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Barbanotti D, Tincati C, Tavelli A, Santoro A, Sala M, Bini T, De Bona A, d’Arminio Monforte A, Marchetti GC. HIV-Indicator Condition Guided Testing in a Hospital Setting. Life (Basel) 2023; 13:1014. [PMID: 37109543 PMCID: PMC10145962 DOI: 10.3390/life13041014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 04/06/2023] [Accepted: 04/12/2023] [Indexed: 04/29/2023] Open
Abstract
Late diagnosis is still a major issue in HIV infection management, leading to important consequences for both patients and community. In this perspective, HIV screening targeted on some clinical conditions (HIV indicator conditions-HIVICs) emerged as a useful strategy, also involving patients not considered at high behavioral risk. We organized an in-hospital HIVICs guided screening campaign named ICEBERG in Milan, Italy, between 2019 and 2021. Among the 520 subjects enrolled, mainly presenting with viral hepatitis or mononucleosis-like syndrome, 20 resulted HIV positive (3.8% prevalence). A significant proportion of them had multiple conditions and advanced immunosuppression, with 40% being AIDS-presenters. As adherence to the screening campaign was modest for non-ID specialists, educational interventions to raise clinicians' sensitivity are urgently needed. HIV-ICs guided testing was confirmed as a useful tool, but a combined approach with other screening strategies seems to be essential for early HIV diagnosis.
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Affiliation(s)
- Diletta Barbanotti
- Unit of Infectious Diseases, ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, 20122 Milan, Italy
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Mastrorosa I, Gagliardini R, Segala FV, Mondi A, Lorenzini P, Cerva C, Taddei E, Bai F, Vergori A, Marcantonio N, Pinnetti C, Cicalini S, Murri R, Mazzotta V, Camici M, Mosti S, Bini T, Maffongelli G, Beccacece A, Milozzi E, Iannetta M, Lamonica S, Fusto M, Plazzi MM, Ottou S, Lichtner M, Fantoni M, Andreoni M, Sarmati L, Cauda R, Girardi E, Nicastri E, D'Arminio Monforte A, Palmieri F, Cingolani A, Vaia F, Antinori A. Sarilumab plus standard of care vs standard of care for the treatment of severe COVID-19: a phase 3, randomized, open-labeled, multi-center study (ESCAPE study). EClinicalMedicine 2023; 57:101895. [PMID: 36936403 PMCID: PMC9999914 DOI: 10.1016/j.eclinm.2023.101895] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 02/15/2023] [Accepted: 02/15/2023] [Indexed: 03/12/2023] Open
Abstract
BACKGROUND Among interleukin-6 inhibitors suggested for use in COVID-19, there are few robust evidences for the efficacy of sarilumab. Herein, we evaluated the efficacy and safety of sarilumab in severe COVID-19. METHODS In this phase 3, open-labeled, randomized clinical trial, conducted at 5 Italian hospitals, adults with severe COVID-19 pneumonia (excluding mechanically ventilated) were randomized 2:1 to receive intravenous sarilumab (400 mg, repeatable after 12 h) plus standard of care (SOC) (arm A) or to continue SOC (arm B). Randomization was web-based. As post-hoc analyses, the participants were stratified according to baseline inflammatory parameters. The primary endpoint was analysed on the modified Intention-To-Treat population, including all the randomized patients who received any study treatment (sarilumab or SOC). It was time to clinical improvement of 2 points on a 7-points ordinal scale, from baseline to day 30. We used Kaplan Meier method and log-rank test to compare the primary outcome between two arms, and Cox regression stratified by clinical center and adjusted for severity of illness, to estimate the hazard ratio (HR). The trial was registered with EudraCT (2020-001390-76). FINDINGS Between May 2020 and May 2021, 191 patients were assessed for eligibility, of whom, excluding nine dropouts, 176 were assigned to arm A (121) and B (55). At day 30, no significant differences in the primary endpoint were found (88% [95% CI 81-94] in arm A vs 85% [74-93], HR 1.07 [0.8-1.5] in arm B; log-rank p = 0.50). After stratifying for inflammatory parameters, arm A showed higher probability of improvement than B without statistical significance in the strata with C reactive protein (CRP) < 7 mg/dL (88% [77-96] vs 79% [63-91], HR 1.55 [0.9-2.6]; log-rank p = 0.049) and in the strata with lymphocytes <870/mmc (90% [79-96]) vs (73% [55-89], HR 1.53 [0.9-2.7]; log-rank p = 0.058). Overall, 39/121 (32%) AEs were reported in arm A and 14/55 (23%) in B (p = 0.195), while serious AEs were 22/121 (18%) and 7/55 (11%), respectively (p = 0.244). There were no treatment-related deaths. INTERPRETATION The efficacy of sarilumab in severe COVID-19 was not demonstrated both in the overall and in the stratified for severity analysis population. Exploratory analyses suggested that subsets of patients with lower CRP values or lower lymphocyte counts might have had benefit with sarilumab treatment, but this finding would require replication in other studies. The relatively low rate of concomitant corticosteroid use, could partially explain our results. FUNDING This study was supported by INMI "Lazzaro Spallanzani" Ricerca Corrente Linea 1 on emerging and reemerging infections, funded by Italian Ministry of Health.
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Affiliation(s)
- Ilaria Mastrorosa
- National Institute for Infectious Diseases, Lazzaro Spallanzani IRCCS, Rome, Italy
- Corresponding author. Clinical Department of Infectious Diseases and Research, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Via Portuense 292, 00149, Roma, Italy.
| | - Roberta Gagliardini
- National Institute for Infectious Diseases, Lazzaro Spallanzani IRCCS, Rome, Italy
| | | | - Annalisa Mondi
- National Institute for Infectious Diseases, Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Patrizia Lorenzini
- National Institute for Infectious Diseases, Lazzaro Spallanzani IRCCS, Rome, Italy
- National Center for Disease Prevention and Health Promotion, National Institute of Health, Rome, Italy
| | - Carlotta Cerva
- National Institute for Infectious Diseases, Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Eleonora Taddei
- Fondazione Policlinico A. Gemelli, Catholic University of the Sacred Heart, Rome, Italy
| | - Francesca Bai
- ASST Santi Paolo e Carlo, University of Milan, Italy
| | - Alessandra Vergori
- National Institute for Infectious Diseases, Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Negri Marcantonio
- Fondazione Policlinico A. Gemelli, Catholic University of the Sacred Heart, Rome, Italy
| | - Carmela Pinnetti
- National Institute for Infectious Diseases, Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Stefania Cicalini
- National Institute for Infectious Diseases, Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Rita Murri
- Fondazione Policlinico A. Gemelli, Catholic University of the Sacred Heart, Rome, Italy
| | - Valentina Mazzotta
- National Institute for Infectious Diseases, Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Marta Camici
- National Institute for Infectious Diseases, Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Silvia Mosti
- National Institute for Infectious Diseases, Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Teresa Bini
- ASST Santi Paolo e Carlo, University of Milan, Italy
| | - Gaetano Maffongelli
- National Institute for Infectious Diseases, Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Alessia Beccacece
- National Institute for Infectious Diseases, Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Eugenia Milozzi
- National Institute for Infectious Diseases, Lazzaro Spallanzani IRCCS, Rome, Italy
| | | | - Silvia Lamonica
- Fondazione Policlinico A. Gemelli, Catholic University of the Sacred Heart, Rome, Italy
| | - Marisa Fusto
- National Institute for Infectious Diseases, Lazzaro Spallanzani IRCCS, Rome, Italy
| | | | - Sandrine Ottou
- National Institute for Infectious Diseases, Lazzaro Spallanzani IRCCS, Rome, Italy
| | | | - Massimo Fantoni
- Fondazione Policlinico A. Gemelli, Catholic University of the Sacred Heart, Rome, Italy
| | | | | | - Roberto Cauda
- Fondazione Policlinico A. Gemelli, Catholic University of the Sacred Heart, Rome, Italy
| | - Enrico Girardi
- National Institute for Infectious Diseases, Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Emanuele Nicastri
- National Institute for Infectious Diseases, Lazzaro Spallanzani IRCCS, Rome, Italy
| | | | - Fabrizio Palmieri
- National Institute for Infectious Diseases, Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Antonella Cingolani
- Fondazione Policlinico A. Gemelli, Catholic University of the Sacred Heart, Rome, Italy
| | - Francesco Vaia
- National Institute for Infectious Diseases, Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Andrea Antinori
- National Institute for Infectious Diseases, Lazzaro Spallanzani IRCCS, Rome, Italy
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d’Arminio Monforte A, Tavelli A, De Benedittis S, Bai F, Tincati C, Gazzola L, Viganò O, Allegrini M, Mondatore D, Tesoro D, Barbanotti D, Mulé G, Castoldi R, De Bona A, Bini T, Chiumello D, Centanni S, Passarella S, Orfeo N, Marchetti G, Cozzi-Lepri A. Real World Estimate of Vaccination Protection in Individuals Hospitalized for COVID-19. Vaccines (Basel) 2022; 10:vaccines10040550. [PMID: 35455299 PMCID: PMC9031136 DOI: 10.3390/vaccines10040550] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 03/29/2022] [Accepted: 03/30/2022] [Indexed: 12/17/2022] Open
Abstract
Whether vaccination confers a protective effect against progression after hospital admission for COVID-19 remains to be elucidated. Observational study including all the patients admitted to San Paolo Hospital in Milan for COVID-19 in 2021. Previous vaccination was categorized as: none, one dose, full vaccination (two or three doses >14 days before symptoms onset). Data were collected at hospital admission, including demographic and clinical variables, age-unadjusted Charlson Comorbidity index (CCI). The highest intensity of ventilation during hospitalization was registered. The endpoints were in-hospital death (primary) and mechanical ventilation/death (secondary). Survival analysis was conducted by means of Kaplan-Meier curves and Cox regression models. Effect measure modification by age was formally tested. We included 956 patients: 151 (16%) fully vaccinated (18 also third dose), 62 (7%) one dose vaccinated, 743 (78%) unvaccinated. People fully vaccinated were older and suffering from more comorbidities than unvaccinated. By 28 days, the risk of death was of 35.9% (95%CI: 30.1−41.7) in unvaccinated, 41.5% (24.5−58.5) in one dose and 28.4% (18.2−38.5) in fully vaccinated (p = 0.63). After controlling for age, ethnicity, CCI and month of admission, fully vaccinated participants showed a risk reduction of 50% for both in-hospital death, AHR 0.50 (95%CI: 0.30−0.84) and for mechanical ventilation or death, AHR 0.49 (95%CI: 0.35−0.69) compared to unvaccinated, regardless of age (interaction p > 0.56). Fully vaccinated individuals in whom vaccine failed to keep them out of hospital, appeared to be protected against critical disease or death when compared to non-vaccinated. These data support universal COVID-19 vaccination.
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Affiliation(s)
- Antonella d’Arminio Monforte
- Unit of Infectious Diseases ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, 20142 Milan, Italy; (A.T.); (S.D.B.); (F.B.); (C.T.); (L.G.); (O.V.); (M.A.); (D.M.); (D.T.); (D.B.); (G.M.); (R.C.); (A.D.B.); (T.B.); (G.M.)
- Correspondence:
| | - Alessandro Tavelli
- Unit of Infectious Diseases ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, 20142 Milan, Italy; (A.T.); (S.D.B.); (F.B.); (C.T.); (L.G.); (O.V.); (M.A.); (D.M.); (D.T.); (D.B.); (G.M.); (R.C.); (A.D.B.); (T.B.); (G.M.)
| | - Sara De Benedittis
- Unit of Infectious Diseases ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, 20142 Milan, Italy; (A.T.); (S.D.B.); (F.B.); (C.T.); (L.G.); (O.V.); (M.A.); (D.M.); (D.T.); (D.B.); (G.M.); (R.C.); (A.D.B.); (T.B.); (G.M.)
| | - Francesca Bai
- Unit of Infectious Diseases ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, 20142 Milan, Italy; (A.T.); (S.D.B.); (F.B.); (C.T.); (L.G.); (O.V.); (M.A.); (D.M.); (D.T.); (D.B.); (G.M.); (R.C.); (A.D.B.); (T.B.); (G.M.)
| | - Camilla Tincati
- Unit of Infectious Diseases ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, 20142 Milan, Italy; (A.T.); (S.D.B.); (F.B.); (C.T.); (L.G.); (O.V.); (M.A.); (D.M.); (D.T.); (D.B.); (G.M.); (R.C.); (A.D.B.); (T.B.); (G.M.)
| | - Lidia Gazzola
- Unit of Infectious Diseases ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, 20142 Milan, Italy; (A.T.); (S.D.B.); (F.B.); (C.T.); (L.G.); (O.V.); (M.A.); (D.M.); (D.T.); (D.B.); (G.M.); (R.C.); (A.D.B.); (T.B.); (G.M.)
| | - Ottavia Viganò
- Unit of Infectious Diseases ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, 20142 Milan, Italy; (A.T.); (S.D.B.); (F.B.); (C.T.); (L.G.); (O.V.); (M.A.); (D.M.); (D.T.); (D.B.); (G.M.); (R.C.); (A.D.B.); (T.B.); (G.M.)
| | - Marina Allegrini
- Unit of Infectious Diseases ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, 20142 Milan, Italy; (A.T.); (S.D.B.); (F.B.); (C.T.); (L.G.); (O.V.); (M.A.); (D.M.); (D.T.); (D.B.); (G.M.); (R.C.); (A.D.B.); (T.B.); (G.M.)
| | - Debora Mondatore
- Unit of Infectious Diseases ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, 20142 Milan, Italy; (A.T.); (S.D.B.); (F.B.); (C.T.); (L.G.); (O.V.); (M.A.); (D.M.); (D.T.); (D.B.); (G.M.); (R.C.); (A.D.B.); (T.B.); (G.M.)
| | - Daniele Tesoro
- Unit of Infectious Diseases ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, 20142 Milan, Italy; (A.T.); (S.D.B.); (F.B.); (C.T.); (L.G.); (O.V.); (M.A.); (D.M.); (D.T.); (D.B.); (G.M.); (R.C.); (A.D.B.); (T.B.); (G.M.)
| | - Diletta Barbanotti
- Unit of Infectious Diseases ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, 20142 Milan, Italy; (A.T.); (S.D.B.); (F.B.); (C.T.); (L.G.); (O.V.); (M.A.); (D.M.); (D.T.); (D.B.); (G.M.); (R.C.); (A.D.B.); (T.B.); (G.M.)
| | - Giovanni Mulé
- Unit of Infectious Diseases ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, 20142 Milan, Italy; (A.T.); (S.D.B.); (F.B.); (C.T.); (L.G.); (O.V.); (M.A.); (D.M.); (D.T.); (D.B.); (G.M.); (R.C.); (A.D.B.); (T.B.); (G.M.)
| | - Roberto Castoldi
- Unit of Infectious Diseases ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, 20142 Milan, Italy; (A.T.); (S.D.B.); (F.B.); (C.T.); (L.G.); (O.V.); (M.A.); (D.M.); (D.T.); (D.B.); (G.M.); (R.C.); (A.D.B.); (T.B.); (G.M.)
| | - Anna De Bona
- Unit of Infectious Diseases ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, 20142 Milan, Italy; (A.T.); (S.D.B.); (F.B.); (C.T.); (L.G.); (O.V.); (M.A.); (D.M.); (D.T.); (D.B.); (G.M.); (R.C.); (A.D.B.); (T.B.); (G.M.)
| | - Teresa Bini
- Unit of Infectious Diseases ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, 20142 Milan, Italy; (A.T.); (S.D.B.); (F.B.); (C.T.); (L.G.); (O.V.); (M.A.); (D.M.); (D.T.); (D.B.); (G.M.); (R.C.); (A.D.B.); (T.B.); (G.M.)
| | - Davide Chiumello
- Intensive Care Unit ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, 20142 Milan, Italy;
| | - Stefano Centanni
- Pneumology Unit ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, 20142 Milan, Italy;
| | - Sabrina Passarella
- Medical Direction ASST Santi Paolo e Carlo, 20142 Milan, Italy; (S.P.); (N.O.)
| | - Nicola Orfeo
- Medical Direction ASST Santi Paolo e Carlo, 20142 Milan, Italy; (S.P.); (N.O.)
| | - Giulia Marchetti
- Unit of Infectious Diseases ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, 20142 Milan, Italy; (A.T.); (S.D.B.); (F.B.); (C.T.); (L.G.); (O.V.); (M.A.); (D.M.); (D.T.); (D.B.); (G.M.); (R.C.); (A.D.B.); (T.B.); (G.M.)
