In May 2022, a new case of Monkeypox Virus (MPX) was reported in a non-endemic area, the United Kingdom, and since then, the number of confirmed cases in Europe has been increasing until WHO, on May ...10 2023, declared that MPOX is no longer a public health emergency of international concern. We aimed to describe the clinical and microbiological characteristics of sixteen patients with a confirmed diagnosis of MPX followed by a single Italian clinical centre, the Fondazione Policlinico Universitario Agostino Gemelli, between May 20 and August 30.
A prospective observational study has been conducted, collecting microbiological samples during the time of the infection, as well as epidemiological and clinical data of the patients. All patients provided written informed consent.
During clinical practice, 16 individuals presenting with consistent symptoms tested positive for MPX on a polymerase chain reaction. All patients were men having sex with men (MSM). The most frequent clinical presentation was a vesicular erythematous cutaneous rash, mainly distributed on the genital and perianal area, but also regarding limbs, face, neck, chest and back in some of the patients. Systemic symptoms, such as fever or lymphadenopathy, involved eight patients. The symptom most frequently reported by patients was pruritus in the area of the vesicles. Thirteen patients also reported pain. Nine patients were HIV-1 coinfected, but no significant differences have been observed compared to other cohort patients. The median time between the onset of symptoms and the healing was 19.5 days (IQR 14.0-20.3).
Our cohort of patients presented a mild manifestation of the disease with no complications and no need for antiviral therapy nor hospitalization. This population seems different from the ones reported in the literature during the previous outbreaks in endemic areas in epidemiological data and clinical manifestations but also from a cohort of patients described in the literature from the 2022 outbreak, suggesting the importance for healthcare workers to keep in mind the possibility of an MPX infection in the differential diagnosis of patients presenting with consistent symptoms, even in non-endemic areas, to ensure efficient isolation of the patient for infection control purposes and effective management of the infection preventing the development of MPOX-related complications.
Thanks to the modern ARV regimens and the fact that the morbidity and mortality of metabolic syndrome increases with age, clinicians are continuously researching effective and safe antiretroviral ...regimens with low impact on the lipid profile. Doravirine (DOR) is the latest non-nucleoside reverse-transcriptase inhibitor (NNRTI) that shows long-term safety and tolerability and a favorable lipid profile. The aim of this study is to assess the impact of DOR-based three-drug regimens on the lipid profile in clinical practice. We retrospectively analyzed a cohort of 38 treatment-experienced, virologically suppressed people living with HIV (PLWH) switching to this regimen, following the eligibility criteria. We carried out comparison analysis of immunological and metabolic parameters between baseline and 48 weeks of follow up. In our cohort of treatment-experienced, virologically suppressed PLWH, three-drug regimens with DOR showed good efficacy and a positive profile on lipid metabolism at 48 weeks of follow up.
Dolutegravir (DTG)-based first-line regimens have shown superior efficacy versus darunavir (DRV)-based ones in randomized trials. We compared these two strategies in clinical practice, particularly ...considering the role of pre-treatment drug resistance mutations (DRMs) and of the HIV-1 subtype.
The multicenter Antiretroviral Resistance Cohort Analysis (ARCA) database was queried to identify HIV-1-positive patients starting a first-line therapy with 2NRTIs plus either DTG or DRV between 2013 and 2019. Only adult (≥18 years) patients with a genotypic resistance test (GRT) prior to therapy and with HIV-1 RNA ≥1000 copies/mL were selected. Through multivariable Cox regressions, we compared DTG- versus DRV-based regimens in the time to virological failure (VF) stratifying for pre-treatment DRMs and the viral subtype.
A total of 649 patients was enrolled, with 359 (55.3%) and 290 (44.7) starting DRV and DTG, respectively. In 11 months of median follow-up time, there were 41 VFs (8.4 in 100 patient-years follow-up, PYFU) and 15 VFs (5.3 per 100 PYFU) in the DRV and DTG groups, respectively. Compared with a fully active DTG-based regimen, the risk of VF was higher with DRV (aHR 2.33;
= 0.016), and with DTG-based regimens with pre-treatment DRMs to the backbone (aHR 17.27;
= 0.001), after adjusting for age, gender, baseline CD4 count and HIV-RNA, concurrent AIDS-defining event and months since HIV diagnosis. Compared with patients harboring a B viral subtype and treated with a DTG-based regimen, patients on DRV had an increased risk of VF, both in subtype B (aHR 3.35;
= 0.011), C (aHR 8.10;
= 0.005), CRF02-AG (aHR 5.59;
= 0.006) and G (aHR 13.90;
< 0.001); DTG also demonstrated a reduced efficacy in subtypes C (versus B, aHR 10.24;
= 0.035) and CRF01-AE (versus B; aHR 10.65;
= 0.035). Higher baseline HIV-RNA and a longer time since HIV diagnosis also predicted VF.
