Profile of Persons Recently Infected with HIV-1 in Belgium: New Insights to Tailor Prevention Efforts

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Abstract

Despite wide availability of prevention and treatment services, including the ongoing roll-out of pre-exposure prophylaxis (PrEP), the HIV epidemic is not under control in Belgium. Hence, there is a recognized need to improve case finding and early diagnosis to curb the further spread of HIV more effectively. The objective of the present study was to improve insight into the profiles of persons recently infected with HIV-1 and on their prevention trajectory. Between May 2018 and December 2022, we selected persons diagnosed in Belgium within three months of the presumed infection date. We then analyzed information collected using a questionnaire covering topics on HIV testing, sexually transmitted infections (STIs), PrEP use, sexual behavior, partner notification and substance use. The data obtained were analyzed alongside information derived from phylogenetic cluster analysis of the viral source of infection. A total of 93 persons with a recent HIV-1 infection completed the questionnaire, the majority (74%) being MSM, 14% were heterosexual women and 12% were heterosexual men. Nearly one-third of participants engaged in sexual activity with an average of 2 to 5 casual partners around the presumed time of infection. A significant percentage reported frequent substance use during sexual activity (65%), being previously diagnosed with STI (65%) and using condoms infrequently (44%). 63% reported a testing frequency of at least one HIV test per year before being diagnosed and 46% notified their previous sex partner(s) after being diagnosed. Over 20% of respondents (including 11 MSM, 4 heterosexual men and 5 heterosexual women) reported exclusive sexual activity with their steady partner. Eight participants (9%, all MSM, 75% born outside of Belgium) reported PrEP use in the past. No significant differences in behavioral characteristics were found between persons who were part of a local transmission cluster (48%) and persons that were not part of a cluster (47%). The study results revealed that the majority of persons diagnosed early with HIV-1 infection in Belgium exhibited characteristics corresponding to a high-at-risk population and were aware of this risk, as evidenced by a high testing frequency. However, partner notification rates were low and use and awareness of PrEP limited. A notable group of persons not corresponding to the high-risk profiles was also identified. This information may help to expose missed opportunities for prevention and contribute to enhancing the implementation of future prevention measures.

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Epidemiological study of phylogenetic transmission clusters in a local HIV-1 epidemic reveals distinct differences between subtype B and non-B infections

Kristen Chalmet, Delfien Staelens, Stijn Blot … (2010)

Background The number of HIV-1 infected individuals in the Western world continues to rise. More in-depth understanding of regional HIV-1 epidemics is necessary for the optimal design and adequate use of future prevention strategies. The use of a combination of phylogenetic analysis of HIV sequences, with data on patients' demographics, infection route, clinical information and laboratory results, will allow a better characterization of individuals responsible for local transmission. Methods Baseline HIV-1 pol sequences, obtained through routine drug-resistance testing, from 506 patients, newly diagnosed between 2001 and 2009, were used to construct phylogenetic trees and identify transmission-clusters. Patients' demographics, laboratory and clinical data, were retrieved anonymously. Statistical analysis was performed to identify subtype-specific and transmission-cluster-specific characteristics. Results Multivariate analysis showed significant differences between the 59.7% of individuals with subtype B infection and the 40.3% non-B infected individuals, with regard to route of transmission, origin, infection with Chlamydia (p = 0.01) and infection with Hepatitis C virus (p = 0.017). More and larger transmission-clusters were identified among the subtype B infections (p < 0.001). Overall, in multivariate analysis, clustering was significantly associated with Caucasian origin, infection through homosexual contact and younger age (all p < 0.001). Bivariate analysis additionally showed a correlation between clustering and syphilis (p < 0.001), higher CD4 counts (p = 0.002), Chlamydia infection (p = 0.013) and primary HIV (p = 0.017). Conclusions Combination of phylogenetics with demographic information, laboratory and clinical data, revealed that HIV-1 subtype B infected Caucasian men-who-have-sex-with-men with high prevalence of sexually transmitted diseases, account for the majority of local HIV-transmissions. This finding elucidates observed epidemiological trends through molecular analysis, and justifies sustained focus in prevention on this high risk group.

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Reduced sexual contacts with non-steady partners and less PrEP use among MSM in Belgium during the first weeks of the COVID-19 lockdown: results of an online survey

Thijs Reyniers, Anke Rotsaert, Estrelle Thunissen … (2020)

Objectives To examine changes in the occurrence of physical sex with non-steady partners among men who have sex with men (MSM) in Belgium during the first weeks of the COVID-19 lockdown and associations with sociodemographic factors, sexual practices, drug, alcohol and pre-exposure prophylaxis (PrEP) use. A secondary objective was to explore changes in PrEP use and the need for PrEP follow-up. Methods A cross-sectional online survey. The questionnaire was available in Dutch, French and English, between April 10 and 27 (2020), and disseminated via sexual health and lesbian, gay, bisexual, trans, queer or intersex organisations throughout Belgium. Eligibility criteria included being 18 years or older, not being exclusively heterosexual and living or being born in Belgium. Results The sample included 694 MSM. Physical sex with non-steady partners decreased from 59.1% to 8.9% during the first weeks of the lockdown. Those who had sex with non-steady partners were significantly more likely to be HIV positive, to use PrEP or to have engaged in sexual practices such as group sex, chemsex and sex work before the lockdown, compared with their counterparts. Among those who used PrEP before the lockdown, 47.0% stopped using PrEP, 19.7% used event-driven PrEP and 33.3% used daily PrEP during the lockdown. Almost two-thirds of PrEP users had a PrEP care appointment in the weeks before the lockdown and a minority received follow-up elsewhere or online. Some PrEP users had concerns regarding their follow-up. Conclusions MSM in our survey substantially reduced sexual contact with non-steady partners during the first weeks of the COVID-19 lockdown, suggesting that the risk for HIV and STI transmission in this period was low. We recommend ensuring access to sexual health services, such as HIV testing and follow-up for PrEP for the small group having multiple sex partners and engaging in sexual practices such as chemsex, or group sex, even in times of a pandemic threat.

