The life expectancy in well-treated HIV-infected persons approaches that of the general populatio... more The life expectancy in well-treated HIV-infected persons approaches that of the general population, but HIV-infected persons have a greater incidence of fractures and osteoporosis. A decrease in bone mineral density is observed primarily during the first 1-2 years of antiretroviral therapy. Dual X-ray absorptiometry scan should be considered in HIV-infected men ≥ 50 years and postmenopausal women. In case of osteoporosis, bisphosphonate treatment should follow guidelines for the general population. Future research should focus on pathogenesis and prevention of bone density loss in HIV.
Objectives: Anti-müllerian hormone (AMH) is a marker of ovarian reserve. The purpose of this stud... more Objectives: Anti-müllerian hormone (AMH) is a marker of ovarian reserve. The purpose of this study was to compare AMH in women living with HIV with an age-matched control group of HIV-uninfected women, and to identify possible variables associated with decreasing AMH levels in women living with HIV. Methods: AMH was measured in frozen EDTA samples from 84 white women living with HIV, aged 20-40 years, with fully suppressed HIV RNA viral loads for at least 6 months and no hepatitis B or C virus co-infection. All women living with HIV were age-matched with HIV-uninfected control women. Results: Eighty-four women living with HIV and 252 control women were included. Median age for the women living with HIV was 33.5 years (interquartile range [IQR] 30.6−35.3), and 33.2 years (IQR 30.6−35.5) for the control women. A significant difference (P=0.03) was found in the mean AMH levels for all age groups combined, which was 17.23 pmol/L (95% confidence interval [CI] 14.56−19.89) in the women living with HIV versus 21.65 pmol/L (95% CI 19.50−23.81) in the control women, although levels were within reference limits in both groups. Only increasing age was significantly associated with decreasing AMH levels and not CD4 cell count, AIDS prior to inclusion, antiretroviral treatment/lack of treatment or antiretroviral treatment regimen. Conclusions: Well-treated, white women living with HIV in Denmark, have reduced AMH levels compared with age-matched control HIV-uninfected women. The only variable associated with decreasing AMH levels in women living with HIV was increasing age.
Scandinavian Journal of Infectious Diseases, Jan 31, 2012
The impressive effects of highly active antiretroviral therapy (HAART) have transformed the lives... more The impressive effects of highly active antiretroviral therapy (HAART) have transformed the lives of HIV-1-infected individuals, with life expectancies approaching those of HIV-uninfected individuals [1]. As a consequence of this substantial decline in mortality and morbidity, there is an increasing number of serodiscordant or seroconcordant couples who would like to have children [2,3]. HIV-1-infected individuals seem to have an increased risk of infertility/subfertility [4 – 6], though data are scarce and partly inconsistent. The demands for assisted reproductive treatments in HIV-1infected patients are largely unknown. Attempts have been made to estimate the extent to which the demands are met in some Western countries, i.e. in the UK [7] and the USA [8,9]. However, to our knowledge no such analysis has been undertaken in the Nordic countries. We describe the guidelines for assisted reproductive treatments, either governmental or from relevant medical societies, as well as the services actually offered in the Nordic countries. Though the countries (Denmark, Norway, Sweden, and Finland) are in many respects similar, e.g. regarding social security systems and health services [10], differences also exist. HIV clinicians from Denmark, Norway, Sweden, and Finland with special interest in the care of HIV-1-infected women investigated the national guidelines from their countries, either governmental or issued by relevant medical societies, as well as the assisted reproductive treatment actually offered. Whether or not adoption was an option for couples where one or both parties are HIV-1-infected was also investigated. Major differences in the assisted reproductive treatments offered were found (Table I). In Norway [11,12] and Finland [13] no assisted reproductive treatment is available for couples with HIV. In Sweden, serodiscordant couples where the man is infected are offered sperm washing and intracytoplasmic sperm injection (ICSI) [14]. However, this is solely offered to couples without fertility problems. The treatments are centralized. It is recommended that the viral load is suppressed at the time of treatment. No assisted reproductive treatment is available for HIV-1-infected women or couples where both the man and woman are infected. The age limitations are similar to those for the general population and the treatment is free-of-charge. In Denmark, assisted reproductive treatment is an option for couples where one, or since 2010, both parties are infected [15,16], if the patients are on HIV treatment or if treatment is perceived to be possible (i.e., no adherence or resistance problems known or anticipated). Insemination after sperm washing or with donor semen, in vitro fertilization, and ICSI can be offered to HIV-1-infected patients LETTER TO THE EDITOR
Objective: To identify disclosure, stigma and predictors of non-disclosure among women living wit... more Objective: To identify disclosure, stigma and predictors of non-disclosure among women living with HIV in Denmark. Methods: A questionnaire study of women living with HIV in Denmark was performed. The enrolment period was from February 2013 to March 2014. Logistic regression was used to estimate predictors of non-disclosure. Results: A total of 234 participants were included. The majority (94%) had disclosed their HIV status to at least one person outside their healthcare environment, although 29% had disclosed to fewer than three people. Confidantes were mostly partners (96%), siblings (63%), friends (63%) and children (41%). The primary reason for non-disclosure was a feeling that it did not concern others (55%), although reactions upon disclosure were mainly positive in 53%. Predictors of non-disclosure were being of black or Asian ethnicity. Following their HIV diagnosis, 40% no longer dared to have sex, 40% felt isolated and 23% felt that others were afraid and kept a physical distance. In contrast, after disclosure 75% felt better at taking decisions about life and 50% were in closer contact with family and friends. Conclusion: Almost one-third of participants disclosed their HIV diagnosis to fewer than three people and black or Asian ethnicity predicted non-disclosure. HIV-related stigma regarding sex and contact with others is still highly prevalent; however, reactions to disclosure were mainly positive and associated with secondary positive gains. We strongly urge healthcare professionals to initiate a dialogue regarding stigma and disclosure with women living with HIV with a view to increasing disclosure and minimising stigmatisation in this vulnerable population.
