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Camici M, Gagliardini R, Lanini S, Del Duca G, Mondi A, Ottou S, Plazzi MM, De Zottis F, Pinnetti C, Vergori A, Grilli E, Mastrorosa I, Mazzotta V, Paulicelli J, Bellagamba R, Cimini E, Tartaglia E, Notari S, Tempestilli M, Cicalini S, Amendola A, Abbate I, Forbici F, Fabeni L, Girardi E, Vaia F, Maggi F, Antinori A. Rapid ART initiation with bictegravir/emtricitabine/tenofovir alafenamide in individuals presenting with advanced HIV disease (Rainbow study). Int J Antimicrob Agents 2024; 63:107049. [PMID: 38056572 DOI: 10.1016/j.ijantimicag.2023.107049] [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: 07/16/2023] [Revised: 11/10/2023] [Accepted: 11/28/2023] [Indexed: 12/08/2023]
Abstract
BACKGROUND A rapid ART initiation approach can be beneficial in people with advanced HIV disease, in consideration of their high morbidity and mortality. The aim of our study was to evaluate the feasibility, efficacy and safety of rapid ART start with BIC/FTC/TAF in this setting. METHODS Pilot, single-centre, single-arm, prospective, phase IV clinical trial conducted in a tertiary Italian hospital. Thirty ART-naïve people presenting with advanced HIV-1 diagnosis (defined as the presence of an AIDS-defining event and/or CD4 cell count <200 µL), were enrolled. Main exclusion criteria were active tuberculosis, cryptococcosis and pregnant/breastfeeding women. BIC/FTC/TAF was started within 7 days from HIV diagnosis. The primary endpoint was clinical or virologic failure (VF). Immunological parameters, safety, feasibility, neurocognitive performances and patient-reported outcomes were assessed as well. RESULTS Over the study period, 40 (34%) of 116 patients diagnosed with HIV infection at INMI Spallanzani had advanced disease, of whom 30 (26%) were enrolled. The proportion of participants with HIV-RNA <50 cp/mL was 9/30 (30%) at week (w) 4, 19/30 (63%) at w12, 24/30 (80%) at w24, 23/30 (77%) at w36 and 27/30 (90%) at w48. Two unconfirmed VF occurred. No ART discontinuation due to toxicity or VF was observed. No ART modification was performed based on the review of genotype and no mutations for the study drugs were detected. Mean CD4 cells count changed by 133 cells/μL at BL to 309 cells/μL at w 48 and 83% of participants had a CD4 > 200 cells/µL at w 48. Two participants developed IRIS and one was diagnosed with disseminated TB and needed an ART switch. INTERPRETATIONS Our results support the feasibility, efficacy and safety of BIC/FTC/TAF as a rapid ART strategy in patients with advanced HIV disease.
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Affiliation(s)
- Marta Camici
- Clinical and Research Infectious Diseases Department, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy.
