HIV/Hepatitis co-infection situation in BALTIC COUNTRIESregist2.virology-education.com/presentations/3rdcee/05_caplinskas.p… · Viral Hepatitis and Co-infection with HIV. BALTIC

3rd Central and Eastern European Meeting on Viral Hepatitis and Co-infection with HIV

HIV/Hepatitis co-infectionsituation in BALTIC COUNTRIES

Prof. Dr. SAULIUS ČAPLINSKASDirector, Centre for Communicable Diseases and AIDS

Vilnius [email protected]

http://www.sauliuscaplinskas.lt/

Date from Latvia:Riga East University Hospital clinic “Infectology Centre of Latvia”

Inga Ažiņa, MD, Ph.D.Head of HIV/AIDS Out-patient DepartmentVelga Ķūse, MD, Deputy Chief PhysicianAnastasija Šangirejeva, MD, Head of HIV/AIDS In-patient DepartmentProf. Baiba Rozentāle, Chief doctor of “Infectology Centre of Latvia”

Date from Estonia:Kristi Rüütel, MD, PhD Scientific secretary/Senior researcher National Institute for Health Development, TallinnKerstin Kase Department of Infectious DiseasesWest Tallinn Central Hospital Tallinn

Date from Lithuania: andProf. Ligita Jančorienė, Vilnius University, Vilnius University Hospital Santaros klinikos, Centre of Infectious DiseasesVilnius Lithuania; [email protected]

mailto:[email protected]

BALTIC COUNTRIES

BALTIC COUNTRIES

HIVCumulative cases

diagnosed (end 2016)Prevalence per

100 000 population(in 2016)

Annual Incidence (in 2016)

Estonia 9 492 721.2 17.4Latvia 6 972 353.4 18.5

Lithuania 2 749 95.8 7.5


0.0

50.0

100.0

150.0

200.0

250.0

300.0

0.0

5.0

10.0

15.0

20.0

25.0

30.0

35.0

40.0

45.0

50.0

2000 2005 2010 2011 2012 2013 2014 2015 2016

Cum

ulat

ive

case

s per

100

000

per

pop

ulat

ion

New

ly d

iagn

osed

case

s per

100

000

pop

ulat

ion

Overview of new HIV and AIDS cases in the Baltic countries

Latvia new HIV cases Latvia new AIDS cases Estonia new HIV casesEstonia new AIDS cases Lithuania new HIV cases Lithuania new AIDS casesLatvia Cumulitive HIV cases Latvia Cumulitive AIDS cases Estonia Cumulitive HIV casesEstonia Cumulitive AIDS cases Lithuania Cumulitive HIV cases Lithuania Cumulitive AIDS cases

0.0

50.0

100.0

150.0

200.0

250.0

300.0

0.0

5.0

10.0

15.0

20.0

25.0

30.0

35.0

40.0

45.0

50.0

2000 2005 2010 2011 2012 2013 2014 2015 2016

Cum

ulat

ive

case

s per

100

000

per

pop

ulat

ion

New

ly d

iagn

osed

case

s per

100

000

pop

ulat

ion



N = 9 492

N = 6 972

N = 2 749

Cumulative cases of diagnosed HIV cases, end 2016

0.0

50.0

100.0

150.0

200.0

250.0

300.0

0.0

5.0

10.0

15.0

20.0

25.0

30.0

35.0

40.0

45.0

50.0

2000 2005 2010 2011 2012 2013 2014 2015 2016

Cum

ulat

ive

case

s per

100

000

per

pop

ulat

ion

New

ly d

iagn

osed

case

s per

100

000

pop

ulat

ion



721.2

353.4

95.8

2016 Prevalence per 100 000 population

0.0

50.0

100.0

150.0

200.0

250.0

300.0

0.0

5.0

10.0

15.0

20.0

25.0

30.0

35.0

40.0

45.0

50.0

2000 2005 2010 2011 2012 2013 2014 2015 2016

Cum

ulat

ive

case

s per

100

000

per

pop

ulat

ion

New

ly d

iagn

osed

case

s per

100

000

pop

ulat

ion



No data

6600 (5900-7400)

2900 (2700-3300)

UNAIDS 2016 estimated number (total)Coud be

around 7900

28.2

12.9

4.9

27.5

14.4

5.4

23.8

16.6

5.3

24.6

16.8

6.0

22.1

17.3

4.8

20.6 19.8

5.4

17.418.7

7.5

0.0

5.0

10.0

15.0

20.0

25.0

30.0

Estonia Latvia Lithuania2010 2011 2012 2013 2014 2015 2016

HIV incidence in Estonia, Latvia and Lithuania, 2010-2016(new cases per 100 000 population)

N=229N=365

N=214

Incidence of acute VHB and VHC in Lithuania, 1993-2016(cases per 100 00 population)

