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A Network Approach to Determine Optimization of PrEP Uptake in Athens, Greece. AIDS Behav 2022; 26:2703-2712. [PMID: 35147808 DOI: 10.1007/s10461-022-03581-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2022] [Indexed: 11/01/2022]
Abstract
Although the HIV epidemic in Athens, Greece has reemerged and spread in men who have sex with men (MSM), state-supported PrEP programs have not been instituted. A PrEP intervention was implemented building upon an existing network cohort of MSM (308 participants; 1212 network members). A PrEP intervention cohort of 106 participants was selected based upon sex behaviors. Individual, partner, and network characteristics were compared between the cohorts. The PrEP cohort members were more highly connected and in more influential positions in the network than their peers. Further, their sexual network connections' behaviors increased their vulnerability to HIV infection relative to the rest of the network's sex partners. This included greater stimulant use (24.2% vs 7.0%; χ2 = 28.2; p < 0.001), greater rates of at least weekly condomless sex (OR = 2.7; 95% CI 2.1-3.5; χ2 = 59.2; p < 0.001) and at least weekly use of drugs or alcohol during sex (OR = 3.4; 95% CI 2.6-4.3; χ2 = 89.7; p < 0.001). Finally the PrEP cohort's social networks showed similarly increased vulnerability to seroconversion, including greater rates of injection drug use (4.1% vs 0.5%; χ2 = 3.9; p = 0.04), greater stimulant use (33.6% vs 14.6%; χ2 = 16.9, p < 0.001), and higher rates of recent STIs (21.6% vs 13.1%; χ2 = 4.4; p = 0.04). Thus, this PrEP intervention engaged individuals in vulnerable positions with vulnerable connections within an MSM community.
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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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Stoycheva MV, Vatev NT, Georgieva VB, Dineva AP, Atanasova MV, Popova TA. Lethality among Patients with HIV/AIDS Monitored in the Clinic of Infectious Diseases in St George University Hospital, Plovdiv, 2010-2014. Folia Med (Plovdiv) 2019; 59:454-460. [PMID: 29341953 DOI: 10.1515/folmed-2017-0052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Accepted: 03/22/2017] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The introduction of complex antiretroviral therapy has resulted in signifi cant decrease in the mortality rate of HIV positive patients, but it still remains unacceptably high, especially in some groups of patients. AIM To investigate the death rate in patients with HIV/AIDS, lethality and mortality in co-infection, and the most common causes and predictors of fatal outcome, focused on early diagnosis and appropriate therapy. MATERIALS AND METHODS The study included 53 deceased patients with HIV/AIDS, monitored at the Clinic of Infectious Diseases in St George University Hospital, Plovdiv between 01.01.2010 and 31.12.2014. The methods of research included clinical analysis, laboratory tests, microbiological and serological tests (HCV, HBV, toxoplasmosis), ELISA, PCR. Statistical analysis was performed by descriptive statistics, the Student's t-test, the method of Van der Ward, and regression analysis (logistic regression). RESULTS During the study period 316 patients with HIV/AIDS were monitored, 53 of them with lethal outcome. Lethality was 16.7% for the whole group; in intravenous drug users - 13.8%; in co-infected patients: HIV/M. tuberculosis - 46%, in HIV/HCV - 17.8%. Lethality and mortality in HIV(+) patients with co-infections in populations of diff erent age, gender, duration since starting сАRТ and degree of immunodefi ciency (according to CD4, VL) was compared with the lethality and mortality in patients with these conditions from the general population. CONCLUSIONS Fatal outcome in patients with HIV/AIDS was most commonly associated with co-infections HIV/M. tuberculosis and HIV/HCV. Predictors of a fatal outcome are pulmonary tuberculosis, advanced immunodefi ciency with VL> 500 000 c/μL and CD4 <100/mm3, absence or non-systemic antiretroviral therapy.
