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Zaccarelli M. Reassessing the emphasis on limited options in antiretroviral treatment. AIDS 2024; 38:599-601. [PMID: 38416552 DOI: 10.1097/qad.0000000000003757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Affiliation(s)
- Mauro Zaccarelli
- STI, HIV and Migration Unit, San Gallicano Dermatological Institute, I.R.C.C.S., Rome, Italy
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Zaccarelli M, Niyongabo B, Conway B. Point-of-care urine tenofovir testing: making a good thing better. AIDS 2023; 37:1159-1160. [PMID: 37139650 DOI: 10.1097/qad.0000000000003539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Affiliation(s)
- Mauro Zaccarelli
- HIV/Infectious Diseases Unit, 'Villa Maraini' Foundation, Italian Red Cross, Rome/Infectious Diseases Unit, 'San Camillo de Lellis' Hospital, Rieti, Italy
| | | | - Brian Conway
- Vancouver Infectious Diseases Centre, Faculty of Health Sciences, Simon Fraser University, Vancouver, Canada
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Donà MG, Giuliani E, Zaccarelli M, Latini A. Monkeypox infection: Should we expect changes in its epidemiological and clinical features? Eur J Intern Med 2023; 107:108-109. [PMID: 36270934 PMCID: PMC9579058 DOI: 10.1016/j.ejim.2022.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 10/14/2022] [Indexed: 01/09/2023]
Affiliation(s)
| | - Eugenia Giuliani
- Scientific Direction, San Gallicano Dermatological Institute IRCCS, Rome, Italy
| | | | - Alessandra Latini
- STI/HIV Unit, San Gallicano Dermatological Institute IRCCS, Rome, Italy.
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Zaccarelli M, Musiime V, Quiñones-Mateu ME. Monitoring antiretroviral therapy in low and middle-income countries: current status and future considerations. AIDS 2022; 36:2071-2073. [PMID: 36305186 DOI: 10.1097/qad.0000000000003381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Mauro Zaccarelli
- HIV/Infectious Diseases Unit, "Villa Maraini" Foundation, Rome/Infectious Diseases Unit, "San Camillo de Lellis" Hospital, Rieti, Italy
| | - Victor Musiime
- Department of Paediatrics and Child Health, School of Medicine, College of Health Sciences, Makerere University/Research Department, Joint Clinical Research Centre, Kampala, Uganda
| | - Miguel E Quiñones-Mateu
- Department of Microbiology & Immunology, School of Biomedical Sciences, University of Otago, Dunedin, New Zealand
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Latini A, Magri F, Giuliani E, Giuliani M, Garelli V, Pontone M, Salvi M, Stingone C, Gianserra L, Pimpinelli F, Buonomini AR, Morrone A, Donà MG, Zaccarelli M. Continuing evidence that COVID-19 has influenced syphilis epidemiology in Rome. Sex Transm Infect 2021; 98:72. [PMID: 34544886 DOI: 10.1136/sextrans-2021-055250] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Alessandra Latini
- STI/HIV Unit, San Gallicano Dermatological Institute IRCCS, Rome, Italy
| | - Francesca Magri
- Department of Dermatology, University of Rome La Sapienza, Rome, Italy
| | - Eugenia Giuliani
- Scientific Direction, San Gallicano Dermatological Institute IRCCS, Rome, Italy
| | - Massimo Giuliani
- STI/HIV Unit, San Gallicano Dermatological Institute IRCCS, Rome, Italy
| | - Valentina Garelli
- STI/HIV Unit, San Gallicano Dermatological Institute IRCCS, Rome, Italy
| | - Martina Pontone
- Microbiology and Pathology Department, San Gallicano Dermatological Institute IRCCS, Rome, Italy
| | - Monica Salvi
- STI/HIV Unit, San Gallicano Dermatological Institute IRCCS, Rome, Italy
| | - Christof Stingone
- STI/HIV Unit, San Gallicano Dermatological Institute IRCCS, Rome, Italy
| | - Laura Gianserra
- STI/HIV Unit, San Gallicano Dermatological Institute IRCCS, Rome, Italy
| | - Fulvia Pimpinelli
- Microbiology and Pathology Department, San Gallicano Dermatological Institute IRCCS, Rome, Italy
| | | | - Aldo Morrone
- Scientific Direction, San Gallicano Dermatological Institute IRCCS, Rome, Italy
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Latini A, Donà MG, Giuliani M, Pontone M, Ancona C, Foracappa S, Morrone A, Zaccarelli M. Short Communication: HIV Viral Load Trends During the Coronavirus Disease 2019 Pandemic in a Reference Center for HIV in Rome, Italy. AIDS Res Hum Retroviruses 2021; 37:624-626. [PMID: 33966477 DOI: 10.1089/aid.2021.0044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) pandemic has reduced the access of HIV patients to reference centers. However, retention-in-care is critical to maintain adherence to therapy and viral suppression. During lockdown in Italy, our center implemented several measures to ensure HIV-care continuum. To assess whether these efforts were successful, we investigated HIV viral load trend for a 1-year period (September 2019-August 2020), which included lockdown and partial lockdown months in our country. No significant changes overtime in the proportion of undetectable HIV-RNA were observed. Continuity of service made it possible to maintain viral suppression in our patients.
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Affiliation(s)
- Alessandra Latini
- STI/HIV Unit, San Gallicano Dermatological Institute IRCCS, Rome, Italy
| | | | - Massimo Giuliani
- STI/HIV Unit, San Gallicano Dermatological Institute IRCCS, Rome, Italy
| | - Martina Pontone
- Microbiology and Virology, San Gallicano Institute, Rome, Italy
| | - Carola Ancona
- STI/HIV Unit, San Gallicano Dermatological Institute IRCCS, Rome, Italy
| | - Silvia Foracappa
- STI/HIV Unit, San Gallicano Dermatological Institute IRCCS, Rome, Italy
| | - Aldo Morrone
- Scientific Direction, San Gallicano Dermatological Institute IRCCS, Rome, Italy
| | - Mauro Zaccarelli
- Clinical Department, National Institute for the Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
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Minosse C, Gruber CEM, Rueca M, Taibi C, Zaccarelli M, Grilli E, Montalbano M, Capobianchi MR, Antinori A, D’Offizi G, McPhee F, Garbuglia AR. Late Relapse and Reinfection in HCV Patients Treated with Direct-Acting Antiviral (DAA) Drugs. Viruses 2021; 13:v13061151. [PMID: 34208646 PMCID: PMC8235384 DOI: 10.3390/v13061151] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 06/09/2021] [Accepted: 06/14/2021] [Indexed: 12/02/2022] Open
Abstract
The risk of hepatitis C virus (HCV) recurrence after direct-acting antiviral (DAA) treatment is <0.5%. However, the distinction between HCV RNA late relapse and reinfection still represents a challenge in virological diagnostics. The aim of this study was to employ next-generation sequencing (NGS) to investigate HCV RNA recurrence in patients achieving a sustained virologic response (SVR) at least six months post-treatment. NGS was performed on plasma samples from six HCV-positive patients (Pt1–6) treated with DAA. NGS of HCV NS5B was analyzed before treatment (T0), after HCV RNA rebound (T1), and, for Pt3, after a second rebound (T2). Reinfection was confirmed for Pt5, and for the first rebound observed in Pt3. Conversely, viral relapse was observed when comparing T0 and T1 for Pt6 and T1 and T2 for Pt3. Z-scores were calculated and used to predict whether HCV-positive patient samples at different time points belonged to the same quasispecies population. A low Z-score of <2.58 confirmed that viral quasispecies detected at T0 and T1 were closely related for both Pt1 and Pt2, while the Z-score for Pt4 was suggestive of possible reinfection. NGS data analyses indicate that the Z-score may be a useful parameter for distinguishing late relapse from reinfection.
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Affiliation(s)
- Claudia Minosse
- Virology Unit, National Institute for Infectious Diseases, INMI Lazzaro Spallanzani IRCCS, Via Portuense 292, 00149 Rome, Italy; (C.M.); (C.E.M.G.); (M.R.); (M.R.C.); (A.R.G.)
| | - Cesare E. M. Gruber
- Virology Unit, National Institute for Infectious Diseases, INMI Lazzaro Spallanzani IRCCS, Via Portuense 292, 00149 Rome, Italy; (C.M.); (C.E.M.G.); (M.R.); (M.R.C.); (A.R.G.)
| | - Martina Rueca
- Virology Unit, National Institute for Infectious Diseases, INMI Lazzaro Spallanzani IRCCS, Via Portuense 292, 00149 Rome, Italy; (C.M.); (C.E.M.G.); (M.R.); (M.R.C.); (A.R.G.)
| | - Chiara Taibi
- Infectious Disease—Clinical Department, National Institute for Infectious Diseases, INMI Lazzaro Spallanzani IRCCS, Via Portuense 292, 00149 Rome, Italy; (M.Z.); (E.G.); (M.M.); (A.A.); (G.D.)
- Correspondence:
| | - Mauro Zaccarelli
- Infectious Disease—Clinical Department, National Institute for Infectious Diseases, INMI Lazzaro Spallanzani IRCCS, Via Portuense 292, 00149 Rome, Italy; (M.Z.); (E.G.); (M.M.); (A.A.); (G.D.)
| | - Elisabetta Grilli
- Infectious Disease—Clinical Department, National Institute for Infectious Diseases, INMI Lazzaro Spallanzani IRCCS, Via Portuense 292, 00149 Rome, Italy; (M.Z.); (E.G.); (M.M.); (A.A.); (G.D.)
| | - Marzia Montalbano
- Infectious Disease—Clinical Department, National Institute for Infectious Diseases, INMI Lazzaro Spallanzani IRCCS, Via Portuense 292, 00149 Rome, Italy; (M.Z.); (E.G.); (M.M.); (A.A.); (G.D.)
| | - Maria R. Capobianchi
- Virology Unit, National Institute for Infectious Diseases, INMI Lazzaro Spallanzani IRCCS, Via Portuense 292, 00149 Rome, Italy; (C.M.); (C.E.M.G.); (M.R.); (M.R.C.); (A.R.G.)
| | - Andrea Antinori
- Infectious Disease—Clinical Department, National Institute for Infectious Diseases, INMI Lazzaro Spallanzani IRCCS, Via Portuense 292, 00149 Rome, Italy; (M.Z.); (E.G.); (M.M.); (A.A.); (G.D.)
| | - Gianpiero D’Offizi
- Infectious Disease—Clinical Department, National Institute for Infectious Diseases, INMI Lazzaro Spallanzani IRCCS, Via Portuense 292, 00149 Rome, Italy; (M.Z.); (E.G.); (M.M.); (A.A.); (G.D.)
| | - Fiona McPhee
- Bristol-Myers Squibb Research and Development, Cambridge, MA 02142, USA;
| | - Anna Rosa Garbuglia
- Virology Unit, National Institute for Infectious Diseases, INMI Lazzaro Spallanzani IRCCS, Via Portuense 292, 00149 Rome, Italy; (C.M.); (C.E.M.G.); (M.R.); (M.R.C.); (A.R.G.)
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Magri F, Donà MG, Panetta C, Pontone M, Pimpinelli F, Cameli N, Cristaudo A, Zaccarelli M, Latini A. Unusual clinical manifestation and challenging serological interpretation of syphilis: insights from a case report. BMC Infect Dis 2021; 21:521. [PMID: 34078297 PMCID: PMC8173822 DOI: 10.1186/s12879-021-06199-0] [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: 06/17/2020] [Accepted: 05/17/2021] [Indexed: 01/23/2023] Open
Abstract
Background The clinical manifestations of recent syphilis can be variable, with typical and atypical patterns. Several conditions may cause atypical clinical aspects, including human immunodeficiency virus (HIV) co-infection. Besides the clinical features, co-infections may completely alter syphilis serological tests, causing interpretative difficulties and diagnostic delays. Aim of the work is to describe the difficulties encountered during the diagnostic evaluation of atypical skin manifestations and of the serology for syphilis of an HIV-infected patient who had contracted it several times. Case presentation In 2020, a 52-year old HIV-positive bisexual male patient was admitted to our department with a 4-month history of moderately itchy cutaneous lesions localized at his neck, trunk and arms. In 2013, the patient presented with a classic syphilitic roseola of the trunk and a secondary syphilis was diagnosed, with increased levels of rapid plasma reagin (RPR), Treponema pallidum hemagglutination assay (TPHA), anti-Treponema pallidum IgM and IgG Index. A second episode occurred in 2018, as a primary syphilis with multiple ulcerative lesions of the penis, and increased levels of RPR, IgG and IgM. In 2019, a further episode of secondary syphilis was treated with Doxycycline. In 2020, erythematous and papular lesions with vesicular components and urticarial erythema multiforme (EM)-like lesions were present at the neck, trunk and arms. Serological tests and Nucleic Acid Amplification Test (NAAT) for Treponema Pallidum were performed, as well as a cutaneous biopsy with histological and immunohistochemical evaluation of one lesion. NAAT was negative for T. pallidum. Serological test results were discordant with a new syphilis infection, showing only increased levels of RPR and anti-Treponema IgG. The cutaneous biopsy revealed a non specific histological pattern, while the immunohistochemical evaluation with anti-spirochetal antibodies was mandatory for the diagnosis of recent syphilis, showing clusters of rod-shaped elements, some of which with spiral form, focally present at the epidermis and adnexal structures. Conclusions Nowadays, syphilis may present with atypical clinical and serological features. Physicians should be aware of these possible alterations and consider syphilis even in case of uncommon clinical aspect and unclear serological tests. Cutaneous biopsy and immunohistochemical exam may be mandatory for the diagnosis.
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Affiliation(s)
- F Magri
- Department of Dermatology, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - M G Donà
- STI/HIV Unit, San Gallicano Dermatological Institute IRCCS, Rome, Italy
| | - C Panetta
- Laboratory of Dermatopathology, San Gallicano Dermatological Institute IRCCS, Rome, Italy
| | - M Pontone
- Clinical Pathology and Microbiology, San Gallicano Dermatologic Institute IRCCS, Rome, Italy
| | - F Pimpinelli
- Clinical Pathology and Microbiology, San Gallicano Dermatologic Institute IRCCS, Rome, Italy
| | - N Cameli
- STI/HIV Unit, San Gallicano Dermatological Institute IRCCS, Rome, Italy
| | - A Cristaudo
- Department of Dermatology, San Gallicano Dermatological Institute IRCCS, Rome, Italy
| | - M Zaccarelli
- Clinical Department, National Institute for the Infectious Diseases Lazzaro Spallanzani, Rome, Italy.
| | - A Latini
- STI/HIV Unit, San Gallicano Dermatological Institute IRCCS, Rome, Italy
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Lapa D, Del Porto P, Minosse C, D’Offizi G, Antinori A, Capobianchi MR, Visco-Comandini U, McPhee F, Garbuglia AR, Zaccarelli M. Clinical Relevance of Torque Teno Virus (TTV) in HIV/HCV Coinfected and HCV Monoinfected Patients Treated with Direct-Acting Antiviral Therapy. J Clin Med 2021; 10:jcm10102092. [PMID: 34068071 PMCID: PMC8152458 DOI: 10.3390/jcm10102092] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 05/02/2021] [Accepted: 05/06/2021] [Indexed: 02/07/2023] Open
Abstract
Torque Teno virus (TTV) is a ubiquitous virus that causes chronic infection in humans with unknown clinical consequences. Here, we investigated the influence of TTV infection on HCV direct-acting antiviral (DAA) efficacy in HIV/HCV coinfected and HCV monoinfected patients as controls. Of 92 study patients, 79.3% were TTV DNA positive; untreated patients exhibited a significantly higher proportion of TTV DNA-positivity vs. sustained virological response (SVR) patients (100.0% vs. 65.2%, p < 0.001), while TTV positivity was not significant in DAA failure patients vs. SVR patients despite HIV/HCV coinfection. TTV DNA viral load was higher among HCV monoinfected patients vs. HIV/HCV coinfected, although marginally significant (p = 0.074) and no significant viral load difference was detected between DAA failures and SVR patients, while untreated vs. SVR patients had a significantly higher viral load (19,884, IQR 5977–333,534, vs. 469, IQR 10–4124, p = 0.004). Alpha-genogroup 3 TTV was the most prevalent genetic group, and no specific strain or genogroup was observed in relapser patients. Among HIV/HCV patients with HCV RNA detectable at end of treatment (EOT), TTV DNA was detected in 9/17 treatment responder patients and 3/5 relapser patients, thus, TTV infection does not appear to influence the control HCV viremia after EOT. Levels of IL-6 IL-4, and CD14 were not significantly different between TTV PCR-positive and -negative patients. These results suggest no association between TTV DNA positivity or viral load and HCV DAA failure whether patients were HIV/HCV coinfected or HCV monoinfected.
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Affiliation(s)
- Daniele Lapa
- Laboratory of Virology, “Lazzaro Spallanzani” National Institute for Infectious Diseases, IRCCS, 00149 Rome, Italy; (D.L.); (C.M.); (M.R.C.)
| | - Paola Del Porto
- Department of Biology and Biotechnology “C. Darwin”, Sapienza University, 00185 Rome, Italy;
| | - Claudia Minosse
- Laboratory of Virology, “Lazzaro Spallanzani” National Institute for Infectious Diseases, IRCCS, 00149 Rome, Italy; (D.L.); (C.M.); (M.R.C.)
| | - Gianpiero D’Offizi
- Hepatology and Infectious Diseases Unit, “Lazzaro Spallanzani” National Institute for Infectious Diseases IRCCS, 00149 Rome, Italy; (G.D.); (U.V.-C.)
| | - Andrea Antinori
- Clinical Department, “Lazzaro Spallanzani ” National Institute for Infectious Diseases, IRCCS, 00149 Rome, Italy; (A.A.); (M.Z.)
| | - Maria Rosaria Capobianchi
- Laboratory of Virology, “Lazzaro Spallanzani” National Institute for Infectious Diseases, IRCCS, 00149 Rome, Italy; (D.L.); (C.M.); (M.R.C.)
| | - Ubaldo Visco-Comandini
- Hepatology and Infectious Diseases Unit, “Lazzaro Spallanzani” National Institute for Infectious Diseases IRCCS, 00149 Rome, Italy; (G.D.); (U.V.-C.)
| | | | - Anna Rosa Garbuglia
- Laboratory of Virology, “Lazzaro Spallanzani” National Institute for Infectious Diseases, IRCCS, 00149 Rome, Italy; (D.L.); (C.M.); (M.R.C.)
- Correspondence: ; Tel.: +39-06-5517-0692; Fax: +39-06-559-455
| | - Mauro Zaccarelli
- Clinical Department, “Lazzaro Spallanzani ” National Institute for Infectious Diseases, IRCCS, 00149 Rome, Italy; (A.A.); (M.Z.)
