1
|
Valenti L, Pelusi S, Aghemo A, Gritti S, Pasulo L, Bianco C, Iegri C, Cologni G, Degasperi E, D'Ambrosio R, Del Poggio P, Soria A, Puoti M, Carderi I, Pigozzi MG, Carriero C, Spinetti A, Zuccaro V, Memoli M, Giorgini A, Viganò M, Rumi MG, Re T, Spinelli O, Colombo MC, Quirino T, Menzaghi B, Lorini G, Pan A, D'Arminio Monforte A, Buscarini E, Autolitano A, Bonfanti P, Terreni N, Aimo G, Mendeni M, Prati D, Lampertico P, Colombo M, Fagiuoli S. Dysmetabolism, Diabetes and Clinical Outcomes in Patients Cured of Chronic Hepatitis C: A Real-Life Cohort Study. Hepatol Commun 2021; 6:867-877. [PMID: 34811949 PMCID: PMC8948549 DOI: 10.1002/hep4.1851] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 09/21/2021] [Accepted: 09/26/2021] [Indexed: 12/14/2022] Open
Abstract
The aim of this study was to examine the impact of features of dysmetabolism on liver disease severity, evolution, and clinical outcomes in a real‐life cohort of patients treated with direct acting antivirals for chronic hepatitis C virus (HCV) infection. To this end, we considered 7,007 patients treated between 2014 and 2018, 65.3% with advanced fibrosis, of whom 97.7% achieved viral eradication (NAVIGATORE‐Lombardia registry). In a subset (n = 748), liver stiffness measurement (LSM) was available at baseline and follow‐up. Higher body mass index (BMI; odds ratio [OR] 1.06 per kg/m2, 1.03‐1.09) and diabetes (OR 2.01 [1.65‐2.46]) were independently associated with advanced fibrosis at baseline, whereas statin use was protective (OR 0.46 [0.35‐0.60]; P < 0.0001 for all). The impact of BMI was greater in those without diabetes (P = 0.003). Diabetes was independently associated with less pronounced LSM improvement after viral eradication (P = 0.001) and in patients with advanced fibrosis was an independent predictor of the most frequent clinical events, namely de novo hepatocellular carcinoma (HCC; hazard ratio [HR] 2.09 [1.20‐3.63]; P = 0.009) and cardiovascular events (HR 2.73 [1.16‐6.43]; P = 0.021). Metformin showed a protective association against HCC (HR 0.32 [0.11‐0.96]; P = 0.043), which was confirmed after adjustment for propensity score (P = 0.038). Diabetes diagnosis further refined HCC prediction in patients with compensated advanced chronic liver disease at high baseline risk (P = 0.024). Conclusion: Metabolic comorbidities were associated with advanced liver fibrosis at baseline, whereas statins were protective. In patients with advanced fibrosis, diabetes increased the risk of de novo HCC and of cardiovascular events. Optimization of metabolic comorbidities treatment by a multi‐disciplinary management approach may improve cardiovascular and possibly liver‐related outcomes.
Collapse
Affiliation(s)
- Luca Valenti
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milano, Italy.,Precision Medicine Lab, Department of Transfusion Medicine and Hematology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milano, Milano, Italy
| | - Serena Pelusi
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milano, Italy.,Precision Medicine Lab, Department of Transfusion Medicine and Hematology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milano, Milano, Italy
| | - Alessio Aghemo
- Department of Internal Medicine and Hepatology, Humanitas University and Research Hospital, Rozzano, Italy
| | - Sara Gritti
- Fondazione Ricerca Ospedale di Bergamo, Papa Giovanni Hospital, Bergamo, Italy
| | - Luisa Pasulo
- Department of Gastroenterology and Hepatology, Papa Giovanni Hospital, Bergamo, Italy
| | - Cristiana Bianco
- Precision Medicine Lab, Department of Transfusion Medicine and Hematology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milano, Milano, Italy
| | - Claudia Iegri
- Department of Gastroenterology and Hepatology, Papa Giovanni Hospital, Bergamo, Italy
| | - Giuliana Cologni
- Department of Internal Medicine, Papa Giovanni Hospital, Bergamo, Italy
| | - Elisabetta Degasperi
- Division of Gastroenterology & Hepatology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milano, Milano, Italy
| | - Roberta D'Ambrosio
- Division of Gastroenterology & Hepatology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milano, Milano, Italy
| | - Paolo Del Poggio
- Department of Gastroenterology and Hepatology, Papa Giovanni Hospital, Bergamo, Zingonia, Italy
| | - Alessandro Soria
- Division of Infectious Diseases, San Gerardo Hospital-ASST Monza, Monza, Italy
| | - Massimo Puoti
- Department of Infectious Diseases, Hepatitis Center, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | | | | | - Canio Carriero
- Department of Infectious Diseases, Spedali Civili Hospital-ASST Brescia, Brescia, Italy
| | - Angiola Spinetti
- Department of Infectious Diseases, Spedali Civili Hospital-ASST Brescia, Brescia, Italy
| | - Valentina Zuccaro
- Department of Infectious Diseases, Fondazione IRCCS Policlinico San Matteo di Pavia, Pavia, Italy
| | - Massimo Memoli
- Liver Center, San Raffaele Scientific Institute IRCCS, Milano, Italy
| | - Alessia Giorgini
- Department of Gastroenterology and Hepatology, San Paolo Hospital, ASST Santi Paolo e Carlo, Milan, Italy
| | - Mauro Viganò
- Department of Gastroenterology and Hepatology, San Giuseppe Hospital, Milan, Italy
| | - Maria Grazia Rumi
- Department of Gastroenterology and Hepatology, San Giuseppe Hospital, Milan, Italy
| | - Tiziana Re
- Department of Gastroenterology and Hepatology, Legnano Hospital-ASST Milano Ovest, Milan, Italy
| | - Ombretta Spinelli
- Department of Gastroenterology and Hepatology, Lariana Como Hospital, Milan, Italy
| | - Maria Chiara Colombo
- Department of Gastroenterology and Hepatology, Lariana Como Hospital, Milan, Italy
| | - Tiziana Quirino
- Department of Gastroenterology and Hepatology, Busto Arsizio Hospital ASST Valle Olona, Milan, Italy
| | - Barbara Menzaghi
- Department of Gastroenterology and Hepatology, Busto Arsizio Hospital ASST Valle Olona, Milan, Italy
| | - Gianpaolo Lorini
- Department of Gastroenterology and Hepatology, ASST Franciacorta, Milan, Italy
| | - Angelo Pan
- Department of Internal Medicine, Ospedale di Cremona, Cremona, Italy
| | | | | | | | - Paolo Bonfanti
- Division of Infectious Diseases, ASST Lecco, Lecco, Italy
| | | | | | | | - Daniele Prati
- Precision Medicine Lab, Department of Transfusion Medicine and Hematology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milano, Milano, Italy
| | - Pietro Lampertico
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milano, Italy.,Division of Gastroenterology & Hepatology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milano, Milano, Italy.,CRC "AM. and A. Migliavacca" Center for Liver Disease, Università degli Studi di Milano, Milano, Italy
| | - Massimo Colombo
- Liver Center, San Raffaele Scientific Institute IRCCS, Milano, Italy
| | - Stefano Fagiuoli
- Department of Gastroenterology and Hepatology, Papa Giovanni Hospital, Bergamo, Italy
| | | |
Collapse
|
2
|
Di Biagio A, Bonfanti P, Madeddu G, De Socio G, Maggi P, Vichi F, Martinelli C, Menzaghi B, Orofino G, Squillace N, Ricci E, Acone B, Quirino T. SLAM Project - Second-Level Diagnostic Assessment: Multidisciplinary approach to HIV Patients. New Microbiol 2019; 42:150-155. [PMID: 31305935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 09/10/2019] [Indexed: 06/10/2023]
Abstract
The aim of the study is to propose a multidimensional second-level diagnostic assessment to allow follow- up in the event physicians observe the presence of risk factors and/or active co-morbidities in HIV-infected patients. To develop our proposal, we chose the Delphi method that has been used for about 30 years in the healthcare field. The CISAI Group (Coordinamento Italiano per lo Studio dell'Allergia in Infezione da HIV) conducted this study. The first phase of the study provided identification of the questionnaire for second-level diagnostic assessment of HIV-infected patients. From March to July 2018 the questionnaire was submitted to 48 experts from 10 Italian HIV-dedicated sites. The questionnaire consisted of 102 items divided into 7 survey areas. The results can be summarized as follows: infectious disease diagnostics, 18 items reached agreement in 9 cases; osteoporosis diagnostics 12 items with 3 agreements; metabolic and cardiovascular diagnostics 13 items with 4 agreements; nephrology diagnostics 19 items with 8 agreements; hepatology diagnostics 12 items with 9 agreements; CNS diagnostics: 18 items with 7 agreements; psychological diagnostics and quality of life assessment (QoL) 10 items with no agreement. If these considerations are confirmed in required discussions and in-depth analyses, they will be able to produce an important indication in the drafting of national guidelines.
Collapse
Affiliation(s)
- Antonio Di Biagio
- Infectious Diseases Unit, Policlinico San Martino-IST, IRCCS per la ricerca sul cancro, Genova, Italy
| | - Paolo Bonfanti
- Infectious Disease Unit, Ospedale A. Manzoni, Lecco, Italy
| | - Giordano Madeddu
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, University of Sassari, Italy
| | | | - Paolo Maggi
- Infectious Disease Unit, Policlinico Giovanni XXIII Hospital, Bari, Italy
| | - Francesca Vichi
- Infectious Diseases Unit, Santa Maria Annunziata Hospital, Florence, Italy
| | | | - Barbara Menzaghi
- Infectious Disease Unit, ASST della Valle Olona, Busto Arsizio, Italy
| | - Giancarlo Orofino
- Unit of Infectious Diseases, "Divisione A," Ospedale Amedeo di Savoia, Turin, Italy
| | - Nicola Squillace
- Infectious Disease Unit, Milano-Bicocca University, San Gerardo Hospital, Monza, Italy
| | - Elena Ricci
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | | |
Collapse
|
3
|
Borderi M, Angarano G, Antinori A, Chirianni A, Cinque P, D'Arminio Monforte A, Di Biagio A, Di Perri G, Galli M, Gori A, Lazzarin A, Mussini C, Perno CF, Quirino T, Rizzardini G, Calza L, Viale P, Acone B, Andreoni M. Managing the long surviving HIV patient: a proposal for a multidimensional first-level diagnostic assessment. New Microbiol 2018; 41:112-117. [PMID: 29806690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Accepted: 05/28/2018] [Indexed: 06/08/2023]
Abstract
We propose a multidimensional first-level diagnostic assessment easy to use in routine clinical practice to allow infectious disease specialists to have a general and complete overview of persons living with HIV. Following the Delphi method, articles published from January 1, 2011 on controlled trials, clinical reports and observational studies dealing specifically with HIV and its co-morbidities were selected for review by the authors. Participants in the poll were selected among clinicians and infectious diseases specialists, working in 38 different dedicated HIV centres in Italy. The participants were given access to a website dedicated to the project and received a standardized information package containing a synopsis of the study and a description of the Delphi process and the selected literature. A total of 131 Items were divided into 10 first-level survey areas: anamnesis, objective examination, infectious diseases, osteoporosis diagnosis, metabolic pathologies diagnosis, cardiovascular diagnosis, nephrologic diagnosis, hepatological diagnosis, central nervous system diagnosis, evaluation of quality of life (QoL). This simple and concise first level tool identifies a few areas of multi-organ diagnostic assessment beyond the infectivity area. The identification of these areas will allow us to find shared and validated evaluation procedures with the intent to increase the likelihood of early recognition of patients at risk of comorbidity development, in order to facilitate more effective prevention, thereby reducing the overall impact on the quality of life of patients affected by this chronic illness.
