Publications by authors named "Tullio Prestileo"

29 Publications

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Effectiveness of a screening program for HBV, HCV, and HIV infections in African migrants to Sicily.

Dig Liver Dis 2021 Oct 11. Epub 2021 Oct 11.

Barcelona Institute for Global Health (ISGlobal), Hospital Cliníc, University of Barcelona, Barcelona, Spain.

Background: Migrants from Africa are vulnerable to viral infections during their journey.

Methods: Migrants who arrived in western Sicily were offered early screening for hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV) infection. A questionnaire was administered to evaluate risk factors, and antiviral therapy was offered to subjects with active infection. A multiple regression analysis and adjusted odds ratio were obtained to evaluate risk factors.

Results: Overall, 2,639 of 2,751 (95.9%) migrants who arrived between 2015 and 2017 accepted screening and 1,911 (72.4%) completed the questionnaire. HBsAg was positive in 257 (9.7%) migrants, 24 (0.9%) were anti-HCV positive and 57 (2.2%) had HIV infection. The prevalence of HBV infection was higher in women (aOR 2.47,95%CI 1.90-3.20),p = 0.003) and in people who endured physical and/or sexual violence (aOR 2.24,95%CI 1.87-3.55,p<0.001), while HIV infection was more frequent in women (aOR 5.40,95%CI 3.09-9.43, p <0.001) who were in Libya for a long period (aOR 5.66,95%CI 2.90-10.70,p = 0.004) and endured physical and/or sexual violence (aOR 14.77,95%CI 8.34-22.11,p<0.001). Being older than 18 was associated with HCV infection (p<0.001). Overall, 77% of 57 subjects with HIV infection were retained in care, 79% of 70 chronic HBV hepatitis cases started nucleot(s)ide analogues and 61% of 18 HCV-RNA positive cases received direct-acting antiviral therapy.

Conclusions: These findings evidence the effectiveness and feasibility of infectious disease screening programs for migrants.
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http://dx.doi.org/10.1016/j.dld.2021.08.024DOI Listing
October 2021

PNPLA3 and TLL-1 Polymorphisms as Potential Predictors of Disease Severity in Patients With COVID-19.

Front Cell Dev Biol 2021 23;9:627914. Epub 2021 Jun 23.

Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties "G. D'Alessandro" - University of Palermo, Palermo, Italy.

Albeit the pathogenesis of COVID-19 remains unclear, host's genetic polymorphisms in genes involved in infection and reinfection, inflammation, or immune stimulation could play a role in determining the course and outcome. We studied in the early phase of pandemic consecutive patients ( = 383) with SARS-CoV-2 infection, whose subsequent clinical course was classified as mild or severe, the latter being characterized by admission to intensive therapy unit or death. Five host gene polymorphisms (MERTK rs4374383, PNPLA3 rs738409, TLL-1 rs17047200, IFNL3 rs1297860, and INFL4 rs368234815) were assessed by using whole nucleic acids extracted from nasopharyngeal swabs. Specific protease cleavage sites of TLL-1 on the SARS-CoV-2 Spike protein were predicted . Male subjects and older patients were significantly at higher risk for a severe outcome ( = 0.02 and < 0.001, respectively). By considering patients ≤65 years, after adjusting for potential confounding due to sex, an increased risk of severe outcome was found in subjects with the GG genotype of PNPLA3 (adj-OR: 4.69; 95% CI = 1.01-22.04) or TT genotype of TLL-1 (adj-OR=9.1; 95% CI = 1.45-57.3). evaluation showed that TLL-1 is potentially involved in the Spike protein cleavage which is essential for viral binding and entry into the host cells using the host receptor angiotensin-converting enzyme 2 (ACE2). Subjects carrying a GG genotype in PNPLA3 gene might have a constitutive upregulation of the NLRP3 inflammasome and be more prone to tissue damage when infected by SARS-CoV-2. The TT genotype in TLL-1 gene might affect its protease activity on the SARS-CoV-2 Spike protein, enhancing the ability to infect or re-infect host's cells. The untoward effect of these variants on disease course is evident in younger patients due to the relative absence of comorbidities as determinants of prognosis. In the unresolved pathogenetic scenery of COVID-19, the identification of genetic variants associates with more prolonged course or with a severe outcome of infection would support the development of predictive tools useful to stratify subjects by risk class at presentation. Moreover, the individuation of key genes could contribute to a better understanding of the pathways involved in the pathogenesis, giving the basis for rational therapeutic approaches.
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http://dx.doi.org/10.3389/fcell.2021.627914DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8262646PMC
June 2021

Liver and cardiovascular mortality after hepatitis C virus eradication by DAA: Data from RESIST-HCV cohort.

J Viral Hepat 2021 08 7;28(8):1190-1199. Epub 2021 May 7.

Gastroenterology and Hepatology Unit, Department of Health Promotion Sciences Maternal and Infantile Care, Internal Medicine and Medical Specialities, PROMISE, University of Palermo, Palermo, Italy.

Real-world evidence on the course of Hepatitis C Virus (HCV) chronic liver disease after Sustained Virologic Response (SVR) obtained with direct-acting antiviral drugs (DAAs) are still limited, and the effects on mortality remain unclear. We evaluated the post-treatment survival of 4307 patients in the RESIST-HCV cohort (mean age 66.3 ± 11.6 years, 56.9% males, 24.7% chronic hepatitis, 66.9% Child-Pugh A cirrhosis and 8.4% Child-Pugh B cirrhosis) treated with DAAs between March 2015 and December 2016 and followed for a median of 73 weeks (range 16-152). Proportional cause-specific hazard regression for competing risks was used to evaluate the survival and to assess the predictors of liver and cardiovascular death. Overall, 94.7% of patients achieved SVR while 5.3% were HCV RNA-positive at last follow-up. Sixty-three patients (1.4%) died during the observation period. SVR was associated with a decreased risk of liver mortality (hazard ratio,HR0.09, beta -2.37, p < .001). Also, platelet count (HR 0.99, beta-0.01, p = .007) and albumin value (HR 0.26, beta -1.36 p = .001) were associated with liver mortality by competing risk analysis. SVR was associated with a reduced risk of cardiovascular mortality regardless of presence of cirrhosis (HR 0.07, beta-2.67, p < .001). Presence of diabetes (HR 3.45, beta 1.24, p = .014) and chronic kidney disease class ≥3 (HR 3.60, beta 1.28, p = 0.016) were two factors independently associated with higher risk of cardiovascular mortality. Patients with SVR to a DAA therapy have a better liver and cardiovascular survival, and the effects of HCV eradication are most evident in patients with compensated liver disease.
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http://dx.doi.org/10.1111/jvh.13523DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8359835PMC
August 2021

