Hello. My name is Cristiana Oprea. I’m an infectious disease and HIV clinician at Victor Babes Hospital for infectious and tropical diseases in Bucharest, and also an associate professor at Carol Davila University of Medicine and Pharmacy in Bucharest, Romania. I am part of the European AIDS Clinical Society governing board since 2014, and also part of the EuroSida steering committee since 2017.
Q: Would you introduce your professional journey and experience in the field of infectious disease, especially in HIV treatment?
Prof. Oprea: Yes, I’m working in infectious diseases since 1991 and in the HIV field since 1994. I was working first in the pediatric HIV department, starting with 1994 -1995 with the pediatric HIV cohort of children, infected between 1987 and 1990, by parental mode, due to unsafe medical procedures. After that, I continued to work with adolescents and adults living with HIV, with people who inject drugs and other people belonging to the key population, or other categories of patients with severe infections (TB or hepatitis co -infection, sepsis etc). So my expertise in the HIV field is extended for almost 30 years. And now I am the head of the department of HIV and infectious diseases in my hospital. And I supervise a department with 60 beds where we take care of patients living with HIV and other immunosuppressive diseases
Q: Thank you so much. And our question is the guidelines provided by ESCS and WHO and DHHS in place in important role in shaping HIV treatment strategies in different regions. What are the consensus and disagreement points of these three guidelines?
Prof. Oprea: The three guidelines have relatively similar indications, however there are small differences.
All 3 guidelines (EACS, WHO, DHHS) recommend as first line regimen 2 NRTIs Tenofovir (TDF or TAF) with emtricitabine or lamivudine in combination with an integrase inhibitor (bictegravir or dolutegravir). However, EACS guidelines remains more comprehensive, still including in the first line regimen some combinations with integrase inhibitors that are not co-formulated in single tablet regimens, such as Raltegravir and also the latest generation of NNRTI Doravirine in combination with 2 NRTIs
EACS and DHHS guidelines are also recommending a 2 drug regimen with lamivudine and dolutegravir in selected patients.
WHO guidelines has a special recommendation for Efavirenz, as alternative, at a lower dose of 400 milligrams that is not recommended in the DHHS and the EACS guideline.
Q: And based on your experience and expertise, can you explain the current situation of HIV treatment strategies across Central, Eastern and South Eastern Europe?
Prof. Oprea: I’m a clinician and not an expert in public health but I think that in these difficult times with war and people struggling with a lot of problems and suffering in different parts of the world, that it would be important that people living with HIV should benefit, let’s say, of an “universal HIV passport, and treated for HIV irrespective if they are migrants, refugees, if they are belonging to key population or hard-to-reach population. I think that all should have the right to be treated equal.
Social barriers and economic barriers, have to be removed for HIV and stigma and discrimination should be reduced in order to achieve the 95, 95, 95 UNAIDS targets for 2030. We should try to give our patients the most efficient, simple and tolerable regimen to improve their quality of life.
Q: Thank you. And lastly, what continuous efforts do you believe are needed to harmonize our strategies to improve this cascade of care in the region?
Prof. Oprea: There are a lot of educational programs and counselling that are useful and important to improve adherence for all these patients. I think that policy makers play also an active role because in some countries there are still periods with shortage of budgets and, as a consequence, shortage in antiretroviral treatment. HIV prevention programs should also be prioritized and it would be important to include in the HIV National programs PrEP (preexposure prophylaxis), used on a large scale in western countries but not in central and eastern European countries. So we have to intensify testing, treatment but also on prevention. Prevention is now I think the most important or the key factor we have to work on.