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Gagliardini R, Giacomelli A, Bozzi G, D'Arminio Monforte A, Tavelli A, Mazzotta V, Bruzzesi E, Cervo A, Saracino A, Mussini C, Girardi E, Cozzi-Lepri A, Antinori A. Impact of COVID-19 pandemic on retention in care of native and migrant people with HIV in the ICONA cohort. Travel Med Infect Dis 2024; 58:102691. [PMID: 38336335 DOI: 10.1016/j.tmaid.2024.102691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 12/19/2023] [Accepted: 01/26/2024] [Indexed: 02/12/2024]
Abstract
BACKGROUND COVID-19 pandemic challenged the UNAIDS 90-90-90 targets. How the COVID-19 pandemic affected HIV retention in care and whether it has disproportionally affected migrant people with HIV (PWH) remained to be investigated. METHODS PWH in ICONA Cohort in follow-up in each of the study periods were included: 01/09/2019-29/02/2020 (pandemic period) and 01/03/2018-31/08/2018 (historical period, as a control). Risk of temporary loss to follow-up (LTFU, defined as no data recorded for a person for one year) was analyzed by logistic regression, with migrant status as the main exposure variable. Difference in difference (DID) analysis was applied to evaluate the effect of COVID-19 pandemic in the different risk of LTFU between natives and migrants. RESULTS 8864 (17.1% migrants) and 8071 (16.8% migrants) PWH constituted the pandemic and the historical period population, respectively. Proportion of PWH defined as LTFU in the pandemic period was 10.5% in native and 19.6% in migrant PWH. After controlling for age, sex and geographical location of enrolling site, risk of temporary LTFU was higher for migrants than native PWH [adjusted odds ratio 1.85 (95%CI 1.54-2.22)] in pandemic period. In PWH contributing to both periods, LTFU was 9.0% (95% CI 8.3-9.8) in natives vs 17.0% (95% CI 14.7-19.4) in migrants during the pandemic. Instead, LTFU was 1.2% (95%CI 0.9, 1.5) in natives vs 2.2% (95% CI 1.3-3.1) in migrants during the historical period, with a resulting DID of 7.0% (95% CI 4.4-9.6). CONCLUSIONS A greater proportion of LTFU in migrant PWH was observed in both periods, which remained unaltered over time. Interventions to reduce LTFU of migrants are necessary.
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Affiliation(s)
- Roberta Gagliardini
- Clinical and Research Infectious Diseases Department, National Institute of Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Andrea Giacomelli
- III Infectious Disease Unit, ASST-Fatebenefratelli Sacco, Milan, Italy
| | - Giorgio Bozzi
- Infectious Diseases Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | | | | | - Valentina Mazzotta
- Clinical and Research Infectious Diseases Department, National Institute of Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Elena Bruzzesi
- UO Malattie Infettive, IRCCS Ospedale San Raffaele, Italy
| | - Adriana Cervo
- Division of Infectious Diseases, University of Modena, Modena, Italy
| | - Annalisa Saracino
- Clinic of Infectious Diseases, University Hospital, University of Bari, Bari, Italy
| | - Cristina Mussini
- Division of Infectious Diseases, University of Modena, Modena, Italy
| | - Enrico Girardi
- Scientific Direction, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Alessandro Cozzi-Lepri
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation (CREME), Institute for Global Health, University College London, London, UK
| | - Andrea Antinori
- Clinical and Research Infectious Diseases Department, National Institute of Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
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Saltini P, Tassis B, Ronchi A, Tagliabue C, Di Pietro G, Dellepiane RM, Muscatello A, Giacomelli A, Pugni L, Ferrazzi E, Bandera A, Bozzi G. Preventing HIV mother-to-child transmission in a vertically infected pregnant woman with multiclass drug resistance, role of bis-in-die dolutegravir and neonatal AZT prophylaxis: A case report. Heliyon 2024; 10:e23072. [PMID: 38163123 PMCID: PMC10754893 DOI: 10.1016/j.heliyon.2023.e23072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 11/18/2023] [Accepted: 11/26/2023] [Indexed: 01/03/2024] Open
Abstract
A suppressive antiretroviral therapy (ART) is necessary to prevent mother-to-child transmission (MTCT) of HIV during pregnancy. During this period, it is recommended to continue an ongoing safe and suppressive regimen, but history of multiclass drug-resistance (MDR) might need tailored, uncommon approaches posing tolerability and toxicity issues. This is the case of a 33 years of age, vertically infected woman with MDR HIV infection suppressed on a darunavir/cobicistat + atazanavir regimen switched during pregnancy to lamivudine + darunavir/ritonavir + dolutegravir 50 mg bis-in-die, maintaining complete viral suppression and delivering via caesarian section and without zidovudine (AZT) intrapartum prophylaxis a healthy HIV-negative newborn who received AZT post-exposure prophylaxis and showed regular growth patterns up to 2 years. Our case shows how archived MDR might complicate the preservation of HIV RNA suppression and highlights the importance of a tailored, multidisciplinary approach for pregnant women with MDR HIV and their newborns.
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Affiliation(s)
- Paola Saltini
- Infectious Diseases Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Università Degli Studi di Milano, Milan, Italy
| | - Beatrice Tassis
- Department of Woman, New-Born and Child, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Mangiagalli Centre, Milan, Italy
| | - Alice Ronchi
- Università Degli Studi di Milano, Milan, Italy
- Department of Woman, New-Born and Child, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Mangiagalli Centre, Milan, Italy
| | - Claudia Tagliabue
- Pediatric Highly Intensive Care Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giada Di Pietro
- Pediatric Highly Intensive Care Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Rosa Maria Dellepiane
- Pediatric Intermediate Intensive Care Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Antonio Muscatello
- Infectious Diseases Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Andrea Giacomelli
- III Infectious Diseases Unit, Azienda Socio-Sanitaria Territoriale-Fatebenefratelli-Sacco, Milan, Italy
| | - Lorenza Pugni
- Neonatology and Neonatal Intensive Care Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Enrico Ferrazzi
- Università Degli Studi di Milano, Milan, Italy
- Department of Woman, New-Born and Child, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Mangiagalli Centre, Milan, Italy
| | - Alessandra Bandera
- Infectious Diseases Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Università Degli Studi di Milano, Milan, Italy
| | - Giorgio Bozzi
- Infectious Diseases Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
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Peri AM, Calabretta D, Bozzi G, Migliorino GM, Bramati S, Gori A, Bandera A. Retrospective analysis of bacteraemia due to extended-spectrum beta-lactamase-producing Enterobacterales: the challenge of healthcare-associated infections. IJID Reg 2023; 6:167-170. [PMID: 36910842 PMCID: PMC9995923 DOI: 10.1016/j.ijregi.2023.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 01/10/2023] [Accepted: 01/11/2023] [Indexed: 02/24/2023]
Abstract
Objectives Healthcare-associated bacteraemia is defined as bacteraemia diagnosed ≤48 h after hospital admission in patients recently exposed to healthcare procedures or settings. It differs from hospital-acquired bacteraemia, which is diagnosed >48 h after hospital admission. Healthcare-associated bacteraemia is reported increasingly, often due to resistant pathogens including extended-spectrum beta-lactamase (ESBL) producers, representing a challenge to empirical treatment. This study aimed to assess the appropriateness of empirical treatment for ESBL bacteraemia at the authors' centre, to perform a descriptive analysis according to the mode of infection acquisition (community-acquired, healthcare-associated, hospital-acquired), and to assess the risk factors for mortality. Methods A retrospective study on patients with ESBL bacteraemia was undertaken. Results In total, 129 consecutive cases of bacteraemia due to ESBL producers were included in this study. Compared with community- and hospital-acquired bacteraemia, healthcare-associated bacteraemia affected older patients (P=0.001) and patients with higher Charlson Comorbidity Index scores (P=0.007), and was more frequently associated with piperacillin-tazobactam resistance (P=0.025) and multi-drug resistance (P=0.026). Overall, ineffective empirical treatment was common (42%). Factors associated with 30-day mortality were septic shock [odds ratio (OR) 7.096, 95% confidence interval (CI) 2.58-24.58], high Pitt score (OR 6.636, 95% CI 1.71-23.62) and unknown source of bacteraemia (OR 19.28, 95% CI 2.80-30.70). Conclusions Antimicrobial stewardship interventions focusing on both in-hospital and community settings are advocated to better manage healthcare-associated infections due to ESBL producers.
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Affiliation(s)
- Anna Maria Peri
- Infectious Diseases Unit, Department of Internal Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Davide Calabretta
- Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Italy
| | - Giorgio Bozzi
- Infectious Diseases Unit, Department of Internal Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | | | - Andrea Gori
- Infectious Diseases Unit, Department of Internal Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Pathophysiology and Transplantation, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Alessandra Bandera
- Infectious Diseases Unit, Department of Internal Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Pathophysiology and Transplantation, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
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Bozzi G, Fabeni L, Abbate I, Berno G, Muscatello A, Taramasso L, Fabbiani M, Nozza S, Tambussi G, Rusconi S, Giacomelli A, Focà E, Pinnetti C, d'Ettorre G, Mussini C, Borghi V, Celesia BM, Madeddu G, Di Biagio A, Ripamonti D, Squillace N, Antinori A, Gori A, Capobianchi MR, Bandera A. Non-B subtypes account for a large proportion of clustered primary HIV-1 infections in Italy. Sex Transm Infect 2023; 99:53-56. [PMID: 35443987 DOI: 10.1136/sextrans-2021-055289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 04/01/2022] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVES AND DESIGN Using pol sequences obtained for routine resistance testing, we characterised the molecular patterns of HIV-1 transmission and factors associated with being part of a transmission cluster among individuals who in 2008-2014 presented with primary HIV-1 infection (PHI) at 11 urban centres across Italy. METHODS Pol sequences were obtained by Sanger sequencing. Transmission clusters were identified by phylogenetic analysis (maximum likelihood method, confirmed by Bayesian analysis). Multivariable logistic regression explored factors associated with a participant being part of a transmission cluster. RESULTS The PHI cohort comprised 186 participants (159/186, 85.5% males) with median age 44 years, median CD4 count 464 cells/mm3 and median plasma HIV-1 RNA 5.6 log10 copies/mL. Drug resistance associated mutations were found in 16/186 (8.6%). A diversity of non-B subtypes accounted for 60/186 (32.3%) of all infections. A total of 17 transmission clusters were identified, including 44/186 (23.7%) participants. Each cluster comprised 2-6 sequences. Non-B subtypes accounted for seven clusters and 22/44 (50%) of clustered sequences. In multivariable logistic regression analysis, factors associated with being part of a transmission cluster comprised harbouring a non-B subtype (adjusted OR (adjOR) 2.28; 95% CI 1.03 to 5.05; p=0.04) and showing a lower plasma HIV-1 RNA (adjOR 0.80, 95% CI 0.64 to 0.99; p=0.04). CONCLUSIONS There was a large contribution of diverse non-B subtypes to transmission clusters among people presenting with acute or recent HIV-1 infection in this cohort, illustrating the evolving dynamics of the HIV-1 epidemic in Italy, where subtype B previously dominated.
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Affiliation(s)
- Giorgio Bozzi
- Infectious Diseases Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico - Milan, Milan, Lombardia, Italy
| | - Lavinia Fabeni
- Virology and Biosafety Laboratories Unit and HIV/AIDS Clinical Unit, National Institute for Infectious Diseases, "Lazzaro Spallanzani"- IRCCS Rome, Rome, Italy
| | - Isabella Abbate
- Virology and Biosafety Laboratories Unit and HIV/AIDS Clinical Unit, National Institute for Infectious Diseases, "Lazzaro Spallanzani"- IRCCS Rome, Rome, Italy
| | - Giulia Berno
- Virology and Biosafety Laboratories Unit and HIV/AIDS Clinical Unit, National Institute for Infectious Diseases, "Lazzaro Spallanzani"- IRCCS Rome, Rome, Italy
| | - Antonio Muscatello
- Infectious Diseases Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico - Milan, Milan, Lombardia, Italy
| | - Lucia Taramasso
- Infectious Diseases Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico - Milan, Milan, Lombardia, Italy.,Infection Diseases Unit, IRCCS Policlinico San Martino Hospital, Genoa, Italy
| | - Massimiliano Fabbiani
- Infectious and Tropical Diseases Unit, Azienda Ospedaliero-Universitaria Senese, Siena, Italy
| | - Silvia Nozza
- Clinic of Infectious Diseases, San Raffaele Hospital, University Vita Salute, Milan, Italy
| | - Giuseppe Tambussi
- Clinic of Infectious Diseases, San Raffaele Hospital, University Vita Salute, Milan, Italy
| | - Stefano Rusconi
- Infectious Diseases Unit, Department of Biomedical and Clinical Sciences "Luigi Sacco" Hospital, University of Milan, Milan, Italy.,Infectious Diseases Unit, Ospedale Civile di Legnano, ASST Ovest Milanese, Legnano, Italy
| | - Andrea Giacomelli
- Infectious Diseases Unit, Department of Biomedical and Clinical Sciences "Luigi Sacco" Hospital, University of Milan, Milan, Italy
| | - Emanuele Focà
- Division of Infectious and Tropical Diseases, University of Brescia, ASST Spedali Civili Hospital, Brescia, Italy
| | - Carmela Pinnetti
- Virology and Biosafety Laboratories Unit and HIV/AIDS Clinical Unit, National Institute for Infectious Diseases, "Lazzaro Spallanzani"- IRCCS Rome, Rome, Italy
| | - Gabriella d'Ettorre
- Infectious Diseases Unit, Umberto I Hospital, La Sapienza University, Rome, Rome, Italy
| | - Cristina Mussini
- Clinic of Infectious Diseases, University of Modena and Reggio Emilia, Modena Hospital, Modena, Italy
| | - Vanni Borghi
- Clinic of Infectious Diseases, University of Modena and Reggio Emilia, Modena Hospital, Modena, Italy
| | | | - Giordano Madeddu
- Department of Medical, Surgical and Experimental Sciences, Unit of Infectious Diseases, University of Sassari, Sassari, Italy
| | - Antonio Di Biagio
- Department of Health Sciences (DiSSal), University of Genoa, Italy, Genoa, Italy
| | - Diego Ripamonti
- Division of Infectious Diseases, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Nicola Squillace
- Infectious Diseases Unit, Department of Internal Medicine, ASST San Gerardo, Monza, Italy
| | - Andrea Antinori
- Virology and Biosafety Laboratories Unit and HIV/AIDS Clinical Unit, National Institute for Infectious Diseases, "Lazzaro Spallanzani"- IRCCS Rome, Rome, Italy
| | - Andrea Gori
- Infectious Diseases Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico - Milan, Milan, Lombardia, Italy.,Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Maria Rosaria Capobianchi
- Virology and Biosafety Laboratories Unit and HIV/AIDS Clinical Unit, National Institute for Infectious Diseases, "Lazzaro Spallanzani"- IRCCS Rome, Rome, Italy
| | - Alessandra Bandera
- Infectious Diseases Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico - Milan, Milan, Lombardia, Italy.,Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
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Peta JA, Coti Zelati G, Tirelli R, Caronni M, Furlan L, Dalla Porta M, Rossi FG, Croci GA, Bozzi G, Milani O. Diagnostic challenges: strange presentation for a common disease-a case of fever with splenic involvement of unknown nature in a peripheral T-cell lymphoma treated with alemtuzumab. Intern Emerg Med 2022; 17:1753-1757. [PMID: 35737178 DOI: 10.1007/s11739-022-03007-8] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 05/14/2022] [Indexed: 11/25/2022]
Affiliation(s)
- Jacopo Alessandro Peta
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
- Division of Internal Medicine, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy.
