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Menichetti F, Popoli P, Puopolo M, Spila Alegiani S, Tiseo G, Bartoloni A, De Socio GV, Luchi S, Blanc P, Puoti M, Toschi E, Massari M, Palmisano L, Marano G, Chiamenti M, Martinelli L, Franchi S, Pallotto C, Suardi LR, Luciani Pasqua B, Merli M, Fabiani P, Bertolucci L, Borchi B, Modica S, Moneta S, Marchetti G, d’Arminio Monforte A, Stoppini L, Ferracchiato N, Piconi S, Fabbri C, Beccastrini E, Saccardi R, Giacometti A, Esperti S, Pierotti P, Bernini L, Bianco C, Benedetti S, Lanzi A, Bonfanti P, Massari M, Sani S, Saracino A, Castagna A, Trabace L, Lanza M, Focosi D, Mazzoni A, Pistello M, Falcone M. Effect of High-Titer Convalescent Plasma on Progression to Severe Respiratory Failure or Death in Hospitalized Patients With COVID-19 Pneumonia: A Randomized Clinical Trial. JAMA Netw Open 2021; 4:e2136246. [PMID: 34842924 PMCID: PMC8630572 DOI: 10.1001/jamanetworkopen.2021.36246] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
IMPORTANCE Convalescent plasma (CP) has been generally unsuccessful in preventing worsening of respiratory failure or death in hospitalized patients with COVID-19 pneumonia. OBJECTIVE To evaluate the efficacy of CP plus standard therapy (ST) vs ST alone in preventing worsening respiratory failure or death in patients with COVID-19 pneumonia. DESIGN, SETTING, AND PARTICIPANTS This prospective, open-label, randomized clinical trial enrolled (1:1 ratio) hospitalized patients with COVID-19 pneumonia to receive CP plus ST or ST alone between July 15 and December 8, 2020, at 27 clinical sites in Italy. Hospitalized adults with COVID-19 pneumonia and a partial pressure of oxygen-to-fraction of inspired oxygen (Pao2/Fio2) ratio between 350 and 200 mm Hg were eligible. INTERVENTIONS Patients in the experimental group received intravenous high-titer CP (≥1:160, by microneutralization test) plus ST. The volume of infused CP was 200 mL given from 1 to a maximum of 3 infusions. Patients in the control group received ST, represented by remdesivir, glucocorticoids, and low-molecular weight heparin, according to the Agenzia Italiana del Farmaco recommendations. MAIN OUTCOMES AND MEASURES The primary outcome was a composite of worsening respiratory failure (Pao2/Fio2 ratio <150 mm Hg) or death within 30 days from randomization. RESULTS Of the 487 randomized patients (241 to CP plus ST; 246 to ST alone), 312 (64.1%) were men; the median (IQR) age was 64 (54.0-74.0) years. The modified intention-to-treat population included 473 patients. The primary end point occurred in 59 of 231 patients (25.5%) treated with CP and ST and in 67 of 239 patients (28.0%) who received ST (odds ratio, 0.88; 95% CI, 0.59-1.33; P = .54). Adverse events occurred more frequently in the CP group (12 of 241 [5.0%]) compared with the control group (4 of 246 [1.6%]; P = .04). CONCLUSIONS AND RELEVANCE In patients with moderate to severe COVID-19 pneumonia, high-titer anti-SARS-CoV-2 CP did not reduce the progression to severe respiratory failure or death within 30 days. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04716556.
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Affiliation(s)
- Francesco Menichetti
- Infectious Disease Unit, Department of Clinical and Experimental Medicine, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Patrizia Popoli
- National Center for Drug Research and Evaluation, Istituto Superiore di Sanità, Rome, Italy
| | - Maria Puopolo
- Department of Neuroscience, Istituto Superiore di Sanità, Rome, Italy
| | | | - Giusy Tiseo
- Infectious Disease Unit, Department of Clinical and Experimental Medicine, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Alessandro Bartoloni
- Infectious and Tropical Diseases Unit, Florence Department of Medicine, Careggi University Hospital, Florence, Italy
| | - Giuseppe Vittorio De Socio
- Clinic of Infectious Diseases, “Santa Maria della Misericordia” Hospital, University of Perugia, Perugia, Italy
| | - Sauro Luchi
- Infectious Disease Unit, Hospital of Lucca, Lucca, Italy
| | - Pierluigi Blanc
- Infectious Diseases, Ospedale S. Maria Annunziata, Firenze, Italy
| | - Massimo Puoti
- University of Milano-Bicocca School of Medicine, Milan, Italy
- Azienda socio sanitaria territorial (ASST) Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Elena Toschi
- Research Coordination and Support Service (CoRi), Istituto Superiore di Sanità, Rome, Italy
| | - Marco Massari
- National Center for Drug Research and Evaluation, Istituto Superiore di Sanità, Rome, Italy
| | - Lucia Palmisano
- National Center for Drug Research and Evaluation, Istituto Superiore di Sanità, Rome, Italy
| | | | | | - Laura Martinelli
- Internal Medicine, Unità Sanitaria Locale (USL)–Umbria 1, Ospedale Città di Castello, Città di Castello, Italy
| | - Silvia Franchi
- Internal Medicine, Unità Sanitaria Locale (USL)–Umbria 1, Ospedale Città di Castello, Città di Castello, Italy
| | - Carlo Pallotto
- Infectious Diseases Unit, San Giuseppe Hospital, Azienda USL Toscana Centro, Empoli, Italy
| | - Lorenzo Roberto Suardi
- Infectious Disease Unit, Department of Clinical and Experimental Medicine, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Pisa, Italy
- Infectious Diseases Unit, San Giuseppe Hospital, Azienda USL Toscana Centro, Empoli, Italy
| | - Barbara Luciani Pasqua
- Centro Regionale Sangue, Servizio Immunotrasfusionale, Azienda Ospedaliera di Perugia, Perugia, Italy
| | - Marco Merli
- Azienda socio sanitaria territorial (ASST) Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Plinio Fabiani
- Internal Medicine, Ospedale Unico della Versilia, Lido di Camaiore, Italy
| | - Luca Bertolucci
- Internal Medicine, Ospedale Unico della Versilia, Lido di Camaiore, Italy
| | - Beatrice Borchi
- Infectious and Tropical Diseases Unit, Florence Department of Medicine, Careggi University Hospital, Florence, Italy
| | - Sara Modica
- Infectious and Tropical Diseases Unit, Florence Department of Medicine, Careggi University Hospital, Florence, Italy
| | - Sara Moneta
- Infectious Disease Unit, Hospital of Lucca, Lucca, Italy
| | - Giulia Marchetti
- Infectious Diseases Unit, Department of Health Sciences, ASST Santi Paolo e Carlo University Hospital, Milan, Italy
| | - Antonella d’Arminio Monforte
- Infectious Diseases Unit, Department of Health Sciences, ASST Santi Paolo e Carlo University Hospital, Milan, Italy
| | | | | | - Stefania Piconi
- Infectious Diseases, Azienda Ospedaliera di Lecco, Lecco, Italy
| | - Claudio Fabbri
- Infectious Diseases, Ospedale San Jacopo, Pistoia, Italy
| | - Enrico Beccastrini
- Cell Therapy and Transfusion Medicine, Careggi University Hospital, Florence, Italy
| | - Riccardo Saccardi
- Cell Therapy and Transfusion Medicine, Careggi University Hospital, Florence, Italy
| | - Andrea Giacometti
- Azienda Ospedaliera Universitaria, Ospedali Riuniti di Ancona, Ancona, Italy
| | - Sara Esperti
- Infectious Diseases, Ospedale S. Maria Annunziata, Firenze, Italy
| | - Piera Pierotti
- Infectious Diseases, Ospedale S. Maria Annunziata, Firenze, Italy
| | - Laura Bernini
- Division of Infectious Diseases, Arezzo Hospital, Arezzo, Italy
| | - Claudia Bianco
- Division of Infectious Diseases, Arezzo Hospital, Arezzo, Italy
| | - Sara Benedetti
- Clinic of Infectious Diseases, “Santa Maria della Misericordia” Hospital, University of Perugia, Perugia, Italy
| | - Alessandra Lanzi
- Clinic of Infectious Diseases, “Santa Maria della Misericordia” Hospital, University of Perugia, Perugia, Italy
| | - Paolo Bonfanti
- Department of Infectious Diseases, ASST Monza, University of Milano-Bicocca, Milan, Italy
| | - Marco Massari
