The evolution of HIV/AIDS Epidemic in Romania 31 December 2013
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
Romania 1985-2013 31 December 2013: 12.273 PLWHA (19.261 cumulative total, since 1985). High rate of HIV incidence in children who were infected in the 1980s in Romania The maximum number of these patients recorded at the beginning of the 1990s ; >90%: sub-type F1. During the same period, HIV incidence rate among the adult population was low, with a slight increase afterwards due to unprotected heterosexual contact, the main route of transmission for the last decade. Currently, Romania has a large number of survivors in the 19 24 age group, who belong to the 1987 1990 cohort (>6000). A large number of PLWHA who receive specific ARV therapy in relation to the total number of infected persons (>8000 December 31, 2012 out of 9800 in active surveillance at1 December 2013). Source: Surveillance Report: HIV/AIDS Surveillance in Europe 2010. ECDC Stockholm Source: Compartment for Monitoring and Evaluation of HIV/AIDS Data in Romania INBI Prof.Dr.M.Balş
HIV subtype: F predominance, unique in Europe 1987-1990 cohort children: homogenous F1 subtype of HIV Thomson and Najera, JID, 2007; Stanojevic et al. AIDS Rev 2011; www.cnlas.ro
Phylogenetic analysis of HIV-1 subtype F1 isolates F= <1% HIV infections worldwide: Africa & South America Romanian F1 subtype: closely related to Angolan subtype distantly related to S America F1 F1 origin: Congo (DRC), around the late 1950s Guimaraes & al Retrovirology 2009
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 2013 TOTAL HIV/AIDS (CUMULATIVE1985-2013) OF WHICH: 19.261 HIV/AIDS cases in children (0-14 years at date of diagnosis ) 9.946 HIV/AIDS cases in adults (> 14 years at date of diagnosis) 9.315 Total no. of AIDS deaths (1985-2013) 6.367 Out of records HIV/AIDS children + adults 621 Number of patients living with HIV/AIDS 12.273 Total AIDS (Cumulative 1985-2013) 13.409 AIDS cases in children (0-14 years at date of diagnosis) 8.065 AIDS cases in adults (> 14 years at date of diagnosis) 5.344 Total HIV (Cumulative 1992-2013) 5.852 HIV cases in children (0-14 years at date of diagnosis) 1.881 HIV cases in adults (> 14 years at date of diagnosis) 3.971 New HIV/AIDS cases, diagnosed in 2013 797 New HIV cases 472 New AIDS cases 325 HIV/AIDS related deaths, confirmed by medical charts in 2013 189
Distribution of ages Age at date of diagnosis Cumulative total 1985-2013 Distribution by age of PLWHA
Kaplan-Meyer survival curve 2013 33% of persons who deceased, survived, on average >50 months: 15% of persons who deceased survived, on average around 100 month; 10% of persons who deceased survived, on average, 100 months. Limitations: we excluded the periods with no treatment, ART schemes, duration of treatment. Average period of survival= 43,4 months (C.I.95% 42,1-44,6) Median period of survival for men=42,2 months (C.I.95% 40,6-43,8) Median period of survival for women=45,4 months (C.I.95% 43-47,2)
New HIV/AIDS Cases 1 JANUARY 31 DECEMBER 2013
Distribution of new HIV/AIDS cases by counties 2013 6 1 6 4 7 1 10 10 10 LEGEND CHILDREN (0-14 yrs) ADULTS (> 14 yrs) 1 19 15 1 8 34 3 1 26 14 2 8 10 1 7 2 14 1 13 4 5 1 6 1 8 14 20 2 3 14 1 357 7 11 2 9 11 2 6 13 11 11 38 6
Distribution of new HIV/AIDS cases by sex, 2013
Distribution of new HIV/AIDS cases by age group and sex, 2013
Distribution of new HIV/AIDS cases by route of transmission in children, 2013 14 12 10 8 6 4 2 10 11 0 Vertical Male female
Distribution of new HIV/AIDS cases by routes of transmission in adults, 2013
