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Prandoni P, Cattelan AM, Carrozzi L, Leone L, Filippi L, De Gaudenzi E, Villalta S, Pesavento R. The hazard of fondaparinux in non-critically ill patients with COVID-19: Retrospective controlled study versus enoxaparin. Thromb Res 2020; 196:395-397. [PMID: 33007739 PMCID: PMC7497738 DOI: 10.1016/j.thromres.2020.09.024] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 08/28/2020] [Accepted: 09/16/2020] [Indexed: 11/03/2022]
Affiliation(s)
| | - Anna Maria Cattelan
- Department of Medicine, Infectious Diseases Unit, University Hospital of Padua, Italy
| | - Laura Carrozzi
- Department of Surgical, Medical, Molecular and Intensive Care Medicine, University Hospital of Pisa, Italy
| | - Lucia Leone
- Division of General Medicine, Ospedali Riuniti Padova Sud, Monselice, Italy
| | - Lucia Filippi
- Division of General Medicine, Alto Vicentino Hospital, Santorso, Italy
| | - Egidio De Gaudenzi
- Division of Internal Medicine, Angiology and Thrombosis Unit, Domodossola, Italy
| | - Sabina Villalta
- Division of General Medicine, San Giacomo Hospital, Castelfranco Veneto, Italy
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Spinner CD, Gottlieb RL, Criner GJ, Arribas López JR, Cattelan AM, Soriano Viladomiu A, Ogbuagu O, Malhotra P, Mullane KM, Castagna A, Chai LYA, Roestenberg M, Tsang OTY, Bernasconi E, Le Turnier P, Chang SC, SenGupta D, Hyland RH, Osinusi AO, Cao H, Blair C, Wang H, Gaggar A, Brainard DM, McPhail MJ, Bhagani S, Ahn MY, Sanyal AJ, Huhn G, Marty FM. Effect of Remdesivir vs Standard Care on Clinical Status at 11 Days in Patients With Moderate COVID-19: A Randomized Clinical Trial. JAMA 2020; 324:1048-1057. [PMID: 32821939 PMCID: PMC7442954 DOI: 10.1001/jama.2020.16349] [Citation(s) in RCA: 846] [Impact Index Per Article: 211.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
IMPORTANCE Remdesivir demonstrated clinical benefit in a placebo-controlled trial in patients with severe coronavirus disease 2019 (COVID-19), but its effect in patients with moderate disease is unknown. OBJECTIVE To determine the efficacy of 5 or 10 days of remdesivir treatment compared with standard care on clinical status on day 11 after initiation of treatment. DESIGN, SETTING, AND PARTICIPANTS Randomized, open-label trial of hospitalized patients with confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and moderate COVID-19 pneumonia (pulmonary infiltrates and room-air oxygen saturation >94%) enrolled from March 15 through April 18, 2020, at 105 hospitals in the United States, Europe, and Asia. The date of final follow-up was May 20, 2020. INTERVENTIONS Patients were randomized in a 1:1:1 ratio to receive a 10-day course of remdesivir (n = 197), a 5-day course of remdesivir (n = 199), or standard care (n = 200). Remdesivir was dosed intravenously at 200 mg on day 1 followed by 100 mg/d. MAIN OUTCOMES AND MEASURES The primary end point was clinical status on day 11 on a 7-point ordinal scale ranging from death (category 1) to discharged (category 7). Differences between remdesivir treatment groups and standard care were calculated using proportional odds models and expressed as odds ratios. An odds ratio greater than 1 indicates difference in clinical status distribution toward category 7 for the remdesivir group vs the standard care group. RESULTS Among 596 patients who were randomized, 584 began the study and received remdesivir or continued standard care (median age, 57 [interquartile range, 46-66] years; 227 [39%] women; 56% had cardiovascular disease, 42% hypertension, and 40% diabetes), and 533 (91%) completed the trial. Median length of treatment was 5 days for patients in the 5-day remdesivir group and 6 days for patients in the 10-day remdesivir group. On day 11, patients in the 5-day remdesivir group had statistically significantly higher odds of a better clinical status distribution than those receiving standard care (odds ratio, 1.65; 95% CI, 1.09-2.48; P = .02). The clinical status distribution on day 11 between the 10-day remdesivir and standard care groups was not significantly different (P = .18 by Wilcoxon rank sum test). By day 28, 9 patients had died: 2 (1%) in the 5-day remdesivir group, 3 (2%) in the 10-day remdesivir group, and 4 (2%) in the standard care group. Nausea (10% vs 3%), hypokalemia (6% vs 2%), and headache (5% vs 3%) were more frequent among remdesivir-treated patients compared with standard care. CONCLUSIONS AND RELEVANCE Among patients with moderate COVID-19, those randomized to a 10-day course of remdesivir did not have a statistically significant difference in clinical status compared with standard care at 11 days after initiation of treatment. Patients randomized to a 5-day course of remdesivir had a statistically significant difference in clinical status compared with standard care, but the difference was of uncertain clinical importance. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04292730.
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Affiliation(s)
- Christoph D. Spinner
- Technical University of Munich, School of Medicine, University Hospital Rechts der Isar, Munich, Germany
| | | | - Gerard J. Criner
- Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | | | | | | | | | | | | | - Antonella Castagna
- IRCCS San Raffaele Hospital and Vita-Salute San Raffaele University, Milan, Italy
| | | | | | | | | | | | | | | | | | | | - Huyen Cao
- Gilead Sciences, Foster City, California
| | | | | | | | | | | | | | | | | | | | - Francisco M. Marty
- Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
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53
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Trevenzoli M, Guarnaccia A, Alberici I, Fassan M, Di Meco E, Farinati F, Cattelan AM. SARS-CoV-2 and hepatitis. J Gastrointestin Liver Dis 2020; 29:473-475. [PMID: 32919428 DOI: 10.15403/jgld-2747] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 07/28/2020] [Indexed: 12/16/2022]
Affiliation(s)
- Marco Trevenzoli
- Department of Medicine, Infectious Diseases Unit, Azienda Ospedale Università di Padova, Padova, Italy. .
| | - Aurelio Guarnaccia
- Department of Medicine, Infectious Diseases Unit, Azienda Ospedale Università di Padova, Padova, Italy.
| | - Irene Alberici
- Department of Medicine, Infectious Diseases Unit, Azienda Ospedale Università di Padova, Padova, Italy.
| | - Matteo Fassan
- Department of Surgery, Oncology and Gastroenterology, Azienda Ospedale Università di Padova, Padova, Italy.
| | - Eugenia Di Meco
- Department of Medicine, Infectious Diseases Unit, Azienda Ospedale Università di Padova, Padova, Italy.
| | - Fabio Farinati
- Department of Surgery, Oncology and Gastroenterology, Azienda Ospedale Università di Padova, Padova, Italy.
| | - Anna Maria Cattelan
- Department of Medicine, Infectious Diseases Unit, Azienda Ospedale Università di Padova, Padova, Italy.
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54
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Barberio B, Massimi D, Bonfante L, Facchin S, Calò L, Trevenzoli M, Savarino EV, Cattelan AM. Fecal microbiota transplantation for norovirus infection: a clinical and microbiological success. Therap Adv Gastroenterol 2020; 13:1756284820934589. [PMID: 32849912 PMCID: PMC7425245 DOI: 10.1177/1756284820934589] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 05/26/2020] [Indexed: 02/04/2023] Open
Affiliation(s)
| | | | - Luciana Bonfante
- Department of Internal Medicine, Division of Nephrology, University of Padua, Italy
| | - Sonia Facchin
- Division of Gastroenterology, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Lorenzo Calò
- Department of Internal Medicine, Division of Nephrology, University of Padua, Italy
| | - Marco Trevenzoli
- Department of Internal Medicine, Division of Infectious Diseases, University of Padua, Italy
| | | | - Anna Maria Cattelan
- Department of Internal Medicine, Division of Infectious Diseases, University of Padua, Italy
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55
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Cattelan AM, Sasset L, Di Meco E, Cocchio S, Barbaro F, Cavinato S, Gardin S, Carretta G, Donato D, Crisanti A, Trevenzoli M, Baldo V. An Integrated Strategy for the Prevention of SARS-CoV-2 Infection in Healthcare Workers: A Prospective Observational Study. Int J Environ Res Public Health 2020; 17:ijerph17165785. [PMID: 32785110 PMCID: PMC7460144 DOI: 10.3390/ijerph17165785] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 08/05/2020] [Accepted: 08/07/2020] [Indexed: 01/02/2023]
Abstract
Background: Since the beginning of SARS-CoV-2 outbreak, a large number of infections have been reported among healthcare workers (HCWs). The aim of this study was to investigate the occurrence of SARS-CoV-2 infection among HCWs involved in the first management of infected patients and to describe the measures adopted to prevent the transmission in the hospital. Methods: This prospective observational study was conducted between February 21 and April 16, 2020, in the Padua University Hospital (north-east Italy). The infection control policy adopted consisted of the following: the creation of the “Advanced Triage” area for the evaluation of SARS-CoV-2 cases, and the implementation of an integrated infection control surveillance system directed to all the healthcare personnel involved in the Advance Triage area. HCWs were regularly tested with nasopharyngeal swabs for SARS-CoV-2; body temperature and suggestive symptoms were evaluated at each duty. Demographic and clinical data of both patients and HCWs were collected and analyzed; HCWs’ personal protective equipment (PPE) consumption was also recorded. The efficiency of the control strategy among HCWs was evaluated identifying symptomatic infection (primary endpoint) and asymptomatic infection (secondary endpoint) with confirmed detection of SARS-CoV-2. Results: 7595 patients were evaluated in the Advanced Triage area: 5.2% resulted positive and 72.4% was symptomatic. The HCW team was composed of 60 members. A total of 361 nasopharyngeal swabs were performed on HCWs. All the swabs resulted negative and none of the HCWs reached the primary or the secondary endpoint. Conclusions: An integrated hospital infection control strategy, consisting of dedicated areas for infected patients, strict measures for PPE use and mass surveillance, is successful to prevent infection among HCWs.
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Affiliation(s)
- Anna Maria Cattelan
- Infectious Diseases Unit, Department of Medicine, Azienda Ospedale Università di Padova, 35128 Padova, Italy; (L.S.); (E.D.M.); (F.B.); (S.C.); (S.G.); (M.T.)
- Correspondence: ; Tel.: +0039-333-7138916
| | - Lolita Sasset
- Infectious Diseases Unit, Department of Medicine, Azienda Ospedale Università di Padova, 35128 Padova, Italy; (L.S.); (E.D.M.); (F.B.); (S.C.); (S.G.); (M.T.)
| | - Eugenia Di Meco
- Infectious Diseases Unit, Department of Medicine, Azienda Ospedale Università di Padova, 35128 Padova, Italy; (L.S.); (E.D.M.); (F.B.); (S.C.); (S.G.); (M.T.)
| | - Silvia Cocchio
- Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padua, 35128 Padova, Italy; (S.C.); (V.B.)
| | - Francesco Barbaro
- Infectious Diseases Unit, Department of Medicine, Azienda Ospedale Università di Padova, 35128 Padova, Italy; (L.S.); (E.D.M.); (F.B.); (S.C.); (S.G.); (M.T.)
| | - Silvia Cavinato
- Infectious Diseases Unit, Department of Medicine, Azienda Ospedale Università di Padova, 35128 Padova, Italy; (L.S.); (E.D.M.); (F.B.); (S.C.); (S.G.); (M.T.)
| | - Samuele Gardin
- Infectious Diseases Unit, Department of Medicine, Azienda Ospedale Università di Padova, 35128 Padova, Italy; (L.S.); (E.D.M.); (F.B.); (S.C.); (S.G.); (M.T.)
| | - Giovanni Carretta
- Health Department, Azienda Ospedale Università di Padova, 35128 Padova, Italy; (G.C.); (D.D.)
| | - Daniele Donato
- Health Department, Azienda Ospedale Università di Padova, 35128 Padova, Italy; (G.C.); (D.D.)
| | - Andrea Crisanti
- Clinical Microbiology and Virology Unit, Department of Molecular Medicine, Azienda Ospedale Università di Padova, 35128 Padova, Italy;
- Department of Life Science, Imperial College London, London SW7 2AZ, UK
| | - Marco Trevenzoli
- Infectious Diseases Unit, Department of Medicine, Azienda Ospedale Università di Padova, 35128 Padova, Italy; (L.S.); (E.D.M.); (F.B.); (S.C.); (S.G.); (M.T.)
| | - Vincenzo Baldo
- Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padua, 35128 Padova, Italy; (S.C.); (V.B.)
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56
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Lai A, Bergna A, Caucci S, Clementi N, Vicenti I, Dragoni F, Cattelan AM, Menzo S, Pan A, Callegaro A, Tagliabracci A, Caruso A, Caccuri F, Ronchiadin S, Balotta C, Zazzi M, Vaccher E, Clementi M, Galli M, Zehender G. Molecular Tracing of SARS-CoV-2 in Italy in the First Three Months of the Epidemic. Viruses 2020; 12:v12080798. [PMID: 32722343 PMCID: PMC7472216 DOI: 10.3390/v12080798] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 07/17/2020] [Accepted: 07/21/2020] [Indexed: 01/15/2023] Open
Abstract
The aim of this study is the characterization and genomic tracing by phylogenetic analyses of 59 new SARS-CoV-2 Italian isolates obtained from patients attending clinical centres in North and Central Italy until the end of April 2020. All but one of the newly-characterized genomes belonged to the lineage B.1, the most frequently identified in European countries, including Italy. Only a single sequence was found to belong to lineage B. A mean of 6 nucleotide substitutions per viral genome was observed, without significant differences between synonymous and non-synonymous mutations, indicating genetic drift as a major source for virus evolution. tMRCA estimation confirmed the probable origin of the epidemic between the end of January and the beginning of February with a rapid increase in the number of infections between the end of February and mid-March. Since early February, an effective reproduction number (Re) greater than 1 was estimated, which then increased reaching the peak of 2.3 in early March, confirming the circulation of the virus before the first COVID-19 cases were documented. Continuous use of state-of-the-art methods for molecular surveillance is warranted to trace virus circulation and evolution and inform effective prevention and containment of future SARS-CoV-2 outbreaks.
