The spectrum of AIDS-defining diseases: temporal trends in Italy prior to the use of highly active anti-retroviral therapies, 1982-1996

Objective To evaluate time trends of the spectrum of AIDS-defining diseases in Italy, 1982-1996. Methods Surveillance data from the Italian National AIDS Registry were used to assess temporal patterns of all AIDS-defining diseases diagnosed among adults as of December 1996. Twenty-six initial clinical manifestations of A IDS were grouped into 12 categories. Relative frequencies were calculated b y year of diagnosis and stratified by age, gender, HIV-exposure category, a nd CD4(+) cell count. A multivariate polychotomous logistic model was used to estimate the proportions of each diagnostic category over time, adjustin g simultaneously for the remaining diagnostic categories and for variables of interest. Results This analysis was based on 41 772 diagnoses of AIDS-defining diseas es among 36 638 reported cases. Mycoses represented the most frequent condi tion (27.3%), followed by Pneumocystis carinii pneumonia (PCP) (21.4%) and viral infections (8.9%). Cancers accounted for less than 10% of diseases. D ownward trends were observed for mycoses, PCP tin the last part of the stud y period), Kaposi's sarcoma (KS), and non-Hodgkin's lymphomas (NHL). Upward trends were observed for mycobacterioses, and bacterial and protozoal infe ctions. Brain toxoplasmosis increased up to 1994, and, thereafter, it appea red to decrease. These trends were less marked when the analysis was restri cted to the diseases included in the pre-1987 AIDS definition. Trends strat ified by CD4(+) cell. count for the period 1990-1996 were substantially con sistent with the above-reported results. Conclusions The downward temporal trends in the most recent years of the st udy period for PCP and for brain toxoplasmosis are likely to be related to the use of prophylactic treatment. This analysis confirms a decline in KS b ut suggests that this was largely over by 1990.