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1. Viral clearance after early corticosteroid treatment in patients with moderate or severe covid-19

Author

Spagnuolo, V., Guffanti, M., Galli, L., Poli, A., Querini, P. Rovere, Ripa, M., Clementi, M., Scarpellini, P., Lazzarin, A., Tresoldi, Moreno, Dagna, L., Zangrillo, A., Ciceri, F., Castagna, A., Andolina, A., Redaelli, M. Baiardo, Baldissera, E., Bigai, G., Bigoloni, A., Boffini, N., Borio, G., Bossolasco, S., Bruzzesi, E., Calabrò, M. G., Calvisi, S., Campochiaro, C., Canetti, D., Canti, V., Castellani, J., Castiglioni, B., Cavalli, G., Cavallo, L., Cernuschi, M., Chiurlo, M., Cilla, M., Cinel, E., Cinque, P., Conte, C., Da Prat, V., Danise, A., De Lorenzo, R., De Luca, G., Dell’Acqua, A., Dell’Acqua, R., Torre, E. Della, Torre, L. Della, Di Terlizzi, G., Dumea, I., Farolfi, F., Ferrante, M., Frangi, C., Fumagalli, L., Gallina, G., Germinario, B., Gianotti, Nicola, Hasson, H., Lalla, F., LANDONI, Giovanni, Lanzillotta, M., Voti, R. Li, Mastrangelo, A., Messina, E., Moizo, E., Montagna, M., Monti, G., Morsica, G., Muccini, C., Nozza, S., Oltolini, C., Pascali, M., Patrizi, A., Pieri, M., Prestifilippo, D., Ramirez, Giuseppe Alvise, Ranzenigo, M., Sapienza, J., Sartorelli, S., Seghi, F., Tambussi, G., Din, C. Tassan, Tomelleri, A., Turi, S., Uberti-Foppa, C., Vinci, C., COVID-BioB study group, Spagnuolo, V., Guffanti, M., Galli, L., Poli, A., Querini, P. R., Ripa, M., Clementi, M., Scarpellini, P., Lazzarin, A., Tresoldi, M., Dagna, L., Zangrillo, A., Ciceri, F., Castagna, A., Andolina, A., Redaelli, M. B., Baldissera, E., Bigai, G., Bigoloni, A., Boffini, N., Borio, G., Bossolasco, S., Bruzzesi, E., Calabro, M. G., Calvisi, S., Campochiaro, C., Canetti, D., Canti, V., Castellani, J., Castiglioni, B., Cavalli, G., Cavallo, L., Cernuschi, M., Chiurlo, M., Cilla, M., Cinel, E., Cinque, P., Conte, C., Da Prat, V., Danise, A., De Lorenzo, R., De Luca, G., Dell'Acqua, A., Dell'Acqua, R., Torre, E. D., Torre, L. D., Di Terlizzi, G., Dumea, I., Farolfi, F., Ferrante, M., Frangi, C., Fumagalli, L., Gallina, G., Germinario, B., Gianotti, N., Hasson, H., Lalla, F., Landoni, G., Lanzillotta, M., Voti, R. L., Mastrangelo, A., Messina, E., Moizo, E., Montagna, M., Monti, G., Morsica, G., Muccini, C., Nozza, S., Oltolini, C., Pascali, M., Patrizi, A., Pieri, M., Prestifilippo, D., Ramirez, G., Ranzenigo, M., Sapienza, J., Sartorelli, S., Seghi, F., Tambussi, G., Din, C. T., Tomelleri, A., Turi, S., Uberti-Foppa, C., and Vinci, C.

Subjects
Male, medicine.medical_specialty, Time Factors, Coronavirus disease 2019 (COVID-19), Lymphocyte, Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), Corticosteroid treatment, Severe disease, Diseases, 030204 cardiovascular system & hematology, Article, 03 medical and health sciences, 0302 clinical medicine, Adrenal Cortex Hormones, Internal medicine, medicine, Humans, In patient, 030212 general & internal medicine, Pandemics, Aged, Retrospective Studies, Multidisciplinary, business.industry, Proportional hazards model, Age Factors, COVID-19, Retrospective cohort study, Middle Aged, Viral Load, Publisher Correction, COVID-19 Drug Treatment, Hospitalization, Treatment Outcome, Infectious diseases, Viral infection, medicine.anatomical_structure, Italy, Female, business
Abstract

