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Fabbiani M, Masini M, Rossetti B, Ciccullo A, Borghi V, Lagi F, Capetti A, Colafigli M, Panza F, Baldin G, Mussini C, Sterrantino G, Farinacci D, Montagnani F, Tumbarello M, Di Giambenedetto S. Efficacy and Durability of Dolutegravir- or Darunavir-Based Regimens in ART-Naïve AIDS- or Late-Presenting HIV-Infected Patients. Viruses 2023; 15:v15051123. [PMID: 37243208 DOI: 10.3390/v15051123] [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: 04/07/2023] [Revised: 05/01/2023] [Accepted: 05/05/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND Since limited data are available, we aimed to compare the efficacy and durability of dolutegravir and darunavir in advanced naïve patients. METHODS Retrospective multicenter study including AIDS- or late-presenting (def. CD4 ≤ 200/µL) HIV-infected patients starting dolutegravir or ritonavir/cobicistat-boosted darunavir+2NRTIs. Patients were followed from the date of first-line therapy initiation (baseline, BL) to the discontinuation of darunavir or dolutegravir, or for a maximum of 36 months of follow-up. RESULTS Overall 308 patients (79.2% males, median age 43 years, 40.3% AIDS-presenters, median CD4 66 cells/µL) were enrolled; 181 (58.8%) and 127 (41.2%) were treated with dolutegravir and darunavir, respectively. Incidence of treatment discontinuation (TD), virological failure (VF, defined as a single HIV-RNA > 1000 cp/mL or two consecutive HIV-RNA > 50 cp/mL after 6 months of therapy or after virological suppression had been achieved), treatment failure (the first of TD or VF), and optimal immunological recovery (defined as CD4 ≥ 500/µL + CD4 ≥ 30% + CD4/CD8 ≥ 1) were 21.9, 5.2, 25.6 and 1.4 per 100 person-years of follow-up, respectively, without significant differences between dolutegravir and darunavir (p > 0.05 for all outcomes). However, a higher estimated probability of TD for central nervous system (CNS) toxicity (at 36 months: 11.7% vs. 0%, p = 0.002) was observed for dolutegravir, whereas darunavir showed a higher probability of TD for simplification (at 36 months: 21.3% vs. 5.7%, p = 0.046). CONCLUSIONS Dolutegravir and darunavir showed similar efficacy in AIDS- and late-presenting patients. A higher risk of TD due to CNS toxicity was observed with dolutegravir, and a higher probability of treatment simplification with darunavir.
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Affiliation(s)
- Massimiliano Fabbiani
- UOC Malattie Infettive e Tropicali, Azienda Ospedaliero-Universitaria Senese, 53100 Siena, Italy
| | - Melissa Masini
- UOC Malattie Infettive, Azienda USL Toscana Sud Est, PO San Donato, 52100 Arezzo, Italy
| | - Barbara Rossetti
- Division of Infectious Diseases, AUSL Toscana Sud Est, Grosseto Hospital, 58100 Grosseto, Italy
| | - Arturo Ciccullo
- Dipartimento di Sicurezza e Bioetica Sezione Malattie Infettive, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- UOC Malattie Infettive, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Vanni Borghi
- Clinica Malattie Infettive e Tropicali, Azienda Ospedaliero Universitaria di Modena, 41100 Modena, Italy
| | - Filippo Lagi
- SOD Malattie Infettive e Tropicali, Azienda Ospedaliero-Universitaria Careggi, 50134 Firenze, Italy
| | - Amedeo Capetti
- Divisione di Malattie Infettive, Dipartimento di Malattie Infettive, Ospedale Universitario Luigi Sacco, 20157 Milano, Italy
| | - Manuela Colafigli
- Unità di Dermatologia Infettiva e Allergologia, Istituto S. Gallicano IRCCS, 00144 Rome, Italy
| | - Francesca Panza
- UOC Malattie Infettive e Tropicali, Azienda Ospedaliero-Universitaria Senese, 53100 Siena, Italy
- Dipartimento di Biotecnologie Mediche, Università degli Studi di Siena, 53100 Siena, Italy
| | - Gianmaria Baldin
- Dipartimento di Sicurezza e Bioetica Sezione Malattie Infettive, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- UOC Malattie Infettive, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Cristina Mussini
- Clinica Malattie Infettive e Tropicali, Azienda Ospedaliero Universitaria di Modena, 41100 Modena, Italy
| | - Gaetana Sterrantino
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy
| | - Damiano Farinacci
- Dipartimento di Sicurezza e Bioetica Sezione Malattie Infettive, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- UOC Malattie Infettive, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Francesca Montagnani
- UOC Malattie Infettive e Tropicali, Azienda Ospedaliero-Universitaria Senese, 53100 Siena, Italy
- Dipartimento di Biotecnologie Mediche, Università degli Studi di Siena, 53100 Siena, Italy
| | - Mario Tumbarello
- UOC Malattie Infettive e Tropicali, Azienda Ospedaliero-Universitaria Senese, 53100 Siena, Italy
- Dipartimento di Biotecnologie Mediche, Università degli Studi di Siena, 53100 Siena, Italy
| | - Simona Di Giambenedetto
- Dipartimento di Sicurezza e Bioetica Sezione Malattie Infettive, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- UOC Malattie Infettive, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
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Fabbiani M, Rossetti B, Ciccullo A, Oreni L, Lagi F, Celani L, Colafigli M, De Vito A, Mazzitelli M, Dusina A, Durante M, Montagnani F, Rusconi S, Capetti A, Sterrantino G, D'Ettorre G, Di Giambenedetto S. Efficacy and durability of two- vs. three-drug integrase inhibitor-based regimens in virologically suppressed HIV-infected patients: Data from real-life ODOACRE cohort. HIV Med 2021; 22:843-853. [PMID: 34318591 DOI: 10.1111/hiv.13146] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Accepted: 07/05/2021] [Indexed: 01/09/2023]
Abstract
OBJECTIVES The aim of the present study was to compare the efficacy and durability of treatment switch to two-drug (2DR) vs. three-drug (3DR) integrase inhibitor (InSTI)-based regimens in a real-life setting. METHODS Within the ODOACRE cohort, we selected adult patients with HIV RNA < 50 copies/mL switching to an InSTI-based 2DR or 3DR. Survival analyses were performed to estimate the probability of virological failure (VF, defined as one HIV RNA > 1000 copies/mL or two consecutive HIV RNA > 50 copies/mL) and treatment discontinuation (TD, defined as any modification, intensification or interruption of the regimen), and to evaluate their predictors. RESULTS Overall, 1666 patients were included, of whom 1334 (80%) were treated with a 3DR (19.9%, 25.0% and 55.1% elvitegravir-, raltegravir- and dolutegravir-based, respectively) and 332 (20%) with a 2DR (79.2% dolutegravir + lamivudine and 20.8% dolutegravir + rilpivirine). Over a median (interquartile range) follow-up of 100 (52-150) weeks, 52 (3.1%) patients experienced VF with an incidence of 1.5/100 person-year of follow-up (PYFU). The estimated 96-week probability of VF was similar for the 2DR and 3DR groups (2.3% vs. 2.8%, P = 0.53), but it was higher for elvitegravir (4.9%) and raltegravir (5.0%) than for dolutegravir (1.5%) (P = 0.04). Four hundred (24%) patients discontinued their InSTI-based regimen, with an incidence of 11.3/100 PYFU. At 96 weeks, 3DRs showed a higher probability of TD for any reason (20.6% vs. 11.2%, P < 0.001) and TD for toxicity (9.0% vs. 6.6%, P = 0.02) when compared with 2DRs. A higher risk of TD for central nervous system toxicity was observed for dolutegravir than for elvitegravir and raltegravir (4.0% vs. 2.5% vs. 0.6%, P = 0.005). CONCLUSIONS In virologically suppressed HIV-infected patients, 2DRs showed an efficacy similar to 3DRs but with better tolerability.
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Affiliation(s)
- Massimiliano Fabbiani
- UOC Malattie Infettive e Tropicali, Azienda Ospedaliero-Universitaria Senese, Siena, Italy
| | - Barbara Rossetti
- UOC Malattie Infettive e Tropicali, Azienda Ospedaliero-Universitaria Senese, Siena, Italy
| | - Arturo Ciccullo
- UOC Malattie Infettive, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Letizia Oreni
- Infectious Diseases Unit, DIBIC Luigi Sacco, University of Milan, Milan, Italy
| | - Filippo Lagi
- Malattie Infettive e Tropicali, Dipartimento di Medicina Clinica e Sperimentale, Università di Firenze, Firenze, Italy
| | - Luigi Celani
- Department of Public Health and Infectious Diseases - "Sapienza" University of Rome, Rome, Italy
| | - Manuela Colafigli
- Infectious Dermatology and Allergology Unit, IFO S. Gallicano Institute (IRCCS), Rome, Italy
| | - Andrea De Vito
- Unit of Infectious Diseases, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Maria Mazzitelli
- Infectious and Tropical Diseases Unit, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - Alex Dusina
- UOC Malattie Infettive, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Miriam Durante
- Dipartimento di Biotecnologie Mediche, Università degli Studi di Siena, Siena, Italy
| | - Francesca Montagnani
- UOC Malattie Infettive e Tropicali, Azienda Ospedaliero-Universitaria Senese, Siena, Italy.,Dipartimento di Biotecnologie Mediche, Università degli Studi di Siena, Siena, Italy
| | - Stefano Rusconi
- Infectious Diseases Unit, DIBIC Luigi Sacco, University of Milan, Milan, Italy
| | - Amedeo Capetti
- Division of Infectious Diseases, Department of Infectious Diseases, Luigi Sacco University Hospital, Milan, Italy
| | - Gaetana Sterrantino
- Malattie Infettive e Tropicali, Dipartimento di Medicina Clinica e Sperimentale, Università di Firenze, Firenze, Italy
| | - Gabriella D'Ettorre
- Department of Public Health and Infectious Diseases - "Sapienza" University of Rome, Rome, Italy
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Armenia D, Di Carlo D, Flandre P, Bouba Y, Borghi V, Forbici F, Bertoli A, Gori C, Fabeni L, Gennari W, Pinnetti C, Mondi A, Cicalini S, Gagliardini R, Vergori A, Bellagamba R, Malagnino V, Montella F, Colafigli M, Latini A, Marocco R, Licthner M, Andreoni M, Mussini C, Ceccherini-Silberstein F, Antinori A, Perno CF, Santoro MM. HIV MDR is still a relevant issue despite its dramatic drop over the years. J Antimicrob Chemother 2021; 75:1301-1310. [PMID: 31976521 DOI: 10.1093/jac/dkz554] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 11/16/2019] [Accepted: 12/11/2019] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVES To evaluate the prevalence and therapeutic relevance of drug resistance among isolates from ART-experienced HIV-1-infected patients over the past two decades in Italy. METHODS Dynamics of resistance to one, two and three or more antiretroviral classes were evaluated from 1999-2018. Virological success (VS) after the latest therapy switch was evaluated according to cumulative class resistance and cumulative genotypic susceptibility score (Stanford HIV_DB algorithm). RESULTS Among 13 663 isolates (from 6739 patients), resistance to at least one drug class decreased sharply from 1999 to 2010 (≤2001, 84.6%; 2010, 43.6%; P < 0.001), then remained relatively constant at ∼40% during 2010-18, with the proportion of resistance to three or more classes also stable (∼5%). After 2008, integrase inhibitor resistance slightly increased from 5.6% to 9.7% in 2018 and contributed to resistance, particularly in isolates with resistance to three or more classes (one class, 8.4%; two classes, 15.3%; three or more classes, 34.7%, P < 0.001). Among 1827 failing patients with an available follow-up, by 1 year after genotype-guided therapy start the probability of VS was 87.6%. Patients with cumulative resistance to three or more classes and receiving a poorly active regimen showed the lowest probability (62.6%) of VS (P < 0.001) compared with all other patients (≥81.8%). By Cox regression analysis, cumulative MDR and receiving poorly active antiretroviral regimens were associated with a lower hazard of VS compared with those without resistance. CONCLUSIONS A dramatic drop of HIV-1 drug resistance at failure has been achieved over the last two decades in Italy; resistance to three or more classes is low but present among currently failing patients. Its management still requires a rational and careful diagnostic and therapeutic approach.
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Affiliation(s)
- D Armenia
- UniCamillus International University of Health and Medical Sciences, Rome, Italy.,University of Rome 'Tor Vergata', Department of Experimental Medicine, Rome, Italy
| | - D Di Carlo
- University of Milan, Pediatric Clinical Research Center 'Romeo and Enrica Invernizzi', Milan, Italy
| | - P Flandre
- INSERM, Sorbonne Université, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP) équipe Epidémiologie clinique des maladies virales chroniques, Paris, France
| | - Y Bouba
- University of Rome 'Tor Vergata', Department of Experimental Medicine, Rome, Italy.,Chantal BIYA International Reference Centre for research on HIV/AIDS prevention and management (CIRCB), Yaoundé, Cameroon
| | - V Borghi
- Clinic of Infectious Diseases, University Hospital, University of Modena and Reggio Emilia, Modena, Italy
| | - F Forbici
- Laboratory of Virology, National Institute for Infectious Diseases 'Lazzaro Spallanzani', IRCCS, Rome, Italy
| | - A Bertoli
- University of Rome 'Tor Vergata', Department of Experimental Medicine, Rome, Italy
| | - C Gori
- Laboratory of Virology, National Institute for Infectious Diseases 'Lazzaro Spallanzani', IRCCS, Rome, Italy
| | - L Fabeni
- University of Rome 'Tor Vergata', Department of Experimental Medicine, Rome, Italy
| | - W Gennari
- Microbiology Unit, University Hospital of Modena, Modena, Italy
| | - C Pinnetti
- HIV/AIDS Department, National Institute for Infectious Diseases 'Lazzaro Spallanzani' IRCCS, Rome, Italy
| | - A Mondi
- HIV/AIDS Department, National Institute for Infectious Diseases 'Lazzaro Spallanzani' IRCCS, Rome, Italy
| | - S Cicalini
- HIV/AIDS Department, National Institute for Infectious Diseases 'Lazzaro Spallanzani' IRCCS, Rome, Italy
| | - R Gagliardini
- HIV/AIDS Department, National Institute for Infectious Diseases 'Lazzaro Spallanzani' IRCCS, Rome, Italy
| | - A Vergori
- HIV/AIDS Department, National Institute for Infectious Diseases 'Lazzaro Spallanzani' IRCCS, Rome, Italy
| | - R Bellagamba
- HIV/AIDS Department, National Institute for Infectious Diseases 'Lazzaro Spallanzani' IRCCS, Rome, Italy
| | - V Malagnino
- Clinical Infectious Diseases, University Hospital 'Tor Vergata', Rome, Italy
| | - F Montella
- Infectious disease Unit, San Giovanni Addolorata Hospital, Rome, Italy
| | - M Colafigli
- Unit of Dermatology and Sexually Transmitted Diseases, San Gallicano Dermatological Institute IRCCS, Rome, Italy
| | - A Latini
- Unit of Dermatology and Sexually Transmitted Diseases, San Gallicano Dermatological Institute IRCCS, Rome, Italy
| | - R Marocco
- Infectious Diseases Unit, 'Sapienza' University, Polo Pontino, Latina, Italy
| | - M Licthner
- Infectious Diseases Unit, 'Sapienza' University, Polo Pontino, Latina, Italy
| | - M Andreoni
- Clinical Infectious Diseases, University Hospital 'Tor Vergata', Rome, Italy
| | - C Mussini
- Clinic of Infectious Diseases, University Hospital, University of Modena and Reggio Emilia, Modena, Italy
| | | | - A Antinori
- HIV/AIDS Department, National Institute for Infectious Diseases 'Lazzaro Spallanzani' IRCCS, Rome, Italy
| | - C F Perno
- Laboratory of Virology, National Institute for Infectious Diseases 'Lazzaro Spallanzani', IRCCS, Rome, Italy
| | - M M Santoro
- University of Rome 'Tor Vergata', Department of Experimental Medicine, Rome, Italy
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4
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Modica S, Redi D, Gagliardini R, Giombini E, Bezenchek A, Di Carlo D, Maggiolo F, Lombardi F, Borghetti A, Farinacci D, Callegaro A, Gismondo MR, Colafigli M, Sterrantino G, Costantini A, Ferrara SM, Rusconi S, Zazzi M, Rossetti B, De Luca A, Gianotti N. Impact of NRTI resistance mutations on virological effectiveness of antiretroviral regimens containing elvitegravir: a multi-cohort study. J Antimicrob Chemother 2021; 75:194-199. [PMID: 31605107 DOI: 10.1093/jac/dkz424] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 09/04/2019] [Accepted: 09/10/2019] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Antiretroviral drug resistance mutations remain a major cause of treatment failure. OBJECTIVES To evaluate the impact of NRTI resistance mutations on virological effectiveness of elvitegravir-containing regimens. MATERIALS AND METHODS We selected treatment-experienced HIV-1-infected patients starting elvitegravir/cobicistat/emtricitabine/tenofovir alafenamide (E/C/F/TAF) or elvitegravir/cobicistat/emtricitabine/tenofovir disoproxil fumarate (E/C/F/TDF), with at least one protease/reverse transcriptase genotype available before switching and at least one HIV-1 RNA viral load (VL) measurement during follow-up. The primary endpoint was virological failure (VF), defined as one VL value of ≥1000 copies/mL or two consecutive VL values of >50 copies/mL. RESULTS We included 264 ART regimens: 75.6% male, median (IQR) age 47 years (39-53), 7 years (3-16) of HIV infection, nadir CD4+ 247 cells/mm3 (105-361), 81.5% with VL ≤50 copies/mL and 11.7% with at least one NRTI mutation at baseline. Eleven (5.2%) VFs occurred in virologically suppressed patients versus eight (15.1%) in viraemic patients. The estimated probability of VF at 48 weeks with versus without any NRTI mutation was 7.4% (95% CI 2.3-12.5) versus 3.8% (2.1-5.5) in virologically suppressed patients and 66.7% (39.5-93.9) versus 11.2% (6.5-15.9) (P<0.001) in viraemic patients. The only predictor of VF was time on therapy (per 1 year more, adjusted HR 1.14, 95% CI 1.02-1.27, P=0.024) in viraemic patients. CONCLUSIONS A switch to E/C/F/TDF or E/C/F/TAF is safe for virologically suppressed patients without documented NRTI resistance, but not recommended in viraemic patients with a history of NRTI resistance. Although we did not detect a detrimental effect of past NRTI resistance in virologically suppressed patients, a fully active regimen remains preferred in this setting due to possible rebound of drug-resistant virus in the long term.
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Affiliation(s)
- Sara Modica
- Department of Medical Biotechnologies, University of Siena, Viale Bracci, 16, 53100, Siena, Italy
| | - David Redi
- Department of Medical Biotechnologies, University of Siena, Viale Bracci, 16, 53100, Siena, Italy.,Infectious Diseases Unit, AOU Senese, Viale Bracci, 16, 53100, Siena, Italy
| | - Roberta Gagliardini
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Via Portuense, 292, 00161, Rome, Italy
| | - Emanuela Giombini
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Via Portuense, 292, 00161, Rome, Italy
| | | | - Domenico Di Carlo
- University of Milan, Pediatric Clinical Research Center 'Romeo and Enrica Invernizzi', Via Giovanni Battista Grassi, 74, 20157, Milan, Italy
| | - Franco Maggiolo
- Infectious Diseases Unit, Ospedali Riuniti, Largo Barozzi, 1, 24128, Bergamo, Italy
| | - Francesca Lombardi
- UOC Malattie Infettive, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli 8, 00168, Roma, Italia
| | - Alberto Borghetti
- UOC Malattie Infettive, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli 8, 00168, Roma, Italia
| | - Damiano Farinacci
- UOC Malattie Infettive, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli 8, 00168, Roma, Italia
| | - Annapaola Callegaro
- Microbiology and Virology Unit, Bergamo Hospital, Piazza OMS, 1, 24127, Bergamo, Italy
| | - Maria R Gismondo
- Microbiology Unit, Ospedale L. Sacco, Via G.B Grassi, 74, 20157, Milan, Italy
| | - Manuela Colafigli
- San Gallicano Dermatologic Institute, STI/HIV Unit, IRCCS, via Elio Chianesi, 53, 00144, Rome, Italy
| | - Gaetana Sterrantino
- Department di Clinical and Experimental Medicine, Clinic of Tropical and Infectious Diseases, University of Florence, Largo Brambilla, 3, 50134, Florence, Italy
| | - Andrea Costantini
- Clinical Immunology Unit, Department of Clinical and Molecular Sciences, Università Politecnica delle Marche, Via Tronto, 10, 60121, Ancona, Italy
| | - Sergio M Ferrara
- Clinic of Infectious Diseases, Azienda ospedaliera-Universitaria Ospedali Riuniti, Viale Luigi Pinto, 1, 71122, Foggia, Italy
| | - Stefano Rusconi
- Infectious and Tropical Diseases Unit, DIBIC L. Sacco Hospital, University of Milano, Via G.B Grassi, 74, 20157, Milan, Italy
| | - Maurizio Zazzi
- Department of Medical Biotechnologies, University of Siena, Viale Bracci, 16, 53100, Siena, Italy
| | - Barbara Rossetti
- Infectious Diseases Unit, AOU Senese, Viale Bracci, 16, 53100, Siena, Italy
| | - Andrea De Luca
- Department of Medical Biotechnologies, University of Siena, Viale Bracci, 16, 53100, Siena, Italy.,Infectious Diseases Unit, AOU Senese, Viale Bracci, 16, 53100, Siena, Italy
| | - Nicola Gianotti
- Infectious Diseases, IRCCS San Raffaele, Via Olgettina 60, 20132, Milan, Italy
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5
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Fabbiani M, Borghetti A, Squillace N, Colafigli M, Taramasso L, Lombardi A, Rossetti B, Ciccullo A, Colella E, Picarelli C, Berruti M, Latini A, Montagnani F, Sambo M, Di Biagio A, Gori A, Di Giambenedetto S, Bandera A. Integrase Inhibitors Use and Cytomegalovirus Infection Predict Immune Recovery in People Living With HIV Starting First-Line Therapy. J Acquir Immune Defic Syndr 2021; 86:119-127. [PMID: 33306566 DOI: 10.1097/qai.0000000000002525] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 12/21/2022]
Abstract
BACKGROUND We explored predictors of CD4/CD8 ratio improvement and optimal immunological recovery (OIR) after initiation of antiretroviral therapy (ART) in naive people living with HIV (PLWH). METHODS Retrospective multicenter study including naive PLWH starting ART with 2 nucleos(t)ide reverse transcriptase inhibitors + 1 integrase strand transfer inhibitor (InSTI) or non-NRTI or protease inhibitor (PI). PLWH were followed from the time of ART initiation (baseline) to the discontinuation of first-line regimen, virological failure, death, or loss to follow-up. Estimated incidence and predictors of time to CD4/CD8 ratio normalization (defined as ≥1) and OIR (defined as CD4/CD8 ratio ≥ 1 plus CD4 ≥ 500 cells/µL plus CD4% ≥ 30%) were explored by Kaplan-Meier curves and Cox regression analysis. RESULTS Overall, 1428 PLWH (77.8% males, median age 39 years, 55.1% with positive cytomegalovirus (CMV) antibodies, median HIV-RNA 4.80 log copies/mL, median CD4 323 cells/µL, median CD4/CD8 ratio 0.32) were included, of which 21.5% (n = 307), 44.5% (n = 636), and 34% (n = 485) treated with InSTI-, PI-, and NNRTI-based regimens, respectively. The estimated proportion of CD4/CD8 normalization and OIR at 36 months was 38.6% and 32.9%, respectively. Multivariate analysis showed that InSTI-based regimens had a higher probability of CD4/CD8 ratio normalization and OIR both in the total population (P < 0.001 versus PI) and in advanced naive PLWH (P ≤ 0.001 versus PI and NNRTI). Moreover, subjects with positive CMV serology showed a lower probability of CD4/CD8 ratio normalization and OIR (P < 0.001). CONCLUSIONS InSTI-based regimens showed a better immune recovery, suggesting that the type of first-line ART can influence immune reconstitution. PLWH with positive CMV serology showed an increased risk of suboptimal immune recovery.
