M Galli

Ospedale Luigi Sacco, Milano, Lombardy, Italy

Are you M Galli?

Claim your profile

Publications (251)1348.09 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Switch to unboosted atazanavir (ATV) is an attractive option due to convenience and tolerability in HIV-positive patients. With limited available data we investigated the determinants of long-term efficacy and the consequences of virological failure of unboosted atazanavir-based regimens. Methods: Retrospective analysis in two Italian large outpatient clinics including demographic, immunovirological, resistance and pharmacokinetic data. Results: 249 patients receiving atazanavir (400 mg once-daily) plus 2 NRTIs were included; 163 were males (65.5%) and median age was 47 years (42-51.5). Median CD4+ T-cell count was 396/uL (261-583); 146 (58.6%) presented a viral load <50 copies/mL. Over a median follow up of 157 weeks (106-203) 193 patients (77.5%) were still on treatment with 10 (4%) and 2 (0.8%) stopping for virological failure or toxicity, respectively. Ten patients with virological failure presented newly selected resistance associated mutations (RAMs) for NRTIs (2/10) or ATV (4/10, one I50L). Total cholesterol and triglycerides showed significant decreases at 48 [-4 mg/dL and -41 mg/dL] and 96 weeks [-14 mg/dL and -54 mg/dL] as compared to baseline. At multivariate analysis a genotypic sensitivity score ≤1, atazanavir RAMs >1 and suboptimal adherence were independently associated with virological failure; in lamivudine/emtricitabine-treated patients the presence of M184V (without other NRTI RAMs) was not associated with virological failure. Conclusions: Unboosted-atazanavir containing regimens were efficacious (with uncommon virological failures) and well-tolerated (with improvements in lipid profile over time) treatments in HIV-positive patients. Isolated M184V in lamivudine/emtricitabine recipients was not associated with higher failure rates supporting the use of functional ATV-based dual therapies as maintenance strategies.
    Current HIV Research 08/2014; · 2.03 Impact Factor
  • Source
  • [Show abstract] [Hide abstract]
    ABSTRACT: To develop recommendations for the management of acute hepatitis B by the Italian Society for the Study of Infectious and Tropical Diseases.
    Infection 07/2014; · 2.44 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: OBJECTIVE: The aim of this study was to validate the classification criteria for cryoglobulinaemic vasculitis (CV). METHODS: Twenty-three centres were involved. New patients with CV (group A) and controls, i.e. subjects with serum cryoglobulins but lacking CV based on the gold standard of clinical judgment (group B) and subjects without cryoglobulins but with clinical features that can be observed in the course of CV (group C), were studied. Positivity of serum cryoglobulins was necessary for CV classification. Sensitivity and specificity of the criteria were calculated by comparing group A vs group B. The group A vs group C comparison was done to demonstrate the possible diagnostic utility of the criteria. RESULTS: The study included 268 patients in group A, 182 controls in group B and 193 controls in group C (small vessel vasculitis, 51.8%). The questionnaire (at least 2/3 positive answers) showed 89.0% sensitivity and 93.4% specificity; the clinical item (at least 3/4 clinical involvement) showed 75.7% sensitivity and 89.0% specificity and the laboratory item (at least 2/3 laboratory data) showed 80.2% sensitivity and 62.4% specificity. The sensitivity and specificity of the classification criteria (at least 2/3 positive items) were 89.9% and 93.5%, respectively. The comparison of group A with group C demonstrated the clinical utility of the criteria in differentiating CV from CV mimickers. CONCLUSION: Classification criteria for CV were validated in a second, large, international study confirming good sensitivity and specificity in a complex systemic disease.
