RESUMO
Potential environmental impacts of engineered nanoparticles (ENPs) can be understood taking into consideration phytotoxicity. We reported on the effects of ionic (FeCl3), micro- and nano-sized zerovalent iron (nZVI) about the development of three macrophytes: Lepidium sativum, Sinapis alba and Sorghum saccharatum. Four toxicity indicators (seed germination, seedling elongation, germination index and biomass) were assessed following exposure to each iron concentration interval: 1.29-1570mg/L (FeCl3), 1.71-10.78mg/L (micro-sized iron) and 4.81-33,560mg/L (nano-iron). Exposure effects were also observed by optical and transmission electron microscopy. Results showed that no significant phytotoxicity effects could be detected for both micro- and nano-sized zerovalent irons, including field nanoremediation concentrations. Biostimulation effects such as an increased seedling length and biomass production were detected at the highest exposure concentrations. Ionic iron showed slight toxicity effects only at 1570mg/L and, therefore, no median effect concentrations were determined. By microscopy, ENPs were not found in palisade cells or xylem. Apparently, aggregates of nZVI were found inside S. alba and S. saccharatum, although false positives during sample preparation cannot be excluded. Macroscopically, black spots and coatings were detected on roots of all species especially at the most concentrated treatments.
Assuntos
Cloretos/toxicidade , Compostos Férricos/toxicidade , Lepidium sativum/efeitos dos fármacos , Sinapis/efeitos dos fármacos , Sorghum/efeitos dos fármacos , Fenômenos Químicos , Cloretos/química , Compostos Férricos/química , Germinação/efeitos dos fármacos , Lepidium sativum/crescimento & desenvolvimento , Nanopartículas/química , Nanopartículas/toxicidade , Raízes de Plantas/efeitos dos fármacos , Plântula/crescimento & desenvolvimento , Sinapis/crescimento & desenvolvimento , Sorghum/crescimento & desenvolvimentoRESUMO
The Health Commission of the Conference between the Italian State and Regions recognized the need to establish an institutional accreditation model for Haemophilia Centres (HCs) to be implemented by 21 Regions in order to provide patients with haemophilia and allied inherited coagulations disorders with high and uniform standards of care. The Italian National Blood Centre, on behalf of the Commission, convened a panel of clinicians, patients, experts, representatives from Regions and Ministry of Health. The agreed methodology included: systematic literature review and best practice collection, analysis of provisions and regulations of currently available services, priority setting, definition of principles and criteria for the development of recommendations on the optimal requirements for HCs. The result was the formulation of two recommendations sets. Two sets of recommendations were produced. The first concerns regional policy planning, in which the following aspects of comprehensive haemophilia care should be considered for implementation: monitoring and auditing, multidisciplinary approach to clinical care, protocols for emergency management, home treatment and its monitoring, patient registries, drug availability and procurement, recruitment and training of health care professionals. The second set concerns the accreditation process and lists 23 organizational requirements for level 1 HCs and 4 additional requirements for level 2 HCs. These recommendations help to provide Italian Regional Health Authorities with an organizational framework for the provision of comprehensive care to patients with inherited coagulation disorders based on current scientific evidence.
Assuntos
Academias e Institutos , Acreditação , Hemofilia A/terapia , Modelos Teóricos , Atenção à Saúde , Diretrizes para o Planejamento em Saúde , Humanos , ItáliaRESUMO
In this research Scenedesmus obliquus and Chlorella vulgaris growth was tested on digestate sludge obtained from the anaerobic co-digestion treatment of the organic fraction of municipal solid waste (OFMSW) together with waste activated sludge (WAS). Digestate was diluted 1:10 and tested in three batch experimental conditions: with no pre-treatments (noPT), after centrifugation (AC) and after filtration (AUF), in order to evaluate microalgae limiting growth factors. The best growth was obtained by C. vulgaris on digestate AC compared to S. obliquus, reaching 479 ± 31 cell million ml-1 and 131 ± 12 cell million ml-1 respectively. Ammonia removal evaluated in C. vulgaris and S. obliquus cultures was 99.2% ± 0.3 and 98.146% ± 0.008 in AC condition, respectively. Considering that AUF showed similar microalgae growth values, the digestate pretreatment for microalgae growth, could be limited to centrifugation.
