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Palmieri O, Castellana S, Bevilacqua A, Latiano A, Latiano T, Panza A, Fontana R, Ippolito AM, Biscaglia G, Gentile A, Gioffreda D, Decina I, Tricarico M, Sinigaglia M, Corbo MR, Mazza T, Perri F, Lamacchia C. Adherence to Gluten-Free Diet Restores Alpha Diversity in Celiac People but the Microbiome Composition Is Different to Healthy People. Nutrients 2022; 14:nu14122452. [PMID: 35745182 PMCID: PMC9228530 DOI: 10.3390/nu14122452] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 06/09/2022] [Accepted: 06/09/2022] [Indexed: 02/06/2023] Open
Abstract
Celiac disease (CD) is an autoimmune disease with the destruction of small intestinal villi, which occurs in genetically predisposed individuals. At the present moment, a gluten-free diet (GFD) is the only way to restore the functionality of gut mucosa. However, there is an open debate on the effects of long-term supplementation through a GFD, because some authors report an unbalance in microbial taxa composition. Methods: For microbiome analysis, fecal specimens were collected from 46 CD individuals in GFD for at least 2 years and 30 specimens from the healthy controls (HC). Data were analyzed using an ensemble of software packages: QIIME2, Coda-lasso, Clr-lasso, Selbal, PICRUSt2, ALDEx2, dissimilarity-overlap analysis, and dysbiosis detection tests. Results: The adherence to GFD restored the alpha biodiversity of the gut microbiota in celiac people but microbial composition at beta diversity resulted as different to HC. The microbial composition of the CD subjects was decreased in a number of taxa, namely Bifidobacterium longum and several belonging to Lachnospiraceae family, whereas Bacteroides genus was found to be more abundant. Predicted metabolic pathways among the CD bacterial communities revealed an important role in tetrapyrrole biosynthesis. Conclusions: CD patients in GFD had a non-dysbiotic microbial composition for the crude alpha diversity metrics. We found significant differences in beta diversity, in certain taxon, and pathways between subjects with inactive CD in GFD and controls. Collectively, our data may suggest the development of new GFD products by modulating the gut microbiota through diet, supplements of vitamins, and the addition of specific prebiotics.
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Affiliation(s)
- Orazio Palmieri
- Division of Gastroenterology, Fondazione IRCCS “Casa Sollievo della Sofferenza”, 71013 San Giovanni Rotondo, Italy; (A.L.); (T.L.); (A.P.); (R.F.); (A.M.I.); (G.B.); (A.G.); (D.G.); (F.P.)
- Correspondence:
| | - Stefano Castellana
- Bioinformatics Unit, Fondazione IRCCS “Casa Sollievo della Sofferenza”, 71013 San Giovanni Rotondo, Italy; (S.C.); (T.M.)
| | - Antonio Bevilacqua
- Department of Agriculture, Food, Natural Resources and Engineering (DAFNE), University of Foggia, 71122 Foggia, Italy; (A.B.); (M.S.); (M.R.C.); (C.L.)
| | - Anna Latiano
- Division of Gastroenterology, Fondazione IRCCS “Casa Sollievo della Sofferenza”, 71013 San Giovanni Rotondo, Italy; (A.L.); (T.L.); (A.P.); (R.F.); (A.M.I.); (G.B.); (A.G.); (D.G.); (F.P.)
| | - Tiziana Latiano
- Division of Gastroenterology, Fondazione IRCCS “Casa Sollievo della Sofferenza”, 71013 San Giovanni Rotondo, Italy; (A.L.); (T.L.); (A.P.); (R.F.); (A.M.I.); (G.B.); (A.G.); (D.G.); (F.P.)
| | - Anna Panza
- Division of Gastroenterology, Fondazione IRCCS “Casa Sollievo della Sofferenza”, 71013 San Giovanni Rotondo, Italy; (A.L.); (T.L.); (A.P.); (R.F.); (A.M.I.); (G.B.); (A.G.); (D.G.); (F.P.)
| | - Rosanna Fontana
- Division of Gastroenterology, Fondazione IRCCS “Casa Sollievo della Sofferenza”, 71013 San Giovanni Rotondo, Italy; (A.L.); (T.L.); (A.P.); (R.F.); (A.M.I.); (G.B.); (A.G.); (D.G.); (F.P.)
| | - Antonio Massimo Ippolito
- Division of Gastroenterology, Fondazione IRCCS “Casa Sollievo della Sofferenza”, 71013 San Giovanni Rotondo, Italy; (A.L.); (T.L.); (A.P.); (R.F.); (A.M.I.); (G.B.); (A.G.); (D.G.); (F.P.)
| | - Giuseppe Biscaglia
- Division of Gastroenterology, Fondazione IRCCS “Casa Sollievo della Sofferenza”, 71013 San Giovanni Rotondo, Italy; (A.L.); (T.L.); (A.P.); (R.F.); (A.M.I.); (G.B.); (A.G.); (D.G.); (F.P.)
| | - Annamaria Gentile
- Division of Gastroenterology, Fondazione IRCCS “Casa Sollievo della Sofferenza”, 71013 San Giovanni Rotondo, Italy; (A.L.); (T.L.); (A.P.); (R.F.); (A.M.I.); (G.B.); (A.G.); (D.G.); (F.P.)
| | - Domenica Gioffreda
- Division of Gastroenterology, Fondazione IRCCS “Casa Sollievo della Sofferenza”, 71013 San Giovanni Rotondo, Italy; (A.L.); (T.L.); (A.P.); (R.F.); (A.M.I.); (G.B.); (A.G.); (D.G.); (F.P.)
| | - Ivana Decina
- New Gluten World s.r.l., 71121 Foggia, Italy; (I.D.); (M.T.)
| | | | - Milena Sinigaglia
- Department of Agriculture, Food, Natural Resources and Engineering (DAFNE), University of Foggia, 71122 Foggia, Italy; (A.B.); (M.S.); (M.R.C.); (C.L.)
| | - Maria Rosaria Corbo
- Department of Agriculture, Food, Natural Resources and Engineering (DAFNE), University of Foggia, 71122 Foggia, Italy; (A.B.); (M.S.); (M.R.C.); (C.L.)
| | - Tommaso Mazza
- Bioinformatics Unit, Fondazione IRCCS “Casa Sollievo della Sofferenza”, 71013 San Giovanni Rotondo, Italy; (S.C.); (T.M.)
| | - Francesco Perri
- Division of Gastroenterology, Fondazione IRCCS “Casa Sollievo della Sofferenza”, 71013 San Giovanni Rotondo, Italy; (A.L.); (T.L.); (A.P.); (R.F.); (A.M.I.); (G.B.); (A.G.); (D.G.); (F.P.)
| | - Carmela Lamacchia
- Department of Agriculture, Food, Natural Resources and Engineering (DAFNE), University of Foggia, 71122 Foggia, Italy; (A.B.); (M.S.); (M.R.C.); (C.L.)
- New Gluten World s.r.l., 71121 Foggia, Italy; (I.D.); (M.T.)
