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Background Implementation level of long-acting injectable agents cabotegravir/rilpivirine (LAI CAB/RPV) for human immunodeficiency virus (HIV) treatment in Italy is still not known. The aim of this study is to identify the status of implementation of LAI CAB-RPV and its barriers. Materials and methods A cross-sectional online survey was conducted among infectious diseases (ID) physicians and nurses belonging to the ICONA network in Italy. Three validate 4-items measures were used: Acceptability of Intervention Measure (AIM), Intervention Appropriateness Measure (IAM) and Feasibility of Intervention Measure (FIM). Results Out of 61 ICONA centres, 38 (62%) completed the survey: 57.9% were academic centres, 42.1% were hospital-based. In total, 104 respondents were ID physicians (57.4%), 77 were nurses (42.5%); 4.5% of all PWH followed at the 38 centres started LAI CAB/RPV at time of study. Centres taking care of >1000 PWH reported 95% application of procedures for LA implementation, higher than other centres (P  = 0.009). Mean score of AIM was (16.0, standard deviation, SD, 3.3), of IAM (16.0, SD 3.0) and FIM (16.0, SD 2.9). A linear correlation was found between AIM and the number of people with HIV who started LAI CAB/RPV (25–50 versus <25, coefficient of correlation [b] 2.57, 95%CI 0.91–4.60, P  = 0.004), academic versus hospital-based centres (b −1.59, 95%CI −2.76–0.110044, P  = 0.007) and the absence of preliminary systematic assessment of staff (b −1.98, 95%CI −3.31–0.65, P  = 0.004). Implementation barriers were not significantly different according to the number of PWH/centre. Conclusions LAI CAB/RPV implementation was low, with a great variability according to centre size. Tailored and centre-specific interventions to address barriers and to optimize the LA treatment implementation should be designed. [ABSTRACT FROM AUTHOR]

Infection with the virus responsible for AIDS, namely, human immunodeficiency virus (HIV), results in a wide variety of immune system-related disorders, invariably ending in death. Many organ systems, including the gastrointestinal tract, are often the site of HIV-induced manifestations, such as malignant tumors or infection by opportunistic organisms. Although many of the gastrointestinal disorders that HIV-infected individuals are prone to might be expected to result in gastrointestinal bleeding, this is apparently an infrequent symptom in AIDS patients. To determine the true cumulative incidence of gastrointestinal bleeding, as well as the cause of such bleeding, a study was carried out involving 453 patients referred to an Italian hospital for the treatment of AIDS. Risk factors for AIDS included evidence of intravenous drug use (67.8 percent), homosexuality (22.5 percent), blood transfusion (0.9 percent), and risky heterosexual behavior (6.9 percent); the remainder (2.4 percent) had unknown risk factors. Half the patients were followed for six months or more; the maximum time a patients was studied was 42 months. Six months after diagnosis, 3 percent of the patients had developed gastrointestinal bleeding; at 14 months, 6 percent reported this complication. Survival in patients who developed gastrointestinal bleeding was significantly lower than in those who did not. In 9 of 15 patients with gastrointestinal bleeding in whom the cause of the bleeding was determined, HIV-related complications were involved; in the remainder of the patients, the bleeding was not a direct consequence of HIV infection. Hence, acute upper gastrointestinal bleeding is a relatively uncommon complication of HIV infection, but one that is associated with an unfavorable prognosis. (Consumer Summary produced by Reliance Medical Information, Inc.)

7‐11 November 2010, Tenth International Congress on Drug Therapy in HIV Infection, Glasgow, UK, Background Elevated PTH plasma levels are associated to an increased cardiovascular risk (CVR) possibly due to a PTH effect on vascular calcification, myocardial impairment and hypertension. Purpose of the study [...]

Objectives: To evaluate the efficacy and safety of low-dose antifungals as prophylaxis of recurrent esophageal candidiasis after the first episode in patients with AIDS. Methods: After the first episode of esophageal candidiasis, 122 consecutive AIDS patients were randomly assigned to two different regimens of continuous long-term antifungal prophylaxis (ketoconazole 200 mg or fluconazole 50 rag/day p.o.) or no antifungal therapy over a period of 2 yr. Patients were followed up by monthly clinical controls and upper GI endoscopy in the case of recurrence of esophageal symptoms. Results: One hundred and six patients were clinically evaluable over a mean observation time of 7.5 months. Prophylaxis with oral antifungals significantly reduced symptomatic relapses of esophageal candidiasis, the cumulative probability of relapse at 12 months being 38% in the prophylaxis group, compared with 84% in the untreated group. Both antifungals were sufficiently safe and well tolerated. The clinical response of a second episode of candidiasis to the reintroduction of standard oral antifungals was markedly worse in patients on prophylaxis (especially with ketoconazole) than in untreated patients, presumably due to the development of resistance to the antifungal. Conclusions: Continuous prophylaxis with both fluconazole and ketoconazole is effective in preventing recurrences of Candida esophagitis in AIDS patients; however, the possible emergence of strains resistant to these antifungals, as well as the high cost of the therapy, should raise doubts as to whether or not this type of prophylaxis should be extended to all AIDS patients with Candida esophagitis, rather than to limit its use to specific subgroups of patients, such as those with frequent symptomatic relapses. [ABSTRACT FROM AUTHOR]