Tuberculosis among Migrant Populations in Sicily: A Field Report.

J Trop Med 2021 30;2021:7856347. Epub 2021 Mar 30.

ANLAIDS (Associazione Nazionale per la Lotta all'AIDS) Sicilia, Palermo, Italy.

Background: In the EU, tuberculosis (TB) mainly affects vulnerable people, including migrants. From 2014 to 2017, we have estimated the frequency of both tuberculosis and latent tuberculosis infection (LTBI) among the migrant population hosted in 41 reception centers in western Sicily (ITaCA network).

Materials And Methods: All migrants were consecutively recruited for the screening of TB infection with physical examination and TST in 1,020 migrants and with IGRA in the others 2,690. The screening was carried out 4-8 weeks after landing in Sicily. For all migrants with a positive screening test, chest X-ray and smear examination were performed. LTBI was defined by positivity of TST or IGRA with negative X-ray chest, clinical, and smear examination. Active TB was defined by radiological and/or clinical and/or sputum positivity in a patient with a TST or IGRA positivity.

Results: We evaluated a total of 3,710 migrants, of which 89% came from Sub-Saharan countries; 2,811 were males, 899 were females, with a median age of 22 years (IQR: 18-25). TB infection was diagnosed in 501 persons (13.5%) of which 440 (11.8%) had LTBI and 61 had active TB (1.6%): 1 had lymph node TB, 1 had intestinal TB, and 59 had pulmonary TB (38 sputum smear positive TB; no drug-resistant TB were observed).

Conclusions: TB screening is critical to early diagnosis and treatment.
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http://dx.doi.org/10.1155/2021/7856347DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8024091PMC
March 2021

Feasibility and efficacy of 8 week Glecaprevir/Pibrentasvir to treat incarcerated viraemic HCV patients: A case-control study.

Liver Int 2021 02 2;41(2):271-275. Epub 2020 Dec 2.

Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy.

Inmates have higher HCV prevalence than general population, representing a fundamental step towards HCV eradication. Our aim was to compare 8-week glecaprevir/pibrentasvir treatment in a case-control study between incarcerated and free patients. Eleven Italian prisons and six outpatient clinics were involved. Patients were matched for sex, risk factors, METAVIR grade, HIV and HBV co-infections. About 131 incarcerated (Group A) and 131 free patients (Group B) were included. Mean age was 43.0 ± 9.6 years and 42.8 ± 9.9 in Group A and B, respectively (P = .74). SVR rates were 96.2% and 99.2% in Group A and Group B respectively (P = .21). Five drop-outs occurred in Group A, one in Group B. Incarceration, being PWIDs and OST were not associated with SVR reductions (CI 95%). In conclusion, imprisonment does not influence unplanned interruptions or SVR rates when receiving short-term therapies. Short schedules with pangenotypic regimens could be a good approach to hard-to-reach populations, such as incarcerated patients.
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http://dx.doi.org/10.1111/liv.14745DOI Listing
February 2021

SARS-CoV-2 Viral Load, IFNλ Polymorphisms and the Course of COVID-19: An Observational Study.

J Clin Med 2020 Oct 15;9(10). Epub 2020 Oct 15.

Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, 90127 Palermo, Italy.

The course of SARS-CoV-2 infection ranges from asymptomatic to a multiorgan disease. In this observational study, we investigated SARS-CoV-2 infected subjects with defined outcomes, evaluating the relationship between viral load and single nucleotide polymorphisms of genes codifying for IFNλs (interferon). The study enrolled 381 patients with laboratory-confirmed SARS-CoV-2 infection. For each patient, a standardized form was filled including sociodemographic variables and clinical outcomes. The host's gene polymorphisms (IFNL3 rs1297860 C/T and INFL4 rs368234815 TT/ΔG) and RtReal-Time PCR cycle threshold (PCR Ct) value on SARS-CoV-2 were assessed on nasal, pharyngeal or nasopharyngeal swabs. Higher viral loads were found in patients aged > 74 years and homozygous mutant polymorphisms DG in IFNL4 (adj-OR = 1.16, 95% CI = 1.01-1.34 and adj-OR = 1.24, 95% CI = 1.09-1.40, respectively). After adjusting for age and sex, a statistically significantly lower risk of hospitalization was observed in subjects with higher RtReal-Time PCR cycle threshold values (adj-OR = 0.95, 95% CI = 0.91, 0.99; = 0.028). Our data support the correlation between SARS-CoV-2 load and disease severity, and suggest that IFNλ polymorphisms could affect the ability of the host to modulate viral infection without a clear impact on the outcome of COVID-19.
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http://dx.doi.org/10.3390/jcm9103315DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7602550PMC
October 2020

Is Transient Elastography Needed for Noninvasive Assessment of High-Risk Varices? The REAL Experience.

Am J Gastroenterol 2019 08;114(8):1275-1282

Sezione di Gastroenterologia e Epatologia, Dipartimento Biomedico di Medicina Interna e Specialistica (Di.Bi.M.I.S.), University of Palermo, Palermo, Italy.

