People With AIDS Research Articles

Increased kidney disease mortality among people with AIDS versus the general population: a population-based cohort study in Italy, 2006–2018

ObjectivesThis study aimed to assess whether an excess mortality related to kidney and other urinary tract diseases exists among Italian people with AIDS (PWA), as compared with the general population...

837. Performance of Blood (1- >3)-β-D-Glucan in People with AIDS Presenting with Respiratory Symptoms

Abstract Background The gold standard for diagnosis of Pneumocystis jirovecii pneumonia (PCP) is direct visualization of the microorganism in respiratory samples, usually obtained via bronchoalveolar lavage (BAL). Blood β-D-glucan (BDG) is used as a non-invasive adjunctive diagnostic test for PCP, but specificity is only modest, in part because other opportunistic fungal infections cause high BDG. We previously showed BDG-positivity in 94% of people with AIDS (PWA), progressive disseminated histoplasmosis (PDH), and respiratory symptoms in our hospital. In this study, we aim to assess the performance of BDG as a diagnostic test for PCP in PWA who have respiratory symptoms. Methods We retrospectively identified PWA who had a BDG result between 2014 and 2019. AIDS was defined as past or current absolute CD4 count < 200 cells/µL, or a past or current AIDS-defining condition. Positive cytological or histological evidence of P. jirovecii in bronchoalveolar lavage (BAL) fluid or lung biopsy, or positive Pneumocystis PCR on sputum or BAL confirmed PCP. The Fungitell Assay (Associates of Cape Cod, East Falmouth, MA) determined BDG levels as follows: negative, < 60 pg/mL; indeterminate, 60-79 pg/mL, and positive, ≥ 80 pg/mL. Values < 31 pg/mL and those >500 pg/mL were censored at 30 pg/mL and 500 pg/mL, respectively. Respiratory symptoms were defined as cough, dyspnea, chest pain, or hypoxia. We compared BDG results for participants with proven PCP and participants without proven PCP. Results We identified 260 PWA with a BDG result, of whom 183 had at least one respiratory symptom. 84 (45.9%) of these participants had a positive BDG. BDG results among participants with and without PCP are shown in Table 1. Of the 44 participants with a positive BDG who did not have PCP, 29 (65.9%) had PDH. Other diagnoses included cryptococcosis and candidemia. The test performance of BDG for the diagnosis of PCP is shown in Table 2. Exclusion of participants with PDH increased the specificity of BDG for PCP to 86.4%. Table 1. Results of (1->3)-β-D-glucan Testing by Pneumocystis jirovecii Pneumonia Diagnosis Among Participants with AIDS and Respiratory Symptoms Table 2. Test Performance of (1->3)-β-D-glucan for the Diagnosis of Pneumocystis jirovecii Pneumonia* Conclusion At our center where histoplasmosis is endemic, a positive BDG should not be attributed to PCP among PWA with respiratory symptoms because of low specificity and low positive predictive value. However, a negative BDG can exclude PCP in this population. Disclosures All Authors: No reported disclosures

Abstract 1056: Elevated incidence of rare cancers among solid organ transplant recipients (SOTRs) in the United States