Collapse
Affiliation(s)
- Marco Borderi
- Infectious Diseases, S. Orsola Malpighi Hospital, University of Bologna, Italy
| | | | - Andrea Antinori
- Clinical Department, National Institute for Infectious Diseases, INMI "L. Spallanzani", Rome, Italy
| | | | - Paola Cinque
- Department of Infectious Diseases, San Raffaele Scientific Institute, Milan, Italy
| | | | - Antonio Di Biagio
- Infectious Disease Clinic, IRCCS University Hospital, San Martino IST, Genova, Italy
| | - Giovanni Di Perri
- Unit of Infectious Diseases, University of Turin, Department of Medical Sciences, "Amedeo di Savoia" Hospital, Turin, Italy
| | - Massimo Galli
- Department of Biomedical and Clinical Science, University of Milan, Italy
| | - Andrea Gori
- Division of Infectious Diseases, Department of Internal Medicine, "San Gerardo" Hospital, University of Milan-Bicocca, Milan, Italy
| | - Adriano Lazzarin
- Department of Infectious Diseases, San Raffaele Scientific Institute, Milan, Italy
| | | | - Carlo Federico Perno
- Sperimental Medicine and Surgery, Department, Of Systems Medicine, Tor Vergata University, Rome, Italy
| | | | - Giuliano Rizzardini
- Department of Infectious Diseases, ASST Fatebenefratelli Sacco, Milan, Italy, and School of Clinical Medicine, Faculty of Health Science, University of the Witwatersrand, Johannesburg, South Africa
| | - Leonardo Calza
- Infectious Diseases, S. Orsola Malpighi Hospital, University of Bologna, Italy
| | - Pierluigi Viale
- Infectious Diseases, S. Orsola Malpighi Hospital, University of Bologna, Italy
| | - Benedetto Acone
- Clinical Infectious Diseases, Department of Systems Medicine, Tor Vergata University, Rome, Italy
| | | |
Collapse
|
4
|
Mingione A, Maruca K, Chiappori F, Pivari F, Brasacchio C, Quirino T, Merelli I, Soldati L, Bonfanti P, Mora S. High parathyroid hormone concentration in tenofovir-treated patients are due to inhibition of calcium-sensing receptor activity. Biomed Pharmacother 2017; 97:969-974. [PMID: 29136775 DOI: 10.1016/j.biopha.2017.11.037] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 10/26/2017] [Accepted: 11/03/2017] [Indexed: 02/03/2023] Open
Abstract
Bone health impairment is a common finding in HIV-infected patients on antiretroviral treatment. High serum parathyroid hormone (PTH) concentration in patients on antiretroviral treatment containing tenofovir disoproxil fumarate (TDF) has been reported. Hyperparathyroidism was not always sustained by a reduction in vitamin D concentration. We thus hypothesized a direct inhibitory effect of TDF on the Calcium-sensing receptor (CaSR), leading to hyperparathyroidism. Human embryonic kidney cells were transfected with CASR wild-type gene or mutated in different sites (N124K, T1051G, C788T, T888M). Cells were grown in standard conditions and the activity of CaSR was assessed after stimulation with CaCl2 with and without TDF (100 nM-1 μM). We evaluated by western blot phospho-p44/42 ERK expression levels as a marker of CaSR activity. In silico structure models were obtained for wild-type and N124K mutant. Molecular docking with TDF was also evaluated. The stimulation by CaCl2 and TDF 100 nM led to a decrease of 55% of CaSR activity (P < 0.001), whereas the stimulation by CaCl2 and TDF 1 μM reduced the activity by 68% (P < 0.001). The decreased CaSR activity was comparable to that observed from known CASR gene inactivating mutations (T1051G, C788T), which inhibit the receptor activity by 56% and 78%, respectively. The TDF inhibits the CaSR activity carrying a gain of function mutation in the intracellular domain (T888M), but it does not influence the activity of the receptor carrying the N124K activating mutation. Our data show that TDF is able to inhibit the activity of CaSR in a dose-dependent manner. Hyperparathyroidism observed in TDF-treated patients may be therefore promoted by the direct effect of the drug on CaSR.
Collapse
Affiliation(s)
- Alessandra Mingione
- Department of Health Sciences, University of Milan, Via A. di Rudinì 8, 20142 Milan, Italy
| | - Katia Maruca
- Laboratory of Pediatric Endocrinology, Division of Genetics and Cell Biology, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy
| | - Federica Chiappori
- Institute of Biomedical Technologies - Italian National Research Council, via F.lli Cervi 93, 20090 Segrate, Italy
| | - Francesca Pivari
- Department of Health Sciences, University of Milan, Via A. di Rudinì 8, 20142 Milan, Italy
| | - Caterina Brasacchio
- Department of Health Sciences, University of Milan, Via A. di Rudinì 8, 20142 Milan, Italy
| | - Tiziana Quirino
- Department of Infectious Diseases, Busto Arsizio Hospital, Piazzale Solaro 3, 21052 Busto Arsizio, Italy
| | - Ivan Merelli
- Institute of Biomedical Technologies - Italian National Research Council, via F.lli Cervi 93, 20090 Segrate, Italy
| | - Laura Soldati
- Department of Health Sciences, University of Milan, Via A. di Rudinì 8, 20142 Milan, Italy
| | - Paolo Bonfanti
- Department of Infectious Diseases, Ospedale "A. Manzoni", Via dell'Eremo 9, 23900 Lecco, Italy
| | - Stefano Mora
- Laboratory of Pediatric Endocrinology, Division of Genetics and Cell Biology, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy.
| |
Collapse
|
5
|
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.
Collapse
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
| |
Collapse
|
6
|
Squillace N, Ricci E, Quirino T, Gori A, Bandera A, Carenzi L, De Socio GV, Orofino G, Martinelli C, Madeddu G, Rusconi S, Maggi P, Celesia BM, Cordier L, Vichi F, Calza L, Falasca K, Di Biagio A, Pellicanò GF, Bonfanti P. Safety and tolerability of Elvitegravir/Cobicistat/Emtricitabine/Tenofovir Disoproxil fumarate in a real life setting: Data from surveillance cohort long-term toxicity antiretrovirals/antivirals (SCOLTA) project. PLoS One 2017. [PMID: 28632758 PMCID: PMC5478131 DOI: 10.1371/journal.pone.0179254] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [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] [Indexed: 12/15/2022] Open
Abstract
Objectives The study aim was to evaluate the impact on Liver and Kidney toxicity of the single tablet regimen Elvitegravir/Cobicistat/Emtricitabine/Tenofovir Disoproxil Fumarate (EVG/COBI/FTC/TDF) on Antiretroviral Therapy (ART) experienced or naïve patients. Methods Patients initiating EVG/COBI/FTC/TDF were enrolled in the SCOLTA project, a multicenter observational study reporting grade 3–4 Adverse Events in subjects beginning new antiretroviral drug regimens. In this analysis, patients were evaluated at T0 (baseline), T1 (six months) and at T2 (twelve months). Results A total of 329 patients were enrolled, and 280 (85.1%) of these had at least one follow-up visit. Median observation time was 11 months (IQR 7.0–15.5). Two hundred and two patients (72.1%) were ART experienced and 78 (27.9%) ART naive. Prevalence of HCV-co-infection was 21.4%. At T1, we observed a significant decline in estimated glomerular filtration rate (eGFR), both in experienced and naive patients (mean change from T0–7.5 ± 12.8 ml/min, -15.5 ± 17.8 ml/min, respectively, p = 0.0005), which was confirmed at T2 (mean change from T0–8.2 ± 15.8 ml/min, -17.6 ± 19.4 ml/min, respectively, p = 0.001). Regarding aspartate aminotransferase (AST) and alanine transaminase (ALT) grade 1–2 modifications, no significant differences were observed between experienced and naïve subjects, but an increased prevalence of abnormal liver function test was observed in patients with chronic HCV infection (p<0.001). Conclusions A significant decline in eGFR was observed in patients initiating EVG/COBI/FTC/TDF in the first 6 months, with no significant worsening occurring at 12 months vs. 6 months of therapy. Patients with chronic HCV infection were at higher risk to develop abnormal liver tests.
Collapse
Affiliation(s)
- Nicola Squillace
- Infectious Diseases Clinic, Azienda Socio Sanitaria Territoriale di MONZA, San Gerardo Hospital-University of Milano-Bicocca, Monza, Italy
- * E-mail:
| | - Elena Ricci
- Department of Infectious Diseases, Azienda Socio Sanitaria Territoriale Fatebenefratelli Sacco, Milano, Italy
| | - Tiziana Quirino
- Unit of Infectious Diseases, Azienda Socio Sanitaria Territoriale della Valle Olona–Busto Arsizio (VA), Italy
| | - Andrea Gori
- Infectious Diseases Clinic, Azienda Socio Sanitaria Territoriale di MONZA, San Gerardo Hospital-University of Milano-Bicocca, Monza, Italy
| | - Alessandra Bandera
- Infectious Diseases Clinic, Azienda Socio Sanitaria Territoriale di MONZA, San Gerardo Hospital-University of Milano-Bicocca, Monza, Italy
| | - Laura Carenzi
- Department of Infectious Diseases, Azienda Socio Sanitaria Territoriale Fatebenefratelli Sacco, Milano, Italy
| | | | - Giancarlo Orofino
- Unit of Infectious Diseases, Amedeo di Savoia Hospital, Torino, Italy
| | | | - Giordano Madeddu
- Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy
| | - Stefano Rusconi
- Infectious Diseases, Department of Biomedical and Clinical Science Luigi Sacco, University of Milan, Milan, Italy
| | - Paolo Maggi
- Infectious Disease Clinic, University of Bari, Italy
| | | | - Laura Cordier
- Department of Infectious Diseases, Azienda Socio Sanitaria Territoriale Fatebenefratelli Sacco, Milano, Italy
| | - Francesca Vichi
- Unit of Infectious Diseases, Santa Maria Annunziata Hospital, Firenze, Italy
| | - Leonardo Calza
- Department of Infectious Diseases, S.Orsola Malpighi Hospital, Bologna, Italy
| | - Katia Falasca
- Clinic of Infectious Diseases, Department of Medicine and Science of Aging, University “G. d’Annunzio” Chieti-Pescara, Chieti, Italy
| | - Antonio Di Biagio
- Infectious Diseases, San Martino Hospital Genoa, University of Genoa, Genoa, Italy
| | | | - Paolo Bonfanti
- Unit of Infectious Diseases, A. Manzoni Hospital, Lecco, Italy
| | | |
Collapse
|
7
|
Cento V, Nguyen THT, Di Carlo D, Biliotti E, Gianserra L, Lenci I, Di Paolo D, Calvaruso V, Teti E, Cerrone M, Romagnoli D, Melis M, Danieli E, Menzaghi B, Polilli E, Siciliano M, Nicolini LA, Di Biagio A, Magni CF, Bolis M, Antonucci FP, Di Maio VC, Alfieri R, Sarmati L, Casalino P, Bernardini S, Micheli V, Rizzardini G, Parruti G, Quirino T, Puoti M, Babudieri S, D’Arminio Monforte A, Andreoni M, Craxì A, Angelico M, Pasquazzi C, Taliani G, Guedj J, Perno CF, Ceccherini-Silberstein F. Improvement of ALT decay kinetics by all-oral HCV treatment: Role of NS5A inhibitors and differences with IFN-based regimens. PLoS One 2017; 12:e0177352. [PMID: 28545127 PMCID: PMC5436665 DOI: 10.1371/journal.pone.0177352] [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] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 04/26/2017] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Intracellular HCV-RNA reduction is a proposed mechanism of action of direct-acting antivirals (DAAs), alternative to hepatocytes elimination by pegylated-interferon plus ribavirin (PR). We modeled ALT and HCV-RNA kinetics in cirrhotic patients treated with currently-used all-DAA combinations to evaluate their mode of action and cytotoxicity compared with telaprevir (TVR)+PR. STUDY DESIGN Mathematical modeling of ALT and HCV-RNA kinetics was performed in 111 HCV-1 cirrhotic patients, 81 treated with all-DAA regimens and 30 with TVR+PR. Kinetic-models and Cox-analysis were used to assess determinants of ALT-decay and normalization. RESULTS HCV-RNA kinetics was biphasic, reflecting a mean effectiveness in blocking viral production >99.8%. The first-phase of viral-decline was faster in patients receiving NS5A-inhibitors compared to TVR+PR or sofosbuvir+simeprevir (p<0.001), reflecting higher efficacy in blocking assembly/secretion. The second-phase, noted δ and attributed to infected-cell loss, was faster in patients receiving TVR+PR or sofosbuvir+simeprevir compared to NS5A-inhibitors (0.27 vs 0.21 d-1, respectively, p = 0.0012). In contrast the rate of ALT-normalization, noted λ, was slower in patients receiving TVR+PR or sofosbuvir+simeprevir compared to NS5A-inhibitors (0.17 vs 0.27 d-1, respectively, p<0.001). There was no significant association between the second-phase of viral-decline and ALT normalization rate and, for a given level of viral reduction, ALT-normalization was more profound in patients receiving DAA, and NS5A in particular, than TVR+PR. CONCLUSIONS Our data support a process of HCV-clearance by all-DAA regimens potentiated by NS5A-inhibitor, and less relying upon hepatocyte death than IFN-containing regimens. This may underline a process of "cell-cure" by DAAs, leading to a fast improvement of liver homeostasis.
