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1. Real-life efficacy and satisfaction of long-acting ART Cabotegravir-Rilpivirine in HIV-infected individuals

Author

S. Spampinato, A. Saia, Y. Russotto, C. Micali, A. Marino, M. Ceccarelli, E. Venanzi Rullo, G. Pellicanò, and G. Nunnari

Subjects
hiv, cabotegravir, rilpivirine, art, long-acting, Infectious and parasitic diseases, RC109-216
Abstract

OBJECTIVE: Switching from oral anti-retroviral therapy (ART) to intramuscular administration of Cabotegravir-Rilpivirine (CAB+RPV) has been observed to decrease the number of pills that patients need to take, enhance patient satisfaction, and promote better adherence to treatment. Clinical trials have reported not only the virological and immunological effectiveness of these intramuscular medications but have also assessed their safety and patient satisfaction. This transition eliminates the challenges related to patient adherence and compliance with daily oral regimens. PATIENTS AND METHODS: Our observational study included 14 people living with HIV (PLWH) who were under medical care at the “Gaetano Martino” University Hospital in Messina, Italy. These individuals were virologically suppressed and had been adherent to ART for at least 6 months. Importantly, they did not have documented or suspected resistance mutations to Cabotegravir + Rilpivirine (CAB+RPV). Data were collected at different time points: at the beginning of the study, one month after the lead-in phase with oral CAB+RPV, and one month after the first and second injections of CAB+RPV. Additionally, we routinely measured CD4+, CD8+, CD4+/CD8+ ratio, HIV-RNA plasma viral load, and clinical chemistry parameters. Statistical analysis was performed with Jamovi 2.0 for MacOS. Patient treatment satisfaction was assessed through a questionnaire, where we formulated and administered a series of questions to our patients to gauge their satisfaction with the intramuscular administration of these long-acting medications. Specifically, we asked them a simple question to determine whether they were satisfied or dissatisfied with the new method of administering CAB+RPV. RESULTS: In our study, we enrolled 14 individuals living with HIV (PLWH), predominantly males (92.9%), with a median age of 36 years (IQR: 30.25-39.75). Of these participants, 85.7% had transitioned from an integrase strand transfer inhibitor (INSTI)-based regimen, 7.1% from a non-nucleoside reverse transcriptase inhibitor (NNRTI)-based regimen, and 7.1% from a protease inhibitor (PI)-based regimen. Notably, HIV-RNA remained undetectable throughout the assessment period. Following the first intramuscular (IM) injection, 78.5% reported moderate to severe pain, decreasing to 57.1% after the second injection. While not statistically significant, we observed a positive trend in CD4+ percentage (p=0.641) and CD4/CD8 ratio (p=0.368), with a non-significant decrease in CD4+ T-cell count (p=0.882). The transition to IM CAB+RPV did not significantly impact low-density lipoprotein cholesterol (LDLc) levels (p=0.417). When questioned about satisfaction with the new treatment regimen, 71.4% of PLWH expressed contentment with the injectable regimen, while 21.4% chose not to respond. CONCLUSIONS: People living with HIV (PLWH) who were on long-acting ART (LA-ART) with CAB+RPV expressed satisfaction with their new treatment regimen, and viral load remained undetectable in all cases. Pain, as reported in clinical trials, emerged as the primary side effect. Our real-life experience affirmed the virological and immunological effectiveness, safety, and patient satisfaction associated with long-acting ART using CAB+RPV.

Published
2023
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2. Statins and aspirin in the prevention of cardiovascular disease among HIV-positive patients between controversies and unmet needs: review of the literature and suggestions for a friendly use

Author

P. Maggi, G. V. De Socio, S. Cicalini, M. D’Abbraccio, G. Dettorre, A. Di Biagio, C. Martinelli, G. Nunnari, S. Rusconi, L. Sighinolfi, V. Spagnuolo, and N. Squillace

Subjects
Statins, Aspirin, HIV, Cardiovascular disease, Antiplatelet agents, Oral anticoagulants, Immunologic diseases. Allergy, RC581-607
Abstract

Abstract Background As in non-infected subjects, statins and aspirin have a pivotal preventive role in reducing the cardiovascular related morbidity and mortality in HIV infected patients. The persistence of immune activation in these subjects, could contribute to accelerate atherosclerosis, therefore, these treatments that reduce inflammation could provide additional cardiovascular protection. However the current guidelines for the use of these drugs in general population are dissimilar, with important differences between American and European ones. Aim of the present position paper is to provide recommendations aimed to overcome the actual differences and limitations among the current ones and to adapt them to the needs of HIV infected patients. Results We propose to adopt the new ACC/AHA guidelines, simple to use and cost effective, to use the ASCVD score that seems to estimate more accurately the cardiovascular risk among these patients. We suggest to start statin therapy in all patients with a calculated 10-year risk of a cardiovascular event of 10% or greater. Rosuvastatin and atorvastatin should be preferred. LDL-C target may be adopted. Aspirin should be always associated with a statin, in secondary prevention, while in primary prevention it should be reserved only to patients with ≥ 20% 10-year risk particularly adherent to treatments, and with low risk of bleeding. We suggest to start with a dose of 100 mg/day. Finally, management of antiplatelet agents or novel oral anticoagulants may include selecting antiretrovirals with a lower potential for drug interactions or choosing agents least likely to interact with antiretrovirals. Conclusions As demonstrated in surveys, HIV physicians are generally highly committed regarding CVD and autonomous in prescribing statins and ASA. Consequently, in the light of the previously discussed discrepancies among the different guidelines and of the incomplete indications regarding HIV-positive persons, the present suggestions could overcome the actual differences and limitations among the current ones.

Published
2019
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3. Epstein Barr Virus related cancer in people living with HIV: a review of the literature

Author

F. D’Andrea, E. Venanzi Rullo, A. Facciolà, M. Di Rosa, F. Condorelli, A. Marino, B. Cacopardo, G. Pellicanò, G. Nunnari, and M. Ceccarelli

Subjects
ebv, hiv, cancer, tumorigenesis, burkitt’s lymphoma, hodgkin’s lymphoma, non- hodgkin’s lymphoma, nasopharyngeal carcinoma, Neoplasms. Tumors. Oncology. Including cancer and carcinogens, RC254-282
Abstract

The introduction of Highly Active Antiretroviral Therapy (HAART) has modified the natural history of Human Immunodeficiency Virus (HIV) infection, leading to an increase in the life expectancy of the patients living with HIV (PLWH). Similar to other oncogenic viruses, EBV increases the risk of developing cancer in immune-depressed hosts, including HIV-infected people. The adherence to anti-retroviral therapy (ART) is important in the management of cancer in HIV-positive patients even if ART has a less favorable impact on EBV related tumors if compared with its impact on AIDS-defining cancers. This review is focused on the epidemiology, pathogenesis, diagnosis, management and therapy of EBV-associated tumors in the setting of HIV infection.

Published
2020
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4. Hepatitis B virus infection and hepatocellular carcinoma in PLWH: epidemiology, pathogenesis and treatment

Author

F. D’Andrea, E. Venanzi Rullo, A. Marino, V. Moscatt, B. Celesia, B. Cacopardo, F. Condorelli, G. La Rocca, M. Di Rosa, G. Pellicanò, G. Nunnari, and M. Ceccarelli

Subjects
hiv, hbv, b hepatitis, cancer, liver, hcc, Neoplasms. Tumors. Oncology. Including cancer and carcinogens, RC254-282
Abstract

Combined Antiretroviral therapy altered the natural history of Human Immunodeficiency Virus (HIV) infection, leading to a substantial decline in morbidity and mortality of patients living with HIV. Due to the shared transmission routes, co-infection with HBV and HIV is not uncommon, especially in those patients with similar socioeconomic vulnerabilities and psycho-social conditions. HBV is a known cause of HCC even in absence of cirrhosis, and HIV-HBV-coinfected patients may have faster progression of hepatic fibrosis and a higher risk of cirrhosis and consequently HCC. In this article we review the epidemiology, the etiology, the role of coinfection HIV/HBV in the pathogenesis of liver cancer, the management and prevention of HBV infection in HIV-infected patients in the era of combined antiretroviral treatment.

Published
2020
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5. Vaccines against HPV in people living with HIV: a review

Author

F. D’Andrea, M. Ceccarelli, E. Venanzi Rullo, A. Facciolà, A. Marino, B. Cacopardo, G. Pellicanò, and G. Nunnari

Subjects
human immunodeficiency virus (hiv), human papilloma virus (hpv), vaccination, safety, efficacy, cancer, adverse effects, Neoplasms. Tumors. Oncology. Including cancer and carcinogens, RC254-282
Abstract

Human Papilloma Virus (HPV) infection represents the most common sexually transmitted infection worldwide. The best weapon to control the HPV infection is the primary prevention that includes interventions related to lifestyle and sexual habits and HPV-vaccination. HPV vaccination must be recommended not only for young girls, but also for boys, MSM and HIV-infected people. People Living with HIV (PLWHA) have high rates of persistent HPV infection if compared with HIV-uninfected people. Several data from HIV negative population have confirmed vaccine safety and efficacy, but there is limited data available on the efficacy of the vaccine among HIV-infected people. In this review, we considered the studies published about anti-HPV vaccination in PLWHA that we found performing a research on PUBMED (Bethesda, MD, USA) with the aim to point out the main aspects of vaccination in this particular population.

Published
2019
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6. Anal cancer in people living with HIV: the importance of the screening and of early diagnosis

Author

F. d’Aleo, M. Ceccarelli, E. Venanzi Rullo, A. Facciolà, F. d’Andrea, C. Micali, M. Coco, M. Pinzone, E. Focà, F. Condorelli, I. Picerno, G. Visalli, B. Cacopardo, G. Nunnari, and G. Pellicanò

Subjects
anal cancer, plwh, hiv, art, hpv, screening, Neoplasms. Tumors. Oncology. Including cancer and carcinogens, RC254-282
Abstract

HIV-positive patients suffer from higher cancer-related mortality compared to the general population. Anal cancer (AC) is considered as a rare form of neoplasm, accounting for 4% of all cancers of the lower gastrointestinal tract in the general population. Approximately 88% of AC cases are associated with human papillomavirus (HPV) infection. This paper purpose is the diagnostic and therapeutic management of AC in HIV infect people.

