hiv/hepatitis co-infection situation in baltic...
TRANSCRIPT
PowerPoint-presentatie2st Central Eastern European Meeting on Viral
Hepatitis and Co-Infection with HIV
HIV/Hepatitis co-infection situation in BALTIC COUNTRIES
Prof. Dr. SAULIUS APLINSKAS Director, Centre for Communicable Diseases and AIDS
Vilnius Lithuania [email protected]
Estonia 1,3 Latvia 2,0 Lithuania 2,9
2st Central Eastern European Meeting on Viral Hepatitis and Co-Infection with HIV
Prevalence Ann.incid. (per 100 000 pop)
Comments / Source
LV. 14.7 newly diagnosed (3.7 acute, 3.3 chronic, 7.7 unknown)
In 2012 [3]
EE. In 2012 4% of IDUs HBsAg positive. 25% - positive for both anti-HBc IgG and anti-HBsAb (immune due to natural infection) [1]. in 2007, HBsAg prevalence - 1% [2] 2013 study among MSM none (0%) out of 43 men tested was positive for HBsAg [5] In a study conducted in 2012 among defence force conscripts (n=584, comprising 18.6% of the total 2012 conscripted forces) none was positive for HBsAg[6]
3.8 newly diagnosed (0.7 acute, 3.1 chronic) In 2012 [3]
[1] Vorobjov S, et al. HIV and other infections and related risk behaviours among IDU in Kohtla-Järve: study report 2012]. [2] Lõhmus L et al. HIV and other infections and related risk behaviours among IDU in Tallinn and Kohtla-Järve: study report 2007]. [5] Rüütel K, Lõhmus L. Tallinn, Tervise Arengu Instituut, 2014. [6] Rüütel K, Parker RD. STI prevalence and knowledge, attitudes, behavior and perception of STIs among conscripts. Study report. 2013.
HBV. Baltic Countries
0,80
5
10
15
20
25
30
35
40
45
1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
In ci
de nc
e ra
te p
er 1
00 0
Data source: Centre for Communicable Diseaseand AIDS, www.ulac.lt Health Protection Inspectorate, http://www.terviseamet.ee
26,2 25,5
0
5
10
15
20
25
30
In ci
de nc
e ra
te p
er 1
00 0
-reporting system
2st Central Eastern European Meeting on Viral Hepatitis and Co-Infection with HIV
Prevalence Ann. Inc. (per 100 000 pop) Comments / Source
LT. 1,8-2,8 % pop. [2]. In 2015 77,0 % of IDUs - HBsAg posit. were HCV-Ab posit. [1]
0,8 acute [1] CCDA. 2015 [2] GELTONOJI KNYGA. Vilnius, 2014
LV. 2,4 62.6 newly diagnosed cases (2.4 acute, 60.2 chronic)
1,7 viremic In 2012 [3]
EE. In 2012 75% of IDUs HBsAg positive were HCV-Ab posit. [1]. In 2007 76% - HCV-Ab prev. in IDUs [2]. In 2013 two (4.7 %) out of 43 MSM - HCV-Ab positive [5]. In 2012 among defence force conscripts (n=584, 18.6% of the total conscripted forces) one participant (0.2%) was positive for HCV-Ab [6].