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2
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Pellicelli A, Messina V, Giannelli V, Distefano M, Palitti VP, Vignally P, Tarquini P, Izzi A, Moretti A, Babudieri S, Dell'Isola S, Marignani M, Scifo G, Iovinella V, Cariti G, Pompili M, Candilo FD, Fontanella L, Ettorre GM, Vennarecci G, Ippolito AM, Barbarini G. High Efficacy and Safety of Flat-Dose Ribavirin Plus Sofosbuvir/Daclatasvir in Genotype 3 Cirrhotic Patients. Gut Liver 2021; 14:357-367. [PMID: 30970444 PMCID: PMC7234881 DOI: 10.5009/gnl18269] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 12/12/2018] [Accepted: 12/21/2018] [Indexed: 12/18/2022] Open
Abstract
Background/Aims Patients with genotype 3 hepatitis C virus (G3-HCV) cirrhosis are very difficult to treat compared to patients with other HCV genotypes. The optimal treatment duration and drug regimen associated with ribavirin (RBV) remain unclear. To evaluate the efficacy and safety of daclatasvir (DCV)/sofosbuvir (SOF) plus a flat dose of 800 mg RBV (flat dose) compared to DCV/SOF without RBV or DCV/SOF plus an RBV dose based on body weight (weight-based) in G3-HCV patients with compensated or decompensated cirrhosis. Methods We analyzed data for 233 G3 cirrhotic patients. Of these, 70 (30%), 87(37%) and 76 (33%) received SOF/DCV, SOF/DCV/RBV flat dose, and SOF/DCV/RBV weight-based dose, respectively. Treatment duration was 24 weeks. Sustained virological response (SVR) was evaluated at week 12 posttreatment (SVR12). Results Overall, SVR12 was achieved in 220 out of 233 patients (94.4%). The SVR12 rate was lower in the DCV/SOF group than in the DCV/SOF/RBV flat-dose group and the DCV/SOF/RBV weight-based group (87.1% vs 97.7% and 97.4%, respectively, p=0.007). A higher incidence of anemia occurred in the DCV/SOF/RBV weight-based group compared to those in the other two groups (p<0.007). Conclusions We found that the DCV/SOF/RBV flat-dose regimen is an effective treatment in terms of efficacy and safety in patients with G3-HCV compensated or decompensated cirrhosis. Therefore, antiviral regimens without RBV should be restricted only to naïve patients with G3-HCV compensated cirrhosis who have a clear contraindication for RBV.
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Affiliation(s)
| | - Vincenzo Messina
- Department of Infectious Disease, Sant'Anna and San Sebastiano Hospital, Caserta, Italy
| | - Valerio Giannelli
- Liver and Transplant Unit, San Camillo Forlanini Hospital, Rome, Italy
| | | | | | | | - Pierluigi Tarquini
- Department of Infectious Disease, Giuseppe Mazzini Hospital, Teramo, Italy
| | - Antonio Izzi
- Department of Infectious Disease and Emergency Infectious Disease, Cotugno Hospital, Napoli, Italy
| | | | - Sergio Babudieri
- Department of Infectious Disease, University of Sassari, Sassari, Italy
| | | | | | - Gaetano Scifo
- Liver Unit, Azienda Umberto I Hospital, Siracusa, Italy
| | | | - Giuseppe Cariti
- Infectious Disease, Department of Medical Science, University of Turin, Turin, Italy
| | - Maurizio Pompili
- Department of Internal Medicine, Catholic University, Rome, Italy
| | | | - Luca Fontanella
- Center for Liver Disease, Fatebenefratelli Hospital, Napoli, Italy
| | - Giuseppe M Ettorre
- Division of General Surgery and Liver Transplantation, San Camillo Forlanini Hospital, Rome, Italy
| | - Giovanni Vennarecci
- Division of General Surgery and Liver Transplantation, San Camillo Forlanini Hospital, Rome, Italy
| | - Antonio Massimo Ippolito
- Division of Gastroenterology, Casa Sollievo Sofferenza Hospital IRCCS, San Giovanni Rotondo, Pavia, Italy
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3
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Andriulli A, Stroffolini T, Mariano A, Valvano MR, Grattagliano I, Ippolito AM, Grossi A, Brancaccio G, Coco C, Russello M, Smedile A, Petrini E, Martini S, Gaeta GB, Rizzetto M. Declining prevalence and increasing awareness of HCV infection in Italy: A population-based survey in five metropolitan areas. Eur J Intern Med 2018; 53:79-84. [PMID: 29475770 DOI: 10.1016/j.ejim.2018.02.015] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [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: 11/13/2017] [Revised: 01/06/2018] [Accepted: 02/14/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND Data on the prevalence of hepatitis C virus (HCV) infection in Italy are outdated and usually derived from studying residents in small towns. METHODS To assess prevalence of and risk factors for HCV infection among Italian residents in 5 metropolitan areas, subjects ≥20 years of age were randomly selected from the list of the general practitioners' registers in 2015. Anti-HCV was tested by a salivary test; HCV-RNA, HCV genotypes, and ALT were determined in positive individuals. Logistic regression analysis evaluated independent risk factors for HCV. RESULTS Of the 4907 enrolled subjects, 112 (2.3%) tested anti-HCV positive. The prevalence of HCV increased with age, from 0.2% in subjects born after the year 1984, to 4.2% in those born before the year 1935 (P < 0.01). The birth-cohort prevalence peaked (7.0%) in elderly. Serum HCV-RNA was detected in 1.7% of the whole population. Nearly 80% of anti-HCV subjects were aware of their status. Age > 70 years, low education level, past use of glass syringes, blood transfusion, intravenous drug use, and cohabitation with an anti-HCV positive subject predicted the HCV positivity. INTERPRETATION In metropolitan areas in Italy, HCV is prevalent in elderly, reflecting a cohort effect determined by modalities of viral transmission no longer operative. The impact of the infection will further diminish in the years to come due to the natural depletion of the reservoir of the virus. This age pattern and the high proportion of subjects aware of their status do not warrant a policy of screening.
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Affiliation(s)
- Angelo Andriulli
- Division of Gastroenterology, Casa Sollievo Sofferenza Hospital, IRCCS, San Giovanni Rotondo, Italy.
| | - Tommaso Stroffolini
- Department of Infectious and Tropical Diseases, Policlinico Umberto I, Rome, Italy
| | - Andrea Mariano
- Division of Infectious and Tropical Diseases, National Institute for Infectious Diseases "L. Spallanzani", IRCCS, Rome, Italy
| | - Maria Rosa Valvano
- Division of Gastroenterology, Casa Sollievo Sofferenza Hospital, IRCCS, San Giovanni Rotondo, Italy
| | | | - Antonio Massimo Ippolito
- Division of Gastroenterology, Casa Sollievo Sofferenza Hospital, IRCCS, San Giovanni Rotondo, Italy
| | - Adriano Grossi
- Clinics of Infectious Diseases, 2nd University of Naples, Naples, Italy
| | | | | | | | - Antonina Smedile
- Department of Medical Sciences, University of Torino, Department of Gastroenterology and Hepatology, Azienda Ospedaliera Città della Salute e della Scienza, Torino, Italy
| | - Elisa Petrini
- Department of Medical Sciences, University of Torino, Department of Gastroenterology and Hepatology, Azienda Ospedaliera Città della Salute e della Scienza, Torino, Italy
| | - Silvia Martini
- Department of Medical Sciences, University of Torino, Department of Gastroenterology and Hepatology, Azienda Ospedaliera Città della Salute e della Scienza, Torino, Italy
| | | | - Mario Rizzetto
- Department of Medical Sciences, University of Torino, Department of Gastroenterology and Hepatology, Azienda Ospedaliera Città della Salute e della Scienza, Torino, Italy
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Ippolito AM, Iacobellis A, Milella M, Conti F, Messina V, Valvano MR, Niro GA, Morisco F, Barone M, Termite AP, Brancaccio G, Andriulli A. Hepatitis C Virus Clearance in Older Adults. J Am Geriatr Soc 2018; 66:85-91. [PMID: 29135030 DOI: 10.1111/jgs.15140] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVES To determine whether older adults with the hepatitis C virus (HCV) achieve a sustained viral response (SVR) after treatment with direct-acting antiviral therapy. PARTICIPANTS Individuals aged 80 and older with chronic HCV infection (N = 253; n = 213 with cirrhosis, n = 40 with advanced fibrosis). MEASUREMENTS We investigated the efficacy, safety, and global clinical effect of treatment with different combinations of direct antiviral agents (DAAs). Participants with cirrhosis were staged according to Child-Pugh-Turcotte class, Model for End-Stage Liver Disease score, and the D'Amico staging system. The type and number of comorbidities at baseline and hepatic and nonhepatic events during follow-up were registered. RESULTS Ninety-five percent of participants with cirrhosis and 95% of those with advanced fibrosis attained SVR. The rate was independent of sex, HCV genotype, and treatment schedule. During a mean follow-up of 14 ± 4 months (range 5-23 months), 34 events occurred in 27 participants: 10 hepatocellular carcinomas, 12 hepatic decompensations, 9 nonhepatic events, 3 deaths. Multivariate analysis of risk factors for experiencing adverse events during follow up showed that participants in D'Amico Stages 4 and 5, with a baseline serum albumin level of 3.5 mg/dL or less, and 3 or more comorbidities were the most at risk. CONCLUSION In a real-world setting, DAAs are safe and effective in older adults with HCV-related advanced fibrosis or cirrhosis. Individuals with preserved albumin synthesis and fewer than 3 comorbidities at baseline have the most to gain from long-term DAA therapy.
