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Orkin C, Schapiro JM, Perno CF, Kuritzkes DR, Patel P, DeMoor R, Dorey D, Wang Y, Han K, Van Eygen V, Crauwels H, Ford SL, Latham CL, St. Clair M, Polli JW, Vanveggel S, Vandermeulen K, D’Amico R, Garges HP, Zolopa A, Spreen WR, van Wyk J, Cutrell AG. Expanded Multivariable Models to Assist Patient Selection for Long-Acting Cabotegravir + Rilpivirine Treatment: Clinical Utility of a Combination of Patient, Drug Concentration, and Viral Factors Associated With Virologic Failure. Clin Infect Dis 2023; 77:1423-1431. [PMID: 37340869 PMCID: PMC10654860 DOI: 10.1093/cid/ciad370] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 06/19/2023] [Indexed: 06/22/2023] Open
Abstract
BACKGROUND Previously reported post hoc multivariable analyses exploring predictors of confirmed virologic failure (CVF) with cabotegravir + rilpivirine long-acting (CAB + RPV LA) were expanded to include data beyond week 48, additional covariates, and additional participants. METHODS Pooled data from 1651 participants were used to explore dosing regimen (every 4 or every 8 weeks), demographic, viral, and pharmacokinetic covariates as potential predictors of CVF. Prior dosing regimen experience was accounted for using 2 populations. Two models were conducted in each population-baseline factor analyses exploring factors known at baseline and multivariable analyses exploring baseline factors plus postbaseline model-predicted CAB/RPV trough concentrations (4 and 44 weeks postinjection). Retained factors were evaluated to understand their contribution to CVF (alone or in combination). RESULTS Overall, 1.4% (n = 23/1651) of participants had CVF through 152 weeks. The presence of RPV resistance-associated mutations, human immunodeficiency virus-1 subtype A6/A1, and body mass index ≥30 kg/m2 were associated with an increased risk of CVF (P < .05 adjusted incidence rate ratio), with participants with ≥2 of these baseline factors having a higher risk of CVF. Lower model-predicted CAB/RPV troughs were additional factors retained for multivariable analyses. CONCLUSIONS The presence of ≥2 baseline factors (RPV resistance-associated mutations, A6/A1 subtype, and/or body mass index ≥30 kg/m2) was associated with increased CVF risk, consistent with prior analyses. Inclusion of initial model-predicted CAB/RPV trough concentrations (≤first quartile) did not improve the prediction of CVF beyond the presence of a combination of ≥2 baseline factors, reinforcing the clinical utility of the baseline factors in the appropriate use of CAB + RPV LA.
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Affiliation(s)
- Chloe Orkin
- SHARE Collaborative, Department of Immunobiology, Queen Mary University of London, London, United Kingdom
| | | | | | - Daniel R Kuritzkes
- Division of Infectious Diseases, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Parul Patel
- ViiV Healthcare, Durham, North Carolina, USA
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2
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Armenia D, Gagliardini R, Alteri C, Svicher V, Cento V, Borghi V, Vergori A, Cicalini S, Forbici F, Fabeni L, Bertoli A, Brugneti M, Gennari W, Malagnino V, Andreoni M, Mussini C, Antinori A, Perno CF, Santoro MM, Ceccherini-Silberstein F. Temporal trend of drug-resistance and APOBEC editing in PBMC genotypic resistance tests from HIV-1 infected virologically suppressed individuals. J Clin Virol 2023; 168:105551. [PMID: 37573167 DOI: 10.1016/j.jcv.2023.105551] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 07/20/2023] [Accepted: 07/21/2023] [Indexed: 08/14/2023]
Abstract
BACKGROUND We aimed at evaluating the temporal trend of drug-resistance and APOBEC editing from HIV-DNA genotypic resistance tests (GRT) in virologically suppressed individuals. MATERIAL AND METHODS Major resistance mutations (MRM), genotypic susceptibility score (GSS) for the current regimen and APOBEC-related mutations (APO-M) were evaluated. Potential changes in trends of MRM and APO-M over-time were assessed and predictors of MRM detection or sub-optimal GSS (GSS<2) at HIV-DNA-GRT were estimated through logistic regression analyses. RESULTS Among the 1126 individuals included, 396 (35.2%) harboured at least one MRM (23.4% to NRTI, 18.8% to NNRTI, 7.7% to PI and 1.4% to INSTI [N=724]); 132 (12.3%) individuals showed a GSS <2. APO-M and stop codons were found in 229 (20.3%) and 105 (9.3%) individuals, respectively. APO-DRMs were found in 16.8% of individuals and were more likely observed in those individuals with stop codons (40.0%) compared to those without (14.4%, P<0.001). From 2010 to 2021 no significant changes of resistance or APO-M were found. Positive predictors of MRM detection at HIV-DNA GRT were drug abuse, subtype B infection, and a prolonged and complex treatment history. Perinatal infection and having at least 2 stop codons were associated with a current suboptimal regimen. CONCLUSIONS In virologically suppressed individuals, resistance in HIV-DNA and the extent of APOBEC editing were generally stable in the last decade. A careful evaluation of APOBEC editing might be helpful to improve the reliability of HIV-DNA GRT. Further investigations are required to understand how to apply the estimation of APOBEC editing in refining genotypic evaluation.
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Affiliation(s)
- D Armenia
- UniCamillus, Saint Camillus International University of Health Sciences, Rome, Italy
| | - R Gagliardini
- National Institute for Infectious Diseases L. Spallanzani, IRCCS, Rome, Italy
| | - C Alteri
- University of Milan, Milan, Italy
| | - V Svicher
- Department of Experimental Medicine, University of Rome "Tor Vergata", Via Montpellier 1, 00133, Rome, Italy
| | - V Cento
- Humanitas Research Hospital, IRCCS, Milan, Italy
| | - V Borghi
- University of Modena and Reggio Emilia, Modena, Italy
| | - A Vergori
- National Institute for Infectious Diseases L. Spallanzani, IRCCS, Rome, Italy
| | - S Cicalini
- National Institute for Infectious Diseases L. Spallanzani, IRCCS, Rome, Italy
| | - F Forbici
- National Institute for Infectious Diseases L. Spallanzani, IRCCS, Rome, Italy
| | - L Fabeni
- National Institute for Infectious Diseases L. Spallanzani, IRCCS, Rome, Italy
| | - A Bertoli
- Department of Experimental Medicine, University of Rome "Tor Vergata", Via Montpellier 1, 00133, Rome, Italy; Polyclinic of Rome "Tor Vergata", Rome, Italy
| | - M Brugneti
- Polyclinic of Rome "Tor Vergata", Rome, Italy
| | - W Gennari
- University of Modena and Reggio Emilia, Modena, Italy
| | - V Malagnino
- Polyclinic of Rome "Tor Vergata", Rome, Italy
| | - M Andreoni
- Polyclinic of Rome "Tor Vergata", Rome, Italy
| | - C Mussini
- University of Modena and Reggio Emilia, Modena, Italy
| | - A Antinori
- National Institute for Infectious Diseases L. Spallanzani, IRCCS, Rome, Italy
| | - C F Perno
- Bambino Gesù Children's Hospital, Rome, Italy
| | - M M Santoro
- Department of Experimental Medicine, University of Rome "Tor Vergata", Via Montpellier 1, 00133, Rome, Italy.
| | - F Ceccherini-Silberstein
- Department of Experimental Medicine, University of Rome "Tor Vergata", Via Montpellier 1, 00133, Rome, Italy
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3
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Cutrell AG, Schapiro JM, Perno CF, Kuritzkes DR, Quercia R, Patel P, Polli JW, Dorey D, Wang Y, Wu S, Van Eygen V, Crauwels H, Ford SL, Baker M, Talarico CL, Clair MS, Jeffrey J, White CT, Vanveggel S, Vandermeulen K, Margolis DA, Aboud M, Spreen WR, van Lunzen J. Exploring predictors of HIV-1 virologic failure to long-acting cabotegravir and rilpivirine: a multivariable analysis. AIDS 2021; 35:1333-1342. [PMID: 33730748 PMCID: PMC8270504 DOI: 10.1097/qad.0000000000002883] [Citation(s) in RCA: 78] [Impact Index Per Article: 26.0] [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: 01/05/2021] [Revised: 02/26/2021] [Accepted: 03/03/2021] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Efficacy and safety of long-acting cabotegravir (CAB) and rilpivirine (RPV) dosed intramuscularly every 4 or 8 weeks has been demonstrated in three Phase 3 trials. Here, factors associated with virologic failure at Week 48 were evaluated post hoc. DESIGN AND METHODS Data from 1039 adults naive to long-acting CAB+RPV were pooled in a multivariable analysis to examine the influence of baseline viral and participant factors, dosing regimen and drug concentrations on confirmed virologic failure (CVF) occurrence using a logistic regression model. In a separate model, baseline factors statistically associated with CVF were further evaluated to understand CVF risk when present alone or in combination. RESULTS Overall, 1.25% (n = 13/1039) of participants experienced CVF. Proviral RPV resistance-associated mutations (RAMs), HIV-1 subtype A6/A1, higher BMI (associated with Week 8 CAB trough concentration) and lower Week 8 RPV trough concentrations were significantly associated (P < 0.05) with increased odds of CVF (all except RPV trough are knowable at baseline). Few participants (0.4%) with zero or one baseline factor had CVF. Only a combination of at least two baseline factors (observed in 3.4%; n = 35/1039) was associated with increased CVF risk (25.7%, n = 9/35). CONCLUSION CVF is an infrequent multifactorial event, with a rate of approximately 1% in the long-acting CAB+RPV arms across Phase 3 studies (FLAIR, ATLAS and ATLAS-2M) through Week 48. Presence of at least two of proviral RPV RAMs, HIV-1 subtype A6/A1 and/or BMI at least 30 kg/m2 was associated with increased CVF risk. These findings support the use of long-acting CAB+RPV in routine clinical practice.
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Affiliation(s)
- Amy G. Cutrell
- ViiV Healthcare, Research Triangle Park, North Carolina, USA
| | | | | | - Daniel R. Kuritzkes
- Division of Infectious Diseases, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Parul Patel
- ViiV Healthcare, Research Triangle Park, North Carolina, USA
| | - Joseph W. Polli
- ViiV Healthcare, Research Triangle Park, North Carolina, USA
| | - David Dorey
- GlaxoSmithKline, Mississauga, Ontario, Canada
| | | | - Sterling Wu
- GlaxoSmithKline, Collegeville, Pennsylvania, USA
| | | | | | - Susan L. Ford
- GlaxoSmithKline, Research Triangle Park, North Carolina, USA
| | | | | | - Marty St Clair
- ViiV Healthcare, Research Triangle Park, North Carolina, USA
| | - Jerry Jeffrey
- ViiV Healthcare, Research Triangle Park, North Carolina, USA
| | - C. Thomas White
- ViiV Healthcare, Research Triangle Park, North Carolina, USA
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4
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Armenia D, Di Carlo D, Flandre P, Bouba Y, Borghi V, Forbici F, Bertoli A, Gori C, Fabeni L, Gennari W, Pinnetti C, Mondi A, Cicalini S, Gagliardini R, Vergori A, Bellagamba R, Malagnino V, Montella F, Colafigli M, Latini A, Marocco R, Licthner M, Andreoni M, Mussini C, Ceccherini-Silberstein F, Antinori A, Perno CF, Santoro MM. HIV MDR is still a relevant issue despite its dramatic drop over the years. J Antimicrob Chemother 2021; 75:1301-1310. [PMID: 31976521 DOI: 10.1093/jac/dkz554] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 11/16/2019] [Accepted: 12/11/2019] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVES To evaluate the prevalence and therapeutic relevance of drug resistance among isolates from ART-experienced HIV-1-infected patients over the past two decades in Italy. METHODS Dynamics of resistance to one, two and three or more antiretroviral classes were evaluated from 1999-2018. Virological success (VS) after the latest therapy switch was evaluated according to cumulative class resistance and cumulative genotypic susceptibility score (Stanford HIV_DB algorithm). RESULTS Among 13 663 isolates (from 6739 patients), resistance to at least one drug class decreased sharply from 1999 to 2010 (≤2001, 84.6%; 2010, 43.6%; P < 0.001), then remained relatively constant at ∼40% during 2010-18, with the proportion of resistance to three or more classes also stable (∼5%). After 2008, integrase inhibitor resistance slightly increased from 5.6% to 9.7% in 2018 and contributed to resistance, particularly in isolates with resistance to three or more classes (one class, 8.4%; two classes, 15.3%; three or more classes, 34.7%, P < 0.001). Among 1827 failing patients with an available follow-up, by 1 year after genotype-guided therapy start the probability of VS was 87.6%. Patients with cumulative resistance to three or more classes and receiving a poorly active regimen showed the lowest probability (62.6%) of VS (P < 0.001) compared with all other patients (≥81.8%). By Cox regression analysis, cumulative MDR and receiving poorly active antiretroviral regimens were associated with a lower hazard of VS compared with those without resistance. CONCLUSIONS A dramatic drop of HIV-1 drug resistance at failure has been achieved over the last two decades in Italy; resistance to three or more classes is low but present among currently failing patients. Its management still requires a rational and careful diagnostic and therapeutic approach.
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Affiliation(s)
- D Armenia
- UniCamillus International University of Health and Medical Sciences, Rome, Italy.,University of Rome 'Tor Vergata', Department of Experimental Medicine, Rome, Italy
| | - D Di Carlo
- University of Milan, Pediatric Clinical Research Center 'Romeo and Enrica Invernizzi', Milan, Italy
| | - P Flandre
- INSERM, Sorbonne Université, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP) équipe Epidémiologie clinique des maladies virales chroniques, Paris, France
| | - Y Bouba
- University of Rome 'Tor Vergata', Department of Experimental Medicine, Rome, Italy.,Chantal BIYA International Reference Centre for research on HIV/AIDS prevention and management (CIRCB), Yaoundé, Cameroon
| | - V Borghi
- Clinic of Infectious Diseases, University Hospital, University of Modena and Reggio Emilia, Modena, Italy
| | - F Forbici
- Laboratory of Virology, National Institute for Infectious Diseases 'Lazzaro Spallanzani', IRCCS, Rome, Italy
| | - A Bertoli
- University of Rome 'Tor Vergata', Department of Experimental Medicine, Rome, Italy
| | - C Gori
- Laboratory of Virology, National Institute for Infectious Diseases 'Lazzaro Spallanzani', IRCCS, Rome, Italy
| | - L Fabeni
- University of Rome 'Tor Vergata', Department of Experimental Medicine, Rome, Italy
| | - W Gennari
- Microbiology Unit, University Hospital of Modena, Modena, Italy
| | - C Pinnetti
- HIV/AIDS Department, National Institute for Infectious Diseases 'Lazzaro Spallanzani' IRCCS, Rome, Italy
| | - A Mondi
- HIV/AIDS Department, National Institute for Infectious Diseases 'Lazzaro Spallanzani' IRCCS, Rome, Italy
| | - S Cicalini
- HIV/AIDS Department, National Institute for Infectious Diseases 'Lazzaro Spallanzani' IRCCS, Rome, Italy
| | - R Gagliardini
- HIV/AIDS Department, National Institute for Infectious Diseases 'Lazzaro Spallanzani' IRCCS, Rome, Italy
| | - A Vergori
- HIV/AIDS Department, National Institute for Infectious Diseases 'Lazzaro Spallanzani' IRCCS, Rome, Italy
| | - R Bellagamba
- HIV/AIDS Department, National Institute for Infectious Diseases 'Lazzaro Spallanzani' IRCCS, Rome, Italy
| | - V Malagnino
- Clinical Infectious Diseases, University Hospital 'Tor Vergata', Rome, Italy
| | - F Montella
- Infectious disease Unit, San Giovanni Addolorata Hospital, Rome, Italy
| | - M Colafigli
- Unit of Dermatology and Sexually Transmitted Diseases, San Gallicano Dermatological Institute IRCCS, Rome, Italy
| | - A Latini
- Unit of Dermatology and Sexually Transmitted Diseases, San Gallicano Dermatological Institute IRCCS, Rome, Italy
| | - R Marocco
- Infectious Diseases Unit, 'Sapienza' University, Polo Pontino, Latina, Italy
| | - M Licthner
- Infectious Diseases Unit, 'Sapienza' University, Polo Pontino, Latina, Italy
| | - M Andreoni
- Clinical Infectious Diseases, University Hospital 'Tor Vergata', Rome, Italy
| | - C Mussini
- Clinic of Infectious Diseases, University Hospital, University of Modena and Reggio Emilia, Modena, Italy
| | | | - A Antinori
- HIV/AIDS Department, National Institute for Infectious Diseases 'Lazzaro Spallanzani' IRCCS, Rome, Italy
| | - C F Perno
- Laboratory of Virology, National Institute for Infectious Diseases 'Lazzaro Spallanzani', IRCCS, Rome, Italy
| | - M M Santoro
- University of Rome 'Tor Vergata', Department of Experimental Medicine, Rome, Italy
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5
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Ammirati E, Varrenti M, Veronese G, Fanti D, Nava A, Cipriani M, Pedrotti P, Garascia A, Bottiroli M, Oliva F, Bramerio M, Veronese S, Giannattasio C, Bonoldi E, Perno CF, Camici PG, Frigerio M. Prevalence and outcome of patients with acute myocarditis and positive viral search on nasopharyngeal swab. Eur J Heart Fail 2021; 23:1242-1245. [PMID: 34036693 DOI: 10.1002/ejhf.2247] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 04/06/2021] [Accepted: 05/18/2021] [Indexed: 12/15/2022] Open
Affiliation(s)
| | - Marisa Varrenti
- De Gasperis Cardio Center, Niguarda Hospital, Milano, Italy.,Department of Health Sciences, University of Milano-Bicocca, Monza, Italy
| | - Giacomo Veronese
- De Gasperis Cardio Center, Niguarda Hospital, Milano, Italy.,Department of Health Sciences, University of Milano-Bicocca, Monza, Italy
| | - Diana Fanti
- Chemical-Clinical and Microbiological Analyses, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Alice Nava
- Chemical-Clinical and Microbiological Analyses, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | | | | | | | | | - Fabrizio Oliva
- De Gasperis Cardio Center, Niguarda Hospital, Milano, Italy
| | | | | | - Cristina Giannattasio
- De Gasperis Cardio Center, Niguarda Hospital, Milano, Italy.,Department of Health Sciences, University of Milano-Bicocca, Monza, Italy
| | | | - Carlo F Perno
- Chemical-Clinical and Microbiological Analyses, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Paolo G Camici
- IRCCS San Raffaele Hospital and Vita Salute University, Milano, Italy
| | - Maria Frigerio
- De Gasperis Cardio Center, Niguarda Hospital, Milano, Italy
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6
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Caruso A, Caccuri F, Bugatti A, Zani A, Vanoni M, Bonfanti P, Cazzaniga ME, Perno CF, Messa C, Alberghina L. Methotrexate inhibits SARS-CoV-2 virus replication "in vitro". J Med Virol 2020; 93:1780-1785. [PMID: 32926453 PMCID: PMC7891346 DOI: 10.1002/jmv.26512] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 09/08/2020] [Accepted: 09/11/2020] [Indexed: 12/31/2022]
Abstract
In early 2020 the new respiratory syndrome COVID‐19 (caused by the zoonotic SARS‐CoV‐2 virus) spread like a pandemic, starting from Wuhan, China, causing severe economic depression. Despite some advances in drug treatments of medical complications in the later stages of the disease, the pandemic's death toll is tragic, as no vaccine or specific antiviral treatment is currently available. By using a systems approach, we identify the host‐encoded pathway, which provides ribonucleotides to viral RNA synthesis, as a possible target. We show that methotrexate, an FDA‐approved inhibitor of purine biosynthesis, potently inhibits viral RNA replication, viral protein synthesis, and virus release. The effective antiviral methotrexate concentrations are similar to those used for established human therapies using the same drug. Methotrexate should be most effective in patients at the earliest appearance of symptoms to effectively prevent viral replication, diffusion of the infection, and possibly fatal complications. The COVID‐19 pandemic caused by the SARS‐CoV‐2 virus is a global public health threat causing over 800000 deaths, millions of infected people, and severe economic depression. No vaccine or specific antiviral treatments are currently available. By inhibiting the host‐encoded pathway, which provides ribonucleotides to viral RNA synthesis, the FDA‐approved drug methotrexate efficiently blocks SARS‐CoV‐2 replication.