    Rheumatology (Oxford, England) 07/2014; · 4.24 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: SETTINGLuigi Sacco Hospital, Milan, Italy, 1 January 2000–31 December 2010. OBJECTIVES To develop a predictive score for identifying human immunodeficiency virus (HIV) infected patients with pulmonary tuberculosis (PTB). DESIGNRetrospective study based on the medical charts of HIV-infected patients admitted consecutively on presumption of PTB. Patients with culture-positive TB were included in the TB group. Culture-negative subjects formed the non-TB group. Risk factors for PTB were identified and a predictive model was developed. The diagnostic test accuracy of the derived score and that of previously developed scores were analysed. RESULTSA total of 65 patients were included in the TB group and 505 subjects in the non-TB group. An eight-variable model (age, origin, alcohol use, respiratory rate, weight loss, haemoglobin, white blood cell count, typical chest X-ray) was derived. When compared with the different scores, this model showed the greatest area under the receiver operating characteristic curve (0.880). This score was the only one to present a negative likelihood ratio of CONCLUSIONS This model may be useful in predicting PTB in HIV patients in low-endemic countries. A validation study is necessary.
    The International Journal of Tuberculosis and Lung Disease 07/2014; 18(7):831-6. · 2.76 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: We have developed a sequencing assay for determining the usage of the genotypic HIV-1 co-receptor using peripheral blood mononuclear cell (PBMC) DNA in virologically suppressed HIV-1 infected patients. Our specific aims were to (1) evaluate the efficiency of V3 sequences in B versus non-B subtypes, (2) compare the efficiency of V3 sequences and tropism prediction using whole blood and PBMCs for DNA extraction, (3) compare the efficiency of V3 sequences and tropism prediction using a single versus a triplicate round of amplification. The overall rate of successful V3 sequences ranged from 100 % in samples with >3,000 copies HIV-1 DNA/10(6) PBMCs to 60 % in samples with <100 copies total HIV-1 DNA /10(6) PBMCs. Analysis of 143 paired PBMCs and whole-blood samples showed successful V3 sequences rates of 77.6 % for PBMCs and 83.9 % for whole blood. These rates are in agreement with the tropism prediction obtained using the geno2pheno co-receptor algorithm, namely, 92.1 % with a false-positive rate (FPR) of 10 or 20 % and of 96.5 % with an FPR of 5.75 %. The agreement between tropism prediction values using single versus triplicate amplification was 98.2 % (56/57) of patients using an FPR of 20 % and 92.9 % (53/57) using an FPR of 10 or 5.75 %. For 63.0 % (36/57) of patients, the FPR obtained via the single amplification procedure was superimposable to all three FPRs obtained by triplicate amplification. Our results show the feasibility and consistency of genotypic testing on HIV-1 DNA tropism, supporting its possible use for selecting patients with suppressed plasma HIV-1 RNA as candidates for CCR5-antagonist treatment. The high agreement between tropism prediction by single and triple amplification does not support the use of triplicate amplification in clinical practice.
    Infection 10/2013; · 2.44 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The prevalence of drug resistance associated with the failure of non-nucleoside reverse transcriptase inhibitor (NNRTI)-based regimens and the predictors of resistance to Etravirine (ETR) were assessed in 2854 subjects: 39 < 18 (paediatric) and 2815 ≥ 18 (adult) years old. These subjects failed to respond to their current NNRTI treatment, were three-class experienced and had been exposed to NNRTI for ≥3 months. A total of 1827 adult (64.9%) and 32 paediatric subjects (82.1%) harboured the virus with at least one ETR mutation. V179I, Y181C and G190A were the most frequent mutations in both groups. A significantly increased risk of ETR resistance with all three algorithms (Monogram (MGR) >3, Tibotec (TBT) >2 and enhanced MGR (ENH) ≥4) emerged in the paediatric population. Multivariate analysis revealed an increased risk of developing TBT >2 for NNRTI exposure, ENH ≥4 for NNRTI and EFV exposure in paediatric subjects; NVP exposure and higher (≥3.5 log10) HIV-RNA values for all three algorithms in adult subjects, whereas CD4 ≥ 200/μL appeared to be protective. The risk of being ETR resistant was more than doubled for paediatric vs. adult subjects, probably due to a more extensive use of NNRTI and an incomplete virological control.
