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Eurosurveillance, Volume 7, Issue 31, 31 July 2003
Articles

Citation style for this article: Forde J. Rising reports of sexually acquired HIV infections in both western and eastern Europe. Euro Surveill. 2003;7(31):pii=2267. Available online: http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=2267

Rising reports of sexually acquired HIV infections in both western and eastern Europe

Josh Forde (josh.forde@hpa.org.uk), Health Protection Agency Communicable Disease Surveillance Centre, London, England.

The European Centre for the Epidemiological Monitoring of AIDS (EuroHIV, http://www.eurohiv.org) this month released the latest biannual report, HIV/AIDS Surveillance in Europe (http://www.eurohiv.org/AidsSurv/Rapport_68/rapport_68.pdf), presenting data on cases of newly diagnosed HIV infections and AIDS reported by the end of 2002. For the purposes of this report, Europe is divided into three regions: West (23 countries of western Europe, plus Israel), East (the 15 Newly Independent States of the former Soviet Union), and Centre (the 13 remaining countries of the World Health Organization European Region).

For the first time data are presented by country or subcontinent of patient origin. This variable is not yet fully standardised across the countries contributing to EuroHIV’s data, however. Table 9 on p.26 of the report shows information used in national surveillance to determine country or subcontinent of origin.

West
A cumulative total of 165 454 HIV infections have been reported. This is a considerable underestimate of the true number, as the three countries with the largest HIV/AIDS epidemic (France, Italy, and Spain) have not yet fully implemented national HIV reporting systems.

During 2002, 14 439 new diagnoses were reported, of which 44% were probably acquired heterosexually, 26% through sex between men (SBM) and 12% through injecting drug use (IDU). Thirty five per cent were female and 30% were aged less than thirty.

The number of new diagnoses during 2002 represented a 23% increase on the number newly diagnosed during 2001. This increase was due to sharp increases in the United Kingdom and Germany, with the former accounting for 42% of all HIV infections reported in the West during 2002. Both countries have seen rises in the numbers of diagnoses of infections acquired abroad heterosexually.

While most newly reported HIV infections in the West (France, Italy, and Spain excluded) are heterosexually acquired, Portugal’s epidemic remains IDU dominated, and in Germany, Greece, and the Netherlands, transmission through SBM predominates.

Data on patient origin are available for 11 countries. In these countries, origin was known for 50% of 12 538 individuals reported HIV positive in 2002. Thirty eight per cent of these were from sub-Saharan Africa. Among heterosexual cases, the proportion was 66%.

In 2002, 9757 cases of AIDS were diagnosed in the West. Thirty eight per cent of these individuals probably acquired HIV heterosexually, 29% through IDU and 21% through SBM. Twenty five per cent were female and 13% were under thirty years of age. Tuberculosis and Pneumocystis carinii pneumonia (PCP) were the most common AIDS indicator diseases.

After several years of decline following the introduction of combination antiretroviral treatment, AIDS incidence has now largely levelled off, and in some countries shows signs of increasing once more. AIDS related mortality, however, continues to decrease.

Centre
During 2002, 1427 HIV infections and 539 AIDS cases were diagnosed in the Centre, rates remaining low and relatively static. Excluding Romania, 26% of new HIV infections were female and 43% were in persons aged less than thirty.

Dominant modes of transmission included: nosocomial (health care acquired) (Romania), IDU (Poland, Yugoslavia), SBM (Bosnia and Herzegovina, the Czech Republic, Hungary, Slovakia, and Slovenia), and heterosexual (Bulgaria, Croatia, FYR Macedonia, and Turkey). Six countries collected information on patients’ country of origin. Where origin was known, it was outside the country of report for 21% of new HIV diagnoses.

Four diseases predominate at AIDS diagnosis in this region: HIV wasting syndrome, tuberculosis, PCP and oesophageal candidiasis.

East
A cumulative total of 300 184 HIV infections have been reported. As in the West and Centre, this number is an underestimate.

During 2002, 64 222 new HIV diagnoses were reported. Of these, 41% were IDU and 10% were heterosexual; while only 0.1% were SBM. For 43% the risk group was unknown. Thirty three per cent were female, and 77% were under thirty years of age. Seven countries provided information about origin. In these countries, 99% of new HIV diagnoses were in persons from the country of report.

After increasing steeply for several years, the number of new HIV diagnoses declined for the first time in 2002 by 36%. This decrease was due to a sharp decline in the number of IDU cases (-53%). By contrast, heterosexually acquired cases increased by 32% in 2002, and the number of reports of children born to HIV positive mothers doubled. The decline in HIV diagnoses in the East is probably due to the saturation of the IDU population (that is, most of those IDU who would be infected with HIV have already been infected)

AIDS is thought to be grossly underreported in several countries of the East. However, incidence, previously extremely low, has started to rise slowly. Seventy seven per cent of individuals newly diagnosed with AIDS were thought to have been infected through IDU and 20% heterosexually; while only 0.6% were thought to have been infected through SBM. A substantial proportion of cases presented with tuberculosis.

Other information
The report also contains information about total numbers of diagnostic HIV tests and the prevalence of HIV infection among sex workers.

Reference:
  1. European Centre for the Epidemiological Monitoring of AIDS. HIV/AIDS Surveillance in Europe. End-year report 2002. Saint-Maurice: Institut de Veille Sanitaire, 2003. No. 68. (http://www.eurohiv.org/AidsSurv/Rapport_68/rapport_68.pdf)

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