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Observational Study
. 2025 Jun;53(3):1013-1028.
doi: 10.1007/s15010-024-02419-2. Epub 2024 Oct 30.

Characterising HIV-Indicator conditions among two nationwide long-term cohorts of people living with HIV in Germany (1999-2023)

Amrei Krings  1 , Christian Kollan  2 , Daniel Schmidt  2 , Barbara Gunsenheimer-Bartmeyer  2 , Frederik Valbert  3 , Anja Neumann  3 , Jürgen Wasem  3 , Georg M N Behrens  4   5 , Markus Bickel  6 , Christoph Boesecke  7   8 , Stefan Esser  9 , Patrik Dröge  10 , Thomas Ruhnke  10 , Uwe Koppe  2 ; HIV-1 Seroconverter, ClinSurv-HIV study groups
Collaborators, Affiliations
Observational Study

Characterising HIV-Indicator conditions among two nationwide long-term cohorts of people living with HIV in Germany (1999-2023)

Amrei Krings et al. Infection. 2025 Jun.

Abstract

Background/objective: Information about occurrence and affected groups of symptoms/diagnoses indicative of an HIV infection (so-called HIV indicator conditions; HIV-ICs) is lacking. We analyse HIV-IC incidence, transmission risks and immune status among people living with HIV (PLWH) antiretroviral therapy (ART) naive.

Methods: Diagnoses reported for ART-naive PLWH from two multicentre observational, prospective cohort studies between 1999-2023 were analysed. Incidence rates per 1,000 person-years (PYs) were calculated for the overall study period and time periods defined by ART treatment recommendations. For further description, CD4 counts around HIV-IC diagnosis (+ -30 days) and HIV-transmission routes were collected.

Results: In total 15,940 diagnoses of 18,534 PLWH in Germany were included. Of those 81% were male (median age: 36 years) and 56% reported being men, who have sex with men as the likely HIV-transmission route. Incidence rates varied between the different HIV-ICs. Syphilis had the highest incidence rate (34 per 1,000 PYs; 95% confidence interval [CI] 29-40) for sexually transmitted infections (STIs), hepatitis B was highest for viral hepatitis diagnoses (18 per 1,000 PYs; 95% CI 17-20); according to CDC-classification herpes zoster for HIV-associated diagnoses (22 per 1,000; 95% CI 20-24) and candidiasis for AIDS-defining diagnoses (30 per 1,000 PYs; 95% CI 29-32). Most PLWH with HIV-ICs (hepatitis, HIV-associated diagnoses and AIDS-defining conditions) had CD4 cell counts < 350.

Conclusion: This analysis characterizes HIV-ICs regarding the incidence, HIV-transmission route and patients' immune status. The results underline the importance of HIV-IC-based screening to detect PLWH with already partially impaired immune status and in need of timely ART initiation.

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

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Conflict of interest statement

Declarations. Conflict of interest: GB: Grants or contracts from Niedersächsisches Ministerium für Wissenschaft und Kultur, COFONI Network, and European Regional Development Fund, 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 DZIF, NEAT ID Foundation, Participation on a Data Safety Monitoring Board or Advisory Board of TherVacB_Phase1a. CB: Grants or contracts from DZIF, DFG and Hector Foundation, consulting fees from Abbvie, Gilead, JnJ, MSD, and ViiV, payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Abbvie, Gilead, JnJ, MSD, and ViiV, support for attending meetings and/or travel from Abbvie, Gilead, JnJ, MSD, and ViiV. 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. UK: Support for attending meetings and/or travel from ECDC, German AIDS Society, German STI Society, and European AIDS Society; 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. Ethical approval: The HIV-1 Seroconverter Study was approved by the Ethics Committee of the Charité University Medicine Berlin (EA2/024/21). Participants of the HIV-1 Seroconverter Study provide their written informed consent to participate. The ClinSurv-HIV Study data (1999–2018) were collected anonymously and in compliance with the German Infection Protection Act (IfSG, 2001). Consent to participate: These data did therefore not require written informed consent. Approval for this was granted by the RKI data protection officer and the Federal Commissioner for Data Protection and Freedom of Information.

Figures

Fig. 1
Fig. 1
Incidence rates of sexually transmitted infections per 1.000 person-years among HIV-1 Seroconverter cohort participants by time period 2008–2010, 2011–2014, 2015–2018 and 2019–2023
Fig. 2
Fig. 2
Incidence rates of viral hepatitis diagnoses per 1.000 person-years among ClinSurv-HIV and HIV-1 Seroconverter cohort participants by time period 1999–2005, 2006–2010, 2011–2014, 2015–2018 and 2019–2023
Fig. 3
Fig. 3
Incidence rates of HIV-associated diagnoses per 1.000 person-years among ClinSurv-HIV and HIV-1 Seroconverter cohort participants by time period 1999–2005, 2006–2010, 2011–2014, 2015–2018 and 2019–2023
Fig. 4
Fig. 4
Incidence rates of AIDS-defining diagnoses per 1.000 person-years among ClinSurv-HIV and HIV-1 Seroconverter cohort participants by time period 1999–2005, 2006–2010, 2011–2014, 2015–2018 and 2019–2023
Fig. 5
Fig. 5
Proportion of CD4-cell count/µl blood category for diagnoses of the respective HIV-IC with available data. HIV-ICs with less than 10 available observations were excluded
See this image and copyright information in PMC

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