Identifier
Created
Classification
Origin
03ROME4137
2003-09-11 07:40:00
UNCLASSIFIED
Embassy Rome
Cable title:  

AIDS EPIDEMIOLOGY IN ITALY

Tags:  TBIO KSCA IT EUN 
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UNCLAS ROME 004137 

SIPDIS


DEPT FOR OES/EID NCARTER-FOSTER
FOR OES/IHA JKAUFMAN/TGALLAGHER
FOR S/GAC DEPUTY COORDINATOR JOSEPH O'NEILL
HHS FOR FDA
HHS FOR NIH/FOGARTY CENTER

E.O. 12958: N/A
TAGS: TBIO KSCA IT EUN
SUBJECT: AIDS EPIDEMIOLOGY IN ITALY

REFTEL: ROME 3542

UNCLAS ROME 004137

SIPDIS


DEPT FOR OES/EID NCARTER-FOSTER
FOR OES/IHA JKAUFMAN/TGALLAGHER
FOR S/GAC DEPUTY COORDINATOR JOSEPH O'NEILL
HHS FOR FDA
HHS FOR NIH/FOGARTY CENTER

E.O. 12958: N/A
TAGS: TBIO KSCA IT EUN
SUBJECT: AIDS EPIDEMIOLOGY IN ITALY

REFTEL: ROME 3542


1. Summary: More than 100,000 Italians are estimated to
be HIV-positive and 51,172 cases of AIDS have been
registered from 1982 to December 31, 2002. Cases of
AIDS, which are still mainly transmitted through
intravenous drug use, have been declining since 1995, as
combination therapy for HIV infection became the standard
of treatment. However, as in the US, Italian health
officials worry that availability of highly effective HIV
treatments could lead to a return to risky behaviors and
a resurgence of AIDS. The Italian health care system
provides universal coverage and assures adequate medical
treatment to infected individuals (all infected
individuals, whether citizens or not). Italy and the
U.S. are cooperating closely in both AIDS research and
clinical trials. End summary.

--------------
GOI'S AIDS ACTION PLAN
--------------


2. In June 1990, the Italian parliament approved Law
135, the GOI's action plan against AIDS. The plan
included numerous research and training initiatives, as
well as prevention measures and assistance improvements.
In particular, Law 135 defined an extraordinary budget
item of USD 75 million over five years for research and
prevention initiatives. The Superior Institute of Health
(ISS) was the agency responsible for organizing training
courses, distributing funds to research institutes, and
coordinating therapeutic clinical trials.


3. The law guarantees free medical assistance to HIV-
positive patients and assures adequate medical treatment
of infected individuals. Because the law was passed when
AIDS incidence was growing quickly, it provides for the
upgrading and creation of many infectious disease
departments, and hiring of specialized personnel.


4. According to Giuseppe Ippolito, Scientific Director
of the National Institute for Infectious Diseases, the
GOI funds AIDS research in Italy at a level of
approximately Euro 10 million per year. This amount does
not cover the costs of prevention campaigns, the number
of which has decreased over time.

--------------
DECREASE IN INCIDENCE HAS HIT FLOOR
--------------


5. AIDS is already the leading cause of death among 25-

35 year-old Italians. From 1982, when the first Italian
AIDS case was diagnosed, to December 31, 2002, a total of
51,172 AIDS cases have been reported to the AIDS
operating center (COA),the public health authority in
charge of recording all Italian AIDS cases. (Note: The
COA belongs to the ISS, which is also responsible for
distributing public AIDS funds to research institutes.
End note.) Considering under-reporting and delays in
reporting to the COA, the actual number of cases is
estimated to be higher, around 51,700.


6. The annual AIDS incidence rate increased steadily
from 1986 to 1995 (from 0.8 to 10.0 people per 100,000
inhabitants),but then started to decrease sharply, as
combination therapy for HIV infection (Highly Active
Antiretroviral Therapy - HAART) became the standard of
treatment for the disease (5.5 in 1997, 4.0 in 1998, 3.5
in 1999, and 3.2 in 2000). The incidence appears to have
stabilized. Total cases in 2002 were roughly equal to
total 2001 cases.

