UPDATE OF HIV EPIDEMIOLOGY IN ROMANIA

OVERVIEW OF HIV EPIDEMIC IN ROMANIA- EXPERIENCE WITH LONG TERM SURVIVORS TEENAGERS AN YOUNG ADULTS

DR.MARIANA MRDRESCU Coordinator of Compartment for

Monitoring and Evaluation of HIV/AIDS Data in Romania - INBI Prof.Dr.M.Bal

At a global level, HIV infection is constantly expanding, with an epidemiologic profile set by local and regional factors. According to UNAIDS estimates, at the end of 2009 there were over 33 million PLWHA worldwide, compared to 26 million PLWHA reported in 1999 (a 27% increase in this number). At the end of 2009, the estimated number of HIV positive children was calculated at the value of 2,5 million, while the proportion of women living with HIV/AIDS apparently remained stable, namely 15,9 million. Unlike the infections in other Eastern and Central European Countries,HIV/AIDS infection in Romania is a different phenomenon.

The specificity of the epidemic consists of a high rate of HIV incidence at children, infected at the end of the 1980s, the maximum number of these patients having been recorded in the beginning of the 1990s. During the same period the rate of HIV incidence among the adult population was low, with a significant increase afterwards, by heterosexual contact. According to the data provided by Compartment for Monitoring and Evaluation of HIV/AIDS Data in Romania, in National Institute of Infectious Diseases Prof. Dr. Matei Bals, at 30 September 2011 17.212 cumulative cases of HIV/AIDS cases were recorded, with a figure of 10.765 people living with HIV/AIDS. Recent information released by UNAIDS (December 2009) ranks the number of PLWHA in Romania between 12.000-16.000 persons.

The difference between the number of the diagnosed patients and the estimates is relatively small next to other Central and Eastern European countries. The rate of HIV prevalence at adults was somewhere below 0.1% , at 31 December, 2010. Currently, Romania has a large number of survivors, integrated in the 19-24 age group, who belong to the 1987-1990 cohort (>6000) and a large number of PLWHA who receive specific ARV therapy in relation to the total number of infected persons (>7000). Due to an optimal therapy administration, the mean period of survival has increased from 3 month is 1990-2000 to 84 months today.

The current tendencies of the HIV/AIDS infection in Romania are:

The same main way of transmission for adults - unsafe heterosexual

contact - 63% of the new cases. A slight decrease in the vertical transmission (mother to child)2,5% in 2011 vs. 4,8% in 2010. A relevant increase for the IDU group (15% in 2011 vs. 3% in 2010). A doubled number of infections among the MSM group compared with 2009, namely from 8% to 16% in 2011. An overall increase of PLWHA who require specific medical services and ARV therapy.

Due to the epidemiologic particularity, namely the long term survivals, who have experienced multiple therapeutic schemes, the problem of ART resistance is major, with many implications in the design of potent therapeutic schemes.

The activity related to HIV/AIDS in Romania is coordinated by Ministry of Health and National Health Insurance House, which provide both the activity of prevention and the specific ART treatment.

The order approving the technical norms for national health programs, during 2011-2012 manages (1591/1110, December 2010):
The program for surveillance and control of the HIV infection through National Institute of Public Health and National Institute of Infectious Diseases Prof. Dr. Matei Bals, the nine Regional HIV/AIDS Centers and Public Health Counties.

The program for surveillance and control for the abovementioned period targets:
Maintaining a low rate of incidence at the adult population; The reduction of mother to child transmission.

The program addresses to the general population and to the vulnerable groups (see HIV TESTS* BY RISK GROUPS IN 2011 slide).

The treatment program is coordinated by National Institute of Infectious Diseases Prof. Dr. Matei Bals, the nine Regional HIV/AIDS Centers and sustained by National Health Insurance House.

The HIV/AIDS Strategy for 2011-2015 is in process of approval.