    Clinical Microbiology and Infection 03/2013; · 4.58 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: There is debate about whether lopinavir/r mono-therapy (LPV/r-MT) is a valid treatment option for HIV-infected patients who have shown perfect adherence to therapy. The objective was to evaluate the durability of LPV/r-MT in terms of time to virological rebound (VR), time to discontinuation/intensification or a composite endpoint considering both (=treatment failure). We also identified factors associated with faster progression to treatment failure and estimated the median CD4 count over time while people were still on LPV/r-MT. Patients enrolled in 10 clinical sites in Italy who ever started LPV/r-MT with a viral load ≤50 copies/mL (baseline) are included. Patients' follow-up accrued from baseline to the date of the event of interest (VR, defined using the thresholds of 50 and 200 copies/mL, or discontinuation/intensification) or at the date of last available visit/VL measurement. Standard survival analysis employing Kaplan-Meier curves was used. We studied 139 patients starting LPV/r-MT on average in 2010 (IQR: 2009-2011) with a VL≤50 copies/mL already for a median of 1 month (range: 1-17). Median age 45 years (IQR: 39-50), 35% females, 32% IDU. Median time from first initiation of ART was 33 months (16-58) with no history of virological failure. Median (IQR) marker values at baseline were 611 (432-741) CD4 count cells/mm(3), 937 (655-1254) CD8 count and 28 (19-47) IU/L of ALT. Median CD4 count were 519 cells/mm(3) at 3 months, 660 at 6 months, 603 at 9 months and 467 at 12 months. The table shows the Kaplan-Meier estimates by 1 year and 2 years for a number of endpoints examined. There was a wide range of estimates depending on the endpoint used. Of those stopping/intensifying, 6 people (4%) added Truvada (n=4), Kivexa (n=1) and darunavir (n=1), the remaining 8 restarted cART.In our 'real-life' setting, by 2 years of starting LPV/r-MT, 70% of patients remained persistently suppressed ≤50 copies/mL. This percentage was >80% when considering only confirmed virological failures while people still remaining on the drug. Our results, though lacking precision because of the small number of events, are consistent with those of recent clinical trials.
    Journal of the International AIDS Society 11/2012; 15(6):18378. · 3.94 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: In HIV-positive patients (pts), CMV co-infection has been proposed as a key factor in sustaining immune activation, which in turn could play a role in determining immune senescence. We evaluated the prevalence and predictors of CMV co-infection in a cohort of HIV+ pts and assessed the impact of CMV co-infection on the risk of AIDS and non-AIDS events. We included pts in the ICONA study with<1 month follow-up and<1 CMVIgG (CMV) test available without active CMV disease. Pts' characteristics at time of the first CMV test (baseline) were compared in those tested positive (CMV+) and negative (CMV-) using X2/Wilcoxon tests. Factors associated with CMV+ were identified by logistic regression. A prospective analysis was also performed with endpoints AIDS/AIDS-related death and severe non-AIDS (SNA: cardio-cerebrovascular, neurologic disease, renal failure, non-AIDS tumours)/death due to SNA. Time to event was estimated by Kaplan-Meier curves and Cox regression (multivariable model included: age, gender, ethnicity, risk factor for HIV, HCVAb and HBsAg, AIDS and CD4 at baseline, initiation of ART prior to baseline). 6,053 pts were included; 83.7% were tested CMV+ a median of 17 (IQR 6-45) months after enrolment. As compared to CMV-, CMV+ were older (adjusted odds ratio (AOR) 1.03 per 1 year older [95% CI 1.02-1.04]), HIV infected by homosexual route (MSM) (AOR 1.39 [95% CI 1.06-1.82]), less frequently Caucasian (AOR 0.56 [95% CI 0.42-0.76]), with higher CD4 count at baseline (AOR per 1 cell higher 1.035 [95% CI 1.00-1.06] By 10 years from first CMV test, 402 (12.6% [95% CI 11.1-13.6]) CMV+ and 74 (10.1% [95% CI 7.7-12.5]) CMV- pts developed AIDS/AIDS-related death (log-rank p=0.43). After adjustment for potential confounders, CMV+was still not associated with the risk of AIDS/AIDS-related death (adjusted hazard ratio (AHR) 1.23 [95% CI 0.96-1.60]). By 10 years, 339 (10.6% [95% CI 9.4-11.9]) CMV+ and 41 (6.4% [95% CI 6.1-6.6]) CMV- pts experienced a non-AIDS event/non-AIDS death (log-rank p=0.0006): 151 cancers, 128 CVD, 33 neurological, 1 renal. The association was still significant after controlling for a number of potential confounders: AHR 1.77 [95% CI 1.25-2.51] p=0.001; Table). In our study population, CMV/HIV co-infection was associated with the risk of non-AIDS events/deaths independently of other prognostic factors, supporting a potential role of CMV infection in vascular/ degenerative organ disorders commonly associated with chronic immune activation and aging.
