HIV/AIDS infection in Romania 30 June 2018

HIV/AIDS infection in Romania 30 June 2018

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

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

UNAIDS objectives Source: http://www.unaids.org/sites/default/files/media_asset/jc2686_wad2014report_en.pdf

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 (CUMULATIVE1985-2017) OF WHICH: 23.302 Total AIDS (Cumulative 1985-2018) 15.784 Total HIV (Cumulative 1992-2018) 7.518 Total no. of AIDS deaths (1985-2018) 739 Out of records HIV/AIDS children + adults 7.351 NUMBER OF PATIENTS LIVING WITH HIV/AIDS OF WHICH: 15.212 0-14 YEARS 190 15-19 YEARS 163 20 YEARS 14.859 New HIV/AIDS cases diagnosed in 2018 257 New HIV cases 142 New AIDS cases 115 HIV/AIDS related deaths, confirmed by medical charts in 2018 68 Source: Compartment for Monitoring and Evaluation of HIV/AIDS in Romania - INBI Prof.Dr.M.Balş

New HIV/AIDS cases 1 January-30 June 2018

Distribution, by counties of new HIV/AIDS cases detected between 01.01 30.06.2018 2 4 4 4 6 1 LEGEND CHILDREN (0-14 YRS) ADULTS AND ADOLESCENTS (> 14 YRS) 1 12 6 1 2 5 7 5 2 5 3 13 1 6 5 5 2 108 3 2 1 1 3 6 2 5 2 23 Source: Compartment for Monitoring and Evaluation of HIV/AIDS in Romania - INBI Prof.Dr.M.Balş

Distribution, by gender, of new HIV/AIDS cases detected between 01.01 30.06.2018 62 (24%) 195 (76%) MALES FEMALES Source: Compartment for Monitoring and Evaluation of HIV/AIDS in Romania - INBI Prof.Dr.M.Balş

Distribution, by age and gender, of new HIV/AIDS cases, detected during 01.01-30.06.2018 60 50 48 40 30 37 28 32 20 10 0 0 2 1 0 6 5 19 11 8 8 7 15 13 5 11 1 <1year 1-4 years 15-19 years 20-24 years 25-29 years 30-34 years 35-39 years 40-49 years 50-59 years >=60 years Males Females Source: Compartment for Monitoring and Evaluation of HIV/AIDS in Romania - INBI Prof.Dr.M.Balş

Distribution, by way of transmission, of new HIV/AIDS cases in children and adults, detected between 01.01-30.06.2018 120 111 100 80 60 58 54 40 23 20 0 6 1 2 0 2 0 Moter-to-child MSM/Bisexual IDUs* Heterosexual Unknown MALES FEMALES *At 30.06.2018 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

CD4 values in new HIV/AIDS cases detected during the first semester of 2018 19% 8% 27% 35% 11% < 100 101-200 201-500 > 500 Under assessment Source: Compartment for Monitoring and Evaluation of HIV/AIDS in Romania - INBI Prof.Dr.M.Balş

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% < 100 101-200 201-500 > 500 Under assessment < 100 101-200 201-500 > 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

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% <10000 10001-100000 100001-500000 >500000 Under assessment <10000 10001-100000 100001-500000 >500000 Under assessment Source: Compartment for Monitoring and Evaluation of HIV/AIDS in Romania - INBI Prof.Dr.M.Balş

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

New cases of HIV/AIDS (January-June 2018) by injecting drug use Age groups distribution Age group Men Women Total 15-19 years 1 1 20-24 years 3 1 4 25-29 years 2 1 3 30-34 years 5 5 35-39 years 5 2 7 40-49 years 8 1 9 50 years 1 1 Total 24 6 30 Source: Compartment for Monitoring and Evaluation of HIV/AIDS in Romania - INBI Prof.Dr.M.Balş

New cases of HIV/AIDS (January-June 2018) by injecting drug use Age groups distribution 31% 3% 3% 13% 10% 23% 17% 15-19 years 20-24 years 25-29 years 30-34 years 35-39 years 40-49 years >=50 years Source: Compartment for Monitoring and Evaluation of HIV/AIDS in Romania - INBI Prof.Dr.M.Balş

