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HIV Europe 2007 — meeting report

Natalya Anderson reports from HIV Europe in Brussels, where it was revealed that an estimated 30 per cent of HIV-positive people in the EU are unaware that they are infected with the virus.

Physicians at all healthcare levels need to be made newly aware of HIV indicator diseases to prevent late presentation, as approximately 760,000 adults and children are living with HIV in Western Europe alone, according to data presented at HIV Europe 2007 in Brussels last November.

Testing patients earlier

“My fear is that people who live in Europe may think that HIV is no longer important, or that it does not exist anymore, because there is less media coverage of the topic,” said Prof Jens Lundgren, Faculty of Health Sciences, Copenhagen University. “People continue to infect each other within Europe. Into places such as Ireland and the UK, we have [also] seen an increase in people immigrating from places in the world where HIV is more prevalent.”

“We need to communicate to our GPs that these disease indicator guidelines can be implemented in the practice of testing patients earlier,” said Prof Lundgren.
“Physicians might say the following to their patients: ‘You have a disease that has increased prevalence in people with HIV. I would like to test you for HIV. Is that okay with you?’ There is always hope. I am always hopeful. We have the information that can save people’s lives.”

According to a presentation by Francoise Hamers of the Unit for Scientific Advice at the European Centre for Disease Prevention and Control (ECDC), median age at diagnosis of HIV is 30-35 years old in Ireland.

30 per cent are unaware

The most common form of transmission of HIV in Europe over the past decade has been between heterosexual partners. Data presented at the conference indicates that an estimated 30 per cent of those who are HIV positive in the EU are actually unaware that they are infected. The number of people living with HIV in the EU is also increasing, according to the panel’s discussion.

The ECDC has reported that increased access to HIV testing is the key to curbing the epidemic in Europe. As a collaborative effort with the University of Ghent, Belgium, the ECDC is undertaking assessment of testing policies and practices throughout Europe to determine what barriers might exist against accessing testing.

The centre intends on providing the results of its study at the end of 2008, and researchers hope that their findings will hold some keys to decreasing the numbers of undiagnosed HIV cases in Europe. The ECDC is further co-ordinating the surveillance of HIV/AIDS in Europe with WHO-EURO since January 2008 and providing information on late diagnosis of HIV along with the above study.

“We would like to outline that we think that there needs to be more widespread testing,” says Prof Lundgren. “This does not indicate testing of entire populations, but of people who are seen by their GP who are suffering from one of a list of diseases where we know that the chance of having HIV if you have that disease is considerable.”

Late presentation

Prof Lundgren and his colleagues at the conference were in agreement that late presentation of HIV is still a huge factor in morbidity and mortality rates in Europe. According to data presented by Dr Richard Coker of the London School of Hygiene & Tropical Medicine, late-presenting patients with HIV are more likely to die of AIDS-defining illness.

He further indicated that 24 per cent of all HIV positive deaths are due to late presentation and that 77 per cent of all AIDS-related deaths are late presenters. Dr Coker presented some statistics on the matter of late presentation from studies published in 2006.

Some of the data he included indicated that HIV transmission is approximately 3.5 times higher among people who are not aware that they have the virus than among those who are aware of diagnosis.

Congruently, a 30 per cent reduction in newly transmitted HIV cases might be achieved if people were tested and made aware of their infections early, (Marks et al, Aids, June 26, 2006).

Dr Coker reported that migrant groups, older patients, heterosexuals, men and people living in lower prevalence areas are all likely to be late presenters.
He suggested that this may be attributed to lack of knowledge or understanding of HIV, a perception that one is at low risk (in men in particular), the social stigma associated with HIV and AIDS, and health system barriers.

Dr Coker’s presentation showed that although free HIV testing is widely provided in Europe, access through primary care varies depending on health systems. People he classified as being part of ‘vulnerable populations’, such as migrants and individuals who are uninsured, can reportedly only access free, confidential testing in a limited number of countries.

“We know that over 300,000 people in Europe died needlessly in the last 10 years because they were tested too late. Unified guidelines for testing could have prevented many deaths; it is now time to share best practices across Europe and take action. A patient’s chance of survival should not be determined by geography.”

As a case for European guidance, Dr Brian Gazzard and colleagues presented a new approach for tackling the problem of late presentation and issues surrounding testing.

Targeted testing

Across Europe today, according to the panel, there exists a case for targeted testing guidance using indicator diseases or situations. The panel discussed the need for increased efforts to inform the full range of healthcare providers of “validated triggers to test”.

