rome and HIV-Infections

To evaluate the effectiveness of peer education when compared to teacher-led curricula in AIDS prevention programs conducted in schools in Rome, Italy.. Eighteen high schools were randomly assigned to one of two prevention programs: one led by teachers and the other by peer leaders. A sample of students attending the last 2 years (n = 1295) completed pre and post-intervention questionnaires. Changes in sexual behaviors, knowledge, prevention skills, risk perception and attitudes were first evaluated within each intervention group. Afterwards, changes in knowledge, prevention skills, risk perception, and attitudes total scale scores (post-test scores minus pre-test scores) were compared between the two groups, through linear regression models, in order to control for confounders, taking into account the within-school correlation in score changes. As for sexual behaviors, number of sexual partners and frequency of condom use in the 3 months before post-test were compared by intervention group through ordinal regression models, also taking into account behaviors reported before pre-test.. For both groups, we observed significant improvements in skills, knowledge, attitudes and risk perception. The peer-led group showed a 6.7% (95% C.I. 1.9-11.5) scores greater improvement in knowledge, compared to the teacher-led group. In neither group were improvements observed in condom use or number of sexual partners.. The only apparent benefit of the peer-led intervention, compared to that led by teachers, was a greater improvement in knowledge of HIV. Neither of the interventions induced changes in sexual behavior. However, the role of possible biases and methodological problems must be considered when interpreting these results.

Topics: Adolescent; Female; Health Knowledge, Attitudes, Practice; HIV Infections; Humans; Male; Peer Group; Rome; Schools; Sex Education; Sexual Behavior; Social Class; Surveys and Questionnaires

To evaluate the validity and reliability of the Italian version of the 35-item Medical Outcome Study HIV Health Survey (MOS-HIV) when applied to persons with AIDS.. The study population consisted of 185 adults with AIDS residing in Rome and participating in a randomised controlled trial on home-care. Diagnosis was made between 1 October 1994 and 1 April 1996, and enrollment took place within 2 months of diagnosis. The MOS-HIV, which measures 10 dimensions of health-related quality of life (QoL), was administered at baseline and every 3 months thereafter during the 1-year follow-up. Tests of convergent and concurrent construct validity were conducted for all scales.. Of the 185 trial participants, 146 responded to the questionnaire; 82 responded at least twice (including baseline collection) during follow-up. For the role functioning, general health, and vitality scales, the distribution of scale scores was concentrated at the lower half of the range. Internal consistency reliability was adequate (>0.80) for all scales. Baseline scores tended to increase with decreasing AIDS severity and with increasing age. There were improvements over time in the role functioning, vitality, and health distress scales.. The MOS-HIV had good reliability among persons with AIDS. There was a moderate floor effect for some of the subscales. Tests of convergent and construct validity were generally confirmed. Additional studies are needed to evaluate the responsiveness to changes over time.

Topics: Adult; Female; Health Services Research; HIV Infections; Home Care Services; Humans; Male; Quality of Life; Rome; Sickness Impact Profile; Surveys and Questionnaires; Translating

We describe the preliminary results of bulevirtide compassionate use in patients with hepatitis B and delta virus (HBV/HDV)-related cirrhosis and clinically significant portal hypertension, including those living with HIV.. We conducted a prospective observational study of consecutive patients. Clinical evaluation, liver function tests, bile acid levels, HDV-RNA, HBV-DNA, hepatitis B surface antigen, and liver and spleen stiffness were assessed at baseline and after treatment months 1, 2, 3, 4, 6, 9, and 12. HIV-RNA and CD4+/CD8+ count were assessed in people living with HIV. The first drug injection was administered under nurse supervision, and counselling was provided and adherence reviewed at each visit.. In total, 13 patients (61.5% migrants) were enrolled. The median treatment duration was 11 months. At month 6, mean alanine aminotransferase (ALT) levels fell by 64.5% and mean liver and spleen stiffness decreased by 8.6 and 0.9 kPa, respectively. The mean baseline HDV-RNA was 3.34 log IU/mL and 5.10 log IU/mL in people without and with HIV (n = 5) (p = 0.28), respectively. A similar mean decline was observed in both groups: -2.06 log IU/mL and -1.93 log IU/mL, respectively (p = 0.87). A combined response (undetectable HDV RNA or ≥ -2 log IU/mL decline vs. baseline, with ALT normalization) was achieved in 66% of subjects without and in 60% of patients with HIV. Patients with HIV showed persistently undetectable HIV-RNA and a progressive increase in CD4+/CD8+ cells during treatment. No patient discontinued bulevirtide because of adverse effects.. Preliminary results suggest that bulevirtide is feasible and well-tolerated in populations with difficult-to-treat conditions, such as those with HIV/HBV/HDV co-infection and migrants, when special attention is given to patient education. HDV-RNA decline during treatment was similar in people living with and without HIV.

Topics: Compassionate Use Trials; Hepatitis B virus; HIV Infections; Humans; Italy; Liver Cirrhosis; RNA; Rome

HIV-infected men who have sex with men (MSM) display the highest prevalence of anal infection by high-risk Human Papillomaviruses (hrHPVs) and incidence of anal carcinoma. Anal specimens were genotyped by the Linear Array. Incidence and clearance of anal infection by hrHPVs, hrHPVs other than HPV16, low-risk HPVs, and four individual types (6,11,16,18) were estimated using a two-state Markov model. Determinants for incidence and clearance were assessed by logistic regression. Overall, 204 individuals were included (median age 42 years, IQR = 34-49). For hrHPVs, incidence and clearance rates were 36.1 × 1000 person-months (p-m) (95% CI 23.3-56.5) and 15.6 × 1000 p-m (95% CI 10.7-23.3), respectively. HPV16 showed a higher incidence than HPV18 (10.2 vs. 7.2 × 1000 p-m). Its clearance was more than twofold lower than that of HPV18 (30.1 vs. 78.2 × 1000 p-m). MSM receiving cART displayed a 68% to 88% decrease in risk of acquiring hrHPVs, hrHPVs other than HPV16, HPV16, and HPV18 (adjusted Hazard Ratio [aHR] 0.13, 95% CI 0.02-0.67; aHR 0.22, 95% CI 0.06-0.78; aHR 0.32, 95% CI 0.12-0.90; aHR 0.12, 95% CI 0.04-0.31, respectively) than patients not treated. A nadir CD4 + count < 200 cells/mm

Topics: Adult; Anal Canal; Anti-HIV Agents; Anus Diseases; Coinfection; Drug Therapy, Combination; HIV Infections; Homosexuality, Male; Humans; Incidence; Longitudinal Studies; Male; Middle Aged; Papillomavirus Infections; Prognosis; Protective Factors; Risk Assessment; Risk Factors; Rome; Time Factors

Topics: COVID-19; Health Services Accessibility; HIV Infections; Humans; Italy; Retention in Care; Rome

Topics: COVID-19; HIV Infections; Humans; Pandemics; Rome; SARS-CoV-2; Sexually Transmitted Diseases; Syphilis; Taiwan

Coronavirus disease 2019 (COVID-19) pandemic has reduced the access of HIV patients to reference centers. However, retention-in-care is critical to maintain adherence to therapy and viral suppression. During lockdown in Italy, our center implemented several measures to ensure HIV-care continuum. To assess whether these efforts were successful, we investigated HIV viral load trend for a 1-year period (September 2019-August 2020), which included lockdown and partial lockdown months in our country. No significant changes overtime in the proportion of undetectable HIV-RNA were observed. Continuity of service made it possible to maintain viral suppression in our patients.

