On 31 March 2020, the Danish Parliament decided to offer free vaccination with the 23-valent pneumococcal polysaccharide vaccine (PPSV23) to all persons aged 65 and above and to individuals at an increased risk of pneumococcal disease. The aim of this study was to evaluate the impact of pneumococcal vaccination on individuals in their fifties by modelling the health economic consequences of an extension of the programme to include individuals aged 50-54 and 55-59. We adapted a Markov model to a Danish healthcare setting to simulate the incidence, costs, and mortality of non-bacteremic pneumococcal pneumonia (NBPP), invasive pneumococcal disease (IPD), and post-meningitis sequalae in a period of five years with and without PPSV23 vaccination. We found that an extension of the Danish age-based PPSV23 programme to include persons aged 55-59 would lead to saved costs of EUR 521,792 over a five-year period per 1 million persons in this age group. Moreover, this would lead to the prevention of 461 cases of IPD, 2,700 cases of NBPP and 83 pneumococcus-related deaths. Similarly, an additional extension of the programme to include persons aged 50-54 would prevent 263 cases of IPD, 1,894 cases of NBPP and 45 pneumococcus-related deaths per 1 million persons in this age group over a five-year period. Moreover, for this age group this implies an incremental societal cost of EUR 9.8 million, corresponding to a net cost of EUR 4,541 per avoided case of pneumococcal disease. When considering an extension of the Danish age-based PPSV23 vaccination programme, we show that inclusion of persons aged 55-59 leads to health gains, reduced mortality and reductions in healthcare resource utilization. An additional extension to include persons in the age group 50-54 has a net cost of EUR 4,541 per avoided case of pneumococcal disease.

OBJECTIVES:To estimate the burden of non-communicable diseases (NCDs) and mortality among PLHIV in the pre-, early- and late-HAART (highly active antiretroviral therapy) era.METHODS:We conducted a cohort study using population-based Danish medical registries including all adult HIV-infected residents of the Central Denmark Region during 1985-2017. For each HIV patient, we selected 10 comparisons from the background population matched by age, sex and municipality of residence. Based on hospital-related diagnoses we estimated the prevalence and incidence of specific NCD at diagnosis and at 5 and 10 years.RESULTS:We identified 1043 PLHIV and 10 430 matched comparisons. PLHIV had lower socioeconomic status and more were born outside western Europe. At HIV diagnosis, 21.9% of PHLIV vs. 18.2% of non-HIV individuals had at least one NCD, increasing to 42.2% vs. 25.9% after 10 years. PLHIV had higher prevalence and cumulative incidence of alcohol abuse, chronic obstructive pulmonary disease (COPD), ischaemic heart disease, mental disorders, renal and liver disease, but no increased risk of diabetes mellitus. Only PLHIV in the age groups 41-50 and > 51 years had an increased incidence of osteoporosis. From the pre- to the late-HAART era, 10-year mortality among PLHIV decreased from 45.5% to 9.4% but continued at more than twice that of uninfected comparisons. However, in the late-HAART era, the mortality of PLHIV who were alive 2 years after HIV diagnosis was approaching that of comparisons.CONCLUSIONS:Even in the late-HAART era, PLHIV have an excess mortality, which may be attributable to several NCDs being more prevalent among PLHIV. The prevalence rates of ischaemic heart disease, diabetes, osteoporosis and renal disease tend to increase over calendar time. Therefore, improvement of survival and quality of life of PLHIV neets strategies to reduce the risk of developing NCDs, including avoiding toxic antiretroviral therapy and lifestyle changes.