Collapse
Affiliation(s)
- Valeria Cento
- Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy
| | - Thi Huyen Tram Nguyen
- INSERM, Université Paris Diderot, IAME, UMR 1137, Sorbonne Paris Cité, Paris, France
| | - Domenico Di Carlo
- Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy
| | - Elisa Biliotti
- Tropical Diseases, Umberto I Hospital – “Sapienza” University, Rome, Italy
| | - Laura Gianserra
- Infectious Diseases, Sant’Andrea Hospital – “Sapienza” University, Rome, Italy
| | - Ilaria Lenci
- Hepatology Unit, Polyclinic of Rome Tor Vergata, Rome, Italy
| | | | | | - Elisabetta Teti
- Infectious Diseases, Polyclinic of Rome Tor Vergata, Rome, Italy
| | - Maddalena Cerrone
- Clinic of Infectious Disease, Department of Health Sciences, San Paolo University Hospital, University of Milan, Milan, Italy
| | - Dante Romagnoli
- Department of Biomedical, Metabolic and Neural Sciences, NOCSAE Baggiovara, Baggiovara, Modena, Italy
| | - Michela Melis
- Infectious Diseases Unit, Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy
| | - Elena Danieli
- Infectious Diseases, AO Ospedale Niguarda Cà Granda, Milan, Italy
| | - Barbara Menzaghi
- Infectious Diseases, Ospedale di circolo di Busto Arsizio, Busto Arsizio, Varese, Italy
| | - Ennio Polilli
- Infectious Disease Unit, “Spirito Santo” General Hospital, Pescara, Italy
| | | | - Laura Ambra Nicolini
- University of Genoa (DISSAL) Infectious Diseases Unit/AOU IRCCS San Martino-IST, Genoa, Italy
| | - Antonio Di Biagio
- University of Genoa (DISSAL) Infectious Diseases Unit/AOU IRCCS San Martino-IST, Genoa, Italy
| | | | - Matteo Bolis
- 1 Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Milan, Italy
| | | | - Velia Chiara Di Maio
- Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy
| | - Roberta Alfieri
- Istituto Nazionale di Genetica Molecolare (INGM) "Romeo ed Enrica Invernizzi", Milan, Italy
| | - Loredana Sarmati
- Infectious Diseases, Polyclinic of Rome Tor Vergata, Rome, Italy
| | - Paolo Casalino
- Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy
| | - Sergio Bernardini
- Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy
| | - Valeria Micheli
- Clinical Microbiology, Virology and Bioemergencies, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Giuliano Rizzardini
- 1 Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Milan, Italy
- School of Clinical Medicine, Faculty of Health Science, University of the Witwatersrand, Johannesburg, South Africa
| | - Giustino Parruti
- Infectious Disease Unit, “Spirito Santo” General Hospital, Pescara, Italy
| | - Tiziana Quirino
- Infectious Diseases, Ospedale di circolo di Busto Arsizio, Busto Arsizio, Varese, Italy
| | - Massimo Puoti
- Infectious Diseases, AO Ospedale Niguarda Cà Granda, Milan, Italy
| | - Sergio Babudieri
- Infectious Diseases Unit, Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy
| | - Antonella D’Arminio Monforte
- Clinic of Infectious Disease, Department of Health Sciences, San Paolo University Hospital, University of Milan, Milan, Italy
| | - Massimo Andreoni
- Infectious Diseases, Polyclinic of Rome Tor Vergata, Rome, Italy
| | - Antonio Craxì
- Gastroenterology, “P. Giaccone” University Hospital, Palermo, Italy
| | - Mario Angelico
- Hepatology Unit, Polyclinic of Rome Tor Vergata, Rome, Italy
| | - Caterina Pasquazzi
- Infectious Diseases, Sant’Andrea Hospital – “Sapienza” University, Rome, Italy
| | - Gloria Taliani
- Tropical Diseases, Umberto I Hospital – “Sapienza” University, Rome, Italy
| | - Jeremie Guedj
- INSERM, Université Paris Diderot, IAME, UMR 1137, Sorbonne Paris Cité, Paris, France
| | - Carlo Federico Perno
- Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy
- * E-mail:
| | | |
Collapse
|
8
|
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.
Collapse
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
| |
Collapse
|
9
|
Garagiola E, Ferrario L, Croce D, Menzaghi B, Quirino T, Rizzardini G, Foglia E. HCV novel therapeutic regimens in Wonderland: A budget impact analysis in the Lombardy Region. Dig Liver Dis 2016; 48:1200-7. [PMID: 27474199 DOI: 10.1016/j.dld.2016.06.028] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Revised: 05/13/2016] [Accepted: 06/24/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND The advent of new HCV drugs has generated widespread economic concerns, particularly within the Italian setting, characterized by continuous linear cuts and spending review actions. The overall trade-off between investments and savings needs an in depth analysis. AIMS The study aimed to estimate the budget impact of the introduction of the novel drugs approved during the year 2015, compared with the historical situation based on the different treatment options available prior to 2015. METHODS A three-year budget impact model was developed, taking into consideration the Lombardy Region (Northern Italy) Health Service perspective. The degree of liver fibrosis, genotypes, presence of only HCV or HIV/HCV co-infections, presence or absence of sustained virological response, and direct healthcare total costs were the variables of the model. RESULTS With the introduction of the novel regimens, a higher number of HCV patients achieved a sustained virological response (+20%). Further analysis showed that an investment in innovative technologies would have given the Regional System significant economic savings within the 36-month period (-6.64%/-7.15%). CONCLUSIONS Treating HCV-infected persons in the Lombardy Region with the new drugs would reduce healthcare expenditure on this specific disease, in each forecast implemented, thus reducing the economic burden of the pathology.
Collapse
Affiliation(s)
- Elisabetta Garagiola
- Centre for Research on Health Economics, Social and Health Care Management, LIUC - Carlo Cattaneo University, Castellanza, Italy
| | - Lucrezia Ferrario
- Centre for Research on Health Economics, Social and Health Care Management, LIUC - Carlo Cattaneo University, Castellanza, Italy.
| | - Davide Croce
- Centre for Research on Health Economics, Social and Health Care Management, LIUC - Carlo Cattaneo University, Castellanza, Italy; School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Barbara Menzaghi
- Infectious Diseases Department, ASST Valle Olona, Busto Arsizio, Italy
| | - Tiziana Quirino
- Infectious Diseases Department, ASST Valle Olona, Busto Arsizio, 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
| | - Emanuela Foglia
- Centre for Research on Health Economics, Social and Health Care Management, LIUC - Carlo Cattaneo University, Castellanza, Italy
| |
Collapse
|
10
|
d’Arminio Monforte A, Cozzi-Lepri A, Maggiolo F, Rizzardini G, Manconi PE, Gianotti N, Quirino T, Pinnetti C, Rusconi S, De Luca A, Antinori A. Response to First-Line Ritonavir-Boosted Protease Inhibitors (PI/r)-Based Regimens in HIV Positive Patients Presenting to Care with Low CD4 Counts: Data from the Icona Foundation Cohort. PLoS One 2016; 11:e0156360. [PMID: 27348592 PMCID: PMC4922579 DOI: 10.1371/journal.pone.0156360] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 05/12/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND There are no data comparing the response to PI/r-based regimens in people presenting for care with low CD4 counts or AIDS (LC). AIM To compare the response to LPV/r-, DRV/r- or ATV/r-based cART regimens in LC initiating cART from ART-naive. METHODS We included people enrolled in Icona with either CD4 counts ≤350 cells/mm3 (low CD4-LC) or CD4 counts ≤200 cells/mm3 (very low CD4-VLC) and/or AIDS, starting their first PI/r-based regimen after 2008. Initial regimens were compared by intention-to-treat: i) time to viral failure (VF) (first of 2 consecutive VL>200 copies/mL after≥6 months); II) time to PI/r discontinuation/switching for any cause (TD) and for toxicity (TDT); III) treatment failure (TF) (VF or TD). Kaplan-Meier and Cox analyses were used. RESULTS 1,362 LC patients were included (DRV/r 607; ATV/r 552; LPV/r 203); 813 VLC. In a median of 18 months (IQR:7-35), the 1-year probability of VF and TF were 2.8% (1.9-3.8) and 21.1% (18.7-23.4). In the adjusted analysis, patients initiating ATV/r had a 53% lower chance, and those initiating DRV/r a 61% lower chance of TD, as compared to LPV/r; the risk of TF was more likely in people starting LPV/r. Results were similar among VLC; in this subgroup LPV/r including regimens demonstrated a lower chance of VF. CONCLUSIONS We confirmed in LC a low chance of virological failure by 1 year, with small differences according to PI/r. However, larger differences were observed when comparing longer-term endpoints such as treatment failure. These results are important for people presenting late for care.
Collapse
Affiliation(s)
- Antonella d’Arminio Monforte
- University of Milan, Department of Health Sciences, Clinic of Infectious and Tropical Diseases, ASST Santi Paolo e Carlo, Milan, Italy
- * E-mail:
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
11
|
Di Biagio A, Cozzi-Lepri A, Prinapori R, Angarano G, Gori A, Quirino T, De Luca A, Costantini A, Mussini C, Rizzardini G, Castagna A, Antinori A, dʼArminio Monforte A. Discontinuation of Initial Antiretroviral Therapy in Clinical Practice: Moving Toward Individualized Therapy. J Acquir Immune Defic Syndr 2016; 71:263-71. [PMID: 26871881 PMCID: PMC4770376 DOI: 10.1097/qai.0000000000000849] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Supplemental Digital Content is Available in the Text. Background: Study aim was to estimate the rate and identify predictors of discontinuation of first combination antiretroviral therapy (cART) in recent years. Methods: Patients who initiated first cART between January 2008 and October 2014 were included. Discontinuation was defined as stop of at least 1 drug of the regimen, regardless of the reason. All causes of discontinuation were evaluated and 3 main endpoints were considered: toxicity, intolerance, and simplification. Predictors of discontinuation were examined separately for all 3 endpoints. Kaplan–Meier analysis was used for the outcome discontinuation of ≥1 drug regardless of the reason. Cox regression analysis was used to identify factors associated with treatment discontinuation because of the 3 reasons considered. Results: A total of 4052 patients were included. Main reason for stopping at least 1 drug were simplification (29%), intolerance (21%), toxicity (19%), other causes (18%), failure (8%), planned discontinuation (4%), and nonadherence (2%). In a multivariable Cox model, predictors of discontinuation for simplification were heterosexual transmission (P = 0.007), being immigrant (P = 0.017), higher nadir lymphocyte T CD4+ cell (P = 0.011), and higher lymphocyte T CD8+ cell count (P = 0.025); for discontinuation due to intolerance: the use of statins (P = 0.029), higher blood glucose levels (P = 0.050). About toxicity: higher blood glucose levels (P = 0.010) and the use of zidovudine/lamivudine as backbone (P = 0.044). Conclusions: In the late cART era, the main reason for stopping the initial regimen is simplification. This scenario reflects the changes in recommendations aimed to enhance adherence and quality of life, and minimize drug toxicity.