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Affiliation(s)
- Mariyana V Stoycheva
- Clinic of Infectious Diseases, St George University Hospital, Plovdiv, Bulgaria.,Department of Infectious Diseases, Parasitology and Tropical Medicine, Faculty of Medicine, Medical University of Plovdiv, Plovdiv, Bulgaria
| | - Nikolay T Vatev
- Department of Epidemiology, Faculty of Public Health, Medical University of Plovdiv, Plovdiv, Bulgaria
| | - Vania B Georgieva
- Clinic of Infectious Diseases, St George University Hospital, Plovdiv, Bulgaria.,Department of Infectious Diseases, Parasitology and Tropical Medicine, Faculty of Medicine, Medical University of Plovdiv, Plovdiv, Bulgaria
| | - Antonina P Dineva
- Clinic of Infectious Diseases, St George University Hospital, Plovdiv, Bulgaria
| | - Maria V Atanasova
- Department of Microbiology and Immunology, Faculty of Pharmacy, Medical University of Plovdiv, Plovdiv, Bulgaria
| | - Tatiana A Popova
- Department of Microbiology and Immunology, Faculty of Pharmacy, Medical University of Plovdiv, Plovdiv, Bulgaria
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Arendt V, Guillorit L, Origer A, Sauvageot N, Vaillant M, Fischer A, Goedertz H, François JH, Alexiev I, Staub T, Seguin-Devaux C. Injection of cocaine is associated with a recent HIV outbreak in people who inject drugs in Luxembourg. PLoS One 2019; 14:e0215570. [PMID: 31095576 PMCID: PMC6522034 DOI: 10.1371/journal.pone.0215570] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 04/04/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND An outbreak of HIV infections among people who inject drugs (PWID) started in 2014 in Luxembourg. OBJECTIVES We conducted phylogenetic and epidemiological analyses among the PWID infected with HIV in Luxembourg or attending the supervised drug consumption facility (SDCF) to understand the main causes of the outbreak. METHODS Between January 2013 and December 2017, analysis of medical files were performed from all PWID infected with HIV at the National Service of Infectious Diseases (NSID) providing clinical care nationwide. PWID were interviewed at NSID and SDCF using a standardized questionnaire focused on drug consumption and risk behaviours. The national drug monitoring system RELIS was consulted to determine the frequency of cocaine/heroin use. Transmission clusters were analysed by phylogenetic analyses using approximate maximum-likelihood. Univariate and multivariate logistic regression analyses were performed on epidemiological data collected at NSID and SDCF to determine risk factors associated with cocaine use. RESULTS From January 2013 to December 2017, 68 new diagnosis of HIV infection reported injecting drug use as the main risk of transmission at NSID. The proportion of female cases enrolled between 2013-2017 was higher than the proportion among cases enrolled prior to 2013. (33% vs 21%, p < 0.05). Fifty six viral sequences were obtained from the 68 PWID newly diagnosed for HIV. Two main transmission clusters were revealed: one HIV-1 subtype B cluster and one CRF14_BG cluster including 37 and 9 patients diagnosed since 2013, respectively. Interviews from 32/68 (47%) newly diagnosed PWID revealed that 12/32 (37.5%) were homeless and 27/32 (84.4%) injected cocaine. Increased cocaine injection was indeed reported by the RELIS participants from 53 to 63% in drug users with services contacts between 2012 and 2015, and from 5 to 22% in SDCF users between 2012 and 2016. Compared with PWID who injected only heroin (n = 63), PWID injecting cocaine and heroin (n = 107) were younger (mean of 38 vs 44 years, p≤0.001), reported more frequent piercing (≤0.001), shared and injected drugs more often (p≤0.01), and were more frequently HIV positive (p<0.05) at SDCF using univariate logistic regression analysis. Finally, in the multivariate analysis, use of heroin and cocaine was independently associated with younger age, piercing, sharing of drugs, and regular consumption (p<0.05). CONCLUSIONS Injecting cocaine is a new trend of drug use in Luxembourg associated with HIV infection in this recent outbreak among PWID.