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Affiliation(s)
- Alessia Lai
- Department of Biomedical and Clinical Sciences Luigi Sacco, University of Milan, 20157 Milan, Italy; (A.B.); (C.B.); (M.G.); (G.Z.)
- Correspondence: ; Tel.: +39-0250319775
| | - Annalisa Bergna
- Department of Biomedical and Clinical Sciences Luigi Sacco, University of Milan, 20157 Milan, Italy; (A.B.); (C.B.); (M.G.); (G.Z.)
| | - Sara Caucci
- Department of Biomedical Sciences and Public Health, Virology Unit, Polytechnic University of Marche, 60131 Ancona, Italy; (S.C.); (S.M.)
| | - Nicola Clementi
- Microbiology and Virology Unit, “Vita-Salute” San Raffaele University, 20132 Milan, Italy; (N.C.); (M.C.)
| | - Ilaria Vicenti
- Department of Medical Biotechnologies, University of Siena, 53100 Siena, Italy; (I.V.); (F.D.); (M.Z.)
| | - Filippo Dragoni
- Department of Medical Biotechnologies, University of Siena, 53100 Siena, Italy; (I.V.); (F.D.); (M.Z.)
| | - Anna Maria Cattelan
- Infectious Diseases Unit, Department of Internal Medicine, Azienda Ospedaliera-Universitaria di Padova, 35128 Padua, Italy;
| | - Stefano Menzo
- Department of Biomedical Sciences and Public Health, Virology Unit, Polytechnic University of Marche, 60131 Ancona, Italy; (S.C.); (S.M.)
| | - Angelo Pan
- Infectious Diseases, ASST Cremona, 26100 Cremona, Italy;
| | - Annapaola Callegaro
- Microbiology and Virology Laboratory, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy;
| | - Adriano Tagliabracci
- Section of Legal Medicine, Universita Politecnica delle Marche, 60126 Ancona, Italy;
| | - Arnaldo Caruso
- Microbiology Unit, Department of Molecular and Translational Medicine, University of Brescia and ASST Spedali Civili Hospital, 25123 Brescia, Italy; (A.C.); (F.C.)
| | - Francesca Caccuri
- Microbiology Unit, Department of Molecular and Translational Medicine, University of Brescia and ASST Spedali Civili Hospital, 25123 Brescia, Italy; (A.C.); (F.C.)
| | | | - Claudia Balotta
- Department of Biomedical and Clinical Sciences Luigi Sacco, University of Milan, 20157 Milan, Italy; (A.B.); (C.B.); (M.G.); (G.Z.)
| | - Maurizio Zazzi
- Department of Medical Biotechnologies, University of Siena, 53100 Siena, Italy; (I.V.); (F.D.); (M.Z.)
| | - Emanuela Vaccher
- Medical Oncology and Immune-related Tumors, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, 33081 Aviano, Italy;
| | - Massimo Clementi
- Microbiology and Virology Unit, “Vita-Salute” San Raffaele University, 20132 Milan, Italy; (N.C.); (M.C.)
| | - Massimo Galli
- Department of Biomedical and Clinical Sciences Luigi Sacco, University of Milan, 20157 Milan, Italy; (A.B.); (C.B.); (M.G.); (G.Z.)
| | - Gianguglielmo Zehender
- Department of Biomedical and Clinical Sciences Luigi Sacco, University of Milan, 20157 Milan, Italy; (A.B.); (C.B.); (M.G.); (G.Z.)
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57
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Spiezia L, Boscolo A, Correale C, Sella N, Pesenti E, Beghetto L, Campello E, Poletto F, Cerruti L, Cola M, De Cassai A, Pasin L, Eugenio S, Vettor R, Cattelan AM, Simioni P, Navalesi P. Different Hypercoagulable Profiles in Patients with COVID-19 Admitted to the Internal Medicine Ward and the Intensive Care Unit. Thromb Haemost 2020; 120:1474-1477. [DOI: 10.1055/s-0040-1714350] [Citation(s) in RCA: 89] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- Luca Spiezia
- General Medicine and Thrombotic and Hemorrhagic Diseases Unit, Department of Medicine, Padua University Hospital, Padua, Italy
| | - Annalisa Boscolo
- Anaesthesia and Intensive Care Unit, Padua University Hospital, Padua, Italy
| | | | - Nicolò Sella
- Department of Medicine (DIMED), Padua University Hospital, Padua, Italy
| | - Elisa Pesenti
- Department of Medicine (DIMED), Padua University Hospital, Padua, Italy
| | - Luca Beghetto
- Department of Medicine (DIMED), Padua University Hospital, Padua, Italy
| | - Elena Campello
- Division of Internal Medicine, Department of Medicine, Padua University Hospital, Padua, Italy
| | - Francesco Poletto
- General Medicine and Thrombotic and Hemorrhagic Diseases Unit, Department of Medicine, Padua University Hospital, Padua, Italy
| | - Lorenzo Cerruti
- General Medicine and Thrombotic and Hemorrhagic Diseases Unit, Department of Medicine, Padua University Hospital, Padua, Italy
| | - Marco Cola
- Infectious Disease Unit, Padua University Hospital, Padua, Italy
| | | | - Laura Pasin
- Anaesthesia and Intensive Care Unit, Padua University Hospital, Padua, Italy
| | - Serra Eugenio
- Anaesthesia and Intensive Care Unit, Padua University Hospital, Padua, Italy
| | - Roberto Vettor
- Division of Internal Medicine, Department of Medicine, Padua University Hospital, Padua, Italy
| | | | - Paolo Simioni
- General Medicine and Thrombotic and Hemorrhagic Diseases Unit, Department of Medicine, Padua University Hospital, Padua, Italy
| | - Paolo Navalesi
- Anaesthesia and Intensive Care Unit, Padua University Hospital, Padua, Italy
- Department of Medicine (DIMED), Padua University Hospital, Padua, Italy
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58
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Gatto M, Perricone C, Tonello M, Bistoni O, Cattelan AM, Bursi R, Cafaro G, De Robertis E, Mencacci A, Bozza S, Vianello A, Iaccarino L, Gerli R, Doria A, Bartoloni E. Frequency and clinical correlates of antiphospholipid antibodies arising in patients with SARS-CoV-2 infection: findings from a multicentre study on 122 cases. Clin Exp Rheumatol 2020; 38:754-759. [PMID: 32723434] [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] [Received: 07/14/2020] [Accepted: 07/20/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES COVID-19 features include disseminated intravascular coagulation and thrombotic microangiopathy indicating a hypercoagulable state. We aimed to investigate antiphospholipid antibodies (aPL) prevalence and clinical relationships in a large cohort of COVID-19 patients. METHODS We analysed the prevalence and titres of serum aPL in 122 patients with COVID-19 and 157 with primary antiphospholipid syndrome (PAPS) and 91 with other autoimmune rheumatic diseases (oARD) for comparison. IgG/IgM anticardiolipin (aCL) and IgG/IgM anti-beta2glycoprotein I (β2GPI) were assayed using homemade ELISA, IgA aCL and anti-β2GPI by commercial ELISA kits and lupus anticoagulant (LAC) by multiple coagulation tests following updated international guidelines. RESULTS Prevalence of IgG and IgM aCL and of IgG and IgM anti-β2GPI across COVID-19 patients were 13.4%, 2.7%, 6.3% and 7.1%, being significantly lower than in PAPS (p<0.0001 for all). Frequency of IgG aCL and IgM anti-β2GPI was comparable to oARD (13.4% vs. 13.2% and 7.1% vs. 11%, respectively), while IgG anti-β2GPI and IgM aCL were lower (p<0.01). IgA aCL and IgA anti-β2GPI were retrieved in 1.7% and 3.3% of COVID-19 patients, respectively. Positive LAC was observed in 22.2% COVID-19 vs. 54.1% of PAPS (p<0.0001) and 14.6% of oARD (p=0.21). Venous or arterial thromboses occurred in 18/46 (39.1%) COVID-19 patients and were not associated with positive aPL (p=0.09). CONCLUSIONS Thrombosis is a frequent manifestation during COVID-19 infection. However, prevalence and titres of aPL antibodies or LAC were neither consistently increased nor associated with thrombosis when measured at a single timepoint, therefore not representing a suitable screening tool in the acute stage of disease.
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Affiliation(s)
- Mariele Gatto
- Rheumatology Unit, Department of Medicine, University of Padova, Italy
| | - Carlo Perricone
- Rheumatology Unit, Department of Medicine, University of Perugia, Italy
| | - Marta Tonello
- Rheumatology Unit, Department of Medicine, University of Padova, Italy
| | - Onelia Bistoni
- Rheumatology Unit, Department of Medicine, University of Perugia, Italy
| | | | - Roberto Bursi
- Rheumatology Unit, Department of Medicine, University of Perugia, Italy
| | - Giacomo Cafaro
- Rheumatology Unit, Department of Medicine, University of Perugia, Italy
| | - Edoardo De Robertis
- Section of Anesthesia, Intensive Care and Pain, Department of Surgical and Biomedical Sciences, University of Perugia, Italy
| | - Antonella Mencacci
- Medical Microbiology Unit, Department of Medicine, University of Perugia, Italy
| | - Silvia Bozza
- Medical Microbiology Unit, Department of Medicine, University of Perugia, Italy
| | - Andrea Vianello
- Respiratory Pathophysiology Division, Department of Cardio-Thoracic and Vascular Sciences, University of Padova, Italy
| | - Luca Iaccarino
- Rheumatology Unit, Department of Medicine, University of Padova, Italy
| | - Roberto Gerli
- Rheumatology Unit, Department of Medicine, University of Perugia, Italy
| | - Andrea Doria
- Rheumatology Unit, Department of Medicine, University of Padova, Italy.
| | - Elena Bartoloni
- Rheumatology Unit, Department of Medicine, University of Perugia, Italy
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Ferrarese A, Pellone M, Cattelan AM, Burra P, Senzolo M. Antibiotic therapy for spontaneous bacterial peritonitis in acute-on-chronic liver failure: Handle with care. Dig Liver Dis 2020; 52:116-117. [PMID: 31272938 DOI: 10.1016/j.dld.2019.06.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Accepted: 06/11/2019] [Indexed: 02/07/2023]
Affiliation(s)
- A Ferrarese
- Multivisceral Transplant Unit, Department of Surgery, Oncology, Gastroenterology, Padua University Hospital, Padua, Italy
| | - M Pellone
- Multivisceral Transplant Unit, Department of Surgery, Oncology, Gastroenterology, Padua University Hospital, Padua, Italy
| | - A M Cattelan
- Tropical and Infectious Diseases Unit, Padua University Hospital, Padua, Italy
| | - P Burra
- Multivisceral Transplant Unit, Department of Surgery, Oncology, Gastroenterology, Padua University Hospital, Padua, Italy
| | - M Senzolo
- Multivisceral Transplant Unit, Department of Surgery, Oncology, Gastroenterology, Padua University Hospital, Padua, Italy.
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60
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Barzon L, Percivalle E, Pacenti M, Rovida F, Zavattoni M, Del Bravo P, Cattelan AM, Palù G, Baldanti F. Virus and Antibody Dynamics in Travelers With Acute Zika Virus Infection. Clin Infect Dis 2019; 66:1173-1180. [PMID: 29300893 DOI: 10.1093/cid/cix967] [Citation(s) in RCA: 80] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2017] [Accepted: 11/02/2017] [Indexed: 11/13/2022] Open
Abstract
Background To improve our understanding of the natural history of Zika virus (ZIKV) infection in humans, we described the dynamics of ZIKV RNA shedding in different body fluids and antibody responses in patients with acute infection. Methods Twenty-nine adults with travel-associated infection and 1 case of sexual transmission were enrolled and followed up with weekly ZIKV RNA testing in blood, urine, saliva, and semen samples and antibody testing. Results ZIKV RNA was detected in plasma, urine, and saliva of 57%, 93.1%, and 69.2% of participants, with estimated median times to clearance of 11.5 days (interquartile range [IQR] 6-24 days), 24 days (IQR, 17-34), and 14 days (IQR, 8-31), respectively. In 2 pregnant women, ZIKV RNA persisted in blood until delivery of apparently healthy infants. ZIKV RNA was detected in semen of 5 of 10 tested men; median time to clearance was 25 days (IQR 14-29), and the longest time of shedding in semen was 370 days. In flavivirus-naive patients, the median times to detection of ZIKV nonstructural protein 1 (NS1)-specific immunoglobulin M (IgM) and immunoglobulin G (IgG) antibodies were estimated as 8 days (IQR, 5-15 days) and 17 days (IQR, 12-26 days), respectively. ZIKV NS1 IgM antibodies were undetectable in patients with previous dengue. Conclusions Prolonged viremia and ZIKV RNA shedding in urine, saliva, and semen occur frequently in patients with acute ZIKV infection. At the time of diagnosis, about half of patients are ZIKV IgM negative. ZIKV NS1 IgM antibodies remain undetectable in patients with previous dengue. Estimates of the times to viral clearance and seroconversion are useful to optimize diagnostic algorithms.
