Evaluation of HIV transmission clusters among natives and foreigners living in Italy

We aimed at evaluating the characteristics of HIV-1 molecular transmission clusters (MTCs) among natives and migrants living in Italy, diagnosed between 1998 and 2018. Phylogenetic analyses were performed on HIV-1 polymerase (pol) sequences to characterise subtypes and identify MTCs, divided into small (SMTCs, 2-3 sequences), medium (MMTCs, 4-9 sequences) and large (LMTCs, ≥10 sequences). Among 3499 drug-naïve individuals enrolled in the Italian Cohort Naive Antiretroviral (ICONA) cohort (2804 natives; 695 migrants), 726 (20.8%; 644 natives, 82 migrants) were involved in 228 MTCs (6 LMTCs, 36 MMTCs, 186 SMTCs). Migrants contributed 14.4% to SMTCs, 7.6% to MMTCs and 7.1% to LMTCs, respectively. HIV-1 non-B subtypes were found in 51 MTCs; noteworthy was that non-B infections involved in MTCs were more commonly found in natives (n = 47) than in migrants (n = 4). Factors such as Italian origin, being men who have sex with men (MSM), younger age, more recent diagnosis and a higher CD4 count were significantly associated with MTCs. Our findings show that HIV-1 clustering transmission among newly diagnosed individuals living in Italy is prevalently driven by natives, mainly MSM, with a more recent diagnosis and frequently infected with HIV-1 non-B subtypes. These results can contribute to monitoring of the HIV epidemic and guiding the public health response to prevent new HIV infections

Evaluation of HIV transmission clusters among natives and foreigners living in Italy

We aimed at evaluating the characteristics of HIV-1 molecular transmission clusters (MTCs) among natives and migrants living in Italy, diagnosed between 1998 and 2018. Phylogenetic analyses were performed on HIV-1 polymerase (pol) sequences to characterise subtypes and identify MTCs, divided into small (SMTCs, 2-3 sequences), medium (MMTCs, 4-9 sequences) and large (LMTCs, ≥10 sequences). Among 3499 drug-naïve individuals enrolled in the Italian Cohort Naive Antiretroviral (ICONA) cohort (2804 natives; 695 migrants), 726 (20.8%; 644 natives, 82 migrants) were involved in 228 MTCs (6 LMTCs, 36 MMTCs, 186 SMTCs). Migrants contributed 14.4% to SMTCs, 7.6% to MMTCs and 7.1% to LMTCs, respectively. HIV-1 non-B subtypes were found in 51 MTCs; noteworthy was that non-B infections involved in MTCs were more commonly found in natives (n = 47) than in migrants (n = 4). Factors such as Italian origin, being men who have sex with men (MSM), younger age, more recent diagnosis and a higher CD4 count were significantly associated with MTCs. Our findings show that HIV-1 clustering transmission among newly diagnosed individuals living in Italy is prevalently driven by natives, mainly MSM, with a more recent diagnosis and frequently infected with HIV-1 non-B subtypes. These results can contribute to monitoring of the HIV epidemic and guiding the public health response to prevent new HIV infections

The impact of DAA-mediated HCV eradication on CD4+ and CD8+ T lymphocyte trajectories in HIV/HCV coinfected patients: Data from the ICONA Foundation Cohort

HCV infection has been hypothesized as a contributor of poor CD4+ recovery in patients living with HIV (PLWHIV). Aim of this study was to evaluate CD4+, CD8+ cells and CD4/CD8 ratio trends before and after HCV treatment with direct acting agents (DAA) in PLWHIV. HIV/HCV patients enrolled in ICONA and HepaICONA cohorts with HIV-RNA 6450 copies/ml who achieved a sustained viral response after DAA treatment were studied. A linear regression model was used to investigate CD4+, CD8+ and CD4/CD8 changes 12 months before and after DAA treatment. A total of 939 HIV/HCV patients were included, 225 (24.0%) female, median age: 53 years (IQR 50\u201356). At DAA initiation, CD4+ T cell count was <350 cells/mm3 in 164 patients (17.5%), and 246 patients (26.2%) had liver stiffness>12.5 kPa. Trends of CD4+ and CD4/CD8 ratio were similar before and after DAA in all study populations (CD4+ change +17.6 cells/mm3 (95%CI 1233.5; 69.4, p = 0.494); CD4/CD8 change 0.013 (95%CI 120.061; 0.036, p = 0.611). However, patients treated with ribavirin (RBV)-free DAA showed a significant decrease in CD8+ cells ( 12204.3 cells/mm3, 95%CI 12375.0;-33.4, p = 0.019), while patients treated with RBV experienced CD8+ cell increase (+141.2 cells/mm3, 95%CI 40.3; 242.1, p = 0.006). In conclusion, HCV eradication following DAA treatment does not seem to have an impact on CD4+ T cell recovery in PLWHIV. However, a fast decline of CD8+T cells has been observed in patients treated without RBV, suggesting a favourable effect of HCV clearance on the general state of immune activation

