Velida Mulabdic

Human herpesvirus 8 (HHV-8) is associated with Kaposi sarcoma (KS), multicentric Castleman disease (MCD), and primary effusion lymphoma (PEL), important causes of morbidity among people living with HIV. Data on these diseases remain limited from Central and Eastern Europe compared with Western Europe. We conducted a multicentre cross-sectional survey, using an online questionnaire distributed to HIV physicians within the Euroguidelines in Central and Eastern Europe Network Group, comprising epidemiology, diagnostic capacity, and management of HHV-8-related diseases. Twenty-six HIV treatment centres from 22 countries participated, providing care for 36,845 people living with HIV. A total of 55 cases of KS (1.49 per 1000 PLWH) were reported, of which 35 (63.6%) had visceral involvement. MCD and PEL were uncommon, with 7 and 4 cases, respectively. Diagnostic capacity varied between centres: computed tomography was available in 80.8%, bronchoscopy in 30.8%, and gastroscopy in 23.1%. Antiretroviral therapy alone was the most common first-line treatment for limited KS, while pegylated liposomal doxorubicin was accessible as first-line and/or second-line treatment in 46.2% of centres. HHV-8-related diseases remain uncommon but clinically relevant complications of HIV infection in Central and Eastern Europe. Regional variability in diagnostic resources and treatment availability highlights the need for strengthened referral pathways and guideline-adherent care.

Introduction: The Central and Eastern Europe (CEE) region differs in access to HIV and co-infections care and treatment. The aim of the study was to analyze the relation between the severity of the COVID-19 disease and HIV specific factors in the European Union (EU) Countries and in non-European Union (non-EU) Countries.Material and methods: The study was conducted between November 2020 and May 2021. Euroguidelines in Central and Eastern Europe (ECEE) Network Group was collecting observational data on HIV-positive patients diagnosed with COVID-19. In total, 16 countries from CEE (Poland, Czech Republic, Ukraine, Croatia, Turkey, Romania, Belarus, Estonia, Lithuania, Greece, Georgia, Albania, Hungary, Serbia, Bosnia and Herzegovina, and Bulgaria) submitted data on HIV-positive patients using an electronic case report form (eCRF). Chi-Square test was used for group comparisons.Results: In total 557 patients were included into the analyses: 361 from EU and 196 from non-EU countries. Access to remdesivir was 1.5% in non-EU countries vs 3.9% in EU-countries (p= 0.1952) . Symptoms of COVID-19 occurred more often in non-EU countries (93.3%) vs non-EU countries (83.6%) [p=0.0009], as well as hospitalization 32.8% vs. 20.8% respectively [0.0027]. Death/ICU was 4.8% in non-EU countries vs 3.4% in EU-countries (p=0.4877). In total 18 (3.23%) patients found out about HIV diagnosis during COVID-19, which was comparable in two groups (11 [3.0%] in UE countries vs. 7 [3.6%] in non-UE countries; p=0.8029).Conclusions: Patients from non- EU countries were more likely to be COVID-19 symptomatic and hospitalized. Access to antiviral therapy for SARS-CoV-2 was very low for all CEE countries.

(1) Background: Viral hepatitis C (HCV) and viral hepatitis B (HBV) are common co-infections in people living with HIV (PLWH). All PLWH should be vaccinated against HBV and hepatitis A (HAV) and treated for HBV and HCV. We aimed to compare testing, prophylaxis and treatment of viral hepatitis in PLWH in Central and Eastern Europe (CEE) in 2019 and 2022. (2) Methods: Data was collected through two on-line surveys conducted in 2019 and 2022 among 18 countries of the Euroguidelines in CEE (ECEE) Network Group. (3) Results: In all 18 countries the standard of care was to screen all PLWH for HBV and HCV both years; screening of HAV was routine in 2019 in 54.5% and in 2022 47.4% of clinics. Vaccination of PLWH against HAV was available in 2019 in 16.7%, in 2022 in 22.2% countries. Vaccination against HBV was available routinely and free of charge in 50% of clinics both in 2019 and 2022. In HIV/HBV co-infected the choice of NRTI was tenofovir-based in 94.4% of countries in both years. All clinics that responded had access to direct-acting antivirals (DAAs) but 50% still had limitations for treatment. (4) Conclusions: Although testing for HBV and HCV was good, testing for HAV is insufficient. Vaccination against HBV and especially against HAV has room for improvement; furthermore, HCV treatment access needs to overcome restrictions.

With no expected vaccine for HIV in the near future, we aimed to define the current situation and challenges for pre- and post-exposure prophylaxis (PrEP and PEP) in Central and Eastern Europe (CEE). The Euroguidelines CEE Network Group members were invited to respond to a 27-item survey including questions on PrEP (response rate 91.6%). PrEP was licensed in 68.2%; 95 centers offered PrEP and the estimated number on PrEP was around 9000. It was available in daily (40.1%), on-demand (13.3%), or both forms (33.3%). The access rate was <1–80%. Three major barriers for access were lack of knowledge/awareness among people who are in need (59.1%), not being reimbursed (50.0%), and low perception of HIV risk (45.5%). Non-occupational PEP was available in 86.4% and was recommended in the guidelines in 54.5%. It was fully reimbursed in 36.4%, only for accidental exposures in 40.9%, and was not reimbursed in 22.72%. Occupational PEP was available in 95.5% and was reimbursed fully. Although PrEP scale-up in the region has gained momentum, a huge gap exists between those who are in need of and those who can access PrEP. Prompt action is required to address the urgent need for PrEP scale-up in the CEE region.