HIV/AIDS infection in Romania 30 June 2018

Transcription

1 HIV/AIDS infection in Romania 30 June 2018

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 by Compartment for Monitoring and Evaluation of HIV/AIDS data in Romania, in National Institute for Infectious Diseases Prof. Dr. Matei Bals

3 Coordination of counties by the Regional HIV/AIDS Monitoring and Evaluation Centers in Romania INBI PROF.DR. MATEI BALŞ Regional Centre BUCHAREST ARGEŞ BUZĂU DAMBOVIŢA GALAŢI IALOMIŢA ILFOV PRAHOVA VÂLCEA CRAIOVA Regional Centre CONSTANŢA Regional Centre DOLJ GORJ MEHEDINŢI OLT CONSTANŢA TULCEA VRANCEA V. BABEŞ BUCUREŞTI Regional Centre BRĂILA CĂLĂRAŞI GIURGIU TELEORMAN V.BABEŞ- BUCUREŞTI IAŞI Regional Centre BACĂU BOTOŞANI IAŞI NEAMŢ SUCEAVA VASLUI BRAŞOV Regional Centre BRAŞOV COVASNA HARGHITA TÂRGU MUREŞ Regional Centre ALBA BISTRIŢA NĂSĂUD MUREŞ SIBIU BIHOR CLUJ Regional Centre CLUJ MARAMUREŞ SATU MARE SĂLAJ TIMIŞOARA Regional Centre ARAD CARAŞ SEVERIN HUNEDOARA TIMIŞ

4 UNAIDS objectives Source:

5 Ministry of Health, Romania National Institute for Infectious Diseases PROF.DR.MATEI BALŞ Compartment for Monitoring and Evaluation of HIV/AIDS Data in Romania General data at 30 June 2018 TOTAL HIV/AIDS (CUMULATIVE ) OF WHICH: Total AIDS (Cumulative ) Total HIV (Cumulative ) Total no. of AIDS deaths ( ) 739 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 142 New AIDS cases 115 HIV/AIDS related deaths, confirmed by medical charts in Source: Compartment for Monitoring and Evaluation of HIV/AIDS in Romania - INBI Prof.Dr.M.Balş

6 New HIV/AIDS cases 1 January-30 June 2018

7 Distribution, by counties of new HIV/AIDS cases detected between LEGEND CHILDREN (0-14 YRS) ADULTS AND ADOLESCENTS (> 14 YRS) Source: Compartment for Monitoring and Evaluation of HIV/AIDS in Romania - INBI Prof.Dr.M.Balş

8 Distribution, by gender, of new HIV/AIDS cases detected between (24%) 195 (76%) MALES FEMALES Source: Compartment for Monitoring and Evaluation of HIV/AIDS in Romania - INBI Prof.Dr.M.Balş

9 Distribution, by age and gender, of new HIV/AIDS cases, detected during <1year 1-4 years years years years years years years years >=60 years Males Females Source: Compartment for Monitoring and Evaluation of HIV/AIDS in Romania - INBI Prof.Dr.M.Balş

10 Distribution, by way of transmission, of new HIV/AIDS cases in children and adults, detected between Moter-to-child MSM/Bisexual IDUs* Heterosexual Unknown MALES FEMALES *At we registered 30 HIV/IDU cases - 29 reported as injecting drug use as way of transmission, while 1 reported MSM (men sex with men)/bisexual contact. Source: Compartment for Monitoring and Evaluation of HIV/AIDS in Romania - INBI Prof.Dr.M.Balş

11 CD4 values in new HIV/AIDS cases detected during the first semester of % 8% 27% 35% 11% < > 500 Under assessment Source: Compartment for Monitoring and Evaluation of HIV/AIDS in Romania - INBI Prof.Dr.M.Balş

12 CD4 values in new HIV/AIDS cases in adults, detected during the first semester of 2018 Men Women 23% 10% 17% 7% 27% 27% 37% 30% 12% 10% < > 500 Under assessment < > 500 Under assessment Total cases: 194 Total cases: 60 Source: Compartment for Monitoring and Evaluation of HIV/AIDS in Romania - INBI Prof.Dr.M.Balş

