Maria Cristina Salfa

Late presenters among persons with a new HIV diagnosis in Italy, 2010–2011

BackgroundIn Western Europe, about 50% of newly diagnosed HIV-positive individuals are diagnosed at a late stage disease and enter in care late (i.e. with a CD4 count ≤350 μL/μL). The aim of the present study is to analyze the characteristics and the factors associated with being diagnosed late or at an advanced stage of disease among persons with a new HIV diagnosis in Italy, in the period 2010–2011.MethodsWe used individual data on new HIV diagnoses reported by the HIV surveillance system in 2010 and in 2011. Persons with CD4 ≤350 cells/μL or diagnosed with AIDS (regardless of the CD4 cell count) were defined as late presenters (LP); persons with CD4 ≤ 200 cells/μL or AIDS (regardless of the CD4 cell count) were defined as presenting with advanced HIV disease (AHD).ResultsOf the 7,300 new diagnoses reported in 2010–2011 by the included regions, 55.2% were LP; among these, 37.9% was diagnosed with AIDS. Persons presenting with AHD were 37.8%.The median age of LP was 40 years (IQR 33–48), significantly higher (p < 0.001) than that of non-LP (35 years); 73.9% were males; 30.7% were non-nationals. The median age of AHD was 42 years (IQR 35–50), 74.5% were males; 31.1% were non-nationals.The proportion of LP among IDUs was 59.8%, among heterosexuals (HET) 61.1% and among MSM 44.3%. The proportion of AHD among IDUs was 43.6%, among HET 43.2% and among MSM 27.4%.Factors significantly associated with being LP were: age older than 50 years (OR = 4.6 [95% CI 3.8-5.6]); having been diagnosed in Southern Italy (Southern vs Northern Italy OR = 1.5 [95% CI 1.3-1.7]) having been diagnosed in Central Italy (Central vs Northern Italy OR = 1.3 [95% CI 1.1-1.6]); being HET (HET vs MSM, OR = 1.7 [95% CI 1.5-2.0]), being non-national (Non-national vs Italian, OR 1.7 (95% CI 1.5-2.0); being IDU (IDU vs MSM, OR = 1.6 [95% CI 1.2-2.1]). The same factors were significantly associated with being AHD.ConclusionsOlder people, people diagnosed in Central and Southern Italy, non nationals, and persons who acquired the infection through injecting drug use or heterosexual contact showed a higher risk of being diagnosed late. A more active offer of HIV testing and targeted interventions focussed on these populations are needed to optimize early access to care and treatment.

Avidity Index for Anti-HIV Antibodies: Comparison between Third- and Fourth-Generation Automated Immunoassays

ABSTRACT The development of assays for detecting recent HIV infections has become crucial for analyzing trends in infection in different populations, both for surveillance and prevention activities. The anti-HIV avidity index (AI), measured with third-generation immunoassays (which detect anti-HIV antibody), has been shown to be an accurate tool for discriminating recent HIV infections (<6 months) from established infections (≥6 months). We compared a third-generation immunoassay (AxSYM HIV 1/2 gO; Abbott Diagnostics) to a fourth-generation immunoassay (Architect HIV Ag/Ab Combo; Abbott Diagnostics; which detects anti-HIV antibody and p24 antigen) in terms of AI performance in distinguishing between recent and established HIV infections. A total of 142 samples from 75 HIV-infected individuals with an estimated date of seroconversion were assayed. The two assays showed the same accuracy in identifying a recent infection (91.5%), using an AI cutoff of 0.80, although Architect HIV Ag/Ab Combo was slightly more sensitive (89.4% versus 84.8%; P > 0.05) and yet less specific (93.4% versus 97.4%; P > 0.05). The correlation between assays was high (r = 0.87). When 20 specimens falling in the gray zone around the cutoff point (0.75 ≤ AI ≤ 0.84) were excluded, the accuracy of AI with Architect HIV Ag/Ab Combo was 94.7%, and the concordance between the two assays was 99.2%. The anti-HIV AI is a serological marker that accurately discriminates recent from established HIV infections. It can be successfully applied on fully automated fourth-generation HIV Ab/Ag immunoassays, which have several advantages, including increased throughput, high reproducibility, no need for specific technical skills, and easy comparability of results obtained in different settings.

Continued high prevalence of HIV, HBV and HCV among injecting and noninjecting drug users in Italy

We estimated the prevalence of HIV, HBV and HCV infections among injecting and noninjecting drug users treated within public drug-treatment centres in Italy to determine the correlates of infection. In the sample of 1330 drug users, the prevalence of HIV was 14.4% among drug injectors and 1.6% among non-injectors; the prevalence of HBV was 70.4% among injecting drug users and 22.8% among non-injectors and of HCV was 83.2% among injecting drug users and 22.0% among non-injectors. Old age, unemployment, and intravenous drug use were significantly correlated with each of the infections, as well as a longer history of injecting drug use. The results indicate that these infections continue to circulate among drug users, highlighting the need for monitoring of this group in Italy.

