HIV testing in the Danish population: a national representative survey, 2000.

AIMS: To describe the accumulated prevalence of HIV testing in the Danish population until and including the year 2000. METHODS: The study was based on nationally representative data from the Danish Health Interview Survey 2000. Multiple logistic regression analysis investigated the association between HIV testing and background variables, such as gender, age, marital status, educational level, and sexual orientation. RESULTS: Overall 28.5% of the Danish population aged over 16 years have "ever been tested for HIV". More females (29.4%) than males (27.6%) were tested; 12.6% might not be aware of their blood being HIV tested when donating blood. More males (17.1%) than females (13.8%) had donated blood after 1985. Although males 30-39 years old were the most tested, males 50-59 years old had the highest odds of having donated blood after 1985. Concerning education, the less education one had, the less likely one was to have been HIV tested. Of men having sex with men, only 44% were "ever HIV tested". CONCLUSIONS: Positive association between extent of HIV testing and some sociodemographic factors was seen. Heterosexuals are HIV tested at lower rates than men having sex with men. Yet, stronger promotion of HIV testing among men having sex with men is recommended. Targeting prevention efforts towards other known risk groups is also recommended.

[Incidence of HIV/AIDS in Denmark, 1990-2005]. / Forekomsten af hiv/aids i Danmark i perioden 1990-2005.

INTRODUCTION: AIDS was defined in 1981, and HIV has spread globally since then. Most of the Danish AIDS patients have been men who have sex with men (MSM). After the introduction of highly active antiretroviral therapy in the mid-1990s, the incidence of AIDS in Denmark decreased dramatically. This article presents a status report on HIV and AIDS epidemiology in Denmark at the beginning of 2005. MATERIALS AND METHODS: Data from the national surveillance systems for AIDS, which has been notifiable since 1983, and HIV, which has been notifiable since August 1990, were used. RESULTS: During the period 1 August 1990-31 December 2004, HIV infection was reported in 4,254 persons, 3,076 men (72%) and 1,178 women (28%). MSM accounted for 39% of the cases (50% of the Danes and 14% of the immigrants). Heterosexual transmission accounted for 45% (32% of the Danes and 73% of the immigrants). Intravenous drug users (IDU) accounted for 9%. In 2004, 124 out of 190 Danes reported with HIV were MSM (65%). A total of 2,530 people were reported with AIDS. From the mid-1990s, the number of cases reported annually dropped. In 2004, 51 cases and 31 AIDS deaths were reported. CONCLUSION: It is estimated that well over 5,000 people are living with HIV in Denmark; about 550 of these have been diagnosed with AIDS. The decrease in the AIDS incidence and in the yearly AIDS mortality has not been mirrored by a decrease in the yearly number of reported HIV cases. Of special concern is the rise in the number of reported HIV cases among MSM during the last few years. This may reflect an increase in unsafe sex, partly due to a conception of HIV as a treatable, chronic disease. Prevention strategies, especially among MSM, are still needed.

The AIDS epidemic in the city of Copenhagen, Denmark: potential years of life lost and impact on life expectancy.

AIMS: This study seeks to describe the impact of AIDS on the city of Copenhagen by estimating potential years of life lost (PYLL) before the age of 65 years and to estimate the impact of AIDS deaths on life expectancy for males and females. METHODS: All AIDS cases reported to the national AIDS surveillance register for residents in the city of Copenhagen in the period 1983-98 were included. For comparative purposes data were obtained on six other causes of death: accidents, suicide, lung cancer, ischaemic heart disease, testicular cancer, and breast cancer. RESULTS: Overall, deaths from AIDS accounted for 8% of all PYLL in men and showed an increasing tendency from 1983 to 1991, when it became the leading cause of PYLL. AIDS had most impact in men in the age group 25-44 years and accounted for 29% of all PYLL in this group at the peak in 1993, decreasing significantly after the introduction of anti-retroviral treatments to 5% of PYLL in 1998. Other leading causes of PYLL, accidents and suicide, also showed a decreasing tendency over the years, but of a much smaller magnitude than AIDS. The impact of AIDS in women was more modest. In the entire study period suicide, accidents, and breast cancer were the leading causes of PYLL in women. It was shown that AIDS deaths at the top of the epidemic in 1991-95 were responsible for a loss of 0.76 years in life expectancy for men and 0.08 years for women. CONCLUSIONS: AIDS has had a considerable impact on potential years of life lost. A significant decline in AIDS deaths has been seen since 1995 with an effect on life expectancy for men in the city of Copenhagen.

Legal access to needles and syringes/needle exchange programmes versus HIV counselling and testing to prevent transmission of HIV among intravenous drug users: a comparative study of Denmark, Norway and Sweden.