| | - Roberta Gagliardini
- Clinical and Research Infectious Diseases Department, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Simone Lanini
- Clinical and Research Infectious Diseases Department, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Giulia Del Duca
- Clinical and Research Infectious Diseases Department, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Annalisa Mondi
- Clinical and Research Infectious Diseases Department, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Sandrine Ottou
- Clinical and Research Infectious Diseases Department, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Maria M Plazzi
- Clinical and Research Infectious Diseases Department, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Federico De Zottis
- Clinical and Research Infectious Diseases Department, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Carmela Pinnetti
- Clinical and Research Infectious Diseases Department, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Alessandra Vergori
- Clinical and Research Infectious Diseases Department, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Elisabetta Grilli
- Clinical and Research Infectious Diseases Department, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Ilaria Mastrorosa
- Clinical and Research Infectious Diseases Department, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Valentina Mazzotta
- Clinical and Research Infectious Diseases Department, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Jessica Paulicelli
- Clinical and Research Infectious Diseases Department, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Rita Bellagamba
- Clinical and Research Infectious Diseases Department, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Eleonora Cimini
- Laboratory of Cellular Immunology and Pharmacology, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Eleonora Tartaglia
- Laboratory of Cellular Immunology and Pharmacology, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Stefania Notari
- Laboratory of Cellular Immunology and Pharmacology, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Massimo Tempestilli
- Laboratory of Cellular Immunology and Pharmacology, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Stefania Cicalini
- Clinical and Research Infectious Diseases Department, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Alessandra Amendola
- Laboratory of Virology, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Isabella Abbate
- Laboratory of Virology, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Federica Forbici
- Laboratory of Virology, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Lavinia Fabeni
- Laboratory of Virology, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Enrico Girardi
- Scientific Direction, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Francesco Vaia
- General Direction, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Fabrizio Maggi
- Laboratory of Virology, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Andrea Antinori
- Clinical and Research Infectious Diseases Department, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
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Mastrorosa I, Gagliardini R, Segala FV, Mondi A, Lorenzini P, Cerva C, Taddei E, Bai F, Vergori A, Marcantonio N, Pinnetti C, Cicalini S, Murri R, Mazzotta V, Camici M, Mosti S, Bini T, Maffongelli G, Beccacece A, Milozzi E, Iannetta M, Lamonica S, Fusto M, Plazzi MM, Ottou S, Lichtner M, Fantoni M, Andreoni M, Sarmati L, Cauda R, Girardi E, Nicastri E, D'Arminio Monforte A, Palmieri F, Cingolani A, Vaia F, Antinori A. Sarilumab plus standard of care vs standard of care for the treatment of severe COVID-19: a phase 3, randomized, open-labeled, multi-center study (ESCAPE study). EClinicalMedicine 2023; 57:101895. [PMID: 36936403 PMCID: PMC9999914 DOI: 10.1016/j.eclinm.2023.101895] [Citation(s) in RCA: 1] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 02/15/2023] [Accepted: 02/15/2023] [Indexed: 03/12/2023] Open
Abstract
BACKGROUND Among interleukin-6 inhibitors suggested for use in COVID-19, there are few robust evidences for the efficacy of sarilumab. Herein, we evaluated the efficacy and safety of sarilumab in severe COVID-19. METHODS In this phase 3, open-labeled, randomized clinical trial, conducted at 5 Italian hospitals, adults with severe COVID-19 pneumonia (excluding mechanically ventilated) were randomized 2:1 to receive intravenous sarilumab (400 mg, repeatable after 12 h) plus standard of care (SOC) (arm A) or to continue SOC (arm B). Randomization was web-based. As post-hoc analyses, the participants were stratified according to baseline inflammatory parameters. The primary endpoint was analysed on the modified Intention-To-Treat population, including all the randomized patients who received any study treatment (sarilumab or SOC). It was time to clinical improvement of 2 points on a 7-points ordinal scale, from baseline to day 30. We used Kaplan Meier method and log-rank test to compare the primary outcome between two arms, and Cox regression stratified by clinical center and adjusted for severity of illness, to estimate the hazard ratio (HR). The trial was registered with EudraCT (2020-001390-76). FINDINGS Between May 2020 and May 2021, 191 patients were assessed for eligibility, of whom, excluding nine dropouts, 176 were assigned to arm A (121) and B (55). At day 30, no significant differences in the primary endpoint were found (88% [95% CI 81-94] in arm A vs 85% [74-93], HR 1.07 [0.8-1.5] in arm B; log-rank p = 0.50). After stratifying for inflammatory parameters, arm A showed higher probability of improvement than B without statistical significance in the strata with C reactive protein (CRP) < 7 mg/dL (88% [77-96] vs 79% [63-91], HR 1.55 [0.9-2.6]; log-rank p = 0.049) and in the strata with lymphocytes <870/mmc (90% [79-96]) vs (73% [55-89], HR 1.53 [0.9-2.7]; log-rank p = 0.058). Overall, 39/121 (32%) AEs were reported in arm A and 14/55 (23%) in B (p = 0.195), while serious AEs were 22/121 (18%) and 7/55 (11%), respectively (p = 0.244). There were no treatment-related deaths. INTERPRETATION The efficacy of sarilumab in severe COVID-19 was not demonstrated both in the overall and in the stratified for severity analysis population. Exploratory analyses suggested that subsets of patients with lower CRP values or lower lymphocyte counts might have had benefit with sarilumab treatment, but this finding would require replication in other studies. The relatively low rate of concomitant corticosteroid use, could partially explain our results. FUNDING This study was supported by INMI "Lazzaro Spallanzani" Ricerca Corrente Linea 1 on emerging and reemerging infections, funded by Italian Ministry of Health.
