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.
Method: National surveillance data on new HIV diagnoses among GBM in the years 2002-11 were analysed. The number and proportion of diagnoses defined as late (a CD4+ cell count of 200 to 349 cells/μl at diagnosis), and advanced (<200 CD4+ cells/μl at diagnosis) is reported. A Chi-square test was used to assess trends in these two categories.
Results: A total of 6,725 HIV diagnoses in GBM were notified in the 10-years 2002-11. The number of diagnoses in GBM increased over time, from 592 in 2002 to 675 in 2006 and 801 in 2011. Of all diagnoses in GBM, 11.9% were defined as advanced, remaining steady over-time at 11.7% in 2002, to 12.7% in 2006 and 11.1% in 2011, with no significant trend (ptrend=0.593). A lower proportion of diagnoses in GBM were defined as late (9.8%), but diagnoses in this category increased steadily from 8.4% in 2002 to 11.3% in 2006 and 13.1% in 2010, with a decline in 2011 to 6.9%. There was a significant increasing trend in the proportion of HIV diagnoses defined as late over the period 2002-11 (ptrend=0.038).
Conclusion: An increasing proportion of HIV diagnoses among GBM were late diagnoses. The pattern of late diagnosis may be affected by patterns of antibody testing. A CD4+ count of 200-350 generally reflects an average time of around 4-7 years since initial infection. Services that offer more convenient and acceptable options for HIV testing may be needed to reduce delayed diagnoses among GBM.
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.
In recent years there has been a widespread uptake of smartphones with internet access and location services and the development of mobile ‘apps’ for gay men to meet each other. We reviewed data collected in the Sydney and Melbourne Gay Community Periodic Surveys (GCPS) to identify which men were relying on mobile and internet methods to meet each other and whether these methods were associated with different risk practices.