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Affiliation(s)
- Antonio Massimo Ippolito
- Division of Gastroenterology, Casa Sollievo Sofferenza Hospital, Istituto di Ricovero e Cura a Carattere Scientifico, San Giovanni Rotondo, Italy
| | - Angelo Iacobellis
- Division of Gastroenterology, Casa Sollievo Sofferenza Hospital, Istituto di Ricovero e Cura a Carattere Scientifico, San Giovanni Rotondo, Italy
| | - Michele Milella
- Clinics of Infectious Diseases, University of Bari, Bari, Italy
| | - Fabio Conti
- Centre for the Study of Hepatitis, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Vincenzo Messina
- Infectious and Tropical Diseases Unit, S. Anna and S. Sebastiano Hospital, Caserta, Italy
| | - Maria Rosa Valvano
- Division of Gastroenterology, Casa Sollievo Sofferenza Hospital, Istituto di Ricovero e Cura a Carattere Scientifico, San Giovanni Rotondo, Italy
| | - Grazia Anna Niro
- Division of Gastroenterology, Casa Sollievo Sofferenza Hospital, Istituto di Ricovero e Cura a Carattere Scientifico, San Giovanni Rotondo, Italy
| | - Filomena Morisco
- Division of Gastroenterology, Department of Clinical Medicine and Surgery, Federico II University of Napoli, Naples, Italy
| | - Michele Barone
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, Azienda Ospedaliero Universitaria Policlinico, University of Bari, Bari, Italy
| | | | | | - Angelo Andriulli
- Division of Gastroenterology, Casa Sollievo Sofferenza Hospital, Istituto di Ricovero e Cura a Carattere Scientifico, San Giovanni Rotondo, Italy
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5
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Barone M, Iannone A, Shahini E, Ippolito AM, Brancaccio G, Morisco F, Milella M, Messina V, Smedile A, Conti F, Gatti P, Santantonio T, Tundo P, Lauletta G, Napoli N, Masetti C, Termite AP, Francavilla R, Di Leo A, Pesce F, Andriulli A. A different perspective on sofosbuvir-ledipasvir treatment of patients with HCV genotype 1b cirrhosis: The ital-c network study. J Viral Hepat 2018; 25:56-62. [PMID: 28787102 DOI: 10.1111/jvh.12765] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [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: 06/02/2017] [Accepted: 07/11/2017] [Indexed: 02/07/2023]
Abstract
The effectiveness of a 12-week course of sofosbuvir-ledipasvir in treatment-experienced HCV genotype 1b-infected patients with cirrhosis is still under debate. Our primary endpoint was to compare the sustained virological response at post-treatment week 12 (SVR12) of sofosbuvir-ledipasvir in combination with ribavirin for 12 weeks, and sofosbuvir-ledipasvir alone for 24 weeks. This was a prospective observational study that enrolled 424 (195 naive, 229 experienced; 164 treated for 12 weeks with Ribavirin and 260 with sofosbuvir-ledipasvir alone for 24 weeks) consecutive HCV genotype 1b-infected patients with cirrhosis. The SVR12 rates were 93.9% and 99.2% in patients treated for 12 and 24 weeks, respectively (P = .002). The baseline characteristics of patients treated for 12 weeks were significantly different from those treated for 24 weeks as regards their younger age (P = .002), prevalence of Child-Pugh class A (P = .002), lower MELD scores (P = .001) and smaller number of nonresponders (P = .04). The shorter treatment was significantly associated with a lower SVR12 in univariate and multivariate analyses (P = .007 and P = .008, respectively). The SVR rate was unaffected by age, gender, BMI, Child-Pugh class, MELD score or previous antiviral treatment. Patients receiving ribavirin experienced more episodes of ascites and headache but less recurrence of hepatocellular carcinoma (HCC), and were prescribed more diuretics and cardiopulmonary drugs. No patient discontinued treatment. The therapeutic regimen of sofosbuvir-ledipasvir plus ribavirin administered for 12 weeks was less effective than sofosbuvir-ledipasvir alone given for 24 weeks. At odds with European guidelines, the recommended 12-week treatment with sofosbuvir-ledipasvir alone might be suboptimal for this setting of patients.