The impact of DAA-mediated HCV eradication on CD4+ and CD8+ T lymphocyte trajectories in HIV/HCV coinfected patients: Data from the ICONA Foundation Cohort

HCV infection has been hypothesized as a contributor of poor CD4+ recovery in patients living with HIV (PLWHIV). Aim of this study was to evaluate CD4+, CD8+ cells and CD4/CD8 ratio trends before and after HCV treatment with direct acting agents (DAA) in PLWHIV. HIV/HCV patients enrolled in ICONA and HepaICONA cohorts with HIV-RNA≤50 copies/ml who achieved a sustained viral response after DAA treatment were studied. A linear regression model was used to investigate CD4+, CD8+ and CD4/CD8 changes 12 months before and after DAA treatment. A total of 939 HIV/HCV patients were included, 225 (24.0%) female, median age: 53 years (IQR 50–56). At DAA initiation, CD4+ T cell count was <350 cells/mm3 in 164 patients (17.5%), and 246 patients (26.2%) had liver stiffness>12.5 kPa. Trends of CD4+ and CD4/CD8 ratio were similar before and after DAA in all study populations (CD4+ change +17.6 cells/mm3 (95%CI −33.5; 69.4, p = 0.494); CD4/CD8 change 0.013 (95%CI −0.061; 0.036, p = 0.611). However, patients treated with ribavirin (RBV)-free DAA showed a significant decrease in CD8+ cells (−204.3 cells/mm3, 95%CI −375.0;-33.4, p = 0.019), while patients treated with RBV experienced CD8+ cell increase (+141.2 cells/mm3, 95%CI 40.3; 242.1, p = 0.006). In conclusion, HCV eradication following DAA treatment does not seem to have an impact on CD4+ T cell recovery in PLWHIV. However, a fast decline of CD8+T cells has been observed in patients treated without RBV, suggesting a favourable effect of HCV clearance on the general state of immune activation

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 >3.25) in the Italian cohort of HIV-infected individuals na\uefve to antiretroviral treatment (ICONA)

Virological response and retention in care according to time of starting ART in Italy: Data from the Icona Foundation Study cohort

