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Mattioli B, Bucciardini R, Falzano L, Bena A, Gilardi L, Capra P, Falcone U, Marra M. A health equity focused National Prevention Plan 2020-2025 and related capacity building (CCM, 201). Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa165.121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
In Italy there are significant differences in life expectancy, morbidity and disability between different social groups: the wealthiest and educated people are better off, get sick less and live longer. The poorer Italian Regions show less favourable health indicators. However, Italy aims to reduce health inequalities (HI) among the priorities of its agenda. The 2014-2018 National Prevention Plan (NPP) had already instructed the Regions to include the fight against HI in the guiding principles of the regional prevention plans (RPP). The new NPP 2020-2025 confirms the need to strengthen the fight against HI and the reduction of the main social and geographical inequalities that are observed in our country represents a priority to all the objectives of the NPP, which requires the disclosure of scientific data, validated methods and tools to guarantee equity in the action. In this scenario, there is a project coordinated by the Istituto Superiore di Sanità with the contribution of DORS, the Documentation Centre for Health Promotion of Piedmont Region. The main objective of this project is to support the Ministry of Health (MoH) and the Regions in order to consolidate the introduction of the equity lenses approach in the new NPP, in particular the project aims at: promoting a health equity-oriented approach in priority and target setting, choice of a strategy, and in the design of the monitoring and evaluation system;investing in a capacity building process for regional officers responsible of the elaboration and implementation of the RPP in each Italian region.
20 Italian Regions participate to this two-year project (2019-2020). Two face-to-face training modules and the sharing of a web community of practice have been planned. The project involves developing support tools that provide equity-oriented practices. The main expected result is the increase of the equity-oriented actions and their dissemination across the country.
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Affiliation(s)
- B Mattioli
- Centre for Global Health, Istituto Superiore di Sanità, Rome, Italy
| | - R Bucciardini
- Centre for Global Health, Istituto Superiore di Sanità, Rome, Italy
| | - L Falzano
- Centre for Global Health, Istituto Superiore di Sanità, Rome, Italy
| | - A Bena
- DORS- Documentation Centre for Health Promotion, Regione Piemonte - ASLTO3, Grugliasco, Italy
| | - L Gilardi
- DORS- Documentation Centre for Health Promotion, Regione Piemonte - ASLTO3, Grugliasco, Italy
| | - P Capra
- DORS- Documentation Centre for Health Promotion, Regione Piemonte - ASLTO3, Grugliasco, Italy
| | - U Falcone
- DORS- Documentation Centre for Health Promotion, Regione Piemonte - ASLTO3, Grugliasco, Italy
| | - M Marra
- Epidemiology Unit, Regione Piemonte - ASLTO3, Grugliasco, Italy
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Bucciardini R, Contoli B, De Castro P, Donfrancesco C, Falzano L, Ferrelli R, Giammarioli AM, Mattioli B, Medda E, Minardi V, Minelli G, Palmieri L, Pasetto R, Pizzi E, Rossi S, Venerosi A. The health equity in all policies (HEiAP) approach before and beyond the Covid-19 pandemic in the Italian context. Int J Equity Health 2020; 19:92. [PMID: 32513189 PMCID: PMC7278241 DOI: 10.1186/s12939-020-01209-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 06/02/2020] [Indexed: 01/16/2023] Open
Affiliation(s)
- R Bucciardini
- Istituto Superiore di Sanità, Viale Regina Elena 299, 00161, Roma, Italy.
