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Ancarani F, Angeli E, Antinori A, Antonucci G, Bonasso M, Bruno R, Capobianchi MR, Cargnel A, Cozzi-Lepri A, Monforte AD, Cingolani A, Galli M, Orofino GC, Girardi E, Marino N, Bongiovanni M, Morsica G, Narciso P, Pastecchia C, Pizzaferri P, Puoti M, Santantonio T, Verucchi G, Montroni M, Scalise G, Braschi MC, Maracci M, Tirelli U, Cinelli R, Pastore G, Ladisa N, Minafra G, Suter F, Arici C, Chiodo F, Colangeli V, Fiorini C, Coronado O, Carosi G, Cadeo GP, Torti C, Minardi C, Bertelli D, Rizzardini G, Migliorino G, Manconi PE, Piano P, Ferraro T, Scerbo A, Pizzigallo E, D'Alessandro M, Santoro D, Pusterla L, Carnevale G, Galloni D, Viganò P, Mena M, Ghinelli F, Sighinolfi L, Leoncini F, Mazzotta F, Pozzi M, Caputo SL, Angarano G, Grisorio B, Saracino A, Ferrara S, Grima P, Tundo P, Pagano G, Cassola G, Alessandrini A, Piscopo R, Toti M, Chigiotti S, Soscia F, Tacconi L, Orani A, Perini P, Scasso A, Vincenti A, Chiodera F, Castelli P, Scalzini A, Fibbia G, Moroni M, Lazzarin A, Cargnel A, Vigevani GM, Caggese L, Monforte AD, Repetto D, Novati R, Galli A, Merli S, Pastecchia C, Moioli MC, Esposito R, Mussini C, Abrescia N, Chirianni A, Izzo CM, Piazza M, De Marco M, Viglietti R, Manzillo E, Graf M, Colomba A, Abbadessa V, Prestileo T, Mancuso S, Ferrari C, Pizzaferri P, Filice G, Minoli L, Bruno R, Novati S, Baldelli F, Tinca M, Petrelli E, Cioppi A, Alberici F, Ruggieri A, Menichetti F, Martinelli C, De Stefano C, La Gala A, Ballardini G, Briganti E, Magnani G, Ursitti MA, Arlotti M, Ortolani P, Cauda R, Dianzani F, Ippolito G, Antinori A, Antonucci G, D'Elia S, Narciso P, Petrosillo N, Vullo V, De Luca A, Di Giambenedetti S, Zaccarelli M, Acinapura R, De Longis P, Ciardi M, D'Offizi G, Trotta MP, Noto P, Lichtner M, Capobianchi MR, Girardi E, Pezzotti P, Rezza G, Mura MS, Mannazzu M, Resta F, Loso K, Caramello P, Sinicco A, Soranzo ML, Orofino G, Sciandra M, Bonasso M, Grossi PA, Basilico C, Poggio A, Bottari G, Raise E, Pasquinucci S, De Lalla F, Tositti G, Lepri AC, Solmone M, Girardi E, Lalle E, Abbate I, Monforte AD, Cozzi-Lepri A, Alessandrini A, Piscopo R, Ebo F, Cosco L, Antonucci G, Ippolito G, Capobianchi MR. Evolution of HVR-1 Quasispecies after 1-Year Treatment in HIV/HCV-Coinfected Patients According to the Pattern of Response to Highly Active Antiretroviral Therapy. Antivir Ther 2006. [DOI: 10.1177/135965350601100102] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Hepatitis C virus (HCV) variability is mainly attributed to the ability of the virus to respond to host immune pressure, acting as a driving force for the evolution of quasispecies. This study was aimed at studying the changes in HVR-1 heterogeneity and the evolution of HCV quasispecies in HIV/HCV-coinfected patients according to the pattern of response to highly active antiretroviral therapy (HAART). Sixteen HIV/HCV-coinfected patients harbouring HCV genotype 1 and who had been on HAART for at least 1 year, 8 showing increasing CD4+T-cell counts (immunological responders) and 8 showing a stable or decreasing CD4+ T-cell counts (immunological non-responders), were selected from a prospective cohort study. After 1 year of HAART, 11 patients showed HIV viral load <2.6 log10 cp/ml (virological responders), and 5 showed HIV viral load above this value (virological non-responders). Plasma samples, collected before starting therapy and after 1 year of HAART, underwent clonal sequence analysis for HVR-1 region of HCV. Non-synonymous/synonymous substitutions ratio (Ka/Ks), aminoacidic complexity (normalized Shannon entropy) and diversity (p-distance), were considered as parameters of quasispecies heterogeneity. After 1 year of HAART, heterogeneity of HVR-1 quasispecies significantly decreased in virological non-responders, whereas the heterogeneity tended to increase in virological responders. The differences in the evolution were less stringent, when considering immunological response. On the other hand, profound qualitative modifications of HVR-1 quasispecies were observed only in patients with both immunological and virological HAART response. On the whole, these findings suggest that, in patients undergoing HAART, the extent of HCV variability and the evolution of HVR-1 quasispecies is influenced by the pattern of response to antiretroviral therapy.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Enrico Girardi
- National Institute of Infectious Diseases “L. Spallanzani”, Rome
| | - Eleonora Lalle
