Identification of risk factors associated with national transmission and late presentation of HIV-1, Denmark, 2009 to 2017

Abstract

Background Despite 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). Aim We aimed to investigate risk factors associated with HIV-1 transmission clusters and late presentation with HIV-1 in Denmark. Methods Blood 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. Results We 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). Conclusion HIV-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.

Estimation of the determinants for HIV late presentation using the traditional definition and molecular clock‐inferred dates: Evidence that older age, heterosexual risk group and more recent diagnosis are prognostic factors

“…In another study from Belgium, similar risk factors were reported, including older age, male sex, heterosexual risk group and sub‐Saharan origin [ 6 ]. Similar findings have been reported in studies from Denmark [ 8 ], Germany [ 10 ], Italy [ 11 , 14 ], Switzerland [ 13 ], France [ 25 ] and Poland [ 9 ], where age, transmission risk group and origin were reported, with minor differences across the different settings. The differences in our study were the identification of PWID as an indicator of non‐late presentation and that origin was not associated with LP.…”

“…LP was more common among heterosexuals, people who inject drugs (PWID) and older people in the region [ 1 ]. In previous studies, major risk factors for LP included heterosexual transmission, and injection drug use, immigration status and older age [ 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 ].…”

Molecular Network Analysis Discloses the Limited Contribution to HIV Transmission for Patients with Late HIV Diagnosis in Northeast China

“…We found that the contribution of patients with LHD to HIV transmission was significantly lower than that of patients with NLHD. This finding was similar to that reported in a recent Danish study, in which the risk for LHD was lower for active clusters compared to non-LHD (van Wijhe et al, 2021 ). Previous studies have shown that undiagnosed infected individuals, particularly those in the acute stage of HIV, could transmit the virus (Narasimhan & Kapila, 2019 ).…”

“…In addition, it can be used to evaluate the risk of HIV transmission and the contribution of individuals to this transmission within the network (Little et al, 2014 ). Thus far, only one Danish study, using phylogenetic analysis, has revealed that the risk of LHD was lower for active clusters compared with non-LHD (van Wijhe et al, 2021 ). To date, molecular network technology has rarely been used to explore the impact of LHD on HIV onward transmission.…”

Risk Factors for Late HIV Presentation in Patients Treated at a Single Belgian Reference Centre from 2018 to 2022

“…Finally, we also recorded the screening context, categorised as voluntary screening, medical condition screening, refugee (defined as a person fleeing armed conflict or persecution and asking for or benefiting from assistance by the state, the Red Cross or other organisations) screening, incidental screening (for instance, before a blood donation), pregnancy screening, screening due to having an HIV+ partner or other/unknown reasons. These variables were chosen because they are commonly studied in the literature [ 14 , 16 , 17 , 18 ], which allowed for comparisons with past studies and especially with our previous study [ 14 ].…”