This study compares the health gains and economic consequences of introducing a PPSV23-based vaccination program for all individuals 65+ versus a strategy of no vaccination. Since June 2020, all adults 65+ in Denmark are offered vaccination against pneumococcal disease with a 23-valent polysaccharide vaccine (PPSV23). The health authorities have an ambition of reaching a vaccination coverage rate (VCR) of 75% within the first year. Based on local data (2017) on invasive pneumococcal disease (IPD) serotype distribution, PPSV23 is reported to cover 73% of all IPD cases in adults 65+. A Markov model was adapted to the Danish healthcare settings to simulate incidence and consequences of IPD and non-bacteremic pneumococcal pneumonia (NBPP) in adults 65+ over a 5-year period with a VCR of 75%. Input data was based on local data from Danish health authorities and international publications. A vaccine efficacy of 73% and 33%, with a linear 5-year waning, for vaccine type IPD and NBPP, respectively, was applied. Five health states were considered in the model: No pneumococcal disease, IPD, NBPP, post-meningitis sequelae and death. Over a 5-year period, implementing a PPSV23-based program for adults 65+ would prevent 625 and 17,177 cases of IPD and NBPP, respectively. Furthermore, over the same time period the program would prevent 141 and 1150 deaths due to IPD and NBPP, respectively. This implies a gain of 18,204 disease-free life-years and a reduction of 52 million Euro (discounted) in healthcare costs. The results show that implementing a single dose PPSV23-based vaccination program for adults 65+, irrespective of additional risk-factors, leads to health gains, reduced mortality and reductions in healthcare resource utilization.

investigated. We hypothesized that rituximab‐based therapy would improve survival in B‐cell–mediated AID‐associated lymphoma, given its beneficial clinical effect in AID. We aimed to examine the association between pre‐existing AIDs and B‐NHL and the possible influence of AIDs on NHL outcome. Methods: In this hospital‐based case‐control study in Hadassah– Hebrew University Medical Center, we recruited 435 newly‐diagnosed adult (>18 years) CD20+ B‐NHL patients diagnosed 2009 to 2014 and 414 controls frequency‐matched by age and sex to cases. The study is based on questionnaires in Hebrew, English, and Russian that included sociodemographic variables, medical information including a history of AIDs and medications; pathology confirmation; and chart review. We examined the association between NHL and AIDs in general, B‐ and T‐cell–mediated AIDs and autoimmune thyroid diseases, using logistic regression, reporting odds ratios (OR), and 95% confidence intervals (CI). In the second part of the study, we compared overall (OS) and relapse‐free survival (RFS) in B‐NHL patients with and without AID. We constructed Kaplan‐Meier curves for univariate analysis, and multivariable Cox regression models adjusting for important patient and disease characteristics such as Ki67% staining, international prognostic index score (IPI), and histological subgroup. Results: B‐NHL risk was associated with the presence of AIDs (OR = 1.98; 95% CI, 1.01‐3.9) especially those mediated by B‐cell activation (OR = 5.97; 95% CI, 2.3‐15.6). The strongest association was observed for marginal zone lymphoma (OR = 13.2, 95% CI, 4.02‐43.6). Time to relapse for all B‐NHL patients with AIDs was significantly shorter (mean of 49.21 months [±3.22]) than for patients without AID (mean of 59.74 months [±1.62]), hazard ratio (HR) = 1.7 (95% CI, 1.03‐2.79), after adjusting for IPI, Ki67% staining, and histological subgroup. Specifically in DLBCL, in which >99% received rituximab‐based therapy, both RFS and OS were adversely affected by the presence of B‐cell mediated AIDs with HR = 7.84 (95% CI, 2.86‐21.5) and 3.99 (95% CI, 1.24‐12.6), respectively (see figure). Conclusions: Beyond the well‐known association between AIDs and B‐NHL (particularly AIDs mediated by B‐cell activation), we found in addition that AID is an adverse prognostic factor in B‐cell lymphoma. AID‐associated B‐NHL patients have poorer outcomes. Specifically, B‐cell mediated AID results in inferior RFS and OS in DLBCL, suggesting that rituximab‐based therapy does not provide adequate coverage for the subgroup of patients. Further exploration of molecular subtypes and mechanisms of resistance of B‐NHL associated with AID is warranted.