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Mondi A, Lorenzini P, Castilletti C, Gagliardini R, Lalle E, Corpolongo A, Valli MB, Taglietti F, Cicalini S, Loiacono L, Di Gennaro F, D'Offizi G, Palmieri F, Nicastri E, Agrati C, Petrosillo N, Ippolito G, Vaia F, Girardi E, Capobianchi MR, Antinori A, Zito S, Abbonizio MA, Abdeddaim A, Agostini E, Agrati C, Albarello F, Amadei G, Amendola A, Antinori A, Antonica MA, Antonini M, Bartoli TA, Baldini F, Barbaro R, Bartolini B, Bellagamba R, Benigni M, Bevilacqua N, Biava G, Bibas M, Bordi L, Bordoni V, Boumis E, Branca M, Buonomo R, Busso D, Camici M, Campioni P, Canichella F, Capobianchi MR, Capone A, Caporale C, Caraffa E, Caravella I, Carletti F, Castilletti C, Cataldo A, Cerilli S, Cerva C, Chiappini R, Chinello P, Cianfarani MA, Ciaralli C, Cimaglia C, Cinicola N, Ciotti V, Cicalini S, Colavita F, Corpolongo A, Cristofaro M, Curiale S, D'Abramo A, Dantimi C, De Angelis A, De Angelis G, De Palo MG, De Zottis F, Di Bari V, Di Lorenzo R, Di Stefano F, D'Offizi G, Donno D, Evangelista F, Faraglia F, Farina A, Ferraro F, Fiorentini L, Frustaci A, Fusetti M, Galati V, Gagliardini R, Gallì P, Garotto G, Gaviano I, Tekle SG, Giancola ML, Giansante F, Giombini E, Granata G, Greci MC, Grilli E, Grisetti S, Gualano G, Iacomi F, Iaconi M, Iannicelli G, Inversi C, Ippolito G, Lalle E, Lamanna ME, Lanini S, Lapa D, Lepore L, Libertone R, Lionetti R, Liuzzi G, Loiacono L, Lucia A, Lufrani F, Macchione M, Maffongelli G, Marani A, Marchioni L, Mariano A, Marini MC, Maritti M, Mastrobattista A, Mastrorosa I, Matusali G, Mazzotta V, Mencarini P, Meschi S, Messina F, Micarelli S, Mogavero G, Mondi A, Montalbano M, Montaldo C, Mosti S, Murachelli S, Musso M, Nardi M, Navarra A, Nicastri E, Nocioni M, Noto P, Noto R, Oliva A, Onnis I, Ottou S, Palazzolo C, Pallini E, Palmieri F, Palombi G, Pareo C, Passeri V, Pelliccioni F, Penna G, Petrecchia A, Petrone A, Petrosillo N, Pianura E, Pinnetti C, Pisciotta M, Piselli P, Pittalis S, Pontarelli A, Proietti C, Puro V, Ramazzini PM, Rianda A, Rinonapoli G, Rosati S, Rubino D, Rueca M, Ruggeri A, Sacchi A, Sampaolesi A, Sanasi F, Santagata C, Scarabello A, Scarcia S, Schininà V, Scognamiglio P, Scorzolini L, Stazi G, Strano G, Taglietti F, Taibi C, Taloni G, Nardi T, Tonnarini R, Topino S, Tozzi M, Vaia F, Vairo F, Valli MB, Vergori A, Vincenzi L, Visco-Comandini U, Vita S, Vittozzi P, Zaccarelli M, Zanetti A, Zito S. Risk and predictive factors of prolonged viral RNA shedding in upper respiratory specimens in a large cohort of COVID-19 patients admitted to an Italian reference hospital. Int J Infect Dis 2021; 105:532-539. [PMID: 33676001 PMCID: PMC7927669 DOI: 10.1016/j.ijid.2021.02.117] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 02/26/2021] [Accepted: 02/27/2021] [Indexed: 12/15/2022] Open
Abstract
Background Limited data are available about the predictors and outcomes associated with prolonged SARS-CoV-2 RNA shedding (VS). Methods A retrospective study including COVID-19 patients admitted to an Italian hospital between March 1 and July 1, 2020. Predictors of viral clearance (VC) and prolonged VS from the upper respiratory tract were assessed by Poisson regression and logistic regression analyses. The causal relation between VS and clinical outcomes was evaluated through an inverse probability weighted Cox model. Results The study included 536 subjects. The median duration of VS from symptoms onset was 18 days. The estimated 30-day probability of VC was 70.2%. Patients with comorbidities, lymphopenia at hospital admission, or moderate/severe respiratory disease had a lower chance of VC. The development of moderate/severe respiratory failure, delayed hospital admission after symptoms onset, baseline comorbidities, or D-dimer >1000 ng/mL at admission independently predicted prolonged VS. The achievement of VC doubled the chance of clinical recovery and reduced the probability of death/mechanical ventilation. Conclusions Respiratory disease severity, comorbidities, delayed hospital admission and inflammatory markers negatively predicted VC, which resulted to be associated with better clinical outcomes. These findings highlight the importance of prompt hospitalization of symptomatic patients, especially where signs of severity or comorbidities are present.
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Affiliation(s)
- Annalisa Mondi
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Patrizia Lorenzini
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Concetta Castilletti
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Roberta Gagliardini
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy.
| | - Eleonora Lalle
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Angela Corpolongo
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Maria Beatrice Valli
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Fabrizio Taglietti
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Stefania Cicalini
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Laura Loiacono
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Francesco Di Gennaro
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Gianpiero D'Offizi
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Fabrizio Palmieri
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Emanuele Nicastri
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Chiara Agrati
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Nicola Petrosillo
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Giuseppe Ippolito
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Francesco Vaia
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Enrico Girardi
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | | | - Andrea Antinori
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Sara Zito
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | | | - Amina Abdeddaim
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Elisabetta Agostini
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Chiara Agrati
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Fabrizio Albarello
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Gioia Amadei
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Alessandra Amendola
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Andrea Antinori
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | | | - Mario Antonini
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | | | - Francesco Baldini
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Raffaella Barbaro
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Barbara Bartolini
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Rita Bellagamba
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Martina Benigni
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Nazario Bevilacqua
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Gianluigi Biava
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Michele Bibas
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Licia Bordi
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Veronica Bordoni
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Evangelo Boumis
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Marta Branca
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Rosanna Buonomo
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Donatella Busso
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Marta Camici
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Paolo Campioni
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Flaminia Canichella
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | | | - Alessandro Capone
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Cinzia Caporale
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Emanuela Caraffa
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Ilaria Caravella
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Fabrizio Carletti
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Concetta Castilletti
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Adriana Cataldo
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Stefano Cerilli
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Carlotta Cerva
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Roberta Chiappini
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Pierangelo Chinello
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | | | - Carmine Ciaralli
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Claudia Cimaglia
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Nicola Cinicola
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Veronica Ciotti
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Stefania Cicalini
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Francesca Colavita
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Angela Corpolongo
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Massimo Cristofaro
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Salvatore Curiale
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Alessandra D'Abramo
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Cristina Dantimi
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Alessia De Angelis
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Giada De Angelis
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Maria Grazia De Palo
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Federico De Zottis
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Virginia Di Bari
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Rachele Di Lorenzo
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Federica Di Stefano
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Gianpiero D'Offizi
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Davide Donno
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | | | - Francesca Faraglia
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Anna Farina
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Federica Ferraro
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Lorena Fiorentini
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Andrea Frustaci
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Matteo Fusetti
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Vincenzo Galati
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Roberta Gagliardini
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Paola Gallì
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Gabriele Garotto
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Ilaria Gaviano
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | | | | | - Filippo Giansante
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Emanuela Giombini
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Guido Granata
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Maria Cristina Greci
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Elisabetta Grilli
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Susanna Grisetti
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Gina Gualano
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Fabio Iacomi
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Marta Iaconi
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | | | - Carlo Inversi
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Giuseppe Ippolito
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Eleonora Lalle
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Maria Elena Lamanna
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Simone Lanini
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Daniele Lapa
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Luciana Lepore
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Raffaella Libertone
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Raffaella Lionetti
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Giuseppina Liuzzi
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Laura Loiacono
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Andrea Lucia
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Franco Lufrani
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Manuela Macchione
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Gaetano Maffongelli
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Alessandra Marani
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Luisa Marchioni
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Andrea Mariano
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | | | - Micaela Maritti
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | | | - Ilaria Mastrorosa
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Giulia Matusali
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Valentina Mazzotta
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Paola Mencarini
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Silvia Meschi
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Francesco Messina
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Sibiana Micarelli
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Giulia Mogavero
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Annalisa Mondi
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Marzia Montalbano
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Chiara Montaldo
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Silvia Mosti
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Silvia Murachelli
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Maria Musso
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Michela Nardi
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Assunta Navarra
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Emanuele Nicastri
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Martina Nocioni
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Pasquale Noto
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Roberto Noto
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Alessandra Oliva
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Ilaria Onnis
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Sandrine Ottou
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Claudia Palazzolo
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Emanuele Pallini
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Fabrizio Palmieri
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Giulio Palombi
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Carlo Pareo
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Virgilio Passeri
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Federico Pelliccioni
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Giovanna Penna
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Antonella Petrecchia
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Ada Petrone
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Nicola Petrosillo
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Elisa Pianura
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Carmela Pinnetti
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Maria Pisciotta
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Pierluca Piselli
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Silvia Pittalis
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Agostina Pontarelli
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Costanza Proietti
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Vincenzo Puro
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | | | - Alessia Rianda
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Gabriele Rinonapoli
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Silvia Rosati
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Dorotea Rubino
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Martina Rueca
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Alberto Ruggeri
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Alessandra Sacchi
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | | | - Francesco Sanasi
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Carmen Santagata
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | | | - Silvana Scarcia
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Vincenzo Schininà
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Paola Scognamiglio
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Laura Scorzolini
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Giulia Stazi
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Giacomo Strano
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Fabrizio Taglietti
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Chiara Taibi
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Giorgia Taloni
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Tetaj Nardi
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Roberto Tonnarini
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Simone Topino
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Martina Tozzi
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Francesco Vaia
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Francesco Vairo
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Maria Beatrice Valli
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Alessandra Vergori
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Laura Vincenzi
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | | | - Serena Vita
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Pietro Vittozzi
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Mauro Zaccarelli
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Antonella Zanetti
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Sara Zito
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
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- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
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11
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Amele S, Peters L, Rodger A, Lundgren J, Rockstroh J, Matulionyte R, Leen C, Jabłonowska E, Østergaard L, Bhagani S, Sarcletti M, Clarke A, Falconer K, Wandeler G, Domingo P, Maltez F, Zaccarelli M, Chkhartisvili N, Szlavik J, Stephan C, Fonquernie L, Aho I, Mocroft A. Effectiveness and Safety of Interferon-Free Direct-Acting Antiviral Hepatitis C Virus Therapy in HIV/Hepatitis C Virus Coinfected Individuals: Results From a Pan-European Study. J Acquir Immune Defic Syndr 2021; 86:248-257. [PMID: 33079903 DOI: 10.1097/qai.0000000000002541] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 10/05/2020] [Indexed: 12/26/2022]
Abstract
OBJECTIVES To investigate the effectiveness, safety, and reasons for premature discontinuation of direct-acting antivirals (DAAs) in a diverse population of HIV/hepatitis C virus (HCV) coinfected individuals in Europe. METHODS All HIV/HCV coinfected individuals in the EuroSIDA study that started interferon free DAA treatment between January 6, 2014, and January 3, 2018, with ≥12 weeks of follow-up after treatment stop were included in this analysis. Sustained virological response (SVR) was defined as a negative HCV-RNA result ≥12 weeks after stopping treatment (SVR12). Logistic regression was used to explore factors associated with SVR12. RESULTS 1042 individuals started interferon-free DAA treatment after 1/6/2014 and were included, 862 (82.2%) had a known response to treatment, and 789 [91.5%, 95% confidence interval (CI): 89.7 to 93.4] of which achieved SVR12. There were no differences in SVR12 across regions of Europe (P = 0.84). After adjustment, the odds of achieving SVR12 was lower in individuals that received sofosbuvir/simeprevir ± ribavirin (RBV) [adjusted odds ratio 0.21 (95% CI: 0.08 to 0.53)] or ombitasvir/paritaprevir/dasabuvir ± RBV [adjusted odds ratio 0.46 (95% CI: 0.22 to 1.00)] compared with sofosbuvir/ledipasvir ± RBV. Forty-three (4.6%) individuals had one or more components of their HCV regimen stopped early, most commonly because of toxicity (n = 14); of these 14, 11 were treated with ribavirin. Increased bilirubin was the most common grade 3 or 4 laboratory adverse event (n = 15.3%) and was related to treatment with atazanavir and ribavirin. CONCLUSIONS Our findings from real-world data on HIV/HCV coinfected individuals across Europe show DAA treatment is well tolerated and that high rates of SVR12 can be achieved in all regions of Europe.
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Affiliation(s)
- Sarah Amele
- Institute for Global Health, University College London, London, United Kingdom
| | - Lars Peters
- CHIP, Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Alison Rodger
- Institute for Global Health, University College London, London, United Kingdom
| | - Jens Lundgren
- CHIP, Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Jurgen Rockstroh
- Department of Internal Medicine, University Hospital Bonn, Bonn, Germany
| | - Raimonda Matulionyte
- Vilnius University, Faculty of Medicine, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | | | | | | | - Sanjay Bhagani
- Royal Free and University College Medical School, London, United Kingdom
| | | | - Amanda Clarke
- Royal Sussex County Hospital, Brighton, United Kingdom
| | | | - Gilles Wandeler
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | | | - Mauro Zaccarelli
- Istituto Nazionale Malattie Infettive Lazzaro Spallanzani, Rome, Italy
| | | | | | | | | | - Inka Aho
- Helsinki University Hospital, Helsinki, Finland
| | - Amanda Mocroft
- Institute for Global Health, University College London, London, United Kingdom
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12
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Pigliacelli F, Donà MG, Giglio A, Cameli N, Morrone A, Zaccarelli M, Latini A. Did the coronavirus pandemic reveal old neglected infections? Int J Dermatol 2020; 59:1391-1392. [PMID: 33078398 DOI: 10.1111/ijd.15174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 08/13/2020] [Indexed: 11/30/2022]
Affiliation(s)
| | | | - Amalia Giglio
- Microbiology and Clinical Pathology, San Gallicano Dermatologic Institute IRCCS, Rome, Italy
| | - Norma Cameli
- STI/HIV Unit, San Gallicano Dermatologic Institute IRCCS, Rome, Italy
| | - Aldo Morrone
- Scientific Direction, San Gallicano Dermatologic Institute IRCCS, Rome, Italy
| | - Mauro Zaccarelli
- National Institute for Infectious Diseases "Lazzaro Spallanzani", Rome, Italy
| | - Alessandra Latini
- STI/HIV Unit, San Gallicano Dermatologic Institute IRCCS, Rome, Italy
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13
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Latini A, Donà MG, Giuliani M, Magri F, Zaccarelli M. Implications of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) epidemic for sexual behaviours of men who have sex with men. HIV Med 2020; 22:e7-e8. [PMID: 32892480 DOI: 10.1111/hiv.12954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 08/04/2020] [Indexed: 11/29/2022]
Affiliation(s)
- A Latini
- STI/HIV Unit, San Gallicano Dermatological Institute IRCCS, Rome, Italy
| | - M G Donà
- STI/HIV Unit, San Gallicano Dermatological Institute IRCCS, Rome, Italy
| | - M Giuliani
- STI/HIV Unit, San Gallicano Dermatological Institute IRCCS, Rome, Italy
| | - F Magri
- Department of Dermatology, Policlinico Umberto I, The Sapienza University of Rome, Rome, Italy
| | - M Zaccarelli
- Clinical Department, National Institute for the Infectious Diseases, Lazzaro Spallanzani, Rome, Italy
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14
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Gualano G, Musso M, Mosti S, Mencarini P, Mastrobattista A, Pareo C, Zaccarelli M, Migliorisi P, Vittozzi P, Zumla A, Ippolito G, Palmieri F. Usefulness of bronchoalveolar lavage in the management of patients presenting with lung infiltrates and suspect COVID-19-associated pneumonia: A case report. Int J Infect Dis 2020; 97:174-176. [PMID: 32437932 PMCID: PMC7211646 DOI: 10.1016/j.ijid.2020.05.027] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 05/04/2020] [Accepted: 05/07/2020] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE To report a clinical case of a patient with a compatible HRCT scan and two negative SARS-CoV-2 RNA upper respiratory tract specimens but with a confirmed viral infection by BAL (19 days after symptom onset). METHODS Revision of a patient's clinical charts with COVID-19 admitted at INMI L. Spallanzani Hospital RESULTS: Two oropharyngeal swab tests of SARS-CoV-2 by qualitative real-time reverse-transcriptase-polymerase-chain-reaction (RT-PCR) assay were performed at admission (17 days from symptoms onset) and a day apart and were found negative. BAL fluid collected 19 days after symptoms onset was positive for SARS-CoV-2. CONCLUSION This case highlights importance of clinical suspicion of SARS-CoV-2 infection in diagnosis and infectivity assessment. We suggest collection of BAL fluid when consecutive nasopharyngeal swabs are negative, to confirm or exclude the diagnosis of COVID-19-associated pneumonia. Healthcare workers should perform aerosol-generating procedures in an adequately ventilated room and should wear adequate PPE.
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Affiliation(s)
- Gina Gualano
- National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS, Rome, Italy.
| | - Maria Musso
- National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS, Rome, Italy.
| | - Silvia Mosti
- National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS, Rome, Italy.
| | - Paola Mencarini
- National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS, Rome, Italy.
| | | | - Carlo Pareo
- National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS, Rome, Italy.
| | - Mauro Zaccarelli
- National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS, Rome, Italy.
| | - Paolo Migliorisi
- National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS, Rome, Italy.
| | - Pietro Vittozzi
- National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS, Rome, Italy.
| | - Alimudin Zumla
- Department of Infection, Division of Infection and Immunity, Centre for Clinical Microbiology, University College London, London, United Kingdom; National Institute for Health Research Biomedical Research Centre, University College London Hospitals, London, United Kingdom.
| | - Giuseppe Ippolito
- National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS, Rome, Italy.
| | - Fabrizio Palmieri
- National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS, Rome, Italy.
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Latini A, Magri F, Donà MG, Giuliani M, Cristaudo A, Zaccarelli M. Is COVID-19 affecting the epidemiology of STIs? The experience of syphilis in Rome. Sex Transm Infect 2020; 97:78. [PMID: 32719105 DOI: 10.1136/sextrans-2020-054543] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 06/15/2020] [Accepted: 06/27/2020] [Indexed: 11/04/2022] Open
Affiliation(s)
- Alessandra Latini
- STI/HIV Unit, San Gallicano Dermatological Institute IRCCS, Roma, Italy
| | - Francesca Magri
- Department of Dermatology, Sapienza University of Rome, Roma, Italy
| | | | - Massimo Giuliani
- STI/HIV Unit, San Gallicano Dermatological Institute IRCCS, Roma, Italy
| | - Antonio Cristaudo
- STI/HIV Unit, San Gallicano Dermatological Institute IRCCS, Roma, Italy
| | - Mauro Zaccarelli
- Clinical Department, National Institute for Infectious Diseases, Lazzaro Spallanzani, IRCCS, Roma, Italy
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16
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Santoro MM, Di Carlo D, Armenia D, Zaccarelli M, Pinnetti C, Colafigli M, Prati F, Boschi A, Antoni AMD, Lagi F, Sighinolfi L, Gervasoni C, Andreoni M, Antinori A, Mussini C, Perno CF, Borghi V, Sterrantino G. Viro-immunological response of drug-naive HIV-1-infected patients starting a first-line regimen with viraemia >500,000 copies/ml in clinical practice. Antivir Ther 2019; 23:249-257. [PMID: 28935850 DOI: 10.3851/imp3197] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Virological success (VS) and immunological reconstitution (IR) of antiretroviral-naive HIV-1-infected patients with pre-therapy viral load (VL) >500,000 copies/ml was assessed after 12 months of treatment according to initial drug-class regimens. METHODS An observational multicentre retrospective study was performed. VS was defined as the first VL <50 copies/ml from treatment start. IR was defined as an increase of at least 150 CD4+ T-lymphocytes from treatment start. Survival analysis was used to estimate the probability and predictors of VS and IR by 12 months of therapy. RESULTS 428 HIV-1-infected patients were analysed. Patients were grouped according to the different first-line drug-classes used: a non-nucleoside reverse transcriptase inhibitor (NNRTI) plus two nucleoside reverse transcriptase inhibitors (NRTIs; NNRTI-group; n=105 [24.5%]); a protease inhibitor (PI) plus two NRTIs (PI-group; n=260 [60.8%]); a four-drug regimen containing a PI-regimen plus an integrase inhibitor (PI+INI-group; n=63 [14.7%]). Patients in the PI-group showed the lowest probability of VS (PI-group: 72.4%; NNRTI-group: 75.5%; PI+INI-group: 81.0%; P<0.0001). By Cox regression, patients in PI+INI and NNRTI-groups showed a higher adjusted hazard ratio (95% CI) of VS compared to those in the PI-group (PI+INI-group: 1.48 [1.08, 2.03]; P=0.014; NNRTI-group: 1.37 [1.06-1.78]; P=0.015). The probability of IR was 76.2%, and was similar among groups. Patients with AIDS showed a lower adjusted hazard ratio (95% CI) of IR compared to non-AIDS presenters (0.70 [0.54, 0.90]; P=0.005). CONCLUSIONS In this multicentre retrospective study, patients with viraemia >500,000 copies/ml who start a first-line regimen containing PI+INI or NNRTI yield a better VS compared to those receiving a PI-based regimen.