New cases of HIV/AIDS (January-June 2018) by injecting drug use Counties distribution County Men Women Total Arad 1 1 Bucureşti 20 4 24 Călăraşi 2 2 Cluj 1 1 Ilfov 1 1 Mures 1 1 Total 24 6 30 Source: Compartment for Monitoring and Evaluation of HIV/AIDS in Romania - INBI Prof.Dr.M.Balş

HIV/HBC, HCV, STDs and TB co-infections in IDUs Screened for Number of patients with a positive test % AgHBs 1/30 3.33% VHC 17/30 56.66% AgHBs + VHC 5/30 16.66% STDs (sexually transmitted 3.33% 1/30 diseases) TB co-infection 5/30 16.66% Source: Compartment for Monitoring and Evaluation of HIV/AIDS in Romania - INBI Prof.Dr.M.Balş

HIV/HBV, HCV, STDs and TB co-infections in IDUs Total patients: 30 100.00% 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

Drugs used by HIV-IDU patients, diagnosed during the first 6 months of 2018 37% 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

IDUs diagnosed HIV+ during the first 6 months of 2018, who underwent a previous HIV screening Year of previous screening No. patients 2007 1 2015 1 2017 1 Total 3 Source: Compartment for Monitoring and Evaluation of HIV/AIDS in Romania - INBI Prof.Dr.M.Balş

New HIV/AIDS cases registered in the National HIV/AIDS Data Base during 2009-2018 vs. New HIV/AIDS cases in IDUs registered in the National Data Base during 2009-2018 CRITERION TOTAL of wich YEAR 2009 2010 2011 2012 2013 2014 2015 2016 2017 01.01-30.06.2018 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 258 6 294 6 405 95 484 154 532 149 483 81 429 61 418 45 420 58 142 14 No. of AIDS cases 297 6 282 12 378 64 430 139 441 152 425 117 410 115 350 79 312 56 115 16 Total number of HIV/AIDS cases 555 12 576 18 783 159 914 293 973 301 908 198 839 176 768 124 732 114 257 30 Source: Compartment for Monitoring and Evaluation of HIV/AIDS in Romania - INBI Prof.Dr.M.Balş

CD4 count in IDUs diagnosed with HIV/AIDS during the first 6 months of 2018 7% 10% 40% 36% 7% < 100 101-200 201-500 > 500 Under assessment Source: Compartment for Monitoring and Evaluation of HIV/AIDS in Romania - INBI Prof.Dr.M.Balş

Evolution of HIV/AIDS infection in Romania 1985-2018

Distribution of ages Age at date of diagnosis/notification Cumulative total 1985-2017 Distribution by age of PLWHA Source: Compartment for Monitoring and Evaluation of HIV/AIDS Infection in Romania INBI Prof.Dr.M.Balş

Distribution of HIV/AIDS living patients, by age groups, current age and gender at 30 June 2018 (cumulative total 1985-2018) Age group Male Source: Compartment for Monitoring and Evaluation of HIV/AIDS in Romania - INBI Prof.Dr.M.Balş Gender Female TOTAL < 1 year 4 0 4 1-4 years 24 13 37 5-9 years 58 27 85 10-12 years 28 23 51 13-14 years 6 7 13 15-19 years 116 47 163 20-24 years 365 127 492 25-29 years 2053 3231 5284 30-34 years 1335 1503 2838 35-39 years 920 628 1548 40-49 years 1304 1162 2466 50-59 years 582 733 1315 60 347 569 916 TOTAL 7142 8070 15212

Tendencies in routes of transmission in Romania 2007-2018* Route of transmission Vertical** MSM IDU (injecting drug use) MSM/IDU Heterosexual Unkown 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 9 (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 471 557 555 574 782 911 967 905 836 762 692 254 *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

Gender distribution of AIDS cases at 30 June 2018 (Cumulative number 1985-2018) 6401 9383 Males Females Source: Compartment for Monitoring and Evaluation of HIV/AIDS in Romania - INBI Prof.Dr.M.Balş