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D’Arminio Monforte A, Tavelli A, Bai F, Tomasoni D, Falcinella C, Castoldi R, Barbanotti D, Mulè G, Allegrini M, Suardi E, Tesoro D, Tagliaferri G, Mondatore D, Augello M, Cona A, Beringheli T, Gemignani N, Sala M, Varisco B, Molà F, Pettenuzzo S, Biasioli L, Copes A, Gazzola L, Viganò O, Tincati C, De Bona A, Bini T, Marchetti G. Declining Mortality Rate of Hospitalised Patients in the Second Wave of the COVID-19 Epidemics in Italy: Risk Factors and the Age-Specific Patterns. Life (Basel) 2021; 11:979. [PMID: 34575128 PMCID: PMC8464683 DOI: 10.3390/life11090979] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 09/10/2021] [Accepted: 09/13/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Mortality rate from COVID-19 in Italy is among the world's highest. We aimed to ascertain whether there was any reduction of in-hospital mortality in patients hospitalised for COVID-19 in the second-wave period (October 2020-January 2021) compared to the first one (February-May 2020); further, we verified whether there were clusters of hospitalised patients who particularly benefitted from reduced mortality rate. METHODS Data collected related to in-patients' demographics, clinical, laboratory, therapies and outcome. Primary end-point was time to in-hospital death. Factors associated were evaluated by uni- and multivariable analyses. A flow diagram was created to determine the rate of in-hospital death according to individual and disease characteristics. RESULTS A total of 1561 patients were included. The 14-day cumulative incidence of in-hospital death by competing risk regression was of 24.8% (95% CI: 21.3-28.5) and 15.9% (95% CI: 13.7-18.2) in the first and second wave. We observed that the highest relative reduction of death from first to second wave (more than 47%) occurred mainly in the clusters of patients younger than 70 years. CONCLUSIONS Progress in care and supporting therapies did affect population over 70 years to a lesser extent. Preventive and vaccination campaigns should focus on individuals whose risk of death from COVID-19 remains high.
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Affiliation(s)
- Antonella D’Arminio Monforte
- Institute of Infectious Diseases, Department of Health Science, ASST Santi Paolo e Carlo, University of Milan, 20142 Milan, Italy; (A.T.); (F.B.); (D.T.); (C.F.); (R.C.); (D.B.); (G.M.); (M.A.); (E.S.); (D.T.); (G.T.); (D.M.); (M.A.); (A.C.); (T.B.); (N.G.); (M.S.); (B.V.); (F.M.); (S.P.); (L.B.); (A.C.); (L.G.); (O.V.); (C.T.); (A.D.B.); (T.B.); (G.M.)
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Cona A, Iannotti N, Gazzola L, Aldieri C, Viganò O, Bini T, Marchetti G, Monforte AD. Long-term positive effect of an educational antimicrobial stewardship program implemented in an Internal Medicine Department: a prospective analysis and a point prevalence survey on long-term effect. J Chemother 2020; 33:238-244. [PMID: 33375926 DOI: 10.1080/1120009x.2020.1861515] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The study aims to evaluate antimicrobial consumption and appropriateness one year after the implementation of an antimicrobial stewardship (AMS) program in an Internal Medicine Department in Milan. AMS program structured in two phases: "AMS phase", 5 months AMS-program based on an "audit-and-feedback model"; the "follow-up phase", 5 months long point prevalence survey conducted one year later. Outcomes of the study: antimicrobial consumption and appropriateness of antimicrobial therapy. Secondary outcomes: in-hospital mortality and length of stay (LOS). During the "AMS phase", we obtained a mean decrease of -11.4% of total antibiotic consumption as compared to the previous year (67.9 defined daily dose (DDD)/100 bed-days (bd) vs. 79.4 DDD/100bd, p = 0.07). Antibiotic consumption remained stable during "follow-up phase" (66.3 DDD/100bd, p = 0.9). Rate of appropriateness during the project increased from 48% to 85% (p < 0.01). No difference in in-hospital mortality and in LOS were observed. The study documents a positive long-term effect of AMS program on consumption and appropriate use of antibiotics.
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Affiliation(s)
- Andrea Cona
- Clinic of Infectious and Tropical Diseases, Department of Health Sciences, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
| | - Nathalie Iannotti
- Clinic of Infectious and Tropical Diseases, Department of Health Sciences, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
| | - Lidia Gazzola
- Clinic of Infectious and Tropical Diseases, Department of Health Sciences, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
| | - Chiara Aldieri
- Clinic of Infectious and Tropical Diseases, Department of Health Sciences, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
| | - Ottavia Viganò
- Clinic of Infectious and Tropical Diseases, Department of Health Sciences, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
| | - Teresa Bini
- Clinic of Infectious and Tropical Diseases, Department of Health Sciences, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
| | - Giulia Marchetti
- Clinic of Infectious and Tropical Diseases, Department of Health Sciences, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
| | - Antonella d'Arminio Monforte
- Clinic of Infectious and Tropical Diseases, Department of Health Sciences, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
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Cona A, Gazzola L, Viganò O, Bini T, Marchetti GC, d'Arminio Monforte A. Impact of daily versus weekly service of infectious diseases consultation on hospital antimicrobial consumption: a retrospective study. BMC Infect Dis 2020; 20:812. [PMID: 33160320 PMCID: PMC7648268 DOI: 10.1186/s12879-020-05550-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 10/27/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To verify whether a daily service of Infectious Diseases consultation (ID-cons) is more effective than a weekly service in reducing antibiotic (ATB) consumption without worsening of clinical outcomes. METHODS Two-year observational analysis of the ID-cons provided in a hospital setting in Milan, Italy. ID-cons resulted in: start-of-ATB; no-ATB; confirmation; modification-of-ATB. The impact of a weekly (September 1, 2016 - August 31, 2017 versus a daily (September 1, 2017 - September 30, 2018) service of ID-cons was evaluated in terms of: time-from-admission-to-first-ID-cons, type of ATB-intervention and number-of-ID-cons per 100 bed-days (bd). Primary outcomes: reduction of hospital ATB consumption overall and by department and classes expressed as Defined Daily Dose (DDD)/100bd (by Wilcoxon test for paired data). SECONDARY OUTCOMES overall and sepsis-related in-hospital annual mortality rates (as death/patient's admissions). RESULTS Overall 2552 ID-cons in 1111 patients (mean, 2.3 ID-cons per patient) were performed (18.6% weekly vs 81.4% daily). No differences in patient characteristics were observed. In the daily-service, compared to the weekly-service, patients were seen by the ID-consultant earlier (time-from-admission-to-ID-cons: 6 days (IQR 2-13) vs 10 days (IQR 6-19), p < 0.001) and ATB was more often started by the ID-consultant (Start-of-ATB: 11.6% vs 8%, p = 0.02), rather than treating physicians. After switching to daily-service, the number-of-ID-cons increased from 0.4/100bd to 1.5/100bd (p = 0.01), with the greatest increase in the emergency department (1.5/100bd vs 6.7/100bd, p < 0.001). Total ATB consumption decreased from 64 to 60 DDD/100bd. As for the number-of-cons, the consumption of ATB decreased mainly in the emergency area. According to ATB classes, glycopeptides consumption was reduced from 3.1 to 2.1 DDD/100bd (p = 0.02) while carbapenem use decreased from 3.7 to 3.1 DDD/100bd (p = 0.07). No changes in overall mortality (5.2% vs 5.2%) and sepsis-related mortality (19.3% vs 20.9%; p = 0.7) were observed among the two time-period. CONCLUSIONS Daily-ID-cons resulted in a more comprehensive management of the infected patient by the ID-consultant, especially in the emergency area where we also observed the highest rate of reduction of ATB-usage. No change in mortality was observed.
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Affiliation(s)
- Andrea Cona
- Clinic of Infectious and Tropical Diseases, Department of Health Sciences, ASST Santi Paolo e Carlo, University of Milan, Via A. di Rudinì 8, 20142, Milan, Italy.
| | - Lidia Gazzola
- Clinic of Infectious and Tropical Diseases, Department of Health Sciences, ASST Santi Paolo e Carlo, University of Milan, Via A. di Rudinì 8, 20142, Milan, Italy
| | - Ottavia Viganò
- Clinic of Infectious and Tropical Diseases, Department of Health Sciences, ASST Santi Paolo e Carlo, University of Milan, Via A. di Rudinì 8, 20142, Milan, Italy
| | - Teresa Bini
- Clinic of Infectious and Tropical Diseases, Department of Health Sciences, ASST Santi Paolo e Carlo, University of Milan, Via A. di Rudinì 8, 20142, Milan, Italy
| | - Giulia Carla Marchetti
- Clinic of Infectious and Tropical Diseases, Department of Health Sciences, ASST Santi Paolo e Carlo, University of Milan, Via A. di Rudinì 8, 20142, Milan, Italy
| | - Antonella d'Arminio Monforte
- Clinic of Infectious and Tropical Diseases, Department of Health Sciences, ASST Santi Paolo e Carlo, University of Milan, Via A. di Rudinì 8, 20142, Milan, Italy
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Gazzola L, Tagliaferri G, De Bona A, Mondatore D, Borsino C, Bini T, Marchetti G, d'Arminio Monforte A. Dyslipidaemia after switch to tenofovir alafenamide (TAF)-based cART regimens in a cohort of HIV-positive patients: what clinical relevance? HIV Med 2020; 22:140-145. [PMID: 33084173 DOI: 10.1111/hiv.12984] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 08/25/2020] [Accepted: 09/17/2020] [Indexed: 12/31/2022]
Abstract
OBJECTIVES Switching from tenofovir (TDF) to tenofovir alafenamide (TAF) affects lipid profile. The aim of this study was to evaluate whether this results in an increased frequency of patients with low-density lipoprotein (LDL) above their cardiovascular-related target. METHODS All HIV patients switching from TDF to TAF, with no changes of the anchor drug, and with plasma lipids available within 6 months before and after the switch, were included. Demographic, HIV-related parameters, cardiovascular (CV) risk factors and lipid profile on both TDF and TAF were collected. The CV risk score and the relative target of LDL for each patient were calculated according to 2016 European Society of Cardiology/European Atherosclerosis Society (ESC/EAS) guidelines for the management of dyslipidaemias. Modifications in lipid profiles and in the prevalence of patients with LDL above their CV-related target were evaluated after switch to TAF. RESULTS Overall, 221 HIV patients were included, according to CV risk: 55% at low risk, 34% at moderate risk, and 11% at high/very high risk. By analysing lipid profiles according to CV risk, 38% of patients on TDF had LDL above their CV target; this prevalence increases to 60% after switching to TAF (P < 0.0001). The presence of cobicistat in the combination antiretroviral therapy (cART) regimen was associated with an increased risk of LDL above the CV-related target after switch to TAF [adjusted odds ratio (aOR) = 2.4, 95% confidence interval (CI): 1-5.1], P = 0.03) and with an increased prescription of lifestyle/therapeutic intervention (OR = 3.0, 95% CI: 1.7-5.3, P < 0.0001). DISCUSSION Switching from TDF to TAF affects lipid parameters, and data from real life suggest a clinical relevance of this worsening that often leads clinicians to implement lifestyle/therapeutic interventions.
