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29 Nov 2016

#HIV/AIDS #surveillance in #Europe 2015 (@ECDC_EU, overview)

 

Title: #HIV/AIDS #surveillance in #Europe 2015.

Subject: Human Immunodeficiency Virus and AIDS, epidemiological situation in Europe, 2015.

Source: European Centre for Disease Control and Prevention (ECDC), full PDF file: (LINK). Overview.

Code: [     ]

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HIV/AIDS surveillance in Europe 2015

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Suggested citation for full report: European Centre for Disease Prevention and Control/ WHO Regional Office for Europe. HIV/AIDS surveillance in Europe 2015. Stockholm: ECDC; 2016. Tables and figures should be referenced: European Centre for Disease Prevention and Control, WHO Regional Office for Europe. HIV/AIDS surveillance in Europe 2015.

This publication follows the ECDC terminological practice, which reflects the European Union Interinstitutional Style Guide with regard to names and designations of countries. The names and designations of countries used in this publication should not be understood as an endorsement by WHO of the terminology used in this publication. ECDC amended the maps supplied by the WHO Regional Office for Europe for this publication.

The designations employed and the presentation of this material do not imply the expression of any opinion whatsoever on the part of the Secretariat of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers and boundaries. The WHO Regional Office for Europe is responsible for the accuracy of the translation of the Russian summary.

© World Health Organization, 2016.

Keywords ACQUIRED IMMUNODEFICIENCY SYNDROME – EPIDEMIOLOGY AIDS AND ITS CONTROL DISEASE OUTBREAKS – STATISTICS HIV INFECTIONS – EPIDEMIOLOGY POPULATION SURVEILLANCE

The report was coordinated by

  • Anastasia Pharris (ECDC),
  • Annemarie Stengaard and Andrei Dadu (WHO Regional Office for Europe).

Report review and production support were provided by Andrew J. Amato-Gauci, Julien Beauté, Mike Catchpole, Denis Coulombier, Masoud Dara, Martin Donoghoe, Nedret Emiroglu, Shahin Khasiyev, Valentina Lazdina, Marc Rondy, Chantal Quinten and Phillip Zucs.

The European Centre for Disease Prevention and Control (ECDC) and the WHO Regional Office for Europe would like to thank the nominated national operational contact points for HIV/AIDS surveillance from EU/EEA Member States and the national HIV/AIDS surveillance focal points from other countries of the WHO European Region for providing data and valuable comments on this report:

  • Albania: Marjeta Dervishi;
  • Andorra: Jennifer Fernández Garcia;
  • Armenia: Trdat Grigoryan;
  • Austria: Daniela Schmid;
  • Azerbaijan: Farhad Singatulov, Shahin Khasiyev;
  • Belarus: Svetlana Sergeenko, Pavel Yurovski;
  • Belgium: Andre Sasse, Dominique Van Beckhoven;
  • Bosnia and Herzegovina: Serifa Godinjak;
  • Bulgaria: Tonka Varleva;
  • Croatia: Tatjana Nemeth Blazic;
  • Cyprus: Linos Hadjihannas, Maria Koliou;
  • Czech Republic: Marek Maly;
  • Denmark: Susan Cowan;
  • Estonia: Kristi Rüütel;
  • Finland: Kirsi Liitsola, Mika Salminen;
  • the former Yugoslav Republic of Macedonia: Zarko Karadzovski, Zvonko Milenkovic, Katerina Spasovska;
  • France: Françoise Cazein, Josiane Pillonel, Florence Lot;
  • Georgia: Otar Chokoshvili, Maia Tsereteli;
  • Germany: Barbara Gunsenheimer-Bartmeyer;
  • Greece: Georgios Nikolopoulos, Dimitra Paraskeva;
  • Hungary: Maria Dudas;
  • Iceland: Haraldur Briem, Gudrun Sigmundsdottir;
  • Ireland: Derval Igoe, Kate O’Donnell, Darina O’Flanagan;
  • Israel: Daniel Chemtob, Yana Roshal;
  • Italy: Barbara Suligoi;
  • Kazakhstan: Lolita Ganina, Gulnar Temirkhanov;
  • Kyrgyzstan: Aigul Solpueva;
  • Latvia: Šarlote Konova;
  • Liechtenstein: Sabine Erne;
  • Lithuania: Irma Čaplinskienė;
  • Luxembourg: Aurelie Fischer Jean-Claude Schmit;
  • Malta: Jackie Maistre Melillo, Tanya Melillo;
  • Moldova: Silvia Stratulat, Stepan Gheorghita, Lucia Pirtina;
  • Monaco: Dominique De Furst;
  • Montenegro: Boban Mugosa, Alma Cicic;
  • Netherlands: Eline Op de Coul;
  • Norway: Hans Blystad;
  • Poland: Magdalena Rosinska;
  • Portugal: Kamal Mansinho, Helena Cortes Martins;
  • Romania: Mariana Mardarescu;
  • Russia: Natalia Ladnaia;
  • San Marino: Andrea Gualtieri, Mauro Fiorini;
  • Serbia: Danijela Simic;
  • Kosovo: Luljeta Gashi;
  • Slovakia: Peter Truska;
  • Slovenia: Irena Klavs;
  • Spain: Asuncion Diaz;
  • Sweden: Maria Axelsson;
  • Switzerland: Martin Gebhardt;
  • Tajikistan: Zukhra Nurlaminova;
  • Turkey: Emel Özdemir Şahin;
  • Ukraine: Ihor Kuzin, Violetta Martsynovska;
  • United Kingdom: Valerie Delpech;
  • Uzbekistan: Vokhid Nurmatov.

