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G Rezza

Publications and source records attributed to G Rezza.

At least 109 records · Page 6Linked to original sources
PubMed1998

Predictors of survival in children with acquired immunodeficiency syndrome in Italy, 1983 to 1995.

To evaluate length and predictors of survival among children with AIDS, 529 pediatric cases diagnosed in Italy from 1983 to August 1995 were reviewed. Data were analyzed using Kaplan-Meier curves and the Cox proportional hazards regression model. Various survival patterns were subsequently analyzed. All survival analyses were truncated on March 1, 1996. Cases were examined by gender, age at diagnosis, HIV transmission category, type and number of the first AIDS-defining diseases, level of immunosuppression at AIDS diagnosis, HIV transmission category of the mother, and period of diagnosis. The overall median survival time was approximately 24 months. There wer no significant differences in survival by gender, HIV transmission category, mother's risk factor, or period of diagnosis. The Kaplan-Meier analysis showed the greatest differences in survival time between children less than 6 months of age at diagnosis (median survival 6.4 months) and all others (median 28.7 months). Children with recurrent bacterial infections or lymphoid interstitial pneumonia (LIP) had a survival time at least four times longer than those with Pneumocystis carinii pneumonia (PCP), mycobacteriosis, cytomegalovirus, tumors, or progressive multifocal leukoencephalopathy. At the multivariate analysis, the risk of death was lower among children with LIP (Relative Hazard [RH] 0.72) compared with other opportunistic diseases, whereas age less than 6 months, diagnosis of PCP or of two or more diseases, and severe immunosuppression at diagnosis increased the risk of death. Both demographic factors (age) and clinical factors (type and number of initial diseases, level of immunosuppression) were found to be independent predictors of a poor prognosis in children with AIDS. This information may be of use in improving prognosis and planning healthcare and treatment.

Acquired Immunodeficiency Syndrome↗
PubMed1998

Determinants of progression to AIDS in HIV-infected individuals: an update from the Italian Seroconversion Study.

The Italian Seroconversion Study (ISS) involves 16 major HIV-treatment centers across Italy and about 1,200 individuals. These individuals were HIV-negative less than 2 years before the first positive test and seroconverted between 1980 and 1994. The majority were infected through i.v. drug use (56%), male-to-male sex (25%), and heterosexual contact (7%). For each end point, crude and adjusted relative hazards were calculated using standard survival techniques such as Kaplan-Meier curves, log-rank test, and Cox proportional hazards regression models. Autoregression models were used to describe CD4 cell reductions. Objectives were as follows: to estimate HIV disease progression rates; to assess whether there are differences in the rate of development of severe immunosuppression, AIDS, and death according to age, gender, and exposure category; to identify co-factors and predictors of disease progression; and to evaluate the clinic-based population "effect" of antiretroviral treatment. The risk for developing AIDS among individuals in the ISS cohort was less than 50% by 10 years after HIV seroconversion. Using univariate analysis, more rapid progression was found for older individuals than for younger individuals and for homosexual men compared with those in other exposure categories. No difference between men and women was observed. After adjusting for age, differences among exposure groups disappeared. Individuals with a history of acute HIV disease were more likely to develop AIDS than other seroconverters. Co-infection with HCV and HTLV-II did not accelerate progression to AIDS. The cumulative incidence of receiving pre-AIDS therapy within 7 years of seroconversion was 49.2% (95% CI 45.3-53.0). The relative hazards of developing AIDS in patients who started treatment with zidovudine (AZT) monotherapy was 0.57 (0.36-0.91) and 0.92 (0.64-1.33) within the first year and after 1 year from AZT initiation, respectively. The effect was greater among homosexual men than among i.v. drug users. In conclusion, incident cohort studies may provide accurate information on incubation time and co-factors for disease progression. Observational studies may also provide useful information about the effect of treatment at the community level, which may complement the results of clinical trials.

Acquired Immunodeficiency Syndrome↗
PubMed1997

Long-term perspective on the prevalent-cohort biases in studies of human immunodeficiency virus progression.

