Pub Date : 2009-01-01DOI: 10.1080/00365540902887730
Kari J Syrjänen
In addition to cancer of the lower female genital tract, human papillomaviruses (HPV) are associated with a large number of benign, precancer and cancer lesions at different anatomic sites in both genders. Malignant tumours and their precursors are usually attributed to the oncogenic (high-risk, HR) HPV types, whereas benign lesions (papillomas) are associated with the low-risk (LR) HPV types, most notably with HPV6 and HPV11. Until recently, the main interest in HPV research has been focused on HR-HPV types and their associated pathology, and much less attention has been paid to the lesions caused by the LR-HPV types. With the recent licensing of an effective prophylactic vaccine against the 2 most important LR-HPV types (HPV6 and HPV11), it has become timely to make a systematic survey on the annual disease burden due to these 2 HPV genotypes in our country. These types of data should form the foundation for all calculations of the annual costs needed to treat these diseases by conventional means. Accurate estimates of disease burden are also mandatory for all modelling of the cost-effectiveness of prophylactic HPV6 and HPV11 vaccines. If proven useful for any of these purposes, this document will have fulfilled its purpose. In the first step, published HPV literature was used to create a list of benign, premalignant and malignant lesions associated with this virus at different anatomic sites. GLOBOCAN 2004 (IARC) database was used to derive the global numbers of incident cases for each of these malignancies in 2002, and the Finnish Cancer Registry (FCR) website for obtaining these (y 2005) numbers in Finland. The evidence linking HPV to each individual tumour category was classified as: 1) established, 2) emerging, and 3) controversial. All published evidence was weighted for each individual malignant, premalignant and benign lesion, anatomic region by region, while assessing the attributable fraction of HPV6/11 genotypes in each lesion. Because benign and most of the precancer lesions are not registered by FCR or GLOBOCAN, different approaches had to be used to derive the best estimates for their incidence, based on published literature or other registries (e.g. genital wart registry of the UK and Wales, and mass screening registry of FCR). With a lack of reasonable consensus, a lower and an upper limit was set for the range of estimates. In cases with different age-specific incidence (e.g. genital warts), the population pyramid of Finland was used to calculate the incident cases. Where well established, the different incidence rates among males and females were used to calculate the numbers of incident cases by gender. The malignant neoplasms with established or emerging evidence on the causal role of HPV are listed by their ICD-10 codes in Table I. Included in this list are also 2 controversial malignancies (colorectal cancer and endometrial cancer), of which the contradictory HPV data are critically discussed. The third major cancer
{"title":"Annual disease burden due to human papillomavirus (HPV) 6 and 11 infections in Finland.","authors":"Kari J Syrjänen","doi":"10.1080/00365540902887730","DOIUrl":"https://doi.org/10.1080/00365540902887730","url":null,"abstract":"<p><p>In addition to cancer of the lower female genital tract, human papillomaviruses (HPV) are associated with a large number of benign, precancer and cancer lesions at different anatomic sites in both genders. Malignant tumours and their precursors are usually attributed to the oncogenic (high-risk, HR) HPV types, whereas benign lesions (papillomas) are associated with the low-risk (LR) HPV types, most notably with HPV6 and HPV11. Until recently, the main interest in HPV research has been focused on HR-HPV types and their associated pathology, and much less attention has been paid to the lesions caused by the LR-HPV types. With the recent licensing of an effective prophylactic vaccine against the 2 most important LR-HPV types (HPV6 and HPV11), it