17.8 newly diagnosed cases (1.7 acute, 16 chronic) [3]
1.6 acute [4]
[4] in 2014
HCV. Baltic Countries
2,1
0
5
10
15
20
25
30
1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
In ci
de nc
e ra
te p
er 1
00 0
Data source: Centre for Communicable Diseaseand AIDS, Lithuania www.ulac.lt Health Protection Inspectorate, Estonia http://www.terviseamet.ee
Chart1
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Denmark
Finland
Sweden
Norway
Estonia
Latvia
Lithuania
EU/EEA
7.4
22.2
20.2
33.1
14.9
65.2
1.8
9.3
7.6
22
22.5
7.2
13.8
75.6
1.4
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5.8
21.6
26.9
70.4
14.9
65.6
1.3
7.3
5.4
21.3
23.5
47.8
16.9
58.3
1.4
7.4
5.7
21.1
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36.7
20.6
50.9
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7.1
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1.4
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62.6
1.3
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20.4
26.1
19.5
62.7
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9.6
Blad1
Years
Denmark
Finland
Sweden
Norway
Estonia
Latvia
Lithuania
EU/EEA
2006
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65.6
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7.3
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16.9
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62.6
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2013
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26.1
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9.6
2st Central Eastern European Meeting on Viral Hepatitis and Co-Infection with HIV
Prevalence (UNAIDS
LT 0.1% 5,4 newly diagnosed cases
2015 CCDA data
EE 1.3% 22 newly diagnosed cases
in 2014 (no recent incident estimations available)
HIV. Baltic Countries
50 49
32 30 49
65 72
141 157
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
N ew
H IV
c as
2011
2012
2013
2014
HIV incidence in Lithuania, Latvia, Estonia, 2011-2014 m. (new cases per 100 000 population)
Source:
Chart1
Estonia
Estonia
Estonia
Estonia
Latvia
Latvia
Latvia
Latvia
Lithuania
Lithuania
Lithuania
Lithuania
2011
2012
2013
2014
27.3
23.5
24.6
22.1
13.4
16.6
16.6
17.3
5.1
5.3
5.9
4.8
Sheet1
2011
2012
2013
2014
Estonia
27.3
23.5
24.6
22.1
Latvia
13.4
16.6
16.6
17.3
Lithuania
5.1
5.3
5.9
4.8
To resize chart data range, drag lower right corner of range.
2st Central Eastern European Meeting on Viral Hepatitis and Co-Infection with HIV
Co- infected
Country Prev. Annual Incid. Comments / Sources
HIV/HBV LT 2 cases of new HIV treated cases (N=140)
2015 CCDA
HIV/HCV LT 45 cases of new HIV treated cases (N=140)
2015 CCDA
EE 70 % 89.3% of HIV-infected IDUs are also HCV-positive 70.1% HCV-positive IDUs are also HIV-positive (Narva, 2014) (Vorobjov et al, 2015) 70.9% of people living with HIV in care are HCV-positive (Lõhmus et al, 2014
Baltic Countries
Prof. Saulius aplinskas, MD, PhD
1990 - 2008
IDUsHomosex.Heterosx.
A
B
CRF03_AB
Other
2st Central Eastern European Meeting on Viral Hepatitis and Co-Infection with HIV
Prevalence of Different Subtype/Genotype in Country
HIV Subtype
HCV Genotype
Distribution:
LT G1 = 65% (90 % 1b), G2 = 8,7% (80% 2a/c), G3 = 26,3% (80 % 3a) Liakina V, Valantinas J. Med Sci Monit, 2012 Mar:18(3):PH28-35
LV G1= 63.8%, G2= 3.6%, G3= 31.9%, G4= 0.7% EE
Baltic Countries
Source
Where will be next 100 cases diagnosed?