BACKGROUND: Countries have adopted different strategies to prevent the transmission of HIV among intravenous drug users. Legal access to needles and syringes/needle exchange programmes as part of such a strategy has been heavily debated. HIV counselling and testing has also been part of prevention strategies. The objective of this study was to discuss the effectiveness of legal access to needles and syringes/ needle exchange programmes versus HIV counselling and testing among intravenous drug users (IDUs) as part of HIV prevention strategies. METHODS: Differences in HIV prevention strategies in Denmark, Norway and Sweden among IDUs are described. Outcome variables of effectiveness were HIV incidence rates over time. These were estimated by back calculation methods from 1980 through 1996, using data from the national HIV and AIDS registers. RESULTS: A comparison of HIV prevention strategies in Denmark, Norway and Sweden suggests that a high level of HIV counselling and testing might be more effective than legal access to needles and syringes/needle exchange programmes. Sweden and Norway, with higher levels of HIV counselling and testing, have had significantly lower incidence rates of HIV among IDUs than Denmark where there was legal access to needles and syringes and a lower level of HIV counselling and testing. In Sweden there was no legal access to drug injection equipment. CONCLUSION: Promotion and accessibility of HIV counselling and testing among intravenous drug users should be considered in countries where such a strategy is not adopted or has low priority.

Efficacy of selective antenatal screening for hepatitis B among pregnant women in Denmark: is selective screening still an acceptable strategy in a low-endemicity country?

The prevalence of hepatitis B virus (HBV) carriage in Denmark is unknown, but expected to be low (0.1%). This study aimed to evaluate the efficacy of selective antenatal screening for HBV infection and the epidemiology of HBV and hepatitis C virus (HCV) among pregnant women. 4098 women were included in the study. Blood tests were examined for hepatitis B surface antigen (HBsAg), anti-hepatitis B core antigen (HBc) and anti-HCV. Case records were studied to evaluate whether patients at risk for HBV infection had been tested. Among the 4098 women, 18 10.4%, 95% confidence interval (95% CI) 0.3-0.71 were HBsAg positive. All had a risk factor for HBV infection. Only 13 (72%) were identified as HBsAg positive in the selective screening programme. 115 women (2.8%, 95% CI 2.3-3.4) were anti-HBc positive only. 95 (83%) were at risk for HBV. Only 72 of these (63%) were tested for HBsAg. The screening programme in this area of Denmark did not pick up one-third of pregnant women at risk of HBV.

[Needlestick injuries among medical students at the University of Copenhagen. A questionnaire study in 2001]. / Stikuheld blandt medicinstuderende på Københavns Universitet. En spørgeskemaundersøgelse i foråret 2001.

INTRODUCTION: The aim of the study was to investigate the frequency of percutaneous and mucocutaneous injuries sustained by fourth and fifth year medical students at the University of Copenhagen. MATERIAL AND METHODS: A questionnaire including questions on experience with invasive procedures, number and types of exposures, and post-exposure actions was mailed to 576 medical students. Enclosed was a prepaid return envelope, and a definition of percutaneous and mucocutaneous injuries was given in the introduction letter. RESULTS: A total of 406 out of 568 (72%) responded. Out of them 90 (22%) had sustained percutaneous injuries, and 18 of these (20%) had experienced more than one percutaneous injury. A number of 89 of 406 (22%) had sustained mucocutaneous injury and of these 18 had experienced more than one mucocutaneous injury. Reporting of the accident was done by 59% of the 90 with percutaneous injury and 33% of the 89 with mucocutaneuos injury. 34% of the 82 that had reported the injury had not received an offer for testing and/or vaccination against HIV, hepatitis C and B. DISCUSSION: Efforts need to be made to ensure greater awareness amongst Danish medical students about the risk of mucocutaneous and percutaneous injuries. It should be evaluated whether vaccination against hepatitis B should be offered to students before entering the clinical part of the study. Proper training in percutaneous procedures and how to act in case of injury should be made to reduce the number of injuries.

Cancer in a population-based cohort of men and women in registered homosexual partnerships.

Cancer patterns among broad populations of homosexual men and women have not been studied systematically. The authors followed 1,614 women and 3,391 men in Denmark for cancer from their first registration for marriage-like homosexual partnership between 1989 and 1997. Ratios of observed to expected cancers measured relative risk. Women in homosexual partnerships had cancer risks similar to those of Danish women in general (overall relative risk (RR) = 0.9, 95% confidence interval (CI): 0.6, 1.4), but only one woman developed cervical carcinoma in situ versus 5.8 women expected (RR = 0.2, 95% CI: 0.0, 0.97). Overall, men in homosexual partnerships were at elevated cancer risk (RR = 2.1, 95% CI: 1.8, 2.5), due mainly to human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS)-associated Kaposi's sarcoma (RR = 136, 95% CI: 96, 186) and non-Hodgkin's lymphoma (RR = 15.1, 95% CI: 10.4, 21.4). Anal squamous carcinoma also occurred in excess (RR = 31.2, 95% CI: 8.4, 79.8). After exclusion of Kaposi's sarcoma, non-Hodgkin's lymphoma, and anal squamous carcinoma, no unusual cancer risk remained (RR = 1.0, 95% CI: 0.8, 1.3). With anal squamous carcinoma and HIV/AIDS-associated cancers as notable exceptions in men, cancer incidence rates among homosexual persons in marriage-like partnerships are similar to those prevailing in society at large.

