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Rossetti B, Gagliardini R, Meini G, Sterrantino G, Colangeli V, Re MC, Latini A, Colafigli M, Vignale F, Rusconi S, Micheli V, Di Biagio A, Orofino G, Ghisetti V, Fantauzzi A, Vullo V, Grima P, Francisci D, Mastroianni C, Antinori A, Trezzi M, Lisi L, Navarra P, Canovari B, D’Arminio Monforte A, Lamonica S, D’Avino A, Zazzi M, Di Giambenedetto S, De Luca A. Switch to maraviroc with darunavir/r, both QD, in patients with suppressed HIV-1 was well tolerated but virologically inferior to standard antiretroviral therapy: 48-week results of a randomized trial. PLoS One 2017; 12:e0187393. [PMID: 29161288 PMCID: PMC5697828 DOI: 10.1371/journal.pone.0187393] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 10/18/2017] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES Primary study outcome was absence of treatment failure (virological failure, VF, or treatment interruption) per protocol at week 48. METHODS Patients on 3-drug ART with stable HIV-1 RNA <50 copies/mL and CCR5-tropic virus were randomized 1:1 to maraviroc with darunavir/ritonavir qd (study arm) or continue current ART (continuation arm). RESULTS In June 2015, 115 patients were evaluable for the primary outcome (56 study, 59 continuation arm). The study was discontinued due to excess of VF in the study arm (7 cases, 12.5%, vs 0 in the continuation arm, p = 0.005). The proportion free of treatment failure was 73.2% in the study and 59.3% in the continuation arm. Two participants in the study and 10 in the continuation arm discontinued therapy due to adverse events (p = 0.030). At VF, no emergent drug resistance was detected. Co-receptor tropism switched to non-R5 in one patient. Patients with VF reported lower adherence and had lower plasma drug levels. Femoral bone mineral density was significantly improved in the study arm. CONCLUSION Switching to maraviroc with darunavir/ritonavir qd in virologically suppressed patients was associated with improved tolerability but was virologically inferior to 3-drug therapy.
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Affiliation(s)
- Barbara Rossetti
- Infectious Diseases Unit, Azienda Ospedaliera Universitaria Senese, Siena, Italy
- Clinic of Infectious Diseases, Catholic University of Sacred Heart, Rome, Italy
- * E-mail:
| | - Roberta Gagliardini
- Clinic of Infectious Diseases, Catholic University of Sacred Heart, Rome, Italy
| | - Genny Meini
- Department of Medical Biotechnology, University of Siena, Siena, Italy
| | - Gaetana Sterrantino
- Clinic of Infectious Diseases, Azienda Ospedaliera Universitaria Careggi, Firenze, Italy
| | - Vincenzo Colangeli
- Clinic of Infectious Diseases, Azienda Ospedaliera Universitaria S.Orsola Malpighi, Bologna, Italy
| | - Maria Carla Re
- Microbiology, Azienda Ospedaliera Universitaria S.Orsola Malpighi, Bologna, Italy
| | | | | | - Francesca Vignale
- Clinic of Infectious Diseases, G. D’Annunzio University, Chieti, Italy
| | - Stefano Rusconi
- Infectious and Tropical Diseases Unit, DIBIC L. Sacco Hospital, University of Milano, Milano, Italy
| | - Valeria Micheli
- Microbiology and Virology Laboratory, L. Sacco Hospital, Milano, Italy
| | | | - Giancarlo Orofino
- Infectious Diseases Unit A, Amedeo di Savoia Hospital, Torino, Italy
| | - Valeria Ghisetti
- Microbiology and Virology Laboratory, Amedeo di Savoia Hospital, Torino, Italy
| | | | - Vincenzo Vullo
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Roma, Italy
| | - Pierfrancesco Grima
- Division of Infectious Diseases, S. Caterina Novella Hospital, Galatina, Lecce, Italy
| | - Daniela Francisci
- Clinic of Infectious Diseases, University of Perugia, Perugia, Italy
| | - Claudio Mastroianni
- Infectious Disease Unit, SM Goretti Hospital, Department of Public Health and Infectious Diseases, Sapienza University, Latina, Italy
| | | | - Michele Trezzi
- Infectious Diseases Unit, Pistoia Hospital, Pistoia, Italy
| | - Lucia Lisi
- Pharmacology Department, Catholic University of Sacred Heart, Rome, Italy
| | - Pierluigi Navarra
- Pharmacology Department, Catholic University of Sacred Heart, Rome, Italy
| | | | - Antonella D’Arminio Monforte
- Infectious and Tropical Diseases Institute, Department of Health Sciences, University of Milan San Paolo Hospital, Milan, Italy
| | - Silvia Lamonica
- Clinic of Infectious Diseases, Catholic University of Sacred Heart, Rome, Italy
| | - Alessandro D’Avino
- Clinic of Infectious Diseases, Catholic University of Sacred Heart, Rome, Italy
| | - Maurizio Zazzi
- Department of Medical Biotechnology, University of Siena, Siena, Italy
| | | | - Andrea De Luca
- Infectious Diseases Unit, Azienda Ospedaliera Universitaria Senese, Siena, Italy
- Department of Medical Biotechnology, University of Siena, Siena, Italy
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Falasca F, Di Carlo D, De Vito C, Bon I, d'Ettorre G, Fantauzzi A, Mezzaroma I, Fimiani C, Re MC, Vullo V, Antonelli G, Turriziani O. Evaluation of HIV-DNA and inflammatory markers in HIV-infected individuals with different viral load patterns. BMC Infect Dis 2017; 17:581. [PMID: 28830393 PMCID: PMC5568129 DOI: 10.1186/s12879-017-2676-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Accepted: 08/09/2017] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Persistent residual viremia (RV) and low grade inflammation and immune activation have been associated with non-AIDS defining events. The impact of persistent RV and HIV-DNA load on immune activation/inflammation remains unclear. The purpose of this study was to gain new insights into the relation between viremia, markers of inflammation and HIV-DNA levels. METHODS Three hundred and twenty-one HIV-infected patients were studied. A retrospective analysis of viremia values, prospectively collected for 48 months, was performed. Patients were separated into three groups: 113 TND (Target Not Detected, patients with sustained undetectable viremia); 113 RV (Residual Viremia, patients who had at least three detectable viral load (VL) values <37 copies/ml); 95 LLV (Low Level Viremia, patients with at least two VL values >37 but <200 copies/ml). HIV-DNA, TNF-α, IL-6 and sCD14 were analyzed. RESULTS HIV-DNA, sCD14 and TNF-α were significantly lower in the TND group than in the RV and LLV groups. In addition, RV patients showed lower levels of HIV-DNA and sCD14 than LLV individuals. HIV-DNA load was not related to markers of inflammation. The ordinal logistic analysis showed that two independent variables were significantly associated with VL pattern: sCD14, HIV-DNA. In addition NRTIs plus NNRTIs and NRTIs plus PIs were negatively associated to VL pattern compared to INI-containing regimen. CONCLUSIONS Persistent undetectable viremia was associated with lower levels of inflammatory markers and HIV-DNA. However, the lack of normalization of these biomarkers in the TND group and the fact that HIV-DNA load was not associated with inflammation strongly suggest that other mechanisms play a major role in maintaining inflammation over time.
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Affiliation(s)
- Francesca Falasca
- Department of Molecular Medicine, "Sapienza" University of Rome, Viale dell'Università 31, 00185, Rome, Italy
| | - Daniele Di Carlo
- Department of Molecular Medicine, "Sapienza" University of Rome, Viale dell'Università 31, 00185, Rome, Italy
| | - Corrado De Vito
- Department of Public Health and Infectious Diseases, "Sapienza" University of Rome, Rome, Italy
| | - Isabella Bon
- Microbiology Section of the Department of Experimental, Diagnostic and Specialty Medicine, School of Medicine, University of Bologna, Bologna, Italy
| | - Gabriella d'Ettorre
- Department of Public Health and Infectious Diseases, "Sapienza" University of Rome, Rome, Italy
| | | | - Ivano Mezzaroma
- Department of Clinical Medicine, "Sapienza" University of Rome, Rome, Italy
| | | | - Maria Carla Re
- Microbiology Section of the Department of Experimental, Diagnostic and Specialty Medicine, School of Medicine, University of Bologna, Bologna, Italy
| | - Vincenzo Vullo
- Department of Public Health and Infectious Diseases, "Sapienza" University of Rome, Rome, Italy
| | - Guido Antonelli
- Department of Molecular Medicine, "Sapienza" University of Rome, Viale dell'Università 31, 00185, Rome, Italy
| | - Ombretta Turriziani
- Department of Molecular Medicine, "Sapienza" University of Rome, Viale dell'Università 31, 00185, Rome, Italy.