Collapse
Affiliation(s)
- Antonio Di Biagio
- *Infectious Diseases Unit, IRCCS AOU S. Martino-IST, National Institute for Cancer Research, Genoa, Italy;†Department of Infection and Population Health, Division of Population Health, UCL Medical School, Royal Free Campus, London, United Kingdom;‡Department of Biomedical Science and Human Oncology, University of Bari, Bari, Italy;§Clinic of Infectious Diseases, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy;‖Infectious Diseases Unit, Busto Arsizio Hospital, Busto Arsizio (VA), Italy;¶Infectious Diseases Unit, Siena University Hospital, Siena, Italy;#Department of Health Sciences, University of Ancona, Ancona, Italy;**Infectious Diseases Clinic, Policlinico of Modena, University of Modena and Reggio Emilia, Modena, Italy;††Infectious Diseases Unit, Sacco Hospital, Milan, Italy;‡‡Infectious Diseases Unit, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy;§§National Institute for Infectious Diseases IRCCS L. Spallanzani, Rome, Italy; and‖‖Clinic of Infectious and Tropical Diseases, Department of Health Sciences, S Paolo Hospital, University of Milan, Milan, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
12
|
Taramasso L, Madeddu G, Ricci E, De Socio GV, Menzaghi B, Orofino G, Passerini S, Franzetti M, Maggi P, Dentone C, Martinelli C, Celesia BM, Penco G, Libertone R, Quirino T, Bonfanti P, Di Biagio A. Raltegravir-based therapy in a cohort of HIV/HCV co-infected individuals. Biomed Pharmacother 2014; 69:233-6. [PMID: 25661363 DOI: 10.1016/j.biopha.2014.12.006] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Accepted: 12/01/2014] [Indexed: 12/18/2022] Open
Abstract
The relationship between hepatic tolerance and hepatitis C virus (HCV) co-infection has not been extensively studied in clinical practice. We assessed the efficacy and safety of raltegravir-based therapy in an Italian cohort of HIV/HCV co-infected patients. One hundred and forty patients with HIV/HCV co-infection initiating raltegravir from SCOLTA project (Surveillance Cohort Long-Term Toxicity Antiretrovirals) were examined. Of them, 43 were women, with mean age of 45.4±6.4years; 65 (46%) had undetectable HIV-RNA<50copies/mL and 75 (54%) HIV-RNA≥50copies/mL. According to CDC classification, 49 (35%) were in stage C. Based on Fib4 score at the time of starting raltegravir, patients were classified in class I in 41 cases, class II in 68 and in class III in 31 cases. Globally, the Fib4 score slightly decreased during 24months follow-up, from 2.2 to a value of 1.8. Hepatic adverse events of any grade were observed in 67 patients, of which only 2 cases (3%) had severe liver toxicity (grade 3-4). Only one patient had to discontinue the therapy because of adverse events. According to univariate analysis, being in CDC stage C represented a risk for the development of liver toxicity, with a hazard ratio (HR) of 2.27 (95% CI 1.06-4.84, P=0.033). None of the other variables considered (age, sex, years since detection of HIV and HCV-RNA detectable, years of previous HIV therapy, concomitant therapy with PI or NRTI, CD4+ cell count, Fib4, and transaminases level at baseline) resulted statistically correlated to the outcome. In conclusion, raltegravir-based regimens can be safely used in HCV infected patients; in this study, the hepatic toxicity has been found to be more frequent in patients with an advanced HIV disease (CDC stage C), independently of HIV-RNA suppression at raltegravir initiation.
Collapse
Affiliation(s)
- L Taramasso
- University of Genova (DISSAL), Infectious Diseases Clinic, IRCCS AOU San Martino-IST, Genova, Italy.
| | - G Madeddu
- Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy
| | - E Ricci
- Epi2004, Luigi Sacco Hospital, Milano, Italy
| | - G V De Socio
- Unit of Infectious Diseases, Santa Maria Hospital, Perugia, Italy
| | - B Menzaghi
- Unit of Infectious Diseases, Busto Arsizio Hospital, Busto Arsizio, Italy
| | - G Orofino
- Department of Infectious Diseases, Amedeo Di Savoia Hospital, Torino, Italy
| | - S Passerini
- Department of Infectious Diseases, L. Sacco Hospital, University of Milano, Milano, Italy
| | - M Franzetti
- Department of Infectious Diseases, L. Sacco Hospital, University of Milano, Milano, Italy
| | - P Maggi
- Infectious Diseases Clinic, University Hospital Policlinico, Bari, Italy
| | - C Dentone
- Department of Infectious Diseases, Sanremo Hospital, Sanremo, Italy
| | - C Martinelli
- Unit of Infectious Diseases, Careggi Hospital, Firenze, Italy
| | - B M Celesia
- Department of Clinical and Molecular Biomedicine, Division of Infectious Diseases, University of Catania, Catania, Italy
| | - G Penco
- Department of Infectious Diseases, Galliera Hospital, Genova, Italy
| | - R Libertone
- National Institute of Infectious Diseases "L. Spallanzani", Roma, Italy
| | - T Quirino
- Unit of Infectious Diseases, Busto Arsizio Hospital, Busto Arsizio, Italy
| | - P Bonfanti
- Infectious Diseases Unit, A. Manzoni Hospital, Lecco, Italy
| | - A Di Biagio
- Infectious Disease Clinic, IRCCS AOU San Martino-IST, Genova, Italy.
| | | |
Collapse
|
13
|
Madeddu G, De Socio GVL, Ricci E, Quirino T, Orofino G, Carenzi L, Franzetti M, Parruti G, Martinelli C, Vichi F, Penco G, Dentone C, Celesia BM, Maggi P, Libertone R, Bagella P, Di Biagio A, Bonfanti P. Muscle symptoms and creatine phosphokinase elevations in patients receiving raltegravir in clinical practice: Results from the SCOLTA project long-term surveillance. Int J Antimicrob Agents 2014; 45:289-94. [PMID: 25476452 DOI: 10.1016/j.ijantimicag.2014.10.013] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Revised: 09/02/2014] [Accepted: 10/05/2014] [Indexed: 01/11/2023]
Abstract
Muscle alterations ranging from asymptomatic creatine phosphokinase (CPK) increases to rhabdomyolysis and central nervous system (CNS) symptoms have been reported in patients receiving raltegravir. Muscle symptoms and CPK increases were investigated in a cohort of HIV-infected patients receiving raltegravir-based antiretroviral therapy, and possible associated predictors were evaluated. The SCOLTA Project is a prospective, observational, multicentre study created to assess the incidence of adverse events in patients receiving new antiretroviral drugs in clinical practice. In total, 496 HIV-infected patients were enrolled [333 (67.1%) male]. CDC stage was C in 196 patients (39.5%). Mean age at enrolment was 45.9 ± 9.3 years. Median follow-up was 21 months. Twenty-six patients (5.2%) reported muscle symptoms (16 muscle pain and 17 weakness; 7 had both). Of 342 patients with normal baseline CPK values, 72 (21.1%) had a CPK increase. Seven patients (1.4%) discontinued raltegravir because of muscular events (three for muscle pain/weakness and four CPK increases). No cases of rhabdomyolysis were observed. Patients with muscle symptoms were more frequently receiving in their regimen than those not receiving atazanavir (P=0.04) and were more likely to also report CNS symptoms (P<0.0001). Significant predictors of muscle symptoms were CNS symptoms and use of atazanavir. Female sex was associated with a reduced risk of CPK increase. In conclusion, muscle symptoms and CPK elevations occurred frequently and caused most discontinuations due to adverse events. Their monitoring in patients receiving raltegravir should be considered, especially when co-administered with atazanavir or when CNS symptoms are also present.
Collapse
Affiliation(s)
- Giordano Madeddu
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, University of Sassari, Viale San Pietro 8, 07100 Sassari, Italy.
| | | | | | - Tiziana Quirino
- Unit of Infectious Diseases, Busto Arsizio Hospital, Busto Arsizio, Italy
| | - Giancarlo Orofino
- Department of Infectious Diseases, Amedeo di Savoia Hospital, Turin, Italy
| | - Laura Carenzi
- Department of Infectious Diseases, L. Sacco Hospital, Milan, Italy
| | - Marco Franzetti
- Department of Infectious Diseases, L. Sacco Hospital, Milan, Italy
| | - Giustino Parruti
- Department of Infectious Diseases, Pescara Hospital, Pescara, Italy
| | | | - Francesca Vichi
- Unit of Infectious Diseases, Santa Maria Annunziata Hospital, Firenze, Italy
| | - Giovanni Penco
- Unit of Infectious Diseases, Galliera Hospital, Genoa, Italy
| | - Chiara Dentone
- Unit of Infectious Diseases, San Remo Hospital, San Remo, Italy
| | | | - Paolo Maggi
- Infectious Disease Clinic, University of Bari, Bari, Italy
| | | | - Paola Bagella
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, University of Sassari, Viale San Pietro 8, 07100 Sassari, Italy
| | - Antonio Di Biagio
- Infectious Diseases, IRCCS San Martino Hospital, University of Genoa, Genoa, Italy
| | - Paolo Bonfanti
- Unit of Infectious Diseases, A. Manzoni Hospital, Lecco, Italy
| |
Collapse
|
14
|
Gianotti N, Poli A, Galli M, Pan A, Rizzardini G, Soria A, Viale P, Di Biagio A, Quirino T, Viganò P, Bonfanti P, d'Arminio Monforte A, Fortino I, Lazzarin A. Monotherapy with lopinavir/ritonavir versus standard of care in HIV-infected patients virologically suppressed while on treatment with protease inhibitor-based regimens: results from the MoLo study. New Microbiol 2014; 37:439-448. [PMID: 25387282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/12/2014] [Accepted: 07/26/2014] [Indexed: 06/04/2023]
Abstract
This study compared the cost-efficacy ratios of lopinavir/ritonavir monotherapy (LPV/r-MT) and of standard of care in virologically suppressed HIV-infected patients. The results of the efficacy and safety analyses are presented. We conducted a multicentre, randomised, open-label trial of HIV-infected adults on stable treatment, with HIV- RNA <50 copies/mL, randomised to continue the ongoing regimen (cART-arm) or to switch to LPV/r (400/100 mg BID) MT (MT-arm). Time to virological rebound (VR = confirmed HIV-RNA ?50 copies/mL) was estimated by Ka- plan-Meier method and changes in laboratory values during follow-up were evaluated by univariate mixed-linear models. Ninety-four patients were randomised and analysed (43 in the MT-arm and 51 in the cART-arm). Five (four in the MT and 1 in the cART-arm; p=0.175) had VR, but time to VR did not statistically differ between the two arms (p=0.143). Major PI mutations were not detected at VR. Patients on MT had significant increases in total choles- terol [difference in mean change between MT and cART arm: 0.77 (±0.30) mg/dL per month; p=0.012] and eGFR [difference in mean change between MT and cART arm: 0.24 (±0.11) mL/min/1.73 m2 per month; p=0.029]. LPV/r-MT seems safe in most patients and should be considered in patients who have developed kidney toxicity from tenofovir.