- National Institute of Infectious Diseases “L. Spallanzani”, Rome
| | - Isabella Abbate
- National Institute of Infectious Diseases “L. Spallanzani”, Rome
| | | | - Alessandro Cozzi-Lepri
- Department of Primary Care and Population Sciences, Royal Free and University College Medical School, London
| | | | - Rita Piscopo
- Department of Infectious Diseases, Galliera Hospital, Genova
| | - Francesca Ebo
- Department of Infectious Diseases, Hosp Civile San Giovanni e Paolo, Venezia
| | - Lucio Cosco
- Department of Infectious Diseases, A. Pugliesi Catanzaro
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Antonucci G, Girardi E, Cozzi-Lepri A, Capobianchi MR, Morsica G, Pizzaferri P, Ladisa N, Sighinolfi L, Chiodera A, Solmone M, Lalle E, Ippolito G, Monforte AD, Ancarani F, Antinori A, Antonucci G, Bonasso M, Bruno R, Capobianchi MR, Cargnel A, Cozzi-Lepri A, d'Arminio Monforte A, Luca AD, Galli M, Gennero L, Girardi E, Lipani F, Marino N, Milazzo L, Morsica G, Narciso P, Pizzaferri P, Puoti M, Santantonio T, Verucchi G, Montroni M, Scalise G, Braschi MC, Prete MSD, Tirelli U, Cinelli R, Pastore G, Ladisa N, Suter GMBF, Arici C, Chiodo F, Colangeli V, Fiorini C, Coronado O, Carosi G, Cadeo GP, Torti C, Minardi C, Bertelli D, Rizzardini G, Migliorino G, Manconi PE, Piano P, Ferraro T, Scerbo A, Pizzigallo E, D'Alessandro M, Santoro D, Pusterla L, Carnevale G, Galloni D, Viganò P, Mena M, Ghinelli F, Sighinolfi L, Leoncini F, Mazzotta F, Pozzi M, Caputo SL, Angarano G, Grisorio B, Saracino A, Ferrara S, Grima P, Tundo P, Pagano G, Cassola G, Alessandrini A, Piscopo R, Toti M, Chigiotti S, Soscia F, Tacconi L, Orani A, Perini P, Scasso A, Vincenti A, Chiodera F, Castelli P, Scalzini A, Fibbia G, Moroni M, Lazzarin A, Cargnel A, Vigevani GM, Caggese L, Monforte AD, Repetto D, Novati R, Galli A, Merli S, Pastecchia C, Moioli MC, Esposito R, Mussini C, Abrescia N, Chirianni A, Izzo CM, Piazza M, Marco MD, Viglietti R, Manzillo E, Graf M, Colomba A, Abbadessa V, Prestileo T, Mancuso S, Ferrari C, Pizzaferri P, Filice G, Minoli L, Bruno R, Novati S, Baldelli F, Tinca M, Petrelli E, Cioppi A, Alberici F, Ruggieri A, Menichetti F, Martinelli C, Stefano CD, Gala AL, Ballardini G, Briganti E, Magnani G, Ursitti MA, Arlotti M, Ortolani P, Cauda R, Dianzani F, Ippolito G, Antinori A, Antonucci G, D'Elia S, Narciso P, Petrosillo N, Vullo V, Luca AD, Giambenedetti SD, Zaccarelli M, Acinapura R, Longis PD, Ciardi M, D'Offizi G, Trotta MP, Noto P, Lichtner M, Capobianchi MR, Girardi E, Pezzotti P, Rezza G, Mura MS, Mannazzu M, Resta F, Loso K, Caramello P, Sinicco A, Soranzo ML, Orofino G, Sciandra M, Bonasso M, Grossi PA, Basilico C, Poggio A, Bottari G, Raise E, Pasquinucci S, Lalla FD, Tositti G, Lepri AC. Response to Haart and Gb Virus Type C Coinfection in a Cohort of Antiretroviral-Naive HIV-Infected Individuals. Antivir Ther 2005. [DOI: 10.1177/135965350501000108] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The prognostic role of GB virus type C (GBV-C) viraemia in HIV-infected subjects treated with highly active antiretroviral therapy (HAART) is still undefined, The aim of this analysis is to assess the relationship between GBV-C infection and response to antiretroviral therapy among HIV-infected subjects initiating HAART when antiretroviral-naive. A prospective, observational study of 400 HIV-infected patients with measurements of GBV-C RNA, hepatitis C virus (HCV) antibodies and HCV RNA determined from plasma stored prior to HAART initiation, Time to virological (achieving HIV RNA ≤500 copies/ml) and immunological success (a CD4+ count increase of ≥200cells/μl), and the time to virological relapse (confirmed HIV RNA >500 copies/ml) were assessed by Kaplan-Meier methods and Cox proportional hazard regression model. Of the subjects, 117 (29.3%) were GBV-C positive and, overall, 351 (87.8%) patients achieved virological success, After controlling for a number of confounders including HCV RNA, GBV-C viraemic patients experienced a significantly lower risk of HIV rebound than those who were GBV-C negative [relative hazard (RH)=0.56, 95% CI: 0.34–0.93, P=0.03], Conversely, the probability of achieving initial virological success or CD4+ count response after HAART did not differ between GBV-C-negative and -positive subjects, These results suggest that GBV-C coinfection may play a role in determining the rate of HIV rebound possibly by competing with HIV replication after HIV load has been successfully suppressed by HAART.
