Despite an overall decline in HIV incidence in France, transmission seems to be "out of control" among men who have sex with men (MSM). Nearly half of the 7000 people newly infected with HIV in 2008 were in MSM, and incidence is 200 times higher than in the French heterosexual population. These findings from a modelling analysis highlight the urgent need for alternative HIV prevention efforts and safer sex initiatives targeted at the most-at-risk groups in France. These are the conclusions of an Article published Online First and in the November edition of The Lancet Infectious Diseases.
To monitor the HIV epidemic in Europe, national and regional surveillance figures are calculated using new diagnoses of HIV infection data. But because of the long and variable time between infection and diagnosis, this method fails to show current patterns of virus transmission. Routine national incidence testing with an enzyme immunoassay (EIA-RI) that can distinguish recent from older HIV-1 infections has been done in France since 2003.
In this study, a team of French investigators led by Stéphane le Vu from the French National Institute for Public Health estimated yearly trends in incidence of HIV infection in France between January 2003 and December 2008 using EIA-RI diagnoses data. All patients newly diagnosed with HIV were grouped into recent or non-recent infection based on the results of the EIA-RI test. After accounting for testing patterns and under-reporting the researchers used incidence modelling to calculate the number of new HIV infections in MSM, injecting drug users (IDUs), and heterosexual men and women by nationality.
Overall, HIV in France decreased significantly from 8930 new infections in 2003 to 6940 in 2008. However, the number of new infections among MSM remained stable and accounted for 48% of new infections in 2008.
In 2008, non-French-nationals living in France accounted for around 23% of all new infections and 45% of the infections transmitted heterosexually. Most were immigrants from sub-Saharan Africa.
By contrast, the number of new infections among IDUs was low and stable over the 5-year-study period, accounting for 1% of new infections every year. The authors suggest that this trend might partly be the result of effective harm-reduction measures introduced in the mid 1990s.
They conclude: "Our results provide a new perspective on the HIV epidemic in France, which could not be garnered from data for HIV-diagnosis reporting alone. Despite an overall decline in HIV incidence, the highest rates estimated for MSM and sub-Saharan Africans living in France warrant renewed prevention strategies. Incidence should be tracked to monitor transmission dynamics in the various population risk groups and to help target and assess prevention strategies."
In a Comment, Robert S Hogg from the British Colombia Centre for Excellence in HIV/AIDS, Vancouver, Canada, and colleagues suggest that the "unacceptably high" number of new infections in MSM worldwide could be reduced by a combined prevention approach: "This approach should include targeted structural interventions directed at specific populations, behavioural interventions directed at individuals, and new biomedical interventions, including expanded coverage of antiretroviral therapy to all HIV infected individuals who meet eligibility criteria for treatment."
Dr Stéphane le Vu, French National Institute for Public Health Surveillance, France. s.levu@invs.sante.fr or stephane.levu@gmail.com
Or via press office French National Institute for Public Health Surveillance T) + 33 (0) 1 41 79 67 79
Dr Robert S Hogg, British Colombia Centre for Excellence in HIV/AIDS, Vancouver, Canada. T) +1 604 377 8606 (mobile) E) bobhogg@cfenet.ubc.ca
For full Article and Comment see: http://press.thelancet.com/tlidhivfrance.pdf
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