Rapid communications HIV and AIDS in the European Union, 2009

In 2009, 28 European Union and European Economic Area (EU/EEA) countries reported 25,917 newly diagnosed cases of human immunodeficiency virus (HIV). Sex among men who have sex with men was the most common transmission mode (35%) followed by heterosexual contact (24%). Overall, the number of HIV cases in 2009 increased while the number of reported acquired immunodeficiency syndrome (AIDS) diagnoses continued to decline. It is of concern that a high proportion of the patients with known CD4 cells count at the time of HIV diagnosis had a CD4 cell count below 350 cells/µl suggesting no timely access to treatment and care.


Human immunodeficiency virus (HIV) cases in the European Union and European Economic Area (EU/EEA), 2009
In the EU/EEA, 25,917 people were newly diagnosed with HIV in 2009, reported by 28 countries, a rate of 5.7 per 100,000 population.Data was not reported from Austria or Liechtenstein.The overall rate for men was 8.3 per 100,000 male population and 3.2 for women.The highest rates of new HIV diagnoses were reported by Estonia (30.7),Latvia (12.2), the United Kingdom (UK) (10.7) and Belgium (10.3).The lowest rates (<1.0) were reported by Romania and Slovakia.Twelve per cent of new HIV diagnoses were reported in 15-24 year-old individuals and 28% were female.Sex among men who have sex with men (MSM) is the predominant reported mode of transmission in EU/EEA, accounting for 35% of the HIV diagnoses, followed by heterosexual contact (24%) when cases from countries with generalised HIV epidemics are excluded.Five per cent of HIV cases were reported among intravenous drug users (IDU).Transmission mode was unknown for 20.3% of the cases.The highest proportion of cases classified as heterosexually transmitted and originating from countries with generalised epidemics, was observed in Norway (70%), Sweden (69%), Ireland (62%) and Belgium (60%).

Trends in HIV cases in the EU/EEA
Among the 28 EU/EEA countries that have consistently reported HIV data since 2004, the rate of HIV diagnoses per 100,000 population has been relatively stable, ranging from 6.5 in 2004 to 5.7 in 2009.In recent years, more than 25,000 HIV diagnoses were reported each year, resulting in a cumulative total number of nearly 350,000 diagnoses reported since the beginning of the epidemic (Figure 1).

Proportion of late presenters
Late presenters are defined as patients with a CD4 cell count below 350 cells/µl at time of HIV diagnosis [1].Data on CD4 cell counts at the time of diagnosis were available for cases in 18 countries, ranging from 1.2% in Bulgaria to 87% in Spain.For 11 countries, CD4 count information was available for more than 50% of the cases (Table ).Half of these were reported as late presenters, also taking into account possible reporting bias for more advanced HIV diagnoses.A slightly higher proportion of female cases (54.4%) were reported as late presenters compared with male cases (49.6%), with high heterogeneity among females across countries ranging from 33% in Cyprus and Luxembourg to 68% in Denmark.Among males, the proportion of late presenters ranged from 20% in Luxembourg to 60% in Denmark.
Among new diagnoses acquired heterosexually the proportion of late presenters ranged from 20% in Luxembourg to 67% in Slovakia, while seven countries reported more than 50% of the newly diagnosed cases as late presenters (Table ).For MSM, the proportion of late presenters varied from 25% in Luxembourg to 50% in Slovenia (Table ).Among IDU, the proportion of late presenters ranged from 49% in the UK to 60% in Denmark.All countries but Spain and the UK reported more than half of their cases with unknown risk factor as late presenters.
Figure 3 shows that among 10 222 cases with CD4 cell count reported, 51% were "late presenters".Member States in the increasing the uptake of HIV testing in Europe [4][5][6][7] Surveillance of HIV and AIDS in Europe provides the large scale picture of the HIV epidemics within its regions and of its main characteristics and risk groups affected, which is necessary to monitor the epidemic and guide the public health response to control HIV transmission of infections.Ensuring high quality of the data is of utmost importance to follow up and achieve the objectives set up in the EU Commission communication and action plan 'Combating HIV/AIDS in the European Union and Neighbouring countries, 2009-2013'.

Figure 1
Figure 1 Number of diagnosed and reported HIV infections, EU/EEA, 1984-2009 ,975 cases.The proportion of heterosexually acquired HIV diagnoses from countries with a generalised epidemic, varied from 52% in 2004 to 38% in 2009.In the same period, the number of cases among MSM increased by 24% in, from 7,263 cases to 8,974 cases and declined among IDU by 40% from 1,952 cases to 1,171 cases.The number of cases for which the transmission category was unknown increased by 40% (Figure2).There are reporting delays for a number of countries which overall limits the ability to interpret the trends in recent years.
[4]a, followed by cases from the Caribbean and Latin America.The proportion of late presenters is slightly higher in eastern Europe compared with central and western Europe.The areas are defined in the most recent ECDC/WHO HIV/AIDS surveillance report[4].
The largest proportion of late presenters is among individuals originating from sub-Saharan Africa and southeast/ EEA: European Economic Area; EU: European Union.a Data from Austria, Estonia and Poland not included eastern