African Australians living with HIV: a case series from Victoria
Chris N. Lemoh A B C D E F , Samia Baho A , Jeffrey Grierson E , Margaret Hellard C D , Alan Street B D and Beverley-Ann Biggs A B DA Department of Medicine, The University of Melbourne, 4th Floor, Clinical Sciences Building, Royal Melbourne Hospital, Parkville, Vic. 3050, Australia.
B Centre for Clinical Research Excellence in Infectious Diseases, 9 North, 9th Floor, City Campus, Main Block, Royal Melbourne Hospital, Parkville, Vic. 3050, Australia.
C Centre for Population Health, Burnet Institute, 85 Commercial Road, Prahan, Vic. 3004, Australia.
D Victorian Infectious Diseases Service, 9th Floor, Royal Melbourne Hospital, Parkville, Vic. 3050, Australia.
E Australian Research Centre in Sex, Health and Society, La Trobe University, 215 Franklin Street, Melbourne, Vic. 3000, Australia.
F Corresponding author. Email: chrislemoh@netspace.net.au; chris.lemoh@gmail.com
Sexual Health 7(2) 142-148 https://doi.org/10.1071/SH09120
Submitted: 12 November 2009 Accepted: 17 February 2010 Published: 14 May 2010
Abstract
Background: This research aimed to describe the characteristics of African-born Victorians living with HIV, identify associations with delayed HIV diagnosis and describe their response to combination antiretroviral therapy (cART). Methods: A case series of African-born adults living with HIV in Victoria was conducted. Data was collected in interviews and reviews of case notes. Associations with delayed HIV diagnosis (CD4 below 200 cells µL–1 at diagnosis and/or AIDS within 3 months of HIV diagnosis) were explored using univariate regression. AIDS-defining illnesses and response to cART were described. Results: Fourteen males and six females were included. Ten were born in the Horn of Africa (nine in Ethiopia). Sixteen had sexual exposure (12 heterosexual; four male-to-male sex). Seven reported acquiring HIV in Australia. Median CD4 count at diagnosis was 145 cells µL–1. Ten had delayed HIV diagnosis, of whom eight were born in the Horn of Africa. Delayed HIV diagnosis was associated with birth in the Horn of Africa (odds ratio: 11.56). Nine had a diagnosis of AIDS, including three cases of tuberculosis, three of Pneumocystis jiroveci pneumonia and two of cerebral toxoplasmosis. Eighteen had received cART, of which 16 achieved virological suppression and 15 achieved a CD4 count above 200 cells µL–1. Clinical failure and virological failure occurred in seven and five cases, respectively. Conclusions: HIV prevention strategies for Victoria’s African communities should address HIV exposure in Australia. Ethiopian-born Victorians with HIV appear to be at particular risk of delayed diagnosis. Response to cART in this series was comparable to that observed in other industrialised countries.
Additional keywords: AIDS, Australia, delivery of health care, emigrants and immigrants, ethnic groups, infections.
Acknowledgements
CL designed the study and developed data collection tools in close consultation with SB, JG, MH, AS and BB. CL collected and analysed the data. BB was the principal investigator for the project of which this study formed a part. CL took primary responsibility for writing the article. The authors thank the research assistants, their affiliated community groups, study participants and the doctors and other clinic staff who assisted with recruitment. Thanks are due to Jim Black for advice on study design, Tim Spelman and Maelenn Gouillou for advice on statistical analysis, and to Rebecca Guy, Isabel Bergeri and Carol El-Hayek for reports and advice on Victorian HIV surveillance data. The authors are grateful for the financial and material support provided by the Centre for Clinical Research Excellence in Infectious Diseases and the Department of Medicine, the financial support received from the Victorian Government Department of Human Services, the Victor Hurley Research Fund and the Australasian Society for Infectious Diseases, and the material support provided by the Burnet Institute and the Victorian Infectious Diseases Service.
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