1
|
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.
Collapse
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
| | | |
Collapse
|
2
|
Calleri G, Torta I, Gobbi F, Angheben A, Lipani F, Lucchini A, Burdino E, Ghisetti V, Caramello P. [Imported dengue in two tertiary Italian hospitals: Use of rapid diagnostic tests]. ACTA ACUST UNITED AC 2016; 110:13-19. [PMID: 28012140 DOI: 10.1007/s13149-017-0542-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Accepted: 11/03/2016] [Indexed: 10/20/2022]
Abstract
Dengue fever is growing at a global level both as number of cases and as geographic area of endemicity. Italy is not in endemic area, but the competent vector Aedes albopictus is widespread in this country, so that the possibility of introduction of the infection cannot be ruled out. We retrospectively collected demographic, clinical, and laboratory data about consecutive cases diagnosed in Torino and Negrar-Verona in the period 2010-2015. One hundred thirteen cases of dengue were observed, with an increasing trend during years. The infection was imported mostly from south-east Asia, but the risk appears to be higher in Latin America. More than half of the patients were admitted to the hospital but only one case of severe dengue was observed. Many patients presented after the resolution of symptoms. Rapid diagnostic tests were done in the majority of patients and allowed a diagnosis both in the acute (NS1 antigen) and convalescent (IgMantibodies) phases of the disease. An early diagnosis is paramount to avoid the spreading of the infection.
Collapse
Affiliation(s)
- G Calleri
- Travel Medicine Unit, Amedeo di Savoia Hospital, Torino, Italy.
| | - I Torta
- Travel Medicine Unit, Amedeo di Savoia Hospital, Torino, Italy
| | - F Gobbi
- Centre for Tropical Diseases, Sacro Cuore-Don Calabria Hospital, Negrar-Verona, Italy
| | - A Angheben
- Centre for Tropical Diseases, Sacro Cuore-Don Calabria Hospital, Negrar-Verona, Italy
| | - F Lipani
- Infectious Diseases Unit, University of Torino, Amedeo di Savoia Hospital, Torino, Italy
| | - A Lucchini
- Infectious Diseases Unit, University of Torino, Amedeo di Savoia Hospital, Torino, Italy
| | - E Burdino
- Microbiology and Virology Laboratory, Amedeo di Savoia Hospital, Torino, Italy
| | - V Ghisetti
- Microbiology and Virology Laboratory, Amedeo di Savoia Hospital, Torino, Italy
| | - P Caramello
- Infectious and Tropical Diseases Unit, Amedeo di Savoia Hospital, Torino, Italy
| |
Collapse
|
3
|
Saracino A, Lorenzini P, Lo Caputo S, Girardi E, Castelli F, Bonfanti P, Rusconi S, Caramello P, Abrescia N, Mussini C, Monno L, d'Arminio Monforte A. Increased risk of virologic failure to the first antiretroviral regimen in HIV-infected migrants compared to natives: data from the ICONA cohort. Clin Microbiol Infect 2015; 22:288.e1-8. [PMID: 26551839 DOI: 10.1016/j.cmi.2015.10.026] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [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: 07/02/2015] [Revised: 10/08/2015] [Accepted: 10/21/2015] [Indexed: 10/22/2022]
Abstract
Migrant and Italian HIV-infected patients (n = 5773) enrolled in the ICONA cohort in 2004-2014 were compared for disparities in access to an initial antiretroviral regimen and/or risk of virologic failure (VF), and determinants of failure were evaluated. Variables associated with initiating antiretroviral therapy (ART) were analysed. Primary endpoint was time to failure after at least 6 months of ART and was defined as: VF, first of two consecutive virus loads (VL) >200 copies/mL; treatment discontinuation (TD) for any reason; and treatment failure as confirmed VL >200 copies/mL or TD. A Poisson multivariable analysis was performed to control for confounders. Migrants presented significantly lower CD4 counts and more frequent AIDS events at baseline. When adjusting for baseline confounders, migrants presented a lower likelihood to begin ART (odds ratio 0.80, 95% confidence interval (CI) 0.67-0.95, p 0.012). After initiating ART, the incidence VF rate was 6.4 per 100 person-years (95% CI 4.8-8.5) in migrants and 2.7 in natives (95% CI 2.2-3.3). Multivariable analysis confirmed that migrants had a higher risk of VF (incidence rate ratio 1.90, 95% CI 1.25-2.91, p 0.003) and treatment failure (incidence rate ratio 1.16, 95% CI 1.01-1.33, p 0.031), with no differences for TD. Among migrants, variables associated with VF were age, unemployment and use of a boosted protease inhibitor-based regimen versus nonnucleoside reverse transcriptase inhibitors. Despite the use of more potent and safer drugs in the last 10 years, and even in a universal health care setting, migrants living with HIV still present barriers to initiating ART and an increased risk of VF compared to natives.
Collapse
Affiliation(s)
- A Saracino
- Clinic of Infectious Diseases, University of Bari, Bari, Italy.
| | - P Lorenzini
- Clinical Department, National Institute for Infectious Diseases 'Lazzaro Spallanzani' IRCCS, Rome, Italy
| | - S Lo Caputo
- Santissima Annunziata Hospital, Firenze, Italy
| | - E Girardi
- Department of Epidemiology, National Institute for Infectious Diseases 'L. Spallanzani,' IRCCS, Rome, Italy
| | - F Castelli
- University Division of Infectious and Tropical Diseases, University of Brescia and Spedali Civili General Hospital, Brescia, Italy
| | - P Bonfanti
- Department of Infectious Diseases, Azienda Ospedaliera Lecco, Lecco, Italy
| | - S Rusconi
- Department of Infectious Disease, L. Sacco University Hospital, University of Milan, Milan, Italy
| | - P Caramello
- Infectious and Tropical Diseases Unit I, Department of Infectious Diseases, Amedeo di Savoia Hospital, Torino, Italy
| | - N Abrescia
- Department of Infectious Diseases, Cotugno Hospital, Naples, Italy
| | - C Mussini
- Clinic of Infectious Diseases, University of Modena and Reggio Emilia, Modena, Italy
| | - L Monno
- Clinic of Infectious Diseases, University of Bari, Bari, Italy
| | - A d'Arminio Monforte
- Clinic of Infectious Diseases, Department of Health Sciences, San Paolo Hospital, University of Milan, Milan, Italy
| | | |
Collapse
|
4
|
Calleri G, Balbiano R, Caramello P. Are artemisinin-based combination therapies effective against Plasmodium malariae? J Antimicrob Chemother 2013; 68:1447-8. [DOI: 10.1093/jac/dkt005] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
|
5
|
Caramello P, Balbiano R, De Blasi T, Chiriotto M, Deagostini M, Calleri G. Severe malaria, artesunate and haemolysis. J Antimicrob Chemother 2012; 67:2053-4. [DOI: 10.1093/jac/dks139] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
6
|
Leombruni P, Picardi A, Lavagnino L, Orofino GC, Caramello P, Morosini P, Fassino S. Depression and the existential domain in the assessment of quality of life in HIV outpatients with the McGill questionnaire. Panminerva Med 2009; 51:197-203. [PMID: 20195230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
AIM The aim of the present study was to further test criterion validity and factorial validity of the McGIll Quality Of Life (MQOL) questionnaire, and to assess its reliability and sensitivity to clinical change in outpatients with HIV infection. METHODS The authors present a longitudinal study on a consecutive sample of 216 adults treated with HAART at the outpatient facility of an hospital-based tertiary care center in Italy. Patients completed the MQOL and the Beck Depression Inventory (BDI) both at baseline and follow-up assessments. Patients were classified into subgroups (improved, unchanged, worsened) based on change in BDI scores or CD4 count over time. RESULTS The pattern of correlation between MQOL subscales and the BDI was as hypothesised. A fairly simple factor structure emerged, with a striking resemblance between the factors and the MQOL subscales. The internal consistency of the MQOL and its subscales was high. The test-retest reliability in clinically unchanged patients was satisfactory. Sensitivity to change, as measured by Guyatt responsiveness statistic, was also satisfactory. CONCLUSIONS This study contributed to building evidence of reliability and validity for the MQOL questionnaire, which may be particularly useful to assess the so-called "existential" aspects of QOL that are particularly relevant for patients infected with HIV.
