The emerging face of the HIV epidemic in the Middle East and North Africa

Mumtaz, Ghina R.; Riedner, Gabriele; Abu‐Raddad, Laith J.

doi:10.1097/coh.0000000000000038

Cited by 74 publications

(77 citation statements)

References 20 publications

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“…In addition, clinic-based cohort studies have suggested that patients are presenting late with AIDS. It is hoped that with better surveys, and more programmatic work to reduce the stigma associated with HIV/AIDS, the epidemic in this region will be better understood and reduced [6,7].…”

Section: Introductionmentioning

confidence: 99%

Antiretroviral therapy, CD4, viral load, and disease stage in HIV patients in Saudi Arabia: a 2001–2013 cross-sectional study

Memish

Al‐Tawfiq

Filemban

et al. 2015

J Infect Dev Ctries

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Introduction: The incidence of HIV/AIDS is increasing worldwide and in the Middle East. In this study, we analyzed the use of antiretroviral therapy (ART), the patterns of CD4 and viral load (VL), and stage of presentation. Methodology: Laboratory variables, ART use, and CD4 count were obtained and analyzed retrospectively. Results: A total of 997 cases from eight HIV/AIDS care providers were included. Of the total cases, 274 (28.3%) had a CD4 count of < 200 cells/mm 3 , and 413 (42.3%) had a viral load of > 5 log 10 . Of the total cases, 50% were on highly active antiretroviral therapy (HAART), and the majority of cases were asymptomatic (70%). Of those patients on ART, 247 (39.5%) took tenofovir/emtricitabine combined with either efavirenz (147; 14.7%) or lopinavir/ritonavir (100; 10%), and 158 (15.8%) were on lamivudine and zidovudine with either efavirenz (32; 3.2%) or lopinavir/ritonavir (126; 12.6%). Other combinations were used in 70 (7%) patients. The mean (± standard deviation) of baseline CD4 and viral load were 401 cells/mm 3 (322 cells/mm 3 ) and 4.6 log10 10 (1.3 log 10 ), respectively. At diagnosis, 72% of patients were asymptomatic; 50% had AIDS and 20% had CD4 count < 350. Conclusions: ART use was in line with international guidelines, but the number of patients receiving ART was lower than expected. Large proportions of cases presented late with AIDS at diagnosis or had CD4 < 350. Further data is needed to evaluate the medical care of patients with HIV/AIDS in the Kingdom of Saudi Arabia.

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Section: Introductionmentioning

confidence: 99%

Antiretroviral therapy, CD4, viral load, and disease stage in HIV patients in Saudi Arabia: a 2001–2013 cross-sectional study

Memish

Al‐Tawfiq

Filemban

et al. 2015

J Infect Dev Ctries

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“…The data have been identified through comprehensive systematic searches of literature, conducted as part of the MENA HIV/AIDS Epidemiology Synthesis Project [11,23] and the MENA HCV Epidemiology Synthesis Project [24]. Data collection in the MENA HIV/AIDS Epidemiology Synthesis Project started in mid-2003 with the mandate to collect and synthesize all available data on HIV, sexually transmitted infections, and sexual behaviour in MENA through a series of systematic sub-studies focused on different aspects of the HIV epidemic [10,11,15,23,25–28]. Data collection on the MENA HCV Epidemiology Synthesis Project started in April 2011 with the mandate to characterize HCV epidemiology in MENA and estimate country-specific population-level HCV prevalence through a series of systematic sub-studies focused on sub-regional analyses [20,24,29–36].…”

Section: Methodsmentioning

confidence: 99%

“…The search terms used in the literature searches included broad geographic, infection, and epidemiological qualifiers to ensure inclusiveness, as can be seen in different sub-studies of the two Synthesis Projects [10,11,15,20,23–26,28–38]. …”

Section: Methodsmentioning

confidence: 99%

Status of HIV and hepatitis C virus infections among prisoners in the Middle East and North Africa: review and synthesis

