Eurosurveillance - Volume 18, Issue 48, 28 November 2013

In 2012, newly reported human immunodeficiency virus diagnoses in the European Union /European Economic Area remained stable at around 30,000 cases. Since 2003, cases in men who have sex with men (MSM) aged 20 to 29 years-old doubled, while the proportion of late presenters in this group remained stable. Persistent declines occurred among older MSM age groups, particularly that between 30 and 39 years-old. Interventions targeting younger MSM are needed to prevent a resurgence of the epidemic in Europe.

In most European Union (EU)/European Economic Area (EEA) countries, between 2010 and 2012, reports of new human immunodeficiency virus (HIV) diagnoses among people who inject drugs have been stable or declining. HIV outbreaks in Greece and Romania, first reported in 2011, continue and economic conditions hinder provision of effective response coverage. When measured against some established thresholds, prevention coverage remains inadequate in at least one-third of EU/EEA countries. Urgent consideration to scale up prevention efforts is merited.

Re-emergence of the human immunodeficiency virus (HIV) epidemic among men who have sex with men (MSM) has been observed in countries of western Europe, North America and Australia since the mid-1990s. We aimed to describe the trends in notification rate of HIV infection among MSM in Poland in order to provide evidence for further public health action. We performed a descriptive analysis of 2000-11 surveillance data, accounting for missing information on transmission category through multiple imputations. There were 9,286 new HIV diagnoses in Poland in 2000-11, ranging from 546 to 1,095 per year. A total of 6,896 cases were male, 1,943 female. For 5,615 (60.5%) new diagnoses, the transmission category was not reported; among the rest, MSM constituted 24.1% (n=885/3,671). The rate of new HIV diagnoses among MSM per million men increased from 2.5 in 2000 to 33.8 in 2011; in the Mazowieckie region, which includes Warsaw, it rose from 2.2 to 88.8, when adjusting for missing data on transmission category. Our results suggest the need for enhanced, comprehensive prevention among MSM, especially in regions where the increasing rate of new HIV diagnoses suggests ongoing transmission. .

The aim of this review is to summarise the evidence on the population-level effect of antiretroviral therapy (ART) in preventing HIV infections, and to discuss potential implications in the European context of recommending starting ART when the CD4 count is above 350 cells/mm³. The ability of ART to reduce the risk of HIV transmission has been reported in observational studies and in a randomised controlled trial (HPTN 052), in which ART initiation reduced HIV transmission by 96% within serodiscordant couples. As yet, there is no direct evidence for such an effect among men having sex with men or people who inject drugs. HPTN 052 led international organisations to develop recommendations with a higher CD4 threshold for ART initiation. However, there remains a lack of strong evidence of clinical benefit for HIV-positive individuals starting ART with CD4 count above 350 cells/mm³. The main goal of ART provision should be to increase ART coverage for all those in need, based on the current guidelines, and the offer of ART to those who wish to reduce infectivity; increased HIV testing is therefore a key requirement. Other proven prevention means such as condom use and harm reduction for people who inject drugs remain critical.