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Pastori D, Esposito A, Carnevale R, Bartimoccia S, Nocella C, Fantauzzi A, Pignatelli P, Violi F, Mezzaroma I. Short-term in vivo modifications of platelet NADPH oxidase 2 (NOX2) and prostaglandin F 2α in HIV-1 patients on abacavir-based therapies. HIV Med 2017; 17:774-777. [PMID: 27164434 DOI: 10.1111/hiv.12383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The aim of the study was to investigate the in vivo effect of abacavir (ABC) on platelet oxidative stress. METHODS We performed a randomized pilot study including 39 HIV-1-infected patients, 17 on zidovudine/lamivudine (ZDV/3TC) and 22 on tenofovir/emtricitabine (TDF/FTC). Ten patients on ZDV/3TC and eight patients on TDF/FTC were randomly allocated to switching the nucleoside backbone to ABC/3TC. At baseline and after 6 months, platelet oxidative stress was assessed by platelet NADPH oxidase 2 (NOX2)-derived peptide (sNOX2-dp), a marker of NOX2 activation, and platelet prostaglandin F2α (8-iso-PGF2α ). Platelet activation was measured by soluble CD40L (sCD40L). RESULTS At baseline, no differences between ZDV/3TC or TDF/FTC recipients were found. After 6 months, patients switching from ZDV/3TC showed a decrease of sNOX2-dp (from 20.9±5.7 to 12.5±3.8 pg/ml, p=0.002) and 8-iso-PGF2α (from 154.3±41.9 to 122.9±28.0 pmol/l, p=0.025). No effects on platelet oxidative stress biomarkers were observed in subjects from TDF/FTC, who showed a significant increase in blood glucose (p=0.043) and total cholesterol (p=0.027). ABC showed no effect on sCD40L levels in both groups. CONCLUSIONS ABC reduced platelet sNOX2-dp and 8-iso-PGF2α in HIV-1 subjects switching from ZDV/3TC but not in those from TDF/FTC after 6 months. No changes in platelet activation were found in both groups.
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Affiliation(s)
- D Pastori
- Department of Internal Medicine and Medical Specialties, 'Sapienza' University of Rome, Rome, Italy
| | - A Esposito
- Department of Clinical Medicine, 'Sapienza' University of Rome, Rome, Italy
| | - R Carnevale
- Department of Internal Medicine and Medical Specialties, 'Sapienza' University of Rome, Rome, Italy.,Department of Medical-Surgical Sciences and Biotechnologies, 'Sapienza' University of Rome, Latina, Italy
| | - S Bartimoccia
- Department of Internal Medicine and Medical Specialties, 'Sapienza' University of Rome, Rome, Italy
| | - C Nocella
- Department of Internal Medicine and Medical Specialties, 'Sapienza' University of Rome, Rome, Italy
| | - A Fantauzzi
- Department of Clinical Medicine, 'Sapienza' University of Rome, Rome, Italy
| | - P Pignatelli
- Department of Internal Medicine and Medical Specialties, 'Sapienza' University of Rome, Rome, Italy.
| | - F Violi
- Department of Internal Medicine and Medical Specialties, 'Sapienza' University of Rome, Rome, Italy
| | - I Mezzaroma
- Department of Clinical Medicine, 'Sapienza' University of Rome, Rome, Italy
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Sessa R, Di Pietro M, Filardo S, Bressan A, Mazzuti L, Serafino S, Fantauzzi A, Turriziani O. Lack of association of Chlamydia pneumoniae with cardiovascular diseases in virologically suppressed HIV patients. New Microbiol 2017; 40:33-37. [PMID: 27819396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Accepted: 02/17/2017] [Indexed: 06/06/2023]
Abstract
Cardiovascular disease (CVD) is a major public health problem in developed countries with over 17 million deaths per year. In the last decade, several infectious agents rather than any single pathogen, including Chlamydia pneumoniae and human immunodeficiency virus (HIV), have been shown to contribute to the development of atherosclerosis and subsequent cardiovascular events by inducing systemic inflammation and/or acting directly on the vascular wall. For the first time, we evaluated C. pneumonia DNA in peripheral blood mononuclear cells from HIV patients by real-time polymerase chain reaction in order to shed light on C. pneumonia as a co-factor with HIV in the development of CVDs. C. pneumonia DNA was not detected in our virologically suppressed HIV patients (<37 copies/mL). This finding may be related to high CD4+T cell count (>500 cells/μl) found in HIV patients suggesting functional cell-mediated immunity as a fundamental mechanism for the clearance of chlamydial infection in this population. Larger studies are needed to confirm this hypothesis.
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Affiliation(s)
- Rosa Sessa
- Department of Public Health and Infectious Diseases, "Sapienza" University of Rome
| | - Marisa Di Pietro
- Department of Public Health and Infectious Diseases, "Sapienza" University of Rome
| | - Simone Filardo
- Department of Public Health and Infectious Diseases, "Sapienza" University of Rome
| | - Alessia Bressan
- Department of Public Health and Infectious Diseases, "Sapienza" University of Rome
| | - Laura Mazzuti
- Department of Molecular Medicine, "Sapienza" University of Rome
| | - Sara Serafino
- Department of Public Health and Infectious Diseases, "Sapienza" University of Rome
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Di Carlo D, Fantauzzi A, Melengu T, Maida P, Serafino S, Giustini N, Tozzi S, Antonelli G, Falasca F, Turriziani O. Analysis of the mRNA expression of DNA damage response genes in HIV infected patients. J Clin Virol 2016. [DOI: 10.1016/j.jcv.2016.08.180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Pepe J, Mezzaroma I, Fantauzzi A, Falciano M, Salotti A, Di Traglia M, Diacinti D, Biondi P, Cipriani C, Cilli M, Minisola S. An oral high dose of cholecalciferol restores vitamin D status in deficient postmenopausal HIV-1-infected women independently of protease inhibitors therapy: a pilot study. Endocrine 2016; 53:299-304. [PMID: 26254790 DOI: 10.1007/s12020-015-0693-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2015] [Accepted: 07/15/2015] [Indexed: 02/07/2023]
Abstract
The best repletion and maintenance dosing regimens with cholecalciferol in vitamin D-deficient HIV-1 patients remain unknown. Protease inhibitors (PIs) have been shown to inhibit vitamin D 1α- and 25α-hydroxylation in hepatocyte and monocyte cultures. We therefore evaluated the effect of a single high dose of cholecalciferol in vitamin D-deficient HIV-1 postmenopausal women undergoing treatment with highly active anti-retroviral therapy (cART), with and without PIs. Forty HIV-1 postmenopausal women treated with cART, with hypovitaminosis D (<20 ng/ml), were enrolled. We measured serum changes of 25-hydroxyvitamin D [25(OH)D]; 1,25-dihydroxyvitamin D [1,25(OH)2D], parathyroid hormone (PTH), serum calcium, and urinary calcium excretion following a loading dose of 600,000 IU of cholecalciferol after 3, 30, 60, 90, and 120 days. Patients were divided into two groups, whether or not they were taking PI. A significant increase in mean 25(OH)D and 1,25(OH)2D levels at day 3 and throughout the entire observation period was found in both groups (p < 0.001). PTH levels concomitantly decreased in both groups (p < 0.001). Mean albumin-adjusted serum calcium increases with respect to baseline were significant only at day 3 and day 30 for both groups (p < 0.01). Considering remaining parameters, there were no significant differences between the groups at any time, by two-way RM ANOVA. An oral dose of 600,000 IU of cholecalciferol in HIV-1 postmenopausal women rapidly increases 25(OH)D and 1,25(OH)2D levels reducing PTH levels, regardless of the presence of PIs in the cART scheme.
