Deniz Gökengin

2014 European Guideline on HIV testing

Testing for HIV is one of the cornerstones in the fight against HIV spread. The 2014 European Guideline on HIV Testing provides advice on testing for HIV infection in individuals aged 16 years and older who present to sexually transmitted infection, genito-urinary or dermato-venereology clinics across Europe. It may also be applied in other clinical settings where HIV testing is required, particularly in primary care settings. The aim of the guideline is to provide practical guidance to clinicians and laboratories that within these settings undertake HIV testing, and to indicate standards for best practice.

HIV/AIDS: trends in the Middle East and North Africa region

OBJECTIVES To give an overview of the HIV epidemic in the Middle East and North Africa (MENA) region. METHODS Articles on the MENA region were reviewed. RESULTS The MENA region comprises a geographically defined group of countries including both high-income, well-developed nations and low- and middle-income countries. While the annual number of new HIV infections in Sub-Saharan Africa has declined by 33% since 2005, new HIV infections in the MENA region have increased by 31% since 2001, which is the highest increase among all regions in the world. Moreover, the number of AIDS-related deaths in 2013 was estimated to be 15000, representing a 66% increase since 2005. However, the current prevalence of 0.1% is still among the lowest rates globally. There is substantial heterogeneity in HIV epidemic dynamics across MENA, and different risk contexts are present throughout the region. Despite unfavorable conditions, many countries in the region have put significant effort into scaling up their response to this growing epidemic, while in others the response to HIV is proving slower due to denial, stigma, and reluctance to address sensitive issues. CONCLUSIONS The HIV epidemic in the MENA region is still at a controllable level, and this opportunity should not be missed.

Brucellosis: a retrospective evaluation.

One hundred and sixty-six presumed brucellosis patients were included in the study. These patients were classified as primary (91), relapse (18) and suspected (57) cases according to their clinical presentations, and serologic and microbiologic test results. Primary and relapse cases were evaluated retrospectively according to age, sex, residence, routes of transmission, clinical and laboratory findings, treatment regimens, duration of treatment, and relapse rates. Of the 109 primary and relapse patients, 57 were male and 52 female. The ages of the patients ranged between 16–75 (mean age 40.2). The percentages of the urban and rural residence of the patients were 41.3% and 58.7%, respectively. The most common mode of transmission was consumption of unpasteurized milk and milk products (67.9%). Malaise, fever and sweating were the most frequently observed symptoms (96.3%, 95.4%, 91.7%, respectively). The most common signs were fever (97.2%), splenomegaly (59.6%), and hepatomegaly (37.6%). The liver was the most frequently involved organ (21.1%). Almost all (99.1%) patients were serologically positive. However, the positivity rate of culture was low (15.6%). The most frequently preferred antimicrobial regimen was rifampin and doxycycline combination. The relapse rate was 8.3%. Brucellosis is still prevalent in Turkey as in many other countries in the Mediterranean basin. The clinical presentation of the disease may show regional variations. Patients with a history of occupational or nutritional contact with the bacterium and with a compatible clinical picture should be examined using appropriate diagnostic techniques before any attempt to prescribe an antimicrobial.

In vitro activities of various antimicrobials against Brucella melitensis strains in the Aegean region in Turkey.

Objective: To study in vitro activities of three quinolones (ciprofloxacin, levofloxacin, moxifloxacin), four macrolides (erythromycin, dirithromycin, azithromycin, clarithromycin) and doxycycline against 44 clinical isolates of Brucella melitensis. Materials and Methods: Forty-four B. melitensis strains were isolated from blood cultures of adult patients with acute brucellosis who were hospitalized in the clinical ward of the Department of Clinical Microbiology and Infectious Diseases. The minimum inhibitory concentrations (MICs) of the tested antimicrobials were measured by the agar dilution method. MIC90 and MIC50 values were defined as the lowest concentration of the antibiotic at which 90 and 50% of the isolates were inhibited, respectively. Results: Doxycycline (MIC50: 0.25 µg/ml, MIC90: 0.50 µg/ml) had the lowest MIC in vitro against the B. melitensis strains. Among the quinolones, ciprofloxacin and levofloxacin had similar activities (MIC50: 0.5 µg/ml, MIC90: 2 µg/ml), whereas MIC of moxifloxacin (MIC50: 1 µg/ml, MIC90: 8 µg/ml) was higher than both antibiotics in this group. Clarithromycin and azithromycin were the most active macrolides (MIC50: 8 µg/ml and MIC90: 32 µg/ml), followed by erythromycin (MIC50: 16 µg/ml, MIC90: 32 µg/ml) and dirithromycin (MIC50: 64 µg/ml and MIC90: 64 µg/ml). Conclusion: The results indicate that the conventional agent doxycycline is more active than quinolones and macrolides against the B. melitensis in vitro.

Euroguidelines in Central and Eastern Europe (ECEE) conference and the Warsaw Declaration - a comprehensive meeting report.

The objective of this paper is to summarize the outcomes of the Euroguidelines in Central and Eastern Europe (ECEE) conference held in Warsaw in February 2016. The main aim of this conference was to facilitate a discussion on European AIDS Clinical Society (EACS) guidelines implementation across the region and neighbouring countries and to present the current obstacles in benchmarking HIV care in Europe.