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Affiliation(s)
- Maria Mercedes Santoro
- Department of Experimental Medicine and Surgery, University of Rome 'Tor Vergata', Rome, Italy
| | - Domenico Di Carlo
- Department of Experimental Medicine and Surgery, University of Rome 'Tor Vergata', Rome, Italy
| | - Daniele Armenia
- Department of Experimental Medicine and Surgery, University of Rome 'Tor Vergata', Rome, Italy
| | - Mauro Zaccarelli
- Infectious Diseases Division, National Institute for Infectious Diseases L Spallanzani (IRCCS), Rome, Italy
| | - Carmela Pinnetti
- Infectious Diseases Division, National Institute for Infectious Diseases L Spallanzani (IRCCS), Rome, Italy
| | - Manuela Colafigli
- Clinic of Dermatology and Infectious Diseases, San Gallicano Dermatologic Institute (IRCCS), Rome, Italy
| | - Francesca Prati
- Infectious Diseases Unit, Azienda Ospedaliera di Reggio Emilia, Reggio Emilia, Italy
| | - Andrea Boschi
- Infectious Diseases Unit, Azienda Ospedaliera di Rimini, Rimini, Italy
| | | | - Filippo Lagi
- Department of Tropical and Infectious Diseases, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Laura Sighinolfi
- Infectious Diseases Unit, Azienda Ospedaliero-Universitaria di Ferrara, Ferrara, Italy
| | - Cristina Gervasoni
- Section of Infectious Diseases, L Sacco University Hospital, Milan, Italy
| | - Massimo Andreoni
- Department of Medicine of Systems, University of Rome 'Tor Vergata', Rome, Italy
| | - Andrea Antinori
- Infectious Diseases Division, National Institute for Infectious Diseases L Spallanzani (IRCCS), Rome, Italy
| | - Cristina Mussini
- Clinic of Infectious Diseases, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Carlo Federico Perno
- Antiretroviral Drugs Monitoring Unit, National Institute for Infectious Diseases L Spallanzani (IRCCS), Rome, Italy
| | - Vanni Borghi
- Clinic of Infectious Diseases, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Gaetana Sterrantino
- Department of Tropical and Infectious Diseases, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
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17
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Latini A, Dona' MG, Alei L, Colafigli M, Frasca M, Orsini D, Giuliani M, Morrone A, Cristaudo A, Zaccarelli M. Recreational drugs and STI diagnoses among patients attending an STI/HIV reference clinic in Rome, Italy. Sex Transm Infect 2019; 95:588-593. [PMID: 31101722 DOI: 10.1136/sextrans-2019-054043] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 04/30/2019] [Accepted: 05/05/2019] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND An observational study was conducted to assess recreational drug use in association with recent STIs among clients of an STI/HIV reference centre in Rome, Italy. METHODS Attendees self-compiled a questionnaire concerning sexual behaviours and drug use, including the nine drugs used for sex (amphetamines, poppers, cocaine, ketamine, erectile dysfunction agent (EDA), steroids and the three chemsex drugs, ie, chems: γ-hydroxybutyric acid/γ-butyrolactone, crystal and Mcat). RESULTS Overall, 703 patients participated, with men who have sex with men (MSM) accounting for 50.4% of the total and 73.2% of HIV-positive patients. Apart from condylomatosis, whose prevalence was higher among females (38.8%) and non-MSM (45.8%) than MSM (14.4%), STIs were more frequent among MSM, particularly syphilis (14.1%), gonorrhoea (4.8%), urethritis (3.4%) and hepatitis A (6.5%). Recreational drug use was significantly more frequent among MSM (39.8% vs 17.6% in females and 22.7% in non-MSM). A total of 26.3% of MSM used at least one of the nine drugs and 5.1% at least one of the three chems. Cocaine (13.3%) and poppers (13.0%) were the most used sex drugs in MSM.The use of any of the nine drugs was associated with being MSM (adjusted OR (AOR): 1.94, 95% CI 1.05 to 3.58), sex with partner contacted online (1.99, 95% CI 1.14 to 3.45), group sex (4.08, 95% CI 2.40 to 6.93) and STI in the last year (1.65, 95% CI 1.05 to 2.61). Use of any of the nine chems among MSM was associated with condomless sex (2.24, 95% CI 1.21 to 4.14), group sex (2.08, 95% CI 1.01 to 4.31) and STI diagnosis in the last year (4.08, 95% CI 2.32 to 7.19). CONCLUSIONS Our data suggest that recreational drug use is quite common among MSM in Italy. No evidence of association with STI was found among non-MSM and females, where only cannabis and cocaine use was reported. The use of chems is still limited, but cocaine, poppers and EDA are widely used among MSM. Recreational drug use appears associated with high-risk sexual behaviours and a higher risk of STI.
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Affiliation(s)
- Alessandra Latini
- STI/HIV Unit, San Gallicano Dermatological Institute IRCCS, Rome, Italy
| | | | - Lavinia Alei
- STI/HIV Unit, San Gallicano Dermatological Institute IRCCS, Rome, Italy
| | - Manuela Colafigli
- STI/HIV Unit, San Gallicano Dermatological Institute IRCCS, Rome, Italy
| | - Mirko Frasca
- STI/HIV Unit, San Gallicano Dermatological Institute IRCCS, Rome, Italy
| | - Diego Orsini
- STI/HIV Unit, San Gallicano Dermatological Institute IRCCS, Rome, Italy
| | - Massimo Giuliani
- STI/HIV Unit, San Gallicano Dermatological Institute IRCCS, Rome, Italy
| | - Aldo Morrone
- Scientific Direction, San Gallicano Dermatological Institute IRCCS, Rome, Italy
| | - Antonio Cristaudo
- STI/HIV Unit, San Gallicano Dermatological Institute IRCCS, Rome, Italy
| | - Mauro Zaccarelli
- Clinical Department, National Institute for the Infectious Diseases Lazzaro Spallanzani, Rome, Italy
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18
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Sterrantino G, Borghi V, Callegaro AP, Bruzzone B, Saladini F, Maggiolo F, Maffongelli G, Andreoni M, De Gennaro M, Gianotti N, Bagnarelli P, Vergori A, Antinori A, Zazzi M, Zaccarelli M. Prevalence of predicted resistance to doravirine in HIV-1-positive patients after exposure to non-nucleoside reverse transcriptase inhibitors. Int J Antimicrob Agents 2019; 53:515-519. [PMID: 30769200 DOI: 10.1016/j.ijantimicag.2019.02.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [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: 11/20/2018] [Revised: 01/29/2019] [Accepted: 02/06/2019] [Indexed: 11/17/2022]
Abstract
This study investigated the prevalence of doravirine (DOR) resistance mutations in non-nucleoside reverse transcriptase inhibitor (NNRTI)-experienced patients. DOR resistance was assessed in samples from NNRTI-experienced patients who underwent genotypic testing for virological failure from the Antiretroviral Response Cohort Analysis (ARCA) database. Intermediate DOR resistance was defined as detection of any of V106A/M, Y188C/H, V108I, and K103N+P225H. High-level DOR resistance was defined as detection of any of Y188L, M230L, G190E, V106A/M+F227L, and V106A/M+L234I. Overall, 6893 patients were included in the study: 64.2% had experienced efavirenz (EFV), 54.4% nevirapine (NVP), 6.8% etravirine (ETR), 7.7% rilpivirine (RPV) and 0.7% delavirdine. Among NNRTI-experienced patients, 12.7% and 6.1% of subjects had intermediate and high-level DOR resistance, respectively. The most common DOR resistance mutation was Y188L. In multivariable analysis, previous EFV use (OR = 1.52, 95% CI 1.15-2.02) and ETR use (OR = 1.91, 95% CI 1.34-2.73) were associated with detection of high-level DOR resistance, whilst RPV use was associated with a lower probability of high-level DOR resistance (OR = 0.39, 95% CI 0.22-0.71). Moreover, EFV use (OR = 1.76, 95% CI 1.19-2.58) and ETR use (OR = 1.72, 95% CI 1.10-2.68) were associated with detection of the Y188L mutation, whereas RPV use was not (OR = 0.16, 95% CI 0.05-0.50). In Italy, DOR resistance is uncommon among NNRTI-experienced patients, confirming a distinguishing resistance pattern within NNRTIs. However, previous EFV and ETR experience poses a higher risk of DOR resistance. These results support the use of DOR in NNRTI-experienced patients.
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Affiliation(s)
- Gaetana Sterrantino
- Tropical and Infectious Diseases Unit, Department of Clinical and Experimental Medicine, Università degli studi di Firenze, Largo Brambilla 3, 50134 Florence, Italy.
| | - Vanni Borghi
- Department of Infectious Diseases, Università di Modena, Modena, Italy
| | - Anna Paola Callegaro
- Microbiology and Virology Unit, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy
| | - Bianca Bruzzone
- Hygiene Unit, Azienda Ospedaliera-Universitaria San Martino, Genoa, Italy
| | - Francesco Saladini
- Department of Medical Biotechnologies, Università di Siena, Siena, Italy
| | - Franco Maggiolo
- Department of Infectious Diseases, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy
| | | | - Massimo Andreoni
- Department of Infectious Diseases, Università di Tor Vergata, Rome, Italy
| | | | - Nicola Gianotti
- Department of Infectious Diseases, Ospedale San Raffaele, Milan, Italy
| | - Patrizia Bagnarelli
- Virology Unit, Azienda Ospedaliera Universitaria Ospedali Riuniti di Ancona, Ancona, Italy
| | - Alessandra Vergori
- Clinical Department, Istituto Nazionale per le Malattie Infettive 'Lazzaro Spallanzani', IRCCS, Rome, Italy
| | - Andrea Antinori
- Clinical Department, Istituto Nazionale per le Malattie Infettive 'Lazzaro Spallanzani', IRCCS, Rome, Italy
| | - Maurizio Zazzi
- Department of Medical Biotechnologies, Università di Siena, Siena, Italy
| | - Mauro Zaccarelli
- Clinical Department, Istituto Nazionale per le Malattie Infettive 'Lazzaro Spallanzani', IRCCS, Rome, Italy
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Giancola ML, Balestra P, Ammassari A, Ricottini M, Lorenzini P, Angeletti C, Bellagamba R, Tommasi C, Tempestilli M, Zaccarelli M, Pinnetti C, Gallo AL, Antinori A, Narciso P, Nicastri E. Prevalence and Associated Factors of Neurocognitive Impairment in HIV-Positive Patients on Effective Efavirenz/Emtricitabine/Tenofovir Disoproxil Fumarate Treatment. AIDS Res Hum Retroviruses 2018; 34:907-908. [PMID: 29929374 DOI: 10.1089/aid.2018.0074] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Affiliation(s)
| | | | - Adriana Ammassari
- National Institute for Infectious Diseases “Lazzaro Spallanzani”, IRCCS, Rome, Italy
| | - Martina Ricottini
- National Institute for Infectious Diseases “Lazzaro Spallanzani”, IRCCS, Rome, Italy
| | - Patrizia Lorenzini
- National Institute for Infectious Diseases “Lazzaro Spallanzani”, IRCCS, Rome, Italy
| | - Claudio Angeletti
- National Institute for Infectious Diseases “Lazzaro Spallanzani”, IRCCS, Rome, Italy
| | - Rita Bellagamba
- National Institute for Infectious Diseases “Lazzaro Spallanzani”, IRCCS, Rome, Italy
| | - Chiara Tommasi
- National Institute for Infectious Diseases “Lazzaro Spallanzani”, IRCCS, Rome, Italy
| | - Massimo Tempestilli
- National Institute for Infectious Diseases “Lazzaro Spallanzani”, IRCCS, Rome, Italy
| | - Mauro Zaccarelli
- National Institute for Infectious Diseases “Lazzaro Spallanzani”, IRCCS, Rome, Italy
| | - Carmela Pinnetti
- National Institute for Infectious Diseases “Lazzaro Spallanzani”, IRCCS, Rome, Italy
| | - Anna Loredana Gallo
- National Institute for Infectious Diseases “Lazzaro Spallanzani”, IRCCS, Rome, Italy
| | - Andrea Antinori
- National Institute for Infectious Diseases “Lazzaro Spallanzani”, IRCCS, Rome, Italy
| | - Pasquale Narciso
- National Institute for Infectious Diseases “Lazzaro Spallanzani”, IRCCS, Rome, Italy
| | - Emanuele Nicastri
- National Institute for Infectious Diseases “Lazzaro Spallanzani”, IRCCS, Rome, Italy
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20
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Giuliani M, Latini A, Colafigli M, Benevolo M, Rollo F, Zaccarelli M, Giuliani E, Moretto D, Giglio A, Rezza G, Cristaudo A, Donà MG. Vaccine-preventable anal infections by human papillomavirus among HIV-infected men who have sex with men. Future Microbiol 2018; 13:1463-1472. [PMID: 30311788 DOI: 10.2217/fmb-2018-0149] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM HIV-infected men who have sex with men (MSM) show the highest prevalence of anal HPV infection. Anal prevalence of the HPVs targeted by the quadrivalent HPV vaccine (4vHPV) and nonavalent HPV vaccine (9vHPV) was estimated in this population. MATERIALS & METHODS Anal specimens were collected from HIV-infected MSM attending a sexually transmitted infection/HIV center. Specimens were analyzed using the Linear Array HPV Genotyping Test. RESULTS A total of 49.5 and 71.2% of the 313 enrolled MSM harbored at least one of the 4vHPV and 9vHPV types, respectively. A significantly decreasing trend was observed for the prevalence of both 4vHPV (p = 0.04) and 9vHPV types (p < 0.001) across age classes. CONCLUSION A substantial proportion of HIV-infected MSM do not harbor a current anal infection with vaccine-preventable HPVs. The potential benefit of the 4vHPV versus 9vHPV vaccination in these subjects, including older MSM, should be investigated.
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Affiliation(s)
- Massimo Giuliani
- HIV/STI Unit, Clinical and Experimental Dermatology Department, San Gallicano Dermatological Institute IRCCS, Via Elio Chianesi 53, 00144, Rome, Italy
| | - Alessandra Latini
- HIV/STI Unit, Clinical and Experimental Dermatology Department, San Gallicano Dermatological Institute IRCCS, Via Elio Chianesi 53, 00144, Rome, Italy
| | - Manuela Colafigli
- HIV/STI Unit, Clinical and Experimental Dermatology Department, San Gallicano Dermatological Institute IRCCS, Via Elio Chianesi 53, 00144, Rome, Italy
| | - Maria Benevolo
- Pathology Department, Regina Elena National Cancer Institute IRCCS, Via Elio Chianesi 53, 00144, Rome, Italy
| | - Francesca Rollo
- Pathology Department, Regina Elena National Cancer Institute IRCCS, Via Elio Chianesi 53, 00144, Rome, Italy
| | - Mauro Zaccarelli
- Clinical and Research Department, Istituto Nazionale Malattie Infettive INMI Lazzaro Spallanzani IRCCS, Via Portuense, 292, 00149, Rome, Italy
| | - Eugenia Giuliani
- Department of Molecular Medicine, Sapienza University, Viale Regina Elena, 291-293 00161, Rome, Italy
| | - Domenico Moretto
- Microbiology & Clinical Pathology Department, San Gallicano Dermatological Institute IRCCS, Via Elio Chianesi 53, 00144, Rome, Italy
| | - Amalia Giglio
- Microbiology & Clinical Pathology Department, San Gallicano Dermatological Institute IRCCS, Via Elio Chianesi 53, 00144, Rome, Italy
| | - Giovanni Rezza
- Department of Infectious, Parasitic & Immune-mediated Diseases, Istituto Superiore di Sanità, Viale Regina Elena 299, 00141, Rome, Italy
| | - Antonio Cristaudo
- HIV/STI Unit, Clinical and Experimental Dermatology Department, San Gallicano Dermatological Institute IRCCS, Via Elio Chianesi 53, 00144, Rome, Italy
| | - Maria G Donà
- HIV/STI Unit, Clinical and Experimental Dermatology Department, San Gallicano Dermatological Institute IRCCS, Via Elio Chianesi 53, 00144, Rome, Italy
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Castagna A, Ferrara M, Galli L, Comi L, Sterrantino G, Cenderello G, Zaccarelli M, Focà E, Roncadori A, Lazzarin A. Long-term efficacy of dolutegravir in treatment-experienced subjects failing therapy with HIV-1 integrase strand inhibitor-resistant virus. J Antimicrob Chemother 2018; 73:177-182. [PMID: 29077927 DOI: 10.1093/jac/dkx371] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Accepted: 09/12/2017] [Indexed: 11/14/2022] Open
Abstract
Objectives This study evaluated the virological efficacy of dolutegravir 50 mg twice daily in 190 HIV-1 failing antiretroviral-experienced patients with previous exposure to first-generation integrase strand transfer inhibitor (INSTI) over a 5 year follow-up using data from clinical practice. Patients and methods This analysis included HIV-1-infected patients who were ≥18 years of age, treatment experienced, had HIV-1 RNA >50 copies/mL, with INSTI-resistant virus, who started dolutegravir 50 mg twice daily plus optimized background therapy (OBT), recorded in the national prospective database PRESTIGIO (www.progettoprestigio.it). Follow-up accrued from the start of dolutegravir 50 mg twice daily + OBT until virological failure (VF) or dolutegravir discontinuation for any reason or the last treatment visit on dolutegravir 50 mg twice daily treatment. VF was defined by the lack of achievement of HIV-1 RNA <50 copies/mL by 6 months and thereafter, or the occurrence of two consecutive HIV-1 RNA ≥50 copies/mL after achievement of undetectable viral load. Results The estimated VF probabilities were 17% (95% CI = 12%-24%), 28% (95% CI = 21%-37%), 33% (95% CI = 25%-43%), 39% (95% CI = 29%-51%) and 52% (95% CI = 39%-67%) at 12, 24, 36, 48 and 60 months since baseline, respectively. A higher risk of VF was independently associated with baseline viral load >100000 copies/mL (adjusted HR = 4.73, 95% CI = 1.33-16.78, P = 0.016) and with ≥1 INSTI mutations plus Q148H/K/R/N and the G140S/A/C as compared with other subjects (adjusted HR = 4.18, 95% CI = 1.32-13.23, P = 0.015). Conclusions Our data showed a favourable long-term efficacy of dolutegravir 50 mg twice daily in association with OBT in treatment-experienced failing subjects, with INSTI-resistant virus, in the real world. A close monitoring of adherence is crucial for maintenance of virological response in this fragile subgroup of subjects.