| | - Giulia Coti Zelati
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- Division of Internal Medicine, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Riccardo Tirelli
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- Division of Internal Medicine, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Monica Caronni
- Division of Internal Medicine, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Ludovico Furlan
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- Division of Internal Medicine, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Francesca Gaia Rossi
- Division of Hematology, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Giorgio Alberto Croci
- Division of Pathology, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Giorgio Bozzi
- Division of Infectious Disease, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Olivia Milani
- Division of Internal Medicine, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
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Palomba E, Liparoti A, Tonizzo A, Castelli V, Alagna L, Bozzi G, Ungaro R, Muscatello A, Gori A, Bandera A. Nocardia Infections in the Immunocompromised Host: A Case Series and Literature Review. Microorganisms 2022; 10:microorganisms10061120. [PMID: 35744638 PMCID: PMC9229660 DOI: 10.3390/microorganisms10061120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 05/10/2022] [Revised: 05/25/2022] [Accepted: 05/27/2022] [Indexed: 02/01/2023] Open
Abstract
Nocardia is primarily considered an opportunistic pathogen and affects patients with impaired immune systems, solid-organ transplant recipients (SOTRs), and patients with haematologic malignancies. We present the cases of six patients diagnosed with nocardiosis at our center in the last two years, describing the various predisposing conditions alongside the clinical manifestation, the diagnostic workup, and the treatment course. Moreover, we propose a brief literature review on Nocardia infections in the immunocompromised host, focusing on SOTRs and haematopoietic stem cell transplantation recipients and highlighting risk factors, clinical presentations, the diagnostic tools available, and current treatment and prophylaxis guidelines.
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Affiliation(s)
- Emanuele Palomba
- Infectious Diseases Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milano, Italy; (A.L.); (A.T.); (V.C.); (L.A.); (G.B.); (R.U.); (A.M.); (A.G.); (A.B.)
- Department of Pathophysiology and Transplantation, University of Milano, 20133 Milano, Italy
- Correspondence: ; Tel.: +39-349-4073517
| | - Arianna Liparoti
- Infectious Diseases Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milano, Italy; (A.L.); (A.T.); (V.C.); (L.A.); (G.B.); (R.U.); (A.M.); (A.G.); (A.B.)
- Department of Pathophysiology and Transplantation, University of Milano, 20133 Milano, Italy
| | - Anna Tonizzo
- Infectious Diseases Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milano, Italy; (A.L.); (A.T.); (V.C.); (L.A.); (G.B.); (R.U.); (A.M.); (A.G.); (A.B.)
- Department of Pathophysiology and Transplantation, University of Milano, 20133 Milano, Italy
| | - Valeria Castelli
- Infectious Diseases Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milano, Italy; (A.L.); (A.T.); (V.C.); (L.A.); (G.B.); (R.U.); (A.M.); (A.G.); (A.B.)
- Department of Pathophysiology and Transplantation, University of Milano, 20133 Milano, Italy
| | - Laura Alagna
- Infectious Diseases Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milano, Italy; (A.L.); (A.T.); (V.C.); (L.A.); (G.B.); (R.U.); (A.M.); (A.G.); (A.B.)
| | - Giorgio Bozzi
- Infectious Diseases Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milano, Italy; (A.L.); (A.T.); (V.C.); (L.A.); (G.B.); (R.U.); (A.M.); (A.G.); (A.B.)
| | - Riccardo Ungaro
- Infectious Diseases Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milano, Italy; (A.L.); (A.T.); (V.C.); (L.A.); (G.B.); (R.U.); (A.M.); (A.G.); (A.B.)
| | - Antonio Muscatello
- Infectious Diseases Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milano, Italy; (A.L.); (A.T.); (V.C.); (L.A.); (G.B.); (R.U.); (A.M.); (A.G.); (A.B.)
| | - Andrea Gori
- Infectious Diseases Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milano, Italy; (A.L.); (A.T.); (V.C.); (L.A.); (G.B.); (R.U.); (A.M.); (A.G.); (A.B.)
- Department of Pathophysiology and Transplantation, University of Milano, 20133 Milano, Italy
| | - Alessandra Bandera
- Infectious Diseases Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milano, Italy; (A.L.); (A.T.); (V.C.); (L.A.); (G.B.); (R.U.); (A.M.); (A.G.); (A.B.)
- Department of Pathophysiology and Transplantation, University of Milano, 20133 Milano, Italy
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7
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Bozzi G, Saltini P, Matera M, Morena V, Castelli V, Peri AM, Taramasso L, Ungaro R, Lombardi A, Muscatello A, Bono P, Grancini A, Maraschini A, Matinato C, Gori A, Bandera A. Pneumocystis jirovecii pneumonia in HIV-negative patients, a frequently overlooked problem. A case series from a large Italian center. Int J Infect Dis 2022; 121:172-176. [PMID: 35568363 DOI: 10.1016/j.ijid.2022.05.024] [Citation(s) in RCA: 3] [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: 03/14/2022] [Revised: 05/06/2022] [Accepted: 05/08/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Pneumocystis jirovecii pneumonia (PCP) still has substantial morbidity and mortality. For non-HIV patients, the course of infection is severe, and management guidelines are relatively recent. We collected all PCP cases (European Organization for Research and Treatment of Cancer criteria) diagnosed in HIV-negative adult inpatients in 2019-2020 at our center in northern Italy. RESULTS Of 20 cases, nine had microbiologic evidence of probable (real-time polymerase chain reaction, RT-PCR) and 11 proven (immunofluorescence) PCP on respiratory specimens. Half were female; the median age was 71.5 years; 14 of 20 patients had hematologic malignancies, five had autoimmune/hyperinflammatory disorders, and one had a solid tumor. RT-PCR cycle threshold (Ct) was 24-37 for bronchoalveolar lavage (BAL) and 32-39 for sputum; Ct was 24-33 on BAL proven cases. Of 20 cases, four received additional diagnoses on BAL. At PCP diagnosis, all patients were not on anti-pneumocystis prophylaxis. We retrospectively assessed prophylaxis indications: 9/20 patients had a main indication, 5/9 because of prednisone treatment ≥ 20 mg (or equivalents) for ≥4 weeks. All patients underwent antimicrobial treatment according to guidelines; 18/20 with concomitant corticosteroids. A total of 4/20 patients died within 28 days from diagnosis. CONCLUSION Despite appropriate treatment, PCP is still associated to high mortality (20%) among non-HIV patients. Strict adherence to prophylaxis guidelines, awareness of gray areas, and prompt diagnosis can help manage this frequently overlooked infection.
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Affiliation(s)
- Giorgio Bozzi
- Infectious Diseases Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Via Francesco Sforza, 35, 20122, Milan, Italy.
| | - Paola Saltini
- Infectious Diseases Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Via Francesco Sforza, 35, 20122, Milan, Italy; Department of Pathophysiology and Transplantation, University of Milan, Via Francesco Sforza, 35, 20122, Milan, Italy
| | - Malvina Matera
- Infectious Diseases Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Via Francesco Sforza, 35, 20122, Milan, Italy
| | - Valentina Morena
- Department of Pathophysiology and Transplantation, University of Milan, Via Francesco Sforza, 35, 20122, Milan, Italy; III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milan, Italy Via Giovanni Battista Grassi, 74, 20157, Milano, Italy
| | - Valeria Castelli
- Infectious Diseases Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Via Francesco Sforza, 35, 20122, Milan, Italy; Department of Pathophysiology and Transplantation, University of Milan, Via Francesco Sforza, 35, 20122, Milan, Italy
| | - Anna Maria Peri
- Infectious Diseases Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Via Francesco Sforza, 35, 20122, Milan, Italy
| | - Lucia Taramasso
- Infectious Diseases Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Via Francesco Sforza, 35, 20122, Milan, Italy; Department of Pathophysiology and Transplantation, University of Milan, Via Francesco Sforza, 35, 20122, Milan, Italy
| | - Riccardo Ungaro
- Infectious Diseases Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Via Francesco Sforza, 35, 20122, Milan, Italy
| | - Andrea Lombardi
- Infectious Diseases Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Via Francesco Sforza, 35, 20122, Milan, Italy; Department of Pathophysiology and Transplantation, University of Milan, Via Francesco Sforza, 35, 20122, Milan, Italy
| | - Antonio Muscatello
- Infectious Diseases Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Via Francesco Sforza, 35, 20122, Milan, Italy
| | - Patrizia Bono
- Medical Laboratory of Clinical Chemistry and Microbiology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza, 35, 20122, Milan, Italy
| | - Anna Grancini
- Medical Laboratory of Clinical Chemistry and Microbiology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza, 35, 20122, Milan, Italy
| | - Anna Maraschini
- Medical Laboratory of Clinical Chemistry and Microbiology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza, 35, 20122, Milan, Italy
| | - Caterina Matinato
- Medical Laboratory of Clinical Chemistry and Microbiology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza, 35, 20122, Milan, Italy
| | - Andrea Gori
- Infectious Diseases Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Via Francesco Sforza, 35, 20122, Milan, Italy; Department of Pathophysiology and Transplantation, University of Milan, Via Francesco Sforza, 35, 20122, Milan, Italy
| | - Alessandra Bandera
- Infectious Diseases Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Via Francesco Sforza, 35, 20122, Milan, Italy; Department of Pathophysiology and Transplantation, University of Milan, Via Francesco Sforza, 35, 20122, Milan, Italy
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8
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Lombardi A, Saydere A, Ungaro R, Bozzi G, Viero G, Bandera A, Gori A, Mondelli MU. Infectious events in patients treated with immune checkpoint inhibitors, chimeric antigen receptor T cells and Bi-specific T-cell engagers: a review of registration studies. Int J Infect Dis 2022; 120:77-82. [DOI: 10.1016/j.ijid.2022.04.022] [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] [Received: 03/22/2022] [Revised: 04/07/2022] [Accepted: 04/08/2022] [Indexed: 10/18/2022] Open
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9
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Bozzi G, Lombardi A, Ludovisi S, Muscatello A, Manganaro L, Cattaneo D, Gori A, Bandera A. Transient increase in plasma HIV RNA after COVID-19 vaccination with mRNA-1272. Int J Infect Dis 2021; 113:125-126. [PMID: 34666164 PMCID: PMC8520177 DOI: 10.1016/j.ijid.2021.10.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Revised: 10/07/2021] [Accepted: 10/08/2021] [Indexed: 01/04/2023] Open
Affiliation(s)
- Giorgio Bozzi
- Infectious Diseases Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Andrea Lombardi
- Infectious Diseases Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.
| | - Serena Ludovisi
- Infectious Diseases Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Antonio Muscatello
- Infectious Diseases Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Lara Manganaro
- Infectious Diseases Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; "Romeo ed Enrica Invernizzi", Istituto Nazionale di Genetica Molecolare (INGM), Milan, Italy
| | - Dario Cattaneo
- Unit of Clinical Pharmacology, ASST Fatebenefratelli Sacco University Hospital, Milan, Italy
| | - Andrea Gori
- Infectious Diseases Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Alessandra Bandera
- Infectious Diseases Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
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10
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Bozzi G, Meneri M, Peri AM, Taramasso L, Muscatello A, Bandera A, Comi GP, Gori A. Starting HIV therapy in patients with mitochondrial disease. AIDS 2021; 35:2063-2065. [PMID: 34471077 DOI: 10.1097/qad.0000000000002996] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Giorgio Bozzi
- Infectious Disease Unit, Department of Internal Medicine
| | - Megi Meneri
- Neurology Unit, Department of Internal Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico
| | | | | | | | - Alessandra Bandera
- Infectious Disease Unit, Department of Internal Medicine
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Giacomo Pietro Comi
- Neurology Unit, Department of Internal Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Andrea Gori
- Infectious Disease Unit, Department of Internal Medicine
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
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11
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Castelli V, Lombardi A, Palomba E, Bozzi G, Ungaro R, Alagna L, Mangioni D, Muscatello A, Bandera A, Gori A. Immune Checkpoint Inhibitors in People Living with HIV/AIDS: Facts and Controversies. Cells 2021; 10:2227. [PMID: 34571876 PMCID: PMC8467545 DOI: 10.3390/cells10092227] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [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: 06/28/2021] [Revised: 08/21/2021] [Accepted: 08/26/2021] [Indexed: 12/16/2022] Open
Abstract
Immune checkpoint inhibitors (ICIs) are reshaping the landscape of cancer treatment, redefining the prognosis of several tumors. They act by restoring the cytotoxic activity of tumor-specific T lymphocytes that are in a condition of immune exhaustion. The same condition has been widely described in chronic HIV infection. In this review, we dissect the role of ICIs in people living with HIV/AIDS (PLWHIV). First, we provide an overview of the immunologic scenario. Second, we discuss the possible use of ICIs as adjuvant treatment of HIV to achieve elimination of the viral reservoir. Third, we examine the influence of HIV infection on ICI safety and effectiveness. Finally, we describe how the administration of ICIs impacts opportunistic infections.
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Affiliation(s)
- Valeria Castelli
- Infectious Diseases Unit, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milano, Italy; (V.C.); (E.P.); (G.B.); (R.U.); (L.A.); (D.M.); (A.M.); (A.B.); (A.G.)
| | - Andrea Lombardi
- Infectious Diseases Unit, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milano, Italy; (V.C.); (E.P.); (G.B.); (R.U.); (L.A.); (D.M.); (A.M.); (A.B.); (A.G.)
- Department of Pathophysiology and Transplantation, University of Milano, 20122 Milano, Italy
| | - Emanuele Palomba
- Infectious Diseases Unit, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milano, Italy; (V.C.); (E.P.); (G.B.); (R.U.); (L.A.); (D.M.); (A.M.); (A.B.); (A.G.)
| | - Giorgio Bozzi
- Infectious Diseases Unit, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milano, Italy; (V.C.); (E.P.); (G.B.); (R.U.); (L.A.); (D.M.); (A.M.); (A.B.); (A.G.)
| | - Riccardo Ungaro
- Infectious Diseases Unit, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milano, Italy; (V.C.); (E.P.); (G.B.); (R.U.); (L.A.); (D.M.); (A.M.); (A.B.); (A.G.)
| | - Laura Alagna
- Infectious Diseases Unit, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milano, Italy; (V.C.); (E.P.); (G.B.); (R.U.); (L.A.); (D.M.); (A.M.); (A.B.); (A.G.)
| | - Davide Mangioni
- Infectious Diseases Unit, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milano, Italy; (V.C.); (E.P.); (G.B.); (R.U.); (L.A.); (D.M.); (A.M.); (A.B.); (A.G.)
| | - Antonio Muscatello
- Infectious Diseases Unit, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milano, Italy; (V.C.); (E.P.); (G.B.); (R.U.); (L.A.); (D.M.); (A.M.); (A.B.); (A.G.)
| | - Alessandra Bandera
- Infectious Diseases Unit, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milano, Italy; (V.C.); (E.P.); (G.B.); (R.U.); (L.A.); (D.M.); (A.M.); (A.B.); (A.G.)
