[A vaccination campaign for gypsy children in Rome]. / Una campagna vaccinale in favore dei bambini Rom e Sinti a Roma.

Several studies conducted in Rome have shown low levels of vaccination coverage in gypsy communities. Thus a vaccination campaign targeting to 2400 gypsy children aged 0-13 years, present in 32 settlements in Rome, was conducted in 2002. The campaign was related to vaccinations required and recommended in Italy: diphtheria, tetanus, hepatitis B, pertussis (whooping cough), haemophilus influenzae and measles. In the majority of cases it was decided to carry out the vaccinations directly in the gypsy settlements, in accordance with the methods of pulse immunisation. In the case of small settlements a strategy for reorienting the population to vaccination centres was adopted. Around 2000 children were vaccinated, equivalent to 80% of the paediatric population present during the period. The number of children who have never been vaccinated has decreased from 40% prior to the campaign to 9% after the third week. Vaccination coverage in medium- and small-sized settlements (<200 inhabitants) after the campaign shows values of over 70%; in the large settlements, more modest increases have been recorded and coverage has rarely exceeded 50%. This experience has highlighted the importance of networking between public healthcare institutions and non-profit organisations. The mobilisation of a wide range of competences has thus enabled the attainment of a high level of effectiveness.

Increasing survival time after AIDS in Italy: the role of new combination antiretroviral therapies. Tuscany AIDS Study Group.

BACKGROUND: In Italy, antiretroviral combination therapy was adopted in mid-1995 and protease inhibitors in mid-1996. OBJECTIVE: To conduct a prospective, population-based, observational study to evaluate the effect of these therapies on the survival of persons with AIDS (PWA). METHODS: PWA living in the Tuscany region diagnosed between 1985 and 31 March 1997 (National AIDS Registry) were studied. Information on antiretroviral drugs, prophylactic treatment, CD4 cell count, and AIDS-defining illnesses was collected for PWA still alive at 1 January 1996 and those diagnosed thereafter (analysis cut-off date, 30 November 1997). Kaplan-Meier curves were calculated by year of diagnosis. A Cox model was then used to estimate the adjusted (by sex, age, HIV exposure category, CD4 cell count, type and number of AIDS-defining illnesses) relative hazard (RH) of death by year of diagnosis and calendar date (considered as a time-dependent variable). Similar analyses were repeated for PWA diagnosed after 1989, having been stratified by disease-specific AIDS condition. A final analysis was performed for PWA still alive at 1 January 1996 or diagnosed thereafter for estimating the effect of single, double and triple combination therapy (time-dependent variables), having adjusted for the above variables and for prophylactic treatment. RESULTS: A total of 1683 (79.5%) out of 2118 PWA died before 1 December 1997. Use of more potent combination therapies, including protease inhibitors, greatly increased during 1997. Median survival was 2.9, 12.3, 13.4, 11.4 and 17.6 months for diagnoses before 1987, in 1987-1990, 1991-1993, 1994 and 1995, respectively; an estimated 62% of those diagnosed in 1996-1997 had survived 15 months after diagnosis. The Cox model showed a trend of decrease of RH for calendar time starting in the first half of 1996, compared with 1994. When stratifying by specific AIDS-defining disease there was no statistically significant evidence that the improved overall survival was due to increased survival only for certain diseases. The final multivariate analysis for the 771 PWA still alive at 1 January 1996 or diagnosed thereafter estimated significant RH < 1.0 for double and triple therapy (RH, 0.61 and 0.36, respectively) compared with no therapy. CONCLUSIONS: A significant reduction in risk of death after AIDS was observed from the second half of 1996, apparently due to the widespread use of antiretroviral combination therapies.

Frequency and determinants of use of antiretroviral and prophylactic therapies against Pneumocystis carinii Pneumonia (PCP) before AIDS diagnosis in Italy.

To determine the frequency and the determinants of use of antiretroviral drugs and prophylaxis for Pneumocystis carinii Pneumonia (PCP) among HIV-infected individuals before AIDS diagnosis, a questionnaire was sent to all physicians reporting at least one AIDS case during the first six months of 1994 to the Italian National AIDS Registry. Information on cases diagnosed between 1 January and 31 March 1995 was collected. Information was obtained for 878 (66.4%) of the 1323 persons with AIDS: 447 (50.9%) had received antiretroviral drugs and 343 (39.1%) PCP prophylaxis, whereas 303 cases (34.5%) had received both. Individuals who became aware of being HIV-positive shortly before AIDS diagnosis were less likely to have started antiretroviral therapy (adjusted odds ratio (AOR): 0.05, 95% CI: 0.03-0.09). Homosexual men and heterosexuals were more likely to begin therapy (AOR: 1.40, 95% CI: 0.83-2.37 and AOR: 1.79, 95% CI: 1.05-3.05, respectively) compared to injecting drug users. Individuals living in Southern Italy and foreigners were less likely to start therapy (AOR: 0.75, 95% CI: 0.49-1.16 and AOR: 0.40, 95% CI: 0.15-1.09, respectively) compared to those living in Northern Italy. Results were similar for PCP prophylaxis. Lack of awareness of HIV infection, HIV exposure category, and geographical area were the most important factors associated with treatment before AIDS diagnosis.

Predictors of survival in children with acquired immunodeficiency syndrome in Italy, 1983 to 1995.

