Heavily treatment-experienced persons living with HIV currently in care in Italy: characteristics, risk factors, and therapeutic options—the ICONA Foundation cohort study

Objectives: Heavily treatment-experienced (HTE) people living with HIV (PLWH) pose unique challenges due to limited antiretroviral treatment (ART) options. Our study aimed to investigate the prevalence and features of HTE individuals followed up in the Italian Cohort Naïve Antiretrovirals (ICONA) cohort as of December 31, 2021. Methods: HTE were defined based on meeting specific conditions concerning their current ART and their ART history up to December 31, 2021. Descriptive statistics were performed by HTE status. Regression analyses explored factors associated with becoming HTE based on pre-ART patients' characteristics. Cluster dendrogram analysis provided insights into subgroups with inadequate responses based on clusters of differentiation (CD4) counts and viral load (VL) trajectories. Results: Among the 8758 PLWH actively followed in our cohort, 163 individuals (1.9%), mainly female, younger, Italian, and infected through heterosexual contact, met the HTE criteria. A lower CD4 count at ART initiation (odds ratio [OR] 1.60 per 100 cells/mmc lower CD4, 95% confidence interval [CI] 1.06-2.41, P = 0.03) and hepatitis C virus antibody positivity (OR 1.90, 95% CI 1.16-3.11, P = 0.01) were associated with higher HTE risk. Thirty PLWH exhibited ongoing immune-virological failure (18% of the HTE subgroup and 0.003% of the total population). Thirty PLWH exhibited ongoing immune-virological failure (i.e., with a current CD4 count 200 copies/mL). A cluster analysis identified 13 (43%) with a current CD4 count <200 cells/mmc. Also, notably, 19/30 (63%) had major acquired resistance-associated mutations to at least one antiretroviral drug class. Conclusions: HTE is rare in our cohort and tends to co-exist with major resistance mutations. A focused investigation into treatment history and immuno-virological response is warranted, particularly given the availability of new antiretroviral drugs

Intra-Operative Electron Radiation Therapy (IOERT) Anticipated Boost in Breast Cancer Treatment: An Italian Multicenter Experience

In breast cancer, the use of a boost to the tumor bed can improve local control. The aim of this research is to evaluate the safety and efficacy of the boost with intra-operative electron radiotherapy (IOERT) in patients with early-stage breast cancer undergoing conservative surgery and postoperative whole breast irradiation (WBI). The present retrospective multicenter large data were collected between January 2011 and March 2018 in 8 Italian Radiation Oncology Departments. Acute and late toxicity, objective (obj) and subjective (subj) cosmetic outcomes, in-field local control (LC), out-field LC, disease-free survival (DFS) and overall survival (OS) were evaluated. Overall, 797 patients were enrolled. IOERT-boost was performed in all patients during surgery, followed by WBI. Acute toxicity (&ge;G2) occurred in 179 patients (22.46%); one patient developed surgical wound infection (G3). No patients reported late toxicity &ge; G2. Obj-cosmetic result was excellent in 45%, good in 35%, fair in 20% and poor in 0% of cases. Subj-cosmetic result was excellent in 10%, good in 20%, fair in 69% and poor in 0.3% of cases. Median follow-up was 57 months (range 12&ndash;109 months). At 5 years, in-field LC was 99.2% (95% CI: 98&ndash;99.7); out-field LC 98.9% (95% CI: 97.4&ndash;99.6); DFS 96.2% (95% CI: 94.2&ndash;97.6); OS 98.6% (95% CI: 97.2&ndash;99.3). In conclusion, IOERT-boost appears to be safe, providing excellent local control for early-stage breast cancer. The safety and long-term efficacy&nbsp;should encourage use of this treatment, with the potential to reduce local recurrence

Italian consensus Guidelines for the management of hepatitis B virus infections in patients with rheumatoid arthritis

Hepatitis B (HBV) infection, which is prevalent worldwide, is also frequently seen in patients with rheumatoid arthritis (RA). The Italian Society of Rheumatology (SIR) and the Italian Society of Infectious and Tropical Diseases (SIMIT) endorsed a national consensus process to review the available evidence on HBV management in RA patients and to produce practical, hospital-wide recommendations

Italian consensus recommendations for the management of hepatitis C infection in patients with rheumatoid arthritis