ISBN 978-92-9498-023-6 / ISSN 2363-3085 / doi 10.2900/348956 / Catalogue number TQ-AL-16-001-EN-N

© European Centre for Disease Prevention and Control, 2016.

Reproduction is authorised, provided the source is acknowledged.

 

Overview of HIV and AIDS in Europe

Although HIV is preventable through effective public health measures, significant HIV transmission continues in Europe. In 2015, 153,407 people were newly diagnosed with HIV in 50 of the 53 countries in the WHO European Region1 which corresponds to a rate of 17.6 newly diagnosed infections per 100000 population (Table  A).

Of those, 55230 were officially reported to the joint ECDC/ WHO Regional Office for Europe surveillance system by 49 countries, including 29747 from the European Union and European Economic Area (EU/EEA), while information about 98177 new diagnoses was published by the Russian Federal Scientific and Methodological Centre for Prevention and Control of AIDS [1]2 .

Among the 49 reporting countries3 the rate was 7.6 per 100000 population and 6.3 per 100000 for the EU/EEA (Figure A). As in recent years, rates and overall numbers of people diagnosed with HIV were highest in the East of the Region and lowest in the Centre4 (Table  A).

The main transmission mode varied by geographical area, illustrating the diversity in the epidemiology of HIV in Europe; sexual transmission between men was the most common mode in the EU/EEA and transmission through heterosexual contact and injecting drug use were the  main reported transmission modes in the East of the Region.

In 2015, 14579 people were diagnosed with AIDS in 47 countries5 of the WHO European Region and the rate of new diagnoses was 2.1 per 100000 population.

In the EU/EEA, 3754 people were diagnosed with AIDS in 2015, giving a rate of 0.8 per 100000 population (Table  15).

Although the number of AIDS cases has continued to decline steadily in the West and the EU/EEA, it has increased by 80% in the East during the last decade (Figures 1.12 and 2.5).

 

European Union and European Economic Area

In 2015, 29747 people were diagnosed with HIV in the 31 countries of the EU/EEA, with a rate of 6.3 per 100000 when adjusted for reporting delay (Table  1; Annex  6).

Countries with the highest rates of new HIV diagnoses reported in 2015 were Estonia (20.6; 270 cases), Latvia (19.8; 393 cases) and Malta (14.2; 61 cases).

The lowest rates were reported by Slovakia (1.6; 86 cases), Slovenia (2.3; 48 cases) and the Czech Republic (2.5; 266 cases).

The rate of new HIV diagnoses was higher among men (9.1 per 100000 population; Table  2), than women (2.6 per 100000 population; Table  3).

The overall male-tofemale ratio was 3.3 (Table  A). This ratio was highest in Croatia (18.5), the Czech Republic (13.8), and Cyprus (9.0) (Figure 1.1).

The predominant mode of transmission in these countries was sex between men (Figure 1.5). The highest crude age-specific rate of HIV diagnoses was observed among 25-to-29-year-olds (14.8 per 100000 population) with the rates for men and women peaking in this age group at 22.7 and 6.7 per 100000, respectively (Figure 1.2).

Similar to recent years, the highest proportion of HIV diagnoses was reported to be in men who have sex with men (MSM) (42%), with heterosexual contact the second most common transmission mode (32%).

Transmission due to injecting drug use accounted for 4% of HIV diagnoses, and for 20% of new HIV diagnoses the transmission mode was not reported or was reported to be unknown (Table  A).

More than one third (37%) of the total number of people diagnosed originated from outside of the reporting country (Figure 1.6), although this varied widely from over 70% of cases in Luxembourg and Sweden to less than 5% of cases in Croatia, Latvia, Lithuania, Poland, and Romania.

