Efficacy and safety of darunavir and etravirine in an antiretroviral multi-experienced youth with vertically HIV-1 infection

Multiclass-drug resistance, often caused by poor treatment compliance, is a challenging problem in all categories of HIV-infected patients. Selective pressure is higher in youth for both biological and behavioral reasons. We report the case of a 15-year-old Caucasian male, with vertically acquired HIV-1 infection, who failed several lines of antiretroviral therapy and was successfully treated with darunavir/ritonavir and etravirine

Apolarity, Hessian and Macaulay polynomials

A result by Macaulay states that an Artinian graded Gorenstein ring R of socle dimension one and socle degree b can be realized as the apolar ring of a homogeneous polynomial f of degree b. If R is the Jacobian ring of a smooth hypersurface g=0, then b is just equal to the degree of the Hessian polynomial of g. In this paper we investigate the relationship between f and the Hessian polynomial of g.Comment: 12 pages. Improved exposition, minor correction

Evolution of temperature, O3, CO, and N2O profiles during the exceptional 2009 Arctic major stratospheric warming as observed by lidar and mm-wave spectroscopy at Thule (76.5°N, 68.8°W), Greenland.

The 2009 Arctic sudden stratospheric warming (SSW) was the most intense event of this kind ever observed. Unique ground-based measurements of middle atmospheric profiles for temperature, O3, CO, and N2O obtained at Thule (76.5°N, 68.8°W), Greenland, in the period January – early March are used to show the evolution of the 2009 SSW in the region of its maximum intensity. The first sign of the SSW was detected at θ~2000 K on January 19, when a rapid decrease in CO mixing ratio took place. The first evidence of a temperature increase was observed at the same level on 22 January, the earliest date on which lidar measurements reached above ~50 km. The warming propagated from the upper to the lower stratosphere in 7 days and the record maximum temperature of 289 K was observed between 1300 and 1500 K potential temperature on 22 January. A strong vortex splitting was associated with the SSW. Stratospheric backward trajectories indicate that airmasses arriving to Thule during the warming peak underwent a rapid compression and an intense adiabatic warming of up to 50 K. The rapid advection of air from the extra-tropics was also occasionally observed to produce elevated values of N2O mixing ratio. Starting from mid-February the temperature profile and the N2O mixing ratio returned to the pre-warming values in the mid and upper stratosphere, indicating the reformation of the vortex at these levels. In late winter, vertical descent from starting altitudes of ~60 km is estimated from CO profiles to be 0.25±0.05 km/day

Impact on bone mineral density of tenofovir-containing HAART in HIV-1 infected children and adolescents: a report from 5 years of clinical experience

Purpose of the study Tenofovir disoproxil fumarate (TDF) is not approved for use in HIV-infected children (<18 years). In clinical practice a TAMs-sparing regimen may be needed. Use of TDF in children seems to be associated with decrease in bone mineral density that sometimes can stabilize after 24 weeks. The primary purpose was to characterized the change in bone mineral density (BMD), as measured by osteosonography (QUS), during and after treatment with tenofovir-containing HAART

Ten Years of Medical Informatics and Standards Support for Clinical Research in an Infectious Diseases Network

Background It is 30 years since evidence-based medicine became a great support for individual clinical expertise in daily practice and scientific research. Electronic systems can be used to achieve the goal of collecting data from heterogeneous datasets and to support multicenter clinical trials. The Ligurian Infectious Diseases Network (LIDN) is a web-based platform for data collection and reuse originating from a regional effort and involving many professionals from different fields. Objectives The objective of this work is to present an integrated system of ad hoc interfaces and tools that we use to perform pseudonymous clinical data collection, both manually and automatically, to support clinical trials. Methods The project comprehends different scenarios of data collection systems, according to the degree of information technology of the involved centers. To be compliant with national regulations, the last developed connection is based on the standard Clinical Document Architecture Release 2 by Health Level 7 guidelines, interoperability is supported by the involvement of a terminology service. Results Since 2011, the LIDN platform has involved more than 8,000 patients from eight different hospitals, treated or under treatment for at least one infectious disease among human immunodeficiency virus (HIV), hepatitis C virus, severe acute respiratory syndrome coronavirus 2, and tuberculosis. Since 2013, systems for the automatic transfer of laboratory data have been updating patients' information for three centers, daily. Direct communication was set up between the LIDN architecture and three of the main national cohorts of HIV-infected patients. Conclusion The LIDN was originally developed to support clinicians involved in the project in the management of data from HIV-infected patients through a web-based tool that could be easily used in primary-care units. Then, the developed system grew modularly to respond to the specific needs that arose over a time span of more than 10 years