Prof. Saulius Čaplinskas, MD, PhD

Chart1

19931993

19941994

19951995

19961996

19971997

19981998

19991999

20002000

20012001

20022002

20032003

20042004

20052005

20062006

20072007

20082008

20092009

20102010

20112011

20122012

20132013

20142014

20152015

20162016

VHC

VHB

Year

Cases per 100 thousand population

0.89

12.6

1

13.9

2.48

14.2

2.72

13.9

3.02

11.6

3

12.6

3.24

10.1

2.84

9.4

5.36

10.9

3.67

7.8

2.8

5.05

2.41

5.42

1.98

4.1

1.82

3.14

1.36

2.48

1.28

2.67

1.4

1.74

1.2

2.1

1.3

1.8

1.3

0.8

2

1.3

1.2

0.9

0.79

1.1

0.56

1.1

Hepatitas B

2009 metai

gyventojų skaičius 2009 m.--3349,9

miestas:vyrai- 1020,1

moteris- 1220,4

kaimas:vyrai- 539,2

moteris- 570,2

199216.6

199312.6

199413.92 pav. Lietuvos gyventojų sergamumas ūminių virusinių hepatitų B 1992 - 2012 metais

199514.2

199613.9

199711.6

199812.6

199910.1

20009.4

200110.9

20027.8

20035.05

20045.42

20054.1

20063.14

20072.48

20082.67

20091.74

20102.1

20111.8

20120.8

1 pav. Lietuvos gyventojų sergamumas ūminių virusinių hepatitų B 2012 metais

viso: 229ūminis VHA42.8

HAV- 17 atv.ūminis VHB8.7

HBV- 60 atv.ūminis VHC15.2

HCV- 43 atv.nepatikslintas VH1.5

lėtinis VHB3.4

lėtinis VHC26.1

kitas patikslintas ŪVH (nei A nei B)1.9

ūminis VHB, nepatekės į 4 forma0.4

Vilniaus apskritis1.2

Kauno apskritis1.23 pav. Lietuvos gyventojų sergamumas ūminiu virusiniu hepatitu B apskrityse 2012 metais

Panevėžio apskritis0.4

Alytaus apskritis0.6

Šiaulių apskritis1

Lietuvoje0.8

Utenos apskritis0.7

Klaipėdos apskritis0

Tauragės apskritis0

Marijampolės apkritis0

Telšių apskritis0

4 pav. Lietuvos gyventojų sergamumas uminiu virusiniu hepatitu B pagal amžiaus grupes ir lytį 2012 metais

VyraiMoterys

0-1400

15-240.460

25-343.191.62

35-4420.93

45-540.451.23

55-641.290.5

65-741.850

75-8400

85+00

iš viso1.10.5

5 pav. Sergamumas ūminiu virusiniu hepatitu B pagal lytį Lietuvoje 1997 - 2012 metais

VyraiMoterys

199714.78.8

199817.58.8

199913.96.7

200012.36.7

200114.76.4

2002105.9

20036.83.5

20045.75.1

20054.63.6

20064.22.2

20072.732.27

20082.872.5

20092.181.34

20102.431.84

20112.391.38

20121.10.5

6 pav. Diagnozuoti susirgimai ūminio virusinio hepatito B pagal labiausiai tikėtina užsikrėtimo vietą / būdą Lietuvoje 2010 metais

Neišaiškintas45.1

Sveikatos priežiūros įstaigos15.5

Odontologinės procedūros5.6

Grožio paslaugos4.2

Lytinis4.2

Kitur15.5

Švirkščiamųjų narkotinių medžiagų vartojimas7.1

Medicinos darbuotojų mikrotraumos darbo metu2.8

7 pav. Bendras ir hospitalinių diagnozuotų susirgimų ūminiu virusiniu hepatitu B skaičius Lietuvoje 1995 - 2010 metais

Viso susirgimųHospitalinis HBV

1995528219

1996518228

1997432176

1998470140

1999375113

200034896

200138269

200227477

200317543

200418757

200514131

200610718

20078422

20089018

20095811

20107113

8 pav. Medicinos darbuotojų dalis tarp diagnozuotų hospitalinių susirgimu ūminiu virusiniu hepatitu B skaičiaus Lietuvoje 1995 - 2010 metais

Hospitalinis HBVTarp medicinos darbuotojų

199521919

199622823

199717615

199814017

199911317

20009610

20016915

2002779

2003436

2004579

2005317

2006182

2007221

2008183

2009112

2010172

9 pav. Medicinos darbuotojų sergamumas ūminiu virusiniu hepatitu B Lietuvoje 1995 - 2010metais

Viso susirgimųHospitalinis HBVTarp medicinos darbuotojų

199552821919

199651822823

199743217615

199847014017

199937511317

20003489610

20013826915

2002274779

2003175436

2004187579

2005141317

2006107182

200784221

200890183

200958112

201071212

10 pav. ŠVN vartojančių asmenų dalis tarp visų diagnozuotų ūminiu virusiniu hepatitu B susirgimų Lietuvoje 1995 - 2011 metais

