Rilpivirine plus cobicistat-boosted darunavir as a two-drug switch regimen in HIV-infected, virologically suppressed subjects on steady standard three-drug therapy: a randomized, controlled, non-inferiority trial (PROBE 2)

BACKGROUND

We explored the combination of rilpivirine plus cobicistat-boosted darunavir [a two-drug regimen (2DR)] when switching from standard triple combined ART.

METHODS

In this randomized, open-label, non-inferiority trial, participants had an HIV-RNA <50 copies/mL on a stable (>6 months) three-drug regimen. The primary endpoint was proportion with HIV-RNA <50 copies/mL at Week 24 (snapshot algorithm), with a -12% non-inferiority margin. ClinicalTrials.gov: NCT04064632.

RESULTS

One hundred and sixty patients were allocated (1:1) to 2DR or to continue current ART (CAR). At Week 24, 72 (90.0%) of participants with 2DR and 75 (93.8%) with CAR maintained HIV-RNA <50 copies/mL [difference -3.75% (95% CI = -11.63 to 5.63)], confirming non-inferiority. Non-inferiority was confirmed considering an HIV-RNA >50 copies/mL (0% for 2DR; 3.7% for CAR; 95% CI = -0.4 to 7.9). Four patients reported adverse events not leading to treatment discontinuation (one patient in the 2DR group and three patients in the CAR group); eight subjects discontinued therapy in the 2DR group and three in the CAR group. With 2DR, lipid serum concentrations increased, but differences were statistically significant only for tenofovir disoproxil fumarate-containing CAR and in 2DR patients receiving a pre-switch regimen including tenofovir disoproxil fumarate. Median bone stiffness decreased in the CAR group from 86.1 g/cm2 (IQR = 74-98) to 83.2 g/cm2 (IQR = 74-97) and increased in the 2DR group from 84.9 g/cm2 (IQR = 74-103) to 85.5 g/cm2 (IQR = 74-101). The reduction within the CAR group was significant (P = 0.043).

CONCLUSIONS

Once-daily rilpivirine plus cobicistat-boosted darunavir is an effective 2DR that combines a high virological efficacy with a potential to avoid major NRTI toxicities.

Auditing HIV Testing Rates across Europe: Results from the HIDES 2 Study

European guidelines recommend the routine offer of an HIV test in patients with a number of AIDS-defining and non-AIDS conditions believed to share an association with HIV; so called indicator conditions (IC). Adherence with this guidance across Europe is not known. We audited HIV testing behaviour in patients accessing care for a number of ICs. Participating centres reviewed the case notes of either 100 patients or of all consecutive patients in one year, presenting for each of the following ICs: tuberculosis, non-Hodgkins lymphoma, anal and cervical cancer, hepatitis B and C and oesophageal candidiasis. Observed HIV-positive rates were applied by region and IC to estimate the number of HIV diagnoses potentially missed. Outcomes examined were: HIV test rate (% of total patients with IC), HIV test accepted (% of tests performed/% of tests offered) and new HIV diagnosis rate (%). There were 49 audits from 23 centres, representing 7037 patients. The median test rate across audits was 72% (IQR 32–97), lowest in Northern Europe (median 44%, IQR 22–68%) and highest in Eastern Europe (median 99%, IQR 86–100). Uptake of testing was close to 100% in all regions. The median HIV+ rate was 0.9% (IQR 0.0–4.9), with 29 audits (60.4%) having an HIV+ rate >0.1%. After adjustment, there were no differences between regions of Europe in the proportion with >0.1% testing positive (global p = 0.14). A total of 113 patients tested HIV+. Applying the observed rates of testing HIV+ within individual ICs and regions to all persons presenting with an IC suggested that 105 diagnoses were potentially missed. Testing rates in well-established HIV ICs remained low across Europe, despite high prevalence rates, reflecting missed opportunities for earlier HIV diagnosis and care. Significant numbers may have had an opportunity for HIV diagnosis if all persons included in IC audits had been tested.

Radical retropubic prostatectomy using endoscopic gastrointestinal anastomosis staplers

OBJECTIVE

To investigate whether the use of the endoscopic gastrointestinal anastomosis (GIA) stapler for hemostasis of the dorsal vein complex during radical retropubic prostatectomy saves operation time and blood loss together with therapeutic efficacy.

MATERIALS AND METHODS

From April 1990 to December 1998, a total of 296 patients underwent radical retropubic prostatectomy for prostate cancer in clinical stages T1, T2 and T3. In 157 patients we evaluated the efficacy of the endoscopic GIA stapler in order to minimize blood loss from the dorsal vein complex and to reduce mean operative time.

RESULTS

The mean total operative time decreased an average of 35 min and the mean blood loss fell from 850 to 400 cm(3) using the stapling technique. Although complications are seen with traditional methods, we noted a net increase in anastomotic strictures with this new technique.

CONCLUSIONS

Even if this technical trick is effective in reducing blood loss, a higher incidence of anastomotic strictures has to be taken into account when using staplers close to the anastomotic site.

Multiple prostheses for complex urethral diseases

Urethral prostheses for strictures or urinary incontinence are becoming more and more diffuse in urological practice for their simple use and low complication rate. Multiple prostheses can be used for complex urethral diseases, in which the contemporary correction of a stricture and urinary incontinence due to a sphincteric disease are needed.

[Nephrogenic adenoma of the bladder associated with urinary tuberculosis. Case report]

Nephrogenic adenoma is an uncommon benign lesion of the urinary tract, that histologically is characterised by glandular-like aspects resembling the distal part of the nephron. It is usually associated with antecedent inflammation, surgical procedures or other injuries. Personal experience with one additional case nephrogenic adenoma of the bladder in a patient with urinary tract tuberculosis is presented.

A proposed new tecnique for tailoring the megaureter with ureterocele using G.I.A. and endo-G.I.A

The very low rate of complications obtained with mechanical sutures in urinary diversions after cystectomy incited the Authors to use the mechanical stapling devices on the upper urinary tract. One case of surgical correction of meaureter with ureterocele has performed using GIA and ENDO-GIA stapling devices. Surgical time is shorter because with GIA stapling devices the ureter is cutted and sutured at the same time. The mechanical suture is tigh but at the same time preserves intact the blood supply to the ureteral wall. The ENDO-GIA devices are very maneageable, far from the body and allow to operate through a small incision of the wound. The follow-up I.V.P. performed 6 months later, shows the absence of urinary stones and a thin, peristaltic ureter with absence of hydronephrosis.

[Inverted papilloma of the bladder (Report of a clinical case)]

Inverted papilloma of the urinary bladder is a rare variant of the common transitional cell papilloma. This tumor, although histologically distinctive and clinically benign, has often been pathologically mistaken for a low grade transitional cell carcinoma. For this reason it seems appropriate to document one case seen in recent years at Maria Vittoria Hospital - Turin.

[Benign neoplasms of the stomach: personal cases]

After discussing the diagnostic approach to benign tumours of the stomach on the basis of the most valid classifications in literature, the Authors describe the symptoms and frequency of these tumours. They then report 12 personally observed cases, and in particular one case of neurofibroma of the gastric fundus, which was exceptional for localisation, volume and clinical course. They conclude that only open extemporaneous surgical examination can provide confirmation of the benign nature of the neoformation. Therapy must in any case be surgical: the extent of removal will be governed by the extent and location of the tumour, and by the outcome of the histological examination.