Antibodies against human herpesvirus 8 in subjects with non-venereal dermatological conditions.

BACKGROUND: Human herpesvirus 8 (HHV8) is considered as the infectious cofactor involved in the pathogenesis of Kaposi's sarcoma (KS). Its seroprevalence and modes of transmission in the general population are still undetermined. OBJECTIVES: We aimed to estimate the prevalence of HHV8 infection in a population at low risk for sexually transmitted diseases. METHODS: We conducted a seroepidemiological survey on randomly selected individuals attending the dermatology department of a teaching hospital in Rome. Of 257 patients, 248 had their blood analysed for anti-HHV8 antibodies and 201 completed a standardized interview. Serological analysis was performed by an immunofluorescence assay able to detect antilytic antibodies. RESULTS: We found an overall seroprevalence of 15.7% (95% confidence interval, CI 11.4-20.9%), similar in men and women (15.1% vs. 16.3%) and higher at older ages. Seropositivity was not related to sexual habits, while it was significantly associated with a history of hepatitis (seroprevalence 34.6%, adjusted odds ratio, OR 4.08, 95% CI 1.52-11.00) and with a diagnosis of non-melanoma skin cancer (42.9%, OR 4.20, 95% CI 1.26-14.02) or atypical naevi (35.3%, OR 6.21, 95% CI 1.85-20.86). CONCLUSIONS: Our data suggest that a non-sexual mode of transmission of HHV8 infection is plausible in an Italian population at low risk for sexually transmitted diseases and that other factors, besides differences in prevalence of HHV8 infection, may be involved in the epidemiology of classical KS. The unexpectedly high seropositivity rates in subjects with non-melanoma skin cancer and atypical naevi should be viewed with caution and require confirmation.

Exposure to indoor background radiation and urinary concentrations of 8-hydroxydeoxyguanosine, a marker of oxidative DNA damage.

We investigated whether exposure to indoor [gamma]-radiation and radon might be associated with enough free radical formation to increase urinary concentrations of 8-hydroxydeoxyguanosine (8-OHdG), a sensitive marker of DNA damage, due to a hydroxyl radical attack at the C8 of guanine. Indoor radon and [gamma]-radiation levels were measured in 32 dwellings for 6 months by solid-state nuclear track detectors and thermoluminescent dosimeters, respectively. Urine samples for 8-OHdG determinations were obtained from 63 healthy adult subjects living in the measured dwellings. An overall tendency toward increasing levels of 8-OHdG with increasing levels of radon and [gamma]-radiation was seen in the females, presumably due to their estimated longer occupancy in the dwellings measured. Different models were considered for females, with the steepest slopes obtained for [gamma]-radiation with a coefficient of 0.500 (log nmol/l of 8-OHdG for each unit increase of [gamma]-radiation on a log scale) (p<0.01), and increasing to 0.632 (p = 0.035), but with larger variance, when radon was included in the model. In conclusion, there seems to be an effect of indoor radioactivity on the urinary excretion of 8-OHdG for females, who are estimated to have a higher occupancy in the dwellings measured than for males, for whom occupational and other agents may also influence 8-OHdG excretion. ree radicals; [gamma]-radiation; radon.

The changing distribution of HIV infection: HIV surveillance in Lazio, Italy, 1985 through 1994. Lazio HIV Surveillance Collaborative Group.

OBJECTIVES: This study sought to describe the human immunodeficiency virus (HIV) surveillance system in Lazio, Italy, and to analyze exposure patterns and time trends of HIV serodiagnoses from January 1985 to December 1994. METHODS: A linkage procedure made it possible to identify newly diagnosed HIV cases. Anonymous information was collected on demographic and exposure factors for each individual. RESULTS: Of 35,425 reports, 13,660 were newly diagnosed HIV cases, 70.9% of them in men. The proportion of women increased at the beginning of the study period (the male:female ratio declined from 3.5 in 1985 to 2.6 in 1986) and then remained stable. The proportion of subjects reporting heterosexual exposure, in men and women, respectively, increased from 1.5% and 2.0% in 1985 to 21.2% and 60.8% in 1994. Starting in 1992, heterosexual contact has become the main transmission route for women. CONCLUSIONS: A changing pattern in the HIV epidemic is emerging, with a shift in the incidence of HIV diagnosis from "core" high-risk groups (drug injectors) to the large low-risk population (the general population) exposed through heterosexual transmission. This is probably occurring in other areas (e.g., large urban centers in the United States) with a similar epidemiological situation.

