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J Acquir Immune Defic Syndr. 2013 Dec 1;64(4):409-16. doi: 10.1097/QAI.0b013e3182a6b20c.

HIV treatment as prevention in a developed country setting: the current situation and future scenarios for Australia.

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1
*School of Mathematics and Statistics, and †The Kirby Institute, University of New South Wales, Sydney, Australia.

Abstract

OBJECTIVE:

We investigated the current success of early HIV detection in Australia and the likely effectiveness of Treatment as Prevention.

METHODS:

HIV diagnoses data from the Australian National HIV/AIDS Registry were analyzed for CD4 T-cell counts at diagnosis and for prior HIV testing. Mathematical modeling based on these data estimated future HIV prevalence and incidence under different scenarios of antiretroviral therapy (ART) usage.

RESULTS:

CD4 T-cell counts significantly decreased with age (P < 0.0001) for men who have sex with men (MSM) and women in all HIV diagnoses, and for diagnoses at primary HIV infection (P < 0.02). This decrease with age meant that >50% of MSM aged 29 years and older are diagnosed with a CD4 T-cell count <500 cells per cubic millimeters. Diagnosis during primary HIV infection has stabilized at 15% for MSM, with a lower percentage for older individuals (P = 0.002), but only 5% of women were diagnosed at this early stage. MSM older than 50 years were significantly less likely to have had an HIV test before diagnosis (P < 0.0001), whereas women of all ages at HIV diagnosis were less likely to have been tested than MSM. Mathematical modeling indicated that current levels of ART would see a continuing increase in HIV diagnoses among MSM. A 90% ART enrollment would result in an almost immediate decline in prevalence and would be cost effective in terms of person-years on ART by 2028.

CONCLUSION:

Treatment as Prevention would be an effective intervention in Australia and other developed countries.

PMID:
24169123
DOI:
10.1097/QAI.0b013e3182a6b20c
[Indexed for MEDLINE]
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