Screening of 488 Syrian unaccompanied minor refugees (< 18 years-old) in Berlin showed low prevalence of intestinal parasites (Giardia, 7%), positive schistosomiasis serology (1.4%) and absence of hepatitis B. Among 44 ill adult Syrian refugees examined at GeoSentinel clinics worldwide, cutaneous leishmaniasis affected one in three patients; other noteworthy infections were active tuberculosis (11%) and chronic hepatitis B or C (9%). These data can contribute to evidence-based guidelines for infectious disease screening of Syrian refugees.

We evaluated EuroTravNet (a GeoSentinel subnetwork) data from June 2013 to May 2016 on 508 ill travellers returning from Brazil, to inform a risk analysis for Europeans visiting the 2016 Olympic and Paralympic Games in Brazil. Few dengue fever cases (n = 3) and no cases of chikungunya were documented during the 2013-15 Brazilian winter months, August and September, the period when the Games will be held. The main diagnoses were dermatological (37%), gastrointestinal (30%), febrile systemic illness (29%) and respiratory (11%).

Epstein-Barr Virus (EBV) infection can lead to infectious mononucleosis syndrome with the typical symptoms of fever, pharyngitis, and lymphadenopathy. Self-limited mild to moderate elevation of liver enzymes and hepatosplenomegaly are common. However, cholecystitis is not usually considered part of a primary EBV infection and ultrasound scan (USS) of the liver and gallbladder is not routinely performed. Acute acalculous cholecystitis (AAC) caused by etiologies other than primary EBV infection is often associated with severe illness and antibiotic treatment and surgery may be needed. We present a case with primary EBV infection and AAC and a literature review. Our patient was a 34-year-old woman with clinical, biochemical and serological signs of primary EBV infection (lymphocytes 7.6×10˄9/l, monocytes 2.6×10˄9/l, positive early antigen IgM test and 14 days later positive early antigen IgG test). During admission, increasing liver function tests indicated cholestasis (alanine aminotransferase 61 U/l, alkaline phosphatase 429 U/l and bilirubin 42μmol/l). USS revealed a thickened gallbladder wall indicating cholecystitis but no calculus. All other microbiological tests were negative. The literature search identified 26 cases with AAC and acute EBV infection; 25 cases involved females. Sore throat was not predominant (six reported this), and all cases experienced gastrointestinal symptoms. Our and previous published cases were not severely ill and recovered without surgical drainage. In conclusion primary EBV infection should be considered in cases of AAC, especially in young women. In cases associated with EBV infection neither administration of antibiotics nor surgical drainage may be indicated.

Objectives The objective was to estimate the utilization of psychotropic drugs in HIV ‐infected individuals compared with that in the background population. Methods Using data obtained from the D anish HIV C ohort S tudy and the D anish N ational P rescription R egistry, we analysed aggregated data on redeemed prescription of psychotropic drugs during 1995–2009. We primarily focused our analyses on HIV ‐infected individuals with no history of injecting drug use ( IDU ) or hepatitis C virus ( HCV ) infection. Drug utilization was expressed as defined daily doses per 1000 person‐days ( DDD /1000 PD ). The utilization rate ratio ( URR ) was calculated as utilization in the HIV ‐infected cohort compared with that in the comparison cohort. We estimated longitudinal trends in utilization and potential associations with HIV and exposure to highly active antiretroviral therapy ( HAART ), especially efavirenz. Results During 1995–2009, 54.5% of the HIV ‐infected cohort ( 3615 non‐ IDU /non‐ HCV ‐infected HIV ‐infected individuals) and 29.2% of the comparison cohort (32 535 individuals) had at least one prescription of a psychotropic drug. HIV infection was associated with a URR of 1.13 for antipsychotics, 1.76 for anxiolytics, 4.42 for hypnotics and sedatives, and 2.28 for antidepressants. Antidepressants were confined primarily to men who have sex with men ( MSM ). Older age, more recent calendar time, and increased time after HIV diagnosis were associated with increased drug utilization. However, no association with exposure to HAART or efavirenz was found. Conclusions HIV ‐infected individuals had a higher utilization of psychotropic drugs than the background population, which was not confined to individuals with a history of IDU or HCV infection. This emphasizes the need to focus on diagnosis of, and appropriate psychopharmacological interventions for, mental disorders in this population.

