Introduction: Diagnoses of HIV in Australia remain at historic highs with the majority occurring among men who have sex with men (MSM). Frequent HIV testing to reduce undiagnosed infections is an essential component of HIV prevention. This research aims to describe HIV testing among MSM.
Methods: HIV testing data (2007- 2011) from HIV negative MSM attending Victorian Primary Care Network for Sentinel Surveillance (VPCNSS) sites for HIV testing were included. We examined patterns of repeat HIV testing within 365 days of a previous (index) test. Poisson regression was used to assess trends in repeat testing over time and logistic regression used to examine predictors of returning for a test within 365 days.
Results: In total, 32915 tests from 13286 individuals were included. The number of tests increased from 3135 in 2006 to 7010 in 2011 (p<0.01). Younger MSM (16-29 years) accounted for 42.2% of tests in 2011. The number of tests <365 days of an index test increased over the follow up period (p<0.01). A divergence in the rate of tests and the rate of returning for a test <365 days was seen; this effect was greater among older MSM (>=30 years, p<0.01). Younger MSM were more likely to return for a HIV test <365 days (AOR 1.24, 95%CI: 1.13-1.37) and MSM who reported inconsistent condom use less likely to return for testing (AOR 0.93, 95%CI: 0.88- 0.98).
Conclusion: There was an increase in number of HIV tests among MSM; however the number returning for testing <365 days remained stable at around half of all tests. Younger MSM returned for testing in the analysis, however the data suggests infrequent testing among other risk groups. Current guidelines recommend three monthly testing for high risk MSM. Future research should be aimed at informing strategies for increased testing among high risk groups.
The majority of HIV diagnoses including delayed diagnoses in Australia occur among men who report homosexual contact – hereafter called gay and bisexual men (GBM). Delayed diagnosis is strongly associated with increased HIV-related mortality and morbidity. People who are unaware of their HIV-positive status may also be unwittingly transmitting HIV. We assessed trends in delayed HIV diagnoses among GBM in Australia.
HIV-associated leishmaniasis, endemic in the Mediterranean basin is a growing problem in India, Brazil and East Africa. Despite surviving for than 20 years, the clinical course of our visceral-leishmania (VL)-HIV co-infected patient illustrates several management challenges including diagnosis, speciation and drug resistance; monitoring burden of disease; access to and use of VL-treatments; end-organ toxicity and the combined immunosuppressive effects of HIV-VL.
Adherence to combination antiretroviral therapy (cART ) plays an important role on treatment outcomes. The TREAT Asia Studies to Evaluate Resistance – Monitoring Cohort Study (TASER-M) collects patients’ adherence based on a Visual Analogue Scale. The aim of this analysis was to assess the rates of, and factors associated with, suboptimal adherence in the first 24 months of initial cART in Asian patients.
REACH was a collaborative research and practice initiative to develop evidence building frameworks, capacity, tools and resources with the Victorian HIV community partnership.
HIV disease is associated with chronic inflammation and activation of the innate immune system. This state, as measured using plasma markers of inflammation, persists following suppression of HIV viremia using antiretroviral therapy, and may increase risk of non-AIDS co-morbidities. The causes of innate immune activation in the setting of virological suppression are unclear. Natural killer (NK) cells are innate immune cells that kill virus-infected and transformed cells without prior sensitization. We have shown that NK cells are activated both phenotypically (elevated expression of HLA-DR) and functionally (increased spontaneous degranulation measured by CD107a surface expression) in virologically suppressed (VS) HIV+ individuals. NK cells also lose expression of CD16, the receptor which mediates antibody-dependent cellular cytotoxicity.
Regular HIV testing is recommended in men who take sexual risks. We assessed the relationship between perceived barriers to HIV testing, and frequency of testing among men who engaged in unprotected anal intercourse with casual partners (UAIC), to inform HIV testing strategies.
Gay men remain the primary population affected by HIV in Australia. While recent attention has been focused on increasing HIV testing and the use of antiretroviral-based prevention to reduce infections, it is equally important to sustain safe sex and other risk reduction practices. Increases in unprotected anal intercourse (UAI), for example, may counteract any beneficial changes in testing and treatment.