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Affiliation(s)
- Antonella Castagna
- Clinic of Infectious Diseases, Vita-Salute San Raffaele University, Milano, Italy
| | - Micol Ferrara
- Unit of Infectious Diseases, Department of Medical Sciences, University of Torino, Torino, Italy
| | - Laura Galli
- Clinic of Infectious Diseases, Istituto Scientifico San Raffaele, Milano, Italy
| | - Laura Comi
- Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy
| | | | | | - Mauro Zaccarelli
- Istituto Nazionale per le Malattie Infettive, Lazzaro Spallanzani, IRCCS, Roma, Italy
| | - Emanuele Focà
- Università degli Studi di Brescia - Spedali Civili di Brescia, Brescia, Italy
| | - Andrea Roncadori
- Healthcare Systems Department, CINECA, Casalecchio di Reno, Bologna, Italy
| | - Adriano Lazzarin
- Clinic of Infectious Diseases, Istituto Scientifico San Raffaele, Milano, Italy
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Tempestilli M, Fabbri G, Mastrorosa I, Timelli L, Notari S, Bellagamba R, Libertone R, Lupi F, Zaccarelli M, Antinori A, Agrati C, Ammassari A. Plasma trough concentrations of antiretrovirals in HIV-infected persons treated with direct-acting antiviral agents for hepatitis C in the real world. J Antimicrob Chemother 2018; 73:160-164. [PMID: 29106584 DOI: 10.1093/jac/dkx348] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Accepted: 08/28/2017] [Indexed: 12/14/2022] Open
Abstract
Background Possible drug-drug interactions (DDIs) between antiretrovirals (ARVs) and direct-acting antiviral agents (DAAs) are of some concern. Objectives To investigate ARV plasma trough concentrations (Ctrough) before and during DAAs in patients treated in the real world. Methods Single-centre, prospective, observational study including HIV/HCV coinfected persons undergoing DAA treatment. Self-reported adherence was assessed and ARVs Ctrough measured by HPLC-UV. Blood samples were collected before and after 2 months of DAA treatment. Results One-hundred and thirty-seven patients were included: 21.2% treated with ombitasvir/paritaprevir/ritonavir ± dasabuvir (2D/3D) and 78.8% with sofosbuvir-based regimens. Suboptimal Ctrough before and during DAA was found, respectively, in 3 (10.3%) and 3 (10.3%) cases treated with 2D/3D, and 16 (14.8%) and 11 (10.2%) with sofosbuvir-based regimens, even if self-reported ARV adherence was always ≥93%. In 2D/3D-treated patients, median darunavir Ctrough during DAAs was significantly lower than observed before DAAs [1125 ng/mL (IQR, 810-1616) versus 1903 ng/mL (IQR 1387-3983), respectively] (n = 5; P = 0.009), with a 40.9% decrease. In the same group, no differences in atazanavir or raltegravir concentrations were found. In patients treated with sofosbuvir-based regimens, Ctrough of all ARVs were similar before and during DAAs. Conclusions In the real world of HIV/HCV coinfected patients, ARV plasma concentrations during DAAs were generally not different from those found before anti-HCV treatment. Although assessed in a small number of patients, darunavir concentrations during 2D/3D showed a significant reduction when compared with those found before DAAs. ARV plasma concentrations measurement during anti-HCV treatment may give useful information for managing HIV/HCV coinfected persons receiving treatment for both infections.
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Affiliation(s)
- Massimo Tempestilli
- Cellular Immunology and Pharmacology Laboratory, National Institute for Infectious Diseases "L. Spallanzani" IRCCS, Via Portuense 292, 00149, Rome, Italy
| | - Gabriele Fabbri
- Clinical Department, National Institute for Infectious Diseases "L. Spallanzani" IRCCS, Via Portuense 292, 00149, Rome, Italy
| | - Ilaria Mastrorosa
- Clinical Department, National Institute for Infectious Diseases "L. Spallanzani" IRCCS, Via Portuense 292, 00149, Rome, Italy
| | - Laura Timelli
- Clinical Department, National Institute for Infectious Diseases "L. Spallanzani" IRCCS, Via Portuense 292, 00149, Rome, Italy
| | - Stefania Notari
- Cellular Immunology and Pharmacology Laboratory, National Institute for Infectious Diseases "L. Spallanzani" IRCCS, Via Portuense 292, 00149, Rome, Italy
| | - Rita Bellagamba
- Clinical Department, National Institute for Infectious Diseases "L. Spallanzani" IRCCS, Via Portuense 292, 00149, Rome, Italy
| | - Raffaella Libertone
- Clinical Department, National Institute for Infectious Diseases "L. Spallanzani" IRCCS, Via Portuense 292, 00149, Rome, Italy
| | - Federico Lupi
- Clinical Department, National Institute for Infectious Diseases "L. Spallanzani" IRCCS, Via Portuense 292, 00149, Rome, Italy
| | - Mauro Zaccarelli
- Clinical Department, National Institute for Infectious Diseases "L. Spallanzani" IRCCS, Via Portuense 292, 00149, Rome, Italy
| | - Andrea Antinori
- Clinical Department, National Institute for Infectious Diseases "L. Spallanzani" IRCCS, Via Portuense 292, 00149, Rome, Italy
| | - Chiara Agrati
- Cellular Immunology and Pharmacology Laboratory, National Institute for Infectious Diseases "L. Spallanzani" IRCCS, Via Portuense 292, 00149, Rome, Italy
| | - Adriana Ammassari
- Clinical Department, National Institute for Infectious Diseases "L. Spallanzani" IRCCS, Via Portuense 292, 00149, Rome, Italy
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Saracino A, Zaccarelli M, Lorenzini P, Bandera A, Marchetti G, Castelli F, Gori A, Girardi E, Mussini C, Bonfanti P, Ammassari A, d'Arminio Monforte A. Impact of social determinants on antiretroviral therapy access and outcomes entering the era of universal treatment for people living with HIV in Italy. BMC Public Health 2018; 18:870. [PMID: 30005709 PMCID: PMC6044027 DOI: 10.1186/s12889-018-5804-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [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: 04/13/2018] [Accepted: 07/05/2018] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Social determinants are known to be a driving force of health inequalities, even in high income countries. Aim of our study was to determine if these factors can limit antiretroviral therapy (ART) access, outcome and retention in care of people living with HIV (PLHIV) in Italy. METHODS All ART naïve HIV+ patients (pts) of Italian nationality enrolled in the ICONA Cohort from 2002 to 2016 were included. The association of socio-demographic characteristics (age, sex, risk factor for HIV infection, educational level, occupational status and residency area) with time to: ART initiation (from the first positive anti-HIV test), ART regimen discontinuation, and first HIV-RNA < 50 cp/mL, were evaluated by Cox regression analysis, Kaplan Meier method and log-rank test. RESULTS A total of 8023 HIV+ pts (82% males, median age at first pos anti-HIV test 36 years, IQR: 29-44) were included: 6214 (77.5%) started ART during the study period. Women, people who inject drugs (PWID) and residents in Southern Italy presented the lowest levels of education and the highest rate of unemployment compared to other groups. Females, pts aged > 50 yrs., unemployed vs employed, and people with lower educational levels presented the lowest CD4 count at ART initiation compared to other groups. The overall median time to ART initiation was 0.6 years (yrs) (IQR 0.1-3.7), with a significant decrease over time [2002-2006 = 3.3 yrs. (0.2-9.4); 2007-2011 = 1.0 yrs. (0.1-3.9); 2012-2016 = 0.2 yrs. (0.1-2.1), p < 0.001]. By multivariate analysis, females (p < 0.01) and PWID (p < 0.001), presented a longer time to ART initiation, while older people (p < 0.001), people with higher educational levels (p < 0.001), unemployed (p = 0.02) and students (p < 0.001) were more likely to initiate ART. Moreover, PWID, unemployed vs stable employed, and pts. with lower educational levels showed a lower 1-year probability of achieving HIV-RNA suppression, while females, older patients, men who have sex with men (MSM), unemployed had higher 1-year risk of first-line ART discontinuation. CONCLUSIONS Despite median time to ART start decreased from 2002 to 2016, socio-demographic factors still contribute to disparities in ART initiation, outcome and durability.
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Affiliation(s)
- Annalisa Saracino
- Clinic of Infectious Diseases, University of Bari, Piazza G. Cesare, 11 -, 70124, Bari, Italy.
| | - Mauro Zaccarelli
- Clinical Department, National Institute for Infectious Diseases "Lazzaro Spallanzani" IRCCS, Rome, Italy
| | - Patrizia Lorenzini
- Clinical Department, National Institute for Infectious Diseases "Lazzaro Spallanzani" IRCCS, Rome, Italy
| | - Alessandra Bandera
- Clinic of Infectious Diseases, "San Gerardo" Hospital - University of Milano-Bicocca, Monza, Italy
| | - Giulia Marchetti
- Clinic of Infectious Diseases, San Paolo Hospital, University of Milan, Milan, Italy
| | - Francesco Castelli
- University Division of Infectious and Tropical Diseases, University of Brescia and Spedali Civili General Hospital, Brescia, Italy
| | - Andrea Gori
- Infectious Diseases Unit, Department of Internal Medicine, IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Enrico Girardi
- Department of Epidemiology, National Institute for Infectious Diseases "L. Spallanzani," IRCCS, Rome, Italy
| | - Cristina Mussini
- Clinic of Infectious Diseases, University of Modena and Reggio Emilia, Modena, Italy
| | - Paolo Bonfanti
- Unit of Infectious Diseases, ASST Lecco, "A. Manzoni" Hospital, Lecco, Italy
| | - Adriana Ammassari
- Clinical Department, National Institute for Infectious Diseases "Lazzaro Spallanzani" IRCCS, Rome, Italy
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24
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Fabbri G, Mastrorosa I, Vergori A, Timelli L, Lorenzini P, Zaccarelli M, Cicalini S, Bellagamba R, Plazzi MM, Mazzotta V, Antinori A, Ammassari A. Liver stiffness reduction and serum fibrosis score improvement in HIV/hepatitis C virus-coinfected patients treated with direct-acting antivirals. HIV Med 2018; 19:578-584. [PMID: 29953713 DOI: 10.1111/hiv.12632] [Citation(s) in RCA: 12] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/22/2018] [Indexed: 12/30/2022]
Abstract
OBJECTIVES Only a few studies have addressed liver stiffness dynamics after hepatitis C virus (HCV) treatment in patients with HIV/HCV coinfection. The aim was to evaluate the variation in liver stiffness and in serum liver fibrosis scores in HIV/HCV-coinfected patients before and after treatment with direct-acting antivirals (DAAs). METHODS Liver stiffness measured using transient elastography as well as serum liver fibrosis scores [fibrosis-4 (FIB-4) score and the aspartate aminotransferase to platelet ratio index (APRI)] were evaluated before and at 6-12 months after DAA treatment. Variation in the outcome variables was evaluated using the Wilcoxon nonparametric test. Univariate analysis and multivariate regression models were used. RESULTS A total of 78 HIV/HCV-coinfected subjects were included in the study. Median values of hepatic stiffness significantly decreased after DAA treatment compared with baseline [16.8 (interquartile range (IQR) 10.2-27.0) kPa at baseline vs. 9.4 (IQR 6.7-15.0) kPa after DAA treatment; P < 0.01). Further, a decrease in median FIB-4 score [2.8 (IQR 1.5-4.8) vs. 2.0 (IQR 1.3-3.2), respectively; P < 0.01] and APRI [0.9 (IQR 0.5-2.2) vs. 0.4 (IQR 0.2-0.7), respectively; P < 0.01] was found. In univariate analysis, liver stiffness decrease was associated with increasing age, 'other' HCV genotype (vs. G1), the presence of cirrhosis, higher pre-DAA liver stiffness, sofosbuvir-based regimens and longer DAA treatment (all P < 0.05). Multivariate regression confirmed the significance of the association only with higher baseline liver stiffness (P < 0.01). Greater FIB-4 and APRI reductions were associated with higher respective baseline values, while the presence of hepatic steatosis correlated with lower score reduction after DAA. CONCLUSIONS A reduction in liver stiffness and an improvement in fibrosis scores were observed in HIV/HCV-coinfected patients soon after DAA treatment. The clinical implications of these observations need to be evaluated in larger populations with longer follow-up.
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Affiliation(s)
- G Fabbri
- Clinical Department, HIV/AIDS Unit, National Institute for Infectious Diseases 'L. Spallanzani', IRCCS, Rome, Italy
| | - I Mastrorosa
- Clinical Department, HIV/AIDS Unit, National Institute for Infectious Diseases 'L. Spallanzani', IRCCS, Rome, Italy
| | - A Vergori
- Clinical Department, HIV/AIDS Unit, National Institute for Infectious Diseases 'L. Spallanzani', IRCCS, Rome, Italy
| | - L Timelli
- Clinical Department, HIV/AIDS Unit, National Institute for Infectious Diseases 'L. Spallanzani', IRCCS, Rome, Italy
| | - P Lorenzini
- Clinical Department, HIV/AIDS Unit, National Institute for Infectious Diseases 'L. Spallanzani', IRCCS, Rome, Italy
| | - M Zaccarelli
- Clinical Department, HIV/AIDS Unit, National Institute for Infectious Diseases 'L. Spallanzani', IRCCS, Rome, Italy
| | - S Cicalini
- Clinical Department, HIV/AIDS Unit, National Institute for Infectious Diseases 'L. Spallanzani', IRCCS, Rome, Italy
| | - R Bellagamba
- Clinical Department, HIV/AIDS Unit, National Institute for Infectious Diseases 'L. Spallanzani', IRCCS, Rome, Italy
| | - M M Plazzi
- Clinical Department, HIV/AIDS Unit, National Institute for Infectious Diseases 'L. Spallanzani', IRCCS, Rome, Italy
| | - V Mazzotta
- Clinical Department, HIV/AIDS Unit, National Institute for Infectious Diseases 'L. Spallanzani', IRCCS, Rome, Italy
| | - A Antinori
- Clinical Department, HIV/AIDS Unit, National Institute for Infectious Diseases 'L. Spallanzani', IRCCS, Rome, Italy
| | - A Ammassari
- Clinical Department, HIV/AIDS Unit, National Institute for Infectious Diseases 'L. Spallanzani', IRCCS, Rome, Italy
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Taramasso L, Di Biagio A, Maggiolo F, Tavelli A, Lo Caputo S, Bonora S, Zaccarelli M, Caramello P, Costantini A, Viscoli C, d'Arminio Monforte A, Cozzi-Lepri A. First-line antiretroviral therapy with efavirenz plus tenofovir disiproxil fumarate/emtricitabine or rilpivirine plus tenofovir disiproxil fumarate/emtricitabine: a durability comparison. HIV Med 2018; 19:475-484. [PMID: 29846042 DOI: 10.1111/hiv.12628] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The aim of this study was to compare the durabilities of efavirenz (EFV) and rilpivirine (RPV) in combination with tenofovir/emtricitabine (TDF/FTC) in first-line regimens. METHODS A multicentre prospective and observational study was carried out. We included all patients participating in the Italian Cohort Naive Antiretrovirals (ICONA) Foundation Study who started first-line combination antiretroviral therapy (cART) with TDF/FTC in combination with RPV or EFV, with a baseline viral load < 100 000 HIV-1 RNA copies/mL. Survival analyses using Kaplan-Meier (KM) curves and Cox regression with time-fixed covariates at baseline were employed. RESULTS Overall, 1490 ART-naïve patients were included in the study, of whom 704 were initiating their first cART with EFV and 786 with RPV. Patients treated with EFV, compared with those on RPV, were older [median 36 (interquartile range (IQR) 30-43) years vs. 33 (IQR 27-39) years, respectively; P < 0.001], were more frequently at Centers for Disease Control and Prevention (CDC) stage C (3.1% vs. 1.4%, respectively; P = 0.024), and had a lower median baseline CD4 count [340 (IQR 257-421) cells/μL vs. 447 (IQR 347-580) cells/μL, respectively; P < 0.001] and a higher median viral load [4.38 (IQR 3.92-4.74) log10 copies/mL vs. 4.23 (IQR 3.81-4.59) log10 copies/mL, respectively], (P = 0.004). A total of 343 patients discontinued at least one drug of those included in the first cART regimen, more often EFV (26%) than RPV (13%), by 2 years (P < 0.0001). After adjustment, patients treated with EFV were more likely to discontinue at least one drug for any cause [relative hazard (RH) 4.09; 95% confidence interval (CI) 2.89-5.80], for toxicity (RH 2.23; 95% CI 1.05-4.73) for intolerance (RH 5.17; 95% CI 2.66-10.07) and for proactive switch (RH 10.96; 95% CI 3.17-37.87) than those starting RPV. CONCLUSIONS In our nonrandomized comparison, RPV was better tolerated, less toxic and showed longer durability than EFV, without a significant difference in rates of discontinuation because of failures.
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Affiliation(s)
- L Taramasso
- Infectious Disease Clinic, Policlinico Hospital San Martino, University of Genoa, Genoa, Italy
| | - A Di Biagio
- Infectious Disease Clinic, Policlinico Hospital San Martino, Genoa, Italy
| | - F Maggiolo
- Division of Infectious Diseases, ASST Papa Giovanni XXIII, Bergamo, Italy
| | | | - S Lo Caputo
- Infectious Diseases Clinic, Policlinico Hospital Giovanni XXIII, Bari, Italy
| | - S Bonora
- Unit of Infectious Diseases, Department of Medical Sciences, University of Torino, Torino, Italy
| | - M Zaccarelli
- National Institute of Infectious Diseases Lazzaro Spallanzani, Rome, Italy
| | - P Caramello
- Department of Infectious Diseases, Amedeo di Savoia Hospital, Torino, Italy
| | - A Costantini
- Department of Health Sciences, University of Ancona, Ancona, Italy
| | - C Viscoli
- Infectious Disease Clinic, Policlinico Hospital San Martino, University of Genoa, Genoa, Italy
| | - A d'Arminio Monforte
- Department of Health Sciences, Clinic of Infectious and Tropical Diseases, S Paolo Hospital, University of Milan, Milan, Italy
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Donà MG, Benevolo M, Latini A, Rollo F, Colafigli M, Frasca M, Zaccarelli M, Giglio A, Moretto D, Pescarmona E, Cristaudo A, Giuliani M. Anal cytological lesions and HPV infection in individuals at increased risk for anal cancer. Cancer Cytopathol 2018; 126:461-470. [PMID: 29694716 DOI: 10.1002/cncy.22003] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 03/20/2018] [Accepted: 03/30/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND Anal cytology may be useful for evaluating lesions associated with human papillomavirus (HPV) in individuals at increased risk for anal cancer. METHODS Liquid-based cytology was used to assess anal cytological lesions among human immunodeficiency virus (HIV)-infected and HIV-uninfected men who have sex with men (MSM). The Linear Array HPV genotyping test was used for HPV detection. RESULTS This cross-sectional study included 1021 MSM, of whom 388 were HIV-infected (38.0%). Anal cytological lesions (atypical squamous cells of undetermined significance or more severe [ASCUS+]) were observed in 32.5% and 53.2% of the HIV-uninfected and HIV-infected individuals, respectively (P < .0001). The highest ASCUS + prevalence was observed among ≥45-year-old HIV-uninfected MSM (37.3%) and 25-to 29-year-old HIV-infected MSM (66.7%). High-grade squamous intraepithelial lesions (HSILs) peaked in ≥ 45-year-old HIV-uninfected subjects and 35- to 39-year-old HIV-infected subjects. Individuals with anal infections with high-risk (HR) HPV types were 3 to 4 times more likely to have an ASCUS + report. An HPV-16 and/or HPV-18 infection increased the odds of HSIL or more severe cytology (HSIL+) for HIV-infected MSM almost 4 times. MSM concurrently infected with HR and low-risk HPVs were significantly more likely to have low-grade squamous intraepithelial lesions or more severe cytology (LSIL+) than those infected with only HR types. No significant associations were found between cytological abnormalities and the HIV load and nadir and current CD4 + counts. CONCLUSIONS The prevalence of anal cytological lesions is high in MSM, even in HIV-infected individuals treated with combined antiretroviral therapy. In these subjects, HSILs occur more frequently and at a younger age in comparison with HIV-uninfected counterparts. Specific diagnostic procedures should be implemented to manage individuals at increased risk for anal cancer with an abnormal anal Papanicolaou test. Cancer Cytopathol 2018. © 2018 American Cancer Society.
