The evolution of HIV/AIDS infection in Romania 31 December 2017

Transcription

1 The evolution of HIV/AIDS infection in Romania 31 December 2017

2 The data is collected from the HIV/AIDS confirmation charts, sent by the nine Regional Centers for Evaluation and Monitoring of HIV/AIDS Data and further processed and elaborated by Compartment for Monitoring and Evaluation of HIV/AIDS data in Romania, in National Institute for Infectious Diseases Prof. Dr. Matei Bals

3 UNAIDS objectives Source:

4 Romania December 2017: PLWHA ( cumulative total since 1985). Currently, Romania has a large number of survivors in the age group, who belong to the cohort (>5500). Total no. of patients benefitting from ART and post exposure prophylaxis in 2017 (according to the report released by the Technical Assistance and Management Unit): Source: Surveillance Report: HIV/AIDS Surveillance in Europe ECDC Stockholm Source: Compartment for Monitoring and Evaluation of HIV/AIDS Data in Romania INBI Prof.Dr.M.Balş Rates of new HIV diagnoses, by geographical area and year of diagnosis, WHO European Region, (including Russia)

5 Ministry of Health National Institute for Infectious Diseases Prof. Dr. Matei Bals Compartment for Monitoring and Evaluation of HIV/AIDS Infection in Romania General Data at 31 December 2017 TOTAL HIV/AIDS (CUMULATIVE ) OF WHICH: Total AIDS (Cumulative ) Total HIV (Cumulative ) Total no. of AIDS deaths ( ) 714 Out of records HIV/AIDS children + adults NUMBER OF PATIENTS LIVING WITH HIV/AIDS OF WHICH: YEARS YEARS YEARS New HIV/AIDS cases diagnosed in New HIV cases 399 New AIDS cases 293 HIV/AIDS related deaths, confirmed by medical charts in Total no. of ART and post exposure prophylaxis beneficiaries in 2017 (based on UATM report)

6 Distribution of ages Age at date of diagnosis/notification Cumulative total Distribution by age of PLWHA

7 AIDS incidence in adults and children between ( ) Children 2017: 0.13/ Adults 2017: 1.74/

8 HIV incidence rate in adults and children between ( ) Children 2017: 0.34/ Adults 2017: 2.41/

9 Distribution of HIV/AIDS cases in PLWHA by age groups and current age at 31 December 2017 (cumulative total ) Age group MASCULINE SEX FEMININE TOTAL < 1 year yrs yrs yrs yrs yrs yrs yrs yrs yrs yrs yrs yrs TOTAL

10 Tendencies in routes of transmission Romania Route of transmission Vertical** MSM (1.91%) 19 (4.03%) 13 (2,33%) 43 (7,71%) 23 (4,14%) 51 (9,18%) 27 (4,7%) 65 (11,32%) 22 (2.81%) 102 (13.04%) 21 (2,3%) 99 (10.86%) 28 (2.89%) 100 (10.34%) 17 (1.87%) 139 (15,35%) 19 (2,27%) 127 (15,19%) 6 (0,78%) 137 (17.97%) 14 (2.02%) 133 (19.21%) IDU (injecting drug use) 6 (1.27%) 4 (0.71%) 11 (1.98%) 17 (2.96%) 153 (19.56%) 283 (31.06%) 290 (29.98%) 187 (20,66%) 164 (19.61%) 118 (15.48%) 106 (15.31%) MSM/IDU 1 (0.21%) 1 (0,18%) 1 (0.17%) 8 (1.02%) 7 (0,76%) 10 (1.03%) 9 (0.99%) 10 (1.19%) 3 (0,39%) 2 (0.28%) Heterosexual 367 (77.91%) 424 (76.12%) 419 (75,49%) 430 (74.91%) 470 (60.1%) 460 (50,49%) 524 (54.18%) 532 (58,78%) 491 (58,73%) 488 (64.04%) 430 (62.13%) Unkown 69 (14.64%) 73 (13.1%) 50 (9%) 34 (5,92%) 27 (3.45%) 41 (4,5%) 15 (1.55%) 21 (2,32%) 25 (2.99%) 10 (1.31%) 7 (1.01%) Total *Updating late reporting and case confirmation are performed annually. **New borns perinatally exposed to HIV with HIV positive status in 2017 and perinatally exposed children under surveillance since the previous years