Assuntos
Chlorella vulgaris , Microalgas , Scenedesmus , Esgotos , Resíduos Sólidos , Águas Residuárias/análiseRESUMO
This study consists of a review based on 104 papers published between 1980 and 2019, which dealt with the occurrence of pharmaceuticals, hormones and a selection of microorganisms in raw and treated manure from different types of animal farms. The selected pharmaceuticals and hormones are those regularly administered to livestock for treating and preventing diseases. Worldwide, manure is commonly spread on soil as a fertilizer due to its nutrient content. However, this practice also represents a potential pathway for micropollutant release into the environment. In this context, this study evaluates the predicted concentrations of some antibiotics in soil after the application of swine slurry on soil and compares them with corresponding measured concentrations found in the literature. Enrofloxacin, oxytetracycline and chlortetracycline were the antibiotics with the highest concentrations that were found in raw and treated manure and that showed a high risk together with sulfamethazine. Future research should focus on monitoring other pathogens, parent compounds and their main metabolites in raw and treated manure, studying the spread and development of antibiotic resistance genes in the environment due to residues of antibiotics in manure applied to soil, and evaluating predicted no effect concentrations of pharmaceuticals and hormones commonly administered to livestock with regard to terrestrial organisms.
Assuntos
Esterco , Poluentes do Solo , Animais , Antibacterianos , Resistência Microbiana a Medicamentos , SoloRESUMO
A large number of tourist structures in Venice (Italy) have small sized on-site treatment systems for their wastewater. Due to its historical characteristics, the city has no public sewerage system and untreated hotel wastewater represents a serious hazard for its lagoon environment. This study focused on the wastewater facilities installed in two hotels adopting an Activated Sludge Sequencing Batch Reactor (AS-SBR) and an Ultra-Filtration Membrane Biological Reactor (UF-MBR). Their performance was checked in terms of both traditional physico-chemical and ecotoxicological parameters, the importance of which has recently been recognised by EU regulatory dispositions and OSPAR indications. Acute and sub-chronic endpoints were both considered on a whole effluent toxicity basis by means of Vibrio fischeri and Crassostrea gigas, respectively. The two months monitoring survey evidenced that the UF-MBR was more efficient than the AS-SBR in providing high-quality discharges under both chemical and ecotoxicological viewpoints.
Assuntos
Monitoramento Ambiental/métodos , Resíduos Industriais , Eliminação de Resíduos Líquidos/normas , Poluentes Químicos da Água/química , Água/química , Itália , Microbiologia da Água/normas , Poluição Química da Água/prevenção & controle , Purificação da Água/métodosRESUMO
One of the main concerns in wastewater whole effluent assessment is the sampling phase and the sample chain of custody before any toxicity evaluation. The major problem is related to establishing the correct method for sample storage in order to perform toxicity bioassays. The toxicity of some domestic and glass factory industrial wastewater samples stored both by refrigeration at 4 +/- 1 degrees C for no more than three days, and freezing at -18 +/- 1 degrees C for no more than one month was compared via the embryo larval development bioassay with the oyster Crassostrea gigas. The results showed no significant differences between the toxicities of refrigerated and frozen wastewater samples. The wastewater classification, according to a score based on four toxicity classes, showed that the preservation methods did not alter the toxicity classification of the samples. In particular, it was demonstrated that the samples considered as 'not acutely toxic' after refrigeration were also found to have this classification after freezing.