Tendencies in routes of transmission Romania 2007-2013 Route of transmission 31 December 2007 31 December 2008 31 December 2009 31 December 2010 31 December 2011 31 December 2012 31 December 2013 Vertical 8 (2%) 7 (1%) 20 (4%) 25 (5%) 21 (3%) 21 (2,6%) 21 (2,64%) MSM IDU 14 (3%) 40 (8%) 44 (9%) 60 (11) 95 (13%) 89 (10,8%) 4 (1%) 3 (1%) 7 (1,4%) 14 (3%) 131 (18%) MSM/IDU 1 (<0,5%) 5 (1%) Heterosexual 352 (79%) 397 (76) 383 (77%) 399 (75%) 440 (61%) Unknown 67 (15%) 71 (14%) 43 (8,6%) 32 (6%) 28 (4%) 252 (30,6%) 6 (1%) 414 (50%) 39 (5%) 88 (11,04%) 233 (29,23%) 5 (0,63%) 435 (54,58%) 15 (1,88%) Total 445 522 497 531 720 821 797
Tendencies in the routes of transmission Romania 2007-2013 Heterosexual IDUs
New HIV/AIDS cases (January-December 2013) through i.v. drug use, by age groups Age group Male Female Total 15-19 yrs 14 3 17 20-24 yrs 23 12 35 25-29 yrs 58 11 69 30-34 yrs 55 17 72 35-39 yrs 23 4 27 40-49 yrs 15 2 15 50 4 2 6 Total 192 49 241
New cases of HIV/AIDS infection through i.v. drug use, by age groups, recorded in 2013 11% 6% 2% 7% 15% 30% 29% 15-19 yrs. 20-24 yrs. 25-29 yrs. 30-34 yrs. 35-39 yrs. 40-49 yrs. 50
Drugs used by HIV patients, diagnosed in 2013
Drugs declared by HIV/IDU patients, diagnosed in 2013 18% 10% 3% 69% Heroine Heroine/Ethnobotanicals/Cocaine Heroine/Ethnobotanicals Ethnobotanicals
New HIV/AIDS cases (January-December 2013) through i.v. drug use, by counties County Male Female Total Arad 1 1 Argeş 1 1 Bucureşti 160 40 200 Braşov 1 1 Brăila 1 1 Buzau 1 1 Constanţa 3 3 Giurgiu 1 1 Gorj 1 1 Hunedoara 1 1 Ialomita 4 4 Ilfov 10 4 14 Mureş 1 1 Neamţ 2 2 Olt 1 1 Prahova 1 1 2 Timiş 3 3 Tulcea 1 1 Vâlcea 2 2 Total 192 49 241
HBV, HCV, STDs in new HIV/AIDS cases through i.v. drug use Tested for Positive % AgHBs 3 1,24% VHC 188 78% AgHBs + VHC 29 12,03% STDs 34 14,10%
HIV/TB Co-infection in HIV/IDUs, diagnosed in 2013
I.V. drug users diagnosed HIV+ in 2013, previously tested before the current HIV positive test Year of previous testing No. of patients 2013 6 2012 12 2011 11 2010 9 2009 4 2008 1 2007 4 2006 1 2005 3 2004 1 2001 1 Total 53
New HIV/AIDS cases registered in the National Data Base: 2009-2013 vs. New HIV/AIDS cases in IDUs registered in the National Data Base: 2009-2013 Year Criterion Number of HIV cases TOTAL of which 2009 2010 2011 2012 2013 IDUs TOTAL of which IDUs TOTAL of which IDUs TOTAL of which IDUs TOTAL of which 237 5 278 5 413 102 513 180 472 145 IDUs Number of AIDS cases 267 3 259 10 320 39 334 84 325 96 Total number of HIV/AIDS cases 504 8 537 15 733 141 847 264 797 241
HIV prevalence in IDUs under treatment- 2012 HIV/HCV Prevalence in IDUs under treatment HCV prevalence in IDUs under treatment- 2012 Source: The evolution of the HIV/AIDS outbreak among IDUs in Romania. Andrei Botescu- Romanian National Antidrug Agency
HIV testing in IDUs performed by the Public Health Directions 2007-2013 Year Negative tests Positive tests TOTAL % positive tests 2007 620 6 626 0.95% 2008 380 3 383 0.78% 2009 277 6 283 2.12% 2010 96 1 97 1.03% 2011 46 3 49 6.12% 2012 255 19 274 6.93% 2013 106 22 128 20.75%
CD4 values in new HIV/AIDS cases at adults- 2013 Total no. of cases: 776
CD4 values in new cases diagnosed in adults- 2013 Male Female Total no. of cases: 550 Total no. of cases: 226
CD4 values in new HIV/AIDS cases at adults- 2013 Total no. of new cases: 776
CD4 values in new HIV/AIDS cases at adults- 2013 Male Female Total no. of cases: 550 Total no. of cases : 226
CD4 values in i.v. drug users vs. HIV/AIDS patients with different routes of transmission, 2013 IDUs Patients with different routes of HIV transmission
