1887
  1. Home
  2. Eurosurveillance
  3. Volume 29, Issue 42, 17/Oct/2024
  4. Article
Surveillance Open Access
Like 0
Download

SDG 3: HIV/AIDS

Abstract

Background

Sweden reached the UNAIDS 90–90–90 target in 2015. It is important to reassess the HIV epidemiological situation due to ever-changing migration patterns, the roll-out of PrEP and the impact of the COVID-19 pandemic.

Aim

We aimed to assess the progress towards the UNAIDS 95–95–95 targets in Sweden by estimating the proportion of undiagnosed people with HIV (PWHIV) and HIV incidence trends.

Methods

We used routine laboratory data to inform a biomarker model of time since infection. When available, we used previous negative test dates, arrival dates for PWHIV from abroad and transmission modes to inform our incidence model. We also used data collected from the Swedish InfCareHIV register on antiretroviral therapy (ART).

Results

The yearly incidence of HIV in Sweden decreased after 2014. In part, this was because the fraction of undiagnosed PWHIV had decreased almost twofold since 2006. After 2015, three of four PWHIV in Sweden were diagnosed within 1.9 and 3.2 years after infection among men who have sex with men and in heterosexual groups, respectively. While 80% of new PWHIV in Sweden acquired HIV before immigration, they make up 50% of the current PWHIV in Sweden. By 2022, 96% of all PWHIV in Sweden had been diagnosed, and 99% of them were on ART, with 98% virally suppressed.

Conclusions

By 2022, about half of all PWHIV in Sweden acquired HIV abroad. Using our new biomarker model, we assess that Sweden has reached the UNAIDS goal at 96–99–98.

© Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.
Loading

Article metrics loading...

/content/10.2807/1560-7917.ES.2024.29.42.2400058
2024-10-17
2024-10-18
http://instance.metastore.ingenta.com/content/10.2807/1560-7917.ES.2024.29.42.2400058
Loading
Loading full text...

Full text loading...

/deliver/fulltext/eurosurveillance/29/42/eurosurv-29-42-4.html?itemId=/content/10.2807/1560-7917.ES.2024.29.42.2400058&mimeType=html&fmt=ahah