Abstract Background: SOTRs, like people with AIDS (PWA), have elevated rates of virus-related cancers. This is due to immunosuppression caused by anti-rejection medications. Cancer classification based only on organ site may mask rare cancer subtypes with distinct etiology that are elevated in SOTRs. Methods: We used data from a linkage of the US SOTR registry with 17 population-based cancer registries. We categorized first cancers in SOTRs using a classification based on site and histology (Gatta, Eur J Cancer 2011). Standardized incidence ratios (SIRs) compared incidence in SOTRs to the general population. Results: In a cohort of 262,455 SOTRs, we evaluated 694 cancer types, of which 33 had significantly elevated SIRs (Bonferroni p<7.2E-05, Table). All 33 are rare and some have known viral etiology: Merkel cell carcinoma (SIR 24.7), leiomyosarcoma (26.5), and squamous cell carcinoma (SCC) of the anus (range 6.1-18.8), vulva/vagina (6.8), and penis (3.5). Other cancers with high SIRs include SCC of the lip (SIR 18.3-19.8), salivary gland (9.3), and conjunctiva (13.8); sebaceous adenocarcinoma (34.3); malignant fibrous histiocytoma (15.4); and subtypes of bladder and kidney cancers (10.3-13.3). Some of these cancers are also elevated in PWA to a lesser extent (Shiels, Cancer 2012). Table:Standardized incidence ratios for cancers that occur at increased incidence among solid organ transplant recipientsCancer typeCasesSIR95% CIOral cavity/pharynxLip, SCC w/variants of lip, NOS2919.7913.2628.43Lip, SCC w/variants of lip, SCC16318.3015.6021.33Salivary gland, epithelial tumors, mucoepidermoid carcinoma184.322.566.82Salivary gland, epithelial tumors, SCC279.256.0913.45Oropharynx, SCC w/variants, SCC1612.231.902.60Digestive systemColon/rectum, adenocarcinoma, signet ring cell carcinoma314.453.026.31Anal canal, SCC, NOS1176.105.057.32Anal canal, SCC, verrucous carcinoma518.766.0943.78Liver and IBD, cholangiocarcinoma of IBD332.631.813.69Respiratory systemNasal cavity and sinuses, SCC, SCC214.472.766.83Lung, adenocarcinoma, mucinous adenocarcinoma213.211.994.91Lung, adenocarcinoma, papillary adenocarcinoma NOS193.552.145.54Soft tissueSarcoma of head and neck, leiomyosarcoma1226.5413.7146.36Sarcoma of head and neck, malignant fibrous histiocytoma815.416.6530.36Non-melanoma skin cancerAdnexal carcinoma NOS159.765.4616.10Adnexal carcinoma, malignant nodular hidradenoma720.398.2042.01Adnexal carcinoma, sclerosing sweat duct carcinoma613.394.9129.14Adnexal carcinoma, sebaceous adenocarcinoma6234.3426.3344.02Merkel cell carcinoma14024.6720.7529.11Soft tissue sarcoma536.464.848.45Breast, male302.351.593.36Genital systemVulva and vagina, SCC w/variants796.765.358.42Penis, SCC w/variants, SCC213.532.185.39Urinary systemBladder, adenocarcinoma NOS156.173.4510.18Bladder, adenocarcinoma, signet ring cell carcinoma610.593.8923.05Bladder, TCC, micropapillary714.185.7029.22Kidney, RCC, clear cell adenocarcinoma NOS3793.783.414.19Kidney, RCC, collecting duct carcinoma610.333.7922.48Kidney, RCC, papillary adenocarcinoma NOS32413.3011.8914.83Kidney, RCC, renal cell adenocarcinoma3963.653.304.03Kidney, RCC, RCC chromophobe type252.901.874.28Eye and adnexa, SCC, squamous carcinoma1613.757.8622.32NET, well differentiated endocrine tumors, carcinoid282.401.593.46Abbreviations: CI confidence interval, IBD intrahepatic bile duct, NET neuroendocrine tumor, NOS not otherwise specified, RCC renal cell carcinoma, SCC squamous cell carcinoma, SIR standardized incidence ratio, TCC transitional cell carcinoma Conclusion: SOTRs experience elevated rates of selected rare cancers. Further characterization of cancers caused by immunosuppression and viral infections could facilitate prevention and treatment. Citation Format: Eric Engels, Monica D'Arcy, Ruth Pfeiffer, Meredith Shiels, Lindsay Morton, Amy Kahn, Charles Lynch. Elevated incidence of rare cancers among solid organ transplant recipients (SOTRs) in the United States [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 1056.

Pendidikan Islam Pada Penderita AIDS di Kecamatan Trucuk Kabupaten Bojonegoro

The religion with an unknown number of functions of spiritual functions, psychological functions and social functions. The spiritual function is related to our peace and one's beliefs. Psychological functions are related to remembering someone who can increase one's degree. Social functions are related to human interaction with each other. These three functions can be conveyed and embedded in the heart through Islamic education. Religion does not only occur in formal education institutions, but for Islamic education can survive around the family and in reality sometimes not all religious functions can be done well. For example in the community, people with AIDS (PLWHA), most people judge them with negative ratings. This negative assessment sometimes makes a person not good, even worse. In this study examined how Islamic education in PLWHA (HIV/AIDS sufferers). Basically, Islam teaches about: Aqeedah, shari'ah, morality. This study discusses the faith and practice of worshiping AIDS patients in Trucuk District. In this study using a phenomenological qualitative research approach. Associated with religious education ODHA (people with HIV AIDS) are different. This depends on the background of PLWHA. Most of them understand Islamic teachings from aspects of aqeedah, shari'ah, and morality.

