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Fusco FM, Sangiovanni N, Papa N, Mattera Iacono V, Cuomo N, Viglietti R, Tambaro O, Borrelli F, Pisapia R, Carleo MA, Rizzo V, Spatarella M, Esposito V, Sangiovanni V. Unexpected effects of COVID-19 outbreak: adaption of Anti-Retroviral Therapy (ART) delivery policies improved adherence in a population of People Living With HIV (PLWH). Infez Med 2023; 31:204-208. [PMID: 37283642 PMCID: PMC10241403 DOI: 10.53854/liim-3102-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 05/02/2023] [Indexed: 06/08/2023]
Abstract
Background Adherence to Anti-Retroviral Therapy (ART) is crucial for People Living With HIV (PLWH). In Italy, ART is delivered by Hospital Pharmacies, on a renewable prescription from the hospital physician. The measurement of package-refill (the rate of ART packages actually collected out of those to be collected in order to comply with therapy) is an effective tool to evaluate the adherence.During COVID-19 outbreak, at "D. Cotugno" hospital in Naples, Italy, the ART delivery policies have been adapted, in order to reduce the number of patients' access. We analysed the impact of these changes on the pill-refill of ART in January-August 2020, compared with 2018-2019. Methods "D. Cotugno" hospital is a mono-specialistic Infectious Diseases hospital, caring for about 2500 PLWH. Since February 2020, the hospital was almost entirely dedicated to COVID-19 patients. All out-patient activities were interrupted, except for those dedicated to HIV/AIDS patients.In this preliminary study we included all patients assigned to one of the three Medical Divisions dedicated to HIV, who were already under treatment since at least 2017. Rate of package-refill was obtained by the Hospital Pharmacy registry, demographic and clinical data were derived from clinical database.During COVID-19, many measures were adopted in order to increase safety of PLWH attending to hospital. Among these, medical prescription validity increased from 4 to 6 months, and number of packages to be collected increased from 2 to 4, adopting a multi-month dispensing strategy.Package-refill is adequate if at least 95% of ART have been actually collected; partial and inadequate if 75%-94% or less than 75% of ART, respectively, have been collected. Package-refill was measured during the first year of COVID-19 (March 2020 - February 2021), compared to the same period in the two years before. Results A total of 594 PLWH were included. PLWH with optimal pill-refill significantly increased in 2020-21 compared to 2018-2020 (62% vs 55%, p 0.013). Discussion Due to COVID-19, we would have expected a reduction in ART deliveries. Surprisingly, the opposite occurred. The increase of pill-refill rates may be due to different reasons, but we hypothesized that the adaption of delivery policies, with a higher number of packages allowed to be collected, strongly contributed to this result. This study suggests that multi-month dispensing policies may contribute to the improvement of adherence among PLWH.
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Affiliation(s)
| | - Nadia Sangiovanni
- Infectious Diseases Unit, "D. Cotugno" Hospital, AORN dei Colli, Naples, Italy
| | - Nunzia Papa
- Infectious Diseases Unit, "D. Cotugno" Hospital, AORN dei Colli, Naples, Italy
| | | | - Nunzia Cuomo
- Infectious Diseases Unit, "D. Cotugno" Hospital, AORN dei Colli, Naples, Italy
| | - Rosaria Viglietti
- Infectious Diseases Unit, "D. Cotugno" Hospital, AORN dei Colli, Naples, Italy
| | - Orsola Tambaro
- Infectious Diseases Unit, "D. Cotugno" Hospital, AORN dei Colli, Naples, Italy
| | - Francesco Borrelli
- Infectious Diseases Unit, "D. Cotugno" Hospital, AORN dei Colli, Naples, Italy
| | - Raffaella Pisapia
- Infectious Diseases Unit, "D. Cotugno" Hospital, AORN dei Colli, Naples, Italy
| | - Maria Aurora Carleo
- Infectious Diseases Unit, "D. Cotugno" Hospital, AORN dei Colli, Naples, Italy
| | - Viviana Rizzo
- Infectious Diseases Unit, "D. Cotugno" Hospital, AORN dei Colli, Naples, Italy
| | - Micaela Spatarella
- Infectious Diseases Unit, "D. Cotugno" Hospital, AORN dei Colli, Naples, Italy
| | - Vincenzo Esposito
- Infectious Diseases Unit, "D. Cotugno" Hospital, AORN dei Colli, Naples, Italy
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2
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Fusco FM, Carleo MA, Sangiovanni N, D'Abbraccio M, Tambaro O, Borrelli F, Viglietti R, Camaioni C, Bruner V, Falanga R, Pisapia R, Palmiero G, Rizzo V, Rosario P, Cuomo N, Spatarella M, Esposito V, Sangiovanni V. Does COVID-19 Vaccination with BNT162b2 Influence HIV-Related Immunological and Virological Markers? Data from 235 Persons Living with HIV at Cotugno Hospital, Naples, Italy: Immune Response After Second and Third Doses, and Influence on Immunovirological Markers. Viral Immunol 2023; 36:360-365. [PMID: 37140991 DOI: 10.1089/vim.2022.0182] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023] Open
Abstract
Few data are available on the impact of COVID-19 vaccination on CD4 counts and HIV-RNA in persons living with HIV (PLWH). We present the data of 235 PLWH who were vaccinated with BNT162b2 in March 2021-February 2022 at the "Cotugno" hospital in Naples. PLWH treated at the "Cotugno" hospital, who were vaccinated at the hospital vaccination center, without prior COVID-19 and for whom immunological/virological data were available in the last 12 months and in the 6 months after vaccination were included. Antispike Ab were available for 187 and 64 PLWH after the second and third doses: PLWH with antispikes >33 binding antibodies units (BAU)/mL increased from 91% to 98%. Antinucleocapsid Ab performed in 147 and 56 patients identified 19 (13%) asymptomatic/paucisymptomatic COVID-19 infections after the second dose and an additional 15 (27%) after the third dose. Immunological/virological data were collected before vaccination (T0), after the second dose (T1), and after the third dose (T2). The absolute number of CD4 increased after the third dose (median 663, 657, and 707 at T0, T1, and T2; p < 0.000 T0 vs. T2). The proportion of patients with HIV-RNA <50 copies/mL increases significantly after the second dose (73%; 85.7%; 87.7%; p < 0.000 T0 vs. T2). The presence of COVID-19 asymptomatic/paucisymptomatic infections (demonstrated by the presence of antinucleocapsid Ab) significantly increases SARS-CoV-2 antispike Ab after second dose, but not after third dose. Asymptomatic/paucisymptomatic COVID-19 infections do not have influence on CD4 cell number and HIV-RNA level. Similarly, the presence of not-controlled HIV-RNA (HIV-RNA >50 copies/mL) does not influence antispike Ab response. According to our data, the response to SARS-CoV2 vaccination is effective in people living with HIV. Vaccination against COVID-19 appears to positively affect immunological and virological levels in people living with HIV.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Rosa Falanga
- "D. Cotugno" Hospital, AOS dei Colli, Naples, Italy
| | | | | | | | | | - Nunzia Cuomo
- "D. Cotugno" Hospital, AOS dei Colli, Naples, Italy
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3
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Fusco FM, Sangiovanni N, Papa N, Cuomo N, Tambaro O, Iodice V, Bruner V, Carleo MA, Rizzo V, Palmiero G, Di Lorenzo M, Spatarella M, Viglietti R, Sangiovanni V, Esposito V. Adherence to antiretroviral therapy thought package-refill among HIV+ persons at "D. Cotugno" hospital, Naples, Italy. Infez Med 2022; 30:440-445. [PMID: 36148167 PMCID: PMC9448314 DOI: 10.53854/liim-3003-13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 07/03/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND A gold-standard for the measurement of adherence to antiretroviral therapy (ART) is lacking. Aim of this study is to verify the feasibility of a package-refill-based measurement of ART at "D. Cotugno" hospital, Naples, Italy, and the factors associated to adherence. METHODS In the period January 2018-August 2020, we calculated the package-refill as the ratio between ART-packages actually withdrawn, and the ART packages needed to regularly take ART. Adherence was associated, trough a univariate e multivariate logistic regression, to demographical, behavioural and clinical factors. RESULTS 1140 HIV+ subjects were included. At univariate logistic regression inadequate package-refill-based adherence is associated with HIV-RNA higher than 50 copies/mmL (OR 3.77-IC95% 2.76-5.13) and with HIVRNA higher than 200 copies/mmL (OR 3.98-IC95% 2.69-5.90). Being not-Italian and Injective-drug-user are associated with low adherence, having HIV/AIDS for more than 8 years is associated with better adherence. CONCLUSIONS Package-refill is a suitable method for measuring adherence and is associated with the condition of viral failure.