has become timely to make a systematic survey on the annual disease burden due to these 2 HPV genotypes in our country. These types of data should form the foundation for all calculations of the annual costs needed to treat these diseases by conventional means. Accurate estimates of disease burden are also mandatory for all modelling of the cost-effectiveness of prophylactic HPV6 and HPV11 vaccines. If proven useful for any of these purposes, this document will have fulfilled its purpose. In the first step, published HPV literature was used to create a list of benign, premalignant and malignant lesions associated with this virus at different anatomic sites. GLOBOCAN 2004 (IARC) database was used to derive the global numbers of incident cases for each of these malignancies in 2002, and the Finnish Cancer Registry (FCR) website for obtaining these (y 2005) numbers in Finland. The evidence linking HPV to each individual tumour category was classified as: 1) established, 2) emerging, and 3) controversial. All published evidence was weighted for each individual malignant, premalignant and benign lesion, anatomic region by region, while assessing the attributable fraction of HPV6/11 genotypes in each lesion. Because benign and most of the precancer lesions are not registered by FCR or GLOBOCAN, different approaches had to be used to derive the best estimates for their incidence, based on published literature or other registries (e.g. genital wart registry of the UK and Wales, and mass screening registry of FCR). With a lack of reasonable consensus, a lower and an upper limit was set for the range of estimates. In cases with different age-specific incidence (e.g. genital warts), the population pyramid of Finland was used to calculate the incident cases. Where well established, the different incidence rates among males and females were used to calculate the numbers of incident cases by gender. The malignant neoplasms with established or emerging evidence on the causal role of HPV are listed by their ICD-10 codes in Table I. Included in this list are also 2 controversial malignancies (colorectal cancer and endometrial cancer), of which the contradictory HPV data are critically discussed. The third major cancer ","PeriodicalId":76520,"journal":{"name":"Scandinavian journal of infectious diseases. Supplementum","volume":"107 ","pages":"3-32"},"PeriodicalIF":0.0,"publicationDate":"2009-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/00365540902887730","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28145360","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2009-01-01DOI: 10.3109/00365540903331985
Kari J Syrjänen
Apart from cancers of the lower female genital tract, human papillomaviruses (HPV) are associated with a large number of benign, premalignant and malignant lesions at different anatomic sites in both genders. Malignant tumours and their precursors are usually attributed to the oncogenic (high-risk, HR) HPV types, whereas benign lesions (mostly papillomas) are ascribed to the low-risk (LR) HPV types, most notably HPV6 and HPV11. To date, the main interest has been focused on HR-HPV types and their associated pathology, and much less attention has been paid to the lesions caused by the LR-HPV types. The recent licensing of an effective prophylactic vaccine against the 2 most important LR-HPV types (HPV6 and HPV11) has resulted in considerably increased interest in these LR-HPV types as well. This author recently conducted a systematic survey of the annual disease burden due to HPV6/11 infections in Finland. As a rational continuation, the present survey was conducted to estimate the annual disease burden due to HPV16 and HPV18 infections in our country. Together, these 2 documents form the foundation for calculations of the annual costs needed to treat the diseases caused by these 2 most common LR and HR HPV types. Similar to HPV6/11, accurate estimates of disease burden are also mandatory for all modelling of the cost-effectiveness of prophylactic HPV16/18 vaccines. In