The aim of this study was to evaluate the impact of early treatment with corticosteroids on SARS-CoV-2 clearance in hospitalized COVID-19 patients. Retrospective analysis on patients admitted to the San Raffaele Hospital (Milan, Italy) with moderate/severe COVID-19 and availability of at least two nasopharyngeal swabs. The primary outcome was the time to nasopharyngeal swab negativization. A multivariable Cox model was fitted to determine factors associated with nasopharyngeal swab negativization. Of 280 patients included, 59 (21.1%) patients were treated with steroids. Differences observed between steroid users and non-users included the proportion of patients with a baseline PaO2/FiO2 ≤ 200 mmHg (45.8% vs 34.4% in steroids and non-steroids users, respectively; p = 0.023) or ≤ 100 mmHg (16.9% vs 12.7%; p = 0.027), and length of hospitalization (20 vs 14 days; p 2/FiO2 > 200 mmHg, and a lymphocyte count at admission > 1.0 × 109/L. SARS-CoV-2 clearance was not associated with corticosteroid use. Our study shows that delayed SARS-CoV-2 clearance in moderate/severe COVID-19 is associated with older age and a more severe disease, but not with an early use of corticosteroids.

Published
2020
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3. Cerebrospinal fluid viral replication and burden of resistance in three HIV-1-infected people taking Ibalizumab with multiple drug class-wide resistance

Author

Massimo Cernuschi, Camilla Muccini, Michela Sampaolo, Antonella Castagna, Alba Bigoloni, Diana Canetti, Michela Franzin, Vincenzo Spagnuolo, Muccini, C., Spagnuolo, V., Canetti, D., Bigoloni, A., Cernuschi, M., Franzin, M., Sampaolo, M., and Castagna, A.

Subjects
Adult, Male, Anti-HIV Agents, Immunology, Human immunodeficiency virus (HIV), HIV Infections, medicine.disease_cause, Virus Replication, Cerebrospinal fluid, Drug Resistance, Multiple, Viral, medicine, Immunology and Allergy, Humans, Cerebrospinal Fluid, Ibalizumab, business.industry, Antibodies, Monoclonal, Middle Aged, Viral Load, Virology, Infectious Diseases, Drug class, Viral replication, HIV-1, RNA, Viral, business, medicine.drug
Published
2020

4. Secondary infections in patients hospitalized with COVID-19: incidence and predictive factors

Author

Raffaele Li Voti, Massimo Clementi, Barbara Castiglioni, Maria Grazia Calabrò, Alberto Zangrillo, Hamid Hasson, Valentina Da Prat, Anna Danise, Ludovica Cavallo, Valentina Canti, Chiara Molinari, Alba Bigoloni, Antonio Dell'Acqua, Giovanni Landoni, Raffaele Dell’Acqua, Francesca Lalla, Patrizia Rovere Querini, Simona Bossolasco, Adriano Lazzarin, Rebecca De Lorenzo, Alessandro Patrizi, Vincenzo Spagnuolo, Paola Cinque, Jacopo Castellani, Paolo Scarpellini, Marica Ferrante, Marco Ripa, Giacomo Monti, Caterina Uberti-Foppa, Emanuel Della Torre, Antonella Castagna, Giorgia Borio, Martina Ranzenigo, Federico Seghi, Bruno Germinario, Giorgia Bigai, Giacomo De Luca, Corrado Campochiaro, Giulio Cavalli, Giulia Morsica, Liviana Della Torre, Marta Cilla, Gabriele Gallina, Fabio Ciceri, Gaetano Di Terlizzi, Nicola Gianotti, Maria Pascali, Silvia Nozza, Marina Pieri, Giuseppe Tambussi, Andrea Andolina, Caterina Conte, Federica Farolfi, Luca Fumagalli, Andrea Poli, Elena Cinel, Monica Guffanti, Moreno Tresoldi, Camilla Muccini, Lorenzo Dagna, Chiara Oltolini, Marco Montagna, Dario Prestifilippo, Concetta Vinci, Emanuela Messina, Diana Canetti, Elena Bruzzesi, Laura Galli, Martina Baiardo Redaelli, Jacopo Sapienza, Iulia Dumea, Elena Moizo, Matteo Chiurlo, Chiara Tassan Din, Stefania Calvisi, Stefano Turi, Massimo Cernuschi, Marco Lanzillotta, Antonella Poloniato, Giuseppe A. Ramirez, Claudia Frangi, Andrea Mastrangelo, Ripa, M., Galli, L., Poli, A., Oltolini, C., Spagnuolo, V., Mastrangelo, A., Muccini, C., Monti, G., De Luca, G., Landoni, G., Dagna, L., Clementi, M., Rovere Querini, P., Ciceri, F., Tresoldi, M., Lazzarin, A., Zangrillo, A., Scarpellini, P., Castagna, A., Andolina, A., Redaelli, M. B., Bigai, G., Bigoloni, A., Borio, G., Bossolasco, S., Bruzzesi, E., Calabro, M. G., Calvisi, S., Campochiaro, C., Canetti, D., Canti, V., Castellani, J., Castiglioni, B., Cavalli, G., Cavallo, L., Cernuschi, M., Chiurlo, M., Cilla, M., Cinel, E., Cinque, P., Conte, C., Da Prat, V., Danise, A., De Lorenzo, R., Dell'Acqua, A., Dell'Acqua, R., Della Torre, E., Della Torre, L., Di Terlizzi, G., Dumea, I., Farolfi, F., Ferrante, M., Frangi, C., Fumagalli, L., Gallina, G., Germinario, B., Gianotti, N., Guffanti, M., Hasson, H., Lalla, F., Lanzillotta, M., Li Voti, R., Messina, E., Molinari, C., Moizo, E., Montagna, M., Morsica, G., Nozza, S., Pascali, M., Patrizi, A., Pieri, M., Poloniato, A., Prestifilippo, D., Ramirez, G., Ranzenigo, M., Sapienza, J., Seghi, F., Tambussi, G., Tassan Din, C., Turi, S., Uberti-Foppa, C., and Vinci, C.

