International Journal of Epidemiology, Vol 28, 975-981, Copyright © 1999 by International Epidemiological Association
P Pezzotti, D Serraino, G Rezza, L Dal Maso, E Vaccher, AC Lepri and S Franceschi
OBJECTIVE: To evaluate time trends of the spectrum of AIDS-defining
diseases in Italy, 1982-1996. METHODS: Surveillance data from the Italian
National AIDS Registry were used to assess temporal patterns of all
AIDS-defining diseases diagnosed among adults as of December 1996.
Twenty-six initial clinical manifestations of AIDS were grouped into 12
categories. Relative frequencies were calculated by year of diagnosis and
stratified by age, gender, HIV-exposure category, and CD4+ cell count. A
multivariate polychotomous logistic model was used to estimate the
proportions of each diagnostic category over time, adjusting simultaneously
for the remaining diagnostic categories and for variables of interest.
RESULTS: This analysis was based on 41772 diagnoses of AIDS-defining
diseases among 36 638 reported cases. Mycoses represented the most frequent
condition (27.3%), followed by Pneumocystis carinii pneumonia (PCP) (21.4%)
and viral infections (8.9%). Cancers accounted for less than 10% of
diseases. Downward trends were observed for mycoses, PCP (in the last part
of the study period), Kaposi's sarcoma (KS), and non-Hodgkin's lymphomas
(NHL). Upward trends were observed for mycobacterioses, and bacterial and
protozoal infections. Brain toxoplasmosis increased up to 1994, and,
thereafter, it appeared to decrease. These trends were less marked when the
analysis was restricted to the diseases included in the pre- 1987 AIDS
definition. Trends stratified by CD4+ cell count for the period 1990-1996
were substantially consistent with the above-reported results. CONCLUSIONS:
The downward temporal trends in the most recent years of the study period
for PCP and for brain toxoplasmosis are likely to be related to the use of
prophylactic treatment. This analysis confirms a decline in KS but suggests
that this was largely over by 1990.
ARTICLES
The spectrum of AIDS-defining diseases: temporal trends in Italy prior to the use of highly active anti-retroviral therapies, 1982-1996
Centro Operativo AIDS, Istituto Superiore di Sanita, Rome, Italy. patrizio.pezzotti@iss.it
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