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Affiliation(s)
- Massimiliano Fabbiani
- Infectious and Tropical Diseases Unit, Azienda Ospedaliero-Universitaria Senese, Siena, Italy
| | - Alberto Borghetti
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, UOC Malattie Infettive, Rome, Italy
| | - Nicola Squillace
- Unit of Infectious Diseases, San Gerardo Hospital, ASST Monza, Monza, Italy
| | - Manuela Colafigli
- Infectious Dermatology and Allergology, San Gallicano Dermatological Institute IRCCS, Rome, Italy
| | - Lucia Taramasso
- Department of Health Sciences (DISSAL), Infectious Diseases Clinic, Policlinico San Martino Hospital, University of Genoa, Genova, Italy
| | - Andrea Lombardi
- Infectious Diseases Unit, IRCCS Ca' Granda Ospedale Maggiore Policlinico Foundation, Milano, Italy
| | - Barbara Rossetti
- Infectious and Tropical Diseases Unit, Azienda Ospedaliero-Universitaria Senese, Siena, Italy
| | - Arturo Ciccullo
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, UOC Malattie Infettive, Rome, Italy
| | - Elisa Colella
- Unit of Infectious Diseases, San Gerardo Hospital, ASST Monza, Monza, Italy
| | - Chiara Picarelli
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, UOC Malattie Infettive, Rome, Italy
| | - Marco Berruti
- Department of Health Sciences (DISSAL), Infectious Diseases Clinic, Policlinico San Martino Hospital, University of Genoa, Genova, Italy
| | - Alessandra Latini
- Infectious Dermatology and Allergology, San Gallicano Dermatological Institute IRCCS, Rome, Italy
| | - Francesca Montagnani
- Infectious and Tropical Diseases Unit, Azienda Ospedaliero-Universitaria Senese, Siena, Italy
- Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Margherita Sambo
- Infectious and Tropical Diseases Unit, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Antonio Di Biagio
- Department of Health Sciences (DISSAL), Infectious Diseases Clinic, Policlinico San Martino Hospital, University of Genoa, Genova, Italy
| | - Andrea Gori
- Infectious Diseases Unit, IRCCS Ca' Granda Ospedale Maggiore Policlinico Foundation, Milano, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy; and
| | - Simona Di Giambenedetto
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, UOC Malattie Infettive, Rome, Italy
- Section of Infectious Diseases, Department of Safety and Bioethics, Catholic University of Sacred Heart, Rome, Italy
| | - Alessandra Bandera
- Infectious Diseases Unit, IRCCS Ca' Granda Ospedale Maggiore Policlinico Foundation, Milano, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy; and
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6
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Ciccullo A, Baldin G, Borghi V, Sterrantino G, Madeddu G, Latini A, d'Ettorre G, Lanari A, Mazzitelli M, Colafigli M, Capetti AF, Oreni L, Lagi F, Rusconi S, Di Giambenedetto S. Overall Tolerability of Integrase Inhibitors in Clinical Practice: Results from a Multicenter Italian Cohort. AIDS Res Hum Retroviruses 2021; 37:4-10. [PMID: 32998526 DOI: 10.1089/aid.2020.0078] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
International guidelines recommend the use of integrase strand transfer inhibitor (INI)-based regimens as first-line antiretroviral (ARV) in both naive and experienced HIV-infected patients. We analyzed a multicenter cohort of HIV-infected patients, both naive and experienced, starting an ARV, including an INI. Chi-square test and nonparametric tests were used to assess differences in categorical and continuous variables, respectively. Kaplan-Meier survival analysis was performed to estimate the probability of maintaining the study drug and Cox-regression analysis to evaluate predictors of discontinuation. We enrolled 4,343 patients: 3,143 (72.4%) were males, with a median age of 49 years (interquartile range 41-55). Naive patients were 733 (16.9%), of whom 168 (22.9%) were AIDS presenters. Overall, 2,282 patients (52.5%) started dolutegravir (DTG), 1,426 (32.8%) raltegravir (RAL), and 635 (14.7%) elvitegravir (EVG). During 10,032 patient years of follow-up (PYFU), we observed 1,278 discontinuations (13 per 100 PYFU); 448 of them (35%) due to simplification and 355 (28%) to toxicities (98 for central nervous system toxicity). Reasons of discontinuation were different between INIs. Estimated probability of maintaining DTG at 3 and 4 years were 81.5% [95% confidence interval (CI): 80.5-82.5] and 76.3% (95% CI: 73.9-78.7), respectively; RAL 61.6% (95% CI: 60.2-63.0) and 54.1% (95% CI: 52.7-55.5); EVG 71.6% (95% CI: 69.2-74.0) and 68.3% (95% CI: 65.3-71.3) (p < .001). At a multivariable analysis, being on a RAL-based ARV [vs. DTG, adjusted hazard ratio (aHR) 2.9, 95% CI: 2.3-3.6, p < .001], a EVG-based ARV (vs. DTG, aHR 1.3 95% CI: 1.1-1.7, p = .049), and a peak HIV-RNA >500k cp/mL (aHR 1.3, 95% CI: 1.1-1.6, p = .006) predicted INI discontinuation. Our data confirm the good tolerability of INIs in clinical practice. Differences emerge between the three drugs in reasons for discontinuation.
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Affiliation(s)
- Arturo Ciccullo
- Section of Infectious Diseases, Department of Safety and Bioethics, Catholic University of the Sacred Heart, Rome, Italy
- Infectious Diseases Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Gianmaria Baldin
- Section of Infectious Diseases, Department of Safety and Bioethics, Catholic University of the Sacred Heart, Rome, Italy
- Mater Olbia Hospital, Olbia, Italy
| | - Vanni Borghi
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria Policlinico of Modena, Modena, Italy
| | - Gaetana Sterrantino
- Division of Tropical and Infectious Diseases, ‘Careggi’ Hospital, Florence, Italy
| | - Giordano Madeddu
- Department of Clinical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Alessandra Latini
- Infectious Dermatology and Allergology Unit, IFO S. Gallicano Institute (IRCCS), Rome, Italy
| | - Gabriella d'Ettorre
- Department of Public Health and Infectious Diseases, Azienda Policlinico Umberto I, Rome, Italy
| | - Alessandro Lanari
- Infectious Diseases Unit, AOU Senese, Siena, Italy
- Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Maria Mazzitelli
- Department of Medical and Surgical Sciences, Unit of Infectious and Tropical Diseases, Magna Graecia University, Catanzaro, Italy
| | - Manuela Colafigli
- Infectious Dermatology and Allergology Unit, IFO S. Gallicano Institute (IRCCS), Rome, Italy
| | - Amedeo Ferdinando Capetti
- Division of Infectious Diseases, Department of Infectious Diseases, Luigi Sacco University Hospital, Milan, Italy
| | - Letizia Oreni
- Infectious Diseases Unit, DIBIC Luigi Sacco, University of Milan, Milan, Italy
| | - Filippo Lagi
- Division of Tropical and Infectious Diseases, ‘Careggi’ Hospital, Florence, Italy
| | - Stefano Rusconi
- Infectious Diseases Unit, DIBIC Luigi Sacco, University of Milan, Milan, Italy
| | - Simona Di Giambenedetto
- Section of Infectious Diseases, Department of Safety and Bioethics, Catholic University of the Sacred Heart, Rome, Italy
- Infectious Diseases Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
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Armenia D, Bouba Y, Gagliardini R, Gori C, Bertoli A, Borghi V, Gennari W, Micheli V, Callegaro AP, Gazzola L, Bruzzone B, Giannetti A, Mazzotta V, Vergori A, Mastrorosa I, Colafigli M, Lichtner M, di Biagio A, Maggiolo F, Rizzardini G, d'Arminio Monforte A, Andreoni M, Mussini C, Antinori A, Ceccherini-Silberstein F, Perno CF, Santoro MM. Evaluation of virological response and resistance profile in HIV-1 infected patients starting a first-line integrase inhibitor-based regimen in clinical settings. J Clin Virol 2020; 130:104534. [PMID: 32769022 DOI: 10.1016/j.jcv.2020.104534] [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] [Received: 05/07/2020] [Accepted: 07/05/2020] [Indexed: 01/04/2023]
Abstract
BACKGROUND Virological response and resistance profile were evaluated in drug-naïve patients starting their first-line integrase inhibitors (INIs)-based regimen in a clinical setting. STUDY DESIGN Virological success (VS) and virological rebound (VR) after therapy start were assessed by survival analyses. Drug-resistance was evaluated at baseline and at virological failure. RESULTS Among 798 patients analysed, 38.6 %, 27.1 % and 34.3 % received raltegravir, elvitegravir and dolutegravir, respectively. Baseline resistance to NRTIs, NNRTIs, PIs and INIs was: 3.9 %, 13.9 %, 1.6 % and 0.5 %, respectively. Overall, by 12 months of treatment, the probability of VS was 95 %, while the probability of VR by 36 months after VS was 13.1 %. No significant differences in the virological response were found according to the INI used. The higher pre-therapy viremia strata was (<100,000 vs. 100,000-500,000 vs. > 500,000 copies/mL), lower was the probability of VS (96.0 % vs. 95.2 % vs. 91.1 %, respectively, P < 0.001), and higher the probability of VR (10.2 % vs. 15.8 % vs. 16.6 %, respectively, P = 0.010). CD4 cell count <200 cell/mm3 was associated with the lowest probability of VS (91.5 %, P < 0.001) and the highest probability of VR (20.7 %, P = 0.008) compared to higher CD4 levels. Multivariable Cox-regression confirmed the negative role of high pre-therapy viremia and low CD4 cell count on VS, but not on VR. Forty-three (5.3 %) patients experienced VF (raltegravir: 30; elvitegravir: 9; dolutegravir: 4). Patients failing dolutegravir did not harbor any resistance mutation either in integrase or reverse transcriptase. CONCLUSIONS Our findings confirm that patients receiving an INI-based first-line regimen achieve and maintain very high rates of VS in clinical practice.
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Affiliation(s)
- Daniele Armenia
- Saint Camillus International University of Health and Medical Sciences, Rome, Italy
| | - Yagai Bouba
- Department of Experimental Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Roberta Gagliardini
- Clinical Division of HIV/AIDS, National Institute for Infectious Diseases "Lazzaro Spallanzani", IRCCS, Rome, Italy
| | - Caterina Gori
- Laboratory of Virology, National Institute for Infectious Diseases "Lazzaro Spallanzani", IRCCS, Rome, Italy
| | - Ada Bertoli
- Department of Experimental Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Vanni Borghi
- Clinic of Infectious Diseases, University Hospital, University of Modena and Reggio Emilia, Modena, Italy
| | - William Gennari
- Microbiology and Virology Unit, University Hospital, University of Modena and Reggio Emilia, Modena, Italy
| | - Valeria Micheli
- Department of Clinical Microbiology, Virology and Diagnosis of Bioemergency, Luigi Sacco University Hospital, Milano, Italy
| | | | - Lidia Gazzola
- Department of Health Sciences, Clinic of Infectious Diseases, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
| | - Bianca Bruzzone
- Hygiene Unit, Ospedale Policlinico San Martino, Genoa, Italy
| | - Alberto Giannetti
- Clinical Division of HIV/AIDS, National Institute for Infectious Diseases "Lazzaro Spallanzani", IRCCS, Rome, Italy
| | - Valentina Mazzotta
- Clinical Division of HIV/AIDS, National Institute for Infectious Diseases "Lazzaro Spallanzani", IRCCS, Rome, Italy
| | - Alessandra Vergori
- Clinical Division of HIV/AIDS, National Institute for Infectious Diseases "Lazzaro Spallanzani", IRCCS, Rome, Italy
| | - Ilaria Mastrorosa
- Clinical Division of HIV/AIDS, National Institute for Infectious Diseases "Lazzaro Spallanzani", IRCCS, Rome, Italy
| | - Manuela Colafigli
- Unit of Dermatology and Sexually Transmitted Diseases, San Gallicano Dermatological Institute IRCCS, Rome, Italy
| | - Miriam Lichtner
- Infectious Diseases Unit, "Sapienza" University, Polo Pontino, Latina, Italy
| | - Antonio di Biagio
- Infectious Diseases Clinic, Policlinico San Martino Hospital, Department of Health Sciences (DISSAL), University of Genoa, Genova, Italy
| | - Franco Maggiolo
- Division of Infectious Diseases, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Giuliano Rizzardini
- Department of Infectious Diseases, Luigi Sacco University Hospital, Milano, Italy
| | - Antonella d'Arminio Monforte
- Department of Health Sciences, Clinic of Infectious Diseases, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
| | - Massimo Andreoni
- Clinical Infectious Diseases, University Hospital "Tor Vergata", Rome, Italy
| | - Cristina Mussini
- Clinic of Infectious Diseases, University Hospital, University of Modena and Reggio Emilia, Modena, Italy
| | - Andrea Antinori
- Clinical Division of HIV/AIDS, National Institute for Infectious Diseases "Lazzaro Spallanzani", IRCCS, Rome, Italy
| | | | - Carlo Federico Perno
- Department of Experimental Medicine, University of Rome "Tor Vergata", Rome, Italy
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8
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Borghetti A, Calcagno A, Lombardi F, Cusato J, Belmonti S, D'Avolio A, Ciccarelli N, La Monica S, Colafigli M, Delle Donne V, De Marco R, Tamburrini E, Visconti E, Di Perri G, De Luca A, Bonora S, Di Giambenedetto S. SLC22A2 variants and dolutegravir levels correlate with psychiatric symptoms in persons with HIV. J Antimicrob Chemother 2020; 74:1035-1043. [PMID: 30561642 DOI: 10.1093/jac/dky508] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 10/29/2018] [Accepted: 11/12/2018] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Neuropsychiatric symptoms (NPs) have been reported with dolutegravir use. We hypothesized that increasing dolutegravir trough concentrations (Ctrough) and/or polymorphism in the SLC22A2 gene, encoding the organic cation transporter-2 (OCT2), which is involved in monoamine clearance in the CNS and is inhibited by dolutegravir, might be associated with NPs. METHODS A cross-sectional cohort of HIV-positive patients treated with a dolutegravir-containing regimen underwent determination of allelic discrimination for SLC22A2 808 C → A polymorphism and dolutegravir Ctrough. The Symptom Checklist-90-R [investigating 10 psychiatric dimensions and reporting a general severity index (GSI)], a self-reported questionnaire and the Mini-International Neuropsychiatric Interview were offered to investigate current NPs. The effects of dolutegravir Ctrough and the SLC22A2 gene variant on NPs were explored by multivariable logistic regression. RESULTS A cohort of 203 patients was analysed: 71.4% were male, with median age 51 years and 11 years of ART exposure. Median time on dolutegravir was 18 months. Dolutegravir was associated with different antiretroviral combinations (mainly lamivudine, 38.9%, and abacavir/lamivudine, 35.5%). SLC22A2 CA genotype was independently associated with an abnormal GSI [adjusted OR (aOR) 2.43; P = 0.072], anxiety (aOR 2.61; P = 0.044), hostility (aOR 3.76; P = 0.012) and with moderate to severe headache (aOR 5.55; P = 0.037), and dolutegravir Ctrough was associated with hostility (fourth versus first quartile aOR 6.70; P = 0.007) and psychoticism (fourth versus first quartile aOR 19.01; P = 0.008). Other NPs were not associated with SLC22A2 polymorphism or dolutegravir Ctrough. CONCLUSIONS A variant of the OCT2-encoding gene, in addition to or in synergy with higher dolutegravir Ctrough, is associated with a set of NPs observed during dolutegravir therapy.
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Affiliation(s)
- A Borghetti
- Institute of Clinical Infectious Diseases, Catholic University of Sacred Heart, Rome, Italy
| | - A Calcagno
- Unit of Infectious Diseases, Department of Infectious Diseases, University of Torino, Torino, Italy
| | - F Lombardi
- Institute of Clinical Infectious Diseases, Catholic University of Sacred Heart, Rome, Italy
| | - J Cusato
- Unit of Infectious Diseases, Department of Infectious Diseases, University of Torino, Torino, Italy
| | - S Belmonti
- Institute of Clinical Infectious Diseases, Catholic University of Sacred Heart, Rome, Italy
| | - A D'Avolio
- Unit of Infectious Diseases, Department of Infectious Diseases, University of Torino, Torino, Italy
| | - N Ciccarelli
- Department of Psychology, Catholic University of Sacred Heart, Milan, Italy
| | - S La Monica
- Institute of Clinical Infectious Diseases, Catholic University of Sacred Heart, Rome, Italy
| | - M Colafigli
- Infectious Dermatology, IFO S. Gallicano, Rome, Italy
| | - V Delle Donne
- Institute of Clinical Infectious Diseases, Catholic University of Sacred Heart, Rome, Italy
| | - R De Marco
- Institute of Clinical Infectious Diseases, Catholic University of Sacred Heart, Rome, Italy
| | - E Tamburrini
- Institute of Clinical Infectious Diseases, Catholic University of Sacred Heart, Rome, Italy
| | - E Visconti
- Institute of Clinical Infectious Diseases, Catholic University of Sacred Heart, Rome, Italy
| | - G Di Perri
- Unit of Infectious Diseases, Department of Infectious Diseases, University of Torino, Torino, Italy
| | - A De Luca
- Infectious Diseases Unit, Siena University Hospital, Siena, Italy
| | - S Bonora
- Unit of Infectious Diseases, Department of Infectious Diseases, University of Torino, Torino, Italy
| | - S Di Giambenedetto
- Institute of Clinical Infectious Diseases, Catholic University of Sacred Heart, Rome, Italy
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9
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Ciccullo A, Baldin G, Capetti A, Rusconi S, Sterrantino G, d'Ettorre G, Colafigli M, Modica S, Lagi F, Giacomelli A, Cossu MV, Restelli S, De Luca A, Di Giambenedetto S. A comparison between two dolutegravir-based two-drug regimens as switch strategies in a multicentre cohort of HIV-1-infected patients. Antivir Ther 2020; 24:63-67. [PMID: 30277466 DOI: 10.3851/imp3270] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/24/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Two-drug regimens are increasingly used in clinical practice as switch strategies. We compared the efficacy and safety of two dolutegravir (DTG)-based dual therapies: DTG plus lamivudine (3TC group) versus DTG plus rilpivirine (RPV group). METHODS In a multicentre cohort of virologically suppressed (HIV RNA <50 copies/ml) HIV+ patients switching to DTG+3TC or DTG+RPV we analysed the incidence of virological failures (VF) and treatment discontinuations (TD), as well as their predictors. RESULTS We analysed 416 patients, 229 in the 3TC group and 187 in the RPV group. The 3TC group, during 344.4 person-years of follow-up (PYFU), had 10 VF without the emergence of resistance mutations, while 30 patients discontinued the regimen. In the RPV group, during 371.0 PYFU, there were 5 VF (1 developed non-nucleoside reverse transcriptase inhibitor mutations Y181C and E138Q) and 13 TD. The estimated probability of remaining free from VF at 48 weeks showed no significant difference between groups (log-rank 0.172). We found a higher risk of VF in patients with peak viral load >500,000 copies/ml in both treatment groups (log-rank P=0.004 in each group). The estimated probability of remaining in the study regimen at week 48 was 89.0% with DTG+3TC and 96.1% with DTG+RPV (log-rank 0.015). After adjusting for potential confounders, treatment group was not associated with TD. A significant decrease in total cholesterol was observed at week 48 in both groups while renal function remained unchanged. CONCLUSIONS DTG+RPV and DTG+3TC were compared in populations with different characteristics in clinical practice: both regimens showed good effectiveness and improved lipid profile.