In line with randomized trials, DTG-based first-line regimens showed an overall superior efficacy compared with DRV-based regimens. GRT may still play a role in identifying patients more at risk of VF and in guiding the choice of an antiretroviral backbone.
Our aim was to assess the association between different types of stigma and physical, behavioural and emotional wellbeing, and to evaluate whether these associations were mediated by the level of ...social support, age, education, sex and time from HIV diagnosis in an Italian cohort of people living with HIV (PLWH). We enrolled 96 PLWH and had them complete a cross-sectional online survey that included the "HSS-12", the "SF-12" and the "DASS-21". We performed linear regression analyses to explore the associations between the HSS-12 scores and cART adherence, viral load, SF-12 and DASS-21 scores, and a mediation analysis to identify mediators in the significant associations. We showed that higher level of depression and worse perception of mental health were significantly associated with higher HSS-12 "personalised stigma" (
= .009,
= .020) "disclosure concerns" (
= .012,
= .039), "concerns about public attitudes" (
=.007,
= .005) and "negative self-image" scores; (
< .001,
= .001); worse perception of physical health status was associated with higher HSS-12 "personalised stigma" scores (
= .018); higher level of anxiety and stress were associated with higher "negative self-image" scores (0.001 and
< .001). The association between higher HSS-12 "negative self-image" and higher levels of depression, anxiety and stress were mediated by lower age (a*b = +0.10; a*b = +0.12; a*b = +0.11). This study may have important implications for clinical practice as it contributes to understanding the characteristics and consequences of HIV-related stigma in a population of PLWH with excellent viroimmunological status and therapeutic adherence.
Evidence accumulated during past years confirm that people living with HIV (PLWH) still have to deal with comorbidities and chronic complications that can increase physical and psychological issues ...and can affect daily functioning, quality of life and mental health. Moreover, during the COVID-19 pandemic PLWH proved to be a population at increased risk of psychological distress. We explored the ongoing issues and the characteristics of the mental health interventions for which a cohort of Italian PLWH interacted with a psychologist over the past five years. We analysed a dataset that included 61 PLWH who underwent a psychological intervention between 2018 and 2022. We compared different frequencies in characteristics of mental health interventions according to different demographic and clinical variables, psychopathological symptoms and time of the request for intervention. We showed that psychopathological symptoms most frequently reported by patients were anxiety (55.7%), and depression (49.2%). Furthermore, we reported that most our patients undertook occasional psychological support meetings (31%), sought an intervention after the outbreak of the COVID-19 pandemic (62.3%) and complained about disclosure issues (48.5%). Disclosure issues were mainly reported by younger PLWH (p = 0.002) with a shorter disease (p = 0.031) and treatment history (p = 0.032), and higher interpersonal sensitivity (p = 0.042). It seems fundamental to integrate psychological interventions into the care of PLWH, to give particular attention to PLWH with risky demographic, clinical and mental health factors and to pay special attention to emergency conditions (such as the COVID-19 pandemic) and the most widespread issues to create ad hoc interventions.
Increased renewable energy production and storage is a key pillar of net-zero emission. The expected growth in the exploitation of offshore renewable energy sources, e.g., wind, provides an ...opportunity for decarbonising offshore assets and mitigating anthropogenic climate change, which requires developing and using efficient and reliable energy storage solutions offshore. The present work reviews energy storage systems with a potential for offshore environments and discusses the opportunities for their deployment. The capabilities of the storage solutions are examined and mapped based on the available literature. Selected technologies with the largest potential for offshore deployment are thoroughly analysed. A landscape of technologies for both short- and long-term storage is presented as an opportunity to repurpose offshore assets that are difficult to decarbonise.
This research tries to investigate, in the current condition of the Italian real estate market, the economic advantage of investing in energy retrofitting of existing buildings or in expenditure ...aimed at obtaining higher energy performances in the construction phase of new buildings. A cost-benefit analysis is developed referring to the construction industry entrepreneur. Firstly, the increase in value due to a different measurement of the energy performance of new buildings or newly redeveloped residential buildings is achieved through an innovative statistical approach. Energy performance is measured by taking as a reference the category of energy certification, as required by European legislation. In the estimate of the contribution, the measurement of energy performance, expressed on an ordinal scale, is treated as a categorical variable in the implementation of an iterative regression model, called the alternating least squares model. Afterwards, this contribution is compared to the cost of sustainable building, trying to define a percentage increase in cost compared to a minimum condition according to different and increasing levels of energy performance. In the developed case studies, the comparison between likely benefits and investment spending showed that the entrepreneur would have no convenience at an expense for energy retrofitting while obtaining a positive balance in the construction phase of new buildings. The financial advantage grows if the investment is aimed at achieving the best energy performance and in areas where the price level of the real estate market is lower. The finding can be used as a guide for construction industry investors to make decisions in energy-efficient residential buildings production or transformation.
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