Estimates of the Number of People Living with HIV in Italy

Objective. To estimate the HIV prevalence and the number of people living with HIV (PLHIV) in Italy with a projection for 2020. Methods. Two methods elaborated by Joint United Nations Programme on HIV/AIDS (UNAIDS) were used: Estimate and Projection Package and Spectrum. Results. A total of 123,000 (115,000–145,000) individuals aged 15 or more were estimated to be living with HIV in Italy at the end of 2012 and the estimated HIV prevalence was 0.28 (0.24–0.32) per 100 residents aged 15 or more. In 2012, the estimated number of new HIV infections among adults was 3,000 (2,700–4,000), and the number of adults in need for ART was 93,000 (80,000–110,000). The projection estimates that 130,000 (110,000–150,000) adults will live with HIV/AIDS in 2020 in Italy. Conclusion. Estimates of PLHIV in Italy stress the high number of PLHIV in need of care and treatment, as well as the need for more information and prevention campaigns.

Epidemiology of human immunodeficiency virus infection in blood donations in Europe and Italy

BACKGROUND The safety of blood with regards to transmission of infectious diseases is guaranteed by European laws that regulate both the selection of donors through pre-donation questionnaires and serological screening. However, variability in the epidemiology of human immunodeficiency virus (HIV) infection in different countries and some differences in the selection of donors can influence the efficacy (with regards to the safety of blood) of these processes. In this study we compared the prevalence of HIV in blood donations in the three macro-areas of Europe and in various western European countries, analysed the criteria of selection and rewarding of donors in western European countries, and studied the trend in the prevalence of HIV in Italy from to 1995 and 2006. METHODS European data were derived from the European Centre for the Surveillance of HIV; Italian data were obtained from the Transfusion-Transmitted Infections Surveillance System and National and Regional Register of blood and plasma. The information on eligibility criteria and rewarding offered to donors was derived from international sources. RESULTS The prevalence of HIV in blood donations was highest in eastern Europe, followed by central Europe and western Europe. Among the western European countries, Spain, Italy and Israel had the highest prevalences; the prevalence was noted to be higher in countries which did not offer any rewarding to the donor. In Italy the prevalence of HIV was 3.8 cases per 100,000 donations in 2006 and increased between 1995 and 2006, both among donations from repeat donors and first time donors. CONCLUSIONS The data highlight the need to continue improving the selection of donors and the coverage of the surveillance systems for HIV infection in transfusion services.

Prevalence and correlates of infection with human immunodeficiency virus, hepatitis B virus, and hepatitis C virus among drug users in Italy: a cross-sectional study.

Drug users in Italy continue to have a high prevalence of infection with the human immunodeficiency virus and hepatitis B and C viruses, associated with older age, being unemployed, injecting use, and a longer history of injecting. The results underline the need for control programmes among drug users in Italy.

AIDS patients with tuberculosis: characteristics and trend of cases reported to the National AIDS Registry in Italy--1993-2010.

BACKGROUND The co-infection of tuberculosis (TB) and human immunodeficiency virus (HIV) continue to be a severe problem in the European region. We estimated the extent of this phenomenon in Italy, describing and analysing the characteristics of persons with acquired immune deficiency syndrome (AIDS) and TB reported to the National AIDS Registry. METHODS We analysed the cases of TB reported to the National AIDS Registry in Italy since 1993, the year in which TB was introduced as an AIDS-defining disease. RESULTS From 1993 to 2010, 45,403 cases of AIDS were reported; among these, 4075 (8.9%) had TB (any location). Since 1993, there has been a progressive increase in the proportion of persons with TB, from 6.8% in 1993 to 11.0% in 2010. Men accounted for 76.3%; the median age at diagnosis was 35 years (interquartile range: 31-42 years), and 34.1% were non-nationals. Compared with AIDS cases without TB, AIDS cases with TB were significantly associated with young age (≤33 years), being non-Italian, having heterosexual contacts, living in the south of Italy, being a late tester and being alive at the time of data analysis. The proportion of non-nationals increased from 10.8% in 1993 to 64.6% in 2010. The incidence of AIDS and TB among non-nationals for the whole study period was 2.97 cases per 100,000 non-nationals, compared with 0.11 cases per 100,000 Italians. CONCLUSION These data suggest that the occurrence of TB among persons with AIDS is also increasing in Italy, with an increasing proportion of non-nationals, and emphasize the need to undergo HIV screening for all persons diagnosed with TB.

