Trend of estimated glomerular flitration rate in a large cohort of HIV mother-to -child infected patients, an observational multicenter study from 2010 to 2018

Background: People vertically infected with HIV (PVI-HIV) are a special population, due to exposition since birth to HIV and antiretroviral therapy (ART). Among ART, Tenofovir disoproxil fumarate (TDF) was widely used in recent years, but there are few data on safety in these patients; in particular, data about estimated glomerular filtration rate (eGFR) trend in this population. Aim of our study is to evaluate eGFR trend in a multicentre cohort of PVI-HIV exposed to TDF

The increasing burden and complexity of multi-morbidity and polypharmacy in geriatric HIV patients: a cross sectional study of people aged 65 - 74 years and more than 75 years

Geriatric Patients Living with HIV/AIDS (GEPPO) is a new prospective observational multicentre cohort consisting of all the HIV-positive geriatric patients being treated at 10 clinics in Italy, and HIV-negative controls attending a single geriatric clinic. The aim of this analysis of the GEPPO cohort was to compare prevalence and risk factors of individual non-communicable diseases (NCD), multi-morbidity (MM) and polypharmacy (PP) amongst HIV positive and HIV negative controls at enrolment into the GEPPO cohort

The epidemiology of Varicella Zoster Virus infection in Italy

<p>Abstract</p> <p>Background</p> <p>The epidemiological importance of varicella and zoster and the availability of an efficacious and safe vaccine have led to an important international debate regarding the suitability of mass vaccination. The objective of the study was to describe the epidemiology of varicella and zoster in Italy and to determine whether there have been changes with respect to observations provided by an analogous study conducted 8 years ago, in order to define the most appropriate vaccination strategy.</p> <p>Methods</p> <p>A number of data sources were evaluated, a cross-sectional population-based seroprevalence study was conducted on samples collected in 2004, and the results were compared with data obtained in 1996.</p> <p>Results</p> <p>The data from active and passive surveillance systems confirm that varicella is a widespread infectious disease which mainly affects children. VZV seroprevalence did not substantially differ from that found in the previous study. The sero-epidemiological profile in Italy is different from that in other European countries. In particular, the percentage of susceptible adolescents is at least nearly twice as high as in other European countries and in the age group 20–39 yrs, approximately 9% of individuals are susceptible to VZV.</p> <p>Conclusion</p> <p>The results of this study can contribute to evaluating the options for varicella vaccination. It is possible that in a few years, in all Italian Regions, there will exist the conditions necessary for implementing a mass vaccination campaign and that the large-scale availability of MMRV tetravalent vaccines will facilitate mass vaccination.</p

Virological effectiveness and CD4+ T-cell increase over early and late courses in HIV infected patients on antiretroviral therapy: focus on HCV and anchor class received

ABSTRACT: BACKGROUND: The aim of this study was to explore the effects of HCV co-infection on virological effectiveness and on CD4+ T-cell recovery in patients with an early and sustained virological response after HAART. METHODS: We performed a longitudinal analysis of 3,262 patients from the MASTER cohort, who started HAART from 2000 to 2008. Patients were stratified into 6 groups by HCV status and type of anchor class. The early virological outcome was the achievement of HIV RNA &lt;500 copies/ml 4-8 months after HAART initiation. Time to virological response was also evaluated by Kaplan-Meier analysis. The main outcome measure of early immunological response was the achievement of CD4+ T-cell increase by [greater than or equal to]100/mm3 from baseline to month 4-8 in virological responder patients. Late immunological outcome was absolute variation of CD4+ T-cell count with respect to baseline up to month 24. Multivariable analysis (ANCOVA) investigated predictors for this outcome. RESULTS: The early virological response was higher in HCV Ab-negative than HCV Ab-positive patients prescribed PI/r (92.2% versus 88%; p = 0.01) or NNRTI (88.5% versus 84.7%; p = 0.06). HCV Ab-positive serostatus was a significant predictor of a delayed virological suppression independently from other variables, including types of anchor class. Reactivity for HCV antibodies was associated with a lower probability of obtaining [greater than or equal to]100/mm3 CD4+ increase within 8 months from HAART initiation in patients treated with PI/r (62.2% among HCV Ab-positive patients versus 70.9% among HCV Ab-negative patients; p = 0.003) and NNRTI (63.7% versus 74.7%; p &lt; 0.001). Regarding late CD4+ increase, positive HCV Ab appeared to impair immune reconstitution in terms of absolute CD4+ T-cell count increase both in patients treated with PI/r (p = 0.013) and in those treated with NNRTI (p = 0.002). This was confirmed at a multivariable analysis up to 12 months of follow-up. CONCLUSIONS: In this large cohort, HCV Ab reactivity was associated with an inferior virological outcome and an independent association between HCV Ab-positivity and smaller CD4+ increase was evident up to 12 months of follow-up. Although the difference in CD4+ T-cell count was modest, a stricter follow-up and optimization of HAART strategy appear to be important in HIV patients co-infected by HCV. Moreover, our data support anti-HCV treatment leading to HCV eradication as a means to facilitate the achievement of the viro-immunological goals of HAART