Published
2019
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7. Hodgkin’s lymphoma in people living with HIV: epidemiology and clinical management

Author

A. Facciolà, E. Venanzi Rullo, M. Ceccarelli, F. d’Aleo, F. D’Andrea, G. Visalli, M. Pinzone, I. Picerno, B. Cacopardo, F. Condorelli, G. Madeddu, G. Nunnari, and G. Pellicanò

Subjects
hiv-associated hodgkin’s lymphoma, Neoplasms. Tumors. Oncology. Including cancer and carcinogens, RC254-282
Abstract

e1295-Hodgkin’s lymphoma in people living with HIV- epidemiology and clinical managementAfter the introduction of combination Antiretroviral Therapy (cART), survival of people living with HIV/AIDS (PLWH) has improved, bringing to the appearance of new health problems. Among these problems, there is an increased risk to develop malignancies. Hodgkin’s lymphoma (HL) is a curable malignancy, suspected to be associated with Epstein-Barr Virus (EBV) infection. Median age of HL incidence in PLWHs is 30 years, after approximately 7 and a half years from the HIV infection diagnosis. HL is significantly more frequent in PLWHs than in the general population. As a matter of fact, the incidence of this disease is 8-fold higher than the general population during the pre-cART era, and the difference worsened, reaching a 13-fold higher incidence during the cART era. Early diagnosis is crucial. The detection of cancer in an early stage improves the outcome of patients, indeed. The aim of this paper was to review the epidemiological characteristics and the diagnostic and therapeutic management of HL in HIV infected patients.

Published
2019
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8. Cervical cancer in women living with HIV: a review of the literature

Author

F. D’Andrea, G. Pellicanò, E. Venanzi Rullo, F. d’Aleo, A. Facciolà, C. Micali, M. Coco, G. Visalli, I. Picerno, F. Condorelli, M. Pinzone, B. Cacopardo, G. Nunnari, and M. Ceccarelli

Subjects
cervical cancer, human immunodeficiency virus (hiv), human papilloma virus (hpv), screening, vaccination, Neoplasms. Tumors. Oncology. Including cancer and carcinogens, RC254-282
Abstract

The introduction of ART had a significant impact on PWLH survival. The incidence of AIDS-defining cancers has decreased, but the risk is still higher than general population. Women living with HIV have a high prevalence of HPV infection and related disease, including cervical cancer. HIV-related risk factors, such as immunodeficiency and chronic persistence of infection play an important role in its pathogenesis. HPV vaccine, screening and early antiretroviral therapies, are recommended to reduce the risk of developing cervical cancer. In this review, we considered the studies published about cervical cancer in PLWHA that we found performing a research on PUBMED (Bethesda MD, USA) with the following research terms “Papillomavirus”, “Cervical Cancer”, “HIV infection”, “Screening”, “Vaccination” with the aim to point out the main aspects of cervical cancer in HIV infected women, its management and prophylaxis.

Published
2019
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10. FEM and ANN combined approach for predicting pressure source parameters at Etna volcano

Author

A. Di Stefano, G. Currenti, C. Del Negro, L. Fortuna, and G. Nunnari

Subjects
Science, Physics, QC1-999, Geophysics. Cosmic physics, QC801-809
Abstract

A hybrid approach for forward and inverse geophysical modeling, based on Artificial Neural Networks (ANN) and Finite Element Method (FEM), is proposed in order to properly identify the parameters of volcanic pressure sources from geophysical observations at ground surface. The neural network is trained and tested with a set of patterns obtained by the solutions of numerical models based on FEM. The geophysical changes caused by magmatic pressure sources were computed developing a 3-D FEM model with the aim to include the effects of topography and medium heterogeneities at Etna volcano. ANNs are used to interpolate the complex non linear relation between geophysical observations and source parameters both for forward and inverse modeling. The results show that the combination of neural networks and FEM is a powerful tool for a straightforward and accurate estimation of source parameters in volcanic regions.

Published
2010
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11. Denoising gravity and geomagnetic signals from Etna volcano (Italy) using multivariate methods

Author

C. Del Negro, F. Greco, R. Napoli, and G. Nunnari

Subjects
Science, Physics, QC1-999, Geophysics. Cosmic physics, QC801-809
Abstract

Multivariate methods were applied to denoise the gravity and geomagnetic signals continuously recorded by the permanent monitoring networks on the Etna volcano. Gravity and geomagnetic signals observed in volcanic areas are severely influenced by meteorological variables (i.e. pressure, temperature and humidity), whose disturbances can make the detection of volcanic source effects more difficult. For volcano monitoring it is necessary, therefore, to reduce the effects of these perturbations. To date filtering noise is a very complex problem since the spectrum of each noise component has wide intervals of superposition and, some times, traditional filtering techniques provide unsatisfactory results. We propose the application of two different approaches, the adaptive neuro-fuzzy inference system (ANFIS) and the Independent Component Analysis (ICA) to remove noise effects from gravity and geomagnetic time series. Results suggest a good efficiency of the two proposed approaches since they are capable of finding and effectively representing the underlying factors or sources, and allow local features of the signal to be detected.

Published
2008

12. Inversion of SAR data in active volcanic areas by optimization techniques

Author

G. Nunnari, G. Puglisi, and F. Guglielmino

Subjects
Science, Physics, QC1-999, Geophysics. Cosmic physics, QC801-809
Abstract

The inversion problem concerns the identification of parameters of a volcanic source causing observable changes in ground deformation data recorded in volcanic areas. In particular, this paper deals with the inversion of ground deformation measured by using SAR (Synthetic Aperture Radar) interferometry and an inversion approach formulated in terms of an optimization problem is proposed. Based on this inversion scheme, it is shown that the problem of inverting ground deformation data in terms of a single source, of Mogi or Okada type, is numerically well conditioned. In the paper, two case studies of inverting actual SAR data recorded on Mt. Etna during eruptions occurring in 1998 and 2001 are investigated, showing the suitability of the proposed technique.

Published
2005

14. Intravenous Immunoglobulin Therapy When Plasmapheresis Fails in Thrombotic Thrombocytopenic Purpura Associated with Severe ADAMTS 13 Deficiency in Childhood: A Case Report

Author

P. Pavone, E. Passaniti, R. Taibi, M.R. Longo, G. Nunnari, A. Verrotti, A. Serra, R. Falsaperla, and S. Cocuzza

Subjects
Medicine
Abstract

Thrombotic thrombocytopenic purpura (TTP) is a disorder of the blood-coagulation system, causing extensive microscopic clots to form in the small blood vessels throughout the body. TTP is quite a rare pathology in childhood, being more frequent among adults. Often it is hardly to distinguish from other haematological pathologies in children both for its uncommon incidence and for the presence of clinical forms that are heterogeneous and difficult to classify. We report the case of an 11-year-old girl suffering from TTP, in whom the study of metallo-protease ADAMST 13 showed a low value (

Published
2013
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15. Impact of the COVID-19 pandemic on HPV vaccination coverage in the general population and in PLWHs

Author

S, D'Amato, G, Nunnari, G, Trimarchi, A, Squeri, A, Cancellieri, R, Squeri, and G F, Pellicanò

Subjects
Vaccination Coverage, Cross-Sectional Studies, Vaccine-Preventable Diseases, Papillomavirus Infections, Communicable Disease Control, Vaccination, Humans, COVID-19, Papillomavirus Vaccines, Pandemics, Retrospective Studies
Abstract

On March 11, 2020, the World Health Organization (WHO) has declared the novel coronavirus (COVID-19) outbreak as a global pandemic. COVID-19 pandemic has impacted health services, including immunization programs, with a consequent reduction in vaccination coverage in those categories for which the prevention of vaccine-preventable diseases is strongly recommended.We conducted a retrospective cross-sectional study on the general population and on PLWHs, comparing anti-human papillomavirus (HPV) vaccination coverage data in 2019, before COVID-19 pandemic, and the 2020 data, after the announcement of the pandemic state and the lockdown and the implementation of restrictive measures to contain the contagion.Compared to 2019, 2020 data show a 42% reduction in HPV vaccine coverage in the general population and 36% in PLWHs. The greatest reduction in anti-HPV vaccination coverage occurred during periods of greatest restriction and mainly concerned the general population.The prevention of vaccine-preventable diseases remains essential. Above all, it is essential to increase and recover the anti-HPV vaccine coverage, in consideration of the data that show its preventive oncological efficacy.

Published
2022

17. HBcAb Positivity Increases the Risk of Severe Hepatic Fibrosis Development in HIV/HCV-Positive Subjects from the ICONA Italian Cohort of HIV-Infected Patients