Excess mortality related to circulatory system diseases and diabetes mellitus among Italian AIDS patients vs. non-AIDS population: a population-based cohort study using the multiple causes-of-death approach

BackgroundChronic diseases, chiefly cancers and circulatory system diseases (CSDs), have become the leading non-AIDS-related causes of death among HIV-infected people, as in the general population. After our previous report of an excess mortality for several non-AIDS-defining cancers, we now aim to assess whether people with AIDS (PWA) experience also an increased mortality for CSDs and diabetes mellitus (DM), as compared to the non-AIDS general population (non-PWA).MethodsA nationwide, population-based, retrospective cohort study was conducted including 5285 Italians, aged 15−74 years, who were diagnosed with AIDS between 2006 and 2011. Multiple cause-of-death (MCoD) data, i.e. all conditions reported in death certificates, were retrieved through record-linkage with the National Register of Causes of Death up to 2011. Using MCoD data, sex- and age-standardized mortality ratios (SMRs) with 95% confidence intervals (CIs) were calculated by dividing the observed number of PWA reporting a specific disease among MCoD to the expected number, estimated on the basis of mortality rates (based on MCoD) of non-PWA.ResultsAmong 1229 deceased PWA, CSDs were mentioned in 201 (16.4%) certificates and DM in 46 (3.7%) certificates among the various causes of death. These values corresponded to a 13-fold higher mortality related to CSDs (95% CI 10.8–14.4) and DM (95% CI: 9.5–17.4) as compared to 952,019 deceased non-PWA. Among CSDs, statistically significant excess mortality emerged for hypertension (23 deaths, SMR = 6.3, 95% CI: 4.0–9.4), ischemic heart diseases (39 deaths, SMR = 6.1, 95% CI: 4.4–8.4), other forms of heart diseases (88 deaths, SMR = 13.4, 95% CI: 10.8–16.5), and cerebrovascular diseases (42 deaths, SMR = 13.4, 95% CI: 9.7–18.2). The SMRs were particularly elevated among PWA aged < 50 years and those infected through drug injection.ConclusionsThe use of MCoD data disclosed the fairly high mortality excess related to several CSDs and DM among Italian PWA as compared to non-PWA. Study findings also indicate to start preventive strategies for such diseases at a younger age among AIDS patients than in the general population and with focus on drug users.

Risk for cancer among people living with AIDS, 1997-2012: the São Paulo AIDS-cancer linkage study.

Previous studies have reported an increased risk for certain types of cancer in the HIV-infected population. The aim of this study was to assess the risk for cancer in people with AIDS (PWA) in comparison with the general population in São Paulo (Brazil), between 1997 and 2012. A population-based registry linkage study was carried out to assess the risk for cancer, using a standardized incidence ratio (SIR) approach. A total of 480 102 person-years, of which 337 941 (70.4%) person-years were men, were included in the analysis. Around 2074 cancer cases were diagnosed among PWA, of which 51.0% were non-AIDS-defining cancers (NADC). The risk for AIDS-defining cancers and NADC in the male population with AIDS was significantly higher than that in the general population (SIR=27.74 and 1.87, respectively), as it was in the female population with AIDS compared with the general population (SIR=8.71 and 1.44, respectively). Most virus-related NADC occurred at elevated rates among PWA: anal cancer (SIR=33.02 in men and 11.21 in women), liver (SIR=4.35 in men and 4.84 in women), vulva and vagina (SIR=6.78 in women) and Hodgkin lymphoma (SIR=5.84 in men and 2.71 in women). Lung (SIR=2.24 in men and 2.60 in women) and central nervous system (SIR=1.92 in men and 3.48 in women) cancers also occurred at increased rates. Cancer burden among PWA in São Paulo was similar to that described in high-income countries such as the USA and Italy following the introduction of the highly active antiretroviral therapy. As coinfection with oncogenic viruses disproportionally affects this population, virus-related cancers accounted for a great share of excessive cases.

Changing temporal trends in non-AIDS cancer mortality among people diagnosed with AIDS: San Francisco, California, 1996–2013