Subjects
0301 basic medicine, Microbiology (medical), Male, medicine.medical_specialty, Secondary infection, 030106 microbiology, Aspergillosis, Cohort Studies, Fungal infections, 03 medical and health sciences, 0302 clinical medicine, Bacterial infections, Risk Factors, Internal medicine, Sepsis, Medicine, Humans, Cumulative incidence, 030212 general & internal medicine, Secondary infections, Respiratory Tract Infections, Aged, Respiratory tract infections, biology, business.industry, Coinfection, SARS-CoV-2, Incidence (epidemiology), Incidence, COVID-19, General Medicine, Acinetobacter, Middle Aged, medicine.disease, biology.organism_classification, Lower respiratory tract infections, Hospitalization, Infectious Diseases, Respiratory failure, Italy, Original Article, Female, Bloodstream infections, business, Cohort study
Abstract

Objectives The aim of our study was to describe the incidence and predictive factors of secondary infections in patients with coronavirus disease 2019 (COVID-19). Methods This was a cohort study of patients hospitalized with COVID-19 at IRCCS San Raffaele Hospital between 25th February and 6th April 2020 (NCT04318366). We considered secondary bloodstream infections (BSIs) or possible lower respiratory tract infections (pLRTIs) occurring 48 hours after hospital admission until death or discharge. We calculated multivariable Fine–Gray models to assess factors associated with risk of secondary infections. Results Among 731 patients, a secondary infection was diagnosed in 68 patients (9.3%); 58/731 patients (7.9%) had at least one BSI and 22/731 patients (3.0%) at least one pLRTI. The overall 28-day cumulative incidence was 16.4% (95%CI 12.4–21.0%). Most of the BSIs were due to Gram-positive pathogens (76/106 isolates, 71.7%), specifically coagulase-negative staphylococci (53/76, 69.7%), while among Gram-negatives (23/106, 21.7%) Acinetobacter baumanii (7/23, 30.4%) and Escherichia coli (5/23, 21.7%) predominated. pLRTIs were caused mainly by Gram-negative pathogens (14/26, 53.8%). Eleven patients were diagnosed with putative invasive aspergillosis. At multivariable analysis, factors associated with secondary infections were low baseline lymphocyte count (≤0.7 versus >0.7 per 109/L, subdistribution hazard ratios (sdHRs) 1.93, 95%CI 1.11–3.35), baseline PaO2/FiO2 (per 100 points lower: sdHRs 1.56, 95%CI 1.21–2.04), and intensive-care unit (ICU) admission in the first 48 hours (sdHR 2.51, 95%CI 1.04–6.05). Conclusions Patients hospitalized with COVID-19 had a high incidence of secondary infections. At multivariable analysis, early need for ICU, respiratory failure, and severe lymphopenia were identified as risk factors for secondary infections.

