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Colaneri M, Scaglione G, Fassio F, Galli L, Lai A, Bergna A, Gabrieli A, Tarkowski M, Ventura CD, Colombo V, Cordier L, Bernasconi D, Corbellino M, Dedivitiis G, Borghetti S, Visigalli D, Sollima S, Casalini G, Rizzardini G, Gori A, Antinori S, Riva A, Schiavini M. Early administration of nirmatrelvir/ritonavir leads to faster negative SARS-CoV-2 nasal swabs than monoclonal antibodies in COVID 19 patients at high-risk for severe disease. Virol J 2024; 21:68. [PMID: 38509536 PMCID: PMC10953281 DOI: 10.1186/s12985-024-02333-x] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 02/28/2024] [Indexed: 03/22/2024] Open
Abstract
PURPOSE Besides the well-established efficacy in preventing severe COVID-19, the impact of early treatments, namely antivirals and monoclonal antibodies (mAbs), on the time length to negativization of SARS-CoV-2 nasal swabs is still unclear. The aim of this study was to compare the efficacy of different early treatments in reducing the SARS-CoV-2 viral shedding, identifying a single drug that might potentially lead to a more rapid negativization of SARS-CoV-2 nasal swab. METHODS This was a single-centre, retrospective, observational study conducted at Ospedale Luigi Sacco in Milan. Data of high-risk COVID-19 patients who received early treatments between 23 December 2021 and March 2023 were extracted. The comparison across treatments was conducted using the Kruskall-Wallis test for continuous variables. Dunn's test with Bonferroni adjustment was performed for post-hoc comparisons of days to negativization. Secondly, a negative binomial regression adjusted for age, sex, number of comorbidities, immunosuppression, and SARS-CoV-2 vaccination status was implemented. RESULTS Data from 428 patients receiving early treatments were collected. The majority were treated with Nirmatrelvir/Ritonavir and were affected by SARS-CoV-2 Omicron infection with BA.2 sublineage. The median length time to SARS-CoV-2 nasal swab negativization was 9 days [IQR 7-13 days]. We found that Nirmatrelvir/Ritonavir determined a significant decrease of the length time to SARS-CoV-2 nasal swab negativization compared to mAbs (p = 0.003), but not compared to Remdesivir (p = 0.147) and Molnupiravir (p = 0.156). CONCLUSION Our findings highlight the importance of promptly treating high-risk COVID-19 patients with Nirmatrelvir/Ritonavir, as it also contributes to achieving a faster time to negative SARS-CoV-2 nasal swabs.
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Affiliation(s)
- Marta Colaneri
- Department of Infectious Diseases, Unit II, L. Sacco Hospital, ASST Fatebenefratelli Sacco, Milan, Italy
- Centre for Multidisciplinary Research in Health Science (MACH), University of Milan, Milan, Italy
| | - Giovanni Scaglione
- Department of Infectious Diseases, Unit II, L. Sacco Hospital, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Federico Fassio
- Department of Public Health, Experimental and Forensic Medicine, Unit of Biostatistics and Clinical Epidemiology, University of Pavia, Pavia, Italy
| | - Lucia Galli
- Department of Infectious Diseases, Unit II, L. Sacco Hospital, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Alessia Lai
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Annalisa Bergna
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Arianna Gabrieli
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Maciej Tarkowski
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Carla Della Ventura
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Valeria Colombo
- Department of Infectious Diseases, Unit I, L. Sacco Hospital, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Laura Cordier
- Department of Infectious Diseases, Unit II, L. Sacco Hospital, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Davide Bernasconi
- Department of Infectious Diseases, Unit II, L. Sacco Hospital, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Mario Corbellino
- Institute of Infectious Diseases & Tropical Medicine, III Division, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milan, Italy
| | - Gianfranco Dedivitiis
- Department of Infectious Diseases, Unit II, L. Sacco Hospital, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Silvia Borghetti
- Pharmacy Unit, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milan, Italy
| | - Debora Visigalli
- Pharmacy Unit, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milan, Italy
| | - Salvatore Sollima
- Institute of Infectious Diseases & Tropical Medicine, III Division, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milan, Italy
| | - Giacomo Casalini
- Institute of Infectious Diseases & Tropical Medicine, III Division, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milan, Italy
| | - Giuliano Rizzardini
- Department of Infectious Diseases, Unit I, L. Sacco Hospital, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Andrea Gori
- Department of Infectious Diseases, Unit II, L. Sacco Hospital, ASST Fatebenefratelli Sacco, Milan, Italy
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
- Centre for Multidisciplinary Research in Health Science (MACH), University of Milan, Milan, Italy
| | - Spinello Antinori
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
- Institute of Infectious Diseases & Tropical Medicine, III Division, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milan, Italy
| | - Agostino Riva
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
- Institute of Infectious Diseases & Tropical Medicine, III Division, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milan, Italy
| | - Monica Schiavini
- Department of Infectious Diseases, Unit II, L. Sacco Hospital, ASST Fatebenefratelli Sacco, Milan, Italy.
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Cattaneo D, Sollima S, Meraviglia P, Milazzo L, Minisci D, Fusi M, Filice C, Gervasoni C. Dolutegravir-Based Antiretroviral Regimens for HIV Liver Transplant Patients in Real-Life Settings. Drugs R D 2020; 20:155-160. [PMID: 32189238 PMCID: PMC7221036 DOI: 10.1007/s40268-020-00300-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Background and Objectives Liver transplantation is now considered a safe procedure in patients with HIV because of the advent of potent antiretroviral therapies (ART). Objective We aimed to describe the use of dolutegravir-based maintenance ART in patients with HIV and liver transplant regularly followed in our hospital. Methods We searched the database of our Department of Infectious Diseases for liver transplant recipients receiving calcineurin inhibitor-based maintenance immunosuppression concomitantly treated with dolutegravir for at least 1 month. Results Ten HIV-positive liver transplant recipients were identified. At 4.6 ± 3.5 years post-transplant, all the patients were switched to dolutegravir-based therapies for treatment simplification. However, at 1 year after the switch, five of the ten patients returned to their previous ART regimens because of increased serum transaminases (n = 1), reversible increased serum creatinine (n = 4), repeated episodes of nausea/vomiting (n = 1) and variable out-of-range concentrations of tacrolimus or cyclosporine (n = 2). However, it should be recognized that these events cannot be unequivocally ascribed to dolutegravir and, in the case of increased serum creatinine, are predictable. Conclusions The management of HIV-positive liver transplant recipients in clinical practice is a complex task, where possibility of simplifying antiretroviral regimens must be balanced with the need to guarantee optimal immunosuppression and the finest treatment tolerability. A multidisciplinary approach involving physicians and clinical pharmacologists/pharmacists could help achieve this goal.
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Affiliation(s)
- Dario Cattaneo
- Gestione Ambulatoriale Politerapie (GAP) Outpatient Clinic, ASST Fatebenefratelli Sacco University Hospital, Milan, Italy. .,Unit of Clinical Pharmacology, ASST Fatebenefratelli Sacco University Hospital, Milan, Italy.
| | - Salvatore Sollima
- Department of Infectious Diseases, ASST Fatebenefratelli Sacco University Hospital, Milan, Italy
| | - Paola Meraviglia
- Department of Infectious Diseases, ASST Fatebenefratelli Sacco University Hospital, Milan, Italy
| | - Laura Milazzo
- Department of Infectious Diseases, ASST Fatebenefratelli Sacco University Hospital, Milan, Italy
| | - Davide Minisci
- Department of Infectious Diseases, ASST Fatebenefratelli Sacco University Hospital, Milan, Italy
| | - Marta Fusi
- Unit of Clinical Pharmacology, ASST Fatebenefratelli Sacco University Hospital, Milan, Italy
| | - Carlo Filice
- Infectious Diseases Department, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Cristina Gervasoni
- Gestione Ambulatoriale Politerapie (GAP) Outpatient Clinic, ASST Fatebenefratelli Sacco University Hospital, Milan, Italy.,Department of Infectious Diseases, ASST Fatebenefratelli Sacco University Hospital, Milan, Italy
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Antinori S, Torre A, Antinori C, Bonazzetti C, Sollima S, Ridolfo AL, Galli M. SARS-COV-2 infection: Across the border into the family. Travel Med Infect Dis 2020; 36:101784. [PMID: 32526371 PMCID: PMC7280111 DOI: 10.1016/j.tmaid.2020.101784] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 06/05/2020] [Accepted: 06/06/2020] [Indexed: 01/16/2023]
Affiliation(s)
- Spinello Antinori
- Luigi Sacco Department of Biomedical and Clinical Sciences, University of Milan, Italy; III Division of Infectious Diseases, Department of Infectious Diseases, Luigi Sacco Hospital, ASST Fatebenefratelli Sacco, Milan, Italy.
| | - Alessandro Torre
- III Division of Infectious Diseases, Department of Infectious Diseases, Luigi Sacco Hospital, ASST Fatebenefratelli Sacco, Milan, Italy
| | | | - Cecilia Bonazzetti
- Luigi Sacco Department of Biomedical and Clinical Sciences, University of Milan, Italy; III Division of Infectious Diseases, Department of Infectious Diseases, Luigi Sacco Hospital, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Salvatore Sollima
- III Division of Infectious Diseases, Department of Infectious Diseases, Luigi Sacco Hospital, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Anna Lisa Ridolfo
- III Division of Infectious Diseases, Department of Infectious Diseases, Luigi Sacco Hospital, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Massimo Galli
- Luigi Sacco Department of Biomedical and Clinical Sciences, University of Milan, Italy; III Division of Infectious Diseases, Department of Infectious Diseases, Luigi Sacco Hospital, ASST Fatebenefratelli Sacco, Milan, Italy
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Morena V, Milazzo L, Oreni L, Bestetti G, Fossali T, Bassoli C, Torre A, Cossu MV, Minari C, Ballone E, Perotti A, Mileto D, Niero F, Merli S, Foschi A, Vimercati S, Rizzardini G, Sollima S, Bradanini L, Galimberti L, Colombo R, Micheli V, Negri C, Ridolfo AL, Meroni L, Galli M, Antinori S, Corbellino M. Off-label use of tocilizumab for the treatment of SARS-CoV-2 pneumonia in Milan, Italy. Eur J Intern Med 2020; 76:36-42. [PMID: 32448770 PMCID: PMC7241995 DOI: 10.1016/j.ejim.2020.05.011] [Citation(s) in RCA: 132] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 05/05/2020] [Accepted: 05/06/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Tocilizumab, a humanized monoclonal antibody, targets IL-6 receptors blocking downstream pro-inflammatory effects of IL-6. In preliminary reports it was suggested to be beneficial in patients with severe COVID-19. METHODS In this open-label prospective study we describe clinical characteristics and outcome of 51 patients hospitalized with confirmed and severe COVID-19 pneumonia treated with tocilizumab intravenously. All patients had elevated IL-6 plasma level (>40 pg/mL) and oxygen saturation <93% in ambient air. Clinical outcomes, oxygen support, laboratory data and adverse events were collected over a follow-up of 30 days. RESULTS Forty-five patients (88%) were on high-flow oxygen supplementation, six of whom with invasive ventilation. From baseline to day 7 after tocilizumab we observed a dramatic drop of body temperature and CRP value with a significant increase in lymphocyte count (p<0.001). Over a median follow-up time of 34 days from tocilizumab, 34 patients (67%) showed an improvement in their clinical severity class; 31 were discharged; 17 (33%) showed a worsening of their clinical status, of these 14 died (27%). The mortality rate was significantly associated with mechanical ventilation at baseline (83.3% vs 20% of patients on non-invasive oxygen support; p=0.0001). The most frequent side effects were an increase of hepatic enzymes (29%), thrombocytopenia (14%), and serious bacterial and fungal infections (27%). CONCLUSION Tocilizumab exerts a rapidly beneficial effect on fever and inflammatory markers, although no significant impact on the clinical outcome can be inferred by our results. Critically ill patients seem to have a high risk of serious infections with this drug.