Because considerable information about progression of human immunodeficiency virus (HIV) infection has been provided by studies of cohorts of individuals with prevalent HIV infection, this study was designed to investigate bias due to onset confounding (differential time-since-infection distributions) and differential length-biased sampling in epidemiologic analyses of data from such cohorts. Subjects were participants in the Italian Seroconverters Study, a seroincident cohort of more than 1,200 adults seen at ambulatory care clinics in Italy, with observed HIV seroconversion in 1980-1988. Acquired immunodeficiency syndrome (AIDS) diagnoses, based on the 1987 Centers for Disease Control case definition, and mortality were ascertained through Italian national registries through 1994. To estimate bias in prevalent cohorts, a series of pseudoseroprevalent (PSP) cohorts were drawn by sampling, from among the total seroincident cohort, prevalent AIDS-free subjects in each calendar year. The relative AIDS risk associated with a given covariate was calculated in each PSP cohort and compared with the relative AIDS risk for that covariate in the seroincident cohort. Relative risks were estimated by both the ratio of AIDS incidence densities and the relative AIDS hazards from proportional hazards regression. Differential length bias was not evident, as assessed in the following way: Among 338 individuals with seroconversion dates in 1983-1986, the relative risk of AIDS for subjects born before 1951 compared with those born more recently was 1.67 (95% confidence interval (CI) 1.30-2.14). Although differential length-biased sampling was expected to bias this relative risk toward 1.0, the observed relative risk for earlier birth ranged from 1.79 to 2.86 in 1987-1992 PSP cohorts. Onset bias was observed: Among 644 subjects with seroconversion in 1980-1988, the AIDS relative risk for 1980-1985 seroconverters compared with 1986-1988 seroconverters was 1.09 (95% CI 0.76-1.55). Onset bias was seen in 1988-1990 PSP cohorts (relative risks for early seroconversion = 1.47, 1.46, and 1.34, respectively); in 1991-1992, relative risks were close to the expected value of 1.09, and CIs on relative risks from all PSP cohorts after 1989 included 1.0. Confounding attributable to differential length-biased sampling in prevalent cohorts does not necessarily bias estimates of the impact of covariates on rate of progression to AIDS. Bias can arise when a covariate suspected of affecting AIDS risk is closely linked to date of acquisition of HIV infection. However, onset bias appears to wane as subjects' dates of infection become more remote.

Acquired Immunodeficiency Syndrome↗
PubMed1997

HIV infection increases the risk of squamous intra-epithelial lesions in women with HPV infection: an analysis of HPV genotypes. DIANAIDS Collaborative Study Group.

We assessed the association between different HPV genotypes, HIV infection, and cervical squamous intra-epithelial lesions (SIL) in 236 women with known HIV serostatus enrolled in a longitudinal multicentric study in Italy. Of these women, 135 were HIV-infected, and were not markedly different from HIV-negative women with regard to demographic characteristics, sexual practices, smoking, or intravenous drug use. We obtained 232 cervical smears suitable for cytological examination and HPV-genotype analysis (134 from HIV-positive women and 98 from HIV-negative women). For 86 HIV-positive and 89 HIV-negative women, the smears appeared normal at cytomorphological analysis. Cytological dysplasia of varying degrees was detected in 48 smears from HIV-positive women and in 9 from HIV-negative women. HPV prevalence, assessed using polymerase-chain-reaction analysis, did not significantly differ between HIV-positive and HIV-negative women. The prevalence of HPV-associated SIL was much greater among HIV-infected women. The most frequently detected genotypes in both groups were HPV 16 and HPV 18. The prevalence of HPV 16 among HIV-positive women was similar to that for HIV-negative women; this was also true for HPV 18. However, in the HIV-positive group, most of these genotypes were associated with SIL. HIV-positive women showed a wider spectrum of genotypes, including non-oncogenic and rare types. An association between SIL and HIV infection was confirmed for all HPV genotype classes.

Adult↗
PubMed1997

Antiretroviral treatment and progression to AIDS in HIV seroconverters from different risk groups. HIV Italian Seroconversion Study.

