New data from European investigators presented at the 8th European Conference on Clinical Aspects and Treatment of HIV Infection in Athens today illustrate the shifting dynamics of the HIV epidemic amongst Europeans, and the likely challenges of the future. Amongst them high rates of co-infection with hepatitis C virus, and emerging outbreaks of both HIV infection and AIDS in often socially deprived African migrant populations.
The World Health Organisation estimates that to the end of 2000, there have been 540,000 HIV infections in Western Europe. Relative to other regions, the epidemic here is considered to be relatively stable. Changes have occurred nevertheless - while those affected initially have predominantly been gay and bisexual men and injecting drug users, heterosexually acquired cases make up an increasing proportion of those diagnosed.
HIV and AIDS in Paris
Delassus and colleagues from the Seine-Saint-Denis suburb of Paris described recent trends in HIV diagnoses amongst the local population. Seine-Saint-Denis is the second most important district in France in terms of AIDS incidence, having reported more than 3,000 cases since 1978. The new data involved 782 patients presenting to hospitals in the region between the beginning of 1999 and the end of 2000. About half of this population is made up of migrants from Sub-Saharan African countries. Many are female, often diagnosed during pregnancy.
Remembered by many as the hospital where Diana, Princess of Wales died, Pitie-Salpetriere is sited in a more affluent Parisian district. A retrospective analysis from the hospital's Infectious Diseases Department reported the prevalence of AIDS cases in Paris from 1998 to 2000 (Ghosn). Whilst cases have been less frequent since the introduction of HAART, the annual prevalence remains significant, having fallen from 12% during 1994 to 1996, to 3% in later years. The total number of cases between 1998 and 2000 was 224. Around half of these were in people who were not aware of their HIV-positive status. Mirroring the findings of Delassus, Ghosn reported the emergence of a new AIDS population, with a predominance of heterosexuals, people of Africa origin, and people of low socio-economic status.
Co-infection with hepatitis C virus in Belgium
Data from the USA suggest that around 15% of HIV-positive people are co-infected with hepatitis C virus (HCV). According to new information from de Wit and colleagues at Brussels' major HIV treatment centre, the rate of co-infection in Belgium is similarly substantial.
Seven hundred and sixty-five HIV-positive patients attending the Saint Pierre University Hospital between June 1997 and May 2001 were screened for HCV infection. Seventeen per cent were found to be HCV-positive. Prevalence amongst gay and bisexual men was 8%, much lower than in other groups. The co-infection rate in injecting drug users was 47%, but this was little different to that seen in heterosexuals, 42% of whom were HCV-positive. Overall, the prevalence of HCV infection amongst those who contracted HIV via sexual exposure was 10%, pointing to the importance of sexual transmission in HCV epidemiology, a route which is being increasingly recognised.
According to de Wit, "These data confirm that co-infection with HIV and HCV will represent a major health challenge in the coming years".
Delassus JL et al. Picture of HIV epidemic through the newly followed patients in a poor suburb of Paris. 8th European Conference on Clinical Aspects and Treatment of HIV Infection, Athens 28-31 October, abstract P353, 2001.
Ghosn J et al. Who gets AIDS in the HAART era? A retrospective analysis in Paris 1998-2000. 8th European Conference on Clinical Aspects and Treatment of HIV Infection, Athens 28-31 October, abstract P271, 2001.
De Wit S et al. High prevalence of co-infection with HIV and HCV in heterosexuals in Belgium: comparison with other transmission groups. 8th European Conference on Clinical Aspects and Treatment of HIV Infection, Athens 28-31 October, abstract P278, 2001.