To evaluate length and predictors of survival among children with AIDS, 529 pediatric cases diagnosed in Italy from 1983 to August 1995 were reviewed. Data were analyzed using Kaplan-Meier curves and the Cox proportional hazards regression model. Various survival patterns were subsequently analyzed. All survival analyses were truncated on March 1, 1996. Cases were examined by gender, age at diagnosis, HIV transmission category, type and number of the first AIDS-defining diseases, level of immunosuppression at AIDS diagnosis, HIV transmission category of the mother, and period of diagnosis. The overall median survival time was approximately 24 months. There wer no significant differences in survival by gender, HIV transmission category, mother's risk factor, or period of diagnosis. The Kaplan-Meier analysis showed the greatest differences in survival time between children less than 6 months of age at diagnosis (median survival 6.4 months) and all others (median 28.7 months). Children with recurrent bacterial infections or lymphoid interstitial pneumonia (LIP) had a survival time at least four times longer than those with Pneumocystis carinii pneumonia (PCP), mycobacteriosis, cytomegalovirus, tumors, or progressive multifocal leukoencephalopathy. At the multivariate analysis, the risk of death was lower among children with LIP (Relative Hazard [RH] 0.72) compared with other opportunistic diseases, whereas age less than 6 months, diagnosis of PCP or of two or more diseases, and severe immunosuppression at diagnosis increased the risk of death. Both demographic factors (age) and clinical factors (type and number of initial diseases, level of immunosuppression) were found to be independent predictors of a poor prognosis in children with AIDS. This information may be of use in improving prognosis and planning healthcare and treatment.

The effect of the 1993 European revision of the AIDS case definition in Italy: implications for modelling the HIV epidemic.

OBJECTIVES: To evaluate the effect of the 1993 European AIDS definition on reducing pre-AIDS mortality and to what degree an earlier diagnosis can be made. DESIGN: Prospective observational study. METHODS: All patients diagnosed between January 1993 and December 1994 and reported to the National AIDS Registry from four Italian regions, who met only the new criteria for the 1993 case definition (AIDS-1993) were studied. Follow-up of patients who did not eventually meet the 1987 definition (AIDS-1987), or had not died from other causes (pre-AIDS-1987 death), was censored at the last available clinical visit before 1 April 1996. We analysed the data using Kaplan-Meier non-parametric survival analysis and Cox proportional hazards model. RESULTS: A total of 74 (4.1%) individuals met only the new criteria. Of these, 49 (62.2%) were men, 42 (56.8%) had pulmonary tuberculosis, 22 (29.7%) had recurrent bacterial pneumonia, and 10 (13.5%) had cervical cancer. During follow-up, 35 (45.3%) individuals developed an AIDS-1987 disease, and 10 (13.5%) died without fulfilling the AIDS-1987 definition. Pre-AIDS-1987 death accounted for 22.2% (10 out of 45) of the subsequent outcomes observed prior to 1 April 1996. Using Kaplan-Meier technique, we estimated that after 9.8 months 50% of these individuals were diagnosed with AIDS-1987 disease, or died without such a diagnosis. Individuals with lower CD4+ count at the time of the AIDS-1993 diagnosis progressed more rapidly to AIDS-1987 than those with a higher count. In contrast, pre-AIDS-1987 mortality was strongly associated with injecting drug use, whereas no association was found with CD4+ count. CONCLUSIONS: Approximately 50% of individuals with one of the three new AIDS-defining diseases will develop an AIDS-1987 disease or will die within 1 year. Time from AIDS-1993 to AIDS-1987 disease is strongly associated with CD4+ count at diagnosis. AIDS_1993 diagnosis reduced the pre-AIDS-1987 mortality in injecting drug users. Furthermore, approximately 20% of individuals diagnosed with AIDS-1993 disease are expected to die without developing an AIDS-1987 disease. These data should be useful for correcting the AIDS incidence curve in Europe for the effect of the changes in the AIDS definition.

AIDS: a major health problem among young Italian women.

OBJECTIVE: To estimate the extent of the HIV/AIDS epidemic among Italian women and to assess its impact on mortality. Further, to assess the incidence of AIDS and the main characteristics of women affected by AIDS: with particular attention to those aged 25-34 years, and to identify differences in these characteristics compared with men infected with AIDS. METHODS: Incidence data were derived from the Italian National Register of AIDS Cases (RAIDS). The most recent complete data refer to cases diagnosed to the end of 1994. Mortality data were collected from the Italian mortality database, which is held by the Italian National Census Bureau (ISTAT) and processed by the Laboratory of Epidemiology and Biostatistics at the National Institute of Health of Italy (Istituto Superiore di Sanitá; ISS). The most recent mortality data refer to 1992, but projections were made to obtain mortality data up to 1994. All the rates were standardized by age and sex. RESULTS: A total of 26 957 cases of AIDS, 21 441 men (79.5%) and 5516 women (20.5%), diagnosed before the end of 1994 were reported to RAIDS. The majority of cases and deaths occurred in individuals aged 25-34 years. The incidence of AIDS among women increased from 2.1 per 100 000 in 1987 to 17.2 per 100 000 in 1994. The sex ratio (men:women) fell from 5.2 in 1987 to 2.9 in 1994. In 1992, AIDS was the second most common cause of death (slightly behind cancer and ahead of traffic accidents) in Italy, but was the most common cause in three regions of northern Italy (Liguria, Lombardia and Emilia). CONCLUSIONS: Although the AIDS epidemic in the past has predominantly affected young men, AIDS is now rapidly becoming a major health problem for young women in Italy. Moreover, as these women are at reproductive age, this may have important consequences in terms of increased morbidity and mortality among children.