Author

Malagnino, Vincenzo, Cerva, Carlotta, Cingolani, Antonella, Ceccherini-Silberstein, Francesca, Vergori, Alessandra, Cuomo, Gianluca, Perno, Carlo Federico, Puoti, Massimo, d'Arminio Monforte, Antonella, Cozzi-Lepri, Alessandro, Andreoni, Massimo, Sarmati, Loredana, d’Arminio Monforte (President), Icona Fundation Study Group. Board of Directors: A., Antinori (Vice-President), 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., d’Arminio Monforte, P. Viale. Scientific Secretary: A., Antinori, A., Ceccherinisilberstein, F., Cozzi-Lepri, A., Girardi, E., Gori, A., Lo Caputo, S., Maggiolo, F., Mussini, C., Puoti, M., Antinori, C. F. Perno. Steering Committee: A., Bai, F., Bandera, A., Bonora, S., Borderi, M., Calcagno, A., Capobianchi, M. R., Ceccherini-Silberstein, F., Cicalini, S., Cingolani, A., Cinque, P., d’Arminio Monforte, A., Di Biagio, A., Gagliardini, R., Gianotti, N., Guaraldi, G., Lapadula, G., Lichtner, M., Lai, A., Madeddu, G., Marchetti, G., Merlini, E., Nozza, S., Perno, C. F., Piconi, S., Pinnetti, C., Quiros Roldan, E., Rossotti, R., Rusconi, S., Santoro, M. M., Saracino, A., Sarmati, L., Spagnuolo, V., Svicher, V., Taramasso, L., Cozzi-Lepri, Statistical and Monitoring Team: A., Fanti, I., Galli, L., Lorenzini, P., Rodanó, A., Macchia, M., Bove, A. Tavelli. Community Advisory Board: A., Camposeragna, A., Errico, M., Manfredini, M., Perziano, A., Carletti, V. Calvino. Biological Bank INMI: F., Carrara, S., Di Caro, A., Graziano, S., Petroni, F., Prota, G., Giacometti, S. Truffa. Participating Physicians and Centers: Italy: A., Costantini, A., Barocci (Ancona), V., Angarano, G., Monno, L., Milano (Bari), E., F. Maggiolo, C. Suardi (Bergamo), Viale, P., Donati, V., Verucchi (Bologna), G., Castelnuovo, F., Minardi, C., Quiros Roldan (Brescia), E., B. Menzaghi, C. Abeli (Busto Arsizio), L. Chessa, F. Pes (Cagliarti), B. Cacopardo, B. Celesia (Catania), J. Vecchiet, K. Falasca (Chieti), A. Pan, S. Lorenzotti (Cremona), L. Sighinolfi, D. Segala (Ferrara), P. Blanc, F. Vichi (Firenze), Cassola, G., Bassetti, M., Alessandrini, A., Bobbio, N., Mazzarello (Genova), G., M. Lichtner, L. Fondaco (Latina), P. Bonfanti, C. Molteni (Lecco), A. Chiodera, P. Milini (Macerata), G. Nunnari, G. Pellicanò (Messina), Rizzardini, G., Cannizzo, E. S., Moioli, M. C., Piolini, R., Bernacchia, D., Poli, A., Tincati (Milano), C., C. Mussini, C. Puzzolante (Modena), C. Migliorino, G. Lapadula (Monza), Sangiovanni, V., Borgia, G., Esposito, V., Di Flumeri, G., Gentile, I., Rizzo (Napoli), V., A. M. Cattelan, S. Marinello (Padova), A. Cascio, M. Trizzino (Palermo), D. Francisci, E. Schiaroli (Perugia), G. Parruti, F. Sozio (Pescara), C. Lazzaretti, R. Corsini (Reggio Emilia), Cristaudo, A., Vullo, V., Acinapura, R., Lamonica, S., Capozzi, M., Mondi, A., Rivano Capparuccia, M., Iaiani, G., Latini, A., Onnelli, G., Plazzi, M. M., De Girolamo, G., Vergori (Roma), A., M. Cecchetto, F. Viviani (Rovigo), G. Madeddu, A. De Vito (Sassari), B. Rossetti, F. Montagnani (Siena), A. Franco, R. Fontana Del Vecchio (Siracusa), Di Giuli (Terni), C., Caramello, P., Orofino, G. C., Sciandra (Torino), M., Londero (Udine), A., V. Manfrin, G. Battagin (Vicenza), G. Starnini, A. Ialungo (Viterbo)., Malagnino, V, Cerva, C, Cingolani, A, Ceccherini-Silberstein, F, Vergori, A, Cuomo, G, Perno, C, Puoti, M, D'Arminio Monforte, A, Cozzi-Lepri, A, Andreoni, M, Sarmati, L, Malagnino, V., Cerva, C., Cingolani, A., Ceccherini-Silberstein, F., Vergori, A., Cuomo, G., Perno, C. F., Puoti, M., D'Arminio Monforte, A., Cozzi-Lepri, A., Andreoni, M., Sarmati, L., ICONA Foundation Study, Group, Castagna, A., Malagnino V., Cerva C., Cingolani A., Ceccherini-Silberstein F., Vergori A., Cuomo G., Perno C.F., Puoti M., D'Arminio Monforte A., Cozzi-Lepri A., Andreoni M., and Sarmati L.A Castagna, F Castelli, R Cauda, G Di Perri, M Galli, R Iardino, G Ippolito, A Lazzarin, G C Marchetti, G Rezza, F von Schloesser, E Girardi, A Gori, S Lo Caputo, F Maggiolo, F Bai, A Bandera, S Bonora, M Borderi, A Calcagno, M R Capobianchi, S Cicalini, P Cinque, A Di Biagio, R Gagliardini, N Gianotti, G Guaraldi, G Lapadula, M Lichtner, A Lai, S Lo Caputo, G Madeddu, G Marchetti, E Merlini, C Mussini, S Nozza, S Piconi, C Pinnetti, E Quiros Roldan, R Rossotti, S Rusconi, M M Santoro, A Saracino, V Spagnuolo, V Svicher, L Taramasso, I Fanti, L Galli, P Lorenzini, A Rodanó, M Macchia, A Tavelli, A Bove, A Camposeragna, M Errico, M Manfredini, A Perziano, V Calvino, F Carletti, S Carrara, A Di Caro, S Graziano, F Petroni, G Prota, S Truffa, A Giacometti, A Costantini, V Barocci, G Angarano, L Monno, E Milano, C Suardi, V Donati, G Verucchi, F Castelnuovo, C Minardi, B Menzaghi, C Abeli, L Chessa, F Pes, B Cacopardo, B Celesia, J Vecchiet, K Falasca, A Pan, S Lorenzotti, L Sighinolfi, D Segala, P Blanc, F Vichi, G Cassola, M Bassetti, A Alessandrini, N Bobbio, G Mazzarello, M Lichtner, L Fondaco, P Bonfanti, C Molteni, A Chiodera, P Milini, G Nunnari, G Pellicanò, , G Rizzardini, E S Cannizzo, M C Moioli, R Piolini, D Bernacchia, A Poli, C Tincati, C Puzzolante, C Migliorino, G Lapadula, V Sangiovanni, G Borgia, V Esposito, G Di Flumeri, I Gentile, V Rizzo, A M Cattelan, S Marinello, A Cascio, M Trizzino, D Francisci, E Schiaroli, G Parruti, F Sozio, C Lazzaretti, R Corsini, A Antinori, A Cristaudo, V Vullo, R Acinapura, S Lamonica, M Capozzi, A Mondi, M Rivano Capparuccia, G Iaiani, A Latini, G Onnelli, M M Plazzi, G De Girolamo, M Cecchetto, F Viviani, G Madeddu, A De Vito, B Rossetti, F Montagnani, A Franco, R Fontana Del Vecchio, C Di Giuli, P Caramello, G C Orofino, M Sciandra, A Londero, V Manfrin, G Battagin, G Starnini, A Ialungo

Subjects
HBsAg, medicine.medical_specialty, Hepatitis C virus, Liver fibrosis, Human immunodeficiency virus (HIV), OBI, medicine.disease_cause, anti-HBc, HBV, HIV/HBV coinfection, liver fibrosis, Gastroenterology, Major Articles, NO, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, medicine, Hiv infected patients, 030212 general & internal medicine, Hepatitis B virus, business.industry, liver fibrosi, virus diseases, Settore MED/17, digestive system diseases, Anti-HBc, HIV-HBV coinfection, HBV, Liver fibrosis, OBI, Infectious Diseases, AcademicSubjects/MED00290, HIV-HBV coinfection, Oncology, Cohort, 030211 gastroenterology & hepatology, business, Hepatic fibrosis
Abstract

Background 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 naïve to antiretroviral treatment (ICONA). Methods All patients with FIB-4 Results Patients who were HBcAb+/HCV-/HBs antigen (HBsAg)- and HCV+/HBcAb+/HBsAg- or HBsAg+/HBcAb+/HCV- had CD4+ cell counts below the nadir and significantly higher prevalence of AIDS diagnosis at baseline than the other groups (P < .0001). A Cox regression model adjusted for age, HIV transmission mode, country of birth, and alcohol consumption showed a higher relative risk (HR) of progression to FIB-4 >3.25 in HCV+/HBcAb+/HBsAg- patients (HR, 7.2; 95% CI, 3 8–13.64). Conclusions HBcAb+ contributes to liver damage in HIV+/HCV+/HBcAb+/HBsAg- subjects. A careful monitoring for signs of previous HBV infection is needed in this kind of patients.

Published
2021

19. In the face of the SARS-CoV-2 outbreak, do people suffering from oncological disease need specific attention?

Author

M G, Carta, G, Orrù, A, Scano, F, Coghe, G, Nunnari, G, Facchini, F G, Numis, and M, Berretta

Subjects
SARS-CoV-2, Pneumonia, Viral, COVID-19, Hematology, Medical Oncology, Orthomyxoviridae, Disease Outbreaks, Betacoronavirus, Severe acute respiratory syndrome-related coronavirus, Neoplasms, Surveys and Questionnaires, Humans, Attention, Original Article, Seasons, Coronavirus Infections, Pandemics
Abstract

Influenza virus infections (IVI) may pose a vital threat to immunocompromised patients such as those suffering from malignancies, but specific data on epidemiology and outcome in these patients are scarce. In this study, we collected data on patients with active cancer or with a history of cancer, presenting with documented IVI in eight centres in Germany. Two hundred and three patients were identified, suffering from haematological malignancies or solid tumours; 109 (54 %) patients had active malignant disease. Influenza A was detected in 155 (77 %) and Influenza B in 46 (23 %) of patients (genera not determined in two patients). Clinical symptoms were consistent with upper respiratory tract infection in 55/203 (27 %), influenza-like illness in 82/203 (40 %), and pneumonia in 67/203 (33 %). Anti-viral treatment with oseltamivir was received by 116/195 (59 %). Superinfections occurred in 37/203 (18 %), and admission on an intensive care unit was required in 26/203 (13 %). Seventeen patients (9 %) died. Independent risk factors for death were delayed diagnosis of IVI and bacterial or fungal superinfection, but not underlying malignancy or ongoing immunosuppression. In conclusion, patients with IVI show high rates of pneumonia and mortality. Early and rapid diagnosis is essential. The high rate of pneumonia and superinfections should be taken into account when managing IVI in these patients.

Published
2020

20. Switching from TDF to TAF or dual therapy (DT)-based regimens in HIV-infected individuals with viral load <= 50 copies/ml: does eGFR matter?

Author

Vergori, A, Gagliardini, R, Gianotti, N, Gori, A, Lichtner, M, Saracino, A, A De Vito, Cascio, A, A Di Biagio, A d'Arminio Monforte, Antinori, A, A Cozzi-Lepri on behalf of the ICONA Foundation Study Network, Giacometti, A., Costantini, A., Barocci, V., Angarano, G., Monno, L., Milano, E., F. Maggiolo, C. Suardi, Viale, P., Donati, V., Verucchi, G., Castelnuovo, F., Minardi, C., Quiros Roldan, E., B. Menzaghi, C. Abeli, L. Chessa, F. Pes, B. Cacopardo, B. Celesia, J. Vecchiet, K. Falasca (Chieti), A. Pan, S. Lorenzotti, Sighinolfi, L., Segala, Daniela, P. Blanc, F. Vichi, Cassola, G., Bassetti, M., Alessandrini, A., Bobbio, N., Mazzarello, G., M. Lichtner, L. Fondaco (Latina), P. Bonfanti, C. Molteni, A. Chiodera, P. Milini, G. Nunnari, G. Pellicanò, d’Arminio Monforte, A., Galli, M., Lazzarin, A., Rizzardini, G., Puoti, M., Castagna, A., Cannizzo, E. S., Moioli, M. C., Piolini, R., Bernacchia, D., Poli, A., Tincati, C., Mussini, C., Puzzolante, C., C. Migliorino, G. Lapadula, Sangiovanni, V., Borgia, G., Esposito, V., Di Flumeri, G., Gentile, I., Rizzo, V., A. M. Cattelan, S. Marinello, A. Cascio, C. Colomba, D. Francisci, E. Schiaroli, G. Parruti, F. Sozio, C. Lazzaretti, R. Corsini, Andreoni, M., Antinori, A., Cauda, R., Cristaudo, A., Vullo, V., Acinapura, R., Lamonica, S., Capozzi, M., Mondi, A., Cingolani, A., Rivano Capparuccia, M., Iaiani, G., Latini, A., Onnelli, G., Plazzi, M. M., De Girolamo, G., Vergori, A., M. Cecchetto, F. Viviani, G. Madeddu, A. De Vito, B. Rossetti, F. Montagnani, A. Franco, R. Fontana Del Vecchio, Di Giuli, C., Caramello, P., Di Perri, G., Bonora, S., Orofino, G. C., Sciandra, M., C. Tascini, A. Londer, V. Manfrin, G. Battagin, and G. Starnini, A. Ialungo