| | - B Contoli
- Istituto Superiore di Sanità, Viale Regina Elena 299, 00161, Roma, Italy
| | - P De Castro
- Istituto Superiore di Sanità, Viale Regina Elena 299, 00161, Roma, Italy
| | - C Donfrancesco
- Istituto Superiore di Sanità, Viale Regina Elena 299, 00161, Roma, Italy
| | - L Falzano
- Istituto Superiore di Sanità, Viale Regina Elena 299, 00161, Roma, Italy
| | - R Ferrelli
- Istituto Superiore di Sanità, Viale Regina Elena 299, 00161, Roma, Italy
| | - A M Giammarioli
- Istituto Superiore di Sanità, Viale Regina Elena 299, 00161, Roma, Italy
| | - B Mattioli
- Istituto Superiore di Sanità, Viale Regina Elena 299, 00161, Roma, Italy
| | - E Medda
- Istituto Superiore di Sanità, Viale Regina Elena 299, 00161, Roma, Italy
| | - V Minardi
- Istituto Superiore di Sanità, Viale Regina Elena 299, 00161, Roma, Italy
| | - G Minelli
- Istituto Superiore di Sanità, Viale Regina Elena 299, 00161, Roma, Italy
| | - L Palmieri
- Istituto Superiore di Sanità, Viale Regina Elena 299, 00161, Roma, Italy
| | - R Pasetto
- Istituto Superiore di Sanità, Viale Regina Elena 299, 00161, Roma, Italy
| | - E Pizzi
- Istituto Superiore di Sanità, Viale Regina Elena 299, 00161, Roma, Italy
| | - S Rossi
- Istituto Superiore di Sanità, Viale Regina Elena 299, 00161, Roma, Italy
| | - A Venerosi
- Istituto Superiore di Sanità, Viale Regina Elena 299, 00161, Roma, Italy
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Bucciardini R, D'ettorre G, Baroncelli S, Ceccarelli G, Parruti G, Weimer LE, Fragola V, Galluzzo CM, Pirillo MF, Lucattini S, Bellagamba R, Francisci D, Ladisa N, Antoni AD, Guaraldi G, Manconi PE, Vullo V, Preziosi R, Cirioni O, Verucchi G, Floridia M. Virological failure at one year in triple-class experienced patients switching to raltegravir-based regimens is not predicted by baseline factors. Int J STD AIDS 2016; 23:459-63. [DOI: 10.1258/ijsa.2012.011391] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We evaluated rates and determinants of virological failure in triple-class experienced patients receiving raltegravir-based regimens from a national observational study over 48 weeks, defined by any one of the following: (1) no HIV-RNA suppression to undetectable levels (<50 copies/mL) during follow-up; (2) detectable viral load after obtaining undetectable levels; and (3) leaving the study before 48 weeks. Among 101 eligible patients, 26 (25.7%; 95% CI 17.2–34.2) had virological failure. No significant differences between patients with and without virological failure were observed for gender, age, route of transmission, baseline CD4/HIV-RNA, CDC group, hepatitis B or C co-infections, resistance (based on the last genotype available), type and number of concomitant drug classes, concomitant use of darunavir, atazanavir, etravirine, enfuvirtide or maraviroc, and health-related quality-of-life measures. A high rate of treatment response was observed. The analyses did not identify any baseline factor associated with failure, including resistance status. Even if we cannot exclude the presence of pre-existing minority resistant variants not captured by genotypic tests, the lack of baseline predictors of failure suggests the need to monitor patients closely during follow up for other factors, such as potential drug interactions and reduced levels of adherence, which may favour virological failure.
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Affiliation(s)
- R Bucciardini
- Department of Therapeutic Research and Medicines Evaluation, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Rome
| | - G D'ettorre
- Department of Infectious Diseases and Public Health, University of Sapienza, Rome
| | - S Baroncelli
- Department of Therapeutic Research and Medicines Evaluation, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Rome
| | - G Ceccarelli
- Department of Infectious Diseases and Public Health, University of Sapienza, Rome
| | - G Parruti
- Unit of Infectious Diseases, Ospedale Civile Spirito Santo, Pescara
| | - L E Weimer
- Department of Therapeutic Research and Medicines Evaluation, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Rome
| | - V Fragola
- Department of Therapeutic Research and Medicines Evaluation, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Rome
| | - C M Galluzzo
- Department of Therapeutic Research and Medicines Evaluation, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Rome
| | - M F Pirillo
- Department of Therapeutic Research and Medicines Evaluation, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Rome
| | - S Lucattini