Guiding principles of National HIV/AIDS Strategy

1. 2. HIV/AIDS represents more than a public health priority. It is a complex problem, which affects all the layers of a society. The strategy will emphasize the prevention methods against HIV transmission and the reduction of the social impact. The assigned resources must take in consideration vulnerable groups and individuals at risk as well as the affected communities. Multisectoral and interdisciplinary involvement at a national level is essential for an adequate answer to the HIV/AIDS problem. Vulnerable persons and groups at risk must have the necessary knowledge and access to adequate services in view of preventing the infection with HIV virus.

3. 4.

Guiding principles of National HIV/AIDS Strategy

5. HIV/AIDS programs/interventions, especially those addressing to vulnerable and at high risk of infection groups must be adapted to age, sex, culture and behavious differences. All PLWHA or diagnosed with AIDS, as well as vulnerable groups have equal and permanent to tratement, medical care and social services, in accordance with according the standards stipulated by the legislation. The rights of PLWHA and of vulnerable groups are granted by the national legislation and by the International Ttreaties, which Romania signed. Law establishes individual responsibilities of PLWHA.

6.

7. 8.

Guiding principles of National HIV/AIDS Strategy

9. Universal precautions will be applied in view of preventing all possibilities of HIV transmission, within the sanitary and the social assistance systems. HIV testing is voluntary, and/or anonymous, confidential, accompanied by pre- and post - test counselling, in both private and state sectors. The form of policies and and socio-economic programs development must also be based on HIV/AIDS phenomenon. The present strategy serves as a main orientation document for the elaboration of programs and national, local projects of intervention within the HIV/AIDS field.

10.

11. 12.

MINISTRY OF HEALTH NATIONAL INSTITUTE OF INFECTIOUS DISEASES PROF.DR.MATEI BAL Compartment for Monitoring and Evaluation of HIV/AIDS Infection in Romania GENERAL DATA AT 30 SEPTEMBER 2011

TOTAL HIV/AIDS CASES (CUMULATIVE 1985-2011) OUT OF WHICH:

HIV/AIDS CASES at children (0-14 years at diagnosis date) HIV/AIDS CASES at adults (> 14 years at diagnosis date)

17.212
9.866 7.346

Total no. of AIDS deaths

Out of records HIV/AIDS children + adults

5.850
597

NUMBER OF PLWHA (people living with HIV/AIDS) TOTAL AIDS CASES (CUMULATIVE 1985-2011)
AIDS Cases at children (0-14 years at diagnosis date) AIDS Cases at adults (> 14 years at diagnosis date)

10. 765 12.369

7.941 4.428

TOTAL HIV CASES (CUMULATIVE 1992-2011)

HIV Cases at children (0-14 years at diagnosis date) HIV Cases at adults (> 14 years at diagnosis date)
NEW HIV/AIDS CASES, diagnosed during 01.01 30.09.2011
NEW HIV NOTIFIED CASES NEW AIDS NOTIFIED CASES

4.843
1. 925 2.918
405 226 179

NUMBER OF DEATHS IN 2011 (01.01-30.09.2011)

117

S ource: Compartment for Monitoring and Evaluation of HIV/AIDS Infection in Romania INBI Prof.Dr.M.Bal

MINISTRY OF HEALTH NATIONAL INSTITUTE OF INFECTIOUS DISEASES PROF.DR.MATEI BAL Compartment for Monitoring and Evaluation of HIV/AIDS Infection in Romania GENERAL DATA AT 30 SEPTEMBER 2011

Patients in active records HIV+AIDS Children (0-14 years*) Adults(> 14 years*) Patients with ARV treatment Children (0-14 years*) Adults (> 14 years*) Persons who received ARV prophylaxis Persons who interrupted the ART treatment voluntarily
*current age