Collapse
Affiliation(s)
- P Leombruni
- Psychiatry Section, Neuroscience Department, University of Turin, Turin, Italy
| | | | | | | | | | | | | |
Collapse
|
7
|
Calleri G, Cariti G, Gaiottino F, De Rosa FG, Bargiacchi O, Audagnotto S, Quaglia S, De Blasi T, Romano P, Traverso A, Leo G, Carbone R, Del Mastro B, Tinelli M, Caramello P, Di Perri G. A short course of pegylated interferon-alpha in acute HCV hepatitis. J Viral Hepat 2007; 14:116-21. [PMID: 17244251 DOI: 10.1111/j.1365-2893.2006.00802.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Acute hepatitis C virus (HCV) infection evolves to chronicity in 50-84% cases. Treatment with interferon-alpha (IFN-alpha) was repeatedly found to provide sustained cure rates higher than that in chronic HCV infection, but the optimal treatment strategy has not yet been defined. In a multicentre open-label study, we investigated the therapeutic performance of a short course of pegylated (peg) IFN-alpha in patients with acute HCV hepatitis. Peg IFN-alpha2b, 1.0-1.5 micro g/kg weekly, was administered for 12 weeks. Forty-six patients were enrolled; 26 of them were intravenous drug users. Eleven patients had jaundice. Treatment was started within 1-90 days from the peak alanine aminotransferase. Treatment was well tolerated with a single dropout (2%). Thirty-three of 46 patients (72%) had a sustained virological response (SVR) after a 6 months post-treatment follow-up, 8 (17%) relapsed after treatment and 4 were nonresponders (9%). A lower peak viraemia, receiving at least 1.2 micro g/kg of peg IFN-alpha, and a negative HCV-RNA at week 4 and week 12 were predictors of SVR. Thus, in patients with early (week 4) viral response, a short course of peg IFN-alpha at a weekly dose >1.2 micro g/kg, may be a valuable option for the treatment of acute HCV hepatitis.
Collapse
Affiliation(s)
- G Calleri
- Department of Infectious Diseases, Amedeo di Savoia Hospital, Torino, Italy.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
8
|
Ancarani F, Angeli E, Antinori A, Antonucci G, Bonasso M, Bruno R, Capobianchi MR, Cargnel A, Cozzi-Lepri A, Monforte AD, Cingolani A, Galli M, Orofino GC, Girardi E, Marino N, Bongiovanni M, Morsica G, Narciso P, Pastecchia C, Pizzaferri P, Puoti M, Santantonio T, Verucchi G, Montroni M, Scalise G, Braschi MC, Maracci M, Tirelli U, Cinelli R, Pastore G, Ladisa N, Minafra G, Suter F, Arici C, Chiodo F, Colangeli V, Fiorini C, Coronado O, Carosi G, Cadeo GP, Torti C, Minardi C, Bertelli D, Rizzardini G, Migliorino G, Manconi PE, Piano P, Ferraro T, Scerbo A, Pizzigallo E, D'Alessandro M, Santoro D, Pusterla L, Carnevale G, Galloni D, Viganò P, Mena M, Ghinelli F, Sighinolfi L, Leoncini F, Mazzotta F, Pozzi M, Caputo SL, Angarano G, Grisorio B, Saracino A, Ferrara S, Grima P, Tundo P, Pagano G, Cassola G, Alessandrini A, Piscopo R, Toti M, Chigiotti S, Soscia F, Tacconi L, Orani A, Perini P, Scasso A, Vincenti A, Chiodera F, Castelli P, Scalzini A, Fibbia G, Moroni M, Lazzarin A, Cargnel A, Vigevani GM, Caggese L, Monforte AD, Repetto D, Novati R, Galli A, Merli S, Pastecchia C, Moioli MC, Esposito R, Mussini C, Abrescia N, Chirianni A, Izzo CM, Piazza M, De Marco M, Viglietti R, Manzillo E, Graf M, Colomba A, Abbadessa V, Prestileo T, Mancuso S, Ferrari C, Pizzaferri P, Filice G, Minoli L, Bruno R, Novati S, Baldelli F, Tinca M, Petrelli E, Cioppi A, Alberici F, Ruggieri A, Menichetti F, Martinelli C, De Stefano C, La Gala A, Ballardini G, Briganti E, Magnani G, Ursitti MA, Arlotti M, Ortolani P, Cauda R, Dianzani F, Ippolito G, Antinori A, Antonucci G, D'Elia S, Narciso P, Petrosillo N, Vullo V, De Luca A, Di Giambenedetti S, Zaccarelli M, Acinapura R, De Longis P, Ciardi M, D'Offizi G, Trotta MP, Noto P, Lichtner M, Capobianchi MR, Girardi E, Pezzotti P, Rezza G, Mura MS, Mannazzu M, Resta F, Loso K, Caramello P, Sinicco A, Soranzo ML, Orofino G, Sciandra M, Bonasso M, Grossi PA, Basilico C, Poggio A, Bottari G, Raise E, Pasquinucci S, De Lalla F, Tositti G, Lepri AC, Solmone M, Girardi E, Lalle E, Abbate I, Monforte AD, Cozzi-Lepri A, Alessandrini A, Piscopo R, Ebo F, Cosco L, Antonucci G, Ippolito G, Capobianchi MR. Evolution of HVR-1 Quasispecies after 1-Year Treatment in HIV/HCV-Coinfected Patients According to the Pattern of Response to Highly Active Antiretroviral Therapy. Antivir Ther 2006. [DOI: 10.1177/135965350601100102] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Hepatitis C virus (HCV) variability is mainly attributed to the ability of the virus to respond to host immune pressure, acting as a driving force for the evolution of quasispecies. This study was aimed at studying the changes in HVR-1 heterogeneity and the evolution of HCV quasispecies in HIV/HCV-coinfected patients according to the pattern of response to highly active antiretroviral therapy (HAART). Sixteen HIV/HCV-coinfected patients harbouring HCV genotype 1 and who had been on HAART for at least 1 year, 8 showing increasing CD4+T-cell counts (immunological responders) and 8 showing a stable or decreasing CD4+ T-cell counts (immunological non-responders), were selected from a prospective cohort study. After 1 year of HAART, 11 patients showed HIV viral load <2.6 log10 cp/ml (virological responders), and 5 showed HIV viral load above this value (virological non-responders). Plasma samples, collected before starting therapy and after 1 year of HAART, underwent clonal sequence analysis for HVR-1 region of HCV. Non-synonymous/synonymous substitutions ratio (Ka/Ks), aminoacidic complexity (normalized Shannon entropy) and diversity (p-distance), were considered as parameters of quasispecies heterogeneity. After 1 year of HAART, heterogeneity of HVR-1 quasispecies significantly decreased in virological non-responders, whereas the heterogeneity tended to increase in virological responders. The differences in the evolution were less stringent, when considering immunological response. On the other hand, profound qualitative modifications of HVR-1 quasispecies were observed only in patients with both immunological and virological HAART response. On the whole, these findings suggest that, in patients undergoing HAART, the extent of HCV variability and the evolution of HVR-1 quasispecies is influenced by the pattern of response to antiretroviral therapy.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Enrico Girardi
- National Institute of Infectious Diseases “L. Spallanzani”, Rome
| | - Eleonora Lalle
- National Institute of Infectious Diseases “L. Spallanzani”, Rome
| | - Isabella Abbate
- National Institute of Infectious Diseases “L. Spallanzani”, Rome
| | | | - Alessandro Cozzi-Lepri
- Department of Primary Care and Population Sciences, Royal Free and University College Medical School, London
| | | | - Rita Piscopo
- Department of Infectious Diseases, Galliera Hospital, Genova
| | - Francesca Ebo
- Department of Infectious Diseases, Hosp Civile San Giovanni e Paolo, Venezia
| | - Lucio Cosco
- Department of Infectious Diseases, A. Pugliesi Catanzaro
| | | | | | | |
Collapse
|
9
|
Cargnel A, Angeli E, Mainini A, Gubertini G, Giorgi R, Schiavini M, Duca P, Scalise G, Cesare SD, Chiodo F, Verucchi G, Farci P, Serra G, Sagnelli E, Nacca C, Ferraro T, Scerbo A, Santoro D, Pusterla L, Viganò P, Magnani C, Ghinelli F, Sighinolfi L, Vigevani G, Pastecchia C, Moroni M, Milazzo L, Esposito R, Borghi V, Piccinino F, Filippini P, Cadrobbi P, Sattin A, Ferrari C, Antoni AD, Stagni G, Francisci D, Petrelli E, Alberici F, Sacchini D, Zauli T, Donà DD, Arlotti M, Mori F, Marranconi F, Caramello P, Lipani F, Soranzo ML, Macor A, Vaglia A, Rossi MC, Grossi P, Tambini R, De Lalla F, Tositti G. Open, Randomized, Multicentre Italian Trial on Peg-Ifn plus Ribavirin versus Peg-Ifn Monotherapy for Chronic Hepatitis C in HIV-Coinfected Patients on Haart. Antivir Ther 2005. [DOI: 10.1177/135965350501000215] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Chronic hepatitis C is common and aggressive in HIV-positive patients, so the development of a well-tolerated HCV therapy is a priority. We evaluated the efficacy and safety of pegylated interferon α2b (PEG-IFN) plus ribavirin (RBV) versus PEG-IFN monotherapy in HIV/HCV-coinfected patients undergoing highly active antiretroviral therapy (HAART), and analysed the predictive factors of response. Methods An Italian, multicentre, open-label trial including 135 coinfected patients, randomized to PEG-IFN 1.5 μg/kg/week plus RBV 400 mg twice daily ( n=69, arm A) or PEG-IFN 1.5 μg/kg/week ( n=66, arm B) for 48 weeks. We assessed the predictive values of early virological response (EVR) at week 8 (HCV-RNA drop >2 log10 compared with baseline or undetectable levels) on sustained virological response (SVR). Results Fifty-five patients (28 from arm A and 27 from arm B) completed 48 weeks of therapy. At the end of treatment, 20/28 patients in arm A and 11/27 in arm B had HCV-RNA <50 IU/ml. In a per-protocol analysis, SVR was reached by 54% of patients in arm A (genotype 2–3, 11/16; genotype 1–4, 4/12) and 22% in arm B (genotype 2–3, 3/15; genotype 1–4, 3/12). In an intention-to-treat analysis, the SVR was 22% in arm A (genotype 2–3, 11/32; genotype 1–4, 4/37) versus 9% in arm B (genotype 2–3, 3/32; genotype 1–4, 3/34). The best predictors of SVR were the use of combination therapy, infection with HCV genotype 3 versus genotype 1, and EVR at week 8. Thirty patients (15 from arm A and 15 from arm B) dropped out of the trial prematurely due to side effects. The positive predictive value of EVR at week 8 was 65%, the negative predictive value was 86%. Conclusions PEG-IFN plus RBV can be considered a solid option for the treatment of HIV/HCV-coinfected patients. The key to successfully improving efficacy is strong compliance through strict overall patient monitoring, in order to best manage drug toxicity. EVR assessment at week 8 may become a useful stategy in the management of therapy.