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Affiliation(s)
- Arnaldo Caruso
- Department of Molecular and Translational Medicine, Section of Microbiology and Virology, University of Brescia Medical School, Brescia, Italy
| | - Francesca Caccuri
- Department of Molecular and Translational Medicine, Section of Microbiology and Virology, University of Brescia Medical School, Brescia, Italy
| | - Antonella Bugatti
- Department of Molecular and Translational Medicine, Section of Microbiology and Virology, University of Brescia Medical School, Brescia, Italy
| | - Alberto Zani
- Department of Molecular and Translational Medicine, Section of Microbiology and Virology, University of Brescia Medical School, Brescia, Italy
| | - Marco Vanoni
- Department of Biotechnology and Biosciences, ISBE.IT-SYSBIO/Centre of Systems Biology, University of Milano Bicocca, Milano, Italy
| | - Paolo Bonfanti
- School of Medicine and Surgery, University of Milano Bicocca, Milano, Italy.,Clinic of Infectious Diseases-ASST Monza, Monza, Italy
| | - Marina E Cazzaniga
- School of Medicine and Surgery, University of Milano Bicocca, Milano, Italy.,ASST Monza, Phase 1 Research Unit, Monza, Italy
| | | | - Cristina Messa
- School of Medicine and Surgery, University of Milano Bicocca, Milano, Italy.,Tecnomed Foundation, Milan, Italy
| | - Lilia Alberghina
- Department of Biotechnology and Biosciences, ISBE.IT-SYSBIO/Centre of Systems Biology, University of Milano Bicocca, Milano, Italy
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7
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Gregson J, Rhee SY, Datir R, Pillay D, Perno CF, Derache A, Shafer RS, Gupta RK. Human Immunodeficiency Virus-1 Viral Load Is Elevated in Individuals With Reverse-Transcriptase Mutation M184V/I During Virological Failure of First-Line Antiretroviral Therapy and Is Associated With Compensatory Mutation L74I. J Infect Dis 2020; 222:1108-1116. [PMID: 31774913 PMCID: PMC7459140 DOI: 10.1093/infdis/jiz631] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 11/26/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND M184V/I cause high-level lamivudine (3TC) and emtricitabine (FTC) resistance and increased tenofovir disoproxil fumarate (TDF) susceptibility. Nonetheless, 3TC and FTC (collectively referred to as XTC) appear to retain modest activity against human immunodeficiency virus-1 with these mutations possibly as a result of reduced replication capacity. In this study, we determined how M184V/I impacts virus load (VL) in patients failing therapy on a TDF/XTC plus nonnucleoside reverse-transcriptase inhibitor (NNRTI)-containing regimen. METHODS We compared VL in the absence and presence of M184V/I across studies using random effects meta-analysis. The effect of mutations on virus reverse-transcriptase activity and infectiousness was analyzed in vitro. RESULTS M184I/V was present in 817 (56.5%) of 1445 individuals with virologic failure (VF). Virus load was similar in individuals with or without M184I/V (difference in log10 VL, 0.18; 95% confidence interval, .05-.31). CD4 count was lower both at initiation of antiretroviral therapy and at VF in participants who went on to develop M184V/I. L74I was present in 10.2% of persons with M184V/I but absent in persons without M184V/I (P < .0001). In vitro, L74I compensated for defective replication of M184V-mutated virus. CONCLUSIONS Virus loads were similar in persons with and without M184V/I during VF on a TDF/XTC/NNRTI-containing regimen. Therefore, we did not find evidence for a benefit of XTC in the context of first-line failure on this combination.
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Affiliation(s)
- J Gregson
- Department of Biostatistics, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - S Y Rhee
- Department of Medicine, Stanford University, Stanford, California, USA
| | - R Datir
- Division of Infection and Immunity, UCL, London, United Kingdom
| | - D Pillay
- Division of Infection and Immunity, UCL, London, United Kingdom
- Africa Health Research Institute, Durban, South Africa
| | - C F Perno
- Department of Oncology and Haematoncology, University of Milan, Milan, Italy
| | - A Derache
- Africa Health Research Institute, Durban, South Africa
| | - R S Shafer
- Department of Medicine, Stanford University, Stanford, California, USA
| | - R K Gupta
- Africa Health Research Institute, Durban, South Africa
- Department of Medicine, University of Cambridge, Cambridge, United Kingdom
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8
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Armenia D, Di Carlo D, Cozzi-Lepri A, Calcagno A, Borghi V, Gori C, Bertoli A, Gennari W, Bellagamba R, Castagna A, Latini A, Pinnetti C, Cicalini S, Saracino A, Lapadula G, Rusconi S, Castelli F, Di Giambenedetto S, Andreoni M, Di Perri G, Antinori A, Mussini C, Ceccherini-Silberstein F, Monforte AD, Perno CF, Santoro MM. Very high pre-therapy viral load is a predictor of virological rebound in HIV-1-infected patients starting a modern first-line regimen. Antivir Ther 2020; 24:321-331. [PMID: 30977466 DOI: 10.3851/imp3309] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Pre-cART (combined antiretroviral therapy) plasma viral load >500,000 copies/ml has been associated with a lower probability of achieving virological suppression, while few data about its role on maintenance of virological suppression are available. In this study we aimed to clarify whether high levels of pre-cART viraemia are associated with virological rebound (VR) after virological suppression. METHODS HIV-infected individuals who achieved virological suppression after first-line cART were included. VR was defined as the first of two consecutive viraemia >50 copies/ml (VR50) or, in an alternative analysis, >200 copies/ml (VR200). The impact of pre-cART viraemia on the risk of VR was evaluated by survival analyses. RESULTS Among 5,766 patients included, 59.2%, 31.4%, 5.2% and 4.2% had pre-cART viraemia ≤100,000, 100,001-500,000, 500,001-1,000,000 and >1,000,000 copies/ml, respectively. Patients with pre-cART viraemia levels >1,000,000 copies/ml had the highest probability of VR (>1,000,000; 500,000-1,000,000; 100,000-500,000; <100,000 copies/ml; VR50: 28.4%; 24.3%; 17.6%; 13.8%, P<0.0001; VR200: 14.4%; 11.1%; 7.2%; 7.6%; P=0.009). By Cox multivariable analyses, patients with pre-cART viraemia >500,000 and >1,000,000 copies/ml showed a significantly higher risk of VR regardless of the VR end point used. No difference in the risk of VR was found between patients with pre-cART viraemia ranging 500,000-1,000,000 copies/ml and those with pre-cART viraemia >1,000,000 copies/ml, regardless of the VR end point used. CONCLUSIONS Pre-cART plasma viral load levels >500,000 copies/ml can identify fragile patients with poorer chance of maintaining virological control after an initial response. An effort in defining effective treatment strategies is mandatory for these patients that remain difficult to treat.
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Affiliation(s)
- Daniele Armenia
- Department of Experimental Medicine, University of Rome 'Tor Vergata', Rome, Italy.,Saint Camillus International University of Health Sciences, Rome, Italy
| | - Domenico Di Carlo
- Pediatric Clinical Research Center 'Romeo and Erica Invernizzi', University of Milan, Milan, Italy
| | | | - Andrea Calcagno
- Unit of Infectious Diseases, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Vanni Borghi
- Clinic of Infectious Diseases, University Hospital, University of Modena and Reggio Emilia, Modena, Italy
| | - Caterina Gori
- Virology Unit, National Institute for Infectious Diseases L. Spallanzani, IRCCS, Rome, Italy
| | - Ada Bertoli
- Department of Experimental Medicine, University of Rome 'Tor Vergata', Rome, Italy
| | - William Gennari
- Microbiology and Virology Unit, University Hospital Polyclinic, Modena, Italy
| | - Rita Bellagamba
- Clinical Division of HIV/AIDS, National Institute for Infectious Diseases L. Spallanzani, IRCCS, Rome, Italy
| | - Antonella Castagna
- Infectious Diseases Department, IRCCS San Raffaele Scientific Institute & Vita-Salute University, Milan, Italy
| | - Alessandra Latini
- Unit of Dermatology and Sexually Transmitted Diseases, San Gallicano Dermatological Institute IRCCS, Rome, Italy
| | - Carmela Pinnetti
- Clinical Division of HIV/AIDS, National Institute for Infectious Diseases L. Spallanzani, IRCCS, Rome, Italy
| | - Stefania Cicalini
- Clinical Division of HIV/AIDS, National Institute for Infectious Diseases L. Spallanzani, IRCCS, Rome, Italy
| | - Annalisa Saracino
- Division of Infectious Diseases, University of Bari, Policlinic Hospital, Bari, Italy
| | - Giuseppe Lapadula
- Division of Infectious Diseases, 'San Gerardo' Hospital, Monza, Italy
| | - Stefano Rusconi
- Infectious Diseases Unit, DIBIC Luigi Sacco, University of Milan, Milan, Italy
| | - Francesco Castelli
- University Department of Infectious and Tropical Diseases, University of Brescia and Spedali Civili General Hospital, Brescia, Italy
| | | | - Massimo Andreoni
- Clinical Infectious Diseases, University Hospital 'Tor Vergata', Rome, Italy
| | - Giovanni Di Perri
- Unit of Infectious Diseases, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Andrea Antinori
- Clinical Division of HIV/AIDS, National Institute for Infectious Diseases L. Spallanzani, IRCCS, Rome, Italy
| | - Cristina Mussini
- Clinic of Infectious Diseases, University Hospital, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Antonella D'Arminio Monforte
- Department of Health Sciences, Clinic of Infectious Diseases, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
| | - Carlo F Perno
- Virology Unit, National Institute for Infectious Diseases L. Spallanzani, IRCCS, Rome, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Maria M Santoro
- Department of Experimental Medicine, University of Rome 'Tor Vergata', Rome, Italy
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9
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Moreno S, Perno CF, Mallon PW, Behrens G, Corbeau P, Routy JP, Darcis G. Two-drug vs. three-drug combinations for HIV-1: Do we have enough data to make the switch? HIV Med 2020; 20 Suppl 4:2-12. [PMID: 30821898 DOI: 10.1111/hiv.12716] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2019] [Indexed: 01/01/2023]
Abstract
Three-drug combination antiretroviral therapy (ART) became available in 1996, dramatically improving the prognosis of people living with HIV. The clinical benefits of ART are due to the sustained viral load suppression and CD4 T cell gains. Major drawbacks of the first ART regimens were adverse events, and high pill burden, which led to the reduction of drug adherence resulting in frequent treatment discontinuations and the development of drug resistance. Due to increased viral potency of new antiretroviral drugs consideration of a two-drug combination therapy repositioning occurred in an effort to reduce adverse events, drug-drug interactions and cost, while maintaining a sustained antiviral effect. Various combinations of two-drug regimens have been studied, and non-inferiority compared to a three-drug regimen has been shown only for some of them. In addition, a two-drug combination regimen may not be suitable for every patient, especially those who are pregnant, those with tuberculosis or coexisting HBV infection. Furthermore no information has been generated concerning the secondary transmission of HIV from patients who have undetectable plasma viral load on two-drug regimens. Additional studies of two-drug combinations are also necessary to evaluate the debated existence of low viral replication in tissues and on immune activation. While there is no urgent need to routinely switch patients to two-drug combination therapy, due to the availability of drug combinations without significant toxicities, dual regimens represent a suitable option that deserve long-term evaluation before being introduced to clinical practice.
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Affiliation(s)
- S Moreno
- Department of Infectious Diseases, University Hospital Ramón y Cajal, Alcalá University, IRYCIS, Madrid, Spain
| | - C F Perno
- Department of Laboratory Medicine, ASST Niguarda Hospital, University of Milan, Milan, Italy
| | - P W Mallon
- HIV Molecular Research Group, School of Medicine, University College Dublin, Dublin, Ireland
| | - G Behrens
- Department for Rheumatology and Clinical Immunology, Hannover Medical School, Hannover, Germany
| | - P Corbeau
- Institute for Human Genetics, CNRS-Montpellier University UMR9002, Montpellier, France.,Immunology Department, University Hospital, Nîmes, France
| | - J-P Routy
- Division of Hematology and Chronic Viral Infection Service, McGill University Health Centre, Montréal, QC, Canada
| | - G Darcis
- Department of Infectious Diseases, Liege University Hospital, University of Liege, Liège, Belgium
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10
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Aragri M, Milana M, Di Maio VC, Lenci I, Carioti L, Perno CF, Svicher V, Angelico M, Ceccherini-Silberstein F. Successful ongoing retreatment with glecaprevir/pibrentasvir + sofosbuvir + ribavirin in a patient with HCV genotype 3 who failed glecaprevir/pibrentasvir with both NS3 and NS5A resistance. Clin Microbiol Infect 2020; 26:1266-1268. [PMID: 32240711 DOI: 10.1016/j.cmi.2020.03.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 03/18/2020] [Accepted: 03/21/2020] [Indexed: 01/26/2023]
Affiliation(s)
- M Aragri
- Department of Experimental Medicine, University of Rome Tor Vergata, Rome, Italy
| | - M Milana
- Hepatology Unit, University Hospital of Rome Tor Vergata, Rome, Italy
| | - V C Di Maio
- Department of Experimental Medicine, University of Rome Tor Vergata, Rome, Italy
| | - I Lenci
- Hepatology Unit, University Hospital of Rome Tor Vergata, Rome, Italy
| | - L Carioti
- Department of Experimental Medicine, University of Rome Tor Vergata, Rome, Italy
| | - C F Perno
- Department of Oncology and Oncohematology, University of Milan, Milan, Italy
| | - V Svicher
- Department of Experimental Medicine, University of Rome Tor Vergata, Rome, Italy
| | - M Angelico
- Hepatology Unit, University Hospital of Rome Tor Vergata, Rome, Italy
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11
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Sorbo MC, Carioti L, Bellocchi MC, Antonucci F, Sforza D, Lenci I, Ciancio Manuelli M, Armenia D, De Leonardis F, Milana M, Manzia TM, Angelico M, Tisone G, Cento V, Perno CF, Ceccherini-Silberstein F. HCV resistance compartmentalization within tumoral and non-tumoral liver in transplanted patients with hepatocellular carcinoma. Liver Int 2019; 39:1986-1998. [PMID: 31172639 DOI: 10.1111/liv.14168] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 05/09/2019] [Accepted: 05/10/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND & AIMS We investigated the HCV-RNA amount, variability and prevalence of resistance-associated substitutions (RASs), in plasma, hepatic tumoral and non-tumoral tissue samples in patients undergoing liver-transplant/hepatic-resection (LT/HR), because of hepatocellular carcinoma and/or cirrhosis. METHODS Eighteen HCV-infected patients undergoing LT/HR, 94.0% naïve to direct-acting antivirals (DAAs), were analysed. HCV-RNA was quantified in all compartments. NS3/NS5A/NS5B in plasma and/or in tumoral/non-tumoral tissues were analysed using Sanger and Ultra-deep pyrosequencing (UDPS, 9/18 patients). RASs prevalence, genetic-variability and phylogenetic analysis were evaluated. RESULTS At the time of LT/HR, HCV-RNA was quantifiable in all compartments of DAA-naïve patients and was generally lower in tumoral than in non-tumoral tissues (median [IQR] = 4.0 [1.2-4.3] vs 4.3[3.1-4.9] LogIU/µg RNA; P = 0.193). The one patient treated with sofosbuvir + ribavirin represented an exception with HCV-RNA quantifiable exclusively in the liver, but with higher level in tumoral than in non-tumoral tissues (51 vs 7 IU/µg RNA). RASs compartmentalization was found by Sanger in 4/18 infected-patients, and by UDPS in other two patients. HCV-compartmentalization resulted to be associated with HBcAb-positivity (P = 0.013). UDPS showed approximately higher genetic-variability in NS3/NS5A sequences in all compartments. Phylogenetic-analysis showed defined and intermixed HCV-clusters among/within all compartments, and were strongly evident in the only non-cirrhotic patient, with plasma and non-tumoral sequences generally more closely related. CONCLUSIONS Hepatic compartments showed differences in HCV-RNA amount, RASs and genetic variability, with a higher segregation within the tumoral compartment. HBV coinfection influenced the HCV compartmentalization. These results highlight HCV-strain diversifications within the liver, which could explain some of the failures occurring even today in the era of DAAs.