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Affiliation(s)
- M Barone
- Department of Emergency and Organ Transplantation, Section of Gastroenterology, AOU Policlinico, University of Bari, Bari, Italy
| | - A Iannone
- Department of Emergency and Organ Transplantation, Section of Gastroenterology, AOU Policlinico, University of Bari, Bari, Italy
| | - E Shahini
- Department of Emergency and Organ Transplantation, Section of Gastroenterology, AOU Policlinico, University of Bari, Bari, Italy
| | - A M Ippolito
- Division of Gastroenterology, "Casa Sollievo Sofferenza" Hospital, IRCCS, San Giovanni Rotondo, Italy
| | - G Brancaccio
- Clinics of Infectious Diseases, "Federico II" University of Naples, Naples, Italy
| | - F Morisco
- Division of Gastroenterology, Department of Clinical Medicine and Surgery, "Federico II" University of Naples, Naples, Italy
| | - M Milella
- Clinics of Infectious Diseases, University of Bari, Bari, Italy
| | - V Messina
- Infectious and Tropical Diseases Unit, S. Anna and S. Sebastiano Hospital, Caserta, Italy
| | - A Smedile
- Department of Medical Sciences, University of Turin, Turin, Italy
- Department of Gastroenterology and Hepatology, Azienda Ospedaliera Cittàdella Salute e della Scienza, Turin, Italy
| | - F Conti
- Department of Medical and Surgical Sciences (DIMEC), Centre for the Study of Hepatitis, University of Bologna, Bologna, Italy
| | - P Gatti
- Internal Medicine, Hospital of Ostuni, Ostuni, Italy
| | - T Santantonio
- Clinics of Infectious Diseases, University of Foggia, Foggia, Italy
| | - P Tundo
- Division of Infectious Diseases, Hospital of Galatina, Galatina, Italy
| | - G Lauletta
- Clinics of Internal Medicine "G. Baccelli", University of Bari, Bari, Italy
| | - N Napoli
- Clinics of Internal Medicine "C. Frugoni", University of Bari, Bari, Italy
| | - C Masetti
- Hepatology and Liver Transplantation Unit, University of Tor Vergata, Rome, Italy
| | - A P Termite
- Liver Unit, Hospital of Castellaneta, Castellaneta, Italy
| | - R Francavilla
- Unit of Infectious Diseases, Hospital of Bisceglie, Bisceglie, Italy
| | - A Di Leo
- Department of Emergency and Organ Transplantation, Section of Gastroenterology, AOU Policlinico, University of Bari, Bari, Italy
| | - F Pesce
- Department of Emergency and Organ Transplantation, Section of Nephrology, AOU Policlinico, University of Bari, Bari, Italy
| | - A Andriulli
- Division of Gastroenterology, "Casa Sollievo Sofferenza" Hospital, IRCCS, San Giovanni Rotondo, Italy
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6
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Ippolito AM, Milella M, Messina V, Conti F, Cozzolongo R, Morisco F, Brancaccio G, Barone M, Santantonio T, Masetti C, Tundo P, Smedile A, Carretta V, Gatti P, Termite AP, Valvano MR, Bruno G, Fabrizio C, Andreone P, Zappimbulso M, Gaeta GB, Napoli N, Fontanella L, Lauletta G, Cuccorese G, Metrangolo A, Francavilla R, Ciracì E, Rizzo S, Andriulli A. HCV clearance after direct-acting antivirals in patients with cirrhosis by stages of liver impairment: The ITAL-C network study. Dig Liver Dis 2017; 49:1022-1028. [PMID: 28487083 DOI: 10.1016/j.dld.2017.03.025] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [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: 11/26/2016] [Revised: 03/27/2017] [Accepted: 03/30/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Sustained virological response (SVR12) rates at 12 weeks after treatment for HCV-infected patients with decompensated cirrhosis are used when referring to those with moderate functional impairment, while few data are available for those with more severe impairment. The use of the cirrhosis staging system proposed by D'Amico might provide new insights on timing for antiviral therapy. METHODS We investigated efficacy (SVR12), safety, and post-treatment variations in clinical and laboratory parameters in 2612 patients with advanced fibrosis (n=575) or cirrhosis (n=2037). Cirrhosis was in the compensated phase (without/with varices) or had previously been in the decompensated stage. Different direct-acting antiviral (DAA) regimens were administered in accordance with scientific guidelines. RESULTS The SVR12 rate was 97.6% in patients with advanced fibrosis. For patients with cirrhosis, the rate was 96.5% in stage 1, 95.1% in stage 2, 100% in stage 3, 95.7% in stage 4, and 93.6% in stage 5. These rates were independent of gender, age, HCV genotype, and treatment schedule. Positive changes in biochemical parameters and CPT classes following therapy were evident in compensated and previously decompensated patients. CONCLUSION Our findings support the use of DAAs in patients with advanced cirrhosis (stages 3-5) who are at greatest risk and have the most to gain from therapy.
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Affiliation(s)
- Antonio Massimo Ippolito
- Division of Gastroenterology, "Casa Sollievo Sofferenza" Hospital, IRCCS, San Giovanni Rotondo, Italy.
| | - Michele Milella
- Clinics of Infectious Diseases, University of Bari, Bari, Italy
| | - Vincenzo Messina
- Infectious and Tropical Diseases Unit, S. Anna and S. Sebastiano Hospital, Caserta, Italy
| | - Fabio Conti
- Centre for the Study of Hepatitis, Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Raffaele Cozzolongo
- Division of Gastroenterology, "De Bellis" Hospital, IRCCS, Castellana Grotte, Italy
| | - Filomena Morisco
- Division of Gastroenterology, Department of Clinical Medicine and Surgery, "Federico II" University of Naples, Naples, Italy
| | | | - Michele Barone
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, AOU Policlinico, University of Bari, Bari, Italy
| | | | - Chiara Masetti
- Hepatology and Liver Transplantation Unit, University of Tor Vergata, Rome, Italy
| | - Paolo Tundo
- Division of Infectious Diseases, "S. Caterina Novella" Hospital, Galatina, Italy
| | - Antonina Smedile
- Department of Medical Sciences, University of Turin and Department of Gastroenterology and Hepatology, Azienda Ospedaliera Città della Salute e della Scienza, Turin, Italy
| | - Vito Carretta
- Liver Unit, Department of Internal Medicine, Hospital of Venosa, Venosa, Italy
| | - Pietro Gatti
- Internal Medicine, Hospital of Ostuni, Ostuni, Italy
| | | | - Maria Rosa Valvano
- Division of Gastroenterology, "Casa Sollievo Sofferenza" Hospital, IRCCS, San Giovanni Rotondo, Italy
| | - Giuseppe Bruno
- Clinics of Infectious Diseases, University of Bari, Bari, Italy
| | | | - Pietro Andreone
- Centre for the Study of Hepatitis, Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Marianna Zappimbulso
- Division of Gastroenterology, "De Bellis" Hospital, IRCCS, Castellana Grotte, Italy
| | | | - Nicola Napoli
- Clinica Medica "C. Frugoni", University of Bari, Bari, Italy
| | - Luca Fontanella
- Centre for Liver Disease, Fatebenefratelli Hospital, Naples, Italy
| | | | - Giuseppe Cuccorese
- Division of Internal Medicine, "Monsignor Di Miccoli" Hospital, Barletta, Italy
| | | | | | | | - Salvatore Rizzo
- Division of Internal Medicine, Hospital of Martina Franca, Martina Franca, Italy
| | - Angelo Andriulli
- Division of Gastroenterology, "Casa Sollievo Sofferenza" Hospital, IRCCS, San Giovanni Rotondo, Italy
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7
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Guarino M, Morisco F, Valvano MR, Ippolito AM, Librandi M, Andriulli N, Greco M, Amoruso A, Iacobellis A, Niro G, Caporaso N, Andriulli A. Systematic review: interferon-free regimens for patients with HCV-related Child C cirrhosis. Aliment Pharmacol Ther 2017; 45:1193-1200. [PMID: 28261822 DOI: 10.1111/apt.14017] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 01/21/2017] [Accepted: 02/07/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND It is unclear whether the efficacy and long-term outcome of treating patients with hepatitis C virus (HCV)-positive cirrhosis with the new protease inhibitors will extend to those with Child C cirrhosis. AIM To assess the effectiveness of the interferon-free regimens in Child C cirrhotic patients with HCV infection. METHODS A systematic Medline search was conducted to retrieve studies describing the treatment of Child C patients with direct-acting agents. Citations from identified studies were cross-referenced and abstracts from European Association for the Study of the Liver (EASL) and American Association for the Study of Liver Disease (AASLD) meetings were checked. Extracted data were evaluated using a meta-analysis to calculate a weighted response rate. RESULTS Seven full-text records and two conference abstracts were retained for analysis from the 649 records identified. Data from an Italian real-life trial were also interrogated. Information on treatment outcome was available for 228 of the 240 Child C patients evaluated in the 10 trials. Overall, the weighted mean sustained virological response (SVR12) was 74.9% (95% CI: 65.6-82.4%). Neither duration of treatment (24 or 12 weeks), nor addition of ribavirin influenced these rates. The weighted SVR12 was 65.4% (95% CI: 46.8-80.2) after sofosbuvir/simeprevir, 76.0% (95% CI: 54.4-89.3%) after sofosbuvir/daclatasvir and 83.0% (95% CI: 73.4-89.6) after sofosbuvir/ledipasvir. Some studies did not provide information on the rate of post-treatment relapse or functional improvement. However, in those studies that did provide such data, a relapse was documented in 12.1% of patients and an improvement of ≥2 points on the model for end-stage liver disease (MELD) score in 61.1% of patients. CONCLUSION The improvement in MELD scores strongly suggests HCV-positive patients with Child C cirrhosis should be treated with these agents.