    Journal of the International AIDS Society 11/2012; 15(6):18197. · 3.94 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: To evaluate the factors that may influence the persistence and the virological failure of an atazanavir (ATV)-containing antiretroviral regimen. We conducted a retrospective cohort study in HIV-positive patients (pts) who were being followed at the Infectious Diseases Division, University of Milan. Data regarding viral load, CD4 lymphocytes and the blood chemistry parameters were collected at 1st, 3rd, 6th months from the beginning of therapy and then every six months. Factors related to persistence of therapy with ATV and virological failure (HIV-RNA>50cp/mL after six months) were evaluated with Kaplan-Meier curve, Cox model and logistic regression. 574 pts were evaluated: 480 experienced therapy with ATV with ritonavir (ATV/r) (80 naïve), 218 with unboosted ATV (5 naïve) and 124 with both regimens. At baseline: median age of 43 years (IQR 39-48), CD4+median count 418 cell/mm(3) (IQR 277-606), VL<50cp/mL in 370 pts (54.4%), and median duration of infection 12 years (IQR 6-18). The median duration of therapy was 21 months (IQR 7-49) in pts treated with ATV/r and 22 months (IQR 8-44) with unboosted ATV. We observed a borderline significant difference for the persistence of the regimen between the two groups (p=0.05) that disappears after removing the suspensions for simplification. Pts treated with ritonavir (OR=1.563; 95% CI 1.058-2.308, p=0.025) and with a backbone containing AZT-ddI-d4T (OR=3.34; 95% CI 1.873-5.956, p<0.001) had an increased risk of therapy suspension, whereas starting therapy with ATV in recent years resulted protective (OR=0.741; 95% CI 0.678-0.809, p<0.001). The suspension for toxicity was not significantly different between pts treated with ATV/r and unboosted ATV. No significant difference between the two therapies was observed regarding virological failure. Of note, pts with an elevated VL at baseline (OR 1.234; 95% CI 1.065-1.429, p=0.005) and male gender (OR 1.667; 95% CI 1.06-2.621, p=0.027) were at elevated risk of failure, whereas a backbone containing AZT-ddI-d4T (OR 0.356; 95% CI 0.196-0.638, p=0.001) and a recent year of starting ATV (OR 0.64; 95% CI 0.579-0.71, p<0.001) are protective factors. No significant difference between pts treated with ATV/r or unboosted was observed regarding the induction of hyperbilirubinemia of ACTG grade III and IV. Treatment with unboosted ATV can last longer than that with ATV/r without an increased risk of therapeutic failure. A comparable safety profile was seen for pts who received ATV/r or unboosted ATV.
