Lali Sharvadze MD, PhDLali Sharvadze MD, PhDDirector of inpatient Department .Director of inpatient Department .

Associated Professor.Associated Professor.

Overview of HIV/AIDS and ARV Overview of HIV/AIDS and ARV

Treatment in GeorgiaTreatment in Georgia

2518251825182518

13691369 - AIDS- AIDS13691369 - AIDS- AIDS

Estimated number Estimated number 35 350000

538538 - - DeathsDeaths538538 - - DeathsDeaths

Reported Cases of HIV/AIDSReported Cases of HIV/AIDSin Georgiain Georgia

Women 665

Men 1853

05

101520253035404550

Distribution of HIV/AIDS PatientsDistribution of HIV/AIDS Patientsby Sex and Age Groupsby Sex and Age Groups

Age distribution

1 3 1 6 0 6 2 821 25 34

79 93 95100

163

242276

344351

385

261

254

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

Nu

mb

er

of

cas

es HIV Cases Registered in Georgia HIV Cases Registered in Georgia

AnnuallyAnnually

891Tbilisi

(55 Foreigners)

Samegrelo

369

Kvemo Kartli94

Kakheti102

Svaneti8

Abkhazia 168

Adjara322

Guria54

Imereti319

Mtianeti19

Shida Kartli66

Samtskhe Javakheti29

Lechkhumi

5

Poti39

Distribution of HIV/AIDS CasesDistribution of HIV/AIDS Casesby Regions of Georgiaby Regions of Georgia

(number of registered cases)(number of registered cases)

Incidence of AIDS Cases Incidence of AIDS Cases per 100 000 populationper 100 000 population(Source – WHO reports, 2007)(Source – WHO reports, 2007)

Incidence of AIDS Cases Incidence of AIDS Cases per 100 000 populationper 100 000 population(Source – WHO reports, 2007)(Source – WHO reports, 2007)

4.12

1.63

AIDS Incidence per 100 000 population

Georgia

EU

1.10%1.34%

0.67%

1.27%

0.04% 0.05%

0.36%

0

0.5

1

1.5

IDUs Prisoners TB Patients CSWs Militaries PregnantWomen

STI patients

HIV Prevalence among High Risk

Behavior Groups (2007)

HIV Prevalence among High Risk

Behavior Groups (2007)

HIV Prevalence in General Population - 0.13HIV Prevalence in General Population - 0.13

Undetermined

1.0%

Mother to child transmission

2.3%

Male-to-male sex

2.6%

Blood transfusion

0.6%

Heterosexual contacts

34.9%

Injecting drug use

58.6%

Distribution of HIV Cases by RoutesDistribution of HIV Cases by Routesof Transmissionof Transmission

AIDS Control Service in Georgia

Country Coordinating Mechanism (CCM)Country Coordinating Mechanism (CCM)

Infectious Diseases, AIDS & Clinical Immunology Research

Center

Infectious Diseases, AIDS & Clinical Immunology Research

Center

ZugdidiAIDS treatment center

BatumiAIDS treatment center

9 VCT centers in regions of Georgia9 VCT centers in regions of Georgia

217 HIV diagnostic labs

National Center of Disease Control and

Public Health

National Center of Disease Control and

Public Health

KutaisiAIDS treatment center

Universal Access to HIV Treatment, Universal Access to HIV Treatment, Care and Support and PreventionCare and Support and Prevention

Georgia is the First Among FSU Countries that from 2004

Ensured Universal (100%) Access to ARV Treatment.

Georgia is the First Among FSU Countries that from 2004

Ensured Universal (100%) Access to ARV Treatment.

