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Desimplification to multi-tablet antiretroviral regimens in human immunodeficiency virus-type 1 infected adults: A cohort study

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World Journal of Clinical Cases 2019年第14期7卷 1814-1824页

作者： Maria C Rossi Walter O Inojosa giuseppe Battistella Antonella Carniato Francesca Farina Mario giobbia Rodolfo Fuser pier g scotton Infectious Diseases Unit Treviso HospitalTreviso 31100Italy Epidemiology and Statistic Unit Azienda ULSS 2 “Marca Trevigiana”Treviso 31100Italy

BACKgROUND Highly active antiretroviral therapy (HAART) is provided free of charge to all human immunodeficiency virus (HIV) positive residents in Italy. As fixed dose coformulations (FDCs) are often more expensive in comparison to the same drugs administered separately in a multi-tablet regimen (MTR), we considered a costeffective strategy involving patients in the switch from their FDCs to corresponding MTRs including generic antiretrovirals. AIM To verify if this would affect the virological and immunological response in comparison to maintaining the FDC regimens. METHODS From January 2012 to December 2013, we assessed the eligibility of all the HIV-1 positive adults on stable HAART being treated at our hospital-based outpatient clinic in Treviso, Italy. Participants who accepted to switch from their FDC regimen to the corresponding MTR joined the MTR group, while those who maintained a FDC regimen joined the FDC group. Clinical data, including changes in HAART regimens, respective reasons why and adverse effects, were recorded at baseline and at follow-up visits occurring at weeks 24, 48 and 96. All participants were assessed for virological and immunological responses at baseline and at weeks 24, 48 and 96. RESULTS Two hundred and forty-three eligible HIV-1 adults on HAART were enrolled: 163 (67%) accepted to switch to a MTR, joining the MTR group, while 80 (33%) maintained their FDCs, joining the FDC group. In a parallel analysis, there were no significant differences in linear trend of distribution of HIV-RNA levels between the two groups and there were no significant odds in favour of a higher level of HIV-RNA in either group at any follow-up and on the overall three strata analysis. In a before-after analysis, both FDC and MTR groups presented no significant differences in distribution of HIV-RNA levels at either weeks 48 vs 24 and weeks 96 vs 24 cross tabulations. A steady increase of mean CD4 count was observed in the MTR group only, while in the FDC grou

关键词： Fixed-dose coformulations Fixed dose coformulation regimens Multitablet regimens Human immunodeficiency virus Highly active antiretroviral therapy

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Mycobacterium chimaera infections following cardiac surgery in Treviso Hospital, Italy, from 2016 to 2019: Cases report

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World Journal of Clinical Cases 2019年第18期7卷 2776-2786页

作者： Walter O Inojosa Mario giobbia giovanna Muffato giuseppe Minniti Francesco Baldasso Antonella Carniato Francesca Farina gabriella Forner Maria C Rossi Stefano Formentini Roberto Rigoli pier g scotton Infectious Diseases Unit Treviso HospitalTreviso 31100Italy Microbiology Unit Treviso HospitalTreviso 31100Italy Cardiac Surgery Unit Treviso HospitalTreviso 31100Italy Health Management Unit Treviso HospitalTreviso 31100Italy

BACKgROUND An epidemic of Mycobacterium chimaera (M. chimaera) infections following cardiac surgery is ongoing worldwide. The outbreak was first discovered in 2011, and it has been traced to a point source contamination of the LivaNova 3T heater-cooler unit, which is used also in Italy. International data are advocated to clarify the spectrum of clinical features of the disease as well as treatment options and outcome. We report a series of M. chimaera infections diagnosed in Treviso Hospital, including the first cases notified in Italy in 2016. CASE SUMMARY Since June 2016, we diagnosed a M. chimaera infection in nine patient who had undergone cardiac valve surgery between February 2011 and November 2016. The time between cardiac surgery and developing symptoms ranged from 6 to 97 mo. Unexplained fever, psychophysical decay, weight loss, and neurological symptoms were common complaints. The median duration of symptoms was 32 wk, and the longest was almost two years. A new cardiac murmur, splenomegaly, choroidoretinitis, anaemia or lymphopenia, abnormal liver function tests and hyponatremia were common findings. All the patients presented a prosthetic valve endocarditis, frequently associated to an ascending aortic pseudoneurysm or spondylodiscitis. M. chimaera was cultured from blood, bioprosthetic tissue, pericardial abscess, vertebral tissue, and bone marrow. Mortality is high in our series, reflecting the poor outcome observed in other reports. Three patients have undergone repeat cardiac surgery. Five patients are being treated with a targeted multidrug antimycobacterial regimen. CONCLUSION Patients who have undergone cardiac surgery in Italy and presenting with signs and symptoms of endocarditis must be tested for M. chimaera.

关键词： Mycobacterium chimaera Prosthetic valve endocarditis Spondylodiscitis Cardiac surgery infections Case report

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