Topics: Communicable Disease Control; COVID-19; Female; HIV Infections; Humans; Male; Medication Adherence; Pandemics; Rome; SARS-CoV-2; Viral Load

Italy is a low-incidence region for hepatitis A; however, during the last 2 years an increase in the incidence of hepatitis A virus (HAV) infection was reported in Europe. The aim of this study was to describe this recent outbreak.. We retrospectively analysed all cases of acute hepatitis A diagnosed at our laboratory between January 2010 and June 2017. We evaluated the following variables at the time of diagnosis: sex, age, nationality, glutamic oxaloacetic transaminase (GOT/AST), glutamic pyruvic transaminase (GPT/ALT), bilirubin concentration, international normalized ratio (INR) and the presence or absence of anti-HIV-1/2 antibodies. Hospitalization was also considered. We analysed these parameters using the χ. A total of 225 cases were analysed; 82.7% were in male patients, 94.2% were in Italians and the median age of the patients was 36.4 years. At diagnosis, the median GOT value was 306 U/L, the median GPT was 1389 U/L, and the median total bilirubin value was 5.88 mg/dL. Hospitalization was required for 142 patients, with a median duration of hospital stay of 8.5 days. In 2016-2017 we registered 141 cases, with a higher prevalence of male patients, higher GPT values and a higher prevalence of patients aged 20-39 years compared with older (2010-2015) cases. Homosexual intercourse was reported as the HAV risk factor in 70.2% of patients. HIV serology was available for 120 patients: 24 were HIV-positive, four of whom represented new diagnoses. HIV-positive patients showed lower bilirubin and GPT values and fewer hospitalizations than HIV-negative patients.. In 2016-2017, we saw a rise in the number of hepatitis A cases, with a higher prevalence of adult male patients. No significant differences regarding the prevalence of HIV coinfection emerged.

Topics: Adult; Disease Outbreaks; Female; Health Promotion; Hepatitis A; Hepatitis A Vaccines; HIV Infections; Hospitals, Teaching; Humans; Male; Middle Aged; Retrospective Studies; Risk Factors; Rome; Vaccination

Lymphogranuloma venereum (LGV) is a sexually transmitted infection caused by L1, L2, L3 serovars of C. trachomatis (CT). Since 2003, LGV cases have been increasing in Europe. Aim of this report is to describe the LGV cases diagnosed in the largest STI center in Rome, Italy, from 2000 to 2016. This report shows that two clinically and epidemiologically different series of cases exist, and that, at present, the ano-rectal LGV represents the clinical variant occurring more frequently among men having sex with men (MSM), particularly those HIV-infected.. Ten cases of LGV were observed. Three were diagnosed in 2009 in HIV-negative heterosexuals patients that presented the classical genito-ulcerative form with lymphadenopathy. Seven cases were observed in 2015-2016 in HIV-infected MSM, that presented the rectal variant and L2b serovar infection; 4 of these had been misclassified as a chronic bowel disease. Chlamydia infection was confirmed by CT-specific PCR (ompA gene nested PCR), followed by sequence analysis to identify the serovar. All the patients were treated with doxycycline for 3 weeks, obtaining a complete response with healing of both clinical symptoms and dermatological lesions.. Our findings suggest that, in case of persistent rectal symptoms in HIV-infected MSM, LGV should be taken into account and investigated through molecular analyses, in order to achieve a correct diagnosis and management of the patients.

Topics: Adult; AIDS-Related Opportunistic Infections; Chlamydia trachomatis; Female; HIV Infections; Homosexuality, Male; Humans; Lymphogranuloma Venereum; Male; Middle Aged; Rome

Interferon-gamma (IFN-γ)-inducible protein-10 (IP-10), soluble (s) CD163 and sCD14 play an important role in the pathogenesis of HCV and HIV infection and are involved in inflammation and liver fibrosis. The aim of the present study was to evaluate at a single time point, plasma soluble biomarkers and inflammatory monocytes subsets in different groups of subjects: (i) HIV monoinfected patients on suppressive ART; (ii) HIV/HCV coinfected patients on ART, with undetectable HIV viremia (including either subjects who had active HCV replication or those who cleared HCV); (iii) HCV monoinfected individual with active viral replication.. Hundred and twenty-nine plasma samples were analyzed including HCV and HIV monoinfected patients, HIV/HCV coinfected patients, with active HCV infection (AHI) or with HCV viral clearance (VHC) and healthy donors (HD). Levels of IP-10, sCD163 and sCD14 were measured by ELISA. Absolute cell counts of monocyte subpopulations were enumerated in whole blood by using flow cytometric analyses.. IP-10 and sCD163 plasma levels were higher in HCV monoinfected and in AHI coinfected pts compared to HIV monoinfected and HD, whereas sCD14 levels were higher only in HIV monoinfected patients. Considering the degree of fibrosis, sCD163 and sCD14 levels positively correlated with kPa values (as assessed by fibroscan) and FIB-4 in HCV monoinfected group. On the other hand, IP-10 did not correlate with the fibrosis stage and it was found increased also in patients with low fibrosis. Moreover, we found an increase of the inflammatory NCM subset, in non-cirrhotic HCV subjects, while no alterations were observed in HIV, AHI and VHC.. Our study suggests a scenario in which active HCV infection is associated with a strong pro-inflammatory state, even in the initial stage of liver fibrosis, regardless the presence of HIV coinfection, thus underlying the need of an early anti-HCV treatment.

