Abstract
BackgroundDespite availability of pre-exposure prophylaxis (PrEP), the incidence of HIV-1 in Europe remained stable the past decade. Reduction of new HIV-1 infections requires more knowledge about the profiles of high-risk transmitters and late presenters (LP).AimWe aimed to investigate risk factors associated with HIV-1 transmission clusters and late presentation with HIV-1 in Denmark.MethodsBlood samples and epidemiological information were collected from newly diagnosed HIV-1 patients between 2009 and 2017. We genotyped pol genes and performed phylogenetic analyses to identify clusters. Risk factors for clustering and LP were investigated with partial proportional odds and logistic regression. Covariates included transmission mode, HIV-1 subtype, age, origin and cluster activity.ResultsWe included 1,040 individuals in the analysis, 59.6% identified with subtype B and 48.4% in a cluster. Risk factors for clustering included Danish origin (odds ratio (OR): 2.95; 95% confidence interval (CI): 2.21–3.96), non-LP (OR: 1.44; 95% CI: 1.12–1.86), and men who have sex with men (MSM). Increasing age and non-B subtype infection decreased risk (OR: 0.69; 95% CI: 0.50–0.94). Risk for late presentation was lower for active clusters (OR: 0.60; 95% CI: 0.44–0.82) and Danish origin (OR: 0.43; 95% CI: 0.27–0.67). Non-Danish MSM had a lower risk than non-Danish heterosexuals (OR: 0.34; 95% CI: 0.21–0.55).ConclusionHIV-1 transmission in Denmark is driven by early diagnosed, young, subtype B infected MSM. These may benefit most from PrEP. Non-Danish heterosexual HIV-1 patients could benefit from improved communication to achieve earlier diagnosis and treatment.
Highlights
The use of highly active antiretroviral therapy (HAART) has substantially increased the survival of people infected with HIV-1 [1,2] and has been used to prevent transmission between partners [3,4] and from mother to child [5]
The aim of this study was to identify HIV-1 transmission clusters in Denmark between 2009 and 2017 by phylogenetic analysis; and to investigate whether origin, age, transmission mode, presentation status, and/or HIV-1 subtype are risk factors associated with being in a national cluster and whether these risk factors have changed during the study period
Late presentation with HIV-1 (LP or very late presenters (VLP)) was observed among 48.0% (499/1,040) of the study population and 48.4% (503/1,040) of the study population was identified in clusters, with 29.0% (146/503) of these in clusters composed of 11 or more patients
Summary
The use of highly active antiretroviral therapy (HAART) has substantially increased the survival of people infected with HIV-1 [1,2] and has been used to prevent transmission between partners [3,4] and from mother to child [5]. Pre-exposure prophylaxis (PrEP) has been shown to be both effective in reducing the number of new HIV-1 infections among people at risk [6] as well as being cost-effective [7]. Aim: We aimed to investigate risk factors associated with HIV-1 transmission clusters and late presentation with HIV-1 in Denmark. Covariates included transmission mode, HIV-1 subtype, age, origin and cluster activity. Risk factors for clustering included Danish origin (odds ratio (OR): 2.95; 95% confidence interval (CI): 2.21–3.96), non-LP (OR: 1.44; 95% CI: 1.12–1.86), and men who have sex with men (MSM). Conclusion: HIV-1 transmission in Denmark is driven by early diagnosed, young, subtype B infected MSM. Non-Danish heterosexual HIV-1 patients could benefit from improved communication to achieve earlier diagnosis and treatment
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