Catia Valdarchi

Differential impact of combined antiretroviral therapy on the survival of italian patients with specific AIDS-defining illnesses.

Background: A decrease in HIV‐related mortality and morbidity has been observed since 1996 in most developed countries as a consequence of the extensive use of combined antiretroviral therapies. The purpose of this study was to investigate whether combined antiretroviral therapies had a differential impact on the survival of patients with different AIDS‐defining illnesses (ADIs). Methods: In total, 35,318 persons representing all the adults with AIDS (PWAs) diagnosed in Italy from January 1, 1990 to August 31, 1998 were studied. Actuarial life tables and the Kaplan‐Meier method were used to estimate the cumulative probability of survival; the multivariate Cox proportional hazards model was used to estimate adjusted relative hazard of death (RH). Results: Among PWAs diagnosed after 1995, the proportion of survivors 24 months after diagnosis was more than doubled (66%) compared with that of PWAs diagnosed before the end of 1995 (31%). Significantly decreased RHs for some ADIs were observed as early as 1996 (i.e., esophageal candidiasis, Pneumocystis carinii pneumonia, brain toxoplasmosis, HIV‐wasting syndrome, and pulmonary tuberculosis). In the last period (1997‐1998), the decrease was marked and significant for almost all the ADIs, ranging from 55% to 80% compared with the RHs of the reference year (1995). Conversely, primary lymphoma of the brain and Burkitts lymphoma showed a low and not statistically significant decrease; these were the ADIs with the worst outcome. Conclusions: After 1995, there was a rather uniform increase in the survival of PWAs diagnosed with most specific ADIs but not for patients affected by primary brain lymphoma and Burkitts lymphoma. The determinants of this differential effect need to be investigated.

The effect of hepatitis C on progression to AIDS before and after highly active antiretroviral therapy.

Objectives: To assess the effect of infection with hepatitis C virus (HCV) on the progression of human immunodeficiency virus (HIV) disease, before and after the introduction of highly active antiretroviral therapy (HAART). Methods: We used data from a multi-centre prospective study of HIV seroconverters. Survival analyses were performed to compare the progression to AIDS by HCV serostatus in the period before HAART (i.e. June 1991–May 1996) and in the HAART era (i.e. June 1996–June 2001), controlling for duration of HIV infection. Results: Among the 1052 persons enrolled, 595 (56.6%) were co-infected; the median follow-up time was 9.7 years. Adjusting for demographic variables (age at HIV seroconversion and gender), HCV infection had no effect on the progression to AIDS in the pre-HAART era [relative hazard (RH) = 0.84; 95% confidence interval (CI), 0.63–1.11], whereas it increased the risk in the HAART era (RH = 1.77; 95% CI, 1.15–2.73). In the HAART era, the proportion of person-time spent on HAART out of the total time at risk was significantly lower among co-infected persons (30 versus 40% for non-co-infected persons; P-value = 0.001); no significant difference was found for dual-therapy (29 versus 25%, respectively; P-value = 0.205); a significant difference was found for mono-therapy (15 versus 8%, respectively; P-value < 0.001). Conclusions: HCV infection was not a determinant of HIV disease progression in the pre-HAART era, whereas since the introduction of HAART, co-infected individuals seem to have had a faster disease progression. This may in part be explained by differences in person-time spent on different antiretroviral regimens.

Viral causes of influenza-like illness: insight from a study during the winters 2004-2007.

Limited information is available on the viral etiology of influenza‐like illness in southern European countries, and it is still a matter of debate whether certain symptoms can be used to distinguish among the specific viruses that cause influenza‐like illness. The main objective of the present study was to identify the demographic and clinical predictors of influenza‐like illness due to specific viral agents. The study, which was observational in design, was conducted in Rome and Naples, Italy. Cases of influenza‐like illness were defined as individuals with fever >37.5°C and at least one systemic and one respiratory symptom, recruited during the winters of 2004–2005, 2005–2006, and 2006–2007. Influenza and other respiratory viruses were identified using the polymerase chain reaction (PCR), performed on throat swabs. Basic individual information was collected using a standard form. A total of 580 persons were included in the analysis. Viral pathogens were identified in fewer than 50% of the cases. Overall, 240 viral agents were detected: 22.8% were positive for influenza viruses, 10.9% for adenoviruses, 6.0% for parainfluenza viruses, and 1.7% for respiratory syncytial virus. The month of diagnosis, and muscle and joint pain were associated with influenza virus, though the positive predictive value (PPV) was low. Abdominal pain was associated with adenovirus infection. Although the PPV of symptoms for influenza virus infection was low, especially in low activity periods, these findings may help clinicians to improve their ability to perform diagnoses. J. Med. Virol. 81:2066–2071, 2009.

Identification of the novel KI polyomavirus in the respiratory tract of an Italian patient.

