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Background: the delay of HIV diagnosis represents an important risk of spreading HIV infection within the community and, at the same time, a loss of opportunity for undiagnosed subjects to start the antiretroviral therapy., Objectives: to evaluate the difference, over time, between early and late HIV diagnosis in a large University Hospital of Southern Italy and to emphasize the importance of spreading the culture of prevention, based on the improvement of the HIV screening test adherence, in order to reduce the incidence of late HIV diagnosis., Design: retrospective cross-sectional study., Setting and Participants: all the HIV screening tests performed in the six-year period 2013-2018 by the HIV laboratory of a third-level University hospital of Sicily (Southern Italy) were considered. The tests were performed on four categories of patients: voluntary HIV screening participants, inpatients, outpatients, and healthcare workers., Main Outcome Measures: number of performed HIV tests and frequency of early and late HIV diagnosis in the studied categories of subjects., Results: in the considered period, 16,290 HIV tests were performed and the new diagnosis, considering all the four categories of patients, were in total 72, of which the highest percentage (45.8%) concerned voluntary HIV screening participants showing a mean CD4+ level >350/μL (threshold to discriminate early or late infection), followed by inpatients (27.8%) and outpatients (26.4%) with a mean CD4+ levels <350/μL. Moreover, from 2013 to 2018, the detection of serological positivity on voluntary HIV screening participants showed a decrease of 12.5%, while there was a parallel increase of 18.2% in the inpatients group. In the outpatients, the serological positivity remains quite stable. Concerning sexual habits, in the voluntary HIV screening participants, more than half (55.5%) of the HIV positive subjects were homo-bisexuals, while in the inpatients and outpatients' groups the highest percentage (83.3%) were heterosexuals., Conclusions: in this study, the majority (45.8%) of the new HIV diagnosis were detected on voluntary HIV screening participants in an earlier phase of infection. However, adding the percentages of inpatients and outpatients, it results that more than half (54.2%) of the new diagnosis occurred in a more advanced phase of infection. For these reasons, it appears necessary to stress the importance of an early diagnosis, reachable only by the spread of an HIV screening culture through health education campaigns addressed to the entire population and, especially, to heterosexual category that was the most interested group in the late diagnosis.

Tuberculosis (TB) is a diffuse communicable disease; and healthcare workers (HCWs) are among the at-risk populations for the disease. This study reports the result of TB surveillance in HCWs operating in three hospitals: one classified as 'low' risk for TB and two as 'medium' risk. A total of 2228 HCWs underwent TB screening using the standard Mantoux technique (also known as the tuberculin sensitivity test [TST]). Interferon-γ release assay (IGRA) was carried out in TST-positive subjects. Results showed an overall positivity of 21% to TST and 2% to IGRA test. TST and IGRA results were statistically associated with HCWs born after 1981. This result is due to university policies that highly recommend TB immunization. Data support the use of IGRA assay in TST-positive HCWs, in order to identify latent TB infection from vaccination.

Aim: Measles is one of the most infectious communicable diseases. The objective of this study was to determine the immunity to measles of healthcare workers (HCWs) operating in three hospitals of Catania. Methods: A total of 549 HCWs underwent measles screening. A 5 ml blood sample was taken from each worker to measure IgG antibody levels. Results: Overall seroprotection was 86%. Unvaccinated HCWs agreed to undergo the vaccination offered by the hospital. Furthermore, it was found that younger workers are less seroprotected than older ones. Conclusion: Model legislation may be helpful to countries wishing to implement immunization requirements in healthcare settings in order to virtually eliminate the risk of acquiring and spreading measles in healthcare settings.

Brucellosis is one of the most common zoonoses in the world, especially in Southern Italy, where many cases are still recorded every year. 128 cases of brucellosis were observed in Messina (Sicily) in 2016, representing a tenfold increase in the number of cases of brucellosis expected. The aim of this multicenter retrospective study was to analyze clinical and microbiological aspects of a brucellosis outbreak in the province of Messina in 2016, the incidence of its complications and the treatment combinations applied. The principal transmission route was through the ingestion of unpasteurized fresh cheese. The mean latency period between the onset of the symptoms and diagnosis was 35.58±42.75 days. A late diagnosis increases the risk of developing complications. Drug-resistant strains of B. melitensis to Trimethoprim/ Sulfamethoxazole and Ciprofloxacin were found in blood cultures of 58.4% patients. Brucellosis is still present in Sicily. A diagnostic delay predisposes to complications requiring prolonged therapies. The finding of Brucella melitensis strains resistant to the most widespread treatments is worrisome and needs further investigation. Moreover, the use of alternative combination antibiotic therapy is recommended.