Collapse
Affiliation(s)
| | | | - Elena Angeli
- II Department Infectious Diseases, Luigi Sacco Hospital, Milan, Italy
| | - Annalisa Mainini
- II Department Infectious Diseases, Luigi Sacco Hospital, Milan, Italy
| | - Guido Gubertini
- II Department Infectious Diseases, Luigi Sacco Hospital, Milan, Italy
| | - Riccardo Giorgi
- II Department Infectious Diseases, Luigi Sacco Hospital, Milan, Italy
| | - Monica Schiavini
- II Department Infectious Diseases, Luigi Sacco Hospital, Milan, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
10
|
Antonucci G, Girardi E, Cozzi-Lepri A, Capobianchi MR, Morsica G, Pizzaferri P, Ladisa N, Sighinolfi L, Chiodera A, Solmone M, Lalle E, Ippolito G, Monforte AD, Ancarani F, Antinori A, Antonucci G, Bonasso M, Bruno R, Capobianchi MR, Cargnel A, Cozzi-Lepri A, d'Arminio Monforte A, Luca AD, Galli M, Gennero L, Girardi E, Lipani F, Marino N, Milazzo L, Morsica G, Narciso P, Pizzaferri P, Puoti M, Santantonio T, Verucchi G, Montroni M, Scalise G, Braschi MC, Prete MSD, Tirelli U, Cinelli R, Pastore G, Ladisa N, Suter GMBF, Arici C, Chiodo F, Colangeli V, Fiorini C, Coronado O, Carosi G, Cadeo GP, Torti C, Minardi C, Bertelli D, Rizzardini G, Migliorino G, Manconi PE, Piano P, Ferraro T, Scerbo A, Pizzigallo E, D'Alessandro M, Santoro D, Pusterla L, Carnevale G, Galloni D, Viganò P, Mena M, Ghinelli F, Sighinolfi L, Leoncini F, Mazzotta F, Pozzi M, Caputo SL, Angarano G, Grisorio B, Saracino A, Ferrara S, Grima P, Tundo P, Pagano G, Cassola G, Alessandrini A, Piscopo R, Toti M, Chigiotti S, Soscia F, Tacconi L, Orani A, Perini P, Scasso A, Vincenti A, Chiodera F, Castelli P, Scalzini A, Fibbia G, Moroni M, Lazzarin A, Cargnel A, Vigevani GM, Caggese L, Monforte AD, Repetto D, Novati R, Galli A, Merli S, Pastecchia C, Moioli MC, Esposito R, Mussini C, Abrescia N, Chirianni A, Izzo CM, Piazza M, Marco MD, Viglietti R, Manzillo E, Graf M, Colomba A, Abbadessa V, Prestileo T, Mancuso S, Ferrari C, Pizzaferri P, Filice G, Minoli L, Bruno R, Novati S, Baldelli F, Tinca M, Petrelli E, Cioppi A, Alberici F, Ruggieri A, Menichetti F, Martinelli C, Stefano CD, Gala AL, Ballardini G, Briganti E, Magnani G, Ursitti MA, Arlotti M, Ortolani P, Cauda R, Dianzani F, Ippolito G, Antinori A, Antonucci G, D'Elia S, Narciso P, Petrosillo N, Vullo V, Luca AD, Giambenedetti SD, Zaccarelli M, Acinapura R, Longis PD, Ciardi M, D'Offizi G, Trotta MP, Noto P, Lichtner M, Capobianchi MR, Girardi E, Pezzotti P, Rezza G, Mura MS, Mannazzu M, Resta F, Loso K, Caramello P, Sinicco A, Soranzo ML, Orofino G, Sciandra M, Bonasso M, Grossi PA, Basilico C, Poggio A, Bottari G, Raise E, Pasquinucci S, Lalla FD, Tositti G, Lepri AC. Response to Haart and Gb Virus Type C Coinfection in a Cohort of Antiretroviral-Naive HIV-Infected Individuals. Antivir Ther 2005. [DOI: 10.1177/135965350501000108] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The prognostic role of GB virus type C (GBV-C) viraemia in HIV-infected subjects treated with highly active antiretroviral therapy (HAART) is still undefined, The aim of this analysis is to assess the relationship between GBV-C infection and response to antiretroviral therapy among HIV-infected subjects initiating HAART when antiretroviral-naive. A prospective, observational study of 400 HIV-infected patients with measurements of GBV-C RNA, hepatitis C virus (HCV) antibodies and HCV RNA determined from plasma stored prior to HAART initiation, Time to virological (achieving HIV RNA ≤500 copies/ml) and immunological success (a CD4+ count increase of ≥200cells/μl), and the time to virological relapse (confirmed HIV RNA >500 copies/ml) were assessed by Kaplan-Meier methods and Cox proportional hazard regression model. Of the subjects, 117 (29.3%) were GBV-C positive and, overall, 351 (87.8%) patients achieved virological success, After controlling for a number of confounders including HCV RNA, GBV-C viraemic patients experienced a significantly lower risk of HIV rebound than those who were GBV-C negative [relative hazard (RH)=0.56, 95% CI: 0.34–0.93, P=0.03], Conversely, the probability of achieving initial virological success or CD4+ count response after HAART did not differ between GBV-C-negative and -positive subjects, These results suggest that GBV-C coinfection may play a role in determining the rate of HIV rebound possibly by competing with HIV replication after HIV load has been successfully suppressed by HAART.
