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Piemonti L, Landoni G, Voza A, Puoti M, Gentile I, Coppola N, Nava S, Mattei A, Marinangeli F, Marchetti G, Bonfanti P, Mastroianni CM, Bassetti M, Crisafulli E, Grossi PA, Zangrillo A, Desai A, Merli M, Foggia M, Carpano M, Schiavoni L, D'Arminio Monforte A, Bisi L, Russo G, Busti F, Rovelli C, Perrotta E, Goisis G, Gavioli EM, Toya S, De Pizzol M, Mantelli F, Allegretti M, Minnella EM. Efficacy and Safety of Reparixin in Patients with Severe COVID-19 Pneumonia: A Phase 3, Randomized, Double-Blind Placebo-Controlled Study. Infect Dis Ther 2023; 12:2437-2456. [PMID: 37798468 PMCID: PMC10600076 DOI: 10.1007/s40121-023-00871-5] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 09/06/2023] [Indexed: 10/07/2023] Open
Abstract
INTRODUCTION Polymorphonuclear cell influx into the interstitial and bronchoalveolar spaces is a cardinal feature of severe coronavirus disease 2019 (COVID-19), principally mediated by interleukin-8 (IL-8). We sought to determine whether reparixin, a novel IL-8 pathway inhibitor, could reduce disease progression in patients hospitalized with severe COVID-19 pneumonia. METHODS In this Phase 3, randomized, double-blind, placebo-controlled, multicenter study, hospitalized adult patients with severe COVID-19 pneumonia were randomized 2:1 to receive oral reparixin 1200 mg three times daily or placebo for up to 21 days or until hospital discharge. The primary endpoint was the proportion of patients alive and free of respiratory failure at Day 28, with key secondary endpoints being the proportion of patients free of respiratory failure at Day 60, incidence of intensive care unit (ICU) admission by Day 28 and time to recovery by Day 28. RESULTS Of 279 patients randomized, 182 received at least one dose of reparixin and 88 received placebo. The proportion of patients alive and free of respiratory failure at Day 28 was similar in the two groups {83.5% versus 80.7%; odds ratio 1.63 [95% confidence interval (CI) 0.75, 3.51]; p = 0.216}. There were no statistically significant differences in the key secondary endpoints, but a numerically higher proportion of patients in the reparixin group were alive and free of respiratory failure at Day 60 (88.7% versus 84.6%; p = 0.195), fewer required ICU admissions by Day 28 (15.8% versus 21.7%; p = 0.168), and a higher proportion recovered by Day 28 compared with placebo (81.6% versus 74.9%; p = 0.167). Fewer patients experienced adverse events with reparixin than placebo (45.6% versus 54.5%), most mild or moderate intensity and not related to study treatment. CONCLUSIONS This trial did not meet the primary efficacy endpoints, yet reparixin showed a trend toward limiting disease progression as an add-on therapy in COVID-19 severe pneumonia and was well tolerated. TRIAL REGISTRATION ClinicalTrials.gov: NCT04878055, EudraCT: 2020-005919-51.