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Affiliation(s)
| | - Giorgio Antonucci
- National Institute of Infectious Diseases, L Spallanzani, Roma, Italy
| | - Enrico Girardi
- National Institute of Infectious Diseases, L Spallanzani, Roma, Italy
| | - Alessandro Cozzi-Lepri
- Department of Primary Care and Population Sciences, Royal Free and University College Medical School, London, UK
| | | | - Giulia Morsica
- Institute of Infectious Diseases, Ateneo Vita e Salute, S Raffaele Hospital, Milano, Italy
| | - Paolo Pizzaferri
- Department of Infectious Diseases and Hepatology, Azienda Ospedaliera, Parma, Italy
| | - Nicoletta Ladisa
- Institute of Infectious and Tropical Diseases, University of Bari, Bari, Italy
| | - Laura Sighinolfi
- Department of Infectious Diseases, Arcispedale S Anna, Ferrara, Italy
| | | | | | - Eleonora Lalle
- National Institute of Infectious Diseases, L Spallanzani, Roma, Italy
| | - Giuseppe Ippolito
- National Institute of Infectious Diseases, L Spallanzani, Roma, Italy
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Landonio S, Quirino T, Bonfanti P, Gabris A, Boccassini L, Gulisano C, Vulpio L, Ricci E, Carrabba M, Vigevani GM. Osteopenia and osteoporosis in HIV+ patients, untreated or receiving HAART. Biomed Pharmacother 2004; 58:505-8. [PMID: 15511607 DOI: 10.1016/j.biopha.2004.08.019] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2004] [Indexed: 11/26/2022] Open
Abstract
In the last few years there are increasing evidences suggesting that osteopenia and osteoporosis are frequent among HIV positive patients. It is still not clear if the bone demineralization is a direct consequence of viral infection or of the antiretroviral drugs. Studies to date therefore give conflicting results. We performed a study to evaluate the prevalence of osteopenia and osteoporosis in HIV positive patients, either untreated or receiving antiretroviral therapy, to asses the frequency of these conditions and the role of antiretroviral drugs.
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Affiliation(s)
- S Landonio
- 1st Department of Infectious Diseases and Allergy, Luigi Sacco Hospital, Via GB Grassi 74, 20157 Milan, Italy
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Luca AD, Cozzi-Lepri A, Perno CF, Balotta C, Giambenedetto SD, Poggio A, Pagano G, Tositti G, Piscopo R, Forno AD, Chiodo F, Magnani G, Monforte AD, Angarano G, Antinori A, Balotta C, Cozzi-Lepri A, Monforte AD, De Luca A, Monno L, Perno CF, Rusconi S, Montroni M, Scalise G, Zoli A, Del Prete MS, Tirelli U, Di Gennaro G, Pastore G, Ladisa N, Minafra G, Suter F, Arici C, Chiodo F, Colangeli V, Fiorini C, Coronado O, Carosi G, Cadeo GP, Castelli F, Minardi C, Vangi D, Rizzardini G, Migliorino G, Manconi PE, Piano P, Ferraro T, Scerbo A, Pizzigallo E, D'Alessandro M, Santoro D, Pusterla L, Carnevale G, Galloni D, Viganò P, Mena M, Ghinelli F, Sighinolfi L, Leoncini F, Mazzotta F, Pozzi M, Caputo SL, Angarano G, Grisorio B, Ferrara S, Grima P, Tundo P, Pagano G, Piersantelli N, Alessandrini A, Piscopo R, Toti M, Chigiotti S, Soscia F, Tacconi L, Orani A, Perini P, Scasso A, Vincenti A, Chiodera F, Castelli P, Scalzini A, Fibbia G, Moroni M, Lazzarin A, Cargnel A, Vigevani GM, Caggese L, d'Arminio Monforte A, Repetto D, Novati R, Galli A, Merli S, Pastecchia C, Moioli MC, Esposito R, Mussini C, Abrescia N, Chirianni A, Izzo C, Piazza M, De Marco M, Montesarchio V, Manzillo E, Graf M, Colomba A, Abbadessa V, Prestileo T, Mancuso S, Ferrari C, Pizzaferri P, Filice G, Minoli L, Bruno R, Novati S, Balzelli F, Loso K, Petrelli E, Cioppi A, Alberici F, Ruggieri A, Menichetti F, Martinelli C, De Stefano C, Gala AL, Ballardini G, Briganti E, Magnani G, Ursitti MA, Arlotti M, Ortolani P, Cauda R, Dianzani F, Ippolito G, Antinori A, Antonucci G, D'Elia S, Narciso P, Petrosillo N, Vullo V, De Luca A, Di Giambenedetto S, Zaccarelli M, Acinapura R, De Longis P, Ciardi M, D'Offizi G, Trotta MP, Noto P, Lichtner M, Capobianchi MR, Girardi E, Pezzotti P, Rezza G, Mura MS, Mannazzu M, Caramello P, Sinicco A, Soranzo ML, Gennero L, Sciandra M, Bonasso M, Grossi PA, Basilico C, Poggio A, Bottari G, Raise E, Pasquinucci S, De Lalla F, Tositti G, Resta F, Chimienti A, Lepri AC. Variability in the Interpretation of Transmitted Genotypic HIV-1 Drug Resistance and Prediction of Virological Outcomes of the Initial Haart by Distinct Systems. Antivir Ther 2004. [DOI: 10.1177/135965350400900505] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
High level HIV-1 drug resistance in recently infected treatment-naive individuals correlates with sub-optimal virological responses to highly active antiretroviral therapy (HAART). To determine whether genotypic HIV-1 drug resistance in chronic naive patients, as interpreted by various systems, could predict the virological outcomes of HAART, isolates from patients enrolled in a prospective observational cohort (ICoNA) prior to treatment start were genotyped. Genotypic susceptibility scores (GSS) assigned to the initial HAART regimens using the interpretations of pre-therapy resistance mutations by 13 systems were related to virological outcomes. Of 415 patients, 42 (10%) had at least one major resistance mutation. According to the different interpretations, 1.9–20.5% of patients had some level of resistance to at least one drug in the initial regimen. In multivariable analysis, GSS from two systems significantly predicted the time to virological success: Rega 5.5, for each unit increase in GSS adjusted relative hazard (RH) 1.86 [95% confidence intervals (95% CI): 1.15–3.02] and hivresistanceWeb v3, RH 1.87 (95% CI: 1.00–3.48). With three other systems, GSS showed a trend towards a significant prediction of success: Retrogram 1.6, RH 2.33 (95% CI: 0.98–5.53), Menéndez 2002, RH 2.36 (95% CI: 0.97–5.72) and Stanford hivdb, RH 2.06 (95% CI: 0.94–4.49). Genotypic resistance testing coupled with adequate interpretation in chronic naive patients can usefully identify those at risk of sub-optimal virological response to HAART.