Collapse
Affiliation(s)
- Nicola Gianotti
- Infectious Diseases Department, San Raffaele Scientific Institute, Milan, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
15
|
De Socio GV, Ricci E, Maggi P, Parruti G, Pucci G, Di Biagio A, Calza L, Orofino G, Carenzi L, Cecchini E, Madeddu G, Quirino T, Schillaci G. Prevalence, awareness, treatment, and control rate of hypertension in HIV-infected patients: the HIV-HY study. Am J Hypertens 2014; 27:222-8. [PMID: 24077828 DOI: 10.1093/ajh/hpt182] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND We aimed to assess the prevalence of hypertension in an unselected human immunodeficiency virus (HIV)-infected population and to identify factors associated with hypertension prevalence, treatment, and control. METHODS We used a multicenter, cross-sectional, nationwide study that sampled 1,182 unselected, consecutive, HIV-infected patients. Office blood pressure was accurately measured with standard procedures. RESULTS Patients were 71% men and 92% white, with a median age of 47 years (range = 18-78); 6% were antiretroviral treatment naive. The overall prevalence of hypertension was 29.3%; high-normal pressure accounted for an additional 12.3%. Among hypertensive subjects, 64.9% were aware of their hypertensive condition, 52.9% were treated, and 33.0% were controlled (blood pressure < 140/90 mm Hg). Blood pressure-lowering medications were used in monotherapy in 54.3% of the subjects. Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers were the most frequently used drugs (76.1%: monotherapy = 39.1%, combination treatment = 37.0%). In multivariable regression models, hypertension was independently predicted by traditional risk factors, including age ≥50 years, male sex, family history of cardiovascular disease, body mass index ≥25 kg/m2, previous cardiovascular events, diabetes, central obesity, and metabolic syndrome, as well as by duration of HIV infection, duration of antiretroviral therapy, and nadir CD4+ T-cell count <200/μl. The choice of protease inhibitors vs. nonnucleoside reverse transcriptase inhibitors as a third antiretroviral drug was irrelevant. CONCLUSIONS Hypertension affects nearly 30% of HIV adult outpatients in Italy. More than one-third of the hypertensive subjects are unaware of their condition, and more than two-thirds are uncontrolled. A higher level of attention to the diagnosis and treatment of hypertension is mandatory in this setting.
Collapse
|
16
|
Di Biagio A, Ricci E, Viscoli C, Mesini A, Menzaghi B, Carenzi L, Orofino G, Parruti G, Martinelli C, Madeddu G, De Socio GV, Franzetti M, Quirino T, Bonfanti P. The use of nucleoside reverse transcriptase inhibitors sparing regimens in treatment-experienced HIV-1 infected patients. Curr HIV Res 2014; 11:179-86. [PMID: 23432466 DOI: 10.2174/1570162x113119990036] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2012] [Revised: 01/18/2013] [Accepted: 02/19/2013] [Indexed: 11/22/2022]
Abstract
Despite the relative lack of data, nucleoside/nucleotide reverse transcriptase inhibitor (NRTI)-sparing regimens are increasingly prescribed in clinical practice in treatment-experienced HIV-1 infected patients. We aimed to assess the frequency of NRTI-sparing regimens among these subjects, and to evaluate and compare their safety and tolerability. Patients were included if enrolled in the currently ongoing cohorts (raltegravir and darunavir) of the Surveillance Cohort Long-Term Toxicity Antiretrovirals (SCOLTA) Project. The duration of treatment with antiretroviral therapy was evaluated using the Kaplan-Meier curve and NRTI-sparing and NRTI-based regimens were compared using the log-rank test. From 2006 to 2011, 689 experienced patients were analyzed, of whom 210 (30.5%) were on NRTI-sparing regimens. Patients on NRTI-sparing regimens were older (p=0.004) and had higher median CD4+ cell counts (p=0.002) than patients on NRTI-based regimens. The most frequent combination regimens were raltegravir plus darunavir/ritonavir (n=65; 30.95%) among patients on NRTI-sparing regimen and tenofovir DF/emtricitabine plus darunavir/ritonavir in the NRTI-containing group (n=102; 21.3%). There was no difference between groups in terms of total withdrawal, treatment discontinuation was more likely due to therapeutic failure in NRTI-sparing regimen. NRTI-sparing regimens should be evaluated in a prospective randomized trial.
Collapse
Affiliation(s)
- Antonio Di Biagio
- Infectious Diseases, San Martino Hospital, University of Genoa, Genoa, Italy.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
17
|
Svicher V, Alteri C, Montano M, Nori A, D'Arrigo R, Andreoni M, Angarano G, Antinori A, Antonelli G, Allice T, Bagnarelli P, Baldanti F, Bertoli A, Borderi M, Boeri E, Bon I, Bruzzone B, Barresi R, Calderisi S, Callegaro AP, Capobianchi MR, Gargiulo F, Castelli F, Cauda R, Ceccherini-Silberstein F, Clementi M, Chirianni A, Colafigli M, D'Arminio Monforte A, De Luca A, Di Biagio A, Di Nicuolo G, Di Perri G, Di Santo F, Fadda G, Galli M, Gennari W, Ghisetti V, Costantini A, Gori A, Gulminetti R, Leoncini F, Maffongelli G, Maggiolo F, Maserati R, Mazzotta F, Meini G, Micheli V, Monno L, Mussini C, Nozza S, Paolucci S, Palù G, Parisi S, Parruti G, Pignataro AR, Quirino T, Re MC, Rizzardini G, Sanguinetti M, Santangelo R, Scaggiante R, Sterrantino G, Turriziani O, Vatteroni ML, Viscoli C, Vullo V, Zazzi M, Lazzarin A, Perno CF. Genotypic testing on HIV-1 DNA as a tool to assess HIV-1 co-receptor usage in clinical practice: results from the DIVA study group. Infection 2013; 42:61-71. [PMID: 24146352 PMCID: PMC3906530 DOI: 10.1007/s15010-013-0510-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2013] [Accepted: 07/16/2013] [Indexed: 11/29/2022]
Abstract
PURPOSE We have developed a sequencing assay for determining the usage of the genotypic HIV-1 co-receptor using peripheral blood mononuclear cell (PBMC) DNA in virologically suppressed HIV-1 infected patients. Our specific aims were to (1) evaluate the efficiency of V3 sequences in B versus non-B subtypes, (2) compare the efficiency of V3 sequences and tropism prediction using whole blood and PBMCs for DNA extraction, (3) compare the efficiency of V3 sequences and tropism prediction using a single versus a triplicate round of amplification. RESULTS The overall rate of successful V3 sequences ranged from 100 % in samples with >3,000 copies HIV-1 DNA/10(6) PBMCs to 60 % in samples with <100 copies total HIV-1 DNA /10(6) PBMCs. Analysis of 143 paired PBMCs and whole-blood samples showed successful V3 sequences rates of 77.6 % for PBMCs and 83.9 % for whole blood. These rates are in agreement with the tropism prediction obtained using the geno2pheno co-receptor algorithm, namely, 92.1 % with a false-positive rate (FPR) of 10 or 20 % and of 96.5 % with an FPR of 5.75 %. The agreement between tropism prediction values using single versus triplicate amplification was 98.2 % (56/57) of patients using an FPR of 20 % and 92.9 % (53/57) using an FPR of 10 or 5.75 %. For 63.0 % (36/57) of patients, the FPR obtained via the single amplification procedure was superimposable to all three FPRs obtained by triplicate amplification. CONCLUSIONS Our results show the feasibility and consistency of genotypic testing on HIV-1 DNA tropism, supporting its possible use for selecting patients with suppressed plasma HIV-1 RNA as candidates for CCR5-antagonist treatment. The high agreement between tropism prediction by single and triple amplification does not support the use of triplicate amplification in clinical practice.
Collapse
Affiliation(s)
- V Svicher
- Department of Experimental Medicine, University of Rome "Tor Vergata", Via Montpellier 1, 00133, Rome, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
18
|
Menzaghi B, Ricci E, Carenzi L, Parruti G, Orofino G, Guastavigna M, Madeddu G, Maggi P, Di Biagio A, Corsi P, Penco G, De Socio G, Martinelli C, Vichi F, Celesia BM, Franzetti M, Grosso C, Molteni C, Bonfanti P, Quirino T. Safety and durability in a cohort of HIV-1 positive patients treated with once and twice daily darunavir-based therapy (SCOLTA Project). Biomed Pharmacother 2013; 67:293-8. [DOI: 10.1016/j.biopha.2012.12.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2012] [Accepted: 12/07/2012] [Indexed: 01/31/2023] Open
|
19
|
Bonfanti P, Ricci E, Molteni C, De Socio GV, Rusconi S, Vichi F, Penco G, Antinori A, Cordier L, Maggi P, Celesia BM, Grosso C, Quirino T. Low frequency of skin reactions in a cohort of patients on raltegravir. J Antimicrob Chemother 2012; 67:1800-2. [DOI: 10.1093/jac/dks096] [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: 11/14/2022] Open
|
20
|
Bonfanti P, De Socio GV, Ricci E, Antinori A, Martinelli C, Vichi F, Penco G, Madeddu G, Orofino G, Valsecchi L, Rusconi S, Menzaghi B, Pocaterra D, Quirino T. The feature of Metabolic Syndrome in HIV naive patients is not the same of those treated: results from a prospective study. Biomed Pharmacother 2012; 66:348-53. [PMID: 22705335 DOI: 10.1016/j.biopha.2012.01.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2012] [Accepted: 01/25/2012] [Indexed: 01/04/2023] Open
Abstract
Metabolic Syndrome (MS) is a common disorder combining obesity, dyslipidemia, hypertension, and insulin resistance. Its prevalence among HIV-infected people is still debated. Besides, how antiretroviral therapy and HIV infection per se are related to MS is still unclear. All treatment-naïve patients attending scheduled visits at CISAI group hospitals between January and December 2007 were eligible for the study. Patients without MS at enrolment were followed-up for 3 years or until they developed MS, diagnosed according to the National Cholesterol Education Program (NCEP) definition. The main objective was to assess the 3-years incidence of MS. MS was evaluated for 188 subjects. Out of them, 62 (33.0%) had started HAART at enrolment, whereas 67 (35.6%) more started during the observation. 59 (31.4%) were still treatment-naive at the study end. MS was newly diagnosed in 14 patients. The incidence was 2.60 cases/100 person-years (95% CI 1.47-4.51), 2.75 (1.11-5.72) among HAART-naïve patients and 2.65 (1.23-5.03) in subjects on HAART. Blood pressure did not change in the study period, whereas in naive patients the HDL level significantly lowered (median -6.0 vs. 4.0, P<0.0001) compared to HAART-treated patients. Triglicerides increased significantly in HAART subjects (median 12.0 vs. 1.0, P=0.02), as well as blood glucose (median 6.0 vs. 1.0, P=0.01). In our population, the overall MS incidence was low and largely similar in patients who started HAART or remained naive. However, the feature of MS was different in the two groups, suggesting that in untreated and treated patients MS developed through different metabolic pathways.
Collapse
Affiliation(s)
- Paolo Bonfanti
- Department of Infectious Diseases, A. Manzoni Hospital, Via dell'Eremo 9, Lecco, Italy.