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Affiliation(s)
- Maria C Sorbo
- Chair of Virology, Department of Experimental Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Luca Carioti
- Chair of Virology, Department of Experimental Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Maria C Bellocchi
- Chair of Virology, Department of Experimental Medicine, University of Rome Tor Vergata, Rome, Italy
| | - FrancescoPaolo Antonucci
- Chair of Virology, Department of Experimental Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Daniele Sforza
- Hepatobiliary and Transplant Unit, Department of Surgery, Policlinico Tor Vergata/Tor Vergata University, Rome, Italy
| | - Ilaria Lenci
- Hepatology Unit, Department of Systems Medicine, Policlinico Tor Vergata/Tor Vergata University, Rome, Italy
| | - Matteo Ciancio Manuelli
- Hepatobiliary and Transplant Unit, Department of Surgery, Policlinico Tor Vergata/Tor Vergata University, Rome, Italy
| | - Daniele Armenia
- Chair of Virology, Department of Experimental Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Francesco De Leonardis
- Hepatology Unit, Department of Systems Medicine, Policlinico Tor Vergata/Tor Vergata University, Rome, Italy
| | - Martina Milana
- Hepatology Unit, Department of Systems Medicine, Policlinico Tor Vergata/Tor Vergata University, Rome, Italy
| | - Tommaso M Manzia
- Hepatobiliary and Transplant Unit, Department of Surgery, Policlinico Tor Vergata/Tor Vergata University, Rome, Italy
| | - Mario Angelico
- Hepatology Unit, Department of Systems Medicine, Policlinico Tor Vergata/Tor Vergata University, Rome, Italy
| | - Giuseppe Tisone
- Hepatobiliary and Transplant Unit, Department of Surgery, Policlinico Tor Vergata/Tor Vergata University, Rome, Italy
| | - Valeria Cento
- Chair of Virology, Department of Experimental Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Carlo F Perno
- Chair of Virology, Department of Experimental Medicine, University of Rome Tor Vergata, Rome, Italy
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12
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Rucci F, Cigoli MS, Marini V, Fucile C, Mattioli F, Robbiano L, Cavallari U, Scaglione F, Perno CF, Penco S, Marocchi A. Combined evaluation of genotype and phenotype of thiopurine S-methyltransferase (TPMT) in the clinical management of patients in chronic therapy with azathioprine. Drug Metab Pers Ther 2019; 34:dmpt-2018-0037. [PMID: 30840585 DOI: 10.1515/dmpt-2018-0037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 01/29/2019] [Indexed: 06/09/2023]
Abstract
Background The thiopurine S-methyltransferase (TPMT)/azathioprine (AZA) gene-drug pair is one of the most well-known pharmacogenetic markers. Despite this, few studies investigated the implementation of TPMT testing and the combined evaluation of genotype and phenotype in multidisciplinary clinical settings where patients are undergoing chronic therapy with AZA. Methods A total of 356 AZA-treated patients for chronic autoimmune diseases were enrolled. DNA was isolated from whole blood and the samples were analyzed for the c.460G>A and c.719A>G variants by the restriction fragment length polymorphism (RFLP) technique and sequenced for the c.238G>C variant. The TPMT enzyme activity was determined in erythrocytes by a high-performance liquid chromatography (HPLC) assay. Results All the patients enrolled were genotyped while the TPMT enzyme activity was assessed in 41 patients. Clinical information was available on 181 patients. We found no significant difference in the odds of having adverse drug reactions (ADRs) in wild-type patients and variant allele carriers, but the latter had an extra risk of experiencing hematologically adverse events. The enzyme activity was significantly associated to genotype. Conclusions TPMT variant allele carriers have an extra risk of experiencing hematologically adverse events compared to wild-type patients. Interestingly, only two out of 30 (6.6%) patients had discordant results between genotype, phenotype and onset of ADRs.
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Affiliation(s)
- Francesco Rucci
- Department of Laboratory Medicine, Medical Genetics, ASST Niguarda Hospital, Piazza Ospedale Maggiore, 3-20162 - Milan, Italy, Tel. +39 0264442803
- University of Milan, Department of Oncology and Onco-Hematology, Postgraduate School of Clinical Pharmacology and Toxicology, Milan, Italy
| | - Maria Sole Cigoli
- Department of Laboratory Medicine, Medical Genetics, ASST Niguarda Hospital, Milan, Italy
| | - Valeria Marini
- Department of Internal Medicine, University of Genova, Genova, Italy
| | - Carmen Fucile
- Department of Internal Medicine, University of Genova, Genova, Italy
| | | | - Luigi Robbiano
- Department of Internal Medicine, University of Genova, Genova, Italy
| | - Ugo Cavallari
- Department of Laboratory Medicine, Medical Genetics, ASST Niguarda Hospital, Milan, Italy
| | - Francesco Scaglione
- University of Milan, Department of Oncology and Onco-Hematology, Postgraduate School of Clinical Pharmacology and Toxicology, Milan, Italy
| | - Carlo F Perno
- Department of Laboratory Medicine, ASST Niguarda Hospital, Milan, Italy
| | - Silvana Penco
- Department of Laboratory Medicine, Medical Genetics, ASST Niguarda Hospital, Milan, Italy
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13
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Salpini R, Surdo M, Cortese MF, Palumbo GA, Carioti L, Cappiello G, Spanò A, Trimoulet P, Fleury H, Vecchiet J, Pasquazzi C, Mirabelli C, Scutari R, Sacco A, Alkhatib M, Missale G, Francioso S, Sarmati L, Andreoni M, Angelico M, Ceccherini-Silberstein F, Levrero M, Perno CF, Belloni L, Svicher V. The novel HBx mutation F30V correlates with hepatocellular carcinoma in vivo, reduces hepatitis B virus replicative efficiency and enhances anti-apoptotic activity of HBx N terminus in vitro. Clin Microbiol Infect 2018; 25:906.e1-906.e7. [PMID: 30472417 DOI: 10.1016/j.cmi.2018.11.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 11/06/2018] [Accepted: 11/09/2018] [Indexed: 02/07/2023]
Abstract
OBJECTIVE We aimed to investigate HBx genetic elements correlated with hepatitis B virus (HBV) -related hepatocellular carcinoma (HCC) and their impact on (a) HBV replicative efficiency, (b) HBx binding to circular covalently closed DNA (cccDNA), (c) apoptosis and cell-cycle progression, and (d) HBx structural stability. METHODS This study included 123 individuals chronically infected with HBV: 27 with HCC (77.9% (21/27) genotype D; 22.1% (6/27) genotype A) and 96 without HCC (75% (72/96) genotype D; 25.0% (24/96) genotype A). HepG2 cells were transfected by wild-type or mutated linear HBV genome to assess pre-genomic RNA (pgRNA) and core-associated HBV-DNA levels, HBx-binding onto cccDNA by chromatin immunoprecipitation-based quantitative assay, and rate of apoptosis and cell-cycle progression by cytofluorimetry. RESULTS F30V was the only HBx mutation correlated with HCC (18.5% (5/27) in HCC patients versus 1.0% (1/96) in non-HCC patients, p 0.002); a result confirmed by multivariate analysis. In vitro, F30V determined a 40% and 60% reduction in pgRNA and core-associated HBV-DNA compared with wild-type (p <0.05), in parallel with a significant decrease of HBx binding to cccDNA and decreased HBx stability. F30V also decreased the percentage of apoptotic cells compared with wild-type (14.8 ± 6.8% versus 19.1 ± 10.1%, p <0.01, without affecting cell-cycle progression) and increased the probability of HBx-Ser-31 being phosphorylated by PI3K-Akt kinase (known to promote anti-apoptotic activity). CONCLUSIONS F30V was closely correlated with HBV-induced HCC in vivo, reduced HBV replicative efficiency by affecting HBx-binding to cccDNA and increased anti-apoptotic HBx activity in vitro. This suggests that F30V (although hampering HBV's replicative capacity) may promote hepatocyte survival, so potentially allowing persistent production of viral progeny and initiating HBV-driven hepatocarcinogenesis. Investigation of viral genetic markers associated with HCC is crucial to identify those patients at higher risk of HCC, who hence deserve intensive liver monitoring and/or early anti-HBV therapy.
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Affiliation(s)
- R Salpini
- Department of Experimental Medicine and Surgery, University of Rome 'Tor Vergata' Rome, Italy
| | - M Surdo
- Department of Experimental Medicine and Surgery, University of Rome 'Tor Vergata' Rome, Italy
| | - M F Cortese
- Department of Experimental Medicine and Surgery, University of Rome 'Tor Vergata' Rome, Italy; Liver Pathology Unit, Departments of Biochemistry and Microbiology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - G A Palumbo
- Department of Internal Medicine-DMISM, Sapienza University, Rome, Italy
| | - L Carioti
- Department of Experimental Medicine and Surgery, University of Rome 'Tor Vergata' Rome, Italy
| | | | - A Spanò
- 'S. Pertini Hospital', Rome, Italy
| | | | - H Fleury
- Hôpital Pellegrin Tripode, Bordeaux, France
| | | | | | - C Mirabelli
- Department of Experimental Medicine and Surgery, University of Rome 'Tor Vergata' Rome, Italy; University of Michigan Medical School, Ann Arbor, MI, USA
| | - R Scutari
- Department of Experimental Medicine and Surgery, University of Rome 'Tor Vergata' Rome, Italy
| | - A Sacco
- Department of Experimental Medicine and Surgery, University of Rome 'Tor Vergata' Rome, Italy
| | - M Alkhatib
- Department of Experimental Medicine and Surgery, University of Rome 'Tor Vergata' Rome, Italy
| | | | - S Francioso
- Hepatology Unit, Tor Vergata University Hospital, Rome, Italy
| | - L Sarmati
- Infectious Diseases Unit, Tor Vergata University Hospital, Rome, Italy
| | - M Andreoni
- Infectious Diseases Unit, Tor Vergata University Hospital, Rome, Italy
| | - M Angelico
- Hepatology Unit, Tor Vergata University Hospital, Rome, Italy
| | | | - M Levrero
- Department of Internal Medicine-DMISM, Sapienza University, Rome, Italy; INSERM U1052 - Cancer Research Centre of Lyon, 69008 Lyon, France
| | - C F Perno
- Department of Experimental Medicine and Surgery, University of Rome 'Tor Vergata' Rome, Italy; Haematology and Oncohaematology, University of Milan, Italy
| | - L Belloni
- Department of Internal Medicine-DMISM, Sapienza University, Rome, Italy; Centre for Life NanoSciences, IIT-Sapienza, Rome, Italy
| | - V Svicher
- Department of Experimental Medicine and Surgery, University of Rome 'Tor Vergata' Rome, Italy.
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14
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Fabeni L, Alteri C, Di Carlo D, Orchi N, Carioti L, Bertoli A, Gori C, Forbici F, Continenza F, Maffongelli G, Pinnetti C, Vergori A, Mondi A, Ammassari A, Borghi V, Giuliani M, De Carli G, Pittalis S, Grisetti S, Pennica A, Mastroianni CM, Montella F, Cristaudo A, Mussini C, Girardi E, Andreoni M, Antinori A, Ceccherini-Silberstein F, Perno CF, Santoro MM. Dynamics and phylogenetic relationships of HIV-1 transmitted drug resistance according to subtype in Italy over the years 2000-14. J Antimicrob Chemother 2018; 72:2837-2845. [PMID: 29091206 DOI: 10.1093/jac/dkx231] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Accepted: 06/09/2017] [Indexed: 11/14/2022] Open
Abstract
Background Transmitted drug-resistance (TDR) remains a critical aspect for the management of HIV-1-infected individuals. Thus, studying the dynamics of TDR is crucial to optimize HIV care. Methods In total, 4323 HIV-1 protease/reverse-transcriptase sequences from drug-naive individuals diagnosed in north and central Italy between 2000 and 2014 were analysed. TDR was evaluated over time. Maximum-likelihood and Bayesian phylogenetic trees with bootstrap and Bayesian-probability supports defined transmission clusters. Results Most individuals were males (80.2%) and Italian (72.1%), with a median (IQR) age of 37 (30-45) years. MSM accounted for 42.2% of cases, followed by heterosexuals (36.4%). Non-B subtype infections accounted for 30.8% of the overall population and increased over time (<2005-14: 19.5%-38.5%, P < 0.0001), particularly among Italians (<2005-14: 6.5%-28.8%, P < 0.0001). TDR prevalence was 8.8% and increased over time in non-B subtypes (<2005-14: 2%-7.1%, P = 0.018). Overall, 467 transmission clusters (involving 1207 individuals; 27.9%) were identified. The prevalence of individuals grouping in transmission clusters increased over time in both B (<2005-14: 12.9%-33.5%, P = 0.001) and non-B subtypes (<2005-14: 18.4%-41.9%, P = 0.006). TDR transmission clusters were 13.3% within the overall cluster observed and dramatically increased in recent years (<2005-14: 14.3%-35.5%, P = 0.005). This recent increase was mainly due to non-B subtype-infected individuals, who were also more frequently involved in large transmission clusters than those infected with a B subtype [median number of individuals in transmission clusters: 7 (IQR 6-19) versus 4 (3-4), P = 0.047]. Conclusions The epidemiology of HIV transmission changed greatly over time; the increasing number of transmission clusters (sometimes with drug resistance) shows that detection and proper treatment of the multi-transmitters is a major target for controlling HIV spread.