Objectives Recent studies have reported faster progression of HIV infection than anticipated based on results from earlier studies. The aim of the present study was to examine if the virulence of HIV-1 infection changed in the period 1995-2010 among chronically HIV-infected individuals in Denmark. Methods We included all patients registered in the Danish HIV Cohort Study, who were diagnosed in 1995-2009, had a CD4 count >100 cells/L at diagnosis and had at least two CD4 measurements prior to initiation of antiretroviral therapy (ART). Changes in viral set point and rate of CD4 cell decline from enrolment until the initiation of ART by calendar year of HIV diagnosis were analysed. Time to first CD4 count <350 cells/L was compared among patients diagnosed in 1995-2000, 2001-2005 and 2006-2010. Results We followed 1469 HIV-infected patients for a total of 5783 person-years. The median viral set point was 4.27 log10 HIV-1 RNA copies/mL [interquartile range (IQR) 3.58-4.73 log10 copies/mL]. The median CD4 cell decline per year was 57 cells/L (IQR 10-139 cells/L). In analyses adjusted for age, gender, origin, route of transmission and CD4 count at diagnosis, there were no associations between year of diagnosis and viral set point or CD4 cell decline. Time to first CD4 count <350 cells/L did not change in the study period [incidence rate ratio (IRR) 0.90 (95% confidence interval (CI) 0.76-1.06) for 2001-2005 and 1.09 (95% CI 0.79-1.34) for 2006-2010 compared with 1995-2000]. Conclusions We found no evidence of changing trends in viral set point, CD4 cell decline or time to CD4 count <350 cells/L during the period 1995-2010 in a cohort of chronically HIV-infected individuals.

Purpose To compare the mortality and causes of death in human immunodeficiency syndrome (HIV) patients with the background population. Methods All adult HIV patients treated in Danish HIV centers from 1995 to 2008 and 14 controls for each HIV patient were included. Age-adjusted mortality rates (MR) and mortality rate ratios (MRR) were estimated using direct standardization and Poisson regression analyses. Up to four contributory causes of death for each person were included in analyses of cause-specific MR. Results A total of 5,137 HIV patients and 71,918 controls were followed for 37,838 and 671,339 person-years (PY), respectively. Among non-injection drug use (IDU) HIV patients, the acquired immune deficiency syndrome (AIDS)-related MR/1,000 PY declined dramatically from 122.9 [95 % confidence interval (CI) 106.8–141.4] in 1995 to 5.0 (95 % CI 3.1–8.1) in 2008. The non-AIDS-related MR did not change substantially from 6.9 (95 % CI 3.8–12.5) to 5.6 (95 % CI 3.6–8.8). The MR of unnatural causes declined from 6.9 (95 % CI 3.8–12.5) to 2.7 (95 % CI 1.4–5.1). The MRR of infections declined from 46.6 (95 % CI 19.6–110.9) to 3.3 (95 % CI 1.6–6.6). The MRR of other natural causes of death remained constant. Conclusions After the introduction of highly active antiretroviral therapy (HAART), the AIDS-related mortality has decreased substantially, but the long-term exposure to HIV and HAART has not translated into increasing mortality from malignancy, cardiovascular, and hepatic diseases.

