INTRODUCTION: Sex workers (SW) clients represent a bridge population for HIV transmission from high risk to low risk general population. MATERIALS AND METHODS: A cross-sectional anonymous telephone survey was carried out at the AIDS and Sexually Transmitted Infections Helpline of National Institute of Health in Italy. The questionnaire was proposed on a voluntary basis to a sample of 119 subjects from helpline users. RESULTS: The 119 participants were all males, aged between 19 and 59 years and mostly accessed female prostitutes. Vaginal intercourses with SW were more frequently reported, followed by passive oral, active oral sex and active anal intercourses. Cumulatively, 86.6% and 84.6% of vaginal and anal intercourses were respectively reported as regularly protected by condom. DISCUSSION: The telephone interview allowed an eased access, a high response rate and a standardised evaluation of questions CONCLUSIONS: It is necessary a constant monitoring of the characteristics, behaviour, risk perception and testing of SW clients in Italian and other populations.

BACKGROUND: Clients of sex workers represent a relevant target for interventions aimed at the prevention of HIV and sexually transmitted infections (STIs). Within prevention strategies, the AIDS and sexually transmitted infections helpline (Telefono Verde AIDS/ IST, TVA-IST) of National Institute of Health in Italy has provided, since 1987, specific information and counselling interventions. AIM: The present study reports data on anagraphical characteristics and behaviours of clients of sex workers, anonymously reported at TVA-IST in the period 1987-2010. DISCUSSION: Among 95 149 phone calls (14% of the total) considered 99.5% came from males, over 80% aged under 37 years and prevalently from Northern Italy. Among sexual behaviours, unprotected sexual intercourses were reported in the 26% of the calls. Subjects under 27 years reported a higher frequency of unprotected anal intercourse, while they used protection with oral and vaginal intercourses in a greater extent than older ones. Due to differential behaviours within clients of sex workers, specific informative strategies for this targeted population should adequately consider age-related differences.

INTRODUCTION: In the last 10 years migration processes have progressively increased worldwide and in Italy about 5 millions of residing migrants are estimated. To meet health needs of these new residents, effective relational and communication tools, which allow a reciprocal intercultural interaction within health care structures, are therefore necessary. AIM: This article faces the main features of the relational-communication processes associated with health promotion and care in the migrant population in Italy to the aim of identifying the key and critical points within the interaction between different cultures, focusing on the role of specific professional figures, including cultural mediators and health educators. RESULTS: Within the activity of HIV phone counselling operated by Psyco-socio-behavioural, Communication and Training Operating Unit of National Institute of Health in Italy, an intercultural approach was successfully experienced in a project targeted to migrants (2007-2008). Specifically, the presence of cultural mediators answering in the languages of main migrants' groups allowed the increase of calls from migrant people and of the information provided.

Studies on HIV virology and pathogenesis address the complex mechanisms that result in the HIV infection of the cell and destruction of the immune system. These studies are focused on both the structure and the replication characteristics of HIV and on the interaction of the virus with the host. Continuous updating of knowledge on structure, variability and replication of HIV, as well as the characteristics of the host immune response, are essential to refine virological and immunological mechanisms associated with the viral infection and allow us to identify key molecules in the virus life cycle that can be important for the design of new diagnostic assays and specific antiviral drugs and vaccines. In this article we review the characteristics of molecular structure, replication and pathogenesis of HIV, with a particular focus on those aspects that are important for the design of diagnostic assays.

Gli studi sulla virologia e la patogenesi dell'HIV sono importanti per comprendere i complessi meccanismi che regolano l'infezione della cellula da parte del virus e la distruzione del sistema immunitario. Questi studi si focalizzano sulle caratteristiche della struttura e della replicazione di HIV e sui meccanismi di interazione con l'ospite. Infatti, l'aggiornamento continuo di questi aspetti della biologia dell'HIV è fondamentale, poiché può portare all'identificazione di nuove molecole che giocano un ruolo chiave nella patogenesi del virus e che possono indirizzare nuovi campi di ricerca per la generazione di farmaci, vaccini e nuovi saggi diagnostici. Questo breve articolo riassume brevemente le attuali conoscenze sulle caratteristiche molecolari, del ciclo replicativo e della patogenesi dell'HIV, dando particolare rilievo ad aspetti che risultano importanti per l'allestimento di saggi diagnostici.