8.916
234 8. 682

7.352
192 7.160 384 354

TENDENCES OF THE TRANSMISSION WAY IN ROMANIA 2007-2011

TRANSMISSION WAY Vertical MSM IDU Heterosexual Undetermined Total

2007 9 (2,44%) 14 (3,8%) 3 (0,8%) 278 (75%) 64 (17%) 368

2008 12 (2,7%) 33 (7,5%) 3 (0,7%) 302 (69%) 86 (20%) 436

2009 22 (5%) 34 (8%) 5 (1,1%) 324 (75%) 43 (10%) 428

2010 21 (4,8%) 46 (10,5) 12 (2,7%) 32 (7,3%) 440

30 September 2011 10 (2,5%) 63 (15,5%) 62 (15,3%) 16 (4%) 405

329 (74,7%) 254 (62,7%)

S ursa: Compartimentul pentru Monitorizarea i Evaluarea infeciei HIV/S IDA n Romnia INBI Prof.Dr.M.Bal

TENDENCES OF THE TRANSMISSION WAY IN ROMANIA 2007-2009

2007
17% 1% 2% 4% Vertical MSM Heterosexual IDU Undetermined 76%
68% 1% 20% 3% 8%

2008
Vertical MSM Heterosexual IDU Undetermined

2009
1% 10% 5% 8%

Vertical MSM Heterose xual IDU Undetrem ined

76%

Source: Compartment forMonitoring and Ev aluation of HIV/AIDS Infection in Romania INBI Prof.Dr.M.Bal

TENDENCES OF THE TRANSMISSION WAY IN ROMANIA 2010-2011

2010
3% 7% 5% 10%

30 September 2011
Vertical MSM Heterosexual IDU Undetermined
15% 4% 2% 16%

Vertical MSM Heterosexual IDU Undetermined

63%

75%

Source: Compartment forMonitoring and Ev aluation of HIV/AIDS Infection in Romania INBI Prof.Dr.M.Bal

HIV/AIDS incidence at adults and children, between 1985 2010 (per 100.000)
6 5,65 5,43 5,19 5 4,98 4,83

4,13 3,91

3 2,78 2,27 2 1,76 1,5 1 1,09 0,84 0,59 0,08 1992 0,08 0,09 0,2 0,29 1996 1997 1998 1999 2000 2001 2002 2003 2004 0,52 0,7 0,59 1,17 1,22 1,43 1,12 1,06 0,83 0,54 0,39 0,45 0,27 2007 0,21 0,27 0,43 1,3 1,25 1,24

1993

1994

1995

2005

2006

2008

2009

2010

Children

Adults

Children 2010: 0,43/100.000 Adults 2010: 1,24/100.000

Source: Compartment for Monitoring and Evaluation of HIV/A IDS Infection in Romania INBI Prof.Dr.M.Bal

AGE PYRAMID TOTAL 31 DECEMBER 2010

AGE AT DISCOVERY/NOTIFICATION DATE TOTAL 1985-2010
sex GENDER F
peste 70 ani 65-69 ani 60-64 ani 55-59 ani 50-54 ani 45-49 ani
grupa varsta A gede group

CURRENT AGE

M
peste 70 ani 65-69 ani 60-64 ani 55-59 ani 50-54 ani 45-49 ani 40-44 ani 35-39 ani 30-34 ani 25-29 ani 21-24 ani 19-20 ani 17-18 ani 15-16 ani 10-14 ani 5-9 ani 1-4 ani 0-1 an peste 65 ani 60-64 ani 55-59 ani 50-54 ani 45-49 ani

SEX GENDER

M
peste 65 ani 60-64 ani 55-59 ani 50-54 ani 45-49 ani
grupa de varsta

40-44 ani 35-39 ani 30-34 ani 25-29 ani 21-24 ani 19-20 ani 17-18 ani 15-16 ani 10-14 ani 5-9 ani 1-4 ani 0-1 an

A ge group grupa de varsta

grupa de varsta

40-44 ani 35-39 ani 30-34 ani 25-29 ani 20-24 ani 15-19 ani 10-14 ani 5-9 ani 1-4 ani 0-11 luni

40-44 ani 35-39 ani 30-34 ani 25-29 ani 20-24 ani 15-19 ani 10-14 ani 5-9 ani 1-4 ani 0-11 luni