Objectives Incidence rates (IRs) of Staphylococcus aureus bacteraemia (SAB) are known to be higher in HIV‐infected individuals than in the general population, but have not been assessed in the era of highly active antiretroviral therapy. Methods From 1 January 1995 to 31 December 2007, all Danish HIV‐infected individuals ( n =4871) and population controls ( n =92 116) matched on age and sex were enrolled in a cohort and all cases of SAB were registered. IRs and risk factors were estimated using time‐updated Poisson regression analysis. Results We identified 329 cases of SAB in 284 individuals, of whom 132 individuals were infected with HIV and 152 were not [crude IR ratio (IRR) 24.2; 95% confidence interval (CI) 19.5–30.0, for HIV‐infected vs . non‐HIV‐infected individuals]. Over time, IR declined for HIV‐infected individuals (IRR 0.40). Injecting drug users (IDUs) had the highest incidence and the smallest decline in IR, while men who have sex with men (MSM) had the largest decline over time. Among HIV‐infected individuals, a latest CD4 count <100 cells/μL was the strongest independent predictor of SAB (IRR 10.2). Additionally, HIV transmission group was associated with risk of SAB. MSM were more likely to have hospital‐acquired SAB, a low CD4 cell count and AIDS at the time of HIV acquisition compared with IDUs. Conclusions We found that the incidence of SAB among HIV‐infected individuals declined during the study period, but remained higher than that among HIV‐uninfected individuals. There was an unevenly distributed burden of SAB among HIV transmission groups (IDU>MSM). Low CD4 cell count and IDU were strong predictors of SAB among HIV‐infected individuals.

OBJECTIVE:The association between HIV infection and the risk of venous thromboembolism (VTE) is controversial. We examined the risk of VTE in HIV-infected individuals compared with the general population and estimated the impact of low CD4 cell count, highly active antiretroviral therapy (HAART) and injecting drug use (IDU).METHODS:We identified 4333 Danish HIV-infected patients from the Danish HIV Cohort Study and a population-based age- and gender-matched comparison cohort of 43,330 individuals. VTE diagnoses were extracted from the Danish National Hospital Registry. Cumulative incidence curves were constructed for time to first VTE. Incidence rate ratios (IRRs) and impact of low CD4 cell count and HAART were estimated by Cox regression analyses. Analyses were stratified by IDU, adjusted for comorbidity and disaggregated by overall, provoked and unprovoked VTE.RESULTS:The 5-year risk of VTE was 8.0% [95% confidence interval (CI) 5.78-10.74%] in IDU HIV-infected patients, 1.5% (95% CI 1.14-1.95%) in non-IDU HIV-infected patients and 0.3% (95% CI 0.29-0.41%) in the population comparison cohort. In non-IDU HIV-infected patients, adjusted IRRs for unprovoked and provoked VTE were 3.42 (95% CI 2.58-4.54) and 5.51 (95% CI 3.29-9.23), respectively, compared with the population comparison cohort. In IDU HIV-infected patients, the adjusted IRRs were 12.66 (95% CI 6.03-26.59) for unprovoked VTE and 9.38 (95% CI 1.61-54.50) for provoked VTE. Low CD4 cell count had a minor impact on these risk estimates, while HAART increased the overall risk (IRR 1.93; 95% CI 1.00-3.72).CONCLUSION:HIV-infected patients are at increased risk of VTE, especially in the IDU population. HAART and possibly low CD4 cell count further increase the risk.

OBJECTIVE:The aim of the study was to examine whether exposure to abacavir increases the risk for myocardial infarction (MI). DESIGN, SETTING AND SUBJECTS:This was a prospective nationwide cohort study which included all Danish HIV-infected patients on highly active antiretroviral therapy (HAART) from 1995 to 2005 (N = 2952). Data on hospitalization for MI and comorbidity were obtained from Danish medical databases. Hospitalization rates for MI after HAART initiation were calculated for patients who used abacavir and those who did not. We used Cox's regression to compute incidence rate ratios (IRR) as a measure of relative risk for MI, while controlling for potential confounders (as separate variables and via propensity score) including comorbidity. MAIN OUTCOME:Relative risk of hospitalization with MI in abacavir users compared with abacavir nonusers. RESULTS:Hospitalization rates for MI were 2.4/1000 person-years (PYR) [95% confidence interval (CI) 1.7-3.4] for abacavir nonusers and 5.7/1000 PYR (95% CI 4.1-7.9) for abacavir users. The risk of MI increased after initiation of abacavir [unadjusted IRR = 2.22 (95% CI 1.31-3.76); IRR adjusted for confounders = 2.00 (95% CI 1.10-3.64); IRR adjusted for propensity score = 2.00 (95% CI 1.07-3.76)]. This effect was also observed among patients initiating abacavir within 2 years after the start of HAART and among patients who started abacavir as part of a triple nucleoside reverse transcriptase inhibitor (NRTI) regimen. CONCLUSIONS:We confirmed the association between abacavir use and increased risk of MI. Further studies are needed to control for potential confounding not measured in research to date.

