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Lanzafame M, Rizzardo S, Lattuada E, Luise D, Vento S. Letter to the Editor: Dolutegravir Monotherapy and Body Weight Gain in Antiretroviral Naïve Patients. AIDS Res Hum Retroviruses 2022; 38:771-773. [PMID: 35815473 DOI: 10.1089/aid.2021.0234] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Affiliation(s)
- Massimiliano Lanzafame
- Department of Specialistic Area, Unit of Infectious Diseases, S. Maria della Misericordia Hospital, Rovigo, Italy
| | | | - Emanuela Lattuada
- Infectious Diseases Unit, G.B. Rossi University Hospital, Verona, Italy
| | - Dora Luise
- Unit of Infectious Diseases, S. Bortolo Hospital, Vicenza, Italy
| | - Sandro Vento
- Faculty of Medicine, University of Puthisastra, Phnom Penh, Cambodia
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Luise D, Lattuada E, Rizzardo S, Nicolè S, Lambertenghi L, Coledan I, Gambino S, Gottardo R, Lanzafame M, Vento S. Short-cycle therapy in HIV-infected adults: rilpivirine combination 4 days on/3 days off therapy. J Antimicrob Chemother 2021; 77:747-752. [PMID: 34849955 DOI: 10.1093/jac/dkab442] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 10/29/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Short-cycle therapy (SCT) is the administration of ART for 4 or 5 consecutive days a week, followed by 3 or 2 days off therapy. Its benefits include improving patient satisfaction and reducing ART toxicity and costs. METHODS In this observational study we included HIV-infected adults with a three-drug ART containing rilpivirine, a history of long-term virological suppression and no evidence of resistance to previous drug regimens. Patients switched to a SCT of 4 days on/3 days off and were followed for 48 weeks with regular check-ups. The primary outcome was virological suppression; secondary outcomes were changes in CD4+ cells and rilpivirine plasma concentration, the occurrence of adverse events and resistance in the case of failure, and patient satisfaction. RESULTS At week 48 no virological failure was observed, with a virological suppression rate of 30/30 (100%). Three patients switched back to continuous therapy for other reasons, with an overall success rate of SCT of 30/33 (90.9%, 95% CI = 81.24% to 100%). The CD4+ mean value increased by +64 cells/mm3 (95% CI = -59 to +187 cells/mm3; P = 0.052). No adverse events were observed and the mean total score in the satisfaction questionnaire was 57.7/60 (96.22%). Rilpivirine plasma concentration was below the efficacy threshold in 71.3% of the samples, suggesting that the patients' characteristics, more than the drug's pharmacokinetics, played a role in maintaining virological suppression. CONCLUSIONS SCT with rilpivirine-containing regimens could be an effective alternative to continuous therapy in selected HIV-infected patients with previous long-term virological suppression.
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Affiliation(s)
- Dora Luise
- Infectious Diseases Unit, Vicenza Hospital, Vicenza, Italy
| | - Emanuela Lattuada
- Division of Infectious Diseases, Department of Diagnostic and Public Health, Integrated University Hospital of Verona, Verona, Italy
| | - Sebastiano Rizzardo
- Infectious Diseases Section, Internal Medicine Unit, Rovereto Hospital, Rovereto, Italy
| | - Stefano Nicolè
- Infectious Diseases Unit, Vicenza Hospital, Vicenza, Italy
| | - Lorenza Lambertenghi
- Division of Infectious Diseases, Department of Diagnostic and Public Health, Integrated University Hospital of Verona, Verona, Italy
| | - Ilaria Coledan
- Infectious Diseases Unit, Rovigo Hospital, Rovigo, Italy
| | - Silvia Gambino
- Infectious Diseases Unit, Bolzano Hospital, Bolzano, Italy
| | - Rossella Gottardo
- Division of Legal Medicine, Department of Diagnostic and Public Health, Integrated University Hospital of Verona, Verona, Italy
| | | | - Sandro Vento
- Faculty of Medicine, University of Puthisastra, Phnom Penh, Cambodia