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MESH Headings
- Antibodies, Monoclonal, Humanized/administration & dosage
- Antibodies, Monoclonal, Humanized/adverse effects
- Antiviral Agents/adverse effects
- Betacoronavirus/drug effects
- Betacoronavirus/isolation & purification
- COVID-19
- Coronavirus Infections/blood
- Coronavirus Infections/epidemiology
- Coronavirus Infections/physiopathology
- Coronavirus Infections/therapy
- Female
- Fever/diagnosis
- Fever/drug therapy
- Humans
- Italy/epidemiology
- Lymphocyte Count/methods
- Male
- Middle Aged
- Outcome and Process Assessment, Health Care
- Pandemics
- Pneumonia, Viral/blood
- Pneumonia, Viral/diagnosis
- Pneumonia, Viral/drug therapy
- Pneumonia, Viral/epidemiology
- Pneumonia, Viral/etiology
- Pneumonia, Viral/physiopathology
- Pneumonia, Viral/therapy
- Receptors, Interleukin-6/antagonists & inhibitors
- Respiration, Artificial/methods
- Respiratory Insufficiency/etiology
- Respiratory Insufficiency/therapy
- Retrospective Studies
- SARS-CoV-2
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Affiliation(s)
- Valentina Morena
- Luigi Sacco Department of Biomedical and Clinical Sciences, University of Milan, Italy
| | - Laura Milazzo
- Department of Infectious Diseases, ASST Fatebenefratelli Sacco, Milan, Italy.
| | - Letizia Oreni
- Department of Infectious Diseases, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Giovanna Bestetti
- Department of Infectious Diseases, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Tommaso Fossali
- Department of Anesthesiology and Intensive Care, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milan, Italy
| | - Cinzia Bassoli
- Luigi Sacco Department of Biomedical and Clinical Sciences, University of Milan, Italy
| | - Alessandro Torre
- Department of Infectious Diseases, ASST Fatebenefratelli Sacco, Milan, Italy
| | | | - Caterina Minari
- Department of Anesthesiology and Intensive Care, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milan, Italy
| | - Elisabetta Ballone
- Department of Anesthesiology and Intensive Care, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milan, Italy
| | - Andrea Perotti
- Department of Anesthesiology and Intensive Care, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milan, Italy
| | - Davide Mileto
- Microbiology, Virology and Bioemergence Diagnostics, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Fosca Niero
- Department of Infectious Diseases, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Stefania Merli
- Department of Infectious Diseases, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Antonella Foschi
- Department of Infectious Diseases, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Stefania Vimercati
- Clinical Pathology Laboratory, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Giuliano Rizzardini
- Department of Infectious Diseases, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Salvatore Sollima
- Department of Infectious Diseases, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Lucia Bradanini
- Luigi Sacco Department of Biomedical and Clinical Sciences, University of Milan, Italy
| | - Laura Galimberti
- Department of Infectious Diseases, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Riccardo Colombo
- Department of Anesthesiology and Intensive Care, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milan, Italy
| | - Valeria Micheli
- Microbiology, Virology and Bioemergence Diagnostics, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Cristina Negri
- Department of Infectious Diseases, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Anna Lisa Ridolfo
- Department of Infectious Diseases, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Luca Meroni
- Department of Infectious Diseases, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Massimo Galli
- Department of Infectious Diseases, ASST Fatebenefratelli Sacco, Milan, Italy; Luigi Sacco Department of Biomedical and Clinical Sciences, University of Milan, Italy
| | - Spinello Antinori
- Department of Infectious Diseases, ASST Fatebenefratelli Sacco, Milan, Italy; Luigi Sacco Department of Biomedical and Clinical Sciences, University of Milan, Italy
| | - Mario Corbellino
- Department of Infectious Diseases, ASST Fatebenefratelli Sacco, Milan, Italy
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Milazzo L, van den Bogaart L, Sollima S, Oreni L, Lai A, Morena V, Bonazzetti C, Ridolfo Anna L, Antinori S. Impact of HCV eradication with direct-acting antiviral agents on serum gamma globulin levels in HCV and HCV/HIV coinfected patients. Eur J Intern Med 2020; 75:50-54. [PMID: 31980330 DOI: 10.1016/j.ejim.2020.01.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 12/08/2019] [Accepted: 01/13/2020] [Indexed: 01/17/2023]
Abstract
BACKGROUND chronic viral infections by both HCV and HIV may lead to polyclonal activation of B cells resulting in hypergammaglobulinemia. This study retrospectively analyzed the effect of HCV eradication with interferon-free direct-acting antiviral agents (DAAs) on the gamma globulin levels in HCV-infected patients with or without HIV coinfection to identify factors potentially associated with gamma globulins decrease. METHODS The charts of patients treated with DAAs for HCV chronic infection between January 2015-June 2019 were retrospectively reviewed. Gamma globulin levels before treatment and 12 weeks after the end of anti-HCV therapy were evaluated along with liver tests, liver fibrosis stage by elastography, SVR achievement, HIV-coinfection. Multivariate analyses were carried out to assess the factors and the potential confounders related to the changes in gamma globulin levels. RESULTS A significant decrease of gamma globulin concentration was found in both cirrhotic and non-cirrhotic HCV-infected patients after treatment (from mean ± SD of 1.5 ± 0.44 g/dL to 1.31 ± 0.37 g/dL; p = 0.0001). Adjusted linear regression analyses of serum gamma globulin changes from baseline to SVR12 showed a positive significant association with pre-treatment gamma-globulin levels (β-coefficient -0.23; p = 0.0001), Metavir fibrosis score (β-coefficient -0.74; p = 0.008), ALT values and baseline HCV-RNA levels > 800,000. No difference was found between HIV-infected and HIV-uninfected patients. CONCLUSIONS Our study confirms previous preliminary observation of the decrease of serum gamma globulins after HCV eradication either achieved with interferon-based therapy or with DAAs, suggesting a leading role of the virus on the activation of B cell compartment and gamma globulins production.
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Affiliation(s)
- Laura Milazzo
- III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Milano, Italy; Department of Biomedical and Clinical Sciences "Luigi Sacco", Università degli Studi di, Milano, Italy.
| | - Lorena van den Bogaart
- III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Milano, Italy; Department of Biomedical and Clinical Sciences "Luigi Sacco", Università degli Studi di, Milano, Italy
| | - Salvatore Sollima
- III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Milano, Italy; Department of Biomedical and Clinical Sciences "Luigi Sacco", Università degli Studi di, Milano, Italy
| | - Letizia Oreni
- III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Milano, Italy; Department of Biomedical and Clinical Sciences "Luigi Sacco", Università degli Studi di, Milano, Italy
| | - Alessia Lai
- III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Milano, Italy; Department of Biomedical and Clinical Sciences "Luigi Sacco", Università degli Studi di, Milano, Italy
| | - Valentina Morena
- III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Milano, Italy; Department of Biomedical and Clinical Sciences "Luigi Sacco", Università degli Studi di, Milano, Italy
| | - Cecilia Bonazzetti
- III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Milano, Italy; Department of Biomedical and Clinical Sciences "Luigi Sacco", Università degli Studi di, Milano, Italy
| | - Lisa Ridolfo Anna
- III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Milano, Italy; Department of Biomedical and Clinical Sciences "Luigi Sacco", Università degli Studi di, Milano, Italy
| | - Spinello Antinori
- III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Milano, Italy; Department of Biomedical and Clinical Sciences "Luigi Sacco", Università degli Studi di, Milano, Italy
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6
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Sebastiani M, Milazzo L, Atzeni F, Vacchi C, Manfredi A, Quartuccio L, Scirè C, Gaeta GB, Lapadula G, Armignacco O, Tavio M, D'Angelo S, Meroni P, Bazzichi L, Grassi W, Mathieu A, Mastroianni C, Sagnelli E, Santantonio T, Foppa CU, Puoti M, Sarmati L, Airò P, Epis OM, Scrivo R, Gargiulo M, Riva A, Ciancio G, Zehender G, Taliani G, Meroni L, Sollima S, Sarzi-Puttini P, Galli M. Italian consensus recommendations for the management of hepatitis C infection in patients with rheumatoid arthritis. Mod Rheumatol 2019; 29:895-902. [PMID: 30582388 DOI: 10.1080/14397595.2018.1558918] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Objectives: The recent introduction of direct-acting antiviral agents (DAAs) which can eliminate Hepatitis C virus (HCV) had revolutionized the treatment of HCV infections also in a complex clinical setting such as the patients with rheumatoid arthritis (RA). HCV elimination is also opportune due to the availability of more efficient immunosuppressive drugs, whose effect on the course of HCV infection is largely unknown.Methods: Consensus process was endorsed by the Italian Society of Rheumatology (SIR) and the Italian Society of Infectious and Tropical Diseases (SIMIT) to review the available evidence and produce practical, hospital-wide recommendations. The consensus panel consisted of 18 infectious diseases consultants, 20 rheumatologists and one clinical epidemiologist, who used the criteria of the Oxford Centre for Evidence-based Medicine to assess the quality of the evidence and the strength of their recommendations.Results: A core-set of statements about management of patients with RA and infection by HCV have been developed to help clinicians in their clinical practice.Conclusions: A screening for HCV should be performed in all RA patients and it is mandatory before starting an immunosuppressive therapy. Finally, a DAA treatment should be considered in all HCV-infected patients.Significance and InnovationsHCV antibodies should be investigated at the time of diagnosis of RA and, in any case, before starting immunosuppressive therapy with disease-modifying antirheumatic drugs (DMARDs).HCV eradication with DAA should be attempted as soon as possible, depending on patient conditions allowing a continuous oral treatment lasting 8-12 weeksConventional and biological DMARDs are allowed in patients with HCV infection, but they should be used cautiously in presence of advanced liver disease.
