Trends in antiretroviral treatment use and treatment response in three Australian states in the first decade of combination antiretroviral treatment
Kathleen Falster A B H , Linda Gelgor A , Ansari Shaik A , Iryna Zablotska C , Garrett Prestage A , Jeffrey Grierson D , Rachel Thorpe D , Marian Pitts D , Jonathan Anderson A E , John Chuah F , Brian Mulhall G , Kathy Petoumenos A , Anthony Kelleher A and Matthew Law AA National Centre in HIV Epidemiology and Clinical Research, University of New South Wales, Sydney, NSW 2010, Australia.
B School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW 2052, Australia.
C National Centre in HIV Social Research, University of New South Wales, NSW 2052, Australia.
D Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Vic 3000, Australia.
E Carlton Clinic, 88 Rathdowne Street, Carlton, Melbourne, Vic 3000, Australia.
F Gold Coast Sexual Health Clinic, 2019 Gold Coast Highway, Miami, Qld 4220, Australia.
G School of Public Health, University of Sydney, Sydney, NSW 2006, Australia.
H Corresponding author. Email: kfalster@nchecr.unsw.edu.au
Sexual Health 5(2) 141-154 https://doi.org/10.1071/SH07082
Submitted: 22 April 2008 Accepted: 22 April 2008 Published: 2 June 2008
Abstract
Objectives: To determine if there were any differences in antiretroviral treatment (ART) use across the three eastern states of Australia, New South Wales (NSW), Victoria and Queensland, during the period 1997 to 2006. Methods: We used data from a clinic-based cohort, the Australian HIV Observational Database (AHOD), to determine the proportion of HIV-infected patients on ART in selected clinics in each state and the proportion of treated patients with an undetectable viral load. Data from the national Highly Specialised Drugs program and AHOD were used to estimate total numbers of individuals on ART and the proportion of individuals living with HIV on ART nationally and by state. Data from the HIV Futures Survey and the Gay Community Periodic Survey were used to determine the proportion of community-based men who have sex with men on ART. The proportion of patients with primary HIV infection (PHI) who commenced ART within 1 year of diagnosis was obtained from the Acute Infection and Early Disease Research Program (AIEDRP) CORE01 protocol and Primary HIV and Early Disease Research: Australian Cohort (PHAEDRA) cohorts. Results: We estimated that the numbers of individuals on ART increased from 3181 to 4553 in NSW, 1309 to 1926 in Victoria and 809 to 1615 in Queensland between 2000 and 2006. However, these numbers may reflect a lower proportion of individuals living with HIV on ART in NSW compared with the other states (37% compared with 49 and 55% in 2000). We found similar proportions of HIV-positive men who have sex with men participants were on ART in all three states over the study period in the clinic-based AHOD cohort (81–92%) and two large, community-based surveys in Australia (69–85% and 49–83%). Similar proportions of treated patients had an undetectable viral load across the three states, with a consistently increasing trend over time observed in all states. We found that more PHI patients commenced treatment in the first year following HIV diagnosis in NSW compared with Victoria; however, the sample size was very small. Conclusions: For the most part, patterns of ART use were similar across NSW, Victoria and Queensland using a range of available data from cohort studies, community surveys and national prescription databases in Australia. However, there may be a lower proportion of individuals living with HIV on ART in NSW compared with the other states, and there is some indication of a more aggressive treatment approach with PHI patients in NSW compared with Victoria.
