Claudio Viscoli

Azienda Ospedaliera Universitaria San Martino di Genova, Genova, Liguria, Italy

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Publications (306)1130.69 Total impact

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    ABSTRACT: This study reviews recent trends of HIV inpatient admissions in two HIV centres in Europe. Chelsea and Westminster Hospital, London (UK) and four infectious diseases departments in Liguria, Italy (IT) collected data on inpatient HIV admissions from January to December 2012, including patient demographic, discharge diagnoses, CD4, viral load (VL) and combined anti-retroviral therapy (cART). Rate of patient admissions per 100 years was 6.12 for IT and 12.91 for UK (number of admissions UK=474, IT=257), 66.8% (n=488) of admissions had a VL under 400 copies/ml with 83.6% (n=611) of admissions were on cART. Median age was 47 years old. Mortality rate was 10.2% in IT and 2.8% in UK. Hepatitis C co-infection occurred in 64.6% of patients (n=166) in IT and 13.5% (n=64) in UK. Commonest diagnoses were infectious diseases (29.1%), respiratory diseases (16.6%) and neoplasms (15.0%). Majority of inpatients were taking cART and had a suppressed VL. The complications of Hepatitis C co-infection has a major impact on mortality rates and inpatient case load in Italy, and may cause similar patterns in London where rates are increasing. In the UK, a wider range of diagnoses is seen, requiring specialist input and working with other specialties. Copyright © 2015. Published by Elsevier Ltd.
    The Journal of infection. 01/2015;
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    ABSTRACT: Invasive aspergillosis remains associated with significant morbidity and mortality, necessitating new options for salvage therapy. The objective of this study was to evaluate the efficacy and safety of micafungin as salvage monotherapy in patients with invasive aspergillosis. Patients with proven or probable invasive aspergillosis, who were refractory or intolerant to previous systemic antifungal therapy, were randomised 2 : 1 to receive 300 mg day(-1) intravenous micafungin monotherapy or an intravenous control monotherapy [lipid amphotericin B (5 mg kg(-1) day(-1) ), voriconazole (8 mg kg(-1) day(-1) ) or caspofungin (50 mg day(-1) )] for 3-12 weeks. Patients underwent final assessment 12 weeks after treatment start. Seventeen patients with invasive aspergillosis (proven, n = 2; probable, n = 14; not recorded, n = 1) participated in the study (micafungin arm, n = 12; control arm, n = 5). Three patients each in the micafungin (25.0%; 95% CI: 5.5-57.2) and control arm (60.0%; 95% CI: 14.7-94.7) had successful therapy at end of treatment as assessed by an Independent Data Review Board. Eleven patients died; six due to invasive aspergillosis. No deaths were considered related to study treatment. During this study it became increasingly common to use combination treatment for salvage therapy. Consequently, enrolment was low and the study was discontinued early. No clear trends in efficacy and safety can be concluded. © 2014 Blackwell Verlag GmbH.
    Mycoses 01/2015; 58(1):58-64. · 1.81 Impact Factor
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    ABSTRACT: Background A multicenter observational study was conducted in Italy to assess the safety of micafungin in the daily clinical practice for the treatment of proven and suspected invasive candidiasis (IC), as well as to describe rates of clinical response to micafungin treatment. Methods From October 2010 to March 2012, data from consecutive eligible neonate, pediatric, and adult patients treated with micafungin for a proven or suspected IC were collected. Patients were deemed as eligible if they or their parents signed an informed consent. The study endpoints were to assess safety of micafungin in the treatment of both proven and suspected IC, and to describe rates of clinical response to micafungin treatment. Clinical response was assessed at the end of micafungin treatment (EOMT) and defined as favorable (complete or partial resolution of signs and symptoms) or unfavorable (stability or progression). Results During the study period, 108 patients with proven or suspected IC were enrolled. Thirty-six out of 108 patients (33%) were < 18 year-old (median 1 year), whereas 72 (67%) were ≥ 18 year-old (median 71 years). Neonates in NICU accounted for 36% of pediatric patients, with the majority of them (54%) being extremely low birth weight (ELBW) newborns. Fifty-eight out of 108 patients (54%) received micafungin for a proven IC, whereas 50/108 patients (46%) were treated for a suspected IC. Among proven IC, candidemia accounted for the majority of events (54/58, 93%), with Candida albicans (35/58, 60%) as the most frequently isolated species. Therapy was discontinued due to occurrence of an adverse event in 4/108 subjects (4%). No pediatric patient had treatment interruption because of adverse events. A 67% favorable response rate was observed at EOMT. No age-, species-, underlying conditions- or ward-related differences of favorable response were observed. Survival at EOMT was 90% (97/108 patients), with rates of 97% (35/36) and 86% (62/72) among children and adults, respectively.