13 Viral load in new HIV/AIDS cases in adults, detected during the first semester of 2018 Men Women 32% 6% 7% 33% 20% 19% 22% 23% 18% 20% < > Under assessment < > Under assessment Source: Compartment for Monitoring and Evaluation of HIV/AIDS in Romania - INBI Prof.Dr.M.Balş

14 New HIV-IDU cases (injecting drug users) 1 January- 30 June 2018

15 New cases of HIV/AIDS (January-June 2018) by injecting drug use Age groups distribution Age group Men Women Total years years years years years years years 1 1 Total Source: Compartment for Monitoring and Evaluation of HIV/AIDS in Romania - INBI Prof.Dr.M.Balş

16 New cases of HIV/AIDS (January-June 2018) by injecting drug use Age groups distribution 31% 3% 3% 13% 10% 23% 17% years years years years years years >=50 years Source: Compartment for Monitoring and Evaluation of HIV/AIDS in Romania - INBI Prof.Dr.M.Balş

17 New cases of HIV/AIDS (January-June 2018) by injecting drug use Counties distribution County Men Women Total Arad 1 1 Bucureşti Călăraşi 2 2 Cluj 1 1 Ilfov 1 1 Mures 1 1 Total Source: Compartment for Monitoring and Evaluation of HIV/AIDS in Romania - INBI Prof.Dr.M.Balş

18 HIV/HBC, HCV, STDs and TB co-infections in IDUs Screened for Number of patients with a positive test % AgHBs 1/ % VHC 17/ % AgHBs + VHC 5/ % STDs (sexually transmitted 3.33% 1/30 diseases) TB co-infection 5/ % Source: Compartment for Monitoring and Evaluation of HIV/AIDS in Romania - INBI Prof.Dr.M.Balş

19 HIV/HBV, HCV, STDs and TB co-infections in IDUs Total patients: % 90.00% 80.00% 70.00% 60.00% 56.66% 50.00% 40.00% 30.00% 20.00% 16.66% 16.66% 10.00% 0.00% 3.33% AgHBs VHC AgHBs + VHC 3.33% STDs TBC Source: Compartment for Monitoring and Evaluation of HIV/AIDS in Romania - INBI Prof.Dr.M.Balş

20 Drugs used by HIV-IDU patients, diagnosed during the first 6 months of % 23% 10% 3% 27% HEROINE HEROINE+NEW HIGHS UNSPECIFIED NEW HIGHS HEROINE+COCAINE+NEW HIGHS Source: Compartment for Monitoring and Evaluation of HIV/AIDS in Romania - INBI Prof.Dr.M.Balş

21 IDUs diagnosed HIV+ during the first 6 months of 2018, who underwent a previous HIV screening Year of previous screening No. patients Total 3 Source: Compartment for Monitoring and Evaluation of HIV/AIDS in Romania - INBI Prof.Dr.M.Balş

22 New HIV/AIDS cases registered in the National HIV/AIDS Data Base during vs. New HIV/AIDS cases in IDUs registered in the National Data Base during CRITERION TOTAL of wich YEAR IDU TOTAL of wich IDU TOTAL of wich IDU TOTAL of wich IDU TOTAL of wich IDU TOTAL of wich IDU TOTAL of wich IDU TOTAL of wich IDU TOTAL of wich IDU TOTAL of wich IDU No. of HIV infections No. of AIDS cases Total number of HIV/AIDS cases Source: Compartment for Monitoring and Evaluation of HIV/AIDS in Romania - INBI Prof.Dr.M.Balş

23 CD4 count in IDUs diagnosed with HIV/AIDS during the first 6 months of % 10% 40% 36% 7% < > 500 Under assessment Source: Compartment for Monitoring and Evaluation of HIV/AIDS in Romania - INBI Prof.Dr.M.Balş

24 Evolution of HIV/AIDS infection in Romania

25 Distribution of ages Age at date of diagnosis/notification Cumulative total Distribution by age of PLWHA Source: Compartment for Monitoring and Evaluation of HIV/AIDS Infection in Romania INBI Prof.Dr.M.Balş

26 Distribution of HIV/AIDS living patients, by age groups, current age and gender at 30 June 2018 (cumulative total ) Age group Male Source: Compartment for Monitoring and Evaluation of HIV/AIDS in Romania - INBI Prof.Dr.M.Balş Gender Female TOTAL < 1 year years years years years years years years years years years years TOTAL

