Introduction. In industrialized countries, the availability of highly active antiretroviral therapy (HAART) caused a slow but substantial ageing of the AIDS epidemic mainly due to the longer survival of persons with HIV/AIDS which has turned HIV into a manageable, chronic disease. The number of older people with AIDS is growing in many European countries. We described the impact of AIDS among persons aged 50 years or more in Italy and compared the characteristics of these cases with those of persons diagnosed with AIDS at an age younger than 50. Methods. The source of data was the Italian AIDS Registry, from 1982 to 2011. We defined "older" persons those aged 50 years or more, and younger individuals those aged less than 50 years. We built two multivariate logistic regression models: the first one to identify factors associated with being older, and the second one to identify AIDS-defining diseases correlated with being older. Variables with a P value of < 0.05 were entered in the model. Results. Of the total AIDS cases, 10.5% were among persons older than 49 years. This proportion progressively increased from 0.0% in 1983 to 26.4% in 2011. Among older cases, the incidence of AIDS was 2.0 per 100 000 residents in 1996, then decreased to 1.4 per 100 000 in 2000 and levelled off around 1 per 100 000 residents until 2011. Compared to younger cases, older cases were more frequently males, Italians, diagnosed with AIDS in recent years, residing in Northern or Central Italy, non-injecting drug users, and late testers. Discussion. These findings stress the need for physicians to consider carefully the possibility of HIV infection among older individuals not to miss the opportunity to deliver prevention messages, offer HIV testing, and make an early diagnosis.

In 2006 we conducted a cross-sectional study involving hospital clinical centres in five Italian cities to compare the sexual behaviour of HIV-positive MSM (men who have sex with men) before and after the diagnosis of HIV infection. Each centre was asked to enrol 30 HIV-positive persons aged > 18 years. The questionnaire was administered to 143 MSM on average 9 years after HIV diagnosis. After diagnosis there was a decrease in the number of sexual partners: the percentage of persons who reported having had more than 2 partners decreased from 95.8% before diagnosis to 76.2% after diagnosis. After diagnosis, there was a significant decrease in the percentage of persons who had never (or not always) used a condom with their stable partner for anal sex from 69.2% before diagnosis to 26.6% after diagnosis and for oral-genital sex from 74.8% before diagnosis to 51.7% after diagnosis. Though at-risk behaviour seems to decrease after diagnosis, seropositive MSM continue to engage in at-risk practices: one fourth of them did not use a condom during sexually transmitted infections (STI) episodes, 12.5% of the participants had had sex for money, and 8.4% had paid for sex. The study shows that our sample of Italian HIV-positive MSM, though aware of being infected, engage in sexual behaviours that could sustain transmission of HIV and other STIs. The results could constitute the first step in implementing national prevention programs for persons living with HIV.

Nel 2006 abbiamo condotto uno studio trasversale in 5 centri clinici ospedalieri di cinque città italiane per confrontare negli uomini HIV positivi che avevano avuto rapporti sessuali con altri uomini, il comportamento sessuale prima e dopo la diagnosi di infezione da HIV. Ogni centro clinico ha reclutato 30 maschi omosessuali HIV positivi di età > 18 anni. Il questionario, appositamente preparato per questo studio, è stato somministrato a 143 uomini HIV positivi in media 9 anni dopo la diagnosi di HIV. Allo studio hanno partecipato143 uomini. Dopo la diagnosi di HIV è stata evidenziata una diminuzione del numero di partner sessuali: la percentuale di uomini che avevano più di 2 partner è passata dal 95,8% prima della diagnosi al 76,2% dopo la diagnosi. Dopo la diagnosi di HIV tra le persone con relazioni stabili è diminuita la percentuale di persone che non usavano il preservativo nei rapporti anali dal 69,2% prima della diagnosi al 26,6% dopo la diagnosi e nei rapporti oro-genitali dal 74,8% al 51,7%. Un quarto dei partecipanti ha dichiarato di non aver usato il condom con una infezione sessualmente trasmessa (IST) in atto, il 12,5% aveva avuto rapporti sessuali in cambio di soldi e l'8,4% aveva pagato per avere rapporti sessuali. Questo studio mostra che il nostro campione di omosessuali HIV-positivi, anche se consapevole di essere infetto, ancora pratica comportamenti sessuali a rischio che potrebbero trasmettere l'infezione da HIV e altre IST. I risultati di questo studio potrebbero costituire un primo passo nella realizzazione dei programmi nazionali di prevenzione per le persone affette da HIV.

We estimated the prevalence of HIV, HBV and HCV infections among injecting and non-injecting drug users treated within public drug-treatment centres in Italy to determine the correlates of infection. In the sample of 1330 drug users, the prevalence of HIV was 14.4% among drug injectors and 1.6% among non-injectors; the prevalence of HBV was 70.4% among injecting drug users and 22.8% among non-injectors and of HCV was 83.2% among injecting drug users and 22.0% among non-injectors. Old age, unemployment, and intravenous drug use were significantly correlated with each of the infections, as well as a longer history of injecting drug use. The results indicate that these infections continue to circulate among drug users, highlighting the need for monitoring of this group in Italy.

Abbiamo stimato la prevalenza dell'infezione da HIV, HBV e HCV tra i tossicodipendenti iniettivi e non iniettivi che sono in trattamento presso i Servizi Pubblici per le Farmacodipendenze e l'Alcolismo italiani (SerT) e abbiamo determinato i correlati per queste infezioni. Tra i 1330 tossicodipendenti, la prevalenza dell'HIV era del 14,4% tra gli iniettivi e del 1,6% tra i non iniettivi; dell'HBV era del 70,4% tra gli iniettivi e del 22,8% tra i non iniettivi e dell'HCV era del 83,2% tra gli iniettivi e del 22,0% tra i non iniettivi. L'età avanzata, l'essere disoccupato e l'uso iniettivo sono risultati essere fattori significativamente associati con queste infezioni, così come una lunga storia di uso iniettivo tra gli endovenosi. Lo studio sottolinea la necessità di una sorveglianza continua di queste infezione nella popolazione tossicodipendente.