A ge group

A ge group

2,500 2,000 1,500 1,000

500

500

1,000 1,500 2,000 2,500

4,000

3,000

2,000

1,000

1,000

2,000

3,000

4,000

nr cazuri

Count

Count

Source: Compartment for Monitoring and Evaluation of HIV/A IDS Infection in Romania INBI Prof.Dr.M.Bal

AGE PYRAMID (deceased patients vs.PLWHA) BY CURRENT AGE

DECEASED PLWHA

Current age

Current age

No. cases

No. of cases

Analysis of the survival rate, Kaplan-Meier type

50% of deaths had a mean period of survival (POS)< 50 months; 25% of deaths had a mean POS of 50 months; 10% of deaths had a mean POS 100 months; Limits: periods without treatment, ARV schemes, duration of treatment are excluded Mean POS= 37.4 months (C.I.95% 35,1-38,1)
Mean POS for men= 36,6 months (C.I.95% 35,1-38,1) Mean POS for women= 38,6 months (C.I.95% 36,7-40,5)

months
Source: Compartment for Monitoring and Ev aluation of HIV/AIDS Infection in Romania INBI Prof.Dr.M.Bal

PATIENTS WITH ART AND IN ACTIVE RECORDS BY REGIONAL CENTRES 30 SEPTEMBER 2011
3000 2734 2492 2500

2000

1852

1500 1154 1000 914 744 518 500 189 170 0 INBI M.BAL S V.BABES BRASOV CLUJ CONSTANTA ART CRAIOVA 245 204 460

1345 1166

760 662

359 301

IASI

T G.MURES

TIMISOARA

ACT IVE RECORDS

Source: Compartment for Monitoring and Evaluation of HIV/A IDS Infection in Romania INBI Prof.Dr.M.Bal

ARV SCHEMES AT 30 SEPTEMBER 2011

1% 2% 2%

1% 2%

10%

18%
2 1 3 2 INRT + 1 IP/r INRT + 1 INNRT + 1 IP/r INRT INRT + 1 IP/r + 1 II

64%
2 INRT + 1 INNRT 3 INRT + 1 IP/r 2 INRT + 1 INNRT + 1 IP/r OTHER

Source: Compartment for Monitoring and Ev aluation of HIV/AIDS Infection in Romania INBI Prof.Dr.M.Bal

ADULTS ( 15 YEARS): NUMBER OF ARV SCHEMES, PRIOR TO THE CURRENT ONE NO. OF PATIENTS
0% 0% 0% 0% 20 %

1% 00% % 2% 0% 11% 6% 3%

0 sc hemes 1 schemes 2 sc hemes 3 sc hemes 4 sc hemes 5 sc hemes 6 sc hemes 7 sc hems 8 sc hemes 9 sc hemes 10 schemes 11 sc hemes

2 2% 15 % 2 0%

12 schemes 13 schemes 14 schemes 17 schemes

Source: Compartment for Monitoring and Ev aluation of HIV/AIDS Infection in Romania INBI Prof.Dr.M.Bal

CHILDREN (0-14 YEARS): NUMBER OF ARV SCHEMES, PRIOR TO THE CURRENT ONE

4% 10%

2%

1% 1% ? 29% 0 schemes 1 schemes 2 schemes 3 schemes

23% 4 schemes 30% 5 schemes 8 schemes

Source: Compartment for Monitoring and Ev aluation of HIV/AIDS Infection in Romania INBI Prof.Dr.M.Bal

AVERAGE SURVIVAL PERIOD (IN MONTHS) OF AIDS PATIENTS , BETWEEN 1990 - 2010

90 80 70 60 50 40 30 20 10 0 No. of months 90 3 91 9 92 16 93 18 94 28 95 26 96 31 97 34 98 36 99 42 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 44 42 56 60 55 57 61 77 82 83 82

Initiation of ART bi therapy

Initiation of ART tri therapy

Source: Compartment for Monitoring and Evaluation of HIV/A IDS Infection in Romania INBI Prof.Dr.M.Bal

