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. 2024 Jun 24:73:102694.
doi: 10.1016/j.eclinm.2024.102694. eCollection 2024 Jul.

Prevalence of HIV in people with potential HIV-indicator conditions in Germany: an analysis of data from statutory health insurances

Frederik Valbert  1 , Georg M N Behrens  2   3 , Markus Bickel  4 , Christoph Boesecke  5   6 , Stefan Esser  7 , Patrik Dröge  8 , Thomas Ruhnke  8 , Amrei Krings  9 , Daniel Schmidt  9 , Uwe Koppe  9 , Barbara Gunsenheimer-Bartmeyer  9 , Lea Wienholt  1 , Jürgen Wasem  1 , Anja Neumann  1
Affiliations

Prevalence of HIV in people with potential HIV-indicator conditions in Germany: an analysis of data from statutory health insurances

Frederik Valbert et al. EClinicalMedicine. .

Abstract

Background: In care of people living with human immunodeficiency virus (HIV), early diagnosis of infection is one of the greatest challenges remaining. A promising approach to increase early diagnosis could be optimized HIV testing in persons with indicator conditions (ICs). ICs are conditions which are AIDS-defining in people living with HIV, conditions that may have significant adverse consequences for the individual's clinical management if the presence of HIV infection is not detected, and conditions with an (undiagnosed) HIV prevalence of ≥0.1%.

Methods: In this cohort study, anonymous routine healthcare data of German statutory health insurances from 07/01/2016 to 06/30/2021 based on insured persons with an ICD-10-based diagnosis of selected ICs were analyzed. In a primary analysis, two stratifications (gender and age), and four sensitivity analyses HIV prevalence/incidence were calculated for persons with at least one of 26 IC described in international literature. This study is registered in the German Clinical Trials Register (identifier: DRKS0002874).

Findings: Routine healthcare data from 513,509 insured persons were selected for analysis. In the primary analysis, only in malignant neoplasm of bronchus and lung a HIV prevalence was observed with a 95%-CI < 0.1%. ICs with particularly high HIV prevalence were pneumocystosis (40.33%), oral hairy leukoplakia (36.71%), and Kaposi's sarcoma (29.86%). When stratified by gender, it was observed that in female patients, the 95%-CI of HIV prevalence fell below 0.1% for seven ICs. No such effect was observed in male patients. Stratified by age, among patients aged 30 to <60 years, the 95%-CI of HIV prevalence were always ≥0.1%, while in the other groups the 95%-CI fell below 0.1% for several ICs.

Interpretation: In samples of patients with ICs in Germany, HIV prevalences/incidences were found to be ≥0.1% for all ICs except malignant neoplasm of bronchus and lung. This confirms the classification of these conditions as ICs for the German context and emphasizes the importance of HIV testing in these populations.

Funding: This analysis is part of the HIV testing recommendations in guidelines and practice study (German title of the study: "HIV-Testempfehlungen in Leitlinien und Praxis"; acronym: HeLP), which is funded by the German Federal Joint Committee as part of the Innovationsfonds program to further develop the German healthcare system (funding number 01VSF21050).

Keywords: AIDS; Acquired immune deficiency syndrome; HIV; Human immunodeficiency virus; Indicator conditions.

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Conflict of interest statement

GB: Grants or contracts from Niedersächsisches Ministerium für Wissenschaft und Kultur, COFONI Network, European Regional Development Fund, German Center for Infection Research, consulting fees Gilead, ViiV, MSD, Virology Education, Janssen, payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Gilead, ViiV, MSD, Virology Education, Janssen, support for attending meetings and/or travel from Gilead, ViiV, MSD, Janssen, Participation on a Data Safety Monitoring Board or Advisory Board of TherVacB_Phase1a. CB: Grants or contracts from DZIF, DFG and NEAT ID, consulting fees from Abbvie, JnJ, MSD, Gilead, Pfizer and ViiV, payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Abbvie, AZ, BN, JnJ, Gilead, MSD, Pfizer and ViiV, support for attending meetings and/or travel from Abbvie, AZ, JnJ, Gilead, MSD, Pfizer and ViiV, leadership or fiduciary role in other board, society, committee or advocacy group, paid or unpaid in EACS. SE: Grants or contracts from Gilead, Janssen, MSD, and ViiV consulting fees from Gilead, GSK, Janssen, MSD, and ViiV, payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Gilead, Janssen, MSD, and ViiV, support for attending meetings and/or travel from Gilead, Janssen, MSD, and ViiV, Leadership or fiduciary role in other board, society, committee or advocacy group, paid or unpaid in DAIG, DAGNÄ, DSTIG, DDG, DGI, Regional commission AIDS NRW. MB: Grants or contracts from Merck & Co, GSK plc, Gilead Science, leadership or fiduciary role in other board, society, committee or advocacy group, paid or unpaid in Deutsche Arbeitsgemeinschaft ambulant tätiger Ärztinnen und Ärzte für Infektionskrankheiten und HIV-Medizin e. V. (DAGNÄ e. V.). UK: Support for attending meetings and/or travel (travel and accommodation costs for participation in meetings/conferences from ECDC, German AIDS Society, German STI Society, and European AIDS Society), other financial or non-financial interests (UK owns ‘Exchange-traded fund’ (ETF) shares, which includes stocks of companies that are involved in health care). The remaining authors have no competing interests to declare.

Figures

Fig. 1
Fig. 1
IC population in the primary analysis.
See this image and copyright information in PMC

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