- Department of Pathophysiology and Transplantation, University of Milano, 20122 Milano, Italy
- Centre for Multidisciplinary Research in Health Science (MACH), University of Milano, 20122 Milano, Italy
| | - Andrea Gori
- Infectious Diseases Unit, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milano, Italy; (V.C.); (E.P.); (G.B.); (R.U.); (L.A.); (D.M.); (A.M.); (A.B.); (A.G.)
- Department of Pathophysiology and Transplantation, University of Milano, 20122 Milano, Italy
- Centre for Multidisciplinary Research in Health Science (MACH), University of Milano, 20122 Milano, Italy
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12
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Peri AM, Cagliani R, Bozzi G, Pompa A, Manganaro L, Baldini L, Gori A, Bandera A. Chromosomally integrated human herpesvirus 6 (ci-HHV-6) in autologous bone marrow transplant recipients: are we missing a reactivation or is it just mimicking? J Clin Virol 2021; 139:104823. [PMID: 33910132 DOI: 10.1016/j.jcv.2021.104823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 04/07/2021] [Accepted: 04/08/2021] [Indexed: 11/27/2022]
Affiliation(s)
- Anna Maria Peri
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Infectious Diseases Unit, Departement of Internal Medicine, Milan, Italy.
| | - Rachele Cagliani
- Bioinformatics, Scientific Institute, IRCCS E. MEDEA, 23842 Bosisio Parini, Lecco, Italy
| | - Giorgio Bozzi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Infectious Diseases Unit, Departement of Internal Medicine, Milan, Italy
| | - Alessandra Pompa
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico and University of Milan, Hematology Unit, Milan, Italy
| | - Lara Manganaro
- INGM, National Institute of Molecular Genetics, Romeo ed Enrica Invernizzi, Milan, Italy
| | - Luca Baldini
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico and University of Milan, Hematology Unit, Milan, Italy
| | - Andrea Gori
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Infectious Diseases Unit, Departement of Internal Medicine, Milan, Italy; Università degli Studi di Milano, Department of Pathophysiology and Transplantation, Milan, Italy. Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico
| | - Alessandra Bandera
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Infectious Diseases Unit, Departement of Internal Medicine, Milan, Italy; Università degli Studi di Milano, Department of Pathophysiology and Transplantation, Milan, Italy. Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico
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13
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Lombardi A, Bozzi G, Ungaro R, Villa S, Castelli V, Mangioni D, Muscatello A, Gori A, Bandera A. Mini Review Immunological Consequences of Immunization With COVID-19 mRNA Vaccines: Preliminary Results. Front Immunol 2021; 12:657711. [PMID: 33777055 PMCID: PMC7994748 DOI: 10.3389/fimmu.2021.657711] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Accepted: 02/22/2021] [Indexed: 12/12/2022] Open
Abstract
Background: BNT162b2 and mRNA-1273 are the two recently approved mRNA-based vaccines against COVID-19 which has shown excellent safety and efficacy. Preliminary data about specific and neutralizing antibodies is available covering the first 100 days after vaccination. Methods: We reviewed all the publications regarding the immunologic consequences of BNT162b2 and mRNA-1273 vaccination. A summary of specific antibodies concentration and neutralizing antibodies titers elicited by each vaccine is provided. Results: BNT162b2 and mRNA-1273 displayed a reassuring safety and efficacy profile, with the latter above 94%. They can elicit specific antibodies titers and neutralizing antibodies concentrations that are far superior from those observed among COVID-19 human convalescent serum, across a wide span of age, for at least 100 days after vaccination. Moreover, the vaccine-induced T cellular response is oriented toward a TH1 response and no evidence of vaccine-enhanced disease have been reported. Discussion: BNT162b2 and mRNA-1273 can elicit specific antibodies titers and neutralizing antibodies concentrations above those observed among COVID-19 human convalescent serum in the first 100 days after vaccination. Data about vaccine efficacy in those with previous COVID-19 or immunocompromised is still limited.
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Affiliation(s)
- Andrea Lombardi
- Infectious Diseases Unit, Foundation Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milano, Milan, Italy
| | - Giorgio Bozzi
- Infectious Diseases Unit, Foundation Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Riccardo Ungaro
- Infectious Diseases Unit, Foundation Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Simone Villa
- Center for Multidisciplinary Research in Health Science (MACH), University of Milano, Milan, Italy
| | - Valeria Castelli
- Infectious Diseases Unit, Foundation Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Davide Mangioni
- Infectious Diseases Unit, Foundation Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Antonio Muscatello
- Infectious Diseases Unit, Foundation Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Andrea Gori
- Infectious Diseases Unit, Foundation Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milano, Milan, Italy
- Center for Multidisciplinary Research in Health Science (MACH), University of Milano, Milan, Italy
| | - Alessandra Bandera
- Infectious Diseases Unit, Foundation Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milano, Milan, Italy
- Center for Multidisciplinary Research in Health Science (MACH), University of Milano, Milan, Italy
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14
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Bozzi G, Mangioni D, Minoia F, Aliberti S, Grasselli G, Barbetta L, Castelli V, Palomba E, Alagna L, Lombardi A, Ungaro R, Agostoni C, Baldini M, Blasi F, Cesari M, Costantino G, Fracanzani AL, Montano N, Monzani V, Pesenti A, Peyvandi F, Sottocorno M, Muscatello A, Filocamo G, Gori A, Bandera A. Anakinra combined with methylprednisolone in patients with severe COVID-19 pneumonia and hyperinflammation: An observational cohort study. J Allergy Clin Immunol 2020; 147:561-566.e4. [PMID: 33220354 PMCID: PMC7674131 DOI: 10.1016/j.jaci.2020.11.006] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 11/01/2020] [Accepted: 11/06/2020] [Indexed: 12/15/2022]
Abstract
Background Immunomodulants have been proposed to mitigate severe acute respiratory syndrome coronavirus 2–induced cytokine storm, which drives acute respiratory distress syndrome in coronavirus disease 2019 (COVID-19). Objective We sought to determine efficacy and safety of the association of IL-1 receptor antagonist anakinra plus methylprednisolone in severe COVID-19 pneumonia with hyperinflammation. Methods A secondary analysis of prospective observational cohort studies was carried out at an Italian tertiary health care facility. COVID-19 patients consecutively hospitalized (February 25, 2020, to March 30, 2020) with hyperinflammation (ferritin ≥1000 ng/mL and/or C-reactive protein >10 mg/dL) and respiratory failure (oxygen therapy from 0.4 FiO2 Venturi mask to invasive mechanical ventilation) were evaluated to investigate the effect of high-dose anakinra plus methylprednisolone on survival. Patients were followed from study inclusion to day 28 or death. Crude and adjusted (sex, age, baseline PaO2:FiO2 ratio, Charlson index, baseline mechanical ventilation, hospitalization to inclusion lapse) risks were calculated (Cox proportional regression model). Results A total of 120 COVID-19 patients with hyperinflammation (median age, 62 years; 80.0% males; median PaO2:FiO2 ratio, 151; 32.5% on mechanical ventilation) were evaluated. Of these, 65 were treated with anakinra and methylprednisolone and 55 were untreated historical controls. At 28 days, mortality was 13.9% in treated patients and 35.6% in controls (Kaplan-Meier plots, P = .005). Unadjusted and adjusted risk of death was significantly lower for treated patients compared with controls (hazard ratio, 0.33, 95% CI, 0.15-0.74, P = .007, and HR, 0.18, 95% CI, 0.07-0.50, P = .001, respectively). No significant differences in bloodstream infections or laboratory alterations were registered. Conclusions Treatment with anakinra plus methylprednisolone may be a valid therapeutic option in COVID-19 patients with hyperinflammation and respiratory failure, also on mechanical ventilation. Randomized controlled trials including the use of either agent alone are needed to confirm these results.
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Affiliation(s)
- Giorgio Bozzi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Infectious Disease Unit, Milan, Italy
| | - Davide Mangioni
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Infectious Disease Unit, Milan, Italy; Department of Medical Biotechnology and Translational Medicine, University of Milan, Milan, Italy.
| | - Francesca Minoia
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, UOC Pediatria a Media Intensità di Cure, Milan, Italy
| | - Stefano Aliberti
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Respiratory Unit and Cystic Fibrosis Adult Center, Milan, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Giacomo Grasselli
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Department of Anesthesia, Critical Care and Emergency, Milan, Italy
| | - Laura Barbetta
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Acute Medical Unit, Milan, Italy
| | - Valeria Castelli
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Infectious Disease Unit, Milan, Italy
| | - Emanuele Palomba
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Infectious Disease Unit, Milan, Italy
| | - Laura Alagna
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Infectious Disease Unit, Milan, Italy
| | - Andrea Lombardi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Infectious Disease Unit, Milan, Italy
| | - Riccardo Ungaro
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Infectious Disease Unit, Milan, Italy
| | - Carlo Agostoni
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, UOC Pediatria a Media Intensità di Cure, Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Marina Baldini
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Internal Medicine Unit, Milan, Italy
| | - Francesco Blasi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Respiratory Unit and Cystic Fibrosis Adult Center, Milan, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Matteo Cesari
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Geriatric Unit, Milan, Italy
| | - Giorgio Costantino
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Department of Anesthesia, Critical Care and Emergency, Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Anna Ludovica Fracanzani
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Internal Medicine and Metabolic Diseases Unit, Milan, Italy
| | - Nicola Montano
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Internal Medicine, Immunology and Allergology Unit, Milan, Italy
| | - Valter Monzani
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Acute Medical Unit, Milan, Italy
| | - Antonio Pesenti
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Department of Anesthesia, Critical Care and Emergency, Milan, Italy
| | - Flora Peyvandi
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Internal Medicine and Hemostasis and Thrombosis Unit, Milan, Italy
| | - Marcello Sottocorno
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Hospital Pharmacy, Milan, Italy
| | - Antonio Muscatello
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Infectious Disease Unit, Milan, Italy
| | - Giovanni Filocamo
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, UOC Pediatria a Media Intensità di Cure, Milan, Italy
| | - Andrea Gori
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Infectious Disease Unit, Milan, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy; Centre for Multidisciplinary Research in Health Science, University of Milan, Milan, Italy
| | - Alessandra Bandera
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Infectious Disease Unit, Milan, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy; Centre for Multidisciplinary Research in Health Science, University of Milan, Milan, Italy
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15
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Aliberti S, Amati F, Pappalettera M, Di Pasquale M, D'Adda A, Mantero M, Gramegna A, Simonetta E, Oneta AM, Privitera E, Gori A, Bozzi G, Peyvandi F, Minoia F, Filocamo G, Abbruzzese C, Vicenzi M, Tagliabue P, Alongi S, Blasi F. COVID-19 multidisciplinary high dependency unit: the Milan model. Respir Res 2020; 21:260. [PMID: 33036610 PMCID: PMC7545383 DOI: 10.1186/s12931-020-01516-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 09/21/2020] [Indexed: 12/14/2022] Open
Abstract
COVID-19 is a complex and heterogeneous disease. The pathogenesis and the complications of the disease are not fully elucidated, and increasing evidence shows that SARS-CoV-2 causes a systemic inflammatory disease rather than a pulmonary disease. The management of hospitalized patients in COVID-19 dedicated units is advisable for segregation purpose as well as for infection control. In this article we present the standard operating procedures of our COVID-19 high dependency unit of the Policlinico Hospital, in Milan. Our high dependency unit is based on a multidisciplinary approach. We think that the multidisciplinary involvement of several figures can better identify treatable traits of COVID-19 disease, early identify patients who can quickly deteriorate, particularly patients with multiple comorbidities, and better manage complications related to off-label treatments. Although no generalizable to other hospitals and different healthcare settings, we think that our experience and our point of view can be helpful for countries and hospitals that are now starting to face the COVID-19 outbreak.
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Affiliation(s)
- Stefano Aliberti
- IRCCS Fondazione Ca' Granda Ospedale Maggiore Policlinico, Respiratory Unit and Cystic Fibrosis Adult Center, Via Francesco Sforza 35, 20122, Milan, Italy.
