HIV-1 subtype F1 epidemiological networks among Italian heterosexual males are associated with introduction events from South America

About 40% of the Italian HIV-1 epidemic due to non-B variants is sustained by F1 clade, which circulates at high prevalence in South America and Eastern Europe. Aim of this study was to define clade F1 origin, population dynamics and epidemiological networks through phylogenetic approaches. We analyzed pol sequences of 343 patients carrying F1 subtype stored in the ARCA database from 1998 to 2009. Citizenship of patients was as follows: 72.6% Italians, 9.3% South Americans and 7.3% Rumanians. Heterosexuals, Homo-bisexuals, Intravenous Drug Users accounted for 58.1%, 24.0% and 8.8% of patients, respectively. Phylogenetic analysis indicated that 70% of sequences clustered in 27 transmission networks. Two distinct groups were identified; the first clade, encompassing 56 sequences, included all Rumanian patients. The second group involved the remaining clusters and included 10 South American Homo-bisexuals in 9 distinct clusters. Heterosexual modality of infection was significantly associated with the probability to be detected in transmission networks. Heterosexuals were prevalent either among Italians (67.2%) or Rumanians (50%); by contrast, Homo-bisexuals accounted for 71.4% of South Americans. Among patients with resistant strains the proportion of clustering sequences was 57.1%, involving 14 clusters (51.8%). Resistance in clusters tended to be higher in South Americans (28.6%) compared to Italian (17.7%) and Rumanian patients (14.3%). A striking proportion of epidemiological networks could be identified in heterosexuals carrying F1 subtype residing in Italy. Italian Heterosexual males predominated within epidemiological clusters while foreign patients were mainly Heterosexual Rumanians, both males and females, and South American Homo-bisexuals. Tree topology suggested that F1 variant from South America gave rise to the Italian F1 epidemic through multiple introduction events. The contact tracing also revealed an unexpected burden of resistance in epidemiological clusters underlying the need of public interventions to limit the spread of non-B subtypes and transmitted drug resistance

factors associated with low-Level viremia in people living with HIV in the Italian antiviral response cohort analysis cohort: a case-control Study

despite effective antiretroviral therapies (ARTs), a subset of people living with HIV (PLWH) still experience low-level viremia (LLV, i.e., 50-1,000 copies/mL). the present study compared PLWH experiencing LLV with those maintaining virological suppression (VS) and explored the potential impact of preexisting drug resistance and other factors on LLV. We conducted a retrospective, 1:1 matched case-control study within a cohort of drug-experienced VS subjects from the Italian Antiviral Response Cohort Analysis database, followed in the period 2009-2019. cases were individuals experiencing LLV, while controls were those who maintained VS. matching was for calendar year of first ART regimen. preexisting drug resistance was calculated as cumulative genotypic susceptibility score (GSS) according to regimen administered at the observational period start. to explore the effect of cumulative GSS, treated as a binary variable (& GE;2 and <2) and other factors on LLV, we performed a logistic regression analysis. within a main population of 3,455 PLWH, 337 cases were selected. Cases were comparable to the controls for both gender and age. However, cases showed that they had experienced a longer time since HIV diagnosis, a higher number of drugs previously administered, lower baseline CD4(+) T cell count and a higher zenith viral load (VL). By multivariate analysis, we found that higher zenith VL [adjusted odds ratio (aOR) (95% confidence interval [CI]) 1.30 (1.14-1.48)], a cumulative usage of both PI [aOR (95% CI): 2.03 (1.19-3.48)] and InSTI [aOR (95% CI): 2.23 (1.47-3.38)] and a cumulative GSS <2 [aOR (95% CI) 0.67 (0.46-0.98)], were associated with a higher risk in developing LLV. In current high-efficacy ART era, in drug-experienced PLWH, the predictors of increased risk of LLV were the presence of preexisting drug resistance, higher zenith VL, and previous PI, and InSTI exposure

Pretreatment HIV drug resistance and treatment failure in non-Italian HIV-1-infected patients enrolled in ARCA

Abstract BACKGROUND: An increase in pretreatment drug resistance (PDR) to first-line antiretroviral therapy (ART) in low-income countries has been recently described. Herein we analyze the prevalence of PDR and risk of virologic failure (VF) over time among migrants to Italy enrolled in ARCA. METHODS: HIV-1 sequences from ART-na\uefve patients of non-Italian-nationality were retrieved from ARCA database from 1998 to 2017. PDR was defined by at least one mutation from the reference 2009-WHO-surveillance-list. RESULTS: Protease/reverse-transcriptase sequences from 1,155 patients, mainly migrants from Sub-Saharan Africa (SSA) (42%), followed by Latin America (LA) (25%) and Western Countries (WE) (21%), were included. PDR was detected in 8.6% of sequences (13.1% vs 5.8% for B and non-B strains, respectively, p<0.001). 2.1% of patients carried a PDR for protease inhibitors (PIs) (2.1% vs 2.3%, p=0.893), 3.9% for nucleos(t)ide-reverse-transcriptase inhibitors (NRTI) (6.8% vs 2.1%, p<0.001) and 4.3% for non-nucleos(t)ide-reverse-transcriptase inhibitors (NNRTI) (6.3% vs 3.1%, p=0.013). Overall, prevalence of PDR over the years remained stable, while it decreased for PIs in LA (p=0.021), and for NRTI (p=0.020) among migrants from WE. Having more than 1 class of PDR (p=0.015 vs. absence of PDR), higher viral load at diagnosis (p=0.008) and being migrants from SSA (p=0.001 vs. WE) were predictive of VF, while a recent calendar year of diagnosis (p<0.001) was protective for VF. CONCLUSIONS: PDR appeared to be stable over the years in migrants to Italy enrolled in ARCA; however, it still remains an important cause of VF together with VL at diagnosis

Clusters characteristics and Time of Most Recent Common Ancestor (TMRCA) stratified according to country of origin.

<p>Clusters characteristics and Time of Most Recent Common Ancestor (TMRCA) stratified according to country of origin.</p

Study population and epidemiological network: risk factor and gender according to the most frequent citizenship of patients (n = 306).

1<p>Risk factor was known for 153 Italians, 18 South Americans and 14 Rumanians.</p>2<p>HETs: heterosexuals.</p>3<p>HO-BISEXs: homo-bisexuals.</p>4<p>Gender was known for 248 Italians, 32 South Americans and 25 Rumanians.</p

Rumanian cluster details.

<p>Time-line scale is displayed underneath the tree. Node labels indicate posterior probability values.</p

Real-life effectiveness and safety of sofosbuvir/velpatasvir/voxilaprevir in hepatitis C patients with previous DAA failure

Sofosbuvir/velpatasivr/voxilaprevir (SOF/VEL/VOX) is approved for retreatment of patients with HCV and a previous failure on direct-acting antivirals (DAAs), however real-life data are limited. The aim of this study was to assess the effectiveness and safety of SOF/VEL/VOX in a real-life setting

Valuation of hospital bed-days released by infection control programs:a comparison of methods

We performed a contingent valuation survey to elicit the opportunity cost of bed-days consumed by healthcare-associated infections in 11 European hospitals. The opportunity cost of a bed-day was significantly lower than the accounting cost; median values were i72 and i929, respectively (P ! .001). Accounting methods overestimate the opportunity cost of bed-days..