Subjects
HIV, Tenofovir alafenamide, Tenofovir disoproxil fumarate, Antiretroviral therapy, eGFR, Dual therapy, Dual therapy, Tenofovir disoproxil fumarate, eGFR, HIV, Tenofovir alafenamide, NO, Antiretroviral therapy
Published
2020

21. Non-AIDS defining cancers: a comprehensive update on diagnosis and management

Author

M, Ceccarelli, E, Venanzi Rullo, M A, Marino, F, d'Aleo, G F, Pellicanò, F, D'Andrea, A, Marino, B, Cacopardo, B M, Celesia, G, La Rocca, M, Di Rosa, F, Condorelli, M, Berretta, and G, Nunnari

Subjects
PLWH, Prostate cancer, Hodgkin's lymphoma, Hepatocellular carcinoma, HIV, HIV Infections, Colorectal cancer, CRC, People living with HIV, Breast cancer, Neoplasms, Humans, Lung cancer, HCC
Abstract

The increasing incidence of chronic pathologies and especially non-AIDS defining cancers, such as lung cancer, hepatocellular carcinoma, breast cancer, colorectal cancer, prostate cancer, and Hodgkin's lymphoma after the introduction of combined antiretroviral therapy requires the infectious diseases specialist to know how and when to suspect and diagnose cancer in people living with HIV. The aim of this review is to provide updated studies and information about non-AIDS defining cancers and their management in PLWH sheading a light on possible futures scenarios.

Published
2020

22. Patologie virali tropicali (Flavivirus, Filovirus, Arenavirus, Bunyavirus, Togavirus: Chikungunya

Author

G. Borgia, G. B. Gaeta, I. gentile, N. Coppola, L. Alessio, G. Angarano, S. Babudieri, A. Bartoloni, F. Borgia, F. Borrelli, G. Brancaccio, A. R. Buonomo, B. S. Cacopardo, A. Cascio, C. Contini, S. Esposito, M. Fasano, M. Foggia, M. Gatti, V. Gentile, M. Macera, A. E. Maraolo, A. Marino, C. M. Mastroianni, C. Mussini, G. Nunnari, L. Onorato, M. Pacenti, G. F. Pellicanò, B. Pinchera, G. Pipitone, M. A. Pisaturo, C. Sagnelli, T. A. Santantonio, A. Santoro, A. Saracino, M. Spaziante, M. Spinicci, M. Stanzione, G. Stornaiuolo, G. Taliani, G. Tosone, C. Torti, P. Viale, L. Zammarchi, E. Zappulo, G. Borgia, G.B. Gaeta, I. Gentile, N. Coppola, Borgia, G., Gaeta, G. B., Gentile, I., Coppola, N., Alessio, L., Angarano, G., Babudieri, S., Bartoloni, A., Borgia, F., Borrelli, F., Brancaccio, G., Buonomo, A. R., Cacopardo, B. S., Cascio, A., Contini, C., Esposito, S., Fasano, M., Foggia, M., Gatti, M., Gentile, V., Macera, M., Maraolo, A. E., Marino, A., Mastroianni, C. M., Mussini, C., Nunnari, G., Onorato, L., Pacenti, M., Pellicanò, G. F., Pinchera, B., Pipitone, G., Pisaturo, M. A., Sagnelli, C., Santantonio, T. A., Santoro, A., Saracino, A., Spaziante, M., Spinicci, M., Stanzione, M., Stornaiuolo, G., Taliani, G., Tosone, G., Torti, C., Viale, P., Zammarchi, L., and Zappulo, E.

Published
2019

23. The unwelcome trio: HIV plus cutaneous and visceral leishmaniasis

Author

Georgi Tchernev, Claudio Guarneri, Valentina Bevelacqua, G. Nunnari, and Torello Lotti

Subjects
0301 basic medicine, medicine.medical_specialty, business.industry, Treatment regimen, First line, 030106 microbiology, Human immunodeficiency virus (HIV), Dermatology, General Medicine, medicine.disease, Delayed diagnosis, medicine.disease_cause, 03 medical and health sciences, Visceral leishmaniasis, Immunology, Coinfection, medicine, Vector (molecular biology), business, Intensive care medicine
Abstract

Leishmania/Human Immunodeficiency Virus (HIV) coinfection has emerged as an extremely serious and increasingly frequent health problem in the last decades. Considering the insidious and not typical clinical picture in presence of immunosuppressive conditions, the increasing number of people travelling in endemic zones, the ability to survive, within both human and vector bodies, of the parasite, clinicians and dermatologists as the first line should be aware of these kind of "pathologic alliances," to avoid delayed diagnosis and treatment. In this setting, the occurrence of cutaneous lesions can, paradoxically, aid the physician in recognition and approaching the correct staging and management of the two (or three) diseases. Treatment of these unwelcome synergies is a challenge: apart from the recommended anti-retroviral protocols, different anti-leishmanial drugs have been widely used, according with the standard guidelines for visceral leishmaniasis (VL), with no successful treatment regimen still been established.

Published
2015

24. Longitudinal proviral sequencing provides a window into selection pressures exerted on infected cells and provides an upper bound estimate of proviral half-lives which are influenced by expression and splicing potential

Author

Una O'Doherty, M.P. Bertuccio, M. Ceccarelli, J. Van Belzen, G. Nunnari, S. Weissman, LaMont Cannon, E. Venanzi-Rullo, and Marilia Rita Pinzone

Subjects
Epidemiology, Immunology, Public Health, Environmental and Occupational Health, Window (computing), Computational biology, Biology, Microbiology, Upper and lower bounds, QR1-502, Expression (mathematics), Infectious Diseases, Virology, RNA splicing, Public aspects of medicine, RA1-1270, Selection (genetic algorithm)
Published
2019

25. Kaposi’s sarcoma in HIV-infected patients in the era of new antiretrovirals

Author

A, Facciolà, E, Venanzi Rullo, M, Ceccarelli, F, D'Aleo, M, Di Rosa, M R, Pinzone, F, Condorelli, G, Visalli, I, Picerno, R, Fisichella, G, Nunnari, and G F, Pellicanò

Subjects
Kaposi’s sarcoma, HAART, Kaposi’s sarcoma, KS, HIV, HHV8, ART, HAART, KS, Antiretroviral Therapy, Highly Active, Humans, HIV, HHV8, Antineoplastic Agents, HIV Infections, Sarcoma, Kaposi, ART
Abstract

Kaposi's Sarcoma (KS) is a multicentric angioproliferative cancer of endothelial cells (ECs) caused by Human Herpesvirus 8 (HHV8) characterized by clinical heterogeneity depending on the host immune conditions. Despite its incidence has dramatically decreased in developed countries after the introduction of Highly Active Antiretroviral Therapy (HAART), KS remains the most frequent tumor in HIV-infected patients worldwide. Clinical presentation varies from an indolent slowly progressive behavior, generally limited to the skin, to an aggressive and rapidly progressing disease. In more than 50% of cases, the skin lesions are often associated with a more or less important visceral involvement, particularly to the oral cavity and the gastrointestinal tract that are involved in 35% and 40% of cases respectively. A large number of treatments can be used both as local and as systemic therapy. Particularly, HAART represents the first treatment in patients with moderate lesions limited to skin, and it can be sufficient to reduce significantly the size of lesions and, often, the complete disappear in 35% of cases after 3-9 months of treatment. In case of a rapidly progressive disease with extensive cutaneous and/or visceral involvement systemic drugs are used such as the liposomal anthracyclines pegylated liposomal doxorubicin (PLD) and daunorubicin citrate liposome (DNX), the combined treatment adriamycin-bleomycin-vincristine (ABV) and bleomycin-vincristine (BV), Paclitaxel and Interferon-alfa. In patients with limited skin localization, the local treatment can play an important role. Local medical therapy is based on the use of alitretinoin, antineoplastic drugs vincristine, vinblastine and bleomycin and Sodium Tetradecyl Sulfate (STS). In addition to medical therapy, physical treatment, such as cryotherapy and radiotherapy, are also commonly used.

Published
2017

26. Switching regimens in virologically suppressed HIV-1-infected patients: evidence base and rationale for integrase strand transfer inhibitor (INSTI)-containing regimens

Author

Laura Waters, François Raffi, Stefan Esser, G Nunnari, and Ignacio Pérez-Valero

Subjects
0301 basic medicine, Oncology, medicine.medical_specialty, Sustained Virologic Response, 030106 microbiology, Medizin, Integrase inhibitor, HIV Infections, regimen switch, Tenofovir alafenamide, 03 medical and health sciences, chemistry.chemical_compound, 0302 clinical medicine, Abacavir, Internal medicine, Antiretroviral Therapy, Highly Active, medicine, Humans, Pharmacology (medical), 030212 general & internal medicine, HIV Integrase Inhibitors, Elvitegravir, business.industry, Health Policy, Cobicistat, integrase inhibitor, Raltegravir, virologically suppressed, Regimen, Infectious Diseases, Treatment Outcome, chemistry, Dolutegravir, HIV-1, business, medicine.drug
Abstract

In an era when most individuals with treated HIV infection can expect to live into old age, clinicians should proactively review their patients' current and future treatment needs and challenges. Clinical guidelines acknowledge that, in the setting of virological suppression, treatment switch may yield benefits in terms of tolerability, regimen simplification, adherence, convenience and long-term health considerations, particularly in the context of ageing. In this paper, we review evidence from six key clinical studies on switching virologically suppressed patients to regimens based on integrase strand transfer inhibitors (INSTIs), the antiretroviral class increasingly preferred as initial therapy in clinical guidelines. We review these studies and focus on the virological efficacy, safety, and tolerability of switching to INSTI-based regimens in suppressed HIV-positive individuals. We review the early switch studies SWITCHMRK and SPIRAL [assessing a switch from a ritonavir-boosted protease inhibitor (PI/r) to raltegravir (RAL)-containing regimens], together with data from STRATEGY-PI [assessing a switch to elvitegravir (EVG)-containing regimens; EVG/cobicistat (COBI)/emtricitabine (FTC)/tenofovir disoproxil fumarate (TDF) vs. remaining on a PI/r-containing regimen], STRATEGY-NNRTI [assessing a switch to EVG/COBI/FTC/TDF vs. continuation of a nonnucleoside reverse transcriptase inhibitor (NNRTI) and two nucleoside reverse transcriptase inhibitors (NRTIs)], STRIIVING [assessing a switch to a dolutegravir (DTG)-containing regimen (abacavir (ABC)/lamivudine (3TC)/DTG) vs. staying on the background regimen], and GS study 109 [assessing a switch to EVG/COBI/FTC/tenofovir alafenamide fumarate (TAF) vs. continuation of FTC/TDF-based regimens]. Switching to INSTI-containing regimens has been shown to support good virological efficacy, with evidence from two studies demonstrating superior virological efficacy for a switch to EVG-containing regimens. In addition, switching to INSTI regimens was associated with improved tolerability and greater reported patient satisfaction and outcomes in some studies. INSTI-based regimens offer an important contemporary switch option that may be tailored to meet and optimize the needs of many patients.