199Objectives: To describe: (i) factors associated with rapid and delayed ART initiation; (ii) rates of 12 week virological response; and (iii) virologically controlled retention in care by 1 year from ART initiation according to timing of start in a real-life setting. Methods: All individuals in the Icona cohort diagnosed with HIV in 2016-17 who initiated ART were grouped according to the time between HIV diagnosis and ART initiation: Group 1, ≤7 days; Group 2, 8-14 days; Group 3, 15-30 days; Group 4, 31-120 days; and Group 5, >120 days. Multivariable logistic regression models were used to identify factors associated with: (i) the probability of rapid (Group 1) and very delayed (Group 5) ART initiation; (ii) the 12 week virological response (by a modified snapshot algorithm); and (iii) the probability of retention in care at 1 year (on ART with HIV-RNA <50 copies/mL). Results: A total of 1247 individuals were included [82 (6.6%) in Group 1, 115 (9.2%) in Group 2, 267 (21.4%) in Group 3, 641 (51.4%) in Group 4 and 142 (11.4%) in Group 5]. Main predictors of rapid ART start (Group 1) were low CD4 cell count and high HIV-RNA at first contact with the infectious diseases centre. There was no association between probability of virological response and timing of ART initiation. Overall, 90% of individuals remained on ART after 1 year, 91% with undetectable HIV-RNA. Participants of Italian nationality, those with higher CD4 cell count and lower HIV-RNA at ART initiation were more likely to be retained in care after 1 year. Conclusions: In our high-income observational setting, we did not observe differences in the 1 year rate of virological response and retention in care according to timing of ART initiation.nonenoneD'Arminio Monforte A.; Tavelli A.; Cozzi-Lepri A.; Castagna A.; Passerini S.; Francisci D.; Saracino A.; Maggiolo F.; Lapadula G.; Girardi E.; Perno C.F.; Antinori A.; D'Arminio Monforte A.; Antinori A.; Andreoni M.; Castagna A.; Castelli F.; Cauda R.; Di Perri G.; Galli M.; Iardino R.; Ippolito G.; Lazzarin A.; Marchetti G.C.; Rezza G.; Von Schloesser F.; Viale P.; D'Arminio Monforte A.; Antinori A.; Castagna A.; Ceccherini-Silberstein F.; Cozzi-Lepri A.; Girardi E.; Lo Caputo S.; Mussini C.; Puoti M.; Perno C.F.; Antinori A.; Bai F.; Balotta C.; Bandera A.; Bonora S.; Borderi M.; Calcagno A.; Capetti A.; Capobianchi M.R.; Castagna A.; Ceccherini-Silberstein F.; Cicalini S.; Cingolani A.; Cinque P.; Cozzi-Lepri A.; D'Arminio Monforte A.; De Luca A.; Di Biagio A.; Girardi E.; Gianotti N.; Gori A.; Guaraldi G.; Lapadula G.; Lichtner M.; Lo Caputo S.; Madeddu G.; Maggiolo F.; Marchetti G.; Monno L.; Mussini C.; Nozza S.; Perno C.F.; Pinnetti C.; Puoti M.; Quiros Roldan E.; Rossotti R.; Rusconi S.; Santoro M.M.; Saracino A.; Sarmati L.; Cozzi-Lepri A.; Fanti I.; Galli L.; Lorenzini P.; Rodano A.; MacChia M.; Tavelli A.; Carletti F.; Carrara S.; Di Caro A.; Graziano S.; Petroni F.; Prota G.; Truffa S.; Giacometti A.; Costantini A.; Barocci V.; Angarano G.; Monno L.; Milano E.; Maggiolo F.; Suardi C.; Viale P.; Donati V.; Verucchi G.; Castelnuovo F.; Minardi C.; Quiros Roldan E.; Menzaghi B.; Abeli C.; Cacopardo B.; Celesia B.; Vecchiet J.; Falasca K.; Pan A.; Lorenzotti S.; Sighinolfi L.; Segala D.; Blanc P.; Vichi F.; Cassola G.; Viscoli C.; Alessandrini A.; Bobbio N.; Mazzarello G.; Lichtner M.; Fondaco L.; Bonfanti P.; Molteni C.; Chiodera A.; Milini P.; Nunnari G.; Pellicano G.; D'Arminio Monforte A.; Galli M.; Lazzarin A.; Rizzardini G.; Puoti M.; Castagna A.; Cannizzo E.S.; Moioli M.C.; Piolini R.; Bernacchia D.; Salpietro S.; Tincati C.; Mussini C.; Puzzolante C.; Migliorino C.; Lapadula G.; Sangiovanni V.; Borgia G.; Esposito V.; Di Flumeri G.; Gentile I.; Rizzo V.; Cattelan A.M.; Marinello S.; Cascio A.; Trizzino M.; Francisci D.; Schiaroli E.; Parruti G.; Sozio F.; Magnani G.; Ursitti M.A.; Andreoni M.; Antinori A.; Cauda R.; Cristaudo A.; Vullo V.; Acinapura R.; Moschese D.; Capozzi M.; Mondi A.; Cingolani A.; Rivano Capparuccia M.; Iaiani G.; Latini A.; Gagliardini R.; Plazzi M.M.; De Girolamo G.; Vergori A.; Cecchetto M.; Viviani F.; Madeddu G.; De Vito A.; Rossetti B.; Montagnani F.; Franco A.; Fontana Del Vecchio R.; Di Giuli C.; Caramello P.; Di Perri G.; Bonora S.; Orofino G.C.; Sciandra M.; Bassetti M.; Londero A.; Manfrin V.; Battagin G.; Starnini G.; Ialungo A.D'Arminio Monforte, A.; Tavelli, A.; Cozzi-Lepri, A.; Castagna, A.; Passerini, S.; Francisci, D.; Saracino, A.; Maggiolo, F.; Lapadula, G.; Girardi, E.; Perno, C. F.; Antinori, A.; D'Arminio Monforte, A.; Antinori, A.; Andreoni, M.; Castagna, A.; Castelli, F.; Cauda, R.; Di Perri, G.; Galli, M.; Iardino, R.; Ippolito, G.; Lazzarin, A.; Marchetti, G. C.; Rezza, G.; Von Schloesser, F.; Viale, P.; D'Arminio Monforte, A.; Antinori, A.; Castagna, A.; Ceccherini-Silberstein, F.; Cozzi-Lepri, A.; Girardi, E.; Lo Caputo, S.; Mussini, C.; Puoti, M.; Perno, C. F.; Antinori, A.; Bai, F.; Balotta, C.; Bandera, A.; Bonora, S.; Borderi, M.; Calcagno, A.; Capetti, A.; Capobianchi, M. R.; Castagna, A.; Ceccherini-Silberstein, F.; Cicalini, S.; Cingolani, A.; Cinque, P.; Cozzi-Lepri, A.; D'Arminio Monforte, A.; De Luca, A.; Di Biagio, A.; Girardi, E.; Gianotti, N.; Gori, A.; Guaraldi, G.; Lapadula, G.; Lichtner, M.; Lo Caputo, S.; Madeddu, G.; Maggiolo, F.; Marchetti, G.; Monno, L.; Mussini, C.; Nozza, S.; Perno, C. F.; Pinnetti, C.; Puoti, M.; Quiros Roldan, E.; Rossotti, R.; Rusconi, S.; Santoro, M. M.; Saracino, A.; Sarmati, L.; Cozzi-Lepri, A.; Fanti, I.; Galli, L.; Lorenzini, P.; Rodano, A.; Macchia, M.; Tavelli, A.; Carletti, F.; Carrara, S.; Di Caro, A.; Graziano, S.; Petroni, F.; Prota, G.; Truffa, S.; Giacometti, A.; Costantini, A.; Barocci, V.; Angarano, G.; Monno, L.; Milano, E.; Maggiolo, F.; Suardi, C.; Viale, P.; Donati, V.; Verucchi, G.; Castelnuovo, F.; Minardi, C.; Quiros Roldan, E.; Menzaghi, B.; Abeli, C.; Cacopardo, B.; Celesia, B.; Vecchiet, J.; Falasca, K.; Pan, A.; Lorenzotti, S.; Sighinolfi, L.; Segala, D.; Blanc, P.; Vichi, F.; Cassola, G.; Viscoli, C.; Alessandrini, A.; Bobbio, N.; Mazzarello, G.; Lichtner, M.; Fondaco, L.; Bonfanti, P.; Molteni, C.; Chiodera, A.; Milini, P.; Nunnari, G.; Pellicano, G.; D'Arminio Monforte, A.; Galli, M.; Lazzarin, A.; Rizzardini, G.; Puoti, M.; Castagna, A.; Cannizzo, E. S.; Moioli, M. C.; Piolini, R.; Bernacchia, D.; Salpietro, S.; Tincati, C.; Mussini, C.; Puzzolante, C.; Migliorino, C.; Lapadula, G.; Sangiovanni, V.; Borgia, G.; Esposito, V.; Di Flumeri, G.; Gentile, I.; Rizzo, V.; Cattelan, A. M.; Marinello, S.; Cascio, A.; Trizzino, M.; Francisci, D.; Schiaroli, E.; Parruti, G.; Sozio, F.; Magnani, G.; Ursitti, M. A.; Andreoni, M.; Antinori, A.; Cauda, R.; Cristaudo, A.; Vullo, V.; Acinapura, R.; Moschese, D.; Capozzi, M.; Mondi, A.; Cingolani, A.; Rivano Capparuccia, M.; Iaiani, G.; Latini, A.; Gagliardini, R.; Plazzi, M. M.; De Girolamo, G.; Vergori, A.; Cecchetto, M.; Viviani, F.; Madeddu, G.; De Vito, A.; Rossetti, B.; Montagnani, F.; Franco, A.; Fontana Del Vecchio, R.; Di Giuli, C.; Caramello, P.; Di Perri, G.; Bonora, S.; Orofino, G. C.; Sciandra, M.; Bassetti, M.; Londero, A.; Manfrin, V.; Battagin, G.; Starnini, G.; Ialungo, A