the first step, the published HPV literature was used to create a list of benign, premalignant and malignant lesions associated with this virus at different anatomic sites. The GLOBOCAN 2004 (IARC; International Agency for Research on Cancer) database was used to derive the global numbers of incident cases for each of these malignancies in 2002, and the Finnish Cancer Registry (FCR) website was used to obtain these numbers for Finland (y 2005). The evidence linking HPV to each individual tumour category was classified as: (1) established, (2) emerging, and (3) controversial. All published evidence was weighted for each individual malignant, premalignant and benign lesion, anatomic region-by-region, while assessing the attributable fraction of HPV16/18 genotypes in each lesion. Because benign and most of the precancer lesions are not registered by the FCR or GLOBOCAN, different approaches had to be used to derive the estimates for their incidence, based on published literature or other registries. In cases with no reasonable consensus, a lower and an upper boundary was set for the range of these estimates. Where well established, the different incidence rates among males and females were used to calculate the numbers of incident cases by gender. The present survey implicates that a minimum of 7859 to 8316 new cases of HPV16- or HPV18-associated clinical lesions would be detected each y in Finland, if all were registered. In other words, these numbers represent the annual disease burden due to these 2 most common HR-HPV genotypes. In the Finnish population, these lower and upper
除了女性下生殖道的癌症外,人乳头瘤病毒(HPV)还与两性不同解剖部位的大量良性、癌前和恶性病变有关。恶性肿瘤及其前体通常归因于致瘤性(高风险,HR) HPV型,而良性病变(主要是乳头状瘤)归因于低风险(LR) HPV型,最明显的是HPV6和HPV11。迄今为止,主要的兴趣集中在HR-HPV类型及其相关病理上,而对LR-HPV类型引起的病变的关注要少得多。最近,针对两种最重要的低级别hpv类型(HPV6和HPV11)的有效预防性疫苗获得许可,这也大大增加了人们对这些低级别hpv类型的兴趣。本文作者最近在芬兰进行了一项由HPV6/11感染引起的年度疾病负担的系统调查。作为合理的延续,本调查旨在估计我国因HPV16和HPV18感染而造成的年度疾病负担。这两份文件共同构成了计算治疗这两种最常见的LR型和HR型HPV引起的疾病所需的年度费用的基础。与HPV6/11类似,对预防性HPV16/18疫苗的成本效益进行所有建模时,也必须准确估计疾病负担。第一步,使用已发表的HPV文献在不同解剖部位创建与该病毒相关的良性、癌前和恶性病变列表。GLOBOCAN 2004 (IARC;利用国际癌症研究机构(International Agency for Research on Cancer)的数据库得出2002年每种恶性肿瘤的全球病例数,并利用芬兰癌症登记处(FCR)网站获得芬兰的这些数字(2005年)。将HPV与每个肿瘤类别联系起来的证据分为:(1)已建立的,(2)新出现的,和(3)有争议的。在评估HPV16/18基因型在每个病变中的归因比例的同时,对每个恶性、癌前和良性病变的解剖区域进行加权。由于良性和大多数癌前病变未被FCR或GLOBOCAN登记,因此必须使用不同的方法来根据已发表的文献或其他登记来得出其发生率的估计。在没有达成合理共识的情况下,为这些估计的范围设定了一个下限和一个上限。在确定的情况下,使用男性和女性之间的不同发病率来计算按性别划分的事件病例数。目前的调查表明,芬兰每年至少会发现7859至8316例HPV16或hpv18相关临床病变的新病例,如果所有病例都登记在案的话。换句话说,这些数字代表了由这两种最常见的HR-HPV基因型引起的年度疾病负担。在芬兰人口中,这些下限和上限转化为粗年发病率分别为147/100,000和156/100,000。根据欧洲标准人口进行调整后,年龄调整后的发病率分别为137/100,000和145/100,000。与该国HPV6/11的年度疾病负担(12,666-13,066新病例)相比,HPV16/18的这些数字要小得多。HPV6/11和HPV16/18之间的另一个主要区别是,前者造成的疾病负担在性别之间的分布更为均匀,只有轻微的女性优势(约7500例对5500例)。这与HPV16/18的疾病负担形成鲜明对比,到目前为止,HPV16/18的主要比例是由女性造成的(大约7000例对1300例)。值得注意的是,本报告中统计的HPV16/18的临床病变仅占这两种HR-HPV基因型感染引起的总病毒负担的一小部分。这是因为这些HR-HPV感染绝大多数是短暂的,并在几个月内自行消退,而不会发展为临床疾病。然而,这种自发清除并不会降低这些潜伏感染的重要性,因为只要病毒库存在,它就会成为病毒传播给易感个体的来源,从而导致大量hpv16 /18相关病理。在有效预防性HPV疫苗接种时代,这些数据的含义应该是直截了当的。然而,未来HPV疫苗和疫苗接种规划的设计者面临两个迫在眉睫的挑战:(1)HPV16/18疾病负担在性别之间的明显不平衡;(2)HPV6/11年度疾病负担远远超过HPV16/18,而且男女之间的贡献更加均匀。
{"title":"Annual disease burden due to human papillomavirus 16 and 18 infections in Finland.","authors":"Kari J Syrjänen","doi":"10.3109/00365540903331985","DOIUrl":"https://doi.org/10.3109/00365540903331985","url":null,"abstract":"<p><p>Apart from cancers of the lower female genital tract, human papillomaviruses (HPV) are associated with a large number of benign, premalignant and malignant lesions at different anatomic sites in both genders. Malignant tumours and their precursors are usually attributed to the oncogenic (high-risk, HR) HPV types, whereas benign lesions (mostly papillomas) are ascribed to the low-risk (LR) HPV types, most notably HPV6 and HPV11. To date, the main interest has been focused on HR-HPV types and their associated pathology, and much less attention has been paid to the lesions caused by the LR-HPV types. The recent licensing of an effective prophylactic vaccine