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NEW DIAGNOSIS OF HIV INFECTION STUDY

(NU.DI.H STUDY): PRELIMINARY RESULTS


S. Casari, B. Suligoi(*), L. Camoni(*), A. Pavan(°), L. Macchi(°), F.
Donato(^), G. Paraninfo, S. Compostella, R. Allegri, G. Carosi &
Nu.Di.H. Collaborative Group

Dipartimento di Malattie Infettive, AO Spedali Civili - Brescia (Italy)


(*) Istituto Superiore di Sanità - Roma
(°) Direzione Generale Sanità, Regione Lombardia - Milano
(^) Sezione di Igiene, Epidemiologia e Sanità Pubblica, Università
degli Studi-Brescia
Nu.Di.H. Collaborative Group
• UUOO Malattie Infettive, Brescia (G. Carosi, G. Cristini): Silvia
Costarelli, Cristina Muscio
• UUOO Malattie Infettive, Ospedale L. Sacco, Milano (G.
Rizzardini, M. Galli): Amedeo Capetti, Laura Castagnoli,
Vincenza Di Rosa, Maria Michela Fasolo, Angelica Lupo, Michela
Maria Pellegrini, Emanuela Sirmioni
• UO Malattie Infettive, Ospedale San Raffaele, Milano (A.
Lazzarin): Alba Maria Bigoloni
• UO Malattie Infettive, Ospedale Niguarda, Milano (I.
Schlacht): Donatella Bombacini, Maria Cristina Moioli
• UO Malattie Infettive, Monza (A. Gori): Patrizia Acquaviva,
Noemi Tagliabue, Maria Libera Vaira
• UO Malattie Infettive, Como (D. Santoro): Ernesto Longoni,
Enrico Rinaldi, Giuseppa Tamburello
• UO Malattie Infettive, Lecco (A. Orani): Manuela Gatti
• UO Malattie Infettive, Mantova (A. Scalzini): Lucia Bevilacqua,
Sebastiano Miccolis, Maria Soregotti
../.
Nu.Di.H. Collaborative Group (cont.)
• UO Malattie Infettive, Legnano (P. Viganò): Tiziana Re, Maria
Grazia Tajè
• UO Malattie Infettive, Busto Arsizio (T. Quirino): Raffaella
Visonà
• UO Malattie Infettive, Lodi (M. Tinelli): Maria Irene Arcidiacono
• UO Malattie Infettive, Pavia (L. Minoli): Roberto Gulminetti,
Stefano Novati, Alessia Uglietti
• UO Malattie Infettive e Tropicali, Ospedale San Paolo,
Milano (A. D’Arminio): Anna De Bona
• UO Malattie Infettive e Tropicali, Varese (P. Grossi): Helga
Gariani, Laura Rizzi
• UO Malattie Infettive, Cremona (G. Carnevale): Silvia
Lorenzotti, Daniele Omodei
• UO Malattie Infettive e Tropicali, Pavia (G. Filice): Giorgio
Barbarini, Paolo Sacchi
• Centro MST, ASL Città di Milano (G. Vidoni): Paola Bizzoni,
Livia Brignolo
• I.Re.F., Milano: Giovanna Rabbufetti
Objective

To describe the socio-demographic,


epidemiological, behavioral, clinical and
laboratory features of subjects with new
diagnosis of HIV infection (incident
cases)
Methods
• Cross-sectional, observational, multicenter study
(17 Centers in Lombardy Region)
• Inclusion criteria:
o Patients with positive test for HIV in the last 90
days, performed from 01/12/2008 to 30/11/2009
o Age ≥ 18 yrs.
o Well understanding of the Italian language
o No cognitive impairments
o Able to provide informed consent
• An investigator-administered questionnaire with
63 items, including epidemiological, socio-
behavioral, clinical and laboratory data
Results
Gender

All patients (= 472)


104;
22%
Males
Females

368;
Heterosexuals (= 229)
78%
84;
37%
Males
Females

145;
63%
Age and classes
• Mean age = 39.8 yrs. (SD 11.5)
160 152 (32.2) 152 (32.2)

122 (25.9)
120
N. (%)

80
46 (9.7)
40

0
Age groups (yrs.)
< 25 25-34 35-44 ≥ 45
Transmission route
Heterosex. Homo/Bisex IVDU Other/NA

300
229
(48.5%)
187
200 (39.6%)
N. (%)

100 45
12 (9.5%)
(2.5%)
0
Education

Primary/Second. sch. 10-13 yrs.