- Infectious Disease Unit, Azienda USL–Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) di Reggio Emilia, Reggio Emilia, Italy
| | - Spartaco Sani
- Infectious Diseases, Livorno Hospital, Livorno, Italy
| | - Annalisa Saracino
- Division of Infectious Diseases, Bari University Hospital, Bari, Italy
| | - Antonella Castagna
- Infectious Diseases, IRCCS Ospedale San Raffaele, Università Vita-Salute San Raffaele, Milan, Italy
| | - Luigia Trabace
- Department of Experimental and Clinical Medicine, University of Foggia, Foggia, Italy
| | - Maria Lanza
- North-Western Tuscany Blood Bank, Pisa University Hospital, Pisa, Italy
| | - Daniele Focosi
- North-Western Tuscany Blood Bank, Pisa University Hospital, Pisa, Italy
| | - Alessandro Mazzoni
- Division of Transfusion Medicine and Transplant Biology, Pisa University Hospital, Pisa, Italy
| | - Mauro Pistello
- Division of Virology, University Hospital of Pisa, Retrovirus Center, Department of Translational Research, University of Pisa, Pisa, Italy
| | - Marco Falcone
- Infectious Disease Unit, Department of Clinical and Experimental Medicine, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Pisa, Italy
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Pallotto C, Blanc P, Esperti S, Suardi LR, Gabbuti A, Vichi F, Mecocci L, Esposti AD, Pierotti P, Attala L, Salomoni E, Baragli F, Francisci D, Pietro MAD. Remdesivir treatment and transient bradycardia in patients with coronavirus diseases 2019 (COVID-19). J Infect 2021; 83:237-279. [PMID: 34052239 PMCID: PMC8159715 DOI: 10.1016/j.jinf.2021.05.025] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 05/23/2021] [Indexed: 12/18/2022]
Affiliation(s)
- Carlo Pallotto
- Infectious Diseases Unit 1, Santa Maria Annunziata Hospital, Azienda USL Toscana Centro, via Antella, 56, Bagno a Ripoli, Florence, Italy; Infectious Diseases Clinic, Santa Maria della Misericordia University Hospital, University of Perugia, Piazzale Gambuli, 1, Perugia, Italy.
| | - Pierluigi Blanc
- Infectious Diseases Unit 1, Santa Maria Annunziata Hospital, Azienda USL Toscana Centro, via Antella, 56, Bagno a Ripoli, Florence, Italy; Infectious Diseases Unit 2, San Jacopo Hospital, Azienda USL Toscana Centro, via Ciliegiole, 97, Pistoia, Italy
| | - Sara Esperti
- Infectious Diseases Unit 1, Santa Maria Annunziata Hospital, Azienda USL Toscana Centro, via Antella, 56, Bagno a Ripoli, Florence, Italy; Department of Infectious Diseases, University of Modena and Reggio Emilia, Modena, Italy
| | - Lorenzo Roberto Suardi
- Infectious Diseases Unit 1, Santa Maria Annunziata Hospital, Azienda USL Toscana Centro, via Antella, 56, Bagno a Ripoli, Florence, Italy; Infectious Diseases Unit, Azienda Ospedaliero Universitaria Pisana, Via Paradisa 2, Pisa, Italy
| | - Andrea Gabbuti
- Infectious Diseases Unit 1, Santa Maria Annunziata Hospital, Azienda USL Toscana Centro, via Antella, 56, Bagno a Ripoli, Florence, Italy
| | - Francesca Vichi
- Infectious Diseases Unit 1, Santa Maria Annunziata Hospital, Azienda USL Toscana Centro, via Antella, 56, Bagno a Ripoli, Florence, Italy
| | - Lorenzo Mecocci
- Infectious Diseases Unit 1, Santa Maria Annunziata Hospital, Azienda USL Toscana Centro, via Antella, 56, Bagno a Ripoli, Florence, Italy
| | - Anna Degli Esposti
- Infectious Diseases Unit 1, Santa Maria Annunziata Hospital, Azienda USL Toscana Centro, via Antella, 56, Bagno a Ripoli, Florence, Italy
| | - Piera Pierotti
- Infectious Diseases Unit 1, Santa Maria Annunziata Hospital, Azienda USL Toscana Centro, via Antella, 56, Bagno a Ripoli, Florence, Italy
| | - Letizia Attala
- Infectious Diseases Unit 1, Santa Maria Annunziata Hospital, Azienda USL Toscana Centro, via Antella, 56, Bagno a Ripoli, Florence, Italy
| | - Elena Salomoni
- Infectious Diseases Unit 1, Santa Maria Annunziata Hospital, Azienda USL Toscana Centro, via Antella, 56, Bagno a Ripoli, Florence, Italy
| | - Filippo Baragli
- Infectious Diseases Unit 1, Santa Maria Annunziata Hospital, Azienda USL Toscana Centro, via Antella, 56, Bagno a Ripoli, Florence, Italy
| | - Daniela Francisci
- Infectious Diseases Clinic, Santa Maria della Misericordia University Hospital, University of Perugia, Piazzale Gambuli, 1, Perugia, Italy
| | - Massimo Antonio Di Pietro
- Infectious Diseases Unit 1, Santa Maria Annunziata Hospital, Azienda USL Toscana Centro, via Antella, 56, Bagno a Ripoli, Florence, Italy
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Torti C, Raffetti E, Donato F, Castelli F, Maggiolo F, Angarano G, Mazzotta F, Gori A, Sighinolfi L, Pan A, Cauda R, Scalzini A, Quiros-Roldan E, Nasta P, Gregis G, Benatti S, Digiambenedetto S, Ladisa N, Giralda M, Saracino A, Castelnuovo F, Di Pietro M, Lo Caputo S, Lapadula G, Costarelli S, Lorenzotti S, Mazzini N, Paraninfo G, Casari S, Focà E, Pezzoli C, Fabbiani M, Monno L, Pierotti P, Ble C, Leone S, Postorino MC, Fornabaio C, Zacchi F, Zoncada A, Carosi G. Cohort Profile: Standardized Management of Antiretroviral Therapy Cohort (MASTER Cohort). Int J Epidemiol 2018; 46:e12. [PMID: 26445966 DOI: 10.1093/ije/dyv192] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/02/2015] [Indexed: 12/14/2022] Open
Affiliation(s)
- Carlo Torti
- Unità di Malattie Infettive e Tropicali, Dipartimento di Scienze Mediche e Chirurgiche, Università Magna Grecia di Catanzaro, Catanzaro, Italia
| | - Elena Raffetti
- Unità di Igiene, Epidemiologia e Sanità Pubblica, Università degli Studi di Brescia, Brescia, Italia
| | - Francesco Donato
- Unità di Igiene, Epidemiologia e Sanità Pubblica, Università degli Studi di Brescia, Brescia, Italia
| | - Francesco Castelli
- Divisione Universitaria di Malattie Infettive Spedali Civili di Brescia-Università degli Studi di Brescia, Brescia, Italia
| | - Franco Maggiolo
- Malattie Infettive Ospedale Papa Giovanni XXIII, Bergamo, Italia
| | | | | | - Andrea Gori
- Malattie Infettive Ospedale San Gerardo di Monza, Monza, Italia
| | - Laura Sighinolfi
- Malattie Infettive Nuovo Polo Ospedaliero di Cona, Ferrara, Italia
| | - Angelo Pan
- Malattie Infettive Istituti Ospitalieri di Cremona, Cremona, Italia
| | - Roberto Cauda
- Clinica di Malattie Infettive Policlinico A. Gemelli-Università Cattolica di Roma, Roma, Italia
| | - Alfredo Scalzini
- Divisione Ospedaliera di Malattie Infettive Spedali Civili, Brescia, Italia and
| | - Eugenia Quiros-Roldan
- Divisione Universitaria di Malattie Infettive Spedali Civili di Brescia-Università degli Studi di Brescia, Brescia, Italia
| | - Paola Nasta
- Divisione Universitaria di Malattie Infettive Spedali Civili di Brescia-Università degli Studi di Brescia, Brescia, Italia
| | | | - Simone Benatti
- Malattie Infettive Ospedale Papa Giovanni XXIII, Bergamo, Italia
| | - Simona Digiambenedetto
- Clinica di Malattie Infettive Policlinico A. Gemelli-Università Cattolica di Roma, Roma, Italia
| | | | - Mariarosaria Giralda
- Divisione Universitaria di Malattie Infettive Spedali Civili di Brescia-Università degli Studi di Brescia, Brescia, Italia
| | | | - Filippo Castelnuovo
- Divisione Ospedaliera di Malattie Infettive Spedali Civili, Brescia, Italia and
| | | | | | | | | | | | - Nicola Mazzini
- Fondazione Malattie Infettive e Salute Internazionale, Brescia, Italia
| | - Giuseppe Paraninfo
- Divisione Universitaria di Malattie Infettive Spedali Civili di Brescia-Università degli Studi di Brescia, Brescia, Italia
| | - Salvatore Casari
- Divisione Universitaria di Malattie Infettive Spedali Civili di Brescia-Università degli Studi di Brescia, Brescia, Italia
| | - Emanuele Focà
- Divisione Universitaria di Malattie Infettive Spedali Civili di Brescia-Università degli Studi di Brescia, Brescia, Italia
| | - Chiara Pezzoli
- Divisione Universitaria di Malattie Infettive Spedali Civili di Brescia-Università degli Studi di Brescia, Brescia, Italia