Topics: Adult; Aged; Antigens, CD; Antigens, Differentiation, Myelomonocytic; Biomarkers; Case-Control Studies; Chemokine CXCL10; Female; Hepatitis C; HIV Infections; Humans; Liver Cirrhosis; Male; Middle Aged; Monocytes; Outpatients; Predictive Value of Tests; Receptors, Cell Surface; Rome; Sensitivity and Specificity

Little is known regarding the natural history of anal human papillomavirus (HPV) infection. We aimed to evaluate incidence and clearance rates, their risk factors, and duration of anal HPV infection in HIV-uninfected men who have sex with men (MSM). A longitudinal study was conducted. Anal samples were analysed using the Linear Array HPV Genotyping test. Incidence and clearance rates, and corresponding risk factors, were estimated using a two-state Markov model. Overall, 155 MSM (median age 33.4 years) attending the largest sexually transmitted infection (STI) centre in Rome, Italy, were followed for a median of 12.2 months (Q1-Q3: 7.0-18.1). Incidence and clearance rates for any HPV were 85.6 (95% CI: 58.4-125.4) and 35.6 (95% CI: 24.7-51.5) × 1000 person-months, respectively; the median duration of infection was 9.4 months (Q1-Q3: 7.5-12.1). Receptive anal sex emerged as the only risk factor for the acquisition of any HPV (Hazard Ratio, HR = 2.65, 95% CI: 1.16-6.06). The incidence rates for carcinogenic and non-carcinogenic types were 42.3 (95% CI: 29.2-61.4) and 29.2 (95% CI: 19.5-43.7) × 1000 person-months, respectively (p = 0.13); their clearance rates were 62.9 (95% CI: 45.1-87.7) and 65.7 (95% CI: 47.4-91.0) × 1000 person-months, respectively (p = 0.83). HPV16 showed the lowest clearance rate among carcinogenic types (59.7 × 1000 person-months), and a duration of infection of 16.8 months. In conclusion, a higher incidence rate was observed for carcinogenic compared to non-carcinogenic HPV types, although the difference was not significant. HPV16 emerged as the type with the longest duration of infection and the lowest clearance rate among carcinogenic types.

Topics: Adult; Anal Canal; DNA, Viral; Genotype; Genotyping Techniques; HIV Infections; Homosexuality, Male; Human papillomavirus 16; Humans; Incidence; Longitudinal Studies; Male; Multivariate Analysis; Papillomaviridae; Papillomavirus Infections; Risk Factors; Rome; Socioeconomic Factors

The Fourth International Symposium on Thymosins in Health and Disease brought together many of the leading scientists, clinicians and thought-leaders from the United States, Israel, Europe, China and Japan to discuss the latest advances and clinical applications of the thymosins in both basic and clinical areas. The symposium, held in Rome, Italy, on October 23 - 25, 2014, was sponsored by The George Washington University and the University of Rome 'Tor Vergata.'

Topics: Animals; Cardiovascular Diseases; Europe; Health Status; HIV Infections; Humans; Internationality; Rome; Thymosin

The performances of the new Geenius rapid confirmatory test (Bio-Rad) were evaluated with emphasis towards identifying acute infection (AHI) and discriminating HIV-1/2 in a clinical setting. Serum samples from individuals attending the L. Spallanzani Institute in Rome, Italy, for HIV diagnosis (one year retrospective collection), repeatedly reactive at 4th generation HIV-1/2 screening assays, confirmed with HIV-1 and HIV-2 Western blot (New LAV I and II Bio-Rad), were retested with Geenius.. Of 6,200 samples, 406 resulted repeatedly reactive at screening, including samples from clinically confirmed AHI. New LAV I identified 378 HIV-1-positive samples. Of these, Geenius found 377 HIV-1-positive and one unclassified HIV-positive. New LAV I classified as indeterminate 18 samples, including 14 from AHI. Among these 14, Geenius results were: 12 positive, 1 indeterminate and 1 negative. Of the remaining, 2 resulted Geenius negative (false-positive screening results) and 2 HIV-2. Ten samples were New LAV I-negative (5 AHI). Geenius results were: 1 (AHI) positive and 9 negative. Geenius detected 110 additional positive samples with no p31 reactivity with respect to New LAV I, with an almost similar prevalence of low avidity samples. Geenius confirmed 3 out of 4 HIV-2 infections identified by New LAV II (one coinfected with HIV-1), while rated as HIV-1 the remaining sample, classified as coinfection by New LAV I and II.. Geenius allows fast, sensitive and accurate confirmation of HIV serodiagnosis, including AHI and HIV-2 infections. The high sensitivity, in particular towards AHI, could avoid additional sampling and molecular tests.

Topics: HIV Infections; HIV-1; HIV-2; Humans; Retrospective Studies; Rome; Sensitivity and Specificity; Serologic Tests; Time Factors

To assess trends in HIV-1 incidence and risk factors for seroconversion among men who have sex with men (MSM) resident in Rome, Italy, a retrospective longitudinal cohort study was conducted over 25 years. Incidence rates and trends were modelled using Poisson regression and risk factors were assessed by multivariate Cox models. Of 1,862 HIV-1-negative individuals, 347 seroconverted during follow-up. HIV-1 incidence rates increased from 5.2/100 persons/year (p/y) in 1986 (95% confidence interval (CI): 2.3–11.5) to 9.2/00 p/y in 1992 (95% CI: 6.4–13.0), decreased to 1.3/100 p/y in 2001 and increased until 2009 (11.7/100 p/y; 95% CI: 7.4–18.6). The risk of HIV-1 seroconversion increased during the study period in younger MSM (incidence rate ratio (IRR) = 17.18; 95% CI: 9.74–30.32 in 16–32 year-olds and IRR = 5.09; 95% CI: 2.92–8.87 in 33–41 year-olds) and in those who acquired syphilis (IRR = 7.71; 95% CI: 5.00–11.88). In contrast, the risk of seroconversion decreased among highly educated MSM (IRR = 0.54; 95% CI: 0.35–0.82) and those without Italian citizenship (IRR = 0.45; 95% CI: 0.28–0.71). The HIV epidemic in MSM living in Rome continues to expand. Targeted prevention programmes against sexually transmitted infections to enhance knowledge transfer and behavioural skills are urgently required.

Topics: Adolescent; Adult; Age Distribution; Follow-Up Studies; HIV Infections; HIV Seroprevalence; HIV-1; Homosexuality, Male; Humans; Incidence; Italy; Male; Middle Aged; Multivariate Analysis; Poisson Distribution; Proportional Hazards Models; Retrospective Studies; Risk Factors; Risk-Taking; Rome; Sexually Transmitted Diseases, Viral; Socioeconomic Factors; Young Adult

Outbreaks of Acute Hepatitis A Virus (HAV) among men who have sex with men (MSM) have been reported in Europe and, recently, in Italy. From July 2008 through January 2010, 162 HAV infections were diagnosed at National Institute for Infectious Diseases, Rome, Italy, with high male-to-female ratio (M:F=7.5).. The aim of this study was to characterize viral strains involved in this outbreak.. The sequences of VP1-2A junction of HAV genome, obtained from 67/97 HAV-RNA-positive samples, were used for phylogenetic analysis.. All but 1 of the HAV sequences were genotype 1A, 1 was genotype 1B. A monophyletic cluster, including 59/66 genotype IA sequences, was identified by phylogenetic analysis. This cluster included also 2 HAV strains isolated in Germany (2007) and France (2008) from MSM, that, in turn, were reported to be genetically correlated to HAV strains circulating in Tuscany in 2008. Among the males harboring an HAV strain belonging to the cluster, 62% reported to be MSM, and 25% were HIV-positive, 2 with acute HIV infection.. The outbreak occurred in Rome in 2008-2010, involving high proportion of HIV-infected MSM, is sustained by a monophyletic HAV strain, circulating around the same period also in other European countries. Possible factors favouring HAV spread among HIV-infected persons, such as high risk behavior and prolonged fecal excretion, need to be further elucidated. Timely identification of outbreaks with one or the same source of infection may be helpful to implement preventive measures addressing at risk populations.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Cluster Analysis; Disease Outbreaks; Female; Hepatitis A; Hepatitis A virus; HIV Infections; Homosexuality, Male; Humans; Male; Middle Aged; Molecular Epidemiology; Molecular Sequence Data; Phylogeny; RNA, Viral; Rome; Sequence Analysis, DNA; Young Adult