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Affiliation(s)
- Vic Arendt
- Service National des Maladies Infectieuses, Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg
| | - Laurence Guillorit
- Department of Infection and Immunity, Luxembourg Institute of Health, Esch sur Alzette, Luxembourg
| | - Alain Origer
- National Drug Coordinator, Ministry of Health, Luxembourg, Luxembourg
| | - Nicolas Sauvageot
- Competence Center for Methodology and Statistics, Luxembourg Institute of Health, Strassen, Luxembourg
| | - Michel Vaillant
- Competence Center for Methodology and Statistics, Luxembourg Institute of Health, Strassen, Luxembourg
| | - Aurélie Fischer
- Clinical and Epidemiological Investigation Center, Luxembourg Institute of Health, Strassen, Luxembourg
| | | | - Jean-Hugues François
- Molecular Biology Laboratory, Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg
| | - Ivailo Alexiev
- National Reference Laboratory of HIV, National Center of Infectious and Parasitic Diseases, Sofia, Bulgaria
| | - Thérèse Staub
- Service National des Maladies Infectieuses, Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg
| | - Carole Seguin-Devaux
- Department of Infection and Immunity, Luxembourg Institute of Health, Esch sur Alzette, Luxembourg
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Alexiev I, Lo Presti A, Dimitrova R, Foley B, Gancheva A, Kostadinova A, Nikolova L, Angeletti S, Cella E, Elenkov I, Stoycheva M, Nikolova D, Doychinova T, Pekova L, Ciccozzi M. Origin and Spread of HIV-1 Subtype B Among Heterosexual Individuals in Bulgaria. AIDS Res Hum Retroviruses 2018; 34:244-253. [PMID: 29258326 DOI: 10.1089/aid.2017.0167] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Human immunodeficiency virus (HIV) was originally introduced in Bulgaria through heterosexual transmission (HET) and later transferred to other vulnerable groups along with numerous more recent introductions from outside Bulgaria. To define the diversity, origins, and dynamics of the HIV-1 subtypes prevalent in HET population in Bulgaria, we applied phylogenetic and phylodynamic analyses using polymerase (pol) sequences from HET individuals to infer the spatiotemporal evolutionary history of the HIV-1 epidemic in this population in Bulgaria. High genetic diversity was found, including 13 different HIV-1 subtypes: 45.7% subtype B, 19.9% CRF01_AE, 7.5% CRF02_AG, 7.5% sub-subtypes A1 and A6, 7.1% subtype C, 5.3% subtype F1, 4.0% URFs, 1.2% CRF05_DF, 0.6% subtype G, 0.3% CRF04_cpx, 0.3% CRF29_BF, 0.3% CRF14_BG, and 0.3% subtype H. The estimated root of the subtype B in the phylogenetic tree dated back to the year 1980 largely due to multiple introductions of subtype B from outside the country. Several significant clades have been identified highlighting six different main epidemic entrances of subtype B dating from 1989 to 2007. The Bayesian skyline plot showed two different exponential growth periods starting in the 1980s to 1990 followed by a constant phase up to about 2008, with another exponential growth period from 2008 to the year 2012. The migration analysis identified dynamic pattern of gene flow and demonstrated that many HET probably acquired the infection abroad (14.6%), while only (6.6%) of non-HET were infected outside country. The phylogenetic analysis showed an intermixing between sequences from Bulgarians with sequences from other countries, suggesting different HIV introduction in this country followed by the internal spread through local transmission networks.
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Affiliation(s)
- Ivailo Alexiev
- National Reference Laboratory of HIV, National Center of Infectious and Parasitic Diseases, Sofia, Bulgaria
| | - Alessandra Lo Presti
- Epidemiology Unit, Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Reneta Dimitrova
- National Reference Laboratory of HIV, National Center of Infectious and Parasitic Diseases, Sofia, Bulgaria
| | - Brian Foley
- Theoretical Biology and Biophysics Group, Los Alamos National Laboratory, Los Alamos, New Mexico
| | - Anna Gancheva
- National Reference Laboratory of HIV, National Center of Infectious and Parasitic Diseases, Sofia, Bulgaria
| | - Asya Kostadinova
- National Reference Laboratory of HIV, National Center of Infectious and Parasitic Diseases, Sofia, Bulgaria
| | - Lora Nikolova
- National Reference Laboratory of HIV, National Center of Infectious and Parasitic Diseases, Sofia, Bulgaria
| | - Silvia Angeletti
