2019 saw a total of 190 notified cases of HIV, including 146 men and 44 women, Table 1.
- In 2019, a total of 143 persons were notified with newly diagnosed HIV, along with 47 persons who had already been diagnosed abroad.
- Among the newly diagnosed persons, 96 were either Danes who had become infected in Denmark or abroad, or immigrants infected after their arrival to Denmark. The remaining 47 were immigrants who had become infected before their arrival to Denmark. These 47 persons could not have been reached with Danish HIV-preventive measures.
- Among the newly diagnosed persons, 76 were men who have sex with men (MSM), 65 were infected heterosexually (HTX) and two were people who inject drugs.
- 63% of the MSM and 34% of the HTX had become infected in Denmark.
- Among the newly diagnosed MSM, 28% were immigrants. The corresponding share for HTX was 55%.
- Among MSM, 45% were tested late. The same applied to 62% 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 provided they are in effective treatment), PrEP (Pre Exposure Prophylaxis, HIV medication taken before exposure) and PEP (Post Exposure Prophylaxis, HIV medication taken shortly after exposure).
The median age of patients notified in 2018 was 39 years for men (range 16-80 years) and 38 years for women (range 13-59 years).
The median age of patients notified in 2019 was 41 years for men (range 18-77 years) and 38 years for women (range 22-63 years).
Among these 190 notified cases, 47 persons (25%) had previously been diagnosed with HIV abroad, including six persons born in Denmark.
The number of notified HIV-positive persons may be considered in three different ways:
- How many persons with HIV have been added to the Danish population in the course of the year (often coined People Living With HIV (PLWH) or People Living With diagnosed HIV (PLWDH).
- How many persons have been diagnosed with HIV in Denmark (i.e. newly diagnosed persons, who had not already been diagnosed with HIV abroad).
- How many new HIV diagnoses could, in principle, have been prevented through measures targeting the Danish population (i.e. not persons who were already HIV positives when they arrived to Denmark).
For each of the three approaches, a decline was observed in the number of cases (except for an inexplicable drop in 2012), Figure 1.
Box 1. The estimated number of HIV positives in Denmark, the undiagnosed share and the number of cases who were tested late as per 31 December 2019
Newly diagnosed HIV positives in 2019: 143
Hereof MSM: 76Estimated number of persons who are living with HIV in Denmark: 6,600
Hereof MSM: 3,600The number of persons who are living with HIV in Denmark and have been diagnosed with HIV: 6,000Hereof MSM: 3,275
The undiagnosed share (the dark figure): 600
Hereof MSM: 325
Share with a CD4 count below 350 and/or AIDS at the time of their diagnosis in 2019: 53% (71 among 135)
Among MSM, the share was 45% (34 among 75)
Origin, country of infection and mode of infection
Among the 143 persons who were diagnosed with HIV for the first time, a total of 85 (59%) were born in Denmark (including five second-generation immigrants), and 58 (41%) were immigrants, including six tourists.
Among 76 MSM, a total of 42 (55%) were born in Denmark and had become infected in Denmark, six (8%) were born abroad and had become infected in Denmark, whereas 13 (17%) were born in Denmark and had become infected abroad. These 61 (80%) together constitute the number of MSM for whom the preventive measures in Denmark have been insufficient. The final 15 (20%) were born abroad and had become infected before their arrival to Denmark.
Among 65 HTX, a total of 18 (28%) were born in Denmark and had become infected in Denmark, four (6%) were born abroad and had become infected after arriving to Denmark, whereas 11 (17%) were born in Denmark and had become infected abroad. These 33 (51%) together constitute the number of HTX for whom the preventive measures in Denmark have been insufficient. The final 32 (49%) were born abroad and had become infected before their arrival to Denmark.
In addition to the sexually infected persons, two of the notified persons had become infected by IV drug use (one of whom has born in Denmark and the other abroad). Both had become infected in Denmark.
Four of the 31 notified women were pregnant.
Trend in the number of MSM and HTX notified
In all of Denmark, the number of newly diagnosed MSM has decreased from 97 in 2017 to 84 in 2018 and to 76 in 2019. A similar decline has not been observed among HTX in recent years.
A similar trend is seen when only persons infected in Denmark are included in the calculations, Figure 2. Here, we observe a continued decrease among MSM from 2017 to 2019, whereas only a modest decline is seen among HTX in the same period.
The geographical variation in the decline of notified MSM is considerable, as, e.g., the Copenhagen area (Copenhagen City and Copenhagen Subs.) did not record a decline among MSM from 2018 to 2019, Table 2.
CD4 counts at diagnosis - Late testers
For 137 (96%) of the 143 persons who were diagnosed with HIV for the first time in 2019, information was available about their CD4 count at diagnosis and/or about recent infection (negative test and/or acute HIV disease) or about AIDS at diagnosis. In the remaining six cases, CD4 counts were unavailable.
The CD4 count is a marker that indicates how the HIV virus affects the cellular immune response. For a long period of time, a CD4 count below 350 cells per µl blood has been indication for initiation of highly active antiretroviral therapy (HAART) in Denmark if the patient had not wanted to initiate such treatment earlier. In August 2015, the guidelines were changed so that everyone who is diagnosed with HIV is offered to start treatment immediately, regardless of the CD4 count at the time of diagnosis. CD4 counts below 350 and/or AIDS at the time of diagnosis are still used in this report as a marker for late testing.
Among the 137 for whom a CD4 count was stated, a total of 71 (52%) had a CD4 count at diagnosis below 350 cells per µl blood, whereas 66 (48%) had a CD4 count of 350 or above.
Among 75 MSM for whom the CD4 counts were stated, a total of 41 (55%) had a CD4 count > 349 or signs of new infection at the time of their diagnosis, whereas 34 (45%) had been tested late (CD4 counts below 350). Among 60 HTX for whom the CD4 counts were stated, a total of 23 (38%) had a CD4 count > 349 or signs of new infection at the time of their diagnosis, whereas 37 (62%) had been tested late.
In 2018, 40% of MSM were notified as having been tested late. Thus, late testing has increased since last year, and the effort made to have MSM test sufficiently frequently to ensure their early diagnosis seems to have failed. The share of MSM who were tested late in the Copenhagen area is in line with the corresponding share observed for all of Denmark (45%).
A total of 22 persons were notified with AIDS in 2019.
Among 143 newly HIV-diagnosed persons in 2019, a total of 21 (15%) were diagnosed with an AIDS-defining condition concurrently with their HIV diagnosis, including 13 HTX and eight MSM.
Furthermore, one person who had previously been diagnosed with HIV was notified with AIDS in 2019. The most frequently recorded AIDS-defining diagnosis was Pneumocystis jirovecii-pneumonia.
Checkpoint is the Danish AIDS Foundation's test sites for MSM and immigrants. Here, you can be tested for HIV and syphilis without scheduling an appointment, and you will receive the results immediately. A total of eight persons tested HIV positive for the first time; two Danes, two second-generation immigrants and four immigrants, all of whom were MSM.
A total of eight of the 143 newly-diagnosed people (6%) were tested at a Checkpoint, and eight of the 76 newly diagnosed MSM (11%) were established at Checkpoints.
(A.K. Hvass, S. Cowan, Department of Infectious Disease Epidemiology and Prevention)