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Affiliation(s)
- Lorenzo Piemonti
- Diabetes Research Institute, IRCCS Ospedale San Raffaele, Via Olgettina 60. 20132, Milan, Italy
| | - Giovanni Landoni
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Antonio Voza
- Department of Emergency Medicine, Humanitas University, Pieve Emanuele, Milan, Italy
- IRCCS Humanitas Research Hospital, Milan, Italy
| | - Massimo Puoti
- Department of Infectious Diseases, Hospital Niguarda, Milan, Italy
| | - Ivan Gentile
- Section of Infectious Diseases, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Nicola Coppola
- Infectious Diseases Unit, Department of Mental Health and Public Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Stefano Nava
- Respiratory and Critical Care Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Alessia Mattei
- Anesthesia, Intensive Care and Pain Management, Campus Bio-Medico University Hospital Foundation, Rome, Italy
| | - Franco Marinangeli
- Department of Anesthesiology, Pain Treatment and Palliative Care, University of L'Aquila, L'Aquila, Italy
| | - Giulia Marchetti
- Department of Health Sciences, Clinic of Infectious Diseases, ASST Santi Paolo E Carlo, University of Milan, Milan, Italy
| | - Paolo Bonfanti
- Infectious Diseases Unit, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Claudio Maria Mastroianni
- Department of Public Health and Infectious Diseases, Policlinico Umberto I, La Sapienza University, Rome, Italy
| | - Matteo Bassetti
- Department of Health Sciences, Infectious Diseases Clinic, University of Genoa, Genoa, Italy
- Policlinico San Martino Hospital, Genoa, Italy
| | - Ernesto Crisafulli
- Department of Medicine, Respiratory Medicine Unit, University of Verona and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
| | - Paolo Antonio Grossi
- Infectious and Tropical Diseases Unit, Department of Medicine and Surgery, University of Insubria-ASST-Sette Laghi, Varese, Italy
| | - Alberto Zangrillo
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Antonio Desai
- Department of Emergency Medicine, Humanitas University, Pieve Emanuele, Milan, Italy
- IRCCS Humanitas Research Hospital, Milan, Italy
| | - Marco Merli
- Department of Infectious Diseases, Hospital Niguarda, Milan, Italy
| | - Maria Foggia
- Section of Infectious Diseases, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Marco Carpano
- Respiratory and Critical Care Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Lorenzo Schiavoni
- Anesthesia, Intensive Care and Pain Management, Campus Bio-Medico University Hospital Foundation, Rome, Italy
| | - Antonella D'Arminio Monforte
- Department of Health Sciences, Clinic of Infectious Diseases, ASST Santi Paolo E Carlo, University of Milan, Milan, Italy
| | - Luca Bisi
- Infectious Diseases Unit, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Gianluca Russo
- Department of Public Health and Infectious Diseases, Policlinico Umberto I, La Sapienza University, Rome, Italy
| | - Fabiana Busti
- Department of Medicine, Respiratory Medicine Unit, University of Verona and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
| | - Cristina Rovelli
- Infectious and Tropical Diseases Unit, Department of Medicine and Surgery, University of Insubria-ASST-Sette Laghi, Varese, Italy
| | | | - Giovanni Goisis
- Dompé Farmaceutici SpA, Via Santa Lucia 6, 20122, Milan, Italy
| | | | - Sophie Toya
- Dompé Farmaceutici SpA, Via Santa Lucia 6, 20122, Milan, Italy
| | - Maria De Pizzol
- Dompé Farmaceutici SpA, Via Santa Lucia 6, 20122, Milan, Italy
| | - Flavio Mantelli
- Dompé Farmaceutici SpA, Via Santa Lucia 6, 20122, Milan, Italy
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Fezzi M, Antolini L, Soria A, Bisi L, Iannuzzi F, Sabbatini F, Rossi M, Limonta S, Rugova A, Columpsi P, Squillace N, Foresti S, Pollastri E, Valsecchi MG, Migliorino GM, Bonfanti P, Lapadula G. Early prone positioning does not improve the outcome of patients with mild pneumonia due to SARS-CoV-2: results from an open-label randomised controlled trial - the EPCoT study. ERJ Open Res 2023; 9:00181-2023. [PMID: 37389899 PMCID: PMC10291725 DOI: 10.1183/23120541.00181-2023] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 05/20/2023] [Indexed: 07/01/2023] Open
Abstract
Background Prone positioning is routinely used among patients with COVID-19 requiring mechanical ventilation. However, its utility among spontaneously breathing patients is still debated. Methods In an open-label randomised controlled trial, we enrolled patients hospitalised with mild COVID-19 pneumonia, whose arterial oxygen tension to inspiratory oxygen fraction ratio (PaO2/FIO2) was >200 mmHg and who did not require mechanical ventilation or continuous positive airway pressure at hospital admission. Patients were randomised 1:1 to prone positioning on top of standard of care (intervention group) versus standard of care only (controls). The primary composite outcome included death, mechanical ventilation, continuous positive airway pressure and PaO2/FIO2 <200 mmHg; secondary outcomes were oxygen weaning and hospital discharge. Results A total of 61 subjects were enrolled, 29 adjudicated to prone positioning and 32 to the control group. By day 28, 24 out of 61 patients (39.3%) met the primary outcome: 16 because of a PaO2/FIO2 ratio <200 mmHg, five because of the need for continuous positive airway pressure and three because of the need for mechanical ventilation. Three patients died. Using an intention-to-treat approach, 15 out of 29 patients in the prone positioning group versus nine out of 32 controls met the primary outcome, corresponding to a significantly higher risk of progression among those randomised to prone positioning (HR 2.38, 95% CI 1.04-5.43; p=0.040). Using an as-treated approach, which included in the intervention group only patients who maintained prone positioning for ≥3 h·day-1, no significant differences were found between the two groups (HR 1.77, 95% CI 0.79-3.94; p=0.165). Also, we did not find any statistically significant difference in terms of time to oxygen weaning or hospital discharge between study arms in any of the analyses conducted. Conclusions We observed no clinical benefit from prone positioning among spontaneously breathing patients with COVID-19 pneumonia requiring conventional oxygen therapy.
