Search

OBJECTIVES: Across Europe, more than one third of patients are diagnosed with HIV infection late. Late presentation for care has been associated with higher risk of clinical progression and mortality. In the present study, we evaluated the prevalence, epidemiological characteristics and survival probability of patients with late and very late presentation, newly diagnosed with HIV infection in Catania, Italy, from 1985 to 2010. PATIENTS AND METHODS: According to the European Consensus definition, Late Presenters (LP) were defined as subjects presenting for care with a CD4+ T-cell count below 350 cells/µl or with an AIDS-defining event, regardless of CD4+ T-cell count; patients with advanced HIV disease (Very Late Presenters) (VLP) were those presenting with a CD4+ T-cell count below 200 cells/µl or with an AIDS-defining event, regardless of CD4+ T-cell count. RESULTS: 620 patients were included in the study. 345 (55.6%) subjects were LP, 35% of them were asymptomatic; 246 (39.7%) were VLP. In univariate analysis, late presentation was related to age (p < 0.001), to heterosexual exposure to HIV infection (70% of heterosexual subjects were LP) (p < 0.005) and to being diagnosed during the calendar period from 1991 to 2000 (p < 0.001). Very late presentation was related to age (p < 0.001), male sex (p < 0.01), heterosexual risk (p < 0.001) and to being diagnosed during the calendar period from 1991 to 2000 (p < 0.001). In multivariate analysis, age (p < 0.0001), being older than 50 years old (p = 0.02), years of diagnosis 1991-1995 (p < 0.005) and 1996-2000 (p < 0.05) in the subgroup of late presenters and age (p < 0.0001), being older than 50 years old (p < 0.005), male sex (p < 0.0001), years of diagnosis 1991-1995 (p < 0.05) and 1996-2000 (p < 0.005) in the subgroup of very late presenters maintained statistical significance. The survival probability within LP and VLP group was statistically lower than no LP/VLP (log rank test p < 0.0005 and p < 0.0001, respectively). For both LP (p < 0.002) and VLP (p < 0.0001), survival probability was significantly lower in the pre-HAART era, in comparison with the period of mono/dual therapy and the HAART era. CONCLUSIONS: More than fifty percent of patients in our setting were diagnosed late with HIV infection and, consequently, treated late. Late and very late presentation were associated with lower survival probability. The implementation of strategies focused on targeted prevention efforts and HIV testing programs appears fundamental to diagnose and treat HIV infection as early as possible. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Anxiety disorders are frequent in HIV-infected individuals, can pre-exist or occur during HIV infection. We evaluated with a self-reported questionnaire whether anxiety is related to HIV clinical status and therapeutic success in a cohort of HIV-positive subjects in Sicily. PATIENTS AND METHODS: We enrolled 251 patients on combination antiretroviral therapy (cART) for at least six months; Self Rating Anxiety State SAS 054 was used to diagnose anxiety and a Z score = = 45 points was considered diagnostic. RESULTS: 47% of patients were diagnosed with anxiety. Patients showing symptoms related to anxiety had experienced a high number of therapeutic switches (fourth line or more). CONCLUSIONS: These data confirm a high prevalence of anxiety symptoms among subjects with HIV infection in Eastern Sicily. Physicians should be aware of the extent of the problem and should be able to adequately manage anxiety in the setting of HIV infection. [ABSTRACT FROM AUTHOR]

An abstract of the research paper "Sexual Dysfunction and Anxiety in HIV-1-Infected Males in Eastern Sicily," by B.M. Celesia and colleagues which was presented at the Tenth International Congress on Drug Therapy in HIV Infection held at Glasgow, Scotland from November 7-11, 2010 is presented.