CD4 values in IDUs diagnosed with HIV/AIDS in 2013
CD4 values in IDUs vs. patients with different routes of HIV transmission, diagnosed in 2013 IDU Patients with different routes of transmission
CD4 values in IDUs diagnosed with HIV/AIDS in 2013
Viral load (VL) values for 2013 Total no. of cases in adults: 776 2% 3% 11% 11% 56% 6% 11% <1000 1001-10000 10001-100000 100001-500000 > 500000 Under assessment Not assessed Sursa: Compartimentul pentru Monitorizarea şi Evaluarea Infecţiei HIV/SIDA în România INBI Prof.Dr.M.Balş
Viral load values in new cases at adults, diagnosed in 2013 Male Female Total no. of assessed cases: 174 Total no. of assessed cases: 89
Evolution of HIV/AIDS infection in Romania 1985-2013
AIDS incidence in adults and children 1985 2013 (100.000) Children 2013: 0,28/100.000 Adults 2013: 1,74/100.000
Distribution of AIDS cases by sex at 31 December 2013 (cumulative total 1985-2013)
Age groups and sex distribution of AIDS cases at 31 December 2013 (cumulative total 1985-2013)
Probable route of transmission in children with AIDS (0-14 years at date of diagnosis) 31 December 2013 (cumulative total 1989-2013) *Persons who received blood transfusions at the end of the 1980s and beginning of 1990s. **Persons with repeated and/or parenteral treatments and admissions at the end 1980s and beginning of 1990s
Probable routes of transmission in adults diagnosed with AIDS (>14 years at date of diagnoses) at 31 December 2013 (cumulative total 1985-2013) * Persons who received blood transfusions at the end of the 1980s and beginning of 1990s.
Distribution of AIDS cases in women, by age groups and year of diagnosis, between 1985-2013
HIV incidence in adults and children, 1985-2013 (100.000) Children 2013: 0,37/100.000 Adults 2013: 2,54/100.000
Distribution of HIV cases by sex at 31 December 2013 (cumulative total 1992-2013)
Distribution of HIV cases by sex and age groups (at date of diagnosis) at 31 December 2013 (cumulative total)
Probable route of transmission in children with HIV (0-14 years at date of diagnosis) at 31 December 2013 (cumulative total) *Persons who received blood transfusions at the end of the 1980s and beginning of 1990s. **Persons with repeated and/or parenteral treatments and admissions at the end 1980s and beginning of 1990s
Probable route of transmission in adults with HIV (>14 years at date of diagnosis) at 31 December 2013 (cumulative total) * Persons who received blood transfusions at the end of the 1980s and beginning of 1990s
Distribution of HIV cases in women, by year of dagnosis and age groups (192-2013)
Distribution of PLWHA by age group and sex at 31 December 2013 (cumulative total 1985-2013) Age group Male SEX Female TOTAL < 1 year 3 4 7 1-4 yrs. 25 28 53 5-9 yrs. 31 37 68 10-12 yrs. 24 38 63 13-14 yrs. 7 4 11 15-19 yrs. 118 85 203 20-24 yrs. 1885 1664 3548 25-29 yrs. 1941 1523 3464 30-34 yrs. 587 382 969 35-39 yrs. 587 452 1039 40-49 yrs. 880 686 1566 50-59 yrs 497 324 821 60 yrs and >60 292 170 462 TOTAL 6877 5396 12273
HBV, HCV and HBC+HCV infections in children HIV+ 1989-2013
HBV, HCV and HBC+HCV infections in HIV+ adults 1985-2013 250 200 No. cases 150 100 50 Year of diagn. 0 '85 '86 '87 '88 '89 '90 '91 '92 '93 '94 '95 '96 '97 '98 '99 '00 '01 '02 '03 '04 '05 '06 '07 '08 '09 '10 '11 '12 13 VHB 1 0 1 2 7 16 10 5 11 22 29 40 27 39 59 47 47 85 103 65 62 57 42 59 50 45 38 35 41 VHC 0 0 0 0 1 1 1 1 3 5 8 10 3 14 4 12 12 20 16 20 23 17 9 20 13 17 102 231213 VHB+VHC 0 1 0 1 0 0 1 0 1 1 1 3 1 0 1 3 3 3 6 6 5 2 3 2 4 3 17 33 30