BackgroundAntiretroviral therapy (ART) has reduced AIDS-defining cancer (ADC) mortality, but its effect on non-AIDS-defining cancer (NADC) mortality is unclear. To help inform cancer prevention and screening, we evaluated trends in NADC mortality among people with AIDS (PWA) in the ART era. MethodsThis retrospective cohort study analyzed AIDS surveillance data, including causes of death from death certificates, for PWA in San Francisco who died in 1996–2013. Proportional mortality ratios (PMRs), and year, age, race, sex-adjusted standardized mortality ratios (SMRs) were calculated for 1996–1999, 2000–2005, and 2006–2013, corresponding to advances in ART. ResultsThe study included 5822 deceased PWA of whom 90% were male and 68% were aged 35–54 at time of death. Over time, the PMRs significantly decreased for ADCs (2.6%, 1.4%, 1.2%) and increased for NADCs (4.3%, 7.0%, 12.3%). For all years combined (1996–2013) and compared to the California population, significantly elevated SMRs were observed for these cancers: all NADCs combined (2.1), anal (58.4), Hodgkin lymphoma (10.5), liver (5.2), lung/larynx (3.0), rectal (5.2), and tongue (4.7). Over time, the SMRs for liver cancer (SMR 19.8, 11.2, 5.0) significantly decreased while the SMRs remained significantly elevated over population levels for anal (SMR 123, 48.2, 45.5), liver (SMR 19.8, 11.2, 5.0), and lung/larynx cancer (SMR 5.3, 4.7, 3.6). ConclusionA decline in ADC PMRs and increase in NADC PMRs represent a shift in the cancer burden, likely due to ART use. Moreover, given their elevated SMRs, anal, liver, and lung/larynx cancer remain targets for improved cancer prevention, screening, and treatment.

Cancer survival in people with AIDS: A population-based study from São Paulo, Brazil.

Cancer survival among people with AIDS (PWA) has been described in developed countries, but there is lack of data from developing countries. The aim of this study was to evaluate survival after cancer diagnosis in PWA and compare it with people without AIDS (non-PWA) in São Paulo, Brazil. A probabilistic record linkage was carried out between the databases of the Population-based Cancer Registry of São Paulo (PBCR-SP) and the AIDS registry of SP (SINAN) to identify PWA who developed cancer. For comparison, non-PWA were frequency matched from the PBCR-SP by cancer site/type, sex, age, and period. Hazard ratio (HR) stratified by matching variables was estimated using a Cox proportional hazards model. A total of 1,294 PWA (20 patients with two primary site tumors) were included in the site/type-specific analyses. AIDS-defining cancers (ADC) comprised 51.9% of cases assessed. The all-cancer 5-year overall survival in PWA was 49.4% versus 72.7% in non-PWA (HR = 2.64; 95%CI = 2.39-2.91). Survival was impaired in PWA for both ADC (HR = 2.93; 95%CI = 2.49-3.45) and non-ADC (HR = 2.51; 95%CI = 2.21-2.84), including bladder (HR = 8.11; 95% CI = 2.09-31.52), lung (HR = 2.93; 95%CI = 1.97-4.36) and anal cancer (HR = 2.53; 95%CI = 1.63-3.94). These disparities were seen mainly in the first year after cancer diagnosis. The overall survival was significantly lower in PWA in comparison with non-PWA in São Paulo, as seen in high-income countries. Efforts to enhance early diagnosis and ensure proper cancer treatment in PWA should be emphasized.

Multiple cause-of-death data among people with AIDS in Italy: a nationwide cross-sectional study

BackgroundMultiple cause-of-death (MCOD) data allow analyzing the contribution to mortality of conditions reported on the death certificate that are not selected as the underlying cause of death. Using MCOD data, this study aimed to fully describe the cause-specific mortality of people with AIDS (PWA) compared to people without AIDS.MethodsWe conducted a nationwide investigation based on death certificates of 2,515 Italian PWA and 123,224 people without AIDS who had died between 2006 and 2010. The conditions most frequently associated with PWA mortality, compared to people without AIDS, were identified using an age-standardized proportion ratio (ASPR) calculated as the ratio between the age-standardized proportion of a specific cause among PWA and the same proportion among people without AIDS.ResultsThe most frequently reported conditions at death among PWA were infectious/parasitic diseases (52%), digestive (36%), respiratory (33%), and circulatory (32%) system diseases, and neoplasms (29%). All AIDS-defining conditions resulted highly associated (ASPR significantly greater than unity) with PWA deaths. Significant associations also emerged for leishmaniasis (ASPR = 188.0), encephalitis/myelitis/encephalomyelitis (ASPR = 14.3), dementia (ASPR = 13.1), chronic viral hepatitis (ASPR = 13.1), liver fibrosis/cirrhosis (ASPR = 4.4), pneumonia (ASPR = 4.4), anal (ASPR = 12.1) and liver (ASPR = 1.9) cancers, and Hodgkin’s disease (ASPR = 3.1).ConclusionsStudy findings identified the contribution of several non-AIDS-defining conditions on PWA mortality, emphasizing the need of preventive public health interventions targeting this population.