Published
2016

27. Integrated HIV DNA accumulates more rapidly in non-controllers than controllers

Author

Una O'Doherty, Stephen A. Migueles, G. Nunnari, E. Graf, Marilia Rita Pinzone, Frederick Hecht, L. Lynch, and B. McLaughlin

Subjects
Infectious Diseases, Epidemiology, Virology, Immunology, Public Health, Environmental and Occupational Health, Public aspects of medicine, RA1-1270, Biology, Microbiology, QR1-502
Published
2015

28. Tetanus immunity in construction workers in Italy

Author

Venerando Rapisarda, G. Nunnari, Margherita Ferrante, Caterina Ledda, and Massimo Bracci

Subjects
Adult, Male, medicine.medical_specialty, Adolescent, media_common.quotation_subject, Immigration, Construction workers, Tetanus Antitoxin, Logistic regression, Occupational safety and health, Young Adult, Clostridium tetani, Environmental health, Occupational Exposure, Tetanus Toxoid, Medicine, Humans, Occupational Health, media_common, Tetanus, business.industry, Medicine (all), Public health, Environmental and Occupational Health, Construction Industry, Vaccination, Public Health, Environmental and Occupational Health, Age Factors, Odds ratio, Immigrant, Italy, Vaccine, Cross-Sectional Studies, Educational Status, Middle Aged, Immunization, medicine.disease, Confidence interval, Immunology, Public Health, business
Abstract

Background Tetanus is a serious vaccine-preventable disease that remains a significant health risk in certain occupations. Since 2006, Italy has reported the highest number of cases in Europe. Some professions, such as construction workers, are more exposed to tetanus. Aims To evaluate tetanus immunity status and associated factors in construction workers in Italy. Methods A cross-sectional study of construction workers attending for periodic occupational health surveillance at one site in Italy between September 2011 and January 2013. Serum tetanus antitoxin levels were measured and analysed according to demographic and clinical variables. Results All 5275 workers attending for health surveillance between September 2011 and January 2013 agreed to participate. Protective tetanus antitoxin levels (>0.1 IU/ml) were found in 4116 workers (78%). Multivariate logistic regression analysis suggested that the following risk factors were significantly associated with inadequate immunization status: older age (age >58 years, odds ratio [OR] 1.78, 95% confidence intervals [CIs] 1.76-1.84), poor education (no formal education: OR 3.74, 95% CI: 3.69-3.78), unskilled work tasks (OR 2.71, 95% CI: 2.67-2.77) and country of origin (Egypt: OR 1.72, 95% CI: 1.67-1.77; Morocco: OR 1.69, 95% CI: 1.62-1.76). Conclusions In this study, a significant proportion of construction workers in Italy were not adequately immunized against tetanus, as required by Italian law. Occupational health professionals should promote and implement vaccination campaigns, especially among migrant workers, for public health and legal reasons.

Published
2014

29. Lung cancer in HIV positive patients: the GICAT experience

Author

A, Bearz, E, Vaccher, F, Martellotta, M, Spina, R, Talamini, A, Lleshi, B, Cacopardo, G, Nunnari, M, Berretta, and U, Tirelli

Subjects
Adult, Male, Lung Neoplasms, Time Factors, Anti-HIV Agents, Antineoplastic Agents, HIV Infections, Chemoradiotherapy, Kaplan-Meier Estimate, Middle Aged, HIV Long-Term Survivors, Treatment Outcome, Italy, Risk Factors, Antiretroviral Therapy, Highly Active, Cause of Death, Health Care Surveys, Surveys and Questionnaires, Humans, Female, Karnofsky Performance Status, Pneumonectomy, Aged
Abstract

AIDS incidence and mortality have decreased since the introduction of highly active antiretroviral therapy (HAART) into clinical practice. HIV-related malignancies, namely Kaposi's sarcoma and Non-Hodgkin's lymphoma, have decreased, whereas non-AIDS defining tumors have been increasing. Our aim was to study the impact of HAART on natural history of lung cancer in HIV-positive patients, comparing patients with HIV-lung cancer treated in the pre-HAART era versus the HAART era.We collected 68 patients with HIV-lung cancer diagnosed from 1986 to 2003. Pre-HAART era included 34 patients who did not receive HAART, whereas the HAART era included 34 patients diagnosed after January 1997 who received HAART.At diagnosis Performance Status (PS) was significantly different, patients with PS ≥ 2 were 44% in the pre-HAART era, versus 29% in the post-HAART era, p = 0.02. The 79.4% of patients in the post-HAART era received chemotherapy alone or with radiotherapy versus 47% in the pre-HAART era, p = 0.04. Cancer was the leading cause of death for both groups, with 29 (85.3%) and 21 (61.8%) patients in the pre- and post-HAART settings, respectively. The median overall survival (OS) was 3.8 months for the pre-HAART population vs. 7 months for the post-HAART patients, p = 0.01.HIV-lung cancer patients have a longer overall survival in the post-HAART era versus the pre-HAART era, due to a not detrimental effect of chemotherapy and positive effect of HAART. Lung cancer is the leading cause of death, showing that treatment of the cancer is the most important target now to improve their outcome.

Published
2014

30. Model Order Reduction Techniques with Applications in Electrical Engineering

Author

L. Fortuna, G. Nunnari, A. Gallo, L. Fortuna, G. Nunnari, and A. Gallo

Subjects
Control engineering, Engineering mathematics, Engineering—Data processing, Engineering design
Abstract

Model Order Reduction Techniqes focuses on model reduction problems with particular applications in electrical engineering. Starting with a clear outline of the technique and their wide methodological background, central topics are introduced including mathematical tools, physical processes, numerical computing experience, software developments and knowledge of system theory. Several model reduction algorithms are then discussed. The aim of this work is to give the reader an overview of reduced-order model design and an operative guide. Particular attention is given to providing basic concepts for building expert systems for model reducution.

Published
2012

31. Acoustic Radial Force Impulse as an effective tool for a prompt and reliable diagnosis of hepatocellular carcinoma - preliminary data

Author

L, Rizzo, G, Nunnari, M, Berretta, and B, Cacopardo

Subjects
Carcinoma, Hepatocellular, Liver Neoplasms, Elasticity Imaging Techniques, Humans
Abstract

ARFI (Acoustic Radiation Force Impulse) is a novel method based on the use of shear acoustic waves remotely induced by the radiation force of a focused ultrasonic beam. Recently, ARFI has been investigated as a non-invasive method for the assessment of liver fibrosis. The reproducibility of ARFI technology was proved in determining liver fibrosis: in detail, for cirrhosis Fibroscan had its best cut-off at/= 11 kPa (AUROC of 0.80) whereas ARFI/= 2.0 m/s (AUROC of 0.89). By pair-wise comparison of AUROC, ARFI was significantly more accurate than TE for a diagnosis of significant and severe fibrosis. Due to the low amount of collagen deposition within hepatocellular carcinoma (HCC) nodules in a context of "hard" cirrhotic parenchyma, ARFI propose itself also as a novel, specific method for an early identification of primitive neoplastic nodules during the follow up of cirrhotic patients. The diagnostic accuracy can be demonstrated either versus the surrounding liver tissue or versus dysplastic or metastatic nodules. Further studies are required to confirm ARFI as a useful tool for HCC follow-up.

Published
2012

32. CLUSTERING OF INFRASONIC EVENTS AS TOOL TO DETECT AND LOCATE EXPLOSIVE ACTIVITY AT MT. ETNA VOLCANO

Author

G. Nunnari, D. Patanè, P. Montalto, A. Cannata, and E. Privitera

Subjects
geography, Amplitude, geography.geographical_feature_category, Explosive material, Volcano, Etna volcano, Infrasound, Genetic algorithm, k-means clustering, Cluster analysis, Geology, Seismology, Remote sensing
Abstract

Active volcanoes characterized by open conduit conditions effectively generate sonic and infrasonic signals, whose investigation provides useful information for both monitoring purposes and study of the dynamics of explosive phenomena. At Mt. Etna volcano (Italy) a clustering algorithm based on spectral features and amplitude of the infrasonic events was developed. It allows to recognize the active vent with no location algorithm and by using only one station. Moreover, a waveform inversion procedure was coded, based on genetic algorithm, that enables us to quantitatively investigate the infrasound source parameters.

Published
2010

33. Clearance of HCV RNA following acute hepatitis A superinfection

Author

Bruno Cacopardo, G. Nunnari, and L. Nigro

Subjects
Male, viruses, Hepatitis C virus, Remission, Spontaneous, Disease, Hepacivirus, medicine.disease_cause, Hepatitis A Antibodies, Peripheral blood mononuclear cell, Virus, HCV, HAV, Superinfection, Young Adult, medicine, Humans, Interferon gamma, Hepatology, Interferon-gamma production, medicine.diagnostic_test, business.industry, Gastroenterology, Alanine Transaminase, Bilirubin, gamma-Glutamyltransferase, Hepatitis A, Hepatitis C, Chronic, Virology, Liver, Liver biopsy, Immunology, Cytokines, RNA, Viral, business, medicine.drug
Abstract

A transient reduction of hepatitis C virus replication during the course of acute hepatitis A virus infection has already been reported in the literature. The present study reports the case study of a subject with chronic hepatitis due to hepatitis C virus who went on to develop an acute hepatitis A. From the early onset of acute disease, hepatitis C virus ribonucleic acid became undetectable. Following recovery from acute hepatitis, alanine amino-transferase levels became persistently normal and liver biopsy revealed a reduction in the Knodell histological activity index score. Hepatitis C virus ribonucleic acid clearance was maintained up to 4 years after the onset of acute hepatitis A. During the course of the acute disease, a sharp increase in interferon gamma levels was detected in serum and in the supernatant of both unstimulated and phytoemagglutinin/lipopolysaccharide-stimulated peripheral blood mononuclear cells. Interferon gamma levels were still high 3 months later. We hypothesize that acute hepatitis A virus superinfection during the course of chronic hepatitis C may lead to hepatitis C virus ribonucleic acid clearance through an immunological mechanism related to interferon gamma production.