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
21
|
Svicher V, Alteri C, Montano M, D'Arrigo R, Andreoni M, Angarano G, Antinori A, Antonelli G, Allice T, Bagnarelli P, Baldanti F, Bertoli A, Borderi M, Boeri E, Bon I, Bruzzone B, Callegaro AP, Capobianchi MR, Carosi G, Cauda R, Ceccherini-Silberstein F, Clementi M, Chirianni A, Colafigli M, D'Arminio Monforte A, De Luca A, Di Biagio A, Di Nicuolo G, Di Perri G, Di Pietro M, Di Santo F, Fabeni L, Fadda G, Galli M, Gennari W, Ghisetti V, Giacometti A, Gori C, Gori A, Gulminetti R, Leoncini F, Maffongelli G, Maggiolo F, Manca G, Gargiulo F, Martinelli C, Maserati R, Mazzotta F, Meini G, Micheli V, Monno L, Mussini C, Narciso P, Nozza S, Paolucci S, Pal G, Parisi S, Parruti G, Pignataro AR, Pollicita M, Quirino T, Re MC, Rizzardini G, Santangelo R, Scaggiante R, Sterrantino G, Turriziani O, Vatteroni ML, Vecchi L, Viscoli C, Vullo V, Zazzi M, Lazzarini A, Perno CF. Performance of genotypic tropism testing on proviral DNA in clinical practice: results from the DIVA study group. New Microbiol 2012; 35:17-25. [PMID: 22378549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/05/2011] [Accepted: 11/10/2011] [Indexed: 05/31/2023]
Abstract
OBJECTIVE The DIVA study is aimed at setting up a standardized genotypic tropism-testing on proviral-DNA for the routine clinical diagnostic-laboratory. METHODS Twelve local centres and 5 reference centres (previously cross-validated) were identified. For inter-center validation-procedure, 60 peripheral-blood mononuclear cells (PBMCs) aliquots from 45 HAART-treated patients were randomly chosen for population V3 sequencing on proviral-DNA at local HIV centre and at reference-laboratory. Viral tropism was predicted by Geno2Pheno algorithm (False Positive Rate [FPR] = 20%) as proposed by the European-Guidelines. Quantification of total HIV-1 DNA was based on a method described by Viard (2004). RESULTS Quantification of HIV-1 DNA was available for 35/45 (77.8%) samples, and gave a median value of 598 (IQR:252- 1,203) copies/10 PBMCs. A total of 56/60 (93.3%) samples were successfully amplified by both the reference and the local virological centers. The overall concordance of tropism prediction between local and reference centers was 54/56 (96.4%). Results of tropism prediction by local centers were: 33/54 (61.1%) R5 and 21/54 (38.9%) X4/DM. CONCLUSION There was high concordance in the genotypic tropism prediction based on proviral DNA among different virological centers throughout Italy. Our results are in line with other European studies, and support the use of genotypic tropism testing on proviral DNA in patients with suppressed plasma HIV-1 RNA candidate to CCR5-antagonist treatment.
Collapse
Affiliation(s)
- Valentina Svicher
- Department of Experimental Medicine, University of Rome, Roma, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
22
|
|
23
|
Madeddu G, Soddu V, Ricci E, Quirino T, Menzaghi B, Bellacosa C, Grosso C, Melzi S, Valsecchi L, Franzetti M, Vichi F, Penco G, Di Biagbio A, Pellicanò G, Corsico L, De Socio GVL, Mazzotta E, Parruti G, Guastavigna M, Orofino G, Mura MS, Bonfanti P. Muscle symptoms and creatine phosphokinase elevations in patients receiving raltegravir in clinical practice: results from a multicenter study. J Int AIDS Soc 2010. [PMCID: PMC3112886 DOI: 10.1186/1758-2652-13-s4-p111] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
|
24
|
De Socio GVL, Ricci E, Parruti G, Maggi P, Madeddu G, Quirino T, Bonfanti P. Chronological and biological age in HIV infection. J Infect 2010; 61:428-30. [DOI: 10.1016/j.jinf.2010.09.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2010] [Revised: 08/31/2010] [Accepted: 09/02/2010] [Indexed: 10/19/2022]
|
25
|
Svicher V, D'Arrigo R, Alteri C, Andreoni M, Angarano G, Antinori A, Antonelli G, Bagnarelli P, Baldanti F, Bertoli A, Borderi M, Boeri E, Bonn I, Bruzzone B, Callegaro AP, Cammarota R, Canducci F, Ceccherini-Silberstein F, Clementi M, Monforte AD, De Luca A, Di Biagio A, Di Gianbenedetto S, Di Perri G, Di Pietro M, Fabeni L, Fadda G, Galli M, Gennari W, Ghisetti V, Giacometti A, Gori A, Leoncini F, Maggiolo F, Maserati R, Mazzotta F, Micheli V, Meini G, Monno L, Mussini C, Nozza S, Paolucci S, Parisi S, Pecorari M, Pizzi D, Quirino T, Re MC, Rizzardini G, Santangelo R, Soria A, Stazi F, Sterrantino G, Turriziani O, Viscoli C, Vullo V, Lazzarin A, Perno CF. Performance of genotypic tropism testing in clinical practice using the enhanced sensitivity version of Trofile as reference assay: results from the OSCAR Study Group. New Microbiol 2010; 33:195-206. [PMID: 20954437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
OBJECTIVE The goal of the OSCAR programme is to evaluate the performances of genotypic HIV-1 tropism testing in clinical practice using the enhanced sensitivity version of Trofile (ESTA) as reference-assay. METHODS HIV-1 coreceptor-usage was assessed using plasma samples from 406 HIV-1 infected patients by ESTA and by gp120 V3 population-sequencing followed by Geno2pheno (set at a False Positive Rate [FPR] of 10% and 5%). RESULTS ESTA was successful in 365 (89.9%) samples indicating R5 in 254 (69.6%), and DM/X4 in 111 (30.4% of samples (104 [28.5%] DM and 7 [1.9%] X4). Genotypic-testing successfully assessed viral tropism for all 406 samples, including the 41 with undetermined result by ESTA. Genotypic-tropism testing at a FPR of 5% and 10% was 81.1% and 78.4% concordant with ESTA, respectively. Despite a sensitivity of 48.7% and 55.9% at a FPR of 5% and 10%, respectively, a high concordance (specificity: 95.3% for FPR of 5% and 88.2% for FPR of 10%) between genotypic-tropism testing and ESTA was reached in the detection of R5-tropic viruses. CONCLUSION Our results are in line with other European studies, and support the routine use of genotypic tropism testing in clinical-settings for monitoring of HIV-1 infected patients candidate to or failing CCR5-antagonists.
Collapse
Affiliation(s)
- Valentina Svicher
- University of Rome Tor Vergata, Department of Experimental Medicine, Roma, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
26
|
Schillaci G, Pucci G, Martinelli C, Quirino T, Bonfanti P, De Socio GV. ADVERSE EFFECTS OF HIV INFECTION ON DAY-NIGHT BLOOD PRESSURE VARIABILITY: PP.14.29. J Hypertens 2010. [DOI: 10.1097/01.hjh.0000378955.77231.6d] [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: 11/25/2022]
|
27
|
De Socio GVL, Martinelli C, Ricci E, Orofino G, Valsecchi L, Vitiello P, Martinelli L, Quirino T, Maggi P, Bonfanti P. Relations between cardiovascular risk estimates and subclinical atherosclerosis in naïve HIV patients: results from the HERMES study. Int J STD AIDS 2010; 21:267-72. [DOI: 10.1258/ijsa.2009.009165] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Summary The aim of the study was to evaluate the cardiovascular risk factors associated with subclinical carotid atherosclerosis in antiretroviral therapy-naïve HIV-infected patients. The HERMES (HIV Exposure and Risk of Metabolic Syndrome) study enrolled therapy-naïve patients attending hospitals in the Italian coordination group for the study of allergies and HIV infection (CISAI [Coordinamento Italiano per lo Studio Allergia e Infezione da HIV]) in 2007. It was designed to identify metabolic syndrome (MS) and cardiovascular risk factors. The present analysis is a nested cross-sectional study with a subset of patients examined by carotid ultrasonography. Consecutive antiretroviral therapy-naïve HIV patients attending the facilities involved in the CISAI were included. Their 10-year probability of cardiovascular events was calculated using the Framingham Risk Score (FRS) and three other cardiovascular algorithms (the Global Framingham Risk Score – GFRS, ‘Progetto Cuore’ and ‘SCORE’). Vascular age was estimated using a new model derived from GFRS and was compared with chronological age. The diagnosis of MS was based on the National Cholesterol Education Programme and International Diabetes Federation (IDF) definitions. Subclinical atherosclerosis was determined as ultrasound carotid intima-media thickness >0.9 mm. Out of 140 patients enrolled in the HERMES study by the four centres participating in the nested study, a total of 72 (51.4%) subjects, with no overt cardiovascular disease, were examined using carotid ultrasonography. The median age was 40 years, 79.2% men. The vascular age was 7.6 years higher than the chronological age. The factors associated with subclinical atherosclerosis were age (P < 0.0001), vascular age (P = 0.0002), body mass index (P = 0.003), waist circumference (P = 0.0002), MS (IDF definition, P = 0.004) and all the cardiovascular (CV) models (FRS, P = 0.01, GFRS, P = 0.002, Progetto Cuore, P = 0.018, SCORE, P = 0.03). Independent of other significant factors, waist circumference was significantly associated with pathological results (P = 0.007). The GFRS (area under the receiver-operating characteristic curves, 0.78; P < 0.001) had slightly better predictive accuracy than the other three CV models (FRS, areas under the curve [AUC] = 0.71, P = 0.003; Progetto Cuore, AUC = 0.74, P = 0.0005; SCORE, AUC = 0.77, P < 0.0001); 55% of patients at intermediate risk (6–20%) had subclinical carotid lesions. Subclinical carotid lesions had a highly significant direct association with all the CV risk predictors. The GFRS and vascular age were highly predictive. We recommend a carotid ultrasonographic examination at least among HIV patients with GFRS >6% or with an elevated waist circumference.
Collapse
Affiliation(s)
| | - G V L De Socio
- Department of Infectious Diseases, Santa Maria Hospital, Perugia
| | - C Martinelli
- Department of Infectious Diseases, Careggi Hospital, Firenze
| | - E Ricci
- Department of Infectious Diseases, Luigi Sacco Hospital, Milano
| | - G Orofino
- Department of Infectious Diseases, Amedeo di Savoia Hospital, Torino
| | - L Valsecchi
- Department of Infectious Diseases, Luigi Sacco Hospital, Milano
| | - P Vitiello
- Department of Infectious Diseases, Luigi Sacco Hospital, Milano
| | - L Martinelli
- Department of Infectious Diseases, Santa Maria Hospital, Perugia
| | - T Quirino
- Department of Infectious Diseases, Busto Arsizio Hospital, Busto Arsizio
| | - P Maggi
- Department of Infectious Diseases, University of Bari, Italy
| | - P Bonfanti
- Department of Infectious Diseases, Luigi Sacco Hospital, Milano
| |
Collapse
|
28
|
Giuntini R, Martinelli C, Ricci E, Vichi F, Gianelli E, Madeddu G, Abeli C, Palvarini L, Penco G, Marconi P, Grosso C, Pellicano G, Bonfanti P, Quirino T. Efficacy and safety of boosted and unboosted atazanavir-containing antiretroviral regimens in real life: results from a multicentre cohort study. HIV Med 2010; 11:40-5. [DOI: 10.1111/j.1468-1293.2009.00740.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
29
|
Maggi P, Quirino T, Ricci E, De Socio GVL, Gadaleta A, Ingrassia F, Perilli F, Lillo A, Bonfanti P. Cardiovascular risk assessment in antiretroviral-naïve HIV patients. AIDS Patient Care STDS 2009; 23:809-13. [PMID: 19824809 DOI: 10.1089/apc.2009.0102] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Various studies have been conducted to evaluate the role of antiretroviral therapy in the onset of cardiovascular risk among HIV-1-infected patients, while fewer data are available regarding antiretroviral-naïve patients. Our objective was to evaluate the cardiovascular risk among naïve subjects examining traditional risk factors, immunovirologic parameters, assessing the Framingham risk score (FRS), and detecting the presence of subclinical carotid lesions by means of color Doppler ultrasonography. One hundred seventy-two antiretroviral-naïve patients underwent color Doppler ultrasonography. An intima-media thickness (IMT) greater than 0.9 mm and/or atherosclerotic plaques were considered pathologic findings. Demographic, immunovirologic data, and risk factors for cardiovascular disease were collected. The 10-year probability of acute coronary events was assessed by the FRS. The statistical analysis was performed using t test and chi(2), Fisher's test, and conditional multiple logistic. Thirty-six patients (20.9%) had lesions at ultrasonographic investigation. The presence of lesions was significantly related to male gender (p = 0.005), age (p = 0.003), sedentary life (p = 0.05), Centers for Disease Control and Prevention (CDC) group C or CD4(+) less than 150 cells/mm(3), and viral load (VL) > 100,000 copies per milliliter (p = 0.04). The presence of subclinical carotid lesions showed a highly significant direct association with the estimated FRS (p < 0.002). The presence of subclinical atheromasic lesion results was also high among antiretroviral-naïve patients. FRS is highly predictive of the lesions, but also an advanced stage of disease plays a significant role. Our data support the hypothesis that HIV infection per se is a risk factor for atherosclerosis. We recommend an ultrasonographic assessment both among patients with FRS 6% or more and among those in advanced stage of disease.
