI, haemoglobin, disease severity, and mortality were analysed. Results The plasma levels of the biomarkers were significantly higher in TB-positive (n:21) compared to TB-negative (n:122) subjects. WHO symptoms, increased neopterin (>10 nmol/L) and CRP (>10 mg/L) showed similar sensitivity and different specificity, with increased CRP showing higher and increased neopterin lower specificity. The three markers were inversely correlated to haemoglobin and to CD4, and CRP levels inversely correlated to BMI. The markers were also significantly higher in individuals with subsequent mortality and in individuals with higher mycobacterial load in sputum according to Xpert results (IP-10 and CRP). Conclusion This study showed significant associations of the biomarkers analysed with TB infection and mortality, that could have potential clinical relevance. Biomarker levels may be included in operational research on TB screening and diagnosis.
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Affiliation(s)
- Fausto Ciccacci
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
- Corresponding author.
| | - Marco Floridia
- National Center for Global Health, Istituto Superiore di Sanità, Rome, Italy
| | - Roberta Bernardini
- Centro Servizi Interdipartimentale – STA, University of Rome Tor Vergata, Rome, Italy
| | - Zita Sidumo
- DREAM Program, Community of S. Egidio, Maputo, Mozambique
| | | | - Mauro Andreotti
- National Center for Global Health, Istituto Superiore di Sanità, Rome, Italy
| | | | | | - Stefano Orlando
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Maurizio Mattei
- Centro Servizi Interdipartimentale – STA, University of Rome Tor Vergata, Rome, Italy
- Department. of Biology, University of Rome Tor Vergata, Rome, Italy
| | - Marina Giuliano
- National Center for Global Health, Istituto Superiore di Sanità, Rome, Italy
| | - Sandro Mancinelli
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | | | - Leonardo Palombi
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
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Hoppe A, Giuliano M, Lugemwa A, Thompson JA, Floridia M, Walker AS, Senoga I, Abwola MC, Pirillo MF, Kityo CM, Arenas-Pinto A, Paton NI. HIV-1 viral load and resistance in genital secretions in patients taking protease-inhibitor-based second-line therapy in Africa. Antivir Ther 2019; 23:191-195. [PMID: 29021409 DOI: 10.3851/imp3200] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/01/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND HIV is transmitted primarily through sexual intercourse, and the objective of this study was therefore to assess whether there is occult viral replication and resistance in genital secretions in patients on protease inhibitor (PI)-based second-line therapy. METHODS HIV-infected adults taking ritonavir-boosted lopinavir with either two nucleoside reverse transcriptase inhibitors (NRTIs), raltegravir or as monotherapy for 96 weeks, were enrolled at seven clinical sites in Uganda. Viral load (VL) was measured in cervico-vaginal secretions or semen and in a corresponding plasma sample. Genotypic resistance was assessed in genital secretion samples and plasma samples. Results were compared between compartments and with the plasma resistance profile at first-line failure. RESULTS Of the 111 participants enrolled (91 female, 20 male), 16 (14%) and 30 (27%) had VL >1,000 and >40 copies/ml, respectively, in plasma; 3 (3%) and 23 (21%) had VL >1,000 copies/ml and >40 copies/ml, respectively, in genital secretions. There was 74% agreement between plasma and genital secretion VL classification above/below 40 copies/ml threshold (kappa-statistic =0.29; P=0.001). RT mutations (both NRTI and non-nucleoside reverse transcriptase inhibitor) were detected in genital secretions in four patients (similar profile to corresponding plasma sample at first-line failure) and PI mutations were detected in two (one polymorphism with no impact on resistance; one with high-level PI resistance). CONCLUSIONS High level (>1,000 copies/ml) viral replication and development of new RT or PI resistance in the genital compartment were rare. The risks of transmission arising from resistance evolution in the genital compartment are likely to be low on PI-based second-line therapy.
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Affiliation(s)
- Anne Hoppe
- Infection and Immunity, University College London, London, United Kingdom.,MRC Clinical Trials Unit at University College London, London, United Kingdom
| | | | - Abbas Lugemwa
- Joint Clinical Research Centre (JCRC), Mbarara, Uganda
| | - Jennifer A Thompson
- MRC Clinical Trials Unit at University College London, London, United Kingdom
| | | | - Ann S Walker
- MRC Clinical Trials Unit at University College London, London, United Kingdom
| | | | | | | | | | | | - Nicholas I Paton
- MRC Clinical Trials Unit at University College London, London, United Kingdom.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Baroncelli S, Maria Galluzzo C, Liotta G, Orlando S, Ciccacci F, Andreotti M, Mpwhere R, Luhanga R, Sagno JB, Amici R, Marazzi MC, Giuliano M. IgG abnormalities in HIV-positive Malawian women initiating antiretroviral therapy during pregnancy persist after 24 months of treatment. Int J Infect Dis 2019; 88:1-7. [PMID: 31499207 DOI: 10.1016/j.ijid.2019.09.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 08/27/2019] [Accepted: 09/03/2019] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES Hypergammaglobulinemia and anomalies in the IgG subclass distribution are common in HIV-infected individuals and persist even after many years of antiretroviral therapy (ART). The aim of this study was to investigate the IgG profile and dynamics in pregnant HIV-infected Malawian women in the Option B era. METHODS Thirty-seven treatment-naive women received ART from the third trimester of pregnancy to 6 months post delivery (end of the breastfeeding period). ART continuation (group C) or interruption (group I) was then decided on the basis of the CD4+ cell count at enrolment (>350 or ≤350/μl). Total IgG and IgG subclasses were determined in maternal serum using a nephelometric assay at baseline and at 6 and 24 months postpartum. RESULTS At enrolment, 36/37 women had IgG levels >15g/l and there was a predominance of the IgG1 isotype (more than 90%) in parallel with underrepresentation of IgG2 (5.0%). After 6 months of ART, both groups showed a significant median decrease in total IgG (-3.1g/l in group I, -3.5g/l in group C) and in IgG1 (-4.0g/l and -3.6g/l, respectively), but only a modest recovery in IgG2 levels (+0.16 in group I, +0.14g/l in group C). At month 24, hypergammaglobulinemia was still present in 73.7% of women in group C, although a significant reduction was observed in total IgG level and in IgG1 and IgG3 subclasses (p<0.0001 in all cases). IgG2 levels did not show any significant change. In group I at 24 months, total IgG and IgG subclasses had returned to levels comparable to those at baseline. CONCLUSIONS The beneficial effects of 24 months of ART appear to be limited in the B-cell compartment, with an incomplete reduction of total IgG levels and no recovery of IgG2 depletion. A short ART period did not have significant effects on IgG abnormalities in women who interrupted treatment.
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Affiliation(s)
- Silvia Baroncelli
- National Centre for Global Health, Istituto Superiore di Sanità, Viale Regina Elena, 299, 00161 Rome, Italy.
| | - Clementina Maria Galluzzo
- National Centre for Global Health, Istituto Superiore di Sanità, Viale Regina Elena, 299, 00161 Rome, Italy
| | - Giuseppe Liotta
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Via Montpellier, 1, 00133 Rome, Italy
| | - Stefano Orlando
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Via Montpellier, 1, 00133 Rome, Italy
| | - Fausto Ciccacci
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Via Montpellier, 1, 00133 Rome, Italy
| | - Mauro Andreotti
- National Centre for Global Health, Istituto Superiore di Sanità, Viale Regina Elena, 299, 00161 Rome, Italy
| | - Robert Mpwhere
- DREAM Program, Community of S. Egidio, PO Box 30355, Blantyre, Malawi
| | - Richard Luhanga
- DREAM Program, Community of S. Egidio, PO Box 30355, Blantyre, Malawi
| | | | - Roberta Amici
- National Centre for Global Health, Istituto Superiore di Sanità, Viale Regina Elena, 299, 00161 Rome, Italy
| | | | - Marina Giuliano
- National Centre for Global Health, Istituto Superiore di Sanità, Viale Regina Elena, 299, 00161 Rome, Italy
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Liotti A, Tortora M, La Civita E, Ottaviano M, Cennamo M, Giuliano M, Palmieri G, De Placido S, Beguinot F, Formisano P, Terracciano D. Circulating cell-free DNA as a tool to assess prognosis in thymic epithelial tumors. Clin Chim Acta 2019. [DOI: 10.1016/j.cca.2019.03.266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Buono G, Crispo A, Giuliano M, Rea CG, Forestieri V, Lauria R, De Placido P, De Laurentiis M, Pacilio C, Grimaldi M, Nocerino F, Montella M, De Placido S, Arpino G. Abstract P2-08-15: Metabolic syndrome and early-stage breast cancer outcome: Results from a prospective observational study. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p2-08-15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background:Previous studies suggested a link between obesity, insulin-resistance and breast cancer outcome. The aim of the present prospective observational study was to investigate the role of metabolic syndrome (MetS) and its components on early breast cancer (EBC) patients' outcome.