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Affiliation(s)
- Jessica Pepe
- Department of Internal Medicine and Medical Disciplines, "Sapienza" University, Viale del Policlinico 155, 00161, Rome, Italy.
| | - Ivano Mezzaroma
- Department of Clinical Medicine, "Sapienza" University, Viale del Policlinico 155, 00161, Rome, Italy
| | - Alessandra Fantauzzi
- Department of Clinical Medicine, "Sapienza" University, Viale del Policlinico 155, 00161, Rome, Italy
| | - Mario Falciano
- Department of Public Health and Infectious Diseases, "Sapienza" University, Viale del Policlinico 155, 00161, Rome, Italy
| | - Alessandra Salotti
- Department of Public Health and Infectious Diseases, "Sapienza" University, Viale del Policlinico 155, 00161, Rome, Italy
| | - Mario Di Traglia
- Department of Public Health and Infectious Diseases, "Sapienza" University, Viale del Policlinico 155, 00161, Rome, Italy
| | - Daniele Diacinti
- Department of Radiology, "Sapienza" University, Viale del Policlinico 155, 00161, Rome, Italy
| | - Piergianni Biondi
- Department of Internal Medicine and Medical Disciplines, "Sapienza" University, Viale del Policlinico 155, 00161, Rome, Italy
| | - Cristiana Cipriani
- Department of Internal Medicine and Medical Disciplines, "Sapienza" University, Viale del Policlinico 155, 00161, Rome, Italy
| | - Mirella Cilli
- Department of Internal Medicine and Medical Disciplines, "Sapienza" University, Viale del Policlinico 155, 00161, Rome, Italy
| | - Salvatore Minisola
- Department of Internal Medicine and Medical Disciplines, "Sapienza" University, Viale del Policlinico 155, 00161, Rome, Italy
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Falasca F, Russo CD, Mora B, Pirazzoli A, Fantauzzi A, Navarra P, Pizzuti A, De Vito C, Antonelli G, Turriziani O. Comparative Analysis of Real-Time Polymerase Chain Reaction Methods to Typing HLA-B*57:01 in HIV-1-Positive Patients. AIDS Res Hum Retroviruses 2016; 32:654-7. [PMID: 26750774 PMCID: PMC4931735 DOI: 10.1089/aid.2015.0303] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
The HLA-B*57:01 allele is strongly associated with the hypersensitivity reaction to Abacavir (ABC). Therefore, treatment guidelines recommend that patients initiating ABC are preventively tested for the presence of this allele. To date, four different commercial assays based on the real-time quantitative polymerase chain reaction (Q-PCR) technique are available for the detection of HLA-B*57:01: Duplicα-RealTime Reagent Set HLA-B*57:01 by Euroclone, HLA-B*57:01 Real-TM by Sacace Biotechnologies, COBAS AmpliPrep/COBAS TaqMan HLA-B*57:01 Screening Test by Roche Diagnostic, and HLA-B*57:01 by Nuclear Laser Medicine. The study was carried out to compare the performance of the first three commercially available Q-PCR kits in a routine clinical setting. A total of 98 samples from Policlinico Umberto I Hospital were tested. Results obtained by the Duplicα-RealTime Genotyping kit and AmpliPrep/TaqMan system were 100% concordant. In contrast, genotyping by the HLA-B*57:01 Real-TM kit showed poor agreement with the other systems, that is, 12 out of 33 positive samples were detected as HLA-B*57:01 negative. To confirm the correct genotype of these discordant samples, two additional methods with rapid turnaround times and already implemented into routine clinical practice were used, that is, a PCR-based microsequence-specific primer DNA typing test and a laboratory-developed screening test in Q-PCR. All 12 discordant samples were genotyped as HLA-B*57:01-positive samples using these two additional methods in a single-blinded manner, thus confirming the low sensitivity of HLA-B*57:01 Real-TM test. These findings underline the need to compare results obtained with commercial assays before choosing a test suitable for use in a routine clinical laboratory.
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Affiliation(s)
- Francesca Falasca
- Department of Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Cinzia Dello Russo
- Institute of Pharmacology, Catholic University Medical School, Rome, Italy
| | - Barbara Mora
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | | | | | - Pierluigi Navarra
- Institute of Pharmacology, Catholic University Medical School, Rome, Italy
| | - Antonio Pizzuti
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Corrado De Vito
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Guido Antonelli
- Department of Molecular Medicine, Sapienza University of Rome, Rome, Italy
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Fantauzzi A, Floridia M, Ceci F, Cacciatore F, Vullo V, Mezzaroma I. Usefulness of calcaneal quantitative ultrasound stiffness for the evaluation of bone health in HIV-1-infected subjects: comparison with dual X-ray absorptiometry. HIV AIDS (Auckl) 2016; 8:109-17. [PMID: 27330330 PMCID: PMC4898038 DOI: 10.2147/hiv.s99904] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Objectives With the development of effective treatments and the resulting increase in life expectancy, bone mineral density (BMD) alteration has emerged as an important comorbidity in human immunodeficiency virus type-1 (HIV-1)-infected individuals. The potential contributors to the pathogenesis of osteopenia/osteoporosis include a higher prevalence of risk factors, combined antiretroviral therapy (cART)-exposure, HIV-1 itself and chronic immune activation/inflammation. Dual-energy X-ray absorptiometry (DXA) is the “gold standard” technique for assessing bone status in HIV-1 population. Methods We conducted a cross-sectional study to investigate bone mineral status in a group of 158 HIV-1-infected subjects. The primary endpoint was the feasibility of calcaneal quantitative ultrasound (QUS) as a screening tool for BMD. All subjects were receiving stable cART and were virologically suppressed (HIV-RNA <37 copies/mL) from at least 12 months. Calcaneal QUS parameters were analyzed to obtain information on bone mass and microarchitecture. The results were compared with those obtained by DXA. Results No correlations were found between DXA/QUS parameters and demographic or HIV-1-specific characteristics, also including cART strategies. In the univariate analyses BMD, QUS indexes, and Fracture Risk Assessment Tool scores conversely showed significant associations with one or more demographic or HIV-1-related variables. Moreover, a significant relationship between calcaneal quantitative ultrasound index/stiffness and femoral/lumbar BMD values from DXA was described. The multivariate analysis showed an independent association between calcaneal quantitative ultrasound index/stiffness and body mass index, higher CD4+ T-cell numbers and low 25-OH D2/D3 vitamin D levels <10 ng/mL (P-values: 0.004, 0.016, and 0.015, respectively). Conclusion As an alternative and/or integrative examination to DXA, calcaneal QUS could be proposed as a useful screening in HIV-1-infected patients for assessing bone health impairment. In fact, the results obtained confirm that calcaneal QUS may be useful for monitoring bone status, being a noninvasive and inexpensive technique, especially in those subjects with the classical traditional risk factors for bone damage that were observed earlier in HIV-1 population.
