Resolving dilemma whether the rise in the number of HIV diagnoses represents an actual increase in HIV transmissions or is a result of improved HIV surveillance is crucial before implementing national HIV prevention strategies. Annual proportions of recent infections (RI) among newly diagnosed persons infected with HIV-1 in Slovenia during 27 years (1986-2012) were determined using an algorithm consisting of routine baseline CD4 and HIV viral load measurements and the Aware BED EIA HIV-1 Incidence Test (BED test). The study included the highest coverage of persons diagnosed with HIV during the entire duration of an HIV epidemic in a given country/region (71%). Out of 416 patients, 170 (40.9%) had a baseline CD4 cell count less than 200 cells/mm(3) and/or HIV-1 viral load less than 400 copies/ml and were characterized as having a long-standing infection (LSI). The remaining 246 patients were additionally tested using the BED test. Overall, 23% (97/416) of the patients were labeled RI. The characteristics significantly associated with RI were as follows: younger age, acute retroviral syndrome, CDC class A and other than C, no AIDS defining illnesses, HIV test performed in the past, a higher viral load, and a higher CD4 cell count. An interesting trend in the proportion of RI was observed, with a peak in 2005 (47% of RI) and the lowest point in 2008 (12%) in parallel with a rise in the numbers of new HIV diagnoses. This study could help promote the idea of introducing periodic HIV incidence monitoring using a simple and affordable algorithm.
Background: Globally, 10 million injecting drug users (IDUs) are estimated to be HCV-positive, resulting in a prevalence of 67%. We evaluated the previously unassessed HCV infection amongst IDUs in Kosovo. We determined the distribution of HCV genotypes among IDUs in Prishtina, ascertained their phylogenetic relatedness, and investigated the main risk factors associated with the HCV infection. Methods: Samples were obtained from 205 IDUs in Prishtina, Kosovo, during the Biological and Behavioral Surveillance Study (BioBSS). HCV-positive samples were further genotyped and sequenced. The results were linked with epidemiological data obtained in interviews determining the underlying causes of HCV transmission. Results: The majority of the 205 IDUs participating in the BioBSS were men (89.3%) with a mean age of 36 years and a history of imprisonment, unemployment, and over a decade of injection drug use. Forty-eight percent of the IDUs were positive for anti-HCV antibodies, and HCV RNA was detected in 70 IDUs (70.7% of the anti-HCV positive IDUs). The following HCV subtypes were detected: subtype 1a (64.3%), subtype 3a (34.3%), and subtype 2k (1.4%). Phylogenetic clustering was evident among 66.7% of the HCV subtype 1a samples and 71.4% of the subtype 3a samples. Significant independent predictors for anti-HCV positivity among IDUs were older age, longer duration of drug use, low education level, drug injection in "shooting galleries", and imprisonment. Conclusions: In Prishtina, Kosovo, nearly half of the IDUs were determined to be anti-HCV positive and the majority had an active infection. HCV subtype 1a was found to be most prevalent, followed by subtype 3a. Our results emphasize the urgent need for the implementation of harm-reduction programs among IDUs in Kosovo, specifically treatment and prevention through needle/syringe exchange programs directed at gathering places, such as shooting galleries.
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