Transmission of HIV Drug Resistance and the Predicted Effect on Current First-line Regimens in Europe

Background. 

Numerous studies have shown that baseline drug resistance patterns may influence the outcome of antiretroviral therapy. Therefore, guidelines recommend drug resistance testing to guide the choice of initial regimen. In addition to optimizing individual patient management, these baseline resistance data enable transmitted drug resistance (TDR) to be surveyed for public health purposes. The SPREAD program systematically collects data to gain insight into TDR occurring in Europe since 2001.

Methods. 

Demographic, clinical, and virological data from 4140 antiretroviral-naive human immunodeficiency virus (HIV)–infected individuals from 26 countries who were newly diagnosed between 2008 and 2010 were analyzed. Evidence of TDR was defined using the WHO list for surveillance of drug resistance mutations. Prevalence of TDR was assessed over time by comparing the results to SPREAD data from 2002 to 2007. Baseline susceptibility to antiretroviral drugs was predicted using the Stanford HIVdb program version 7.0.

Results. 

The overall prevalence of TDR did not change significantly over time and was 8.3% (95% confidence interval, 7.2%–9.5%) in 2008–2010. The most frequent indicators of TDR were nucleoside reverse transcriptase inhibitor (NRTI) mutations (4.5%), followed by nonnucleoside reverse transcriptase inhibitor (NNRTI) mutations (2.9%) and protease inhibitor mutations (2.0%). Baseline mutations were most predictive of reduced susceptibility to initial NNRTI-based regimens: 4.5% and 6.5% of patient isolates were predicted to have resistance to regimens containing efavirenz or rilpivirine, respectively, independent of current NRTI backbones.

Conclusions. 

Although TDR was highest for NRTIs, the impact of baseline drug resistance patterns on susceptibility was largest for NNRTIs. The prevalence of TDR assessed by epidemiological surveys does not clearly indicate to what degree susceptibility to different drug classes is affected.

Below:  Overall weighted prevalence of transmitted drug resistance in patients with newly diagnosed human immunodeficiency virus (HIV) in Europe. The error bars indicate the standard error. Abbreviations: NNRTI, nonnucleoside reverse transcriptase inhibitor; NRTI, nucleoside reverse transcriptase inhibitor; PI, protease inhibitor; TDR, transmitted drug resistance.

Below:  Genotypic sensitivity scores (GSSs) of 8 recommended first-line regimens in patients in Europe newly diagnosed with human immunodeficiency virus in 2008–2010. Abbreviations: ATV, atazanavir; DRV, darunavir; EFV, efavirenz; KVX, Kivexa (abacavir + lamivudine); NNRTI, nonnucleoside reverse transcriptase inhibitor; PI, protease inhibitor; RPV, rilpivirine; TVD, Truvada (tenofovir +emtricitabine).

Full article at:   http://goo.gl/GF3BXW

By:  L. Marije Hofstra,^1,2 Nicolas Sauvageot,¹ Jan Albert,^3,4 Ivailo Alexiev,⁵ Federico Garcia,⁶ Daniel Struck,¹ David A. M. C. Van de Vijver,⁷ Birgitta Åsjö,⁸ Danail Beshkov,⁵ Suzie Coughlan,⁹ Diane Descamps,¹⁰ Algirdas Griskevicius,¹¹ Osamah Hamouda,¹² Andrzej Horban,¹³ Marjo Van Kasteren,¹⁴ Tatjana Kolupajeva,¹⁵ Leondios G. Kostrikis,¹⁶ Kirsi Liitsola,¹⁷Marek Linka,¹⁸ Orna Mor,¹⁹ Claus Nielsen,²⁰ Dan Otelea,²¹ Dimitrios Paraskevis,²² Roger Paredes,²³ Mario Poljak,²⁴Elisabeth Puchhammer-Stöckl,²⁵ Anders Sönnerborg,^3,4 Danica Staneková,²⁶ Maja Stanojevic,²⁷ Kristel Van Laethem,²⁸ Maurizio Zazzi,²⁹ Snjezana Zidovec Lepej,³⁰ Charles A. B. Boucher,⁷ Jean-Claude Schmit,¹ and Annemarie M. J. Wensing², for the SPREAD Program

¹Luxembourg, Institute of Health, Luxembourg

²Department of Virology, University Medical Center Utrecht, The Netherlands

³Karolinska Institute, Solna

⁴Karolinska University Hospital, Stockholm, Sweden

⁵National Center of Infectious and Parasitic Diseases, Sofia, Bulgaria

⁶Complejo Hospitalario Universitario de Granada, Instituto de Investigación IBS Granada; on behalf of Cohorte de Adultos de la Red de Investigación en SIDA, Spain