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Affiliation(s)
- L Fabeni
- National Institute for Infectious Diseases L Spallanzani, IRCCS, Rome, Italy
| | - C Alteri
- University of Rome Tor Vergata, Rome, Italy
| | - D Di Carlo
- University of Rome Tor Vergata, Rome, Italy
| | - N Orchi
- National Institute for Infectious Diseases L Spallanzani, IRCCS, Rome, Italy
| | - L Carioti
- University of Rome Tor Vergata, Rome, Italy
| | - A Bertoli
- University of Rome Tor Vergata, Rome, Italy
| | - C Gori
- National Institute for Infectious Diseases L Spallanzani, IRCCS, Rome, Italy
| | - F Forbici
- National Institute for Infectious Diseases L Spallanzani, IRCCS, Rome, Italy
| | - F Continenza
- National Institute for Infectious Diseases L Spallanzani, IRCCS, Rome, Italy
| | | | - C Pinnetti
- National Institute for Infectious Diseases L Spallanzani, IRCCS, Rome, Italy
| | - A Vergori
- National Institute for Infectious Diseases L Spallanzani, IRCCS, Rome, Italy
| | - A Mondi
- National Institute for Infectious Diseases L Spallanzani, IRCCS, Rome, Italy
| | - A Ammassari
- National Institute for Infectious Diseases L Spallanzani, IRCCS, Rome, Italy
| | - V Borghi
- Modena University Hospital, Modena, Italy
| | - M Giuliani
- San Gallicano Dermatological Institute, IRCCS, Rome, Italy
| | - G De Carli
- National Institute for Infectious Diseases L Spallanzani, IRCCS, Rome, Italy
| | - S Pittalis
- National Institute for Infectious Diseases L Spallanzani, IRCCS, Rome, Italy
| | - S Grisetti
- National Institute for Infectious Diseases L Spallanzani, IRCCS, Rome, Italy
| | | | | | - F Montella
- S. Giovanni Addolorata Hospital, Rome, Italy
| | - A Cristaudo
- San Gallicano Dermatological Institute, IRCCS, Rome, Italy
| | - C Mussini
- Modena University Hospital, Modena, Italy
| | - E Girardi
- National Institute for Infectious Diseases L Spallanzani, IRCCS, Rome, Italy
| | - M Andreoni
- University Hospital Tor Vergata, Rome, Italy
| | - A Antinori
- National Institute for Infectious Diseases L Spallanzani, IRCCS, Rome, Italy
| | | | - C F Perno
- National Institute for Infectious Diseases L Spallanzani, IRCCS, Rome, Italy
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15
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Colagrossi L, Hermans LE, Salpini R, Di Carlo D, Pas SD, Alvarez M, Ben-Ari Z, Boland G, Bruzzone B, Coppola N, Seguin-Devaux C, Dyda T, Garcia F, Kaiser R, Köse S, Krarup H, Lazarevic I, Lunar MM, Maylin S, Micheli V, Mor O, Paraschiv S, Paraskevis D, Poljak M, Puchhammer-Stöckl E, Simon F, Stanojevic M, Stene-Johansen K, Tihic N, Trimoulet P, Verheyen J, Vince A, Lepej SZ, Weis N, Yalcinkaya T, Boucher CAB, Wensing AMJ, Perno CF, Svicher V. Immune-escape mutations and stop-codons in HBsAg develop in a large proportion of patients with chronic HBV infection exposed to anti-HBV drugs in Europe. BMC Infect Dis 2018; 18:251. [PMID: 29859062 PMCID: PMC5984771 DOI: 10.1186/s12879-018-3161-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Accepted: 05/23/2018] [Indexed: 12/27/2022] Open
Abstract
Background HBsAg immune-escape mutations can favor HBV-transmission also in vaccinated individuals, promote immunosuppression-driven HBV-reactivation, and increase fitness of drug-resistant strains. Stop-codons can enhance HBV oncogenic-properties. Furthermore, as a consequence of the overlapping structure of HBV genome, some immune-escape mutations or stop-codons in HBsAg can derive from drug-resistance mutations in RT. This study is aimed at gaining insight in prevalence and characteristics of immune-associated escape mutations, and stop-codons in HBsAg in chronically HBV-infected patients experiencing nucleos(t)ide analogues (NA) in Europe. Methods This study analyzed 828 chronically HBV-infected European patients exposed to ≥ 1 NA, with detectable HBV-DNA and with an available HBsAg-sequence. The immune-associated escape mutations and the NA-induced immune-escape mutations sI195M, sI196S, and sE164D (resulting from drug-resistance mutation rtM204 V, rtM204I, and rtV173L) were retrieved from literature and examined. Mutations were defined as an aminoacid substitution with respect to a genotype A or D reference sequence. Results At least one immune-associated escape mutation was detected in 22.1% of patients with rising temporal-trend. By multivariable-analysis, genotype-D correlated with higher selection of ≥ 1 immune-associated escape mutation (OR[95%CI]:2.20[1.32–3.67], P = 0.002). In genotype-D, the presence of ≥ 1 immune-associated escape mutations was significantly higher in drug-exposed patients with drug-resistant strains than with wild-type virus (29.5% vs 20.3% P = 0.012). Result confirmed by analysing drug-naïve patients (29.5% vs 21.2%, P = 0.032). Strong correlation was observed between sP120T and rtM204I/V (P < 0.001), and their co-presence determined an increased HBV-DNA. At least one NA-induced immune-escape mutation occurred in 28.6% of patients, and their selection correlated with genotype-A (OR[95%CI]:2.03[1.32–3.10],P = 0.001). Finally, stop-codons are present in 8.4% of patients also at HBsAg-positions 172 and 182, described to enhance viral oncogenic-properties. Conclusions Immune-escape mutations and stop-codons develop in a large fraction of NA-exposed patients from Europe. This may represent a potential threat for horizontal and vertical HBV transmission also to vaccinated persons, and fuel drug-resistance emergence. Electronic supplementary material The online version of this article (10.1186/s12879-018-3161-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Luna Colagrossi
- Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, Via Montpellier, 1, 00133, Rome, Italy
| | - Lucas E Hermans
- Virology, Department of Medical Microbiology, University Medical Centre Utrecht, Utrecht, The Netherlands.,Department of Viroscience, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Romina Salpini
- Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, Via Montpellier, 1, 00133, Rome, Italy
| | - Domenico Di Carlo
- Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, Via Montpellier, 1, 00133, Rome, Italy
| | - Suzan D Pas
- Department of Viroscience, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Marta Alvarez
- Servicio de Microbiología, Hospital San Cecilio, Instituto de Investigación Biosanitaria ibs.GRANADA, Hospitales Universitarios de Granada, Granada, Spain
| | - Ziv Ben-Ari
- Liver Disease Centre, Sheba Medical Centre, Ramat Gan, Israel
| | - Greet Boland
- Virology, Department of Medical Microbiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | | | - Nicola Coppola
- Malattie Infettive, Seconda Università degli studi di Napoli, Naples, Italy
| | | | - Tomasz Dyda
- Molecular Diagnostics Laboratory, Hospital of Infectious Diseases, Warsaw, Poland
| | - Federico Garcia
- Servicio de Microbiología, Hospital San Cecilio, Instituto de Investigación Biosanitaria ibs.GRANADA, Hospitales Universitarios de Granada, Granada, Spain
| | - Rolf Kaiser
- Institute of Virology, University of Cologne, Cologne, Germany
| | - Sukran Köse
- Izmir Tepecik Education and Research Hospital, Clinic of Infectious Diseases and Clinical Microbiology, Izmir, Turkey
| | - Henrik Krarup
- Section of Molecular Diagnostics, Clinical Biochemistry, Aalborg University Hospital, Aalborg, Denmark
| | - Ivana Lazarevic
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Maja M Lunar
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Sarah Maylin
- Service de Microbiologie, University Paris Diderot, Hôpital Saint Louis, Paris, France
| | | | - Orna Mor
- National HIV Reference Laboratory, Central Virology Laboratory, Ministry of Health, Tel Hashomer, Ramat Gan, Israel
| | - Simona Paraschiv
- Molecular Diagnostics Laboratory, National Institute for Infectious Diseases "Matei Bals", Bucharest, Romania
| | - Dimitros Paraskevis
- National Retrovirus Reference Centre, Department of Hygiene, Epidemiology and Medical Statistics, Faculty of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Mario Poljak
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | | | - François Simon
- Service de Microbiologie, University Paris Diderot, Hôpital Saint Louis, Paris, France
| | - Maja Stanojevic
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | | | - Nijaz Tihic
- Institute of Microbiology, Polyclinic for Laboratory Diagnostics, University Clinical Centre Tuzla, Tuzla, Bosnia and Herzegovina
| | - Pascale Trimoulet
- Virology Laboratory, Centre Hospitalier Régional et Université "Victor Segalen", Bordeaux, France
| | - Jens Verheyen
- Institute of Virology, University-Hospital, University Duisburg-Essen, Essen, Germany
| | - Adriana Vince
- University of Zagreb School of Medicine and University Hospital for Infectious Diseases, Zagreb, Croatia
| | - Snjezana Zidovec Lepej
- University of Zagreb School of Medicine and University Hospital for Infectious Diseases, Zagreb, Croatia
| | - Nina Weis
- Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre, Copenhagen, Denmark
| | | | - Charles A B Boucher
- Department of Viroscience, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Annemarie M J Wensing
- Virology, Department of Medical Microbiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Carlo F Perno
- Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, Via Montpellier, 1, 00133, Rome, Italy.
| | - Valentina Svicher
- Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, Via Montpellier, 1, 00133, Rome, Italy.
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Sorbo MC, Cento V, Di Maio VC, Howe AYM, Garcia F, Perno CF, Ceccherini-Silberstein F. Corrigendum to "Hepatitis C virus drug resistance associated substitutions and their clinical relevance: Update 2018" [Drug Resist. Updates 37 (March) (2018) 17-39]. Drug Resist Updat 2018; 40:40-41. [PMID: 29680499 DOI: 10.1016/j.drup.2018.04.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Maria C Sorbo
- Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy
| | - Valeria Cento
- Residency Program in Microbiology and Virology, Università degli Studi di Milano, Milan, Italy.
| | - Velia C Di Maio
- Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy
| | - Anita Y M Howe
- Centre for Excellence in HIV/AIDS, St Paul's Hospital, Vancouver, BC, Canada
| | - Federico Garcia
- Clinical Microbiology Service, Hospital Universitario San Cecilio, Granada, Spain
| | - Carlo F Perno
- Department of Oncology and Oncohematology, Università degli Studi di Milano, Milan, Italy
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17
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Lopez M, Di Lauro L, Perno CF, Papaldo P, Barduagni M, Barduagni A. 5-Fluorouracil, Adriamycin and Cyclophosphamide Combined with High-Dose Medroxyprogesterone Acetate in Advanced Breast Cancer. Tumori 2018; 69:545-51. [PMID: 6229920 DOI: 10.1177/030089168306900610] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Seventy-six patients with metastatic breast cancer were treated with fluorouracil, adriamycin (doxorubicin) and cyclophosphamide (FAC) plus high-dose medroxyprogesterone acetate (HD-MPA). MPA was given for 21 days at the dose of 500 mg/day i.m., then on a randomized basis, either 500 mg/week i.m. (FAC+HD-MPA i.m.) or 300 mg/day p.o. (FAC+HD-MPA p.o.). Objective response rates were 79% in 39 patients on FAC+HD-MPA i.m. and 73% in the 37 patients on FAC+HD-MPA p.o. There was no significant difference in the median duration of response and median survival for the 2 regimens (respectively, 17 months and 22 months, and 15 months and 21 months for FAC+HD-MPA i.m. and FAC+HD-MPA p.o.). Toxicity was mild and similar in both groups. Although FAC+HD-MPA was highly effective, at present it is difficult to select which regimen provides the best initial treatment for metastatic breast cancer.
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18
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Sorbo MC, Cento V, Di Maio VC, Howe AYM, Garcia F, Perno CF, Ceccherini-Silberstein F. Hepatitis C virus drug resistance associated substitutions and their clinical relevance: Update 2018. Drug Resist Updat 2018. [PMID: 29525636 DOI: 10.1016/j.drup.2018.01.004] [Citation(s) in RCA: 134] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Nowadays, due to the development of potent Direct-Acting Antiviral Agents (DAAs) that specifically target NS3, NS5A and NS5B viral proteins, several new and highly efficacious options to treat chronic Hepatitis C virus (HCV) infection are available. The natural presence of resistance associated substitutions (RASs), as well as their rapid emergence during incomplete drug-pressure, are intrinsic characteristics of HCV that greatly affect treatment outcome and the chances to achieve a virolgical cure. To date, a high number of RASs in NS3, NS5A, and NS5B have been associated in vivo and/or in vitro with reduced susceptibility to DAAs, but no comprehensive RASs list is available. This review thus provides an updated, systematic overview of the role of RASs to currently approved DAAs or in phase II/III of clinical development against HCV-infection, discriminating their impact in different HCV-genotypes and DAAs, providing assistance for a fruitful use of HCV resistance testing in clinical practice.
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Affiliation(s)
- Maria C Sorbo
- Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy
| | - Valeria Cento
- Residency program in Microbiology and Virology, Università degli Studi di Milano. Milan, Italy.
| | - Velia C Di Maio
- Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy
| | - Anita Y M Howe
- Centre for Excellence in HIV/AIDS, St Paul's Hospital, Vancouver, BC, Canada
| | - Federico Garcia
- Clinical Microbiology Service, Hospital Universitario San Cecilio, Granada, Spain
| | - Carlo F Perno
- Department of Oncology and Oncohematology, Università degli Studi di Milano. Milan, Italy.
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19
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Andreoni M, Babudieri S, Bruno S, Colombo M, Zignego AL, Di Marco V, Di Perri G, Perno CF, Puoti M, Taliani G, Villa E, Craxì A. Current and future challenges in HCV: insights from an Italian experts panel. Infection 2017; 46:147-163. [PMID: 29098647 DOI: 10.1007/s15010-017-1093-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Accepted: 10/25/2017] [Indexed: 12/14/2022]
Abstract
BACKGROUND The recent availability of direct acting antiviral drugs (DAAs) has drastically changed hepatitis C virus (HCV) treatment scenarios, due to the exceedingly high rates of sustained virological response (SVR) and excellent tolerability allowing for treatment at all disease stages. METHODS A panel of Italian experts was convened twice, in November 2016 and January 2017, to provide further support on some open issues and provide guidance for personalized HCV care, also in light of forthcoming regimens. RESULTS AND CONCLUSIONS Treatment recommendations issued by international and national liver societies to guide clinicians in the management of HCV infection are constantly updated due to accumulating new data. Such recommendations may not be applicable to all healthcare settings for a variety of reasons. Moreover, some gaps still remain and the spectrum of patients to be treated is also evolving.
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Affiliation(s)
- Massimo Andreoni
- Infectious Diseases, Polyclinic of Rome Tor Vergata, Rome, Italy
| | - Sergio Babudieri
- Infectious Diseases Unit, Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy
| | - Savino Bruno
- Humanitas University and Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Massimo Colombo
- Humanitas Clinical and Research Center, Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Anna L Zignego
- Department of Experimental and Clinical Medicine, Interdepartmental Centre MASVE, University of Florence, Florence, Italy
| | - Vito Di Marco
- Sezione di Gastroenterologia e Epatologia, DiBiMIS, University of Palermo, Palermo, Italy
| | - Giovanni Di Perri
- Unit of Infectious Diseases, Department of Medical Sciences, Amedeo di Savoia Hospital, University of Turin, Turin, Italy
| | - Carlo F Perno
- Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy
| | - Massimo Puoti
- Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy
| | - Gloria Taliani
- Infectious and Tropical Diseases Unit, Umberto I Hospital-"Sapienza" University, Rome, Italy
| | - Erica Villa
- Department of Internal Medicine, Gastroenterology Unit, Azienda Ospedaliero-Universitaria Policlinico di Modena, Modena, Italy
| | - Antonio Craxì
- Gastroenterology and Liver Unit, DiBiMIS, University of Palermo, Palermo, Italy.
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20
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Armenia D, Di Carlo D, Calcagno A, Vendemiati G, Forbici F, Bertoli A, Berno G, Carta S, Continenza F, Fedele V, Bellagamba R, Cicalini S, Ammassari A, Libertone R, Zaccarelli M, Ghisetti V, Andreoni M, Ceccherini-Silberstein F, Bonora S, Di Perri G, Antinori A, Perno CF, Santoro MM. Pre-existent NRTI and NNRTI resistance impacts on maintenance of virological suppression in HIV-1-infected patients who switch to a tenofovir/emtricitabine/rilpivirine single-tablet regimen. J Antimicrob Chemother 2017; 72:855-865. [PMID: 27999048 DOI: 10.1093/jac/dkw512] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 11/01/2016] [Indexed: 01/04/2023] Open
Abstract
Objectives To evaluate the maintenance of virological suppression (VS) in antiretroviral-treated HIV-1-suppressed patients switching to a tenofovir/emtricitabine/rilpivirine (TDF/FTC/RPV) single-tablet regimen, by considering pre-existent resistance (pRes). Methods pRes was evaluated according to resistance on all previous plasma genotypic resistance tests. Probability and predictors of virological rebound (VR) were evaluated. Results Three hundred and nine patients were analysed; 5.8% of them showed resistance to both NRTIs and NNRTIs, while 12.6% showed resistance to only one of these drug classes. By 72 weeks, the probability of VR was 11.3%. A higher probability of VR was found in the following groups: (i) patients with NRTI + NNRTI pRes compared with those harbouring NRTI or NNRTI pRes and with those without reverse transcriptase inhibitor pRes (39.2% versus 11.5% versus 9.4%, P < 0.0001); (ii) patients with a virus with full/intermediate resistance to both tenofovir/emtricitabine and rilpivirine compared with those having a virus with full/intermediate resistance to tenofovir/emtricitabine or rilpivirine and those having a virus fully susceptible to TDF/FTC/RPV (36.4% versus 17.8% versus 9.7%, P < 0.001); and (iii) patients with pre-therapy viraemia >500 000 copies/mL compared with those with lower viraemia levels (>500 000: 16.0%; 100 000-500 000: 9.3%; <100 000 copies/mL: 4.8%, P = 0.009). pRes and pre-therapy viraemia >500 000 copies/mL were independent predictors of VR by multivariable Cox regression. Conclusions TDF/FTC/RPV as a treatment simplification strategy shows a very high rate of VS maintenance. The presence of pRes to both NRTIs and NNRTIs and a pre-therapy viraemia >500 000 copies/mL are associated with an increased risk of VR, highlighting the need for an accurate selection of patients before simplification.
