Anca Streinu-Cercel1,2, Oana Săndulescu1,2, Alina Cristina Neguț1,2, Mioara Predescu2,
Alexandra Mărdărescu3, Mihai Săndulescu1, Adrian Streinu-Cercel1,
Sibiu mai 2016
• Despite the introduction of national immunization against HBV since 1996 through neonatal vaccination and catch-up regimens, hepatitis B remains prevalent and underdiagnosed in Romania in 2016
• Hepatitis C and HIV infection also remain important public health concerns and require the implementation of nationwide screening studies to ascertain real-life incidences and the extent to which they are underdiagnosed.
• We have implemented a study to screen for hepatitis B and C viruses (HBV, HCV) and HIV infection in the general population in Romania
• Patients were referred to the National Institute for Infectious Diseases “Prof. Dr. Matei Balș” from the general practitioner (GP)*
*The GPs were previously trained by infectious diseases
specialists and received support during the program
All subjects voluntary signed a study-specific informed consent form and filled out a questionnaire assessing risk
factors for transmission of HBV, HCV and HIV
We present the results of the first 9937 patients screened in this study from May to August 2015
Screened
9937 pts
Ethnicity Romanian Romani(gipsy)
9 751 pts 186 pts
M/F ratio 36% Male 64% female
Mean age 48 years old ± 29 years
0
100
200
300
400
500
19
23
19
25
19
28
19
30
19
32
19
34
19
36
19
38
19
40
19
42
19
44
19
46
19
48
19
50
19
52
19
54
19
56
19
58
19
60
19
62
19
64
19
66
19
68
19
70
19
72
19
74
19
76
19
78
19
80
19
82
19
84
19
86
19
88
19
90
19
92
19
94
19
96
19
98
20
00
20
02
20
04
20
06
20
08
20
10
20
12
20
14
Distributie dupa an nastere
Results • Out of the total number of 9937 persons
tested, 540 were found positive for HBsAg(5.4%), 267 for anti-HCV (2.7%), and 11 (0.1%) had positive ELISA tests for HIV infection.
• However, viral loads for HBV DNA, HCV RNA and HIV RNA were negative in 230 (42.6%), 104 (39.0%) and 2 (18.2%) cases, respectively.
11,75612,452 12,108
0
2,000
4,000
6,000
8,000
10,000
12,000
14,000
AgHBs Anti HIV 1+2 Anti-HCV
Negativ
Pozitiv
Special populations
• The Romani population group had good addressability to general practitioners and to the screening study.
• Notably, the incidence of HBV, HCV and HIV infection was lower in the Romani group than in the rest of the patients: 2/186 (1.1%) HBV, 1/186 (0.5%) HCV, 0/186 (0%) HIV infection vs. 308/9751 (3.2%) HBV, 162/9751 (1.7%) HCV and 9/9751 (0.1%) HIV infection.
Ag HBs positive
0%10%20%30%40%50%60%70%80%90%
100%
Alb
a
Ara
d
Arg
eș
Bac
ău
Bih
or
Bis
triț
a-N
ăsău
d
Bo
toșa
ni
Bră
ila
Bra
șov
Bu
cure
ști
Bu
zău
Căl
ăraș
i
Car
aș-S
ever
in
Clu
j
Co
nst
anța
Co
vasn
a
Dâm
bo
vița
Do
lj
Gal
ați
Giu
rgiu
Go
rj
Har
ghit
a
Hu
ned
oar
a
Ialo
miț
a
Iași
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v
Mar
amu
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ți
Mu
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mț
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Satu
Mar
e
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iu
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ava
Tele
orm
an
Tim
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Tulc
ea
Vâl
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nce
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Rezultat HBV-DNA la pacienții cu AgHBs pozitiv
Nedetectabil
Detectabil
50%55%60%65%70%75%80%85%90%95%
100%
Alb
a
Ara
d
Arg
eș
Bac
ău
Bih
or
Bis
triț
a-N
ăsău
d
Bo
toșa
ni
Bră
ila
Bra
șov
Bu
cure
ști
Bu
zău
Căl
ăraș
i
Car
aș-S
ever
in
Clu
j
Co
nst
anța
Co
vasn
a
Dâm
bo
vița
Do
lj
Gal
ați
Giu
rgiu
Go
rj
Har
ghit
a
Hu
ned
oar
a
Ialo
miț
a
Iași
Ilfo
v
Mar
amu
reș
Meh
edin
ți
Mu
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Nea
mț
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Pra
ho
va
Săla
j
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e
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iu