- University of Milan, Department of Pathophysiology and Transplantation, Milan, Italy.
| | - Francesco Amati
- IRCCS Fondazione Ca' Granda Ospedale Maggiore Policlinico, Respiratory Unit and Cystic Fibrosis Adult Center, Via Francesco Sforza 35, 20122, Milan, Italy
- University of Milan, Department of Pathophysiology and Transplantation, Milan, Italy
| | - Maria Pappalettera
- IRCCS Fondazione Ca' Granda Ospedale Maggiore Policlinico, Respiratory Unit and Cystic Fibrosis Adult Center, Via Francesco Sforza 35, 20122, Milan, Italy
- University of Milan, Department of Pathophysiology and Transplantation, Milan, Italy
| | - Marta Di Pasquale
- IRCCS Fondazione Ca' Granda Ospedale Maggiore Policlinico, Respiratory Unit and Cystic Fibrosis Adult Center, Via Francesco Sforza 35, 20122, Milan, Italy
- University of Milan, Department of Pathophysiology and Transplantation, Milan, Italy
| | - Alice D'Adda
- IRCCS Fondazione Ca' Granda Ospedale Maggiore Policlinico, Respiratory Unit and Cystic Fibrosis Adult Center, Via Francesco Sforza 35, 20122, Milan, Italy
- University of Milan, Department of Pathophysiology and Transplantation, Milan, Italy
| | - Marco Mantero
- IRCCS Fondazione Ca' Granda Ospedale Maggiore Policlinico, Respiratory Unit and Cystic Fibrosis Adult Center, Via Francesco Sforza 35, 20122, Milan, Italy
- University of Milan, Department of Pathophysiology and Transplantation, Milan, Italy
| | - Andrea Gramegna
- IRCCS Fondazione Ca' Granda Ospedale Maggiore Policlinico, Respiratory Unit and Cystic Fibrosis Adult Center, Via Francesco Sforza 35, 20122, Milan, Italy
- University of Milan, Department of Pathophysiology and Transplantation, Milan, Italy
| | - Edoardo Simonetta
- IRCCS Fondazione Ca' Granda Ospedale Maggiore Policlinico, Respiratory Unit and Cystic Fibrosis Adult Center, Via Francesco Sforza 35, 20122, Milan, Italy
- University of Milan, Department of Pathophysiology and Transplantation, Milan, Italy
| | - Anna Maria Oneta
- IRCCS Fondazione Ca' Granda Ospedale Maggiore Policlinico, Respiratory Unit and Cystic Fibrosis Adult Center, Via Francesco Sforza 35, 20122, Milan, Italy
- University of Milan, Department of Pathophysiology and Transplantation, Milan, Italy
| | - Emilia Privitera
- IRCCS Fondazione Ca' Granda Ospedale Maggiore Policlinico, Respiratory Unit and Cystic Fibrosis Adult Center, Via Francesco Sforza 35, 20122, Milan, Italy
- University of Milan, Department of Pathophysiology and Transplantation, Milan, Italy
| | - Andrea Gori
- University of Milan, Department of Pathophysiology and Transplantation, Milan, Italy
- Infectious Disease Unit, Department of Internal Medicine, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Giorgio Bozzi
- University of Milan, Department of Pathophysiology and Transplantation, Milan, Italy
- Infectious Disease Unit, Department of Internal Medicine, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Flora Peyvandi
- University of Milan, Department of Pathophysiology and Transplantation, Milan, Italy
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Milan, Italy
| | - Francesca Minoia
- Pediatric Rheumatology, Medium Intensity Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giovanni Filocamo
- Pediatric Rheumatology, Medium Intensity Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Chiara Abbruzzese
- University of Milan, Department of Pathophysiology and Transplantation, Milan, Italy
- Departement of Anesthesiology, Intensive Care and Emergency, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Marco Vicenzi
- University of Milan, Department of Pathophysiology and Transplantation, Milan, Italy
- Cardiovascular Disease Unit, Internal Medicine Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Dyspnea Lab, Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Paola Tagliabue
- University of Milan, Department of Pathophysiology and Transplantation, Milan, Italy
- Departement of Anesthesiology, Intensive Care and Emergency, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Salvatore Alongi
- University of Milan, Department of Pathophysiology and Transplantation, Milan, Italy
- Departement of Anesthesiology, Intensive Care and Emergency, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Francesco Blasi
- IRCCS Fondazione Ca' Granda Ospedale Maggiore Policlinico, Respiratory Unit and Cystic Fibrosis Adult Center, Via Francesco Sforza 35, 20122, Milan, Italy
- University of Milan, Department of Pathophysiology and Transplantation, Milan, Italy
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Lombardi A, Consonni D, Carugno M, Bozzi G, Mangioni D, Muscatello A, Castelli V, Palomba E, Cantù AP, Ceriotti F, Tiso B, Pesatori AC, Riboldi L, Bandera A, Lunghi G, Gori A. Characteristics of 1573 healthcare workers who underwent nasopharyngeal swab testing for SARS-CoV-2 in Milan, Lombardy, Italy. Clin Microbiol Infect 2020; 26:1413.e9-1413.e13. [PMID: 32569835 PMCID: PMC7305713 DOI: 10.1016/j.cmi.2020.06.013] [Citation(s) in RCA: 82] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 06/09/2020] [Accepted: 06/13/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVES The management of healthcare workers (HCWs) exposed to confirmed cases of coronavirus disease 2019 (COVID-19) is still a matter of debate. We aimed to assess in this group the attack rate of asymptomatic carriers and the symptoms most frequently associated with infection. METHODS Occupational and clinical characteristics of HCWs who underwent nasopharyngeal swab testing for the detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in a university hospital from 24 February 2020 to 31 March 2020 were collected. For those who tested positive and for those who tested positive but who were asymptomatic, we checked the laboratory and clinical data as of 22 May to calculate the time necessary for HCWs to then test negative and to verify whether symptoms developed thereafter. Frequencies of positive tests were compared according to selected variables using multivariable logistic regression models. RESULTS There were 139 positive tests (8.8%) among 1573 HCWs (95% confidence interval, 7.5-10.3), with a marked difference between symptomatic (122/503, 24.2%) and asymptomatic (17/1070, 1.6%) workers (p < 0.001). Physicians were the group with the highest frequency of positive tests (61/582, 10.5%), whereas clerical workers and technicians had the lowest frequency (5/137, 3.6%). The likelihood of testing positive for COVID-19 increased with the number of reported symptoms; the strongest predictors of test positivity were taste and smell alterations (odds ratio = 76.9) and fever (odds ratio = 9.12). The median time from first positive test to a negative test was 27 days (95% confidence interval, 24-30). CONCLUSIONS HCWs can be infected with SARS-CoV-2 without displaying any symptoms. Among symptomatic HCWs, the key symptoms to guide diagnosis are taste and smell alterations and fever. A median of almost 4 weeks is necessary before nasopharyngeal swab test results are negative.
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Affiliation(s)
- A Lombardi
- Infectious Diseases Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
| | - D Consonni
- Epidemiology Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - M Carugno
- Epidemiology Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - G Bozzi
- Infectious Diseases Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - D Mangioni
- Infectious Diseases Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - A Muscatello
- Infectious Diseases Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - V Castelli
- Infectious Diseases Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - E Palomba
- Infectious Diseases Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - A P Cantù
- Medical Direction, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - F Ceriotti
- Clinical Laboratory, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - B Tiso
- Medical Direction, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - A C Pesatori
- Epidemiology Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - L Riboldi
- Occupational Health Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - A Bandera
- Infectious Diseases Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Centre for Multidisciplinary Research in Health Science (MACH), University of Milan, Milan, Italy
| | - G Lunghi
- Clinical Laboratory, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - A Gori
- Infectious Diseases Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Centre for Multidisciplinary Research in Health Science (MACH), University of Milan, Milan, Italy
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17
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Alagna L, Palomba E, Mangioni D, Bozzi G, Lombardi A, Ungaro R, Castelli V, Prati D, Vecchi M, Muscatello A, Bandera A, Gori A. Multidrug-Resistant Gram-Negative Bacteria Decolonization in Immunocompromised Patients: A Focus on Fecal Microbiota Transplantation. Int J Mol Sci 2020; 21:ijms21165619. [PMID: 32764526 PMCID: PMC7460658 DOI: 10.3390/ijms21165619] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 07/28/2020] [Accepted: 08/03/2020] [Indexed: 02/07/2023] Open
Abstract
Antimicrobial resistance is an important issue for global health; in immunocompromised patients, such as solid organ and hematological transplant recipients, it poses an even bigger threat. Colonization by multidrug-resistant (MDR) bacteria was acknowledged as a strong risk factor to subsequent infections, especially in individuals with a compromised immune system. A growing pile of studies has linked the imbalance caused by the dominance of certain taxa populating the gut, also known as intestinal microbiota dysbiosis, to an increased risk of MDR bacteria colonization. Several attempts were proposed to modulate the gut microbiota. Particularly, fecal microbiota transplantation (FMT) was successfully applied to treat conditions like Clostridioides difficile infection and other diseases linked to gut microbiota dysbiosis. In this review we aimed to provide a look at the data gathered so far on FMT, focusing on its possible role in treating MDR colonization in the setting of immunocompromised patients and analyzing its efficacy and safety.
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Affiliation(s)
- Laura Alagna
- Infectious Disease Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (L.A.); (D.M.); (G.B.); (A.L.); (R.U.); (V.C.); (A.M.); (A.B.); (A.G.)
| | - Emanuele Palomba
- Infectious Disease Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (L.A.); (D.M.); (G.B.); (A.L.); (R.U.); (V.C.); (A.M.); (A.B.); (A.G.)
- Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy;
- Centre for Multidisciplinary Research in Health Science, University of Milan, 20122 Milan, Italy
- Correspondence: ; Tel.: +39-3494073517
| | - Davide Mangioni
- Infectious Disease Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (L.A.); (D.M.); (G.B.); (A.L.); (R.U.); (V.C.); (A.M.); (A.B.); (A.G.)
- Department of Medical Biotechnology and Translational Medicine, University of Milan, 20122 Milan, Italy
| | - Giorgio Bozzi
- Infectious Disease Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (L.A.); (D.M.); (G.B.); (A.L.); (R.U.); (V.C.); (A.M.); (A.B.); (A.G.)
| | - Andrea Lombardi
- Infectious Disease Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (L.A.); (D.M.); (G.B.); (A.L.); (R.U.); (V.C.); (A.M.); (A.B.); (A.G.)
| | - Riccardo Ungaro
- Infectious Disease Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (L.A.); (D.M.); (G.B.); (A.L.); (R.U.); (V.C.); (A.M.); (A.B.); (A.G.)
| | - Valeria Castelli
- Infectious Disease Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (L.A.); (D.M.); (G.B.); (A.L.); (R.U.); (V.C.); (A.M.); (A.B.); (A.G.)
- Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy;
- Centre for Multidisciplinary Research in Health Science, University of Milan, 20122 Milan, Italy
| | - Daniele Prati
- Department of Transfusion Medicine and Hematology, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy;
| | - Maurizio Vecchi
- Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy;
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Antonio Muscatello
- Infectious Disease Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (L.A.); (D.M.); (G.B.); (A.L.); (R.U.); (V.C.); (A.M.); (A.B.); (A.G.)
| | - Alessandra Bandera
- Infectious Disease Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (L.A.); (D.M.); (G.B.); (A.L.); (R.U.); (V.C.); (A.M.); (A.B.); (A.G.)
- Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy;
- Centre for Multidisciplinary Research in Health Science, University of Milan, 20122 Milan, Italy
| | - Andrea Gori
- Infectious Disease Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (L.A.); (D.M.); (G.B.); (A.L.); (R.U.); (V.C.); (A.M.); (A.B.); (A.G.)
- Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy;
- Centre for Multidisciplinary Research in Health Science, University of Milan, 20122 Milan, Italy
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Taramasso L, Fabbiani M, Nozza S, De Benedetto I, Bruzzesi E, Mastrangelo A, Pinnetti C, Calcagno A, Ferrara M, Bozzi G, Focà E, Quiros-Roldan E, Ripamonti D, Campus M, Celesia BM, Torti C, Cosco L, Di Biagio A, Rusconi S, Marchetti G, Mussini C, Gulminetti R, Cingolani A, d'Ettorre G, Madeddu G, Franco A, Orofino G, Squillace N, Muscatello A, Gori A, Antinori A, Tambussi G, Bandera A. Predictors of incomplete viral response and virologic failure in patients with acute and early HIV infection. Results of Italian Network of ACuTe HIV InfectiON (INACTION) cohort. HIV Med 2020; 21:523-535. [PMID: 32578947 DOI: 10.1111/hiv.12885] [Citation(s) in RCA: 6] [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] [Accepted: 05/13/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate the factors that can influence an incomplete viral response (IVR) after acute and early HIV infection (AEHI). METHODS This was a retrospective, observational study including patients with AEHI (Fiebig stages I-V) diagnosed between January 2008 and December 2014 at 20 Italian centres. IVR was defined by: (1) viral blip (51-1000 HIV-1 RNA copies/mL after achievement of < 50 HIV-1 RNA copies/mL); (2) virologic failure [> 1000 copies/mL after achievement of < 200 copies/mL, or ≥ 200 copies/mL after 24 weeks on an antiretroviral therapy (ART)]; (3) suboptimal viral response (> 50 copies/mL after 48 weeks on ART or two consecutive HIV-1 RNA levels with ascending trend during ART). Cox regression analysis was used to calculate the hazard ratios (HRs) and 95% confidence intervals (95% CIs) for IVR. RESULTS In all, 263 patients were studied, 227 (86%) males, with a median [interquartile range (IQR)] age of 38 (30-46) years. During a median follow-up of 13.0 (5.7-31.1) months, 38 (14.4%) had IVR. The presence of central nervous system (CNS) symptoms was linked to a higher risk of IVR (HR = 4.70, 95% CI: 1.56-14.17), while a higher CD4/CD8 cell count ratio (HR = 0.13, 95% CI: 0.03-0.51 for each point increase) and first-line ART with three-drug regimens recommended by current guidelines (HR = 0.40, 95% CI: 0.18-0.91 compared with other regimens including four or five drugs, older drugs or non-standard backbones) were protective against IVR. CONCLUSIONS Patients with lower CD4/CD8 ratio and CNS symptoms could be at a higher risk of IVR after AEHI. The use of recommended ART may be relevant for improving short-term viral efficacy in this group of patients.