- Department of Therapeutic Research and Medicines Evaluation, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Rome
| | - R Bellagamba
- National Institute for Infectious Diseases ‘L. Spallanzani’, Rome
| | - D Francisci
- Clinic of Infectious Diseases, University of Perugia, Perugia
| | - N Ladisa
- Clinic of Infectious Diseases, University of Bari, Bari
| | - A Degli Antoni
- Department of Infectious Diseases and Hepatology, Azienda Ospedaliera di Parma, Parma
| | - G Guaraldi
- Department of Medical Specialties, Infectious Diseases Clinic, University of Modena and Reggio Emilia, Modena
| | - P E Manconi
- Clinic of Infectious Diseases, Department of Medicine and Immunology, University of Cagliari, Cagliari
| | - V Vullo
- Department of Infectious Diseases and Public Health, University of Sapienza, Rome
| | | | - O Cirioni
- Clinic of Infectious Diseases, Department of Biomedical Sciences, Università Politecnica delle Marche, Ancona
| | - G Verucchi
- Department of Internal Medicine, Geriatrics and Nephrologie Diseases, Section of Infectious Diseases, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - M Floridia
- Department of Therapeutic Research and Medicines Evaluation, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Rome
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Bucciardini R, Massella M, Corpolongo A, Narciso P, Fragola V, Mirra M, Donnini S, Viganò O, Costarelli S, Tozzi V. T20QoL: an observational multicenter cohort study to evaluate the quality of life in HIV-patients treated with enfuvirtide (ENF, T-20) in combination with an optimized background therapy. Biologics 2011; 2:577-81. [PMID: 19707388 PMCID: PMC2721382 DOI: 10.2147/btt.s3187] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIM To evaluate the impact of health-related quality of life (HRQoL) enfuvirtide-based (ENF-based) salvage regimens of treatment-experienced HIV patients, in an observational multicenter cohort study. METHODS HRQoL was measured in a cohort of 16 patients over a 6-month follow-up using 2 instruments: the ISSQoL (Istituto Superiore di Sanità Quality of Life), a recently validated HIV-specific questionnaire; the EQ-5D (EuroQol), a generic widely used instrument. ENF was given at standard dosage along with an optimized background regimen. RESULTS Most of HRQoL dimensions showed improvement in ENF-treated patients at the post-baseline time points. Social functioning was the only dimension showing a negative effect. Monthly care costs of antiretroviral drugs for HIV patients taking ENF plus an optimized background regimen were approximately euro2,348 per patient-month (range euro382-euro2,940). CONCLUSION Our results show that the addition of ENF to an optimized background salvage-HAART may positively affect HRQoL not only in clinical trials but also in a sample population of patients used in a routine clinical practice.
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Lauriola M, Murri R, Massella M, Mirra M, Donnini S, Fragola V, Ivanovic J, Pavoni M, Mancini G, Bucciardini R. A factor analytic study of the Italian National Institute of Health Quality of Life - Core Evaluation Form (ISSQoL-CEF). Patient Prefer Adherence 2010; 4:33-44. [PMID: 20361064 PMCID: PMC2846138 DOI: 10.2147/ppa.s6454] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES The Italian National Institute of Health Quality of Life - Core Evaluation Form (ISSQoL-CEF) is a specific questionnaire measuring health-related quality of life for human immunodeficiency virus-infected people in the era of highly active antiretroviral therapy. The main goal of this study was to examine the construct validity of this questionnaire by confirmation of its hypothesized dimensional structure. METHODS Baseline quality of life data from four clinical studies were collected and a confirmatory factor analysis of the ISSQoL-CEF items was carried out. Both first-order and second-order factor models were tested: Model 1 with nine correlated first-order factors; Model 2 with three correlated second-order factors (Physical, Mental, and Social Health); Model 3 with two correlated second-order factors (Physical and Mental/Social Health); Model 4 with only one second-order factor (General Health). RESULTS A total of 261 patients were surveyed. Model 1 had a good fit to the data. Model 2 had an acceptable fit to the data and it was the best of all hierarchical models. However, Model 2 fitted the data worse than Model 1. CONCLUSIONS The findings of in this study, consistent with the results of previous study, pointed out the construct validity of the ISSQoL-CEF.