against the 2 most important LR-HPV types (HPV6 and HPV11) has resulted in considerably increased interest in these LR-HPV types as well. This author recently conducted a systematic survey of the annual disease burden due to HPV6/11 infections in Finland. As a rational continuation, the present survey was conducted to estimate the annual disease burden due to HPV16 and HPV18 infections in our country. Together, these 2 documents form the foundation for calculations of the annual costs needed to treat the diseases caused by these 2 most common LR and HR HPV types. Similar to HPV6/11, accurate estimates of disease burden are also mandatory for all modelling of the cost-effectiveness of prophylactic HPV16/18 vaccines. In the first step, the published HPV literature was used to create a list of benign, premalignant and malignant lesions associated with this virus at different anatomic sites. The GLOBOCAN 2004 (IARC; International Agency for Research on Cancer) database was used to derive the global numbers of incident cases for each of these malignancies in 2002, and the Finnish Cancer Registry (FCR) website was used to obtain these numbers for Finland (y 2005). The evidence linking HPV to each individual tumour category was classified as: (1) established, (2) emerging, and (3) controversial. All published evidence was weighted for each individual malignant, premalignant and benign lesion, anatomic region-by-region, while assessing the attributable fraction of HPV16/18 genotypes in each lesion. Because benign and most of the precancer lesions are not registered by the FCR or GLOBOCAN, different approaches had to be used to derive the estimates for their incidence, based on published literature or other registries. In cases with no reasonable consensus, a lower and an upper boundary was set for the range of these estimates. Where well established, the different incidence rates among males and females were used to calculate the numbers of incident cases by gender. The present survey implicates that a minimum of 7859 to 8316 new cases of HPV16- or HPV18-associated clinical lesions would be detected each y in Finland, if all were registered. In other words, these numbers represent the annual disease burden due to these 2 most common HR-HPV genotypes. In the Finnish population, these lower and upper","PeriodicalId":76520,"journal":{"name":"Scandinavian journal of infectious diseases. Supplementum","volume":"108 ","pages":"2-32"},"PeriodicalIF":0.0,"publicationDate":"2009-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.3109/00365540903331985","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28529279","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2003-01-01DOI: 10.1080/03008870310009597
Enrico Girardi
Transmitted human immunodeficiency virus (HIV) resistance to antiretrovirals (i.e. resistance in antiretroviral naive patients) emerged during the 1990s as a potentially relevant public health problem. HIV variants resistant to all classes of approved antiretroviral agents have been identified in significant proportions antiretroviral naive patients, and this phenomenon appears as a potential threat to the effectiveness of highly active antiretroviral therapy. Available data from surveys conducted between 1996 and 2001 show the prevalence of drug resistance among newly HIV-infected individuals to range from 3%, to above 20% in North America, and from 5% to 15% in Europe. Increases in prevalence observed during the late 1990s in some studies are not confirmed by most recent data. Transmission of multidrug resistance still appears to be an uncommon occurrence. However, methodological heterogeneity and problems in study design make it difficult to compare results between different surveys and to draw firm conclusions from the results. There is a clear need to improve surveillance systems aimed at identifying patients at the time of primary infection and to standardize laboratory methods for the identification of genetic markers of resistance to be used for epidemiological purposes.