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Affiliation(s)
- D Armenia
- Experimental Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy
| | - D Di Carlo
- Experimental Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy
| | - A Calcagno
- Division of Infectious Diseases, University of Turin, Turin, Italy
| | - G Vendemiati
- Division of Infectious Diseases, University of Turin, Turin, Italy
| | - F Forbici
- Antiretroviral Drug Monitoring Laboratory, National Institute for Infectious Diseases L. Spallanzani, IRCCS, Rome, Italy
| | - A Bertoli
- Experimental Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy
| | - G Berno
- Antiretroviral Drug Monitoring Laboratory, National Institute for Infectious Diseases L. Spallanzani, IRCCS, Rome, Italy
| | - S Carta
- Antiretroviral Drug Monitoring Laboratory, National Institute for Infectious Diseases L. Spallanzani, IRCCS, Rome, Italy
| | - F Continenza
- Antiretroviral Drug Monitoring Laboratory, National Institute for Infectious Diseases L. Spallanzani, IRCCS, Rome, Italy
| | - V Fedele
- Antiretroviral Drug Monitoring Laboratory, National Institute for Infectious Diseases L. Spallanzani, IRCCS, Rome, Italy
| | - R Bellagamba
- Infectious Diseases Division, National Institute for Infectious Diseases L. Spallanzani, IRCCS, Rome, Italy
| | - S Cicalini
- Infectious Diseases Division, National Institute for Infectious Diseases L. Spallanzani, IRCCS, Rome, Italy
| | - A Ammassari
- Infectious Diseases Division, National Institute for Infectious Diseases L. Spallanzani, IRCCS, Rome, Italy
| | - R Libertone
- Infectious Diseases Division, National Institute for Infectious Diseases L. Spallanzani, IRCCS, Rome, Italy
| | - M Zaccarelli
- Infectious Diseases Division, National Institute for Infectious Diseases L. Spallanzani, IRCCS, Rome, Italy
| | - V Ghisetti
- Division of Infectious Diseases, University of Turin, Turin, Italy
| | - M Andreoni
- Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | | | - S Bonora
- Division of Infectious Diseases, University of Turin, Turin, Italy
| | - G Di Perri
- Division of Infectious Diseases, University of Turin, Turin, Italy
| | - A Antinori
- Infectious Diseases Division, National Institute for Infectious Diseases L. Spallanzani, IRCCS, Rome, Italy
| | - C F Perno
- Antiretroviral Drug Monitoring Laboratory, National Institute for Infectious Diseases L. Spallanzani, IRCCS, Rome, Italy
| | - M M Santoro
- Experimental Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy
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21
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Sarmati L, Andreoni M, Antonelli G, Arcese W, Bruno R, Coppola N, Gaeta GB, Galli M, Girmenia C, Mikulska M, Pane F, Perno CF, Picardi M, Puoti M, Rambaldi A, Svicher V, Taliani G, Gentile G. Recommendations for screening, monitoring, prevention, prophylaxis and therapy of hepatitis B virus reactivation in patients with haematologic malignancies and patients who underwent haematologic stem cell transplantation-a position paper. Clin Microbiol Infect 2017; 23:935-940. [PMID: 28668466 DOI: 10.1016/j.cmi.2017.06.023] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [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: 03/07/2017] [Revised: 06/15/2017] [Accepted: 06/17/2017] [Indexed: 12/18/2022]
Abstract
SCOPE Hepatitis B virus (HBV) infection reactivation is associated with high morbidity and mortality in patients with haematologic malignancy and/or haematopoietic stem cell transplantation (HSCT). However, information on this issue is limited. The scope of this position paper is to provide recommendations on HBV screening, monitoring, prophylaxis, treatment and vaccination in the patients described above. METHODS These recommendations were developed from one meeting of experts attended by different Italian scientific societies as well as from a systematic literature review (of articles published through December 31, 2016) on HBV infection in haematologic patients and in patients who underwent haematopoietic stem cell transplantation published in the same issue of the journal. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology was used to assess each recommendation's quality. QUESTIONS ADDRESSED These recommendations provide the answers to the following questions: (a) HBV screening and monitoring: Who should be screened before chemotherapy? Which screening tests should be used? Should HBV-DNA detection be used to monitor HBV reactivation before starting antivirals? What is the best timeline to monitor HBV reactivation? (b) Prophylaxis in HBsAg-positive patients: Which antiviral drugs should be used to treat HBsAg-positive patients? How long should antiviral prophylaxis be provided to HBsAg-positive patients? (c) Prophylaxis in patients with resolved HBV infection: Which patients with resolved HBV infection should receive antiviral prophylaxis? Which antiviral drug should be used? How long should antiviral prophylaxis be provided? (d) HBV infection management strategy in autologous (auto-HSCT) and allogeneic HSCT (allo-HSCT): Which HSCT recipients should receive antiviral prophylaxis? Which antiviral drug should be used? How long should antiviral prophylaxis be provided? (e) Choice of antiviral drugs in the treatment of HBV reactivation: Should third-generation anti-HBV drugs be preferred to first- or second-generation antiviral drugs in the treatment of HBV reactivation with or without hepatitis flare in haematologic patients? (f) Immunization against HBV in patients with haematologic malignancies and/or patients who underwent HSCT: Should these patients be vaccinated? Which HBV vaccination schedule should be adopted? RECOMMENDATIONS Haematologic patients should be screened for hepatitis B surface antigen (HBsAg) plus anti-hepatitis B core protein (HBc), and HBV DNA before chemotherapy. HBV DNA levels should be monitored monthly in all HBV-positive patients who do not receive prophylaxis. HBsAg-positive haematologic patients and those undergoing HSCT should receive third-generation antiviral therapy as prophylaxis. Anti-HBc-positive lymphoma patients and those receiving HSCT should receive antiviral prophylaxis. All HBV-negative haematologic patients should be vaccinated for HBV. The acquisition of data from well-designed studies is desirable in the near future.
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Affiliation(s)
- L Sarmati
- Department of System Medicine, Clinical Infectious Diseases, Tor Vergata University, Rome, Italy.
| | - M Andreoni
- Department of System Medicine, Clinical Infectious Diseases, Tor Vergata University, Rome, Italy
| | - G Antonelli
- Department of Molecular Medicine, 'La Sapienza' University, Rome, Italy
| | - W Arcese
- Department of Hematology, Stem Cell Transplant Unit, Tor Vergata University, Rome, Italy
| | - R Bruno
- Department of Infectious Diseases, Hepatology Outpatients Unit, University of Pavia, IRCCS Policlinico San Matteo, Pavia, Italy
| | - N Coppola
- Department of Mental Health and Public Medicine, Section of Infectious Diseases, Second University of Naples, Naples, Italy
| | - G B Gaeta
- Infectious Diseases and Viral Hepatitis, Department of Mental and Physical Health and Preventive Medicine, Università della Campania, Naples, Italy
| | - M Galli
- Infectious Diseases Unit, University of Milan, L. Sacco Hospital, Milan, Italy
| | - C Girmenia
- Dipartimento di Ematologia, Oncologia, Anatomia Patologica e Medicina Rigenerativa, Azienda Policlinico Umberto I, La Sapienza University, Rome, Italy
| | - M Mikulska
- Division of Infectious Diseases, Department of Health Sciences, University of Genoa, Genoa, Italy; Division of Infectious Diseases, IRCCS San Martino University Hospital-IST, Genoa, Italy
| | - F Pane
- Department of Clinical Medicine and Surgery, Hematology, Federico II University, Naples, Italy
| | - C F Perno
- Department of Experimental Medicine and Surgery, Tor Vergata University, Rome, Italy
| | - M Picardi
- Department of Clinical Medicine and Surgery, Hematology, Federico II University, Naples, Italy
| | - M Puoti
- Infectious Diseases Department, Azienda Ospedaliera Ospedale Niguarda Ca' Granda, Milan, Italy
| | - A Rambaldi
- Dipartimento di Scienze Cliniche e di Comunità, Università degli Studi di Milano, Milan, Italy; Hematology and Bone Marrow Transplant Unit, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy
| | - V Svicher
- Department of Experimental Medicine and Surgery, Tor Vergata University, Rome, Italy
| | - G Taliani
- Clinic of Infectious and Tropical Medicine, Policlinico Umberto I, Rome, Italy
| | - G Gentile
- Department of Cellular Biotechnologies and Hematology, 'La Sapienza' University, Rome, Italy
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22
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Pellicelli AM, Pace Palitti V, Vignally P, Ceccherini-Silberstein F, Siciliano M, Giannelli V, Moretti A, Tarquini P, Scifo G, Messina V, Ascione A, Izzi A, Marignani M, D'Ambrosio C, Fondacaro L, Ettorre GM, Ialongo P, Sacco R, Perno CF, Barbarini G. Efficacy and safety of sofosbuvir/simeprevir plus flat dose ribavirin in genotype 1 elderly cirrhotic patients: A real-life study. Liver Int 2017; 37:653-661. [PMID: 27782373 DOI: 10.1111/liv.13288] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Accepted: 10/21/2016] [Indexed: 12/13/2022]
Abstract
BACKGROUND & AIMS The proportion of HCV-infected patients over age 65 years in Western countries is increasing. This growth and the advent of new antiviral therapy bring into the question the real-world efficacy and safety of the combination of sofosbuvir (SOF) and simeprevir (SMV) plus a flat dose of 800 mg/d ribavirin (RBV) in elderly patients with cirrhosis compared to younger patients. METHODS Retrospective observational multicentre real-life investigation study of SOF/SMV/RBV for a duration of 12 weeks in HCV genotype 1-infected patients with cirrhosis. RESULTS Of the 270 patients enrolled in this study, with compensated cirrhosis, 133 (49.2%) were ≥65 years of age. Sustained virological response at 12 weeks (SVR12) was achieved by 94.2% (129/137) of those aged <65 years and 97.7% (130/133) of those ≥65 years. Diabetes was the most common comorbidity in patients ≥65 years compared to younger patients (26.3% vs 12.4% P<.003). The most common adverse event (AE) in elderly patients was a grade 2 anaemia (35.3% vs 19.9% P<.004). CONCLUSIONS Sofosbuvir/simeprevir plus a daily flat dose of RBV 800 mg for 12 weeks was highly effective and safe in genotype 1 elderly patients with compensated cirrhosis.
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Affiliation(s)
- Adriano M Pellicelli
- Liver Disease Unit, Department of Liver Transplantation, San Camillo Forlanini Hospital, Rome, Italy
| | | | | | | | - Massimo Siciliano
- Internal Medicine, Catholic University Policlinico Gemelli, Rome, Italy
| | - Valerio Giannelli
- Liver Disease Unit, Department of Liver Transplantation, San Camillo Forlanini Hospital, Rome, Italy
| | | | | | - Gaetano Scifo
- Infectious Disease, Umberto I Hospital, Siracusa, Italy
| | - Vincenzo Messina
- Infectious Disease, Sant'Anna and San Sebastiano Hospital Caserta, Rome, Italy
| | - Antonio Ascione
- Center for Liver Disease, Fatebenefratelli Hospital, Napoli, Italy
| | - Antonio Izzi
- Infectious Disease, Cotugno Hospital, Napoli, Italy
| | - Massimo Marignani
- Digestive and Liver Disease Unit, Faculty Medicine and Psychology, S. Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Cecilia D'Ambrosio
- Liver Disease Unit, Department of Liver Transplantation, San Camillo Forlanini Hospital, Rome, Italy
| | - Lucia Fondacaro
- Liver Disease Unit, Department of Liver Transplantation, San Camillo Forlanini Hospital, Rome, Italy
| | - Giuseppe M Ettorre
- Division of General Surgery and Liver Transplantation, S. Camillo Forlanini Hospital, Rome, Italy
| | | | - Rodolfo Sacco
- Liver Unit, Azienda Universitaria Pisana, Pisa, Italy
| | - Carlo F Perno
- Department of Experimental Medicine and Surgery, University of Tor Vergata, Rome, Italy
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23
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Di Maio VC, Cento V, Lenci I, Aragri M, Rossi P, Barbaliscia S, Melis M, Verucchi G, Magni CF, Teti E, Bertoli A, Antonucci F, Bellocchi MC, Micheli V, Masetti C, Landonio S, Francioso S, Santopaolo F, Pellicelli AM, Calvaruso V, Gianserra L, Siciliano M, Romagnoli D, Cozzolongo R, Grieco A, Vecchiet J, Morisco F, Merli M, Brancaccio G, Di Biagio A, Loggi E, Mastroianni CM, Pace Palitti V, Tarquini P, Puoti M, Taliani G, Sarmati L, Picciotto A, Vullo V, Caporaso N, Paoloni M, Pasquazzi C, Rizzardini G, Parruti G, Craxì A, Babudieri S, Andreoni M, Angelico M, Perno CF, Ceccherini-Silberstein F. Multiclass HCV resistance to direct-acting antiviral failure in real-life patients advocates for tailored second-line therapies. Liver Int 2017; 37:514-528. [PMID: 28105744 DOI: 10.1111/liv.13327] [Citation(s) in RCA: 78] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Accepted: 11/12/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND & AIMS Despite the excellent efficacy of direct-acting antivirals (DAA) reported in clinical trials, virological failures can occur, often associated with the development of resistance-associated substitutions (RASs). This study aimed to characterize the presence of clinically relevant RASs to all classes in real-life DAA failures. METHODS Of the 200 virological failures that were analyzed in 197 DAA-treated patients, 89 with pegylated-interferon+ribavirin (PegIFN+RBV) and 111 without (HCV-1a/1b/1g/2/3/4=58/83/1/6/24/25; 56.8% treatment experienced; 65.5% cirrhotic) were observed. Sanger sequencing of NS3/NS5A/NS5B was performed by home-made protocols, at failure (N=200) and whenever possible at baseline (N=70). RESULTS The majority of the virological failures were relapsers (57.0%), 22.5% breakthroughs, 20.5% non-responders. RAS prevalence varied according to IFN/RBV use, DAA class, failure type and HCV genotype/subtype. It was 73.0% in IFN group vs 49.5% in IFN free, with the highest prevalence of NS5A-RASs (96.1%), compared to NS3-RASs (75.9% with IFN, 70.5% without) and NS5B-RASs (66.6% with IFN, 20.4% without, in sofosbuvir failures). In the IFN-free group, RASs were higher in breakthrough/non-responders than in relapsers (90.5% vs 40.0%, P<.001). Interestingly, 57.1% of DAA IFN-free non-responders had a misclassified genotype, and 3/4 sofosbuvir breakthroughs showed the major-RAS-S282T, while RAS-L159F was frequently found in sofosbuvir relapsers (18.2%). Notably, 9.0% of patients showed also extra target RASs, and 47.4% of patients treated with ≥2 DAA classes showed multiclass resistance, including 11/11 NS3+NS5A failures. Furthermore, 20.0% of patients had baseline-RASs, which were always confirmed at failure. CONCLUSIONS In our failure setting, RAS prevalence was remarkably high in all genes, with a partial exception for NS5B, whose limited resistance is still higher than previously reported. This multiclass resistance advocates for HCV resistance testing at failure, in all three genes for the best second-line therapeutic tailoring.
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Affiliation(s)
- Velia C Di Maio
- Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy
| | - Valeria Cento
- Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy
| | - Ilaria Lenci
- Hepatology Unit, University Hospital of Rome Tor Vergata, Rome, Italy
| | - Marianna Aragri
- Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy
| | - Piera Rossi
- Hepatology Unit, University Hospital of Rome Tor Vergata, Rome, Italy
| | - Silvia Barbaliscia
- Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy
| | - Michela Melis
- Infectious Diseases Unit, University of Sassari, Sassari, Italy
| | | | - Carlo F Magni
- Division of Infectious Disease, Hospital Sacco of Milan, Milan, Italy
| | - Elisabetta Teti
- Infectious Diseases, University Hospital of Rome Tor Vergata, Rome, Italy
| | - Ada Bertoli
- Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy
| | | | - Maria C Bellocchi
- Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy
| | | | - Chiara Masetti
- Hepatology Unit, University Hospital of Rome Tor Vergata, Rome, Italy
| | - Simona Landonio
- Division of Infectious Disease, Hospital Sacco of Milan, Milan, Italy
| | - Simona Francioso
- Hepatology Unit, University Hospital of Rome Tor Vergata, Rome, Italy
| | | | - Adriano M Pellicelli
- Liver Disease Unit, Department of Liver Transplantation, San Camillo Forlanini Hospital, Rome, Italy
| | | | - Laura Gianserra
- Infectious Diseases, Sant'Andrea Hospital - Sapienza University of Rome, Rome, Italy
| | | | - Dante Romagnoli
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Raffaele Cozzolongo
- Department of Gastroenterology, Scientific Institute for Digestive Disease "Saverio de Bellis" Hospital, Castellana Grotte, Bari, Italy
| | - Antonio Grieco
- Gastroenterology, Catholic University of Rome, Rome, Italy
| | - Jacopo Vecchiet
- Infectious Disease Clinic, Hospital of Chieti, Chieti, Italy
| | - Filomena Morisco
- Gastroenterology, Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy
| | - Manuela Merli
- Gastroenterology, Department of Clinical Medicine, Sapienza University of Rome, Rome, Italy
| | | | - Antonio Di Biagio
- Infectious Diseases Unit, Department of Social Health (DISSAL) of the University of Genoa, IRCCS S. Martino-IST, Genoa, Italy
| | - Elisabetta Loggi
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Claudio M Mastroianni
- Department of Public Health and Infectious Diseases, Sapienza University, Polo Pontino, Latina, Italy
| | | | | | - Massimo Puoti
- Department of Infectious Diseases, Hospital Niguarda Ca'Granda, Milan, Italy
| | - Gloria Taliani
- Infectious and Tropical Diseases Unit, Department of Clinical Medicine, Sapienza University of Rome, Rome, Italy
| | - Loredana Sarmati
- Infectious Diseases, University Hospital of Rome Tor Vergata, Rome, Italy
| | - Antonino Picciotto
- Department of Internal Medicine, Gastroenterology Unit, University of Genova, Genoa, Italy
| | - Vincenzo Vullo
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Nicola Caporaso
- Gastroenterology, Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy
| | - Maurizio Paoloni
- Infectious Disease Unit, Avezzano General Hospital, Avezzano, Italy
| | - Caterina Pasquazzi
- Infectious Diseases, Sant'Andrea Hospital - Sapienza University of Rome, Rome, Italy
| | - Giuliano Rizzardini
- Division of Infectious Disease, Hospital Sacco of Milan, Milan, Italy.,School of Clinical Medicine, Faculty of Health Science University of the Witwatersrand, Johannesburg, South Africa
| | - Giustino Parruti
- Infectious Disease Unit, Pescara General Hospital, Pescara, Italy
| | - Antonio Craxì
- Gastroenterology, "P. Giaccone" University Hospital, Palermo, Italy
| | | | - Massimo Andreoni
- Infectious Diseases, University Hospital of Rome Tor Vergata, Rome, Italy
| | - Mario Angelico
- Hepatology Unit, University Hospital of Rome Tor Vergata, Rome, Italy
| | - Carlo F Perno
- Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy
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24
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Armenia D, Di Carlo D, Maffongelli G, Borghi V, Alteri C, Forbici F, Bertoli A, Gori C, Giuliani M, Nicastri E, Zaccarelli M, Pinnetti C, Cicalini S, D'Offizi G, Ceccherini-Silberstein F, Mussini C, Antinori A, Andreoni M, Perno CF, Santoro MM. Virological response and resistance profile in HIV-1-infected patients starting darunavir-containing regimens. HIV Med 2016; 18:21-32. [PMID: 27353061 DOI: 10.1111/hiv.12388] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVES We evaluated the virological response in patients starting a regimen based on darunavir/ritonavir (DRV/r), which is currently the most widely used ritonavir-boosted protease inhibitor. METHODS Data from 206 drug-naïve and 327 PI-experienced patients starting DRV/r 600/100 mg twice daily (DRV600) or 800/100 mg once daily (DRV800) were examined. The probabilities of virological success (VS) and virological rebound (VR) were evaluated in survival analyses. Baseline DRV/r resistance and its evolution at failure were also examined. RESULTS DRV600 was preferentially administered in patients with complex requirements (older age, higher viraemia, lower CD4 cell count and DRV/PI resistance) compared with DRV800. By 12 months, the probability of achieving VS was 93.2% and 84.3% in drug-naïve and PI-experienced patients, respectively. The higher the baseline viraemia, the longer was the time required to achieve VS, both in drug-naïve patients [>500 000 HIV-1 RNA copies/mL: median [interquartile range (IQR)] 6.1 (5.1-10.3) months; 100 000-500 000 copies/mL: median (IQR) 4.9 (3.8-6.1) months; <100 000 copies/mL: median (IQR) 3.9 (3.5-4.8) months; P < 0.001] and in PI-experienced patients [≥100 000 copies/mL: median (IQR) 7.2 (5.7-11.6) months; <100 000 copies/mL: median (IQR) 2.8 (2.4-3.3) months; P < 0.001]. In PI-experienced patients, the probability of VR was higher for higher viraemia levels (22.3% for ≥100 000 copies/ml vs. 9.7% for <100 000 copies/mL; P = 0.007). Baseline resistance did not affect the virological response. At failure, a high percentage of patients maintained virus susceptible to all PIs (drug-naïve: 95%; PI-experienced: 80%). Despite being used more often in patients with more complex requirements, DRV600 performed as well as DRV800. CONCLUSIONS In clinical practice, use of DRV/r (with its flexible dosage) results in high rates of virological response. These data support the use of PI/r in patients whose characteristics require potent drugs with a high genetic barrier.