OBJECTIVES: To evaluate the association between time since initiation of pre-AIDS antiretroviral therapy [mainly with zidovudine (ZDV)] and AIDS-free survival in a cohort of HIV seroconverters, and to assess possible differences in this association and in the use of antiretroviral therapy by HIV exposure group. DESIGN: Observational study of HIV-infected individuals, both those treated with antiretroviral therapy and those untreated, enrolled in an ongoing prospective cohort (median follow-up, 5.3. years). SETTING: Sixteen HIV outpatient clinics throughout Italy. PATIENTS: A total of 1,078 individuals infected with HIV through injecting drug use or homo-/heterosexual activity, and with accurately estimated dates of seroconversion. MAIN OUTCOME MEASURES AND METHODS: Kaplan-Meier estimates of the probability of receiving antiretroviral therapy before AIDS. Crude and adjusted relative hazards of AIDS and of death from AIDS using Cox regression models. RESULTS: The cumulative incidence of beginning pre-AIDS antiretroviral therapy within 7 years of seroconversion was 49.2%. Injecting drug users (IDU) were less likely to undergo antiretroviral treatment before AIDS than homosexual men and heterosexual contacts. The adjusted relative hazard of developing AIDS for patients treated with ZDV (relative hazard adjusted for occurrence of acute HIV disease, pre-AIDS HIV-related diseases, CD4 count, and use of prophylaxis for Pneumocystis carinii pneumonia) was 0.57 within the first year of starting zidovudine and 0.92 after 1 year of therapy. Stratifying by HIV exposure category, the adjusted relative hazards of AIDS for individuals who started ZDV less and more than 1 year before AIDS were 0.74 and 0.99 among IDU, 0.31 and 0.89 among homosexual men, and 0.69 and 0.72 among heterosexuals, respectively. Similar results were obtained when using death from AIDS as an endpoint. CONCLUSIONS: IDU began pre-AIDS antiretroviral therapy significantly later than homosexual men and heterosexuals, even after adjusting for CD4 count. Results from this non-randomized study confirm that antiretroviral treatment has only a short-term clinical benefit. There was a stronger association between antiretroviral treatment and lower risk of AIDS in homosexual men than in IDU.

Acquired Immunodeficiency Syndrome↗
PubMed1997

Cancer incidence in a cohort of human immunodeficiency virus seroconverters. HIV Italian Seroconversion Study Group.

BACKGROUND: In addition to Kaposi's sarcoma and non-Hodgkin's lymphomas, it has been postulated that human immunodeficiency virus (HIV) infection may increase the risk of other cancers. The aim of the current study was to compare incidence rates of cancer among individuals who seroconverted for HIV infection with the rates in the general population of Italy. METHODS: This study is part of an ongoing cohort investigation conducted by the HIV Italian Seroconversion Study Group. The study has enrolled 1255 individuals (906 males and 349 females) between the ages of 20 and 49 years who are at risk for HIV infection and have had a documented negative HIV test followed by a positive test. For each individual, the midpoint in time between the negative and positive tests was used to estimate the seroconversion date. The person-years at risk for cancer were then computed from the midpoint date to the last follow-up date or to death, and the number of cases of cancer observed in the cohort was compared with the expected number, based on rates among the general population of the same age and gender. Standardized incidence ratios (SIR) and 95% confidence intervals (CI) were computed. RESULTS: A total of 58 cases of cancer were observed in the cohort. In comparison with rates in the general population, Kaposi's sarcoma was 1051 times more frequent, and non-Hodgkin's lymphomas were 157 times more frequent. Hodgkin's disease was observed in 3 men (i.e., 38 times more often in the cohort of HIV seroconverters [95% CI, 8-111]), in particular among homosexual men (SIR = 103). One woman developed stomach carcinoma. CONCLUSIONS: The findings of the current incidence study are in agreement with previous studies showing excesses of Kaposi's sarcoma and non-Hodgkin's lymphomas in HIV-positive individuals. In addition, the findings suggest an association of HIV infection with Hodgkin's disease. Whether Hodgkin's disease in HIV-infected individuals should be considered an AIDS-defining illness is a question that is worthy of attention.

Adult↗
PubMed1997

How many HIV-infected individuals may be defined as long-term nonprogressors? A report from the Italian Seroconversion Study. Italian Seroconversion Study Group (ISS)

We prospectively examined a cohort of HIV-positive persons with an accurately estimated date of HIV seroconversion who were infected through injecting drug use or sexual contact to estimate the proportion of long-term nonprogressors (LTNP), considering four definitions of LTNPs. We also evaluated whether factors such as gender, age, and HIV-exposure category were associated with being LTNP; we determined the overlap among the definitions and compared the CD4 and CD8 counts and the CD4/CD8 decline among LTNPs and "moderate" and "fast" progressors. Of the 528 persons selected for analysis, 2 to 4% were considered LTNPs, depending on the definition. The proportion of LTNPs varied by definition, and there was little overlap among definitions. The LTNPs did not appear to differ from "moderate" and "fast" progressors with regard to main demographic characteristics, and they showed a better trend of immunological parameters, appearing to have a slower progression rather than a permanently arrested infection.

Adolescent↗
PubMed1997

Determinants of squamous intraepithelial lesions (SIL) on Pap smear: the role of HPV infection and of HIV-1-induced immunosuppression. DIANAIDS Collaborative Study Group.

