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Newly diagnosed HIV infection at reference centre of Northern Italy
R. Manfredi, L. Calza
University of Bologna, S. Orsola Hospital, Infectious Diseases, Bologna, Italy
Background: All newly diagnosed cases of HIV infection at our reference centre,which serves around 800,000 inhabitants of the Bologna metropolitan area,were assessed.
Methods-Results: All patients with a newly diagnosed HIV infection were evaluated according to several demographic,epidemiological,diagnostic,clinical,and laboratory features.
Results: From July 2006 up to December 2008 (30 months),141 patients were first diagnosed with HIV disease (mean 5.6 novel cases/month),and 56 of them were judged to have a recent infection (as established on the ground of a specific “avidity” serologic testing).Males greatly prevailed over females (97 versus 44 cases),while homosexual exposure (71 cases) was prevalent over heterosexual one (66 patients),and only two cases were registered among i.v. drug users.The median age at diagnosis was 37 years,while the main laboratory parameters showed a mean CD4+ count of 522 cells/µL,and a mean HIV-RNA load of 1.02x105 copies/mL.Although subtype B of HIV greatly prevailed (127 cases:90.1%),also subtypes A1, and recombinant virions of HIV were found among newly infected patients.When conducting a genotypic resistance assay,the prevalence of primary mutations accounted for 13% of newly infected patients:10% of them had one-more mutations of the reverse transcriptase gene,and 7% of subjects had one-more mutations of the protease inhibitor gene.The majority of patients with recent infection (86 of 141:61%) were asymptomatic-paucisymptomatic,while AIDS or a symptomatic disease were present in 34 and 21 cases,respectively.
Conclusions: Nothwistanding the massive prevention campaigns,HIV infection continues to spread predominantly via sexual route,and may increasingly involve immigrants. Adelayed-missed recognition of HIV infection poses patients at high risk to develop HIV-related disorders (since these subjects could not take advantage from antiretrovirals).Non-subtype B viruses,recombinant viruses,and HIV strains already encoding for resistance against different antiretroviral compounds,are of concern.A permanent,active monitoring of this phenomenon and its correlates,is strongly warranted.
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