53 research outputs found
Abnormal elevation of international normalized ratio in a patient during the coadministration of elvitegravir/cobicistat/emtricitabine/tenofovir alafenamide and warfarin: a case report
No full textImpact of HIV-1 tropism on the emergence of non-AIDS events in HIV-infected patients receiving fully suppressive antiretroviral therapy
No full textObjective:The impact of HIV-1 tropism on the emergence of non-AIDS events was evaluated in a cohort of 116 antiretroviral therapy (ART) responder patients.Methods:The patients were followed for the emergence of hypertension, renal impairment, metabolic and bone disorders (defined as non-AIDS events) each 8 weeks at standard visits. A V3 plasma sequence genotype analysis was performed at the time of ART initiation and the geno2pheno algorithm with the results that defines the false-positive rate (FPR) was used to infer HIV tropism. The associations between the non-AIDS events and the FPR at baseline were evaluated using the chi(2) test for trend. A Cox-regression analysis using the counting process formulation of Andersen and Gill was performed to define whether the emergence of non-AIDS events was correlated to FPR.Results:The prevalence of at least one non-AIDS event resulted higher in patients with a FPR below 10% than in patients with a R5 virus (P = 0.033). Patients with a FPR below 5.0% most frequently developed non-AIDS events during ART (P = 0.01). A higher prevalence of patients with at least two AIDS events was found in the group of patients with a FPR below 5.0% with respect to the others (P < 0.001). At multivariate Cox-regression analysis, having an X4 virus and age were independently associated with a higher probability of non-AIDS event development.Conclusion:This study shows that an X4 virus, particularly a FPR less than 5%, is related to non-AIDS events development. Further studies are warranted to understand the mechanisms underlying this phenomenon
Hepatitis B reactivation characterized by HBsAg negativity and anti-HbsAg antibodies persistence in haematopoietic stem cell transplanted patient after lamivudine withdrawal
No full textHBV reactivation is associated with high mortality rates in hematopoietic stem cell transplantation (HSCT) and prophylactic lamivudine (LMV) treatment is suggested to prevent this phenomenon. However, the duration of LMV treatment in HSCT patients is not fully defined and the time of immune recovery is considered the best parameter for a drug to be safely interrupted. In patients undergoing allogeneic HSCT, the time of immune recovery is not easy to define and may take years after transplantation and prolonged LMV treatments, which can lead to drug-resistant viral strains
Cerebrospinal fluid HIV-1 escape according to different thresholds and underlying comorbidities: is it time to assess the definitions?
No full textNo consensus has been reached on how to define cerebrospinal fluid HIV-1 escape (CSF-E). We describe its prevalence in 1095 paired CSF-plasma HIV-RNA measurements from antiretroviral-treated patients according to several definitions and neurological affections. CSF-E prevalence varied substantially (9.0-38.9%) and was higher in patients with cerebrovascular disorders, HIV-associated dementia and white matter abnormalities. Considering the variability in HIV-RNA quantification assays, the biological relevance of viral escape at different thresholds needs to be accurately assessed
Role of pretreatment variables on plasma HIV RNA value at the sixth month of antiretroviral therapy including all first line drugs in HIV naïve patients: A path analysis approach
No full textWe investigated the conditioning roles of viral tropism and other variables on plasma HIV RNA levels after 6 months of combination antiretroviral therapy (cART) in an HIV-infected Italian naïve population using regression tree, random forest regression, and path analysis (PA). Patients in this multicenter observational study were treated with all antiviral drugs that are currently recommended as first-line therapies
18-Fluoro-2-deoxyglucose positron emission tomography–computed tomography: an additional tool in the diagnosis of prosthetic valve endocarditis
No full textSummaryObjectivesTo evaluate the role of 18-fluoro-2-deoxyglucose positron emission tomography–computed tomography (18F-FDG-PET–CT) in the diagnosis of infectious endocarditis (IE).MethodsWe retrospectively examined 27 consecutive patients who were admitted to the Infectious Diseases Department of Tor Vergata University Hospital between 2009 and 2013 with a suspicion of IE. The final IE diagnosis was defined according to the modified Duke criteria, and the microbiological and diagnostic results were collected for each patient.ResultsTwenty out of 27 patients had a suspected prosthetic valve endocarditis (PVE) and seven had a suspected native valve endocarditis (NVE). Twenty-five out of 27 patients (92%) had a confirmed diagnosis of IE (18/25 PVE and 7/25 NVE); 16 had a positive echocardiography evaluation and 16 had positive 18F-FDG-PET–CT findings. Echocardiography showed a higher sensitivity as a diagnostic tool for the detection of IE compared to 18F-FDG-PET–CT (80% vs. 55%). However, a greater number of PVE had positive 18F-FDG-PET–CT results compared to those with positive echocardiography findings (11/13 vs. 9/13), and overall 89% (16/18) of confirmed PVE resulted 18F-FDG-PET–CT positive. Analyzing only the cases who underwent transoesophageal echocardiography, 18F-FDG-PET–CT showed a sensitivity of 85% in PVE (vs. 69% for echocardiography and 77% for the Duke criteria). All seven patients with NVE had a positive echocardiography and negative 18F-FDG-PET–CT findings (p<0.001).ConclusionsThe results of this study further highlight the limitations of echocardiography in the diagnosis of PVE and the potential advantages of 18F-FDG-PET–CT in these cases