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Affiliation(s)
- Marco Sebastiani
- Rheumatology Unit, Department of Medical and Surgical Science, University of Modena, Azienda Policlinico of Modena, Modena, Italy
| | - Laura Milazzo
- Infectious Diseases Unit, University of Milano, Luigi Sacco Hospital, Milan, Italy
| | - Fabiola Atzeni
- Rheumatology Unit, L. Sacco University Hospital, Milan, Italy
| | - Caterina Vacchi
- Rheumatology Unit, Department of Medical and Surgical Science, University of Modena, Azienda Policlinico of Modena, Modena, Italy
| | - Andreina Manfredi
- Rheumatology Unit, Department of Medical and Surgical Science, University of Modena, Azienda Policlinico of Modena, Modena, Italy
| | - Luca Quartuccio
- Department of Medical and Biological Sciences, Rheumatology Clinic, University of Udine, Udine, Italy
| | - Carlo Scirè
- Epidemiology Unit, Italian Society for Rheumatology (SIR), Milan, Italy
| | - Giovanni Battista Gaeta
- Infectious Diseases and Viral Hepatitis Unit, Department of Internal and Specialistic Medicine, Second University of Naples, Naples, Italy
| | - Giovanni Lapadula
- Department of Medicine - Rheumatology Unit, Medical School, University of Bari, Bari, Italy
| | | | - Marcello Tavio
- Unit of Emerging and Immunosuppressed Infectious Diseases, Department of Gastroenterology and Transplantation, Azienda Ospedaliero-Universitaria "Ospedali Riuniti", Torrette Ancona, Italy
| | - Salvatore D'Angelo
- Rheumatology Department of Lucania, San Carlo Hospital of Potenza and Madonna delle Grazie Hospital of Matera, Potenza, Italy
| | - Pierluigi Meroni
- Division of Rheumatology, Department of Clinical Sciences and Community Health, Gaetano Pini Orthopedic Institute, University of Milan, Milan, Italy
| | - Laura Bazzichi
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Walter Grassi
- Department of Rheumatology, Università Politecnica delle Marche, Ospedale "C. Urbani", Jesi Ancona, Italy
| | - Alessandro Mathieu
- Rheumatology Unit, University Clinic and AOU of Cagliari, Cagliari, Italy
| | - Claudio Mastroianni
- Infectious Diseases Unit, Department Public Health and Infectious Disease, "Sapienza" University of Rome, Rome, Italy
| | - Evangelista Sagnelli
- Department of Mental Health and Public Medicine, Second University of Naples, Naples, Italy
| | | | - Caterina Uberti Foppa
- Department of Infectious Diseases, San Raffaele Scientific Institute, Università Vita-Salute, Milan, Italy
| | - Massimo Puoti
- Department of Infectious Diseases, AO Niguarda Ca' Granda, Milano, Italy
| | - Loredana Sarmati
- Clinical Infectious Diseases, Tor Vergata University, Rome, Italy
| | - Paolo Airò
- Rheumatology and Clinical Immunology Unit, Spedali Civili of Brescia, Brescia, Italy
| | | | - Rossana Scrivo
- Department of Internal Medicine and Medical Specialties-Rheumatology Unit, Sapienza University of Rome, Rome, Italy
| | - Miriam Gargiulo
- Third Department of Infectious Diseases- D. Cotugno Hospital- AORN dei Colli, Naple, Italy
| | - Agostino Riva
- Rheumatology Unit, L. Sacco University Hospital, Milan, Italy
| | - Giovanni Ciancio
- Rheumatology Unit, Department of Medical Sciences, University of Ferrara and Sant'Anna University Hospital, Ferrara, Italy
| | | | - Gloria Taliani
- Infectious Diseases Unit, Department Public Health and Infectious Disease, "Sapienza" University of Rome, Rome, Italy
| | - Luca Meroni
- Rheumatology Unit, L. Sacco University Hospital, Milan, Italy
| | | | | | - Massimo Galli
- Rheumatology Unit, L. Sacco University Hospital, Milan, Italy
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Pezzani MD, Di Cristo V, Parravicini C, Sonzogni A, Tonello C, Franzetti M, Sollima S, Corbellino M, Galli M, Milazzo L, Antinori S. Gastrointestinal basidiobolomycosis: An emerging mycosis difficult to diagnose but curable. Case report and review of the literature. Travel Med Infect Dis 2019; 31:101378. [PMID: 30660554 DOI: 10.1016/j.tmaid.2019.01.013] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 12/18/2018] [Accepted: 01/16/2019] [Indexed: 01/28/2023]
Abstract
BACKGROUND Gastrointestinal basidiobolomycosis (GIB) is a rare mycosis affecting almost exclusively immunocompetent subjects. METHODS We describe a case of GIB caused by Basidiobolus ranarum in a 25-year-old Italian immunocompetent man resident in Ireland who presented a 2-month history of epigastric pain. Suspecting colon cancer he underwent a right hemicolectomy subsequently leading to a diagnosis of GIB by means of molecular biology. After surgery a 9-month therapy with itraconazole was employed with a good outcome. A review of medical literature regarding GIB cases published in the period 1964-2017 is presented. RESULTS One-hundred and two cases of GIB were included in this analysis. The disease was observed predominantly in male gender (74.5%) and children (41.2%). Abdominal pain was the single most common complaint (86.3%) followed by fever (40.2%) and evidence of an abdominal mass (30.4%). Peripheral blood eosinophilia was detected in 85.7% of cases. Most of the patients were diagnosed in Saudi Arabia (37.2%) followed by USA (21.6%) and Iran (20.6%). Surgery plus antifungal therapy was employed in the majority of patients (77.5%). An unfavourable outcome was documented globally in 18.6% of patients. CONCLUSIONS GIB seems to be an emerging intestinal mycosis among immunocompetent patients living in the Middle East and Arizona.
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Affiliation(s)
- Maria Diletta Pezzani
- Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milano, Italy
| | - Valentina Di Cristo
- Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milano, Italy
| | | | | | | | - Marco Franzetti
- III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Ospedale L Sacco, Milano, Italy
| | - Salvatore Sollima
- III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Ospedale L Sacco, Milano, Italy
| | - Mario Corbellino
- III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Ospedale L Sacco, Milano, Italy
| | - Massimo Galli
- Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milano, Italy; III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Ospedale L Sacco, Milano, Italy
| | - Laura Milazzo
- III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Ospedale L Sacco, Milano, Italy
| | - Spinello Antinori
- Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milano, Italy; III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Ospedale L Sacco, Milano, Italy.
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Antinori S, Sollima S, Corbellino M, Ridolfo AL. Severe imported falciparum malaria. Dilemmas regarding treatment availability and tolerability. Travel Med Infect Dis 2018; 25:13-15. [PMID: 30171893 DOI: 10.1016/j.tmaid.2018.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 08/26/2018] [Accepted: 08/28/2018] [Indexed: 10/28/2022]
Affiliation(s)
- Spinello Antinori
- Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milano, Italy.
| | - Salvatore Sollima
- III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Milano, Italy
| | - Mario Corbellino
- III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Milano, Italy
| | - Anna Lisa Ridolfo
- III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Milano, Italy
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9
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Ferraris L, Milazzo L, Rimoldi SG, Mazzali C, Barosi A, Gismondo MR, Vanelli P, Cialfi A, Sollima S, Galli M, Antona C, Antinori S. Epidemiological trends of infective endocarditis in a single center in Italy between 2003-2015. Infect Dis (Lond) 2018; 50:749-756. [PMID: 29842820 DOI: 10.1080/23744235.2018.1472806] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE Changes in the incidence, clinical features and microbiology of infective endocarditis (IE) observed in a single center in Italy were compared between the period 2003-2010 and 2011-2015. METHODS All cases of IE, defined as definite or possible according to the modified Duke criteria, observed at the 'L. Sacco' Hospital in Milan, Italy between 2003 and 2015 were retrospectively reviewed. RESULTS 366 episodes of IE were identified in 325 patients. The mean number of incident IE over the period 2003-2015 was 1.43 (range: 0.6-2.1) cases per 1000 admissions, with a significantly increasing trend from a mean of 1.28-1.72 cases per 1000 admissions/year in 2003-2010 and 2011-2015, respectively (+34%; p = .04). Staphylococci remain the leading pathogens causing IE (29%) with a relative increase of methicillin-resistant Staphylococcus aureus between the two periods. Streptococci and enterococci account for 26% and 18% of IE, respectively. We found an increase in the proportion of cases due to enterococci (from 14% in 2003-2010 to 22% in 2011-2015). The rate of in-hospital mortality was 19%, similar in the two periods studied. CONCLUSION The incidence of IE continuously increased in our cohort over the past decade and, along with the aging of the population, a raise in the incidence of health care-associated infections and a change in the distribution of prevalent pathogens were observed. Surgery was independently associated with higher in-hospital survival (AOR, 95% CI: 0.38, 0.19-0.74; p = .005). A constant surveillance is required to guide the optimal management of the changing epidemiology of IE.
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Affiliation(s)
- Laurenzia Ferraris
- a Department of Biomedical and Clinical Sciences "Luigi Sacco" , University of Milan , Milan , Italy
| | - Laura Milazzo
- a Department of Biomedical and Clinical Sciences "Luigi Sacco" , University of Milan , Milan , Italy
| | - Sara Giordana Rimoldi
- b Laboratory of Clinical Microbiology, Virology and Bioemergencies , ASST Fatebenefratelli Sacco, University Hospital "Luigi Sacco" , Milan , Italy
| | - Cristina Mazzali
- c Department of Management, Economics and Industrial Engineering (DIG) , Politecnico di Milano , Milan , Italy
| | - Alberto Barosi
- d Department of Cardiology , ASST Fatebenefratelli Sacco, University Hospital "Luigi Sacco" , Milan , Italy
| | - Maria Rita Gismondo
- b Laboratory of Clinical Microbiology, Virology and Bioemergencies , ASST Fatebenefratelli Sacco, University Hospital "Luigi Sacco" , Milan , Italy
| | - Paolo Vanelli
- e Cardiosurgery Unit, ASST Fatebenefratelli Sacco, University Hospital "Luigi Sacco" , Milan , Italy
| | - Alessandro Cialfi
- d Department of Cardiology , ASST Fatebenefratelli Sacco, University Hospital "Luigi Sacco" , Milan , Italy
| | - Salvatore Sollima
- a Department of Biomedical and Clinical Sciences "Luigi Sacco" , University of Milan , Milan , Italy
| | - Massimo Galli
- a Department of Biomedical and Clinical Sciences "Luigi Sacco" , University of Milan , Milan , Italy
| | - Carlo Antona
- e Cardiosurgery Unit, ASST Fatebenefratelli Sacco, University Hospital "Luigi Sacco" , Milan , Italy
| | - Spinello Antinori
- a Department of Biomedical and Clinical Sciences "Luigi Sacco" , University of Milan , Milan , Italy
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10
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Sollima S, Milazzo L, Vassalini P, Antinori S, Galli M. Recurrence of mixed cryoglobulinaemia vasculitis following influenza vaccination despite clearance of hepatitis C virus infection. Clin Exp Rheumatol 2018; 36 Suppl 111:161-162. [PMID: 29185964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Accepted: 06/12/2017] [Indexed: 06/07/2023]
Affiliation(s)
- Salvatore Sollima
- III Division of Infectious Diseases, L. Sacco University Hospital, Milan, Italy.
| | - Laura Milazzo
- III Division of Infectious Diseases, L. Sacco University Hospital, Milan, Italy
| | - Paolo Vassalini
- III Division of Infectious Diseases, L. Sacco University Hospital, Milan, Italy
| | - Spinello Antinori
- Department of Biomedical and Clinical Sciences L Sacco, University of Milan, Italy
| | - Massimo Galli
- Department of Biomedical and Clinical Sciences L Sacco, University of Milan, Italy
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Taramasso L, Di Biagio A, Bovis F, Nicolini LA, Antinori A, Milazzo L, Sollima S, Gubertini G, Niero F, Saracino A, Bruno R, Borghi V, Montagnani F, Cattelan A, Hasson H, Taliani G, D’Arminio Monforte A, Mastroianni C, Di Perri G, Bigoni S, Puoti M, Spinetti A, Gori A, Boffa N, Cacopardo B, Giacometti A, Parruti G, Vullo V, Chirianni A, Teti E, Pasquazzi C, Segala D, Andreoni M. Trend of estimated glomerular filtration rate during ombistasvir/paritaprevir/ritonavir plus dasabuvir ± ribavirin in HIV/HCV co-infected patients. PLoS One 2018; 13:e0192627. [PMID: 29462201 PMCID: PMC5819795 DOI: 10.1371/journal.pone.0192627] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Accepted: 01/26/2018] [Indexed: 12/13/2022] Open
Abstract
The renal function is a key-issue in HIV/HCV co-infected patients, nevertheless, it has not established so far whether HCV treatment with new direct acting agents could impact on estimated glomerular filtration rate (eGFR) variations. In the present work, we examined the real-life data on renal function that have been prospectively collected in the SIMIT compassionate-use program of ombitasvir/paritaprevir/ritonavir plus dasabuvir (OBV/PTV/r + DSV) in 144 HIV/HCV genotype 1 co-infected patients. The population was 74% male, 30.5% in CDC stage C, with median age of 52 years (48.0-56.5) and median liver stiffness of 7.8 kPa (6.7-9.2). Median baseline eGFR was 102.0 (90.8-108.1), changing to 99.8 (83.5-104.8) at the end of treatment (EoT), and 100.0 (87.3-105.6) 12 weeks after the EoT (FU12), p<0.0001. No patient had grade 3-4 increase of creatinine. At EoT 60/144 (41.7%) patients had ≥ 5% reduction in their eGFR, confirmed at FU12 in 39/60 (65.0%) cases. Longer duration of HCV infection (cut-off 12.9 years), lower HCV-RNA viral load (cut-off 1,970,160 IU/ml) and lower platelet count (cut-off 167,000 x106/L) were significantly associated with eGFR decline at logistic analysis (adjOR 2.9, 95%CI 1.0-8.8, p = 0.05; adjOR 3.5, 95%CI 1.2-10.4, p = 0.02; adjOR 2.8, 95%CI 1.1-6.8, p = 0.03, respectively). After repeating the analysis throughout a mixed model, a higher eGFR decline was highlighted in patients concomitantly treated with tenofovir (p = 0.0001), ribavirin (p = 0.0001), or integrase inhibitors (p <0.0001), with longer duration of HIV (p = 0.0002) and HCV infection (p = 0.035), lower baseline HCV RNA (p <0.0001), previous HCV treatment (p<0.0001), and older age (p<0.0001). In conclusion, our study confirms a good renal safety profile of OBV/PTV/r + DSV treatment in HIV/HCV patients, and the median decline of 2 ml/min in eGFR, albeit statistically significant, is of doubtful clinical significance. The role of aging, concomitant therapies and duration of HIV/HCV infection needs to be further investigated.