    Journal of the International AIDS Society 11/2012; 15(6):18287. · 3.94 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: We performed a genome-wide association study comparing a cohort of 144 human immunodeficiency virus (HIV type 1-infected, untreated white long-term nonprogressors (LTNPs) with a cohort of 605 HIV-1-infected white seroconverters. Forty-seven single-nucleotide polymorphisms (SNPs), located from class I to class III major histocompatibility complex (MHC) subregions, show statistical association (false discovery rate, <0.05) with the LTNP condition, among which 5 reached genome-wide significance after Bonferonni correction. The MHC LTNP-associated SNPs are ordered in ≥4 linkage disequilibrium blocks; interestingly, an MHC class III linkage disequilibrium block (defined by the rs9368699 SNP) seems specific to the LTNP phenotype.
    The Journal of Infectious Diseases 03/2012; 205(5):718-24. · 5.85 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Since recent observations demonstrated that extended resistance to protease inhibitors, nucleosidic and non - nucleosidic retrotranscriptase inhibitors (PI, NRTI, NNRTI) is a marker of disease progression and death, it is a matter of the greatest importance that experienced human immunodeficiency virus (HIV) - infected patients with limited therapeutic options receive a suppressive therapy pending the availability of at least two new antiretroviral drugs. Aim of the present study is to evaluate if the GSS score, calculated by analyzing the resistance to historical antiretroviral drugs and drug classes, is still relevant since several new potent drugs and drug classes entered the current clinical use. Taking into account patients without suppression of HIV replication for ≥ 6 months from October 2008 and October 2009, we analyzed viroimmunological and resistance data of 38 outpatients starting their last antiretroviral regimen including at least one of the following: maraviroc, enfuvirtide, raltegravir, etravirine, darunavir/ritonavir or tipranavir/ritonavir. Mutations present in all available genotypic resistance tests were recorded for each patient and then correlated to GSS value, assessed using the last genotypic ribonucleic acid (RNA) resistance test. GSS was studied as predictor of virological treatment outcome by univariate and multivariate logistic regression. At 48 weeks, undetectable viral load was obtained in 80% of patients without difference between GSS classes (HIV-RNA median < 50 copies/ml); 95.8% of patients with baseline HIV-RNA < 50,000 copies/ml obtained virological suppression (p=0.003). 48 weeks CD4+ median value was 412 cells/μl considering GSS1 and 300 cells/μl for combined GSS2 and GSS3 scores. Data also showed a > 60% recurrence of specific mutations for NRTI: M41L, M184IV, L210W, T215FY, K219EQ and 75% for D67N. K103N and Y181CIV mutations for NNRTI persisted in 35% of cases and their prevalence incresed in parallel with the number of GRTs. About 60% of tests reported L10FIRVC, M36ILV, M46IL, I54VLAMTS, V82AFTSLI, and L90M mutations in the protease region. 63P mutation was found in a total number of GRTs close to 80%. This percentages, when correlated to GSS, revealed a distinct pattern for most mutations, that showed a greater prevalence for GSS = 2. Conversely, only NNRTI 181CIV and NRTI 210W showed larger numbers in GSS1 and GSS3. Single drugs belonging to new antiretroviral classes did not correlate to viroimmunological success for any GSS. High frequency and recurrence over GRTs for specific mutations confirm their key role following the exposure to ARVs classes. A baseline HIV-RNA < 50,000 cp/ml is a predictor of therapeutic success and a carefully selected HAART based upon the evaluation of GRTs can favorably influence the immunovirologic response.
