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Özkaya HD, Elazab K, Turan B, Nazlı A, Öztürk B, Pullukçu H, Gökengin D. Missed Opportunities in HIV Testing in Turkiye: Implications for Late Diagnoses. J Acquir Immune Defic Syndr 2024; 96:77-84. [PMID: 38346425 DOI: 10.1097/qai.0000000000003398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 01/19/2024] [Indexed: 04/12/2024]
Abstract
BACKGROUND Late diagnosis of HIV infection is a major global problem. In Turkiye, only 41%-50% of people living with HIV are diagnosed, suggesting that many opportunities for HIV testing might be missed. SETTING The aim of this study was to determine the missed testing opportunities for HIV in healthcare settings in Turkiye and the predictors for missed opportunities (MOs). METHODS The study included patients with a new HIV diagnosis, presenting to care between January 2018 and December 2020. They were given a verbal questionnaire face to face, by a telephone call or an online meeting for visits to a health care setting within the year before their diagnosis. Electronic medical records were also examined. RESULTS The sample included 198 patients with at least 1 visit to any health care setting, with a total of 1677 visits. Patients had an indication for HIV testing in 51.3% (861/1677) of the visits; an HIV test was not offered in 77.9% (671/861) and was considered a MO. The highest number of MOs was in emergency departments (59.8%) (180/301). The most common reason for visiting was constitutional symptoms and indicator conditions (55.4%) (929/1677). University graduates and those with a CD4+ T-cell count <200/mm 3 were more likely to have a MO. CONCLUSIONS Many opportunities to diagnose HIV at an early stage are missed in health care settings in Turkiye. Considering the rapidly increasing number of new diagnoses in the last decade, urgent action needs to be taken.
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Affiliation(s)
- Hacer Deniz Özkaya
- Bakırçay University Çiğli Training and Research Hospital, Izmir, Turkiye
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Luc CM, Levy J, Bahromov M, Jonbekov J, Mackesy-Amiti ME. HIV knowledge, self-perception of HIV risk, and sexual risk behaviors among male Tajik labor migrants who inject drugs in Moscow. BMC Public Health 2024; 24:156. [PMID: 38212755 PMCID: PMC10782601 DOI: 10.1186/s12889-023-17543-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 12/19/2023] [Indexed: 01/13/2024] Open
Abstract
BACKGROUND The interplay of human immunodeficiency virus (HIV) knowledge and self-perception of risk for HIV among people who inject drugs is complex and understudied, especially among temporary migrant workers who inject drugs (MWID) while in a host country. In Russia, Tajik migrants make up the largest proportion of Moscow's foreign labor. Yet, HIV knowledge and self-perceived risk in association with sexual risk behavior among male Tajik MWID in Moscow remains unknown. OBJECTIVE This research examines knowledge about HIV transmission, self-perception of HIV risk, and key psychosocial factors that possibly contribute to sexual risk behaviors among male Tajik labor MWID living in Moscow. METHODS Structured interviews were conducted with 420 male Tajik labor MWID. Modified Poisson regression models investigated possible associations between major risk factors and HIV sexual risk behavior. RESULTS Of the 420 MWID, 255 men (61%) reported sexual activity in the last 30 days. Level of HIV knowledge was not associated in either direction with condom use or risky sexual partnering, as measured by sex with multiple partners or female sex workers (FSW). Lower self-perceived HIV risk was associated with a greater likelihood of sex with multiple partners (aPR: 1.79, 95% CI: 1.34, 2.40) and FSW (aPR: 1.28, 95% CI: 1.04, 1.59), but was not associated with condom use. Police-enacted stigma was associated with sex with multiple partners (aPR: 1.22, 95% CI: 1.01, 1.49) and FSW (aPR: 1.32, 95% CI: 1.13, 1.54). While depression and lower levels of loneliness were associated with condomless sex (aPR: 1.14, 95% CI: 1.05, 1.24; aPR: 0.79, 95% CI: 0.68, 0.92, respectively), only depression was associated with condomless sex with FSW (aPR: 1.26, 95% CI: 1.03, 1.54). CONCLUSIONS HIV prevention programing for male Tajik MWID must go beyond solely educating about factors associated with HIV transmission to include increased awareness of personal risk based on engaging in these behaviors. Additionally, psychological services to counter depression and police-enacted stigma are needed.
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Affiliation(s)
| | - Judith Levy
- University of Illinois Chicago, Chicago, USA
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Schweitzer AM, Dišković A, Krongauz V, Newman J, Tomažič J, Yancheva N. Addressing HIV stigma in healthcare, community, and legislative settings in Central and Eastern Europe. AIDS Res Ther 2023; 20:87. [PMID: 38082352 PMCID: PMC10714556 DOI: 10.1186/s12981-023-00585-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 11/29/2023] [Indexed: 12/18/2023] Open
Abstract
INTRODUCTION Surging HIV prevalence across countries of Central and Eastern Europe (CEE) is largely a result of poor HIV care engagement and a lack of comprehensive support for key populations. This is fostered by widespread stigma across healthcare, community, and legislative settings. DISCUSSION Throughout CEE, HIV stigma and intersectional stigma are serious obstacles to providing adequate medical care to people living with HIV. Anticipated and enacted (experienced) stigma from healthcare professionals, and fears of breaches in confidentiality, deter individuals from having an HIV test and engaging in HIV care. Furthermore, negative connotations surrounding HIV infection can lead to discrimination from family, friends, colleagues, and the public, leading to internalized stigma and depression. Key populations that have higher HIV prevalence, such as men who have sex with men, people who inject drugs, transgender individuals, and sex workers, experience additional stigma and discrimination based on their behaviour and identities. This contributes to the concentrated HIV epidemics seen in these populations in many CEE countries. The stigma is exacerbated by punitive legislation that criminalizes HIV transmission and penalizes sexual orientation, drug use, gender identities, and sex work. Despite high levels of HIV stigma and intersectional stigma, there are many evidence-based interventions that have reduced stigma in other parts of the world. Here, we discuss the interventions that are currently being enacted in various countries of CEE, and we suggest additional effective, evidence-based interventions that will tackle stigma and lead to increased HIV care engagement and higher rates of viral suppression. We cover the promotion of the undetectable = untransmittable (U = U) message, stigma-reduction education and training for healthcare professionals, patient-centric approaches for testing and treatment, and advocacy for non-discriminatory legislation, policies, and practices. We also consider targeted stigma-reduction interventions that acknowledge the wider challenges faced by marginalized populations. CONCLUSIONS HIV stigma and intersectional stigma in CEE drive poor engagement with HIV testing services and care. Widespread adoption of evidence-based interventions to tackle stigma highlighted in this review will improve the quality of life of people living with HIV, improve HIV care engagement, and ultimately slow the surging HIV prevalence and concentrated epidemics occurring throughout CEE.
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Affiliation(s)
| | - Arian Dišković
- Croatian Association for HIV and Viral Hepatitis (HUHIV), Zagreb, Croatia
| | - Veronica Krongauz
- European Distributor Markets, Medical Department, Gilead Sciences, Uxbridge, UK
| | - Julie Newman
- HIV Strategic Implementation & Franchise, Global Medical Affairs, Gilead Sciences, Melbourne, Australia
| | - Janez Tomažič
- Clinic for Infectious Diseases and Febrile Illnesses, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Nina Yancheva
- Department for AIDS, Specialized Hospital for Active Treatment of Infectious and Parasitic Diseases, Sofia, Bulgaria
- Department for Infectious Diseases, Parasitology and Tropical Medicine, Medical University of Sofia, Sofia, Bulgaria
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Rockstroh J, Laut KG, Jakobsen SF, Raben D, Verluyten J, Behrens G, Martinez E, Noori T, Pharris A, Simões D, Sullivan A. An opinion piece on how we move towards common European standards of care for people with HIV. AIDS 2023; 37:1941-1948. [PMID: 37428204 DOI: 10.1097/qad.0000000000003652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/11/2023]
Affiliation(s)
| | - Kamilla G Laut
- Centre of Excellence for Health, Immunity and Infections, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Stine F Jakobsen
- Centre of Excellence for Health, Immunity and Infections, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Dorthe Raben
- Centre of Excellence for Health, Immunity and Infections, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | | | - Georg Behrens
- Department for Rheumatology and Immunology, Hannover Medical School, Hannover, Germany
| | - Esteban Martinez
- Infectious Diseases Unit, Hospital Clínic/University of Barcelona, Spain
| | - Teymur Noori
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Anastasia Pharris
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Daniel Simões
- Coalition PLUS/GAT- Grupo de Ativistas em Tratamentos, Lisbon, Portugal
| | - Ann Sullivan
- Directorate of HIV and Sexual Health, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
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Gökengin D, Noori T, Alemany A, Bienkowski C, Liegon G, İnkaya AÇ, Carrillo J, Stary G, Knapp K, Mitja O, Molina JM. Prevention strategies for sexually transmitted infections, HIV, and viral hepatitis in Europe. THE LANCET REGIONAL HEALTH. EUROPE 2023; 34:100738. [PMID: 37927439 PMCID: PMC10625023 DOI: 10.1016/j.lanepe.2023.100738] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 08/26/2023] [Accepted: 09/12/2023] [Indexed: 11/07/2023]
Abstract
The current prevention efforts for STIs, HIV and viral hepatitis in the WHO European Region, especially in the Central and Eastern subregions, are hindered by healthcare disparities, data gaps, and limited resources. In this comprehensive narrative review, we aim to highlight both achievements and persisting challenges while also exploring new developments that could significantly impact the prevention of these infections in the near future. While pre-exposure prophylaxis (PrEP) for HIV has been broadly approved and implemented in 38 out of 53 countries in the region, challenges remain, including cost, limited licensing, and incomplete adherence. We explore innovative approaches like on-demand PrEP, long-acting injectable cabotegravir, and intravaginal rings that have shown promising results, alongside the use of six-monthly lenacapavir, the outcomes of which are pending. Additionally, the potential of doxycycline post-exposure prophylaxis has been discussed, revealing efficacy in reducing chlamydia and syphilis risk, but effectiveness against gonorrhoea being contingent on tetracycline resistance rates, and the need of further data to determine potential resistance development in other bacteria and its impact on the gut microbiome. We examine successful vaccination campaigns against HBV and HPV, the ongoing development of vaccines for chlamydia, syphilis, herpesvirus, and gonorrhoea, and challenges in HIV vaccine research, including lines of research with significant potential like sequential immunization, T-cell responses, and mRNA technology. This review underscores the research endeavors that pave the way for a more resilient and robust approach to combating STIs, HIV, and viral hepatitis in the region.
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Affiliation(s)
- Deniz Gökengin
- Department of Infectious Diseases and Clinical Microbiology, School of Medicine, Ege University, Izmir, Turkiye
- Ege University HIV/AIDS Practice and Research Center, Izmir, Turkiye
| | - Teymur Noori
- European Centre for Disease Prevention and Control STI, Blood-Borne Viruses and TB DPR, Stockholm, Sweden
| | - Andrea Alemany
- Skin Neglected Tropical Diseases and Sexually Transmitted Infections Section, Fight Infectious Diseases Foundation, University Hospital Germans Trias i Pujol, Badalona, Spain
| | - Carlo Bienkowski
- Department of Adults' Infectious Diseases, Medical University of Warsaw, Poland and Hospital for Infectious Diseases in Warsaw, Poland
| | - Geoffroy Liegon
- Section of Infectious Diseases and Global Health University of Chicago Medicine Chicago, Illinois, United States
| | - Ahmet Çağkan İnkaya
- Hacettepe University Faculty of Medicine Department of Infectious Diseases Ankara, Turkey
| | - Jorge Carrillo
- IrsiCaixa AIDS Research Institute, Campus Can Ruti, Badalona, Spain
- Germans Trias i Pujol Research Institute (IGTP), Campus Can Ruti, Badalona, Spain
- CIBERINFEC, Instituto de Salud Carlos IIII, Madrid, Spain
| | - Georg Stary
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - Katja Knapp
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - Oriol Mitja
- Skin Neglected Tropical Diseases and Sexually Transmitted Infections Section, Fight Infectious Diseases Foundation, University Hospital Germans Trias i Pujol, Badalona, Spain
| | - Jean-Michel Molina
- University of Paris Cité and Department of Infectious Diseases Saint-Louis and Lariboisiére Hospitals, APHP, Paris, France
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Yang Y, Yao X, Liu Y, Zhao J, Sun P, Zhang Y, Li K, Chen Y, Zheng J, Deng L, Fan S, Ma X, Guo S, Shuai P, Wan Z. Global and Regional Estimate of HIV-Associated Stroke Burden: A Meta-Analysis and Population Attributable Modeling Study. Stroke 2023; 54:2390-2400. [PMID: 37477007 DOI: 10.1161/strokeaha.123.043410] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 06/20/2023] [Indexed: 07/22/2023]
Abstract
BACKGROUND This study aimed to determine the correlation between human-immunodeficiency-virus (HIV) infection and stroke, as well as to estimate the global, regional, and national burden of HIV-associated stroke. METHODS A registered meta-analysis was performed by searching PubMed, Embase, and Web of Science for relevant literature up to October 31, 2022. The pooled relative risk of stroke in HIV-infected people was calculated using a random-effects model. HIV prevalence and disability-adjusted life years (DALYs) datasets were obtained from the Joint United Nations Program on HIV and AIDS, and the Global Health Data Exchange, respectively. The population attributable fraction was estimated and delivered to calculate the HIV-associated DALYs of stroke from 1990 to 2019, at the global, regional, and national levels. Pearson correlation analysis were conducted to assess the correlation between the age-standardized rate or estimated annual percentage changes and the sociodemographic index. RESULTS Out of 10 080 identified studies, 11 were included in this meta-analysis. Compared with individuals without HIV-infection, the pooled relative risk of stroke in HIV-infected individuals was 1.40 (95% CI, 1.18-1.65). From 1990 to 2019, the global population attributable fraction of HIV-associated stroke increased almost 3-fold, while the HIV-associated DALYs increased from 18 595 (95% CI, 7485-31 196) in 1990 to 60 684 (95% CI, 24 281-101 894) in 2019. Meanwhile, HIV-associated DALYs varied by region, with Eastern and Southern Africa having the highest value of 126 160 in 2019. Moreover, countries with middle social development index were shouldering the highest increase trend of the HIV-associated DALYs age-standardized rates. CONCLUSIONS HIV-infected individuals face a significantly higher risk of stroke, and the global burden of HIV-associated stroke has increased over the past 3 decades, showing regional variations. Eastern and Southern Africa bear the highest burden, while Eastern Europe and Central Asia have seen significant growth. Health care providers, researchers, and decision-makers should give increased attention to stroke prevention and management in HIV-endemic areas. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifier: CRD42022367450.
