Showing papers by "Raffaele Bruno published in 2018"
TL;DR: In a prospective, non‐randomized study of patients with cirrhosis, under‐dilation of PTFE‐SGs during TIPS placement is found to be feasible, associated with lower rates of PSE, and effective.
79 citations
Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico1, Marche Polytechnic University2, University of Milan3, University of Bari4, Vita-Salute San Raffaele University5, Sapienza University of Rome6, University of Turin7, University of Brescia8, University of Catania9, University of Rome Tor Vergata10
TL;DR: This study confirms a good renal safety profile of OBV/PTV/r + DSV treatment in HIV/HCV patients, and the median decline of 2 ml/min in eGFR, albeit statistically significant, is of doubtful clinical significance.
Abstract: The renal function is a key-issue in HIV/HCV co-infected patients, nevertheless, it has not established so far whether HCV treatment with new direct acting agents could impact on estimated glomerular filtration rate (eGFR) variations. In the present work, we examined the real-life data on renal function that have been prospectively collected in the SIMIT compassionate-use program of ombitasvir/paritaprevir/ritonavir plus dasabuvir (OBV/PTV/r + DSV) in 144 HIV/HCV genotype 1 co-infected patients. The population was 74% male, 30.5% in CDC stage C, with median age of 52 years (48.0-56.5) and median liver stiffness of 7.8 kPa (6.7-9.2). Median baseline eGFR was 102.0 (90.8-108.1), changing to 99.8 (83.5-104.8) at the end of treatment (EoT), and 100.0 (87.3-105.6) 12 weeks after the EoT (FU12), p<0.0001. No patient had grade 3-4 increase of creatinine. At EoT 60/144 (41.7%) patients had ≥ 5% reduction in their eGFR, confirmed at FU12 in 39/60 (65.0%) cases. Longer duration of HCV infection (cut-off 12.9 years), lower HCV-RNA viral load (cut-off 1,970,160 IU/ml) and lower platelet count (cut-off 167,000 x106/L) were significantly associated with eGFR decline at logistic analysis (adjOR 2.9, 95%CI 1.0-8.8, p = 0.05; adjOR 3.5, 95%CI 1.2-10.4, p = 0.02; adjOR 2.8, 95%CI 1.1-6.8, p = 0.03, respectively). After repeating the analysis throughout a mixed model, a higher eGFR decline was highlighted in patients concomitantly treated with tenofovir (p = 0.0001), ribavirin (p = 0.0001), or integrase inhibitors (p <0.0001), with longer duration of HIV (p = 0.0002) and HCV infection (p = 0.035), lower baseline HCV RNA (p <0.0001), previous HCV treatment (p<0.0001), and older age (p<0.0001). In conclusion, our study confirms a good renal safety profile of OBV/PTV/r + DSV treatment in HIV/HCV patients, and the median decline of 2 ml/min in eGFR, albeit statistically significant, is of doubtful clinical significance. The role of aging, concomitant therapies and duration of HIV/HCV infection needs to be further investigated.
25 citations
University of Modena and Reggio Emilia1, University of Southern California2, Istituto Superiore di Sanità3, Sapienza University of Rome4, University of Turin5, University of Naples Federico II6, AbbVie7, Humanitas University8, University of Pisa9, University of Cagliari10, University of Florence11, University of Milan12, University of Padua13, University of Salerno14, Vita-Salute San Raffaele University15, Seconda Università degli Studi di Napoli16
TL;DR: Ovarian senescence in women of childbearing age who are HCV+ is associated with a lower chance of live birth, greater risk of infertility, gestational diabetes, pre-eclampsia and miscarriage, and such risks could be positively influenced by successful HCV cure.
19 citations
01 Dec 2018
TL;DR: A case of sepsis due to methicillin-resistant S. pettenkoferi is described, a recently identified organism reported to be responsible for a growing number of infections.
Abstract: Coagulase-negative staphylococci are part of the human skin flora but are frequently responsible for bloodstream infection, especially in the presence of intravascular devices or immunosuppressive conditions. Antibiotic resistance in such bacteria is common, with more than 80% of isolates resistant to methicillin. Among this genus Staphylococcus pettenkoferi is a recently identified organism, reported to be responsible for a growing number of infections. Here we describe a case of sepsis due to methicillin-resistant S. pettenkoferi.
9 citations
TL;DR: The findings suggest that OBV/PTV/r + DSV’s + RBV is safe and effective in real-life use in patients with compensated cirrhosis, HCV-GT1 infection, and age over 65.
