Treatment and disease outcomes of migrants from low- and middle-income countries in the Australian HIV Observational Database cohort

Abstract

People from culturally and linguistically diverse backgrounds, including low- and middle-income countries, account for a third of new HIV diagnoses in Australia and are a priority for HIV prevention and treatment programs. We describe the demographic and clinical characteristics of participants in the Australian HIV Observational Database (AHOD) and compare disease outcomes, progression to AIDS and treatment outcomes of those born in low- and middle-income countries, with those born in high-income countries and Australia. All participants enrolled in AHOD sites where country of birth is routinely collected were included in the study. Age, CD4 count, HIV viral load, antiretroviral therapy, hepatitis co-infection, all-cause mortality and AIDS illness were analysed. Of 2403 eligible participants, 77.3% were Australian born, 13.7% born in high-income countries and 9.0% born in middle- or low-income countries. Those born in Australia or high-income countries were more likely to be male (96%) than those from middle- or low-income countries (76%), p < .0001 and more likely to have acquired HIV via male to male sexual contact (77%; 79%) compared with those from middle- or low-income countries (50%), p < .0001. At enrolment, mean CD4 cell count was higher in Australian born (528 cells/µL) than both those born in high-income countries (468 cells/µL) and those born in middle- and low-income countries (451 cells/µL), p < .0001; whereas the mean HIV RNA level (log10 copies/mL) was similar in all three groups (4.44, 4.76 and 4.26, respectively), p = .19. There was no difference in adjusted incidence risk ratios for all-cause mortality and AIDS incidence in all three groups, p = .39. These findings reflect successful outcomes of people born in low- and middle-income countries once engaged in HIV care.

Human immunodeficiency virus‐infected young people in Australia: data from the Australian HIV Observational Database

“…Individuals diagnosed with HIV under 25 years of age in Australia were predominantly male, although a greater proportion of newly diagnosed young adults were females compared to their older counterparts. In part these figures reflect overall trends in Australia with an increasing but relatively small proportion of women diagnosed with HIV, and they are also reflective of migration trends in Australia . In our cohort, male‐to‐male sexual contact was the predominant risk factor for HIV acquisition in both groups, and most received their HIV care at publicly funded sexual health clinics.…”

“…In part these figures reflect overall trends in Australia with an increasing but relatively small proportion of women diagnosed with HIV, 18 and they are also reflective of migration trends in Australia. 19 In our cohort, male-to-male sexual contact was the predominant risk factor for HIV acquisition in both groups, and most received their HIV care at publicly funded sexual health clinics. Risk factors were similar to US data in 2014, where 70% of HIV infection in adolescents and young adults was attributed to male to male sexual contact.…”

Effect of human development index parameters on tuberculosis incidence in Turkish provinces

“…In the literature, there are few studies that compare the differences between the developmental levels and incidence of TB and other infectious diseases in various countries [1,[4][5][6]. We did not find any existing study investigating the relationship between TB incidence and all detailed HDI parameters.…”

Chronic kidney disease in Australian Human Immunodeficiency Virus‐infected patients: Analysis of the Australian HIV Observational Database

“…In our study, neither of these variables were associated with CKD across the board after adjusting for other factors. This may be explained by high rates of ART uptake across the cohort and low prevalence of patients of African descent in the AHOD population . Interestingly, analysis of those aged over 50 years in our study showed low CD4+ count and high viral load to be significant risk factors for CKD.…”