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Effective antiretroviral treatment of HIV-1, defined as continuously undetectable virus in blood, has substantial effects on the infectiousness and spread of HIV.This paper outlines the assessment of the Swedish Reference Group for Antiviral Therapy (RAV) and Public Health Agency of Sweden regarding contagiousness of HIV-infected persons on antiretroviral therapy (ART).

BackgroundMost HIV infections originate from individuals who are undiagnosed and unaware of their infection. Estimation of this quantity from surveillance data is hard because there is incomplete knowledge abouti)the time between infection and diagnosis (TI) for the general population andii)the time between immigration and diagnosis for foreign-born persons.DevelopmentWe developed a new statistical method for estimating the number of undiagnosed people living with HIV (PLHIV) and the incidence of HIV-1 based on dynamic modeling of heterogenous HIV-1 surveillance data. We formulated a Bayesian non-linear mixed effects model using multiple biomarkers to estimate TI accounting for biomarker correlation and individual heterogeneities. We explicitly model the probability that an HIV-1 infected foreign-born person was infected either before or after immigration to distinguish between endogenous and exogeneous incidence. The incidence estimator allows for direct calculation of the number of undiagnosed persons.ApplicationThe model was applied to surveillance data in Sweden. The dynamic biomarker model was trained on longitudinal data from 31 treatment-naïve patients with well-defined TI, using CD4 counts, BED serology, polymorphisms in HIV-1polsequences, and testing history. The multiple-biomarker model was more accurate than single biomarkers (mean absolute error 1.01 vs ≥ 1.95). We estimate that 813 (95% CI 780-862) PLHIV were undiagnosed in 2015, representing a proportion of 10.8% (95% CI 10.4-11.3%) of all PLHIV.ConclusionsThe proposed methodology will enhance the utility of standard surveillance data streams and will be useful to monitor progress towards and compliance with the 90-90-90 UNAIDS target.Key messagesCombined heterogeneous HIV-1 surveillance data and biomarker data can be used to estimate both local incidence and the number of undiagnosed people living with HIV.Explicit modeling of the dynamics, heterogeneity, and correlation of multiple biomarkers over time improved estimation of time between infection and diagnosis.Explicit modeling of the probability that foreign-born persons were infected before or after immigration improves accuracy of estimates of endogenous incidence and undiagnosed persons living with HIV.The endogenous incidence of HIV-1 in Sweden is declining, despite continued immigration of HIV-1 infected persons.The proportion of undiagnosed PLHIV decreased over 2010-2015 and was estimated to be 10.8% (95% CI, 10.4-11.3%) in 2015.

Hepatitis B virus (HBV) infection remains a global health threat. The World Health Organization (WHO) established a goal to eliminate HBV infection as a public health threat by 2030, and defined targets for key interventions to achieve that goal. We evaluated HBV burden and relevant national recommendations for progress towards WHO targets in circumpolar countries. Viral hepatitis experts of circumpolar countries were surveyed regarding their country’s burden of HBV, achievement of WHO targets and national public health authority recommendations for HBV prevention and control. Eight of nine circumpolar countries responded. All countries continue to see new HBV infections. Data about HBV prevalence and progress in reaching WHO 2030 elimination targets are lacking. No country was able to report data for all seven WHO target measures. All countries have recommendations targeting the prevention of mother-to-child transmission. Only the USA and Greenland recommend universal birth dose vaccination. Four countries have recommendations to screen persons at high risk for HBV. Existing recommendations largely address prevention; however, recommendations for universal birth dose vaccination have not been widely introduced. Opportunities remain for the development of trackable targets and national elimination planning to screen and treat for HBV to reduce incidence and mortality.

