Abstract
Serological methods exist that allow differentiating between recent and long-standing infections in persons infected with HIV. During a pilot study in Berlin between 2005 and 2007 methodologies have been evaluated. In a cross-sectional study blood samples, demographic, laboratory, clinical and behavioural data based on a KABP survey were collected from patients with newly diagnosed HIV infections. The BED-CEIA was used to determine recency of infection. Recent HIV infections contributed 54% (CI [95%]: 45; 64) in MSM and 16% (CI [95%]: 0; 39) in patients with other transmission risks (p=0.041). Proportions of recent infections were significantly higher in MSM <or=30 years (p=0.019). The mean age was 33.9 (median 34 years) in recent compared with 38.6 years (median: 38 years) in long-standing infections (p=0.011). High-risk behaviour indicated through very low condom use in recently HIV infected MSM could be identified. The results of the pilot study support expectations that the modified application of the method may contribute to improving HIV prevention efforts in Germany. On this basis the Robert Koch Institute implemented a countrywide HIV incidence study to complement HIV surveillance in early 2008. The study is funded by the German Ministry of Health. Data on recent HIV infections and current HIV transmission risks are collected. Design, methods and impact are described in detail. .
Highlights
In Germany newly diagnosed human immunodeficiency virus (HIV) infections reached a peak of 2,360 cases in 1993
The 132 cases represent 27% of all newly diagnosed HIV cases reported to the Robert Koch Institute (RKI) from the Federal State of Berlin during the study period between November 2005 and February 2007 (n=495)
Proportions of recent out of newly diagnosed HIV infections were found to be 54% in men having sex with men (MSM) (95% Confidence Interval (CI): 38-56) and 16% in patients stating other risks
Summary
In Germany newly diagnosed human immunodeficiency virus (HIV) infections reached a peak of 2,360 cases in 1993. There are several possible explanations for these changes: an increase in HIV transmission (“true” incident infections); improved (earlier) case detection and reporting following the implementation of the “Protection against Infection Act” (Infektionsschutzgesetz - IfSG) in 2001; an increased number of HIV tests performed; changing attitudes towards HIV testing; and more widespread availability of testing facilities and better access to these facilities. The higher number of HIV tests (ELISA and Western blot) performed in German laboratories when comparing the year 1999 to 2004 and the augmented use of HIV-NAT in primary HIV diagnosis indicate changes regarding HIV testing [3].The rising number of cases reported between 1996 and 1997 may reflect increased testing for HIV following the implementation of highly active antiretroviral treatment (HAART). The upwards trend in syphilis cases reported in Germany was discussed as a possible cofactor for increased HIV transmission in men having sex with men (MSM) [1]. The implications of these trends have not yet been analysed systematically
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