References

  1. Joint United Nations Programme on HIV/AIDS (UNAIDS). The path that ends AIDS: UNAIDS Global AIDS Update 2023. Geneva: UNAIDS; 2023. Available from: https://thepath.unaids.org/wp-content/themes/unaids2023/assets/files/2023_report.pdf
  2. Trickey A, Sabin CA, Burkholder G, Crane H, d’Arminio Monforte A, Egger M, et al. Life expectancy after 2015 of adults with HIV on long-term antiretroviral therapy in Europe and North America: a collaborative analysis of cohort studies. Lancet HIV. 2023;10(5):e295-307.  https://doi.org/10.1016/S2352-3018(23)00028-0  PMID: 36958365 
  3. Sullivan AK, Raben D, Reekie J, Rayment M, Mocroft A, Esser S, et al. Feasibility and effectiveness of indicator condition-guided testing for HIV: results from HIDES I (HIV indicator diseases across Europe study). PLoS One. 2013;8(1):e52845.  https://doi.org/10.1371/journal.pone.0052845  PMID: 23341910 
  4. Joint United Nations Programme on HIV/AIDS (UNAIDS). Undetectable = untransmittable. Public health and hiv viral load suppression. Geneva: UNAIDS; 2018. Available from: https://www.unaids.org/en/resources/presscentre/featurestories/2018/july/undetectable-untransmittable
  5. Working Group on Estimation of HIV Prevalence in Europe. HIV in hiding: methods and data requirements for the estimation of the number of people living with undiagnosed HIV. AIDS. 2011;25(8):1017-23.  https://doi.org/10.1097/QAD.0b013e3283467087  PMID: 21422986 
  6. Gourlay AJ, Pharris AM, Noori T, Supervie V, Rosinska M, van Sighem A, et al. Towards standardized definitions for monitoring the continuum of HIV care in Europe. AIDS. 2017;31(15):2053-8.  https://doi.org/10.1097/QAD.0000000000001597  PMID: 28906276 
  7. Sommen C, Commenges D, Vu SL, Meyer L, Alioum A. Estimation of the distribution of infection times using longitudinal serological markers of HIV: implications for the estimation of HIV incidence. Biometrics. 2011;67(2):467-75.  https://doi.org/10.1111/j.1541-0420.2010.01473.x  PMID: 20731647 
  8. Giardina F, Romero-Severson EO, Axelsson M, Svedhem V, Leitner T, Britton T, et al. Getting more from heterogeneous HIV-1 surveillance data in a high immigration country: estimation of incidence and undiagnosed population size using multiple biomarkers. Int J Epidemiol. 2019;48(6):1795-803.  https://doi.org/10.1093/ije/dyz100  PMID: 31074780 
  9. Romero-Severson EO, Lee Petrie C, Ionides E, Albert J, Leitner T. Trends of HIV-1 incidence with credible intervals in Sweden 2002-09 reconstructed using a dynamic model of within-patient IgG growth. Int J Epidemiol. 2015;44(3):998-1006.  https://doi.org/10.1093/ije/dyv034  PMID: 26163684 
  10. Lundgren E, Romero-Severson E, Albert J, Leitner T. Combining biomarker and virus phylogenetic models improves HIV-1 epidemiological source identification. PLOS Comput Biol. 2022;18(8):e1009741.  https://doi.org/10.1371/journal.pcbi.1009741  PMID: 36026480 
  11. Mahiane SG, Eaton JW, Glaubius R, Case KK, Sabin KM, Marsh K. Updates to Spectrum’s case surveillance and vital registration tool for HIV estimates and projections. J Int AIDS Soc. 2021;24(Suppl 5) Suppl 5;e25777.  https://doi.org/10.1002/jia2.25777  PMID: 34546641 
  12. Yan P, Zhang F, Wand H. Using HIV diagnostic data to estimate HIV incidence: method and simulation. Stat Commun Infect Dis. 2011;3(1).  https://doi.org/10.2202/1948-4690.1011 
  13. European Centre for Disease Prevention and Control ECDC). HIV Platform tool. 2.0.0 ed. Stockholm: ECDC; 2021. Available from: https://www.ecdc.europa.eu/en/publications-data/hiv-platform-tool
  14. Carlander C, Brännström J, Månsson F, Elvstam O, Albinsson P, Blom S, et al. Cohort profile: InfCareHIV, a prospective registry-based cohort study of people with diagnosed HIV in Sweden. BMJ Open. 2023;13(3):e069688.  https://doi.org/10.1136/bmjopen-2022-069688  PMID: 36931676 
  15. Andersson E, Nakagawa F, van Sighem A, Axelsson M, Phillips AN, Sönnerborg A, et al. Challenges in modelling the proportion of undiagnosed HIV infections in Sweden. Euro Surveill. 2019;24(14):1800203.  https://doi.org/10.2807/1560-7917.ES.2019.24.14.1800203  PMID: 30968824 
  16. Brännström J, Sönnerborg A, Svedhem V, Neogi U, Marrone G. A high rate of HIV-1 acquisition post immigration among migrants in Sweden determined by a CD4 T-cell decline trajectory model. HIV Med. 2017;18(9):677-84.  https://doi.org/10.1111/hiv.12509  PMID: 28444865 
  17. Skar H, Axelsson M, Berggren I, Thalme A, Gyllensten K, Liitsola K, et al. Dynamics of two separate but linked HIV-1 CRF01_AE outbreaks among injection drug users in Stockholm, Sweden, and Helsinki, Finland. J Virol. 2011;85(1):510-8.  https://doi.org/10.1128/JVI.01413-10  PMID: 20962100 
