No 45 - 2011

Annual HIV and AIDS report 2010

HIV 2010

2010 saw a total of 274 notified cases of newly diagnosed HIV infection, 201 men and 73 women; 138 Danes, 108 immigrants, 25 tourists and three second-generation immigrants. Among immigrants, 49% were from Sub-Saharan Africa, 20% from Europe, 19% from Asia, 6% from North or South America, 3% from Greenland and 2% from North Africa. Information on the year of immigration was available for 73 (76%) of the 96 immigrants who were not notified as having been infected in Denmark. Only 36 (49%) of these had immigrated in 2010. The median age was 41 years for men (range 2-75 years) and 33 years for women (range 0-70 years). Three children above the age of four years were notified, the remaining cases were all older than 18 years of age. A total of 131 (48%) were infected in Denmark and 132 (48%) abroad. In 11 cases (4%), the country of infection was not stated. Among 265 cases with information on mode of infection, 248 (94%) were infected via sexual con-tact, including 113 MSM and 135 heterosexually infected (HTX). Fourteen (5%) were infected by IV drug use (IDU). Three children (1%) were infected perinatally, two of these in Denmark before the mother was comprised by the general HIV screening of pregnant women. Among the notified cases, 34% resided in the Capital Region of Denmark. See the Annual HIV and AIDS report 2010 (pdf)

Danish men

Among 127 Danish men, 86 (68%) were MSM. A total of 33 were HTX: in 24 cases infected by a woman from a known risk group and in nine cases by a woman without known risks. Five (3%) were infected by IDU and in two cases the mode of infection was unknown. One person was infected perinatally. Among MSM, eight (9%) were infected abroad. The corresponding number for HTX was 17 (52%).

Danish women

Among 11 Danish women, seven (64%) were HTX, all infected by a man with no known risks. Two (18%) were IDU and one was probably infected by sex with a man infected via blood transfusion abroad. One person was infected perinatally. Two of the 11 women were detected via the pregnancy screening programme, EPI-NEWS 15/11.

Immigrant men

Among 60 immigrant men, 22 (37%) were MSM. A total of 30 were HTX: 21 cases were infected by a woman from a known risk group and nine cases by a woman without known risks. Three were infected via IDU and in four cases the mode of infection was not stated. One was infected perinatally. Among MSM, seven (32%) were infected in Denmark; the corresponding figure among HTX was five (17%). In six cases, the country of infection was not stated.

Immigrant women

Among 51 immigrant women, 48 (94%) were HTX: in 42 cases infected by a man from a known risk group and in six cases by a man without known risks. Two were IDU and in one case the mode of infection was unknown. Among HTX infected immigrant women seven (15%) were notified as infected in Denmark. Nine of the 51 women were detected via the pregnancy screening programme, one pregnant women was known to have HIV, but had not previously been notified.

Tourists

Among the 25 tourists, 14 were men and 11 women, five MSM, 16 HTX, two IDU and two had no known risks.

CD4 counts and treatment initiation

Among 249 notified cases residing in Denmark, 226 (91%) had information on CD4 counts at time of diagnosis. In the remaining 23 cases, CD4 were unavailable. The CD4 count is a marker that indicates how HIV virus affects the cellular immune response. CD4 counts < 350 cells per µl blood currently constitutes indication for initiation of HAART treatment in Denmark. Figures 1 and 2 show the distribution of CD4 counts at time of diagnosis for MSM and HTX infected immigrants in 2007-2010.

AIDS 2010

In 2010, 45 persons were notified with AIDS, 35 (78%) men and 10 (22%) women. Among men, 15 (43%) were MSM, 16 (46%) were HTX and three were infected via IDU. The median age was 45 years (range 23-62 years). Among women, eight were infected by HTX and one by perinatal infection. The median age was 41 years (range 0-69 years). A total of 19 were immigrants; 13 men and six women. Among the 45 diagnosed with AIDS in 2010, 30 (67%) were diagnosed with HIV the same year. In 2010, four persons previously notified with AIDS died. See the Annual HIV and AIDS report 2010 (pdf)

Commentary
MSM and HTX infected immigrants infected prior to arrival in Denmark remain the primary infection groups. Persons with a CD4 count below 350 are considered late HIV testees as they were diagnosed so late that they needed treatment at time of diagnosis. Among MSM, 45% had a CD4 count below 350. The corresponding share was 53% for HTX-infected immigrants and 74% for HTX-infected Danes. As in 2009, only half of the HIV infected immigrants were tested the year they entered Denmark. In the National Board of Health test guidelines, EPI-NEWS 46/09 and EPI-NEWS 48/09, HIV testing is recommended for all immigrants arriving from highly endemic areas. Seemingly, this practice has not yet gained foothold and in line herewith, too few MSMs are tested regularly. As both MSM- and HTX-infected immigrants from highly endemic countries are known to have an increased risk of HIV infection, there is hope that increased information efforts among risk groups and among the physicians who encounter these patients in the treatment system may help optimize test routines. The share of HTX infected Danes infected without knowing that they were at risk cannot be expected to have HIV testing performed. Physicians should pay special attention to the risk of HIV in persons with unexplained symptoms/conditions associated with HIV infection.
(A.H. Christiansen, S. Cowan, Department of Epidemiology)

The Annual HIV and AIDS report 2010

See the Annual HIV and AIDS report 2010 (pdf)

(Department of Epidemiology) 

9. november 2011