Methods: MetS was defined by the presence of 3 to 5 of the following components: waist circumference (WC) > 88 cm, blood pressure ≥ 130/≥85 mmHg, serum levels of triglycerides (TG) ≥ 150 mg/dL, high-density lipoprotein (HDL) < 50 mg/dL and fasting glucose (FG) ≥ 110 mg/ dL (National Cholesterol Education Program Expert Panel on Detection, Evaluation, And Treatment of High Blood Cholesterol In Adults - NCEP-ATPIII criteria). Overall, 955 EBC patients were prospectively enrolled between January 2009 and December 2013 at University Hospital Federico II and National Cancer Institute G.Pascale, Naples, Italy. Clinical and tumor characteristics were collected for all the patients. A total of 494 patients (51.7%) had complete data on all the components of MetS at first diagnosis and thus were included in the current analysis. Study population was divided into 2 main groups: (1) patients with less than 3 components (No MetS); (2) patients with 3-5 components (MetS). Categorical variables were analyzed by the chi-square test and survival data by the log-rank test and Cox proportional hazards regression model.
Results: Overall 366 (74.1%) and 128 (25.9%) women were categorized as No MetS and MetS, respectively. MetS patients were more likely to be older and postmenopausal compared to No MetS patients. In detail, 46% vs 38% were older than 55 yrs (p<0.0001) and 87% vs 54% were postmenopausal (p<0.0001) in MetS vs No MetS groups, respectively. No statistically significant differences in tumor stage, type of adjuvant therapy or tumor subtypes defined by immunohistochemistry (IHC) were identified among the two groups. At univariate analysis, stage, tumor subtypes, TG and FG values, number of components of MetS, and presence of MetS were significantly associated to both disease free survival (DFS) and overall survival (OS). Age, BMI, WC, and HDL levels were correlated to OS only. At the multivariate Cox proportional hazards model (adjusted for age, menopausal status, stage, IHC subtypes and adjuvant therapy) MetS patients had numerically higher risk of relapse and significantly higher risk of death compared to No MetS patients [DFS hazard ratio (HR): 1.64 95% confidence interval (CI): 0.94-2.86, p=0.07 and OS HR: 3.83, 95% CI 1.7-6.77 p=0.001]. Additionally, of the 366 No MetS patients included in the analysis, 122 (33.3%) had 0 and 244 (66.7%) had “1 to 2” components of MetS. Interestingly, patients with “1 to 2” components of MetS had increased risk of dying compared to patients with 0 components (OS HR: 4.39, 95% CI:1.26-15.36, p=0.02) . No significant difference among these two groups was observed in terms of DFS.
Conclusions: MetS is correlated with poor outcome in EBC patients. Among patients without full criteria for MetS diagnosis, the presence of 1 or 2 components of the syndrome may predict for worse survival. Testing for components of MetS in BC patients is recomended to predict outcome and to eventually suggest lifestyle changes, exercise and diet.
Citation Format: Buono G, Crispo A, Giuliano M, Rea CG, Forestieri V, Lauria R, De Placido P, De Laurentiis M, Pacilio C, Grimaldi M, Nocerino F, Montella M, De Placido S, Arpino G. Metabolic syndrome and early-stage breast cancer outcome: Results from a prospective observational study [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P2-08-15.
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Affiliation(s)
- G Buono
- University of Naples Federico II, Naples, Italy; Unit of Epidemiology, National Cancer Institute, G. Pascale Foundation, Naples, Italy; Lester and Sue Smith Breast Center, Baylor College of Medicine, Houston, TX; Breast Unit, National Cancer Institute, G. Pascale Foundation, Naples, Italy
| | - A Crispo
- University of Naples Federico II, Naples, Italy; Unit of Epidemiology, National Cancer Institute, G. Pascale Foundation, Naples, Italy; Lester and Sue Smith Breast Center, Baylor College of Medicine, Houston, TX; Breast Unit, National Cancer Institute, G. Pascale Foundation, Naples, Italy
| | - M Giuliano
- University of Naples Federico II, Naples, Italy; Unit of Epidemiology, National Cancer Institute, G. Pascale Foundation, Naples, Italy; Lester and Sue Smith Breast Center, Baylor College of Medicine, Houston, TX; Breast Unit, National Cancer Institute, G. Pascale Foundation, Naples, Italy
| | - CG Rea
- University of Naples Federico II, Naples, Italy; Unit of Epidemiology, National Cancer Institute, G. Pascale Foundation, Naples, Italy; Lester and Sue Smith Breast Center, Baylor College of Medicine, Houston, TX; Breast Unit, National Cancer Institute, G. Pascale Foundation, Naples, Italy
| | - V Forestieri
- University of Naples Federico II, Naples, Italy; Unit of Epidemiology, National Cancer Institute, G. Pascale Foundation, Naples, Italy; Lester and Sue Smith Breast Center, Baylor College of Medicine, Houston, TX; Breast Unit, National Cancer Institute, G. Pascale Foundation, Naples, Italy
| | - R Lauria
- University of Naples Federico II, Naples, Italy; Unit of Epidemiology, National Cancer Institute, G. Pascale Foundation, Naples, Italy; Lester and Sue Smith Breast Center, Baylor College of Medicine, Houston, TX; Breast Unit, National Cancer Institute, G. Pascale Foundation, Naples, Italy
| | - P De Placido
- University of Naples Federico II, Naples, Italy; Unit of Epidemiology, National Cancer Institute, G. Pascale Foundation, Naples, Italy; Lester and Sue Smith Breast Center, Baylor College of Medicine, Houston, TX; Breast Unit, National Cancer Institute, G. Pascale Foundation, Naples, Italy
| | - M De Laurentiis
- University of Naples Federico II, Naples, Italy; Unit of Epidemiology, National Cancer Institute, G. Pascale Foundation, Naples, Italy; Lester and Sue Smith Breast Center, Baylor College of Medicine, Houston, TX; Breast Unit, National Cancer Institute, G. Pascale Foundation, Naples, Italy
| | - C Pacilio
- University of Naples Federico II, Naples, Italy; Unit of Epidemiology, National Cancer Institute, G. Pascale Foundation, Naples, Italy; Lester and Sue Smith Breast Center, Baylor College of Medicine, Houston, TX; Breast Unit, National Cancer Institute, G. Pascale Foundation, Naples, Italy
| | - M Grimaldi
- University of Naples Federico II, Naples, Italy; Unit of Epidemiology, National Cancer Institute, G. Pascale Foundation, Naples, Italy; Lester and Sue Smith Breast Center, Baylor College of Medicine, Houston, TX; Breast Unit, National Cancer Institute, G. Pascale Foundation, Naples, Italy
| | - F Nocerino
- University of Naples Federico II, Naples, Italy; Unit of Epidemiology, National Cancer Institute, G. Pascale Foundation, Naples, Italy; Lester and Sue Smith Breast Center, Baylor College of Medicine, Houston, TX; Breast Unit, National Cancer Institute, G. Pascale Foundation, Naples, Italy
| | - M Montella
- University of Naples Federico II, Naples, Italy; Unit of Epidemiology, National Cancer Institute, G. Pascale Foundation, Naples, Italy; Lester and Sue Smith Breast Center, Baylor College of Medicine, Houston, TX; Breast Unit, National Cancer Institute, G. Pascale Foundation, Naples, Italy
| | - S De Placido
- University of Naples Federico II, Naples, Italy; Unit of Epidemiology, National Cancer Institute, G. Pascale Foundation, Naples, Italy; Lester and Sue Smith Breast Center, Baylor College of Medicine, Houston, TX; Breast Unit, National Cancer Institute, G. Pascale Foundation, Naples, Italy
| | - G Arpino
- University of Naples Federico II, Naples, Italy; Unit of Epidemiology, National Cancer Institute, G. Pascale Foundation, Naples, Italy; Lester and Sue Smith Breast Center, Baylor College of Medicine, Houston, TX; Breast Unit, National Cancer Institute, G. Pascale Foundation, Naples, Italy
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De Placido S, De Laurentiis M, Bruzzese D, Bernardo A, Baldini EE, Montesarchio V, Fabi A, Gamucci T, De Placido P, Russo S, Lauria R, De Santo I, De Angelis C, Del Mastro L, Giuliano M, Arpino G. Abstract P6-21-13: A phase II single arm trial evaluating the efficacy and safety of eribulin in combination with bevacizumab for second-line treatment of human epidermal growth factor receptor 2 (HER2)–negative metastatic breast cancer (MBC) progressing after first-line therapy with bevacizumab and paclitaxel. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p6-21-13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: At present, there is no standard second-line chemotherapy-based treatment in patients with HER2-negative MBC. Continued VEGF inhibition with bevacizumab is a new potential option in patients progressing to first line bevacizumab and chemotherapy. Eribulin is a non-taxane microtubule dynamics inhibitor, with a unique mechanism of action and suggested beneficial effects on tumor microenvironment and neoangiogenesis. This study evaluated efficacy and safety of eribulin plus bevacizumab as a novel second-line chemotherapy scheme, in patients progressing after first line paclitaxel and bevacizumab.