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Affiliation(s)
| | | | - Nunzia Papa
- "D. Cotugno" Hospital, AOS dei Colli, Naples, Italy
| | - Nunzia Cuomo
- "D. Cotugno" Hospital, AOS dei Colli, Naples, Italy
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4
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Fusco FM, Sangiovanni N, Mascolo S, Carleo MA, Sardo M, Viglietti R, Parrella G, Tambaro O, Iodice V, Di Flumeri G, Menna A, Galano A, Laudiero A, Mariniello A, De Cenzo M, Manzillo E, Esposito V, Chirianni A, Sangiovanni V. Evolving epidemiology of HIV/AIDS in Campania region, 2011–2018: Is HIV/AIDS population in Campania different? SAGE Open Med 2022; 10:20503121221113938. [PMID: 35924140 PMCID: PMC9340358 DOI: 10.1177/20503121221113938] [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: 11/25/2021] [Accepted: 06/29/2022] [Indexed: 11/21/2022] Open
Abstract
Objectives: Data on HIV/AIDS cases in Italy are collected using a standardised form.
Regional epidemiology may vary. We described the epidemiological and
clinical characteristics of newly diagnosed persons with HIV in the
‘Cotugno’ hospital in Naples during 2011–2018 and compared them with
national data to identify similarities and differences. Methods: Data source for the Campania region is the data collection forms sent to the
national surveillance system. The data source for the national data is from
the periodic annual bulletins on HIV/AIDS published by the National
Institute of Health. Results: In all, 1149 persons with HIV were diagnosed in ‘Cotugno’ (69.7% of those
diagnosed in Campania). Persons with HIV in Campania showed many
similarities with the Italian population: men were in the majority in both
groups (about 75%), foreign origin was about 30%, heterosexuals were the
most represented risk group, followed by men who have sex with men and
injecting drug use in both samples. Some notable differences are also
present. Among the risk factors for HIV acquisition, injecting drug use is
significantly more common in Campania. Among the reasons for testing,
significant differences are evident for almost all reasons, with screening
activities (testing for concurrent diseases, for diagnosis of sexually
transmitted diseases, screening in hospital during maternity care and
screening in drug-addition services or prisons) being more common at the
national level. The Campania population has a more severe disease pattern,
with a significantly higher proportion of patients diagnosed with less than
200 CD4 cells/µL and AIDS. For each variable, we compared trends in the
Campania region and in Italy using Spearman’s correlation coefficient.
Almost all trends show a weak correlation. Conclusion: In conclusion, the prevalence of injecting drug use is still consistent, and
requires specific campaigns. The reasons for testing are different:
screening activities work less in Campania than in Italy. This untimely
approach contributes to a more severe clinical picture in Campania.
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Affiliation(s)
- Francesco Maria Fusco
- UOC Infezioni sistemiche e dell’Immunodepresso, ‘D. Cotugno’ Hospital, AORN Ospedali dei Colli, Naples, Italy
| | - Nadia Sangiovanni
- UOC Immunodeficienze e Malattie Infettive di Genere, ‘D. Cotugno’ Hospital, AORN Ospedali dei Colli, Naples, Italy
| | - Silvia Mascolo
- UOC Immunodeficienze e Malattie Infettive di Genere, ‘D. Cotugno’ Hospital, AORN Ospedali dei Colli, Naples, Italy
| | - Maria Aurora Carleo
- UOC Immunodeficienze e Malattie Infettive di Genere, ‘D. Cotugno’ Hospital, AORN Ospedali dei Colli, Naples, Italy
| | - Massimo Sardo
- UOC Immunodeficienze e Malattie dell’Immigrazione, ‘D. Cotugno’ Hospital, AORN Ospedali dei Colli, Naples, Italy
| | - Rosaria Viglietti
- UOC Infezioni sistemiche e dell’Immunodepresso, ‘D. Cotugno’ Hospital, AORN Ospedali dei Colli, Naples, Italy
| | - Giovanni Parrella
- UOC Infezioni sistemiche e dell’Immunodepresso, ‘D. Cotugno’ Hospital, AORN Ospedali dei Colli, Naples, Italy
| | - Orsola Tambaro
- UOC Infezioni sistemiche e dell’Immunodepresso, ‘D. Cotugno’ Hospital, AORN Ospedali dei Colli, Naples, Italy
| | - Valentina Iodice
- UOC Immunodeficienze e Malattie dell’Immigrazione, ‘D. Cotugno’ Hospital, AORN Ospedali dei Colli, Naples, Italy
| | - Giusy Di Flumeri
- UOC Infezioni sistemiche e dell’Immunodepresso, ‘D. Cotugno’ Hospital, AORN Ospedali dei Colli, Naples, Italy
| | - Anna Menna
- UOC Infezioni sistemiche e dell’Immunodepresso, ‘D. Cotugno’ Hospital, AORN Ospedali dei Colli, Naples, Italy
| | - Assunta Galano
- UOC Infezioni sistemiche e dell’Immunodepresso, ‘D. Cotugno’ Hospital, AORN Ospedali dei Colli, Naples, Italy
| | - Anna Laudiero
- UOC Infezioni sistemiche e dell’Immunodepresso, ‘D. Cotugno’ Hospital, AORN Ospedali dei Colli, Naples, Italy
| | - Antonietta Mariniello
- UOC Infezioni sistemiche e dell’Immunodepresso, ‘D. Cotugno’ Hospital, AORN Ospedali dei Colli, Naples, Italy
| | - Milena De Cenzo
- UOC Infezioni sistemiche e dell’Immunodepresso, ‘D. Cotugno’ Hospital, AORN Ospedali dei Colli, Naples, Italy
| | - Elio Manzillo
- UOC Immunodeficienze e Malattie dell’Immigrazione, ‘D. Cotugno’ Hospital, AORN Ospedali dei Colli, Naples, Italy
| | - Vincenzo Esposito
- UOC Immunodeficienze e Malattie Infettive di Genere, ‘D. Cotugno’ Hospital, AORN Ospedali dei Colli, Naples, Italy
| | - Antonio Chirianni
- UOC Infezioni sistemiche e dell’Immunodepresso, ‘D. Cotugno’ Hospital, AORN Ospedali dei Colli, Naples, Italy
| | - Vincenzo Sangiovanni
- UOC Infezioni sistemiche e dell’Immunodepresso, ‘D. Cotugno’ Hospital, AORN Ospedali dei Colli, Naples, Italy
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5
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Iodice V, Pisaturo M, Fusco FM, Tambaro O, Parrella G, Di Flumeri G, Viglietti R, Pisapia R, Palmiero G, Bignardi E, Coppola M, Rescigno C, Sangiovanni V. Use of lung ultrasound in COVID-19: comparison with ultra-high-resolution computed tomography among 29 patients at "D. Cotugno" hospital, Naples, Italy. Infez Med 2020; 28:346-350. [PMID: 32920569] [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: 06/11/2023]
Abstract
Ultra-High-Resolution Computed Tomography (U-HR-CT) is the reference imaging technique for pneumonia in the new coronavirus disease (COVID-19). Pulmonary Ultrasound (LUS) could be a valid diagnostic alternative for the imaging of COVID-19. Our study aimed to investigate the clinical performance of LUS in the initial evaluation of pneumonia in COVID-19 patients, compared to standard U-HR-CT. Among 29 patients with confirmed COVID-19, all U-HR-CT hallmarks showed an excellent concordance with LUS findings according to Cohen coefficient. In our experience, LUS is a viable alternative to U-HR-CT, with the advantages of being radiation-free, flexible, cost-effective, and reasonably reducing nosocomial transmission risks because performed at bed-side.
