Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia.
Central Clinical School, Monash University, Melbourne, Australia.
BMC Infect Dis. 2018 Aug 20;18(1):410. doi: 10.1186/s12879-018-3325-0.
We examined differences in incident HIV infection between newly-arrived Asian-born and other men who have sex with men (MSM) after the introduction of universal HIV treatment guidelines in 2015 and pre-exposure prophylaxis in 2016.
Clinical, demographic, laboratory and behavioural data on MSM presenting for HIV testing at the Melbourne Sexual Health Centre from July 2013 to June 2017 were extracted. We compared the proportion of newly-arrived (four years or less in Australia), Asian-born and other MSM tested each year who were diagnosed with incident HIV infection (negative test within one year or diagnosis with indeterminate or negative Western Blot).
We analysed 35,743 testing episodes in 12,180 MSM, including 2781 testing episodes in 1047 newly-arrived Asian-born MSM. The proportion of other MSM tested each year who were diagnosed with incident HIV infection fell from 0.83% in 2014 to 0.38% in 2017 (p = .001), but did not fall in newly-arrived Asian-born MSM (from 1.18% in 2014 to 1.56% in 2017, p = .76). In the multivariate logistic regression, in 2016/2017 but not in 2014/2015, being newly-arrived Asian-born was associated with an increased odds of diagnosis of incident HIV infection (aOR 3.29, 95%CI 1.82-5.94, p < .001).
The epidemiology of HIV in Melbourne Australia has changed dramatically. While there has been an overall reduction amongst MSM, the incidence of HIV in newly-arrived Asian-born MSM remains high. Failing to address these new inequalities leaves individuals at risk and may offset the population benefit of biomedical HIV prevention.
我们研究了 2015 年普遍的 HIV 治疗指南和 2016 年暴露前预防措施推出后，新抵达的亚洲出生和其他男男性行为者（MSM）之间新发 HIV 感染的差异。
从 2013 年 7 月至 2017 年 6 月，在墨尔本性健康中心接受 HIV 检测的 MSM 的临床、人口统计学、实验室和行为数据被提取出来。我们比较了每年接受检测的新抵达（在澳大利亚四年或以下）、亚洲出生和其他 MSM 的比例，这些人被诊断为新发 HIV 感染（一年内阴性检测或不确定或阴性 Western Blot 诊断）。
我们分析了 12180 名 MSM 中的 35743 次检测，包括 1047 名新抵达的亚洲出生的 MSM 中的 2781 次检测。每年被诊断为新发 HIV 感染的其他 MSM 的比例从 2014 年的 0.83%下降到 2017 年的 0.38%（p=0.001），但新抵达的亚洲出生的 MSM 没有下降（从 2014 年的 1.18%到 2017 年的 1.56%，p=0.76）。在多变量逻辑回归中，在 2016/2017 年而不是 2014/2015 年，新抵达的亚洲出生与诊断为新发 HIV 感染的几率增加有关（aOR 3.29，95%CI 1.82-5.94，p<0.001）。
澳大利亚墨尔本的 HIV 流行病学发生了巨大变化。虽然 MSM 的总体感染率有所下降，但新抵达的亚洲出生的 MSM 的 HIV 发病率仍然很高。未能解决这些新的不平等问题，使个人处于危险之中，并可能抵消生物医学 HIV 预防的人群效益。