HIV TESTS* BY RISK GROUPS IN 2011

Risk group
STI TBC MATERNITY PREGNANT WOMEN MEDICAL STAFF HEMODIALYSIS TRANSFUSION RECEPIENT PRENUPTIAL CHECK-UP IV DRUG USERS INMATES MSM SEX WORKERS HIV CONTACTS SAILORS DRIVERS WORK ABROAD > 6 MONTHS STAY ABROAD > 6 MONTHS REQUEST OCCASIONAL

Negative tests
2960 11201 411 91068 6748 2598 230 4989 42 304 50 66 693 5625 15 359 115 86472 15228 229174

Positive tests
23 168 27 68

TOTAL

%POZITIVE

2983 11369 438 91136 6748 2598 230

0,77 1,48 6,16 0,07 0,00 0,00 0,00 0,10 6,67 0,00 12,28 5,71 8,09 0,04 0,00 0,28 0,86 1,05 4,87 0,89

5 3

4994 45 304

7 4 61 2

57 70 754 5627 15

1 1 918 780

360 116 87390 16008

* The data is received from County Public Health Authorities

TOTAL

2068

231242

Source: Compartment for Monitoring and Evaluation of HIV/A IDS Infection in Romania INBI Prof.Dr.M.Bal

POSITIVE TESTS BY RISK GROUPS IN 2011 (%)*

0% 0% 0% 0% 0% 0% 0% 1% 1% 3% 3%
PRENUPTIAL CHECK-UP IDU MSM

8%

SEX WORKERS SAILORS STAY ABROAD > 6 MONT HS WORK ABROAD > 6 MONT HS STI MATE RNITY HIV CONTACTS PREGNANT WOMEN

39%

45%

TBC REQUEST OCCA SIONAL

*From 2527 positive tests

Source: Compartment for Monitoring and Evaluation of HIV/A IDS Infection in Romania INBI Prof.Dr.M.Bal

HIV TESTINGS IN STI PATIENTS

16000 14000 12000 50 10000 40 70

60

T ota l tes ts

8000 30 6000 20 4000 2000 0 10

YEAR
Positive testings

91

92

93

94

95

96

97

98

99

'00

'01

'02

'03

'04

'05

'06

'07

'08

'09

' 10

TOTAL NO. OF TESTS 4106 3779 4741 3116 3725 3849 4317 4873 5200 10640 8216 14414 13283 14856 12139 6149 5632 9343 5353 4019 8 6 6 4 23 19 24 21 19 39 46 60 42 43 29 21 35 27 27 27

TOTAL NO. OF TESTS

Positive testing s

Source: Compartment of Monitoring and Evaluation of HIV/AIDS data in Romania INBI Prof.Dr.M.Bal

P ositi ve tests

HIV TESTINGS IN TBC PATIENTS

18000 16000 14000 140 120 100 12000 10000 8000 6000 40 4000 2000 0 20 0 80 60

YEAR
Postive tests

'90

'91

'92

' 93

'94

'95

'96

'97

' 98

' 99

'00

'01

'02

'03

' 04

'05

'06

'07

'08

' 09

'10

Total no. of testings 1300 842 821 1662 1067 597 3451 3195 1527 1822 10719 10578 11946 11025 7440 10392 10821 11832 15799 14032 13451 15 18 8 14 15 23 27 25 19 39 54 37 55 55 47 75 84 94 113 101 128

Source: Compartment of Monitoring and Evaluation of HIV/AIDS data in Romania INBI Prof.Dr.M.Bal

P o s itiv e te s ts

T o ta l te s ts

HIV TESTINGS IN BLOOD DONORS

60000 0 60

50000 0

50

30000 0

30

20000 0

20

10000 0

10

0 1990 1991 1992 199 3 199 4 199 5 199 6 19 97 1 998 1 999 2 000 2 001 2002 2003 2004 2005 2006 2007 2008 2009 2010

