The HIV epidemic in Ontario: 2004 update Robert S. Remis, MD, MPH, FRCPC Ontario HIV Epidemiologic Monitoring Unit Department of Public Health Sciences, University of Toronto Ontario HIV Treatment Network Research Conference November 25, 2004

instructional media centre, Laboratories Branch Background HIV epidemic in Ontario is unstable and dynamic HIV epidemic in Ontario is unstable and dynamic Critical to monitor trends in HIV transmission (incidence) and burden of HIV infection (prevalence) to evaluate effectiveness of prevention and assess the need for health and support services Critical to monitor trends in HIV transmission (incidence) and burden of HIV infection (prevalence) to evaluate effectiveness of prevention and assess the need for health and support services Dr. Robert S. Remis Public Health Sciences, University of Toronto

instructional media centre, Laboratories Branch Organization of presentation Brief review of Ontario AIDS and HIV data Brief review of Ontario AIDS and HIV data Ontario HIV model 2003 Ontario HIV model 2003 Focus on evolving situations with respect to: Focus on evolving situations with respect to: MSM MSM IDU IDU HIV-endemic HIV-endemic Other heterosexual Other heterosexual Dr. Robert S. Remis Public Health Sciences, University of Toronto

instructional media centre, Laboratories Branch Number of first-time HIV diagnoses by sex and proportion female, 1985–2003 Dr. Robert S. Remis Public Health Sciences, University of Toronto

instructional media centre, Laboratories Branch First-time HIV-positive diagnoses among males (n=21,325), Ontario, 1985–2003 Dr. Robert S. Remis Public Health Sciences, University of Toronto

instructional media centre, Laboratories Branch First-time HIV-positive diagnoses among females (n=3,409), Ontario, 1985–2003 Dr. Robert S. Remis Public Health Sciences, University of Toronto

instructional media centre, Laboratories Branch Number first-time HIV diagnoses by sex Ontario, 1999–2004* * Annual, projected from first half of year

instructional media centre, Laboratories Branch Number of first-time HIV diagnoses MSM, Ontario, 1999–2004* * Annual, projected from first half of year

instructional media centre, Laboratories Branch Number of first-time HIV diagnoses for selected exposure categories, 1999–2004* * Annual, projected from first half of year

instructional media centre, Laboratories Branch Reported AIDS cases among MSM, Ontario, 1981–2003 Dr. Robert S. Remis Public Health Sciences, University of Toronto

instructional media centre, Laboratories Branch Reported AIDS cases by exposure category, Ontario, 1981–2003 Dr. Robert S. Remis Public Health Sciences, University of Toronto

instructional media centre, Laboratories Branch Modeled HIV prevalence and diagnoses by exposure category, Ontario, 2003 Dr. Robert S. Remis Public Health Sciences, University of Toronto

instructional media centre, Laboratories Branch HIV incidence from detuned assay among MSM, Ontario, October 1999 – December 2003 Source: Laboratory Enhancement Study

instructional media centre, Laboratories Branch HIV incidence from detuned assay among MSM, Toronto, October 1999 – December 2003 Source: Laboratory Enhancement Study

instructional media centre, Laboratories Branch HIV incidence from detuned assay among MSM, Ottawa, October 1999 – December 2003 Source: Laboratory Enhancement Study

instructional media centre, Laboratories Branch HIV incidence from detuned assay among MSM, other regions, October 1999 – December 2003 Source: Laboratory Enhancement Study

instructional media centre, Laboratories Branch Modeled HIV prevalence among MSM Ontario, 1977–2003 Dr. Robert S. Remis Public Health Sciences, University of Toronto

instructional media centre, Laboratories Branch MSM: Epidemiologic overview 14,370 HIV-infected (61% of Ontario infections), 69% diagnosed 14,370 HIV-infected (61% of Ontario infections), 69% diagnosed New HIV diagnoses 2004 up 54% over 2001, especially in Toronto and Central West regions New HIV diagnoses 2004 up 54% over 2001, especially in Toronto and Central West regions HIV prevalence 15% (Toronto 19%, Ottawa 18%, other 8%) HIV prevalence 15% (Toronto 19%, Ottawa 18%, other 8%) prevalence up 29% (annual 5%) prevalence up 29% (annual 5%) 690 new infections in new infections in 2003 HIV incidence 0.9% (Toronto 1.1%, Ottawa 1.5%, other 0.3%) HIV incidence 0.9% (Toronto 1.1%, Ottawa 1.5%, other 0.3%) Dr. Robert S. Remis Public Health Sciences, University of Toronto

instructional media centre, Laboratories Branch HIV incidence from detuned assay among IDU, Ontario, October 1999 – December 2003 Source: Laboratory Enhancement Study

instructional media centre, Laboratories Branch HIV incidence from detuned assay among IDU, Toronto, October 1999 – December 2003 Source: Laboratory Enhancement Study

instructional media centre, Laboratories Branch HIV incidence from detuned assay among IDU, Ottawa, October 1999 – December 2003 Source: Laboratory Enhancement Study

instructional media centre, Laboratories Branch HIV incidence from detuned assay among IDU, other regions, October 1999 – December 2003 Source: Laboratory Enhancement Study