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Affiliation(s)
- Ilaria Mastrorosa
- National Institute for Infectious Diseases, Lazzaro Spallanzani IRCCS, Rome, Italy
- Corresponding author. Clinical Department of Infectious Diseases and Research, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Via Portuense 292, 00149, Roma, Italy.
| | - Roberta Gagliardini
- National Institute for Infectious Diseases, Lazzaro Spallanzani IRCCS, Rome, Italy
| | | | - Annalisa Mondi
- National Institute for Infectious Diseases, Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Patrizia Lorenzini
- National Institute for Infectious Diseases, Lazzaro Spallanzani IRCCS, Rome, Italy
- National Center for Disease Prevention and Health Promotion, National Institute of Health, Rome, Italy
| | - Carlotta Cerva
- National Institute for Infectious Diseases, Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Eleonora Taddei
- Fondazione Policlinico A. Gemelli, Catholic University of the Sacred Heart, Rome, Italy
| | - Francesca Bai
- ASST Santi Paolo e Carlo, University of Milan, Italy
| | - Alessandra Vergori
- National Institute for Infectious Diseases, Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Negri Marcantonio
- Fondazione Policlinico A. Gemelli, Catholic University of the Sacred Heart, Rome, Italy
| | - Carmela Pinnetti
- National Institute for Infectious Diseases, Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Stefania Cicalini
- National Institute for Infectious Diseases, Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Rita Murri
- Fondazione Policlinico A. Gemelli, Catholic University of the Sacred Heart, Rome, Italy
| | - Valentina Mazzotta
- National Institute for Infectious Diseases, Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Marta Camici
- National Institute for Infectious Diseases, Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Silvia Mosti
- National Institute for Infectious Diseases, Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Teresa Bini
- ASST Santi Paolo e Carlo, University of Milan, Italy
| | - Gaetano Maffongelli
- National Institute for Infectious Diseases, Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Alessia Beccacece
- National Institute for Infectious Diseases, Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Eugenia Milozzi
- National Institute for Infectious Diseases, Lazzaro Spallanzani IRCCS, Rome, Italy
| | | | - Silvia Lamonica
- Fondazione Policlinico A. Gemelli, Catholic University of the Sacred Heart, Rome, Italy
| | - Marisa Fusto
- National Institute for Infectious Diseases, Lazzaro Spallanzani IRCCS, Rome, Italy
| | | | - Sandrine Ottou
- National Institute for Infectious Diseases, Lazzaro Spallanzani IRCCS, Rome, Italy
| | | | - Massimo Fantoni
- Fondazione Policlinico A. Gemelli, Catholic University of the Sacred Heart, Rome, Italy
| | | | | | - Roberto Cauda
- Fondazione Policlinico A. Gemelli, Catholic University of the Sacred Heart, Rome, Italy
| | - Enrico Girardi
- National Institute for Infectious Diseases, Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Emanuele Nicastri
- National Institute for Infectious Diseases, Lazzaro Spallanzani IRCCS, Rome, Italy
| | | | - Fabrizio Palmieri
- National Institute for Infectious Diseases, Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Antonella Cingolani
- Fondazione Policlinico A. Gemelli, Catholic University of the Sacred Heart, Rome, Italy
| | - Francesco Vaia
- National Institute for Infectious Diseases, Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Andrea Antinori
- National Institute for Infectious Diseases, Lazzaro Spallanzani IRCCS, Rome, Italy
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Lanini S, Capone S, Antinori A, Milleri S, Nicastri E, Camerini R, Agrati C, Castilletti C, Mori F, Sacchi A, Matusali G, Gagliardini R, Ammendola V, Cimini E, Grazioli F, Scorzolini L, Napolitano F, Plazzi MM, Soriani M, De Luca A, Battella S, Sommella A, Contino AM, Barra F, Gentile M, Raggioli A, Shi Y, Girardi E, Maeurer M, Capobianchi MR, Vaia F, Piacentini M, Kroemer G, Vitelli A, Colloca S, Folgori A, Ippolito G, Ottou S, Vita S, Vergori A, D'Abramo A, Petrecchia A, Montaldo C, Scalise E, Grassi G, Casetti R, Bordoni V, Notari S, Colavita F, Meschi S, Lapa D, Bordi L, Murachelli S, Tambasco T, Grillo A, Masone E, Marchioni E, Bardhi D, Porzio O, Cocca F, Murachelli S, Turrini I, Malescio F, Ziviani L, Lawlor R, Poli F, Martire F, Zamboni D, Mazzaferri F. GRAd-COV2, a gorilla adenovirus-based candidate vaccine against COVID-19, is safe and immunogenic in younger and older adults. Sci Transl Med 2021; 14:eabj1996. [PMID: 34698501 DOI: 10.1126/scitranslmed.abj1996] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Simone Lanini
- Istituto Nazionale per Le Malattie Infettive Lazzaro Spallanzani IRCCS; 00149, Rome, Italy
| | | | - Andrea Antinori
- Istituto Nazionale per Le Malattie Infettive Lazzaro Spallanzani IRCCS; 00149, Rome, Italy
| | - Stefano Milleri
- Centro Ricerche Cliniche di Verona srl; 37134, Verona, Italy
| | - Emanuele Nicastri
- Istituto Nazionale per Le Malattie Infettive Lazzaro Spallanzani IRCCS; 00149, Rome, Italy