Assuntos
Crassostrea/efeitos dos fármacos , Monitoramento Ambiental/métodos , Manejo de Espécimes/métodos , Testes de Toxicidade/métodos , Poluentes Químicos da Água/toxicidade , Animais , Crassostrea/crescimento & desenvolvimento , Larva/efeitos dos fármacos , Larva/crescimento & desenvolvimento , Poluentes Químicos da Água/químicaRESUMO
One of the main problems of the Whole Effluent Toxicity is related to the use of bioindicator species representative of the target environment. Most wastewater discharges are of fresh water, so their salinity has to be adjusted when they are discharged to transitional and marine coastal waters, in order to perform toxicity bioassays with reliable organisms. At the moment, there is no optimum technique to allow sample salinity to be adjusted and no specific information regarding salinity adjustment when bivalves are being considered for toxicity test performance. This paper provides information on the potential use of different methods to adjust the salinity of hotel/domestic wastewater samples with different brands of natural and synthetic Dry Salts (DS) and HyperSaline Brine (HSB) for use in the embryo larval development bioassay with the mussel Mytilus galloprovincialis. HyperSaline Brine derived from reconstructed artificial seawater proved to be more viable for wastewater salinity adjustment than DS.
Assuntos
Bivalves/efeitos dos fármacos , Testes de Toxicidade/métodos , Poluentes Químicos da Água/toxicidade , Purificação da Água/métodos , Animais , Bivalves/crescimento & desenvolvimento , Feminino , Masculino , SalinidadeRESUMO
The objective of this study is to provide a snapshot of the quality of surface runoff and tile drainage in sludge-amended soil in terms of 57 microcontaminants, including pharmaceuticals, hormones and fragrances, and 5 different species of bacteria. It also discusses the main factors affecting their occurrence (soil characteristics, applied sludge load and rate, sludge application method, rain intensity and frequency). It is based on 38 investigations carried out by different research groups in Canada, Australia, the USA and Ireland. The most frequently investigated compounds were hormones, the antiseptics triclosan and triclocarban, the analgesics and anti-inflammatories acetaminophen, ibuprofen and naproxen, the antibiotic sulfamethoxazole, the lipid regulator gemfibrozil and the psychiatric drug carbamazepine. Of all the bacteria, E. coli was the most monitored species. It was found that concentrations of the studied pollutants in surface runoff and tile drainage may vary, depending on many factors. They are generally lower than those observed in the secondary municipal effluent and in surface water, but their contribution to the deterioration of surface water quality might be relevant, mainly in wide rural areas. In this context, the reported data or their ranges represent an attempt to provide reference thresholds and bands of observed concentrations for a rough estimation of the contribution made by the release of the selected pollutants into surface water bodies via surface runoff and tile drainage.
Assuntos
Agricultura/métodos , Bactérias/metabolismo , Monitoramento Ambiental , Poluentes do Solo/análise , Poluentes Químicos da Água/análise , Bactérias/classificação , Fertilizantes/análise , Solo/químicaRESUMO
The aims of this work were (a) to develop a simple and reproducible procedure for percutaneous absorption and distribution tests of sunscreens using one human skin culture model (Epiderm 606; reconstructed epidermis, RE), (b) to compare the said model with rat skin (RS) in vitro and (c) to evaluate the effect of different formulations. The cutaneous permeation and distribution of two UV filters, ethylhexylmethoxycinnamate (MC80) and ethylhexyltriazone (T150), using 3 different vehicles were investigated. The permeation studies demonstrated that neither MC80 nor T150 permeated through both RS and RE in spite of different thicknesses of the 2 substrates. Distribution studies demonstrated that sectioning by cryomicrotome to obtain horizontal skin layers was suitable for both RS and RE (apart from its small thickness) with a good reproducibility of data. The amounts of sunscreens retained in the 2 substrates were in the same order of magnitude for all formulations with a greater depot in RS. Different distribution profiles of the tested formulations could be ascribed to the different lipid compositions of RE and RS. Since the physicochemical characteristics of RE are closer to those of human skin, the results obtained with reconstructed human skin models could be suitable to replace human skin in 'in vitro testing'.