The persistent problem of late HIV diagnosis in people with AIDS: a population-based study in Italy, 1999–2013

ObjectivesDespite the wide accessibility to free human immunodeficiency virus (HIV) testing and combined antiretroviral therapy (cART), late HIV diagnosis remains common with severe consequences at individual and population level. This study aimed to describe trends of late HIV testing and to identify their determinants in the late cART era in Italy. Study designWe conducted a population-based, nationwide analysis of the Italian National AIDS Registry data (AIDS – acquired immune deficiency syndrome) for the years 1999–2013. MethodsLate testers (LTs) were defined as people with AIDS (PWA) whose first HIV-positive test preceded AIDS diagnosis by 3 months or less. Odds ratios (ORs) with the corresponding 95% confidence intervals (CIs) were estimated to examine factors associated with being LTs. Joinpoint analysis was used to estimate annual percent changes (APCs) of LTs' proportion over time. ResultsAmong 20,753 adult PWA, 50.8% were LTs. Italian PWA showed a lower proportion of LTs than non-Italian PWA (46.5% vs 68.2%). Among Italian PWA, the odds of being LTs was higher in men than in women (OR = 2.62, 95% CI: 2.38–2.90); in the age groups below 35 years and over 49 years at diagnosis (OR = 1.24, 95% CI: 1.12–1.37 and OR = 1.51, 95% CI: 1.38–1.67, respectively) vs PWA aged 35–49 years; and in those infected through sexual contact as compared with injecting drug use (OR = 13.34, 95% CI: 12.06–14.76 for heterosexual contact and OR = 8.13, 95% CI: 7.30–9.06 for male-to-male sexual contact). The proportion of LTs increased over time among Italians, especially in the latest period (APC2006–2013 = 5.3, 95% CI: 3.8–6.9). The LTs' proportion resulted higher, though stable, among PWA aged ≥50 years. Conversely, an increasing trend was observed among PWA aged 18–34 years (APC = 5.3, 95% CI: 4.5–6.1). The LTs' proportion was persistently higher among PWA who acquired HIV infection through sexual contact, even if a marked increase among injecting drug users was observed after 2005 (APC = 11.4, 95% CI: 5.7–17.5). ConclusionsThe increasing trend of LTs' proportion in the late cART era highlights the need of new strategies tailored to groups who may not consider themselves to be at a high risk of infection. Active promotion of early testing and continuous education of infection, especially among young people, need to be implemented.

Non-AIDS-Defining Cancer Mortality: Emerging Patterns in the Late HAART Era.

Non-AIDS-defining cancers (non-ADCs) have become the leading non-AIDS-related cause of death among people with HIV/AIDS. We aimed to quantify the excess risk of cancer-related deaths among Italian people with AIDS (PWA), as compared with people without AIDS (non-PWA). A nationwide, population-based, retrospective cohort study was carried out among 5285 Italian PWA, aged 15-74 years, diagnosed between 2006 and 2011. Date of death and multiple-cause-of-death data were retrieved up to December 2011. Excess mortality, as compared with non-PWA, was estimated using sex- and age-standardized mortality ratios (SMRs) and the corresponding 95% confidence intervals (CIs). Among 1229 deceased PWA, 10.3% reported non-ADCs in the death certificate, including lung (3.1%), and liver (1.4%), cancers. A 7.3-fold (95% CI: 6.1 to 8.7) excess mortality was observed for all non-ADCs combined. Statistically significant SMRs emerged for specific non-ADCs, ie, anus (5 deaths, SMR = 227.6, 95% CI: 73.9 to 531.0), Hodgkin lymphoma (12 deaths, SMR = 122.0, 95% CI: 63.0 to 213.0), unspecified uterus (4 deaths, SMR = 52.5, 95% CI: 14.3 to 134.5), liver (17 deaths, SMR = 13.2, 95% CI: 7.7 to 21.1), skin melanoma (4 deaths, SMR = 10.9, 95% CI: 3.0 to 27.8), lung (38 deaths, SMR = 8.0, 95% CI: 5.7 to 11.0), head and neck (9 deaths, SMR = 7.8, 95% CI: 3.6 to 14.9), leukemia (5 deaths, SMR = 7.6, 95% CI: 2.4 to 17.7), and colon-rectum (10 deaths, SMR = 5.4, 95% CI: 2.6 to 10.0). SMRs for non-ADCs were particularly elevated among PWA infected through injecting drug use. This population-based study documented extremely elevated risks of death for non-ADCs among PWA. These findings stress the need of preventive interventions for both virus-related and non-virus-related cancers among HIV-infected individuals.

