1
|
Vasylyev M, Wit FWNM, Jordans CCE, Soetekouw R, van Lelyveld SFL, Kootstra GJ, Delsing CE, Ammerlaan HSM, van Kasteren MEE, Brouwer AE, Leyten EMS, Claassen MAA, Hassing RJ, den Hollander JG, van den Berge M, Roukens AHE, Bierman WFW, Groeneveld PHP, Lowe SH, van Welzen BJ, Richel O, Nellen JF, van den Berk GEL, van der Valk M, Rijnders BJA, Rokx C. Dolutegravir/Lamivudine Is Noninferior to Continuing Dolutegravir- and Non-Dolutegravir-Based Triple-Drug Antiretroviral Therapy in Virologically Suppressed People With Human Immunodeficiency Virus: DUALING Prospective Nationwide Matched Cohort Study. Open Forum Infect Dis 2024; 11:ofae160. [PMID: 38567196 PMCID: PMC10986854 DOI: 10.1093/ofid/ofae160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 03/15/2024] [Indexed: 04/04/2024] Open
Abstract
Background Confirming the efficacy of dolutegravir/lamivudine in clinical practice solidifies recommendations on its use. Methods Prospective cohort study (DUALING) in 24 human immunodeficiency virus (HIV) treatment centers in the Netherlands. HIV RNA-suppressed cases were on triple-drug antiretroviral regimens without prior virological failure or resistance and started dolutegravir/lamivudine. Cases were 1:2 matched to controls on triple-drug antiretroviral regimens by the use of dolutegravir-based regimens, age, sex, transmission route, CD4+ T-cell nadir, and HIV RNA zenith. The primary endpoint was the treatment failure rate in cases versus controls at 1 year by intention-to-treat and on-treatment analyses with 5% noninferiority margin. Results The 2040 participants were 680 cases and 1380 controls. Treatment failure in the 390 dolutegravir-based cases versus controls occurred in 8.72% and 12.50% (difference: -3.78% [95% confidence interval {CI}, -7.49% to .08%]) by intention-to-treat and 1.39% and 0.80% (difference: 0.59% [95% CI, -.80% to 1.98%]) by on-treatment analyses. The treatment failure risk in 290 non-dolutegravir-based cases was also noninferior to controls. Antiretroviral regimen modifications unrelated to virological failure explained the higher treatment failure rate by intention-to-treat. A shorter time on triple-drug antiretroviral therapy and being of non-Western origin was associated with treatment failure. Treatment failure, defined as 2 consecutive HIV RNA >50 copies/mL, occurred in 4 cases and 5 controls but without genotypic resistance detected. Viral blips occured comparable in cases and controls but cases gained more weight, especially when tenofovir-based regimens were discontinued. Conclusions In routine care, dolutegravir/lamivudine was noninferior to continuing triple-drug antiretroviral regimens after 1 year, supporting the use of dolutegravir/lamivudine in clinical practice. Clinical Trials Registration NCT04707326.
Collapse
Affiliation(s)
- Marta Vasylyev
- Section of Infectious Diseases, Department of Internal Medicine, and Department of Medical Microbiology and Infectious Diseases, Erasmus University Medical Center, Rotterdam, The Netherlands
| | | | - Carlijn C E Jordans
- Section of Infectious Diseases, Department of Internal Medicine, and Department of Medical Microbiology and Infectious Diseases, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Robin Soetekouw
- Department of Internal Medicine, Spaarne Gasthuis, Haarlem/Hoofddorp, The Netherlands
| | | | - Gert-Jan Kootstra
- Department of Internal Medicine, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Corine E Delsing
- Department of Internal Medicine, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Heidi S M Ammerlaan
- Department of Internal Medicine, Catharina Ziekenhuis Eindhoven, Eindhoven, The Netherlands
| | - Marjo E E van Kasteren
- Department of Internal Medicine, Elisabeth Tweesteden Ziekenhuis, Tilburg, The Netherlands
| | - Annemarie E Brouwer
- Department of Internal Medicine, Elisabeth Tweesteden Ziekenhuis, Tilburg, The Netherlands
| | - Eliane M S Leyten
- Department of Internal Medicine, Haaglanden Medisch Centrum, The Hague, The Netherlands
| | - Mark A A Claassen
- Department of Internal Medicine, Rijnstate Ziekenhuis, Arnhem, The Netherlands
| | - Robert-Jan Hassing
- Department of Internal Medicine, Rijnstate Ziekenhuis, Arnhem, The Netherlands
| | - Jan G den Hollander
- Department of Internal Medicine, Maasstadziekenhuis, Rotterdam, The Netherlands
| | - Marcel van den Berge
- Department of Internal Medicine, Admiraal de Ruyter Ziekenhuis, Vlissingen, The Netherlands
| | - Anna H E Roukens
- Department of Infectious Diseases, Leiden University Medical Center, Leiden, The Netherlands
| | - Wouter F W Bierman
- Section of Infectious Diseases, Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | | | - Selwyn H Lowe
- Infectious Diseases and Infection Prevention, Department of Internal Medicine and Department of Medical Microbiology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Berend J van Welzen
- Department of Internal Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Olivier Richel
- Section of Infectious Diseases, Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jeannine F Nellen
- Amsterdam Infection and Immunity Institute, Department of Infectious Diseases, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Marc van der Valk
- Stichting HIV Monitoring, Amsterdam, The Netherlands
- Amsterdam Infection and Immunity Institute, Department of Infectious Diseases, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Bart J A Rijnders
- Section of Infectious Diseases, Department of Internal Medicine, and Department of Medical Microbiology and Infectious Diseases, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Casper Rokx
- Section of Infectious Diseases, Department of Internal Medicine, and Department of Medical Microbiology and Infectious Diseases, Erasmus University Medical Center, Rotterdam, The Netherlands
| |
Collapse
|
2
|
Vasylyev M, Buhiichyk V, Buhiichyck N, Groenendijk A, Ben I, Ostapiuk L, Sluzhynska M, Bierman WFW, van Kampen JJA, Wit FWNM, Reiss P, Rijnders BJA, Sluzhynska O, Rokx C. COVID-19 epidemiology and performance of the WHO clinical algorithm to diagnose COVID-19 in people with HIV from Ukraine. Int J STD AIDS 2024:9564624241231016. [PMID: 38318789 DOI: 10.1177/09564624241231016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Abstract
BACKGROUND The two main objectives were to evaluate the COVID-19 point prevalence and the test performance of the WHO case definition to diagnose COVID-19 clinically in people with HIV in West Ukraine. METHODS Multicenter cross-sectional study in Lviv, Ukraine, from October 2020-November 2021. COVID-19 unvaccinated people with HIV were included regardless of COVID-19 symptoms at routine clinical visits and had standardized medical, quality of life (EQ(5D)) and SARS-CoV-2 serology assessments. Reported symptoms indicating potential COVID-19 events at inclusion or between March 2020 and inclusion were classified by the WHO case definition as suspected, probable or confirmed. A clinical COVID-19 case was defined as being SARS-CoV-2 seropositive with at least a suspected COVID-19 according to the WHO case definition. The primary endpoints were the clinical COVID-19 prevalence and the test characteristics of the WHO case definition with SARS-CoV-2 serology as reference. (Clinicaltrials.gov:NCT04711954). RESULTS The 971 included people with HIV were median 40 years, 38.8% women, 44.8% had prior AIDS, and 55.6% had comorbidities. SARS-CoV-2 seroprevalence was 40.1% (95%CI:37.0-43.1) and 20.5% (95%CI:18.0-23.1) had clinical COVID-19 median 4 months (IQR:2-7) before inclusion. Clinical COVID-19 occurred less frequently in people with HIV with tuberculosis history, injecting drug use, CD4+ T-cells <200/mL and unemployment. The quality of life was not impacted after COVID-19. An at least probable COVID-19 classification by the WHO case definition had 44.1% sensitivity (95%CI:38.7-49.7), 85.2% specificity (95%CI:81.5-88.4), 66.6% positive predictive value (95%CI:59.8-73.0) and 69.5% negative predictive value (95%CI:65.5-73.3) to diagnose COVID-19. CONCLUSIONS COVID-19 unvaccinated people with HIV from Ukraine had a significant COVID-19 rate and using the WHO case definition had insufficient diagnostic accuracy to diagnose these cases. The lower burden in vulnerable people with HIV was unexpected but might reflect a shielding effect.