European AIDS Clinical Society Standard of Care meeting on HIV and related coinfections: The Rome Statements

The objective of the 1st European AIDS Clinical Society meeting on Standard of Care in Europe was to raise awareness of the European scenario and come to an agreement on actions that could be taken in the future.

Hepatic adverse events during highly active antiretroviral therapy containing nevirapine: a case report

BackgroundHepatotoxicity is one of the most serious complications of highly active antiretroviral therapy (HAART). The aim of this report is to analyse an HIV infected patient on HAART including nevirapine and taking antidepressive agents, with acute toxic hepatitis.Case presentationA 39 year old patient diagnosed as HIV positive one month ago administered to the clinical ward of the Department of Infectious Diseases and Clinical Microbiology in Ege University Medical School with high fever, malaise, nausea, diarrheae and elevated liver enzymes (ALT 1558 U/L, AST 4288 U/L). He has been using HAART including zidovudine+lamivudine (2 × 1/day) and nevirapine (2 × 200 mg/day, following dose escalation) for 22 days, sertralin and diazepam for 12 days and lithium for 10 days.The patient was hospitalized. Antiretroviral and antidepressant treatments were stopped. The day after admission, his fever dropped and his symptoms improved. Clinical improvement continued on the following days. The patient was discharged upon his request on the 14th day of hospitalization. The liver function tests returned to normal levels in two weeks following discharge.ConclusionClose monitoring of liver enzymes during the first 12 weeks of nevirapine therapy is critical to prevent life threatening events.

The effect of psychodrama on people living with HIV/AIDS

Aim: To help people living with HIV/AIDS gain better insight, overcome the intensity of negative feelings, better cope with problems and prejudices; and to evaluate the efficacy of psychodrama in increasing the quality of life. Methods: The study included seven people living with HIV/AIDS. To evaluate the efficacy of psychodrama, focus group interviews were carried out and the SF-36 scale was used. Focus group interviews were evaluated using the descriptive analysis method, Wilcoxon test was used for the comparison of the means of scores, and effect sizes were calculated using Cohens d. Results: The results showed that the participants had become more courageous in declaring their diagnoses, communicating more openly and effectively, having a better acceptance about the diagnosis. The results also showed a decrease in the symptoms of depression and the fear of death. The increase in the SF-36 scale was statistically significant only in mental health. Conclusions: The participants showed a significant improvement in the following: insight and awareness, skills of coping with difficulties, and relationships. The improvement in the life quality of participants suggests that psychodrama has a positive effect.

Attitudes towards HIV/AIDS and other sexually transmitted diseases in secondary school students in Izmir, Turkey: changes in time:

The aim of this study was to evaluate the changes in the sexual attitudes of young people in a period of 7 years (1997-2004). The participants in the first and the second surveys were 633 and 654 grade 10 students from six high schools located in the central district of Izmir, Turkey, chosen randomly according to the stratified sampling method. The rate of having had sexual experience was 11.3% and 22.8% in the first and second surveys, respectively (x 2 P < 0.001).

HIV care in Central and Eastern Europe: How close are we to the target?

OBJECTIVES The aim of this survey was to describe the current status of HIV care in the countries of Central and Eastern Europe and to investigate how close the region is to achieving the UNAIDS 2020 target of 90-90-90. METHODS In 2014, data were collected from 24 Central and Eastern European countries using a 38-item questionnaire. RESULTS All countries reported mandatory screening of blood and organ donors for HIV. Other groups subjected to targeted screening included people who inject drugs (PWID) (15/24, 62.5%), men who have sex with men (MSM) (14/24, 58.3%), and sex workers (12/24, 50.0%). Only 14 of the 24 countries (58.3%) screened pregnant women. The percentages of late presentation and advanced disease were 40.3% (range 14-80%) and 25.4% (range 9-50%), respectively. There was no difference between countries categorized by income or by region in terms of the percentages of persons presenting late or with advanced disease. The availability of newer antiretroviral drugs (rilpivirine, etravirine, darunavir, maraviroc, raltegravir, dolutegravir) tended to be significantly better with a higher country income status. Ten countries reported initiating antiretroviral therapy (ART) regardless of CD4+ T cell count (41.7%), five countries (20.8%) used the threshold of <500 cells/μl, and nine countries (37.5%) used the threshold of <350cells/μl. Initiation of ART regardless of the CD4+ T cell count was significantly more common among high-income countries than among upper-middle-income and lower-middle-income countries (100% vs. 27.3% and 0%, respectively; p=0.001). Drugs were provided free of charge in all countries and mostly provided by governments. There were significant discrepancies between countries regarding the follow-up of people living with HIV. CONCLUSIONS There are major disparities in the provision of HIV care among sub-regions in Europe, which should be addressed. More attention in terms of funding, knowledge and experience sharing, and capacity building is required for the resource-limited settings of Central and Eastern Europe. The exact needs should be defined and services scaled up in order to achieve a standard level of care and provide an adequate and sustainable response to the HIV epidemic in this region.