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Affiliation(s)
- Valentina Iodice
- UOC Infezioni Sistemiche e dell'Immunodepresso, AORN Ospedali dei Colli, P.O. "D. Cotugno", Naples, Italy
| | - Mariantonietta Pisaturo
- UOC Infezioni Sistemiche e dell'Immunodepresso, AORN Ospedali dei Colli, P.O. "D. Cotugno", Naples, Italy
| | - Francesco Maria Fusco
- UOC Infezioni Sistemiche e dell'Immunodepresso, AORN Ospedali dei Colli, P.O. "D. Cotugno", Naples, Italy
| | - Orsola Tambaro
- UOC Infezioni Sistemiche e dell'Immunodepresso, AORN Ospedali dei Colli, P.O. "D. Cotugno", Naples, Italy
| | - Giovanni Parrella
- UOC Infezioni Sistemiche e dell'Immunodepresso, AORN Ospedali dei Colli, P.O. "D. Cotugno", Naples, Italy
| | - Giusy Di Flumeri
- UOC Infezioni Sistemiche e dell'Immunodepresso, AORN Ospedali dei Colli, P.O. "D. Cotugno", Naples, Italy
| | - Rosaria Viglietti
- UOC Infezioni Sistemiche e dell'Immunodepresso, AORN Ospedali dei Colli, P.O. "D. Cotugno", Naples, Italy
| | - Raffaella Pisapia
- UOC Malattie Infettive ad Indirizzo Neurologico, AORN Ospedali dei Colli, P.O. "D. Cotugno", Naples, Italy
| | - Giulia Palmiero
- UOC Malattie Infettive ad Indirizzo Neurologico, AORN Ospedali dei Colli, P.O. "D. Cotugno", Naples, Italy
| | - Elio Bignardi
- UOC Radiodiagnostica, AORN Ospedali dei Colli, P.O. "D. Cotugno", Naples, Italy
| | - Michele Coppola
- UOC Radiodiagnostica, AORN Ospedali dei Colli, P.O. "D. Cotugno", Naples, Italy
| | - Carolina Rescigno
- UOC Malattie Infettive ad Indirizzo Neurologico, AORN Ospedali dei Colli, P.O. "D. Cotugno", Naples, Italy
| | - Vincenzo Sangiovanni
- UOC Infezioni Sistemiche e dell'Immunodepresso, AORN Ospedali dei Colli, P.O. "D. Cotugno", Naples, Italy
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6
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Fusco FM, Pisaturo M, Iodice V, Bellopede R, Tambaro O, Parrella G, Di Flumeri G, Viglietti R, Pisapia R, Carleo MA, Boccardi M, Atripaldi L, Chignoli B, Maturo N, Rescigno C, Esposito V, Dell'Aversano R, Sangiovanni V, Punzi R. COVID-19 among healthcare workers in a specialist infectious diseases setting in Naples, Southern Italy: results of a cross-sectional surveillance study. J Hosp Infect 2020; 105:596-600. [PMID: 32565367 PMCID: PMC7301109 DOI: 10.1016/j.jhin.2020.06.021] [Citation(s) in RCA: 66] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 06/15/2020] [Indexed: 01/12/2023]
Abstract
A coronavirus disease 2019 (COVID-19) surveillance study was performed in March–April 2020 among asymptomatic healthcare workers (HCWs) at a specialist infectious diseases hospital in Naples, Italy. All HCWs underwent two rounds of molecular and serological testing for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). One hundred and fifteen HCWs were tested; of these, two cases of infection were identified by reverse transcriptase polymerase chain reaction and two HCWs were SARS-CoV-2 immunoglobulin G seropositive. The overall prevalence of current or probable previous infection was 3.4%. The infection rate among HCWs was reasonably low. Most of the infected HCWs had been asymptomatic for the preceding 30 days, which supports the need for periodic screening of HCWs for COVID-19.
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Affiliation(s)
- F M Fusco
- UOC Infezioni Sistemiche e dell'Immunodepresso, AORN Ospedali dei Colli, P.O. 'D. Cotugno', Naples, Italy.
| | - M Pisaturo
- UOC Infezioni Sistemiche e dell'Immunodepresso, AORN Ospedali dei Colli, P.O. 'D. Cotugno', Naples, Italy
| | - V Iodice
- UOC Infezioni Sistemiche e dell'Immunodepresso, AORN Ospedali dei Colli, P.O. 'D. Cotugno', Naples, Italy
| | - R Bellopede
- UOC Pronto Soccorso Infettivologico ed Accettazione, AORN Ospedali dei Colli, P.O. 'D. Cotugno', Naples, Italy
| | - O Tambaro
- UOC Infezioni Sistemiche e dell'Immunodepresso, AORN Ospedali dei Colli, P.O. 'D. Cotugno', Naples, Italy
| | - G Parrella
- UOC Infezioni Sistemiche e dell'Immunodepresso, AORN Ospedali dei Colli, P.O. 'D. Cotugno', Naples, Italy
| | - G Di Flumeri
- UOC Infezioni Sistemiche e dell'Immunodepresso, AORN Ospedali dei Colli, P.O. 'D. Cotugno', Naples, Italy
| | - R Viglietti
- UOC Infezioni Sistemiche e dell'Immunodepresso, AORN Ospedali dei Colli, P.O. 'D. Cotugno', Naples, Italy
| | - R Pisapia
- UOC Malattie Infettive ad Indirizzo Neurologico, AORN Ospedali dei Colli, P.O. 'D. Cotugno', Naples, Italy
| | - M A Carleo
- UOC Immunodeficienze e Malattie Infettive di Genere, AORN Ospedali dei Colli, P.O. 'D. Cotugno', Naples, Italy
| | - M Boccardi
- UOC Malattie Infettive ad Indirizzo Neurologico, AORN Ospedali dei Colli, P.O. 'D. Cotugno', Naples, Italy
| | - L Atripaldi
- UOC Microbiologia e Virologia, AORN Ospedali dei Colli, P.O. Monaldi, Naples, Italy
| | - B Chignoli
- UOSD Medicina del Lavoro, AORN Ospedali dei Colli, Naples, Italy
| | - N Maturo
- UOC Pronto Soccorso Infettivologico ed Accettazione, AORN Ospedali dei Colli, P.O. 'D. Cotugno', Naples, Italy
| | - C Rescigno
- UOC Malattie Infettive ad Indirizzo Neurologico, AORN Ospedali dei Colli, P.O. 'D. Cotugno', Naples, Italy
| | - V Esposito
- UOC Immunodeficienze e Malattie Infettive di Genere, AORN Ospedali dei Colli, P.O. 'D. Cotugno', Naples, Italy
| | - R Dell'Aversano
- UOC Direzione Medica di Ospedale, AORN Ospedali dei Colli, P.O. 'D. Cotugno', Naples, Italy
| | - V Sangiovanni
- UOC Infezioni Sistemiche e dell'Immunodepresso, AORN Ospedali dei Colli, P.O. 'D. Cotugno', Naples, Italy
| | - R Punzi
- UOC Malattie Infettive ed Urgenze Infettivologiche, AORN Ospedali dei Colli, P.O. 'D. Cotugno', Naples, Italy
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7
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Pisapia R, Pisaturo M, Fusco FM, Parrella G, Iodice V, Tambaro O, Di Flumeri G, Viglietti R, Palmiero G, Falco E, Raffone M, Di Martino F, Maturo N, Rescigno C, Sangiovanni V. Differences among confirmed and not-confirmed COVID-19 patients at "D.Cotugno" hospital, Naples (Italy): what we learned from first suspected cases? Infez Med 2020; 28:84-88. [PMID: 32532943] [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: 06/11/2023]
Abstract
Clinical presentation of COVID-19 is common to other respiratory infections. We compared the characteristics at hospital admission of confirmed and not-confirmed COVID-19 patients, in the early phase of the epidemic. Thirty-seven suspected patients were enrolled, and COVID-19 was confirmed in 17. Confirmed patients are older, have more frequently contact with confirmed cases. Distinctive clinical characteristics among COVID-19 were the grand-glass opacities at CT scan, and a pO2/FiO2 ratio less than 250. In not-confirmed group, Influenza represented the most frequent alternative diagnosis. This study contributes to highlight the characteristics to consider at hospital admission in order to promptly suspect COVID-19.
