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Biomedical subjects

M Zaccarelli

Publications and source records attributed to M Zaccarelli.

33 records · Page 2Linked to original sources
PubMed1993

Time from diagnosis of acquired immune deficiency syndrome (AIDS) to death among persons with blood-borne AIDS in Italy.

The objective of the study reported here was to analyze survival time and factors associated with more rapid death among persons with acquired immune deficiency syndrome (AIDS) in Italy who acquired human immunodeficiency virus (HIV) infection through the transfusion of blood (n = 115) or blood components (n = 111). Subjects included all persons with AIDS all reported to the Italian AIDS Registry. The Kaplan-Meier method was used to estimate both the median survival time from the date of AIDS diagnosis to the date of death and the median survival time stratified by age at diagnosis, time of diagnosis, and AIDS-indicator disease. The Cox proportional-hazard model was used to assess factors independently associated with death. The prognosis for persons with blood-borne AIDS in Italy remains poor: overall median survival time was estimated to be 9.2 months, with no significant differences between hemophiliacs and transfusion recipients (p = 0.91). The median survival time for subject > 60 years old was 6.0 months, which is a significantly shorter time than that for younger subjects (p < 0.001). Subjects diagnosed prior to 1988 had a median survival time of 8.2 months, which is a significantly shorter time than that for subjects diagnosed after 1987 (p < 0.03). Subjects neurologically affected by AIDS had a median survival time of 4.1 months, which is a significantly shorter time than that for subjects diagnosed with any other disease (p = 0.03). Such factors were independently associated with more rapid death.

Acquired Immunodeficiency Syndrome↗
PubMed1993

Risk factors for overdose mortality: a case-control study within a cohort of intravenous drug users.

Overdose mortality is the major adverse health effect of drug injection. The potential determinants of overdose death are poorly understood; the aim of this study was to investigate risk factors for overdose mortality among intravenous drug users (IVDU). A cohort of 4200 IVDU attending methadone treatment centres in Rome during the period 1980-1988, was enrolled. Data were collected from clinical records. Vital status and cause of death were ascertained as of 31 December 1988. A matched case-control analysis within the cohort was performed to identify risk factors of death from overdose. All overdose deaths were included as cases and four controls, matched on year of birth and sex, were selected for each case from among the cohort members still alive at the time of death of the corresponding case. In all, 81 deaths from overdose were identified as cases and compared with 324 controls. A high risk of overdose death occurred among subjects who left treatment compared with those still in treatment (odds ratio [OR] = 3.55, 95% confidence interval [CI]: 1.82-6.90). The OR was particularly elevated in the first 12 months after drop-out compared with those retained in treatment (OR = 7.98, 95% CI: 3.40-18.73). The risk of overdose death was higher for unmarried compared with married people (OR = 2.48, 95% CI: 1.31-4.68); a higher risk of overdose death was also associated with lower educational status and younger age at first drug use, but such association was not statistically significant.(ABSTRACT TRUNCATED AT 250 WORDS)

Case-Control Studies↗
PubMed1992

Typhoid fever in the Neapolitan area: a case-control study.

Typhoid fever is endemic in the Neapolitan area, where its yearly incidence rate largely exceeds the corresponding national figure. During the period from January to June, 1990, a matched case-control study was carried out in order to identify risk factors of the disease in this area; 51 subjects (mean age 27.2 years) with typhoid fever were compared with 102 controls matched with respect to age, sex and educational level. Consumption of raw shellfish was reported by 76.5% of the cases, as opposed to 19.6% of the controls (P < 0.01). Subjects who had eaten this food item had a 13.3-fold risk (C.I. 95% = 5.5 - 32.8) of contracting typhoid fever. In contrast, no risk was found to be associated with consumption of cooked shellfish, raw vegetables, ice-cream, non-potable water, or unpasteurized milk. The risk factor identified in this study shows that hazardous dietary habits and inadequate sewage treatment facilities, combined with lack of sanitation in the harvesting and marketing of shellfish, play a major role in the endemicity of typhoid fever in the Neapolitan area.