| | - Massimiliano Fabbiani
- Clinica di Malattie Infettive Policlinico A. Gemelli-Università Cattolica di Roma, Roma, Italia
| | - Laura Monno
- Clinica di Malattie Infettive Policlinico di Bari, Bari, Italia
| | | | - Claudio Ble
- Malattie Infettive S.M. Annunziata, Firenze, Italia
| | | | - Maria Concetta Postorino
- Unità di Malattie Infettive e Tropicali, Dipartimento di Scienze Mediche e Chirurgiche, Università Magna Grecia di Catanzaro, Catanzaro, Italia
| | - Chiara Fornabaio
- Malattie Infettive Istituti Ospitalieri di Cremona, Cremona, Italia
| | - Fabio Zacchi
- Malattie Infettive Istituti Ospitalieri di Cremona, Cremona, Italia
| | - Alessia Zoncada
- Malattie Infettive Istituti Ospitalieri di Cremona, Cremona, Italia
| | - Giampiero Carosi
- Fondazione Malattie Infettive e Salute Internazionale, Brescia, Italia
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Mastrolorenzo A, D’Errico A, Pierotti P, Vannucchi M, Giannini S, Fossi F. Pleomorphic cutaneous xanthomas disclosing homozygous familial hypercholesterolemia. World J Dermatol 2017; 6:59-65. [DOI: 10.5314/wjd.v6.i4.59] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2017] [Revised: 08/30/2017] [Accepted: 11/10/2017] [Indexed: 02/06/2023] Open
Abstract
Homoxygous Familial Hypercholesterolemia is characterized by a presence of several types of cutaneous xanthomas with an abnormal lipid profile. Some of these could be pathognomonic. Although these could be initially interpreted as isolated and localized benign disorders and offered surgical treatment, it has become increasingly clear that they could be a part of a systemic pathology. Here we describe a case of this rare disorder in a 19 years old non-obese young man who presented multiple, intertriginous, tuberous and tendinous xanthomas and had an associated abnormal lipid profile with elevated low-density lipoprotein cholesterol levels. A detailed history with clinical assessment in the differential diagnosis and laboratory investigations led to a precise diagnosis.
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Affiliation(s)
- Antonio Mastrolorenzo
- Department of Surgery and Translational Medicine, Section of Dermatology, University of Florence, Public Hospital Piero Palagi, Florence 50125, Italy
| | - Antonietta D’Errico
- Department of Surgery and Translational Medicine, Section of Dermatology, University of Florence, Public Hospital Piero Palagi, Florence 50125, Italy
| | - Piera Pierotti
- Azienda Sanitaria di Firenze, Department of Infectious Diseases, Ospedale SM Annunziata, Florence 50012, Italy
| | - Margherita Vannucchi
- Histopathology and Molecular Diagnostics Institute, Careggi University Hospital, Florence 50134, Italy
| | - Stefano Giannini
- Diabetes and Metabolic Disease Agency, Careggi University Hospital, Florence 50134, Italy
| | - Fiammetta Fossi
- SODc of Transfusion Medicine and Cell Therapy, Careggi University Hospital, Florence 50134, Italy
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Fusco FM, Burla MC, Degli Esposti A, Pierotti P, Rabatti L, Vichi F. Reasons for switching ART: Comparison of data collected in 2012-2013 and 2014-2015 in Florence, Italy. Int J STD AIDS 2017; 29:392-395. [PMID: 28853677 DOI: 10.1177/0956462417728207] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Persons living with HIV should remain on antiretroviral therapy (ART) indefinitely; however, a switch in the drug regimen is often necessary. In order to investigate if reasons for switching ART changed over time, we retrospectively analyzed reasons for switching and characteristics of switches among patients at Santa Maria Annunziata Hospital (OSMA), Florence area, Tuscany, Italy, over two periods (November 2012-October 2013 and November 2014-October 2015). The reasons for switching were classified as: simplification; virologic failure; occurrence of co-morbidities; and drug tolerability/toxicity issues. In period 1 (2012-2013), 18% patients changed their regimen vs. 13.5% in period 2 (2014-2015) (p = 0.019). Among reasons for switching, switches for simplification significantly increased from 41% in period 1 to 53% in period 2 (p = 0.004), with an increasing use of single tablet regimens (p = 0.002); no other statistically significant differences were found in other reasons for switching in periods 1 and 2. Characteristics of patients and of switches were analyzed and described. According to our data, the main reason for switching is now simplification, reflecting the recent changes in recommendations aimed to enhance adherence and quality of life, and to minimize, at the same time, drug toxicity and side effects.
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Affiliation(s)
- Francesco Maria Fusco
- 1 Infectious Disease Unit, 18497 Santa Maria Annunziata Hospital , Bagno a Ripoli, Florence, Italy
| | - Maria Chiara Burla
- 2 Hospital Pharmacy, 18497 Santa Maria Annunziata Hospital , Bagno a Ripoli, Florence, Italy
| | - Anna Degli Esposti
- 1 Infectious Disease Unit, 18497 Santa Maria Annunziata Hospital , Bagno a Ripoli, Florence, Italy
| | - Piera Pierotti
- 1 Infectious Disease Unit, 18497 Santa Maria Annunziata Hospital , Bagno a Ripoli, Florence, Italy
| | - Loredana Rabatti
- 2 Hospital Pharmacy, 18497 Santa Maria Annunziata Hospital , Bagno a Ripoli, Florence, Italy
| | - Francesca Vichi
- 1 Infectious Disease Unit, 18497 Santa Maria Annunziata Hospital , Bagno a Ripoli, Florence, Italy
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Raffetti E, Albini L, Gotti D, Segala D, Maggiolo F, di Filippo E, Saracino A, Ladisa N, Lapadula G, Fornabaio C, Castelnuovo F, Casari S, Fabbiani M, Pierotti P, Donato F, Quiros-Roldan E. Cancer incidence and mortality for all causes in HIV-infected patients over a quarter century: a multicentre cohort study. BMC Public Health 2015; 15:235. [PMID: 25884678 PMCID: PMC4364101 DOI: 10.1186/s12889-015-1565-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [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: 10/27/2014] [Accepted: 02/17/2015] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND We aimed to assess cancer incidence and mortality for all-causes and factors related to risk of death in an Italian cohort of HIV infected unselected patients as compared to the general population. METHODS We conducted a retrospective (1986-2012) cohort study on 16 268 HIV infected patients enrolled in the MASTER cohort. The standardized incidence ratios (SIRs) and standardized mortality ratios (SMRs) were computed using cancer incidence rates of Italian Cancer Registries and official national data for overall mortality. The risk factors for death from all causes were assessed using Poisson regression models. RESULTS 1,195 cancer cases were diagnosed from 1986 to 2012: 700 AIDS-defining-cancers (ADCs) and 495 non-AIDS-defining-cancers (NADCs). ADC incidence was much higher than the Italian population (SIR = 30.8, 95% confidence interval 27.9-34.0) whereas NADC incidence was similar to the general population (SIR = 0.9, 95% CI 0.8-1.1). The SMR for all causes was 11.6 (11.1-12.0) in the period, and it decreased over time, mainly after 1996, up to 3.53 (2.5-4.8) in 2012. Male gender, year of enrolment before 1993, older age at enrolment, intravenous drug use, low CD4 cell count, AIDS event, cancer occurrence and the absence of antiretroviral therapy were all associated independently with risk of death. CONCLUSIONS In HIV infected patients, ADC but not NADC incidence rates were higher than the general population. Although overall mortality in HIV infected subjects decreased over time, it is about three-fold higher than the general population at present.