Viso susirgimųŠvirkščiamąsias narkotines medžiagas vartojantys asmenys

1995528111

199651858

199743287

199847096

199937566

200034866

2001382162

200227472

200317538

200418729

200514125

200610716

20078411

2008908

2009581

2010714

2011608

2012232

11 pav. Teigiamas HBsAg tarp donorų Lietuvoje

Mokami donoraiNemokami donorai

20050.890.32

20060.70.87

20070.750.66

20081.50.6

20090.180.31

12 pav. Atliktų serologinių tyrimų skaičius dėl anti - CHV nešiojimo pagal apskritis 2009 metais

Rastas HBsAg(+)Iš viso tyrimų skaičius


Utenos apskritis33


Kauno apskritis9230

Telšių apskritis18479

Alytaus apskritis18815

Marijampolės apskritis3831

KAM padaliniai1955

Panevėžio apskritis118926

Šiaulių apskritis6512278

Vilniaus apskritis52447502

Viso Lietuvoje65472193

13 pav. Sergamumas ūminiu virusiniu hepatitu B kaimyninėse šalyse 2004 - 2008 metais

LietuvaLatvijaEstijaBaltarusijaDanija

20045.49.29.44.80.8

20054.17.375.83.90.5

20063.17.283.33.20.3

20072.57.23.32.90.44

20082.76.23.92.10.47

Ūminiu virusiniu hepatitu struktūra 2005 - 2009 metais Lietuvoje

HAVHBVHCVNediferencijoti

20052546236

20063437218

200711.843.123.621.5

200812.455.926.75

20098.9322633.1

Iš jų tarp medicinos darbuotojųIš jų hospitalinisKiti užsikrėtimo būdai

199519200309

199623205290

199715161256

199817123330

19991796262

20001086252

20011554313

2002968197

2003637132

2004948130

2005724110

200621689

200712162

200831572

20092947

201021171

užsikretimo vieta 2012 metais

Neišaiškintas47.8

Švirkščiamųjų narkotinių medžiagų vartojimas8.7

Heteroseksualus43.5

Lietuvos gyventojų sergamumas ūminiu hepatitu B pagal socialinė grupė 2012 metais

Bedarbis8.7

Darbininkas39

Pensininkas8.7

Tarnautojas4.4

Neįgalus4.4

Nenurodo34.8

Hepatitas B

metai

Atvejai - 100 000 gyv.

Hepatitas C

Vyrai

Moterys

Rodiklis 100 000 gyventojų

Chroniniai hepatitai B ir C

Viso susirgimų

Hospitalinis HBV

Susirgimų skaičius

Hospitalinis HBV

Tarp medicinos darbuotojų

Viso susirgimų

Hospitalinis HBV

Tarp medicinos darbuotojų


Viso susirgimų

Švirkščiamąsias narkotines medžiagas vartojantys asmenys


Mokami donorai

Nemokami donorai

Procentai

0,89℅

0,7℅

0,75℅

1,5℅

0,18℅

0,32℅

0,87℅

0,66℅

0,6℅

0,31℅

Lietuva

Latvija

Estija

Baltarusija

Danija

Metai


HAV

HBV

HCV

Nediferencijoti

Metai

Procentai

46

Iš jų tarp medicinos darbuotojų

Iš jų hospitalinis

Kiti užsikrėtimo būdai

Metai


Vyrai

Moterys


N = 71

45,1 %(32 atv.)

15,5 %(11 atv.)

5,6 %(4 atv.)

4,2 %(3 atv.)

4,2 %( 3 atv.)

15,5 % (11 atv.)

7,1% (5 atv.)

2,8% (2 atv.)

Viso: 264

42,8% (n=113)

8,7% (n=23)

15,2% (n=40)

1,5% (n=4)

3,4% (n=9)

26,1% (n=69)

1,9% (n=5)

0,4% (n=1)


1,2 (10 atv.)

1,2 (7 atv.)

0,4 (1 atv.)

0,6 (1 atv.)

1,0 (3 atv.)

0,8 (23 atv.)

0,7 (1 atv.)

0

0

N = 23

47,8%

8,7%

43,5%

N = 23

8,7% (2 atv.)

39% (9 atv.)

8,7% (2 atv.)

4,4% (1 atv.)

4,4% (1 atv.)

34,8% (8 atv.)

21,7% (13 atv.)

