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Gregori N, Renzetti S, Izzo I, Faletti G, Fumarola B, Degli Antoni M, Arsuffi S, Storti S, Tiecco G, Calza S, Caruso A, Castelli F, Quiros-Roldan E, Focà E. Does the rapid initiation of antiretroviral therapy at HIV diagnosis impact virological response in a real-life setting? A single-centre experience in Northern Italy. AIDS Care 2023; 35:1938-1947. [PMID: 36795128 DOI: 10.1080/09540121.2023.2176425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 01/22/2023] [Indexed: 02/17/2023]
Abstract
Rapid initiation of antiretroviral therapy (ART) has been proven efficacious and safe, but more investigations are needed to define feasibility of rapid ART approach in real-life settings.We conducted a retrospective, observational study on newly HIVdiagnosed patients referred to our Infectious Diseases Department from September 1st, 2015, to July 31st, 2019. According to the timing of ART initiation, we distinguished 3 groups of patients (rapid, intermediate and late group) and represented the trend of virological response during a 400-days-period. The hazard ratios of each predictor on viral suppression were estimated through the Cox proportional hazard model.The median time from HIV diagnosis to the first medical referral was 15 days and the median time from the first care access to therapy start was 24 days. Among patients, 37.6% started ART within 7 days, 20.6% between 8 and 30 days, and 41.8% after 30 days. Longer time to ART start and higher baseline viral load were associated with a lower probability of viral suppression. After one year, all groups showed a high viral suppression rate (99%). In a high-income setting the rapid ART approach seems useful to accelerate viral suppression which is great over time regardless of ART initiation timing.
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Affiliation(s)
- Natalia Gregori
- University Department of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili, Brescia, Italy
| | - Stefano Renzetti
- Unit of Biostatistics and Bioinformatics, Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Ilaria Izzo
- Department of Infectious and Tropical Diseases, ASST Spedali Civili, Brescia, Italy
| | - Giulio Faletti
- University Department of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili, Brescia, Italy
| | - Benedetta Fumarola
- University Department of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili, Brescia, Italy
| | - Melania Degli Antoni
- University Department of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili, Brescia, Italy
| | - Stefania Arsuffi
- University Department of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili, Brescia, Italy
| | - Samuele Storti
- University Department of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili, Brescia, Italy
| | - Giorgio Tiecco
- University Department of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili, Brescia, Italy
| | - Stefano Calza
- Unit of Biostatistics and Bioinformatics, Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Arnaldo Caruso
- Section of Microbiology, Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Francesco Castelli
- University Department of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili, Brescia, Italy
| | - Eugenia Quiros-Roldan
- University Department of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili, Brescia, Italy
| | - Emanuele Focà
- University Department of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili, Brescia, Italy
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Marchese V, Formenti B, Marchese L, Gregori N, Gardini G, Russo G, Bona F, Di Rosario G, Gulletta M, Tomasoni LR, Castelli F, Matteelli A. COVID-19 effect on TB presentation and outcome. Int J Tuberc Lung Dis 2022; 26:375-377. [PMID: 35351245 DOI: 10.5588/ijtld.22.0036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- V Marchese
- Department of Infectious and Tropical Diseases, Azienda Socio Sanitaria Territoriale Spedali Civili of Brescia and University of Brescia, Brescia, Italy, WHO Collaborating Center for TB/HIV Co-infection and the TB Elimination Strategy, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - B Formenti
- Department of Infectious and Tropical Diseases, Azienda Socio Sanitaria Territoriale Spedali Civili of Brescia and University of Brescia, Brescia, Italy, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - L Marchese
- Institute for Particle Physics And Astrophysics, Eidgenössische Technische Hochschule Zürich, Zurich, Switzerland
| | - N Gregori
- Department of Infectious and Tropical Diseases, Azienda Socio Sanitaria Territoriale Spedali Civili of Brescia and University of Brescia, Brescia, Italy
| | - G Gardini
- Department of Infectious and Tropical Diseases, Azienda Socio Sanitaria Territoriale Spedali Civili of Brescia and University of Brescia, Brescia, Italy
| | - G Russo
- Department of Infectious and Tropical Diseases, Azienda Socio Sanitaria Territoriale Spedali Civili of Brescia and University of Brescia, Brescia, Italy, WHO Collaborating Center for TB/HIV Co-infection and the TB Elimination Strategy, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - F Bona
- Department of Infectious and Tropical Diseases, Azienda Socio Sanitaria Territoriale Spedali Civili of Brescia and University of Brescia, Brescia, Italy
| | - G Di Rosario
- Department of Infectious and Tropical Diseases, Azienda Socio Sanitaria Territoriale Spedali Civili of Brescia and University of Brescia, Brescia, Italy
| | - M Gulletta
- Department of Infectious and Tropical Diseases, Azienda Socio Sanitaria Territoriale Spedali Civili of Brescia and University of Brescia, Brescia, Italy
| | - L R Tomasoni
- Department of Infectious and Tropical Diseases, Azienda Socio Sanitaria Territoriale Spedali Civili of Brescia and University of Brescia, Brescia, Italy
| | - F Castelli
