HIV in Ireland: Latest trends November 2017 2016 provisional data

HIV notifications, 2003 to 2016 Note: Change in case definition (in Jan 2015 for HSE East and in Jan 2016 for all other HSE areas) resulted in more timely and increased number of notifications 4 2016 provisional data

HIV notification rate, 2003 to 2016 Note: Change in case definition (in Jan 2015 for HSE East and in Jan 2016 for all other HSE areas) resulted in more timely and increased number of notifications 5

HIV notifications by history of previous diagnosis abroad, 2012 to 2016 Note: Change in case definition (in Jan 2015 for HSE East and in Jan 2016 for all other HSE areas) resulted in more timely and increased number of notifications, ion particular among people who had previously been diagnosed positive 6 2016 provisional data

HIV notifications by sex, 2003 to 2016 7

HIV notifications by age group 2003 to 2016 8 2016 provisional data

Proportion of HIV notifications by age group, 2003 to 2016 9

HIV notifications by probable route of transmission, 2006 to 2016 10

Proportion of HIV notifications by probable route of transmission, 2006 to 2016 11

HIV notifications by history of previous diagnosis and route of transmission, 2012 to 2016 2016 provisional data

HIV notifications in heterosexuals by region of birth, 2003 to 2016 13

HIV notifications in people who inject drugs (PWID) by gender, 2003 to 2016 Outbreak of HIV among PWID in Dublin 14

HIV notifications in Irish born and migrants, 2003 to 2016 15

HIV rates per 100,000 in Irish born and migrants, 2003 to 2016

HIV notification rate by HSE area 2014 to 2016 HSE East: Dublin, Wicklow, Kildare; HSE Midlands: Laois, Longford, Offaly, Westmeath; HSE Midwest: Limerick, Clare, Tipp (N); HSE Northeast: Louth, Meath, Cavan, Monaghan; HSE Northwest: Sligo, Leitrim, Donegal; HSE South: Cork, Kerry; HSE Southeast: Wexford, Waterford, Carlow, Kilkenny, Tipp (S); HSE West: Galway, Mayo, Roscommon 17

Summary of trends Trends in HIV notifications (slides 4 and 5) HIV notifications were relatively stable between 2003 and 2014. Between 2014 and 2015, there was a large increase in notifications (30%) followed by a small increase (5%) between 2015 and 2016 A change in the case definition for surveillance was introduced in 2015 in HSE East and to all other areas in 2016 which improved both the timeliness of notifications and was partly responsible for the increase in notifications. Previously positive versus new diagnoses (slide 6) Since 2012, notifications among those previously diagnosed HIV positive abroad has increased by 150% (from 70 to 175 in 2016). Excluding those with a previous positive HIV diagnosis, there has been a 6% decrease in the number of HIV notifications between 2015 and 2016. 2

Summary of trends Probable route of transmission (slides 10-14) Notifications among men who have sex with men (MSM) have increased over three-fold since 2003. In 2016, notifications among those without a previous positive diagnosis decreased by 14%. Notifications among heterosexuals decreased sharply between 2003 and 2010 and have been relatively stable between 2010 and 2016. Since 2009, there were less than 30 notifications per year among people who inject drugs (PWID), apart from in 2015 (n=49) when there was an outbreak of HIV among homeless PWID living in Dublin. Region of Birth (slides 15-16) Since 2003, the number of notifications of HIV among those who were born in Ireland has been less than among those born abroad. Although there was a lower number of cases among migrants in the early 2000’s, the rate among migrants was higher due to overall lower number of migrants living in Ireland. 3 2016 provisional data

Explanatory Notes Data for this report were extracted from CIDR on 23rd August 2017 and were correct at the time of publication. It is important to note that - the HIV surveillance system captures new diagnoses of HIV infection and therefore does not measure incidence. - persons newly diagnosed in Ireland may have been previously diagnosed with HIV in another country and are included in surveillance figures at first confirmatory test in Ireland. - data are presented by date of notification on CIDR (Computerised Infectious Disease Reporting) system 18

Further Information A detailed annual report on HIV in 2016 is available at http://www.hpsc.ie/a-z/hivstis/hivandaids/hivdataandreports/ Trend slides on HIV among MSM are available at http://www.hpsc.ie/a-z/hivstis/sexuallytransmittedinfections/dataonhivandstisamongmenwhohavesexwithmenmsm/ Weekly HIV and STI reports are available at http://www.hpsc.ie/notifiablediseases/weeklyidreports/ 19

Acknowledgements We would  like to sincerely thank all who provided data for this report namely The National Virus Reference Laboratory (NVRL),  Microbiology laboratories Departments of Public Health Consultants in Infectious Disease/Genitourinary Medicine, HIV clinical nurse specialists Health advisors GPs All other clinical staff involved. Data on paediatric infections are kindly provided by the Infectious Disease Unit, Our Lady’s Hospital for Children (OLHC), Crumlin. 20