VHCVHB

19930.8912.6

1994113.9

19952.4814.2

19962.7213.9

19973.0211.6

1998312.6

19993.2410.1

20002.849.4

20015.3610.9

20023.677.8

20032.85.05

20042.415.42

20051.984.1

20061.823.14

20071.362.48

20081.282.67

20091.41.74

20101.22.1

20111.31.8

20121.30.8

201321.3

20141.20.9

20150.791.1

20160.561.1

VHB

BendrasVyrųMoterų

0-17 m.000

18-24 m.0.40.70

25-34 m.2.13.70.5

35-44 m.2.42.72.1

45-54 m.1.21.50.9

55-64 m.11.80.5

65+ m.0.90.51.1

VHC

BendrasVyrųMoterų

0-17 m.000

18-24 m.1.12.20

25-34 m.0.81.60

35-44 m.2.72.23.1

45-54 m.0.91.50.4

55-64 m.000

65+ m.0.52.20.3

VHC

VHB

Years

Cases per 100 thousand population

0-17 m.0-17 m.0-17 m.

18-24 m.18-24 m.18-24 m.

25-34 m.25-34 m.25-34 m.

35-44 m.35-44 m.35-44 m.

45-54 m.45-54 m.45-54 m.

55-64 m.55-64 m.55-64 m.

65+ m.65+ m.65+ m.

Bendras

Vyrų

Moterų

Rodiklis 100 tūkst. gyv.

0

0

0

1.1

2.2

0

0.8

1.6

0

2.7

2.2

3.1

0.9

1.5

0.4

0

0

0

0.5

2.2

0.3

0-17 m.0-17 m.0-17 m.

18-24 m.18-24 m.18-24 m.

25-34 m.25-34 m.25-34 m.

35-44 m.35-44 m.35-44 m.

45-54 m.45-54 m.45-54 m.

55-64 m.55-64 m.55-64 m.

65+ m.65+ m.65+ m.

Bendras

Vyrų

Moterų

Rodiklis 100 tūkst. gyv.

0

0

0

0.4

0.7

0

2.1

3.7

0.5

2.4

2.7

2.1

1.2

1.5

0.9

1

1.8

0.5

0.9

0.5

1.1

Lėtinis HCV 2012 metais

Pagal apskritis

Kauno apskritis6

Šiaulių apskritis6.07

Panevėžio apskriris2.02

Vilniaus apskritis0.74

Utenos apskritis2.68

Lietuvoje2.3

Marijampolės apskritis0


Alytaus apskritis0


Telšių apskritis0

pagal amžių ir lytį

VyraiMoterys

0-1400

15-242.341.96

25-345.852.7

35-446.021.87

45-545.511.64

55-642.590.5

65-741.851.12

75-8402.14

85+00

Iš viso:3.311.41

pagal socialinė grupė

Bedarbis29

Studentas1.5

Tarnautojas1.5

Darbininkas4.3

Pensininkas7.2

Neįgalus5.8

Vaiko auginimo atostogos1.5

Nenurodo49.2

pagal užsikrėtimo vieta

Švirkščiamųjų narkotinių medžagų vartojimas5.8

Nešaiškinta94.2


6 (36 atv.)

6,07 (18 atv.)

2,02 (5 atv.)

0,74 (6 atv.)

2,68 (4 atv.)

2,3 (69 atv.)

Vyrai

Moterys

Metai


= 76

N = 69

29% (20 atv.)

1,5% (1 atv.)

1,5% (1 atv.)

4,3% (3 atv.)

7,2% (5 atv.)

5,8% (4 atv.)

1,5% (1 atv.)

49,2% (34 atv.)

N = 69

5,8% (4 atv.)

94,2% (65 atv.)

BALTIC COUNTRIESHBV HCV

Prevalence Incidence Prevalence IcidenceEstonia Acute 0.6 Acute 1.1

Latvia 2,3 % HBsAg pos.*

Acute 4.3Chronic 18.0**

2% *(HCV RNS -1,7%anti-HCV-2,4%)

Lithuania Acute 1.12 Acute 0.56


*The Centre for Disease Prevention and Control of Latvia.The Prevalence of Viral Hepatitis C in Latvia: A Population-Based Study; medicina.lsmuni.lt/med/1110/1110-02e.pdf**The Centre for Disease Prevention and Control of Latvia. https://www.spkc.gov.lv/lv/statistika-un-petijumi/infekcijas-slimibas/epidemiologijas-bileteni1

https://www.spkc.gov.lv/lv/statistika-un-petijumi/infekcijas-slimibas/epidemiologijas-bileteni1

BALTIC COUNTRIESCo-infected HIV/HBV HIV/HCV

Prevalence Incidence Prevalence IncidenceEstonia High prevalence

among PWID Latvia About 634 cases * About 2435 cases *

Lithuania 5% ** 39% **


Source: * Infectology Centre of Latvia; ** Center For Communicable Diseases And AIDS (CCDA), 2016

** Among new HIV treated patients

HIV and hepatitis co-infection prevalence among PWID in Estonia in 2016

HCV Ab prevalence in different regions ranges from 61% to 90%; HBsAg prevalence from 4% to 22%

98% of those who were HIV-positive, were also HCV-Ab positive. Vice versa:

80% among those HCV-Ab positive, were also HIV positive.

