Svilen Konov, HIV i-Base

It is commendable that this conference is already organised as a regular event and focuses on a region that was not so high on the list of other major international HIV/AIDS events. It is also good that local researchers can show their concepts of science development and scientific agenda. Unfortunately, the quality of the majority of abstracts was not high and hardly any research breakthroughs were presented. The section on HIV treatment in IDUs illustrates this, though the same can be said for many mainstream HIV medical meetings.

While recognising that IDU is heavily political, especially in the Russian Federation, not allocating enough of time and attention to this topic is a particularly near-sighted, given that the main characteristic of the HIV population in the region is still IDU.

The following article is a general overview of three abstracts that I found of the more interest. Nevertheless, the community should insist on more research and better in terms of methodology research among the IDUs in the region.

Dolzhanskaya and colleagues analysed medical notes to study the attitude of doctors to providing narcological help and HAART assessed the situation with providing help with overdose in different countries from the region. It is well documented that educational programmes have small to insignificant effect in avoiding overdose, while naloxone, a medicinal product that helps people in overdose to recover from it, has the potential to have a major impact.

They found that many medical forms were not filled as required and that there was considerable amounts of missing data, especially on patients’ social background and their risk behavior. This may be due to either doctors not valuing this information to patients withholding information through concerns related to disclosure.

People who were registered with AIDS Centres and who are IDUs were hardly ever referred to, or visited, the Narcological Units. The lack of medical documentation for visits to TB Units or STI clinics also indicates that there is no clear idea about these patient needs, as well as perhaps little or no cooperation among the different institutions that are involved in provision of treatment, care and support for PLWHA.

A group of researchers from Armenia looked into the use of HAART and survival of HIV-positive IDUs in Armenia. [2]

Even though this topic has been researched on many occasions and in quite diverse settings and the results have been consistently good, it is commendable that now we have findings from the Caucasus too.

The study included 71 HIV-positive men using injecting drugs who were on first- or second-line ARV therapy (according to the National Guidelines of Armenia) and who were followed from February 2005 till May 2009. CD4 count, viral load and hepatitis B and C markers were recorded. Adherence was evaluated through a special computer programme that was created by the National AIDS Centre of Armenia.

During the study period, all people started therapy but 18 (25.3%) interrupted the treatment either because of complications (including side effects) or as a personal decision and 10 people consequently died. In this group, 62 (87%) of the participants had AIDS, 45 (63%) had hepatitis C and two (3%) had hepatitis B. One person had both hepatitis B and C. TB was registered in 46.5% patients.

All 10 people who died were staged as AIDS. Their average CD4 count was 93 cells/mm3. Nine had chronic hepatitis C and six had TB coinfection. It was postulated that two deaths were a result of drug overdose. Four people stopped ARVs as a result of complications (hepatotoxicity and anaemia), one gave up treatment as a personal decision, two died as a result of TB complications and one as a result of complictions from hepatitis C.

From the 33 (62%) people continuing therapy, 8 had adherence <95% and 25 >95%. Three people on therapy failed to reduce their viral load to undetectable, probably due to low adherence. In people continuing therapy, the average CD4 count increased to 245 cells/mm3.

Shonning and colleagues presented an abstract on the results of a study conducted by the Eurasion Harm Reduction Network in 2008. Shockingly, in 2006 from 3 555 568 registered IDUs, 9354 died of overdose. The researchers assessed the situation with providing help with overdose in different countries from the region. It is well documented that educational programmes have small to insignificant effect in avoiding overdose, while naloxone, a medicinal product that helps people in overdose to recover from it, has the potential to have a major impact.

The pilot programmes for distributing naloxone in Tajikistan and Russia showed that this is a viable option. The researchers suggest that if the existing harm reduction programmes are allowed to enhance access and start delivering naloxone to IDUs, their partners, relatives, etc, many unnecessary deaths from overdose will be avoided. Easy access to naloxone will also help with avoiding the psychological barriers to search help-fear of contacting the medical establishment and/or police or in cases logistics problems like late arrival of the ambulance.

References

Unless otherwise indicated, all references are to the book of abstracts of the conference.

1. Должанская Н и др. Анализ медицинской документации и изучение отношения врачей к оказанию наркологической помощи пациентам с ВИЧ-инфекцией и готовности к проведению совр. методов лечения (ВААРТ). Стр. 81

2. Мкртчян А и др. ВААРТ и выживаемость ВИЧ-инфицированных потребителей инъекционных наркотиков в Армении. Стр. 83

3. Шоннинг Ш. и др. Передозировка: основная причина предотвратимой смертности среди ЛЖВ.