Assuntos
Modelos Biológicos , Absorção Cutânea , Protetores Solares/farmacocinética , Animais , Cinamatos/administração & dosagem , Cinamatos/farmacocinética , Humanos , Masculino , Compostos Orgânicos/administração & dosagem , Compostos Orgânicos/farmacocinética , Permeabilidade , Veículos Farmacêuticos/química , Ratos , Reprodutibilidade dos Testes , Pele , Especificidade da Espécie , Protetores Solares/administração & dosagem , Técnicas de Cultura de Tecidos , Distribuição TecidualRESUMO
Toxicity from industrial oily wastewater remains a problem even after conventional activated sludge treatment process, because of the persistence of some toxicant compounds. This work verified the removal efficiency of organic and inorganic pollutants and the effects of evaporation and air-stripping techniques on oily wastewater toxicity reduction. In a lab-scale plant, a vacuum evaporation procedure at three different temperatures and an air-stripping stage were tested on oily wastewater. Toxicity reduction/removal was observed at each treatment step via Microtox bioassay. A case study monitoring real scale evaporation was also done in a full-size wastewater treatment plant (WWTP). To implement part of a general project of toxicity reduction evaluation, additional investigations took into account the monoethanolamine (MEA), diethanolamine (DEA) and triethanolamine (TEA) role in toxicity definition after the evaporation phase, both as pure substances and mixtures. Only MEA and TEA appeared to contribute towards effluent toxicity.
Assuntos
Etanolamina/toxicidade , Etanolaminas/toxicidade , Eliminação de Resíduos Líquidos/métodos , Poluentes Químicos da Água/toxicidade , Ar , Aliivibrio fischeri/efeitos dos fármacos , Aliivibrio fischeri/metabolismo , Etanolamina/química , Etanolaminas/química , Temperatura Alta , Concentração de Íons de Hidrogênio , Resíduos Industriais , Luminescência , Óleos , Vácuo , Volatilização , Poluentes Químicos da Água/químicaRESUMO
Wood is widely used in the development of freshwater, estuarine and marine coastlines. Timbers last according to their content of naturally occurring preservatives (mostly phenols and aldehydes), produced to prevent decay from biotic agents. When untreated woods are exposed to aquatic media, leachates are generated with likely toxic effects on the target environment. The potential impact on saltwaters of leachates from some untreated timbers of both native and tropical species has been assessed. The leaching procedure was set up considering British Standard test methods for paints and OECD guidelines for wood preservatives emission scenarios. Toxicity was monitored via the acute toxicity test with the brine shrimp Artemia franciscana and the sub-chronic embryotoxicity test with the oyster Crassostrea gigas. Brine shrimps evidenced no toxic effects while oysters discriminated well among leachates: the tropical wood species showed similar or relatively lower toxic effects than the native ones according to both leaching cycles (24 and 72 h). The ecotoxicological data have been integrated with some physical and chemical parameters.
Assuntos
Artemia/efeitos dos fármacos , Crassostrea/efeitos dos fármacos , Poluentes Químicos da Água/toxicidade , Madeira , Animais , Crassostrea/embriologia , Embrião não Mamífero/efeitos dos fármacos , Dose Letal Mediana , Magnoliopsida , Picea , Água do MarRESUMO
Bauxite extraction by-products (red mud) were used to evaluate their potential ability to stabilize trace elements from dredged and aerated/humidified marine sediment. The investigated by-products were: bauxaline®(BX) that is a press-filtered red mud; bauxsol™(BS) that is a press-filtered red mud previously washed with excess of seawater, and gypsum neutralized bauxaline® (GBX). These materials were separately mixed to dredged composted sediment sample considering 5% and 20% sediment: stabilizer ratios. For pilot experiments, rainfall events were regularly simulated for 3 months. Concentrations of As, Mo, Cd, Cr, Zn, Cu, and Ni were analyzed in collected leachates as well as toxicity. Results showed that Cd, Mo, Zn, and Cu were efficiently stabilized in the solid matrix when 20% of BX, BS, and GBX was applied. Consequently, toxicity of leachates was lower than for the untreated sediment, meaning that contaminants mobility was reduced. A 5% GBX was also efficient for Mo, Zn and Cu stabilization. In all scenarios, As stabilization was not improved. Compared to all other monitored elements, Mo mobility seemed to depend upon temperature-humidity conditions during pilot experiments suggesting the need of further investigations.