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Affiliation(s)
- M Guarino
- Gastroenterology Unit, Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - F Morisco
- Gastroenterology Unit, Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - M R Valvano
- Division of Gastroenterology, Casa Sollievo Sofferenza Hospital, IRCCS, San Giovanni Rotondo, Italy
| | - A M Ippolito
- Division of Gastroenterology, Casa Sollievo Sofferenza Hospital, IRCCS, San Giovanni Rotondo, Italy
| | | | | | - M Greco
- Division of Internal Medicine and Clinical Immunology, San Martino Hospital, IRCCS, Genova, Italy
| | - A Amoruso
- Division of Emergency Medicine, San Carlo Hospital, Potenza, Italy
| | - A Iacobellis
- Division of Gastroenterology, Casa Sollievo Sofferenza Hospital, IRCCS, San Giovanni Rotondo, Italy
| | - G Niro
- Division of Gastroenterology, Casa Sollievo Sofferenza Hospital, IRCCS, San Giovanni Rotondo, Italy
| | - N Caporaso
- Gastroenterology Unit, Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - A Andriulli
- Division of Gastroenterology, Casa Sollievo Sofferenza Hospital, IRCCS, San Giovanni Rotondo, Italy
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Cassino R, Ippolito AM, Cuffaro P, Corsi A, Forma O. Evaluation of the effectiveness of a hyperoxidized oil-based medication in the treatment of skin lesions: observational study. MINERVA CHIR 2015; 70:23-31. [PMID: 25650650] [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: 06/04/2023]
Abstract
AIM Aim of the study was to demonstrate the effectiveness, in the management of recalcitrant wounds, of a hyperoxidized oil-based gel with film-forming and protective functions. METHODS The study involved 50 patients with recalcitrant not infected and/or necrotic chronic ulcers. All patients had 0.7 minimum ABPI value; terminal and/or cancer and/or under immunosuppressive therapy patients were excluded. The dressing consisted in a uniform gel layer applied on the lesion, after cleansing with a 0.05% sodium hypochlorite chloroxidating solution. The dressing was changed every 48 hours (or every 24 hours, in case of hyperexuding wound). The effectiveness was assessed by the evaluation of the WBP score changes and area reduction (via the Visitrak™ Digital System) after an observation period of 4 weeks. RESULTS All patients achieved area improvement; WBP score improved in more than 90% of the B score patients; pain reduction was reported by all patients: more than 55% of the total number of patients limited the use of analgesic drugs and in 6 cases (12%) they discontinued the antalgic therapy. CONCLUSION The dressing showed an actual effectiveness, promoting granulation and accelerating epithelialization; no patient suffered from allergy/intolerance and all of them reported a decrease in pain, until complete relief.
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Affiliation(s)
- R Cassino
- Vulnera - Italian Vulnological Center, Turin, Italy -
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9
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Andriulli A, Morisco F, Ippolito AM, Di Marco V, Valvano MR, Angelico M, Fattovich G, Granata R, Smedile A, Milella M, Felder M, Gaeta GB, Gatti P, Fasano M, Mazzella G, Santantonio T. HCV genotype 1 subtypes (1a and 1b): similarities and differences in clinical features and therapeutic outcome. Hepatol Int 2015; 9:52-7. [PMID: 25788379 DOI: 10.1007/s12072-014-9556-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Accepted: 06/21/2014] [Indexed: 01/06/2023]
Abstract
AIM To evaluate similarities and differences in HCV-1 subtypes 1a and 1b in the presenting clinical features and the response to peg-interferon and ribavirin (Peg/RIBA). PATIENTS AND METHODS A total of 1,233 naïve patients with HCV genotype-1 infection, 159 (13%) with subtype 1a and 1,074 (87%) with subtype 1b were treated with Peg-IFN/RIBA at 12 Italian centers. Covariates included in the logistic model were age, gender, BMI, serum alanine aminotransferase, serum gamma-glutamiltranspeptidase (γGT), platelets counts, liver fibrosis, the occurrence of type 2 diabetes, baseline viremia, and IL28B genotype. RESULTS At multivariate analysis, baseline characteristics differentiating patients with HCV-1a versus HCV-1b were young age, male gender, no F4 fibrosis, and no diabetes. SVR was achieved by 37% of patients with subtype 1b and 45% of those with subtype 1a, a nonsignificant difference of 8% (p = 0.069). In patients with subtype 1a, predictors of SVR were IL28B CC (OR 5.78, CI 1.98-16.83), RVR (OR 4.18, CI 1.66-10.55), female gender (OR 2.83, CI 1.83-6.78), and HCVRNA (OR 0.55, CI 0.32-0.96). In patients with subtype 1b, the ranking of predictors was levels RVR (OR 6.49, CI 4.32-9.73), IL28B CC (OR 3.32, CI 2.15-4.58), γGT (OR 1.59, CI 0.14-2.22), HCVRNA (OR 0.61, CI 0.47-0.79), and age (OR 0.01, CI 0.02-0.42). CONCLUSION In Italy HCV-1 subtype 1a prevails in young male patients with less advanced liver damage, findings that imply a more recent spreading of the infection with this viral strain. The two HCV-1 subtypes appear equally responsive to Peg-IFN/RIBA, with IL28B genotyping and monitoring of RVR mostly influencing the therapeutic response.
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Affiliation(s)
- A Andriulli
- Division of Gastroenterology, Casa Sollievo Sofferenza Hospital, IRCCS, San Giovanni Rotondo, Italy,
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10
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Andriulli A, Nardi A, Di Marco V, Ippolito AM, Gavrila C, Aghemo A, Di Paolo D, Squadrito G, Grassi E, Calvaruso V, Valvano MR, Brancaccio G, Craxi A, Angelico M. An a priori prediction model of response to peginterferon plus ribavirin dual therapy in naïve patients with genotype 1 chronic hepatitis C. Dig Liver Dis 2014; 46:818-25. [PMID: 24953209 DOI: 10.1016/j.dld.2014.05.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [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: 04/02/2014] [Revised: 05/08/2014] [Accepted: 05/18/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND Aim was to select naïve patients with genotype 1 chronic hepatitis C having a high probability of response to Peg-interferon+ribavirin therapy. METHODS In 1073 patients (derivation cohort), predictors of rapid and sustained virological response were identified by logistic analysis; regression coefficients were used to generate prediction models for sustained virological response. Probabilities at baseline and treatment week 4 were utilized to develop a decision rule to select patients with high likelihood of response. The model was then validated in 423 patients (validation cohort). RESULTS In the derivation cohort, 257 achieved rapid virological response and 818 did not, with sustained virological response rates of 80.2% and 25.4%, respectively; interleukin-28B polymorphisms, fibrosis staging, gamma-glutamyl transferase, and viral load predicted sustained virological response. Assuming a <30% sustained virological response probability for not recommending Peg-interferon+ribavirin, 100 patients (25.6%) in the validation cohort were predicted a priori to fail this regimen. Assuming a ≥80% sustained virological response probability as a threshold to continue with Peg-interferon+ribavirin, 61 patients were predicted to obtain sustained virological response, and 55 of them (90.2%) eventually did. CONCLUSIONS This model uses easily determined variables for a personalized estimate of the probability of sustained virological response with Peg-interferon+ribavirin, allowing to identify patients who may benefit from conventional therapy.
