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1. The ratio of cardiac troponin T to troponin I may indicate non-necrotic troponin release among COVID-19 patients

Author

Ola Hammarsten, Pontus Ljungqvist, Björn Redfors, Mathias Wernbom, Hannes Widing, Bertil Lindahl, Sabin Salahuddin, Ruwayda Sammantar, Sandeep Jha, Annica Ravn-Fischer, Magnus Brink, and Magnus Gisslen

Subjects
Emergency department risk assessment, Clinical Biochemistry, Myocardial Infarction, macromolecular substances, Biochemistry, Article, cTnI, cardiac troponin I, Troponin T, cardiac troponin, cTnT, cardiac troponin T, Humans, Cardiac and Cardiovascular Systems, cardiovascular diseases, PCI, percutaneous coronary intervention, Kardiologi, CT, X-ray computed tomography, SARS-CoV-2, Troponin I, Biochemistry (medical), COVID-19, General Medicine, musculoskeletal system, Cardiovascular disease, MI, Myocardial infarction, cardiovascular system, Cardiac troponin, emergency department risk assessment, Biomarkers
Abstract

Background: Although cardiac troponin T (cTnT) and troponin I(cTnI) are expressed to similar amount in cardiac tissue, cTnI often reach ten-times higher peak levels compared to cTnT in patients with myocardial necrosis such as in acute myocardial infarction (MI). In contrast, similar levels of cTnT and cTnI are observed in other situations such as stable atrial fibrillation and after strenuous exercise.Objective: Examine cTnT and cTnI levels in relation to COVID-19 disease and MI. Methods: Clinical and laboratory data from the local hospital from an observational cohort study of 27 patients admitted with COVID-19 and 15 patients with myocardial infarction (MI) that were analyzed with paired cTnT and cTnI measurement during hospital care.Results: Levels of cTnI were lower than cTnT in COVID-19 patients (TnI/TnT ratio 0.3, IQR: 0.1-0.6). In contrast, levels of cTnI were 11 times higher compared to cTnT in 15 patients with MI (TnI/TnT ratio 11, IQR: 7-14). The peak cTnI/cTnT ratio among the patients with MI following successful percutaneous intervention were 14 (TnI/ TnT ratio 14, IQR: 12-23). The 5 COVID-19 patient samples collected under possible necrotic events had a cTnI/ cTnT ratio of 5,5 (IQR: 1,9-8,3).Conclusions: In patients with COVID-19, cTnT is often elevated to higher levels than cTnI in sharp contrast to patients with MI, indicating that the release of cardiac troponin has a different cause in COVID-19 patients.

Published
2022
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2. Ritonavir-boosted darunavir combined with raltegravir or tenofovir–emtricitabine in antiretroviral-naive adults infected with HIV-1: 96 week results from the NEAT001/ANRS143 randomised non-inferiority trial

Author

Michal Odermarsky, Andrea Antinori, Nina Friis-Moller, Jean-michel Molina, Manuel Marquez, Magnus Gisslen, Mili Estee Torok, Clifford Leen, CARLO FEDERICO PERNO, Vicente Soriano, Mark Boyd, Pythia Nieuwkerk, Linos Vandekerckhove, Anne-Laure Knellwolf, Juan González-García, MAURIZIO MASSELLA, Elizabeth C George, STEFANO VELLA, André Cabié, Laura Richert, Juan Berenguer, Hernando Knobel, Jose Arribas, Julie Fox, Joaquín Portilla, Maladies infectieuses et tropicales, Fonctions et dysfonctions épithéliales - UFC (EA 4267) (FDE), Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC), Institut Universitaire d'Hématologie (IUH), Université Paris Diderot - Paris 7 (UPD7), Inserm, Service des Maladies Infectieuses et Tropicales [CHU Saint Louis], Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Development and Differentiation, Institut de biochimie et génétique cellulaires (IBGC), Université Bordeaux Segalen - Bordeaux 2-Centre National de la Recherche Scientifique (CNRS), Institut des Sciences Chimiques de Rennes (ISCR), Centre National de la Recherche Scientifique (CNRS)-Institut de Chimie du CNRS (INC)-Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Ecole Nationale Supérieure de Chimie de Rennes (ENSCR)-Institut National des Sciences Appliquées - Rennes (INSA Rennes), Institut National des Sciences Appliquées (INSA)-Université de Rennes (UNIV-RENNES)-Institut National des Sciences Appliquées (INSA), Stockholm University Library (SUB), Stockholm University, Service de maladies infectieuses et tropicales [Nantes], Université de Nantes (UN)-Hôtel-Dieu-Centre hospitalier universitaire de Nantes (CHU Nantes), Service de médecine interne et maladies infectieuses, Hôpital Bicêtre-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris-Sud - Paris 11 (UP11), Aménagement, Développement, Environnement, Santé et Sociétés (ADES), Centre National de la Recherche Scientifique (CNRS)-Université Bordeaux Segalen - Bordeaux 2-Université Bordeaux Montaigne, Epidémiologie et Biostatistique [Bordeaux], Université Bordeaux Segalen - Bordeaux 2-Institut de Santé Publique, d'Épidémiologie et de Développement (ISPED)-Institut National de la Santé et de la Recherche Médicale (INSERM), DARMIGNY, Sandrine, Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Assistance publique - Hôpitaux de Paris (AP-HP) (APHP), Institut National des Sciences Appliquées - Rennes (INSA Rennes), Institut National des Sciences Appliquées (INSA)-Université de Rennes (UNIV-RENNES)-Institut National des Sciences Appliquées (INSA)-Université de Rennes (UNIV-RENNES)-Centre National de la Recherche Scientifique (CNRS)-Ecole Nationale Supérieure de Chimie de Rennes-Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES), Université Paris-Sud - Paris 11 (UP11)-Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Hôpital Bicêtre, Université Bordeaux Segalen - Bordeaux 2-Université Bordeaux Montaigne-Centre National de la Recherche Scientifique (CNRS), Raffi, Franã§oi, Babiker, Abdel G., Richert, Laura, Molina, Jean michel, George, Elizabeth C., Antinori, Andrea, Arribas, Jose R., Grarup, Jesper, Hudson, Fleur, Schwimmer, Christine, Saillard, Juliette, Wallet, Cã©drick, Jansson, Per O., Allavena, Clotilde, Van Leeuwen, Remko, Delfraissy, Jean franã§oi, Vella, Stefano, Chãªne, Geneviãve, Pozniak, Anton, Neat001/anrs143 Study, Group, Castagna, Antonella, Global Health, Amsterdam institute for Infection and Immunity, Infectious diseases, Amsterdam Public Health, Medical Psychology, Université de Rennes (UR)-Institut National des Sciences Appliquées - Rennes (INSA Rennes), Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Ecole Nationale Supérieure de Chimie de Rennes (ENSCR)-Institut de Chimie du CNRS (INC)-Centre National de la Recherche Scientifique (CNRS), Université Paris-Sud - Paris 11 (UP11)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Bicêtre, and Université Bordeaux Segalen - Bordeaux 2-Université Bordeaux Montaigne (UBM)-Centre National de la Recherche Scientifique (CNRS)