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Affiliation(s)
| | - Marco Floridia
- Department of Therapeutic Research and Medicines Evaluation, Istituto Superiore di Sanità (ISS), Sapienza University of Rome, Rome, Italy
| | - Fabrizio Ceci
- Department of Cellular Biotechnologies and Hematology, Sapienza University of Rome, Rome, Italy
| | - Francesco Cacciatore
- U.O. of Cardiac Rehabilitation, Fondazione Salvatore Maugeri, IRCCS, Istituto di Telese Terme, Benevento, Italy
| | - Vincenzo Vullo
- Department of Public Health and Infectious Diseases, Sapienza - University of Rome, Rome, Italy
| | - Ivano Mezzaroma
- Department of Clinical Medicine, Sapienza - University of Rome, Rome, Italy
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Michelini Z, Baroncelli S, Fantauzzi A, Pasquale C, Galluzzo CM, Sanchez M, Gatto M, Amici R, Franco M, d'Ettorre G, Fimiani C, Mezzaroma I, Vullo V, Merli M, Palmisano L. Reduced Plasma Levels of sCD14 and I-FABP in HIV-infected Patients with Mesalazine-treated Ulcerative Colitis. HIV Clin Trials 2016; 17:49-54. [PMID: 26739837 DOI: 10.1080/15284336.2015.1125077] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Microbial translocation (MT) is a shared feature of HIV infection and inflammatory bowel disease (IBD). AIMS This study was conducted to assess the impact of IBD (and particularly ulcerative colitis, UC) on plasma markers of MT and immune activation in HIV+ subjects. METHODS A cross-sectional study was conducted in 3 groups of patients: HIV+/UC+(group HIV/UC); HIV+/UC- (group HIV); HIV-/UC+(group UC). Plasma levels of soluble CD14 (sCD14), intestinal fatty acid-binding protein (I-FABP), and endotoxin core antibodies (endoCAB) were measured as plasma markers of MT. Inflammation and immune activation were evaluated by measuring plasma levels of IL-6, IL-21, TNF-alpha, and high-sensitivity C-reactive protein (hs-CRP). T- and B-cells subpopulations were characterized by FACS analysis. RESULTS Seven patients were enrolled in group HIV/UC, 9 in HIV, and 10 in UC. All HIV-positive patients had plasma values of HIV-1 RNA<37 copies/mL for at least 12 months and good immunological recovery. All patients with UC were treated with oral mesalazine. Markers of MT, immune activation, and inflammation were not increased in subjects with HIV/UC. In fact, they had lower levels of I-FABP (p=0.001) and sCD14 (p=0.007) when compared to other patients groups. Positive correlations were found between I-FABP and sCD14 (r=.355, p=0.076). Frequency of T- and B-cell subsets did not differ among groups. CONCLUSIONS Our results suggest that UC does not worsen MT, inflammation, or immune activation in HIV-infected subjects. The anti-inflammatory activity of chronic mesalazine administration on intestinal mucosa may contribute to this finding.
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Affiliation(s)
- Zuleika Michelini
- a Department of Therapeutic Research and Medicines Evaluation , Istituto Superiore di Sanità , Rome , Italy
| | - Silvia Baroncelli
- a Department of Therapeutic Research and Medicines Evaluation , Istituto Superiore di Sanità , Rome , Italy
| | | | - Chiara Pasquale
- c Gastroenterology, Department of Clinical Medicine , Sapienza University of Rome , Rome , Italy
| | - Clementina Maria Galluzzo
- a Department of Therapeutic Research and Medicines Evaluation , Istituto Superiore di Sanità , Rome , Italy
| | - Massimo Sanchez
- d Department of Cell Biology and Neurosciences , Istituto Superiore di Sanità , Rome , Italy
| | - Manuela Gatto
- c Gastroenterology, Department of Clinical Medicine , Sapienza University of Rome , Rome , Italy
| | - Roberta Amici
- a Department of Therapeutic Research and Medicines Evaluation , Istituto Superiore di Sanità , Rome , Italy
| | - Marina Franco
- a Department of Therapeutic Research and Medicines Evaluation , Istituto Superiore di Sanità , Rome , Italy
| | - Gabriella d'Ettorre
- e Department of Infectious and Tropical Diseases , Policlinico Umberto I , Rome , Italy
| | - Caterina Fimiani
- e Department of Infectious and Tropical Diseases , Policlinico Umberto I , Rome , Italy
| | - Ivano Mezzaroma
- c Gastroenterology, Department of Clinical Medicine , Sapienza University of Rome , Rome , Italy
| | - Vincenzo Vullo
- f Department of Public Health and Infectious Diseases , Sapienza University of Rome , Rome , Italy
| | - Manuela Merli
- c Gastroenterology, Department of Clinical Medicine , Sapienza University of Rome , Rome , Italy
| | - Lucia Palmisano
- a Department of Therapeutic Research and Medicines Evaluation , Istituto Superiore di Sanità , Rome , Italy
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Fantauzzi A, Floridia M, Falasca F, Spanedda P, Turriziani O, Vullo V, Mezzaroma I. Backbone switch to abacavir/lamivudine fixed-dose combination: implications for antiretroviral therapy optimization. New Microbiol 2015; 38:531-540. [PMID: 26485011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Accepted: 08/23/2015] [Indexed: 06/05/2023]
Abstract
Current guidelines recommend treatment optimization in virologically suppressed patients through switching/ simplification strategies to minimize long-term toxicities and improve adherence. The assessment of inflammation/ coagulation profiles may support therapeutic decisions. We undertook a prospective, non-randomized study to evaluate the efficacy and safety of switching to ABC/3TC from ZDV/3TC or TDF/FTC backbones, in 40 HIV-1 infected patients with HIV-RNA levels <37 copies/mL (>24 months). Main endpoints were viral load levels, CD4+ T cells and toxicities after 48 weeks. Serum inflammation/coagulation markers (ESR, CRP, D-dimer and fibrinogen) and pro-inflammatory cytokines (IL-6, TNF-α, adiponectin, resistin) were evaluated. Baseline characteristics were similar in the two arms, with significantly lower values of e-GFR in patients on TDF/FTC. Markers of inflammation/ coagulation and cytokine profile were also similar, except for higher values of resistin in patients on TDF/ FTC. During follow up, CD4+ T cells increased and viral load remained undetectable in both groups. Patient from ZDV/3TC had significantly greater changes in total cholesterol and serum creatinine. Markers of inflammation/ coagulation remained unchanged. Adiponectin significantly increased in patients from ZDV/3TC. Switching to ABC/3TC was effective and safe. Inflammatory markers remained low in both groups. Some changes in metabolic, kidney and cytokine profiles were apparently specific for baseline cART treatment.
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Affiliation(s)
| | - Marco Floridia
- Department of Therapeutic Research and Medicines Evaluation, Istituto Superiore di Sanità (ISS), Rome, Italy
| | - Francesca Falasca
- Department of Molecular Medicine, Sapienza, University of Rome, Rome, Italy
| | - Pierpaolo Spanedda
- Department of Experimental Medicine, Sapienza, University of Rome, Rome, Italy
| | | | - Vincenzo Vullo
- Department of Public Health and Infectious Diseases, Sapienza, University of Rome, Rome, Italy
| | - Ivano Mezzaroma
- Department of Clinical Medicine, Sapienza, University of Rome, Rome, Italy
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11
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Montagna C, Mazzuti L, Falasca F, Maida P, Bucci M, D'Ettorre G, Mezzaroma I, Fantauzzi A, Alvaro N, Vullo V, Antonelli G, Turriziani O. Trends in drug resistance-associated mutations in a real-life cohort of Italian patients infected with HIV-1. J Glob Antimicrob Resist 2015; 3:267-272. [PMID: 27842871 DOI: 10.1016/j.jgar.2015.07.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Revised: 06/26/2015] [Accepted: 07/08/2015] [Indexed: 11/29/2022] Open
Abstract
Recent studies support the idea that human immunodeficiency virus type 1 (HIV-1) drug resistance is declining in developed countries. To help assess the current situation in Italy, the dynamics of drug resistance mutations in pol and integrase genes in plasma samples from HIV-1-positive patients attending Sapienza University Hospital, Rome, from 2003 to 2014 were analysed. In total, 1730 genotype resistance tests (GRTs) were retrospectively analysed. The prevalence of major drug resistance mutations (DRMs) was evaluated over time in the global population and in patients with antiretroviral therapy (ART) failure. Population dynamics, changes in ART administration, and HIV-1 RNA levels were analysed in combination with DRM trends. The global population showed a strong reduction in major DRMs to all drug classes. Over the 2003-2014 decade, resistance to nucleoside reverse transcriptase inhibitors (NRTIs), non-nucleoside reverse transcriptase inhibitors (NNRTIs) and protease inhibitors (PIs) declined from 80.0% to 18.7%, from 42.8% to 20.1% and from 74.2% to 8.3%, respectively (P<0.005 for all comparisons). However, only PI-associated mutations showed a significant decrease in patients experiencing ART failure. Interestingly, analysis of the integrase gene disclosed an increased resistance to integrase inhibitors, mainly regarding N155H, detected in 32.6% of raltegravir-treated patients in 2012-2014. In conclusion, in line with previous findings, this study shows that drug resistance is declining in Italy. However, the persistence of DRMs to NRTIs and NNRTIs suggests that despite adherence and treatment optimisation, some patients still experience therapy failure, emphasising the need for GRTs both in naïve and ART-failed patients.
