TOPIC

Infectious diseases, HIV

HIV/AIDS

The Italian National Institute of Health (ISS) is at the forefront in the fight against infectious agents which, constantly changing over time, make it necessary the frequent updating  of priority actions.

The ISS implements surveillance, prevention and control measures against emerging diseases such as those deriving from the spread of antibiotic-resistant biological agents commonly found in hospital environment, and those transmitted by vectors, such as chikungunya, dengue and West Nile.

Vaccine preventable diseases, although they have been reduced due to effective interventions, represent a significant burden of diseases which require to maintain a high level of attention.

Viral hepatitis and sexually transmitted infections, as human papillomavirus (HPV) infection, are a paradigmatic example of how chronic infections can result in degenerative diseases and even cancers. A vaccine is available for hepatitis B virus (HBV) and HPV infection.

Infectious diseases include also neglected tropical diseases, as intestinal parasitosis and echinococcosis, found in many parts of the world.

With regard to HIV / AIDS, the antiretroviral therapy (ART), although it has saved millions of lives, does not eliminate the HIV from the body nor restore the immune system completely back to normal. Furthermore, it has limited effects if started late or not taken regularly.

In order to stop the HIV epidemic and assure those living with the infection (about 38 million people with HIV / AIDS in the world, including 20.6 million in Africa) better quality of life and life expectancy, the ISS develops surveillance, prevention and treatment strategies, working in cooperation with the National Health Service (SSN), Regions, developing countries and international bodies.

General aims of ISS research activities on HIV/AIDS include:

  • study and surveillance of the spread of HIV and its variants, and of co-infections in general and vulnerable populations
  • study of the mechanisms of infection, of development of AIDS and associated diseases
  • facilitating ART adherence by improving its effectiveness and reducing its side effects
  • development of new strategies capable of preventing infection, reducing its progression and enhancing the effectiveness of ART, in particular preventive and therapeutic vaccines
     

The variability of HIV in developing countries

To study the dynamics of HIV genetic forms and variants of resistance to antiretroviral therapy.

CNAIDS is committed to identifying the different genetic variants of HIV circulating in the geographical areas endemic to infection, determining their frequency, evaluating the association of these variants with antiretroviral drug resistance and determining their dynamics in the population. These are fundamental data to implement public health interventions in order to prevent the spread of HIV infection and optimize antiretroviral therapy in the global fight against HIV/AIDS.

HIV includes subtypes and circulating recombinant forms (CRF). The distribution of these genetic forms is geographically characterized, but it evolves continuously as a result of population movements due to war or poverty, or business or leisure travel. Sub-Saharan Africa is the "hub" of these genetic variants. 

In Southern Sudan, little data is available on the circulation of HIV strains due to 40 years of civil war. CNAIDS has, therefore, launched a study for the characterization of genetic forms of HIV in this region. The data highlighted the appearance of different genetic forms of the virus due to population movements across the borders of Sudan during the civil war. Hence the importance of a continuous surveillance of the dynamics of these genetic forms in this country.

The study will be expanded to include South Africa, characterized by large population movements due to migratory phenomena or due to mobility for work. In particular, the study will use biological samples collected as part of the observational clinical studies conducted in situ by CNAIDS on 500 HIV-positive people, naïve for ART and ART-treated, who live in a trans-frontier area frequented by people with high risk behaviors for HIV infection (e.g. prostitutes and their clients, such as mining and seasonal workers). These samples will be used to characterize circulating HIV strains and assess the presence of viral variants including those of resistant to antiretroviral therapy, both in ART naïve and ART-treated patients.