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Affiliation(s)
- Elena Raffetti
- Unit of Hygiene, Epidemiology and Public Health, University of Brescia, Brescia, Italy.
| | - Laura Albini
- University Division of Infectious and Tropical Diseases, University of Brescia, Brescia, Italy.
| | - Daria Gotti
- University Division of Infectious and Tropical Diseases, University of Brescia, Brescia, Italy.
| | - Daniela Segala
- Department of Infectious Diseases of Nuovo Polo Ospedaliero S.Anna di Cona, Ferrara, Italy.
| | - Franco Maggiolo
- Department of Infectious Diseases of Papa Giovanni XXIII Hospital, Bergamo, Italy.
| | - Elisa di Filippo
- Department of Infectious Diseases of Papa Giovanni XXIII Hospital, Bergamo, Italy.
| | - Annalisa Saracino
- Department of Infectious Diseases of Polyclinic of Bari, University of Bari, Bari, Italy.
| | - Nicoletta Ladisa
- Department of Infectious Diseases of Polyclinic of Bari, University of Bari, Bari, Italy.
| | - Giuseppe Lapadula
- Department of Infectious Diseases, San Gerardo de' Tintori" Hospital, Monza, Italy.
| | - Chiara Fornabaio
- Clinic of Infectious Diseases of Istituti Ospitalieri of Cremona, Cremona, Italy.
| | - Filippo Castelnuovo
- Hospital Division of Infectious and Tropical Diseases, Spedali Civili Hospital, Brescia, Italy.
| | - Salvatore Casari
- University Division of Infectious and Tropical Diseases, University of Brescia, Brescia, Italy.
| | - Massimiliano Fabbiani
- Institute of Clinical Infectious Diseases of Polyclinic A. Gemelli, University of Sacred Heart, Rome, Italy.
| | - Piera Pierotti
- Department of Infectious Diseases of SM, Annunziata Hospital of Florence, Florence, Italy.
| | - Francesco Donato
- Unit of Hygiene, Epidemiology and Public Health, University of Brescia, Brescia, Italy.
| | - Eugenia Quiros-Roldan
- University Division of Infectious and Tropical Diseases, University of Brescia, Brescia, Italy.
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Biasin M, Piacentini L, Lo Caputo S, Naddeo V, Pierotti P, Borelli M, Trabattoni D, Mazzotta F, Shearer GM, Clerici M. TLR activation pathways in HIV-1-exposed seronegative individuals. J Immunol 2010; 184:2710-7. [PMID: 20124101 DOI: 10.4049/jimmunol.0902463] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
TLRs trigger innate immunity that recognizes conserved motifs of invading pathogens, resulting in cellular activation and release of inflammatory factors. The influence of TLR activation on resistance to HIV-1 infection has not been investigated in HIV-1 exposed seronegative (ESN) individuals. PBMCs isolated from heterosexually ESN individuals were stimulated with agonists specific for TLR3 (poly I:C), TLR4 (LPS), TLR7 (imiquimod), and TLR7/8 (ssRNA40). We evaluated expression of factors involved in TLR signaling cascades, production of downstream effector immune mediators, and TLR-expression in CD4+ and CD14+ cells. Results were compared with those obtained in healthy controls (HCs). ESN individuals showed: 1) comparable percentages of CD14+/TLR4+ and CD4+/TLR8+ CD14+/TLR8+ cells; 2) higher responsiveness to poly I:C, LPS, imiquimod, and ssRNA40 stimulation, associated with significantly increased production of IL-1beta, IL-6, TNF-alpha, and CCL3; 3) augmented expression of mRNA specific for other targets (CCL2, CSF3, CSF2, IL-1alpha, IL-8, IL-10, IL-12, cyclooxygenase 2) demonstrated by broader TLRs pathway expression analyses; and 4) increased MyD88/MyD88s(short) ratio, mainly following TLR7/8 stimulation. We also compared TLR-agonist-stimulated cytokine/chemokine production in CD14+ PBMCs and observed decreased IFN-beta production in ESN individuals compared with HCs upon TLR7/8-agonist stimulation. These data suggest that TLR stimulation in ESN individuals results in a more robust release of immunologic factors that can influence the induction of stronger adaptive antiviral immune responses and might represent a virus-exposure-induced innate immune protective phenotype against HIV-1.
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Affiliation(s)
- Mara Biasin
- Cattedra di Immunologia, Università degli Studi di Milano, Milan, Italy
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9
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Lo Caputo S, Santoro M, Ceccherini-Silberstein CSF, Svicher V, Pierotti P, Vichi F, D'Arrigo R, Gori C, Perno CF, Mazzotta F. Antiretroviral treatment efficacy after mutations reversion during T20 monotherapy, an alternative strategy in multi-failed HIV-1 infected patients. J Int AIDS Soc 2008. [DOI: 10.1186/1758-2652-11-s1-p35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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10
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Torti C, Lapadula G, Barreiro P, Soriano V, Mandalia S, De Silvestri A, Suter F, Maggiolo F, Antinori A, Antonucci F, Maserati R, El Hamad I, Pierotti P, Sighinolfi L, Migliorino G, Ladisa N, Carosi G. CD4+ T cell evolution and predictors of its trend before and after tenofovir/didanosine backbone in the presence of sustained undetectable HIV plasma viral load. J Antimicrob Chemother 2007; 59:1141-7. [PMID: 17434879 DOI: 10.1093/jac/dkm100] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Tenofovir with full-dose didanosine has been associated with paradoxical CD4 + T cell decrease despite virological suppression. We investigated whether tenofovir plus didanosine at a weight-adjusted dosage could be responsible for such an effect, and factors associated with CD4 + T cell count evolution under this combination. METHODS This was a prospective observational multicohort study (Italian MASTER and Spanish Hospital Carlos III HIV cohorts). Patients with HIV plasma viral load suppression for >/= 6 months who switched to an antiretroviral combination including tenofovir plus didanosine were studied, as long as virological success was maintained. CD4 + T cell count variations over time (slopes) were compared before and after switching to tenofovir plus didanosine using linear mixed models and segmented regression analysis. RESULTS Annual time-weighted CD4 + T cell count slope did not change significantly after the prescription of tenofovir plus didanosine: it was 14 cells/mm(3) [95% confidence interval (CI) - 7 to 35] from month - 24 to month - 12, 12 cells/mm(3) (95% CI - 14 to 38) from month - 12 to the time of switching, 30 cells/mm(3) (95% CI 5-55) from switching to month + 12 and 15 cells/mm(3) (95% CI - 8 to 39) from month + 12 to month + 24 after switching to tenofovir plus didanosine. No significant change in the slope of the segment after the switch to tenofovir plus didanosine-containing regimens when compared with the segment preceding the intervention was found (CD4 + T cell count slope change: 24 cells/mm(3); 95% CI - 10 to 58). Similar results were obtained using CD4 + T cell percentage over total lymphocytes. The significant independent predictors of lower CD4 + T cell count slope were older age (P = 0.006), lower nadir CD4 + T cell count (P < 0.001) and positive hepatitis C virus antibody (P = 0.03). Moreover, reduced estimated creatinine clearance was an additional independent predictor of lower CD4 + T cell count slope (P = 0.02), but only after excluding nadir CD4 + T cell count. CONCLUSIONS Tenofovir plus didanosine (weight-adjusted dosage) was not associated with paradoxical CD4 + T cell decrease in our patients maintaining undetectable HIV plasma viral load for a maximum of 24 months after switching. Several factors could explain variability in CD4 + T cell count evolution in these patients.