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Affiliation(s)
- Yumei Yang
- Department of Health Management Center & Institute of Health Management, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China (Y.Y., X.Y., Y.L., P. Sun, Y.C., L.D., X.M., S.G., P. Shuai, Z.W.)
| | - Xiaoqin Yao
- Department of Health Management Center & Institute of Health Management, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China (Y.Y., X.Y., Y.L., P. Sun, Y.C., L.D., X.M., S.G., P. Shuai, Z.W.)
| | - Yuping Liu
- Department of Health Management Center & Institute of Health Management, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China (Y.Y., X.Y., Y.L., P. Sun, Y.C., L.D., X.M., S.G., P. Shuai, Z.W.)
- Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, China (Y.L., P. Sun, Z.W.)
| | - Jianhui Zhao
- Department of School of Public Health, and Epidemiology and Biostatistics, Zhejiang University School of Medicine, Hangzhou, China (J. Zhao, Y.Z., K.L.)
| | - Ping Sun
- Department of Health Management Center & Institute of Health Management, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China (Y.Y., X.Y., Y.L., P. Sun, Y.C., L.D., X.M., S.G., P. Shuai, Z.W.)
- Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, China (Y.L., P. Sun, Z.W.)
| | - Yixuan Zhang
- Department of School of Public Health, and Epidemiology and Biostatistics, Zhejiang University School of Medicine, Hangzhou, China (J. Zhao, Y.Z., K.L.)
| | - Kangning Li
- Department of School of Public Health, and Epidemiology and Biostatistics, Zhejiang University School of Medicine, Hangzhou, China (J. Zhao, Y.Z., K.L.)
| | - Yan Chen
- Department of Health Management Center & Institute of Health Management, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China (Y.Y., X.Y., Y.L., P. Sun, Y.C., L.D., X.M., S.G., P. Shuai, Z.W.)
- School of Public Health, Southwest Medical University, Luzhou, China (Y.C., S.F.)
| | - Jinxin Zheng
- School of Global Health, Chinese Center for Tropical Diseases Research, Shanghai Jiao Tong University School of Medicine, China (J. Zheng)
| | - Ling Deng
- Department of Health Management Center & Institute of Health Management, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China (Y.Y., X.Y., Y.L., P. Sun, Y.C., L.D., X.M., S.G., P. Shuai, Z.W.)
| | - Song Fan
- School of Public Health, Southwest Medical University, Luzhou, China (Y.C., S.F.)
| | - Xiaoxiang Ma
- Department of Health Management Center & Institute of Health Management, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China (Y.Y., X.Y., Y.L., P. Sun, Y.C., L.D., X.M., S.G., P. Shuai, Z.W.)
| | - Shujin Guo
- Department of Health Management Center & Institute of Health Management, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China (Y.Y., X.Y., Y.L., P. Sun, Y.C., L.D., X.M., S.G., P. Shuai, Z.W.)
| | - Ping Shuai
- Department of Health Management Center & Institute of Health Management, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China (Y.Y., X.Y., Y.L., P. Sun, Y.C., L.D., X.M., S.G., P. Shuai, Z.W.)
| | - Zhengwei Wan
- Department of Health Management Center & Institute of Health Management, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China (Y.Y., X.Y., Y.L., P. Sun, Y.C., L.D., X.M., S.G., P. Shuai, Z.W.)
- Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, China (Y.L., P. Sun, Z.W.)
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Luc CM, Levy J, Bakhromov M, Jonbekov J, Mackesy-Amiti ME. HIV Knowledge, Self-Perception of HIV Risk, and Sexual Risk Behaviors among Male Tajik Labor Migrants who inject Drugs in Moscow. RESEARCH SQUARE 2023:rs.3.rs-2972274. [PMID: 37398250 PMCID: PMC10312903 DOI: 10.21203/rs.3.rs-2972274/v1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/04/2023]
Abstract
Background The interplay of HIV knowledge and self-perception of risk for HIV among people who inject drugs is complex and understudied, especially among temporary migrant workers (MWID) who inject drugs while in a host country. In Russia, Tajik migrants make up the largest proportion of Moscow's foreign labor. Yet, HIV knowledge and self-perceived risk in association with sexual risk behavior among Tajik MWID in Moscow remains unknown. Objective This research examines knowledge about HIV transmission, self-perception of HIV risk, and key psychosocial factors that possibly contribute to sexual risk behaviors among male Tajik MWIDs living in Moscow. Methods Structured interviews were conducted with 420 male Tajik MWIDs. Modified Poisson regression models investigated possible associations between major risk factors and HIV sexual risk behavior. Results Of the 420 MWIDs, 255 men (61%) reported sexual activity in the last 30 days. Level of HIV knowledge was not associated in either direction with condom use or risky sexual partnering, as measured by sex with multiple partners or female sex workers. Higher self-perceived HIV risk predicted less risky sexual partnering, but not condom use. Depression and police-enacted societal stigma were positively associated with risky sexual partnering, while loneliness and depression were associated with condomless sex. Conclusions HIV prevention programing for male Tajik MWIDs must go beyond solely educating about factors associated with HIV transmission to include increased awareness of personal risk based on engaging in these behaviors. Additionally, psychological services to counter loneliness, depression, and societal stigma through police harassment are needed.
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Sevgi DY, Demirbas ND, Genc Yaman I, Derin O, Oncul A, Atasoy Tahtasakal C, Gul O, Diktas H, Dokmetas I. Evaluation of the late presentation and associated factors of people living with HIV in Turkey. J Med Virol 2023; 95:e28781. [PMID: 37212337 DOI: 10.1002/jmv.28781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 03/31/2023] [Accepted: 04/28/2023] [Indexed: 05/23/2023]
Abstract
To identify the frequency of late presentation and late presentation with advanced disease, and associated factors in people living with HIV (PLHIV). Data from PLHIV diagnosed between 2008 and 2021 were retrospectively analyzed. Time of diagnosis (categorized based on key events affecting HIV care continuum e.g., national strategies, HIV guidelines, COVID-19 pandemic) and characteristics of late presenters (LP: CD4 ≤350 cells/mm³ or an AIDS defining event) and late presenters with advanced disease (LPAD: CD4 <200 cells/mm³) were describe. Associations between dependent (LP, LPAD) and independent variables were assessed using univariate/multivariate regression tests and presented as odds ratios (95% confidential interval). Of 1585 individuals (93.7% men), 42.5% were LPs and 19.3% were LPADs. Most common route of transmission was sex between men (54.3%). Non-LPs were younger (30 vs. 34 and 36 years; p < 0.001) and included more men who have sex with men (60.3% vs. 46.3% and 39.5%; p < 0.001). Factors associated with being LP and LPAD were age >30 years, heterosexual/unknown route of transmission (vs. sex between men), diagnosis in 2008-2013 or 2020-2021, (vs. 2014-2019). With reference to Turkish subjects, migrants from Africa had higher odds of being LPAD. LP is still an important health issue in HIV care. Heterosexuality, older age (>30 years), migration from Africa, and the COVID-19 pandemic are associated with delays in HIV presentation in Turkey. These factors need to be considered when developing and implementing policies to enable earlier diagnosis and treatment of PLHIV to achieve UNAIDS 95-95-95 targets.
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Affiliation(s)
- Dilek Yildiz Sevgi
- Infectious Diseases and Clinical Microbiology, Sisli Hamidiye Etfal Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Nazife Duygu Demirbas
- Infectious Diseases and Clinical Microbiology, Sisli Hamidiye Etfal Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Irem Genc Yaman
- Infectious Diseases and Clinical Microbiology, Sisli Hamidiye Etfal Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Okan Derin
- Infectious Diseases and Clinical Microbiology, Sisli Hamidiye Etfal Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Ahsen Oncul
- Infectious Diseases and Clinical Microbiology, Sisli Hamidiye Etfal Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Ceren Atasoy Tahtasakal
- Infectious Diseases and Clinical Microbiology, Sisli Hamidiye Etfal Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Ozlem Gul
- Infectious Diseases and Clinical Microbiology, Sisli Hamidiye Etfal Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Husrev Diktas
- Infectious Diseases and Clinical Microbiology, Sisli Hamidiye Etfal Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Ilyas Dokmetas
- Infectious Diseases and Clinical Microbiology, Sisli Hamidiye Etfal Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
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Loghin II, Vâţă A, Mihai IF, Silvaş G, Rusu ŞA, Luca CM, Dorobăţ CM. Profile of Newly Diagnosed Patients with HIV Infection in North-Eastern Romania. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:440. [PMID: 36984440 PMCID: PMC10056804 DOI: 10.3390/medicina59030440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 02/20/2023] [Accepted: 02/21/2023] [Indexed: 02/25/2023]
Abstract
Background and Objectives: Human immunodeficiency virus infection and the acquired immunodeficiency syndrome (HIV/AIDS) pandemic are unquestionably the most serious public crisis of our time. Identifying, preventing, and treating HIV-associated comorbidities remains a challenge that must be addressed even in the era of antiretroviral therapy. Materials and Methods: In this study, we aimed to characterize the aspects of newly diagnosed patients with HIV/AIDS, during 2021-2022 in Northeastern Romania. We reviewed the frequency and associated comorbidities of these patients in correspondence with national and global results. Results: Our study found that of all newly diagnosed HIV cases (167 cases-74 cases in 2021 and 98 cases in 2022), 49.70% were diagnosed with HIV infection and 50.30% had AIDS. Based on sex correlated with the CD4+ T-lymphocyte level, the most affected were males, with a lower CD4+ T-lymphocyte level overall. The average HIV viral load was 944,689.55 copies/mL. Half of males had an abnormal ALT or AST (39.53% and 49.61%); as for the females, less than a quarter had an increased value of ALT or AST, respectively (18% and 26%). The most frequent co-infections were as follows: oral candidiasis (34.73% of patients), hepatitis B (17.37% of patients), and SARS-CoV-2 infection (8.38%), followed by hepatitis C (6.39%), tuberculosis (TB), syphilis, toxoplasmosis, Cryptococcus, Cytomegalovirus infections. Males were more affected than females, with a higher percentage of co-infections. The prescribed antiretroviral treatment focused on a single-pill regimen (79.04%) to ensure adherence, effectiveness, and safety. Therefore, 20.96% had been prescribed a regimen according to their comorbidities. Conclusions: Our study found a concerning rise in the incidence of HIV in 2022 compared to that in 2021 in Northeastern Romania, because of the rise in post-SARS-CoV-2 pandemic addressability. Advanced immunodeficiency and the burden of opportunistic infections characterize newly diagnosed HIV patients. The physicians should keep in mind that these patients may have more than one clinical condition at presentation.
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Affiliation(s)
- Isabela Ioana Loghin
- Department of Infectious Diseases, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
- Department of Infectious Diseases, "St. Parascheva" Clinical Hospital of Infectious Diseases, 700116 Iasi, Romania
| | - Andrei Vâţă
- Department of Infectious Diseases, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
- Department of Infectious Diseases, "St. Parascheva" Clinical Hospital of Infectious Diseases, 700116 Iasi, Romania
| | - Ioana Florina Mihai
- Department of Infectious Diseases, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - George Silvaş
- Department of Infectious Diseases, "St. Parascheva" Clinical Hospital of Infectious Diseases, 700116 Iasi, Romania
| | - Şerban Alin Rusu
- Department of Infectious Diseases, "St. Parascheva" Clinical Hospital of Infectious Diseases, 700116 Iasi, Romania
| | - Cătălina Mihaela Luca
- Department of Infectious Diseases, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
- Department of Infectious Diseases, "St. Parascheva" Clinical Hospital of Infectious Diseases, 700116 Iasi, Romania
| | - Carmen Mihaela Dorobăţ
- Department of Infectious Diseases, "St. Parascheva" Clinical Hospital of Infectious Diseases, 700116 Iasi, Romania
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Nikolaichuk M, Mocroft A, Wandeler G, Szlavik J, Gottfredsson M, Reikvam DH, Svedhem V, Elinav H, Laguno M, Mansinho K, Devitt E, Chkhartishvili N, Behrens G, Bogner J, Viard JP, Winston A, Benfield T, Leen C, Fursa O, Rockstroh J, Peters L. Use of contraindicated antiretroviral drugs in people with HIV/HCV coinfections receiving HCV treatment with direct-acting antivirals-Results from the EuroSIDA study. HIV Med 2023; 24:224-230. [PMID: 35934954 DOI: 10.1111/hiv.13357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 06/22/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Our objective was to determine whether antiretroviral drugs (ARVs) were used according to the European AIDS Clinical Society (EACS) guidelines for people with HIV/hepatitis C virus (HCV) coinfection treated with direct-acting antivirals (DAAs) between 30 November 2014 and 31 December 2019 in the pan-European EuroSIDA study. METHODS At each publication date of the EACS guidelines, plus 3 and 6 months, we calculated the number of people receiving DAAs with potential and actual ARV contraindications ('red shading' in the EACS guidelines). We used logistic regression to investigate factors associated with using contraindicated ARVs. RESULTS Among 1406 people starting DAAs, the median age was 51 years, 75% were male, 57% reported injected drug use as an HIV risk, and 76% were from western Europe. Of 1624 treatment episodes, 609 (37.5%) occurred while the patient was receiving ARVs with potential contraindications; among them, 38 (6.2%; 95% confidence interval [CI] 4.3-8.2) involved a contraindicated ARV (18 non-nucleoside reverse transcriptase inhibitors), 16 involved protease inhibitors, and four involved integrase strand transfer inhibitors. The adjusted odds of receiving a contraindicated ARV were higher (3.25; 95% CI 1.40-7.57) among participants from east/central east Europe (vs. south) and lower (0.22; 95% CI 0.08-0.65) for 2015-2018 guidelines (vs. 2014). In total, 29 of the 32 (90.6%) patients receiving a contraindicated ARV and 441 of the 461 (95.7%) with potential ARV contraindications experienced a sustained virological response ≥12 weeks after stopping treatment (SVR12; p = 0.55). CONCLUSION In this large heterogenous European cohort, more than one-third of people with HIV/HCV coinfection received DAAs with potential ARV contraindications, but few received a contraindicated ARV. Use of contraindicated ARVs declined over time, corresponding to the increased availability of ARV therapy regimens without interactions with DAA across Europe. Participants who received a contraindicated DAA and ARV combination still had a high rate of SVR12.