11 Tendencies in the routes of transmission Romania Heterosexual IDUs

12 New HIV/AIDS Cases 1 JANUARY 31 DECEMBER 2017

13 Distribution of new HIV/AIDS cases by counties LEGEND CHILDREN (0-14 YEARS) ADULTS (> 14 YEARS)

14 Distribution of new HIV/AIDS cases by sex 2017

15 Distribution of new HIV/AIDS cases by age group and sex 2017

16 Distribution of new HIV/AIDS cases by probable routes of transmission Sursa: Compartimentul pentru Monitorizarea şi Evaluarea Infecţiei HIV/SIDA în România INBI Prof.Dr.M.Balş

17 New HIV/AIDS cases (January-December 2017) through i.v. drug use, by age groups Age group Masculine Feminine Total Total

18 New cases of HIV/AIDS infection through i.v. drug use, by age groups, recorded in 2017

19 Drugs used by HIV patients (declared by patients), diagnosed in 2017

20 New HIV/AIDS cases (January-December 2017) through i.v. drug use, by counties County Masculine Feminine Total Brăila 1 1 Bucureşti Călăraşi 4 4 Galaţi 1 1 Gorj 1 1 Ialomiţa 1 1 Ilfov Mehedinţi 1 1 Olt 1 1 Sibiu 1 1 Teleorman Vrancea 2 2 Total

21 HBV, HCV, STDs in new HIV/AIDS cases through i.v. drug use (100 cases) Tested for Positive % AgHBs 1/108 0,92% VHC 90/ % AgHBs + VHC 8/ % STDs 12/ % TBC 22/ %

22 HIV/TB Co-infection in HIV/IDUs, diagnosed in 2017

23 I.V. drug users diagnosed HIV+ in 2017, previously tested before the current HIV positive test Year of previous testing No.of patients TOTAL 13

24 New HIV/AIDS cases registered in the National Data Base: vs. New HIV/AIDS cases in IDUs registered in the National Data Base: YEAR CRITERIA TOTAL of which IDU TOTA L of which IDU TOTAL of which IDU TOTAL of which IDU TOTAL of which IDU TOTAL of which IDU TOTAL of which IDU TOTAL of which IDU TOTAL of which IDU Number of HIV cases Number of AIDS cases Total number of HIV/ AIDS cases

25 HIV testing in IDUs performed by the District Public Health Departments Year NEGATIVE TEST RESULTS POZITIVE TESTS RESULTS TOTAL % POZITIVE TESTS % % % % % % % % % % %

26 CD4 values in new cases diagnosed in adults MASCULINE FEMININE

27 CD4 values in new HIV/AIDS cases at adults

28 CD4 values in new HIV/AIDS cases at adults MASCULINE FEMININE

29 CD4 values in i.v. drug users vs. HIV/AIDS patients with different routes of transmission 2017 IDU Patients with different routes of HIV transmission

30 CD4 values in IDUs vs. patients who acquired HIV though different ways, detected with HIV/AIDS in 2017 IDUs Pts. with other ways of transmission

31 Evolution of HIV/AIDS in Romania

32 AIDS incidence in adults and children between ( ) Children 2017: 0.13/ Adults 2017: 1.74/

33 Sex distribution of AIDS cases at 31 December 2017 (cumulative total )

34 Age group and sex distribution (at the date of diagnosis) at 31 December 2017 (cumulative total )

35 Probable way of transmission in children with AIDS (0-14 years at the date of diagnosis) at 31 December 2017 (cumulative total ) *Persons who received blood transfusions in the late 1980s and early 1990s. ** Persons with repeated admissions and/or multiple parenteral treatments in the late 1980s and early 1990s

36 Probable way of transmission in adults with AIDS (>14 years at the date of diagnosis) at 31 December 2017 (cumulative total ) * Persons who received blood transfusions in the late 1980s and early 1990s

37 Distribution of AIDS cases in women, by age group and year of diagnosis, between

38 HIV incidence rate in adults and children between ( ) Children 2017: 0.34/ Adults 2017: 2.41/

39 Sex distribution of HIV cases at 31 December 2017 (cumulative total )

40 Age and sex distribution (at the date of diagnosis) of HIV infection cases at 31 December 2017 (cumulative total )

41 Probable way of transmission in children with HIV infection (0-14 years at the date of diagnosis) at 31 December 2017 (cumulative total ) *Persons who received blood transfusions in the late 1980s and early 1990s ** Persons with repeated admissions and/or multiple parenteral treatments in the late 1980s and early 1990s