  18. Lundgren JD, Babiker AG, Gordin F, Emery S, Grund B, Sharma S, et al. Initiation of antiretroviral therapy in early asymptomatic HIV infection. N Engl J Med. 2015;373(9):795-807.  https://doi.org/10.1056/NEJMoa1506816  PMID: 26192873 
  19. Danel C, Moh R, Gabillard D, Badje A, Le Carrou J, Ouassa T, et al. A trial of early antiretrovirals and isoniazid preventive therapy in Africa. N Engl J Med. 2015;373(9):808-22.  https://doi.org/10.1056/NEJMoa1507198  PMID: 26193126 
  20. World Health Organization (WHO). Guideline on when to start antiretroviral therapy and on pre-exposure prophylaxis for HIV. Geneva: WHO; 2015. Available from: https://www.ncbi.nlm.nih.gov/books/NBK327115
  21. Ludvigsson JF. The first eight months of Sweden’s COVID-19 strategy and the key actions and actors that were involved. Acta Paediatr. 2020;109(12):2459-71.  https://doi.org/10.1111/apa.15582  PMID: 32951258 
  22. Teke Lloyd A, Sirkeci I. A long-term view of refugee flows from Ukraine: war, insecurities, and migration. Migrat Lett. 2022;19(4):523-35.  https://doi.org/10.33182/ml.v19i4.2313 
  23. Fakoya I, Álvarez-del Arco D, Woode-Owusu M, Monge S, Rivero-Montesdeoca Y, Delpech V, et al. A systematic review of post-migration acquisition of HIV among migrants from countries with generalised HIV epidemics living in Europe: mplications for effectively managing HIV prevention programmes and policy. BMC Public Health. 2015;15(1):561.  https://doi.org/10.1186/s12889-015-1852-9  PMID: 26085030 
  24. Kall M, Marcellin F, Harding R, Lazarus JV, Carrieri P. Patient-reported outcomes to enhance person-centred HIV care. Lancet HIV. 2020;7(1):e59-68.  https://doi.org/10.1016/S2352-3018(19)30345-5  PMID: 31776101 
Sweden surpasses the UNAIDS 95-95-95 target: estimating HIV-1 incidence, 2003 to 2022
<p class="citation"> <span>Citation style for this article:</span> <span class="meta-value authors"> <a href="/search?value1=Erik+Lundgren&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Lundgren Erik</a>, <a href="/search?value1=Macauley+Locke&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Locke Macauley</a>, <a href="/search?value1=Ethan+Romero-Severson&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Romero-Severson Ethan</a>, <a href="/search?value1=Mira+Dimitrijevic&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Dimitrijevic Mira</a>, <a href="/search?value1=Maria+Axelsson&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Axelsson Maria</a>, <a href="/search?value1=Emmi+Andersson&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Andersson Emmi</a>, <a href="/search?value1=Christina+Carlander&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Carlander Christina</a>, <a href="/search?value1=Johanna+Br%C3%A4nnstr%C3%B6m&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Brännström Johanna</a>, <a href="/search?value1=Hans+Norrgren&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Norrgren Hans</a>, <a href="/search?value1=Fredrik+Mansson&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Mansson Fredrik</a>, <a href="/search?value1=Olof+Elvstam&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Elvstam Olof</a>, <a href="/search?value1=Magnus+Gissl%C3%A9n&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Gisslén Magnus</a>, <a href="/search?value1=Lisa+Fohlin&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Fohlin Lisa</a>, <a href="/search?value1=Anders+S%C3%B6nnerborg&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Sönnerborg Anders</a>, <a href="/search?value1=Jan+Albert&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Albert Jan</a>, <a href="/search?value1=Thomas+Leitner&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Leitner Thomas</a></span>. Sweden surpasses the UNAIDS 95-95-95 target: estimating HIV-1 incidence, 2003 to 2022. <a href="/content/ecdc">Euro Surveill.</a> 2024;29(42):pii=2400058. <a href="https://doi.org/10.2807/1560-7917.ES.2024.29.42.2400058" title="doi link" target="_blank">https://doi.org/10.2807/1560-7917.ES.2024.29.42.2400058</a> <span class="ES_Article_citation"> <span class="generated">Received</span>: 25 Jan 2024;&nbsp;&nbsp; <span class="generated">Accepted</span>: 08 Aug 2024 </span> </p>
/content/10.2807/1560-7917.ES.2024.29.42.2400058
/content/10.2807/1560-7917.ES.2024.29.42.2400058
Loading

Data & Media loading...

Supplementary data

Submit comment
Close
Comment moderation successfully completed
This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error