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Affiliation(s)
- Miriam Fezzi
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Laura Antolini
- Bicocca Bioinformatics Biostatistics and Bioimaging Center – B4, University of Milano-Bicocca, Milan, Italy
| | - Alessandro Soria
- Infectious Diseases Unit, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Luca Bisi
- Infectious Diseases Unit, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Francesca Iannuzzi
- Infectious Diseases Unit, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Francesca Sabbatini
- Infectious Diseases Unit, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Marianna Rossi
- Infectious Diseases Unit, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Silvia Limonta
- Infectious Diseases Unit, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Alban Rugova
- Infectious Diseases Unit, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Paola Columpsi
- Infectious Diseases Unit, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Nicola Squillace
- Infectious Diseases Unit, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Sergio Foresti
- Infectious Diseases Unit, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Ester Pollastri
- Infectious Diseases Unit, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Maria Grazia Valsecchi
- Bicocca Bioinformatics Biostatistics and Bioimaging Center – B4, University of Milano-Bicocca, Milan, Italy
| | - Guglielmo Marco Migliorino
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
- Infectious Diseases Unit, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Paolo Bonfanti
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
- Infectious Diseases Unit, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Giuseppe Lapadula
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
- Infectious Diseases Unit, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
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Peri AM, Bisi L, Cappelletti A, Colella E, Verga L, Borella C, Foresti S, Migliorino GM, Gori A, Bandera A. Invasive aspergillosis with pulmonary and central nervous system involvement during ibrutinib therapy for relapsed chronic lymphocytic leukaemia: case report. Clin Microbiol Infect 2018; 24:785-786. [PMID: 29427802 DOI: 10.1016/j.cmi.2018.01.028] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 01/21/2018] [Accepted: 01/24/2018] [Indexed: 10/18/2022]
Affiliation(s)
- A M Peri
- Division of Infectious Diseases, San Gerardo Hospital, ASST Monza (MB), Italy.
