Abstract #114  -  Late diagnosis among adults with HIV in New Zealand
Authors:   Presenting Author:   Ms Sue McAllister - University of Otago
Additional Authors:  Dr Nigel Dickson,
Aim: The introduction of antiretroviral therapy (ART) in the mid-1990’s has resulted in a decrease in the number of people developing AIDS in most developed countries, including New Zealand. Early diagnosis of HIV is needed for people with HIV to benefit best from these treatments. The objectives of this study are to identify the number and characteristics of people diagnosed late with HIV in New Zealand, from 1 January 2005 to 31 December 2008 in order to improve knowledge and understanding of who should be encouraged to test earlier.
Method / Issue: AIDS - based on when a person with HIV infection has an AIDS-defining condition - is a notifiable disease in New Zealand. While HIV is not notifiable, information is received through a voluntary system of reporting using the same quasi-anonymous code as for AIDS. Through information provided by the reference laboratories that confirm HIV diagnoses clinicians are asked to provide anonymous demographic and behavioural information. Since 2005, information on the first CD4 count undertaken after diagnosis has also been requested. “Late testers” were defined as having an initial CD4 count < 200 cells per microlitres or criteria for AIDS at the time of, or within three months of, HIV diagnosis.
Results / Comments: During the period 2005 to 2008, 682 adults were diagnosed with HIV through antibody testing in New Zealand for whom a CD4 count was available for 490 (71%). Of these 490, 150 (30.6%) people were designated as “late testers”. The number and proportion of ‘late testers’ by means of infection were: Men who had sex with men - 245 (24.5%), Age adjusted OR 1.0 (Ref.); Heterosexual - 217 (36.9%), Age adjusted OR 2.0 (95% CI 1.34-3.1); ‘Other’ - 6 (33.3%) Age adjusted OR 1.6 (95% CI 0.21-7.1); and Unknown - 22 (36.4%). Additional findings were that: (1) Heterosexual men (46.0%) had a higher proportion of ‘late testers’ than MSM (24.5%) and heterosexual women (28.0%). (2) A higher proportion of ‘late testers’ were in those aged greater than 40 years for both MSM and heterosexual people. (3) Among MSM, those of Maori ethnicity had a significantly higher proportion of ‘late testers’ (40.6% Adjusted OR 4.5, 95%CI 1.9-11.0). (4) For both MSM (46.0%) and people heterosexually infected (66.1%), the main reason for testing was because of symptoms. (5) No differences were noted in the place of infection and ‘late testers’.
Discussion: There continues to be a significant number of people with HIV in New Zealand who are being diagnosed late. This is similar to the rates found in other countries such as the UK, Ireland and France, and slightly higher than Australia. A greater emphasis on testing, particularly of people over the age of 40, and Maori and Pacific ethnic groups, would not only enable HIV positive people to benefit from treatment and care that is available but would also contribute to the control and prevention of HIV in New Zealand.
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