Background Sweden has a low HIV prevalence. However, among new HIV diagnoses in 2016, the proportion of late presenters and migrants was high (59% and 81%, respectively). This poses challenges in estimating the proportion of undiagnosed persons living with HIV (PLHIV). Aim To estimate the proportion of undiagnosed PLHIV in Sweden comparing two models with different demands on data availability and modelling expertise. Methods An individual-based stochastic simulation model of HIV positive populations (SSOPHIE) and the incidence method of the European Centre for Disease Prevention and Control (ECDC) HIV Modelling Tool were applied to clinical, surveillance and migration data from Sweden 1980–2016. Results SSOPHIE estimated that the proportion of undiagnosed PLHIV in 2013 was 26% (n = 2,100; 90% plausibility range (PR): 900–5,000) for all PLHIV, 17% (n = 600; 90% PR: 100–2,000) for men who have sex with men (MSM), 35% in male (n = 300; 90% PR: 200–700) and 34% in female (n = 400; 90% PR: 200–800) migrants from sub-Saharan Africa (SSA). The estimates for the ECDC model in 2013 were 21% (n = 2,013; 95% confidence interval (CI): 1,831–2,189) for all PLHIV, 15% (n = 369; 95% CI: 299–434) for MSM and 21% (n = 530; 95% CI: 436–632) for migrants from SSA. Conclusions The proportion of undiagnosed PLHIV in Sweden is uncertain. SSOPHIE estimates had wide PR. The ECDC model estimates were unreliable because migration was not accounted for. Better migration data and estimation methods are required to obtain reliable estimates of proportions of undiagnosed PLHIV in similar settings.

We summarised available hepatitis C virus (HCV) surveillance data for 2012–14 from Arctic/sub-Arctic countries/regions. We sent a HCV data collection template by email to public health authorities in all jurisdictions. Population statistics obtained from census sources for each country were used to estimate rates of reported acute and chronic/undifferentiated HCV cases. Seven countries with Arctic regions (Canada, Denmark, Finland, Greenland, Norway, Sweden and the United States, represented by the state of Alaska), including three Canadian territories and one province, as well as 11 Russian subnational Arctic regions, completed the data collection template. Data on acute HCV infection during 2014 was available from three Arctic countries and all Russian Arctic regions (rate range 0/100,000 population in Greenland, as well as Nenets and Chukotka Automous Okrugs (Russian subnational Arctic regions) to 3.7/100,000 in the Russian Republic of Komi). The rate of people with chronic/undifferentiated HCV infection in 2014 ranged from 0/100,000 in Greenland to 171.2/100,000 in Alaska. In most countries/regions, the majority of HCV-infected people were male and aged 19–64 years. Differences in surveillance methods preclude direct comparisons of HCV surveillance data between Arctic countries/regions. Our data can inform future efforts to develop standardised approaches to HCV surveillance in the Arctic countries/regions by identifying similarities/differences between the surveillance data collected.

EU/EEA HIV Surveillance Network: Daniela Schmid, André Sasse, Dominique Van Beckhoven, Tonka Varleva, Tatjana Nemeth Blazic, Linos Hadjihannas, Maria Koliou, Marek Maly, Susan Cowan, Kristi Rüütel, Kirsi Liitsola, Mika Salminen, Françoise Cazein, Josiane Pillonel, Florence Lot, Barbara Gunsenheimer-Bartmeyer, Stavros Patrinos, Dimitra Paraskeva, Maria Dudas, Haraldur Briem, Gudrun Sigmundsdottir, Derval Igoe, Kate O'Donnell, Darina O'Flanagan, Barbara Suligoi, Šarlote Konova, Sabine Erne, Irma Caplinskiene, Aurélie Fischer, Jackie Maistre Melillo, Tanya Melillo, Eline Op de Coul, Hans Blystad, Magdalena Rosinska, Isabel Aldir, Helena Cortes Martins, Mariana Mardarescu, Peter Truska, Irena Klavs, Asunción Díaz, Maria Axelsson, Valerie Delpech Helena Cortes Martins: Departamento de Doenças Infeciosas do Instituto Nacional de Saúde Doutor Ricardo Jorge. Background: The HIV burden is increasing in older adults in the European Union (EU) and European Economic Area (EEA). We investigated factors associated with HIV diagnosis in older adults in the 31 EU/EEA countries during a 12 year period. Methods: In this analysis of surveillance data, we compared data from older people (aged ≥50 years) with those from younger people (aged 15–49 years). We extracted new HIV diagnoses reported to the European Surveillance System between Jan 1, 2004, and Dec 31, 2015, and stratified them by age, sex, migration status, transmission route, and CD4 cell count. We defined late diagnosis as CD4 count of less than 350 cells per μL at diagnosis and diagnosis with advanced HIV disease as less than 200 cells per μL. We compared the two age groups with the χ² test for difference, and used linear regression analysis to assess temporal trends. Findings: During the study period 54 102 new HIV diagnoses were reported in older adults. The average notification rate of new diagnoses was 2·6 per 100 000 population across the whole 12 year period, which significantly increased over time (annual average change [AAC] 2·1%, 95% CI 1·1–3·1; p=0·0009). Notification rates for new HIV diagnoses in older adults increased significantly in 16 countries in 2004–15, clustering in central and eastern EU/EEA countries. In 2015, compared with younger adults, older individuals were more likely to originate from the reporting country, to have acquired HIV via heterosexual contact, and to present late (p