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Pezzani MD, Tornimbene B, Pessoa-Silva C, de Kraker M, Rizzardo S, Salerno ND, Harbarth S, Tacconelli E. Methodological quality of studies evaluating the burden of drug-resistant infections in humans due to the WHO Global Antimicrobial Resistance Surveillance System target bacteria. Clin Microbiol Infect 2021; 27:S1198-743X(21)00006-9. [PMID: 33450389 PMCID: PMC8113024 DOI: 10.1016/j.cmi.2021.01.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 10/10/2020] [Accepted: 01/05/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND The health impact of antimicrobial resistance (AMR) has not been included in the Global Burden of Disease (GBD) report, as reliable data have been lacking. AMR burden estimates have been derived from models combining incidence and/or prevalence data from national and/or international surveillance systems and mortality estimates from clinical studies. Depending on utilized empirical data, statistical methodology and applied endpoints, the validity and reliability of results can differ substantially. OBJECTIVES We assessed comprehensiveness, and internal and external validity of studies estimating the clinical impact of infections caused by the priority antibiotic resistant pathogens monitored by the WHO Global Antimicrobial Resistance Surveillance System. DATA SOURCES Ovid MEDLINE, January 1950 to March 2019, In-Process and other non-indexed citations were searched. STUDY ELIGIBILITY CRITERIA Studies reporting mortality, length of hospital stay, duration of the disease until remission and/or death, complications, hospital re-admissions, and follow-up beyond hospital discharge were eligible. METHODS The literature was searched according to the Cochrane recommendations and reported according to Preferred Reporting Items for Systematic Reviews. RESULTS Two-hundred and eighty-six studies out of 3529 were eligible. Studies derived mainly from high-income countries (215, 75%) and relied on data from retrospective (226, 79%), single-centre (201, 70%), cohort studies (243, 85%). The health impact was mostly limited to all-cause mortality (128, 45%) with heterogeneity in timing of assessment; attributable length of hospital stay was seldom adjusted for pre-infection admission time and a few studies had enough follow-up for assessing long-term sequelae. Overall, adjustment for confounding has shown a substantial improvement. Data on health state definitions and duration of diseases are generally lacking, precluding calculation of disability-adjusted life years, critical for application of the GBD study methodology. CONCLUSION Efforts to improve harmonization, representativeness, quality of AMR surveillance data and cohort studies to determine AMR attributable mortality and morbidity are urgently required. Policy makers need accurate and detailed burden estimates to inform prioritization of resource allocation, and to select the most effective intervention strategies to halt the AMR crisis.
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Affiliation(s)
- Maria Diletta Pezzani
- Infectious Diseases Section, Department of Diagnostics and Public Health, University of Verona, Verona, Italy.
| | - Barbara Tornimbene
- Surveillance, Evidence & Laboratory Strengthening Unit, SPC Department, AMR Division, World Health Organization, Geneva, Switzerland
| | - Carmem Pessoa-Silva
- Surveillance, Evidence & Laboratory Strengthening Unit, SPC Department, AMR Division, World Health Organization, Geneva, Switzerland
| | - Marlieke de Kraker
- Infection Control Programme, Geneva University Hospitals and Faculty of Medicine, World Health Organization Collaborating Centre on Patient Safety, Geneva, Switzerland
| | - Sebastiano Rizzardo
- Infectious Diseases Section, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Nicola Duccio Salerno
- Infectious Diseases Section, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Stephan Harbarth
- Infection Control Programme, Geneva University Hospitals and Faculty of Medicine, World Health Organization Collaborating Centre on Patient Safety, Geneva, Switzerland
| | - Evelina Tacconelli
- Infectious Diseases Section, Department of Diagnostics and Public Health, University of Verona, Verona, Italy; German Centre for Infection Research (DZIF TTU-HAARBI), Tübingen University Hospital, Tübingen, Germany
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Piacentini D, Lanzafame M, Rizzardo S, Chiesi S, Lattuada E, Mehrabi S, Zamboni G, Mazzi R, Tacconelli E, Vento S. Increase in visceral adipose tissue in a woman living with HIV after introduction of integrase strand transfer inhibitor. Int J STD AIDS 2020; 31:1407-1410. [PMID: 33081650 DOI: 10.1177/0956462420955075] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Integrase strand transfer inhibitors (INSTIs) are a class of antiretroviral drugs with high virologic efficacy and excellent tolerability. Recent evidence showed a possible link of dolutegravir-based regimens with weight gain, and a relationship between raltegravir use and changes in adipose tissue density and metabolic abnormalities, with an increased cardiovascular risk, has been suggested. We describe a case where dolutegravir monotherapy led to a decrease in adipose tissue density.
