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

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.

Infections in hospitalised Russian children with AIDS

OBJECTIVES

(1) To determine the most common infections in hospitalised children with AIDS. (2) To identify the pathogens causing the above infections. (3) To investigate the possibility of nosocomial transmission of potential pathogens in a Russian AIDS hospital.

SETTING

Russian AIDS Hospital for Children.

SUBJECTS AND METHODS

Swabs/samples of skin, mouth, nose, urine and stool were collected from 95 hospitalised children with AIDS, 12 of their mothers and 11 health care workers in contact with the children. Hospital objects were also sampled. The predominant isolates from the infection sites were speciated. Antibiotic sensitivity profiles, phagotyping and gel electrophoresis of cell lysates were used for the epidemiological marking of Candida albicans, Staphylococcus aureus and Klebsiella pneumoniae.

RESULTS

Oral infections were the most prevalent infections in this study group. The most frequently isolated micro-organisms were C. albicans, S. aureus, K. pneumoniae and Escherichia coli. The results of the epidemiological study suggests nosocomial transmission of these strains.

CONCLUSIONS

The present chemoprophylaxis programme for opportunistic oral infections requires revision. Systems of microbiological surveillance and cross-infection control monitoring in relation to immunocompromised patients need to be developed to decrease the possibility of nosocomial transmission of potential pathogens between hospitalised children with AIDS, their mothers and health care providers.