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Australian clinic records show significant reduction in duration of infectiousness in HIV-positive gay men from 2007-2016
Michael Carter, 2017-09-25 07:10:00
The period during
which HIV-positive men who have sex with men (MSM) are potentially infectious
fell significantly between 2007 and 2016, investigators from Australia report
in the online edition of AIDS. Data
from Melbourne Sexual Health Centre showed that the intervals between
HIV infection and diagnosis, between diagnosis to viral suppression and between
infection to viral suppression all fell significantly during the study period.
The proportion of people with serological evidence of recent infection also
more than doubled.
“The estimated duration of infectiousness…fell
more than fivefold from 49.0 months for patients diagnosed between 2007 and
2009 and 9.6 months in those diagnosed between 2015 and March 2016,” comment
the authors. “If replicated across the community, this reduction in the period
of infectiousness could be expected to have a substantial impact on HIV
transmission and incidence.”
is associated with reductions in the transmission of HIV at both the community
and individual level. People with an undetectable viral load have a very low
– probably as low as zero – risk of transmitting HIV to their sexual partners.
A priority of HIV prevention is therefore to reduce the duration in which a
person is potentially infectious – the interval between infection and
diagnosis and diagnosis and viral suppression.
at risk of HIV to test frequently is the main intervention to reduce the
interval between infection and diagnosis. The rapid initiation of antiretroviral
therapy (ART) reduces the interval between diagnosis and viral suppression. Modern
ART regimens are potent, have few side-effects and are easy to take.
International treatment guidelines now recommend that all people should be
offered ART, regardless of CD4 cell count because of its health benefits and
impact on infectiousness.
Health Centre (MSHC) provides HIV and sexual health testing to in excess of
11,000 MSM a year. Researchers at the clinic wanted to determine the combined
effect of early diagnosis of HIV and prompt initiation of ART on the time
period in which patients were potentially infectious. They therefore designed a
retrospective cohort study involving 437 MSM newly diagnosed at their clinic
between 2007 and 2016.
Date of infection
was estimated using previous testing history, serological evidence of recent
infection or baseline CD4 cell count. The period between diagnosis and viral
suppression was established by a review of clinic notes.
Patients had a
median age of 30 years and a third of individuals were also diagnosed with
another sexually transmitted infection on the day of their HIV diagnosis.
Over the nine
years of the study, the proportion of patients with serological evidence of
recent HIV infection more than doubled, from 15.6% in 2007 to 34.3% in 2016 (p
< 0.001). These individuals had significantly higher viral loads and CD4 cell
counts than individuals without evidence of very recent infection (p <
The median time to
diagnosis among patients with a known date of a previous HIV-negative result or
serological evidence of recent infection fell significantly from 5.4 months to
4.2 months (p = 0.0054). After inclusion of patients without a previous testing
history or serological data, in whom time to diagnosis was based on CD4 cell
count, the median interval between infection and diagnosis fell from 6.8 months
to 4.3 months (p = 0.0004).
decline was also observed in the median interval between diagnosis and viral
suppression, from 22.7 months to 3.2 months (p < 0.001). The overall period
of potential infectiousness declined from 49 months for patients diagnosed
between 2007 and 2009 to 9.6 months for patients diagnosed in 2015 and 2016 (p
“About one third
of HIV diagnoses in MSM in the state of Victoria are made at MSHC. If
replicated across the community, the reduction in duration of infectiousness
and the increase in the proportion with recent infection can be expected to
have had a profound influence on HIV incidence,” write the investigators.
“Additionally, a government program now provides PrEP free of charge for 3,600
individuals in the state [of Victoria]. A reduction in both the number of
infectious and susceptible individuals can be expected to be complementary or
Changes in testing
practices and treatment guidelines appeared to be behind the improvements
detected in the study. Diagnosis in a more recent time period was associated
with increased chances of having serological evidence of recent infection, a
shorter time to viral suppression and a shorter duration of infectiousness.
Men with a history
of injecting drug use, as well as individuals who had recently arrived in
Australia from a non-English-speaking country, were less likely to be diagnosed
promptly and to achieve rapid viral suppression. “This is significant because
these groups have been identified as likely to experience delayed care,” comment
“The duration of
infectiousness in MSM diagnosed with HIV at MSHC in Victoria has fallen
dramatically between 2007 and 2016 and the proportion diagnosed with
serological evidence of recent infection has significantly increased,” conclude
the researchers. “This effect is across all population subgroups and marks a
very positive milestone for the treatment as prevention paradigm.”