Collapse
Affiliation(s)
- Paolo Maggi
- Clinica delle Malattie Infettive, Università degli Studi di Bari-Policlinico, Bari, Italy
| | - Tiziana Quirino
- Divisione Malattie Infettive, A.O. “Ospedale di Circolo”, Busto Arsizio, Italy
| | - Elena Ricci
- Divisione Malattie Infettive, A.O. “L. Sacco,” Milano, Italy
| | | | - Aurora Gadaleta
- Clinica delle Malattie Infettive, Università degli Studi di Bari-Policlinico, Bari, Italy
| | - Fabrizio Ingrassia
- Clinica delle Malattie Infettive, Università degli Studi di Bari-Policlinico, Bari, Italy
| | - Francesco Perilli
- Cattedra di Chirurgia Vascolare, Università degli Studi di Bari-Policlinico, Bari, Italy
| | - Antonio Lillo
- Cattedra di Chirurgia Vascolare, Università degli Studi di Bari-Policlinico, Bari, Italy
| | - Paolo Bonfanti
- Divisione Malattie Infettive, A.O. “L. Sacco,” Milano, Italy
| |
Collapse
|
30
|
De Socio GVL, Parruti G, Quirino T, Ricci E, Schillaci G, Adriani B, Marconi P, Franzetti M, Martinelli C, Vichi F, Penco G, Sfara C, Madeddu G, Bonfanti P. Identifying HIV patients with an unfavorable cardiovascular risk profile in the clinical practice: Results from the SIMONE study. J Infect 2008; 57:33-40. [DOI: 10.1016/j.jinf.2008.03.007] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2007] [Revised: 03/09/2008] [Accepted: 03/15/2008] [Indexed: 11/28/2022]
|
31
|
Sozio F, Soddu V, De Socio G, D'Alessandro M, Polilli E, Madeddu G, Bonfanti P, Mazzotta E, Vecchiet J, Mura MS, Quirino T, Manzoli L, Parruti G. Comparison of the efficacy at 48 weeks of first-line antiretroviral treatment for HIV infection in 1998 and 2006: a multicentric investigation. J Int AIDS Soc 2008. [DOI: 10.1186/1758-2652-11-s1-p19] [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
|
32
|
Bonfanti P, Giannattasio C, Ricci E, Facchetti R, Rosella E, Franzetti M, Cordier L, Pusterla L, Bombelli M, Sega R, Quirino T, Mancia G. HIV and metabolic syndrome: a comparison with the general population. J Acquir Immune Defic Syndr 2007; 45:426-31. [PMID: 17514013 DOI: 10.1097/qai.0b013e318074ef83] [Citation(s) in RCA: 85] [Impact Index Per Article: 5.0] [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: 01/22/2023]
Abstract
OBJECTIVE To compare the prevalence of metabolic syndrome (MS) in HIV-positive patients with that from a sample of a general Italian population. DESIGN Cross-sectional study. METHODS A total of 1263 HIV-infected patients 18 years of age or older were recruited in 18 centers for infectious diseases in northern and central Italy. Controls were 2051 subjects aged 25 to 74 years representative of the residents of Monza, a town in Milan province, who were enrolled in the Pressioni Arteriose Monitorate E Loro Associazioni study. RESULTS The prevalence of MS in the HIV group was 20.8%, whereas in the control group, it was only 15.8%, with the difference being statistically significant. The age- and gender-adjusted risk of having MS in HIV-infected patients was twice as great as that in controls. Compared with controls, HIV-infected patients had a greater prevalence of the impaired fasting glucose, increased plasma triglycerides, and reduced high-density lipoprotein cholesterol components. MS prevalence was similar in treated and never-treated HIV-infected patients, and so were the various MS components. CONCLUSIONS The risk of MS is greater in HIV-infected patients compared with the general population because of a greater prevalence of lipid and glucose abnormalities. The prevalence of MS and its components is similar in treated and untreated HIV-positive patients.
Collapse
Affiliation(s)
- Paolo Bonfanti
- Department of Infectious Diseases, Luigi Sacco Hospital, Via G.B. Grassi 44, 20157 Milan, Italy.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
33
|
De Socio GVL, Bonfanti P, Ricci E, Orofino G, Madeddu G, Penco G, Gianelli E, Martinelli C, Carradori S, Quirino T, Rizzardini G. Cholesterol levels in HIV-HCV infected patients treated with lopinavir/r: results from the SCOLTA project. Biomed Pharmacother 2007; 62:16-20. [PMID: 17851026 DOI: 10.1016/j.biopha.2007.07.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2007] [Accepted: 07/25/2007] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND It is not known whether antiretroviral therapy (ART) including lopinavir/r has a different effect on the lipid metabolism in HIV patients co-infected with HCV. This study investigated changes in lipid levels, comparing patients with HIV infection alone and those with HCV too, in the lopinavir/r cohort of the SCOLTA project. METHODS We analyzed the data for the lopinavir/r nationwide cohort from 25 Italian infectious disease departments, which comprises 743 HIV-infected patients followed prospectively, comparing subjects with HIV-HCV co-infection and those with single-infection. RESULTS At enrolment, co-infected patients had significantly lower mean cholesterol than HCV negative cases (162+/-43mg/dL vs. 185+/-52mg/dL, p=0.0009). Total and non-HDL cholesterol and triglycerides rose significantly from baseline in HIV single-infection patients, but not in those with co-infection. The patients with dual HIV-HCV infection, treated with an ART regimen including lopinavir/r, have only limited increases in total and non-HDL cholesterol and triglycerides. CONCLUSIONS Changes in serum lipids in co-infected patients differed significantly from those in patients without HCV. It remains to be seen whether this is associated with a lower risk of progression of atherosclerotic disease.
Collapse
Affiliation(s)
- Giuseppe Vittorio L De Socio
- Clinica di Malattie Infettive, Università degli Studi di Perugia, Ospedale Santa Maria della Misericordia, Piazzale Menghini 1, 06129 Perugia, Italy.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
34
|
Lapadula G, Torti C, Maggiolo F, Casari S, Suter F, Minoli L, Pezzoli C, Pietro MD, Migliorino G, Quiros-Roldan E, Ladisa N, Sighinolfi L, Costarelli S, Carosi G, Carosi G, Puoti M, Torti C, Roldan EQ, Paraninfo G, Casari S, Antinori A, Antonucci G, Ammassari A, Angarano A, Saracino A, Cauda R, De Luca A, Monforte AD, Cicconi P, Mazzotta F, Caputo SL, Marino N, Minoli L, Maserati R, Novati S, Tinelli C, Ghinelli F, Sighinolfi L, Pastore G, Ladisa N, Quirino T, Migliorino M, Suter F, Maggiolo F, Suligoi B, Zeni C, Brognoli F, Bando R. Predictors of Clinical Progression among HIV-1–Positive Patients starting HAART with CD4 + T-cell Counts ≥200 cells/mm 3. Antivir Ther 2007. [DOI: 10.1177/135965350701200611] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Baseline and follow-up predictors of new AIDS-defining events (ADE) or death among patients who started HAART with CD4+ T-cell counts ≥200 cells/mm3 have rarely been assessed simultaneously. Methods A prospective observational cohort study (1996–2002) is reported. HIV-infected patients initiating HAART with a CD4+ T-cell count ≥200 cells/mm3 were studied. Baseline and time-varying factors were tested for the prediction of new ADE/death using Cox regression models. Results A total of 896 subjects were studied over a median of 5.1 years. The incidence of a new ADE was 1.6 (95% confidence interval 1.3–2.1) per 100 person-years. Among baseline factors, higher CD4+ T-cell counts before HAART were associated with lower risk of ADE/death, but not after adjustment for time-varying factors. On a multivariable analysis including both baseline and time-varying covariates, longer delay from HIV diagnosis to HAART was an independent predictor of ADE/death (per year, hazard ratio [HR] 1.06; P=0.025) and was independent of CD4+ T-cell count before treatment. Longer time spent with HIV RNA <400 copies/ml (per month, HR 0.96; P=0.003) and higher latest CD4+ T-cell count (per log2 cells/mm3, HR 0.65; P<0.001) were found to be protective. Conclusions Patients with higher CD4+ T-cell counts before HAART initiation had a better prognosis. However, except for the delay in starting HAART, viro-immunological evolution outweighed the effect of baseline factors. Moreover, suppressing HIV replication for as long as possible could improve the clinical outcome. Prospective randomized clinical trials to assess the optimal timing of HAART initiation are both feasible and urgently needed.
Collapse
Affiliation(s)
- Giuseppe Lapadula
- Institute for Infectious and Tropical Diseases, University of Brescia, Italy
| | - Carlo Torti
- Institute for Infectious and Tropical Diseases, University of Brescia, Italy
| | | | | | | | - Lorenzo Minoli
- Institute of Clinical Infectious Diseases, IRCCS Policlinico S Matteo, Pavia, Italy
| | - Chiara Pezzoli
- Institute for Infectious and Tropical Diseases, University of Brescia, Italy
| | | | | | | | | | | | - Silvia Costarelli
- Institute for Infectious and Tropical Diseases, University of Brescia, Italy
| | - Giampiero Carosi
- Institute for Infectious and Tropical Diseases, University of Brescia, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Barbara Suligoi
- Operational AIDS Centre of the Italian National Institute of Health (cross-check of data)
| | | | | | | | | |
Collapse
|
35
|
Madeddu G, Bonfanti P, De Socio GV, Carradori S, Grosso C, Marconi P, Penco G, Rosella E, Miccolis S, Melzi S, Mura MS, Landonio S, Ricci E, Quirino T. Tenofovir renal safety in HIV-infected patients: results from the SCOLTA Project. Biomed Pharmacother 2007; 62:6-11. [PMID: 17574807 DOI: 10.1016/j.biopha.2007.04.008] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2007] [Accepted: 04/26/2007] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE To evaluate the prevalence and incidence of nephrotoxicity in HIV-infected patients enrolled in the SCOLTA Project tenofovir cohort and to identify possible risk factors. DESIGN The SCOLTA Project is a prospective, observational, multicenter study involving 25 infectious disease departments in Italy created to assess the incidence of severe adverse events in patients receiving new antiretroviral drugs. PATIENTS The SCOLTA Project tenofovir cohort includes a total of 754 HIV infected patients. RESULTS Data including grade II-IV creatinine elevations according to ACTG scale were available in 354 patients, 237 (67%) males with a mean age of 40.1+/-7.6 years enrolled in the SCOLTA Project tenofovir cohort. During a mean follow up of 19.5+/-11.5 months creatinine elevations were reported in 9/354 (2.5%) patients, all males. Mean duration of tenofovir therapy at the event was 9.5+/-5 months. The overall incidence was 1.6 (95% CI 1.5-1.7) per 100 person-years (p-y) and 0.5 (95% CI 0.4-0.6) p-y for grade III. No grade IV creatinine elevations were reported. Patients with nephrotoxicity were older and more frequently male, HCV infected, in CDC stage C and their CD4 cell count was significantly lower than those without nephrotoxicity. No significant difference was found between tenofovir co-administered antiretroviral drugs. CONCLUSIONS Both prevalence and incidence of nephrotoxicity were low in patients receiving tenofovir in a non-selected clinical setting. Renal injury in patients receiving tenofovir seems associated with the presence of co-morbidities and with advanced HIV infection.
Collapse
Affiliation(s)
- Giordano Madeddu
- Department of Infectious Diseases, University of Sassari, Via De Nicola 1, Sassari, Italy.