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Affiliation(s)
- Luisa Barzon
- Department of Molecular Medicine, University of Padova, Italy.,Microbiology and Virology Unit, Padova University Hospital, Italy
| | - Elena Percivalle
- Molecular Virology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Monia Pacenti
- Microbiology and Virology Unit, Padova University Hospital, Italy
| | - Francesca Rovida
- Molecular Virology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Maurizio Zavattoni
- Molecular Virology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | | | - Giorgio Palù
- Department of Molecular Medicine, University of Padova, Italy.,Microbiology and Virology Unit, Padova University Hospital, Italy
| | - Fausto Baldanti
- Molecular Virology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.,Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Italy
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Mussini C, Roncaglia E, Borghi V, Rusconi S, Nozza S, Cattelan AM, Segala D, Bonfanti P, Di Biagio A, Barchi E, Focà E, Degli Antoni A, Bonora S, Francisci D, Limonta S, Antinori A, D’Ettorre G, Maggiolo F. A prospective randomized trial on abacavir/lamivudine plus darunavir/ritonavir or raltegravir in HIV-positive drug-naïve patients with CD4<200 cells/uL (the PRADAR study). PLoS One 2019; 14:e0222650. [PMID: 31560700 PMCID: PMC6764686 DOI: 10.1371/journal.pone.0222650] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 09/02/2019] [Indexed: 01/11/2023] Open
Abstract
Background Very few data are available on treatment in HIV Late presenter population that still represents a clinical challenge. Methods Prospective, multicenter, randomized open-label, 2 arm, phase-3 trial comparing the 48-week virological response of two different regimens: abacavir/lamivudine + darunavir/r vs abacavir/lamivudine + raltegravir in antiretroviral naive with CD4+ counts < 200/mm3 and a viral load (VL)<500,000 copies/mL. The primary Endpoint was the proportion of patients with undetectable viremia (VL<50 copies/mL) after 48 weeks. The planned sample size for this trial was 350 patients. Results In 3 years, 53 patients were screened and 46 enrolled: 22 randomized to raltegravir and 24 to darunavir/r; 7 patients were excluded, 4 because of a VL >500,000 copies/mL and 3 for HLAB5701 positivity. The snapshot analysis at 48 weeks showed a virologic success of 77.3% in raltegravir and 66.7% in darunavir/r. Time to starting treatment was 34.5 days in raltegravir and 53 days in darunavir/r. At the as treated analysis, the median CD4 counts at 48 weeks was 297 cells/μL in raltegravir and 239 cells/μL in darunavir/r. No difference in total cholesterol, while triglycerides were higher in the darunavir/r arm. No statistical analyses were performed due to the low number of patients enrolled. Conclusions Late presenter patients are frequent but very difficult to enroll in clinical trials, especially in western countries. These regimens and the conditions of many patients could not allow the test and treat strategy. The rate of virologic success was higher than 65% in both arms with a median CD4 cell count >200/μL at week 48. Trial registration EUDRACT number: 2011-005973-21
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Affiliation(s)
- Cristina Mussini
- Clinic of Infectious Diseases, University of Modena and Reggio Emilia, Modena, Italy
- * E-mail:
| | - Enrica Roncaglia
- Clinic of Infectious Diseases, University of Modena and Reggio Emilia, Modena, Italy
| | - Vanni Borghi
- Clinic of Infectious Diseases, University of Modena and Reggio Emilia, Modena, Italy
| | - Stefano Rusconi
- Clinic of Infectious Diseases, DIBIC Luigi Sacco, University of Milan, Milan, Italy
| | - Silvia Nozza
- Clinic of Infectious Diseases, University Vita e Salute, San Raffaele Hospital, Milan, Italy
| | | | - Daniela Segala
- Clinic of Infectious Diseases, Sant’Anna Hospital, Ferrara, Italy
| | - Paolo Bonfanti
- Department of Infectious Diseases, Lecco Hospital, Lecco, Italy
| | | | - Enrico Barchi
- Department of Infectious Diseases, Santa Maria Nuova Hospital, Reggio Emilia, Italy
| | - Emanuele Focà
- Clinic of Infectious Diseases, University of Brescia and ASST Spedali Civili, Brescia, Italy
| | | | - Stefano Bonora
- Clinic of Infectious Diseases, University of Torino, Torino, Italy
| | - Daniela Francisci
- Clinic of Infectious Diseases, University of Perugia, Perugia, Italy
| | - Silvia Limonta
- Clinic of Infectious Diseases, DIBIC Luigi Sacco, University of Milan, Milan, Italy
| | - Andrea Antinori
- National Institute for Infectious Diseases L. Spallanzani, Rome, Italy
| | | | - Franco Maggiolo
- Department of Infectious Diseases, Bergamo Hospital, Bergamo, Italy
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62
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Parrino D, Brescia G, Trimarchi MV, Tealdo G, Sasset L, Cattelan AM, Bovo R, Marioni G. Cochlear-Vestibular Impairment due to West Nile Virus Infection. Ann Otol Rhinol Laryngol 2019; 128:1198-1202. [PMID: 31366220 DOI: 10.1177/0003489419866219] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES West Nile virus (WNV) has been spreading over the last 20 years. Human infection is asymptomatic in most cases. When the disease becomes clinically manifest, it may involve a range of issues, from a mild infection with flu-like symptoms to a neuroinvasive disease. Albeit rarely, WNV-associated sensorineural hearing loss (SNHL) has also been reported. Here we describe two new cases of SNHL and balance impairment caused by WNV infection. METHODS The patients were investigated with repeated audiometric tests and, for the first time, videonystagmography was also used. RESULTS Unlike findings in the few other published cases, an improvement in audiometric thresholds and vestibular function was documented in both of our patients. CONCLUSIONS In the light of our findings, a prospective study would be warranted on a large series of patients with WNV infection in order: (i) to better define the epidemiology of the related cochlear-vestibular involvement; and (ii) to elucidate the virus-related changes to peripheral and central auditory and vestibular functions.
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Affiliation(s)
- Daniela Parrino
- Department of Neuroscience DNS, Otolaryngology Section, Padova University, Padova, Italy
| | - Giuseppe Brescia
- Department of Neuroscience DNS, Otolaryngology Section, Padova University, Padova, Italy
| | | | - Giulia Tealdo
- Department of Neuroscience DNS, Otolaryngology Section, Padova University, Padova, Italy
| | - Lolita Sasset
- Unit of Tropical and Infectious Diseases, Azienda Ospedaliera- Padova University, Padova, Italy
| | - Anna Maria Cattelan
- Unit of Tropical and Infectious Diseases, Azienda Ospedaliera- Padova University, Padova, Italy
| | - Roberto Bovo
- Department of Neuroscience DNS, Otolaryngology Section, Padova University, Padova, Italy
| | - Gino Marioni
- Department of Neuroscience DNS, Otolaryngology Section, Padova University, Padova, Italy
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Ferrarese A, Vitale A, Sgarabotto D, Russo FP, Germani G, Gambato M, Cattelan AM, Angeli P, Cillo U, Burra P, Senzolo M. Outcome of a First Episode of Bacterial Infection in Candidates for Liver Transplantation. Liver Transpl 2019; 25:1187-1197. [PMID: 31021050 DOI: 10.1002/lt.25479] [Citation(s) in RCA: 3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Accepted: 04/22/2019] [Indexed: 12/13/2022]
Abstract
Bacterial infection (BI) is a major cause of worsening of liver function and death in patients with cirrhosis who are awaiting liver transplantation (LT). This study aimed to evaluate the outcome of LT candidates after a first episode of BI between January 2006 and December 2014 at Padua University Hospital. Among 876 LT candidates with cirrhosis, 114 (13%) experienced an episode of BI. Of the 114 patients, 79 were male and 35 were female, and the median (interquartile range) age and Model for End-Stage Liver Disease scores were 58 (12) years and 19 (8), respectively. When compared with matched LT candidates who experienced no BI, they had a higher probability of death (P = 0.004) and a lower probability of undergoing LT (P = 0.01). Considering only patients who recovered from BI within 30 days, their probabilities of death and of undergoing LT were similar to those of matched controls (P = 0.34 and P = 0.43, respectively). The 90-day post-LT mortality was equal between groups (P = 0.90). BI was a strong predictor of early death on the waiting list for LT. Conversely, patients who fully recovered from a BI episode within 30 days did not have a higher mortality risk than matched controls without infection.
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Affiliation(s)
- Alberto Ferrarese
- Multivisceral Transplant Unit, Department of Surgery, Oncology and Gastroenterology, Padua University Hospital, Padua, Italy
| | - Alessandro Vitale
- Hepatobiliary Surgery and Liver Transplant Center, Padua University Hospital, Padua, Italy
| | - Dino Sgarabotto
- Tropical and Infectious Diseases Unit, Padua University Hospital, Padua, Italy
| | - Francesco Paolo Russo
- Multivisceral Transplant Unit, Department of Surgery, Oncology and Gastroenterology, Padua University Hospital, Padua, Italy
| | - Giacomo Germani
- Multivisceral Transplant Unit, Department of Surgery, Oncology and Gastroenterology, Padua University Hospital, Padua, Italy
| | - Martina Gambato
- Multivisceral Transplant Unit, Department of Surgery, Oncology and Gastroenterology, Padua University Hospital, Padua, Italy
| | - Anna Maria Cattelan
- Tropical and Infectious Diseases Unit, Padua University Hospital, Padua, Italy
| | - Paolo Angeli
- Internal Medicine, Padua University Hospital, Padua, Italy
| | - Umberto Cillo
- Hepatobiliary Surgery and Liver Transplant Center, Padua University Hospital, Padua, Italy
| | - Patrizia Burra
- Multivisceral Transplant Unit, Department of Surgery, Oncology and Gastroenterology, Padua University Hospital, Padua, Italy
| | - Marco Senzolo
- Multivisceral Transplant Unit, Department of Surgery, Oncology and Gastroenterology, Padua University Hospital, Padua, Italy
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Piano MA, Gianesello L, Grassi A, Del Bianco P, Mattiolo A, Cattelan AM, Sasset L, Zanovello P, Calabrò ML. Circulating miRNA-375 as a potential novel biomarker for active Kaposi's sarcoma in AIDS patients. J Cell Mol Med 2018; 23:1486-1494. [PMID: 30549196 PMCID: PMC6349189 DOI: 10.1111/jcmm.14054] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 10/09/2018] [Accepted: 11/02/2018] [Indexed: 11/28/2022] Open
Abstract
The aim of this study was to identify circulating microRNAs (miRNAs) that could be used as biomarkers in patients at risk for or affected by AIDS‐Kaposi's sarcoma (KS). Screening of 377 miRNAs was performed using low‐density arrays in pooled plasma samples of 10 HIV/human herpesvirus 8 (HHV8)‐infected asymptomatic and 10 AIDS‐KS patients before and after successful combined antiretroviral therapy (cART). MiR‐375 was identified as a potential marker of active KS, being the most down‐regulated in AIDS‐KS patients after cART and the most up‐regulated in naïve AIDS‐KS patients compared to naïve asymptomatic subjects. Validation on individual plasma samples confirmed that miR‐375 levels were higher in AIDS‐KS compared to asymptomatic patients, decreased after cART‐induced remission in most AIDS‐KS patients and increased in patients with active KS. In asymptomatic patients miR‐375 was up‐regulated after cART in both screening and validation. Statistical analyses revealed an association between miR‐375 changes and CD4 cell counts, which could explain the discordant cases and the opposite trend between asymptomatic and AIDS‐KS patients. These data suggest that circulating miR‐375 might be a good indicator of active AIDS‐KS. Moreover, changes in miR‐375 levels may have a prognostic value in HIV/HHV8‐infected patients undergoing treatment. Further large‐scale validation is needed.
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Affiliation(s)
- Maria Assunta Piano
- Immunology and Molecular Oncology, Veneto Institute of Oncology IOV - IRCCS, Padova, Italy
| | - Lisa Gianesello
- Immunology and Molecular Oncology, Veneto Institute of Oncology IOV - IRCCS, Padova, Italy
| | - Angela Grassi
- Immunology and Molecular Oncology, Veneto Institute of Oncology IOV - IRCCS, Padova, Italy
| | - Paola Del Bianco
- Clinical Trials and Biostatistics, Veneto Institute of Oncology IOV - IRCCS, Padova, Italy
| | - Adriana Mattiolo
- Immunology and Molecular Oncology, Veneto Institute of Oncology IOV - IRCCS, Padova, Italy
| | - Anna Maria Cattelan
- Infectious and Tropical Diseases, Azienda Ospedaliera and University of Padova, Padova, Italy
| | - Lolita Sasset
- Infectious Diseases, ULSS 18 - Azienda Ospedaliera, Rovigo, Italy
| | - Paola Zanovello
- Immunology and Molecular Oncology, Veneto Institute of Oncology IOV - IRCCS, Padova, Italy.,Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
| | - Maria Luisa Calabrò
- Immunology and Molecular Oncology, Veneto Institute of Oncology IOV - IRCCS, Padova, Italy
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65
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Barzon L, Percivalle E, Pacenti M, Rovida F, Zavattoni M, Del Bravo P, Cattelan AM, Palù G, Baldanti F. Reply to Fontaine. Clin Infect Dis 2018; 67:1144-1145. [DOI: 10.1093/cid/ciy262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Luisa Barzon
- Department of Molecular Medicine, University of Padova, Italy
- Microbiology and Virology Unit, Padova University Hospital, Italy
| | - Elena Percivalle
- Molecular Virology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Monia Pacenti
- Microbiology and Virology Unit, Padova University Hospital, Italy
| | - Francesca Rovida
- Molecular Virology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Maurizio Zavattoni
- Molecular Virology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | | | - Giorgio Palù
- Department of Molecular Medicine, University of Padova, Italy
- Microbiology and Virology Unit, Padova University Hospital, Italy
| | - Fausto Baldanti
- Molecular Virology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Italy
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66
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Nozza S, Malagoli A, Maia L, Calcagno A, Focà E, De Socio G, Piconi S, Orofino G, Cattelan AM, Celesia BM, Gervasi E, Guaraldi G. Antiretroviral therapy in geriatric HIV patients: the GEPPO cohort study. J Antimicrob Chemother 2018; 72:2879-2886. [PMID: 28605493 DOI: 10.1093/jac/dkx169] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 04/28/2017] [Indexed: 02/01/2023] Open
Abstract
Background GEPPO is a prospective observational multi-centric cohort including HIV-infected geriatric patients. We hypothesized that the GEPPO cohort may help characterize antiretroviral (ARV) prescribing criteria used in real life by Italian infectious disease (ID) physicians. Methods This was a cross-sectional study describing the current ARV regimen in a geriatric HIV population (≥65 years). Antiretroviral strategies were categorized as follows: (i) multidrug regimens (MDRs), which comprised triple or mega ART combinations; (ii) less drug regimens (LDRs), which comprised fewer than three ART compounds. Multi-morbidity (MM) was defined as the presence of three or more non-communicable diseases, and polypharmacy (PP) as the use of five or more medications in chronic use. Four alternative combinations (MM+PP+, MM+PP-, MM-PP+, MM-PP-) were used in logistic regression analyses. Results A total of 1222 HIV-positive patients were included (median age 70 years). Females composed 16% of the cohort. Median duration of HIV infection was 17 years; 335 population members had been infected for >20 years. MM was present in 64% and PP in 37% of the patients. Treatment consisted of triple therapy in 66.4%, dual therapy in 25.3%, monotherapy in 6.5% and 'mega-ART' with more than three drugs in 1.64% of the patients. In multivariate logistic regression MM and PP were predictive for mono-dual, NRTI-sparing and tenofovir disoproxil fumarate (TDF)-sparing combinations. Female gender and age were predictors of unboosted ARV regimens. Conclusions High prevalence of non-conventional ARV regimens in elderly HIV patients suggests that clinicians try to tailor ARV regimens according to age, HIV duration, MM and PP.