27 Tendencies in routes of transmission in Romania * Route of transmission Vertical** MSM IDU (injecting drug use) MSM/IDU Heterosexual Unkown (1.91%) 19 (4.03%) 6 (1.27%) 1 (0.21%) 367 (77.91%) 69 (14.64%) 13 (2,33%) 43 (7,71%) 4 (0.71%) 424 (76.12%) 73 (13.1%) 23 (4,14%) 51 (9,18%) 11 (1.98%) 1 (0,18%) 419 (75,49%) 50 (9%) 27 (4,7%) 65 (11,32%) 17 (2.96%) 1 (0.17%) 430 (74.91%) 34 (5,92%) 22 (2.81%) 102 (13.04%) 153 (19.56%) 8 (1.02%) 470 (60.1%) 27 (3.45%) 21 (2,3%) 99 (10.86%) 283 (31.06%) 7 (0,76%) 460 (50,49%) 41 (4,5%) 28 (2.89%) 100 (10.34%) 290 (29.98%) 10 (1.03%) 524 (54.18%) 15 (1.55%) 17 (1.87%) 139 (15,35%) 187 (20,66%) 9 (0.99%) 532 (58,78%) 21 (2,32%) 19 (2,27%) 127 (15,19%) 164 (19.61%) 10 (1.19%) 491 (58,73%) 25 (2.99%) 6 (0,78%) 137 (17.97%) 118 (15.48%) 3 (0,39%) 488 (64.04%) 10 (1.31%) 14 (2.02%) 133 (19.21%) 106 (15.31%) 2 (0.28%) 430 (62.13%) 7 (1.01%) 3 (1.2%) 57 (22.2%) 29 (11.3%) 1 (0.4%) 165 (64%) 2 (0.8%) Total *The update of delayed reporting data and the confirmation of cases is performed annually. ** 2017 New bourns perinatally exposed to HIV, whose status was declared HIV infected in 2017 and perinatally exposed to HIV during the previous years and confirmed HIV positive in 2017 Sursa: Compartimentul pentru Monitorizarea şi Evaluarea Infecţiei HIV/SIDA în România INBI Prof.Dr.M.Balş

28 Gender distribution of AIDS cases at 30 June 2018 (Cumulative number ) Males Females Source: Compartment for Monitoring and Evaluation of HIV/AIDS in Romania - INBI Prof.Dr.M.Balş

29 Age groups (at time of diagnosis) and gender distribution of AIDS cases at June (Cumulative total ) < 1 year 1-4 years 5-9 years years years years years years years >=60 years Males Females Source: Compartment for Monitoring and Evaluation of HIV/AIDS in Romania - INBI Prof.Dr.M.Balş

30 Probable route of transmission in children diagnosed with AIDS (0-14 years at time of diagnosis) at 30 June 2018 (cumulative total ) Mother-to-child Blood and derivates* Nosocomial** Heterosexual Unknown Male Female *Persons who received blood transfusions at the end of 1980s and in the early 1990s. **Persons with multiple admissions and/or multiple parenteral treatments at the end of 1980s and in the early 1990s. Source: Compartment for Monitoring and Evaluation of HIV/AIDS in Romania - INBI Prof.Dr.M.Balş

31 Probable route of transmission in teenagers and adults diagnosed with AIDS (>14 at time of diagnosis) at 30 June 2018 (cumulative total ) MSM/Bisexual IDUs Blood and derivates* Heterosexual Unknwon Male Female * Persons who received blood transfusions in the late 1980s and early 1990s Source: Compartment for Monitoring and Evaluation of HIV/AIDS in Romania - INBI Prof.Dr.M.Balş

32 Distribution of AIDS cases in women, by age group and year of diagnosis, between Source: Compartment for Monitoring and Evaluation of HIV/AIDS Infection in Romania INBI Prof.Dr.M.Balş

33 Gender distribution of HIV infection cases at June 30, 2018 (cumulative total ) Male Female Source: Compartment for Monitoring and Evaluation of HIV/AIDS in Romania - INBI Prof.Dr.M.Balş

