Derval Igoe

Injection of new psychoactive substance snow blow associated with recently acquired HIV infections among homeless people who inject drugs in Dublin, Ireland, 2015.

In February 2015, an outbreak of recently acquired HIV infections among people who inject drugs (PWID) was identified in Dublin, following similar outbreaks in Greece and Romania in 2011. We compared drug and risk behaviours among 15 HIV cases and 39 controls. Injecting a synthetic cathinone, snow blow, was associated with recent HIV infection (AOR: 49; p=0.003). Prevention and control efforts are underway among PWID in Dublin, but may also be needed elsewhere in Europe.

New HIV diagnoses among adults aged 50 years or older in 31 European countries, 2004–15: an analysis of surveillance data

BACKGROUND The HIV burden is increasing in older adults in the European Union (EU) and European Economic Area (EEA). We investigated factors associated with HIV diagnosis in older adults in the 31 EU/EEA countries during a 12 year period. METHODS In this analysis of surveillance data, we compared data from older people (aged ≥50 years) with those from younger people (aged 15-49 years). We extracted new HIV diagnoses reported to the European Surveillance System between Jan 1, 2004, and Dec 31, 2015, and stratified them by age, sex, migration status, transmission route, and CD4 cell count. We defined late diagnosis as CD4 count of less than 350 cells per μL at diagnosis and diagnosis with advanced HIV disease as less than 200 cells per μL. We compared the two age groups with the χ2 test for difference, and used linear regression analysis to assess temporal trends. FINDINGS During the study period 54 102 new HIV diagnoses were reported in older adults. The average notification rate of new diagnoses was 2·6 per 100 000 population across the whole 12 year period, which significantly increased over time (annual average change [AAC] 2·1%, 95% CI 1·1-3·1; p=0·0009). Notification rates for new HIV diagnoses in older adults increased significantly in 16 countries in 2004-15, clustering in central and eastern EU/EEA countries. In 2015, compared with younger adults, older individuals were more likely to originate from the reporting country, to have acquired HIV via heterosexual contact, and to present late (p<0·0001 for all comparisons). HIV diagnoses increased significantly over time among older men (AAC 2·2%, 95% CI 1·2-3·3; p=0·0006), women (1·3%, 0·2-2·4; p=0·025), men who have sex with men (5·8%, 4·3-7·5; p<0·0001), and injecting drug users (7·4%, 4·8-10·2; p<0·0001). INTERPRETATION Our findings suggest that there is a compelling need to deliver more targeted testing interventions for older adults and the general adult population, such as by increasing awareness among health-care workers and expanding opportunities for provider-initiated and indicator-condition-guided testing programmes. FUNDING European Centre for Disease Prevention and Control.

There has been a true rise in Neisseria gonorrhoeae but not in Chlamydia trachomatis in men who have sex with men in Dublin, Ireland.

A recent letter from Haidari et al 1 on Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT) in men who have sex with men (MSM) in the UK suggests that recent increases are mainly related to increased use of NAATs with testing at extra-genital sites. In the greater Dublin area (population 1.6 million), surveillance data indicated a marked increase in cases of gonococcal infection (GC) from 2010 to 2012, crude incidence …

A24 Role of phylogenetic analysis in epidemiological case definitions during an outbreak of HIV-1 in people who inject drugs in Ireland