Prevalence and determinants of Chlamydia trachomatis infection among sexually active women in Turin, Italy

Background : According to the World Health Organisation, Chlamydia trachomatis (Ct) is the most common sexually transmitted bacterial agent worldwide. The aim of the present study was to determine the prevalence and risk factors for genital infection with Ct among sexually active women (14-60 years of age), in Turin (northern Italy). Methods : A cross-sectional study was performed between January 2002 and December 2007 among sexually active women in Turin. All women were tested for Ct infection using the Amplified Ct Assay (Gen-Probe) on an endocervical specimen. The prevalence was calculated as the proportion of Ct-positive women out of the total study population. Associations between Ct infection and risk factors (socio-demographic, behavioural, and clinical-gynaecological) were analyzed using the Chi-square test. The level of significance was set at 0.05. Risk factors independently associated with Ct infection were determined using a multivariate logistic regression model. The statistical analyses were performed using SPSS (version 17.0). Results : The study included 25,289 women, of whom 1.8% were found to have Ct infection. The prevalence of Ct infection increased significantly from 1.5% in 2002 to 2.2% in 2007 (χ2 =5.6; p-value <0.05). The prevalence significantly increased by decreasing age (χ2 linear trend 213.7; p-value <0.001) and was significantly higher among non-Italian women compared to Italian women (3.3% vs. 1.6%, p-value <0.001). In the multivariate analysis, Ct infection was significantly associated with an adjusted odds ratio higher than 2 for young age (14-24 years), being non-Italian, having had 2 or more lifetime sexual partners, and having had more than 1 partner in the previous six months. Conclusions: Our results showed an increase in Ct prevalence in Turin between 2002 and 2007. A significant association between Ct infection and young age, multiple sexual partners, and originating from Eastern Europe was observed. To reduce the spread of the infection, women with at least one of the above mentioned risk factors, should be encouraged to undergo a free-of-charge Ct testing.

An improved data-collection form for the surveillance of HIV infection in Italy

Background : The data-collection form used for Italys recently established national HIV surveillance system does not include sufficient information to thoroughly describe the dynamics of the epidemic. In addition, comparisons with data from other European countries are difficult. To address this issue, we have developed a more detailed form based on forms used in other European countries. Methods : Data-collection forms used in other countries were evaluated, and the information collected was categorised by topic. Based on this evaluation, a form was developed for use in Italy. Results : The forms used in other countries are more detailed than the Italian form, and we propose adding the following information to the Italian form: i) the year of entry in Italy for non-nationals; ii) testing pattern (i.e., the number of tests in the previous two years and during lifetime); iii) whether or not infection was recent, based on the antibody avidity index, and which test and cut-off were used; iv) whether or not testing was performed in the acute phase of infection, based on symptoms; and v) a checklist of reasons for undergoing testing. We also added a “Comments” section for information not recorded elsewhere on theform. Discussion : The more detailed form will allow for a more thorough description of the characteristics of newly infected persons and of the dynamics of the epidemic in Italy, which is fundamental for prevention and control initiatives. It will also allow for comparisons to be made against data from other European countries, revealing important similarities and differences.

Prevalence and incidence of external genital warts in a sample of Italian general female population

BackgroundThe Human papillomavirus is the most common sexually transmitted virus worldwide. The objective of this study was to estimate: 1) the prevalence and the incidence of external genital warts (eGW) in a sample of women attending community outpatient clinics and 2) the total number of eGW cases in the Italian female population aged 15–64 years.MethodsA prospective study was performed for a 12-month period between 2009 and 2010, among a sample of women attending community gynecological outpatient clinics located throughout Italy. Demographic data, for every woman aged 15–64 years, were collected. For women diagnosed with eGW, behavioral and clinical data were recorded. Prevalence of eGW was calculated as the proportion between the number of women with eGW and that of women visiting any of the participating gynecologists; incidence of eGW was calculated as the proportion between the number of women with a new diagnosis of eGW and that of women visiting any of the participating gynecologists. Standardized prevalence by age was used to estimate the number of eGW cases occurring in the Italian female population aged 15–64 years.ResultsIn 2009–2010, 44 community gynecologists were included in the network. In one-year period, 16,410 women visited any of the participating gynecologists; 63 women were diagnosed with eGW, corresponding to a prevalence of 3.8 cases per 1,000 women per year (95%CI: 2.9-4.9). The incidence of eGW was 3.0 cases per 1,000 women per year (95%CI: 2.2-3.9). Women aged 15–24 years showed both the highest prevalence and incidence. Prevalence and incidence significantly decreased by increasing age group (p <0.001), and were higher in Southern Italy compared to Central-Northern Italy. The estimated number of women with eGW among women aged 15–64 years in Italy, in 2010, was approximately 69,000.ConclusionsThese data show a high prevalence and incidence of eGW among young women in Italy, stress the effectiveness of community clinical networks in investigating STI epidemiology among women from the general population, confirm the relevance of HPV vaccination programs among adolescents, and underscore the need of promoting safe sex, implementing early diagnosis, treatment and prevention of genital warts.