Published
2007

34. On-line induction motor drive diagnostic and control by expert systems

Author

A. Consoli, Luigi Fortuna, and G. Nunnari

Subjects
Data acquisition, Computer science, Control system, Control (management), Control engineering, Line (text file), computer.software_genre, Application software, computer, Expert system, Induction motor
Published
2005

35. Synthesis of a greenhouse climate controller using AI-based techniques

Author

G. Nunnari and L. Occhipinti

Subjects
Fuzzy electronics, Nonlinear system, Engineering, Temperature control, Neuro-fuzzy, Control theory, business.industry, MIMO, Greenhouse, Control engineering, business, Intelligent control, Physics::Atmospheric and Oceanic Physics
Abstract

The methodology proposed in the paper deals with the use of artificial intelligence techniques in the modeling and control of some climate variables within a greenhouse. The nonlinear physical phenomena governing the dynamics of temperature and humidity on such systems are, in fact, difficult to be modelled and controlled using traditional techniques. The paper propose a framework for the development of a multi-input-multi-output (MIMO) fuzzy logic controller (FLCs) in modern greenhouses.

Published
2002

36. On the σ-reciprocal system for model order reduction

Author

G. Muscato and G. Nunnari

Subjects
Reduction (complexity), Model order reduction, Approximation theory, Singular perturbation, Truncation, Linear system, Mathematical analysis, Sigma, Reciprocal, Mathematics
Abstract

In this paper the definition of the /spl sigma/-reciprocal system is introduced. This allow one to show that the generalized singular perturbation approximation method for model reduction is related to the direct truncation of the /spl sigma/-reciprocal system. Based on this definition two new model order reduction algorithms are presented. The suitability of the proposed reduction methods is illustrated by means of two numerical examples. >

Published
2002

37. A Neural Prediction Model for the Maximum Daily Ozone Concentration

Author

G. Nunnari and A. Nucifora

Subjects
Pollutant, chemistry.chemical_compound, Petrochemical, Ozone, chemistry, Ground Level Ozone, Cloud cover, Environmental science, Nitrogen dioxide, Tropospheric ozone, Atmospheric sciences, Wind speed
Abstract

Tropospheric Ozone has been recognised as a harmful pollutant since it accumulates when the natural equilibrium between ozone and nitrogen dioxide is altered due to the presence of air pollutants (e.g. volatile compounds) in presence of high values of the solar radiation and with the contribution of not favourable meteo-climatic conditions (low wind speed, opaque cloud cover etc) [1]. In this paper we present some results concerning the modelling of Ozone time series in an area characterised by a high density of petrochemical plants. In order to handle the difficulties which arise in identifying non-linear systems with traditional techniques, neural networks are used to build 1-day-ahead prediction models.

Published
2002

38. Acute non A-E hepatitis in eastern Sicily: the natural history and the role of hepatitis G virus

Author

B, Cacopardo, G, Nunnari, A, Berger, H W, Doer, and R, Russo

Subjects
Adult, Male, Hepatitis, Viral, Human, Humans, Female, GB virus C, Sicily, Retrospective Studies
Abstract

The etiology and the natural history of acute non A-E hepatitis is still undefined.We examined the prevalence of HGV viraemia and the long-term outcome in 54 patients with non A-E acute hepatitis.HGV-RNA was found in 19 out of 54 (35%) patients. There was no difference between HGV-RNA positives and negatives in terms of age sex, parenteral risk factors and alanine amino-transferase peak level. Gamma-glutamyl transpeptidase levels were higher in the HGV-RNA positive group. During a 3-year follow up, 10 out of 54 (18.5%) patients progressed to chronic hepatitis and 4 out of 10 (40%) had an histologically advanced disease. None of the 19 subjects infected with HGV showed a chronic evolution of liver disease.Our results confirm the limited role of HGV as the etiological agent of non A-E acute hepatitis. The great majority of non A-E hepatitis cases are yet of undetermined origin and unfortunately, are characterized by a high rate of progression to chronic active hepatitis.

Published
2001

39. Introduction

Author

L. Fortuna, G. Nunnari, and A. Gallo

Published
1992

40. Model Reduction

Author

L. Fortuna, G. Nunnari, and A. Gallo

Published
1992

41. Measurements of Ground Movement on Mount Etna, Sicily: A Systematic Plan to Record Different Temporal and Spatial Components of Ground Movement Associated with Active Volcanism

Author

Pierre Briole, Jean-Claude Ruegg, Giuseppe Puglisi, G. Nunnari, R. Gaulon, Laboratoire de géologie de l'ENS (LGENS), Institut national des sciences de l'Univers (INSU - CNRS)-Centre National de la Recherche Scientifique (CNRS)-Département des Géosciences - ENS Paris, École normale supérieure - Paris (ENS Paris), Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-École normale supérieure - Paris (ENS Paris), Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL), Institut de Physique du Globe de Paris (IPGP), Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut national des sciences de l'Univers (INSU - CNRS)-IPG PARIS-Université Paris Diderot - Paris 7 (UPD7)-Université de La Réunion (UR)-Centre National de la Recherche Scientifique (CNRS), Department of Electrical, Istituto Nazionale di Geofisica e Vulcanologia, and Institut de Physique du Globe de Paris

Subjects
geography, geography.geographical_feature_category, 010504 meteorology & atmospheric sciences, Levelling, business.industry, Plan (archaeology), Tiltmeter, Volcanism, 010502 geochemistry & geophysics, Geodesy, 01 natural sciences, Lava tube, Volcano, 13. Climate action, Global Positioning System, [SDU.STU.VO]Sciences of the Universe [physics]/Earth Sciences/Volcanology, business, Trilateration, Seismology, ComputingMilieux_MISCELLANEOUS, 0105 earth and related environmental sciences
Abstract

Several techniques are being used on Mount Etna, to record ground movements. A network of automatic tiltmeters has been installed to record rapid ground movements associated both with the sudden changes in volcanic activity (that may occur over a time period of a few days) and the long-term deformation component. Tilt changes that occur over long time periods are recorded by repeated relevelling of short lines, using a standard levelling technique. Short aperture levelling lines have also been sited near some tiltmeters, so that we will be able to record both short-term and long-term changes in ground movements at several locations on Etna. Such information also allows us to validate the data recorded by automatic tiltmeters. Horizontal strain is recorded by making repeated trilateration surveys, using the global positioning system (GPS) to measure ground movements on Etna while electronic distance measurements (EDM) are performed whenever it was possible to compare the precision of the GPS and EDM techniques. Our first comparison shows that these two methods agree at about the 2 ppm level.

Published
1992

44. An improved back propagation algorithm topredict episodes of poor air quality.

Author

G. Nunnari

Abstract

This paper deals with the problem of modelling air pollution time series recorded at a given point by using a multi-layer perceptron based approach. In particular it is shown that the traditional back propagation (BP) algorithm, widely considered in the literature for this kind of application, can be improved to predict episodes of poor air quality. A novel version of the BP algorithm is developed and its performance is compared with that of the traditional algorithm in a case study which refers to the modelling of 1 h average maximum daily ozone concentration recorded in the industrial area of Melilli (Siracusa, Italy). The results obtained so far indicate that the proposed algorithm outperforms the traditional BP algorithm. [ABSTRACT FROM AUTHOR]

Published
2006
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45. Modelling air pollution time-series by using wavelet functions and genetic algorithms.

Author

G. Nunnari

Subjects
AIR pollution, GENETIC algorithms, WAVELETS (Mathematics)
Abstract

This paper proposes a novel approach based on the use of wavelet functions to model air pollution time series. One peculiarity of the approach is that of combining the use of wavelets and genetic algorithms to search for the best wavelet parameters. A case study, referring to the modelling of daily averages of SO 2 time series recorded in the industrial area of Syracuse (Italy) is reported in order to compare the performance of a wavelet-based prediction model and a Multi-layer perceptron neural model. The results obtained show that there are no significant differences between the neural and the wavelet approach in terms of model performance and computational effort. There is however an appreciable advantage in using the proposed wavelet-based technique in terms of model readability. [ABSTRACT FROM AUTHOR]

Published
2004
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46. Reduction of Serum Melatonin Levels in HIV-1-Infected Individuals' Parallel Disease Progression: Correlation with Serum Interleukin-12 Levels.

Author

G. Nunnari, L. Nigro, F. Palermo, D. Leto, R. J. Pomerantz, and B. Cacopardo

Subjects
HIV, SERUM, MELATONIN, CELLULAR immunity
Abstract

Background: During the natural history of human immunodeficiency virus type I (HIV-1) infection, an impairment of interleukin-12 (IL-12) production precedes a switch from a T-helper 1 (Th1) to a T-helper 2 (Th2) stage of cellular immunity. Melatonin, the main hormone produced by the pineal gland, seems to promote a Th1 response by increasing the production of IL-12 in vitro. The aim of this study was to measure and correlate serum levels of melatonin and IL-12 in a cohort of HIV-1-infected individuals. Patients and Methods: 77 anti-HIV-1-positive subjects were enrolled: 20 were in CDC stage A, 25 in CDC stage B and 32 in CDC stage C. 30 healthy HIV-1-seronegative subjects were recruited as controls. IL-12 and melatonin concentrations were quantitated in serum samples. Results: Mean levels of serum melatonin were significantly lower in HIV-1-infected individuals in comparison with controls (p < 0.001). Within the HIV-1-seropositive group, mean melatonin and IL-12 concentrations were significantly lower in patients in CDC stage C, as compared with patients in CDC stages B and A (p < 0.01). Conclusion: During the natural history of HIV-1 disease, serum melatonin levels are progressively reduced. This reduction may be related to the impairment of Th1 immunoresponses. [ABSTRACT FROM AUTHOR]

Published
2003

48. Toward a medical prolepsis by chronobiology

Author

B, Tarquini, C, Amaducci, M, Benvenuti, R, Branchi, M, Buffoni, A, Cariddi, V, Cavallini, M, Cecchettin, P, Cinelli, R, De Cristofaro, M, Legnaioli, A, Markiewicz, V, Martinelli, G, Nunnari, A, Pieri, A C, Santoro, I, Taddei, and M, Cagnoni

Subjects
Risk, Periodicity, Arteriosclerosis, Fibrinolysis, Lipoproteins, Smoking, Thyrotropin, Models, Biological, Circadian Rhythm, Prolactin, Reference Values, Humans, Disease, Female, Fibrocystic Breast Disease
Abstract

Medicine today strongly aims at prevention and optimization of diagnosis and therapy Studies tried staging and standardization of clinical trials in diseases and made search of markers for early diagnosis, prognosis and therapy. Moreover, risk factors and other variables such as predictors are now investigated more often in groups or populations of apparently healthy subjects, especially for such diseases as atherosclerosis and neoplasia. This new aspect of increasing interest may be defined as medical prolepsis (from the Greek pi rho ómicron lambda eta psi iota zeta = anticipated idea). It includes early signals of disease (protopathology) as well as other signals the host shows as defence or alarm reaction. Hence, we suggest a chronobiological approach in this field, which allows to quantify health and reveals more subtle differences in many physiological variables. According to these views, we reported studies concerning humoral markers and other parameters considered as risk factors both in atherosclerosis and in some endocrine tumors.

