Australia is close to achieving global targets for the testing and treatment of HIV, but more needs to be done to identify and treat infections early, according to a new report by the Kirby Institute at UNSW Australia, released today at the World STI and HIV Congress in Brisbane.
“Over a quarter of the people diagnosed with HIV in Australia last year already had substantial damage to their immune system, indicating they had likely contracted their infection a number of years ago,” said Associate Professor Rebecca Guy, Head of the Surveillance Evaluation and Research Program at the Kirby Institute.“Every year that a person delays being diagnosed is a year that they miss out on treatment to help maintain healthy immune function, and a year that they are at higher risk of passing on the virus to their sexual partners. If we’re going to end HIV, we will need to maintain and strengthen the established strategies of testing, treatment and prevention, as well as increasing the use of new technologies such as pre-exposure prophylaxis (PrEP) to prevent infection.”
The report shows that deaths related to chronic hepatitis C virus infection have increased by 146% in ten years and the uptake of treatment remains extremely low.
“There has been a substantial increase in illness and death due to hepatitis C as the population with this chronic infection ages, because the vast majority of people with the infection have not received curative therapy,” said Professor Greg Dore, Head of the Viral Hepatitis and Clinical Research Program at the Kirby Institute. “This all stands to change if we see approval of funding for breakthrough new treatments that have the potential to turn around Australia’s hepatitis C epidemic.”
The report also shows declining rates of new hepatitis B infection diagnosis, probably as a result of Australia’s immunisation programs, but the proportion of people with chronic hepatitis B infection who are tested and on treatment remains low.
“Evidence is emerging that the immunisation programs for hepatitis B are starting to have a real benefit, with declining rates of new infection most strikingly in the younger age groups that have had the highest level of vaccine coverage. On the other side of the coin, almost half of all people living with hepatitis B remain undiagnosed,” said Professor Dore. “More testing is needed, and especially among the key affected populations.”
Chlamydia remains the most frequently reported notifiable infection in Australia with the majority (78%) of diagnoses among 15-29 year olds.
“We have seen a decade of steady increases in both testing and diagnoses of chlamydia but the vast majority of infections still remain undiagnosed and hence untreated, emphasising the need for testing to be routinely offered to sexually active adolescents, young adults and other at-risk populations.” said Associate Professor Guy.
Numbers of new gonorrhoea diagnoses continue to increase substantially and are they highest in a decade. Increased testing for this infection may explain much of this increase.
Another sexually transmitted infection on the rise in Australia is syphilis. The number of cases in 2014 was the highest since record keeping began around 10 years ago. Rises in infectious syphilis occurred in most jurisdictions over the last 5-10 years, particularly among gay men and Aboriginal people in remote communities.
“The resurgence of this sexually transmitted infection in Aboriginal people living in remote communities after years of declining rates, bringing with it cases of congenital syphilis, emphasises the need for testing and treatment in this population, particularly in antenatal settings,” said Dr Marlene Kong, Head of the Aboriginal and Torres Strait Islander Research Program at the Kirby Institute.
Data presented in the report indicates that Aboriginal and Torres Strait Islander populations in Australia remain disproportionally affected by blood-borne viruses and STIs. In 2014, the rate of HIV diagnosis among Aboriginal and Torres Strait Islander people was almost two times higher, diagnosis of hepatitis C virus was almost five times higher, gonorrhoea infection was 18 times higher, chlamydia was over three times higher, and syphilis was four times higher than the rate of diagnosis in the non-Indigenous population.
“STI rates are high in the Aboriginal and Torres Strait Islander population and especially in regional and very remote areas,” said Dr Kong. “We must continue to promote awareness of symptoms and the need for regular testing across all communities, and improve access to, and uptake of testing and treatment for these curable infections.”
The report highlights the success of Australia’s human papillomavirus (HPV) vaccination program. Launched in 2007, the program has led to the virtual disappearance of new cases of sexually transmitted genital warts in young women and a 57% drop in the rate of detection of abnormal cervical cells among young women undergoing ‘Pap tests’ for cancer prevention.
The Kirby Institute’s 2015 Annual Surveillance Report of HIV, viral hepatitis and sexually transmissible infections in Australia and the 2015 Aboriginal Surveillance Report of HIV, viral hepatitis, STIs is released today alongside the Annual Report of Trends in Behaviour 2015 by UNSW’s Centre for Social Research in Health.
Download the reports