The epidemiology of acquired immunodeficiency syndrome and associated tumours in Europe

Annals of Oncology 3: 595-603, 1992. © 1992 Kluwer Academic Publishers. Printed in the Netherlands. Special article The epidemiology of acquired immunodeficiency syndrome and associated tumours in Europe D. Serraino, 1 S. Franceschi, 1 U. Tirelli 2 & S. Monfardini 3 'Epidemiology Unit, 2 A1DS Unit and 'Medical Oncology, Aviano Cancer Centre (PN), Italy Summary. By the end of September 1991, more than 60,000 cases of acquired immunodeficiency syndrome (AIDS) had been reported to the World Health Organization (WHO) by 31 countries in the WHO European region. Most of the cases (58,280/60,485 - 96%) were recorded in western Europe, chiefly in five countries: France (16,552 cases), Italy (10,584), Spain (10,101), Germany (6,968) and the United Kingdom (5,065). From the first reports in 1981 of Euro- pean cases of AIDS until 1987, AIDS spread faster in the northern and central areas than elsewhere in the European region. Since then, the spread of the epidemic has been remarkably more rapid in southern Europe, while in eastern Europe AIDS is still in an early phase. More than 70% of the cases among homosexual or bisexual men were from the northern part of Europe, while the cases among intravenous drug users (IVDUs) were concentrated in the southern Euro- pean countries, principally Italy and Spain. Over time, an in- creasing proportion of cases was recorded among IVDUs and in heterosexuals. More than 10,000 patients in Europe were diagnosed as having Kaposi's sarcoma (KS) (14% of all AIDS cases) or non-Hodgkin's lymphoma (NHL) (3%) as the presenting clinical manifestation of AIDS. The possibility of predicting the evolution of the epidemic in Europe depends heavily on the development of unbiased monitoring systems for HIV infection in the general population (i.e. anonymous unlinked testing). Key words: AIDS, epidemiology, Europe, tumours Introduction Acquired immunodeficiency syndrome (AIDS) was first recognized as a distinct disease entity in homosexual men in the United States in 1981 [1]. Its causative agent, the human immunodeficiency virus (HTV or HTV-1), was discovered in 1983-1984 [2, 3], while serologic testing for HIV antibody was introduced in 1985 [4]. By the mid-1980s, the major modes of HTV transmission were already rather well understood. It became increasingly evident that HIV was primarily transmitted by vaginal and/or anal sexual intercourse or by transfusion or injection of HIV-infected blood or blood derivatives, as can occur in haemophiliacs, recipients of blood transfusions and intravenous drug users (IVDUs) [5]. In addition, data documented HIV transmission from an infected woman to her newborn infant (peri- natal transmission) [6]. Worldwide, three major epidemiologic patterns of AIDS have been described [7]. In pattern I, the vast majority of AIDS cases are recorded in homosexual or bisexual men and IVDUs, their sexual partners and off- spring. Such a pattern occurs in North America, West- ern Europe and Australia. Pattern II includes sub- Saharan African countries and other parts of the world, such as South America, where HIV infection is mainly transmitted heterosexually, perinatally or by blood transfusion. Pattern III occurs in those countries where the AIDS epidemic is still in a very early phase such as the eastern European countries and where a small number of patients infected in various ways has been reported [7]. This review outlines the epidemiology of AIDS in Europe from the beginning of the epidemic through September 1991, with emphasis on geographic patterns and temporal trends in the major HIV transmission categories. The epidemiology of AIDS-associated tumours is also briefly outlined. Most of our data base was generated by European epidemiological and clinical studies. Geographic and temporal patterns By 30 September 1991, a total of 60,485 AIDS cases had been reported to the World Health Organization (WHO) by 31 countries of the WHO European region [8]. In 1990 Switzerland, France and Spain showed the highest annual incidence rates in western Europe (ap- proximately 60 new cases per million population), while the lowest rates were registered in Ireland, Nor- way and Greece (with about ten new cases per million population). Countries in the eastern part of the region generally reported very low number of cases, with rates below 3 per million population. An exception is Romania, where more than 1,000 cases were reported from January 1990 through September 1991 [8].

The epidemiology of acquired immunodeficiency syndrome and associated tumours in Europe

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