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Affiliation(s)
- L Gazzola
- Department of Health Sciences, Clinic of Infectious Diseases, 'San Paolo' Hospital, University of Milan, Milan, Italy
| | - G Tagliaferri
- Department of Health Sciences, Clinic of Infectious Diseases, 'San Paolo' Hospital, University of Milan, Milan, Italy
| | - A De Bona
- Department of Health Sciences, Clinic of Infectious Diseases, 'San Paolo' Hospital, University of Milan, Milan, Italy
| | - D Mondatore
- Department of Health Sciences, Clinic of Infectious Diseases, 'San Paolo' Hospital, University of Milan, Milan, Italy
| | - C Borsino
- Pharmacy Unit, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
| | - T Bini
- Department of Health Sciences, Clinic of Infectious Diseases, 'San Paolo' Hospital, University of Milan, Milan, Italy
| | - G Marchetti
- Department of Health Sciences, Clinic of Infectious Diseases, 'San Paolo' Hospital, University of Milan, Milan, Italy
| | - A d'Arminio Monforte
- Department of Health Sciences, Clinic of Infectious Diseases, 'San Paolo' Hospital, University of Milan, Milan, Italy
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d'Arminio Monforte A, Tavelli A, Bai F, Tomasoni D, Falcinella C, Castoldi R, Barbanotti D, Mulè G, Allegrini M, Tesoro D, Tagliaferri G, Mondatore D, Augello M, Cona A, Ancona G, Gazzola L, Iannotti N, Tincati C, Viganò O, De Bona A, Bini T, Cozzi-Lepri A, Marchetti G. The importance of patients' case-mix for the correct interpretation of the hospital fatality rate in COVID-19 disease. Int J Infect Dis 2020; 100:67-74. [PMID: 32950738 PMCID: PMC7497732 DOI: 10.1016/j.ijid.2020.09.037] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 08/31/2020] [Accepted: 09/13/2020] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE We aimed to document data on the epidemiology and factors associated with clinical course leading to death of patients hospitalised with COVID-19. METHODS Prospective observational cohort study on patients hospitalised with COVID-19 disease in February-24th/May-17th 2020 in Milan, Italy. Uni-multivariable Cox regression analyses were performed. Death's percentage by two-weeks' intervals according to age and disease severity was analysed. RESULTS A total of 174/539 (32.3%) patients died in hospital over 8228 person-day follow-up; the 14-day Kaplan-Meier probability of death was 29.5% (95%CI: 25.5-34.0). Older age, burden of comorbidities, COVID-19 disease severity, inflammatory markers at admission were independent predictors of increased risk, while several drug-combinations were predictors of reduced risk of in-hospital death. The highest fatality rate, 36.5%, occurred during the 2nd-3rd week of March, when 55.4% of patients presented with severe disease, while a second peak, by the end of April, was related to the admission of older patients (55% ≥80 years) with less severe disease, 30% coming from long-term care facilities. CONCLUSIONS The unusual fatality rate in our setting is likely to be related to age and the clinical conditions of our patients. These findings may be useful to better allocate resources of the national healthcare system, in case of re-intensification of COVID-19 epidemics.
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Affiliation(s)
- Antonella d'Arminio Monforte
- Clinic of Infectious Diseases, Department of Health Science, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy.
| | - Alessandro Tavelli
- Clinic of Infectious Diseases, Department of Health Science, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
| | - Francesca Bai
- Clinic of Infectious Diseases, Department of Health Science, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
| | - Daniele Tomasoni
- Clinic of Infectious Diseases, Department of Health Science, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
| | - Camilla Falcinella
- Clinic of Infectious Diseases, Department of Health Science, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
| | - Roberto Castoldi
- Clinic of Infectious Diseases, Department of Health Science, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
| | - Diletta Barbanotti
- Clinic of Infectious Diseases, Department of Health Science, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
| | - Giovanni Mulè
- Clinic of Infectious Diseases, Department of Health Science, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
| | - Marina Allegrini
- Clinic of Infectious Diseases, Department of Health Science, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
| | - Daniele Tesoro
- Clinic of Infectious Diseases, Department of Health Science, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
| | - Gianmarco Tagliaferri
- Clinic of Infectious Diseases, Department of Health Science, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
| | - Debora Mondatore
- Clinic of Infectious Diseases, Department of Health Science, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
| | - Matteo Augello
- Clinic of Infectious Diseases, Department of Health Science, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
| | - Andrea Cona
- Clinic of Infectious Diseases, Department of Health Science, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
| | - Giuseppe Ancona
- Clinic of Infectious Diseases, Department of Health Science, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
| | - Lidia Gazzola
- Clinic of Infectious Diseases, Department of Health Science, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
| | - Nathalie Iannotti
- Clinic of Infectious Diseases, Department of Health Science, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
| | - Camilla Tincati
- Clinic of Infectious Diseases, Department of Health Science, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
| | - Ottavia Viganò
- Clinic of Infectious Diseases, Department of Health Science, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
| | - Anna De Bona
- Clinic of Infectious Diseases, Department of Health Science, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
| | - Teresa Bini
- Clinic of Infectious Diseases, Department of Health Science, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
| | - Alessandro Cozzi-Lepri
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation, Institute for Global Health, University College London, London, UK
| | - Giulia Marchetti
- Clinic of Infectious Diseases, Department of Health Science, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
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9
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Garagiola E, Foglia E, Ferrario L, Meraviglia P, Tebini A, Menzaghi B, Atzori C, Rizzardini G, Bini T, D'Arminio Monforte A, Croce D. Comorbidities and HCV coinfection in the management of HIV+ patients: evidence from the Italian clinical practice. Health Econ Rev 2020; 10:27. [PMID: 32860539 PMCID: PMC7456501 DOI: 10.1186/s13561-020-00284-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 08/05/2020] [Indexed: 05/09/2023]
Abstract
BACKGROUND Since HIV+ treatment has become more effective, the average age of people living with HIV (PLWHIV) has increased, and consequently the incidence of developing comorbidities, making the clinical and economic management of HIV+ patients more complex. Limited literature exists regarding the management of comorbidities costs. This study is aimed at defining and comparing the total annual costs of comorbidities, in an Italian cohort of HIV and HIV/HCV patients, from the National Healthcare Service perspective. The authors hypothesised that there are higher costs, for patients with multiple comorbidities, and a greater consumption of resources for HIV/HCV co-infected patients versus HIV mono-infected patients. METHODS An observational retrospective multi-centre health-economics study, enrolling HIV+ and HIV/HCV consecutive patients with at least one comorbidity, was conducted. The consecutive cases, provided by three Italian infectious diseases centres, were related to the year 2016. The enrolled patients were on a stable antiviral therapy for at least six months. Demographic and clinical information was recorded. Costs related to HIV and HCV therapies, other treatments, medical examinations, hospitalizations and outpatient visits were evaluated. Data from mono-infected and co-infected groups of patients were compared, and the statistical analysis was performed by t-tests, chi-square and ANOVA. A sub-analysis excluding HCV therapy costs, was also conducted. The hierarchical sequential linear regression model was used to explore the determinants of costs, considering the investigated comorbidities. All analyses were conducted with a significant level of 0.05. RESULTS A total of 676 patients, 82% male, mean age 52, were identified and divided into groups (338 mono-infected HIV+ and 338 co-infected HIV/HCV patients), comparable in terms of age, gender, and demographic characteristics. A trend towards higher annual costs, for patients with multiple comorbidities was observed in HIV mono-infected patients (respectively € 8272.18 for patients without comorbidities and € 12,532.49 for patients with three or more comorbidities, p-value: 0.001). Excluding anti-HCV therapies costs, HIV/HCV co-infected patients generally required more resources, with statistically significant differences related to cardiovascular events (€10,116.58 vs €11,004.28, p-value: 0.001), and neurocognitive impairments events (€7706.43 vs €11,641.29 p- value: < 0.001). CONCLUSIONS This study provides a differentiated and comprehensive analysis of the healthcare resources needed by HIV and HIV/HCV patients with comorbidities and may contribute to the decision process of resources allocation, in the clinical management of different HIV+ patient populations.
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Affiliation(s)
- Elisabetta Garagiola
- Centre for Research on Health Economics, Social and Health Care Management, LIUC-Università Cattaneo, Castellanza, Italy.
| | - Emanuela Foglia
- Centre for Research on Health Economics, Social and Health Care Management, LIUC-Università Cattaneo, Castellanza, Italy
| | - Lucrezia Ferrario
- Centre for Research on Health Economics, Social and Health Care Management, LIUC-Università Cattaneo, Castellanza, Italy
| | | | | | | | | | - Giuliano Rizzardini
- Fatebenefratelli Sacco Hospital, Milan, Italy
- School of Clinical Medicine, Faculty of Health Science, University of the Witwatersrand, Johannesburg, South Africa
| | | | | | - Davide Croce
- Centre for Research on Health Economics, Social and Health Care Management, LIUC-Università Cattaneo, Castellanza, Italy
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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10
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Antinori A, Rusconi S, Gianotti N, Bini T, Mancusi D, Termini R. Cardiovascular adverse events during treatment with darunavir-based regimens in an Italian observational study. Drug Des Devel Ther 2019; 13:1667-1685. [PMID: 31190745 PMCID: PMC6526181 DOI: 10.2147/dddt.s180981] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 04/02/2019] [Indexed: 12/11/2022]
Abstract
Background: The protease inhibitor (PI) darunavir (DRV) has proven to be highly effective and well tolerated for HIV treatment. The DAD (Data collection on Adverse Effects of Anti-HIV Drugs) cohort showed an increased 5-year cumulative cardiovascular (CV) risk in patients given various PIs, including DRV, whereas two other recent studies found no association between DRV and CV diseases. Methods: We performed a post-hoc analysis of CV adverse events (CVAEs) in an Italian cohort, the TMC114-HIV4042 observational study, where 875 patients treated with ritonavir-boosted DRV-based regimens were followed for a total of 1,566 patient-years. Results: We observed 23 CVAEs of any type, including 17 [12 (95%CI, 7–19) per 1,000 patient-years] primary; 14 [10 (95%CI, 5–17) per 1,000 patient-years] were primary Framingham-type general CVAEs, close to what expected according to the Framingham algorithm based on traditional risk factors. Age and systolic blood pressure (SBP) at the time of study enrolment were the only relevant (p<0.01) independent predictors of CVAEs in all models; patients with any CVAE were on average 10 years older and had an SBP 14 mmHg higher than patients without CVAEs. When controlling for age and SBP, the association with other traditional factors, including serum lipids, and with HIV-specific factors was not statistically significant (p>0.05). Models that also adjusted for previous ARV exposure showed no statistically significant association between any-type CVAEs and either DRV doses, 1,200 or 800 mg/daily (as also suggested by propensity score stratification), or previous DRV exposure duration. Conclusion: We found no evidence of a relationship between DRV use and increased CV risk.
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Affiliation(s)
- A Antinori
- HIV/AIDS Department, National Institute for Infectious Diseases "Lazzaro Spallanzani" IRCCS, Rome, Italy
| | - S Rusconi
- Infectious Diseases Unit, DIBIC Luigi Sacco, University of Milan, Milan, Italy
| | - N Gianotti
- Infectious Diseases, San Raffaele Scientific Institute, Milan, Italy
| | - T Bini
- Clinic of Infectious Diseases, ASST "Santi Paolo e Carlo" Hospital, Milan, Italy
| | - D Mancusi
- Medical Affairs Department, Infectious Diseases, Janssen-Cilag SpA, Cologno Monzese (MI), Italy
| | - R Termini
- Medical Affairs Department, Infectious Diseases, Janssen-Cilag SpA, Cologno Monzese (MI), Italy
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11
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Aulicino G, Boselli L, Negroni L, Rivolta S, Bini T, Perotti GM. The continued presence of an infectious diseases specialist in a hospital to reduce the HAIs burden. Eur J Public Health 2018. [DOI: 10.1093/eurpub/cky218.127] [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: 11/14/2022] Open
Affiliation(s)
- G Aulicino
- Post Graduate School in Public Health, Department Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - L Boselli
- ASST Santi Paolo e Carlo, Milan, Italy
| | - L Negroni
- ASST Santi Paolo e Carlo, Milan, Italy
| | - S Rivolta
- Post Graduate School in Public Health, Department Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - T Bini
- ASST Santi Paolo e Carlo, Milan, Italy
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12
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Borghi L, Tesoro V, Vegni E, Bini T, Leone D. [A qualitative content analysis of HIV consultation: when conversation is about aother than disease]. Recenti Prog Med 2018; 107:149-56. [PMID: 27030225 DOI: 10.1701/2182.23608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION In recent decades the literature has paid growing attention to the communicative and relational aspects of the medical consultation, showing a consistent presence - besides contents related to the disease and the patient's agenda - of friendly conversations or "chitchat", i.e. interventions related to social, relational and personal aspects made by the physician or by the patient. The aim of the study is to analyze the content, frequency and who between the doctor and the patient introduce the "chitchat" during the check-up visits with HIV+ patients and assess the patient satisfaction at the end of the visit. METHODS 52 visits at the clinic of Infectious Diseases in a hospital in Northern Italy were videotaped and transcribed. All patients filled out a satisfaction questionnaire at the end of the visit. The friendly conversations were extrapolated, and analyzed qualitatively with a content thematic analysis, and quantitatively using descriptive statistics. RESULTS The following thematic areas were identified: patient's medical issue not related to HIV; medical condition of a family member or others; labour issues of the patient; patient's relational/emotional issues; relational/working issues work of others; social conversations; physician's self-disclosure. "Chitchat" accounted for 26.5% of the time of the visit and in 63% of cases was introduced by doctors. The 91.4% of the patients was highly satisfied. CONCLUSIONS The presence of friendly conversations during the doctor-patient exchanges in the field of HIV infection seems to have a role of consolidation of the therapeutic relationship and seems to reflect an authentic interest of the physician towards the patient as a person.
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Affiliation(s)
- Lidia Borghi
- Psicologia Clinica, Dipartimento di Scienze della Salute, Università di Milano
| | - Vincenza Tesoro
- USD di Psicologia Clinica, Dipartimento di Salute Mentale, Ospedale San Paolo
| | - Elena Vegni
- Psicologia Clinica, Dipartimento di Scienze della Salute, Università di Milano - USD di Psicologia Clinica, Dipartimento di Salute Mentale, Ospedale San Paolo
| | - Teresa Bini
- Clinica di Malattie Infettive, Dipartimento di Scienze della Salute, Ospedale San Paolo, Università di Milano
| | - Daniela Leone
- Psicologia Clinica, Dipartimento di Scienze della Salute, Università di Milano
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Di Biagio A, Riccardi N, Signori A, Maserati R, Nozza S, Gori A, Bonora S, Borderi M, Ripamonti D, Rossi MC, Orofino G, Quirino T, Nunnari G, Celesia BM, Martini S, Sagnelli C, Mazzola G, Colletti P, Bartolozzi D, Bini T, Ladisa N, Castelnuovo F, Saracino A, Lo Caputo S. PrEP in Italy: The time may be ripe but who's paying the bill? A nationwide survey on physicians' attitudes towards using antiretrovirals to prevent HIV infection. PLoS One 2017; 12:e0181433. [PMID: 28727818 PMCID: PMC5519091 DOI: 10.1371/journal.pone.0181433] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 07/02/2017] [Indexed: 11/18/2022] Open
Abstract
Several studies have demonstrated the efficacy of the oral pre-exposure prophylaxis (PrEP) with tenofovir (with or without emtricitabine) on preventing HIV-negative partners of HIV infected patients to become infected through sexual contacts. PrEP is already available in the United States and now is approved by European Medicine Agency. In this setting we would like to gauge physicians' knowledge, acquaintance with and attitude to include PrEP in their clinical practice. A cross sectional survey was conducted among Italian physicians expert on antiretroviral therapy. Out of 146 physicians, 35% of participants declared to be familiar with PrEP but only 46% of them believed that, currently, there are not enough reasons to make it available in Italy. 51% of physicians have already been attracted to prescribe it and 63.4% have been openly asked about PrEP. The main concerns noticed were: the risk of acquire other sexual transmitted diseases (STDs) (70% of physicians feared that PrEP could favor STDs spread), the potential harmful of PrEP if not adequately implemented and, especially the risk of possible side effects if not properly used. Nevertheless, 55.9% of participants believed that Health Authorities face an ethical obligation to make PrEP available as part of the strategies to protect from HIV transmission and half of the respondents asked for further researches to better define the role for PrEP. Attitudes regarding PrEP impact on Italian National Health Organization were also very interesting: 57.5% of participants did not believe that investing in PrEP would be an appropriate use of healthcare resources, while 70.6% affirmed that PrEP's financial coverage should not be funded by the Italian National System of Health (SSN). This survey showed a high awareness of PrEP potential among Italian physicians coupled with a great deal of skepticism about how and if implementing it in clinical practice.