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Affiliation(s)
- Maria Gabriella Donà
- Sexually Transmitted Infection/Human Immunodeficiency Virus Unit, San Gallicano Dermatological Institute, IFO-IRCCS, Rome, Italy
| | - Maria Benevolo
- Pathology Department, Regina Elena National Cancer Institute, IFO-IRCCS, Rome, Italy
| | - Alessandra Latini
- Sexually Transmitted Infection/Human Immunodeficiency Virus Unit, San Gallicano Dermatological Institute, IFO-IRCCS, Rome, Italy
| | - Francesca Rollo
- Pathology Department, Regina Elena National Cancer Institute, IFO-IRCCS, Rome, Italy
| | - Manuela Colafigli
- Sexually Transmitted Infection/Human Immunodeficiency Virus Unit, San Gallicano Dermatological Institute, IFO-IRCCS, Rome, Italy
| | - Mirko Frasca
- Sexually Transmitted Infection/Human Immunodeficiency Virus Unit, San Gallicano Dermatological Institute, IFO-IRCCS, Rome, Italy
| | - Mauro Zaccarelli
- Clinical Department, Lazzaro Spallanzani National Institute for Infectious Diseases, IRCCS, Rome, Italy
| | - Amalia Giglio
- Microbiology and Clinical Pathology Department, San Gallicano Dermatological Institute, IFO-IRCCS, Rome, Italy
| | - Domenico Moretto
- Microbiology and Clinical Pathology Department, San Gallicano Dermatological Institute, IFO-IRCCS, Rome, Italy
| | - Edoardo Pescarmona
- Pathology Department, Regina Elena National Cancer Institute, IFO-IRCCS, Rome, Italy
| | - Antonio Cristaudo
- Sexually Transmitted Infection/Human Immunodeficiency Virus Unit, San Gallicano Dermatological Institute, IFO-IRCCS, Rome, Italy
| | - Massimo Giuliani
- Sexually Transmitted Infection/Human Immunodeficiency Virus Unit, San Gallicano Dermatological Institute, IFO-IRCCS, Rome, Italy
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Armenia D, Zaccarelli M, Borghi V, Gennari W, Di Carlo D, Giannetti A, Forbici F, Bertoli A, Gori C, Fabeni L, Pinnetti C, Marocco R, Latini A, Ceccherini-Silberstein F, Mastroianni CM, Mussini C, Antinori A, Perno CF, Santoro MM. Resistance detected in PBMCs predicts virological rebound in HIV-1 suppressed patients switching treatment. J Clin Virol 2018; 104:61-64. [PMID: 29738896 DOI: 10.1016/j.jcv.2018.04.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Accepted: 04/02/2018] [Indexed: 01/14/2023]
Abstract
BACKGROUND Genotypic resistance test (GRT) performed in peripheral blood mononuclear cells (PBMC) represents a chance to evaluate resistance in virologically suppressed HIV infected patients. OBJECTIVES To evaluate the impact of baseline resistance detected through PBMC GRT on virological rebound after switching treatment. STUDY DESIGN Baseline genotypic susceptibility scores (GSS) from PBMC GRT (DNA-GSS) and from previous cumulative plasma GRTs (when available, pRNA-GSS) were evaluated. Survival analysis was used to assess the probability and predictors of virological rebound (VR). RESULTS 227 virologically suppressed patients were analysed. Twenty-four months after switching therapy, the probability of VR was 15.3%. Patients showing an intermediate or full resistant DNA-GSS had a higher probability of experiencing VR compared to those carrying a fully susceptible DNA-GSS (27.2% vs. 13.7%, p = 0.001). By multivariable Cox regression, patients with an intermediate/full resistant DNA-GSS, with a nadir CD4 count <100 cell/mm3 and with a shorter time of previous virological suppression showed a higher adjusted hazard of experiencing VR. In a sub-group of 114 patients with previous plasma GRTs available, patients with an intermediate or fully resistance showed by both GSSs (from plasma and PBMCs) had the highest probability of experiencing VR. CONCLUSIONS Resistance detected in proviral DNA, together with a low nadir CD4 count and a short previous virological control, predicts VR after therapy switching in virologically suppressed patients. PBMC GRT can be a useful tool for tailoring treatment switch, especially if paired with information about previous cumulative resistance and previous viro-immunological history.
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Affiliation(s)
| | - Mauro Zaccarelli
- National Institute for Infectious Diseases L. Spallanzani, IRCCS, Rome, Italy.
| | | | | | | | - Alberto Giannetti
- National Institute for Infectious Diseases L. Spallanzani, IRCCS, Rome, Italy
| | - Federica Forbici
- National Institute for Infectious Diseases L. Spallanzani, IRCCS, Rome, Italy
| | - Ada Bertoli
- University of Rome "Tor Vergata", Rome, Italy
| | - Caterina Gori
- National Institute for Infectious Diseases L. Spallanzani, IRCCS, Rome, Italy
| | | | - Carmela Pinnetti
- National Institute for Infectious Diseases L. Spallanzani, IRCCS, Rome, Italy
| | | | | | | | | | | | - Andrea Antinori
- National Institute for Infectious Diseases L. Spallanzani, IRCCS, Rome, Italy
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Latini A, Orsini D, Ambrifi M, Colafigli M, Zaccarelli M, Cristaudo A. Classical Kaposi's sarcoma concurrent with ledipasvir-sofosbuvir therapy for hepatitis C infection. GIORN ITAL DERMAT V 2017; 154:593-594. [PMID: 29192474 DOI: 10.23736/s0392-0488.17.05788-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Alessandra Latini
- Unit of Infectious Dermatology and Allergology, San Gallicano Institute for Cancer Research and Care, Rome, Italy
| | - Diego Orsini
- Unit of Infectious Dermatology and Allergology, San Gallicano Institute for Cancer Research and Care, Rome, Italy -
| | - Marina Ambrifi
- Unit of Infectious Dermatology and Allergology, San Gallicano Institute for Cancer Research and Care, Rome, Italy
| | - Manuela Colafigli
- Unit of Infectious Dermatology and Allergology, San Gallicano Institute for Cancer Research and Care, Rome, Italy
| | - Mauro Zaccarelli
- Clinical Department, "Lazzaro Spallanzani" National Institute for Infectious Diseases, Rome, Italy
| | - Antonio Cristaudo
- Unit of Infectious Dermatology and Allergology, San Gallicano Institute for Cancer Research and Care, Rome, Italy
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Rozera G, Fabbri G, Lorenzini P, Mastrorosa I, Timelli L, Zaccarelli M, Amendola A, Vergori A, Plazzi MM, Cicalini S, Antinori A, Capobianchi MR, Abbate I, Ammassari A. Peripheral blood HIV-1 DNA dynamics in antiretroviral-treated HIV/HCV co-infected patients receiving directly-acting antivirals. PLoS One 2017; 12:e0187095. [PMID: 29077766 PMCID: PMC5659787 DOI: 10.1371/journal.pone.0187095] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Accepted: 10/15/2017] [Indexed: 12/14/2022] Open
Abstract
Background Aim was to determine the dynamics of peripheral blood mononuclear cells (PBMC)- associated total HIV-1 DNA in successfully ART-treated HIV/HCV co-infected patients receiving DAA treatment and to explore possible virological hypotheses underlying the phenomenon. Methods Longitudinal, single-centre study measuring total HIV-1 DNA before the start of DAA, at the end of treatment (EOT), and 3 months after treatment. Univariable and multivariable analyses were used to assess factors associated with HIV-1 DNA increase ≥0.5 Log copies/million PBMC. Episomal 2-LTR forms, residual HIV-1 viremia and proviral DNA quasispecies evolution were also investigated. Results 119 successfully ART-treated HIV/HCV co-infected patients were included. Median baseline HIV-1 DNA was 3.84 Log copies/million PBMC (95%CI 3.49–4.05), and no significant variation with respect to baseline was found at EOT and after 3 months of DAA termination. In 17% of cases an increase ≥0.5 Log copies/million PBMC was observed at EOT compared to baseline. HIV-1 DNA increase was independently associated with lower baseline HIV-1 DNA, longer HIV suppression, raltegravir-based ART and previous exposure to interferon/ribavirin for HCV treatment. In none of the patients with HIV-1 DNA increase, 2-LTR forms were detected at baseline, while in 2 cases 2-LTR forms were found at EOT, without association with residual HIV-1 RNA viremia. No evidence of viral evolution was observed. Conclusions In successfully ART-treated HIV/HCV co-infected patients receiving DAA, PBMC-associated total HIV-1 DNA was quite stable over time, but some patients showed a considerable increase at EOT when compared to baseline. A significantly higher risk of HIV DNA increase was found, in presence of lower cellular HIV reservoir at baseline. Activation of replicative-competent virus generating new rounds of viral replication seems unlikely, while mobilization of cell-associated HIV from tissue reservoirs could be hypothesized.
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Affiliation(s)
- Gabriella Rozera
- Laboratory of Virology, National Institute for Infectious Diseases “L. Spallanzani” IRCCS, Rome, Italy
| | - Gabriele Fabbri
- Clinical Department, National Institute for Infectious Diseases “L. Spallanzani” IRCCS, Rome, Italy
| | - Patrizia Lorenzini
- Clinical Department, National Institute for Infectious Diseases “L. Spallanzani” IRCCS, Rome, Italy
| | - Ilaria Mastrorosa
- Clinical Department, National Institute for Infectious Diseases “L. Spallanzani” IRCCS, Rome, Italy
| | - Laura Timelli
- Clinical Department, National Institute for Infectious Diseases “L. Spallanzani” IRCCS, Rome, Italy
| | - Mauro Zaccarelli
- Clinical Department, National Institute for Infectious Diseases “L. Spallanzani” IRCCS, Rome, Italy
| | - Alessandra Amendola
- Laboratory of Virology, National Institute for Infectious Diseases “L. Spallanzani” IRCCS, Rome, Italy
| | - Alessandra Vergori
- Clinical Department, National Institute for Infectious Diseases “L. Spallanzani” IRCCS, Rome, Italy
| | - Maria Maddalena Plazzi
- Clinical Department, National Institute for Infectious Diseases “L. Spallanzani” IRCCS, Rome, Italy
| | - Stefania Cicalini
- Clinical Department, National Institute for Infectious Diseases “L. Spallanzani” IRCCS, Rome, Italy
| | - Andrea Antinori
- Clinical Department, National Institute for Infectious Diseases “L. Spallanzani” IRCCS, Rome, Italy
| | - Maria Rosaria Capobianchi
- Laboratory of Virology, National Institute for Infectious Diseases “L. Spallanzani” IRCCS, Rome, Italy
| | - Isabella Abbate
- Laboratory of Virology, National Institute for Infectious Diseases “L. Spallanzani” IRCCS, Rome, Italy
- * E-mail: (IA); (AA)
| | - Adriana Ammassari
- Clinical Department, National Institute for Infectious Diseases “L. Spallanzani” IRCCS, Rome, Italy
- * E-mail: (IA); (AA)
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Armenia D, Di Carlo D, Calcagno A, Vendemiati G, Forbici F, Bertoli A, Berno G, Carta S, Continenza F, Fedele V, Bellagamba R, Cicalini S, Ammassari A, Libertone R, Zaccarelli M, Ghisetti V, Andreoni M, Ceccherini-Silberstein F, Bonora S, Di Perri G, Antinori A, Perno CF, Santoro MM. Pre-existent NRTI and NNRTI resistance impacts on maintenance of virological suppression in HIV-1-infected patients who switch to a tenofovir/emtricitabine/rilpivirine single-tablet regimen. J Antimicrob Chemother 2017; 72:855-865. [PMID: 27999048 DOI: 10.1093/jac/dkw512] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 11/01/2016] [Indexed: 01/04/2023] Open
Abstract
Objectives To evaluate the maintenance of virological suppression (VS) in antiretroviral-treated HIV-1-suppressed patients switching to a tenofovir/emtricitabine/rilpivirine (TDF/FTC/RPV) single-tablet regimen, by considering pre-existent resistance (pRes). Methods pRes was evaluated according to resistance on all previous plasma genotypic resistance tests. Probability and predictors of virological rebound (VR) were evaluated. Results Three hundred and nine patients were analysed; 5.8% of them showed resistance to both NRTIs and NNRTIs, while 12.6% showed resistance to only one of these drug classes. By 72 weeks, the probability of VR was 11.3%. A higher probability of VR was found in the following groups: (i) patients with NRTI + NNRTI pRes compared with those harbouring NRTI or NNRTI pRes and with those without reverse transcriptase inhibitor pRes (39.2% versus 11.5% versus 9.4%, P < 0.0001); (ii) patients with a virus with full/intermediate resistance to both tenofovir/emtricitabine and rilpivirine compared with those having a virus with full/intermediate resistance to tenofovir/emtricitabine or rilpivirine and those having a virus fully susceptible to TDF/FTC/RPV (36.4% versus 17.8% versus 9.7%, P < 0.001); and (iii) patients with pre-therapy viraemia >500 000 copies/mL compared with those with lower viraemia levels (>500 000: 16.0%; 100 000-500 000: 9.3%; <100 000 copies/mL: 4.8%, P = 0.009). pRes and pre-therapy viraemia >500 000 copies/mL were independent predictors of VR by multivariable Cox regression. Conclusions TDF/FTC/RPV as a treatment simplification strategy shows a very high rate of VS maintenance. The presence of pRes to both NRTIs and NNRTIs and a pre-therapy viraemia >500 000 copies/mL are associated with an increased risk of VR, highlighting the need for an accurate selection of patients before simplification.
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Affiliation(s)
- D Armenia
- Experimental Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy
| | - D Di Carlo
- Experimental Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy
| | - A Calcagno
- Division of Infectious Diseases, University of Turin, Turin, Italy
| | - G Vendemiati
- Division of Infectious Diseases, University of Turin, Turin, Italy
| | - F Forbici
- Antiretroviral Drug Monitoring Laboratory, National Institute for Infectious Diseases L. Spallanzani, IRCCS, Rome, Italy
| | - A Bertoli
- Experimental Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy
| | - G Berno
- Antiretroviral Drug Monitoring Laboratory, National Institute for Infectious Diseases L. Spallanzani, IRCCS, Rome, Italy
| | - S Carta
- Antiretroviral Drug Monitoring Laboratory, National Institute for Infectious Diseases L. Spallanzani, IRCCS, Rome, Italy
| | - F Continenza
- Antiretroviral Drug Monitoring Laboratory, National Institute for Infectious Diseases L. Spallanzani, IRCCS, Rome, Italy
| | - V Fedele
- Antiretroviral Drug Monitoring Laboratory, National Institute for Infectious Diseases L. Spallanzani, IRCCS, Rome, Italy
| | - R Bellagamba
- Infectious Diseases Division, National Institute for Infectious Diseases L. Spallanzani, IRCCS, Rome, Italy
| | - S Cicalini
- Infectious Diseases Division, National Institute for Infectious Diseases L. Spallanzani, IRCCS, Rome, Italy
| | - A Ammassari
- Infectious Diseases Division, National Institute for Infectious Diseases L. Spallanzani, IRCCS, Rome, Italy
| | - R Libertone
- Infectious Diseases Division, National Institute for Infectious Diseases L. Spallanzani, IRCCS, Rome, Italy
| | - M Zaccarelli
- Infectious Diseases Division, National Institute for Infectious Diseases L. Spallanzani, IRCCS, Rome, Italy
| | - V Ghisetti
- Division of Infectious Diseases, University of Turin, Turin, Italy
| | - M Andreoni
- Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | | | - S Bonora
- Division of Infectious Diseases, University of Turin, Turin, Italy
| | - G Di Perri
- Division of Infectious Diseases, University of Turin, Turin, Italy
| | - A Antinori
- Infectious Diseases Division, National Institute for Infectious Diseases L. Spallanzani, IRCCS, Rome, Italy
| | - C F Perno
- Antiretroviral Drug Monitoring Laboratory, National Institute for Infectious Diseases L. Spallanzani, IRCCS, Rome, Italy
| | - M M Santoro
- Experimental Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy
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Gagliardini R, Bandera A, Zaccarelli M, Sterrantino G, Latini A, D'Avino A, Lapadula G, Antinori A, Cauda R, De Luca A, Gori A, Di Giambenedetto S, Fabbiani M. 3-Year efficacy and durability of simplification to single tablet regimens: a comparison between co-formulated efavirenz/emtricitabine/tenofovir and rilpivirine/emtricitabine/tenofovir. Antivir Ther 2017; 23:139-148. [PMID: 28799920 DOI: 10.3851/imp3188] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/02/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Few data are available about efficacy and durability of simplification from multi-tablet antiretroviral regimens to co-formulated efavirenz (EFV)/emtricitabine (FTC)/tenofovir (TDF) versus rilpivirine (RPV)/FTC/TDF in virologically suppressed HIV-1-infected patients. METHODS We retrospectively analysed HIV-infected patients with HIV RNA <50 copies/ml switching to co-formulated EFV/FTC/TDF or RPV/FTC/TDF at five Italian centres. Patients were followed from time of switch until regimen discontinuation or a maximum of 3-years follow-up. Time to treatment discontinuation (TD) and virological failure (VF; defined as two consecutive HIV RNA >50 copies/ml or a single determination >1,000 copies/ml) and their predictors were investigated. RESULTS 1,560 patients were reviewed of which 1,097 (70%) switched to EFV/FTC/TDF and 463 (30%) to RPV/FTC/TDF. During follow-up, VF and TD occurred in 44 (4%) and 242 (22%) patients in EFV/FTC/TDF and in 29 (6%) and 50 (11%) patients in RPV/FTC/TDF, respectively. The 3-year estimated probability of remaining free from VF was 96.2% with EFV/FTC/TDF versus 92.7% with RPV/FTC/TDF (P=0.003). At multivariate analysis, regimen type (EFV/FTC/TDF versus RPV/FTC/TDF aHR 0.24; P=0.004) and time of virological suppression (aHR 0.85; P=0.048) were the only independent predictors of VF. The estimated 3-year probability of remaining free from TD was 77.4% with EFV/FTC/TDF versus 88.4% with RPV/FTC/TDF (P=0.001). Predictors of TD were female sex, switching from PI-based regimens, older age, shorter time of virological suppression and regimen type (EFV/FTC/TDF versus RPV/FTC/TDF aHR 2.48; P<0.001). RPV/FTC/TDF showed a safer lipid profile and a greater increase in creatinine. CONCLUSIONS Both regimens showed good safety and efficacy in this real-life setting, although switch to RPV/FTC/TDF seemed better tolerated while EFV/FTC/TDF was associated with a lower probability of VF.