Chart1
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Sheet1
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107
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Unknown
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1
6
7
9
6
12
14
15
18
17
11
38
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35
24
26
MTC
1
1
1
2
0
2st Central Eastern European Meeting on Viral Hepatitis and Co-Infection with HIV
Main Risk factors for Transmission HIV LT Hetero= 37.6 %, IDU = 28.0%, MSM= 17.8%, Unkn.= 16.6 %
LV Hetero=38.0 %, IDU=21.3%, MSM=8.1 (in 2014) EE Hetero=46%, IDU=23%, MSM=1%
HBV LT Unknown=84.4 %, Hetero= 9.4 %, IDU= 6.3 % (new acute HBV cases, 2015)
LV IDU=33.3% , Sexual transmission (not specified)=22.7% (2012, ECDC)
EE Hetero=11% , IDU=11%, Needlestick exposure=11%, Unknown=55% (2012, ECDC)
HCV LT Unknown =95.7 %, IDU = 4.3 % (new acute HCV cases, 2015) LV IDU=29%, Sexual transmission (not specified)=25%,
Nosocomial= 22% (2012, ECDC) EE IDU=21%, Hetero=13% (2012, ECDC)
Baltic Countries
2st Central Eastern European Meeting on Viral Hepatitis and Co-Infection with HIV
Antiviral Treatment Currently Available
HIV LT ALL New HIV treated cases: 59 (42.1%) cases 2NATI+1NNATI; 80 (57.1) cases 2NATI+2PI, 1 (0.7) cases 3NATI
LV All
EE All
LV 3TC, alpha Interferon
EE
HCV LT PegIFN alfa 2a ir alfa 2b, RVB, TEL, BOC, Viekirax (ambitasvir+Paritaprevir+Ritonavir)+Exviera(Sasabuvir)
LV Peg, Riba
Baltic Countries
2st Central Eastern European Meeting on Viral Hepatitis and Co-Infection with HIV
Percent of Patients on HAART
Percent of patient
Number Dying of AIDS
LT 566 (N at the end of 2015) No data available 7 (2015)
LV ~17% No data available 106 (2014) EE Out of 8993 diganosed
with HIV, 2998 were on HAART (31.12.2014)
No data available 47 (2013)
HIV. Baltic Countries
2014 – 128 40.6% - IDUs
Total on ART 491
New HIV cases diagnosed:
2012 – 94 55.3% - IDUs
Total on ART 291
– 160
Total on ART 583 – 75 (15 –death, 60 – other reasons)
– 157
Source:
Prof. Saulius aplinskas, MD, PhD
For 1 new ART patient there are– 1 plus… newly diagnosed infections
2st Central Eastern European Meeting on Viral Hepatitis and Co-Infection with HIV
Percent of Patients on Therapy
Of Those Treated
Percent of Patients
LT 200 patients/year (1%)
caused fibrosis and cirrhosis of
liver
HBV. Baltic Countries
Neonatal vaccination of hepatitis B vaccine trends in Lithuania 2002-2013 m.
Metai Asmen sk. Paskiepytj sk. Nepaskiepytj sk. Skiepijim apimtys 2002 27267 27158 109 99,6 2003 27459 27294 165 99,4 2004 27211 26803 408 98,5 2005 26299 26036 263 99 2006 26570 26411 159 99,4 2007 26724 26457 267 99 2008 29407 29142 265 99,1 2009 29506 29211 295 99 2010 29461 28960 501 98,3 2011 29990 28707 1283 95,7 2012 29381 27396 1985 93,2 2013 25899 25311 588 97,7
Not vaccinated newborns – 6 288
N au
ja gi
m ia
Metai
2st Central Eastern European Meeting on Viral Hepatitis and Co-Infection with HIV
Percent of Patients Received Therapy
Of Those Treated
Source
300–350 patients
463 patients were died in 2014 caused fibrosis and cirrhosis
of liver
LV, EE No data
Rates of all reported HBV cases in Baltic countries, 2006-2012
Dianummer 6
Dianummer 8
Dianummer 9
Dianummer 11
HIV incidence in Lithuania, Latvia, Estonia, 2011-2014 m.(new cases per 100 000 population)
Dianummer 13
Dianummer 15
Dianummer 16
Dianummer 17
Dianummer 18
Dianummer 19
Dianummer 20
Dianummer 21
Neonatal vaccination of hepatitis B vaccine trends in Lithuania 2002-2013 m.