instructional media centre, Laboratories Branch Modeled HIV prevalence among IDUs Ontario, 1977–2003 Dr. Robert S. Remis Public Health Sciences, University of Toronto

instructional media centre, Laboratories Branch IDU: Epidemiologic overview 1,960 HIV-infected (8% of Ontario infections), 67% diagnosed 1,960 HIV-infected (8% of Ontario infections), 67% diagnosed New HIV diagnoses stable overall past five years, though increase in 2004 in Southwest and Northern regions New HIV diagnoses stable overall past five years, though increase in 2004 in Southwest and Northern regions HIV prevalence 5% (Ottawa 15%, elsewhere 4%) HIV prevalence 5% (Ottawa 15%, elsewhere 4%) prevalence up 8% (annual 1.5%) prevalence up 8% (annual 1.5%) 80 new infections in 2003; HIV incidence 0.2% 80 new infections in 2003; HIV incidence 0.2% Relatively reassuring Relatively reassuring Dr. Robert S. Remis Public Health Sciences, University of Toronto

instructional media centre, Laboratories Branch Modeled HIV prevalence persons from HIV-endemic regions, Ontario, 1977–2003 Dr. Robert S. Remis Public Health Sciences, University of Toronto

instructional media centre, Laboratories Branch HIV-endemic: Epidemiologic overview 3,310 HIV-infected (13% of Ontario infections); 48% diagnosed 3,310 HIV-infected (13% of Ontario infections); 48% diagnosed HIV prevalence 0.8% HIV prevalence 0.8% Most HIV-infected persons in Toronto (75%) and Ottawa (15%) Most HIV-infected persons in Toronto (75%) and Ottawa (15%) prevalence up 86% (annual 13%) prevalence up 86% (annual 13%) New HIV diagnoses increased 1999 (160) to 2002 (280) then decreased somewhat (230 in 2004) New HIV diagnoses increased 1999 (160) to 2002 (280) then decreased somewhat (230 in 2004) 330 new HIV infections in 2003 (imported & Canada) 330 new HIV infections in 2003 (imported & Canada) Dr. Robert S. Remis Public Health Sciences, University of Toronto

instructional media centre, Laboratories Branch Modeled HIV prevalence other persons infected heterosexually, Ontario, 1977–2003 Dr. Robert S. Remis Public Health Sciences, University of Toronto

instructional media centre, Laboratories Branch Heterosexual : Epidemiologic overview 3,310 HIV-infected (14% of Ontario infections), 48% diagnosed 3,310 HIV-infected (14% of Ontario infections), 48% diagnosed HIV prevalence up 64% (annual 10%) HIV prevalence up 64% (annual 10%) 2000 to 2004, HIV diagnoses increased 70%; increased in most regions but especially Central West (+202%), Southwest (+160%) and Toronto (+74%) 2000 to 2004, HIV diagnoses increased 70%; increased in most regions but especially Central West (+202%), Southwest (+160%) and Toronto (+74%) 320 new HIV infections in new HIV infections in 2003 Dr. Robert S. Remis Public Health Sciences, University of Toronto

instructional media centre, Laboratories Branch Limitations Populations at risk not well characterized Populations at risk not well characterized Adjustments for HIV diagnoses, AIDS cases and HIV-related mortality subject to uncertainty Adjustments for HIV diagnoses, AIDS cases and HIV-related mortality subject to uncertainty Data on HIV incidence limited and biased Data on HIV incidence limited and biased Despite challenges, triangulation allows obtaining plausible estimates for HIV incidence and prevalence Despite challenges, triangulation allows obtaining plausible estimates for HIV incidence and prevalence Dr. Robert S. Remis Public Health Sciences, University of Toronto

instructional media centre, Laboratories Branch Conclusions Good news: AIDS incidence and mortality decreasing and situation reassuring among IDUs Good news: AIDS incidence and mortality decreasing and situation reassuring among IDUs Overall, HIV epidemic in Ontario unstable Overall, HIV epidemic in Ontario unstable HIV prevalence up 36% past 5 years (17,400 to 23,600) HIV prevalence up 36% past 5 years (17,400 to 23,600) Concerning in MSM, HIV-endemic and heterosexual Concerning in MSM, HIV-endemic and heterosexual Sustained HIV transmission in these groups Sustained HIV transmission in these groups Dr. Robert S. Remis Public Health Sciences, University of Toronto

instructional media centre, Laboratories Branch Acknowledgements Frank McGee, AIDS Bureau, Ontario Ministry of Health and Long Term Care (MOHLTC) Frank McGee, AIDS Bureau, Ontario Ministry of Health and Long Term Care (MOHLTC) Carol Swantee, HIV Laboratory, MOHLTC Carol Swantee, HIV Laboratory, MOHLTC Jane Njiah, FSO, PHAC / MOHLTC Jane Njiah, FSO, PHAC / MOHLTC Maraki Fikre Merid, University of Toronto Maraki Fikre Merid, University of Toronto Lorraine Schiedel, Public Health Branch, MOHLTC Lorraine Schiedel, Public Health Branch, MOHLTC Ontario HIV Treatment Network (OHTN) and Health Canada for funding Laboratory Enhancement Study Ontario HIV Treatment Network (OHTN) and Health Canada for funding Laboratory Enhancement Study