42 Probable way of transmission in adults with HIV infection (> 14 years at the date of diagnosis) at 31 December 2017 (cumulative total ) *Persons who received blood transfusions in the late 1980s and early 1990s

43 Distribution of HIV infection in women by years of diagnosis and age group ( )

44 HBV, HCV and HBV+HCV infection in seropositive children during

45 HBV, HCV and HBV+HCV infection in seropositive adults during Year of diagnosis

46 AIDS defining illnesses in 2017

47 Deaths by year

48 Mean rate of survival (measured in months) in AIDS patients, between Introduction of ART double therapy Introduction of ART triple therapy Universal access to ART ART as prevention

49 Mother to child transmission of HIV in Romania

50 HIV/AIDS Infection in children with mother to child transmission

51 Age group distribution of HIV/AIDS infection cases acquired through vertical transmission by age group

52 Children (0-14 years): number of schemes prior to the actual one 31 December 2017

53 ART schemes in children 31 December 2017

54 Viral load values in children under antiretroviral treatment

55 Prophylaxis of mother to child transmission in pregnant women

56 Prophylaxis of mother to child transmission in children born to HIV positive mothers Year No. of born children No. of prophylaxis

57 HIV testing 2017

58 HIV testing* in risk groups in 2017 Risk group Negative tests Positive tests TOTAL %POZITIV STD TBC Maternity testing Pregnant women Health care staff Pts. with hemodialysis Pts. with transfusions Prenuptial check-up I.V. drug users Inmates Homosexuals Commercial sex workers HIV Contacts Sailors Drivers Work abroad> 6 month Stay abroad> 6 month Testing by request Occasional TOTAL * The data are sent by County Public Health Authorities

59 HIV testing in pregnant women, by age group in 2017 Age group Negative tests Positive tests TOTAL %Positive yrs yrs yrs yrs yrs yrs > 40 yrs Unspecified age TOTAL * The data are sent by County Public Health Authorities

60 HIV testing in pregnant women by age group in 2017

61 Total testing Positive tests HIV testing in pregnant women Year

62 HIV testing in blood donors Year

63 STD testing in HIV patients Year

64 HIV testing in TB patients Year

65 HIV testing in HIV contacts Year

66 HIV testing by request Year

67 Challenges in

68 Source : A. Streinu-Cercel. cnlas.ro: Specific Challenges of the HIV Epidemic in Romania. EACS M. Mardarescu. Et All. Risk factors involved in late detection of HIV mother to child transmission - data from the National Registry of HIV pregnant women and perinatally exposed children in Romania. 2 nd Vilnius Summit on Communicable Diseases. Oct 4-7, th Congress of the BADV, October 5-7, Vilnius, Lithuania. CURRENT SITUATION Romania 2017 PLWHA MTCT ART IDUs Young by age, old by treatment Therapeutic fatigue New HIV infection cases: young people in their fertile age, late presentations in the sanitary system. MSM: increase of the number in dynamics Increase in HIV cases in adults. Young mothers, with multiple therapeutic schemes Mothers with unknown HIV status- recommendation for HIV testing and specific ART treatment New approach of HIV peinatalally exposed new bourns management. National Registry of HIV perinatally exposed children and of women infected with HIV. Most ARTs- available in Romania Universal access to treatment. Treatment introduction regardless of CD4 count. Treatment as prevention. Sub-optimal regimen during the first weeks of life Management of ART toxicity ART approach in young women living with HIV/AIDS New psychoactive substances. New approach of mothers who uses drugs and of new- bourns, perinatally exposed to HIV.

69 CURRENT SITUATION Romania 2017 Tx Fatigue Comorbidities Aging Future challenges? Long term therapy + many therapeutic schemes + many VF + immunologic failure A lot of co-morbidities Important implication from DDI point of view New approaches, New mechanism New understandings New attitude New outcomes Source : A. Streinu-Cercel. cnlas.ro: Specific Challenges of the HIV Epidemic in Romania. EACS M. Mardarescu. Et All. Risk factors involved in late detection of HIV mother to child transmission - data from the National Registry of HIV pregnant women and perinatally exposed children in Romania. 2 nd Vilnius Summit on Communicable Diseases. Oct 4-7, th Congress of the BADV, October 5-7, Vilnius,

70 Global HIV/AIDS infection 2016

71 Source: UNAIDS - Jully 2017

72 million Source: UNAIDS - Jully 2017 Estimates on the number of PLWHA ( )

