Adriana Cervo

Scopus Publications

Risk of Developing Low-Level Viral Rebound Among People With HIV Receiving 2- or 3-Drug Regimens: A Case-Control Study Nested in the ICONA Cohort
Alessandra Vergori, Adriana Cervo, Ashley Roen, Roberta Gagliardini, Tommaso Clemente, et al.
Open Forum Infectious Diseases, 2026
Background The risk of developing low-level viral rebound (LLVR) after achieving human immunodeficiency virus HIV-1 (HIV) RNA suppression with 2-drug regimens (2DR) compared to 3-drug regimens (3DR) remains uncertain. Methods We conducted a matched 1:3 case-control study nested within the ICONA cohort including persons with HIV (PWH) who achieved virological suppression (≥2 consecutive HIV-RNA ≤50 copies/mL over 6 months) after 11 November 2014 (baseline [BL]). Cases were defined as PWH experiencing a single HIV-RNA of 51–199 copies/mL after BL (index date); controls were defined as those who maintained HIV-RNA ≤50 copies/mL up to the index date and were matched for history of care gaps and number of drugs failed. The cumulative incidence of LLVR after virological suppression was estimated using Kaplan–Meier methods, and conditional logistic regression models were used to evaluate the association between the current antiretroviral therapy regimen (2DR [dolutegravir/lamivudine, dolutegravir/rilpivirine, dolutegravir/doravirine, or cabotegravir/rilpivirine] vs 3DR [dolutegravir, bictegravir, rilpivirine, doravirine, boosted darunavir, or boosted atazanavir–based with a backbone of tenofovir and lamivudine or emtricitabine]) and LLVR risk. In sensitivity analyses cases were defined as PWH experiencing 2 consecutive HIV-RNA of 51–199 copies/mL. Results Among 1033 PWH (261 cases, 772 matched controls), 21% were female, median age was 43 (interquartile range [IQR], 34–51) years, and BL CD4 count was 601 (IQR, 379–826) cells/μL; 2DR use was 25% in cases versus 29% in controls (P = .23). Two years after viral suppression, cumulative LLVR incidence was 2.7% (95% CI, 2.3%–3.1%) when considering single LLVR events and 1.8% (95% CI, 1.4%–2.1%) when limited to 2 consecutive values. After adjusting for confounding, evidence for an association with current regimen was inconclusive (adjusted odds ratio, 0.86 [95% CI, .57–1.29]). Conclusions Despite the wide range of plausibility, we can exclude a risk of LLVR higher than 29% when using 2DR versus 3DR regimens.
‘Leaving no stones unturned’: up to 10 years results on the effectiveness, tolerability and metabolic safety of dolutegravir+lamivudine (DTG+3TC) as a switch regimen in the ODOACRE cohort
Arturo Ciccullo, Gianmaria Baldin, Adriana Cervo, Letizia Oreni, Maria Mazzitelli, et al.
Journal of Antimicrobial Chemotherapy, 2026
Background Dolutegravir plus lamivudine (DTG+3TC) is widely used as a two-drug switch regimen for virologically suppressed PWH. We report long-term real-world data on effectiveness, tolerability, immunological recovery and metabolic/cardiovascular outcomes in a large, multicentre Italian cohort. Methods We performed a retrospective observational analysis of participants in the ODOACRE cohort who switched to DTG+3TC between January 2015 and January 2025 across eight Italian centres. Inclusion criteria were age ≥18, HIV-RNA <50 copies/mL for ≥6 months at switch, HBsAg negative. Primary outcomes were time to virological failure (VF) and time to treatment discontinuation (TD) for any cause. Kaplan–Meier survival analysis and Cox regression models were used to evaluate predictors. Changes in metabolic and immunological markers were assessed using linear mixed models and linear regression. Results A total of 2535 participants were included. Estimated probabilities of maintaining virological suppression were 99.5% at 48 weeks, 96.1% at 240 weeks and 90.4% at 480 weeks. In multivariate analysis, longer time since HIV diagnosis (per year aHR 1.038) and zenith HIV-RNA >500 000 copies/mL (aHR 2.205) predicted VF, whereas longer prior virological suppression was protective (per year aHR 0.869). During 9721.6 PYFU we observed 362 TDs (3.72 per 100 PYFU), with probabilities of regimen maintenance of 94.4%, 83.5% and 78.7% at weeks 48, 240 and 480, respectively. Conclusions In our real-world cohort with extended follow-up, DTG+3TC as a switch regimen was associated with durable virological suppression and favourable tolerability. Metabolic findings should be considered descriptive and exploratory, within the limits of an observational, uncontrolled study.