Despite continuing prevention efforts and resources allocated by countries in the EU/EEA, there has been only a minimal decline in the number of HIV diagnoses per 100000 population over the last decade, with a rate of 6.6 per 100000 in 2006 (29156 cases) compared with 6.3 per 100000 (32483 cases) in 2015 when adjusted for reporting delay (Table  1, Annex  6).

Trends by transmission mode show that the number of HIV diagnoses among MSM in countries with consistent reporting has continued to increase in the EU/EEA as a whole (Table 8; Figure 1.9), with sustained increases over the last decade reported in the majority of EU/EEA countries (Table  4).

Cases attributed to MSM increased over this period both among men born in the country of report and those born outside it (Figure 1.10).

The number of HIV diagnoses due to heterosexual transmission declined steadily during the last decade, with sharper decreases seen among people born outside of the country of report, particularly those coming from countries with generalised HIV epidemics (Table  8, Figures  1.9 and  1.10).

The number of people who acquired HIV through injecting drug use has decreased by 44% over the same period (Table 8). An overall increase among cases attributed to injecting drug use was observed in 2011 and 2012, due to localised outbreaks in Greece and Romania (Table 5), but cases reported in these countries during 2013–2015 show a downward trend.

Mother-to-child transmission and transmission through nosocomial infection or blood transfusion decreased steadily between 2006 and 2015 and these now represent less than 1% of cases diagnosed (Table 8).

In 2015, information on CD4 cell count at the time of HIV diagnosis was provided by 24 countries (Table  14) for 18103 (75%) people (>14 years old) diagnosed with HIV in the countries reporting on this variable (Table 14). Nearly half (47%) of all people diagnosed who had CD4 cell count information available had a reported CD4 cell count of less than 350 cells per mm3 at diagnosis, including 28% of cases with advanced HIV infection (CD4 <200 cells/mm3 ). Among all those diagnosed for whom CD4 cell count information was available, 20% had a CD4 cell count of between 350 and 500 cells per mm3 and 33% had a CD4 cell count above 500 per mm3 . When analysing CD4 cell count by transmission mode, the highest proportion of people presenting at a later stage of HIV infection (CD4 <350 cells/mm3 ) was observed among people who inject drugs (58%) and those acquiring HIV through heterosexual contact (57%) (Figure 1.7). The lowest proportion with a CD4 count below 350 cells per mm3 was observed among people who acquired HIV through sex between men (37%).

The proportion of cases diagnosed at or below 350 CD4 cells per mm3 increased with age, and 63% of persons aged 50 or older were diagnosed with HIV at or below 350 cells per mm3 .

Higher proportions of people from sub-Saharan Africa and south and south-east Asia (both 56%) had CD4 counts of below 350 cells per mm3 at diagnosis than non-migrants (47%) and other migrant groups (Figure 1.8).

In 2015, 3754 people were diagnosed with AIDS in 29 EU/EEA countries, which is a rate of 0.8 cases per 100000 population (Table  15). The highest rates were reported by Latvia (6.6) and Portugal (2.3).

In the EU/ EEA, the number of AIDS cases has consistently declined since the mid-1990s. Nineteen countries reported tuberculosis (TB) (pulmonary and/or extra-pulmonary) as an AIDS-defining illness in 16% of those newly diagnosed with AIDS in 2015, ranging from less than 5% (Hungary and Czech Republic) to more than 40% of cases (Latvia, Lithuania, Malta and Romania) (Figure 1.13).

(…)

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{1} No data available from Bosnia and Herzegovina, Turkmenistan or Uzbekistan. Liechtenstein is not a WHO Member State and hence their data are included in the totals for the EU/EEA but not for the WHO European Region.

{2} The cited data source from Russia allowed inclusion of Russian data within the other countries’ reported data for the overall number and rate of HIV diagnoses in the WHO European Region and the East of the Region to enable a more complete presentation of the epidemiology of HIV in Europe. All other regional figures presented in this report (including those by age, gender and transmission mode) are based on data from the 49 countries reporting to ECDC/ WHO.

{3} No data from Bosnia and Herzegovina, Russia, Turkmenistan or Uzbekistan.

{4} The grouping of countries into the West (23 countries), Centre (15 countries) and East (15 countries) of the WHO European Region is based on epidemiological considerations and follows the division of countries used in previous reports published by EuroHIV since 1984: See Annex 1, Figure A1 for details.

{5} No data available from Belgium, Bosnia and Herzegovina, Russia, Sweden, Turkmenistan or Uzbekistan.

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Keywords: ECDC; Updates; European Region; EU; HIV/AIDS.

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