Case-Control Studies↗
PubMed1992

Behavioural patterns and HIV infection among drug using transvestites practising prostitution in Rome.

Fifty-seven male prostitutes who were also drug users, underwent HIV-1 testing in a drug dependency unit in Rome. The overall prevalence of HIV antibody was 74% (42/57). Of the 57 subjects, 46 completed a standard questionnaire and were interviewed by a trained psychologist about use of drugs, sexual and AIDS-related behaviours. Among the 46 patients responding to the questionnaire, the prevalence of HIV was 67% (31/46). HIV prevalence increased with the duration of drug use, rising from 48% for less than 2 years use, to 64% for 2 to 4 years, and 100% for more than 4 years. It also increased with duration of stay in Italy: from 59% for less than 2 years, 78% for 2-4 years and to 83% for more than 4 years. Prevalence of HIV antibody was higher among those who reported injecting drugs (73% vs 63%), or who reported needle sharing (83% vs 62%). Higher prevalence was also related to the number of partners in the last year (74% for more than 1,500 partners vs 50% for less than 1,500), and to non-use of condoms (70% for 'sometimes/never' vs 50% for 'always'). The results indicate that further educational outreach efforts are required among male transvestite prostitutes since they may constitute a potential source of infection for their clients.

Adult↗
PubMed1992

The epidemiology of AIDS-associated Kaposi's sarcoma in Italy.

OBJECTIVE: To describe the epidemiology of AIDS-associated Kaposi's sarcoma (KS) in Italy between January 1982 and September 1991. DESIGN: To make this study comparable with previous research from other countries, statistical analysis of data from the Italian AIDS surveillance system was performed. METHODS: Odds ratios (OR) and 95% confidence intervals (CI) were used to examine the association between several characteristics of AIDS cases and the presence of KS as the presenting clinical manifestation of AIDS. Trends in the frequency of AIDS-associated KS were also estimated. RESULTS: Of the 10,584 Italian AIDS cases reported up to September 1991, 720 (6.8%) had KS as the presenting clinical manifestation. In comparison with intravenous drug users (IVDU), of whom 2.6% had KS, homosexual or bisexual men had a nearly 10-fold higher risk of KS (OR, 10.2; 95% CI, 8.2-12.8), homosexual men who were also IVDU a nearly fourfold increased risk (OR, 4.4; 95% CI, 3.0-6.6) and heterosexuals a 2.6-fold risk (95% CI, 1.7-3.7). Men were more likely to have KS than women. The percentage of new AIDS cases with KS recorded each year in Italy declined from 12.0% in 1982-1986 to 5.8% in 1990-1991, a significant relative decrease of 19.0% per year (95% CI, 14.1-23.6%). The decline was observed among both IVDU (20% per year) and homosexual or bisexual men (11.4% per year). The frequency of KS was similar across age groups within each transmission category, whereas geographical differences emerged in the prevalence of AIDS-associated KS, especially among IVDU. CONCLUSIONS: Our data on the epidemiology of AIDS-associated KS in Italy are similar to reports from North America and Europe, which show that KS is more common among individuals who acquired HIV infection by sexual transmission rather than parenterally, and that the incidence of this neoplasm is declining over time. The still poorly understood aetiology of AIDS-associated KS needs to be investigated further.

Acquired Immunodeficiency Syndrome↗
PubMed1991

Epidemic Kaposi's sarcoma in Italy, a country with intravenous drug users as the main group affected by HIV infection.