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Affiliation(s)
- Arturo Ciccullo
- Institute of Clinical Infectious Diseases, Catholic University of the Sacred Heart, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Gianmaria Baldin
- Institute of Clinical Infectious Diseases, Catholic University of the Sacred Heart, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Amedeo Capetti
- Division of Infectious Diseases, Department of Infectious Diseases, Luigi Sacco University Hospital, Milan, Italy
| | - Stefano Rusconi
- Infectious Diseases Unit, DIBIC Luigi Sacco, University of Milan, Milan, Italy
| | - Gaetana Sterrantino
- Division of Tropical and Infectious Diseases, 'Careggi' Hospital, Florence, Italy
| | - Gabriella d'Ettorre
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Manuela Colafigli
- Infectious Dermatology and Allergology Unit, IFO S. Gallicano Institute (IRCCS), Rome, Italy
| | - Sara Modica
- Infectious Diseases Unit, Siena University Hospital, Siena, Italy
| | - Filippo Lagi
- Division of Tropical and Infectious Diseases, 'Careggi' Hospital, Florence, Italy
| | - Andrea Giacomelli
- Infectious Diseases Unit, DIBIC Luigi Sacco, University of Milan, Milan, Italy
| | - Maria Vittoria Cossu
- Division of Infectious Diseases, Department of Infectious Diseases, Luigi Sacco University Hospital, Milan, Italy
| | - Sibilla Restelli
- Division of Infectious Diseases, Department of Infectious Diseases, Luigi Sacco University Hospital, Milan, Italy
| | - Andrea De Luca
- Infectious Diseases Unit, Siena University Hospital, Siena, Italy
| | - Simona Di Giambenedetto
- Institute of Clinical Infectious Diseases, Catholic University of the Sacred Heart, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
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10
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Ciccullo A, Baldin G, Capetti A, Borghi V, Sterrantino G, Latini A, Madeddu G, Celani L, Vignale F, Rossetti B, Dusina A, Cossu MV, Restelli S, Gennari W, Lagi F, Giacomelli A, Colafigli M, Brescini L, Borghetti A, Mussini C, Rusconi S, Di Giambenedetto S. Cohort profile: The Observational cohort for the study of DOlutegravir in Antiretroviral Combination REgimens (ODOACRE). BMJ Open 2019; 9:e029960. [PMID: 31796476 PMCID: PMC7003384 DOI: 10.1136/bmjopen-2019-029960] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE The Observational cohort for the study of DOlutegravir in Antiretroviral Combination REgimens (ODOACRE) cohort was established in Italy in 2016 to evaluate the overall efficacy and tolerability of dolutegravir (DTG)-based antiretroviral (ARV) regimens in clinical practice. PARTICIPANTS The ODOACRE cohort enrols all adult HIV-1-infected patients, both treatment-naïve and treatment-experienced, starting a DTG-based ARV regimen, in 11 clinical centres in Italy from 2014. FINDINGS TO DATE In recent years, various works by the ODOACRE cohort have been produced, demonstrating the high efficacy and tolerability of DTG-based ARV regimens in clinical practice, both in ART-naïve (in the setting of acute HIV-1 infection and late presenters patient) and experienced patients. We confirmed the virological efficacy of DTG-based regimens and we evaluated predictors of virological failure. We investigated cause of discontinuation and evaluated tolerability and metabolic profile of the regimens. Within these investigations, we explored particularly the use of DTG in simplification in two-drug regimen with either rilpivirine or lamivudine. We also compared DTG-based regimens with other integrase inhibitors in clinical practice. FUTURE PLANS To continue to study long-term efficacy and tolerability of DTG-based regimens is the purpose of the ODOACRE cohort.
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Affiliation(s)
- Arturo Ciccullo
- Università Cattolica del Sacro Cuore, Facoltà di Medicina e Chirurgia, Roma, Italy
| | - Gianmaria Baldin
- Università Cattolica del Sacro Cuore, Facoltà di Medicina e Chirurgia, Roma, Italy
| | - Amedeo Capetti
- Università degli Studi di Milano Dipartimento di Scienze Cliniche Luigi Sacco, Milano, Lombardia, Italy
| | - Vanni Borghi
- Università degli Studi di Modena e Reggio Emilia Facoltà di Medicina e Chirurgia, Modena, Emilia-Romagna, Italy
| | - Gaetana Sterrantino
- Division of Tropical and Infectious Diseases, Azienda Ospedaliera Careggi, Firenze, Italy
| | - Alessandra Latini
- Infectious Dermatology and Allergology Unit, IFO, Roma, Lazio, Italy
| | - Giordano Madeddu
- Department of Clinical, Surgical and Experimental Sciences, Sassari University Hospital, Sassari, Sardegna, Italy
| | - Luigi Celani
- Department of Public Health and Infectious Diseases, Universita degli Studi di Roma La Sapienza, Roma, Lazio, Italy
| | - Francesca Vignale
- Infectious Disease Clinic- Department of Medicine and Science of Aging, School of Medicine, "G. d'Annunzio" University, Chieti, Italy
| | - Barbara Rossetti
- Università degli Studi di Siena Facoltà di Medicina e Chirurgia, Siena, Toscana, Italy
| | - Alex Dusina
- Università Cattolica del Sacro Cuore, Facoltà di Medicina e Chirurgia, Roma, Italy
| | - Maria Vittoria Cossu
- Università degli Studi di Milano Dipartimento di Scienze Cliniche Luigi Sacco, Milano, Lombardia, Italy
| | - Sibilla Restelli
- Università degli Studi di Milano Dipartimento di Scienze Cliniche Luigi Sacco, Milano, Lombardia, Italy
| | - William Gennari
- Università degli Studi di Modena e Reggio Emilia Facoltà di Medicina e Chirurgia, Modena, Emilia-Romagna, Italy
| | - Filippo Lagi
- Division of Tropical and Infectious Diseases, Azienda Ospedaliera Careggi, Firenze, Italy
| | - Andrea Giacomelli
- Università degli Studi di Milano Dipartimento di Scienze Cliniche Luigi Sacco, Milano, Lombardia, Italy
| | - Manuela Colafigli
- Infectious Dermatology and Allergology Unit, IFO, Roma, Lazio, Italy
| | - Lucia Brescini
- Università Politecnica delle Marche Facoltà di Medicina e Chirurgia, Ancona, Marche, Italy
| | - Alberto Borghetti
- UOC Malattie Infettive, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | - Cristina Mussini
- Università degli Studi di Modena e Reggio Emilia Facoltà di Medicina e Chirurgia, Modena, Emilia-Romagna, Italy
| | - Stefano Rusconi
- Università degli Studi di Milano Dipartimento di Scienze Cliniche Luigi Sacco, Milano, Lombardia, Italy
| | - Simona Di Giambenedetto
- Università Cattolica del Sacro Cuore, Facoltà di Medicina e Chirurgia, Roma, Italy
- UOC Malattie Infettive, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
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11
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Colafigli M, Ciccullo A, Borghetti A, Fanti I, Melis F, Modica S, Uccella I, Bonadies A, Ferraresi V, Anzalone E, Pennica A, Migliano E, Rossetti B, Madeddu G, Cauda R, Cristaudo A, Di Giambenedetto S, Latini A. Impact of Antiretroviral Therapy on the Risk of Recurrence in HIV-1 Infected Patients with Kaposi Sarcoma: A Multicenter Cohort Experience. J Clin Med 2019; 8:jcm8122062. [PMID: 31771172 PMCID: PMC6947508 DOI: 10.3390/jcm8122062] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Revised: 11/19/2019] [Accepted: 11/21/2019] [Indexed: 12/17/2022] Open
Abstract
Kaposi sarcoma (KS) remains a relevant malignancy in human immunodeficiency virus (HIV)-infected patients with a non-standardized management; despite past suggestions that ritonavir-boosted protease inhibitor (bPI)-based regimens could be preferable, no combination antiretroviral therapy (cART) regimen was demonstrated to outperform the others and the impact of new drugs, drug classes or paradigms was never investigated nor proven better than previous therapeutic regimes. In order to do this, we retrospectively collected data regarding HIV-infected patients with a diagnosis of KS last seen in six Italian centers after 1 January 2013. A total of 104 KS cases in 99 patients was analyzed for 945.34 patient-year follow-up (PYFU). Twenty-six patients had visceral localizations. Thirty-three patients were treated with chemotherapy, four with electrochemotherapy, and 12 with α-interferon (α-IFN). At censor, 22% received a bPI-based, 14% a non-nucleoside reverse transcriptase inhibitor (NNRTI)-based, and 28% an integrase inhibitor (INI)-based standard cART, 24% a less drug regimen and 12% a mega-cART. Twelve recurrence episodes were observed in seven patients for an incidence of 1.27 per 100 PYFU. Two patients with no evidence of recurrence episodes died for other reasons. In our experience, KS recurrence episodes were infrequent. Despite the increasing use of new antiretroviral drug classes and new treatment paradigms, no excess of recurrence episodes was observed in patients receiving such cART regimens.
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Affiliation(s)
- Manuela Colafigli
- Infectious Dermatology and Allergology, San Gallicano Dermatological Institute IRCCS, 00144 Rome, Italy
- Correspondence ; Tel.: +39-0652662808
| | - Arturo Ciccullo
- Clinical Infectious Diseases, Catholic University of S. Heart, 00168 Rome, Italy
| | - Alberto Borghetti
- Clinical Infectious Diseases, Catholic University of S. Heart, 00168 Rome, Italy
| | - Iuri Fanti
- Clinical Infectious Diseases, Catholic University of S. Heart, 00168 Rome, Italy
| | - Federico Melis
- Unit of Infectious Diseases, Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100 Sassari Italy
| | - Sara Modica
- Department of Medical Biotechnologies, Azienda Ospedaliera Universitaria Senese, 53100 Siena, Italy
- Infectious Diseases Unit, Azienda Ospedaliera Universitaria Senese, 53100 Siena, Italy
| | | | - Antonio Bonadies
- Plastic Surgery, San Gallicano Dermatological Institute IRCCS, 00144 Rome, Italy
| | - Virginia Ferraresi
- First Division of Medical Oncology, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy
| | | | | | - Emilia Migliano
- Plastic Surgery, San Gallicano Dermatological Institute IRCCS, 00144 Rome, Italy
| | - Barbara Rossetti
- Infectious Diseases Unit, Azienda Ospedaliera Universitaria Senese, 53100 Siena, Italy
| | - Giordano Madeddu
- Unit of Infectious Diseases, Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100 Sassari Italy
| | - Roberto Cauda
- Clinical Infectious Diseases, Catholic University of S. Heart, 00168 Rome, Italy
| | - Antonio Cristaudo
- Infectious Dermatology and Allergology, San Gallicano Dermatological Institute IRCCS, 00144 Rome, Italy
| | | | - Alessandra Latini
- Infectious Dermatology and Allergology, San Gallicano Dermatological Institute IRCCS, 00144 Rome, Italy
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12
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Spertilli Raffaelli C, Rossetti B, Paglicci L, Colafigli M, Punzi G, Borghi V, Pecorari M, Santoro MM, Penco G, Antinori A, Zazzi M, De Luca A, Zanelli G. Impact of transmitted HIV-1 drug resistance on the efficacy of first-line antiretroviral therapy with two nucleos(t)ide reverse transcriptase inhibitors plus an integrase inhibitor or a protease inhibitor. J Antimicrob Chemother 2019; 73:2480-2484. [PMID: 29945251 DOI: 10.1093/jac/dky211] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 05/09/2018] [Indexed: 11/14/2022] Open
Abstract
Objectives To examine the impact of transmitted drug resistance (TDR) on response to first-line regimens with integrase strand transfer inhibitors (INSTIs) or boosted protease inhibitors (bPIs). Methods From an Italian observational database (ARCA) we selected HIV-1-infected drug-naive patients starting two NRTIs and either an INSTI or a bPI, with an available pre-ART resistance genotype. The endpoint was virological failure (VF; plasma HIV-1 RNA >200 copies/mL after week 24). WHO surveillance drug resistance mutations and the Stanford algorithm were used to classify patients into three resistance categories: no TDR (A), TDR but fully-active ART prescribed (B), TDR and at least low-level resistance to one or more prescribed drug (C). Results We included 1365 patients with a median follow-up of 96 weeks (IQR 54-110): 1205 (88.3%) starting bPI and 160 (11.7%) INSTI. Prevalence of TDR was 6.1%, 12.5%, 2.6% and 0% for NRTI, NNRTI, bPI and INSTI, respectively. Cumulative Kaplan-Meier estimates for VF at 48 weeks were 11% (95% CI 10.1%-11.9%) for the bPI group and 7.7% (95% CI 5.4%-10%) for the INSTI group. In the INSTI group, cumulative estimates for VF at 48 weeks were 6% (95% CI 4%-8%) in resistance category A, 5% (95% CI 1%-10%) in B and 50% (95% CI 30%-70%) in C (P < 0.001). Resistance category C [versus A, adjusted hazard ratio (aHR) 12.6, 95% CI 3.2-49.8, P < 0.001] and nadir CD4 (+100 cells/mm3, aHR 0.6, 95% CI 0.4-0.9, P = 0.03) predicted VF. In the bPI group, VF rates were not influenced by baseline resistance. Conclusions Our data support the need for NRTI resistance genotyping in patients starting an INSTI-based first-line ART.
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Affiliation(s)
- C Spertilli Raffaelli
- Department of Medical Biotechnologies, University of Siena, Siena, Italy.,University Division of Infectious Diseases, Hospital Department of Specialized and Internal Medicine, Siena University Hospital, Siena, Italy
| | - B Rossetti
- University Division of Infectious Diseases, Hospital Department of Specialized and Internal Medicine, Siena University Hospital, Siena, Italy.,Clinic of Infectious Diseases, Catholic University of Sacred Heart, Rome, Italy
| | - L Paglicci
- Department of Medical Biotechnologies, University of Siena, Siena, Italy.,University Division of Infectious Diseases, Hospital Department of Specialized and Internal Medicine, Siena University Hospital, Siena, Italy
| | - M Colafigli
- Clinic of Infectious Diseases, Catholic University of Sacred Heart, Rome, Italy
| | - G Punzi
- Virology, Bari Hospital, Bari, Italy
| | - V Borghi
- Infectious Diseases Unit, Modena Hospital, Modena, Italy
| | - M Pecorari
- Microbiology and Virology Unit, University Hospital, Modena, Italy
| | - M M Santoro
- Department of Experimental Medicine and Surgery, University of Rome 'Tor Vergata', Rome, Italy
| | - G Penco
- Infectious Diseases Department, Ente Ospedaliero Ospedali Galliera, Genoa, Italy
| | - A Antinori
- Infectious Diseases Department, INMI 'Lazzaro Spallanzani', Rome, Italy
| | - M Zazzi
- Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - A De Luca
- Department of Medical Biotechnologies, University of Siena, Siena, Italy.,University Division of Infectious Diseases, Hospital Department of Specialized and Internal Medicine, Siena University Hospital, Siena, Italy
| | - G Zanelli
- Department of Medical Biotechnologies, University of Siena, Siena, Italy.,University Division of Infectious Diseases, Hospital Department of Specialized and Internal Medicine, Siena University Hospital, Siena, Italy
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13
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Fabbiani M, Gagliardini R, Ciccarelli N, Quiros Roldan E, Latini A, d'Ettorre G, Antinori A, Castagna A, Orofino G, Francisci D, Chinello P, Madeddu G, Grima P, Rusconi S, Del Pin B, Lombardi F, D'Avino A, Focà E, Colafigli M, Cauda R, Di Giambenedetto S, De Luca A. Atazanavir/ritonavir with lamivudine as maintenance therapy in virologically suppressed HIV-infected patients: 96 week outcomes of a randomized trial. J Antimicrob Chemother 2019; 73:1955-1964. [PMID: 29668978 DOI: 10.1093/jac/dky123] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2017] [Accepted: 03/10/2018] [Indexed: 11/14/2022] Open
Abstract
Objectives To investigate the long-term safety and efficacy of a treatment switch to dual ART with atazanavir/ritonavir + lamivudine versus continuing a standard regimen with atazanavir/ritonavir + 2NRTI in virologically suppressed patients. Methods ATLAS-M is a 96 week open-label, randomized, non-inferiority (margin -12%) trial enrolling HIV-infected adults on atazanavir/ritonavir + 2NRTI, with stable HIV-RNA <50 copies/mL and CD4 counts >200 cells/mm3. At baseline, patients were randomized 1:1 to switch to atazanavir/ritonavir + lamivudine or to continue the previous regimen. Here, we report the 96 week efficacy and safety data. The study was registered with ClinicalTrials.gov, number NCT01599364. Results Overall, 266 subjects were enrolled (133 in each arm). At 96 weeks, in the ITT population, patients free of treatment failure totalled 103 (77.4%) with atazanavir/ritonavir + lamivudine and 87 (65.4%) with triple therapy (difference +12.0%, 95% CI +1.2/+22.8, P = 0.030), demonstrating the superiority of dual therapy. Two (1.5%) and 9 (6.8%) virological failures occurred in the dual-therapy arm and the triple-therapy arm, respectively, without development of resistance to any study drug. Clinical adverse events occurred at similar rates in both arms. A higher frequency of grade 3-4 hyperbilirubinemia (66.9% versus 50.4%, P = 0.006) and hypertriglyceridaemia (6.8% versus 1.5%, P = 0.031) occurred with dual therapy, although this never led to treatment discontinuation. A significant improvement in renal function and lumbar spine bone mineral density occurred in the dual-therapy arm. The evolution of CD4, HIV-DNA levels and neurocognitive performance was similar in both arms. Conclusions In this randomized study, a treatment switch to atazanavir/ritonavir + lamivudine was superior over the continuation of atazanavir/ritonavir + 2NRTI in virologically suppressed patients, with a sustained benefit in terms of improved renal function and bone mineral density.
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Affiliation(s)
- Massimiliano Fabbiani
- Department of Infectious Diseases, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Roberta Gagliardini
- Institute of Clinical Infectious Diseases, Catholic University of Sacred Heart, Rome, Italy.,Infectious Diseases Unit, Siena University Hospital and Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Nicoletta Ciccarelli
- Institute of Clinical Infectious Diseases, Catholic University of Sacred Heart, Rome, Italy
| | - Eugenia Quiros Roldan
- University Division of Infectious and Tropical Diseases, University of Brescia, Brescia, Italy
| | - Alessandra Latini
- Infectious Dermatology and Allergology Unit, IFO S. Gallicano Institute (IRCCS), Rome, Italy
| | | | - Andrea Antinori
- National Institute for Infectious Diseases 'Lazzaro Spallanzani' IRCCS, Rome, Italy
| | - Antonella Castagna
- Department of Infectious and Tropical Diseases, Vita-Salute San Raffaele University, San Raffaele Hospital, Milan, Italy
| | - Giancarlo Orofino
- Infectious and Tropical Diseases Unit, Amedeo di Savoia Hospital, Turin, Italy
| | | | - Pierangelo Chinello
- Systemic Infections and Immunodeficiency Unit, National Institute for Infectious Diseases 'Lazzaro Spallanzani' IRCCS, Rome, Italy
| | - Giordano Madeddu
- Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy
| | - Pierfrancesco Grima
- Division of Infectious Diseases, 'S. Caterina Novella' Hospital, Galatina, Italy
| | - Stefano Rusconi
- Infectious Disease Unit, DIBIC Luigi Sacco, University of Milan, Milan, Italy
| | - Barbara Del Pin
- Unit of Infectious Diseases, S.M. Annunziata Hospital, Florence, Italy
| | - Francesca Lombardi
- Institute of Clinical Infectious Diseases, Catholic University of Sacred Heart, Rome, Italy
| | - Alessandro D'Avino
- Institute of Clinical Infectious Diseases, Catholic University of Sacred Heart, Rome, Italy
| | - Emanuele Focà
- University Division of Infectious and Tropical Diseases, University of Brescia, Brescia, Italy
| | - Manuela Colafigli
- Infectious Dermatology and Allergology Unit, IFO S. Gallicano Institute (IRCCS), Rome, Italy
| | - Roberto Cauda
- Institute of Clinical Infectious Diseases, Catholic University of Sacred Heart, Rome, Italy
| | | | - Andrea De Luca
- Infectious Diseases Unit, Siena University Hospital and Department of Medical Biotechnologies, University of Siena, Siena, Italy
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14
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Santoro MM, Di Carlo D, Armenia D, Zaccarelli M, Pinnetti C, Colafigli M, Prati F, Boschi A, Antoni AMD, Lagi F, Sighinolfi L, Gervasoni C, Andreoni M, Antinori A, Mussini C, Perno CF, Borghi V, Sterrantino G. Viro-immunological response of drug-naive HIV-1-infected patients starting a first-line regimen with viraemia >500,000 copies/ml in clinical practice. Antivir Ther 2019; 23:249-257. [PMID: 28935850 DOI: 10.3851/imp3197] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Virological success (VS) and immunological reconstitution (IR) of antiretroviral-naive HIV-1-infected patients with pre-therapy viral load (VL) >500,000 copies/ml was assessed after 12 months of treatment according to initial drug-class regimens. METHODS An observational multicentre retrospective study was performed. VS was defined as the first VL <50 copies/ml from treatment start. IR was defined as an increase of at least 150 CD4+ T-lymphocytes from treatment start. Survival analysis was used to estimate the probability and predictors of VS and IR by 12 months of therapy. RESULTS 428 HIV-1-infected patients were analysed. Patients were grouped according to the different first-line drug-classes used: a non-nucleoside reverse transcriptase inhibitor (NNRTI) plus two nucleoside reverse transcriptase inhibitors (NRTIs; NNRTI-group; n=105 [24.5%]); a protease inhibitor (PI) plus two NRTIs (PI-group; n=260 [60.8%]); a four-drug regimen containing a PI-regimen plus an integrase inhibitor (PI+INI-group; n=63 [14.7%]). Patients in the PI-group showed the lowest probability of VS (PI-group: 72.4%; NNRTI-group: 75.5%; PI+INI-group: 81.0%; P<0.0001). By Cox regression, patients in PI+INI and NNRTI-groups showed a higher adjusted hazard ratio (95% CI) of VS compared to those in the PI-group (PI+INI-group: 1.48 [1.08, 2.03]; P=0.014; NNRTI-group: 1.37 [1.06-1.78]; P=0.015). The probability of IR was 76.2%, and was similar among groups. Patients with AIDS showed a lower adjusted hazard ratio (95% CI) of IR compared to non-AIDS presenters (0.70 [0.54, 0.90]; P=0.005). CONCLUSIONS In this multicentre retrospective study, patients with viraemia >500,000 copies/ml who start a first-line regimen containing PI+INI or NNRTI yield a better VS compared to those receiving a PI-based regimen.
