War in Ukraine raises concerns about HIV spread, care in region

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Key takeaways:

  • More than 8.1 million Ukrainian refugees have been recorded across Europe since Russia’s 2022 invasion of Ukraine.
  • Among 260,000 people with HIV living in Ukraine before the invasion last year, researchers said more than 15,000 who started ART may be lost to follow-up because they had to flee the war.
  • Mass migration into Poland may be worsening an existing HIV-1 A6 epidemic that has been linked to Ukraine.

Russia’s 2022 invasion of Ukraine has worsened the spread of HIV in the region as thousands of war refugees migrate to neighboring countries, according to two studies.

Although most are receiving adequate care, the high number of people with HIV fleeing to surrounding nations and an epidemic of HIV-1 A6 in Poland that researchers linked to Ukraine have raised concerns.

According to the United Nations, more than 8.1 million Ukrainian refugees have been recorded across Europe, with nearly 2.9 million fleeing to Russia and Belarus and 1.56 million fleeing to Poland.

Experts said previously that tuberculosis services could be disrupted by the invasion. Treatment for HIV is another concern, according to the two studies published in Clinical Infectious Diseases.

“[The] Russian invasion in Ukraine has resulted in a considerable distress for people with HIV, resulting in both internal displacement and international migration,” Milosz Parczewski, MD, PhD, president of the Polish AIDS Society and chief of the department of infectious, tropical diseases and acquired immunodeficiency at Pomeranian Medical University in Szczecin, Poland, told Healio.

“Many of the approximately 300 antiretroviral treatment centers [in Ukraine] were affected and temporarily closed or have had reduced functionality. Migration has also forced several thousand people to seek refuge, shelter and medical assistance outside of the country,” Parczewski said.

Parczewski and colleagues analyzed data on 955 Ukrainian people with HIV who started care in Poland since February 2022. Of these, 851 had been diagnosed and treated in Ukraine and 104 were newly diagnosed with HIV in Poland.

Among the study group, 70.05% of the patients were women and 70.3% acquired HIV through heterosexual transmission. Additionally, anti-hepatitis C antibody was present in 28.7% of patients, hepatitis B antigen was present in 2.9% of the patients, and 10.1% of patients had a history of TB.

The researchers estimated that there were 260,000 people with HIV living in Ukraine before Russia’s 2022 invasion, 45% of whom were women. Around 130,000 of them — including 2,700 children and teens — were receiving ART.

The researchers suggested that at least 15,000 patients who initiated treatment in Ukraine could be lost to follow-up, although about 4,000 registered people with HIV are receiving ART outside the country.

Eastern European nations and several Russian regions have long had some of the highest rates of HIV globally. A second study by Parczewski and colleagues noted that by the end of 2020, Ukraine had the second highest incidence of HIV in Europe after Russia, with 37.5 cases per 100,000 people. This is compared with 1.9 cases per 100,000 people in Poland.

Between 2012 and 2015, the primary source of HIV transmissions internally was people displaced from eastern regions of Ukraine to central and southern regions, with Russia’s 2014 annexation of the Donbas — both the run-up and the actual war — significantly contributing to Ukrainian migration into Poland. Over the last decade, as of February 2020, 62.8% of registered foreigners in Poland — more than 1.39 million people — were Ukrainian, according to the study.

According to the second study, in every region of the former Soviet Union, including Ukraine, the A6 lineage of HIV has been the dominant variant and slowly increased in prevalence in other parts of Europe, including Germany.

The researchers linked an “increasing A6 epidemic in Poland” to Ukrainian people fleeing the war. Although they noted that the finding requires future observational studies, “the number of incoming and outgoing virus transmissions between Poland may become a gateway for HIV-1 A6 influx into” European Union (EU) countries, the researchers wrote.

The spread of the A6 lineage raises concern because it does not respond as well to ART as other HIV-1 lineages, according to the researchers.

Parczewski also noted that some of the biggest concerns for Ukrainian war refugees are ART-treated patients who need to switch treatments because of EU patent protection, people unaware of infection — many of whom have advanced disease — language barriers and making sure that the high number of female people with HIV have adequate access to obstetric and gynecologic care.

However, there are several initiatives underway to improve the situation, he said, including improving medical information exchange between Poland and Ukraine, ART donations from WHO, and early-stage HIV diagnosis programs that are still under development.

“Dealing with health in the time of warfare requires personal courage and resilience, a quality which Ukrainian medical personnel have in abundance. It should be highly praised and admired,” Parczewski said. “It should also be emphasized that the majority of displaced patients are treated effectively, and without major interruptions, which allows for maintenance of virologic suppression and health.”

By Stephen Feller



Source : Healio

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