Methods: This is a multicenter, single-arm, Simon's two-stage, Phase II study. Patients with HER2-negative MBC progressing to paclitaxel and bevacizumab received eribulin (1.23 mg/m2 intravenously on Days 1 and 8 of every 21-day cycle) plus bevacizumab (10 mg/kg every 2 weeks or 15 mg/kg every 3 weeks intravenously), as second-line chemotherapy. The primary endpoint was the overall response rate (ORR), considered as sum of partial (PR) and complete response (CR), basing on the best overall response. The present safety and efficacy analyses, as planned per study design, refer to six cycles of treatment (18 weeks).
Results: Among the 61 patients enrolled in the study, 55 (90,2% ) were evaluable for efficacy. ORR (PR/CR) was 9.1% [95% confidence intervals (C.I.) 3.0 to 19.9]; stable disease (SD) rate was 63.6% [95% C.I. 49.6 to 76.2]; clinical benefit rate (CR/PR/SD) at 24 weeks was 35% [95% C.I. 22.0 to 49.1]. The median progression free survival was 6.3 months [95% C.I. 4.1 to 7.8 months]. Drugs-related adverse events (AEs) were: 49.5% related to eribulin, 7.7% related to bevacizumab, and 11.8% related to both the study drugs. The most common AEs were fatigue (9.9% of all AEs), paresthesia (6.5% of all AEs) and neutropenia (6.2% of all AEs). Quality of life was well preserved among the majority of patients.
Conclusions: The results of our trial suggest that continuing bevacizumab in combination with eribulin, beyond first line treatment with bevacizumab and paclitaxel, offers a reasonable therapeutic option for patients with HER2-negative MBC, without detrimentally affecting quality of life.
Citation Format: De Placido S, De Laurentiis M, Bruzzese D, Bernardo A, Baldini EE, Montesarchio V, Fabi A, Gamucci T, De Placido P, Russo S, Lauria R, De Santo I, De Angelis C, Del Mastro L, Giuliano M, Arpino G. A phase II single arm trial evaluating the efficacy and safety of eribulin in combination with bevacizumab for second-line treatment of human epidermal growth factor receptor 2 (HER2)–negative metastatic breast cancer (MBC) progressing after first-line therapy with bevacizumab and paclitaxel [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P6-21-13.
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Affiliation(s)
- S De Placido
- Università degli Studi di Napoli "Federico II", Napoli, NA, Italy; Istituto Nazionale Tumori - IRCCS "Fondazione G.Pascale", Napoli, NA, Italy; Istituti Clinici Scientifici Maugeri SpA SB, Pavia, PV, Italy; Ospedale San Luca, Lucca, LU, Italy; Azienda Ospedaliera dei Colli Monaldi, Napoli, NA, Italy; IFO - Istituto Nazionale Tumori Regina Elena, Roma, RM, Italy; Ospedale 'SS. Trinità', Sora, FR, Italy; A.O.U. Santa Maria della Misericordia di Udine, Udine, UD, Italy; Azienda Ospedaliera Universitaria Pisana - Ospedale S. Chiara, Pisa, PI, Italy; I.R.C.C.S. A.O.U. San Martino - I.S.T., Genova, GE, Italy
| | - M De Laurentiis
- Università degli Studi di Napoli "Federico II", Napoli, NA, Italy; Istituto Nazionale Tumori - IRCCS "Fondazione G.Pascale", Napoli, NA, Italy; Istituti Clinici Scientifici Maugeri SpA SB, Pavia, PV, Italy; Ospedale San Luca, Lucca, LU, Italy; Azienda Ospedaliera dei Colli Monaldi, Napoli, NA, Italy; IFO - Istituto Nazionale Tumori Regina Elena, Roma, RM, Italy; Ospedale 'SS. Trinità', Sora, FR, Italy; A.O.U. Santa Maria della Misericordia di Udine, Udine, UD, Italy; Azienda Ospedaliera Universitaria Pisana - Ospedale S. Chiara, Pisa, PI, Italy; I.R.C.C.S. A.O.U. San Martino - I.S.T., Genova, GE, Italy
| | - D Bruzzese
- Università degli Studi di Napoli "Federico II", Napoli, NA, Italy; Istituto Nazionale Tumori - IRCCS "Fondazione G.Pascale", Napoli, NA, Italy; Istituti Clinici Scientifici Maugeri SpA SB, Pavia, PV, Italy; Ospedale San Luca, Lucca, LU, Italy; Azienda Ospedaliera dei Colli Monaldi, Napoli, NA, Italy; IFO - Istituto Nazionale Tumori Regina Elena, Roma, RM, Italy; Ospedale 'SS. Trinità', Sora, FR, Italy; A.O.U. Santa Maria della Misericordia di Udine, Udine, UD, Italy; Azienda Ospedaliera Universitaria Pisana - Ospedale S. Chiara, Pisa, PI, Italy; I.R.C.C.S. A.O.U. San Martino - I.S.T., Genova, GE, Italy
| | - A Bernardo
- Università degli Studi di Napoli "Federico II", Napoli, NA, Italy; Istituto Nazionale Tumori - IRCCS "Fondazione G.Pascale", Napoli, NA, Italy; Istituti Clinici Scientifici Maugeri SpA SB, Pavia, PV, Italy; Ospedale San Luca, Lucca, LU, Italy; Azienda Ospedaliera dei Colli Monaldi, Napoli, NA, Italy; IFO - Istituto Nazionale Tumori Regina Elena, Roma, RM, Italy; Ospedale 'SS. Trinità', Sora, FR, Italy; A.O.U. Santa Maria della Misericordia di Udine, Udine, UD, Italy; Azienda Ospedaliera Universitaria Pisana - Ospedale S. Chiara, Pisa, PI, Italy; I.R.C.C.S. A.O.U. San Martino - I.S.T., Genova, GE, Italy
| | - EE Baldini
- Università degli Studi di Napoli "Federico II", Napoli, NA, Italy; Istituto Nazionale Tumori - IRCCS "Fondazione G.Pascale", Napoli, NA, Italy; Istituti Clinici Scientifici Maugeri SpA SB, Pavia, PV, Italy; Ospedale San Luca, Lucca, LU, Italy; Azienda Ospedaliera dei Colli Monaldi, Napoli, NA, Italy; IFO - Istituto Nazionale Tumori Regina Elena, Roma, RM, Italy; Ospedale 'SS. Trinità', Sora, FR, Italy; A.O.U. Santa Maria della Misericordia di Udine, Udine, UD, Italy; Azienda Ospedaliera Universitaria Pisana - Ospedale S. Chiara, Pisa, PI, Italy; I.R.C.C.S. A.O.U. San Martino - I.S.T., Genova, GE, Italy
| | - V Montesarchio
- Università degli Studi di Napoli "Federico II", Napoli, NA, Italy; Istituto Nazionale Tumori - IRCCS "Fondazione G.Pascale", Napoli, NA, Italy; Istituti Clinici Scientifici Maugeri SpA SB, Pavia, PV, Italy; Ospedale San Luca, Lucca, LU, Italy; Azienda Ospedaliera dei Colli Monaldi, Napoli, NA, Italy; IFO - Istituto Nazionale Tumori Regina Elena, Roma, RM, Italy; Ospedale 'SS. Trinità', Sora, FR, Italy; A.O.U. Santa Maria della Misericordia di Udine, Udine, UD, Italy; Azienda Ospedaliera Universitaria Pisana - Ospedale S. Chiara, Pisa, PI, Italy; I.R.C.C.S. A.O.U. San Martino - I.S.T., Genova, GE, Italy
| | - A Fabi
- Università degli Studi di Napoli "Federico II", Napoli, NA, Italy; Istituto Nazionale Tumori - IRCCS "Fondazione G.Pascale", Napoli, NA, Italy; Istituti Clinici Scientifici Maugeri SpA SB, Pavia, PV, Italy; Ospedale San Luca, Lucca, LU, Italy; Azienda Ospedaliera dei Colli Monaldi, Napoli, NA, Italy; IFO - Istituto Nazionale Tumori Regina Elena, Roma, RM, Italy; Ospedale 'SS. Trinità', Sora, FR, Italy; A.O.U. Santa Maria della Misericordia di Udine, Udine, UD, Italy; Azienda Ospedaliera Universitaria Pisana - Ospedale S. Chiara, Pisa, PI, Italy; I.R.C.C.S. A.O.U. San Martino - I.S.T., Genova, GE, Italy
| | - T Gamucci