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Affiliation(s)
- Raffaella Pisapia
- UOC Malattie Infettive ad Indirizzo Neurologico, AORN Ospedali dei Colli, P.O. "D. Cotugno", Naples, Italy
| | - Mariantonietta Pisaturo
- UOC Infezioni Sistemiche e dell'Immunodepresso, AORN Ospedali dei Colli, P.O. "D. Cotugno", Naples, Italy
| | - Francesco Maria Fusco
- UOC Infezioni Sistemiche e dell'Immunodepresso, AORN Ospedali dei Colli, P.O. "D. Cotugno", Naples, Italy
| | - Giovanni Parrella
- UOC Infezioni Sistemiche e dell'Immunodepresso, AORN Ospedali dei Colli, P.O. "D. Cotugno", Naples, Italy
| | - Valentina Iodice
- UOC Infezioni Sistemiche e dell'Immunodepresso, AORN Ospedali dei Colli, P.O. "D. Cotugno", Naples, Italy
| | - Orsola Tambaro
- UOC Infezioni Sistemiche e dell'Immunodepresso, AORN Ospedali dei Colli, P.O. "D. Cotugno", Naples, Italy
| | - Giusy Di Flumeri
- UOC Infezioni Sistemiche e dell'Immunodepresso, AORN Ospedali dei Colli, P.O. "D. Cotugno", Naples, Italy
| | - Rosaria Viglietti
- UOC Infezioni Sistemiche e dell'Immunodepresso, AORN Ospedali dei Colli, P.O. "D. Cotugno", Naples, Italy
| | - Giulia Palmiero
- UOC Malattie Infettive ad Indirizzo Neurologico, AORN Ospedali dei Colli, P.O. "D. Cotugno", Naples, Italy
| | - Erasmo Falco
- UOC Microbiologia e Virologia, AORN Ospedali dei Colli, Ospedale Monaldi, Naples, Italy
| | - Marcello Raffone
- UOC Microbiologia e Virologia, AORN Ospedali dei Colli, Ospedale Monaldi, Naples, Italy
| | - Filomena Di Martino
- UOC Pronto Soccorso Infettivologico ed Accettazione, AORN Ospedali dei Colli, P.O. "D. Cotugno", Naples, Italy
| | - Nicola Maturo
- UOC Pronto Soccorso Infettivologico ed Accettazione, AORN Ospedali dei Colli, P.O. "D. Cotugno", Naples, Italy
| | - Carolina Rescigno
- UOC Malattie Infettive ad Indirizzo Neurologico, AORN Ospedali dei Colli, P.O. "D. Cotugno", Naples, Italy
| | - Vincenzo Sangiovanni
- UOC Infezioni Sistemiche e dell'Immunodepresso, AORN Ospedali dei Colli, P.O. "D. Cotugno", Naples, Italy
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Maggi P, Bellacosa C, Leone A, Volpe A, Ricci ED, Ladisa N, Cicalini S, Grilli E, Viglietti R, Chirianni A, Bellazzi LI, Maserati R, Martinelli C, Corsi P, Celesia BM, Sozio F, Angarano G. Cardiovascular risk in advanced naïve HIV-infected patients starting antiretroviral therapy: Comparison of three different regimens - PREVALEAT II cohort. Atherosclerosis 2017; 263:398-404. [PMID: 28522147 DOI: 10.1016/j.atherosclerosis.2017.05.004] [Citation(s) in RCA: 17] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2017] [Revised: 04/29/2017] [Accepted: 05/04/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND AND AIMS PREVALEAT (PREmature VAscular LEsions and Antiretroviral Therapy) II is a multicenter, longitudinal cohort study aimed at the evaluation of cardiovascular risk among advanced HIV-positive, treatment-naïve patients starting their first therapy. We hypothesized that these patients, present a higher cardiovascular (CV) risk. METHODS The study included all consecutive naïve patients with less than 200 CD4 cells/ml starting antiretroviral therapy. Our primary objective was to evaluate changes in carotid intima- media thickness (IMT). Secondary endpoints included changes in flow mediated vasodilation (FMD), inflammatory markers, triglycerides and cholesterol. Patients were evaluated at time 0, and after 3, 6 and 12 months. RESULTS We enrolled 119 patients, stratified into three different groups: patients receiving atazanavir/ritonavir boosted (ATV/r) based regimens, efavirenz (EFV) based regimens and darunavir/ritonavir boosted (DRV/r) based regimens. At baseline, advanced naïve patients showed a relevant deterioration of CV conditions in terms of traditional CV risk factors, endothelial dysfunction and serum biomarkers. During the 12-month follow up period, mean blood lipids significantly increased: total cholesterol from 159 to 190 mg/dL, HDL-C from 31 to 41 mg/dL, and LDL-C from 99 to 117 mg/dL. D-dimers steadily decreased (median level 624 at baseline and 214 at T3), whereas ICAM and VCAM consistently raised. DRV/r and ATV/r determined a more marked decrease of D-dimers as compared to EFV. Regarding the epi-aortic changes (IMT >1 mm or presence of atherosclerotic plaques), patients in the DRV/r group were at risk of developing pathological IMT during the study (OR 6.0, 95% CI 0.9-36.9), as compared to EFV ones. CONCLUSIONS CV risk was elevated in advanced naïve patients and tended to remain high in the first year of therapy.
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Affiliation(s)
- Paolo Maggi
- Institute of Infectious Diseases, University of Bari, Policlinico Consorziale, Bari, Italy.