⁷Erasmus MC, University Medical Center, Rotterdam, The Netherlands

⁸University of Bergen, Norway

⁹University College Dublin, Ireland

¹⁰AP-HP Groupe hospitalier Bichat-Claude Bernard, IAME INSERM UMR 1137, Université Paris Diderot Sorbonne Paris Cité, Paris, France

¹¹Lithuanian AIDS Center, Vilnius, Lithuania

¹²Robert Koch Institute, Berlin, Germany

¹³Hospital of Infectious Diseases, Warsaw, Poland

¹⁴St Elisabeth Hospital, Tilburg, The Netherlands

¹⁵Infectiology Center of Latvia, Riga

¹⁶University of Cyprus, Nicosia

¹⁷Department of Infectious Diseases, National Institute for Health and Welfare, Helsinki, Finland

¹⁸National Reference Laboratory for HIV/AIDS, National Institute of Public Health, Prague, Czech Republic

¹⁹National HIV Reference Laboratory, Chaim Sheba Medical Center, Tel-Hashomer, Israel

²⁰Statens Serum Institut, Copenhagen, Denmark

²¹National Institute for Infectious Diseases “Prof. dr. Matei Bals”, Bucharest, Romania

²²National Retrovirus Reference Center, University of Athens, Greece

²³IrsiCaixa Foundation, Badalona, Spain

²⁴Faculty of Medicine, Slovenian HIV/AIDS Reference Centre, University of Ljubljana, Slovenia

²⁵Medical University Vienna, Austria

²⁶Slovak Medical University, Bratislava, Slovakia

²⁷Faculty of Medicine, University of Belgrade, Serbia

²⁸Rega Institute for Medical Research, KU Leuven, Belgium

²⁹University of Siena, Italy

³⁰University Hospital for Infectious Diseases “Dr. Fran Mihaljevic”, Zagreb, Croatia

¹Luxembourg, Institute of Health, Luxembourg

²Department of Virology, University Medical Center Utrecht, The Netherlands

³Karolinska Institute, Solna

⁴Karolinska University Hospital, Stockholm, Sweden

⁵National Center of Infectious and Parasitic Diseases, Sofia, Bulgaria

6Complejo Hospitalario Universitario de Granada, Instituto de Investigación IBS Granada; on behalf of Cohorte de Adultos de la Red de Investigación en SIDA, Spain

⁷Erasmus MC, University Medical Center, Rotterdam, The Netherlands

⁸University of Bergen, Norway

⁹University College Dublin, Ireland

¹⁰AP-HP Groupe hospitalier Bichat-Claude Bernard, IAME INSERM UMR 1137, Université Paris Diderot Sorbonne Paris Cité, Paris, France

¹¹Lithuanian AIDS Center, Vilnius, Lithuania

¹²Robert Koch Institute, Berlin, Germany

¹³Hospital of Infectious Diseases, Warsaw, Poland

¹⁴St Elisabeth Hospital, Tilburg, The Netherlands

¹⁵Infectiology Center of Latvia, Riga

¹⁶University of Cyprus, Nicosia

¹⁷Department of Infectious Diseases, National Institute for Health and Welfare, Helsinki, Finland

18National Reference Laboratory for HIV/AIDS, National Institute of Public Health, Prague, Czech Republic

¹⁹National HIV Reference Laboratory, Chaim Sheba Medical Center, Tel-Hashomer, Israel

²⁰Statens Serum Institut, Copenhagen, Denmark

²¹National Institute for Infectious Diseases “Prof. dr. Matei Bals”, Bucharest, Romania

²²National Retrovirus Reference Center, University of Athens, Greece

²³IrsiCaixa Foundation, Badalona, Spain

²⁴Faculty of Medicine, Slovenian HIV/AIDS Reference Centre, University of Ljubljana, Slovenia

²⁵Medical University Vienna, Austria

²⁶Slovak Medical University, Bratislava, Slovakia

²⁷Faculty of Medicine, University of Belgrade, Serbia

²⁸Rega Institute for Medical Research, KU Leuven, Belgium

²⁹University of Siena, Italy

³⁰University Hospital for Infectious Diseases “Dr. Fran Mihaljevic”, Zagreb, Croatia

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Evaluation of Holistic Sexuality Education: A European Expert Group Consensus Agreement

Objectives 

Holistic sexuality education (HSE) is a new concept in sexuality education (SE). Since it differs from other types of SE in a number of important respects, strategies developed for the evaluation of the latter are not necessarily applicable to HSE. In this paper the authors provide a basis for discussion on how to evaluate HSE. 

