Bridging the Gap: Conference Record [Abstract book, International Conference on AIDS (12th: 1998: Geneva, Switzerland)]

12th World AIDS Conference

Abstracts 13187-13191 123

13187 Monitoring of HIV-seroprevalence in childbearing women
in Germany - Unlinked anonymous testing of newborns
1993-1997
Anette Siedler', O. Hamouda1, E. M6nch2, R. Heckler3. 1Robert Koch-lnstitut,
AIDS-Zentrum Stresemannstr. 90-102/D-10963 Berlin; 2 Virchow-Klinikum der
Humboldt-Universitat Berlin; 3Niedersachsiches Landesgesundheitsamt
Hannover, Germany
Objectives: To estimate HIV seroprevalence in childbearing women in different
geographic areas of Germany.
Methods: Since anti-HIV IgG antibody is transmitted across the placenta from
mother to infant, HIV antibody in newborns reflects maternal HIV serostatus.
Unlinked anonymous testing of neonatal dried blood spots collected routinely on
Guthrie cards has been performened in Berlin and Niedersachsen since 1993 in
two central laboratories. Before testing, all personal indentifiers were removed
except month of birth and residential areas. Samples were collected monthly and
tested by EIA, since 1995 in pools of six samples. Repeatedly reactive specimen
were confirmed by Western blot.
Results: From 1993 to 1997 approximately 510,000 samples were tested,
covering about 95% of all deliveries. A total of 128 (0.25 per 1,000) specimens
were seropositive. Seroprevalence remained stable in all areas throughout the
study period. The overall seroprevalence in Berlin (0.58 per 1,000; 77 samples
out of 133,855) was 4-fold higher than that in Niedersachsen (0.14 per 1,000; 51
of 375,714). Similarly, the seroprevalence in West Berlin (0.74 per 1,000; 72 of
96,683) was 5-fold higher than that in East Berlin (0.14 per 1,000; 5 of 36,743).
In Niedersachsen, seroprevalence in urban areas was higher than in rural areas.
Conclusion: HIV-prevalence remains low in the general population in Germany.
No significant temporal trends could be detected in any of the regions surveyed.
The differences in the rates between metropolitan cities and rural areas reflect
the expected difference in HIV-prevalence in these geographic areas. In Berlin,
the German city with the highest cumulative AIDS-incidence, HIV-seroprevalence
in childbearing women has remained below 0.1%.
13188 Frequency of antiretroviral therapy before AIDS diagnosis
in Germany data from the German AIDS register
Osamah Hamouda, L. Voss, W. Niessing. Robert Koch-lnstitut, AIDS-Zentrum
Stresemannstr: 90-102, 10963 Berlin, Germany
Objectives: To determine the number and proportion of patients who received
antiretroviral therapy (ARVT) before being diagnosed with AIDS and to analyse
the changes in patterns of ARVT over time.
Design: Analysis of AIDS register data
Methods: Data on AIDS cases in Germany are collected through a national
surveillance system on a voluntary basis since 1982. Coverage of the AIDS case
register is estimated to exceed 85% of all cases diagnosed. Cases reported up
to December 1997 were evaluated after adjustment for reporting delay. Data on
the use of ARVT prior to AIDS (for >3 months within the last 2 years) is collected
in the register since 1991.
Results: Reported AIDS incidence has been stable at around 1,800 cases per
year from 1991 until 1994. A modest decline in AIDS incidence in 1995 (10%) and
1996 (13%) was observed following the introduction of effective ARVT. A sharp
decline in AIDS incidence of 30%-40% compared to 1996 is expected for cases
diagnosed in 1997. The absolute number of AIDS patients who were unaware
of their HIV-positive serostatus at the time of AIDS diagnosis (and thus did not
receive ARVT) has remained constant up to 1996, but decreased by almost 50%
in 1997. Also the number of AIDS patients who were aware of their HIV-positive
serostatus and did not receive ARVT declined by 40% from 1994 to 1997. Use of
mono- or combination therapy not containing protease inhibitors decreased after
1995. The number of AIDS patients diagnosed, who did receive combinations
including protease inhibitors increased by 60% from 1995 to 1996.
Conclusion: The large decrease in AIDS incidence is likely due to the increased efficacy of new antiviral regimens as well as increased use of antivirals
by HIV infected persons. An increasing number of newly diagnosed persons with
AIDS who had previously used protease inhibitors is occurring.
13189 Unlinked anonymous HIV prevalence monitoring in IDU,
MSM, STD patients, and pregnancies in Slovenia
Irena Klavs1, Lidija KristanCid2, M. Poljak2, B. Celan Lucu3, J. Krek1, M. Krek1,
Z. Kastelic1, R. Kroselj2. Institute of Public Health Trubarjeva 21000 Ljubljana;
2Microbiology Institute, Ljubljana; 3Health Care Centre Ljubljana, Ljubljana,
Slovenia
Objectives: We monitor the prevalence of HIV infection in accessible groups.
Methods: Saliva samples are voluntarily obtained from IDUs entering
methadone maintenance programme at two sites and once per year from MSM at
one of their gathering places. Residual sera from sera samples of STD patients
and pregnant women sent for syphilis serology are consecutively sampled in
syphilis serology laboratories. Samples are labelled with sampling period, sen
tinel site, population group, sex and age group, frozen, stored at -200 C and
tested for antibodies to HIV-1 and HIV-2 yearly.
Results are presented in the table.
Conclusions: Rapid and extensive spread of HIV among IDUs has not started.
More then 1 in 100 MSM gathering at one of the gays' sites are infected with
HIV. HIV prevalence in all unlinked anonymously tested STD patients in Slovenia

