PMID- 12003179 OWN - NLM STAT- MEDLINE DCOM- 20021204 LR - 20101118 IS - 0393-974X (Print) IS - 0393-974X (Linking) VI - 16 IP - 1 DP - 2002 Jan-Mar TI - Implementation of an Italian multicentric care network for early HIV infection diagnosis: 1999-2001 report. PG - 73-8 AB - BACKGROUND: Diagnosis of a new HIV infection during the primary phase (PHI) is sometimes misleading in a primary care setting. Since 1999 the Italian network for the study of acute HIV infection (ISAI) has been operative. At the time of PHI diagnosis the case is reported to the coordinating centre and enrolled in the National Register which records all epidemiological, demographic and clinical information. PATIENTS AND METHODS: From 1999 to September 2001, 51 symptomatic or asymptomatic patients with diagnosis of primary HIV infection were signalled to the coordinating centre. At screening, assessments were: interview to collect demographic and epidemiological data, clinical history (regarding PHI signs and symptoms) and, if available, relevant index case information; physical examination; routine hematology and chemistry; lymphocyte count; plasma HIV-RNA. In a subset of patients PBMC HIV-DNA, HIV-RNA, resistance genotyping and HIV subtype characterization were assessed. RESULTS: 74.5% of patients were males and all but four were Italian. Hetero and homosexual contacts were the prevalent route of HIV transmission. Forty-five patients (89%) were symptomatic and the most frequent signs and symptoms were: fever, lymphadenopathy, malaise and pharyngodinia. Baseline reverse-transcriptase (RT) and protease (PR) genotyping analysis was available for 29 patients. Only one of 29 patients harbored a virus with a resistance-associated mutation in the RT region (215Y); NNRTI mutations were identified in 3 of 29 patients. In the remaining 20 (69%) patients no mutations were found in the RT region. Sequence data from PR region were successfully obtained in 21 patients. Only one of these had a high-level resistance mutation (46L); in an additional 10 cases 1 or more secondary mutations were identified. The remaining 10 patients harbored a PR region wild type virus. One patient presenting two secondary mutations in the PR region, even if highly adherent and tolerant to drug regimen, showed a slow viral load decrease. CONCLUSIONS: Our cohort confirms the uptrend of new infections through unsafe sexual contacts involving both homosexual and heterosexual couples. Genotype sequencing for antiretroviral resistant viral variants describes a low prevalence of RT resistance-associated mutations, as well as primary mutations in the PR region. On the contrary, a higher prevalence of PR gene polymorphisms and mutations is not known with any certainty to confer resistance to NRTI and NNRTI. The identification of antiretroviral drug resistant HIV strains is strategic for clinical and therapeutical intervention, even though from a public health point of view cost-efficacy must be considered. FAU - Capiluppi, B AU - Capiluppi B AD - Clinic of Infectious Diseases, San Raffaele Scientific Institute, Milan, Italy. FAU - Saracco, A AU - Saracco A FAU - Gianotti, N AU - Gianotti N FAU - Mussini, C AU - Mussini C FAU - Butini, L AU - Butini L FAU - Tomasoni, L AU - Tomasoni L FAU - De Gennaro, M AU - De Gennaro M FAU - Rizzolo, L AU - Rizzolo L FAU - Monolo, G AU - Monolo G FAU - Cargnel, A AU - Cargnel A FAU - Moioli, C AU - Moioli C FAU - Arici, C AU - Arici C FAU - Portelli, V AU - Portelli V FAU - Rizzardini, G AU - Rizzardini G FAU - Lazzarin, A AU - Lazzarin A FAU - Tambussi, G AU - Tambussi G LA - eng PT - Journal Article PT - Multicenter Study PT - Research Support, Non-U.S. Gov't PL - Italy TA - J Biol Regul Homeost Agents JT - Journal of biological regulators and homeostatic agents JID - 8809253 RN - 0 (Anti-HIV Agents) RN - 0 (DNA, Viral) RN - 0 (HIV Core Protein p24) RN - 0 (RNA, Viral) SB - IM MH - AIDS Serodiagnosis MH - Acute Disease MH - Adolescent MH - Adult MH - Anti-HIV Agents/*pharmacology/therapeutic use MH - CD4-CD8 Ratio MH - DNA, Viral/blood MH - Disease Transmission, Infectious MH - Drug Resistance, Viral/genetics MH - Female MH - Genotype MH - HIV Core Protein p24/blood MH - HIV Infections/*diagnosis/epidemiology/immunology/transmission/virology MH - HIV-1/classification/drug effects/genetics/isolation & purification MH - *Health Facility Administration MH - Humans MH - Interinstitutional Relations MH - Italy/epidemiology MH - Lymphocyte Count MH - Male MH - Middle Aged MH - Mutation MH - RNA, Viral/blood MH - Sexual Behavior MH - Viral Load EDAT- 2002/05/11 10:00 MHDA- 2002/12/05 04:00 CRDT- 2002/05/11 10:00 PHST- 2002/05/11 10:00 [pubmed] PHST- 2002/12/05 04:00 [medline] PHST- 2002/05/11 10:00 [entrez] PST - ppublish SO - J Biol Regul Homeost Agents. 2002 Jan-Mar;16(1):73-8.