| | - L Bisi
- Division of Infectious Diseases, San Gerardo Hospital, ASST Monza (MB), Italy
| | - A Cappelletti
- Division of Infectious Diseases, San Gerardo Hospital, ASST Monza (MB), Italy
| | - E Colella
- Division of Infectious Diseases, San Gerardo Hospital, ASST Monza (MB), Italy
| | - L Verga
- Hematology Department, San Gerardo Hospital, ASST Monza (MB), Italy
| | - C Borella
- Hematology Department, San Gerardo Hospital, ASST Monza (MB), Italy
| | - S Foresti
- Division of Infectious Diseases, San Gerardo Hospital, ASST Monza (MB), Italy
| | - G M Migliorino
- Division of Infectious Diseases, San Gerardo Hospital, ASST Monza (MB), Italy
| | - A Gori
- Division of Infectious Diseases, San Gerardo Hospital, ASST Monza (MB), Italy
| | - A Bandera
- Division of Infectious Diseases, San Gerardo Hospital, ASST Monza (MB), Italy
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Bisi L, Bolondi M, Mattei G, Sacchetti A, Ferrari S. Attempted suicide: Study of the phenomenon in a sample of patients in the province of Modena. Eur Psychiatry 2017. [DOI: 10.1016/j.eurpsy.2017.02.465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
IntroductionAttempted suicide consists in a self-damaging non-fatal behaviour, with an explicit or implicit evidence of the intent to die. It has a multifactorial aetiology: presence of psychiatric disorder, particularly major depression and other non-psychiatric components, like a series of stressful events.AimTo describe suicidal behavior among patients who attempted suicide.MethodsCross-sectional study. Patients admitted to three hospitals in the Province of Modena (Italy) after having attempted suicide were enrolled. Observation time: August 2015–August 2016 (13 months). Descriptive statistics made with STATA 13.0.ResultsA total of 187 subjects (female 65%) were enrolled in the period of time considered. Forty-one percent were aged 45–64; 43.7% had higher education; 50.4% were unemployed; 49.6% had regular income. Common means to attempt suicide were drugs (64%), weapons (11%), precipitation (10%), other (6%), choking (4%). Recent stressful events were reported by the 83.4% of respondents, namely: family conflicts (29%), economic problems (17%), personal health problems (11%), health problems affecting a family member (5%), emotional separation (9%), job loss (7%), other (22%), alcohol abuse (27%), substance abuse (4%). The main psychiatric diagnoses were: depressive disorder (56.67%), personality disorder (20%), psychotic disorder (6.67%), bipolar disorder (5.33%), behavioural disorders (2.67%), anxiety disorders (2%), dementia (1.33%).ConclusionsFindings of the present study are consistent with available literature and could help to identify “high risk” groups to plan future targeted programmes.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Rossi M, Chatenoud L, Viganò EF, Peri AM, Alagna L, Bramati S, Manenti M, Raggi M, Cavallero A, Bisi L, Leone S, Migliorino GM, Bandera A, Gori A. Clinical Usefulness of Klebsiella Pneumoniae Carbapenemase-Producing K. Pneumoniae Genotyping: The Experience of a Single-Center Epidemic. Pathog Immun 2017; 1:352-370. [PMID: 30993245 PMCID: PMC6457170 DOI: 10.20411/pai.v1i2.109] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Background: During the last decade, the spread of Klebsiella pneumoniae-carbapenemase-producing Klebsiella pneumoniae (KPC-Kp) has increased dramatically worldwide. In this scenario, growing interest has been addressed to genotyping of KPC-Kp strains, which emerged as an important tool for a better understanding of the epidemiological and clinical characteristics of the outbreaks. Methods: We performed a retrospective cohort study on patients infected with KPC-Kp during a 28-month outbreak period (January 2010–April 2012) at San Gerardo Hospital (Monza, Italy), investigating KPC-Kp genotypes by means of repetitive element sequence-based polymerase chain reaction (Rep-PCR). Results: We enrolled 97 patients infected with KPC-Kp. Rep-PCR analysis identified 5 distinct clone types, with different distribution over time. During the first 12 months of the outbreak period, only 1 clone was detected (clone A, in 47 patients), while the 4 other clones were identified over the remaining 16 months (clones C, E, and F/L in 23, 24, and 3 patients respectively). Mechanical ventilation was less frequent in patients infected with clones C/E/F/L (OR = 0.14; 95% CI: 0.05-0.37) compared to clone A, and the Charlson comorbidity index (CI) was more likely to have a score >5 in patients infected with clones C/E/F/L (OR = 7.21; 95% CI: 2.24-23.14) compared to clone A. Overall mortality was higher in patients infected with clones C/E/F/L (13/20 patients, 65%) compared to those infected with clone A (7/20, 35%). Mortality in patients infected with clones C/E/F/L remained significantly higher even after adjusting for the potential confounding effect of comorbidities (ie, CI), with a hazard ratio (HR) of 4.65 (95% CI: 1.83-11.89). Conclusions: Our results suggested a close relationship between strain genotype and clinical outcome.
