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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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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 (

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]

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]

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]