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Affiliation(s)
- Lucia Taramasso
- University of Genova (DISSAL), Infectious Diseases Clinic, Policlinico Hospital San Martino, Genova, Italy
| | - Antonio Di Biagio
- Infectious Diseases Clinic, Policlinico Hospital San Martino, Genova, Italy
- * E-mail:
| | - Francesca Bovis
- Biostatistics Unit, Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Laura Ambra Nicolini
- University of Genova (DISSAL), Infectious Diseases Clinic, Policlinico Hospital San Martino, Genova, Italy
| | - Andrea Antinori
- Clinical Department, National Institute for Infectious Diseases, INMI L. Spallanzani, Rome, Italy
| | - Laura Milazzo
- Department of Biomedical and Clinical Science, University of Milan, Milan, Italy
| | - Salvatore Sollima
- Department of Biomedical and Clinical Science, University of Milan, Milan, Italy
| | - Guido Gubertini
- 1st Division of Infectious Diseases, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Fosca Niero
- 1st Division of Infectious Diseases, ASST Fatebenefratelli-Sacco, Milan, Italy
| | | | - Raffaele Bruno
- Division of Infectious and Tropical Diseases, IRCCS Policlinico San Matteo, Pavia, Italy
| | - Vanni Borghi
- Infectious Diseases Clinic, University Hospital, Modena, Italy
| | - Francesca Montagnani
- Department of Internal and Specialty Medicine University Infectious Diseases Unit, AOU Senese, Siena, Italy
| | - Annamaria Cattelan
- Department of Infectious and Tropical Diseases, University Hospital, Padova, Italy
| | - Hamid Hasson
- Department of Infectious Diseases, San Raffaele Scientific Institute, Milan, Italy
| | - Gloria Taliani
- Department of Clinical Medicine, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | | | - Claudio Mastroianni
- Infectious Diseases Unit, Sapienza University of Rome, Latina, Italy, and Department of Public Health and Infectious Diseases, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Giovanni Di Perri
- Unit of Infectious Diseases, University of Turin, Department of Medical Sciences, Amedeo di Savoia Hospital, Turin, Italy
| | - Sara Bigoni
- Division of Infectious Diseases, AO Papa Giovanni XXIII, Bergamo, Italy
| | - Massimo Puoti
- Division of Infectious Diseases, AO Niguarda Ca' Granda Hospital, Milan, Italy
| | - Angiola Spinetti
- Division of Infectious and Tropical Diseases, University of Brescia and Spedali Civili General Hospital, Brescia, Italy
| | - Andrea Gori
- Division of Infectious Diseases, Department of Internal Medicine, San Gerardo Hospital, University of Milan-Bicocca, Milan, Italy
| | - Nicola Boffa
- First Division of Infectious Diseases, S. Giovanni di Dio e Ruggi d'Aragona Hospital, Salerno, Italy
| | - Bruno Cacopardo
- Division of Infectious Diseases, Department of Clinical and Experimental Medicine, ARNAS Garibaldi Hospital, University of Catania, Catania, Italy
| | - Andrea Giacometti
- Infectious Diseases Unit, Department of Biomedical Sciences and Public Health, Marche Polytechnic University c/o Ospedali Riuniti, Ancona, Italy
| | - Giustino Parruti
- Infectious Disease Unit, Pescara General Hospital, Pescara, Italy
| | - Vincenzo Vullo
- Department of Public Health and Infectious Diseases, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | | | - Elisabetta Teti
- Clinical Infectious Diseases, Department. of Systems Medicine, Tor Vergata University, Rome, Italy
| | - Caterina Pasquazzi
- Clinical Infectious Diseases, Sant'Andrea Hospital—Sapienza University of Rome, Rome, Italy
| | - Daniela Segala
- Unit of Infectious Diseases, University Hospital of Ferrara, Ferrara, Italy
| | - Massimo Andreoni
- Clinical Infectious Diseases, Department. of Systems Medicine, Tor Vergata University, Rome, Italy
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Milazzo L, Magni C, Niero F, Schiavini M, Lai A, Cento V, Binda F, Antinori S, Sollima S. Short article: Retreatment of chronic hepatitis C virus infection after unsuccessful therapy with all-oral direct-acting antiviral regimens: a real-life experience. Eur J Gastroenterol Hepatol 2017; 29:1231-1234. [PMID: 28877086 DOI: 10.1097/meg.0000000000000965] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVE Few real-life data are available on the retreatment of patients who failed direct-acting antiviral (DAA)-regimens. We reported the outcome of retreatment with approved DAA regimens in a real-life cohort of patients who previously failed an all-oral DAAs combination and we analyzed the association with resistance substitutions (RASs) performed at the time of virological failure. AIM AND METHODS Next-generation sequencing of the NS3, NS5A, and NS5B regions was performed by Illumina deep sequencing. The sequence reads were analyzed by an in-house pipeline. RESULTS Of the 16/759 (2%) patients who failed to achieve a sustained virological response at 12 weeks to all-oral DAAs from December 2014 to January 2016, 10 were retreated with licensed DAAs regimens. In all the patients, retreatment was followed by sustained virological response at 12 weeks. Baseline NS3-RASs before retreatment were observed in two patients who failed a sofosbuvir/simeprevir regimen: D168V RAS was detected in a genotype-4 patient, whereas the complex RAS-pattern Q80K, I170V, R155K, D168E was observed in a genotype-1a patient. Only one of the two patients who previously failed ombitasvir, paritaprevir/ritonavir, and dasabuvir underwent RAS analysis at relapse and showed baseline NS5A RAS (M28V) before retreatment. CONCLUSION These real-life findings indicated a high efficacy of sofosbuvir+NS5A-inihbitors in retreating NS3-experienced patients and also NS5A-experienced patients by using a 24-week course ribavirin-containing regimen. The relevance of hepatitis C virus resistance testing before retreatment remains to be better defined to guide the choice of the new regimen before retreatment in DAA-experienced patients.
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Affiliation(s)
- Laura Milazzo
- aDepartment of Biomedical and Clinical Sciences L. Sacco, University of Milan bFirst Division of Infectious Diseases, ASST Fatebenefratelli-Sacco, Milan cDepartment of Experimental Medicine and Surgery, University of Rome 'Tor Vergata', Rome, Italy
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13
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Sebastiani M, Atzeni F, Milazzo L, Quartuccio L, Scirè C, Gaeta GB, Lapadula G, Armignacco O, Tavio M, Olivieri I, Meroni P, Bazzichi L, Grassi W, Mathieu A, Mastroianni C, Sagnelli E, Santantonio T, Uberti Foppa C, Puoti M, Sarmati L, Airò P, Epis OM, Scrivo R, Gargiulo M, Riva A, Manfredi A, Ciancio G, Zehender G, Taliani G, Meroni L, Sollima S, Sarzi-Puttini P, Galli M. Italian consensus Guidelines for the management of hepatitis B virus infections in patients with rheumatoid arthritis. Joint Bone Spine 2017; 84:525-530. [DOI: 10.1016/j.jbspin.2017.05.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Accepted: 05/04/2017] [Indexed: 01/05/2023]
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14
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Milazzo L, Gervasoni C, Falvella FS, Cattaneo D, Mazzali C, Ronzi P, Binda F, Cheli S, Sollima S, Antinori S. Renal function in HIV/HBV co-infected and HBV mono-infected patients on a long-term treatment with tenofovir in real life setting. Clin Exp Pharmacol Physiol 2017; 44:191-196. [PMID: 27809359 DOI: 10.1111/1440-1681.12691] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2016] [Revised: 10/07/2016] [Accepted: 10/29/2016] [Indexed: 12/11/2022]
Abstract
The human immunodeficiency virus (HIV)/hepatitis B virus (HBV) co-infection is likely to be associated with an increased risk of kidney disease, due to the additional factors that may affect renal function in the HIV population. We aimed to evaluate renal toxicity in HIV/HBV and HBV mono-infected patients on long-term therapy with tenofovir (TDF) and to explore the association of polymorphisms in ATP-binding cassette (ABCC)2, ABCC4, ABCC10 with the development of renal dysfunction. From September 2006 to November 2014, 44 HIV/HBV co-infected and 34 HBV mono-infected patients were commenced on TDF. Data of renal safety were retrospectively collected and analyzed. ABCC2, ABCC4 and ABCC10 genotypes were identified by real-time PCR. Over 60 months of observation, there was a significant increase in mean creatinine levels from baseline (P<.01) that was not significantly different between the two study groups. Moreover, a significant decline in estimated glomerular filtration rate (eGFR) was observed from baseline (P<.01), and it was significantly greater in HBV mono-infected than co-infected patients (P=.03). The distribution of ABCC2, ABCC4 and ABCC10 genotypes among a subgroup of 34 patients did not show significant association with eGFR decline <90 mL/min per 1.73 m2 . Although our findings showed a statistically significant decrease in eGFR with long-term use of TDF, its clinical impact seems to be modest. The role of genetic factors to identify patients at greater risk for developing tenofovir-induced renal toxicity needs to be further investigated.
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Affiliation(s)
- Laura Milazzo
- Department of Biomedical and Clinical Sciences L. Sacco, University of Milan, Milan, Italy
| | - Cristina Gervasoni
- Department of Biomedical and Clinical Sciences L. Sacco, University of Milan, Milan, Italy
| | | | - Dario Cattaneo
- Unit of Clinical Pharmacology, L. Sacco University Hospital, Milan, Italy
| | - Cristina Mazzali
- Department of Management, Economics and Industrial Engineering, Milan Politecnico, Milan, Italy
| | - Paola Ronzi
- Department of Biomedical and Clinical Sciences L. Sacco, University of Milan, Milan, Italy
| | - Francesca Binda
- Department of Biomedical and Clinical Sciences L. Sacco, University of Milan, Milan, Italy
| | - Stefania Cheli
- Unit of Clinical Pharmacology, L. Sacco University Hospital, Milan, Italy
| | - Salvatore Sollima
- Department of Biomedical and Clinical Sciences L. Sacco, University of Milan, Milan, Italy
| | - Spinello Antinori
- Department of Biomedical and Clinical Sciences L. Sacco, University of Milan, Milan, Italy
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15
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Galli M, Oreni L, Saccardo F, Castelnovo L, Filippini D, Marson P, Mascia MT, Mazzaro C, Origgi L, Ossi E, Pietrogrande M, Pioltelli P, Quartuccio L, Scarpato S, Sollima S, Riva A, Fraticelli P, Zani R, Giuggioli D, Sebastiani M, Sarzi Puttini P, Gabrielli A, Zignego AL, Scaini P, Ferri C, De Vita S, Monti G. HCV-unrelated cryoglobulinaemic vasculitis: the results of a prospective observational study by the Italian Group for the Study of Cryoglobulinaemias (GISC). Clin Exp Rheumatol 2017; 35 Suppl 103:67-76. [PMID: 28466806] [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] [Received: 01/19/2017] [Accepted: 03/27/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES To investigate the clinical and laboratory patterns of HCV-unrelated cryoglobulinaemic vasculitis (CV), and the factors influencing its outcome. METHODS Prospective study of all anti-HCV and HCV-RNA negative patients with CV who have been observed since January 2004 in 17 centres participating in the Italian Group for the Study of Cryoglobulinaemias (GISC). RESULTS 175 enrolled were followed up for 677 person-years. The associated conditions were primary Sjögren's syndrome (21.1%), SLE (10.9%), other autoimmune disorders (10.9%), lymphoproliferative diseases (6.8%), solid tumours (2.3%) and HBsAg positivity (8.6%), whereas 69 patients (39.4%) had essential CV. There were significant differences in age (p<0.001), gender (p=0.002), the presence of purpura (p=0.005), arthralgia (p=0.009), liver abnormalities (p<0.001), sicca syndrome (p<0.001), lymphadenopathy (p=0.003), splenomegaly (p=0.002), and rheumatoid factor titres (p<0.001) among these groups. Type II mixed cryoglobulins were present in 96 cases (54.9%) and were independently associated with purpura and fatigue (odds ratio [OR]4.3; 95% confidence interval [CI] 1.8-10.2; p=0.001; and OR2.8; 95%CI 1.3-6.3; p=0.012). Thirty-one patients died during follow-up, a mortality rate of 46/1000 person-years. Older age (for each additional year, adjusted hazard ratio [aHR] 1.13; 95%CI 1.06-1.20; p<0.001), male gender (aHR 3.45; 95%CI 1.27-9.40; p=0.015), type II MCG (aHR 3.31; 95%CI 0.09-1.38; p=0.047) and HBsAg positivity (aHR 7.84; 95%CI 1.20-36.04; p=0.008) were independently associated with greater mortality. CONCLUSIONS HCV-unrelated CV is a multifaceted and often disabling disorder. The associated conditions influence its clinical severity, giving rise to significantly different clinical and laboratory profiles and outcomes.
