HIV infection in the European countries

By Momchil Baev

The European Center for Disease Control (ECDC) annually publishes a report of the surveillance on the HIV infection in Europe. In the very end of 2017 the institution announced the final data for 2016 in a detailed report that was jointly prepared with the European office of the World Health Organization (WHO).

Although HIV is a preventable disease, the exceptional morbidity continues to occur in Europe. Newly infected with HIV in 2016 amounted to 160,453 people in 51 out of the 53 countries in the WHO European Region, an incidence rate of 18.2 new diagnoses per 100,000 population. Of these, 29,444 are in the European Union and the European Economic Area (EEA). A steady trend since the last decade has been that most recently infected people are in Eastern Europe, and less in Western and Central Europe. Methods of transmission of infection vary across geographical areas, indicating the diversity of epidemiology of HIV in Europe. Sexual transmission of the virus among men is most prevalent in the EU and EEA, and in the eastern regions of Europe the transmission through heterosexual contacts and the use of venous narcotics through contaminated needles is most prevalent.

A negative trend that the report points out is that at least half of the reported cases occur in the late phase of the infection – when CD4 cells are below 350 mm3, which is more typical in Eastern Europe than in the West. Despite the progress of anti-retroviral therapy, 14,897 AIDS-diagnosed patients were reported in 2016, of which 3,628 in the EU and EEA. Although the number of AIDS cases has declined steadily in the West and the EU, it has almost doubled in the eastern parts of the continent over the past decade.

As it was pointed out, 29,444 are the new cases of HIV in the EU and EEA in 2016, equivalent to 5.9 people per 100,000 population, and the countries with the highest share of newly diagnosed are Latvia (365 cases), Estonia (229 case) and Malta (63 cases). The lowest levels were registered in Slovakia (87 cases) and Hungary (228 cases).

A steady trend that is particularly noticeable in Bulgaria is that men are more affected than women. In Bulgaria this is three times more. Men in general are most affected in the age group 25-29 years, while for women – this is the age between 30-39 years old. Similar to previous years, the highest share of HIV infection is among men who have sex with men, which is 40% of all new cases. This percentage in heterosexual contacts is 32%. Transmission of infection by injection has been steadily decreasing over a decade to reach 4%. It is important to note that in 23% of the cases, the way the virus is transmitted is not clear or is not reported.

In the context of the refugee crisis in Europe, we should note that 40% of new cases in the EU / EEA are registered among refugees and migrants, as the presumption is that they were HIV-positive before arriving in the host country. At the same time, the percentage of HIV-positive migrants sharply varies from country to country, from 80% in Sweden to less than 5% in Bulgaria, Latvia, Lithuania, Poland and Romania.

A positive trend in disease control across Europe, including Bulgaria, is the significant decline in mother-to-child infection during pregnancy or lactation. This is due, on one hand, to good screening programs for pregnant women, but also to the availability of anti-retroviral therapy that is available to HIV-positive women who wish to give birth. In Bulgaria, HIV-negative children, born by HIV-positive mothers, are already being born and are growing up. In Europe, cases of transmission of mother-to-child virus amount to less than 1% of all cases.

Even though some trends in the spread of the virus to be positive, the overall number of HIV positive in Europe is growing steadily and reaching the figure of 2 167 684 people, of which at least half are in Russia. The data shows that Eastern and Western Europe are disproportionately affected – 80% against 17%.