Published
1982

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

Author

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., Andreoni, M., 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., Ceccherini-Silberstein, F., Lo Caputo, S., Mussini, C., Puoti, M., Bai, F., Balotta, C., Bandera, A., Bonora, S., Borderi, M., Calcagno, A., Capetti, A., Capobianchi, M. R., Cicalini, S., Cingolani, A., Cinque, P., De Luca, A., Di Biagio, A., Gianotti, N., Gori, A., Guaraldi, G., Lichtner, M., Madeddu, G., Marchetti, G., Monno, L., Nozza, S., Pinnetti, C., Quiros Roldan, E., Rossotti, R., Rusconi, S., Santoro, M. M., Sarmati, L., Fanti, I., Galli, L., Lorenzini, P., Rodano, A., Macchia, M., Carletti, F., Carrara, S., Di Caro, A., Graziano, S., Petroni, F., Prota, G., Truffa, S., Giacometti, A., Costantini, A., Barocci, V., Angarano, G., Milano, E., Suardi, C., Donati, V., Verucchi, G., Castelnuovo, F., Minardi, C., 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., Fondaco, L., Bonfanti, P., Molteni, C., Chiodera, A., Milini, P., Nunnari, G., Pellicano, G., Rizzardini, G., Cannizzo, E. S., Moioli, M. C., Piolini, R., Bernacchia, D., Salpietro, S., Tincati, C., Puzzolante, C., Migliorino, C., Sangiovanni, V., Borgia, G., Esposito, V., Di Flumeri, G., Gentile, I., Rizzo, V., Cattelan, A. M., Marinello, S., Cascio, A., Trizzino, M., Schiaroli, E., Parruti, G., Sozio, F., Magnani, G., Ursitti, M. A., Cristaudo, A., Vullo, V., Acinapura, R., Moschese, D., Capozzi, M., Mondi, A., Rivano Capparuccia, M., Iaiani, G., Latini, A., Gagliardini, R., Plazzi, M. M., De Girolamo, G., Vergori, A., Cecchetto, M., Viviani, F., De Vito, A., Rossetti, B., Montagnani, F., Franco, A., Fontana Del Vecchio, R., Di Giuli, C., Caramello, P., 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., Andreoni, M., 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., Ceccherini-Silberstein, F., Lo Caputo, S., Mussini, C., Puoti, M., Bai, F., Balotta, C., Bandera, A., Bonora, S., Borderi, M., Calcagno, A., Capetti, A., Capobianchi, M. R., Cicalini, S., Cingolani, A., Cinque, P., De Luca, A., Di Biagio, A., Gianotti, N., Gori, A., Guaraldi, G., Lichtner, M., Madeddu, G., Marchetti, G., Monno, L., Nozza, S., Pinnetti, C., Quiros Roldan, E., Rossotti, R., Rusconi, S., Santoro, M. M., Sarmati, L., Fanti, I., Galli, L., Lorenzini, P., Rodano, A., Macchia, M., Carletti, F., Carrara, S., Di Caro, A., Graziano, S., Petroni, F., Prota, G., Truffa, S., Giacometti, A., Costantini, A., Barocci, V., Angarano, G., Milano, E., Suardi, C., Donati, V., Verucchi, G., Castelnuovo, F., Minardi, C., 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., Fondaco, L., Bonfanti, P., Molteni, C., Chiodera, A., Milini, P., Nunnari, G., Pellicano, G., Rizzardini, G., Cannizzo, E. S., Moioli, M. C., Piolini, R., Bernacchia, D., Salpietro, S., Tincati, C., Puzzolante, C., Migliorino, C., Sangiovanni, V., Borgia, G., Esposito, V., Di Flumeri, G., Gentile, I., Rizzo, V., Cattelan, A. M., Marinello, S., Cascio, A., Trizzino, M., Schiaroli, E., Parruti, G., Sozio, F., Magnani, G., Ursitti, M. A., Cristaudo, A., Vullo, V., Acinapura, R., Moschese, D., Capozzi, M., Mondi, A., Rivano Capparuccia, M., Iaiani, G., Latini, A., Gagliardini, R., Plazzi, M. M., De Girolamo, G., Vergori, A., Cecchetto, M., Viviani, F., De Vito, A., Rossetti, B., Montagnani, F., Franco, A., Fontana Del Vecchio, R., Di Giuli, C., Caramello, P., Orofino, G. C., Sciandra, M., Bassetti, M., Londero, A., Manfrin, V., Battagin, G., Starnini, G., Ialungo, A., A d'Arminio Monforte, A Antinori, M Andreoni, A Castagna, F Castelli, R Cauda, G Di Perri, M Galli, R Iardino, G Ippolito, A Lazzarin, G C Marchetti, G Rezza, F von Schloesser, F Ceccherini-Silberstein, A Cozzi-Lepri, E Girardi, S Lo Caputo, C Mussini, M Puoti, C F Perno, F Bai, C Balotta, A Bandera, S Bonora, M Borderi, A Calcagno, A Capetti, M R Capobianchi, S Cicalini, A Cingolani, P Cinque, , A Di Biagio, N Gianotti, A Gori, G Guaraldi, G Lapadula, M Lichtner, G Madeddu, F Maggiolo, L Monno, S Nozza, C Pinnetti, E Quiros Roldan, R Rossotti, S Rusconi, M M Santoro, A Saracino, L Sarmati, I Fanti, L Galli, P Lorenzini, A Rodano', M Macchia, A Tavelli, F Carletti, S Carrara, A Di Caro, S Graziano, F Petroni, G Prota, S Truffa, A Giacometti, A Costantini, V Barocci, G Angarano, E Milano, C Suardi, V Donati, G Verucchi, F Castelnuovo, C Minardi, B Menzaghi, C Abeli, B Cacopardo, B Celesia, J Vecchiet, K Falasca, A Pan, S Lorenzotti, L Sighinolfi, D Segala, P Blanc, F Vichi, G Cassola, C Viscoli, A Alessandrini, N Bobbio, G Mazzarello, L Fondaco, P Bonfanti, C Molteni, A Chiodera, P Milini, G Nunnari, G Pellicanò, G Rizzardini, E S Cannizzo, M C Moioli, R Piolini, D Bernacchia, S Salpietro, C Tincati, C Puzzolante, C Migliorino, V Sangiovanni, G Borgia, V Esposito, G Di Flumeri, I Gentile, V Rizzo, A M Cattelan, S Marinello, A Cascio, M Trizzino, D Francisci, E Schiaroli, G Parruti, F Sozio, G Magnani, M A Ursitti, A Cristaudo, V Vullo, R Acinapura, D Moschese, M Capozzi, A Mondi, M Rivano Capparuccia, G Iaiani, A Latini, R Gagliardini, M M Plazzi, G De Girolamo, A Vergori, M Cecchetto, F Viviani, A De Vito, B Rossetti, F Montagnani, A Franco, R Fontana Del Vecchio, C Di Giuli, P Caramello, G C Orofino, M Sciandra, M Bassetti, A Londero, V Manfrin, G Battagin, G Starnini, A Ialungo, 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, Antinori, A, Andreoni, M, Castelli, F, Cauda, R, Di Perri, G, Galli, M, Iardino, R, Ippolito, G, Lazzarin, A, Marchetti, G, Rezza, G, Von Schloesser, F, Viale, P, Ceccherini-Silberstein, F, Lo Caputo, S, Mussini, C, Puoti, M, Bai, F, Balotta, C, Bandera, A, Bonora, S, Borderi, M, Calcagno, A, Capetti, A, Capobianchi, M, Cicalini, S, Cingolani, A, Cinque, P, De Luca, A, Di Biagio, A, Gianotti, N, Gori, A, Guaraldi, G, Lichtner, M, Madeddu, G, Monno, L, Nozza, S, Pinnetti, C, Quiros Roldan, E, Rossotti, R, Rusconi, S, Santoro, M, Sarmati, L, Fanti, I, Galli, L, Lorenzini, P, Rodano, A, Macchia, M, Carletti, F, Carrara, S, Di Caro, A, Graziano, S, Petroni, F, Prota, G, Truffa, S, Giacometti, A, Costantini, A, Barocci, V, Angarano, G, Milano, E, Suardi, C, Donati, V, Verucchi, G, Castelnuovo, F, Minardi, C, 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, Fondaco, L, Bonfanti, P, Molteni, C, Chiodera, A, Milini, P, Nunnari, G, Pellicano, G, Rizzardini, G, Cannizzo, E, Moioli, M, Piolini, R, Bernacchia, D, Salpietro, S, Tincati, C, Puzzolante, C, Migliorino, C, Sangiovanni, V, Borgia, G, Esposito, V, Di Flumeri, G, Gentile, I, Rizzo, V, Cattelan, A, Marinello, S, Cascio, A, Trizzino, M, Schiaroli, E, Parruti, G, Sozio, F, Magnani, G, Ursitti, M, Cristaudo, A, Vullo, V, Acinapura, R, Moschese, D, Capozzi, M, Mondi, A, Rivano Capparuccia, M, Iaiani, G, Latini, A, Gagliardini, R, Plazzi, M, De Girolamo, G, Vergori, A, Cecchetto, M, Viviani, F, De Vito, A, Rossetti, B, Montagnani, F, Franco, A, Fontana Del Vecchio, R, Di Giuli, C, Caramello, P, Orofino, G, 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., Andreoni M., 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., Ceccherini-Silberstein F., Lo Caputo S., Mussini C., Puoti M., Bai F., Balotta C., Bandera A., Bonora S., Borderi M., Calcagno A., Capetti A., Capobianchi M.R., Cicalini S., Cingolani A., Cinque P., De Luca A., Di Biagio A., Gianotti N., Gori A., Guaraldi G., Lichtner M., Madeddu G., Marchetti G., Monno L., Nozza S., Pinnetti C., Quiros Roldan E., Rossotti R., Rusconi S., Santoro M.M., Sarmati L., Fanti I., Galli L., Lorenzini P., Rodano A., MacChia M., Carletti F., Carrara S., Di Caro A., Graziano S., Petroni F., Prota G., Truffa S., Giacometti A., Costantini A., Barocci V., Angarano G., Milano E., Suardi C., Donati V., Verucchi G., Castelnuovo F., Minardi C., 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., Fondaco L., Bonfanti P., Molteni C., Chiodera A., Milini P., Nunnari G., Pellicano G., Rizzardini G., Cannizzo E.S., Moioli M.C., Piolini R., Bernacchia D., Salpietro S., Tincati C., Puzzolante C., Migliorino C., Sangiovanni V., Borgia G., Esposito V., Di Flumeri G., Gentile I., Rizzo V., Cattelan A.M., Marinello S., Cascio A., Trizzino M., Schiaroli E., Parruti G., Sozio F., Magnani G., Ursitti M.A., Cristaudo A., Vullo V., Acinapura R., Moschese D., Capozzi M., Mondi A., Rivano Capparuccia M., Iaiani G., Latini A., Gagliardini R., Plazzi M.M., De Girolamo G., Vergori A., Cecchetto M., Viviani F., De Vito A., Rossetti B., Montagnani F., Franco A., Fontana Del Vecchio R., Di Giuli C., Caramello P., Orofino G.C., Sciandra M., Bassetti M., Londero A., Manfrin V., Battagin G., Starnini G., and Ialungo A.