{"title":"Epidemiological aspects of transmitted HIV drug resistance.","authors":"Enrico Girardi","doi":"10.1080/03008870310009597","DOIUrl":"https://doi.org/10.1080/03008870310009597","url":null,"abstract":"<p><p>Transmitted human immunodeficiency virus (HIV) resistance to antiretrovirals (i.e. resistance in antiretroviral naive patients) emerged during the 1990s as a potentially relevant public health problem. HIV variants resistant to all classes of approved antiretroviral agents have been identified in significant proportions antiretroviral naive patients, and this phenomenon appears as a potential threat to the effectiveness of highly active antiretroviral therapy. Available data from surveys conducted between 1996 and 2001 show the prevalence of drug resistance among newly HIV-infected individuals to range from 3%, to above 20% in North America, and from 5% to 15% in Europe. Increases in prevalence observed during the late 1990s in some studies are not confirmed by most recent data. Transmission of multidrug resistance still appears to be an uncommon occurrence. However, methodological heterogeneity and problems in study design make it difficult to compare results between different surveys and to draw firm conclusions from the results. There is a clear need to improve surveillance systems aimed at identifying patients at the time of primary infection and to standardize laboratory methods for the identification of genetic markers of resistance to be used for epidemiological purposes.</p>","PeriodicalId":76520,"journal":{"name":"Scandinavian journal of infectious diseases. Supplementum","volume":"106 ","pages":"17-20"},"PeriodicalIF":0.0,"publicationDate":"2003-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/03008870310009597","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24424960","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Single withess: Drug resistance is one of the main factors limiting the success of antiretroviral therapy. Some other factors, such as individual enzymatic pattern and immune system function, play a role in the outcome of therapy in HIV infection. Moreover, adherence to treatment could also be a pivotal factor. Thus, there is a complex network that influences patients' response and ultimately contributes to the development of drug resistance. A particular situation among HIV-infected individuals is the finding of a 'discordant' response, which means a virological failure with the maintenance of an optimal immune function. In these subjects, the mere determination of the genotypic pattern of drug resistance is not necessary. Rather, the quantification of phenotypic drug resistance together with the measurement of viral fitness and/or CD4+ T-cell dynamics will help in defining further therapeutic strategies.
{"title":"Genotypic resistance tests for the management of patients with viro-immunological discordant response to highly active antiretroviral therapy.","authors":"Mauro Moroni","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Single withess: Drug resistance is one of the main factors limiting the success of antiretroviral therapy. Some other factors, such as individual enzymatic pattern and immune system function, play a role in the outcome of therapy in HIV infection. Moreover, adherence to treatment could also be a pivotal factor. Thus, there is a complex network that influences patients' response and ultimately contributes to the development of drug resistance. A particular situation among HIV-infected individuals is the finding of a 'discordant' response, which means a virological failure with the maintenance of an optimal immune function. In these subjects, the mere determination of the genotypic pattern of drug resistance is not necessary. Rather, the quantification of phenotypic drug resistance together with the measurement of viral fitness and/or CD4+ T-cell dynamics will help in defining further therapeutic strategies.</p>","PeriodicalId":76520,"journal":{"name":"Scandinavian journal of infectious diseases. Supplementum","volume":"106 ","pages":"85-7"},"PeriodicalIF":0.0,"publicationDate":"2003-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24426020","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Single witness: The current development of guidelines for antiretroviral therapy in resource-limited settings raised the issues of the possible use of drug resistance testing (DRT) in middle- and low-income countries, especially in the context of prevention of mother-to-child transmission (MTCT) programmes. Although resource limitation make it clear that DRT cannot be recommended as an essential part of clinical management of HIV-infected pregnant women in Africa, it is important to monitor the prevalence and incidence of drug resistance on a population basis as ART is scaled up worldwide and programmes for the prevention of MTCT will be implemented. Moreover, even in low-resource countries there are some special settings where DRT may be available for patient care and its use may be considered.
