Increasing HIV diagnoses in Australia among men who have sex with men correlated with the growing number not taking antiretroviral therapy
John M. Murray A B D , Garrett Prestage B , Jeffrey Grierson C , Melanie Middleton B and Ann McDonald BA School of Mathematics and Statistics, University of New South Wales, Sydney, NSW 2052, Australia.
B National Centre in HIV Epidemiology and Clinical Research, University of New South Wales, Sydney, NSW 2052, Australia.
C Australian Research Centre in Sex, Health and Society, La Trobe University, 215 Franklin Street, Melbourne, Vic. 3000, Australia.
D Corresponding author. Email: J.Murray@unsw.edu.au
Sexual Health 8(3) 304-310 https://doi.org/10.1071/SH10114
Submitted: 13 September 2010 Accepted: 31 January 2011 Published: 23 May 2011
Journal Compilation © CSIRO Publishing 2011 Open Access CC BY-NC-ND
Abstract
Background: Australia has experienced rising notifications of HIV diagnoses despite widely available combination antiretroviral therapy (CART). New HIV diagnoses have also been younger than the average age of those living with HIV. We investigated the degree to which several risk factors could explain this rise in notifications and the younger age profile. Methods: Numbers and ages of men who have sex with men (MSM) living with HIV in Australia from 1983 to 2007 were calculated from notifications of HIV diagnoses and deaths. We compared the trend over time as well as the average ages of MSM newly diagnosed with HIV infection from 1998 to 2007 with those for: notifications of gonorrhoea and syphilis, total MSM living with HIV infection, and the component not on CART. Results: The percentage of younger MSM not taking CART has increased since 1998 (aged <30 years P < 0.001; 30–39 years P = 0.004). The trend of new HIV diagnoses was most significantly correlated with the total number of MSM living with HIV infection and the sector not taking CART (P < 0.0001). Based on similarity of average ages, MSM living with HIV infection and not taking CART was the best predictor of the increasing trend in new HIV diagnoses (99.9999% probability, Akaike information criterion). Conclusions: Our analyses suggest MSM living with HIV infection and not taking CART could be the source of the increase in HIV infections. Consequently, greater CART enrolment should decrease HIV incidence, especially in younger MSM.
Additional keywords: age, AIDS, combined antiretroviral therapy, epidemiology.
References
[1] Sullivan PS, Hamouda O, Delpech V, Geduld JE, Prejean J, Semaille C, et al Reemergence of the HIV epidemic among men who have sex with men in North America, Western Europe, and Australia, 1996–2005. Ann Epidemiol 2009; 19 423–31.| Reemergence of the HIV epidemic among men who have sex with men in North America, Western Europe, and Australia, 1996–2005.Crossref | GoogleScholarGoogle Scholar |
[2] UNAIDS. North America, Western and Central Europe: AIDS epidemic update regional summary; 2007. WHO Library Cataloguing-in-Publication Data, UNAIDS: Geneva; 2007.
[3] National Centre in HIV Epidemiology and Clinical Research. HIV/AIDS, viral hepatitis and sexually transmissible infections in Australia annual surveillance Report 2007. Sydney: The University of New South Wales; 2007.
[4] Attia S, Egger M, Muller M, Zwahlen M, Low N. Sexual transmission of HIV according to viral load and antiretroviral therapy: systematic review and meta-analysis. AIDS 2009; 23 1397–404.
| Sexual transmission of HIV according to viral load and antiretroviral therapy: systematic review and meta-analysis.Crossref | GoogleScholarGoogle Scholar |
[5] Quinn TC, Wawer MJ, Sewankambo N, Serwadda D, Li C, Wabwire-Mangen F, et al Viral load and heterosexual transmission of human immunodeficiency virus type 1. Rakai Project Study Group. N Engl J Med 2000; 342 921–9.
| Viral load and heterosexual transmission of human immunodeficiency virus type 1. Rakai Project Study Group.Crossref | GoogleScholarGoogle Scholar |
[6] Lohse N, Hansen AB, Pedersen G, Kronborg G, Gerstoft J, Sorensen HT, et al Survival of persons with and without HIV infection in Denmark, 1995–2005. Ann Intern Med 2007; 146 87–95.
[7] Murray JM, McDonald AM, Law MG. Rapidly ageing HIV epidemic among men who have sex with men in Australia. Sex Health 2009; 6 83–6.
| Rapidly ageing HIV epidemic among men who have sex with men in Australia.Crossref | GoogleScholarGoogle Scholar |
[8] Centers for Disease Control and Prevention. HIV/AIDS surveillance report, 2005. Volume 17, revised edn. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention; 2007.
[9] Health Protection Agency. HIV in the United Kingdom: 2009 report. London: Health Protection Agency, Centre for Infections; 2009.
[10] Vernazza P, Hirschel B, Bernasconi E, Flepp M. Les personnes séropositives ne souffrant d’aucune autre MST et suivant un traitment antirétroviral efficace ne transmettent pas le VIH par voie sexuelle. Bull Med Suisses 2008; 89 165–9.
[11] Zablotska I, Prestage G, Frankland A, Chong S, Sutherland R, Corrigan N, et al. Gay community periodic survey: Sydney, February 2007. Sydney: National Centre in HIV Social Research, The University of New South Wales; 2007.
[12] Jain SK. Trends in mortality: by causes of death in Australia, the states and territories during 1971–92, and in statistical divisions and sub-divisions during 1991–92. Contract No.: 3313.0. Canberra: Australian Bureau of Statistics; 1994.