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Affiliation(s)
- Myroslava Nikolaichuk
- Department of the Infectious Diseases, Dnipro State Medical University, Dnipro, Ukraine
| | - Amanda Mocroft
- CHIP, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.,Centre for Clinical Research, Epidemiology, Modelling and Evaluation (CREME), Institute for Global Health, UCL, London, UK
| | - Gilles Wandeler
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland
| | - János Szlavik
- South-Pest Hospital Centre-National Institute for Infectology and Haematology, Budapest, Hungary
| | - Magnus Gottfredsson
- Landspitali University Hospital, Reykjavik, Iceland.,Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | - Dag Henrik Reikvam
- Department of Infectious diseases, Oslo University Hospital, Oslo, Norway
| | - Veronica Svedhem
- Infectious Diseases Department, Karolinska University Hospital, Stockholm, Sweden
| | - Hila Elinav
- Department of Clinical Microbiology and Infectious Diseases, Hadassah Hospital, Jerusalem, Israel
| | | | | | - Emma Devitt
- Department of Genitourinary Medicine and Infectious Diseases, St James's Hospital, Dublin, Ireland
| | | | | | - Johannes Bogner
- Division of Infectious Diseases, Medizinische Klinik und Poliklinik IV, Ludwig Maximilian University of Munich, Munich, Germany
| | - Jean-Paul Viard
- Diagnostic and Therapeutic Center, Hôtel-Dieu, AP-HP, Paris, France
| | - Alan Winston
- Department of Infectious Disease, Imperial College London, London, UK
| | - Thomas Benfield
- Department of Infectious Diseases, Hvidovre Hospital, Hvidovre, Denmark
| | | | - Olga Fursa
- CHIP, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | | | - Lars Peters
- CHIP, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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Gokengin D, Bursa D, Skrzat-Klapaczynska A, Alexiev I, Arsikj E, Balayan T, Begovac J, Cicic A, Dragovic G, Harxhi A, Aimla K, Lakatos B, Matulionyte R, Mulabdic V, Oprea C, Papadopoulos A, Rukhadze N, Sedlacek D, Sojak L, Tomazic J, Vassilenko A, Vasylyev M, Verhaz A, Yancheva N, Yurin O, Kowalska J. PrEP Scale-Up and PEP in Central and Eastern Europe: Changes in Time and the Challenges We Face with No Expected HIV Vaccine in the near Future. Vaccines (Basel) 2023; 11:vaccines11010122. [PMID: 36679967 PMCID: PMC9867039 DOI: 10.3390/vaccines11010122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 12/19/2022] [Accepted: 12/22/2022] [Indexed: 01/06/2023] Open
Abstract
With no expected vaccine for HIV in the near future, we aimed to define the current situation and challenges for pre- and post-exposure prophylaxis (PrEP and PEP) in Central and Eastern Europe (CEE). The Euroguidelines CEE Network Group members were invited to respond to a 27-item survey including questions on PrEP (response rate 91.6%). PrEP was licensed in 68.2%; 95 centers offered PrEP and the estimated number on PrEP was around 9000. It was available in daily (40.1%), on-demand (13.3%), or both forms (33.3%). The access rate was <1−80%. Three major barriers for access were lack of knowledge/awareness among people who are in need (59.1%), not being reimbursed (50.0%), and low perception of HIV risk (45.5%). Non-occupational PEP was available in 86.4% and was recommended in the guidelines in 54.5%. It was fully reimbursed in 36.4%, only for accidental exposures in 40.9%, and was not reimbursed in 22.72%. Occupational PEP was available in 95.5% and was reimbursed fully. Although PrEP scale-up in the region has gained momentum, a huge gap exists between those who are in need of and those who can access PrEP. Prompt action is required to address the urgent need for PrEP scale-up in the CEE region.
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Affiliation(s)
- Deniz Gokengin
- Department of Infectious Diseases and Clinical Microbiology, Medical Faculty, Ege University, Izmir 35100, Türkiye
- HIV/AIDS Research and Practice Center, Ege University, Izmir 35100, Türkiye
- Correspondence: or
| | - Dominik Bursa
- Department of Adults’ Infectious Diseases, Hospital for Infectious Diseases, Medical University of Warsaw, 01-201 Warsaw, Poland
| | - Agata Skrzat-Klapaczynska
- Department of Adults’ Infectious Diseases, Hospital for Infectious Diseases, Medical University of Warsaw, 01-201 Warsaw, Poland
| | - Ivailo Alexiev
- Department of Virology, National Center of Infectious and Parasitic Diseases, 1504 Sofia, Bulgaria
| | - Elena Arsikj
- University Clinic for Infectious Diseases and Febrile Conditions Skopje, Faculty of Medicine Skopje, Ss.Cyril and Methodius University, 1010 Skopje, North Macedonia
| | - Tatevik Balayan
- National Center for Disease Control and Prevention, Yerevan 0025, Armenia
| | - Josip Begovac
- Department of Infectious Diseases, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | - Alma Cicic
- Center for Communicable Disease Control and Prevention, Institute for Public Health of Montenegro, 81000 Podgorica, Montenegro
| | - Gordana Dragovic
- Department of Pharmacology, Clinical Pharmacology and Toxicology, School of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Arjan Harxhi
- Department of Infectious Disease, Faculty of Medicine, University Hospital Center of Tirana, 1001 Tirana, Albania
| | - Kerstin Aimla
- Department of Infectious Diseases, Tartu University Hospital, 50406 Tartu, Estonia
| | - Botond Lakatos
- Department of HIV and Tropical Diseases, South Pest Central Hospital, National Institute of Hematology and Infectious Diseases, 1097 Budapest, Hungary
| | - Raimonda Matulionyte
- Department of Infectious Diseases and Dermatovenerology, Vilnius University Hospital Santaros Klinikos, Vilnius University, LT-08410 Vilnius, Lithuania
| | - Velida Mulabdic
- Clinic for Infectious Diseases, Clinical Center University of Sarajevo, 71000 Sarajevo, Bosnia and Herzegovina
| | - Cristiana Oprea
- Victor Babes Hospital for Infectious and Tropical Diseases, Carol Davila University of Medicine and Pharmacy, 030303 Bucharest, Romania
| | - Antonios Papadopoulos
- 4th Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, University General Hospital “ATTIKON”, 12462 Athens, Greece
| | - Nino Rukhadze
- Infectious Diseases, AIDS & Clinical Immunology Research Center, 0160 Tbilisi, Georgia
| | - Dalibor Sedlacek
- HIV Center University Hospital, Charles University, 11000 Pilsen, Czech Republic
| | - Lubomir Sojak
- Center for Treatment of HIV/AIDS Patients, Department of Infectology and Geographical Medicine, Academic L. Derer’s University Hospital, 2412 Bratislava, Slovakia
| | - Janez Tomazic
- Department of Infectious Diseases, University Medical Center Ljubljana, 1525 Ljubljana, Slovenia
| | - Anna Vassilenko
- Global Fund Grant Management Department, Republican Scientific and Practical Center of Medical Technologies, Informatization, Management and Economics of Public Health (RNPT MT), 220013 Minsk, Belarus
| | - Marta Vasylyev
- Astar Medical Center, 79054 Lviv, Ukraine
- Internal Medicine Department, Erasmus MC, 2040 3000 Rotterdam, The Netherlands
| | - Antonija Verhaz
- Clinic for Infectious Diseases, University Clinical Center of the Republic of Srpska, 78000 Banja Luka, Bosnia and Herzegovina
| | - Nina Yancheva
- Department for AIDS, Specialized Hospital for Active Treatment of Infectious and Parasitic Diseases—Sofia, Medical University Sofia, 1431 Sofia, Bulgaria
| | - Oleg Yurin
- Department of AIDS, Epidemiology and Prevention, Central Research Institute of Epidemiology, Federal AIDS Centre, 111123 Moscow, Russia
| | - Justyna Kowalska
- Department of Adults’ Infectious Diseases, Hospital for Infectious Diseases, Medical University of Warsaw, 01-201 Warsaw, Poland
- HIV Out-Patient Clinic, Hospital for Infectious Diseases, Medical University of Warsaw, 01-201 Warsaw, Poland
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12
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HIV-1 subtype B spread through cross-border clusters in the Balkans: a molecular analysis in view of incidence trends. AIDS 2023; 37:125-135. [PMID: 36129113 DOI: 10.1097/qad.0000000000003394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To analyze phylogenetic relations and assess the role of cross-border clusters in the spread of HIV-1 subtype B across the Balkans, given the general trends of new HIV diagnoses in seven Balkan countries. DESIGN Retrospective phylogenetic and trend analysis. METHODS In-depth phylogenetic, phylodynamic and phylogeographic analysis performed on 2415 HIV-1 subtype B sequences from 1999 to 2019 using maximal likelihood and Bayesian methods. The joinpoint regression analysis of new HIV diagnoses by country and modes of transmission using 2004-2019 ECDC data. RESULTS Ninety-three HIV-1 Subtype B transmission clusters (68% of studied sequences) were detected of which four cross-border clusters (11% of studied sequences). Phylodynamic analysis showed activity of cross-border clusters up until the mid-2000s, with a subsequent stationary growth phase. Phylogeography analyses revealed reciprocal spread patterns between Serbia, Slovenia and Montenegro and several introductions to Romania from these countries and Croatia. The joinpoint analysis revealed a reduction in new HIV diagnoses in Romania, Greece and Slovenia, whereas an increase in Serbia, Bulgaria, Croatia and Montenegro, predominantly among MSM. CONCLUSION Differing trends of new HIV diagnoses in the Balkans mirror differences in preventive policies implemented in participating countries. Regional spread of HIV within the countries of former Yugoslavia has continued to play an important role even after country break-up, whereas the spread of subtype B through multiple introductions to Romania suggested the changing pattern of travel and migration linked to European integration of Balkan countries in the early 2000s.
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Prevalence of Pretreatment HIV-1 Drug Resistance in Armenia in 2017-2018 and 2020-2021 following a WHO Survey. Viruses 2022; 14:v14112320. [PMID: 36366418 PMCID: PMC9698750 DOI: 10.3390/v14112320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 10/19/2022] [Accepted: 10/20/2022] [Indexed: 11/06/2022] Open
Abstract
The increased antiretroviral therapy (ART) coverage of patients in the absence of routine genotyping tests and in the context of active labor migration highlight the importance of HIV-1 drug resistance (DR) surveillance in Armenia. We conducted a two-phase pretreatment DR (PDR) study in 2017-2018 (phase I; 120 patients) and 2020-2021 (phase II; 133 patients) according to the WHO-approved protocol. The analysis of HIV-1 genetic variants showed high degrees of viral diversity, with the predominance of A6. The prevalence of any PDR was 9.2% in phase I and 7.5% in phase II. PDR to protease inhibitors was found only in 0.8% in phase II. PDR to efavirenz and nevirapine was found among 5.0% and 6.7% of patients in phase I, and 6.0% and 6.8% of patients in phase II, respectively. The prevalence of PDR to nucleoside reverse-transcriptase inhibitors decreased from 5.0% in phase I to 0.8% in phase II. In addition, we identified risk factors associated with the emergence of DR-male, MSM, subtype B, and residence in or around the capital of Armenia-and showed the active spread of HIV-1 among MSM in transmission clusters, i.e., harboring DR, which requires the immediate attention of public health policymakers for the prevention of HIV-1 DR spread in the country.