Abstract: To analyse safety and efficacy of treatment based on ombitasvir/paritaprevir/ritonavir/dasabuvir plus ribavirin in the sub-group of GT1 patients older than 65 years. We collected data extracted from the ABACUS compassionate-use nationwide Italian programme, in patients with cirrhosis due to hepatitis C virus (HCV) Genotype-1 (GT1) or 4 and at high risk of decompensation. GT1-HCV-infected patients received once-daily ombitasvir/paritaprevir, with the pharmacokinetic enhancer ritonavir (25/150/100 mg) and twice-daily dasabuvir (250 mg) plus Ribavirin (RBV) (OBV/PTV/r + DSV + RBV) for 12 (GT1b) or 24 (GT1a) weeks. Endpoints were to evaluate safety and efficacy, the latter defined as HCV RNA negative 12 weeks after the end of treatment (SVR12). Patients who suffered any adverse event (AE) were 74/240 (30.8%); 13/240 (5.4%) discontinued the treatment. A multivariate analysis found albumin < 3.5 g/dL (OR 2.04: 95% CI 1.0–4.2, p < 0.05) and hypertension (OR 4.6: 95% CI 2.3–9.2, p < 0.001) as variables independently associated with AE occurrence. The SVR12 was 95% (228/240). Multivariate analysis identified baseline bilirubin < 2 mg/dL (OR 4.9: 95% CI 1.17–20.71, p = 0.029) as the only variable independently associated with SVR12. Our findings suggest that OBV/PTV/r + DSV + RBV is safe and effective in real-life use in patients with compensated cirrhosis, HCV-GT1 infection, and age over 65.
7 citations
TL;DR: Treatment of AHC with direct-acting antivirals (DAA) is safe and effective; it overcomes the limitations of INF-based treatments.
Abstract: This paper is aimed at providing practical recommendations for the management of acute hepatitis C (AHC). This is an expert position paper based on the literature revision. Final recommendations were graded by level of evidence and strength of the recommendations. Treatment of AHC with direct-acting antivirals (DAA) is safe and effective; it overcomes the limitations of INF-based treatments. Early treatment with DAA should be offered when available.
6 citations
TL;DR: Patients at risk of any flare of HCV-related liver disease during active therapy for cancer should be managed with a multidisciplinary approach where all relevant diagnostic techniques and therapeutic resources are available.
2 citations
TL;DR: A 47-year-old Egyptian patient seen in the hepatology outpatient clinic for portal hypertension in chronic hepatitis B virus (HBV) infection, HbeAg negative, had a strongly positive serology by ELISA and by indirect hemagglutination test, whereas microscopic examination of stools and urine did not show Schistosoma eggs.
Abstract: A 47-year-old Egyptian patient was seen in our hepatology outpatient clinic for portal hypertension in chronic hepatitis B virus (HBV) infection, HbeAg negative. In consideration of the patient's origin, investigations were undertaken to identify Schistosoma infection. There was a strongly positive serology by ELISA and by indirect hemagglutination test (IHA), whereas microscopic examination of stools and urine did not show Schistosoma eggs.
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TL;DR: A meta‐analyses of FibroTest diagnosis value in chronic liver disease and prognostic significance of blood fibrosis tests and liver stiffness measurement by FibroScan in non‐alcoholic fatty liver disease found that non‐invasive tests are enough.
Abstract: 1. Younossi ZM, Koenig AB, Abdelatif D, et al. Global epidemiology of nonalcoholic fatty liver disease‐Meta‐analytic assessment of prevalence, incidence, and outcomes. Hepatology. 2016;64:73‐84. 2. Ekstedt M, Hagstrom H, Nasr P, et al. Fibrosis stage is the strongest predictor of disease specific mortality in NAFLD after up to 33 years of follow‐up. Hepatology. 2015;61:1547‐1554. 3. Castera L. Diagnosis of non‐alcoholic fatty liver disease/non‐alcoholic steatohepatitis: non‐invasive tests are enough. Liver Int. 2018;38:67‐70. 4. Poynard T, Morra R, Halfon R, et al. Meta‐analyses of FibroTest diagnosis value in chronic liver disease. BMC Gastroenterol. 2007;7:40. 5. Munteanu M, Pais R, Peta V, et al. Long‐term prognostic value of the FibroTest in patients with non‐alcoholic fatty liver disease, compared to chronic hepatitis C, B, and alcoholic liver disease. Aliment Pharmacol Ther. 2018;48:1117‐1127. 6. Boursier J, Vergniol J, Guillet A, et al. Diagnostic accuracy and prognostic significance of blood fibrosis tests and liver stiffness measurement by FibroScan in non‐alcoholic fatty liver disease. J Hepatol. 2016;65:570‐578. 7. Vilar‐Gomez CN. Non‐invasive assessment of non‐alcoholic fatty liver disease: clinical prediction rules and blood based biomarkers. J Hepatol. 2018;68:305‐315.