Impact of Vancomycin-Resistant Enterococci (VRE)–Active Perioperative Prophylaxis in Liver Transplant Patients Colonized by VRE
Giulia Jole Burastero, Emmanuel Q Wey, Veronica Guidetti, Samuele Cantergiani, Valentina Menozzi, et al.
Clinical Infectious Diseases, 2026
Background Data regarding the effectiveness of vancomycin-resistant Enterococci (VRE)–active prophylaxis for preventing early post–liver transplantation (LT) VRE infections in VRE-colonized patients are scarce. Methods 131 pre-LT VRE-colonized patients who underwent LT were enrolled in a retrospective, observational, multicenter study. The incidence of early-onset VRE infections was compared between patients who received active prophylaxis for VRE and those who did not. Results Sixty-nine (52.7%) and 62 (47.3%) patients were enrolled in the VRE-active and non–VRE-active prophylaxis group. Tigecycline was the most common drug prescribed as VRE-active for prophylaxis (55/69; 79.7%). There was no significant difference in the number of patients who developed early-onset VRE infections in the VRE-active versus non–VRE-active groups at 7 (0 [0.0%] vs 2 [3.2%]; P = .222), 14 (4 [5.7%] vs 4 [6.4%]; P = 1.000), and 30 (6 [8.7%] vs 8 [12.9%]; P = .621) days post-LT, respectively. Risk of early-onset VRE infection within 30 days was not lower in the VRE-active group (log-rank P = .16 with Kaplan-Meier analysis; odds ratio [OR]: .643; 95% CI: .210–1.969; P = .439 with univariate analysis). Conversely, early infections caused by any pathogen were significantly lower in the VRE-active prophylaxis group compared with the control group (11 [15.9%] vs 20 [32.2%]; P = .047). Tigecycline prophylaxis was associated with a lower risk of early-onset infections with multivariate analysis (OR: .106; 95% CI: .015–.745; P = .024) and after adjusting for propensity score (adjusted OR: .146; 95% CI: .031–.708; P = .017). Conclusions VRE-active prophylaxis at LT did not reduce the incidence of early post-LT VRE infections and should not be recommended.
HIV infection among adolescents and young adults in Italy: Epidemiology, viro-immunological and treatment outcomes
Francesco Maria Fusco, Ilaria Mastrorosa, Francesca Vichi, Adriana Cervo, Annalisa Saracino, et al.
International Journal of Infectious Diseases, 2026
Durability of lenacapavir in viremic heavily treatment-experienced people with HIV: Real-world data from the PRESTIGIO Registry
Tommaso Clemente, Golnaz Torkjazi, Nicolò Capra, Roberta Gagliardini, Anna Maria Cattelan, et al.
Journal of Antimicrobial Chemotherapy, 2026
All-Cause Mortality in People with Four-Class Drug-Resistant HIV: A Matched Cohort Analysis with Data from the PRESTIGIO Registry
Andrea Giacomelli, Nicolò Capra, Riccardo Lolatto, Roberta Gagliardini, Tommaso Clemente, et al.
Clinical Infectious Diseases, 2025
People with human immunodeficiency virus (HIV) (PWH) with 4-drug class resistance (4DR) had a higher risk of death than non-4DR PWH, primarily due to lower CD4 cell counts. The priority for this vulnerable population is achieving virological control to enable immune recovery.
Evaluation of HIV-1 DNA resistance evolution in highly treatment-experienced and multi-resistant individuals under suppressive antiretroviral therapy: a longitudinal study from the PRESTIGIO Registry
D Armenia, G Marchegiani, V Spagnuolo, M C Bellocchi, L Galli, et al.