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Papadopoulos A, Thomas K, Protopapas K, Antonyak S, Begovac J, Dragovic G, Gökengin D, Aimla K, Krasniqi V, Lakatos B, Mardarescu M, Matulionyte R, Mulabdic V, Oprea C, Panteleev A, Sedláček D, Sojak L, Skrzat-Klapaczyńska A, Vassilenko A, Yancheva N, Yurin O, Horban A, Kowalska JD. HIV treatment strategies across Central, Eastern and Southeastern Europe: New times, old problems. HIV Med 2022; 24:462-470. [PMID: 36196025 DOI: 10.1111/hiv.13416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 09/15/2022] [Indexed: 12/01/2022]
Abstract
INTRODUCTION In the last decade, substantial differences in the epidemiology of, antiretroviral therapy (ART) for, cascade of care in and support to people with HIV in vulnerable populations have been observed between countries in Western Europe, Central Europe (CE) and Eastern Europe (EE). The aim of this study was to use a survey to explore whether ART availability and therapies have evolved in CE and EE according to European guidelines. METHODS The Euroguidelines in Central and Eastern Europe (ECEE) Network Group conducted two identical multicentre cross-sectional online surveys in 2019 and 2021 concerning the availability and use of antiretroviral drugs (boosted protease inhibitors [bPIs], integrase inhibitors [INSTIs] and nucleoside reverse transcriptase inhibitors [NRTIs]), the introduction of a rapid ART start strategy and the use of two-drug regimens (2DRs) for starting or switching ART. We also investigated barriers to the implementation of these strategies in each region. RESULTS In total, 18 centres participated in the study: four from CE, six from EE and eight from Southeastern Europe (SEE). Between those 2 years, older PIs were less frequently used and darunavir-based regimens were the main PIs (83%); bictegravir-based and tenofovir alafenamide-based regimens were introduced in CE and SEE but not in EE. The COVID-19 pandemic did not significantly interrupt delivery of ART in most centres. Two-thirds of centres adopted a rapid ART start strategy, mainly in pregnant women and to improve linkage of care in vulnerable populations. The main obstacle to rapid ART start was that national guidelines in several countries from all three regions did not support such as strategy or required laboratory tests first; an INSTI/NRTI combination was the most commonly prescribed regimen (75%) and was exclusively prescribed in SEE. 2DRs are increasingly used for starting or switching ART (58%), and an INSTI/NRTI was the preferred regimen (75%) in all regions and exclusively prescribed in SEE, whereas the use of bPIs declined. Metabolic disorders and adverse drug reactions were the main reasons for starting a 2DR; in the second survey, HIV RNA <500 000 c/ml and high cluster of differentiation (CD)-4 count emerged as additional important reasons. CONCLUSIONS In just 2 years and in spite of the emergence of the COVID-19 pandemic, significant achievements concerning ART availability and strategies have occurred in CE, EE and SEE that facilitate the harmonization of those strategies with the European AIDS Clinical Society guidelines. Few exceptions exist, especially in EE. Continuous effort is needed to overcome various obstacles (administrative, financial, national guideline restrictions) in some countries.
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Affiliation(s)
- Antonios Papadopoulos
- 4th Department of Internal Medicine, University General Hospital Attikon, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantinos Thomas
- 4th Department of Internal Medicine, University General Hospital Attikon, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantinos Protopapas
- 4th Department of Internal Medicine, University General Hospital Attikon, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Sergii Antonyak
- Gromashevsky Institute of Epidemiology and Infectious Diseases, Viral Hepatitis and AIDS Department, Kiev, Ukraine
| | - Josip Begovac
- University Hospital for Infectious Diseases, Zagreb, Croatia
| | - Gordana Dragovic
- Department of Pharmacology, Clinical Pharmacology and Toxicology, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Deniz Gökengin
- Ege University, Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Izmir, Turkey
| | | | - Valbon Krasniqi
- Infectious Diseases Clinic, University Clinical Center at Kosovo, Prishtina, Kosovo
| | - Botond Lakatos
- National Institute of Hematology and Infectious Diseases, South-Pest Central Hospital, National Center of HIV, Budapest, Hungary
| | - Mariana Mardarescu
- National Institute for Infectious Diseases Matei Bals, Bucharest, Romania
| | - Raimonda Matulionyte
- Vilnius University, Faculty of Medicine, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Velida Mulabdic
- Clinic for Infectious Diseases, Clinical Center, University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Cristiana Oprea
- Carol Davila University of Medicine and Pharmacy, Victor Babes Clinical Hospital for Infectious and Tropical Diseases, Bucharest, Romania
| | | | - Dalibor Sedláček
- Department of Infectious Diseases and Travel Medicine, Charles University of Prague, Prague, Czech Republic
| | - Lubomir Sojak
- Department of Infectology and Geographical Medicine, Academic L. Derer's University Hospital, Bratislava, Slovakia
| | - Agata Skrzat-Klapaczyńska
- Department of Adults' Infectious Diseases, Hospital for Infectious Diseases, Medical University of Warsaw, Warsaw, Poland
| | - Anna Vassilenko
- Republican Scientific and Practical Center for Medical Technologies, Global Fund Grant Management Department, Belarusian State Medical University, Minsk, Belarus
| | - Nina Yancheva
- Department for AIDS, Specialized Hospital for Active Treatment of Infectious and Parasitic Diseases, Sofia, Bulgaria
| | - Oleg Yurin
- Central Research Institute of Epidemiology, Moskow, Russia
| | - Andrzej Horban
- Department of Adults' Infectious Diseases, Hospital for Infectious Diseases, Medical University of Warsaw, Warsaw, Poland
| | - Justyna D Kowalska
- Department of Adults' Infectious Diseases, Hospital for Infectious Diseases, Medical University of Warsaw, Warsaw, Poland
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The Management of HIV Care Services in Central and Eastern Europe: Data from the Euroguidelines in Central and Eastern Europe Network Group. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19137595. [PMID: 35805250 PMCID: PMC9265352 DOI: 10.3390/ijerph19137595] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 06/19/2022] [Accepted: 06/19/2022] [Indexed: 12/18/2022]
Abstract
Introduction: The COVID-19 pandemic has been challenging time for medical care, especially in the field of infectious diseases (ID), but it has also provided an opportunity to introduce new solutions in HIV management. Here, we investigated the changes in HIV service provision across Central and Eastern European (CEE) countries before and after the COVID-19 outbreak. Methods: The Euroguidelines in Central and Eastern Europe Network Group consists of experts in the field of ID from 24 countries within the CEE region. Between 11 September and 29 September 2021, the group produced an on-line survey, consisting of 32 questions on models of care among HIV clinics before and after the SARS-CoV-2 outbreak. Results: Twenty-three HIV centers from 19 countries (79.2% of all countries invited) participated in the survey. In 69.5% of the countries, there were more than four HIV centers, in three countries there were four centers (21%), and in four countries there was only one HIV center in each country. HIV care was based in ID hospitals plus out-patient clinics (52%), was centralized in big cities (52%), and was publicly financed (96%). Integrated services were available in 21 clinics (91%) with access to specialists other than ID, including psychologists in 71.5% of the centers, psychiatrists in 43%, gynecologists in 47.5%, dermatologists in 52.5%, and social workers in 62% of all clinics. Patient-centered care was provided in 17 centers (74%), allowing consultations and tests to be planned for the same day. Telehealth tools were used in 11 centers (47%) before the COVID-19 pandemic outbreak, and in 18 (78%) after (p = 0.36), but were represented mostly by consultations over the telephone or via e-mail. After the COVID-19 outbreak, telehealth was introduced as a new medical tool in nine centers (39%). In five centers (28%), no new services or tools were introduced. Conclusions: As a consequence of the COVID-19 pandemic, tools such as telehealth have become popularized in CEE countries, challenging the traditional approach to HIV care. These implications need to be further evaluated in order to ascertain the best adaptations, especially for HIV medicine.
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Kirichenko A, Kireev D, Lopatukhin A, Murzakova A, Lapovok I, Saleeva D, Ladnaya N, Gadirova A, Ibrahimova S, Safarova A, Grigoryan T, Petrosyan A, Sarhatyan T, Gasich E, Bunas A, Glinskaya I, Yurovsky P, Nurov R, Soliev A, Ismatova L, Musabaev E, Kazakova E, Rakhimova V, Pokrovsky V. Prevalence of HIV-1 drug resistance in Eastern European and Central Asian countries. PLoS One 2022; 17:e0257731. [PMID: 35061671 PMCID: PMC8782385 DOI: 10.1371/journal.pone.0257731] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 09/08/2021] [Indexed: 11/18/2022] Open
Abstract
Background Eastern Europe and Central Asia (EECA) is one of the regions where the HIV epidemic continues to grow at a concerning rate. Antiretroviral therapy (ART) coverage in EECA countries has significantly increased during the last decade, which can lead to an increase in the risk of emergence, transmission, and spread of HIV variants with drug resistance (DR) that cannot be controlled. Because HIV genotyping cannot be performed in these countries, data about HIV DR are limited or unavailable. Objectives To monitor circulating HIV-1 genetic variants, assess the prevalence of HIV DR among patients starting antiretroviral therapy, and reveal potential transmission clusters among patients in six EECA countries: Armenia, Azerbaijan, Belarus, Russia, Tajikistan, and Uzbekistan. Materials and methods We analyzed 1071 HIV-1 pol-gene fragment sequences (2253–3369 bp) from patients who were initiating or reinitiating first-line ART in six EECA counties, i.e., Armenia (n = 120), Azerbaijan (n = 96), Belarus (n = 158), Russia (n = 465), Tajikistan (n = 54), and Uzbekistan (n = 178), between 2017 and 2019. HIV Pretreatment DR (PDR) and drug resistance mutation (DRM) prevalence was estimated using the Stanford HIV Resistance Database. The PDR level was interpreted according to the WHO standard PDR survey protocols. HIV-1 subtypes were determined using the Stanford HIV Resistance Database and subsequently confirmed by phylogenetic analysis. Transmission clusters were determined using Cluster Picker. Results Analyses of HIV subtypes showed that EECA, in general, has the same HIV genetic variants of sub-subtype A6, CRF63_02A1, and subtype B, with different frequencies and representation for each country. The prevalence of PDR to any drug class was 2.8% in Uzbekistan, 4.2% in Azerbaijan, 4.5% in Russia, 9.2% in Armenia, 13.9% in Belarus, and 16.7% in Tajikistan. PDR to protease inhibitors (PIs) was not detected in any country. PDR to nucleoside reverse-transcriptase inhibitors (NRTIs) was not detected among patients in Azerbaijan, and was relatively low in other countries, with the highest prevalence in Tajikistan (5.6%). The prevalence of PDR to nonnucleoside reverse-transcriptase inhibitors (NNRTIs) was the lowest in Uzbekistan (2.8%) and reached 11.1% and 11.4% in Tajikistan and Belarus, respectively. Genetic transmission network analyses identified 226/1071 (21.1%) linked individuals, forming 93 transmission clusters mainly containing two or three sequences. We found that the time since HIV diagnosis in clustered patients was significantly shorter than that in unclustered patients (1.26 years vs 2.74 years). Additionally, the K103N/S mutation was mainly observed in clustered sequences (6.2% vs 2.8%). Conclusions Our study demonstrated different PDR prevalence rates and DR dynamics in six EECA countries, with worrying levels of PDR in Tajikistan and Belarus, where prevalence exceeded the 10% threshold recommended by the WHO for immediate public health action. Because DR testing for clinical purposes is not common in EECA, it is currently extremely important to conduct surveillance of HIV DR in EECA due to the increased ART coverage in this region.
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Affiliation(s)
- Alina Kirichenko
- Central Research Institute of Epidemiology, Moscow, Russian Federation
- * E-mail:
| | - Dmitry Kireev
- Central Research Institute of Epidemiology, Moscow, Russian Federation
| | - Alexey Lopatukhin
- Central Research Institute of Epidemiology, Moscow, Russian Federation
| | | | - Ilya Lapovok
- Central Research Institute of Epidemiology, Moscow, Russian Federation
| | - Daria Saleeva
- Central Research Institute of Epidemiology, Moscow, Russian Federation
| | - Natalya Ladnaya
- Central Research Institute of Epidemiology, Moscow, Russian Federation
| | | | | | - Aygun Safarova
- Republic Center of the Struggle against AIDS, Baku, Azerbaijan
| | | | | | | | - Elena Gasich
- Republican Research and Practical Center for Epidemiology and Microbiology, Minsk, Belarus
| | - Anastasia Bunas
- Republican Research and Practical Center for Epidemiology and Microbiology, Minsk, Belarus
| | - Iryna Glinskaya
- Republican Center for Hygiene, Epidemiology and Public Health, Minsk, Belarus
| | - Pavel Yurovsky
- Republican Center for Hygiene, Epidemiology and Public Health, Minsk, Belarus
| | - Rustam Nurov
- Republican AIDS prevention center, Dushanbe, Tajikistan
| | - Alijon Soliev
- Republican AIDS prevention center, Dushanbe, Tajikistan
| | | | | | | | - Visola Rakhimova
- Center for development of profession qualification of medical workers, Tashkent, Uzbekistan
| | - Vadim Pokrovsky
- Central Research Institute of Epidemiology, Moscow, Russian Federation
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Kowalska JD, Wójcik G, Rutkowski J, Antonyak S, Siewaszewicz E. Rapid antiretroviral treatment start seems as vital and cost-effective strategy in Central and Eastern Europe. PRZEGLAD EPIDEMIOLOGICZNY 2022; 76:304-313. [PMID: 36520041 DOI: 10.32394/pe.76.29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
BACKGROUND It is essential to deliver specialist human immunodeficiency virus (HIV) care with maximum effectiveness, but also minimum time delay. Therefore, we aimed to determine whether rapid linkage to care defined as starting combined antiretroviral therapy (cART) on the day of the first visit at the HIV clinic is a costeffective approach. METHODS In the analysis, Markov's lifetime model presented in our previous study was implemented. The inputs used in the model were updated in the terms of costs, life expectancy, and patient characteristics. For the analysis we used information from the previous model about the additional costs of treatment and qualityadjusted life years (QALYs) lost in the life horizon for people newly infected with HIV. The number of newly infected persons was estimated based on available data. RESULTS Input data was available for 344 men having sex with men (MSM) who registered in the HIV specialist care between 2016 and 2017. The estimated QALY loss due to lack of rapid treatment initiation, where the viral load is not (was) taken into account, equals 0·018 (0·022), 0·039 (0·047), 0·131 (0·158) respectively in low, medium and high risk transmission groups. Rapid cART initiation was dominant regardless of the chosen scenarios. CONCLUSIONS Cost-effectiveness analysis considering the HIV transmission indicates that the rapid initiation of HIV treatment is a cost-effective and potentially cost-saving approach to improve HIV care and reduce HIV transmission in Central and Eastern Europe.
