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Epidemiologie Van Aids En Hiv-Infectie in België

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Epidemiologie Van Aids En Hiv-Infectie in België EPIDEMIOLOGIE VAN INFECTIEZIEKTEN EPIDEMIOLOGIE VAN AIDS EN HIV-INFECTIE IN BELGIË TOESTAND OP 31 DECEMBER 2019 levenslang gezond WIE WE ZIJN SCIENSANO telt meer dan 700 medewerkers die zich elke dag opnieuw inzetten voor ons motto: levenslang gezond. Zoals uit onze naam blijkt, vormen wetenschap en gezondheid de kern van ons bestaan. De kracht van SCIENSANO ligt in de holistische en multidisciplinaire benadering van gezondheid. Onze aandacht gaat daarbij uit naar het nauwe en onlosmakelijke verband tussen de gezondheid van mensen en die van dieren, en hun omgeving (het “One health” concept). Daarom combineren we meerdere invalshoeken in ons onderzoek om op een unieke manier bij te dragen aan ieders gezondheid. SCIENSANO kan hiervoor verder bouwen op de meer dan 100 jaar wetenschappelijke expertise van het voormalige Centrum voor Onderzoek in Diergeneeskunde en Agrochemie (CODA) en het vroegere Wetenschappelijk Instituut Volksgezondheid (WIV). Sciensano Epidemiologie en volksgezondheid · Epidemiologie van infectieziekten November 2020 · Brussel · België AUTEURS SASSE A. DEBLONDE J. DE ROUCK M. MONTOURCY M. VAN BECKHOVEN D. 02/642.50.39 (André Sasse) [email protected] 02/642.57.05 (Jessika Deblonde) [email protected] 02/642.57.02 (Maarten De Rouck) [email protected] 02/642.55.62 (Marion Montourcy) [email protected] 02/642.57.09 (Dominique Van Beckhoven) [email protected] Dit project werd gefinancierd door: In samenwerking met: EPIDEMIOLOGIE VAN AIDS EN HIV-INFECTIE IN BELGIË Dankwoord Het programma hiv/aids van de dienst Epidemiologie van infectieziekten van Sciensano wenst in het bijzonder de Aids Referentielaboratoria (ARL) en de Hiv-Referentiecentra (HRC) te bedanken evenals de artsen-clinici voor het doorgeven van de nodige gegevens voor de analyse van de epidemiologie van hiv/aids in België, beschreven in dit rapport. Layout Ledia JANI, Sciensano © Sciensano Verantwoordelijke uitgever: Dr Christian Léonard ISSN : 1783-4988 Wettelijk depot: D/2020/14.440/86 DOI: https://doi.org/10.25608/35mc-0z39 www.sciensano.be INHOUDSTAFEL 1. SAMENVATTING ..............................................................................................9 2. DE HIV-SURVEILLANCE: CONTEXT EN METHODEN ....................................13 2.1 HIV-DIAGNOSES ......................................................................................................13 2.2 HIV-COHORTE: HIV-PATIËNTEN IN MEDISCHE OPVOLGING ..........................14 2.3 OPSPORING VAN HIV ..............................................................................................15 2.4 PRE-EXPOSURE PROFYLAXIS (PREP)......................................................................15 2.5 POST-EXPOSURE PROFYLAXIS (PREP) ...................................................................16 3. HIV-DIAGNOSES ...........................................................................................17 3.1 ALGEMENE TENDENS ..............................................................................................17 3.2 GESLACHT, LEEFTIJD, VERBLIJFSREGIO EN NATIONALITEIT ...........................18 3.3 VERMOEDELIJKE OVERDRACHTSWIJZE ..............................................................21 3.4 MANNEN DIE SEKS HEBBEN MET MANNEN .........................................................23 3.5 HETEROSEKSUELE VROUWEN EN MANNEN ........................................................26 3.6 VROEG- OF LAATTIJDIGHEID VAN DE DIAGNOSE .............................................29 3.6.1 CD4 LYMPHOCYTEN ............................................................................................. 29 3.6.2 LAATTIJDIGE DIAGNOSES ................................................................................... 30 3.6.3 VROEGTIJDIGE DIAGNOSES: ACUTE INFECTIES ............................................ 32 4. OPSPORING VAN HIV ....................................................................................35 4.1 AANTAL HIV-TESTS ...................................................................................................35 4.2 TYPE ARTS DIE DE OPSPORING EN DIAGNOSESTELLING UITVOERT ..............37 4.2.1 OPSPORING ........................................................................................................... 37 4.2.2 DIAGNOSESTELLING ............................................................................................ 