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Affiliation(s)
- Angelo Andriulli
- Division of Gastroenterology, Casa Sollievo Sofferenza Hospital, IRCCS, Italy
| | | | - Vito Di Marco
- Unit of Gastroenterology, Di.B.I.S., University of Palermo, Italy
| | | | - Caius Gavrila
- Department of Mathematics, Tor Vergata University, Roma, Italy
| | - Alessio Aghemo
- Division of Gastroenterology and Hepatology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Daniele Di Paolo
- Hepatology and Liver Transplantation Unit, University of Tor Vergata, Roma, Italy
| | - Giovanni Squadrito
- Division of Clinical and Molecular Hepatology, University of Messina, Italy
| | - Eleonora Grassi
- Division of Gastroenterology and Hepatology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | | | - Maria Rosa Valvano
- Division of Gastroenterology, Casa Sollievo Sofferenza Hospital, IRCCS, Italy
| | | | - Antonio Craxi
- Unit of Gastroenterology, Di.B.I.S., University of Palermo, Italy
| | - Mario Angelico
- Hepatology and Liver Transplantation Unit, University of Tor Vergata, Roma, Italy
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Andriulli A, Di Marco V, Margaglione M, Ippolito AM, Fattovich G, Smedile A, Valvano MR, Calvaruso V, Gioffreda D, Milella M, Morisco F, Felder M, Brancaccio G, Fasano M, Gatti P, Tundo P, Barone M, Cozzolongo R, Angelico M, D'Andrea G, Andriulli N, Abate ML, Mazzella G, Gaeta GB, Craxi A, Santantonio T. Identification of naïve HCV-1 patients with chronic hepatitis who may benefit from dual therapy with peg-interferon and ribavirin. J Hepatol 2014; 60:16-21. [PMID: 23973930 DOI: 10.1016/j.jhep.2013.07.040] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Revised: 07/17/2013] [Accepted: 07/29/2013] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS The pool of HCV genotype 1 patients likely to be cured by peg-interferon and ribavirin remains to be quantified. METHODS In 1045 patients treated with peg-interferon and ribavirin, two therapeutic strategies were confronted: the first one evaluated only baseline variables associated with sustained virological response (SVR), and the second one included the rapid virologic response (RVR) in addition to baseline predictors. An 80% SVR rate was the threshold to retain a strategy as clinically relevant. RESULTS Overall, 414 patients (39.6%) attained SVR. In the first strategy, the hierarchy of features independently associated with SVR was IL28B CC genotype (OR 5.082; CI 3.637-7.101), low (<400,000 IU) viremia (OR 2.907; CI 2.111-4.004), F0-F2 fibrosis (OR 1.631; CI 1.122-2.372) and type 2 diabetes (OR 0.528; CI 0.286-0.972). In the alternative strategy, SVR was associated with RVR (OR 6.273; CI 4.274-9.208), IL28B CC genotype (OR 3.306; CI 2.301-4.751), low viremia (OR 2.175; CI 1.542-3.070), and F0-F2 fibrosis (OR 1.506; CI 1.012-2.242). Combining the favorable baseline variables, the rates of SVR ranged from 42.4% to 83.3%, but only 66 patients (6.3%, overall) with all predictors could be anticipated to reach the >80% SVR threshold. Only 26.6% of no-RVR patients attained SVR. Among the 255 RVR patients, the likelihood of SVR was 61.8% in those with unfavorable predictors, 80% in the presence of a single predictor, and 100% when both predictors were present. By using this model, 200 patients (19.1%) were predicted to have an 80% chance of being cured with dual therapy. CONCLUSIONS A consistent subset of naïve HCV-1 patients, identified by some baseline characteristics and RVR, may benefit from dual treatment with peg-interferon and ribavirin.
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Affiliation(s)
- Angelo Andriulli
- Division of Gastroenterology, Casa Sollievo Sofferenza Hospital, IRCCS, San Giovanni Rotondo, Italy.
| | - Vito Di Marco
- Clinic of Gastroenterology, University of Palermo, Italy
| | | | - Antonio Massimo Ippolito
- Division of Gastroenterology, Casa Sollievo Sofferenza Hospital, IRCCS, San Giovanni Rotondo, Italy
| | - Giovanna Fattovich
- Clinic of Gastroenterology, Department of Medicine, University of Verona, Italy
| | - Antonina Smedile
- Department of Medical Sciences, University of Torino and Department of Gastroenterology and Hepatology, Azienda Ospedaliera Città della Salute e della Scienza, Torino, Italy
| | - Maria Rosa Valvano
- Division of Gastroenterology, Casa Sollievo Sofferenza Hospital, IRCCS, San Giovanni Rotondo, Italy
| | | | - Domenica Gioffreda
- Division of Gastroenterology, Casa Sollievo Sofferenza Hospital, IRCCS, San Giovanni Rotondo, Italy
| | | | - Filomena Morisco
- Gastroenterology, Department of Clinical Medicine and Surgery, Federico II University of Napoli, Italy
| | - Martina Felder
- Division of Gastroenterology, Central Hospital, Bolzano, Italy
| | | | - Massimo Fasano
- Clinic of Infectious Diseases, University of Foggia, Italy
| | - Pietro Gatti
- DIMO Medical Oncology, University of Bari, Italy
| | - Paolo Tundo
- Division of Infectious Diseases, S. Caterina Novella Hospital, Galatina, Italy
| | | | - Raffaele Cozzolongo
- Division of Gastroenterology, "S. de Bellis" Hospital, IRCCS, Castellana Grotte, Italy
| | - Mario Angelico
- Hepatology and Liver Transplantation Unit, Tor Vergata University, Roma, Italy
| | - Giovanna D'Andrea
- Department of Clinical and Experimental Medicine, University of Foggia, Italy
| | - Nicola Andriulli
- Department of Chemical Pharmaceutics, University La Sapienza, Rome, Italy
| | - Maria Lorena Abate
- Department of Medical Sciences, University of Torino and Department of Gastroenterology and Hepatology, Azienda Ospedaliera Città della Salute e della Scienza, Torino, Italy
| | | | | | - Antonio Craxi
- Clinic of Gastroenterology, University of Palermo, Italy
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12
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Niro GA, Ippolito AM, Fontana R, Valvano MR, Gioffreda D, Iacobellis A, Merla A, Durazzo M, Lotti G, Di Mauro L, Andriulli A. Long-term outcome of hepatitis B virus-related Chronic Hepatitis under protracted nucleos(t)ide analogues. J Viral Hepat 2013; 20:502-9. [PMID: 23730844 DOI: 10.1111/jvh.12054] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [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: 09/01/2012] [Accepted: 11/01/2012] [Indexed: 12/11/2022]
Abstract
Long-term outcome of patients with chronic hepatitis B virus (HBV) infection under continuous nucleos(t)ide analogues (NUCs) has been poorly elucidated. We enrolled 121 anti-HBe-positive patients into a prospective surveillance programme while on (>36 months) NUCs therapy. HBV-DNA clearance, add-on therapy and safety were evaluated. Development of cirrhosis, events of liver decompensation and hepatocellular carcinoma (HCC) during the follow-up were the main endpoints, as the complication-free survival. At baseline, 74 patients (61%) had chronic hepatitis, the remainders a cirrhotic liver. HBV-DNA levels >38 000 IU/mL were discovered in 103 patients. At enrolment, 79 patients were naïve to NUCs treatment. Lamivudine monotherapy (n = 70) or a different NUC (n = 51) was administered. At month 6 of therapy, HBV-DNA clearance was documented in 88 patients (73%). Treatment schedule was modified in 52 patients due to breakthrough or suboptimal response. During a mean follow-up of 6 ± 3 years, viral clearance was achieved in the majority of patients. Ten of 74 patients (13.5%) with chronic hepatitis progressed to cirrhosis, 1 patient developed a HCC. In the 47 patients with cirrhosis at presentation, HCC occurred in 14 (30%) and liver decompensation in 5 (11%). The 5 and 10-year event-free survivals were, respectively, 89.3% (95% CI, 81.7 -96.9) and 75.6% (95% CI, 61.5 -89.7) for patients with chronic hepatitis, and 70.2% (95% CI, 56.3 -84.1) and 40.4% (95% CI, 16.9 -63.9) for those with cirrhosis. Protracted, effective treatment with oral NUCs affects the natural history of chronic HBV infection by reducing the incidence of cirrhosis and risk of complications, but does not guarantee against the development of HCC in cirrhosis at presentation.
