This article by Gus Cairns first appeared on aidsmap.com here.
Denmark shows first clear evidence of the success of treatment as prevention in gay men in a high income country
Very high diagnosis, treatment and viral suppression rates needed, say researchers
A study by the University of California, Los Angeles, and Copenhagen University Hospital provides the first unambiguous evidence of a link between high rates of viral suppression in gay men and falling HIV incidence (the proportion of men who catch HIV each year).
The researchers say that HIV incidence among gay men, at a rate of 0.14% a year or one in 700 gay men infected annually, is now so low that it approaches the one per 1000 annual incidence rate that the World Health Organization has set as the threshold for eventually eliminating the HIV epidemic.
They estimate that the percentage of gay men and other men who have sex with men (MSM) in Denmark who have HIV and an undetectable viral load on treatment is now 72.1% – very close to the 72.9% that UNAIDS’ 90/90/90 target sets for ending the HIV epidemic.
Denmark’s HIV epidemic has long been concentrated in MSM and in particular has had very low HIV prevalence in people who inject drugs due to harm reduction programmes being available for decades. Reducing HIV in MSM would therefore reduce it in the whole country.
The researchers find that the reduction in HIV incidence was not driven by changes in the CD4 count threshold for starting treatment, as it started falling before guidelines were changed. Instead, increased rates of testing drew more people into medical care directly and so they were diagnosed earlier, at higher CD4 cell counts.
They also find that despite the falling incidence, the transmission rate – the number of people infected on average by each virally unsuppressed man – almost doubled during the period of the study. They comment that this is probably due to increased risk behaviour, but that increasing the number of people on antiretroviral therapy (ART) has nonetheless more than compensated for this. They add, however, that it will be essential to use other interventions with proven efficacy such as pre-exposure prophylaxis (PrEP) in order to reduce transmission and infection rates among the undiagnosed and those at high risk of HIV.
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