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Affiliation(s)
- Maria Mercedes Santoro
- Department of Experimental Medicine and Surgery, University of Rome 'Tor Vergata', Rome, Italy
| | - Domenico Di Carlo
- Department of Experimental Medicine and Surgery, University of Rome 'Tor Vergata', Rome, Italy
| | - Daniele Armenia
- Department of Experimental Medicine and Surgery, University of Rome 'Tor Vergata', Rome, Italy
| | - Mauro Zaccarelli
- Infectious Diseases Division, National Institute for Infectious Diseases L Spallanzani (IRCCS), Rome, Italy
| | - Carmela Pinnetti
- Infectious Diseases Division, National Institute for Infectious Diseases L Spallanzani (IRCCS), Rome, Italy
| | - Manuela Colafigli
- Clinic of Dermatology and Infectious Diseases, San Gallicano Dermatologic Institute (IRCCS), Rome, Italy
| | - Francesca Prati
- Infectious Diseases Unit, Azienda Ospedaliera di Reggio Emilia, Reggio Emilia, Italy
| | - Andrea Boschi
- Infectious Diseases Unit, Azienda Ospedaliera di Rimini, Rimini, Italy
| | | | - Filippo Lagi
- Department of Tropical and Infectious Diseases, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Laura Sighinolfi
- Infectious Diseases Unit, Azienda Ospedaliero-Universitaria di Ferrara, Ferrara, Italy
| | - Cristina Gervasoni
- Section of Infectious Diseases, L Sacco University Hospital, Milan, Italy
| | - Massimo Andreoni
- Department of Medicine of Systems, University of Rome 'Tor Vergata', Rome, Italy
| | - Andrea Antinori
- Infectious Diseases Division, National Institute for Infectious Diseases L Spallanzani (IRCCS), Rome, Italy
| | - Cristina Mussini
- Clinic of Infectious Diseases, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Carlo Federico Perno
- Antiretroviral Drugs Monitoring Unit, National Institute for Infectious Diseases L Spallanzani (IRCCS), Rome, Italy
| | - Vanni Borghi
- Clinic of Infectious Diseases, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Gaetana Sterrantino
- Department of Tropical and Infectious Diseases, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
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15
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Baldin G, Ciccullo A, Rusconi S, Capetti A, Sterrantino G, Colafigli M, d'Ettorre G, Giacometti A, Cossu MV, Borghetti A, Gennari W, Mussini C, Borghi V, Di Giambenedetto S. Long-term data on the efficacy and tolerability of lamivudine plus dolutegravir as a switch strategy in a multi-centre cohort of HIV-1-infected, virologically suppressed patients. Int J Antimicrob Agents 2019; 54:728-734. [PMID: 31521809 DOI: 10.1016/j.ijantimicag.2019.09.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [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: 05/23/2019] [Revised: 08/08/2019] [Accepted: 09/08/2019] [Indexed: 01/16/2023]
Abstract
BACKGROUND Results from clinical trials and observational studies suggest that lamivudine plus dolutegravir (3TC+DTG) could be an effective and tolerated option for simplification in human immunodeficiency virus (HIV)-1-positive patients. MATERIALS AND METHODS This observational study enrolled HIV-1-infected, virologically suppressed patients switching to 3TC+DTG. Kaplan-Meyer survival analysis was performed to evaluate time to virological failure (VF; defined by a single HIV-RNA determination ≥1000 copies/mL or by two consecutive HIV-RNA determinations ≥50 copies/mL) and time to treatment discontinuation (TD; defined as interruption of either 3TC or DTG), Cox regression was performed to assess predictors, and linear mixed model was performed for repeated measures to measure changes in immunological and metabolic parameters. RESULTS Five hundred and fifty-six patients were eligible for analysis. Their median CD4+ count at baseline was 668 cells/mm3 and median time of virological suppression was 88 months. Estimated probabilities of maintaining virological suppression at 96 and 144 weeks of follow-up were 97.5% [standard deviation (SD) 0.8] and 96.5% (SD 1.0), respectively. Years since HIV diagnosis was the only predictor of VF. In patients with time of virological suppression <88 months, the rate of VF was higher in the presence of the M184V mutation. Estimated probabilities of remaining on 3TC+DTG at 96 and 144 weeks of follow-up were 79.2% (SD 1.9) and 75.2% (SD 2.2), respectively. A significant increase in CD4 cell count (+44 cells/mm3, P=0.015), CD4/CD8 ratio (+0.10, P=0.002) and high-density lipoprotein cholesterol (+5.4 mg/dL, P=0.036) was found at 144 weeks of follow-up; meanwhile, total cholesterol (-9.1 mg/dL, P=0.007) and triglycerides (-2.7, P=0.009) decreased significantly. CONCLUSIONS These findings confirm the efficacy and tolerability of 3TC+DTG in virologically suppressed patients.
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Affiliation(s)
- Gianmaria Baldin
- Institute of Infectious Diseases, Catholic University of the Sacred Heart, Rome, Italy; Mater Olbia Hospital, Olbia, Italy
| | - Arturo Ciccullo
- Institute of Infectious Diseases, Catholic University of the Sacred Heart, Rome, Italy.
| | - Stefano Rusconi
- Infectious Diseases Unit, DIBIC Luigi Sacco, University of Milan, Milan, Italy
| | - Amedeo Capetti
- Division of Infectious Diseases, Department of Infectious Diseases, Luigi Sacco University Hospital, Milan, Italy
| | - Gaetana Sterrantino
- Infectious Diseases Unit, Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
| | - Manuela Colafigli
- Infectious Dermatology and Allergology Unit, IFO S. Gallicano Institute (IRCCS), Rome, Italy
| | - Gabriella d'Ettorre
- Department of Public Health and Infectious Diseases, Azienda Policlinico Umberto I, Rome, Italy
| | - Andrea Giacometti
- Clinic of Infectious Diseases, Department of Biomedical Sciences and Public Health, Polytechnic University of Marche, Ancona, Italy
| | - Maria Vittoria Cossu
- Division of Infectious Diseases, Department of Infectious Diseases, Luigi Sacco University Hospital, Milan, Italy
| | - Alberto Borghetti
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, UOC Malattie Infettive, Rome, Italy
| | - William Gennari
- Azienda Ospedaliero Universitaria di Modena Laboratorio di Microbiologia e Virologia, Modena, Italy
| | - Cristina Mussini
- Azienda Ospedaliero Universitaria di Modena, Clinica Malattie Infettive e Tropicali, Modena, Italy
| | - Vanni Borghi
- Azienda Ospedaliero Universitaria di Modena, Clinica Malattie Infettive e Tropicali, Modena, Italy
| | - Simona Di Giambenedetto
- Institute of Infectious Diseases, Catholic University of the Sacred Heart, Rome, Italy; Fondazione Policlinico Universitario Agostino Gemelli IRCCS, UOC Malattie Infettive, Rome, Italy
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16
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Rossetti B, Baldin G, Sterrantino G, Rusconi S, De Vito A, Giacometti A, Gagliardini R, Colafigli M, Capetti A, d'Ettorre G, Celani L, Lagi F, Ciccullo A, De Luca A, Di Giambenedetto S, Madeddu G. Efficacy and safety of dolutegravir-based regimens in advanced HIV-infected naïve patients: results from a multicenter cohort study. Antiviral Res 2019; 169:104552. [PMID: 31283942 DOI: 10.1016/j.antiviral.2019.104552] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [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: 03/11/2019] [Revised: 06/21/2019] [Accepted: 07/04/2019] [Indexed: 10/26/2022]
Abstract
The aims were to describe efficacy and tolerability of regimens containing dolutegravir (DTG) in advanced ART-naïve people living with HIV (PLHIV) from the clinical practice. The frequency of Immune Reconstitution Inflammatory Syndrome (IRIS), the estimated time of discontinuation of the first ART regimen and the time to reach virological suppression in a multicenter cohort of AIDS-presenters or late-presenters with CD4 <350/μL were assessed. We included 272 PLHIV: 120 (44%) AIDS-presenters and 152 (56%) late-presenters. The most frequent AIDS-defining event was Pneumocystis jirovecii pneumonia in 41 (34%). One hundred-thirty-two PLHIV (48%) started first-line cART regimens including DTG and 140 PLHIV (52%) were treated with cART regimens without DTG. One-hundred-eighty-two (67%) individuals discontinued their first-line regimen: 109 (60%) for simplification, 32 (18%) for toxicities, 4 (2%) for drug-drug interactions, 37 (20%) for other reasons. DTG was interrupted in 19/132 (14%) PLHIV: 13 (68%) for adverse events (5 intolerance, 4 gastrointestinal disorders and 4 neurological symptoms), 2 (11%) for proactive switch and 4 (21%) for medical/individual choice. IRIS was reported in 13 (5%) AIDS-presenters without differences between arms. During a median observation time of 16 months (IQR 5-24), HIV-1 RNA<50 copies/mL was achieved in 95/132 (72%) individuals on DTG-based regimen and in 92/140 (66%) individuals with other regimens. The 12-month estimated probability of DTG interruption was 14% (95% CI 11-17). The results demonstrated the low risk for IRIS and the high potency, good tolerability and safety of DTG in our population of advanced naïve PLHIV.
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Affiliation(s)
- Barbara Rossetti
- Infectious Diseases Unit, Azienda Ospedaliera Universitaria Senese, Viale Bracci 16, 53100, Siena, Italy.
| | - Gianmaria Baldin
- Institute of Clinical Infectious Diseases, Catholic University of Sacred Heart, Largo Agostino Gemelli, 8, 00168, Rome, Italy.
| | - Gaetana Sterrantino
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla 3, 50134, Florence, Italy.
| | - Stefano Rusconi
- Infectious Diseases Unit, DIBIC Luigi Sacco, University of Milan, Via G.B. Grassi 74, 20157, Milan, Italy.
| | - Andrea De Vito
- Unit of Infectious Diseases, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Viale San Pietro 43, 07100, Sassari, Italy.
| | - Andrea Giacometti
- Infectious Diseases, Department of Biological Sciences and Public Health, Marche Polytechnic University, Via Conca, 71, 60200, Ancona, Italy.
| | - Roberta Gagliardini
- Department of Medical Biotechnologies, University of Siena, Viale Bracci 16, 53100, Siena, Italy.
| | - Manuela Colafigli
- Infectious Dermatology and Allergology Unit, IFO S. Gallicano Institute (IRCCS), via Elio Chianesi, 53, 00144, Rome, Italy.
| | - Amedeo Capetti
- First Division of Infectious Diseases, Department of Infectious Diseases, Luigi Sacco University Hospital, Via G.B. Grassi 74, 20157, Milan, Italy.
| | - Gabriella d'Ettorre
- Department of Infectious Diseases and Public Health, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185, Rome, Italy.
| | - Luigi Celani
- Department of Infectious Diseases and Public Health, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185, Rome, Italy.
| | - Filippo Lagi
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla 3, 50134, Florence, Italy.
| | - Arturo Ciccullo
- Institute of Clinical Infectious Diseases, Catholic University of Sacred Heart, Largo Agostino Gemelli, 8, 00168, Rome, Italy.
| | - Andrea De Luca
- Infectious Diseases Unit, Azienda Ospedaliera Universitaria Senese, Viale Bracci 16, 53100, Siena, Italy; Department of Medical Biotechnologies, University of Siena, Viale Bracci 16, 53100, Siena, Italy.
| | - Simona Di Giambenedetto
- Institute of Clinical Infectious Diseases, Catholic University of Sacred Heart, Largo Agostino Gemelli, 8, 00168, Rome, Italy; IRCCS Fondazione Policlinico Universitario Agostino Gemelli,Largo Agostino Gemelli, 8, 00168, Rome, Italy.
| | - Giordano Madeddu
- Unit of Infectious Diseases, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Viale San Pietro 43, 07100, Sassari, Italy.
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17
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Lagi F, Baldin G, Colafigli M, Capetti A, Madeddu G, Kiros ST, Di Giambenedetto S, Sterrantino G. Viro-immunological efficacy and tolerability of dolutegravir-based regimens compared to regimens based on other integrase strand inhibitors, protease inhibitors or non-nucleoside reverse transcriptase inhibitors in patients with acute HIV-1 infection: A multicenter retrospective cohort study. Int J Antimicrob Agents 2019; 54:487-490. [PMID: 31195121 DOI: 10.1016/j.ijantimicag.2019.06.003] [Citation(s) in RCA: 5] [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: 01/10/2019] [Revised: 05/10/2019] [Accepted: 06/02/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVES The aim of this study was to compare the tolerability and viro-immunological efficacy of dolutegravir-based regimens (DTG group) with regimens based on EVG, RAL, PI or NNRTI (NODTG group) in patients with acute HIV-1 infections (AHI). METHODS All patients diagnosed with AHI and on antiretroviral therapy (ART) between January 2015 and December 2017 from five centers in Italy were included and followed-up to 30th April 2018. AHI was defined by the presence of the positive p24 antigen with negative or indeterminate western blot. RESULTS Forty-three patients were enrolled: 20 in the DTG group, 23 in the NODTG group. Nine patients (20.9%; four in the DTG group, five in the NODTG group) were prescribed a four-drug regimen. In the cohort, 81.4% were Italian and 83.7% were male, with a median age of 41 years (interquartile range [IQR] 31-48). Median time between HIV diagnosis and ART initiation was 12 days (IQR 5-28). Seven patients harbored a virus with transmitted mutations at baseline (16.2%), all were in the DTG group (P=0.005). All patients had undetectable HIV-RNA at the end of follow-up except two patients, one of whom had 57 copies and one who was lost to follow-up. In Kaplan-Meier analysis, time to virological suppression was similar in the two groups (log rank: P= 0.7155). After achieving virological suppression, four patients stopped ART because of toxicity: two on DTG, two on EVG for neurological and gastrointestinal toxicity, respectively. CONCLUSION In our setting, ART in AHI is started very early. DTG showed good viro-immunological efficacy even in the presence of NRTI-transmitted mutations. DTG interruptions were rare.
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Affiliation(s)
- F Lagi
- Infectious Disease Unit, Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla 3, 50134, Firenze, (Italy)
| | - G Baldin
- Institute of Clinical Infectious Diseases, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of the Sacred Heart, L. go Agostino Gemelli, 8 - 00168, Rome (Italy)
| | - M Colafigli
- Infectious Dermatology and Allergology Unit, IFO S. Gallicano Institute (IRCCS), via Elio Chianesi, 53 - 00144, Rome, (Italy)
| | - A Capetti
- Division of Infectious Diseases, Department of Infectious Diseases, Luigi Sacco University Hospital, via Giovanni Battista Grassi, 74, 20157, Milan, (Italy)
| | - G Madeddu
- Unit of Infectious Diseases, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Viale San Pietro, 10- 07100 Sassari, (Italy)
| | - S Tekle Kiros
- Infectious Disease Unit, Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla 3, 50134, Firenze, (Italy)
| | - S Di Giambenedetto
- Institute of Clinical Infectious Diseases, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of the Sacred Heart, L. go Agostino Gemelli, 8 - 00168, Rome (Italy)
| | - G Sterrantino
- Infectious Disease Unit, Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla 3, 50134, Firenze, (Italy).
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18
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Latini A, Dona' MG, Alei L, Colafigli M, Frasca M, Orsini D, Giuliani M, Morrone A, Cristaudo A, Zaccarelli M. Recreational drugs and STI diagnoses among patients attending an STI/HIV reference clinic in Rome, Italy. Sex Transm Infect 2019; 95:588-593. [PMID: 31101722 DOI: 10.1136/sextrans-2019-054043] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 04/30/2019] [Accepted: 05/05/2019] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND An observational study was conducted to assess recreational drug use in association with recent STIs among clients of an STI/HIV reference centre in Rome, Italy. METHODS Attendees self-compiled a questionnaire concerning sexual behaviours and drug use, including the nine drugs used for sex (amphetamines, poppers, cocaine, ketamine, erectile dysfunction agent (EDA), steroids and the three chemsex drugs, ie, chems: γ-hydroxybutyric acid/γ-butyrolactone, crystal and Mcat). RESULTS Overall, 703 patients participated, with men who have sex with men (MSM) accounting for 50.4% of the total and 73.2% of HIV-positive patients. Apart from condylomatosis, whose prevalence was higher among females (38.8%) and non-MSM (45.8%) than MSM (14.4%), STIs were more frequent among MSM, particularly syphilis (14.1%), gonorrhoea (4.8%), urethritis (3.4%) and hepatitis A (6.5%). Recreational drug use was significantly more frequent among MSM (39.8% vs 17.6% in females and 22.7% in non-MSM). A total of 26.3% of MSM used at least one of the nine drugs and 5.1% at least one of the three chems. Cocaine (13.3%) and poppers (13.0%) were the most used sex drugs in MSM.The use of any of the nine drugs was associated with being MSM (adjusted OR (AOR): 1.94, 95% CI 1.05 to 3.58), sex with partner contacted online (1.99, 95% CI 1.14 to 3.45), group sex (4.08, 95% CI 2.40 to 6.93) and STI in the last year (1.65, 95% CI 1.05 to 2.61). Use of any of the nine chems among MSM was associated with condomless sex (2.24, 95% CI 1.21 to 4.14), group sex (2.08, 95% CI 1.01 to 4.31) and STI diagnosis in the last year (4.08, 95% CI 2.32 to 7.19). CONCLUSIONS Our data suggest that recreational drug use is quite common among MSM in Italy. No evidence of association with STI was found among non-MSM and females, where only cannabis and cocaine use was reported. The use of chems is still limited, but cocaine, poppers and EDA are widely used among MSM. Recreational drug use appears associated with high-risk sexual behaviours and a higher risk of STI.
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Affiliation(s)
- Alessandra Latini
- STI/HIV Unit, San Gallicano Dermatological Institute IRCCS, Rome, Italy
| | | | - Lavinia Alei
- STI/HIV Unit, San Gallicano Dermatological Institute IRCCS, Rome, Italy
| | - Manuela Colafigli
- STI/HIV Unit, San Gallicano Dermatological Institute IRCCS, Rome, Italy
| | - Mirko Frasca
- STI/HIV Unit, San Gallicano Dermatological Institute IRCCS, Rome, Italy
| | - Diego Orsini
- STI/HIV Unit, San Gallicano Dermatological Institute IRCCS, Rome, Italy
| | - Massimo Giuliani
- STI/HIV Unit, San Gallicano Dermatological Institute IRCCS, Rome, Italy
| | - Aldo Morrone
- Scientific Direction, San Gallicano Dermatological Institute IRCCS, Rome, Italy
| | - Antonio Cristaudo
- STI/HIV Unit, San Gallicano Dermatological Institute IRCCS, Rome, Italy
| | - Mauro Zaccarelli
- Clinical Department, National Institute for the Infectious Diseases Lazzaro Spallanzani, Rome, Italy
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19
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Fabeni L, Alteri C, Berno G, Scutari R, Orchi N, De Carli G, Bertoli A, Carioti L, Gori C, Forbici F, Salpini R, Vergori A, Gagliardini R, Cicalini S, Mondi A, Pinnetti C, Mazzuti L, Turriziani O, Colafigli M, Borghi V, Montella F, Pennica A, Lichtner M, Girardi E, Andreoni M, Mussini C, Antinori A, Ceccherini-Silberstein F, Perno CF, Santoro MM. Characterisation of HIV-1 molecular transmission clusters among newly diagnosed individuals infected with non-B subtypes in Italy. Sex Transm Infect 2019; 95:619-625. [PMID: 31076456 DOI: 10.1136/sextrans-2019-054017] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 04/19/2019] [Accepted: 04/24/2019] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE We evaluated the characteristics of HIV-1 molecular transmission clusters (MTCs) in 1890 newly diagnosed individuals infected with non-B subtypes between 2005 and 2017 in Italy. METHODS Phylogenetic analyses were performed on pol sequences to characterise subtypes/circulating recombinant forms and identify MTCs. MTCs were divided into small (SMTCs, 2-3 sequences), medium (MMTCs, 4-9 sequences) and large (LMTCs, ≥10 sequences). Factors associated with MTCs were evaluated using logistic regression analysis. RESULTS 145 MTCs were identified and involved 666 individuals (35.2%); 319 of them (16.9%) were included in 13 LMTCs, 111 (5.9%) in 20 MMTCs and 236 (12.5%) in 112 SMTCs. Compared with individuals out of MTCs, individuals involved in MTCs were prevalently Italian (72.7% vs 30.9%, p<0.001), male (82.9% vs 62.3%, p<0.001) and men who have sex with men (MSM) (43.5% vs 14.5%, p<0.001). Individuals in MTCs were also younger (median (IQR) years: 41 (35-49) vs 43 (36-51), p<0.001) and had higher CD4 cell count in comparison with individuals out of MTCs (median (IQR): 109/L: 0.4 (0.265-0.587) vs 0.246 (0.082-0.417), p<0.001). The viral load remained stable between the two groups (median (IQR) log10 copies/mL: 4.8 (4.2-5.5) vs 5.0 (4.3-5.5), p=0.87). Logistic regression confirmed that certain factors such as being MSM, of Italian origin, younger age and higher CD4 cell count were significantly associated with MTCs. CONCLUSIONS Our findings show that HIV-1 newly diagnosed individuals infected with non-B subtypes are involved in several MTCs in Italy. These MTCs include mainly Italians and MSM and highlight the complex phenomenon characterising the HIV-1 spread. This is important especially in view of monitoring the HIV epidemic and guiding the public health response.
