Risk assessment of central nervous system (CNS) infection patients is of key importance in predicting likely pathogens. However, data are lacking on the epidemiology globally. We performed a multicenter study to understand the burden of community-acquired CNS (CA-CNS) infections between 2012 and 2014. A total of 2583 patients with CA-CNS infections were included from 37 referral centers in 20 countries. Of these, 477 (18.5%) patients survived with sequelae and 227 (8.8%) died, and 1879 (72.7%) patients were discharged with complete cure. The most frequent infecting pathogens in this study were Streptococcus pneumoniae (n = 206, 8%) and Mycobacterium tuberculosis (n = 152, 5.9%). Varicella zoster virus and Listeria were other common pathogens in the elderly. Although staphylococci and Listeria resulted in frequent infections in immunocompromised patients, cryptococci were leading pathogens in human immunodeficiency virus (HIV)-positive individuals. Among the patients with any proven etiology, 96 (8.9%) patients presented with clinical features of a chronic CNS disease. Neurosyphilis, neurobrucellosis, neuroborreliosis, and CNS tuberculosis had a predilection to present chronic courses. Listeria monocytogenes, Staphylococcus aureus, M. tuberculosis, and S. pneumoniae were the most fatal forms, while sequelae were significantly higher for herpes simplex virus type 1 (p < 0.05 for all). Tackling the high burden of CNS infections globally can only be achieved with effective pneumococcal immunization and strategies to eliminate tuberculosis, and more must be done to improve diagnostic capacity.

Economic evaluation of nevirapine plus raltegravir as maintenance antiretroviral therapy in virologically suppressed HIV-1 infected patientsBackground: A one-year cost analysis was conducted to estimate the impact on the Italian National Health Service (NHS) of nevirapine plus raltegravir administration as maintenance antiretroviral therapy in virologically suppressed HIV-1 infected patients. Methods: Patient data were retrieved from the electronic medical record system in use (year 2014) in a reference HIV centre in Northern Italy. The analysis considered patients with long-term (more than one year) virological suppression (HIV-1 RNA <50 copies/ml) on Highly Active Antiretroviral Therapy (HAART) and no prior exposure to integrase inhibitors (INIs). To estimate the total HAART expenditure, we calculated the annual treatment cost for each enrolled patients. Subsequently, to estimate the dual therapy hypothetical expenditure, we assumed to treat the same patients with nevirapine (400 mg) and raltegravir (400 mg twice daily). We took into account only drug costs (ex-factory prices, included all discounts and VAT) from the perspective of the Italian NHS. Results: In 2014, the total expenditure for the 103 enrolled HIV-1 patients treated with HAART was €814,543. The mean treatment cost per patient was €7,908. If all patients were treated with the dual therapy (nevirapine and raltegravir), the total expenditure would be €573,298 (-29.6%) with a mean treatment cost per patient of €5,566. Conclusions: From the Italian NHS perspective, nevirapine/raltegravir represent a cost-saving option as maintenance antiretroviral therapy in virologically suppressed HIV-1 infected patients.

Objective: The purpose of our study was to evaluate the alterations of bone metabolism and the prevalence of vertebral fractures in the population with HIV and hepatitis B and C seropositivity in treatment with antiretroviral drugs (HAART). Methods: We selected 83 patients with diagnosis of HIV, HBV, HCV infection. In all these patients biochemical examinations of phospho-calcium metabolism and a densitometry of lumbar spine were performed. We also evaluated lateral spine X-rays in order to analyze the presence of vertebral deformities and to define their severity. As a control group we analyzed the prevalence of vertebral fractures in a group of 40 non-infectious patients. Results: We selected 82 seropositive patients, 46 males and 37 females, with a median age of 55 ± 10 years. Out of these patients, 55 were infected by HIV, 12 were infected by HBV, 11 presented HIV and HCV co-infection and 4 were HCV+. The prevalence of hypovitaminosis D in the studied population was 53%, while the prevalence of osteoporosis and osteopenia was 14 and 48%, respectively. The average T-score in the fractured population was −1.9 SD. The viral load and the CD4+ cell count were respectively, directly, and inversely correlated with the number and severity of vertebral fractures. Antiretroviral therapy regimen containing TDF and PI was a significant determinant of the presence of vertebral deformities. The use of these drugs was also associated with lower levels of vitamin D and higher bone turnover levels compared to other antiretroviral drugs. Conclusions: HIV patients suffer from bone fragility, particularly at spine, independently by the level of bone mineral density. In this population, the T-score threshold for the risk of fracture is higher than that usually used in general population. For this reason, it would be indicated to perform an X-ray of the spine in order to detect vertebral deformities even in patients with a normal or slighlty reduced bone mineral density.

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