EPI-NEWS

About diseases and vaccines

No 42/44 - 2018

HIV 2017

  • In 2017, a total of 182 persons were notified with newly diagnosed HIV, along with 71 persons who had already been diagnosed abroad.
     
  • Among the newly diagnosed persons, 97 were men who have sex with men (MSM), 73 were infected heterosexually (HTX), four cases were mother-to-child transmission (MTCT) and another four were people who inject drugs (PWID). In four cases, the mode of infection was unknown.
     
  • One of the four children was born in Denmark. The mother had become infected after having tested negative in the pregnancy screening.
     
  • 81% of the MSM and 39% of the HTX had become infected in Denmark.
     
  • Among the newly-diagnosed MSM, 35% were immigrants. The corresponding share for HTX was 47%.
     
  • Among MSM, 31% were tested late. The same applied to 47% of the HTX.
     
  • All MSM who have not been diagnosed with HIV should be HIV tested annually. Furthermore, MSM who lead an active sex life and who do not consistently use a condom should be tested for HIV and other sexually transmitted diseases more frequently, e.g. every 3 months.
     
  • Initiation of treatment immediately after the diagnosis means that people who are known HIV positives do not pose a risk for further HIV transmission, as well-treated HIV positives are not infectious.
     
  • Prevention of HIV infection includes use of condoms, TasP (Treatment As Prevention, i.e. that you only have unprotected sex with people who are known to be HIV positives and who are in effective treatment), PrEP (Pre Exposure Prophylaxis, HIV medication taken before exposure) and PEP (Post Exposure Prophylaxis, HIV medication taken shortly after exposure).
     
  • Ignorance and stigma lead to unfounded fear and rejection of HIV positives, even in MSM communities, why dissemination of more knowledge about the topic is essential. 

For a detailed epidemiological description of the 2017 incidence, please see the 2017 annual HIV report.

The number of notified, newly-diagnosed HIV cases in 2017 was 182, which is on a par with the number observed in the preceding years.

At 53% of the notifications, MSM remained the largest infection group. An increasing share of the newly-diagnosed MSM are immigrants. This fact warrants the introduction of special preventive measures, as HIV transmission in Denmark occurs mainly in the MSM group. In contrast to HIV positives in the HTX group, MSM have more contacts of varying origins and ethnicity.

Despite considerable testing activity, not least at the Checkpoints (the Danish AIDS Foundation’s testing sites for MSM and immigrants), a high share of the newly diagnosed cases are tested long after having become infected. This trend is seen not just for the heterosexually infected, but also among MSM. MSM should be tested for HIV annually, and the MSM who lead an active sex life and do not consistently use a condom should be tested for HIV and the other sexually transmitted infections more frequently, e.g. every three months.

It is our hope that more of the relevant exposed persons will become tested if testing options are enhanced. This may be done by introducing home-testing or by increasing the number of test sites. For example, the Infectious Medicine Outpatient Clinic at Hvidovre Hospital has introduced a quick test offer that allows people to get their rest result immediately even if they visit the clinic without an appointment.

More initiatives may contribute to further reducing the infection pressure in Denmark. If the testing activity increases and if it is targeted towards the right persons, the new guidelines on treatment immediately after the diagnosis will reduce the infection pressure, as well-treated HIV positives cannot pass on the infection to others (known as TasP, Treatment as Prevention). Another initiative is PrEP, which is offered in more and more countries, and which is currently being dispensed in pilot projects in Denmark. Just like the price of HIV treatment, the price of PrEP follows a decreasing trend, and it is expected that PrEP will shortly become available as HIV prophylactic medication.

In connection with inclusion of MSM into PrEP projects, six MSM - 6% of all the MSM who had HIV diagnosed in 2017 - were diagnosed with HIV at the initial tests, which goes to underline the interest in and need to employ this prophylactic method. Condoms are still a good preventive method, not only for HIV, but also for most other sexually transmittable diseases.

Even though several biological and technical methods are available in the effort to reduce the infection pressure in Denmark, HIV remains shrouded in ignorance and stigma, and stigma has been identified as the cause why persons who are aware that they are at risk of being HIV positive choose not to be tested. It is more important than ever to endeavour to overcome ignorance and stigma, both in the general population and particularly in the affected communities. It is important that MSM become aware that those who are diagnosed as HIV positives in the vast majority of cases are well-treated and therefore do not constitute a risk for transmission of the infection. The focus needs to be shifted to those who believe that they are HIV negatives, but who have had unprotected sex after their latest HIV negative test, as the largest share of HIV transmissions in Denmark are from non-diagnosed HIV-positive people.

In the 2015-2017 period, HIV-1 from 349 patients were tested for resistance mutations and subtyped via sequencing of the HIV-1 pol gene. Based on these analyses, no significant increase in the occurrence of resistance mutations has been observed, either among people infected in Denmark or abroad. Furthermore, there is no marked difference in the distribution of subtypes between the two groups, where subtype B remains the most frequently occurring among all persons diagnosed with HIV-1 in Denmark.

Even though resistance mutations are observed against one of the two components in PrEP among newly diagnosed people, PrEP is expected to remain fully effective, as no patients have been observed to be resistant to both of the active components in PrEP.

Like last year, the resistance and typing findings that are presented in this year's annual HIV report, include only persons who were diagnosed for the first time. I.e. the report excludes persons who are known HIV positives because they have been diagnosed abroad.

There is a continuous effort to collect and update epidemiological information in between the release of EPI-NEWS reports; and changes to previous data may therefore occur in subsequent publications.

(A.H. Christiansen, S. Cowan, Department for Infectious Disease Epidemiology and Prevention, J. Fonager, Virus and Specialised Microbiological Diagnostics)

31 October 2018

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