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Affiliation(s)
- Lavinia Fabeni
- Experimental Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Claudia Alteri
- Oncology and Oncohematology, University of Milan, Milan, Italy
| | - Giulia Berno
- Laboratory of Virology, INMI "Lazzaro Spallanzani"-IRCCS, Rome, Italy
| | - Rossana Scutari
- Experimental Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Nicoletta Orchi
- AIDS Reference Center, INMI "Lazzaro Spallanzani"-IRCCS, Rome, Italy
| | | | - Ada Bertoli
- Experimental Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Luca Carioti
- Experimental Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Caterina Gori
- Laboratory of Virology, INMI "Lazzaro Spallanzani"-IRCCS, Rome, Italy
| | - Federica Forbici
- Laboratory of Virology, INMI "Lazzaro Spallanzani"-IRCCS, Rome, Italy
| | - Romina Salpini
- Experimental Medicine, University of Rome "Tor Vergata", Rome, Italy
| | | | | | | | - Annalisa Mondi
- Clinical Department, INMI "Lazzaro Spallanzani"-IRCCS, Rome, Italy
| | - Carmela Pinnetti
- Clinical Department, INMI "Lazzaro Spallanzani"-IRCCS, Rome, Italy
| | - Laura Mazzuti
- Molecular Medicine, "Sapienza" University of Rome, Rome, Italy
| | | | | | - Vanni Borghi
- Infectious Diseases, University Hospital of Modena, Modena, Italy
| | | | | | - Miriam Lichtner
- Infectious Diseases Unit, "Sapienza" University, Polo Pontino, Latina, Italy
| | - Enrico Girardi
- Clinical Epidemiology, INMI "Lazzaro Spallanzani" IRCCS, Rome, Lazio, Italy
| | - Massimo Andreoni
- Infectious Diseases, University Hospital "Tor Vergata", Rome, Italy
| | - Cristina Mussini
- Infectious Diseases, University Hospital of Modena, Modena, Italy
| | - Andrea Antinori
- Clinical Department, INMI "Lazzaro Spallanzani"-IRCCS, Rome, Italy
| | | | - Carlo Federico Perno
- Oncology and Oncohematology, University of Milan, Milan, Italy.,Laboratory of Virology, INMI "Lazzaro Spallanzani"-IRCCS, Rome, Italy
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20
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Rollo F, Pichi B, Benevolo M, Giuliani M, Latini A, Lorenzon L, Colafigli M, Frasca M, Pellini R, Cristaudo A, Donà MG. Oral testing for high-risk human papillomavirus DNA and E6/E7 messenger RNA in healthy individuals at risk for oral infection. Cancer 2019; 125:2587-2593. [PMID: 31034590 DOI: 10.1002/cncr.32152] [Citation(s) in RCA: 5] [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: 11/23/2018] [Revised: 03/04/2019] [Accepted: 03/29/2019] [Indexed: 01/21/2023]
Abstract
BACKGROUND Testing for oral high-risk human papillomavirus (HPV) DNA may be useful for identifying individuals at increased risk for HPV-driven oropharyngeal cancer (OPC). However, positivity for HPV DNA provides no information on the transforming potential of the infection. In contrast, the detection of high-risk HPV E6/E7 messenger RNA (mRNA) may help to identify clinically significant infections because of the indispensable role of E6/E7 viral oncoproteins in the carcinogenic process. METHODS Oral rinses were collected with a mouthwash from cancer-free individuals at increased risk for oral HPV infection. High-risk HPV DNA and mRNA were evaluated via the testing of the oral rinses with the Linear Array HPV genotyping test and the Aptima HPV assay, respectively. RESULTS Overall, 310 subjects with no clinical evidence of lesions of the oral cavity and oropharynx were included in the study. Thirty-three (10.6%) harbored high-risk HPV DNA in their oral rinse. These cases, together with 10 random samples negative for high-risk HPV DNA, were tested with the Aptima assay. A valid result was obtained for 41 of the 43 specimens (95.3%). Among the 31 cases that were positive for high-risk HPV DNA and had a valid Aptima result, 4 (12.9%) were positive for HPV mRNA. HPV mRNA was not detected in any of the samples negative for high-risk HPV DNA. CONCLUSIONS HPV mRNA is detectable in oral rinses of cancer-free subjects. Oral HPV mRNA testing may be useful in the screening and/or early detection of HPV-driven OPC by possibly identifying active and transforming oral infections. The testing of individuals at increased risk for HPV-related OPC via simply and noninvasively collected oral specimens is an attractive option for future screening strategies.
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Affiliation(s)
- Francesca Rollo
- Pathology Department, Regina Elena National Cancer Institute, Scientific Institute for Research and Healthcare, Rome, Italy
| | - Barbara Pichi
- Otolaryngology-Head and Neck Surgery Department, Regina Elena National Cancer Institute, Scientific Institute for Research and Healthcare, Rome, Italy
| | - Maria Benevolo
- Pathology Department, Regina Elena National Cancer Institute, Scientific Institute for Research and Healthcare, Rome, Italy
| | - Massimo Giuliani
- STI/HIV Unit, San Gallicano Dermatologic Institute, Scientific Institute for Research and Healthcare, Rome, Italy
| | - Alessandra Latini
- STI/HIV Unit, San Gallicano Dermatologic Institute, Scientific Institute for Research and Healthcare, Rome, Italy
| | - Laura Lorenzon
- Surgical and Medical Department of Translational Science, Sant'Andrea Hospital, Sapienza University, Rome, Italy.,Fondazione Policlinico Universitario Agostino Gemelli, Scientific Institute for Research and Healthcare, Rome, Italy
| | - Manuela Colafigli
- STI/HIV Unit, San Gallicano Dermatologic Institute, Scientific Institute for Research and Healthcare, Rome, Italy
| | - Mirko Frasca
- STI/HIV Unit, San Gallicano Dermatologic Institute, Scientific Institute for Research and Healthcare, Rome, Italy
| | - Raul Pellini
- Otolaryngology-Head and Neck Surgery Department, Regina Elena National Cancer Institute, Scientific Institute for Research and Healthcare, Rome, Italy
| | - Antonio Cristaudo
- STI/HIV Unit, San Gallicano Dermatologic Institute, Scientific Institute for Research and Healthcare, Rome, Italy
| | - Maria Gabriella Donà
- STI/HIV Unit, San Gallicano Dermatologic Institute, Scientific Institute for Research and Healthcare, Rome, Italy
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21
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Donà MG, Pichi B, Rollo F, Benevolo M, Latini A, Laquintana V, Pellini R, Colafigli M, Frasca M, Giuliani M, Cristaudo A. Human papillomavirus detection in matched oral rinses, oropharyngeal and oral brushings of cancer-free high-risk individuals. Oral Oncol 2019; 91:1-6. [PMID: 30926054 DOI: 10.1016/j.oraloncology.2019.02.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 01/25/2019] [Accepted: 02/04/2019] [Indexed: 01/10/2023]
Abstract
OBJECTIVES The detection of oral Human Papillomavirus (HPV) may be of clinical utility because of the major role HPV plays in the etiology of oropharyngeal cancer. However, oral HPV testing is not standardized and the best sampling method has yet to be identified. We aimed to compare HPV findings in matched oral rinse-and-gargles (rinses), oropharyngeal brushings and oral brushings. MATERIALS AND METHODS HPV-DNA was investigated using Linear Array in samples collected from cancer-free individuals at increased risk for oral HPV. RESULTS 163 oral rinses already tested for HPV were selected. The matched oropharyngeal (n = 163) and oral brushings (n = 100) were analyzed. The detection rate for any HPV, high-risk (HR)-HPVs and HPV16 was significantly higher in rinses than brushings. The overall agreement for any HPV between rinses and oropharyngeal brushings was 51.2% (Cohen K: 0.14, 95% CI: 0.07-0.21). The proportion of positive agreement was 16.8%. The overall agreement for HR-HPVs was 74.1% (Cohen K: 0.20, 95% CI: 0.07-0.33). The genotype-specific profile of rinses and brushings which were concomitantly HPV-positive only partially overlapped in cases with multiple infections, with more genotypes detected in the rinse, which were not isolated in the corresponding brushings. CONCLUSION The agreement for HPV status between rinses and brushings is poor, particularly for the HPV-positive findings. Despite the fact that the origin of the HPV-infected cells present in the oral rinse is unclear, since they could not be traced back to the oropharynx or oral cavity, oral rinses provided the highest detection rate for HR-HPVs and HPV16.
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Affiliation(s)
- Maria Gabriella Donà
- STI/HIV Unit, San Gallicano Dermatologic Institute IRCCS, Via Elio Chianesi 53, 00144 Rome, Italy
| | - Barbara Pichi
- Otolaryngology Head Neck Surgery Department, Regina Elena National Cancer Institute IRCCS, Via Elio Chianesi 53, 00144 Rome, Italy
| | - Francesca Rollo
- Pathology Department, Regina Elena National Cancer Institute IRCCS, Via Elio Chianesi 53, 00144 Rome, Italy.
| | - Maria Benevolo
- Pathology Department, Regina Elena National Cancer Institute IRCCS, Via Elio Chianesi 53, 00144 Rome, Italy
| | - Alessandra Latini
- STI/HIV Unit, San Gallicano Dermatologic Institute IRCCS, Via Elio Chianesi 53, 00144 Rome, Italy
| | - Valentina Laquintana
- Pathology Department, Regina Elena National Cancer Institute IRCCS, Via Elio Chianesi 53, 00144 Rome, Italy
| | - Raul Pellini
- Otolaryngology Head Neck Surgery Department, Regina Elena National Cancer Institute IRCCS, Via Elio Chianesi 53, 00144 Rome, Italy
| | - Manuela Colafigli
- STI/HIV Unit, San Gallicano Dermatologic Institute IRCCS, Via Elio Chianesi 53, 00144 Rome, Italy
| | - Mirko Frasca
- STI/HIV Unit, San Gallicano Dermatologic Institute IRCCS, Via Elio Chianesi 53, 00144 Rome, Italy
| | - Massimo Giuliani
- STI/HIV Unit, San Gallicano Dermatologic Institute IRCCS, Via Elio Chianesi 53, 00144 Rome, Italy
| | - Antonio Cristaudo
- STI/HIV Unit, San Gallicano Dermatologic Institute IRCCS, Via Elio Chianesi 53, 00144 Rome, Italy
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22
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Alteri C, Fabeni L, Scutari R, Berno G, Di Carlo D, Gori C, Bertoli A, Vergori A, Mastrorosa I, Bellagamba R, Mussini C, Colafigli M, Montella F, Pennica A, Mastroianni CM, Girardi E, Andreoni M, Antinori A, Svicher V, Ceccherini-Silberstein F, Perno CF, Santoro MM. Genetic divergence of HIV-1 B subtype in Italy over the years 2003-2016 and impact on CTL escape prevalence. Sci Rep 2018; 8:15739. [PMID: 30356083 PMCID: PMC6200748 DOI: 10.1038/s41598-018-34058-7] [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: 06/27/2018] [Accepted: 10/04/2018] [Indexed: 12/05/2022] Open
Abstract
HIV-1 is characterized by high genetic variability, with implications for spread, and immune-escape selection. Here, the genetic modification of HIV-1 B subtype over time was evaluated on 3,328 pol and 1,152 V3 sequences belonging to B subtype and collected from individuals diagnosed in Italy between 2003 and 2016. Sequences were analyzed for genetic-distance from consensus-B (Tajima-Nei), non-synonymous and synonymous rates (dN and dS), CTL escapes, and intra-host evolution over four time-spans (2003–2006, 2007–2009, 2010–2012, 2013–2016). Genetic-distance increased over time for both pol and V3 sequences (P < 0.0001 and 0.0003). Similar results were obtained for dN and dS. Entropy-value significantly increased at 16 pol and two V3 amino acid positions. Seven of them were CTL escape positions (protease: 71; reverse-transcriptase: 35, 162, 177, 202, 207, 211). Sequences with ≥3 CTL escapes increased from 36.1% in 2003–2006 to 54.0% in 2013–2016 (P < 0.0001), and showed better intra-host adaptation than those containing ≤2 CTL escapes (intra-host evolution: 3.0 × 10−3 [2.9 × 10−3–3.1 × 10−3] vs. 4.3 × 10−3 [4.0 × 10−3–5.0 × 10−3], P[LRT] < 0.0001[21.09]). These data provide evidence of still ongoing modifications, involving CTL escape mutations, in circulating HIV-1 B subtype in Italy. These modifications might affect the process of HIV-1 adaptation to the host, as suggested by the slow intra-host evolution characterizing viruses with a high number of CTL escapes.
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Affiliation(s)
- Claudia Alteri
- Department of Experimental Medicine and Surgery, University of Rome "Tor Vergata", Rome, 00133, Italy.
| | - Lavinia Fabeni
- Department of Experimental Medicine and Surgery, University of Rome "Tor Vergata", Rome, 00133, Italy
| | - Rossana Scutari
- Department of Experimental Medicine and Surgery, University of Rome "Tor Vergata", Rome, 00133, Italy
| | - Giulia Berno
- National Institute for Infectious Diseases L. Spallanzani, IRCCS, Rome, 00161, Italy
| | - Domenico Di Carlo
- Department of Biomedical and Clinical Sciences "L. Sacco", University of Milan, Pediatric Clinical Research Center "Romeo and Enrica Invernizzi", Milan, 20133, Italy
| | - Caterina Gori
- National Institute for Infectious Diseases L. Spallanzani, IRCCS, Rome, 00161, Italy
| | - Ada Bertoli
- Department of Experimental Medicine and Surgery, University of Rome "Tor Vergata", Rome, 00133, Italy
| | - Alessandra Vergori
- National Institute for Infectious Diseases L. Spallanzani, IRCCS, Rome, 00161, Italy
| | - Ilaria Mastrorosa
- National Institute for Infectious Diseases L. Spallanzani, IRCCS, Rome, 00161, Italy
| | - Rita Bellagamba
- National Institute for Infectious Diseases L. Spallanzani, IRCCS, Rome, 00161, Italy
| | | | | | | | | | | | - Enrico Girardi
- National Institute for Infectious Diseases L. Spallanzani, IRCCS, Rome, 00161, Italy
| | | | - Andrea Antinori
- National Institute for Infectious Diseases L. Spallanzani, IRCCS, Rome, 00161, Italy
| | - Valentina Svicher
- Department of Experimental Medicine and Surgery, University of Rome "Tor Vergata", Rome, 00133, Italy
| | | | - Carlo Federico Perno
- National Institute for Infectious Diseases L. Spallanzani, IRCCS, Rome, 00161, Italy.,Department of Oncology, University of Milan, Milan, 20122, Italy
| | - Maria Mercedes Santoro
- Department of Experimental Medicine and Surgery, University of Rome "Tor Vergata", Rome, 00133, Italy
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23
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Giuliani M, Latini A, Colafigli M, Benevolo M, Rollo F, Zaccarelli M, Giuliani E, Moretto D, Giglio A, Rezza G, Cristaudo A, Donà MG. Vaccine-preventable anal infections by human papillomavirus among HIV-infected men who have sex with men. Future Microbiol 2018; 13:1463-1472. [PMID: 30311788 DOI: 10.2217/fmb-2018-0149] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM HIV-infected men who have sex with men (MSM) show the highest prevalence of anal HPV infection. Anal prevalence of the HPVs targeted by the quadrivalent HPV vaccine (4vHPV) and nonavalent HPV vaccine (9vHPV) was estimated in this population. MATERIALS & METHODS Anal specimens were collected from HIV-infected MSM attending a sexually transmitted infection/HIV center. Specimens were analyzed using the Linear Array HPV Genotyping Test. RESULTS A total of 49.5 and 71.2% of the 313 enrolled MSM harbored at least one of the 4vHPV and 9vHPV types, respectively. A significantly decreasing trend was observed for the prevalence of both 4vHPV (p = 0.04) and 9vHPV types (p < 0.001) across age classes. CONCLUSION A substantial proportion of HIV-infected MSM do not harbor a current anal infection with vaccine-preventable HPVs. The potential benefit of the 4vHPV versus 9vHPV vaccination in these subjects, including older MSM, should be investigated.
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Affiliation(s)
- Massimo Giuliani
- HIV/STI Unit, Clinical and Experimental Dermatology Department, San Gallicano Dermatological Institute IRCCS, Via Elio Chianesi 53, 00144, Rome, Italy
| | - Alessandra Latini
- HIV/STI Unit, Clinical and Experimental Dermatology Department, San Gallicano Dermatological Institute IRCCS, Via Elio Chianesi 53, 00144, Rome, Italy
| | - Manuela Colafigli
- HIV/STI Unit, Clinical and Experimental Dermatology Department, San Gallicano Dermatological Institute IRCCS, Via Elio Chianesi 53, 00144, Rome, Italy
| | - Maria Benevolo
- Pathology Department, Regina Elena National Cancer Institute IRCCS, Via Elio Chianesi 53, 00144, Rome, Italy
| | - Francesca Rollo
- Pathology Department, Regina Elena National Cancer Institute IRCCS, Via Elio Chianesi 53, 00144, Rome, Italy
| | - Mauro Zaccarelli
- Clinical and Research Department, Istituto Nazionale Malattie Infettive INMI Lazzaro Spallanzani IRCCS, Via Portuense, 292, 00149, Rome, Italy
| | - Eugenia Giuliani
- Department of Molecular Medicine, Sapienza University, Viale Regina Elena, 291-293 00161, Rome, Italy
| | - Domenico Moretto
- Microbiology & Clinical Pathology Department, San Gallicano Dermatological Institute IRCCS, Via Elio Chianesi 53, 00144, Rome, Italy
| | - Amalia Giglio
- Microbiology & Clinical Pathology Department, San Gallicano Dermatological Institute IRCCS, Via Elio Chianesi 53, 00144, Rome, Italy
| | - Giovanni Rezza
- Department of Infectious, Parasitic & Immune-mediated Diseases, Istituto Superiore di Sanità, Viale Regina Elena 299, 00141, Rome, Italy
| | - Antonio Cristaudo
- HIV/STI Unit, Clinical and Experimental Dermatology Department, San Gallicano Dermatological Institute IRCCS, Via Elio Chianesi 53, 00144, Rome, Italy
| | - Maria G Donà
- HIV/STI Unit, Clinical and Experimental Dermatology Department, San Gallicano Dermatological Institute IRCCS, Via Elio Chianesi 53, 00144, Rome, Italy
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Rossetti B, Di Giambenedetto S, Torti C, Postorino MC, Punzi G, Saladini F, Gennari W, Borghi V, Monno L, Pignataro AR, Polilli E, Colafigli M, Poggi A, Tini S, Zazzi M, De Luca A. Evolution of transmitted HIV-1 drug resistance and viral subtypes circulation in Italy from 2006 to 2016. HIV Med 2018; 19:619-628. [PMID: 29932313 DOI: 10.1111/hiv.12640] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [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: 05/08/2018] [Indexed: 12/13/2022]
Abstract
OBJECTIVES The aim was to evaluate the evolution of transmitted HIV-1 drug resistance (TDR) prevalence in antiretroviral therapy (ART)-naïve patients from 2006 to 2016. METHODS HIV-1 sequences were retrieved from the Antiviral Response Cohort Analysis (ARCA) database and TDR was defined as detection of at least one mutation from the World Health Organization (WHO) surveillance list. RESULTS We included protease/reverse transcriptase sequences from 3573 patients; 455 had also integrase sequences. Overall, 68.1% of the patients were Italian, the median CD4 count was 348 cells/μL [interquartile range (IQR) 169-521 cells/μL], and the median viral load was 4.7 log10 HIV-1 RNA copies/mL (IQR 4.1-5.3 log10 copies/mL). TDR was detected in 10.3% of patients: 6% carried mutations to nucleos(t)ide reverse transcriptase inhibitors (NRTIs), 4.4% to nonnucleos(t)ide reverse transcriptase inhibitors (NNRTIs), 2.3% to protease inhibitors (PIs), 0.2% to integrase strand transfer inhibitors (INSTIs) and 2.1% to at least two drug classes. TDR declined from 14.5% in 2006 to 7.3% in 2016 (P = 0.003): TDR to NRTIs from 9.9 to 2.9% (P = 0.003) and TDR to NNRTIs from 5.1 to 3.7% (P = 0.028); PI TDR remained stable. The proportion carrying subtype B virus declined from 76.5 to 50% (P < 0.001). The prevalence of TDR was higher in subtype B vs. non-B (12.6 vs. 4.9%, respectively; P < 0.001) and declined significantly in subtype B (from 17.1 to 8.8%; P = 0.04) but not in non-B subtypes (from 6.1 to 5.8%; P = 0.44). Adjusting for country of origin, predictors of TDR were subtype B [adjusted odds ratio (AOR) for subtype B vs. non-B 2.91; 95% confidence interval (CI) 1.93-4.39; P < 0.001], lower viral load (per log10 higher: AOR 0.86; 95% CI 0.75-0.99; P = 0.03), site in northern Italy (AOR for southern Italy/island vs. northern Italy, 0.61; 95% CI 0.40-0.91; P = 0.01), and earlier calendar year (per 1 year more recent: AOR 0.95; 95% CI 0.91-0.99; P = 0.02). CONCLUSIONS The prevalence of HIV-1 TDR has declined during the last 10 years in Italy.
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Affiliation(s)
- B Rossetti
- Infectious Diseases Unit, University Hospital of Siena, Siena, Italy
| | - S Di Giambenedetto
- Clinic of Infectious Diseases, Catholic University of Sacred Heart, Rome, Italy
| | - C Torti
- Infectious Diseases Unit, Catanzaro, Italy
| | | | - G Punzi
- Virology, Bari Hospital, Bari, Italy
| | - F Saladini
- Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - W Gennari
- Virology, Modena Hospital, Modena, Italy
| | - V Borghi
- Infectious Diseases Unit, Modena Hospital, Modena, Italy
| | - L Monno
- Infectious Diseases Unit, Bari Hospital, Bari, Italy
| | | | - E Polilli
- Virology, Pescara Hospital, Pescara, Italy
| | - M Colafigli
- Clinic of Infectious Diseases, Catholic University of Sacred Heart, Rome, Italy
| | - A Poggi
- Infectious Diseases Unit, S. Maria Annunziata Hospital, Firenze, Italy
| | - S Tini
- Medicine Department, Città di Castello, Italy
| | - M Zazzi
- Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - A De Luca
- Infectious Diseases Unit, University Hospital of Siena, Siena, Italy.,Department of Medical Biotechnologies, University of Siena, Siena, Italy
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25
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Donà MG, Benevolo M, Latini A, Rollo F, Colafigli M, Frasca M, Zaccarelli M, Giglio A, Moretto D, Pescarmona E, Cristaudo A, Giuliani M. Anal cytological lesions and HPV infection in individuals at increased risk for anal cancer. Cancer Cytopathol 2018; 126:461-470. [PMID: 29694716 DOI: 10.1002/cncy.22003] [Citation(s) in RCA: 13] [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] [Received: 01/19/2018] [Revised: 03/20/2018] [Accepted: 03/30/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND Anal cytology may be useful for evaluating lesions associated with human papillomavirus (HPV) in individuals at increased risk for anal cancer. METHODS Liquid-based cytology was used to assess anal cytological lesions among human immunodeficiency virus (HIV)-infected and HIV-uninfected men who have sex with men (MSM). The Linear Array HPV genotyping test was used for HPV detection. RESULTS This cross-sectional study included 1021 MSM, of whom 388 were HIV-infected (38.0%). Anal cytological lesions (atypical squamous cells of undetermined significance or more severe [ASCUS+]) were observed in 32.5% and 53.2% of the HIV-uninfected and HIV-infected individuals, respectively (P < .0001). The highest ASCUS + prevalence was observed among ≥45-year-old HIV-uninfected MSM (37.3%) and 25-to 29-year-old HIV-infected MSM (66.7%). High-grade squamous intraepithelial lesions (HSILs) peaked in ≥ 45-year-old HIV-uninfected subjects and 35- to 39-year-old HIV-infected subjects. Individuals with anal infections with high-risk (HR) HPV types were 3 to 4 times more likely to have an ASCUS + report. An HPV-16 and/or HPV-18 infection increased the odds of HSIL or more severe cytology (HSIL+) for HIV-infected MSM almost 4 times. MSM concurrently infected with HR and low-risk HPVs were significantly more likely to have low-grade squamous intraepithelial lesions or more severe cytology (LSIL+) than those infected with only HR types. No significant associations were found between cytological abnormalities and the HIV load and nadir and current CD4 + counts. CONCLUSIONS The prevalence of anal cytological lesions is high in MSM, even in HIV-infected individuals treated with combined antiretroviral therapy. In these subjects, HSILs occur more frequently and at a younger age in comparison with HIV-uninfected counterparts. Specific diagnostic procedures should be implemented to manage individuals at increased risk for anal cancer with an abnormal anal Papanicolaou test. Cancer Cytopathol 2018. © 2018 American Cancer Society.