Radical Distribution

Toward its goal of ending the AIDS crisis, ACT UP (the AIDS Coalition to Unleash Power) used ephemeral media to stage demonstrations. Slogans such as “SILENCE = DEATH” and “ALL PEOPLE WITH AIDS ARE INNOCENT” galvanized collective action and took control of the unjust representation of gay men and other minorities with AIDS. Updating protest tactics for the headline-driven televisuality of late 20th-century American society, ACT UP relied on ephemera as a mode of distribution for activist slogans and images. Ephemeral materials provided activists with a powerful mode of representation that was inexpensive to reproduce. This essay examines the means by which ACT UP and its associated collectives deployed visual ephemera to create a ubiquitous presence in New York City, when AIDS cases there were among the highest in the United States. Against histories of ACT UP that acknowledge the importance of agitprop but neglect to fully account for its status as ephemera, I argue that the ephemeral properties of activist materials are central to the meaning of these cultural artifacts, and meaningful because they enabled the discursive and spatial representations of collectivity that defined and sustained the most active period of ACT UP, from the mid-1980s to the mid-1990s.

Risk factors for early mortality after AIDS in the cART era: A population-based cohort study in Italy.

BackgroundDespite the dramatically improved survival due to combination antiretroviral therapies (cART), life expectancy of people with HIV/AIDS remains lower than that of the general population. This study aimed to estimate, at a population level, the survival experience of Italian people with AIDS (PWA) and to quantify the prognostic role of selected factors at diagnosis in the risk of early mortality (i.e., within six months from AIDS diagnosis).MethodsA population-based, retrospective-cohort study was conducted among Italian PWA diagnosed between 1999 and 2009 and recorded in the national AIDS registry. The vital status, up to December 2010, of 14,552 PWA was ascertained through a record linkage procedure with the Italian mortality database. Survival probabilities were estimated through Kaplan-Meier method. To identify risk factors for early mortality from any cause, odds ratios (ORs) and corresponding 95 % confidence intervals (CIs), adjusted for major confounders, were computed using multivariate logistic regression models.ResultsOf the 5,706 deaths registered among the 14,552 PWA included in the study, 2,757 (18.9 %) occurred within six months from AIDS diagnosis. The probability of surviving six months increased from 81.2 % in PWA diagnosed in 1999–2000 to 82.9 % in 2009, while the 5-year survival augmented from 60.7 % in PWA diagnosed in 1999–2000 to 65.4 % for PWA diagnosed in 2005–2006. Elevated risks of early mortality were associated to older age (OR = 5.28; 95 % CI: 4.41-6.32 for age ≥60 vs. <35 years), injecting drug use (OR = 1.71; 95 % CI: 1.53-1.91 vs. heterosexual intercourse), and CD4 count <50 cells/mm3 at AIDS diagnosis (OR = 1.87, 95 % CI: 1.55-2.27 vs. ≥350). Elevated ORs for early mortality also emerged for PWA diagnosed with primary brain lymphoma (OR = 11.66, 95 % CI: 7.32-18.57), or progressive multifocal leukoencephalopathy (OR = 4.21, 95 % CI: 3.37-5.27).ConclusionsOur study documented, among Italian PWA, the high - though slightly decreasing - frequency of early mortality in the full cART era. These findings indicate the need for enduring and ameliorating preventive actions aimed at timely HIV testing among all individuals at risk for HIV infection and/or those who present diseases known to be related with HIV infection.

REFLECTIONS ON BURNOUT AND SELF-CARE MANAGEMENT IN SOCIAL WORK

Working with people with AIDS (PWAs) invariably requires that caregivers provide optimalcare both to PWAs with serious illness and functional impairment, and to themselves.Although this work is extremely rewarding, the enormity of the stress and strain it places oncaregivers should not be under-estimated. While it is tacitly assumed that family and friendswill provide care for the PWA, the caregiver is expected to possess an exceptional capacity forcaring, despite the multifarious problems associated with this.

Opportunistic Intestinal Infections and Risk of Colorectal Cancer Among People with AIDS

