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Agency Financial Reports. Also, there are several prevalence studies on specific population groups which provide a snapshot on the spread of the infection in subpopulations at different levels of risk of infection such as pregnant women, blood donors, injecting drug users IDUs , men who have sex with men MSM , and female sex workers FSW. Data from the above mentioned two surveillance systems show that the annual trend of both incident AIDS cases and new HIV diagnoses in Italy has leveled off in the last decade and the number of people living with HIV has increased since the introduction of ART in [ 1 ].
A projection for was also provided. The projections start with an estimate and projection of adult incidence, which is combined with information on the age and sex distribution of incidence and progression to death to estimate the number of new adult infections by age and sex. People at any stage are also subject to non-AIDS mortality at the same rates as those who are not infected [ 7 ]. This method can be applied both to generalized and concentrated epidemics. EPP uses data obtained from both surveillance systems and surveys conducted in subpopulations; it requires data on subpopulation size and at least three HIV prevalence data points for every subpopulation included.
Foreigners are not considered separately. Spectrum is a modular program that uses data obtained from EPP and applies demographic corrections, examines effects and projections of the HIV epidemic based on estimated prevalence, and provides results stratified by age group and calendar year. Moreover, Spectrum takes into account mortality data and the survival expected for people on ART.
This model produces national estimates of PLHIV stratified in two age groups: young people 15—24 years old and adults people older than 15 years.
These estimates include only females; no data on male sex workers are available in Italy, mainly because this group is small and hard to reach [ 17 ]. This calculation was based on the average annual number of male clients reported by FSW, ranging from 20 to 30 clients per FSW personal communication, Pia Covre, For every subpopulation, we included the gender distribution and the mean time of permanence in the group. HIV prevalence based on surveillance data was obtained from the following sources:.
The HIV prevalence data was available for the following subpopulations. We used the HIV prevalence among non-IDU women who had more than five sexual partners in the last year, reported by the STD sentinel surveillance system, per year, from to [ 18 ]. MHET: we used the prevalence among non-IDU heterosexual men who had more than five sexual partners in the last year, reported both by the HIV surveillance system and by the STD sentinel surveillance system, per year, from to These studies found an HIV prevalence of Number of adults receiving ART: we estimated the number of individuals receiving ART using data obtained from a survey conducted in Italy in with the collaboration of all the Italian Infectious Diseases clinics [ 28 ].
The estimated HIV prevalence among adults in Italy in was 0. In , the estimated number of new HIV infections among adults was 3, 2,—4, ; — new infections were estimated among males aged 15—24 and 90 70— among females aged 15— The estimated number of adults with AIDS who died in was 1, 1,—1, and the number of adults receiving ART was 93, 80,—, The projection estimates that , ,—, adults will live with HIV in in Italy Figure 1.
The EPP module depicts the trend of HIV prevalence in every subpopulation of interest, from the estimated beginning of the epidemic from to Figure 2.
Estimates of the Number of People Living with HIV in Italy
After , the prevalence among IDUs shows a sharp decrease, whereas the prevalence among MSM remains relatively stable after Much lower prevalence rates are observed overall among FSW and MHET, with a slight prevalence increase in both subpopulations until from 0. Also, in the male and female remaining population, an increase in prevalence is observed until 0. In , the estimated prevalence among IDUs was This analysis presents the first estimate of PLHIV in Italy which is approximately of , adults in with a prevalence of 0. This estimated HIV prevalence is slightly lower than that reported for Italy 0.
Moreover, this estimate is lower than that reported in [ 2 ] because the estimate did not include non-AIDS mortality. The overall HIV prevalence trend shows a permanent increase of PLHIV over time, primarily because of the beneficial effects of antiretroviral treatment longer survival of PLHIV and decrease in the number of deaths correlated with AIDS not being compensated by a decrease in the number of new infections [ 1 ]. The results of the model indicate that the HIV epidemic in Italy occurred with the main contribution of two subpopulations: IDUs in the early phase of the epidemic in the 80s and MSM since the 90s.
The decline of IDUs living with HIV which is predicted by the model can be attributed to the following factors: the progressive reduction of the number of individuals who inject drugs, the mortality due to AIDS and other blood-transmitted infections, the decline in the proportion of susceptible HIV-uninfected drug users over time, and the efficacy of prevention campaigns and harm reduction programs conducted in all Italian PDTC which started in the late 80s [ 12 ] and that did not include free distribution of needles.
The stabilization of the estimated prevalence trend between and can be partially due to the introduction of ART in leading to an improved survival. The beginning of the epidemic among MSM is estimated about a decade later than that among IDUs, at a minor level in terms of prevalence. However, these differences are greatly reduced when taking into account the absolute number of PLHIV in the two subpopulations.
HIV Infection and AIDS in Sub-Saharan Africa: Current Status, Challenges and Opportunities
The rather stable prevalence trend predicted by the model after among MSM may imply that, in the last two decades, the incidence has been fairly constant and the mortality was low or the incidence increased with minor changes in mortality rates. Some limitations of the results obtained must be underlined.
First, the number of about AIDS deaths estimated for appears to be too high compared to the approximately AIDS deaths reported by the mortality database of the Italian Institute of Statistics [ 1 ]. Third, the present estimates do not specify the proportion of undiagnosed cases, which is an important piece of information for planning HIV screening strategies and promotion of HIV testing in specific risk groups. When applied in countries with concentrated epidemics, as in Italy, a certain level of uncertainty on subpopulation size or a poor representativeness of prevalence surveys can lead to some inaccuracy in estimates, and small fluctuations in the values inputted for these parameters can generate fairly important differences in estimate.
Although no corrections can be applied to the model for specific parameters, the overall depiction of the epidemic and short-term projections are valuable and are in agreement with surveillance findings. National Center for Biotechnology Information , U.