Subjects
0301 basic medicine, diagnosis, hiv, communicable diseases, HIV Infections, Logistic regression, Virological response, Cohort Studies, 0302 clinical medicine, Retention in Care, Medicine, Pharmacology (medical), HIV Infection, 030212 general & internal medicine, Prospective cohort study, cd4 count determination procedure, drug, suppression, Viral Load, CD4 Lymphocyte Count, Humans, Italy, Anti-HIV Agents, virology, Infectious Diseases, blood hiv rna, Cohort, hiv, cd4 count determination procedure, communicable diseases, incomeitaly, diagnosis, virology, blood hiv rna, retention in care, incomeitaly, Viral load, HIV, ART, Cohort study, Human, Microbiology (medical), medicine.medical_specialty, antiretroviral therapy, Settore MED/17 - MALATTIE INFETTIVE, NO, 03 medical and health sciences, HIV viral load, Internal medicine, HIV, CD4, ART, Pharmacology, business.industry, double blind, Anti-HIV Agent, HIV viral load, antiretroviral therapy, double blind, initiation, suppression, infection, Retention in care, 030112 virology, infection, initiation, Observational study, Cohort Studie, business
Abstract

Objectives 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 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.

Published
2020

50. Incidence and risk factors for liver enzyme elevation among naive HIV-1-infected patients receiving ART in the ICONA cohort

Author

Taramasso, L., Lorenzini, P., Di Biagio, A., Lichtner, M., Marchetti, G., Rossotti, R., Lapadula, G., Cozzi-Lepri, A., Vichi, F., Antinori, A., Bonora, S., D'Arminio Monforte, A., ICONA Foundation Study Group:, A d'Arminio Monforte, Antinori, A, Andreoni, M, Castagna, A, Castelli, F, Cauda, R, G Di Perri, Galli, M, Iardino, R, Ippolito, G, Lazzarin, A, C Marchetti, G, Rezza, G, F von Schloesser, Viale, P, A d'Arminio Monforte, Ceccherini-Silberstein, F, Cozzi-Lepri, A, Girardi, E, S Lo Caputo, Mussini, C, Puoti, M, F Perno, C, Bai, F, Balotta, C, Bandera, A, Bonora, S, Borderi, M, Calcagno, A, Capetti, A, R Capobianchi, M, Cicalini, S, Cingolani, A, Cinque, P, A De Luca, A Di Biagio, Gianotti, N, Gori, A, Guaraldi, G, Lapadula, G, Lichtner, M, Madeddu, G, Maggiolo, F, Marchetti, G, Monno, L, Nozza, S, Pinnetti, C, QUIROS ROLDAN, Maria Eugenia, Rossotti, R, Rusconi, S, M Santoro, M, Saracino, A, Sarmati, L, Fanti, I, Galli, L, Lorenzini, P, Rodano', A, Macchia, M, Tavelli, A, Carletti, F, Carrara, S, A Di Caro, Graziano, S, Petroni, F, Prota, G, Truffa, S, Giacometti, A, Costantini, A, Barocci, V, Angarano, G, Milano, E, Suardi, C, Donati, V, Verucchi, G, Castelnuovo, F, Minardi, C, 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, Vita, S, Bonfanti, P, Molteni, C, Chiodera, A, Milini, P, Nunnari, G, Pellicanò, G, Rizzardini, G, S Cannizzo, E, C Moioli, M, Piolini, R, Bernacchia, D, Salpietro, S, Tincati, C, Puzzolante, C, Migliorino, C, Sangiovanni, V, Borgia, G, Esposito, V, F Di Martino, Gentile, I, Rizzo, V, M Cattelan, A, Marinello, S, Cascio, A, Trizzino, M, Baldelli, F, Schiaroli, E, Parruti, G, Sozio, F, Magnani, G, A Ursitti, M, Cristaudo, A, Vullo, V, Acinapura, R, Moschese, D, Capozzi, M, Mondi, A, M Rivano Capparuccia, Iaiani, G, Latini, A, Gagliardini, R, M Plazzi, M, Savinelli, S, Vergori, A, Cecchetto, M, Viviani, F, A De Vito, Rossetti, B, Montagnani, F, Franco, A, R Fontana Del Vecchio, Francisci, D, C Di Giuli, Caramello, P, C Orofino, G, Sciandra, M, Bassetti, M, Londero, A, Pellizzer, G, Manfrin, V, Starnini, G, Ialungo, A, Taramasso, L, Lorenzini, P, Di Biagio, A, Lichtner, M, Marchetti, G, Rossotti, R, Lapadula, G, Cozzi-Lepri, A, Vichi, F, Antinori, A, Bonora, S, D'Arminio Monforte, A, d'Arminio Monforte, A, Andreoni, M, Castagna, A, Castelli, F, Cauda, R, Di Perri, G, Galli, M, Iardino, R, Ippolito, G, Lazzarin, A, Marchetti, Gc, Rezza, G, von Schloesser, F, Viale, P, Ceccherini-Silberstein, F, Girardi, E, Lo Caputo, S, Mussini, C, Puoti, M, Perno, Cf, Bai, F, Balotta, C, Bandera, A, Borderi, M, Calcagno, A, Capetti, A, Capobianchi, Mr, Cicalini, S, Cingolani, A, Cinque, P, De Luca, A, Gianotti, N, Gori, A, Guaraldi, G, Madeddu, G, Maggiolo, F, Monno, L, Nozza, S, Pinnetti, C, Quiros Roldan, E, Rusconi, S, Santoro, Mm, Saracino, A, Sarmati, L, Fanti, I, Galli, L, 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Subjects
0301 basic medicine, Male, Integrase inhibitor, Hepatitis B Surface Antigen, HIV Infections, 0302 clinical medicine, Risk Factors, hivh epatitis c rna surface antigens follow-up homosexuality integrase inhibitors hepatitis b virus hepatitis b virus measurement hiv infections hepatotoxicity hepatitis c virus coinfection nucleoside reverse transcriptase inhibitors non-nucleoside reverse transcriptase inhibitors cox proportional hazards models baseline value liver enzyme raltegravir, Pharmacology (medical), HIV Infection, 030212 general & internal medicine, Prospective Studies, Prospective cohort study, Coinfection, Incidence (epidemiology), Liver Disease, Incidence, Liver Diseases, virus diseases, Hepatitis C, Middle Aged, Reverse Transcriptase Inhibitor, Infectious Diseases, Cohort, Population study, Regression Analysis, Reverse Transcriptase Inhibitors, Female, medicine.drug, Human, Microbiology (medical), Adult, medicine.medical_specialty, Anti-HIV Agents, Regression Analysi, NO, 03 medical and health sciences, Internal medicine, medicine, Humans, HIV Integrase Inhibitors, HIV Protease Inhibitor, Pharmacology, Hepatitis B Surface Antigens, business.industry, Anti-HIV Agent, HIV, ART, HIV Protease Inhibitors, medicine.disease, Raltegravir, 030112 virology, HIV Integrase Inhibitor, Prospective Studie, HIV-1, business, Adult, Anti-HIV Agents, Coinfection, Female, Hepatitis B Surface Antigens, Hepatitis C, HIV Infections, HIV Integrase Inhibitors, HIV Protease Inhibitors, HIV-1, Humans, Incidence, Liver Diseases, Male, Middle Aged, Prospective Studies, Regression Analysis, Reverse Transcriptase Inhibitors, Risk Factors
Abstract

ObjectivesTo evaluate the incidence and risk factors for liver enzyme elevations (LEE) in patients initiating first-line ART in the ICONA prospective observational cohort, between June 2009 and December 2017.Patients and methodsIn total, 6575 ART-naive patients were selected, initiating two NRTIs with the third drug being a boosted PI (n=2436; 37.0%), an NNRTI (n=2384; 36.3%) or an integrase strand transfer inhibitor (INSTI) (n=1755; 26.7%). HBV surface antigen and HCV RNA were detected in 3.9% and 5.8% of the study population. Inverse probability weighted Cox regression analysis was used to calculate the HRs, according to first-line regimen, for LEE, defined as ALT or AST increases of ≥2.5× upper limit of normal (ULN) for patients with normal baseline values or ≥2.5× baseline for patients with higher baseline values.ResultsOne hundred and eighty-three LEE occurred over 20722 patient-years of follow-up. After adjusting for the main confounders, the risk of LEE halved with INSTIs compared with NNRTIs (HR 0.46, 95% CI 0.25–0.86), with a significant reduction in the raltegravir group (HR 0.11, 95% CI 0.02–0.84 using the NNRTI class as reference). HRs for LEE were significantly higher in subjects with HBV or HCV coinfection, in patients with poorly controlled HIV infection and in those who acquired HIV through homosexual transmission.ConclusionsIn our study, INSTI use almost halved the risk of LEE compared with other regimens. This finding could be particularly important for choosing ART in patients with risk factors for liver toxicity such as HCV and HBV coinfections.

Published
2019

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