Deliveries, abortion and HIV-1 infection in Rome, 1989-1994. The Lazio AIDS Collaborative Group.

The prevalence of HIV-1 among women of reproductive age is currently estimated at the time they give birth. We assessed HIV-1 prevalence at the end of pregnancy, whether they delivered or had an induced or spontaneous abortion. Women admitted at the end of pregnancy to hospitals in the Lazio Region, Italy, were tested for antibodies to HIV-1. Consent for testing was granted by 97.1% of 218,357 subjects; women who did not consent were tested anonymously. The prevalences of infection were 0.34% in 1989, 0.38% in 1990, 0.28% in 1991, 0.23% in 1992, 0.28% in 1993, and 0.24% in 1994. Significantly higher prevalences of infection were associated with induced abortion (0.49%) than with delivery (0.18%; OR: 2.72; 95% CI: 2.29-3.22) and among women who refused (0.85%) than among those who consented to testing (0.27%; OR: 3.14; 95% CI: 2.35-4.19). A significant temporal reduction in prevalence was observed only among women who delivered (0.15% in 1993 and 1994; 0.26% in 1989 and 1990). The prevalence of HIV-1 infection is thus higher among women undergoing induced abortions than among those who deliver and higher among women who refuse testing than among those who consent. Studies confined to neonatal testing or to voluntary testing of pregnant women would thus underestimate the prevalence of HIV-1 among women of reproductive age.

Prevalence of HIV-1 infection in 18 year old men in Tuscany. The Toscana Collaborative Group.

BACKGROUND: The main route of transmission of the human immunodeficiency virus type 1 (HIV-1) is sexual contact. A high proportion of young adults is exposed to this mode of transmission. Therefore it is important to assess the level of HIV-1 prevalence among 18 year olds in Italy. METHODS: Available blood samples taken at the physical examination of the military draft visit in Tuscany, Italy, have been tested in an anonymous unlinked fashion for HIV-1 infection in 1990 and 1991. RESULTS: In the 2 years, 4478 and 4959 men were tested, respectively, representing 91.7% of all subjects included in the draft lists. Prevalence of HIV-1 infection was 1.12 per 1000 (95%CI: 0.36-2.61 per 1000) in 1990 and 0.20 per 1000 (95% CI: 0.01-1.12) in 1991. CONCLUSIONS: Prevalence of HIV-1 infection in the 18 year old male population in Tuscany is close to or below 1/1000. Evidence of the presence of HIV-1 infection in this population should prompt the implementation of adequate prevention programmes among adolescents.

HIV risk-related behaviors among injection drug users in Rome: differences between 1990 and 1992.

Temporal differences in human immunodeficiency virus (HIV) risk-related behaviors among injection drug users in Rome, Italy, were analyzed in 487 drug users recruited in 1990 and 450 recruited in 1992. Sharing of syringes decreased among self-reported HIV-positive drug users between 1990 and 1992, but there was no change in their sexual behavior. Fewer HIV-seronegative drug users reported passing on used syringes in 1992 than in 1990; however, there was no change in the percentage of seronegative subjects using previously used syringes, and a reduction in condom use with primary partners. There still exists a great potential for transmission of HIV infection among injection drug users and from injection drug users to the general population.

Capture-recapture to estimate the size of the population with human immunodeficiency virus type 1 infection.

Estimating and monitoring the total number of people infected with human immunodeficiency virus type 1 (HIV-1) is a critical public health objective. No single epidemiologic methodology yields completely reliable estimates. We used techniques originally designed to estimate the size of wildlife populations to complement estimates of the size of the population with HIV-1 infection in Lazio, Italy, during 1990 obtained from surveillance, surveys, and dynamic mathematical models. We used reports from four large testing sites to generate incomplete, partially overlapping lists of HIV-positive subjects. Log-linear models yielded estimated prevalences of 5.65 per 1,000 among males (95% confidence interval = 4.52-6.78) and 1.84 per 1,000 (95% confidence interval = 1.34-2.33) among females in the population age 15-64 years. This method provides a simple and inexpensive means of obtaining accurate estimates of the total number of HIV seropositives. It could be applied easily in all situations in which data from multiple sources are available.

[Behavior associated with HIV-1 infection in drug addicts in Rome, 1990-1992]. / Comportamenti associati ad infezione da HIV-1 nei tossicodipendenti a Roma, 1990-1992.