Introduction: The Baveno VI consensus guidelines and an expanded algorithm suggest that transient elastography (TE) and platelet (PLT) count can be used to identify patients with cirrhosis who can avoid esophagogastroduodenoscopy (EGD). The primary aims of this study were to assess the ability of a simple algorithm, which uses only laboratory parameters, to predict medium/large esophageal varices (EV) in patients with hepatitis C virus (HCV) and cirrhosis from the Rete Sicilia Selezione Terapia-HCV (RESIST-HCV) cohort and to compare the performance of the algorithm with Baveno VI and Expanded Baveno VI criteria. The secondary aim was to assess the role of TE in ruling out large EV.

Methods: In total, 1,381 patients with HCV-associated cirrhosis who had EGD and TE within 1 year of starting treatment with direct-acting antivirals were evaluated. Using multivariate logistic analysis, laboratory variables were selected to determine which were independently associated with medium/large EV to create the RESIST-HCV criteria. These criteria were tested in a training cohort with patients from a single center (Palermo) and validated with patients from the 21 other centers of the RESIST-HCV program (validation cohort).

Results: In the entire cohort, medium/large EV were identified in 5 of 216 patients (2.3%) using the Baveno VI criteria and 13 of 497 patients (2.6%) using the Expanded Baveno VI criteria. PLT count and albumin level were independently associated with medium/large EV. The best cut-off values were a PLT count greater than 120 × 10 cells/μL and serum albumin level greater than 3.6 g/dL; negative predictive values (NPVs) were 97.2% and 94.7%, respectively. In the training cohort of 326 patients, 119 (36.5%) met the RESIST-HCV criteria and the NPV was 99.2%. Among 1,055 patients in the validation cohort, 315 (30%) met the RESIST-HCV criteria and the NPV was 98.1%. Adding TE to the RESIST-HCV criteria reduced the avoided EGDs for approximately 25% of patients and the NPV was 98.2%.

Discussion: The "easy-to-use" RESIST-HCV algorithm avoids EGD for high-risk EV screening for more than 30% of patients and has the same performance criteria as TE. Using these criteria simplifies the diagnosis of portal hypertension.
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http://dx.doi.org/10.14309/ajg.0000000000000266DOI Listing
August 2019

Direct-acting antivirals after successful treatment of early hepatocellular carcinoma improve survival in HCV-cirrhotic patients.

J Hepatol 2019 08 6;71(2):265-273. Epub 2019 Apr 6.

Semeiotica Medica, Dipartimento di Scienze Mediche e Chirurgiche, Alma Mater Studiorum - University of Bologna, Italy.

Background & Aims: The effectiveness of direct-acting antivirals (DAAs) against hepatitis C virus (HCV), following successful treatment of early hepatocellular carcinoma (HCC), has been studied extensively. However, the benefit in terms of overall survival (OS) remains to be conclusively demonstrated. The aim of this study was to assess the impact of DAAs on OS, HCC recurrence, and hepatic decompensation.

Methods: We prospectively enrolled 163 consecutive patients with HCV-related cirrhosis and a first diagnosis of early Barcelona Clinic Liver Cancer stage 0/A HCC, who had achieved a complete radiologic response after curative resection or ablation and were subsequently treated with DAAs. DAA-untreated patients from the ITA.LI.CA. cohort (n = 328) served as controls. After propensity score matching, outcomes of 102 DAA-treated (DAA group) and 102 DAA-untreated patients (No DAA group) were compared.

Results: In the DAA group, 7/102 patients (6.9%) died, HCC recurred in 28/102 patients (27.5%) and hepatic decompensation occurred in 6/102 patients (5.9%), after a mean follow-up of 21.4 months. OS was significantly higher in the DAA group compared to the No DAA group (hazard ratio [HR] 0.39; 95% CI0.17-0.91; p = 0.03). HCC recurrence was not significantly different between the DAA and No DAA groups (HR0.70; 95% CI0.44-1.13; p = 0.15). A significant reduction in the rate of hepatic decompensation was observed in the DAA group compared with the No DAA group (HR0.32; 95% CI0.13-0.84; p = 0.02). In the DAA group, sustained virologic response was a significant predictor of OS (HR 0.02; 95% CI 0.00-0.19; p <0.001), HCC recurrence (HR 0.25; 95% CI 0.11-0.57; p <0.001) and hepatic decompensation (HR 0.12; 95% CI 0.02-0.38; p = 0.02).

Conclusions: In patients with HCV-related cirrhosis who had been successfully treated for early HCC, DAAs significantly improved OS compared with No DAA treatment.

Lay Summary: We aimed to determine whether direct-acting antivirals (DAAs) significantly improve overall survival in patients with hepatitis C virus-related compensated cirrhosis and a first diagnosis of hepatocellular carcinoma (HCC) which has been successfully treated with curative resection or ablation. Using propensity-score matched patients, we found that DAAs improved overall survival and reduced the risk of hepatic decompensation. However, the risk of HCC recurrence was not significantly reduced.
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http://dx.doi.org/10.1016/j.jhep.2019.03.027DOI Listing
August 2019

Real life experiences in HCV management in 2018.

Expert Rev Anti Infect Ther 2019 02 15;17(2):117-128. Epub 2019 Jan 15.

y Division of Clinical and Molecular Hepatology, Department of Internal Medicine , University Hospital of Messina , Messina , Italy.