Objectives: Across Europe, more than one third of patients are diagnosed with HIV infection late. Late presentation for care has been associated with higher risk of clinical progression and mortality. In the present study, we evaluated the prevalence, epidemiological characteristics and survival probability of patients with late and very late presentation, newly diagnosed with HIV infection in Catania, Italy, from 1985 to 2010., Patients and Methods: According to the European Consensus definition, Late Presenters (LP) were defined as subjects presenting for care with a CD4+ T-cell count below 350 cells/µl or with an AIDS-defining event, regardless of CD4+ T-cell count; patients with advanced HIV disease (Very Late Presenters) (VLP) were those presenting with a CD4+ T-cell count below 200 cells/µl or with an AIDS-defining event, regardless of CD4+ T-cell count., Results: 620 patients were included in the study. 345 (55.6%) subjects were LP, 35% of them were asymptomatic; 246 (39.7%) were VLP. In univariate analysis, late presentation was related to age (p < 0.001), to heterosexual exposure to HIV infection (70% of heterosexual subjects were LP) (p < 0.005) and to being diagnosed during the calendar period from 1991 to 2000 (p < 0.001). Very late presentation was related to age (p < 0.001), male sex (p < 0.01), heterosexual risk (p < 0.001) and to being diagnosed during the calendar period from 1991 to 2000 (p < 0.001). In multivariate analysis, age (p < 0.0001), being older than 50 years old (p = 0.02), years of diagnosis 1991-1995 (p < 0.005) and 1996-2000 (p < 0.05) in the subgroup of late presenters and age (p < 0.0001), being older than 50 years old (p < 0.005), male sex (p < 0.0001), years of diagnosis 1991-1995 (p < 0.05) and 1996-2000 (p < 0.005) in the subgroup of very late presenters maintained statistical significance. The survival probability within LP and VLP group was statistically lower than no LP/VLP (log rank test p < 0.0005 and p < 0.0001, respectively). For both LP (p < 0.002) and VLP (p < 0.0001), survival probability was significantly lower in the pre-HAART era, in comparison with the period of mono/dual therapy and the HAART era., Conclusions: More than fifty percent of patients in our setting were diagnosed late with HIV infection and, consequently, treated late. Late and very late presentation were associated with lower survival probability. The implementation of strategies focused on targeted prevention efforts and HIV testing programs appears fundamental to diagnose and treat HIV infection as early as possible.

Introduction: Anxiety disorders are frequent in HIV-infected individuals, can pre-exist or occur during HIV infection. We evaluated with a self-reported questionnaire whether anxiety is related to HIV clinical status and therapeutic success in a cohort of HIV-positive subjects in Sicily., Patients and Methods: We enrolled 251 patients on combination antiretroviral therapy (cART) for at least six months; Self Rating Anxiety State SAS 054 was used to diagnose anxiety and a Z score ≥ 45 points was considered diagnostic., Results: 47% of patients were diagnosed with anxiety. Patients showing symptoms related to anxiety had experienced a high number of therapeutic switches (fourth line or more)., Conclusions: These data confirm a high prevalence of anxiety symptoms among subjects with HIV infection in Eastern Sicily. Physicians should be aware of the extent of the problem and should be able to adequately manage anxiety in the setting of HIV infection.

Background: The etiology and the natural history of acute non A-E hepatitis is still undefined., Methods: We examined the prevalence of HGV viraemia and the long-term outcome in 54 patients with non A-E acute hepatitis., Results: HGV-RNA was found in 19 out of 54 (35%) patients. There was no difference between HGV-RNA positives and negatives in terms of age sex, parenteral risk factors and alanine amino-transferase peak level. Gamma-glutamyl transpeptidase levels were higher in the HGV-RNA positive group. During a 3-year follow up, 10 out of 54 (18.5%) patients progressed to chronic hepatitis and 4 out of 10 (40%) had an histologically advanced disease. None of the 19 subjects infected with HGV showed a chronic evolution of liver disease., Conclusions: Our results confirm the limited role of HGV as the etiological agent of non A-E acute hepatitis. The great majority of non A-E hepatitis cases are yet of undetermined origin and unfortunately, are characterized by a high rate of progression to chronic active hepatitis.