This study aimed to identify risk factors for squamous intraepithelial lesions (SIL) in women with known HIV status and to explore the association between SIL, HPV subtype, and HIV-induced immunosuppression. The study population consisted of women with known HIV serological status who were attending a network of 16 clinical centres in Italy. Detailed behavioural data, clinical and laboratory parameters, and samples for diagnosis of SIL by Papanicolau smear and HPV infection using a polymerase chain reaction (PCR) were obtained from each study participant. The strength of the association between SIL and possible risk factors was assessed calculating crude and adjusted odds ratios derived from univariate analysis and multivariate models. We enrolled 236 women, of whom 135 (57.2%) were HIV-infected. SIL was diagnosed in 57 women (24.1%); of these, 48 (35.6%) were HIV-infected and 9 (8.9%) were HIV-negative. HPV-DNA was detected in 41 (72%) women with SIL and in 45 (25%) women without SIL. HPV-DNA was more often detected among HIV-infected women than among HIV-negative women (40% vs. 32%), but the difference was not statistically significant. Women infected with high-risk types or with low-risk-uncharacterised types of HPV both had a higher risk of SIL compared with HPV-negative women (respectively, AOR: 17.53 and AOR: 2.89). HIV-infected women with severe or moderate immunosuppression were more likely to have SIL than HIV-negative women (respectively, AOR: 7.29 and AOR: 3.09) also independently from HPV infection. Women reporting use of a contraceptive pill had a 2.5 times higher risk of SIL compared with those who never used hormonal contraceptives. The results confirm that high-risk HPV types are strongly associated with SIL, and that HIV infection may strengthen the effect of HPV at cervical level. The use of oral contraceptives may slightly increase the risk of SIL in women with at-risk behaviour for HIV infection.

Adult↗
PubMed1997

Is there a general tendency for CD4 lymphocyte decline to speed up during human immunodeficiency virus infection? Evidence from the Italian Seroconversion Study.

It has been suggested that the rate of CD4 cell decline accelerates in parallel with decreasing numbers of cells; however, the statistical literature suggests the opposite. CD4 cells were counted about every 6 months in a cohort of 1264 human immunodeficiency virus-infected subjects (the Italian Seroconversion Study cohort). Kaplan-Meier analysis was used to estimate the time for CD4 cells to decline by 100 cells/mm3, conditional on reaching predefined levels. In addition, CD4 cell counts were modeled as a function of time since seroconversion in individuals with > or = 5 counts. Kaplan-Meier survival times for a 100 cell/mm3 decrease in CD4 cells increased as lower counts were reached (log rank test, P < .001). The shape of the overall fitted curve of the CD4 cell counts does not suggest an increasing rate of decline. Data from the Italian Seroconversion Study cohort do not show a general tendency for accelerating CD4 cell decline in association with lower counts.

CD4 Lymphocyte Count↗
PubMed1997

Clinical cryptosporidiosis and human immunodeficiency virus (HIV)-induced immunosuppression: findings from a longitudinal study of HIV-positive and HIV-negative former injection drug users.

The natural history of cryptosporidiosis was investigated during a waterborne outbreak among 1731 members of a drug rehabilitation community in Italy; 19.6% of the members were positive for human immunodeficiency virus (HIV). Demographic and clinical information and pre-outbreak serum samples were available. Clinical data were analyzed, stratifying the study population by HIV serostatus and CD4 cell count. The attack rate of clinical cryptosporidiosis was 13.6% among HIV-negative individuals and 30.7% among HIV-positive individuals, although in the latter, it varied according to CD4 cell count. Clinical symptoms and their duration were also related to CD4 cell count. Chronic symptoms were observed in only 16 individuals (15.4%), who all had <150 CD4 cells at the onset of the illness. Among a systematic sample of 198 individuals, 14.1% already had anti-Cryptosporidium antibodies before the outbreak, and 51.2% developed specific antibodies during the outbreak. The development and clinical manifestations of cryptosporidiosis were strongly influenced by the level of HIV-induced immunosuppression.

Adolescent↗
PubMed1997

Premature mortality in Italy during the first decade of the AIDS epidemic: 1984-1993.