| | | | - Chiara Agrati
- Istituto Nazionale per Le Malattie Infettive Lazzaro Spallanzani IRCCS; 00149, Rome, Italy
| | - Concetta Castilletti
- Istituto Nazionale per Le Malattie Infettive Lazzaro Spallanzani IRCCS; 00149, Rome, Italy
| | | | - Alessandra Sacchi
- Istituto Nazionale per Le Malattie Infettive Lazzaro Spallanzani IRCCS; 00149, Rome, Italy
| | - Giulia Matusali
- Istituto Nazionale per Le Malattie Infettive Lazzaro Spallanzani IRCCS; 00149, Rome, Italy
| | - Roberta Gagliardini
- Istituto Nazionale per Le Malattie Infettive Lazzaro Spallanzani IRCCS; 00149, Rome, Italy
| | | | - Eleonora Cimini
- Istituto Nazionale per Le Malattie Infettive Lazzaro Spallanzani IRCCS; 00149, Rome, Italy
| | | | - Laura Scorzolini
- Istituto Nazionale per Le Malattie Infettive Lazzaro Spallanzani IRCCS; 00149, Rome, Italy
| | | | - Maria M Plazzi
- Istituto Nazionale per Le Malattie Infettive Lazzaro Spallanzani IRCCS; 00149, Rome, Italy
| | | | - Aldo De Luca
- Istituto Nazionale per Le Malattie Infettive Lazzaro Spallanzani IRCCS; 00149, Rome, Italy
| | | | | | | | | | | | | | - Yufang Shi
- First Affiliated Hospital of Soochow University; Suzhou, 215008, Jiangsu, China.,Shanghai Institute of Nutrition and Health, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences; 200061, Shanghai, China
| | - Enrico Girardi
- Istituto Nazionale per Le Malattie Infettive Lazzaro Spallanzani IRCCS; 00149, Rome, Italy
| | - Markus Maeurer
- Division of Immunotherapy, ImmunoSurgery, Champalimaud Foundation; 1400-038, Lisboa, Portugal.,I Medical Clinic, University of Mainz; 55122, Mainz, Germany
| | - Maria R Capobianchi
- Istituto Nazionale per Le Malattie Infettive Lazzaro Spallanzani IRCCS; 00149, Rome, Italy.,Saint Camillus International University of Health Sciences, 00131, Rome, Italy
| | - Francesco Vaia
- Istituto Nazionale per Le Malattie Infettive Lazzaro Spallanzani IRCCS; 00149, Rome, Italy
| | - Mauro Piacentini
- Department of Biology, University of Rome "Tor Vergata; 00133, Rome, Italy
| | - Guido Kroemer
- Centre de Recherche des Cordeliers, Equipe labellisée par la Ligue contre le cancer, Université de Paris, Sorbonne Université, Inserm U1138, Institut Universitaire de France, 75006, Paris, France.,Metabolomics and Cell Biology Platforms, Institut Gustave Roussy; 94805, Villejuif, France.,Pôle de Biologie, Hôpital Européen Georges Pompidou; 75015, Paris, France.,Department of Women's and Children's Health, Karolinska University Hospital, 17164, Stockholm, Sweden
| | | | | | | | - Giuseppe Ippolito
- Istituto Nazionale per Le Malattie Infettive Lazzaro Spallanzani IRCCS; 00149, Rome, Italy
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4
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Mondi A, Lorenzini P, Castilletti C, Gagliardini R, Lalle E, Corpolongo A, Valli MB, Taglietti F, Cicalini S, Loiacono L, Di Gennaro F, D'Offizi G, Palmieri F, Nicastri E, Agrati C, Petrosillo N, Ippolito G, Vaia F, Girardi E, Capobianchi MR, Antinori A, Zito S, Abbonizio MA, Abdeddaim A, Agostini E, Agrati C, Albarello F, Amadei G, Amendola A, Antinori A, Antonica MA, Antonini M, Bartoli TA, Baldini F, Barbaro R, Bartolini B, Bellagamba R, Benigni M, Bevilacqua N, Biava G, Bibas M, Bordi L, Bordoni V, Boumis E, Branca M, Buonomo R, Busso D, Camici M, Campioni P, Canichella F, Capobianchi MR, Capone A, Caporale C, Caraffa E, Caravella I, Carletti F, Castilletti C, Cataldo A, Cerilli S, Cerva C, Chiappini R, Chinello P, Cianfarani MA, Ciaralli C, Cimaglia C, Cinicola N, Ciotti V, Cicalini S, Colavita F, Corpolongo A, Cristofaro M, Curiale S, D'Abramo A, Dantimi C, De Angelis A, De Angelis G, De Palo MG, De Zottis F, Di Bari V, Di Lorenzo R, Di Stefano F, D'Offizi G, Donno D, Evangelista F, Faraglia F, Farina A, Ferraro F, Fiorentini L, Frustaci A, Fusetti M, Galati V, Gagliardini R, Gallì P, Garotto G, Gaviano I, Tekle SG, Giancola ML, Giansante F, Giombini E, Granata G, Greci MC, Grilli E, Grisetti S, Gualano G, Iacomi F, Iaconi M, Iannicelli G, Inversi C, Ippolito G, Lalle E, Lamanna ME, Lanini S, Lapa D, Lepore L, Libertone R, Lionetti R, Liuzzi G, Loiacono L, Lucia A, Lufrani F, Macchione M, Maffongelli G, Marani A, Marchioni L, Mariano A, Marini MC, Maritti M, Mastrobattista A, Mastrorosa I, Matusali G, Mazzotta V, Mencarini P, Meschi S, Messina F, Micarelli S, Mogavero G, Mondi A, Montalbano M, Montaldo C, Mosti S, Murachelli S, Musso M, Nardi M, Navarra A, Nicastri E, Nocioni M, Noto P, Noto R, Oliva A, Onnis I, Ottou S, Palazzolo C, Pallini E, Palmieri F, Palombi G, Pareo C, Passeri V, Pelliccioni F, Penna G, Petrecchia A, Petrone A, Petrosillo N, Pianura E, Pinnetti C, Pisciotta M, Piselli P, Pittalis S, Pontarelli A, Proietti C, Puro V, Ramazzini PM, Rianda A, Rinonapoli G, Rosati S, Rubino D, Rueca M, Ruggeri A, Sacchi A, Sampaolesi A, Sanasi F, Santagata C, Scarabello A, Scarcia S, Schininà V, Scognamiglio P, Scorzolini L, Stazi G, Strano G, Taglietti F, Taibi C, Taloni G, Nardi T, Tonnarini R, Topino S, Tozzi M, Vaia F, Vairo F, Valli MB, Vergori A, Vincenzi L, Visco-Comandini U, Vita S, Vittozzi P, Zaccarelli M, Zanetti A, Zito S. Risk and predictive factors of prolonged viral RNA shedding in upper respiratory specimens in a large cohort of COVID-19 patients admitted to an Italian reference hospital. Int J Infect Dis 2021; 105:532-539. [PMID: 33676001 PMCID: PMC7927669 DOI: 10.1016/j.ijid.2021.02.117] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 02/26/2021] [Accepted: 02/27/2021] [Indexed: 12/15/2022] Open