Structural equation modelling of viral tropism reveals its impact on achieving viral suppression within 6 months in treatment-naive HIV-1-infected patients after combination antiretroviral therapy
No full textTo evaluate the role of pre-treatment co-receptor tropism of plasma HIV on the achievement of viral suppression (plasma HIV RNA 1.69 log10 copies/mL) at the sixth month of combination antiretroviral therapy (cART) in a cohort of naive patients using, for the first time in this context, a path analysis (PA) approach
Infectious disease ward admission positively influences P. jiroveci pneumonia (PjP) outcome: A retrospective analysis of 116 HIV-positive and HIV-negative immunocompromised patients
No full textP. jiroveci (Pj) causes a potentially fatal pneumonia in immunocompromised patients and the factors associated with a bad outcome are poorly understood. A retrospective analysis on Pj pneumonia (PjP) cases occurring in Tor Vergata University Hospital, Italy, during the period 2011-2015. The patients' demographic, clinical and radiological characteristics and the Pj genotypes were considered. The study population included 116 patients, 37.9% of whom had haematological malignancy or underwent haematological stem cell transplantation (HSCT), 22.4% had HIV infection, 16.4% had chronic lung diseases (CLD), 7.8% had a solid cancer, and 3.4% underwent a solid organ transplant (SOT). The remaining 12.1% had a miscellaneous other condition. At univariate analysis, being older than 60 years was significantly correlated with a severe PjP (OR [95%CI] 2.52 [0.10-5.76]; p = 0.031) and death (OR [95%CI] 2.44 [1.05-5.70]; p = 0.036), while a previous trimethoprim/sulfamethoxazole (TMP/SMX) prophylaxis were significantly associated with a less severe pneumonia (OR[95%CI] 0.35 [0.15-0.84], p = 0.023); moreover, death due to PjP was significantly more frequent in patients with CLD (OR[95%CI] 3.26 [1.17-9.05]; p = 0.019) while, admission to the Infectious Diseases Unit was significantly associated with fewer deaths (OR[95%CI] 0.10 [0.03-0.36], p = 0.002). At multivariate analysis, a better PjP outcome was observed in patients taking TMP/SMX prophylaxis and that were admitted to the Infectious Diseases Unit (OR[95%CI] 0.27 [0.07-1.03], p = 0.055, OR[95%CI] 0.16 [0.05-0.55]; p = 0.004, respectively). In conclusion, in our study population, TMP/SMX prophylaxis and infectious disease specialist approach were variables correlated with a better PjP outcome
Structural-equation-modelling of the tropism impact on achieving viral suppression within six months in naïve HIV patients.
No full textDengue Virus Dynamic and Persistence in Body Fluids of Infected Patients in Italy, 2018-2023
No full textDengue, a mosquito-borne disease caused by the dengue virus (DENV), is constantly expanding worldwide. We investigated the presence and persistence of DENV RNA in the bloodstream and other body fluids to describe the viral kinetics in the human host. We longitudinally collected serum (n = 118), plasma (n = 110), whole blood (n = 90), urine (n = 118), oral swabs (n = 68), saliva (n = 42), semen (n = 23), and vaginal fluids (n = 49) from 42 DENV patients. We measured DENV RNA for a median of 28 (range 1-63) days from symptom onset (DSO). We estimated the probability of viral detection applying a generalized linear model, and the duration of viremia using Monte Carlo-Markov Chain approach. In the bloodstream, the highest rate of positivity, levels of DENV RNA, and persistence were observed in whole blood. The estimated probability of a positive test dropped below 5% after 12.5, 20.7, and 35.4 DSO for plasma, serum, and whole blood, respectively. The average duration of viremia was estimated to be 19.9 DSO. Saliva and oral swabs showed 76.2% and 58.8% of DENV RNA positivity during the first week of symptoms while the longest persistence was observed in urine (39 DSO). DENV was revealed in 20% cervicovaginal (up to 11 DSO) and 30% seminal (up to 35 DSO) fluids. Whole blood represents the preferential specimen for dengue molecular detection and the correct estimation of viremia duration which have clear implications for onward transmission and public health countermeasures. Blood, urine, and oral samples can be assayed according to time from disease onset, severity, and screening purposes
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