Update and Challenges on HIV Infection in Romania in worldwide context

Abstract

The issue to be addressed are the nowadays particularities and challenges of HIV infections in Romania and worldwide. Based on official data, other relevant information and our clinical experience, we have reviewed transmission, prevalence, screening, diagnostic and therapy of HIV Infection in Romania, identified problems, considered modern therapies and alternative management options, drawing logical conclusions and reflecting on possible solutions.

Introduction: The UN and EU proposed aim of eradicating HIV infection is worldwide hardly to attain. HIV virus primarily attacks T helper cells/ CD4+cells, which are  T-lymphocyte cells with a critical role for immune system. If HIV infection goes untreated, the virus replicates in the host cells, destroying CD4+ cells. The remaining infected cells release virions, which infect other cells, leading to rapid spreading of the virus in the body (1). The loss of CD4+ T lymphocytes results in incapacity to develop a proper immune response against bacterial and fungal infections, like Tuberculosis, Pneumocystis or Cryptococcus, but also against viral infections like Herpes and against cancers, like lymphoma and Kaposi‘s Sarcom.

The CD4+count remains the most significant predictor for HIV disease progression. The normal CD4+count is >500/microL. When CD4+cells are lower than 200/microL, AIDS is diagnosed.

Method: Critical thinking methodology based on national and european statistics, focusing on problem analysis and options to resolve the problems.

Results: Romania has a very low incidence of new HIV cases comparative to EU, due to an effective national surveillance system, including early testing for risk groups. However, prevention through medication (PrEP) and new long-acting antiviral therapies are lacking and a lot of HIV-infected people are currently not under treatment.

Conclusions: Particular to Romanian HIV Infection is the long- living cohort of previous babies with HIV perinatally transmission, followed from nowadays predominant heterosexuell transmission. Another particularities are the late diagnosis to not at risk categories and the Tuberculosis co-infection.

More HIV Testing, inclusive to general practitioners and emergency-rooms, also self-testing, could make possible earlier diagnosis and therapy. Pre-exposure therapies (PrEP) and post- exposure prophylaxis (PEP) could be largely implemented, to prevent spriding of the virus.