Observations of surface radiation and stratospheric processes at Thule Air Base, Greenland, during the IPY

Ground-based measurements of atmospheric parameters have been carried out for more than 20 years at the Network for the Detection of Atmospheric Composition Change (NDACC) station at Thule Air Base (76.5°N, 68.8°W), on the north-western coast of Greenland. Various instruments dedicated to the study of the lower and middle polar atmosphere are installed at Thule in the framework of a long standing collaboration among Danish, Italian, and US research institutes and universities. This effort aims at monitoring the composition, structure and dynamics of the polar stratosphere, and at studying the Arctic energy budget and the role played by different factors, such as aerosols, water vapour, and surface albedo. During the International Polar Year (IPY), in winter 2008-2009, an intensive measurement campaign was conducted at Thule within the framework of the IPY project “Ozone layer and UV radiation in a changing climate evaluated during IPY” (ORACLE-O3) which sought to improve our understanding of the complex mechanisms that lead to the Arctic stratospheric O3 depletion. The campaign involved a lidar system, measuring aerosol backscatter and depolarization ratios up to 35 km and atmospheric temperature profiles from 25 to 70 km altitude, a ground-based millimeter-wave spectrometer (GBMS) used to derive stratospheric mixing ratio profiles of different chemical species involved in the stratospheric ozone depletion cycle, and then ground-based radiometers and a Cimel sunphotometer to study the Arctic radiative budget at the surface. The observations show that the surface radiation budget is mainly regulated by the longwave component throughout most of the year. Clouds have a significant impact contributing to enhance the role of longwave radiation. Besides clouds, water vapour seasonal changes produce the largest modification in the shortwave component at the surface, followed by changes in surface albedo and in aerosol amounts. For what concerns the middle atmosphere, during the first part of winter 2008-2009 the cold polar vortex allowed for the formation of polar stratospheric clouds (PSCs) which were observed above Thule by means of the lidar. This period was also characterized by GBMS measurements of low values of O3 due to the catalytic reactions prompted by the PSCs. In mid- January, as the most intense Sudden Stratospheric Warming event ever observed in the Arctic occurred, GBMS and lidar measurements of O3, N2O, CO and temperature described its evolution as it propagated from the upper atmosphere to the lower stratosphere

PIN92 Quality of Life Among Hiv Patients: Results from the Ianua Clinical Trial

OBJECTIVES To understand the relationship between socio-demographic variables, clinical factors, highly active anti-retroviral therapy (HAART) and health related quality of life (QoL) in HIV-infected individuals participants in the IANUA multicenter study. METHODS Data relating to patients with HIV infection admitted to 3 infectious disease units in Genoa (Italy) between 2012 and 2014 are collected and analyzed. Univariate and multivariate association of demographic and clinical factors with QoL (computed using EQ-5D-3L) are examined. QoL determinants are assessed using a tobit model, while a logistic model is implemented in order to investigate the relation between specific patients characteristics and the likelihood of having higher QoL. RESULTS Results of the empirical modeling suggest that being Italian and having a job are positively associate with QoL, whereas being a female, taking other drugs in addition to anti-retroviral drugs and being subsidisied are negatively related to QoL. Among clinical factors, CD4 cell count level cannot be considered as significant predictor of QoL, while higher QoL seem to be defined by single tablet regimens. CONCLUSION The study investigates the major determinants of QoL among HIV patients and the results provide some informative tools useful to improve strategies aiming at maximizing QoL. As monitoring of QoL is nowadays a priority for clinicians, further work will be based on \u201cdynamic\u201d analysis comparing QoL at the initial time and QoL at 6-months follow up