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Affiliation(s)
| | - Andrea De Luca
- Institute of Clinical Infectious Diseases, Catholic University, Rome, Italy
| | - Alessandro Cozzi-Lepri
- Royal Free Centre for HIV Medicine and Department of Primary Care and Population Sciences, Royal Free and University College Medical School, London, UK
| | | | - Claudia Balotta
- Institute of Infectious Diseases and Tropical Medicine, University of Milan, Milan, Italy
| | | | - Antonio Poggio
- Department of Infectious Diseases, Civile Hospital, Verbania, Italy
| | - Gabriella Pagano
- Department of Infectious Diseases, S Martino Hospital, Genova, Italy
| | - Giulia Tositti
- Department of Infectious Diseases, Vicenza Hospital, Vicenza, Italy
| | - Rita Piscopo
- Department of Infectious Diseases, Galliera Hospital, Genova, Italy
| | - Antonio Del Forno
- Institute of Clinical Infectious Diseases, Catholic University, Rome, Italy
| | - Francesco Chiodo
- Institute of Infectious Diseases, University of Bologna, Bologna, Italy
| | - Giacomo Magnani
- Department of Infectious Diseases, Santa Maria Nuova Hospital, Reggio Emilia, Italy
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5
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Puoti M, Cozzi-Lepri A, Ancarani F, Bruno R, Ambu S, Ferraro T, Tundo P, Santantonio T, Toti M, Bonasso M, Monforte AD, Ancarani F, Antonucci G, Bonasso M, Bruno R, Cozzi-Lepri A, Monforte AD, Luca AD, Galli M, Gennero L, Girardi E, Lipani F, Marino N, Milazzo L, Morsica G, Narciso P, Pizzaferri P, Puoti M, Santantonio T, Verucchi G, Montroni M, Scalise G, Zoli A, Prete MSD, Tirelli U, Di Gennaro G, Pastore G, Ladisa N, Minafra G, Suter F, Arici C, Chiodo F, Colangeli V, Fiorini C, Coronado O, Carosi G, Cadeo GP, Castelli F, Minardi C, Vangi D, Rizzardini G, Migliorino G, Manconi PE, Piano P, Ferraro T, Scerbo A, Pizzigallo E, D'Alessandro M, Santoro D, Pusterla L, Carnevale G, Galloni D, Viganò P, Mena M, Ghinelli F, Sighinolfi L, Leoncini F, Mazzotta F, Pozzi M, Lo Caputo S, Angarano G, Grisorio B, Ferrara S, Grima P, Tundo P, Pagano G, Piersantelli N, Alessandrini A, Piscopo R, Toti M, Chigiotti S, Soscia F, Tacconi L, Orani A, Perini P, Scasso A, Vincenti A, Chiodera F, Castelli P, Scalzini A, Fibbia G, Moroni M, Lazzarin A, Cargnel A, Vigevani GM, Caggese L, d'Arminio Monforte A, Repetto D, Novati R, Galli A, Merli S, Pastecchia C, Moioli MC, Esposito R, Mussini C, Abrescia N, Chirianni A, Izzo C, Piazza M, De Marco M, Montesarchio V, Manzillo E, Graf M, Colomba A, Abbadessa V, Prestileo T, Mancuso S, Ferrari C, Pizzaferri P, Filice G, Minoli L, Bruno R, Novati S, Balzelli F, Loso K, Petrelli E, Cioppi A, Alberici F, Ruggieri A, Menichetti F, Martinelli C, De Stefano C, La Gala A, Ballardini G, Briganti E, Magnani G, Ursitti MA, Arlotti M, Ortolani P, Ortona L, Dianzani F, Ippolito G, Antinori A, Antonucci G, D'Elia S, Narciso P, Petrosillo N, Vullo V, De Luca A, Del Forno L, Zaccarelli M, Acinapura R, De Longis P, Ciardi M, D'Offizi G, Trotta MP, Noto P, Lichtner M, Capobianchi MR, Girardi E, Pezzotti P, Rezza G, Mura MS, Mannazzu M, Caramello P, Sinicco A, Soranzo ML, Gennero L, Sciandra M, Bonasso M, Grossi PA, Basilico C, Poggio A, Bottari G, Raise E, Pasquinucci S, De Lalla F, Tositti G, Resta F, Chimienti A, Cozzi-Lepri A. The Management of Hepatitis B Virus/HIV-1 Co-Infected Patients Starting Their First Haart Regimen. Treating Two Infections for the Price of One Drug? Antivir Ther 2004. [DOI: 10.1177/135965350400900506] [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: 11/15/2022]
Abstract
We examined the impact of a lamivudine-containing highly active antiretroviral therapy (HAART) regimen on 164 hepatitis B virus/HIV co-infected individuals starting their first HAART. Lamivudine-treated patients (accounting for 73% of the study population) showed a significantly lower level of alanine aminotransferase over follow-up [–81.1 mU/ml mean difference; 95% confidence intervals (95% CI): –30.3; –131.7, P=0.003] and a significantly reduced risk of liver-related morbidity/mortality [Relative hazard (RH)=0.07; 95% CI: 0.01–0.38, P=0.002] than those starting a lamivudine sparing-regimen.