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Affiliation(s)
- Marianna Rossi
- Division of Infectious Diseases, Department of Internal Medicine, "San Gerardo" Hospital, Monza, Italy
| | - Liliane Chatenoud
- IRCCS-Istituto di Ricerche Farmacologiche "Mario Negri," Milan, Italy
| | | | - Anna Maria Peri
- Division of Infectious Diseases, Department of Internal Medicine, "San Gerardo" Hospital, Monza, Italy
| | - Laura Alagna
- Division of Infectious Diseases, Department of Internal Medicine, "San Gerardo" Hospital, Monza, Italy
| | | | | | - Monica Raggi
- Microbiology Unit, "San Gerardo" Hospital, Monza, Italy
| | | | - Luca Bisi
- Division of Infectious Diseases, Department of Internal Medicine, "San Gerardo" Hospital, Monza, Italy
| | - Sebastiano Leone
- Division of Infectious Diseases, Department of Internal Medicine, "San Gerardo" Hospital, Monza, Italy
| | | | - Alessandra Bandera
- Division of Infectious Diseases, Department of Internal Medicine, "San Gerardo" Hospital, Monza, Italy
| | - Andrea Gori
- Division of Infectious Diseases, Department of Internal Medicine, "San Gerardo" Hospital, Monza, Italy
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Mangioni D, Muscatello A, Sabbatini F, Soria A, Rossi M, Bisi L, Squillace N, De Grandi C, Gori A, Bandera A. A Case of Cerebrospinal Fluid Viral Escape on a Dual Antiretroviral Regimen: Worth the Risk? Clin Infect Dis 2014; 59:1655-6. [DOI: 10.1093/cid/ciu679] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Leone S, Bisi L, Rossi M, Gori A. Comment on "Management of infections in cirrhotic patients: report of a consensus conference" S Fagiuoli et al. [Dig liver dis 2014;46:204-212]. Dig Liver Dis 2014; 46:573-4. [PMID: 24618097 DOI: 10.1016/j.dld.2014.01.155] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2013] [Revised: 01/15/2014] [Accepted: 01/20/2014] [Indexed: 02/08/2023]
Affiliation(s)
- Sebastiano Leone
- Division of Infectious Diseases, "San Gerardo" Hospital, University of Milano-Bicocca, Monza, Italy.
| | - Luca Bisi
- Division of Infectious Diseases, "San Gerardo" Hospital, University of Milano-Bicocca, Monza, Italy
| | - Marianna Rossi
- Division of Infectious Diseases, "San Gerardo" Hospital, University of Milano-Bicocca, Monza, Italy
| | - Andrea Gori
- Division of Infectious Diseases, "San Gerardo" Hospital, University of Milano-Bicocca, Monza, Italy
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Leone S, Rossi M, Bisi L, Gori A, Esposito S. Letter: antibiotic dose adjustment in patients with advanced liver disease. Aliment Pharmacol Ther 2013; 38:561-2. [PMID: 23937471 DOI: 10.1111/apt.12411] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2013] [Accepted: 06/23/2013] [Indexed: 12/11/2022]
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Leone S, Rossi M, Bisi L, Gori A, Esposito S. Antimicrobial therapy duration: a major matter in the management of severe infections. Int J Antimicrob Agents 2013; 42:287-8. [PMID: 23880171 DOI: 10.1016/j.ijantimicag.2013.06.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Accepted: 06/07/2013] [Indexed: 10/26/2022]
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Cossarizza A, Pinti M, Nasi M, Gibellini L, Manzini S, Roat E, De Biasi S, Bertoncelli L, Montagna JP, Bisi L, Manzini L, Trenti T, Borghi V, Mussini C. Increased plasma levels of extracellular mitochondrial DNA during HIV infection: a new role for mitochondrial damage-associated molecular patterns during inflammation. Mitochondrion 2011; 11:750-5. [PMID: 21722755 DOI: 10.1016/j.mito.2011.06.005] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2011] [Revised: 05/02/2011] [Accepted: 06/15/2011] [Indexed: 12/13/2022]
Abstract
HIV infection is characterized by a chronic inflammatory state. Recently, it has been shown that mitochondrial DNA (mtDNA) released from damaged or dead cells can bind Toll like receptor-9 (TLR9), an intracellular receptor that responds to bacterial or viral DNA molecules. The activation of TLR9 present within monocytes or neutrophils results in a potent inflammatory reaction, with the production of proinflammatory cytokines. We measured plasma levels of mtDNA in different groups of HIV(+) patients, i.e., those experiencing an acute HIV infection (AHI), long term non progressors (LTNP), late presenters (LP) taking antiretroviral therapy for the first time, and healthy controls. We found that in AHI and LP mtDNA plasma levels were significantly higher than in healthy individuals or in LTNP. Plasma mtDNA levels were not correlated to peripheral blood CD4(+) T cell count, nor to markers of immune activation, but had a significant correlation with plasma viral load, revealing a possible role for mtDNA in inflammation, or as a biomarker of virus-induced damage.