Conclusion Kinetic oscillation stimulation (KOS) of nasal mucosa at low frequency seems to be a possibly effective and safe short-term treatment of non-allergic nasal stuffiness. Objective To assess the relief of rhinitis symptoms, especially stuffiness, by comparing active treatment, i.e. KOS at low frequency of the nasal mucosa, with placebo. Methods Patients were randomized to active or placebo treatment in this double-blinded parallel design study. Treatment with an inflatable oscillating catheter was administered on day 0, and symptom scores (stuffiness, secretion, and itching) were graded daily until day 14. An overall grading of symptoms from 1 week before treatment and during 14 days thereafter was made at day 14. Eighty-six patients (52 with non-allergic perennial rhinitis, NAR; 34 with rhinitis medicamentosa, RM) were randomized, and 71 were evaluated (active treatment, n = 35; placebo, n = 36). Results Patients with either NAR or RM who received active treatment reported reduced symptom scores by some measures, e.g. median RQSS stuffiness measure fell from 2 to 1 on a scale from 0 to 3 during the week following treatment. No significant effect was observed for patients treated with placebo. Mild side effects were reported.

Detailed phylogenetic analyses were performed to characterize an HIV-1 outbreak among injection drug users (IDUs) in Stockholm, Sweden, in 2006. This study investigated the source and dynamics of HIV-1 spread during the outbreak as well as associated demographic and clinical factors. Seventy Swedish IDUs diagnosed during 2004 to 2007 were studied. Demographic, clinical, and laboratory data were collected, and the V3 region of the HIV-1 envelope gene was sequenced to allow detailed phylogenetic analyses. The results showed that the Stockholm outbreak was caused by a CRF01_AE variant imported from Helsinki, Finland, around 2003, which was quiescent until the outbreak started in 2006. Local Swedish subtype B variants continued to spread at a lower rate. The number of new CRF01_AE cases over a rooted phylogenetic tree accurately reflected the transmission dynamics and showed a temporary increase, by a factor of 12, in HIV incidence during the outbreak. Virus levels were similar in CRF01_AE and subtype B infections, arguing against differences in contagiousness. Similarly, there were no major differences in other baseline characteristics. Instead, the outbreak in Stockholm (and Helsinki) was best explained by an introduction of HIV into a standing network of previously uninfected IDUs. The combination of phylogenetics and epidemiological data creates a powerful tool for investigating outbreaks of HIV and other infectious diseases that could improve surveillance and prevention.

The EDA project “Detection in Urban scenario using Combined Airborne imaging Sensors” (DUCAS) is in progress. The aim of the project is to investigate the potential benefit of combined high spatial and spectral resolution airborne imagery for several defense applications in the urban area. The project is taking advantage of the combined resources from 7 contributing nations within the EDA framework. An extensive field trial has been carried out in the city of Zeebrugge at the Belgian coast in June 2011. The Belgian armed forces contributed with platforms, weapons, personnel (soldiers) and logistics for the trial. Ground truth measurements with respect to geometrical characteristics, optical material properties and weather conditions were obtained in addition to hyperspectral, multispectral and high resolution spatial imagery. High spectral/spatial resolution sensor data are used for detection, classification, identification and tracking.

Fibre orientation influences many important properties of fibre-based materials, for example, strength and stiffness. Fibre orientation and the orientation anisotropy in paper and other wood fibre-based materials have previously been estimated using two-dimensional images. Recently, we presented a method for estimating the three-dimensional fibre orientation in volume images based on local orientation estimates. Here, we present an evaluation of the method with respect to scale and noise sensitivity. The evaluation is performed for both tubular and solid fibres. We also present a new method for automatic scale selection for solid fibres. The method is based on a segmentation of the fibres that also provides an estimate of the fibre dimension distribution in an image. The results show that the fibre orientation estimation performs well both in noisy images and at different scales. The presented results can be used as a guide to select appropriate parameters for the method when it is applied to real data. The applicability of the fibre orientation estimation to fibre-based materials with solid fibres is demonstrated for a volume image of a press felt acquired with X-ray microtomography.