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Affiliation(s)
- Silvia Nozza
- Department of Infectious Diseases, San Raffaele Scientific Institute, Milano, Italy
| | - Andrea Malagoli
- University of Modena and Reggio Emilia, Department of Mother, Child and Adult Medicine and Surgical Science, Infectious Disease Clinic, Modena, Italy
| | - Lilian Maia
- Department of Infectious Diseases of Centro Hospitalar do Porto, Porto, Portugal
| | - Andrea Calcagno
- Unit of Infectious Diseases, Department of Medical Sciences, University of Torino, Torino, Italy
| | - Emanuele Focà
- Department of Infectious and Tropical Diseases, University of Brescia, Brescia, Italy
| | - Giuseppe De Socio
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria di Perugia, Perugia, Italy
| | - Stefania Piconi
- 1st Division of Infectious Diseases Unit, University of Milano, Ospedale L. Sacco, Milano, Italy
| | - Giancarlo Orofino
- Unit of Infectious Diseases, 'Divisione A', Ospedale Amedeo di Savoia, ASLTO2, Torino, Italy
| | - Anna Maria Cattelan
- Unit of Infectious Diseases, Department of Internal Medicine, Azienda Ospedaliero-Universitaria di Padova, Padova, Italy
| | - Benedetto Maurizio Celesia
- Department of Clinical and Molecular Biomedicine, Division of Infectious Diseases, University of Catania, ARNAS Garibaldi, Catania, Italy
| | - Elena Gervasi
- 3rd Division of Infectious Diseases, University of Milano, Ospedale L. Sacco, Milano, Italy
| | - Giovanni Guaraldi
- University of Modena and Reggio Emilia, Department of Mother, Child and Adult Medicine and Surgical Science, Infectious Disease Clinic, Modena, Italy
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Aversa SM, Cattelan AM, Salvagno L, Meneghetti F, Francavilla E, Sattin L, Sasset L, Cadrobbi P. Chemo-Immunotherapy of Advanced Aids-Related Kaposi'S Sarcoma. Tumori 2018; 85:54-9. [PMID: 10228499 DOI: 10.1177/030089169908500112] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Aims and background Kaposi's sarcoma (KS) is the most common neoplastic complication of HIV infection and AIDS. Multiple cytotoxic chemotherapy regimens have been used with various response rates. We have evaluated the efficacy and toxicity of low-dose chemotherapy in patients with poor-prognosis AIDS-related KS and the role of interferon alpha (IFN-α) in complete responders. Methods Twenty-five previously untreated patients with advanced KS received bleomycin (BL) 10 mg/m2 and vinblastine (VB) 6 mg/m2 on days 1 and 15 every two weeks. After six cycles, patients in complete remission received IFN-alpha (3 million U s.c. 3 times/week) combined with antiretroviral therapy. All patients were evaluated for toxicity using the World Health Organization (WHO) toxicity schedule. Both Eastern Cooperative Oncology Group (ECOG) and AIDS Clinical Trials Group (ACTG) response criteria were used to evaluate response and survival. Results The overall response rate was 84% (95% confidence interval, 51–117%) with six complete remissions (24%) and 15 partial remissions (60%) by ECOG criteria, and 92% (95% confidence interval: 58–128%) with 17 partial remissions (68%) by ACTG criteria. The median duration of response on IFN-alpha treatment was 4.5 months (range, 2–10). The overall median survival duration for all 25 patients was 9 months (range, 2–39). Grade 3–4 anemia was observed in five patients and grade 3–4 neutropenia in two patients. No other clinically significant (> grade 3) toxicities were observed. Conclusions Combination of BL and VB is effective and well tolerated, even if new therapeutic options are developing. This disease remains a challenging problem, so larger studies using the combination of chemotherapy and/or IFN-alpha with antiretroviral treatment are warranted.
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Affiliation(s)
- S M Aversa
- Division of Medical Oncology, Padua General Hospital, Italy
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Guaraldi G, Malagoli A, Calcagno A, Mussi C, Celesia BM, Carli F, Piconi S, De Socio GV, Cattelan AM, Orofino G, Riva A, Focà E, Nozza S, Di Perri G. The increasing burden and complexity of multi-morbidity and polypharmacy in geriatric HIV patients: a cross sectional study of people aged 65 - 74 years and more than 75 years. BMC Geriatr 2018; 18:99. [PMID: 29678160 PMCID: PMC5910563 DOI: 10.1186/s12877-018-0789-0] [Citation(s) in RCA: 106] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 04/12/2018] [Indexed: 02/06/2023] Open
Abstract
Background Geriatric Patients Living with HIV/AIDS (GEPPO) is a new prospective observational multicentre cohort consisting of all the HIV-positive geriatric patients being treated at 10 clinics in Italy, and HIV-negative controls attending a single geriatric clinic. The aim of this analysis of the GEPPO cohort was to compare prevalence and risk factors of individual non-communicable diseases (NCD), multi-morbidity (MM) and polypharmacy (PP) amongst HIV positive and HIV negative controls at enrolment into the GEPPO cohort. Methods This cross-sectional study was conducted between June 2015 and May 2016. The duration of HIV infection was subdivided into three intervals: < 10, 10–20 and > 20 years. The NCD diagnoses were based on guidelines defined criteria, including cardiovascular disease, hypertension, type 2 diabetes, chronic kidney disease, dyslipidaemia, chronic obstructive pulmonary disease. MM was classified as the presence of two or more co-morbidities. The medications prescribed for the treatment of comorbidities were collected in both HIV positive and HIV negative group from patient files and were categorized using the Anatomical Therapeutic Chemical (ATC) classification. PP was defined as the presence of five or more drug components other than anti-retroviral agents. Results The study involved a total of 1573 patient: 1258 HIV positive and 315 HIV negative). The prevalence of individual comorbidities was similar in the two groups with the exception of dyslipidaemia, which was more frequent in the HIV-positive patients (p < 0.01). When the HIV-positive group was stratified based on the duration of HIV infection, most of the co-morbidities were significantly more frequent than in control patients, except for hypertension and cardiovascular disease, while COPD was more prevalent in the control group. MM and PP were both more prevalent in the HIV-positive group, respectively 64% and 37%. Conclusions MM and PP burden in geriatric HIV positive patients are related to longer duration of HIV-infection rather than older age per se.
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Affiliation(s)
- G Guaraldi
- Infectious Disease Clinic, Department of Medical and Surgical Sciences for Children & Adults, University of Modena and Reggio Emilia, Modena, Italy.
| | - A Malagoli
- Infectious Disease Clinic, Department of Medical and Surgical Sciences for Children & Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - A Calcagno
- Unit of Infectious Diseases, Department of Medical Sciences, University of Turin, Turin, Italy
| | - C Mussi
- Centre of Gerontological Evaluation and Research, University of Modena and Reggio Emilia, Modena, Italy
| | - B M Celesia
- Department of Clinical and Molecular Biomedicine, Division of Infectious Diseases, University of Catania, ARNAS Garibaldi, Catania, Italy
| | - F Carli
- Infectious Disease Clinic, Department of Medical and Surgical Sciences for Children & Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - S Piconi
- First Division of Infectious Diseases Unit, University of Milan, Ospedale L. Sacco, Milan, Italy
| | - G V De Socio
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria di Perugia, Perugia, Italy
| | - A M Cattelan
- Unit of Infectious Diseases, Department of Internal Medicine, Azienda Ospedaliera-Universitaria di Padova, Padua, Italy
| | - G Orofino
- Unit of Infectious Diseases, Division A, Ospedale Amedeo di Savoia, ASLTO2, Turin, Italy
| | - A Riva
- Third Division of Infectious Diseases, University of Milan, Ospedale L. Sacco, Milan, Italy
| | - E Focà
- Unit of Infectious and Tropical Diseases, University of Brescia, Brescia, Italy
| | - S Nozza
- Department of Infectious Diseases, San Raffaele Scientific Institute, Milan, Italy
| | - G Di Perri
- Unit of Infectious Diseases, Department of Medical Sciences, University of Turin, Turin, Italy
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Capetti AF, Cossu MV, Orofino G, Sterrantino G, Cenderello G, De Socio GV, Cattelan AM, Soria A, Rusconi S, Riccardi N, Baldin GM, Niero FP, Barbarini G, Rizzardini G. A dual regimen of ritonavir/darunavir plus dolutegravir for rescue or simplification of rescue therapy: 48 weeks' observational data. BMC Infect Dis 2017; 17:658. [PMID: 28964268 PMCID: PMC5622573 DOI: 10.1186/s12879-017-2755-4] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 09/21/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Dolutegravir (DTG) plus darunavir/ritonavir (DRV/r) is a simple combination of drugs that has the best genetic barrier to HIV-1 resistance and may be fit for salvage therapy. METHODS All HIV-1-infected subjects treated with DTG plus DRV/r between March 2014 and September 2015 in eight Italian centres were included in the analysis. The main metabolic data, efficacy parameters and safety data routinely collected were provided. This observational study is aimed to assess the efficacy of such approach. The primary end-point was the proportion of subjects achieving or maintaining virologic suppression <50 copies/mL at week 24. Secondary end points were maintaining virologic suppression in the follow-up (weeks 48 and 96) and safety. RESULTS One hundred and thirty subjects were followed for a median of 56 months. Reasons for switching were simplification (44.6%), viral failure (30%), toxicity (16.9%), non-adherence (4.6%), persistent low-level viremia (3.1%), and drug-drug interaction (0.8%). At baseline, 118 subjects had documented resistance to 1 to 5 antiretroviral classes while 12 had viral rebound at a time when genotypic tests were not yet available. Seventeen and 14 subjects took DRV/r and DTG twice daily, respectively. One subject was lost to follow-up, one discontinued for liver enzymes' elevation, one died of illicit drug abuse and one of cancer-related complications. The proportion of subjects with ongoing HIV replication dropped from 40% to 6.1%. Those with undetectable viral load increased from 38.5% to 76.2%. At week 48, 17.7% had HIV RNA between 1 and 49 copies/mL. The number of subjects with altered serum glucose, creatinine, ALT, AST, total-, HDL- and LDL-cholesterol, triglycerides and MDRD <90 mL/min decreased by week 48, while those having MDRD <60 mL/min remained 4.6%. Overall 90/283 baseline laboratory alterations returned to normality. CONCLUSIONS Switching to DTG plus DRV/r proved to be safe, suppressing viral replication without metabolic impact.
