HIV In Europe: Remaining challenges III HIV Portugal Conference: Zero HIV infections, zero discrimination, zero AIDS related deaths Professor Jens D. Lundgren, MD DMSc Copenhagen HIV Program, Department of Infectious Diseases Rigshospitalet, University of Copenhagen Denmark
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HIV In Europe:
Remaining challenges
III HIV Portugal Conference:
Zero HIV infections, zero discrimination, zero AIDS related deaths
Professor Jens D. Lundgren, MD DMSc
Copenhagen HIV Program, Department of Infectious Diseases
Rigshospitalet, University of Copenhagen
Denmark
HIV epidemic in eastern Europe and central Asia the
fastest growing in the world:
Estimated number of people
living with HIV in WHO-EURO Region, 1990-2011
Source: UNAIDS. Global report: UNAIDS report on the global AIDS epidemic 2012.
0,0
0,2
0,4
0,6
0,8
1,0
1,2
1,4
1,6
1,8
2,0
2,2
2,4
2,6
2,8
3,0
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
Es
tim
ate
d n
um
be
r o
f p
eo
ple
liv
ing
wit
h H
IV
(Mil
lio
ns
)
WHO European Region (total estimated) 2.4 million
Eastern Europe and central Asia 1.5 million
Western and central Europe 860 000
The number of new cases of HIV infection
in Russian citizens, 1987 - 2009
UNAIDS Country Report
*
*: numbers continue to increase in 2010/11 (app 70,000)
20-25 million HIV tests per year – www. hivrussia.org
Infection increasing faster than treatment:
WHO European Region, 1985–2011
0
200
400
600
800
1 000
1 200
1 400
1 600
1 800
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
HIV
AIDS
AIDS deaths
People on ART
Sources: ECDC/WHO. HIV/AIDS surveillance in Europe 2011. Stockholm: ECDC; 2012; Federal Scientific and
Methodological Center for the Prevention and Control of AIDS, Russian Federation; Ukrainian AIDS Centre, Ukraine;
WHO/UNICEF/UNAIDS monitoring and reporting on the Health Sector Response to HIV/AIDS.
(diagnosed)
Treatment cascade in Europe
0
10
20
30
40
50
60
70
80
90
100
% o
f all i
nfe
cte
d
All Europe
Western E
Eastern E
*: incomplete data on number of persons in care in Eastern Europe
*: % of follow-up (FU) on ART where >90% FU has VL <
500
EuroSIDA (unpublished)
Opioid-substitution-therapy (OST) and
ART among IDU in selected Eastern
European countries in 2010 # IDU % of IDU
receiving
OST
# IDU HIV+
in 2010
# of HIV+ IDU
on ART
Belarus 75,000 0,3% 10,500 ?
Kazakhstan 186,000 0,1% 5,580 182
Lithuania 5,458 ? 1,250 62
Moldova 25,000 1,4% 4,450 446
Russia 2 million 0% ? ?
Ukraine 375,000 2,1% 85,000 1732 15,9 million IDU’s globally – 80% in low-middle income countries Countries from where data was collected: Afghanistan, Bangladesh, Belarus, China, India, Indonesia, Kenya, Kazakhstan, Kyrgyzstan, Lithuania, Mauritius, Moldova, Myanmar, Nepal, Nigeria, Pakistan, Russia, South Africa, Tanzania, Ukraine and Vietnam.
Petersen et al. Harm Reduction J, 2013
Opioid substitution treatment clients as a percentage
of the estimated number of problem opioid users
0
10
20
30
40
50
60
70
80
90
100
Op
ioid
mai
nte
nan
ce t
reat
men
t cl
ien
ts (
%)
2011 or most recent year; EMCDDA Statistical Bulletin 2013
Crude odds ratio 0.96 (0.95 – 0.97) per calendar year
Crude odds ratio 0.95 (0.94 – 0.96) per calendar year Crude odds ratio 0.94 (0.93 – 0.95) per calendar year Crude 4.4 (3.8 – 5.0/mm3) per year increase in CD4 at presentation