Recently, a new human polyomavirus, KIV, was detected in respiratory specimens of patients with acute respiratory tract infection. Whether this reflects a causal role of the virus in the respiratory tract is still debated. To investigate the presence of KIV in respiratory samples of Italian patients and to determine the degree of similarity with other known polyomaviruses, 222 respiratory specimens collected by general practitioners between 2006 and 2007 were screened. The entire VP1 gene region was amplified and sequenced. Maximum Likelihood tree was generated by PAUP* software. One out of 222 samples tested was positive for KIV. Phylogenetic analysis indicated that this isolate clustered with other KIV isolates, while the WUV isolates seem to belong to a different lineage. The phylogenetic tree also showed that all other known polyomaviruses are quite distant from this isolate. This is the first report describing the presence of KIV in the respiratory tract of a 5‐year‐old Italian child with acute respiratory symptoms. Further investigations are needed to establish an etiological link of KIV with acute respiratory illness. J. Med. Virol. 80:2012–2014, 2008.

response to Highly Active Antiretroviral Therapy According to Duration of Hiv Infection

Objective: To evaluate whether duration of HIV‐1 infection influences the response to highly active antiretroviral therapy (HAART). Design: Prospective study of individuals (Italian Seroconversion Study cohort) with well‐estimated dates of HIV‐1 seroconversion. Methods: This analysis included 277 participants who began HAART (defined as three antiretroviral drugs used in combination). Cox regression models were used to evaluate the association between duration of infection (as categorical variable [≤3, 3‐7.5, >7.5 years from seroconversion] or continuous variable) and an immunologic (rise in CD4 count >100 cells/mm3) and a virologic (decline in plasma HIV‐RNA to unquantifiable levels) outcome. All analyses were stratified by center of recruitment and adjustment, when used, was for gender, age at inception of HAART, injection drug use, previous antiretroviral therapy, lag‐time between positive and negative HIV test result, year of starting HAART, clinical stage, CD4 count, and HIV‐RNA at time of HAART. Results: HAART was initiated a median of 6.4 years after seroconversion. There was a median follow‐up of 1.6 years after starting HAART to the calendar cut‐off (November 1999). One‐hundred‐eighty‐one (65.3%) patients experienced a decline in viral load to below quantifiable levels and 184 (66.4%) experienced a rise in CD4 >100 cells/mm3. In the Cox models, by 1‐year increase in duration of infection, we estimated a lower crude hazard of achieving a CD4 count increase >100 cells (relative hazard [RH], 0.96; 95% confidence interval [CI], 0.92‐1.01; p = .09), and a lower hazard of reaching an unquantifiable level of plasma HIV‐RNA (RH, 0.97; 95%CI, 0.93‐1.02; p = .20). After adjustment, these values became 0.99 (95%CI, 0.93‐1.04; p = .62) and 0.98 (95%CI, 0.93‐1.04; p = .48), respectively. When duration of HIV infection was considered as a categorical variable, the results were consistent with those already described. Conclusions: These results suggest that the duration of HIV infection does not seem to play an important independent role in determining the virologic and immunologic responses to HAART.

Epidemiological investigation of a varicella outbreak in an Italian prison

Five cases of varicella occurred in a womens prison in Rome. A serosurvey conducted in the prison found that 14.5% of the inmates were susceptible. The sensitivity and positive predictive value of a history of varicella were high, whereas specificity was rather low. The attack rate among susceptible inmates was approximately 22%. Preventive measures probably contributed to reduce infection spread.

Diagnosis of HEV infection by serological and real-time PCR assays: a study on acute non-A-C hepatitis collected from 2004 to 2010 in Italy.

BackgroundThe impact of hepatitis E in developed countries, like Italy, still requires a clear definition. In the present study, we evaluated HEV infection in patients with acute non-A-C hepatitis by an approach comparing data from Real-time PCR and serological assays.MethodsIn a first analysis, sera from 52 patients hospitalized with a diagnosis of acute viral non-A-C hepatitis in Italy were tested by in-house Real-Time PCR assay for identification of Hepatitis E Virus (HEV) RNA and by anti-HEV IgM and IgG assays. In a subsequent analysis, selected samples were evaluated by additional IgM tests to confirm diagnosis.ResultsAmong the 52 samples, 21 showed positive results for all three markers (IgM, IgG and HEV RNA). One patient showed HEV RNA as single marker. Uncertain results were found in 8 samples while the remaining 22 were negative for all markers. Further analysis of the 8 undefined samples by additional IgM tests confirmed HEV infection in 1 patient. Overall, acute HEV infections were reliably identified in 23 (44.2%) out of 52 patients.ConclusionsIn the present paper, we performed a study evaluating HEV infection in 52 sporadic non-A-C acute hepatitis cases. All samples were collected from 2004 to 2010 in Italy. By a diagnostic strategy based on genomic and serological assays we identified HEV infections in 23 out of 52 patients (44.2%), a percentage higher than previous estimates. Thus, the actual impact of HEV infections in Italy needs to be further evaluated on a national scale by a diagnostic strategy based on multiple and last generation assays.

A national voice for information about HIV infections: The Italian state AIDS hot-line

Because of the variety of problems connected with the AIDS epidemic, there is an urgent need for qualified information and counselling. In June 1987, The Italian Ministry of Health established a hot-line, acting within the National AIDS Operational Centre. Through the analysis of more than 39,000 calls received during the first year of activity, a clear outline has been obtained of the emotional impact of the disease on Italian public opinion, and of the problems raised. 67% of callers belong to 20-39 age group; the male/female ratio is 2:1. Interesting correlations have been found between the content of the questions and the sex, age, and type of caller. The vast majority of questions concerning basic concepts and notions about HIV infections are asked by no-risk-related subjects. During the first year, the percentage of questions asked by subjects actually at risk increased, and the questions themselves have become more specific.

Seroprevalence of West Nile and dengue virus in the human population of the Bolivian Chaco: BARTOLONI et al.

To determine the seroprevalence of antibodies against dengue virus (DENV) and West Nile virus (WNV) in the human population of the Bolivian Chaco, we tested 256 inhabitants of two rural communities. The seroprevalence, confirmed by plaque reduction neutralization test, was 7.8% and 2.7% for DENV and WNV, respectively.