Collapse
Affiliation(s)
- Marta Vasylyev
- Department of Internal Medicine, Section Infectious Diseases, and Department of Medical Microbiology and Infectious Diseases, Erasmus University Medical Center, Rotterdam, The Netherlands
- Astar Medical Center, Lviv, Ukraine
| | | | | | - Albert Groenendijk
- Department of Internal Medicine, Section Infectious Diseases, and Department of Medical Microbiology and Infectious Diseases, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Iryna Ben
- Department of Infectious Diseases, Danylo Halytsky National Medical University, Lviv, Ukraine
| | | | | | - Wouter F W Bierman
- University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Jeroen J A van Kampen
- Department of Viroscience, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Ferdinand W N M Wit
- Stichting HIV Monitoring, Amsterdam, The Netherlands
- Amsterdam UMC, Location University of Amsterdam, Global Health, Meibergdreef 9, Amsterdam, The Netherlands
| | - Peter Reiss
- Amsterdam UMC, Location University of Amsterdam, Global Health, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam Institute for Global Health and Development, Paasheuvelweg 25, Amsterdam, The Netherlands
| | - Bart J A Rijnders
- Department of Internal Medicine, Section Infectious Diseases, and Department of Medical Microbiology and Infectious Diseases, Erasmus University Medical Center, Rotterdam, The Netherlands
| | | | - Casper Rokx
- Department of Internal Medicine, Section Infectious Diseases, and Department of Medical Microbiology and Infectious Diseases, Erasmus University Medical Center, Rotterdam, The Netherlands
| |
Collapse
|
3
|
Vliegenthart-Jongbloed KJ, Vasylyev M, Jordans CCE, Bernardino JI, Nozza S, Psomas CK, Voit F, Barber TJ, Skrzat-Klapaczyńska A, Săndulescu O, Rokx C. Systematic Review: Strategies for Improving HIV Testing and Detection Rates in European Hospitals. Microorganisms 2024; 12:254. [PMID: 38399659 PMCID: PMC10892502 DOI: 10.3390/microorganisms12020254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 01/21/2024] [Accepted: 01/22/2024] [Indexed: 02/25/2024] Open
Abstract
Undiagnosed HIV infection is a prominent clinical issue throughout Europe that requires the continuous attention of all healthcare professionals and policymakers to prevent missed testing opportunities and late diagnosis. This systematic review aimed to evaluate interventions to increase HIV testing rates and case detection in European hospitals. Out of 4598 articles identified, 29 studies fulfilled the selection criteria. Most of the studies were conducted in single Western European capital cities, and only one study was from Eastern Europe. The main interventions investigated were test-all and indicator-condition-based testing strategies. Overall, the prevalence of undiagnosed HIV was well above 0.1%. The studied interventions increased the HIV testing rate and the case detection rate. The highest prevalence of undiagnosed HIV was found with the indicator-condition-driven testing strategy, whereas the test-all strategy had the most profound impact on the proportion of late diagnoses. Nevertheless, the HIV testing rates and case-finding varied considerably across studies. In conclusion, effective strategies to promote HIV testing in European hospitals are available, but relevant knowledge gaps regarding generalizability and sustainability remain. These gaps require the promotion of adherence to HIV testing guidelines, as well as additional larger studies representing all European regions.
Collapse
Affiliation(s)
- Klaske J. Vliegenthart-Jongbloed
- Section Infectious Diseases, Department of Internal Medicine, Erasmus University Medical Center, 3015 CN Rotterdam, The Netherlands; (K.J.V.-J.); (M.V.)
| | - Marta Vasylyev
- Section Infectious Diseases, Department of Internal Medicine, Erasmus University Medical Center, 3015 CN Rotterdam, The Netherlands; (K.J.V.-J.); (M.V.)
- Astar Medical Center, 79041 Lviv, Ukraine
| | - Carlijn C. E. Jordans
- Department of Medical Microbiology and Infectious Diseases, Erasmus University Medical Center, 3015 CN Rotterdam, The Netherlands;
| | - Jose I. Bernardino
- HIV and Infectious Diseases Section, Department of Internal Medicine, Hospital Universitario La Paz-Carlos III, IdiPAZ, 28029 Madrid, Spain;
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, CIBERINFEC, 28029 Madrid, Spain
| | - Silvia Nozza
- Department of Infectious Diseases, Università Vita Salute IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy;
| | | | - Florian Voit
- Department of Internal Medicine II, University Hospital Rechts der Isar, School of Medicine, Technical University of Munich, 80333 Munich, Germany;
| | - Tristan J. Barber
- Department of HIV Medicine, Royal Free Hospital, London NW3 2QG, UK;
- Institute for Global Health, University College London, London WC1E 6BT, UK
| | - Agata Skrzat-Klapaczyńska
- Department of Adults’ Infectious Diseases, Hospital for Infectious Diseases, Medical University of Warsaw, Wolska Street 37, 01-201 Warsaw, Poland;
| | - Oana Săndulescu
- Department of Infectious Diseases I, Carol Davila University of Medicine and Pharmacy Bucharest, No. 1 Dr. Calistrat Grozovici Street, 021105 Bucharest, Romania;
- National Institute for Infectious Diseases “Prof. Dr. Matei Balș”, No. 1 Dr. Calistrat Grozovici Street, 021105 Bucharest, Romania
| | - Casper Rokx
- Section Infectious Diseases, Department of Internal Medicine, Erasmus University Medical Center, 3015 CN Rotterdam, The Netherlands; (K.J.V.-J.); (M.V.)
- Astar Medical Center, 79041 Lviv, Ukraine
| |
Collapse
|
4
|
Scott K, Chappell E, Mostafa A, Volokha A, Najmi N, Ebeid F, Posokhova S, Sikandar R, Vasylyev M, Zulfiqar S, Kaminskyi V, Pett S, Malyuta R, Karpus R, Ayman Y, Ahmed RHM, Hamid S, El-Sayed MH, Gibb D, Judd A, Collins IJ. Acceptability of hepatitis C screening and treatment during pregnancy in pregnant women in Egypt, Pakistan, and Ukraine: A cross-sectional survey. Clin Liver Dis (Hoboken) 2024; 23:e0140. [PMID: 38567091 PMCID: PMC10986914 DOI: 10.1097/cld.0000000000000140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 12/17/2023] [Indexed: 04/04/2024] Open
Abstract
Chronic hepatitis C (HCV) in women of childbearing age is a major public health concern with ∼15 million women aged 15-49 years living with HCV globally in 2019. Evidence suggests HCV in pregnancy is associated with adverse pregnancy and infant outcomes. This includes ∼6% risk of infants acquiring HCV vertically, and this is the leading cause of HCV in children globally. However, few countries offer routine universal antenatal HCV screening, and direct-acting antivirals (DAAs) are not approved for pregnant or breastfeeding women although small clinical trials are ongoing. We conducted a survey of pregnant and postpartum women in 3 high HCV burden lower-middle-income countries to assess the acceptability of universal antenatal HCV screening and DAA treatment in the scenario that DAAs are approved for use in pregnancy. Pregnant and postpartum women attending antenatal clinics in Egypt, Pakistan, and Ukraine were invited to complete a survey and provide demographic and clinical data on their HCV status. Among the 630 women included (n=210 per country), 73% were pregnant and 27% postpartum, 27% were ever HCV antibody or PCR positive. Overall, 586 (93%) reported acceptability of universal antenatal HCV screening and 544 (88%) would take DAAs in pregnancy (92%, 98%, and 73% in Egypt, Pakistan, and Ukraine, respectively). Most said they would take DAAs in pregnancy to prevent vertical acquisition and other risks for the baby, and a smaller proportion would take DAAs for maternal cure. Our findings suggest that should DAAs be approved for use in pregnancy, the uptake of both HCV screening and DAA treatment may be high in women living in lower-middle-income countries.