Several outbreaks of hepatitis A affecting homosexual men have been reported in Europe. However, the prevalence of HIV infection in patients affected by hepatitis A has not been extensively studied and hepatitis A is not considered as an indicator disease for routine HIV testing.. We retrospectively analyzed all adult cases of acute hepatitis A, reported by the National Institute of Infectious Disease "L. Spallanzani", Rome-Italy, in 2002-2008. Data on HIV infection were obtained by chart review and cross-linkage with laboratory. Information on exposure to risk factors were collected from the standard questionnaire of the Local Health Unit.. We analyzed a total of 473 cases of hepatitis A, 368 (77.2%) males that accounted for 75% of all reported cases in Rome, aged 25-64 years (same gender distribution). During the study period, we diagnosed a high proportion of cases among male individuals (78%). Among the male patients, HIV serology was available for 203/368 (55.2%). The overall HIV prevalence was 15.2% (56/368); it was significantly associated with same gender sex and was significantly higher than that observed among patients with hepatitis B (4.0%).. We found a high HIV prevalence, associated with same gender sex, among adult male patients diagnosed with hepatitis A in the period 2002-2008, except for 2006. Our data suggest that in a low incidence area for hepatitis A, with a constant high proportion of cases among male individuals, all individuals with acute hepatitis A should be routinely offered an HIV test.

Topics: Adult; Hepatitis A; HIV Infections; HIV Seroprevalence; Homosexuality, Male; Humans; Male; Middle Aged; Retrospective Studies; Risk Factors; Risk-Taking; Rome

To assess the prevalence of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) colonization in HIV-1-infected men who have sex with men (MSM), a cross-sectional study was conducted on 104 persons attending a large STI/HIV unit in Rome, Italy in the period June 2007-June 2008. Swabs obtained from both anterior nares and S. aureus isolates were characterized by phenotypic and genotypic methods. A total of 24 individuals (23.1%) were colonized with S. aureus but none carried MRSA. No statistically significant association between colonization with S. aureus and behavioural, clinical, virological or immunological characteristics was identified. This study indicates a lack of circulation of CA-MRSA in HIV-1-infected MSM in Italy and underscores large epidemiological differences between the USA and a European country, so that only locally conducted epidemiological studies can provide insight into the local circulation of CA-MRSA in general and selected populations.

Topics: Adult; Carrier State; Community-Acquired Infections; Cross-Sectional Studies; HIV Infections; HIV-1; Homosexuality, Male; Humans; Male; Methicillin-Resistant Staphylococcus aureus; Middle Aged; Nose; Rome; Staphylococcal Infections

A recent increase in HIV diagnoses among men-having-sex-with-men (MSM) has been shown by surveillance data from Europe and Italy, and new approaches to inferring viral population dynamics from heterochronously sampled gene sequences have been developed. The aim of this study was to reconstruct the epidemiological history of HIV-1 subtype B in a homogeneous group of Italian MSM using a coalescent-based Bayesian framework. A total of 125 HIV-1 subtype B pol sequences were analyzed using Bayesian methods and a relaxed molecular clock to reconstruct their dated phylogeny and estimate population dynamics. At least 10 epidemiological clusters of 3-9 isolates were identified: half including the largest clades originated in the early 1990s and the other half radiated from 1999. Demographic analysis showed that the HIV epidemic grew in accordance with a logistic model characterized by a rapid exponential increase in the effective number of infections (r = 1.54 year) starting from the early 1980s and reaching a plateau 10 years later. Our data suggest that the HIV B epidemic entered our MSM population through multiple transmission chains about 20 years later than in other Western European country. Epidemiological clusters originating in the early 2000s suggest a recent re-emergence of HIV in Italian MSM.

Topics: Bayes Theorem; Cohort Studies; HIV Infections; HIV-1; Homosexuality, Male; Humans; Male; Phylogeny; Population Dynamics; Rome; Time Factors

An increase in the circulation of HIV-1 non-B subtypes has been observed in recent years in Western European countries. Due to the lack of data on the circulation of HIV-1 non-B subtypes among European HIV-1-infected men who have sex with men (MSM), a biomolecular study was conducted in Rome, Italy. HIV-1 partial pol gene sequences from 111 MSM individuals (76 drug naive and 35 drug experienced) were collected during the years 2004-2006. All these sequences were analyzed using the REGA HIV-1 Subtyping Tool, and aligned using CLUSTAL X followed by manual editing using the Bioedit software. A BLAST search for non-B subtype sequences was also performed. Twenty-six (23.4%) MSM were not Italians. Eight individuals (7.2%) were diagnosed as HIV infected before 1991, 20 (18.0%) between 1991 and 1999, and 83 (74.8%) from 2000 to 2006. Fifteen (15/111, 13.5%) individuals were infected with the non-B subtype. The percentage of infection with HIV-1 non-B subtypes was 8.2% (7/85) among Italian MSM and 30.8% (8/26) among the non-Italians (OR = 4.95 95% IC: 1.40-17.87). Individuals infected with the non-B subtype were significantly younger than those infected with the HIV-1 B subtype (28 years vs. 34 years, p = 0.003). The CRFs were more prevalent (8.1%) than pure subtypes (5.4%), which were distributed as follows: subtype C (2.6%), subtype A1 (1.7%), and subtype F1 (0.9%). Major mutations conferring resistance to antiretroviral drugs (ARV) were not found among HIV-1 non-B subtype drug-naive patients but were found in two ARV-experienced individuals. The data show that viral diversity is likely increasing in a population group that had been previously characterized by the circulation of HIV-1 subtype B.

Topics: Adult; Cluster Analysis; Genotype; HIV Infections; HIV-1; Homosexuality; Humans; Male; Molecular Epidemiology; Molecular Sequence Data; pol Gene Products, Human Immunodeficiency Virus; Prevalence; Rome; Sequence Analysis, DNA; Sequence Homology; Young Adult

HIV spread among low-risk populations through heterosexual intercourse is a major public health concern. This study was aimed at describing prevalence and determinants of HIV infection among Italian low-risk subjects seeking their first lifetime HIV test.. Information collected between January 1990 and December 2000 at a major counseling and testing site in Rome, Italy, was analyzed. Multiple logistic regression odds ratios (OR) and 95% confidence intervals (CI) were computed.. Among the 14,313 study subjects, 64 (0.4%) were seropositive for HIV infection. HIV seropositivity increased with age (OR = 4.0, 95% CI: 2.1-7.6 for >/= 40 years vs 18-24), and it seemed to be more common among men (OR = 1.6, lower 95% CI:0.9). There was no evidence of temporal variations, whereas motivations for HIV testing were strongly associated with HIV prevalence. Testing for alarming symptoms (OR = 13.8) or for heterosexual intercourse (OR = 11.0) were associated with a more than 10-fold increased HIV risk.. Our findings are consistent with data from other industrialized countries and they show a strong association between HIV seropositivity and reason for first-time testing. Moreover, they indicate a stable trend of HIV prevalence among low-risk persons in the last decade. Further studies on time trends in low-risk populations would be useful to evaluate current HIV prevention programs.