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Affiliation(s)
- M Lauriola
- Department of Social and Developmental Psychology
| | - R Murri
- Catholic University of “Sacro Cuore”, Rome, Italy
| | - M Massella
- Istituto Superiore di Sanità, Rome, Italy
| | - M Mirra
- Istituto Superiore di Sanità, Rome, Italy
| | - S Donnini
- Istituto Superiore di Sanità, Rome, Italy
| | - V Fragola
- Istituto Superiore di Sanità, Rome, Italy
| | - J Ivanovic
- National Institute for Infectious Diseases Lazzaro Spallanzani, Rome, Italy
| | - M Pavoni
- Ospedale Civile Santa Maria delle Croci, Ravenna, Italy
| | - G Mancini
- Department of Infectious and Tropical Diseases, University of Rome “La Sapienza”, Rome, Italy
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Ferrara M, Murri R, Bertaccini E, Orlando G, Vandelli M, De Paola M, Bucciardini R, Rigatelli M, Esposito R, Guaraldi G, Ferrari S. P02-132 - Evaluation of psychological impact of facial lipoatrophy in HIV: the “assessment of face & body change and distress” questionnaire. Eur Psychiatry 2010. [DOI: 10.1016/s0924-9338(10)70746-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Palmisano L, Giuliano M, Galluzzo CM, Amici R, Andreotti M, Weimer LE, Pirillo MF, Fragola V, Bucciardini R, Vella S. The mutational archive in proviral DNA does not change during 24 months of continuous or intermittent highly active antiretroviral therapy. HIV Med 2009; 10:477-81. [DOI: 10.1111/j.1468-1293.2009.00715.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Bucciardini R, Murri R, Guarinieri M, Starace F, Martini M, Vatrella A, Cafaro L, Fantoni M, Grisetti R, Monforte AD, Fragola V, Arcieri R, Del Borgo C, Tramarin A, Massella M, Lorenzetti D, Vella S. ISSQoL: A New Questionnaire for Evaluating the Quality of Life of People Living with HIV in the HAART Era*. Qual Life Res 2006; 15:377-90. [PMID: 16547775 DOI: 10.1007/s11136-005-3212-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/17/2005] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To design a Health-related Quality of Life (HRQoL) instrument for HIV-infected people in the era of highly active antiretroviral therapy (HAART). METHODS The self-administered questionnaire was developed by an Italian network including researchers, physicians, people living with HIV, national institutions and community-based organizations (CBO) through several steps: (1) review of existing HRQoL literature and questionnaires for HIV-infected people; (2) selection of relevant domains measuring HRQoL in HIV-infected people, and identification of new domains related to new aspects of HRQoL concerning HAART-treated individuals; (3) conduction of two pre-test analyses in independent groups of Italian HIV-positive people (n approximately =100) distributed throughout the country. The objectives of the first pre-test were to verify the usefulness of the questionnaire, to construct a form easily understandable by everyone, to define the domains and their significance; the second pre-test aimed at evaluating and reshaping the questionnaire based on a statistical analysis of the outcomes of first pre-test; (4) validation analysis. A large cohort of people with HIV infection was recruited for the last step. RESULTS The internal consistence reliability (Cronbach's alpha) was >or=0.70 for all domains. Most domains had Cronbach's coefficient >0.80. All domains demonstrated convergent and discriminant validity. The final version of ISSQoL includes two sections: HRQoL Core Evaluation Form (9 domains) and Additional Important Areas for HRQoL (6 domains). The ISSQoL was administered together with two additional forms: a Daily Impact of Symptoms Form and a Demographic Information Form. The Additional Important Areas for HRQoL include social support, interaction with medical staff, treatment impact, body changes, life planning, and motherhood/fatherhood. CONCLUSION The data reported in the present paper provide preliminary evidence of the reliability and validity of the ISSQoL questionnaire for the measurement of HRQoL in HIV-infected people. The direct involvement of HIV-positive people in all the phases of the project was a key aspect of our work.
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Affiliation(s)
- R Bucciardini
- Department of Drug Research and Evaluation, Istituto Superiore di Sanità, Rome, Italy.
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Floridia M, Bucciardini R, Fragola V, Galluzzo CM, Giannini G, Pirillo MF, Amici R, Andreotti M, Ricciardulli D, Tomino C, Vella S. Risk factors and occurrence of rash in HIV-positive patients not receiving nonnucleoside reverse transcriptase inhibitor: data from a randomized study evaluating use of protease inhibitors in nucleoside-experienced patients with very low CD4 levels (<50 cells/mmuL). HIV Med 2004; 5:1-10. [PMID: 14731162 DOI: 10.1111/j.1468-1293.2004.00177.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Most of the studies evaluating rash in HIV-positive patients have focused on nonnucleoside reverse transcriptase inhibitors (NNRTI), particularly nevirapine, and little is known about the occurrence of rash and the risk factors for its development in patients receiving regimens not based on NNRTI. METHODS We evaluated all cases of rash observed during a 48-week randomized multicentre trial in 1251 nucleoside-experienced patients who started treatment with protease inhibitors (ritonavir or indinavir) at CD4 counts below 50 cells/microL. Incidence rates for rash were calculated according to gender, clinical status, age, use of highly active antiretroviral therapy (HAART), Pneumocystis carinii pneumonia (PCP) prophylaxis and use of individual antiretroviral drugs at enrollment. Differences between groups defined according to the above characteristics were tested for statistical significance using the log-rank test in a Kaplan-Meier survival analysis. All factors that gave results in the univariate analyses below the significance level of 0.05 were included in a multivariate analysis using a Cox regression model. RESULTS During a follow-up period of 9690 person-months, 66 patients (5.3%) developed rash (0.68 events/100 person-months). In the univariate analyses, risk of rash did not differ with trial treatment (indinavir or ritonavir), clinical status, PCP prophylaxis, or age. During follow-up, rash was observed in 7.5% of enrolled women and in 4.5% of enrolled men (P=0.03). Serious rash occurred in 4.5% of enrolled women and in 1.6% of enrolled men (P=0.003). Use of HAART (P<0.001) and inclusion of zidovudine and of zalcitabine in the prescribed regimen (P=0.02) appeared to be associated with a lower risk of rash. In the multivariate analysis, the variables that remained significantly predictive of rash were gender (risk for women compared to men: 1.65, 95% confidence interval (CI): 1.00-2.72, P=0.048) and use of a non-HAART regimen (risk for non-HAART patients compared to HAART: 2.73, 95% CI: 1.49-5.02, P=0.001). CONCLUSIONS In our study, about 5% of HIV-positive patients who started treatment with protease inhibitors at very low CD4 counts developed rash, generally in the first few weeks after treatment. Risk was significantly higher in women and in patients who did not receive a HAART regimen. Our data indicate that women have a higher risk of rash than men, also with regimens that do not include NNRTI.
