The prognosis of late presenters in the era of highly active antiretroviral therapy in serbia

HIV care in Central and Eastern Europe: How close are we to the target?

OBJECTIVES

The aim of this survey was to describe the current status of HIV care in the countries of Central and Eastern Europe and to investigate how close the region is to achieving the UNAIDS 2020 target of 90-90-90.

METHODS

In 2014, data were collected from 24 Central and Eastern European countries using a 38-item questionnaire.

RESULTS

All countries reported mandatory screening of blood and organ donors for HIV. Other groups subjected to targeted screening included people who inject drugs (PWID) (15/24, 62.5%), men who have sex with men (MSM) (14/24, 58.3%), and sex workers (12/24, 50.0%). Only 14 of the 24 countries (58.3%) screened pregnant women. The percentages of late presentation and advanced disease were 40.3% (range 14-80%) and 25.4% (range 9-50%), respectively. There was no difference between countries categorized by income or by region in terms of the percentages of persons presenting late or with advanced disease. The availability of newer antiretroviral drugs (rilpivirine, etravirine, darunavir, maraviroc, raltegravir, dolutegravir) tended to be significantly better with a higher country income status. Ten countries reported initiating antiretroviral therapy (ART) regardless of CD4+ T cell count (41.7%), five countries (20.8%) used the threshold of <500 cells/μl, and nine countries (37.5%) used the threshold of <350cells/μl. Initiation of ART regardless of the CD4+ T cell count was significantly more common among high-income countries than among upper-middle-income and lower-middle-income countries (100% vs. 27.3% and 0%, respectively; p=0.001). Drugs were provided free of charge in all countries and mostly provided by governments. There were significant discrepancies between countries regarding the follow-up of people living with HIV.

CONCLUSIONS

There are major disparities in the provision of HIV care among sub-regions in Europe, which should be addressed. More attention in terms of funding, knowledge and experience sharing, and capacity building is required for the resource-limited settings of Central and Eastern Europe. The exact needs should be defined and services scaled up in order to achieve a standard level of care and provide an adequate and sustainable response to the HIV epidemic in this region.

The growing HIV epidemic in Central Europe: a neglected issue?

The number of new cases of HIV infection has been decreasing in some parts of the world (e.g. sub-Saharan Africa) with the highest burden of disease in recent years. However, other regions are showing a different trend, such as Eastern Europe, the Middle East, North Africa and Central Asia. This trend seems also to apply to the Central European region. This article analyses HIV data for Central Europe derived from annual surveillance reports of the European Centre for Disease Prevention and Control (ECDC) and gives an overview of the recent status of the epidemic in this specific region. We show that, although still at a low level, the HIV epidemic in Central Europe continues to grow and requires more resources and interventions to curtail the ongoing epidemic.

Clinical Characteristics of HIV-Infected Patients Who Survive after the Diagnosis of HIV Infection for More Than 10 Years in a Resource-Limited Setting

A retrospective cohort study was conducted and 129 patients with a diagnosis of HIV infection for more than 10 years were identified. Half the patients were men and mean (standard deviation, SD) age at HIV diagnosis was 33.2 (9.2) years. One third had a diagnosis of AIDS at cohort entry with median (interquartile range, IQR) CD4 counts of 259 (112-430) cells/mm3. All received antiretroviral therapy with median (IQR) current CD4 counts of 502 (363-607) cells/mm3 and 95% had HIV RNA <50 copies/mL. For adverse events, 28% experienced drug resistance, 27% experienced hospitalization, 59% had dyslipidemia, 35% had creatinine >1.0 mg/dL, and 5% had glucose >126 mg/dL. In conclusion, immunological and virological responses can be achieved among patients with a diagnosis of HIV infection for more than 10 years even in a resource-limited setting. Adverse events are common. Preparation for monitoring and management of these adverse events is a crucial part of successful long-term HIV care.