- Università degli Studi di Napoli "Federico II", Napoli, NA, Italy; Istituto Nazionale Tumori - IRCCS "Fondazione G.Pascale", Napoli, NA, Italy; Istituti Clinici Scientifici Maugeri SpA SB, Pavia, PV, Italy; Ospedale San Luca, Lucca, LU, Italy; Azienda Ospedaliera dei Colli Monaldi, Napoli, NA, Italy; IFO - Istituto Nazionale Tumori Regina Elena, Roma, RM, Italy; Ospedale 'SS. Trinità', Sora, FR, Italy; A.O.U. Santa Maria della Misericordia di Udine, Udine, UD, Italy; Azienda Ospedaliera Universitaria Pisana - Ospedale S. Chiara, Pisa, PI, Italy; I.R.C.C.S. A.O.U. San Martino - I.S.T., Genova, GE, Italy
| | - P De Placido
- Università degli Studi di Napoli "Federico II", Napoli, NA, Italy; Istituto Nazionale Tumori - IRCCS "Fondazione G.Pascale", Napoli, NA, Italy; Istituti Clinici Scientifici Maugeri SpA SB, Pavia, PV, Italy; Ospedale San Luca, Lucca, LU, Italy; Azienda Ospedaliera dei Colli Monaldi, Napoli, NA, Italy; IFO - Istituto Nazionale Tumori Regina Elena, Roma, RM, Italy; Ospedale 'SS. Trinità', Sora, FR, Italy; A.O.U. Santa Maria della Misericordia di Udine, Udine, UD, Italy; Azienda Ospedaliera Universitaria Pisana - Ospedale S. Chiara, Pisa, PI, Italy; I.R.C.C.S. A.O.U. San Martino - I.S.T., Genova, GE, Italy
| | - S Russo
- Università degli Studi di Napoli "Federico II", Napoli, NA, Italy; Istituto Nazionale Tumori - IRCCS "Fondazione G.Pascale", Napoli, NA, Italy; Istituti Clinici Scientifici Maugeri SpA SB, Pavia, PV, Italy; Ospedale San Luca, Lucca, LU, Italy; Azienda Ospedaliera dei Colli Monaldi, Napoli, NA, Italy; IFO - Istituto Nazionale Tumori Regina Elena, Roma, RM, Italy; Ospedale 'SS. Trinità', Sora, FR, Italy; A.O.U. Santa Maria della Misericordia di Udine, Udine, UD, Italy; Azienda Ospedaliera Universitaria Pisana - Ospedale S. Chiara, Pisa, PI, Italy; I.R.C.C.S. A.O.U. San Martino - I.S.T., Genova, GE, Italy
| | - R Lauria
- Università degli Studi di Napoli "Federico II", Napoli, NA, Italy; Istituto Nazionale Tumori - IRCCS "Fondazione G.Pascale", Napoli, NA, Italy; Istituti Clinici Scientifici Maugeri SpA SB, Pavia, PV, Italy; Ospedale San Luca, Lucca, LU, Italy; Azienda Ospedaliera dei Colli Monaldi, Napoli, NA, Italy; IFO - Istituto Nazionale Tumori Regina Elena, Roma, RM, Italy; Ospedale 'SS. Trinità', Sora, FR, Italy; A.O.U. Santa Maria della Misericordia di Udine, Udine, UD, Italy; Azienda Ospedaliera Universitaria Pisana - Ospedale S. Chiara, Pisa, PI, Italy; I.R.C.C.S. A.O.U. San Martino - I.S.T., Genova, GE, Italy
| | - I De Santo
- Università degli Studi di Napoli "Federico II", Napoli, NA, Italy; Istituto Nazionale Tumori - IRCCS "Fondazione G.Pascale", Napoli, NA, Italy; Istituti Clinici Scientifici Maugeri SpA SB, Pavia, PV, Italy; Ospedale San Luca, Lucca, LU, Italy; Azienda Ospedaliera dei Colli Monaldi, Napoli, NA, Italy; IFO - Istituto Nazionale Tumori Regina Elena, Roma, RM, Italy; Ospedale 'SS. Trinità', Sora, FR, Italy; A.O.U. Santa Maria della Misericordia di Udine, Udine, UD, Italy; Azienda Ospedaliera Universitaria Pisana - Ospedale S. Chiara, Pisa, PI, Italy; I.R.C.C.S. A.O.U. San Martino - I.S.T., Genova, GE, Italy
| | - C De Angelis
- Università degli Studi di Napoli "Federico II", Napoli, NA, Italy; Istituto Nazionale Tumori - IRCCS "Fondazione G.Pascale", Napoli, NA, Italy; Istituti Clinici Scientifici Maugeri SpA SB, Pavia, PV, Italy; Ospedale San Luca, Lucca, LU, Italy; Azienda Ospedaliera dei Colli Monaldi, Napoli, NA, Italy; IFO - Istituto Nazionale Tumori Regina Elena, Roma, RM, Italy; Ospedale 'SS. Trinità', Sora, FR, Italy; A.O.U. Santa Maria della Misericordia di Udine, Udine, UD, Italy; Azienda Ospedaliera Universitaria Pisana - Ospedale S. Chiara, Pisa, PI, Italy; I.R.C.C.S. A.O.U. San Martino - I.S.T., Genova, GE, Italy
| | - L Del Mastro
- Università degli Studi di Napoli "Federico II", Napoli, NA, Italy; Istituto Nazionale Tumori - IRCCS "Fondazione G.Pascale", Napoli, NA, Italy; Istituti Clinici Scientifici Maugeri SpA SB, Pavia, PV, Italy; Ospedale San Luca, Lucca, LU, Italy; Azienda Ospedaliera dei Colli Monaldi, Napoli, NA, Italy; IFO - Istituto Nazionale Tumori Regina Elena, Roma, RM, Italy; Ospedale 'SS. Trinità', Sora, FR, Italy; A.O.U. Santa Maria della Misericordia di Udine, Udine, UD, Italy; Azienda Ospedaliera Universitaria Pisana - Ospedale S. Chiara, Pisa, PI, Italy; I.R.C.C.S. A.O.U. San Martino - I.S.T., Genova, GE, Italy
| | - M Giuliano
- Università degli Studi di Napoli "Federico II", Napoli, NA, Italy; Istituto Nazionale Tumori - IRCCS "Fondazione G.Pascale", Napoli, NA, Italy; Istituti Clinici Scientifici Maugeri SpA SB, Pavia, PV, Italy; Ospedale San Luca, Lucca, LU, Italy; Azienda Ospedaliera dei Colli Monaldi, Napoli, NA, Italy; IFO - Istituto Nazionale Tumori Regina Elena, Roma, RM, Italy; Ospedale 'SS. Trinità', Sora, FR, Italy; A.O.U. Santa Maria della Misericordia di Udine, Udine, UD, Italy; Azienda Ospedaliera Universitaria Pisana - Ospedale S. Chiara, Pisa, PI, Italy; I.R.C.C.S. A.O.U. San Martino - I.S.T., Genova, GE, Italy
| | - G Arpino
- Università degli Studi di Napoli "Federico II", Napoli, NA, Italy; Istituto Nazionale Tumori - IRCCS "Fondazione G.Pascale", Napoli, NA, Italy; Istituti Clinici Scientifici Maugeri SpA SB, Pavia, PV, Italy; Ospedale San Luca, Lucca, LU, Italy; Azienda Ospedaliera dei Colli Monaldi, Napoli, NA, Italy; IFO - Istituto Nazionale Tumori Regina Elena, Roma, RM, Italy; Ospedale 'SS. Trinità', Sora, FR, Italy; A.O.U. Santa Maria della Misericordia di Udine, Udine, UD, Italy; Azienda Ospedaliera Universitaria Pisana - Ospedale S. Chiara, Pisa, PI, Italy; I.R.C.C.S. A.O.U. San Martino - I.S.T., Genova, GE, Italy
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Palmieri G, Ottaviano M, Tortora M, Perrone P, Rea C, De Placido S, Giuliano M. P1.14-18 The Promising Role of Sunitinib Rechallenge in Heavily Pre-Treated Thymic Carcinoma: A Case Report. J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Orlando S, Triulzi I, Ciccacci F, Palla I, Palombi L, Marazzi MC, Giuliano M, Floridia M, Mancinelli S, Mutemba E, Turchetti G. Delayed diagnosis and treatment of tuberculosis in HIV+ patients in Mozambique: A cost-effectiveness analysis of screening protocols based on four symptom screening, smear microscopy, urine LAM test and Xpert MTB/RIF. PLoS One 2018; 13:e0200523. [PMID: 30024890 PMCID: PMC6053163 DOI: 10.1371/journal.pone.0200523] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 06/28/2018] [Indexed: 01/21/2023] Open
Abstract