AIDS defining illnesses 2013
Distribution of deaths cases by years 1985-2013
Mean period of survival (months) of PLWA, between 1990-2013 BI-therapy Triple therapy
Mother to child transmission in Romania
HIV/AIDS in children with mother to child transmission
HIV/AIDS acquired through vertical transmission by age groups
Children 0-14 years: number of therapeutic regimens, prior to the current one: 31 December 2013
ARV schemes in children- 31 December 2013
Viral load in children under antiretroviral treatment
MTCT prophylaxis in pregnant women 2009-2013 300 250 200 150 100 50 0 2009 2010 2011 2012 2013 Total no. pregnant women Prophylaxis No prophylaxis
Prophylaxis of mother to child transmission in children to HIV positive mothers 2009-2013 Year Number of newborns Number of prophylaxis 2009 204 192 2010 222 204 2011 196 183 2012 203 196 2013 239 230
HIV testing 2013
*Data are sent by County Public Health Authorities HIV testing* in risk groups 2013 Risk groups Negative tests Positive tests TOTAL %positive STI 3205 87 3292 2,71 TBC 12184 99 12283 0,81 Maternity testing 613 15 628 2,45 Pregnant women 129131 128 129259 0,10 Health professionals 6995 0 6995 0,00 Persons with hemodialysis 2702 0 2702 0,00 Persons with transfusions 182 0 182 0,00 Prenuptial check-up 6253 0 6253 0,00 IDU 106 22 128 20,75 Inmates 204 3 207 1,47 MSM 46 6 52 13,04 SWs 102 7 109 6,86 HIV contacts 1074 110 1184 10,24 Sailors 5577 1 5578 0,02 Drivers 46 1 47 2,17 Work abroad > 6 months 343 2 345 0,58 Stay abroad > 6 months 141 0 141 0,00 On request 112383 1117 113500 0,99 Occasional 19394 619 20013 3,19 TOTAL 300681 2217 302898 0,74
HIV testing in pregnant women*, by age groups 2013 Age group Negative tests Positive tests TOTAL 12-14 years 458 0 458 15-19 years 12255 10 12265 20-24 years 30003 42 30045 25-29 years 38297 50 38347 30-34 years 26797 13 26810 35-39 years 12641 8 12649 > 40 years 2793 0 2793 Unspecified age 5887 5 5892 TOTAL 129131 128 129259 *Data are sent by County Public Health Authorities
HIV testing in pregnant women by age groups 2013
Total testing HIV testing in pregnant women Total testing Year
HIV testing in blood donors Year
HIV testing in STI patients 16000 100 14000 90 80 12000 70 Total tests 10000 8000 6000 60 50 40 Positive tests 30 4000 20 2000 10 0 Year 91 92 93 94 95 96 97 98 99 '00 '01 '02 '03 '04 '05 '06 '07 '08 '09 '10 '11 '12 '13 Total tests 4106 3779 4741 3116 3725 3849 4317 4873 5200 10640 8216 14414 1328314856 12139 6149 5632 9343 5353 4019 3803 3593 3292 Positive tests 8 6 6 4 23 19 24 21 19 39 46 60 42 43 29 21 35 27 27 27 29 53 87 0 Total tests Positive tests
HIV testing in TB patients 18000 200 16000 180 Total tests 14000 12000 10000 8000 6000 4000 160 140 120 100 80 60 40 Positive tests 2000 Year 0 '90 '91 '92 '93 '94 '95 '96 '97 '98 '99 '00 '01 '02 '03 '04 '05 '06 '07 '08 '09 '10 '11 '12 '13 20 0 Total tests 1300 842 821 1662 1067 597 3451 3195 1527 1822 10719 10578 1194611025 7440 10392 10821 1183215799 14032 1345113875 1411512283 Positive tests 15 18 8 14 15 23 27 25 19 39 54 37 55 55 47 75 84 94 113 101 128 190 143 99
HIV testing in HIV contacts 1400 120 1200 100 Total tests 1000 800 600 80 60 Positive tests 400 40 200 20 Year 0 '01 '02 '03 '04 '05 '06 '07 '08 '09 '10 '11 '12 '13 0 Total tests 769 655 977 563 383 569 704 966 909 976 984 976 1184 Positive tests 7 19 36 23 39 17 35 92 70 78 85 100 110
Source: Compartment for Monitoring and Evaluation of HIV/AIDS Infection in Romania INBI Prof.Dr.M.Balş HIV testing on request Year
Challenges 2013...