Background In rich countries the prevalence of HIV/AIDS among elderly patients (&#ge;50 years) is increasing as a result of the extended survival of HIV+ patients receiving antiretroviral treatment (HAART), growing new infections and new late diagnosis. Data about efficacy and tolerability of HAART in old age are controversial. The aim of this retrospective study is to evaluate the efficacy of HAART and clinical outcome in a ≥50 year group of patients compared to a control group (<50 years old). Materials and methods The study population includes all naive patients treated with HAART from November 1996 to June 2008 and followed in two different units of Infectious disease in Catania (Sicily). We evaluated the following parameters: epidemiological (sex, age, risk factors), immuno-virological (CD4 cell count, HIV RNA viral load), and clinical (CDC stage, first treatment, number and causes of therapeutic switch, new AIDS diseases and death). Results 272 HIV+ patients were enrolled for the analysis: 212 (78%) male; 121 (44%) heterosexuals, 101 (38%) homobisexuals, 44 (16%) injection drug users; 138 (50%) CDC A, 32 (12%) CDC B, 102 (38%) CDC C; median CD4 cell count was 163/µl (IQ range 49.322), median HIVRNA viral load 5.0 log10 (IQ range 4.3.5.4). Fifty-six subjects (20.6%) were ≥50 years. At baseline, among the elderly, the sexual risk was more frequent than in young (p<0.01); older patients were also more frequently symptomatic (p = 0.002). Instead we did not observe any difference as to CD4 cell count and HIV-RNA copies/ml. After twelve months of HAART no divergence was noticed between elderly and younger patients regarding median absolute increase of the CD4 cell count (+170 vs. +208 cells/µl) and percentage of patients with HIVRNA <400 copies/ml (85% vs 83%). After twenty-four months, a higher number of patients with HIV-RNA <400 copies/ml (as treated analysis) was been shown in elderly group (p<0.05). Probability of first treatment discontinuation (Kaplan Meier analysis), number and causes of therapeutic switch were similar in both groups. After a median follow-up of 65 months no differences were seen regarding new AIDS diseases whereas elderly patients had a higher probability of death compared to younger (14.3% vs 4.6%) (p=0.02). Conclusions This retrospective study shows a similar immunological response in elderly and younger naive patients on HAART. Older patients have a higher probability to maintain undetectable HIV-RNA viral load (adherence effect?). However, hard clinical end-points are more frequent in older subjects. Prospective studies are necessary to further investigate our findings. [ABSTRACT FROM AUTHOR]

Fulminant hepatitis by Epstein-Barr virus is a rare event which is predominantly due to primary infection. We report a rare case of fatal hepatic failure due to Epstein-Barr virus reactivation in a 19-year-old boy who was taking oral steroids. Transaminase peak and the fulminant course of the disease began soon after steroid interruption. Epstein-Barr virus reactivation was diagnosed on the basis of past clinical history of heterophile-positive infectious mononucleosis, a high titer of IgG anti Epstein-Barr virocapsidic antigen, slight elevation of anti-virocapsidic IgM, a high titer of anti-EA IgG antibodies and elevated viral load in serum measured by polymerase chain reaction. It is concluded that Epstein-Barr virus should be considered as a possible etiological agent of fulminant hepatitis.

The authors point out a high serological incidence of HCMV infection in the course of HCV hepatitis compared to a low incidence detected in HBV and HAV hepatitis. Three immunoglobulin classes (IgG, IgM, and IgA) specific to HCMV were investigated. Antibody titers of each immunoglobulin class are reported for all the cases of HCMV infection.

The prevalence of anti-HCV antibodies was determined for a group of 68 patients with various forms of chronic liver disease. All patients that were anti-HCV positive but did not show signs of HBV replication had severe liver disease. We therefore suggest that HCV may be responsible for liver damage in HBsAg positive subjects when there are no evident signs of HBV replication.

To determine the risk of cohabitant HCV infection, we investigated the sera of 101 family members of 53 anti-HCV antibody positive chronic liver disease patients. Altogether 14.8% of the cohabitants were also anti-HCV antibody positive, compared to a prevalence of 1.4% in the general population. These results suggest that hepatitis-C-virus may spread by person-to-person infection.

In a study of 175 intravenous drug addicts from Eastern Sicily, 58.3% were found to be anti-HCV positive. In this population, the presence of anti-HCV was independent of HIV infection, age, duration of drug use and the practice of needle sharing. This may indicate that HCV is more readily transmitted (or spread earlier in this population) among drug addicts than is HIV.