HIV/AIDS epidemiology in Poland. Late presentation of HIV infection & AIDS

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1 HIV/AIDS epidemiology in Poland. Late presentation of HIV infection & AIDS Magdalena Leszczyszyn-Pynka Department of Infectious Diseases, Hepatology and Acquired Immunodeficiences Pomeranian Medical University in Szczecin Potsdam,

2 HIV i AIDS in Europie r. ~ 1,6 mln infected r. ~ 2,3 mln infected - ~ 50% do not know about the infection - ~ 50% are co-infected with HCV 1

3 FACTS 1. HIV pozwala dożyć średniej wieku swojej płci w swoim kraju 2. Zakażenie jest BEZOBJAWOWE przez średnio 10 lat 3. DIAGNOSIS of HIV infection in Europe in > 50% cases in pts with AIDS 4. globally HIV is the major cause of mortality among women of reproductive age and was responsible for the death of children in Bhavan KP i wsp. Curr HIV/AIDS Rep 2008; 5: , 2. EACS 05, PE18.4/7, 3. Mack KA i wsp.jaids WHO HIV/AIDS Strategy for WHA, 21 May 2010, document UNAIDS/09.13E

globally HIV is the major cause of mortality among women of reproductive age and was responsible for the death of 280 000

4 Doświadczenia własne (Our own experiences) PONAD 50% NOWO WYKRYTYCH ZAKAŻEŃ HIV = DIAGNOZA AIDS Bander D. i wsp., PÓŹNE WYKRYWANIE AIDS MATERIALE WŁASNYM (2009, Przeg. Epidem.) W

5 Poland 31 Aug polish citizens confirmed HIV inf AIDS cases (CDC/WHO def) 1220 AIDS deaths 25% - women, 75% - men ~ % - HIV/HCV Source: Department of Epidemiology National Institute of Public Health National Institute of Hygiene (NIZP PZH)

- HIV/HCV Source: Department of Epidemiology National Institute of Public

6 HIV cases, AIDS cases, AIDS deaths

7 HIV in Poland new diagnosis

8 Annual HIV infections incidence - cases/ citizens (mean for ) We are here

9 Annual AIDS cases incidence - cases/ citizens (mean for )

10 AIDS cases route of the transmission??? MSM Ht sex IDUs

11 wsse-poznan.pl Polska

12 Definitions 1. Late presentation: persons presenting for care with a CD4 count below 350 cells/µl or presenting with an AIDS-defining event, regardless of the CD4 cell count. 2. Presentation with advanced HIV disease: persons presenting for care with a CD4 count below 200 cells/µl or presenting with an AIDS-defining event, regardless of the CD4 cell count. Antinori A et al for the European Late Presenter Consensus working group, HIV Medicine (2010) DOI: /j x

event, regardless of the CD4 cell count. 2.

13 HIV in Szczecin new patients * (mean age) 2013 (till ) % 50 + % LATE PRESEN- TERS DEATHS MEN 114 (34,1 ys) = 77,6% 41 (34,8 ys) 36 (37,3 ys) 37 (31,3 ys) 13/114 = 11,4 % 72/114 = 63,2% 6(5,3%) WOMEN 33 (44,9 ys) = 22,4% 6 (45,6 ys) 14 (36,8 ys) 13 (51,5 ys) 10/33 = 30,3 % 24/33 = 72,7% 4 (12,1%) ALL 147 (36,3 ys) 47 (36,1 ys) 50 (37,2 ys) 50 (35,3 ys) 23/147 = 15,6 % 96/147 = 65,3 % 10 (6,9%) 8 - AIDS Data on records, PNNI, Szczecin

14 HIV in Szczecin new patients * 15/147 = 10,2 % cases of syphilis solely men (13 MSM) 29/147 = 19,7 % HIV/HCV (tends to be lower than earlier) Only 2 cases of acute Hep C Data on records, PNNI, Szczecin

15 Syphilis in Poland congenital 14 (3,6/ births) 32 (8,28/ births) early sy 655 (1,7/ ) 677(1,76/ ) late sy 286 (0,74/ ) 284(0,74/ ) Infectious diseases and poisonings in Poland in 2012, Warszawa 2013 National Institute of Public Health National Institute of Hygiene Department of Epidemiology Chief Sanitary Inspectorate Department for Communicable Disease and Infection Prevention and Control

poisonings in Poland in 2012, Warszawa 2013 National Institute of Public Health National Institute of Hygiene

16 Annual HIV infections incidence - cases/ citizens (mean for ) Syphilis incidence ,82-4,61/ West Pomerania 1,22/

2011-2012 1,82-4,61/100 000 West Pomerania 1,22/100

17 1069 records HIV in Szczecin 664 patients under care (at least 1 visit during last 12 mth) migration, treated in other centers, no need to be checked, lost of follow up ~ 10% 41% - HIV/HCV 38 % - IDUs Methadone programme full access (still not in all cities in Poland!)

need to be checked, lost of follow up ~ 10% 41% - HIV/HCV 38 % -

18 HIV in Szczecin cont. MTCT Szczecin when all preventic procedures vertical transmission of HIV 0,0 ( pregnancies) MTCT of HIV 9 cases 8 not tested in pregnancy 1 no prophylaxis with ARV (parents decision)

transmission of HIV 0,0 (1995-2013 211 pregnancies)

19 Ciąża a testowanie w kierunku zakażenia HIV 2 x tj. do 10 Hbd oraz Hbd Less than 20% pregnant women are tested for HIV in Poland! Despite of being mandatory!

20 Polish patients on ART: 1.X adults, children & adolescents < 18 ys of age - If recommended start (Zalecenia PTN AIDS Krajowy Program Zapobiegania HIV/AIDS )

21 Pacjenci leczeni ARV w grupie 50+ Na dzień r. było 1052 osób leczonych ARV w wieku 50+ = to 15,66% wszystkich leczonych (6717) Z tego liczbowo i procentowo dla pacjentów 50+: 1. Kobiety: 195 = 18,54 % (1595/ 23,75% wszystkie kobiety) 2. Mężczyźni: 857 = 81,46 % (5122 / 76,25% wszyscy mężczyźni) Courtesy: dr Beata Zawada, National AIDS Centre, Vistula 2013

22 Local efforts: post-graduate & continuus education 1. Family doctors 2. Internal medicins residents 3. Gin/obstetr., dermatology, - Case studies presentations interdisciplinary meetings

23 CONCLUSIONS Stable situation of new diagnosis Still late diagnosis Focus on 50+ Insufficient HIV testing in pregnancy and among heterosexual population at any age Underestimation of STDs?

24 Special thanks to: Małgorzata Kłys-Rachwalska, MSc, Miłosz Parczewski, MD, PhD Katarzyna Maciejewska, MD

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