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Affiliation(s)
- L Taramasso
- Infectious Diseases Unit, Department of Internal Medicine, Fondazione IRCCS Ca' Granda, Policlinico Maggiore Hospital, Milan, Italy
| | - M Fabbiani
- Infectious Diseases Unit, IRCCS San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - S Nozza
- Clinic of Infectious Diseases, San Raffaele Hospital, University Vita Salute, Milan, Italy
| | - I De Benedetto
- Department of Medical Sciences, Unit of Infectious Diseases, Amedeo di Savoia Hospital, University of Turin, Turin, Italy
| | - E Bruzzesi
- Clinic of Infectious Diseases, San Raffaele Hospital, University Vita Salute, Milan, Italy
| | - A Mastrangelo
- Clinic of Infectious Diseases, San Raffaele Hospital, University Vita Salute, Milan, Italy
| | - C Pinnetti
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - A Calcagno
- Department of Medical Sciences, Unit of Infectious Diseases, Amedeo di Savoia Hospital, University of Turin, Turin, Italy
| | - M Ferrara
- Department of Medical Sciences, Unit of Infectious Diseases, Amedeo di Savoia Hospital, University of Turin, Turin, Italy
| | - G Bozzi
- Infectious Diseases Unit, Department of Internal Medicine, Fondazione IRCCS Ca' Granda, Policlinico Maggiore Hospital, Milan, Italy
| | - E Focà
- Division of Infectious and Tropical Diseases, ASST Spedali Civili Hospital, University of Brescia, Brescia, Italy
| | - E Quiros-Roldan
- Division of Infectious and Tropical Diseases, ASST Spedali Civili Hospital, University of Brescia, Brescia, Italy
| | - D Ripamonti
- Infectious Disease Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - M Campus
- Infectious Diseases Unit, SS Trinità Hospital, ASSL Cagliari, Cagliari, Italy
| | - B M Celesia
- Unit of Infectious Diseases, Garibaldi Hospital, Catania, Italy
| | - C Torti
- Unit of Infectious Diseases, Department of Medical and Surgical Sciences, University "Magna Graecia", Catanzaro, Italy
| | - L Cosco
- Infectious Diseases Unit, "Pugliese-Ciaccio" Hospital, Catanzaro, Italy
| | - A Di Biagio
- Department of Infectious Diseases, Policlinico San Martino Hospital, Genoa, Italy
| | - S Rusconi
- Infectious Diseases Unit, Department of Biomedical and Clinical Sciences, "Luigi Sacco" Hospital, University of Milan, Milan, Italy
| | - G Marchetti
- Clinic of Infectious Diseases, Department of Health Sciences, University of Milan, ASST Santi Paolo e Carlo, Milan, Italy
| | - C Mussini
- Clinic of Infectious Diseases, Modena Hospital, University of Modena and Reggio Emilia, Modena, Italy
| | - R Gulminetti
- Infectious Diseases Unit, IRCCS San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - A Cingolani
- Institute of Clinical Infectious Diseases, Agostino Gemelli Hospital, Catholic University of Sacred Heart, Rome, Italy
| | - G d'Ettorre
- Infectious Diseases Unit, Umberto I Hospital, La Sapienza University, Rome, Italy
| | - G Madeddu
- Unit of Infectious Diseases, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - A Franco
- Infectious Diseases Unit, ASP Siracusa, Siracusa, Italy
| | - G Orofino
- Unit of Infectious Diseases, Divisione A, Amedeo di Savoia Hospital, Turin, Italy
| | - N Squillace
- Infectious Diseases Unit, Department of Internal Medicine, ASST San Gerardo, Monza, Italy.,University of Milano-Bicocca, Milan, Italy
| | - A Muscatello
- Infectious Diseases Unit, Department of Internal Medicine, Fondazione IRCCS Ca' Granda, Policlinico Maggiore Hospital, Milan, Italy
| | - A Gori
- Infectious Diseases Unit, Department of Internal Medicine, Fondazione IRCCS Ca' Granda, Policlinico Maggiore Hospital, Milan, Italy.,School of Medicine and Surgery, University of Milan, Milan, Italy
| | - A Antinori
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - G Tambussi
- Clinic of Infectious Diseases, San Raffaele Hospital, University Vita Salute, Milan, Italy
| | - A Bandera
- Infectious Diseases Unit, Department of Internal Medicine, Fondazione IRCCS Ca' Granda, Policlinico Maggiore Hospital, Milan, Italy.,School of Medicine and Surgery, University of Milan, Milan, Italy
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Villa S, Lombardi A, Mangioni D, Bozzi G, Bandera A, Gori A, Raviglione MC. The COVID-19 pandemic preparedness ... or lack thereof: from China to Italy. Glob Health Med 2020; 2:73-77. [PMID: 33330781 PMCID: PMC7731270 DOI: 10.35772/ghm.2020.01016] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 04/05/2020] [Accepted: 04/06/2020] [Indexed: 01/16/2023]
Abstract
COVID-19, that emerged in December 2019 in the city of Wuhan, China and is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has rapidly evolved into a pandemic. Italy has become one of the largest epicentres outside Asia, accounting now for at least 80,539 infections (cumulative incidence of 95.9/100,000) and 8,165 deaths (case fatality rate 10.1%). It has seriously affected people above the age of 60 years. The International Health Regulations (IHR) revised in 2005 bind governments to disclose vital information regarding the identification and detection of new disease outbreaks regardless of its causative agent. In contrast to the previous SARS epidemic, China timely informed the world about the onset of a new outbreak. It also soon disclosed the clinical characteristics of patients with COVID-19. Unfortunately, despite the fast recognition of the Chinese epidemic, the application of the 2005 IHR was not followed by an effective response in every country and most health authorities failed to rapidly perceive the threat posed by COVID-19. To further complicate matters, IHR implementation, which relies primarily on self-reporting data rather than on an external review mechanism, was limited in speed and further hindered by high costs. The response in Italy suffered from several limitations within the health system and services. The action against this threat must instead be quick, firm and at the highest trans-national level. The solution lies in further strengthening countries' preparedness through a clear political commitment, mobilization of proper resources and implementation of a strict surveillance and monitoring process.
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Affiliation(s)
- Simone Villa
- Centre for Multidisciplinary Research in Health Science, University of Milan, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milano, Milan, Italy
| | - Andrea Lombardi
- Infectious Diseases Unit, IRCCS Ca' Granda Ospedale Maggiore Policlinico Foundation, Milan, Italy
| | - Davide Mangioni
- Infectious Diseases Unit, IRCCS Ca' Granda Ospedale Maggiore Policlinico Foundation, Milan, Italy
- Department of Medical Biotechnology and Translational Medicine, University of Milan, Milan, Italy
| | - Giorgio Bozzi
- Infectious Diseases Unit, IRCCS Ca' Granda Ospedale Maggiore Policlinico Foundation, Milan, Italy
| | - Alessandra Bandera
- Department of Pathophysiology and Transplantation, University of Milano, Milan, Italy
- Infectious Diseases Unit, IRCCS Ca' Granda Ospedale Maggiore Policlinico Foundation, Milan, Italy
| | - Andrea Gori
- Centre for Multidisciplinary Research in Health Science, University of Milan, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milano, Milan, Italy
- Infectious Diseases Unit, IRCCS Ca' Granda Ospedale Maggiore Policlinico Foundation, Milan, Italy
| | - Mario C. Raviglione
- Centre for Multidisciplinary Research in Health Science, University of Milan, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milano, Milan, Italy
- Institute of Global Health, University of Geneva, Geneva, Switzerland
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20
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Lombardi A, Bozzi G, Mangioni D, Muscatello A, Peri AM, Taramasso L, Ungaro R, Bandera A, Gori A. Duration of quarantine in hospitalized patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection: a question needing an answer. J Hosp Infect 2020; 105:S0195-6701(20)30102-X. [PMID: 32151674 PMCID: PMC7134399 DOI: 10.1016/j.jhin.2020.03.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 03/02/2020] [Indexed: 11/10/2022]
Affiliation(s)
- Andrea Lombardi
- Infectious Diseases Unit, IRCCS Ca' Granda Ospedale Maggiore Policlinico Foundation, Milano, Italy.
| | - Giorgio Bozzi
- Infectious Diseases Unit, IRCCS Ca' Granda Ospedale Maggiore Policlinico Foundation, Milano, Italy
| | - Davide Mangioni
- Infectious Diseases Unit, IRCCS Ca' Granda Ospedale Maggiore Policlinico Foundation, Milano, Italy; Department of Pathophysiology and Transplantation, University of Milano, Milano, Italy
| | - Antonio Muscatello
- Infectious Diseases Unit, IRCCS Ca' Granda Ospedale Maggiore Policlinico Foundation, Milano, Italy
| | - Anna Maria Peri
- Infectious Diseases Unit, IRCCS Ca' Granda Ospedale Maggiore Policlinico Foundation, Milano, Italy
| | - Lucia Taramasso
- Infectious Diseases Unit, IRCCS Ca' Granda Ospedale Maggiore Policlinico Foundation, Milano, Italy; Department of Pathophysiology and Transplantation, University of Milano, Milano, Italy
| | - Riccardo Ungaro
- Infectious Diseases Unit, IRCCS Ca' Granda Ospedale Maggiore Policlinico Foundation, Milano, Italy
| | - Alessandra Bandera
- Infectious Diseases Unit, IRCCS Ca' Granda Ospedale Maggiore Policlinico Foundation, Milano, Italy; Department of Pathophysiology and Transplantation, University of Milano, Milano, Italy
| | - Andrea Gori
- Infectious Diseases Unit, IRCCS Ca' Granda Ospedale Maggiore Policlinico Foundation, Milano, Italy; Department of Pathophysiology and Transplantation, University of Milano, Milano, Italy
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Lai A, Bergna A, Simonetti FR, Franzetti M, Bozzi G, Micheli V, Atzori C, Ridolfo A, Zehender G, Ciccozzi M, Galli M, Balotta C. Contribution of transgender sex workers to the complexity of the HIV-1 epidemic in the metropolitan area of Milan. Sex Transm Infect 2020; 96:451-456. [PMID: 31900319 DOI: 10.1136/sextrans-2019-054103] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 09/23/2019] [Accepted: 12/12/2019] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVES Transgender people are disproportionately affected by the HIV-1 epidemic. We evaluated the origin of HIV-1 variants carried by South American transgenders living in Milan by combining accurate phylogenetic methods and epidemiological data. METHODS We collected 156 HIV-1 pol sequences obtained from transgender patients engaged in sex work (TSWs) followed between 1999 and 2015 at L. Sacco Hospital, Milan, Italy. Phylogenetic analyses were conducted by HIV-TRACE, MrBayes, MacClade and Beast programs. Reference sequences were retrieved from Los Alamos and local databases. Last negative testing or proxy data from clinical records of infected individuals were used to investigate the country of infection. RESULTS Among South American TSWs, the most represented HIV-1 subtypes were B (70.5%), F1 (12.8%) and C (4.4%). Gene flow migrations of B subtype indicated significant fluxes from TSWs to Italians (21.3%) belonging to all risk groups (26.4% to heterosexuals (HEs), 18.9% to men who have sex with men (MSM), 15.1% to injecting drug users). The largest proportion of bidirectional fluxes were observed between Italians and TSWs (24.6%). For F1 subtype, bidirectional viral fluxes involved TSWs and Italians (7.1% and 14.3%), and a similar proportion of fluxes linked TSWs and Italian HEs or MSM (both 15.8%). Significant fluxes were detected from Italians to TSWs for subtype C involving both MSM (30%) and HEs (40%). Country of HIV-1 acquisition was identified for 72 subjects; overall, the largest proportion of patients with B subtype (73.5%) acquired HIV-1 infection in South America. CONCLUSIONS Our results indicated that South American transgenders largely contribute to the heterogeneity of HIV-1 variants in our country. The high number of clusters based on all subtypes indicated numerous transmission chains in which TSWs were constantly intermixed with HEs and MSM. Our results strongly advocate interventions to facilitate prevention, diagnosis and HIV-1 care continuum among transgender people.
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Affiliation(s)
- Alessia Lai
- Department of Biomedical and Clinical Sciences 'L. Sacco', University of Milan, Milano, Lombardia, Italy
| | - Annalisa Bergna
- Department of Biomedical and Clinical Sciences 'L. Sacco', University of Milan, Milano, Lombardia, Italy
| | | | - Marco Franzetti
- Infectious Diseases Unit, Alessandro Manzoni Hospital, Lecco, Lombardia, Italy
| | - Giorgio Bozzi
- Department of Pathophysiology and Transplantation, La Fondazione IRCCS Ca' Granda Ospedale Maggiore di Milano Policlinico, Milano, Lombardia, Italy
| | - Valeria Micheli
- Department of Clinical Microbiology Virology and Diagnosis of Bioemergency, Luigi Sacco University Hospital, Milano, Lombardia, Italy
| | - Chiara Atzori
- 1st Division of Infectious Diseases, Luigi Sacco University Hospital, Milano, Lombardia, Italy
| | - Annalisa Ridolfo
- Department of Infectious Diseases, Luigi Sacco University Hospital, Milano, Lombardia, Italy
| | - Gianguglielmo Zehender
- Department of Biomedical and Clinical Sciences 'L. Sacco', University of Milan, Milano, Lombardia, Italy
| | - Massimo Ciccozzi
- Unit of Clinical Pathology and Microbiology, University Campus Bio-Medico University of Rome Faculty of Medicine and Surgery, Roma, Lazio, Italy
| | - Massimo Galli
- Department of Biomedical and Clinical Sciences 'L. Sacco', University of Milan, Milano, Lombardia, Italy
| | - Claudia Balotta
- Department of Biomedical and Clinical Sciences 'L. Sacco', University of Milan, Milano, Lombardia, Italy
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Taramasso L, Bozzi G, Muscatello A, Bandera A, Gori A. Immunonutrition in Human Immunodeficiency Virus Infection: Which Populations to Target? Clin Infect Dis 2019; 69:2228-2229. [DOI: 10.1093/cid/ciz337] [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: 11/14/2022] Open
Affiliation(s)
- Lucia Taramasso
- Infectious Diseases Unit, Department of Internal Medicine
- Department of Health Science, Infectious Disease Clinic, University of Genova, Italy
| | - Giorgio Bozzi
- Infectious Diseases Unit, Department of Internal Medicine
| | | | - Alessandra Bandera
- Infectious Diseases Unit, Department of Internal Medicine
- University of Milan, Infectious Diseases, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Andrea Gori
- Infectious Diseases Unit, Department of Internal Medicine
- University of Milan, Infectious Diseases, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
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23
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Bozzi G, Simonetti FR, Watters SA, Anderson EM, Gouzoulis M, Kearney MF, Rote P, Lange C, Shao W, Gorelick R, Fullmer B, Kumar S, Wank S, Hewitt S, Kleiner DE, Hattori J, Bale MJ, Hill S, Bell J, Rehm C, Grossman Z, Yarchoan R, Uldrick T, Maldarelli F. No evidence of ongoing HIV replication or compartmentalization in tissues during combination antiretroviral therapy: Implications for HIV eradication. Sci Adv 2019; 5:eaav2045. [PMID: 31579817 PMCID: PMC6760922 DOI: 10.1126/sciadv.aav2045] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 08/29/2019] [Indexed: 05/28/2023]
Abstract
HIV persistence during combination antiretroviral therapy (cART) is the principal obstacle to cure. Mechanisms responsible for persistence remain uncertain; infections may be maintained by persistence and clonal expansion of infected cells or by ongoing replication in anatomic locations with poor antiretroviral penetration. These mechanisms require different strategies for eradication, and determining their contributions to HIV persistence is essential. We used phylogenetic approaches to investigate, at the DNA level, HIV populations in blood, lymphoid, and other infected tissues obtained at colonoscopy or autopsy in individuals who were on cART for 8 to 16 years. We found no evidence of ongoing replication or compartmentalization of HIV; we did detect clonal expansion of infected cells that were present before cART. Long-term persistence, and not ongoing replication, is primarily responsible for maintaining HIV. HIV-infected cells present when cART is initiated represent the only identifiable source of persistence and is the appropriate focus for eradication.