    BMC Infectious Diseases 12/2014; 14(1):3852. · 2.56 Impact Factor
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    ABSTRACT: The aim of this study is to describe longitudinal changes in estimated glomerular filtration rate (eGFR) in a cohort of mother-to-child HIV-infected adolescents exposed to tenofovir dixoproxil fumarate (TDF) for at least 2 years. We retrospectively examined eGFR at starting TDF (T0), at 24 months (T2) and at the final assessment (T3). Twenty-nine patients were studied. The mean duration of TDF exposure was 67 months (24-123). At baseline, the mean eGFR was 152 ml/min/1.73 m(2) (105-227, SD, 33). There was a significant decrease of eGFR from a mean of 152 ml/min/1.73 m(2) (SD, 33) at T0 to 140 ml/min/1.73 m(2) (SD, 33) at T2 and 123 ml/min/1.73 m(2) (SD, 14) at T3. The decrease of eGFR was significant, with ΔGFR (T3-T0) of -29 ml/min/1.73 m(2) (SD, 30; p < 0.0001) and a mean ΔGFR per year of -6 and ml/min/1.73 m(2) (SD, 8). Conclusion: We noted a long-term decline in eGFR in this small cohort of mother-to-child HIV-infected adolescents receiving TDF-containing cART, even if the lack of a control group and the small sample size are major limitations.
    European Journal of Pediatrics 12/2014; · 1.98 Impact Factor
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    ABSTRACT: The spread of carbapenem-resistant gram negatives is a global emergency, and surveillance of new resistant clones is critical from both public health and clinical standpoints. Herein, we describe the emergence of a KPC-3-producing Escherichia coli ST69 as a cause of bloodstream infection in two Italian patients.
    Microbial drug resistance (Larchmont, N.Y.) 12/2014; · 1.99 Impact Factor
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    ABSTRACT: Invasive fungal diseases carry a high mortality risk which can be reduced by early treatment. Diagnosing invasive fungal diseases is challenging, because invasive methods for obtaining histological samples are frequently not feasible in thrombocytopenic immunocompromised patients, while fungal cultures have low sensitivity and a long turn-around time. Non-cultural methods are fundamental for a rapid diagnosis of invasive fungal diseases and they include assays based on the detection of fungal antigens (galactomannan, Aspergillus-lateral flow device, [1,3]-β-D-glucan, mannan), antibodies, such as anti-mannan, and molecular tests. With the exception of some molecular methods for rare fungi, the non-cultural assays are usually applied to the diagnosis of invasive aspergillosis, invasive candidiasis and pneumocystosis. The performance of a single test or a combination of tests will be discussed, with particular focus on choosing the most appropriate marker(s) for every specific patient population. Reasons for potential false-positive or false-negative results will be discussed.
    Expert Review of Anti-infective Therapy 11/2014; · 3.06 Impact Factor
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    ABSTRACT: Introduction: The persistence of immune activation and inflammation in HIV patients with HIV-RNA (VL) undetectable causes many co-morbidities [1-3]. The aim of this study is to correlate monocytes (m) and NK cell activation levels, soluble markers and oxidative stress with clinical, biochemical and metabolic data in HIV-1 infected patients with VL≤50 copies (cp)/mL on antiretroviral therapy. Materials and Methods: Multicentre, cross-sectional study in patients with VL≤50 cp/mL and on antiretroviral therapy by at least six months. We studied: activation/homing markers (CD38, HLA-DR, CCR-2, PDL-1) on inflammatory, intermediate, proinflammatory m; activatory receptors NKp30, NKp46 and HLA-DR on NK cells; soluble inflammatory (sCD14, adiponectina, MCP-1) and stress oxidative markers (dRoms, antiRoms). Univariate analyses are performed with non-parametric and Pearson tests. The significant correlations were adjusted for possible known confounding factors (smoking, Cytomegalovirus IgG serology, Raltegravir, Protease Inhibitor [PI] therapy and HCV-RNA) with multivariate analysis. Results: In the 68 patients the positive correlation between age and antiRoms was significant also after adjustment for PI use (p=0.05). The% CD8+T was associated with% proinflammatory m (p=0.043) and with their expression of CCR2 mean fluorescence intensity (MFI) (p=0.012). The% NKp46+ was positively correlated with CD4+T count (p=0.001). The fibrinogen was positively associated with dRoms (p=0.052) and the positive correlation between triglycerides and antiRoms has been confirmed (p<0.001); the impact of antiRoms on HDL/triglycerides ratio (p=0.006) was observed after adjustment for PI use. The BMI was associated with smoking (p=0.011). Only the maraviroc-treated patients showed minimal arterial pressure, fibrinogen and antiRoms lower (p=0.001, 0.004 e 0.006) and sCD14 values higher (p=0.029). Conclusions: Patients with long history of HIV infection and stable immunological and virological status showed interactions between acquired and innate immunity activation; moreover, the levels of some metabolic and inflammatory parameters correlate with oxidative stress values and innate immunity activation. The age, BMI and smoking impact metabolic and immunological parameters. The correlations between antiretroviral drugs and clinical-immunological parameters need further confirmations.
