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In spite of public health prevention
campaigns to raise awareness of high-risk behavior for HIV transmission, about
300 new HIV cases are diagnosed every year in Denmark. To determine how to
target future prevention programs, researchers investigated the role of late
presenters, persons with a CD4 T-cell count of less than 200 cells at
diagnosis, in driving the HIV epidemic.
The researchers performed
phylogenetic analysis to identify transmission clusters in a study of 1,515
individuals newly diagnosed in Denmark since 2001. About one-fifth of the
individuals had primary infections, and 460 were diagnosed late. A total of 696
infections were in gay men. The researchers identified 46 epidemic clusters
involving 502 patients. The median cluster size was 7 patients (range 4–82).
People in transmission clusters had a significantly higher CD4 cell count and
higher viral loads than those who could not be identified in transmission
networks. Half of all individuals with a primary HIV infection could be placed
in a cluster, compared to only 22 percent of those who were diagnosed late.
Other factors such as a young age (under 30 years), intravenous drug use, and
men who had sex with men were significantly associated with being in a cluster.
Large clusters involved significantly more homosexual transmission, primary
infections, younger age, higher CD4 T-cell count, and lower viral load.
Findings show that persons with
lower CD4 T-cell counts contributed less to the epidemic than those with higher
CD4 T-cell counts. Researchers concluded that the epidemic is driven by mostly
younger homosexual men, diagnosed with a primary infection. They recommended
that prevention efforts should focus on young gay men, particularly those at
risk of primary infection.
The study titled, “Phylogenetics of
the Danish HIV epidemic: The Role of Very Late Presenters in Sustaining the
Epidemic,” was published online ahead of print in the Journal of Acquired
Deficiency Syndromes (doi: 10.1097/QAI.0b013e318276becc).
The Friends of AIDS Foundation is
dedicated to enhancing the quality of life for HIV positive individuals and
empowering people to make healthy choices to prevent the spread of the HIV
virus. To learn more about The Friends of AIDS Foundation, please visit: http://www.friendsofaids.org.
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