Hepatitis A incidence and hospital-based seroprevalence in Italy: a nation-wide study

To define the pattern of HAV infection in Italy and to study the differences among geographic areas (northern, central and southern Italy) and age-classes, we performed HAV antibody testing on sera collected in 1996-1997 from a large sample of the Italian population and compared the results with those of other seroprevalence studies and with incidence data for the period 1985-2005, calculated by a surveillance system specific for acute viral hepatitis based on symptomatic cases. A total of 3,561 sera, collected by hospital-based reference laboratories in 18 out of 20 Italian Regions, were tested; 1,138 (32%, 95% CI: 30.5-33.5) were positive. The age-adjusted prevalence was 60.1% and the age-specific rates were among the highest rates reported in Europe in the 1990s. The age-adjusted seroprevalence showed a significant north-south gradient, increasing from 55% in northern Italy to 68% in southern Italy. Age and area of residence were found to be strong predictors of previous HAV infection: the marked increase in prevalence with increasing age represents a strong cohort effect. In northern Italy, a marked increase with age was observed beginning with the 20- to 29-year age-class, whereas in southern Italy, such an increase was observed beginning with the 12- to 19-year age-class, indicating that northern Italy preceded southern Italy by 10-20 years in terms of improvements in hygiene and sanitation. The incidence of HAV infection shows an evident peak in 1997, when an outbreak occurred in southern Italy, mainly affecting 15- to 24-year-old individuals. In the period from 1998 to 2005, the incidence drastically decreased (average of 3.2/100,000 inhabitants), reaching a minimum of 2/100,000 inhabitants in 2005

Exploratory analysis for the evaluation of estimated glomerular filtration rate, cholesterol and triglycerides after switching from tenofovir/emtricitabine plus atazanavir/ritonavir (ATV/r) to abacavir/lamivudine plus ATV/r in patients with preserved renal function

Background and Objectives: Renal toxicity due to tenofovir (TDF) has been largely described in patients with HIV infection. However, other antiretroviral drugs (such as atazanavir [ATV], especially when boosted by ritonavir, ATV/r) could perpetuate some degrees of renal impairment with or without TDF co-administration. Also, possible benefits of stopping TDF in patients without renal diseases is not well known. This study aimed at exploring evolution of renal function and lipid profile after switching from tenofovir/emtricitabine (TDF/FTC) to abacavir/lamivudine (ABC/3TC), maintaining the ATV/r component of the regimen. Methods: Patients in the Italian MASTER Cohort, who switched from TDF/FTC plus ATV/r to ABC/3TC plus ATV/r were included, provided that major renal diseases were not diagnosed before switching (i.e., baseline). Serum creatinine, estimated glomerular filtration rate (eGFR), total cholesterol, HDL and triglycerides were evaluated at baseline and at month 18 after switching. Results: 126 patients were selected (80% males). Patients were mostly Italians (92%). 79% had undetectable HIV-RNA and 44% were coinfected by HBV and/or HCV. Median age at switch was 47 years (IQR 43-55). A small but significant decrease in serum creatinine [from 1.06 mg/dl (SD: 0.3) to 0.94 mg/dl (SD: 0.2); p&lt;0.001] with an improvement in eGFR [from 86.8 ml/min (SD: 33) to 96.4 ml/min (SD: 37); p&lt;0.001] were observed in per protocol analysis at month 18. Also ITT analysis showed a decrease in mean serum creatinine [from 1.08 mg/dl (SD: 0.35) to 0.95 mg/dl (SD: 0.24); p&lt;0.001] with an improvement in mean eGFR [from 86.9 ml/min/1.73m2 (SD: 24.11) to 95.8 ml/min/1.73m2 (SD: 19.99); p&lt;0.001]. Total cholesterol increased [from 188 mg/dl (SD: 42) to 206 mg/dl (SD: 44); p&lt;0.001] but also HDL increased as well [from 46 mg/dl (SD: 14) to 54 mg/dl (SD: 19); p=0.015]. An increase in triglycerides concentration was observed [from 162 mg/dl (SD: 144) to 214 mg/dl (SD: 109); p=0.027] in per protocol analysis. Also ITT analysis showed increases of both total cholesterol [from 187 mg/dl (SD: 43.69) to 203 mg/dl (SD: 44.10); p&lt;0.001] and HDL fraction [from 46 mg/dl (SD: 15.49) to 52 mg/dl (SD: 17.13); p=0.002] at month 18. Conclusion: This analysis reports an improvement in eGFR and an increase in total cholesterol and HDL fraction at month 18 after switching to ABC/3TC plus ATV/r. Given the fact that renal function was not significantly affected at baseline, our findings may suggest the utility of a proactive switch from TDF to ABC, when otherwise indicated, in patients who cannot avoid using a nucleoside backbone

Long-term efficacy of dolutegravir in treatment-experienced subjects failing therapy with HIV-1 integrase strand inhibitor-resistant virus