Objectives:To analyse the incidence, prevalence, and predictors for development of triple-class antiretroviral drug failure (TCF) in individuals infected with HIV. Design:Population-based observational cohort study from 1 January 1995 to 31 December 2003, focusing on all 2722 recipients of highly active antiretroviral therapy (HAART) in Denmark. Methods:We used person-years analysis, Kaplan–Meier survival curves and Cox regression analysis. TCF was defined as a minimum of 120 days with viral load > 1000 copies/ml on treatment with each of the three major drug classes. Results:We observed 177 TCFs, yielding a crude incidence rate (IR) of 1.8 per 100 person-years [95% confidence interval (CI), 1.6–2.1]. Seven years after initiation of HAART, 17.2% (95% CI, 14.5–20.5) of antiretroviral (ART)-experienced patients, but only 7.0% (95% CI, 4.3–11.2) of ART-naive patients were estimated to have failed. After an initial rise, the IR from the third to the sixth year of HAART declined significantly for ART-experienced patients [incidence rate ratio (IRR), 0.80 per year (95% CI, 0.66–0.97); P = 0.022], and non-significantly for ART-naive patients [IRR, 0.79 per year (95% CI, 0.53–1.18); P = 0.255]. The IR for all patients being followed each year declined from 1997 to 2003 [IRR, 0.88 (95% CI, 0.81–0.96); P = 0.002]. The prevalence of TCF remained stable at less than 7% after 2000. Predictors of TCF at commencement of HAART were a CD4 cell count below 200, a previous AIDS-defining event, previous antiretroviral exposure, earlier year of HAART initiation, and young age. Conclusions:The risk of TCF is declining in Denmark and the prevalence remains stable.

BACKGROUNDOur objective was to examine whether virological control during the first 6-18 months after HAART initiation is a predictor for viral suppression, CD4+ cell count increase, and mortality in human immunodeficiency virus (HIV)-infected patients 18-90 months after initiation of highly active antiretroviral therapy (HAART).METHODSWe conducted a population-based observational cohort study in Denmark. Patients were divided into 3 groups, according to the proportion of time each patient had a detectable HIV RNA load (i.e., > or = 400 copies/mL) during the 6-18 months after HAART initiation: 0% of the time interval (group 1), 1%-99% of the time interval (group 2), and 100% of the time interval (group 3). The proportion of patients with undetectable HIV RNA, CD4+ cell count changes, and mortality were examined by logistic, linear, and Cox regression analyses, respectively. We constructed cumulative mortality curves.RESULTSWe observed 2046 patients, for a total of 8898 person-years of follow-up that started at 18 months after HAART initiation. Mean CD4+ cell count increase rates during 72 months of follow-up were as follows: group 1, 3.3 x 10(6) cells/L per month (95% confidence interval [CI], 2.9-3.7 x 10(6) cells/L); group 2, 2.9 x 10(6) (95% CI, 2.5-3.3 x 10(6) cells/L); and group 3, 2.6 x 10(6) (95% CI, 2.0-3.3 x 10(6) cells/L). Survival at 72 months were as follows: group 1, 92.7% (95% CI, 90.5%-94.4%); group 2, 85.6% (95% CI, 82.1%-88.5%); and group 3, 76.1% (95% CI, 70.6%-80.7%). At 72 months, 96% of group 1, 83% of group 2, and 57% of group 3 had an HIV RNA load of < 400 copies/mL (P < .01). Treatment interruption before baseline was a predictor of mortality in group 2 (adjusted rate ratio, 2.94; 95% CI, 1.75-4.92]).CONCLUSIONSViral suppression during the first 6-18 months after HAART initiation predicts viral suppression, CD4+ cell count progression, and survival at 72 months.