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Affiliation(s)
- Antonio Di Biagio
- Infectious Diseases Clinic, Department of Internal Medicine, Ospedale Policlinico San Martino, Genoa, Italy
| | - Niccolò Riccardi
- Infectious Diseases Clinic, Department of Internal Medicine, Ospedale Policlinico San Martino, Genoa, Italy
- * E-mail:
| | - Alessio Signori
- Department of Health Science, Biostatistics, University of Genoa, Genoa, Italy
| | - Renato Maserati
- Malattie Infettive, Fondazione IRCCS Policlinico San Matteo di Pavia, Pavia, Italy
| | - Silvia Nozza
- Department of Infectious Diseases, IRCCS San Raffaele, Milan, Italy
| | - Andrea Gori
- Clinic of Infectious Diseases, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - Stefano Bonora
- Unit of Infectious Diseases, Department of Medical Sciences, University of Torino, Torino, Italy
| | - Marco Borderi
- Infection Diseases Unit, Sant’Orsola Hospital, University of Bologna, Bologna, Italy
| | - Diego Ripamonti
- Infectious Diseases Unit, AO Papa Giovanni XXIII, Bergamo, Italy
| | | | - Giancarlo Orofino
- Unit of Infectious Diseases, "Divisione A", Ospedale Amedeo di Savoia, Torino, Italy
| | - Tiziana Quirino
- Infectious Diseases Unit, Ospedali di Busto Arsizio, Varese, Italy
| | - Giuseppe Nunnari
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Benedetto Maurizio Celesia
- Department of Clinical and Molecular Biomedicine, Division of Infectious Diseases, University of Catania, ARNAS Garibaldi, Catania, Italy
| | - Salvatore Martini
- Department of Clinical and Experimental Medicine and Surgery "F. Magrassi e A. Lanzara, Second University of Naples, Naples, Italy
| | - Caterina Sagnelli
- Department of Clinical and Experimental Medicine and Surgery "F. Magrassi e A. Lanzara, Second University of Naples, Naples, Italy
| | - Giovanni Mazzola
- Department of Medicinal Clinics and Emerging Diseases, "Paolo Giaccone" Polyclinic University Hospital, Palermo, Italy
| | - Pietro Colletti
- Department of Medicinal Clinics and Emerging Diseases, "Paolo Giaccone" Polyclinic University Hospital, Palermo, Italy
| | - Dario Bartolozzi
- Infectious Disease Unit, Careggi University Hospital, Florence, Italy
| | - Teresa Bini
- Clinical of Infectious Disease, San Paolo Hospital, Milan, Italy
| | - Nicoletta Ladisa
- Institute of Infectious Disease, University of Bari, Bari, Italy
| | | | | | - Sergio Lo Caputo
- Institute of Infectious Disease, University of Bari, Bari, Italy
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Volpe M, Uglietti A, Castagna A, Mussini C, Marchetti G, Bellagamba R, Bini T, Mancusi D, Termini R. Cardiovascular disease in women with HIV-1 infection. Int J Cardiol 2017; 241:50-56. [PMID: 28285796 DOI: 10.1016/j.ijcard.2017.02.117] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2016] [Revised: 01/30/2017] [Accepted: 02/24/2017] [Indexed: 12/14/2022]
Abstract
Cardiovascular disease is a leading cause of death in women, nevertheless it is often underestimated in female patients without overt risk factors. The chronic infection by Human Immunodeficiency Virus (HIV) is clearly associated, along with the use of certain antiretroviral drugs and traditional risk factors, with an increased risk of cardiovascular diseases. The aim of this manuscript is to review the epidemiology, risk factors, pathogenesis, diagnostic approach, primary and secondary prevention strategies of cardiovascular disease in HIV-negative and HIV-positive female subjects. The ultimate goal is to promote knowledge and development of specific and appropriate clinical interventions and guidelines in this group of high-risk patients, mostly in view of the expected growth of ageing females with HIV.
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Affiliation(s)
- Massimo Volpe
- Cardiology Unit, Department of Clinical and Molecular Medicine, Sant'Andrea Hospital, Via di Grottarossa 1035-1039, 00189, University of Rome Sapienza, Italy; IRCCS Neuromed, IS, Italy.
| | | | | | - Cristina Mussini
- Clinic of Infectious Diseases, University of Modena and Reggio Emilia, Modena, Italy
| | - Giulia Marchetti
- Department of Health Sciences, Clinic of Infectious Diseases, University of Milan, ASST Santi Paolo and Carlo, Milan, Italy
| | | | - Teresa Bini
- Department of Health Sciences, Clinic of Infectious Diseases, University of Milan, ASST Santi Paolo and Carlo, Milan, Italy
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Croce D, Lazzarin A, Rizzardini G, Gianotti N, Scolari F, Foglia E, Garagiola E, Ricci E, Bini T, Quirino T, Viganò P, Re T, D’Arminio Monforte A, Bonfanti P. HIV Clinical Pathway: A New Approach to Combine Guidelines and Sustainability of Anti-Retroviral Treatment in Italy. PLoS One 2016; 11:e0168399. [PMID: 28030621 PMCID: PMC5193418 DOI: 10.1371/journal.pone.0168399] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Accepted: 11/29/2016] [Indexed: 11/18/2022] Open
Abstract
The present article describes the case study of a “real world” HIV practice within the debate concerning the strategic role of Clinical Governance (CG) tools in the management of a National Healthcare System’s sustainability. The study aimed at assessing the impact of a Clinical Pathway (CP) implementation, required by the Regional Healthcare Service, in terms of effectiveness (virological and immunological conditions) and efficiency (economic resources absorption), from the budget holder perspective. Data derived from a multi-centre cohort of patients treated in 6 Hospitals that provided care to approximately 42% of the total HIV+ patients, in Lombardy Region, Italy. Two phases were compared: Pre-CP (2009–2010) vs. Post-CP implementation (2011–2012). All HIV infected adults, observed in the participating hospitals during the study periods, were enrolled and stratified into the 3 categories defined by the Regional CP: first-line, switch for toxicity/other, and switch for failure. The study population was composed of 1,284 patients (Pre-CP phase) and 1,135 patients (Post-CP phase). The results showed that the same level of virological and immunological effectiveness was guaranteed to HIV+ patients: 81.2% of Pre-CP phase population and 83.2% of Post-CP phase population had undetectable HIV-RNA (defined as <50 copies/mL) at 12-month follow up. CD4+ cell counts increased by 28 ± 4 cells/mm3 in Pre-CP Phase and 39 ± 5 cells/mm3 in Post-CP Phase. From an economic point of view, the CP implementation led to a substantial advantage: the mean total costs related to the management of the HIV disease (ART, hospital admission and laboratory tests) decreased (-8.60%) in the Post-CP phase (p-value < 0.0001). Results confirmed that the CP provided appropriateness and quality of care, with a cost reduction for the budget holder.
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Affiliation(s)
- Davide Croce
- Centre for Research in Health Economics, Social and Health Care Management, LIUC-Università Cattaneo, Varese, Italy
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Adriano Lazzarin
- Clinic of Infectious Diseases, San Raffaele Scientific Institute, Milan, Italy
| | - Giuliano Rizzardini
- Department of Infectious Diseases, Fatebebefratelli Sacco Hospital, Milan, Italy
- School of Clinical Medicine, Faculty of Health Science, University of the Witwatersrand, Johannesburg, South Africa
| | - Nicola Gianotti
- Clinic of Infectious Diseases, San Raffaele Scientific Institute, Milan, Italy
| | - Francesca Scolari
- Centre for Research in Health Economics, Social and Health Care Management, LIUC-Università Cattaneo, Varese, Italy
| | - Emanuela Foglia
- Centre for Research in Health Economics, Social and Health Care Management, LIUC-Università Cattaneo, Varese, Italy
| | - Elisabetta Garagiola
- Centre for Research in Health Economics, Social and Health Care Management, LIUC-Università Cattaneo, Varese, Italy
- * E-mail:
| | - Elena Ricci
- Department of Infectious Diseases, Fatebebefratelli Sacco Hospital, Milan, Italy
| | - Teresa Bini
- Unit of Infectious Diseases, Santi Paolo e Carlo Hospital, Milan, Italy
| | - Tiziana Quirino
- Department of Infectious Diseases, Valle Olona Hospital, Busto Arsizio, Italy
| | - Paolo Viganò
- Department of Infectious Diseases, Ovest Milanese Hospital, Legnano, Italy
| | - Tiziana Re
- Department of Infectious Diseases, Ovest Milanese Hospital, Legnano, Italy
| | | | - Paolo Bonfanti
- Department of Infectious Diseases, Lecco Hospital, Lecco, Italy
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Leone D, Borghi L, Lamiani G, Barlascini L, Bini T, d’Arminio Monforte A, Vegni E. Illness Representations of HIV Positive Patients Are Associated with Virologic Success. Front Psychol 2016; 7:1991. [PMID: 28066307 PMCID: PMC5179507 DOI: 10.3389/fpsyg.2016.01991] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 12/06/2016] [Indexed: 11/13/2022] Open
Abstract
Introduction: It is important for HIV positive patients to be engaged in their care and be adherent to treatment in order to reduce disease progression and mortality. Studies found that illness representations influence adherence through the mediating role of coping behaviors. However, no study has ever tested if patient engagement to the visits mediate the relationship between illness perceptions and adherence. This study aimed to explore illness representations of HIV positive patients and test the hypothesis that illness representations predict adherence through the mediating role of a component of behavioral engagement. Methods: HIV-positive patients treated with highly active antiretroviral therapy (HAART) for at least one year and presenting to a check-up visit were eligible to participate in the study. Patients completed the Illness Perception Questionnaire-Revised. Behavioral engagement was measured based on the patients' clinical attendance to the check-up visits; adherence to HAART was measured by viral load. Undetectable viral load or HIV-RNA < 40 copies/ml were considered indexes of virologic success. Results: A total of 161 patients participated in the study. Most of them coherently attributed the experienced symptoms to HIV/HAART; perceived their condition as chronic, stable, coherent, judged the therapy as effective, and attributed their disease to the HIV virus and to their behavior or bad luck. The majority of patients (80.1%) regularly attended check-up visits and 88.5% of them reached virologic success. The mediation model did not show good fit indexes. However, a significant direct effect of two independent variables on virologic success was found. Specifically, the perception that the disease does not have serious consequences on patient's life and the prevalence of negative emotions toward HIV were associated with virologic success. On the contrary, the patient's perception that the disease has serious consequences on his/her life and the prevalence of positive emotions were associated with virologic failure. This model showed good fit indexes (CFI = 1; TLI = 1; RMSEA = 0.00; and WRMSR = 0.309). Discussion: Results do not support the mediating role of behavioral engagement in the relationship between illness representations and adherence. As perception of serious consequences coupled with positive emotions are directly associated with virologic failure, clinicians should take them into account to promote treatment adherence.
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Affiliation(s)
- Daniela Leone
- Unit of Clinical Psychology, Department of Health Sciences, University of MilanMilan, Italy
| | - Lidia Borghi
- Unit of Clinical Psychology, Department of Health Sciences, University of MilanMilan, Italy
| | - Giulia Lamiani
- Department of Biomedical Sciences, Humanitas UniversityMilan, Italy
| | - Luca Barlascini
- Unit of Clinical Psychology, ASST Santi Paolo e Carlo, Presidio San Paolo University HospitalMilan, Italy
| | - Teresa Bini
- Clinic of Infectious Diseases, Department of Health Sciences, ASST Santi Paolo e Carlo, Presidio San Paolo University Hospital, University of MilanMilan, Italy
| | - Antonella d’Arminio Monforte
- Clinic of Infectious Diseases, Department of Health Sciences, ASST Santi Paolo e Carlo, Presidio San Paolo University Hospital, University of MilanMilan, Italy
| | - Elena Vegni
- Unit of Clinical Psychology, Department of Health Sciences, University of MilanMilan, Italy
- Unit of Clinical Psychology, ASST Santi Paolo e Carlo, Presidio San Paolo University HospitalMilan, Italy
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Rodger AJ, Cambiano V, Bruun T, Vernazza P, Collins S, van Lunzen J, Corbelli GM, Estrada V, Geretti AM, Beloukas A, Asboe D, Viciana P, Gutiérrez F, Clotet B, Pradier C, Gerstoft J, Weber R, Westling K, Wandeler G, Prins JM, Rieger A, Stoeckle M, Kümmerle T, Bini T, Ammassari A, Gilson R, Krznaric I, Ristola M, Zangerle R, Handberg P, Antela A, Allan S, Phillips AN, Lundgren J. Sexual Activity Without Condoms and Risk of HIV Transmission in Serodifferent Couples When the HIV-Positive Partner Is Using Suppressive Antiretroviral Therapy. JAMA 2016; 316:171-81. [PMID: 27404185 DOI: 10.1001/jama.2016.5148] [Citation(s) in RCA: 915] [Impact Index Per Article: 114.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
IMPORTANCE A key factor in assessing the effectiveness and cost-effectiveness of antiretroviral therapy (ART) as a prevention strategy is the absolute risk of HIV transmission through condomless sex with suppressed HIV-1 RNA viral load for both anal and vaginal sex. OBJECTIVE To evaluate the rate of within-couple HIV transmission (heterosexual and men who have sex with men [MSM]) during periods of sex without condoms and when the HIV-positive partner had HIV-1 RNA load less than 200 copies/mL. DESIGN, SETTING, AND PARTICIPANTS The prospective, observational PARTNER (Partners of People on ART-A New Evaluation of the Risks) study was conducted at 75 clinical sites in 14 European countries and enrolled 1166 HIV serodifferent couples (HIV-positive partner taking suppressive ART) who reported condomless sex (September 2010 to May 2014). Eligibility criteria for inclusion of couple-years of follow-up were condomless sex and HIV-1 RNA load less than 200 copies/mL. Anonymized phylogenetic analysis compared couples' HIV-1 polymerase and envelope sequences if an HIV-negative partner became infected to determine phylogenetically linked transmissions. EXPOSURES Condomless sexual activity with an HIV-positive partner taking virally suppressive ART. MAIN OUTCOMES AND MEASURES Risk of within-couple HIV transmission to the HIV-negative partner. RESULTS Among 1166 enrolled couples, 888 (mean age, 42 years [IQR, 35-48]; 548 heterosexual [61.7%] and 340 MSM [38.3%]) provided 1238 eligible couple-years of follow-up (median follow-up, 1.3 years [IQR, 0.8-2.0]). At baseline, couples reported condomless sex for a median of 2 years (IQR, 0.5-6.3). Condomless sex with other partners was reported by 108 HIV-negative MSM (33%) and 21 heterosexuals (4%). During follow-up, couples reported condomless sex a median of 37 times per year (IQR, 15-71), with MSM couples reporting approximately 22,000 condomless sex acts and heterosexuals approximately 36,000. Although 11 HIV-negative partners became HIV-positive (10 MSM; 1 heterosexual; 8 reported condomless sex with other partners), no phylogenetically linked transmissions occurred over eligible couple-years of follow-up, giving a rate of within-couple HIV transmission of zero, with an upper 95% confidence limit of 0.30/100 couple-years of follow-up. The upper 95% confidence limit for condomless anal sex was 0.71 per 100 couple-years of follow-up. CONCLUSIONS AND RELEVANCE Among serodifferent heterosexual and MSM couples in which the HIV-positive partner was using suppressive ART and who reported condomless sex, during median follow-up of 1.3 years per couple, there were no documented cases of within-couple HIV transmission (upper 95% confidence limit, 0.30/100 couple-years of follow-up). Additional longer-term follow-up is necessary to provide more precise estimates of risk.