170; 36%
Secondary school 14-18 yrs.
Degree
N.A.

90; 19%

3; 1%

209; 44%
CD4+ Lymphocytes count
• Median value = 327 cells/cmm (25-75% = 101-550)
(23 missing)
P < 0.001
500
Median CD4+ Lymph. count

435
400
(cells/cmm)

300 252
220
200

100 76

Heterosex. Homo/Bisex IVDU Other/NA


Previous HIV negative test
• 224 pts. (47.5%) reported a previous test
Related variables OR (CI95%) P
(multivariate analysis)
Transmission route:
• Heterosexual 1 -
• Homosex./Bisexual 3.49 (2.13-5.71) < 0.001
Education:
• Primary/sec. 10-13 yrs. 1 -
• Secondary 14-18 yrs. 1.52 (0.94-2.45) 0.085
• Degree 2.25 (1.26-4.04) 0.006
Gender:
• Male 1 -
• Female 1.97 (1.08-3.60) 0.026

No statistically significant results for: Age and Nationality


Severe immunodeficiency
• 162/449 pts. (36.1%) had CD4+ < 200 (23 missing)
Related variables OR (CI95%) P
(multivariate analysis)
Previous negative test:
• No 1 -
• Yes 0.33 (0.20-0.56) < 0.001
Age (yrs.):
• < 25 1 -
• 25-34 4.82 (1.05-22.13) 0.043
• 35-44 14.87 (3.35-65.93) < 0.001
• ≥ 45 11.36 (2.54-50.81) 0.001
Education:
• Primary/sec. 10-13 yrs. 1 -
• Secondary 14-18 yrs. 0.72 (0.43-1.18) 0.193
• Degree 0.47 (0.23-0.95) 0.037

No statistically significant results for: Transmission route, Gender and


Nationality
Partner notification
• 205/443 pts. (46.3%) had not yet informed the partners
(29 reported no present/previous partnerships)
Related variables OR (CI95%) P
(multivariate analysis)
Transmission route:
• Heterosexual 1 -
• Homosex./Bisexual 0.44 (0.26-0.76) 0.003
Gender:
• Male 1 -
• Female 2.10 (1.11-3.97) 0.023
Education:
• Primary/sec. 10-13 yrs. 1 -
• Secondary 14-18 yrs. 1.28 (0.78-2.10) 0.324
• Degree 1.92 (1.01-3.63) 0.046

No statistically significant results for: Nationality, Age and Previous


negative test
Awareness of the risk
• 182/454 pts. (40.9%) declared they were aware of
the risk of transmission before infection (18 missing)
Related variables OR (CI95%) P
(multivariate analysis)
N. partners during the life:
• ≤ 10 1 -
• > 10 4.53 (2.36-8.69) < 0.001
Prev. informations about HIV:
• No 1 -
• Yes 2.61 (1.52-4.47) 0.001
Transmission route:
• Heterosexual 1 -
• Homosex./Bisexual 2.87 (1.55-5.33) 0.001
Nationality:
• Italian 1 -
• Others 0.39 (0.19-0.81) 0.011
Gender:
• Male 1 -
• Female 2.55 (1.04-6.27) 0.041

No statistically significant result for: Previous negative test, Education,


Age
Conclusions (1)

• The study confirms that in Italy the majority of


HIV infections is due to sexual transmission,
with a large proportion of homo/bisexuals
among subjects with recent infections
• Homo/bisexuals are admitted to clinical
Centers at earlier stage of HIV infection than
heterosexuals
• Homo/bisexuals, more educated patients and
females undergo more often HIV testing
Conclusions (2)

• Older and less educated patients are more at


risk for late testing
• Homo/bisexuals, males and less educated
patients inform less often their partners
before counseling
• The awareness of the risk of transmission
seems to be more common in homo/bisexuals,
Italians, females and patients with many
partners in their life