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Affiliation(s)
- G. Bozzi
- HIV Dynamics and Replication Program, NCI, NIH, Frederick, MD, USA
- Department of Biomedical and Clinical Sciences, L. Sacco Hospital, University of Milan, Milan, Italy
| | - F. R. Simonetti
- HIV Dynamics and Replication Program, NCI, NIH, Frederick, MD, USA
- Department of Biomedical and Clinical Sciences, L. Sacco Hospital, University of Milan, Milan, Italy
| | - S. A. Watters
- HIV Dynamics and Replication Program, NCI, NIH, Frederick, MD, USA
- Department of Infection and Immunity, University College London, London, UK
| | - E. M. Anderson
- HIV Dynamics and Replication Program, NCI, NIH, Frederick, MD, USA
| | - M. Gouzoulis
- HIV Dynamics and Replication Program, NCI, NIH, Frederick, MD, USA
| | - M. F. Kearney
- HIV Dynamics and Replication Program, NCI, NIH, Frederick, MD, USA
| | - P. Rote
- HIV Dynamics and Replication Program, NCI, NIH, Frederick, MD, USA
| | - C. Lange
- HIV Dynamics and Replication Program, NCI, NIH, Frederick, MD, USA
| | - W. Shao
- Advanced Biomedical Computing Center, Leidos Biomedical Research Inc., Frederick National Laboratory for Cancer Research, Frederick, MD, USA
| | - R. Gorelick
- AIDS and Cancer Virus Program, Frederick National Laboratory for Cancer Research, Frederick, MD, USA
| | - B. Fullmer
- AIDS and Cancer Virus Program, Frederick National Laboratory for Cancer Research, Frederick, MD, USA
| | - S. Kumar
- Digestive Diseases Branch, NIDDK, NIH, Bethesda, MD, USA
| | - S. Wank
- Digestive Diseases Branch, NIDDK, NIH, Bethesda, MD, USA
| | - S. Hewitt
- Laboratory of Pathology, NCI, NIH, Bethesda, MD, USA
| | - D. E. Kleiner
- Laboratory of Pathology, NCI, NIH, Bethesda, MD, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - J. Hattori
- HIV Dynamics and Replication Program, NCI, NIH, Frederick, MD, USA
| | - M. J. Bale
- HIV Dynamics and Replication Program, NCI, NIH, Frederick, MD, USA
| | - S. Hill
- HIV Dynamics and Replication Program, NCI, NIH, Frederick, MD, USA
| | - J. Bell
- HIV Dynamics and Replication Program, NCI, NIH, Frederick, MD, USA
| | - C. Rehm
- Laboratory of Immunoregulation, NIAID, NIH, Bethesda, MD, USA
| | - Z. Grossman
- HIV Dynamics and Replication Program, NCI, NIH, Frederick, MD, USA
| | - R. Yarchoan
- HIV and AIDS Malignancy Branch, NCI, NIH, Bethesda, MD, USA
| | - T. Uldrick
- HIV and AIDS Malignancy Branch, NCI, NIH, Bethesda, MD, USA
| | - F. Maldarelli
- HIV Dynamics and Replication Program, NCI, NIH, Frederick, MD, USA
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24
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Bandera A, Taramasso L, Bozzi G, Muscatello A, Robinson JA, Burdo TH, Gori A. HIV-Associated Neurocognitive Impairment in the Modern ART Era: Are We Close to Discovering Reliable Biomarkers in the Setting of Virological Suppression? Front Aging Neurosci 2019; 11:187. [PMID: 31427955 PMCID: PMC6687760 DOI: 10.3389/fnagi.2019.00187] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 07/10/2019] [Indexed: 11/24/2022] Open
Abstract
The prevalence of the most severe forms of HIV-associated neurocognitive disorders (HAND) is decreasing due to worldwide availability and high efficacy of antiretroviral treatment (ART). However, several grades of HIV-related cognitive impairment persist with effective ART and remain a clinical concern for people with HIV (PWH). The pathogenesis of these cognitive impairments has yet to be fully understood and probably multifactorial. In PWH with undetectable peripheral HIV-RNA, the presence of viral escapes in cerebrospinal fluid (CSF) might explain a proportion of cases, but not all. Many other mechanisms have been hypothesized to be involved in disease progression, in order to identify possible therapeutic targets. As potential indicators of disease staging and progression, numerous biomarkers have been used to characterize and implicate chronic inflammation in the pathogenesis of neuronal injuries, such as certain phenotypes of activated monocytes/macrophages, in the context of persistent immune activation. Despite none of them being disease-specific, the correlation of several CSF cellular biomarkers to HIV-induced neuronal damage has been investigated. Furthermore, recent studies have been evaluating specific microRNA (miRNA) profiles in the CSF of PWH with neurocognitive impairment (NCI). The aim of the present study is to review the body of evidence on different biomarkers use in research and clinical settings, focusing on PWH on ART with undetectable plasma HIV-RNA.
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Affiliation(s)
- Alessandra Bandera
- Infectious Disease Unit, Department of Internal Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Pathophysiology and Transplantation, University of Milano, Milan, Italy
| | - Lucia Taramasso
- Infectious Disease Unit, Department of Internal Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Infectious Diseases Clinic, Department of Health Sciences, School of Medical and Pharmaceutical Sciences, Policlinico Hospital San Martino, University of Genova (DISSAL), Genova, Italy
| | - Giorgio Bozzi
- Infectious Disease Unit, Department of Internal Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Antonio Muscatello
- Infectious Disease Unit, Department of Internal Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Jake A Robinson
- Department of Neuroscience, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, United States
| | - Tricia H Burdo
- Department of Neuroscience, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, United States
| | - Andrea Gori
- Infectious Disease Unit, Department of Internal Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Pathophysiology and Transplantation, University of Milano, Milan, Italy
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Abstract
Introduction: The burden of nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH) is increasing worldwide. This phenomenon poses a potentially dangerous risk of rise in mortalities caused by cirrhosis and liver cancer. Owing to a complex combination of factors, NAFLD and NASH arise in a majority of people living with HIV (PLWH), but accurate estimates of prevalence differ, depending on sample selection, type of analysis, and data interpretation. The wide range of diagnostic tools used to assess liver steatosis and lack of control groups in many studies further contributes to current difficulties in properly assessing prevalence of these conditions. Areas covered: Thoroughly scrutinizing the current literature, we compared the prevalence of NAFLD and NASH in PLWH to rates found in the general population. We highlighted strengths and limitations of the studies, in order to determine the effective impact of these medical conditions in PLWH. Expert opinion: The prevalence and progression of NAFLD in human immunodeficiency virus (HIV) infection are reported to be widely variable. HIV infection itself and antiretroviral treatment have been demonstrated to play a role in the development of NAFLD. Larger and more effective studies are needed to evaluate the effects of NASH in PLWH and its progression.
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Affiliation(s)
- Nicola Squillace
- a Infectious Diseases Unit, Azienda Socio Sanitaria Territoriale di MONZA, San Gerardo Hospital , University of Milano-Bicocca , Monza , Italy
| | - Alessandro Soria
- a Infectious Diseases Unit, Azienda Socio Sanitaria Territoriale di MONZA, San Gerardo Hospital , University of Milano-Bicocca , Monza , Italy
| | - Giorgio Bozzi
- b Infectious Diseases Unit, Department of Internal Medicine, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico , University of Milan , Milan , Italy
| | - Andrea Gori
- b Infectious Diseases Unit, Department of Internal Medicine, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico , University of Milan , Milan , Italy
| | - Alessandra Bandera
- b Infectious Diseases Unit, Department of Internal Medicine, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico , University of Milan , Milan , Italy
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Squillace N, Bozzi G, Colella E, Gori A, Bandera A. Darunavir-cobicistat-emtricitabine-tenofovir alafenamide: safety and efficacy of a protease inhibitor in the modern era. Drug Des Devel Ther 2018; 12:3635-3643. [PMID: 30464395 PMCID: PMC6211373 DOI: 10.2147/dddt.s147493] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
A fixed-dose combination consisting of darunavir (Drv), cobicistat (Cobi), emtricitabine (2′,3′-dideoxy-5-fluoro-3′-thiacytidine [FTC]), and tenofovir alafenamide (Taf) has been recently approved by the European Medicines Agency for the treatment of HIV infection, and is the first ever protease-inhibitor-based single-tablet regimen. This article provides a detailed description of its pharmacokinetic, efficacy, and safety profile. The pharmacokinetics of single compounds were analyzed, with a special focus on contrasts between Drv/Cobi and Drv/ritonavir (Rtv). When comparing Cobi and Rtv, multiple interactions must be taken into account: in comparison to Rtv, Cobi is a more selective CYP3A4 inhibitor and has no clinical effect on other isoenzymes inhibited by Rtv (eg, 2C8 and 2C9). Moreover, unlike Cobi, Rtv shows in vivo induction activity on some CYP isoenzymes (eg, 1A2, 2C19, 2C8, 2C9, and 2B6), glucuronyltransferases (eg, UGT1A4), and Pgp. Drv-Cobi-FTC-Taf has recently been demonstrated to be of equal efficacy to Drv-Rtv and other protease inhibitors in both experienced (EMERALD study) and naïve (AMBER study) patients. Moreover, kidney and bone safety profiles have been shown to be good, as has central nervous system tolerance. Total cholesterol:low-density-lipoprotein cholesterol and total cholesterol:high-density-lipoprotein cholesterol ratios are generally high in Drv-Cobi-FTC-Taf vs Rtv-Drv-FTC + tenofovir disoproxil fumarate. An unlikely role of Drv in influencing cardiovascular risk in HIV infection has also been reported. Kidney safety profile is influenced by Cobi, with an increase in creatinine plasma concentration of 0.05–0.1 mg/dL and a parallel glomerular filtration-rate reduction of 10 mL/min within the first 4 weeks after Cobi introduction, which remains stable during treatment. Bone and central nervous system safety profiles were found to be good in randomized clinical trials of both experienced and naïve patients. The efficacy and safety of Drv/Cobi/FTC/Taf are comparable to other drug regimens recommended for HIV treatment.
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Affiliation(s)
- Nicola Squillace
- Infectious Diseases Unit, Azienda Socio Sanitaria Territoriale di Monza, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy,
| | - Giorgio Bozzi
- Infectious Disease Unit, Department of Internal Medicine, Fondazione IRCCS Ca'Granda, Ospedale Maggiore Policlinico, Department of Pathophysiology and Transplantation, University of Milano, Milan, Italy
| | - Elisa Colella
- Infectious Diseases Unit, Azienda Socio Sanitaria Territoriale di Monza, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy,
| | - Andrea Gori
- Infectious Disease Unit, Department of Internal Medicine, Fondazione IRCCS Ca'Granda, Ospedale Maggiore Policlinico, Department of Pathophysiology and Transplantation, University of Milano, Milan, Italy
| | - Alessandra Bandera
- Infectious Diseases Unit, Azienda Socio Sanitaria Territoriale di Monza, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy,
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Grossman Z, Rico SV, Cone K, Shao W, Rehm C, Jones S, Bozzi G, Dean S, Dewar R, Rehman T, Purdy J, Hadigan C, Pau AK, Maldarelli F. Early Presence of HIV-1 Subtype C in Washington, D.C. AIDS Res Hum Retroviruses 2018; 34:680-684. [PMID: 29936863 DOI: 10.1089/aid.2018.0041] [Citation(s) in RCA: 3] [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] [Indexed: 12/25/2022] Open
Abstract
The presence of non-B HIV subtypes in the USA has been documented during the epidemic, although the timing of early introductions of different subtypes remains uncertain. Subtype C, the most common HIV variant worldwide, was first reported in the USA in 1996-97, after subtype C had expanded greatly in sub-Saharan Africa. In this study, we report a patient with subtype C infection acquired by mother-to-child transmission, born in the USA in 1990 to a Washington, D.C. resident who never traveled outside the USA, demonstrating that subtype C was present in the USA much earlier. Comparative analysis of the sequence from this patient and subtype C sequences in the USA and elsewhere suggest multiple independent introductions of this subtype into the USA have taken place, many of which are traced to sub-Saharan or East Africa. These data indicate subtype C HIV was already present in the USA years earlier than previously reported, and during the early period of subtype C expansion.
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Affiliation(s)
- Zehava Grossman
- HIV Dynamics and Replication Program, NCI, NIH, Frederick, Maryland
- Sackler Faculty of Medicine, School of Public Health, Tel Aviv University, Tel Aviv, Israel
| | - Sheryl-vi Rico
- Intramural Clinical Management & Operations Branch, NIAID, NIH, Bethesda, Maryland
| | - Katherine Cone
- Intramural Clinical Management & Operations Branch, NIAID, NIH, Bethesda, Maryland
- Department of Social Work, NIH Clinical Center, Bethesda, Maryland
| | - Wei Shao
- Leidos Biomedical Research, Inc., Frederick, National Laboratory for Cancer Research, Frederick, Maryland
| | - Catherine Rehm
- Intramural Clinical Management & Operations Branch, NIAID, NIH, Bethesda, Maryland
| | - Sara Jones
- Clinical Research Directorate/Clinical Monitoring Research Program, Frederick National Laboratory for Cancer Research sponsored by the National Cancer Institute, Frederick, Maryland
| | - Giorgio Bozzi
- HIV Dynamics and Replication Program, NCI, NIH, Frederick, Maryland
| | - Sophie Dean
- HIV Dynamics and Replication Program, NCI, NIH, Frederick, Maryland
| | - Robin Dewar
- Leidos Biomedical Research, Inc., Frederick, National Laboratory for Cancer Research, Frederick, Maryland
| | - Tauseef Rehman
- Leidos Biomedical Research, Inc., Frederick, National Laboratory for Cancer Research, Frederick, Maryland
| | - Julia Purdy
- Critical Care Medicine Department, NIH Clinical Center, NIH, Bethesda, Maryland
| | - Colleen Hadigan
- Intramural Clinical Management & Operations Branch, NIAID, NIH, Bethesda, Maryland
| | - Alice K. Pau
- Intramural Clinical Management & Operations Branch, NIAID, NIH, Bethesda, Maryland
| | - Frank Maldarelli
- HIV Dynamics and Replication Program, NCI, NIH, Frederick, Maryland
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Lai A, Bozzi G, Franzetti M, Binda F, Simonetti FR, De Luca A, Micheli V, Meraviglia P, Bagnarelli P, Di Biagio A, Monno L, Saladini F, Zazzi M, Zehender G, Ciccozzi M, Balotta C. HIV-1 A1 Subtype Epidemic in Italy Originated from Africa and Eastern Europe and Shows a High Frequency of Transmission Chains Involving Intravenous Drug Users. PLoS One 2016; 11:e0146097. [PMID: 26752062 PMCID: PMC4709132 DOI: 10.1371/journal.pone.0146097] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Accepted: 12/14/2015] [Indexed: 12/04/2022] Open
Abstract
Background Subtype A accounts for only 12% of HIV-1 infections worldwide but predominates in Russia and Former Soviet Union countries of Eastern Europe. After an early propagation via heterosexual contacts, this variant spread explosively among intravenous drug users. A distinct A1 variant predominates in Greece and Albania, which penetrated directly from Africa. Clade A1 accounts for 12.5% of non-B subtypes in Italy, being the most frequent after F1 subtype. Aim Aim of this study was to investigate the circulation of A1 subtype in Italy and trace its origin and diffusion through phylogenetic and phylodynamic approaches. Results The phylogenetic analysis of 113 A1 pol sequences included in the Italian ARCA database, indicated that 71 patients (62.8%) clustered within 5 clades. A higher probability to be detected in clusters was found for patients from Eastern Europe and Italy (88.9% and 60.4%, respectively) compared to those from Africa (20%) (p < .001). Higher proportions of clustering sequences were found in intravenous drug users with respect to heterosexuals (85.7% vs. 59.3%, p = .056) and in women with respect to men (81.4% vs. 53.2%, p < .006). Subtype A1 dated phylogeny indicated an East African origin around 1961. Phylogeographical reconstruction highlighted 3 significant groups. One involved East European and some Italian variants, the second encompassed some Italian and African strains, the latter included the majority of viruses carried by African and Italian subjects and all viral sequences from Albania and Greece. Conclusions Subtype A1 originated in Central Africa and spread among East European countries in 1982. It entered Italy through three introduction events: directly from East Africa, from Albania and Greece, and from the area encompassing Moldavia and Ukraine. As in previously documented A1 epidemics of East European countries, HIV-1 A1 subtype spread in Italy in part through intravenous drug users. However, Eastern European women contributed to the penetration of such variant, probably through sex work.