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Affiliation(s)
- Daniela Piacentini
- Department of Diagnostics and Public Health, Infectious Diseases Section, University of Verona, Verona, Italy
| | | | - Sebastiano Rizzardo
- Department of Diagnostics and Public Health, Infectious Diseases Section, University of Verona, Verona, Italy
| | - Sheila Chiesi
- Department of Diagnostics and Public Health, Infectious Diseases Section, University of Verona, Verona, Italy
| | - Emanuela Lattuada
- Department of Diagnostics and Public Health, Infectious Diseases Section, University of Verona, Verona, Italy
| | - Sara Mehrabi
- Department of Radiology, University of Verona, Verona, Italy
| | - Giulia Zamboni
- Department of Radiology, University of Verona, Verona, Italy
| | - Romualdo Mazzi
- Department of Diagnostics and Public Health, Infectious Diseases Section, University of Verona, Verona, Italy
| | - Evelina Tacconelli
- Department of Diagnostics and Public Health, Infectious Diseases Section, University of Verona, Verona, Italy
| | - Sandro Vento
- Faculty of Medicine, University of Puthisastra, Phnom Penh, Cambodia
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Lanzafame M, Lattuada E, Rizzardo S, Piacentini D, Chiesi S, Mazzi R. Dolutegravir Monotherapy's Virological Efficacy in a Highly Treatment-Experienced Patient. AIDS Res Hum Retroviruses 2019; 35:359-360. [PMID: 30525872 DOI: 10.1089/aid.2018.0117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Massimiliano Lanzafame
- 1 "Diagnosis and Therapy of HIV Infection" Unit, G.B. Rossi University Hospital, Verona, Italy
| | - Emanuela Lattuada
- 2 Infectious Diseases Unit, G.B. Rossi University Hospital, Verona, Italy
| | | | - Daniela Piacentini
- 2 Infectious Diseases Unit, G.B. Rossi University Hospital, Verona, Italy
| | - Sheila Chiesi
- 2 Infectious Diseases Unit, G.B. Rossi University Hospital, Verona, Italy
| | - Romualdo Mazzi
- 2 Infectious Diseases Unit, G.B. Rossi University Hospital, Verona, Italy
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Rizzardo S, Lanzafame M, Lattuada E, Bragantini D, Nicolè S, Calza L, Tacconelli E. Efficacy and safety of abacavir/lamivudine with raltegravir in treatment-experienced and treatment-naïve patients with HIV-1 infection: an observational, retrospective, multi-centre study. Int J STD AIDS 2019; 30:467-471. [PMID: 30999834 DOI: 10.1177/0956462418817049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Raltegravir (RAL) is an HIV-1 integrase strand transfer inhibitor that is well established as a component of highly active antiretroviral therapy regimens for the treatment of adults living with human immunodeficiency virus (HIV), due to its high virological efficacy and good tolerability profile. To date, limited data are available on the use of RAL with abacavir/lamivudine (ABC/3TC). We investigated retrospectively 62 HIV-1 infected patients managed by three Italian Infectious Diseases Outpatient Departments, including 57 treatment-experienced patients and 5 treatment-naïve patients, treated with ABC/3TC plus RAL. In all five naïve patients (100%), virological suppression was achieved and maintained , while 55 experienced patients (96.5%) maintained viral suppression at the most recent review. In the treatment-experienced patients, we observed a significant decrease in triglyceride levels (p < 0.01), while liver transaminases, renal function and cholesterol levels remained substantially stable. In the 34 treatment-experienced patients who switched from a protease inhibitor (PI)-based regimen, we observed a significant improvement of total cholesterol (p=0.03) and triglyceride (p < 0.01) levels. No significant alterations were found on renal and liver function and serum lipid profile of treatment-naïve patients. Despite the small number of participants, results support the efficacy and safety of ABC/3TC plus RAL, either in treatment-naïve or treatment-experienced patients.