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Affiliation(s)
- Carlo Torti
- Università degli Studi di Brescia, p le Spedali Civili 1, Brescia, Italy.
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11
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Quiros-Roldan E, Torti C, Lapadula G, Ladisa N, Micheli V, Patroni A, Cusato M, Pierotti P, Tirelli V, Uccelli MC, Di Giambenedetto S, Castelnuovo F, Gargiulo F, Manca N, Carosi G. Adherence and plasma drug concentrations are predictors of confirmed virologic response after 24-week salvage highly active antiretroviral therapy. AIDS Patient Care STDS 2007; 21:92-9. [PMID: 17328658 DOI: 10.1089/apc.2005.0037] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Data from 197 patients for whom highly active antiretroviral therapy (HAART) failed, who started a new regimen chosen under the guide of resistance testing results interpreted by experts, were retrospectively studied, provided that at least 2 determinations of adherence and plasma drug concentrations were performed during the follow-up. Univariate and multivariable logistic regression analyses were conducted, using confirmed virologic response at week 24 as outcome measure (i.e., achievement of undetectable HIV plasma viral load at any time point before week 24 and its maintenance up to week 24). Suboptimal drug concentrations (odds ratio [OR]: 0.3; 95% confidence interval [CI] 0.2-0.7; p = 0.006) and suboptimal adherence (OR: 0.4; 95% CI 0.2-0.8; p = 0.014) were both negative independent predictors of sustained virologic response, while the use of boosted protease inhibitor-containing regimens resulted to be protective (OR: 2.4; 95% CI 1.1-5.3; p = 0.032).
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Affiliation(s)
- Eugenia Quiros-Roldan
- Institute for Infectious and Tropical Diseases, University of Brescia, Brescia, Italy
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12
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Torti C, Uccelli MC, Quiros-Roldan E, Gargiulo F, Tirelli V, Lapadula G, Regazzi M, Pierotti P, Tinelli C, De Luca A, Patroni A, Manca N, Carosi G. Prediction of early and confirmed virological response by genotypic inhibitory quotients for lopinavir in patients naïve for lopinavir with limited exposure to previous protease inhibitors. J Clin Virol 2006; 35:414-9. [PMID: 16280255 DOI: 10.1016/j.jcv.2005.10.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2005] [Revised: 09/20/2005] [Accepted: 10/08/2005] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To determine the impact of genotypic inhibitory quotient (GIQ) for lopinavir (LPV) in patients failing HAART with limited antiretroviral exposure. DESIGN Retrospective analysis of a prospective trial. METHODS Lopinavir GIQ was calculated as the ratio between the mean trough concentration (C(trough)) and the number of protease mutations using eight different HIV drug resistance mutation lists or algorithms. Early (by week 12) and confirmed (up to week 24) virological response (HIV-RNA< 400 copies/mL, ECVR) was used as dependent variable in logistic regression model. RESULTS Seventy-one of 109 (65%) patients achieved ECVR. At multivariable logistic regression analysis, each mug/mL increase of GIQ was correlated with increasing probability of ECVR as far as the following mutations were computed: multi-protease inhibitor (PI) associated mutations listed by IAS (OR=1.17; 95% CI=0.99-1.39; P=0.058), mutations associated with LPV resistance by ANRS algorithm (OR=1.21; 95% CI=1.02-1.44; P=0.03), major mutations associated with LPV resistance by Stanford database (OR=1.16; 95% CI=1-1.35; P=0.05), and the whole set of mutations associated with LPV resistance in the same database (OR=1.22; 95% CI=1.02-1.46; P=0.03). Using ROC curve method, a specific threshold GIQ was assessed, above which this parameter could predict ECVR with the highest sensitivity (74.6% with GIQ obtained through Stanford LPV mutations) or specificity (89.5% with GIQ obtained through ANRS LPV mutations). CONCLUSIONS Our results suggest that increasing GIQ can improve virological outcome even in patients with limited exposure to PIs. Further studies are necessary to understand what HIV protease mutations should be considered and whether such mutations should be weighted differently to improve LPV GIQ predictive value.
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Affiliation(s)
- Carlo Torti
- Institute for Infectious and Tropical Diseases, University of Brescia, School of Medicine, Piazzale Spedali Civili 1, 25123 Brescia, Italy.
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13
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Trabattoni D, Caputo SL, Maffeis G, Vichi F, Biasin M, Pierotti P, Fasano F, Saresella M, Franchini M, Ferrante P, Mazzotta F, Clerici M. Human alpha defensin in HIV-exposed but uninfected individuals. J Acquir Immune Defic Syndr 2005; 35:455-63. [PMID: 15021310 DOI: 10.1097/00126334-200404150-00003] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Human alpha defensins 1, 2, and 3 are produced by CD8 T cells of HIV-infected long-term nonprogressors and have an antiviral activity. alpha Defensins were examined in peripheral blood mononuclear cells (PBMCs), cervical-vaginal mononuclear cells (CVMCs), and cervical biopsies of 9 HIV-1-exposed but uninfected women (ESNs), 10 HIV-infected patients (HIV), and 13 low-risk healthy controls (HCs). Results showed that, whereas alpha defensin production and alpha defensin-expressing CD8 lymphocytes were comparable in ESNs and HIV patients, constitutive alpha defensin production by peripheral CD8 and CVMCs was augmented in ESNs compared with HCs (P = 0.001 and P = 0.058, respectively); alpha defensin mRNA was increased in PBMCs of ESNs; unstimulated, alpha defensin-expressing peripheral and mucosal CD8 lymphocytes were 10-fold higher in ESNs compared with HCs (P = 0.003 and P = 0.01, respectively); and alpha defensin mRNA and alpha defensin-expressing cells were augmented in cervical biopsies of ESN compared with HCs (mRNA:P = 0.03). The differences were reduced upon in vitro mitogen stimulation. A robust constitutive production of alpha defensin is seen in HIV-exposed uninfected individuals; these peptides could have a role in the potentially protective immune response that characterizes ESNs.
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14
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Torti C, Maggiolo F, Patroni A, Suter F, Ladisa N, Paraninfo G, Pierotti P, Orani AM, Minoli L, Arici C, Sighinolfi L, Tinelli C, Carosi G. Exploratory analysis for the evaluation of lopinavir/ritonavir-versus efavirenz-based HAART regimens in antiretroviral-naive HIV-positive patients: results from the Italian MASTER Cohort. J Antimicrob Chemother 2005; 56:190-5. [PMID: 15917286 DOI: 10.1093/jac/dki172] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE This retrospective longitudinal cohort study compared the virological and immunological responses to highly active antiretroviral therapy containing either efavirenz or lopinavir/ritonavir in previously antiretroviral-naive HIV-infected patients. PATIENTS AND METHODS A total of 472 patients were selected (348 efavirenz and 124 lopinavir/ritonavir). The primary endpoint of this study was virological success (HIV RNA <50 copies/mL). The immunological response was assessed on the basis of either CD4+ T cell count variations (absolute and percentage) with respect to baseline values or categorical endpoints (defined as either a CD4+ T cell increase of > or =1;50 cells/mm(3) at week 24 or of > or =1;75 cells/mm(3) at week 48). RESULTS At intention-to-treat (ITT) analysis, the adjusted odds ratio of virological success for patients who started lopinavir/ritonavir, compared with those who started efavirenz, was 0.54 (95% CI: 0.33-0.89, P = 0.016) at week 24 and 0.40 (95% CI: 0.33-0.89, P = 0.002) at week 48. However, patients receiving lopinavir/ritonavir had a more pronounced CD4+ T cell recovery, demonstrating both a mean absolute and percentage increase up to week 48 (MANOVA P < 0.0001). CONCLUSIONS Although comparisons of drug efficacy in non-randomized studies should be viewed with caution, from a virological point of view efavirenz-containing regimens performed as well (on-treatment analysis) or better (ITT analysis) than those containing lopinavir/ritonavir. In contrast, immunological outcome appeared to favour lopinavir/ritonavir.
