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AIDS incidence and AIDS-related mortality in British Columbia, Canada, between 1981 and 2013: a retrospective study.

ABSTRACT: Appropriate use of highly active antiretroviral therapy (ART) can substantially decrease the risk of progression to AIDS and of premature mortality. We aimed to characterise the trends between 1981 and 2013 in AIDS-defining illnesses (ADIs) and the number AIDS-related deaths in British Columbia, Canada, where ART has been fully subsidised since 1996.We included data on HIV-positive individuals, aged 19 years or older, from four administrative databases in British Columbia: the British Columbia Centre for Excellence in HIV/AIDS, St Paul's Hospital, the British Columbia Vital Statistics Agency, the British Columbia Cancer Agency. We estimated the relative risk of developing an ADI over time by use of a negative binomial model, and we investigated trends in the proportion of all deaths associated with AIDS by use of generalised additive models.Data were available for 3550 people with HIV. 6205 ADIs were recorded. In 2013, 84 ADIs occurred, the lowest number since 1990. The peak of the AIDS epidemic in the region happened in 1994 with 696 ADIs reported (42 ADIs per 100 person-years). Since 1997, the number of ADIs decreased from 253 (7 per 100 person-years) to 84 cases in 2013 (1 per 100 person-years; p<0·0001 for trend in number of ADIs). We have also shown that of 22 ADIs included, only Pneumocystis jirovecii pneumonia remained prominent (albeit with much reduced overall prevalence). 2828 deaths were from AIDS-related causes, peaking in 1996 with 241 (96%) of 252 deaths in people with HIV and declining to 44 (20%) of 218 in 2013.Our results provide further evidence that integrated comprehensive free programmes that facilitate testing and deliver treatment and care can be eff ective in decreasing AIDS-related morbidity and mortality, thus suggesting that control of and eventually an end to AIDS are possible.

SUBMITTER: Lima VD

PROVIDER: S-EPMC4357843 | biostudies-literature | 2015 Mar

REPOSITORIES: biostudies-literature

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AIDS incidence and AIDS-related mortality in British Columbia, Canada, between 1981 and 2013: a retrospective study.

Lima Viviane D VD Lourenço Lillian L Yip Benita B Hogg Robert S RS Phillips Peter P Montaner Julio S G JS

The lancet. HIV 20150301 3

<h4>Background</h4>Appropriate use of highly active antiretroviral therapy (ART) can substantially decrease the risk of progression to AIDS and of premature mortality. We aimed to characterise the trends between 1981 and 2013 in AIDS-defining illnesses (ADIs) and the number AIDS-related deaths in British Columbia, Canada, where ART has been fully subsidised since 1996.<h4>Methods</h4>We included data on HIV-positive individuals, aged 19 years or older, from four administrative databases in Briti ...[more]

PMID: 25780802

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Project description:Antiretroviral therapy (ART) and harm reduction services have been cited as key contributors to control of HIV epidemics; however, the specific contribution of ART has been questioned due to uncertainty of its true efficacy on HIV transmission through needle sharing. We aimed to isolate the independent effects of harm reduction services (opioid agonist treatment uptake and needle distribution volumes) and ART on HIV transmission via needle sharing in British Columbia, Canada, from 1996 to 2013.We used comprehensive linked individual health administrative and registry data for the population of diagnosed people living with HIV in British Columbia to populate a dynamic, compartmental transmission model to simulate the HIV/AIDS epidemic in British Columbia from 1996 to 2013. We estimated HIV incidence, mortality, and quality-adjusted life-years (QALYs). We also estimated scenarios designed to isolate the independent effects of harm reduction services and ART, assuming 50% (10-90%) efficacy, in reducing HIV incidence through needle sharing, and we investigated structural and parameter uncertainty.We estimate that 3204 (upper bound-lower bound 2402-4589) incident HIV cases were averted between 1996 and 2013 as a result of the combined effect of the expansion of harm reduction services and ART coverage on HIV transmission via needle sharing. In a hypothetical scenario assuming ART had zero effect on transmission through needle sharing, we estimated harm reduction services alone would have accounted for 77% (upper bound-lower bound 62-95%) of averted HIV incidence. In a separate hypothetical scenario where harm reduction services remained at 1996 levels, we estimated ART alone would have accounted for 44% (10-67%) of averted HIV incidence. As a result of high distribution volumes, needle distribution predominantly accounted for incidence reductions attributable to harm reduction but opioid agonist treatment provided substantially greater QALY gains.If the true efficacy of ART in preventing HIV transmission through needle sharing is closer to its efficacy in sexual transmission, ART's effect on incident cases averted could be greater than that of harm reduction. Nonetheless, harm reduction services had a vital role in reducing HIV incidence in British Columbia, and should be viewed as essential and cost-effective tools in combination implementation strategies to reduce the public health and economic burden of HIV/AIDS.BC Ministry of Health; National Institutes of Health (R01DA041747); Genome Canada (142HIV).

Project description:BackgroundLate HIV diagnosis is associated with increased AIDS-related morbidity and mortality as well as an increased risk of HIV transmission. In this study, we quantified and characterized missed opportunities for earlier HIV diagnosis in British Columbia (BC), Canada.DesignRetrospective cohort.MethodsA missed opportunity was defined as a healthcare encounter due to a clinical manifestation which may be caused by HIV infection, or is frequently present among those with HIV infection, but no HIV diagnosis followed within 30 days. We developed an algorithm to identify missed opportunities within one, three, and five years prior to diagnosis. The algorithm was applied to the BC STOP HIV/AIDS population-based cohort. Eligible individuals were ≥18 years old, and diagnosed from 2001-2014. Multivariable logistic regression identified factors associated with missed opportunities.ResultsOf 2119 individuals, 7%, 12% and 14% had ≥1 missed opportunity during one, three and five years prior to HIV diagnosis, respectively. In all analyses, individuals aged ≥40 years, heterosexuals or people who ever injected drugs, and those residing in Northern health authority had increased odds of experiencing ≥1 missed opportunity. In the three and five-year analysis, individuals with a CD4 count <350 cells/mm3 were at higher odds of experiencing ≥1 missed opportunity. Prominent missed opportunities were related to recurrent pneumonia, herpes zoster/shingles among younger individuals, and anemia related to nutritional deficiencies or unspecified cause.ConclusionsBased on our newly-developed algorithm, this study demonstrated that HIV-diagnosed individuals in BC have experienced several missed opportunities for earlier diagnosis. Specific clinical indicator conditions and population sub-groups at increased risk of experiencing these missed opportunities were identified. Further work is required in order to validate the utility of this proposed algorithm by establishing the sensitivity, specificity, positive and negative predictive values corresponding to the incidence of the clinical indicator conditions among both HIV-diagnosed and HIV-negative populations.

Dataset Information

AIDS incidence and AIDS-related mortality in British Columbia, Canada, between 1981 and 2013: a retrospective study.

Publications

AIDS incidence and AIDS-related mortality in British Columbia, Canada, between 1981 and 2013: a retrospective study.

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