To determine the spectrum of esophageal disease responsible for dysphagia/odynophagia in AIDS patients not responding to current oral antifungals, we studied 49 consecutive patients whose esophageal symptoms failed to improve after a minimum of 3 wk of therapy with oral ketoconazole or fluconazole. An esophageal candidiasis resistant to oral antifungals was the most frequent disease found (22 single infections and four mixed with viruses). Viral esophagitis was identified in 13 cases (eight herpes simplex virus and five cytomegalovirus), and an esophagitis of unknown origin was documented in two patients. Other causes of symptoms included peptic esophagitis (four cases), esophageal stenosis (two cases), and Kaposi's sarcoma of the esophagus (one patient). Most patients with esophageal opportunistic infection experienced prompt relief of symptoms and complete endoscopic resolution on the specific antifungal (amphotericin B or fluconazole iv) or antiviral (acyclovir or gancyclovir iv) therapy, with the exception of those with concomitant fungal and viral infection who responded poorly to treatment. We conclude that most AIDS patients with dysphagia/odynophagia who do not respond to oral antifungals have an opportunistic infection of the esophagus. Nevertheless, specific antifungal or antiviral therapy is worthwhile, because it will eradicate, at least temporarily, the causative pathogens in most such patients. [ABSTRACT FROM AUTHOR]

Men who have sex with men (MSM) and people with HIV are at increased risk of anal HPV infection and cancer. This study aimed to assess the prevalence of anal HPV among MSM with HIV (MWH) and without HIV (MWoH), as well as among MSM under and over 35 years. Factors associated with infection from high-risk (HR) HPV were investigated. This retrospective cohort analysis included MSM receiving care at IRCCS San Raffaele, Milan, Italy, with at least one HPV test collected from 2014 to 2023. Among 1577 MSM, 1427 (90%) were MWH. At first screening, 87.6% were had HR-HPV and MWoH were significantly younger, as compared to MWH. Cytological abnormalities were more frequent among younger MSM, while high-grade lesions were more frequent among those over 35 years of age. In multivariate regressions, the risk of ≥1 HR-HPV genotype at first and last screening was associated with younger age (adjusted odds ratio, aOR (95% confidence interval): 0.33 (0.18, 0.59); 0.34 (0.18, 0.58), p < 0.001) and concomitant STI (aOR 2.74 (1.59, 5.08), p < 0.001; 1.68 (1.09, 2.67), p : 0.023). A discrepancy between the recommend and actual age for screening was found. As a younger age and concomitant STIs were associated with infection by ≥1 HR-HPV, we promote a more tailored screening approach for both MWH and MWoH.

Objectives: Pre-exposure prophylaxis (PrEP) with emtricitabine/tenofovir to prevent HIV in individuals with hepatitis B virus (HBV) raises concerns about HBV reactivation when stopping event-driven PrEP or redundancy in HBV treatment for continuous PrEP (since tenofovir alone would be enough for HBV). Real-world data from PrEP services could provide useful epidemiological information on HBV prevalence in PrEP attendees in low-prevalence countries., Methods: A retrospective analysis on PrEP attendees of three services in northern Italy were conducted to assess HBV prevalence among PrEP attendees and the need for primary cycle/booster dose HBV vaccination despite previous vaccination during childhood (at birth or 12 years). Risk factors possibly associated with HBV exposure were evaluated with a binary logistic regression analysis, controlling for age, gender, place of birth (Italy vs abroad) and chemsex use (as a proxy of high-risk sexual behaviour for contracting sexually transmitted infections)., Results: Among 10 hepatitis B surface antigen (HBsAg)-positive out of 2152 PrEP attendees (0.46%), PrEP was started in 7 subjects mainly with a daily schedule, 1 has declined after counselling, 2 were lost to follow-up. Around three-fourth of the 2152 PrEP attendees were born in Italy after 1979, thus were previously vaccinated during childhood. The probability of needing a booster for low-titre HBs antibodies was higher among those vaccinated at birth with respect to those vaccinated at 12 years (OR 2.30, 95% CI 1.80 to 2.96). The risk of previous HBV exposure (resulting in either HBsAg+ or antibodies against HBV core antigen [HBcAb]+) was higher for increasing age (OR 3.07, 95% CI 2.49 to 3.78 per 10 years more) and lower for being born in Italy (OR 0.23, 95% CI 0.14 to 0.36)., Conclusions: Our real-world data on a large PrEP cohort suggest that, although uncommon, HBV infection in PrEP users in low-prevalence countries should be considered and managed. In addition, HBV screening offers the opportunity to expand prevention services through vaccination., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Oral HPV infection is the main risk factor for the development of oropharyngeal carcinoma. Men who have sex with men (MSM), especially if living with HIV (PLWH), are at increased risk of infection and consequently of cancer development. Aim of this study is to evaluate the impact of nonavalent vaccine on oral HPV infection in a cohort of MSM and transgender women (TGW). This prospective study included all MSM and TGW who started nonavalent HPV vaccination from May 2019 to September 2021. Oral rinse was collected before each vaccine administration and after six months of follow up. Descriptive statistics were used. Kaplan Meier probability curves and Cox regression models for HPV acquisition and clearance were calculated. The analysis included 211 individuals (202 MSM and 9 TGW). PLWH were 138 (65.4%). Baseline oral rinse was positive in 30 subjects (14.2%). Positivity rate did not change over time (p = 0.742), even when restricting the analysis only to high-risk genotypes (p = 0.575) and to genotypes covered by vaccine (p = 0.894). The risk to acquire HPV infection was 12.8% at one year and 33.4% at two years after vaccination. The probability to clear the infection was 67.6% at one year and 87.9% at two years. HIV infection had no impact on vaccine efficacy. Age above 45 years was the only factor associated to HPV acquisition (aHR 4.06, 95% CI 1.03-15.98, p = 0.045). Prevalence of oral HPV infection was higher in PLWH, but HIV had no impact on viral clearance or acquisition after vaccination., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)