So co-infection is very common (but it’s just HCV Ab positivity)

Data from Kristi Rüütel

HIV and hepatitis co-infection prevalence among sex workers in three regions in Estonia in 2016

22% were HCV-Ab positive

13% were HIV-positive Out of those who were HIV-positive, ¾ were also HCV-

positive

Data from Kristi Rüütel

HIV Prevalence of Different Subtype/Genotype in Country

Estonia

Latvia

Lithuania A = 25,29%, B = 31,03%, Other = 43,68% *


BALTIC COUNTRIES

Source: * National Public Health Surveillance Laboratory

Molecular epidemiology of HIV infection in Lithuania, 1990-2008


IVDUMSMHetero

AB

CRF03_ABOther

49%

27%

6%18%

95%

5%

82%

3% 14%

1%



IVDUMSMHetero

AB

CRF03_ABOther

49%

27%

6%18%

95%

5%

82%

3% 14%

1%

25.3

31.040.2

5.7

Prevalence of HIV-1 subtypes in Lithuania, 2016

mixes with B

Other (C, D, F, G, K and mixes with them)

All



IVDUMSMHetero

AB

CRF03_ABOther

49%

27%

6%18%

95%

5%

82%

3% 14%

1%

25.3

31.040.2

5.7

Prevalence of HIV-1 subtypes in Lithuania, 2016

mixes with B

Other (C, D, F, G, K and mixes with them)

All

30.2

24.836.4

5.418.5

42.847.1

3.3

Tested repeatedly Tested for the first time

HCV Prevalence of Different Subtype/Genotype in Country

Estonia

Latvia 1a = 7%, 1b = 72%, 1 unndifferentiated = 21%, 2 = 4%, 3 = 32%, 4 = 0,7%1= 63.8%, 2= 3.6%, 3= 31.9%, 4= 0.7%

Lithuania 1 = 65% (90 % 1b), 2 = 8,7% (80% 2a/c), 3 = 26,3% (80 % 3a)Liakina V, Valantinas J. Med Sci Monit, 2012 Mar:18(3):PH28-35


BALTIC COUNTRIES

HIV Main Risk factors for Transmission(among new diagnosed HIV cases in 2016)

Estonia IVDU = 14%, Hetero = 49%, MSM = 4%, UNK = 33% (in 2016)Proper transmission data for all routes only since 2010 **

Latvia IVDU = 17%, Hetero = 38%, MSM = 7%, UNK = 37%, MTCT = 1% (in 2016)IVDU = 44.6 %, Hetero = 35.6%, MSM = 18.4%, MTCT = 1.4% **

Lithuania IVDU = 39%, Hetero = 30%, MSM = 12%, UNK = 18%, MTCT = 0.5% (in 2016)IVDU = 60%, Hetero = 22%, MSM = 8%, UNK = 10%, MTCT = 0.2% **


BALTIC COUNTRIES

** Among all HIV cases (1988-2016)

Main risk factors for HIV transmission in 2016

0%

10%

20%

30%

40%

50%

60%

70%

IVDU Hetero MSM UNK MTCT

in Lithuania

-10%

0%

10%

20%

30%

40%

50%

60%

70%

IVDU Hetero MSM UNK MTCT

in Latvia

Chart1

IVDUIVDU

HeteroHetero

MSMMSM

UNKUNK

MTCTMTCT

Among new diagnosed HIV cases in 2016

Among all HIV cases (1988-2016)

0.39

0.6

0.3

0.22

0.12

0.08

0.18

0.1

0.005

0.002

Sheet1

Main Risk factors for Transmission, HIV

IVDUHeteroMSMUNKMTCT

Among new diagnosed HIV cases in 201639%30%12%18%0.5%

Among all HIV cases (1988-2016)60%22%8%10%0.2%

Sheet1

Among new diagnosed HIV cases in 2016

Among all HIV cases (1988-2016)

Main Risk factors for Transmission, HIV

Main Risk factors for HIV Transmission –among new cases in 2016 (%)

Chart1

EstoniaEstoniaEstoniaEstoniaEstonia

LatviaLatviaLatviaLatviaLatvia

LithuaniaLithuaniaLithuaniaLithuaniaLithuania

IVDU

Hetero

MSM

UNK

MTCT

14

49

4

33

17

38

7

37

1

39

30

12

18

0.5

Sheet1


Estonia1449433

Latvia17387371

Lithuania393012180.5

To resize chart data range, drag lower right corner of range.