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Affiliation(s)
- D Armenia
- Experimental Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy
| | - D Di Carlo
- Experimental Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy
| | - G Maffongelli
- Infectious Diseases Division, University Hospital Tor Vergata, Rome, Italy
| | - V Borghi
- Infectious Diseases Division, Modena University Hospital, Modena, Italy
| | - C Alteri
- Experimental Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy
| | - F Forbici
- Antiretroviral Therapy Monitoring Unit, L Spallanzani Hospital, Rome, Italy
| | - A Bertoli
- Experimental Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy.,Molecular Virology Division, University Hospital Tor Vergata, Rome, Italy
| | - C Gori
- Antiretroviral Therapy Monitoring Unit, L Spallanzani Hospital, Rome, Italy
| | - M Giuliani
- Infectious Dermatology Unit, San Gallicano Hospital, Rome, Italy
| | - E Nicastri
- Infectious Diseases Division, L Spallanzani Hospital, Rome, Italy
| | - M Zaccarelli
- Infectious Diseases Division, L Spallanzani Hospital, Rome, Italy
| | - C Pinnetti
- Infectious Diseases Division, L Spallanzani Hospital, Rome, Italy
| | - S Cicalini
- Infectious Diseases Division, L Spallanzani Hospital, Rome, Italy
| | - G D'Offizi
- Infectious Diseases Division, L Spallanzani Hospital, Rome, Italy
| | | | - C Mussini
- Infectious Diseases Division, Modena University Hospital, Modena, Italy
| | - A Antinori
- Infectious Diseases Division, L Spallanzani Hospital, Rome, Italy
| | - M Andreoni
- Infectious Diseases Division, University Hospital Tor Vergata, Rome, Italy
| | - C F Perno
- Antiretroviral Therapy Monitoring Unit, L Spallanzani Hospital, Rome, Italy
| | - M M Santoro
- Experimental Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy
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25
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Lambert-Niclot S, George EC, Pozniak A, White E, Schwimmer C, Jessen H, Johnson M, Dunn D, Perno CF, Clotet B, Plettenberg A, Blaxhult A, Palmisano L, Wittkop L, Calvez V, Marcelin AG, Raffi F. Antiretroviral resistance at virological failure in the NEAT 001/ANRS 143 trial: raltegravir plus darunavir/ritonavir or tenofovir/emtricitabine plus darunavir/ritonavir as first-line ART. J Antimicrob Chemother 2015; 71:1056-62. [PMID: 26702926 DOI: 10.1093/jac/dkv427] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2015] [Accepted: 11/10/2015] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVES To describe the pattern of drug resistance at virological failure in the NEAT001/ANRS143 trial (first-line treatment with ritonavir-boosted darunavir plus either tenofovir/emtricitabine or raltegravir). METHODS Genotypic testing was performed at baseline for reverse transcriptase (RT) and protease genes and for RT, protease and integrase (IN) genes for patients with a confirmed viral load (VL) >50 copies/mL or any single VL >500 copies/mL during or after week 32. RESULTS A resistance test was obtained for 110/805 (13.7%) randomized participants qualifying for resistance analysis (61/401 of participants in the raltegravir arm and 49/404 of participants in the tenofovir/emtricitabine arm). No resistance-associated mutation (RAM) was observed in the tenofovir/emtricitabine plus darunavir/ritonavir arm, and all further analyses were limited to the raltegravir plus darunavir arm. In this group, 15/55 (27.3%) participants had viruses with IN RAMs (12 N155H alone, 1 N155H + Q148R, 1 F121Y and 1 Y143C), 2/53 (3.8%) with nucleotide analogue RT inhibitor RAMs (K65R, M41L) and 1/57 (1.8%) with primary protease RAM (L76V). The frequency of IN mutations at failure was significantly associated with baseline VL: 7.1% for a VL of <100,000 copies/mL, 25.0% for a VL of ≥100,000 copies/mL and <500,000 copies/mL and 53.8% for a VL of ≥500,000 copies/mL (PTREND = 0.007). Of note, 4/15 participants with IN RAM had a VL < 200 copies/mL at time of testing. CONCLUSIONS In the NEAT001/ANRS143 trial, there was no RAM at virological failure in the standard tenofovir/emtricitabine plus darunavir/ritonavir regimen, contrasting with a rate of 29.5% (mostly IN mutations) in the raltegravir plus darunavir/ritonavir NRTI-sparing regimen. The cumulative risk of IN RAM after 96 weeks of follow-up in participants initiating ART with raltegravir plus darunavir/ritonavir was 3.9%.
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Affiliation(s)
- S Lambert-Niclot
- Sorbonne Universités, UPMC Univ Paris 06, Institut Pierre Louis d'Epidémiologie et de Santé Publique, INSERM, UMR_S 1136, AP-HP, Hôpital Pitié-Salpêtrière, Service de Virologie, Paris, F-75013, France
| | - E C George
- MRC Clinical Trials Unit at UCL, London, UK
| | - A Pozniak
- Chelsea and Westminster Hospital, London, UK
| | - E White
- MRC Clinical Trials Unit at UCL, London, UK
| | - C Schwimmer
- INSERM, ISPED, Centre INSERM U897-Epidemiologie-Biostatistique, Bordeaux, France
| | - H Jessen
- Gemeinschaftspraxis Jessen-Stein, Berlin, Germany
| | - M Johnson
- Department of HIV Medicine, Royal Free Hospital, London, UK
| | - D Dunn
- MRC Clinical Trials Unit at UCL, London, UK
| | - C F Perno
- Department of Experimental Medicine, University of Rome Tor Vergata, Rome, Italy
| | - B Clotet
- HIV Unit and Retrovirology Laboratory 'Irsicaixa' Foundation, Hospital Universitari Germans Trias i Pujol, UAB, Badalona, Catalonia, Spain
| | - A Plettenberg
- Ifi-institut, an der Asklepios-Klinik St Georg, Hamburg, Germany
| | - A Blaxhult
- Department of Infectious Diseases, Venhaelsan-Sodersjukhuset, Stockholm, Sweden
| | - L Palmisano
- Department of Therapeutic Research and Medicine Evaluation, Istituto Superiore di Sanità, Rome, Italy
| | - L Wittkop
- INSERM, ISPED, Centre INSERM U897-Epidemiologie-Biostatistique, Bordeaux, France CHU de Bordeaux, Pôle de Santé Publique, Service d'Information Médicale, Bordeaux, France Université de Bordeaux, ISPED, Centre INSERM U897-Epidemiologie-Biostatistique, Bordeaux, France
| | - V Calvez
- Sorbonne Universités, UPMC Univ Paris 06, Institut Pierre Louis d'Epidémiologie et de Santé Publique, INSERM, UMR_S 1136, AP-HP, Hôpital Pitié-Salpêtrière, Service de Virologie, Paris, F-75013, France
| | - A G Marcelin
- Sorbonne Universités, UPMC Univ Paris 06, Institut Pierre Louis d'Epidémiologie et de Santé Publique, INSERM, UMR_S 1136, AP-HP, Hôpital Pitié-Salpêtrière, Service de Virologie, Paris, F-75013, France
| | - F Raffi
- CMIT, 46 Rue Henri Huchard, 75018 Paris, France
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26
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Armenia D, Fabeni L, Alteri C, Di Pinto D, Di Carlo D, Bertoli A, Gori C, Carta S, Fedele V, Forbici F, D'Arrigo R, Svicher V, Berno G, Pizzi D, Nicastri E, Sarmati L, Pinnetti C, Ammassari A, D'Offizi G, Latini A, Andreoni M, Antinori A, Ceccherini-Silberstein F, Perno CF, Santoro MM. HIV-1 integrase genotyping is reliable and reproducible for routine clinical detection of integrase resistance mutations even in patients with low-level viraemia. J Antimicrob Chemother 2015; 70:1865-73. [PMID: 25712318 DOI: 10.1093/jac/dkv029] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Accepted: 01/25/2015] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Integrase drug resistance monitoring deserves attention because of the increasing number of patients being treated with integrase strand-transfer inhibitors. Therefore, we evaluated the integrase genotyping success rate at low-level viraemia (LLV, 51-1000 copies/mL) and resistance in raltegravir-failing patients. METHODS An integrase genotypic resistance test (GRT) was performed on 1734 HIV-1 samples collected during 2006-13. Genotyping success rate was determined according to the following viraemia levels: 51-500, 501-1000, 1001-10 000, 10 001-100 000 and >100 000 copies/mL. The reproducibility of integrase GRT was evaluated in 41 plasma samples processed in duplicate in two reference centres. The relationship between LLV and resistance prevalence was evaluated in a subset of 120 raltegravir-failing patients. RESULTS Overall, the integrase genotyping success rate was 95.7%. For viraemia levels 51-500 and 501-1000 copies/mL, the rate of success was 82.1% and 94.0%, respectively. GRT was reproducible, producing sequences with a high similarity and an equal resistance profile regardless of the sequencing centre or viraemia level. Resistance was detected both at LLV and at viraemia >1000 copies/mL (51-500 copies/mL = 18.2%; 501-1000 = 37.5%; 1001-10 000 = 53.7%; 10 001-100 000 = 30.0%; and >100 000 = 30.8%). At viraemia ≤500 copies/mL, Q148H/K/R and N155H had the same prevalence (9.1%), while the Y143C/H/R was completely absent. At early genotyping (within 3 months of raltegravir treatment), Q148H/K/R and N155H mutations were detected regardless of the viraemia level, while Y143C/H/R was observed only in samples with viraemia >1000 copies/mL. CONCLUSIONS Our findings prove the reliability of HIV-1 integrase genotyping and reinforce the concept that this assay may be useful in the management of failures even at LLV.
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Affiliation(s)
- D Armenia
- University of Rome Tor Vergata, Rome, Italy
| | - L Fabeni
- L. Spallanzani Hospital, Rome, Italy
| | - C Alteri
- University of Rome Tor Vergata, Rome, Italy
| | - D Di Pinto
- University of Rome Tor Vergata, Rome, Italy
| | - D Di Carlo
- University of Rome Tor Vergata, Rome, Italy
| | - A Bertoli
- University of Rome Tor Vergata, Rome, Italy University Hospital Tor Vergata, Rome, Italy
| | - C Gori
- L. Spallanzani Hospital, Rome, Italy
| | - S Carta
- L. Spallanzani Hospital, Rome, Italy
| | - V Fedele
- L. Spallanzani Hospital, Rome, Italy
| | - F Forbici
- L. Spallanzani Hospital, Rome, Italy
| | | | - V Svicher
- University of Rome Tor Vergata, Rome, Italy
| | - G Berno
- L. Spallanzani Hospital, Rome, Italy
| | - D Pizzi
- L. Spallanzani Hospital, Rome, Italy
| | | | - L Sarmati
- University Hospital Tor Vergata, Rome, Italy
| | | | | | | | - A Latini
- San Gallicano Hospital, Rome, Italy
| | - M Andreoni
- University Hospital Tor Vergata, Rome, Italy
| | | | | | - C F Perno
- L. Spallanzani Hospital, Rome, Italy
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27
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Surdo M, Alteri C, Puertas MC, Saccomandi P, Parrotta L, Swenson L, Chapman D, Costa G, Artese A, Balestra E, Aquaro S, Alcaro S, Lewis M, Clotet B, Harrigan R, Valdez H, Svicher V, Perno CF, Martinez-Picado J, Ceccherini-Silberstein F. Effect of maraviroc on non-R5 tropic HIV-1: refined analysis of subjects from the phase IIb study A4001029. Clin Microbiol Infect 2014; 21:103.e1-6. [PMID: 25636934 DOI: 10.1016/j.cmi.2014.08.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Revised: 07/31/2014] [Accepted: 08/29/2014] [Indexed: 12/26/2022]
Abstract
We characterized maraviroc susceptibility of dual/mixed tropic viruses from subjects enrolled onto phase IIb study A4001029. Maraviroc baseline plasma samples from 13 multidrug-experienced subjects were sequenced and the HIV-1-env gene cloned into pNL4.3Δenv to obtain recombinant viruses. The V3 region was sequenced by the Sanger method and ultradeep sequencing. By analysing subjects having a weighted optimized background therapy susceptibility (wOBT) score of <1, 3/7 subjects were characterized by good in vivo and in vitro response to maraviroc therapy. Molecular docking simulations allowed us to rationalize the maraviroc susceptibility of dual/mixed tropic viruses. A subset of subjects with dual/mixed tropic viruses responded to maraviroc. Further investigations are warranted of CCR5 antagonists in subjects carrying dual/mixed tropic virus that explore the feasible use of maraviroc in subjects that is potentially larger than those infected with a pure R5 virus.
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Affiliation(s)
- M Surdo
- Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy
| | - C Alteri
- Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy
| | - M C Puertas
- Institut de Recerca de la SIDA irsiCaixa, Hospital Universitari 'Germans Trias i Pujol', Badalona, Universitat Autònoma de Barcelona (UAB), Catalonia, Spain
| | - P Saccomandi
- Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy
| | - L Parrotta
- Department of Pharmacobiological Sciences, University of Catanzaro 'Magna Græcia', Catanzaro, Italy
| | - L Swenson
- BC Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | | | - G Costa
- Department of Pharmacobiological Sciences, University of Catanzaro 'Magna Græcia', Catanzaro, Italy
| | - A Artese
- Department of Pharmacobiological Sciences, University of Catanzaro 'Magna Græcia', Catanzaro, Italy
| | - E Balestra
- Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy
| | - S Aquaro
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Rende, Italy
| | - S Alcaro
- Department of Pharmacobiological Sciences, University of Catanzaro 'Magna Græcia', Catanzaro, Italy
| | | | - B Clotet
- Institut de Recerca de la SIDA irsiCaixa, Hospital Universitari 'Germans Trias i Pujol', Badalona, Universitat Autònoma de Barcelona (UAB), Catalonia, Spain; Universitat de Vic (UVic), Catalonia, Spain
| | - R Harrigan
- BC Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | | | - V Svicher
- Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy
| | - C F Perno
- Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy
| | - J Martinez-Picado
- Institut de Recerca de la SIDA irsiCaixa, Hospital Universitari 'Germans Trias i Pujol', Badalona, Universitat Autònoma de Barcelona (UAB), Catalonia, Spain; Universitat de Vic (UVic), Catalonia, Spain; Institució Catalana de Recerca i Estudis Avançats (ICREA), Barcelona, Spain
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Armignacco O, Andreoni M, Sagnelli E, Puoti M, Bruno R, Gaeta GB, Perno CF, Santantonio TA, Bonfanti P, Bonora S, Borderi M, Castagna A, d'Arminio Monforte A, De Luca A, Grossi P, Guaraldi G, Maggiolo F, Mussini C, Sagnelli C, Tavio M, Torti C, Uberti-Foppa C, Andreoni M, Angarano G, Antinori A, Armignacco O, Carosi G, Chirianni A, Di Perri G, Galli M, Lazzarin A, Rizzardini G, Sagnelli E, Taliani G. Recommendations for the use of hepatitis C virus protease inhibitors for the treatment of chronic hepatitis C in HIV-infected persons. A position paper of the Italian Association for the Study of Infectious and Tropical Disease. New Microbiol 2014; 37:423-38. [PMID: 25387281] [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: 03/17/2014] [Accepted: 07/26/2014] [Indexed: 06/04/2023]
Abstract
The efficacy data obtained with boceprevir and telaprevir for persons with hepatitis C virus (HCV) genotype 1 infection raise the question of whether HCV protease inhibitors should be used in human immunodeficiency virus (HIV)/HCV co-infected persons. The Italian Association for the Study of Infectious and Tropical Diseases has made these recommendations to provide the rationale and practical indications for the use of triple anti-HCV therapy in persons living with HIV (PLWHIV). A Writing Committee of experts indicated by the President of the Association and a Consulting Committee con- tributed to the document. The final draft was submitted to the evaluation of external experts and the text modified according to their suggestions and comments. Treatment of HCV co-infection should be considered for all HCV RNA positive PLWHIV. Response-guided therapy with pegylated interferon and ribavirin is the standard treatment of PLWHIV with infection by HCV genotype 2, 3, 4, 5 and 6. Boceprevir and telaprevir should be used to treat HCV genotype 1 infection in HIV/HCV co-infected patients for 48 weeks on an individual basis, with close monitoring of their efficacy and tolerability with concur- rent antiretroviral therapy, taking into account potential drug-drug interactions. The decision to treat a patient or to wait for better treatment options, or to discontinue treatment should be made on an individual basis taking into account pre-treatment variables and the on-treatment HCV RNA kinetics.