Introduction: Hepatitis C virus (HCV) infection is a major cause of chronic liver disease, with approximately 71 million chronically infected individuals worldwide. Treatment of chronic hepatitis C has considerably improved in the last few years thanks to the introduction of direct-acting antivirals able to achieve sustained virological response in more than 95% of patients. Successful anti-HCV treatment can halt liver disease progression and solve the HCV-related extra-hepatic manifestations, eventually reducing liver-related and overall mortality. Areas covered: With the aim to respond to unmet needs in patient's identification, universal access to antiviral therapy and treatment optimization in specific setting of HCV-infected patients, a group of Italian experts met in Stresa in May 2018. The summary of the considerations arising from this meeting and the final statements are reported in this paper. Expert commentary: All the advances on HCV cure may have a real clinical impact not only in individual patients but also at the social health level if they are applied to all infected patients, independently from the stage of liver disease. Further improvements are needed in order to attain HCV elimination, such as the development of an enhanced screening program working in parallel to the present treatment options.
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http://dx.doi.org/10.1080/14787210.2019.1563755DOI Listing
February 2019

Suboptimal performance of APRI and FIB-4 in ruling out significant fibrosis and confirming cirrhosis in HIV/HCV co-infected and HCV mono-infected patients.

Infection 2019 Jun 5;47(3):409-415. Epub 2018 Dec 5.

Department of Sciences for Health Promotion "G. D'Alessandro", University of Palermo, Palermo, Italy.

Purpose: We aimed to assess the diagnostic reliability of two indirect biomarkers, APRI and FIB-4, for the staging of liver fibrosis using transient elastography (TE) as reference standard, among HIV/HCV co-infected and HCV mono-infected patients.

Methods: This is an observational, retrospective study on subjects who had access to the RESIST HCV from October 2013 to December 2016, a regional network encompassing 22 hospitals and academic centers throughout Sicily. Sensitivity, specificity and diagnostic accuracy of indirect biomarkers for liver stiffness measurement (LSM) < 9.5 kPa (significant fibrosis) and LSM ≥ 12.5 kPa (cirrhosis) were determined by receiver operator characteristics (ROC) curves.

Results: 238 HIV/HCV co-infected and 1937 HCV mono-infected patients were included. Performances of FIB-4 and APRI for the detection of significant fibrosis and cirrhosis proved to be unsatisfactory, with very high false negative and false positive rates among both cohorts. No significant differences were found after stratification of HIV/HCV co-infected patients for BMI < or ≥ 25, ALT < or ≥ 40 IU/L, ALT < or ≥ 80 IU/L, and presence/absence of a bright liver echo pattern on ultrasonography.

Conclusions: Differently from other studies, we detected the unreliability of APRI and FIB-4 for the assessment of liver fibrosis in both HCV mono-infected and HIV/HCV co-infected patients.
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http://dx.doi.org/10.1007/s15010-018-1258-6DOI Listing
June 2019

Epidemiology and Microbiology of Skin and Soft Tissue Infections: Preliminary Results of a National Registry.

J Chemother 2019 Feb 3;31(1):9-14. Epub 2018 Dec 3.

q Infectious Diseases Unit , Legnago Hospital , Verona , Italy.

Skin and soft tissue infections (SSTIs) represent a wide range of clinical conditions characterized by a considerable variety of clinical presentations and severity. Their aetiology can also vary, with numerous possible causative pathogens. While other authors previously published analyses on several types of SSTI and on restricted types of patients, we conducted a large nationwide surveillance programme on behalf of the Italian Society of Infectious and Tropical Diseases to assess the clinical and microbiological characteristics of the whole SSTI spectrum, from mild to severe life-threatening infections, in both inpatients and outpatients. Twenty-five Infectious Diseases (ID) Centres throughout Italy collected prospectively data concerning both the clinical and microbiological diagnosis of patients affected by SSTIs via an electronic case report form. All the cases included in our database, independently from their severity, have been managed by ID specialists joining the study while SSTIs from other wards/clinics have been excluded from this analysis. Here, we report the preliminary results of our study, referring to a 12-month period (October 2016-September 2017). During this period, the study population included 254 adult patients and a total of 291 SSTI diagnoses were posed, with 36 patients presenting more than one SSTIs. The type of infection diagnosed, the aetiological micro-organisms involved and some notes on their antimicrobial susceptibilities were collected and are reported herein. The enrichment of our registry is ongoing, but these preliminary results suggest that further analysis could soon provide useful information to better understand the national epidemiologic data and the current clinical management of SSTIs in Italy.
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http://dx.doi.org/10.1080/1120009X.2018.1536320DOI Listing
February 2019

Urinary schistosomiasis in migrant population: a case series from a single centre in southern Italy.

Infection 2019 Jun 30;47(3):395-398. Epub 2018 Oct 30.

Unit of Infectious Diseases and Centre for Migration and Health, ARNAS, Ospedale Civico Benfratelli, Piazza Nicola Leotta 4, 90127, Palermo, Italy.

Purpose: To understand the frequency of urinary schistosomiasis, in migrants in clinical follow-up at the infectious disease outpatient clinic of ARNAS Civico Hospital in Palermo Italy, to raise awareness on this neglected tropical disease.

Methods: A retrospective analysis of migrant patients in clinical care in our centre during the triennium 2015-2017.

Results: 2639 migrants have been in clinical care during the triennium 2015-2017, 72% are male and 28% are female. 214 patients were tested for the presence of Schistosoma eggs in urine, these patients are all male. All the patients tested, reported macroscopic haematuria and the 54% had an increase in the peripheral blood eosinophil count. Ninety subjects had a positive microscopic examination for Schistosoma haematobium eggs. Patients were treated with a standard dose of praziquantel (40 mg/kg), and tested for Schistosoma 1 month after the end of therapy. All the subjects fully recovered.

Conclusions: Considering the migration phenomenon, the observation of these tropical diseases in European hospitals is becoming more and more common and an increasing number of health care professionals will be dealing with migrants. Searching for haematuria and eosinophilia and then testing for Schistosoma in this specific population will increase the number of diagnosis and correct treatment of urinary schistosomiasis, improving the patients' quality of life and preventing severe complications of the disease.
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http://dx.doi.org/10.1007/s15010-018-1244-zDOI Listing
June 2019

HIV testing history and access to treatment among migrants living with HIV in Europe.

J Int AIDS Soc 2018 07;21 Suppl 4:e25123

Institute for Global Health, University College London, London, United Kingdom.