Objectives: To assess the mortality in a cohort of HIV-infected patients starting highly active antiretroviral therapy (HAART) compared to the mortality of the general population, focusing on the influence of the CD4 cell count at the time of starting HAART.Methods: Patients in the HIV Cohort Study in Western Denmark starting HAART before 1 January 2002 were identified. For each patient, 100 population controls matched on age and gender were extracted from the Danish Civil Registration System. Mortality rates were compared between the two cohorts overall, and in four groups defined by baseline CD4 cell counts.Results: A total of 647 HIV-infected patients and 64 700 population controls were included, accounting for 53 and 815 deaths during follow-up. In-the HIV group, mortality rates were 70.0 per 1000 person-years at risk in the lowest CD4 cell group (< 50x10(6) cells/l), and 3.2 in the highest (>= 200x10(6) cells/l). Compared with population controls, mortality rate ratios declined with increasing CD4 cell counts, being 15.3 [95% confidence interval (CI), 9.8-23.8], 8.6 (95% CI, 4.3-16.8), 5.9 (95% CI, 3.0-11.4), and 3.6 (95% CI, 2.0-6.5) in the groups with CD4 cell count < 50, 50-99, 100-199, and greater than or equal to200x10(6) cells/l.Conclusion: In comparison with the general population, HIV-infected patients starting HAART with a CD4 cell count above 200x10(6) cells/l had low mortality rates that were comparable with the rates found in other chronic medical diseases. The mortality rates increased considerably when treatment was started at lower baseline CD4 cell counts. (C) 2004 Lippincott Williams Wilkins.

New antiretroviral drugs, expanding knowledge of their long-term toxic effects and the large number of patients with treatment failure have increased the demand for new strategies in the antiretroviral treatment of HIV-infected patients. The present study was conducted as part of the HIV Cohort Study in western Denmark to reveal trends in the use of antiretrovirals in the region. The cohort includes all patients attached to those centers treating HIV patients in western Denmark. A total of 537 patients who started highly active antiretroviral therapy (HAART) were included. The number of patients receiving HAART increased dramatically in 1996 and 1997 before leveling off, with 45-75 patients initiating treatment annually thereafter. Median follow-up time after initiation of HAART was 151 weeks. An estimated 45.1% of patients had the initial HAART regimen modified during the first year of follow-up. Side-effects and treatment failure were the main reasons for treatment modifications. Major new strategies implemented in the region in 1999 and 2000 included treatment with boosted protease inhibitors and non-nucleoside reverse transcriptase inhibitors.

We performed a population- based cohort study to assess the impact of nonwhite origin on the outcome of highly active antiretroviral therapy (HAART) for a Danish cohort of human immunodeficiency virus (HIV)- infected patients. A total of 389 whites and 135 nonwhites started receiving HAART before 1 April 2001. After 1 year of treatment, 78% of nonwhites and 76% of whites achieved a virus load of < 500 HIV RNA copies/ mL. No major differences were found between the 2 groups with respect to achievement of a virus load of < 500 copies/ mL (relative risk [RR], 0.94; 95% confidence interval [CI], 0.74- 1.18), risk of clinical progression (RR, 0.63; 95% CI, 0.32- 1.24), or response measured by total CD4(+) cell count. One year after fulfilling Danish recommendations for initiation of HAART, 91% of nonwhites and 93% of whites had started receiving HAART. Race and ethnic origin play no major role in the outcome associated with HAART if access to health care is free.