Proportion and factors associated with recent HIV infection in a cohort of patients seen for care in Italy over 1996-2014

Data from the ICONA Foundation Study cohort

Silvia Nozza, Alessandro Cozzi-Lepri, Francesca Bai, Stefano Rusconi, Andrea Gori, Paola Cinque, Adriana Ammassari, Pietro Caramello, Giuseppe Tambussi, Antonella D’Arminio Monforte, Giulia Marchetti, Icona Foundation Study Group

Research output: Contribution to journalArticle

Abstract

In Italy the prevalence of recent HIV infection (RHI) isn’t currently monitored. Early diagnosis is crucial to allow introduction of antiretroviral therapy (cART) in the recent phase of infection. We aimed to estimate the proportion and the determinants of RHI among patients enrolled in the ICONA cohort; we explored differences in the median time from HIV diagnosis to cART initiation and in the viro-immunological response between RHI and Less Recent HIV infections (NRHI). We included antiretroviral-naïve HIV-positive patients enrolled in the cohort with documented dates of HIV-negative and positive antibodies tests, grouped in RHI (estimated date of seroconversion within 12 months of enrolment) and NRHI. Proportion of RHI and the trend of this proportion by calendar period (1996–2014) were investigated (Chi-square test). Logistic regression analysis was employed to identify factors associated with RHI. The time from seroconversion to cART initiation was compared in RHI and NRHI overall and after stratification by calendar period (survival analysis). We finally explored the time from starting cART to HIV-RNA <50 copies/mL and to CD4+ gain 200 cells/mmc by Cox regression. HIV seroconversion could be estimated for 2608/12,616 patients: 981/2608 (37.6%) were RHI. Proportion of RHI increased in recent calendar periods and was associated with younger age, baseline higher HIV-RNA and CD4+ count. There wasn’t difference in the 2-year estimates of cART start between RHI and NRHI, regardless of calendar period. Rates and hazards of virological response were similar in RHI versus NRHI. RHI showed a 1.5-fold higher probability of CD4+ gain, also following adjustment for calendar period and cART regimen, and for age, HCV and smoking; the difference in probability was however attenuated after further controlling for baseline HIV-RNA and CD4+ T-cells. The increased proportion of RHI over time suggests that in recent years in Italy HIV infections are more likely to be detected earlier than before. The similar rates of cART introduction and viroimmunological response in RHI and NRHI probably reflect the efficacy of the modern cART regimens. An improvement of the prevention services is warranted to allow an early cART access, also in the perspective of therapy as prevention.

Original languageEnglish
Article numbere0189045
JournalPLoS One
Volume12
Issue number12
DOIs
Publication statusPublished - Dec 1 2017

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patient care
HIV infections
cohort studies
Italy
HIV Infections
Patient Care
Cohort Studies
RNA
T-cells
Regression analysis
Logistics
Hazards
HIV
seroconversion
Antibodies
HIV Seropositivity
therapeutics
early diagnosis
Chi-Square Distribution
CD4 Lymphocyte Count

ASJC Scopus subject areas

  • Biochemistry, Genetics and Molecular Biology(all)
  • Agricultural and Biological Sciences(all)

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Proportion and factors associated with recent HIV infection in a cohort of patients seen for care in Italy over 1996-2014 : Data from the ICONA Foundation Study cohort. / Nozza, Silvia; Cozzi-Lepri, Alessandro; Bai, Francesca; Rusconi, Stefano; Gori, Andrea; Cinque, Paola; Ammassari, Adriana; Caramello, Pietro; Tambussi, Giuseppe; D’Arminio Monforte, Antonella; Marchetti, Giulia; Icona Foundation Study Group.

In: PLoS One, Vol. 12, No. 12, e0189045, 01.12.2017.

Research output: Contribution to journalArticle

Nozza, Silvia ; Cozzi-Lepri, Alessandro ; Bai, Francesca ; Rusconi, Stefano ; Gori, Andrea ; Cinque, Paola ; Ammassari, Adriana ; Caramello, Pietro ; Tambussi, Giuseppe ; D’Arminio Monforte, Antonella ; Marchetti, Giulia ; Icona Foundation Study Group. / Proportion and factors associated with recent HIV infection in a cohort of patients seen for care in Italy over 1996-2014 : Data from the ICONA Foundation Study cohort. In: PLoS One. 2017 ; Vol. 12, No. 12.
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AU - Bai, Francesca

AU - Rusconi, Stefano

AU - Gori, Andrea

AU - Cinque, Paola

AU - Ammassari, Adriana

AU - Caramello, Pietro

AU - Tambussi, Giuseppe

AU - D’Arminio Monforte, Antonella

AU - Marchetti, Giulia

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N2 - In Italy the prevalence of recent HIV infection (RHI) isn’t currently monitored. Early diagnosis is crucial to allow introduction of antiretroviral therapy (cART) in the recent phase of infection. We aimed to estimate the proportion and the determinants of RHI among patients enrolled in the ICONA cohort; we explored differences in the median time from HIV diagnosis to cART initiation and in the viro-immunological response between RHI and Less Recent HIV infections (NRHI). We included antiretroviral-naïve HIV-positive patients enrolled in the cohort with documented dates of HIV-negative and positive antibodies tests, grouped in RHI (estimated date of seroconversion within 12 months of enrolment) and NRHI. Proportion of RHI and the trend of this proportion by calendar period (1996–2014) were investigated (Chi-square test). Logistic regression analysis was employed to identify factors associated with RHI. The time from seroconversion to cART initiation was compared in RHI and NRHI overall and after stratification by calendar period (survival analysis). We finally explored the time from starting cART to HIV-RNA <50 copies/mL and to CD4+ gain 200 cells/mmc by Cox regression. HIV seroconversion could be estimated for 2608/12,616 patients: 981/2608 (37.6%) were RHI. Proportion of RHI increased in recent calendar periods and was associated with younger age, baseline higher HIV-RNA and CD4+ count. There wasn’t difference in the 2-year estimates of cART start between RHI and NRHI, regardless of calendar period. Rates and hazards of virological response were similar in RHI versus NRHI. RHI showed a 1.5-fold higher probability of CD4+ gain, also following adjustment for calendar period and cART regimen, and for age, HCV and smoking; the difference in probability was however attenuated after further controlling for baseline HIV-RNA and CD4+ T-cells. The increased proportion of RHI over time suggests that in recent years in Italy HIV infections are more likely to be detected earlier than before. The similar rates of cART introduction and viroimmunological response in RHI and NRHI probably reflect the efficacy of the modern cART regimens. An improvement of the prevention services is warranted to allow an early cART access, also in the perspective of therapy as prevention.

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