Assuntos
Poluentes Ambientais/análise , Sedimentos Geológicos/química , Metais Pesados/análise , Oligoelementos/análise , Óxido de Alumínio/química , Sulfato de Cálcio/química , Poluentes Ambientais/química , Concentração de Íons de Hidrogênio , Metais Pesados/química , Chuva , Água do Mar , Solo , Oligoelementos/químicaRESUMO
Nanosized titanium dioxide (nTiO2) is widespread in many commercial products and several authors investigated its ecotoxicity effects focusing mainly on freshwater environments. Data on saltwater species are still lacking or present contradicting results. We compared for the first time the toxicity of TiCl4 and nTiO2 considering standard toxicity tests with microalgae Phaeodactylum tricornutum (growth inhibition test, 1.8-90mg/L) and crustacean Artemia franciscana (mortality test, 0.5-64mg/L). For A. franciscana, two alternative scenarios were considered beside standard protocol: i) darkness; and ii) starvation. About microalgae, results evidenced that effects of TiCl4 (EC50=63mg/L) were greater than nTiO2 (no EC50), but IC10 and IC20 were significantly lower suggesting that nTiO2 is more harmful than TiCl4 at lower concentrations. The effects of TiCl4 to crustaceans larvae in all exposure scenarios were lower compared to nTiO2 (EC50(96h)=15mg/L - standard protocol). During toxicity testing, the absence of light generally lowered nTiO2 effects while starvation increased the toxicity of both TiCl4 and nTiO2.
Assuntos
Nanopartículas/toxicidade , Água do Mar/química , Titânio/toxicidade , Testes de Toxicidade , Poluentes Químicos da Água/toxicidade , Animais , Artemia/fisiologia , Diatomáceas/fisiologia , Titânio/químicaRESUMO
This review paper examined 529 papers reporting experimental nanoecotoxicological original data. Only 126 papers referred to saltwater environments (water column and sediment) including a huge variety of species (n=51), their relative endpoints and engineered nanoparticles (ENPs) (n=38). We tried to provide a synthetic overview of the ecotoxicological effects of ENPs from existing data, refining papers on the basis of cross-cutting selection criteria and supporting a "mind the gap" approach stressing on missing data for hazard and risk assessment. After a codified selection procedure, attention was paid to Ag, Au, CuO, TiO2, ZnO and C60 ENPs, evidencing and comparing the observed nanoecotoxicity range of effect. Several criticisms were evidenced: i) some model organisms are overexploited like microalgae and molluscs compared to annelids, echinoderms and fish; ii) underexploited model organisms: mainly bacteria and fish; iii) exposure scenario variability: high species-specific and ENP scenarios including organism life stage and way of administration/spiking of toxicants; iv) scarce comparability between results due to exposure scenario variability; v) micro- and mesocosms substantially unexplored; vi) mixture effects: few examples are available only for ENPs and traditional pollutants; mixtures of ENPs have not been investigated yet; vii) effects of ions and ENPs: nAg, nCuO and nZnO toxicity aetiology is still a matter of discussion; viii) size and morphology effects of ENPs: scarcely investigated, justified and understood. Toxicity results evidenced that: nAu>nZnO>nAg>nCuO>nTiO2>C60.
Assuntos
Nanopartículas Metálicas/química , Nanopartículas Metálicas/toxicidade , Metais/química , Metais/toxicidade , Poluentes Químicos da Água/química , Poluentes Químicos da Água/toxicidade , Animais , Medição de Risco , Água do Mar/químicaRESUMO
The capacity of two toxicity bioassays (fertilization and embryo toxicity tests) to discriminate sediment toxicity using the sea urchin Paracentrotus lividus was tested in five stations with different levels of pollution in the Lagoon of Venice. Two stations were located in estuarine sites, two in the industrial zone, and one in a site at the top of our quality gradient (reference). Elutriate was chosen as sediment matrix to assess the potential effects of bioavailable pollutants in the water column as a consequence of sediment resuspension (dredging and dumping, fishing gear, etc.). An experimental design based on Quality Assurance/Quality Control procedures (QA/QC) was adopted in order to set the methodological basis for an effective use of these bioassays in monitoring programs. Results revealed both higher embriotoxicity than spermiotoxicity in all stations and the efficacy of combined use of both toxicity bioassays in discriminating differing pollution/bioavailability between stations and periods. The good representativeness of the integrated sampling scheme and the standardization of all experimental phases yielded high precision of results. Clear Toxicity Fingerprints were evidenced for the investigated sites through the combined use of both bioassays. A good fit between ecotoxicological data and chemical contamination levels was found, except for unnatural sediment texture.
