Abstract: High hepatitis C virus (HCV) prevalence has been documented among many injecting drug user (IDU) populations worldwide; however, there is limited published data on trends in incidence of infection in these epidemics over time. To address this, we used a novel method of analyzing data collected via repeat, cross-sectional sero-surveys by injection initiation cohorts to investigate trends in HCV seropositivity among a population of needle and syringe program (NSP) attendees in Australia between 1995 and 2004, and thereby infer annual incidence trends. Injection initiation cohorts were defined by their time of entry into the IDU population. We also investigated the associations between HCV antibody seroprevalence and risk factor data, and trends in risk factor data over the decade. Approximately 20,000 NSP attendees participated in the study over the 10-year period. Within each injection initiation cohort, we found an increase in HCV prevalence over time, with prevalence appearing to reach saturation around 90%. There was little indication that the slopes of increase had changed with more recent initiation cohorts. While duration of injecting was most strongly associated with HCV seropositivity in this study, we also found that self-reported history of needle and syringe sharing and imprisonment were independently associated with higher HCV prevalence regardless of duration of injecting, with the exception of IDUs who have 15 or more years injecting experience. In this group, recent risk behavior had no relationship to prevalence. In summary, our findings suggest a persistent HCV epidemic despite significant harm reduction efforts in Australia since the mid-1980s, with HIV incidence effectively constant in successive initiation cohorts.
Abstract: Objective: Although studies have shown reductions in mortality from AIDS after the introduction of combination antiretroviral treatment (cART), little is known about cause-specific mortality in low-income settings in the cART era. We explored predictors of AIDS and non-AIDS mortality and compared cause-specific mortality across high-income and low-income settings in the Asia-Pacific region. Methods: We followed patients in the Asia Pacific HIV Observational Database from the date they started cART (or cohort enrolment if cART initiation was identified retrospectively), until the date of death or last follow-up visit. Competing risks methods were used to estimate the cumulative incidence, and to investigate predictors, of AIDS and non-AIDS mortality. Results: Of 4252 patients, 215 died; 89 from AIDS, 97 from non-AIDS causes and 29 from unknown causes. Age more than 50 years [hazard ratio 4.29; 95% confidence interval (CI) 2.10-8.79] and CD4 cell counts less than or equal to 100 cells/mu l (hazard ratio 8.59; 95%% CI 5.66-13.03) were associated with an increased risk of non-AIDS mortality. Risk factors for AIDS mortality included CD4 cell counts less than or equal to 100 cells/mu l (hazard ratio 34.97; 95% CI 18.01-67.90) and HIV RNA 10001 or more (hazard ratio 4.21; 95% CI 2.07-8.55). There was some indication of a lower risk of non-AIDS mortality in Asian high-income, and possibly low-income, countries compared to Australia. Conclusion: Immune deficiency is associated with an increased risk of AIDS and non-AIDS mortality. Older age predicts non-AIDS mortality in the cART era. Less conclusive was the association between country-income level and cause-specific mortality because of the relatively high proportion of unknown causes of death in low-income settings. (C) 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins
Abstract: Objectives: To determine the prevalence and predictors of an incomplete immune response in patients with sustained viral suppression after starting their first or second combination antiretroviral treatment (cART) regimen. Methods: All patients were recruited to the Australian HIV Observational Database (AHOD) by March 2006. Data were analyzed to assess the prevalence of an incomplete immune response (< 350 cells/mu L) in the 12-24 months after starting the first or second cART regimen. Factors associated with an incomplete immune response were assessed using logistic regression and time to AIDS/death was assessed using survival analysis. Results: Of the 2493 patients recruited to AHOD by March 2006, 590 were eligible for the analysis. Twenty-eight percent of patients with a baseline CD4 count < 350 cells per microliter had an incomplete immune response 12-24 months after starting their first or second cART regimen. Lower baseline CD4 count before starting the cART regimen was predictive of ail incomplete immune response. There was a nonsignificant trend toward faster AIDS or death in incomplete immune responders. Conclusions: An incomplete immune response in patients with sustained viral Suppression is associated with poorer immune function before starting cART. Type of cART or individual antiretroviral drug was not associated with an incomplete immune response.