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Affiliation(s)
- Claudia Montagna
- Department of Molecular Medicine, Sapienza University, Viale di Porta Tiburtina 28, 00185 Rome, Italy
| | - Laura Mazzuti
- Department of Molecular Medicine, Sapienza University, Viale di Porta Tiburtina 28, 00185 Rome, Italy
| | - Francesca Falasca
- Department of Molecular Medicine, Sapienza University, Viale di Porta Tiburtina 28, 00185 Rome, Italy
| | - Paola Maida
- Department of Molecular Medicine, Sapienza University, Viale di Porta Tiburtina 28, 00185 Rome, Italy
| | - Mauro Bucci
- Department of Molecular Medicine, Sapienza University, Viale di Porta Tiburtina 28, 00185 Rome, Italy
| | - Gabriella D'Ettorre
- Department of Public Health and Infectious Diseases, Sapienza University, Rome, Italy
| | - Ivano Mezzaroma
- Department of Clinical Medicine, Sapienza University, Rome, Italy
| | | | - Nadia Alvaro
- Department of Molecular Medicine, Sapienza University, Viale di Porta Tiburtina 28, 00185 Rome, Italy
| | - Vincenzo Vullo
- Department of Public Health and Infectious Diseases, Sapienza University, Rome, Italy
| | - Guido Antonelli
- Department of Molecular Medicine, Sapienza University, Viale di Porta Tiburtina 28, 00185 Rome, Italy
| | - Ombretta Turriziani
- Department of Molecular Medicine, Sapienza University, Viale di Porta Tiburtina 28, 00185 Rome, Italy.
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Falasca F, Maida P, Gaeta A, Verzaro S, Mezzaroma I, Fantauzzi A, Donato G, Bonci E, Castilletti C, Antonelli G, Turriziani O. Detection and quantification of EBV, HHV-6 and CMV DNA in the gastrointestinal tract of HIV-positive patients. Infection 2014; 42:1033-7. [PMID: 25326253 DOI: 10.1007/s15010-014-0690-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2014] [Accepted: 10/06/2014] [Indexed: 12/22/2022]
Abstract
Human herpes viruses (HHVs) have been frequently detected in the gastrointestinal (GI) tract and may contribute to the development of gastric cancer. In the present study, the detection rate and viral load of Epstein Barr virus (EBV), HHV-6 and Cytomegalovirus (CMV) were assessed in the GI tract of human immunodeficiency virus (HIV) positive patients and of uninfected patients. The analysis revealed a significantly higher detection rate of EBV and HHV-6 in HIV-infected individuals than in uninfected subjects (88.5 vs 63%; p = 0.03). Moreover, EBV DNA load was significantly higher in the stomach of HIV patients than in controls. These data suggest that the HIV infection status may increase the persistence of these viruses in the GI compartment. Intriguingly, CMV DNA was undetectable in all biopsy specimens analyzed.
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Affiliation(s)
- F Falasca
- Department of Molecular Medicine, Sapienza University, Viale dell'Università 31, 00185, Rome, Italy
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13
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Milito C, Carello R, Fantauzzi A, Vullo V, Mezzaroma I. Streptococcus dysgalactiae subspecies equisimilis bacteraemia in an HIV-1 patient with HBV/HCV co-infections: case report and literature review. Infez Med 2014; 22:241-246. [PMID: 25269968] [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: 06/03/2023]
Abstract
Streptococcus dysgalactiae subspecies equisimilis (SDSE) is a common pathogen in animals and generally considered a rare cause of infection in humans. Recently, epidemiological studies demonstrated an increasing number of severe infections, including bacteraemia and endocarditis, caused by SDSE, mainly in predisposed hosts, immunocompromised by underlying conditions. Even though the immune status seems to play an important role in the appearance of SDSE infections, this microorganism has been rarely described as a pathogen in HIV-1 infected subjects. An extensive review of the literature on this pathogen is reported, with a description of a case of SDSE bacteraemia associated to septic arthritis with soft tissue infection in a patient with HIV-1 disease and chronic hepatitis due to HCV and HBV co-infections.
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Affiliation(s)
- Cinzia Milito
- Department of Molecular Medicine, Sapienza University of Rome; Department of Paediatric Allergy, Research Centre, Villa San Pietro Fatebenefratelli Hospital; Department of Clinical Medicine, Sapienza University of Rome; Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Rossella Carello
- Department of Molecular Medicine, Sapienza University of Rome; Department of Paediatric Allergy, Research Centre, Villa San Pietro Fatebenefratelli Hospital; Department of Clinical Medicine, Sapienza University of Rome; Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Alessandra Fantauzzi
- Department of Molecular Medicine, Sapienza University of Rome; Department of Paediatric Allergy, Research Centre, Villa San Pietro Fatebenefratelli Hospital; Department of Clinical Medicine, Sapienza University of Rome; Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Vincenzo Vullo
- Department of Molecular Medicine, Sapienza University of Rome; Department of Paediatric Allergy, Research Centre, Villa San Pietro Fatebenefratelli Hospital; Department of Clinical Medicine, Sapienza University of Rome; Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Ivano Mezzaroma
- Department of Molecular Medicine, Sapienza University of Rome; Department of Paediatric Allergy, Research Centre, Villa San Pietro Fatebenefratelli Hospital; Department of Clinical Medicine, Sapienza University of Rome; Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
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Abstract
The human immunodeficiency virus type-1 (HIV-1) integrase enzyme has recently emerged as a primary alternative target to block viral replication, and integrase strand transfer inhibitors (INSTIs) are now considered an alternative 'third agent' class of antiretroviral (ARV) drugs. Dolutegravir is the first next-generation INSTI showing some novel and intriguing characteristics: it has a favorable pharmacokinetic profile with a prolonged intracellular halflife, rendering feasible a once daily dosing without the need for pharmacokinetic boosting. Secondly, it is largely metabolized via uridine diphosphate glucuronosyltransferase-1A1 with a minor component of cytochrome P450 isoforms, thus allowing a low grade of drug-drug interactions, so that its metabolic profile consents co-administration with the majority of the other ARV drugs without dose adjustments. Lastly, but no less important, virological studies have clearly demonstrated that dolutegravir has a significant activity against HIV-1 isolates showing raltegravir and/or elvitegravir associated resistance mutations. The attributes of once daily administration and the potential to treat INSTI-resistant viruses make dolutegravir an interesting and promising new agent in the treatment of both naïve and experienced HIV-1 subjects. In this review, the main concerns on dolutegravir efficacy are focused through the analysis of the currently available data from clinical studies in naïve and experienced patients, evaluating its possible place within the anti-HIV-1 drug armamentarium. The development of newer once daily, single tablet coformulations improved drug adherence and maximized the success of ARV therapy. Pharmacokinetic studies and dose-ranging trials suggested that dolutegravir is a good candidate for a single tablet regimen in one or more new coformulated pills that will be available in the near future.
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Affiliation(s)
| | - Ivano Mezzaroma
- Department of Clinical Medicine, Sapienza - University of Rome, Viale dell'Università 37, Rome, 00185, Italy
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15
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Fantauzzi A, Digiulio MA, Cavallari EN, d'Ettorre G, Vullo V, Mezzaroma I. Guillain Barre syndrome in an HIV-1-infected patient after the beginning of combined antiretroviral therapy: an immune reconstitution inflammatory syndrome? New Microbiol 2014; 37:103-107. [PMID: 24531178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Accepted: 11/26/2013] [Indexed: 06/03/2023]
Abstract
HIV-1-associated Guillan-Barre syndrome (hGBS) is an ascendant progressive polyradiculoneuropathy described throughout the course of the viral disease, mainly associated with the acute retroviral syndrome. HGBS is occasionally described in severely immunocompromised subjects in the context of the immune reconstitution inflammatory syndrome. The case described occurred soon after the start of a combined antiretroviral treatment in an HIV-1 infected patient with ulcerative colitis in the absence of severe immunosuppression. This manifestation may be interpreted as an uncommon appearance of an immune reconstitution syndrome in the presence of a predisposing autoimmune pathology.
