Background We aimed to characterize changes in patterns of new HIV diagnoses, HIV-related mortality, and HAART use in Canada from 1995 to 2008. Methods Data on new HIV diagnoses were obtained from Health Canada, HIV-related mortality statistics were obtained from Statistics Canada, and information on the number of people on HAART was obtained from the single antiretroviral distribution site in British Columbia (BC), and the Intercontinental Marketing Services Health for Ontario and Quebec. Trends of new HIV-positive tests were assessed using Spearman rank correlations and the association between the number of individuals on HAART and new HIV diagnoses were estimated using generalized estimating equations (GEE). Results A total of 34,502 new HIV diagnoses were observed. Rates of death in BC are higher than those in Ontario and Quebec with the rate being 2.03 versus 1.06 and 1.21 per 100,000 population, respectively. The number of HIV infected individuals on HAART increased from 5,091 in 1996 to 20,481 in 2008 in the three provinces (4 fold increase). BC was the only province with a statistically significant decrease (trend test p<0.0001) in the rate of new HIV diagnoses from 18.05 to 7.94 new diagnoses per 100,000 population. Our analysis showed that for each 10% increment in HAART coverage the rate of new HIV diagnoses decreased by 8% (95% CI: 2.4%, 13.3%) Interpretation Except for British Columbia, the number of new HIV diagnoses per year has remained relatively stable across Canada over the study period. The decline in the rate of new HIV diagnoses per year may be in part attributed to the greater expansion of HAART coverage in this province.
References
[1]
Yang Q, Boulos D, Yan P, Zhang F, Remis RS, et al. (2010) Estimates of the Number of Prevalent and Incident Human Immunodeficiency Virus (HIV) Infections in Canada, 2008. Canadian Journal of Public Health 101: 486–490.
[2]
Public Health Agency of Canada (2009) HIV and AIDS in Canada. Surveillance Report to December 31, 2008. Ottawa, ON: Surveillance and Risk Assessment Division, Centre for Communicable Diseases and Infection Control, PHAC.
[3]
Hall HI, Geduld J, Boulos D, Rhodes P, An Q, et al. (2009) Epidemiology of HIV in the United States and Canada: Current status and ongoing challenges. J Acquir Immune Defic Syndr 51: S13–520.
[4]
Public Health Agency of Canada (2006) I-Track: Enhanced Surveillance of Risk Behaviours among Injecting Drug Users in Canada. Phase I Report, August 2006. Surveillance and Risk Assessment Division, Centre for Infectious Disease Prevention and Control, Public Health Agency of Canada. Available at: http://www.phac-aspc.gc.ca/i-track/sr-re？-1/pdf/itrack06_e.pdf. Accessed September 24, 2012.
[5]
Public Health Agency of Canada (2011) M-Track: Enhanced surveillance of HIV, sexually transmitted and blood-borne infections, and associated risk behaviours among men who have sex with men in Canada. Phase I Report. Centre for Communicable Diseases and Infection Control Infectious Disease, Prevention and Control Branch, Public Health Agency of Canada. Available at: http://library.catie.ca/pdf/ATI-20000s/2？6403.pdf. Accessed September 24, 2012.
[6]
Public Health Agency of Canada (2011) Population-Specific HIV/AIDS Status Report: Aboriginal Peoples. HIV/AIDS Policy, Coordination and Programs Division Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada. Available at: http://www.phac-aspc.gc.ca/aids-sida/pub？lication/ps-pd/index-eng.php. Accessed September 24, 2012.
[7]
Saskatchewan Ministry of Health (2010) HIV and AIDS in Saskatchewan 2009. Annual Report. Population Health Branch, Saskatchewan Ministry of Health. Available at: http://www.health.gov.sk.ca/hiv-aids-ann？ual-report-2009. Accessed September 24, 2012.
[8]
Moss AR, Bacchetti P (1989) Natural history of HIV infection. AIDS 3: 55–61.
[9]
Carpenter CJC, Fischl MA, Hammer SM, Hirsch MS, Jacobsen DM, et al. (1996) Antiretroviral Therapy for HIV Infection in 1996. JAMA 276: 146–154.
[10]
Moore RD, Chaisson RE (1999) Natural history of HIV infection in the era of combination antiretroviral therapy. AIDS 13: 1933–1942.
[11]
Antiretroviral Cohort Collaboration (2008) Life expectancy of individuals on combination antiretroviral therapy in high-income countries: a collaborative analysis of 14 cohort studies. Lancet 372: 293–299.
[12]
Wood E, Kerr T, Marshall BDL, Li K, Zhang R, et al. (2009) Longitudinal community plasma HIV-1 RNA concentrations and incidence of HIV-1 among injecting drug users: prospective cohort study. BMJ 338: b1649.
[13]
Attia S, Egger M, Müller M, Zwahlen M, Low N (2009) Sexual transmission of HIV according to viral load and antiretroviral therapy: systematic review and meta-analysis. AIDS 23: 1397–1404.
[14]
Cohen MS, Chen YQ, McCauley M, Gamble T, Hosseinipour MC, et al. (2011) Prevention of HIV-1 Infection with early antiretroviral therapy. N Engl J Med 365: 493–505.
[15]
Government of Canada, Health Canada (2012) “Canada's Health Care System (Medicare)” Available at: http://www.hc-sc.gc.ca/hcs-sss/medi-assu？r/index-eng.php. Accessed September 24, 2012.