Background: Bacterial vaginosis (BV) has been found to be associated with HIV acquisition and tra... more Background: Bacterial vaginosis (BV) has been found to be associated with HIV acquisition and transmission. This is suggested to be due to higher HIV RNA levels in cervicovaginal fluids in women living with HIV (WLWH) with BV, as bacteria associated with BV may induce viral replication and shedding in the genital tract despite undetectable HIV RNA plasma viral load. We examined the prevalence and diagnostic predictors of BV and HIV-1 RNA vaginal shedding in women living with HIV (WLWH) in Denmark, taking into account the presence of human papillomavirus (HPV) and herpes viridae. Methods: WLWH between 18-51 years were recruited from six Departments of Infectious Diseases in Denmark during enrolment in the SHADE cohort; a prospective cohort study of WLWH attending regular outpatient care. BV was diagnosed by microscopy of vaginal swabs and PCR was used for detection of BV-associated bacteria, HPV, herpes viridae, and vaginal HIV viral load. Results: Median age of the 150 included women was 41 years; ethnicity was predominantly White (35%) or Black (47%). The majority (96%) was on ART and had undetectable (85%) plasma HIV RNA (<40 copies/mL). BV was diagnosed in 32%. Overall, 11% had detectable vaginal HIV RNA. Both before and after adjustment for BV, age, ethnicity, plasma HIV RNA, CD4 cell count, herpes viridae and HPV, we found no significant predictors of HIV RNA vaginal shedding. Conclusion: In well-treated WLWH, BV, herpes viridae or HPV do not predict vaginal HIV RNA shedding. This implies that HIV shedding does not seem to be increased by BV.
Introduction: As the human immunodeficiency virus (HIV)-positive population ages, issues concerni... more Introduction: As the human immunodeficiency virus (HIV)-positive population ages, issues concerning sexuality and fertility, among others, are becoming relevant. HIV is still surrounded by stigma and taboos, and there have been few studies conducted in industrialized settings concerning these questions. We therefore wanted to investigate the perception of sexuality and fertility in women living with HIV (WLWH) in an industrialized setting, using a questionnaire.
Abstract Abstract: Increased prevalence of low bone mineral density (BMD) and fractures among peo... more Abstract Abstract: Increased prevalence of low bone mineral density (BMD) and fractures among people living with HIV (PLWH) have been reported. The aim of the DANHIV-OSTEO study is to longitudinally monitor BMD among successfully treated PLWH. Here we report the baseline Dual-energy X-ray Absorptiometry (DXA) data. Furthermore, we analyze the influence of mode of analysis on BMD results. Well-treated PLWH aged 40–70 (women) and 50–70 years (men) were included. Using T-scores and a newly described Z-score grading we investigated the frequencies of low BMD. Logistic regression models were used to delineate the influence of age, sex, BMI, smoking, exercise, tenofovir (TDF) and protease inhibitor (PI) usage on low BMD (Z/T scores < −1). 226 PLWH had baseline DXA scans. The frequency of low BMD was 57 % (osteopenia and osteoporosis: 44 and 13 %). Higher age, current smoking and male sex were associated with higher risk of low BMD. Higher BMI and exercise were protective. We found an OR suggesting a negative effect of TDF. PI usage was not associated with low BMD. Mode of analysis influenced the findings. Low BMD was highly prevalent among Danish well-treated PLWH. Neither TDF nor PI usage was significantly associated with low BMD. Greater uniformity in the mode of analysis is recommended.
Objective: To identify disclosure, stigma and predictors of non-disclosure among women living wit... more Objective: To identify disclosure, stigma and predictors of non-disclosure among women living with HIV in Denmark. Methods: A questionnaire study of women living with HIV in Denmark was performed. The enrolment period was from February 2013 to March 2014. Logistic regression was used to estimate predictors of non-disclosure. Results: A total of 234 participants were included. The majority (94%) had disclosed their HIV status to at least one person outside their healthcare environment, although 29% had disclosed to fewer than three people. Confidantes were mostly partners (96%), siblings (63%), friends (63%) and children (41%). The primary reason for non-disclosure was a feeling that it did not concern others (55%), although reactions upon disclosure were mainly positive in 53%. Predictors of non-disclosure were being of black or Asian ethnicity. Following their HIV diagnosis, 40% no longer dared to have sex, 40% felt isolated and 23% felt that others were afraid and kept a physical distance. In contrast, after disclosure 75% felt better at taking decisions about life and 50% were in closer contact with family and friends. Conclusion: Almost one-third of participants disclosed their HIV diagnosis to fewer than three people and black or Asian ethnicity predicted non-disclosure. HIV-related stigma regarding sex and contact with others is still highly prevalent; however, reactions to disclosure were mainly positive and associated with secondary positive gains. We strongly urge healthcare professionals to initiate a dialogue regarding stigma and disclosure with women living with HIV with a view to increasing disclosure and minimising stigmatisation in this vulnerable population.
