Results of Epidemiological Surveillance of AIDS Cases in Tuscany

The Regional Public Health System of Tuscany recently achieved remarkable successes in fighting AIDS with fewer than 10 deaths per year of diagnosis in 2008 and 2009 in a population of almost 4 million residents. Of the many factors that contributed to this success, here we shall focus on results obtained by accurate epidemiological surveillance conducted by the Regional Agency for Health (Agenzia Regionale di Sanita`). It is worth noting that a regional registry of new HIV infections is not yet available; therefore the data reported here refer only to new AIDS cases. However, the very low numbers of AIDS deaths (2 in 2008 and 7 in 2009) seem to indicate that surveillance of new AIDS cases is probably the most effective epidemiological tool in fighting AIDS. In fact, data from the regional registry of new AIDS cases reveals that the male-to-female ratio for the incidence of AIDS has been essentially constant from 1985 to 2008 at *3.6, whereas the purported mode of transmission changed drastically: from *8% of HIV being transmitted heterosexually in 1985–1990, to *44% being transmitted in that way in 2006–2008. Consistent with these data, in recent years (updated to 2009), 44.5% HIV-positive heterosexuals reported being aware of their serostatus before the diagnosis of AIDS, and 17.8% had been treated with antiretroviral drugs prior to the diagnosis of AIDS. Conversely, about 90% HIV-positive intravenous drug users reported knowing their serostatus before the diagnosis of AIDS, and 57% of them were treated with antiretroviral drugs before the diagnosis of AIDS. Regrettably, however, the probability of survival in the HIVpositive intravenous drug user population has been constantly lower than that observed in the other categories since 1996. Drug-associated multi-organ toxicity might have contributed to this phenomenon. Also the age trend for new AIDS cases shows interesting changes that might have contributed to the decline in AIDS mortality in Tuscany. In 1988, the mean age for new AIDS cases was 31 for males and 28 for females, whereas in 2009 the mean ages were 44.5 and 40, respectively. We believe that information strategies focussed on risky sexual behaviours might have contributed to this trend. In fact, a recent survey of teenagers’ sexual behaviour (Indagine EDIT 2008) showed that 43.5% of teenagers had had actual sexual intercourse and only 37.9% (males) and 26.4% (females) teenagers reported more than three partners. Among female teenagers reporting more than three partners, 45% reported using condoms. Taken together, these most recent data are consistent with previous observations on AIDS epidemiology (Ital J Anat Embryol. 2009 Apr–Sep;114 (2–3): 97–108. Oct–Dec;114 (4):179–91), and may suggest that further improvement in AIDS patient survival could be achieved by focussing efforts on reducing or eliminating drug-associated toxicity.