Abstract: Aim To compare the estimated 10-year risk of cardiovascular death between ethnic Norwegians and five immigrant groups in Norway, according to the European Systematic Coronary Risk Evaluation (SCORE) system. Methods Data were obtained from the Oslo Health Study and the Oslo Immigrant Health Study (2000-2002). Fourteen thousand eight hundred and fifty-six individuals born between 1940 and 1971 in Norway, Turkey, Iran, Pakistan, Sri Lanka and Vietnam were included in the study, The European SCORE high-risk models, one including total cholesterol and the other including total cholesterol/HDL cholesterol ratio, were used to estimate 10-year cardiovascular mortality risk. A model assuming no smoking was also applied. Age was projected to 60 years and estimates were adjusted for age at screening. Results Norwegians had higher total cholesterol and systolic blood pressure, but lower triglycerides and higher HDL cholesterol compared with immigrants. The mean SCORE (total cholesterol model) varied between 6.6% (Turkey) and 5.4% (Sri Lanka) in men, and 2.1% (Norway) and 1.5% (Pakistan, Sri Lanka and Vietnam) in women. Application of the ratio model gave higher estimated risk in all immigrant groups except for Vietnamese, with 10-year risk varying between 7.7% (Turkey/Pakistan) and 5.7% (Vietnam) in men, and 2.0% (Norway) and 1.5% (Vietnam) in women. When the ratio model was applied assuming no smoking in all ethnic groups, the mean SCORE risk was reduced by 30% in Turkish men and 25% in Norwegian women, with less significant reductions observed in the other groups. Conclusion Norwegians ranked high with the SCORE total cholesterol model and Norwegian men low with the SCORE ratio model. Although the predictive accuracy of the SCORE models for immigrants in Norway remains to be evaluated, our findings suggest that the ratio model could be more applicable to the entire population in Norway. Eur J Cardiovasc Prev Rehabil 16:229-234 (C) 2009 The European Society of Cardiology
Abstract: Background: Random effects models were used to explore how the shape of CD4 cell count responses after commencing combination antiretroviral therapy (cART) develop over time and, in particular, the role of baseline and follow-up covariates. Methods: Patients in Asia Pacific HIV Observational Database who first commenced cART after January 1, 1997, and who had a baseline CD4 cell count and viral load measure and at least I follow-up measure between 6 and 24 months, were included. CD4 cell counts were determined at every 6-month period after the commencement of cART for up to 6 years. Results: A total of 1638 patients fulfilled the inclusion criteria with a median follow-up time of 58 months. Lower post-cART mean CD4 cell counts were found to be associated with increasing age (P < 0.001), pre-cART hepatitis C coinfection (P = 0.038), prior AIDS (P = 0.019), baseline viral load <= 100,000 copies per milliliter (P < 0.001), and the Asia Pacific region compared with Australia (P = 0.005). A highly significant 3-way interaction between the effects of time, baseline CD4 cell count, and post-cART viral burden (P < 0.0001) was demonstrated. Higher long-term mean CD4 cell counts were associated with lower baseline CD4 cell count and consistently undetectable viral loads. Among patients with consistently detectable viral load, CD4 cell counts seemed to converge for all baseline CD4 levels. Conclusions: Our analyses Suggest that the long-term shape of post-cART CD4 cell count changes depends only on a 3-way interaction between baseline CD4 cell count, viral load response, and time.
Abstract: Objectives: To determine if there were any differences in antiretroviral treatment (ART) use across the three eastern states of Australia, New South Wales (NSW), Victoria and Queensland, during the period 1997 to 2006. Methods: We used data from a clinic-based cohort, the Australian HIV Observational Database (AHOD), to determine the proportion of HIV-infected patients on ART in selected clinics in each state and the proportion of treated patients with an undetectable viral load. Data from the national Highly Specialised Drugs program and AHOD were used to estimate total numbers of individuals on ART and the proportion of individuals living with HIV on ART nationally and by state. Data from the HIV Futures Survey and the Gay Community Periodic Survey were used to determine the proportion of community-based men who have sex with men on ART. The proportion of patients with primary HIV infection (PHI) who commenced ART within 1 year of diagnosis was obtained from the Acute Infection and Early Disease Research Program (AIEDRP) CORE01 protocol and Primary HIV and Early Disease Research: Australian Cohort (PHAEDRA) cohorts. Results: We estimated that the numbers of individuals on ART increased from 3181 to 4553 in NSW, 1309 to 1926 in Victoria and 809 to 1615 in Queensland between 2000 and 2006. However, these numbers may reflect a lower proportion of individuals living with HIV on ART in NSW compared with the other states (37% compared with 49 and 55% in 2000). We found similar proportions of HIV-positive men who have sex with men participants were on ART in all three states over the study period in the clinic-based AHOD cohort (81-92%) and two large, community-based surveys in Australia (69-85% and 49-83%). Similar proportions of treated patients had an undetectable viral load across the three states, with a consistently increasing trend over time observed in all states. We found that more PHI patients commenced treatment in the first year following HIV diagnosis in NSW compared with Victoria; however, the sample size was very small. Conclusions: For the most part, patterns of ART use were similar across NSW, Victoria and Queensland using a range of available data from cohort studies, community surveys and national prescription databases in Australia. However, there may be a lower proportion of individuals living with HIV on ART in NSW compared with the other states, and there is some indication of a more aggressive treatment approach with PHI patients in NSW compared with Victoria.
Abstract: Background The levels of cardiovascular risk factors vary in different segments of a population. Our aim was to investigate ethnic differences in cardiovascular risk factors among five major immigrant groups in Oslo, Norway. Design A population-based, cross-sectional study. Methods The Oslo Immigrant Health study was conducted in 2002. All first-generation immigrants aged 31-60 years living in Oslo from Sri Lanka, Turkey, Iran, Vietnam, and a random sample of 30% of those from Pakistan, were invited. A total of 3019 individuals provided written consent and met the inclusion criteria. Participants had a clinical examination, blood test, and were asked to complete the study questionnaire. Results Immigrants from Vietnam had the highest high-density lipoprotein (HDL) cholesterol, whereas immigrants from Sri Lanka and Pakistan, and men from Turkey, had the lowest HDL-cholesterol and highest triglycerides. Immigrants from Sri Lanka, Pakistan and Turkey had the highest blood pressure. Smoking was least prevalent among Sri Lankan immigrants and most common among Turkish immigrants. Ethnic differences in blood pressure and HDL-cholesterol, and triglycerides among women, were attenuated after adjusting for obesity measures. A moderate and higher (>= 10%) Framingham risk score was most common among Turkish and Pakistani immigrants. Conclusions We found ethnic differences in triglycerides, HDL-cholesterol and blood pressure; however, the differences in blood pressure were surprisingly small. Ethnic differences were partly explained by obesity. The prevalence of smoking also varied greatly between the different ethnic groups.