Collapse
Affiliation(s)
| | - Giorgio Antonucci
- National Institute of Infectious Diseases, L Spallanzani, Roma, Italy
| | - Enrico Girardi
- National Institute of Infectious Diseases, L Spallanzani, Roma, Italy
| | - Alessandro Cozzi-Lepri
- Department of Primary Care and Population Sciences, Royal Free and University College Medical School, London, UK
| | | | - Giulia Morsica
- Institute of Infectious Diseases, Ateneo Vita e Salute, S Raffaele Hospital, Milano, Italy
| | - Paolo Pizzaferri
- Department of Infectious Diseases and Hepatology, Azienda Ospedaliera, Parma, Italy
| | - Nicoletta Ladisa
- Institute of Infectious and Tropical Diseases, University of Bari, Bari, Italy
| | - Laura Sighinolfi
- Department of Infectious Diseases, Arcispedale S Anna, Ferrara, Italy
| | | | | | - Eleonora Lalle
- National Institute of Infectious Diseases, L Spallanzani, Roma, Italy
| | - Giuseppe Ippolito
- National Institute of Infectious Diseases, L Spallanzani, Roma, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
11
|
Luca AD, Cozzi-Lepri A, Perno CF, Balotta C, Giambenedetto SD, Poggio A, Pagano G, Tositti G, Piscopo R, Forno AD, Chiodo F, Magnani G, Monforte AD, Angarano G, Antinori A, Balotta C, Cozzi-Lepri A, Monforte AD, De Luca A, Monno L, Perno CF, Rusconi S, Montroni M, Scalise G, Zoli A, Del Prete MS, Tirelli U, Di Gennaro G, Pastore G, Ladisa N, Minafra G, Suter F, Arici C, Chiodo F, Colangeli V, Fiorini C, Coronado O, Carosi G, Cadeo GP, Castelli F, Minardi C, Vangi D, Rizzardini G, Migliorino G, Manconi PE, Piano P, Ferraro T, Scerbo A, Pizzigallo E, D'Alessandro M, Santoro D, Pusterla L, Carnevale G, Galloni D, Viganò P, Mena M, Ghinelli F, Sighinolfi L, Leoncini F, Mazzotta F, Pozzi M, Caputo SL, Angarano G, Grisorio B, Ferrara S, Grima P, Tundo P, Pagano G, Piersantelli N, Alessandrini A, Piscopo R, Toti M, Chigiotti S, Soscia F, Tacconi L, Orani A, Perini P, Scasso A, Vincenti A, Chiodera F, Castelli P, Scalzini A, Fibbia G, Moroni M, Lazzarin A, Cargnel A, Vigevani GM, Caggese L, d'Arminio Monforte A, Repetto D, Novati R, Galli A, Merli S, Pastecchia C, Moioli MC, Esposito R, Mussini C, Abrescia N, Chirianni A, Izzo C, Piazza M, De Marco M, Montesarchio V, Manzillo E, Graf M, Colomba A, Abbadessa V, Prestileo T, Mancuso S, Ferrari C, Pizzaferri P, Filice G, Minoli L, Bruno R, Novati S, Balzelli F, Loso K, Petrelli E, Cioppi A, Alberici F, Ruggieri A, Menichetti F, Martinelli C, De Stefano C, Gala AL, Ballardini G, Briganti E, Magnani G, Ursitti MA, Arlotti M, Ortolani P, Cauda R, Dianzani F, Ippolito G, Antinori A, Antonucci G, D'Elia S, Narciso P, Petrosillo N, Vullo V, De Luca A, Di Giambenedetto S, Zaccarelli M, Acinapura R, De Longis P, Ciardi M, D'Offizi G, Trotta MP, Noto P, Lichtner M, Capobianchi MR, Girardi E, Pezzotti P, Rezza G, Mura MS, Mannazzu M, Caramello P, Sinicco A, Soranzo ML, Gennero L, Sciandra M, Bonasso M, Grossi PA, Basilico C, Poggio A, Bottari G, Raise E, Pasquinucci S, De Lalla F, Tositti G, Resta F, Chimienti A, Lepri AC. Variability in the Interpretation of Transmitted Genotypic HIV-1 Drug Resistance and Prediction of Virological Outcomes of the Initial Haart by Distinct Systems. Antivir Ther 2004. [DOI: 10.1177/135965350400900505] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
High level HIV-1 drug resistance in recently infected treatment-naive individuals correlates with sub-optimal virological responses to highly active antiretroviral therapy (HAART). To determine whether genotypic HIV-1 drug resistance in chronic naive patients, as interpreted by various systems, could predict the virological outcomes of HAART, isolates from patients enrolled in a prospective observational cohort (ICoNA) prior to treatment start were genotyped. Genotypic susceptibility scores (GSS) assigned to the initial HAART regimens using the interpretations of pre-therapy resistance mutations by 13 systems were related to virological outcomes. Of 415 patients, 42 (10%) had at least one major resistance mutation. According to the different interpretations, 1.9–20.5% of patients had some level of resistance to at least one drug in the initial regimen. In multivariable analysis, GSS from two systems significantly predicted the time to virological success: Rega 5.5, for each unit increase in GSS adjusted relative hazard (RH) 1.86 [95% confidence intervals (95% CI): 1.15–3.02] and hivresistanceWeb v3, RH 1.87 (95% CI: 1.00–3.48). With three other systems, GSS showed a trend towards a significant prediction of success: Retrogram 1.6, RH 2.33 (95% CI: 0.98–5.53), Menéndez 2002, RH 2.36 (95% CI: 0.97–5.72) and Stanford hivdb, RH 2.06 (95% CI: 0.94–4.49). Genotypic resistance testing coupled with adequate interpretation in chronic naive patients can usefully identify those at risk of sub-optimal virological response to HAART.
Collapse
Affiliation(s)
| | - Andrea De Luca
- Institute of Clinical Infectious Diseases, Catholic University, Rome, Italy
| | - Alessandro Cozzi-Lepri
- Royal Free Centre for HIV Medicine and Department of Primary Care and Population Sciences, Royal Free and University College Medical School, London, UK
| | | | - Claudia Balotta
- Institute of Infectious Diseases and Tropical Medicine, University of Milan, Milan, Italy
| | | | - Antonio Poggio
- Department of Infectious Diseases, Civile Hospital, Verbania, Italy
| | - Gabriella Pagano
- Department of Infectious Diseases, S Martino Hospital, Genova, Italy
| | - Giulia Tositti
- Department of Infectious Diseases, Vicenza Hospital, Vicenza, Italy
| | - Rita Piscopo
- Department of Infectious Diseases, Galliera Hospital, Genova, Italy
| | - Antonio Del Forno
- Institute of Clinical Infectious Diseases, Catholic University, Rome, Italy
| | - Francesco Chiodo
- Institute of Infectious Diseases, University of Bologna, Bologna, Italy
| | - Giacomo Magnani
- Department of Infectious Diseases, Santa Maria Nuova Hospital, Reggio Emilia, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
12
|
Puoti M, Cozzi-Lepri A, Ancarani F, Bruno R, Ambu S, Ferraro T, Tundo P, Santantonio T, Toti M, Bonasso M, Monforte AD, Ancarani F, Antonucci G, Bonasso M, Bruno R, Cozzi-Lepri A, Monforte AD, Luca AD, Galli M, Gennero L, Girardi E, Lipani F, Marino N, Milazzo L, Morsica G, Narciso P, Pizzaferri P, Puoti M, Santantonio T, Verucchi G, Montroni M, Scalise G, Zoli A, Prete MSD, Tirelli U, Di Gennaro G, Pastore G, Ladisa N, Minafra G, Suter F, Arici C, Chiodo F, Colangeli V, Fiorini C, Coronado O, Carosi G, Cadeo GP, Castelli F, Minardi C, Vangi D, Rizzardini G, Migliorino G, Manconi PE, Piano P, Ferraro T, Scerbo A, Pizzigallo E, D'Alessandro M, Santoro D, Pusterla L, Carnevale G, Galloni D, Viganò P, Mena M, Ghinelli F, Sighinolfi L, Leoncini F, Mazzotta F, Pozzi M, Lo Caputo S, Angarano G, Grisorio B, Ferrara S, Grima P, Tundo P, Pagano G, Piersantelli N, Alessandrini A, Piscopo R, Toti M, Chigiotti S, Soscia F, Tacconi L, Orani A, Perini P, Scasso A, Vincenti A, Chiodera F, Castelli P, Scalzini A, Fibbia G, Moroni M, Lazzarin A, Cargnel A, Vigevani GM, Caggese L, d'Arminio Monforte A, Repetto D, Novati R, Galli A, Merli S, Pastecchia C, Moioli MC, Esposito R, Mussini C, Abrescia N, Chirianni A, Izzo C, Piazza M, De Marco M, Montesarchio V, Manzillo E, Graf M, Colomba A, Abbadessa V, Prestileo T, Mancuso S, Ferrari C, Pizzaferri P, Filice G, Minoli L, Bruno R, Novati S, Balzelli F, Loso K, Petrelli E, Cioppi A, Alberici F, Ruggieri A, Menichetti F, Martinelli C, De Stefano C, La Gala A, Ballardini G, Briganti E, Magnani G, Ursitti MA, Arlotti M, Ortolani P, Ortona L, Dianzani F, Ippolito G, Antinori A, Antonucci G, D'Elia S, Narciso P, Petrosillo N, Vullo V, De Luca A, Del Forno L, Zaccarelli M, Acinapura R, De Longis P, Ciardi M, D'Offizi G, Trotta MP, Noto P, Lichtner M, Capobianchi MR, Girardi E, Pezzotti P, Rezza G, Mura MS, Mannazzu M, Caramello P, Sinicco A, Soranzo ML, Gennero L, Sciandra M, Bonasso M, Grossi PA, Basilico C, Poggio A, Bottari G, Raise E, Pasquinucci S, De Lalla F, Tositti G, Resta F, Chimienti A, Cozzi-Lepri A. The Management of Hepatitis B Virus/HIV-1 Co-Infected Patients Starting Their First Haart Regimen. Treating Two Infections for the Price of One Drug? Antivir Ther 2004. [DOI: 10.1177/135965350400900506] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We examined the impact of a lamivudine-containing highly active antiretroviral therapy (HAART) regimen on 164 hepatitis B virus/HIV co-infected individuals starting their first HAART. Lamivudine-treated patients (accounting for 73% of the study population) showed a significantly lower level of alanine aminotransferase over follow-up [–81.1 mU/ml mean difference; 95% confidence intervals (95% CI): –30.3; –131.7, P=0.003] and a significantly reduced risk of liver-related morbidity/mortality [Relative hazard (RH)=0.07; 95% CI: 0.01–0.38, P=0.002] than those starting a lamivudine sparing-regimen.
