Overview of HIV/AIDS and ARV Treatment in Georgia Lali Sharvadze MD, PhD Director of inpatient Department . Associated Professor.

Reported Cases of HIV/AIDS in Georgia 2518 1369 - AIDS 538 - Deaths Estimated number  3500

Distribution of HIV/AIDS Patients by Sex and Age Groups 2518 Women 665 Men 1853 Age distribution

HIV Cases Registered in Georgia Annually Number of cases

Distribution of HIV/AIDS Cases (number of registered cases) by Regions of Georgia (number of registered cases) Abkhazia 168 891 Tbilisi (55 Foreigners) Svaneti 8 Lechkhumi 5 Samegrelo 369 Mtianeti 19 Poti 39 Imereti 319 Guria 54 Shida Kartli 66 Adjara 322 Kakheti 102 Samtskhe Javakheti 29 Kvemo Kartli 94

Incidence of AIDS Cases per 100 000 population (Source – WHO reports, 2007)

HIV Prevalence among High Risk Behavior Groups (2007) HIV Prevalence in General Population - 0.13

Distribution of HIV Cases by Routes of Transmission

AIDS Control Service in Georgia Country Coordinating Mechanism (CCM) Infectious Diseases, AIDS & Clinical Immunology Research Center National Center of Disease Control and Public Health Zugdidi AIDS treatment center Batumi AIDS treatment center Kutaisi AIDS treatment center 9 VCT centers in regions of Georgia 217 HIV diagnostic labs

Universal Access to HIV Treatment, Care and Support and Prevention Georgia is the First Among FSU Countries that from 2004 Ensured Universal (100%) Access to ARV Treatment.

What Does It Mean - The Universal (100%) Access to ARV Treatment Georgian Approach Investigation of all HIV infected persons by special algorithm To identify all patients requiring ARV treatment according to special criteria To offer ARV therapy to all patients requiring treatment Monitoring of all patients receiving ARV treatment

according to WHO/UNAIDS/UNICEF report on universal access of 2008 Access to HAART RUS* BEL* UKR* KAZ* GEO UZB* KGZ* AZE* ARM* TKM TJK* ALB* FYM* according to WHO/UNAIDS/UNICEF report on universal access of 2008 no HAART individuals on HAART (<1%) * in the process of scaling up ART very poor access ( 1-25%) poor access (25-50%) disputed coverage estimates or insufficient data available moderate access (50-75%) good access (over 75%)

Implementation of Major Laboratory Methods in Georgia 1984 – ELISA 1984 – Immunophenotyping of CD3, CD4, CD8 lymphocytes 1985 – Western blot 1995 – Qualitative PCR (Polymerase Chain Reaction) 1996 – Quantitative PCR (Polymerase Chain Reaction) 2003 – HIV and HCV Genotyping 2005 – HIV Genotypic Resistance Testing 2006 - HIV subtype analysis using phylogenetic methods 2006 – HIV, HCV & HBV quantitative- Real time PCR 2006 – CCR5, CCR2 and SDF1 genotyping testing 2009 – Abacavir hypersensitivity testing HLA-B*5701 SSP genotyping assay.

ARV implemented in Georgia NRTI AZT 3TC D4T DDI Abacavir Tenofovir FTC Téno/FTC Truvada® ABC/3TC Protease Inhibitors (PI) Ritonavir Norvir® Indinavir Crixivan® Saquinavir Invirase® Nelfinavir Viracept® Lopinavir Kaletra ® Atazanavir Reyataz® Fosamprenavir Telzir ® Tipranavir Aptivus® Darunavir Prezista® Entry inhibitor Enfuvirtide NNRTI Nevirapine Viramune® Efavirenz Sustiva®* Integrase inhibitor Raltegravir

739 Patients are currently receiving ART ARV Treatment 739 Patients are currently receiving ART 710 adults 29 children

National Guidelines Criteria for Initiation of Antiretroviral Therapy Based on WHO and DHHS ART Guidelines History of an AIDS-defining illness; CD4 T - cell count <350 cells/mm3; Patients with HIV-associated nephropathy; Patients co infected with HBV when treatment is indicated.

Georgian HIV/AIDS National Guidelines updated annually

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