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Affiliation(s)
- Andrea Cossarizza
- Department of Biomedical Sciences, University of Modena and Reggio Emilia, via Campi 287, 41125 Modena, Italy.
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Cocchi S, Bisi L, Codeluppi M, Venturelli C, Di Benedetto F, Ballarin R, Gerunda GE, Rumpianesi F, Esposito R, Guaraldi G. Brucellosis in a patient with end-stage liver disease undergoing liver transplantation: successful treatment with tigecycline. Liver Transpl 2010; 16:1215-6. [PMID: 20589653 DOI: 10.1002/lt.22104] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Airoldi M, Zaccarelli M, Bisi L, Bini T, Antinori A, Mussini C, Bai F, Orofino G, Sighinolfi L, Gori A, Suter F, Maggiolo F. One-pill once-a-day HAART: a simplification strategy that improves adherence and quality of life of HIV-infected subjects. Patient Prefer Adherence 2010; 4:115-25. [PMID: 20517472 PMCID: PMC2875721 DOI: 10.2147/ppa.s10330] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2010] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE The aim of the ADONE (ADherence to ONE pill) study was to verify the effect of a reduced number of pills on adherence and quality of life (QoL) in HIV-infected patients on highly active antiretroviral therapy (HAART). DESIGN Prospective, multicenter, study. METHODS Patients chronically treated with emtricitabine (FTC) + tenofovir (TDF) + efavirenz (EFV) or lamivudine (3TC) +TDF +EFV and with a HIV-RNA < 50 copies/mL were switched to the single-pill fixed-dose regimen (FDR) of FTC +TDF +EFV. Data were collected with SF-36 using visual analog scales. Results of the final (6 months) primary as-treated analysis are reported. RESULTS 212 patients (77.4% males) of mean age 45.8 years were enrolled; 202 completed the study. One month post switch to FDR the adherence rate increased significantly to 96.1% from a baseline value of 93.8% (P < 0.01). The increase was steadily maintained throughout the study (96.2% at 6 months). QoL improved over time from 68.8% to 72.7% (P = 0.042) as well, and was significantly associated with the perception of health status, presence of adverse events (AEs) and number of reported AEs (P < 0.0001). QoL significantly influenced adherence (P < 0.0001). During FDR use the mean CD4 count increased from 556 to 605 cells/muL (P < 0.0001). At the end of follow-up 98% of patients maintained HIV-RNA level < 50 copies/mL and 100% <400 copies/mL. Four patients stopped therapy because they were lost to follow-up and 6 because of AEs (insomnia/nervousness 4, allergy 1, difficulties swallowing pills 1). CONCLUSION By substituting a one-pill once-a-day HAART, we observed an improvement of both adherence and QoL while maintaining high virologic and immunologic efficacy. HAART simplicity is an added value that favors adherence and may improve long-term success.