Collapse
Affiliation(s)
| | - Massimo Puoti
- Institute of Infectious and Tropical Diseases, Spedali Civili, University of Brescia, Brescia, Italy
| | - Alessandro Cozzi-Lepri
- Department of Primary Care and Population Sciences, Royal Free and University College Medical School, London, UK
| | - Fausto Ancarani
- Institute of Infectious Diseases and Public Health, Umberto I Hospital, University of Ancona, Ancona, Italy
| | - Raffaele Bruno
- Institute of Infectious and Tropical Diseases, IRCCS S Matteo, University of Pavia, Pavia, Italy
| | - Silvia Ambu
- Department of Infectious Diseases, Azienda Ospedaliera Careggi, Firenze, Italy
| | - Teresa Ferraro
- Department of Infectious Diseases, Ospedale A Puglise, Catanzaro, Italy
| | - Paolo Tundo
- Department of Infectious Diseases, Ospedale Santa Caterina Novella, Galatina (Lecce), Italy
| | | | - Mario Toti
- Department of Infectious Diseases, Ospedale di Grosseto, Grosseto, Italy
| | - Marino Bonasso
- Department of Infectious Diseases, Ospedale ‘Amedeo Savoia’, Torino, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
13
|
Antinori A, Cozzi-Lepri A, Ammassari A, Trotta MP, Nauwelaers D, Hoetelmans R, Murri R, Melzi S, Narciso P, Nasta P, Zaccarelli M, Santopadre P, Vecchiet J, Izzo CM, Monforte AD, Tirelli U, Nasti G, Carosi G, Nasta P, Manconi PE, Piano P, Pizzigallo E, Dalessandro M, Vecchiet J, Mazzotta F, Caputo SL, Soscia F, Tacconi L, Scasso A, Vincenti A, Scalzini A, Fibbia GC, Moroni M, Manforte AD, Melzi S, Esposito R, Mussini C, Piazza M, Abrescia N, Izzo MC, Marco MD, Manzillo E, Nappa S, Alberici F, Sisti M, Baldelli F, Loso K, Mele P, Acinapura R, Ammassari A, Antinori A, Antonucci G, Ciardi M, Delia S, Longis PD, D'Offizi G, Ippolito G, Lichtner M, Marconi P, Murri R, Narciso P, Noto P, Petrosillo N, Pezzotti P, Santopadre P, Trotta MP, Vullo V, Zaccarelli M, Caramello P, Orofino GC, Cozzi-Lepri A, Baltimore MD, Wu AW. Relative Prognostic Value of Self-Reported Adherence and Plasma Nnrti/Pi Concentrations to Predict Virological Rebound in Patients Initially Responding to Haart. Antivir Ther 2004. [DOI: 10.1177/135965350400900214] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We studied the predictive value of self-reported adherence and plasma drug concentrations on virological rebound to HAART. Among 238 participants in the AdICoNA study who had viral load ≤500 copies/ml, 42 (17.6%) experienced virological rebound by 96 weeks. Both self-reported non-adherence and sub-optimal concentration were independently associated with a higher risk of virological rebound.
Collapse
Affiliation(s)
| | - Andrea Antinori
- Istituto Nazionale per le Malattie Infettive, L Spallanzani IRCCS, Roma, Italy
| | | | - Adriana Ammassari
- Istituto di Clinica delle Malattie Infettive, Università Cattolica del S Cuore, Roma, Italy
| | - Maria Paola Trotta
- Istituto Nazionale per le Malattie Infettive, L Spallanzani IRCCS, Roma, Italy
| | | | | | - Rita Murri
- Istituto di Clinica delle Malattie Infettive, Università Cattolica del S Cuore, Roma, Italy
| | - Sara Melzi
- Istituto di Malattie Infettive e Tropicali, Università di Milano, Milano, Italy
| | - Pasquale Narciso
- Istituto Nazionale per le Malattie Infettive, L Spallanzani IRCCS, Roma, Italy
| | - Paola Nasta
- Istituto di Malattie Infettive e Tropicali, Università di Brescia, Brescia, Italy
| | - Mauro Zaccarelli
- Istituto Nazionale per le Malattie Infettive, L Spallanzani IRCCS, Roma, Italy
| | - Paola Santopadre
- Dipartimento di Malattie Infettive e Tropicali, Università ‘La Sapienza’, Roma. Italy
| | - Jacopo Vecchiet
- Clinica delle Malattie Infettive, Università degli Studi di Chieti, Chieti, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
14
|
Caramello P, Vitali A, Canta F, Caldana A, Santi F, Caputo A, Lipani F, Balbiano R. Intestinal localization of anisakiasis manifested as acute abdomen. Clin Microbiol Infect 2003; 9:734-7. [PMID: 12925120 DOI: 10.1046/j.1469-0691.2003.00660.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Anisakis pathology is due mainly to two mechanisms: allergic reactions (from isolated urticaria and angioedema to life-threatening anaphylactic shock associated with gastrointestinal symptoms or 'gastroallergic anisakiasis'), and direct tissue damage, due to invasion of the gut wall, development of eosinophilic granuloma, or perforation (gastric or intestinal anisakiasis). Anisakiasis is a misdiagnosed and underestimated cause of acute abdomen: most patients undergo laparotomy, and virtually no cases are diagnosed before surgery. In some cases, diagnosis is obtained accidentally during other pathologic investigations. We report a case of acute abdomen due to terminal ileum involvement. Microscopic examination of the resected segment showed the presence of helminthic sections consistent with larvae of Anisakis spp. A history of raw fish ingestion was recorded. Histopathologic features are illustrated. A short but up-to-date review of the literature on diagnostic devices (particularly imaging and serology), clinical aspects and therapy is presented.
Collapse
Affiliation(s)
- P Caramello
- Infectious Diseases Unit 'A', Ospedale Amedeo di Savoia, C.so Svizzera 164, 10149 Torino, Italy.
| | | | | | | | | | | | | | | |
Collapse
|
15
|
Balotta C, Facchi G, Violin M, Van Dooren S, Cozzi-Lepri A, Forbici F, Bertoli A, Riva C, Senese D, Caramello P, Carnevale G, Rizzardini G, Cremonini L, Monno L, Rezza G, Perno CF, Ippolito G, d'Arminio-Monforte A, Vandamme AM, Moroni M. Increasing prevalence of non-clade B HIV-1 strains in heterosexual men and women, as monitored by analysis of reverse transcriptase and protease sequences. J Acquir Immune Defic Syndr 2001; 27:499-505. [PMID: 11511828 DOI: 10.1097/00126334-200108150-00012] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE We evaluated the prevalence of HIV-1 non-clade B over time in a formerly clade B-restricted area. Protease and reverse transcriptase regions of the pol gene were used for phylogenetic and recombination analysis and for clade assignment to HIV-1 A-D, F-H, J, and K strains of the M group. METHODS The pol gene of 349 HIV-1 patients belonging to the Italian Cohort Naive for Antiretrovirals (ICONA) were genotypically analyzed to study the prevalence of antiretroviral-associated resistance mutations. All HIV-1 pol sequences and 32 HIV reference strains were analyzed, including the reference strains for the major HIV-1 subtypes. The non-clade B sequences according to the HIV-1 Subtyping Tool program were further studied by a bootscan analysis (SimPlot) to investigate the likelihood of recombination between subtypes. RESULTS Phylogenetic analysis detected 19 of 349 (5.4%) non-clade B subtypes. The proportions of patients carrying non-clade B virus before and after 1997 were 1.9% and 8.4%, respectively (p =.008). Among whites, heterosexual infection and female gender were significantly associated with the presence of non-clade B subtypes (p =.001 and.005, respectively). Non-clade B HIV-1 was harbored by 14.5% of the heterosexuals who were found to be HIV-1 positive after 1997, 60% of whom were women. Bootscan analysis identified four strains as F, two as A, one as C, one as G, and 11 (57.9 %) as non-clade B recombinant subtypes. CONCLUSION Detection of HIV-1 subtypes and intersubtype recombinants in a previously clade B-homogeneous area indicates that the HIV-1 epidemic is evolving in Italy and that heterosexuals and women are at increased risk of infection with non-clade B HIV-1 subtypes. Sequences inferred from the pol gene yield to establish the subtype of circulating HIV-1 strains. As a consequence, genotyping of pol gene for testing resistance to antiretrovirals warrants concomitant surveillance of non-clade B subtypes.
