General Penta Pubblications

6

Nov, 2017

Treatment of Community-Acquired Pneumonia: Are All Countries Treating Children in the Same Way? A Literature Review

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Authors: Donà D, Luise D, Da Dalt L, Giaquinto C.

Published in: Int J Pediatr; 2017: 4239268. Epub 2017

AbstractBackground. Pneumonia represents an important threat to children’s health in both developed and developing countries. In the last 10 years, many national and international guidelines on the treatment of pediatric CAP have been published, in order to optimize the prescription of antibiotics and limit their cost and side effects. However, the practical implementation of these guidelines is still limited. Main Text. We analyzed the current recommendations for the therapy of pediatric community-acquired pneumonia (CAP) that all converge on the identification of aminopenicillins and beta-lactams as the optimal treatment for CAP. We also conducted a review of the current literature on antibiotic regimens used for pediatric CAP to identify the current state of guidelines implementation in different settings. We selected 37 studies published from 2010 to 2016, including both retrospective and prospective studies, mainly cross-sectional and hospital based. The results show a global heterogeneity in the antibiotics prescription for pediatric CAP, with application of guidelines varying from 0% to more than 91% and with important differences even within the same country. Conclusions. Our review has demonstrated that the implementation of the guidelines is still limited but also that achieving the optimal prescription is possible and can be done in both developed and developing countries.

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5

Jul, 2017

The Bill Marshall award 2017 ceremony now live

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The stream video coverage of the Bill Marshall Award 2017 Ceremony is now available.

Many thanks to ESPID and the Multilearning Group for this webcast.

 

 

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10

Mar, 2016

Children and young people with perinatal HIV in Europe: epidemiological sitation in 2014 and implications for the future

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Authors: Writing group for the Kids to Adults Working Group and Data Management and Harmonisation Group in EuroCoord.

Published in: Euro Surveill. 2016; 21: ES.201621.10.30162.

Abstract: Accurate ascertainment of the number of children living with human immunodeficiency virus (HIV) is important to plan paediatric and adolescent health services. In Europe, the first generation of perinatally HIV-infected survivors are transferring to adult care and their health needs are unknown. We undertook an online survey of HIV cohort studies participating in the EuroCoord Network of Excellence to ascertain the number of perinatally HIV-infected (pHIV) patients included, to compare it with those published by the European Centre for Disease Prevention and Control (ECDC) and the World Health Organization (WHO) and to assess the ability of countries to follow up pHIV patients after transfer to adult care. At the end of 2013, 16 countries in EuroCoord reported 8,229 pHIV patients in follow-up in cohorts, compared with 5,160 cumulative diagnoses reported by the ECDC in the same area. Follow-up of pHIV patients after transfer to adult care varied. It is likely that the number of diagnoses of perinatal HIV reported to ECDC is an underestimate, although this varies by country. Further work is needed to refine estimates and encourage follow-up in adult HIV cohorts to investigate long-term outcomes and improve the care of the next generation of children with HIV.

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19

Jun, 2015

Italian guidelines for the use of antiretroviral agents and the diagnostic-clinical management of HIV-1 infected persons. Update Decemebr 2014

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Authors: Antinori A., Marcotullio S., Andreoni M., Ammassari A., d’Arminio Monforte A., Galli M., Girardi E., Mazzotta F., Mussini C., Puoti M., Lazzarin A.; Italian HIV Guidelines Working Group.

Published inNew Microbiol. 2015, 38: 299-328

Abstract: This short version complies with the intention expressed in the introduction to the full text Italian Guidelines for the use of antiretroviral drugs and the diagnostic-clinical management of people with HIV-1 infection. By definition, this version should not be considered completely exhaustive with respect to the full text version of the Guidelines (HIV/AIDS Italian Expert Panel, 2014)

 

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19

Jun, 2015

Pediatric drug safety surveillance in FDA-AERS: a description of adverse events from GRIP project.

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Authors:  De Bie S., Ferrajolo C., Straus S.M., Verhamme K.M., Bonhoeffer J., Wong I.C., Sturkenboom M.C., GRiP network

Published in: PLoS One. 2015, 10: 0130399.

