Department of Science and Environment, Roskilde University, Roskilde, Denmark.
Virus Research & Development Laboratory, Virus & Microbiological Special Diagnostics, Statens Serum Institut, Copenhagen, Denmark.
Euro Surveill. 2021 Nov;26(47). doi: 10.2807/1560-7917.ES.2021.26.47.2002008.
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.
尽管有暴露前预防（PrEP）可用，但过去十年中，欧洲的 HIV-1 发病率仍保持稳定。减少新的 HIV-1 感染需要更多地了解高危传播者和晚期出现（LP）的特征。
我们旨在研究与丹麦 HIV-1 传播集群和 LP 相关的危险因素。
我们收集了 2009 年至 2017 年间新诊断的 HIV-1 患者的血液样本和流行病学信息。我们对 pol 基因进行基因分型，并进行系统发育分析以识别集群。使用部分比例优势和逻辑回归分析来调查聚类和 LP 的危险因素。协变量包括传播模式、HIV-1 亚型、年龄、来源和集群活动。
我们纳入了 1040 名个体进行分析，其中 59.6%鉴定为 B 亚型，48.4%在一个集群中。聚类的危险因素包括丹麦起源（优势比（OR）：2.95；95%置信区间（CI）：2.21-3.96）、非 LP（OR：1.44；95% CI：1.12-1.86）和男男性行为者（MSM）。年龄增加和非 B 亚型感染降低了风险（OR：0.69；95% CI：0.50-0.94）。活跃集群（OR：0.60；95% CI：0.44-0.82）和丹麦起源（OR：0.43；95% CI：0.27-0.67）的 LP 风险较低。非丹麦 MSM 的风险低于非丹麦异性恋者（OR：0.34；95% CI：0.21-0.55）。
丹麦的 HIV-1 传播是由早期诊断、年轻、B 亚型感染的 MSM 驱动的。这些人可能最受益于 PrEP。非丹麦异性恋 HIV-1 患者可能受益于改善沟通，以实现更早的诊断和治疗。