| | - Chiara Bellacosa
- Institute of Infectious Diseases, University of Bari, Policlinico Consorziale, Bari, Italy
| | - Armando Leone
- Institute of Infectious Diseases, University of Bari, Policlinico Consorziale, Bari, Italy
| | - Anna Volpe
- Institute of Infectious Diseases, University of Bari, Policlinico Consorziale, Bari, Italy
| | - Elena Delfina Ricci
- CISAI (Coordinamento Italiano per lo Studio dell'Allergia in Infezione da HIV), Italy
| | - Nicoletta Ladisa
- Institute of Infectious Diseases, University of Bari, Policlinico Consorziale, Bari, Italy
| | | | | | - Rosaria Viglietti
- Department of Infectious Diseases, Ospedale Cotugno Napoli3, Napoli, Italy
| | - Antonio Chirianni
- Department of Infectious Diseases, Ospedale Cotugno Napoli3, Napoli, Italy
| | | | - Renato Maserati
- Institute of Infectious Diseases, Policlinico San Matteo, Pavia, Italy
| | - Canio Martinelli
- Institute of Infectious Diseases, Ospedale Careggi, Firenze, Italy
| | - Paola Corsi
- Institute of Infectious Diseases, Ospedale Careggi, Firenze, Italy
| | | | - Federica Sozio
- Department of Infectious Diseases, Ospedale Civile Spirito Santo, Pescara, Italy
| | - Gioacchino Angarano
- Institute of Infectious Diseases, University of Bari, Policlinico Consorziale, Bari, Italy
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Esposito V, Perna A, Lucariello A, Carleo MA, Viglietti R, Sangiovanni V, Coppola N, Guerra G, De Luca A, Chirianni A. Different Impact Of Antiretroviral Drugs On Bone Differentiation In An In Vitro Model. J Cell Biochem 2016; 116:2188-94. [PMID: 25808410 DOI: 10.1002/jcb.25169] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [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: 12/16/2014] [Accepted: 03/19/2015] [Indexed: 11/07/2022]
Abstract
Recently increasing emphasis is placed on preventive health and management of chronic comorbidities avoiding long-term toxicities of antiretroviral therapy (ART). Drawing from this background we decided to use the Saos-2, osteosarcoma cell line, as a cellular model, to evaluate the effects of some antiretroviral drugs such as abacavir (ABC), tenofovir (TDF), efavirenz (EFV), etravirine (ETR), and darunavir (DRV), on bone differentiation related pathways. According to our observation, treatment with TDF and ABC affects the ability of the cells to produce calcium deposits with a reduced expression of type I collagen gene and p21 mRNA, also increasing the activity of Wnt3a related pathway. On the other hand treatment with EFV and DRV was not related to any significant reduction of calcium deposits but displayed a decrease in the expression of Wnt3a at day 14 and Type I Collagen at day 7 compared with untreated cells, even if this last down regulation was not confirmed at day 14. Instead ETR administration to Saos-2 cells increases the calcium deposits collagen type I production, as a result of Wnt3a mRNA overexpression, and of an upregulation of collagen type I expression, being also the only drug able to increase the expression of p21 cdk inhibitor as further marker of terminal differentiation. In summary these data suggest the potential negative interference of TDF and ABC on bone differentiation. DRV and EFV partially affect collagen type I production, instead ETR facilitates a positive bone balance as a result of an increased osteoblasts terminal differentiation.
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Affiliation(s)
| | - Angelica Perna
- Department of Mental and Physical Health and Preventive Medicine, Section of Human Anatomy, Second University of Naples, Italy
| | - Angela Lucariello
- Department of Mental and Physical Health and Preventive Medicine, Section of Human Anatomy, Second University of Naples, Italy
| | | | | | | | - Nicola Coppola
- Department of Mental and Physical Health and Preventive Medicine, Section of Infection Diseases, Second University of Naples, Italy
| | - Germano Guerra
- Department of Health Sciences, University of Molise, Campobasso
| | - Antonio De Luca
- Department of Mental and Physical Health and Preventive Medicine, Section of Human Anatomy, Second University of Naples, Italy
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Carleo MA, Del Giudice A, Viglietti R, Rosario P, Esposito V. Aortic Valve Endocarditis Caused by Abiotrophia defectiva: Case Report and Literature Overview. In Vivo 2015; 29:515-518. [PMID: 26359407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
UNLABELLED Abiotrophia defectiva or nutritionally variant Streptococcus (NVS) are a rare but important cause of infectious endocarditis, with high rates of bacteriological failure and mortality. We report the case of a 74-year-old man admitted for fever, fatigue and general malaise in the absence of any underlying cardiac, immunosuppressive illness and previous dental manipulations. Transthoracic and transesophageal echocardiogram revealed bacterial vegetation and significant aortic stenosis and regurgitation. Initial blood culture reported gram-positive cocci in chains, subsequently identified as A. defectiva. The patient completed 6 weeks of antibiotic therapy with ampicillin, with a significant decrease of serum inflammatory markers. He refused cardiac surgery and had relapsing endocarditis with positive blood culture for the same pathogen. The patient was then submitted to double-valve cardiac surgery, obtaining a prompt resolution of clinical signs and symptoms, without other relapse or any complications. CONCLUSION Infectious diseases caused by A. defectiva are extremely rare illnesses. Due to the difficult isolation of the pathogen and the slow clinical progression, clinicians should be aware of this bacterium when dealing with blood culture-negative infective endocarditis.
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Affiliation(s)
- Maria Aurora Carleo
- Third Unit of Infectious Diseases, D. Cotugno Hospital, A.O. Dei Colli, Naples, Italy
| | | | - Rosaria Viglietti
- Third Unit of Infectious Diseases, D. Cotugno Hospital, A.O. Dei Colli, Naples, Italy
| | - Pietro Rosario
- Fifth Unit of Infectious Diseases, D. Cotugno Hospital, A.O. Dei Colli, Naples, Italy
| | - Vincenzo Esposito
- Fifth Unit of Infectious Diseases, D. Cotugno Hospital, A.O. Dei Colli, Naples, Italy
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Carleo MA, Di Martino F, Del Giudice A, Gargiulo M, Parrella G, Rosario P, Sangiovanni V, Viglietti R, Esposito V, Chirianni A. Different impact of anti-retroviral regimen containing protease inhibitors on development of HIV-related Kaposi sarcoma. In Vivo 2015; 29:133-136. [PMID: 25600542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND The incidence of Kaposi's sarcoma (KS), an AIDS-related malignancy, has dramatically decreased in the Highly Active Anti-retroviral Therapy (HAART) era. However, KS remains the second most frequent tumor in HIV-infected patients worldwide and has become the most common cancer in the sub-Saharan Africa. Experimental studies have demonstrated a direct anti-neoplastic effect of HAART, and overall of protease inhibitors (PIs), on KS. CASE REPORT We describe five cases of KS in HIV-infected patients on HAART regimen, containing PIs as atazanavir/r (ATV/r), darunavir/r (DRV/r), lopinavir/r (LPV/r) and fosamprenavir (fAMP/r). CONCLUSION Clinical and experimental observations support the hypothesis that PIs may play an important role in prevention and treatment of KS. In our study, the treatment with PIs of recent generation was not protective against the development of KS. Therefore, it could be necessary to re-evaluate the therapeutic effects of PIs and their role in the development and treatment of KS in HIV-infected patients.
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Affiliation(s)
- Maria Aurora Carleo
- Fifth Unit of Infectious Diseases, "D. Cotugno" Hospital, A.O. Dei Colli, Naples, Italy
| | - Filomena Di Martino
- Third Unit of Infectious Diseases, "D. Cotugno" Hospital, A.O. Dei Colli, Naples, Italy
| | | | - Miriam Gargiulo
- Third Unit of Infectious Diseases, "D. Cotugno" Hospital, A.O. Dei Colli, Naples, Italy
| | - Giovanni Parrella
- Third Unit of Infectious Diseases, "D. Cotugno" Hospital, A.O. Dei Colli, Naples, Italy
| | - Pietro Rosario
- Fifth Unit of Infectious Diseases, "D. Cotugno" Hospital, A.O. Dei Colli, Naples, Italy
| | - Vincenzo Sangiovanni
- Third Unit of Infectious Diseases, "D. Cotugno" Hospital, A.O. Dei Colli, Naples, Italy
| | - Rosaria Viglietti
- Third Unit of Infectious Diseases, "D. Cotugno" Hospital, A.O. Dei Colli, Naples, Italy
| | - Vincenzo Esposito
- Fifth Unit of Infectious Diseases, "D. Cotugno" Hospital, A.O. Dei Colli, Naples, Italy
| | - Antonio Chirianni
- Third Unit of Infectious Diseases, "D. Cotugno" Hospital, A.O. Dei Colli, Naples, Italy
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Parrella R, Esposito V, Onofrio M, Parrella G, Viglietti R, Sangiovanni V, Gargiulo M, Di Martino F, Del Giudice A, Santoro G, Bernardo M, Carleo MA, Chirianni A. Interferon gamma release assays and tubercolin skin test performance in different settings of HIV immunodeficiency. In Vivo 2015; 29:137-140. [PMID: 25600543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND/AIM HIV infection is a risk factor for re-activation of latent tubercolosis infection (LTBI). In recent years new blood tests for the detection of TB infection have been developed: Quantiferon TB Gold in Tube and TSPOT TB, which are interferon-γ releasing assays (IGRAs), have improved the identification of LTBI. In our study we have compared IGRAs and TST in HIV-positive patients with different settings of immunodeficiency. PATIENTS AND METHODS 98 consecutive HIV patients were recruited. They underwent a blood draw, a chest radiography and a tuberculin skin test. The HIV infection setting was detected and IGRAs were carried-out. Five patients showed a complete correspondence of TST, TSPOT-TB and QFT-IT. Discordant results were observed in patients testing positive to IGRAs but negative to TST. Only 2 patients showed positive TST and negative IGRAs. CONCLUSION Our study showed a poor concordance between tuberculin skin test and IGRAs, mainly in patients with a low CD4 cell count.