Challenges of HIV/AIDS management in Romania Impact of therapeutic fatigue on adherence to antiretroviral therapy. Advanced stage of diseases+ virologic and immunologic failure. Multiple associated diseases that require specific treatment and antiretroviral treatment. Management: ART in TB/HIV co-infection ART în HIV, HBV/HCV co-infection New HIV-IDU cases (78% HC co-infection, 12% HBV-HCV coinfection, 14% STDs in 2013) Source: Compartment for Monitoring and Evaluation of HIV/AIDS Infection in Romania INBI Prof.Dr.M.Balş
*National HIV/AIDS Strategy 2012-2015 Challenges of HIV/AIDS management in Romania Most WLHA are long term survivors, infected at the end of the 1980s: Multiple therapeutic regimens- impact on ART resistance. ~50% of couples are serodiscordant (>50% women are HIV+). In this context, during the last few years the rate of MTCT has maintained a low value- <5%, due to the National Prevention Program of Mother to Child Transmission, established in 1998. In 2013 the rate represented 2,64% of the new reported cases. Further efforts are made to keep MTCT rate at low values.
Challenges of HIV/AIDS management in Romania During the last few years the main route of transmission has been heterosexual contact (unprotected)> in 2013-54,58% of the new cases. IDU/HIV increased: from 3% in 2010 to 329,23% in 2013. MSM/HIV has the same value: 11% of the new cases in 2013. The largest number of newly diagnosed cases has been recorded for the 20-24 age group, 35% of these being late presenters. Increase in the number PLWHA whose state requires specialized medical care. Source: Compartment for Monitoring and Evaluation of HIV/AIDS Infection in Romania INBI Prof.Dr.M.Balş
Challenges: 2013 PLWHA MTCT ART Use IDUs Young by age, old by treatment Therapeutic fatigue Young mothers, multi- experienced in ART Mothers with unknown HIV status- tested and treated for HIV Treatment as prevention Legal drugs Source : A. Streinu-Cercel. cnlas.ro: Specific Challenges of the Hiv Epidemic in Romania. EACS 2013.
1987-1990 cohort The largest cohort in Europe- 23-26 age group. It represents ~half of the HIV+ population in Romania Share by sexes: 1:1 F1 subtype: approximatively 100 % Long term survivors (~6000 survivors) Multiple ART regimens (10-15!) Salvage therapy ARV toxicity therapeutic fatigue They have/want children: problemes vertical transmission Long term teratogenic effects of ART Sourse: A. Streinu-Cercel. cnlas.ro: Specific Challenges of the Hiv Epidemic in Romania. EACS 2013.
New cases: Late presenters: heterosexual persons, F1 subtype Real time presenters: MSM&IDUs (primary HIV infection!): MSMs: high level of education voluntary and pro-active IDUs: socially integrated tested by the healthcare professionals in the system Transmitted resistance: low levels in all groups <10% (4.6%) An important problem: children to mothers who inject drugs, which represents a risk of HIV+HCV+HBV co-infections! Source : A. Streinu-Cercel. cnlas.ro: Specific Challenges of the Hiv Epidemic in Romania. EACS 2013.