-------------- --------------
INCREASING PERCENTAGES OF WOMEN AND HETEROSEXUALS
-------------- --------------


7. The highest percentage (71.3 percent) of AIDS cases
for both males and females was observed for the age group
25-39 years. Male cases constitute 78 percent of total
AIDS cases. Pediatric cases (children under 13 years
old) make up 1.5 pct. Foreigners make up 5.8 pct of the
cases (2,959 cases). (Note: AIDS incidence among
foreigners has increased over time: from 3.0 pct in 1982-
93 to 15.4 pct in 2001-2. End note.)


8. The percentage of female patients has also increased,
from 16 pct in 1985 to 23.6 pct in 2002. The majority of
AIDS cases (61 pct in total prevalence 2002) are among
intravenous drug users (59 pct if we do not include the
homosexual drug users). However, since 1995, HIV
transmission through heterosexual contact is the second
most frequent cause of AIDS (38 pct in 2001-2),
surpassing homosexual transmission (17 pct in 2001-2).
Moreover, the decreasing trend of AIDS incidence is less
evident among heterosexuals, who, according to Italian
surveys, do not take advantage of early testing and thus
early treatment.

9. Out of 725 pediatric cases (age at diagnosis less
than 13 years),554 (93.5 pct) were vertical (mother-
child) transmission cases. Thanks to a program of
prevention and combination therapy administered to HIV-
positive pregnant women, Italy has reported a huge
decrease in new pediatric cases since 1997 (from 48 in
1997-98 to 14 in 2001-2).

--------------
MORE CASES IN CENTRAL-NORTHERN ITALY
--------------


10. A north-south gradient in the diffusion of the
disease is evident and has been observed since 1983.
AIDS incidence (number of new cases per 100,000
inhabitants per year) is higher in Lombardy (5.6),Lazio
(5.4),and Emilia Romagna (4.5). The lowest incidence is
observed in Calabria and Molise (0.6),and Sicily (1.3).


11. The COA's AIDS mortality figures continue
underestimate the real levels. Reporting of AIDS
patients' deaths to the authorities is still not
compulsory, but has become more reliable due to a
national survey carried out in 2001 on AIDS patients.
From 1982 to the end of December 2002, a total of 33,308
AIDS patients died (65.1 pct). The mortality rate (i.e.
number of deaths/number of new cases for the same year)
has been decreasing: 90 pct in 1992, 79 pct in 1994, 46
pct in 1996, 27 pct in 1998, 18 pct in 2000, and 11.2 pct
in 2002.

-------------- --------------
PREVENTION ONLY SURE WAY TO BRING INFECTION RATES DOWN
-------------- --------------


12. The AIDS operating center's director, Giovanni
Rezza, told us that the sharp decrease in AIDS incidence
and mortality in the past three years is not due to a
reduction in HIV infections - HIV positive people are
estimated to be 80,000-110,000 - but to the effects of
combined antiretroviral therapies. Successful HIV
prevention programs and early testing for HIV infection
are considered critical to bringing infection rates down
and reducing new cases of AIDS. As in the United States,
Italian health officials worry that availability of
highly effective HIV treatments could lead to a return to
risky behaviors and a resurgence of AIDS.

--------------
U.S.-ITALY COOPERATION ON HIV/AIDS
--------------


13. On September 25, 2002, Health Minister Sirchia
announced the agreement between the ISS and CHIRON
Corporation for the development of a combined, second-
generation vaccine against AIDS. Both ISS and CHIRON (co-
funded by NIH) have developed their own anti-HIV vaccine
and have been independently testing their clinical
efficacy. The agreement will allow to develop a combined
vaccine, which, joining the single ones, should be more
powerful and tested more quickly (within 3-4 years
instead of 6-7). The 12-million-Euro costs will be
equally shared between the Health Ministry and CHIRON.


14. On July 28, President of ISS Prof. Enrico Garaci and
NIH Director Dr. Elias A. Zerhouni signed a Letter of
Intent on research cooperation (reftel). The Letter
opened the cooperation to a broad range of diseases,
including cardiovascular and neurodegenerative diseases,
like Parkinson's and Alzheimer's. The cooperation will
also focus on vaccine development, especially for

HIV/AIDS. The Italian contribution will be about 7.5
million USD. (Note: The US and Italy are the two
largest contributors to the Global Fund - the Fund to
fight AIDS, Malaria and Tuberculosis. This bilateral
cooperation in vaccine development is a logical extension
of, and a complement to, the broader international effort
through the Global Fund, and to President Bush's new
initiative to combat HIV/AIDS in Africa. End note.)
Sembler


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2003ROME04137 - Classification: UNCLASSIFIED