Immigration, HIV infection, and antiretroviral therapy in Italy. An epidemiological and clinical survey.
Epidemiological, clinical, and therapeutic features of 77 consecutive HIV-infected non-European Union immigrants were compared according to gender. Immigrants (from Sub-Saharan Africa in around 60% of cases) represented 7.9% of our patient cohort at the end of 2002. Compared with male patients, females were more numerous, significantly younger (p.0001), and experienced sexual exposure versus drug addiction (p.02), while no difference was observed according to place of origin. A negative HIV serology preceding immigration was available for five women and four males only, while HIV disease was known before migration in 14 men versus 7 women (p.04). The tendency towards a shorter known history of HIV infection (p.05) of females versus males may be responsible for a lower incidence of AIDS among women (p.02). The use of antiretroviral treatment was matched by time and selected regimens, but compliance proved significantly greater in females versus males (p.0001), and women had less need of a regimen switch due to poor tolerability or refusal (73.2% versus 61.1%); the latter could be responsible for a greater mean CD4+ count (p.02), and lower mean plasma viremia (p.0001), although no difference was found when considering viral suppression rate (70.7% among women, 52.8% among men). Surveillance studies and prospective therapeutic trials are strongly warranted, in order to have a reliable assessment of HIV-infected immigrated people, to check the efficacy of preventive measures, obtain validated data about the clinical, virologic, and immunological evolution and outcome of HIV infection undergoing HAART, and to evaluate the frequency and role of eventual untoward effects of pharmacologic treatment.
Manfredi
Roberto
R
Dipartimento di Medicina Clinica Specialistica e Sperimentale, Sezione di Malattie Infettive, Universita degli Studi di Bologna Alma Mater Studiorum, Policlinico S. Orsola-Malpighi, Bologna, Italy.
Calza
Leonardo
L
Chiodo
Francesco
F
D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D004641:Emigration and Immigration; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology*; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male
D044966:Anti-Retroviral Agents