Hepatitis C virus infection among drug addicts in Italy.

There is a lack of updated nationwide records regarding hepatitis C virus (HCV) infection among drug addicts in Italy. The prevalence and characteristics of HCV infection in a national sample of drug addicts in Italy were determined. Five hundred forty-three drug addicts (mean age 35.3 years, 85.1% males), selected from 25 Italian Centers for Substance Dependence were enrolled to be evaluated for anti-HCV, HCV-RNA, HCV genotype, HBV markers, anti-HDV, and anti-HIV during the period of April-November 2009. Anti-HCV prevalence was 63.9%. HCV-RNA was detected in 68.3% of patients positive for anti-HCV. Genotypes 1 and 3 prevailed (49.3% and 39.7%, respectively). However, 9.3% of the subjects had genotype 4, a rate over threefold higher than the one observed in 1996 among drug addicts in central Italy. Needle sharing was the strongest independent predictor of the likelihood to contract an HCV infection (OR 8.9; 95% CI: 5.0-16.0). Only 19.3% of subjects received antiviral treatment for HCV. The prevalence of HBsAg and HIV positivity was 2.8% and 3.1%, respectively. The pattern of HBV markers showed that nearly one-third of subjects had been vaccinated, while 42.3% were negative for any marker of HCV. The prevalence of HCV infection is high among drug addicts in Italy. The incidence of Genotype 4 is increasing and this may lead to the spreading of the disease to the general population in the near future. Efforts should be made to improve the rate of antiviral treatment for drug addicts with HCV infection and vaccination against hepatitis B.

Effects of age, gender, duration of drug use and infection with viral hepatitis B and C on lymphocyte subsets in a population of HIV-negative injecting drug users in Italy.

A series of 716 HIV-negative IDUs entering a large drug treatment centre in central Italy was studied to evaluate the pattern of T-lymphocyte subsets among IDUs and to determine the effects of individual variables such as age, gender, duration of drug use and infection with viral hepatitis B and C. To this end, white cell count, total lymphocyte count and absolute number of lymphocyte subsets (i.e. CD3+, CD4+ and CD8+), HBV markers and HCV serology, were determined. For each individual, information on age, gender and duration of drug use was collected. To evaluate the association between level of lymphocyte subsets and phases of HBV infection, participants were stratified into three groups: (A) negative for all markers; (B) HBsAg-positive, with or without HBeAg, and HBsAb-negative; and (C) HBsAg and HBeAg-negative, positive for any other serological marker. The median absolute number of CD3+, CD4+ and CD8+ was 1909, 1080 and 770 cells/mm3, respectively, and did not vary across age bands. The CD8+ count was higher in males than in females. There was a tendency for CD3+ lymphocyte counts (mainly due to CD8+ counts) to be higher in individuals with 6-8 years of drug use compared to those who started injecting 4 years before or less. There was no evidence of increasing counts for a duration of drug use of more than 8 years. With regard to HBV, there was a general tendency for individuals in group "C" to have higher CD3+ and CD8+ counts than those in group "A". Finally, there was no difference in absolute lymphocyte count subsets between HCV-positive and HCV-negative IDUs. In conclusion, demographic and behavioural factors such as long-term heroin use or infection with HCV do not seem to influence the level of lymphocyte subsets among HIV-negative IDUs, nor does the infection with HBV seem to determine dramatic changes in CD4+ counts.

[HIV-induced clinical conditions: rheumatic conditions]. / Condizioni cliniche HIV-indotte: le sindromi reumatiche.

Many retroviruses have been shown to be involved in the etiology of rheumatic diseases both in animal models and in humans. In particular, HIV infection has been correlated to a greater incidence of Reiter syndrome, psoriatic arthritis, sicca syndrome and other seronegative polyarthritides. Aim of this paper is to discuss clinical findings, diagnostic strategies and therapy of these diseases. We will describe how the profound abnormalities in the immune system brought about by the HIV infection can induce the development of reactive arthritides, inhibit the clinical expression of rheumatoid arthritis and affect the clinical presentation of SLE.

A new nonvascular interpretation of syncopal migraine.

Migraine suffers who experience spontaneous syncopes (syncopal migraine) during attacks exhibit a dramatic intolerance to bromocriptine, a dopamine agonist. An oral dose of this drug renders these patients unable to stand, even for some hours, because of precipitously falling of arterial blood pressure. Treatment with domperidone, a specific dopamine receptor antagonist, abolishes the syncopal effect of bromocriptine. This evidence is compatible with a supersensitivity of those dopamine receptors, which exert an inhibiting activity and are located on blood pressure regulating centers as well as on cardiovascular sympathergic neurons.