[16]
Yoong D (2012) Access and coverage of HIV medications across Canada, 2009. Available at: http://www.hivclinic.ca/main/drugs_reimb？use_files/Provincial%20Coverage%20of%20H？IV%20medications.pdf. Accessed September 24, 2012.
[17]
Montaner JSG, Lima VD, Barrios R, Yip B, Wood E, et al. (2010) Association of highly active antiretroviral therapy coverage, population viral load, and yearly new HIV diagnoses in British Columbia, Canada: a population-based study. Lancet 376: 532–539.
[18]
BC Centre for Disease Control (2011) HIV/AIDS Annual Report 2009. STI/HIV Prevention and Control, BC Centre for Disease Control. Available at: http://www.bccdc.ca/NR/rdonlyres/A8CE7DC？6-EBD3-4E90-9142-50B9367C8B35/0/STI_HIVR？eport_HIVAIDSUpdate2009_20110401.pdf. Accessed September 24, 2012.
[19]
Statistics Canada Causes of Death 84-208-XIE. Available at: http://www.statcan.gc.ca/bsolc/olc-cel/o？lc-cel?catno=84-208-x&lang=eng. Accessed September 24, 2012.
[20]
US Centers for Disease Control and Prevention International classification of diseases, ninth revision (ICD-9), 2009. Available at: http://www.cdc.gov/nchs/icd/icd9.htm. Accessed September 24, 2012.
[21]
World Health Organization International statistical classification of diseases and related health problems, 10th revision, 2005. Available at: http://apps.who.int/classifications/apps？/icd/icd10online2005/fr-icd.htm. Accessed September 24, 2012.
[22]
Remis RS, Swantee C, Liu J (2010) Report on HIV/AIDS in Ontario 2008. Ontario HIV Epidemiologic Monitoring Unit. Available at: http://www.phs.utoronto.ca/ohemu/doc/201？1/PHERO2008_report_final_rev_Sept2010.pd？f. Accessed September 24, 2012.
[23]
Statistics Canada Table 051-0001: Estimates of population, by age group and sex for July 1, Canada, provinces and territories, annual (persons unless otherwise noted). Available at: http://cansim2.statcan.gc.ca/cgi-win/cns？mcgi.exe?Lang=E&RootDir=CII/&ResultTempl？ate=CII/CII___&Array_Pick=1&ArrayId=0510？001. Accessed September 24, 2012.
[24]
Montaner JSG, Reiss P, Cooper D, Vella S, Harris M, et al. (1998) A randomized, double-blinded trial comparing combinations of nevirapine, didanosine and zidovudine for HIV infected patients. The INCAS Trial. JAMA 279: 930–937.
Kerr T, Tyndall M, Li K, Montaner J, Wood E (2005) Safer injection facility use and syringe sharing in injection drug users. Lancet 366: 316–318.
[27]
Wood E, Tyndall MW, Stoltz JA, Small W, Lloyd-Smith E, et al. (2005) Factors associated with syringe sharing among users of a medically supervised safer injecting facility. American Journal of Infectious Diseases 1: 50–54.
[28]
Hogg RS, Yip B, Kully C, Craib KJP, O'Shaughnessy MV, et al. (1999) Improved survival among HIV-infected patients after initiation of triple-drug antiretroviral regimens. CMAJ 60: 659–665.
[29]
Hogg RS, O'Shaughnessy MV, Gataric N, Yip B, Craib K, et al. (1997) Decline in deaths from AIDS due to new antiretrovirals. Lancet 349: 1294.
[30]
Lima VD, Hogg RS, Harrigan PR, Moore D, Yip B, et al. (2007) Continued improvement in survival among HIV-infected individuals with newer forms of highly active antiretroviral therapy. AIDS 21: 685.
[31]
Montaner JS, Hogg R, Wood E, Kerr T, Tyndall M, et al. (2006) The case for expanding access to highly active antiretroviral therapy to curb the growth of the HIV epidemic. Lancet 368: 531–536.
[32]
Fang CT, Hsu HM, Twu SJ, Chen MY, Chang YY, et al. (2004) Decreased HIV transmission after a policy of providing free access to highly active antiretroviral therapy in Taiwan. The Journal of infectious diseases 190: 879–885.
[33]
Porco TC, Martin JN, Page-Shafer KA, Cheng A, Charlebois E, et al. (2004) Decline in HIV infectivity following the introduction of highly active antiretroviral therapy. AIDS 18: 81–88.
[34]
Miller CL, Spittal PM, Wood E, Chan K, Schechter MT, et al. (2006) Inadequacies in antiretroviral therapy use among Aboriginal and other Canadian populations. AIDS Care 18: 968–976.
[35]
Public Health Agency of Canada HIV/AIDS Epi Updates – July 2010. Ottawa, ON: Surveillance and Risk Assessment Division, Centre for Infectious Disease Prevention and Control, Public Health Agency of Canada. Available at: http://www.phac-aspc.gc.ca/aids-sida/pub？lication/epi/2010/index-eng.php. Accessed September 24, 2012.
[36]
Au-Yeung CG, Anema A, Chan K, Yip B, Montaner JSG, et al. (2010) Physician's manual reporting underestimates mortality: evidence from a population-based HIV/AIDS treatment program BMC Public. Health 10: 64.
[37]
Crum NF, Riffenburgh RH, Wegner S, Agan BK, Tasker SA, et al. (2006) Comparisons of causes of death and mortality rates among HIV-infected persons: analysis of the pre-, early, and late HAART (highly active antiretroviral therapy) eras. J Acquir Immune Defic Syndr 41: 194–200.