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
36
|
Rizzardini G, Trabattoni D, Capetti A, Castelletti E, Migliorino M, Panebianco R, Pacei M, Quirino T, Clerici M. An immunological comparison of third companion in advanced drug-naive HIV-infected patients. HIV Clin Trials 2007; 7:221-8. [PMID: 17162315 DOI: 10.1310/hct0705-221] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
An immunological comparison of three different third companions (abacavir [ABC], efavirenz [EFV], ritonavir-boosted indinavir [IDVr]) on a backbone of either zidovudine plus didanosine (AZT/ddI) or zidovudine plus lamivudine (AZT/3TC) was performed in 76 HIV-infected, advanced-naive patients. Baseline median CD4 count and viremia were 217/microL and 238,301 copies/mL, respectively. Immunologic parameters were measured at baseline and after months of therapy. By the end of the study, 36 patients (mostly in the protease inhibitor [PI]-containing arms) had dropped out of the study; 22/36 cases of drop out were due to tolerability issues. All regimens resulted in increases in CD4 counts, with the most solid changes seen in patients using ABC as a third companion. Median HIV plasma viremia at month 12 was <50 copies/mL, and viremia was undetectable in 26/38 patients (68%). At the end of the study period, HIV antigen- and mitogen-stimulated proliferation overall was better in patients using either of the PI-boosted third companions. In these patients, the strongest down-modulation of activation marker-bearing cells was also observed. Finally, CD8+/28-/CD45RA+ lymphocytes (effector cells) were increased in all groups of patients with the exception of individuals receiving PI-boosted therapies. Results of this pilot study, although very preliminary, suggest that different combinations of antivirals result in a range of effects on immune cell functions. The clinical implications of these results need to be further analyzed in follow-up studies and in larger cohorts of patients.
Collapse
|
37
|
Bonfanti P, Giannattasio C, Ricci E, Facchetti R, Capra A, Citterio F, Rosella E, Franzetti M, Cordier L, Pusterla L, Bombelli M, Sega R, Quirino T, Mancia G. Prevalence of the Metabolic Syndrome in HIV Patients. High Blood Press Cardiovasc Prev 2007. [DOI: 10.2165/00151642-200714030-00023] [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: 11/02/2022] Open
|
38
|
Madeddu G, Quirino T, Carradori S, Ricci E, Grosso C, Penco G, De Socio G, Rossella E, Palvarini L, Marconi P, Melzi S, Mura MS, Bonfanti P. [Renal toxicity in HIV-infected patients receiving HAART including tenofovir]. Infez Med 2006; 14:125-34. [PMID: 17127826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
HIV-infected patients may undergo renal damage related to the HIV infection itself, to the presence of co-infections, arterial hypertension, diabetes or to the exposure to nephrotoxic drugs. Tenofovir has been associated with the development of acute renal failure with Fanconi syndrome and acute tubular necrosis and, albeit rarely, with chronic liver disease. Patients with low CD4 cell count, low body weight and with concomitant diseases such as arterial hypertension and diabetes or co-infections with HCV, HBV or Treponema pallidum seem at higher risk of tenofovir-related nephrotoxicity. Other risk factors include previous exposure to nephrotoxic drugs and the association of tenofovir with boosted protease inhibitors or with didanosine. However, from the analysis of published papers the incidence of tenofovir-related renal toxicity seems low, as confirmed also by our personal casuistry (SCOLTA Project). Thus, a careful selection of patients including the evaluation of existent renal disease before starting an antiretroviral regimen including tenofovir is necessary to prevent renal damage. Furthermore, frequent monitoring of renal function in patients at higher risk of renal damage is strongly recommended, as well as a tenofovir dose adjustment if an alteration of renal function is detected.
Collapse
|
39
|
Capetti A, Piconi S, Magni C, Quirino T, Trabattoni D, Clerici M. Unusual presentation of acute cytomegalovirus disease during primary HIV-1 infection: antigen-specific T-cell response analyses and clinical outcome. AIDS 2006; 20:1566-7. [PMID: 16847419 DOI: 10.1097/01.aids.0000237380.54186.35] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [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]
|
40
|
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]
|
41
|
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.
Collapse
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
| |
Collapse
|
42
|
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.
Collapse
Affiliation(s)
- Andrea Antinori
- National Institute for Infectious Diseases L. Spallanzani IRCCS, Roma.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
43
|
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.
Collapse
Affiliation(s)
- Paolo Bonfanti
- I Divisione di Malattie Infettive, Ospedale Luigi Sacco, Milan, Italy
| | | | | | | | | | | | | | | | | |
Collapse
|
44
|
Bonfanti P, Martinelli C, Ricci E, Carradori S, Parruti G, Armignacco O, Magnani C, Quirino T. An Italian Approach to Postmarketing Monitoring: Preliminary Results From the SCOLTA (Surveillance Cohort Long-Term Toxicity Antiretrovirals) Project on the Safety of Lopinavir/Ritonavir. J Acquir Immune Defic Syndr 2005; 39:317-20. [PMID: 15980692 DOI: 10.1097/01.qai.0000164248.56722.3c] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The SCOLTA project (Surveillance Cohort Long-term Toxicity Antiretrovirals) is a system for online surveying of adverse reactions to recently commercialized antiretroviral drugs and a "sentinel" for unexpected and late adverse reactions arising during any antiretroviral treatment (available at: http://www.cisai.info). To date, 25 Italian departments of infectious diseases have participated at the project. The New Drugs Project is a prospective, multicenter, observational pharmacovigilance study involving 1 cohort of patients for each new drug. All patients who were consecutively started on lopinavir (LPV), tenofovir (TDF), peginterferon (IFN), atazanavir (ATZ), enfuvirtide (T-20), and tipranavir (TPV) were enrolled. All grade III or IV adverse events (according to the AIDS Clinical Trials Group definitions) are reported on the web site. The Unexpected Events Project identifies unexpected adverse reactions during treatment and reports them. This paper presents the preliminary findings for the New Drugs Project. Between October 1, 2002, and March 30, 2004, 1184 patients were enrolled. The lopinavir/ritonavir (LPV/r) cohort comprises 703 patients, the TDF cohort 585, IFN 35, ATZ 95, T-20 10, and TPV 8. So far 100 grades III and IV adverse events have been reported, 73 in the LPV/r group. In this cohort the rate of adverse events per 100 person-years was 14.2 on the basis of all patients treated, 9.8 for treatment-naive patients, and 15 for treatment-experienced patients. These findings, though preliminary, show that this data collection method gives timely real-life information from which to assess the impact of short- and long-term toxicity of new antiretroviral drugs.
Collapse
Affiliation(s)
- Paolo Bonfanti
- Department of Infectious Diseases, Luigi Sacco Hospital, Milan, Italy
| | | | | | | | | | | | | | | |
Collapse
|
45
|
Landonio S, Quirino T, Bonfanti P, Gabris A, Boccassini L, Gulisano C, Vulpio L, Ricci E, Carrabba M, Vigevani GM. Osteopenia and osteoporosis in HIV+ patients, untreated or receiving HAART. Biomed Pharmacother 2004; 58:505-8. [PMID: 15511607 DOI: 10.1016/j.biopha.2004.08.019] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2004] [Indexed: 11/26/2022] Open
Abstract
In the last few years there are increasing evidences suggesting that osteopenia and osteoporosis are frequent among HIV positive patients. It is still not clear if the bone demineralization is a direct consequence of viral infection or of the antiretroviral drugs. Studies to date therefore give conflicting results. We performed a study to evaluate the prevalence of osteopenia and osteoporosis in HIV positive patients, either untreated or receiving antiretroviral therapy, to asses the frequency of these conditions and the role of antiretroviral drugs.
Collapse
Affiliation(s)
- S Landonio
- 1st Department of Infectious Diseases and Allergy, Luigi Sacco Hospital, Via GB Grassi 74, 20157 Milan, Italy
| | | | | | | | | | | | | | | | | | | |
Collapse
|
46
|
Quirino T, Bongiovanni M, Ricci E, Chebat E, Carradori S, Martinelli C, Valsecchi L, Landonio S, Bini T, Bonfanti P. Hypothyroidism in HIV‐Infected Patients Who Have or Have Not Received HAART. Clin Infect Dis 2004; 38:596-7. [PMID: 14765359 DOI: 10.1086/381442] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
47
|
Bonfanti P, Gulisano C, Ricci E, Timillero L, Valsecchi L, Carradori S, Pusterla L, Fortuna P, Miccolis S, Magnani C, Gabbuti A, Parazzini F, Martinelli C, Faggion I, Landonio S, Quirino T, Vigevani G. Risk factors for lipodystrophy in the CISAI cohort. Biomed Pharmacother 2003; 57:422-7. [PMID: 14652168 DOI: 10.1016/j.biopha.2003.06.002] [Citation(s) in RCA: 19] [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: 11/30/2022] Open
Abstract
PURPOSE This study set out to describe the frequency of lipodystrophy, and identify its risk factors, in HIV-positive patients treated with HAART containing at least one protease inhibitor (PI). We analyzed the data collected in the CISAI study. METHODS The CISAI is a multicenter cohort study that has enrolled 1480 patients. We assessed whether patients had lipodystrophy at a medical visit, with follow-up visits by the same physician at least every 2 months, and also on the basis of patients' own reports. RESULTS The lipodystrophy syndrome was detected in about 25% of the patients. Multivariate analysis showed the risk of lipodystrophy was correlated with female sex (RR 1.5; 95% confidence interval, CI, 1.2-2.1), with older age, with homosexuality (RR 1.5; 95% CI 1.0-2.4), with overt disease (RR 1.4; 95% CI 1.1-1.8) and with the duration of treatment before entering this study. The RR for ritonavir was higher than for the other PI (RR 1.4; 95% CI 0.9-1.9). Among patients receiving concomitant antiretroviral therapy the risk of lipodystrophy was greater with stavudine (RR 1.7; 95% CI 1.3-2.3). CONCLUSIONS The study confirmed the high frequency of the lipodystrophy syndrome among patients treated with PI.
Collapse
Affiliation(s)
- Paolo Bonfanti
- I Divisione Malattie Infettive, Ospedale Luigi Sacco, Via GB Grassi 74, 20157, Milan, Italy.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
48
|
Landonio S, Quirino T, Pelucchi A, Magni C, Coen M, Porretta T, Faggion I, Bonfanti P, Vigevani GM. Bilateral carotid stenosis in a young female HIV patient treated with highly active antiretroviral therapy. AIDS 2002; 16:2225-7. [PMID: 12409747 DOI: 10.1097/00002030-200211080-00018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Simona Landonio
- Department of Infectious Diseases, Luigi Sacco Hospital, Milan, Italy
| | | | | | | | | | | | | | | | | |
Collapse
|
49
|
Spazzolini A, Brusa M, Zerega G, Quirino T, Iemoli E, Gallucci A, Olivieri P, Toia E, Ravagnan R. [Latex allergy]. Minerva Med 2002; 93:119-28. [PMID: 12032443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
The incidence of latex allergy has increased in the last decade in particular for medical and health care staff. The "L. Sacco" Hospital in Milan has developed an organisational model for dealing with clinical problems of patients allergic to latex who need to be admitted in hospital. Guidelines have been drawn up to handle the problem of latex allergy in hospital. An Interdisciplinary Working Group has systematically re-examined the epidemiological, etiopathogenetic, clinical diagnostic and therapeutic aspects of this important medical problem. This last topic has been particularly developed to facilitate doctors with emergency drugs. Nevertheless the most efficient method against the sensitisation is the elimination and reduction in hospital of the allergens causing the disease.
Collapse
Affiliation(s)
- A Spazzolini
- Azienda Ospedaliera, Polo Universitario, Unità Operative di Anestesia e Rianimazione, Ospedale L. Sacco, Milan, Italy
| | | | | | | | | | | | | | | | | |
Collapse
|
50
|
Bonfanti P, Landonio S, Ricci E, Martinelli C, Fortuna P, Faggion I, Quirino T. Risk factors for hepatotoxicity in patients treated with highly active antiretroviral therapy. J Acquir Immune Defic Syndr 2001; 27:316-8. [PMID: 11464155 DOI: 10.1097/00126334-200107010-00017] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.9] [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]
|