The Hidradenitis suppurativa patient journey in Italy: current status, unmet needs and opportunities.

BACKGROUND: Hidradenitis suppurativa (HS) is a chronic, progressive inflammatory, debilitating, follicular disease of the skin with a reported incidence of less than 1% in the general population. Diagnosis of HS may typically be delayed for years, and even when diagnosed, is challenging to treat. Thus, HS has considerable negative impact on patient quality of life. OBJECTIVES: To describe the HS patient journey in Italy, identify unmet needs and provide a proposal for integrated patient care. METHODS: A multidisciplinary panel of leading Italian experts met to evaluate routine clinical practice and patient experience, and analyse the available scientific evidence on HS. RESULTS: A comprehensive map of the journey of the HS patient in Italy was built based on integrated data obtained from clinical practice and patient experience. The journey is non-linear and can be grouped into four broad stages that are somewhat overlapping and intersecting: (i) onset to diagnosis; (ii) circle of visits; (iii) circle of treatments; (iv) living with HS. Several unmet needs were identified that included greater awareness of disease by both healthcare practitioners and patients. CONCLUSION: Improved disease awareness can be addressed through continuing medical education for physicians and development of educational materials for patients, in addition to greater utilization of social networks. Moreover, the development of integrated treatment centres was considered a worthwhile goal, and would offer patients the possibility to receive multidisciplinary care, ideally with dermatologists coordinating treatment, along with surgeons, psychologists, endocrinologists, gastroenterologists, pain specialists, gynaecologists and paediatricians as needed. Lastly, standardized management protocols for HS are also needed.

Primary HIV-1 resistance in recently and chronically infected individuals of the Italian Cohort Naive for Antiretrovirals.

The risk of acquiring HIV-1 drug resistance at time of infection has become a public health problem following the widespread use of antiretroviral drugs in developed countries. Although a number of studies have reported data regarding the prevalence of HIV-1 primary resistance in developed countries over the past years, limited knowledge is available regarding the proportion of mutations related to drug resistance in antiretroviral naive subjects with chronic HIV-1 disease. In this study, we evaluated the prevalence of mutations in the reverse-transcriptase (RT) and protease region both in a representative group of recently HIV-1 infected subjects (n=68) and a cohort of chronically-infected HIV-positive patients (n=347) enrolled in the Italian Cohort of Antiretroviral Naive patients (I.CO.NA.). In recently infected individuals, the overall prevalence of mutations for nucleoside RTI (NRTIs) was 10/68 (14.7%). The distribution of mutations by calendar year were 0, 1 in 1996, 9, 3 in 1997 and 1, 0 in 1998 for NRTIs and protease inhibitors (PIs) respectively. Thymidine associated mutations were identified in six subjects (8.8%), five of whom had one mutation [41L, 70K (n=2), 215Y] and one had two mutations (67N+219Q). Four subjects (5.9%) showed the changes associated with resistance to lamivudine (184V or 118I). No non nucleoside-RTI (NNRTI) mutations were present in the study period. Primary PIs mutations (two 46L and two 82I) were present in four subjects (5.9%). Of note, mutations related to resistance to more than one class of antiretrovirals were present in one (1.5%). Among patients with chronic infection a large proportion (88.5%) carried no mutations in RT region, 11.5% individuals carried one or more mutations associated with resistance to NRTI (7.8%), or NNRTI (4.9%), with 4 patients carrying mutations to both classes. Among mutations associated with high-level resistance to RTI, T215Y was found in only 2 patients, M184V in 2 cases, T69D in another case, and K103N in only 1 patient, for a total of 6 patients (one carrying both T215Y and M184V) (1.7%). Primary mutations associated with substantial resistance to PIs were found in only 5/347 patients (1.4%); all the other patients carried only secondary mutations. Prevalence of mutations associated with high-level resistance to antiretroviral drugs is stable in recently infected individuals and low in patients with established HIV infection. The potential impact of transmitted mutations on the response to first regimen in individuals carrying transmitted mutations needs to be assessed by prospective studies.

Secondary mutations in the protease region of human immunodeficiency virus and virologic failure in drug-naive patients treated with protease inhibitor-based therapy.

The role of mutations in protease (PR) and reverse-transcriptase (RT) of human immunodeficiency virus (HIV) in predicting virologic failure was assessed in 248 antiretroviral-naive HIV-positive patients who began a PR inhibitor-containing antiretroviral regimen. Genotypic testing was performed on plasma samples stored before the start of therapy. Twenty-seven patients (10.9%) had mutations in the RT, 5 (2%) carried primary mutations in the PR, and 131 (52.8%) showed only secondary PR mutations. Virologic failure at week 24 occurred in 62 (25.0%) of 248 patients. There was a statistically significant correlation between virologic failure and the number of PR mutations (P= .04, chi(2) test). Mutations at codons 10 and 36 of PR (present in 39.3% and 40.0% of patients in whom treatment failed, respectively) were identified by stepwise logistic regression as the strongest predictors of virologic failure (odds ratio, 2.20; 95% confidence interval, 1.30-3.75; P= .004). If confirmed in independent studies, this result may justify the increased use of HIV genotyping in drug-naive patients requiring antiretroviral therapy.

[Delta agent infection and immunoglobulin G in acute HBsAg-positive hepatitis with chronic course]. / Infezione da agente delta ed immunoglobuline G nella epatite acuta HBsAg-positiva ad evoluzione cronica.

In 18 patients with clinical evidence of acute hepatitis, positive for HBsAg, and evolution to chronic infection, we detected the presence of antibodies to the delta agent (anti-HDV), in relation to the immunoglobulin serum level. The IgG were significantly higher during the beginning of the acute phase in the 6 positive cases for anti-HDV than in the patients who were anti-HDV negative. In the group positive for anti-HDV, the IgG remained high also during the following months, with a more severe clinical evolution. Among patients positive for anti-HDV there were no significant differences between the initial level of IgG and the presence or not of IgM anti-HBc during the acute phase of the disease (respectively patients with co-infection or super-infection). These results show that the presence of high levels of IgG during the acute phase of HBsAg positive hepatitis suggests the co-existence of delta infection.