Topics: Adolescent; Adult; Female; HIV Infections; Humans; Male; Odds Ratio; Prevalence; Risk Factors; Rome

This article describes a pilot project carried out in collaboration between the Istituto Superiore di Sanita and the Azienda Sanitaria Locale Roma E without any specific funding. The aim was to take a group of adolescents and provide them with a grounding in both HIV/AIDS infection and social communication, and with the instruments necessary to develop an informative campaign with other adolescents as the target group. The project was divided into three phases: sessions for raising levels of HIV/AIDS information and awareness involving 702 secondary school students; workshops to provide 120 selected students with communication and advertising know-how, to allow them to develop an HIV/AIDS infection information campaign targeted at their peers; a final event for the presentation of the students' findings. Prevention was the focus of the adolescents' resulting products, with particular attention to condoms as means of protection. The target population was judged as best influenced by channels such as posters and television ads, and the resulting messages were cartoon based, both ironic and fun yet accompanied by strong and direct statements designed to shock the viewer. The methods used in the project turned out to be particularly suitable for giving importance to the input of the participants who went from being publicity targets to developers.

Topics: Academies and Institutes; Adolescent; Communication; Condoms; Education; Female; Government Agencies; Health Education; Health Promotion; HIV Infections; Humans; Information Dissemination; Interinstitutional Relations; Male; Mass Media; Peer Group; Psychology, Adolescent; Rome; Safe Sex; Sex Education; Students; Teaching Materials

Topics: Catholicism; HIV Infections; Humans; Rome

The 5(th) International Workshop on Clinical Pharmacology of HIV Therapy was held at the Università Cattolica del Sacro Cuore, Rome, Italy on April 1 - 3, 2004. More than 180 participants registered for this workshop demonstrating the growing interest in antiretroviral pharmacology. The purpose of this meeting was to present and discuss antiretroviral pharmacokinetics, pharmacodynamics, drug interactions, therapeutic drug monitoring-related research and the assays necessary for measuring antiretroviral concentrations. A total of 31 oral and 48 poster presentations were accepted to this meeting, the largest number of accepted submissions in the 5-year history of this workshop. Herein, examples of the research that was presented are highlighted.

Topics: Clinical Trials as Topic; Drug Interactions; HIV Infections; HIV Reverse Transcriptase; Humans; Nucleosides; Protease Inhibitors; Reverse Transcriptase Inhibitors; Rome

To investigate the knowledge of the risk of HIV vertical transmission as well as the feeling about the new therapy in reducing that rate.. We included 152 HIV-infected women. A self reported questionnaire was administered from September to December 2000.. About the risk rate of transmitting HIV to their baby, 21 (13.8%) women indicated 100%; 67 (44.1%) 50-80%; 35 (23%) 10-50% and only 22 women (14.5%) answered the correct value of less than 5%. Regarding the effect of highly active antiretroviral therapy, 82 women (53.9%) considered therapy effective in reducing vertical HIV transmission, while 63 women (41.4%) considered therapy powerless in preventing mother to child HIV transmission. Any statistically significant difference in sociodemographic, clinical, viroimmunological characteristics and antiretroviral therapy emerged between the groups.. Our data highlight the importance of providing appropriate counselling about perinatal HIV transmission to all childbearing age HIV infected women.

Topics: Adolescent; Adult; Anti-HIV Agents; Female; HIV Infections; Humans; Infant, Newborn; Infectious Disease Transmission, Vertical; Middle Aged; Pregnancy; Pregnancy Complications, Infectious; Rome

To assess changes in clinical presentation and outcome of HIV-associated tuberculosis (TB) before and after widespread implementation of highly active antiretroviral therapy (HAART).. We reviewed clinical charts of HIV-infected patients with culture-confirmed pulmonary TB in two referral clinical centers in Rome, Italy. The 67 patients diagnosed in 1995 to 1996 were compared with 51 patients diagnosed in 1997 to 1998. To analyze factors associated with survival we used a Cox model including antiretroviral therapy as a time-dependent covariate.. Patients diagnosed in 1997 to 1998 were more likely to have TB as the first AIDS-defining illness (78% versus 58%, p <.05), to have HIV diagnosed <2 months before TB (33% vs. 7%, p <.005) and to have typical chest radiograph pattern (45% vs. 25%, p <.05), and had a higher CD4(+) count (median 105 vs. 43, p <.005). Survival at 1 year was 80% for patients diagnosed in 1997 to 1998 vs. 65% for those diagnosed in 1995 to 1996 (p by log-rank =.02). After adjusting at multivariate analysis, time period of diagnosis was not confirmed as associated with survival (hazard ratio, 1.05; 95% confidence interval, 0.39--2.81). Age, CD4+ cell count <25/mm(3), and AIDS-defining illnesses before TB diagnosis were all associated with an higher risk of death, whereas a decreased risk of death was observed in patients starting a triple combination antiretroviral therapy after TB diagnosis (hazard ratio, 0.14; 95% confidence interval, 0.03--0.57).. Cases of HIV-associated TB occurring in patients with advanced immunosuppression and presenting with atypical radiologic appearance tend to be relatively less common in the HAART era. HAART is a major factor in prolonging survival in these patients.

Topics: Adult; Anti-HIV Agents; Antiretroviral Therapy, Highly Active; CD4 Lymphocyte Count; Disease Progression; Drug Resistance, Microbial; Drug Resistance, Multiple; Female; HIV Infections; Humans; Male; Middle Aged; Proportional Hazards Models; Retrospective Studies; Rome; Substance Abuse, Intravenous; Survival Rate; Time Factors; Tuberculosis, Pulmonary

A cross-sectional survey was carried out between April 1997 and February 1998 among street prostitutes in Rome. The study population (n = 142) consisted of 102 women and 40 transsexuals: 20% from Western Europe, 38% Eastern Europe, 23% Latin America and 17% Africa. Two-thirds of the population had more than 20 clients during the last week and most respondents (95%) reported always using condoms with clients. Eight per cent of the women and 2% of the transsexuals report a history of injecting drug use. Only 38% of the women with a stable partner reported use of contraceptives and 33% of them had undergone a voluntary abortion during the last year. Only 38% of the women had been checked for STDs during the last year, compared with 80% of the transsexuals. The HIV-prevalence was 6% among the women and 20% among the transsexuals. Four out of the six positive women and one of the positive transsexuals had a history of injecting drug use. Five out of the six HIV-positive women were Italian. Transsexual prostitutes seem to pay more attention to their medical wellbeing compared with females who rarely go for medical check-ups and only a minority uses efficient contraceptive methods.