    Journal of the International AIDS Society 11/2014; 17(4(Suppl 3)):19718. · 4.21 Impact Factor
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    ABSTRACT: Introduction: The introduction of combined antiretroviral treatment (cART) has reduced HIV-associated morbidity and mortality, and changed the patients' perspective of life. As a result, Health Related Quality of Life (HRQOL) has become a crucial clinical issue. Objective: Assessment of HRQOL in a sample of Italian patients from IANUA study. Investigate correlation between CD4 cell counts, viral load and changes in HRQOL. Materials and Methods: EQ-5D-3L self-reported questionnaire has been used in the evaluation of HRQOL. It assesses five dimensions: "mobility," "self care," "usual activities," "pain/discomfort" and "anxiety/depression." Each dimension has three levels: no problems, some problems and extreme problems. In addition, it includes a Visual Analogue Scale (VAS) where one's own health "today" is rated from 0 "worst imaginable health" to 100 "best imaginable health." The respondents provide information on marital status, education, employment/unemployment, other treatments used in addition to HAART (1,2,3,4,5 or more) and number of hospitalizations due to HIV/AIDS. Results: 684 patients completed the questionnaire: 231 females and 453 males. The mean age of the sample was 51 years (range 21-78). The mean VAS score was 69.9. 558 patients (81.5%) reported no problems in mobility. 642 patients (93.5%) had no problems in self care. 423 patients (61.8%) had no pain/discomfort while 219 had some problems. 326 patients (46.1%) had some problems in anxiety/depression. Conclusions: The analysis of self-reported questionnaires indicates that HRQOL in our sample group is not deeply affected by HIV/AIDS. The dimensions that are affected in the least are "mobility" and "self care" while the major problem is "anxiety/depression" with half of the sample reporting moderate or high level.
    Journal of the International AIDS Society 11/2014; 17(4(Suppl 3)):19581. · 4.21 Impact Factor
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    ABSTRACT: We would like to add some comments to the paper “Detection of carbapenemases in Enterobacteriaceae: a challenge for diagnostic microbiological laboratories” by Hrabák J et al., which provides an exhaustive review of the state of the art in laboratory detection of carbapenemase-producing Enterobacteriaceae (CPE), including carbapenemase-producing Klebsiella pneumoniae (CPKP) [1].This article is protected by copyright. All rights reserved.
    Clinical Microbiology and Infection 11/2014; · 4.58 Impact Factor
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    ABSTRACT: Bacterial infections are among the most frequent complications of hematopoietic stem cell transplant (HSCT). This review describes current epidemiology and management of bacterial infections.
    Current Opinion in Hematology 11/2014; 21(6):451-458. · 4.05 Impact Factor
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    ABSTRACT: In the contest of HIV infected patients with several past antiretroviral therapies and multiple failures, it is possible to be faced with viruses resistant to all drug classes. We report on two HIV-1 infected patients in which the historical genotype showed mutations against all the major drug classes and in which viral suppression has been obtained by non-conventional combined antiretroviral therapy choices, including the association of darunavir at high dosage (800 mg bid), dolutegravir (50 mg bid) and a third agent, i.e. enfuvirtide in the first case and etravirine in the second one.