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Affiliation(s)
- Massimo Galli
- Clinica delle Malattie Infettive, L. Sacco Department of Biomedical and Clinical Sciences, University of Milan, Italy.
| | - Letizia Oreni
- Clinica delle Malattie Infettive, L. Sacco Department of Biomedical and Clinical Sciences, University of Milan, Italy
| | - Francesco Saccardo
- Rheumatology Unit, Internal Medicine Unit, Presidio Ospedaliero di Saronno, ASST della Valle Olona, Italy
| | - Laura Castelnovo
- Rheumatology Unit, Internal Medicine Unit, Presidio Ospedaliero di Saronno, ASST della Valle Olona, Italy
| | - Davide Filippini
- Rheumatology Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Piero Marson
- Apheresis Unit, Blood Transfusion Service, University Hospital of Padua, Italy
| | - Maria Teresa Mascia
- Immune-Rheumatology Unit, Department of Diagnostic and Clinical Medicine and Public Health, University of Modena and Reggio Emilia, Modena, Italy
| | - Cesare Mazzaro
- Onco-Haematology Unit, CRO Aviano, National Cancer Institute, Aviano, Italy
| | - Laura Origgi
- Allergology and Clinical Immunology Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Elena Ossi
- Department of Medicine, University of Padua, Italy
| | | | - Piero Pioltelli
- Bicocca San Gerardo Haematology Unit, S. Gerardo Hospital, ASST Monza, Italy
| | - Luca Quartuccio
- Rheumatology Clinic, DSMB, AOU Santa Maria della Misericordia, University of Udine, Italy
| | | | - Salvatore Sollima
- Clinica delle Malattie Infettive, L. Sacco Department of Biomedical and Clinical Sciences, University of Milan, Italy
| | - Agostino Riva
- Clinica delle Malattie Infettive, L. Sacco Department of Biomedical and Clinical Sciences, University of Milan, Italy
| | - Paolo Fraticelli
- Department of Clinical and Molecular Sciences, Clinical Medicine, Università Politecnica delle Marche, Ancona, Italy
| | - Roberta Zani
- Unit of Nephrology, ASST degli Spedali Civili di Brescia, Italy
| | - Dilia Giuggioli
- Rheumatology Unit, Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Marco Sebastiani
- Rheumatology Unit, Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Armando Gabrielli
- Department of Clinical and Molecular Sciences, Clinical Medicine, Università Politecnica delle Marche, Ancona, Italy
| | - Anna Linda Zignego
- Centro Manifestazioni Sistemiche da virus epatitici, University of Florence, Italy
| | - Patrizia Scaini
- Unit of Nephrology, ASST degli Spedali Civili di Brescia, Italy
| | - Clodoveo Ferri
- Rheumatology Unit, Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Salvatore De Vita
- Rheumatology Clinic, DSMB, AOU Santa Maria della Misericordia, University of Udine, Italy
| | - Giuseppe Monti
- Rheumatology Unit, Internal Medicine Unit, Presidio Ospedaliero di Saronno, ASST della Valle Olona, Italy
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16
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Antinori S, Milazzo L, Sollima S, Galli M, Corbellino M. Critically ill patients at risk of invasive candidiasis: The "dilemma" of the best antifungal treatment strategy. Eur J Intern Med 2017; 37:e20-e21. [PMID: 27650506 DOI: 10.1016/j.ejim.2016.09.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Accepted: 09/07/2016] [Indexed: 12/11/2022]
Affiliation(s)
- Spinello Antinori
- Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milano, Italy; III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milano, Italy.
| | - Laura Milazzo
- III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milano, Italy
| | - Salvatore Sollima
- III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milano, Italy
| | - Massimo Galli
- Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milano, Italy; III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milano, Italy
| | - Mario Corbellino
- III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milano, Italy
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17
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Sollima S, Antinori S, Torre A, Binda F, Giacomelli A, Milazzo L. Successful treatment of sexually acquired acute HCV reinfection with ledipasvir/sofosbuvir in a HIV-infected patient. Int J STD AIDS 2016. [PMID: 28632109 DOI: 10.1177/0956462416684462] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Here we describe the case of a HIV-positive patient with acute hepatitis C virus reinfection, who was successfully treated with an interferon-free regimen of ledipasvir/sofosbuvir.
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Affiliation(s)
- Salvatore Sollima
- 1 III Division of Infectious Diseases, L. Sacco University Hospital, Milan, Italy
| | - Spinello Antinori
- 1 III Division of Infectious Diseases, L. Sacco University Hospital, Milan, Italy.,2 Department of Clinical and Biomedical Sciences L. Sacco, University of Milan, Milan, Italy
| | - Alessandro Torre
- 1 III Division of Infectious Diseases, L. Sacco University Hospital, Milan, Italy
| | - Francesca Binda
- 1 III Division of Infectious Diseases, L. Sacco University Hospital, Milan, Italy
| | - Andrea Giacomelli
- 1 III Division of Infectious Diseases, L. Sacco University Hospital, Milan, Italy
| | - Laura Milazzo
- 1 III Division of Infectious Diseases, L. Sacco University Hospital, Milan, Italy
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18
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Antinori S, Milazzo L, Sollima S, Galli M, Corbellino M. Candidemia and invasive candidiasis in adults: A narrative review. Eur J Intern Med 2016; 34:21-28. [PMID: 27394927 DOI: 10.1016/j.ejim.2016.06.029] [Citation(s) in RCA: 125] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2016] [Revised: 06/12/2016] [Accepted: 06/22/2016] [Indexed: 12/29/2022]
Abstract
Candidemia and invasive candidiasis are major causes of morbidity and mortality, and their incidence is increasing because of the growing complexity of patients. Five species of Candida (Candida albicans, Candida glabrata, Candida parapsilosis, Candida tropicalis and Candida krusei) account for more than 90% of all diagnosed cases, but their relative frequency varies depending on the population involved, geographical region, previous anti-fungal exposure, and patient age. The best evidence regarding the anti-fungal treatment for invasive candidiasis comes from randomized controlled trials in which more than 85% of the recruited patients had candidemia. In the case of less frequent forms of invasive candidiasis, the recommendations are based on retrospective studies, meta-analyses (when available) and experts' opinions. A pre-emptive approach based on biomarkers and clinical rules is recommended because of the high rate of infection-related mortality among critically ill patients.
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Affiliation(s)
- Spinello Antinori
- Department of Clinical and Biomedical Sciences "Luigi Sacco", University of Milano, Milano, Italy; III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milano, Italy.
| | - Laura Milazzo
- III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milano, Italy
| | - Salvatore Sollima
- III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milano, Italy
| | - Massimo Galli
- Department of Clinical and Biomedical Sciences "Luigi Sacco", University of Milano, Milano, Italy; III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milano, Italy
| | - Mario Corbellino
- III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milano, Italy
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Milazzo L, Lai A, Calvi E, Ronzi P, Micheli V, Binda F, Ridolfo AL, Gervasoni C, Galli M, Antinori S, Sollima S. Direct-acting antivirals in hepatitis C virus (HCV)-infected and HCV/HIV-coinfected patients: real-life safety and efficacy. HIV Med 2016; 18:284-291. [DOI: 10.1111/hiv.12429] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/19/2016] [Indexed: 12/19/2022]
Affiliation(s)
- L Milazzo
- Department of Biomedical and Clinical Sciences L. Sacco; University of Milan; Milan Italy
| | - A Lai
- Department of Biomedical and Clinical Sciences L. Sacco; University of Milan; Milan Italy
| | - E Calvi
- Department of Biomedical and Clinical Sciences L. Sacco; University of Milan; Milan Italy
| | - P Ronzi
- Department of Biomedical and Clinical Sciences L. Sacco; University of Milan; Milan Italy
| | - V Micheli
- Clinical Microbiology Virology and Diagnosis of Bioemergency; L. Sacco University Hospital; Milan Italy
| | - F Binda
- Department of Biomedical and Clinical Sciences L. Sacco; University of Milan; Milan Italy
| | - AL Ridolfo
- Department of Biomedical and Clinical Sciences L. Sacco; University of Milan; Milan Italy
| | - C Gervasoni
- Department of Biomedical and Clinical Sciences L. Sacco; University of Milan; Milan Italy
| | - M Galli
- Department of Biomedical and Clinical Sciences L. Sacco; University of Milan; Milan Italy
| | - S Antinori
- Department of Biomedical and Clinical Sciences L. Sacco; University of Milan; Milan Italy
| | - S Sollima
- Department of Biomedical and Clinical Sciences L. Sacco; University of Milan; Milan Italy
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20
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Antinori S, Milazzo L, Sollima S, Corbellino M. South Sudan to Martha's Vineyard: Malaria Always First! Am J Med 2016; 129:e99. [PMID: 27320720 DOI: 10.1016/j.amjmed.2015.10.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Revised: 10/28/2015] [Accepted: 10/28/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Spinello Antinori
- Department of Biomedical and Clinical Sciences L Sacco, III Division of Infectious Diseases, Luigi Sacco Hospital, University of Milano, Milano, Italy
| | - Laura Milazzo
- Department of Biomedical and Clinical Sciences L Sacco, III Division of Infectious Diseases, Luigi Sacco Hospital, University of Milano, Milano, Italy
| | - Salvatore Sollima
- Department of Biomedical and Clinical Sciences L Sacco, III Division of Infectious Diseases, Luigi Sacco Hospital, University of Milano, Milano, Italy
| | - Mario Corbellino
- Department of Biomedical and Clinical Sciences L Sacco, III Division of Infectious Diseases, Luigi Sacco Hospital, University of Milano, Milano, Italy
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21
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Sollima S, D'Avolio A, Cattaneo D, Micheli V, Milazzo L, Gervasoni C. Darunavir-based Antiretroviral Therapy may Affect the Efficacy of Ombitasvir/Paritaprevir/Ritonavir and Dasabuvir in HCV/HIV-1 Coinfected Patients: Table 1. Clin Infect Dis 2016; 63:285-6. [DOI: 10.1093/cid/ciw292] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
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22
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Sollima S, Milazzo L, Torre A, Calvi E, Regalia E, Antinori S. Paritaprevir/ritonavir, ombitasvir, and dasabuvir for treatment of recurrent hepatitis C virus infection in the human immunodeficiency virus coinfected liver transplant recipient. Liver Transpl 2016; 22:252-3. [PMID: 26439308 DOI: 10.1002/lt.24353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Revised: 09/20/2015] [Accepted: 09/30/2015] [Indexed: 01/13/2023]
Affiliation(s)
- Salvatore Sollima
- III Division of Infectious Diseases, L. Sacco University Hospital, Milan, Italy
| | - Laura Milazzo
- III Division of Infectious Diseases, L. Sacco University Hospital, Milan, Italy
| | - Alessandro Torre
- III Division of Infectious Diseases, L. Sacco University Hospital, Milan, Italy
| | - Elisa Calvi
- III Division of Infectious Diseases, L. Sacco University Hospital, Milan, Italy
| | - Enrico Regalia
- Liver Unit, Department of Surgery, National Cancer Institute, IRCCS Foundation, Naples, Italy
| | - Spinello Antinori
- III Division of Infectious Diseases, L. Sacco University Hospital, Milan, Italy
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23
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Cattaneo D, Puoti M, Sollima S, Moioli C, Foppa CU, Baldelli S, Clementi E, Gervasoni C. Reduced raltegravir clearance in HIV-infected liver transplant recipients: an unexpected interaction with immunosuppressive therapy? J Antimicrob Chemother 2016; 71:1341-5. [PMID: 26755497 DOI: 10.1093/jac/dkv466] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Accepted: 12/03/2015] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVES Liver transplantation (LTx) is considered a safe procedure in selected HIV-infected patients. In this clinical setting raltegravir is the antiretroviral of choice due to its optimal tolerability and its negligible interactions with immunosuppressive drugs. We aimed at providing data on the pharmacokinetics of raltegravir in LTx recipients, on which the available information is inconclusive. METHODS In this retrospective multicentre study we characterized the pharmacokinetics of raltegravir in a consecutive series of HIV-infected LTx recipients referred to our laboratory for therapeutic drug monitoring (TDM) and compared the obtained profiles with those collected from a control group of HIV-infected patients. RESULTS Seventeen HIV-infected LTx patients were considered. LTx recipients had significantly higher raltegravir AUC0-12 compared with the control group of HIV-infected patients [14 314 (11 627-19 998) versus 8795 (5218-12 954) ng·h/mL; P < 0.01]. Two LTx patients experienced moderate increments in serum transaminases, nausea and vomiting that improved after raltegravir dose reduction. CONCLUSIONS High raltegravir exposure and acceptable safety profile were observed in HIV-infected LTx recipients. Our results highlight that some patients may obtain an advantage from TDM-guided raltegravir dose adjustments with potential benefits in terms of drug tolerability.