YEAR
Po stiv e test s

Total no. of te stings 3E+0 5 5E+05 4E+05 5 E+05 5 E+05 6 E+05 4 E+05 5E+05 5E+05 4E+05 3E+05 4E+05 4E+05 3E+05 4E+0 5 4E+0 5 3E+0 5 3E+05 4E+05 4 E+05 4E+05 20 12 19 33 21 14 18 34 29 21 20 35 15 29 28 17 19 25 38 36 50

Tot al no. o f t est ing s

Pos tiv e t est s

Source: Compartment of Monitoring and Evaluation of HIV/AIDS data in Romania INBI Prof.Dr.M.Bal

Positive tests

40000 0

40

Total tests

HIV TESTINGS IN PREGNANT WOMEN

120000 100000 140 120 100 80 60000 60 40000 20000 0 40 20 0

80000

YEAR
Total no. of testings Postive tests

' 93 890 0

' 94

' 95

' 96

'97

'98

'99

'00

'01

'02

'03

'04

'05

'06

'07

' 08

' 09

' 10

711 13166 5823 17367 4580 7746 27367 26064 43024 51978 72802 61127 78020 81439 100061 99730 111037 0 3 0 3 1 2 11 15 33 27 40 62 81 86 107 83 117

Source: Compartment of Monitoring and Evaluation of HIV/AIDS data in Romania INBI Prof.Dr.M.Bal

P o si tiv e te s ts

T o ta l te s ts

TESTINGS IN HIV CONTACTS

1200 1000 100 90 80 70 60 600 400 200 0 50 40 30 20 10

800

YEAR
Total no. of testings Positive testings

' 01 769 7

' 02 655 19

'03 977 36

'04 563 23

'05 383 39

'06 569 17

'07 704 35

'08 966 92

'09 909 70

'10 976 78

Source: Compartment of Monitoring and Evaluation of HIV/AIDS data in Romania INBI Prof.Dr.M.Bal

P o s itiv e te s ts

T o ta l te s ts

REQUESTED HIV TESTINGS

140000 120000 2000 100000 80000 60000 40000 500 20000 0 0 2500

1500

1000

YEAR
Total no. of testings Positive tests

2003 78915 1349

2004 101392 1926

2005 89537 884

2006 81099 945

2007 99524 1098

2008 107998 838

2009 118981 893

2010 117345 918

Source: Compartment of Monitoring and Evaluation of HIV/AIDS data in Romania INBI Prof.Dr.M.Bal

P o s itiv e te s ts

T o ta l te s ts

HIV TESTINGS* AT PREGNANT WOMEN BY AGE GROUPS IN 2011

8%

2%

5% 0,24%

9%

26%

21%

29%

12-14 years 30-34 years

15-19 years 35-39 years

20-24 years > 40 years

25-29 years Unknown age

Source: Compartment for Monitoring and Evaluation of HIV/A IDS Infection in Romania INBI Prof.Dr.M.Bal

TB global incidence in Romania 1985-2009

160 142,2 140 123,7 119,6 115,4 106,5 95 82,5 73,5 64,6 61,6 58,3 87,4 98,7 97,8 102,1 103,8 134,1 121,9 116,2 114,3 135,6 134,6 123,6 113,5 106,4 103,3 93,9 105,5 99,9 83,2

120 102,6 100 79,6 80 63,4 58,2 61,3 70 66,8 55,8 56,4 94,2 89,4

114,5 107 106,8

87,8 87,1

60

50,7 51,3 53,2 56,2 40

20 5,1 0 5,1 5 5,1 5,1 5,4 5,2 6,1 6,9 6,8 7,6 8,3 9

12,4

15,8

20,3 19,4 20,3 20,3 19,6 18,6 18,4 17,2 18,7 16,7

1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

New cases & Relapses

New cases

Relapses

Source: National Institute of Pneumoftiziology Marius Nasta, Bucharest

Number of TB new cases and relapses, 1985-2009

35000 30984 30044 30000 25765 24189 25000 21422 20349 20000 18097 16256 18773 15482 14676 14137 12860 16719 15000 13361 12677 14997 14275 13494 12960 12222 10000 11519 11692 21538 19871 22317 22976 22157 23271 23304 24189 27756 26847 29470 29163 26722 24640 22921 22348 20396 18914 22679 21457