Abstract: Individual case safety reports (ICSRs) are a cornerstone in drug safety surveillance. The knowledge on using these data specifically for children is limited. We studied characteristics of pediatric ICSRs reported to the US Food and Drug Administration (FDA) Adverse Event Reporting System (FAERS). Public available ICSRs reported in children (0–18 years) to FAERS were downloaded from the FDA-website for the period Jan 2004-Dec 2011. Characteristics of these ICSRs, including the reported drugs and events, were described and stratified by age-groups. We included 106,122 pediatric ICSRs (55% boys and 58% from United States) with a median of 1 drug [range 1–3] and 1 event [1–2] per ICSR. Mean age was 9.1 years. 90% was submitted through expedited (15-days) (65%) or periodic reporting (25%) and 10% by non-manufacturers. The proportion and type of pediatric ICSRs reported were relatively stable over time. Most commonly reported drug classes by decreasing frequency were ‘nervous system drugs’ (58%), ‘antineoplastics’ (32%) and ‘anti-infectives’ (25%). Most commonly reported system organ classes were ‘general’ (13%), ‘nervous system’ (12%) and ‘psychiatric’ (11%) disorders. Duration of use could be calculated for 19.7% of the reported drugs, of which 14.5% concerned drugs being used long-term (>6 months). Knowledge on the distribution of the drug classes and events within FAERS is a key first step in developing pediatric specific methods for drug safety surveillance. Because of several differences in terms of drugs and events among age-categories, drug safety signal detection analysis in children needs to be stratified by each age group.

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28

Aug, 2012

Insufficient antiretroviral therapy in pregnancy: missed opportunities for prevention of mother-to-child transmission of HIV in Europe

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Authors: European Collaborative Study in Eurocord

Published in: Antivir Ther, 2011,16: 859-903.

Background: Although mother-to-child transmission (MTCT) rates are at an all-time low in Western Europe, potentially preventable transmissions continue to occur. Duration of antenatal combination antiretroviral therapy (ART) is strongly associated with MTCT risk.

Methods: Data on pregnant HIV-infected women enrolled in the Western and Central European sites of the European Collaborative Study between January 2000 and July 2009 were analysed. The proportion of women receiving no antenatal ART or 1-13 days of treatment was investigated, and associated factors explored using logistic regression models.

Results: Of 2148 women, 142 (7%) received no antenatal ART, decreasing from 8% in 2000-03 to 5% in 2004-09 (χ2 =8.73, p<0.01). A further 41 (2%) received 1-13 days of ART. A third (64/171) of women with “insufficient” (no or 1-13 days) antenatal ART had a late HIV diagnosis (in the third trimester or intrapartum), but half (85/171) were diagnosed pre-conception. Preterm delivery <34 weeks was associated with receipt of no and 1-13 days antenatal ART (AOR 2.9 p<0.01 and AOR 4.5 p<0.01 respectively). Injecting drug use history was associated with an increased risk of no ART (AOR 2.9 p<0.01) and severe symptomatic HIV disease with a decreased risk (AOR 0.2, p<0.01). MTCT rates were 1.1% (15/1318) among women with ≥14 days antenatal ART and 7.4% (10/136) among those with insufficient ART.

Conclusions: Over the last 10 years, around 1 in 11 women in this study received insufficient antenatal ART, accounting for 40% of mother-to-child transmissions. Half of these women were diagnosed pre-conception, suggesting disengagement from care.

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19

Apr, 2012

Italian guidelines for the use of antiretroviral agents and the diagnostic-clinical management of HIV-1 infected persons. Update 2011

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Authors: Antinori A., Marcotullio S., Ammassari A., Andreoni M., Angarano G., Armignacco O., Carosi G., Cinque P., d’Arminio Monforte A., Di Perri G., Ensoli B., Florida M., Galli M., Mastroianni C., Matteelli A., Mazzotta F., Moroni M., Pal G., Puoti M., Puro V., Rizzardini G., Sagnelli E., Vella S., Vullo V., Lazzarin A., Italian HIV Guidelines Working Group (Giaquinto C.  member of Study Group)

Published inNew Microbiol 2012, 35: 113 – 59

Abstract: This short version complies with the intention expressed in the methodological introduction to the full text Italian Guidelines for the use of antiretroviral drugs and the diagnostic-clinical management of people with HIV-1 infection. By definition, this version should not be considered completely exhaustive with respect to the full text version of the Guidelines available at the website: http://www.salute.gov.it/imgs/C_17_pubblicazioni_1301_allegato.pdf.