BACKGROUND: AIDS has become a leading cause of premature mortality in many countries, owing to the decline in other major causes of premature death and the increase in AIDS itself. This study was carried out to determine the trends in premature mortality due to selected causes in Italy. METHODS: Data from the Italian Mortality Data Base, for the ten years from 1984 to 1993 (the first decade of the AIDS epidemic) were analysed. Premature mortality was measured in terms of years of potential life lost before the age of 70 years (YPLL), excluding infant mortality. Trends in premature mortality due to AIDS were compared with those of the principal causes of premature death: lung cancer, colon-rectum cancer, stomach cancer, leukaemia, female breast cancer, uterine cancer, myocardial infarction, stroke, liver diseases, suicide, road accidents and overdose. RESULTS: In this period there has been a marked increase in premature mortality from AIDS both among males aged 1-69 years (from a rate of YPLL of 0.01 per 1000 in 1984 to 3.71 in 1993) and females of the same age group (from 0 deaths in 1984 to a rate of YPLL of 1.02). Throughout the same period all the other causes of premature death have been declining, with the exception of suicide and overdose among males, and overdose and lung cancer among females. For people aged 25-44 years, AIDS has become the greatest cause of premature death. The increasing trend in premature mortality due to AIDS is most pronounced in the northern and central areas of Italy. CONCLUSIONS: AIDS is the leading cause of death among males aged 25-44 years in Italy and is having an important impact on premature mortality among females in the same age group.

Acquired Immunodeficiency Syndrome↗
PubMed1997

Multiple imputation method for estimating incidence of HIV infection. The Multicenter Prospective HIV Study.

BACKGROUND: CD4+ T-lymphocyte (CD4) and platelet counts are good predictors of the 'maturity' of HIV infection and can be used to impute the date of infection/seroconversion in individuals for whom this date is unknown. METHODS: Data from the Italian Seroconversion Study were used to develop a Weibull regression model for time since seroconversion as a function of the haematologic markers. The model was used to impute time since HIV infection/seroconversion in individuals from a prevalent cohort, recruited through the Lazio regional HIV surveillance system. RESULTS: The range of the imputed calendar times of infection/seroconversion in 2599 HIV prevalent individuals was 1972-1992; the earliest seroconversions occurred among injecting drug users (IDU). The peak of incidence was reached in 1986 with 340 seroconversions. Among males, the estimated median time from seroconversion to HIV diagnosis was shorter in IDU (30 months) as compared to non-IDU (36 months). This difference was smaller for females (26.6 versus 28.4 in IDU and non-IDU, respectively). CONCLUSIONS: This method permits the estimation of population-based curves of HIV incidence, using data from surveillance. The results support the hypotheses of an early spread of the epidemic among IDU in the Lazio region, and of shorter lead times in this population.

AIDS Serodiagnosis↗
PubMed1997

Combining HIV and AIDS surveillance: an experience from an Italian region.

BACKGROUND: Surveillance systems based on the reporting of AIDS cases do not provide a completely up to date picture of the trend of the HIV epidemic, stressing the need for systems based on the diagnosis of HIV infection. However, implementation of these systems has been hindered by low feasibility, poor access to HIV testing, and problems related to confidentiality. The advantages and disadvantages of the two systems and of combined use were explored by comparing and integrating information from AIDS and HIV testing registries in a region of Northern Italy. METHODS: Linkage of AIDS and HIV testing registries allowed the annual number of incident and prevalent infections to be calculated. For linked cases, concordance of exposure category was determined. RESULTS: Up to the end of 1995, 2186 AIDS cases and 5306 HIV-positive individuals were diagnosed. Linkage identified 1212 individuals reported to both registries. From 1990 to 1995, annual AIDS incidence steadily increased, while incidence of new HIV diagnoses decreased. The AIDS-to-AIDS-free ratio among those infected decreased from 1:5.6 in 1989 to 1:4.2 in 1995. The proportion of women and noninjecting drug users was higher among AIDS-free cases than among AIDS cases. The concordance of the exposure category was high (K = 0.70; 95% CI: 0.67-0.74), but it varied by exposure category; the highest concordance was for injecting drug users. CONCLUSIONS: Integrated use of the information provided by these surveillance systems allowed us to better understand and foresee the AIDS epidemic dynamics. The data also suggested that the reliability of information on exposure category may vary among categories.

Acquired Immunodeficiency Syndrome↗
PubMed1997

The effect of the 1993 European revision of the AIDS case definition in Italy: implications for modelling the HIV epidemic.

