Use of efavirenz or atazanavir/ritonavir is associated with better clinical outcomes of HAART compared to other protease inhibitors: routine evidence from the Italian MASTER Cohort.

Randomized trials and observational cohorts reported higher rates of virological suppression after highly active antiretroviral therapy (HAART) including efavirenz (EFV), compared with boosted protease inhibitors (PIs). Correlations with immunological and clinical outcomes are unclear. Patients of the Italian MASTER cohort who started HAART from 2000 to 2010 were selected. Outstanding outcome (composite outcome for success (COS)) was introduced. We evaluated predictors of COS (no AIDS plus CD4+ count >500/ mm3 plus HIV-RNA <500 copies/mL) and of eight single outcomes either at month 6 or at year 3. Multivariable logistic regression was conducted. There were 6259 patients selected. Patients on EFV (43%) were younger, had greater CD4+ count, presented with AIDS less frequently, and more were Italians. At year 3, 90% of patients had HIV RNA <500 copies/mL, but only 41.4% were prescribed EFV, vs. 34.1% prescribed boosted PIs achieved COS (p <0.0001). At multivariable analysis, patients on lopinavir/ritonavir had an odds ratio of 0.70 for COS at year 3 (p <0.0001). Foreign origin and positive hepatitis C virus-Ab were independently associated with worse outcome (OR 0.54, p <0.0001 and OR 0.70, p 0.01, respectively). Patients on boosted PIs developed AIDS more frequently either at month 6 (13.8% vs. 7.6%, p <0.0001) or at year 3 (17.1% vs. 13.8%, p <0.0001). At year 3, deaths of patients starting EFV were 3%, vs. 5% on boosted PIs (p 0.008). In this study, naïve patients on EFV performed better than those on boosted PIs after adjustment for imbalances at baseline. Even when virological control is achieved, COS is relatively rare. Hepatitis C virus-positive patients and those of foreign origin are at risk of not obtaining COS. Clinical Microbiology and Infection © 2014 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved

Gender differences in the use of cardiovascular interventions in HIV-positive persons; the D:A:D Study

Peer reviewe

A survey of methicillin-resistant Staphylococcus aureus control strategies in Italy

Data regarding the implementation of state-of-the-art methicillin-resistant Staphylococcus aureus (MRSA) control procedures in Italy are lacking. There is a need to evaluate compliance with MRSA recommendations (CR) in Italian hospitals

Cohort Profile: Standardized Management of Antiretroviral Therapy Cohort (MASTER Cohort).

Cohort Profile of the Standardized Management of Antiretroviral Therapy Cohort (MASTER Cohort

Cohort Profile: Standardized Management of Antiretroviral Therapy Cohort (MASTER Cohort)

The Italian MASTER (MAnagement Standardizzato di TErapia antiRetrovirale, standardized management of antiretroviral therapy) cohort is a hospital-based multicentre, open, dynamic HIV cohort established in the mid 1990s, with retrospective patient enrolment from 1986 to 1997 and subsequent prospective recruitment. At that time, no institutional system of surveillance of HIV infection was available, apart from the registration of AIDS cases. Accurate, precise and up-to-date data on HIV infection were therefore needed. To this end, we established a network of various HIV infection treatment centres in Italy, using a common clinical chart and an electronic database for data collection and management. The MASTER cohort enrols all HIV-infected patients, both treatment naïve and treatment experienced, in care at several HIV clinics throughout the country in order to represent the epidemiological and clinical scenario of HIV infection in Italy. A Steering Committee guarantees the scientific accuracy of the cohort. The Committee is made up of members from each centre and controls data quality by verifying the completeness, accuracy and updating of data collected by each centre. Furthermore, a working group proposes new studies, carries them out, analyses and discusses the findings and writes the final papers, under the supervision of the Steering Committee. The committee also verifies the consistency of the final paper with the initial proposal before its submission to a journal for publication. In performing these activities, the working group is supported by a data manager, a statistician and an epidemiologist. The main objectives of this cohort study are: (i) to create a hospital-based database of HIV-positive subjects for clinical and epidemiological research projects; (ii) to monitor the epidemiological pattern of HIV infection in Italy; (iii) to monitor highly active antiretroviral therapy (HAART) effectiveness and safety, and HIV drug resistance emergence; (iv) to investigate the predictive role of traditional and new risk factors for developing chronic diseases, particularly in HIV and HCV co-infected subjects; (v) to evaluate the prognostic role of traditional and new biomarkers for survival in HIV patients with cancer and other chronic diseases