Methods 

First, the international literature on evaluation of SE in general was reviewed in terms of its applicability to HSE. Second, the European Expert Group on Sexuality Education extensively discussed the requirements of its evaluation and suggested appropriate indicators and methods for evaluating HSE. 

Results 

The European experience in SE is scarcely represented in the general evaluation literature. The majority of the literature focuses on impact and neglects programme and implementation evaluations. Furthermore, the current literature demonstrates that evaluation criteria predominantly focus on the public health impact, while there is not yet a consensus on sexual well-being criteria and aspects of positive sexuality, which are crucial parts of HSE. Finally, experimental designs are still considered the gold standard, yet several of the conditions for their use are not fulfilled in HSE. Realising that a new evaluation framework for HSE is needed, the European expert group initiated its development and agreed upon a number of indicators that provide a starting point for further discussion. 

Conclusions 

Aside from the health impact, the quality of SE programmes and their implementation also deserve attention and should be evaluated. To be applicable to HSE, the evaluation criteria need to cover more than the typical public health aspects. Since they do not register long-term and multi-component characteristics, evaluation methods such as randomised controlled trials are not sufficiently suitable for HSE. The evaluation design should rely on a number of different information sources from mixed methods that are complemented and triangulated to build a plausible case for the effectiveness of SE in general and HSE in particular.

Purchase full article at:   http://goo.gl/RYgbAv

By:  Ketting E1, Friele M2, Michielsen K3; European Expert Group on Sexuality Education.

• 1 * University Medical Centre, Radboud University , Nijmegen , the Netherlands.
• 2 Federal Centre for Health Education (BZgA) , Cologne , Germany.
• 3 International Centre for Reproductive Health, Ghent University , Ghent , Belgium.
• Eur J Contracept Reprod Health Care. 2016 Feb;21(1):68-80. doi: 10.3109/13625187.2015.1050715. Epub 2015 May 29. 

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What The Eye Does Not See: A Critical Interpretive Synthesis of European Union Policies Addressing Sexual Violence in Vulnerable Migrants

Abstract

In Europe, refugees, asylum seekers and undocumented migrants are more vulnerable to sexual victimisation than European citizens. They face more challenges when seeking care. This literature review examines how legal and policy frameworks at national, European and international levels condition the prevention of and response to sexual violence affecting these vulnerable migrant communities living in the European Union (EU). 

Applying the Critical Interpretive Synthesis method, we reviewed 187 legal and policy documents and 80 peer-reviewed articles on migrant sexual health for elements on sexual violence and further analysed the 37 legal and 12 peer-reviewed articles among them that specifically focused on sexual violence in vulnerable migrants in the EU-27 States. 

Legal and policy documents dealing with sexual violence, particularly but not exclusively in vulnerable migrants, apply ‘tunnel vision’. They ignore: 

1. frequently occurring types of sexual violence, 
2. victimisation rates across genders and 
3. specific risk factors within the EU such as migrants’ legal status, gender orientation and living conditions. 

The current EU policy-making paradigm relegates sexual violence in vulnerable migrants as an ‘outsider’ and ‘female only’ issue while EU migration and asylum policies reinforce its invisibility. Effective response must be guided by participatory rights- and evidence-based policies and a public health approach, acknowledging the occurrence and multiplicity of sexual victimisation of vulnerable migrants of all genders within EU borders.

Résumé

En Europe, les réfugiés, les demandeurs d’asile et les migrants sans papiers sont plus vulnérables à la victimisation sexuelle que les citoyens européens. Ils rencontrent davantage d’obstacles pour obtenir des soins. Cet examen des publications analyse comment les cadres juridiques et politiques aux niveaux national, européen et international conditionnent la prévention et le traitement de la violence sexuelle touchant ces communautés migrantes vulnérables qui vivent dans l’Union européenne (UE). À l’aide de la méthode de synthèse interprétative critique, nous avons recherché des éléments sur la violence sexuelle dans 187 documents juridiques et politiques et 80 articles publiés dans des revues à comité de lecture sur la santé sexuelle des migrants. Parmi ces documents, nous avons également analysé les 37 articles juridiques et 12 articles de revues à comité de lecture qui traitaient spécifiquement de la violence sexuelle chez les migrants vulnérables dans les 27 pays de l’UE. Les documents politiques et juridiques abordant la violence sexuelle, en particulier, mais pas exclusivement chez les migrants vulnérables, appliquent une « vision étroite ». Ils ignorent : a) les types fréquents de violence sexuelle ; b) les taux de victimisation entre sexes ; et c) les facteurs spécifiques de risque au sein de l’UE, comme la situation juridique des migrants, leur orientation sexuelle et leurs conditions de vie. Actuellement, le paradigme politique de l’UE confine la violence sexuelle chez les migrants vulnérables à une question « extérieure » et « uniquement féminine », alors que les politiques de l’UE en matière de migrations et d’asile renforcent son invisibilité. Pour être opérante, la riposte doit être guidée par des politiques participatives à base factuelle et fondées sur les droits, et par une approche de santé publique, et elle doit reconnaître la réalité et la multiplicité de la victimisation sexuelle des migrants vulnérables de tous les sexes au sein des frontières de l’UE.