Collapse
Affiliation(s)
- Karen Scott
- MRC Clinical Trials Unit at University College London (UCL), Institute of Clinical Trials and Methodology, UCL, London, UK
| | - Elizabeth Chappell
- MRC Clinical Trials Unit at University College London (UCL), Institute of Clinical Trials and Methodology, UCL, London, UK
| | - Aya Mostafa
- Department of Community, Environmental, and Occupational Medicine, Ain Shams University Faculty of Medicine, Cairo, Egypt
| | - Alla Volokha
- Department of Pediatric Infectious Diseases and Pediatric Immunology, Shupyk National Healthcare University of Ukraine, Kyiv, Ukraine
| | - Nida Najmi
- Department of Obstetrics and Gynaecology, Aga Khan University Hospital, Karachi, Pakistan
| | - Fatma Ebeid
- Department of Pediatrics, Faculty of Medicine, Ain Shams University and Faculty of Medicine, Ain Shams University, Ain Shams University Research Institute-Clinical Research Centre (MASRI-CRC), Cairo, Egypt
| | | | - Raheel Sikandar
- Department of Obstetrics and Gynaecology, Liaquat University of Medical and Health Sciences, Jamshoro, Pakistan
| | | | - Saima Zulfiqar
- Sheikh Zayed Medical College and Hospital, Rahim Yar Khan, Pakistan
| | - Viacheslav Kaminskyi
- Department of Pediatric Infectious Diseases and Pediatric Immunology, Shupyk National Healthcare University of Ukraine, Kyiv, Ukraine
- Kyiv City Center of Reproductive and Perinatal Medicine, Kyiv, Ukraine
| | - Sarah Pett
- MRC Clinical Trials Unit at University College London (UCL), Institute of Clinical Trials and Methodology, UCL, London, UK
- Institute for Global Health, UCL, London, UK
| | | | - Ruslana Karpus
- Kyiv City Center of Reproductive and Perinatal Medicine, Kyiv, Ukraine
| | - Yomna Ayman
- Department of Community, Environmental, and Occupational Medicine, Ain Shams University Faculty of Medicine, Cairo, Egypt
| | - Rania H. M. Ahmed
- Department of Gynecology and Obstetrics, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Saeed Hamid
- Department of Medicine, Aga Khan University, Karachi, Pakistan
| | - Manal H. El-Sayed
- Department of Pediatrics, Faculty of Medicine, Ain Shams University and Faculty of Medicine, Ain Shams University, Ain Shams University Research Institute-Clinical Research Centre (MASRI-CRC), Cairo, Egypt
| | - Diana Gibb
- MRC Clinical Trials Unit at University College London (UCL), Institute of Clinical Trials and Methodology, UCL, London, UK
| | - Ali Judd
- MRC Clinical Trials Unit at University College London (UCL), Institute of Clinical Trials and Methodology, UCL, London, UK
| | - Intira Jeannie Collins
- MRC Clinical Trials Unit at University College London (UCL), Institute of Clinical Trials and Methodology, UCL, London, UK
| |
Collapse
|
5
|
Aimla K, Kowalska JD, Matulionyte R, Mulabdic V, Vassilenko A, Bolokadze N, Jilich D, Antoniak S, Oprea C, Balayan T, Harxhi A, Papadopoulos A, Lakatos B, Vasylyev M, Begovac J, Yancheva N, Streinu-Cercel A, Verhaz A, Gokengin D, Dragovic G, Sojak L, Skrzat-Klapaczyńska A. Vaccination against HBV and HAV as Mode of Hepatitis Prevention among People Living with HIV-Data from ECEE Network Group. Vaccines (Basel) 2023; 11:vaccines11050980. [PMID: 37243084 DOI: 10.3390/vaccines11050980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 04/27/2023] [Accepted: 05/11/2023] [Indexed: 05/28/2023] Open
Abstract
(1) Background: Viral hepatitis C (HCV) and viral hepatitis B (HBV) are common co-infections in people living with HIV (PLWH). All PLWH should be vaccinated against HBV and hepatitis A (HAV) and treated for HBV and HCV. We aimed to compare testing, prophylaxis and treatment of viral hepatitis in PLWH in Central and Eastern Europe (CEE) in 2019 and 2022. (2) Methods: Data was collected through two on-line surveys conducted in 2019 and 2022 among 18 countries of the Euroguidelines in CEE (ECEE) Network Group. (3) Results: In all 18 countries the standard of care was to screen all PLWH for HBV and HCV both years; screening of HAV was routine in 2019 in 54.5% and in 2022 47.4% of clinics. Vaccination of PLWH against HAV was available in 2019 in 16.7%, in 2022 in 22.2% countries. Vaccination against HBV was available routinely and free of charge in 50% of clinics both in 2019 and 2022. In HIV/HBV co-infected the choice of NRTI was tenofovir-based in 94.4% of countries in both years. All clinics that responded had access to direct-acting antivirals (DAAs) but 50% still had limitations for treatment. (4) Conclusions: Although testing for HBV and HCV was good, testing for HAV is insufficient. Vaccination against HBV and especially against HAV has room for improvement; furthermore, HCV treatment access needs to overcome restrictions.
Collapse
Affiliation(s)
- Kerstin Aimla
- Department of Infectious Diseases, Tartu University Hospital, 50406 Tartu, Estonia
| | - Justyna Dominika Kowalska
- Department of Adults' Infectious Diseases, Hospital for Infectious Diseases, Medical University of Warsaw, 02-091 Warsaw, Poland
| | - Raimonda Matulionyte
- Department of Infectious Diseases and Dermatovenerology, Faculty of Medicine, Vilnius University, Vilnius University Hospital Santaros Klinikos, LT-08410 Vilnius, Lithuania
| | - Velida Mulabdic
- Clinic for Infectious Diseases, University Clinical Center Sarajevo, 71000 Sarajevo, Bosnia and Herzegovina
| | - Anna Vassilenko
- City Clinical Hospital of Infectious Diseases, 220002 Minsk, Belarus
| | - Natalie Bolokadze
- Infectious Diseases, AIDS and Clinical Immunology Research Center, 0160 Tbilisi, Georgia
| | - David Jilich
- Department of Infectious Diseases, 1st Faculty of Medicine, Charles University in Prague and Faculty Hospital Bulovka, 18000 Prague, Czech Republic
| | - Sergii Antoniak
- Clinic of the Gromashevsky Institute of Epidemiology and Infectious Diseases, 01001 Kyiv, Ukraine
| | - Cristiana Oprea
- Victor Babes Clinical Hospital for Infectious and Tropical Diseases, 030303 Bucharest, Romania
| | | | - Arjan Harxhi
- Department of Infectious Disease, Faculty of Medicine, Medical University of Tirana, 1000 Tirana, Albania
| | - Antonios Papadopoulos
- HIV Unit, 4th Department of Internal Medicine, School of Medicine, National and Kapodistrian University of Athens, Attikon University Hospital, 12462 Athens, Greece
| | - Botond Lakatos
- National Instititue of Hematology and Infectious Diseases, National Center of HIV, 1097 Budapest, Hungary
| | - Marta Vasylyev
- Lviv Regional Public Health Center, HIV Unit, 79000 Lviv, Ukraine
| | - Josip Begovac
- University Hospital of Infectious Diseases, 10000 Zagreb, Croatia
| | - Nina Yancheva
- Department for AIDS, Specialized Hospital for Active Treatment of Infectious and Parasitic Diseases, Medical University of Sofia, 1606 Sofia, Bulgaria
| | - Anca Streinu-Cercel
- National Institute of Infectious Diseases "Prof. Dr. Matei Balș", 021105 Bucharest, Romania
| | - Antonija Verhaz
- Clinic for Infectious Diseases Republic of Srpska Banja Luka, 78000 Banja Luka, Bosnia and Herzegovina
| | - Deniz Gokengin
- Department of Infectious Diseases and Clinical Microbiology, Medical Faculty, Ege University, 35100 Izmir, Turkey
| | - Gordana Dragovic
- Department of Pharmacology, Clinical Pharmacology and Toxicology, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Lubomir Sojak
- Department of Infectology and Geographical Medicine, 833 05 Bratislava, Slovakia
| | - Agata Skrzat-Klapaczyńska
- Department of Adults' Infectious Diseases, Hospital for Infectious Diseases, Medical University of Warsaw, 02-091 Warsaw, Poland
| |
Collapse
|
6
|