Acknowledgements
AHOD is funded as part of the Asia Pacific HIV Observational Database, a program of The Foundation for AIDS Research and is support in part by a grant from the USA National Institutes of Health’s National Institute of Allergy and Infectious Diseases (grant no. U01-AI069907). The authors thank participating AHOD sites and steering committee members (Appendix 1) and all patients who participated in this study. We acknowledge the Australian Government Department of Health and Ageing Highly Specialised Drugs program for provision of the data on antiretroviral treatment dispensed in Australia. The contribution of the National Blood Borne Virus and Sexually Transmissible Infections Surveillance Committee to monitoring new diagnoses of HIV/AIDS and its outcome in Australia is gratefully acknowledged. The National Institute of Allergy and Infectious Diseases Division of AIDS through the Acute HIV Infection and Early Disease Research Program funded the study entitled ‘Pathogenesis and treatment of acute HIV infection’ (grant no. 5UOI-A152403-04), which provided the data for the primary HIV infection analysis. The authors thank the members of the Primary Infection Advisory Committee, including Don Smith, Pat Grey, Tim Ramacciotti, Rob Finlayson, Mark Bloch, Rob McFarland, Nick Medland, Norm Roth, Cassy Workman, Andrew Carr, David Cooper, John Kaldor, John Murray and Anthony Kelleher, and the participating clinics: Taylor Square Private Clinic, 407 Doctors, AIDS Research Initiative, Holdsworth House, St Vincent’s Hospital, Sydney Sexual Health Clinic, The Burwood Street Practice, The Centre Clinic, Prahran Market Clinic, Carlton Clinic, The Alfred Hospital and the Melbourne Sexual Health Centre. They also express their gratitude to the participants of this study. The HIV Futures Survey was funded by the Australian Government Department of Health and Ageing. The authors of this paper acknowledge the contribution of coinvestigators and coauthors on the five HIV Futures studies. The GCPS in NSW was funded by the New South Wales Health Department, in Victoria by the Victoria Department of Human Services, and in Queensland by Queensland Health. The National Centre in HIV Epidemiology and Clinical Research is funded by the Australian Government Department of Health and Ageing, and is affiliated with the Faculty of Medicine, The University of New South Wales.
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Appendix 1: The Australian HIV Observational Database
Asterisks indicate steering committee members in 2006–2007.
New South Wales: D. Ellis, General Medical Practice, Coffs Harbour; M. Bloch, T. Franic, S. Agrawal, Holdsworth House General Practice, Darlinghurst; D. Allen, Holden Street Clinic, Gosford; D. Smith, C. Mincham, Lismore Sexual Health and AIDS Services, Lismore; D. Baker*, R Vale, 407 Doctors, Surry Hills; C. O’Connor; Royal Prince Alfred Hospital Sexual Health, Camperdown; E. Jackson, D. Hunter, K. McCallum, Blue Mountains Sexual Health and HIV Clinic, Katoomba; M. Gotowski, S. Taylor, L. Stuart-Hill, Bligh Street Clinic, Tamworth; D. Cooper, A. Carr, M. Lacey, K. Hesse, St Vincent’s Hospital, Darlinghurst; R. Finlayson, I. Prone, Taylor Square Private Clinic, Darlinghurst; M. T. Liang, Nepean Sexual Health and HIV Clinic, Penrith; K. Brown, N. Skobalj, Illawarra Sexual Health Clinic, Warrawong; L. Wray, H. Lu, Sydney Sexual Health Centre, Sydney; Dubbo Sexual Health Centre, Dubbo; P. Canavan*, National Association of People living with HIV/AIDS; C. Lawrence*, National Aboriginal Community Controlled Health Organisation; I. Zablotska*, National Centre in HIV Social Research, University of New South Wales; B. Mulhall*, School of Public Health, University of Sydney; M. Law*, K. Petoumenos*, K. Falster*, National Centre in HIV Epidemiology and Clinical Research, University of New South Wales.
Northern Territory: A. Kulatunga, P. Knibbs, Communicable Disease Centre, Royal Darwin Hospital, Darwin.
Queensland: J. Chuah*, D. Lester, W. Fankhauser, B. Dickson, Gold Coast Sexual Health Clinic, Miami; D. Russell, J. Leamy, C. Remington, Cairns Sexual Health Service, Cairns; D. Sowden, A. Walker*, Clinic 87, Sunshine Coast and Cooloola HIV Sexual Health Service, Nambour; D. Orth; D. Youds, Gladstone Road Medical Centre, Highgate Hill; M. Kelly, P. Negus, H. Magon, AIDS Medical Unit, Brisbane.
South Australia: W. Donohue, A. Lohmeyer, The Care and Prevention Program, Adelaide University, Adelaide.
Victoria: J. Anderson, P. Cortissos, The Carlton Clinic, Carlton; N. J. Roth*, J. Nicholson, Prahran Market Clinic, South Yarra; T. Read, J. Silvers, Melbourne Sexual Health Centre, Melbourne; A. Mijch, J. Hoy, K. Watson*, M. Bryant, The Alfred Hospital, Melbourne; I. Woolley, Monash Medical Centre, Clayton.
Western Australia: S. Mallal, C. Forsdyke, S. Bulgannawar, Department of Clinical Immunology, Royal Perth Hospital, Perth.