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Affiliation(s)
| | - Massimiliano Lanzafame
- 2 "Diagnosis and Therapy of HIV Infection" Unit, G.B. Rossi University Hospital, Verona, Italy
| | - Emanuela Lattuada
- 1 Infectious Diseases Unit, G.B. Rossi University Hospital, Verona, Italy
| | - Damiano Bragantini
- 1 Infectious Diseases Unit, G.B. Rossi University Hospital, Verona, Italy
| | - Stefano Nicolè
- 1 Infectious Diseases Unit, G.B. Rossi University Hospital, Verona, Italy
| | - Leonardo Calza
- 3 Infectious Diseases Unit, Policlinico Sant'Orsola-Malpighi, Bologna, Italy
| | - Evelina Tacconelli
- 1 Infectious Diseases Unit, G.B. Rossi University Hospital, Verona, Italy
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Lanzafame M, Rizzardo S, Piacentini D, Lattuada E, Chiesi S, Vento S. Dolutegravir monotherapy: an option for highly adherent HIV1-infected naive patients with relatively low zenith HIV-RNA? Infect Dis (Lond) 2018; 51:77-78. [PMID: 30317907 DOI: 10.1080/23744235.2018.1518585] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Affiliation(s)
- Massimiliano Lanzafame
- a Diagnosis and Therapy of HIV Infection Unit , G.B. Rossi University Hospital , Verona , Italy
| | - Sebastiano Rizzardo
- b Infectious Diseases Unit , G.B. Rossi University Hospital , Verona , Italy
| | - Daniela Piacentini
- b Infectious Diseases Unit , G.B. Rossi University Hospital , Verona , Italy
| | - Emanuela Lattuada
- b Infectious Diseases Unit , G.B. Rossi University Hospital , Verona , Italy
| | - Sheila Chiesi
- c Department of Medicine , School of Medicine, Nazarbayev University , Astana , Kazakhstan
| | - Sandro Vento
- d University Medical Center , Astana , Kazakhstan
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Lanzafame M, Nicole S, Rizzardo S, Piacentini D, Chiesi S, Lattuada E, Diani E, Carelli M, Vento S, Gibellini D. Immunovirological outcome and HIV-1 DNA decay in a small cohort of HIV-1-infected patients deintensificated from Abacavir/Lamivudine/Dolutegravir to Lamivudine plus Dolutegravir. New Microbiol 2018; 41:262-267. [PMID: 30311623] [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] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 01/03/2019] [Indexed: 06/08/2023]
Abstract
Combination abacavir/lamivudine/dolutegravir (ABC/3TC/DTG) is approved as a first-line treatment for antiretroviral naïve patients. This report investigated the immunovirological outcome and total HIV-1 DNA decay in a small cohort of naïve HIV-1-positive patients treated with this regimen. In the presence of viral suppression and increased lymphocyte T CD4+ cells, the quantitative analysis of total HIV-1 DNA content revealed a significant decay after 12 months of treatment. Subsequently, we deintensificated the treatment of these patients from (ABC/3TC/DTG) to lamivudine plus dolutegravir (3TC/DTG) after 12 months of virological suppression, as a strategy of "induction-maintenance" therapy. The analysis of HIV-1 RNA viral load, total HIV-1 DNA, CD4+ T lymphocyte count and CD8+ HLA-DR+ T lymphocyte percentage after a mean 3.5 months of therapy deintensification showed no significant difference with respect to data detected after 12 months of ABC/3TC/DTG treatment in the presence of continuous viral suppression. These results indicate that the deintensification of highly active antiretroviral therapy (HAART) from ABC/ 3TC/DTG to 3TC/DTG effectively controls HIV-1 replication and in the early period does not induce any significant variations of total HIV-1 DNA. This suggests that HAART deintensification might be proposed as a therapeutic evolution in the treatment of HIV-1 infection.