Main Risk factors for HIV Transmission - among new cases in 2016 (%)

(Total 6)

(Total 72)

(Total 48)

Chart1

EstoniaEstoniaEstoniaEstoniaEstonia

LatviaLatviaLatviaLatviaLatvia

LithuaniaLithuaniaLithuaniaLithuaniaLithuania

IVDU

Hetero

MSM

UNK

MTCT

0 cases

6 cases

1 case

0.14

0.49

0.04

0.33

0.001

0.17

0.38

0.07

0.37

0.01

0.39

0.3

0.12

0.18

0.005

Sheet1


Estonia14%49%4%33%0%

Latvia17%38%7%37%1.0%

Lithuania39%30%12%18%0.5%


1989-1993MSM

1994-1996Hetero Sex

1997-2012IDUs

From 2013 SEX

Total No: 2744New HIV cases by transmission mode in Lithuania (%) 1988-2016

IDUs 59.9%

Chart1

19881988198819881988

19891989198919891989

19901990199019901990

19911991199119911991

19921992199219921992

19931993199319931993

19941994199419941994

19951995199519951995

19961996199619961996

19971997199719971997

19981998199819981998

19991999199919991999

20002000200020002000

20012001200120012001

20022002200220022002

20032003200320032003

20042004200420042004

20052005200520052005

20062006200620062006

20072007200720072007

20082008200820082008

20092009200920092009

20102010201020102010

20112011201120112011

20122012201220122012

20132013201320132013

20142014201420142014

20152015201520152015

20162016201620162016

Hetero

MSM

IVDU

UNK

MTCT

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

63

28

44

22

65

26

83

39

1

Sheet1

19881989199019911992199319941995199619971998199920002001200220032004200520062007200820092010201120122013201420152016

Hetero11127953546761324201527263628324850666365

MSM171421135899453439499791129112826

IVDU11423374649553798510185625942118107866362384483

UNK2716796121415181711383835242239

MTCT11121

30.4%

12.1%

38.8%

18.2 %

59.8%

HIV cases by mode of transmission in Lithuania


9.8%

21.8%

8.4%

0.2% 0.5%

1988 - 2016 2016

Chart1

Homo

Hetero

ŠNV

Nežin

Perinat

Viso nuo reg. Pradžios iki 2017 m.

230

599

1644

270

6

Sheet1

Viso nuo reg. Pradžios iki 2017 m.

Homo230

Hetero599

ŠNV1644

Nežin270

Perinat6


Chart1

MSM

Hetero

IVDU

UNK

MTCT

2016 metais

26

65

83

39

1

Sheet1

2016 metais

MSM26

Hetero65

IVDU83

UNK39

MTCT1


HBV Main Risk factors for Transmission

Estonia Hetero=11% , IVDU=11%, Needlestick exposure=11%, UNK=55% (2012, ECDC)Latvia IVDU=33.3% , Sex. (not specified)=22.7% (2012, ECDC)

Lithuania IVDU = 6,3%, Hetero = 15,6%, UNK = 75%, OTHER = 3% *UNK=84.4 %, Hetero= 9.4 %, IVDU= 6.3 % (new acute HBV cases, 2015)


BALTIC COUNTRIES

* Acute infection, Center For Communicable Diseases and AIDS (CCDA), 2016

HCV Main Risk factors for Transmission

Estonia IVDU=21%, Hetero=13% (2012, ECDC)

Latvia IVDU=29%, Sexual transmission (not specified)=25%, Nosocomial= 22% (2012, ECDC)

LithuaniaIVDU = 19%, UNK = 81% *

UNK =95.7 %, IVDU = 4.3 % (new acute HCV cases, 2015)


BALTIC COUNTRIES

* Acute infection, Center For Communicable Diseases and AIDS (CCDA), 2016

HIV Antiviral Treatment Currently Available

Estonia All

Latvia *1st line regimens: 2 NRTI + NNRTI ( ABC/3TC or TDF/FTC + EFV)2nd line : 2NRTI + II (ABC/3TC or FTC/TDF + RTG or DTG)

2 NRTI + PI/r ( ABC/3TC or FTC/TDF + DRV/c or ATV +RTV or LPV/r

Lithuania 1st line reg.: NNRTI – EFV1 (35 % all new HIV treated patients in 2016 ***)

PI/r-ALL (56,6 % all new HIV treated patients in 2016 **)


BALTIC COUNTRIES

Source: * Clinical guidlines for HIV diagnostics, Treatment and Prophylaxis ( Latvia, 2014).http://www.vmnvd.gov.lv/uploads/files/5322e63b987d4.pdf

***According MoH Order ; ** Center For Communicable Diseases And AIDS (CCDA), 2016

http://www.vmnvd.gov.lv/uploads/files/5322e63b987d4.pdf

ARV in Lithuania

Drugs No of patients %Abacavirum et Lamivudinum 545 79Lopinavirum et Ritonavirum 360 52Lopinavirum et Ritanovirum (child) 1Efavirenzum 289 42Zidovudinum et Lamivudinum 143 21Darunavir et Cobicistat 94 14Darunavir 89 13Ritonavir 86 12Raltegravirum 28 4Dolutegravirum 28 4

