Resistance patterns and genetic variations in patients with hepatitis C virus: emerging role of telaprevir

C Argentini, D Genovese, S CatoneIstituto Superiore di Sanità, Department of Therapeutic Research and Medicine Evaluation, Rome, ItalyAbstract: High genetic variability is a characteristic of hepatitis C virus (HCV) infection: infinite virus isolates are classified into six genotypes plus an emerging seventh one, and an indefinite number of subtypes. The variability is directly connected to the environmental adaptation of infective agents or to the change induced by antiviral therapies. During therapy, wild type isolates are substituted by resistant mutants that are able to maintain the infection. The standard therapy (pegylated interferon [PEG-IFN] and ribavirin) only partially eradicates HCV infection. However, particularly in genotype 1 infection, the rate of uncured patients remains high (between 50% and 60%). Specifically targeted antiviral therapies for HCV infection (STAT-C) consist of developing new antivirals aimed at blocking the virus proteins involved in different replication steps. Telaprevir is an anti-NS3-NS4 protease in phase III trials and represents a promising therapy, especially when associated with PEG-IFN and ribavirin. In vitro and in vivo research studies describe mutations that confers resistance to telaprevir in NS3-NS4 protease (V36A/M/L/G, F43, T54A, R130K, R155L/K/T/Q, A156T/S/V, V170A and Q195K). The emergence of these mutations describes the adaptation capability of HCV infection.Keywords: HCV, telaprevir, resistance, antiviral therapy, virus adaptatio

New perspectives in vaccination and immunotherapies for HBV infections

AbstractThe woodchuck hepatitis B virus (WHV), the closest genetically related virus of HBV, and its natural host Marmota monax constitute a well recognized animal model. The application of this model for the evaluation of immunogenicity and protection of new formulations of HBV vaccines for human use, for lamivudine-CHO-PreS/S vaccine therapy and WHV particles coupled with HBV derived woodchuck PreS/S antibodies (IC complex) studies, as shown that the PreS/S-CHO vaccine is the first human vaccine able to elicit non sterilizing protection in the woodchuck model. The very early appearance and selection of the domain B FLLA motif resistant mutant not neutralized by the antibodies produced following vaccination, has confirmed that more potent antivirals and/or multiple targeted options with possible inclusion of immune complexes should be considered

Characterization of snowfall estimated by in situ and ground-based remote-sensing observations at Terra Nova Bay, Victoria Land, Antarctica

AbstractKnowledge of the precipitation contribution to the Antarctic surface mass balance is essential for defining the ice-sheet contribution to sea-level rise. Observations of precipitation are sparse over Antarctica, due to harsh environmental conditions. Precipitation during the summer months (November–December–January) on four expeditions, 2015–16, 2016–17, 2017–18 and 2018–19, in the Terra Nova Bay area, were monitored using a vertically pointing radar, disdrometer, snow gauge, radiosounding and an automatic weather station installed at the Italian Mario Zucchelli Station. The relationship between radar reflectivity and precipitation rate at the site can be estimated using these instruments jointly. The error in calculated precipitation is up to 40%, mostly dependent on reflectivity variability and disdrometer inability to define the real particle fall velocity. Mean derived summer precipitation is ~55 mm water equivalent but with a large variability. During collocated measurements in 2018–19, corrected snow gauge amounts agree with those derived from the relationship, within the estimated errors. European Centre for the Medium-Range Weather Forecasts (ECMWF) and the Antarctic Mesoscale Prediction System (AMPS) analysis and operational outputs are able to forecast the precipitation timing but do not adequately reproduce quantities during the most intense events, with overestimation for ECMWF and underestimation for AMPS

Role of interferon lambda 4 and ALT levels in optimising treatment of HCV for patients with low-stage fibrosis

The use of new anti-HCV drugs is currently limited by high costs and dual therapy; pegylated interferon and ribavirin (peg-IFN+RBV) still represents the only affordable treatment in patients with low-stage fibrosis. We evaluated the role of Interferon lambda4 (IFNL4) polymorphisms and its combination with on-treatment alanine transaminase (ALT) modification in predicting sustained virological response (SVR) in HCV genotype 1 and 4 patients with low-stage fibrosis. We retrospectively analysed 124 patients with Metavir ≤F2, who received dual therapy at our centre. Genotyping for IFNL4 polymorphisms was assessed at baseline, as well as ALT levels (baseline and week 2, 4, 12 and 24 of therapy). Thirty patients (24%) were TT/TT, 74 (60%) TT/DG and 20 (16%) DG/DG. The SVR rate was significantly higher in TT/TT genotype compare to TT/DG and DG/DG (97% vs. 53% and 50%, respectively, p=0.001). Patients that achieved a 60% reduction of ALT baseline value after 4 weeks of therapy had a significantly higher SVR rate (94% vs. 52%, p<0.001). Factors significantly associated with SVR were TT/TT genotype (p=0.029), RVR (p=0.019) and 60% ALT reduction at 4 week of therapy (p=0.005). The absence of both TT/TT genotype and 60% ALT reduction were negative predictors of SVR (p<0.001). In conclusion, the combined use of IFNL4 polymorphisms and ALT reduction at 4 week of treatment is able to optimize candidates’ selection for peg-IFN+RBV, discriminating those that could still benefit from dual therapy from the ones that need the new regimen

Imported arboviral infections in Italy, July 2014-October 2015: A National Reference Laboratory report