- Unit of Clinical Pathology and Microbiology, University Campus Bio-Medico, Rome, Italy
| | - Eleonora Cella
- Unit of Clinical Pathology and Microbiology, University Campus Bio-Medico, Rome, Italy
- Public Health and Infectious Diseases, University of Rome La Sapienza, Rome, Italy
| | - Ivaylo Elenkov
- Hospital for Infectious and Parasitic Diseases, Sofia, Bulgaria
| | - Mariyana Stoycheva
- Department of Infectious Diseases, Medical University, Plovdiv, Bulgaria
| | | | - Tsetsa Doychinova
- Department of Infectious Diseases, Medical University, Pleven, Bulgaria
| | - Liliya Pekova
- Clinic of Infectious Diseases, University Hospital, Stara Zagora, Bulgaria
| | - Massimo Ciccozzi
- Epidemiology Unit, Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
- Unit of Clinical Pathology and Microbiology, University Campus Bio-Medico, Rome, Italy
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Alexiev I, Shankar A, Dimitrova R, Gancheva A, Kostadinova A, Teoharov P, Golkocheva E, Nikolova M, Muhtarova M, Elenkov I, Stoycheva M, Nikolova D, Varleva T, Switzer WM. Origin and spread of HIV-1 in persons who inject drugs in Bulgaria. INFECTION, GENETICS AND EVOLUTION : JOURNAL OF MOLECULAR EPIDEMIOLOGY AND EVOLUTIONARY GENETICS IN INFECTIOUS DISEASES 2016; 46:269-278. [PMID: 27221346 PMCID: PMC11318570 DOI: 10.1016/j.meegid.2016.05.029] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2016] [Revised: 05/18/2016] [Accepted: 05/20/2016] [Indexed: 01/15/2023]
Abstract
Increased HIV transmission in persons who inject drugs (PWIDs) has led to subepidemics and outbreaks in several countries in Europe, including Bulgaria. In this study in Bulgaria, we investigate the origin and spatiotemporal evolutionary history of HIV-1 infections in PWIDs and the distribution of antiretroviral resistance mutations and hepatitis co-infections in these populations. We analyzed HIV-1 polymerase sequences available from 117 of 359 PWIDs diagnosed with HIV/AIDS from 1999 to 2011. Of these, 50 (42.7%) were classified as CRF02_AG, 41 (35.0%) CRF01_AE, 12 (10.3%) URFs, ten (8.5%) subtype B, two (1.7%) subtype F1 and two (1.7%) CRF14_BG. Most recent common ancestor dating suggests that CRF01_AE was likely first introduced from Southeast Asia into persons reporting heterosexual infection in Bulgaria in 1992 and spread subsequently to PWIDs in the capital city of Sofia around 2003. Conversely, CRF02_AG in Bulgaria was likely first introduced into PWID from Germany in 2000 and later entered heterosexual populations around 2009. The overall prevalence of resistance mutations was 6.8% (8/117), of which 5.1% (5/117) was observed in patients on antiretroviral therapy and 1.7% (2/117) was from transmitted drug resistance mutations in drug-naïve individuals. 189/204 (92.6%) PWIDs were also co-infected with hepatitis C (HCV) and 31/183 (16.9%) were co-infected with hepatitis B (HBV). Our study provides valuable molecular epidemiological information on the introduction and distribution of the main HIV-1 subtypes, resistance mutations and hepatitis co-infections among PWIDs with HIV-1 in Bulgaria which can be used to target prevention efforts.
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Affiliation(s)
- Ivailo Alexiev
- National Reference Laboratory of HIV, National Center of Infectious and Parasitic Diseases, Sofia, Bulgaria.
| | - Anupama Shankar
- Laboratory Branch, Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Reneta Dimitrova
- National Reference Laboratory of HIV, National Center of Infectious and Parasitic Diseases, Sofia, Bulgaria
| | - Anna Gancheva
- National Reference Laboratory of HIV, National Center of Infectious and Parasitic Diseases, Sofia, Bulgaria
| | - Asia Kostadinova
- National Reference Laboratory of HIV, National Center of Infectious and Parasitic Diseases, Sofia, Bulgaria
| | - Pavel Teoharov
- National Reference Laboratory of Hepatitis, National Center of Infectious and Parasitic Diseases, Sofia, Bulgaria
| | - Elitsa Golkocheva
- National Reference Laboratory of Hepatitis, National Center of Infectious and Parasitic Diseases, Sofia, Bulgaria
| | - Maria Nikolova
- National Reference Laboratory of Immunology, National Center of Infectious and Parasitic Diseases, Sofia, Bulgaria
| | - Mariya Muhtarova
- National Reference Laboratory of Immunology, National Center of Infectious and Parasitic Diseases, Sofia, Bulgaria
| | - Ivaylo Elenkov
- Hospital for Infectious and Parasitic Diseases, Sofia, Bulgaria