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Affiliation(s)
- Roberta Gagliardini
- Institute of Clinical Infectious Diseases, Catholic University of Sacred Heart, Rome, Italy
| | - Alessandra Bandera
- Clinic of Infectious Diseases, San Gerardo Hospital - ASST Monza, Monza, Italy
| | - Mauro Zaccarelli
- National Institute for Infectious Diseases 'Lazzaro Spallanzani' IRCCS, Rome, Italy
| | - Gaetana Sterrantino
- Clinic of Infectious and Tropical Diseases, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | | | - Alessandro D'Avino
- Institute of Clinical Infectious Diseases, Catholic University of Sacred Heart, Rome, Italy
| | - Giuseppe Lapadula
- Clinic of Infectious Diseases, San Gerardo Hospital - ASST Monza, Monza, Italy
| | - Andrea Antinori
- National Institute for Infectious Diseases 'Lazzaro Spallanzani' IRCCS, Rome, Italy
| | - Roberto Cauda
- Institute of Clinical Infectious Diseases, Catholic University of Sacred Heart, Rome, Italy
| | - Andrea De Luca
- Infectious Diseases Unit, Siena University Hospital, Siena, Italy
| | - Andrea Gori
- Clinic of Infectious Diseases, San Gerardo Hospital - ASST Monza, Monza, Italy
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Fabbri G, Mastrorosa I, Vergori A, Mazzotta V, Pinnetti C, Grisetti S, Zaccarelli M, Ammassari A, Antinori A. Reactivation of occult HBV infection in an HIV/HCV Co-infected patient successfully treated with sofosbuvir/ledipasvir: a case report and review of the literature. BMC Infect Dis 2017; 17:182. [PMID: 28249574 PMCID: PMC5333431 DOI: 10.1186/s12879-017-2287-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [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: 11/30/2016] [Accepted: 02/23/2017] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Reactivation of occult or inactive Hepatitis B virus (HBV) infection during immunosuppressant treatments is well known and widely described in literature. The same observation has been made in Hepatitis C (HCV)-infected patients previously exposed to HBV and treated with interferon-free DAA treatments. Because of common transmission routes, persons may have been exposed to HCV, HBV and HIV, but few cases have been reported in this scenario to date. Frequency of HBV reactivation in HIV/HCV co-infected patients previously exposed to HBV and treated with DAA remains unclear. Herein, we report an episode of HBV reactivation in an HIV/HCV co-infected patient prescribed with sofosbuvir/ledipasvir for HCV. CASE PRESENTATION The patient is a Caucasian 54-years old female, with HIV/HCV co-infection (genotype 4), and a previous exposure to HBV, documented by negativity of HBsAg and positivity of HBsAb and HBcAb. Her medical history included: myocardial infarct, chronic kidney disease stage 3, chronic obstructive pulmonary disease, and mild pulmonary hypertension. HCV had not been treated with interferon (IFN)-based regimens and liver stiffness was 10.5 KPa (Metavir stage F3) at hepatic elastography. Because of CKD, she was prescribed with a nucleoside reverse transcriptase (NRTI)-sparing regimen including darunavir/ritonavir plus etravirine, and thereafter with sofosbuvir/ledipasvir for 12 weeks. Four weeks after DAA termination, the patient was hospitalized with symptoms of acute hepatitis. Blood tests showed HCV RNA <12 IU/ml, but positivity of HBAg, HBeAg, and of anti-core antibodies (IgM and IgG), while anti-HBs and anti-HBe antibodies were negative. HBV DNA was 6.06 Log10 IU/ml. Entecavir was started obtaining resolution of symptoms, normalization of liver enzymes, as well as reduction of HBV DNA and of quantitative HBV surface antigen. CONCLUSIONS This case-report highlights the risk of HBV reactivation with interferon-free DAA treatment in HIV/HCV co-infected patients previously exposed to HBV and who have contraindications for treatment with nucleoside/nucleotide reverse transcriptase Inhibitors because of comorbid conditions. In the setting of HIV infection, clinicians prescribing DAA should be aware of this risk, and HBV assessment at treatment start as well as virological monitoring during DAA treatment is recommended. Large epidemiological and virological studies are needed to investigate reactivation of occult HBV infection more in depth.
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Affiliation(s)
- Gabriele Fabbri
- National Institute of Infectious Diseases "Lazzaro Spallanzani", Via Portuense 292, 00152, Rome, Italy.
| | - Ilaria Mastrorosa
- National Institute of Infectious Diseases "Lazzaro Spallanzani", Via Portuense 292, 00152, Rome, Italy
| | - Alessandra Vergori
- National Institute of Infectious Diseases "Lazzaro Spallanzani", Via Portuense 292, 00152, Rome, Italy
| | - Valentina Mazzotta
- National Institute of Infectious Diseases "Lazzaro Spallanzani", Via Portuense 292, 00152, Rome, Italy
| | - Carmela Pinnetti
- National Institute of Infectious Diseases "Lazzaro Spallanzani", Via Portuense 292, 00152, Rome, Italy
| | - Susanna Grisetti
- National Institute of Infectious Diseases "Lazzaro Spallanzani", Via Portuense 292, 00152, Rome, Italy
| | - Mauro Zaccarelli
- National Institute of Infectious Diseases "Lazzaro Spallanzani", Via Portuense 292, 00152, Rome, Italy
| | - Adriana Ammassari
- National Institute of Infectious Diseases "Lazzaro Spallanzani", Via Portuense 292, 00152, Rome, Italy
| | - Andrea Antinori
- National Institute of Infectious Diseases "Lazzaro Spallanzani", Via Portuense 292, 00152, Rome, Italy
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Affiliation(s)
- Alessandra Latini
- Dermatologic Infectious Diseases Unit, San Gallicano Dermatological Institute, Rome, Italy
| | - Viviana Lora
- Dermathopathology Unit, San Gallicano Dermatological Institute, Rome, Italy
| | - Mauro Zaccarelli
- Viral Immunodeficiency Unit, National Institute for Infectious Diseases “Lazzaro Spallanzani,” Rome, Italy
| | - Antonio Cristaudo
- Dermatologic Infectious Diseases Unit, San Gallicano Dermatological Institute, Rome, Italy
| | - Carlo Cota
- Dermathopathology Unit, San Gallicano Dermatological Institute, Rome, Italy
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Lapa D, Brega C, Mammone A, Zaccarelli M, Capobianchi MR, Garbuglia AR. Diagnostic performance of hepatitis E virus antigen assay in hepatitis E virus acute infection. New Microbiol 2016; 40:246-250. [PMID: 28994445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 11/28/2017] [Indexed: 06/07/2023]
Abstract
The aim of this study was to analyze the sensitivity of hepatitis E virus antigen (HEV-Ag) to determine acute E hepatitis. Ninety-four serum samples resulting anti-HEV IgM by DIA.PRO assay were analyzed with Wantai assay to check for HEV-Ag. Thirty samples were anti-HEV IgM positive and HEV-RNA positive, 19 samples harbored genotype 3, whereas 11 samples were genotype 1. Overall, 16% of anti-HEV IgM samples resulted HEV-Ag positive and 33.3% of HEV-RNA positive were also HEV-Ag positive. Among 64 HEV-RNA negative samples, 5 (7.8%) were HEV-Ag positive. The concordance of HEV-RNA and HEV-Ag was low (Cohen's Kappa=0.36). The Bland-Altman plot revealed a low agreement between HEV-RNA viral load and HEV-Ag, confirmed by a not significant Spearman's correlation coefficient (rho=0.137, p>0.05). Moreover, the HEV-Ag showed 100% specificity. In genotype 3f samples with a viral load >800 cp/ml HEV-Ag was positive in 80% of samples, whereas all patients harboring genotype 3e were HEV-Ag-negative irrespective of HEV-RNA viral load. Among genotype 1, HEV-Ag positivity was observed only in 27.7% patients and in all samples the viremia was >2000 cp/ml. These data suggest that anti-HEV IgM positivity represents the main biological marker of hepatitis E acute infection in clinical real life settings in developed countries.
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Affiliation(s)
- Daniele Lapa
- Laboratory of Virology, "Lazzaro Spallanzani" National Institute for Infectious Diseases, IRCCS, Rome, Italy
| | - Carla Brega
- Laboratory of Virology, "Lazzaro Spallanzani" National Institute for Infectious Diseases, IRCCS, Rome, Italy
| | - Alessia Mammone
- Department of Epidemiology, "Lazzaro Spallanzani" National Institute for Infectious Diseases, IRCCS, Rome, Italy
| | - Mauro Zaccarelli
- Clinical Department, "Lazzaro Spallanzani" National Institute for Infectious Diseases, IRCCS, Rome, Italy
| | - Maria Rosaria Capobianchi
- Laboratory of Virology, "Lazzaro Spallanzani" National Institute for Infectious Diseases, IRCCS, Rome, Italy
| | - Anna Rosa Garbuglia
- Laboratory of Virology, "Lazzaro Spallanzani" National Institute for Infectious Diseases, IRCCS, Rome, Italy
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Latini A, Fabbiani M, Borghi V, Sterrantino G, Giannetti A, Lorenzini P, Loiacono L, Ammassari A, Bellagamba R, Colafigli M, D’Ettorre G, Di Giambenedetto S, Antinori A, Zaccarelli M. Switching to boosted protease inhibitor plus a second antiretroviral drug (dual therapy) for treatment simplification: a multicenter observational study. BMC Infect Dis 2016; 16:401. [PMID: 27515949 PMCID: PMC4982404 DOI: 10.1186/s12879-016-1703-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2016] [Accepted: 07/08/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Aim of the study was to assess predictors of discontinuation/toxicity of boosted PI-based (PI/r) dual therapy (DT). METHODS Observational, retrospective switch study in patients successfully treated with triple drugs regimen. Patients switched to PI/r based DT [darunavir (DRV/r), lopinavir (LPV/r) or atazanavir (ATV/r)] plus a second drug: [raltegravir (RAL), maraviroc (MVC) etravirine (ETR), lamivudine (3TC) or tenofovir (TDF)] between 2009 and 2014 were included. The effect of each drug as well as other clinical and virological cofactors over treatment discontinuation (TD) was assessed using survival analysis. RESULTS Overall, 376 patients were included with mean follow-up of 73 weeks. The most commonly used drugs in DT were DRV/r (63.0 %) and RAL (53.7 %). TD was observed in 77 (20,4 %) patients: 38 (10,1 %) virological failure, 35 (9,3 %) toxicity/intolerance (4 deaths) and 4 (1 %) interruptions for patients decision. At Cox Model, adjusted by demographic and laboratory variables, DRV/r and ATV/r significantly reduced the likelihood of TD and longer treatment was associated with lower risk, while low CD4 count at baseline and number of previous regimens with a higher risk. Moreover, RAL and 3TC use were significantly associated with lower TD by toxicity. CONCLUSIONS In our clinical practice experience, switching virologically suppressed patients to PI/r based DT showed adequate safety and efficacy, so that it may be used in selected patients with specific medical needs.
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Affiliation(s)
- Alessandra Latini
- San Gallicano Dermatologic Institute (IRCCS), Clinic of Dermatology and Infectious Diseases, Rome, Italy
| | - Massimiliano Fabbiani
- Department of Infectious Diseases, Catholic University of the Sacred Heart, Rome, Italy
- Division of Infectious Diseases, Department of Internal Medicine, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - Vanni Borghi
- Azienda Ospedaliero Universitaria, Clinic of Infectious Diseases, Modena, Italy
| | | | - Alberto Giannetti
- Clinical Department, National Institute for the Infectious Diseases “Lazzaro Spallanzani”, Rome, Italy
| | - Patrizia Lorenzini
- Clinical Department, National Institute for the Infectious Diseases “Lazzaro Spallanzani”, Rome, Italy
| | - Laura Loiacono
- Clinical Department, National Institute for the Infectious Diseases “Lazzaro Spallanzani”, Rome, Italy
| | - Adriana Ammassari
- Clinical Department, National Institute for the Infectious Diseases “Lazzaro Spallanzani”, Rome, Italy
| | - Rita Bellagamba
- Clinical Department, National Institute for the Infectious Diseases “Lazzaro Spallanzani”, Rome, Italy
| | - Manuela Colafigli
- San Gallicano Dermatologic Institute (IRCCS), Clinic of Dermatology and Infectious Diseases, Rome, Italy
| | - Gabriella D’Ettorre
- Policlinico Universitario “Umberto I”, Clinic of Infectious Diseases, Rome, Italy
| | | | - Andrea Antinori
- Clinical Department, National Institute for the Infectious Diseases “Lazzaro Spallanzani”, Rome, Italy
| | - Mauro Zaccarelli
- Clinical Department, National Institute for the Infectious Diseases “Lazzaro Spallanzani”, Rome, Italy
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Zaccarelli M, Santoro MM, Armenia D, Borghi V, Gennari W, Gori C, Forbici F, Bertoli A, Fabeni L, Giannetti A, Cicalini S, Bellagamba R, Andreoni M, Mastroianni CM, Mussini C, Ceccherini-Silberstein F, Perno CF, Antinori A. Genotypic resistance test in proviral DNA can identify resistance mutations never detected in historical genotypic test in patients with low level or undetectable HIV-RNA. J Clin Virol 2016; 82:94-100. [PMID: 27472519 DOI: 10.1016/j.jcv.2016.07.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Revised: 06/17/2016] [Accepted: 07/15/2016] [Indexed: 11/15/2022]
Abstract
BACKGROUND Beyond the detection of resistant HIV strains found in plasma samples, archival HIV-DNA in peripheral blood mononuclear cells (PBMCs) might represent a reservoir of additional resistance. OBJECTIVE To characterize the HIV-1 resistance in PBMCs from patients with suppressed or low-level viremia (50-1000 copies/mL) and evaluate its added value compared to the resistance detected in previous plasma genotypic resistance tests (GRTs). STUDY DESIGN HIV-1 infected patients selected for treatment change despite low/undetectable viremia were tested. Number and type of primary resistance mutations (PRMs) detected in PBMCs were compared to those detected in previous plasma GRTs. Logistic regression assessed factors associated with presence of at least one PRM in PBMCs. RESULT 468 patients with a PBMC GRT were analyzed; 149 of them had at least 2 plasma GRTs performed before PBMC genotyping. 42.3% of patients showed at least one PRM in PBMCs. The highest proportion of PRMs in PBMCs was observed for NRTI class (30.6%), followed by NNRTI (22.2%), PI (14.1%) and INI (4.9%). In 20.1% of patients, PRMs were detected only in PBMCs and not in any of the plasma GRT previously performed. By using multivariable analysis, a higher number of previous regimens, injecting drug-use route and a lower nadir CD4 were associated with significantly higher risk of detecting PRMs in PBMCs. CONCLUSION Our findings support the usage of PBMC GRT in addition to the current recommended plasma RNA test, especially when therapeutic and/or resistance information is not available.
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Affiliation(s)
- Mauro Zaccarelli
- National Institute for Infectious Diseases L. Spallanzani, IRCCS, Rome, Italy
| | | | | | | | | | - Caterina Gori
- National Institute for Infectious Diseases L. Spallanzani, IRCCS, Rome, Italy
| | - Federica Forbici
- National Institute for Infectious Diseases L. Spallanzani, IRCCS, Rome, Italy
| | | | - Lavinia Fabeni
- National Institute for Infectious Diseases L. Spallanzani, IRCCS, Rome, Italy
| | - Alberto Giannetti
- National Institute for Infectious Diseases L. Spallanzani, IRCCS, Rome, Italy
| | - Stefania Cicalini
- National Institute for Infectious Diseases L. Spallanzani, IRCCS, Rome, Italy
| | - Rita Bellagamba
- National Institute for Infectious Diseases L. Spallanzani, IRCCS, Rome, Italy
| | | | | | | | | | | | - Andrea Antinori
- National Institute for Infectious Diseases L. Spallanzani, IRCCS, Rome, Italy
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Armenia D, Di Carlo D, Maffongelli G, Borghi V, Alteri C, Forbici F, Bertoli A, Gori C, Giuliani M, Nicastri E, Zaccarelli M, Pinnetti C, Cicalini S, D'Offizi G, Ceccherini-Silberstein F, Mussini C, Antinori A, Andreoni M, Perno CF, Santoro MM. Virological response and resistance profile in HIV-1-infected patients starting darunavir-containing regimens. HIV Med 2016; 18:21-32. [PMID: 27353061 DOI: 10.1111/hiv.12388] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVES We evaluated the virological response in patients starting a regimen based on darunavir/ritonavir (DRV/r), which is currently the most widely used ritonavir-boosted protease inhibitor. METHODS Data from 206 drug-naïve and 327 PI-experienced patients starting DRV/r 600/100 mg twice daily (DRV600) or 800/100 mg once daily (DRV800) were examined. The probabilities of virological success (VS) and virological rebound (VR) were evaluated in survival analyses. Baseline DRV/r resistance and its evolution at failure were also examined. RESULTS DRV600 was preferentially administered in patients with complex requirements (older age, higher viraemia, lower CD4 cell count and DRV/PI resistance) compared with DRV800. By 12 months, the probability of achieving VS was 93.2% and 84.3% in drug-naïve and PI-experienced patients, respectively. The higher the baseline viraemia, the longer was the time required to achieve VS, both in drug-naïve patients [>500 000 HIV-1 RNA copies/mL: median [interquartile range (IQR)] 6.1 (5.1-10.3) months; 100 000-500 000 copies/mL: median (IQR) 4.9 (3.8-6.1) months; <100 000 copies/mL: median (IQR) 3.9 (3.5-4.8) months; P < 0.001] and in PI-experienced patients [≥100 000 copies/mL: median (IQR) 7.2 (5.7-11.6) months; <100 000 copies/mL: median (IQR) 2.8 (2.4-3.3) months; P < 0.001]. In PI-experienced patients, the probability of VR was higher for higher viraemia levels (22.3% for ≥100 000 copies/ml vs. 9.7% for <100 000 copies/mL; P = 0.007). Baseline resistance did not affect the virological response. At failure, a high percentage of patients maintained virus susceptible to all PIs (drug-naïve: 95%; PI-experienced: 80%). Despite being used more often in patients with more complex requirements, DRV600 performed as well as DRV800. CONCLUSIONS In clinical practice, use of DRV/r (with its flexible dosage) results in high rates of virological response. These data support the use of PI/r in patients whose characteristics require potent drugs with a high genetic barrier.
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Affiliation(s)
- D Armenia
- Experimental Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy
| | - D Di Carlo
- Experimental Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy
| | - G Maffongelli
- Infectious Diseases Division, University Hospital Tor Vergata, Rome, Italy
| | - V Borghi
- Infectious Diseases Division, Modena University Hospital, Modena, Italy
| | - C Alteri
- Experimental Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy
| | - F Forbici
- Antiretroviral Therapy Monitoring Unit, L Spallanzani Hospital, Rome, Italy
| | - A Bertoli
- Experimental Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy.,Molecular Virology Division, University Hospital Tor Vergata, Rome, Italy
| | - C Gori
- Antiretroviral Therapy Monitoring Unit, L Spallanzani Hospital, Rome, Italy
| | - M Giuliani
- Infectious Dermatology Unit, San Gallicano Hospital, Rome, Italy
| | - E Nicastri
- Infectious Diseases Division, L Spallanzani Hospital, Rome, Italy
| | - M Zaccarelli
- Infectious Diseases Division, L Spallanzani Hospital, Rome, Italy
| | - C Pinnetti
- Infectious Diseases Division, L Spallanzani Hospital, Rome, Italy
| | - S Cicalini
- Infectious Diseases Division, L Spallanzani Hospital, Rome, Italy
| | - G D'Offizi
- Infectious Diseases Division, L Spallanzani Hospital, Rome, Italy
| | | | - C Mussini
- Infectious Diseases Division, Modena University Hospital, Modena, Italy
| | - A Antinori
- Infectious Diseases Division, L Spallanzani Hospital, Rome, Italy
| | - M Andreoni
- Infectious Diseases Division, University Hospital Tor Vergata, Rome, Italy
| | - C F Perno
- Antiretroviral Therapy Monitoring Unit, L Spallanzani Hospital, Rome, Italy
| | - M M Santoro
- Experimental Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy
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Fabbiani M, Zaccarelli M, Latini A, Sterrantino G, D'Ettorre G, Grima P, Mondi A, Rossetti B, Borchi B, Giuliani M, Antinori A, De Luca A, Di Giambenedetto S. Reduced risk of Efavirenz Discontinuation in Naïve Patients Starting First-Line Antiretroviral Therapy with Single Tablet versus dual Tablet Regimen. HIV Med 2015; 17:385-9. [PMID: 26394902 DOI: 10.1111/hiv.12313] [Citation(s) in RCA: 3] [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] [Accepted: 07/24/2015] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Despite not being approved in Europe as first-line therapy, the efavirenz (EFV)-containing single tablet regimen (STR) is frequently used in clinical practice in naïve patients but few data are available on this strategy. In our study, we aimed to assess the risk of EFV discontinuation in patients starting antiretroviral therapy with STR vs. nonSTR. METHODS This was a multicentre study retrospectively enrolling naïve patients starting EFV+TDF+FTC. Patients were followed from the time of treatment initiation to the discontinuation of the EFV-containing regimen, comparing STR vs. nonSTR. Two different analyses were performed: (A) nonSTR patients censored at the last observation (switch to STR not considered as the end of observation); (B) nonSTR patients censored at the time of switch to STR. RESULTS The study included 235 patients, of whom 74 (31.5%) directly started STR. Among patients starting nonSTR, 108 (67.1%) switched to STR after a median period of 6 months. Forty-four EFV discontinuations were observed (13 among STR vs. 31 among nonSTR patients). The overall estimated probability of discontinuation was 30% at 5 years, about half (14.8%) of these occurring during the first year. Analysis A did not show significant differences between STR and nonSTR regarding the probability of efavirenz discontinuation (19.9% vs. 24.7% at 5 years, P = 0.630). In contrast, Analysis B showed that the probability of EFV discontinuation was similar (8.3%) between STR and nonSTR patients up to 8 months. Thereafter, a significantly higher rate of discontinuation was observed in nonSTR patients (47.5% vs. 19.9% at 5 years, P = 0.034). CONCLUSIONS Our data suggest that an early switch to STR during the first months of treatment could reduce the risk of EFV discontinuation.