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Fantauzzi A, Falasca F, d’Ettorre G, Cavallari EN, Turriziani O, Vullo V, Mezzaroma I. Microbial translocation, residual viremia and immune senescence in the pathogenesis of HIV-1 infection. World J Clin Infect Dis 2013; 3:47-57. [DOI: 10.5495/wjcid.v3.i4.47] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Revised: 09/16/2013] [Accepted: 11/16/2013] [Indexed: 02/06/2023] Open
Abstract
The pathophysiological mechanisms that underlie the progression of human immunodeficiency virus-1 (HIV-1) disease to full-blown AIDS are not well understood. Findings suggest that, during HIV-1 infection, plasma lipopolysaccharide (LPS) levels, which are used as an indicator of microbial translocation (MT), are elevated throughout the acute and chronic phases of HIV-1 disease. The translocation of bacterial products through the damaged gastrointestinal barrier into the systemic circulation has been described as a driver of immune activation. In contrast, comorbidities that are associated with HIV-1 infection have been attributed to chronic inflammation and immune system dysfunction secondary to MT or low-level HIV-1 replication in plasma and cell reservoirs. Moreover, accelerated aging is significantly associated with chronic inflammation, immune activation, and immune senescence. In this review, we aimed to investigate the role of inflammation as a pivotal marker in the pathogenesis of HIV-1 disease. We will discuss the key features of chronic inflammation and immune activation that are observed during the natural course of the disease and those features that are detected in cART-modified infection. The review will focus on the following aspects of HIV-1 infection: (1) MT; (2) the role of residual viremia; and (3) “immune senescence” or “inflammaging.” Many questions remain unanswered about the potential mechanisms that are involved in HIV-1 pathogenesis. Further studies are needed to better investigate the mechanisms that underlie immune activation and their correlation with HIV-1 disease progression.
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Falasca F, Montagna C, Maida P, Bucci M, Fantauzzi A, Mezzaroma I, Antonelli G, Turriziani O. Analysis of intracellular human immunodeficiency virus (HIV)-1 drug resistance mutations in multi-failed HIV-1-infected patients treated with a salvage regimen: 72-week follow-up. Clin Microbiol Infect 2013; 19:E318-21. [PMID: 23438096 DOI: 10.1111/1469-0691.12175] [Citation(s) in RCA: 5] [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] [Received: 11/05/2012] [Revised: 12/28/2012] [Accepted: 01/25/2013] [Indexed: 11/29/2022]
Abstract
The human immunodeficiency virus (HIV) mutational archive of proviral DNA was monitored during a 72-week follow-up in 20 multidrug-experienced HIV-1-infected patients treated with a darunavir/ritonavir-based salvage therapy. At the beginning of the study, all patients harboured a number of intracellular drug resistance-associated mutations (RAMs) in peripheral blood mononuclear cells. In some patients, a significant fluctuation in the number of RAMs was observed during the observation period. However, all patients, notwithstanding the presence or the fluctuation of intracellular RAMs, showed a persistently undetectable viraemia. The data suggest that the archived resistant viral variants change during suppressive therapy, but that the variants are unable to re-emerge and to affect virological response.
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Affiliation(s)
- F Falasca
- Department of Molecular Medicine, Sapienza University, Rome, Italy
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18
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Abstract
The viral integrase enzyme has recently emerged as a primary alternative target to block HIV-1 replication, and integrase inhibitors are considered a pivotal new class of antiretroviral drugs. Dolutegravir is an investigational next-generation integrase inhibitor showing some novel and intriguing characteristics, ie, it has a favorable pharmacokinetic profile with a prolonged intracellular half-life, rendering feasible once-daily dosing without the need for ritonavir boosting and without regard to meals. Moreover, dolutegravir is primarily metabolized via uridine diphosphate glucuronosyltranferase 1A1, with a minor component of the cytochrome P450 3A4 isoform, thereby limiting drug–drug interactions. Furthermore, its metabolic profile enables coadministration with most of the other available antiretroviral agents without dose adjustment. Recent findings also demonstrate that dolutegravir has significant activity against HIV-1 isolates with resistance mutations associated with raltegravir and/or elvitegravir. The attributes of once-daily administration and the potential to treat integrase inhibitor-resistant viruses make dolutegravir an interesting and promising investigational drug. In this review, the main concerns about the efficacy and safety of dolutegravir as well as its resistance profile are explored by analysis of currently available data from preclinical and clinical studies.
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Baroncelli S, Mezzaroma I, Fantauzzi A, Galluzzo MC, Antoni AD, Vullo V, Francisci D, Ladisa N, Vivarelli A, Cirioni O, Sighinolfi L, Weimer LE, Fragola V, Fidanza R, Cara A, Palmisano L. No evidence of autoimmune disorders in antiretroviral-experienced HIV-1-infected subjects after long-term treatment with raltegravir. Antivir Ther 2012; 18:321-7. [DOI: 10.3851/imp2433] [Citation(s) in RCA: 3] [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] [Accepted: 08/03/2012] [Indexed: 10/27/2022]
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20
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Esposito A, Floridia M, d'Ettorre G, Pastori D, Fantauzzi A, Massetti P, Ceccarelli G, Ajassa C, Vullo V, Mezzaroma I. Rate and determinants of treatment response to different antiretroviral combination strategies in subjects presenting at HIV-1 diagnosis with advanced disease. BMC Infect Dis 2011; 11:341. [PMID: 22166160 PMCID: PMC3297656 DOI: 10.1186/1471-2334-11-341] [Citation(s) in RCA: 5] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2011] [Accepted: 12/14/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The optimal therapeutic strategies for patients presenting with advanced disease at HIV-1 diagnosis are as yet incompletely defined. METHODS All patients presenting at two outpatient clinics in 2000-2009 with an AIDS-defining clinical condition or a CD4+ T cell count < 200/μL at HIV-1 diagnosis were analyzed for the presence of combined immunovirological response, defined by the concomitant presence of an absolute number of CD4+ T cells > 200 cells/μL and a plasma HIV-1 RNA copy number < 50/mL after 12 months of HAART. RESULTS Among 102 evaluable patients, first-line regimens were protease inhibitors [PI]-based in 78 cases (77%) and efavirenz-based in 24 cases (23%). The overall response rate was 65% (95% CI: 55-74), with no differences by gender, age, nationality, route of transmission, hepatitis virus coinfections, presence of AIDS-defining clinical events, baseline HIV-1 viral load, or type of regimen (response rates with PI-based and efavirenz-based therapy: 63% and 71%, respectively, p = 0.474). Response rate was significantly better with higher baseline CD4+ T cell counts (78% with CD4+ ≥ 100/μL, compared to 50% with CD4+ < 100/μL; odds ratio: 3.5; 95% CI: 1.49-8.23, p = 0.003). Median time on first-line antiretroviral therapy was 24 months (interquartile range: 12-48). Switch to a second line treatment occurred in 57% of patients, mainly for simplification (57%), and was significantly more common with PI-based regimens [adjusted hazard ratios (AHR) with respect to efavirenz-based regimens: 3.88 for unboosted PIs (95% CI: 1.40-10.7, p = 0.009) and 4.21 for ritonavir-boosted PI (95% CI 1.7-10.4, p = 0.002)] and in older subjects (≥ 50 years) (AHR: 1.83; 95% CI: 1.02-3.31, p = 0.044). Overall mortality was low (3% after a median follow up of 48 months). CONCLUSIONS Our data indicate that a favorable immunovirological response is possible in the majority of naive patients presenting at HIV-1 diagnosis with AIDS or low CD4+ T cell counts, and confirm that starting HAART with a more compromised immune system may be associated with a delayed and sometimes partial immune recovery. Simpler regimens may be preferable in this particular population.