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Affiliation(s)
- Dario Cattaneo
- Unit of Clinical Pharmacology, L. Sacco University Hospital, Milan, Italy
| | - Massimo Puoti
- Division of Infectious Diseases, AO Ospedale Niguarda Ca' Granda, Milano, Italy
| | - Salvatore Sollima
- Department of Infectious Diseases, L. Sacco University Hospital, Milan, Italy
| | - Cristina Moioli
- Division of Infectious Diseases, AO Ospedale Niguarda Ca' Granda, Milano, Italy
| | | | - Sara Baldelli
- Unit of Clinical Pharmacology, L. Sacco University Hospital, Milan, Italy
| | - Emilio Clementi
- Clinical Pharmacology Unit, CNR Institute of Neuroscience, Department of Biomedical and Clinical Sciences, L. Sacco University Hospital, Università di Milano, 20157 Milan, Italy Scientific Institute IRCCS E. Medea, 23842 Bosisio Parini, Italy
| | - Cristina Gervasoni
- Department of Infectious Diseases, L. Sacco University Hospital, Milan, Italy
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Cattaneo D, Sollima S, Charbe N, Resnati C, Clementi E, Gervasoni C. Suspected pharmacokinetic interaction between raltegravir and the 3D regimen of ombitasvir, dasabuvir and paritaprevir/ritonavir in an HIV-HCV liver transplant recipient. Eur J Clin Pharmacol 2015; 72:365-7. [PMID: 26362279 DOI: 10.1007/s00228-015-1936-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Accepted: 08/31/2015] [Indexed: 11/27/2022]
Affiliation(s)
- Dario Cattaneo
- Unit of Clinical Pharmacology, L. Sacco University Hospital, Milan, Italy
| | - Salvatore Sollima
- Department of Infectious Diseases, Luigi Sacco University Hospital, Via GB Grassi 74, 20157, Milan, Italy
| | - Nitin Charbe
- Unit of Clinical Pharmacology, L. Sacco University Hospital, Milan, Italy
| | - Chiara Resnati
- Department of Infectious Diseases, Luigi Sacco University Hospital, Via GB Grassi 74, 20157, Milan, Italy
| | - Emilio Clementi
- Clinical Pharmacology Unit, CNR Institute of Neuroscience, Dept Biomedical and Clinical Sciences, L. Sacco University Hospital, Università di Milano, 20157, Milan, Italy
- Scientific Institute IRCCS E. Medea, 23842, Bosisio Parini, Italy
| | - Cristina Gervasoni
- Department of Infectious Diseases, Luigi Sacco University Hospital, Via GB Grassi 74, 20157, Milan, Italy.
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Sollima S, Torre A. A comparison between entecavir and tenofovir in chronic hepatitis B in the clinical practice: a single-center experience. CMI 2015. [DOI: 10.7175/cmi.v9i2.1191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Chronic Hepatitis B (CHB) affects 350-400 million of patients worldwide. Entecavir (ETV) and tenofovir disoproxil fumarate (TDF) are two nucleoside/nucleotide analogs recommended as first-line treatments in CHB.This retrospective study aimed at comparing effectiveness and renal safety of ETV and TDF through the analysis of data obtained from our CHB outpatients from June 2007 to September 2014. 41 out of 126 CHB outpatients were treated with ETV and 18 with TDF.TDF showed greater, though not statistically significant, effectiveness, in the three groups considered, i.e. naïve, pretreated with nucleoside/nucleotide analogs other than ETV or TDF, and pretreated with ETV or TDF patients. In particular, in naïve patients, those treated with TDF attained not detectable levels of viremia more rapidly (7 months versus 9 months) than ETV-treated patients, even starting from higher HBV DNA levels. In addition, virologic failure was observed in 0 versus 11% in TDF and ETV group, respectively. Also in patients pretreated with nucleoside/nucleotide analogs other than ETV or TDF, virologic failure was observed just in ETV patients. In patients who switched from ETV or TDF the mean time to attain undetectable HBV DNA levels was shorter in TDF group (3 months versus 6 months).Considering renal toxicity, there was no difference in creatinine and GFR levels between the two groups. Proteinuria and phosphaturia were greater in TDF patients, reaching statistical significance just in those pretreated with nucleoside/nucleotide analogs other than ETV or TDF.
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26
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Antinori S, Ferraris L, Orlando G, Tocalli L, Ricaboni D, Corbellino M, Sollima S, Galli M, Milazzo L. Fungal Endocarditis Observed Over an 8-Year Period and a Review of the Literature. Mycopathologia 2014; 178:37-51. [DOI: 10.1007/s11046-014-9754-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Accepted: 05/01/2014] [Indexed: 12/13/2022]
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27
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Monti G, Saccardo F, Castelnovo L, Novati P, Sollima S, Riva A, Sarzi-Puttini P, Quartuccio L, De Vita S, Galli M. Prevalence of mixed cryoglobulinaemia syndrome and circulating cryoglobulins in a population-based survey: the Origgio study. Autoimmun Rev 2014; 13:609-14. [PMID: 24418294 DOI: 10.1016/j.autrev.2013.11.005] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Accepted: 11/10/2013] [Indexed: 12/16/2022]
Abstract
Mixed cryoglobulinaemia syndrome (MCS) is associated with a number of infectious, autoimmune and lymphoproliferative disorders, particularly chronic hepatitis C infection. Although circulating mixed cryoglobulins (cMCGs) are a frequent finding in HCV-infected patients, only a minority of them develop a frank MCS. The only available data concerning the prevalence of MCS, which is generally considered a rare disease, come from hospital records. The aim of this investigation was to estimate the prevalence of cMCGs and MCS in a population-based study. All of the adult residents in Origgio, a town of about seven thousand inhabitants in northern Italy, were mailed a validated questionnaire, and a randomly selected sample of respondents was invited to undergo a clinical examination and laboratory tests including the determination of cMCGs. The 1594 respondents to the questionnaire (54.3% women, 64.5% aged >49years) accounted for 26.4% of the total adult population. Forty-nine (3.1%) positively responded to at least two questions, including a disproportionately high number of people aged >70years (p=0.001). Of the 266 randomly selected subjects invited to undergo a clinical examination and laboratory tests, 147 accepted, 30 (20.4%) of whom had asymptomatic type III cMCGs and four MCS. The risk of cMCG positivity was independently associated with C4 levels of <16mg/dL (adjusted odds ratio [AOR] 4.40, 95% confidence interval [CI] 1.07-18.08; p=0.040) and HCV positivity (AOR 6.87, 95% CI 1.16-40.79; p=0.034). No co-morbidities known to be related to cMCG production could be detected in more than 50% of the positive cases. After including the other positive respondents who agreed to undergo a clinical examination, the number of diagnosed MCS increased to seven: five HCV-related, one HBV-related, and one essential MCS. In conclusion, MCS seems to be more frequent than expected for a 'rare' disease, and the unexpectedly high prevalence of cMCGs raises questions about the frequency with which they are triggered, the spectrum of diseases involved in triggering them, and their real role as disease indicators.
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Affiliation(s)
- Giuseppe Monti
- Busto Arsizio, Ospedale di Saronno UO Medicina Interna, Pz.le Borella 1, 21047 Saronno, Italy.
| | - Francesco Saccardo
- Busto Arsizio, Ospedale di Saronno UO Medicina Interna, Pz.le Borella 1, 21047 Saronno, Italy.
| | - Laura Castelnovo
- Busto Arsizio, Ospedale di Saronno UO Medicina Interna, Pz.le Borella 1, 21047 Saronno, Italy.
| | - Paola Novati
- Busto Arsizio, Ospedale di Saronno UO Medicina Interna, Pz.le Borella 1, 21047 Saronno, Italy.
| | - Salvatore Sollima
- Institute of Infectious and Tropical Diseases, University of Milan, Luigi Sacco Hospital, via GB Grassi 74, 20157 Milan, Italy.
| | - Agostino Riva
- Institute of Infectious and Tropical Diseases, University of Milan, Luigi Sacco Hospital, via GB Grassi 74, 20157 Milan, Italy.
| | - Piercarlo Sarzi-Puttini
- Rheumatology Unit, University of Milan, Luigi Sacco Hospital, via GB Grassi 74, 20157 Milan, Italy.
| | - Luca Quartuccio
- Clinic of Rheumatology, Department of Medical and Biological Sciences, University of Udine, P.za Misericordia, 33100 Udine, Italy.
| | - Salvatore De Vita
- Clinic of Rheumatology, Department of Medical and Biological Sciences, University of Udine, P.za Misericordia, 33100 Udine, Italy.
| | - Massimo Galli
- Institute of Infectious and Tropical Diseases, University of Milan, Luigi Sacco Hospital, via GB Grassi 74, 20157 Milan, Italy.
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Antinori S, Corbellino M, Meroni L, Resta F, Sollima S, Tonolini M, Tortorano AM, Milazzo L, Bello L, Furfaro E, Galli M, Viscoli C. Aspergillus meningitis: a rare clinical manifestation of central nervous system aspergillosis. Case report and review of 92 cases. J Infect 2013; 66:218-38. [PMID: 23178421 PMCID: PMC7112586 DOI: 10.1016/j.jinf.2012.11.003] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2012] [Revised: 09/17/2012] [Accepted: 11/05/2012] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To describe the pathogenesis, clinical presentation, cerebrospinal fluid findings and outcome of Aspergillus meningitis, meningoencephalitis and arachnoiditis. METHODS A case of Aspergillus meningitis is described. A comprehensive review of the English-language literature was conducted to identify all reported cases of Aspergillus meningitis described between January 1973 and December 2011. RESULTS Ninety-three cases (including the one described herein) of Aspergillus meningitis were identified. Fifty-two (55.9%) were in individuals without any predisposing factor or known causes of immunosuppression. Acute and chronic meningitis was diagnosed in 65.6% of patients and meningoencephalitis in 24.7% of them with the remaining presenting with spinal arachnoiditis and ventriculitis. Cerebrospinal fluid cultures for Aspergillus spp. were positive in about 31% of cases and the galactomannan antigen test in 87%. Diagnosis during life was achieved in 52 patients (55.9%) with a case fatality rate of 50%. The overall case fatality rate was 72.1%. CONCLUSIONS Aspergillus meningitis may occur in both immunocompetent and immunocompromised patients and run an acute or chronic course. The findings of this systematic review extend the information on this life-threatening infection and could assist physicians in achieving an improved outcome.
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Affiliation(s)
- Spinello Antinori
- Department of Biomedical and Clinical Sciences Luigi Sacco, Università di Milano, Milano, Italy.