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Affiliation(s)
- M Floridia
- Istituto Superiore di Sanità, Rome, Italy.
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Floridia M, Tomino C, Bucciardini R, Ricciardulli D, Fragola V, Pirillo MF, Amici R, Giannini G, Galluzzo CM, Andreotti M, Seeber AC, Ammassari A, Cingolani A, Lazzarin A, Scalise G, Cargnel A, Suter F, Milazzo F, Pastore G, Moroni M, Ciammarughi R, Pini R, Carosi G, D'Amato C, Contu L, Concia E, Bonazzi L, Aiuti F, Vigevani G, Vella S. A randomized trial comparing the introduction of ritonavir or indinavir in 1251 nucleoside-experienced patients with advanced HIV infection. AIDS Res Hum Retroviruses 2000; 16:1809-20. [PMID: 11118067 DOI: 10.1089/08892220050195775] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
ISS-IP1, a multicenter, randomized, 48-week open trial, was designed to compare the introduction of ritonavir or indinavir in patients with previous nucleoside experience and CD4+ cell counts below 50/mm3. Concomitant antiretroviral treatment with nucleoside analogs was allowed. Primary efficacy measures were survival and time to a new AIDS-defining event or death, analyzed through the whole period of observation by the intention-to-treat approach. Primary toxicity measures were time to treatment discontinuation and adverse events, grade at least 3/serious, analyzed by an on-treatment approach. Evaluation-of efficacy also included CD4+ cell and RNA response. The trial enrolled 1251 patients in 5 months. At baseline, mean CD4+ cell count was about 20 cells/mm3 and mean HIV RNA copy number was 4.9 log10/ml in both groups. Overall, 402 patients in the ritonavir group and 250 patients in the indinavir group permanently discontinued the assigned treatment (relative risk, 1.96; 95% CI, 1.68-2.30; p = 0.0001), with most of this difference dependent on a higher number of discontinuation for adverse events in the ritonavir group. After a mean follow-up of 307 days (ritonavir, 304; indinavir, 309), 124 deaths (ritonavir, 61; indinavir, 63; relative risk, 0.96; 95% CI, 0.67-1.36; p = 0.80) and 330 new AIDS-defining events (ritonavir, 170; indinavir, 160; relative risk, 1.05; 95% CI, 0.85-1.31; p = 0.60) were observed. CD4+ cell counts increased in both groups in patients still receiving treatment, with about 100 cells gained by week 24 and 150 cells gained by week 48. Body weight also increased over time in both groups. Analysis of RNA response showed a decrease of 1.5 log10 or higher in both treatment groups. Overall, 400 patients in the ritonavir group and 338 patients in the indinavir group developed at least one grade 3/serious new adverse event during follow-up (relative risk, 1.48; 95% CI, 1.28-1.72; p = 0.0001). Favorable CD4+ cell and RNA responses at 24 and 48 weeks were observed in both groups of patients remaining on treatment. Indinavir showed slightly better effects in sustaining RNA, CD4+ cell, and body weight responses. Ritonavir and indinavir results were comparable in terms of clinical outcome (survival and AIDS-defining events).