Topics: Adult; Africa; Condoms; Cross-Sectional Studies; Europe; Female; Health Knowledge, Attitudes, Practice; HIV Infections; HIV Seropositivity; Humans; Latin America; Male; Prevalence; Risk-Taking; Rome; Sex Work; Substance-Related Disorders; Transsexualism

The Azienda Sanitaria Locale Roma E (ASL-RME) outpatient clinic is the main reference center in Rome for HIV testing of foreign people.. To define the prevalence and incidence of HIV infection among foreign transsexual sex workers attending the center.. A cross-sectional, follow-up study was conducted.. Between 1993 and 1999, 353 transsexuals attended the ASL-RME. They were from Colombia (n = 208), Brazil (n = 122), and other countries (n = 23). Most of these transsexuals reported having 5 to 10 partners per day. The overall HIV prevalence was 38.2%, which multivariate analysis found to be associated with origin from Brazil and a higher number of sex partners. The observed HIV seroconversion rate was 4.1 per 100 person-years, and non-regular condom use was the only factor related to seroconversion.. The data from this study suggest that promotion of safer sex practices and regular condom use still is the main priority among marginalized population subgroups, such as foreign prostitutes, involved in sex activities that put them at risk for HIV infection.

Topics: Adult; Brazil; Colombia; Condoms; Cross-Sectional Studies; Emigration and Immigration; Follow-Up Studies; Health Promotion; HIV Infections; HIV Seropositivity; HIV Seroprevalence; Humans; Incidence; Male; Multivariate Analysis; Needs Assessment; Population Surveillance; Proportional Hazards Models; Risk Factors; Rome; Sex Education; Sex Work; Sexual Behavior; Sexual Partners; Surveys and Questionnaires; Transsexualism

To compare self-reported nonadherence with antiretroviral therapy (ART) with predose plasma levels of protease inhibitor (PI).. A cross-sectional study of consecutive patients from a university-based HIV clinic in Rome, Italy, was conducted. One hundred and forty HIV-infected patients were prescribed regimens containing ritonavir or indinavir. A patient questionnaire assessing knowledge of treatment regimen, adherence behavior, reasons for taking and missing therapy, factors influencing adherence, and health behaviors was administered. A predose PI plasma level was measured concurrently.. By patient report, 12% missed at least one dose "yesterday," and 24% missed doses in the last 3 days; 14% had a predose plasma concentration below the assay limit of quantitation (2 ritonavir and 18 indinavir samples). Confusion, poor psychological well-being, long office wait, running out of drugs between visits, having relatives to remind the patient to take medication, children, and alteration of sense of taste were related to unquantifiable predose levels of PI. In multivariable analysis, reported nonadherence (odds ratio [OR], 15.8; 95% confidence interval [CI], 4.0-63.3) and confusion (OR, 9.9; 95% CI, 1.4-69.6) were related to unquantifiable predose levels of PI.. Self-report of missing a dose of antiretroviral medication "yesterday" was related to an unmeasurable plasma PI level.

Topics: Adult; Analysis of Variance; Anti-HIV Agents; Cross-Sectional Studies; Drug Monitoring; Drug Therapy, Combination; Female; HIV Infections; HIV Protease Inhibitors; Hospitals, University; Humans; Indinavir; Male; Outpatient Clinics, Hospital; Patient Compliance; Ritonavir; Rome; Treatment Refusal

The purpose of this study was to characterise the epidemiological and the clinical features of non-AIDS-defining neoplasms (NAN) in HIV-infected subjects in the era of highly active antiretroviral therapy (HAART). A retrospective cohort of 4,041 subjects was established. Patients were recruited from January 1989 to December 1998. We observed 51 NAN over the study period. The overall incidence rate was 0.21 per 100 person-years (PY) and it remained stable, also after the introduction, in 1996 of HAART. Moreover, stratifying according to the type of neoplasms there was no statistically significant difference in the incidence of NAN over the study period. While the epidemiological features of NAN generally was not different from that observed in immunocompetent individuals, the neoplasms had a more aggressive clinical course and a poor prognosis. Survival analysis showed that the presence of NAN significantly reduced the survival of patients with AIDS (P=0.01; OR=0.62; 95% CI=0.47-0.96) compared with matched controls. The overall mortality-rate was 63% with an incidence rate of 0.13 per 100 PY. Although the incidence rate of NAN is not of great magnitude, as the number of HIV-infected individuals continues to increase and their survival improves, the number of HIV-infected subjects with NAN might consequently increase as well as the related morbidity and mortality.

Topics: Adult; Anti-HIV Agents; Cohort Studies; Female; HIV Infections; HIV Protease Inhibitors; Humans; Incidence; Life Tables; Male; Middle Aged; Neoplasms; Prognosis; Proportional Hazards Models; Retrospective Studies; Reverse Transcriptase Inhibitors; Rome; Survival Analysis

Between September 1993 and December 1995, 528 foreign individuals at risk of HIV infection attended the drug treatment centre located in the Santo Spirito Hospital in Rome, undergoing medical examination, HIV testing and counselling. The geographic distribution showed that the majority of the participants were from South America (40.0%), most of whom were transsexual sex workers (from Brazil or Columbia), and from North Africa (37.5%); all the individuals coming from Western and Eastern Europe and the USA were heroin users. The overall HIV prevalence was high (21.6%), though it varied by nationality, ranging from 5.1% among North Africans to 68.3% among Brazilian transsexuals. During the study period, 170 of the individuals returned for at least one follow-up visit. Three seroconversions occurred among the 118 initially HIV-negative immigrants who were retested, all three among the 26 HIV-negative Columbian transsexuals; the seroconversion rate within this group was 10.1 per 100 persons/years. During follow-up, there was no reduction observed in drug-related practices associated with HIV infection, yet a general increase in regular condom use was reported. The increasing number of foreign persons contacting our programme emphasizes the need for easy access to care and treatment for marginalized populations possibly engaging in behaviour at risk for HIV infection. Counselling strategies seem to be relatively effective in promoting safer sex among these population groups.

