6th Regional Conference in Sarajevo, May 17-18 2012.

1. Treatment and care of HIV+ patients in
Croatia
Sarajevo, 2012.
UNIVERSITY HOSPITAL FOR INFECTIOUS DISEASES,
UNIVERSITY OF ZAGREB MEDICAL
SCHOOL, ZAGREB, CROATIA

2. Outline
 Epidemiology
 New data on HIV prevalence among MSM
 Organization of care
 Data on patients and different outcomes
of care

3. HIV infection, AIDS and deaths in Croatia in
the period 1985-2011 (n=943)
Total= 943; AIDS=349; Deaths:179

4. HIV/AIDS cases according to gender and risk
groups
Source: Croatian HIV/AIDS register

5. Prevalence of HIV and sexually
transmitted infections and patterns of
recent HIV testing among men who
have sex with men in Zagreb, Croatia
Bozicevic et al STI (in press)

6. 40.0 37.8
35.0
30.0
25.0
20.4
20.0
14.2 13.2
15.0 11.2
9.4 10.6
9.2 9.0
10.0 6.9 7.6 7.2
5.9
4.5
5.0 2.8 3.0 2.7
0.80.9 0.6
0.0
2011 2006

7. 90.0
80.0
70.0
60.0
50.0
40.0
30.0
20.0 2011
10.0
0.0 2006

8. Interpretation
 No increase in prevalence of HIV and STIs
 There were differences in samples in 2011 there were
more highly educated individuals and more with
better income
 Younger MSM mainly surveyed
 Lower prevalence of gonorrhea might be due to fewer
false positive results (different methods used)

9. Chalenges
 How to increase the rate of HIV testing in MSM?
 In the past 12 months 32.7% MSM had an
HIV test compared to 50.8% in London,
61.0% in USA, 38.0% in Slovenia
 Move to community based testing?
 Screening and treatment of STI in MSM

10. HIV/AIDS care in Croatia
• Croatia has a centralized system of care, all
HIV/AIDS patients are treated at the University
Hospital for Infectious Diseases in Zagreb.
• Patients do not need referral from primary care
physicians.
• Monitoring tools such as CD4 cell counts, viral
load measurements, resistance testing and HLA
B57 testing are available.
• Croatian treatment guidelines are regularly
updated.

11. Provision of ARV
• ARV drugs are given from the hospital
pharmacy.
• ARV are free of charge for all Croatian citizens
with Health Care Insurance since April 1998.
• Fewer antiretrovirals are available in Croatia
compared to EU countries.

12. HIV care in 2011, Croatia
 647 patients enrlolled in care
 Males 85%
 8 children
 623 treated with ART
 Survival after 12 months of ART (for
patients starting therapy in 2010) 96%

13. Virological outcome of ART in Croatia
1998-2007
1
Less than 400 copies of HIV1 RNA per ml
0.9
0.8
0.7
0.6
0.5
1998 to 2002
0.4
2003 to 2007
0.3
0.2
0.1
0
0 1 3 6 9 12 15 18 24
Time (months)

14. Percentage of patients with < 50 or < 400
copies of HIV1 RNA at last measurment in a
calendar year
85
80
75
VL < 400
70 VL < 50
65
60
2007 2008 2009 2010 2011
Included are also patients who did not receive ART

15. Percentage of patients with a CD4 cell count >350 or
>500 at last measurment iin a calendar year
0.9
0.8
0.7
0.6
0.5 CD4 > 350
0.4 CD4 > 500
0.3
0.2
0.1
0
2007 2008 2009 2010 2011
Included are also patients who did not receive ART

16. The problem of late presentation to
care, Croatia 2007-2011

17. Integration into HIV care: Time of first CD4
count within one months of HIV-diagnosis
Croatia 2007-2011
1.00 0.94
0.88 0.86
0.90 0.83
0.80 0.75
0.70
0.60
0.50
0.40
0.30
0.20
0.10
0.00
2007 2008 2009 2010 2011

18. Antiretrovirals available in Croatia in
2012. (in red)
Fusion NRTI NNRTI PI II
ENF ZDV NVP SQV Raltegravir
ddI EFV r
anti CCR5 d4T ETV IDV
Maraviroc 3TC/FTC RPV NFV
ABC LPV/r
TDF fAPV
ATA
ZDV/3TC; ZDV/3TC/ABC; TPV
3TC/ABC; TDF/FTC DRV
TDF/FTC/EFV TDF/FTC/RPV

19. Antiretroviral treatment in Croatia
Antiretroviral combinations given to patient in Croatia in 2008
(Nov), 2009 (Nov), 2010 (Nov) and 2011 (Nov)
350
308
300
259
250 236
217
200 193197
2008
177
2009
154
2010
150
2011
100
50 40
32
10 9 9 6 4 9
2 2 0 1
0
NNRTI PI NNRT+PI 3NRTI RAL-based

20. Antiretrovral treatment in Croatia
NRTI combinations given to patient in Croatia in 2008
(Nov), 2009 (Nov), 2010 (Nov) and 2011 (Nov)
350
300 290
250 240
201
197
200 2008
178
2009
154 151 2010
150
2011
104
100
71
50 30 24 30 24
23 22 23 28
12 8 11 14 15 14
2
0
ZDV+3TC D4T+3TC 3TC+ABC DDI+3TC TDF+FTC other/none

21. THANK YOU!