[13] Australian Standard Geographical Classification, Australian Bureau of Statistics, Catalogue no. 1216.0. Canberra: Commonwealth of Australia; 2010.
[14] Grierson JW, Pitts MK, Thorpe RD. State of the (positive) nation: findings from the fourth national Australian HIV futures survey. Int J STD AIDS 2007; 18 622–5.
| State of the (positive) nation: findings from the fourth national Australian HIV futures survey.Crossref | GoogleScholarGoogle Scholar |
[15] Hoare A, Wilson DP, Regan DG, Kaldor J, Law MG. Using mathematical modelling to help explain the differential increase in HIV incidence in New South Wales, Victoria and Queensland: importance of other sexually transmissible infections. Sex Health 2008; 5 169–87.
| Using mathematical modelling to help explain the differential increase in HIV incidence in New South Wales, Victoria and Queensland: importance of other sexually transmissible infections.Crossref | GoogleScholarGoogle Scholar |
[16] Ginige S, Chen MY, Hocking JS, Grulich AE, Fairley CK. Rising HIV notifications in Australia: accounting for the increase in people living with HIV and implications for the HIV transmission rate. Sex Health 2007; 4 31–3.
| Rising HIV notifications in Australia: accounting for the increase in people living with HIV and implications for the HIV transmission rate.Crossref | GoogleScholarGoogle Scholar |
[17] Wagenmakers EJ, Farrell S. AIC model selection using Akaike weights. Psychon Bull Rev 2004; 11 192–6.
| AIC model selection using Akaike weights.Crossref | GoogleScholarGoogle Scholar |
[18] Wilson DP, Hoare A, Regan DG, Law MG. Importance of promoting HIV testing for preventing secondary transmissions: modelling the Australian HIV epidemic among men who have sex with men. Sex Health 2009; 6 19–33.
| Importance of promoting HIV testing for preventing secondary transmissions: modelling the Australian HIV epidemic among men who have sex with men.Crossref | GoogleScholarGoogle Scholar |
[19] Chadborn TR, Baster K, Delpech VC, Sabin CA, Sinka K, Rice BD, et al No time to wait: how many HIV-infected homosexual men are diagnosed late and consequently die? (England and Wales, 1993–2002). AIDS 2005; 19 513–20.
| No time to wait: how many HIV-infected homosexual men are diagnosed late and consequently die? (England and Wales, 1993–2002).Crossref | GoogleScholarGoogle Scholar |
[20] Prestage G, Jin F, Zablotska IB, Imrie J, Grulich AE, Pitts M. Trends in HIV testing among homosexual and bisexual men in eastern Australian states. Sex Health 2008; 5 119–23.
| Trends in HIV testing among homosexual and bisexual men in eastern Australian states.Crossref | GoogleScholarGoogle Scholar |
[21] Marrone J, Fairley CK, Chen M, Hocking JS. Comparisons of trends in antiretroviral use and HIV notification rates between three Australian states. Aust N Z J Public Health 2007; 31 131–4.
| Comparisons of trends in antiretroviral use and HIV notification rates between three Australian states.Crossref | GoogleScholarGoogle Scholar |
[22] Prestage G, Ferris J, Grierson J, Thorpe R, Zablotska I, Imrie J, et al Homosexual men in Australia: population, distribution and HIV prevalence. Sex Health 2008; 5 97–102.
| Homosexual men in Australia: population, distribution and HIV prevalence.Crossref | GoogleScholarGoogle Scholar |
[23] Perelson AS, Essunger P, Cao Y, Vesanen M, Hurley A, Saksela K, et al Decay characteristics of HIV-1-infected compartments during combination therapy. Nature 1997; 387 188–91.
| Decay characteristics of HIV-1-infected compartments during combination therapy.Crossref | GoogleScholarGoogle Scholar |
[24] Gazzard BG. British HIV Association guidelines for the treatment of HIV-1-infected adults with antiretroviral therapy 2008. HIV Med 2008; 9 563–608.
| British HIV Association guidelines for the treatment of HIV-1-infected adults with antiretroviral therapy 2008.Crossref | GoogleScholarGoogle Scholar |
[25] SMART. Major clinical outcomes in antiretroviral therapy (ART)-naive participants and in those not receiving ART at baseline in the SMART study. J Infect Dis 2008; 197 1133–44.
| Major clinical outcomes in antiretroviral therapy (ART)-naive participants and in those not receiving ART at baseline in the SMART study.Crossref | GoogleScholarGoogle Scholar |
[26] Zingmond DS, Wenger NS, Crystal S, Joyce GF, Liu H, Sambamoorthi U, et al Circumstances at HIV diagnosis and progression of disease in older HIV-infected Americans. Am J Public Health 2001; 91 1117–20.
| Circumstances at HIV diagnosis and progression of disease in older HIV-infected Americans.Crossref | GoogleScholarGoogle Scholar |
[27] May MT, Sterne JA, Costagliola D, Sabin CA, Phillips AN, Justice AC, et al HIV treatment response and prognosis in Europe and North America in the first decade of highly active antiretroviral therapy: a collaborative analysis. Lancet 2006; 368 451–8.
| HIV treatment response and prognosis in Europe and North America in the first decade of highly active antiretroviral therapy: a collaborative analysis.Crossref | GoogleScholarGoogle Scholar |
[28] Montaner JS, Wood E, Kerr T, Yip B, Lima V, Shannon K, et al. Abstract 88LB: association of expanded HAART coverage with a decrease in new HIV diagnoses, particularly among injection drug users in British Columbia, Canada. 17th Conference on Retroviruses and Opportunistic Infections; San Francisco; 27 February 2010.