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Svicher V, Alteri C, Montano M, Nori A, D'Arrigo R, Andreoni M, Angarano G, Antinori A, Antonelli G, Allice T, Bagnarelli P, Baldanti F, Bertoli A, Borderi M, Boeri E, Bon I, Bruzzone B, Barresi R, Calderisi S, Callegaro AP, Capobianchi MR, Gargiulo F, Castelli F, Cauda R, Ceccherini-Silberstein F, Clementi M, Chirianni A, Colafigli M, D'Arminio Monforte A, De Luca A, Di Biagio A, Di Nicuolo G, Di Perri G, Di Santo F, Fadda G, Galli M, Gennari W, Ghisetti V, Costantini A, Gori A, Gulminetti R, Leoncini F, Maffongelli G, Maggiolo F, Maserati R, Mazzotta F, Meini G, Micheli V, Monno L, Mussini C, Nozza S, Paolucci S, Palù G, Parisi S, Parruti G, Pignataro AR, Quirino T, Re MC, Rizzardini G, Sanguinetti M, Santangelo R, Scaggiante R, Sterrantino G, Turriziani O, Vatteroni ML, Viscoli C, Vullo V, Zazzi M, Lazzarin A, Perno CF. Genotypic testing on HIV-1 DNA as a tool to assess HIV-1 co-receptor usage in clinical practice: results from the DIVA study group. Infection 2013; 42:61-71. [PMID: 24146352 PMCID: PMC3906530 DOI: 10.1007/s15010-013-0510-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2013] [Accepted: 07/16/2013] [Indexed: 11/29/2022]
Abstract
PURPOSE We have developed a sequencing assay for determining the usage of the genotypic HIV-1 co-receptor using peripheral blood mononuclear cell (PBMC) DNA in virologically suppressed HIV-1 infected patients. Our specific aims were to (1) evaluate the efficiency of V3 sequences in B versus non-B subtypes, (2) compare the efficiency of V3 sequences and tropism prediction using whole blood and PBMCs for DNA extraction, (3) compare the efficiency of V3 sequences and tropism prediction using a single versus a triplicate round of amplification. RESULTS The overall rate of successful V3 sequences ranged from 100 % in samples with >3,000 copies HIV-1 DNA/10(6) PBMCs to 60 % in samples with <100 copies total HIV-1 DNA /10(6) PBMCs. Analysis of 143 paired PBMCs and whole-blood samples showed successful V3 sequences rates of 77.6 % for PBMCs and 83.9 % for whole blood. These rates are in agreement with the tropism prediction obtained using the geno2pheno co-receptor algorithm, namely, 92.1 % with a false-positive rate (FPR) of 10 or 20 % and of 96.5 % with an FPR of 5.75 %. The agreement between tropism prediction values using single versus triplicate amplification was 98.2 % (56/57) of patients using an FPR of 20 % and 92.9 % (53/57) using an FPR of 10 or 5.75 %. For 63.0 % (36/57) of patients, the FPR obtained via the single amplification procedure was superimposable to all three FPRs obtained by triplicate amplification. CONCLUSIONS Our results show the feasibility and consistency of genotypic testing on HIV-1 DNA tropism, supporting its possible use for selecting patients with suppressed plasma HIV-1 RNA as candidates for CCR5-antagonist treatment. The high agreement between tropism prediction by single and triple amplification does not support the use of triplicate amplification in clinical practice.
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Affiliation(s)
- V Svicher
- Department of Experimental Medicine, University of Rome "Tor Vergata", Via Montpellier 1, 00133, Rome, Italy
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Di Minno G, Canaro M, Ironside JW, Navarro D, Perno CF, Tiede A, Guertler L. Pathogen safety of long-term treatments for bleeding disorders: (un)predictable risks and evolving threats. Semin Thromb Hemost 2013; 39:779-93. [PMID: 24030344 DOI: 10.1055/s-0033-1354420] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Substantial improvements in the safety of blood and plasma products for the management of bleeding disorders have been achieved in recent decades. This has led some clinicians to believe that the infectious threat is over and that inhibitor formation is the foremost complication of hemophilia therapy. On the contrary, elimination of all microbes from blood is difficult, potentially impossible, and there are always threats from emerging pathogens. The risk of infection transmission is also increasing due to greater exposure to products, increasing prophylaxis and high-dose regimens for immune tolerance, and longevity of hemophilia patients. Current products can be considered "reasonably safe," but pathogen testing is not all-inclusive, and manufacturing and purification techniques are often not standardized. Although safer nonplasma-derived products are widely used, they are not available for all bleeding disorders, and so there is an ongoing need for plasma-derived products. This review will discuss the evolving risk from emerging pathogens in the context of the issues described. Reducing the risk from emerging infections requires global collaboration to devise ways to monitor and continue to improve blood safety.
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Affiliation(s)
- Giovanni Di Minno
- Department of Clinical Medicine and Surgery, Regional Reference Centre for Coagulation Disorders, Napoli, Italy
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31
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Santoro MM, Sabin C, Forbici F, Bansi L, Dunn D, Fearnhill E, Boumis E, Nicastri E, Antinori A, Palamara G, Callegaro A, Francisci D, Zoncada A, Maggiolo F, Zazzi M, Perno CF, Ceccherini-Silberstein F, Mussini C. Drug-resistance development differs between HIV-1-infected patients failing first-line antiretroviral therapy containing nonnucleoside reverse transcriptase inhibitors with and without thymidine analogues. HIV Med 2013; 14:571-7. [PMID: 23668660 DOI: 10.1111/hiv.12044] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/19/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVES We evaluated the emergence of drug resistance in patients failing first-line regimens containing one nonnucleoside reverse transcriptase inhibitor (NNRTI) administered with zidovudine (ZDV) + lamivudine (the ZDV group) or non-thymidine analogues (non-TAs) (tenofovir or abacavir, + lamivudine or emtricitabine; the non-TA group). METHODS Three hundred HIV-1-infected patients failing a first-line NNRTI-containing regimen (nevirapine, n = 148; efavirenz, n = 152) were included in the analysis. Virological failure was defined as viraemia ≥ 400 HIV-1 RNA copies/mL for the first time at least 6 months after starting the NNRTI-based regimen. For each patient, a genotypic resistance test at failure was available. The presence of drug-resistance mutations in HIV-1 reverse transcriptase was evaluated by comparing patients treated with NNRTI + zidovudine + lamivudine vs. those treated with NNRTI + non-TA. RESULTS A total of 208 patients were failing with NNRTI + zidovudine + lamivudine and 92 with NNRTI + non-TA. No significant differences were observed between the non-TA group and the ZDV group regarding the time of virological failure [median (interquartile range): 12 (8-25) vs. 13 (9-32) months, respectively; P = 0.119] and viraemia [median (interquartile range): 4.0 (3.2-4.9) vs. 4.0 (3.3-4.7) log₁₀ copies/mL, respectively; P = 0.894]. Resistance to reverse transcriptase inhibitors (RTIs) occurred at a significant lower frequency in the non-TA group than in the ZDV group (54.3 vs. 75.5%, respectively; P = 0.001). This difference was mainly attributable to a significantly lower prevalence of NNRTI resistance (54.3 vs. 74.0%, respectively; P = 0.002) and of the nucleoside reverse transcriptase inhibitor (NRTI) mutation M184V (23.9 vs. 63.5%, respectively; P < 0.001) in the non-TA group compared with the ZDV group. As expected, the mutation K65R was found only in the non-TA group (18.5%; P < 0.001). CONCLUSIONS At first-line regimen failure, a lower prevalence of RTI resistance was found in patients treated with NNRTI + non-TA compared with those treated with NNRTI + zidovudine + lamivudine. These results confirm that the choice of backbone may influence the prevalence of drug resistance at virological failure.
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Surdo M, Cortese MF, Perno CF, Aquaro S. NeuroAIDS: virological aspects of HIV infection. J BIOL REG HOMEOS AG 2013; 27:115-128. [PMID: 24813320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
NeuroAIDS is one of the main complications of chronic HIV-infection. The Central Nervous System is an immunologic sanctuary for HIV and allows the persistence of the virus despite an efficient antiretroviral therapy. HIV-1 could promote the neurodegeneration through the induction of inflammation by the release of neurotoxins from infected cells. In addition, several viral proteins can directly contribute to the neuronal damages, activate cell-signaling involved in the control of cellular survival and apoptosis, favoring functional alterations in the target cells. Macrophages play a key role in the pathogenesis of NeuroAIDS, they are the main reservoirs of the infection in brain, promoting the inflammatory escalation, astrogliosis and degeneration process. This review aims to highlight the virological aspects associated with NeuroAIDS including pathogenesis, and treatment of HIV-1 in the CNS sanctuaries.
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Affiliation(s)
- M Surdo
- Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy
| | - M F Cortese
- Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy
| | - C F Perno
- Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy
| | - S Aquaro
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Rende (CS), Italy
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Cento V, Landonio S, De Luca F, Di Maio VC, Micheli V, Mirabelli C, Niero F, Magni C, Rizzardini G, Perno CF, Ceccherini-Silberstein F. A boceprevir failure in a patient infected with HCV genotype 1g: importance and limitations of virus genotyping prior to HCV protease-inhibitor-based therapy. Antivir Ther 2013; 18:645-8. [PMID: 23411358 DOI: 10.3851/imp2529] [Citation(s) in RCA: 17] [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] [Subscribe] [Scholar Register] [Accepted: 12/11/2012] [Indexed: 01/12/2023]
Abstract
A patient classified as HCV-1a-positive by both LiPA Siemens 2.0 and Abbott RealTime HCV Genotype II was instead found to be infected with HCV-1g, as determined by phylogenetic analysis of NS3 sequences. HCV-1g NS3 sequences available to date naturally harbour the resistance substitution T54S, plus P131S and L135F changes, located in the highly conserved NS3 positions within the boceprevir-binding site, as determined by structural modelling. HCV-1g NS3 sequences show some similarities to HCV-4 and are poorly responsive to interferon/ribavirin and to boceprevir/telaprevir; this patient was also a null-responder to boceprevir treatment. Baseline genotypic resistance testing may provide crucial information for the management of first-generation protease-inhibitor-based regimens, including both HCV genotype/subtype and natural resistance.
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Affiliation(s)
- Valeria Cento
- Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy
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Paba P, Morosetti G, Criscuolo AA, Chiusuri V, Marcuccilli F, Sesti F, Piccione E, Perno CF, Ciotti M. Prevalence of human papillomavirus infection in Italian and immigrant women. Int J Immunopathol Pharmacol 2013; 25:1055-62. [PMID: 23298495 DOI: 10.1177/039463201202500422] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Human papillomavirus (HPV) is the most common sexually transmitted agent worldwide. Prevalence varies according to the geographic regions, and is highest in developing countries. Geographic differences exist also in the detection rate of oncogenic types in malignant cervical lesions. In this study, the prevalence of HPV infection as well as the spectrum of HPV types was evaluated in Italian and immigrant women of the urban area of Rome. Several risk factors (age at first intercourse, number of partners, smoking, pregnancy, age at first pregnancy, contraception, education, and menarche) were taken into consideration. Overall, there was a high prevalence of HPV infection in the two groups studied. No significant differences were observed in the spectrum of HPV types detected. HPV 16 and 18 were the types detected more frequently in both groups. Interestingly, HPV 54 and 70 were found only in the immigrants. Whether this finding reflects a recent introduction of these HPV types in the population studied remains to be established. Monitoring of HPV types in the population is advisable, especially in countries like Italy which is a destination and a gateway for immigrants directed towards north and central Europe. The introduction of high risk HPV variants may have a clinical impact and affect the diagnostic procedures.
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Affiliation(s)
- P Paba
- Laboratory of Molecular Virology, Tor Vergata University Hospital, Rome, Italy
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Ceccarelli L, Salpini R, Moudourou S, Cento V, Santoro MM, Fokam J, Takou D, Nanfack A, Dori L, Torimiro J, Sarmati L, Andreoni M, Perno CF, Colizzi V, Cappelli G. Characterization of drug resistance mutations in naïve and ART-treated patients infected with HIV-1 in Yaounde, Cameroon. J Med Virol 2012; 84:721-7. [PMID: 22431019 DOI: 10.1002/jmv.23244] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Currently the prevalence of HIV-1 infection in Cameroon is 5.1%, CRF02_AG subtype is responsible for about 50% of infections. Since an HIV-1 drug resistance test is not yet available widely, accurate data on the prevalence of resistant viral strains are missing. The objective of this study was to determine HIV-1 genetic diversity and to characterize HIV-1 mutations conferring drug resistance among antiretroviral therapy (ART)-naïve and ART-treated patients. A cohort of 239 patients infected with HIV were followed-up between January 2007 and July 2010 in Cameroon. Two hundred and sixteen plasma samples were sequenced for phylogenetic analysis and identification of drug resistance mutations in the HIV-1 pol region. A significant genetic diversity was found: Seven pure subtypes (A1, A3, D, F1, F2, G, H), nine circulating recombinant forms (CRFs: 01_AE, 02_AG, 06cpx, 09cpx, 11cpx, 13cpx, 16cpx, 18cpx, 37cpx) and one new unique recombinant form (URF) (G/F2). The rate of transmitted drug resistance (TDR) in naïve patients was 8.2% (4/49). Around 80% of patients failing a first-line ART harbored a virus with at least one resistance mutation to two antiretroviral (ARV) classes, and 36% of those failing a second-line regimen carried a virus with at least one resistant mutation to three ARV classes. The high level of drug resistance observed in the cohort is alarming because this occurred as a result of only few years of treatment. Adherence to therapy, adequate education of physicians, and the appropriate use of genotypic resistance assay are critical points of intervention for the improvement of patient care.
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Affiliation(s)
- Laura Ceccarelli
- Clinical Infectious Disease, Tor Vergata University Hospital, Rome, Italy.
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Santoro MM, Armenia D, Fabeni L, Santoro M, Gori C, Forbici F, Svicher V, Bertoli A, Dori L, Surdo M, Balestra E, Palamara G, Girardi E, Angarano G, Andreoni M, Narciso P, Antinori A, Ceccherini-Silberstein F, Perno CF. The lowest X4 Geno2Pheno false-positive rate is associated with greater CD4 depletion in HIV-1 infected patients. Clin Microbiol Infect 2012; 18:E289-98. [PMID: 22681969 DOI: 10.1111/j.1469-0691.2012.03905.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Through this study we evaluated whether the HIV-1 tropism determined by genotypic analysis correlates with HIV-1 markers, such as CD4 cell count and plasma HIV-RNA. The analysis was performed on 1221 HIV-1 B-subtype infected patients with an available V3 sequence (all maraviroc naive). Of them, 532 were antiretroviral therapy (ART) naive and 689 ART experienced. Tropism determination was performed by using the geno2pheno (co-receptor) algorithm set at a false-positive rate (FPR) of 10% and 2%. Potential associations of FPR with CD4 cell count and viraemia were evaluated. Association of V3 mutations with genotypic-determined tropism was also evaluated according to different FPR ranges. About 26% of patients (either ART naive or ART experienced) were infected by X4-tropic viruses (using the classical 10% FPR cut-off). However, a significantly lower proportion of ART-naive patients had FPR ≤ 2% in comparison with ART-experienced patients (4.9% vs. 12.6%, respectively, p <0.001). The risk of advanced HIV-1 infection (with CD4 cell count ≤ 200 cells/mm(3)) was significantly greater in X4-infected patients, either ART-naive (OR (95% CI)), 4.2 (1.8-9.2); p 0.0006) or ART-experienced (2.3 (1.4-3.6); p 0.0003), with FPR set at 2% (but not at 10%). This finding was confirmed by multivariable logistic analysis. No relationship was found between viraemia and FPR ≤2%. Some X4-related mutations were significantly associated with FPR ≤2% (ART-naive patients, S11R, Y21V, G24K and G24R, p ≤0.001; ART-experienced patients, Y7K, S11R, H13Y, p ≤0.002). In conclusion, these findings show that within the context of genotypically-assessed CXCR4 tropism, FPR ≤2% defines (far better than 10%-FPR) a viral population associated with low CD4 rank, with potentially greater cytopathic effect, and with more advanced disease.