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ava
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orm
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Tim
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Un
k
Vâl
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nce
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Chart Title
Pozitiv
Negativ
Ab HCV positive
0%10%20%30%40%50%60%70%80%90%
100%
Rezultat HCV-RNA la pacienții cu AcHCV pozitiv
Detectabil
Nedetectabil
50%
55%
60%
65%
70%
75%
80%
85%
90%
95%
100%
Alb
a
Ara
d
Arg
eș
Bac
ău
Bih
or
Bis
triț
a-N
ăsău
d
Bo
toșa
ni
Bră
ila
Bra
șov
Bu
cure
ști
Bu
zău
Căl
ăraș
i
Car
aș-S
ever
in
Clu
j
Co
nst
anța
Co
vasn
a
Dâm
bo
vița
Do
lj
Gal
ați
Giu
rgiu
Go
rj
Har
ghit
a
Hu
ned
oar
a
Ialo
miț
a
Iași
Ilfo
v
Mar
amu
reș
Meh
edin
ți
Mu
reș
Nea
mț
Olt
Pra
ho
va
Săla
j
Satu
Mar
e
Sib
iu
Suce
ava
Tele
orm
an
Tim
iș
Tulc
ea
Un
k
Vâl
cea
Vas
lui
Vra
nce
a
Chart Title
Pozitiv
Negativ
Ab HIV
80%
85%
90%
95%
100%
Alb
a
Ara
d
Arg
eș
Bac
ău
Bih
or
Bis
triț
a-N
ăsău
d
Bo
toșa
ni
Bră
ila
Bra
șov
Bu
cure
ști
Bu
zău
Căl
ăraș
i
Car
aș-S
ever
in
Clu
j
Co
nst
anța
Co
vasn
a
Dâm
bo
vița
Do
lj
Gal
ați
Giu
rgiu
Go
rj
Har
ghit
a
Hu
ned
oar
a
Ialo
miț
a
Iași
Ilfo
v
Mar
amu
reș
Meh
edin
ți
Mu
reș
Nea
mț
Olt
Pra
ho
va
Săla
j
Satu
Mar
e
Sib
iu
Suce
ava
Tele
orm
an
Tim
iș
Tulc
ea
Un
k
Vâl
cea
Vas
lui
Vra
nce
a
Număr pacienți testați pe județe
Pozitiv
Negativ
0%
50%
100%
Arad Argeș Brașov București Constanța Covasna Olt Tulcea Total
Rezultat HIV-RNA la pacienții cu AcHIV pozitiv
Detectabil
Nedetectabil
• Among self-declared diabetic patients, the seroprevalence of HCV Ab was 6.2%, compared with 2.8% in the rest of the study population, p=0.008, χ(2)=9.745.
• This association was however not true for HIV infection (0% vs. 0.1%, p=0.820), or for HBV infection (6.2% vs. 5.7%, p=0.939)
• Patients reporting previous STDs had a higher prevalence of HBV infection (16.7% vs. 5.7%, p=0.020),
• but not HCV (0% vs. 2.9%, p=0.620) or HIV (0% vs. 0.1%, p=0.980)
• Patients reporting chronic kidney diseases had a higher prevalence of HCV infection (7.4% vs.2.9%, p<0.001), but not HBV (10.5% vs. 5.7%, p=0.128) or HIV (0% vs. 0.1%, p=0.031).
• Patients reporting hemodialysis had a higher prevalence of HCV infection (10.5% vs.2.9%, p=0.024), but not HBV (10.5% vs. 5.7%, p=0.277) or HIV (0% vs. 0.1%, p=0.952)
• Patients reporting needle sharing had a higher prevalence of HCV infection (20% vs.2.9%, p=0.032), but not HBV (0% vs. 5.7%, p=0.554) or HIV (0% vs. 0.1%, p=0.987)
• Interestingly, patients reporting intercourse with more than one partner in the past 6 months had consistently lower prevalences of HCV (1.3% vs.3 %, p=0.030), HBV (3.4% vs. 5.8%, p=0.016) or HIV infection (0.1% vs. 0.1%, p=0.493), suggesting a better adherence to barrier protection.
Conclusion
• The preliminary results of the study characterized the relative incidence of HBV, HCV and HIV infection in Romania.
• The study group was representative, and the age distribution was normal, suggesting that the data are valid for the general population in Romania, although specific high-risk groups still need to be defined.
• The relative incidences of HIV and hepatitis B and C in this study were fairly low, and the Romani population had lower incidences compared with the rest of the group, suggesting that these viral infections may still be underdiagnosed in the general population.
VHB 5,4%
VHC 2,7%
HIV 0,1%
• O15. Romanian nationwide screening for infection with HIV and hepatitis B and C viruses
•
• Anca Streinu-Cercel1,2, Oana Săndulescu1,2, Alina Cristina Neguț1,2, Mioara Predescu2, Alexandra Mărdărescu3, MihaiSăndulescu1, Adrian Streinu-Cercel1,2
•
• 1Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
• 2National Institute for Infectious Diseases “Prof. Dr. MateiBalș”, Bucharest, Romania
• 3Romanian HIV Center, Bucharest, Romania
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