Year Number Number Number %HIV Prevalence
of sites tested HIV infected infected range
IDU 1995 2 105 0 0

1996
1997
MSM 1996
1997
STD patients 1995
1996
1997
Pregnancies 1995

2
2
1
1
4
2
3
7

177
137
85
136
814
358
506
8528

1
0
2
2
4
0
1
0

0.6
0
2.4
1.5
0.5
0
0.2
0

0-0.8%
0-1.4%
0-0.4%

in years 1995, 1996 and 1997 has been 0.5%, 0% and 0.2% respectively. HIV
prevalence in low risk heterosexual population in Slovenia is very low.
13190 HIV-1 genetic subtype A/B recombinant strain causing an
explosive IDU epidemic in Kaliningrad
Kirsi Liitsola1, I. Tashkinova2, G. Korovina2, T. Smolskana2, N. Mashkileyson3,
P. Leinikki3, M.O. Salminen3. 'Kaliningrad AIDS Center, Kaliningrad; 2St.
Petersburg Pasteur Institute, St, Petersburg,, Russia; 3National Public Health
Institute, Helsinki,, Finland
Background: The number of newly diagnosed individuals testing seropositive
for HIV-1 infection in the Kaliningrad province of the Russian Federation rose
from less than one per month to more than 100 per month during the period
of August-September 1996. A total of 1335 new infections were been identified
between July 1996 and July 1997. We have investigated the molecular epidemiology and genetic structure of the virus strain(s) causing the outbreak in
Kaliningrad and compared the relationship of this outbreak to some other emerging HIV-1 epidemics in the Commonwealth of Independent States (CIS) member
countries.
Methods: A molecular epidemiological investigation was conducted in the city
of Kaliningrad among individuals recently diagnosed as HIV-1 positive. Samples
were also collected from neighboring Lithuania and from the Ukraine. Incident and
population data was collected from official health statistics. For genotyping, two
regions of the virus were directly sequenced from patient lymphocytes collected
on two separate occasions and classified by phylogenetic analysis.
Results: The main reported risk factor for HIV-1 infection (80%) was injecting
drug use (IDU), in particular a locally produced opiate. Analysis of patient viruses
showed that the epidemic is caused by a highly homogenous HIV-1 strain (less
than 1% interpatient variation), recombinant between genetic subtypes A and B.
Comparison to subtype A strains prevalent among IDUs in Ukraine shows that
one of these strains is the direct subtype A parent of the epidemic recombinant
strain in Kaliningrad.
Conclusions: The HIV-1 epidemic in Kaliningrad probably started from a single
source, with rapid spread of the virus through the IDU population. The origin of
the epidemic strain is a recombination event occurring between the subtype A
strain virus prevalent among IDU in some southern CIS countries, and a subtype
B strain of unknown origin. Due to the geographical location of the Kaliningrad
province, the possibility that this A/B recombinant strain may be introduced into
Western Europe should be considered in future prevention strategies.
131911 A recent epidemy of HIV infection in Russian IVDUs
Vadim Pokrovski1, I.Y. Savchenkol, N.N. Ladnaial, A.T. Youliousov2. 12b 15
Vosmaia Ulitsa Sokolinoy Gory, Moscow 10575, Russia AIDS Centre; 2Ministry
of Health, Moscow, Russia
Objective: To describe the HIV dissemination among IVDUs in Russia in
1996-1997.
Design: Descriptive study.
Methods: Monthly reports about risk factors for HIV-positive persons were
analysed.
Results: Only 158 HIV positive persons were recorded in Russia in 1994 and
196 in 1995. Not a single case of HIV in IVDUs was registered in Russia before
1994. 2 persons had IVDU as a known main risk factor for HIV infection were
found in 1994, 5 persons in 1995, 1018 in 1996 and 2220 new cases in 1997.
The first case of HIV infection in IVDUs had been registered in Kaliningrad in
Jan 1996. Krasnodar and Ekaterinburg began to report HIV-positive cases in
IVDUs from Feb 1996, Hizniy Novgorod and Saratov from Mar 1996, Tumen from
Apr 1996, Rostov on Don from Jun 1996, Tver from Jan 1997, Tula from Apr
1997. Up to Jan 1998 3245 cases of HIV-infection in known IVDUs was reported
from 56 of 79 regions of Russia. However only 27 cases were reported from
Moscow and 14 from Sankt-Petersburg. Initial cases in southern regions were
associated with travelling to or from Ukraine. HIV-transmission was registered
mainly in users of solutions of poppy drugs and only in Novorossisk in users of
amphetamine-like "pervitin". The spreading of HIV may be explained with general
growth of a number of IVDUs in Russia after 1991 and an introduction of a new
type of drug selling in a form of prepared solutions. A supposition that not only
shared syringes but also drug solutions contaminated with HIV during numerous
"testing of drug" and some other manipulations had to be possible vectors of HIV
would be discussed.
Conclusion: HIV-1 had began to spread among IVDUs in Russia not early than
in 1994 and in a few years the virus reached the majority of IVDUs populations of
Russia. Further spread of HIV in IVDUs is expected.