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Affiliation(s)
- Amedeo F Capetti
- 1st Division of Infectious Diseases, ASST Fatebenefratelli-Sacco, Via Giovanni Battista Grassi, 74, pavillion 56, Malattie Infettive, 2nd floor, 20157, Milan, Italy.
| | - Maria Vittoria Cossu
- 1st Division of Infectious Diseases, ASST Fatebenefratelli-Sacco, Via Giovanni Battista Grassi, 74, pavillion 56, Malattie Infettive, 2nd floor, 20157, Milan, Italy
| | - Giancarlo Orofino
- 1st Division of Infectious Diseases Amedeo di Savoia Hospital, Torino, Italy
| | | | | | - Giuseppe V De Socio
- Infectious Diseases Clinic, Azienda Ospedaliero-Universitaria di Perugia, Perugia, Italy
| | - Anna Maria Cattelan
- Infectious and Tropical Diseases, Azienda Ospedaliera-Universitaria di Padova, Padova, Italy
| | - Alessandro Soria
- Clinic of Infectious Diseases, San Gerardo Hospital, ASST Monza, University of Milano-Bicocca, Monza, Italy
| | - Stefano Rusconi
- Infectious Diseases Clinic, DIBIC Luigi Sacco, University of Milano, Milano, Italy
| | - Niccolò Riccardi
- Infectious Diseases Clinic, "San Martino" Hospital, Genova, Italy
| | - Gian Maria Baldin
- 2nd Division of Infectious Diseases, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Fosca P Niero
- 1st Division of Infectious Diseases, ASST Fatebenefratelli-Sacco, Via Giovanni Battista Grassi, 74, pavillion 56, Malattie Infettive, 2nd floor, 20157, Milan, Italy
| | - Giorgio Barbarini
- 2nd Division of Infectious Diseases, "Policlinico San Matteo" Hospital, Pavia, Italy
| | - Giuliano Rizzardini
- 1st Division of Infectious Diseases, ASST Fatebenefratelli-Sacco, Via Giovanni Battista Grassi, 74, pavillion 56, Malattie Infettive, 2nd floor, 20157, Milan, Italy.,Whitwaterstrand University, Johannesburg, South Africa
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Petrara MR, Cattelan AM, Sasset L, Freguja R, Carmona F, Sanavia S, Zanchetta M, Del Bianco P, De Rossi A. Impact of monotherapy on HIV-1 reservoir, immune activation, and co-infection with Epstein-Barr virus. PLoS One 2017; 12:e0185128. [PMID: 28926641 PMCID: PMC5605085 DOI: 10.1371/journal.pone.0185128] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2017] [Accepted: 09/05/2017] [Indexed: 01/03/2023] Open
Abstract
Objectives Although monotherapy (mART) effectiveness in maintaining viral suppression and CD4 cell count has been extensively examined in HIV-1-infected patients, its impact on HIV-1 reservoir, immune activation, microbial translocation and co-infection with Epstein-Barr Virus (EBV) is unclear. Methods This retrospective study involved 32 patients who switched to mART; patients were studied at baseline, 48 and 96 weeks after mART initiation. Thirty-two patients who continued combined antiretroviral therapy (cART) over the same period of time were included in the study. Markers of HIV-1 reservoir (HIV-1 DNA and intracellular HIV-1 RNA) were quantified by real-time PCR. Markers of T-(CD3+CD8+CD38+) and B-(CD19+CD80/86+ and CD19+CD10-CD21lowCD27+) cell activation were evaluated by flow cytometry. Plasma levels of microbial translocation markers were quantified by real-time PCR (16S ribosomal DNA and mitochondrial [mt]DNA) or by ELISA (LPS and sCD14). EBV was typed and quantified by multiplex real-time PCR. Results At baseline, no differences were found between mART and cART groups. Three (10%) mART-treated patients had a virological failure vs none in the cART group. Levels of HIV-1 DNA, intracellular HIV-1 RNA and EBV-DNA remained stable in the mART group, while decreased significantly in the cART group. Percentages of T- and B-activated cells significantly increased in the mART-treated patients, while remained at low levels in the cART-treated ones (p = 0.014 and p<0.001, respectively). Notably, levels of mtDNA remained stable in the cART group, but significantly rose in the mART one (p<0.001). Conclusions Long-term mART is associated with higher levels of T- and B-cell activation and, conversely to cART, does not reduce the size of HIV-1 reservoir and EBV co-infection.
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Affiliation(s)
- Maria Raffaella Petrara
- Department of Surgery, Oncology and Gastroenterology, Section of Oncology and Immunology, AIDS Reference Centre, University of Padova, Padova, Italy
| | - Anna Maria Cattelan
- Division of Infectious and Tropical Diseases, Azienda Ospedaliera and University of Padova, Padova, Italy
| | - Lolita Sasset
- Division of Infectious Disease, Azienda Ospedaliera of Rovigo, Rovigo, Italy
| | - Riccardo Freguja
- Department of Surgery, Oncology and Gastroenterology, Section of Oncology and Immunology, AIDS Reference Centre, University of Padova, Padova, Italy
| | | | | | | | | | - Anita De Rossi
- Department of Surgery, Oncology and Gastroenterology, Section of Oncology and Immunology, AIDS Reference Centre, University of Padova, Padova, Italy
- Istituto Oncologico Veneto (IOV)-IRCCS, Padova, Italy
- * E-mail:
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Parisi SG, Andreis S, Basso M, Cavinato S, Scaggiante R, Franzetti M, Andreoni M, Palù G, Cattelan AM. Time course of cellular HIV-DNA and low-level HIV viremia in HIV-HCV co-infected patients whose HCV infection had been successfully treated with directly acting antivirals. Med Microbiol Immunol 2017; 206:419-428. [PMID: 28864951 DOI: 10.1007/s00430-017-0518-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [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: 07/04/2017] [Accepted: 08/27/2017] [Indexed: 12/21/2022]
Abstract
This longitudinal study described cellular HIV-DNA changes and their correlation with HIV low-level plasma viremia (LLV) in HIV-HCV co-infected patients on successful antiretroviral and anti-HCV therapy by treatment with direct-acting antivirals (DAA). Thirty-nine patients were examined prior to the start of DAA (T0), after week 12 (T1) and 24 weeks (T2) of anti-HCV therapy. Cellular PBMC HIV-DNA was analysed as an absolute value and as the percentage of increase or decrease from T0 to T2. Patients were classified as having undetectable plasma HIV viraemia (UV) or LLV in the year before the start of anti-HCV treatment and within the T0-T2 study period. Thirty-five patients (89.7%) of the 39 subjects enrolled had the same plasma HIV viraemia control in the year before HCV treatment and in the T0-T2 interval. The HIV-DNA value at T0 and at T2 was higher in patients with LLV than in subjects with UV (p = 0.015 and p = 0.014, respectively). A similar proportion of patients with LLV and UV experienced an increase or decrease of HIV-DNA from T0 to T2. The percentage increase in HIV-DNA value (262.8%) from T0 to T2 was higher compared to the decrease (43.5%) in patients with UV (p = 0.012), and it was higher compared to the percentage increase in HIV-DNA value reported in subjects with LLV (262.8 versus 49%, p = 0.026). HIV-HCV co-infected patients experienced a multifaceted perturbation of cellular HIV-DNA levels within a 24-week period during anti-HCV treatment; the extent of the phenomenon was greater in subjects with UV. Fast HCV-RNA clearance seemed to have a greater influence on the cellular reservoir than on plasma HIV-RNA.
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Affiliation(s)
- Saverio G Parisi
- Department of Molecular Medicine, University of Padova, Via Gabelli 63, 35100, Padua, Italy.
| | - Samantha Andreis
- Department of Molecular Medicine, University of Padova, Via Gabelli 63, 35100, Padua, Italy
| | - Monica Basso
- Department of Molecular Medicine, University of Padova, Via Gabelli 63, 35100, Padua, Italy
| | - Silvia Cavinato
- Infectious Diseases Unit, Padova Hospital, Via Giustiniani, 2, 35128, Padua, Italy
| | - Renzo Scaggiante
- Infectious Diseases Unit, Padova Hospital, Via Giustiniani, 2, 35128, Padua, Italy
| | - Marzia Franzetti
- Infectious Diseases Unit, Padova Hospital, Via Giustiniani, 2, 35128, Padua, Italy
| | - Massimo Andreoni
- Clinical Infectious Diseases, Tor Vergata University, Viale Oxford, 81, 00133, Rome, Italy
| | - Giorgio Palù
- Department of Molecular Medicine, University of Padova, Via Gabelli 63, 35100, Padua, Italy
| | - Anna Maria Cattelan
- Infectious Diseases Unit, Padova Hospital, Via Giustiniani, 2, 35128, Padua, Italy
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Nozza S, Malagoli A, Maia L, Calcagno A, Focà E, De Socio G, Piconi S, Orofino G, Cattelan AM, Celesia BM, Gervasi E, Guaraldi G. Antiretroviral therapy in geriatric HIV patients: the GEPPO cohort study. J Antimicrob Chemother 2017; 72:2961. [DOI: 10.1093/jac/dkx282] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Parisi SG, Basso M, Mengoli C, Scaggiante R, Andreis S, Franzetti MM, Cattelan AM, Zago D, Cruciani M, Andreoni M, Piovesan S, Palù G, Alberti A. Liver stiffness is not associated with short- and long-term plasma HIV RNA replication in immunocompetent patients with HIV infection and with HIV/HCV coinfection. Ann Gastroenterol 2017; 30:534-541. [PMID: 28845109 PMCID: PMC5566774 DOI: 10.20524/aog.2017.0175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 06/06/2017] [Indexed: 12/24/2022] Open
Abstract
Background Human immunodeficiency virus (HIV) may be directly responsible for liver damage but there are contrasting data regarding the influence of detectable plasma viremia. We analyzed the influence of plasma HIV RNA (pHIV) detectability and of other clinical and viro-immunological variables on liver stiffness (LS) measurement in adult immunocompetent HIV-monoinfected patients and in patients coinfected with hepatitis C virus (HCV). Methods Logistic regression analysis was performed using the value of LS>7.1 kPa as the dependent variable. A linear regression model was applied using LS measurement after log10 transformation (lkpa) as the dependent variable and we analyzed the predicted values versus the observed lkpa values; pHIV was classified as detectable or undetectable in the 12- and 36-month study periods before LS measurement. Results We studied 251 patients (178 with HIV monoinfection), most of whom were on antiviral treatment; 36-month study time was available for 154 subjects. The mean CD4+ cell count was 634 cells/mm3 in HIV-monoinfected patients and 606 cells/mm3 in coinfected patients. No difference in LS was found between patients with detectable or undetectable pHIV in either the 12- or the 36-month study period before transient elastography. The mean LS was higher in HIV/HCV coinfected patients (P<0.0001) than in the HIV-monoinfected subjects; lkpa was positively correlated with HCV coinfection (P<0.0001) and aspartate aminotransferase levels (P<0.0001). Detectable pHIV failed to reach significance. Eight HIV-monoinfected patients had a predicted LS measurement lower than the observed one, while eight patients had the opposite result. Conclusion LS was not correlated with ongoing HIV replication during the 12- and 36-month study periods in immunocompetent HIV-monoinfected and HIV/HCV-coinfected patients.
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Affiliation(s)
- Saverio Giuseppe Parisi
- Department of Molecular Medicine, University of Padova, Padova (Saverio Giuseppe Parisi, Monica Basso, Carlo Mengoli, Samantha Andreis, Daniela Zago, Sara Piovesan, Giorgio Palù, Alfredo Alberti), Italy
| | - Monica Basso
- Department of Molecular Medicine, University of Padova, Padova (Saverio Giuseppe Parisi, Monica Basso, Carlo Mengoli, Samantha Andreis, Daniela Zago, Sara Piovesan, Giorgio Palù, Alfredo Alberti), Italy
| | - Carlo Mengoli
- Department of Molecular Medicine, University of Padova, Padova (Saverio Giuseppe Parisi, Monica Basso, Carlo Mengoli, Samantha Andreis, Daniela Zago, Sara Piovesan, Giorgio Palù, Alfredo Alberti), Italy
| | - Renzo Scaggiante
- Infectious Disease Unit, Padova Hospital, Padova (Renzo Scaggiante, Marzia Maria Franzetti, Anna Maria Cattelan), Italy
| | - Samantha Andreis
- Department of Molecular Medicine, University of Padova, Padova (Saverio Giuseppe Parisi, Monica Basso, Carlo Mengoli, Samantha Andreis, Daniela Zago, Sara Piovesan, Giorgio Palù, Alfredo Alberti), Italy
| | - Marzia Maria Franzetti
- Infectious Disease Unit, Padova Hospital, Padova (Renzo Scaggiante, Marzia Maria Franzetti, Anna Maria Cattelan), Italy
| | - Anna Maria Cattelan
- Infectious Disease Unit, Padova Hospital, Padova (Renzo Scaggiante, Marzia Maria Franzetti, Anna Maria Cattelan), Italy
| | - Daniela Zago
- Department of Molecular Medicine, University of Padova, Padova (Saverio Giuseppe Parisi, Monica Basso, Carlo Mengoli, Samantha Andreis, Daniela Zago, Sara Piovesan, Giorgio Palù, Alfredo Alberti), Italy
| | - Mario Cruciani
- Center of Diffusive Diseases, ULSS 20, Verona (Mario Cruciani), Italy
| | - Massimo Andreoni
- Clinical Infectious Diseases, Tor Vergata University of Rome, Rome (Massimo Andreoni), Italy
| | - Sara Piovesan
- Department of Molecular Medicine, University of Padova, Padova (Saverio Giuseppe Parisi, Monica Basso, Carlo Mengoli, Samantha Andreis, Daniela Zago, Sara Piovesan, Giorgio Palù, Alfredo Alberti), Italy
| | - Giorgio Palù
- Department of Molecular Medicine, University of Padova, Padova (Saverio Giuseppe Parisi, Monica Basso, Carlo Mengoli, Samantha Andreis, Daniela Zago, Sara Piovesan, Giorgio Palù, Alfredo Alberti), Italy
| | - Alfredo Alberti
- Department of Molecular Medicine, University of Padova, Padova (Saverio Giuseppe Parisi, Monica Basso, Carlo Mengoli, Samantha Andreis, Daniela Zago, Sara Piovesan, Giorgio Palù, Alfredo Alberti), Italy
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Marinello S, Marini G, Parisi G, Gottardello L, Rossi L, Besutti V, Cattelan AM. Vibrio cholerae non-O1, non-O139 bacteraemia associated with pneumonia, Italy 2016. Infection 2016; 45:237-240. [PMID: 27837335 DOI: 10.1007/s15010-016-0961-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Accepted: 11/03/2016] [Indexed: 11/26/2022]
Abstract
This paper describes an elderly male patient, living in the Veneto Region, Italy, who developed Vibrio cholerae bacteraemia and pneumonia. Some days previously, while on holiday in the Lagoon of Venice, he had been collecting clams in seawater, during which he suffered small abrasions of the skin. On admission to hospital, he was confused, had fever and a cough, but neither diarrhoea nor signs of gastroenteritis were found. Both blood and stool cultures grew V. cholerae of non-O1 non-O-139 type, and the patient recovered after prompt administration of intravenous ceftriaxone for 2 weeks. This clinical case emphasises the role of global warming and climate changes in causing increasing numbers of water-borne infections.