Objectives: Anti-müllerian hormone (AMH) is a marker of ovarian reserve. The purpose of this stud... more Objectives: Anti-müllerian hormone (AMH) is a marker of ovarian reserve. The purpose of this study was to compare AMH in women living with HIV with an age-matched control group of HIV-uninfected women, and to identify possible variables associated with decreasing AMH levels in women living with HIV. Methods: AMH was measured in frozen EDTA samples from 84 white women living with HIV, aged 20-40 years, with fully suppressed HIV RNA viral loads for at least 6 months and no hepatitis B or C virus co-infection. All women living with HIV were age-matched with HIV-uninfected control women. Results: Eighty-four women living with HIV and 252 control women were included. Median age for the women living with HIV was 33.5 years (interquartile range [IQR] 30.6−35.3), and 33.2 years (IQR 30.6−35.5) for the control women. A significant difference (P=0.03) was found in the mean AMH levels for all age groups combined, which was 17.23 pmol/L (95% confidence interval [CI] 14.56−19.89) in the women living with HIV versus 21.65 pmol/L (95% CI 19.50−23.81) in the control women, although levels were within reference limits in both groups. Only increasing age was significantly associated with decreasing AMH levels and not CD4 cell count, AIDS prior to inclusion, antiretroviral treatment/lack of treatment or antiretroviral treatment regimen. Conclusions: Well-treated, white women living with HIV in Denmark, have reduced AMH levels compared with age-matched control HIV-uninfected women. The only variable associated with decreasing AMH levels in women living with HIV was increasing age.
ObjectiveSyphilis is an STI that potentially affects any organ. Syphilitic hepatitis and neurosyp... more ObjectiveSyphilis is an STI that potentially affects any organ. Syphilitic hepatitis and neurosyphilis have been reported in both HIV-uninfected and HIV-infected individuals. The aim of this study was to investigate syphilitic hepatitis and neurosyphilis among HIV-infected individuals during a 13-year period.MethodsThis retrospective study included all HIV-infected individuals ≥18 years diagnosed with syphilis between 1 May 2004 and 31 December 2016 in Copenhagen, Denmark. We used the unique 10-digit personal identification number assigned to all individuals in Denmark to link data from two nationwide registers to identify the patients. Patient files were revised to obtain clinical and laboratory data.ResultsA total of 509 episodes of syphilis were diagnosed in 427 HIV-infected individuals attending three hospitals in Copenhagen, Denmark. The majority of the patients were men (99.5%), and the majority of men were men who have sex with men (96%). Twenty-seven patients (6%) met the cr...
The life expectancy in well-treated HIV-infected persons approaches that of the general populatio... more The life expectancy in well-treated HIV-infected persons approaches that of the general population, but HIV-infected persons have a greater incidence of fractures and osteoporosis. A decrease in bone mineral density is observed primarily during the first 1-2 years of antiretroviral therapy. Dual X-ray absorptiometry scan should be considered in HIV-infected men ≥ 50 years and postmenopausal women. In case of osteoporosis, bisphosphonate treatment should follow guidelines for the general population. Future research should focus on pathogenesis and prevention of bone density loss in HIV.
Bacterial vaginosis (BV) has been found to be associated with HIV acquisition and transmission. T... more Bacterial vaginosis (BV) has been found to be associated with HIV acquisition and transmission. This is suggested to be due to higher HIV RNA levels in cervicovaginal fluids in women living with HIV (WLWH) with BV, as bacteria associated with BV may induce viral replication and shedding in the genital tract despite undetectable HIV RNA plasma viral load. We examined the prevalence and diagnostic predictors of BV and HIV-1 RNA vaginal shedding in women living with HIV (WLWH) in Denmark, taking into account the presence of human papillomavirus (HPV) and herpes viridae. WLWH between 18-51 years were recruited from six Departments of Infectious Diseases in Denmark during enrolment in the SHADE cohort; a prospective cohort study of WLWH attending regular outpatient care. BV was diagnosed by microscopy of vaginal swabs and PCR was used for detection of BV-associated bacteria, HPV, herpes viridae, and vaginal HIV viral load. Median age of the 150 included women was 41 years; ethnicity was ...