Subjects
Male, MESH: CD4 Lymphocyte Count, [SDV]Life Sciences [q-bio], MESH: Sulfonamides, Lopinavir/ritonavir, HIV Infections, Kaplan-Meier Estimate, Pharmacology, Deoxycytidine, MESH: HIV-1, Emtricitabine, MESH: Anti-HIV Agents, MESH: Treatment Outcome, Darunavir, media_common, Sulfonamides, MESH: Middle Aged, MESH: Drug Resistance, Viral, Medicine (all), Standard treatment, MESH: HIV Infections, General Medicine, Middle Aged, Pyrrolidinones, 3. Good health, [SDV] Life Sciences [q-bio], Treatment Outcome, Drug Therapy, Combination, Female, MESH: Cholesterol, HDL, MESH: Organophosphonates, MESH: Cholesterol, LDL, medicine.drug, Adult, medicine.medical_specialty, MESH: Adenine, Anti-HIV Agents, Organophosphonates, MESH: Pyrrolidinones, Raltegravir Potassium, Internal medicine, Drug Resistance, Viral, medicine, Humans, media_common.cataloged_instance, European union, Tenofovir, MESH: Kaplan-Meier Estimate, MESH: Humans, Ritonavir, business.industry, Adenine, MESH: Deoxycytidine, Cholesterol, HDL, MESH: Adult, Cholesterol, LDL, Raltegravir, MESH: Male, CD4 Lymphocyte Count, MESH: Drug Therapy, Combination, Regimen, [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie, HIV-1, MESH: Ritonavir, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, business, MESH: Female
Abstract

Summary Background Standard first-line antiretroviral therapy for HIV-1 infection includes two nucleoside or nucleotide reverse transcriptase inhibitors (NtRTIs), but these drugs have limitations. We assessed the 96 week efficacy and safety of an NtRTI-sparing regimen. Methods Between August, 2010, and September, 2011, we enrolled treatment-naive adults into this randomised, open-label, non-inferiority trial in treatment-naive adults in 15 European countries. The composite primary outcome was change to randomised treatment before week 32 because of insufficient virological response, no virological response by week 32, HIV-1 RNA concentration 50 copies per mL or higher at any time after week 32; death from any cause; any new or recurrent AIDS event; or any serious non-AIDS event. Patients were randomised in a 1:1 ratio to receive oral treatment with 400 mg raltegravir twice daily plus 800 mg darunavir and 100 mg ritonavir once daily (NtRTI-sparing regimen) or tenofovir–emtricitabine in a 245 mg and 200 mg fixed-dose combination once daily, plus 800 mg darunavir and 100 mg ritonavir once daily (standard regimen). This trial was registered with ClinicalTrials.gov, number NCT01066962. Findings Of 805 patients enrolled, 401 received the NtRTI-sparing regimen and 404 the standard regimen, with median follow-up of 123 weeks (IQR 112–133). Treatment failure was seen in 77 (19%) in the NtRTI-sparing group and 61 (15%) in the standard group. Kaplan-Meier estimated proportions of treatment failure by week 96 were 17·8% and 13·8%, respectively (difference 4·0%, 95% CI −0·8 to 8·8). The frequency of serious or treatment-modifying adverse events were similar (10·2 vs 8·3 per 100 person-years and 3·9 vs 4·2 per 100 person-years, respectively). Interpretation Our NtRTI-sparing regimen was non-inferior to standard treatment and represents a treatment option for patients with CD4 cell counts higher than 200 cells per μL. Funding European Union Sixth Framework Programme, Inserm-ANRS, Gilead Sciences, Janssen Pharmaceuticals, Merck Laboratories.

Published
2014
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