Abstract
Background Limited data are available about the predictors and outcomes associated with prolonged SARS-CoV-2 RNA shedding (VS). Methods A retrospective study including COVID-19 patients admitted to an Italian hospital between March 1 and July 1, 2020. Predictors of viral clearance (VC) and prolonged VS from the upper respiratory tract were assessed by Poisson regression and logistic regression analyses. The causal relation between VS and clinical outcomes was evaluated through an inverse probability weighted Cox model. Results The study included 536 subjects. The median duration of VS from symptoms onset was 18 days. The estimated 30-day probability of VC was 70.2%. Patients with comorbidities, lymphopenia at hospital admission, or moderate/severe respiratory disease had a lower chance of VC. The development of moderate/severe respiratory failure, delayed hospital admission after symptoms onset, baseline comorbidities, or D-dimer >1000 ng/mL at admission independently predicted prolonged VS. The achievement of VC doubled the chance of clinical recovery and reduced the probability of death/mechanical ventilation. Conclusions Respiratory disease severity, comorbidities, delayed hospital admission and inflammatory markers negatively predicted VC, which resulted to be associated with better clinical outcomes. These findings highlight the importance of prompt hospitalization of symptomatic patients, especially where signs of severity or comorbidities are present.
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Affiliation(s)
- Annalisa Mondi
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Patrizia Lorenzini
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Concetta Castilletti
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Roberta Gagliardini
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy.
| | - Eleonora Lalle
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Angela Corpolongo
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Maria Beatrice Valli
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Fabrizio Taglietti
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Stefania Cicalini
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Laura Loiacono
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Francesco Di Gennaro
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Gianpiero D'Offizi
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Fabrizio Palmieri
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Emanuele Nicastri
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Chiara Agrati
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Nicola Petrosillo
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Giuseppe Ippolito
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Francesco Vaia
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Enrico Girardi
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | | | - Andrea Antinori
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Sara Zito
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | | | - Amina Abdeddaim
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Elisabetta Agostini
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Chiara Agrati
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Fabrizio Albarello
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Gioia Amadei
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Alessandra Amendola
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Andrea Antinori
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | | | - Mario Antonini
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | | | - Francesco Baldini
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Raffaella Barbaro
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Barbara Bartolini
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Rita Bellagamba
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Martina Benigni
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Nazario Bevilacqua
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Gianluigi Biava
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Michele Bibas
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Licia Bordi
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Veronica Bordoni
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Evangelo Boumis
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Marta Branca
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Rosanna Buonomo
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Donatella Busso
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Marta Camici
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Paolo Campioni
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Flaminia Canichella
