Fewer HIV diagnoses and fewer recently newly-acquired HIV infections
The Netherlands is on track to achieve goals set in its National Action Plan for STI, HIV and Sexual Health, according to latest figures released today by Stichting HIV Monitoring (SHM) in the run up to World AIDS Day on December 1. Data featured in the report covers years up to and including 2019.
The number of new HIV diagnoses in 2019 has dropped to 580 compared to 890 in 2015. This decrease confirms one of the national goals, reaching a 50 percent reduction in the number of annual HIV diagnoses by 2022 compared to 2015, is within reach.
A new HIV diagnosis can either reflect an HIV infection that has existed for years without having been previously discovered, or a new recently acquired infection. In cases where the infection has existed for years, this is usually apparent from signs and symptoms of disease noted at the time of diagnosis, and/or from blood tests revealing an already impaired immune system. Whether HIV has only recently been contracted is often much less clear, especially if someone is not known to have tested negative for HIV in the recent past. Mathematical modelling, however, allows us to make reliable estimations of the number of newly-acquired infections.
SHM data also show a reduction in the estimated number of newly-acquired HIV infections – a trend indicative of a declining spread of HIV. Estimated numbers of newly-acquired infections have dropped by 72 percent, from 960 in 2010 to 270 in 2019. Among men who have sex with men (MSM), there was a drop of 76 percent in the same period, from 690 to 160.
Overall there were 23,700 people living with HIV in the Netherlands by the end of 2019, of whom 93 percent have been tested and are aware of their HIV-positive status. Of those, 93 percent are treated with medicines against HIV. In percent of those on treatment the virus is suppressed to such degree that it is no longer measurable in the blood and therefore can no longer be passed on to others. SHM data show each of these three percentages to be over percent in all regions of the country. This means that everywhere in the Netherlands the national target for its HIV cascade of care (95-95-95 percent in 2022) is within reach.
Finally, the National Action Plan also states that in 2022 no one in the Netherlands is to die of AIDS. In 2019 18 people died of AIDS – almost always after having lived with HIV for years without knowing it.
Professor Peter Reiss, director of SHM: “The latest data make me optimistic that everywhere in the Netherlands it should be possible to go the last mile of becoming a country where no one gets HIV and no one dies of AIDS anymore. To achieve this ultimate goal we need to work with even more precision. This means testing the right people in the right place at the right time, and to provide them with proper HIV prevention and care at the right time. Not easy, but definitely possible, and especially when supported with data from the various regions which we continue to collect and track.”
For the full report, executive summary and factsheet go to: www.hiv-monitoring.nl/en/resources/monitoring-report-2020
- At the end of 2019, 23,700 people were estimated to be living with HIV in the Netherlands, of whom an estimated 1,730 were undiagnosed; 20,612 were in care (20,427 adults and 185 children and adolescents) in one of the 24 adult or 4 paediatric HIV treatment centres.
- 10,290 (43%) people with HIV are estimated to be living in the four big cities (Amsterdam, Rotterdam, Den Haag, Utrecht). Of these 10,290 individuals, 610 are estimated to be undiagnosed.
- Differences remain in the proportion of people with undetectable HIV virus in their blood. Rates of undetectable level of HIV virus are lower for people originating from the Caribbean (91%), sub-Saharan Africa (93%) and Central Europe (93%) and in those who are younger (81% in those aged 18-24 years and 89% in those aged 25-29 years).
- 61% (355) of new HIV diagnoses were among men who acquired HIV through having sex with men (MSM), 28% (160) through heterosexual contact and 11% (65) through other or unknown modes of transmission.
- Approximately 45% of all new diagnoses in 2019 were among people who were been born outside the Netherlands.
- A quarter of all newly-diagnosed people in 2019 were aged 50 years or older at the time of diagnosis.
- Of the people who first started treatment (ART) in 2019, 71% did so within six months after receiving their HIV diagnosis. With few exceptions, almost all had started ART in the first 6 months after having entered care in an HIV treatment centre.
- The great majority of people who, in addition to HIV, also have hepatitis C virus (HCV) infection have now been successfully treated with the available combinations of direct-acting antiviral agents (DAAs) against HCV. Of those who have completed DAA treatment and have been followed sufficiently long to measure the effect of the treatment, 97% were cured of their HCV infection.
- Successful treatment of HCV may also prevent onward HCV transmission, as suggested by a drop in the incidence of newly-acquired HCV infections and reinfections. However, newly-acquired first-time HCV infections, as well as re-infections following successful treatment of a previous infection, do continue to be reported. This indicates some level of ongoing transmission of HCV and reinforces the need for additional interventions to further reduce ongoing HCV transmission.
- The risk of chronic hepatitis B (HBV) infection in those with HIV has decreased over time as a result of increased vaccination rates and the prophylactic effect of tenofovir (TDF and TAF) when used as part of the treatment for HIV. Nonetheless, around 20% of HIV-positive individuals registered by SHM are estimated to remain at risk of acquiring HBV. This illustrates the importance of continuing to promote vaccination against HBV, particularly among those who are not receiving an TDF or TAF- containing HIV treatment.
- Roughly 50% of HIV-positive MSM under the age of 50 were not protected against hepatitis A virus (HAV) infection. Given the European-wide outbreak of HAV among sexually-active MSM in 2017, these individuals should be strongly considered for HAV vaccination.
- Among children under 18 years of age living with HIV and receiving treatment 97% have an undetectable level of HIV in their blood. After turning 18 they enter a period in their lives when sustained adherence to treatment becomes more challenging, as demonstrated by an increased proportion of these young adults (around 30%) having a detectable level of virus in their blood in spite of treatment.
- Due to standardised voluntary HIV screening for pregnant women during the first trimester of pregnancy and high rates of successful treatment in women living with HIV, it is nowadays very rare in the Netherlands for a mother to transmit HIV to her infant; since 2015 only occasional cases have occurred in the Netherlands.