Grosso TM, Hernández-Sánchez D, Dragovic G, Vasylyev M, Saumoy M, Blanco JR, García D, Koval T, Loste C, Westerhof T, Clotet B, Sued O, Cahn P, Negredo E. Identifying the needs of older people living with HIV (≥ 50 years old) from multiple centres over the world: a descriptive analysis. AIDS Res Ther 2023; 20:10. [PMID: 36782210 PMCID: PMC9924192 DOI: 10.1186/s12981-022-00488-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 12/01/2022] [Indexed: 02/15/2023] Open
Abstract
BACKGROUND Older People Living with HIV (OPWH) combine both aging and HIV-infection features, resulting in ageism, stigma, social isolation, and low quality of life. This context brings up new challenges for healthcare professionals, who now must aid patients with a significant comorbidity burden and polypharmacy treatments. OPWH opinion on their health management is hardly ever considered as a variable to study, though it would help to understand their needs on dissimilar settings. METHODS We performed a cross-sectional, comparative study including patients living with HIV aged ≥50 years old from multiple centers worldwide and gave them a survey addressing their perception on overall health issues, psychological problems, social activities, geriatric conditions, and opinions on healthcare. Data was analyzed through Chisquared tests sorting by geographical regions, age groups, or both. RESULTS We organized 680 participants data by location (Center and South America [CSA], Western Europe [WE], Africa, Eastern Europe and Israel [EEI]) and by age groups (50- 55, 56-65, 66-75, >75). In EEI, HIV serostatus socializing and reaching undetectable viral load were the main problems. CSA participants are the least satisfied regarding their healthcare, and a great part of them are not retired. Africans show the best health perception, have financial problems, and fancy their HIV doctors. WE is the most developed region studied and their participants report the best scores. Moreover, older age groups tend to live alone, have a lower perception of psychological problems, and reduced social life. CONCLUSIONS Patients' opinions outline region- and age-specific unmet needs. In EEI, socializing HIV and reaching undetectable viral load were the main concerns. CSA low satisfaction outcomes might reflect high expectations or profound inequities in the region. African participants results mirror a system where general health is hard to achieve, but HIV clinics are much more appealing to them. WE is the most satisfied region about their healthcare. In this context, age-specific information, education and counseling programs (i.e. Patient Reported Outcomes, Patient Centered Care, multidisciplinary teams) are needed to promote physical and mental health among older adults living with HIV/AIDS. This is crucial for improving health-related quality of life and patient's satisfaction.
Collapse
Affiliation(s)
- Tomás Martín Grosso
- grid.491017.a0000 0004 7664 5892Unidad de Ensayos Clínicos, Fundación Huésped, Buenos Aires, Argentina ,grid.26089.350000 0001 2228 6538Laboratorio de Inmunología, Universidad Nacional de Luján, Buenos Aires, Argentina
| | - Diana Hernández-Sánchez
- grid.411438.b0000 0004 1767 6330Lluita contra les Infeccions, Hospital Universitari Germans Trias i Pujol, Badalona, Spain ,grid.7080.f0000 0001 2296 0625Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Gordana Dragovic
- grid.7149.b0000 0001 2166 9385Department of Pharmacology, Clinical Pharmacology and Toxicology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | | | - María Saumoy
- grid.411129.e0000 0000 8836 0780HIV and STD Unit, Hospital de Bellvitge, Barcelona, Spain
| | - José Ramón Blanco
- grid.428104.bInfectious Disease Department, Hospital Universitario San Pedro - CIBIR, Logroño, Spain
| | - Diego García
- Adhara HIV/AIDS Association, Sevilla Checkpoint, Seville, Spain
| | - Tetiana Koval
- grid.513024.1Department of Infectious Diseases, Poltava State Medical University, Poltava, Ukraine
| | - Cora Loste
- grid.411438.b0000 0004 1767 6330Lluita contra les Infeccions, Hospital Universitari Germans Trias i Pujol, Badalona, Spain ,grid.7080.f0000 0001 2296 0625Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Tendayi Westerhof
- grid.411438.b0000 0004 1767 6330AIDS Research Institute-IRSICAIXA, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Bonaventura Clotet
- grid.7080.f0000 0001 2296 0625Universitat Autònoma de Barcelona, Barcelona, Spain ,grid.7080.f0000 0001 2296 0625AIDS Research Institute-IRSICAIXA, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain ,grid.440820.aUniversitat de Vic - Universidad Central de Catalunya (UVIC-UCC), Vic, Spain
| | - Omar Sued
- grid.491017.a0000 0004 7664 5892Unidad de Ensayos Clínicos, Fundación Huésped, Buenos Aires, Argentina
| | - Pedro Cahn
- grid.491017.a0000 0004 7664 5892Unidad de Ensayos Clínicos, Fundación Huésped, Buenos Aires, Argentina
| | - Eugènia Negredo
- Lluita contra les Infeccions, Hospital Universitari Germans Trias i Pujol, Badalona, Spain. .,Universitat Autònoma de Barcelona, Barcelona, Spain. .,Universitat de Vic - Universidad Central de Catalunya (UVIC-UCC), Vic, Spain.
| |
Collapse
|
7
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
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
| |
Collapse
|
8
|
Jordans CC, Vasylyev M, Rae C, Jakobsen ML, Vassilenko A, Dauby N, Grevsen AL, Jakobsen SF, Raahauge A, Champenois K, Papot E, Malin JJ, Boender TS, Behrens GM, Gruell H, Neumann A, Spinner CD, Valbert F, Akinosoglou K, Kostaki EG, Nozza S, Giacomelli A, Lapadula G, Mazzitelli M, Torti C, Matulionyte R, Matulyte E, Van Welzen BJ, Hensley KS, Thompson M, Ankiersztejn-Bartczak M, Skrzat-Klapaczyńska A, Săndulescu O, Streinu-Cercel A, Streinu-Cercel A, Miron VD, Pokrovskaya A, Hachfeld A, Dorokhina A, Sukach M, Lord E, Sullivan AK, Rokx C. National medical specialty guidelines of HIV indicator conditions in Europe lack adequate HIV testing recommendations: a systematic guideline review. Euro Surveill 2022; 27:2200338. [PMID: 36695464 PMCID: PMC9716648 DOI: 10.2807/1560-7917.es.2022.27.48.2200338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
BackgroundAdequate identification and testing of people at risk for HIV is fundamental for the HIV care continuum. A key strategy to improve timely testing is HIV indicator condition (IC) guided testing.AimTo evaluate the uptake of HIV testing recommendations in HIV IC-specific guidelines in European countries.MethodsBetween 2019 and 2021, European HIV experts reviewed guideline databases to identify all national guidelines of 62 HIV ICs. The proportion of HIV IC guidelines recommending HIV testing was reported, stratified by subgroup (HIV IC, country, eastern/western Europe, achievement of 90-90-90 goals and medical specialty).ResultsOf 30 invited European countries, 15 participated. A total of 791 HIV IC guidelines were identified: median 47 (IQR: 38-68) per country. Association with HIV was reported in 69% (545/791) of the guidelines, and 46% (366/791) recommended HIV testing, while 42% (101/242) of the AIDS-defining conditions recommended HIV testing. HIV testing recommendations were observed more frequently in guidelines in eastern (53%) than western (42%) European countries and in countries yet to achieve the 90-90-90 goals (52%) compared to those that had (38%). The medical specialties internal medicine, neurology/neurosurgery, ophthalmology, pulmonology and gynaecology/obstetrics had an HIV testing recommendation uptake below the 46% average. None of the 62 HIV ICs, countries or medical specialties had 100% accurate testing recommendation coverage in all their available HIV IC guidelines.ConclusionFewer than half the HIV IC guidelines recommended HIV testing. This signals an insufficient adoption of this recommendation in non-HIV specialty guidelines across Europe.
