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josip begovac -  treatment and care in croatia
 

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6th Regional Conference in Sarajevo, May 17-18 2012.

6th Regional Conference in Sarajevo, May 17-18 2012.

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    josip begovac -  treatment and care in croatia josip begovac - treatment and care in croatia Presentation Transcript

    • Treatment and care of HIV+ patients in Croatia Sarajevo, 2012.UNIVERSITY HOSPITAL FOR INFECTIOUS DISEASES, UNIVERSITY OF ZAGREB MEDICAL SCHOOL, ZAGREB, CROATIA
    • Outline Epidemiology New data on HIV prevalence among MSM Organization of care Data on patients and different outcomes of care
    • HIV infection, AIDS and deaths in Croatia in the period 1985-2011 (n=943)Total= 943; AIDS=349; Deaths:179
    • HIV/AIDS cases according to gender and risk groups Source: Croatian HIV/AIDS register
    • Prevalence of HIV and sexuallytransmitted infections and patterns of recent HIV testing among men whohave sex with men in Zagreb, Croatia Bozicevic et al STI (in press)
    • 40.0 37.835.030.025.0 20.420.0 14.2 13.215.0 11.2 9.4 10.6 9.2 9.010.0 6.9 7.6 7.2 5.9 4.5 5.0 2.8 3.0 2.7 0.80.9 0.6 0.0 2011 2006
    • 90.080.070.060.050.040.030.020.0 201110.0 0.0 2006
    • Interpretation No increase in prevalence of HIV and STIs  There were differences in samples in 2011 there were more highly educated individuals and more with better income  Younger MSM mainly surveyed  Lower prevalence of gonorrhea might be due to fewer false positive results (different methods used)
    • Chalenges How to increase the rate of HIV testing in MSM?  In the past 12 months 32.7% MSM had an HIV test compared to 50.8% in London, 61.0% in USA, 38.0% in Slovenia Move to community based testing? Screening and treatment of STI in MSM
    • HIV/AIDS care in Croatia• Croatia has a centralized system of care, allHIV/AIDS patients are treated at the UniversityHospital for Infectious Diseases in Zagreb.• Patients do not need referral from primary carephysicians.• Monitoring tools such as CD4 cell counts, viralload measurements, resistance testing and HLAB57 testing are available.• Croatian treatment guidelines are regularlyupdated.
    • Provision of ARV• ARV drugs are given from the hospital pharmacy.• ARV are free of charge for all Croatian citizens with Health Care Insurance since April 1998.• Fewer antiretrovirals are available in Croatia compared to EU countries.
    • HIV care in 2011, Croatia 647 patients enrlolled in care  Males 85%  8 children 623 treated with ART Survival after 12 months of ART (for patients starting therapy in 2010) 96%
    • Virological outcome of ART in Croatia 1998-2007 1Less than 400 copies of HIV1 RNA per ml 0.9 0.8 0.7 0.6 0.5 1998 to 2002 0.4 2003 to 2007 0.3 0.2 0.1 0 0 1 3 6 9 12 15 18 24 Time (months)
    • Percentage of patients with < 50 or < 400 copies of HIV1 RNA at last measurment in a calendar year858075 VL < 40070 VL < 506560 2007 2008 2009 2010 2011 Included are also patients who did not receive ART
    • Percentage of patients with a CD4 cell count >350 or >500 at last measurment iin a calendar year 0.9 0.8 0.7 0.6 0.5 CD4 > 350 0.4 CD4 > 500 0.3 0.2 0.1 0 2007 2008 2009 2010 2011 Included are also patients who did not receive ART
    • The problem of late presentation to care, Croatia 2007-2011
    • Integration into HIV care: Time of first CD4 count within one months of HIV-diagnosis Croatia 2007-20111.00 0.94 0.88 0.860.90 0.830.80 0.750.700.600.500.400.300.200.100.00 2007 2008 2009 2010 2011
    • Antiretrovirals available in Croatia in 2012. (in red) Fusion NRTI NNRTI PI II ENF ZDV NVP SQV Raltegravir ddI EFV r anti CCR5 d4T ETV IDV Maraviroc 3TC/FTC RPV NFV ABC LPV/r TDF fAPV ATAZDV/3TC; ZDV/3TC/ABC; TPV3TC/ABC; TDF/FTC DRVTDF/FTC/EFV TDF/FTC/RPV
    • Antiretroviral treatment in CroatiaAntiretroviral combinations given to patient in Croatia in 2008 (Nov), 2009 (Nov), 2010 (Nov) and 2011 (Nov)350 308300 259250 236 217200 193197 2008 177 2009 154 2010150 201110050 40 32 10 9 9 6 4 9 2 2 0 1 0 NNRTI PI NNRT+PI 3NRTI RAL-based
    • Antiretrovral treatment in Croatia NRTI combinations given to patient in Croatia in 2008 (Nov), 2009 (Nov), 2010 (Nov) and 2011 (Nov)350300 290250 240 201 197200 2008 178 2009 154 151 2010150 2011 104100 7150 30 24 30 24 23 22 23 28 12 8 11 14 15 14 2 0 ZDV+3TC D4T+3TC 3TC+ABC DDI+3TC TDF+FTC other/none
    • THANK YOU!