Collapse
Affiliation(s)
- C Balotta
- Institute of Infectious and Tropical Diseases, L. Sacco Hospital, University of Milan, Via G.B. Grassi 74, 20157 Milan, Italy.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
16
|
Volpe G, Sbaiz L, Avanzini C, Caramello P, Savoia D. Genetic diversity of Pneumocystis carinii isolated from human immunodeficiency virus-positive patients in Turin, Italy. J Clin Microbiol 2001; 39:2995-8. [PMID: 11474032 PMCID: PMC88279 DOI: 10.1128/jcm.39.8.2995-2998.2001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
By DNA sequence analysis we identified two new strain types and five novel sporadic variations among 25 isolates of Pneumocystis carinii f. sp. hominis obtained from 19 human immunodeficiency virus-positive patients. Of these, 13 were infected with a single strain and 6 were coinfected. Fifteen different combination types were identified among the 18 strains for which complete molecular typing was accomplished.
Collapse
Affiliation(s)
- G Volpe
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | | | | | | | | |
Collapse
|
17
|
Perno CF, Cozzi-Lepri A, Balotta C, Forbici F, Violin M, Bertoli A, Facchi G, Pezzotti P, Angarano G, Arici C, Narciso P, Orani A, Raise E, Scalzini A, Poggio A, Ippolito G, Moroni M, Monforte AD, Montroni M, Scalise G, Costantini A, Del Prete MS, Tirelli U, Nasti G, Pastore G, Perulli LM, Suter F, Arici C, Chiodo F, Gritti FM, Colangeli V, Fiorini C, Guerra L, Carosi G, Cadeo GP, Castelli F, Minardi C, Vangi D, Rizzardini G, Migliorino G, Manconi PE, Piano P, Ferraro T, Cosco L, Pizzigallo E, Ricci F, Vigevani GM, Pusterla L, Carnevale G, Pan A, Viganò P, Mena M, Ghinelli F, Sighinolfi L, Leoncini F, Mazzotta F, Ambu S, Lo Caputo S, Angarano G, Grisorio B, Ferrara S, Grima P, Tundo P, Pagano G, Piersantelli N, Alessandrini A, Piscopo R, Toti M, Chigiotti, Soscia F, Tacconi L, Orani A, Castaldo G, Scasso A, Vincenti A, Scalzini A, Alessi F, Moroni M, Lazzarin A, Cargnel A, Milazzo F, Caggese L, Monforte AD, Melzi S, Delfanti F, Carini B, Adriani B, Garavaglia S, Moioli C, Esposito R, Mussini C, Abrescia N, Chirianni A, Perrella O, Piazza M, De Marco M, Montesarchio V, Manzillo E, Nappa S, Cadrobbi P, Scaggiante R, Colomba A, Abbadesse V, Prestileo T, Mancuso S, Filice G, Minoli L, Savino FAP, Maserati R, Pauluzzi S, Baldelli F, Petrelli E, Ciotti A, Alberici F, Sisti M, Menichetti F, Smorfa A, De Stefano C, La Gala A, Zauli T, Ballardini G, Bonazzi L, Ursitti MA, Ciammarughi R, Giordani S, Ortona L, Dianzani F, Ippolito G, Antinori A, Antonucci G, D'Elia S, Narciso P, Petrosillo N, Vullo V, De Luca A, Del Forno A, Zaccarelli M, De Longis P, Ciardi M, D'Offizi G, Palmieri F, Lichter M, Capobianchi MR, Girardi E, Pezzotti P, Rezza G, Mura MS, Mannazzu M, Caramello P, Sinicco A, Soranzo ML, Quaglia S, Sciandra M, Salassa B, Torre D, Basilico C, Poggio A, Bottari G, Raise E, Pasquinucci S, De Lalla F, Tositti G, Resta F, Chimienti A, Lepri AC, Phillips AN. Impact of Mutations Conferring Reduced Susceptibility to Lamivudine on the Response to Antiretroviral Therapy. Antivir Ther 2001. [DOI: 10.1177/135965350100600306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Carlo Federico Perno
- IRCCS L. Spallanzani, Rome, Italy
- Department Experimental Medicine, University of Rome Tor Vergata, Rome, Italy
| | | | - Claudia Balotta
- Institute of Tropical and Infectious Diseases, University of Milan, Milan, Italy
| | | | - Michela Violin
- Institute of Tropical and Infectious Diseases, University of Milan, Milan, Italy
| | | | - Guido Facchi
- Institute of Tropical and Infectious Diseases, University of Milan, Milan, Italy
| | | | | | - Claudio Arici
- Department of Infectious Diseases, Ospedali Riuniti, Bergamo, Italy
| | | | - Anna Orani
- Department of Infectious Diseases, Lecco Hospital, Lecco, Italy
| | - Enzo Raise
- Department of Infectious Diseases, SS Giovanni e Paolo Hospital, Venice, Italy
| | - Alfredo Scalzini
- Department of Infectious Diseases, Mantova Hospital, Mantova, Italy
| | - Antonio Poggio
- Department of Infectious Diseases, Verbania Hospital, Verbania, Italy
| | | | - Mauro Moroni
- Institute of Tropical and Infectious Diseases, University of Milan, Milan, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
18
|
Abstract
Imported malaria has been an important public health problem in Western countries in the last 20 years, since international travel has become an increasing habit for nonimmune populations and since chemoresistance to most antimalarial drugs has been spreading throughout the world. Moreover, immigration from African and Asian countries has been rapidly increasing, especially in Italy in the last few years. Malaria had been widespread in Italy in the past, but no new autochthonous cases have been reported since 1961. Nonetheless the number of reported cases throughout the country has been steadily growing because of imported malaria1-3 in nonimmune travelers as well as in immigrants from tropical countries. In our experience as well as according to other statistics, the vast majority of patients have Plasmodium falciparum malaria acquired in Africa.4,5 The clinical spectrum of this disease is wide, and severe cases are frequently observed, including a few fatal cases, which, although rare, are highlighted by mass media and impress the public opinion.5-8 The purpose of this study was to examine the clinical spectrum of malaria, with particular interest in severe falciparum malaria, and to define the frequency of this phenomenon and epidemiologic characteristics of patients who experience it as a life-threatening disease.
Collapse
Affiliation(s)
- G Calleri
- Department of Infectious Diseases "A", Amedeo di Savoia Hospital, Turin, Italy
| | | | | | | | | | | |
Collapse
|
19
|
Savoia D, Millesimo M, Cassetta I, Forno B, Caramello P. Detection of Pneumocystis carinii by DNA amplification in human immunodeficiency virus-positive patients. Diagn Microbiol Infect Dis 1997; 29:61-5. [PMID: 9368080 DOI: 10.1016/s0732-8893(97)00126-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The opportunistic pathogen Pneumocystis carinii (PC) is a frequent cause of a life-threatening pneumonia in human immunodeficiency virus (HIV)-infected individuals and in other immunocompromised hosts. Specimens obtained from 128 bronchoalveolar lavage (BAL) fluid samples from 123 HIV-positive patients with pulmonary disease and undergoing a diagnostic bronchoscopy were evaluated to detect this organism. We have developed a rapid DNA extraction procedure for nested polymerase chain reaction (PCR) using two sets of primers (pAZ102-E, pAZ102-H and P1 = 5'-CTAGGATATAGCTGGTTTTC-3' and P2 = 5'-TCGACTATCTAGCTTATCGC-3'). The results were compared using cytological techniques (direct wet mount, Giemsa, toluidine blue O) and related to the clinical follow-up of patients. The nested PCR had a 91% sensitivity and a 93% specificity. The effect of chemoprophylaxis and the evaluation of the follow-up of patients are discussed. Nested PCR may represent an important additional tool, along with current cytological methods, for the detection of P. carinii; however, at present it cannot replace routine microbiological methods more simple and less expensive.
Collapse
Affiliation(s)
- D Savoia
- Department of Clinical and Biological Sciences, University of Torino, Italy
| | | | | | | | | |
Collapse
|
20
|
Affiliation(s)
- F Lipani
- Amedeo di Savoia Hospital for Infectious Diseases, Torino, Italy
| | | | | | | |
Collapse
|
21
|
Abstract
Detection of parasites in culture or by microscopy is still necessary to make diagnosis of visceral leishmaniasis (VL). Serological methods still need assessment, as they are quick but not very sensitive, especially in immunosuppressed subjects. This paper compares the results obtained with three serological methods (indirect immunofluorescence test (IFAT), direct agglutination test (DAT), and enzyme-linked immunosorbent assay (ELISA) and the specific cell-mediated immune response, evaluated as proliferation and IFN-gamma production by peripheral blood lymphocytes (PBL) following stimulation with heat-killed L. infantum promastigotes. PBL and sera were obtained from 10 healthy donors, 3 VL patients in acute phase, and 3 patients recovering after two glucantim treatment courses. No false positive results were observed with the serological methods. IFAT can be considered the most sensitive and best suited for follow-up, as it allowed a good discrimination between the acute and remission phase. DAT did not discriminate between healthy donors and remission-phase patients, whereas ELISA is unsuited for follow-up, as it did not show any significant difference between remission- and acute-phase patients. Assessment of the cellular response is not recommended for making a diagnosis, because false positive results are frequent. However, a strong cellular response in a patient stands for a successful treatment. IFN-gamma titration is preferable to the proliferation test, because it gives earlier results and does not require the use of radioactive isotopes.