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Affiliation(s)
| | - Massimo Puoti
- Institute of Infectious and Tropical Diseases, Spedali Civili, University of Brescia, Brescia, Italy
| | - Alessandro Cozzi-Lepri
- Department of Primary Care and Population Sciences, Royal Free and University College Medical School, London, UK
| | - Fausto Ancarani
- Institute of Infectious Diseases and Public Health, Umberto I Hospital, University of Ancona, Ancona, Italy
| | - Raffaele Bruno
- Institute of Infectious and Tropical Diseases, IRCCS S Matteo, University of Pavia, Pavia, Italy
| | - Silvia Ambu
- Department of Infectious Diseases, Azienda Ospedaliera Careggi, Firenze, Italy
| | - Teresa Ferraro
- Department of Infectious Diseases, Ospedale A Puglise, Catanzaro, Italy
| | - Paolo Tundo
- Department of Infectious Diseases, Ospedale Santa Caterina Novella, Galatina (Lecce), Italy
| | | | - Mario Toti
- Department of Infectious Diseases, Ospedale di Grosseto, Grosseto, Italy
| | - Marino Bonasso
- Department of Infectious Diseases, Ospedale ‘Amedeo Savoia’, Torino, Italy
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6
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Antinori S, Galimberti L, Magni C, Casella A, Vago L, Mainini F, Piazza M, Nebuloni M, Fasan M, Bonaccorso C, Vigevani GM, Cargnel A, Moroni M, Ridolfo A. Cryptococcus neoformans infection in a cohort of Italian AIDS patients: natural history, early prognostic parameters, and autopsy findings. Eur J Clin Microbiol Infect Dis 2001; 20:711-7. [PMID: 11757972 DOI: 10.1007/s100960100616] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
This observational cohort study of 4,160 AIDS patients hospitalised in a single institution in northern Italy between January 1985 and December 1999 was carried out in order to assess the natural history of cryptococcosis, the epidemiological trend of this opportunistic infection, the risk factors predictive of death at 10 weeks, the response to therapy, and autopsy findings. Cryptococcosis was diagnosed in 177 (4.2%) patients and was the AIDS-defining disease in 2.8% of cases. Its prevalence decreased significantly over time (from 6.4% in the period 1985-1989 to 5.7% in 1990-1993, 3.1% in 1994-1996, and 1.9% in 1997-1999, P <0.0001). Although neurologic disease was the most frequent clinical picture, a significant proportion of the patients (24.2%) presented with extraneural cryptococcosis. In a Cox multivariate analysis, high titres of cerebrospinal fluid antigen (>5000) and drug addiction were predictive of death at 10 weeks. A complete clinical and mycological response was achieved in 60.8% of the treated patients, with the highest response rate being observed in those treated with amphotericin plus flucytosine (66.6%). Cryptococcosis relapsed in 12.8% of patients on secondary prophylaxis. Autopsy findings demonstrated that cryptococcosis is a disseminated disease, but long-term antifungal treatment may be able to eradicate it in a subgroup of patients.
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Affiliation(s)
- S Antinori
- Department of Infectious and Tropical Diseases, L. Sacco Hospital, University of Milan, Italy.
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7
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Monforte ADA, Bugarini R, Pezzotti P, De Luca A, Antinori A, Mussini C, Vigevani GM, Tirelli U, Bruno R, Gritti F, Piazza M, Chigiotti S, Chirianni A, De Stefano C, Pizzigallo E, Perrella O, Moroni M. Low frequency of severe hepatotoxicity and association with HCV coinfection in HIV-positive patients treated with HAART. J Acquir Immune Defic Syndr 2001; 28:114-23. [PMID: 11588504 DOI: 10.1097/00042560-200110010-00002] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Highly active antiretroviral therapy (HAART) is strongly effective in reducing morbidity and mortality in HIV-1-positive individuals. Its main drawback is the potential toxicity. Data on the frequency and determinants of severe hepatotoxicity in a clinical setting are still sparse. METHODS This is a prospective study of HIV-1-positive individuals with known HBsAg and HCV-Ab serology. The study end point was progression to alanine aminotransferase (ALT) levels > or =200 IU/L after HAART initiation. Cumulative probability of progression to this end point was estimated by the Kaplan-Meier method. Crude and adjusted hazard ratios (HR) were estimated by proportional hazards regression model. RESULTS One thousand two hundred fifty-five patients were included. HBsAg was found in 91 (7.2%), HCV-Ab in 578 (46.5%) patients; almost all injection drug users (451 of 482; 93.6%) were HCV-Ab positive. Sixty-one individuals progressed to the end point with a probability of 7.9% (95% confidence interval [CI], 5.6-10.0) of progression at 24 months from starting. Independent factors predicting progression to the end point were baseline ALT levels (HR, 5.29; 95% CI, 3.24-8.65; every 10 IU/L higher), HCV-Ab positivity (HR, 4.01; 95% CI, 1.48-10.85) or both HBsAg and HCV Ab positivity (HR, 3.85, 95% CI, 1.01-14.61), and previous non-HAART therapy (HR, 1.84, 95% CI, 1.04-3.42). Patients receiving stavudine-containing regimens had a lower risk than those receiving zidovudine-containing regimens (HR, 0.30, 95% CI, 0.12-0.71). CONCLUSIONS There was a low risk of ALT > or =200 IU/L in our cohort. Hepatitis C coinfection and elevated ALT levels at HAART initiation are important predictors of progression to ALT > or =200 IU/L; stavudine-containing regimens were associated with a lower risk compared with zidovudine-containing regimens.