Total: 689

High % of ART being composed of abacavir, lopinavir/ritonavir and zidovudine

HBV Antiviral Treatment Currently Available

Estonia

Latvia TDF , 3TC, alpha Interferon

Lithuania Lamuvudin, PegIFN alfa 2a, Entecavir, Tenofovir*(*on the basis of individual request for Lithuanian Sick Funds)


BALTIC COUNTRIES

HCV Antiviral Treatment Currently Available

Estonia

Latvia

Acute: Interferonum alfaChronic: PegIFN alfa 2a and alfa 2b +/- RBV) till December 2016;Simeprevir (till December 2016);Viekirax (Ombitasvir/Paritaprevir/ritonavir) + Exviera (Dasabuvir);Zepatier (Grazoprevir/Elbasvir)

LithuaniaPegIFN alfa 2a and alfa 2b +/- RVB (GT1 – GT3; treatment naïve or experienced)Viekirax (Ombitasvir/Paritaprevir/ritonavir) + Exviera (Dasabuvir);Zepatier (Grazoprevir/Elbasvir) (GT1, treatment naïve or experienced, F-2 and more)


BALTIC COUNTRIES

Chronic hepatitis C treatment in Lithuania: 2015 - 2016 GT1 (≤F2) 24-48 week:•PEG-IFN alfa + RBV

GT1 (≥F3): 12 week:•Ombitasvir/Paritaprevir/Ritonavir + Dasabuvir (3D therapy)

GT2 24 week:•PEG-IFN alfa + RBV

GT3: 24 - 48 week. •PEG-IFN alfa + RBV

Chronic hepatitis C treatment in Lithuania from 2016-07-13

GT1 (≤F1) 24-48 week:•PEG-IFN alfa + RBVGT1 (≥F2): 12 week:•Ombitasvir/Paritaprevir/Ritonavir + Dasabuvir (3D therapy) Data from prof. Ligita Jančorienė

Chronic hepatitis C treatment in Lithuania from 2017-10-01

GT1 (≤F1) 24-48 week:• PEG-IFN alfa + RBVGT1b (≥F2): 8 -12 week:• Ombitasvir/Paritaprevir/Ritonavir + Dasabuvir

(3D therapy)GT1a (F2-F3): 12 week:

• Ombitasvir/Paritaprevir/Ritonavir + Dasabuvir(3D therapy) + RBV

GT1a (F4) 24 week:• Ombitasvir/Paritaprevir/Ritonavir + Dasabuvir

(3D therapy) + RBV

GT2 24 week:• PEG-IFN alfa + RBVGT3: 24 - 48 week.

• PEG-IFN alfa + RBV Data from prof. Ligita Jančorienė

GT1b (≥F2): 12 week:

•Grazoprevir/ElbasvirGT1a (≥F2): 12 week, if baseline HCV-RNA ≤ 800 000 IU/ml:•Grazoprevir/ElbasvirGT1a (≥F2): 16 week, if baseline HCV-RNA > 800 000 IU/ml: •Grazoprevir/Elbasvir

GT4 (≥F2): 12 week, if baseline HCV-RNA ≤ 800 000 IU/ml: •Grazoprevir/ElbasvirGT4 (≥F2): 16 week, if baseline HCV-RNA > 800 000 IU/ml:

•Grazoprevir/Elbasvir

HIV Percent of Patients on HAART

Percent of patient suppressed (

Continuum of HIV care – Lithuanian HIV cascade (up to 01/01/2016)

100%

81.7%

29.8%

………………………….

…………………….

UNAIDS target 90%

Regional average 90%

75%…………………………..………………………….

81.9%

…………………………………………………………

77%

88%

90%

90%

N = 3100 N = 2535 N = 2173 N = 647 N = 530

Chart1

PLHIV estimatedPLHIV estimatedPLHIV estimated

DiagnosedDiagnosedDiagnosed

Diagnosed aliveDiagnosed aliveDiagnosed alive

On ARTOn ARTOn ART

Viral suppressionViral suppressionViral suppression

Series 1

Column1

Column2

3100

2535

2173

647

530

Sheet1

Series 1Column1Column2

PLHIV estimated3100

Diagnosed2535

Diagnosed alive2173

On ART647

Viral suppression530


100%

81.7%

29.8%

………………………….

…………………….

UNAIDS target 90%


75%

81.9%

…………………………………………………………88%

90%

N = 3100 N = 2535 N = 2173 N = 647 N = 530

……………………………….N = 365

Chart1




On ARTOn ARTOn ART


Series 1

Column1

Column2

3100

2535

2173

647

530

Sheet1


PLHIV estimated3100

Diagnosed2535

Diagnosed alive2173

On ART647



100%

81.7%

29.8%

………………………….

