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.

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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.

In 2012, we conducted a retrospective cross-sectional study to assess the number of people living with HIV linked to care and, among these, the number of people on antiretroviral therapy. The health authority in each of the 20 Italian Regions provided the list of Public Infectious Diseases Clinics providing antiretroviral therapy and monitoring people with HIV infection. We asked every Public Infectious Diseases Clinic to report the number of HIV-positive people diagnosed and linked to care and the number of those on antiretroviral therapy during 2012. In 2012, 94,146 people diagnosed with HIV and linked to care were reported. The majority were males (70.1%), Italians (84.4%), and aged between 25 and 49 years (63.4%); the probable route of transmission was heterosexual contact in 37.5% of cases, injecting drug use in 28.1%, and male-to-male contact in 27.9%. Among people in care, 20.1% had less than 350 CD4 cells/μl, 87.6% received antiretroviral therapy, and among these, 62.4% had a CD4 cell count higher than 350 cells/μl. The overall estimated prevalence of individuals diagnosed and linked to care in 2012 in Italy was 0.16 per 100 residents (all ages). Adding the estimated proportion of undiagnosed people, the estimated HIV prevalence would range between 0.19 and 0.26 per 100 residents. In Italy, the majority of people diagnosed and linked to care receive antiretroviral therapy. A higher prevalence of individuals diagnosed and linked to care was observed in Northern Italy and among males. More information for developing the HIV care continuum is necessary to improve the entire engagement in care, focusing on test-and-treat strategies to substantially reduce the proportion of people still undiagnosed or with a detectable viral load.

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.

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.

Bacterial and protozoal sexually transmitted infections (STIs), such as Chlamydia trachomatis, Trichomonas vaginalis and Neisseria gonorrhoeae, may cause acute symptoms, chronic infections and severe long-term complications. The complications of these infections in women include pelvic inflammatory disease, chronic pelvic pain, tubal infertility, ectopic pregnancy, and infertility. Moreover, infection during pregnancy is associated with premature rupture of the membranes, low birth weight and miscarriage.In Italy, Chlamydia trachomatis and Trichomonas vaginalis infections are not subject to mandatory reporting; while gonorrhoea is subject to mandatory reporting.To extend surveillance to STIs that are widespread yet often asymptomatic and to improve the knowledge on the epidemiology of these infections in Italy, in 2009 the "Centro Operativo AIDS of the Istituto Superiore di SanitÁ", in collaboration with the Association of Italian Clinical Microbiologists (AMCLI, Associazione Microbiologi Clinici Italiani), launched the sentinel STIs surveillance system based on a network of 13 clinical microbiology laboratories.The main objective of the surveillance was to assess the prevalence and risk factors associated with Chlamydia trachomatis, Trichomonas vaginalis and Neisseria gonorrhoea infections among individuals attending microbiology laboratories in Italy.

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.