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Affiliation(s)
- A de A Monforte
- Institute of Infectious and Tropical Diseases, University of Milan, L Sacco H, Milan, Italy.
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8
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Carosi G, Castelli F, Suter F, Maggiolo F, Orani AM, Pan A, Andreoni M, Vigevani GM, Maserati R, Mazzotta F, Tinelli C. Antiviral potency of HAART regimens and clinical success are not strictly coupled in real life conditions: evidence from the MASTER-1 study. HIV Clin Trials 2001; 2:399-407. [PMID: 11673814 DOI: 10.1310/5xcl-5xe9-jafk-xk7y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
PURPOSE To compare in a real clinical setting the largely unknown midterm clinical effectiveness of two protease inhibitor (PI)-based highly active antiretroviral therapy (HAART) regimens with different potency and tolerability profiles in naïve patients. METHOD This study was a multicenter, open-label, randomized trial in naïve patients with less than 400 CD4+ cell count/microL, regardless of viral load. Treatment arms were hard gel capsule saquinavir (HGC-SQV)-based HAART (Arm A), with an expected more favorable tolerability profile, and indinavir (IDV)-based HAART (Arm B), with more potent virologic activity. While viro-immunological surrogate markers and World Health Organization (WHO) grade III toxicity (secondary endpoints) were regularly monitored, primary endpoints of the study were clinical and defined as any AIDS-defining event, AIDS-related death, WHO grade IV toxicity, drop outs, and protocol violations. RESULTS 262 consecutive patients were enrolled in the study from March 1, 1997 to December 31, 1997, in 24 different Italian clinical centers (132, Arm A; 130, Arm B). After 24 months of follow-up, patients who were enrolled in Arm B showed a significantly higher rate of virological success (75% had viremia below 500 copies/mL, CI = 12.9%, in the on-treatment analysis) and immunological gain (mean CD4+ cell count increase of 274 CD4+ cells/microL, SD = 234) when compared to patients enrolled in arm A (57%, CI = 15.5% and 223 CD4+ cells/microL, SD = 192; p =.0353 and.026, respectively). Despite the significant difference observed in surrogate markers, the number of total primary endpoints did not differ in the two groups (55 out of 132 in Arm A vs. 58 out of 130 person-years in Arm B; p =.86). CONCLUSION Our results suggest that, after 24 months of follow-up in a real clinical setting, a PI-based HAART induces significant clinical benefits in naïve patients even in the absence of a complete suppression of viral replication. However, the long-term clinical impact of the possible accumulation of viral mutations in the presence of low-grade viral replication remains to be elucidated.
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Affiliation(s)
- G Carosi
- Institute of Infectious and Tropical Diseases, University of Brescia, Italy.
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9
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Perno CF, Cozzi-Lepri A, Balotta C, Forbici F, Violin M, Bertoli A, Facchi G, Pezzotti P, Angarano G, Arici C, Narciso P, Orani A, Raise E, Scalzini A, Poggio A, Ippolito G, Moroni M, Monforte AD, Montroni M, Scalise G, Costantini A, Del Prete MS, Tirelli U, Nasti G, Pastore G, Perulli LM, Suter F, Arici C, Chiodo F, Gritti FM, Colangeli V, Fiorini C, Guerra L, Carosi G, Cadeo GP, Castelli F, Minardi C, Vangi D, Rizzardini G, Migliorino G, Manconi PE, Piano P, Ferraro T, Cosco L, Pizzigallo E, Ricci F, Vigevani GM, Pusterla L, Carnevale G, Pan A, Viganò P, Mena M, Ghinelli F, Sighinolfi L, Leoncini F, Mazzotta F, Ambu S, Lo Caputo S, Angarano G, Grisorio B, Ferrara S, Grima P, Tundo P, Pagano G, Piersantelli N, Alessandrini A, Piscopo R, Toti M, Chigiotti, Soscia F, Tacconi L, Orani A, Castaldo G, Scasso A, Vincenti A, Scalzini A, Alessi F, Moroni M, Lazzarin A, Cargnel A, Milazzo F, Caggese L, Monforte AD, Melzi S, Delfanti F, Carini B, Adriani B, Garavaglia S, Moioli C, Esposito R, Mussini C, Abrescia N, Chirianni A, Perrella O, Piazza M, De Marco M, Montesarchio V, Manzillo E, Nappa S, Cadrobbi P, Scaggiante R, Colomba A, Abbadesse V, Prestileo T, Mancuso S, Filice G, Minoli L, Savino FAP, Maserati R, Pauluzzi S, Baldelli F, Petrelli E, Ciotti A, Alberici F, Sisti M, Menichetti F, Smorfa A, De Stefano C, La Gala A, Zauli T, Ballardini G, Bonazzi L, Ursitti MA, Ciammarughi R, Giordani S, Ortona L, Dianzani F, Ippolito G, Antinori A, Antonucci G, D'Elia S, Narciso P, Petrosillo N, Vullo V, De Luca A, Del Forno A, Zaccarelli M, De Longis P, Ciardi M, D'Offizi G, Palmieri F, Lichter M, Capobianchi MR, Girardi E, Pezzotti P, Rezza G, Mura MS, Mannazzu M, Caramello P, Sinicco A, Soranzo ML, Quaglia S, Sciandra M, Salassa B, Torre D, Basilico C, Poggio A, Bottari G, Raise E, Pasquinucci S, De Lalla F, Tositti G, Resta F, Chimienti A, Lepri AC, Phillips AN. Impact of Mutations Conferring Reduced Susceptibility to Lamivudine on the Response to Antiretroviral Therapy. Antivir Ther 2001. [DOI: 10.1177/135965350100600306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Carlo Federico Perno
- IRCCS L. Spallanzani, Rome, Italy
- Department Experimental Medicine, University of Rome Tor Vergata, Rome, Italy
| | | | - Claudia Balotta
- Institute of Tropical and Infectious Diseases, University of Milan, Milan, Italy
| | | | - Michela Violin
- Institute of Tropical and Infectious Diseases, University of Milan, Milan, Italy
