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to estimate survival, after AIDS diagnosis, in people who got infected with HIV through injecting drug use (IDUs), to identify among variables collected at AIDS diagnosis those which were associated to prognosis and to assess the frequency of morbid conditions at death.population-based, longitudinal study.4,040 IDUs diagnosed with AIDS in Italy between 1999 and 2005.vital status up to 2006, was retrieved through a record-linkage procedure with italian mortality database. Kaplan-Meier method and multivariate Cox model were used to estimate survival curves and compute hazard ratios of death (HR), and corresponding 95% confidence intervals (95% CI), for several prognostic factors, respectively.the 2-year and 5-year survival probabilities after AIDS diagnosis of IDUs were 72% and 60%, respectively. Elevated risks of death emerged for IDUs with older ages (HR=2.0 95% CI 1.6-2.4 for45 years old vs.35 years old), lower education (HR=1.4 95% CI 1.2-1.7 for elementary school vs. high school/university), longer time span between first HIV positive test and AIDS diagnosis (HR=1.6 95% CI 1.4-1.9 for6 months vs.6 months), and lower CD4 cell count at diagnosis (HR=1.5 95% CI 1.3-1.7 for50 cells/mm3 vs.200 cells/mm3). Compared to Pneumocystis carinii pneumonia, non-Hodgkin lymphomas were the worst prognostic factors, particularly primary brain lymphoma (HR=7.2, 95% CI 4.4-11.8). Over 1,581 deceased IDUs, for 1,567 cases death certificates were available. 52% of cases reported no AIDS-defining illnesses: 64 (4%) violent causes, 94 (6%) cancers, and 656 (42%) only non neoplastic illnesses, among which 415 (27%) liver diseases.the results of this population-based study showed that, in the highly active antiretroviral therapy era, survival of IDUs with AIDS was still lower compared to that of HIV sexual transmission groups. The presence at death, in 52% of cases, of non AIDS-defining illnesses indicates the important role on mortality of co-morbidities, including liver diseases and violent causes.

to analyse demographic characteristics and risk factors of people living with HIV and to compare data from the surveillance system for new HIV diagnoses with those from the National AIDS Registry (RAIDS).comparison of two surveillance systems.province of Modena.cases reported to the RAIDS and to the HIV surveillance system, from 1985 to 2004 regarding residents in the province of Modena.number of cases and incidence, by exposure categories, age, and gender.from 1985 to 2004, 615AIDS cases and 1731 new HIV diagnoses were reported among residence in the province of Modena. The incidence of AIDS progressively decreased after 1995, whereas incidence of new HIV diagnoses remained stable since 1994 with annual rates up to three-fold higher than those reported for the AIDS cases. Individuals with a new HIV diagnosis were younger (30 years of age), with a higher proportion of females and heterosexuals compared to AIDS cases. The most represented age group among AIDS cases was 30-49 years whereas it was30 years for newly diagnosed HIV cases. The proportion of intravenous drug users decreased over time both among new AIDS cases and new HIV diagnoses, whereas the proportion of cases attributed to sexual transmission increased. The proportion of foreigners among newly diagnosed HIV cases was twice as high as among AIDS cases.this study shows that, especially after the introduction of highly active antiretroviral therapies, information on AIDS cases has become less representative of the trends to HIV epidemic. Therefore, AIDS surveillance systems should be combined with local surveillance systems on new HIV diagnoses.

AIDS surveillance systems, which have provided for many years useful information on HIV epidemic dynamics, are no longer useful for estimating the evolution of the HIV epidemic due to the effect of anti-retroviral treatments that have strongly improved survival of HIV-infected persons. To obtain reliable data on the HIV epidemic, some Italian provinces and regions (Lazio, Veneto, Friuli Venezia-Giulia, Trento, Modena) have set up local surveillance systems of the new HIV diagnoses. Aggregated data collected by these systems since 1988, show that the rapid spread of the infection in the eighties has been followed by a progressive decrease in the number of new diagnoses during the nineties; in more recent years this trend has levelled-off. The composition of cases by exposure category has greatly changed over time: in 1988 75.2% of cases were injecting drug users, whereas in 2000 58.5% of cases acquired the infection through sexual contacts. HIV incidence for the considered areas decreased from 19.2 per 100.000 inhabitants in 1992, to 6.7 per 100.000 inhabitants in 2000. Median age at diagnosis increased over time, from 27 years in 1988 to 34 years in 2000. The changed pattern of the HIV epidemic in Italy stresses the need of a nation-wide surveillance system for HIV infections aimed at allocation of adequate economic resources and planning specific prevention programmes.