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Affiliation(s)
- M Fabbiani
- Division of Infectious Diseases, Department of Internal Medicine, University of Milano-Bicocca, San Gerardo Hospital, Monza, Italy.,Institute of Clinical Infectious Diseases, Catholic University of Sacred Heart, Rome, Italy
| | - M Zaccarelli
- Viral Immunodeficiency Unit, National Institute for Infectious Diseases 'Lazzaro Spallanzani', Rome, Italy
| | - A Latini
- Unit of Infectious Dermatology, San Gallicano Hospital, Rome, Italy
| | - G Sterrantino
- Infectious Diseases Unit, Careggi University Hospital, Florence, Italy
| | - G D'Ettorre
- Department of Infectious Diseases, University 'La Sapienza', Rome, Italy
| | - P Grima
- Infectious Diseases Unit, S. Caterina Novella Hospital, Galatina (Lecce), Italy
| | - A Mondi
- Institute of Clinical Infectious Diseases, Catholic University of Sacred Heart, Rome, Italy
| | - B Rossetti
- Infectious Diseases Unit, Siena University Hospital, Siena, Italy
| | - B Borchi
- Infectious Diseases Unit, Careggi University Hospital, Florence, Italy
| | - M Giuliani
- Unit of Infectious Dermatology, San Gallicano Hospital, Rome, Italy
| | - A Antinori
- Viral Immunodeficiency Unit, National Institute for Infectious Diseases 'Lazzaro Spallanzani', Rome, Italy
| | - A De Luca
- Institute of Clinical Infectious Diseases, Catholic University of Sacred Heart, Rome, Italy.,Infectious Diseases Unit, Siena University Hospital, Siena, Italy
| | - S Di Giambenedetto
- Institute of Clinical Infectious Diseases, Catholic University of Sacred Heart, Rome, Italy
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Donà MG, Gheit T, Latini A, Benevolo M, Torres M, Smelov V, McKay-Chopin S, Giglio A, Cristaudo A, Zaccarelli M, Tommasino M, Giuliani M. Alpha, beta and gamma Human Papillomaviruses in the anal canal of HIV-infected and uninfected men who have sex with men. J Infect 2015; 71:74-84. [PMID: 25698067 DOI: 10.1016/j.jinf.2015.02.001] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [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: 11/20/2014] [Revised: 01/30/2015] [Accepted: 02/10/2015] [Indexed: 02/06/2023]
Abstract
OBJECTIVES Anal infection by cutaneous Human Papillomaviruses (HPV) has been rarely investigated. We aimed to assess the prevalence, genotype diversity, and determinants of mucosal (alpha) and cutaneous (beta and gamma) anal HPV infection in men who have sex with men (MSM). METHODS Anal samples were collected with a Dacron swab. Alpha HPVs were detected using the Linear Array HPV genotyping test, while beta and gamma HPVs using a PCR combined with Luminex technology. RESULTS A total of 609 MSM (437 HIV-uninfected and 172 HIV-infected, most of which were undergoing cART) were enrolled. Alpha, beta, and gamma HPVs were detected in 78.0%, 27.6% and 29.3% of the participants. Only alpha HPV prevalence was significantly higher among HIV-infected compared to uninfected MSM (93.0% vs. 72.1%, p < 0.0001). Beta2 and gamma10 represented the most frequent cutaneous HPV species, with no significant differences between HIV-infected and uninfected individuals. The most common alpha, beta, and gamma genotypes were HPV16, HPV111, HPV121, respectively. Alpha HPV infection was significantly associated with lifetime number of partners, receptive anal sex, and HIV status. Beta and/or gamma HPV infection showed no significant association with HIV status, socio-demographic or sexual behavioral factors. CONCLUSIONS A wide spectrum of mucosal and cutaneous HPV types is present in the anal canal. Only mucosal HPV prevalence increased significantly in cases of concomitant HIV infection.
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Affiliation(s)
- Maria Gabriella Donà
- STI/HIV Unit, San Gallicano Dermatologic Institute, IRCCS, Via Elio Chianesi 53, 00144, Rome, Italy.
| | - Tarik Gheit
- Infections and Cancer Biology Group, International Agency for Research on Cancer, 150 Cours Albert Thomas, 69372, Lyon, France
| | - Alessandra Latini
- STI/HIV Unit, San Gallicano Dermatologic Institute, IRCCS, Via Elio Chianesi 53, 00144, Rome, Italy
| | - Maria Benevolo
- Pathology Department, Regina Elena National Cancer Institute, IRCCS, Via Elio Chianesi 53, 00144, Rome, Italy
| | - Montserrat Torres
- Infections and Cancer Biology Group, International Agency for Research on Cancer, 150 Cours Albert Thomas, 69372, Lyon, France
| | - Vitaly Smelov
- Infections and Cancer Biology Group, International Agency for Research on Cancer, 150 Cours Albert Thomas, 69372, Lyon, France
| | - Sandrine McKay-Chopin
- Infections and Cancer Biology Group, International Agency for Research on Cancer, 150 Cours Albert Thomas, 69372, Lyon, France
| | - Amalia Giglio
- Clinical Pathology and Microbiology Department, San Gallicano Dermatologic Institute, IRCCS, Via Elio Chianesi 53, 00144, Rome, Italy
| | - Antonio Cristaudo
- STI/HIV Unit, San Gallicano Dermatologic Institute, IRCCS, Via Elio Chianesi 53, 00144, Rome, Italy
| | - Mauro Zaccarelli
- National Institute for Infectious Diseases "Lazzaro Spallanzani", IRCCS, Via Portuense 292, 00149, Rome, Italy
| | - Massimo Tommasino
- Infections and Cancer Biology Group, International Agency for Research on Cancer, 150 Cours Albert Thomas, 69372, Lyon, France
| | - Massimo Giuliani
- STI/HIV Unit, San Gallicano Dermatologic Institute, IRCCS, Via Elio Chianesi 53, 00144, Rome, Italy
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d'Ettorre G, Ceccarelli G, Zaccarelli M, Ascoli-Bartoli T, Bianchi L, Bellelli V, De Girolamo G, Serafino S, Giustini N, Mastroianni CM, Vullo V. Impact of switching from lopinavir/ritonavir to boosted and un-boosted atazanavir on glucose metabolism: the ATAzanavir & GLUcose metabolism (ATAGLU) study. Int J STD AIDS 2015; 27:638-43. [PMID: 26068963 DOI: 10.1177/0956462415590724] [Citation(s) in RCA: 5] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Accepted: 05/14/2015] [Indexed: 11/15/2022]
Abstract
Previous studies have reported that protease inhibitors (PIs) can contribute to glycaemic alterations. However, there are few trials examining the direct effect of a single PI. The objective of the study was to evaluate the modifications of glucose and lipid profiles after a switch from lopinavir/ritonavir (LPV/r) to atazanavir, used as ritonavir-boosted (ATV/r) or un-boosted. We conducted a retrospective observational cohort study on the effect of ATV/(r) on glycaemic metabolism (ATAGLU) in patients with undetectable levels of HIV-RNA who switched from LPV/r. In total, 235 patients treated for 48 weeks with LPV/r plus two nucleoside reverse transcriptase inhibitors (NRTIs) and with undetectable HIV-RNA were included: 134 continued LPV/r after the initial 48 weeks and 101 switched to ATV(/r) (18.3% to ATV; 24.7% to ATV/r). A significant decrease in mean glucose level and insulin resistance was observed in patients who switched to ATV(/r). The mean cholesterol triglyceride levels increased in the LPV/r group and decreased among the patients who switched. A significant increase of CD4 T cells with undetectable levels of HIV-RNA was observed in all groups. The long-term results obtained in this real-life study suggest that patients who have achieved initial suppression on a regimen including LPV/r + two NRTIs can switch to ATV/(r) + two NRTIs with an improvement in lipid and glycaemic metabolism.
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Affiliation(s)
- Gabriella d'Ettorre
- Department of Public Health and Infectious Diseases, University of Rome "Sapienza", Rome, Italy
| | - Giancarlo Ceccarelli
- Department of Public Health and Infectious Diseases, University of Rome "Sapienza", Rome, Italy
| | - Mauro Zaccarelli
- Clinical Department, National Institute for infectious Diseases "Lazzaro Spallanzani", IRCCS, Rome, Italy
| | - Tommaso Ascoli-Bartoli
- Department of Public Health and Infectious Diseases, University of Rome "Sapienza", Rome, Italy
| | - Luigi Bianchi
- Department of Public Health and Infectious Diseases, University of Rome "Sapienza", Rome, Italy
| | - Valeria Bellelli
- Department of Public Health and Infectious Diseases, University of Rome "Sapienza", Rome, Italy
| | - Gabriella De Girolamo
- Department of Public Health and Infectious Diseases, University of Rome "Sapienza", Rome, Italy
| | - Sara Serafino
- Department of Public Health and Infectious Diseases, University of Rome "Sapienza", Rome, Italy
| | - Noemi Giustini
- Department of Public Health and Infectious Diseases, University of Rome "Sapienza", Rome, Italy
| | - Claudio M Mastroianni
- Department of Infectious Diseases, University of Rome "Sapienza" (Polo Pontino), Latina, Italy
| | - Vincenzo Vullo
- Department of Public Health and Infectious Diseases, University of Rome "Sapienza", Rome, Italy
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Sterrantino G, Zaccarelli M, Di Biagio A, Biondi ML, Antinori A, Penco G. Darunavir-based dual therapy of treatment-experienced HIV-infected patients: analysis from a national multicenter database. Infection 2015; 43:339-43. [PMID: 25821204 DOI: 10.1007/s15010-015-0764-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2014] [Accepted: 03/16/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND We assessed the virological response of dual therapy with DRV/r, plus raltegravir, maraviroc or etravirine, in virological failure patients and in virologically suppressed patients collected in the Italian Antiretroviral Resistance Database (ARCA). MATERIAL AND METHODS The primary endpoint was the percentage of patients remaining free of virological failure (confirmed >50 copies/mL or any change in the regimen). Subjects had a resistance test and at least one follow-up visit. Observation was censored at last visit under dual therapy and survival analysis and proportional hazard models were used. RESULTS Sixty-seven percent of the 221 patients started DRV/r with RAL, 20.4 % with ETV, and 12.2 % with MAR; 31.2 % virological failures were observed. At survival analysis, the overall proportion of failure was 29.2 % at 1 year and 33.8 % at 2 years. The proportion of failure was lower in patients starting with undetectable vs. detectable viral load (13.3 and 25.2 % vs. 37.4 and 38.8 % at 1 and 2 years, respectively, p = 0.001 for both analyses) and in patients treated with DRV 600 BID vs. 800 QD (HR: 0.56, 95 % CI: 0.31-0.99, p < 0.05). By regimen, the adjusted proportional model showed no significant difference among the three regimens. A significant lower risk of failure was associated with higher GSS (HIV-DB HR: 0.53, 95 % CI: 0.32-0.88, p = 0.014; Rega 0.60, 0.40-0.88, p < 0.01; ANRS 0.55, 0.34-0.90, p = 0.017), while a higher risk of failure with detectable HIV-RNA (3.02, 1.70-5.72, p < 0.001). CONCLUSIONS Among experienced patients, the best candidates for dual-therapy regimens including DRV/r are those with undetectable viral load and higher GSS.
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Affiliation(s)
- Gaetana Sterrantino
- Malattie Infettive e Tropicali, Azienda Ospedaliera Universitaria Careggi, Largo Brambilla 3, 50134, Florence, Italy,
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Nozza S, Galli L, Antinori A, Chiappetta S, Mazzotta F, Zaccarelli M, Ottou S, De Battista D, Pogliaghi M, Di Pietro M, Malnati M, Ripa M, Bonora S, Lazzarin A. Maraviroc 150 mg daily plus lopinavir/ritonavir, a nucleoside/nucleotide reverse transcriptase inhibitor-sparing regimen for HIV-infected naive patients: 48-week final results of VEMAN study. Clin Microbiol Infect 2014; 21:510.e1-9. [PMID: 25656621 DOI: 10.1016/j.cmi.2014.12.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2014] [Revised: 09/03/2014] [Accepted: 12/06/2014] [Indexed: 01/28/2023]
Abstract
Non-conventional strategies with nucleoside/nucleotide reverse transcriptase inhibitor-sparing regimens in antiretroviral naive human immunodeficiency virus (HIV) -infected patients have been explored in clinical trials. A prospective, open-label, randomized (1:1), multicentre, proof-of-concept trial (VEMAN study, EUDRACT number 2008-006287-11) was conducted assigning HIV-infected naive patients to once-daily maraviroc plus lopinavir/ritonavir (MVC group) or to tenofovir/emtricitabine plus lopinavir/ritonavir (TDF/FTC group). Clinical and laboratory data were collected at baseline, and after 4, 12, 24, 36 and 48 weeks with the objective to evaluate the 48-week virological and immunological efficacy. HIV-1 DNA load and CD4(+) T-cell subsets were analysed on frozen peripheral blood mononuclear cells collected at baseline, 4 and 48 weeks to explore the trend in HIV reservoirs. Fifty patients were randomized and included in the analysis. During follow up, HIV-1 RNA decreased similarly in both groups and, at week 48, all patients in the MVC group and 22/24 (96%) in the TDF/FTC group had < 50 copies/ml of HIV-1 RNA. CD4(+) trend during follow up was higher in maraviroc-treated patients (MVC group: 286 (183-343) versus TDF/FTC group: 199 (125-285); Mann-Whitney U-test: p 0.033). A significant 48-week increase of CCR5(+) CD4(+) T cells and CD4(+) effector memory cells was observed among maraviroc-treated patients (Wilcoxon signed rank test: p 0.016 and p 0.007, respectively). No significant variations were found in naive and central memory CD4(+) T cells. Among naive patients with an R5 virus, treatment with maraviroc and lopinavir/ritonavir was shown to provide a virological response compared to a triple therapy and a greater immunological benefit.
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Affiliation(s)
- S Nozza
- Department of Infectious Diseases, OSR Scientific Institute, Milan, Italy.
| | - L Galli
- Department of Infectious Diseases, OSR Scientific Institute, Milan, Italy
| | - A Antinori
- IRCCS INMI Spallanzani, Infectious Disease, Rome, Italy
| | - S Chiappetta
- Department of Infectious Diseases, OSR Scientific Institute, Milan, Italy; University Vita e Salute San Raffaele, Milan, Italy
| | - F Mazzotta
- Division of Infectious Diseases, Ospedale S.M. Annunziata, Antella, Florence, Italy
| | - M Zaccarelli
- IRCCS INMI Spallanzani, Infectious Disease, Rome, Italy
| | - S Ottou
- IRCCS INMI Spallanzani, Infectious Disease, Rome, Italy
| | - D De Battista
- Unit of Human Virology, Division of Immunology, Transplantation and Infectious Diseases, San Raffaele Scientific Institute, Milan, Italy
| | - M Pogliaghi
- Department of Infectious Diseases, OSR Scientific Institute, Milan, Italy; University Vita e Salute San Raffaele, Milan, Italy
| | - M Di Pietro
- Division of Infectious Diseases, Ospedale S.M. Annunziata, Antella, Florence, Italy
| | - M Malnati
- Unit of Human Virology, Division of Immunology, Transplantation and Infectious Diseases, San Raffaele Scientific Institute, Milan, Italy
| | - M Ripa
- Department of Infectious Diseases, OSR Scientific Institute, Milan, Italy; University Vita e Salute San Raffaele, Milan, Italy
| | - S Bonora
- Unit of Infectious Diseases, Department of Medical Sciences, University of Torino, Italy
| | - A Lazzarin
- Department of Infectious Diseases, OSR Scientific Institute, Milan, Italy; University Vita e Salute San Raffaele, Milan, Italy
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Armenia D, Soulie C, Di Carlo D, Fabeni L, Gori C, Forbici F, Svicher V, Bertoli A, Sarmati L, Giuliani M, Latini A, Boumis E, Zaccarelli M, Bellagamba R, Andreoni M, Marcelin AG, Calvez V, Antinori A, Ceccherini-Silberstein F, Perno CF, Santoro MM. A very low geno2pheno false positive rate is associated with poor viro-immunological response in drug-naïve patients starting a first-line HAART. PLoS One 2014; 9:e105853. [PMID: 25153969 PMCID: PMC4143365 DOI: 10.1371/journal.pone.0105853] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Accepted: 07/27/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND We previously found that a very low geno2pheno false positive rate (FPR ≤ 2%) defines a viral population associated with low CD4 cell count and the highest amount of X4-quasispecies. In this study, we aimed at evaluating whether FPR ≤ 2% might impact on the viro-immunological response in HIV-1 infected patients starting a first-line HAART. METHODS The analysis was performed on 305 HIV-1 B subtype infected drug-naïve patients who started their first-line HAART. Baseline FPR (%) values were stratified according to the following ranges: ≤ 2; 2-5; 5-10; 10-20; 20-60; >60. The impact of genotypically-inferred tropism on the time to achieve immunological reconstitution (a CD4 cell count gain from HAART initiation ≥ 150 cells/mm(3)) and on the time to achieve virological success (the first HIV-RNA measurement <50 copies/mL from HAART initiation) was evaluated by survival analyses. RESULTS Overall, at therapy start, 27% of patients had FPR ≤ 10 (6%, FPR ≤ 2; 7%, FPR 2-5; 14%, FPR 5-10). By 12 months of therapy the rate of immunological reconstitution was overall 75.5%, and it was significantly lower for FPR ≤ 2 (54.1%) in comparison to other FPR ranks (78.8%, FPR 2-5; 77.5%, FPR 5-10; 71.7%, FPR 10-20; 81.8%, FPR 20-60; 75.1%, FPR >60; p = 0.008). The overall proportion of patients achieving virological success was 95.5% by 12 months of therapy. Multivariable Cox analyses showed that patients having pre-HAART FPR ≤ 2% had a significant lower relative adjusted hazard [95% C.I.] both to achieve immunological reconstitution (0.37 [0.20-0.71], p = 0.003) and to achieve virological success (0.50 [0.26-0.94], p = 0.031) than those with pre-HAART FPR >60%. CONCLUSIONS Beyond the genotypically-inferred tropism determination, FPR ≤ 2% predicts both a poor immunological reconstitution and a lower virological response in drug-naïve patients who started their first-line therapy. This parameter could be useful to identify patients potentially with less chance of achieving adequate immunological reconstitution and virological undetectability.