Two cross-sectional surveys have been conducted in Rome in 1990 and 1992 to investigate prevalence and temporal differences of risk behaviours among drug injectors. A total of 487 drug injectors in 1990, and 450 in 1992 have been interviewed both in the street and in treatment services. Twenty-four percent of the subjects interviewed in 1990 reported having used second-hand syringes in the preceding 6 months, as compared to 14% in 1992; in the two years 29% and 13%, respectively, reported having passed a second-hand syringe to other drug injectors. Fifty-six percent (46% in 1992) of primary partners of drug injectors interviewed were not drug users themselves, while the prevalence of non drug using occasional partners was 34% and 43% in the two surveys. In 1990 condom use with primary partner was reported by 48% of drug injectors, and by 41% in 1992; condom use with occasional partners was 56% and 64% in the two years. The differences in sharing behaviours were observed for HIV-1 positive subjects, while HIV-1 negatives reported the same prevalence of use of second-hand syringes in 1990 and 1992; no statistically significant differences have been found for sexual behaviours among the HIV-1 positives, while the HIV-1 negatives reported a lower prevalence of condom use with primary partner. The observed differences in the two years remain also adjusting for the socio-demographic characteristics of the two populations in a multiple logistic regression model. Prevalence of HIV-1 related risk behaviours among drug injectors is still too high.(ABSTRACT TRUNCATED AT 250 WORDS)

Risk factors for overdose mortality: a case-control study within a cohort of intravenous drug users.

Overdose mortality is the major adverse health effect of drug injection. The potential determinants of overdose death are poorly understood; the aim of this study was to investigate risk factors for overdose mortality among intravenous drug users (IVDU). A cohort of 4200 IVDU attending methadone treatment centres in Rome during the period 1980-1988, was enrolled. Data were collected from clinical records. Vital status and cause of death were ascertained as of 31 December 1988. A matched case-control analysis within the cohort was performed to identify risk factors of death from overdose. All overdose deaths were included as cases and four controls, matched on year of birth and sex, were selected for each case from among the cohort members still alive at the time of death of the corresponding case. In all, 81 deaths from overdose were identified as cases and compared with 324 controls. A high risk of overdose death occurred among subjects who left treatment compared with those still in treatment (odds ratio [OR] = 3.55, 95% confidence interval [CI]: 1.82-6.90). The OR was particularly elevated in the first 12 months after drop-out compared with those retained in treatment (OR = 7.98, 95% CI: 3.40-18.73). The risk of overdose death was higher for unmarried compared with married people (OR = 2.48, 95% CI: 1.31-4.68); a higher risk of overdose death was also associated with lower educational status and younger age at first drug use, but such association was not statistically significant.(ABSTRACT TRUNCATED AT 250 WORDS)

The impact of intravenous drug use on mortality of young adults in Rome, Italy.

To estimate the impact of intravenous drug use (IVDU) on mortality in the general population of young adults in Rome, Italy, the Population Attributable Risk (PAR) was calculated for the overall and cause-specific mortality in the 15-34 years age group. Relative risks were derived from a previous historical cohort study on mortality among 4200 intravenous drug users (IVDUs) in Rome, in which increased mortality from cardiovascular, respiratory, and gastrointestinal diseases as well as from violence, overdose and AIDS had been observed. The prevalence of the risk factor (i.e. the proportion of IVDUs) in the general population was estimated using the 'multiplier formula' and 'capture-recapture' methods. The proportion of all deaths attributable to IVDU in the 15-34 age group in the Roman population was 16% and 9% in males and females, respectively. The cause-specific attributable proportions were 66% for endocarditis and 37% for cirrhosis in males, and 36% for endocarditis and pneumonia in females. These findings further document the relevant health consequences of IVDU on the general population of a large metropolitan area.

Mortality of intravenous drug users in Rome: a cohort study.

A historical cohort study was carried out in Rome to examine overall and cause-specific mortality among intravenous drug users (IVDUs). A total of 4200 IVDUs (3411 men and 789 women) enrolled in methadone treatment centers between 1980 and 1988 were studied. There were 239 deaths during the follow-up period. The overall SMR was 10.10 in the entire cohort (95% confidence interval, 8.86-11.47), 9.30 in males and 18.07 in females. A large excess of mortality in both sexes was found for infectious, circulatory, respiratory, and digestive diseases as well as for violence, overdose, AIDS, and unknown or ill-defined causes. Tumors and suicide were excessive only in males. Deaths due to drug overdose, violence or trauma, and cirrhosis accounted for 63.6%, AIDS for 7.1%, endocarditis and other bacterial infections for 7.1%, and neoplasms for 3.8% of total mortality. These findings document serious health consequences of drug abuse in Italy.