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Affiliation(s)
- Carlo Torti
- Institute for Infectious and Tropical Diseases, University of Brescia, Italy.
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15
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Torti C, Quiros-Roldan E, Regazzi M, Antinori A, Patroni A, Villani P, Tirelli V, Cologni G, Zinzi D, Caputo SL, Perini P, Carosi G, Torti C, Quiros-Roldan E, Patroni A, Tirelli V, Cologni G, Lapadula G, Castelnuovo F, Paraninfo G, Casari S, Moretti F, Costarelli S, Carosi G, Zinzi D, Zaccarelli M, Marconi P, Antinori A, Lo Caputo S, Pierotti P, Mazzotta F, Perini P, Orani AM, Villani P, Cusato M, Regazzi M, Gargiulo F, Manca N, Tinelli C. Early Virological Failure after Tenofovir + Didanosine + Efavirenz Combination in HIV-Positive Patients upon Starting Antiretroviral Therapy. Antivir Ther 2005. [DOI: 10.1177/135965350501000405] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A prospective, randomized pilot trial was conducted in naive patients comparing three different combinations: zidovudine+lamivudine+lopinavir/ritonavir (arm A) versus tenofovir+lamivudine+efavirenz (arm B) versus tenofovir+didanosine+efavirenz (arm C). HIV-RNA slope (days 1, 3, 7, 14 and 28) was slower in arm C with respect to arm B ( P<0.0001). Seven out of eight patients (87.5%) reached undetectable HIV-RNA by week 28 in arm A, 10/10 (100%) in arm B and 6/10 (60%) in arm C. Among arm C patients who failed at week 4, one HIV isolate showed 67N and 219Q, and another one showed 210F and 215D substitutions in the HIV reverse transcriptase gene at baseline, respectively. Non-nucleoside reverse transcriptase inhibitor resistance-related mutations appeared first, followed by 65R mutations in all cases. Efavirenz AUC0–24 values were lower in arm C with respect to arm B, especially in patients who failed early. A high virological failure rate after tenofovir+didanosine+efavirenz correlated with a slower HIV-RNA decrease and a peculiar accumulation of resistance mutations. A constellation of factors could be correlated with early failure events in patients receiving this combination such as resistance mutations or polymorphisms present at baseline, low CD4+ T-cell count or advanced disease and unexpectedly low efavirenz plasma levels.
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Affiliation(s)
| | - Carlo Torti
- Institute for Infectious and Tropical Diseases, University of Brescia, Brescia, Italy
| | - Eugenia Quiros-Roldan
- Institute for Infectious and Tropical Diseases, University of Brescia, Brescia, Italy
| | - Mario Regazzi
- Department of Clinical Pharmacology, IRCCS Policlinico S Matteo, Pavia, Italy
| | - Andrea Antinori
- National Institute for Infectious Diseases ‘L Spallanzani’, IRCCS, Rome, Italy
| | - Andrea Patroni
- Institute for Infectious and Tropical Diseases, University of Brescia, Brescia, Italy
- Department of Biostatistics, IRCCS Policlinico S Matteo, Pavia, Italy
| | - Paola Villani
- Department of Clinical Pharmacology, IRCCS Policlinico S Matteo, Pavia, Italy
| | - Valeria Tirelli
- Institute for Infectious and Tropical Diseases, University of Brescia, Brescia, Italy
| | - Giuliana Cologni
- Institute for Infectious and Tropical Diseases, University of Brescia, Brescia, Italy
| | - Daniela Zinzi
- National Institute for Infectious Diseases ‘L Spallanzani’, IRCCS, Rome, Italy
| | - Sergio Lo Caputo
- Department of Infectious Diseases, ‘SM Annunziata Hospital’, Florence, Italy
| | - Paolo Perini
- Department of Infectious Diseases ‘A Manzoni Hospital’, Lecco, Italy
| | - Giampiero Carosi
- Institute for Infectious and Tropical Diseases, University of Brescia, Brescia, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - P Villani
- Clinical Pharmacology Unit, IRCCS S Matteo, Pavia
| | - M Cusato
- Clinical Pharmacology Unit, IRCCS S Matteo, Pavia
| | | | - F Gargiulo
- Virology Department, University of Brescia
| | - N Manca
- Virology Department, University of Brescia
| | - C Tinelli
- Biostatistics Unit, IRCCS Policlinico S Matteo, Pavia
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16
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Schenal M, Lo Caputo S, Fasano F, Vichi F, Saresella M, Pierotti P, Villa ML, Mazzotta F, Trabattoni D, Clerici M. Distinct patterns of HIV-specific memory T lymphocytes in HIV-exposed uninfected individuals and in HIV-infected patients. AIDS 2005; 19:653-61. [PMID: 15821391 DOI: 10.1097/01.aids.0000166088.85951.25] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [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: 12/12/2022]
Abstract
BACKGROUND Repeated exposure to HIV is not always associated with infection and multiple cohorts of HIV-exposed but seronegative individuals (ESN) have been described. HIV-specific CD4 and CD8 T lymphocytes are detected both in HIV patients and in ESN; we verified whether different patterns of HIV-specific memory T lymphocytes would be detected in individuals in whom exposure to HIV results or does not result in infection. METHODS Gag-specific T cells were analysed in 15 ESN, 14 HIV patients, and 15 healthy controls using extensive flow cytometry analysis. RESULTS Data confirmed that gag-specific T lymphocytes are present in ESN. Gag-specific T cells mainly secrete interleukin-2 in ESN and interferon-gamma in HIV patients. In addition the CD4/CD8 and the memory/naive ratios are altered, central memory (45RA-/CCR7+) CD4 and CD8 T lymphocytes are more abundant, and terminally differentiated (45RA+/CCR7- and 27-/28-) CD8 T lymphocytes are augmented in ESN individuals. CONCLUSIONS Exposure to HIV occurs in high risk seronegative individuals; the observation that naive cells and CM are skewed in ESN indicate that this exposure is robust enough to modulate the CM/EM ratio. The increase in late effectors and in natural killer cells seen in ESN suggests a role for these cells in preventing actual infection.
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Affiliation(s)
- Monica Schenal
- Immunology DISP LITA Vialba, University of Milano, Milano, Italy
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17
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Monno L, Brindicci G, Lo Caputo S, Punzi G, Scarabaggio T, Riva C, Di Bari C, Pierotti P, Saracino A, Lagioia A, Mazzotta F, Balotta C, Angarano G. HIV-1 subtypes and circulating recombinant forms (CRFs) from HIV-infected patients residing in two regions of central and southern Italy. J Med Virol 2005; 75:483-90. [PMID: 15714483 DOI: 10.1002/jmv.20300] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
A total of 347 pol gene sequences from 88 Tuscan and 259 Apulian subjects (including 52 non-Italians and 9 children) were analyzed phylogenetically. Forty-four (12.6%) non-B subtypes were found, including 3.4% C, 1.4% F1, 0.8% G, and 0.3% each for J and A pure subtypes, and 3.7% CRF02_AG, 1.4% CRF01_AE, 0.6% BF, and 0.3% CRF06-cpx recombinant forms. An additional sample close-matched the pol gene of an unique recombinant form (URF AGK 99GR303). The non-B subtypes were from 40 adults and 4 children; 12 of these 44 patients were epidemiologically linked. Thirty-three of the 44 non-B viruses pertained to non-Italian immigrants and 11 to Italians, signifying that 63.4% immigrants and 3.7% Italians harbored non-B subtypes. The overall frequency of non-B subtypes was higher in Tuscany than in Apulia (18.1% vs. 10.8%). Moreover, 6.1% and 3.0% non-B subtypes were found among Italians from Florence and Apulia, respectively, while 52.1% and 72.4% of immigrants living in Tuscany and Apulia harbored non-B subtypes. Women infected by means of sexual contact prevailed among non-Italian adults; the majority of Italians were males and admitted high-risk sexual behavior. Four Italians had a history of extensive travel in countries of high endemicity. Social and epidemiological changes are responsible for an increasing circulation of non-B subtypes in Italy. Although non-B subtypes principally infect non-Italian patients, in Italy they can no longer be considered exclusively restricted to subjects from endemic areas.