Collapse
Affiliation(s)
- Carlijn C.E. Jordans
- Erasmus University Medical Center, Department of Internal Medicine and Department of Medical Microbiology and Infectious Diseases, Rotterdam, the Netherlands
| | | | - Caroline Rae
- Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom
| | - Marie Louise Jakobsen
- Centre of Excellence for Health, Immunity & Infections (CHIP), Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Anna Vassilenko
- Republican Scientific and Practical Center of Medical Technologies, Informatization, Management and Economics of Public Health, Minsk, Belarus
| | - Nicolas Dauby
- CHU Saint-Pierre, Université Libre de Bruxelles (ULB), and School of Public Health, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Anne Louise Grevsen
- Centre of Excellence for Health, Immunity & Infections (CHIP), Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Stine Finne Jakobsen
- Centre of Excellence for Health, Immunity & Infections (CHIP), Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Anne Raahauge
- Centre of Excellence for Health, Immunity & Infections (CHIP), Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | | | | | - Jakob J. Malin
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Division of Infectious Diseases, Cologne, Germany
| | - T. Sonia Boender
- Robert Koch Institute, Department of Infectious Disease Epidemiology, Berlin, Germany,ECDC Fellowship Programme, Field Epidemiology path (EPIET), European Centre for Disease Prevention and Control (ECDC), Solna, Sweden
| | - Georg M.N Behrens
- Hannover Medical School, Department for Rheumatology and Immunology, Hannover, Germany
| | - Henning Gruell
- Institute of Virology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Anja Neumann
- Institute for Health Care Management and Research, University of Duisburg-Essen, Essen, Germany
| | - Christoph D. Spinner
- Technical University of Munich, School of Medicine, University hospital rechts der Isar, Department of Internal Medicine II, Munich, Germany
| | - Frederik Valbert
- Institute for Health Care Management and Research, University of Duisburg-Essen, Essen, Germany
| | - Karolina Akinosoglou
- Department of Internal Medicine and Infectious Diseases, University General Hospital of Patras, Patras, Greece
| | - Evangelia G. Kostaki
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Andrea Giacomelli
- III Infectious Diseases Unit, ASST Fatebenefratelli Sacco, Via G.B. Grassi, Milan, Italy
| | - Giuseppe Lapadula
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Maria Mazzitelli
- Magna Graecia University of Cantanzaro, Catanzaro, Italy,Infectious and Tropical Diseases Unit, University Hospital, Padua, Italy
| | - Carlo Torti
- University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Raimonda Matulionyte
- Department of Infectious Diseases and Dermatovenerology, Faculty of Medicine, Vilnius University; Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Elzbieta Matulyte
- Department of Infectious Diseases and Dermatovenerology, Faculty of Medicine, Vilnius University; Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Berend J. Van Welzen
- Department of Internal Medicine and Infectious Diseases, University Medical Center Utrecht, Utrecht, Netherlands
| | - Kathryn S. Hensley
- Erasmus University Medical Center, Department of Internal Medicine and Department of Medical Microbiology and Infectious Diseases, Rotterdam, the Netherlands
| | | | | | - Agata Skrzat-Klapaczyńska
- Hospital for Infectious Diseases Warsaw, Medical University of Warsaw, Department of Adults’ Infectious Diseases, Warsaw, Poland
| | - Oana Săndulescu
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania,National Institute for Infectious Diseases “Prof.Dr. Matei Bals”, Bucharest, Romania
| | - Adrian Streinu-Cercel
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania,National Institute for Infectious Diseases “Prof.Dr. Matei Bals”, Bucharest, Romania
| | - Anca Streinu-Cercel
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania,National Institute for Infectious Diseases “Prof.Dr. Matei Bals”, Bucharest, Romania
| | | | - Anastasia Pokrovskaya
- Central Research Institute of Epidemiology of Rospotrebnadzor, Moscow, Russian Federation
| | - Anna Hachfeld
- Department of Infectious Diseases, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Antonina Dorokhina
- National Children's Specialized Hospital “OKHMATDYT” of Ministry of Health of Ukraine, Kyiv, Ukraine,O.O.Bogomolets’ National Medical University, Kyiv, Ukraine
| | - Maryna Sukach
- O.O.Bogomolets’ National Medical University, Kyiv, Ukraine
| | - Emily Lord
- Oxford University Hospitals NHS Trust, Oxford, United Kingdom
| | - Ann K. Sullivan
- Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom
| | - Casper Rokx
- Erasmus University Medical Center, Department of Internal Medicine and Department of Medical Microbiology and Infectious Diseases, Rotterdam, the Netherlands
| | | |
Collapse
|
9
|
Vasylyev M, Skrzat-Klapaczyńska A, Bernardino JI, Săndulescu O, Gilles C, Libois A, Curran A, Spinner CD, Rowley D, Bickel M, Aichelburg MC, Nozza S, Wensing A, Barber TJ, Waters L, Jordans C, Bramer W, Lakatos B, Tovba L, Koval T, Kyrychenko T, Dumchev K, Buhiichyk V, Smyrnov P, Antoniak S, Antoniak S, Vasylyeva TI, Mazhnaya A, Kowalska J, Bhagani S, Rokx C. Unified European support framework to sustain the HIV cascade of care for people living with HIV including in displaced populations of war-struck Ukraine. The Lancet HIV 2022; 9:e438-e448. [DOI: 10.1016/s2352-3018(22)00125-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 04/08/2022] [Accepted: 04/11/2022] [Indexed: 12/24/2022]
|
10
|
Kowalska JD, Pelchen-Matthews A, Ryom L, Losso MH, Trofimova T, Mitsura VM, Khromova I, Paduta D, Stephan C, Domingo P, Bakowska E, Monforte AD, Oestergaard L, Jablonowska E, Kuznetsova A, Moreno S, Vasylyev M, Pradier C, Battegay M, Vandekerckhove L, Castagna A, Raben D, Mocroft A. Prevalence and outcomes of pregnancies in women with HIV over a 20-year period. AIDS 2021; 35:2025-2033. [PMID: 34033590 DOI: 10.1097/qad.0000000000002954] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To evaluate time trends in pregnancies and pregnancy outcomes among women with HIV in Europe. DESIGN European multicentre prospective cohort study. METHODS EuroSIDA has collected annual cross-sectional audits of pregnancies between 1996 and 2015. Pregnancy data were extracted and described. Odds of pregnancy were modelled, adjusting for potential confounders using logistic regression with generalized estimating equations. RESULTS Of 5535 women aged 16 to <50 years, 4217 (76.2%) had pregnancy information available, and 912 (21.6%) reported 1315 pregnancies. The proportions with at least one pregnancy were 28.1% (321/1143) in East, 24.5% (146/596) in North, 19.8% (140/706) in West/Central, 19.3% (110/569) in Central East and 16.2% (195/1203) in South Europe. Overall 319 pregnancies (24.3%) occurred in 1996-2002, 576 (43.8%) in 2003-2009 and 420 (31.9%) in 2010-2015. After adjustment, the odds of pregnancy were lower in 1996-2002, in South, Central East and East compared to West/Central Europe, in older women, those with low CD4+ cell count or with prior AIDS, and higher in those with a previous pregnancy or who were hepatitis C virus positive.Outcomes were reported for 999 pregnancies in 1996-2014, with 690 live births (69.1%), seven stillbirths (0.7%), 103 spontaneous (10.3%) and 199 medical abortions (19.9%). CONCLUSIONS Around 20% of women in EuroSIDA reported a pregnancy, with most pregnancies after 2002, when more effective antiretroviral therapy became available. Substantial differences were seen between European regions. Further surveillance of pregnancies and outcomes among women living with HIV is warranted to ensure equal access to care.