| | - Mariyana Stoycheva
- Department of Infectious Diseases, Medical University, Plovdiv, Bulgaria
| | - Daniela Nikolova
- Clinic of Infectious Diseases, Medical University, Varna, Bulgaria
| | - Tonka Varleva
- Program Prevention and Control of HIV/AIDS, Ministry of Health, Sofia, Bulgaria
| | - William M Switzer
- Laboratory Branch, Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Sargin F, Goktas S. HIV prevalence among men who have sex with men in Istanbul. Int J Infect Dis 2016; 54:58-61. [PMID: 27894981 DOI: 10.1016/j.ijid.2016.11.406] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Revised: 11/12/2016] [Accepted: 11/20/2016] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES The re-emergence of the HIV epidemic among men who have sex with men (MSM) represents a serious health issue. This study aimed to assess the HIV prevalence among MSM in a very low prevalence population of a large city. METHODS A public campaign to raise awareness of HIV infection and to provide access to anonymous testing was conducted in places frequented by MSM and through a mobile phone application. No identity information was requested from individuals contacting the call centre, and anonymous and free HIV testing was offered proactively. Those who agreed to have a test were provided a code number, which was used in blood sampling procedures. RESULTS Of 1200 subjects who contacted the call centre, 197 consented to undergo HIV testing and visited the laboratory to give a blood sample. Twenty-five subjects were found to have a reactive ELISA result on two different occasions plus a positive Western blot test result. Thus, the HIV prevalence in this group of MSM was 12.7%. CONCLUSIONS MSM remain a high risk group for HIV infection in a low prevalence setting, and thus represent a key target population for diagnostic and therapeutic interventions.
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Affiliation(s)
- Fatma Sargin
- Department of Infectious Diseases and Clinical Microbiology, Istanbul Medeniyet University, Goztepe Training and Research Hospital, Istanbul, Turkey.
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Handanagic S, Bozicevic I, Civljak M, Dominkovic Z, Sevic S, Barbaric J, Nemeth Blazic T, Dakovic Rode O, Begovac J. HIV and hepatitis C prevalence, and related risk behaviours among people who inject drugs in three cities in Croatia: Findings from respondent-driven sampling surveys. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2016; 32:57-63. [PMID: 27160504 DOI: 10.1016/j.drugpo.2016.04.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Revised: 03/30/2016] [Accepted: 04/07/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND There are limited data on HIV and hepatitis C virus (HCV) epidemiology among people who inject drugs (PWID) in Croatia. This study aims to provide data on HIV and HCV prevalence and sexual and injecting risk behaviours among PWID in Zagreb, Split, and Rijeka. METHODS Using respondent-driven sampling (RDS) we recruited from November 2014 to February 2015 a total of 176 PWID in Zagreb, 255 in Rijeka and 399 in Split. Participants provided biological specimens for HIV and HCV testing and completed a behavioural questionnaire. RESULTS The proportion of female PWID ranged from 19.5% in Zagreb to 26.0% in Split. In the month before the survey, 2.5% of PWID in Split, 5.6% in Rijeka and 8.0% in Zagreb reported sharing non-sterile needles and syringes. Many PWID injected opioid substitution therapy (OST) in the month before the survey (57.0% in Zagreb and 57.5% in Split and Rijeka, respectively). Among PWID who had a casual sexual partner in the past 12 months (ranging from 39.2% in Split to 44.4% in Rijeka) condom use was low. Although HIV prevalence was low (0.2% in Rijeka and Zagreb, 0.3% in Split), HCV antibody prevalence was considerable (29.1% in Zagreb, 31.5% in Rijeka, 38.3% in Split). HIV and HCV testing coverage in the past 12 months was insufficient (6.8% and 7.0% in Split; 13.2% and 13.5% in Zagreb; 20.2% and 21.5% in Rijeka, respectively). CONCLUSION We found a low-level HIV epidemic and a sizable HCV epidemic among PWID in Zagreb, Split and Rijeka. Presence of high-risk injecting and sexual behaviours together with inadequate HIV and HCV testing coverage call for development of a comprehensive approach to harm reduction and introduction of needle and syringe exchange programmes in prisons, as well as strengthening sexual health interventions.