{"title":"Genotypic resistance tests for the management of the HIV-infected pregnant patient in Africa.","authors":"Carlo Giaquinto","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Single witness: The current development of guidelines for antiretroviral therapy in resource-limited settings raised the issues of the possible use of drug resistance testing (DRT) in middle- and low-income countries, especially in the context of prevention of mother-to-child transmission (MTCT) programmes. Although resource limitation make it clear that DRT cannot be recommended as an essential part of clinical management of HIV-infected pregnant women in Africa, it is important to monitor the prevalence and incidence of drug resistance on a population basis as ART is scaled up worldwide and programmes for the prevention of MTCT will be implemented. Moreover, even in low-resource countries there are some special settings where DRT may be available for patient care and its use may be considered.</p>","PeriodicalId":76520,"journal":{"name":"Scandinavian journal of infectious diseases. Supplementum","volume":"106 ","pages":"88-90"},"PeriodicalIF":0.0,"publicationDate":"2003-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24426021","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2003-01-01DOI: 10.1080/03008870310009588
Barbara Suligoi, Patrizio Pezzotti, Stefano Boros, Roberta Urciuoli, Giovanni Rezza
This article describes the major changes in the human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/ AIDS) epidemic in Italy, using data from the National AIDS Registry and from 5 local surveillance systems for new HIV diagnoses. From 1982 to 2001, 49,063 adults with AIDS were reported to the AIDS Registry. From 1988 to 2000, the 5 local systems reported 23,252 new HIV diagnoses. The AIDS incidence increased until 1995, followed by a progressive decrease. A decrease was also observed for the incidence of new HIV diagnoses after 1989, with an apparent stabilization after 1998. Most AIDS cases have been represented by intravenous drug users (IDU), yet since 1999 the percentage of cases attributable to sexual transmission has exceeded that for IDUs. Similarly, among new HIV diagnoses, the percentage of cases attributable to sexual transmission increased from 23.6% before 1993 to 58.5% in 2000. The percentage of people with AIDS who discovered their seropositivity no earlier than 6 months before AIDS diagnosis increased from 20.6% in 1996 to 48.8% in 2001. Although the incidence of both AIDS and new HIV diagnoses has declined, a possible resurgence of the epidemic cannot be ruled out, in light of various factors that could lead to an increasing number of living infected people.
{"title":"Epidemiological changes in AIDS and HIV infection in Italy.","authors":"Barbara Suligoi, Patrizio Pezzotti, Stefano Boros, Roberta Urciuoli, Giovanni Rezza","doi":"10.1080/03008870310009588","DOIUrl":"https://doi.org/10.1080/03008870310009588","url":null,"abstract":"<p><p>This article describes the major changes in the human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/ AIDS) epidemic in Italy, using data from the National AIDS Registry and from 5 local surveillance systems for new HIV diagnoses. From 1982 to 2001, 49,063 adults with AIDS were reported to the AIDS Registry. From 1988 to 2000, the 5 local systems reported 23,252 new HIV diagnoses. The AIDS incidence increased until 1995, followed by a progressive decrease. A decrease was also observed for the incidence of new HIV diagnoses after 1989, with an apparent stabilization after 1998. Most AIDS cases have been represented by intravenous drug users (IDU), yet since 1999 the percentage of cases attributable to sexual transmission has exceeded that for IDUs. Similarly, among new HIV diagnoses, the percentage of cases attributable to sexual transmission increased from 23.6% before 1993 to 58.5% in 2000. The percentage of people with AIDS who discovered their seropositivity no earlier than 6 months before AIDS diagnosis increased from 20.6% in 1996 to 48.8% in 2001. Although the incidence of both AIDS and new HIV diagnoses has declined, a possible resurgence of the epidemic cannot be ruled out, in light of various factors that could lead to an increasing number of living infected people.</p>","PeriodicalId":76520,"journal":{"name":"Scandinavian journal of infectious diseases. Supplementum","volume":"106 ","pages":"12-6"},"PeriodicalIF":0.0,"publicationDate":"2003-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/03008870310009588","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24424959","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2003-01-01DOI: 10.1080/03008870310009614
Emanuele Nicastri, Giuseppe Ippolito
Resistance is the inherent capacity of a living being to resist untoward circumstances (disease, malnutrition or toxic agents). Resistance has developed to nearly all specific and effective antiviral agents, including all drugs against human immunodeficiency virus (HIV). Resistance develops rapidly when viral replication is not maximally suppressed. Drug-resistant viruses may be transmitted at the moment of primary infection. Assays to measure drug resistance are available in specialized laboratories and warnings are related to possible expanded use of these assays in the absence of randomized studies with prolonged clinical endpoints. Randomized clinical trials to allow general recommendations for the use of resistance assays in clinical practice are still urgently required.