- Department of Infectious and Tropical Diseases, Azienda Socio Sanitaria Territoriale Spedali Civili of Brescia and University of Brescia, Brescia, Italy, WHO Collaborating Center for TB/HIV Co-infection and the TB Elimination Strategy, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - A Matteelli
- Department of Infectious and Tropical Diseases, Azienda Socio Sanitaria Territoriale Spedali Civili of Brescia and University of Brescia, Brescia, Italy, WHO Collaborating Center for TB/HIV Co-infection and the TB Elimination Strategy, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
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Formenti B, Gregori N, Crosato V, Marchese V, Tomasoni LR, Castelli F. The impact of COVID-19 on communicable and non-communicable diseases in Africa: a narrative review. Infez Med 2022; 30:30-40. [PMID: 35350264 DOI: 10.53854/liim-3001-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 02/20/2022] [Indexed: 01/06/2023]
Abstract
The global pandemic of coronavirus disease 2019 (COVID-19) has disproportionately impacted global human health, economy, and security. Because of weaker health-care systems, existing comorbidities burden (HIV, malaria, tuberculosis, and non-communicable conditions), and poor socioeconomic determinants, initial predictive models had forecast a disastrous impact of COVID-19 in Africa in terms of transmission, severity, and deaths. Nonetheless, current epidemiological data seem not to have matched expectations, showing lower SARS-CoV-2 infection and fatality rates compared to Europe, the Americas and Asia. However, only few studies were conducted in low- and middle-income African settings where high poverty and limited access to health services worsen underlying health conditions, including endemic chronic infectious diseases such as HIV and tuberculosis. Furthermore, limited, and heterogeneous research was conducted to evaluate the indirect impact of the pandemic on general health services and on major diseases across African countries. International mitigation measures, such as resource reallocation, lockdowns, social restrictions, and fear from the population have had multi-sectoral impacts on various aspects of everyday life, that shaped the general health response. Despite the vast heterogeneity of data across African countries, available evidence suggests that the COVID-19 pandemic has severely impacted the control and prevention programs, the diagnosis capacity and the adherence to treatment of major infectious diseases (HIV, TB, and Malaria) - including neglected diseases - and non-communicable diseases. Future research and efforts are essential to deeply assess the medium- and long-term impact of the pandemic, and to implement tailored interventions to mitigate the standstill on decades of improvement on public health programs.
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Affiliation(s)
- Beatrice Formenti
- UNESCO Training and Empowering Human Resources for Health Development in Resource-Limited Countries, University of Brescia, Italy
| | - Natalia Gregori
- Department of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili of Brescia, Italy
| | - Verena Crosato
- Department of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili of Brescia, Italy
| | - Valentina Marchese
- Department of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili of Brescia, Italy
| | | | - Francesco Castelli
- UNESCO Training and Empowering Human Resources for Health Development in Resource-Limited Countries, University of Brescia, Italy.,Department of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili of Brescia, Italy
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Marchese V, Formenti B, Cola G, Gregori N, Albini E, De Palma G, Possenti I, Scala M, Castelli F, Matteelli A. Importance of mitigation measures for hospital transmission of SARS-CoV-2 at the onset of the epidemic: the experience of Brescia, Northern Italy. Infection 2021; 49:1241-1248. [PMID: 34524648 PMCID: PMC8441227 DOI: 10.1007/s15010-021-01692-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 09/01/2021] [Indexed: 11/21/2022]
Abstract
Purpose Since the first Italian case of SARS-CoV-2 was detected in Lombardy (Northern Italy) Italy quickly became one of the worst-affected European countries, with a severe impact on health-care workers (HCWs). In the first epidemic, HCWs accounted for 12% of all national COVID-19 cases. We evaluated the burden of COVID-19 among HCWs and other non-health-care workers (nHCWs) in a large Italian hospital. Methods From March 1st to May 31st 2020, we performed a retrospective study at ASST Civil Hospital, in the Province of Brescia, Lombardy. The study population included all hospital personnel (n = 9265), categorized by professional status. Results A SARS-CoV-2 test was performed in 3572 workers (38.5%), with a positive result in 552 (5.9% of all hospital personnel). The temporal trend of SARS-CoV-2 cases in hospital staff broadly reflected that in the community, with a great majority of infections occurred during March 2020 (87.7%). From April onward, a steep decrease of positive cases was observed among hospital personnel, while in the community the decrease was much slower. Medical doctors (8.9%) and nurses (8.5%) were the most affected professional categories with a significantly higher risk of SARS-CoV-2 infection (OR 1.436 and OR 1.410, respectively p < 0.0001). HCWs in COVID-19 units presented a significantly higher risk of infection compared to HCWs in non-COVID units (p < 0.001). Conclusion HCWs were severely affected by the COVID-19 epidemic, probably associated with an overwhelming burden of work and lack of preparedness in prevention of nosocomial transmission of the infection. The rapid decrease of COVID-19 spread in the hospital, registered before the one in the community, suggests that the adopted preventive measures were effective.