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Affiliation(s)
- Serena Marinello
- Department of Infectious Diseases, Azienda Ospedaliera and University of Padova, Padua, Italy.
| | - Giulia Marini
- Department of Infectious Diseases, Azienda Ospedaliera and University of Padova, Padua, Italy
| | - Giancarlo Parisi
- Department of Internal Medicine, Hospital of Piove di Sacco, Padua, Italy
| | - Lorena Gottardello
- Department of Hygiene and Public Health, Azienda Ospedaliera and University of Padova, Padua, Italy
| | - Lucia Rossi
- Department of Microbiology, Azienda Ospedaliera and University of Padova, Padua, Italy
| | - Valeria Besutti
- Department of Microbiology, Azienda Ospedaliera and University of Padova, Padua, Italy
| | - Anna Maria Cattelan
- Department of Infectious Diseases, Azienda Ospedaliera and University of Padova, Padua, Italy
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Parisi SG, Loregian A, Andreis S, Nannetti G, Cavinato S, Basso M, Scaggiante R, Dal Bello F, Messa L, Cattelan AM, Palù G. Daclatasvir plasma level and resistance selection in HIV patients with hepatitis C virus cirrhosis treated with daclatasvir, sofosbuvir, and ribavirin. Int J Infect Dis 2016; 49:151-3. [PMID: 27378577 DOI: 10.1016/j.ijid.2016.06.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Revised: 06/12/2016] [Accepted: 06/28/2016] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVES Effective treatment with direct-acting antiviral drugs against hepatitis C virus (HCV) is a medical need in cirrhotic HIV-HCV co-infected patients. METHODS This study investigated the plasma levels of daclatasvir (DCV) and ribavirin (RBV) in HIV-HCV co-infected subjects treated with DCV, sofosbuvir, and RBV. Drug concentrations were quantified using validated high-performance liquid chromatography methods with ultraviolet detection. The HCV non-structural protein 5A and non-structural protein 5B coding regions were analyzed by population-based sequencing. RESULTS DCV was dosed at week 4 and at week 8 of treatment, and RBV at week 8. One patient had the lowest DCV level, corresponding to 32.7% of the overall median value of the other patients at week 4 and about 40% at week 8. The Y93H variant was detected in this subject at weeks 8, 16, and 20 of treatment, but not before treatment or at day 2, and the patient experienced virological failure. Another subject with the Y93H variant at baseline and appropriate DCV levels had HCV RNA <12 IU/ml at week 12 and undetectable at week 16. CONCLUSIONS Sub-optimal DCV drug levels allow the selection of resistance-associated variants and fail to contribute to antiviral activity. No definite reason for the low DCV level was found. Quantifying the drug is suggested in difficult-to-treat patients.
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Affiliation(s)
- Saverio G Parisi
- Department of Molecular Medicine, University of Padova, Via Gabelli 63, 35100 Padova, Italy.
| | - Arianna Loregian
- Department of Molecular Medicine, University of Padova, Via Gabelli 63, 35100 Padova, Italy
| | - Samantha Andreis
- Department of Molecular Medicine, University of Padova, Via Gabelli 63, 35100 Padova, Italy
| | - Giulio Nannetti
- Department of Molecular Medicine, University of Padova, Via Gabelli 63, 35100 Padova, Italy
| | | | - Monica Basso
- Department of Molecular Medicine, University of Padova, Via Gabelli 63, 35100 Padova, Italy
| | | | - Federico Dal Bello
- Department of Molecular Medicine, University of Padova, Via Gabelli 63, 35100 Padova, Italy
| | - Lorenzo Messa
- Department of Molecular Medicine, University of Padova, Via Gabelli 63, 35100 Padova, Italy
| | | | - Giorgio Palù
- Department of Molecular Medicine, University of Padova, Via Gabelli 63, 35100 Padova, Italy
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Cattelan AM, Mattiolo A, Grassi A, Piano MA, Sasset L, Trevenzoli M, Zanovello P, Calabrò ML. Predictors of immune reconstitution inflammatory syndrome associated with Kaposi's sarcoma: a case report. Infect Agent Cancer 2016; 11:5. [PMID: 26848307 PMCID: PMC4740995 DOI: 10.1186/s13027-016-0051-3] [Citation(s) in RCA: 8] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Accepted: 01/21/2016] [Indexed: 12/05/2022] Open
Abstract
We present here a case of immune reconstitution inflammatory syndrome associated with Kaposi’s sarcoma (KS-IRIS) developed in an AIDS patient two months after initiation of antiretroviral therapy (ART). Baseline characteristics of this IRIS-KS case, within a cohort of 12 naïve AIDS-KS patients, were analyzed. No statistically significant differences in CD4 cell counts, plasma HIV RNA load, KS clinical staging, human herpesvirus 8 (HHV8) antibody titers and HHV8 load in peripheral blood mononuclear cells and saliva were evidenced. HHV8 load in plasma was found to be significantly higher in the KS-IRIS patient (> 6 log10 genome equivalents/ml, p = 0.01, t–test) compared to the 11 patients with KS regression. This case highlights that measurement of HHV8 load in plasma may be useful to identify patients at risk for KS-IRIS, and that this parameter should be included in the design of larger studies to define KS-IRIS risk predictors.
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Affiliation(s)
- Anna Maria Cattelan
- Infectious and Tropical Diseases, Azienda Ospedaliera and University of Padova, Padova, Italy
| | - Adriana Mattiolo
- Immunology and Molecular Oncology, Veneto Institute of Oncology, IOV IRCCS, Padova, Italy
| | - Angela Grassi
- Immunology and Molecular Oncology, Veneto Institute of Oncology, IOV IRCCS, Padova, Italy
| | - Maria Assunta Piano
- Immunology and Molecular Oncology, Veneto Institute of Oncology, IOV IRCCS, Padova, Italy
| | - Lolita Sasset
- Infectious Diseases, ULSS 18 - Azienda Ospedaliera, Rovigo, Italy
| | - Marco Trevenzoli
- Department of Infectious and Tropical Diseases, University of Padova, School of Medicine, Padova, Italy
| | - Paola Zanovello
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
| | - Maria Luisa Calabrò
- Immunology and Molecular Oncology, Veneto Institute of Oncology, IOV IRCCS, Padova, Italy
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Nasta P, Maida I, Cattelan AM, Pontali E, Angeli E, Giralda M, Verucchi G, Caputo A, Iannacone C, Puoti M, Carosi G. Effect of aging, glucose level, and HIV viral load on response to treatment with pegylated interferon plus ribavirin in HIV/HCV co-infected women. J Womens Health (Larchmt) 2015; 24:159-64. [PMID: 25682817 DOI: 10.1089/jwh.2014.4796] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND This was a post-hoc analysis of the Optimized Pegylated interferons Efficacy and anti-Retroviral Approach (OPERA) study, originally designed to document routine clinical and treatment data in HIV/HCV coinfected patients treated with pegylated interferon/ribavirin (PEG-IFN/RBV). The aim of this study was to define the impact of several variables, such as age, glucose metabolism, and HIV viral load, on PEG-IFN/RBV treatment outcomes, in HIV/HCV coinfected women. METHODS Female subjects from the OPERA database were retrospectively evaluated and factors associated with sustained virological response (SVR) were assessed and compared to the male population by logistic regression analysis. At baseline, clinical and demographic data were collected. Patients were then administered with PEG-IFN/RBV therapy for 48 weeks. After a 24-week follow-up period, SVR was evaluated. RESULTS A total of 1523 patients were enrolled in 98 centers across Italy, 1284 of whom were IFN therapy naïve and were included in the post-hoc analysis. In the female group, factors associated with SVR were the presence of HCV genotype 2,3 (adjusted odds ratio [AOR]=6.87, p<0.0001), age ≤45 years (AOR=2.61, p=0.014), ≥80% exposure to PEG-IFN (AOR=3.85, p=0.019) and RBV (AOR=3.94, p=0.015) therapy. Also, increased glucose plasma level negatively correlated with SVR (AOR=0.98, p=0.066). In the male population, undetectable HIV-RNA (AOR=1.47, p=0.033) but not glucose level (AOR=1.0, p=0.95) predicted SVR. CONCLUSIONS Findings from the present study demonstrate that several factors may be predictive of SVR when pegylated interferon plus ribavirin is used (i.e., age, gender, HIV viral load and HCV genotype) that need to be carefully considered prior to therapeutic intervention, since they may hinder successful therapy. Use of PEG-IFN/RBV with novel direct antiviral agents will likely be still maintained until less expensive and effective interferon-free strategies become available.
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Affiliation(s)
- Paola Nasta
- 1 University Division of Infectious and Tropical Diseases, University of Brescia and Spedali Civili General Hospital , Brescia, Italy
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Gobbi F, Capelli G, Angheben A, Giobbia M, Conforto M, Franzetti M, Cattelan AM, Raise E, Rovere P, Mulatti P, Montarsi F, Drago A, Barzon L, Napoletano G, Zanella F, Pozza F, Russo F, Rosi P, Palù G, Bisoffi Z. Human and entomological surveillance of West Nile fever, dengue and chikungunya in Veneto Region, Italy, 2010-2012. BMC Infect Dis 2014; 14:60. [PMID: 24499011 PMCID: PMC3922982 DOI: 10.1186/1471-2334-14-60] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2013] [Accepted: 01/30/2014] [Indexed: 11/23/2022] Open
Abstract
Background Since 2010 Veneto region (North-Eastern Italy) planned a special integrated surveillance of summer fevers to promptly identify cases of West Nile Fever (WNF), dengue (DENV) and chikungunya (CHIKV). The objectives of this study were (i) To increase the detection rate of imported CHIKV and DENV cases in travellers from endemic areas and promptly identify potential autochthonous cases.(ii) To detect autochthonous cases of WNF, besides those of West Nile Neuroinvasive Disease (WNND) that were already included in a national surveillance. Methods Human surveillance: a traveler who had returned within the previous 15 days from endemic countries, with fever >38°C, absence of leucocytosis (leukocyte count <10,000 μL), and absence of other obvious causes of fever, after ruling out malaria, was considered a possible case of CHIKV or DENV. A possible autochthonous case of WNF was defined as a patient with fever >38°C for <7 days, no recent travel history and absence of other obvious causes of fever. Entomologic surveillance: for West Nile (WNV) it was carried out from May through November placing CDC-CO2 traps in five provinces of Veneto Region, while for DENV and CHIKV it was also performed around residences of viremic cases. Results Human surveillance: between 2010 and 2012, 234 patients with fever after travelling were screened, of which 27 (11,5%) were found infected (24 with DENV and 3 with CHIKV). No autochthonous case of DENV or CHIKV was detected. Autochthonous patients screened for WNF were 408, and 24 (5,9%) were confirmed cases. Entomologic surveillance: the WNV was found in 10, 2 and 11 pools of Culex pipiens from 2010 to 2012 respectively, in sites of Rovigo, Verona, Venezia and Treviso provinces). No infected Aedes albopictus with DENV or CHIKV was found. Conclusions Veneto is the only Italian region reporting WNV human cases every year since 2008. WNV is likely to cause sporadic cases and unforeseeable outbreaks for decades. Including WNF in surveillance provides additional information and possibly an early alert system. Timely detection of DENV and CHIKV should prompt vector control measures to prevent local outbreaks.
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Affiliation(s)
- Federico Gobbi
- Centre for Tropical Diseases, Sacro Cuore-Don Calabria Hospital, Negrar, Verona, Italy.
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Nasta P, Cattelan AM, Maida I, Gatti F, Chiari E, Puoti M, Carosi G. Antiretroviral Therapy in HIV/HCV Co-Infection Italian Consensus Workshop. ACTA ACUST UNITED AC 2013. [DOI: 10.4236/aid.2013.32017] [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: 11/20/2022]
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80
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Ammassari A, Cicconi P, Ladisa N, Di Sora F, Bini T, Trotta MP, D'Ettorre G, Cattelan AM, Vichi F, d'Arminio Monforte A. Induced first abortion rates before and after HIV diagnosis: results of an Italian self-administered questionnaire survey carried out in 585 women living with HIV. HIV Med 2012; 14:31-9. [DOI: 10.1111/j.1468-1293.2012.01032.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2012] [Indexed: 11/29/2022]
Affiliation(s)
- A Ammassari
- Department of Infectious Diseases; INMI; L Spallanzani; Rome; Italy
| | - P Cicconi
- Institute of Infectious and Tropical Diseases; Department of Medicine; Surgery and Dentistry; San Paolo University Hospital; Milan; Italy
| | - N Ladisa
- Institute of Infectious Diseases; University of Bari; Bari; Italy
| | - F Di Sora
- Department of Infectious Diseases; Hospital San Giovanni Addolorata; Rome; Italy
| | - T Bini
- Institute of Infectious and Tropical Diseases; Department of Medicine; Surgery and Dentistry; San Paolo University Hospital; Milan; Italy
| | - MP Trotta
- Department of Infectious Diseases; INMI; L Spallanzani; Rome; Italy
| | - G D'Ettorre
- Institute of Infectious Diseases; Policlinico Umberto I; Rome; Italy
| | - AM Cattelan
- Department of Infectious Diseases; Hospital of Rovigo; Rovigo; Italy
| | - F Vichi
- Department of Infectious Diseases; Hospital SS Annunziata, bagno a Ripoli; Florence; Italy
| | - A d'Arminio Monforte
- Institute of Infectious and Tropical Diseases; Department of Medicine; Surgery and Dentistry; San Paolo University Hospital; Milan; Italy
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81
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Petrara MR, Cattelan AM, Zanchetta M, Sasset L, Freguja R, Gianesin K, Cecchetto MG, Carmona F, De Rossi A. Epstein-Barr virus load and immune activation in human immunodeficiency virus type 1-infected patients. J Clin Virol 2011; 53:195-200. [PMID: 22209290 DOI: 10.1016/j.jcv.2011.12.013] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2011] [Revised: 12/06/2011] [Accepted: 12/09/2011] [Indexed: 12/30/2022]
Abstract
BACKGROUND Patients infected with HIV-1 are at high risk of developing Epstein-Barr Virus (EBV)-related diseases. Chronic immune activation is a hallmark of HIV-1 pathogenesis and may play a role in B-cell stimulation and expansion of EBV-infected cells. OBJECTIVES The aim of the study was to define the relationship between parameters of immune activation and EBV load in HIV-1-infected subjects. STUDY DESIGN A total of 156 HIV-1-infected patients were studied. EBV types 1 and 2 were quantified on peripheral blood mononuclear cells by multiplex real-time PCR. Plasma levels of cytokines and lipopolysaccharide (LPS) were determined by immunoenzymatic assays. B-cell activation was analyzed by flow cytometry. RESULTS EBV-DNA was detected in 114 patients, and in all but 3 was EBV type 1. The median [interquartile] EBV-DNA load was 43[1-151] copies/10(5) PBMC. EBV-DNA load was higher in patients with detectable HIV-1 plasma viremia, despite good immunological status (CD4>500 cells/μl), than in patients with undetectable HIV-1 plasma viremia regardless of immunological status (46[5-136] copies/10(5) cells vs 17[1-56] copies/10(5) cells, p=0.008). Patients with high EBV-DNA load (>median value) had higher levels of LPS and proinflammatory cytokines (IL-6, IL-10 and TNF-α) than patients with low EBV load. Furthermore, percentages of activated B-cells correlated with EBV-DNA load (r(s)=0.754; p<0.001). CONCLUSIONS Overall, these findings indicate a strong association between HIV-1 viremia, markers of immune activation and EBV load and suggest that persistence of HIV-1 viremia and immune activation, regardless of peripheral CD4 cell depletion/repopulation, may favor expansion of EBV-infected cells and onset of EBV-related malignancies.
