Since introduction of highly active antiretroviral therapy (HAART) the prevalence of Danish HIV-positive men who have sex with men (MSM) has increased substantially. In contrast the incidence of MSM diagnosed with HIV has not increased and this paradox has been the focus of intensive debate.
Study period was 1995-2010. Data were obtained from two Danish nationwide registries of HIV and syphilis, and five consecutive surveys on sexual behavior in Danish MSM. We calculated incidences of HIV and syphilis in MSM, prevalence of HIV positive MSM with detectable viral load (>400 HIV-RNA copies/ml), and changes in frequency of unprotected anal intercourse (UAI). We introduce The Cohort Community Reproductive Rate (CCRR) to describe the number of newly diagnosed MSM per HIV-positive MSM per year and used Poisson regression to model CCRR.
From 1995-2010 the prevalence of Danish MSM diagnosed with HIV increased from 1,035 to 1,813 (75%), while the number of HIV-positive MSM with detectable viral load (VL) (>400 HIV-RNA copies/ml) decreased by 75% from 1,035 to 262. The incidence of syphilis and UAI rose dramatically in the same period, while CCRR decreased from 0.099 (CI95% 0.092-0.108) to 0.071 (CI 95% 0.065-0.079).
Our results strongly indicate that HAART has decreased the risk of transmission of HIV despite increased practise of unsafe sex and thereby substantiate that HAART should be offered to MSM to reduce risk of transmission of the disease.
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