Resumen

En Europa, refugiados, solicitantes de asilo y migrantes indocumentados son más vulnerables a la persecución sexual que la ciudadanía europea. Enfrentan más retos cuando buscan atención médica. Esta revisión de la literatura examina cómo los marcos jurídicos y políticos a nivel nacional, europeo e internacional condicionan la prevención de y respuesta a la violencia sexual que afecta a estas comunidades de migrantes vulnerables que viven en la Unión Europea (UE). Aplicando el método de Síntesis Interpretativa Crítica, revisamos 187 documentos jurídicos y políticos y 80 artículos revisados por pares sobre la salud sexual de migrantes, en busca de elementos de violencia sexual; de estos, analizamos los 37 artículos jurídicos y 12 artículos revisados por pares enfocados específicamente en violencia sexual contra migrantes vulnerables en la UE-27 Estados. Los documentos jurídicos y políticos que tratan sobre violencia sexual, particular pero no exclusivamente en migrantes vulnerables, aplican la ‘visión de túnel’. Hacen caso omiso de: a) los tipos de violencia sexual que ocurren con frecuencia, b) las tasas de persecución de todos los géneros c) factores de riesgo específicos en la UE, tales como el estatus legal, orientación de género y condiciones de vida de cada migrante. El paradigma de formulación de políticas de la UE relega la violencia sexual en migrantes vulnerables como un asunto de ‘extranjeros’ y ‘mujeres únicamente’, mientras que las políticas de migración y asilo de la UE reafirman su invisibilidad. Una respuesta eficaz debe ser guiada por políticas participativas basadas en derechos y evidencia y un enfoque en salud pública, reconociendo la ocurrencia y multiplicidad de la persecución sexual de migrantes vulnerables de todos los géneros dentro de las fronteras de la UE.

  

Full article at:    http://goo.gl/JRNwgS

By:   

Ines Keygnaert, 

 Aurore Guieu

International Centre for Reproductive Health (ICRH)

Ghent University

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Gaps in HIV Prevention Expose Europe to Risk of Outbreaks

The trend can quickly change, however, as it did when HIV spread rapidly among injecting drug users in Greece and Romania in 2011 and 2012. In the absence of effective measures to curb these epidemics, the explosive spread of infections among injecting drug users in the capital cities resulted in these two countries accounting for more than one third of all new HIV diagnoses associated with injecting drug use notified in the whole of the European Union and European Economic Area (EU/EEA) in 2012, whereas in 2010 they had represented only 2% of the total.

In 2013, all but four EU/EEA countries reported rates of new HIV diagnoses associated with injecting drug use below 10 per million population. However, Lithuania reported a rate of 21 and Greece of 22 new diagnoses per million population, while Latvia and Estonia reported 38 and 55 new diagnoses per million population, respectively…

Full article at: http://goo.gl/wobFFp  By: https://twitter.com/emcdda

  

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HIV Infection in Migrant Populations in the European Union and European Economic Area in 2007-2012: An Epidemic on the Move

Migrants are considered a key group at risk for HIV infection. This study describes the epidemiology of HIV and the distribution of late HIV presentation among migrants within the European Union/European Economic Area during 2007-2012.

HIV cases reported to European Surveillance System (TESSy) were analyzed. Migrants were defined as people whose geographical origin was different than the reporting country. Multiple logistic regression was used to model late HIV presentation.

Overall, 156,817 HIV cases were reported, of which 60,446 (38%) were migrants. Of these, 

• 53% were from Sub-Saharan Africa, 
• 12% from Latin America, 
• 9% from Western Europe, 
• 7% from Central Europe, 
• 5% from South and Southeast Asia, 
• 4% from East Europe, 
• 4% from Caribbean, and 
• 3% from North Africa and Middle East. 