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Affiliation(s)
- Alessia Lai
- Department of Biomedical and Clinical Sciences ‘L. Sacco’, Infectious Diseases and Immunopathology Section, ‘L. Sacco’ Hospital, University of Milan, Milan, Italy
- * E-mail:
| | - Giorgio Bozzi
- Department of Biomedical and Clinical Sciences ‘L. Sacco’, Infectious Diseases and Immunopathology Section, ‘L. Sacco’ Hospital, University of Milan, Milan, Italy
| | - Marco Franzetti
- Department of Biomedical and Clinical Sciences ‘L. Sacco’, Infectious Diseases and Immunopathology Section, ‘L. Sacco’ Hospital, University of Milan, Milan, Italy
| | - Francesca Binda
- Department of Biomedical and Clinical Sciences ‘L. Sacco’, Infectious Diseases and Immunopathology Section, ‘L. Sacco’ Hospital, University of Milan, Milan, Italy
| | - Francesco R. Simonetti
- Department of Biomedical and Clinical Sciences ‘L. Sacco’, Infectious Diseases and Immunopathology Section, ‘L. Sacco’ Hospital, University of Milan, Milan, Italy
| | - Andrea De Luca
- Division of Infectious Diseases, Siena University Hospital, Siena, Italy
| | - Valeria Micheli
- Laboratory of Microbiology, ‘L. Sacco’ Hospital, Milan, Italy
| | - Paola Meraviglia
- 2nd Division of Infectious Diseases, ‘L. Sacco’ Hospital, Milan, Italy
| | - Patrizia Bagnarelli
- Department of Biomedical Science, Section of Microbiology, Laboratory of Virology, University Politecnica delle Marche, Ancona, Italy
| | | | - Laura Monno
- Division of Infectious Disease, University of Bari, Bari, Italy
| | | | - Maurizio Zazzi
- Department of Medical Biotechnology, University of Siena, Siena, Italy
| | - Gianguglielmo Zehender
- Department of Biomedical and Clinical Sciences ‘L. Sacco’, Infectious Diseases and Immunopathology Section, ‘L. Sacco’ Hospital, University of Milan, Milan, Italy
| | - Massimo Ciccozzi
- Epidemiology Unit, Department of Infectious, Parasite and Immune-Mediated Diseases, Italian Institute of Health, Rome, Italy
| | - Claudia Balotta
- Department of Biomedical and Clinical Sciences ‘L. Sacco’, Infectious Diseases and Immunopathology Section, ‘L. Sacco’ Hospital, University of Milan, Milan, Italy
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Simonetti FR, Lai A, Monno L, Binda F, Brindicci G, Punzi G, Bozzi G, Violin M, Galli M, Zazzi M, Angarano G, Balotta C. Identification of a new HIV-1 BC circulating recombinant form (CRF60_BC) in Italian young men having sex with men. Infection, Genetics and Evolution 2014; 23:176-81. [DOI: 10.1016/j.meegid.2014.02.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2013] [Revised: 02/14/2014] [Accepted: 02/17/2014] [Indexed: 12/20/2022]
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31
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Lai A, Bozzi G, Franzetti M, Binda F, Simonetti FR, Micheli V, Meraviglia P, Corsi P, Bagnarelli P, De Luca A, Ciccozzi M, Zehender G, Zazzi M, Balotta C. Phylogenetic analysis provides evidence of interactions between Italian heterosexual and South American homosexual males as the main source of national HIV-1 subtype C epidemics. J Med Virol 2014; 86:729-36. [PMID: 24482324 DOI: 10.1002/jmv.23891] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2014] [Indexed: 11/08/2022]
Abstract
The HIV-1 clade C is prevalent worldwide and spread from Africa to South East Asia and South America early in the course of the epidemic. As a consequence of migration waves about 13% of the Italian HIV-1 epidemic is sustained by this clade. Two hundred fifty-four C pol sequences from the Italian ARCA database collected during 1997-2011 were analyzed. Epidemiological networks and geographical fluxes were identified through phylogeny using Bayesian approaches. Patients' country of origin was Italy, Africa, South America, and South East Asia for 44.9%, 23.6%, 4.7%, and 1.6%, respectively. Heterosexuals and men having sex with men accounted for 83.2% and 16.8%, respectively. Modality of infection was distributed differently: heterosexuals were largely prevalent among Italians (84.1%) and Africans (95.3%), while men having sex with men predominated among South Americans (66.7%). Eight significant clusters encompassing 111 patients (43.7%) were identified. Comparison between clustering and non-clustering patients indicated significant differences in country of origin, modality of infection and gender. Men having sex with men were associated to a higher probability to be included in networks (70% for men having sex with men vs. 30.3% for heterosexuals). Phylogeography highlighted two significant groups. One contained Indian strains and the second encompassed South Americans and almost all Italian strains. Phylogeography indicated that the spread of C subtype among Italians is related to South American variant. Although Italian patients mainly reported themselves as heterosexuals, homo-bisexual contacts were likely their source of infection. Phylogenetic monitoring is warranted to guide public health interventions aimed at controlling HIV infection.
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Affiliation(s)
- Alessia Lai
- Department of Biomedical and Clinical Science, Infectious Diseases and Immunopathology Section, 'L. Sacco' Hospital, University of Milan, Milan, Italy
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Lai A, Ciccozzi M, Franzetti M, Simonetti FR, Bozzi G, Binda F, Rosi A, Bonora S, De Luca A, Balotta C, Zehender G. Local and global spatio-temporal dynamics of HIV-1 subtype F1. J Med Virol 2013; 86:186-92. [PMID: 24122963 DOI: 10.1002/jmv.23783] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/27/2013] [Indexed: 12/22/2022]
Abstract
Previous studies have attempted to explore the origin of the F1 subtype, but the precise origin of the Romanian and South American F1 variants remains controversial. As the F1 subtype is the most frequent non-B variant among Europeans residing in Italy, the aim of this study was to estimate its phylogeography in order to reconstruct its origin and route of dispersion. The phylogeographical analyses, which were made using the Bayesian Markov Chain Monte Carlo approach and BEAST software, revealed two significant clades: the first included all of the Romanian strains together with a few Italian and four African isolates; the second encompassed all of the South American sequences and the large majority of Italian variants. By putting the African reference sequences into two discrete groups based on specific countries, phylogeographic analysis indicated that the F1 epidemic originated in Cameroon/Democratic Republic of Congo in the early 1940s, and was exported to South America 10 years later. Subsequently, the F1 virus spread to Angola and, from there, was exported to Romania in the early 1960s. It reached Italy in the 1970s from South America and Romania. The South American and Romanian variants of F1 have different African countries of origin and different temporal spreads. The South American variant seems to be characterized by multiple introduction events, whereas the Romanian strain probably spread as a result of a single entry. Two different pathways from South America and Romania led the F1 variant to Italy in the 1970s.
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Affiliation(s)
- Alessia Lai
- Department of Biomedical and Clinical Sciences, Infectious Diseases and Immunopathology Section, L. Sacco Hospital, University of Milan, Milan, Italy
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Lai A, Violin M, Ebranati E, Franzetti M, Micheli V, Gismondo MR, Capetti A, Meraviglia P, Simonetti FR, Bozzi G, Ciccozzi M, Galli M, Zehender G, Balotta C. Transmission of resistant HIV type 1 variants and epidemiological chains in Italian newly diagnosed individuals. AIDS Res Hum Retroviruses 2012; 28:857-65. [PMID: 21936750 DOI: 10.1089/aid.2011.0245] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Transmission of HIV-1 and drug resistance continue to occur at a considerable level in Italy, influenced mainly by changes in modality of infection. However, the long period of infectivity makes difficult the interpretation of epidemiological networks, based on epidemiological data only. We studied 510 naive HIV-1-infected individuals, of whom 400 (78.4%) were newly diagnosed patients with an unknown duration of infection (NDs), with the aim of identifying sexual epidemiological networks and transmitted drug resistance (TDR) over a 7-year period. Clusters were identified by Bayesian methods for 412 patients with B subtype; 145 individuals (35.2%) clustered in 34 distinct clades. Within epidemiological networks males were 93.1% (n=135); the same proportion of patients has been infected by the sexual route; 62.1% (n=90) were men having sex with men (MSM) of whom 67.8% (n=61) were NDs. Among heterosexuals (n=44), males were predominant (79.5%, n=35) and 77.3% (n=34) were NDs. TDR in clusters was 11.7 % (n=17), of whom 76.5% (n=13) was found in MSM. TDR was predominantly associated with NRTI resistance in individuals with chronic infection (n=11). A high prevalence of epidemiological networks has been found in the metropolitan area of Milan, indicating a high frequency of transmission events. The cluster analysis of networks suggested that the source of new infections was mainly represented by males and MSM who have long lasting HIV-1 infection. Notably, the prevalence of resistance-conferring mutations was higher in chronically infected patients, carrying mainly resistance to thymidine analogs, the backbone of first antiretroviral (ARV) generation. Intervention strategies of public health are needed to limit HIV-1 transmission and the associated TDR.
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Affiliation(s)
- Alessia Lai
- Department of Clinical Sciences ‘L. Sacco’ Hospital, Section of Infectious Diseases and Immunopathology, University of Milan, Milan, Italy
| | - Michela Violin
- Department of Clinical Sciences ‘L. Sacco’ Hospital, Section of Infectious Diseases and Immunopathology, University of Milan, Milan, Italy
| | - Erika Ebranati
- Department of Clinical Sciences ‘L. Sacco’ Hospital, Section of Infectious Diseases and Immunopathology, University of Milan, Milan, Italy
| | - Marco Franzetti
- Department of Clinical Sciences ‘L. Sacco’ Hospital, Section of Infectious Diseases and Immunopathology, University of Milan, Milan, Italy
| | - Valeria Micheli
- Department of Clinical Sciences ‘L. Sacco’ Hospital, Section of Microbiology, University of Milan, Milan, Italy
| | - Maria Rita Gismondo
- Department of Clinical Sciences ‘L. Sacco’ Hospital, Section of Microbiology, University of Milan, Milan, Italy
| | - Amedeo Capetti
- 1st Infectious Diseases Clinic, ‘L. Sacco’ Hospital, Milan, Italy
| | - Paola Meraviglia
- 2nd Infectious Diseases Clinic, ‘L. Sacco’ Hospital, Milan, Italy
| | - Francesco Roberto Simonetti
- Department of Clinical Sciences ‘L. Sacco’ Hospital, Section of Infectious Diseases and Immunopathology, University of Milan, Milan, Italy
| | - Giorgio Bozzi
- Department of Clinical Sciences ‘L. Sacco’ Hospital, Section of Infectious Diseases and Immunopathology, University of Milan, Milan, Italy
| | - Masimo Ciccozzi
- Epidemiology Unit, Department of Infectious, Parasite and Immune-Mediated Diseases, Italian Institute of Health, Rome, Italy
| | - Massimo Galli
- Department of Clinical Sciences ‘L. Sacco’ Hospital, Section of Infectious Diseases and Immunopathology, University of Milan, Milan, Italy
| | - Gianguglielmo Zehender
- Department of Clinical Sciences ‘L. Sacco’ Hospital, Section of Infectious Diseases and Immunopathology, University of Milan, Milan, Italy
| | - Claudia Balotta
- Department of Clinical Sciences ‘L. Sacco’ Hospital, Section of Infectious Diseases and Immunopathology, University of Milan, Milan, Italy
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Franzetti M, Lai A, Simonetti FR, Bozzi G, De Luca A, Micheli V, Meraviglia P, Corsi P, Bagnarelli P, Almi P, Zoncada A, Balotta C. High burden of transmitted HIV-1 drug resistance in Italian patients carrying F1 subtype. J Antimicrob Chemother 2012; 67:1250-3. [PMID: 22302564 DOI: 10.1093/jac/dks013] [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: 11/14/2022] Open
Abstract
BACKGROUND Transmitted drug resistance (TDR) is mainly restricted to individuals carrying B subtype, with low prevalence among non-B subtypes when grouped together. Subtype F1 is the most frequent non-B variant found in subjects living in Italy, allowing a specific assessment of TDR associated with this clade. METHODS We analysed pol sequences of HIV-1-positive individuals carrying the F1 variant included in the Antiretroviral Resistance Cohort Analysis database in the 1998-2009 period. Mutations were analysed with the Surveillance Drug Resistance Mutation and the International AIDS Society lists for naive and treated patients, respectively. RESULTS Among 343 HIV-1-infected patients carrying an F1 subtype, resistance was evaluated in a subset of 221 patients whose treatment status was known (169 drug naive and 52 drug experienced). The prevalence of TDR was 15.4% (11.8% for nucleoside/nucleotide reverse transcriptase inhibitors, 6.5% for non-nucleoside reverse transcriptase inhibitors and 7.1% for protease inhibitors). Among the 169 naive patients, 75.1%, 10.1% and 7.1% were Italians, South Americans and Romanians, respectively. Heterosexuals were prevalent among Italians and Romanians, while men who have sex with men were predominant among South Americans. The overall frequency of TDR declined from 21.4% to 7.1% in the 1998-2009 period. Although no statistical difference was detected, the frequency of TDR was higher in South Americans (23.5%) compared with Italian and Romanian naive patients (15% and 8.3%, respectively). DISCUSSION Our study shows a remarkable frequency of TDR in the F1 subtype-infected population. The high prevalence of TDR detected in South American subjects is linked to the homosexual route of infection. However, TDR was considerably high also in Italian subjects harbouring the F1 subtype, deserving careful monitoring.
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Affiliation(s)
- Marco Franzetti
- Department of Clinical Science L. Sacco, Section of Infectious Diseases and Immunopathology, University of Milan, Milan, Italy.
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Abstract
Evaluation of the efficiency of tissue procurement (TP) requires appropriate indicators. We report the results of a survey on all in-hospital deaths in Tuscany performed to identify potential indicators of efficiency with regard to donor identification and evaluation. In January 2004, we established a regional, compulsory, prospective program to monitor all in-hospital deaths in Tuscany. Currently, in Tuscany TP is performed if donors are < or =75 years without evidence of infectious or malignant diseases. Between January 2004 and December 2008, we analyzed data on 75,921 in-hospital deaths, including 50,001 (66.9%) in subjects older than 75 years, while 25,920 (33.1%) were < or =75 years and thus considered for TP. Among the latter cohort, 11,657 (15.3%) presented with clinical contraindication(s), while 14,263 (18.8%) were fit for tissue donation. Of the latter population, tissue donation occurred in 3083 cases (ie, 4% of in-hospital deaths or 11.8% of potential tissue donors). Contraindications to tissue donation were identified in 9861 cases (12.9%) based on clinical files, and in 1796 (2.4%) after interview with the family. There was a great variability by regional hospital in the percent of contraindications identified after the family interview, from a low of 4% to a high of 45%. Based on our experience, implementation of efficiency parameters and improvement of the efficiency of the entire TP process requires compulsory reporting of in-hospital deaths by local transplant coordinators.