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Affiliation(s)
- Justyna D Kowalska
- Department of Adults' Infectious Diseases, Medical University of Warsaw, Warsaw, Poland
- HIV Out-Patients Clinic, Hospital for Infectious Diseases in Warsaw, Warsaw, Poland
| | | | | | - Svitlana Antonyak
- HIV Department of Clinic of the Gromashevsky Institute of Epidemiology and Infectious Diseases, Kiev, Ukraine
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18
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Săndulescu O, Irimia M, Benea OE, Mărdărescu M, Preoțescu LL, Dorobăț CM, Loghin II, Nicolau IC, Jipa RE, Popescu RȘ, Benea CL, Cozma A, Dărămuș IA, Miron VD, Prisăcariu LJ, Bahnă AF, Nistor I, Secrieru OM, George S, Bîrcă A, Dobrea L, Șogorescu AȘ, Viziteu I, Streinu-Cercel A. Treatment initiation or switch to BIC/FTC/TAF - real-world safety and efficacy data from two HIV centers in Romania. Germs 2021; 11:512-522. [PMID: 35096668 PMCID: PMC8789359 DOI: 10.18683/germs.2021.1286] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 11/29/2021] [Accepted: 11/30/2021] [Indexed: 09/01/2023]
Abstract
INTRODUCTION Development of highly active antiretroviral therapy marked an important step forward in the management of people living with HIV and fixed dose combinations are now available to be used as modern antiretroviral regimens. The single-tablet regimen bictegravir/emtricitabine/tenofovir alafenamide (BIC/FTC/TAF) was recently approved in Europe and included in international guidelines and recommendations. It became available in Romania in early 2021. We present the real-world results from a retrospective analysis of patients initiating BIC/FTC/TAF in two HIV centers in Romania. METHODS This retrospective analysis included patients treated with BIC/FTC/TAF (first-line or switch) in two HIV centers in Romania, one in Bucharest and one in Iași. We collected data on baseline patient characteristics, reasons for initiation of BIC/FTC/TAF and preliminary clinical and laboratory efficacy, safety and tolerability data. All assessments had been performed according to local practice. Statistical analyses were mostly descriptive and association analysis was performed to assess changes in laboratory parameters from baseline to data cut-off (October 2021). RESULTS In total, 122 patients were initiated on BIC/FTC/TAF in routine clinical practice from February to October 2021 in the two HIV centers, either as first-line or switch. The majority of patients were male (71%). The median age at baseline was 35.0 years (IQR 32.0-50.8 years). Overall, 91 patients (75%) were treatment-experienced and the most frequent reason for switch was treatment simplification (79%). The mean ± standard deviation follow-up duration on treatment with BIC/FTC/TAF was 101.6 ± 64.2 days until the cut-off date for this analysis. We found no significant changes in lipid values, blood glucose or liver enzymes, coupled with a significant decrease in viral load (p=0.001). A low number of adverse events occurred during the treatment period (n=4): two cases of fatigue and two gastrointestinal reactions. No patient discontinued BIC/FTC/TAF and the overall tolerability was good. CONCLUSIONS The insights of the first report on BIC/FTC/TAF use in routine clinical practice in Romania provide an overview of effectiveness and safety to local clinicians treating this patient population.
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Affiliation(s)
- Oana Săndulescu
- MD, PhD, Carol Davila University of Medicine and Pharmacy Bucharest, National Institute for Infectious Diseases “Prof. Dr. Matei Balș”, No. 1 Dr Calistrat Grozovici street, Bucharest, 021105, Romania
| | - Mădălina Irimia
- MD, National Institute for Infectious Diseases “Prof. Dr. Matei Balș”, No. 1 Dr Calistrat Grozovici street, Bucharest, 021105, Romania
| | - Otilia Elisabeta Benea
- MD, PhD, Carol Davila University of Medicine and Pharmacy Bucharest, National Institute for Infectious Diseases “Prof. Dr. Matei Balș”, No. 1 Dr Calistrat Grozovici street, Bucharest, 021105, Romania
| | - Mariana Mărdărescu
- MD, National Institute for Infectious Diseases “Prof. Dr. Matei Balș”, No.1 Dr Calistrat Grozovici street, Bucharest, 021105, Romania
| | - Liliana Lucia Preoțescu
- MD, PhD, Carol Davila University of Medicine and Pharmacy Bucharest, National Institute for Infectious Diseases “Prof. Dr. Matei Balș”, No. 1 Dr Calistrat Grozovici street, Bucharest, 021105, Romania
| | - Carmen Mihaela Dorobăț
- MD, PhD, HIV/AIDS Department, Clinical Infectious Diseases Hospital “Sf Parascheva”, 2 Octav Botez Street, Iaşi, 700116, Romania
| | - Isabela Ioana Loghin
- MD, University of Medicine and Pharmacy “Grigore T. Popa” Iași, HIV/AIDS Department, Clinical Infectious Diseases Hospital “Sf Parascheva”, 2 Octav Botez Street, Iaşi, 700116, Romania
| | - Irina Cristina Nicolau
- MD, HIV/AIDS Department, Clinical Infectious Diseases Hospital “Sf Parascheva”, 2 Octav Botez Street, Iaşi, 700116, Romania
| | - Raluca Elena Jipa
- MD, Carol Davila University of Medicine and Pharmacy Bucharest, National Institute for Infectious Diseases “Prof. Dr. Matei Balș”, No. 1 Dr Calistrat Grozovici street, Bucharest, 021105, Romania
| | - Ramona Ștefania Popescu
- MD, PhD, Carol Davila University of Medicine and Pharmacy Bucharest, National Institute for Infectious Diseases “Prof. Dr. Matei Balș”, No. 1 Dr Calistrat Grozovici street, Bucharest, 021105, Romania
| | - Cristina Loredana Benea
- MD, National Institute for Infectious Diseases “Prof. Dr. Matei Balș”, No. 1 Dr Calistrat Grozovici street, Bucharest, 021105, Romania
| | - Alina Cozma
- MD, National Institute for Infectious Diseases “Prof. Dr. Matei Balș”, No. 1 Dr Calistrat Grozovici street, Bucharest, 021105, Romania
| | - Ioana Andreea Dărămuș
- MD, PhDc, Carol Davila University of Medicine and Pharmacy Bucharest, National Institute for Infectious Diseases “Prof. Dr. Matei Balș”, No. 1 Dr Calistrat Grozovici street, Bucharest, 021105, Romania
| | - Victor Daniel Miron
- MD, PhDc, Carol Davila University of Medicine and Pharmacy Bucharest, No. 1 Dr Calistrat Grozovici street, Bucharest, 021105, Romania
| | - Liviu Jany Prisăcariu
- MD, HIV/AIDS Department, Clinical Infectious Diseases Hospital “Sf Parascheva”, 2 Octav Botez Street, Iaşi, 700116, Romania
| | - Adriana Florina Bahnă
- MD, HIV/AIDS Department, Clinical Infectious Diseases Hospital “Sf Parascheva”, 2 Octav Botez Street, Iaşi, 700116, Romania
| | - Irina Nistor
- MD, HIV/AIDS Department, Clinical Infectious Diseases Hospital “Sf Parascheva”, 2 Octav Botez Street, Iaşi, 700116, Romania
| | - Oana Manuela Secrieru
- MD, HIV/AIDS Department, Clinical Infectious Diseases Hospital “Sf Parascheva”, 2 Octav Botez Street, Iaşi, 700116, Romania
| | - Silvas George
- MD, HIV/AIDS Department, Clinical Infectious Diseases Hospital “Sf Parascheva”, 2 Octav Botez Street, Iaşi, 700116, Romania
| | - Andreea Bîrcă
- MD, National Institute for Infectious Diseases “Prof. Dr. Matei Balș”, No. 1 Dr Calistrat Grozovici street, Bucharest, 021105, Romania
| | - Loredana Dobrea
- MD, National Institute for Infectious Diseases “Prof. Dr. Matei Balș”, No. 1 Dr Calistrat Grozovici street, Bucharest, 021105, Romania
| | - Alexandra-Ștefana Șogorescu
- MD, National Institute for Infectious Diseases “Prof. Dr. Matei Balș”, No. 1 Dr Calistrat Grozovici street, Bucharest, 021105, Romania
| | - Ioana Viziteu
- Medical student, Carol Davila University of Medicine and Pharmacy Bucharest, No. 1 Dr Calistrat Grozovici street, Bucharest, 021105, Romania
| | - Anca Streinu-Cercel
- MD, PhD, Carol Davila University of Medicine and Pharmacy Bucharest, National Institute for Infectious Diseases “Prof. Dr. Matei Balș”, No. 1 Dr Calistrat Grozovici street, Bucharest, 021105, Romania
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Comparison of Tolerability and Impact on Metabolic Profiles of Antiretroviral Regimens Containing Darunavir/Ritonavir or Darunavir/Cobicistat in Romanian HIV Infected Patients. Biomedicines 2021; 9:biomedicines9080987. [PMID: 34440191 PMCID: PMC8392338 DOI: 10.3390/biomedicines9080987] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 08/04/2021] [Accepted: 08/05/2021] [Indexed: 01/12/2023] Open
Abstract
The management of the side effects caused by the antiretroviral therapy is one of the main problems facing clinicians. The patient’s tolerability and safety influence the success of the therapy. This retrospective study assesses the tolerability and impact on metabolic profiles of antiretroviral regimens containing darunavir/ritonavir (DRV/r) versus those containing darunavir/cobicistat (DRV/c), in routine clinical practice. The database of Prof. Dr Matei Bals of the National Institute of Infectious Diseases (INBI MB) was studied for the period 2017–2020, allowing the inclusion in the study of 462 HIV-infected patients who received the current regimen at least three months before evaluation. The following parameters were collected and analyzed: significant medical history, associated diseases, serum levels for profile evaluation: carbohydrate, lipidic, serum level of liver and pancreatic enzymes, serum markers of cardiac function, coagulation, and renal function. DRV/c (800 mg/150 mg, once daily) administrated in combination with other antiretroviral (ARV) in HIV-1 infected subjects proved to be better tolerated and with a lower impact on metabolic profile than DRV/r (600 mg/100 mg, twice daily). Patients in DRV/r group are significantly more at risk of developing, over time, side effects and metabolic impairments than those in DRV/c group, in all body functions studied, with statistically significant differences (p < 0.05) between the two groups. Laboratory data were correlated with patient’s demographic and clinical characteristics and statistically significant outcomes have been found, proving that a personalized regimen is needed to minimize the ART side effects and to maximize the success of therapy. The results of the study showed that DRV/c, associated with other antiretroviral drugs in the regimens of Romanian HIV infected subjects, have a more favorable metabolic profile than those containing DRV/r.
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Langmia IM, Just KS, Yamoune S, Brockmöller J, Masimirembwa C, Stingl JC. CYP2B6 Functional Variability in Drug Metabolism and Exposure Across Populations-Implication for Drug Safety, Dosing, and Individualized Therapy. Front Genet 2021; 12:692234. [PMID: 34322158 PMCID: PMC8313315 DOI: 10.3389/fgene.2021.692234] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 06/14/2021] [Indexed: 12/11/2022] Open
Abstract
Adverse drug reactions (ADRs) are one of the major causes of morbidity and mortality worldwide. It is well-known that individual genetic make-up is one of the causative factors of ADRs. Approximately 14 million single nucleotide polymorphisms (SNPs) are distributed throughout the entire human genome and every patient has a distinct genetic make-up which influences their response to drug therapy. Cytochrome P450 2B6 (CYP2B6) is involved in the metabolism of antiretroviral, antimalarial, anticancer, and antidepressant drugs. These drug classes are commonly in use worldwide and face specific population variability in side effects and dosing. Parts of this variability may be caused by single nucleotide polymorphisms (SNPs) in the CYP2B6 gene that are associated with altered protein expression and catalytic function. Population variability in the CYP2B6 gene leads to changes in drug metabolism which may result in adverse drug reactions or therapeutic failure. So far more than 30 non-synonymous variants in CYP2B6 gene have been reported. The occurrence of these variants show intra and interpopulation variability, thus affecting drug efficacy at individual and population level. Differences in disease conditions and affordability of drug therapy further explain why some individuals or populations are more exposed to CYP2B6 pharmacogenomics associated ADRs than others. Variabilities in drug efficacy associated with the pharmacogenomics of CYP2B6 have been reported in various populations. The aim of this review is to highlight reports from various ethnicities that emphasize on the relationship between CYP2B6 pharmacogenomics variability and the occurrence of adverse drug reactions. In vitro and in vivo studies evaluating the catalytic activity of CYP2B6 variants using various substrates will also be discussed. While implementation of pharmacogenomic testing for personalized drug therapy has made big progress, less data on pharmacogenetics of drug safety has been gained in terms of CYP2B6 substrates. Therefore, reviewing the existing evidence on population variability in CYP2B6 and ADR risk profiles suggests that, in addition to other factors, the knowledge on pharmacogenomics of CYP2B6 in patient treatment may be useful for the development of personalized medicine with regards to genotype-based prescription.