The team also touched on how integrated efforts might lead to success in minimising the social stigma and sense of rejection surrounding HIV patients. The panel presented recent study results indicating that between 2003 and 2005, a number of cases of missed opportunity for diagnosing primary HIV infection were identified in London. Of these cases, 76 patients (70 per cent) had reported symptoms of seroconversion, 40 (53 per cent) were seen by health care providers, and 21 (52 per cent) were diagnosed correctly. The panel reported that, among the 19 (48 per cent) missed diagnoses, 15 were seen by primary care practitioners, three were in emergency wards, and one was in genito-urinary medicine, (Sudarshi et al, Sex Transm Infect., Oct 2007).

“Testing, until now, has been voluntary and initiated by the patient,” said Prof Lundgren. “That’s not [to say that it is] because people have been ignorant. However, we as physicians are now seeing how we can get people into care earlier. Having a discussion of how useful indicator diseases are to identify patients earlier in the course of their HIV infection seems important to do.”

Dr Gazzard listed sexually-transmitted infections, hepatitis B and hepatitis C as known AIDS-related complex definers and AIDS associated diseases. Strong associations were listed as TB and lymphoma. Listed by the panel as ‘category 1 unequivocal triggers for HIV testing’ were male sex with other males, injection drug users, opportunistic infection, and oral thrush. Listed as ‘category 2 suggestible triggers’ were tuberculosis, varicella zoster, lymphadenopathy, hepatitis B and hepatitis C.

‘Category 3 triggers’ were listed as gonorrhoea, pelvic inflammatory disease, chlamydia, syphilis, trichomoniasis and genital herpes. Alcohol abuse, alcohol withdrawal, homelessness, psychiatric diagnosis, pregnancy, abnormal pap smears, candida vaginalis and community-acquired pneumonia were listed as ‘category 4 borderline triggers’, (categorised by the Likelihood of its Clinical Association with an HIV Diagnosis, J. Gen. Intern. Med. 2004).

Voluntary counselling

As suggestions for how to encourage greater HIV infection recognition in the general European population, the panel recommended increased offering of voluntary counselling and testing through health centres and targeted campaigns. They stressed that there should be more strict regulations within healthcare structures around anonymity and confidentiality for HIV patients, more access to free therapy, a conscious effort towards minimising social stigma in environments such as the workplace, and no rejection of HIV patients in the area of insurance.

The team suggested that an increased awareness on the part of healthcare providers is also needed in the areas of HIV associated diseases (specifically with the indicators outlined), behavioural risks associated with HIV, and travel risks in endemic areas. Particular care should be taken by primary care physicians, urgent care clinic physicians, STD specialists, gynaecologists, obstetricians, dermatologists, dentists and pneumologists to be more sharply aware of the discussed HIV indicators.
Prof Lundgren recommends that physicians begin gently integrating discussion of testing when these indicators are present in patients.

Posted in on 14 April 2008
Tags: HIV, infection

Tagcloud

abortion, accupuncture, ACE inhibitors, acne, actinic keratoses, ADHD, ageing, AIDS, alcohol, allergies, Alzheimer's, anaemia, anaethesia, anti-retroviral drugs, antibiotics, antidepressants, antihistamine, anxiety, appetite control, arthritis, ASCOT, aspirin, asthma, atherosclerosis, autism, autoantibodies, back pain, balloon kyphoplasty, beta carotene, beta-blockers, bipolar disorder, birth, birth defects, bleeding, blindness, blood pressure, body dysmorphic disorder, breast cancer, bronchitis, Caesarean section, calcium, cancer, carcinogens, carcinoma, cardiac syncope, cardiolgy, cervical cancer, chemotherapy, child psychiatry, children, chocolate, cholecystectomy, cholesterol, clinical meetings, clopidogrel, Clostridium difficile, coenzyme Q10, coffee, cognitive behavioural therapy, colectomy, colic, colorectal cancer, common cold, complementary and alternative therapies, contraception, COPD, coronary care, coronary stents, cystic fibrosis, defibrillator, dementia, depression, dermatology, diabetes management, diet, disability, diuretics, DNA, Down's syndrome, dyslexia, eating disorders, echinacea, eczema, elderly people, endoscopy, epilepsy, erectile dysfunction, Eurordis, euthanasia, exercise, fertility, fibre optics, fibromyalgia, fitness, flu pandemic, fluoxetine, folic acid, food labelling, fracture, fragile X syndrome, gastric bypass surgery, general surgery, genetics, gerontology, GIK infusion therapy, gout, gum disease, haemodialysis, hearing aids, hearing loss, heart attack, heart disease, heart failure, heart health, hepatitis, HIV, hospital care, HPV, HRT, hyperglycaemia, hypertension, hypoglycaemia, ICU, incontinence, infant, infant mortality, infection, inflammatory bowel disease, influenza, information technology, interleukin inhibitors, IQ, Irish Heart Foundation, irritable bowel syndrome, keyhole surgery, kidney disease, laser, learning difficulties, leukaemia, life expectancy, liver disease, lumbar disk herniation, lung cancer, lung disease, lymph nodes, macular degeneration, macular oedema, magnetic resonance imaging (MRI), malaria, malnutrition, manual handling, Marfan syndrome, medical ethics, medical research, medication, meningioma, meningitis, mental illness, metabolic syndrome, metformin, migraine, miscarriage, mononucleosis, mortality rate, MRSA, multiple sclerosis (MS), myalgic encephalitis (ME), nephrology, neural tube defects, neurology, Nutrition, obesity, obstetrics, occupational therapy, ocular medicine, omega-3, opthalmology, oral cancer, organ transplantation, osteoporosis, otolaryngology, ovarian cancer, paediatrics, pain management, pancreatic cancer, panic, Parkinson’s disease, patient safety, patient-physician communication, personality disorders, physiotherapy, plastic surgery, polio, polycystic ovary syndrome (PCOS), pre-eclampsia, pregnancy, prehypertension, preventative health care, probiotics, prostate cancer, psoriasis, psychiatric admission, psychiatry, psychotherapy, PTSD, public health, quality of life, radiology, reproductive health, resuscitation, rhinitis, salt, SARS, schizophrenia, seizures, sexual abuse, sexual health, sexually transmitted infections, SGA, shiftwork, Sick leave, sinusitis, skin cancer, sleep disorders, Smoking, smoking, smoking ban, spinal injury, sports injuries, sports medicine, statins, streptococcus pneumoniae, stroke, substance abuse, sugar, suicide, supplement, surgery, syncope, teenagers, testosterone, thoracic surgery, thrombosis, thyroid cancer, tonsillectomy, tonsillitis, Tourette's syndrome, toxicology, travel medicine, tuberculosis, tumour angiogenesis, type 1 diabetes, type 2 diabetes, ulcer, ulcerative colitis, vaccine, vitamin A, vitamin B12, vitamin C, vitamin D, vitamins, weight, wheeze, WHO, women's health, World Health Assembly, wound

