Marked increase in first time hiv diagnoses in ontario 2002
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Marked increase in first-time HIV diagnoses in Ontario, 2002. Acknowledgements. Public Health Laboratory staff, Ontario Ministry of Health and Long-Term Care Keyi Wu, programming Mark Fisher, systems consulting and custom download. Background.

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Marked increase in first-time HIV diagnoses in Ontario, 2002

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Marked increase in first time hiv diagnoses in ontario 2002

Marked increase in first-timeHIV diagnoses in Ontario, 2002


Acknowledgements

Acknowledgements

  • Public Health Laboratory staff, Ontario Ministry of Health and Long-Term Care

  • Keyi Wu, programming

  • Mark Fisher, systems consulting and custom download


Background

Background

  • In Ontario, HIV diagnostic testing is conducted at the HIV Laboratory and regional labs

  • Use HIV Laboratory data to monitor the HIV epidemics in Ontario

  • In late 2002, observed a marked increase in first-time diagnoses in the first three quarters


Study objectives

Study objectives

1. To characterize the increase in first-time HIV diagnoses at the Ontario HIV Laboratory in 2002

2. To better understand to what extent this increase was due to increased HIV testing or HIV incidence


Methods

Methods

  • Examined first-time HIV-positive and total HIV tests from 1985 to 2002

  • First-time HIV positive: confirmed positive with no link to a previous positive result in database and no other evidence of previous HIV-positive test in Ontario

  • Based on the observed pattern, defined the period of increase as calendar year 2002

  • Compared HIV test results for 2002 to those in 2001 by sex, age, exposure category, reason for testing, health region and seroconverter or not


Results first time hiv positives and hiv tests by year ontario 1985 2002

RESULTS First-time HIV positives and HIV tests by year, Ontario, 1985-2002

First-time HIV positives

All HIV tests

2500

400000

350000

2000

300000

250000

1500

All HIV tests

First-time HIV postive tests

200000

1000

150000

100000

500

50000

0

0

1985

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

Year of testing


First time hiv positives and hiv tests by quarter ontario 1999 2002

First-time HIV positives and HIV tests by quarter, Ontario, 1999-2002

First-time HIV positives

All Tests

350

140000

300

120000

250

100000

Number of First-time

Number of all HIV tests

HIV positive tests

200

80000

150

60000

100

40000

50

20000

0

0

1999Q1

1999Q2

1999Q3

1999Q4

2000Q1

2000Q2

2000Q3

2000Q4

2001Q1

2001Q2

2001Q3

2001Q4

2002Q1

2002Q2

2002Q3

2002Q4

Year-Quarter


First time hiv diagnoses by sex ontario 2002 versus 2001

First-time HIV diagnoses by sex Ontario, 2002 versus 2001

Year Female Male Unknown Total

2001 254 733 31 1,0182002 317 880 32 1,238

Relative rate

(2002/2001) 1.28 1.20 1.03 1.22

Excess tests

(2002-2001) 72 147 1 220


First time hiv diagnoses by health region ontario 2002 versus 2001

First-time HIV diagnoses by health region Ontario, 2002 versus 2001

Year Northern Eastern Ottawa Central East Toronto South Central Other Other West West

2001 22 38147 7460465632002 24 30164 708095384

Relative rate

(2002/2001) 1.09 0.79 1.12 0.951.34 0.82 1.33

Excess tests

(2002-2001) 2 2 17 -4 205 -12 21

Proportion of

Excess0.80%6.90% 83.70% 8.60%


First time hiv diagnoses by exposure category by year ontario 1985 2002

First-time HIV diagnoses by exposure category by year, Ontario, 1985-2002

Unknown

MSM

IDU

Endemic

HR Hetero

LR Hetero

1400

1200

1000

Number of first-time positives

800

600

400

200

0

1985

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

Year of testing


First time hiv diagnoses by exposure category ontario 2002 versus 2001

First-time HIV diagnoses by exposure category , Ontario, 2002 versus 2001

Year MSM IDU Endemic HR hetero LR hetero Unknown

2001 221 35 36 24 99 5562002 317 37 45 26 107 660

Relative rate

(2002/2001) 1.43 1.06 1.25 1.08 1.08 1.19

Excess tests

(2002-2001) 96 2 9 2 8 104

Proportion of

Excess42.7% 0.9% 4.0% 0.9% 3.6% 46.2%


First time hiv diagnoses by reason for testing ontario 2002 versus 2001

First-time HIV diagnoses by reason for testing, Ontario, 2002 versus 2001

Year Donor of

blood, tissue

Diagnostic Follow-up Insurance Prenatal semenVisa (Known) Unknown

2001 380 31 2 11 2 6 8 5782002 447 40 2 8 0 119 12 610

Relative rate

(2002/2001) 1.18 1.29 1.00 0.73 0.00 19.83 1.50 1.06

Excess tests

(2002-2001) 67 9 0 -3 -2 1 13 4 32


Is the the increase due to an increase in hiv testing

Is the the increase due to an increase in HIV testing?


Summary of increase in major categories

Summary of increase in major categories


Proportion of seroconverters linked and in progress among first time hiv diagnoses 2002 versus 2001

Proportion of seroconverters, linked and in progress, among first-time HIV diagnoses 2002 versus 2001

2001

2002

Relativerate

Excess


Summary of observations

Summary of observations

  • Excess of 220 (+22%) first-time HIV diagnoses from 2001 to 2002

  • Exposure category: MSM and persons from HIV-endemic regions (PHER) highest

  • Health region: Toronto and Central West highest

  • Reason for test, visa applicants highest

  • Reasons for testing and exposure categories were mutually exclusive, e.g., no MSM among visa applicants

  • Proportion of excess: MSM 43%, PHER 4%, visa 51%


Conclusions

Conclusions

  • Increase among visa applicants entirely due to increase in HIV testing

  • Among MSM and PHER, increase in HIV diagnoses

    not due to increased HIV testing

  • Increases in these groups may be due to selective increased HIV testing in persons at high risk for HIV infection

  • Also, evidence of increased HIV incidence in MSM

  • Thus, both increased HIV testing and increased HIV incidence responsible for observed increase in HIV diagnoses

  • Relative importance not clear; requires further study


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