Male and female migrants from Sub-Saharan Africa and Latin America had higher odds of late HIV presentation than native men and women. Migrants accounted for 40% of all HIV notifications in 2007 versus 35% in 2012. HIV cases in women from Sub-Saharan Africa decreased from 3725 in 2007 to 2354 in 2012. The number of HIV cases from Latin America peaked in 2010 to decrease thereafter. HIV diagnoses in migrant men who have sex with men increased from 1927 in 2007 to 2459 in 2012.

Migrants represent two-fifths of the HIV cases reported and had higher late HIV presentation. HIV epidemic in migrant populations in European Union/European Economic Area member states is changing, probably reflecting the global changes in the HIV pandemic, the impact of large-scale ART implementation, and migration fluctuations secondary to the economic crisis in Europe.

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By: Hernando V1, Alvárez-Del Arco D, Alejos B, Monge S, Amato-Gauci AJ, Noori T, Pharris A, Del Amo J.

• 1*Red de Investigación en Sida, Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid, Spain; †CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; ‡Department of Surgery, Medical and Social Sciences, Universidad Alcalá, Alcalá de Henares, Spain; and §Surveillance and Response Section, European Centre for Disease Prevention and Control, Stockholm, Sweden.  

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Changes in Chlamydia Control Activities in Europe Between 2007 & 2012: A Cross-National Survey

In 2012, the levels of chlamydia control activities including primary prevention, effective case management with partner management and surveillance were assessed in 2012 across countries in the European Union and European Economic Area (EU/EEA), on initiative of the European Centre for Disease Control (ECDC) survey, and the findings were compared with those from a similar survey in 2007.

Experts in the 30 EU/EEA countries were invited to respond to an online questionnaire; 28 countries responded, of which 25 participated in both the 2007 and 2012 surveys. Analyses focused on 13 indicators of chlamydia prevention and control activities; countries were assigned to one of five categories of chlamydia control.

In 2012, more countries than in 2007 reported availability of national chlamydia case management guidelines (80% vs. 68%), opportunistic chlamydia testing (68% vs. 44%) and consistent use of nucleic acid amplification tests (64% vs. 36%). The number of countries reporting having a national sexually transmitted infection control strategy or a surveillance system for chlamydia did not change notably. In 2012, most countries (18/25, 72%) had implemented primary prevention activities and case management guidelines addressing partner management, compared with 44% (11/25) of countries in 2007.

Overall, chlamydia control activities in EU/EEA countries strengthened between 2007 and 2012. Several countries still need to develop essential chlamydia control activities, whereas others may strengthen implementation and monitoring of existing activities.

Below:  EU/EEA countries with a national strategy or plan about STI control in 2012. CT = chlamydia. UK situation based on England. Adapted from ECDC Report7

Below:  Map of Europe indicating the level of chlamydia control based on the countries’ accomplishments of key indicators assessed in the survey in 2012. UK situation based on England. Adapted from ECDC Report7

Full article at: http://goo.gl/nWGa1D

By: van den Broek IV1, Sfetcu O2, van der Sande MA3, Andersen B4, Herrmann B5, Ward H6, Götz HM7, Uusküla A8, Woodhall SC9, Redmond SM10, Amato-Gauci AJ2, Low N10, van Bergen JE11.

• 1Unit of Epidemiology and Surveillance, RIVM/Centre for Infectious Disease Control Netherlands, Bilthoven, The Netherlands ingrid.van.den.broek@rivm.nl.
• 2European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden.
• 3Unit of Epidemiology and Surveillance, RIVM/Centre for Infectious Disease Control Netherlands, Bilthoven, The Netherlands Julius Centre, UMC Utrecht, Utrecht, The Netherlands.
• 4Department of Public Health, Randers Hospital, Skovlyvej, Randers, Denmark.
• 5Section of Clinical Bacteriology, Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
• 6Infectious Diseases Epidemiology, School of Public Health, Imperial College London, St Mary's Campus, Norfolk Place, London, UK.
• 7Department of Infectious Disease Control, Municipal Public Health Service Rotterdam-Rijnmond, Rotterdam, The Netherlands.
• 8Department of Public Health, University of Tartu, Tartu, Estonia.
• 9HIV & STI Department, National Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK.
• 10Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.
• 11Unit of Epidemiology and Surveillance, RIVM/Centre for Infectious Disease Control Netherlands, Bilthoven, The Netherlands Department of General Practice, University of Amsterdam, Amsterdam, The Netherlands STI AIDS Netherlands, Amsterdam, The Netherlands.  

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