What Does It Mean - The Universal What Does It Mean - The Universal (100%) Access to ARV Treatment (100%) Access to ARV Treatment

Georgian ApproachGeorgian Approach

Investigation of all HIV infected persons by special algorithm

Investigation of all HIV infected persons by special algorithm

To identify all patients requiring ARV treatment according to special criteriaTo identify all patients requiring ARV

treatment according to special criteria

To offer ARV therapy to all patients requiring treatment

To offer ARV therapy to all patients requiring treatment

Monitoring of all patients receiving ARV treatmentMonitoring of all patients receiving ARV treatment

RUSRUS**

ARM*ARM*

KAZ*KAZ*

KGZ*KGZ*UZB*UZB*

TKMTKM TJK*TJK*

AZE*AZE*

BEL*BEL*

UKRUKR**

no HAART individuals on HAART (<1%) * in the process of scaling up ART

very poor access ( 1-25%) poor access (25-50%) disputed coverage estimates or insufficient data available

moderate access (50-75%) good access (over 75%)

ALB* FYM*

Access to HAARTAccess to HAART

GEOGEO

according to WHO/UNAIDS/UNICEF report on universal access of 2008according to WHO/UNAIDS/UNICEF report on universal access of 2008

1984 – ELISA1984 – ELISA

19951995 – – Qualitative PCR (Polymerase Chain Reaction) 19951995 – – Qualitative PCR (Polymerase Chain Reaction)

19851985 – – Western blot19851985 – – Western blot

19841984 – – Immunophenotyping of CD3, CD4, CD8 lymphocytes19841984 – – Immunophenotyping of CD3, CD4, CD8 lymphocytes

19961996 – – Quantitative PCR (Polymerase Chain Reaction)19961996 – – Quantitative PCR (Polymerase Chain Reaction)

20032003 – – HIV and HCV Genotyping20032003 – – HIV and HCV Genotyping

20052005 – – HIV Genotypic Resistance Testing20052005 – – HIV Genotypic Resistance Testing

20062006 - - HIV subtype analysis using phylogenetic methods20062006 - - HIV subtype analysis using phylogenetic methods

20062006 – – HIV, HCV & HBV quantitative- Real time PCR 20062006 – – HIV, HCV & HBV quantitative- Real time PCR

20062006 – – CCR5, CCR2 and SDF1 genotyping testing20062006 – – CCR5, CCR2 and SDF1 genotyping testing

Implementation of Major Laboratory Methods Implementation of Major Laboratory Methods in Georgiain Georgia

Implementation of Major Laboratory Methods Implementation of Major Laboratory Methods in Georgiain Georgia

20092009 – – Abacavir hypersensitivity testing HLA-B*5701 SSP genotyping assay.20092009 – – Abacavir hypersensitivity testing HLA-B*5701 SSP genotyping assay.

ARV implemented in Georgia

NRTI • AZT • 3TC • D4T • DDI • Abacavir • Tenofovir • FTC • Téno/FTC Truvada®• ABC/3TC

NNRTI• Nevirapine Viramune®• Efavirenz Sustiva®*

Protease Inhibitors (PI)• Ritonavir Norvir®• Indinavir Crixivan®• Saquinavir Invirase®• Nelfinavir Viracept®• Lopinavir Kaletra ®• Atazanavir Reyataz®• Fosamprenavir Telzir ®• Tipranavir Aptivus®• Darunavir Prezista®

Entry inhibitorEnfuvirtide

Integrase inhibitorRaltegravir

ARV TreatmentARV Treatment

739 Patients are currently receiving ART739 Patients are currently receiving ART

710adults

710adults

29 children

29 children

National Guidelines CriteriaNational Guidelines Criteriafor Initiation of Antiretroviral Therapy for Initiation of Antiretroviral Therapy

Based on WHO and DHHS ART GuidelinesBased on WHO and DHHS ART Guidelines

• History of an AIDS-defining illness;

• CD4 T - cell count <350 cells/mm3;

• Patients with HIV-associated nephropathy;

• Patients co infected with HBV when treatment is indicated.

Georgian HIV/AIDS National Guidelinesupdated annually

Georgian HIV/AIDS National Guidelinesupdated annually

Infectious Diseases, AIDS and Clinical Immunology Research Center

Thank you for your Thank you for your attention!attention!

Thank you for your Thank you for your attention!attention!