The HIV epidemic in Ontario: 2005 update

Transcription

1 The HIV epidemic in Ontario: 2005 update Robert S. Remis MD, MPH, FRCPC Ontario HIV Epidemiologic Monitoring Unit Department of Provincial Community Planning Meeting AIDS Bureau, OMHLTC Toronto, Ontario, June 9, 2006

2 Background HIV epidemic in Ontario is still unstable and dynamic Critical to: Monitor trends in HIV transmission (incidence) and burden of HIV infection (prevalence) Evaluate effectiveness of prevention Quantify the need for health and support services

3 Organization of presentation Summary of Ontario AIDS and HIV data Ontario HIV model to end-2004 Focus on emerging situations MSM IDU HIV-endemic Other heterosexual Analyses of AIDS/HIV by race ethnicity

4 Number of new HIV diagnoses by sex and proportion female, Number HIV diagnoses 2,000 1,800 1,600 1,400 1,200 1, Males Females % female 35.0% 30.0% 25.0% 20.0% 15.0% 10.0% 5.0% 0.0% Proportion female (%) Year

5 New HIV diagnoses among males (n=22,266) Ontario, % 0.8% 3.8% 0.9% 76.1% MSM MSM-IDU IDU Clotting factor Transfusion HIV-endemic HR hetero LR hetero Perinatal Other 4.5% 6.7% 4.6% 1.2% 1.0%

6 New HIV diagnoses among females (n=3,768) Ontario, % 19.3% 17.4% IDU Clotting factor Transfusion HIV-endemic HR hetero LR hetero Perinatal Other 5.2% 1.0% 16.9% 1.8% 4.7%

7 Number of new HIV diagnoses by sex Ontario, ,600 1,400 1,200 Males Females Both sexes Number of cases 1,

8 Number of new HIV diagnoses for selected exposure categories, Ontario, Number of cases 1,200 1, MSM HIV-endemic LR hetero HR hetero MSM-IDU IDU

9 Number of new HIV diagnoses in MSM for selected health regions, Number of cases Northern Ottawa Eastern, Other Central East, Other Southwest Central West

10 Number of new HIV diagnoses for selected health regions, Ontario, Northern Eastern, Other Ottawa Central East, Other Southwest Central West Number of cases

11 Number of new HIV diagnoses Toronto, Number of cases 1,400 1,200 1,

12 Number of new HIV diagnoses in MSM Toronto, Toronto 400 Number of cases

13 Number of new HIV diagnoses for selected exposure categories, Southwest, MSM IDU HR Hetero MSM-IDU HIV-endemic LR hetero Number of cases

14 Number of new HIV diagnoses for selected exposure categories, Central West, MSM IDU HR Hetero MSM-IDU HIV-endemic LR hetero Number of cases

15 Number of new HIV diagnoses for selected exposure categories, Northern, Number of cases MSM IDU HR Hetero MSM-IDU HIV-endemic LR hetero

16 Reported AIDS cases among MSM, Ontario, Number of reported cases MSM 0 < Year of diagnosis

17 Reported AIDS cases for other exposure categories, Ontario, Number of reported cases MSM-IDU IDU HIV-endemic Heterosexual Blood 0 < Year of diagnosis

18 Modeled HIV prevalence and number diagnosed by exposure category, Ontario, 2004 HIV Proportion HIV Proportion prevalence Ontario diagnosed diagnosed MSM 14, % 10, % MSM-IDU % % IDU 1, % 1, % Endemic 3, % 1, % Hetero 3, % 1, % Clotting % % Transfusion % % 24, % 15, %

19 HIV incidence from detuned assay among MSM Ontario, Incidence density (/100 p-y) ID measured ID adjusted Source: Laboratory Enhancement Study

20 HIV incidence from detuned assay among MSM Toronto, Incidence density (/100 p-y) ID measured ID adjusted Source: Laboratory Enhancement Study

21 HIV incidence from detuned assay among MSM Ottawa, Incidence density (/100 p-y) ID measured ID adjusted Source: Laboratory Enhancement Study

22 HIV incidence from detuned assay among MSM Ontario other, Incidence density (/100 p-y) ID measured ID adjusted Source: Laboratory Enhancement Study

23 Modeled HIV prevalence among MSM Ontario, Proportion HIV infected 18.0% 16.0% 14.0% 12.0% 10.0% 8.0% 6.0% 4.0% 2.0% Prevalence % Prevalence number ,000 14,000 12,000 10,000 8,000 6,000 4,000 2,000 Number of HIV-infected men % 0 Year

24 Modeled MSM number, HIV prevalence and incidence by health region, Ontario, 2004 Health region (aggregated) Proportion MSM Number MSM Number HIV Prevalence HIV Annual HIV incidence (No.) Annual HIV incidence (%) Toronto 5.5% 54,308 10, % % Ottawa 3.4% 10,586 1, % % Rest of Ontario 0.8% 26,621 2, % % Ontario, total 2.0% 91,515 14, % %

25 MSM: Epidemiologic overview 14,900 infected, 71% diagnosed New diagnoses in 2005 increased 54% from 2000 HIV prevalence 16.3% (Toronto 19.6%, Ottawa 14.2%, other 10.3%) HIV prevalence up 29% (annual 5.2%) 866 new HIV infections in 2004 (versus 467 in 1996) HIV incidence 1.1% (Toronto 1.4%, Ottawa 1.1%, other 0.67%)