Published
2020

5. Predictors of sustained response to therapy resumption after treatment interruption in HIV-infected patients failing antiretroviral therapy

Author

Antonella Castagna, Hamid Hasson, Nicola Gianotti, Massimo Cernuschi, Alessandro Soria, Laura Galli, Adriano Lazzarin, Giannotti, N, Soria, A, Galli, L, Castagna, Antonella, Cernuschi, M, Hasson, H, and Lazzarin, A.

Subjects
Anti-HIV Agents, medicine.medical_treatment, Salvage therapy, HIV Infections, Drug Administration Schedule, Pharmacotherapy, Predictive Value of Tests, Interquartile range, Antiretroviral Therapy, Highly Active, Virology, medicine, Humans, Treatment Failure, Sida, Retrospective Studies, Salvage Therapy, Chemotherapy, biology, business.industry, Retrospective cohort study, Viral Load, biology.organism_classification, CD4 Lymphocyte Count, Treatment Outcome, Infectious Diseases, Predictive value of tests, HIV-1, RNA, Viral, Reverse Transcriptase Inhibitors, Drug Therapy, Combination, business, Viral load
Abstract

In order to evaluate whether a sustained virologic response to therapy resumption after treatment interruption can be achieved in the setting of virologic failure, we reviewed retrospectively the data relating to 56 human immunodeficiency virus (HIV)-infected subjects selected from 3,145 patient charts. At the time of treatment interruption (study entry), the median (interquartile range) CD4+ counts and HIV-RNA levels were respectively 247 (127-502) x 10(6) cells/L and 4.24 (3.68-5.02) log(10) copies/ml, and the patients had been exposed to eight (5-9) antiretroviral drugs. After treatment interruption, the patients received at least three drugs depending on their treatment history. Forty-eight weeks after the resumption of therapy, 19 of the 56 patients (34%) had HIV-RNA levels of

Published
2003
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6. Virological rebound in human immunodeficiency virus-infected patients with or without residual viraemia: results from an extended follow-up

Author

Laura Galli, Nicola Gianotti, A Castagna, Massimo Cernuschi, Vincenzo Spagnuolo, Stefania Salpietro, Massimo Clementi, Simona Bossolasco, Myriam Maillard, Adriano Lazzarin, Filippo Canducci, Gianotti, N., Galli, L., Salpietro, S., Cernuschi, M., Bossolasco, S., Maillard, M., Spagnuolo, Vincenzo, Canducci, F., Clementi, Massimo, Lazzarin, Adriano, and Castagna, Antonella

Subjects
Male, Microbiology (medical), Anti-HIV Agents, Human immunodeficiency virus (HIV), HIV Infections, Viremia, medicine.disease_cause, Group A, Group B, Virological failure, Interquartile range, medicine, Antiretroviral therapy, Human immunodeficiency virus type 1viral load, Kinetic PCR, Virological rebound, Humans, business.industry, Follow up studies, HIV, General Medicine, Middle Aged, Viral Load, medicine.disease, Virology, CD4 Lymphocyte Count, Infectious Diseases, Multivariate Analysis, RNA, Viral, Female, business, Viral load, Follow-Up Studies
Abstract

Human immunodeficiency virus (HIV) -infected patients with HIV RNA loads of < 50 copies/mL were followed-up for a median (interquartile range) of 30.8 (11.7–32.9) months to study the effect of residual viraemia (RV) on virological rebound (VR). At baseline, 446 (60.3%) patients had undetectable HIV RNA (group A) and 293 (39.7%) had RV (1–49 HIV RNA copies/mL, group B) by kinetic PCR. VR occurred in 4 (0.9%) patients in group A and in 12 (4.1%) patients in group B (p 0.007). Time to VR was shorter among patients of group B (Log-rank test: p 0.003). However, the proportion of VR was extremely low also among patients with RV.