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Affiliation(s)
- Monica Airoldi
- Division of Infectious Diseases, Ospedali Riuniti, Bergamo
- Division of Infectious Diseases, Ospedale San Gerardo, Monza
| | | | - Luca Bisi
- Division of Infectious Diseases, Università, Modena
| | - Teresa Bini
- Division of Infectious Diseases, Ospedale San Paolo, Milano
| | | | | | - Francesca Bai
- Division of Infectious Diseases, Ospedale San Paolo, Milano
| | | | - Laura Sighinolfi
- Division of Infectious Diseases, Ospedale Sant’Anna, Ferrara, Italy
| | - Andrea Gori
- Division of Infectious Diseases, Ospedale San Gerardo, Monza
| | - Fredy Suter
- Division of Infectious Diseases, Ospedali Riuniti, Bergamo
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Nasi M, Pinti M, Manzini S, Gibellini L, Manzini L, Bisi L, De Biasi S, Del Giovane C, D'Amico R, Borghi V, Mussini C, Cossarizza A. Predictive value of intracellular HIV-1 DNA levels during CD4-guided treatment interruption in HIV+ patients. AIDS Res Hum Retroviruses 2010; 26:553-8. [PMID: 20455764 DOI: 10.1089/aid.2009.0256] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The amount of HIV-1 DNA within peripheral blood mononuclear cells is an important marker of viral activity. We studied intracellular HIV-1 DNA content in purified CD4(+) T cells from 28 chronically HIV-1-infected adults with sustained CD4(+) T cell counts (>500 cells/microl) and undetectable plasma viral load (<50 copies/ml), who underwent CD4-guided treatment interruption (TI). Patients were followed up for 18 months during TI, and for 6 months after treatment resumption (TR). Six naïve HIV(+) patients starting therapy were also enrolled and followed up for 6 months. All patients were studied every 2 months; HIV-1 DNA copy number was quantified with real-time PCR. Considering all patients remaining off-treatment, in the first 18 months of TI, intracellular HIV-1 DNA levels (expressed as Log(10) copies/million cells) remained stable (mean, 3.82 and 3.77 at time 0 and after 18 months, respectively). Similarly, HIV-1 DNA values, either in patients who restarted treatment after TI (time 0, 4.90) or in naïve patients who started treatment for the first time (time 0, 4.37), did not change significantly in the first 6 months of therapy (4.42 and 3.67, respectively). Evaluating HIV-1 DNA variations during the first 2 months of TI, we found that patients with a stable level had a lower risk to reach a CD4(+) T cell count <350 cells/microl, and thus to restart therapy, whereas this risk was significantly higher in those with a marked increase of HIV-1 DNA. In conclusion, intracellular HIV-1 DNA is a predictive marker for the length of CD4-guided TI.
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Affiliation(s)
- Milena Nasi
- Department of Biomedical Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Marcello Pinti
- Department of Biomedical Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Serena Manzini
- Department of Biomedical Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Lara Gibellini
- Department of Biomedical Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Lisa Manzini
- Infectious Diseases Clinics, Azienda Ospedaliero-Universitaria, Modena, Italy
| | - Luca Bisi
- Infectious Diseases Clinics, Azienda Ospedaliero-Universitaria, Modena, Italy
| | - Sara De Biasi
- Department of Biomedical Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Cinzia Del Giovane
- Department of Oncology, Hematology and Respiratory System Diseases, University of Modena and Reggio Emilia, Modena, Italy
| | - Roberto D'Amico
- Department of Oncology, Hematology and Respiratory System Diseases, University of Modena and Reggio Emilia, Modena, Italy
| | - Vanni Borghi
- Infectious Diseases Clinics, Azienda Ospedaliero-Universitaria, Modena, Italy
| | - Cristina Mussini
- Infectious Diseases Clinics, Azienda Ospedaliero-Universitaria, Modena, Italy
| | - Andrea Cossarizza
- Department of Biomedical Sciences, University of Modena and Reggio Emilia, Modena, Italy
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14
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Maggiolo F, Airoldi M, Trotta MP, Sette P, Bisi L, Mussini C, Bai F, Bini T, Orofino G, Gori A. Effect of a fixed-dose combination of emtricitabine, tenofovir and efavirenz on adherence and treatment acceptability (ADONE study). J Int AIDS Soc 2008. [DOI: 10.1186/1758-2652-11-s1-p167] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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15
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Borghi V, Mussini C, Manzini L, Bisi L, Esposito R. Absence of liver steatosis in HIV-infected patients receiving tenofovir-containing regimen. J Int AIDS Soc 2008. [DOI: 10.1186/1758-2652-11-s1-p273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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