Because mucosal inflammation contributes to colorectal carcinogenesis, we studied the impact of intestinal infections on risk of this malignancy among people with AIDS (PWA). Using the population-based HIV/AIDS Cancer Match, which includes approximately half of all PWA in the United States, the cancer registries ascertained colorectal cancers (ICD-O3 codes C180-C189, C199, C209, and C260). During 4-120 months after AIDS onset, risk of cancer occurring after AIDS-defining intestinal infections (considered as time-dependent exposures) was estimated with hazard ratios (HR) and 95% confidence intervals (CI) calculated by Cox regression. Analyses included cancers overall and by histology and anatomic site. After excluding 118 squamous cell rectal cancers (possible anal cancers), we analyzed 320 incident colorectal cancer cases that occurred among 471,909 PWA. Colorectal cancer risk was marginally elevated following cryptosporidiosis (HR=2.08, 95% CI=0.93-4.70, p=0.08) and mucocutaneous herpes (HR=1.69, 95% CI=0.97-2.95, p=0.07) but not with Pneumocystis pneumonia (HR=0.79, 95% CI=0.57-1.10). Cryptosporidiosis was associated with rare colon squamous cell carcinoma [N=8, HR=13, 95% CI=1.5-110] and uncommon histologies [HR=4.4, 95% CI=1.1-18, p=0.04], but it was not associated with colorectal adenocarcinoma (N=269, HR=1.3, 95% CI=0.4-3.9, p=0.70). Mucocutaneous herpes was associated with colon squamous cell carcinoma (HR=13, 95% CI=2.4-67, p=0.003) but not with colorectal adenocarcinoma (HR=1.3, 95% CI=0.6-2.6, p=0.52) or uncommon histologies (HR=2.5, 95% CI=0.8-8.2, p=0.13). Colon squamous cell carcinoma risk was significantly elevated among PWA who had cryptosporidiosis or mucocutaneous herpes. These findings might suggest that HPV or inflammation from other infection may contribute to carcinogenesis.

People with AIDS (PWA) Since Highly Active Antiretroviral Therapy, 1996

Although clarity about HIV transmission biology and effective therapy should mean that an AIDS diagnosis is more socially acceptable today, for some groups the cultural stigma of HIV infection has changed little in the last 30 years. This paper will examine why representations of HIV-positive gay men suggest they pose a special civic risk and how these conceptualizations have harnessed cultural anxieties about racial and sexual minorities to shape public policy and behavior since the advent of Highly Active Antiretroviral Therapy (HAART) in 1996.

Mortality for non-AIDS-defining cancers among people with AIDS.

1590 Background: In the era of highly active antiretroviral therapies, the impact of non-AIDS-defining cancers on mortality of people with HIV/AIDS has been rarely quantified. To evaluate the risk of death for non-AIDS-defining cancers, among Italian people with AIDS (PWA). Methods: Population-based, retrospective, cohort study. 10,391 Italian citizens, aged 15 years or more, diagnosed with AIDS, in Italy, between 1999 and 2006, were included in the study. Record-linkage with mortality databases of the Italian Institute of Statistics was carried out to retrieve vital status and death certificates. Follow-up was calculated from date of AIDS diagnosis to date of death, or to December 31, 2006 for PWA who were still alive. Standardized mortality ratios (SMRs) and 95% confidence intervals (CIs), in comparison with the Italian population, were calculated for each non-AIDS-defining cancer, which was the underlying cause of death. Results: Among 3,209 deceased PWA, 7.4% died for non-AIDS-defining cancers, with a SMR of 6.6 (95% CI 5.8-7.5). Significantly elevated SMRs were found for several cancer types, notably for Hodgkin lymphoma (SMR = 174, 95% CI 115-251), and cancers of liver (SMR = 11.1, 95% CI 7.4-16.1), brain (SMR = 10.0, 95% CI 5.4-16.8), head and neck (SMR = 8.2, 95% CI 4.8-12.9), lung (SMR = 5.9, 95% CI 4.4-7.6), and myeloma and leukaemias (SMR = 5.9, 95% CI 2.8- 10.8). Overall mortality for non-AIDS-defining cancers was particularly high among injecting drug users (SMR = 15.5, 95% CI 12.5-18.9). Conclusions: The finding of elevated SMRs for non-AIDS-defining cancers should be interpreted as the joint result of the increased incidence and of the worse prognosis for these malignancies among PWA. They also reveal the importance of monitoring the cancer burden on mortality of PWA. No significant financial relationships to disclose.

The impact of Kaposi sarcoma and non-Hodgkin lymphoma on mortality of people with AIDS in the highly active antiretroviral therapies era

Background: Kaposi sarcoma (KS) and non-Hodgkin lymphoma (NHL) have strongly diminished in the HAART era, but their impact on life expectancy of people with AIDS (PWA) needs to be monitored. We aimed at quantifying the burden of KS and NHL on mortality of PWA in the HAART period in Italy. Methods: Death certificates of 3209 PWA diagnosed in 1999–2006 who died as of December 2006 were reviewed to identify those deaths in which KS or NHL was the underlying cause. Standardized mortality ratios (SMR) were computed. Results: KS or NHL appeared in 4.3% and 14.6% death certificates, respectively; they were the underlying cause of death in 3.1% and 13.4% of cases. SMR were 8698-fold higher for KS and 349-fold higher for NHL, and tended to decline over the study period. Conclusion: KS and NHL caused about 16% of deaths of PWA in the HAART era, with 100-fold higher risks of death compared to the Italian general population also in recent years. Clinicians and public health officials should be aware of the persisting negative impact of these cancers on life expectancy of PWA.