Age groups (at time of diagnosis) and gender distribution of AIDS cases at June 30 2018 (Cumulative total 1985-2018) 2000 1800 1891 1600 1400 1543 1418 1490 1200 1000 800 600 1051 928 740 592581 1144 940 707 850 400 380 315 388 395 200 0 < 1 year 1-4 years 5-9 years 10-14 years 15-19 years 20-29 years 30-39 years 40-49 years 50-59 years 183 170 78 >=60 years Males Females Source: Compartment for Monitoring and Evaluation of HIV/AIDS in Romania - INBI Prof.Dr.M.Balş

Probable route of transmission in children diagnosed with AIDS (0-14 years at time of diagnosis) at 30 June 2018 (cumulative total 1989-2018) 3500 3000 3046 2500 2247 2000 1500 1000 1023 707 500 0 280 205 Mother-to-child Blood and derivates* 392 363 0 1 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

Probable route of transmission in teenagers and adults diagnosed with AIDS (>14 at time of diagnosis) at 30 June 2018 (cumulative total 1985-2018) 3000 2814 2500 2000 2050 1500 1000 500 0 417 0 619 135 155 196 MSM/Bisexual IDUs Blood and derivates* Heterosexual 636 496 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

Distribution of AIDS cases in women, by age group and year of diagnosis, between 1985-2017 Source: Compartment for Monitoring and Evaluation of HIV/AIDS Infection in Romania INBI Prof.Dr.M.Balş

Gender distribution of HIV infection cases at June 30, 2018 (cumulative total 1992-2018) 2985 4533 Male Female Source: Compartment for Monitoring and Evaluation of HIV/AIDS in Romania - INBI Prof.Dr.M.Balş

Age group (at time of diagnosis) and gender distribution of HIV infection cases at 30 June 2018 (cumulative total 1992-2018) 1600 1530 1400 1200 1152 1000 965 800 600 400 200 0 536 447 399 370 339 338 311 261 174 128 150 101 68 72 87 60 30 < 1 year 1-4 years 5-9 years 10-14 years 15-19 years 20-29 years 30-39 years 40-49 years 50-59 years >=60 years Male Female Source: Compartment for Monitoring and Evaluation of HIV/AIDS in Romania - INBI Prof.Dr.M.Balş

Probable route of transmission in children with HIV infection (0-14 years at time of diagnosis) at 30 June 2018 (cumulative total 1992-2018) 600 569 500 490 400 300 200 128 125 165 138 100 69 68 0 Mother-tochild Blood and derivates* 1 0 0 1 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

Probable route of transmission in teenagers and adults with HIV infection (>14 years at time of diagnosis) at 30 June 2018 (cumulative total 1992-2018) 2000 1800 1947 1831 1600 1400 1200 1000 882 800 600 538 400 200 0 0 123 48 62 MSM/Bisexual IDUs Blood and derivates* Heterosezual 185 146 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

Distribution of HIV infection in women by years of diagnosis and age group (1992-2017) Source: Compartment for Monitoring and Evaluation of HIV/AIDS Infection in Romania INBI Prof.Dr.M.Balş

HBV, HCV and HBV+HCV infection in seropositive children during 1989-2017 Source: Compartment for Monitoring and Evaluation of HIV/AIDS Infection in Romania INBI Prof.Dr.M.Balş

HBV, HCV and HBV+HCV infection in seropositive adults during 1985-2017 Year of diagnosis Source: Compartment for Monitoring and Evaluation of HIV/AIDS Infection in Romania INBI Prof.Dr.M.Balş

Associated diseases 01.01 30.06.2018 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 0 10 20 30 40 50 60 70 Source: Compartment for Monitoring and Evaluation of HIV/AIDS in Romania - INBI Prof.Dr.M.Balş

1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 Deaths by year 1985-2017 500 450 400 350 300 250 200 150 100 50 0 Source: Compartment for Monitoring and Evaluation of HIV/AIDS Infection in Romania INBI Prof.Dr.M.Balş