26 HIV incidence from detuned assay among IDU Ontario, Incidence density (/100 p-y) ID measured ID adjusted Source: Laboratory Enhancement Study

27 HIV incidence from detuned assay among IDU Toronto, Incidence density (/100 p-y) ID measured ID adjusted Source: Laboratory Enhancement Study

28 HIV incidence from detuned assay among IDU Ottawa, ID measured ID adjusted Incidence density (/100 p-y) Source: Laboratory Enhancement Study

29 HIV incidence from detuned assay among IDU Ontario other, Incidence density (/100 p-y) ID measured ID adjusted Source: Laboratory Enhancement Study

30 Modeled HIV incidence among IDU Ontario, % 0.6% 0.5% 0.4% 0.3% 0.2% 0.1% 0.0% Annual incidence rate Year 250 Number of new infections Incidence rate Incidence number

31 Modeled HIV prevalence among IDU Ontario, proportion HIV infected 5.0% 4.5% 4.0% 3.5% 3.0% 2.5% 2.0% 1.5% 1.0% 0.5% 0.0% Prevalence % Prevalence number N u m b er o f H IV -infected ID U s Year

32 Modeled IDU number, HIV prevalence and incidence by health region, Ontario, 2004 Health region (aggregated) Proportion IDU Number IDU Number HIV Prevalence HIV Annual HIV incidence (No.) Annual HIV incidence (%) Toronto 0.60% 15, % % Ottawa 0.40% 3, % % Rest of Ontario 0.20% 17, % % Ontario, total 0.30% 37,076 1, % %

33 IDU: Epidemiologic overview 1,770 infected, 81% diagnosed New diagnoses in 2005 increased 27% from 2000 HIV prevalence 4.8% (Toronto 3.4%, Ottawa 13.8%, other 4.3%) HIV prevalence up 9% (annual 1.8%) 80 new HIV infections in 2004 HIV incidence 0.23% (Toronto 0.18%, Ottawa 0.87%, other 0.18%) Relatively reassuring

34 Modeled HIV incidence among persons from HIV-endemic regions, Ontario, Year

35 Modeled HIV prevalence among persons from HIV-endemic regions, Ontario, ,000 3,500 3,000 2,500 2,000 1,500 1, Year

36 Modeled HIV prevalence and incidence among persons from HIV-endemic countries by health region, Ontario, 2004 Health region (aggregated) Proportion Endemic Number Endemic Number HIV Prevalence HIV Annual HIV incidence (No.) Annual HIV incidence (%) Toronto 11.4% 301,872 2, % % Ottawa 2.9% 24, % % Rest of Ontario 0.50% 44, % % Ontario, total 3.0% 370,707 3, % %

37 HIV endemic: Epidemiologic overview 3,360 infected, 50% diagnosed New HIV diagnoses in 2005 increased 28% from 2000 HIV prevalence 0.90% (Toronto 0.67%, Ottawa 2.2%, other 1.6%) HIV prevalence up 87% (annual 13.3%) 340 new HIV infections in 2004 Fastest growing category (13.8% Ontario HIV-infected)

38 Modeled HIV prevalence among other persons infected heterosexually, Ontario, % 0.4% 0.3% 0.3% 0.2% 0.2% 0.1% 0.1% Prevalence % Prevalence number 4,000 3,500 3,000 2,500 2,000 1,500 1, Number HIV-infected persons Year % 0

39 Other heterosexual: Epidemiologic overview In 2004, 3,370 infected, 47% diagnosed HIV diagnoses in 2005 increased 55% from 2000 HIV prevalence up 82% (annual 12.7%) 370 new HIV infections in 2004 Second fastest growing category (13.9% Ontario HIV- infected)

40 Limitations Populations at risk (especially MSM, IDU) not well characterized (e.g. size, behavioural patterns, regional variations) Adjustments for HIV diagnoses, AIDS cases and HIV-related mortality subject to uncertainty Limited data on HIV incidence. Available data biased; taken into account in HIV model Despite challenges, triangulation allows obtaining plausible estimates for HIV incidence and prevalence

41 Conclusions HIV epidemic in Ontario is not yet under control Good news: AIDS incidence and mortality decreasing However..... Overall, HIV prevalence increased by 37% (17,660 to 24,250) MSM, HIV-endemic and hetero: Preventive intervention efforts need to be systematically reviewed and reinforced

42 Conclusions Persons infected by heterosexual contact increasing in both exposure categories HIV-endemic: prevention objectives and guidelines need to be developed and programs conceived, funded and implemented Increase among others infected heterosexually requires validation and elucidation

43 Acknowledgements Frank McGee, Coordinator, AIDS Bureau, Ontario Ministry of Health and Long Term Care (MOHLTC) Juan Liu, OHEMU, University of Toronto Carol Swantee, HIV Laboratory, MOHLTC Liviana Calzavara, Ann Burchell and Polaris coinvestigators Maraki Fikre Merid, University of Toronto Lorraine Schiedel, Public Health Branch, MOHLTC Ontario HIV Treatment Network (OHTN) and Health Canada for funding Laboratory Enhancement Study