Laboratory diagnosis of human immunodeficiency virus (HIV) infection is fundamental for detecting and monitoring infection. Many diagnostic tools are available that are based on both detection of HIV-specific antibodies and virus antigen, or nucleic acid. As technology evolves, HIV testing assays are being improved providing better sensitivity and specificity. In this short review, we summarize the common and new methodologies that are being used in laboratories, from the HIV antibody-based assays to the new tests for the detection of HIV nucleic acids.

La diagnosi di laboratorio è uno strumento fondamentale per identificare e monitorare l'infezione dal virus dell'immunodeficienza umana (HIV). Oggi sono disponibili molti saggi diagnostici, basati sulla determinazione sia degli anticorpi HIV-specifici, sia degli antigeni o degli acidi nucleici virali. Con l'evolversi della tecnologia, la diagnosi di laboratorio di infezione da HIV avviene attraverso saggi sempre più sensibili e specifici. In questo breve articolo vengono riassunte le metodologie utilizzate in laboratorio, dai saggi basati sugli anticorpi, ai nuovi test per la determinazione degli acidi nucleici del virus.

In Europe, the incidence of new diagnoses of HIV infection in 2008 was 86.7 cases per one million population, and most cases were attributable to sexual transmission. In Italy, in 2007, the incidence was 60.0 cases per one million population (in the areas in which surveillance exists), and 73.7% of the cases were attributable to sexual transmission. At present, there are an estimated 170 000-180 000 persons living with HIV/AIDS in Italy, some of whom are unaware of being infected. Based on available epidemiological data and taking into consideration the level of risk of exposure to HIV, we describe several proposals for promoting access to HIV testing in diverse population groups and contexts, including some innovative approaches. The promotion of HIV testing is fundamental for public health and human rights and must be associated with treatment, care and prevention activities, which must be guaranteed for the entire population.

In Europa, il tasso delle nuove diagnosi di infezione da HIV nel 2008 è stato pari a 86,7 casi per milione di abitanti; la maggiore proporzione di casi è attribuibile alla trasmissione sessuale. In Italia nel 2007, l'incidenza (nelle aree in cui è attivo il sistema di sorveglianza) è stata pari a 60,0 casi per milione di residenti e i casi attribuibili alla trasmissione sessuale sono il 73,7%. La stima attuale delle persone viventi con HIV/AIDS in Italia è pari a 170 000-180 000 casi, di cui una parte non sa di essere infetta. Sulla base dei dati epidemiologici disponibili e in relazione alle diverse probabilità di trasmissione, vengono presentate alcune proposte per promuovere l'accesso al test HIV in diversi gruppi di popolazione e in diversi contesti, anche attraverso l'utilizzo di approcci innovativi. La promozione del test HIV è un imperativo per la sanità pubblica e per i diritti umani, che si deve associare ad attività di cura, assistenza e prevenzione, garantite per tutta la popolazione.

HIV/AIDS surveillance data indicate that, in 2008, approximately one-fourth of all HIV infections in adults remain undiagnosed in Italy and that close to 60% of Aids diagnosed individuals discovered their seropositivity at the diagnosis of AIDS. Late diagnosis of HIV infection is associated with increased mortality and morbidity and increased cost to healthcare services. From a public health perspective, knowledge of HIV status is associated with a reduction in risk behaviour. Thus, a routine screening for HIV infection is important for both a better prognostic outcome, and control of HIV spreading in the population. In Italy there are not shared guidelines for the laboratory diagnosis. In this paper, we suggest two algorithms that can be adopted for the diagnosis of HIV infection in individuals undergoing HIV testing.

Dati di sorveglianza stimano che, nel 2008, in Italia, erano circa un quarto le infezioni da HIV non diagnosticate e che quasi il 60% delle persone con AIDS ha scoperto la propria sieropositività alla diagnosi di Aids. La diagnosi tardiva di infezione da HIV è associata a incrementata mortalità e morbidità ed aumentati costi per i servizi sanitari. Dal punto di vista della sanità pubblica, una diagnosi precoce di infezione da HIV è associata alla riduzione dei comportamenti a rischio di infezione. Pertanto, è importante potenziare lo screening sierologico per la diagnosi di laboratorio di infezione da HIV, per migliorare la prognosi e controllare più efficacemente la diffusione del virus, riducendo, così, i costi sanitari. In Italia non esistono linee guida per la diagnosi di laboratorio dell'infezione da HIV condivise a livello nazionale. In questo articolo suggeriamo due possibili algoritmi per la diagnosi di infezione da HIV in individui che desiderano sottoporsi al test per HIV.