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Affiliation(s)
- M Floridia
- Laboratory of Virology, Istituto Superiore di Sanità, Rome, Italy
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Bucciardini R, Wu AW, Floridia M, Fragola V, Ricciardulli D, Tomino C, Weimer LE, Pirillo MF, Mirra M, Marzi M, Giannini G, Galluzzo CM, Andreotti M, Massella M, Vella S. Quality of life outcomes of combination zidovudine- didanosine-nevirapine and zidovudine-didanosine for antiretroviral-naive advanced HIV-infected patients. AIDS 2000; 14:2567-74. [PMID: 11101069 DOI: 10.1097/00002030-200011100-00020] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To evaluate the quality of life outcomes in antiretroviral-naive patients randomized to zidovudine plus didanosine versus zidovudine plus didanosine plus nevirapine for treatment of advanced HIV disease (the Istituto Superiore di Sanità 047 trial). DESIGN A 48-week randomized, double-blind trial. METHODS Sixty patients were enrolled and evaluated over 24 weeks. Quality of life was assessed using a modified version of the Medical Outcomes Study-HIV Health Survey. For analysis, we calculated two summary scores reflecting the physical (PHS) and the mental (MHS) components of health. RESULTS Although the three-drug combination was superior at inducing immunologic and virologic responses, the two-drug regimen was superior for both PHS and MHS, especially at week 8 where differences were both statistically and clinically significant (5.8 and 9.2 points, respectively, P< 0.02 for both). Quality of life changes paralleled trends in body weight and Karnofsky performance status score. CONCLUSION Although a three-drug antiretroviral therapy regimen was superior in terms of short term virologic/immunologic response, the two-drug regimen was better in terms of quality of life. In general, triple therapy remains the most effective treatment option. However, quality of life assessments can yield results that may be discordant with and complementary to those obtained using conventional endpoints. Comparative trials should collect a comprehensive range of outcome measures, including patient-reported quality of life, in order to provide clinicians and patients with additional information that may influence treatment decisions.
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Affiliation(s)
- R Bucciardini
- Laboratory of Virology, Istituto Superiore di Sanità, Rome, Italy.
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Vella S, Galluzzo MC, Giannini G, Pirillo MF, Andreotti M, Tomino C, Fragola V, Bucciardini R, Ricciardulli D, Binelli A, Weimer LE, Floridia M. Plasma HIV-1 copy number and in vitro infectivity of plasma prior to and during combination antiretroviral treatment. Antiviral Res 2000; 47:189-98. [PMID: 10974371 DOI: 10.1016/s0166-3542(00)00107-8] [Citation(s) in RCA: 11] [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: 11/21/2022]
Abstract
Some studies on untreated patients have shown a general correlation between plasma HIV copy number and plasma infectivity in in vitro models. Recent observations also indicate that HIV-RNA level is an important predictor of perinatal transmission and may also have a role in heterosexual transmission. To further analyse the correlation between HIV viral load and plasma infectivity, we studied the relationship between HIV-1 plasma copy number and plasma infectivity prior to and during treatment with antiretroviral combination regimens in HIV-1 infected adults. Plasma infectivity was assessed in vitro by coculture of plasma from HIV-positive patients with PHA-stimulated fresh PBMC from uninfected donors. A positive plasma isolation, in almost all cases (43/45) and irrespective of treatment status, was associated with an HIV viral load higher than 100000 copies per ml, with higher plasma HIV-1 RNA values in isolation-positive samples compared with isolation-negative samples (median values, 710000 vs. 37500 copies per ml, respectively). SI and NSI strains had similarly high viral load values (470000 vs. 790000 copies per ml), but CD4 counts were lower in the SI phenotype group. Our data indicate that low levels of viral load are only exceptionally associated with isolation from plasma in the in vitro model we used. This observation confirms indirectly the presence of an association between viral load and infectivity. The requisite of a high plasma viral load in order to obtain infectivity (i.e. positivity of HIV isolation from plasma) also seems maintained under antiretroviral treatment, adding confidence in the conclusion that reductions in viral load translate into reduction of plasma infectivity. Due to the extreme complexity of factors determining transmission, a very prudent interpretation of the results is essential when information from experimental studies has to be transferred to clinical situations requiring assessment of risks or clinical decisions.