Background Tuberculosis (TB) represents the ninth leading cause of death worldwide. In 2016 are estimated 1.3 million TB deaths among HIV negative people and an additional 374,000 deaths among HIV positive people. In 2016 are estimated 1.4 million new cases of TB in people living with HIV (PLHIV), 74% of whom were living in Africa. In light of these data, the reduction of mortality caused by TB in PLHIV is strongly required specially in low-income countries as Mozambique. According to international guidelines, the initial TB screening in HIV+ patients should be done with the four symptoms screening (4SS: fever, current cough, night sweats and weight loss). The diagnostic test more used in resource-limited countries is smear microscopy (SMEAR). World Health Organization (WHO) recommended Lateral Flow urine LipoArabinoMannan assay (LF-LAM) in immunocompromised patients; in 2010 WHO endorsed the use of Xpert Mycobacterium Tuberculosis/Rifampicin (MTB/RIF) test for rapid TB diagnosis but the assay is not used as screening test in all HIV+ patients irrespectively of symptoms due to cost and logistical barriers. The paper aims to evaluate the cost-effectiveness of three screening protocols: standard (4SS and SMEAR in positive patients to 4SS); MTB/RIF; LF-LAM / MTB/RIF. Methods We developed a model to assess the cost-effectiveness of the MTB/RIF protocol versus the common standard and LF-LAM / MTB/RIF protocol. The model considered a sample of 1,000 HIV+ antiretroviral treatment naïve patients in Mozambique. We evaluated disability-adjusted life year (DALY) averted for each protocol, cost per DALY, and incremental cost-effectiveness ratio (ICER), over 1-year, assuming a national healthcare system perspective. The model considered the delayed diagnosis as the time elapsed between a false negative test and the diagnosis and treatment of TB. Additional health system organization delay is defined as the time interval between positive test and treatment initiation caused by a delay in the delivery of results due organization of services. We conducted a sensitivity analysis on more relevant variables. Results The MTB/RIF protocol was cost-effective as compared to the standard protocol with an ICER of $56.54 per DALY saved. In a cohort of 1,000 patients MTB/RIF and LF-LAM / MTB/RIF protocol generated 1,281 and 1,254 DALY’s saved respectively, with a difference of 174 and 147 DALY respect to the standard protocol. The total cost of MTB/RIF protocol was lower ($92,263) than the standard ($147,226) and the LF-LAM / MTB/RIF ($113,196). Therefore, the cost per DALY saved including new infections due to delayed diagnosis with the standard protocol was $79.06, about 5 fold higher than MTB/RIF and LF-LAM / MTB/RIF protocols. The cost of additional TB infections due to delays in diagnosis plus health system delay seemed the more relevant costs. The low sensibility and sensitivity of the standard protocol led to a high number of false negatives, thus delayed TB diagnoses and treatment lead to the development of newly transmitted TB infections. Conclusions Our study shows that the MTB/RIF adoption could lead to an increasing of TB case-finding and a reduction in costs compared with standard and LF-LAM / MTB/RIF protocols.
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Affiliation(s)
- S. Orlando
- Department of Biomedicine, University of Tor Vergata, Rome, Italy
- * E-mail: (SO); (IT)
| | - I. Triulzi
- Institute of Management, Scuola Superiore Sant' Anna, Pisa, Italy
- * E-mail: (SO); (IT)
| | - F. Ciccacci
- Department of Biomedicine, University of Tor Vergata, Rome, Italy
| | - I. Palla
- Institute of Management, Scuola Superiore Sant' Anna, Pisa, Italy
| | - L. Palombi
- Department of Biomedicine, University of Tor Vergata, Rome, Italy
| | - M. C. Marazzi
- Department of Human Science, LUMSA University, Rome, Italy
| | - M. Giuliano
- National Center for Global Health, Istituto Superiore di Sanità, Rome, Italy
| | - M. Floridia
- National Center for Global Health, Istituto Superiore di Sanità, Rome, Italy
| | - S. Mancinelli
- Department of Biomedicine, University of Tor Vergata, Rome, Italy
| | - E. Mutemba
- DREAM programme, Community of Sant’Egidio, Maputo, Mozambique
| | - G. Turchetti
- Institute of Management, Scuola Superiore Sant' Anna, Pisa, Italy
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Floridia M, Ciccacci F, Andreotti M, Hassane A, Sidumo Z, Magid NA, Sotomane H, David M, Mutemba E, Cebola J, Mugunhe RJ, Riccardi F, Marazzi MC, Giuliano M, Palombi L, Mancinelli S. Tuberculosis Case Finding With Combined Rapid Point-of-Care Assays (Xpert MTB/RIF and Determine TB LAM) in HIV-Positive Individuals Starting Antiretroviral Therapy in Mozambique. Clin Infect Dis 2018; 65:1878-1883. [PMID: 29020319 DOI: 10.1093/cid/cix641] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 07/20/2017] [Indexed: 12/12/2022] Open
Abstract
Background Tuberculosis is a major health concern in several countries, and effective diagnostic algorithms for use in human immunodeficiency virus (HIV)-positive patients are urgently needed. Methods At prescription of antiretroviral therapy, all patients in 3 Mozambican health centers were screened for tuberculosis, with a combined approach: World Health Organization (WHO) 4-symptom screening (fever, cough, night sweats, and weight loss), a rapid test detecting mycobacterial lipoarabinomannan in urine (Determine TB LAM), and a molecular assay performed on a sputum sample (Xpert MTB/RIF; repeated if first result was negative). Patients with positive LAM or Xpert MTB/RIF results were referred for tuberculosis treatment. Results Among 972 patients with a complete diagnostic algorithm (58.5% female; median CD4 cell count, 278/μL; WHO HIV stage I, 66.8%), 98 (10.1%) tested positive with Xpert (90, 9.3%) or LAM (34, 3.5%) assays. Compared with a single-test Xpert strategy, dual Xpert tests improved case finding by 21.6%, LAM testing alone improved it by 13.5%, and dual Xpert tests plus LAM testing improved it by 32.4%. Rifampicin resistance in Xpert-positive patients was infrequent (2.5%). Among patients with positive results, 22 of 98 (22.4%) had no symptoms at WHO 4-symptom screening. Patients with tuberculosis diagnosed had significantly lower CD4 cell counts and hemoglobin levels, more advanced WHO stage, and higher HIV RNA levels. Fifteen (15.3%) did not start tuberculosis treatment, mostly owing to rapidly deteriorating clinical conditions or logistical constraints. The median interval between start of the diagnostic algorithm and start of tuberculosis treatment was 7 days. Conclusions The prevalence of tuberculosis among Mozambican HIV-positive patients starting antiretroviral therapy was 10%, with limited rifampicin resistance. Use of combined point-of-care tests increased case finding, with a short time to treatment. Interventions are needed to remove logistical barriers and prevent presentation in very advanced HIV/tuberculosis disease.
