The battle to avoid the Wooden Spoon takes place in Rome on Saturday between two sides yet to win but seemingly heading in opposite directions.
Italy have finished last in the past seven tournaments but victory over Wales last year and strong performances this year have given them renewed belief of securing a first Six Nations home win since 2013.
Wales, whose final game is against defending champions France in Paris, will be facing a first sixth-place finish since 2003 if they lose.
Wales have amassed just 27 points and three tries so far in a troubled campaign which has seen them lose their opening three Six Nations games for the first time since 2007.
Meanwhile, Italy have caused problems for France, England and Ireland, even if all three games ended in defeat.
Italy team news
Italy have made one enforced change from the side that lost to Ireland with Harlequins' Tommaso Allan replacing Ange Capuozzo at full-back.
The Toulouse star, World Rugby's Breakthrough Player of the Year and a key player in last year's win in Cardiff, will miss the remainder of the tournament with a shoulder injury.
Wales team news
Warren Gatland has made six changes from the side that were beaten at home by England, with 34-year-old scrum-half Rhys Webb making his first Six Nations start since 2017.
Rio Dyer is back on the wing and Liam Williams returns at full-back, with forwards Wyn Jones, Dafydd Jenkins and Jac Morgan the others to come in.
Tomos Williams, Louis Rees-Zammit and Gareth Thomas drop to the bench where George North is involved once more, while Alun Wyn Jones, Christ Tshiunza, Dan Biggar and Leigh Halfpenny miss out altogether.
Commentator's notes
Sara Orchard: Rightly or wrongly neither Italy or Wales are expected to win their final games so arguably this match is a Wooden Spoon shootout.
The pressure will hang heavily on Wales who continue to play with the weight of a country's rugby troubles on their shoulders.
Whilst the loss of talisman and attacking inspiration Ange Capuozzo is significant for the Italians, they go into the match as favourites. They can also end a 24-game run of consecutive home losses in the Six Nations by playing an attractive brand of rugby that hasn't failed to entertain on Roman soil so far this Championship.
View from both camps
Italy head coach Kieran Crowley: "We've recovered well since the last game and this week we've been working on the areas where we needed to improve.
"We know the challenge ahead against Wales and look forward to playing and hope to be able to continue to develop the way we want to play."
Wales head coach Warren Gatland: "We've been disappointed with the results so far and for me it's hard to take as it's the first time I've lost three games in the Six Nations with Wales.
'We've had a lot of things going on off the field as well but there are no excuses.
"The message to the players has been that we have to be smart in terms of the way we play but we've also got to be brave."
Line-ups
Italy: 15-Allan; 14-Padovani, 13-Brex, 12-Menoncello, 11-Bruno; 10-Garbisi, 9-Varney; 1-Fischetti, 2-Nicotera, 3-Ferrari, 4-Niccolo Cannone, 5-Ruzza, 6-Negri, 7-Lamaro (capt), 8-Lorenzo Cannone.
Replacements: 16-Bigi, 17-Zani, 18-Riccione, 19-Iachizzi, 20-Pettinelli, 21-Zuliani, 22-Fusco, 23-Morisi.
Wales: 15-Liam Williams; 14-Adams, 13-Grady, 12-Hawkins, 11-Dyer; 10-Owen Williams, 9-Webb; 1-Wyn Jones, 2-Owens (capt), 3-Francis, 4-Jenkins, 5-Beard, 6-Morgan, 7-Tipuric, 8-Faletau.
Replacements: 16-Baldwin, 17-Thomas, 18-Lewis, 19-Davies, 20-Reffell, 21-Tomos Williams, 22-North, 23-Rees-Zammit.
Match facts
Head-to-head
Italy
Wales
Match officials
Referee: Damon Murphy (Australia)
Touch judges: Karl Dickson (England) & Chris Busby (Ireland)
TMO: Joy Neville (Ireland)