34 Age group (at time of diagnosis) and gender distribution of HIV infection cases at 30 June 2018 (cumulative total ) < 1 year 1-4 years 5-9 years years years years years years years >=60 years Male Female Source: Compartment for Monitoring and Evaluation of HIV/AIDS in Romania - INBI Prof.Dr.M.Balş

35 Probable route of transmission in children with HIV infection (0-14 years at time of diagnosis) at 30 June 2018 (cumulative total ) Mother-tochild Blood and derivates* Nosocomial** IDUs heterosexual Unknown Male Female *Persons who received blood transfusions at the end of 1980s and in the early 1990s. **Persons with multiple admissions and/or multiple parenteral treatment at the end of 1980s and in the early 1990s. Source: Compartment for Monitoring and Evaluation of HIV/AIDS in Romania - INBI Prof.Dr.M.Balş

36 Probable route of transmission in teenagers and adults with HIV infection (>14 years at time of diagnosis) at 30 June 2018 (cumulative total ) MSM/Bisexual IDUs Blood and derivates* Heterosezual Unknown Male Female * Persons who received blood transfusions at the end of 1980s and in the early 1990s Source: Compartment for Monitoring and Evaluation of HIV/AIDS in Romania - INBI Prof.Dr.M.Balş

37 Distribution of HIV infection in women by years of diagnosis and age group ( ) Source: Compartment for Monitoring and Evaluation of HIV/AIDS Infection in Romania INBI Prof.Dr.M.Balş

38 HBV, HCV and HBV+HCV infection in seropositive children during Source: Compartment for Monitoring and Evaluation of HIV/AIDS Infection in Romania INBI Prof.Dr.M.Balş

39 HBV, HCV and HBV+HCV infection in seropositive adults during Year of diagnosis Source: Compartment for Monitoring and Evaluation of HIV/AIDS Infection in Romania INBI Prof.Dr.M.Balş

40 Associated diseases Tumour-others Pulmonary TB Extrapulmonary TB Toxoplasmosis Wasting Syndrome Recurrent Sepsis Kaposi Sarcoma Recurrent pneumonia Pneumocistis Carinii Penumonia Disseminated mycobacterium Burkitt Lymphoma/others Progressive Multifocal Leucoencephalopathy Bacterial infections, multiple or recurrent HIV Encephaloptahy Cryptosporidiosis Cryptococcosis CMV Disease Pulmonary candidiasis: bronchi/trahea/lungs Candidiasis of the esophagus Invasive cervical cancer Source: Compartment for Monitoring and Evaluation of HIV/AIDS in Romania - INBI Prof.Dr.M.Balş

41 Deaths by year Source: Compartment for Monitoring and Evaluation of HIV/AIDS Infection in Romania INBI Prof.Dr.M.Balş

42 HIV testing January-June 2018

43 HIV testing* in risk groups during the first 6 months of 2018 Risk group Negative tests Positive tests TOTAL %POSITIVE STDs TBC Maternity testing Pregnant women Health workers Pts. with hemodialysis Persons who received transfusions Prenuptial check-up IDUs Prisoners MSM SWs (sex workers) HIV contacts Sailors Drivers Work abroad> 6 months Stay abroad> 6 months On request Occasional TOTAL *The data are sent by the County Public Health Authorities Source: Compartment for Monitoring and Evaluation of HIV/AIDS in Romania - INBI Prof.Dr.M.Balş

44 HIV testing * in pregnant women, by age groups, during the first six months of 2018 Age group Negative tests Positive tests TOTAL %POSITIVE years years years years years years > 40 years Unspecified age TOTAL *The data are sent by the County Public Health Authorities Source: Compartment for Monitoring and Evaluation of HIV/AIDS in Romania - INBI Prof.Dr.M.Balş

45 HIV testing * in blood donors during the first six months of 2018 Group Gender Positive Negative TOTAL %Positive Male ,03 First time donor Regular donor Female ,013 Total ,023 Male ,003 Female ,002 Total ,003 Occasional donor Male ,01 Female Total ,007 TOTAL ,009 *The data are sent by the National Institute for Hematology PROF.C.T.NICOLAU Bucharest

