Long Term Nationwide Analysis of HIV and AIDS in Iceland, 1983-2012.

• Main Authors: Indridason H, Gudmundsson S, Karlsdottir B, Löve A, Briem H, Gottfredsson M
• Other Authors: Faculty of Medicine, School of Health Sciences, University of Iceland, Iceland 2Department of Infectious Diseases, Landspitali University Hospital of Iceland, Iceland 3Department of Virology, Landspitali University Hospital of Iceland, Iceland 4Directorate of Health, Reykjavik, Iceland
• Format: Article in Journal/Newspaper
• Language: English
• Published: 2015
• Subjects: Alnæmi; Tíðni; HIV; Iceland; Epidemiology; Injections; Homosexuality; Delayed Diagnosis; Antiretroviral Therapy; Highly Active
• Online Access: http://hdl.handle.net/2336/552115

To access publisher's full text version of this article, please click on the hyperlink in Additional Links field or click on the hyperlink at the top of the page marked Files. This article is open access. Introduction: Iceland is well suited for epidemiological research due to well-kept patient records, easy followup of patients and nation-wide health care databases. This study provides a nationwide 30-year epidemiological overview of the HIV epidemic in the country. Materials and methods: Retrospective study on all HIV positive individuals in Iceland, 1983-2012. Clinical data, CD4+ T-cell counts, plasma HIV RNA, proportion of late presenters and effectiveness of combined antiretroviral therapy (cART) were compared by different time intervals. Results: In total, 313 were diagnosed with HIV in 1983-2012, thereof 222 (71%) men and 91 (29%) women. Most infections (65%) were acquired outside the country. Mean incidence of HIV was 3.7/100,000 inhabitants/year, with a significant increase in 2010-2012 (p=0.0113), related to misuse of the prescription drug methylphenidate among intravenous drug users. Official prescriptions for this drug increased from 3.5 in 2002 to 17.4 defined daily doses/ 1,000 inhabitants/day in 2012. Mortality decreased by 70% during the study period (p=0.0275). Proportion of late presenters decreased from 74% in the first decade to 36% during the third (p=0.0001). After 6 months of ART, CD4+ T-cells increased by only 26 cells/µl on average during the monotherapy era (1987-1995; p=0,174), by 107 cells/µl during the early-cART era (1996-2004; p<0.0001) and by 159 cells/µl during the late-cART era (2005-2012; p<0,0001). Similarly, progressively greater reductions in plasma HIV RNA were observed from 1996-2004 to 2005-2012 (p<0.0001). Conclusions: HIV incidence remained relatively low in Iceland until 2010, when it increased significantly due to spread among IDUs. The majority of HIV infections diagnosed in Iceland were imported. With ever more effective drug treatments on CD4+ T-cells ...