Longitudinal trends of recent HIV-1 infections in Slovenia (1986-2012) determined using an incidence algorithm

• Published in: Journal of medical virology 2015-09, Vol.87 (9), p.1510-1516
• Main Authors: Lunar, Maja M., Matković, Ivana, Tomažič, Janez, Vovko, Tomaž D., Pečavar, Blaž, Poljak, Mario
• Format: Article
• Language: English
• Subjects: Adult; Algorithms; BED-EIA; CD4 Lymphocyte Count; Epidemiology; Female; HIV; HIV Infections - diagnosis; HIV Infections - epidemiology; HIV Infections - virology; HIV-1; HIV-1 - genetics; HIV-1 - isolation & purification; Human immunodeficiency virus; Human immunodeficiency virus 1; Humans; Incidence; Male; Mass Screening; Middle Aged; Population Surveillance; Slovenia - epidemiology; surveillance; Time Factors; Viral Load; Virology
• ISSN: 0146-6615; 1096-9071
• DOI: 10.1002/jmv.24209

Resolving dilemma whether the rise in the number of HIV diagnoses represents an actual increase in HIV transmissions or is a result of improved HIV surveillance is crucial before implementing national HIV prevention strategies. Annual proportions of recent infections (RI) among newly diagnosed persons infected with HIV‐1 in Slovenia during 27 years (1986–2012) were determined using an algorithm consisting of routine baseline CD4 and HIV viral load measurements and the Aware BED EIA HIV‐1 Incidence Test (BED test). The study included the highest coverage of persons diagnosed with HIV during the entire duration of an HIV epidemic in a given country/region (71%). Out of 416 patients, 170 (40.9%) had a baseline CD4 cell count less than 200 cells/mm3 and/or HIV‐1 viral load less than 400 copies/ml and were characterized as having a long‐standing infection (LSI). The remaining 246 patients were additionally tested using the BED test. Overall, 23% (97/416) of the patients were labeled RI. The characteristics significantly associated with RI were as follows: younger age, acute retroviral syndrome, CDC class A and other than C, no AIDS defining illnesses, HIV test performed in the past, a higher viral load, and a higher CD4 cell count. An interesting trend in the proportion of RI was observed, with a peak in 2005 (47% of RI) and the lowest point in 2008 (12%) in parallel with a rise in the numbers of new HIV diagnoses. This study could help promote the idea of introducing periodic HIV incidence monitoring using a simple and affordable algorithm. J. Med. Virol. 87:1510–1516, 2015. © 2015 Wiley Periodicals, Inc.