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Affiliation(s)
- S Vella
- Laboratory of Virology, Istituto Superiore di Sanità, Viale Regina Elena, 299-00161, Rome, Italy
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Floridia M, Massella M, Bucciardini R, Perucci CA, Rossi L, Tomino C, Fragola V, Ricciardulli D, Galluzzo CM, Giannini G, Pirillo MF, Andreotti M, Mirra M, Vella S. Hospitalizations and costs of treatment for protease inhibitor-based regimens in patients with very advanced HIV-infection (CD4 < 50/mm(3)). HIV Clin Trials 2000; 1:9-16. [PMID: 11590493 DOI: 10.1310/6ulm-xyb7-h4xp-bhfj] [Citation(s) in RCA: 11] [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] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To describe the cost of hospitalization and treatment in patients with very advanced disease who tart different regimens based on a protease inhibitor (PI). METHOD An observational retrospective analysis was performed on data from a 48-week randomized, multicenter study. Analysis was based on a subgroup of centers that were geographically defined. Costs of ordinary hospital admissions and of antiretroviral treatment were considered. Incidence of hospitalization and number of days free from hospitalization during the period of observation were calculated. Cost and hospitalization measures were compared among patients receiving three different therapeutic regimens: only PI, PI plus one nucleoside, or PI plus two nucleosides. A multivariate analysis was used to assess cost differences, controlling for variables potentially able to influence outcome. RESULTS Overall, among 166 patients starting PI (PI plus two nucleosides, 71;PI plus one nucleoside, 65; only PI, 30), 162 ordinary hospital admissions were observed during about 1 year of follow-up. Monthly rates of admission per person and incidence of first hospitalization on 100 person-months showed a clear inverse relationship with the number of drugs comprising the baseline treatment regimen, with the lower rates for the triple therapy group (0.06 and 3.9, respectively), intermediate values for the dual therapy group (0.10 and 8.1, respectively), and higher rates for the PI monotherapy group (0.15 and 13.7, respectively). The average number of days free from hospitalization per month was 29.5 in the triple therapy group, 28.6 in the dual therapy group, and 27.9 in the monotherapy group. The results of cost analysis showed, despite higher cost of antiretroviral treatment, that global costs were progressively lower using regimens of increasing potency: Compared to PI monotherapy, global cost (costs of antiretroviral treatment and of hospitalizations combined) per month per patient was 31.9% lower for the triple therapy group and 19.3% lower for the dual therapy. Global cost for the triple therapy was 15.7% lower compared to global cost for dual therapy. After adjustment for CD4 count, AIDS status, and Karnofsky score, both hospitalization costs and global costs were significantly lower for triple therapy compared to monotherapy (p =.002 and.039, respectively). CONCLUSION In advanced and nucleoside-experienced patients, PI-containing regimens have a differential impact according to the overall strength of the regimen, with the best effects on both hospitalizations and treatment costs obtained using PI within potent combination regimens.
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Affiliation(s)
- M Floridia
- The Laboratory of Virology, Istituto Superiore di Sanitá, Rome, Italy
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Raboud JM, Rae S, Vella S, Harrigan PR, Bucciardini R, Fragola V, Ricciardulli D, Montaner JS. Meta-analysis of two randomized controlled trials comparing combined zidovudine and didanosine therapy with combined zidovudine, didanosine, and nevirapine therapy in patients with HIV. INCAS study team. J Acquir Immune Defic Syndr 1999; 22:260-6. [PMID: 10770346 DOI: 10.1097/00126334-199911010-00007] [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: 11/26/2022]
Abstract
OBJECTIVES To extend the range of CD4 counts in which a plasma viral load nadir (pVL) <20 copies/ml was known to be predictive of the duration of virologic response. To determine whether baseline pVL is predictive of virologic response during the study periods. METHODS A meta-analysis was conducted of the original individual patient data from two randomized controlled trials comparing zidovudine (ZDV)/didanosine (ddI) with ZDV/ddI/nevirapine (NVP). RESULTS In total, 87 patients received ZDV/ddI and 83 received ZDV/ddI/NVP. Study subjects on triple therapy with baseline pVL <100,000 copies/ml were more likely to achieve a pVL <400 copies/ml (odds ratio [OR] = 2.49; p = .02) and <20 copies/ml (OR = 4.76; p = .001) during the trial than those with baseline pVL > 100,000 copies/ml. Among triple therapy patients, the relative risk of virologic failure was higher for patients with higher baseline pVL (rate ratio [RR] = 2.51/log10 copies/ ml; p = .01), after controlling for compliance and pVL nadir. The relative risks of virologic failure associated with pVL nadir <20 copies/ml and between 21 and 400 copies/ml were .04 (p = .0001) and .56 (p = .26), respectively, compared with patients with a pVL nadir >400 copies/ml. CONCLUSIONS We have extended our earlier results that achieving a pVL nadir <20 copies/ml is important for maintaining virologic suppression. In particular, we have demonstrated that a pVL nadir <20 copies/ml is at least fivefold more protective against virologic failure than achieving a pVL nadir between 20 and 400 copies/ml. Baseline pVL is significantly associated with the probability of achieving and sustaining virologic suppression.
