The epidemic of HIV infection and AIDS, promotion of testing, and innovative strategies

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

HIV virology and pathogenetic mechanisms of infection: a brief overview

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

The professional skills of the nurse involved in the care of individuals with sexually transmitted infections

INTRODUCTION: Sexually Transmitted Infections (STIs) represent a relevant public health issue that requires the combined contribution of different health care professionals in order to put in place proper prevention, diagnosis and treatment activities  METHODS: The Integrated health care model (PIC) is here applied to STIs. Designed as a territorial network of services including a multidisciplinary team of health care workers, this model works across a number of settings and levels of care. The specific contribution of the nurse with an adequate technical-scientific and relational communication background in STI care provision is analyzed.  RESULTS: Nurses and other Health Care Workers involved in the PIC for STIs are able to respond in a tailored manner to the various health needs of the person. The technical-scientific and relational communication competencies ensure the delivery of quality services. Moreover, nursing care should be STIs person-centred and used for to improve empowerment and healthy behaviors. Appropriate nursing staff education and training aimed at integrating technical-scientific knowledge with relational communication skills on STIs is highly desiderable.  CONCLUSIONS: Nurses area a crucial component in the PIC for STIs, because they are engaged in the care of a complex, delicate and intimate component of the individual. Therefore, to improve service performance, an improvement and extension of nurses duties in STI centers would be highly desirable. Standardized care protocols established by the local Health Department could be used as direction as well as an updating of the current Italian legislation which does not allow to adapt nursing competencies to the real care requirements.  KEYWORDS: sexually transmitted infections, Italy, nurses, integrated care, training, health communication.INTRODUZIONE: Le Infezioni Sessualmente Trasmesse (IST) rappresentano a livello nazionale un importante problema di sanità pubblica che richiede interventi di prevenzione, diagnosi e cura condotti attraverso la collaborazione integrata di professionisti sanitari differenti.  METODI: È stato utilizzato il modello di Percorso Integrato di Cura (PIC) applicandolo alle IST, inteso come rete territoriale che prevede il coordinamento tra le diverse strutture sanitarie e tra i vari operatori sanitari coinvolti in questa specifica area. In tale ambito è stato analizzato il possibile contributo che il professionista infermiere, con un bagaglio tecnico-scientifico e comunicativo-relazionale adeguato, può fornire alla persona direttamente o indirettamente coinvolta in una IST.  RISULTATI: La conduzione di un intervento infermieristico professionale all’interno del PIC per le IST, ovviamente integrato con quello di altre figure professionali, intende rispondere in modo personalizzato ai diversi bisogni di salute espressi dalla persona. Inoltre, mira a promuovere nella persona con IST l’attivazione di processi di empowerment fondamentali per la messa in atto di stili comportamentali adeguati. Emerge, pertanto, l’esigenza di proporre al personale infermieristico un percorso di formazione/aggiornamento finalizzato all’integrazione delle conoscenze tecnico-scientifiche con quelle comunicativo-relazionali in tema di IST.  CONCLUSIONI: Il ruolo dell’infermiere costituisce un elemento cruciale all’interno di un PIC per le IST in quanto impegnato in un’area complessa e delicata che tocca la sfera più intima della persona coinvolgendola nella sua globalità. Appare, pertanto, fortemente auspicabile un ampliamento delle competenze dell’infermiere attraverso, prima, una elaborazione di protocolli aziendali standardizzati stabiliti dalla Direzione Sanitaria in cui opera il professionista infermiere, e successivamente un superamento della normativa vigente che ad oggi non consente di adeguare le competenze infermieristiche alle reali esigenze assistenziali.  PAROLE CHIAVE: infezioni sessualmente trasmesse, Italia, infermiere, percorso di cura integrato, formazione, epidemiologia, comunicazione&nbsp

Demographic and socio-economic determinants of poor HIV-risk perception at first HIV diagnosis: analysis of the HIV Surveillance data, Italy 2010-2016

HIV infections in Italy has not undergone a substantial decline over recent years. For this reason, we analysed risk-factors and socio-economic indicators of HIV-risk perception in HIV surveillance data

Performance of V3-based HIV-1 sero subtyping in HIV endemic areas

HIV-1 serosubtyping based on reactivity to peptides from the V3 region of gp120 is a low-cost and easy to perform procedure often used in geographical areas with high prevalence and incidence of HIV infection. We evaluated the performance of V3-based serotyping on 148 sera from 118 HIV-1-infected individuals living in Uganda, with estimated dates of seroconversion. Of the 148 tested samples, 68 (46.0%) specifically reacted with only one of the V3 peptides included in the test (SP), 64 (43.2%) did not react with any peptide (NR) and 16 (10.8%) reacted with two or more peptides (CR). According to the estimated seroconversion date, the large majority of samples collected early after infection belonged to the NR group. These samples had also a low Avidity Index. In contrast, samples collected later after infection belonged mainly to CR and SP groups and had also a higher avidity index. These results indicate that the performance of V3-based assays depends on maturation of HIV-specific immune response and can be significantly lowered when these tests are carried out on specimens collected from recently infected individuals

Incidence of Newly HIV Diagnosed Cases among Foreign Migrants in Italy: 2006-2013

Objective: In Europe, during the last years the proportion of foreign migrants among AIDS and HIV cases is growing. In Italy, the number of new cases of HIV represented by foreign migrants has progressively increased, but the new HIV diagnoses incidence among foreign migrants has decreased, because of the increase in the total number of foreign migrants in recent years. Nevertheless, the new HIV diagnoses incidence among foreign migrants is still high if compared to that among Italians. The aim of the study was to analyze the characteristics of foreign migrants with a new HIV diagnosis and the new HIV diagnoses incidence among foreign migrants diagnosed in Italy between 2006 and 2013. Methods: The new diagnoses incidence was calculated as the ratio between the number of new HIV diagnoses among foreign migrants and the number of foreign migrants residing in Italy. The new HIV diagnoses incidence was compared with that among Italians using the standardized incidence ratio (SIR) adjusted by age and gender. Results: During the study period (2006-2013), of the 25,545 new diagnoses reported by the HIV surveillance system, 28.8% were among foreign migrants. The incidence of new HIV diagnoses among foreign migrants for the entire study period was 26.7 cases per 100,000 foreign migrant residents, compared to 5.1 per 100,000 among Italians. The incidence of new HIV diagnoses decreased over time for foreign migrants: from 42.5 per 100,000foreign migrant residents in 2006 to 20.0 per 100,000 foreign migrant residents in 2013, whereas for Italians it remained stable. The SIR confirmed the marked difference between the two populations: specifically the overall incidence of new diagnoses was more than four times higher among foreign migrants, compared to Italians.Conclusion: The results stress the need to reinforce the efforts aimed at reducing the circulation of HIV in this population

Continued high prevalence of HIV, HBV and HCV among injecting and noninjecting drug users in Italy

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