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Affiliation(s)
- Senad Handanagic
- WHO Collaborating Centre for HIV Surveillance, Andrija Stampar School of Public Health, School of Medicine, University of Zagreb, Rockefellerova 4, 10000, Zagreb, Croatia.
| | - Ivana Bozicevic
- WHO Collaborating Centre for HIV Surveillance, Andrija Stampar School of Public Health, School of Medicine, University of Zagreb, Rockefellerova 4, 10000, Zagreb, Croatia
| | - Marta Civljak
- Andrija Stampar School of Public Health, School of Medicine, University of Zagreb, Rockefellerova 4, 10000, Zagreb, Croatia
| | - Zoran Dominkovic
- WHO Collaborating Centre for HIV Surveillance, Andrija Stampar School of Public Health, School of Medicine, University of Zagreb, Rockefellerova 4, 10000, Zagreb, Croatia
| | - Sandra Sevic
- Department of Sociology, Faculty of Humanities and Social Sciences, University of Zagreb, Ivana Lucica 3, 10000, Zagreb, Croatia
| | - Jelena Barbaric
- WHO Collaborating Centre for HIV Surveillance, Andrija Stampar School of Public Health, School of Medicine, University of Zagreb, Rockefellerova 4, 10000, Zagreb, Croatia
| | | | - Oktavija Dakovic Rode
- University Hospital for Infectious Diseases "Dr Fran Mihaljevic", School of Medicine, University of Zagreb, Mirogojska 8, 10000, Zagreb, Croatia
| | - Josip Begovac
- University Hospital for Infectious Diseases "Dr Fran Mihaljevic", School of Medicine, University of Zagreb, Mirogojska 8, 10000, Zagreb, Croatia
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McLarty L, Becker M, Pavlova D, Isak S, Emmanuel F, Balakireva O, Bondar T, Sazonova Y, Sakovych O, Blanchard J. Characterizing HIV risk and vulnerability among commercial sex workers in Zaporizhzhya, Ukraine. ACTA ACUST UNITED AC 2016. [DOI: 10.15407/socium2016.01.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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11
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Csete J, Kamarulzaman A, Kazatchkine M, Altice F, Balicki M, Buxton J, Cepeda J, Comfort M, Goosby E, Goulão J, Hart C, Kerr T, Lajous AM, Lewis S, Martin N, Mejía D, Camacho A, Mathieson D, Obot I, Ogunrombi A, Sherman S, Stone J, Vallath N, Vickerman P, Zábranský T, Beyrer C. Public health and international drug policy. Lancet 2016; 387:1427-1480. [PMID: 27021149 PMCID: PMC5042332 DOI: 10.1016/s0140-6736(16)00619-x] [Citation(s) in RCA: 305] [Impact Index Per Article: 38.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
In September 2015, the member states of the United Nations endorsed sustainable development goals (SDG) for 2030 that aspire to human rights-centered approaches to ensuring the health and well-being of all people. The SDGs embody both the UN Charter values of rights and justice for all and the responsibility of states to rely on the best scientific evidence as they seek to better humankind. In April 2016, these same states will consider control of illicit drugs, an area of social policy that has been fraught with controversy, seen as inconsistent with human rights norms, and for which scientific evidence and public health approaches have arguably played too limited a role. The previous UN General Assembly Special Session (UNGASS) on drugs in 1998 – convened under the theme “a drug-free world, we can do it!” – endorsed drug control policies based on the goal of prohibiting all use, possession, production, and trafficking of illicit drugs. This goal is enshrined in national law in many countries. In pronouncing drugs a “grave threat to the health and well-being of all mankind,” the 1998 UNGASS echoed the foundational 1961 convention of the international drug control regime, which justified eliminating the “evil” of drugs in the name of “the health and welfare of mankind.” But neither of these international agreements refers to the ways in which pursuing drug prohibition itself might affect public health. The “war on drugs” and “zero-tolerance” policies that grew out of the prohibitionist consensus are now being challenged on multiple fronts, including their health, human rights, and development impact. The Johns Hopkins – Lancet Commission on Drug Policy and Health has sought to examine the emerging scientific evidence on public health issues arising from drug control policy and to inform and encourage a central focus on public health evidence and outcomes in drug policy debates, such as the important deliberations of the 2016 UNGASS on drugs. The Johns Hopkins-Lancet Commission is concerned that drug policies are often colored by ideas about drug use and drug dependence that are not scientifically grounded. The 1998 UNGASS declaration, for example, like the UN drug conventions and many national drug laws, does not distinguish between drug use and drug abuse. A 2015 report by the UN High Commissioner for Human Rights, by contrast, found it important to emphasize that “[d]rug use is neither a medical condition nor does it necessarily lead to drug dependence.” The idea that all drug use is dangerous and evil has led to enforcement-heavy policies and has made it difficult to see potentially dangerous drugs in the same light as potentially dangerous foods, tobacco, alcohol for which the goal of social policy is to reduce potential harms.