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Affiliation(s)
- Maria Gabriella Donà
- Sexually Transmitted Infection/Human Immunodeficiency Virus Unit, San Gallicano Dermatological Institute, IFO-IRCCS, Rome, Italy
| | - Maria Benevolo
- Pathology Department, Regina Elena National Cancer Institute, IFO-IRCCS, Rome, Italy
| | - Alessandra Latini
- Sexually Transmitted Infection/Human Immunodeficiency Virus Unit, San Gallicano Dermatological Institute, IFO-IRCCS, Rome, Italy
| | - Francesca Rollo
- Pathology Department, Regina Elena National Cancer Institute, IFO-IRCCS, Rome, Italy
| | - Manuela Colafigli
- Sexually Transmitted Infection/Human Immunodeficiency Virus Unit, San Gallicano Dermatological Institute, IFO-IRCCS, Rome, Italy
| | - Mirko Frasca
- Sexually Transmitted Infection/Human Immunodeficiency Virus Unit, San Gallicano Dermatological Institute, IFO-IRCCS, Rome, Italy
| | - Mauro Zaccarelli
- Clinical Department, Lazzaro Spallanzani National Institute for Infectious Diseases, IRCCS, Rome, Italy
| | - Amalia Giglio
- Microbiology and Clinical Pathology Department, San Gallicano Dermatological Institute, IFO-IRCCS, Rome, Italy
| | - Domenico Moretto
- Microbiology and Clinical Pathology Department, San Gallicano Dermatological Institute, IFO-IRCCS, Rome, Italy
| | - Edoardo Pescarmona
- Pathology Department, Regina Elena National Cancer Institute, IFO-IRCCS, Rome, Italy
| | - Antonio Cristaudo
- Sexually Transmitted Infection/Human Immunodeficiency Virus Unit, San Gallicano Dermatological Institute, IFO-IRCCS, Rome, Italy
| | - Massimo Giuliani
- Sexually Transmitted Infection/Human Immunodeficiency Virus Unit, San Gallicano Dermatological Institute, IFO-IRCCS, Rome, Italy
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26
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Latini A, Orsini D, Ambrifi M, Colafigli M, Zaccarelli M, Cristaudo A. Classical Kaposi's sarcoma concurrent with ledipasvir-sofosbuvir therapy for hepatitis C infection. GIORN ITAL DERMAT V 2017; 154:593-594. [PMID: 29192474 DOI: 10.23736/s0392-0488.17.05788-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Alessandra Latini
- Unit of Infectious Dermatology and Allergology, San Gallicano Institute for Cancer Research and Care, Rome, Italy
| | - Diego Orsini
- Unit of Infectious Dermatology and Allergology, San Gallicano Institute for Cancer Research and Care, Rome, Italy -
| | - Marina Ambrifi
- Unit of Infectious Dermatology and Allergology, San Gallicano Institute for Cancer Research and Care, Rome, Italy
| | - Manuela Colafigli
- Unit of Infectious Dermatology and Allergology, San Gallicano Institute for Cancer Research and Care, Rome, Italy
| | - Mauro Zaccarelli
- Clinical Department, "Lazzaro Spallanzani" National Institute for Infectious Diseases, Rome, Italy
| | - Antonio Cristaudo
- Unit of Infectious Dermatology and Allergology, San Gallicano Institute for Cancer Research and Care, Rome, Italy
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27
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Rossetti B, Gagliardini R, Meini G, Sterrantino G, Colangeli V, Re MC, Latini A, Colafigli M, Vignale F, Rusconi S, Micheli V, Di Biagio A, Orofino G, Ghisetti V, Fantauzzi A, Vullo V, Grima P, Francisci D, Mastroianni C, Antinori A, Trezzi M, Lisi L, Navarra P, Canovari B, D’Arminio Monforte A, Lamonica S, D’Avino A, Zazzi M, Di Giambenedetto S, De Luca A. Switch to maraviroc with darunavir/r, both QD, in patients with suppressed HIV-1 was well tolerated but virologically inferior to standard antiretroviral therapy: 48-week results of a randomized trial. PLoS One 2017; 12:e0187393. [PMID: 29161288 PMCID: PMC5697828 DOI: 10.1371/journal.pone.0187393] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 10/18/2017] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES Primary study outcome was absence of treatment failure (virological failure, VF, or treatment interruption) per protocol at week 48. METHODS Patients on 3-drug ART with stable HIV-1 RNA <50 copies/mL and CCR5-tropic virus were randomized 1:1 to maraviroc with darunavir/ritonavir qd (study arm) or continue current ART (continuation arm). RESULTS In June 2015, 115 patients were evaluable for the primary outcome (56 study, 59 continuation arm). The study was discontinued due to excess of VF in the study arm (7 cases, 12.5%, vs 0 in the continuation arm, p = 0.005). The proportion free of treatment failure was 73.2% in the study and 59.3% in the continuation arm. Two participants in the study and 10 in the continuation arm discontinued therapy due to adverse events (p = 0.030). At VF, no emergent drug resistance was detected. Co-receptor tropism switched to non-R5 in one patient. Patients with VF reported lower adherence and had lower plasma drug levels. Femoral bone mineral density was significantly improved in the study arm. CONCLUSION Switching to maraviroc with darunavir/ritonavir qd in virologically suppressed patients was associated with improved tolerability but was virologically inferior to 3-drug therapy.
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Affiliation(s)
- Barbara Rossetti
- Infectious Diseases Unit, Azienda Ospedaliera Universitaria Senese, Siena, Italy
- Clinic of Infectious Diseases, Catholic University of Sacred Heart, Rome, Italy
- * E-mail:
| | - Roberta Gagliardini
- Clinic of Infectious Diseases, Catholic University of Sacred Heart, Rome, Italy
| | - Genny Meini
- Department of Medical Biotechnology, University of Siena, Siena, Italy
| | - Gaetana Sterrantino
- Clinic of Infectious Diseases, Azienda Ospedaliera Universitaria Careggi, Firenze, Italy
| | - Vincenzo Colangeli
- Clinic of Infectious Diseases, Azienda Ospedaliera Universitaria S.Orsola Malpighi, Bologna, Italy
| | - Maria Carla Re
- Microbiology, Azienda Ospedaliera Universitaria S.Orsola Malpighi, Bologna, Italy
| | | | | | - Francesca Vignale
- Clinic of Infectious Diseases, G. D’Annunzio University, Chieti, Italy
| | - Stefano Rusconi
- Infectious and Tropical Diseases Unit, DIBIC L. Sacco Hospital, University of Milano, Milano, Italy
| | - Valeria Micheli
- Microbiology and Virology Laboratory, L. Sacco Hospital, Milano, Italy
| | | | - Giancarlo Orofino
- Infectious Diseases Unit A, Amedeo di Savoia Hospital, Torino, Italy
| | - Valeria Ghisetti
- Microbiology and Virology Laboratory, Amedeo di Savoia Hospital, Torino, Italy
| | | | - Vincenzo Vullo
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Roma, Italy
| | - Pierfrancesco Grima
- Division of Infectious Diseases, S. Caterina Novella Hospital, Galatina, Lecce, Italy
| | - Daniela Francisci
- Clinic of Infectious Diseases, University of Perugia, Perugia, Italy
| | - Claudio Mastroianni
- Infectious Disease Unit, SM Goretti Hospital, Department of Public Health and Infectious Diseases, Sapienza University, Latina, Italy
| | | | - Michele Trezzi
- Infectious Diseases Unit, Pistoia Hospital, Pistoia, Italy
| | - Lucia Lisi
- Pharmacology Department, Catholic University of Sacred Heart, Rome, Italy
| | - Pierluigi Navarra
- Pharmacology Department, Catholic University of Sacred Heart, Rome, Italy
| | | | - Antonella D’Arminio Monforte
- Infectious and Tropical Diseases Institute, Department of Health Sciences, University of Milan San Paolo Hospital, Milan, Italy
| | - Silvia Lamonica
- Clinic of Infectious Diseases, Catholic University of Sacred Heart, Rome, Italy
| | - Alessandro D’Avino
- Clinic of Infectious Diseases, Catholic University of Sacred Heart, Rome, Italy
| | - Maurizio Zazzi
- Department of Medical Biotechnology, University of Siena, Siena, Italy
| | | | - Andrea De Luca
- Infectious Diseases Unit, Azienda Ospedaliera Universitaria Senese, Siena, Italy
- Department of Medical Biotechnology, University of Siena, Siena, Italy
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Di Giambenedetto S, Fabbiani M, Quiros Roldan E, Latini A, D'Ettorre G, Antinori A, Castagna A, Orofino G, Francisci D, Chinello P, Madeddu G, Grima P, Rusconi S, Di Pietro M, Mondi A, Ciccarelli N, Borghetti A, Focà E, Colafigli M, De Luca A, Cauda R. Treatment simplification to atazanavir/ritonavir + lamivudine versus maintenance of atazanavir/ritonavir + two NRTIs in virologically suppressed HIV-1-infected patients: 48 week results from a randomized trial (ATLAS-M). J Antimicrob Chemother 2017; 72:1163-1171. [PMID: 28093483 DOI: 10.1093/jac/dkw557] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2016] [Accepted: 11/27/2016] [Indexed: 11/14/2022] Open
Abstract
Background Combination ART (cART)-related toxicities and costs have prompted the need for treatment simplification. The ATLAS-M trial explored 48 week non-inferior efficacy of simplification to atazanavir/ritonavir + lamivudine versus maintaining three-drug atazanavir/ritonavir-based cART in virologically suppressed patients. Methods We performed an open-label, multicentre, randomized, non-inferiority study, enrolling HIV-infected adults on atazanavir/ritonavir + two NRTIs, with stable HIV-RNA <50 copies/mL and CD4 + >200 cells/mm 3 . Main exclusion criteria were hepatitis B virus coinfection, past virological failure on or resistance to study drugs, recent AIDS and pregnancy. Patients were randomly assigned 1:1 to either switch to 300 mg of atazanavir/100 mg of ritonavir once daily and 300 mg of lamivudine once daily (atazanavir/ritonavir + lamivudine arm) or to continue the previous regimen (atazanavir/ritonavir + two NRTIs arm). The primary study outcome was the maintenance of HIV-RNA <50 copies/mL at week 48 of the ITT-exposed (ITT-e) analysis with switch = failure. The non-inferiority margin was 12%. This study is registered at ClinicalTrials.gov, number NCT01599364. Results Between July 2011 and June 2014, 266 patients were randomized (133 to each arm). After 48 weeks, the primary study outcome was met by 119 of 133 patients (89.5%) in the atazanavir/ritonavir + lamivudine arm and 106 of 133 patients (79.7%) in the atazanavir/ritonavir + two NRTIs arm [difference atazanavir/ritonavir + lamivudine versus atazanavir/ritonavir + two NRTIs arm: +9.8% (95% CI + 1.2 to + 18.4)], demonstrating non-inferiority and superior efficacy of the atazanavir/ritonavir + lamivudine arm. Virological failure occurred in two (1.5%) patients in the atazanavir/ritonavir + lamivudine arm and six (4.5%) patients in the atazanavir/ritonavir + two NRTIs arm, without resistance selection. A similar proportion of adverse events occurred in both arms. Conclusions Treatment simplification to atazanavir/ritonavir + lamivudine showed non-inferior efficacy (superiority on post-hoc analysis) and a comparable safety profile over continuing atazanavir/ritonavir + two NRTIs in virologically suppressed patients.
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Affiliation(s)
| | - Massimiliano Fabbiani
- Institute of Clinical Infectious Diseases, Catholic University of Sacred Heart, Rome, Italy
| | - Eugenia Quiros Roldan
- University Division of Infectious and Tropical Diseases, University of Brescia, Brescia, Italy
| | - Alessandra Latini
- Infectious Dermatology and Allergology Unit, IFO S. Gallicano Institute (IRCCS), Rome, Italy
| | | | - Andrea Antinori
- National Institute for Infectious Diseases 'Lazzaro Spallanzani' IRCCS, Rome, Italy
| | - Antonella Castagna
- Department of Infectious and Tropical Diseases, Vita-Salute San Raffaele University, San Raffaele Hospital, Milan, Italy
| | - Giancarlo Orofino
- Infectious and Tropical Diseases Unit, Amedeo di Savoia Hospital, Torino, Italy
| | | | - Pierangelo Chinello
- Systemic Infections and Immunodeficiency Unit, National Institute for Infectious Diseases 'Lazzaro Spallanzani' IRCCS, Rome, Italy
| | - Giordano Madeddu
- Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy
| | | | - Stefano Rusconi
- Infectious Diseases Unit, DIBIC Luigi Sacco, University of Milan, Milan, Italy
| | - Massimo Di Pietro
- Unit of Infectious Diseases, S.M. Annunziata Hospital, Florence, Italy
| | - Annalisa Mondi
- Institute of Clinical Infectious Diseases, Catholic University of Sacred Heart, Rome, Italy
| | - Nicoletta Ciccarelli
- Institute of Clinical Infectious Diseases, Catholic University of Sacred Heart, Rome, Italy
| | - Alberto Borghetti
- Institute of Clinical Infectious Diseases, Catholic University of Sacred Heart, Rome, Italy
| | - Emanuele Focà
- University Division of Infectious and Tropical Diseases, University of Brescia, Brescia, Italy
| | - Manuela Colafigli
- Infectious Dermatology and Allergology Unit, IFO S. Gallicano Institute (IRCCS), Rome, Italy
| | - Andrea De Luca
- UOC Malattie Infettive, Azienda Ospedaliera Universitaria Senese, Siena, Italy.,Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Roberto Cauda
- Institute of Clinical Infectious Diseases, Catholic University of Sacred Heart, Rome, Italy
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Rollo F, Latini A, Pichi B, Colafigli M, Benevolo M, Sinopoli I, Sperduti I, Laquintana V, Fabbri G, Frasca M, Cristaudo A, Giuliani M, Donà MG. Prevalence and determinants of oral infection by Human Papillomavirus in HIV-infected and uninfected men who have sex with men. PLoS One 2017; 12:e0184623. [PMID: 28910359 PMCID: PMC5599005 DOI: 10.1371/journal.pone.0184623] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Accepted: 08/28/2017] [Indexed: 12/02/2022] Open
Abstract
Background Oral Human Papillomavirus (HPV) infection is rare in the general population but common in high-risk individuals. Recent data indicate that oral HPV is associated with the development of head and neck carcinomas. HPV16 infection, in particular, increases the risk of oropharyngeal cancer. Methods We evaluated oral HPV prevalence and determinants of infection in cancer-free HIV-infected and uninfected men who have sex with men (MSM) recruited among attendees of an STI/HIV centre. Oral rinse and gargles were collected using a mouthwash and analyzed with the Linear Array HPV Genotyping Test. Socio-demographic and behavioral data were collected through face-to-face interviews. Results Overall, 170 MSM participated: 98 HIV-uninfected and 72 HIV-infected (91.7% under cART). Oral HPV was detected in 17.3% and 27.8% of the subjects, respectively (p = 0.13). Non-carcinogenic HPVs were significantly more common among HIV-infected MSM (18.1% vs. 5.1%, p = 0.01). Prevalence of the HPV types included in the quadrivalent HPV vaccine was similar (6.1% vs. 8.3% for the HIV-negative and positive MSM, respectively, p = 0.76). HPV16 was the most frequent type in HIV-negative (5.1%), and HIV-positive individuals, in the latter group together with HPV18, 72 and 84 (4.2% each). Older age at first sex (AOR: 4.02, 95% CI: 1.17–13.86 for those older than 18 years of age at first intercourse, p = 0.027) and a higher lifetime number of receptive oral sex partners (AOR: 9.14, 95% CI: 2.49–33.62 for those with >50 compared to ≤50 partners, p<0.001) were determinants of oral HPV among HIV-infected MSM. Conclusion Oral HPV infection among MSM attending an urban STI center is very frequent compared to the general population. Sexual behavior appears to be the major determinant of infection among the HIV-infected individuals.
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Affiliation(s)
- Francesca Rollo
- Pathology Department, Regina Elena National Cancer Institute, IFO, IRCCS, Rome, Italy
| | - Alessandra Latini
- STI/HIV Unit, San Gallicano Dermatologic Institute, IFO, IRCCS, Rome, Italy
| | - Barbara Pichi
- Otolaryngology Head Neck Surgery Department, Regina Elena National Cancer Institute, IFO, IRCCS, Rome, Italy
| | - Manuela Colafigli
- STI/HIV Unit, San Gallicano Dermatologic Institute, IFO, IRCCS, Rome, Italy
| | - Maria Benevolo
- Pathology Department, Regina Elena National Cancer Institute, IFO, IRCCS, Rome, Italy
| | - Ilenia Sinopoli
- Otolaryngology Head Neck Surgery Department, Regina Elena National Cancer Institute, IFO, IRCCS, Rome, Italy
| | - Isabella Sperduti
- Biostatistics Unit, Regina Elena National Cancer Institute, IFO, IRCCS, Rome, Italy
| | - Valentina Laquintana
- Pathology Department, Regina Elena National Cancer Institute, IFO, IRCCS, Rome, Italy
| | - Giulia Fabbri
- Pathology Department, Regina Elena National Cancer Institute, IFO, IRCCS, Rome, Italy
| | - Mirko Frasca
- STI/HIV Unit, San Gallicano Dermatologic Institute, IFO, IRCCS, Rome, Italy
| | - Antonio Cristaudo
- STI/HIV Unit, San Gallicano Dermatologic Institute, IFO, IRCCS, Rome, Italy
| | - Massimo Giuliani
- STI/HIV Unit, San Gallicano Dermatologic Institute, IFO, IRCCS, Rome, Italy
| | - Maria Gabriella Donà
- STI/HIV Unit, San Gallicano Dermatologic Institute, IFO, IRCCS, Rome, Italy
- * E-mail:
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30
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Gagliardini R, Fabbiani M, Colafigli M, D'Avino A, Mondi A, Borghetti A, Lamonica S, Cauda R, De Luca A, Di Giambenedetto S. Lipid-lowering effect and changes in estimated cardiovascular risk after switching to a tenofovir-containing regimen for the treatment of HIV-infected patients. J Chemother 2016; 29:299-307. [PMID: 28019192 DOI: 10.1080/1120009x.2016.1269040] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Tenofovir could have a direct lipid-lowering effect. The aim of our retrospective study was to investigate changes in cardiovascular risk after switching from a tenofovir-sparing to a tenofovir-containing backbone. Lipid parameters and cardiovascular risk [calculated using 10-years Framingham Risk Score (FRS) and 5-years DAD Risk Score (DRS)] were analysed at baseline and after three months. 273 patients were enrolled. After switching, significant decreases in total cholesterol (TC) (-8.2mg/dl, p < 0.001), LDL (-8.7mg/dl, p < 0.001) and DRS (mean -0.26%, p < 0.001) were observed, while a reduction in FRS was only observed in patients with pre-switch high TC or medium-high (>10%) FRS. Pre-switch factors associated with DRS reduction were higher TC, abacavir, new generation protease inhibitors, while zidovudine predicted an increase of DRS. Our results suggest that the improvement of lipid parameters observed after switching to a tenofovir-containing backbone could lead to a significant reduction in predicted cardiovascular risk, which became more evident in subjects with higher cardiovascular risk.