Introduction: Migrants are overrepresented in the European HIV epidemic. We aimed to understand the barriers and facilitators to HIV testing and current treatment and healthcare needs of migrants living with HIV in Europe.

Methods: A cross-sectional study was conducted in 57 HIV clinics in nine countries (Belgium, Germany, Greece, Italy, The Netherlands, Portugal, Spain, Switzerland and United Kingdom), July 2013 to July 2015. HIV-positive patients were eligible for inclusion if they were as follows: 18 years or older; foreign-born residents and diagnosed within five years of recruitment. Questionnaires were completed electronically in one of 15 languages and linked to clinical records. Primary outcomes were access to primary care and previous negative HIV test. Data were analysed using random effects logistic regression. Outcomes of interest are presented for women, heterosexual men and gay/bisexual men.

Results: A total of 2093 respondents (658 women, 446 heterosexual men and 989 gay/bisexual men) were included. The prevalence of a previous negative HIV test was 46.7%, 43.4% and 82.0% for women, heterosexual and gay/bisexual men respectively. In multivariable analysis previous testing was positively associated with: receipt of post-migration antenatal care among women, permanent residency among heterosexual men and identifying as gay rather than bisexual among gay/bisexual men. Access to primary care was found to be high (>83%) in all groups and was strongly associated with country of residence. Late diagnosis was common for women and heterosexual men (60.8% and 67.1%, respectively) despite utilization of health services prior to diagnosis. Across all groups almost three-quarters of people on antiretrovirals had an HIV viral load <50 copies/mL.

Conclusions: Migrants access healthcare in Europe and while many migrants had previously tested for HIV, that they went on to test positive at a later date suggests that opportunities for HIV prevention are being missed. Expansion of testing beyond sexual health and antenatal settings is still required and testing opportunities should be linked with combination prevention measures such as access to PrEP and treatment as prevention.
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http://dx.doi.org/10.1002/jia2.25123DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6053481PMC
July 2018

The Micro-Elimination Approach to Eliminating Hepatitis C: Strategic and Operational Considerations.

Semin Liver Dis 2018 08 9;38(3):181-192. Epub 2018 Jul 9.

Department of Medicine, Clinical and Research Center, Humanitas Hospital, Rozzano, Italy.

The introduction of efficacious new hepatitis C virus (HCV) treatments galvanized the World Health Organization to define ambitious targets for eliminating HCV as a public health threat by 2030. Formidable obstacles to reaching this goal can best be overcome through a micro-elimination approach, which entails pursuing elimination goals in discrete populations through multi-stakeholder initiatives that tailor interventions to the needs of these populations. Micro-elimination is less daunting, less complex, and less costly than full-scale, country-level initiatives to eliminate HCV, and it can build momentum by producing small victories that inspire more ambitious efforts. The micro-elimination approach encourages stakeholders who are most knowledgeable about specific populations to engage with each other and also promotes the uptake of new models of care. Examples of micro-elimination target populations include medical patients, people who inject drugs, migrants, and prisoners, although candidate populations can be expected to vary greatly in different countries and subnational areas.
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http://dx.doi.org/10.1055/s-0038-1666841DOI Listing
August 2018

Treatment with direct-acting antivirals in a multicenter cohort of HCV-infected inmates in Italy.

Int J Drug Policy 2018 09 6;59:50-53. Epub 2018 Jul 6.

Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy.

Background: People who are incarcerated have a significantly higher prevalence of HCV infection than the general population. Given their high-risk behavior, they represent a reservoir of HCV infection for the whole community.

Methods: We evaluated all HCV-infected people who were incarcerated in 25 Italian prisons starting direct-acting antivirals (DAAs) treatment between May 2015 and October 2016. We collected information on demographic characteristics, liver disease, HCV-related aspects, anti-HCV treatment, HIV or HBV co-infection.

Results: We enrolled 142 incarcerated people treated with DAAs. They were mostly Italians (93.7%) and males (98.6%). Median age was 50 years and 108/142 (76.1%) were cirrhotic patients. Prevalent genotypes were 1a (35.9%) and 3 (35.9%). Two patients were HBV co-infected, twenty-one patients (14.8%) were HIV co-infected and almost all (95.2%) received antiretroviral therapy. 118/142 (83.1%) DAAs-based regimens included sofosbuvir. Treatment completion rate was 94.4%. There were eight (5.6%) discontinuations, one (0.7%) due to an adverse reaction, one due to death (0.7%) and six (5.6%) due to release from prison. SVR12 was achieved in 90.8%. Four patients relapsed but no breakthrough occurred.

Conclusions: Our study shows that in Italian penitentiary settings DAAs treatment is feasible and effective. This intervention is crucial for reducing HCV circulation with possible benefits to the general population.
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http://dx.doi.org/10.1016/j.drugpo.2018.06.017DOI Listing
September 2018

Incidence of Hepatocellular Carcinoma in Patients With HCV-Associated Cirrhosis Treated With Direct-Acting Antiviral Agents.

Gastroenterology 2018 08 12;155(2):411-421.e4. Epub 2018 Apr 12.

Sezione di Gastroenterologia e Epatologia, Dipartimento Biomedico di Medicina Interna e Specialistica (Di.Bi.M.I.S.), University of Palermo, Palermo, Italy.

Background & Aims: Studies have produced conflicting results of the incidence of hepatocellular carcinoma (HCC) in patients with hepatitis C virus-associated cirrhosis treated with direct-acting antivirals (DAAs). Data from clinics are needed to accurately assess the occurrence rate of HCC in patients with cirrhosis in the real world.

Methods: We collected data from a large prospective study of 2,249 consecutive patients (mean age = 65.4 years, 56.9% male) with hepatitis C virus-associated cirrhosis (90.5% with Child-Pugh class A and 9.5% with Child-Pugh class B) treated with DAAs from March 2015 through July 2016 at 22 academic and community liver centers in Sicily, Italy. HCC occurrence was evaluated by Kaplan-Meier curves. Cox regression analysis was used to identify variables associated with HCC development.

