Advanced HIV diagnoses among gay and bisexual men in Australia 2007-2016 Phillip Keen, Handan Wand, Hamish McManus, Muhammad Jamil, Skye McGregor, James Ward, Andrew Grulich, Margaret Hellard, Robert Monaghan, Michelle Tobin, Garrett Prestage, Rebecca Guy. Phillip Keen | 24th September 2018, Australasian HIV Conference, Sydney Thanks to the conference organisers for the opportunity to present the results of this study today. I’d like to acknowledge my co-authors, who assisted with this study, and in particular Handan Wand and Hamish McManus who conducted the data analyses. I would also like to acknowledge the gay and bisexual men with HIV whose data are the focus of this study. Today I’ll be presenting results of an analysis of factors associated with advanced HIV diagnosis among GBM. Despite high HIV testing rates in Australia we continue to see many people diagnosed with late and advanced HIV disease, so more attention to this problem is warranted.

Definitions Advanced HIV infection (CD4+ <200 cells/µl) Advanced HIV diagnoses among Australian GBM 2007-2016 Definitions Advanced HIV infection (CD4+ <200 cells/µl) ~8 years following seroconversion (Lodi, CID, 2011) Late HIV diagnoses (CD4+ = 200-349 cells/µl) ~4 years following seroconversion (Lodi, CID, 2011) Excludes cases with evidence of primary HIV infection (<12 months) and seroconversion illness Categories: Using data from CASCADE, which is a large collaboration of observational cohort studies in 14 European countries, Lodi and colleagues estimated that on average it takes just over 4 years following seroconversion for someone’s CD4 to drop below 350, and 8

Late and Advanced HIV Diagnoses - Impacts Advanced HIV diagnoses among Australian GBM 2007-2016 Late and Advanced HIV Diagnoses - Impacts Strongly linked to increased mortality and morbidity, and reduced life expectancy (Mocroft, PLOS 2013; Nakagawa, AIDS, 2012; Sabin, Stocle, HIV Medicine 2012) Higher costs to health systems (NAT, Commissioning HIV Testing Services in England 2014) People with undiagnosed HIV infections may unwittingly transmit to others 10-fold increased risk of death in first year after diagnosis Sabin: Among people diagnosed very late, with 50 or less CD4, over a follow-up period of two and a half years, 13% of people diagnosed late died. Costs 2 x increased in first year and %0% more every year thereafter Note that these were studies in high income countries with universal healthcare systems

Results - Multivariate analysis Advanced HIV diagnoses among Australian GBM 2007-2016 Results - Multivariate analysis Factor Advanced HIV Diagnosis Adjusted Odds Ratio 95% CI p-value Age 15-29 1 - 30-39 1.89 1.49-2.40 <0.001 40-49 3.49 2.74-4.43 50-59 5.78 4.43-7.55 60+ 8.43 6.05-11.74 HIV exposure Homosexual Bisexual 2.41 1.92-3.01 MSM + IDU 1.76 1.30-2.38 Region of birth Australia/Oceania South East Asia 2.63 2.07-3.33 North West Europe 0.91 0.76-1.25 0.562 Americas All 1.36 0.92-2.02 0.127 North East Asia 1.35 0.89-2.05 0.025 South Central Asia 0.20 0.05-0.82 Sub-Saharan Africa 1.03 0.53-1.99 0.933 Others 0.66 0.44-1.01 0.058 This table shows the results of our multivariate analysis. In our analysis, Age, HIV exposure and Region of birth were associated with Advanced HIV diagnoses. INCREASING TREND WITH AGE In relation to age, compared to men between 15 and 29 years old, men in every older age category had increased odds of being diagnosed with Advanced HIV infection. Men who were 50 and above had greatly increased odds of Advanced diagnosis. OTHER FACTORS CONCIDERED BUT NOT STATISTICALLY WERE X, Y, Z In relation to HIV exposure, compared to men who reported only homosexual contact, Bisexual men and gay and bisexual men who also injected drugs had increased odds of Advanced diagnosis. In relation to region of birth, compared to m

Advanced HIV diagnoses among Australian GBM 2007-2016 Conclusions Advanced HIV diagnoses among GBM are associated with a small number of factors: Age: 30-39, 40-49, 50-59, 60+ Exposure: Bisexual, MSM + IDU Region of birth: South East Asia and North East Asia Men with these characteristics account for most advanced infections among GBM

Thanks to State and territory HIV surveillance officers Handan Wand Advanced HIV diagnoses among Australian GBM 2007-2016 Thanks to State and territory HIV surveillance officers Handan Wand Hamish McManus Rebecca Guy Garrett Prestage Shawn Clackett