As the human immunodeficiency virus (HIV)-positive population ages, issues concerning sexuality a... more As the human immunodeficiency virus (HIV)-positive population ages, issues concerning sexuality and fertility, among others, are becoming relevant. HIV is still surrounded by stigma and taboos, and there have been few studies conducted in industrialized settings concerning these questions. We therefore wanted to investigate the perception of sexuality and fertility in women living with HIV (WLWH) in an industrialized setting, using a questionnaire. WLWH were recruited at their regular outpatient clinic visits, at the major Departments of Infectious Diseases in Denmark and Finland, from January 2012 to October 2013. A questionnaire was developed, study participants were informed of the nature of study and, if they agreed to participate and signed a consent form, they filled in the questionnaire. Demographic information on the participants was obtained from patient files (in Finland) or from a national HIV cohort (in Denmark). Statistical analysis was performed using STATA, version 11...
The impressive effects of highly active antiretroviral therapy (HAART) have transformed the lives... more The impressive effects of highly active antiretroviral therapy (HAART) have transformed the lives of HIV-1-infected individuals, with life expectancies approaching those of HIV-uninfected individuals [1]. As a consequence of this substantial decline in mortality and morbidity, there is an increasing number of serodiscordant or seroconcordant couples who would like to have children [2,3]. HIV-1-infected individuals seem to have an increased risk of infertility/subfertility [4 – 6], though data are scarce and partly inconsistent. The demands for assisted reproductive treatments in HIV-1infected patients are largely unknown. Attempts have been made to estimate the extent to which the demands are met in some Western countries, i.e. in the UK [7] and the USA [8,9]. However, to our knowledge no such analysis has been undertaken in the Nordic countries. We describe the guidelines for assisted reproductive treatments, either governmental or from relevant medical societies, as well as the services actually offered in the Nordic countries. Though the countries (Denmark, Norway, Sweden, and Finland) are in many respects similar, e.g. regarding social security systems and health services [10], differences also exist. HIV clinicians from Denmark, Norway, Sweden, and Finland with special interest in the care of HIV-1-infected women investigated the national guidelines from their countries, either governmental or issued by relevant medical societies, as well as the assisted reproductive treatment actually offered. Whether or not adoption was an option for couples where one or both parties are HIV-1-infected was also investigated. Major differences in the assisted reproductive treatments offered were found (Table I). In Norway [11,12] and Finland [13] no assisted reproductive treatment is available for couples with HIV. In Sweden, serodiscordant couples where the man is infected are offered sperm washing and intracytoplasmic sperm injection (ICSI) [14]. However, this is solely offered to couples without fertility problems. The treatments are centralized. It is recommended that the viral load is suppressed at the time of treatment. No assisted reproductive treatment is available for HIV-1-infected women or couples where both the man and woman are infected. The age limitations are similar to those for the general population and the treatment is free-of-charge. In Denmark, assisted reproductive treatment is an option for couples where one, or since 2010, both parties are infected [15,16], if the patients are on HIV treatment or if treatment is perceived to be possible (i.e., no adherence or resistance problems known or anticipated). Insemination after sperm washing or with donor semen, in vitro fertilization, and ICSI can be offered to HIV-1-infected patients LETTER TO THE EDITOR
In 2009, 2.5 million children under the age of 15 y were living with human immunodeficiency virus... more In 2009, 2.5 million children under the age of 15 y were living with human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS); 370,000 were diagnosed with HIV and 260,000 died due to AIDS. More than 90% of the children infected with HIV live in sub-Saharan Africa. Most children infected with HIV contract the infection in utero, during delivery, or via breast milk. This review outlines the current diagnostic methods to determine the HIV status of infants born to HIV-infected mothers. The HIV DNA and RNA polymerase chain reaction (PCR) tests are highly accurate and are recommended as the first-choice diagnostic methods. However, they are expensive and require complex laboratory procedures. Consequently, a search for less costly and complicated methods has led to the testing of p24 antigen analyses as an alternative to the gold-standard PCR tests, with encouraging results. The p24 antigen Perkin Elmer assay currently most often used has a sensitivity of 98.8% and a specificity of 100% (infants 6 weeks of age). Larger-scale studies should be performed in resource-limited settings to confirm these findings.
Abstract Abstract: Increased prevalence of low bone mineral density (BMD) and fractures among peo... more Abstract Abstract: Increased prevalence of low bone mineral density (BMD) and fractures among people living with HIV (PLWH) have been reported. The aim of the DANHIV-OSTEO study is to longitudinally monitor BMD among successfully treated PLWH. Here we report the baseline Dual-energy X-ray Absorptiometry (DXA) data. Furthermore, we analyze the influence of mode of analysis on BMD results. Well-treated PLWH aged 40–70 (women) and 50–70 years (men) were included. Using T-scores and a newly described Z-score grading we investigated the frequencies of low BMD. Logistic regression models were used to delineate the influence of age, sex, BMI, smoking, exercise, tenofovir (TDF) and protease inhibitor (PI) usage on low BMD (Z/T scores < −1). 226 PLWH had baseline DXA scans. The frequency of low BMD was 57 % (osteopenia and osteoporosis: 44 and 13 %). Higher age, current smoking and male sex were associated with higher risk of low BMD. Higher BMI and exercise were protective. We found an OR suggesting a negative effect of TDF. PI usage was not associated with low BMD. Mode of analysis influenced the findings. Low BMD was highly prevalent among Danish well-treated PLWH. Neither TDF nor PI usage was significantly associated with low BMD. Greater uniformity in the mode of analysis is recommended.