26567 25847 25245 24776 23897

18717

17866

5000 1158 0 1177 1182 1259 1207 1378 1576 1551 1733 1872 1168 1139 2032

2789

3543 3859

4197 4417

4225

4387 4374

4244

4007 3962 3591

1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 N ew cases&Relapses New cases Relap ses

Source: National Institute of Pneumoftiziology Marius Nasta, Bucharest

HIV-TB association
Current situation : - In 2009 142 cases of HIV-TB co-infection were registered, out of which 78 at the new AIDS cases (2 children and 76 adults). - In 2010 178 cases of HIV-TB co-infection were registered, out of which 66 at the new AIDS cases (1 child and 65 adults).
Source: Compartment for Monitoring and Evaluation of HIV/A IDS Infection in Romania INBI Prof.Dr.M.Bal

AIDS INDICATIVE DISEASES IN 2010

Recurrent sepsis Burkitt l imphoma Unspecified lymphoma Extrapul monary tuberculosi s Pul monary tuberculosis Progressive mul tifocal l eukoencephalopathy Herpes Simplex Vi rus Infection Cryptococcosis CMV disease Kaposi' s Sarcoma Toxoplasmosis Recurrent pneumonia Encephal opathy HIV related Pneumocysti s pneumoni a Wasti ng syndrome Pulmonary candidiasis: bronchi/trachea/lung Oesophageal candidiasis 0 20 40 60 80 100 120 140 160 180

Source: Compartment for Monitoring and Evaluation of HIV/A IDS Infection in Romania INBI Prof.Dr.M.Bal

AIDS INDICATIVE DISEASES IN 2011

Cryptosporidiosis Recurrent sepsis Burkitt l imphoma Unspecified lymphoma Extrapul monary tuberculosi s Pul monary tuberculosis Progressive mul tifocal l eukoencephalopathy Herpes Simplex Vi rus Infection Cryptococcosis CMV disease Kaposi' s Sarcoma Toxoplasmosis Recurrent pneumonia Encephal opathy HIV related Pneumocysti s pneumoni a Wasti ng syndrome Pulmonary candidiasis: bronchi/trachea/lung Oesophageal candidiasis 0 20 40 60 80 100 120 140

Source: Compartment for Monitoring and Evaluation of HIV/A IDS Infection in Romania INBI Prof.Dr.M.Bal

The immunologic and virologic data represent the joint effort of laboratories in the nine Regional Centers in collaboration with Compartment for Monitoring and Evaluation of HIV/AIDS data in Romania, in National Infectious Diseases InstituteBucharest.

Infectious Diseases Hospital

Regional Centers University Clinics

County Public Health

National Institute of Infectious Diseases Prof. Dr. Matei Bals

M.O.H.

Naional Institute of Statistics

ECDC Stockholm

WHO- Copenhagen

The data is collected from the HIV/AIDS confirmation charts, sent by the nine Regional Centers for Evaluation and Monitoring of HIV/AIDS Data and further processed and elaborated by Compartment for Monitoring and Evaluation of HIV/AIDS data in Romania, in National Infectious Diseases InstituteBucharest.

NATIONAL INSTITUTE OF INFECTIOUS DISEASES PROF.DR.MATEI BAL Compartment for Monitoring and Evaluation of HIV/AIDS Infection in Romania

Manager:

Prof Adrian Streinu-Cercel Head of Infectious Diseases Dep. Carol Davila Medicine and Pharmacy Univ. President of Infectious Diseases and AIDS Commission

Coordinator: Coordinator of Adults Program: Coordinator of Children Program:

Dr. Mariana M rdrescu Conf.Dr.Elisabeta Otilia Benea Dr.Sorin Petrea

Statistical data operators :

PC Operators:

As.med. Marieta Iancu Daniela Vielaru Sanda Vintil

Collaborators:

Dr. Ionel Iosif- ISP Bucuresti Romanian HIV/AIDS Center