Collapse
Affiliation(s)
- Justyna D Kowalska
- Department of Adults' Infectious Diseases, Medical University of Warsaw, Warsaw, Poland
| | - Annegret Pelchen-Matthews
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation (CREME), Institute for Global Health, University College London, London, UK
| | - Lene Ryom
- CHIP Centre of Excellence for Health, Immunity and Infections, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | | | - Tatiana Trofimova
- Novgorod Centre for AIDS prevention and control, Novgorod the Great, Russian Federation
| | | | - Irina Khromova
- Centre for HIV/AIDS & Infectious Diseases, Kaliningrad, Russian Federation
| | | | | | - Pere Domingo
- Department of Infectious Diseases, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | | | | | - Elzbieta Jablonowska
- Clinic of Infectious Diseases and Hepatology, Medical University of Lodz, Łódź, Poland
| | | | - Santiago Moreno
- Servicio Enfermedades Infecciosas, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Marta Vasylyev
- Lviv Regional HIV/AIDS Prevention and Control Center, Lviv, Ukraine
| | | | - Manuel Battegay
- Department of Medicine, University Hospital Basel, Basel, Switzerland
| | | | | | - Dorthe Raben
- CHIP Centre of Excellence for Health, Immunity and Infections, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Amanda Mocroft
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation (CREME), Institute for Global Health, University College London, London, UK
- CHIP Centre of Excellence for Health, Immunity and Infections, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
11
|
Pelchen-Matthews A, Borges ÁH, Reekie J, Rasmussen LD, Wiese L, Weber J, Pradier C, Degen O, Paredes R, Tau L, Flamholc L, Gottfredsson M, Kowalska J, Jablonowska E, Mozer-Lisewska I, Radoi R, Vasylyev M, Kuznetsova A, Begovac J, Svedhem V, Clark A, Cozzi-Lepri A. Prevalence and Outcomes for Heavily Treatment-Experienced Individuals Living With Human Immunodeficiency Virus in a European Cohort. J Acquir Immune Defic Syndr 2021; 87:806-817. [PMID: 33587506 DOI: 10.1097/qai.0000000000002635] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 12/01/2020] [Indexed: 12/27/2022]
Abstract
BACKGROUND Although antiretroviral treatments have improved survival of persons living with HIV, their long-term use may limit available drug options. We estimated the prevalence of heavily treatment-experienced (HTE) status and the potential clinical consequences of becoming HTE. SETTING EuroSIDA, a European multicenter prospective cohort study. METHODS A composite definition for HTE was developed, based on estimates of antiretroviral resistance and prior exposure to specific antiretroviral regimens. Risks of progressing to clinical outcomes were assessed by Poisson regression, comparing every HTE individual with 3 randomly selected controls who never became HTE. RESULTS Of 15,570 individuals under follow-up in 2010-2016, 1617 (10.4%, 95% CI: 9.9% to 10.9%) were classified as HTE. 1093 individuals became HTE during prospective follow-up (HTE incidence rate 1.76, CI: 1.66 to 1.87 per 100 person-years of follow-up). The number of HTE individuals was highest in West/Central Europe (636/4019 persons, 15.7%) and lowest in East Europe (26/2279 persons, 1.1%). Although most HTE individuals maintained controlled viral loads (<400 copies/mL), many had low CD4 counts (≤350 cells/µL). After controlling for age, immunological parameters and pre-existing comorbidities, HTE status was not associated with the risk of new AIDS (adjusted incidence rate ratio, aIRR 1.44, CI: 0.86 to 2.40, P = 0.16) or non-AIDS clinical events (aIRR 0.96, CI: 0.74 to 1.25, P = 0.77). CONCLUSIONS HTE prevalence increased with time. After adjusting for key confounding factors, there was no evidence for an increased risk of new AIDS or non-AIDS clinical events in HTE. Additional therapeutic options and effective management of comorbidities remain important to reduce clinical complications in HTE individuals.
Collapse
Affiliation(s)
- Annegret Pelchen-Matthews
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation (CREME), Institute for Global Health, University College London, London, United Kingdom
| | - Álvaro H Borges
- Department of Infectious Diseases Immunology, Statens Serum Institut, Copenhagen, Denmark
| | - Joanne Reekie
- Department of Infectious Diseases, Centre for Health and Infectious Disease Research, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Line D Rasmussen
- Department of Infectious Diseases, Odense University Hospital, Odense, Denmark
| | - Lothar Wiese
- Sjællands Universitetshospital, Roskilde, Denmark
| | | | | | - Olaf Degen
- University Clinic Hamburg Eppendorf, Hamburg, Germany
| | - Roger Paredes
- Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Luba Tau
- Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | | | | | | | - Elzbieta Jablonowska
- Clinic of Infectious Diseases and Hepatology, Medical University of Lodz, Lodz, Poland
| | | | - Roxana Radoi
- Victor Babes Clinical Hospital for Infectious and Tropical Diseases, Bucharest, Romania
| | - Marta Vasylyev
- HIV Unit, Lviv Regional Public Health Center, Lviv, Ukraine
| | | | - Josip Begovac
- University Hospital for Infectious Diseases Dr. Fran Mihaljević, Zagreb, Croatia
| | - Veronica Svedhem
- Infectious Diseases Department, Karolinska University Hospital, Infectious Diseases Department, Stockholm, Sweden ; and
| | | | - Alessandro Cozzi-Lepri
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation (CREME), Institute for Global Health, University College London, London, United Kingdom
| |
Collapse
|
12
|
Moseholm E, Gilleece Y, Collins B, Kowalska JD, Vasylyev M, Pérez Elía MJ, Cairns G, Aebi-Popp K. Achievements and gaps to provide pre-exposure prophylaxis (PrEP) for women across the European Region - Results from a European survey study. J Virus Erad 2020; 7:100026. [PMID: 33489306 PMCID: PMC7809379 DOI: 10.1016/j.jve.2020.100026] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 12/04/2020] [Accepted: 12/08/2020] [Indexed: 11/25/2022] Open
Abstract
Introduction The use of pre-exposure prophylaxis (PrEP) is a safe and effective prevention option to all people at substantial risk of HIV acquisition, irrespective of gender. However, in most European countries PrEP services focus on key populations, in particular men who have sex with men (MSM). This study aims to explore PrEP availability and implementation for women across the European region. Methods An online survey was sent to all members of Women Against Viruses in Europe (WAVE) from 50 countries in September 2019. It consisted of 19 questions, including both multiple choice and free text answers. Results In total, responses from 34 countries were included in the study (Western Europe n = 12, Central Europe = 12, Eastern Europe n = 6). PrEP was accessible in 30 WHO European countries. More than half of them stated that PrEP was available for all groups at-risk of HIV acquisition (n = 18), while in many countries PrEP was only available to MSM and transgender persons. Two-thirds of country respondents confirmed the availability of a national guideline for PrEP (n = 23), of which six countries had specific recommendations for PrEP in women. The most cited obstacles for PrEP access were lack of information about PrEP, lack of political support, and high cost for the individual. Fifteen country respondents stated that there were specific obstacles for PrEP access for women, such as guidelines prioritizing MSM, women not being seen as a target population for PrEP, and lack of knowledge about which subgroup of women would benefit most from PrEP. Seven countries had made efforts to encourage women’s access to PrEP, most of which were individually based or initiated by local NGOs. Conclusions PrEP is an important addition to HIV combination prevention. Women’s access to PrEP in Europe remains limited. Women are often not included in the guidelines or targeted with education or information, resulting in a general lack of information about the use of PrEP for women.