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Affiliation(s)
- Roberto Parrella
- Third Department of Infectious Diseases- D. Cotugno Hospital- AORN dei Colli, Naples, Italy
| | - Vincenzo Esposito
- Third Department of Infectious Diseases- D. Cotugno Hospital- AORN dei Colli, Naples, Italy
| | - Mirella Onofrio
- Third Department of Infectious Diseases- D. Cotugno Hospital- AORN dei Colli, Naples, Italy
| | - Giovanni Parrella
- Third Department of Infectious Diseases- D. Cotugno Hospital- AORN dei Colli, Naples, Italy
| | - Rosaria Viglietti
- Third Department of Infectious Diseases- D. Cotugno Hospital- AORN dei Colli, Naples, Italy
| | - Vincenzo Sangiovanni
- Third Department of Infectious Diseases- D. Cotugno Hospital- AORN dei Colli, Naples, Italy
| | - Miriam Gargiulo
- Third Department of Infectious Diseases- D. Cotugno Hospital- AORN dei Colli, Naples, Italy
| | - Filomena Di Martino
- Third Department of Infectious Diseases- D. Cotugno Hospital- AORN dei Colli, Naples, Italy
| | - Annalisa Del Giudice
- Unit of Microbiology and Virology- D. Cotugno Hospital- AORN dei Colli, Naples, Italy
| | - Giulia Santoro
- Unit of Microbiology and Virology- D. Cotugno Hospital- AORN dei Colli, Naples, Italy
| | - Mariano Bernardo
- Unit of Microbiology and Virology- D. Cotugno Hospital- AORN dei Colli, Naples, Italy
| | - Maria Aurora Carleo
- Third Department of Infectious Diseases- D. Cotugno Hospital- AORN dei Colli, Naples, Italy
| | - Antonio Chirianni
- Third Department of Infectious Diseases- D. Cotugno Hospital- AORN dei Colli, Naples, Italy
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13
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Esposito V, Verdina A, Manente L, Spugnini EP, Viglietti R, Parrella R, Pagliano P, Parrella G, Galati R, De Luca A, Baldi A, Montesarchio V, Chirianni A. Amprenavir inhibits the migration in human hepatocarcinoma cell and the growth of xenografts. J Cell Physiol 2012; 228:640-5. [DOI: 10.1002/jcp.24173] [Citation(s) in RCA: 16] [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: 04/17/2012] [Accepted: 07/31/2012] [Indexed: 11/08/2022]
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Esposito V, Manente L, Lucariello A, Perna A, Viglietti R, Gargiulo M, Parrella R, Parrella G, Baldi A, De Luca A, Chirianni A. Role of FAP48 in HIV‐associated lipodystrophy. J Cell Biochem 2012; 113:3446-54. [DOI: 10.1002/jcb.24221] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
| | - Lucrezia Manente
- Department of Medicine and Public Health, Second University of Naples, Naples, Italy
| | - Angela Lucariello
- Department of Medicine and Public Health, Second University of Naples, Naples, Italy
| | - Angelica Perna
- Department of Medicine and Public Health, Second University of Naples, Naples, Italy
| | | | | | | | | | - Alfonso Baldi
- Department of Biochemistry, Section of Pathology, Second University of Naples, Naples, Italy
| | - Antonio De Luca
- Department of Medicine and Public Health, Second University of Naples, Naples, Italy
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15
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Esposito V, Manente L, Viglietti R, Parrella G, Parrella R, Gargiulo M, Sangiovanni V, Perna A, Baldi A, De Luca A, Chirianni A. Comparative transcriptional profiling in HIV-infected patients using human stress arrays: clues to metabolic syndrome. In Vivo 2012; 26:237-242. [PMID: 22351664] [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: 05/31/2023]
Abstract
Highly active antiretroviral therapy (HAART therapy) for HIV-1 infection has significantly increased the survival and quality of life of patients with this disease. However, in several epidemiological studies the onset of metabolic syndrome is a phenomenon reported to be extremely frequent. In the present study, genes involved in the molecular cascade responsible for the alteration of fat tissue and of lipid and glucose metabolism in patients with HIV-1 infection treated with antiretroviral therapy were identified. Towards this goal, hybridization using Atlas cDNA Expression Arrays allowed simultaneous monitoring of the expression levels of approximately 250 genes and identification of a panel of changes in relation to different therapeutic groups and in the presence of metabolic syndrome, with some genes being up-regulated, while others are down-regulated in the different subgroups of patients. The results of this analysis have shown a panel of transcriptional changes associated with oxidative stress mechanisms that provide a basis for further studies on understanding of mechanisms that, in vivo, are the foundation the metabolic disorders in patients with HIV infection.
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Manente L, Lucariello A, Costanzo C, Viglietti R, Parrella G, Parrella R, Gargiulo M, De Luca A, Chirianni A, Esposito V. Suppression of pre adipocyte differentiation and promotion of adipocyte death by anti-HIV drugs. In Vivo 2012; 26:287-291. [PMID: 22351671] [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: 05/31/2023]
Abstract
In the present study, we investigated the ability of anti-HIV drugs to interfere with normal cell cycle progression and to induce oxidative stress by perturbing the redox environment. Our results provide evidence that anti-HIV drugs have a differential effect on adipocyte cell cycle and differentiation, being able to modify the response to oxidative stress through an increase of reactive oxygen species (ROS) that compromises the induction of phase-2 and antioxidant enzymes. In detail, saquinavir, efavirenz, and stavudine exert antiadipogenic influences on the model 3T3-L1 cell line, perturbing the oxidative response and inducing of apoptosis. When considered together, the effects of anti-HIV drugs on 3T3-L1 pre adipocytes are distinct but commonly antiadipogenic, thus suggesting another additional possible mechanism by which antiretroviral therapies could contribute to lipoatrophy.
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Affiliation(s)
- Lucrezia Manente
- Department of Medicine and Public Health, Section of Human Anatomy, Second University of Naples, Naples, Italy
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Esposito V, Chiodini P, Viglietti R, Parrella R, Parrella G, Maddaloni A, Sangiovanni V, Gargiulo M, Abrescia N, Chirianni A. Safety of fosamprenavir in a cohort of HIV-1-infected patients with co-morbidities. In Vivo 2011; 25:813-819. [PMID: 21753139] [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: 05/31/2023]
Abstract
BACKGROUND The hypothesis that fosamprenavir-including highly active antiretroviral therapy (HAART) regimens would be associated with few metabolic and hepatic side-effects was investigated. PATIENTS AND METHODS An observational single-arm retrospective study was set up on a cohort of 139 human immunodeficiency virus (HIV)-infected patients, followed up at A.O.R.N. Cotugno Hospital, Naples, Italy, treated with antiretroviral regimens including fosamprenavir, in order to evaluate the safety of these regimens in relationship to hepatic and metabolic side-effects, also considering co-morbidities and other risk factors. RESULTS Only seven patients met the criteria to reach the primary end-point (grade ≥ 3 adverse event) and none of them discontinued HAART therapy during the follow-up period. Eighty percent of the patients reached viral load <50 cp/μl at 48 weeks of observation. At the end of follow-up, no patient with fasting serum total cholesterol and/or fasting serum triglycerides above grade 3 was found, while 1 out of 114 (0.88%) cases presented aspartate transaminase and alanine transaminase ≥ grade 3 and 1 out of 114 (0.88%) cases had fasting serum glucose ≥ grade 3. One out of 137 patients developed a malignant neoplasm (0.73%) and 4 (2.92%) displayed newly diagnosed hypertension. CONCLUSION Fosamprenavir-based regimens caused a low number of serious metabolic adverse events during a 48 week follow-up period, with a low incidence of co-morbidities and satisfying results in terms of viro-immunological response including for patients with already existing co-morbidities requiring other therapies.
