HIV TRENDS IN NEW ZEALAND
Patricia Priest
AIDS Epidemiology Group
Department of Preventive and Social Medicine
University of Otago, Dunedin
HIV Treatments Update Seminar
25 August 2017
1
Presentation overview
• HIV epidemiology (time, person, place)
• Overall
• Men who have sex with men (MSM)
• Heterosexually infected women and men
• People who inject drugs
• Children
• AIDS
• Prevalence of HIV
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HIV data collection
• Enhanced HIV surveillance
• HIV “Diagnosis” = could have been first
diagnosed in NZ or overseas
• Year of diagnosis may not reflect the year
of infection
Annual numbers “diagnosed” with HIV in New Zealand
by means of infection - 1985-2016
Includes people diagnosed with HIV in New Zealand through Western blot (WB) antibody test, and since
2002, those reported through viral load (VL) test.
4
Diagnoses among MSM and heterosexual men
and women (1996-2016)
5
People diagnosed with HIV in 2016 (n=244)
Men (n=218)
Men who have sex with men (MSM) 159
MSM/IDU 5
Heterosexual contact 22
Injecting drug use 1
Unknown 30
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Women (n=27)
Heterosexual contact 20
Unknown 7
Previously
diagnosed overseas
30 people (12%)
(25 men, 5 women)
23 MSM
7 Heterosexual
Men who have sex with men (MSM)
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Includes HIV cases diagnosed by Western Blot antibody test and viral load testing
Annual number MSM diagnosed with HIV in New
Zealand, by place of infection: 1996-2016
8
Is this an
increase in
incidence
among MSM
in New
Zealand?
Median time from seroconversion:
• CD4<500 – 1.19 years
• CD4<350 – 4.19 years
• CD4<200 – 7.93 years
CD4 <350 “Late diagnosis”
Lodi et al. Clin Infect Dis. 2011;53(8):817-825
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CD4 indicates stage of infection and some
indication of duration
Initial CD4 count of MSM diagnosed 2005-2016 who are reported to
be infected in New Zealand
10
v Overall more testing
v CD4 count >500 sustained over the last 3 years suggests probably
higher incidence
v “Late diagnoses” (<350) – up and down – may be due to more testing
MSM diagnosed in 2016 – Age
Includes HIV cases diagnosed by Western Blot antibody test and viral load testing
11
Age of MSM diagnosed: 2005-2016
12
MSM diagnosed in 2016 – Ethnicity
Includes HIV cases diagnosed by Western Blot antibody test and viral load testing
13
Ethnicity of MSM diagnosed in New
Zealand: 2005-2016
14
MSM diagnosed in 2016 – Residence
Includes HIV cases diagnosed by Western Blot antibody test and viral load testing
15
MSM diagnosis rate per 100,000 men aged 15-64
years (2006-2016)
Reference:
Nigel Dickson, Bible Lee, Timothy Foster, Peter Saxton (2015) The first 30 years of HIV in New Zealand: Review of the
epidemiology. NZ Med J. 128 (1426)
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Summary of MSM
• Increase in diagnoses in recent years
• All ages, but greater increase in young men and older men
• Mostly European, but an increasing number of Asian men
• Mostly in the Auckland region
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Women and men heterosexually infected
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Annual number heterosexually acquired HIV diagnosed in
New Zealand, by place of infection: 1996-2016
.Includes HIV cases diagnosed by Western Blot antibody test and viral load testing
19
Heterosexual women and men diagnosed
in 2016 (sex, age)
20
Heterosexual men and women diagnosed
in 2016 (ethnicity, residence)
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Initial CD4 count of men and women heterosexually
infected and MSM in New Zealand: 2010-2016
Men Women MSM
No. % No. % No. %
<350 18 41.9 26 49.1
168
31.0
350-499 14 32.6 15 28.3
119
21.9
500 or more 6 13.9 9 17.0
220
40.5
Unknown 5 11.6 3 5.6
36
6.6
Total 43 100.0 53 100.0 543 100.0
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People who inject drugs (PWID) 1986 – 2016
Total of 89 people reported infected through
injecting drug use since 1986:
• 75 men and 14 women
• 23 in New Zealand, 30 overseas, 36 unknown
Children diagnosed in NZ through mother-to-child
transmission (MTCT) by year and place of birth
• No child with diagnosed MTCT born since 2007
Year of birth
No.
Unk. 86 88 90 92 94 96 98 00 02 04 06 08 10 12 14
0
1
2
3
4
5
6
7
Born outside NZ
Born in NZ
• 16 births to women with diagnosed HIV in 2016
• 2 pregnant women diagnosed with HIV in 2016
Annual number of diagnoses of AIDS and
deaths among people notified with AIDS
Of the 19
diagnosed in
2016, 15 had
an AIDS
diagnosis
within 3
months of
being
diagnosed
with HIV
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Pharmac data on number of people on subsidised
ART at June each year and total annual cost
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Summary
• Two success stories:
ü Injecting drug users – small numbers
ü Mother to child transmission – no child with HIV since
2007
• Heterosexual men and women
v Small number
v High proportion diagnosed late need for strategies
to encourage early testing
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Summary – cont.
• Men who have sex with men (MSM)
v Increase in diagnoses:
Testing – more men being diagnosed earlier
True incidence – probably
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Priority to encompass all aspects of prevention and
control of HIV among MSM
Acknowledgements
• AEG – Dr Sue McAllister and Ms. Bible Lee
• Infectious disease and sexual health clinicians and their
support staff, and GPs
• Laboratory staff
• Ministry of Health
• Body Positive New Zealand
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