HIV/AIDS surveillance in Denmark: the challenges ahead.

In Denmark, AIDS has been a mandatory reportable disease since 1983, and confirmed HIV infection has been the same since August 1990. The annual AIDS incidence increased initially and peaked in 1993 (4.6 per 100,000 inhabitants), then decreased to 1.2 per 100,000 inhabitants in 1998 and further to 0.9 in 2000. Most AIDS cases occur among men who have sex with men (MSM), representing 92% in 1980-1985 and 31% in 2000. Recently, AIDS incidence and mortality has decreased due to the new antiretroviral drugs. In 1995, 43 per million inhabitants died of AIDS, compared with 5 per million in 1998. HIV reporting in Denmark is anonymous. The annual number of new identified cases has been fairly stable at approximately 5.7 per 100,000 inhabitants. Immigrants represent 24% of identified HIV-infected persons and represent nearly 50% of all heterosexually acquired cases. Estimates show that HIV prevalence as of 2000 is 0.1% of the total population, distributed at 0.03% among heterosexuals and 4.8% among MSM. Estimated annual HIV incidence is around 5.6 per 100,000 inhabitants; three times higher among men than women, and as high as 220 per 100,000 among MSM. The spread of HIV is limited in Denmark but the prevalence is increasing due to the effect of antiretroviral therapy. This is a challenge to the existing HIV/AIDS surveillance and prevention strategy.

Gonorrhoea in Denmark: high incidence among HIV-infected men who have sex with men.

Diagnosis of gonorrhoea indicates that relatively recent unprotected sex has been practised and thus there is possibly a risk of HIV transmission. A retrospective analysis of gonorrhoea cases reported to the Danish national surveillance system was carried out for the period 1994-1999. The analysis included demographic pattern and mode of transmission of gonorrhoea in Denmark with the focus on trends and factors related to infection in men who have sex with men (MSM). We found that 646 (82.7%) reported cases of gonorrhoea were men, among whom 41.2% cases were due to sex with men, 52.9% were transmitted by heterosexual contact and 5.9% were due to unknown causes. The estimated mean annual reported incidence of gonorrhoea was more than 30 times greater among MSM than among heterosexual men and 6 times greater in MSM known to be HIV-positive, when gonorrhoea was diagnosed, than among other MSM (p < 0.001). No difference was found between the sites of infection among HIV-positive and HIV-negative MSM. A trend towards increase in the annual incidence of gonorrhoea has been seen since 1997, with an increase of 35% from 1997 to 1998 and a further increase of 41% from 1998 to 1999. The increase was mainly due to an increasing number and proportion of cases among MSM. The notified cases comprised 49% of patients with laboratory-confirmed gonorrhoea, which indicates a similar increasing trend. In conclusion, the rising trend of incident gonorrhoea, especially in MSM, may indicate a relapse to more unsafe sexual practices, which could lead to the spread of HIV infection. The higher incidence among HIV-positive MSM compared with other men underlines this concern.

Persistent high incidence of tuberculosis in immigrants in a low-incidence country.

Immigration from areas of high incidence is thought to have fueled the resurgence of tuberculosis (TB) in areas of low incidence. To reduce the risk of disease in low-incidence areas, the main countermeasure has been the screening of immigrants on arrival. This measure is based on the assumption of a prompt decline in the incidence of TB in immigrants during their first few years of residence in a country with low overall incidence. We have documented that this assumption is not true for 619 Somali immigrants reported in Denmark as having TB. The annual incidence of TB declined only gradually during the first 7 years of residence, from an initial 2,000 per 100,000 to 700 per 100,000. The decline was described by an exponential function with a half-time of 5.7 (95% confidence interval 4.0 to 9.7) years. This finding seriously challenges the adequacy of the customary practice of screening solely on arrival.

Prion diseases: epidemiology in man.

Prion disease in man was first described as Creutzfeldt-Jacob disease (CJD) in the 1920s. CJD may have three different origins: sporadic, familial, due to mutations in the prion gene, or infectious, due to iatrogenic exposure to infectious brain material. As an example of the latter, kuru, in Papua New Guinea, was a variant of CJD transmitted by cannibalism. Between 1957 and 1982 more than 2500 died of kuru. Sporadic CJD is the most common form of CJD and occurs with an incidence of around one per million in most parts of the world. Familial CJD accounts for approximately 10% of all European cases of CJD, and is associated with inherited mutations of the prion protein gene, caused by one of the 24 single amino acid substitutions or insertions of octapeptide repeats. CJD caused by infections involves either iatrogenic cases of CJD, resulting from exposure to infectious brain, pituitary or ocular tissue, or from ingestion of infected food items. As of today, a few hundred iatrogenic cases of CJD have been diagnosed worldwide, the majority due to transmission by cadaveric pituitary HCG. So far, 111 cases of vCJD have been diagnosed caused by BSE-contaminated food. The size of the epidemic is still unclear and worst-case scenarios indicate that we may expect many thousands of cases in the future.