The life expectancy in well-treated HIV-infected persons approaches that of the general populatio... more The life expectancy in well-treated HIV-infected persons approaches that of the general population, but HIV-infected persons have a greater incidence of fractures and osteoporosis. A decrease in bone mineral density is observed primarily during the first 1-2 years of antiretroviral therapy. Dual X-ray absorptiometry scan should be considered in HIV-infected men ≥ 50 years and postmenopausal women. In case of osteoporosis, bisphosphonate treatment should follow guidelines for the general population. Future research should focus on pathogenesis and prevention of bone density loss in HIV.
Objectives: Anti-müllerian hormone (AMH) is a marker of ovarian reserve. The purpose of this stud... more Objectives: Anti-müllerian hormone (AMH) is a marker of ovarian reserve. The purpose of this study was to compare AMH in women living with HIV with an age-matched control group of HIV-uninfected women, and to identify possible variables associated with decreasing AMH levels in women living with HIV. Methods: AMH was measured in frozen EDTA samples from 84 white women living with HIV, aged 20-40 years, with fully suppressed HIV RNA viral loads for at least 6 months and no hepatitis B or C virus co-infection. All women living with HIV were age-matched with HIV-uninfected control women. Results: Eighty-four women living with HIV and 252 control women were included. Median age for the women living with HIV was 33.5 years (interquartile range [IQR] 30.6−35.3), and 33.2 years (IQR 30.6−35.5) for the control women. A significant difference (P=0.03) was found in the mean AMH levels for all age groups combined, which was 17.23 pmol/L (95% confidence interval [CI] 14.56−19.89) in the women living with HIV versus 21.65 pmol/L (95% CI 19.50−23.81) in the control women, although levels were within reference limits in both groups. Only increasing age was significantly associated with decreasing AMH levels and not CD4 cell count, AIDS prior to inclusion, antiretroviral treatment/lack of treatment or antiretroviral treatment regimen. Conclusions: Well-treated, white women living with HIV in Denmark, have reduced AMH levels compared with age-matched control HIV-uninfected women. The only variable associated with decreasing AMH levels in women living with HIV was increasing age.
Scandinavian Journal of Infectious Diseases, Jan 31, 2012
The impressive effects of highly active antiretroviral therapy (HAART) have transformed the lives... more The impressive effects of highly active antiretroviral therapy (HAART) have transformed the lives of HIV-1-infected individuals, with life expectancies approaching those of HIV-uninfected individuals [1]. As a consequence of this substantial decline in mortality and morbidity, there is an increasing number of serodiscordant or seroconcordant couples who would like to have children [2,3]. HIV-1-infected individuals seem to have an increased risk of infertility/subfertility [4 – 6], though data are scarce and partly inconsistent. The demands for assisted reproductive treatments in HIV-1infected patients are largely unknown. Attempts have been made to estimate the extent to which the demands are met in some Western countries, i.e. in the UK [7] and the USA [8,9]. However, to our knowledge no such analysis has been undertaken in the Nordic countries. We describe the guidelines for assisted reproductive treatments, either governmental or from relevant medical societies, as well as the services actually offered in the Nordic countries. Though the countries (Denmark, Norway, Sweden, and Finland) are in many respects similar, e.g. regarding social security systems and health services [10], differences also exist. HIV clinicians from Denmark, Norway, Sweden, and Finland with special interest in the care of HIV-1-infected women investigated the national guidelines from their countries, either governmental or issued by relevant medical societies, as well as the assisted reproductive treatment actually offered. Whether or not adoption was an option for couples where one or both parties are HIV-1-infected was also investigated. Major differences in the assisted reproductive treatments offered were found (Table I). In Norway [11,12] and Finland [13] no assisted reproductive treatment is available for couples with HIV. In Sweden, serodiscordant couples where the man is infected are offered sperm washing and intracytoplasmic sperm injection (ICSI) [14]. However, this is solely offered to couples without fertility problems. The treatments are centralized. It is recommended that the viral load is suppressed at the time of treatment. No assisted reproductive treatment is available for HIV-1-infected women or couples where both the man and woman are infected. The age limitations are similar to those for the general population and the treatment is free-of-charge. In Denmark, assisted reproductive treatment is an option for couples where one, or since 2010, both parties are infected [15,16], if the patients are on HIV treatment or if treatment is perceived to be possible (i.e., no adherence or resistance problems known or anticipated). Insemination after sperm washing or with donor semen, in vitro fertilization, and ICSI can be offered to HIV-1-infected patients LETTER TO THE EDITOR
Objective: To identify disclosure, stigma and predictors of non-disclosure among women living wit... more Objective: To identify disclosure, stigma and predictors of non-disclosure among women living with HIV in Denmark. Methods: A questionnaire study of women living with HIV in Denmark was performed. The enrolment period was from February 2013 to March 2014. Logistic regression was used to estimate predictors of non-disclosure. Results: A total of 234 participants were included. The majority (94%) had disclosed their HIV status to at least one person outside their healthcare environment, although 29% had disclosed to fewer than three people. Confidantes were mostly partners (96%), siblings (63%), friends (63%) and children (41%). The primary reason for non-disclosure was a feeling that it did not concern others (55%), although reactions upon disclosure were mainly positive in 53%. Predictors of non-disclosure were being of black or Asian ethnicity. Following their HIV diagnosis, 40% no longer dared to have sex, 40% felt isolated and 23% felt that others were afraid and kept a physical distance. In contrast, after disclosure 75% felt better at taking decisions about life and 50% were in closer contact with family and friends. Conclusion: Almost one-third of participants disclosed their HIV diagnosis to fewer than three people and black or Asian ethnicity predicted non-disclosure. HIV-related stigma regarding sex and contact with others is still highly prevalent; however, reactions to disclosure were mainly positive and associated with secondary positive gains. We strongly urge healthcare professionals to initiate a dialogue regarding stigma and disclosure with women living with HIV with a view to increasing disclosure and minimising stigmatisation in this vulnerable population.