Dianummer 23
HIV/Hepatitis co-infection situation in BALTIC COUNTRIES
Prof. Dr. SAULIUS APLINSKAS Director, Centre for Communicable Diseases and AIDS
Vilnius Lithuania [email protected]
Estonia 1,3 Latvia 2,0 Lithuania 2,9
2st Central Eastern European Meeting on Viral Hepatitis and Co-Infection with HIV
Prevalence Ann.incid. (per 100 000 pop)
Comments / Source
LV. 14.7 newly diagnosed (3.7 acute, 3.3 chronic, 7.7 unknown)
In 2012 [3]
EE. In 2012 4% of IDUs HBsAg positive. 25% - positive for both anti-HBc IgG and anti-HBsAb (immune due to natural infection) [1]. in 2007, HBsAg prevalence - 1% [2] 2013 study among MSM none (0%) out of 43 men tested was positive for HBsAg [5] In a study conducted in 2012 among defence force conscripts (n=584, comprising 18.6% of the total 2012 conscripted forces) none was positive for HBsAg[6]
3.8 newly diagnosed (0.7 acute, 3.1 chronic) In 2012 [3]
[1] Vorobjov S, et al. HIV and other infections and related risk behaviours among IDU in Kohtla-Järve: study report 2012]. [2] Lõhmus L et al. HIV and other infections and related risk behaviours among IDU in Tallinn and Kohtla-Järve: study report 2007]. [5] Rüütel K, Lõhmus L. Tallinn, Tervise Arengu Instituut, 2014. [6] Rüütel K, Parker RD. STI prevalence and knowledge, attitudes, behavior and perception of STIs among conscripts. Study report. 2013.
HBV. Baltic Countries
0,80
5
10
15
20
25
30
35
40
45
1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
In ci
de nc
e ra
te p
er 1
00 0
Data source: Centre for Communicable Diseaseand AIDS, www.ulac.lt Health Protection Inspectorate, http://www.terviseamet.ee
26,2 25,5
0
5
10
15
20
25
30
In ci
de nc
e ra
te p
er 1
00 0
-reporting system
2st Central Eastern European Meeting on Viral Hepatitis and Co-Infection with HIV
Prevalence Ann. Inc. (per 100 000 pop) Comments / Source
LT. 1,8-2,8 % pop. [2]. In 2015 77,0 % of IDUs - HBsAg posit. were HCV-Ab posit. [1]
0,8 acute [1] CCDA. 2015 [2] GELTONOJI KNYGA. Vilnius, 2014
LV. 2,4 62.6 newly diagnosed cases (2.4 acute, 60.2 chronic)
1,7 viremic In 2012 [3]
EE. In 2012 75% of IDUs HBsAg positive were HCV-Ab posit. [1]. In 2007 76% - HCV-Ab prev. in IDUs [2]. In 2013 two (4.7 %) out of 43 MSM - HCV-Ab positive [5]. In 2012 among defence force conscripts (n=584, 18.6% of the total conscripted forces) one participant (0.2%) was positive for HCV-Ab [6].
17.8 newly diagnosed cases (1.7 acute, 16 chronic) [3]
1.6 acute [4]
[4] in 2014
HCV. Baltic Countries
2,1
0
5
10
15
20
25
30
1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
In ci
de nc
e ra
te p
er 1
00 0
Data source: Centre for Communicable Diseaseand AIDS, Lithuania www.ulac.lt Health Protection Inspectorate, Estonia http://www.terviseamet.ee
Chart1
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Denmark
Finland
Sweden
Norway
Estonia
Latvia
Lithuania
EU/EEA
7.4
22.2
20.2
33.1
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65.2
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7.6
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7.2
13.8
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5.8
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26.9
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14.9
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23.5
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58.3
1.4
7.4
5.7
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36.7
20.6
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5.2
21.6
22.8
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15.7
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1.4
7.9
4.7
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20.4
30.3
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62.6
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26.1
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9.6
Blad1
Years
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Finland
Sweden
Norway
Estonia
Latvia
Lithuania
EU/EEA
2006
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22.2
20.2
33.1
14.9
65.2
1.8
9.3
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7.6
22
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7.2
13.8
75.6
1.4
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7.3
2009
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23.5
47.8
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21.6
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34
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63.7
1.4
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2013
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26.1
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9.6
2st Central Eastern European Meeting on Viral Hepatitis and Co-Infection with HIV
Prevalence (UNAIDS
LT 0.1% 5,4 newly diagnosed cases
2015 CCDA data
EE 1.3% 22 newly diagnosed cases
in 2014 (no recent incident estimations available)
HIV. Baltic Countries
50 49
32 30 49
65 72
141 157
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
N ew
H IV
c as
2011
2012
2013
2014
HIV incidence in Lithuania, Latvia, Estonia, 2011-2014 m. (new cases per 100 000 population)
Source:
Chart1
Estonia
Estonia
Estonia
Estonia
Latvia
Latvia
Latvia
Latvia
Lithuania
Lithuania
Lithuania
Lithuania
2011
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2013
2014
27.3
23.5
24.6
22.1
13.4
16.6
16.6
17.3
5.1
5.3
5.9
4.8
Sheet1
2011
2012
2013
2014
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27.3
23.5
24.6
22.1
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13.4
16.6
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17.3
Lithuania
5.1
5.3
5.9
4.8
To resize chart data range, drag lower right corner of range.