    International Journal of STD & AIDS 10/2014; · 1.04 Impact Factor
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    ABSTRACT: We report safety and tolerability of raltegravir (RAL) as a forth HIV agent in two highly viraemic newborns. Raltegravir (6 mg/kg) was given orally twice daily. The other antiretrovirals were assumed according to standard dose for newborns. The first baby was born at week 36. An antiretroviral therapy consisting of zidovudine, lamivudine, and lopinavir/ritonavir was started 96 hour after delivery. Raltegravir was added at hour 120, being plasma HIV-1 RNA above 10×10(6) copies/ml. HIV RNA declined to 5·000 copies/ml at day 30. The second baby was born at week 40. He was started on zidovudine, lamivudine, and nevirapine at day 0, while RAL was added at day 3. Plasma HIV-1 RNA declined from 6·6×10(6) at birth to 52 copies/ml at day 28. RAL tolerability was good in both patients, one with gamma-glutamyltransferase increase, which normalized after RAL discontinuation. Raltegravir-based four drug regimen may be effective and well tolerated in highly viraemic HIV neonates up to 4 weeks.
    Journal of chemotherapy (Florence, Italy) 09/2014; · 1.07 Impact Factor
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    ABSTRACT: Background Even in the era of highly active antiretroviral therapy (HAART), HIV-infected subjects are at higher risk of complications from vaccine-preventable diseases than those uninfected. The current international guidelines strongly recommend that these patients should receive all the routine childhood vaccinations. Although these children represent an appropriate target for immunization, the available data indicate suboptimal coverage rates. Methods To evaluate seroprotection/seropositivity rates and vaccination coverage against the common vaccine-preventable diseases, all patients with vertically transmitted HIV-1 infection who attended San Martino Hospital were enrolled. Blood samples were collected for testing antibodies against diphtheria, tetanus, hepatitis A and B viruses by Enzyme-Linked ImmunoSorbent Assay and polioviruses by microneutralization test. In order to assess immunization coverage, retrospectively was recorded the vaccination history collecting data from Regional Immunization Database. Results A total of 39 perinatally HIV-1 infected patients were included in the study. At the time of serum was obtained, the mean age was 18,1 years (range: 6-28). The median CD4+ T-lymphocyte count was 702 cells/mm (3) (2-1476 cells/mm (3)). Twenty-nine (74.4%) patients were found with HIV RNA load<50 copies/mL. The proportion of subjects with protective anti-tetanus and anti-HBs were 43.6% and 30.8%, respectively. Seroprotection rates about 20% against rubella and measles were found, less than 20% against all the other antigens investigated. In particular, all patients resulted susceptible to mumps. High immunization rates were observed for polio and HBV (100% and 92.3%, respectively) and suboptimal for diphtheria-tetanus (84.6%). For the other recommended vaccines the rates were generally low. None of the patients received varicella vaccine doses. Conclusions As in the HAART era the vertically acquired HIV infection has become a chronic treatable disease, the vaccine-induced long-term protection plays an increasingly significant role; despite good initial response to primary vaccination, subsequent decline and loss of detectable antibodies may be prevented by additional strategies for booster doses of vaccines in adolescents and young adults.
    Human Vaccines and Therapeutics 08/2014; 11(1). · 3.64 Impact Factor
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    ABSTRACT: Concomitant systemic and intracatheter antibiotic therapy is a therapeutic option for catheter-related bloodstream infections (CRBSI) in patient fitted with long-term intravenous central catheters. CRBSI are mainly caused by Gram-positive bacteria. Daptomycin (DPT) is an antibiotic active against Gram-positive bacteria with high bactericidal activity and good biofilm penetration.
    Infection 08/2014; · 2.86 Impact Factor
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    ABSTRACT: Elvitegravir/cobicistat/emtricitabine/tenofovir (EVG/COBI/FTC/TDF) is the new single-tablet, fixed-dose formulation containing an integrase strand transfer inhibitors recently approved as antiretroviral treatment. In this paper we analyze its use and advantages in naïve and experienced HIV-infected patients and we focused on special populations in which EVG/COBI/FTC/TDF could be a suitable option. Furthermore the manuscript reports the recent patent of EVG which may have an influence in the management of HIV-infected patients in the next future.
    Recent Patents on Anti-Infective Drug Discovery 07/2014;
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    ABSTRACT: Ninety-one serum samples from 51 hematology patients with bacteremia infections were tested for (1-3)-beta-D-glucan (BG). BG was positive in 11 samples (15%) from 7 patients (14%). Of these 7 patients with positive BG results, four (8%) had invasive aspergillosis and 3 (6%)had no invasive fungal disease. Bacteremia is an unlikely cause of false-positive BG.
    Clinical and vaccine Immunology: CVI 07/2014; · 2.37 Impact Factor
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    ABSTRACT: To investigate differences in liver enzyme elevation (LEE) between HIV-infected patients with and without HCV coinfection who start a darunavir/ritonavir-containing regimen.