«Previous article | Next article»

HIV Europe 2007 — meeting report

Natalya Anderson reports from HIV Europe in Brussels, where it was revealed that an estimated 30 per cent of HIV-positive people in the EU are unaware that they are infected with the virus.

Physicians at all healthcare levels need to be made newly aware of HIV indicator diseases to prevent late presentation, as approximately 760,000 adults and children are living with HIV in Western Europe alone, according to data presented at HIV Europe 2007 in Brussels last November.

Testing patients earlier

“My fear is that people who live in Europe may think that HIV is no longer important, or that it does not exist anymore, because there is less media coverage of the topic,” said Prof Jens Lundgren, Faculty of Health Sciences, Copenhagen University. “People continue to infect each other within Europe. Into places such as Ireland and the UK, we have [also] seen an increase in people immigrating from places in the world where HIV is more prevalent.”

“We need to communicate to our GPs that these disease indicator guidelines can be implemented in the practice of testing patients earlier,” said Prof Lundgren.
“Physicians might say the following to their patients: ‘You have a disease that has increased prevalence in people with HIV. I would like to test you for HIV. Is that okay with you?’ There is always hope. I am always hopeful. We have the information that can save people’s lives.”

According to a presentation by Francoise Hamers of the Unit for Scientific Advice at the European Centre for Disease Prevention and Control (ECDC), median age at diagnosis of HIV is 30-35 years old in Ireland.

30 per cent are unaware

The most common form of transmission of HIV in Europe over the past decade has been between heterosexual partners. Data presented at the conference indicates that an estimated 30 per cent of those who are HIV positive in the EU are actually unaware that they are infected. The number of people living with HIV in the EU is also increasing, according to the panel’s discussion.

The ECDC has reported that increased access to HIV testing is the key to curbing the epidemic in Europe. As a collaborative effort with the University of Ghent, Belgium, the ECDC is undertaking assessment of testing policies and practices throughout Europe to determine what barriers might exist against accessing testing.

The centre intends on providing the results of its study at the end of 2008, and researchers hope that their findings will hold some keys to decreasing the numbers of undiagnosed HIV cases in Europe. The ECDC is further co-ordinating the surveillance of HIV/AIDS in Europe with WHO-EURO since January 2008 and providing information on late diagnosis of HIV along with the above study.

“We would like to outline that we think that there needs to be more widespread testing,” says Prof Lundgren. “This does not indicate testing of entire populations, but of people who are seen by their GP who are suffering from one of a list of diseases where we know that the chance of having HIV if you have that disease is considerable.”

Late presentation

Prof Lundgren and his colleagues at the conference were in agreement that late presentation of HIV is still a huge factor in morbidity and mortality rates in Europe. According to data presented by Dr Richard Coker of the London School of Hygiene & Tropical Medicine, late-presenting patients with HIV are more likely to die of AIDS-defining illness.