The Italian Cooperative Group on AIDS & Tumors (GICAT) is collecting data on the epidemiological and clinical features of Kaposi's sarcoma (KS) in Italy, a country where intravenous drug users (IVDUs) comprise the largest group affected by AIDS. As of December 31st 1989, among 5317 cases of CDC-defined AIDS reported to the National Registry of AIDS, there were 419 (8%) cases of KS. Twenty-five percent of all of the homosexual men with CDC-defined AIDS had KS, while only 3% of the IVDU patients with CDC-defined AIDS had KS. The first case of KS was observed in 1982, 2 cases in 1983, 7 cases in 1984, 17 cases in 1985, 55 cases in 1986, 89 cases in 1987, 120 cases in 1988 and 128 cases in 1989. Of the 226 cases of KS reported to GICAT, 60% were in homosexual men, 21% in IVDUs, and 9% in heterosexuals. An increased number of KS has been observed since 1982, although the number of new cases in the past year seems to have been stable, possibly due to the usual delay in notification. There is, however, an actual decrease of the percentage of KS among AIDS patients, from 18% in 1984 to 6% in 1989. Almost half of the patients had had a diagnosis of AIDS prior to the appearance of KS, but in 25% of the patients KS was the first AIDS manifestation. Almost all patients had skin involvement either alone or in association with other sites, whereas very few patients had only lymph node involvement. Only treatment with alpha-2 interferon was able to obtain complete remission in 9% of evaluable patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Acquired Immunodeficiency Syndrome↗
PubMed1991

HIV particles detected in spermatozoa of patients with AIDS.

In this paper the Authors describe the presence of HIV particles on and in mature spermatozoa either ejaculated by AIDS patients or incubated in vitro with HIV. Both kinds of spermatozoa have particles localized around the sperm organelles. In the first case, the nucleoid of the virus can be enveloped by a membrane-like coat or be devoid of it and form buddings in the plasma membrane. In the in vitro infected spermatozoa, only membrane enveloped nucleoids are present, and no process of budding can be found. The Authors conclude considering that the spermatozoa of the AIDS patients can be penetrated by the virus particles in different moments of their life, and show the HIV particles in different stages of their cycle: some of them have freshly penetrated the sperm, and are still contained in a membrane-like coat, others are replicated and are budding through the sperm plasma membrane. On the contrary, in vitro infected spermatozoa have only freshly penetrated virus particles, and lack buddings and membrane-free nucleoids. The presence of the HIV virus in spermatozoa is substantiated by labelling with monoclonal or polyclonal anti-HIV antibodies.

Acquired Immunodeficiency Syndrome↗
PubMed1990

Monitoring HIV trends in injecting drug users: an Italian experience.

To examine the incidence and prevalence of HIV infection, we studied a large sample of intravenous drug users (IVDUs) attending a drug dependency unit in Rome over the period 1985-1989. The annual prevalence of HIV antibodies remained stable over the 5-year period. However, a seroconversion study conducted on 302 subjects consistently attending the same facility showed a continued occurrence of HIV seroconversion, although the incidence declined from 8.9 per 100 person-years in 1985-1987 to 5.3 per 100 person-years in 1987-1989. The cumulative incidence of HIV seropositivity, estimated by the Kaplan-Meier survival technique, was higher in female than in male IVDUs. The findings show that the use of both incidence and prevalence data to monitor the trend of HIV infection allows a better understanding of the current viral spread among IVDUs.

Adult↗
PubMed1990

Hepatitis C virus infection in intravenous drug users: prevalence and risk factors.

We investigated the relation of drug use and sexual behaviour to hepatitis C virus (HCV) infection among 80 intravenous drug users (IVDU) attending a methadone treatment program in Rome. Antibodies to HCV (anti-HCV) were found in 54/80 of IVDU (67.5%). Presence of anti-HCV was associated with duration of intravenous drug use and frequency of needle sharing (p less than 0.003 and p = 0.02, respectively, by chi-square for trend). No association was found between sexual behaviour and anti-HCV prevalence.

Adolescent↗
PubMed1989

The Italian AIDS 'hot-line': providing information to the people.