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Affiliation(s)
- Marco Floridia
- National Center for Global Health, Istituto Superiore di Sanità
| | | | - Mauro Andreotti
- National Center for Global Health, Istituto Superiore di Sanità
| | | | - Zita Sidumo
- DREAM Program, Community of S. Egidio, Maputo
| | | | | | | | - Elsa Mutemba
- DREAM Program, Community of S. Egidio, Beira, Mozambique
| | - Junia Cebola
- DREAM Program, Community of S. Egidio, Beira, Mozambique
| | | | - Fabio Riccardi
- Department of Biomedicine and Prevention, University of Rome Tor Vergata
| | | | - Marina Giuliano
- National Center for Global Health, Istituto Superiore di Sanità
| | - Leonardo Palombi
- Department of Biomedicine and Prevention, University of Rome Tor Vergata
| | - Sandro Mancinelli
- Department of Biomedicine and Prevention, University of Rome Tor Vergata
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Giuliano M, Pirillo MF, Lucaroni F, Liotta G, Andreotti M, Mancinelli S, Mphwere R, Bokola E, Amici R, Marazzi MC, Palombi L. Lack of new HBV infections over 2 years of follow-up in HIV-positive women receiving ART up to 6 or 24 months after delivery. J Infect Dev Ctries 2018; 12:394-396. [DOI: 10.3855/jidc.9915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 01/15/2018] [Indexed: 10/31/2022] Open
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Baroncelli S, Galluzzo CM, Liotta G, Andreotti M, Mancinelli S, Mphwere R, Bokola E, Amici R, Marazzi MC, Palombi L, Lucaroni F, Giuliano M. Deficit of IgG2 in HIV-positive pregnant women is responsible of inadequate IgG2 levels in their HIV-uninfected children in Malawi. Med Microbiol Immunol 2018; 207:175-182. [PMID: 29488063 DOI: 10.1007/s00430-018-0537-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 02/17/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND Transplacental passage of IgGs is impaired in HIV + pregnant women, possibly determining an inadequate immunological protection in their children. We aimed to determine the impact of maternal immunological IgG profile and immunoactivation status on the efficiency of transplacental passage of IgG subclasses in HIV + mothers. METHODS 16 mother/infants pairs were studied in Malawi. Mothers received antiretroviral therapy (ART) from the third trimester of pregnancy. Determinations of pre-ART levels of maternal sCD14, of IgG subclasses in mothers at delivery and in their 1-month-old infants, were performed using commercial ELISA kits. RESULTS At delivery, after a median of 10 weeks of ART, 12/16 mothers were hypergammaglobulinemic, with IgG levels (20.5 mg/ml, 95% CI:18.8-26.8) directly correlated to the plasmatic levels of sCD14 (r = 0.640, p = 0.014). IgG1 levels (17.9 mg/ml) accounted for 82% of IgG, IgG3 and IgG4 levels were in the normal range. A profound deficit of IgG2 was observed both in mothers (0.60 mg/ml) and in infants (0.14 mg/ml). Placental transfer ratio (range 0.16-0.42) did not show a selective impairment between the different IgG subclasses. The transplacental passage of all IgG subclasses was decreased in the presence of maternal IgG over 16 mg/ml (significantly for IgG1, p = 0.031) and of high levels of sCD14 (p = 0.063). CONCLUSIONS Transplacental passage was reduced for all IgG subclasses and inversely correlated to high levels of maternal IgGs and to the degree of immunoactivation. The profound depression of IgG2 in mothers suggests that IgG2 neonatal levels mostly reflect the maternal deficit rather than a selective impairment of IgG2 transfer.
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Affiliation(s)
- Silvia Baroncelli
- National Center for Global Health, Istituto Superiore di Sanità, Viale Regina Elena, 299, 00161, Rome, Italy.
| | - Clementina Maria Galluzzo
- National Center for Global Health, Istituto Superiore di Sanità, Viale Regina Elena, 299, 00161, Rome, Italy
| | - Giuseppe Liotta
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Via Montpellier, 1 00133, Rome, Italy
| | - Mauro Andreotti
- National Center for Global Health, Istituto Superiore di Sanità, Viale Regina Elena, 299, 00161, Rome, Italy
| | - Sandro Mancinelli
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Via Montpellier, 1 00133, Rome, Italy
| | - Robert Mphwere
- DREAM Program, Community of S. Egidio, P.O. Box 30355, Blantyre, Malawi
| | - Enok Bokola
- DREAM Program, Community of S. Egidio, P.O. Box 30355, Blantyre, Malawi
| | - Roberta Amici
- National Center for Global Health, Istituto Superiore di Sanità, Viale Regina Elena, 299, 00161, Rome, Italy
| | | | - Leonardo Palombi
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Via Montpellier, 1 00133, Rome, Italy
| | - Francesca Lucaroni
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Via Montpellier, 1 00133, Rome, Italy
| | - Marina Giuliano
- National Center for Global Health, Istituto Superiore di Sanità, Viale Regina Elena, 299, 00161, Rome, Italy
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Mancinelli S, Pirillo MF, Liotta G, Andreotti M, Mphwere R, Amici R, Marazzi MC, Vella S, Palombi L, Giuliano M. Antibody response to hepatitis B vaccine in HIV-exposed infants in Malawi and correlation with HBV infection acquisition. J Med Virol 2018; 90:1172-1176. [PMID: 29427444 DOI: 10.1002/jmv.25049] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Accepted: 12/18/2017] [Indexed: 11/06/2022]
Abstract
The aim of this study was to assess the immune response to HBV vaccine in HIV-exposed infants and to correlate it to HBV infection acquisition. Protective anti-HBs levels (>10 mIU/mL) were found in 54/58 (93.2%) infants at 6 months, 126/144 (87.5%) at 12 months and 141/176 (80.1%) children at 24 months. HBV infection (seven children were HBsAg + at Month 24) occurred also in the presence of levels above 10 mIU/mL. Our findings indicate limited impact of HIV exposure on anti-HBV immune response, but suggest that levels >10 mIU/mL may be required to confer protection in this context.