Published
2013

7. Lamivudine monotherapy in HIV-1-infected patients harbouring a lamivudine-resistant virus: a randomized pilot study (E-184V study)

Author

Enzo Boeri, Hamid Hasson, Antonella Castagna, Laura Galli, Stefano Menzo, Andrea Galli, Anna Danise, Nicola Gianotti, Massimo Cernuschi, Elisabetta Carini, Massimo Clementi, Adriano Lazzarin, Castagna, Antonella, Danise, A, Menzo, S, Galli, L, Gianotti, N, Carini, E, Boeri, E, Galli, A, Cernuschi, M, Hasson, H, Clementi, Massimo, and Lazzarin, Adriano

Subjects
Adult, Male, medicine.medical_specialty, Anti-HIV Agents, Immunology, Salvage therapy, HIV Infections, Pilot Projects, Biology, Virus Replication, Drug Administration Schedule, Antiretroviral Therapy, Highly Active, Internal medicine, Drug Resistance, Viral, medicine, Clinical endpoint, Humans, Immunology and Allergy, Treatment Failure, Adverse effect, Reverse-transcriptase inhibitor, Lamivudine, Middle Aged, Viral Load, Resistance mutation, HIV Reverse Transcriptase, CD4 Lymphocyte Count, Discontinuation, Treatment Outcome, Infectious Diseases, Mutation, HIV-1, Reverse Transcriptase Inhibitors, Female, Viral load, medicine.drug
Abstract

Objective: We compared the immunological and clinical outcomes of lamivudine monotherapy and complete therapy interruption in the treatment of HIV-1-infected patients harbouring lamivudine-resistant virus. Methods: This 48-week, open-label pilot study randomly assigned HIV-infected patients receiving lamivudine-containing HAART and harbouring the M184V mutation to monotherapy with lamivudine 300 mg once daily (lamivudine group) or the discontinuation of all antiretroviral drugs (TI group). The primary endpoint was the occurrence of immunological or clinical failure; immunological failure was defined as the first report of a CD4 T-cell count less than 350 cells/mu l, and clinical failure as the occurrence of a Centers for Disease Control and Prevention grade B or C event. The data were analysed on the basis of the intention-to-treat principle. Results: By week 48,20 of 29 patients in the TI group (69%; 95% CI 51-83%) and 12 of 29 in the lamivudine group (41%; 95% CI 26-59%) had discontinued the study because of immunological or clinical failure, which was significantly delayed in the lamivudine group (P=0.018). Only patients in the TI group (6/29, 20.7%) experienced grade 3-4 clinical adverse events at least possibly related to HIV-1 (P=0.02). The mean decline in CD4 cell percentage, viral rebound and recovery of HIV-1 replication capacity were significantly lower in the lamivudine group. The 24-week virological and immunological response after therapy resumption in patients who prematurely discontinued the study was similar in the two groups. Conclusion: In HIV-1-infected patients harbouring a lamivudine-resistant virus, lamivudine monotherapy may lead to a better immunological and clinical outcome than complete therapy interruption. (C) 2006 Lippincott Williams & Wilkins.

Published
2006

8. Direct detection of Helicobacter pylori mutations associated with macrolide resistance in gastric biopsy material taken from human immunodeficiency virus-infected subjects

Author

Pier Alberto Testoni, G. Mezzi, Adriano Lazzarin, Paolo Scarpellini, Paola Carrera, Anna Zingale, Massimo Cernuschi, Annalisa Cavallero, Scarpellini, P, Carrera, P, Cavallero, A, Cernuschi, M, Mezzi, G, Testoni, PIER ALBERTO, Zingale, A, and Lazzarin, A.

Subjects
Male, Microbiology (medical), Biopsy, Spirillaceae, HIV Infections, Microbial Sensitivity Tests, DNA, Ribosomal, Virus, Helicobacter Infections, 23S ribosomal RNA, Clarithromycin, Drug Resistance, Bacterial, Genotype, medicine, Humans, Helicobacter pylori, biology, medicine.diagnostic_test, Stomach, Bacteriology, biology.organism_classification, Virology, Anti-Bacterial Agents, RNA, Ribosomal, 23S, Mutation, Immunology, Electrophoresis, Polyacrylamide Gel, Female, Viral disease, medicine.drug
Abstract

One hundred forty gastric biopsies were tested by microbiological methods and by amplifying a sequence of 23S rRNA and identifying mutations associated to clarithromycin resistance. Seventy-six specimens were positive for Helicobacter pylori . Mutational analysis revealed alterations in 18 (39.1%) of 46 and 2 (8.7%) of 23 samples from human immunodeficiency virus-seropositive and -seronegative persons, respectively. The results of the mutational analysis fully correlated with those of the susceptibility tests.

Published
2002

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