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Affiliation(s)
- G A Niro
- Division of Gastroenterology, "Casa Sollievo Sofferenza" Hospital, IRCCS, San Giovanni Rotondo, Italy.
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13
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Cassino R, Ippolito AM, Cuffaro C, Corsi A, Ricci E. A controlled, randomised study on the efficacy of two overlays in the treatment of decubitus ulcers. MINERVA CHIR 2013; 68:105-116. [PMID: 23584270] [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: 06/02/2023]
Abstract
AIM The aims of this study were to evaluate the performance and effectiveness of an antibedsore overlay in 3D structure of new conception towards an overlay of common use. Evaluation parameters: wound area reduction, healing, safety and comfort. METHODS Open randomized multicenter study comparing the two overlays for the treatment and prevention of pressure sores. Patients were recruited in long-term carewards. Recruitment and randomization systems were made using envelopes, with goal of 70 patients with pressure ulcers from I to IV degree. Observation period was extended for 12 weeks. Data collection was made using paper CRF. RESULTS We enrolled 72 patients: 35 in the study group and 37 in the control. The two groups were similar. Mortality during the observation period was 13.8% (unrelated events). Approximately 50% of patients withdrew from the study before the end (trend in favor of the overlay three-dimensional). The resolution of the lesions occurred in 8 cases (11.1%), 3 cases in the overlay 3D and 5 in the gel group (P=NS). The reduction of the area was in favor of the three-dimensional overlay (P<0.005%), data with significance were obtained also in patient comfort (P=0.08) and ease of care (P<0.001). CONCLUSION The first objective of this study was to evaluate the effectiveness of an innovative antibedsore overlay versus a commonly used one. The data obtained showed a better performance, both in terms of treatment of lesions and in terms of comfort for the patients and the operators.
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Affiliation(s)
- R Cassino
- Vulnera Centro Vulnologico Italiano, (Italian Vulnological Centre), Turin, Italy.
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Abstract
The distribution of hepatitis D virus (HDV) is worldwide but not uniform. Current estimates suggest that 15–20 million people have exposure to HDV. Traditionally, areas of high prevalence are the Mediterranean basin, the Middle East, central Africa, the Amazonian basin and parts of Asia. As a consequence of vaccination against HBV and other prophylactic measures, the prevalence of HDV declined in Italy, Spain, Turkey and Taiwan. This downward trend stopped in the 1990s; a new location for HDV epidemics arose in western Europe, due to migration from endemic areas. HDV appeared in new geographic regions, posing a serious health threat in underdeveloped countries. Testing for anti-HVD antibodies in serum is the initial step in diagnosing HDV infection, but unravelling HDV RNA is essential to identify active replication.
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Affiliation(s)
- Grazia Anna Niro
- Division of Gastroenterology, ‘Casa Sollievo della Sofferenza’ Hospital, IRCCS, San Giovanni Rotondo, Italy
| | - Rosanna Fontana
- Division of Gastroenterology, ‘Casa Sollievo della Sofferenza’ Hospital, IRCCS, San Giovanni Rotondo, Italy
| | - Antonio Massimo Ippolito
- Division of Gastroenterology, ‘Casa Sollievo della Sofferenza’ Hospital, IRCCS, San Giovanni Rotondo, Italy
| | - Angelo Andriulli
- Division of Gastroenterology, ‘Casa Sollievo della Sofferenza’ Hospital, IRCCS, San Giovanni Rotondo, Italy
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Ippolito AM, Niro GA, Fontana R, Lotti G, Gioffreda D, Valvano MR, Iacobellis A, Di Mauro L, Stroffolini T, Andriulli A. Unawareness of HBV infection among inpatients in a Southern Italian hospital. J Viral Hepat 2011; 18:e206-11. [PMID: 21692934 DOI: 10.1111/j.1365-2893.2010.01432.x] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Hepatitis B virus (HBV) infection may run undetected. Unawareness of an ongoing infection delays the diagnosis of HBV-related liver disease and favours the spread of the virus. We have evaluated among hepatitis B surface antigen-positive (HBsAg) inpatients admitted to a Southern Italian hospital the proportion of those aware of their carrier status and correlated the status to signs of liver disease. All patients admitted to the San Giovanni Rotondo Hospital from March 2008 to July 2009 were tested for HBV and hepatitis C virus (HCV) markers, and those positive for HBsAg were interviewed and underwent examinations for liver function and abdominal ultrasound. Overall, of 25,000 patients admitted during the observation period 311 (1.2%) were positive for HBsAg, most of them (98%) being anti-HBe positive. HCV and HDV co-infections were ascertained in 2.9% and 0.6% of cases, respectively. Two hundred and fifty-three subjects (81%) agreed to undergo further investigation, 132 of them (52%) were HBV-DNA positive. One hundred and two patients (40.3%) were unaware of their infection; this was encountered among 29% of HBV-DNA-positive and 52% of HBV-DNA-negative subjects (P < 0.01). Subjects already aware of their infection were more likely to present with abnormal alanine aminotransferase (ALT) levels (27%vs 15%), serological presence of HBV-DNA (63.6% vs. 36%) and liver cirrhosis (30%vs. 13%). A high proportion of HBsAg-positive patients (40.3%) were unaware of their infection, which had evolved to the stage of liver cirrhosis in a consistent percentage of them.
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Affiliation(s)
- A M Ippolito
- Division of Gastroenterology Blood Bank, Casa Sollievo Sofferenza Hospital, IRCCS, S. Giovanni Rotondo, Italy
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16
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Niro GA, Smedile A, Ippolito AM, Ciancio A, Fontana R, Olivero A, Valvano MR, Abate ML, Gioffreda D, Caviglia GP, Rizzetto M, Andriulli A. Outcome of chronic delta hepatitis in Italy: a long-term cohort study. J Hepatol 2010; 53:834-40. [PMID: 20800919 DOI: 10.1016/j.jhep.2010.06.008] [Citation(s) in RCA: 97] [Impact Index Per Article: 6.9] [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: 04/20/2010] [Revised: 06/21/2010] [Accepted: 06/30/2010] [Indexed: 12/18/2022]
Abstract
BACKGROUND & AIMS To investigate the impact of HDV infection on morbidity and mortality of patients. PATIENTS AND METHODS This was a retrospective study on 188 patients that underwent a program of periodic surveillance until 2008. The demographic data, stage of liver disease, treatment efficacy, development of liver complications (ascites, oesophageal bleeding, encephalopathy), and survival were registered. A Cox regression analysis was carried out to determine the impact of viral and patient features on survival. RESULTS At baseline, 126 patients (67%) tested positive for serum IgM anti-HDV antibodies, 171 (91%) for anti-HBe, 175 (93%) for serum HDV-RNA, and 61 (33%) for serum HBV-DNA. Eighty-two patients (43%) had chronic hepatitis at histology; the remaining 106 individuals had a clinical/histological diagnosis of cirrhosis. Ninety-six patients received interferon (n = 90) or lamivudine (n = 6) therapy, and 27 of them (30%) attained a sustained response. During follow up, 21 patients with chronic hepatitis progressed to cirrhosis. Of the 127 cirrhotic patients, hepatic decompensation occurred in 42 patients (33%) and hepatocellular carcinoma in 17 (13%). The 5- and 10-year survival free of events were 96.8% and 81.9%, respectively, for patients with chronic hepatitis, and 83.9% and 59.4% for cirrhotics (p<0.01). At multivariate analysis, lack of antiviral therapy (p = 0.01), cirrhosis at presentation (p<0.01), and male sex (p = 0.03) independently predicted a worse outcome. CONCLUSION HDV liver disease lasts several decades. Half of all patients who develop cirrhosis later will advance to liver failure. At present, interferon therapy is recommended as soon as possible to slow or alter the natural course of liver disease.
