Epidemiology of HIV in Croatia

Virus humane imunodeficijencije (HIV) uzročnik je kronične progresivne bolesti koja u zaraženih osoba klinički varira od asimptomatske bolesti prepoznatljive prema laboratorijskim nalazima (HIV-bolest) do stanja potpunog uništenja imunosnog sustava, što rezultira pojavom sindroma stečene imunodeficijencije. Tri su glavna puta kojima se prenosi infekcija HIV-om: spolni put, prijenos krvlju i prijenos sa zaražene majke na dijete tokom trudnoće, poroda ili dojenja. Kako se infekcija manifestira širokim spektrom kliničkih sindroma, ona često duže vrijeme ostaje neprepoznata. Dijagnoza bolesti postavlja se najprije imunoenzimskim ELISA testom nakon čega slijedi potvrđivanje dijagnoze Western blot testom. Početno liječenje HIV-infekcije provodi se primjenom kombinacije dvaju analoga nukleozida/nukleotida s jednim lijekom iz navedenih skupina: nenukleozidnim analogom, inhibitorom integraze ili inhibitorom proteaze potpomognutim niskim dozama ritonavira. Bolest uzrokovana HIV/AIDS-om spada u bolesti pandemijskih razmjera. U svijetu se najviše oboljelih nalazi na području subsaharske Afrike (24.7 milijuna ljudi). U Hrvatskoj je u cjelokupnom razdoblju praćenja (1985.-2014.g) od HIV bolesti oboljelo 1208 ljudi, od čega se njih 441 nalazi u stadiju AIDS-a. Umrlo je 212 ljudi zaraženih HIV-om, od čega je njih 180 imalo AIDS. Prosječan broj novootkrivenih slučajeva HIV-a godišnje u Hrvatskoj je u zadnjih pet godina oko 80 ( raspon od 70 do 92). U ukupnom broju svih slučajeva zaraze HIV-om, 1042 zaraženih (86%) su muškog spola, a 166 zaraženih (14%) su žene. Najveći broj novo dijagnosticiranih zaraza HIV/AIDS-om (53%) otkriva se kada oni imaju između 25 i 39 godina. Najučestaliji način prijenosa u Hrvatskoj je putem homoseksualnih odnosa u 59,1 %, slijedi heteroseksualni put u 29,2 %, zatim intravensko uzimanje droga u 5,9 % te transfuzija zaražene krvi u 1,4 % slučajeva. Vertikalni put prijenosa registriran je u 1,2%, a nepoznat put prijenosa u 3,3% slučajeva. Mjere prevencije nužne su kako bi se smanjio rizik od širenja bolesti u budućnosti i održala sadašnja niska razina novooboljelih od HIV-a.Human immunodeficiency virus (HIV) is the cause of a chronic progressive disease which, among the patients, clinically varies from an asympthomatic disease recognizable by laboratory test results (HIV-infection) to a state of completely distroyed immune system called acquired immune deficiency syndrome (AIDS). There are three common ways of transmission of HIV infection: sexual transmission, blood transmission and transfer from infected mother to child during the pregnancy, delivery or breast-feeding. As the infection is manifested with a wide range of clinical syndromes, it is usually undetected for a long time. The diagnosis of the infection is made by immunoenzyme ELISA test and then confirmed by Western blot test. HIV-infection can be treated by the combination of 2 nucleoside/ nucleotide reverse transcriptase inhibitors with one of the following drugs: non nucleoside reverse transcriptase inhibitor, integrase inhibitor or protease inhibitor combined with low-dose ritonavir. HIV/AIDS disease has a pandemic proportions. The largest number of infected people lives in the Sub-Saharan Africa (24.7 million). The overall period of monitoring in Croatia (1985-2014) shows that there have been 1208 people infected with HIV and 441 of them have had AIDS. 212 HIV infected people died and 180 of them were at the stage of AIDS. The average number of new cases of HIV in Croatia in the last 5 years has been around 80 people per year ( range from 70 to 92). The total number of cases of infection shows that there have been 1042 infected men (86%), and 166 infected women (14%). The most of the new cases of HIV/AIDS infection (53%) have been diagnosed when patients were 25 to 39 years old. The most common way of HIV transmission in Croatia is through homosexual intercourse (59,1%), followed by heterosexual intercourse (29,2%), by intravenous drug use (5,9%) and by transfusion of the infected blood (1,4%). Vertical transmission of HIV has been registrated in 1.2%, and unknown path of transmission in 3.3% of cases. The prevention of HIV infection is necessary to reduce the risk of spreading of the disease in the future and to maintain the low level of the new HIV cases