Objectives: The recent introduction of direct-acting antiviral agents (DAAs) which can eliminate Hepatitis C virus (HCV) had revolutionized the treatment of HCV infections also in a complex clinical setting such as the patients with rheumatoid arthritis (RA). HCV elimination is also opportune due to the availability of more efficient immunosuppressive drugs, whose effect on the course of HCV infection is largely unknown. Methods: Consensus process was endorsed by the Italian Society of Rheumatology (SIR) and the Italian Society of Infectious and Tropical Diseases (SIMIT) to review the available evidence and produce practical, hospital-wide recommendations. The consensus panel consisted of 18 infectious diseases consultants, 20 rheumatologists and one clinical epidemiologist, who used the criteria of the Oxford Centre for Evidence-based Medicine to assess the quality of the evidence and the strength of their recommendations. Results: A core-set of statements about management of patients with RA and infection by HCV have been developed to help clinicians in their clinical practice. Conclusions: A screening for HCV should be performed in all RA patients and it is mandatory before starting an immunosuppressive therapy. Finally, a DAA treatment should be considered in all HCV-infected patients.Significance and Innovations HCV antibodies should be investigated at the time of diagnosis of RA and, in any case, before starting immunosuppressive therapy with disease-modifying antirheumatic drugs (DMARDs). HCV eradication with DAA should be attempted as soon as possible, depending on patient conditions allowing a continuous oral treatment lasting 8–12 weeks Conventional and biological DMARDs are allowed in patients with HCV infection, but they should be used cautiously in presence of advanced liver disease

Recommendations for the management of pulmonary fungal infections in patients with rheumatoid arthritis

Often life-threatening pulmonary fungal infections (PFIs) can occur in patients with rheumatoid arthritis (RA) receiving disease-modifying anti-rheumatic drugs (DMARDs). Most of the data concerning PFIs in RA patients come from case reports and retrospective case series. Of the ve most widely described PFIs, Pneumocystis jirovecii pneumonia (PJP) has rarely been seen outside Japan, pulmonary cryptococcosis has been diagnosed in only a small number of patients worldwide, pulmonary coccidioidomycosis has almost only been observed in endemic areas, the limited number of cases of pulmonary histoplasmosis have mainly occurred in the USA, and the rare cases of invasive pulmonary aspergillosis have only been encountered in leukopenic patients. Many aspects of the prophylaxis, diagnosis and treatment of PFIs in RA patients remain to be defined, as does the role of each DMARD in increasing the risk of infection, and the possibility of resuming biological and non-biological DMARD treatment after the infection has been cured. The recommendations for the management of PFIs described in this paper are the product of a consensus procedure promoted by the Italian group for the Study and Management of Infections in Patients with Rheumatic Diseases (the ISMIR group)

Italian consensus guidelines for the management of hepatitis B virus infections in patients with rheumatoid arthritis

No abstract availabl

Prise en charge de l'infection par le virus de l'hépatite B chez les patients atteints de polyarthrite rhumatoïde: conférence de consensus italienne

No abstract availabl

Prise en charge de l’infection par le virus de l’hépatite B chez les patients atteints de polyarthrite rhumatoïde : conférence de consensus italienne

none33openSebastiani, Marco*; Atzeni, Fabiola; Milazzo, Laura; Quartuccio, Luca; Scirè, Carlo; Gaeta, Giovanni Battista; Lapadula, Giovanni; Armignacco, Orlando; Tavio, Marcello; Olivieri, Ignazio; Meroni, Pierluigi; Bazzichi, Laura; Grassi, Walter; Mathieu, Alessandro; Mastroianni, Claudio; Sagnelli, Evangelista; Santantonio, Teresa; Uberti Foppa, Caterina; Puoti, Massimo; Sarmati, Loredana; Airò, Paolo; Epis, Oscar Massimiliano; Scrivo, Rossana; Gargiulo, Miriam; Riva, Agostino; Manfredi, Andreina; Ciancio, Giovanni; Zehender, Gianguglielmo; Taliani, Gloria; Meroni, Luca; Sollima, Salvatore; Sarzi-Puttini, Piercarlo; Galli, MassimoSebastiani, Marco; Atzeni, Fabiola; Milazzo, Laura; Quartuccio, Luca; Scirè, Carlo; Gaeta, Giovanni Battista; Lapadula, Giovanni; Armignacco, Orlando; Tavio, Marcello; Olivieri, Ignazio; Meroni, Pierluigi; Bazzichi, Laura; Grassi, Walter; Mathieu, Alessandro; Mastroianni, Claudio; Sagnelli, Evangelista; Santantonio, Teresa; Uberti Foppa, Caterina; Puoti, Massimo; Sarmati, Loredana; Airò, Paolo; Epis, Oscar Massimiliano; Scrivo, Rossana; Gargiulo, Miriam; Riva, Agostino; Manfredi, Andreina; Ciancio, Giovanni; Zehender, Gianguglielmo; Taliani, Gloria; Meroni, Luca; Sollima, Salvatore; Sarzi-Puttini, Piercarlo; Galli, Massim

HBcAb Positivity Increases the Risk of Severe Hepatic Fibrosis Development in HIV/HCV-Positive Subjects From the ICONA Italian Cohort of HIV-Infected Patients

The aim of this study was to investigate the impact of anti-HBc (HBcAb) positivity on the progression of liver fibrosis (Fibrosis-4 score &gt;3.25) in the Italian cohort of HIV-infected individuals na\uefve to antiretroviral treatment (ICONA)