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Affiliation(s)
- Daniele Armenia
- Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy
| | - Cathia Soulie
- Unité Mixte de Recherche en Santé (UMR_S) 1136 Pierre Louis Institute of Epidemiology and Public Health, Université Pierre et Marie Curie (UPMC) University Paris 06, Paris, France
- UMR_S 1136 Pierre Louis Institute of Epidemiology and Public Health, Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France
- Laboratoire de Virologie, Assistance Publique-Hôpitaux de Paris (AP-HP), Groupe hospitalier Pitié Salpêtrière, Paris, France
| | - Domenico Di Carlo
- Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy
| | - Lavinia Fabeni
- Antiviral Drug Monitoring Unit, Istituto Nazionale delle Malattie Infettive (INMI) Lazzaro Spallanzani, Rome, Italy
| | - Caterina Gori
- Antiviral Drug Monitoring Unit, Istituto Nazionale delle Malattie Infettive (INMI) Lazzaro Spallanzani, Rome, Italy
| | - Federica Forbici
- Antiviral Drug Monitoring Unit, Istituto Nazionale delle Malattie Infettive (INMI) Lazzaro Spallanzani, Rome, Italy
| | - Valentina Svicher
- Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy
| | - Ada Bertoli
- Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy
- Molecular Virology, University Hospital Tor Vergata, Rome, Italy
| | - Loredana Sarmati
- Infectious Disease Unit, University Hospital Tor Vergata, Rome, Italy
| | - Massimo Giuliani
- Department of Infectious Dermatology, San Gallicano Hospital, Rome, Italy
| | - Alessandra Latini
- Department of Infectious Dermatology, San Gallicano Hospital, Rome, Italy
| | - Evangelo Boumis
- Infectious Diseases Division, Istituto Nazionale delle Malattie Infettive (INMI) Lazzaro Spallanzani, Rome, Italy
| | - Mauro Zaccarelli
- Infectious Diseases Division, Istituto Nazionale delle Malattie Infettive (INMI) Lazzaro Spallanzani, Rome, Italy
| | - Rita Bellagamba
- Infectious Diseases Division, Istituto Nazionale delle Malattie Infettive (INMI) Lazzaro Spallanzani, Rome, Italy
| | - Massimo Andreoni
- Infectious Disease Unit, University Hospital Tor Vergata, Rome, Italy
| | - Anne-Geneviève Marcelin
- Unité Mixte de Recherche en Santé (UMR_S) 1136 Pierre Louis Institute of Epidemiology and Public Health, Université Pierre et Marie Curie (UPMC) University Paris 06, Paris, France
- UMR_S 1136 Pierre Louis Institute of Epidemiology and Public Health, Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France
- Laboratoire de Virologie, Assistance Publique-Hôpitaux de Paris (AP-HP), Groupe hospitalier Pitié Salpêtrière, Paris, France
| | - Vincent Calvez
- Unité Mixte de Recherche en Santé (UMR_S) 1136 Pierre Louis Institute of Epidemiology and Public Health, Université Pierre et Marie Curie (UPMC) University Paris 06, Paris, France
- UMR_S 1136 Pierre Louis Institute of Epidemiology and Public Health, Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France
- Laboratoire de Virologie, Assistance Publique-Hôpitaux de Paris (AP-HP), Groupe hospitalier Pitié Salpêtrière, Paris, France
| | - Andrea Antinori
- Infectious Diseases Division, Istituto Nazionale delle Malattie Infettive (INMI) Lazzaro Spallanzani, Rome, Italy
| | | | - Carlo-Federico Perno
- Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy
- Antiviral Drug Monitoring Unit, Istituto Nazionale delle Malattie Infettive (INMI) Lazzaro Spallanzani, Rome, Italy
- Molecular Virology, University Hospital Tor Vergata, Rome, Italy
| | - Maria Mercedes Santoro
- Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy
- * E-mail:
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Berno G, Zaccarelli M, Gori C, Tempestilli M, Antinori A, Perno CF, Pucillo LP, D'Arrigo R. Analysis of single-nucleotide polymorphisms (SNPs) in human CYP3A4 and CYP3A5 genes: potential implications for the metabolism of HIV drugs. BMC Med Genet 2014; 15:76. [PMID: 24986243 PMCID: PMC4083125 DOI: 10.1186/1471-2350-15-76] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Accepted: 06/25/2014] [Indexed: 01/08/2023]
Abstract
BACKGROUND Drug metabolism via the cytochrome P450 (CYP450) system has emerged as an important determinant in the occurrence of several drug interactions (adverse drug reactions, reduced pharmacological effect, drug toxicities). In particular, CYP3A4 and CYP3A5 (interacting with more than 60% of licensed drugs) exhibit the most individual variations of gene expression, mostly caused by single nucleotide polymorphisms (SNPs) within the regulatory region of the CYP3A4 and CYP3A5 genes which might affect the level of enzyme production.In this study, we sought to improve the performance of sensitive screening for CYP3A polymorphism detection in twenty HIV-1 infected patients undergoing lopinavir/ritonavir (LPV/r) monotherapy. METHODS The study was performed by an effective, easy and inexpensive home-made Polymerase Chain Reaction Direct Sequencing approach for analyzing CYP3A4 and CYP3A5 genes which can detect both reported and unreported genetic variants potentially associated with altered or decreased functions of CYP3A4 and CYP3A5 proteins. Proportions and tests of association were used. RESULTS Among the genetic variants considered, CYP3A4*1B (expression of altered function) was only found in 3 patients (15%) and CYP3A5*3 (expression of splicing defect) in 3 other patients (15%). CYP3A5*3 did not appear to be associated with decreased efficacy of LPV/r in any patient, since none of the patients carrying this variant showed virological rebound during LPV/r treatment or low levels of TDM. In contrast, low-level virological rebound was observed in one patient and a low TDM level was found in another; both were carrying CYP3A4*1B. CONCLUSIONS Our method exhibited an overall efficiency of 100% (DNA amplification and sequencing in our group of patients). This may contribute to producing innovative results for better understanding the inter-genotypic variability in gene coding for CYP3A, and investigating SNPs as biological markers of individual response to drugs requiring metabolism via the cytochrome P450 system.
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Affiliation(s)
| | | | | | | | | | | | | | - Roberta D'Arrigo
- Clinical Biochemistry and Pharmacology Laboratory, National Institute for Infectious Diseases "L, Spallanzani", Via Portuense 292, Rome, 00149, Italy.
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Fabbiani M, Zaccarelli M, Grima P, Prosperi M, Fanti I, Colafigli M, D'Avino A, Mondi A, Borghetti A, Fantoni M, Cauda R, Di Giambenedetto S. Single tablet regimens are associated with reduced Efavirenz withdrawal in antiretroviral therapy naïve or switching for simplification HIV-infected patients. BMC Infect Dis 2014; 14:26. [PMID: 24418191 PMCID: PMC3897945 DOI: 10.1186/1471-2334-14-26] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Accepted: 01/11/2014] [Indexed: 11/19/2022] Open
Abstract
Background Efavirenz (EFV) administration is still controversial for its high rates of interruption mainly related to central nervous system side effects (CNS-SE). Aim of the study was to define if single tablet regimen (STR) as compared to bis-in-die (BID) or once-daily (OD) with ≥2 pills-a-day EFV formulations reduced the risk of interruption. Methods Patients starting any cART regimen including EFV + 2NRTIs or switching to EFV + 2NRTIs for simplification after virological suppression were retrospectively selected. Incidence, probability and prognostic factors of interruption by different causes were assessed by survival analysis and Cox regression model. Results Overall, 553 patients starting EFV-containing regimens were included: 38.2% started BID regimen, 44.5% OD regimens ≥2 pills and 17.4% STR. The overall proportion of EFV interruption was 37.4% at 4 years; at the same time point, interruptions for virological failure and toxicity were 8.8% and 16.5% (8% for CNS-SE), respectively. Starting EFV co-formulated in STR was associated with lower proportion of overall interruption at 4 years (17.1% vs. 40.6%, p < 0.01). Only one virological failure was observed with STR up to 4 years (1.1% vs. 10.3% in non-STR, p = 0.051). STR also accounted for lower proportion of interruption by patient decision (1.5% vs. 11.8%, p = 0.01). No differences of interruption by overall toxicity and CNS-SE were observed. In multivariable analysis, STR and male gender were associated with lower risk of EFV interruption, while higher CD4 nadir and IDU with higher risk. Conclusions In our experience, starting EFV co-formulated in STR was associated with lower virological failure and higher adherence, despite a similar proportion of CNS toxicity, thus reducing the risk of treatment interruption.
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Affiliation(s)
| | - Mauro Zaccarelli
- Viral Immunodeficiency Unit, National Institute for Infectious Diseases "Lazzaro Spallanzani", Rome, Italy.
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Latini A, Cota C, Ferraresi V, Cordiali-Fei P, Giuliani M, Trento E, Zaccarelli M, Bonadies A, Di Carlo A, Palamara G. Radiation recall dermatitis in course of epidemic Kaposi's sarcoma. Dermatol Ther 2013; 26:424-7. [PMID: 24099075 DOI: 10.1111/dth.12017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Radiation recall dermatitis is an acute, rare skin reaction confined to previously irradiated areas that can be triggered by chemotherapeutic drugs (generally doxorubicin and taxanes), which are administrated after radiotherapy. We describe this case report to discuss the timing of the different choice of treatments of progressive Kaposis's sarcoma (KS) disease. KS, the neoplastic disease associated with HHV-8 infection, is still the most commonly diagnosed malignancy in HIV-1 patients, even if its incidence dramatically declined in the highly active antiretroviral therapy (HAART) era. The cutaneous form of disease generally improves with HAART alone or in association with local treatment (cryotherapy, radiotherapy, intralesion chemotherapy), whereas disseminated and/or progressive disease needs to be treated with systemic chemotherapy. In selected patients with progressive disease, systemic and local therapeutic options should be associated. We report a case of a 30-year-old HIV-1-positive man, affected by epidemic cutaneous and mucosal KS, who received several cycles of chemotherapy in succession with radiotherapy and other chemotherapy treatments for disease progression. After 7 months, the end of the last rechallenge with chemotherapy, the patient presented cutaneous painful and ulcerated lesions on the same skin areas previously irradiated.
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Sterrantino G, Zaccarelli M, Di Giambenedetto S, De Luca A, Francisci D, Punzi G, Monno L, Bruzzone B, Antinori A, Zazzi M. HIV tropism and its relationship with transmitted resistance in naive patients. Future Virol 2013. [DOI: 10.2217/fvl.13.63] [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: 11/21/2022]
Abstract
Aim: The objective of the present study was to investigate whether patients with transmitted resistance more frequently harbor X4/DM tropic viral strains. Patients & methods: Patients were included from an Italian nationwide database if they were tested for tropism and resistance at the same time. HIV tropism was assessed by the Geno2pheno coreceptor system (false-positive rate: ≤10%) and enhanced-sensitivity Trofile assay. Overall, 299 naive patients, tested between 2009 and 2011, were included: 252 patients tested by Geno2pheno, 116 by enhanced-sensitivity Trofile assay and 80 by both methods. Results & conclusion: Using Geno2pheno, X4/DM tropic virus was detected in 55 patients (21.8%), with an overall mean false-positive rate of 42.3% (standard deviation: ±33.3). Using the enhanced-sensitivity Trofile assay, 29 patients (25.0%) carried X4/DM tropic virus. Resistance mutations were more frequently detected in patients harboring X4/DM tropic virus (mean: 1.18 ± 3.0 vs 0.41 ± 1.2 per patient; p = 0.001) and with both Geno2pheno (0.82 ± 2.6 vs 0.35 ± 0.9; p = 0.034) and enhanced-sensitivity Trofile assay (1.11 ± 1.9 vs 0.46 ± 1.1; p = 0.039). However, significant differences were found for reverse transcriptase-related mutations, but not for transmitted protease resistance, and this might be explained by the low frequency of transmitted protease resistance. Among single mutations, L33F and L90M with regards to protease and K65R, K70E, K219E and V106A/M with regards to reverse transcriptase were found to be significantly associated with X4/DM tropic virus. X4/DM tropism was also associated with lower CD4+ cell count, but not with higher HIV RNA levels. X4/DM tropic HIV strains were related to a higher frequency of transmitted reverse transcriptase resistance mutations in this unselected set of naive patients. As a consequence, if a patient harbors a non-CCR5 tropic virus and bears more reverse transcriptase resistance and less protease resistance, a boosted protease inhibitor-based first-line regimen should be preferred.
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Affiliation(s)
- Gaetana Sterrantino
- Azienda Ospedaliera Universitaria Careggi, Infectious Diseases, Largo Brambilla 3, 50134 Firenze, Italy
| | - Mauro Zaccarelli
- National Institute for Infectious Diseases ‘Lazzaro Spallanzani’, Viral Immunodeficiency Unit, Rome, Italy
| | | | | | | | - Grazia Punzi
- University of Bari, Laboratory of Virology, Bari, Italy
| | - Laura Monno
- University of Bari, Infectious Diseases, Bari, Italy
| | | | - Andrea Antinori
- National Institute for Infectious Diseases ‘Lazzaro Spallanzani’, Clinical Department, Rome, Italy
| | - Maurizio Zazzi
- University of Siena, Department of Molecular Biology, Siena, Italy, for the ARCA Data-Base Study Group
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Prosperi MCF, Fabbiani M, Fanti I, Zaccarelli M, Colafigli M, Mondi A, D'Avino A, Borghetti A, Cauda R, Di Giambenedetto S. Predictors of first-line antiretroviral therapy discontinuation due to drug-related adverse events in HIV-infected patients: a retrospective cohort study. BMC Infect Dis 2012; 12:296. [PMID: 23145925 PMCID: PMC3519703 DOI: 10.1186/1471-2334-12-296] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2012] [Accepted: 11/01/2012] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Drug-related toxicity has been one of the main causes of antiretroviral treatment discontinuation. However, its determinants are not fully understood. Aim of this study was to investigate predictors of first-line antiretroviral therapy discontinuation due to adverse events and their evolution in recent years. METHODS Patients starting first-line antiretroviral therapy were retrospectively selected. Primary end-point was the time to discontinuation of therapy due to adverse events, estimating incidence, fitting Kaplan-Meier and multivariable Cox regression models upon clinical/demographic/chemical baseline patients' markers. RESULTS 1,096 patients were included: 302 discontinuations for adverse events were observed over 1,861 person years of follow-up between 1988 and 2010, corresponding to an incidence (95% CI) of 0.16 (0.14-0.18). By Kaplan-Meier estimation, the probabilities (95% CI) of being free from an adverse event at 90 days, 180 days, one year, two years, and five years were 0.88 (0.86-0.90), 0.85 (0.83-0.87), 0.79 (0.76-0.81), 0.70 (0.67-0.74), 0.55 (0.50-0.61), respectively. The most represented adverse events were gastrointestinal symptoms (28.5%), hematological (13.2%) or metabolic (lipid and glucose metabolism, lipodystrophy) (11.3%) toxicities and hypersensitivity reactions (9.3%). Factors associated with an increased hazard of adverse events were: older age, CDC stage C, female gender, homo/bisexual risk group (vs. heterosexual), HBsAg-positivity. Among drugs, zidovudine, stavudine, zalcitabine, didanosine, full-dose ritonavir, indinavir but also efavirenz (actually recommended for first-line regimens) were associated to an increased hazard of toxicity. Moreover, patients infected by HIV genotype F1 showed a trend for a higher risk of adverse events. CONCLUSIONS After starting antiretroviral therapy, the probability of remaining free from adverse events seems to decrease over time. Among drugs associated with increased toxicity, only one is currently recommended for first-line regimens but with improved drug formulation. Older age, CDC stage, MSM risk factor and gender are also associated with an increased hazard of toxicity and should be considered when designing a first-line regimen.
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Affiliation(s)
- Mattia C F Prosperi
- Viral Immunodeficiency Unit, National Institute for Infectious Diseases Lazzaro Spallanzani, Rome, Italy.
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Santoro MM, Alteri C, Ronga L, Flandre P, Fabeni L, Mercurio F, D'Arrigo R, Gori C, Palamara G, Bertoli A, Forbici F, Salpini R, Boumis E, Tozzi V, Visco-Comandini U, Zaccarelli M, Van Houtte M, Pattery T, Narciso P, Antinori A, Ceccherini-Silberstein F, Perno CF. Comparative analysis of drug resistance among B and the most prevalent non-B HIV type 1 subtypes (C, F, and CRF02_AG) in Italy. AIDS Res Hum Retroviruses 2012; 28:1285-93. [PMID: 22417570 DOI: 10.1089/aid.2011.0142] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
In recent years, increasing numbers of patients infected with HIV-1 non-B subtypes have been treated with modern antiretroviral regimens. Therefore, a better knowledge of HIV drug resistance in non-B strains is crucial. Thus, we compared the mutational pathways involved in drug resistance among the most common non-B subtypes in Italy (F, C, and CRF02_AG) and the B subtype. In total, 2234 pol sequences from 1231 virologically failing patients from Central Italy were analyzed. The prevalence of resistance mutations in protease and reverse transcriptase between non-B and B subtypes has been evaluated. Among patients treated with nucleoside/nucleotide reverse transcriptase inhibitors (NRTI) and with thymidine analogues (TA) experience, TAMs1 M41L and L210W were less prevalent in CRF02_AG, while TAMs2 T215F and K219E were more prevalent in the F subtype. In NRTI-treated patients having experience with abacavir, didanosine, tenofovir, or stavudine the K65R mutation was mostly prevalent in the C subtype. In non-NRTI (NNRTI)-treated patients infected by the C subtype the prevalence of K103N was lower than in patients infected with other subtypes, while the prevalence of Y181C and Y188L was higher compared to subtype B. The prevalence of Y181C was higher also in subtype F as compared to subtype B. In patients treated with protease inhibitors, L89V was predominantly found in CRF02_AG, while the TPV resistance mutation T74P was predominantly found in the C subtype. Some differences in the genotypic drug resistance have been found among patients infected with B, C, F, and CRF02_AG subtypes in relationship to treatment. These results may be useful for the therapeutic management of individuals infected with HIV-1 non-B strains.
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Affiliation(s)
- Maria Mercedes Santoro
- University of Rome Tor Vergata, Experimental Medicine and Biochemical Sciences, Rome, Italy
| | - Claudia Alteri
- University of Rome Tor Vergata, Experimental Medicine and Biochemical Sciences, Rome, Italy
| | - Luigi Ronga
- University of Rome Tor Vergata, Experimental Medicine and Biochemical Sciences, Rome, Italy
- Department of Pathology and Laboratory Medicine, Section of Microbiology, University of Parma, Parma, Italy
| | | | | | - Fabio Mercurio
- University of Rome Tor Vergata, Experimental Medicine and Biochemical Sciences, Rome, Italy
| | | | | | | | - Ada Bertoli
- University Hospital Tor Vergata, Molecular Virology, Rome, Italy
| | | | - Romina Salpini
- University of Rome Tor Vergata, Experimental Medicine and Biochemical Sciences, Rome, Italy
| | | | | | | | | | | | | | | | | | | | - Carlo Federico Perno
- University of Rome Tor Vergata, Experimental Medicine and Biochemical Sciences, Rome, Italy
- INMI L Spallanzani, Rome, Italy
- University Hospital Tor Vergata, Molecular Virology, Rome, Italy
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Sterrantino G, Zaccarelli M, Colao G, Baldanti F, Di Giambenedetto S, Carli T, Maggiolo F, Zazzi M. Genotypic resistance profiles associated with virological failure to darunavir-containing regimens: a cross-sectional analysis. Infection 2012; 40:311-8. [DOI: 10.1007/s15010-011-0237-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2011] [Accepted: 12/08/2011] [Indexed: 10/14/2022]
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