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Affiliation(s)
- Immaculate M. Langmia
- Institute of Clinical Pharmacology, University Hospital of Rheinisch-Westfälische Technische Hochschule Aachen, Aachen, Germany
| | - Katja S. Just
- Institute of Clinical Pharmacology, University Hospital of Rheinisch-Westfälische Technische Hochschule Aachen, Aachen, Germany
| | - Sabrina Yamoune
- Institute of Clinical Pharmacology, University Hospital of Rheinisch-Westfälische Technische Hochschule Aachen, Aachen, Germany
| | - Jürgen Brockmöller
- Department of Clinical Pharmacology, University Medical Center Göttingen, Georg-August University, Göttingen, Germany
| | - Collen Masimirembwa
- African Institute of Biomedical Science and Technology (AiBST), Harare, Zimbabwe
| | - Julia C. Stingl
- Institute of Clinical Pharmacology, University Hospital of Rheinisch-Westfälische Technische Hochschule Aachen, Aachen, Germany
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21
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Milic M, Dotlic J, Gazibara T, Parlic M, Nicholson D, Mitic K, Lazic D, Stevanovic J. Positive attitudes towards persons living with HIV in North Kosovo: The university students' perspective. HEALTH & SOCIAL CARE IN THE COMMUNITY 2021; 29:1100-1114. [PMID: 32881208 DOI: 10.1111/hsc.13144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 07/24/2020] [Accepted: 07/30/2020] [Indexed: 06/11/2023]
Abstract
HIV-related stigma could delay the identification and treatment of persons living with HIV (PLHIV), particularly in regions affected by ethnic conflicts. The aims of this study were to assess attitudes towards PLHIV and examine factors associated with stronger positive attitudes towards PLHIV among university students in the Serbian province of Kosovo. A cross-sectional study was conducted at the University of Pristina temporarily settled in Kosovska Mitrovica during the academic year 2013-2014. A total of 1,017 first- and fourth-year students completed an anonymous questionnaire about socio-demographic characteristics, PLHIV, high-risk groups for acquiring HIV and health behaviour. The main outcome measure was the Attitude Score (ATS), calculated as a sum of points awarded for all attitude-related items. The majority of students (84%) expressed positive attitudes towards PLHIV, while others were indecisive. Most students held negative opinions about persons who use drugs (64%), homosexual persons of both genders (50%) and sex workers (42%). Being female (odds ratio [OR] = 1.49, 95% confidence interval [CI] 1.05-2.09) and older (OR = 1.13, 95% CI 1.03-1.24), not doing paid work while studying (OR = 3.35, 95% CI = 1.63-6.84), studying health-related disciplines (β = -0.113, 95% CI = -0.085 to -2.747), having stronger positive attitudes towards homosexual persons of both genders (OR = 0.77, 95% CI = 0.64-0.94) and not using illicit drugs (β = 2.08, 95% CI = 1.03-4.20) were associated with stronger positive attitudes towards PLHIV. Social inclusion of PLHIV and individuals at high risk for acquiring HIV could help reduce the HIV-related stigma.
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Affiliation(s)
- Marija Milic
- Department of Epidemiology, Faculty of Medicine, University of Pristina temporarily settled in Kosovska Mitrovica, Kosovo, Serbia
| | - Jelena Dotlic
- Clinic for Obstetrics and Gynecology, Clinical Center of Serbia, University of Belgrade, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Tatjana Gazibara
- Institute of Epidemiology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Milan Parlic
- Department of Epidemiology, Faculty of Medicine, University of Pristina temporarily settled in Kosovska Mitrovica, Kosovo, Serbia
| | - Desmond Nicholson
- Department of Regional Health Services Region Five, Ministry of Public Health, Georgetown, Guyana
| | - Katarina Mitic
- Emergency Relief Project "Solidarity", SOS Children's Villages, Belgrade, Serbia
| | - Dragoslav Lazic
- Faculty of Dentistry, University of Pristina temporarily settled in Kosovska Mitrovica, Kosovo, Serbia
| | - Jasmina Stevanovic
- Department of Epidemiology, Faculty of Medicine, University of Pristina temporarily settled in Kosovska Mitrovica, Kosovo, Serbia
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22
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Erdinc FS, Dokuzoguz B, Unal S, Komur S, Inkaya AC, Inan D, Karaoglan I, Deveci A, Celen MK, Kose S, Erben N, Senturk GC, Heper Y, Kutlu SS, Hatipoglu CA, Sumer S, Kandemir B, Sirmatel F, Bayindir Y, Yilmaz E, Ersoy Y, Kazak E, Yildirmak MT, Kayaaslan B, Ozden K, Sener A, Kara A, Gunal O, Birengel S, Akbulut A, Yetkin F, Cuvalci NO, Sargin F, Pullukcu H, Gokengin D, Multicentric Hiv Study Group. Temporal Trends in the Epidemiology of HIV in Turkey. Curr HIV Res 2021; 18:258-266. [PMID: 32342820 DOI: 10.2174/1570162x18666200427223823] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 04/03/2020] [Accepted: 04/14/2020] [Indexed: 01/07/2023]
Abstract
OBJECTIVE The aim of this study was to analyze the temporal trends of HIV epidemiology in Turkey from 2011 to 2016. METHODS Thirty-four teams from 28 centers at 17 different cities participated in this retrospective study. Participating centers were asked to complete a structured form containing questions about epidemiologic, demographic and clinical characteristics of patients presented with new HIV diagnosis between 2011 and 2016. Demographic data from all centers (complete or partial) were included in the analyses. For the cascade of care analysis, 15 centers that provided full data from 2011 to 2016 were included. Overall and annual distributions of the data were calculated as percentages and the Chi square test was used to determine temporal changes. RESULTS A total of 2,953 patients between 2011 and 2016 were included. Overall male to female ratio was 5:1 with a significant increase in the number of male cases from 2011 to 2016 (p<0.001). The highest prevalence was among those aged 25-34 years followed by the 35-44 age bracket. The most common reason for HIV testing was illness (35%). While the frequency of sex among men who have sex with men increased from 16% to 30.6% (p<0.001) over the study period, heterosexual intercourse (53%) was found to be the most common transmission route. Overall, 29% of the cases presented with a CD4 count of >500 cells/mm3 while 46.7% presented with a CD4 T cell count of <350 cells/mm3. Among newly diagnosed cases, 79% were retained in care, and all such cases initiated ART with 73% achieving viral suppression after six months of antiretroviral therapy. CONCLUSION The epidemiologic profile of HIV infected individuals is changing rapidly in Turkey with an increasing trend in the number of newly diagnosed people disclosing themselves as MSM. New diagnoses were mostly at a young age. The late diagnosis was found to be a challenging issue. Despite the unavailability of data for the first 90, Turkey is close to the last two steps of 90-90-90 targets.
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Affiliation(s)
- F S Erdinc
- Ankara Training and Research Hospital, Infectious Diseases and Clinical Microbiology, Ankara, Turkey
| | - B Dokuzoguz
- Ankara Numune Training and Researh Hospital, Infectious Diseases and Clinical Microbiology, Ankara, Turkey
| | - S Unal
- Hacettepe Universitesi Hastaneleri, Department of Infectious Diseases and Clinical Microbiology, Ankara, Turkey
| | - S Komur
- Cukurova University, Department of Infectious Diseases and Clinical Microbiology, Adana, Turkey
| | - A C Inkaya
- Ankara Numune Training and Researh Hospital, Infectious Diseases and Clinical Microbiology, Ankara, Turkey
| | - D Inan
- Akdeniz University, Department of Infectious Diseases and Clinical Microbiology, Antalya, Turkey
| | - I Karaoglan
- Gaziantep University, Department of Infectious Diseases and Clinical Microbiology, Gaziantep, Turkey
| | - A Deveci
- Ondokuz Mayis University, Department of Infectious Diseases and Clinical Microbiology, Samsun, Turkey
| | - M K Celen
- Dicle University, Department of Infectious Diseases and Clinical Microbiology, Diyarbakır, Turkey
| | - S Kose
- Izmir Tepecik Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, İzmir, Turkey
| | - N Erben
- Eskisehir Osmangazi University Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Eskisehir, Turkey
| | - G C Senturk
- Diskapi Yildirim Beyazit Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Ankara, Turkey
| | - Y Heper
- Uludag University, Department of Infectious Diseases and Clinical Microbiology, Bursa, Turkey
| | - S S Kutlu
- Pamukkale University, Department of Infectious Diseases and Clinical Microbiology, Denizli, Turkey
| | - C A Hatipoglu
- Ankara Training and Research Hospital, Infectious Diseases and Clinical Microbiology, Ankara, Turkey
| | - S Sumer
- Selcuk University, Department of Infectious Diseases and Clinical Microbiology, Konya, Turkey
| | - B Kandemir
- Necmettin Erbakan University, Meram Medical Faculty Hospital, Department of Infectious Diseases and Clinical Microbiology, Konya, Turkey
| | - F Sirmatel
- Abant Izzet Baysal University, Department of Infectious Diseases and Clinical Microbiology, Bolu, Turkey
| | - Y Bayindir
- Inonu University, Department of Infectious Diseases and Clinical Microbiology, Malatya, Turkey
| | - E Yilmaz
- Uludag University, Department of Infectious Diseases and Clinical Microbiology, Bursa, Turkey
| | - Y Ersoy
- Inonu University, Department of Infectious Diseases and Clinical Microbiology, Malatya, Turkey
| | - E Kazak
- Uludag University, Department of Infectious Diseases and Clinical Microbiology, Bursa, Turkey
| | - M T Yildirmak
- Okmeydani Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - B Kayaaslan
- Yildirim Beyazit University Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Ankara, Turkey
| | - K Ozden
- Ataturk University, Department of Infectious Diseases and Clinical Microbiology, Erzurum, Turkey
| | - A Sener
- Canakkale Onsekiz Mart University, Department of Infectious Diseases and Clinical Microbiology, Canakkale, Turkey
| | - A Kara
- Hacettepe University Ihsan Dogramaci Children's Hospital, Department of Infectious Diseases, Ankara, Turkey
| | - O Gunal
- Samsun Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Samsun, Turkey
| | - S Birengel
- Ankara University Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Ankara, Turkey
| | - A Akbulut
- Firat University, Department of Infectious Diseases and Clinical Microbiology, Elazig, Turkey
| | - F Yetkin
- Inonu University, Department of Infectious Diseases and Clinical Microbiology, Malatya, Turkey
| | - N O Cuvalci
- Antalya Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Antalya, Turkey
| | - F Sargin
- Medeniyet University Goztepe Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - H Pullukcu
- Ege University, Department of Infectious Diseases and Clinical Microbiology, Izmir, Turkey
| | - D Gokengin
- Ege University, Department of Infectious Diseases and Clinical Microbiology, Izmir, Turkey
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Dybul M, Attoye T, Baptiste S, Cherutich P, Dabis F, Deeks SG, Dieffenbach C, Doehle B, Goodenow MM, Jiang A, Kemps D, Lewin SR, Lumpkin MM, Mathae L, McCune JM, Ndung'u T, Nsubuga M, Peay HL, Pottage J, Warren M, Sikazwe I. The case for an HIV cure and how to get there. Lancet HIV 2021; 8:e51-e58. [PMID: 33271124 PMCID: PMC7773626 DOI: 10.1016/s2352-3018(20)30232-0] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 08/06/2020] [Accepted: 08/11/2020] [Indexed: 12/12/2022]
Abstract
In light of the increasing global burden of new HIV infections, growing financial requirements, and shifting funding landscape, the global health community must accelerate the development and delivery of an HIV cure to complement existing prevention modalities. An effective curative intervention could prevent new infections, overcome the limitations of antiretroviral treatment, combat stigma and discrimination, and provide a sustainable financial solution for pandemic control. We propose steps to plan for an HIV cure now, including defining a target product profile and establishing the HIV Cure Africa Acceleration Partnership (HCAAP), a multidisciplinary public-private partnership that will catalyse and promote HIV cure research through diverse stakeholder engagement. HCAAP will convene stakeholders, including people living with HIV, at an early stage to accelerate the design, social acceptability, and rapid adoption of HIV-cure products.
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Affiliation(s)
- Mark Dybul
- Center for Global Health Practice and Impact, Georgetown University, Washington, DC, USA.
| | - Timothy Attoye
- Global Health Division, The Bill & Melinda Gates Foundation, Seattle, WA, USA
| | - Solange Baptiste
- International Treatment Preparedness Coalition, Johannesburg, South Africa
| | | | - François Dabis
- Agence Nationale de Recherches sur le SIDA et les Hepatites Virales, Paris, France
| | - Steven G Deeks
- University of California, San Francisco, California, USA
| | - Carl Dieffenbach
- Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Department of Health and Human Services, Rockville, MD, USA
| | - Brian Doehle
- Global Health Division, The Bill & Melinda Gates Foundation, Seattle, WA, USA
| | - Maureen M Goodenow
- Office of AIDS Research, National Institutes of Health, Department of Health and Human Services, Rockville, MD, USA
| | - Adam Jiang
- McKinsey & Company Secondee at The Bill & Melinda Gates Foundation, Seattle, WA, USA
| | | | - Sharon R Lewin
- Peter Doherty Institute for Infection and Immunity, University of Melbourne and Royal Melbourne Hospital, Melbourne, Australia; Department of Infectious Diseases, Alfred Hospital and Monash University, Melbourne, Australia
| | - Murray M Lumpkin
- Global Health Division, The Bill & Melinda Gates Foundation, Seattle, WA, USA
| | - Lauren Mathae
- Center for Global Health Practice and Impact, Georgetown University, Washington, DC, USA
| | - Joseph M McCune
- Global Health Division, The Bill & Melinda Gates Foundation, Seattle, WA, USA
| | - Thumbi Ndung'u
- Africa Health Research Institute, Durban, South Africa; HIV Pathogenesis Programme, Doris Duke Medical Research Institute, University of KwaZulu-Natal, Durban South Africa; Max Planck Institute for Infection Biology, Berlin, Germany; University College London, London, UK
| | - Moses Nsubuga
- Joint Adherent Brothers & Sisters Against AIDS, Kampala, Uganda
| | - Holly L Peay
- RTI International, Research Triangle Park, NC, USA
| | | | | | - Izukanji Sikazwe
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
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Uptake and Discontinuation of Integrase Inhibitors (INSTIs) in a Large Cohort Setting. J Acquir Immune Defic Syndr 2020; 83:240-250. [PMID: 31923088 DOI: 10.1097/qai.0000000000002250] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Despite increased integrase strand transfer inhibitor (INSTI) use, limited large-scale, real-life data exists on INSTI uptake and discontinuation. SETTING International multicohort collaboration. METHODS RESPOND participants starting dolutegravir (DTG), elvitegravir (EVG), or raltegravir (RAL) after January 1, 2012 were included. Predictors of INSTI used were assessed using multinomial logistic regression. Kaplan-Meier and Cox proportional hazards models describe time to and factors associated with discontinuation. RESULTS Overall, 9702 persons were included; 5051 (52.1%) starting DTG, 1933 (19.9%) EVG, and 2718 (28.0%) RAL. The likelihood of starting RAL or EVG vs DTG decreased over time and was higher in Eastern and Southern Europe compared with Western Europe. At 6 months after initiation, 8.9% (95% confidence interval: 8.3% to 9.5%) had discontinued the INSTI (6.4% DTG, 7.4% EVG, and 14.0% RAL). The main reason for discontinuation was toxicity (44.2% DTG, 42.5% EVG, 17.3% RAL). Nervous system toxicity accounted for a higher proportion of toxicity discontinuations on DTG (31.8% DTG, 23.4% EVG, 6.6% RAL). Overall, treatment simplification was highest on RAL (2.7% DTG, 1.6% EVG, and 19.8% RAL). Factors associated with a higher discontinuation risk included increasing year of INSTI initiation, female gender, hepatitis C coinfection, and previous non-AIDS-defining malignancies. Individuals in Southern and Eastern Europe were less likely to discontinue. Similar results were seen for discontinuations after 6 months. CONCLUSIONS Uptake of DTG vs EVG or RAL increased over time. Discontinuation within 6 months was mainly due to toxicity; nervous system toxicity was highest on DTG. Discontinuation was highest on RAL, mainly because of treatment simplification.