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Affiliation(s)
- Vincenzo Esposito
- III Division of Infectious Diseases A.O.R.N. Cotugno, Via G. Quagliariello 54, 80131 Naples, Italy.
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Esposito V, Viglietti R, Gargiulo M, Parrella R, Onofrio M, Sangiovanni V, Ambrosino D, Chirianni A. Successful treatment of Cryptococcal meningitis with a combination of liposomal amphotericin B, flucytosine and posaconazole: two case reports. In Vivo 2009; 23:465-468. [PMID: 19454515] [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: 05/27/2023]
Abstract
Cryptococcus neoformans CNS infection frequently affects HIV-infected patients and is often lethal, despite antifungal therapy. The most recent treatment guidelines for Cryptococcal meningitis recommend therapy with lyposomal amphotericin B and possible association with flucitosine. However, clinical response rates in HIV-infected patients are not satisfactory, with a persistent high mortality rate and long term therapy is affected by a high risk of major side effects. Posaconazole, the latest broad-spectrum azole, with both in vitro- and in vivo-documented potent activity against C. neoformans, clearly showed no antagonism with amphotericin B, echinocandins or flucytosine and it has both in vitro and in vivo agonistic activity with flucytosine against C. neoformans. We report two cases of successful salvage therapy based on the addition of posaconazole to a standard treatment based on liposomal amphotericin B and Flucytosine. In addition we used posaconazole also in a maintenance therapeutic regimen with no evidence of recurrences in the follow up of these patients. Our report confirms that posaconazole has clinical activity in the CNS against C. neoformans infection. In addition posaconazole showed no antagonism with any other currently available antifungal agent, and was in fact synergistic to some of them (flucytosine); consequently, it seems to be an ideal candidate for antimicrobial combination salvage therapies. Finally posaconazole represents a good alternative to parenteral therapy and an ideal candidate for long-term maintenance therapy due to its competent toxicity profile and oral bioavailability.
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Affiliation(s)
- V Esposito
- III U.O. di Malattie Infettive A.O. Cotugno, Via T. Tasso, Napoli, Italy.
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Esposito V, Manente L, Perna A, Gargiulo M, Viglietti R, Sangiovanni V, Doula N, Liuzzi G, Baldi A, De Luca A, Chirianni A. Role of NEDD8 in HIV-associated lipodystrophy. Differentiation 2009; 77:148-53. [DOI: 10.1016/j.diff.2008.09.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2008] [Revised: 07/14/2008] [Accepted: 08/14/2008] [Indexed: 10/20/2022]
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Di Nicuolo G, Battisti S, La Porta R, Starace M, Gargiulo M, Viglietti R. CONFRONTO TRA DATABASE ONLINE PER LA SOTTOTIPIZZAZIONE DI SEQUENZE HVI-1. Microbiol Med 2006. [DOI: 10.4081/mm.2006.3217] [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: 11/23/2022] Open
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Ancarani F, Angeli E, Antinori A, Antonucci G, Bonasso M, Bruno R, Capobianchi MR, Cargnel A, Cozzi-Lepri A, Monforte AD, Cingolani A, Galli M, Orofino GC, Girardi E, Marino N, Bongiovanni M, Morsica G, Narciso P, Pastecchia C, Pizzaferri P, Puoti M, Santantonio T, Verucchi G, Montroni M, Scalise G, Braschi MC, Maracci M, Tirelli U, Cinelli R, Pastore G, Ladisa N, Minafra G, Suter F, Arici C, Chiodo F, Colangeli V, Fiorini C, Coronado O, Carosi G, Cadeo GP, Torti C, Minardi C, Bertelli D, Rizzardini G, Migliorino G, Manconi PE, Piano P, Ferraro T, Scerbo A, Pizzigallo E, D'Alessandro M, Santoro D, Pusterla L, Carnevale G, Galloni D, Viganò P, Mena M, Ghinelli F, Sighinolfi L, Leoncini F, Mazzotta F, Pozzi M, Caputo SL, Angarano G, Grisorio B, Saracino A, Ferrara S, Grima P, Tundo P, Pagano G, Cassola G, Alessandrini A, Piscopo R, Toti M, Chigiotti S, Soscia F, Tacconi L, Orani A, Perini P, Scasso A, Vincenti A, Chiodera F, Castelli P, Scalzini A, Fibbia G, Moroni M, Lazzarin A, Cargnel A, Vigevani GM, Caggese L, Monforte AD, Repetto D, Novati R, Galli A, Merli S, Pastecchia C, Moioli MC, Esposito R, Mussini C, Abrescia N, Chirianni A, Izzo CM, Piazza M, De Marco M, Viglietti R, Manzillo E, Graf M, Colomba A, Abbadessa V, Prestileo T, Mancuso S, Ferrari C, Pizzaferri P, Filice G, Minoli L, Bruno R, Novati S, Baldelli F, Tinca M, Petrelli E, Cioppi A, Alberici F, Ruggieri A, Menichetti F, Martinelli C, De Stefano C, La Gala A, Ballardini G, Briganti E, Magnani G, Ursitti MA, Arlotti M, Ortolani P, Cauda R, Dianzani F, Ippolito G, Antinori A, Antonucci G, D'Elia S, Narciso P, Petrosillo N, Vullo V, De Luca A, Di Giambenedetti S, Zaccarelli M, Acinapura R, De Longis P, Ciardi M, D'Offizi G, Trotta MP, Noto P, Lichtner M, Capobianchi MR, Girardi E, Pezzotti P, Rezza G, Mura MS, Mannazzu M, Resta F, Loso K, Caramello P, Sinicco A, Soranzo ML, Orofino G, Sciandra M, Bonasso M, Grossi PA, Basilico C, Poggio A, Bottari G, Raise E, Pasquinucci S, De Lalla F, Tositti G, Lepri AC, Solmone M, Girardi E, Lalle E, Abbate I, Monforte AD, Cozzi-Lepri A, Alessandrini A, Piscopo R, Ebo F, Cosco L, Antonucci G, Ippolito G, Capobianchi MR. Evolution of HVR-1 Quasispecies after 1-Year Treatment in HIV/HCV-Coinfected Patients According to the Pattern of Response to Highly Active Antiretroviral Therapy. Antivir Ther 2006. [DOI: 10.1177/135965350601100102] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Hepatitis C virus (HCV) variability is mainly attributed to the ability of the virus to respond to host immune pressure, acting as a driving force for the evolution of quasispecies. This study was aimed at studying the changes in HVR-1 heterogeneity and the evolution of HCV quasispecies in HIV/HCV-coinfected patients according to the pattern of response to highly active antiretroviral therapy (HAART). Sixteen HIV/HCV-coinfected patients harbouring HCV genotype 1 and who had been on HAART for at least 1 year, 8 showing increasing CD4+T-cell counts (immunological responders) and 8 showing a stable or decreasing CD4+ T-cell counts (immunological non-responders), were selected from a prospective cohort study. After 1 year of HAART, 11 patients showed HIV viral load <2.6 log10 cp/ml (virological responders), and 5 showed HIV viral load above this value (virological non-responders). Plasma samples, collected before starting therapy and after 1 year of HAART, underwent clonal sequence analysis for HVR-1 region of HCV. Non-synonymous/synonymous substitutions ratio (Ka/Ks), aminoacidic complexity (normalized Shannon entropy) and diversity (p-distance), were considered as parameters of quasispecies heterogeneity. After 1 year of HAART, heterogeneity of HVR-1 quasispecies significantly decreased in virological non-responders, whereas the heterogeneity tended to increase in virological responders. The differences in the evolution were less stringent, when considering immunological response. On the other hand, profound qualitative modifications of HVR-1 quasispecies were observed only in patients with both immunological and virological HAART response. On the whole, these findings suggest that, in patients undergoing HAART, the extent of HCV variability and the evolution of HVR-1 quasispecies is influenced by the pattern of response to antiretroviral therapy.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Enrico Girardi