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Affiliation(s)
- J M Raboud
- Department of Health Care and Epidemiology, University of British Columbia, Vancouver, Canada.
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Floridia M, Bucciardini R, Ricciardulli D, Fragola V, Pirillo MF, Weimer LE, Tomino C, Giannini G, Galluzzo CM, Andreotti M, Cargnel A, Alberici F, De Rienzo B, Leoncini F, Fiaccadori F, Francisci D, Grillone W, Ortona L, Piazza M, Scalzini A, Nigra E, Tumietto F, Vella S. A randomized, double-blind trial on the use of a triple combination including nevirapine, a nonnucleoside reverse transcriptase HIV inhibitor, in antiretroviral-naive patients with advanced disease. J Acquir Immune Defic Syndr Hum Retrovirol 1999; 20:11-9. [PMID: 9928724 DOI: 10.1097/00042560-199901010-00002] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The immunologic and virologic activity of nevirapine in combination with two nucleosides (zidovudine [ZDV] and didanosine [ddI]) was evaluated in antiretroviral-naive patients with a CD4 count <200/mm3 or clinical AIDS. In all, 68 patients were enrolled in a 48-week double-blind, placebo-controlled trial. A group of 32 patients received ZDV + ddI + nevirapine, and 36 patients received ZDV + ddI. Primary efficacy parameters were the activity on HIV-1 RNA and on peripheral blood CD4+ cells, with differences between groups analyzed by the Wilcoxon's nonparametric two-sample test. Baseline RNA was high in both treatment groups (median values, 5.8 and 5.7 log10). RNA and CD4 responses were significantly higher with the triple combination (median RNA reductions, 2.69 versus 1.05 log10 at 24 weeks and 1.97 versus 1.20 log10 at 48 weeks; median CD4 increases, 81 versus 64 cells/mm3 at 24 weeks and 101 versus 27 cells/mm3 at 48 weeks). This study demonstrates that a triple combination of ZDV + ddI + nevirapine used as first-line regimen in antiretroviral-naive patients can induce sustained virologic and immunologic response in patients with low CD4 count or a previous diagnosis of AIDS.
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Affiliation(s)
- M Floridia
- Laboratory of Virology, Istituto Superiore di Sanità, Rome, Italy
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Vella S, Giuliano M, Floridia M, Chiesi A, Tomino C, Seeber A, Barcherini S, Bucciardini R, Mariotti S. Effect of sex, age and transmission category on the progression to AIDS and survival of zidovudine-treated symptomatic patients. AIDS 1995; 9:51-6. [PMID: 7893441 DOI: 10.1097/00002030-199501000-00007] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVE To evaluate the effect of transmission category and demographic, clinical and immunological characteristics on the progression to AIDS and survival of zidovudine-treated patients. DESIGN Prospective multicentre cohort study of symptomatic non-AIDS patients. SETTING Eighty-three clinical centres reporting data to the National Zidovudine Registry. PATIENTS A total of 1468 patients enrolled between July 1987 and January 1991 were analysed. MAIN OUTCOME MEASURES Three-year AIDS-free survival probability estimates since therapy start. Cox proportional hazards regression analysis was used to identify independent predictors of progression to AIDS and survival. RESULTS Faster progression was associated with increasing age (8% risk increase for a 5-year increase), low baseline CD4+ count (39% risk increase for 100 x 10(6)/l cells decrease), and zidovudine > 1000 mg/day (20% risk increase compared with < or = 1000 mg/day). Homosexual men had a 33% risk increase compared with other risk groups. The presence of fever and oral candidiasis at enrolment were also independently associated with a higher risk of progression. Differences in the risk of progression were not significant between men and women. Older age, baseline CD4+ count, homosexual behaviour, fever and oral candidiasis were independently associated with a shorter survival. CONCLUSIONS Our results confirm that age and baseline CD4+ count are independent predictors of progression, but do not provide evidence for differences in clinical outcome between the sexes. The higher risk of progression to AIDS and shorter survival for homosexual men appears to be correlated with the higher risk of developing Kaposi's sarcoma.
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Affiliation(s)
- S Vella
- Laboratory of Virology, Istituto Superiore di Sanità, Rome, Italy
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