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | | | - Alessandro Capone
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Cinzia Caporale
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Emanuela Caraffa
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Ilaria Caravella
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Fabrizio Carletti
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Concetta Castilletti
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Adriana Cataldo
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Stefano Cerilli
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Carlotta Cerva
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Roberta Chiappini
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Pierangelo Chinello
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | | | - Carmine Ciaralli
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Claudia Cimaglia
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Nicola Cinicola
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Veronica Ciotti
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Stefania Cicalini
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Francesca Colavita
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Angela Corpolongo
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Massimo Cristofaro
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Salvatore Curiale
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Alessandra D'Abramo
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Cristina Dantimi
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Alessia De Angelis
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Giada De Angelis
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Maria Grazia De Palo
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Federico De Zottis
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Virginia Di Bari
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Rachele Di Lorenzo
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Federica Di Stefano
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Gianpiero D'Offizi
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Davide Donno
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | | | - Francesca Faraglia
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Anna Farina
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Federica Ferraro
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Lorena Fiorentini
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Andrea Frustaci
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Matteo Fusetti
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Vincenzo Galati
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Roberta Gagliardini
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Paola Gallì
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Gabriele Garotto
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Ilaria Gaviano
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | | | | | - Filippo Giansante
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Emanuela Giombini
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Guido Granata
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Maria Cristina Greci
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Elisabetta Grilli
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Susanna Grisetti
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Gina Gualano
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Fabio Iacomi
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Marta Iaconi
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | | | - Carlo Inversi
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Giuseppe Ippolito
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Eleonora Lalle
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Maria Elena Lamanna
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Simone Lanini
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Daniele Lapa
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Luciana Lepore
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Raffaella Libertone
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Raffaella Lionetti
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Giuseppina Liuzzi
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Laura Loiacono
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Andrea Lucia
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Franco Lufrani
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Manuela Macchione
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Gaetano Maffongelli
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Alessandra Marani
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Luisa Marchioni
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Andrea Mariano
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | | | - Micaela Maritti
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | | | - Ilaria Mastrorosa
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Giulia Matusali
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Valentina Mazzotta
