Where are we with pre-exposure prophylaxis use in Central and Eastern Europe? Data from the Euroguidelines in Central and Eastern Europe (ECEE) Network Group.

OBJECTIVES: Pre-exposure prophylaxis (PrEP) for HIV infection is an important intervention for control of the HIV epidemic. The incidence of HIV infection is increasing in the countries of Central and Eastern Europe (CEE). Therefore, we investigated the change in PrEP use in CEE over time. METHODS: The Euroguidelines in Central and Eastern Europe (ECEE) Network Group was initiated in February 2016 to compare standards of care for HIV and viral hepatitis infections in CEE. Data on access to PrEP were collected from 23 countries through online surveys in May-June 2017 (76 respondents) and in November 2018-May 2019 (28 respondents). RESULTS: About 34.2% of respondents stated that tenofovir/emtricitabine (TDF/FTC) was licensed for use in their country in 2017, and 66.7% that it was licensed for use in 2018 (P = 0.02). PrEP was recommended in national guidelines in 39.5% of responses in 2017 and 40.7% in 2018 (P = 0.378). About 70.7% of respondents were aware of "informal" PrEP use in 2017, while 66.6% were aware of this in 2018 (P = 0.698). In 2018, there were 53 centres offering PreP (the highest numbers in Poland and Romania), whereas six countries had no centres offering PreP. The estimated number of HIV-negative people on PreP in the region was 4500 in 2018. Generic TDF/FTC costs (in Euros) ranged from €10 (Romania) to €256.92 (Slovakia), while brand TDF/FTC costs ranged from €60 (Albania) to €853 (Finland). CONCLUSIONS: Although the process of licensing TDF/FTC use for PrEP has improved, this is not yet reflected in the guidelines, nor has there been a reduction in the "informal" use of PrEP. PrEP remains a rarely used preventive method in CEE countries.

Environmental radionuclides as contaminants of HPGe gamma-ray spectrometers: Monte Carlo simulations for Modane underground laboratory.

The main limitation in the high-sensitive HPGe gamma-ray spectrometry has been the detector background, even for detectors placed deep underground. Environmental radionuclides such as 40K and decay products in the 238U and 232Th chains have been identified as the most important radioactive contaminants of construction parts of HPGe gamma-ray spectrometers. Monte Carlo simulations have shown that the massive inner and outer lead shields have been the main contributors to the HPGe-detector background, followed by aluminum cryostat, copper cold finger, detector holder and the lead ring with FET. The Monte Carlo simulated cosmic-ray background gamma-ray spectrum has been by about three orders of magnitude lower than the experimental spectrum measured in the Modane underground laboratory (4800 m w.e.), underlying the importance of using radiopure materials for the construction of ultra-low-level HPGe gamma-ray spectrometers.

HIV testing uptake among female sex workers and men who have sex with men in Tbilisi, Georgia.

OBJECTIVES: The aim of the study was to investigate HIV testing practice among female sex workers (FSWs) and men who have sex with men (MSM) in Tbilisi, Georgia and to identify determinants of never testing behaviour among MSM. METHODS: Data obtained in two rounds of bio-behavioural surveys among FSWs (2006 and 2009) and MSM (2007 and 2010) were analysed. Determinants of never testing behaviour among MSM were investigated among 278 respondents recruited in 2010 through respondent-driven sampling. RESULTS: Knowledge about the availability of HIV testing and never testing behaviour did not show changes among FSWs and MSM. Every third FSW and every second MSM had never been tested for HIV according to the latest surveys in 2010. In bivariate analysis among MSM, consistent condom use during anal intercourse with a male partner in the last year, awareness of HIV testing locations and preventive programme coverage were negatively associated with never testing behaviour, while those who considered themselves at no risk of HIV transmission were more likely to have never been tested. In multivariate analysis, lower odds of never testing for HIV remained for those who were aware of HIV testing locations [adjusted odds ratio (AOR) 0.12; 95% confidence interval (CI) 0.04-0.32] and who reported being covered by HIV prevention programmes (AOR 0.26; 95% CI 0.12-0.56). CONCLUSIONS: In view of the concentrated HIV epidemic among MSM in Georgia and the low rate of HIV testing uptake, interventions in this key population should take into consideration the factors associated with testing behaviour. The barriers to HIV testing and counselling uptake should be further investigated.

Oral lesions in HIV-positive patients in Georgia.

To study the prevalence of oral lesions in HIV infected patients and its relationship with CD4+ cell count in Georgia 732 HIV positive adult patients who were admitted to the Infectious Diseases, AIDS and Clinical Immunology Research Center (IDACIRC) since January, 2006 till October, 2008 were evaluated. Each patient underwent full clinical and standard laboratory examination. CD4+ cell count was determined by the Becton-Dickinson FACSCalibur flow cytometer (MultiTEST CD3 FITC/CD8 PE/CD45 PerCP/CD4 APC Reagent). Socio-demographic data was obtained using a standard questionnaire at the epidemiology department of IDACIRC. Oral manifestations were diagnosed according to EEC clearinghouse classification (1993). Oral lesions were revealed in 546 patients (75%). 186 patients (25%) did not exhibit any oral complications. The prevalence of two or more simultaneously exhibited types of lesions was as follows: three types of lesions were detected in 45 patients (6%) and two types of lesions were detected in 245 patients (33%). The investigation revealed oral candidiasis constituted the most common form of oral lesions, representing a 64% (467 patients), followed by HIV associated periodontal diseases in 216 patients (30%), recurrent aphthous like ulcerations in 118 patients (16%), oral hairy leukoplakia in 58 patients (8%), orolabial herpes simplex infection in 50 patients (7%), human papillomavirus (wart like lesions) in 37 patients (5%) and Kaposi's sarcoma in 3 patients (0.4%). Most of oral lesions cases were found in patients with low CD4+ cell count. Results of this study provide evidence that mucous membrane disorders with HIV infection might serve as an indicator for advanced HIV infection, immunosuppression and decreased CD4 cell counts. The physicians who are taking care of HIV patients have to be familiar with HIV-associated mucocutaneous diseases, their diagnoses, and management.

[Effect of exogenous factors on clinical features of initial disorders in adolescent schizophrenia]. / Vliianie ékzogennykh faktorov na klinicheskie osobennosti initsial'nykh rasstroistv pri shizofrenii podrostkovogo vozrasta.

Using clinical and experimental-psychological methods (a method of fixed orientation), the authors have studied 34 adolescents with continuous schizophrenia whose manifestation was attended by some exogenic factors (psychogenies, somatogenies, tox-infectious, and cranial traumas). The results obtained indicate some complications of psychopathological disturbances at the initial stage, manifesting in their marked acuteness, extension of the polymorphic spectrum and inclusion of heteronomous formations uncharacteristic of schizophrenia. A group of heteronomous manifestations should include sensorium disorders, pronounced emotional lability, general cerebral impairments, episodes of visual illusions and hallucinations, etc. The fixed orientation in the cases described is largely the same as in "nuclear" schizophrenia but some specificities, predominantly in the presence of psychogenic factors, are also observed.