HIV testing January-June 2018

HIV testing* in risk groups during the first 6 months of 2018 Risk group Negative tests Positive tests TOTAL %POSITIVE STDs 247 5 252 1.98 TBC 2472 12 2484 0.48 Maternity testing 113 1 114 0.88 Pregnant women 35639 22 35661 0.06 Health workers 1923 1923 0.00 Pts. with hemodialysis 325 325 0.00 Persons who received transfusions 12 12 0.00 Prenuptial check-up 1609 1 1610 0.06 IDUs 13 13 0.00 Prisoners 106 2 108 1.85 MSM 3 3 0.00 SWs (sex workers) 1 1 0.00 HIV contacts 148 22 170 12.94 Sailors 839 1 840 0.12 Drivers 2234 1 2235 0.04 Work abroad> 6 months 68 1 69 1.45 Stay abroad> 6 months 0 0 0 0.00 On request 24770 86 24856 0.35 Occasional 10442 165 10607 1.56 TOTAL 80964 319 81283 0.39 *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

HIV testing * in pregnant women, by age groups, during the first six months of 2018 Age group Negative tests Positive tests TOTAL %POSITIVE 12-14 years 178 178 0.00 15-19 years 4185 4185 0.00 20-24 years 7796 11 7807 0.14 25-29 years 9980 6 9986 0.06 30-34 years 8078 3 8081 0.04 35-39 years 3763 2 3765 0.05 > 40 years 1127 1127 0.00 Unspecified age 532 532 0.00 TOTAL 35639 22 35661 0.06 *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

HIV testing * in blood donors during the first six months of 2018 Group Gender Positive Negative TOTAL %Positive Male 10 32826 32836 0,03 First time donor Regular donor Female 3 22577 22580 0,013 Total 13 55403 55416 0,023 Male 2 70783 70785 0,003 Female 1 36315 36316 0,002 Total 3 107098 107101 0,003 Occasional donor Male 3 27717 27720 0,01 Female 0 15735 15735 0 Total 3 43452 43455 0,007 TOTAL 19 205953 205972 0,009 *The data are sent by the National Institute for Hematology PROF.C.T.NICOLAU Bucharest

CURRENT STANDARDS OF HIV CARE IN ROMANIA

Cascade of HIV care - Romania 31 December 2017 16000 15009 (93%) 12806 (85%) 11570 (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

Cascade of HIV cares in Romania 2015-2018 18000 16000 14000 12000 14000 16000 18000 15009 14349 13766 12806 12196 12096 11570 10942 10551 2015 10000 8000 6000 7836 6811 5386 2016 2017 4000 2000 0 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 www.cnlas.ro

Source: UNAIDS Estimates for Romania 2017 UNAIDS Estimates for Romania 2017 ROMANIA SELECTED TRENDS AIDS Deaths Number of people living with HIV 800 20,000 700 600 500 400 300 200 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 100 0 2000 2002 2004 2006 2008 2010 2012 2014 2016 4,000 2,000 0 2000 2002 2004 2006 2008 2010 2012 2014 2016 New HIV Infections Percent of people living with HIV receiving ART 1,000 80 900 800 700 600 500 400 300 200 100 New HIV infections Lower and upper limits 70 60 50 40 30 20 10 Percent of people living with HIV receiving ART Lower and upper limits 0 2000 2002 2004 2006 2008 2010 2012 2014 2016 0 2000 2002 2004 2006 2008 2010 2012 2014 2016

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, 2017. 14 th Congress of the BADV, October 5-7, 2017. Vilnius, Lithuania.

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, 2017. 14 th Congress of the BADV, October 5-7, 2017. Vilnius, Lithuania.

HIV/AIDS Phenomenon in the world

UNAIDS PARIS DECLARATION 1 December 2014 FAST -- TRACK CITIES: ENDING THE AIDS EPIDEMIC Cities Achieving 90-90-90 Targets by 2020 90% 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: http://www.unaids.org/sites/default/files/media_asset/90-90-90_en_0.pdf

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] 180 000 [110 000 260 000] 940 000 [670 000 1.3 million] 830 000 [590 000 1.2 million] 110 000 [63 000 160 000] Sourse: July 2018 - Core epidemiology slides

million Estimates on the numbers of PLWHA 2000-2017 45 40 35 30 25 20 15 10 5 0 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 Sourse: July 2018 - Core epidemiology slides

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 310 000 [260 000 420 000] Latin America 1.8 million [1.5 million 2.3 million] Middle East and North Africa 220 000 [150 000 300 000] 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 2018 - Core epidemiology slides