Collapse
Affiliation(s)
- M Millesimo
- Department of Clinical and Biological Sciences, University of Turin, Italy
| | | | | | | |
Collapse
|
22
|
Calleri G, Lipani F, Gaiotttino F, Caramello P. [Multiple cutaneous leishmaniasis after a stay in Central America]. Minerva Med 1996; 87:249-51. [PMID: 8700351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Leishmaniasis is a protozoal disease affecting at least 12 millions persons, with 400,000 new cases per year. It is transmitted by a small insect, the phlebotomine sand fly. Clinical syndromes include visceral leishmaniasis and various cutaneous affections. We describe here the case of a patient affected by a multiple lesions New World cutaneous leishmaniasis, after staying in Costa Rica for tourism; we discuss the differential diagnosis and make a short summary of the principles of treatment.
Collapse
Affiliation(s)
- G Calleri
- Divisione A Malattie Infettive, Ospedale Amedeo di Savoia, Torino
| | | | | | | |
Collapse
|
23
|
Boldorini R, Tosoni A, Mazzucco G, Cernuschi M, Caramello P, Maran E, Costanzi G, Monga G. Intracellular protozoan infection in small intestinal biopsies of patients with AIDS. Light and electron microscopic evaluation. Pathol Res Pract 1996; 192:249-59. [PMID: 8739472 DOI: 10.1016/s0344-0338(96)80228-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Small intestinal biopsies of 21 patients with acquired immunodeficiency syndrome (AIDS) with light microscopic findings diagnostic or suspicious for parasite infection were investigated by transmission electron microscopy (TEM). TEM allowed us to identify and specify the genus and species of involved parasites in 16 out of the 21 cases: 7 Cryptosporidium parvum, 5 Enterocytozoon bieneusi and 4 Isospora belli. Cryptosporidium was easily identified on light microscopy (LM), and only slightly influenced by parasite burden in all the 7 cases; TEM confirmed LM diagnosis and made it possible to characterize the parasites as C. parvum. The identification of Microsporidium on LM in our cases was related to the burden of parasite; its presence was certainty identified in 2 cases and suspected in 3. TEM allowed to identify these parasites as E. bieneusi. Intracytoplasmic coccidia could be detected with certainly in semithin sections in all 4 cases, but TEM was always needed to specify the infectious agent as I. belli. In 5 cases the suspicious of protozoan infection on LM (3 microsporidia, 1 intracytoplasmic coccidia and 1 Cryptosporidium) was not confirmed by TEM. Our data suggest that TEM is an appropriate diagnostic tool in this field of pathology and necessary in most of the cases.
Collapse
Affiliation(s)
- R Boldorini
- Dipartimento di Scienze Mediche, Facoltà di Medicina e Chirurgia di Novara, Italy
| | | | | | | | | | | | | | | |
Collapse
|
24
|
Caramello P, Brancale T, Forno B, Lucchini A, Macor A, Mazzucco G, Tettoni C, Ullio A. Clinical and Diagnostic Aspects of Travelers' Diarrhea due to Cyclospora Organisms. J Travel Med 1995; 2:232-234. [PMID: 9815398 DOI: 10.1111/j.1708-8305.1995.tb00666.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Cyclospora sp, a recently described protozoan, is associated with prolonged self-limiting and relapsing diarrhea. The species has a worldwide distribution and a high prevalence in tropical countries. Some reports suggest that the agent is a common cause of travelers' diarrhea.
Collapse
Affiliation(s)
- P Caramello
- Institute of Infectious Diseases, University of Torino, Torino, Italy
| | | | | | | | | | | | | | | |
Collapse
|
25
|
Caramello P, Mazzucco G, Romeo M, Ullio A, DeRosa G, Lucchini A, Forno B, Brancale T, Macor A, Preziosi C. Clinical and microscopical features of small-intestinal microsporidiosis in patients with AIDS. Infection 1995; 23:362-8. [PMID: 8655207 DOI: 10.1007/bf01713566] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Intestinal microsporidiosis by Enterocytozoon bieneusi is an increasingly recognized infection in AIDS patients. We report eight cases of microsporidiosis. All patients were severely immunodepressed. Clinical features were highly variable. Patients were followed up for a mean period of 7.8 months. All patients had persistent infection during the follow-up and spore excretion remained constant. Two patients became asymptomatic during the follow-up. None of the patients presented clinical and echographic signs of biliary involvement. Treatment with albendazole, metronidazole or paromomycin failed to produce a durable clinical response or to eradicate the organism. Cases were identified by stool examination and additionally investigated with light and electron microscopy. It was found that light microscopy was a sensitive method, while electron microscopy was less sensitive but allowed the definition of the infecting species. The modified trichrome stain was a satisfactory method for diagnosis on fecal smears. The calcofluor stain and the combination of DAPI with calcofluor was a rapid and simple staining method for screening.
Collapse
Affiliation(s)
- P Caramello
- Institute of Infectious Diseases, University of Turin, Italy
| | | | | | | | | | | | | | | | | | | |
Collapse
|
26
|
Caramello P, Brancale T, Forno B, Lucchini A, Pollono AM, Ullio A, Gioannini P, Viano I, Tonso E. Relapse of Toxoplasma encephalitis and susceptibility to pyrimethamine: lack of evidence of treatment-induced resistance. Antimicrob Agents Chemother 1995; 39:2371-2. [PMID: 8619602 PMCID: PMC162949 DOI: 10.1128/aac.39.10.2371] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
|
27
|
Zucca M, Novelli F, Giovarelli M, Caramello P, Garotta G, Musso T, Savoia D. Human PBMC proliferative response to Leishmania infantum promastigotes is inhibited by anti-IFN-gamma mAb gamma 123. New Microbiol 1995; 18:53-8. [PMID: 7760757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
PBMC from individuals both exposed and non-exposed to leishmaniae proliferative and produce interferon-gamma (IFN-gamma) following stimulation with Leishmania antigens. We studied the kinetics of the proliferative response of PBMC from non-exposed individuals and from patients recovering from visceral leishmaniasis due to Leishmania infantum, using heat-killed stationary-phase promastigotes of L. infantum as stimulating agent. The kinetics of both groups followed a similar temporal pattern, with higher values in the patient's group. Moreover, we observed that in both groups the activation was dose-dependently inhibited following the addition of gamma 123 anti-IFN-gamma monoclonal antibody. These results indicate the need for IFN-gamma in the activation process of PBMC induced by Leishmania antigens and stress the role of IFN-gamma in the immune response to leishmaniasis. The relevance of the elucidation of the immune response mechanism in human leishmaniasis for therapy and vaccination is briefly discussed.
Collapse
Affiliation(s)
- M Zucca
- Institute of Microbiology, Torino, Italy
| | | | | | | | | | | | | |
Collapse
|
28
|
Affiliation(s)
- G Calleri
- Department of Infectious Diseases "A", Amedeo di Savoia Hospital, Turin, Italy
| | | | | | | |
Collapse
|
29
|
Abstract
Malaria diagnosis relies on observation of parasites in blood smears and the Giemsa-stained thick blood smear (G-TS) is the reference test. Diagnosis by G-TS in low-density infections requires long periods of observation and experienced microscopists. Examination of Giemsa-stained thin smears enables more reliable differentiation of species but may miss low-grade infections. Fluorescent stains may offer an alternative technique. We compared the Giemsa technique with 4,6-diamidine-2-phenilindolo-propidium iodide (DAPI-PI) stainings in order to evaluate the time required for diagnosis. A Plasmodium falciparum-infected blood specimen was diluted to obtain concentrations ranging from 6192 to 24 parasites/microliters (p/microliter), and thin and thick smears were stained with the two methods. The DAPI-PI proved useful: parasites were easily recognized and their morphology was preserved in thin and thick smears. The method allowed more rapid evaluation of thin smears as compared with Giemsa staining and enabled recognition of parasites in case of low-level parasitemias. The DAPI-PI staining technique may acquire an important role in malaria diagnosis, especially in nonendemic countries where technicians are not experienced with G-TS; in developing countries, it could be used in epidemiologic surveys of populations with low-density parasitemias, for which it enables a fast examination of smears and possibly the identification of parasite species.