Journal of Antimicrobial Chemotherapy, 2025
Background This study aimed to clarify whether resistance detected in HIV-1 DNA might evolve in virologically suppressed highly treatment-experienced (HTE) individuals with multidrug resistance (MDR). Methods Twenty-three virologically suppressed HTE MDR individuals from the PRESTIGIO Registry with two longitudinal samples available under virological suppression at two different time points (T0−T1) were analysed. HIV-1 DNA levels were quantified using droplet digital PCR, and resistance was assessed through next-generation sequencing (NGS) set at 5%. Mutational load was also evaluated. Results At T0, individuals had been virologically suppressed for a median time of 3 years (IQR 3–5) under a salvage regimen, mostly containing dolutegravir (95.7%) and/or darunavir (69.6%). The median HIV-1 DNA level was 2588 copies/106 CD4+ cells at T0 and remained stable at T1 (2322 copies/106 CD4+ cells; P = 0.831). Individuals with at least ≥3-class resistance in HIV-1 DNA were 20 (87.0%) at T0 and 18 (78.2%) at T1 (P = 0.607). In those receiving NNRTI-sparing treatment (52.2%), the number of NNRTI major resistance mutation (MRM) significantly decreased over time (T0, 2 [1–3]; T1, 0 [0–1]; P = 0.027). No significant temporal differences in the number of PI, NRTI and integrase strand transfer inhibitor (INSTI) MRM were found. Specific MRM, such as M184V, decreased over time, particularly in individuals who were receiving a 3TC-/FTC-sparing salvage regimen or with a T0 mutational load of &lt;1000 copies/106 CD4+ cells. Conclusions Over a year, HIV-1 DNA MRM generally remained unchanged in suppressed HTE MDR people with HIV (PWH) except for a significant decline in M184V and a reduction of NNRTI resistance in the absence of NNRTI pressure.
Proactive antimicrobial stewardship with real-time microbiological alerts improves management of bloodstream infections
Arianna Di Marcello, Antonella Santoro, Vera Todisco, Erica Franceschini, Gabriella Orlando, et al.
Jac Antimicrobial Resistance, 2025
Introduction This study aims to assess the impact of proactive Infectious Disease Specialist (IDS) interventions, in addition to standard antimicrobial stewardship (AMS) practices, triggered by real-time microbiological alerts, on improving the appropriateness and timeliness of antimicrobial prescriptions in hospitalized patients with bloodstream infections (BSIs). Methods We conducted a prospective, single-center, pre-post interventional study at the University Hospital of Modena, Italy. Adult inpatients with monomicrobial BSIs between June 2022 and March 2023 were included. During the intervention phase (November 2022–March 2023), real-time microbiological alerts were automatically delivered to IDS consultants, who proactively reviewed therapy. Primary outcomes included the time to effective therapy (TTE) and the time to appropriate therapy (TTA). Secondary outcomes encompassed the duration of antimicrobial therapy, 14 and 30-day mortality from BSI, and hospital length of stay. Results A total of 446 BSI episodes were analyzed (211 pre-intervention, 235 post-intervention). Post-intervention, the rate of appropriate therapy significantly increased (97.4% versus 76.2%, P &lt; 0.001), and TTE was significantly shorter (0.63 versus 0.87 days, P = 0.022). No statistically significant reduction in TTA was observed (1.97 versus 2.37 days, P = 0.081). Early IDS intervention (&lt;48 h) was associated with the shortest TTE and TTA. No significant differences were observed in mortality or hospital stay. Kaplan–Meier analysis showed a higher probability of receiving effective and appropriate therapy earlier in the post-intervention phase (log-rank test P = 0.014; 0.072, respectively). Subgroup analysis showed TTE improvements across MDR pathogens. Conclusions A proactive intervention of IDS, based on automatic microbiological alert, in addition to routine AMS activities, is significantly associated with improved prescription appropriateness, reducing TTE.
Persistence of CXCR4-tropic virus in people living with four-class drug-resistant HIV and its clinical impact in the modern antiretroviral era
Rebecka Papaioannu Borjesson, Sara Diotallevi, Riccardo Lolatto, Giovanni Cenderello, Laura Comi, et al.
Journal of Antimicrobial Chemotherapy, 2025
Background CXCR4-tropic HIV seems to be associated with more clinical events than CCR5-tropic virus. Objectives This study aims to describe the effect of the persistence of CXCR4-tropic virus on the occurrence of clinical events in people with four-class drug-resistant HIV. Methods This is a retrospective study on people with four-class drug-resistant HIV from the PRESTIGIO Registry, with at least two HIV-tropism determinations during follow-up. Follow-up accrued from the date of the first four-class drug resistance evidence (baseline) until death, loss to follow-up or freezing date (31 December 2023). Univariable Poisson regression was used to estimate and compare incidence rates of clinical events. Predictors of clinical events were assessed by multivariable Poisson regression. Results A total of 144 people with four-class drug-resistant HIV [47 (33%) with persistent CXCR4-tropism, 39 (27%) with persistent CCR5-tropism and 58 (40%) with a tropism switch during follow-up] were included with a median follow-up of 7.80 years (IQR = 5.80–10.6). Overall, 117 (81.3%) 4DR-PLWH experienced at least one clinical event during follow-up [incidence rate = 32.5 (95% CI = 29.3–35.9)]. The persistence of CXCR4-tropic virus was associated with an increased risk of HIV-related events among people living with four-class drug-resistant HIV, even in modern ART era. After adjusting for age, sex at birth and CD4+/CD8+ at baseline, standardized viremia copy-years [adjusted-incidence rate ratio = 1.66 (95% CI = 1.24–2.26), P &lt; 0.001] and persistent CXCR4-tropism [adjusted-incidence rate ratio: 2.01 (95% CI = 1.04–3.91), P = 0.037] were associated with the occurrence of HIV-related events. Conclusions Our findings confirm CXCR4-tropism as a marker of HIV progression also in the four-class drug-resistant population, suggesting the need of further prioritization of viro-immunological control and studies of pathogenic mechanisms in presence of CXCR4-tropic multidrug-resistant viral strains.