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Affiliation(s)
- Valentina Marchese
- University Department of Infectious and Tropical Diseases, WHO Collaborating Centre for TB/HIV Collaborative Activities and for TB Elimination Strategy, University of Brescia, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Beatrice Formenti
- University Department of Infectious and Tropical Diseases, WHO Collaborating Centre for TB/HIV Collaborative Activities and for TB Elimination Strategy, University of Brescia, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Gloria Cola
- Department of Infectious and Tropical Diseases, University of Brescia, Piazza Spedali Civili, 1, 25125, Brescia, Italy
| | - Natalia Gregori
- Department of Infectious and Tropical Diseases, University of Brescia, Piazza Spedali Civili, 1, 25125, Brescia, Italy
| | - Elisa Albini
- Section of Occupational Health, Department of Experimental and Applied Medicine, University of Brescia, Brescia, Italy
| | - Giuseppe De Palma
- Section of Public Health and Human Sciences, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Irene Possenti
- Department of Statistical Sciences "Paolo Fortunati", University of Bologna, Bologna, Italy
| | - Marco Scala
- Department of Environmental Health Sciences, Instituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Francesco Castelli
- University Department of Infectious and Tropical Diseases, WHO Collaborating Centre for TB/HIV Collaborative Activities and for TB Elimination Strategy, University of Brescia, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Alberto Matteelli
- University Department of Infectious and Tropical Diseases, WHO Collaborating Centre for TB/HIV Collaborative Activities and for TB Elimination Strategy, University of Brescia, ASST Spedali Civili of Brescia, Brescia, Italy.
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Properzi M, Della Giustina T, Mentasti S, Castelli F, Chiesa A, Gregori N, Quiros-Roldan E. Low prevalence of symptomatic thyroid diseases and thyroid cancers in HIV-infected patients. Sci Rep 2019; 9:19459. [PMID: 31857648 PMCID: PMC6923431 DOI: 10.1038/s41598-019-56032-7] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 12/05/2019] [Indexed: 12/13/2022] Open
Abstract
Thyroid diseases (TDs) have been widely associated with HIV infection. However, data about TDs prevalence and distribution are controversial, and few published studies are available. The aim of our study was to assess prevalence and risk factors of symptomatic thyroid disturbances, including thyroid cancers, in a large cohort of HIV-infected patients. A retrospective cohort study was performed at the Department of Infectious and Tropical Diseases of the University of Brescia, Italy, in the period 2005–2017. We identified all HIV-positive patients with a diagnosis of symptomatic TD in the electronic database of our Department (HIVeDB); we also operated a record-linkage between our data and the Health Protection Agency database (HPADB) of Brescia Province. Multivariate logistic regression analysis was used to determine risk factors associated with TDs onset; an incidence rate analysis was also performed. During the study period, 6343 HIV-infected patients have been followed at our Department; 123 received a diagnosis of symptomatic TD (1.94% of the entire cohort). In the TDs group, almost half of patients were females (n = 59, 48%), mean age was 47.15 years (SD: 11.56). At TD diagnosis, mean T CD4+ cell count was 491 cell/uL and most patients showed undetectable HIV-RNA (n = 117, 95.12%). Among them, 81 patients were found to have hypothyroidism (63 with Hashimoto’s thyroiditis), 21 hyperthyroidism (17 suffered from Graves’ disease), while 11 subjects were diagnosed with a primitive thyroid cancer. Papillary thyroid cancer was the most frequent histotype (n = 7, 63.63%), followed by medullary (n = 2, 18.18%) and follicular thyroid cancer (n = 1, 9.1%). Male gender was a protective factor for TDs development, especially for hypothyroidism (p < 0.001); age emerged as a variable associated with both hypothyroidism (p = 0.03) and thyroid cancer (p = 0.03), while CD4+ cell nadir <200 cell/mm3 was associated with symptomatic hyperthyroidism (p = 0.005). To conclude, symptomatic thyroid dysfunctions rate in well-treated HIV-infected patients is low. Age and gender are crucial elements in the onset of thyroid abnormalities, together with T CD4+ cell nadir. Interestingly, medullary thyroid cancer seems to be much more frequent in HIV-infected patients compared to the general population.
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Affiliation(s)
- Martina Properzi
- Department of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili Hospital, Brescia, Italy.
| | - Tommaso Della Giustina
- Department of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili Hospital, Brescia, Italy
| | - Sara Mentasti
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Unit of Hygiene, Epidemiology and Public Health, University of Brescia, Brescia, Italy
| | - Francesco Castelli
- Department of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili Hospital, Brescia, Italy
| | - Annacarla Chiesa
- Department of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili Hospital, Brescia, Italy
| | - Natalia Gregori
- Department of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili Hospital, Brescia, Italy
| | - Eugenia Quiros-Roldan
- Department of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili Hospital, Brescia, Italy
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