Chronic hepatitis B: Advances in treatment.

Abstract Treatment of chronic hepatitis B (CHB) has markedly improved in the last 15 years due to the availability of direct antivirals which greatly increase therapeutic options. Currently, there are two classes of agents licensed for CHB treatment: standard or pegylated interferon alpha (IFN or Peg-IFN) and five nucleoside/nucleotide analogues (NAs). Long-term treatment with NAs is the treatment option most often used in the majority of CHB patients. Entecavir and tenofovir, the most potent NAs with high barrier to resistance, are recommended as first-line monotherapy by all major treatment guidelines and can lead to long-lasting virological suppression, resulting in histological improvement or reversal of advanced fibrosis and reduction in disease progression and liver-related complications. In this review, we focus on current treatment strategies of chronic hepatitis B and discuss the most recent efficacy and safety data from clinical trials and real life clinical practice. Recent findings of response-guided approaches are also discussed

Management of cardiac implantable electronic device infections: recommendations from a study panel

Cardiac Implantable Electronic Device (CIED) infections are an emerging clinical issue. There are no national recommendations on the management of these infections, also due to the limited number of dedicated and high quality clinical studies. Therefore, researchers from southern Italian centres have decided to share the clinical experience gathered so far in this field and report practical recommendations for the diagnosis and treatment of adult patients with CIED infection or endocarditis. Here we review the risk factors, diagnostic issues (microbiological and echocardiographic) and aetiology, and describe extensively the best therapeutic approach. We also address the management of complications, follow-up after discharge and the prevention of CIED infections. In this regard, a multidisciplinary approach is fundamental to appropriately manage the initial diagnostic process and the comorbidities, to plan proper antimicrobial treatment and complete percutaneous hardware removal, with the key support of microbiology and echocardiography

Improved Bone Safety of Tenofovir Alafenamide Compared to Tenofovir Disoproxil Fumarate Over 2 Years in Patients With Chronic HBV Infection.

Long-term use of tenofovir disoproxil fumarate (TDF) reduces bone mineral density (BMD). Tenofovir alafenamide (TAF), a new prodrug of tenofovir, has shown non-inferior efficacy to TDF in patients with chronic hepatitis B virus (HBV) infection, with improved bone effects at 48 weeks. We performed a randomized trial to evaluate the bone safety of TAF compared with TDF over 2 years, assessing baseline risk factors for bone loss, were evaluated after 2 years of treatment

Recommendations for the use of Hepatitis C virus protease inhibitors for the treatment of chronic Hepatitis C in HIV-infected persons. A position paper of the Italian Association for the Study of Infectious and Tropical Diseases

31nononeThe efficacy data obtained with boceprevir and telaprevir for persons with hepatitis C virus (HCV) genotype 1 infection raise the question of whether HCV protease inhibitors should be used in human immunodeficiency virus (HIV)/HCV co-infected persons. The Italian Association for the Study of Infectious and Tropical Diseases has made these recommendations to provide the rationale and practical indications for the use of triple anti-HCV therapy in persons living with HIV (PLWHIV). A Writing Committee of experts indicated by the President of the Association and a Consulting Committee contributed to the document. The final draft was submitted to the evaluation of external experts and the text modified according to their suggestions and comments. Treatment of HCV co-infection should be considered for all HCV RNA positive PLWHIV. Response-guided therapy with pegylated interferon and ribavirin is the standard treatment of PLWHIV with infection by HCV genotype 2, 3, 4, 5 and 6. Boceprevir and telaprevir should be used to treat HCV genotype 1 infection in HIV/HCV co-infected patients for 48 weeks on an individual basis, with close monitoring of their efficacy and tolerability with concurrent antiretroviral therapy, taking into account potential drug-drug interactions. The decision to treat a patient or to wait for better treatment options, or to discontinue treatment should be made on an individual basis taking into account pre-treatment variables and the on-treatment HCV RNA kinetics.Armignacco, Orlando; Andreoni, Massimo; Sagnelli, Evangelista; Puoti, Massimo; Bruno, Raffaele; Gaeta, Giovanni Battista; Perno, Carlo F.; Santantonio, Teresa A.; Bonfanti, Paolo; Bonora, Stefano; Borderi, Marco; Castagna, Antonella; D'Arminio Monforte, Antonella; De Luca, Andrea; Grossi, Paolo; Guaraldi, Giovanni; Maggiolo, Franco; Mussini, Cristina; Sagnelli, Caterina; Tavio, Marcello; Torti, Carlo; Uberti-Foppa, Caterina; Angarano, Gioacchino; Antinori, Andrea; Carosi, Giampiero; Chirianni, Antonio; Di Perri, Giovanni; Galli, Massimo; Lazzarin, Adriano; Rizzardini, Giuliano; Taliani, GloriaArmignacco, Orlando; Andreoni, Massimo; Sagnelli, Evangelista; Puoti, Massimo; Bruno, Raffaele; Gaeta, Giovanni Battista; Perno, Carlo F.; Santantonio, Teresa A.; Bonfanti, Paolo; Bonora, Stefano; Borderi, Marco; Castagna, Antonella; D'Arminio Monforte, Antonella; De Luca, Andrea; Grossi, PAOLO ANTONIO; Guaraldi, Giovanni; Maggiolo, Franco; Mussini, Cristina; Sagnelli, Caterina; Tavio, Marcello; Torti, Carlo; Uberti Foppa, Caterina; Angarano, Gioacchino; Antinori, Andrea; Carosi, Giampiero; Chirianni, Antonio; Di Perri, Giovanni; Galli, Massimo; Lazzarin, Adriano; Rizzardini, Giuliano; Taliani, Glori