BACKGROUND: Imported cases of infections due to Dengue (DENV) and Chikungunya (CHIKV) viruses and, more recently, Zika virus (ZIKV) are commonly reported among travelers returning from endemic regions. In areas where potentially competent vectors are present, the risk of autochthonous transmission of these vector-borne pathogens is relatively high. Laboratory surveillance is crucial to rapidly detect imported cases in order to reduce the risk of transmission. This study describes the laboratory activity performed by the National Reference Laboratory for Arboviruses (NRLA) at the Italian National Institute of Health in the period from July 2014 to October 2015. METHODS: Samples from 180 patients visited/hospitalized with a suspected DENV/CHIKV/ZIKV infection were sent to the NRLA from several Italian Hospitals and from Regional Reference Laboratories for Arboviruses, in agreement with the National Plan on human surveillance of vector-borne diseases. Both serological (ELISA IgM test and Plaque Reduction Neutralization Test-PRNT) and molecular assays (Real Time PCR tests, RT-PCR plus nested PCR and sequencing of positive samples) were performed. RESULTS: DENV infection was the most frequently diagnosed (80 confirmed/probable cases), and all four genotypes were detected. However, an increase in imported CHIKV cases (41 confirmed/probable cases) was observed, along with the detection of the first ZIKV cases (4 confirmed cases), as a consequence of the recent spread of both CHIKV and ZIKV in the Americas. CONCLUSIONS: Main diagnostic issues highlighted in our study are sensitivity limitations of molecular tests, and the importance of PRNT to confirm serological results for differential diagnosis of Arboviruses. The continuous evaluation of diagnostic strategy, and the implementation of laboratories networks involved in surveillance activities is essential to ensure correct diagnosis, and to improve the preparedness for a rapid and proper identification of viral threats

Diagnosis of Imported Dengue and Zika Virus Infections in Italy from November 2015 to November 2022: Laboratory Surveillance Data from a National Reference Laboratory

Dengue (DENV) and Zika (ZIKV) viruses are mosquito-borne human pathogens. In Italy, the presence of the competent vector Aedes albopictus increases the risk of autochthonous transmission, and a national plan for arboviruses prevention, surveillance, and response (PNA 2020–2025) is in place. The results of laboratory diagnosis of both viruses by the National Reference Laboratory for arboviruses (NRLA) from November 2015 to November 2022 are presented. Samples from 655 suspected cases were tested by both molecular and serological assays. Virus and antibody kinetics, cross-reactivity, and diagnostic performance of IgM ELISA systems were analysed. Of 524 cases tested for DENV, 146 were classified as confirmed, 7 as probable, while 371 were excluded. Of 619 cases tested for ZIKV, 44 were classified as confirmed, while 492 were excluded. All cases were imported. Overall, 75.3% (110/146) of DENV and 50% (22/44) of ZIKV cases were confirmed through direct virus detection methods. High percentages of cross reactivity were observed between the two viruses. The median lag time from symptoms onset to sample collection was 7 days for both DENV molecular (range 0–20) and NS1 ELISA (range 0–48) tests, with high percentages of positivity also after 7 days (39% and 67%, respectively). For ZIKV, the median lag time was 5 days (range 0–22), with 16% positivity after 7 days. Diagnostic performance was assessed with negative predictive values ranging from 92% to 95% for the anti-DENV systems, and of 97% for the ZIKV one. Lower positive predictive values were seen in the tested population (DENV: 55% to 91%, ZIKV: 50%). DENV and ZIKV diagnosis by molecular test is the gold standard, but sample collection time is a limitation. Serological tests, including Plaque Reduction Neutralization Test, are thus necessary. Co-circulation and cross-reactivity between the two viruses increase diagnostic difficulty. Continuous evaluation of diagnostic strategies is essential to improve laboratory testing

Impact of different exposure models and spatial resolution on the long-term effects of air pollution.

Abstract Long-term exposure to air pollution has been related to mortality in several epidemiological studies. The investigations have assessed exposure using various methods achieving different accuracy in predicting air pollutants concentrations. The comparison of the health effects estimates are therefore challenging. This paper aims to compare the effect estimates of the long-term effects of air pollutants (particulate matter with aerodynamic diameter less than 10 μm, PM10, and nitrogen dioxide, NO2) on cause-specific mortality in the Rome Longitudinal Study, using exposure estimates obtained with different models and spatial resolutions. Annual averages of NO2 and PM10 were estimated for the year 2015 in a large portion of the Rome urban area (12 × 12 km2) applying three modelling techniques available at increasing spatial resolution: 1) a chemical transport model (CTM) at 1km resolution; 2) a land-use random forest (LURF) approach at 200m resolution; 3) a micro-scale Lagrangian particle dispersion model (PMSS) taking into account the effect of buildings structure at 4 m resolution with results post processed at different buffer sizes (12, 24, 52, 100 and 200 m). All the exposures were assigned at the residential addresses of 482,259 citizens of Rome 30+ years of age who were enrolled on 2001 and followed-up till 2015. The association between annual exposures and natural-cause, cardiovascular (CVD) and respiratory (RESP) mortality were estimated using Cox proportional hazards models adjusted for individual and area-level confounders. We found different distributions of both NO2 and PM10 concentrations, across models and spatial resolutions. Natural cause and CVD mortality outcomes were all positively associated with NO2 and PM10 regardless of the model and spatial resolution when using a relative scale of the exposure such as the interquartile range (IQR): adjusted Hazard Ratios (HR), and 95% confidence intervals (CI), of natural cause mortality, per IQR increments in the two pollutants, ranged between 1.012 (1.004, 1.021) and 1.018 (1.007, 1.028) for the different NO2 estimates, and between 1.010 (1.000, 1.020) and 1.020 (1.008, 1.031) for PM10, with a tendency of larger effect for lower resolution exposures. The latter was even stronger when a fixed value of 10 μg/m3 is used to calculate HRs. Long-term effects of air pollution on mortality in Rome were consistent across different models for exposure assessment, and different spatial resolutions