The Italian AIDS hot-line has recently completed its first two operational years. Established as an emergency service, it was initially overloaded with calls, under the emotional impact of a new disease. As the average number of calls settled to around a hundred per day, a wider approach aimed at the concerns raised by callers has been possible. A particular effort has been made to handle psychological and social aspects of HIV infections. A large proportion of the questions analyzed (62,500) deal with doubts about transmission (30%), reliability of diagnostic tests (15%), and handling individual situations. Some categories of callers, such as drug users, parents or relatives of HIV-infected people, and seropositives often require experienced telephone counselling. HIV-positive callers follow the proportional distribution of AIDS cases in Italy: intravenous drug users forming the majority, followed by homosexuals and finally heterosexual subjects (reaching 10%, a value in accordance with trend projections). The demand for advice has increased over time, together with an evident refinement of question content.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

[Decrease in notifications of AIDS dementia complex in 1989-1990 in Italy: possible role of the early treatment with zidovudine].

We evaluated the incidence of AIDS dementia complex (ADC) in groups of patients who acquired infection through different risk behaviours, and attempted to evaluate the possible role of zidovudine (AZT) treatment in preventing or delaying the onset of ADC. The Italian National AIDS Registry was used to study patients with AIDS for whom ADC was reported as an index disease. Relative risk of presenting ADC between different patient categories has been determined. Logistic regression was used to analyse temporal trends in the proportion of AIDS cases presenting with ADC. Of the 6466 cases reported between August '87 and August '90, ADC was seen in 640 (9.9%). I. V. drug addicts had twice the risk (estimated odds ratio: 1.9; 95% confidence interval: 1.5-2.6, p less than 0.001), compared to homo/bisexuals, of presenting with ADC. There is significant evidence (p less than 0.0001) that after a progressive increase in the period '87-'89, it began a definite decrease in the monthly proportion of ADC cases, starting August '89. AZT was introduced in Italy in July 1987 for patients with AIDS or advanced ARC. The incidence of AIDS dementia complex at the moment of AIDS diagnosis in our population of patients, began to decline 24 months after the introduction of systematic AZT treatment in Italy. This could have been due to inhibition of HIV replication in the Central Nervous System among patients who initiated AZT-treatment before developing full-blown AIDS.

AIDS Dementia Complex↗
PubMedDate not supplied

Incidence and consequences of pregnancy in women with known duration of HIV infection. Italian Seroconversion Study Group.

BACKGROUND: The increasing incidence of human immunodeficiency virus (HIV) infection in women of childbearing age led us to evaluate whether pregnancy affects the natural history of this disease. OBJECTIVES: To conduct a prospective study of women with known dates of HIV seroconversion to describe the incidence and outcome of pregnancy and to assess differences according to age and exposure group. To compare the rate of disease progression between pregnant and nonpregnant women. PATIENTS: All participants, recruited from 14 clinical centers in Italy, had documented HIV-seronegative test results followed by confirmed positive test results within 2 years. RESULTS: A total of 331 women, who had seroconversion between 1981 and 1994, were followed up for a median of 5.5 years from seroconversion; 94 developed HIV-related diseases, 47 developed acquired immunodeficiency syndrome, and 53 had at least 1 CD4 cell count lower than 0.10 x 10(9)/L (< 100 cells/mm3). Thirty-eight women (11.5%) were pregnant at the time of HIV seroconversion and 31 (9.4%) became pregnant after HIV seroconversion (cumulative incidence of pregnancy within 8 years of seroconversion, 28.9%; 95% confidence interval, 21.6%-36.2%). Forty-five (65.2%) of the 69 pregnancies were carried to term. There were no discernible differences in these findings by age or exposure group. Pregnant women did not experience a more rapid rate of progression of disease, even when adjusting for age, exposure group, CD4 cell count, or use of treatment (adjusted relative hazards: HIV-related diseases, 0.72; acquired immunodeficiency syndrome, 0.69; CD4 cell count <0.10 x 10(9)/L, 1.24). CONCLUSION: Women infected with HIV continue to become pregnant after seroconversion, yet pregnancy does not appear to influence the rate of progression of HIV disease.

CD4 Lymphocyte Count↗