Heijnen

Mumtaz

Abu‐Raddad

2016

Journal of the International AIDS Society

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IntroductionThe status of HIV and hepatitis C virus (HCV) infections among incarcerated populations in the Middle East and North Africa (MENA) and the links between prisons and the HIV epidemic are poorly understood. This review synthesized available HIV and HCV data in prisons in MENA and highlighted opportunities for action.MethodsThe review was based on data generated through the systematic searches of the MENA HIV/AIDS Epidemiology Synthesis Project (2003 to December 15, 2015) and the MENA HCV Epidemiology Synthesis Project (2011 to December 15, 2015). Sources of data included peer-reviewed publications and country-level reports and databases.Results and discussionWe estimated a population of 496,000 prisoners in MENA, with drug-related offences being a major cause for incarceration. Twenty countries had data on HIV among incarcerated populations with a median prevalence of 0.6% in Afghanistan, 6.1% in Djibouti, 0.01% in Egypt, 2.5% in Iran, 0% in Iraq, 0.1% in Jordan, 0.05% in Kuwait, 0.7% in Lebanon, 18.0% in Libya, 0.7% in Morocco, 0.3% in Oman, 1.1% in Pakistan, 0% in Palestine, 1.2% in Saudi Arabia, 0% in Somalia, 5.3% in Sudan and South Sudan, 0.04% in Syria, 0.05% in Tunisia, and 3.5% in Yemen. Seven countries had data on HCV, with a median prevalence of 1.7% in Afghanistan, 23.6% in Egypt, 28.1% in Lebanon, 15.6% in Pakistan, and 37.8% in Iran. Syria and Libya had only one HCV prevalence measure each at 1.5% and 23.7%, respectively. There was strong evidence for injecting drug use and the use of non-sterile injecting-equipment in prisons. Incarceration and injecting drugs, use of non-sterile injecting-equipment, and tattooing in prisons were found to be independent risk factors for HIV or HCV infections. High levels of sexual risk behaviour, tattooing and use of non-sterile razors among prisoners were documented.ConclusionsPrisons play an important role in HIV and HCV dynamics in MENA and have facilitated the emergence of large HIV epidemics in at least two countries, Iran and Pakistan. There is evidence for substantial but variable HIV and HCV prevalence, as well as risk behaviour including injecting drug use and unprotected sex among prisoners across countries. These findings highlight the need for comprehensive harm-reduction strategies in prisons.

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“…In addition, scarcity of gender-sensitive programs and lack of systematic approach in development of national guidelines hinder enactment of new treatment strategies in MENA [4,5,13,14] . HIV epidemic is characterized by rising incidence and prevalence rates among key at-risk populations, specifically among people who inject drugs (PWIDs) [12] . Hence the co-infections that are diagnosed more commonly among these population groups require particular attention in the implementation of the ART guidelines [15,16] .…”

Section: Introductionmentioning

confidence: 99%

“…From a social perspective, the cultural context that prohibits HIV related high-risk behaviors encourages ubiquitous stigma that affects access to available services in the MENA countries [4][5][6][7] . Availability and allocation of resources, on the other hand, has been threatened by ongoing conflicts and high rates of migration [8][9][10][11][12] . From a public health perspective, in many countries of the MENA lack of integrated data on HIV incidence rates and disease progression among known patients requires to be increased [8] .…”

Section: Introductionmentioning

confidence: 99%

Early initiation of antiretroviral treatment: Challenges in the Middle East and North Africa

Sardashti

Samaei

Firouzeh

et al. 2015

WJV

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New World Health Organization guidelines recommend the initiation of antiretroviral treatment (ART) for asymptomatic patients with CD4+ T-cell counts of ≤ 500 cells/mm 3 . Substantial reduction of human immunodeficiency virus (HIV) transmission is addressed as a major public health outcome of this new approach. Middle East and North Africa (MENA), known as the area of controversies in terms of availability of comprehensive data, has shown concentrated epidemics among most of it's at risk population groups. Serious challenges impede the applicability of new guidelines in the MENA Region. Insufficient resources restrict ART coverage to less than 14%, while only one fourth of the countries had reportable data on patients' CD4 counts at the time of diagnosis. Clinical guidelines need to be significantly modified to reach practical utility, and surveillance systems have not yet been developed in many countries of MENA. Based on available evidence in several countries people who inject drugs and men who have sex with men are increasingly vulnerable to HIV and viral hepatitis, while their sexual partners -either female sex workers or women in monogamous relationships with high-risk men -are potential bridging populations that are not appropriately addressed by regional programs. Research to monitor the response to ART among the mentioned groups are seriously lacking, while drug resistant HIV strains and limited information on adherence patterns to treatment regimens require urgent recognition by health policymakers. Commitment to defined goals in the fight against HIV, development of innovative methods to improve registration and reporting systems, monitoring and evaluation of current programs followed by costeffective modifications are proposed as effective steps to be acknowledged by National AIDS Programs of the countries of MENA Region. 134 MINIREVIEWSSubmit a

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The emerging face of the HIV epidemic in the Middle East and North Africa

Cited by 74 publications

References 20 publications

Antiretroviral therapy, CD4, viral load, and disease stage in HIV patients in Saudi Arabia: a 2001–2013 cross-sectional study

Antiretroviral therapy, CD4, viral load, and disease stage in HIV patients in Saudi Arabia: a 2001–2013 cross-sectional study

Status of HIV and hepatitis C virus infections among prisoners in the Middle East and North Africa: review and synthesis

Early initiation of antiretroviral treatment: Challenges in the Middle East and North Africa

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