| | | | - Guido Facchi
- Institute of Tropical and Infectious Diseases, University of Milan, Milan, Italy
| | | | | | - Claudio Arici
- Department of Infectious Diseases, Ospedali Riuniti, Bergamo, Italy
| | | | - Anna Orani
- Department of Infectious Diseases, Lecco Hospital, Lecco, Italy
| | - Enzo Raise
- Department of Infectious Diseases, SS Giovanni e Paolo Hospital, Venice, Italy
| | - Alfredo Scalzini
- Department of Infectious Diseases, Mantova Hospital, Mantova, Italy
| | - Antonio Poggio
- Department of Infectious Diseases, Verbania Hospital, Verbania, Italy
| | | | - Mauro Moroni
- Institute of Tropical and Infectious Diseases, University of Milan, Milan, Italy
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Abstract
BACKGROUND International migrants represent only 4.5% of the world's population, but they may become a challenge for host countries. The aim of the study was to assess the impact of this population on health parameters in Como county, on the northern border of Italy. METHODS A retrospective analysis of migrants' admissions at Sant'Anna Hospital in 1998 was done, and compared to data from 1994. RESULTS Of 47,378 total admissions at our hospital, 268 involved migrants (0.5%), mostly from the former Yugoslavia, with a slight preponderance of females; 22 out of 268 migrants were admitted in the Infectious Diseases Department (8.2%), mainly from Africa. Most admissions were classified as Drug Related Group (DRG), but an increasing number of miscellaneous DRGs are reported, including obstetric ones. CONCLUSIONS The emergence of a female population among migrant admissions, and the relevance of delivery DRGs in 1998, may suggest that, after a first immigration wave of rather healthy men in search of good job opportunities during the first years of the 90s, we are now observing a second wave of migrants: their families. The increasing number of patients from the former Yugoslavia reported in 1998, could suggest that a third wave is expected in the near future: these will be irregular migrants and refugees.
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Affiliation(s)
- D Santoro
- Infectious Diseases Department, Sant'Anna Hospital, Como, Italy
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11
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Quirino T, Capetti A, Boldorini R, Iemoli E, Almaviva M, Vigevani GM. [Disseminated pneumocystosis. 3 cases in HIV seropositive patients]. Presse Med 1993; 22:1013. [PMID: 8367433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
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12
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Fasan M, Gubertini G, Cargnel A, Vigevani GM, Rizzardini G, Capetti A, Vaglia A, Grancini A, Malaspina C, Tortorano AM. [Primary treatment of cryptococcosis in AIDS: itraconazole in single dose or combined with 5-fluorocytosine]. G Ital Chemioter 1991; 38:199-200. [PMID: 1365593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/25/2023]
Affiliation(s)
- M Fasan
- II Divisione Malattie Infettive, Ospedale L. Sacco, Milano
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13
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Quirino T, Coen M, Iemoli E, Poggiato M, Argenteri B, Vigevani GM, Milazzo F. [Diagnostic features of antibiotic allergy]. G Ital Chemioter 1991; 38:115-6. [PMID: 1365560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/25/2023]
Affiliation(s)
- T Quirino
- Servizio di Allergologia, Ospedale L. Sacco, Milano
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14
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Vigevani GM, Coen M, Rizzardini G, Scorza D, Almaviva M, Milazzo F. [Diabetes insipidus consecutive to meningoencephalitis in an HIV-infected patient]. Presse Med 1990; 19:1638. [PMID: 2147263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
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15
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Viviani MA, Tortorano AM, Pagano A, Vigevani GM, Gubertini G, Cristina S, Assaisso ML, Suter F, Farina C, Minetti B. European experience with itraconazole in systemic mycoses. J Am Acad Dermatol 1990; 23:587-93. [PMID: 2170478 DOI: 10.1016/0190-9622(90)70260-o] [Citation(s) in RCA: 54] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Since January 1985 more than 100 patients with deep fungal infections have been treated with itraconazole (200 to 400 mg/day) in Northern Italy. Evaluation of the drug efficacy and tolerance was possible in one patient with sporotrichosis, in 34 with aspergillosis, and in 36 with cryptococcosis (mainly patients positive for human immunodeficiency virus). Response to itraconazole alone was obtained in the case of sporotrichosis and in 24 of 34 patients with different forms of aspergillosis (of the 18 patients with invasive pulmonary aspergillosis, 15 were cured). Patients with cryptococcosis received itraconazole for active infection and/or for prevention of relapse. Active infection was treated successfully with itraconazole alone in 9 of 12 patients and with itraconazole plus flucytosine in 8 of 10 patients. Of the 31 patients who received itraconazole maintenance therapy for up to 27 months, 4 (13%) had relapses; 14 (45%) did not have relapses, and decline of serum antigen was detected in 12 of them; and 13 (42%) were completely cured (serum antigen titer dropped to zero). With the exception of hypokalemia in one patient, itraconazole was well tolerated even in patients who received the drug for several months or years.