    Current HIV research 12/2011; 9(8):625-9. · 1.98 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: To conduct a long-term, prospective, randomized controlled trial evaluating rituximab (RTX) therapy for severe mixed cryoglobulinemia or cryoglobulinemic vasculitis (CV). Fifty-nine patients with CV and related skin ulcers, active glomerulonephritis, or refractory peripheral neuropathy were enrolled. In CV patients who also had hepatitis C virus (HCV) infection, treatment of the HCV infection with antiviral agents had previously failed or was not indicated. Patients were randomized to the non-RTX group (to receive conventional treatment, consisting of 1 of the following 3: glucocorticoids; azathioprine or cyclophosphamide; or plasmapheresis) or the RTX group (to receive 2 infusions of 1 gm each, with a lowering of the glucocorticoid dosage when possible, and with a second course of RTX at relapse). Patients in the non-RTX group who did not respond to treatment could be switched to the RTX group. Study duration was 24 months. Survival of treatment at 12 months (i.e., the proportion of patients who continued taking their initial therapy), the primary end point, was statistically higher in the RTX group (64.3% versus 3.5% [P < 0.0001]), as well as at 3 months (92.9% versus 13.8% [P < 0.0001]), 6 months (71.4% versus 3.5% [P < 0.0001]), and 24 months (60.7% versus 3.5% [P < 0.0001]). The Birmingham Vasculitis Activity Score decreased only after treatment with RTX (from a mean ± SD of 11.9 ± 5.4 at baseline to 7.1 ± 5.7 at month 2; P < 0.001) up to month 24 (4.4 ± 4.6; P < 0.0001). RTX appeared to be superior therapy for all 3 target organ manifestations, and it was as effective as conventional therapy. The median duration of response to RTX was 18 months. Overall, RTX treatment was well tolerated. RTX monotherapy represents a very good option for severe CV and can be maintained over the long term in most patients.
    Arthritis & Rheumatology 12/2011; 64(3):843-53. · 7.48 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: To develop preliminary classification criteria for the cryoglobulinaemic syndrome or cryoglobulinaemic vasculitis (CV). Study part I developed a questionnaire for CV to be included in the formal, second part (study part II). Positivity of serum cryoglobulins was defined by experts as an essential condition for CV classification. In study part II, a core set of classification items (questionnaire, clinical and laboratory items, as agreed) was tested in three groups of patients and controls-that is, group A (new patients with the CV), group B (controls with serum cryoglobulins but lacking CV) and group C (controls without serum cryoglobulins but with features which can be observed in CV). In study part I (188 cases, 284 controls), a positive response to at least two of three selected questions showed a sensitivity of 81.9% and a specificity of 83.5% for CV. This questionnaire was employed and validated in study part II, which included 272 patients in group A and 228 controls in group B. The final classification criteria for CV, by pooling data from group A and group B, required the positivity of questionnaire plus clinical, questionnaire plus laboratory, or clinical plus laboratory items, or all the three, providing a sensitivity of 88.5% and a specificity of 93.6% for CV. By comparing data in group A versus group C (425 controls), the same classification criteria showed a sensitivity 88.5% and a specificity 97.0% for CV. Classification criteria for CV were developed, and now need validation.
    Annals of the rheumatic diseases 07/2011; 70(7):1183-90. · 8.11 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Exclusive formula feeding, exclusive breastfeeding (EBF) with early weaning or the administration of antiretroviral therapy to lactating mothers and/or to breastfed newborns may lower postnatal HIV transmission. The aim of this study was to assess mothers' knowledge, attitudes and practice (KAP) on lactation in various real-life settings in sub-Saharan Africa. A questionnaire survey investigating KAP with regard to breastfeeding in pregnant women of unknown status (Questionnaire A, 16 items) or HIV-infected women (Questionnaire B, 37 items) was administered. Associations between newborn feeding KAP and demographic, socioeconomic, cultural and obstetric variables were investigated. From January 2007 to January 2008, 2112 pregnant women answered Questionnaire A in Burkina Faso, Cameroon, Chad, Tanzania, Uganda and Zambia. Most women (53.0%) declared EBF as the preferred feeding modality. The practice of strictly defined EBF in previous pregnancies was only 11.4%, which was inversely correlated with education and parity. Questionnaire B was answered by 225 HIV-infected pregnant women in Burkina Faso, Tanzania and Uganda. Knowledge about the lactation-associated risk was associated with previous dead children. Significant variability was observed among collaborating sites. The introduction of fluids other than maternal milk within 6 months of age is common practice in sub-Saharan Africa, requiring intensive health education efforts if strictly defined EBF is to be adopted to decrease HIV postnatal transmission. Significant variation in newborn feeding determinants was observed.