Topics: Adult; Africa; Ambulatory Care; Cross-Sectional Studies; Europe, Eastern; Female; Heroin Dependence; HIV Infections; HIV Seroprevalence; Humans; Male; Middle Aged; Patient Acceptance of Health Care; Risk-Taking; Rome; Sex Work; South America; Transsexualism; United States

The prevalence of HIV-1 among women of reproductive age is currently estimated at the time they give birth. We assessed HIV-1 prevalence at the end of pregnancy, whether they delivered or had an induced or spontaneous abortion. Women admitted at the end of pregnancy to hospitals in the Lazio Region, Italy, were tested for antibodies to HIV-1. Consent for testing was granted by 97.1% of 218,357 subjects; women who did not consent were tested anonymously. The prevalences of infection were 0.34% in 1989, 0.38% in 1990, 0.28% in 1991, 0.23% in 1992, 0.28% in 1993, and 0.24% in 1994. Significantly higher prevalences of infection were associated with induced abortion (0.49%) than with delivery (0.18%; OR: 2.72; 95% CI: 2.29-3.22) and among women who refused (0.85%) than among those who consented to testing (0.27%; OR: 3.14; 95% CI: 2.35-4.19). A significant temporal reduction in prevalence was observed only among women who delivered (0.15% in 1993 and 1994; 0.26% in 1989 and 1990). The prevalence of HIV-1 infection is thus higher among women undergoing induced abortions than among those who deliver and higher among women who refuse testing than among those who consent. Studies confined to neonatal testing or to voluntary testing of pregnant women would thus underestimate the prevalence of HIV-1 among women of reproductive age.

Topics: Abortion, Induced; Abortion, Spontaneous; AIDS Serodiagnosis; Delivery, Obstetric; Female; HIV Infections; HIV Seroprevalence; HIV-1; Humans; Population Surveillance; Pregnancy; Pregnancy Complications, Infectious; Pregnancy Outcome; Rome

The role of sexual transmission of hepatitis C virus (HCV) infection is still not completely understood, partly because of the lack of longitudinal studies among cohorts of HCV-negative individuals who engage in at-risk sexual behavior.. To evaluate the incidence of HCV infection in a population at risk for human immunodeficiency virus type 1 (HIV-1) infection and other sexually transmitted diseases (STD) and to identify factors associated with HCV seroconversion.. A retrospective longitudinal study was carried out on a cohort of consecutive attendees of a voluntary HIV-1 testing and counseling program in a large STD center in Rome. All individuals undergoing at least two consecutive tests for HCV antibodies were enrolled. Clinical data and information on individual behavior were collected for all study participants.. Between June, 1992 and December, 1994, a total of 709 individuals (12 intravenous drug users [IDU], 244 homosexuals, and 453 heterosexual non-IDUs), initially negative for HCV antibody, were tested more than once. Among these individuals, 15 HCV seroconversions occurred. The average follow-up time was 1.25 person/years (p/y) for an incidence rate of 1.69 per 100 p/y. The incidence rates by exposure category were 39.30 per 100 p/y among IDUs, 1.37 per 100 p/y among homosexual men, and 0.97 per 100 p/y among heterosexual non-IDUs. Excluding IDUs, of the 697 STD clinic attendees engaging in at-risk sexual behavior, HIV-1-positive status tended to be associated with HCV seroconversion (relative hazard = 5.48; 95% confidence interval = 0.85-35.40). The HCV crude incidence rates among HIV-1-infected patients at enrollment was 11.5%, 4.2%, and 2.4% in those with severe, moderate, and mild levels of immunosuppression, respectively (chi-square for trend = 2.38, P = 0.1).. In this cohort, HCV infection was confirmed to be strongly associated with intravenous drug use. Nonetheless, the occurrence of two thirds of the total HCV seroconversions in non-IDU individuals engaging in at-risk behavior suggests a role of sexual practices in the transmission of the infection. Among non-IDU individuals, the risk for development of HCV infection tended to increase in those who were HIV-1 infected.

Topics: Adolescent; Adult; Female; Hepatitis C; HIV Infections; Humans; Incidence; Logistic Models; Longitudinal Studies; Male; Middle Aged; Retrospective Studies; Risk; Risk Factors; Rome; Sexual Behavior; Sexually Transmitted Diseases; Substance Abuse, Intravenous; Urban Health

Temporal differences in human immunodeficiency virus (HIV) risk-related behaviors among injection drug users in Rome, Italy, were analyzed in 487 drug users recruited in 1990 and 450 recruited in 1992. Sharing of syringes decreased among self-reported HIV-positive drug users between 1990 and 1992, but there was no change in their sexual behavior. Fewer HIV-seronegative drug users reported passing on used syringes in 1992 than in 1990; however, there was no change in the percentage of seronegative subjects using previously used syringes, and a reduction in condom use with primary partners. There still exists a great potential for transmission of HIV infection among injection drug users and from injection drug users to the general population.

Topics: Adult; Condoms; Female; HIV Infections; HIV Seronegativity; Humans; Male; Needle Sharing; Risk Factors; Rome; Sexual Behavior; Substance Abuse, Intravenous

To assess the use of HIV testing "because of pregnancy".. Cross-sectional study.. Parturients admitted to the obstetric divisions of a public hospital located in Rome (February-April 1994).. Standardized interview during post test counseling. OUT-COMES: Frequency and characteristics of HIV testing "because of pregnancy" and women's know ledge on HIV sexual and vertical transmission.. Among the 506 women admitted all consented to be tested and 3 were found HIV seropositive (0.6%). A total of 239 (47%) unselected parturients were interviewed; the remaining differ only for a lower rate of cesarean delivery (13% vs 54%). Of the interviewed, 140 (58%) had been already tested for HIV infection, 91 (38%) during the current pregnancy according to gynaecologist's prescription (79.87%) and without counseling (55.60%) or ascertained risk factors (82.90%); 40% had been tested after the first trimester of pregnancy. Rate of vertical transmission was estimated higher than 50% in 147 cases; 150 women knew the "window period" but less than half estimated it correctly.. The study showed a unsatisfactory use of HIV testing "because of pregnancy" and suggests the need for implementing in Italy information campaigns targeted both to women and gynecologists.

Topics: Adult; Cross-Sectional Studies; Female; HIV Infections; HIV Seropositivity; Hospitals, Maternity; Humans; Pregnancy; Pregnancy Complications, Infectious; Rome; Zidovudine

Sixty-seven transvestite prostitutes from Latin America (49 from Brazil and 18 from Colombia) who attended an HIV unit located in the inner city of Rome between January 1991 and June 1992 were studied for syphilis markers by means of both the Treponema pallidum haemoagglutination test (TPHA) and a solid phase haemadsorption test for detection of specific IgM (SPHA-IgM) which are typically present in recent infections. All participants reported more than 500 sexual partners in the past year, and 67.1% of them more than 1500 partners (between 5 and 10 partners per working day). The overall prevalence of anti-HIV antibodies in this population was 65.7%. The prevalence of positive TPHA tests in the population studied was 73.1%, while that of positive SPHA-IgM tests was 10.4%. The prevalence of positive TPHA and SPHA-IgM tests was higher among Columbians than among Brazilians (83.3% vs 69.4% and 22.2% vs 6.1%, respectively) and also showed a positive correlation with the duration of their permanence in Italy. The TPHA and SPHA-IgM positivities were significantly higher among subjects older than 29 years. Positive TPHA was also significantly higher in subjects who reported a history of heroin and/or cocaine abuse while positive SPHA-IgM was higher in subjects who did not use condoms or reported irregular use of them than in subjects who regularly used condoms. No overall correlation was evident between TPHA positivity and anti-HIV positivity, while SPHA-IgM positivity was found to be higher among anti-HIV-negative subjects.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adult; Age Factors; Antibodies, Bacterial; Brazil; Cocaine; Colombia; Condoms; Follow-Up Studies; Hemadsorption; Hemagglutination; Heroin Dependence; HIV Antibodies; HIV Infections; HIV Seronegativity; HIV Seropositivity; Humans; Immunoglobulin M; Middle Aged; Rome; Sex Work; Sexual Partners; Substance-Related Disorders; Syphilis Serodiagnosis; Transvestism; Treponema pallidum