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Affiliation(s)
- Laura Monno
- Clinic of Infectious Diseases, University of Bari, Piazza G. Cesare 11, 70124 Bari, Italy.
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18
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Torti C, Quiros-Roldan E, Tirelli V, Regazzi-Bonora M, Moretti F, Pierotti P, Orani A, Maggi P, Cargnel A, Patroni A, De Luca A, Carosi G. Lopinavir plasma levels in salvage regimes by a population of highly active antiretroviral therapy-treated HIV-1-positive patients. AIDS Patient Care STDS 2004; 18:629-34. [PMID: 15633260 DOI: 10.1089/apc.2004.18.629] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Increased lopinavir (LPV) exposure obtained in vivo through combination with low-dose ritonavir may overcome a certain grade of resistance but not all. We sought to analyze LPV variability and possible risk factors. LPV trough plasma concentrations were determined by high-performance liquid chromatography after 1, 4, and 12 weeks from salvage regimens and tested in both univariate and multivariate regression analyses with age, gender, weight, risk factors for HIV acquisition, hepatitis C virus reactivity, hepatitis B surface antigen positivity, baseline aspartate transferase (AST) or alanine transferase (ALT) levels, creatinine, non-nucleoside reverse transcriptase inhibitors (NNRTIs) or tenofovir as concomitant drugs, and NNRTIs administered in the previous regimen. Fifty-six patients were included into the study. Among them, 8 of 56 (14.3%) at week 1, 12 of 56 (21.4%) at week 4, and 9 of 56 (16.1%) at week 12 had suboptimal LPV plasma concentrations, defined as trough concentration less than 4 microg/mL. No correlation was found between LPV trough concentrations and assessed variables. In conclusion, pharmacokinetic variability and low LPV concentrations have been found, supporting the use of therapeutic drug monitoring in those starting this drug.
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Affiliation(s)
- C Torti
- Institute of Infectious and Tropical Diseases, University of Brescia, Brescia, Italy.
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19
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Torti C, Quiros-Roldan E, Monno L, Patroni A, Saracino A, Angarano G, Tinelli C, Mazzotta F, Lo Caputo S, Pierotti P, Carosi G. HIV-1 Resistance to Dideoxynucleoside Reverse Transcriptase Inhibitors: Genotypic???Phenotypic Correlations. J Acquir Immune Defic Syndr 2004; 36:1104-7. [PMID: 15247566 DOI: 10.1097/00126334-200408150-00016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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20
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Torti C, Quiros-Roldan E, Keulen W, Scudeller L, Lo Caputo S, Boucher C, Castelli F, Mazzotta F, Pierotti P, Been-Tiktak AM, Buccoliero G, De Gennaro M, Carosi G, Tinelli C. Comparison between rules-based human immunodeficiency virus type 1 genotype interpretations and real or virtual phenotype: concordance analysis and correlation with clinical outcome in heavily treated patients. J Infect Dis 2003; 188:194-201. [PMID: 12854073 DOI: 10.1086/376512] [Citation(s) in RCA: 41] [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] [Received: 12/20/2002] [Accepted: 02/28/2003] [Indexed: 11/03/2022] Open
Abstract
We compared 2 rules-based genotype interpretation systems and real or virtual phenotype through a retrospective analysis of a prospective trial. Genotypes were determined with VircoGEN II (VIRCO) and were interpreted with either RetroGram 1.4 or TRUGENE HIV-1 (guidelines 3.0) or original virtual phenotype (Virtual Phenotype; VIRCO), as available in the year 2000. Among 188 human immunodeficiency virus (HIV) type 1 isolates, overall concordance (kappa agreement) was observed for the 2 rules-based systems, whereas striking discordances were noted between them and real and virtual phenotype interpretations for stavudine, didanosine, zalcitabine, abacavir, and amprenavir (kappa<0.4). Clinical evaluation of a subset of 173 patients showed that both rules-based sensitivity scores were independently associated with HIV RNA loads <400 copies/mL at week 16 of during-treatment analysis (TRUGENE: odds ratio [OR], 2.90; 95% confidence interval [CI], 1.52-5.52; P=.001; RetroGram: OR, 2.34; 95% CI, 1.21-4.55; P=.012), whereas, in contrast to real or virtual phenotype, interpretations according to biological cut-offs were not (OR, 1.91; 95% CI, 0.77-4.76; P=.162).
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Affiliation(s)
- Carlo Torti
- Institute of Infectious and Tropical Diseases, University of Brescia, P. le Spedali Civili 1, 25123 Brescia, Italy.
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Marino N, Blanc PL, Blè C, Pierotti P, Mazzotta F. Discrepancy in virological and biochemistry response of patients with chronic hepatitis HCV positive on treatment with PEG-IFN plus ribavirin. J BIOL REG HOMEOS AG 2003; 17:205-6. [PMID: 14518725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
Combination therapy of PEG-IFN alpha-2a o alpha-2b plus ribavirin represents a further improvement in treatment of chronic hepatitis HCV+ with a sustained virological response (SVR) either in monotherapy (25-39%) either in association with ribavirin (59-56%). SVR is highly predictable: 75% of all patients who achieve viral clearance at week 12 (EVR), if they had an adherence > 80% of planned therapy, they become sustained viral responders. In spite of virological response, 16-34% of patients on PEG-IFN monotherapy have high value of ALT, and this make them to reduce adherence. 62 patients whith chronic hepatitis HCV+ and no corrhosis, have been treated for 48 weeks with PEG-IFN and ribavirin to evaluate discrepancy incidence between virological (HCVRNA < 200UI) and biochemical (normal value of ALT) response of patients treated with PEG-IFN plus ribavirin and to verify the impact that stuch discrepancy can produce on SVR of treated patients. Our preliminary data confirm that PEG-IFN bring a superior virological response than biochemical one, either on naive patients either on experienced ones even with ribavirin in association. It will be useful to verify if this discepancy cause a superior SVR as already reported by several studies. Even the follow-up of our 5 discordant patients confirm this trend.
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Affiliation(s)
- N Marino
- Department of Infectious Diseases, S.M. Annunziata Hospital, ASL, Florence, Italy
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Mazzotta F, Lo Caputo S, Torti C, Tinelli C, Pierotti P, Castelli F, Lazzarin A, Angarano G, Maserati R, Gianotti N, Ladisa N, Quiros-Roldan E, Rinehart AR, Carosi G. Real versus virtual phenotype to guide treatment in heavily pretreated patients: 48-week follow-up of the Genotipo-Fenotipo di Resistenza (GenPheRex) trial. J Acquir Immune Defic Syndr 2003; 32:268-80. [PMID: 12626886 DOI: 10.1097/00126334-200303010-00005] [Citation(s) in RCA: 43] [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: 11/26/2022]
Abstract
We compared viroimmunologic response after real phenotype (r-PHT) versus virtual phenotype (v-PHT) in patients failing highly active antiretroviral therapy (HAART). A total of 201 patients with >2 years of exposure, more than six experienced drugs, >1000 HIV RNA copies/mL, and on stable HAART for >6 months were randomized to the r-PHT or v-PHT arm. The primary end point was the proportion of HIV plasma viral load (pVL) <400 copies/mL. Secondary end points were absolute pVL change, proportion of pVL reduction >0.5 log(10) copies/mL, and absolute CD4 cell change. In the intention-to-treat-last observation carried forward analysis, study outcomes were not significantly different between arms over 48 weeks of follow-up: 20% and 24% pVL <400 copies/mL; 58% and 61% pVL reduction >0.5 log(10) copies/mL; -0.92 and -0.94(10) log copies/mL mean pVL decrease; and +41.6 and +94.4 cells/mm(3) mean absolute CD4 increase in the r-PHT and v-PHT arms, respectively. On-treatment analyses gave similar results. In the multivariate analysis of pVL <400 copies/mL, the following covariates were independent predictors at week 48: adherence (OR p= 0.25; p=.002), baseline CD4 (OR = 4.39; p=.007), intravenous drug use as risk factor for HIV acquisition (OR = 0.33; p=.024), and sensitivity score of the new regimens by biologic cut-offs (OR = 1.84; p=.029). Prescribed drugs for which patients were naive resulted in marginal prediction (OR = 1.93; p=.054). In conclusion, virologic and immunologic outcomes did not differ when r-PHT or v-PHT was used in this cohort of heavily pretreated patients. Several factors should be considered to take better advantage of resistance testing, including treatment history, clinical status, and patients' ability to adhere to treatment.
