Showing papers by "Elena Ricci published in 2012"

Probiotics reduce gut microbial translocation and improve adult atopic dermatitis.

Abstract: Background:It has been suggested that probiotics modulate atopic dermatitis (AD) progression, but no data are actually available on their mechanisms of action and on their ability to act as immunomodulators in this pathologyObjective:The aim of this randomized double-blinded active treatment versus

Raltegravir central nervous system tolerability in clinical practice: results from a multicenter observational study.

Abstract: Central nervous system (CNS) symptoms have been reported in clinical trials and case reports in patients receiving raltegravir. We investigated CNS symptoms in 453 HIV-infected patients. Of these 47 (10.4%) developed at least one drug-related CNS symptom. Predictors of CNS symptoms were concomitant therapy with tenofovir or with proton pump inhibitors that can increase raltegravir concentration. Thus, our data suggest a possible correlation between high raltegravir plasma concentrations and CNS symptoms, and therefore their monitoring in clinical practice.

Cost of human immunodeficiency virus infection in Italy, 2007-2009: effective and expensive, are the new drugs worthwhile?

Abstract: BACKGROUND In recent years, the increased efficacy and effectiveness of antiretroviral treatment has led to longer survival of patients infected with human immunodeficiency virus (HIV), but has also raised the question of what happens to consumption of resources. Early highly active antiretroviral treatment (HAART), management of hepatitis C virus (HCV) coinfection, and expensive newly marketed drugs may affect the economic sustainability of treatment from the point of view of the National Healthcare Services. The present study aimed to provide information on the economic burden of HIV-positive patients resident in the Lombardy region using a three-year time horizon. METHODS This was a retrospective, observational, budget impact study, based on information collected for the period 2007-2009, including hospitalizations, outpatient services, and HAART and non-HAART drug utilization. Patients with confirmed HIV infection, aged ≥ 18 years, resident in the Lombardy region, and followed at the "L Sacco" Hospital in Milan from 2007 to 2009 were eligible. RESULTS A total of 483 patients (mean age 44.1 years) were included in the study. The mean CD4+ cell count increased over the study period from 462 ± 242 cells/mm(3) in 2007, to 513 ± 267 cells/mm(3) in 2008, to 547 ± 262 cells/mm(3) in 2009. In total, 162 subjects (33.5%) were coinfected with HCV. Hospitalizations and HAART costs increased from 2007 to 2009, whereas outpatient visits and non-HAART drug costs decreased slightly over time. The total cost increase was also significant when limiting the analysis to experienced patients, HCV-negative patients, and experienced HCV-negative patients. CONCLUSION CD4+ cell count, a major predictor of costs, increased over the study period. However, immunological improvement was achieved by greater expense in the short term. Whether this may be compensated by a long-term decrease in opportunistic infections and in the costs of management of HIV-related events is an area still to be investigated.

96 Week follow-up of HIV-infected patients in rescue with raltegravir plus optimized backbone regimens: a multicentre Italian experience.

Abstract: Background Long term efficacy of raltegravir (RAL)-including regimens in highly pre-treated HIV-1-infected patients has been demonstrated in registration trials. However, few studies have assessed durability in routine clinical settings.

Temporal trends in the frequency of hydatidiform mole in lombardy, northern Italy, 1996-2008.

Abstract: Objective To analyze temporal trends of hospital admissions due to molar pregnancies in Italian and non-Italian women in Lombardy during the 1996–2008 period. Methods A standard form is used to register all discharges from public or private hospitals in Lombardy. Hydatidiform mole (HM) cases were identified when searching the database for code 630 of the International Classification of Diseases, Ninth Revision (ICD-9). Ratios of HM per 100,000 pregnancies in strata of age and nationality were computed. Results The estimated frequency of HM in Lombardy over the period 1996–2008 was 104.4 per 100,000 pregnancies (SE, 2.8) or 1 case in 935 pregnancies. The frequency of HM tended to decrease in the late 1990s, the crude ratio per 100,000 pregnancies being 127.3 in 1996, 89.3 in 2000, and 113.1 in 2008. The temporal trend analysis, adjusted for age class and geographical origin, showed a significant decrease (P = 0.025). The frequency of HM was 99.8/100,000 pregnancies among Italian women, 112.1/100,000 pregnancies among women from other European countries, 85.1/100,000 pregnancies among women from Africa, 176.9/100,000 pregnancies from South America, and 163.0/100,000 pregnancies among Asian women. Considering the periods 1996–2001 and 2002–2008 separately, the frequency of HMs was largely similar for all groups, except in Asian women: in this group, the frequency of HMs was 242.7/100,000 pregnancies and 120.1/100,000 pregnancies in 1996–2001 and 2002–2008, respectively. Conclusion Between 1996 and 2008, the HM incidence in Lombardy showed a slight but significant decrease, mostly owing to the decrease of HM incidence among Asian women.

Efficacy of 1998 Vs 2006 first-line antiretroviral regimens for HIV infection: An ordinary clinics retrospective investigation

Abstract: Purpose: The evidence suggesting increased HAART efficacy over time comes from randomized trials or cohort studies. This retrospective multicenter survey aimed to assess the variation over time in the efficacy and tolerability of first-line HAART regimens in unselected patients treated in ordinary clinical settings. Methods: Retrospective analysis of data of all patients starting first-line HAART regimens in 1998 and 2006 at adhering centers in the Italian CISAI group. Results: For the 543 patients included, mean age was 39.1 ± 9.8y in 1998 and 41.0 ± 10.7y in 2006 (p=0.03), with a similar proportion of males. Baseline mean log10 HIV-RNA was 4.56 ± 0.97 copies/mL in 1998 vs 4.91 ± 0.96 copies/mL in 2006 (p<0.001); baseline mean CD4 T-cell counts were 343 ± 314/mm3 in 1998 vs 244 ± 174/mm3 in 2006 (p<0.001). The following outcomes were significantly improved at 48w in 2006: proportion with undetectable HIV-RNA (86.3% vs 58.0%; p<0.001); mean increase in CD4 T-cells count (252 ± 225 vs 173 ± 246; p<0.001); HAART modification (20.1% vs 29.2%; p=0.02); HAART interruption (7.3% vs 14.6%; p=0.01); proportion reporting optimal adherence (92.2% vs 82.7%, p=0.03). No differences were observed in the prevalence of grade 3-4 WHO toxicities (26.4% vs 26.6%; p=0.9). Multivariate logistic regression showed that being treated in 1998 remained an independent predictor of virological failure after several adjustments, including adherence. Conclusions: Our data from patients not included in clinical trials or cohort studies provide an additional line of evidence that the effectiveness of HAART significantly improved in 2006. Treated patients, however, were significantly older and more frequently late HIV presenters in 2006 than in 1998.

Low frequency of skin reactions in a cohort of patients on raltegravir

Abstract: HIV, antiretroviral therapy, safetySir,In the last 25 years, highly active antiretroviral therapy hasbeen continuously improving the life expectation and qualityof HIV-infected people. As new drugs were more effectiveand adverse events less frequent and severe, HIV infectionturned into a chronic disease. Recently licensed drugs, suchas raltegravir and darunavir, are characterized by high efficacyand tolerability. However, on 2 November 2011, updates tothe Isentress (raltegravir) package insert were approved bythe FDA to include a new warning, subsequent to the post-marketing experience.