Assuntos
Bioensaio , Fertilização/efeitos dos fármacos , Sedimentos Geológicos/química , Paracentrotus/efeitos dos fármacos , Poluentes Químicos da Água/toxicidade , Animais , Resíduos Industriais , Itália , Masculino , Metais Pesados/análise , Metais Pesados/toxicidade , Compostos Orgânicos/análise , Compostos Orgânicos/toxicidade , Paracentrotus/embriologia , Paracentrotus/fisiologia , Medição de Risco , Água do Mar , Fatores de Tempo , Testes de Toxicidade , Poluentes Químicos da Água/análiseRESUMO
BACKGROUND: As the potentiality of deceased organ donation mostly depends on the number of brain deaths (BDs), the aim of this study is to quantify rates and probabilities of BD declaration in Italy. METHODS: Deaths with acute cerebral lesion (ACLDs) in the Italian ICUs have been prospectively collected. A total of 27,490 ACDLs occurred in 5 years. Age, gender, etiology, timing of death and ICU Region have been utilized for multivariate analysis. RESULTS: The global ratio of BD declarations to ACLDs was 39.9%. The rates of ACLDs, BD declarations and actual donors were 93.5, 37.3 and 19.7 pmp respectively. Wide variability resulted among Regions, with 148.2 ACLDs, 77.8 BD declarations and 42 donors pmp as benchmark. The probability of being BD declared was significantly higher in stroke compared with head injury (OR 1.6, P<0.001) and in females (OR 1.5, P<0.001), with half the Regions missing around 50% of BD declarations compared with the benchmark, particularly in elderly patients. CONCLUSION: Predictable factors associated with BD declaration can be identified in ACLD management. Positive factors leading to the identification of potential organ donors, i.e., the capacity of declaring BD in all the patients fulfilling BD criteria irrespective of age and etiology, could be captured in the best performing regions and reproduced throughout the Country. The implementation of simple indicators based on prospective ACLD monitoring, i.e. the declared BDs to ACLDs in ICU ratio, may be helpful in achieving efficiency targets and reliable comparisons of outcomes in the identification of BD potential organ donors.
Assuntos
Morte Encefálica , Unidades de Terapia Intensiva , Doadores de Tecidos/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Traumatismos Craniocerebrais/epidemiologia , Traumatismos Craniocerebrais/mortalidade , Feminino , Previsões , Humanos , Lactente , Recém-Nascido , Itália , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/mortalidade , Obtenção de Tecidos e Órgãos/estatística & dados numéricos , Adulto JovemRESUMO
OBJECTIVES: To evaluate rates and predictors of testing and HIV positivity among the sexual partners of Italian HIV-positive haemophiliacs. METHODS: Our index cases were 602 sexually active HIV-positive haemophiliacs (aged 18 years or more) enrolled in the Italian Registry of Haemophilia. Data on the demographic and clinical status of the haemophiliacs, whether their partners had undergone HIV testing, and the results of these tests were collected. RESULTS: To date, 205 (34.1%) partners of HIV-positive haemophiliacs have been tested for HIV, of whom 27 (13.2%) were seropositive. On univariate analysis, haemophiliacs who were unmarried, younger, and asymptomatic were less likely to have partners who had been tested for HIV (P << 0.001). On multivariate analysis, unmarried status [odds ratio (OR), 8.4; 95% confidence interval (CI), 5.4-13.1; P << 0.001] and younger age (OR, 1.9; 95% CI, 1.1-3.2) again predicted a higher rate of non-tested partners. There was no association between the demographic and medical characteristics of HIV-seropositive haemophiliacs and the risk of HIV positivity among their sexual partners. CONCLUSION: This study demonstrates that a high proportion of sexual partners of HIV-positive haemophiliacs have not yet been tested for HIV. The single most important predictor of not being tested was the marital status of the index case. These results emphasize the need to strengthen prevention programmes aimed at minimizing the risk of heterosexual HIV transmission, particularly among younger unmarried haemophiliacs.