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Hasson H, Galli L, Gallotta G, Neri V, Blanc P, D'Annunzio M, Morsica G, Sollima S, Merli M, Lazzarin A, Uberti-Foppa C. HAART simplification with lopinavir/ritonavir monotherapy in HIV/HCV co-infected patients starting anti-HCV treatment: a randomised pilot study (KaMon study). New Microbiol 2012; 35:469-474. [PMID: 23109014] [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] [Received: 03/20/2012] [Accepted: 08/05/2012] [Indexed: 06/01/2023]
Abstract
The aim of this randomised, prospective, open-label, multicentre pilot clinical trial was to compare the 48-week toxicity profile of lopinavir/ritonavir (LPV/r) monotherapy with LPV/r-based HAART (KaMon = Kaletra monotherapy) in HIV/HCV patients undergoing HCV treatment. The study involved 30 HIV/HCV co-infected patients naive to anti- HCV therapy. One patient in each arm (6.7%) discontinued anti-HCV therapy because of adverse events. There were no significant between-group differences in terms of the proportion of patients experiencing AEs (p=0.999) or the number of grade 3-4 AEs (p=0.146). No HIV failure was observed. The safety profile of LPV/r monotherapy was similar to that of LPV/r-based HAART, thus encouraging HAART simplification in patients receiving anti-HCV treatment.
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Affiliation(s)
- Hamid Hasson
- Department of Infectious Diseases, IRCCS Ospedale San Raffaele, Milan, Italy
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30
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Pietrogrande M, De Vita S, Zignego AL, Pioltelli P, Sansonno D, Sollima S, Atzeni F, Saccardo F, Quartuccio L, Bruno S, Bruno R, Campanini M, Candela M, Castelnovo L, Gabrielli A, Gaeta GB, Marson P, Mascia MT, Mazzaro C, Mazzotta F, Meroni P, Montecucco C, Ossi E, Piccinino F, Prati D, Puoti M, Riboldi P, Riva A, Roccatello D, Sagnelli E, Scaini P, Scarpato S, Sinico R, Taliani G, Tavoni A, Bonacci E, Renoldi P, Filippini D, Sarzi-Puttini P, Ferri C, Monti G, Galli M. Recommendations for the management of mixed cryoglobulinemia syndrome in hepatitis C virus-infected patients. Autoimmun Rev 2011; 10:444-54. [DOI: 10.1016/j.autrev.2011.01.008] [Citation(s) in RCA: 157] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2011] [Accepted: 01/28/2011] [Indexed: 02/07/2023]
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31
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Antinori S, Ridolfo AL, Fasan M, Magni C, Galimberti L, Milazzo L, Sollima S, Adorni F, Giuliani G, Galli M, Corbellino M, Parravicini C. AIDS-associated cryptococcosis: a comparison of epidemiology, clinical features and outcome in the pre- and post-HAART eras. Experience of a single centre in Italy. HIV Med 2009; 10:6-11. [DOI: 10.1111/j.1468-1293.2008.00645.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Sollima S, Caramma I, Menzaghi B, Massetto B, Acquaviva V, Giulani G, Moroni M, Antinori S. Chronic coinfection with hepatitis B and hepatitis C viruses in an Italian population of HIV-infected patients. J Acquir Immune Defic Syndr 2007; 44:606-7. [PMID: 17413991 DOI: 10.1097/qai.0b013e318031d5b5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [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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Antinori S, Gianelli E, Bonaccorso C, Ridolfo AL, Croce F, Sollima S, Parravicini C. Disseminated Penicillium marneffei infection in an HIV-positive Italian patient and a review of cases reported outside endemic regions. J Travel Med 2006; 13:181-8. [PMID: 16706952 DOI: 10.1111/j.1708-8305.2006.00039.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
We describe a case of disseminated Penicillium marneffei in a human immunodeficiency virus (HIV)-positive Italian man who stayed for 4 years in Chiang Ray province, northern Thailand. A review of the literature shows that penicilliosis, although unusual, may represent an emerging opportunistic infection among HIV-positive people traveling to endemic areas.
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Affiliation(s)
- Spinello Antinori
- Department of Clinical Sciences, Section of Infections and Tropical Diseases, Luigi Sacco Hospital, University of Milan, Milano, Italy.
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Antinori S, Magni C, Nebuloni M, Parravicini C, Corbellino M, Sollima S, Galimberti L, Ridolfo AL, Wheat LJ. Histoplasmosis among human immunodeficiency virus-infected people in Europe: report of 4 cases and review of the literature. Medicine (Baltimore) 2006; 85:22-36. [PMID: 16523050 DOI: 10.1097/01.md.0000199934.38120.d4] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
We reviewed the clinical, microbiologic, and outcome characteristics of 72 patients with human immunodeficiency virus (HIV)-associated histoplasmosis (4 newly described) reported in Europe over 20 years (1984-2004). Seven cases (9.7%) were acquired in Europe (autochthonous), whereas the majority involved a history of travel or arrival from endemic areas. The diagnosis of progressive disseminated histoplasmosis (PDH) was made during life in 63 patients (87.5%) and was the acquired immunodeficiency syndrome (AIDS)-presenting illness in 44 (61.1%). Disease was widespread in 66 patients (91.7%) and localized in 6 (8.3%), with the skin being the most frequent site of localized infection. Overall skin involvement was reported in 47.2% of the patients regardless of whether histoplasmosis was acquired in Africa or South America. Reticulonodular or diffuse interstial infiltrates occurred in 52.8%. The diagnosis was made during life by histopathology plus culture in 44 patients (69.8%), histopathology alone in 18 (28.5%), and culture alone in 1 (1.5%). During the induction phase amphotericin B and itraconazole (74.6%) were the single most frequently used drugs. Both drugs were also used either in combination (10.2%) or in sequential therapy (11.8%). Cumulative mortality rate during the induction phase of treatment was 15.2%. Overall, 37 patients died (57.8%); death occurred early in the course in 18 (28.1%). Seven of 40 patients (17.5%) who responded to therapy subsequently relapsed. Autopsy data in 13 patients confirmed the widespread disseminated nature of histoplasmosis (85%) among AIDS patients with a median of 4.5 organs involved. The results of the present report highlight the need to consider the diagnosis of PDH among patients with AIDS in Europe presenting with a febrile illness who have traveled to or who originated from an endemic area.
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Affiliation(s)
- Spinello Antinori
- From Department of Clinical Sciences, Section of Infectious and Tropical Diseases (SA, MC, SS, LG, ALR), University of Milan, Milan; Institute of Pathology (MN, CP), and I Infectious Diseases Unit (CM), Luigi Sacco Hospital, Milan, Italy; and MiraVista Diagnostics (LJW), Indianapolis, Indiana, United States
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Sollima S, Croce F, Scalamogna C, Caramma I, Antinori S. Sarcoidosis presenting with massive involvement of the nervous system. Ann Intern Med 2005; 142:475-6. [PMID: 15767634 DOI: 10.7326/0003-4819-142-6-200503150-00024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Sollima S, Corbellino M, Piolini R, Calattini S, Imparato S, Antinori S. Visceral leishmaniasis in a patient with Wegener's granulomatosis. Rheumatology (Oxford) 2004; 43:935-7. [PMID: 15213342 DOI: 10.1093/rheumatology/keh220] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Sollima S, Corbellino M, Castelnuovo B, Tosoni A, Antinori S. Red herrings. Lancet 2003; 362:876. [PMID: 13678975 DOI: 10.1016/s0140-6736(03)14343-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- S Sollima
- Institute of Infectious and Tropical Diseases, University of Milan, Milan, Italy.
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Chiesa E, Bini T, Adorni F, Capetti A, Rizzardini G, Faggion I, Mussini C, Sollima S, Melzi S, Bongiovanni M, Tordato F, Cicconi P, Castelnuovo B, Rusconi S, d'Arminio Monforte A. Simplification of protease inhibitor-containing regimens with efavirenz, nevirapine or abacavir: safety and efficacy outcomes. Antivir Ther 2003; 8:27-35. [PMID: 12713061] [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: 03/02/2023]
Abstract
OBJECTIVE To describe the immunological and virological outcome, and the factors associated to discontinuation in patients switching to a regimen containing efavirenz (EFV), nevirapine (NVP) or abacavir (ABC) after long-term viral suppression under protease inhibitor-including HAART. DESIGN Observational study at three outpatient clinics for HIV care in Italy. METHODS Patients with HIV RNA <80 copies/ml and CD4 >200 cells/ml for at least 6 months on a protease inhibitor-containing treatment who switched to NVP, EFV or ABC were included in the study. End-points were immunological failure, virological failure and discontinuation due to toxicity. Survival analyses were performed to find out any independent variables predictive of reaching the end-points. RESULTS 177 patients were enrolled; 85 started EFV, 54 NVP and 38 ABC as part of the simplification regimen. 16/159 patients experienced immunological failure: the variables associated to CD4 count decrease were HIV RNA set point value (HR 2.32 for each log10 copies more, P=0.040) and intolerance/toxicity as reason for simplification (HR 3.96, P=0.05). 13/151 subjects showed virological failure; an AIDS diagnosis (HR 6.04, P=0.021) and the use of NVP (HR 7.98, P=0.027) were associated to a worse virological outcome, while patients naive before HAART showed a lower risk of failure (HR 0.008, P=0.007). 16/177 patients discontinued simplification regimen due to toxicity; longer HAART duration before switch was associated to risk reduction (HR 0.92, P=0.004). CONCLUSIONS Simplification is safe and effective, but it should be offered to patients with shorter treatment duration, and in good clinical and immunovirological conditions.
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Affiliation(s)
- Elisabetta Chiesa
- Institute of Infectious Diseases and Tropical Medicine, University of Milan, Italy
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Bongiovanni M, Bini T, Tordato F, Cicconi P, Melzi S, Repetto D, Sollima S, Rusconi S, d'Arminio Monforte A. Immunovirological outcomes in 70 HIV-1-infected patients who switched to lopinavir/ritonavir after failing at least one protease inhibitor-containing regimen: a retrospective cohort study. J Antimicrob Chemother 2003; 51:171-4. [PMID: 12493805 DOI: 10.1093/jac/dkg045] [Citation(s) in RCA: 5] [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: 11/14/2022] Open
Abstract
The immunovirological outcome of lopinavir/ritonavir was evaluated in 70 antiretroviral-experienced HIV patients; at baseline, median CD4+ cell count was 218 cells/mm(3) and median plasma viraemia 4.58 log(10) copies/mL. After 12 months, we observed an increase in CD4+ cell count to 322 cells/mm(3) (P = 0.0001) and a decrease in plasma viraemia to 2.35 log(10) copies/mL (P = 0.0001). Four patients discontinued lopinavir/ritonavir during observation. Among metabolic parameters, only triglyceride concentrations increased during treatment (P = 0.02). Twenty-six patients had a genotypic resistance test at baseline; four had > or =6 mutations known to reduce susceptibility to lopinavir/ritonavir. Undetectable plasma viraemia was obtained only in patients with < or =5 mutations (61.9%).
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Affiliation(s)
- Marco Bongiovanni
- Institute of Infectious and Tropical Diseases, University of Milan, Luigi Sacco Hospital, via GB Grassi 74, 20157 Milan, Italy
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Chiesa E, Bini T, Adorni F, Capetti A, Rizzardini G, Faggion I, Mussini C, Sollima S, Melzi S, Bongiovanni M, Tordato F, Cicconi P, Castelnuovo B, Rusconi S, Monforte AD. Simplification of Protease Inhibitor-Containing Regimens with Efavirenz, Nevirapine or Abacavir: Safety and Efficacy Outcomes. Antivir Ther 2003. [DOI: 10.1177/135965350300800104] [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
Objective To describe the immunological and virological outcome, and the factors associated to discontinuation in patients switching to a regimen containing efavirenz (EFV), nevirapine (NVP) or abacavir (ABC) after long-term viral suppression under protease inhibitor-including HAART. Design Observational study at three outpatient clinics for HIV care in Italy. Methods Patients with HIV RNA <80 copies/ml and CD4 >200 cells/ml for at least 6 months on a protease inhibitor-containing treatment who switched to NVP, EFV or ABC were included in the study. End-points were immunological failure, virological failure and discontinuation due to toxicity. Survival analyses were performed to find out any independent variables predictive of reaching the end-points. Results 177 patients were enrolled; 85 started EFV, 54 NVP and 38 ABC as part of the simplification regimen. 16/159 patients experienced immunological failure: the variables associated to CD4 count decrease were HIV RNA set point value (HR 2.32 for each log10 copies more, P=0.040) and intolerance/toxicity as reason for simplification (HR 3.96, P=0.05). 13/151 subjects showed virological failure; an AIDS diagnosis (HR 6.04, P=0.021) and the use of NVP (HR 7.98, P=0.027) were associated to a worse virological outcome, while patients naive before HAART showed a lower risk of failure (HR 0.008, P=0.007). 16/177 patients discontinued simplification regimen due to toxicity; longer HAART duration before switch was associated to risk reduction (HR 0.92, P=0.004). Conclusions Simplification is safe and effective, but it should be offered to patients with shorter treatment duration, and in good clinical and immunovirological conditions.
