Evolution of transmitted HIV-1 drug resistance in HIV-1-infected patients in Italy from 2000 to 2010.

Prevalence and predictors of transmitted drug resistance (TDR), defined as the presence of at least one WHO surveillance drug resistance mutation (SDRM), were investigated in antiretroviral-naïve HIV-1-infected patients, with a genotypic resistance test (GRT) performed ≤6 months before starting cART between 2000 and 2010. 3163 HIV-1 sequences were selected (69% subtype B). Overall, the prevalence of TDR was 12% (13.2% subtype B, 9% non-B). TDR significantly declined overall and for the single drug classes. Older age independently predicted increased odds of TDR, whereas a more recent GRT, a higher HIV-RNA and C vs. B subtype predicted lower odds of TDR.

The evolving burden of HIV infection compared with other chronic diseases in northern Italy.

OBJECTIVES: The aim of the study was to estimate the burden and direct costs of diseases in HIV-infected patients (either opportunistic illnesses or other chronic diseases) with respect to the HIV-uninfected population. These estimates will be useful for the projection of future direct costs of HIV care. PATIENTS AND METHODS: A population-based study was conducted in the Brescia Local Health Agency in northern Italy. An administrative database recorded diagnoses, deaths, drug prescriptions and health resource utilization for all medical and surgical patients in the region from 2003 to 2007. The study estimated the prevalence of HIV infection as well as HIV-related mortality and annual cost per patient, and compared mortality and costs related to HIV infection with those for a set of 15 other chronic diseases. The standardized hazard ratio (SHR) and standardized mortality ratio (SMR) were obtained using an indirect standardization method. RESULTS: The prevalence of HIV infection increased from 218 per 100,000 inhabitants in 2003 to 263 per 100,000 in 2007. Although mortality rates decreased markedly (from 24 per 1000 HIV-infected patients in 2003 to 16 per 1000 in 2007), the data show that mortality was still higher in HIV-infected patients compared with the general population in the most recent years (SMR 8.8 in 2007). In each year included in the study, HIV-infected patients had higher rates of care-seeking for chronic diseases, including liver diseases (SHR>8), neuropathy, oesophagus-gastro-duodenum diseases, serious psychiatric disorders and renal failure (SHR approximately 3 for each). Also, the rate of medical attendance for neoplasias, chronic pulmonary disease, diabetes, and cardiovascular disease increased over time in HIV-infected patients compared with the general population. Ranking diseases in order of their total cost to the health system, HIV infection ranked 12th, with total costs of €28.6 million in 2007. Ranking in order of cost per patient, HIV infection ranked third, with a cost per patient of €9894 in 2007. HIV-infected patients with concomitant chronic diseases had higher average costs. The cost per patient in 2007 was €8104 for HIV-infected patients without other chronic diseases, €9908 for HIV infection plus cardiovascular disease, €11,370 for HIV infection plus chronic liver disease and €12,013 for HIV infection plus neoplasias. CONCLUSIONS: The prevalence and population cost of people living with HIV are likely to increase as a result of prolonged survival, aging of HIV-infected patients and increased risk of other chronic diseases. In the near future, HIV infection will rank as one of the most costly chronic diseases. Prevention strategies need to be more widely adopted to control the growing burden of the HIV epidemic and other chronic diseases affecting HIV-infected patients.

[Intraoperative echography in the localization of pulmonary nodules during video-assisted thoracic surgery]. / Ecografia intraoperatoria nella localizzazione delle lesioni nodulari polmonari durante chirurgia toracica video assistita.

PURPOSE: One of the major limitations of thoracoscopic resection of lung nodules is localization of the target, especially when the lesion is deep or very small: we investigated the efficacy of US as a technique for intraoperative localization. MATERIAL AND METHODS: We examined 11 patients who underwent diagnostic and/or curative thoracoscopic resection of benign or malignant, primary or metastatic lung nodules. The study was preceded by a preliminary phase in which we examined with US 5 patients that underwent thoracotomy. A multifrequency laparoscopic US probe with a deflectable linear headpiece mounted on a portable Esaote-Hitachi Spazio US unit was used. RESULTS: The US exploration of the lung requires the complete collapse of the parenchyma and is therefore particularly difficult in patients with severe chronic obstructive pulmonary disease (COPD). In the patients examined during thoracotomy US showed all the lesions but one 7-mm nodule in an emphysematous patient in whom complete parenchyma collapse could not be achieved. Also in the patients examined during thoracoscopy US detected all the targets (13/13), even a 13-mm metastatic nodule which had been visualized preoperatively by PET only. The smallest lesion found was a 4-mm fibrosarcoma metastasis. The mean time to achieve adequate lung collapse was about 40 minutes from selective exclusion of the affected lung. DISCUSSION: Thoracoscopic US has been recently introduced for the intraoperative localization of pulmonary nodules. In our experience this technique is helpful in localizing the targets, assessing the extent of surgical resection and studying possible vascular involvement. Considering the easy execution, the low cost, the lack of contraindications and complications of the technique and its accuracy when performed under optimal technical conditions, we think there are enough reasons to investigate this approach further. CONCLUSIONS: Intraoperative US proved to be a useful technique of easy execution, even though it is heavily operator-dependent and limited in patients with severe COPD.

Macular hole-induced retinal detachment: treatment with an "armed-silicone" implant.

Thirty-two cases of retinal detachment with macular hole have been treated by applying an explant made of a stainless steel sheet embedded in silicone. The results obtained were very encouraging, and the technique is recommended especially when a vitrectomy cannot be performed.

High frequency of lactose absorbers among adults with idiopathic senile and presenile cataract in a population with a high prevalence of primary adult lactose malabsorption.

22% of a group of adult Neapolitans were found to have persistent high lactase activity, and 16% were lactose absorbers as indicated by measurement of breath hydrogen concentration and rise in blood glucose after oral lactose administration. Among adults in the same area with idiopathic senile or presenile cataract 49% were identified as lactose absorbers with the breath hydrogen test and 55% by the rise in blood glucose. These results suggest that adults able to absorb galactose from a lactose-containing diet are especially susceptible to senile or presenile cataract.

Alteration of serum tryptophan metabolism in patients suffering from senile cataract.

In vitro experimental evidence suggests tryptophan (TRP) is involved in protein modifications which could cause cataract formation in vivo. Previous studies of tryptophan plasma and serum metabolism are conflicting. In this study free and bound TRP plasma levels were measured in patients with senile cataract and in controls after an oral load of L-TRP (20 mg/kg b.w.). Free TRP levels were higher in patients than in controls one hour after L-TRP administration.

Senile macular degeneration and alteration of the metabolism of the lipids.

An accurate study on the alterations of lipid metabolism was made on a sample of 30 patients affected by senile macular degeneration and 13 patients affected by senile macular degeneration complicated by retinopathy due to hyperlipidemia. The authors came to the conclusion that hyperlipidemia can complicate simple macular degeneration, even if a close correlation between the two phenomena can be excluded.