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Affiliation(s)
| | | | - Michel Kazatchkine
- UN Special Envoy, HIV in Eastern Europe and Central Asia, Geneva, Switzerland
| | | | | | | | - Javier Cepeda
- Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Eric Goosby
- University of California, San Francisco, San Francisco, CA, USA
| | | | - Carl Hart
- Columbia University, New York City, NY, USA
| | - Thomas Kerr
- University of British Columbia, Center of Excellence in HIV/AIDS, Vancouver, BC, Canada
| | | | | | | | | | | | | | | | | | - Susan Sherman
- Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Nandini Vallath
- Trivandrum Institute of Palliative Sciences, Trivandrum, India
| | | | | | - Chris Beyrer
- Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
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Soodla P, Rajasaar H, Avi R, Zilmer K, Kink K, Novikova L, Huik K, Maimets M, Lutsar I. Design and structure of the Estonian HIV Cohort Study (E-HIV). Infect Dis (Lond) 2015; 47:768-75. [PMID: 26153824 DOI: 10.3109/23744235.2015.1061203] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Estonia is experiencing the new Eastern Europe human immunodeficiency virus (HIV) epidemic, with the highest incidence of new infections in the EU. We describe demographic changes, HIV-related laboratory parameters and co-infections during the concentrated HIV epidemic using the Estonian HIV Cohort Study (E-HIV) database, founded in 2009. METHODS All 3750 subjects in the E-HIV database on December 31, 2013 were included. Subjects were divided into risk groups: people who inject drugs (PWIDs), sexual transmission (heterosexual/homosexual), and other (perinatal) or unknown risk group. Subjects diagnosed before 2009 (first period) and after (second period) were analyzed separately. RESULTS The mean age at diagnosis has increased from 22.8 years (interquartile range (IQR) = 19.5-27.2) to 29.7 years (IQR = 25.3-36.2) (p < 0.001) between the first and second periods. PWIDs were younger than other transmission groups (23.2 vs 27.1; p < 0.001). There is a statistical difference in the route of transmission among genders, with overall increasing sexual transmission. The most common AIDS-defining illness was tuberculosis (0.5%). HIV/hepatitis C (HCV) co-infection was diagnosed in 42% of cases. The population median CD4 + cell count at diagnosis has declined over the years; in total 53% have been late presenters. Half of the patients are receiving antiretroviral treatment (cART). The most common combinations are nucleoside reverse transcriptase inhibitor (NRTI) backbone plus protease inhibitors (PIs) (57%) or NRTI backbone + non-NRTIs (42%). CONCLUSION The E-HIV enables us to fill the gap in the lack of data on the course of the new Eastern European HIV epidemic. These data demonstrate that the HIV epidemic in Estonia is moving from PWIDs to the general population, suggesting that prevention measures and testing guidelines should be revised.
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Affiliation(s)
- Pilleriin Soodla
- From the Institute of Microbiology, Faculty of Medicine, University of Tartu , Tartu , Estonia
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Begovac J, Dragović G, Višković K, Kušić J, Perović Mihanović M, Lukas D, Jevtović Đ. Comparison of four international cardiovascular disease prediction models and the prevalence of eligibility for lipid lowering therapy in HIV infected patients on antiretroviral therapy. Croat Med J 2015; 56:14-23. [PMID: 25727038 PMCID: PMC4364353 DOI: 10.3325/cmj.2015.56.14] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
AIM To compare four cardiovascular disease (CVD) risk models and to assess the prevalence of eligibility for lipid lowering therapy according to the 2013 American College of Cardiology/American Heart Association (ACC/AHA) guidelines, European AIDS Clinical Society Guidelines (EACS), and European Society of Cardiology and the European Atherosclerosis Society (ESC/EAS) guidelines for CVD prevention in HIV infected patients on antiretroviral therapy. METHODS We performed a cross-sectional analysis of 254 consecutive HIV infected patients aged 40 to 79 years who received antiretroviral therapy for at least 12 months. The patients were examined at the HIV-treatment centers in Belgrade and Zagreb in the period February-April 2011. We compared the following four CVD risk models: the Framingham risk score (FRS), European Systematic Coronary Risk Evaluation Score (SCORE), the Data Collection on Adverse Effects of Anti-HIV Drugs study (DAD), and the Pooled Cohort Atherosclerotic CVD risk (ASCVD) equations. RESULTS The prevalence of current smoking was 42.9%, hypertension 31.5%, and hypercholesterolemia (>6.2 mmol/L) 35.4%; 33.1% persons were overweight, 11.8% were obese, and 30.3% had metabolic syndrome. A high 5-year DAD CVD risk score (>5%) had substantial agreement with the elevated (≥7.5%) 10-year ASCVD risk equation score (kappa=0.63). 21.3% persons were eligible for statin therapy according to EACS (95% confidence intervals [CI], 16.3% to 27.4%), 25.6% according to ESC/EAS (95% CI, 20.2% to 31.9%), and 37.9% according to ACC/AHA guidelines (95% CI, 31.6 to 44.6%). CONCLUSION In our sample, agreement between the high DAD CVD risk score and other CVD high risk scores was not very good. The ACC/AHA guidelines would recommend statins more often than ESC/EAS and EACS guidelines. Current recommendations on treatment of dyslipidemia should be applied with caution in the HIV infected population.
