US embassy cable - 03ROME4137

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. 
 
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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. 
 
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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. 
 
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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). 
 
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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. 
 
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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. 
 
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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