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Affiliation(s)
- M A Viviani
- Istituto di Igiene, Universita degli Studi di Milano, Italy
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16
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Rizzardini G, Boldorini R, Vivirito MC, Berta L, Vigevani GM, Milazzo F. Primary central nervous system lymphomas in AIDS. Acta Neurol (Napoli) 1990; 12:91-4. [PMID: 2337002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- G Rizzardini
- I Divisione di Malattie Infettive, Ospedale L. Sacco Milano
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17
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Quirino T, Coen M, dal Conte I, Infuso A, Bonaccorso C, Vigevani GM, Milazzo F. Cryptococcosis of CNS in AIDS patients. Acta Neurol (Napoli) 1990; 12:88-90. [PMID: 2337000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- T Quirino
- 1a Divisione di Malattie Infettive, Ospedale L. Sacco, Milano
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18
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Milazzo F, Galli M, Fassio PG, Cargnel A, Pugliese A, Tovo PA, Vigevani GM, Esposito R, Lazzarin A, Caredda F. Attempted treatment of fulminant viral hepatitis with human fibroblast interferon. Infection 1985; 13:130-3. [PMID: 3897068 DOI: 10.1007/bf01642872] [Citation(s) in RCA: 11] [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: 01/07/2023]
Abstract
Beta-interferon was administered by intravenous infusion to 16 patients affected with fulminant hepatitis B virus infection in third or fourth-grade coma. Ten patients presented a superinfection or a co-infection due to the delta (delta)-agent. None had detectable interferon (IFN) activity before therapy was begun. Besides fever, no significant side-effects were observed during treatment. Both the IFN-treated group as well as the "historical" control group, made up of 70 cases of fulminant virus hepatitis, not treated with IFN and observed during a previous ten year-period, received supportive therapy; survival rates were similar in both groups. Furthermore, the presence or absence of the delta-agent did not appear to affect survival rates significantly.
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20
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Pugliese A, Galli M, Caredda F, Vigevani GM, Tovo PA. Absence of circulating interferon in acute viral hepatitis. Acta Virol 1984; 28:255. [PMID: 6206707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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21
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Almaviva M, Galli M, Rizzi M, Simonelli E, Negri C, Vigevani GM. Immune response in a symptomatic case of Tetrapetalonema perstans infection. Trans R Soc Trop Med Hyg 1984; 78:489-91. [PMID: 6541380 DOI: 10.1016/0035-9203(84)90069-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
The immune response in a 49-year-old Italian nun affected by Tetrapetalomena (Dipetalonema) perstans following an eight-year stay in Cameroon is reported. On admission the patient presented with polyarthralgia, conjunctival pruritus and irritation, oedema of the limbs, generalized itching, hypereosinophilia and low total IgE titre. During diethylcarbamazine treatment and, subsequently, during mebendazole administration, an exacerbation of her symptoms was observed. At the same time, activation of the alternative complement pathway and the appearance of circulating immune complexes were noted, suggesting a type III hypersensitivity reaction. Circulating immune complexes and diethylcarbamazine-induced release of parasitic antigens may also be considered responsible for the decrease of OKT3 and OKT4 positive lymphocytes.
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22
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Milazzo F, Vigevani GM, Resta M, Vitali D, Lorenzelli A. Treatment of fulminant viral hepatitis with anti-lymphocyte gamma globulins. Boll Ist Sieroter Milan 1979; 58:254-9. [PMID: 518759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Ten patients affected by fulminant viral hepatitis (F.V.H.) were treated with anti-lymphocyte globulins (A.L.G.) besides peritoneal dialysis (P.D.) and exchange blood transfusion (E.T.). Two patients awoke transiently; six recovered from F.V.H., but two of them died afterwards due to later complications. The total of complete recovery was 40%; this result is compared with those previously obtained by the Authors in 38 patients treated only with P.D. and E.T. (28.9% complete recovery), and in seven patients treated with P.D., E.T. and human anti-HBsAg gamma globulins (28.5% complete recovery). The treatment with A.L.G. was performed because of the discouraging results until now obtained with the various liver support systems and is based on the accepted view that lymphocytes might be the true effectors of cell necrosis in F.V.H.
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Milazzo F, Ghezzi E, Resta M, Brugo MA, Vitali D, Vigevani GM, Tassi GC. [Use of an immunomodulator (levamisole) in HbsAg positive patients]. Boll Ist Sieroter Milan 1978; 57:477-84. [PMID: 737040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The results of some clinical trials performed with levamisole on 12 HBsAg-positive subjects, including 5 patients with aggressive chronic hepatitis, (ACH) 2 patients with persistent chronic hepatitis (PCH) and 5 healthy carriers are reported. Levamisole was administered in 2.5 mg/Kg/day doses for three consecutive days. During treatment prothrombin activity normalized in ACH and PCH as well as transaminases, the latter starting from the 4th week, even though a two-fourfold increase of the starting values was observed in the first weeks of disease. HBsAg, anti-HBs titres and immunocomplexes values did not show any significant variations, but for 1 case, while some immunological parameters (E, EA rosettes) normalized in those cases showing base- values lower than the norm.
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Milazzo F, Vigevani GM. [Clinical trials with amoxicillin in patients with Salmonella infections]. Clin Ter 1976; 79:549-54. [PMID: 1051404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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