Effectiveness and predictors of treatment discontinuation of long-acting cabotegravir/rilpivirine in virologically suppressed people with HIV: real-life data from the Icona Cohort
Journal of Antimicrobial Chemotherapy, 2025
Comparison of Patients With or Without COVID-19 and Without Hematological Diseases Treated for Invasive Pulmonary Aspergillosis: A 5-Year Retrospective Cohort Study with Propensity-Based Adjustment
Sara Volpi, Shaniko Kaleci, Erica Franceschini, Samuele Cantergiani, Gabriella Orlando, et al.
Open Forum Infectious Diseases, 2025
Two-fold increased risk of cardiovascular events in people with MDR HIV: a matched cohort analysis with data from the PRESTIGIO registry
Tommaso Clemente, Sara Diotallevi, Davide Minisci, Antonio Di Biagio, Riccardo Lolatto, et al.
Journal of Antimicrobial Chemotherapy, 2025
Comparing the long-term effectiveness and safety of dolutegravir/lamivudine versus bictegravir/emtricitabine/tenofovir alafenamide fumarate as first-line regimens: A real life multicentre cohort
Arturo Ciccullo, Gianmaria Baldin, Adriana Cervo, Davide Moschese, Filippo Lagi, et al.
Journal of Antimicrobial Chemotherapy, 2025
Polypharmacy, anticholinergic burden and drug-drug interaction assessment in people with four-class-resistant HIV: data from the PRESTIGIO registry
Maria Mazzitelli, Domenico Pontillo, Tommaso Clemente, Antonio Di Biagio, Giovanni Cenderello, et al.
Journal of Antimicrobial Chemotherapy, 2024
Use of next-generation sequencing on HIV-1 DNA to assess archived resistance in highly treatment-experienced people with multidrug-resistant HIV under virological control: data from the PRESTIGIO Registry
Daniele Armenia, Vincenzo Spagnuolo, Maria C Bellocchi, Laura Galli, Leonardo Duca, et al.
Journal of Antimicrobial Chemotherapy, 2024
Risk of virological failure after drug burden reduction in people with 4-class drug-resistant HIV on virological suppression: A retrospective cohort analysis of data from the PRESTIGIO Registry
Tommaso Clemente, Sara Diotallevi, Riccardo Lolatto, Roberta Gagliardini, Andrea Giacomelli, et al.
International Journal of Antimicrobial Agents, 2024
Donor-derived carbapenem-resistant gram-negative bacterial infections in solid organ transplant recipients: Active surveillance enhances recipient safety
Alessandra Mularoni, Andrea Cona, Maria Campanella, Floriana Barbera, Alice Annalisa Medaglia, et al.
American Journal of Transplantation, 2024
Impact of COVID-19 pandemic on retention in care of native and migrant people with HIV in the ICONA cohort
Roberta Gagliardini, Andrea Giacomelli, Giorgio Bozzi, Antonella D'Arminio Monforte, Alessandro Tavelli, et al.
Travel Medicine and Infectious Disease, 2024
Cohort profile: PRESTIGIO, an Italian prospective registry-based cohort of people with HIV-1 resistant to reverse transcriptase, protease and integrase inhibitors
Tommaso Clemente, Laura Galli, Riccardo Lolatto, Roberta Gagliardini, Filippo Lagi, et al.
BMJ Open, 2024
Vancomycin resistant enterococcus risk factors for hospital colonization in hematological patients: a matched case-control study
Marianna Meschiari, Shaniko Kaleci, Martina Del Monte, Andrea Dessilani, Antonella Santoro, et al.
Antimicrobial Resistance and Infection Control, 2023
Long-acting combination of cabotegravir plus rilpivirine: A picture of potential eligible and ineligible HIV-positive individuals from the Italian ARCA cohort
Adriana Cervo, Antonio Russo, Domenico Di Carlo, Andrea De Vito, Lavinia Fabeni, et al.