Background: Bacterial vaginosis (BV) has been found to be associated with HIV acquisition and tra... more Background: Bacterial vaginosis (BV) has been found to be associated with HIV acquisition and transmission. This is suggested to be due to higher HIV RNA levels in cervicovaginal fluids in women living with HIV (WLWH) with BV, as bacteria associated with BV may induce viral replication and shedding in the genital tract despite undetectable HIV RNA plasma viral load. We examined the prevalence and diagnostic predictors of BV and HIV-1 RNA vaginal shedding in women living with HIV (WLWH) in Denmark, taking into account the presence of human papillomavirus (HPV) and herpes viridae. Methods: WLWH between 18-51 years were recruited from six Departments of Infectious Diseases in Denmark during enrolment in the SHADE cohort; a prospective cohort study of WLWH attending regular outpatient care. BV was diagnosed by microscopy of vaginal swabs and PCR was used for detection of BV-associated bacteria, HPV, herpes viridae, and vaginal HIV viral load. Results: Median age of the 150 included women was 41 years; ethnicity was predominantly White (35%) or Black (47%). The majority (96%) was on ART and had undetectable (85%) plasma HIV RNA (<40 copies/mL). BV was diagnosed in 32%. Overall, 11% had detectable vaginal HIV RNA. Both before and after adjustment for BV, age, ethnicity, plasma HIV RNA, CD4 cell count, herpes viridae and HPV, we found no significant predictors of HIV RNA vaginal shedding. Conclusion: In well-treated WLWH, BV, herpes viridae or HPV do not predict vaginal HIV RNA shedding. This implies that HIV shedding does not seem to be increased by BV.
Introduction: As the human immunodeficiency virus (HIV)-positive population ages, issues concerni... more Introduction: As the human immunodeficiency virus (HIV)-positive population ages, issues concerning sexuality and fertility, among others, are becoming relevant. HIV is still surrounded by stigma and taboos, and there have been few studies conducted in industrialized settings concerning these questions. We therefore wanted to investigate the perception of sexuality and fertility in women living with HIV (WLWH) in an industrialized setting, using a questionnaire.
Abstract Abstract: Increased prevalence of low bone mineral density (BMD) and fractures among peo... more Abstract Abstract: Increased prevalence of low bone mineral density (BMD) and fractures among people living with HIV (PLWH) have been reported. The aim of the DANHIV-OSTEO study is to longitudinally monitor BMD among successfully treated PLWH. Here we report the baseline Dual-energy X-ray Absorptiometry (DXA) data. Furthermore, we analyze the influence of mode of analysis on BMD results. Well-treated PLWH aged 40–70 (women) and 50–70 years (men) were included. Using T-scores and a newly described Z-score grading we investigated the frequencies of low BMD. Logistic regression models were used to delineate the influence of age, sex, BMI, smoking, exercise, tenofovir (TDF) and protease inhibitor (PI) usage on low BMD (Z/T scores < −1). 226 PLWH had baseline DXA scans. The frequency of low BMD was 57 % (osteopenia and osteoporosis: 44 and 13 %). Higher age, current smoking and male sex were associated with higher risk of low BMD. Higher BMI and exercise were protective. We found an OR suggesting a negative effect of TDF. PI usage was not associated with low BMD. Mode of analysis influenced the findings. Low BMD was highly prevalent among Danish well-treated PLWH. Neither TDF nor PI usage was significantly associated with low BMD. Greater uniformity in the mode of analysis is recommended.
Objective: To identify disclosure, stigma and predictors of non-disclosure among women living wit... more Objective: To identify disclosure, stigma and predictors of non-disclosure among women living with HIV in Denmark. Methods: A questionnaire study of women living with HIV in Denmark was performed. The enrolment period was from February 2013 to March 2014. Logistic regression was used to estimate predictors of non-disclosure. Results: A total of 234 participants were included. The majority (94%) had disclosed their HIV status to at least one person outside their healthcare environment, although 29% had disclosed to fewer than three people. Confidantes were mostly partners (96%), siblings (63%), friends (63%) and children (41%). The primary reason for non-disclosure was a feeling that it did not concern others (55%), although reactions upon disclosure were mainly positive in 53%. Predictors of non-disclosure were being of black or Asian ethnicity. Following their HIV diagnosis, 40% no longer dared to have sex, 40% felt isolated and 23% felt that others were afraid and kept a physical distance. In contrast, after disclosure 75% felt better at taking decisions about life and 50% were in closer contact with family and friends. Conclusion: Almost one-third of participants disclosed their HIV diagnosis to fewer than three people and black or Asian ethnicity predicted non-disclosure. HIV-related stigma regarding sex and contact with others is still highly prevalent; however, reactions to disclosure were mainly positive and associated with secondary positive gains. We strongly urge healthcare professionals to initiate a dialogue regarding stigma and disclosure with women living with HIV with a view to increasing disclosure and minimising stigmatisation in this vulnerable population.