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HIV testing within general practices in Europe: a mixed-methods systematic review

Jessika Deblonde, Dominique Van Beckhoven, Jasna Loos … (2018)

Background Late diagnosis of HIV infection remains a key challenge in Europe. It is acknowledged that general practitioners (GPs) may contribute greatly to early case finding, yet there is evidence that many diagnostic opportunities are being missed. To further promote HIV testing in primary care and to increase the utility of available research, the existing evidence has been synthesised in a systematic review adhering to the PRISMA guidelines. Methods The databases PubMed, Scopus and Embase were searched for the period 2006–2017. Two authors judged independently on the eligibility of studies. Through a mixed-methods systematic review of 29 studies, we provide a description of HIV testing in general practices in Europe, including barriers and facilitators. Results The findings of the study show that although various approaches to target patients are used by GPs, most tests are still carried out based on the patient’s request. Several barriers obstruct HIV testing in general practice. Included are a lack of communication skills on sexual health, lack of knowledge about HIV testing recommendations and epidemic specificities, difficulties with using the complete list of clinical HIV indicator diseases and lack of experience in delivering and communicating test results. The findings also suggest that the provision of specific training, practical tools and promotion programmes has an impact on the testing performance of GPs. Conclusions GPs could have an increased role in provider-initiated HIV-testing for early case finding. To achieve this objective, solutions to the reported barriers should be identified and testing criteria adapted to primary healthcare defined. Providing guidance and training to better identify priority groups for HIV testing, as well as information on the HIV epidemic’s characteristics, will be fundamental to increasing awareness and testing by GPs. Electronic supplementary material The online version of this article (10.1186/s12889-018-6107-0) contains supplementary material, which is available to authorized users.

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Author and article information

Contributors

C. Vanden Bulcke:

ORCID: http://orcid.org/0009-0008-7754-4424

charlotte.vandenbulcke@uzgent.be

Journal

Journal ID (nlm-ta): AIDS Behav

Journal ID (iso-abbrev): AIDS Behav

Title: AIDS and Behavior

Publisher: Springer US (New York )

ISSN (Print): 1090-7165

ISSN (Electronic): 1573-3254

Publication date (Electronic): 17 September 2024

Publication date PMC-release: 17 September 2024

Publication date (Print): 2024

Volume: 28

Issue: 12

Pages: 4167-4178

Affiliations

[1 ]Department of General Internal Medicine, Ghent University Hospital, ( https://ror.org/00xmkp704) Ghent, Belgium

[2 ]Sciensano, Epidemiology of Infectious Diseases, ( https://ror.org/04ejags36) Brussels, Belgium

[3 ]GRID grid.4989.c, ISNI 0000 0001 2348 0746, Univ Libre Bruxelles, CHU St Pierre, Serv Malad Infect, ; Brussels, Belgium

[4 ]GRID grid.420036.3, ISNI 0000 0004 0626 3792, Department Nephrol & Infect Dis, , AZ Sint-Jan Brugge AV, ; Brugge, Belgium

[5 ]GRID grid.8767.e, ISNI 0000 0001 2290 8069, Department Microbiol, , Vrije Univ Brussel, Univ Ziekenhuis Brussel, ; Brussels, Belgium

[6 ]Department Clin Sci, HIV & STD Unit, Inst Trop Med, ( https://ror.org/008x57b05) Med Serv, Antwerp, Belgium

[7 ]Department Clin Sci, Aids Reference Lab, Clin Reference Lab, Inst Trop Med, ( https://ror.org/008x57b05) Antwerp, Belgium

[8 ]Aids Reference Lab, Ctr Hosp Univ St Pierre, Brussels, Belgium

[9 ]Aids Reference Lab, Université libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (H.U.B), CUB Hôpital Erasme, ( https://ror.org/01r9htc13) Ixelles, Belgium

[10 ]Department Diagnost Sci, Aids Reference Lab, Univ Ghent, ( https://ror.org/00cv9y106) Ghent, Belgium

Author information

C. Vanden Bulcke http://orcid.org/0009-0008-7754-4424

Article

Publisher ID: 4488

DOI: 10.1007/s10461-024-04488-8

PMC ID: 11586297

PubMed ID: 39287735

SO-VID: 4163ebf1-f5c6-4914-9626-3b5231642b49

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Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/.

History

Date accepted : 24 August 2024

Funding

Funded by: FundRef http://dx.doi.org/10.13039/100010877, ViiV Healthcare;

Award ID: ViiV Healthcare

Funded by: FundRef http://dx.doi.org/10.13039/100005564, Gilead Sciences;

Award ID: Gilead Sciences

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ScienceOpen disciplines: Infectious disease & Microbiology

Keywords: hiv- recent infections-transmission clusters-behavior-prevention

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ScienceOpen disciplines: Infectious disease & Microbiology

Keywords: hiv- recent infections-transmission clusters-behavior-prevention

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Profile of Persons Recently Infected with HIV-1 in Belgium: New Insights to Tailor Prevention Efforts

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HIV Self-Testing

Most cited references 21

Epidemiological study of phylogenetic transmission clusters in a local HIV-1 epidemic reveals distinct differences between subtype B and non-B infections

Reduced sexual contacts with non-steady partners and less PrEP use among MSM in Belgium during the first weeks of the COVID-19 lockdown: results of an online survey

HIV testing within general practices in Europe: a mixed-methods systematic review

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