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Affiliation(s)
- Roberta Gagliardini
- a Institute of Clinical Infectious Diseases, Catholic University of the Sacred Heart , Rome , Italy
| | - Massimiliano Fabbiani
- b Division of Infectious Diseases, San Gerardo Hospital , University of Milano-Bicocca , Monza , Italy
| | - Manuela Colafigli
- c Infectious Dermatology and Allergology Unit, IFO S. Gallicano Institute (IRCCS) , Rome , Italy
| | - Alessandro D'Avino
- a Institute of Clinical Infectious Diseases, Catholic University of the Sacred Heart , Rome , Italy
| | - Annalisa Mondi
- a Institute of Clinical Infectious Diseases, Catholic University of the Sacred Heart , Rome , Italy
| | - Alberto Borghetti
- a Institute of Clinical Infectious Diseases, Catholic University of the Sacred Heart , Rome , Italy
| | - Silvia Lamonica
- a Institute of Clinical Infectious Diseases, Catholic University of the Sacred Heart , Rome , Italy
| | - Roberto Cauda
- a Institute of Clinical Infectious Diseases, Catholic University of the Sacred Heart , Rome , Italy
| | - Andrea De Luca
- a Institute of Clinical Infectious Diseases, Catholic University of the Sacred Heart , Rome , Italy.,d Infectious Diseases Unit, Azienda Ospedaliera Universitaria Senese , Siena , Italy
| | - Simona Di Giambenedetto
- a Institute of Clinical Infectious Diseases, Catholic University of the Sacred Heart , Rome , Italy
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Latini A, Fabbiani M, Borghi V, Sterrantino G, Giannetti A, Lorenzini P, Loiacono L, Ammassari A, Bellagamba R, Colafigli M, D’Ettorre G, Di Giambenedetto S, Antinori A, Zaccarelli M. Switching to boosted protease inhibitor plus a second antiretroviral drug (dual therapy) for treatment simplification: a multicenter observational study. BMC Infect Dis 2016; 16:401. [PMID: 27515949 PMCID: PMC4982404 DOI: 10.1186/s12879-016-1703-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [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: 03/20/2016] [Accepted: 07/08/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Aim of the study was to assess predictors of discontinuation/toxicity of boosted PI-based (PI/r) dual therapy (DT). METHODS Observational, retrospective switch study in patients successfully treated with triple drugs regimen. Patients switched to PI/r based DT [darunavir (DRV/r), lopinavir (LPV/r) or atazanavir (ATV/r)] plus a second drug: [raltegravir (RAL), maraviroc (MVC) etravirine (ETR), lamivudine (3TC) or tenofovir (TDF)] between 2009 and 2014 were included. The effect of each drug as well as other clinical and virological cofactors over treatment discontinuation (TD) was assessed using survival analysis. RESULTS Overall, 376 patients were included with mean follow-up of 73 weeks. The most commonly used drugs in DT were DRV/r (63.0 %) and RAL (53.7 %). TD was observed in 77 (20,4 %) patients: 38 (10,1 %) virological failure, 35 (9,3 %) toxicity/intolerance (4 deaths) and 4 (1 %) interruptions for patients decision. At Cox Model, adjusted by demographic and laboratory variables, DRV/r and ATV/r significantly reduced the likelihood of TD and longer treatment was associated with lower risk, while low CD4 count at baseline and number of previous regimens with a higher risk. Moreover, RAL and 3TC use were significantly associated with lower TD by toxicity. CONCLUSIONS In our clinical practice experience, switching virologically suppressed patients to PI/r based DT showed adequate safety and efficacy, so that it may be used in selected patients with specific medical needs.
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Affiliation(s)
- Alessandra Latini
- San Gallicano Dermatologic Institute (IRCCS), Clinic of Dermatology and Infectious Diseases, Rome, Italy
| | - Massimiliano Fabbiani
- Department of Infectious Diseases, Catholic University of the Sacred Heart, Rome, Italy
- Division of Infectious Diseases, Department of Internal Medicine, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - Vanni Borghi
- Azienda Ospedaliero Universitaria, Clinic of Infectious Diseases, Modena, Italy
| | | | - Alberto Giannetti
- Clinical Department, National Institute for the Infectious Diseases “Lazzaro Spallanzani”, Rome, Italy
| | - Patrizia Lorenzini
- Clinical Department, National Institute for the Infectious Diseases “Lazzaro Spallanzani”, Rome, Italy
| | - Laura Loiacono
- Clinical Department, National Institute for the Infectious Diseases “Lazzaro Spallanzani”, Rome, Italy
| | - Adriana Ammassari
- Clinical Department, National Institute for the Infectious Diseases “Lazzaro Spallanzani”, Rome, Italy
| | - Rita Bellagamba
- Clinical Department, National Institute for the Infectious Diseases “Lazzaro Spallanzani”, Rome, Italy
| | - Manuela Colafigli
- San Gallicano Dermatologic Institute (IRCCS), Clinic of Dermatology and Infectious Diseases, Rome, Italy
| | - Gabriella D’Ettorre
- Policlinico Universitario “Umberto I”, Clinic of Infectious Diseases, Rome, Italy
| | | | - Andrea Antinori
- Clinical Department, National Institute for the Infectious Diseases “Lazzaro Spallanzani”, Rome, Italy
| | - Mauro Zaccarelli
- Clinical Department, National Institute for the Infectious Diseases “Lazzaro Spallanzani”, Rome, Italy
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Milanini B, Ciccarelli N, Fabbiani M, Baldonero E, Limiti S, Gagliardini R, Borghetti A, D'Avino A, Mondi A, Colafigli M, Cauda R, Di Giambenedetto S. Neuropsychological screening tools in Italian HIV+ patients: a comparison of Montreal Cognitive Assessment (MoCA) and Mini Mental State Examination (MMSE). Clin Neuropsychol 2016; 30:1457-1468. [PMID: 27180611 DOI: 10.1080/13854046.2016.1183048] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Despite the progress in HIV treatments, mild forms of cognitive impairment still persist. Brief and sensitive screening tools are needed. We evaluated the accuracy of the Montreal Cognitive Assessment (MoCA) compared to the Mini Mental State Examination (MMSE) to detect cognitive impairment in HIV-infected participants. METHOD HIV-infected patients were consecutively enrolled during routine outpatient visits at a single institution. The MoCA, the MMSE, and a comprehensive neuropsychological battery were administered. Patients were considered as affected by cognitive impairment if they showed decreased cognitive function in at least two ability domains based on age and education adjusted Italian normative cut-offs. RESULTS Ninety-three HIV-infected participants (75% males, median age 47, all on antiretroviral therapy; 90% HIV-RNA <50copies/mL, median CD4 644 cells/μL) were enrolled. Thirteen participants (14%) were diagnosed as cognitively compromised via a comprehensive neuropsychological examination. The area under the curve of the adjusted MMSE and MoCA scores to detect cognitive impairment were .51 (95% CI = .31-.72, p = .877) and .70 (95% CI = .53-.86, p = .025), respectively. A MoCA score <22 was able to predict the cognitive impairment with 62% of sensitivity and 76% of specificity. CONCLUSIONS Our findings suggested that the prognostic performance of the MoCA to detect cognitive impairment among mildly impaired HIV-infected participants was only moderate. Further investigations are needed to identify optimal cognitive tests to screen HIV-infected individuals or to explore whether a combination of cognitive tests might represent a viable alternative to a single screening tool.
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Affiliation(s)
- Benedetta Milanini
- a Institute of Clinical Infectious Diseases , Catholic University of Sacred Heart , Rome , Italy
| | - Nicoletta Ciccarelli
- a Institute of Clinical Infectious Diseases , Catholic University of Sacred Heart , Rome , Italy
| | - Massimiliano Fabbiani
- a Institute of Clinical Infectious Diseases , Catholic University of Sacred Heart , Rome , Italy
| | - Eleonora Baldonero
- a Institute of Clinical Infectious Diseases , Catholic University of Sacred Heart , Rome , Italy
| | - Silio Limiti
- a Institute of Clinical Infectious Diseases , Catholic University of Sacred Heart , Rome , Italy
| | - Roberta Gagliardini
- a Institute of Clinical Infectious Diseases , Catholic University of Sacred Heart , Rome , Italy
| | - Alberto Borghetti
- a Institute of Clinical Infectious Diseases , Catholic University of Sacred Heart , Rome , Italy
| | - Alessandro D'Avino
- a Institute of Clinical Infectious Diseases , Catholic University of Sacred Heart , Rome , Italy
| | - Annalisa Mondi
- a Institute of Clinical Infectious Diseases , Catholic University of Sacred Heart , Rome , Italy
| | - Manuela Colafigli
- a Institute of Clinical Infectious Diseases , Catholic University of Sacred Heart , Rome , Italy
| | - Roberto Cauda
- a Institute of Clinical Infectious Diseases , Catholic University of Sacred Heart , Rome , Italy
| | - Simona Di Giambenedetto
- a Institute of Clinical Infectious Diseases , Catholic University of Sacred Heart , Rome , Italy
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Giuliani M, Vescio MF, Donà MG, Latini A, Frasca M, Colafigli M, Farinella M, Rezza G, Cristaudo A. Perceptions of Human Papillomavirus (HPV) infection and acceptability of HPV vaccine among men attending a sexual health clinic differ according to sexual orientation. Hum Vaccin Immunother 2016; 12:1542-50. [PMID: 26752151 DOI: 10.1080/21645515.2015.1115935] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Our aim was to gain a better understanding of the knowledge about Human Papillomavirus (HPV) infection and attitudes toward the HPV vaccine among men at risk for sexually transmitted infections (STI). A self-administered questionnaire was completed by attendees of the largest STI Center in Rome, Italy, from April to June 2013. Determinants of vaccine acceptability were investigated using a Structured Equation Model. A total of 423 males participated in the survey: 296 (70.0%) men who have sex with men (MSM) and 127 (30.0%) men who have sex with women (MSW). Only one half of the participants knew that HPV is the cause of genital warts (56.9% of MSM vs. 49.5% of MSW, p=0.28). Even less were aware that HPV causes cancer in men (37.2% vs. 27.3%, p=0.08). MSW were more likely to indicate HPV as a cause of cervical cancer (80.8% vs. 69.3%, p=0.03) and to have heard about the vaccine (58.3 vs. 43.6%, p=0.01). Moreover, 72.1% of MSM and 70.3% of MSW were willing to be vaccinated. A rise of one-unit in the HPV awareness score increased the OR of vaccine acceptability among MSM by 25% (OR 1.25, 95%CI: 1.05-1.49; p=0.013). Differently, only attitudes had a relevant effect on willingness to be vaccinated among MSW (OR 3.32, 95%CI: 1.53-7.17; p=0.002). Efforts should be made to maximize awareness of HPV, especially as a causative agent of genital warts and male cancers, and to reinforce positive attitudes toward vaccination among men visiting STI centers.
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Affiliation(s)
- Massimo Giuliani
- a STI/HIV Unit, UOC Dermatologia Infettiva e Allergologica, San Gallicano Dermatological Institute (IRCCS) , Rome , Italy
| | - Maria Fenicia Vescio
- b Infectious, Parasitic and Immunomediated Diseases Department , Istituto Superiore di Sanità , Rome , Italy
| | - Maria Gabriella Donà
- a STI/HIV Unit, UOC Dermatologia Infettiva e Allergologica, San Gallicano Dermatological Institute (IRCCS) , Rome , Italy
| | - Alessandra Latini
- a STI/HIV Unit, UOC Dermatologia Infettiva e Allergologica, San Gallicano Dermatological Institute (IRCCS) , Rome , Italy
| | - Mirko Frasca
- a STI/HIV Unit, UOC Dermatologia Infettiva e Allergologica, San Gallicano Dermatological Institute (IRCCS) , Rome , Italy
| | - Manuela Colafigli
- a STI/HIV Unit, UOC Dermatologia Infettiva e Allergologica, San Gallicano Dermatological Institute (IRCCS) , Rome , Italy
| | | | - Giovanni Rezza
- b Infectious, Parasitic and Immunomediated Diseases Department , Istituto Superiore di Sanità , Rome , Italy
| | - Antonio Cristaudo
- a STI/HIV Unit, UOC Dermatologia Infettiva e Allergologica, San Gallicano Dermatological Institute (IRCCS) , Rome , Italy
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Fabbiani M, Di Giambenedetto S, Cingolani A, Fanti I, Colafigli M, Tamburrini E, Cauda R, Navarra P, De Luca A, Murri R. Relationship between self-reported adherence, antiretroviral drug concentration measurement and self-reported symptoms in patients treated for HIV-1 infection. Infect Dis (Lond) 2015; 48:48-55. [DOI: 10.3109/23744235.2015.1082034] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Mondi A, Fabbiani M, Ciccarelli N, Colafigli M, D'Avino A, Borghetti A, Gagliardini R, Cauda R, De Luca A, Di Giambenedetto S. Efficacy and safety of treatment simplification to atazanavir/ritonavir + lamivudine in HIV-infected patients with virological suppression: 144 week follow-up of the AtLaS pilot study. J Antimicrob Chemother 2015; 70:1843-9. [PMID: 25885326 DOI: 10.1093/jac/dkv037] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Accepted: 01/25/2015] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES AtLaS was a single-arm pilot study that demonstrated promising efficacy and safety of treatment simplification to a dual regimen with atazanavir/ritonavir + lamivudine in virologically suppressed HIV-positive patients. Here, we report data from the 144 week follow-up. METHODS At baseline, patients treated with a three-drug atazanavir/ritonavir-based regimen were switched to 300/100 mg of atazanavir/ritonavir plus 300 mg of lamivudine once daily. Major clinical events, laboratory parameters, neurocognitive performance, bone composition and body fat distribution were monitored. Treatment failure was defined as a discontinuation/switch of the regimen or virological failure (HIV-RNA >50 copies/mL in two consecutive determinations or a single level above 1000 copies/mL). RESULTS After 144 weeks, 9/40 (22.5%) treatment failures occurred, including two virological failures (Weeks 48 and 53, without resistance). A significant increase in the CD4 count was observed at Week 96 (+124 cells/mm(3); P = 0.002) and Week 144 (+94 cells/mm(3); P = 0.008). After 144 weeks, a significant increase in total cholesterol (+25 mg/dL; P = 0.001), HDL cholesterol (+6 mg/dL; P = 0.024) and LDL cholesterol (+12 mg/dL; P = 0.008) was observed, without any change in triglyceride levels, total cholesterol/HDL ratio or LDL/HDL ratio. A significant increase in the estimated glomerular filtration rate (+25 mL/min/1.73 m(2); P < 0.001) and lumbar spine T-score and Z-score (+0.2, P = 0.011; and +0.35, P = 0.001, respectively) and a decrease in trunk fat (-1.898 g; P = 0.005) were also observed. Neurocognitive function did not decline over time. Concerning safety, 10 moderate to severe adverse events were recorded in eight patients; overall seven cases of renal colic (possibly treatment related) were observed, leading to a discontinuation of treatment in two patients. CONCLUSIONS Data from the 144 week follow-up suggested good long-term efficacy of the simplification strategy that was investigated, with rare virological failure and a potential for improvement of the CD4 count, renal function and bone mineral density. This strategy warrants further investigation in a randomized trial.
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Affiliation(s)
- A Mondi
- Institute of Clinical Infectious Diseases, Catholic University of the Sacred Heart, Rome, Italy
| | - M Fabbiani
- Institute of Clinical Infectious Diseases, Catholic University of the Sacred Heart, Rome, Italy
| | - N Ciccarelli
- Institute of Clinical Infectious Diseases, Catholic University of the Sacred Heart, Rome, Italy
| | - M Colafigli
- Institute of Clinical Infectious Diseases, Catholic University of the Sacred Heart, Rome, Italy
| | - A D'Avino
- Institute of Clinical Infectious Diseases, Catholic University of the Sacred Heart, Rome, Italy
| | - A Borghetti
- Institute of Clinical Infectious Diseases, Catholic University of the Sacred Heart, Rome, Italy
| | - R Gagliardini
- Institute of Clinical Infectious Diseases, Catholic University of the Sacred Heart, Rome, Italy
| | - R Cauda
- Institute of Clinical Infectious Diseases, Catholic University of the Sacred Heart, Rome, Italy
| | - A De Luca
- Infectious Diseases Unit, Siena University Hospital, Siena, Italy
| | - S Di Giambenedetto
- Institute of Clinical Infectious Diseases, Catholic University of the Sacred Heart, Rome, Italy
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Ciccarelli N, Grima P, Fabbiani M, Baldonero E, Borghetti A, Milanini B, Limiti S, Colafigli M, Tamburrini E, Cauda R, De Luca A, Di Giambenedetto S. Baseline CD4(+) T-cell count and cardiovascular risk factors predict the evolution of cognitive performance during 2-year follow-up in HIV-infected patients. Antivir Ther 2014; 20:433-40. [PMID: 25504667 DOI: 10.3851/imp2925] [Citation(s) in RCA: 7] [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] [Accepted: 11/30/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND The aim of our study was to better understand the dynamics between cardiovascular risk factors and immunological parameters in the evolution of cognitive performance in HIV+ patients. METHODS We conducted a prospective longitudinal study, consecutively enrolling asymptomatic HIV+ subjects during routine outpatient visits at two clinical centres. At baseline and after 2 years, all patients underwent a comprehensive neuropsychological battery. Common carotid intima-media thickness (cIMT) was also measured. RESULTS A total of 150 patients completed the study (77% males, median age 46 years, 20% with past AIDS-defining events, 95% on cART, 88% with HIV-RNA<50 copies/ml). After a 2-year follow-up, there was no difference in the proportion of patients with cognitive impairment (32% versus 33% at baseline; P=1.00). However, a significantly worse memory performance was observed (z score mean change -0.51, sd 1.05; P=0.001). At multivariate analysis, baseline dyslipidaemia (OR 2.7, 95% CI 1.1, 7.1; P=0.037) showed a significant association with a higher risk of memory impairment at 2-year follow-up, while higher baseline CD4(+) T-cell count (OR 0.80 per 100 cells/μl higher; 95% CI 0.66, 0.97; P=0.026) was found to be a protective factor, adjusting for the presence of a memory impairment at baseline. When the analysis was restricted to patients who did not change antiretroviral therapy during the study period (n=109), baseline cIMT (OR 14.6 per 0.1 mm higher; 95% CI 1.1, 189.9; P=0.041) also emerged as an independent risk factor for memory impairment at 2-year follow-up. CONCLUSIONS Immunological parameters and cardiovascular risk factors are independently associated with the evolution of cognitive status in HIV+ patients.
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Affiliation(s)
- Nicoletta Ciccarelli
- Department of Public Health, Institute of Clinical Infectious Diseases, Catholic University of Sacred Heart, Rome, Italy.
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Fabbiani M, Grima P, Borghetti A, Colafigli M, D'Avino A, Mondi A, Gagliardini R, De Luca A, Cauda R, Di Giambenedetto S. Ophthalmic artery resistance index is increased in HIV-Infected patients and is influenced by protease inhibitors exposure. J Infect 2014; 68:500-3. [DOI: 10.1016/j.jinf.2014.01.012] [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] [Received: 01/21/2014] [Accepted: 01/27/2014] [Indexed: 10/25/2022]
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Gagliardini R, Fabbiani M, Fortuna S, Visconti E, Navarra P, Cauda R, Colafigli M, De Luca A, Trecarichi EM, Di Giambenedetto S. Pharmacokinetics of etravirine in HIV-infected patients concomitantly treated with rifampin for tuberculosis. Infection 2014; 42:775-8. [PMID: 24531907 DOI: 10.1007/s15010-014-0599-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Accepted: 01/31/2014] [Indexed: 11/30/2022]
Abstract
Etravirine is metabolized by three cytochrome P450 enzymes that are in turn induced by rifampin. Consequently, co-administration of etravirine and rifampin is not recommended. To date, however, no clinical studies exploring the drug-drug interaction of this combination have been conducted. Here we report two cases of off-label etravirine use concurrently with antitubercular treatment, dictated by the unavailability of other treatments. Plasma drug concentrations were monitored by regular measurements. Our results appear to confirm the increased metabolism of etravirine through the induction of cytochrome P450 enzymes, but the adequacy of drug levels in all of the measurements and subsequent virological suppression suggest that this drug interaction may not be clinically relevant.
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Affiliation(s)
- R Gagliardini
- Institute of Infectious Diseases, Catholic University of Sacred Heart, Rome, Italy
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Fabbiani M, Zaccarelli M, Grima P, Prosperi M, Fanti I, Colafigli M, D'Avino A, Mondi A, Borghetti A, Fantoni M, Cauda R, Di Giambenedetto S. Single tablet regimens are associated with reduced Efavirenz withdrawal in antiretroviral therapy naïve or switching for simplification HIV-infected patients. BMC Infect Dis 2014; 14:26. [PMID: 24418191 PMCID: PMC3897945 DOI: 10.1186/1471-2334-14-26] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [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: 10/08/2013] [Accepted: 01/11/2014] [Indexed: 11/19/2022] Open
Abstract
Background Efavirenz (EFV) administration is still controversial for its high rates of interruption mainly related to central nervous system side effects (CNS-SE). Aim of the study was to define if single tablet regimen (STR) as compared to bis-in-die (BID) or once-daily (OD) with ≥2 pills-a-day EFV formulations reduced the risk of interruption. Methods Patients starting any cART regimen including EFV + 2NRTIs or switching to EFV + 2NRTIs for simplification after virological suppression were retrospectively selected. Incidence, probability and prognostic factors of interruption by different causes were assessed by survival analysis and Cox regression model. Results Overall, 553 patients starting EFV-containing regimens were included: 38.2% started BID regimen, 44.5% OD regimens ≥2 pills and 17.4% STR. The overall proportion of EFV interruption was 37.4% at 4 years; at the same time point, interruptions for virological failure and toxicity were 8.8% and 16.5% (8% for CNS-SE), respectively. Starting EFV co-formulated in STR was associated with lower proportion of overall interruption at 4 years (17.1% vs. 40.6%, p < 0.01). Only one virological failure was observed with STR up to 4 years (1.1% vs. 10.3% in non-STR, p = 0.051). STR also accounted for lower proportion of interruption by patient decision (1.5% vs. 11.8%, p = 0.01). No differences of interruption by overall toxicity and CNS-SE were observed. In multivariable analysis, STR and male gender were associated with lower risk of EFV interruption, while higher CD4 nadir and IDU with higher risk. Conclusions In our experience, starting EFV co-formulated in STR was associated with lower virological failure and higher adherence, despite a similar proportion of CNS toxicity, thus reducing the risk of treatment interruption.
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Affiliation(s)
| | - Mauro Zaccarelli
- Viral Immunodeficiency Unit, National Institute for Infectious Diseases "Lazzaro Spallanzani", Rome, Italy.
