Prescription of antimicrobials in primary health care as a marker to identify people living with undiagnosed HIV infection, Denmark, 1998 to 2016
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Prescription of antimicrobials in primary health care as a marker to identify people living with undiagnosed HIV infection, Denmark, 1998 to 2016. / Martin-Iguacel, Raquel; Pedersen, Court; Llibre, Josep M.; Søndergaard, Jens; Ilkjær, Frederik Veitland; Jensen, Janne; Obel, Niels; Johansen, Isik Somuncu; Rasmussen, Line Dahlerup.
In: Euro surveillance : bulletin Europeen sur les maladies transmissibles = European communicable disease bulletin, Vol. 24, No. 41, 1900225, 10.2019.Research output: Contribution to journal › Journal article › Research › peer-review
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TY - JOUR
T1 - Prescription of antimicrobials in primary health care as a marker to identify people living with undiagnosed HIV infection, Denmark, 1998 to 2016
AU - Martin-Iguacel, Raquel
AU - Pedersen, Court
AU - Llibre, Josep M.
AU - Søndergaard, Jens
AU - Ilkjær, Frederik Veitland
AU - Jensen, Janne
AU - Obel, Niels
AU - Johansen, Isik Somuncu
AU - Rasmussen, Line Dahlerup
PY - 2019/10
Y1 - 2019/10
N2 - BackgroundDevelopment of additional diagnostic strategies for earlier HIV diagnosis are needed as approximately 50% of newly diagnosed HIV-infected individuals continue to present late for HIV care.AimWe aimed to analyse antimicrobial consumption in the 3 years preceding HIV diagnosis, assess whether there was a higher consumption in those diagnosed with HIV compared with matched controls and whether the level of consumption was associated with the risk of HIV infection.MethodsWe conducted a nested case-control study, identifying all individuals (n = 2,784 cases) diagnosed with HIV in Denmark from 1998 to 2016 and 13 age-and sex-matched population controls per case (n = 36,192 controls) from national registers. Antimicrobial drug consumption was estimated as defined daily doses per person-year. We used conditional logistic regression to compute odds ratios and 95% confidence intervals.ResultsIn the 3 years preceding an HIV diagnosis, we observed more frequent and higher consumption of antimicrobial drugs in cases compared with controls, with 72.4% vs 46.3% having had at least one prescription (p < 0.001). For all antimicrobial classes, the association between consumption and risk of subsequent HIV diagnosis was statistically significant (p < 0.01). The association was stronger with higher consumption and with shorter time to HIV diagnosis.ConclusionHIV-infected individuals have a significantly higher use of antimicrobial drugs in the 3 years preceding HIV diagnosis than controls. Prescription of antimicrobial drugs in primary healthcare could be an opportunity to consider proactive HIV testing. Further studies need to identify optimal prescription cut-offs that could endorse its inclusion in public health policies.
AB - BackgroundDevelopment of additional diagnostic strategies for earlier HIV diagnosis are needed as approximately 50% of newly diagnosed HIV-infected individuals continue to present late for HIV care.AimWe aimed to analyse antimicrobial consumption in the 3 years preceding HIV diagnosis, assess whether there was a higher consumption in those diagnosed with HIV compared with matched controls and whether the level of consumption was associated with the risk of HIV infection.MethodsWe conducted a nested case-control study, identifying all individuals (n = 2,784 cases) diagnosed with HIV in Denmark from 1998 to 2016 and 13 age-and sex-matched population controls per case (n = 36,192 controls) from national registers. Antimicrobial drug consumption was estimated as defined daily doses per person-year. We used conditional logistic regression to compute odds ratios and 95% confidence intervals.ResultsIn the 3 years preceding an HIV diagnosis, we observed more frequent and higher consumption of antimicrobial drugs in cases compared with controls, with 72.4% vs 46.3% having had at least one prescription (p < 0.001). For all antimicrobial classes, the association between consumption and risk of subsequent HIV diagnosis was statistically significant (p < 0.01). The association was stronger with higher consumption and with shorter time to HIV diagnosis.ConclusionHIV-infected individuals have a significantly higher use of antimicrobial drugs in the 3 years preceding HIV diagnosis than controls. Prescription of antimicrobial drugs in primary healthcare could be an opportunity to consider proactive HIV testing. Further studies need to identify optimal prescription cut-offs that could endorse its inclusion in public health policies.
KW - antibiotic use
KW - antimicrobial use
KW - HIV diagnosis
KW - HIV testing
KW - indicator conditions
KW - late HIV presentation
KW - missed opportunities
U2 - 10.2807/1560-7917.ES.2019.24.41.1900225
DO - 10.2807/1560-7917.ES.2019.24.41.1900225
M3 - Journal article
C2 - 31615598
AN - SCOPUS:85073425519
VL - 24
JO - Eurosurveillance
JF - Eurosurveillance
SN - 1025-496X
IS - 41
M1 - 1900225
ER -
ID: 241582339