37 4.3 HIV-DIAGNOSES PER 1000 TESTS ..........................................................................39 4.4 PLAATS EN REDEN VAN DE TEST ............................................................................42 7 5. HIV-PATIËNTEN IN MEDISCHE OPGEVOLGING ...........................................43 5.1 ALGEMENE TENDENS ..............................................................................................43 5.2 DEMOGRAFISCHE GEGEVENS ..............................................................................44 5.2.1 LEEFTIJD EN GESLACHT ...................................................................................... 44 5.2.2 JAAR VAN DE HIV-DIAGNOSE ............................................................................ 46 5.2.3 OVERDRACHTSWIJZE EN NATIONALITEIT ....................................................... 47 6. CONTINUÜM VAN DE ZORGVERLENING VOOR HIV-PATIËNTEN ...............49 7. PRE-EXPOSURE PROFYLAXIS (PREP) .............................................................51 7.1 PREP STARTES ............................................................................................................51 7.2 PREP-GEBRUIKERS EN SOA-DIAGNOSES .............................................................53 8. POST-EXPOSURE PROFYLAXIS (PEP) ............................................................55 9. BESLUIT ..........................................................................................................57 10. BIJLAGEN .......................................................................................................59 11. BIBLIOGRAFISCHE REFERENTIES .................................................................81 8 1. SAMENVATTING IIn 2019 werden in België 923 nieuwe hiv-diagnoses vastgesteld wat overeenstemt met gemiddeld 2,5 nieuwe diagnoses per dag of 81 nieuwe diagnoses per miljoen inwoners. In 2019 werd 46% van de nieuw geregistreerde hiv-infecties vastgesteld bij mannen die seks hebben met mannen (MSM) en 51% bij heteroseksuelen. Intraveneus druggebruik werd gerapporteerd voor 1,5% van de hiv-diagnoses; perinatale overdracht vertegenwoordigde 0,1% van de nieuwe diagnoses. Tussen 2012 en 2018 werd een aanzienlijke daling waargenomen in het aantal nieuwe hiv-diagnoses (-28%). Deze dalende trend deed zich voor in beide sleutelpopulaties van de Belgische epidemie, met name MSM met Belgische nationaliteit en heteroseksuele mannen en vrouwen afkomstig van Sub- Saharaans Afrika. In 2019 was er een lichte stijging van 4% ten opzichte van 2018 en lijkt een epidemiologisch plateau bereikt te zijn. Mannen die seks hebben met mannen In 2019 was er weinig evolutie in het aantal hiv-diagnoses bij MSM in vergelijking met 2018; de neerwaartse trend zet zich echter voort. Sinds de piek van de epidemie bij MSM in 2013 is het aantal met de Belgische nationaliteit aanzienlijk gedaald (-49%). Belgische MSM vertegenwoordigden 67% van de hiv-diagnoses bij MSM in 2013 en 51% in 2019. Het aantal nieuwe hiv-diagnoses bij MSM met een andere Europese nationaliteit blijft stabiel. In 2019 vertegenwoordigden Europese MSM 20% van het aantal hiv-diagnoses bij MSM. Bij MSM uit niet-Europese landen wordt de laatste jaren een lichte stijging waargenomen: in 2019 had 12% van de gediagnosticeerde MSM een Latijns- Amerikaanse nationaliteit en 8% een Aziatische nationaliteit. De volgende niet- Belgische nationaliteiten werden het meest gerapporteerd voor de diagnoses bij MSM in 2019: Brazilië (12%), Frankrijk (12%), Georgië (6%), Nederland (4%), en Venezuela (4%). Heteroseksuele mannen en vrouwen In 2019 vertegenwoordigden personen afkomstig van Sub-Saharaans Afrika 48% van het aantal vastgestelde hiv-infecties via heteroseksuele overdracht; 30% had de Belgische nationaliteit, 13% had een andere Europese nationaliteit en 9% had een andere nationaliteit. SAMENVATTING 9 In 2019 vertegenwoordigden vrouwen 67% van de hiv-diagnoses bij de heteroseksuelen afkomstig van Sub-Saharaans Afrika en 38% bij de heteroseksuelen met een Belgische nationaliteit. De daling van de diagnoses bij heteroseksuelen die sinds 2012 wordt waargenomen, is gestopt. Tussen 2018 en 2019 werd een lichte stijging vastgesteld. Dit weerspiegelt de evolutie van de diagnoses bij heteroseksuelen afkomstig van Sub-Saharaans Afrika: er was een daling van 47% bij de vrouwen en 60% bij de mannen tot 2018, daarna werd een plateau bereikt. Testen voor hiv en laattijdige diagnoses In 2019 was er een lichte stijging van het aantal opsporingstesten voor hiv. Er werden 66 hiv-tests per 1000 inwoners uitgevoerd en per 1 000 testen werden 1.2 nieuwe hiv-diagnoses vastgesteld. In 2019 werd 36% van de hiv-diagnoses laattijdig vastgesteld. Het aandeel van de laattijdige diagnoses varieerde in functie van de overdrachtswijze: 46% voor infecties overgedragen via heteroseksuele contacten, 28% bij MSM. In de periode 2016-2019 werd de helft (46%) van de diagnoses vastgesteld door huisartsen; 36% door internisten en 5% door gynaecologen en verloskundigen. Hiv-patiënten in medische opvolging In 2019, werden 17 081 hiv-patiënten medisch opgevolgd in België. Men stelt een gelijkmatige stijging vast van
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