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Kanwugu ON, Adadi P. HIV/SARS-CoV-2 coinfection: A global perspective. J Med Virol 2020; 93:726-732. [PMID: 32692406 PMCID: PMC7404432 DOI: 10.1002/jmv.26321] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 07/14/2020] [Accepted: 07/15/2020] [Indexed: 12/20/2022]
Abstract
Since its first appearance in Wuhan, China, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has rapidly spread throughout the world and has become a global pandemic. Several medical comorbidities have been identified as risk factors for coronavirus disease 2019 (COVID-19). However, it remains unclear whether people living with human immunodefeciency virus (PLWH) are at an increased risk of COVID-19 and severe disease manifestation, with controversial suggestion that HIV-infected individuals could be protected from severe COVID-19 by means of antiretroviral therapy or HIV-related immunosuppression. Several cases of coinfection with HIV and SARS-CoV-2 have been reported from different parts of the globe. This review seeks to provide a holistic overview of SARS-CoV-2 infection in PLWH.
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Affiliation(s)
- Osman N Kanwugu
- Department of Technology for Organic Synthesis, Institute of Chemical Engineering, Ural Federal University, Yekaterinburg, Russia
| | - Parise Adadi
- Department of Food Science, University of Otago, Dunedin, New Zealand
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26
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Milic M, Gazibara T, Stevanovic J, Parlic M, Nicholson D, Mitic K, Lazic D, Dotlic J. Patterns of condom use in a university student population residing in a high-risk area for HIV infection. EUR J CONTRACEP REPR 2020; 25:269-278. [PMID: 32436747 DOI: 10.1080/13625187.2020.1766674] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The study objective was to investigate factors associated with condom use among university students. METHODS During the 2013-2014 academic year, 1017 first and fourth year students from the University of Pristina temporarily seated in Kosovska Mitrovica, northern Kosovo, completed a questionnaire on sociodemographic data, HIV-related knowledge, attitudes and risky behaviours. RESULTS Condom use during the most recent sexual encounter and with casual partners was reported by just over half of participants. Factors associated with condom use during the most recent sexual encounter were: being male (35.1%), using medical sources of information about HIV (35.7%), having a positive approach to HIV testing (40.1%) and a positive attitude towards sex workers (17.7%), as well as not having had a sexually transmitted infection in the past year (54.2%). Factors associated with more frequent condom use with casual partners were: being single (28.9%), not living in a rented apartment or own home (32.1%), frequenting night clubs at the weekend (35.3%), not using drugs/opioids (54.1%), not being sure whether to keep a contact after learning of their HIV-positive status (10.1%), and having stronger opinions (either positive or negative) on homosexual individuals (15.5% and 32.1%, respectively), sex workers (18.7% and 23.9%, respectively) and drug users (13.2% and 36.5%, respectively). CONCLUSION Condom use among students in northern Kosovo was low. Strategies for HIV prevention should be focussed on promoting healthy behaviours, especially among female students and students who live alone while at university. Moreover, sexuality education should be carried out in schools and primary health care centres to provide support and enable young people to negotiate safe sex.
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Affiliation(s)
- Marija Milic
- Department of Epidemiology, Faculty of Medicine, University of Pristina temporarily seated in Kosovska Mitrovica, Kosovska Mitrovica, Kosovo, Serbia
| | - Tatjana Gazibara
- Institute of Epidemiology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Jasmina Stevanovic
- Department of Epidemiology, Faculty of Medicine, University of Pristina temporarily seated in Kosovska Mitrovica, Kosovska Mitrovica, Kosovo, Serbia
| | - Milan Parlic
- Department of Epidemiology, Faculty of Medicine, University of Pristina temporarily seated in Kosovska Mitrovica, Kosovska Mitrovica, Kosovo, Serbia
| | - Desmond Nicholson
- Department of Regional Health Services Region Five, Ministry of Public Health, Georgetown, Guyana
| | - Katarina Mitic
- Programme Coordinator of the Emergency Relief Project 'Solidarity', SOS Children's Villages, Belgrade, Serbia
| | - Dragoslav Lazic
- Department of Dentistry, Faculty of Medicine, University of Pristina temporarily seated in Kosovska Mitrovica, Kosovska Mitrovica, Kosovo, Serbia
| | - Jelena Dotlic
- Clinic of Gynaecology and Obstetrics, Clinical Centre of Serbia, University of Belgrade, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Belgrade, Serbia
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HIV care in times of the COVID-19 crisis - Where are we now in Central and Eastern Europe? Int J Infect Dis 2020; 96:311-314. [PMID: 32413608 PMCID: PMC7211569 DOI: 10.1016/j.ijid.2020.05.013] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 05/02/2020] [Accepted: 05/03/2020] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION The SARS-CoV-2 pandemic has hit the European region disproportionately. Many HIV clinics share staff and logistics with infectious disease facilities, which are now on the frontline in tackling COVID-19. Therefore, this study investigated the impact of the current pandemic situation on HIV care and continuity of antiretroviral treatment (ART) supplies in CEE countries. METHODS The Euroguidelines in Central and Eastern Europe (ECEE) Network Group was established in February 2016 to review standards of care for HIV in the region. The group consists of professionals actively involved in HIV care. On March 19, 2020 we decided to review the status of HIV care sustainability in the face of the emerging SARS-CoV-2 pandemic in Europe. For this purpose, we constructed an online survey consisting of 23 questions. Respondents were recruited from ECEE members in 22 countries, based on their involvement in HIV care, and contacted via email. RESULTS In total, 19 countries responded: Albania, Armenia, Belarus, Bosnia and Herzegovina, Bulgaria, Croatia, Czech Republic, Estonia, Georgia, Greece, Hungary, Lithuania, Macedonia, Poland, Republic of Moldova, Russia, Serbia, Turkey, and Ukraine. Most of the respondents were infectious disease physicians directly involved in HIV care (17/19). No country reported HIV clinic closures. HIV clinics were operating normally in only six countries (31.6%). In 11 countries (57.9%) physicians were sharing HIV and COVID-19 care duties. None of the countries expected shortage of ART in the following 2 weeks; however, five physicians expressed uncertainty about the following 2 months. At the time of providing responses, ten countries (52.6%) had HIV-positive persons under quarantine. CONCLUSIONS A shortage of resources is evident, with an impact on HIV care inevitable. We need to prepare to operate with minimal medical resources, with the aim of securing constant supplies of ART. Non-governmental organizations should re-evaluate their earlier objectives and support efforts to ensure continuity of ART delivery.
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King EJ, Denebayeva A, Tukeyev M, Zhandybaeva A, Nurkerimova A, Nugmanova Z. Factors associated with being on antiretroviral treatment among people living with HIV in Almaty, Kazakhstan. AIDS Care 2020; 33:398-402. [PMID: 32000502 DOI: 10.1080/09540121.2020.1719967] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Like other countries in the region of Eastern Europe and Central Asia, Kazakhstan has seen an increase in the number of new HIV cases in recent years. HIV treatment coverage among people living with HIV (PLHIV) in Kazakhstan is suboptimal; however, the country has committed to reaching the 90-90-90 goals for HIV diagnosis and treatment. Kazakhstan has recently committed to the "test and treat" approach, and provides antiretroviral treatment (ART) to all PLHIV. Using registry data from the City AIDS Center, we used logistic regression models to assess the factors associated with uptake of ART and its correlates among 2687 adult PLHIV in Almaty, Kazakhstan. 67.8% were on treatment. PLHIV are more likely to be on ART if diagnosed in the later clinical stages [aOR = 2.45, 95% CI (1.85, 3.25)], diagnosed after the country's change in treatment approach [aOR = 1.97, 95% CI (1.42, 2.72)], and acquired HIV via sexual transmission vs. injection drug use [aOR = 1.72, 95%CI (1.25, 2.35)]. Our findings highlight which subpopulations are most in need of interventions to promote ART in Kazakhstan, and also serve as an example for other countries in Central Asia for thinking about what factors are important to consider in improving HIV treatment coverage.
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Affiliation(s)
- Elizabeth J King
- School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | | | | | | | | | - Zhamilya Nugmanova
- Division of HIV Infection, Asfendiyarov Kazakh National Medical University, Almaty, Kazakhstan
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Relevance of students' demographic characteristics, sources of information and personal attitudes towards HIV testing for HIV knowledge: evidence from a post-conflict setting. J Biosoc Sci 2020; 53:1-19. [PMID: 31987058 DOI: 10.1017/s0021932019000877] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Although studies on HIV knowledge have previously been conducted in central Serbia and southern Kosovo, none has included the Serbian population residing in the northern part of the Kosovo province. The aim of this study was to assess HIV-related knowledge and to estimate factors contributing to a higher HIV-related knowledge level among Serbian university students in the Kosovo province. A cross-sectional study including 1017 first- and fourth-year students enrolled at the University of Pristina temporarily seated in Kosovska Mitrovica was carried out during the academic year 2013-2014. The students completed a 31-item questionnaire comprising demographic data, HIV transmission knowledge and attitude towards HIV testing. Data were statistically analysed. Students demonstrated good knowledge of HIV (average 32.8 ± 3.3 out of a maximum 42). Only 5% of the students reported having been tested for HIV. Factors associated with being more knowledgeable about HIV were studying health-related disciplines (β = -0.09; 95% confidence interval [CI] -0.13, 0.00), using the internet as a source of information about HIV (β = -1.09; 95% CI -1.65, -0.52), having a positive attitude towards HIV testing (β = -0.43; 95% CI -0.59, -0.26), having a low self-perceived risk for HIV infection (β = 0.41; 95% CI 0.23, 0.56) and the position that one would keep the same level of contact with an HIV-positive person after learning their HIV status (β = 0.38; 95% CI 0.21, 0.55). Setting up specialized classes on this topic at high schools and universities could help to increase the awareness of HIV infection and promote HIV testing and a positive attitude towards HIV-positive persons.
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Streinu-Cercel A, Săndulescu O, Poiană C, Dorobanţu M, Mircescu G, Lăzureanu VE, Dumitru IM, Chirilă O, Streinu-Cercel A. Consensus statement on the assessment of comorbidities in people living with HIV in Romania. Germs 2019; 9:198-210. [PMID: 32042727 DOI: 10.18683/germs.2019.1178] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 12/01/2019] [Indexed: 02/04/2023]
Abstract
Introduction The life expectancy of HIV-infected patients has been increased by highly effective therapies. People living with HIV (PLWH) in Romania are exposed to age-related comorbidities occurring earlier than in uninfected individuals. Multidisciplinary care is required to maintain the general health and quality of life in these patients. Currently, the communication among different specialties needs to be enhanced and formalized. Methods A panel consisting of 8 Romanian experts in infectious diseases, cardio-metabolic, bone, and kidney diseases and psychology met in May 2019 in Bucharest Romania to discuss the need to evaluate and monitor the most prevalent comorbidities in PLWH. The meeting resulted in practical guidance on the management of several non-infectious associated diseases. The algorithms were endorsed by the Society for Infectious Diseases and HIV/AIDS, Romania. Results The consensus statement offers practical guidance on how to assess and monitor associated diseases in adult PLWH. The recommendations are grouped for each cluster of comorbidities and are based on international guidelines and clinical experience, including landmarks for referral of PLWH to cardiology, endocrinology, nephrology specialist or clinical psychologist for additional investigations and adequate treatment. Specific indications for diagnosis or treatment were beyond the scope of this consensus. Conclusions Screening for associated diseases and adequate management are required to maintain the overall health status of PLWH. When implemented in clinical practice, the recommended algorithms should be used in addition to diagnosis and treatment guidelines and protocols. The infectious diseases specialist plays a key role in coordinating the overall treatment strategy and working within the multidisciplinary team.