115nononenoneCastagna, Antonella*; Ferrara, Micol; Galli, Laura; Comi, Laura; Sterrantino, Gaetana; Cenderello, Giovanni; Zaccarelli, Mauro; Focà, Emanuele; Roncadori, Andrea; Lazzarin, Adriano; Chichino, G.; Mantia, E.; Butini, L.; Costantini, A.; Giacometti, A.; Tavio, M.; Grassini, M.; Valle, M.; Vaccher, E.; Martellotta, F.; Schioppa, O.; Comi, L.; Maggiolo, F.; Viale, P.; Borderi, M.; Calza, L.; Moratello, L.; Magistrelli, E.; Castelli, F.; Festa, E.; Focà, E.; Quirino, T.; Campus, M.; Businco, F.; Celesia, B.M.; La Rosa, R.; Pan, A.; Fornabaio, C.; Mazzotta, F.; Di Pietro, M.; Sterrantino, G.; Bartoloni, A.; Ferrara, S.; Mastroianni, A.; Di Cesare, S.; Viscoli, C.; Di Biagio, A.; Cassola, G.; Cenderello, G.; Penco, G.; Cericola, A; Nencioni, C.; Carli, T.; Viganò, P.; Re, T.; Del Fiorentino, A.; Gattuso, G.; Palvarini, L.; Taurozzi, M.; Lazzarin, A.; Gianotti, N.; Galizzi, N.; Poli, A.; Galli, L.; Castagna, A.; Rusconi, S.; Galli, S.E. Salvaggio M.; Rizzardini, G.; Mussini, C.; Menozzi, M.; Gori, A.; Muscatello, A.; Cappelletti, E.; Gargiulo, M.; Garavelli, P.L.; Bargiacchi, O.; Prestileo, T.; Di Lorenzo, F.; Bonanno, S.; Ferrari, C.; degli Antoni, A.M.; Cattelan, A.M.; Gulminetti, R.; Pagnucco, L.; Menichetti, F.; Iapoce, R.; Baldelli, F.; Schiaroli, E.; Italiani, F.; Aquilini, D.; Magnani, G.; Corsini, R.; Barchi, E.; Ferrari, E.; Antinori, A.; Zaccarelli, M.; Cristaudo, A.; Latini, A.; Cauda, R.; Vullo, V.; Maffongelli, G.; Andreoni, M.; Sassett, L.; Viviani, F.; De Luca, A.; Rossetti, B.; Franco, A.; Resta, F.; Di Perri, G.; Bonora, S.; Ferrara, M.; Bassetti, M.; Londero, A.; Malena, M.; Luzzati, R.Castagna, Antonella; Ferrara, Micol; Galli, Laura; Comi, Laura; Sterrantino, Gaetana; Cenderello, Giovanni; Zaccarelli, Mauro; Focã , Emanuele; Roncadori, Andrea; Lazzarin, Adriano; Chichino, G.; Mantia, E.; Butini, L.; Costantini, A.; Giacometti, A.; Tavio, M.; Grassini, M.; Valle, M.; Vaccher, E.; Martellotta, F.; Schioppa, O.; Comi, L.; Maggiolo, F.; Viale, P.; Borderi, M.; Calza, L.; Moratello, L.; Magistrelli, E.; Castelli, F.; Festa, E.; Focã , E.; Quirino, T.; Campus, M.; Businco, F.; Celesia, B. M.; La Rosa, R.; Pan, A.; Fornabaio, C.; Mazzotta, Fulvio; DI PIETRO, Anna Maria; Sterrantino, G.; Bartoloni, Alessandro; Ferrara, S.; Mastroianni, Axel; Di Cesare, S.; Viscoli, C.; Di Biagio, A.; Cassola, G.; Cenderello, G.; Penco, G.; Cericola, A; Nencioni, C.; Carli, T.; Viganã², P.; Re, T.; Del Fiorentino, A.; Gattuso, Gianni; Palvarini, L.; Taurozzi, M.; Lazzarin, A.; Gianotti, N.; Galizzi, N.; Poli, A.; Galli, L.; Castagna, A.; Rusconi, S.; Galli, S. E. Salvaggio M.; Rizzardini, G.; Mussini, C.; Menozzi, M.; Gori, A.; Muscatello, A.; Cappelletti, E.; Gargiulo, M.; Garavelli, P. L.; Bargiacchi, O.; Prestileo, T.; Di Lorenzo, F.; Bonanno, Sara; Ferrari, C.; degli Antoni, A. M.; Cattelan, A. M.; Gulminetti, R.; Pagnucco, L.; Menichetti, F.; Iapoce, R.; Baldelli, F.; Schiaroli, E.; Italiani, F.; Aquilini, D.; Magnani, G.; Corsini, R.; Barchi, E.; Ferrari, E.; Antinori, A.; Zaccarelli, M.; Cristaudo, A.; Latini, A.; Cauda, R.; Vullo, V.; Maffongelli, G.; Andreoni, M.; Sassett, L.; Viviani, F.; DE LUCA, Angela; Rossetti, B.; Franco, A.; Resta, F.; Di Perri, G.; Bonora, S.; Ferrara, M.; Bassetti, M.; Londero, A.; Malena, M.; Luzzati, R