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Affiliation(s)
| | - Marco Floridia
- Dpt. of Therapeutic Research and Medicines Evaluation, Istituto Superiore di Sanità, Rome, Italy
| | - Gabriella d'Ettorre
- Dpt. of Public Health and Infectious Diseases, "Sapienza" University of Rome, Rome, Italy
| | - Daniele Pastori
- Dpt. of Internal Medicine and Medical Specialties, "Sapienza" University of Rome, Rome, Italy
| | | | - Paola Massetti
- Dpt. of Public Health and Infectious Diseases, "Sapienza" University of Rome, Rome, Italy
| | - Giancarlo Ceccarelli
- Dpt. of Public Health and Infectious Diseases, "Sapienza" University of Rome, Rome, Italy
| | - Camilla Ajassa
- Dpt. of Public Health and Infectious Diseases, "Sapienza" University of Rome, Rome, Italy
| | - Vincenzo Vullo
- Dpt. of Public Health and Infectious Diseases, "Sapienza" University of Rome, Rome, Italy
| | - Ivano Mezzaroma
- Dpt. of Clinical Medicine, "Sapienza" University of Rome, Rome, Italy
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Esposito A, Conti V, Cagliuso M, Pastori D, Fantauzzi A, Mezzaroma I. Management of HIV-1 associated hepatitis in patients with acquired immunodeficiency syndrome: role of a successful control of viral replication. AIDS Res Ther 2011; 8:9. [PMID: 21362160 PMCID: PMC3055803 DOI: 10.1186/1742-6405-8-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2010] [Accepted: 03/01/2011] [Indexed: 11/13/2022] Open
Abstract
In HIV-1 infected patients, increase of liver enzymes may be mainly due to viral coinfections, alcohol intake, hepatotoxic drugs or autoimmune diseases. Three cases of aminotransferase elevation occurred during a phase of uncontrolled viral replication combined with a severe immunodeficiency and resolved by an effective HAART are described, focusing on the etio-pathogenetic role possibly played by HIV-1 infection.
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22
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Turriziani O, Boni A, Falasca F, Graziano F, Bucci M, D'Ettorre G, Fantauzzi A, Paoletti F, Massetti AP, Mezzaroma I, Antonelli G. Mutational resistance pattern of HIV type 1 in CD14+ monocytes, CD4+ T cells, and plasma from treated patients. AIDS Res Hum Retroviruses 2010; 26:625-34. [PMID: 20507206 DOI: 10.1089/aid.2009.0183] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
It is necessary to understand the molecular nature of the virus population that persists in cellular reservoirs. To achieve this we planned to characterize the patterns of resistance of HIV-1 in CD14(+) monocytes, CD4(+) T cells, and plasma. Blood samples were collected from 42 patients treated for HIV: 32 were in virological failure and in 10 viremia was undetectable. CD14(+) and CD4(+) T cells were isolated using magnetic beads. Genotyping of the reverse transcriptase and protease gene of HIV-1 was undertaken using the fluorescent dideoxy-terminator method. Of the 32 patients in virological failure, 24 (75%) had resistance mutations in at least one compartment. The numbers and types of mutations from monocytes were the same as those detected in both CD4(+) T cell-associated virus and plasma in only 8% whereas in 71% monocytes exhibited a different mutation pattern. In 21% of patients, the profile of drug-resistant mutations in the virus from blood monocytes was identical to that in plasma but differed from that in CD4. In the 71% of patients with virological suppression, the genotypic resistance pattern differed between monocytes and CD4(+) T cells. Circulating monocytes may harbor a viral dominant population different from those viruses circulating in blood and archived in CD4(+) T cells. Hence, monocytes and other cellular reservoirs might serve as an indirect source of a drug-resistant viral variant.
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Affiliation(s)
- Ombretta Turriziani
- Department of Experimental Medicine, Virology Section, “Sapienza” University of Rome and Policlinico Umberto I, Rome, Italy
| | - Arianna Boni
- Department of Experimental Medicine, Virology Section, “Sapienza” University of Rome and Policlinico Umberto I, Rome, Italy
| | - Francesca Falasca
- Department of Experimental Medicine, Virology Section, “Sapienza” University of Rome and Policlinico Umberto I, Rome, Italy
| | - Francesca Graziano
- Department of Experimental Medicine, Virology Section, “Sapienza” University of Rome and Policlinico Umberto I, Rome, Italy
| | - Mauro Bucci
- Department of Experimental Medicine, Virology Section, “Sapienza” University of Rome and Policlinico Umberto I, Rome, Italy
| | - Gabriella D'Ettorre
- Department of Infectious Diseases, “Sapienza” University of Rome and Policlinico Umberto I, Rome, Italy
| | | | - Francesca Paoletti
- Department of Infectious Diseases, “Sapienza” University of Rome and Policlinico Umberto I, Rome, Italy
| | - Anna Paola Massetti
- Department of Infectious Diseases, “Sapienza” University of Rome and Policlinico Umberto I, Rome, Italy
| | | | - Guido Antonelli
- Department of Experimental Medicine, Virology Section, “Sapienza” University of Rome and Policlinico Umberto I, Rome, Italy
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Conti V, Esposito A, Cagliuso M, Fantauzzi A, Pastori D, Mezzaroma I, Aiuti F. Undifferentiated connective tissue disease - an unsolved problem:revision of literature and case studies. Int J Immunopathol Pharmacol 2010; 23:271-8. [PMID: 20378013 DOI: 10.1177/039463201002300125] [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: 11/16/2022] Open
Abstract
In clinical practice, patients with a range of signs and symptoms suggestive of connective tissue disease, but who do not fulfil the classification criteria for a defined disease are often found. This condition is defined as, Undifferentiated Connective Tissue Disease (UCTD). Most of the authors consider UCTD as a distinct clinical entity, generally stable during follow-up. Despite this, no mutual agreement regarding criteria for its diagnosis has been reached. The clinical, serological, therapeutical and evolutional patterns of 41 patients initially diagnosed as having early UCTD during a 3-year followup are described in this study. At the end of the observational period, 21 percent of the enrolled patients, followed throughout the follow-up, demonstrated clinical evolution to a defined connective tissue disease (CTD), whereas 52 percent of the observed subjects maintained an undifferentiated profile with variable clinical findings and presenting a generally stable disease over time. The remaining patients showed clinical improvement or complete regression of the symptoms associated with normalization of the inflammatory indexes. The role of therapy in these different clinical courses is discussed.
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Affiliation(s)
- V Conti
- Department of Clinical Medicine, Sapienza University, Rome, Italy
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Esposito A, Leti W, Fantauzzi A, Pastori D, Isgro A, Aiuti F, Mezzaroma I. [Immunorecovery after prolonged HIV-related immunosuppression: opportunities of the new antiretroviral classes]. Infez Med 2009; 17:178-183. [PMID: 19838091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Treatment of multi-drug experienced patients is an important concern in the management of HIV-1 disease, partially solved by the availability of new drugs acting at different phases of viral replication. Immune recovery during cART is linked both to the activity of antiviral drugs, as well as to the regenerative capability of thymus and bone marrow. We report a patient with a 22-year-old HIV-1 disease and an AIDS diagnosis for 15 years, with extensive resistance to all antiretroviral drugs, who never had treatment interruption, except for short spells due to adverse effects. This decision was supported by both findings elsewhere that interruptions of cART in experienced patients with advanced disease are strongly associated with more rapid disease progression and by our evaluation of his bone marrow activity. The colony-forming cells assay performed in the patient showed residual clonogenic capability, increased in vitro by addition of protease inhibitors and IL-2. A new therapeutic scheme including darunavir and maraviroc allowed dramatic changes leading both to a quick reduction in plasmatic viral load with an impressive immune reconstitution and an improvement in clinical conditions.
