1. Advanced HIV diagnoses among gay and bisexual men in Australia 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.

2. Definitions Advanced HIV infection (CD4+ <200 cells/µl)
Advanced HIV diagnoses among Australian GBM
Definitions
Advanced HIV infection (CD4+ <200 cells/µl)
~8 years following seroconversion (Lodi, CID, 2011)
Late HIV diagnoses (CD4+ = 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

3. Late and Advanced HIV Diagnoses - Impacts
Advanced HIV diagnoses among Australian GBM
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

4. Results - Multivariate analysis
Advanced HIV diagnoses among Australian GBM
Results - Multivariate analysis
Factor
Advanced HIV Diagnosis
Adjusted Odds Ratio
95% CI
p-value
Age
15-29 1 -
30-39
1.89
<0.001
40-49
3.49
50-59
5.78
60+
8.43
HIV exposure
Homosexual
Bisexual
2.41
MSM + IDU
1.76
Region of birth
Australia/Oceania
South East Asia
2.63
North West Europe
0.91
0.562
Americas All
1.36
0.127
North East Asia
1.35
0.025
South Central Asia
0.20
Sub-Saharan Africa
1.03
0.933
Others
0.66
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

5. 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

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