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Affiliation(s)
- A Saviozzi
- Coordinamento Locale alla Donazione e Centro di riferimento per il monitoraggio della qualità della donazione della Regione Toscana, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy.
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Bozzi G, Campanario F, Hankele V, Zeppenfeld D. Next-to-leading order QCD corrections toW+W−γandZZγproduction with leptonic decays. Int J Clin Exp Med 2010. [DOI: 10.1103/physrevd.81.094030] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Abstract
Tissue procurement and transplantation are rarely taken into account as indicators of the efficiency of a regional donor procurement network. We present herein a retrospective review on Tuscany tissue procurement activities from 2004 until 2006. In 2003 the Tuscan Regional Government appointed a transplantation service authority to reorganize all regional donation and transplantation activities: the Organizzazione Toscana Trapianti (OTT). The regional tissue procurement network was based on either brain death (BD) and cardiac death (CD) donors under the responsibility of in-hospital transplantation coordinators (IHTCs). From 2004 to 2006, a total of 397 tissue donors were procured in Tuscany, and 4151 tissue transplantations were performed: 2909 skin grafts, 1209 bone grafts, and 33 heart valves. Over the same period, a total of 2116 cornea donors were procured; 4117 corneas were retrieved; 1779 were fit for transplantation, and 1418 were transplanted. Based on our experience, implementation of tissue procurement requires use of BD donors and paramount organizational efforts from IHTCs.
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Affiliation(s)
- F Filipponi
- Organizzazione Toscana Trapianti, Regione Toscana, Florence, Italy.
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Abstract
The shortage of cadaveric organ donors imposes a severe limit on the number of patients who can benefit from transplantation. This paper describes a programme for evaluation and improvement of the organ donation process, which has been implemented in the hospitals of the Tuscany region, Italy. After analysing the first results it was found that there was great potential for growth, especially in those hospitals with neurosurgery where the weakest points of the process were detected The development of a quality improvement programme in cadaveric organ donation is an adequate and scientific method to detect where the problems in the process of organ donation lie. Ideally, the comparison of these data with those of other Italian or European regions should be very useful to plan adequate strategies to improve cadaveric organ donation.
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Affiliation(s)
- R Matesanz
- President Transplant Committee Council of Europe, Transplant Consulting Tuscany Region, Florence, Italy. http:
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Bozzi G, Saviozzi A, Nardi M, Matesanz R, Rossi Ferrini PL. Corneal explantation activity in 2002: an analysis of the modified operational schedule. Transplant Proc 2004; 36:662-3. [PMID: 15110625 DOI: 10.1016/j.transproceed.2004.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
After data have been gathered about corneal explants performed within the AOP health-care web throughout 2001, the resulting findings were used to update the selection system for donation fitness and operational procedures. The rejection of anti-HBc-positive grafts and tissues coming from subjects more than 79 years old resulted in decreased donations (256 donations, that is 492 corneal explants in 2001 vs 140, that is 273 in 2002), although the number of deaths was unchanged (1298 in 2001 vs 1294 in 2002). Corneas fit for transplantation did not change in number-126 (25.6% of the total available) in 2001 and 113 (41.4%) in 2002-while the instances of rejected corneas occurred 56.3% less frequently, allowing a savings of great deal of human and money resources. After activity schedules were modified, the results analysis confirmed the expected improvement in 2001.
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Affiliation(s)
- G Bozzi
- Organ and Tissue Donation Coordination Board, S Chiara Hospital, Pisa, Italy.
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Abstract
Since October 2002, after a pilot period, a quality improvement program in organ donation has been underway in Tuscany. This program is based on a database elaborated by the Transplant Coordination Office of the Pisa University, according to the Spanish program of the National Transplant Organization. All encephalic deaths occurring in intensive care units beds during mechanical ventilation are registered in the database. Encephalic deaths were evaluated by local transplant coordinators and an esthesiologists after review of the clinical records. The data are sent every month to the Central Unit located in the Santa Chiara Hospital of Pisa. Every 3 and 12 months, we calculate the indices to evaluate organ donation activity in every hospital. The preliminary results show that: (1) the program is a useful tool to evaluate the organ donation process; (2) the experience is limited, but has shown the potential of the program to increase organ donation activity in Tuscany.
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Affiliation(s)
- G Bozzi
- Coordinamento della Donazione Organi e Tessuti, Azienda Ospedaliera Pisana, Pisa, Italy.
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Bozzi G, Saviozzi A, Nardi M, Lombardi N, Giuliano G. Use of resources in corneal tissue procurement: effects of donor characteristics and clinical practice. Transplant Proc 2003; 35:1002. [PMID: 12947835 DOI: 10.1016/s0041-1345(03)00272-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- G Bozzi
- Azienda Ospedaliera Pisana, Coordinamento Della Donazione, Via Roma 52, Pisa 56100, Italy
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Bozzi G, Zerega G. [A competitive model for supply of materials for hemodynamics]. G Ital Cardiol 1998; 28:140-7. [PMID: 9534054] [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: 02/07/2023]
Abstract
INTRODUCTION Cardiology and above all haemodynamics are among the specialities that have received the most emphasis in recent years and remarkable results have been achieved, thanks to technological developments in materials. In practice, therefore, the need to be able to access these required and qualitatively better materials, comes up against the need of state-run companies to prepare and finalize the tenders necessary for the purchase of any goods. METHODS There are essentially three problems to be faced in relation to the need to keep costs down: the large number and the different kinds of medical apparatus to be used, the possibility of reusing expensive materials which enables the use of different configurations without inordinately increasing prices, and the need to hold long and complex tenders. RESULTS/CONCLUSIONS We have decided to supply a pro-forma product description for use in public tenders in order to facilitate the methods for detailing technical characteristics and quality measurement so that medical users can attain a good price quality ratio.
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Affiliation(s)
- G Bozzi
- Divisione di Cardiologia, Azienda Ospedaliera E. Bassini, Cinisello Balsamo, MI
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Di Biasi P, Pajé A, Salati M, Bozzi G, Viecca M, Cialfi A, Di Biasi M, Guzzetti S, Santoli C. Surgical timing in aortic regurgitation: left ventricular function analysis by contractility score. Ann Thorac Surg 1994; 58:509-15. [PMID: 8067855 DOI: 10.1016/0003-4975(94)92241-1] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
In 32 patients with aortic regurgitation, angiographic evaluation of global left ventricular performance before and after aortic valve replacement was carried out by means of a computer-analyzed contractility scoring system. A strong correlation was detected between the preoperative and postoperative contractility score. Postoperatively, the score decreased in all but 3 patients, becoming normal or near normal in 21 of 27 patients whose preoperative value had been less than 40. However, all 5 patients with a preoperative contractility score of 40 or greater exhibited a persistently elevated score after operation that indicated the presence of irreversible contractile dysfunction. Patients in groups A and B (preoperative score, 0 to 40) experienced a good surgical outcome, and at 5-year follow-up were in New York Heart Association functional class I. Patients in group C (preoperative score, > 40) altogether had a very poor surgical outcome, although they did experience a short to midterm period of symptomatic relief. It is important to offer aortic valve replacement to patients with aortic regurgitation before their chances for a good functional result are lost. The computer-analyzed contractility score may be a useful index for determining the optimal timing of operation in these patients, particularly those who show features consistent with impaired left ventricular function but are asymptomatic and who should undergo aortic valve replacement before symptoms of definitive left ventricular failure develop.
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Affiliation(s)
- P Di Biasi
- Divisione di Chirurgia Toracica e Cardiovascolare, Ospedale Luigi Sacco, Milano, Italy
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Abstract
From 1988 to 1991, 48 patients with left ventricular aneurysm underwent endoventriculoplasty with a circular patch to preserve the left ventricular geometry. Of these patients, 98% underwent concomitant myocardial revascularization, and in 77% the left anterior descending coronary artery was bypassed. The overall operative mortality rate was 4.1%. The 3-year survival rate was 91%, and 67% of patients had no further cardiac complications. Cardiac performance was assessed postoperatively by ventriculography in 28 patients. The global ejection fraction rose from 0.39 +/- 0.11 to 0.57 +/- 0.14 (p < 0.001); the left ventricular end-diastolic pressure fell from 20 +/- 7.5 mm Hg to 15 +/- 7.8 mm Hg (p < 0.05). Computerized analysis of regional contraction revealed a significant improvement in the anterolateral and apical segments and in the transitional zone. In 61% of the patients, a normal contraction pattern resumed, whereas in the remaining 39%, a residual deformity of the left ventricular chamber was present. The best results were obtained in patients with a preserved proximal septum at echocardiography.
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Affiliation(s)
- M Salati
- Division of Thoracic and Cardiovascular Surgery, L. Sacco Hospital, Milano, Italy
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Cappiello E, Raggi U, Danna P, Guzzetti S, Presti FL, Sala R, Tempesta A, Bozzi G. Amiodarone-induced euthyroid hyperthyroainemia, non-evolutionary borderline hyperthyroidism and clinical hyperthyroidism: a long-term follow-up study. Resuscitation 1993. [DOI: 10.1016/0300-9572(93)90073-y] [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: 11/25/2022]
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Beretta L, Lemma M, Vanelli P, DiMattia D, Bozzi G, Broso P, Salvaggio A, Santoli C. Coronary “open” endarterectomy and reconstruction: short- and long-term results of the revascularization with saphenous vein versus IMA-graft. Eur J Cardiothorac Surg 1992; 6:382-6; discussion 387. [PMID: 1353977 DOI: 10.1016/1010-7940(92)90177-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
From June 1984 to December 1990, 96 patients underwent "open" coronary endarterectomy and reconstruction. In 50 patients (group 1), a saphenous vein (SV) graft was used to reconstruct and bypass 54 coronary vessels. In 46 patients (group 2), 46 coronary vessels were reconstructed with an SV patch and then bypassed with the internal mammary artery (IMA): Seventy-four LAD coronary arteries (36 in group 1 and 38 in group 2) were treated with these procedures. Operative mortality was 8% in group 1 and 2.1% in group 2. Five patients (10%) in group 1 and 1 patient (2.1%) in group 2 developed perioperative myocardial infarction. The early postoperative patency of the reconstructed vessels was 84.6% in group 1 and 92.5% in group 2. Angiographic controls were performed between 30 and 36 months after operation in 18 patients (72%) of group 1 and in 16 patients (69%) of group 2 with patency rates of 66.7% and 81.5%, respectively. A further angiographic study performed between 54 and 60 months after operation of 9/22 patients of group 1 and 5/9 patients of group 2 did not show any additional closure of the endarterectomized vessels. Three- and 5-year survival analyzed by the Kaplan-Meier method was 79.6% and 69.7%, respectively, in group 1 and 86.8% for both the 3- and 5-year survival in group 2. After a mean follow-up of 51.0 and 35.5 months, 62.8% of the surviving patients of group 1 and 75.6% of group 2 were asymptomatic.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- L Beretta
- Division of Thoracic and Cardiovascular Surgery, L. Sacco Hospital, Milan, Italy
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Lemma M, Vanelli P, Bozzi G, Santoli C. [Myocardial revascularization with arterial grafts alone: our experience]. G Ital Cardiol 1991; 21:1057-63. [PMID: 1687137] [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: 12/28/2022]
Abstract
Bilateral internal mammary artery (IMA) grafting is recognized as a preferred method of myocardial revascularization. However, for multivessel coronary artery disease, saphenous veins often have to be added to complete myocardial revascularization. The right gastroepiploic artery (rGEA) has been recently recognized as a suitable arterial conduit to obtain with both IMAs a complete myocardial revascularization without conventional vein graft. From December 1985 to July 1990, 87 selected patients underwent coronary artery bypass grafting using only the two IMAs and, from December 1988, the rGEA. There were a total of 220 coronary artery bypass grafts (mean 3.06/patient) and 267 coronary artery anastomoses (mean 1.21 anastomoses graft). There was one perioperative death (1.14%), 3 patients (3.5%) developed a perioperative myocardial infarction, and 7 patients (8.04%) needed a transitory inotropic pharmacological support. Two patients (2.29%) underwent reoperation for bleeding, and a third (1.14%) for sternal diastase. Fifty-five patients (63.2%) underwent postoperative angiography: 6/139 grafts (4.31%) (3 rGEA free, 2 rIMA free, 1 rIMA in situ) were occluded. After follow-up, ranging from 12 to 66 months (30.54 average), 77 patients (92.77%) were free from angina, one patient underwent reoperation 7 months later and a third died for sudden death 55 months after the operation. There were no gastric complications due to rGEA harvesting. Actually, bilateral IMA grafting is the best investment for the patient who needs myocardial revascularization. The rGEA is a promising conduit whose only concern could be the long-term patency; this will be resolved in the future. Up-to-date combined arterial graft utilizing the IMA and the rGEA can facilitate complete revascularization by arterial grafts safely and effectively.
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Affiliation(s)
- M Lemma
- Divisione di Chirurgia Toracica e Cardiovascolare, Ospedale L. Sacco, Milano
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Bozzi G. [Standard contraction curves of the left ventricle for the objective quantification of segmental kinetics]. G Ital Cardiol 1991; 21:163-73. [PMID: 1868991] [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: 12/29/2022]
Abstract
Two left ventricle angiographically-standard contraction curves are proposed: one for the 30-degree right anterior oblique (RAO) projection, and the other for the 60-degree left anterior oblique (LAO) projection. These curves are obtained by a calculation which uses the end-diastolic and end-systolic silhouettes along with the longitudinal axes. The best calculation method, which is different in the two projections, has been identified by computer testing of a number of hypothesis over a "normal" population of 18 pairs of RAO and 7 pairs of LAO silhouettes. The working hypothesis was selected by minimizing the standard deviation. In both projections the percent reduction of 20 areas is performed. The 20 RAO areas are defined by 10 equidistant orthogonal coordinates which intersect the longitudinal axis; moreover, the longitudinal axis "angiographic shortening", becomes divided into "cavity real shortening" and "apical parietal effacement'. The 20 LAO areas are defined by radial axes spaced by 15 degree intervals. The proposed standard curves show a low standard deviation of the calculated points: mean 7.8% +/- 3.68 (SD) for the RAO curve, and mean 9.8% +/- 3.68 for the LAO curve. These curves achieve the goal of a standard reference for the objective evaluation of the left ventricle segmentary contraction analysis.
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Affiliation(s)
- G Bozzi
- Divisione di Cardiologia, Ospedale L. Sacco, Milano
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