Collapse
Affiliation(s)
- P Caramello
- Institute of Infectious Diseases, University of Turin, Italy
| | | | | | | |
Collapse
|
30
|
Sinicco A, Gagliano P, Caramello P, Fora R, Sciandra M, Novero D. Unusual eruption of cutaneous metastases from occult gastric carcinoma shortly after HIV-1 infection. Cutis 1993; 52:173-6. [PMID: 8243103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
We report a case of eruptive metastases to the skin of the face and neck from a hitherto unknown gastric carcinoma, occurring in a fifty-two-year-old man (a regular blood donor), about six months after he contracted human immunodeficiency virus-1 infection. The eruption, consisting of more than thirty pea-sized cutaneous nodules appeared within about twenty days. The patient complained of epigastric pain and weight loss. Histologic examination showed signet-ring cells of gastric carcinoma metastases. Gastroscopic examination showed a widely infiltrating tumor. No metastases were found elsewhere after a careful screening. Immunologic variables were only slightly altered. This case and a brief review suggest that gastric carcinomas, possibly as well as other coincidental tumors, may present atypically during human immunodeficiency virus-1 infection.
Collapse
Affiliation(s)
- A Sinicco
- Institute of Infectious Disease, University of Turin, Italy
| | | | | | | | | | | |
Collapse
|
31
|
Sinicco A, Fora R, Sciandra M, Lucchini A, Caramello P, Gioannini P. Risk of developing AIDS after primary acute HIV-1 infection. J Acquir Immune Defic Syndr (1988) 1993; 6:575-81. [PMID: 8098750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
We enrolled 134 newly human immunodeficiency virus type 1 (HIV-1)-infected subjects in a prospective study to determine the natural history of the infection and evaluate the risk of developing AIDS after acute primary HIV-1 infection (API). Twenty-three patients were observed during an acute primary HIV-1 infection, and 111 were asymptomatic seroconverters. Acute primary HIV-1 infection was more frequently observed in subjects who had acquired the infection through sexual transmission. Intravenous drug users were rarely affected and presented with milder symptomatology. Patients observed with an acute primary HIV-1 infection had a significantly higher risk of developing AIDS than asymptomatic seroconverters (68% at 56 months vs. 20% at 66 months; p = 0.026). Low CD4+ cell counts at the onset of acute illness and delayed seroconversion in enzyme-linked immunosorbent assay (ELISA) were associated with evolution to AIDS in acute seroconverters (p = 0.03 and 0.02, respectively). During the follow-up, patients with an acute illness were more likely to show an early fall of CD4+ cell counts below 200/microliters than asymptomatic seroconverters. The results of this follow-up study suggest the opportunity to study antiviral treatment protocols in patients with API as a possible measure to control disease progression.
Collapse
Affiliation(s)
- A Sinicco
- Institute of Infectious Diseases, University of Turin, Italy
| | | | | | | | | | | |
Collapse
|
32
|
Caramello P, Forno B, Lucchini A, Pollono AM, Sinicco A, Gioannini P. Meningoencephalitis caused by Toxoplasma gondii diagnosed by isolation from cerebrospinal fluid in an HIV-positive patient. Scand J Infect Dis 1993; 25:663-6. [PMID: 8284653 DOI: 10.3109/00365549309008558] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Toxoplasmosis of the central nervous system is a frequent opportunistic infection in AIDS patients, usually presenting as a mass brain lesion detected by computerized axial tomography scanning or magnetic resonance imaging. A case of diffuse meningoencephalitis with no radiological evidence of brain lesions is described. Diagnosis was made by culturing cerebrospinal fluid (CSF) on THP1 cells where tachyzoites of Toxoplasma gondii were demonstrated after 8 days of incubation by both direct observation and immunofluorescence. CSF examination with culture should be considered in AIDS patients with neurological signs and symptoms but without radiological evidence of cerebral lesions.
Collapse
Affiliation(s)
- P Caramello
- Istitute of Infectious Diseases, University of Turin, Italy
| | | | | | | | | | | |
Collapse
|
33
|
Calleri G, Macor A, Preziosi C, Vizzi MF, Caramello P. [Malaria imported into Turin: epidemiological observations (1980-1990)]. Epidemiol Prev 1992; 14:56-9. [PMID: 1306171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- G Calleri
- Div. A Malattie Infettive, Ospedale Amedeo di Savoia, Torino
| | | | | | | | | |
Collapse
|
34
|
Calleri G, Macor A, Belloro S, Caramello P, Dirindin N. [Hospital costs of patients with AIDS]. Epidemiol Prev 1989; 11:47-51. [PMID: 2533565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
We carried out a retrospective research into the hospital care cost of 52 AIDS cases we observed in our department, in the period 1984-1988. These patients required an average of 3.2 hospital admissions per year, and 101.3 hospitalization days per year, spending more than one fourth of their life span after their diagnosis of AIDS, in a hospital. The total care cost was Lit. 1,133,614,000, mostly due to the hospital stay (65.0%), but the introduction of expensive drugs will increase the cost of treatment. The average daily cost per patient was Lit. 227,900. Prognosis and cost vary according to the kind of opportunistic infection or neoplasm. The prolongation of hospitalization in consequence of social and economic problems is very frequent. A better accessibility of diagnostic systems, and a development of day-hospital and social services could reduce AIDS patients costs.
Collapse
|
35
|
Affiliation(s)
- D Savoia
- Institute of Microbiology, University of Turin, Italy
| | | |
Collapse
|
36
|
Massaioli N, Paron L, Schieroni R, Villata E, Caramello P. [Observations on a surgical series of 68 cases of hepatic hydatid cyst]. MINERVA CHIR 1987; 42:1829-36. [PMID: 3323943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
|
37
|
Savoia D, Belloro S, Calleri G, Caramello P. [Microscopic diagnosis of Pneumocystis carinii. Comparison of various staining technics]. G Batteriol Virol Immunol 1985; 78:178-84. [PMID: 2435598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The toluidine blue 0 and methenamine-silver nitrate staining techniques allowed a good microscopic distinction of Pneumocystis carinii cysts in lung autoptic impression smears. Poor results we observed with methylene blue and modified Gram techniques. With Giemsa's stain the intracystic bodies are shown, however the microscopic examination requires experience and patience.
Collapse
|
38
|
Caramello P, Giacobbi D, Savoia D. [Identification of Pneumocystis carinii in a patient dying of AIDS]. G Batteriol Virol Immunol 1985; 78:171-7. [PMID: 3879892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
We compared two different techniques in the preparation of slides for the demonstration of Pneumocystis carinii in lung tissue of a patient died for AIDS. The impressions were prepared by imprinting the autopsy tissue surfaces on glass slides, while the concentrates were prepared by a partial homogenization and subsequent centrifugation of the pulmonary tissue. After staining, the number of protozoa microscopically observed resulted similar with both techniques; moreover using impression smears P. carinii were more easily visible.
Collapse
|
39
|
Biglino A, Caramello P, Pischedda P. [Protracted intrahepatic cholestasis with thrombocytosis in leptospirosis]. Minerva Med 1982; 73:3053-8. [PMID: 7145181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
|
40
|
Biglino A, Caramello P. [Extraintestinal localizations of salmonellosis]. Arch Sci Med (Torino) 1982; 139:299-316. [PMID: 6758726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Some of the most frequent extraintestinal infections due to salmonella germs have been examined. The literature on meningoencephalitic, cardiovascular and osteoarticular complications is reviewed and many other observations regarding disseminations in other organs and systems are reported. The pathogenetic mechanisms relating to such complications are considered and assessed.
Collapse
|
41
|
Pischedda PF, Biglino A, Caramello P. [Imported cases of malaria in Italy 1974-1979]. Minerva Med 1981; 72:1143-6. [PMID: 7015176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Malaria is not present in Italy in autochthonous form although cases contracted where the disease is endemic are appearing with ever greater frequency. 767 cases, all imported, were reported to the Ministry of Health between '74 and '79. The number of reports, which is increasing steadily and actually doubled from '76 to '77, is examined here in relation to the age of patients, their work and the aetiological agent. Stress is laid on the epidemiological importance of putting into effect all those measures aimed at preventing an ever greater number of patients from malarial zones reactivating an endemic type of infection transmission in Italy, where an anopheles vector is present.
Collapse
|
42
|
Biglino A, Vercellotti E, Caramello P, Pischedda PF, Gioannini P. ["Markers" of infection with hepatitis A and B viruses among office workers in a heavy industry]. Minerva Med 1980; 71:2833-6. [PMID: 7432693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The spread of "A" and "B" hepatitis virus in a limited working environment has been evaluated and the main serum "markers" of this infection (HBsAg, anti-HBs, anti-HBc, anti-HAV) have been researched in 187 subjects (males and females) after being taken on by a large company in Northern Italy. This research, carried out again after 8--10 months from hiring, showed a moderate spread of "B"virus in 6,4% of the subjects observed. This finding is probably due to deficient personal hygiene rather than to environmental factors related to work (these may on the contrary condition the spread of "A" virus which, in the cases observed showed insignificant diffusion).
Collapse
|