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Affiliation(s)
- Alison J Rodger
- Research Department of Infection and Population Health, University College London, London, United Kingdom
| | - Valentina Cambiano
- Research Department of Infection and Population Health, University College London, London, United Kingdom
| | - Tina Bruun
- Department of Infectious Diseases/CHIP, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Pietro Vernazza
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital, St Gallen, Switzerland
| | | | - Jan van Lunzen
- University Medical Center Hamburg-Eppendorf, Hamburg-Eppendorf, Germany
| | | | - Vicente Estrada
- Hospital Clinico San Carlos and Universidad Complutense, Madrid, Spain
| | - Anna Maria Geretti
- Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom
| | - Apostolos Beloukas
- Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom
| | - David Asboe
- Chelsea and Westminster NHS Foundation Trust, London, United Kingdom
| | | | - Félix Gutiérrez
- Hospital General de Elche & Universidad Miguel Hernández, Alicante, Spain
| | - Bonaventura Clotet
- IrsiCaixa Foundation, UAB, UVIC-UCC, Hospital Universitari "Germans Trias i Pujol," Badalona, Catalonia, Spain
| | - Christian Pradier
- Department of Public Health, Nice University Hospital and EA 6312, University Nice Sophia-Antipolis, France
| | | | - Rainer Weber
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Katarina Westling
- Unit of Infectious Diseases and Dermatology, Department of Medicine, Karolinska Institutet, and Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Gilles Wandeler
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Jan M Prins
- Academic Medical Center, Amsterdam, the Netherlands
| | | | - Marcel Stoeckle
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
| | - Tim Kümmerle
- Department of Internal Medicine 1, University Hospital of Cologne, Cologne, Germany
| | | | | | - Richard Gilson
- Research Department of Infection and Population Health, University College London, London, United Kingdom
| | | | - Matti Ristola
- Helsinki University Central Hospital, Helsinki, Finland
| | | | - Pia Handberg
- Hvidovre Universitets Hospital, Hvidovre, Denamrk
| | - Antonio Antela
- Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - Sris Allan
- Coventry and Warwickshire Hospital, Coventry, United Kingdom
| | - Andrew N Phillips
- Research Department of Infection and Population Health, University College London, London, United Kingdom
| | - Jens Lundgren
- Department of Infectious Diseases/CHIP, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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Antinori A, Meraviglia P, Monforte AD, Castagna A, Mussini C, Bini T, Gianotti N, Rusconi S, Colella E, Airoldi G, Mancusi D, Termini R. Effectiveness, durability, and safety of darunavir/ritonavir in HIV-1-infected patients in routine clinical practice in Italy: a postauthorization noninterventional study. Drug Des Devel Ther 2016; 10:1589-603. [PMID: 27226708 PMCID: PMC4866750 DOI: 10.2147/dddt.s104875] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Current antiretroviral (ARV) therapy for the treatment of human immunodeficiency virus (HIV-1)-infected patients provides long-term control of viral load (VL). Darunavir (DRV) is a nonpeptidomimetic protease inhibitor approved for use with a ritonavir booster (DRV/r). This study evaluated the effectiveness of DRV/r in combination with other ARV agents in routine clinical practice in Italy. In this descriptive observational study, data on utilization of DRV/r, under the conditions described in the marketing authorization, were collected from June 2009 to December 2012. Effectiveness (VL <50 copies/mL), tolerability, and durability in four patient groups (two DRV/r-experienced, one ARV-experienced DRV/r-naïve, and one ARV-naïve) were analyzed. Secondary objectives included immunological response, safety, and persistence/discontinuation rates. In total, 875 of 883 enrolled patients were included in the analysis: of these, 662 (75.7%) completed the follow-up until the end of 2012 and 213 (24.3%) withdrew from the study earlier. Initial DRV dose was 600 mg twice daily (67.1%) or 800 mg once daily (32.9%). Only 16 patients (1.8%) withdrew from the study due to virological failure. Virological response proportions were higher in patients virologically suppressed at study entry versus patients with baseline VL ≥50 copies/mL in each ARV-experienced group, while there was no consistent difference across study groups and baseline VL strata according to baseline CD4+ cell count. CD4+ cell count increased from study entry to last study visit in all the four groups. DRV/r was well tolerated, with few discontinuations due to study-emergent nonfatal adverse events (3.0% overall, including 2.1% drug-related) or deaths (3.0% overall, all non-drug-related); 35.3% of patients reported ≥1 adverse events. These observational data show that DRV/r was effective and well tolerated in the whole patient population described here. The DRV/r-containing regimen provided viral suppression in a high percentage of patients in all groups, with low rates of discontinuation due to virological failure.
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Affiliation(s)
- Andrea Antinori
- Clinical Department, National Institute for Infectious Diseases "L. Spallanzani", Rome, Italy
| | - Paola Meraviglia
- Department of Infectious Disease, "L. Sacco" University Hospital, Milan, Italy
| | - Antonella d'Arminio Monforte
- Department of Health Sciences - University of Milan, Milan, Italy; Clinic of Infectious Diseases, "San Paolo" Hospital, Milan, Italy
| | - Antonella Castagna
- Infectious Diseases, San Raffaele Scientific Institute, Milan, Italy; Università Vita-Salute San Raffaele, Milan, Italy
| | - Cristina Mussini
- Institute of Infectious Diseases, University of Modena and Reggio Emilia, Modena, Italy
| | - Teresa Bini
- Clinic of Infectious Diseases, "San Paolo" Hospital, Milan, Italy
| | - Nicola Gianotti
- Infectious Diseases, San Raffaele Scientific Institute, Milan, Italy
| | - Stefano Rusconi
- Infectious Diseases Unit, DIBIC Luigi Sacco, University of Milan, Cicogna, Ghirri, Italy
| | - Elisa Colella
- Infectious Diseases Unit, DIBIC Luigi Sacco, University of Milan, Cicogna, Ghirri, Italy
| | | | - Daniela Mancusi
- Janssen-Cilag SpA, Medical Affairs, Cologno Monzese, Milan, Italy
| | - Roberta Termini
- Janssen-Cilag SpA, Medical Affairs, Cologno Monzese, Milan, Italy
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Gazzola L, Savoldi A, Bai F, Magenta A, Dziubak M, Pietrogrande L, Tagliabue L, Del Sole A, Bini T, Marchetti G, d'Arminio Monforte A. Assessment of radiological vertebral fractures in HIV-infected patients: clinical implications and predictive factors. HIV Med 2015; 16:563-71. [PMID: 25944496 DOI: 10.1111/hiv.12267] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2015] [Indexed: 12/28/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate the clinical impact of including lateral spine X-ray in the screening of bone diseases in HIV-positive patients. METHODS A total of 194 HIV-positive patients underwent dual-energy X-ray absorptiometry (DEXA), lateral spine X-ray and bone biochemical analysis. Vertebral fractures were identified using a morphometric analysis of X-rays and classified using the semiquantitative scoring system of Genant et al. For each patient, a spine deformity index (SDI) score was calculated by summing the grades of vertebral deformities. Reductions in vertebral body height of > 25% were considered vertebral fractures, and those < 25% were considered vertebral deformities. Risk factors associated with vertebral fractures were evaluated by univariate and multivariate analysis. RESULTS Vertebral fractures were detected in 24 patients (12.4%) and vertebral deformities in 17 patients (8.7%); 153 patients (78.9%) did not show any vertebral deformity. Among patients with fractures, only two with SDI > 10 reported lumbar pain; the remaining were asymptomatic. Patients over 50 years old showed a higher prevalence of vertebral fracture [24.4% versus 11.8% in patients 41-50 years old (P = 0.05) and 1.9% in patients ≤ 40 years old (P = 0.04)]. No significant increase in the prevalence according to bone mineral density (BMD) reduction was observed, and 70% of fractures were diagnosed in nonosteoporotic patients. Older age [adjusted odds ratio 1.09; 95% confidence interval (CI) 1.03-1.13; P = 0.001] and steroid use (adjusted odds ratio 3.64; 95% CI 1.29-10.3; P = 0.01) were independently associated with vertebral fracture; no association was found with HIV- or highly active antiretroviral therapy (HAART)-related variables. CONCLUSIONS A prevalence of vertebral fractures of 12.4% was observed in our HIV-positive cohort. Given that two-thirds of fractures occurred in nonosteoporotic patients, spine X-ray may be considered in patients at increased risk, irrespective of BMD; that is, in elderly patients and/or patients using steroids.
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Affiliation(s)
- L Gazzola
- Department of Health Sciences, Clinic of Infectious Diseases, 'San Paolo' Hospital, University of Milan, Milan, Italy
| | - A Savoldi
- Department of Health Sciences, Clinic of Infectious Diseases, 'San Paolo' Hospital, University of Milan, Milan, Italy
| | - F Bai
- Department of Health Sciences, Clinic of Infectious Diseases, 'San Paolo' Hospital, University of Milan, Milan, Italy
| | - A Magenta
- Department of Radiology, 'San Paolo' Hospital, University of Milan, Milan, Italy
| | - M Dziubak
- Orthopedic Clinic, 'San Paolo' Hospital, University of Milan, Milan, Italy
| | - L Pietrogrande
- Orthopedic Clinic, 'San Paolo' Hospital, University of Milan, Milan, Italy
| | - L Tagliabue
- Department of Biomedical Sciences and Technologies and Center of Molecular and Cellular Imaging, 'San Paolo' Hospital, University of Milan, Milan, Italy
| | - A Del Sole
- Department of Biomedical Sciences and Technologies and Center of Molecular and Cellular Imaging, 'San Paolo' Hospital, University of Milan, Milan, Italy
| | - T Bini
- Department of Health Sciences, Clinic of Infectious Diseases, 'San Paolo' Hospital, University of Milan, Milan, Italy
| | - G Marchetti
- Department of Health Sciences, Clinic of Infectious Diseases, 'San Paolo' Hospital, University of Milan, Milan, Italy
| | - A d'Arminio Monforte
- Department of Health Sciences, Clinic of Infectious Diseases, 'San Paolo' Hospital, University of Milan, Milan, Italy
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Gazzola L, Cicconi P, Ripamonti D, Di Filippo E, Gustinetti G, Di Biagio A, Marchetti G, Bini T, d'Arminio Monforte A. Efficacy and safety of darunavir/ritonavir plus etravirine dual regimen in antiretroviral therapy-experienced patients: a multicenter clinical experience. HIV Clin Trials 2014; 15:140-50. [PMID: 25143023 DOI: 10.1310/hct1504-140] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVES To assess the outcome of a dual regimen combining darunavir/ritonavir plus etravirine in a cohort of antiretroviral therapy (ART)-experienced patients. METHODS A retrospective analysis was performed on all ART-experienced patients starting a darunavir/ritonavir plus etravirine regimen at the 3 clinics. Patients were stratified according to HIV RNA detectability (≥ 40 copies/mL) at baseline. Two efficacy endpoints were evaluated by Kaplan-Meier and Cox multivariable models: virological failure (confirmed HIV RNA ≥ 40 copies/mL after 6 months) and therapeutic failure (including virological failure and treatment discontinuation for any reason). RESULTS Sixty-eight patients were included in the study. They had a median of 10.8 years on ART and 5 previous ART regimens; 61.3% showed primary protease inhibitor (PI) mutations and 70% showed previous non-nucleoside reverse transcriptase inhibitor (NNRTI) exposure. HIV RNA was detectable in 34 (50%) patients. The median observation period was 21 (interquartile range [IQR], 11.9-25.1) months. After 24 months, 75.1% of the patients were still on the study regimen and 88.8% remained free from virological failure. Although a higher therapeutic failure rate was reported in patients with detectable viremia at baseline, only the immunological status revealed an independent predictive role. No differences in virological failure were observed according to HIV RNA detectability at baseline; a higher number of previous ART regimens was the only predictor. Discontinuation due to adverse events occurred in 5.9%. CONCLUSIONS Darunavir/ritonavir plus etravirine regimen proved virological efficacy and safety in heavily pretreated patients with a high rate of virological success, even in patients who switched during virological failure.