Results: A sustained virologic response (SVR) was achieved by 2,140 patients (total = 95.2%; 95.9% with Child Pugh class A and 88.3% with Child Pugh class B; P < .001). Seventy-eight patients (3.5%) developed HCC during a mean follow-up of 14 months (range = 6-24 months). At 1 year after exposure to DAAs, HCC developed in 2.1% of patients with Child-Pugh class A with an SVR and 6.6% of patients with no SVR and in 7.8% of patients with Child-Pugh class B with an SVR and 12.4% of patients with no SVR (P < .001 by log-rank test). Albumin level below 3.5 g/dL (hazard ratio = 1.77, 95% confidence interval = 1.12-2.82, P = .015), platelet count below 120 × 10/L (hazard ratio = 3.89, 95% confidence interval = 2.11-7.15, P < .001), and absence of an SVR (hazard ratio = 3.40, 95% confidence interval = 1.89-6.12, P < .001) were independently associated increased risk for HCC. The mean interval from exposure to DAAs to an HCC diagnosis was 9.8 months (range = 2-22 months) and did not differ significantly between patients with (n = 64, 9.2 months) and without (n = 14, 12.0 months) an SVR (P = .11). A larger proportion of patients with an SVR had a single HCC lesion (78% vs 50% without an SVR; P = .009) or an HCC lesion smaller than 3 cm (58% vs 28% without an SVR; P = .07).

Conclusions: In an analysis of data from a large prospective study of patients with hepatitis C virus-associated compensated or decompensated cirrhosis, we found that the SVR to DAA treatment decreased the incidence of HCC over a mean follow-up of 14 months.
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http://dx.doi.org/10.1053/j.gastro.2018.04.008DOI Listing
August 2018

HBV virological suppression: still not enough to save from hepatocellular carcinoma. A case report on a 15-year, real-life story

Recenti Prog Med 2017 Sep;108(9):379-381

Department of Internal Medicine, National Hospital Trust, ARNAS Civico di Cristina e Benfratelli, Infection Unit, Palermo, Italy.

Among HIV-infected patients worldwide, 2-4 million are chronically infected with HBV. We report a 15-year, real-life story of a patient with HBV-HIV coinfection, who developed HCC despite high treatment adherence and complete viral suppression. The aim of our report is to alert the infectious diseases community to monitor the possible development of HCC regardless of high treatment adherence and complete viral suppression.
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http://dx.doi.org/10.1701/2745.27990DOI Listing
September 2017

High levels of postmigration HIV acquisition within nine European countries.

AIDS 2017 09;31(14):1979-1988

aNational Centre for Epidemiology, Instituto de Salud Carlos III, Madrid bUniversidad Complutense de Madrid cCIBERESP, Instituto de Salud Carlos III, Madrid, Spain dResearch Department of Infection and Population Health, University College London, London, UK eDepartment of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece fDepartment of Infectious Diseases, CHU Saint-Pierre, Brussels, Belgium gDepartment of Infectious Diseases Research and Prevention, Public Health Service of Amsterdam hDepartment of Internal Medicine, Center of Infectious Diseases and Immunology, Amsterdam (CINIMA), Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands iDepartment of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School, Porto, Portugal jClinic for Infectious Diseases, Bern University Hospital, Bern, Switzerland kDepartment of Infectious Diseases, Medical Clinic II, University Clinic Frankfurt, Frankfurt am Main lDepartment of Medicine I, Bonn University Hospital, Bonn, Germany mUnit of Infectious Diseases and Assistance, Coordination and Territorial Integration for Migrants' Emergency, Civico-Benfratelli Hospital, Palermo, Italy nEuropean AIDS Treatment Group, Brussels, Belgium. *Fiona Burns and Julia del Amo are both senior coauthors.

Objective: We aimed to estimate the proportion of postmigration HIV acquisition among HIV-positive migrants in Europe.

Design: To reach HIV-positive migrants, we designed a cross-sectional study performed in HIV clinics.

Methods: The study was conducted from July 2013 to July 2015 in 57 clinics (nine European countries), targeting individuals over 18 years diagnosed in the preceding 5 years and born abroad. Electronic questionnaires supplemented with clinical data were completed in any of 15 languages. Postmigration HIV acquisition was estimated through Bayesian approaches combining extensive information on migration and patients' characteristics. CD4 cell counts and HIV-RNA trajectories from seroconversion were estimated by bivariate linear mixed models fitted to natural history data. Postmigration acquisition risk factors were investigated with weighted logistic regression.

Results: Of 2009 participants, 46% were MSM and a third originated from sub-Saharan Africa and Latin America & Caribbean, respectively. Median time in host countries was 8 years. Postmigration HIV acquisition was 63% (95% confidence interval: 57-67%); 72% among MSM, 58 and 51% in heterosexual men and women, respectively. Postmigration HIV acquisition was 71% for Latin America and Caribbean migrants and 45% for people from sub-Saharan Africa. Factors associated with postmigration HIV acquisition among heterosexual women and MSM were age at migration, length of stay in host country and HIV diagnosis year and among heterosexual men, length of stay in host country and HIV diagnosis year.

Conclusion: A substantial proportion of HIV-positive migrants living in Europe acquired HIV postmigration. This has important implications for European public health policies.
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http://dx.doi.org/10.1097/QAD.0000000000001571DOI Listing
September 2017

Infectious diseases among foreign prisoners: results of a hospital-based management model in Palermo.

Infez Med 2017 Mar;25(1):57-63

Unit of Infectious Diseases and Medicine of Migrant and Vulnerable Populations, National Relevance Hospital Trust (ARNAS), Civico-Benfratelli Hospital, Palermo, Italy.