2st Central Eastern European Meeting on Viral Hepatitis and Co-Infection with HIV
Co- infected
Country Prev. Annual Incid. Comments / Sources
HIV/HBV LT 2 cases of new HIV treated cases (N=140)
2015 CCDA
HIV/HCV LT 45 cases of new HIV treated cases (N=140)
2015 CCDA
EE 70 % 89.3% of HIV-infected IDUs are also HCV-positive 70.1% HCV-positive IDUs are also HIV-positive (Narva, 2014) (Vorobjov et al, 2015) 70.9% of people living with HIV in care are HCV-positive (Lõhmus et al, 2014
Baltic Countries
Prof. Saulius aplinskas, MD, PhD
1990 - 2008
IDUsHomosex.Heterosx.
A
B
CRF03_AB
Other
2st Central Eastern European Meeting on Viral Hepatitis and Co-Infection with HIV
Prevalence of Different Subtype/Genotype in Country
HIV Subtype
HCV Genotype
Distribution:
LT G1 = 65% (90 % 1b), G2 = 8,7% (80% 2a/c), G3 = 26,3% (80 % 3a) Liakina V, Valantinas J. Med Sci Monit, 2012 Mar:18(3):PH28-35
LV G1= 63.8%, G2= 3.6%, G3= 31.9%, G4= 0.7% EE
Baltic Countries
Source
Where will be next 100 cases diagnosed?
Chart1
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2014
2014
2014
2014
2014
2015
2015
2015
2015
2015
Hetero
MSM
IDUs
Unknown
MTC
1
1
1
7
1
1
4
2
2
7
1
1
9
1
1
5
3
4
3
5
23
5
8
37
2
4
9
46
7
6
9
49
1
7
4
55
6
6
5
379
7
13
3
85
9
24
4
101
6
20
3
85
12
15
9
62
14
27
4
59
15
1
26
9
42
18
36
9
118
17
28
7
107
11
32
9
86
38
1
48
11
63
38
50
29
62
35
1
66
11
38
24
2
59
28
44
26
0
Sheet1
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
Hetero
1
1
1
2
7
9
5
3
5
4
6
7
6
13
24
20
15
27
26
36
28
32
48
50
66
59
MSM
1
7
1
4
2
1
1
3
5
8
9
9
4
5
3
4
3
9
4
9
9
7
9
11
29
11
28
IDUs
1
1
4
23
37
46
49
55
379
85
101
85
62
59
42
118
107
86
63
62
38
44
Unknown
2
7
1
6
7
9
6
12
14
15
18
17
11
38
38
35
24
26
MTC
1
1
1
2
0
2st Central Eastern European Meeting on Viral Hepatitis and Co-Infection with HIV
Main Risk factors for Transmission HIV LT Hetero= 37.6 %, IDU = 28.0%, MSM= 17.8%, Unkn.= 16.6 %
LV Hetero=38.0 %, IDU=21.3%, MSM=8.1 (in 2014) EE Hetero=46%, IDU=23%, MSM=1%
HBV LT Unknown=84.4 %, Hetero= 9.4 %, IDU= 6.3 % (new acute HBV cases, 2015)
LV IDU=33.3% , Sexual transmission (not specified)=22.7% (2012, ECDC)
EE Hetero=11% , IDU=11%, Needlestick exposure=11%, Unknown=55% (2012, ECDC)
HCV LT Unknown =95.7 %, IDU = 4.3 % (new acute HCV cases, 2015) LV IDU=29%, Sexual transmission (not specified)=25%,
Nosocomial= 22% (2012, ECDC) EE IDU=21%, Hetero=13% (2012, ECDC)
Baltic Countries