    HIV Clinical Trials 07/2014; 15(4):151-60. · 2.14 Impact Factor
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    ABSTRACT: Knowledge of carbapenem-resistant Klebsiella pneumoniae (CR-KP) colonization is important to prevent nosocomial spread but also to start with prompt adequate antibiotic therapy in patients with infection suspicion. However, few studies have examined the incidence and risk factors for CR-KP bloodstream infection (BSI) among rectal carriers.To identify risk factors for CR-KP BSI among carriers, we performed a multicentre prospective matched case-control study of all adult CR-KP rectal carriers hospitalized in five tertiary teaching hospitals in Italy over 2-year period. Carriers who developed CR-KP BSI were compared with those who did not develop subsequent BSI.Overall, 143 CR-KP BSI were compared with 572 controls without a documented infection during their hospitalization. Multivariate analysis revealed that admission to ICU (OR 1.65, 95%CI 1.05-2.59, p=0.03), abdominal invasive procedure (OR 1.87, 95%CI 1.16-3.04, p=0.01), chemotherapy/radiation therapy (OR 3.07, 95%CI 1.78-5.29, p<0.0001), and number of additional colonization sites (OR 3.37 per site, 95% CI 2.56-4.43, p<0.0001) were independent risk factors for CR-KP BSI development among CR-KP rectal carriers. A CR-KP BSI risk score ranging from 0-28 was developed based on these 4 independent variables. At a cut-off of ≥ 2 the model exhibited a sensitivity, specificity, positive and negative predictive value of 93%, 42%, 29%, and 93%, respectively.Colonization at multiple sites with CR-KP was the strongest predictor of BSI development in our large cohort of CR-KP rectal carriers.This article is protected by copyright. All rights reserved.
    Clinical Microbiology and Infection 07/2014; · 4.58 Impact Factor
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    ABSTRACT: The epidemiology of HBV hepatitis has changed in recent years, especially after the introduction of anti-HBV vaccination, with a consequent decrease in the incidence of HDV-associated hepatitis. However, HDV remains of concern in non-vaccinated people and in immigrants. The aim of this retrospective survey has been to assess prevalence and clinical characteristics of HDV infection in Liguria, a region in Northern Italy, in both HIV positive and negative patients.
    Antiviral therapy 06/2014; · 3.14 Impact Factor
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    ABSTRACT: During June-July 2012, six imipenem-resistant Escherichia coli isolates were isolated from two patients hospitalized in a ward of one large tertiary-care hospital in Genoa, Italy. Genetic features associated with blaNDM-4 gene were investigated.
    BMC Microbiology 06/2014; 14(1):148. · 2.98 Impact Factor

Publication Stats

6k Citations
1,130.69 Total Impact Points

Institutions

  • 1994–2014
    • Azienda Ospedaliera Universitaria San Martino di Genova
      • Department of Surgical Oncology
      Genova, Liguria, Italy
  • 1988–2014
    • Università degli Studi di Genova
      • Dipartimento di Medicina sperimentale (DIMES)
      Genova, Liguria, Italy
  • 2012
    • Catholic University of the Sacred Heart
      • Institute of Clinical Infectious Diseases
      Roma, Latium, Italy
    • University of Milan
      • Department of Biomedical and Clinical Sciences "Luigi Sacco"
      Milano, Lombardy, Italy
  • 2011
    • Radboud University Medical Centre (Radboudumc)
      Nymegen, Gelderland, Netherlands
    • Azienda Ospedaliera Santa Maria della Misericordia
      Udine, Friuli Venezia Giulia, Italy
  • 2010
    • CHRU de Strasbourg
      Strasburg, Alsace, France
  • 2007
    • Universidade Federal de São Paulo
      San Paulo, São Paulo, Brazil
  • 2006
    • Hospital de la Santa Creu i Sant Pau
      Barcino, Catalonia, Spain
  • 2005
    • Hacettepe University
      • Department of Infectious Diseases
      Engüri, Ankara, Turkey
  • 1994–2005
    • CRO Centro di Riferimento Oncologico di Aviano
      Aviano, Friuli Venezia Giulia, Italy
  • 1995–2003
    • University Hospital of Lausanne
      Lausanne, Vaud, Switzerland
  • 1997
    • Great Ormond Street Hospital for Children NHS Foundation Trust
      • Department of Haematology and Oncology
      London, ENG, United Kingdom
  • 1991
    • IRCCS Istituto G. Gaslini
      • Department of Experimental and Laboratory Medicine
      Genova, Liguria, Italy
  • 1988–1991
    • Institut Jules Bordet
      Bruxelles, Brussels Capital Region, Belgium