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Affiliation(s)
- Maria Raffaella Petrara
- Department of Oncology and Surgical Sciences, Section of Oncology, AIDS Reference Centre, University of Padova, Italy
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82
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Barzon L, Pacenti M, Cusinato R, Cattai M, Franchin E, Pagni S, Martello T, Bressan S, Squarzon L, Cattelan AM, Pellizzer G, Scotton P, Beltrame A, Gobbi F, Bisoffi Z, Russo F, Palù G. Human cases of West Nile Virus Infection in north-eastern Italy, 15 June to 15 November 2010. Euro Surveill 2011. [DOI: 10.2807/ese.16.33.19949-en] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
In 2010, for the third consecutive year, human cases of West Nile virus (WNV) infection, including three confirmed cases of neuroinvasive disease and three confirmed cases of West Nile fever, were identified in north-eastern Italy. While in 2008 and 2009 all human cases of WNV disease were recorded in the south of the Veneto region, cases of WNV disease in 2010 additionally occurred in two relatively small northern areas of Veneto, located outside those with WNV circulation in the previous years. WNV IgG antibody prevalence in blood donors resident in Veneto was estimated as ranging from 3.2 per 1,000 in areas not affected by cases of WNV disease to 33.3 per 1,000 in a highly affected area of the Rovigo province. No further autochthonous human cases of WNV disease were notified in Italy in 2010. The recurrence of human cases of WNV infection for the third consecutive year strongly suggests WNV has become endemic in north-eastern Italy.
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Affiliation(s)
- L Barzon
- Regional Reference Centre for Infectious Diseases, Microbiology and Virology Unit, Padova University Hospital, Padova, Italy
- Department of Histology, Microbiology and Medical Biotechnology, University of Padova, Padova, Italy
| | - M Pacenti
- Regional Reference Centre for Infectious Diseases, Microbiology and Virology Unit, Padova University Hospital, Padova, Italy
| | - R Cusinato
- Regional Reference Centre for Infectious Diseases, Microbiology and Virology Unit, Padova University Hospital, Padova, Italy
| | - M Cattai
- Regional Reference Centre for Infectious Diseases, Microbiology and Virology Unit, Padova University Hospital, Padova, Italy
| | - E Franchin
- Department of Histology, Microbiology and Medical Biotechnology, University of Padova, Padova, Italy
- Regional Reference Centre for Infectious Diseases, Microbiology and Virology Unit, Padova University Hospital, Padova, Italy
| | - S Pagni
- Regional Reference Centre for Infectious Diseases, Microbiology and Virology Unit, Padova University Hospital, Padova, Italy
- Department of Histology, Microbiology and Medical Biotechnology, University of Padova, Padova, Italy
| | - T Martello
- Regional Reference Centre for Infectious Diseases, Microbiology and Virology Unit, Padova University Hospital, Padova, Italy
| | - S Bressan
- Regional Reference Centre for Infectious Diseases, Microbiology and Virology Unit, Padova University Hospital, Padova, Italy
| | - L Squarzon
- Department of Histology, Microbiology and Medical Biotechnology, University of Padova, Padova, Italy
| | - A M Cattelan
- Infectious Diseases Unit, Rovigo City Hospital, Rovigo, Italy
| | - G Pellizzer
- Infectious Disease Unit, Vicenza City Hospital, Vicenza, Italy
| | - P Scotton
- Infectious Disease Unit, Treviso City Hospital, Treviso, Italy
| | - A Beltrame
- Clinic of Infectious Diseases, Department of Clinical and Morphological Research, S. M. Misericordia University Hospital, Udine, Italy
| | - F Gobbi
- Center for Tropical Diseases, Sacro Cuore Hospital, Negrar, Verona, Italy
| | - Z Bisoffi
- Center for Tropical Diseases, Sacro Cuore Hospital, Negrar, Verona, Italy
| | - F Russo
- Department of Public Health and Screening, Veneto Region, Venice, Italy
| | - G Palù
- Regional Reference Centre for Infectious Diseases, Microbiology and Virology Unit, Padova University Hospital, Padova, Italy
- Department of Histology, Microbiology and Medical Biotechnology, University of Padova, Padova, Italy
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Cattelan AM, Zanchetta M, Sasset L, Petrara R, Freguja R, Gianesin K, Cecchetto MG, Cremona F, De Rossi A. Relationship between dynamics of Epstein-Barr virus and immune activation in HIV-1 infected subjects in the HAART era. J Int AIDS Soc 2010. [PMCID: PMC3112998 DOI: 10.1186/1758-2652-13-s4-p213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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84
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Gobbi F, Napoletano G, Piovesan C, Russo F, Angheben A, Rossanese A, Cattelan AM, Gallo L, Valsecchi M, Piazza A, Venturi G, Bisoffi Z. Where is West Nile fever? Lessons learnt from recent human cases in northern Italy. Euro Surveill 2009; 14:19143. [PMID: 19317987] [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: 05/27/2023] Open
Abstract
West Nile disease in humans has been detected for the first time in Italy in two regions, Emilia-Romagna and Veneto. We conclude that also West Nile fever cases should be specifically targeted by surveillance.
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Affiliation(s)
- F Gobbi
- Department of Prevention, Verona, Italy.
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85
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Gobbi F, Napoletano G, Piovesan C, Russo F, Angheben A, Rossanese A, Cattelan AM, Gallo L, Valsecchi M, Piazza A, Venturi G, Bisoffi Z. Where is West Nile fever? Lessons learnt from recent human cases in northern Italy. Euro Surveill 2009. [DOI: 10.2807/ese.14.10.19143-en] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
West Nile disease in humans has been detected for the first time in Italy in two regions, Emilia-Romagna and Veneto. Surveillance subsequently set up in Veneto detected a case of West Nile neuroinvasive disease and a few asymptomatic infections, but no case of West Nile fever. We conclude that also West Nile fever cases should be specifically targeted by surveillance.
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Affiliation(s)
- F Gobbi
- Centre for Tropical Diseases, Sacro Cuore Hospital, Negrar (Verona), Italy
- Department of Prevention, ULSS 20, Verona, Italy
| | - G Napoletano
- Department of Prevention, ULSS 20, Verona, Italy
| | - C Piovesan
- Direction of Prevention, Veneto region, Venice, Italy
| | - F Russo
- Direction of Prevention, Veneto region, Venice, Italy
| | - A Angheben
- Centre for Tropical Diseases, Sacro Cuore Hospital, Negrar (Verona), Italy
| | - A Rossanese
- Centre for Tropical Diseases, Sacro Cuore Hospital, Negrar (Verona), Italy
| | - A M Cattelan
- Unit of Infectious Diseases, Rovigo Hospital, Italy
| | - L Gallo
- Department of Prevention, ULSS 18 Rovigo, Italy
| | - M Valsecchi
- Department of Prevention, ULSS 20, Verona, Italy
| | - A Piazza
- Unit of Microbiology and Virology, Padua Hospital, Italy
| | - G Venturi
- Department of Public Health, Local Health Unit, Ravenna, Italy
| | - Z Bisoffi
- Centre for Tropical Diseases, Sacro Cuore Hospital, Negrar (Verona), Italy
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86
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Cattelan AM, Bauer U, Trevenzoli M, Sasset L, Campostrini S, Facchin C, Pagiaro E, Gerzeli S, Cadrobbi P, Chiarelli A. Use of Polylactic Acid Implants to Correct Facial Lipoatrophy in Human Immunodeficiency Virus 1–Positive Individuals Receiving Combination Antiretroviral Therapy. ACTA ACUST UNITED AC 2006; 142:329-34. [PMID: 16549708 DOI: 10.1001/archderm.142.3.329] [Citation(s) in RCA: 34] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To assess the efficacy, safety, and tolerability of facial injections of polylactic acid for human immunodeficiency virus (HIV) 1-associated facial lipoatrophy, which commonly affects HIV-1-infected patients receiving combination antiretroviral therapy. DESIGN A cohort of 50 consecutive HIV-1-infected outpatients with moderate to severe facial lipoatrophy who were receiving antiretroviral therapy were recruited in one institutional center and followed up for 12 months. Patients received the compound subcutaneously at baseline and on days 30, 45, and 60 of the study, for a total of 4 sets of injections; if necessary, 2 additional sets of injections were allowed on days 75 and 90. At enrollment and during follow-up, data on patients' characteristics, facial ultrasonography, and iconography were assessed. Data for 2 questionnaires, on self-perception of severity of facial lipoatrophy and on quality of life measured by the Medical Outcomes Study-HIV, were also obtained. RESULTS Polylactic acid injections led to a significant improvement in facial lipoatrophy, confirmed by the patients' facial lipoatrophy self-perception and by the ultrasonographic evaluation. The mean total cutaneous thickness of each cheek increased significantly between baseline and after completing the polylactic acid injection sessions (4.3 mm [range, 2.7-6.2 mm] [P<.001] and 4.4 mm [range, 2.7-6.1 mm] [P<.001] on the right and left cheeks, respectively) and persisted significantly until month 12 of follow-up (3.4 mm [range, 2.3-4.9 mm] [P<.001] and 3.3 mm [range, 1.6-5.0 mm] [P<.001] on the right and left cheeks, respectively). In addition, a significant (P<.01) improvement in overall quality of life was observed between baseline and the end of the study. No patients discontinued treatment because of toxic effects, and subcutaneous micronodules at the site of injection were never observed. CONCLUSIONS Polylactic acid injections can be considered an effective, safe, and simple procedure in HIV-related facial lipoatrophy. The overall improvement of quality of life was clearly associated with the correction of lipoatrophy, reflecting the positive effect of this strategy on patient well-being.
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Affiliation(s)
- Anna Maria Cattelan
- Department of Infectious Diseases, Unit of Radiology, General Hospital and University of Padua, Via Giustiniani 2, 35128 Padua, Italy.
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87
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Cattelan AM, Calabrò ML, De Rossi A, Aversa SML, Barbierato M, Trevenzoli M, Gasperini P, Zanchetta M, Cadrobbi P, Monfardini S, Chieco-Bianchi L. Long-term clinical outcome of AIDS-related Kaposi's sarcoma during highly active antiretroviral therapy. Int J Oncol 2005; 27:779-85. [PMID: 16077928] [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: 05/03/2023] Open
Abstract
The long-term impact of highly active antiretroviral therapy (HAART) in AIDS patients with Kaposi's sarcoma (KS) was evaluated in 22 consecutive, HAART-naïve KS patients attending a single Italian referral centre for HIV/AIDS. Clinical, virologic and immunologic responses to HAART were assessed at baseline and every three months during the follow-up. Peripheral blood mononuclear cell (PBMC)-associated human herpesvirus 8 (HHV-8) load was also evaluated by real-time PCR in 13 patients with durable clinical KS complete response (CR). In a median follow-up of 40 months (range 17-78), the KS overall clinical response rate was 91%: 18 complete and 2 partial responses were achieved, and two patients experienced disease progression. CR persisted in all 18 patients, including the 5 poor-risk KS patients in whom CR lasted for > 60 months, and was significantly linked to an increase in CD4+ cell counts and a drop in HIV-1-RNA copies. Compared to baseline levels, a decrease in PBMC HHV-8 load was observed at CR, and a significant further reduction was found at the end of follow-up. In this monocentric study, AIDS-KS patients treated with HAART showed high clinical response rate. Patients with CR showed a prolonged remission, lasting more than 5 years in a group of poor-risk patients, and a persistent reduction in circulating HHV-8-infected cells. These findings highlight that HAART deeply modifies the natural history of this tumour in AIDS patients, and that this long-lasting approach may be considered a first-line treatment for the majority of HIV-1-infected patients developing KS.
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Affiliation(s)
- Anna Maria Cattelan
- Department of Infectious Diseases, General Hospital and University of Padova, I-35121 Padova, Italy.