2st Central Eastern European Meeting on Viral Hepatitis and Co-Infection with HIV
Antiviral Treatment Currently Available
HIV LT ALL New HIV treated cases: 59 (42.1%) cases 2NATI+1NNATI; 80 (57.1) cases 2NATI+2PI, 1 (0.7) cases 3NATI
LV All
EE All
LV 3TC, alpha Interferon
EE
HCV LT PegIFN alfa 2a ir alfa 2b, RVB, TEL, BOC, Viekirax (ambitasvir+Paritaprevir+Ritonavir)+Exviera(Sasabuvir)
LV Peg, Riba
Baltic Countries
2st Central Eastern European Meeting on Viral Hepatitis and Co-Infection with HIV
Percent of Patients on HAART
Percent of patient
Number Dying of AIDS
LT 566 (N at the end of 2015) No data available 7 (2015)
LV ~17% No data available 106 (2014) EE Out of 8993 diganosed
with HIV, 2998 were on HAART (31.12.2014)
No data available 47 (2013)
HIV. Baltic Countries
2014 – 128 40.6% - IDUs
Total on ART 491
New HIV cases diagnosed:
2012 – 94 55.3% - IDUs
Total on ART 291
– 160
Total on ART 583 – 75 (15 –death, 60 – other reasons)
– 157
Source:
Prof. Saulius aplinskas, MD, PhD
For 1 new ART patient there are– 1 plus… newly diagnosed infections
2st Central Eastern European Meeting on Viral Hepatitis and Co-Infection with HIV
Percent of Patients on Therapy
Of Those Treated
Percent of Patients
LT 200 patients/year (1%)
caused fibrosis and cirrhosis of
liver
HBV. Baltic Countries
Neonatal vaccination of hepatitis B vaccine trends in Lithuania 2002-2013 m.
Metai Asmen sk. Paskiepytj sk. Nepaskiepytj sk. Skiepijim apimtys 2002 27267 27158 109 99,6 2003 27459 27294 165 99,4 2004 27211 26803 408 98,5 2005 26299 26036 263 99 2006 26570 26411 159 99,4 2007 26724 26457 267 99 2008 29407 29142 265 99,1 2009 29506 29211 295 99 2010 29461 28960 501 98,3 2011 29990 28707 1283 95,7 2012 29381 27396 1985 93,2 2013 25899 25311 588 97,7
Not vaccinated newborns – 6 288
N au
ja gi
m ia
Metai
2st Central Eastern European Meeting on Viral Hepatitis and Co-Infection with HIV
Percent of Patients Received Therapy
Of Those Treated
Source
300–350 patients
463 patients were died in 2014 caused fibrosis and cirrhosis
of liver
LV, EE No data
Rates of all reported HBV cases in Baltic countries, 2006-2012
Dianummer 6
Dianummer 8
Dianummer 9
Dianummer 11
HIV incidence in Lithuania, Latvia, Estonia, 2011-2014 m.(new cases per 100 000 population)
Dianummer 13
Dianummer 15
Dianummer 16
Dianummer 17
Dianummer 18
Dianummer 19
Dianummer 20
Dianummer 21
Neonatal vaccination of hepatitis B vaccine trends in Lithuania 2002-2013 m.
Dianummer 23