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Affiliation(s)
- Elisabetta Chiesa
- Institute of Infectious Diseases and Tropical Medicine, University of Milan, Italy
| | - Teresa Bini
- Institute of Infectious Diseases and Tropical Medicine, University of Milan, Italy
| | | | - Amedeo Capetti
- I Division of Infectious Diseases, L Sacco Hospital, Milan, Italy
| | | | - Ivano Faggion
- I Division of Infectious Diseases, L Sacco Hospital, Milan, Italy
| | | | - Salvatore Sollima
- Institute of Infectious Diseases and Tropical Medicine, University of Milan, Italy
| | - Sara Melzi
- Institute of Infectious Diseases and Tropical Medicine, University of Milan, Italy
| | - Marco Bongiovanni
- Institute of Infectious Diseases and Tropical Medicine, University of Milan, Italy
| | - Federica Tordato
- Institute of Infectious Diseases and Tropical Medicine, University of Milan, Italy
| | - Paola Cicconi
- Institute of Infectious Diseases and Tropical Medicine, University of Milan, Italy
| | - Barbara Castelnuovo
- Institute of Infectious Diseases and Tropical Medicine, University of Milan, Italy
| | - Stefano Rusconi
- Institute of Infectious Diseases and Tropical Medicine, University of Milan, Italy
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Sollima S, Corbellino M, Cicconi P, Piazza M, Viganò O, Antinori S. Resolution of multidrug-refractory oesophageal candidiasis in an AIDS patient after treatment with caspofungin. AIDS 2002; 16:1303-4. [PMID: 12045503 DOI: 10.1097/00002030-200206140-00020] [Citation(s) in RCA: 5] [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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Affiliation(s)
- S Sollima
- Institute of Infectious and Tropical Diseases, University of Milan, Italy
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d' Arminio Monforte A, Adorni F, Meroni L, Bini T, Testa L, Chiesa E, Melzi S, Rusconi S, Sollima S, Galli M, Moroni M. Predictive role of the three-month CD4 cell count in the long-term clinical outcome of the first HAART regimen. Biomed Pharmacother 2001; 55:16-22. [PMID: 11237280 DOI: 10.1016/s0753-3322(00)00017-2] [Citation(s) in RCA: 3] [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: 10/17/2022] Open
Abstract
The aim was to evaluate whether the three-month CD4 cell counts are a reliable predictor of the long-term clinical outcome of HAART-treated patients, by an observational study of 585 patients initiating HAART in a clinical setting. Clinical failure was defined as the occurrence of new or recurrent AIDS-defining events or death, and was analysed by means of intention-to-treat, univariate and multivariate analyses. An adjusted Cox regression model was used to evaluate the effect of three-month CD4+ counts on clinical outcome. Clinical failure occurred in 65 patients (11.1%) during a median follow-up of 31 months (1-65) as a result of new AIDS-defining events (ADEs) in 48 patients, ADE recurrence in six, and death in 11. The mean (median; range) CD4+ counts were 156/microL (155; 4--529) in patients with and 362/microL (326; 18--1162) in patients without clinical failure (P < .0001). Moreover, the proportion of patients with mean CD4+ counts < 200 microL was higher in those experiencing subsequent clinical failure (chi2: 41.11; P< .00001). Multivariate analysis showed that baseline CD4+ counts < 50 microL, HIV-RNA > 100,000 copies/mL and AIDS at baseline predicted failure; after adjusting for three-month CD4+ counts, this marker was the only one independently associated with clinical failure (HR 2.93; 95% Cl: 1.16--7.38). The three-month immunologic response is a reliable predictor of long-term clinical outcome.
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Affiliation(s)
- A d' Arminio Monforte
- Institute of Infectious and Tropical Diseases, University of Milan, L Sacco Hospital, Italy.
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Bini T, Testa L, Chiesa E, Adorni F, Abeli C, Castelnuovo B, Melzi S, Sollima S, Bongiovanni M, d'Arminio Monforte A. Outcome of a second-line protease inhibitor-containing regimen in patients failing or intolerant of a first highly active antiretroviral therapy. J Acquir Immune Defic Syndr 2000; 24:115-22. [PMID: 10935686 DOI: 10.1097/00126334-200006010-00005] [Citation(s) in RCA: 15] [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: 11/26/2022]
Abstract
The outcome of second-line protease inhibitor (PI)-containing highly active antiretroviral therapy (HAART) was investigated in 263 patients who were failed by (n = 148) or intolerant of (n = 115) a first HAART regimen. The endpoints were virologic failure (decline in HIV RNA < 1 log10 copies/ml after > or = 2 months) and discontinuation due to intolerance/toxicity. During a median follow-up of 483 days (33-1087 days), 154 patients (59%) discontinued the second regimen, 86 (33%) because of intolerance/toxicity; another 135 patients (51.3%) showed virologic failure. Independent factors associated with virologic failure (Cox's model) were 7 to 12 months of first HAART (hazard ratio [HR] 1.70 versus < or = 6 months: 95% confidence interval [CI], 1.08-2.70) and gender (HR 1.58 males versus females: 95% CI, 1.04-2.30); the negatively associated factors were advanced age (HR 0.61 > 34 years versus < or = 34 years: 95% CI, 0.42-0.88), a saquinavir-containing first HAART (HR 0.57 versus indinavir: 95% CI, 0.34-0.93) and change due to intolerance/toxicity (HR 0.58 versus failure: 95% CI, 0.35-0.98). The independent variables predictive of discontinuation due to intolerance/toxicity were the reason for switching (HR 1.79 intolerance versus failure: 95% CI, 1.02-3.16) and the first protease inhibitor (PI) regimen (HR 0.42 ritonavir versus indinavir: 95% CI, 0.22-0.80). Given that patients who are failed by a first regimen are at high risk of having rescue therapy fail as well, second-line regimens including therapies directed by testing of drug resistance patterns of clinical viral isolates are warranted. Patients experiencing toxicity due to a first PI-containing regimen are at risk of toxicity to other PIs and should be addressed to PI-sparing HAART.
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Affiliation(s)
- T Bini
- Institute of Infectious and Tropical Diseases, L. Sacco Hospital, University of Milan, Italy
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Sollima S, Pizzuto M, Bonetto S, Ravasio L, Tosoni A, Vago L, Corbellino M, Antinori S. A case of oesophageal leishmaniasis indicating visceral leishmaniasis in a patient with AIDS. Eur J Clin Microbiol Infect Dis 1999; 18:752-5. [PMID: 10584908 DOI: 10.1007/s100960050394] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- S Sollima
- Institute of Infectious Diseases and Tropical Medicine, L. Sacco Hospital, University of Milan, Italy
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d'Arminio Monforte A, Testori V, Adorni F, Castelnuovo B, Bini T, Testa L, Moscatelli G, Chiesa E, Rusconi S, Abeli C, Sollima S, Musicco M, Meroni L, Galli M, Moroni M. CD4 cell counts at the third month of HAART may predict clinical failure. AIDS 1999; 13:1669-76. [PMID: 10509568 DOI: 10.1097/00002030-199909100-00010] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.8] [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: 01/24/2023]
Abstract
OBJECTIVE To evaluate the influence of immunological and virological markers on clinical outcome in patients receiving their first highly active antiretroviral therapy (HAART) regimen. DESIGN AND METHODS Observational study of 585 patients initiating HAART in a clinical setting. Clinical failure was defined as the occurrence of new or recurrent AIDS-defining events or death, and was analysed by means of intention-to-treat, univariate and multivariate analyses. An adjusted Cox regression model was used to evaluate the effect of 3-month CD4 cell counts on clinical outcome. RESULTS Clinical failure occurred in 55 patients (9.4%) during a median follow-up of 483 days (range 33-1334 days): 45 new AIDS-defining events (ADEs) in 38, ADE recurrence in six, and death in 11. Twenty-four of the 45 new ADEs (53.4%) occurred during the first 3 months of HAART, and 11 of 45 (24.4%) in the presence of CD4 cell counts > 200 x 10(6) cells/l. The mean (median, range) CD4 counts were 144 x 10(6) cells/l (128, 4-529) in patients with and 322 x 10(6) cells/l (288, 14-1162) in patients without clinical failure (P < 0.0001). Moreover, the proportion of patients with mean CD4 cell counts < 200 x 10(6) cells/l was higher in those experiencing subsequent clinical failure (X2 test: 26.75; P < 0.00001). Multivariate analysis showed that baseline CD4 cell counts < 50 x 10(6) cells/l and AIDS at enrolment predicted failure; after adjusting for 3-month CD4 cell counts, this marker was the only one independently associated with clinical failure (hazard risk, 4.79; 95% confidence interval, 1.40-16.47). CONCLUSIONS The 3-month immunological response is a reliable predictor of long-term clinical outcome.
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d'Arminio Monforte A, Testa L, Adorni F, Chiesa E, Bini T, Moscatelli GC, Abeli C, Rusconi S, Sollima S, Balotta C, Musicco M, Galli M, Moroni M. Clinical outcome and predictive factors of failure of highly active antiretroviral therapy in antiretroviral-experienced patients in advanced stages of HIV-1 infection. AIDS 1998; 12:1631-7. [PMID: 9764782 DOI: 10.1097/00002030-199813000-00010] [Citation(s) in RCA: 112] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To verify the effectiveness of highly active antiretroviral therapy (HAART) and to identify any factors predictive of clinical outcome in a clinical setting. DESIGN Observational study. METHODS Treatment failure (i.e., the occurrence of new or recurrent AIDS-defining events, death or any definitive discontinuation) and the course of CD4+ cell counts and HIV RNA copies were evaluated in 250 heavily pretreated HIV-infected patients starting HAART [153 with indinavir (IDV), 55 with ritonavir (RTV), 43 with saquinavir (SQV)]. Univariate and multivariate analyses were performed to identify predictors of worse outcome. RESULTS During a median follow-up of 8 months, 75 patients (30%) had treatment failure because of the occurrence of an AIDS-defining event or death (n = 24), inefficacy (n = 24), or severe intolerance (n = 27). Twenty new and six recurrent AIDS-defining events, and nine deaths occurred (six out of 20 AIDS-defining events and two out of nine deaths within 1 month of treatment). CD4+ counts were above 200 x 10(6)/l at AIDS diagnosis in only two patients. None of the SQV patients, 12 (7.8%) of the IDV patients, and 15 (27.3%) of the RTV-treated patients were considered non-compliant. The SQV-containing regimens independently correlated with treatment failure (relative risk, 2.46; 95% confidence interval, 1.20-5.03; versus IDV). Low compliance partially determined outcome in RTV-treated patients; both severe immunodepression and AIDS at baseline were predictive of treatment failure. There was a 10-fold increase in CD4+ cell counts in the patients treated with IDV and RTV; the best virological outcome occurred in IDV-treated patients, with 68.4% of patients showing undetectable HIV RNA copies after 6 months. CONCLUSIONS HAART was effective in 70% of patients; low compliance and previous AIDS diagnosis represented predictive factors of therapy failure.
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d'Arminio Monforte A, Testa L, Gianotto M, Gori A, Franzetti F, Sollima S, Bini T, Moroni M. Indinavir-related alopecia. AIDS 1998; 12:328. [PMID: 9517999] [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: 02/06/2023]
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