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Rusconi S, Vitiello P, Adorni F, Colella E, Focà E, Capetti A, Meraviglia P, Abeli C, Bonora S, D’Annunzio M, Biagio AD, Di Pietro M, Butini L, Orofino G, Colafigli M, d’Ettorre G, Francisci D, Parruti G, Soria A, Buonomini AR, Tommasi C, Mosti S, Bai F, Di Nardo Stuppino S, Morosi M, Montano M, Tau P, Merlini E, Marchetti G. Maraviroc as intensification strategy in HIV-1 positive patients with deficient immunological response: an Italian randomized clinical trial. PLoS One 2013; 8:e80157. [PMID: 24244635 PMCID: PMC3828227 DOI: 10.1371/journal.pone.0080157] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [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: 05/23/2013] [Accepted: 09/26/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Immunological non-responders (INRs) lacked CD4 increase despite HIV-viremia suppression on HAART and had an increased risk of disease progression. We assessed immune reconstitution profile upon intensification with maraviroc in INRs. METHODS We designed a multi-centric, randomized, parallel, open label, phase 4 superiority trial. We enrolled 97 patients on HAART with CD4+<200/µL and/or CD4+ recovery ≤ 25% and HIV-RNA<50 cp/mL. Patients were randomized 1:1 to HAART+maraviroc or continued HAART. CD4+ and CD8+ CD45+RA/RO, Ki67 expression and plasma IL-7 were quantified at W0, W12 and W48. RESULTS By W48 both groups displayed a CD4 increase without a significant inter-group difference. A statistically significant change in CD8 favored patients in arm HAART+maraviroc versus HAART at W12 (p=.009) and W48 (p=.025). The CD4>200/µL and CD4>200/µL + CD4 gain ≥ 25% end-points were not satisfied at W12 (p=.24 and p=.619) nor at W48 (p=.076 and p=.236). Patients continuing HAART displayed no major changes in parameters of T-cell homeostasis and activation. Maraviroc-receiving patients experienced a significant rise in circulating IL-7 by W48 (p=.01), and a trend in temporary reduction in activated HLA-DR+CD38+CD4+ by W12 (p=.06) that was not maintained at W48. CONCLUSIONS Maraviroc intensification in INRs did not have a significant advantage in reconstituting CD4 T-cell pool, but did substantially expand CD8. It resulted in a low rate of treatment discontinuations. TRIAL REGISTRATION ClinicalTrials.gov NCT00884858 http://clinicaltrials.gov/show/NCT00884858.
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Affiliation(s)
- Stefano Rusconi
- Divisione Clinicizzata di Malattie Infettive, DIBIC “Luigi Sacco”, Università degli Studi, Milano, Italy
| | - Paola Vitiello
- Divisione Clinicizzata di Malattie Infettive, DIBIC “Luigi Sacco”, Università degli Studi, Milano, Italy
- Divisione di Malattie Infettive, Ospedale di Circolo, Busto Arsizio (VA), Italy
| | | | - Elisa Colella
- Divisione Clinicizzata di Malattie Infettive, DIBIC “Luigi Sacco”, Università degli Studi, Milano, Italy
| | - Emanuele Focà
- Clinica di Malattie Infettive e Tropicali, Università degli Studi, Brescia, Italy
| | - Amedeo Capetti
- I Divisione di Malattie Infettive, Ospedale Luigi Sacco, Milano, Italy
| | - Paola Meraviglia
- II Divisione di Malattie Infettive, Ospedale Luigi Sacco, Milano, Italy
| | - Clara Abeli
- Divisione di Malattie Infettive, Ospedale di Circolo, Busto Arsizio (VA), Italy
| | - Stefano Bonora
- Clinica delle Malattie Infettive, Ospedale Amedeo di Savoia, Università degli Studi, Torino, Italy
| | - Marco D’Annunzio
- Clinica di Malattie Infettive, A.O.-Universitaria Policlinico, Bari, Italy
| | - Antonio Di Biagio
- Clinica delle Malattie Infettive, Ospedale San Martino, Università degli Studi, Genova, Italy
| | - Massimo Di Pietro
- Divisione di Malattie Infettive, Ospedale S. Maria Annunziata, Antella, Firenze, Italy
| | - Luca Butini
- Servizio di Immunologia Clinica e Tipizzazione. Tissutale, A.O.-Universitaria, Torrette di Ancona, Italy
| | - Giancarlo Orofino
- Divisione A di Malattie Infettive, Ospedale Amedeo di Savoia, Torino, Italy
| | - Manuela Colafigli
- Istituto di clinica Delle Malattie Infettive, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Gabriella d’Ettorre
- U.O. Malattie Infettive, Università La Sapienza, Policlinico Umberto I, Roma, Italy
| | - Daniela Francisci
- Clinica delle Malattie Infettive, Policlinico Monteluce, Perugia, Italy
| | - Giustino Parruti
- Divisione Clinicizzata di Malattie Infettive, Ospedale Santo Spirito, Pescara, Italy
| | - Alessandro Soria
- Divisione Clinicizzata di Malattie Infettive, Ospedale san Gerardo, Monza, Italy
| | | | - Chiara Tommasi
- III Divisione di Malattie Infettive I.N.M.I “Lazzaro Spallanzani”, Roma, Italy
| | - Silvia Mosti
- IV Divisione di Malattie Infettive I.N,M.I “Lazzaro Spallanzani”, Roma, Italy
| | - Francesca Bai
- Clinica delle Malattie Infettive, Dipartimento di Scienze della Salute, Polo Universitario San Paolo, Università degli Studi, Milano, Italy
| | - Silvia Di Nardo Stuppino
- Divisione Clinicizzata di Malattie Infettive, DIBIC “Luigi Sacco”, Università degli Studi, Milano, Italy
| | - Manuela Morosi
- Divisione Clinicizzata di Malattie Infettive, DIBIC “Luigi Sacco”, Università degli Studi, Milano, Italy
| | - Marco Montano
- Clinica delle Malattie Infettive, Policlinico "Tor Vergata", Roma, Italy
| | - Pamela Tau
- Divisione Clinicizzata di Malattie Infettive, DIBIC “Luigi Sacco”, Università degli Studi, Milano, Italy
| | - Esther Merlini
- Clinica delle Malattie Infettive, Dipartimento di Scienze della Salute, Polo Universitario San Paolo, Università degli Studi, Milano, Italy
| | - Giulia Marchetti
- Clinica delle Malattie Infettive, Dipartimento di Scienze della Salute, Polo Universitario San Paolo, Università degli Studi, Milano, Italy
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Fabbiani M, Mondi A, Colafigli M, D’Ettorre G, Paoletti F, D’Avino A, Ciccarelli N, Sidella L, Murri R, Fortuna S, Vullo V, Cauda R, De Luca A, Di Giambenedetto S. Safety and efficacy of treatment switch to raltegravir plus tenofovir/emtricitabine or abacavir/lamivudine in patients with optimal virological control: 48-week results from a randomized pilot study (Raltegravir Switch for Toxicity or Adverse Events, RASTA Study). ACTA ACUST UNITED AC 2013; 46:34-45. [DOI: 10.3109/00365548.2013.840920] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Svicher V, Alteri C, Montano M, Nori A, D'Arrigo R, Andreoni M, Angarano G, Antinori A, Antonelli G, Allice T, Bagnarelli P, Baldanti F, Bertoli A, Borderi M, Boeri E, Bon I, Bruzzone B, Barresi R, Calderisi S, Callegaro AP, Capobianchi MR, Gargiulo F, Castelli F, Cauda R, Ceccherini-Silberstein F, Clementi M, Chirianni A, Colafigli M, D'Arminio Monforte A, De Luca A, Di Biagio A, Di Nicuolo G, Di Perri G, Di Santo F, Fadda G, Galli M, Gennari W, Ghisetti V, Costantini A, Gori A, Gulminetti R, Leoncini F, Maffongelli G, Maggiolo F, Maserati R, Mazzotta F, Meini G, Micheli V, Monno L, Mussini C, Nozza S, Paolucci S, Palù G, Parisi S, Parruti G, Pignataro AR, Quirino T, Re MC, Rizzardini G, Sanguinetti M, Santangelo R, Scaggiante R, Sterrantino G, Turriziani O, Vatteroni ML, Viscoli C, Vullo V, Zazzi M, Lazzarin A, Perno CF. Genotypic testing on HIV-1 DNA as a tool to assess HIV-1 co-receptor usage in clinical practice: results from the DIVA study group. Infection 2013; 42:61-71. [PMID: 24146352 PMCID: PMC3906530 DOI: 10.1007/s15010-013-0510-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2013] [Accepted: 07/16/2013] [Indexed: 11/29/2022]
Abstract
PURPOSE We have developed a sequencing assay for determining the usage of the genotypic HIV-1 co-receptor using peripheral blood mononuclear cell (PBMC) DNA in virologically suppressed HIV-1 infected patients. Our specific aims were to (1) evaluate the efficiency of V3 sequences in B versus non-B subtypes, (2) compare the efficiency of V3 sequences and tropism prediction using whole blood and PBMCs for DNA extraction, (3) compare the efficiency of V3 sequences and tropism prediction using a single versus a triplicate round of amplification. RESULTS The overall rate of successful V3 sequences ranged from 100 % in samples with >3,000 copies HIV-1 DNA/10(6) PBMCs to 60 % in samples with <100 copies total HIV-1 DNA /10(6) PBMCs. Analysis of 143 paired PBMCs and whole-blood samples showed successful V3 sequences rates of 77.6 % for PBMCs and 83.9 % for whole blood. These rates are in agreement with the tropism prediction obtained using the geno2pheno co-receptor algorithm, namely, 92.1 % with a false-positive rate (FPR) of 10 or 20 % and of 96.5 % with an FPR of 5.75 %. The agreement between tropism prediction values using single versus triplicate amplification was 98.2 % (56/57) of patients using an FPR of 20 % and 92.9 % (53/57) using an FPR of 10 or 5.75 %. For 63.0 % (36/57) of patients, the FPR obtained via the single amplification procedure was superimposable to all three FPRs obtained by triplicate amplification. CONCLUSIONS Our results show the feasibility and consistency of genotypic testing on HIV-1 DNA tropism, supporting its possible use for selecting patients with suppressed plasma HIV-1 RNA as candidates for CCR5-antagonist treatment. The high agreement between tropism prediction by single and triple amplification does not support the use of triplicate amplification in clinical practice.
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Affiliation(s)
- V Svicher
- Department of Experimental Medicine, University of Rome "Tor Vergata", Via Montpellier 1, 00133, Rome, Italy
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De Luca A, de Gaetano Donati K, Colafigli M, Cozzi-Lepri A, De Curtis A, Gori A, Sighinolfi L, Giacometti A, Capobianchi MR, D'Avino A, Iacoviello L, Cauda R, D'Arminio Monforte A. The association of high-sensitivity c-reactive protein and other biomarkers with cardiovascular disease in patients treated for HIV: a nested case-control study. BMC Infect Dis 2013; 13:414. [PMID: 24004495 PMCID: PMC3846422 DOI: 10.1186/1471-2334-13-414] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [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: 03/13/2013] [Accepted: 08/30/2013] [Indexed: 02/02/2023] Open
Abstract
Background Elevated high-sensitivity C-reactive protein (hsCRP) increases the risk of cardiovascular disease (CVD) in the general population, but its role as a predictive marker in HIV-positive patients remains unclear. Aim of the study was to evaluate whether hsCRP or other biomarkers are independent predictors of CVD risk in HIV-infected patients. Methods Retrospective, nested case–control study. HIV-positive men and women (35–69 years of age) receiving combination antiretroviral therapy (cART) were included. Cases (n = 35) had a major CVD event. Controls (n = 74) free from CVD events for at least 5 years from starting ART were matched on diabetes and smoking. HsCRP, D-dimer, P-selectin, interleukin-6 (IL-6), tissue plasminogen activator, plasminogen activator inhibitor-1 levels were measured. Results High hsCRP was associated with CVD risk, independently of traditional cardiovascular risk factors, HIV replication and the type of ART received at the time of sampling (adjusted odds ratio 8.00 [1.23-51.94] comparing >3.3 mg/L with <0.9 mg/L; P = 0.03). Higher IL-6 and P-selectin levels were also independently associated with increased CVD risk, although the association was weaker than for hsCRP. Higher total cholesterol and lower HDL cholesterol increased CVD risk, independent of hsCRP. Conclusion hsCRP may be a useful additional biomarker to predict CVD risk in HIV-infected patients receiving cART.
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Affiliation(s)
- Andrea De Luca
- University Division of Infectious Diseases, University Hospital of Siena, Siena, Italy.
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Fabbiani M, Sidella L, Corbi M, Martucci R, Sali M, Colafigli M, Cauda R, Delogu G, Sgambato A, Di Giambenedetto S. HIV-infected patients show impaired cellular immune response to influenza vaccination compared to healthy subjects. Vaccine 2013; 31:2914-8. [PMID: 23623859 DOI: 10.1016/j.vaccine.2013.04.033] [Citation(s) in RCA: 10] [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] [Received: 12/13/2012] [Revised: 02/25/2013] [Accepted: 04/11/2013] [Indexed: 12/20/2022]
Abstract
Detailed data on cellular immune response to influenza vaccination in HIV-infected patients are lacking. We analyzed cellular (IL-2, IL-4, IL-5, IL-10, IL-12, IL-13, IFN-γ, TNF-α, GM-CSF) and humoral (IgG and IgM) immune response in 81 HIV-infected and 30 HIV-negative subjects, before (T0) and 4 weeks (T1) after receiving a single dose of trivalent MF59-adjuvanted influenza vaccine. No difference in humoral response (IgG or IgM) was demonstrated between the two groups. While an increase in most cytokines from T0 to T1 was observed in HIV-uninfected subjects, cytokines production did not significantly increased in HIV-infected patients. Exploring Th1 response, higher CD8 cells count was significantly associated with lower post-vaccination IFNγ levels, while a higher CD4 cells count was associated with a greater response. Exploring Th2 response, higher HIV viral load was significantly associated with reduced post-vaccination IL-10 levels. In conclusion, in HIV-infected patients influenza vaccination could have good efficacy in sustaining humoral response but cellular response appeared impaired.
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Affiliation(s)
- Massimiliano Fabbiani
- Institute of Clinical Infectious Diseases, Catholic University of Sacred Heart, Largo Agostino Gemelli 8, 00168 Rome, Italy.
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Colafigli M, Di Giambenedetto S, Cauda R. Resistance to antiretroviral drugs. Microb Drug Resist 2013. [DOI: 10.2217/ebo.12.429] [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: 11/21/2022] Open
Affiliation(s)
- Manuela Colafigli
- Manuela Colafigli graduated in medicine and surgery at the Catholic University of the Sacred Heart in Rome (Italy) in 2001. She received a postgraduate degree in tropical medicine in 2005 and a PhD in biology and clinics of tropical and infectious diseases in 2010. Her main research focuses are HIV drug resistance and metabolic complications of antiretroviral drugs
| | - Simona Di Giambenedetto
- Simona Di Giambenedetto is Confirmed Research Fellow at the Catholic University of the Sacred Heart in Rome (Italy). Her main research focuses are resistance and therapeutic drug monitoring of antiretroviral drugs and cART-related toxicity. She is author of 85 papers published on peer-reviewed scientific journals with an impact factor of 410 and a H-index of 17
| | - Roberto Cauda
- Roberto Cauda is Professor of Infectious Diseases and Chairman of the Department of Infectious Diseases of the Catholic University of the Sacred Heart in Rome (Italy). He is the author of more than 300 papers in the field of AIDS/HIV, infectious diseases, microbiology and immunology. He is an editor and serves on the editorial board of several international journals
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Baldonero E, Ciccarelli N, Fabbiani M, Colafigli M, Improta E, D’Avino A, Mondi A, Cauda R, Di Giambenedetto S, Silveri MC. Evaluation of emotion processing in HIV-infected patients and correlation with cognitive performance. BMC Psychol 2013; 1:3. [PMID: 25566355 PMCID: PMC4269997 DOI: 10.1186/2050-7283-1-3] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2012] [Accepted: 02/27/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Facial emotion recognition depends on cortical and subcortical networks. HIV infection of the central nervous system can damage these networks, leading to impaired facial emotion recognition. METHODS We performed a cross-sectional single cohort study consecutively enrolling HIV + subjects during routine outpatient visits. Age, gender and education-matched HIV-negative healthy individuals were also selected. Subjects were submitted to a Facial Emotion Recognition Test, which assesses the ability to recognize six basic emotions (disgust, anger, fear, happiness, surprise, sadness). The score for each emotion and a global score (obtained by summing scores for each emotion) were analyzed. General cognitive status of patients was also assessed. RESULTS A total of 49 HIV + and 20 HIV - subjects were enrolled. On the Facial Emotion Recognition Test, ANOVA revealed a significantly lower performance of HIV + subjects than healthy controls in recognizing fear. Moreover, fear facial emotion recognition was directly correlated with Immediate Recall of Rey Words. The lower the patients' neurocognitive performance the less accurate they were in recognizing happiness. AIDS-defining events were negatively related to the correct recognition of happiness. CONCLUSIONS Fear recognition deficit in HIV + patients might be related to the impaired function of neural networks in the frontostriatal system. AIDS events, including non-neurological ones, may have a negative effect on this system. Inclusion of an emotion recognition test in the neuropsychological test battery could help clinicians during the long term management of HIV-infected patients, to better understand the cognitive mechanisms involved in the reduction of emotion recognition ability and the impact of this impairment on daily life.
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Affiliation(s)
- Eleonora Baldonero
- Institute of Clinical and Infectious Diseases, Catholic University of the Sacred Heart, Rome, Italy
- Memory Clinic, Catholic University of the Sacred Heart, Rome, Italy
| | - Nicoletta Ciccarelli
- Institute of Clinical and Infectious Diseases, Catholic University of the Sacred Heart, Rome, Italy
- Memory Clinic, Catholic University of the Sacred Heart, Rome, Italy
| | - Massimiliano Fabbiani
- Institute of Clinical and Infectious Diseases, Catholic University of the Sacred Heart, Rome, Italy
| | - Manuela Colafigli
- Institute of Clinical and Infectious Diseases, Catholic University of the Sacred Heart, Rome, Italy
| | - Erika Improta
- Institute of Clinical and Infectious Diseases, Catholic University of the Sacred Heart, Rome, Italy
- Memory Clinic, Catholic University of the Sacred Heart, Rome, Italy
| | - Alessandro D’Avino
- Institute of Clinical and Infectious Diseases, Catholic University of the Sacred Heart, Rome, Italy
| | - Annalisa Mondi
- Institute of Clinical and Infectious Diseases, Catholic University of the Sacred Heart, Rome, Italy
| | - Roberto Cauda
- Institute of Clinical and Infectious Diseases, Catholic University of the Sacred Heart, Rome, Italy
| | - Simona Di Giambenedetto
- Institute of Clinical and Infectious Diseases, Catholic University of the Sacred Heart, Rome, Italy
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Di Giambenedetto S, Fabbiani M, Colafigli M, Ciccarelli N, Farina S, Sidella L, D'Avino A, Mondi A, Cingolani A, Tamburrini E, Murri R, Navarra P, Cauda R, De Luca A. Safety and feasibility of treatment simplification to atazanavir/ritonavir + lamivudine in HIV-infected patients on stable treatment with two nucleos(t)ide reverse transcriptase inhibitors + atazanavir/ritonavir with virological suppression (Atazanavir and Lamivudine for treatment Simplification, AtLaS pilot study). J Antimicrob Chemother 2013; 68:1364-72. [DOI: 10.1093/jac/dkt007] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
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Ciccarelli N, Fabbiani M, Colafigli M, Trecarichi EM, Silveri MC, Cauda R, Murri R, De Luca A, Di Giambenedetto S. Revised central nervous system neuropenetration-effectiveness score is associated with cognitive disorders in HIV-infected patients with controlled plasma viraemia. Antivir Ther 2013; 18:153-60. [DOI: 10.3851/imp2560] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2012] [Indexed: 10/27/2022]
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Prosperi MCF, Fabbiani M, Fanti I, Zaccarelli M, Colafigli M, Mondi A, D'Avino A, Borghetti A, Cauda R, Di Giambenedetto S. Predictors of first-line antiretroviral therapy discontinuation due to drug-related adverse events in HIV-infected patients: a retrospective cohort study. BMC Infect Dis 2012; 12:296. [PMID: 23145925 PMCID: PMC3519703 DOI: 10.1186/1471-2334-12-296] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [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: 04/20/2012] [Accepted: 11/01/2012] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Drug-related toxicity has been one of the main causes of antiretroviral treatment discontinuation. However, its determinants are not fully understood. Aim of this study was to investigate predictors of first-line antiretroviral therapy discontinuation due to adverse events and their evolution in recent years. METHODS Patients starting first-line antiretroviral therapy were retrospectively selected. Primary end-point was the time to discontinuation of therapy due to adverse events, estimating incidence, fitting Kaplan-Meier and multivariable Cox regression models upon clinical/demographic/chemical baseline patients' markers. RESULTS 1,096 patients were included: 302 discontinuations for adverse events were observed over 1,861 person years of follow-up between 1988 and 2010, corresponding to an incidence (95% CI) of 0.16 (0.14-0.18). By Kaplan-Meier estimation, the probabilities (95% CI) of being free from an adverse event at 90 days, 180 days, one year, two years, and five years were 0.88 (0.86-0.90), 0.85 (0.83-0.87), 0.79 (0.76-0.81), 0.70 (0.67-0.74), 0.55 (0.50-0.61), respectively. The most represented adverse events were gastrointestinal symptoms (28.5%), hematological (13.2%) or metabolic (lipid and glucose metabolism, lipodystrophy) (11.3%) toxicities and hypersensitivity reactions (9.3%). Factors associated with an increased hazard of adverse events were: older age, CDC stage C, female gender, homo/bisexual risk group (vs. heterosexual), HBsAg-positivity. Among drugs, zidovudine, stavudine, zalcitabine, didanosine, full-dose ritonavir, indinavir but also efavirenz (actually recommended for first-line regimens) were associated to an increased hazard of toxicity. Moreover, patients infected by HIV genotype F1 showed a trend for a higher risk of adverse events. CONCLUSIONS After starting antiretroviral therapy, the probability of remaining free from adverse events seems to decrease over time. Among drugs associated with increased toxicity, only one is currently recommended for first-line regimens but with improved drug formulation. Older age, CDC stage, MSM risk factor and gender are also associated with an increased hazard of toxicity and should be considered when designing a first-line regimen.
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Affiliation(s)
- Mattia C F Prosperi
- Viral Immunodeficiency Unit, National Institute for Infectious Diseases Lazzaro Spallanzani, Rome, Italy.
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Grima P, Fabbiani M, Ciccarelli N, Tana M, Farina S, Colafigli M, Mondi A, Cauda R, Di Giambenedetto S. Increased ophthalmic artery resistance index is associated with cognitive impairment in HIV-infected patients. J Infect 2012; 65:439-46. [DOI: 10.1016/j.jinf.2012.07.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2012] [Revised: 07/26/2012] [Accepted: 07/27/2012] [Indexed: 11/28/2022]
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