Journal of Global Antimicrobial Resistance, 2023
Epidemiology and Prevention of Early Infections by Multi-Drug-Resistant Organisms in Adults Undergoing Liver Transplant: A Narrative Review
Giovanni Dolci, Giulia Jole Burastero, Francesca Paglia, Adriana Cervo, Marianna Meschiari, et al.
Microorganisms, 2023
Efficacy of bezlotoxumab in preventing the recurrence of Clostridioides difficile infection: an Italian multicenter cohort study
Marianna Meschiari, Alessandro Cozzi-Lepri, Adriana Cervo, Guido Granata, Carlotta Rogati, et al.
International Journal of Infectious Diseases, 2023
Long-term outcome of lamivudine/dolutegravir dual therapy in HIV-infected, virologically suppressed patients
Franco Maggiolo, Roberto Gulminetti, Layla Pagnucco, Margherita Digaetano, Adriana Cervo, et al.
BMC Infectious Diseases, 2022
“Dangerous liaisons: NAFLD and liver fibrosis increase cardiovascular risk in HIV”
Adriana Cervo, Giada Sebastiani, Jovana Milic, Thomas Krahn, Sergio Mazzola, et al.
HIV Medicine, 2022
Ceftazidime/Avibactam in Ventilator-Associated Pneumonia Due to Difficult-to-Treat Non-Fermenter Gram-Negative Bacteria in COVID-19 Patients: A Case Series and Review of the Literature
Giulia Jole Burastero, Gabriella Orlando, Antonella Santoro, Marianna Menozzi, Erica Franceschini, et al.
Antibiotics, 2022
Long-Term Impact of the COVID-19 Pandemic on In-Hospital Antibiotic Consumption and Antibiotic Resistance: A Time Series Analysis (2015–2021)
Marianna Meschiari, Lorenzo Onorato, Erica Bacca, Gabriella Orlando, Marianna Menozzi, et al.
Antibiotics, 2022
Two-Tier Care Pathways for Liver Fibrosis Associated to Non-Alcoholic Fatty Liver Disease in HIV Mono-Infected Patients
Giada Sebastiani, Jovana Milic, Adriana Cervo, Sahar Saeed, Thomas Krahn, et al.
Journal of Personalized Medicine, 2022
Combination of aztreonam, ceftazidime–avibactam and amikacin in the treatment of VIM-1 Pseudomonas aeruginosa ST235 osteomyelitis
Alessandra Mularoni, Maria Lina Mezzatesta, Michele Pilato, Alice Annalisa Medaglia, Adriana Cervo, et al.
International Journal of Infectious Diseases, 2021
NASH in HIV
Adriana Cervo, Mohamed Shengir, Keyur Patel, Giada Sebastiani
Current HIV AIDS Reports, 2020
Prediction of esophageal varices by liver stiffness and platelets in persons with human immunodeficiency virus infection and compensated advanced chronic liver disease
Nicolás Merchante, Chiara Saroli Palumbo, Giovanni Mazzola, Juan A Pineda, Francisco Téllez, et al.
Clinical Infectious Diseases, 2020
Prevalence, predictors, and severity of lean nonalcoholic fatty liver disease in patients living with human immunodeficiency virus
Adriana Cervo, Jovana Milic, Giovanni Mazzola, Filippo Schepis, Salvatore Petta, et al.
Clinical Infectious Diseases, 2020
Application of guidelines for the management of nonalcoholic fatty liver disease in three prospective cohorts of HIV-monoinfected patients
G Sebastiani, S Cocciolillo, G Mazzola, A Malagoli, J Falutz, et al.
HIV Medicine, 2020
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
Giovanni Mazzola, Lucia Adamoli, Vincenza Calvaruso, Fabio Salvatore Macaluso, Pietro Colletti, et al.
Infection, 2019
Direct-acting antivirals and visceral leishmaniasis: A case report
Claudia Colomba, Laura Saporito, Paola Di Carlo, Manlio Tolomeo, Adriana Cervo, et al.
BMC Infectious Diseases, 2019
Leishmaniasis and biologic therapies for rheumatologic diseases: A concise review
Chiara Iaria, Francesco Scarlata, Valentina Caputo, Teresa Rea, Nicola Serra, et al.
Gazzetta Medica Italiana Archivio Per Le Scienze Mediche, 2018
Madura foot: An imported case of a non-common diagnosis
Infezioni in Medicina, 2018