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Affiliation(s)
- Lidia Gazzola
- Department of Health Sciences, Clinic of Infectious Diseases, "San Paolo" Hospital, University of Milan, Milan, Italy
| | - Paola Cicconi
- Department of Health Sciences, Clinic of Infectious Diseases, "San Paolo" Hospital, University of Milan, Milan, Italy
| | - Diego Ripamonti
- Unit of Infectious Diseases, Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | - Elisa Di Filippo
- Unit of Infectious Diseases, Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | - Giulia Gustinetti
- Clinic of Infectious Diseases, "San Martino" Hospital, University of Genova, Genova, Italy
| | - Antonio Di Biagio
- Clinic of Infectious Diseases, "San Martino" Hospital, University of Genova, Genova, Italy
| | - Giulia Marchetti
- Department of Health Sciences, Clinic of Infectious Diseases, "San Paolo" Hospital, University of Milan, Milan, Italy
| | - Teresa Bini
- Department of Health Sciences, Clinic of Infectious Diseases, "San Paolo" Hospital, University of Milan, Milan, Italy
| | - Antonella d'Arminio Monforte
- Department of Health Sciences, Clinic of Infectious Diseases, "San Paolo" Hospital, University of Milan, Milan, Italy
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Marchetti G, Merlini E, Sinigaglia E, Iannotti N, Bai F, Savoldi A, Tincati C, Carpani G, Bini T, Arminio Monforte A. Immune reconstitution in HIV+ subjects on lopinavir/ritonavir-based HAART according to the severity of pre-therapy CD4+. Curr HIV Res 2013; 10:597-605. [PMID: 22716104 DOI: 10.2174/157016212803306032] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2012] [Revised: 05/13/2012] [Accepted: 06/18/2012] [Indexed: 11/22/2022]
Abstract
BACKGROUND We aimed to assess the impact of TDF/FTC +LPV/r-based HAART on the quality of immune reconstitution and on microbial translocation (MT) in HIV-infected antiretroviral-na�ve late presenting patients. METHODS 40 HIV+ antiretroviral-naive patients starting a first TDF/FTC+LPV/r HAART with CD4+≤350 cell/μL (20 "severe immune depression" patients -SID CD4+≤100/μL; 20 "moderate immune depression" patients -MID, CD4+ 200- 350/μL) were followed for 12 months (T12). CD38+CD8+, CD45R0+CD38+CD8+, CD95+CD4+/CD8+, CD127+CD4+/CD8+, pStat5 signalling (flow cytometry), plasma IL-7, sCD14 (ELISA), LPS (LAL) were tested at T0 and T12. RESULTS By T12, both study groups displayed significant CD4+ increase and HIV-RNA reduction (p < .01). Despite similar CD38+CD8+ reduction in both SID (p=.039) and MID (p=.007), SID displayed a significant rise in CD45R0+CD38+CD8+ (p=.039). MID displayed significant increase of CD95+CD4+ (p=.002), with higher baseline and T12 levels (p=.024; p=.002), suggesting reduced commitment to apoptosis. At T12, different IL-7/IL-7R profile was shown according to pre-therapy immune depression. As compared to SID, MID increased circulating IL-7 (p=.049) displaying higher baseline and T12 CD127+CD4+ (p=.0001; p=.004) and CD127+CD8+ (p=.006; p=.009). By T12, only MID displayed significant reduction in LPS (p=.020) and sCD14 (p=.005). CONCLUSIONS In antiretroviral-naive late presenters, we show different immune reconstitution quality and MT upon 12 months TDF/FTC+LPV/r-containing HAART according to the severity of pre-therapy immune depression. Despite equal T-cell activation decline, only MID patients tend to reduce pro-apoptotic T-lymphocytes, with a gain in circulating IL-7 and higher CD127+ central-memory T-cells, and a possible control over MT.
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Affiliation(s)
- Giulia Marchetti
- Dept of Medicine, Surgery and Dentistry- Clinic of Infectious Diseases - "San Paolo" Hospital - University of Milan, Milan, Italy.
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Ammassari A, Cicconi P, Ladisa N, Di Sora F, Bini T, Trotta MP, D'Ettorre G, Cattelan AM, Vichi F, d'Arminio Monforte A. Induced first abortion rates before and after HIV diagnosis: results of an Italian self-administered questionnaire survey carried out in 585 women living with HIV. HIV Med 2012; 14:31-9. [DOI: 10.1111/j.1468-1293.2012.01032.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2012] [Indexed: 11/29/2022]
Affiliation(s)
- A Ammassari
- Department of Infectious Diseases; INMI; L Spallanzani; Rome; Italy
| | - P Cicconi
- Institute of Infectious and Tropical Diseases; Department of Medicine; Surgery and Dentistry; San Paolo University Hospital; Milan; Italy
| | - N Ladisa
- Institute of Infectious Diseases; University of Bari; Bari; Italy
| | - F Di Sora
- Department of Infectious Diseases; Hospital San Giovanni Addolorata; Rome; Italy
| | - T Bini
- Institute of Infectious and Tropical Diseases; Department of Medicine; Surgery and Dentistry; San Paolo University Hospital; Milan; Italy
| | - MP Trotta
- Department of Infectious Diseases; INMI; L Spallanzani; Rome; Italy
| | - G D'Ettorre
- Institute of Infectious Diseases; Policlinico Umberto I; Rome; Italy
| | - AM Cattelan
- Department of Infectious Diseases; Hospital of Rovigo; Rovigo; Italy
| | - F Vichi
- Department of Infectious Diseases; Hospital SS Annunziata, bagno a Ripoli; Florence; Italy
| | - A d'Arminio Monforte
- Institute of Infectious and Tropical Diseases; Department of Medicine; Surgery and Dentistry; San Paolo University Hospital; Milan; Italy
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Merlini E, Sinigaglia E, Carpani G, Bini T, d'Arminio Monforte A, Marchetti GC. Efficient immune reconstitution in HIV+ naïve patients (pts) starting a first lopinavir/ritonavir-containing regimen with low CD4 counts. J Int AIDS Soc 2010. [PMCID: PMC3112949 DOI: 10.1186/1758-2652-13-s4-p17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Gazzola L, Comi L, Savoldi A, Tagliabue L, Del Sole A, Pietrogrande L, Bini T, d’Arminio Monforte A, Marchetti G. Use of the FRAX Equation as First‐Line Screening of Bone Metabolism Alteration in the HIV‐Infected Population. J Infect Dis 2010; 202:330-1; author reply 331-2. [DOI: 10.1086/653584] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Airoldi M, Zaccarelli M, Bisi L, Bini T, Antinori A, Mussini C, Bai F, Orofino G, Sighinolfi L, Gori A, Suter F, Maggiolo F. One-pill once-a-day HAART: a simplification strategy that improves adherence and quality of life of HIV-infected subjects. Patient Prefer Adherence 2010; 4:115-25. [PMID: 20517472 PMCID: PMC2875721 DOI: 10.2147/ppa.s10330] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2010] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE The aim of the ADONE (ADherence to ONE pill) study was to verify the effect of a reduced number of pills on adherence and quality of life (QoL) in HIV-infected patients on highly active antiretroviral therapy (HAART). DESIGN Prospective, multicenter, study. METHODS Patients chronically treated with emtricitabine (FTC) + tenofovir (TDF) + efavirenz (EFV) or lamivudine (3TC) +TDF +EFV and with a HIV-RNA < 50 copies/mL were switched to the single-pill fixed-dose regimen (FDR) of FTC +TDF +EFV. Data were collected with SF-36 using visual analog scales. Results of the final (6 months) primary as-treated analysis are reported. RESULTS 212 patients (77.4% males) of mean age 45.8 years were enrolled; 202 completed the study. One month post switch to FDR the adherence rate increased significantly to 96.1% from a baseline value of 93.8% (P < 0.01). The increase was steadily maintained throughout the study (96.2% at 6 months). QoL improved over time from 68.8% to 72.7% (P = 0.042) as well, and was significantly associated with the perception of health status, presence of adverse events (AEs) and number of reported AEs (P < 0.0001). QoL significantly influenced adherence (P < 0.0001). During FDR use the mean CD4 count increased from 556 to 605 cells/muL (P < 0.0001). At the end of follow-up 98% of patients maintained HIV-RNA level < 50 copies/mL and 100% <400 copies/mL. Four patients stopped therapy because they were lost to follow-up and 6 because of AEs (insomnia/nervousness 4, allergy 1, difficulties swallowing pills 1). CONCLUSION By substituting a one-pill once-a-day HAART, we observed an improvement of both adherence and QoL while maintaining high virologic and immunologic efficacy. HAART simplicity is an added value that favors adherence and may improve long-term success.
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Affiliation(s)
- Monica Airoldi
- Division of Infectious Diseases, Ospedali Riuniti, Bergamo
- Division of Infectious Diseases, Ospedale San Gerardo, Monza
| | | | - Luca Bisi
- Division of Infectious Diseases, Università, Modena
| | - Teresa Bini
- Division of Infectious Diseases, Ospedale San Paolo, Milano
| | | | | | - Francesca Bai
- Division of Infectious Diseases, Ospedale San Paolo, Milano
| | | | - Laura Sighinolfi
- Division of Infectious Diseases, Ospedale Sant’Anna, Ferrara, Italy
| | - Andrea Gori
- Division of Infectious Diseases, Ospedale San Gerardo, Monza
| | - Fredy Suter
- Division of Infectious Diseases, Ospedali Riuniti, Bergamo
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Carosi G, Nasta P, Fiore S, Matteelli A, Cauda R, Ferrazzi E, Tamburrini E, Savasi V, Bini T, Ravizza M, Bucceri A, Vichi F, Murri R, Mazzotta F, d'Arminio Monforte A. Women facing HIV. Key question on women with HIV infection: Italian consensus workshop. Infection 2009; 37:168-78. [PMID: 19308320 DOI: 10.1007/s15010-008-7361-7] [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] [Received: 09/08/2007] [Accepted: 10/06/2008] [Indexed: 01/13/2023]
Abstract
A panel of leading Italian specialists in infectious diseases, obstetrics and gynaecology met in a national consensus workshop on women facing HIV to review critical aspects and discuss recommendations for selected key questions on four issues: (1) women and highly active antiretroviral therapy (HAART): access to care and adherence to therapy, side effects and drug-drug interaction; (2) HIV-infected pregnant women: prevention of mother to child transmission; (3) desire for children among women living with HIV: assisted reproduction; (4) sexually transmitted diseases and genital disturbances. The method of a nominal group meeting was used, and recommendations were graded for their strength and quality of evidence using a system based on the one adopted by the Infectious Diseases Society of America. Main conclusions are summarized and critically discussed, and some of the most recent data supporting recommendations are provided.
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Affiliation(s)
- G Carosi
- Institute of Infectious and Tropical Diseases, University of Brescia, Italy
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Tincati C, Bauer D, Bellistrì GM, Casana M, Ranieri R, Bini T, Marchetti G, d'Arminio Monforte A. Sudden cardiac death in a young HIV-positive man on effective antiretroviral therapy. Curr HIV Res 2008; 6:560-2. [PMID: 18991622 DOI: 10.2174/157016208786501517] [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: 11/22/2022]
Abstract
We describe the case of a young HIV-positive man on effective HAART with excellent viro-immunological control who presented a massive cardiac infarction. Despite the presence of clinical risk factors for cardiovascular disease, the patient had normal arterial carotid IMT values, known to be strong predictors of atherosclerosis and stroke. Interestingly, parameters of T-cell activation (CD8+CD38+) were shown to increase just before the onset of myocardial infarction. As T-cell activation is known to mediate atherosclerosis, the authors suggest that surrogate immunologic markers should be identified to better assess cardiovascular risk in the setting of HIV infection.
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Affiliation(s)
- Camilla Tincati
- Department of Medicine, Surgery and Dentistry, Clinic of Infectious Diseases and Tropical Medicine, San Paolo Hospital, University of Milan, Italy.
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Casana M, Bini T, Cicconi P, Cuko G, Magenta A, Tagliabue L, Comi L, Pietrogrande L, Monforte AD. Correlates of spinal deforming index (SDI) in HIV-positive patients naive and on treatment. J Int AIDS Soc 2008. [DOI: 10.1186/1758-2652-11-s1-p153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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29
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Maggiolo F, Airoldi M, Trotta MP, Sette P, Bisi L, Mussini C, Bai F, Bini T, Orofino G, Gori A. Effect of a fixed-dose combination of emtricitabine, tenofovir and efavirenz on adherence and treatment acceptability (ADONE study). J Int AIDS Soc 2008. [DOI: 10.1186/1758-2652-11-s1-p167] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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30
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Maggiolo F, Airoldi M, Callegaro A, Martinelli C, Dolara A, Bini T, Gregis G, Quinzan P, Ravasio V, Suter F. O213 CD4-guided STI in patients responding to HAART. J Int AIDS Soc 2008. [DOI: 10.1186/1758-2652-11-s1-o18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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31
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Casana M, Barassi A, Cicconi P, Bini T, Comi L, Turri O, Pateri F, Biondi ML, d'Eril GLM, Monforte AD. Predictors of severe hyperbiliruniaemia in HIV-infected patients treated with atazanavir (ATV). J Int AIDS Soc 2008. [DOI: 10.1186/1758-2652-11-s1-p235] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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32
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Casana M, Bellistrì GM, Tincati C, Bai FB, Comi L, Merlini EM, Cristina MC, Bini T, Monforte AD, Marchetti GM. Abacavir and cardiovascular risk in HIV-infected patients: does T-lymphocyte hyperactivation exert a pathogenic role? J Int AIDS Soc 2008. [DOI: 10.1186/1758-2652-11-s1-p88] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Bongiovanni M, Casana M, Cicconi P, Pisacreta M, Codemo R, Pelucchi M, d'Arminio Monforte A, Bini T. Predictive factors of vascular intima media thickness in HIV-positive subjects. J Antimicrob Chemother 2007; 61:195-9. [PMID: 17999980 DOI: 10.1093/jac/dkm414] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The predictive factors of intima media thickness (IMT) in the HIV-infected population are still poorly understood. PATIENTS AND METHODS We studied three groups of subjects, aged 30-50 years, to find potential predictive factors of carotid and/or femoral thickening (IMT > 1 mm in at least one area): healthy controls (G1, n = 54), HIV-infected naive (G2, n = 53) and highly active antiretroviral treatment (HAART)-treated subjects (G3, n = 133). All the subjects underwent ultrasonography of the carotid and femoral vessels to evaluate IMT. RESULTS Demographic characteristics of the three groups were comparable, except for gender (G1 had a higher percentage of females) and lipid levels (higher in G3). A total of 115 subjects (47.9%) had carotid and/or femoral IMT: 26 in G1 (48.1%), 21 in G2 (39.6%) and 68 in G3 (51.1%). Independent predictive factors of carotid and/or femoral IMT were older age (OR: 2.81, 95% CI: 1.95-4.04, P < 0.01, for each additional 5 years), triglycerides >or=150 mg/dL (OR: 2.66, 95% CI: 1.27-5.57, P < 0.001), serum glucose >or=110 mg/dL (OR: 5.24, 95% CI: 1.02-27.05, P = 0.04), high homocysteinaemia (OR: 2.75, 95% CI: 1.17-6.46, P = 0.02) and high body mass index (OR: 1.10, 95% CI: 1-1.22, P = 0.05 for each additional unit); females had a lower risk (OR: 0.38, 95% CI: 0.18-0.79, P < 0.01 versus males). HAART use was not associated with IMT (OR: 0.64, 95% CI: 0.27-1.53, P = 0.32 and OR: 0.80, 95% CI: 0.30-2.13, P = 0.20 for G3 and G2 versus G1, respectively). CONCLUSIONS This study demonstrates that traditional risk factors for cardiovascular diseases overshadow the role of HAART in determining premature vascular lesions.