Objectives: Anti-müllerian hormone (AMH) is a marker of ovarian reserve. The purpose of this stud... more Objectives: Anti-müllerian hormone (AMH) is a marker of ovarian reserve. The purpose of this study was to compare AMH in women living with HIV with an age-matched control group of HIV-uninfected women, and to identify possible variables associated with decreasing AMH levels in women living with HIV. Methods: AMH was measured in frozen EDTA samples from 84 white women living with HIV, aged 20-40 years, with fully suppressed HIV RNA viral loads for at least 6 months and no hepatitis B or C virus co-infection. All women living with HIV were age-matched with HIV-uninfected control women. Results: Eighty-four women living with HIV and 252 control women were included. Median age for the women living with HIV was 33.5 years (interquartile range [IQR] 30.6−35.3), and 33.2 years (IQR 30.6−35.5) for the control women. A significant difference (P=0.03) was found in the mean AMH levels for all age groups combined, which was 17.23 pmol/L (95% confidence interval [CI] 14.56−19.89) in the women living with HIV versus 21.65 pmol/L (95% CI 19.50−23.81) in the control women, although levels were within reference limits in both groups. Only increasing age was significantly associated with decreasing AMH levels and not CD4 cell count, AIDS prior to inclusion, antiretroviral treatment/lack of treatment or antiretroviral treatment regimen. Conclusions: Well-treated, white women living with HIV in Denmark, have reduced AMH levels compared with age-matched control HIV-uninfected women. The only variable associated with decreasing AMH levels in women living with HIV was increasing age.
ObjectiveSyphilis is an STI that potentially affects any organ. Syphilitic hepatitis and neurosyp... more ObjectiveSyphilis is an STI that potentially affects any organ. Syphilitic hepatitis and neurosyphilis have been reported in both HIV-uninfected and HIV-infected individuals. The aim of this study was to investigate syphilitic hepatitis and neurosyphilis among HIV-infected individuals during a 13-year period.MethodsThis retrospective study included all HIV-infected individuals ≥18 years diagnosed with syphilis between 1 May 2004 and 31 December 2016 in Copenhagen, Denmark. We used the unique 10-digit personal identification number assigned to all individuals in Denmark to link data from two nationwide registers to identify the patients. Patient files were revised to obtain clinical and laboratory data.ResultsA total of 509 episodes of syphilis were diagnosed in 427 HIV-infected individuals attending three hospitals in Copenhagen, Denmark. The majority of the patients were men (99.5%), and the majority of men were men who have sex with men (96%). Twenty-seven patients (6%) met the cr...
The life expectancy in well-treated HIV-infected persons approaches that of the general populatio... more The life expectancy in well-treated HIV-infected persons approaches that of the general population, but HIV-infected persons have a greater incidence of fractures and osteoporosis. A decrease in bone mineral density is observed primarily during the first 1-2 years of antiretroviral therapy. Dual X-ray absorptiometry scan should be considered in HIV-infected men ≥ 50 years and postmenopausal women. In case of osteoporosis, bisphosphonate treatment should follow guidelines for the general population. Future research should focus on pathogenesis and prevention of bone density loss in HIV.
Bacterial vaginosis (BV) has been found to be associated with HIV acquisition and transmission. T... more Bacterial vaginosis (BV) has been found to be associated with HIV acquisition and transmission. This is suggested to be due to higher HIV RNA levels in cervicovaginal fluids in women living with HIV (WLWH) with BV, as bacteria associated with BV may induce viral replication and shedding in the genital tract despite undetectable HIV RNA plasma viral load. We examined the prevalence and diagnostic predictors of BV and HIV-1 RNA vaginal shedding in women living with HIV (WLWH) in Denmark, taking into account the presence of human papillomavirus (HPV) and herpes viridae. WLWH between 18-51 years were recruited from six Departments of Infectious Diseases in Denmark during enrolment in the SHADE cohort; a prospective cohort study of WLWH attending regular outpatient care. BV was diagnosed by microscopy of vaginal swabs and PCR was used for detection of BV-associated bacteria, HPV, herpes viridae, and vaginal HIV viral load. Median age of the 150 included women was 41 years; ethnicity was ...