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Abstract
Kaposi's sarcoma (KS) is the most common cancer associated with AIDS. KS aetiology and pathogenesis are still poorly defined and no definitive treatment has yet been identified. However, the introduction in 1996 of highly active antiretroviral therapy as a standard of care for those infected with HIV-1 determined a strong protection against the development of opportunistic infections, as well as a remission of pre-existing complications, including KS. Under highly active antiretroviral therapy, KS in particular has shown the highest clinical response rate reported to date among AIDS patients. Furthermore, recent insights into the pathogenetic mechanisms involved in KS development have provided new hope for a response and improved survival in patients with AIDS-related KS. This paper presents an overview of the current knowledge concerning pharmacological approaches to treating this disease. Newer treatments such as PEGylated liposomal anthracyclin, paclitaxel and pathogenesis-based strategies are also discussed.
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Affiliation(s)
- Anna Maria Cattelan
- Department of Infectious Diseases, University of Padua, Via Giustiniani 2, 35128 Padua, Italy.
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89
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Aversa SML, Cattelan AM, Salvagno L, Crivellari G, Banna G, Trevenzoli M, Chiarion-Sileni V, Monfardini S. Treatments of AIDS-related Kaposi's sarcoma. Crit Rev Oncol Hematol 2005; 53:253-65. [PMID: 15718150 DOI: 10.1016/j.critrevonc.2004.10.009] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/28/2004] [Indexed: 11/19/2022] Open
Abstract
Although Kaposi's sarcoma (KS) has decreased in countries where the highly active antiretroviral therapy (HAART) regimen is available, however it remains, after non-Hodgkin's lymphomas, the most common malignancy in HIV+ patients. Advances in the treatment of AIDS-KS have been achieved, even though a gold standard therapy has not been yet defined. With the availability of HAART, a dramatic KS clinical response has been documented, making HAART essential in all patients. In case of aggressive and/or life threatening KS, more complex therapeutic schedules have to be taken into account, including chemotherapy and/or immunotherapy. Liposomal anthracyclines and paclitaxel have been approved by FDA as first line and second line mono-therapy, respectively. Interferon-alpha (INF-alpha) is the only immunomodulant agent to have shown a therapeutic effect. Among the new drugs, many antiangiogenetic agents have produced encouraging responses. Finally, the identification of the HHV-8 as a causative agent and new metalloproteinase inhibitors may offer promising targets for the KS treatment.
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90
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Trevenzoli M, Cattelan AM, Marino F, Sasset L, Donà S, Meneghetti F. Sepsis and granulomatous hepatitis after bacillus Calmette-Guerin intravesical installation. J Infect 2004; 48:363-4. [PMID: 15066339 DOI: 10.1016/j.jinf.2004.01.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2004] [Indexed: 11/16/2022]
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91
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Pulido F, Katlama C, Marquez M, Thomas R, Clumeck N, Pedro RDJ, Cattelan AM, Zhu C, Tymkewycz P. A randomized study investigating the efficacy and safety of amprenavir in combination with low-dose ritonavir in protease inhibitor-experienced HIV-infected adults. HIV Med 2004; 5:296-302. [PMID: 15236620 DOI: 10.1111/j.1468-1293.2004.00224.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To compare the safety and efficacy of amprenavir [APV/j Agenerase trade mark; GlaxoSmithKline, [Ware, UK; 600 mg twice a day (bid)] boosted with low-dose ritonavir (RTV, 100 mg bid) with those of other protease inhibitors (PIs) in PI-experienced HIV-infected patients. STUDY DESIGN Parallel-group, randomized, open-label, multicentre study. METHODS One hundred and sixty-three patients with HIV predicted to be sensitive to APV, another PI and a nucleoside reverse transcriptase inhibitor (NRTI) were randomly assigned to receive either APV boosted with low-dose RTV (APV/r) or a standard of care (SOC) PI with or without low-dose RTV. The non-inferiority of APV/r to the SOC PIs was assessed by time-weighted average change from baseline (AAUCMB) in plasma viral load (vRNA) at week 16. RESULTS The antiviral response for APV/r bid was non-inferior to that for the SOC PI group: the vRNA AAUCMB mean treatment difference was 0.043 log(10) HIV-1 RNA copies/mL [95% confidence interval (CI)-0.250, 0.335]. APV/r bid was generally well tolerated. CONCLUSIONS Results confirm the antiviral activity, short-term safety and tolerability of APV/r bid in PI-experienced patients.
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Affiliation(s)
- F Pulido
- Hospital Doce de Octubre, Madrid, Spain.
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92
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Banna GL, Aversa SML, Cattelan AM, Crivellari G, Monfardini S. Respiratory syncytial virus-related pneumonia after stem cell transplantation successfully treated with palivizumab and steroid therapy. ACTA ACUST UNITED AC 2004; 36:155-7. [PMID: 15061675 DOI: 10.1080/00365540410019282] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
A case is reported of a 56-y-old woman with a second relapse of Hodgkin's disease who early developed after autologous stem cell transplantation (ASCT) a severe RSV-related interstitial pneumonia successfully treated with 1-d intravenous palivizumab 8 mg/kg plus low-dose systemic steroid therapy. B-cells suppression with CMV antigenaemia were then observed and required treatment with ganciclovir and liposomal amfotericine B.
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93
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Tramarin A, Parise N, Campostrini S, Yin DD, Postma MJ, Lyu R, Grisetti R, Capetti A, Cattelan AM, Di Toro MT, Mastroianni A, Pignattari E, Mondardini V, Calleri G, Raise E, Starace F. Association between diarrhea and quality of life in HIV-infected patients receiving highly active antiretroviral therapy. Qual Life Res 2004; 13:243-50. [PMID: 15058804 DOI: 10.1023/b:qure.0000015282.24774.36] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Diarrhea is a common symptom that many HIV patients experience either as a consequence of HIV infection or of highly active antiretroviral therapy (HAART). A multicenter, prospective observational study was conducted in 11 AIDS clinics in Italy to determine the effect of diarrhea on health-related quality of life among patients receiving HAART. The study enrolled 100 consecutive HIV positive patients who had diarrhea while on HAART. For each enrolled patient a control patient with matching disease stage who did not have diarrhea was identified using existing data from another prospective observational study conducted in 34 AIDS clinics (including the 11 in current study). Quality of life was measured by MOS-HIV Health Survey (MOS-HIV). Paired t-test and multiple regression analysis were used to compare the quality of life among patients with and without diarrhea. Mean patient age was 40 +/- 7 years; 69% were male. Mean CD4 cell count was 342 +/- 239 cells/mm3; 59% had AIDS. Of the cases, 49 patients had severe diarrhea (> 5 bowel movements or > 3 watery per day) and 46 patients had moderate diarrhea (3-5 bowel movements). Compared to matched control patients, cases experiencing diarrhea while on HAART had significantly lower MOS-HIV scores in all domains. The significant adverse effect of diarrhea on quality of life should be considered when choosing the appropriate antiretroviral drugs regimen.
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Cattelan AM, Trevenzoli M, Sasset L, Lanzafame M, Marchioro U, Meneghetti F. Multiple cerebral cryptococcomas associated with immune reconstitution in HIV-1 infection. AIDS 2004; 18:349-51. [PMID: 15075562 DOI: 10.1097/00002030-200401230-00034] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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95
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Trevenzoli M, Cattelan AM, Lanzafame M, Sasset L, Concia E, Vento S. Inflammatory pseudotumor of lymph nodes. Ann Med Interne (Paris) 2003; 154:557-9. [PMID: 15037835] [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: 04/29/2023]
Abstract
A case of inflammatory pseudotumor in a 22-Year-old man is described. Symptoms and signs showed high fever and prominent cervical lymphadenopathy; laboratory findings were consistent with an acute inflammatory process. Diagnosis was reached through a lymph node biopsy which allowed a definitive diagnosis and ruled out several mimicking pathological processes such as malignant lymphoma, infectious diseases and autoimmune disorders. Inflammatory pseudotumor should be included in the differential diagnosis of patients with persistent fever and lymph node enlargement.
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Affiliation(s)
- Marco Trevenzoli
- Infectious Diseases Division, General Hospital, Via Giustiniani 2, I-35128 Padua, Italy
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96
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Abstract
Sarcoidosis occurring in patients with AIDS is rare. This infrequent association has been attributed to the impairment of the immune system that may interfere with the granuloma formation in HIV infected patients. However, the introduction of highly active antiretroviral therapy (HAART) has brought about a substantial and sustained increase in CD4+ T lymphocyte cells, and has consequently led to the development of the so called "immune restoration disease". The case of an HIV infected man who developed sarcoidosis after the initiation of HAART is described. Skin nodule images and histological specimens are reported. The association between sarcoidosis and HIV infection is also reviewed.
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Affiliation(s)
- M Trevenzoli
- Division of Infectious Diseases, General Hospital and University of Padua, Italy
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97
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Cattelan AM, Calabrò ML, Gasperini P, Aversa SM, Zanchetta M, Meneghetti F, De Rossi A, Chieco-Bianchi L. Acquired immunodeficiency syndrome-related Kaposi's sarcoma regression after highly active antiretroviral therapy: biologic correlates of clinical outcome. J Natl Cancer Inst Monogr 2003:44-9. [PMID: 11158206 DOI: 10.1093/oxfordjournals.jncimonographs.a024256] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Kaposi's sarcoma (KS) is the most common cancer seen in subjects with acquired immunodeficiency syndrome (AIDS). KS etiology and pathogenesis are still ill defined, and no definite improvement in survival has been obtained with current chemotherapeutic regimens. This open prospective study was aimed at evaluating the clinical response of AIDS-related KS to highly active antiretroviral therapy (HAART), a combination of protease and reverse transcriptase inhibitors, as well as the relationship between clinical response, human immunodeficiency virus type 1 (HIV-1) burden, and antibody titer against human herpesvirus 8 (HHV8) proteins. PATIENTS AND METHODS Fourteen KS patients were studied; 12 were in the poor-risk group. At given intervals, the patients underwent clinical examination, and their CD4(+) cell counts, plasma HIV-1 RNA levels, and antibody titers to lytic-phase ORF65 and latent-phase HHV8 proteins were determined. RESULTS When last seen, the overall clinical response rate was 86% (median follow-up, 22 months); 10 complete and two partial responses were achieved, and two patients showed disease progression. All patients with complete or partial response showed a consistent decrease in HIV-1 RNA levels, with a corresponding increase in CD4(+) cell counts; HIV-1 RNA levels in the two progressors remained persistently high, despite a change in HAART. HHV8 ORF65 antibody titers were generally higher in patients with extensive skin or mucosal/visceral involvement versus patients with limited disease; no differences in latent-phase HHV8 antibody titers were observed in relation to tumor burden. CONCLUSION The findings indicate that antiretroviral therapy with protease inhibitors is effective for AIDS-related KS; the clinical response was correlated with a decrease in plasma HIV-1 RNA levels and an increase in CD4(+) lymphocytes, whereas antibody levels to the lytic-phase HHV8 protein were influenced by the extent of tumor involvement.
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Affiliation(s)
- A M Cattelan
- Department of Infectious Diseases, General Hospital of Padova, Italy
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98
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Faggian F, Lattuada E, Lanzafame M, Trevenzoli M, Cattelan AM, Concia E. Acute mediastinitis: a severe complication of transdermal therapy in a patient with ischaemic heart disease. A case report. Infez Med 2003; 11:102-4. [PMID: 15020855] [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: 04/29/2023]
Abstract
Acute mediastinitis is an uncommon and potentially devastating infection. Generally, mediastinitis occurs as a postoperative infection following median sternotomy. We describe a case of acute mediastinitis in a patient with ischaemic heart disease, secondary to the spread of cutaneous infection of the chest wall in the application site of transdermal nitroglycerine patches.
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Affiliation(s)
- Federica Faggian
- Department of Infectious Diseases, Civile Maggiore-Hospital, B.go Trento, Verona, Italy
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99
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100
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Guaraldi G, Murri R, Orlando G, Orlandi E, Sterrantino G, Borderi M, Grosso C, Cattelan AM, Nardini G, Beghetto B, Antinori A, Esposito R, Wu AW. Morphologic alterations in HIV-infected people with lipodystrophy are associated with good adherence to HAART. HIV Clin Trials 2003; 4:99-106. [PMID: 12671777 DOI: 10.1310/w1qf-c9x9-9pft-88jk] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To evaluate the association between adherence to drugs and morphologic alterations (MOA) in a cohort of HIV-infected patients on HAART. METHOD This was a cross-sectional multicenter cohort study in eight tertiary Clinical Centers of Northern and Central Italy. Consecutive outpatients taking HAART were enrolled from August 2000 to March 2001. They completed a self-administered questionnaire for the evaluation of signs of MOA and the self-reported adherence to drugs. Main outcome measures were MOA according to the Multicenter AIDS Cohort Study (MACS) definition and adherence to drugs. RESULTS One hundred seventy-five persons were enrolled into the study. Median CD4 cell count was 522 (interquartile range [IQR] 306-720); 35% of people had undetectable HIV RNA. Patients had been taking HAART for a median of 53 months (IQR 33-62). Among enrolled patients, 83 (47%) had a diagnosis of self-reported MOA; 57 of them reported body changes of more than 12 months duration. Forty persons (23%) self-reported nonadherence in the previous week. Mean time on HAART was 48.7 months (SD = 19.7) for people with MOA and 42.1 months (SD = 21.8) for those without MOA (p =.043). The odds of adherence for people with MOA was 2.36 times (95% CI 1.11-5.00) higher than for people without MOA. On multivariate analysis, being older and female, having an undetectable HIV RNA, longer duration on HAART, and self-reported adherence were independently associated with the presence of MOA. In people with MOA, adherence seems to decrease over time. CONCLUSION Longer time on HAART and self-reported adherence were correlated to MOA. MOA was also associated with older age and female gender.
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Affiliation(s)
- Giovanni Guaraldi
- Department of Medical and Surgery Specialities, infectious Diseases Clinic, University of Modena and Reggio Emilia School of Medicine, Italy.
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