Dasabuvir and Ombitasvir/Paritaprevir/Ritonavir with or without Ribavirin in Patients with HIV-HCV Coinfection. Real Life Interim Analysis of an Italian Multicentre Compassionate Use Program

Background and Aims: An HCV cure is now possible in a large proportion of HIV-HCV patient. We present real life results of a compassionate use program promoted by SIMIT (Infectious and Tropical Diseases Italian Society) of Dasabuvir and Ombitasvir/Paritaprevir/Ritonavir ± Ribavirin for 12 weeks in 213 HIV-HCV genotype 1 patients. Data on efficacy and tolerability of this strategy in HIV patients have been reported until now only in 43 non cirrhotic HIV subjects

Pregnancy and neonatal outcomes among a cohort of HIV-infected women in a large Italian teaching hospital : a 30-year retrospective study

The primary study objective was to investigate three decades from 1985 to 2014 of changes in pregnancies among HIV-infected women. The secondary objective was to assess risk factors associated with preterm delivery and severe small-for-gestational-age (SGA) infants in HIV-infected women. A retrospective review of deliveries among pregnant HIV-infected women at the University of Genoa and IRCCS San Martino-IST in Genoa between 1985 and 2014 was performed. Univariate and multivariable analyses were used to study the variables associated with neonatal outcomes. Overall, 262 deliveries were included in the study. An increase in median age (26 years in 1985-1994 vs. 34 years in 2005-2014), in the proportion of foreigners (none in 1985-1994 vs. 27/70 (38\ub76%) in 2005-2014), and a decrease in intravenous drug use (75\ub72% (91/121) in 1985-1994 vs. 12\ub79% (9/70) in 2005-2014) among pregnant HIV-infected women was observed. Progressively, HIV infections were diagnosed sooner (prior to pregnancy in 80% (56/70) of women in the last decade). An increase in combined antiretroviral therapy (cART) prescription during pregnancy (50% (27/54) in 1995-2004 vs. 92\ub72% (59/64) in 2005-2014) and in HIV-RNA &lt;50 copies/ml at delivery (19\ub72% (5/26) in 1995-2004 vs. 82\ub73% (53/64) in 2005-2014) was observed. The rate of elective caesarean section from 1985 to 1994 was 9\ub71%, which increased to 92\ub73% from 2004 to 2015. Twelve (10\ub71%) mother-to-child transmissions (MTCT) occurred in the first decade, and six (8\ub73%) cases occurred in the second decade, the last of which was in 2000. Preterm delivery (&lt;37 weeks gestation) was 5% (6/121) from 1985 to 1994 and increased to 17\ub71% (12/70) from 2005 to 2014. In univariate and multivariable logistic regression analyses, advancing maternal age and previous pregnancies were associated with preterm delivery (odds ratio (OR) 2\ub77; 95% confidence intervals (CI) 1-7\ub78 and OR 2\ub76; 95% CI 1\ub71-6\ub77, respectively). In the logistic regression analysis, use of heroin or methadone was found to be the only risk factor for severe SGA (OR 3\ub71; 95% CI 1\ub74-6\ub78). In conclusion, significant changes in demographic, clinical and therapeutic characteristics of HIV-infected pregnant women have occurred over the last 30 years. Since 2000, MTCT has decreased to zero. An increased risk of preterm delivery was found to be associated with advancing maternal age and previous pregnancies but not with cART. The use of heroin or methadone has been confirmed as a risk factor associated with severe SGA