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4

Apr, 2012

Antiretroviral use in Italian children with perinatal HIV infection over a 14 – year period

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Authors:  Chiappini E., Galli L., Tovo P.A., Gabiano C., Lisi C., Giacomet V., Bernardi S., Esposito S., Rosso R., Giaquinto C ., Badolato R., Guarino A., Maccabruni A., Masi M., Cellini M., Salvini F., Di Bari C., Dedoni M., Dodi I., De Martino M for the Italian Register for HIV infection in children

Published in: Acta Paediatr, 2012, 101: 287-295

Background:  Information on the use of new antiretroviral drugs in children in the real setting of clinical fields is largely unknown.

Methods:  Data from 2554 combined antiretroviral therapy (cART) regimens administered to 911 children enrolled in the Italian Register for HIV infection in children, between 1996 and 2009, were analysed. Factors potentially associated with undetectable viral load and immunological response to cART were explored by Cox regression analysis.

Results:  Proportion of protease inhibitor (PI)-based regimens significantly decreased from 88.0% to 51.2% and 54.9%, while proportion on non-nucleoside reverse transcriptase inhibitor (NNRTI)-based regimens increased from 4.5% to 38.8% and 40.2% in 1996–1999, 2000–2004 and 2005–2009, respectively (p < 0.0001). Significant change in the use of each antiretroviral drug occurred over the time periods (p < 0.0001). Factors independently associated with virological and immunological success were as follows: later calendar periods, younger age at regimen (only for virological success) and higher CD4+ T-lymphocyte percentage at baseline. Use of unboosted PI was associated with lower adjusted hazard ratio (aHR) of virological or immunological success with respect to NNRTI- and boosted PI-based regimens, with no difference among these two latter types.

Conclusion:  Use of new generation antiretroviral drugs in Italian HIV-infected children is increasing. No different viro-immunological outcomes between NNRTI- and boosted PI-based cART were observed.

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19

Mar, 2012

Body Fat Abnormality in HIV-infected children and adoloscents living in Europe: prevalence and risk factors

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Authors: Alam N., Cortina – Borja M., Goetghebuer T., et al. European Paediatr HIV & Lipodystrop (Giaquinto C.  member of the Study Group)

Published in: JAIDS, 2012, 59: 314 – 32

Objectives: To estimate the prevalence of and identify risk factors for lipodystrophy syndrome (LS) and body fat abnormality in a population of HIV-infected children and adolescents.

Design: Cross-sectional observational study.

Methods: HIV-infected subjects aged 2-18 years were recruited from 15 HIV centers in Belgium, Italy, and Poland between January 2007 and December 2008. Standardized assessments by the patient’s long-term clinician were performed to establish the presence of abnormality. Risk factors were explored in logistic regression models for fat abnormality outcomes and LS (abnormality plus dyslipidemia).

Results: Among 426 subjects (70% white), median age was 12.2 years (interquartile range: 9.0-15.0 years) and median duration of antiretroviral therapy was 5.2 years (interquartile range: 2.2-8.8 years). Prevalence was 57% (n = 235) for LS and 42% (n = 176) for fat abnormality; 90 subjects with abnormality were affected in ≥3 locations. Lipoatrophy occurred in 28% (n = 117) of subjects and lipohypertrophy in 27% (n = 115), most commonly in the face and trunk, respectively. In multivariable analysis, white ethnicity, body mass index, ritonavir/lopinavir, and nonnucleoside reverse transcriptase inhibitors were each associated with an increased risk of LS (P < 0.05). White ethnicity, history of Centers for Disease Control and Prevention-defined disease, and stavudine were associated with risk of lipoatrophy (P < 0.05). Increased risk of lipohypertrophy was associated with body mass index and prior HIV disease.

Conclusions: Fat abnormality was prevalent in close to half of children and adolescents, who had accumulated long treatment durations. Risk of fat abnormality was associated with specific drugs, including stavudine and ritonavir, and other variables. Our results underline the importance of continued surveillance of children treated with antiretroviral therapy.

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