46 CURRENT STANDARDS OF HIV CARE IN ROMANIA

47 Cascade of HIV care - Romania 31 December (93%) (85%) (92%) 7836 (68%) 5500 (37%) 5500 (43%) 5500 (47%) 3968 (51%) E S T I M A T E P L W H A ( U N A I D S 2016) N U M B E R O F P L W H A I N T H E N A T I O N A L D A T A B A S E N U M B E R O F P L W H A F R O M T H E R O M A N I A N C O H O R T P L W A I N A C T I V E R E C O R D S I N T H E N A T I O N A L D A T A B A S E P L W A I N A C T I V E R E C O R D S F R O M T H E R O M A N I A N C O H O R T P L W H A I N A R T I N T H E N A T I O N A L D A T A B A S E P L W H A I N A R T F R O M T H E R O M A N I A N C O H O R T V L < 5 0 C O P I E S / M L I N P A T I E N T S W I T H A R T V L < 5 0 C O P I E S / M L F R O M T H E R O M A N I A N C O H O R T Source: Compartment for Monitoring and Evaluation of HIV/AIDS Data in Romania INBI Prof.Dr.M.Balş / The National HIV/AIDS Data Base Data under assessment

48 Cascade of HIV cares in Romania PLWHA UNAIDS Estimates PLWHA in the national HIV data base Pts. in active records in the national HIV data base Pts. in ART in the national HIV data base from pts. in active records <50 copies/ml from pts. in ART Source: Compartment for Monitoring and Evaluation of HIV/AIDS Data in Romania

49 Source: UNAIDS Estimates for Romania 2017 UNAIDS Estimates for Romania 2017 ROMANIA SELECTED TRENDS AIDS Deaths Number of people living with HIV , AIDS Deaths Lower and upper limits 18,000 16,000 14,000 12,000 10,000 8,000 6,000 Number of people living with HIV Lower and upper limits ,000 2, New HIV Infections Percent of people living with HIV receiving ART 1, New HIV infections Lower and upper limits Percent of people living with HIV receiving ART Lower and upper limits

50 Current standards of care and perspectives related to HIV infection in Romania People living with HIV/AIDS Instruments: National HIV/AIDS Data base (M&E) Young by age but old by treatment Therapeutic fatigue New cases of HIV: young persons, of fertile age, late presentations in the sanitary system Increase in MSM caess Young mothers, with multiple therapeutic schemes Mothers with unknown HIV status- testing recommendation and specific ART treatment for those with confirmed HIV status New approach for perinatally exposed newborn to HIV MTCT Instruments: National Registry of HIV pregnant women and of perinatally exposed newborns Antiretroviral treatment Instruments: National Registry of HIV patients in ART Most ARVs- available in Romania Universal access to treatment Treatment irrespective of CD4 count- since 2001 Suboptimal regimen in the first weeks of life Toxicity associated to ART treatment Psychoactive substances New approach of HIV infected drug using mothers and of perinatally exposed children to HIV and maternal drugs Injecting drug consumers Sursa : 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.

51 Current standards of care and perspectives related to HIV infection in Romania Therapeutic fatigue Co-morbidities Aging with HIV Long term therapy+ multiple schemes VF + immunological and virological failure New mechanisms New meanings New attitude New results Drug interactions Risk groups Adjusting the national efforts to the needs of risk/vulnerbale groups Challenges? Sursa: 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.

52 HIV/AIDS Phenomenon in the world

53 UNAIDS PARIS DECLARATION 1 December 2014 FAST -- TRACK CITIES: ENDING THE AIDS EPIDEMIC Cities Achieving Targets by % of people living with HIV knowing their HIV status. 90% of people who know their HIV-positive status on treatment. 90% of people on treatment with suppressed viral loads. Source:

54 Global summary of the AIDS epidemic 2017 Number of people living with HIV People newly infected with HIV in 2017 AIDS-related deaths in 2017 Total Adults Women (15+ years) Children (<15 years) Total Adults Children (<15 years) Total Adults Children (<15 years) 36.9 million [31.1 million 43.9 million] 35.1 million [29.6 million 41.7 million] 18.2 million [15.6 million 21.4 million] 1.8 million [1.3 million 2.4 million] 1.8 million [1.4 million 2.4 million] 1.6 million [1.3 million 2.1 million] [ ] [ million] [ million] [ ] Sourse: July Core epidemiology slides