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Affiliation(s)
- Sandro Mancinelli
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Maria F Pirillo
- National Center for Global Health, Istituto Superiore di Sanità, Rome, Italy
| | - Giuseppe Liotta
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Mauro Andreotti
- National Center for Global Health, Istituto Superiore di Sanità, Rome, Italy
| | | | - Roberta Amici
- National Center for Global Health, Istituto Superiore di Sanità, Rome, Italy
| | | | - Stefano Vella
- National Center for Global Health, Istituto Superiore di Sanità, Rome, Italy
| | - Leonardo Palombi
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Marina Giuliano
- National Center for Global Health, Istituto Superiore di Sanità, Rome, Italy
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De Angelis C, Nardone A, Cataldo ML, Veeraraghavan J, Fu X, Giuliano M, Malorni L, Jeselsohn R, Osborne KC, Schiff R. Abstract P4-03-05: AP-1 as a potential mediator of resistance to the cyclin-dependent kinase (CDK) 4/6-inhibitor palbociclib in ER-positive endocrine-resistant breast cancer. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p4-03-05] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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
Abstract
Background: The CDK4/6-inhibitor palbociclib (Palbo) in combination with endocrine therapy (ET) substantially improves progression-free survival compared to ET alone. However, almost all initial responders eventually develop resistance and relapse. Delineating the early adaptive signaling and the mechanisms underlying resistance to CDK4/6 inhibition is therefore crucial to identify new biomarkers and therapeutic targets to enhance the efficacy of Palbo and improve patient outcome.
Materials and Methods: MCF7 parental (P) cells and derivative lines made resistant (R) to tamoxifen (TamR), estrogen deprivation (EDR), or fulvestrant (FulR) were used. The MCF7P line and its endocrine-R (EndoR) derivatives were exposed to increasing concentrations of Palbo to generate acquired Palbo-R (PDR) models. The proteomic/signaling profiles of P and EndoR cells upon short-term Palbo treatment and as PDR develops were determined using reverse-phase protein arrays (RPPA). Transcriptional activity of the activator protein-1 (AP-1) transcription factor (TF) was measured by luciferase reporter assay. Global AP-1 blockade was achieved using a pINDUCER system to express doxycycline (Dox)-inducible dominant-negative (DN) c-Jun that lacks the transcriptional activation domain. Cell growth and colony formation were assessed using methylene blue staining and clonogenic assays, respectively. Levels of phosphorylated (p)-RB and CDK2 were assessed by Western Blot.
Results: In P and all EndoR cell models, Palbo inhibited cell growth and colony formation in a dose-dependent manner, though the inhibitory effect was greater in the EndoR cells compared to P cells [IC50 value of P cells >3 times that of EndoR lines (p<0.001); clonogenic % inhibition at 100nM = 54 in P and >85 in EndoR lines (p<0.001)]. Across the P and all EndoR models, short-term Palbo treatment resulted in increased levels of several membrane and intracellular signaling molecules, TFs, and enzymes. Among these, the AP-1 TF components c-Jun and p-c-Jun showed the highest increase across all models, with the utmost change observed in the TamR model (Fold-change = 4.4, 4.0 for total and p-c-Jun, respectively). Since we also observed that acquired resistance to Palbo in the TamR model was associated with higher AP-1 transcriptional activity and increased total and p-c-Fos levels, we assessed the efficacy of combining Palbo with AP-1 blockade in the TamR model. In two independent TamR clones ectopically expressing inducible DN-c-Jun, AP-1 blockade (+Dox) in combination with Palbo was highly effective in inhibiting cell growth and reducing p-RB and CDK2 levels compared to single agent treatments. In addition, in both the TamR/DN-c-Jun-expressing clones, the combination of Palbo, AP-1 blockade, and fulvestrant resulted in cell death and a significantly greater cell growth inhibition compared to any dual or mono treatments.
Conclusion: Our results suggest activation of AP-1 as a potential mechanism of resistance to Palbo in ER+ EndoR models. Transcriptomic profiling of the Palbo-sensitive and R cells, currently underway, will provide an in-depth understanding of the role of AP-1 as well as other key targets and associated molecular mechanisms in Palbo resistance.
Citation Format: De Angelis C, Nardone A, Cataldo ML, Veeraraghavan J, Fu X, Giuliano M, Malorni L, Jeselsohn R, Osborne KC, Schiff R. AP-1 as a potential mediator of resistance to the cyclin-dependent kinase (CDK) 4/6-inhibitor palbociclib in ER-positive endocrine-resistant breast cancer [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P4-03-05.
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Affiliation(s)
- C De Angelis
- Lester and Sue Smith Breast Center, Baylor College of Medicine, Houston, TX; Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX; Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA; University of Naples "Federico II", Naples, Italy; "Sandro Pitigliani" Translational Research Unit, Hospital of Prato-AUSL Toscana Centro, Istituto Toscano Tumori, Prato, Italy
| | - A Nardone
- Lester and Sue Smith Breast Center, Baylor College of Medicine, Houston, TX; Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX; Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA; University of Naples "Federico II", Naples, Italy; "Sandro Pitigliani" Translational Research Unit, Hospital of Prato-AUSL Toscana Centro, Istituto Toscano Tumori, Prato, Italy
| | - ML Cataldo
- Lester and Sue Smith Breast Center, Baylor College of Medicine, Houston, TX; Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX; Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA; University of Naples "Federico II", Naples, Italy; "Sandro Pitigliani" Translational Research Unit, Hospital of Prato-AUSL Toscana Centro, Istituto Toscano Tumori, Prato, Italy
| | - J Veeraraghavan
- Lester and Sue Smith Breast Center, Baylor College of Medicine, Houston, TX; Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX; Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA; University of Naples "Federico II", Naples, Italy; "Sandro Pitigliani" Translational Research Unit, Hospital of Prato-AUSL Toscana Centro, Istituto Toscano Tumori, Prato, Italy
| | - X Fu
- Lester and Sue Smith Breast Center, Baylor College of Medicine, Houston, TX; Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX; Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA; University of Naples "Federico II", Naples, Italy; "Sandro Pitigliani" Translational Research Unit, Hospital of Prato-AUSL Toscana Centro, Istituto Toscano Tumori, Prato, Italy
| | - M Giuliano
- Lester and Sue Smith Breast Center, Baylor College of Medicine, Houston, TX; Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX; Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA; University of Naples "Federico II", Naples, Italy; "Sandro Pitigliani" Translational Research Unit, Hospital of Prato-AUSL Toscana Centro, Istituto Toscano Tumori, Prato, Italy
| | - L Malorni
- Lester and Sue Smith Breast Center, Baylor College of Medicine, Houston, TX; Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX; Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA; University of Naples "Federico II", Naples, Italy; "Sandro Pitigliani" Translational Research Unit, Hospital of Prato-AUSL Toscana Centro, Istituto Toscano Tumori, Prato, Italy
| | - R Jeselsohn
- Lester and Sue Smith Breast Center, Baylor College of Medicine, Houston, TX; Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX; Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA; University of Naples "Federico II", Naples, Italy; "Sandro Pitigliani" Translational Research Unit, Hospital of Prato-AUSL Toscana Centro, Istituto Toscano Tumori, Prato, Italy
| | - KC Osborne
- Lester and Sue Smith Breast Center, Baylor College of Medicine, Houston, TX; Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX; Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA; University of Naples "Federico II", Naples, Italy; "Sandro Pitigliani" Translational Research Unit, Hospital of Prato-AUSL Toscana Centro, Istituto Toscano Tumori, Prato, Italy
| | - R Schiff
- Lester and Sue Smith Breast Center, Baylor College of Medicine, Houston, TX; Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX; Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA; University of Naples "Federico II", Naples, Italy; "Sandro Pitigliani" Translational Research Unit, Hospital of Prato-AUSL Toscana Centro, Istituto Toscano Tumori, Prato, Italy
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Baroncelli S, Galluzzo CM, Liotta G, Andreotti M, Ciccacci F, Mancinelli S, Tolno VT, Gondwe J, Amici R, Marazzi MC, Vella S, Giuliano M, Palombi L, Palmisano L. Soluble CD14 levels in plasma and breastmilk of Malawian HIV+ women: Lack of association with morbidity and mortality in their exposed infants. Am J Reprod Immunol 2018; 79. [PMID: 29323435 DOI: 10.1111/aji.12812] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 12/14/2017] [Indexed: 12/22/2022] Open
Abstract
PROBLEM Data on soluble CD14 (sCD14) during pregnancy and lactation are scarce. We assessed the levels of sCD14 in plasma and breastmilk of Malawian HIV-positive women and evaluated the possible association with morbidity and mortality in the HIV-exposed children. METHOD OF STUDY One hundred and forty-nine mother/child pairs were studied. Women received antiretroviral therapy from 26 weeks of gestation to at least 6 months of exclusive breastfeeding. sCD14 concentrations were determined using an enzyme-linked immunosorbent assay. RESULTS sCD14 levels measured at 26 weeks of pregnancy (median: 1418 ng/mL, IQR: 1086-1757) were inversely correlated to maternal CD4+ cell count (r = -.283, P = .001) and to neonatal birthweight (r = -.233, P = .008). At 6 months, sCD14 plasma levels were significantly higher compared to baseline (1993 ng/mL, IQR: 1482-2604, P < .001), and breastmilk sCD14 levels (7668 ng/mL, IQR: 5495-10207) were 4-fold higher than in plasma (although the concentrations in the two compartments were not correlated). No association was found between sCD14 levels in plasma or breastmilk and morbidity or mortality in children. CONCLUSION Higher sCD14 levels in HIV-positive women were associated with a more compromised maternal immunological status and to a lower neonatal birthweight, but not to poorer clinical outcomes in the HIV-exposed children.