As the human immunodeficiency virus (HIV)-positive population ages, issues concerning sexuality a... more As the human immunodeficiency virus (HIV)-positive population ages, issues concerning sexuality and fertility, among others, are becoming relevant. HIV is still surrounded by stigma and taboos, and there have been few studies conducted in industrialized settings concerning these questions. We therefore wanted to investigate the perception of sexuality and fertility in women living with HIV (WLWH) in an industrialized setting, using a questionnaire. WLWH were recruited at their regular outpatient clinic visits, at the major Departments of Infectious Diseases in Denmark and Finland, from January 2012 to October 2013. A questionnaire was developed, study participants were informed of the nature of study and, if they agreed to participate and signed a consent form, they filled in the questionnaire. Demographic information on the participants was obtained from patient files (in Finland) or from a national HIV cohort (in Denmark). Statistical analysis was performed using STATA, version 11...
The impressive effects of highly active antiretroviral therapy (HAART) have transformed the lives... more The impressive effects of highly active antiretroviral therapy (HAART) have transformed the lives of HIV-1-infected individuals, with life expectancies approaching those of HIV-uninfected individuals [1]. As a consequence of this substantial decline in mortality and morbidity, there is an increasing number of serodiscordant or seroconcordant couples who would like to have children [2,3]. HIV-1-infected individuals seem to have an increased risk of infertility/subfertility [4 – 6], though data are scarce and partly inconsistent. The demands for assisted reproductive treatments in HIV-1infected patients are largely unknown. Attempts have been made to estimate the extent to which the demands are met in some Western countries, i.e. in the UK [7] and the USA [8,9]. However, to our knowledge no such analysis has been undertaken in the Nordic countries. We describe the guidelines for assisted reproductive treatments, either governmental or from relevant medical societies, as well as the services actually offered in the Nordic countries. Though the countries (Denmark, Norway, Sweden, and Finland) are in many respects similar, e.g. regarding social security systems and health services [10], differences also exist. HIV clinicians from Denmark, Norway, Sweden, and Finland with special interest in the care of HIV-1-infected women investigated the national guidelines from their countries, either governmental or issued by relevant medical societies, as well as the assisted reproductive treatment actually offered. Whether or not adoption was an option for couples where one or both parties are HIV-1-infected was also investigated. Major differences in the assisted reproductive treatments offered were found (Table I). In Norway [11,12] and Finland [13] no assisted reproductive treatment is available for couples with HIV. In Sweden, serodiscordant couples where the man is infected are offered sperm washing and intracytoplasmic sperm injection (ICSI) [14]. However, this is solely offered to couples without fertility problems. The treatments are centralized. It is recommended that the viral load is suppressed at the time of treatment. No assisted reproductive treatment is available for HIV-1-infected women or couples where both the man and woman are infected. The age limitations are similar to those for the general population and the treatment is free-of-charge. In Denmark, assisted reproductive treatment is an option for couples where one, or since 2010, both parties are infected [15,16], if the patients are on HIV treatment or if treatment is perceived to be possible (i.e., no adherence or resistance problems known or anticipated). Insemination after sperm washing or with donor semen, in vitro fertilization, and ICSI can be offered to HIV-1-infected patients LETTER TO THE EDITOR
In 2009, 2.5 million children under the age of 15 y were living with human immunodeficiency virus... more In 2009, 2.5 million children under the age of 15 y were living with human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS); 370,000 were diagnosed with HIV and 260,000 died due to AIDS. More than 90% of the children infected with HIV live in sub-Saharan Africa. Most children infected with HIV contract the infection in utero, during delivery, or via breast milk. This review outlines the current diagnostic methods to determine the HIV status of infants born to HIV-infected mothers. The HIV DNA and RNA polymerase chain reaction (PCR) tests are highly accurate and are recommended as the first-choice diagnostic methods. However, they are expensive and require complex laboratory procedures. Consequently, a search for less costly and complicated methods has led to the testing of p24 antigen analyses as an alternative to the gold-standard PCR tests, with encouraging results. The p24 antigen Perkin Elmer assay currently most often used has a sensitivity of 98.8% and a specificity of 100% (infants 6 weeks of age). Larger-scale studies should be performed in resource-limited settings to confirm these findings.
Abstract Abstract: Increased prevalence of low bone mineral density (BMD) and fractures among peo... more Abstract Abstract: Increased prevalence of low bone mineral density (BMD) and fractures among people living with HIV (PLWH) have been reported. The aim of the DANHIV-OSTEO study is to longitudinally monitor BMD among successfully treated PLWH. Here we report the baseline Dual-energy X-ray Absorptiometry (DXA) data. Furthermore, we analyze the influence of mode of analysis on BMD results. Well-treated PLWH aged 40–70 (women) and 50–70 years (men) were included. Using T-scores and a newly described Z-score grading we investigated the frequencies of low BMD. Logistic regression models were used to delineate the influence of age, sex, BMI, smoking, exercise, tenofovir (TDF) and protease inhibitor (PI) usage on low BMD (Z/T scores < −1). 226 PLWH had baseline DXA scans. The frequency of low BMD was 57 % (osteopenia and osteoporosis: 44 and 13 %). Higher age, current smoking and male sex were associated with higher risk of low BMD. Higher BMI and exercise were protective. We found an OR suggesting a negative effect of TDF. PI usage was not associated with low BMD. Mode of analysis influenced the findings. Low BMD was highly prevalent among Danish well-treated PLWH. Neither TDF nor PI usage was significantly associated with low BMD. Greater uniformity in the mode of analysis is recommended.
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Papers by Maria Wessman