Survival After AIDS Diagnosis in Italy, 1999-2006: A Population-Based Study

To provide survival estimates of Italian people with AIDS (PWA) in the highly active antiretroviral therapy era and to identify prognostic factors at diagnosis and illnesses present at death. Longitudinal study with all-cause mortality as end point. The vital status and illnesses present at death of the 9662 Italian PWA diagnosed from 1999 to 2005 were evaluated through a record linkage with the Italian mortality database. The survival was estimated through Kaplan-Meier method, whereas hazard ratios were computed to identify prognostic factors in the first 12 months or later. 80.6% of PWA survived 1 year, 75.2% 2 years, and 66.4% 5 years. Elevated death risks emerged among older individuals, injection drug users, and those with a CD4 cell count <200. Non-Hodgkin lymphoma at AIDS diagnosis was the strongest negative prognostic factor, particularly in the first 12 months after AIDS (hazard ratio = 9.2, for primary brain lymphoma). At death, non-AIDS-defining illnesses increased from 38.4% in 1999 to 56.9% in 2006, with non-AIDS-defining cancers rising from 3.7% to 8.7%. Our study documented the prolonged survival of Italian PWA, the strong impact of non-Hodgkin lymphoma on mortality, and the increasing frequency of non-AIDS-defining illnesses at death.

Differential Reactions toward People with AIDS (PWA) in China

ince its first disclosure in China in 1985,AIDS has been spreading rapidly.Chinese government has done a lot in AIDS prevention and control.Currently,prejudice and discrimination toward PWA is the greatest barrier for AIDS prevention and treatment in China.Undoubtedly,knowing more about people's reactions and attitudes toward PWA would contribute to AIDS prevention and control.The present study for the first time examined people's differential reactions toward PWA who contracted AIDS via different routes,including controllable ones(i.e.sex and drug uses) and uncontrollable ones(i.e.,blood transfusion and mother-fetus).We also examined the mediating role of affective reactions in producing negative attitudes toward PWA. The sample was composed of 188 college students(males: 73;Females: 115).Each of the participants was paid 10 Chinese Yuan for their participation.Four scenarios about a young man who has been recently diagnosed as an AIDS patient were designed and used to elicit participants' reactions toward PWA.All scenarios were identical except for the routes of AIDS contraction.Specifically,the routes included inappropriate sex behaviors,drug uses,transfusion,and mother-fetus.Participants completed the experiment on computer in separate rooms.After providing their demographical information,they were randomly assigned to one of the four scenarios.After reading the scenarios,they finished a series of scales about the PWA described in the scenarios.The scales measure affective feelings(e.g.,angry,disgust,fear,and sympathy) and attitudes toward the described PWA(e.g.,thermometer feeling scale,perceived responsibility,support of coercive policies,and intent to contact). Results showed that(1) on one hand,all subjects showed pronounced negative affective feelings toward PWA regardless of the contracting routes,suggesting apparent instrumental fear of AIDS;on the other hand,strong sympathy was also found among college students;(2) by comparing with those who has contracted AIDS by controllable routes such as inappropriate sexual behaviors and drug uses,college students expressed less angry,less disgust,and less fear toward PWA contracted via transfusion and mother-fetus;they were also less likely to support coercive policies upon them,to have contacts with them,and to attribute the responsibility of contracting AIDS to them;(3) no gender differences were found except that females showed less willingness to contact with PWA;and(4) mediation analyses revealed that affective feelings toward PWA partially mediated the effects of transmission routes on attitudes toward PWA,angry,disgust,and fear increasing negative attitude whereas sympathy increasing positive one. In summary,the present study demonstrated that(1) both instrumental and symbolic concerns contribute to negative attitude;(2) different transmission routes would lead to different reactions;(3) affective reactions partially mediated the differential reactions toward PWA.The findings suggest possible effective ways to control and prevent the AIDS epidemic in China,which are to eliminate inappropriate sexual behaviors and drug uses and to reduce fear of AIDS by disseminating AIDS related knowledge and arousing people's sympathy for PWA.