Estimated number of adults and children newly infected with HIV 2017 North America and western and central Europe 70 000 [57 000 84 000] Eastern Europe and central Asia 130 000 [120 000 150 000] Caribbean 15 000 [11 000 26 000] Latin America 100 000 [77 000 130 000] Middle East and North Africa 18 000 [10 000 31 000] Western and central Africa 370 000 [220 000 570 000] Eastern and southern Africa 800 000 [650 000 1.0 million] Asia and the Pacific 280 000 [210 000 390 000] Total: 1.8 million [1.4 million 2.4 million] Sourse: July 2018 - Core epidemiology slides

Estimated adult and child deaths from AIDS 2017 North America and western and central Europe 13 000 [9900 18 000] Eastern Europe and central Asia 34 000 [25 000 41 000] Caribbean 10 000 [7100 17 000] Latin America 37 000 [26 000 51 000] Middle East and North Africa 9800 [6400 15 000] Western and central Africa 280 000 [180 000 410 000] Eastern and southern Africa 380 000 [300 000 510 000] Asia and the Pacific 170 000 [110 000 280 000] Total: 940 000 [670 000 1.3 million] Sourse: July 2018 - Core epidemiology slides

Global estimates for children (<15 years) 2017 Children living with HIV 1.8 million [1.3 million 2.4 million] New HIV infections in 2017 180 000 [110 000 260 000] AIDS-related deaths in 2017 110 000 [63 000 160 000] Sourse: July 2018 - Core epidemiology slides

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 2018 - Core epidemiology slides

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] 800 000 [650 000 1.0 million] 380 000 [300 000 510 000] Western and central Africa 6.1 million [4.4 million 8.1 million] 370 000 [220 000 570 000] 280 000 [180 00 410 000] Middle East and North Africa 220 000 [150 000 300 000] 18 000 [10 000 31 000] 9800 [6400 15 000] Asia and the Pacific 5.2 million [4.1 million 6.7 million] 280 000 [210 000 390 000] 170 000 [110 000 280 000] Latin America 1.8 million [1.5 million 2.3 million] 100 000 [77 000 130 000] 37 000 [26 000 51 000] Caribbean 310 000 [260 000 420 000] 15 000 [11 000 26 000] 10 000 [7100 17 000] Eastern Europe and central Asia 1.4 million [1.3 million 1.6 million] 130 000 [120 000 150 000] 34 000 [25 000 41 000] Western and central Europe and North America 2.2 million [1.9 million 2.4 million] 70 000 [57 000 84 000] 13 000 [9900 18 000] TOTAL 36.9 million [31.1 million 43.9 million] 1.8 million [1.4 million 2.4 million] 940 000 [670 000 1.3 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 2018 - Core epidemiology slides

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 57 015 (160 453) 26 602 5772 24 641 (128 079) 29 444 Rate per 100.000 population 7.7 (18.2) 6.2 2.9 22.1 (50.2) 5.9 % of cases: 15-24 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 2.3 3.1 5.9 1.5 3.2 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 30 523 Source: HIV/AIDS Surveillance in Europe 2017; https://ecdc.europa.eu/sites/portal/files/documents/20171127-annual_hiv_report_cover%2binner.pdf

Sursa: UNAIDS WORLD AIDS DAY REPORT 2012 *References UNAIDS, July 2018 http://www.unaids.org/en/resources/documents/2018/core-epidemiology-slides HIV/AIDS Surveillance in Europe 2016, ECDC www.ecdc.europa.eu www.euro.who.int

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, 2008 http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5710a1.htm CASE DEFINITIONS OF COMMUNICABLE DISEASES http://eurlex.europa.eu/lexuriserv/lexuriserv.do?uri=consleg:2002d0253:20120927:en :PDF The WHO case definition of HIV surveillance is available at: http://www.who.int/hiv/pub/vct/hivstaging/en/index.html

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 http://eur-lex.europa.eu/lexuriserv/lexuriserv.do?uri=consleg:2002d0253:20120927:en:pdf

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 http://eur-lex.europa.eu/lexuriserv/lexuriserv.do?uri=consleg:2002d0253:20120927:en:pdf

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