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Affiliation(s)
- M Bongiovanni
- Department of Medicine, Surgery and Dentistry, Institute of Infectious Diseases and Tropical Medicine, San Paolo Hospital, University of Milan, Via di Rudinì 8, 20142 Milan, Italy.
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Bongiovanni M, Casana M, Pisacreta M, Tordato F, Cicconi P, Russo U, Ranieri R, Monforte AD, Bini T. Predictive factors of hyperhomocysteinemia in HIV-positive patients. J Acquir Immune Defic Syndr 2007; 44:117-9. [PMID: 17195739 DOI: 10.1097/qai.0b013e31802be3e8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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35
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Bongiovanni M, Bini T, Casana M, Cicconi P, Tordato F, Monforte AD. Long-term immunologic outcome in HAART-experienced subjects receiving lopinavir/ritonavir. AIDS Res Hum Retroviruses 2006; 22:1096-105. [PMID: 17147495 DOI: 10.1089/aid.2006.22.1096] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The long-term immunological efficacy of regimens including lopinavir/ritonavir (LPV/r) has not been assessed in HIV-infected HAART-experienced subjects. The present study included 452 consecutive HIV-infected outpatients starting LPV/r before May 2003 after failing (HIV-RNA > 1000 copies/ml) HAART. Four groups were considered according to CD4 cell counts at LPV/r initiation: group 1 (G1, n = 115) < 100 cells/mm(3); group 2 (G2, n = 113) 100-199 cells/mm(3); group 3 (G3, n = 115) 200-349 cells/mm(3); group 4 (G4, n = 109) >/= 350 cells/mm(3). The majority of patients were males (n = 320, 70.8%), the median age was 38 years, and 180 (39.6%) were on CDC stage C. The median time of previous HAART was 51.1 months (12-81.7) and a median of 7 antiretroviral regimens and of 3 protease inhibitors was changed before LPV/r. The mean CD4 cell count increase was 105, 113, 128, and 144 cells/mm(3) after 12 months (p < 0.01 for each group) and 128, 106, 90, and 100 cells/mm(3) at month 48 (p < 0.01 for each group) in G1, G2, G3, and G4, respectively. The mean increase was comparable among the four groups. The on treatment analysis showed a better immunologic response among G1 and G2 patients from month 36. Forty-seven patients (10.4%), mainly in G1 and G2, maintained LPV/r despite persistent HIV-RNA > 1000 copies/ml. A mean increase of 64 and 65 cells/mm(3) and of 88 and 56 cells/mm(3) at month 12 and 48 was observed in G1 and G2, respectively. The use of LPV/r-based regimens also provided a durable immunologic recovery in highly pretreated HIV-infected subjects.
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Affiliation(s)
- Marco Bongiovanni
- Clinic of Infectious Diseases, San Paolo Hospital, University of Milan, Milan, Italy.
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Murri R, Franceschi S, Ravizza M, Fiore S, Bini T, Mussini C, Fasolo M, Liuzzi G, Ippolito G, D'Arminio Monforte A. Access to gynecological services and Papanicolau tests in HIV-infected Italian women: a questionnaire survey. AIDS Care 2006; 18:376-8. [PMID: 16809116 DOI: 10.1080/09540120500409267] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The objective of the study was to evaluate the access to Papanicolau (Pap) tests of HIV-infected women in Italy. A cross-sectional survey on a cohort of HIV-infected women seen at 27 HIV clinics was performed. At each clinic a female physician involved in the care of HIV-infected women was asked questions on clinic and patients' characteristics and on access to Pap tests. The outcome of the study was to find the percentage of women who had not had a Pap test before coming to the HIV clinic and the percentage having had a Pap test in 2001. In the survey, 7,600 HIV-infected women were represented. Women who came to the clinic without having ever had a Pap test were 62+/-22%, while women who had had a Pap test in 2001 were 43+/-36%. Women who reported never having had a Pap test before coming to the HIV clinic were more often from the south than the north of Italy (17.9+/-49% from the north, 18+/-53% from the center and 9.3+/-83.9% from the south; p<0.001). This a difference disappeared when comparing the women who had had a Pap test in 2001 (28+/-39.6% from the north, 31.6+/-44.2% from the center and 25.6+/-45.7% from the south; p=0.88). Despite the published guidelines in Italy, only 38% of women had ever had a Pap test before coming to the HIV clinic and only 43% had had a Pap test in 2001. Strategies aimed to improve these proportions should be rapidly implemented at all levels of care organization.
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Affiliation(s)
- R Murri
- Depatrment of Infectious Diseases, Catholic University of Rome, Italy.
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37
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Bongiovanni M, Adorni F, Casana M, Tordato F, Tincati C, Cicconi P, Bini T, d'Arminio Monforte A. Subclinical hypothyroidism in HIV-infected subjects. J Antimicrob Chemother 2006; 58:1086-9. [PMID: 16950823 DOI: 10.1093/jac/dkl360] [Citation(s) in RCA: 27] [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: 11/14/2022] Open
Abstract
OBJECTIVES The correlation between subclinical hypothyroidism [thyroid stimulating hormone (TSH)>4 mIU/L with normal free triiodothyroxine and free thyroxine levels], HIV infection and HAART is still unclear. PATIENTS AND METHODS To evaluate the predictive factors of subclinical hypothyroidism in an HIV-infected population, we identified three groups of subjects: G1, subjects on stable highly active antiretroviral therapy (HAART) (for at least 1 year) at baseline and at month 24 (n=97); G2, subjects naive at both baseline and month 24 (n=47); G3, subjects starting HAART at baseline (n=46). RESULTS The three groups were comparable with respect to age, gender, body weight and prevalence of HCV infection. At baseline, subclinical hypothyroidism was detected in 14 subjects in G1 (14.4%), 5 in G2 (10.6%) and 4 in G3 (8.7%) (P=0.18) and these were excluded from the analysis. At month 24, 15 subjects had developed subclinical hypothyroidism: 4 in G1 (4.8%), 3 in G2 (7.1%) and 8 in G3 (19.0%). In the multivariable analysis, the higher increase in total cholesterol was predictive of subclinical hypothyroidism (RR: 1.53 for each additional 10 mg/dL, 95% CI 1.23-1.90; P<0.01); other variables, which were statistically significant in the univariate analysis, such as G3 group, body weight and higher increase in CD4+ cell count and in triglyceride serum levels were not confirmed to be associated with TSH alterations. CONCLUSIONS The occurrence of subclinical hypothyroidism in HIV-positive patients seems to be related to the increase in total cholesterol serum levels occurring after HAART initiation. Thyroid function should be monitored in all HIV-infected subjects, especially in those starting HAART.
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Affiliation(s)
- Marco Bongiovanni
- Clinic of Infectious Diseases, San Paolo Hospital, University of Milan, Milan, Italy.
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Bonfanti P, Ricci E, de Socio G, Zeme D, Carradori S, Penco G, Parruti G, Grosso C, Madeddu G, Vichi F, Bini T, Martinelli C, Melzi S, Quirino T. Metabolic syndrome: a real threat for HIV-positive patients?: Results from the SIMONE study. J Acquir Immune Defic Syndr 2006; 42:128-31. [PMID: 16763502 DOI: 10.1097/01.qai.0000219775.20174.2d] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Bongiovanni M, Fausto A, Cicconi P, Aliprandi A, Cornalba G, Bini T, Sardanelli F, D'Arminio Monforte A. Non-nucleoside-reverse-transcriptase-inhibitor-based HAART and osteoporosis in HIV-infected subjects. J Antimicrob Chemother 2006; 58:485-6. [PMID: 16751202 DOI: 10.1093/jac/dkl229] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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40
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Fausto A, Bongiovanni M, Cicconi P, Menicagli L, Ligabò EV, Melzi S, Bini T, Sardanelli F, Cornalba G, Monforte AD. Potential predictive factors of osteoporosis in HIV-positive subjects. Bone 2006; 38:893-7. [PMID: 16377270 DOI: 10.1016/j.bone.2005.11.001] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.8] [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] [Received: 06/21/2005] [Revised: 08/07/2005] [Accepted: 11/02/2005] [Indexed: 10/25/2022]
Abstract
Recent reports showed a high frequency of osteopenia/osteoporosis in HIV-infected subjects. Mechanism on the basis of this alteration is still unclear, as the direct effect of virus or of antiretroviral drugs. One hundred sixty-one consecutive HIV-infected outpatients aged 30-50 years, both naive and HAART-treated for >1 year, were included. An interview questionnaire was performed to establish prior pathological, toxic, epidemiological histories, medications intake, physical activity and eating habits. Blood and urinary tests were checked to exclude concomitant diseases, as were markers of bone metabolism and vitamin D3-metabolites. Each subject underwent to a lumbar spine and left hipbone mineral density by DEXA, using WHO criteria for diagnosis of osteopenia/osteoporosis. Radiologist was unaware if the subject was receiving HAART or not. For groups' homogeneity Chi-square, Fisher's exact and Student's t tests were used. Logistic regression analysis was used to find predictors of osteopenia/osteoporosis and linear regression model to find differences in bone mass density. The demographic characteristics of the 48 naive subjects and the 113 on HAART were comparable. Eighty subjects (49.7%) showed osteopenia/osteoporosis: 22 (45.8%) naive and 58 (51.3%) on HAART (P = 0.46). Independent predictors of osteopenia/osteoporosis were female gender (OR: 3.02, 95% CI: 1.26-7.25, P = 0.01 vs. male), older age (OR: 1.10, 95% CI: 1.01-1.20, P = 0.03, for each additional year), low body mass index (OR: 0.78, 95% CI: 0.68-0.91, P = 0.001 for each additional unit) and higher HIV-RNA levels at DEXA (OR: 1.97, 95% CI: 1.16-3.34, P = 0.01 for each additional Log(10)), whereas the use of HAART (OR: 2.61, 95% CI: 0.66-10.27, P = 0.17 vs. naive) and the alterations of markers of bone metabolism were not significantly related to osteopenia/osteoporosis. Similar findings were obtained using linear regression model analysis. HIV-infected subjects have a high frequency of osteopenia/osteoporosis. Traditional risk factors are predictive of osteopenia/osteoporosis also in HIV-subjects; the association with higher HIV-RNA levels can suggest a direct role of HIV itself in the occurrence of bone disease.
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Affiliation(s)
- Alfonso Fausto
- Department of Radiology, Policlinico San Donato, University of Milan, Via Morandi, 30, 20097 San Donato Milanese, Milan, Italy.
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Bongiovanni M, Bini T, Cicconi P, Landonio S, Meraviglia P, Testa L, Di Biagio A, Chiesa E, Tordato F, Biasi P, Adorni F, Monforte AD. Predictive factors of hyperlipidemia in HIV-infected subjects receiving lopinavir/ritonavir. AIDS Res Hum Retroviruses 2006; 22:132-8. [PMID: 16478394 DOI: 10.1089/aid.2006.22.132] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [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
We studied 382 multiexperienced HIV-infected patients followed up for > or =3 months after starting lopinavir/ritonavir (LPV/r) to identify the factors predicting hypertriglyceridemia and high non-HDL cholesterol levels (triglycerides > or =200 mg/dl and/or non-HDL cholesterol > or =190 mg/dl) after 6 and 12 months of LPV/r exposure. The predictors of hypertriglyceridemia were higher baseline triglyceride levels [OR: 2.28 (95% CI: 1.67-3.12) for each additional 100 mg/dl; p = 0.001], the total duration of antiretroviral treatment [OR: 1.26 (95% CI: 1.12-1.41) for each additional year; p = 0.01], CDC stage C (OR: 2.06; 95% CI: 1.24-3.88; p = 0.02), and male gender (OR: 2.52; 95% CI: 1.42-4.74; p = 0.02); intravenous drug abusers seem less likely to develop the event (OR: 0.52; 95% CI: 0.37-0.92; p = 0.03). The predictors of high non-HDL cholesterol levels were higher baseline levels [OR: 3.92 (95% CI: 1.92-6.24) for each additional 100 mg/dl; p = 0.001) and the combination of NRTIs and NNRTIs with LPV/r (OR: 1.83; 95% CI: 1.10-3.69; p = 0.03). The 75 patients stopping LPV/r showed a significant reduction in median triglyceride and non-HDL cholesterol levels after 3 months of 39 mg/dl and 20 mg/dl (p = 0.01 for both), respectively. Patients with high triglyceride and non- HDL cholesterol levels at the start of LPV/r treatment are at higher risk of developing hyperlipidemia.
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Affiliation(s)
- Marco Bongiovanni
- Institute of Infectious Diseases and Tropical Medicine, Luigi Sacco Hospital, University of Milan, via G.B. Grassi 74, 20157 Milan, Italy.
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Antinori A, Trotta MP, Nasta P, Bini T, Bonora S, Castagna A, Zaccarelli M, Quirino T, Landonio S, Merli S, Tozzi V, Perri GD, Andreoni M, Perno CF, Carosi G. Antiviral Efficacy and Genotypic Resistance Patterns of Combination Therapy with Stavudine/Tenofovir in Highly Active Antiretroviral Therapy Experienced Patients. Antivir Ther 2006. [DOI: 10.1177/135965350601100210] [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
Objectives To evaluate antiviral efficacy of stavudine/tenofovir (d4T/TDF) backbone combination in late-line antiretroviral therapy, and to assess clinical and virological determinants of treatment success. Design Multicentric retrospective analysis on patients starting d4T/TDF after highly active antiretroviral therapy (HAART) failure. Methods The primary endpoint was the change in plasma HIV-1 RNA from the baseline (time of d4T/TDF initiation) to 6 months of therapy; secondary endpoint was the risk of virological failure. Results Among 172 patients included, a mean change in HIV-1 RNA of -1.69 (+1.23) and -1.53 (+1.43) log10 cp/ml was observed respectively at weeks 24 and 48 after starting d4T/TDF combination. Any single type-1 thymidine analogue mutation (TAM; M41L, L210W, T215Y) had a negative effort on the change in HIV RNA at 6 months, whereas among type-2 TAMs (D67N, K70R, K219Q), only D67N showed a trend for a negative effect. Presence of M184V mutation was related with a greater reduction in HIV RNA during d4T/TDF exposure. The risk of virological failure at 6 months after d4T/TDF starting was 22%. Type-1 TAMs were associated with a greater risk of failure (adjusted hazard ratio [HR]=1.65; 95% confidence interval [CI] 1.19–2.29). Conversely, M184V showed a protective effect. In 17 genotypic tests available at failure, no K65R mutation was detected, whereas a trend for an increasing prevalence of d4T-associated mutations was found. Conclusions Combining TDF with a thymidine analogue as d4T may be effective as component of antiretroviral rescue regimens in HIV-infected patients with previous exposure to nucleoside analogue reverse transcriptase inhibitor. Previous selection of type-1 TAMs induces a detrimental effect over virological response.