Collapse
Affiliation(s)
- Ellen Moseholm
- Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre, Denmark
| | - Yvonne Gilleece
- Department of HIV Medicine, Brighton & Sussex University Hospitals NHS Trust and Brighton & Sussex Medical School, University Hospital, Brighton, UK
| | | | - Justyna D Kowalska
- Department of Adults' Infectious Diseases, Medical University of Warsaw, Poland
| | | | | | - Gus Cairns
- Aidsmap / PrEP in Europe, NAM Publications, London, UK
| | - Karoline Aebi-Popp
- Department of Infectious Diseases, University Hospital Bern, Switzerland
| |
Collapse
|
13
|
Balayan T, Begovac J, Skrzat-Klapaczyńska A, Aho I, Alexiev I, Bukovinova P, Salemovic D, Gokengin D, Harxhi A, Holban T, Jevtovic D, Kase K, Lakatos B, Latysheva I, Matulionyte R, Oprea C, Papadopoulos A, Rukhadze N, Sedlacek D, Tomazic J, Vassilenko A, Vasylyev M, Verhaz A, Yancheva N, Yurin O, Horban A, Kowalska JD. Where are we with pre-exposure prophylaxis use in Central and Eastern Europe? Data from the Euroguidelines in Central and Eastern Europe (ECEE) Network Group. HIV Med 2020; 22:67-72. [PMID: 33021049 DOI: 10.1111/hiv.12960] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 07/03/2020] [Accepted: 08/19/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Pre-exposure prophylaxis (PrEP) for HIV infection is an important intervention for control of the HIV epidemic. The incidence of HIV infection is increasing in the countries of Central and Eastern Europe (CEE). Therefore, we investigated the change in PrEP use in CEE over time. METHODS The Euroguidelines in Central and Eastern Europe (ECEE) Network Group was initiated in February 2016 to compare standards of care for HIV and viral hepatitis infections in CEE. Data on access to PrEP were collected from 23 countries through online surveys in May-June 2017 (76 respondents) and in November 2018-May 2019 (28 respondents). RESULTS About 34.2% of respondents stated that tenofovir/emtricitabine (TDF/FTC) was licensed for use in their country in 2017, and 66.7% that it was licensed for use in 2018 (P = 0.02). PrEP was recommended in national guidelines in 39.5% of responses in 2017 and 40.7% in 2018 (P = 0.378). About 70.7% of respondents were aware of "informal" PrEP use in 2017, while 66.6% were aware of this in 2018 (P = 0.698). In 2018, there were 53 centres offering PreP (the highest numbers in Poland and Romania), whereas six countries had no centres offering PreP. The estimated number of HIV-negative people on PreP in the region was 4500 in 2018. Generic TDF/FTC costs (in Euros) ranged from €10 (Romania) to €256.92 (Slovakia), while brand TDF/FTC costs ranged from €60 (Albania) to €853 (Finland). CONCLUSIONS Although the process of licensing TDF/FTC use for PrEP has improved, this is not yet reflected in the guidelines, nor has there been a reduction in the "informal" use of PrEP. PrEP remains a rarely used preventive method in CEE countries.
Collapse
Affiliation(s)
- T Balayan
- National Center for Disease Control and Prevention, Yerevan, Armenia
| | - J Begovac
- School of Medicine, University of Zagreb, Zagreb, Croatia
| | - A Skrzat-Klapaczyńska
- Department of Adults' Infectious Diseases, Medical University of Warsaw, Warsaw, Poland
| | - I Aho
- Helsinki University Hospital, Helsinki, Finland
| | - I Alexiev
- National Centre of Infectious and Parasitic Diseases, Sofia, Bulgaria
| | - P Bukovinova
- Deptartment of Infectious Diseases and Geographical Medicine UH, University Hospital, Bratislava, Slovakia
| | - D Salemovic
- Clinic for Infectious Diseases, Belgrade, Serbia
| | | | - A Harxhi
- Department of Infectious Disease, Faculty of Medicine, University Hospital Center of Tirana, Tirana, Albania
| | - T Holban
- Nicolae Testemițanu State University of Medicine and Pharmacy, Chisinau, Republic of Moldova
| | - D Jevtovic
- Belgrade University School of Medicine Infectious Diseases Hospital, Belgrade, Serbia
| | - K Kase
- Department of Infectious Diseases, West Tallinn Central Hospital, Tallinn, Estonia
| | - B Lakatos
- Saint Laszlo Hospital National Center of HIV, Semmelweis University Faculty of Infectious Diseases, Budapest, Hungary
| | - I Latysheva
- Republican Clinical Hospital of Infectious Diseases of Ministry of Healthcare of Russian Federation, St Petersburg, Russia
| | - R Matulionyte
- Department of Infectious Diseases and Dermatovenerology, Infectious Diseases Centre, Vilnius University, Vilnius, Lithuania
| | - C Oprea
- Victor Babes Clinical Hospital for Infectious Diseases, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - A Papadopoulos
- Medical School -National and Kapodistrian University of Athens, University General Hospital "ATTIKON", Athens, Greece
| | - N Rukhadze
- Infectious Diseases, AIDS & Clinical Immunology Research Center, Tbilisi, Georgia
| | - D Sedlacek
- HIV Center University Hospital, Pilsen, Czech Republic
| | - J Tomazic
- Department of Infectious Diseases, University Medical Center Ljubljana, Ljubljana, Slovenia
| | - A Vassilenko
- Belarusian State Medical University, Minsk, Belarus
| | - M Vasylyev
- Lviv Regional Public Health Center, Lviv, Ukraine
| | - A Verhaz
- Clinic for Infectious Diseases, University Clinical Center of the Republic of Srpska, Banja Luka, Banja Luka, RS, Bosnia & Herzegovina, Banja Luka, Bosnia and Herzegovina
| | - N Yancheva
- Department for AIDS, Specialized Hospital for Active Treatment of Infectious and Parasitic Diseases - Sofia, Medical University Sofia, Sofia, Bulgaria
| | - O Yurin
- Central Research Institute of Epidemiology, Federal AIDS Centre, Moscow, Russian Federation
| | - A Horban
- Department of Adults' Infectious Diseases, Medical University of Warsaw, Warsaw, Poland
| | - J D Kowalska
- Department of Adults' Infectious Diseases, Medical University of Warsaw, Warsaw, Poland.,HIV Out-Patient Clinic, Hospital for Infectious Diseases, Warsaw, Poland
| | | |
Collapse
|
14
|
Vasylyev M, Davtyan H, Denisiuk O, Chadwick Jayaraj J, Koval T, Piddubna A, Sluzhynska M, Sluzhynska O, Mulcahy F. Anxiety, depression, and quality of life among HIV positive injection drug users in Ukraine, 2017. J Infect Dev Ctries 2019; 13:111S-117S. [PMID: 32065813 DOI: 10.3855/jidc.11295] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 05/25/2019] [Indexed: 10/31/2022] Open
Abstract
INTRODUCTION People who inject drugs (PWID) are one of the key populations most vulnerable to HIV infection, with 28 times higher prevalence compared to the rest of the population. PWID are known to have many physical, psychological and lifestyle challenges that can influence access to care. Depression is common among PWID living with HIV. It has major effect on health-related quality of life (HRQoL) and is influencing adherence to antiretroviral therapy. This study was conducted to explore how anxiety and depression affect HRQoL among HIV-positive PWID in Ukraine. It will provide knowledge for the further policy development. METHODOLOGY A descriptive cross-sectional study using data from interviewer- administrated questionnaires was performed. The questionnaire was based on the Hospital Anxiety and Depression Scale. The questionnaire on HRQoL was based on the SF-36. RESULTS Among the 90 HIV positive PWID 74% (67) and 61% (55) had anxiety and depression scores higher than 7 respectively, indicating that most patients had mental health problems. Average scores for general health (40), role limitations due to physical (44) and emotional health (34), vitality (41) and mental health (45) had mean scores less than 50 along with total physical (43) and mental health scores (35). Having an HIV positive partner or partner with unknown HIV status increases anxiety in HIV positive PWID. CONCLUSION There are increased depressive and anxiety symptoms and poorer QoL among HIV-positive PWID in Ukraine. Strategies focusing on psychosocial support addressing QoL as part of HIV care could improve health outcomes for these comorbid and debilitating conditions.