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Affiliation(s)
- Grazia Anna Niro
- Division of Gastroenterology, Casa Sollievo Sofferenza Hospital, IRCCS, San Giovanni, Rotondo, Italy.
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La Rosa GL, Ippolito AM, Lupo L, Cercabene G, Santonocito MG, Vigneri R, Belfiore A. Cold thyroid nodule reduction with L-thyroxine can be predicted by initial nodule volume and cytological characteristics. J Clin Endocrinol Metab 1996; 81:4385-7. [PMID: 8954046 DOI: 10.1210/jcem.81.12.8954046] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
In a previous study we demonstrated that a 1-yr treatment with L-T4 induces substantial nodule volume reduction (> or = 50%) in approximately 40% of patients with a benign solitary cold thyroid nodule. The present prospective study investigated whether it is possible to identify, before starting L-T4 treatment, nodules with a high probability to shrink in response to L-T4. We recorded several clinical and cytological features in a continuous series of 42 patients with a cold nodule and related them to the nodule volume response to 1-yr treatment with L-T4. Fisher discriminant analysis showed that a combination of some cytological features (colloid, degenerative changes, cellular hyperplasia, and fibrosis) and initial nodule volume can be used for predicting nodule volume reduction. In fact, although only 33% of all nodules shrank, 62% of colloid nodules and 57% of small degenerative nodules shrank. None of the hyperplastic or fibrotic nodules shrank. These results were validated in a different retrospective series of 46 patients and allowed us to predict nodule reduction in over 80% of the cases.
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Affiliation(s)
- G L La Rosa
- Istituto di Medicina Interna, Endocrinologia e Malattie del Metabolismo, Ospedale Garibaldi, Italy
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Dibenedetto SP, Miraglia V, Ippolito AM, D'Amico S, Lo Nigro L, Ragusa R, Schilirò G. Reduction in the incidence of infection by hepatitis C virus in children with acute lymphoblastic leukemia after suspension of sampling from the finger. Pediatr Infect Dis J 1996; 15:265-6. [PMID: 8852917 DOI: 10.1097/00006454-199603000-00018] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- S P Dibenedetto
- Division of Pediatric Hematology and Oncology, University of Catania, Italy
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Dibenedetto SP, Ragusa R, Ippolito AM, Lo Nigro L, Di Cataldo A, D'Amico S, Miraglia V. Assessment of the value of treatment with granulocyte colony-stimulating factor in children with acute lymphoblastic leukemia: a randomized clinical trial. Eur J Haematol 1995; 55:93-6. [PMID: 7543060 DOI: 10.1111/j.1600-0609.1995.tb01816.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The present trial was designed to test the effects of G-CSF on the duration of the second phase of induction chemotherapy in children with newly diagnosed acute lymphoblastic leukemia (ALL). A total of 32 patients were assigned randomly to a group that received (14 patients; group A) or a group that did not receive (18 patients; group B) G-CSF (10 g/kg/day subcutaneously and daily) throughout of the second phase of induction therapy. One of 14 (7.1%) patients in group A and 2 of 18 (11.1%) patients in group B completed the course of chemotherapy within the planned time. The median length of this phase was 37 days (range, 29 to 65; mean, 40; SD, 8.6) for patients in group A and 36 days (range, from 29 to 55; mean, 38; SD, 7.4) for those in group B, and the difference was not statistically significant. The number of days during which patients had granulocyte counts of less than 2 x 10(9)/l, the number of febrile episodes of unknown origin, the number of bacterial and fungal infections and the number of days of hospitalization did not differ in a statistically significant manner between the two groups. Our data suggest that G-CSF supportive therapy may be unnecessary in children with neutropenia of short duration, for whom the risk of infection is low.
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Affiliation(s)
- S P Dibenedetto
- Division of Pediatric Hematology and Oncology, University of Catania, Italy
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Dibenedetto SP, Guardabasso V, Ragusa R, Di Cataldo A, Miraglia V, D'Amico S, Ippolito AM. 6-Mercaptopurine cumulative dose: a critical factor of maintenance therapy in average risk childhood acute lymphoblastic leukemia. Pediatr Hematol Oncol 1994; 11:251-8. [PMID: 8060809 DOI: 10.3109/08880019409141668] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
A multivariate survival analysis including gender, age, log white blood cell (WBC) count, liver and spleen size at diagnosis, mean log WBC count during maintenance therapy, and the prescribed cumulative doses of 6-mercaptopurine (6-MP), methotrexate (MTX), vincristine (VCR), and prednisone (PDN) during maintenance therapy was performed on 53 children with average-risk acute lymphoblastic leukemia (ALL). The 6-MP cumulative dose prescribed during maintenance therapy resulted in the most important statistically significant independent prognostic factor. Patients who received less than the median cumulative dose of 6-MP (86% of planned protocol dose) fared significantly worse than the other patients, regardless of WBC count at diagnosis, gender, age, and other factors studied. Therefore, 6-MP cumulative dose during maintenance therapy may be the critical factor for effective maintenance therapy in childhood ALL.
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Affiliation(s)
- S P Dibenedetto
- Division of Pediatric Hematology-Oncology, University of Catania, Italy
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Dibenedetto SP, Ragusa R, Sciacca A, Di Cataldo A, Miraglia V, D'Amico S, Lo Nigro L, Ippolito AM. Incidence and morbidity of infection by hepatitis C virus in children with acute lymphoblastic leukaemia. Eur J Pediatr 1994; 153:271-5. [PMID: 8194562 DOI: 10.1007/bf01954518] [Citation(s) in RCA: 9] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
A group of 90 patients with acute lymphoblastic leukaemia (ALL) in first continuous complete remission (CCR), admitted in our hospital between January 1986 and September 1992, were tested for the presence of antibodies against hepatitis C virus (HCV), antibodies against hepatitis B virus and antibodies against HIV-1 during maintenance therapy or thereafter. They were compared with a group of 71 children with other malignancies in first CCR who had been diagnosed consecutively from January 1986 to September 1992. No patient with ALL or any other malignancy was found to be positive for hepatitis B surface antigen or HIV-1. HCV-specific antibodies were detected in 28 out of 87 children (32.1%) with ALL and in 4 out of 44 patients (9%) with malignancies other than ALL who had received at least one transfusion of blood or platelets (P < 0.01). HCV-specific antibodies were also detected in one out of three untransfused children with ALL but in none of the untransfused children with malignancies other than ALL. HCV-specific seropositivity influenced the management of children with ALL during maintenance therapy. In fact, as a result of abnormal liver function tests, maintenance therapy had to be suspended significantly more often in the case of HCV-seropositive patients with ALL than in HCV-seronegative ones. Despite the high morbidity during maintenance therapy, chronic liver disease (CLD) was uncommon in both groups: five children with ALL (17.2% of HCV-seropositive children) and one child with a malignancy other than ALL (25%) had CLD.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- S P Dibenedetto
- Division of Paediatric Haematology-Oncology, University of Catania, Italy
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