tion patterns is limited. In this study, we employed a Bayesian phylogeographic approach to reconstruct the spatio-temporal dispersion pattern of this clade in Afghanistan and Iran for the first time. We performed a secondary data analysis on eligible HIV-1 CRF35_AD (gag and pol) sequences available in the Los Alamos HIV database (432 sequences available from Iran, 16 sequences available from Afghanistan, and a single CRF35_ADlike pol sequence available from USA). Sequences were excluded prior to analysis if they showed evidence of incorrect subtype assignment, frameshift, or drug resistance mutations, and/or stop codon positions. Subtype assignment was confirmed by maximum likelihood phylogenetic analysis. In order to reconstruct the spatio-temporal history of CRF35_AD, we used discrete Bayesian phylogeographic model in BEAST v1.8.1. Between-country viral dispersion rates were tested with Bayesian Stochastic Search Variable Selection method as implemented in SPREAD v1.0.7, and were considered as significant when Bayes factor values were >3. We checked the robustness of the key parameter estimates through a sensitivity analysis, using different priors and data subsets. The findings suggested that CRF35_AD sequences were genetically similar to parental sequences from Kenya and Uganda, and to a set of subtype A1 sequences available from Afghan refugees living in Pakistan. Our results also showed that across all phylogenies, Afghan and Iranian CRF35_AD sequences formed a monophyletic cluster (posterior clade credibility> 0.9). The divergence date of this cluster was estimated to be between 1990 and 1992. Within this cluster, a bidirectional dispersal of the virus was observed across Afghanistan and Iran. We could not clearly identify if Afghanistan or Iran first established or received this epidemic, as the root location of this cluster could not be robustly estimated. Three CRF35_AD sequences from Afghan refugees living in Pakistan nested among Afghan and Iranian CRF35_AD branches. However, the CRF35_AD-like sequence available from USA diverged independently from Kenyan subtype A1 sequences, suggesting that it may not be a true CRF35_AD lineage. The CRF35_AD viruses from Afghanistan, Iran, and Afghan refugees living in Pakistan seem to constitute a single epidemic, with multiple genetic exchanges among these populations. The date of onset for this epidemic (1990–1992) coincides with the rise of heroin production in Afghanistan (1970s). This highlights the potential role of drug trafficking in epidemic ignition in this region. Mass migration of Afghan refugees and illegal workers to Iran may be other possible contributors to among-country virus transmission.

Letter to the editor: Increasing proportion of new HIV diagnoses in Ireland previously diagnosed elsewhere – potential impact on estimating incidence

The use of CD4 counts raises important issues for HIV surveillance and interpretation of findings. The Irish surveillance system, for example, includes all persons newly diagnosed with HIV in Ireland, even if previously diagnosed elsewhere. An increasing proportion of newly-diagnosed HIV cases have previously been diagnosed HIV-positive in another country before arrival in Ireland, and have been receiving antiretroviral therapy (ART). In 2015, 27% (129/485) of newly-diagnosed HIV cases had a previous HIV diagnosis in another country, up from a range of 14%–18% for the years 2011 to 2014 [3]. By risk group, heterosexuals were the group with the highest proportion previously diagnosed HIVpositive (35%, 45/130), followed by men who have sex with men (MSM) (29%, 72/247) and people who inject drugs (PWID) (10%, 5/49). The majority (79%, 102/129) of those with a previous HIV diagnosis, transferred their HIV care to Ireland and 63% (81/129) had been receiving ART before arrival in Ireland.

Using data from a behavioural survey of men who have sex with men (MSM) to estimate the number likely to present for HIV pre-exposure prophylaxis (PrEP) in Ireland, 2017

In Ireland, men who have sex with men (MSM) have increased HIV risk. Pre-exposure prophylaxis (PrEP), combined with safe sex practices, can reduce HIV acquisition. We estimated MSM numbers likely to present for PrEP by applying French PrEP criteria to Irish MSM behavioural survey data. We adjusted for survey bias, calculated proportions accessing testing services and those likely to take PrEP. We estimated 1–3% of MSM in Ireland were likely to present for PrEP.

Sexually transmitted infections in adolescents in Ireland: data quality and completeness are improving.

We read with interest the online version of Davoren et al. s1 article on sexually transmitted infections (STIs) among adolescents in Ireland. They point out limitations in national surveillance information, and the fact that surveillance data are available only in aggregate format. In fact, STI surveillance in Ireland has improved considerably in the past 18 months. Since January 2013, all diagnostic laboratories in Ireland are reporting all new cases of notifiable STIs, with the exception of …