Foreign prisoners have a high vulnerability in terms of morbidity and access to care in overcrowded Italian prisons. This paper presents and comments on the management model of infectious diseases in foreign prisoners at our outpatient clinic, in order to describe a model of management for these conditions. Overall, 133 subjects (mean age 35.5 years) from 29 countries were followed for a period of 15 years. The most commonly represented area of origin (54.1%) was the Maghreb region. HCV infection (40.6%), HIV (22.5%), HBV (9.8%) and co-infection (15%, HIV/HCV or HIV/HBV) were observed. Ten subjects had tuberculosis, and only 30% of them were compliant with the treatment. Only 46.3% of HCV mono-infected patients completed the entire diagnostic process and even a lower percentage (37%) of them took treatment regularly. 90% of HBV mono-infected patients and 84% of those HIV mono- and co-infected completed the diagnostic workout. 77% of patients in each group took therapy regularly. Overall, the results show limited effectiveness. Therefore, it would be necessary to improve communication between healthcare professionals and correctional systems. Moreover, it appears urgent to reduce overcrowding in prisons to limit morbidity in prisoners.
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March 2017

Management of HCV infection in the penitentiary setting in the direct-acting antivirals era: practical recommendations from an expert panel.

Infection 2017 Apr 26;45(2):131-138. Epub 2016 Dec 26.

SIMSPe-Italian Society for Penitentiary Medicine and Healthcare, v.le San Pietro35/b, 07100, Sassari, Italy.

Background: The prevalence of HCV infection is higher among prisoners than in the general population. The introduction of HCV direct-acting antivirals (DAA) holds the potential to improve clinical outcomes also in inmates. However, treatment of hepatitis C in inmates has to face several clinical and logistical issues which are peculiar of prison environment. Recommendations on the management of HCV infection specific for the penitentiary setting in the DAA era remain scant. The Italian Society for Penitentiary Medicine and Healthcare has, therefore, issued these recommendations, to provide clinicians with a guide for the comprehensive management of HCV infection in the restriction setting, taking into account its peculiar characteristics.

Results: Dedicated diagnostic and treatment procedures should be established in each prison. In particular, the use of DAAs appears crucial to provide patients with an effective therapeutic option, able to overcome the limitations of IFN-based regimens with a short period of treatment. DAA treatment should be initiated as soon as possible in all eligible subjects with the aim to cure the patient, as well as to limit the transmission of HCV infection both inside the penitentiary system and to the free community, once the inmates ends his/her release. Importantly, efforts should be made to open a discussion with regulatory bodies, to define specific regulations aimed to guarantee wide access to effective therapies of all eligible patients, to optimize the management of and the adherence to the HCV treatment, and to ensure the therapeutic continuity after discharge from prison.
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http://dx.doi.org/10.1007/s15010-016-0973-0DOI Listing
April 2017

Lessons learnt from TB screening in closed immigration centres in Italy.

Int Health 2016 09 20;8(5):324-9. Epub 2016 May 20.

Médecins Sans Frontières, Operational Centre Brussels, Italian Mission.

Background: Between June 2012 and December 2013 Médecins Sans Frontières launched a pilot project with the aim of testing a strategy for improving timely diagnosis of active pulmonary TB among migrants hosted in four centres of identification and expulsion (CIE) in Italy.

Methods: This is a descriptive study. For active TB case finding we used an active symptom screening approach among migrants at admission in four CIE's. Here we describe the feasibility and the yield of this programme.

Results: Overall, 3588 migrants were screened, among whom 87 (2.4%) had a positive questionnaire. Out of 30 migrants referred for further investigations, three were diagnosed as having TB, or 0.1% out of 3588 individuals that underwent screening. Twenty-five (29%, 25/87) migrants with positive questionnaires were not referred for further investigation, following the doctors' decision; however, for 32 (37%, 32/87) migrants the diagnostic work-out was not completed. In multivariate analyses, being over 35 years (OR 1.7; 95% CI 1.1-2.6) and being transgender (OR 4.9; 95% CI 2.1-11.7), was associated with a positive questionnaire.

Conclusions: TB screening with symptom screening questionnaires of migrants at admission in closed centres is feasible. However, to improve the yield, follow-up of patients with symptoms or signs suggestive for TB needs to be improved.
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http://dx.doi.org/10.1093/inthealth/ihw025DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5039819PMC
September 2016

[Contact tracing and partner notification among a cohort of HIV-1 infected patients. A prospective study carried out in Palermo in 2012].

Recenti Prog Med 2014 Sep;105(9):327-32

Introduction. Contact tracing and partner notification are tools to prevent the spread of the HIV and other sexually transmitted infections. These tools protect the rights of the individual contrasting healthcare policies that encourage dangerous kinds of discrimination. Objective. Pointing out the opinion of a sample of HIV-1 infected patients about the possibility of starting a support helpdesk for contract tracing and partner notification. Design and setting. A survey about contact tracing and partner notification procedures was conducted through anonymous questionnaires filled by a sample of 110 HIV-infected patients, involved in a follow-up stage at the Infectious Diseases Outpatients Clinic from the Civic Hospital Benfratelli in Palermo. The survey took place in May 2012. Results. An efficient partner notification is considered essential, both to protect people with whom the patient has come into contact and to contribute to the reduction of HIV spread. The questions dealing with this issue recorded more than 90% of positive answers. The questions about protecting the privacy during the diagnosis notification processes enlightened that notifying the partner is always felt as a greater need compared to the risk of losing one's own privacy; in fact, the positive answers were 81%. As for the role played by the physician during the contact tracing and partner notification process, 34% of the interviewees think that the physician should ask the patient to disclose the names of partners with whom he/she had a risky behavior. Finally, as for the question concerning how partner notification should happen, the results showed that 31% of the interviewees declare to be favorable to a full mandate by the physician, while just above 25% would choose to notify it personally, even though with the physician's help. Conclusion. Overall, the survey showed that more than 70% of people interviewed are favorable to a personal notification, against 25% of the interviewees who would like to have the support of a healthcare operator during the partner notification process. The percentage of patients who would rather completely delegate the notification to the physician is drastically reduced to less than 2%.
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http://dx.doi.org/10.1701/1606.17518DOI Listing
September 2014

[Sexually transmitted infections in a cohort of female sex workers in Palermo].