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Affiliation(s)
- Anca Streinu-Cercel
- MD, PhD, Associate Professor, Department of Infectious Diseases I, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, National Institute for Infectious Diseases "Prof. Dr. Matei Balş", 1 Dr. Calistrat Grozovici Street, Bucharest 021105, Romania
| | - Oana Săndulescu
- MD, PhD, Associate Professor, Department of Infectious Diseases I, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, National Institute for Infectious Diseases "Prof. Dr. Matei Balş", 1 Dr. Calistrat Grozovici Street, Bucharest 021105, Romania
| | - Cătălina Poiană
- MD, PhD, Professor, Department of Endocrinology, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, National Institute of Endocrinology "C. I. Parhon", 34-38 Aviatorilor Boulevard, Bucharest 011863, Romania
| | - Maria Dorobanţu
- MD, PhD, Professor, Department of Cardiology, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, Clinical Emergency Hospital Floreasca, 8 Floreasca Road, Bucharest 014461, Romania
| | - Gabriel Mircescu
- MD, PhD, Professor, Department of Nephrology, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, Clinical Nephrology Hospital "Carol Davila", 4 Griviţei Road, Bucharest 010731, Romania
| | - Voichiţa Elena Lăzureanu
- MD, PhD, Associate Professor, Dr. Victor Babeş University of Medicine and Pharmacy, Timişoara, "Victor Babeş" Clinical Hospital of Infectious Diseases and Pneumology, 2 Eftimie Murgu Plaza, Timişoara, Romania
| | - Irina-Magdalena Dumitru
- MD, PhD, Associate Professor, Clinical Hospital of Infectious Diseases Constanţa; Department of Infectious Diseases, Faculty of Medicine, Ovidius University of Constanţa, 124 Mamaia Boulevard, Constanţa, Romania
| | - Odette Chirilă
- Principal Clinical Psychologist, National Institute for Infectious Diseases "Prof. Dr. Matei Balş", 1 Dr. Calistrat Grozovici Street, Bucharest 021105, Romania
| | - Adrian Streinu-Cercel
- MD, PhD, Professor, Department of Infectious Diseases I, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, National Institute for Infectious Diseases "Prof. Dr. Matei Balş", 1 Dr. Calistrat Grozovici Street, Bucharest 021105, Romania
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Mete B, Gunduz A, Bolukcu S, Karaosmanoglu HK, Yildiz D, Koç MM, Aydın OA, Dokmetas I, Tabak F. HIV care in Istanbul, Turkey: How far is it from the UNAIDS 90-90-90 targets? Int J STD AIDS 2019; 30:1298-1303. [PMID: 31726930 DOI: 10.1177/0956462419866342] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The prevalence of human immunodeficiency virus (HIV) infection is low but it is steadily increasing in Turkey. In the current study, we aimed to assess the status of HIV infection management with the proposed 90–90–90 targets in a large HIV cohort in Istanbul, Turkey. The cohort included 2382 patients (2082 male, 300 female, mean age was 36.3 ± 11.3 years). Mean CD4 cell count was 399 cells/mm3 and HIV-RNA level was 576,235 copies/ml. According to the modeling by the Modeling tool of European Center for Diseases Control Software, 72 and 74% of all HIV patients had been diagnosed in 2016 and 2017, respectively (the first target). Among 2382 patients, 2191 (92%) were on antiretroviral therapy (the second target). The third target of virally suppressing those on treatment was achieved among 70.2% of the patients. The current study suggests that both the fraction of those living with undiagnosed HIV and the proportion of those on treatment who are virally suppressed should be targeted to sustain optimal HIV care. Efforts should continue to surpass the targets of 90–90–90.
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Affiliation(s)
- Bilgul Mete
- Department of Infectious Diseases and Clinical Microbiology, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Alper Gunduz
- Department of Infectious Diseases and Clinical Microbiology, Sisli Hamidiye Etfal Egitim ve Arastirma Hastanesi, Istanbul, Turkey
| | - Sibel Bolukcu
- Infectious Diseases and Clinical Microbiology Department, Medical School, Bezmialem Vakif University, Istanbul, Turkey
| | | | - Dilek Yildiz
- Department of Infectious Diseases and Clinical Microbiology, Sisli Hamidiye Etfal Egitim ve Arastirma Hastanesi, Istanbul, Turkey
| | - Meliha M Koç
- Infectious Diseases and Clinical Microbiology Department, Medical School, Bezmialem Vakif University, Istanbul, Turkey
| | - Ozlem A Aydın
- Bakirkoy Dr Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Ilyas Dokmetas
- Department of Infectious Diseases and Clinical Microbiology, Sisli Hamidiye Etfal Egitim ve Arastirma Hastanesi, Istanbul, Turkey
| | - Fehmi Tabak
- Department of Infectious Diseases and Clinical Microbiology, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
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Sarigül F, Sayan M, İnan D, Deveci A, Ceran N, Çelen MK, Çağatay A, Özdemir HÖ, Kuşcu F, Karagöz G, Heper Y, Karabay O, Dokuzoğuz B, Kaya S, Erben N, Karaoğlan İ, Ersöz GM, Günal Ö, Hatipoğlu Ç, Kutlu SS, Akbulut A, Saba R, Şener A, Büyüktuna SA. Current status of HIV/AIDS-syphilis co-infections: a retrospective multicentre study. Cent Eur J Public Health 2019; 27:223-228. [PMID: 31580558 DOI: 10.21101/cejph.a5467] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 08/22/2019] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Treponema pallidum and HIV are transmitted frequently through sexual contact, these agents with epidemiological similarities co-infect the same host. The current number of HIV-infected cases in Turkey is increasing. For this reason, we aimed to reveal the characteristics of syphilis in HIV/AIDS cases. METHODS A retrospective longitudinal cohort study was performed, patients were followed up at 24 clinics in 16 cities from all seven regions of Turkey between January 2010 to April 2018. We examined the socio-demographic characteristics, laboratory parameters and neurosyphilis association in HIV/AIDS-syphilis co-infected cases. RESULTS Among 3,641 patients with HIV-1 infection, 291 (8%) patients were diagnosed with syphilis co-infection. Most patients were older than 25 years (92%), 96% were males, 74% were working, 23% unemployed, and 3% were students. The three highest prevalence of syphilis were in Black Sea (10.3%), Mediterranean (8.4%) and Marmara Regions (7.4%). As for sexual orientation, 46% were heterosexuals, 42% men who have sex with men (MSM), and no data available for 12%. Patients with the number of CD4+ ≤ 350 mm3 reached 46%, 17% of the patients received antiretroviral therapy and neurosyphilis association reached 9%. CONCLUSION Although HIV/AIDS-syphilis co-infection status appeared high in heterosexuals, MSM had a moderate level increase in cases. Our results suggested syphilis co-infection in HIV/AIDS cases should be integral part of monitoring in a national sexual transmitted diseases surveillance system. However, our data may provide base for HIV/syphilis prevention and treatment efforts in the future.
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Affiliation(s)
- Figen Sarigül
- Infectious Disease and Clinical Microbiology Department, Antalya and Research Hospital, Health Sciences University, Antalya, Turkey
| | - Murat Sayan
- PCR Unit, Clinical Laboratory, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey.,Research Centre of Experiment Health Sciences, Near East University, Nicosia, Northern Cyprus
| | - Dilara İnan
- Infectious Disease and Clinical Microbiology Department, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - Aydin Deveci
- Infectious Disease and Clinical Microbiology Department, Faculty of Medicine, Samsun 19 Mayis University, Samsun, Turkey
| | - Nurgül Ceran
- Infectious Disease and Clinical Microbiology Department, Istanbul Haydarpasa Numune Education and Research Hospital, Health Sciences University, Istanbul, Turkey
| | - Mustafa Kemal Çelen
- Infectious Disease and Clinical Microbiology Department, Faculty of Medicine, Diyarbakir University, Diyarbakir, Turkey
| | - Atahan Çağatay
- Infectious Disease and Clinical Microbiology Department, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Hülya Özkan Özdemir
- Infectious Disease and Clinical Microbiology Department, Bozyaka Education and Research Hospital, Health Sciences University, Izmir, Turkey
| | - Ferit Kuşcu
- Infectious Disease and Clinical Microbiology Department, Faculty of Medicine, Cukurova University, Adana, Turkey
| | - Gül Karagöz
- Infectious Disease and Clinical Microbiology Department, Istanbul Umraniye Education and Research Hospital, Health Sciences University, Istanbul, Turkey
| | - Yasemin Heper
- Infectious Disease and Clinical Microbiology Department, Faculty of Medicine, Bursa University, Bursa, Turkey
| | - Oğuz Karabay
- Infectious Disease and Clinical Microbiology Department, Faculty of Medicine, Sakarya University, Sakarya, Turkey
| | - Başak Dokuzoğuz
- Infectious Disease and Clinical Microbiology Department, Ankara Numune Education and Research Hospital, Health Sciences University, Ankara, Turkey
| | - Selçuk Kaya
- Infectious Disease and Clinical Microbiology Department, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Nurettin Erben
- Infectious Disease and Clinical Microbiology Department, Faculty of Medicine, Eskisehir University, Eskisehir, Turkey
| | - İlkay Karaoğlan
- Infectious Disease and Clinical Microbiology Department, Faculty of Medicine, Gaziantep University, Gaziantep, Turkey
| | - Gülden Munis Ersöz
- Infectious Disease and Clinical Microbiology Department, Faculty of Medicine, Mersin University, Mersin, Turkey
| | - Özgür Günal
- Infectious Disease and Clinical Microbiology Department, Samsun Education and Research Hospital, Health Sciences University, Samsun, Turkey
| | - Çiğdem Hatipoğlu
- Infectious Disease and Clinical Microbiology Department, Ankara Education and Research Hospital, Health Sciences University, Ankara, Turkey
| | - Selda Sayin Kutlu
- Infectious Disease and Clinical Microbiology Department, Faculty of Medicine, Pamukkale University, Denizli, Turkey
| | - Ayhan Akbulut
- Infectious Disease and Clinical Microbiology Department, Faculty of Medicine, Firat University, Elazig, Turkey
| | - Rabin Saba
- Infectious Disease and Clinical Microbiology Department, Private Medstar Antalya Hospital, Antalya, Turkey
| | - Alper Şener
- Infectious Disease and Clinical Microbiology Department, Faculty of Medicine, Onsekiz Mart University, Canakkale, Turkey
| | - Seyit Ali Büyüktuna
- Infectious Disease and Clinical Microbiology Department, Faculty of Medicine, Cumhuriyet University, Sivas, Turkey
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Bereczky T. U=U is a blessing: but only for patients with access to HIV treatment: an essay by Tamás Bereczky. BMJ 2019; 366:l5554. [PMID: 31530547 DOI: 10.1136/bmj.l5554] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Tamás Bereczky
- European Patients' Academy for Therapeutic Innovation, Berlin, Germany
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Emlet CA, O'Brien KK, Fredriksen Goldsen K. The Global Impact of HIV on Sexual and Gender Minority Older Adults: Challenges, Progress, and Future Directions. Int J Aging Hum Dev 2019; 89:108-126. [PMID: 31006251 DOI: 10.1177/0091415019843456] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
According to Joint United Nations Programme on HIV/AIDS (UNAIDS) data, 36.9 million people are living with HIV worldwide. Older adults, those aged 50 years and older, with HIV are increasing worldwide; however, the prevalence and incidence differ substantially across regions. The purpose of this article is to provide an overview of how HIV is impacting older adults globally, with a focus on sexual and gender minority older adults. The article is organized using the eight geographical regions from UNAIDS, with information on the prevalence and incidence among older adults. Among sexual and gender minority older adults, key risks are identified, including laws that criminalize same-sex relationships; issues of stigma and fear; and the concomitant lack of access and barriers to HIV testing, treatment, and prevention. Progress within each region toward the UNAIDS 90-90-90 targets is included, and suggestions for future directions of research and service delivery are made.
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Matulionytė R, Žagminas K, Balčiūnaitė E, Matulytė E, Paulauskienė R, Bajoriūnienė A, Ambrozaitis A. Routine HIV testing program in the University Infectious Diseases Centre in Lithuania: a four-year analysis. BMC Infect Dis 2019; 19:21. [PMID: 30616558 PMCID: PMC6322331 DOI: 10.1186/s12879-018-3661-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 12/26/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND HIV transmission remains a major concern in Eastern Europe, and too many people are diagnosed late. Expanded testing strategies and early and appropriate access to care are required. Infectious disease departments might be targets for expanded HIV testing owing to the intense passage of key patient populations that carry indicators of HIV disease. Our objective was to evaluate the feasibility and clinical effectiveness of a fully integrated, opt-out routine, rapid HIV testing program. METHODS A retrospective four-year study of a screening program was conducted from 2010 through 2014. The program was divided into two periods: from 2010 to 2012 (pilot study) and from 2013 to 2014. The pilot study consisted of routine HIV testing of patients aged 18-55 that were hospitalized in one department. In the second period, all inpatients aged 18-65 were eligible. Targeted testing was conducted in the other inpatient department during the pilot study and the outpatient department during both periods. RESULTS During the pilot study, 2203 patients were hospitalized, 1314 (59.6%) were eligible, 954 (72.6%) were tested, and 3 (0.31%) were newly diagnosed HIV-positive. In the second period, 4911 patients were hospitalized, 3727 (75.9%) were eligible, 3303 (88.6%) were tested, and 7 (0.21%) were HIV-positive. In total, 2800 targeted tests were performed, and 4 (0.14%) patients tested positive with newly discovered HIV. All 14 newly diagnosed patients were provided with care. Comparing cumulative groups of routine and targeted testing, the HIV prevalence was 0.23% vs. 0.14% (p = 0.40) and was above the reported cost-effectiveness threshold of 0.1% (p = 0.012). A lower proportion of advanced disease and a higher proportion of heterosexually transmitted infection were found in the routine testing group. CONCLUSION Routine HIV testing in admissions of infectious diseases is acceptable, feasible, sustainable and clinically effective. Compared to targeted testing, routine testing helped to discover more patients in earlier stages and those with heterosexually transmitted HIV infection.
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Affiliation(s)
- Raimonda Matulionytė
- Department of Infectious Diseases and Dermatovenerology, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
- Infectious Diseases Centre, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Kęstutis Žagminas
- Institute of Health Sciences, Vilnius University, Vilnius, Lithuania
| | - Eglė Balčiūnaitė
- Centre of Laboratory Medicine, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Elžbieta Matulytė
- Department of Infectious Diseases and Dermatovenerology, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
- Infectious Diseases Centre, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Rasutė Paulauskienė
- Infectious Diseases Centre, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Almina Bajoriūnienė
- Centre of Laboratory Medicine, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Arvydas Ambrozaitis
- Department of Infectious Diseases and Dermatovenerology, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
- Infectious Diseases Centre, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
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