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Andreoni M, Perno CF. Positioning of HIV-protease inhibitors in clinical practice. Eur Rev Med Pharmacol Sci 2012; 16:10-18. [PMID: 22338543] [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: 05/31/2023]
Abstract
The availability of more than 20 drugs for the treatment of HIV infection, and the success of the current antiretroviral regimens, should not overlook the difficulty of long-term maintaining the control of viral replication. The therapy needs to be continued for decades, if not for lifetime, and there are clear evidences that, even in patients fully suppressed for many years, HIV starts again its replication cycles in case antiviral pressure is removed. The development of resistance is a natural event at the time of virological failure, that needs to be taken into account in the global strategy against HIV in each particular patient. Taking all together, therapeutic regiments must be embedded, since the beginning, in a long-term strategy whose main task is the stable control of the replication of HIV. To do so, the choice of the first antiviral regimen has to be highly appropriate to keep the virus in check, and at the same time maintain future therapeutic options. Change of therapy at the time of failure has to be also appropriate, in term of timing, diagnostic strategy, and selection of drugs. Under these circumstances, the use of protease inhibitors in the first line acquires a strong rationale, that balances the greater pure potency of non-nucleoside reverse transcriptase inhibitors (NNRTI), and makes them a valuable options for many patients that need to start antiviral therapy.
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Affiliation(s)
- M Andreoni
- Department of Public Health and Cell Biology, School of Medicine, University of Rome Tor Vergata, Rome, Italy.
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Salpini R, Svicher V, Cento V, Gori C, Bertoli A, Scopelliti F, Micheli V, Cappiello T, Spanò A, Rizzardini G, De Sanctis GM, Sarrecchia C, Angelico M, Perno CF. Characterization of drug-resistance mutations in HBV D-genotype chronically infected patients, naïve to antiviral drugs. Antiviral Res 2011; 92:382-5. [PMID: 21920388 DOI: 10.1016/j.antiviral.2011.08.013] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2011] [Revised: 07/12/2011] [Accepted: 08/16/2011] [Indexed: 02/06/2023]
Abstract
Presence of drug-resistance mutations in drug-naïve hepatitis B virus (HBV) infected patients can seriously compromise response to antiviral treatment. Therefore, our study was aimed at defining the prevalence of HBV drug-resistance in a population of 140 patients, all infected with HBV-D-genotype (the most common HBV-genotype in Eastern Europe, Mediterranean countries and Middle East) and naïve to antiviral therapy. HBV reverse-transcriptase (RT) region was sequenced and analyzed for 20 mutations, confirmed by in vitro studies as associated with resistance to nucleos(t)ide HBV-RT inhibitors (rtL80I/V-rtI169T-rtV173L-rtL180M-rtA181T/V/S-rtT184A/S/G/C-rtA194T-rtS202C/G/I-rtM204V/I-rtN236T-rtM250V). Amino acid changes at other six RT positions, potentially associated with resistance, were also analyzed (rtV84M-rtV191I-rtV207L-rtV214A-rtQ215S-rtI233V). Overall, only 2/140 (1.4%) patients carried primary drug-resistance mutations [rtA181V (0.7%), and rtA194T (0.7%)], while 3/140 (2.1%) patients harbored the secondary mutations rtV173L (1.4%) and rtL180M (0.7%). Additionally, five polymorphic mutations, with a suggested role in drug resistance, were detected [rtQ215S (12.8%), rtI233V (4.3%), rtV214A (3.6%), rtV191I (0.7%), rtV207L (0.7%)]. Notably, no YMDD mutations, namely rtM204V/I, were found. Taken together, the rate of important drug resistance mutations in naïve HBV D-genotype infected patients is today very low, and suggests the potential full efficacy of new-generation antiviral drugs used in first line therapy. Whether such low rate can be extrapolated to non HBV-D subtypes, requires a detailed investigation to be performed in a different cohort of patients.
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Affiliation(s)
- R Salpini
- Department of Experimental Medicine and Biochemical Science, University of Tor Vergata, Via Montpellier 1, 00100 Rome, Italy
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Schapiro JM, Scherer J, Boucher CA, Baxter JD, Tilke C, Perno CF, Maggiolo F, Santoro MM, Hall DB. Improving the prediction of virological response to tipranavir: the development and validation of a tipranavir-weighted mutation score. Antivir Ther 2011; 15:1011-9. [PMID: 21041916 DOI: 10.3851/imp1670] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND The purpose of this study was to develop a tipranavir-weighted mutation score that provides guidance to treating physicians on the relative effect of specific protease mutations on tipranavir activity. METHODS Weights were developed using data from RESIST tipranavir-treated patients based on regressions of virological response at weeks 8 and 24, accounting for baseline CD4(+) T-cell count and background regimen activity. The resulting weighted score and cutoffs were validated using a set of cohort patients external to the tipranavir development programme. Response rates were tabulated for the new weighted score and compared with other tipranavir mutation scores used in clinical practice. RESULTS The final weights were 74P, 82L/T, 83D and 47V (+4), 58E and 84V (+3), 36I, 43T and 54A/M/V (+2), 10V, 33F and 46L (+1), 24I and 76V (-2), 50L/V (-4), and 54L (-6). Tipranavir-weighted score susceptibility categories were susceptible ≤3, partially susceptible >3 but ≤10, and resistant ≥11. Week 48 response rates for RESIST patients were 34.6%, 15.9% and 5.9%, respectively. Using the external cohort data (n=150), the weighted score was highly associated with week 8 viral load reduction (P=0.0027). Only one other score achieved statistical significance. CONCLUSIONS The tipranavir-weighted score developed and externally validated here, in three datasets representing a broad population of treatment-experienced patients, can be used to make clinical decisions about whether to consider tipranavir in a treatment-experienced patient who has limited treatment options.
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De Luca A, Di Giambenedetto S, Maserati R, Gianotti N, Narciso P, Antinori A, Di Perri G, Prosperi MCF, Baldanti F, Micheli V, Zazzi M, Perno CF, Santoro MM. Interpretation of genotypic HIV-1 resistance to darunavir and virological response: validation of available systems and of a new score. Antivir Ther 2011; 16:489-97. [DOI: 10.3851/imp1799] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Zaccarelli M, Lorenzini P, Marconi P, Forbici F, Gori C, Sette P, Ceccherini-Silberstein F, Narciso P, Perno CF, Antinori A. Is extended resistance to the historical antiretroviral drugs & drug classes still a risk factor for HIV progression? J Int AIDS Soc 2010. [PMCID: PMC3112914 DOI: 10.1186/1758-2652-13-s4-p138] [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: 11/23/2022] Open
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Tommasi C, Ceccherini-Silberstein F, D'Arrigo R, Bellagamba R, Tempestilli M, Dessì C, Santoro MM, Forbici F, Nicastri E, Pucillo LP, Perno CF, Narciso P. Use of novel antiretroviral agents in rescue regimens: a case of early virological failure to raltegravir. ACTA ACUST UNITED AC 2010; 42:237-9. [PMID: 20085429 DOI: 10.3109/00365540903447018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
In patients with virological failure during highly active antiretroviral therapy (HAART) and drug resistance, guidelines recommend the achievement of maximal virological suppression by the use of a new regimen with at least 2 active drugs. We describe the clinical outcome of a heavily antiretroviral-experienced patient who experienced early failure to raltegravir.
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Affiliation(s)
- Chiara Tommasi
- National Institute for Infectious Diseases, INMI, L Spallanzani, Rome, Italy
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Vandekerckhove LPR, Wensing AMJ, Kaiser R, Brun-Vezinet F, Clotet B, De Luca A, Dressler S, Garcia F, Geretti AM, Klimkait T, Korn K, Masquelier B, Perno CF, Schapiro J, Soriano V, Sönnerborg A, Vandamme ÀM, Verhofstede C, Walter H, Zazzi M, Boucher CA. Consensus statement of the European guidelines on clinical management of HIV-1 tropism testing. J Int AIDS Soc 2010. [PMCID: PMC3112869 DOI: 10.1186/1758-2652-13-s4-o7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Zaccarelli M, Lorenzini P, Tozzi V, Forbici F, Ceccherini-Silberstein F, Gori C, D'Arrigo R, Trotta MP, Narciso P, Perno CF, Antinori A. Effect of suppressing HIV viremia on the HIV progression of patients undergoing a genotype resistance test after treatment failure. Infection 2009; 37:203-9. [PMID: 19274429 DOI: 10.1007/s15010-008-8142-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2008] [Accepted: 10/09/2008] [Indexed: 11/29/2022]
Abstract
BACKGROUND Treatment guidelines for multi-experienced HIV patients have recently evolved from aiming to preserve immunity to achieving virological success, largely due to the availability of new antiretroviral drugs and drug classes. To assess the role of viral suppression on clinical progression following a genotypic resistance test (GRT), we have examined a database on patients failing to respond to combined antiretroviral therapy (cART). METHODS Patients undergoing a GRT after failure to respond to cART between January 1999 and May 2006 were followed up to December 2006. Time-to-death or a new AIDS event/death were considered to be analysis end-points. Viral suppression (< 50 copies/ml [c/ml]) after GRT, a time-dependent covariate, was tested as predictor of disease progression. RESULTS Overall, 1,389 patients were included in this observational study. After the GRT, patients were followed up to 72 months (median 28 months, IQ range 13-51 months). During the follow-up, 124 patients (9%) died, and 86 (6%) experienced a new AIDS event. 774 patients (56%) achieved < 50 c/ml HIV-RNA. The results of an adjusted Cox model showed that undetectable HIV-RNA after the GRT was significantly associated with a lower risk of death (hazard ration [HR] 0.46, 95% confidence interval [CI] 0.27-0.76) and AIDS/death (HR 0.43, 95% CI 0.28-0.65). The adjusted hazard ratios suggested a twofold risk reduction. A threefold risk reduction of death related to achieved undetectable viral load was found in patients with resistance to more than one drug class and with CDC-C diagnosis; a fourfold reduction was found in patients with < 200 CD4+/mm(3). CONCLUSIONS Maximal viral suppression has a large impact on HIV progression, particularly in heavily pre-treated individuals. Our findings support the latest treatment guidelines, which have rapidly evolved from an initial lack of indication to suggestions, and finally to strong recommendations for achieving the goal of suppressing viremia.
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Affiliation(s)
- M Zaccarelli
- Clinical Department, National Institute for Infectious Diseases Lazzaro Spallanzani, Via Portuense 292, 00149, Rome, Italy.
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Zaccarelli M, Lorenzini P, Ceccherini-Silberstein F, Tozzi V, Forbici F, Gori C, Trotta MP, Boumis E, Narciso P, Perno CF, Antinori A. Historical resistance profile helps to predict salvage failure. Antivir Ther 2009. [DOI: 10.1177/135965350901400217] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background This study compared the predictive value for treatment failure of extended resistance detected in the current genotype resistance test (GRT) versus those from GRT history in patients with multiple combination anti-retroviral therapy (cART) failures. Methods Patients who underwent three GRT between 1999 and 2007 were included. Extended resistance at genotypic sensitivity score (GSS) using the Rega 7.1 interpretation system compared with a non-standard definition (defined as class-wide resistance [CWR] on the basis of International AIDS Society–USA mutations) was assessed both for current and historical GRTs (a combination of mutations was detected in all three tests). The predictive role of extended resistance for treatment failure was evaluated with an adjusted Cox proportional hazard model. Results Overall, 177 patients were included. The historical GRT increased the number of patients with extended resistance to all three major drug classes by 25% in comparison with the current GRT. Using the GSS method, the absence of detection of any active drug in any drug class was predictive of failure with both the current and historical GRTs. Similarly, the number of active drugs in the cART regimen after the third resistance test, used as continuous variable, was also predictive of failure. Using both GSS approaches, current genotype had a higher effect than historical genotype on risk of treatment failure. Using the non-standard definition (CWR), historical resistance predicted failure better than current resistance. Conclusions Our results provide an epidemiological demonstration that analysis of a combined latest and historical GRT, which also considers archived mutations, might better identify of the more virologically impaired patients in order to assess the best salvage treatment.
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Affiliation(s)
| | - Mauro Zaccarelli
- Clinical Department, National Institute for Infectious Diseases Lazzaro Spallanzani, Rome, Italy
| | - Patrizia Lorenzini
- Clinical Department, National Institute for Infectious Diseases Lazzaro Spallanzani, Rome, Italy
| | - Francesca Ceccherini-Silberstein
- Virological Department, National Institute for Infectious Diseases Lazzaro Spallanzani, Rome, Italy
- Department of Experimental Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Valerio Tozzi
- Clinical Department, National Institute for Infectious Diseases Lazzaro Spallanzani, Rome, Italy
| | - Federica Forbici
- Virological Department, National Institute for Infectious Diseases Lazzaro Spallanzani, Rome, Italy
| | - Caterina Gori
- Virological Department, National Institute for Infectious Diseases Lazzaro Spallanzani, Rome, Italy
| | - Maria P Trotta
- Clinical Department, National Institute for Infectious Diseases Lazzaro Spallanzani, Rome, Italy
| | - Evangelo Boumis
- Clinical Department, National Institute for Infectious Diseases Lazzaro Spallanzani, Rome, Italy
| | - Pasquale Narciso
- Clinical Department, National Institute for Infectious Diseases Lazzaro Spallanzani, Rome, Italy
| | - Carlo F Perno
- Virological Department, National Institute for Infectious Diseases Lazzaro Spallanzani, Rome, Italy
| | - Andrea Antinori
- Clinical Department, National Institute for Infectious Diseases Lazzaro Spallanzani, Rome, Italy
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Zaccarelli M, Lorenzini P, Ceccherini-Silberstein F, Tozzi V, Forbici F, Gori C, Trotta MP, Boumis E, Narciso P, Perno CF, Antinori A. Historical resistance profile helps to predict salvage failure. Antivir Ther 2009; 14:285-291. [PMID: 19430103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
BACKGROUND This study compared the predictive value for treatment failure of extended resistance detected in the current genotype resistance test (GRT) versus those from GRT history in patients with multiple combination antiretroviral therapy (cART) failures. METHODS Patients who underwent three GRT between 1999 and 2007 were included. Extended resistance at genotypic sensitivity score (GSS) using the Rega 7.1 interpretation system compared with a non-standard definition (defined as class-wide resistance [CWR] on the basis of International AIDS Society-USA mutations) was assessed both for current and historical GRTs (a combination of mutations was detected in all three tests). The predictive role of extended resistance for treatment failure was evaluated with an adjusted Cox proportional hazard model. RESULTS Overall, 177 patients were included. The historical GRT increased the number of patients with extended resistance to all three major drug classes by 25% in comparison with the current GRT. Using the GSS method, the absence of detection of any active drug in any drug class was predictive of failure with both the current and historical GRTs. Similarly, the number of active drugs in the cART regimen after the third resistance test, used as continuous variable, was also predictive of failure. Using both GSS approaches, current genotype had a higher effect than historical genotype on risk of treatment failure. Using the non-standard definition (CWR), historical resistance predicted failure better than current resistance. CONCLUSIONS Our results provide an epidemiological demonstration that analysis of a combined latest and historical GRT, which also considers archived mutations, might better identify of the more virologically impaired patients in order to assess the best salvage treatment.
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Affiliation(s)
- Mauro Zaccarelli
- Clinical Department, National Institute for Infectious Diseases Lazzaro Spallanzani, Rome, Italy.
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Ammassari A, Lorenzini P, Maggiolo F, Sterrantino G, Corpolongo A, Rizzardini G, Abrescia N, Chirianni A, Foggia M, Mussini C, Gianotti N, Andreoni M, Perno CF, Antinori A. Impact of antiretroviral dosing and daily pill burden on viral rebound rates in naive patients receiving a tenofovir-based regimen. J Int AIDS Soc 2008. [DOI: 10.1186/1758-2652-11-s1-p3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Lo Caputo S, Santoro M, Ceccherini-Silberstein CSF, Svicher V, Pierotti P, Vichi F, D'Arrigo R, Gori C, Perno CF, Mazzotta F. Antiretroviral treatment efficacy after mutations reversion during T20 monotherapy, an alternative strategy in multi-failed HIV-1 infected patients. J Int AIDS Soc 2008. [DOI: 10.1186/1758-2652-11-s1-p35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Zaccarelli M, Lorenzini P, Ceccherini-Silberstein CSF, Tozzi V, Forbici F, Trotta MP, D'Arrigo R, Marconi P, Narciso P, Perno CF, Antinori A. Using the latest resistance score to predict etravirine (ETV) resistance in naïve and NNRTI-failing patients. J Int AIDS Soc 2008. [DOI: 10.1186/1758-2652-11-s1-p179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Marazzi CM, Germano P, Liotta G, Guidotti G, Loureiro S, Gomes ADC, Blazquez MCV, Narciso P, Perno CF, Mancinelli S, Altan AD, Nielsen-Saines K, Palombi L. Implementing anti-retroviral triple therapy to prevent HIV mother-to-child transmission: a public health approach in resource-limited settings. Eur J Pediatr 2007; 166:1305-7. [PMID: 17235520 DOI: 10.1007/s00431-006-0405-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [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] [Received: 10/13/2006] [Accepted: 12/18/2006] [Indexed: 11/26/2022]
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