Collapse
Affiliation(s)
- Marta Vasylyev
- Lviv Regional Public Health Center, Charitable Salus Foundation, Lviv, Ukraine.
| | - Hayk Davtyan
- TB Research and Prevention Center, Yerevan, Armenia.
| | | | | | - Tetyana Koval
- Ukrainian Medical Stomatological Academy, Kyiv, Ukraine.
| | | | | | | | - Fiona Mulcahy
- Department of Genito Urinary Medicine and Infectious Diseases, St James's Hospital, Dublin, Ireland.
| |
Collapse
|
15
|
Malin JJ, Boesecke C, Schwarze-Zander C, Wasmuth JC, Schlabe S, Trebicka J, Spengler U, Llibre JM, Jou T, Vasylyev M, Clotet B, Rockstroh JK. Liver stiffness regression after successful Hepatitis C treatment is independent of HIV coinfection. HIV Med 2019; 20:230-236. [PMID: 30687989 DOI: 10.1111/hiv.12705] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/26/2018] [Indexed: 12/28/2022]
Abstract
OBJECTIVES The aim of the study was to assess the regression of liver stiffness after successful direct-acting antiviral (DAA) treatment in patients with hepatitis C virus (HCV) monoinfection and HCV/-HIV coinfection. In addition, we aimed to identify factors associated with liver stiffness regression. METHODS We studied patients treated with interferon-free DAA regimens with a sustained virological response at week 12 (SVR12 ) or 24 (SVR24 ) post-treatment. Liver stiffness was assessed by transient elastography (TE) before the initiation and after the end of treatment (median 12 weeks). RESULTS Of 214 enrolled patients, 85 (40%) were HCV monoinfected and 129 (60%) HCV/HIV coinfected. Baseline median TE values were 7.8 kPa [interquartile range (IQR) 5.9-12.0 kPa] in mono-infected patients and 10.7 kPa (IQR 7.8-17.0 kPa) in coinfected patients. Overall, the median TE value decreased from 10.1 to 6.8 kPa (n = 214; P < 0.0001). There was no difference between mono- and coinfected patients (-2.2 versus -3.3 kPa, respectively; P = 0.88), which was verified by an analysis of covariance (ANCOVA) adjusting for baseline TE values. Significant (≥ 30%) regression of liver stiffness was achieved by 45% of patients (54% with baseline TE ≥ 7.1 kPa). In multivariate analysis, a prior HCV treatment was a negative predictor of liver stiffness regression [odds ratio (OR) 0.31; P = 0.001]. A higher baseline TE value was positively associated with achieving a significant regression (OR 1.06; P = 0.02). HIV coinfection status, HCV genotype, age, sex, treatment duration, controlled attenuation parameter value, bilirubin concentration, platelet count and aspartate aminotransferase concentration were not associated with liver stiffness regression. CONCLUSIONS Regression of liver stiffness after successful DAA treatment did not differ in patients with HCV monoinfection and those with HCV/HIV coinfection. Half of all patients achieved a significant (≥ 30%) regression. Prior treatment for HCV was a negative predictor for this endpoint, while a higher baseline TE value was positively associated with regression.
Collapse
Affiliation(s)
- J J Malin
- Department of Internal Medicine I, University Hospital Cologne, Cologne, Germany
| | - C Boesecke
- Department of Medicine I, Bonn University Hospital, Bonn, Germany
| | | | - J C Wasmuth
- Department of Medicine I, Bonn University Hospital, Bonn, Germany
| | - S Schlabe
- Department of Medicine I, Bonn University Hospital, Bonn, Germany
| | - J Trebicka
- Department of Medicine I, Bonn University Hospital, Bonn, Germany.,European Foundation for Study of Chronic Liver Failure, Barcelona, Spain.,Medical Department I, Goethe University Clinic Frankfurt, Frankfurt, Germany
| | - U Spengler
- Department of Medicine I, Bonn University Hospital, Bonn, Germany
| | - J M Llibre
- Department of Infectious Diseases, University Hospital "Germans Trias i Pujol", Badalona, Spain
| | - T Jou
- Department of Infectious Diseases, University Hospital "Germans Trias i Pujol", Badalona, Spain
| | - M Vasylyev
- HIV Unit Lviv Regional Public Health Center, Lviv, Ukraine
| | - B Clotet
- Irsicaixa Foundation, University Hospital "Germans Trias i Pujol", Badalona, Spain
| | - J K Rockstroh
- Department of Medicine I, Bonn University Hospital, Bonn, Germany
| |
Collapse
|
16
|
Kowalska JD, Bursa D, Gökengin D, Jilich D, Tomazic J, Vasylyev M, Bukovinowa P, Mulabdic V, Antonyak S, Horban A. HIV health care providers are ready to introduce pre-exposure prophylaxis in Central and Eastern Europe and neighbouring countries: data from the Euroguidelines in Central and Eastern Europe (ECEE) Network Group. HIV Med 2018; 19:629-633. [PMID: 29989332 DOI: 10.1111/hiv.12641] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/08/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Pre-exposure prophylaxis (PrEP) for HIV infection has been introduced in only a few European countries. We investigated the potential to provide PrEP in the Central and Eastern European region, and in neighbouring countries. METHODS The Euroguidelines in Central and Eastern Europe (ECEE) Network Group was formed in February 2016 to review standards of care for HIV infection in the region. Information related to PrEP was collected through on-line surveys. Respondents were recruited by ECEE members based on their involvement in HIV care. RESULTS Seventy-six respondents from 23 countries participated in the survey. Twenty-six (34.2%) respondents reported that PrEP [tenofovir disoproxil fumarate (TDF)/emtricitabine (FTC)] was registered by the drug registration authority in their country. Fifty-three (70.7%) respondents reported being aware of 'informal' PrEP use in their country. If they had access to PrEP, 56 (74.7%) would advise its use in their practice. Forty-five (59.2%) respondents had concerns regarding PrEP use, and 10 (13.3%) expressed the need for more training. Most of the respondents (88.2%) would provide PrEP to people with high-risk behaviours. CONCLUSIONS PrEP is already used informally in some countries in the region. Physicians are keen to use PrEP if and when it is accessible. Obstacles towards implementing PrEP in those countries were mostly related to lack of national guidelines, drug registration and governmental strategy.
Collapse
Affiliation(s)
- J D Kowalska
- Department of Adults' Infectious Diseases, Medical University of Warsaw, Warsaw, Poland.,Hospital for Infectious Diseases, HIV Out-Patient Clinic, Warsaw, Poland
| | - D Bursa
- Department of Adults' Infectious Diseases, Medical University of Warsaw, Warsaw, Poland.,Hospital for Infectious Diseases, Warsaw, Poland
| | - D Gökengin
- Infectious Diseases and Clinical Microbiology, Ege University Medical Faculty, Izmir, Turkey
| | - D Jilich
- Department of Infectious and Tropical Diseases, Hospital Na Bulovce, Prague, Czech Republic
| | - J Tomazic
- Department of Infectious Diseases, University Medical Center Ljubljana, Ljubljana, Slovenia
| | - M Vasylyev
- Lviv Regional Public Health Center, Lviv, Ukraine
| | - P Bukovinowa
- Department of Infectious Diseases and Geographical Medicine, University Hospital, Bratislava, Slovakia
| | - V Mulabdic
- Clinic for Infectious Diseases, Clinical Center of Sarajevo University, Sarajevo, Bosnia and Herzegovina
| | - S Antonyak
- Clinic of the Gromahevsky Institute of Epidemiology and Infectious Diseases, Kiev, Ukraine
| | - A Horban
- Department of Adults' Infectious Diseases, Medical University of Warsaw, Warsaw, Poland.,Hospital for Infectious Diseases, HIV Out-Patient Clinic, Warsaw, Poland
| | | |
Collapse
|
17
|
Vasylyev M, Sluzhynska M, Sluzhynska O, Grushynska O, Krystynyak O, Krystynyak O, Krystynyak O, Krystynyak O, Krystynyak O, Krystynyak O. P3.108 Mobile Gynecological Clinic - Effective Tool For HIV\STI Screening Diagnostics For Commercial Sex Workers in Lviv Region (Ukraine). Br J Vener Dis 2013. [DOI: 10.1136/sextrans-2013-051184.0567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|