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Affiliation(s)
- Andrea Antinori
- National institute for Infectious Diseases ‘L. Spallanzani’ IRCCS, Roma
| | | | - Paola Nasta
- Department of Infectious Diseases, University of Brescia, Brescia
| | - Teresa Bini
- Clinic of Infectious Diseases and Tropical Medicine, ‘S. Paulo’ Hospital, Milano
| | - Stefano Bonora
- Department of Infectious Diseases, University of Torino, Torino
| | | | - Mauro Zaccarelli
- National institute for Infectious Diseases ‘L. Spallanzani’ IRCCS, Roma
| | - Tiziana Quirino
- Department of Infectious Diseases, Hospital of Busto Arsizio
| | - Simona Landonio
- Department of Infectious Diseases, ‘L. Sacco’ Hospital, Milano
| | - Stefania Merli
- Department of Infectious Diseases, ‘L. Sacco’ Hospital, Milano
| | - Valerio Tozzi
- National institute for Infectious Diseases ‘L. Spallanzani’ IRCCS, Roma
| | | | - Massimo Andreoni
- Department of Public Health, University Tor Vergata, Roma, Italy
| | | | - Giampiero Carosi
- Department of Infectious Diseases, University of Brescia, Brescia
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Bongiovanni M, Fausto A, Cicconi P, Menicagli L, Melzi S, Ligabo VE, Cornalba G, Bini T, Sardanelli F, Monforte AD. Osteoporosis in HIV-infected subjects: a combined effect of highly active antiretroviral therapy and HIV itself? J Acquir Immune Defic Syndr 2006; 40:503-4. [PMID: 16280710 DOI: 10.1097/01.qai.0000184861.26733.8c] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Antinori A, Trotta MP, Nasta P, Bini T, Bonora S, Castagna A, Zaccarelli M, Quirino T, Landonio S, Merli S, Tozzi V, Di Perri G, Andreoni M, Perno CF, Carosi G. Antiviral efficacy and genotypic resistance patterns of combination therapy with stavudine/tenofovir in highly active antiretroviral therapy experienced patients. Antivir Ther 2006; 11:233-43. [PMID: 16640104] [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: 05/08/2023]
Abstract
OBJECTIVES To evaluate antiviral efficacy of stavudine/tenofovir (d4T/TDF) backbone combination in late-line antiretroviral therapy, and to assess clinical and virological determinants of treatment success. DESIGN Multicentric retrospective analysis on patients starting d4T/TDF after highly active antiretroviral therapy (HAART) failure. METHODS The primary endpoint was the change in plasma HIV-1 RNA from the baseline (time of d4T/TDF initiation) to 6 months of therapy; secondary endpoint was the risk of virological failure. RESULTS Among 172 patients included, a mean change in HIV-1 RNA of -1.69 (+1.23) and -1.53 (+1.43) log10 cp/ml was observed respectively at weeks 24 and 48 after starting d4T/TDF combination. Any single type-1 thymidine analogue mutation (TAM; M41L, L210W, T215Y) had a negative effort on the change in HIV RNA at 6 months, whereas among type-2 TAMs (D67N, K70R, K219Q), only D67N showed a trend for a negative effect. Presence of M184V mutation was related with a greater reduction in HIV RNA during d4T/TDF exposure. The risk of virological failure at 6 months after d4T/TDF starting was 22%. Type-1 TAMs were associated with a greater risk of failure (adjusted hazard ratio [HR]=1.65; 95% confidence interval [CI] 1.19-2.29). Conversely, M184V showed a protective effect. In 17 genotypic tests available at failure, no K65R mutation was detected, whereas a trend for an increasing prevalence of d4T-associated mutations was found. CONCLUSIONS Combining TDF with a thymidine analogue as d4T may be effective as component of antiretroviral rescue regimens in HIV-infected patients with previous exposure to nucleoside analogue reverse transcriptase inhibitor. Previous selection of type-1 TAMs induces a detrimental effect over virological response.
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Affiliation(s)
- Andrea Antinori
- National Institute for Infectious Diseases L. Spallanzani IRCCS, Roma.
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Bongiovanni M, Bini T, Capetti A, Trovati S, Di Biagio A, Tordato F, Monforte AD. Long-term antiretroviral efficacy and safety of lopinavir/ritonavir in HAART-experienced subjects: 4 year follow-up study. AIDS 2005; 19:1934-6. [PMID: 16227813 DOI: 10.1097/01.aids.0000189569.10471.b4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Bongiovanni M, Cicconi P, Landonio S, Meraviglia P, Testa L, Di Biagio A, Chiesa E, Tordato F, Bini T, Monforte AD. Predictive factors of lopinavir/ritonavir discontinuation for drug-related toxicity: results from a cohort of 416 multi-experienced HIV-infected individuals. Int J Antimicrob Agents 2005; 26:88-91. [PMID: 15878262 DOI: 10.1016/j.ijantimicag.2005.03.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2005] [Accepted: 03/03/2005] [Indexed: 10/25/2022]
Abstract
The objective of this study was to find predictive factors of lopinavir/ritonavir (LPV/r) discontinuation for drug-related toxicities in highly pre-treated human immunodeficiency virus (HIV)-infected subjects. The study was an observational study of HIV patients starting LPV/r with HIV RNA > 3log10 copies/mL and a follow-up > or = 6 months. Parameters studied were HIV RNA, CD4+ cell counts, metabolic parameters and drug-related adverse events. Acquired immune deficiency syndrome (AIDS) events and deaths were recorded. The Kaplan-Meier (KM) model was used to estimate time-dependent probability, and the multivariable Cox model to identify predictors of LPV/r discontinuation for adverse events. The study evaluated 416 HIV-infected patients. Seventy-seven patients (18.5%) discontinued LPV/r for toxicities. Adverse events leading to LPV/r discontinuation were gastrointestinal symptoms in 40 cases, hyperlipidaemia in 27 and increase of aspartate aminotransferase (AST)/alanine aminotransferase (ALT) in 10 patients. Nineteen patients (4.6%) developed an AIDS event during observation and 15 (3.6%) died. The KM probability of LPV/r discontinuation for toxicities was 5.3% (range 3.1-7.5%) at month 12 and 15.7% (range 12.1-19.3%) at month 24. Subjects with hepatitis C virus (HCV)-HIV co-infection (odds ratio (OR) 7.40; 95% confidence interval (CI) 3.73-14.66 versus HCV-negative; P = 0.001) and receiving LPV/r plus nucleoside reverse transcriptase inhibitors (NRTIs) and protease inhibitor (PI)/non-nucleoside reverse transcriptase inhibitor (NNRTI) (OR 1.74; 95% CI 1.04-2.91 versus LPV/r plus only NRTIs; P = 0.04) showed a higher risk of LPV/r discontinuation by a Cox analysis, whereas non-intravenous drug abusers (IVDUs) (OR 0.40; 95% CI 0.24-0.67 versus IVDUs; P = 0.001) had a lower risk. The rate of discontinuation for toxicity decreased by 17% for each additional month of LPV/r exposure (OR 0.83; 95% CI 0.80-0.86 for each additional month; P < 0.001). LPV/r was substantially well tolerated. Diarrhoea was the most frequent adverse event leading to discontinuation. HCV-HIV co-infected patients and patients with a short exposure to LPV/r have a higher risk of discontinuing LPV/r and should be strictly monitored.
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Affiliation(s)
- Marco Bongiovanni
- Institute of Infectious and Tropical Diseases, Ospedale Luigi Sacco, University of Milan, Via G.B. Grassi 74, 20157 Milan, Italy.
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Bonfanti P, Ricci E, Penco G, Orofino G, Bini T, Sfara C, Miccolis S, Cristina G, Quirino T. Low incidence of hepatotoxicity in a cohort of HIV patients treated with lopinavir/ritonavir. AIDS 2005; 19:1433-4. [PMID: 16103779 DOI: 10.1097/01.aids.0000180791.85003.3b] [Citation(s) in RCA: 17] [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: 11/26/2022]
Abstract
We describe the hepatotoxicity encountered in a cohort of HIV-positive patients treated with lopinavir/ritonavir. We used the database from the SCOLTA project, an on-line pharmacovigilance programme involving 25 Italian infectious disease centres. A total of 755 patients were followed, over a mean observation period of 16 months. The incidence of severe events was low despite the high prevalence of patients co-infected with hepatitis virus at enrollment.
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Affiliation(s)
- Paolo Bonfanti
- I Divisione di Malattie Infettive, Ospedale Luigi Sacco, Milan, Italy
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Bongiovanni M, Chiesa E, Di Biagio A, Meraviglia P, Capetti A, Tordato F, Cicconi P, Biasi P, Bini T, d'Arminio Monforte A. Use of lopinavir/ritonavir in HIV-infected patients failing a first-line protease-inhibitor-containing HAART. J Antimicrob Chemother 2005; 55:1003-7. [PMID: 15824089 DOI: 10.1093/jac/dki113] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES The long-term virological efficacy of lopinavir/ritonavir-containing highly active antiretroviral therapy (HAART) in HIV-infected patients failing a first-line protease inhibitor (PI)-based regimen is still unclear. METHODS An observational study was carried out from December 2000-December 2002 on 111 consecutive patients starting lopinavir/ritonavir. The primary end-point was virological success (HIV RNA <50 copies/mL in two consecutive determinations). CD4 outcome, lipid levels and adverse events were recorded. The Kaplan-Meier method and log-rank test were used to estimate the time-dependent probability of reaching the end-point using intention-to-treat and on-treatment approaches. RESULTS Ninety-six patients obtained virological success during follow-up; Kaplan-Meier analysis showed that the time-dependent probability of obtaining this end-point was 78.4% at month 12 and 85.8% at month 24. The median CD4+cell count increased by 118 cells/mm(3) from baseline to month 12 and by 153 cells/mm(3) to month 24. Thirty-one patients discontinued lopinavir/ritonavir: 16 because of drug-related toxicities, six for simplification, five because of virological failure, one patient was lost at follow-up and three died. An elevation in lipid parameters was observed, but only a minority of patients developed a grade 3 or higher hypertriglyceridaemia and/or hypercholesterolaemia. Among the 15 patients not reaching virological success, five had < or =5 mutations in the protease region known to reduce susceptibility to lopinavir/ritonavir (one discontinued lopinavir/ritonavir because of gastrointestinal intolerance), five had no mutations (two discontinued lopinavir/ritonavir because of gastrointestinal intolerance) and five showed > or =6 mutations (all discontinued lopinavir/ritonavir); however, of the patients who discontinued lopinavir/ritonavir none achieved HIV RNA <50 copies/mL on subsequent regimens. CONCLUSIONS Lopinavir/ritonavir was highly effective and well tolerated in HIV-infected patients failing a first-line PI-based HAART.
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Affiliation(s)
- Marco Bongiovanni
- Institute of Infectious and Tropical Diseases, Ospedale Luigi Sacco, University of Milan, Via G.B. Grassi 74, 20157 Milano, Italy.
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Bongiovanni M, Pisacreta M, Ortu M, Tordato F, Codemo R, Gervasoni C, Gornati R, Trovati S, Piolini R, Chiesa E, Porretta T, Bini T. Pseudoaneurysm of the femoral artery in a HIV-infected man. Eur J Vasc Endovasc Surg 2004; 28:451-3. [PMID: 15350573 DOI: 10.1016/j.ejvs.2004.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/21/2004] [Indexed: 11/16/2022]
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Meraviglia P, Schiavini M, Castagna A, Viganò P, Bini T, Landonio S, Danise A, Moioli MC, Angeli E, Bongiovanni M, Hasson H, Duca P, Cargnel A. Lopinavir/ritonavir treatment in HIV antiretroviral-experienced patients: evaluation of risk factors for liver enzyme elevation. HIV Med 2004; 5:334-43. [PMID: 15369508 DOI: 10.1111/j.1468-1293.2004.00232.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVES To evaluate the risk factors for lopinavir/ritonavir (LPV/r)-related liver enzyme elevation (LEE) in HIV antiretroviral-experienced patients. METHODS An open prospective observational study was carried out to analyse the incidence and time of LEE development during LPV/r treatment, and to determine whether LEE development was correlated with epidemiological, clinical and biochemical data, immune and virological profiles, concomitant hepatic diseases, antiretroviral therapy, or histological and ultrasonography liver examination results. A diagnosis of LEE was considered when LEE symptoms occurred after LPV/r introduction and was confirmed by a second control within 2 weeks. RESULTS A total of 782 HIV-positive outpatients have been enrolled in six different Infectious Diseases Departments in Northern Italy since August 2000. Of these patients, 71 (9.1%) developed LEE within 115+/-85 days (mean+/-standard deviation); 13 of these subjects discontinued LPV/r and four were hospitalized. Of the patients with LEE, 74.6% and 25.4% had grade 2 and > or =3 toxicity, respectively. No correlation between LEE and sex, baseline CD4 cell count, viral load, HIV stage, triglyceride values, histological and ultrasonography liver examination results, nevirapine use, or increase in CD4 cell count was observed. Higher baseline alanine aminotransferase (ALT) and gamma-glutamyltransferase (GGT) values (P < 0.0001 and P=0.004, respectively), younger age (P=0.008), previous hepatitis B virus (HBV) infection (P=0.012), efavirenz use (P=0.04), and hepatitis C virus (HCV) and/or HBV coinfection (P < 0.0001, relative risk 4.78) were significantly related to LEE. No correlations between LEE and the same risk factors as investigated in the whole study population were found in subgroups of patients with HCV and/or HBV infection. CONCLUSIONS HCV and HBV testing and measurement of baseline ALT values are essential for screening subjects at risk of LEE before starting LPV/r. Strict monitoring of clinical and biochemical parameters should be performed in these patients.
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Affiliation(s)
- P Meraviglia
- 2nd Department of Infectious Diseases, Sacco Hospital, Via G.B. Grassi 74, 20157 Milan, Italy.
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