OBJECTIVES: To evaluate the effect of the 1993 European AIDS definition on reducing pre-AIDS mortality and to what degree an earlier diagnosis can be made. DESIGN: Prospective observational study. METHODS: All patients diagnosed between January 1993 and December 1994 and reported to the National AIDS Registry from four Italian regions, who met only the new criteria for the 1993 case definition (AIDS-1993) were studied. Follow-up of patients who did not eventually meet the 1987 definition (AIDS-1987), or had not died from other causes (pre-AIDS-1987 death), was censored at the last available clinical visit before 1 April 1996. We analysed the data using Kaplan-Meier non-parametric survival analysis and Cox proportional hazards model. RESULTS: A total of 74 (4.1%) individuals met only the new criteria. Of these, 49 (62.2%) were men, 42 (56.8%) had pulmonary tuberculosis, 22 (29.7%) had recurrent bacterial pneumonia, and 10 (13.5%) had cervical cancer. During follow-up, 35 (45.3%) individuals developed an AIDS-1987 disease, and 10 (13.5%) died without fulfilling the AIDS-1987 definition. Pre-AIDS-1987 death accounted for 22.2% (10 out of 45) of the subsequent outcomes observed prior to 1 April 1996. Using Kaplan-Meier technique, we estimated that after 9.8 months 50% of these individuals were diagnosed with AIDS-1987 disease, or died without such a diagnosis. Individuals with lower CD4+ count at the time of the AIDS-1993 diagnosis progressed more rapidly to AIDS-1987 than those with a higher count. In contrast, pre-AIDS-1987 mortality was strongly associated with injecting drug use, whereas no association was found with CD4+ count. CONCLUSIONS: Approximately 50% of individuals with one of the three new AIDS-defining diseases will develop an AIDS-1987 disease or will die within 1 year. Time from AIDS-1993 to AIDS-1987 disease is strongly associated with CD4+ count at diagnosis. AIDS_1993 diagnosis reduced the pre-AIDS-1987 mortality in injecting drug users. Furthermore, approximately 20% of individuals diagnosed with AIDS-1993 disease are expected to die without developing an AIDS-1987 disease. These data should be useful for correcting the AIDS incidence curve in Europe for the effect of the changes in the AIDS definition.

AIDS-Related Opportunistic Infections↗
PubMed1997

Incidence and determinants of hepatitis C virus infection among individuals at risk of sexually transmitted diseases attending a human immunodeficiency virus type 1 testing program.

BACKGROUND: The role of sexual transmission of hepatitis C virus (HCV) infection is still not completely understood, partly because of the lack of longitudinal studies among cohorts of HCV-negative individuals who engage in at-risk sexual behavior. GOALS: To evaluate the incidence of HCV infection in a population at risk for human immunodeficiency virus type 1 (HIV-1) infection and other sexually transmitted diseases (STD) and to identify factors associated with HCV seroconversion. STUDY DESIGN: A retrospective longitudinal study was carried out on a cohort of consecutive attendees of a voluntary HIV-1 testing and counseling program in a large STD center in Rome. All individuals undergoing at least two consecutive tests for HCV antibodies were enrolled. Clinical data and information on individual behavior were collected for all study participants. RESULTS: Between June, 1992 and December, 1994, a total of 709 individuals (12 intravenous drug users [IDU], 244 homosexuals, and 453 heterosexual non-IDUs), initially negative for HCV antibody, were tested more than once. Among these individuals, 15 HCV seroconversions occurred. The average follow-up time was 1.25 person/years (p/y) for an incidence rate of 1.69 per 100 p/y. The incidence rates by exposure category were 39.30 per 100 p/y among IDUs, 1.37 per 100 p/y among homosexual men, and 0.97 per 100 p/y among heterosexual non-IDUs. Excluding IDUs, of the 697 STD clinic attendees engaging in at-risk sexual behavior, HIV-1-positive status tended to be associated with HCV seroconversion (relative hazard = 5.48; 95% confidence interval = 0.85-35.40). The HCV crude incidence rates among HIV-1-infected patients at enrollment was 11.5%, 4.2%, and 2.4% in those with severe, moderate, and mild levels of immunosuppression, respectively (chi-square for trend = 2.38, P = 0.1). CONCLUSIONS: In this cohort, HCV infection was confirmed to be strongly associated with intravenous drug use. Nonetheless, the occurrence of two thirds of the total HCV seroconversions in non-IDU individuals engaging in at-risk behavior suggests a role of sexual practices in the transmission of the infection. Among non-IDU individuals, the risk for development of HCV infection tended to increase in those who were HIV-1 infected.

Adolescent↗