Topics: Abortion, Therapeutic; Boston; Delivery, Obstetric; Female; France; HIV Infections; HIV Seropositivity; HIV Seroprevalence; Hospitals, Public; Humans; Italy; Massachusetts; Paris; Pregnancy; Pregnancy Complications, Infectious; Rome

To estimate the excess mortality of injecting drug users (IDU) stratified by HIV serostatus compared with the general population in Italy. To compare total and cause-specific mortality in HIV-positive versus HIV-negative IDU, in order to identify possible HIV-related non-AIDS causes of death in this population.. All IDU attending two drug-treatment centres in Rome who underwent HIV testing between 1985 and 1991 were enrolled into a prospective study. The end-point of the study was death from any cause by 31 December 1991. Mortality rates were compared using age-adjusted standardized mortality ratios and person-time techniques.. Of the 2431 IDU, 1661 (68.3%) were HIV-seronegative and 82 seroconverted. Of 181 deaths, comprising 89 from AIDS and 92 from other causes, the mortality rate was 4.5 and 0.8 per 100 person-years in HIV-seropositives and HIV-seronegatives, respectively. For non-AIDS mortality in HIV-seropositives, the overall rate was 1.7 per 100 person-years. Deaths from overdose and endocarditis/embolus tended to be higher in HIV-seropositive than HIV-seronegative IDU, although there was no difference in the rate of deaths due to pneumonia by HIV serostatus.. These data are consistent with other studies demonstrating a higher frequency of mortality among HIV-seropositive IDU. The excess in overdose mortality among HIV-seropositives is disturbing and merits further investigation.

Topics: Adult; Cohort Studies; Drug Overdose; Female; HIV Infections; HIV Seronegativity; HIV Seropositivity; Humans; Male; Prospective Studies; Rome; Substance Abuse, Intravenous; Survival Analysis

To analyze the characteristics of persons seeking HIV testing, and to evaluate the potential effectiveness of a regional program of confidential counselling and testing for HIV infection, we reviewed data on 5127 clients seen from July 1985 to December 1990 in a major counselling and testing site of the city of Rome. During the study period, the number of clients attending the service increased without a parallel rise of the number of newly identified HIV seropositive subjects. Consequently, the seroprevalence rate decreased from 27.6% in the second half of 1985, to 4.3% in the second half of 1990 (p < 0.001). This decrease appears to be associated with the increasing attendance of low risk subjects and of those referred for testing by family practitioner. The study suggests the need for more efficient strategies to reach persons at higher risk for HIV infection.

Topics: Adult; AIDS Serodiagnosis; Counseling; Female; HIV Antibodies; HIV Infections; HIV Seropositivity; HIV Seroprevalence; Humans; Male; Rome

To assess the prevalence of HIV-1 infection and study selected risk factors among patients attending a clinic for sexually transmitted diseases in Rome, 1442 outpatients seen consecutively between 20 February and 12 December 1989 were anonymously tested for anti-HIV-1. An evaluation of the trend of the HIV-1 infection was attempted by comparing the results of the present study with those obtained from a similar sample studied in 1986 in the same clinic. The overall estimated prevalence of anti-HIV-1 was 1.2% among heterosexual non-drug user subjects and 16.1% among homosexual or bisexual men. The anti-HIV-1 seropositivity was significantly higher in heterosexual subjects who reported sexual contact with intravenous drug users, as compared with those who did not report such exposure (12.5% vs 0.8%, p less than 0.005). Comparing the present data with those of a study conducted in 1986 in the same clinic, a lower prevalence of anti-HIV-1 was found among heterosexual subjects (1.2% in 1989 vs 6.0% in 1986, p less than 0.001). The availability after 1986 of several outpatient facilities attracting seropositive subjects and a change in the sexual behaviour of anti-HIV-1 positive subjects could explain this finding. Twenty percent of the heterosexual subjects and 62% of the homosexual or bisexual men reported consistent use of condoms.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Condoms; Female; HIV Antibodies; HIV Infections; HIV Seroprevalence; HIV-1; Humans; Male; Middle Aged; Risk Factors; Rome

To examine the incidence and prevalence of HIV infection, we studied a large sample of intravenous drug users (IVDUs) attending a drug dependency unit in Rome over the period 1985-1989. The annual prevalence of HIV antibodies remained stable over the 5-year period. However, a seroconversion study conducted on 302 subjects consistently attending the same facility showed a continued occurrence of HIV seroconversion, although the incidence declined from 8.9 per 100 person-years in 1985-1987 to 5.3 per 100 person-years in 1987-1989. The cumulative incidence of HIV seropositivity, estimated by the Kaplan-Meier survival technique, was higher in female than in male IVDUs. The findings show that the use of both incidence and prevalence data to monitor the trend of HIV infection allows a better understanding of the current viral spread among IVDUs.

Topics: Adult; Female; Follow-Up Studies; HIV Infections; HIV Seroprevalence; Humans; Incidence; Male; Prevalence; Rome; Sex Factors; Substance Abuse, Intravenous

A chronic coinfection with CMV, EBV etc. has been described in patients with HIV infection; recently a coinfection with other retroviruses has been described too. We have looked for the presence of antibodies to HTLV-I (anti HTLV-I) and to HIV-2 (anti HIV-2) in 135 HIV infected (HIV-positive) subjects living in Rome. They were 100 i.v. drug addicts, 24 homo/bisexuals, 4 partners of HIV-positive patients, 5 polytransfused and 2 without any known risk factor; 32 of them had a full-blown AIDS, 52 had ARC and 51 were symptom-free. Anti HIV, anti HTLV-I and anti HIV-2 were detected with ELISA method and confirmed by Western Blot (W.B.) technique. Antibodies to HTLV-I were found in 14 cases (10.4%) and antibodies to HIV-2 in 12 cases (8.9%). The contemporary presence of anti HIV, anti HTLV-I and anti HIV-2 was not found in any subjects. Our data fail to show a clear relationship among the coinfection with different retroviruses and the various risk factors for HIV infection and the HIV-related clinical picture (AIDS, ARC, etc.).

Topics: Acquired Immunodeficiency Syndrome; Adolescent; Adult; Aged; AIDS-Related Complex; Cross-Sectional Studies; Deltaretrovirus Antibodies; Deltaretrovirus Infections; Female; HIV Antibodies; HIV Infections; HIV-1; HIV-2; Human T-lymphotropic virus 1; Humans; Male; Middle Aged; Prognosis; Risk Factors; Rome