Characteristics and behaviors in a sample of patients unaware of their infection until AIDS diagnosis in Italy: a cross-sectional study.

The objective of this study was to define the sociodemographic and behavioral characteristics of people unaware of being HIV-positive at AIDS diagnosis. A multi-center cross-sectional study was conducted in 11 Italian centers of infectious diseases, recruited on a voluntary basis. Each center enrolled individuals diagnosed with AIDS aged ≥ 18 years from May 2003 to December 2005. The patients were classified into two groups on the basis of the amount of time that elapsed from diagnosis of HIV infection to AIDS diagnosis. "Late testers" were defined as those with a time period of ≤ 6 months between first HIV positive test and AIDS diagnosis. In order to evaluate the factors independently associated with being a late tester, a multivariate logistic regression model was performed. The McNemar χ(2) test was used to analyze behavioral changes before and after HIV diagnosis. During the study period, 245 patients were enrolled; of these, 51.8% were late testers. The variables independently associated with being a late testers were as follows: being employed; having acquired the infection through sexual contacts; having taken the HIV test because they didn't feel well; having at least one symptom or illness among those indicating infection; and not having had paid sex within the 12 months prior to HIV diagnosis. Before and after HIV diagnosis a significant increase in safe-sex behaviors was observed among individuals with no delay in diagnosis. However, the proportion of people who continue not to use condoms is still high. This study seems to indicate that sexual transmission is often associated with late testing. Individuals enrolled seem to have a low perception of risk, they do not undergo HIV testing, and consequently miss the opportunity of early diagnosis.

Characterization of the patterns of drug-resistance mutations in newly diagnosed HIV-1 infected patients naïve to the antiretroviral drugs.

BACKGROUND: The transmission of HIV-1 drug-resistant strains in drug naive patients may seriously compromise the efficacy of a first-line antiretroviral treatment. To better define this problem, a study in a cohort of newly diagnosed HIV-1 infected individuals has been conducted. This study is aimed to assess the prevalence and the patterns of the mutations recently associated with transmitted drug resistance in the reverse transcriptase (RT) and in protease (PR) of HIV-1. METHODS: Prevalence of transmitted drug resistant strains is determined in 255 newly diagnosed HIV-1 infected patients enrolled in different counselling and testing (CT) centres in Central Italy; the Avidity Index (AI) on the first available serum sample is also used to estimate time since infection. Logistic regression models are used to determine factors associated with infection by drug resistant HIV-1 strains. RESULTS: The prevalence of HIV-1 strains with at least one major drug resistance mutation is 5.9% (15/255); moreover, 3.9% (10/255) of patients is infected with HIV nucleoside reverse transcriptase inhibitor (NRTI)-resistant viruses, 3.5% (9/255) with HIV non-NRTI-resistant viruses and 0.4% (1/255) with HIV protease inhibitor (PI)-resistant viruses. Most importantly, almost half (60.0%) of patients carries HIV-1 resistant strains with more than one major drug resistance mutation. In addition, patients who had acquired HIV through homosexual intercourses are more likely to harbour a virus with at least one primary resistance mutation (OR 7.7; 95% CI: 1.7-35.0, P = 0.008). CONCLUSION: The prevalence of drug resistant HIV-1 strains among newly diagnosed individuals in Central Italy is consistent with the data from other European countries. Nevertheless, the presence of drug-resistance HIV-1 mutations in complex patterns highlights an additional potential risk for public health and strongly supports the extension of wide genotyping to newly diagnosed HIV-1 infected patients.

Delayed presentation and late testing for HIV: demographic and behavioral risk factors in a multicenter study in Italy.

Ensuring timely access to care for persons with HIV is an important public health goal. To identify factors associated with delayed presentation to medical care after testing HIV-positive or with late HIV testing, we studied 968 patients at their first HIV care visit, enrolled in a multicenter study in Italy from 1997-2000. Patients completed a questionnaire on HIV-testing history, sexual behavior, and drug use behavior. Delayed presenters were patients with >6 months between their first HIV-positive test and presentation for HIV care; late testers were patients with CD4 count < 200 /mm or clinically defined AIDS at their first HIV-positive test. Among the study patients, 255 (26.3%) were delayed presenters, and 280 (28.9%) were late testers. In multinomial logistic regression analysis, injection drug use significantly increased (odds ratio [OR]= 5.04) the probability of delayed presentation but reduced (OR = 0.55) the chance of late testing. A previous HIV-negative test was associated with a reduced risk of both delayed presentation (OR = 0.39) and late testing (OR = 0.36). Unemployment was positively associated with delayed presentation and increasing age with late testing, whereas HIV counseling at the time of first positive HIV test strongly (OR = 0.42) reduced the odds of delayed presentation. Interventions aimed at promoting timely access to care of HIV-infected persons should consider differentiated programs for delayed presentation and late testing.

Behavioral correlates of adherence to antiretroviral therapy.

The objective of this study was to analyze the relationships between adherence to treatment and sexual and drug-taking behaviors among persons with HIV, who started combination antiretroviral therapy as their first regimen. The authors analyzed data from 366 patients enrolled in a multicenter observational cohort study conducted in infectious disease hospital units in Italy. Adherence measurement was based on responses to a self-administered questionnaire regarding following HIV physician advice on taking medications and missed appointments. Questions on sexual and drug-taking behaviors were also included in the questionnaire. The median time since starting antiretroviral therapy was 11.8 months; 37.4% of patients were on a two-drug regimen and 62.6% were on a three-drug regimen. Overall, 68 patients (18.6%) could be classified as nonadherent. The proportion of patients with viral load < or = 500 copies/mL was significantly higher among adherent patients (68%) compared with nonadherent patients (40.4%; p = .001). In multivariable analysis, age (odds ratio [OR], 0.65; 95% confidence interval [CI], 0.42-0.98, per 10-year increment) and current use of injection (OR, 3.47; 95% CI, 1.40-8.5) or noninjection drugs (OR, 4.23; 95% Cl, 1.85-9.67) were significantly associated with nonadherence. No significant association was found between adherence and sexual behaviors. The data do not support the hypothesis that among HIV-infected person on antiretroviral therapy, poor adherence is associated with high-risk sexual behaviors that may further spread the infection.