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Affiliation(s)
| | | | - Klaudija Višković
- Klaudija Višković, University Hospital for Infectious Diseases, University of Zagreb School of Medicine, Mirogojska 8, 10000 Zagreb, Croatia,
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Alexiev I, Shankar A, Wensing AMJ, Beshkov D, Elenkov I, Stoycheva M, Nikolova D, Nikolova M, Switzer WM. Low HIV-1 transmitted drug resistance in Bulgaria against a background of high clade diversity. J Antimicrob Chemother 2015; 70:1874-80. [PMID: 25652746 PMCID: PMC11292601 DOI: 10.1093/jac/dkv011] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Accepted: 01/06/2015] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To determine transmitted drug resistance (TDR) and HIV-1 genetic diversity in Bulgaria. METHODS The prevalence of TDR and HIV-1 subtypes was determined in 305/1446 (21.1%) persons newly diagnosed with HIV/AIDS from 1988 to 2011. TDR mutations (TDRMs) in protease and reverse transcriptase were defined using the WHO HIV drug mutation list. Phylogenetic analysis was used to infer polymerase (pol) genotype. RESULTS TDRMs were found in 16/305 (5.2%) persons, 11 (3.6%) with resistance to NRTIs, 5 (1.6%) with resistance to NNRTIs and 3 (0.9%) with resistance to PIs. Dual-class TDRMs were found in three (1.0%) patients and one statistically supported cluster of TDRMs comprising two individuals with subtype B infection. TDRMs were found in 10 heterosexuals, 4 MSM and two intravenous drug users. Phylogenetic analyses identified high HIV-1 diversity consisting of mostly subtype B (44.6%), subtype C (3.3%), sub-subtype A1 (2.6%), sub-subtype F1 (2.3%), sub-subtype A-like (3.6%), subtype G (0.3%), CRF14_BG (1.6%), CRF05_DF (1.3%), CRF03_AB (0.3%) and unique recombinant forms (1.3%). CONCLUSIONS We found a low prevalence of TDR against a background of high HIV-1 genetic diversity among antiretroviral-naive patients in Bulgaria. Our results provide baseline data on TDR and support continued surveillance of high-risk populations in Bulgaria to better target treatment and prevention efforts.
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Affiliation(s)
- Ivailo Alexiev
- National Reference Laboratory of HIV, National Center of Infectious and Parasitic Diseases, Sofia, Bulgaria
| | - Anupama Shankar
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - A M J Wensing
- University Medical Center Utrecht, Virology, Utrecht, The Netherlands
| | - Danail Beshkov
- National Reference Laboratory of HIV, National Center of Infectious and Parasitic Diseases, Sofia, Bulgaria
| | - Ivaylo Elenkov
- Hospital for Infectious and Parasitic Diseases, Sofia, Bulgaria
| | - Mariyana Stoycheva
- Department of Infectious Diseases, Medical University, Plovdiv, Bulgaria
| | - Daniela Nikolova
- Clinic of Infectious Diseases, Medical University, Varna, Bulgaria
| | - Maria Nikolova
- National Reference Laboratory of Immunology, National Center of Infectious and Parasitic Diseases, Sofia, Bulgaria
| | - William M Switzer
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
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