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Affiliation(s)
- Massimiliano Lanzafame
- Unità Semplice Organizzativa "Diagnosi e Terapia dell'infezione da HIV", University of Verona, Verona, Italy
| | - Stefano Nicole
- Unità Complessa di Malattie Infettive, University of Verona, Verona, Italy
| | | | - Daniela Piacentini
- Unità Complessa di Malattie Infettive, University of Verona, Verona, Italy
| | - Sheila Chiesi
- Unità Complessa di Malattie Infettive, University of Verona, Verona, Italy
| | - Emanuela Lattuada
- Unità Complessa di Malattie Infettive, University of Verona, Verona, Italy
| | - Erica Diani
- Microbiology and Virology Section, Department of Diagnostic and Public Health, University of Verona, Verona, Italy
| | - Maria Carelli
- Microbiology and Virology Section, Department of Diagnostic and Public Health, University of Verona, Verona, Italy
| | - Sandro Vento
- Department of Medicine, Nazarbayev University, Astana, Kazakhstan
- University Medical Center, Astana, Kazakhstan
| | - Davide Gibellini
- Microbiology and Virology Section, Department of Diagnostic and Public Health, University of Verona, Verona, Italy
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Zipeto D, Serena M, Mutascio S, Parolini F, Diani E, Guizzardi E, Muraro V, Lattuada E, Rizzardo S, Malena M, Lanzafame M, Malerba G, Romanelli MG, Tamburin S, Gibellini D. HIV-1-Associated Neurocognitive Disorders: Is HLA-C Binding Stability to β 2-Microglobulin a Missing Piece of the Pathogenetic Puzzle? Front Neurol 2018; 9:791. [PMID: 30298049 PMCID: PMC6160745 DOI: 10.3389/fneur.2018.00791] [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] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 09/03/2018] [Indexed: 01/09/2023] Open
Abstract
AIDS dementia complex (ADC) and HIV-associated neurocognitive disorders (HAND) are complications of HIV-1 infection. Viral infections are risk factors for the development of neurodegenerative disorders. Aging is associated with low-grade inflammation in the brain, i.e., the inflammaging. The molecular mechanisms linking immunosenescence, inflammaging and the pathogenesis of neurodegenerative disorders, such as Alzheimer's disease (AD) and Parkinson's disease, are largely unknown. ADC and HAND share some pathological features with AD and may offer some hints on the relationship between viral infections, neuroinflammation, and neurodegeneration. β2-microglobulin (β2m) is an important pro-aging factor that interferes with neurogenesis and worsens cognitive functions. Several studies published in the 80-90s reported high levels of β2m in the cerebrospinal fluid of patients with ADC. High levels of β2m have also been detected in AD. Inflammatory diseases in elderly people are associated with polymorphisms of the MHC-I locus encoding HLA molecules that, by associating with β2m, contribute to cellular immunity. We recently reported that HLA-C, no longer associated with β2m, is incorporated into HIV-1 virions, determining an increase in viral infectivity. We also documented the presence of HLA-C variants more or less stably linked to β2m. These observations led us to hypothesize that some variants of HLA-C, in the presence of viral infections, could determine a greater release and accumulation of β2m, which in turn, may be involved in triggering and/or sustaining neuroinflammation. ADC is the most severe form of HAND. To explore the role of HLA-C in ADC pathogenesis, we analyzed the frequency of HLA-C variants with unstable binding to β2m in a group of patients with ADC. We found a higher frequency of unstable HLA-C alleles in ADC patients, and none of them was harboring stable HLA-C alleles in homozygosis. Our data suggest that the role of HLA-C variants in ADC/HAND pathogenesis deserves further studies. If confirmed in a larger number of samples, this finding may have practical implication for a personalized medicine approach and for developing new therapies to prevent HAND. The exploration of HLA-C variants as risk factors for AD and other neurodegenerative disorders may be a promising field of study.
