HIV in Portugal

Catarina Oliveira Paulo, Joana Alves, Liliana Maia, Raquel Duro

EACS HIV Summer School 2016

HIV Epidemiology

8,9 cases*/100.000(IC 95%: 13,3-14,8)

Ratio ♂/♀ 2,6

6 new cases < 15 years old

2014

Portugal remains the country in Western Europe with the higher rate of new diagnoses

Data from the last annual report of the INSA, published in October of 2015

52.694 diagnosed patients

20.856 AIDS stage cases

10.377 deaths

1983-2014

Num

bero

fcas

es

HIV infetion casesAIDS casesDeaths

The peak was at the end of the 90s, since then the numberof new cases has fallen

The mean age at the time of the diagnosis has increased, except in the group of MSM

We still have a considerable percentage of diagnoses in an advanced stage of the disease (18,3% in 2014)

• 2264 notified cases(2080 newly diagnosed) » decreasing

• Oporto, Lisbon, Setúbal and Algarve » intermediateincidence (> 20/100.000 and < 50/100.000)

• Male 63,4%; median age 48,5 (84,1% born in Portugal)

• HIV status knowned in 74,3% » 13,3% HIV positive

• 24,6% had social risk factors: alchoolism (11%) and ilicitdrug abuse (9,9%)

• Pulmonary Tb most common (71,3%)

• 23 cases of multirresistant Tb; 6 extensively resistant Tb

31st of December 2014

HIV and Tuberculosis (Tb)

• 1735 notified cases of HIV-2 infection - 3,3% of total

• 656 co-infection HIV-1 and HIV-2 –1,2% of total

• No predominant sex • Heterossexual transmission mainly• 52,8% live in Lisbon – 51,9%

originally from subsaharian Africa

• Former colonial ties with Western Africa

HIV-2

Costs with HAART

26 600 000

26 800 000

27 000 000

27 200 000

27 400 000

27 600 000

27 800 000

28 000 000

28 200 000

28 400 000

175000000

185000000

195000000

205000000

215000000

225000000

235000000

2011 2012 2013 2014

Num

ber o

f pa

ckag

es

Cost

s (E

uros

)

Year

Despite the higher number of treatments, we achieve a reduction

in the costs in the two last years

Data from the last report of the DGS about HIV infection, AIDS and tuberculosis in Portugal – published in 2016

HIV/AIDS in Portugal

Diva TrigoMD, Infectious Diseases ResidentHospital Prof. Dr. Fernando Fonseca, Lisbon

EACS HIV Summer School 2016

Country of origin

ImmigrantsPortuguese

17,1%

Geographic distribution

Oporto

Coimbra

Lisbon

Algarve

Subsarian AfricaLatin AmericaEuropean UnionEast EuropeOther

1220 new HIV diagnoses in 2014

44,3%

18,5%

4,4%

5,7%

Dire

ção

Ger

al d

e Sa

úde,

Infe

ção

por V

IH, S

IDA

e Tu

berc

ulos

e em

núm

eros

, 201

5

Heterosexual (non-generalized epidemics) Heterosexual (generalized epidemics)IV drug useMSM

Mode of transmission

Mother-to-child transmission

1,7%

NoYes

239 babies bornto HIV+ mothers

CD4+ count at diagnosis

31%<200 cells/uL

≥200 cells/uL

1220 new HIV diagnoses in 2014

2004 2014

Dire

ção

Ger

al d

e Sa

úde,

Infe

ção

por V

IH, S

IDA

e Tu

berc

ulos

e em

núm

eros

, 201

5

30956 HIV-infected patients under follow-up in 2014

5827513

2026

14968

3527

1743

597

2761 HIV-patients

3,1%

HIV-1HIV-2

ABC

Geographic distribution HIV type

CDC HIV stage

25,2%

Dire

ção

Ger

al d

e Sa

úde,

Infe

ção

por V

IH, S

IDA

e Tu

berc

ulos

e em

núm

eros

, 201

5

Portuguese HIV treatment recommendations (2015)

Prog

ram

a N

acio

nal p

ara

a in

feçã

oVI

H/SI

DA, R

ecom

enda

ções

Por

tugu

esas

para

o tr

atam

ento

da

infe

ção

por V

IH-1

e V

IH-2

, 201

5

“A TARc está recomendada a todos os doentes com infeção crónica por VIH-1 com CD4+ ≤ 500 células/µl”

“ART should always be recommended irrespective of the CD4 count “

HIV/AIDS in Portugal

Diva TrigoMD, Infectious Diseases ResidentHospital Professor Doutor Fernando Fonseca, Lisbon

EACS HIV Summer School 2016

Thank You