Assuntos
Soropositividade para HIV/complicações , Hemofilia A/complicações , Sorodiagnóstico da AIDS , Adolescente , Adulto , Feminino , Soropositividade para HIV/epidemiologia , Soropositividade para HIV/transmissão , Humanos , Itália/epidemiologia , Masculino , Casamento , Sistema de Registros , Parceiros SexuaisRESUMO
To investigate the interval between HIV-1 infection and the development of clinical AIDS among Italian patients with congenital coagulation disorders, a national cohort study was undertaken in 1988. Information was collected both retrospectively and prospectively on 499 HIV-1-positive patients enrolled in an ongoing national registry of patients with congenital coagulation disorders. Two methods were used to estimate each patient's seroconversion date: the mid-point between the last negative (either known or estimated) and the first positive test, and the median under a Weibull distribution, which was assumed to fit seroconversion data. The two methods of estimating the seroconversion time yielded similar results. The actuarial incidence of AIDS was estimated using the Kaplan-Meier survival analysis at 12.8% (95% confidence interval = 9.7-15.9) over 7 years for Italian haemophiliacs. Progression appears to be slow in the first 5 years after the infection, and to rise steadily thereafter. A strong association between faster progression and older age at seroconversion was found. Zidovudine-treated individuals seem to have a slower progression than untreated individuals, after controlling for CD4, but there was no association between progression and type and severity of the congenital disorder.
Assuntos
Síndrome da Imunodeficiência Adquirida/diagnóstico , Soropositividade para HIV/complicações , HIV-1 , Hemofilia A/complicações , Síndrome da Imunodeficiência Adquirida/tratamento farmacológico , Síndrome da Imunodeficiência Adquirida/imunologia , Síndrome da Imunodeficiência Adquirida/mortalidade , Adolescente , Adulto , Fatores Etários , Idoso , Criança , Pré-Escolar , Estudos de Coortes , Soropositividade para HIV/imunologia , Soropositividade para HIV/mortalidade , HIV-1/imunologia , Hemofilia A/mortalidade , Humanos , Incidência , Lactente , Recém-Nascido , Itália/epidemiologia , Pessoa de Meia-Idade , Estudos Prospectivos , Estudos Retrospectivos , Análise de Sobrevida , Zidovudina/uso terapêuticoRESUMO
OBJECTIVES: To estimate survival trends for persons with haemophilia and HIV/AIDS. DESIGN AND METHODS: Survival analysis conducted among the cohort of HIV-positive haemophiliacs with AIDS at the Italian Haemophilia Registry. Kaplan-Meier method was used to estimate survival times, stratifying for demographic and clinical covariates. Cox proportional hazards model was applied in order to identify factors independently associated with survival. RESULTS: Median survival from the first AIDS diagnosis to death was estimated to be 17.0 months for 176 individuals with AIDS. Median survival after AIDS diagnosis increased from 12.0 months in December 1983-December 1988 to 17.0 months in January 1989-May 1990 and to 25.0 months in June 1990-December 1991. Median survival times were significantly (P < 0.001) lower for individuals diagnosed with non-infective AIDS indicator diseases (lymphoma, AIDS-associated neurological disease, Kaposi's sarcoma, wasting syndrome: 4.0 months), in comparison with haemophiliacs diagnosed with Pneumocystis carinii pneumonia (PCP; 18.0 months) or other infections (35.0 months). Antiretroviral treatment after AIDS diagnosis was associated with a longer survival than that estimated for individuals with no treatment after AIDS; the same was true for PCP prophylaxis. Younger age at HIV seroconversion and at AIDS diagnosis were associated with a longer survival. Multivariate analysis showed that factors independently associated with survival were type of AIDS indicator disease and antiretroviral administration after AIDS diagnosis. CONCLUSIONS: This study indicates an increasing survival from AIDS diagnosis to death over time, also as a result of the introduction of antiretroviral therapy. Survival trends are similar to those reported among homosexual men and intravenous drug users with AIDS, suggesting a similar access to the health-care system for individuals with AIDS. Survival studies may improve our understanding of the natural history of HIV infection and may indicate the impact of preventive measures.