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Affiliation(s)
- Donato Zipeto
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Michela Serena
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Simona Mutascio
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Francesca Parolini
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Erica Diani
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | | | | | | | | | - Marina Malena
- U.O.S. Infectious Diseases, AULSS 9 Scaligera, Verona, Italy
| | | | - Giovanni Malerba
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Maria Grazia Romanelli
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Stefano Tamburin
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Davide Gibellini
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy
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Lanzafame M, Piacentini D, Lattuada E, Rizzardo S, Chiesi S, Vento S. "High" antiretroviral deintensification, a strategy to avoid drug interactions and unfavourable long-term effects of HAART. Infect Dis (Lond) 2018; 50:788-790. [PMID: 29916752 DOI: 10.1080/23744235.2018.1482420] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Affiliation(s)
- Massimiliano Lanzafame
- a Diagnosis and Therapy of HIV Infection Unit , G.B. Rossi University Hospital , Verona , CAP , Italy
| | - Daniela Piacentini
- b Infectious Diseases Unit , G.B. Rossi University Hospital , Verona , CAP , Italy
| | - Emanuela Lattuada
- b Infectious Diseases Unit , G.B. Rossi University Hospital , Verona , CAP , Italy
| | - Sebastiano Rizzardo
- b Infectious Diseases Unit , G.B. Rossi University Hospital , Verona , CAP , Italy
| | - Sheila Chiesi
- b Infectious Diseases Unit , G.B. Rossi University Hospital , Verona , CAP , Italy
| | - Sandro Vento
- c Department of Medicine, School of Medicine , Nazarbayev University , Astana , Kazakhstan
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Sbrana F, Sozio E, Bassetti M, Ripoli A, Pieralli F, Azzini AM, Morettini A, Nozzoli C, Merelli M, Rizzardo S, Bertolino G, Carrara D, Scarparo C, Concia E, Menichetti F, Tascini C. Independent risk factors for mortality in critically ill patients with candidemia on Italian Internal Medicine Wards. Intern Emerg Med 2018; 13:199-204. [PMID: 29322386 DOI: 10.1007/s11739-017-1783-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [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: 10/19/2017] [Accepted: 12/25/2017] [Indexed: 12/31/2022]
Abstract
Candida is an increasing cause of bloodstream infection and is associated with significant morbidity and mortality. The aim of our study is to analyze risk factors for short-term mortality in patients with bloodstream Candida spp. infections admitted to Internal Medicine Wards (IMWs). This was a retrospective case-control study between January 2012 and December 2014 from four University Hospitals in Italy, where patients with candidemia dying within 30 days from diagnosis were matched to control cases with candidemia who survived in the same period of time. Two-hundred and fifty cases of candidemia were registered during the 36 months of enrollment. Among these, 112 patients died (45%) within 30 days from the first blood culture's positivity for Candida spp. At multivariate analysis, septic shock [odds ratio (95% CI) = 2.919 (1.62-5.35), p < 0.001] and concomitant chronic kidney failure [odds ratio (95% CI) = 2.296 (1.07-5.12), p = 0.036] were independent predictors of mortality. Low-dose chronic steroid therapy was protective [odds ratio (95% CI) = 0.461 (0.25-0.83), p = 0.011).
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Affiliation(s)
- Francesco Sbrana
- Fondazione Toscana Gabriele Monasterio, Via Moruzzi, 1, 56124, Pisa, Italy.
| | - Emanuela Sozio
- North-West District, Tuscany HealthCare, Spedali Riuniti Livorno, Emergency Department, Leghorn, Italy
| | - Matteo Bassetti
- Infectious Diseases Division, Santa Maria Misericordia University Hospital, Udine, Italy
| | - Andrea Ripoli
- Fondazione Toscana Gabriele Monasterio, Via Moruzzi, 1, 56124, Pisa, Italy
| | - Filippo Pieralli
- Intermediate Care Unit, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - Anna Maria Azzini
- Infectious Disease Unit, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Alessandro Morettini
- Internal Medicine Unit, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - Carlo Nozzoli
- Internal Medicine Unit, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - Maria Merelli
- Infectious Diseases Division, Santa Maria Misericordia University Hospital, Udine, Italy
| | - Sebastiano Rizzardo
- Infectious Disease Unit, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Giacomo Bertolino
- Pharmaceutical Department, Azienda Ospedaliera Universitaria Pisana, Santa Chiara, Pisa, Italy
| | - Davide Carrara
- U.O.C. Medicina Generale, Ospedale Versilia, Azienda U.S.L. Toscana Nord Ovest, Viareggio, Italy
| | - Claudio Scarparo
- Infectious Diseases Division, Santa Maria Misericordia University Hospital, Udine, Italy
| | - Ercole Concia
- Infectious Disease Unit, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Francesco Menichetti
- Infectious Diseases Clinic, Nuovo Santa Chiara University Hospital, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - Carlo Tascini
- First Division of Infectious Diseases, Cotugno Hospital, Azienda Ospedaliera dei Colli, Naples, Italy
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