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Affiliation(s)
- Silvia Baroncelli
- National Center for Global Health, Istituto Superiore di Sanità, Rome, Italy
| | | | - Giuseppe Liotta
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Mauro Andreotti
- National Center for Global Health, Istituto Superiore di Sanità, Rome, Italy
| | | | - Sandro Mancinelli
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | | | - Jane Gondwe
- DREAM Program, Community of S. Egidio, Blantyre, Malawi
| | - Roberta Amici
- National Center for Global Health, Istituto Superiore di Sanità, Rome, Italy
| | | | - Stefano Vella
- National Center for Global Health, Istituto Superiore di Sanità, Rome, Italy
| | - Marina Giuliano
- National Center for Global Health, Istituto Superiore di Sanità, Rome, Italy
| | - Leonardo Palombi
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Lucia Palmisano
- National Center for Drug Research and Evaluation, Istituto Superiore di Sanità, Rome, Italy
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Van Naarden Braun K, Grazel R, Koppel R, Lakshminrusimha S, Lohr J, Kumar P, Govindaswami B, Giuliano M, Cohen M, Spillane N, Jegatheesan P, McClure D, Hassinger D, Fofah O, Chandra S, Allen D, Axelrod R, Blau J, Hudome S, Assing E, Garg LF. Evaluation of critical congenital heart defects screening using pulse oximetry in the neonatal intensive care unit. J Perinatol 2017; 37:1117-1123. [PMID: 28749481 PMCID: PMC5633653 DOI: 10.1038/jp.2017.105] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Revised: 04/24/2017] [Accepted: 05/22/2017] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To evaluate the implementation of early screening for critical congenital heart defects (CCHDs) in the neonatal intensive care unit (NICU) and potential exclusion of sub-populations from universal screening. STUDY DESIGN Prospective evaluation of CCHD screening at multiple time intervals was conducted in 21 NICUs across five states (n=4556 infants). RESULTS Of the 4120 infants with complete screens, 92% did not have prenatal CHD diagnosis or echocardiography before screening, 72% were not receiving oxygen at 24 to 48 h and 56% were born ⩾2500 g. Thirty-seven infants failed screening (0.9%); none with an unsuspected CCHD. False positive rates were low for infants not receiving oxygen (0.5%) and those screened after weaning (0.6%), yet higher among infants born at <28 weeks (3.8%). Unnecessary echocardiograms were minimal (0.2%). CONCLUSION Given the majority of NICU infants were ⩾2500 g, not on oxygen and not preidentified for CCHD, systematic screening at 24 to 48 h may be of benefit for early detection of CCHD with minimal burden.
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Affiliation(s)
- K Van Naarden Braun
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA,New Jersey Department of Health, Trenton, NJ, USA,National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 4770 Buford Highway NE MS E-86, Atlanta, GA 30341-3717, USA. E-mail:
| | - R Grazel
- New Jersey Department of Health, Trenton, NJ, USA,New Jersey Chapter, American Academy of Pediatrics, East Windsor, NJ, USA
| | - R Koppel
- Long Island Jewish Cohen Children’s Medical Center, New Hyde Park, NY, USA
| | | | - J Lohr
- University of Minnesota Medical System, Minneapolis, MN, USA
| | - P Kumar
- University of Illinois Medical Center, Peoria, IL, USA
| | | | - M Giuliano
- Hackensack University Medical Center, Hackensack, NJ, USA
| | - M Cohen
- Children’s Hospital of New Jersey at Newark Beth Israel Medical Center, Newark, NJ, USA
| | - N Spillane
- Hackensack University Medical Center, Hackensack, NJ, USA
| | - P Jegatheesan
- Santa Clara Valley Medical Center, San Jose, CA, USA
| | - D McClure
- Saint Joseph’s Regional Medical Center, Paterson, NJ, USA
| | - D Hassinger
- Morristown Medical Center, Morristown, NJ, USA
| | - O Fofah
- Rutgers New Jersey Medical School, Newark, NJ, USA
| | - S Chandra
- Saint Peter’s University Hospital, New Brunswick, NJ, USA
| | - D Allen
- Saint Peter’s University Hospital, New Brunswick, NJ, USA
| | - R Axelrod
- Capital Health Medical Center Hopewell, Pennington, NJ, USA
| | - J Blau
- Northwell Staten Island University Hospital, Staten Island, NY, USA
| | - S Hudome
- Monmouth Medical Center, Long Branch, NJ, USA
| | - E Assing
- Jersey Shore University Medical Center, Neptune, NJ, USA
| | - L F Garg
- New Jersey Department of Health, Trenton, NJ, USA
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50
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Giuliano M, Pirillo MF, Liotta G, Andreotti M, Jere H, Sagno JB, Ciccacci F, Amici R, Marazzi MC, Vella S, Palombi L, Mancinelli S. High CMV IgG antibody levels are associated to a lower CD4+ RESPONSE to antiretroviral therapy in HIV-infected women. J Clin Virol 2017; 96:17-19. [PMID: 28918126 DOI: 10.1016/j.jcv.2017.08.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 08/28/2017] [Accepted: 08/31/2017] [Indexed: 01/21/2023]
Abstract
BACKGROUND Virtually all HIV-infected women in sub-Saharan Africa have evidence of Cytomegalovirus (CMV) infection and levels of specific anti-CMV IgG have been suggested to represent more intense reactivation of subclinical infection. Studies have also shown direct influence of CMV on lymphocytes. OBJECTIVE The aim of this study was to determine if levels of anti-CMV specific antibodies could impact on the immunological response to antiretroviral treatment (ART) in HIV-infected pregnant women. STUDY DESIGN CMV-specific IgG were measured in HIV-infected pregnant women at 26 weeks of gestation (before ART initiation). Women received ART until 6 months postpartum or indefinitely according to local guidelines at the time of the study. Immunological and virological responses were assessed 6 months and 24 months after delivery. RESULTS A total of 81 women were studied. At baseline high levels (above the median) of specific IgG were associated to a low CD4+ cell count (P<0.001), a high viral load (P=0.003), and to an older age (P=0.051). In a multivariate model adjusting for baseline CD4+ count, baseline viral load and age, the presence of low levels of CMV IgG was the only independent predictor of a a CD4+ count above 500/mm3 24 months after delivery among women on continuous therapy. CONCLUSIONS In this cohort, levels of CVM IgG had a significant influence on the immunological response to ART, adding information to the known impact of CMV infection in the HIV-positive population, and underlining the need of new strategies to contain the infection.
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Affiliation(s)
- Marina Giuliano
- National Center for Global Health, Istituto Superiore di Sanità, Rome, Italy.
| | | | - Giuseppe Liotta
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Italy
| | - Mauro Andreotti
- National Center for Global Health, Istituto Superiore di Sanità, Rome, Italy
| | - Haswell Jere
- DREAM Program, Community of S. Egidio, Blantyre, Malawi
| | | | | | - Roberta Amici
- National Center for Global Health, Istituto Superiore di Sanità, Rome, Italy
| | | | - Stefano Vella
- National Center for Global Health, Istituto Superiore di Sanità, Rome, Italy
| | - Leonardo Palombi
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Italy
| | - Sandro Mancinelli
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Italy
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