    International Health 03/2011; 3(1):56-65. · 1.01 Impact Factor
  • Value in Health 01/2011; 14(7). · 2.19 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Raltegravir (RAL), an HIV integrase inhibitor, may uncommonly induce an increase of serum creatine kinase (CK) both in naïve and antiretroviral (ARV)-experienced HIV-positive patients. We report the case of severe rhabdomyolysis requiring hospitalization in an ARV-experienced HIV/hepatitis C co-infected patient treated with a RAL-containing drug regimen. Factors favouring a severe clinical occurrence of RAL-induced rhabdomyolysis from cases reported in literature are described.
    International Journal of STD & AIDS 11/2010; 21(11):783-5. · 1.00 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: HIV-1 non-B subtypes have recently entered Western Europe following immigration from other regions. The distribution of non-B clades and their association with demographic factors, over the entire course of the HIV-1 epidemic, have not been fully investigated in Italy. We carried out a phylogenetic analysis of HIV-1 pol sequences derived from 3670 patients followed at 50 Italian clinical centres over nearly three decades. Overall, 417 patients (11.4%) carried non-B subtypes. The prevalence of non-B strains increased from 2.6% in 1980-1992 to 18.9% in 1993-2008 (P<0.0001) in a subset of 2479 subjects with a known year of diagnosis. A multivariate analysis on a subset of 1364 patients for whom relevant demographic data were available indicated that African ethnicity, heterosexual route of infection and year of diagnosis were independently associated with non-B HIV-1 infection (P ≤ 0.0001). All pure subtypes, except for clade K, and seven circulating recombinant forms were detected, accounting for 56.6 and 34.1% of the non-B infections, respectively. The F1 subtype was the most prevalent non-B clade among Europeans and was acquired heterosexually in half of this patient population. Unique recombinant forms accounted for 9.4% of the non-B sequences and showed a B/F1 recombination pattern in one-third of cases. The circulation of non-B clades has significantly increased in Italy in association with demographic changes. Spread of the F1 subtype and B/F recombinants appears to predominate, which may result in a redistribution of the relative proportions of the different strains, and this could lead to overlapping epidemics. Thus, the HIV-1 landscape in Italy may in future be distinct from that of the rest of Europe.
    HIV Medicine 10/2010; 11(9):593-602. · 3.16 Impact Factor
  • Source
    International AIDS Society’s Workshop “Towards a Cure”: HIV Reservoirs and Strategies to Control Them, Vienna, Austria.; 07/2010
  • Source
    Journal of the International AIDS Society 01/2010; 13:1-1. · 3.94 Impact Factor

Publication Stats

3k Citations
1,348.09 Total Impact Points

Institutions

  • 1994–2014
    • Ospedale Luigi Sacco
      Milano, Lombardy, Italy
  • 1980–2013
    • University of Milan
      • • Department of Biomedical and Clinical Sciences "Luigi Sacco"
      • • Malattie Infettive e Tropicali
      Milano, Lombardy, Italy
  • 2011
    • Azienda Ospedaliera Santa Maria della Misericordia
      Udine, Friuli Venezia Giulia, Italy
  • 2008
    • Università degli Studi del Sannio
      Benevento, Campania, Italy
  • 2007
    • Università degli Studi di Brescia
      • Department of Clinical and Experimental Sciences
      Brescia, Lombardy, Italy
  • 2002
    • Ospedali Riuniti di Bergamo
      Bérgamo, Lombardy, Italy
  • 1996–2001
    • Fondazione Salvatore Maugeri IRCCS
      • Divisione di Cardiologia 1
      Ticinum, Lombardy, Italy
  • 1999
    • Ospedale di Circolo e Fondazione Macchi Varese
      Varese, Lombardy, Italy
  • 1997
    • University of Naples Federico II
      Napoli, Campania, Italy
  • 1995
    • Spedali Civili di Brescia
      Brescia, Lombardy, Italy
  • 1985
    • Mario Negri Institute for Pharmacological Research
      Milano, Lombardy, Italy