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Affiliation(s)
- Francesco Mazzotta
- Department of Infectious Diseases, S.M. Annunziata Hospital, ASL Firenze, Italy
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Peduzzi C, Pierotti P, Venturi G, Romano L, Mazzotta F, Zazzi M. Performance of an in-house genotypic antiretroviral resistance assay in patients pretreated with multiple human immunodeficiency virus type 1 protease and reverse transcriptase inhibitors. J Clin Virol 2002; 25:57-62. [PMID: 12126722 DOI: 10.1016/s1386-6532(01)00252-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
An in-house genotypic antiretroviral resistance assay was evaluated by testing 32 plasma samples obtained from heavily pretreated human immunodeficiency virus type 1 (HIV-1)-infected patients failing multiple antiretroviral regimens. The same samples were also sent to Virco Laboratories for genotypic (VircoGEN) and phenotypic (Antivirogram) resistance analysis. Sequencing results obtained by in-house (HG) and VircoGEN (VG) genotyping were concordant for 387 of 400 (96.75%) drug resistance mutations. Genotype-based prediction of drug susceptibility for 13 currently licensed antiretroviral compounds were in agreement in 336 (80.78%) cases, partially concordant in 73 (17.54%) cases and discordant in only seven (1.68%) cases. VG indicated 'possible resistance' twice as much as HG. When genotype interpretation was compared with the Antivirogram phenotypic data, there were 27 (6.49%) and 23 (5.52%) wrong calls by HG and by VG, respectively. Both assays were more sensitive in detecting drug resistance than drug susceptibility (94.61 vs. 65.19% for HG, 80.84 vs. 56.91% for VG) and more specific in detecting drug susceptibility than drug resistance (93.62 vs. 73.49% for HG, 93.62 vs. 80.32% for VG). Rule-based algorithms can reliably interpret genotypic data obtained from most heavily pretreated patients. However, occasional genotypic patterns may be erroneously interpreted without resistance phenotyping.
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Affiliation(s)
- C Peduzzi
- U. O. Malattie Infettive, Ospedale S.M. Annunziata, Firenze, Italy
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Chini G, Pierotti P, Sani L, Martelli L, Zecchi S, Rosso L. [Role of slime in the pathogenesis of pulmonary infections]. Minerva Anestesiol 1995; 61:77-81. [PMID: 7675265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Microorganisms have proved to produce an amorphous substance that adheres to surfaces of several medical devices like intravenous catheters and endotracheal tubes. We investigated the presence of slime in endotracheal tubes in our Intensive Care Unit (ICU) in 12 patients. We found in this study no correlation between the strain of bacteria on the surface of endotracheal devices and those responsible for pneumonia.
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Affiliation(s)
- G Chini
- I.U.O. Anestesia e Rianimazione, USL 10/D-Policlinico di Careggi, Firenze
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Piluso S, Ficarra G, Orsi A, Gaglioti D, Pierotti P, Orlando S. Clinical aspects and microbiology of HIV-associated periodontal lesions. Minerva Stomatol 1993; 42:301-9. [PMID: 8232138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
This study examines the clinical aspects of HIV-associated periodontal lesions and the prevalence of periodontal pathogens. Subgingival plaque samples were taken from 55 subjects in six study groups: 1) HIV-seropositive patients with gingivitis, 2) necrotizing gingivitis, 3) periodontitis or 4) with health periodontium, 5) patients with rapidly progressive periodontitis or 6) periodontally healthy in whom there was no evidence of HIV infection. Among HIV-positive patients there was a majority (66%) of intravenous drug users. We detected more Bacteroides intermedius, B. buccae and B. oralis in HIV-infected patients with periodontal lesions and in HIV-negative subjects with rapidly progressive periodontitis than in the other groups. High levels of Spirochetes were recovered in both HIV associated necrotizing gingivitis and periodontitis. The results indicate that there is a similarity in the microbiological profile of HIV-associated gingivitis, necrotizing gingivitis, periodontitis and rapidly progressive periodontitis of HIV-negative subjects although significant differences in the clinical aspects of the lesions and in the immune status of the host have been observed.
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Affiliation(s)
- S Piluso
- Institute of Odontology and Stomatology, University of Florence, Italy
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Natoli C, Dianzani F, Mazzotta F, Balocchini E, Pierotti P, Antonelli G, Iacobelli S. 90K protein: a new predictor marker of disease progression in human immunodeficiency virus infection. J Acquir Immune Defic Syndr (1988) 1993; 6:370-5. [PMID: 8095982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
A 90,000-Da molecular mass tumor-associated protein has recently been identified in the sera of patients infected by HIV. In this study, we have evaluated the serum levels of 90K for its ability to predict the progression to ARC or AIDS retrospectively in 49 HIV-seropositive subjects who were initially symptom-free. 90K levels were higher in those HIV-seropositive subjects who progressed to ARC or AIDS than in those who had not progressed both at entry into the study and at the latest visit. CD4+ cell number was not different in the two groups at entry but was lower in the progressors at the latest visit. Evaluation of the patterns of change over time showed that 90K increased and CD4+ cells decreased more in progressors than in nonprogressors. During the 3 years preceding the onset of ARC or AIDS, 90K increased regularly while CD4+ cell decrease was later. Elevated levels of 90K (p = 0.007) and lower numbers of CD4+ cells (p = 0.001) were significantly associated with a higher cumulative incidence of ARC or AIDS. These findings suggest that 90K is an early indicator of progression to ARC and AIDS.
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Affiliation(s)
- C Natoli
- Department of Medical Oncology, University G. D'Annunzio, Chieti, Italia
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Longo G, Viganò S, Bellesi GP, Pierotti P, Milo D, RaFanelli D, Ferrini PR. The use of granulocyte colony-stimulating factor in a hemophilia patient suffering from AIDS-related NHL. Haematologica 1992; 77:439-41. [PMID: 1282893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
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Dionisio D, Belli A, Dionisio A, Poggiali G, Corradini S, Pierotti P, Menci R, Favi P, Mecocci L. [Appendicitis: microbial interactions and new pathogens]. Recenti Prog Med 1992; 83:330-6. [PMID: 1323137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The Authors present an exhaustive review on microbial agents of appendicitis by means of literature and personal research data. Thus, a detailed analysis is made on common autochthonous agents and their pathogenetic interactions and on less common exogenous bacterial, viral, mycotic, protozoan and helminthic agents with emphasis to the role of Yersinia enterocolitica. In fact this bacterium seems responsible for 3% to 8% of cases in accordance with literature and personal research data (more detailed, Y. enterocolitica has been isolated in 3.8% of 208 inflamed appendices from both pediatric and adults surgical florentine patients). At the end, the pathogenetic role of "new" other bacteria, like Buttiauxella agrestis, Aeromonas hydrophila, Arizona, Streptococcus lactis, is debated on the basis of a personal study.
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Affiliation(s)
- D Dionisio
- Divisione Malattie infettive, Policlinico Careggi, Firenze
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