- National Institute of Infectious Diseases “L. Spallanzani”, Rome
| | - Eleonora Lalle
- National Institute of Infectious Diseases “L. Spallanzani”, Rome
| | - Isabella Abbate
- National Institute of Infectious Diseases “L. Spallanzani”, Rome
| | | | - Alessandro Cozzi-Lepri
- Department of Primary Care and Population Sciences, Royal Free and University College Medical School, London
| | | | - Rita Piscopo
- Department of Infectious Diseases, Galliera Hospital, Genova
| | - Francesca Ebo
- Department of Infectious Diseases, Hosp Civile San Giovanni e Paolo, Venezia
| | - Lucio Cosco
- Department of Infectious Diseases, A. Pugliesi Catanzaro
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Antonucci G, Girardi E, Cozzi-Lepri A, Capobianchi MR, Morsica G, Pizzaferri P, Ladisa N, Sighinolfi L, Chiodera A, Solmone M, Lalle E, Ippolito G, Monforte AD, Ancarani F, Antinori A, Antonucci G, Bonasso M, Bruno R, Capobianchi MR, Cargnel A, Cozzi-Lepri A, d'Arminio Monforte A, Luca AD, Galli M, Gennero L, Girardi E, Lipani F, Marino N, Milazzo L, Morsica G, Narciso P, Pizzaferri P, Puoti M, Santantonio T, Verucchi G, Montroni M, Scalise G, Braschi MC, Prete MSD, Tirelli U, Cinelli R, Pastore G, Ladisa N, Suter GMBF, Arici C, Chiodo F, Colangeli V, Fiorini C, Coronado O, Carosi G, Cadeo GP, Torti C, Minardi C, Bertelli D, Rizzardini G, Migliorino G, Manconi PE, Piano P, Ferraro T, Scerbo A, Pizzigallo E, D'Alessandro M, Santoro D, Pusterla L, Carnevale G, Galloni D, Viganò P, Mena M, Ghinelli F, Sighinolfi L, Leoncini F, Mazzotta F, Pozzi M, Caputo SL, Angarano G, Grisorio B, Saracino A, Ferrara S, Grima P, Tundo P, Pagano G, Cassola G, Alessandrini A, Piscopo R, Toti M, Chigiotti S, Soscia F, Tacconi L, Orani A, Perini P, Scasso A, Vincenti A, Chiodera F, Castelli P, Scalzini A, Fibbia G, Moroni M, Lazzarin A, Cargnel A, Vigevani GM, Caggese L, Monforte AD, Repetto D, Novati R, Galli A, Merli S, Pastecchia C, Moioli MC, Esposito R, Mussini C, Abrescia N, Chirianni A, Izzo CM, Piazza M, Marco MD, Viglietti R, Manzillo E, Graf M, Colomba A, Abbadessa V, Prestileo T, Mancuso S, Ferrari C, Pizzaferri P, Filice G, Minoli L, Bruno R, Novati S, Baldelli F, Tinca M, Petrelli E, Cioppi A, Alberici F, Ruggieri A, Menichetti F, Martinelli C, Stefano CD, Gala AL, Ballardini G, Briganti E, Magnani G, Ursitti MA, Arlotti M, Ortolani P, Cauda R, Dianzani F, Ippolito G, Antinori A, Antonucci G, D'Elia S, Narciso P, Petrosillo N, Vullo V, Luca AD, Giambenedetti SD, Zaccarelli M, Acinapura R, Longis PD, Ciardi M, D'Offizi G, Trotta MP, Noto P, Lichtner M, Capobianchi MR, Girardi E, Pezzotti P, Rezza G, Mura MS, Mannazzu M, Resta F, Loso K, Caramello P, Sinicco A, Soranzo ML, Orofino G, Sciandra M, Bonasso M, Grossi PA, Basilico C, Poggio A, Bottari G, Raise E, Pasquinucci S, Lalla FD, Tositti G, Lepri AC. Response to Haart and Gb Virus Type C Coinfection in a Cohort of Antiretroviral-Naive HIV-Infected Individuals. Antivir Ther 2005. [DOI: 10.1177/135965350501000108] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The prognostic role of GB virus type C (GBV-C) viraemia in HIV-infected subjects treated with highly active antiretroviral therapy (HAART) is still undefined, The aim of this analysis is to assess the relationship between GBV-C infection and response to antiretroviral therapy among HIV-infected subjects initiating HAART when antiretroviral-naive. A prospective, observational study of 400 HIV-infected patients with measurements of GBV-C RNA, hepatitis C virus (HCV) antibodies and HCV RNA determined from plasma stored prior to HAART initiation, Time to virological (achieving HIV RNA ≤500 copies/ml) and immunological success (a CD4+ count increase of ≥200cells/μl), and the time to virological relapse (confirmed HIV RNA >500 copies/ml) were assessed by Kaplan-Meier methods and Cox proportional hazard regression model. Of the subjects, 117 (29.3%) were GBV-C positive and, overall, 351 (87.8%) patients achieved virological success, After controlling for a number of confounders including HCV RNA, GBV-C viraemic patients experienced a significantly lower risk of HIV rebound than those who were GBV-C negative [relative hazard (RH)=0.56, 95% CI: 0.34–0.93, P=0.03], Conversely, the probability of achieving initial virological success or CD4+ count response after HAART did not differ between GBV-C-negative and -positive subjects, These results suggest that GBV-C coinfection may play a role in determining the rate of HIV rebound possibly by competing with HIV replication after HIV load has been successfully suppressed by HAART.
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Affiliation(s)
| | - Giorgio Antonucci
- National Institute of Infectious Diseases, L Spallanzani, Roma, Italy
| | - Enrico Girardi
- National Institute of Infectious Diseases, L Spallanzani, Roma, Italy
| | - Alessandro Cozzi-Lepri
- Department of Primary Care and Population Sciences, Royal Free and University College Medical School, London, UK
| | | | - Giulia Morsica
- Institute of Infectious Diseases, Ateneo Vita e Salute, S Raffaele Hospital, Milano, Italy
| | - Paolo Pizzaferri
- Department of Infectious Diseases and Hepatology, Azienda Ospedaliera, Parma, Italy
| | - Nicoletta Ladisa
- Institute of Infectious and Tropical Diseases, University of Bari, Bari, Italy
| | - Laura Sighinolfi
- Department of Infectious Diseases, Arcispedale S Anna, Ferrara, Italy
| | | | | | - Eleonora Lalle
- National Institute of Infectious Diseases, L Spallanzani, Roma, Italy
| | - Giuseppe Ippolito
- National Institute of Infectious Diseases, L Spallanzani, Roma, Italy
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Abrescia N, D'Abbraccio M, Figoni M, Busto A, Butrico E, De Marco M, Viglietti R. Fulminant hepatic failure after the start of an efavirenz-based HAART regimen in a treatment-naive female AIDS patient without hepatitis virus co-infection. J Antimicrob Chemother 2002; 50:763-5. [PMID: 12407142 DOI: 10.1093/jac/dkf204] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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