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Paola Mencarini
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Silvia Meschi
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Francesco Messina
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Sibiana Micarelli
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Giulia Mogavero
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Annalisa Mondi
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Marzia Montalbano
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Chiara Montaldo
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Silvia Mosti
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Silvia Murachelli
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Maria Musso
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Michela Nardi
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Assunta Navarra
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Emanuele Nicastri
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Martina Nocioni
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Pasquale Noto
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Roberto Noto
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Alessandra Oliva
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Ilaria Onnis
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Sandrine Ottou
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Claudia Palazzolo
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Emanuele Pallini
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Fabrizio Palmieri
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Giulio Palombi
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Carlo Pareo
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Virgilio Passeri
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Federico Pelliccioni
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Giovanna Penna
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Antonella Petrecchia
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Ada Petrone
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Nicola Petrosillo
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Elisa Pianura
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Carmela Pinnetti
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Maria Pisciotta
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Pierluca Piselli
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Silvia Pittalis
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Agostina Pontarelli
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Costanza Proietti
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Vincenzo Puro
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | | | - Alessia Rianda
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Gabriele Rinonapoli
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Silvia Rosati
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Dorotea Rubino
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Martina Rueca
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Alberto Ruggeri
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Alessandra Sacchi
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | | | - Francesco Sanasi
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Carmen Santagata
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | | | - Silvana Scarcia
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Vincenzo Schininà
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Paola Scognamiglio
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Laura Scorzolini
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Giulia Stazi
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Giacomo Strano
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Fabrizio Taglietti
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Chiara Taibi
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Giorgia Taloni
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Tetaj Nardi
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Roberto Tonnarini
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Simone Topino
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Martina Tozzi
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Francesco Vaia
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Francesco Vairo
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Maria Beatrice Valli
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Alessandra Vergori
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Laura Vincenzi
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | | | - Serena Vita
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Pietro Vittozzi
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Mauro Zaccarelli
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Antonella Zanetti
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Sara Zito
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
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- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
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