{"title":"Use of genotypic assays for the detection of HIV antiretroviral resistance.","authors":"Emanuele Nicastri, Giuseppe Ippolito","doi":"10.1080/03008870310009614","DOIUrl":"https://doi.org/10.1080/03008870310009614","url":null,"abstract":"<p><p>Resistance is the inherent capacity of a living being to resist untoward circumstances (disease, malnutrition or toxic agents). Resistance has developed to nearly all specific and effective antiviral agents, including all drugs against human immunodeficiency virus (HIV). Resistance develops rapidly when viral replication is not maximally suppressed. Drug-resistant viruses may be transmitted at the moment of primary infection. Assays to measure drug resistance are available in specialized laboratories and warnings are related to possible expanded use of these assays in the absence of randomized studies with prolonged clinical endpoints. Randomized clinical trials to allow general recommendations for the use of resistance assays in clinical practice are still urgently required.</p>","PeriodicalId":76520,"journal":{"name":"Scandinavian journal of infectious diseases. Supplementum","volume":"106 ","pages":"24-8"},"PeriodicalIF":0.0,"publicationDate":"2003-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/03008870310009614","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24424962","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2003-01-01DOI: 10.1080/03008870310009650
Andrea Antinori, Antonella Cingolani, Maria Letizia Giancola, Federica Forbici, Andrea De Luca, Carlo Federico Perno
The tropism of human immunodeficiency virus type 1 (HIV-1) for the central nervous system (CNS) develops early during the course of the infection. Potent antiretroviral therapy has been demonstrated to be effective in controlling the replication of HIV-1 in cerebrospinal fluid (CSF), even though a variable response in this compartment compared with that in plasma has been observed. Different concentrations of antiretroviral drugs are found in CSF and the use of antiretroviral drugs penetrating across the blood-brain barrier is considered to be required for controlling CNS infection in advanced patients, particularly in those with neurological disorders. The compartmentalization of HIV-1 infection in the CNS may affect the treatment response, which may cause a different evolution of viral drug resistance in the 2 compartments. Although HIV-1 resistance testing in CSF is not recommended for the routine management of patients with virological failure, treatment decisions in patients with neurological disorders may require knowledge of the resistance profile of the virus in the CSF.
{"title":"Clinical implications of HIV-1 drug resistance in the neurological compartment.","authors":"Andrea Antinori, Antonella Cingolani, Maria Letizia Giancola, Federica Forbici, Andrea De Luca, Carlo Federico Perno","doi":"10.1080/03008870310009650","DOIUrl":"https://doi.org/10.1080/03008870310009650","url":null,"abstract":"<p><p>The tropism of human immunodeficiency virus type 1 (HIV-1) for the central nervous system (CNS) develops early during the course of the infection. Potent antiretroviral therapy has been demonstrated to be effective in controlling the replication of HIV-1 in cerebrospinal fluid (CSF), even though a variable response in this compartment compared with that in plasma has been observed. Different concentrations of antiretroviral drugs are found in CSF and the use of antiretroviral drugs penetrating across the blood-brain barrier is considered to be required for controlling CNS infection in advanced patients, particularly in those with neurological disorders. The compartmentalization of HIV-1 infection in the CNS may affect the treatment response, which may cause a different evolution of viral drug resistance in the 2 compartments. Although HIV-1 resistance testing in CSF is not recommended for the routine management of patients with virological failure, treatment decisions in patients with neurological disorders may require knowledge of the resistance profile of the virus in the CSF.</p>","PeriodicalId":76520,"journal":{"name":"Scandinavian journal of infectious diseases. Supplementum","volume":"106 ","pages":"41-4"},"PeriodicalIF":0.0,"publicationDate":"2003-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/03008870310009650","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24425486","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2003-01-01DOI: 10.1080/03008870310016247
Giuseppe Biondi
{"title":"Too early or too late: a never-ending dilemma with new technologies.","authors":"Giuseppe Biondi","doi":"10.1080/03008870310016247","DOIUrl":"https://doi.org/10.1080/03008870310016247","url":null,"abstract":"","PeriodicalId":76520,"journal":{"name":"Scandinavian journal of infectious diseases. Supplementum","volume":"106 ","pages":"99-104"},"PeriodicalIF":0.0,"publicationDate":"2003-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/03008870310016247","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24425910","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}