Characterising HIV-Indicator conditions among two nationwide long-term cohorts of people living with HIV in Germany (1999–2023)
Authors: Krings Amrei , Kollan Christian , Schmidt Daniel , Gunsenheimer-Bartmeyer Barbara , Valbert Frederik , Neumann Anja , Wasem Jürgen , Behrens Georg M. N. , Bickel Markus , Boesecke Christoph , Esser Stefan , Dröge Patrik , Ruhnke Thomas , Koppe Uwe ,   the HIV-1 Seroconverter, ClinSurv-HIV study groups, Knechten Heribert , Panstrugart Petra , Arasteh Keikawus , Rittweger Michael , Wesselmann Hans , Menner Nikolai , Schürmann Dirk , Warncke Marianne , Bohr Ulrich , Jessen Heiko , Jessen Arne B. , Schulbin Hubert , Brand Sascha , Gumprecht Jan , Weninger Beate , Hillenbrand Heribert , Karcher Heiko , Fischer Klaus , Schranz Dietmar , Vallée Mathias , Hartikainen Jukka , Grunwald Stephan , Claus Jörg A. , Thomas Claudia , Grimm Roland , Schoor Sarah , Cordes Christiane , Schröder Reinhold , Glaunsinger Tobias , Rausch Michael , Reineke Thomas , Weinberg Gordon , Bruhy Manuel , Köppe Siegfried , Kreckel Peter , Berger Andreas , Lindemann Sinah , Brockmeyer Norbert H. , Potthoff Anja , van Bremen Kathrin , Rockstroh Jürgen , Wasmuth Jan-Christian , Hass Svetlana , Hower Martin , Bachmann Claudia , Spornraft-Ragaller Petra , Teichmann Dieter , Jensen Björn-Erik Ole , Hüttig Falk , Feind Cecilie , Schenk-Westkamp Pia , Haberl Annette , Stephan Christoph , Schott Peter , Usadel Susanne , Müller Matthias , Trauth Janina , Chavez-Valladares Alan , Deutschinoff Gerd , Kreft Burkhard , Lange Danica , Degen Olaf , Schäfer Guido , Plettenberg Andreas , Kuhlendahl Frieder , Lorenzen Thore , Wiemer Dorothea , Biemann Lavinia , Adam Axel , Buhk Thomas , Fenske Stephan , Hansen Stefan , Sabranski Michael , Schewe Knud , Hoffmann Christian , Stellbrink Hans-Jürgen , Radzuweit Dennis , Mainka Alexander , Rickassel Constantin , Degen Olaf , Schäfer Guido , Scheiter Robin , Behrens Georg , Stoll Matthias , Gerschmann Steve , Beider Renate , Schleenvoigt Benjamin T. , Pletz Mathias W. , Horst Heinz-August , Trautmann Silke , Rieke Ansgar , Schneeweiß Stephan , Scholten Stefan , Oette Mark , Fätkenheuer Gerd , Vehreschild Jörg Janne , Hamacher Laura , Nicksch Lennart , Arbter Peter A. , Grünewald Thomas , Weidemann Jeannine , Ruck Ines , Claus Bernd , Sprinzl Martin , Galle Peter R. , Ebert Matthias P. , Vogelmann Roger , Bogner Johannes , Hellerer Ulrike , Sonntag Barbara , Pullen Oliver , Todorova Antoniya , Traidl-Hoffmann Claudia , Mück Birgit , Pauli Ramona , Spinner Christoph D. , Schneider Jochen , Mück Birgit , Baumann Robert , Schübel Niels , Berning Christiane , Audebert Franz , Fritzsche Carlos , Trein A , Schnaitmann E , Roll Clemens , Marquardt Simone , Härter Georg , Grüner Beate , Güler Cengiz , Rößler Steve 
Published: October 2024

Abstract
Background/Objective
Information about occurrence and affected groups of symptoms/diagnoses indicative of an HIV infection (so-called HIV indicator conditions; HIV-ICs) is lacking. We analyse HIV-IC incidence, transmission risks and immune status among people living with HIV (PLWH) antiretroviral therapy (ART) naive.

Methods
Diagnoses reported for ART-naive PLWH from two multicentre observational, prospective cohort studies between 1999–2023 were analysed. Incidence rates per 1,000 person-years (PYs) were calculated for the overall study period and time periods defined by ART treatment recommendations. For further description, CD4 counts around HIV-IC diagnosis (+ -30 days) and HIV-transmission routes were collected.

Results
In total 15,940 diagnoses of 18,534 PLWH in Germany were included. Of those 81% were male (median age: 36 years) and 56% reported being men, who have sex with men as the likely HIV-transmission route. Incidence rates varied between the different HIV-ICs. Syphilis had the highest incidence rate (34 per 1,000 PYs; 95% confidence interval [CI] 29–40) for sexually transmitted infections (STIs), hepatitis B was highest for viral hepatitis diagnoses (18 per 1,000 PYs; 95% CI 17–20); according to CDC-classification herpes zoster for HIV-associated diagnoses (22 per 1,000; 95% CI 20–24) and candidiasis for AIDS-defining diagnoses (30 per 1,000 PYs; 95% CI 29–32). Most PLWH with HIV-ICs (hepatitis, HIV-associated diagnoses and AIDS-defining conditions) had CD4 cell counts < 350.

Conclusion
This analysis characterizes HIV-ICs regarding the incidence, HIV-transmission route and patients’ immune status. The results underline the importance of HIV-IC-based screening to detect PLWH with already partially impaired immune status and in need of timely ART initiation.