Human immunodeficiency virus continuum of care in 11 european union countries at the end of 2016 overall and by key population: Have we made progress?

Background. High uptake of antiretroviral treatment (ART) is essential to reduce human immunodeficiency virus (HIV) transmission and related mortality; however, gaps in care exist. We aimed to construct the continuum of HIV care (CoC) in 2016 in 11 European Union (EU) countries, overall and by key population and sex. To estimate progress toward the Joint United Nations Programme on HIV/AIDS (UNAIDS) 90-90-90 target, we compared 2016 to 2013 estimates for the same countries, representing 73% of the population in the region. Methods. A CoC with the following 4 stages was constructed: number of people living with HIV (PLHIV); proportion of PLHIV diagnosed; proportion of those diagnosed who ever initiated ART; and proportion of those ever treated who achieved viral suppression at their last visit. Results. We estimated that 87% of PLHIV were diagnosed; 92% of those diagnosed had ever initiated ART; and 91% of those ever on ART, or 73% of all PLHIV, were virally suppressed. Corresponding figures for men having sex with men were: 86%, 93%, 93%, 74%; for people who inject drugs: 94%, 88%, 85%, 70%; and for heterosexuals: 86%, 92%, 91%, 72%. The proportion suppressed of all PLHIV ranged from 59% to 86% across countries. Conclusions. The EU is close to the 90-90-90 target and achieved the UNAIDS target of 73% of all PLHIV virally suppressed, significant progress since 2013 when 60% of all PLHIV were virally suppressed. Strengthening of testing programs and treatment support, along with prevention interventions, are needed to achieve HIV epidemic control