55 million Estimates on the numbers of PLWHA Sourse: July Core epidemiology slides

56 Adults and children estimated to be living with HIV 2017 North America and western and central Europe 2.2 million [1.9 million 2.4 million] Eastern Europe and central Asia 1.4 million [1.3 million 1.6 million] Caribbean [ ] Latin America 1.8 million [1.5 million 2.3 million] Middle East and North Africa [ ] Western and central Africa 6.1 million [4.4 million 8.1 million] Eastern and southern Africa 19.6 million [17.5 million 22.0 million] Asia and the Pacific 5.2 million [4.1 million 6.7 million] Total: 36.9 million [31.1 million 43.9 million] Sourse: July Core epidemiology slides

57 Estimated number of adults and children newly infected with HIV 2017 North America and western and central Europe [ ] Eastern Europe and central Asia [ ] Caribbean [ ] Latin America [ ] Middle East and North Africa [ ] Western and central Africa [ ] Eastern and southern Africa [ million] Asia and the Pacific [ ] Total: 1.8 million [1.4 million 2.4 million] Sourse: July Core epidemiology slides

58 Estimated adult and child deaths from AIDS 2017 North America and western and central Europe [ ] Eastern Europe and central Asia [ ] Caribbean [ ] Latin America [ ] Middle East and North Africa 9800 [ ] Western and central Africa [ ] Eastern and southern Africa [ ] Asia and the Pacific [ ] Total: [ million] Sourse: July Core epidemiology slides

59 Global estimates for children (<15 years) 2017 Children living with HIV 1.8 million [1.3 million 2.4 million] New HIV infections in [ ] AIDS-related deaths in [ ] Sourse: July Core epidemiology slides

60 About 5000 new HIV infections (adults and children) a day 2017 About 66% are in sub-saharian Africa About 500 are among children under 15 years of age About 4400 are among adults aged 15 years and older, of whom: almost 43% are among women about 33% are among young people (15 24) about 19% are among young women (15 24) Sourse: July Core epidemiology slides

61 Regional HIV and AIDS statistics and features 2017 Adults and children living with HIV Adults and children newly infected with HIV Adult and child deaths due to AIDS Eastern and southern Africa 19.6 million [17.5 million 22.0 million] [ million] [ ] Western and central Africa 6.1 million [4.4 million 8.1 million] [ ] [ ] Middle East and North Africa [ ] [ ] 9800 [ ] Asia and the Pacific 5.2 million [4.1 million 6.7 million] [ ] [ ] Latin America 1.8 million [1.5 million 2.3 million] [ ] [ ] Caribbean [ ] [ ] [ ] Eastern Europe and central Asia 1.4 million [1.3 million 1.6 million] [ ] [ ] Western and central Europe and North America 2.2 million [1.9 million 2.4 million] [ ] [ ] TOTAL 36.9 million [31.1 million 43.9 million] 1.8 million [1.4 million 2.4 million] [ million] The ranges around the estimates in this table define the boundaries within which the actual numbers lie, based on the best available information. Sourse: July Core epidemiology slides

62 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;

63 Sursa: UNAIDS WORLD AIDS DAY REPORT 2012 *References UNAIDS, July HIV/AIDS Surveillance in Europe 2016, ECDC

64 References Revised surviellance Case Definition for HIV Infection Among Adults, Adolescents, and Children Aged < 18 Month sand for HIV Infection and AIDS Among Children Aged 18 Months to <13 years--- CDC, United States, CASE DEFINITIONS OF COMMUNICABLE DISEASES :PDF The WHO case definition of HIV surveillance is available at:

65 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

66 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

67 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, MD PhD Head of the Infectious Diseases Department UMF Carol Davila Coordinator: Mariana Mărdărescu MD PhD Coordinator of the Adults programme: Lecturer Dr.Elisabeta Otilia Benea Coordinator of the children s programme: Sorin Petrea MD Statistical data operators: PC operators : As.med. Marieta Iancu Daniela Viţelaru Sanda Vintilă Colaborators Ionel Iosif, MD CNSCBT