HIV/AIDS mortality in Europe Monitoring mortality among injecting drug users?

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1 European joint DRD/DRID expert meeting Lisbon, October 2013 HIV/AIDS mortality in Europe Monitoring mortality among injecting drug users? Isabelle Giraudon, Lucas Wiessing, João Matias, Julian Vicente, EMCDDA 1

2 Rationale Reducing mortality should be a priority of HIV/AIDS policies Indicator of ART coverage Reduction of mortality is achievable in the EU Access to ART should be equitable for all groups HIV/AIDS is one of the common causes of deaths reported in cohorts (with external causes of deaths: overdoses, suicides, liver disease, other diseases ) QUESTION: How many HIV/AIDS deaths in Europe are accounted for by IDUs? What are the trends? 2

3 Objectives To analyse the numbers and trends of HIV/AIDS related deaths in Europe to describe mortality country differences and trends to estimate HIV/AIDS mortality attributable to IDU 3

4 Methods source 1 Two European level sources: EUROSTAT and HIV/AIDS surveillance EUROSTAT From general mortality registries (national statistics) Underlying cause of death in medical death certificates coded AIDS (HIV-disease) B20-B24 No information on risk group Available from h_database 4

5 B20-B24 ICD-10 codes - Eurostat B20 Human immunodeficiency virus [HIV] disease resulting in infectious and parasitic diseases B21 Human immunodeficiency virus [HIV] disease resulting in malignant neoplasms B22 Human immunodeficiency virus [HIV] disease resulting in other specified diseases (e.g. encephalopathy HIV dementia) B23 Human immunodeficiency virus [HIV] disease resulting in other conditions (e.g. haematological and immunological abnormalities) B24 Unspecified human immunodeficiency virus [HIV] disease ( AIDS and AIDS related complex ) 5

6 Methods source 2 HIV/AIDS SURVEILLANCE - ECDC Data from national AIDS monitoring systems Reports of all deaths among AIDS cases Causes are not specified The risk group (e.g. IDUs) is reported we use this to estimate the proportion of HIV/AIDS Eurostat deaths attributable to IDU Available from the ECDC annual epidemiological report dex.aspx 6

7 Standardised HIV/AIDS death rate per inhabitants in Europe in 2010 Source: Eurostat HIV-AIDS (ICD 10 B20-B24)

8 Standardised HIV/AIDS death rate per inhabitants in Source: Eurostat HIV-AIDS (ICD 10 B20-B24) 15 EU Spain France Italy Portugal 5 0 8

9 Standardised HIV/AIDS death rate per inhabitants, Source: Eurostat HIV-AIDS (ICD 10 codes B20-B24) EU 27 Estonia Latvia Lithuania

10 Numbers of HIV-AIDS deaths in 17 countries where data is available since 1994 Source: Eurostat HIV/AIDS (ICD 10 B20-B24) Czech Republic Denmark Germany Ireland Greece Number of deaths Total EU 27 in 2010: 4365 Total EU 17 in 2010: 3531 Spain Italy Luxembourg Hungary Netherlands Austria Poland Portugal Slovenia Finland Sweden Year United Kingdom 10

11 Monitoring HIV/AIDS deaths in IDUs? How many of these deaths are attributable to IDU? Need to estimate the % and numbers of the total Need to apply to Eurostat numbers the % of IDU observed in the deaths among AIDS cases reported to AIDS surveillance 11

12 Estimated number of deaths in Eurostat attributable to IDU, based on the IDU-related fraction in AIDS deaths Estimated HIV/AIDS deaths others 800 Estimated HIV/AIDS deaths attributed to IDU Spain Italy Portugal France Poland Germany Latvia Estonia UK Austria Lithuania Ireland Belgium Romania Denmark Netherl Norway Sweden Bulgaria Greece Croatia Finland

13 Estimated mortality rates due to HIV/AIDS attributable to IDU and overdose (DRD) mortality rate Rate DRD/million population Romania (n = 15) Turkey (n = 93) Hungary (n = 14) Portugal (n = 19) Czech Republic (n = Slovakia (n = 15) Bulgaria (n = 24) Latvia (n = 11) France (n = 331) Poland (n = 232) Netherlands (n = 101) Italy (n = 362) Greece (n = :) Spain (n = 392) Cyprus (n = 9.66) Slovenia (n = 24) Luxembourg (n = 6) Malta (n = 5) Germany (n = 966) Belgium (n = 142) Croatia (n = 59) Lithuania (n = 43) Austria (n = 201) Sweden (n = 217) Denmark (n = 181) Ireland (n = 159) UK (n = 2153) Finland (n = 189) Rate per million Norway (n = 238) Estonia (n = 123) Estimation of the mortality rate due to HIV/AIDS attributable to IDU/million population (1) Source EMCDDA DRD Statistical Bulletin

14 Problem: the 2 sources are increasingly discrepant and the ratio of data from both sources varies between countries 14

15 Comparison of the number of HIV/AIDS deaths in Eurostat and deaths among AIDS cases in surveillance data in the EU Number of deaths repored Eurostat Surveillance Years 15

16 Comparison of the numbers of HIV/AIDS deaths in Eurostat and among AIDS cases in surveillance Eurostat 2010 Surveillance Countries with Surveillance data > Eurostat data 0 16 Spain Italy Portugal France Germany UK Poland Romania Latvia Netherlands Austria Estonia Greece Lithuania Ireland Croatia Sweden Hungary Norway

17 Conclusions 1/3 Decrease in HIV/AIDS deaths since 1996 (ART) but still ~ 5000 deaths/year, concentrated in a few countries >1600 deaths may be attributable to IDU in 2010 Sustained mortality rates after 1996 in Portugal and recent increases in the Baltic countries 17

18 Conclusions 2/3 Increasing discrepancy between mortality statistics and surveillance data Large variation across countries due to Increasing non-aids mortality among PLHIV Underreporting of AIDS cases and deaths? Coding (differences between countries) Likely different combinations of these factors in different countries 18

19 Conclusions 3/3 This suggests need for: Surveillance of deaths among all HIV cases (not only AIDS cases) Include information on cause of death in surveillance Assess underreporting of death among AIDS cases in national surveillance Compare coding practices National level linkage studies between mortality statistics and AIDS surveillance 19

20 Thank you for your attention Acknowledgments Giedrius Likatavicius - [ECDC] Mercedes Diez - Secretaría del Plan Nacional sobre el Sida-Centro Nacional de Epidemiología, Madrid, Spain 20