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HIV : The 25th Annual World AIDS Day in France

Saturday is the 25th annual World AIDS Day. This article evaluates the trends over the last 20 years in the HIV-related knowledge, risk perceptions and sexual behaviours of adults living in metropolitan France.

Data were obtained from six ANRS-KABP rounds of surveys conducted by telephone between 1992 and 2010 in a representative sample of the population living in France. Similar in terms of the data collected and the target populations covered, the main common indicators produced were compared.

In total 18,404 individuals were interviewed. HIV routes of transmission remain well known, but some mechanisms of transmission appeared to be misunderstood. HIV is no more considered as the main challenge for prevention, particularly among young adults. Still well used at first intercourses, men and women were less convinced in 2010 that condom use is completely effective, reflecting distrust in its efficacy, especially among young adults.

HIV trivialization observed during the surveys is partly due to the improvements in treatment efficacy and the increasing life expectancy of people living with HIV. Preventive actions toward young adults need to be reinforced and focused both on sexually transmitted infections and unintended pregnancies.

HIV testing in France, 2003-2011

In France, an estimated 15,000 to 30,000 HIV infected persons are undiagnosed and half of HIV infected people are diagnosed late at less than 350 CD4/mm3. This article presents data on HIV testing in France in 2003-2011, from the LaboVIH survey.

In 2011, 5.2 million (95% CI: [5.12-5.24]) of HIV tests were performed in France, representing an increase of 4% compared with 2010. The number of tests performed increased in French overseas departments (FOD) and in mainland France except in the Paris region, where it remained stable. The number of HIV positive tests in 2011 was 10,517 (95% CI: [10,276-10,758]). This number increased since 2007 in mainland France except in the Paris region, whereas it decreased in the Paris region and in the French overseas departments. In 2011, free anonymous testing accounted for 7% of all HIV tests performed, and the rates of HIV positive tests were higher than in confidential testing
(3.2 versus 1.9/1,000 tests).

These data show an increase of HIV testing activity during the year following the publication of national guidelines that promoted an expanded HIV testing
policy. However, there was no increase in the number of HIV positive tests. Further data will show if expanded HIV testing is able to improve early diagnosis
and to decrease the undiagnosed HIV prevalence.

HIV types, groups and subtypes diagnosed in France since 2003: data from eight years of surveillance

In France, virological surveillance, including serotyping, is routinely performed in parallel with epidemiological surveillance of new diagnoses of HIV infection. Virological data combined with epidemiological data contribute to describe HIV infected persons by type, group and subtype of HIV.

Between 2003 and 2010, among 55,158 new HIV diagnoses, the proportion of HIV-2 was 2%. HIV-2 concerned mainly people infected through heterosexual intercourse born in Western Africa. Those people are diagnosed at an older age and are often more asymptomatic than those infected by HIV-1. HIV-1 and 2 dual infections accounted for 0.1% of diagnoses, as well as HIV-1 group O infection. Among HIV-1 diagnoses, B subtype virus was predominant (59%). People infected with a non-B virus were younger, and more often asymptomatic than those infected with B virus. The proportion of non-B virus has increased among drug users during the last two years.

Biomarker-based HIV incidence in a community sample of men who have sex with men in Paris, France. PREVAGAY survey 2009, ANRS-InVS*

Population-based estimates of HIV incidence in France reveal that men who have sex with men (MSM) are the most affected population and contribute to nearly half of new infections each year. We sought to estimate HIV incidence among sexually active MSM in Paris gay community social venues.

A cross-sectional survey (PREVAGAY) was conducted in 2009 in a sample of commercial venues such as bars, saunas and backrooms. We collected a behavioural questionnaire and blood sample. Biological samples were tested for HIV infection and positive specimens then tested for recent infection by the enzyme immunoassay for recent HIV-1 infection (EIA-RI). We assessed the presence of antiretroviral therapy among infected individuals to rule out treated patients in the algorithm that determined recent infection.

Among 886 MSM participants, 157 (18%) tested HIV positive. The overall HIV incidence was estimated at 3.8% person-years (PY) [95% CI: 1.5-6.2]. Although differences were not significant, incidence was estimated to be 3.5% PY [0.1-6.1] in men who had a negative HIV test in the previous year, and 4.8% PY [0.1-10.6] in men who had their last HIV test more than one year before the survey, or who were never tested.

This is the first community-based survey to estimate HIV incidence among MSM in France. It includes ART detection and reveals a high level of HIV transmission in sexually active individuals, despite a high uptake of HIV testing. These data call for effective prevention programs targeting MSM engaged in high-risk behaviours.

Causes of death among HIV-infected patients in France in 2010. ANRS EN20 Mortalité 2010

The “Mortalité 2010” survey aimed at describing the causes of death among HIV infected patients (HIV+) in France in 2010 and their trends since 2000. A national sample of clinical sites involved in the management of HIV infection notified and documented deaths through a standardized questionnaire.

The 90 participating centres notified 728 deaths. Median age was 50 years and 75% were men. The main underlying causes of death were AIDSrelated (25% vs. 36% in 2005 and 47% in 2000), cancer non-AIDS or hepatitis related (22% vs. 17% and 11%), liver-related (11% vs. 15% and 13%), cardiovascular disease (10% vs. 8% and 7%), non-AIDS related infections (9% vs. 4% and 7%). Neoplasia accounted for a third of the causes of all deaths. AIDS (36%) and non-AIDS related infections (15%) were the main underlying causes of death in French overseas departments (FOD).

In 2010, AIDS accounted for a quarter of the causes of death of HIV infected patients (but over one third in FOD). The majority of patients died of various causes, while their HIV infection was well controlled under treatment. These results argue in favor of a better case management of HIV-infected patients based on a multidisciplinary approach (prevention, screening, treatment), especially in oncology.

For more information, visit the InVs website (in French).

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