HIV/AIDS infection in the world 2012
General data on HIV/AIDS in the world December 2012 Source: UNAIDS Global Report Epidemiology September 2013 Total 35,3 million (32,2 38,8 million) PLWHA Persons infected with HIV in 2012 Adults Women Children < 15 years Total Adults 32,1 million (29,1 35,3 million) 17,7 million (16,4 19,3 million) 3,3 million (3,0 3,7 million) 2,3 million (1,9 3,7 million) 2,0 million (1,7 2,4 million) Children < 15 years 260.000 (230.000 320.000) AIDS deaths in 2012 Total Adults 1,6 million(1,4 1,9 million) 1,4 million (1,2 1,7 million) Children < 15 ani 210.000 (190.000 250.000)
million Source: UNAIDS Global Report Epidemiology September 2013 Estimates on the numbers of PLWHA 2000-2012
Source: UNAIDS Global Report Epidemiology September 2013 Global estimates for adults and children December 2012 PLWH: 35,3 million (32,2 38,8 million) New cases of HIV cases in 2012 2,3 million (1,9 3,7 million) Deaths caused by AIDS in 2012 1,6 million (1,4 1,9 million)
Estimates on the number of living children and adults with HIV infection at the end of 2012 Source: UNAIDS Global Report Epidemiology September 2013
Estimates on the number of adults and children infected with HIV in 2012 Suource: UNAIDS Global Report Epidemiology September 2013
Estimates on the number of deaths caused by AIDS (adults and children) in 2012 Source: UNAIDS Global Report Epidemiology September 2013
Source: UNAIDS Global Report Epidemiology September 2013 Approximately 6300 persons have been infected with HIV, daily in 2012 Over 95% come from poor and developing countries. Almost 400 are children, with ages <15 years. Almost 5500 are persons between 15-49 years, of whom: ~47% are women ~39% are between 15-24 years
Source: UNAIDS Global Report Epidemiology September 2013 Global estimates on HIV and AIDS at the end of 2012 Children (<15 years) Children LWHA 3,3 million (3,1 3,8 million) Newly infected children in 2012 330 000 (280 000 30 000) Deaths caused by AIDS in 2012 230 000 (200.000 270.000)
Source: UNAIDS Global Report Epidemiology September 2013 Statistical data by regions December 2012
HIV/AIDS estimates within the WHO Region (53 countries)- 2012 Reported cases of HIV/AIDS (cumulative total): AIDS cases: 390.897 AIDS deaths: 205.286 HIV infection: 839.337 Source: HIV surveillance Report 2012
Characteristics of HIV cases, diagnosed in the WHO European Region, by geographical areas- 2012 WHO European Region West Centre East EU/EEA Countries Reporting countries/number 51/53 23/23 15/15 13/15 30/31 Number of HIV cases 55494 27316 3714 24464 29381 Rate/ 100 000 population 7,8 6,6 1,9 22 5,8 % of cases: 15-24 age group 10,3% 9,8% 15,4% 10,1% 10,6% Men/women ratio 2,1 3,1 4,5 1,4 3,2 Route of transmission Heterosexual 45,6% 35,3% 24,6% 60,2% 33,8% MSM 22,8% 41,7% 26,3% 1,2% 40,4% IV Drugs 17,8% 5,1% 7,4% 33,6% 6,1% Unknown 12,3% 17% 36,9% 3,2% 18,7% No data: Liechtenstein, Rusisa şand Uzbekistan; Countries that did not report age groups and routes of transmission are excluded *includes persons(12%) coming from Sub-Saharan African Countries; Source: HIV/AIDS surveillance Report 2012
Case definition: CDC&ECDC Stockholm This section contains the case definitions* for Acquired Immunodeficiency Syndrome (AIDS) and Human Immunodeficiency Virus (HIV) Infection *Source: 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 of the Council Clinical Criteria (AIDS) Any person who has any of the clinical conditions as defined in the European AIDS case definition for: Adults and adolescents > 13 years [1] Children < 13 years of age [2] 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 http://ecdc.europa.eu/en/activities/surveillance/hiv/pages/case_definition.aspx
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 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://ecdc.europa.eu/en/activities/surveillance/hiv/pages/case_definition.aspx
Definitions Incidence = number of new cases x 100.000/population, registered at 1 July 2011. Prevalence = number of new and old cases x 100.000/population registered at 1 July 2011. Child = individual entering the 0-14 age group, according to CDC definition (1993-1994). Adult = individual over 15 years, according to CDC definition (1993-1994).
*Sources Revised surveillance 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 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 Who case definitions of HIV for surveillance and Revised clinical staging and immunological Classification of HIV-related disease in adults and Children (World Health Organization 2007) http://www.who.int/hiv/pub/guidelines/hivstaging150307.pdf
Manager: Prof.Dr. Adrian Streinu-Cercel Head of Infectious Diseases UMF Carol Davila President of National Committee to Fight AIDS& Infectious Diseases Committee Coordinator: Coordinator Adults Programme: CoordInator Children Programme: Mariana Mărdărescu MD PhD Lecturer Dr.Elisabeta Otilia Benea Dr. Sorin Petrea Statistical data operators : PC Operators: Epidemiology: As.med. Marieta Iancu Daniela Viţelaru Sanda Vintilă Dr. Ionel Iosif