Abstract
Presented here are the results of a cohort study conducted on 3,483 consecutive HIV/AIDS patients between January 1993 and December 2000 to determine trends in AIDS incidence and presentation. The incidence of AIDS was calculated in the general population and examined further according to gender, age (≤ or >49 years), and heterosexual behaviour as a risk factor for HIV. Multivariate analysis was used to identify variables associated with AIDS presenters (defined as patients diagnosed with AIDS within 1 month of the first HIV-positive test). The numbers of patients with AIDS classified as (i) AIDS presenters, (ii) known HIV-positive patients on antiretroviral treatment, and (iii) known HIV-positive patients not receiving antiretroviral treatment were calculated. The overall incidence of AIDS decreased over time, mainly due to the lower number of patients on antiretroviral treatment developing AIDS. Factors associated with a higher risk of being an AIDS presenter were male gender and year of HIV diagnosis. Among patients with AIDS, the proportion of AIDS presenters increased from 13.8% prior to 1997 (when protease inhibitors were introduced in Italy) to 32.5% after 1997. Variables predictive of being an AIDS presenter were male gender, age at diagnosis, and AIDS diagnosis in the years 1997–2000. Heterosexuals had a higher risk of being AIDS presenters and a lower risk of being HIV-positive and not receiving antiretroviral treatment than intravenous drug users. In Italy, AIDS occurs mainly in subjects unaware of their HIV status (especially males, the elderly, and those infected heterosexually) or in patients refusing antiretroviral therapy (mainly intravenous drug users who do not refer to specialised centres).
Similar content being viewed by others
References
Palella FG, Delaney KM, Moorman AC, Loveless MO, Fuhrer J, Satten GA, Aschman DJ, Holmberg SD (1998) Declining morbidity and mortality among patients with advanced human immunodeficiency virus infection. N Engl J Med 338:853–860
Mouton Y, Alfandari S, Valette M, Cartier F, Dellamonica P, Humbert G, Lang JM, Massip P, Mechali D, Leclercq P, Modai J, Portier H Federation Nationale des Centres de Lutte contre le SIDA (1997) Impact of protease inhibitors on AIDS-defining events and hospitalization in 10 French AIDS reference centers. AIDS 11:F101–F105
Mocroft A, Vella S, Benfield TL, Chiesi A, Miller V, Gargalianos P, d’Arminio Monforte A, Yust I, Bruun JN, Phillips AN, Lundgren JD (1998) Changing patterns of mortality across Europe in patients infected with HIV-1. Eurosida Study Group. Lancet 352:1725–1730
Autran B, Carcelain G, Li TS, Blanc C, Mathez D, Tubiana R, Katlama C, Debre P, Leibowitch J (1997) Positive effects of combined antiretroviral therapy on CD4+ cell homeostasis and function in advanced HIV disease. Science 277:112–116
Hammer SC, Squires KE, Hughes MD (1997) A controlled trial of two nucleoside analogues plus indinavir in persons with human immunodeficiency virus infection and CD4 cell count of 200 per cubic millimeter or less. N Engl J Med 337:725–733
Staszewsky S, Morales-Ramirez J, Tashima K (1999) Efavirenz plus zidovudine and lamivudine, efavirenz plus indinavir, and indinavir plus zidovudine and lamivudine in the treatment of HIV-1 infection in adults. N Engl J Med 341:1865–1873
Yarchoan R, Venzon DJ, Pluda JM, Lietzau J, Wyvill KM, Tsiatis AA, Steinberg SM, Broder S (1991) CD4 count and the risk for death in patients infected with HIV receiving antiretroviral therapy. Ann Intern Med 115:184–189
O’ Brien WA, Hartigan PM, Martin D, Esinhart J, Hill A, Benoit S, Rubin M, Simberkoff MS, Hamilton JD (1996) Changes in plasma HIV-RNA and CD4+ lymphocyte counts and the risk of progression to AIDS. New Engl J Med 334:426–431
Crowe SM, Carlin JB, Stewart KI, Lucas CR, Hoy JF (1991) Predictive value of CD4+ lymphocyte numbers for the development of opportunistic infections and malignancies in HIV-infected persons. J Acquir Immune Defic Syndr Human Retrovir 4:770–776
Finkelstein DM, Williams PL, Molemberghs G, Feinberg J, Powderly WG, Kahn J, Dolin R, Cotton D (1996) Patterns of opportunistic infection in patients with HIV infection. J Acquir Immune Defic Syndr Human Retrovir 12:38–45
Samet JH, Freedberg KA, Savetsky JB, Sullivan LM, Stein MD (2001) Understanding delay to medical care for HIV infection: the long-term non presenter. AIDS 15:77–85
Girardi E, Sampaolesi A, Gentile M, Nurra G, Ippolito G (2000) Increasing proportion of late diagnosis of HIV infection among patients with AIDS in Italy following introduction of combination antiretroviral therapy. J Acquir Immune Defic Syndr Human Retrovir 25:71–76
Centers for Disease Control (1992) 1993 Revised system for HIV infection and expanded surveillance case definition for AIDS among adolescents and adults. MMWR 41:9–12
Egger M, Hirschel B, Francioli P, Sudre P, Wirz M, Flepp M, Rickenbach M, Malinverni R, Vernazza P, Battegay M (1997) Impact of new antiretroviral combination therapies in HIV infected patients in Switzerland: prospective multicentre study. BMJ 315:1194–1199
Rezza G, De Rose A, Dorrucci M, Arpino C, Serafin I (1993) Declining prevalence of HIV infection among injecting drug users entering drug treatment in Italy: 1990–1991. Eur J Epidemiol 9:663–666
Puro V, D’Ubaldo C, Aloisi MS, Sherr L, Ippolito G (1998) Temporal trends in reasons for and results of HIV-testing among women in Rome, Italy. Eur J Epidemiol 14:443–447
USPHS/IDSA (2001) Guidelines for the prevention of opportunistic infections in persons infected with human immunodeficiency virus. July 2001. A summary. HIV Clin Trials 2:493–554
Wortley PM, Chu SY, Diaz T, Ward JW, Doyle B, Davidson AJ, Checko PJ, Herr M, Conti L, Fann SA (1995) HIV testing patterns: where, why and when were persons with AIDS tested for HIV. AIDS 9:487–492
Porter K, Wall PG, Evans BG (1993) Factors associated with lack of awareness of HIV infection before diagnosis of AIDS. BMJ 307:20–23
Couturier E, Schwoebel V, Michon C, Hubert JB, Delmas MC, Morlat P, Boue F, Simonpoli AM, Dabis F, Brunet JB (1998) Determinants of delayed diagnosis of HIV infection in France, 1993–1995. AIDS 12:795–800
Poznansky MC, Coker R, Skinner C, Hill A, Bailey S, Whitaker L, Renton A, Weber J (1995) HIV positive patients first presenting with an AIDS defining illness: characteristics and survival. BMJ 311:156–158
Kaldor JM, French MA (1993) When do patients present with HIV infection? Med J Aust 158:37–38
Acknowledgement
This work was supported by grants from the Italian Institute of Health AIDS Project 50C.5.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Castelnuovo, B., Chiesa, E., Rusconi, S. et al. Declining Incidence of AIDS and Increasing Prevalence of AIDS Presenters Among AIDS Patients in Italy. Eur J Clin Microbiol Infect Dis 22, 663–669 (2003). https://doi.org/10.1007/s10096-003-1038-8
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10096-003-1038-8