- In 2020, a total of 110 persons were notified with newly diagnosed HIV along with 54 persons who had al-ready been diagnosed abroad.
- Among the newly diagnosed persons, 83 were Danes who had become infected in Denmark or abroad, or immigrants infected after their arrival to Denmark. The remaining 27 were immigrants who had become infected before their arrival to Denmark. These 27 persons could not have been reached with Danish HIV-preventive measures.
- Among the newly diagnosed patients, 61 were men who have sex with men (MSM), 47 were heterosexual-ly infected (HTX), among whom 31 were men and 16 women, one was notified as being a drug user and in one case the mode of transmission was not stated.
- 75% of the MSM and 37% of the HTX had become infected in Denmark.
- Among the newly diagnosed MSM, 36% were immigrants. The corresponding share for HTX was 43%.
- Among MSM, 40% were tested late. The same applied to 72% 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 pose no risk for further HIV transmission as well-treated HIV positives cannot transmit the condition.
- Prevention of HIV infection includes
- Using condoms
- TasP (Treatment as Prevention, i.e. only having unprotected sex with HIV-positive people who are known to be in effective treatment)
- PrEP (Pre Exposure Prophylaxis, HIV medication taken prior to exposure)
- PEP (Post Exposure Prophylaxis, HIV medication taken immediately after exposure)
2020 saw a total of 164 notified cases of HIV, including 134 men and 30 women, Table 1.
The median age of patients notified in 2020 was 41 years for men (range 18-78 years) and 39 years for women (range 2-60 years).
Among these 164 notified cases, 54 persons (33%) had previously been diagnosed with HIV abroad, including eight 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 in Denmark).
In all three cases, a declining number was observed.
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 2020
Newly diagnosed HIV positives in 2020: 110
Hereof MSM: 61
Estimated number of persons who are living with HIV in Denmark: (6,700)
Hereof MSM: 3,700
The number of persons who are living with HIV in Denmark and have been diagnosed with HIV: 6,100
Hereof MSM: 3,400
The undiagnosed share (the dark figure): 600
Hereof MSM: 300
Share tested late (with a CD4 count below 350 and/or AIDS at the time of their diagnosis) in 2020: 55% (60 of 109)Among MSM, the share was 40% (24 out of 60)
Origin, country of infection and mode of infection
Among the 110 people who were diagnosed with HIV for the first time, a total of 67 (61%) were born in Denmark and 43 (39%) were born abroad.
Among 61 MSM, a total of 28 (46%) were born in Denmark and had become infected in Denmark, 13 (21%) were born abroad and had become infected in Denmark, whereas 11 (18%) were born in Denmark and had become infected abroad. These 52 (85%) together constitute the number of MSM for whom the preventive measures in Denmark have been insufficient. The final nine (15%) were born abroad and had become infected before their ar-rival to Denmark.
Among 47 HTX, a total of 13 (28%) were born in Denmark and had become infected in Denmark, three (6%) were born abroad and had become infected after arriving to Denmark, whereas 14 (30%) were born in Denmark and had become infected abroad. These 30 (64%) together constitute the number of HTX for whom the preventive measures in Denmark have been insufficient. The final 17 (36%) were born abroad and had become infected be-fore their arrival to Denmark.
In addition to the sexually infected persons, one of the notified persons had become infected by IV drug use (born abroad) and for one person, the mode of infection was unknown (born in Denmark).
Two of the 30 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 105 in 2015 to 61 in 2020. For HTX, the number of newly diagnosed MSM has decreased from 98 in 2015 to 47 in 2020,
Figure 1. This is primarily owed to a decline in the number of newly diagnosed immigrants infected before their arrival to Denmark. In the same period, the number of notified HTX who were born in Denmark only decreased modestly; from 37 to 27.
A similar trend is seen when only persons who were notified as having become infected in Denmark are included in the calculations, Figure 2. Here, a continued decline is seen among MSM from 2015 to 2020, whereas only a mi-nor decline is seen among HTX in the same period.
Considerable geographical variation exists in the decline of notified MSM from 2019 to 2020; a considerable decline was observed for the city of Copenhagen (49%), but no decline was seen in the rest of Denmark, Table 2.
CD4 counts at diagnosis - tested late
For 109 (99%) of the 110 persons who were diagnosed with HIV for the first time in 2020, information was availa-ble about their CD4 count when they were diagnosed and/or about recent infection (negative test and/or acute HIV disease) or about AIDS at their diagnosis. For one tourist, the CD4 count was 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 109 persons for whom the CD4 count was stated at the time of diagnosis, 60 (55%) had a CD4 count be-low 350 cells per µl and/or had been diagnosed with AIDS, whereas 49 (45%) had a CD4 count of 350 or above or had been diagnosed with acute HIV.
Among 60 MSM for whom the CD4 count was stated, a total of 24 (40%) were tested late (had a CD4 count below 350), whereas 36 (60%) had CD4 counts > 349 or signs of new infection at the time of their diagnosis. Among 47 HTX for whom the CD4 count was stated, a total of 34 (72%) were tested late, whereas 13 (28%) had CD4 counts > 349 or signs of new infection at the time of their diagnosis.
In 2019, 51% of MSM were notified as having been tested late. Thus, an improvement was recorded compared with the previous year, and the efforts made to have MSM tests sufficiently frequently to ensure their early diagnosis seems to be gaining foothold. The share of MSM who were tested late in the Copenhagen area (42%) is large-ly in line with the corresponding share observed for all of Denmark (40%). Even so, in the city of Copenhagen, the share of late tested MSM was 47%. This may possibly be explained by increased testing activity in the city of Co-penhagen (why MSM are now being found who would not otherwise have been tested), either owed to the possibility of receiving PrEP or owed to other unknown factors.
In 2020, 26 of the 110 newly HIV-diagnosed persons (24%) were notified with AIDS as they were diagnosed with an AIDS-defining condition concurrently with their HIV diagnosis. This included 16 HTX, nine MSM and one case in which sexual orientation was not stated. The most frequently recorded AIDS-defining diagnosis was pneumocystis jirovecii-pneumonia.
Checkpoint is the Danish AIDS Foundation's test sites for MSM and immigrants in Copenhagen, Aarhus and Oden-se. Here, you can be tested for HIV and syphilis without scheduling an appointment, and you will receive the re-sults immediately. A total of six persons tested HIV positive for the first time, one Dane and five immigrants; all were MSM.
A total of six of the 110 newly diagnosed people (5%) were tested at a Checkpoint, and six of the 61 newly-diagnosed MSM (10%) were established at Checkpoints.
This annual report is also described in EPI-NEWS no. 47/48-21.
(A.K. Hvass, S. Cowan, Department of Infectious Disease Epidemiology and Prevention)
1 December 2020