…………………….

UNAIDS target 90%


75%…………………………..………………………….

81.9%

77%

90%

N = 3100 N = 2535 N = 2173 N = 647 N = 530

Chart1




On ARTOn ARTOn ART


Series 1

Column1

Column2

3100

2535

2173

647

530

Sheet1


PLHIV estimated3100

Diagnosed2535

Diagnosed alive2173

On ART647



100%

81.7%

29.8%

………………………….

…………………….

UNAIDS target 90%


75%…………………………..………………………….

81.9%

…………………………………………………………

77%

88%

90%

90%

N = 3100 N = 2535 N = 2173 N = 647 N = 530

Chart1




On ARTOn ARTOn ART


Series 1

Column1

Column2

3100

2535

2173

647

530

Sheet1


PLHIV estimated3100

Diagnosed2535

Diagnosed alive2173

On ART647


ART in LithuaniaYear ART start ART end of the

yearDiscontinued ART New HIV cases

total IDU% total IDU% Total IDU%2010 43 55.8 180 38.5 23 153 70.6

2011 66 48.5 226 38.5 19 - 7 M 11 N 1 Vt 166 54.2

2012 94 55.3 291 40.5 33 - 16 M 12 N 1 Vt 1 K 3 Sn 160 41.3

2013 147 42.9 407 39.8 54 - 14 M 29 N 5 Iš 2 K 1 Vt 1 Sn 2 Bpp 177 36.2

2014 128 40.6 491 37.1 63 - 21 M 34 N 4 Iš 4 K 141 26.9

2015 141 45.0 583 38.3 75 - 15 M 51 N 5 Iš 3 K 1 Sn 157 28.0

2016 174 37.9 751 39.9 103 – 30 M 61 N 9 Iš 1 Sn 1 Bpp 214 38.8

M – diedN – do not turn upVt – drug toxicityK – imprisoned

Sn – by own choiceIš – leftBpp – after finishing perinatal

prophylaxis

Reasons for discontinuation of ART :Every year, the number of individuals

receiving ART is increasing

The Estonian HIV Cohort Study: E-HIV

Source: Design and structure of the Estonian HIV Cohort Study (E-HIV) / Pilleriin Soodla , Heli Rajasaar , Radko Avi et al // Infectious Diseases, 2015; Early Online: 1–8.

Percent of Patients on Therapy

Of Those TreatedPercent of Patients

Suppressed

Number Dying of Cirrhosis/Hepatoma

HBV EstoniaLatvia ND ND ND

Lithuania No of patients 264 *HCV Estonia

Latvia 70% (874 patients started treatment in 2016) **

Lithuania No of patients 809 *


BALTIC COUNTRIES

Source: * National Health Insurance Fund under the Ministry of Health, 2016; **The Centre for Disease Prevention and Control of Latvia

Slide Number 1Slide Number 2Slide Number 3Slide Number 4Slide Number 5Slide Number 6Slide Number 7Slide Number 8Slide Number 9Slide Number 10Slide Number 11Incidence of acute VHB and VHC in Lithuania, 1993-2016�(cases per 100 00 population)Slide Number 13Slide Number 14HIV and hepatitis co-infection prevalence �among PWID in Estonia in 2016HIV and hepatitis co-infection prevalence �among sex workers in three regions in Estonia in 2016Slide Number 17Molecular epidemiology of HIV infection in Lithuania, 1990-2008Molecular epidemiology of HIV infection in Lithuania, 1990-2008Molecular epidemiology of HIV infection in Lithuania, 1990-2008Slide Number 21Slide Number 22Main risk factors for HIV transmission in 2016Main Risk factors for HIV Transmission – among new cases in 2016 (%)Main Risk factors for HIV Transmission - among new cases in 2016 (%)Slide Number 26Slide Number 27Slide Number 28Slide Number 29Slide Number 30ARV in LithuaniaSlide Number 32Slide Number 33Chronic hepatitis C treatment in Lithuania: 2015 - 2016 Chronic hepatitis C treatment in Lithuania from 2017-10-01 Slide Number 36Continuum of HIV care – Lithuanian HIV cascade �(up to 01/01/2016)Continuum of HIV care – Lithuanian HIV cascade �(up to 01/01/2016)Continuum of HIV care – Lithuanian HIV cascade �(up to 01/01/2016)Continuum of HIV care – Lithuanian HIV cascade �(up to 01/01/2016)Continuum of HIV care – Lithuanian HIV cascade �(up to 01/01/2016)Continuum of HIV care – Lithuanian HIV cascade �(up to 01/01/2016)Continuum of HIV care – Lithuanian HIV cascade �(up to 01/01/2016)Slide Number 44ART in LithuaniaSlide Number 46Slide Number 47Slide Number 48

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