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De Marco F, Barbosa M, Fantauzzi A, Nascimento C, Imanishi W, Guimares A. Predictive factors of dialytic acute kidney injury in patients admitted to the intensive care unit after nontraumatic emergency abdominal surgery. Crit Care 2007. [PMCID: PMC4095442 DOI: 10.1186/cc5549] [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: 11/10/2022] Open
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De Santis W, Esposito A, Conti V, Fantauzzi A, Guerra A, Mezzaroma I, Aiuti F. [Health care and infective aspects in patients affected by common variable immunodeficiency assisted in the Lazio Regional Authority Reference Centre for Primary Immunodeficiencies]. Infez Med 2006; 14:13-23. [PMID: 16794375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Common variable immunodeficiency (CVID) is a chronic condition characterised by a predominant defect of humoral immunity. In most cases the diagnosis of CVID is made during adulthood; the main clinical features of CVID are chronic and relapsing infections (mainly of respiratory and gastroenteric tracts). CVID patients may also develop neoplastic and autoimmune diseases. In our centre (the Regional Centre for Primary Immunodeficiencies of the Lazio Regional Authority) we administered a 23-item questionnaire to 60 patients with CVID undergoing substitutive therapy with intravenous immunoglobulins (IVIG) about their demographic characteristics, time of clinical onset, time of diagnosis of CVID, clinical features, IVIG doses and administration intervals, and self-assessment of health status. In addition, the clinical history of all patients was reviewed, and the levels of serum IgG, IgA and IgM were evaluated and compared with the pre-therapy serum concentration. Moreover, an analysis of the treatment costs was performed. At onset, 67.2% of patients presented recurrent respiratory infections, and 50% had infections of the lower respiratory tract; 39.6% of the patients had gastroenteric infections. Most patients (57%) had recurrent infections of at least 2 of the respiratory, gastroenteric and/or urogenital tracts. In 37.9% of the group the diagnosis of CVID was made in less than 2 years after the beginning of symptoms, but in many cases (22.4%) the diagnosis took more than 10 years. 93% of patients are treated with a dose of IVIG between 6 and 15 g per administration, with intervals between 2 and 3 weeks. The review of patients'clinical history showed that 43% of patients have had respiratory infections during the follow-up in our Centre, 43% have splenomegaly (3% were also subjected to splenectomy) and 18.3% have autoimmune diseases. The mean concentration of IgG before the beginning of IVIG therapy was 235 mg/dl, while during the follow-up it was 664 mg/dl. Given the long time often required for diagnosis, general physicians and specialists should be better informed in order to make diagnosis swifter. The substitutive therapy with IVIG is effective in preventing recurrent infections and complications. A thorough follow-up is important for diagnosing neoplastic and autoimmune complications; in addition, immunologic analysis of peripheral blood and bone marrow are useful in identifying subgroups of patients with more severe clinical features. Finally, in selected patients, treatment costs may be controlled by modifying the dosage of IVIG or the intervals between administrations.
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Affiliation(s)
- W De Santis
- Dottorato di Ricerca in Scienze Infettivologiche e delle Terapie Immunologiche, Università degli Studi di Roma, La Sapienza, Roma, Italy
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Di Renzo G, Mignosa M, Gerli S, Burnelli L, Luzi G, Clerici G, Taddei F, Marinelli D, Bragetti B, Mezzetti D, Della Torre B, Fantauzzi A, Lungarotti M. Reply. Am J Obstet Gynecol 2006. [DOI: 10.1016/j.ajog.2005.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Isgrò A, Sirianni MC, Gramiccioni C, Mezzaroma I, Fantauzzi A, Aiuti F. Idiopathic CD4+ lymphocytopenia may be due to decreased bone marrow clonogenic capability. Int Arch Allergy Immunol 2005; 136:379-84. [PMID: 15746558 DOI: 10.1159/000084258] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2004] [Accepted: 11/08/2004] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Idiopathic CD4+ lymphocytopenia is defined by a stable decrease of CD4+ T cells in the absence of any known cause of immune deficiency. The mechanisms responsible for the immunological impairment are still unknown, but a regenerative failure of hematopoietic stem/progenitor cells has been hypothesized. METHODS We evaluated in the bone marrow (BM) of 5 patients with idiopathic CD4+ lymphocytopenia the phenotype of BM progenitor cells, their differentiation capacity with colony-forming cells and long-term culture-initiating cell assays, in parallel with the spontaneous IL-7 production in the patient sera. RESULTS Compared with controls, a regenerative failure of hematopoietic stem cells has been observed, both in 'committed' and in 'uncommitted' progenitor cells, despite high IL-7 serum levels. The percentage of phenotypically primitive CD34+CD38-DR+ cells (this includes the lymphoid precursor cells) was decreased, suggesting an involvement of the more primitive BM compartment in the de novo T cell generation. CONCLUSIONS Despite the low number of patients, due to the low incidence of the disease, the decrease of primitive precursors sustains the possibility that diminished stem cell precursors might contribute to the development of CD4+ T cell depletion.
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Affiliation(s)
- Antonella Isgrò
- Division of Allergy and Clinical Immunology, University of Rome La Sapienza, Rome, Italy
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Di Renzo GC, Mignosa M, Gerli S, Burnelli L, Luzi G, Clerici G, Taddei F, Marinelli D, Bragetti P, Mezzetti D, Della Torre B, Fantauzzi A, Lungarotti MS. The combined maternal administration of magnesium sulfate and aminophylline reduces intraventricular hemorrhage in very preterm neonates. Am J Obstet Gynecol 2005; 192:433-8. [PMID: 15695983 DOI: 10.1016/j.ajog.2004.07.078] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To determine whether the adjunctive administration of aminophylline and magnesium sulfate to mothers at risk for preterm birth can reduce the rate of intraventricular hemorrhage in neonates born at less than 30 weeks of gestation. STUDY DESIGN A prospective study was conducted to determine whether the rate of intraventricular hemorrhage was different in patients at risk for preterm delivery treated with ritodrine, magnesium sulfate, aminophylline, and corticosteroids (group A) versus patients treated with ritodrine and corticosteroids (group B). During the study period (January 1996 to December 2001), 125 patients enrolled in the study. Treatment was assigned by alternative allocation, and the study was designed to compare the rate of intraventricular hemorrhage in neonates born before the 30th week of gestation (primary outcome), 78 newborns in group A and 68 in group B. The proportion of neonates with intraventricular hemorrhage was calculated, and data were analyzed with Student t test, chi 2 , and logistic regression analysis. RESULTS The frequency of severe respiratory distress syndrome needing surfactant replacement and high-pressure positive ventilation, patent ductus arteriosus, and retinopathy of prematurity was not different between the 2 groups. However, the rate of intraventricular hemorrhage was lower in neonates born before 30 weeks whose mothers received adjunctive aminophylline and magnesium sulphate (group A) than in the group that did not receive these 2 agents (group B). The overall frequency of intraventricular hemorrhage was 5.1% (4/78) versus 20.6% (14/68) ( P < .001), and the frequency of intraventricular hemorrhage grade 3-4 was 1.3% (1/78) versus 10.3 % (7/68; P < .001), respectively. CONCLUSION Adjunctive maternal administration of aminophylline and magnesium sulfate was associated with a significant reduction in the rate of intraventricular hemorrhage in neonates born before 30 completed weeks.
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Affiliation(s)
- Gian Carlo Di Renzo
- Centre of Perinatal and Reproductive Medicine, Neonatal Intensive Care Unit, University of Perugia, Perugia, Italy.
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Isgrò A, Mezzaroma I, Aiuti A, Fantauzzi A, Pinti M, Cossarizza A, Aiuti F. Decreased apoptosis of bone marrow progenitor cells in HIV-1-infected patients during highly active antiretroviral therapy. AIDS 2004; 18:1335-7. [PMID: 15362667 DOI: 10.1097/00002030-200406180-00013] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Impaired haematopoiesis during HIV-1 infection may be caused by the overproduction of inflammatory cytokines by immune cells at the bone marrow level inducing Fas-mediated apoptosis of stem progenitors. In this study, we evaluated the effects of highly active antiretroviral therapy on apoptosis of CD34+ stem cells derived from the bone marrow of HIV-1-infected patients, and observed decreased Fas expression on progenitor cells, in parallel with the diminution of TNF-alpha levels and the amelioration of clonogenic parameters.
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Affiliation(s)
- Antonella Isgrò
- Division of Allergy and Clinical Immunology, University of Rome La Sapienza, Italy
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Berberian DA, Paquin HO, Fantauzzi A. Longevity of Schistosoma hematobium and Schistosoma mansoni: Observations Based on a Case. J Parasitol 1953. [DOI: 10.2307/3273851] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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