He further indicated that 24 per cent of all HIV positive deaths are due to late presentation and that 77 per cent of all AIDS-related deaths are late presenters. Dr Coker presented some statistics on the matter of late presentation from studies published in 2006.

Some of the data he included indicated that HIV transmission is approximately 3.5 times higher among people who are not aware that they have the virus than among those who are aware of diagnosis.

Congruently, a 30 per cent reduction in newly transmitted HIV cases might be achieved if people were tested and made aware of their infections early, (Marks et al, Aids, June 26, 2006).

Dr Coker reported that migrant groups, older patients, heterosexuals, men and people living in lower prevalence areas are all likely to be late presenters.
He suggested that this may be attributed to lack of knowledge or understanding of HIV, a perception that one is at low risk (in men in particular), the social stigma associated with HIV and AIDS, and health system barriers.

Dr Coker’s presentation showed that although free HIV testing is widely provided in Europe, access through primary care varies depending on health systems. People he classified as being part of ‘vulnerable populations’, such as migrants and individuals who are uninsured, can reportedly only access free, confidential testing in a limited number of countries.

“We know that over 300,000 people in Europe died needlessly in the last 10 years because they were tested too late. Unified guidelines for testing could have prevented many deaths; it is now time to share best practices across Europe and take action. A patient’s chance of survival should not be determined by geography.”

As a case for European guidance, Dr Brian Gazzard and colleagues presented a new approach for tackling the problem of late presentation and issues surrounding testing.

Targeted testing

Across Europe today, according to the panel, there exists a case for targeted testing guidance using indicator diseases or situations. The panel discussed the need for increased efforts to inform the full range of healthcare providers of “validated triggers to test”.

The team also touched on how integrated efforts might lead to success in minimising the social stigma and sense of rejection surrounding HIV patients. The panel presented recent study results indicating that between 2003 and 2005, a number of cases of missed opportunity for diagnosing primary HIV infection were identified in London. Of these cases, 76 patients (70 per cent) had reported symptoms of seroconversion, 40 (53 per cent) were seen by health care providers, and 21 (52 per cent) were diagnosed correctly. The panel reported that, among the 19 (48 per cent) missed diagnoses, 15 were seen by primary care practitioners, three were in emergency wards, and one was in genito-urinary medicine, (Sudarshi et al, Sex Transm Infect., Oct 2007).

“Testing, until now, has been voluntary and initiated by the patient,” said Prof Lundgren. “That’s not [to say that it is] because people have been ignorant. However, we as physicians are now seeing how we can get people into care earlier. Having a discussion of how useful indicator diseases are to identify patients earlier in the course of their HIV infection seems important to do.”

Dr Gazzard listed sexually-transmitted infections, hepatitis B and hepatitis C as known AIDS-related complex definers and AIDS associated diseases. Strong associations were listed as TB and lymphoma. Listed by the panel as ‘category 1 unequivocal triggers for HIV testing’ were male sex with other males, injection drug users, opportunistic infection, and oral thrush. Listed as ‘category 2 suggestible triggers’ were tuberculosis, varicella zoster, lymphadenopathy, hepatitis B and hepatitis C.

‘Category 3 triggers’ were listed as gonorrhoea, pelvic inflammatory disease, chlamydia, syphilis, trichomoniasis and genital herpes. Alcohol abuse, alcohol withdrawal, homelessness, psychiatric diagnosis, pregnancy, abnormal pap smears, candida vaginalis and community-acquired pneumonia were listed as ‘category 4 borderline triggers’, (categorised by the Likelihood of its Clinical Association with an HIV Diagnosis, J. Gen. Intern. Med. 2004).

Voluntary counselling

As suggestions for how to encourage greater HIV infection recognition in the general European population, the panel recommended increased offering of voluntary counselling and testing through health centres and targeted campaigns. They stressed that there should be more strict regulations within healthcare structures around anonymity and confidentiality for HIV patients, more access to free therapy, a conscious effort towards minimising social stigma in environments such as the workplace, and no rejection of HIV patients in the area of insurance.

The team suggested that an increased awareness on the part of healthcare providers is also needed in the areas of HIV associated diseases (specifically with the indicators outlined), behavioural risks associated with HIV, and travel risks in endemic areas. Particular care should be taken by primary care physicians, urgent care clinic physicians, STD specialists, gynaecologists, obstetricians, dermatologists, dentists and pneumologists to be more sharply aware of the discussed HIV indicators.
Prof Lundgren recommends that physicians begin gently integrating discussion of testing when these indicators are present in patients.

Posted in on 14 April 2008
Tags: HIV, infection