Recenti Prog Med 2013 Dec;104(12):615-8

Aim: To evaluate the prevalence of sexually transmitted infections (HIV, HBV, HCV, Treponema pallidum) in a cohort of foreign female sex workers observed in Palermo from 1999 to 2008.

Materials And Methods: Authors conducted a prospective observational study on 239 foreign female sex workers aged between 18 and 36 years old. The nation of origin was Nigeria, Romania, Ucraina, Bulgaria.

Results: Overall, the diagnosis of IST was placed in 17 women, 7.1% of the population under study. In 14 cases we observed a single infection: HIV in 5 cases; syphilis and HBV in 4 cases; HCV in only one case. In the remaining three women were diagnosed a co-infection with HIV and HBV, HIV and HCV, HIV and syphilis LUE. In our study, a statistically significant correlation (p<0.0001) was observed between the non-constant condom use and a higher frequency of HIV, HCV and syphilis infection. This correlation was not statistically significant in the women with HBV infection.

Conclusions: The results of this study show a higher morbidity of this specific population, and, consequently, the need to start as soon as possible specific programs of intervention which can ensure the health of these women. Language and cultural barriers, as well as immigration concern among all vulnerable populations, form barriers to healthcare access.
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http://dx.doi.org/10.1701/1373.15262DOI Listing
December 2013

[Infectious diseases and health in the migrant people: experience from Lampedusa 2011].

Infez Med 2013 Mar;21(1):21-8

Centro di Riferimento Siciliano dell'Istituto Nazionale per la promozione della salute delle popolazioni Migranti e per il contrasto delle malattie della Poverta (INMP), Italy.

Migration is one of the possible points of contact between the rich world and the poor world. This paper analyzes and quantifies the presence of infectious diseases in a cohort of about 25,000 immigrants from Africa who landed in Lampedusa in 2011. The main clinical presentations of a cohort of migrants in Lampedusa were observed consecutively in 2011 during landing and then within the reception centers. In over 75% of the cases observed, the population was healthy. In 23% of cases diseases were observed in relation to the migration route, especially the precarious conditions of the crossing of the Channel of Sicily. Infectious diseases or female genital pathologies were observed in less than 2% of the population. The experience of Lampedusa in 2011 confirmed the Healthy Migrant theory, a population predominantly represented by young people who are at risk of becoming ill during the difficult migration or in the host country due to poor living conditions. Taking care of such people is an act of civilization and ensures the health of this population and of the whole community.
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March 2013

[HPV-related diseases and screening program in male partners].

Infez Med 2011 Sep;19(3):176-81

U.O. Ginecologia Oncologica; ARNAS, Ospedale Civico-Benfratelli, Palermo, Italy.

HPV is a sexually transmitted virus. The main risk factor for infection of the female population is the heterosexual transmission with partners who are infected with human papilloma virus (HPV). HPV infection is very common in sexually active males, and it is the most common STDs. In our experience the prevalence of infection is just under 50%. There are careful and well-established procedures that are applied to women with HPV; on the contrary, with regard to male population, there is, often, less focus and less sensitivity during both diagnostic and therapeutic strategies. The objectives of this study respond to two specific questions: 1. Is it useful to control male partner? 2. What tests are advisable and necessary for a proper definition of the problem? In this study 160 male patients, partners of patients with HPV infection, were examined by peniscopia, the search for HPV-DNA and biopsy of the penis. The study results show that the percentage of HPV infection of the male partners of women with HPV infection is quite high, ranging from 47 to 49% in relation to the methods used. The prevalence of patients with high-risk virus which stands at over 60%. Moreover, from 17.5% to 40.5%, we observed an infection with multiple genotypes of which is known as a hazard factor of aggravation and persistence of HPV infection. In conclusion, HPV-related diseases is a clinical infection of the couple and it is obvious that to the couple should be given great attention. For an important and effective prevention of transmission of HPV from the male subject to viruses to woman, and for the prevention ping-pong effect, it is essential to submit all the male partners of women infected with HPV peniscopia, HPV tests, and possibly a biopsy of the penis.
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September 2011

[Infectious diseases and sexual transmitted diseases in two different cohort of extra communitarian people in Palermo (Sicily, Italy) from 2000 to 2004].

Recenti Prog Med 2005 Apr;96(4):180-2

Dipartimento Malattie Infettive, Centro Intermedio Territoriale, Ospedale Pisani ASL 6, Palermo.

Unlabelled: The Authors have studied the prevalence of Infectious and Sexually Transmitted Diseases (STD) in a cohort of 109 Nigerian prostitutes and 37 extra communitarian drug addicts, with the aim to quantify the circulation of infectious and diffusive diseases in these groups of people.

Results: HIV infection was diagnosed in 2 prostitutes (1.8%) and in 4 drug addicts (10.8%). In the female population it has not been evidence of STD, neither tuberculosis neither active infection from hepatitis virus B and C. In the drug addicts, in a single case it has been evidence active infection from HBV. The search of antibodies anti-HCV has turned out positive in 20 of 37 subject heads (54%). Neither case of tuberculosis nor of syphilis infection was diagnosed in the all population. The analysis of the collected data supplies elements for some considerations: HIV infection in young Nigerian prostitutes with short history is bounded (1.8%) and it correlates with the absence of sexually transmitted diseases (thanks to the use of condom). More in a generalized manner, they are young healthy women probably "selected" at the origin by people interested to protect them from diseases that would compromise their rendering. As far as the population of the drug addicts, the prevalence of HIV infection is meaningfully higher regarding that one of the Italian drug addicts observed in our Division and that their style of life hinders the access to the necessary therapeutic approaches.
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April 2005
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