73 Source: UNAIDS - Jully 2017

74 Source: UNAIDS - Jully 2017

75 Source: UNAIDS - Jully 2017

76 Source: UNAIDS - Jully 2017

77 Source: UNAIDS - Jully 2017

78 Source: UNAIDS - Jully 2017

79 Characteristics of HIV infection cases diagnosed in the WHO European Region in 2016, by geographical areas WHO European Region West Centre East EU/EEA countrie s Reporting countries/no. of reporting countries* 50/53 (51/53) 23/23 15/15 12/15 (13/15) 31/31 Number of HIV infection cases ( ) ( ) Rate per population 7.7 (18.2) (50.2) 5.9 % of cases: age group 9.4% 10.2% 14.8% 7.1% 10.6% Percentage age 50+ years 15.6% 19.6% 12.1% 12.2% 18.5% Men/women ration Way of transmssion Heterosexual 46.8% 32.9% 27.0% 66.4% 32.3% MSM 23.9% 41.3% 29.9% 3.7% 40.1% I.V. drugs 12.5% 2.9% 2.7% 25.2% 3.6% MTCT 0.7% 0.5% 0.5% 0.9% 0.5% Unknown 16.0% 22.1% 39.7% 3.8% 23.2% * No data received from Russia, Turkmenistan, Uzbekistan. All data presented were reported to ECDC/WHO through the European Surveillance System (TESSy), except for data for Russia which were obtained through the Russian Federal Scientific and Methodological Center for Prevention and Control of AIDS [1]. Russian data are included in the numbers in parentheses for the European Region and the East. ** EU/EEA rate is adjusted for reporting delay (Annex 5), the corresponding estimated number of new diagnoses adjusted for reporting delay is Source: HIV/AIDS Surveillance in Europe 2017;

80 CASE DEFINITIONS OF COMMUNICABLE DISEASES ACQUIRED IMMUNODEFICIENCY SYNDROME (AIDS) AND HUMAN IMMUNODEFICIENCY VIRUS (HIV) INFECTION Clinical Criteria (AIDS) Any person who has any of the clinical conditions as defined in the European AIDS case definition for: Adults and adolescents 15 years Children < 15 years of age Laboratory Criteria (HIV) Adults, adolescents and children aged 18 months At least one of the following three: Positive result of a HIV screening antibody test or a combined screening test (HIV antibody and HIV p24 antigen) confirmed by a more specific antibody test (e.g. Western blot) Positive result of 2 EIA antibody test confirmed by a positive result of a further EIA test Positive results on two separate specimens from at least one of the following three: Detection of HIV nucleic acid (HIV-RNA. HIV-DNA) Demonstration of HIV by HIV p24 antigen test. including neutralisation assay Isolation of HIV Children aged < 18 months Positive results on two separate specimens (excluding cord blood) from at least one of the following three: Isolation of HIV Detection of HIV nucleic acid (HIV-RNA. HIV-DNA) Demonstration of HIV by HIV p24 antigen test. including neutralisation assay in a child 1 month of age eur-lex.europa.eu/lexuriserv/lexuriserv.do?uri=consleg:2002d0253: :en:pdf

81 Epidemiological Criteria NA Case Classification A. Possible case NA B. Probable case NA C. Confirmed case HIV infection Any person meeting the laboratory criteria for HIV infection AIDS Any person meeting the clinical criteria for AIDS and the laboratory criteria for HIV infection

82 Definitions INCIDENCE = Number of new cases of infection X population. registered at 1 July 2017 PREVALENCE = Number of new and old cases of infection X population. registered at 1 July 2017

83 Sources and references Commission Decision of 28/IV/2008 amending Decision 2002/253/Ec laying down case definitions for reporting communicable diseases to the Community network under Decision no 2119/98/EC of the European Parliament and Council :EN:PDF

84 National Institute for Infectious Diseases Prof. Dr. Matei Bals Compartment for Monitoring and Evaluation of HIV/AIDS Data in Romania Manager: Prof.Dr. Adrian Streinu-Cercel Head of Infectious Diseases UMF Carol Davila Coordinator: Coordinator Adults Programme: Coordinator Children Programme: Mariana Mărdărescu MD PhD Associated Proffesor Elisabeta Otilia Benea MD PhD Sorin Petrea MD Statistical data operators : PC Operators: Epidemiology: As.med. Marieta Iancu Daniela Viţelaru Sanda Vintilă Ionel Iosif MD