AIDS – New Zealand
Issue 40 – February 1999
ISSN 1170-2656
AIDS and HIV infection in New Zealand to end of December 1998
In the final quarter of 1998, there were 9 notifications of AIDS (all male), while 19 people (16 male and 3 female) were found to be infected with HIV. To the end of December 1998, in total 669 people (637 male and 32 female) have been notified with AIDS, and 1336 people (1173 male, 144 female, and 19 sex not stated) have been found to be infected with HIV.
Trend in numbers of people developing AIDS and living with diagnosed HIV
It is pleasing that ten years after the first issue of AIDS New Zealand we can report that the number of people diagnosed with AIDS in 1998 (23) was the lowest annual total since 1986 (Table 1). In addition the number of people dying from AIDS (15) in 1998 was the lowest since 1987.
It is likely that the levelling in the incidence of AIDS from 1989 seen in Table 1 was due to a reduction of new infections of HIV several years earlier. However, the precipitous drop in 1997, which simultaneously occurred in many developed countries, is considered to be due to the widespread introduction of more effective combination treatments which delayed the development of AIDS in HIV-infected people.
In contrast the number of people found to be infected with HIV in New Zealand was higher in 1998 than in any year since 1992 (Table 1). This was due to an increase in the number of infected people coming to New Zealand from high prevalence areas.
The effect of the fall in the number of people dying from AIDS and the increase in those diagnosed with HIV is that the number of people living in New Zealand with diagnosed HIV has continued to rise. The numbers of people diagnosed with HIV infection, notified with AIDS, dying with AIDS and the estimated number of people living with diagnosed HIV in New Zealand at the end of each year from 1985 to 1998 are shown in the figure below.
Figure
At the end of 1998 it is estimated that there were approximately 770 people (650 males and 120 females) living with diagnosed HIV in New Zealand. These estimates have been made by subtracting from the number of people found to be infected with HIV, the number known to have died or gone overseas.
The latter information is available only for people notified with AIDS. These figures are only estimates as some HIVinfected people may have been counted more than once, others (who have not developed AIDS) may have gone overseas, others may have entered New Zealand and not been tested here, and others may have died without developing AIDS.
Table 1 Annual number of people notified with AIDS, deaths of people with AIDS, and people diagnosed with HIV
* The number of people diagnosed in 1998 may increase due to delayed notification.
† An additional 41 people have either gone overseas or it has not been able to obtain outcome information for another reason
‡Testing first became available in 1985
In addition these estimates are of those diagnosed with HIV. The actual number infected will be higher as some infected people will not have been tested.
An analysis of the impact of the reduction in the number of people progressing to AIDS in the United Kingdom, where a substantial drop first occurred in 1996, has recently been published (Aalen OO, Farewell VT, De Angelis D, Day NE, Gill ON. New therapy explains the fall in AIDS incidence with a substantial rise in number of persons on treatment expected. AIDS 1999;13:103-8). The authors point out that in the UK the wide introduction of combination anti-retroviral therapies will result in a substantial increase in the number of HIV infected people requiring help from the health care system. They also warn that the incidence of AIDS would be expected to rise again if these treatments prove to have a limited duration of effectiveness.
Apart from the workload issues, the pattern of health care required could also be altered by the widespread use of these new therapies. While they remain effective, there will be fewer people requiring management for severe immunosuppression but more people requiring assistance with managing complex long term therapy.
The improvements in treatment also mean that changes in the care and support requirements of HIV-infected people are occurring. There is likely to be less need for care of chronically sick people, and more need for advising on long term issues such as employment, housing and finances among HIV-infected people.
The development of resistance of HIV to antiretroviral drugs is a major concern. A recent study in five cities across the US found drug resistant virus in at least 25% of the HIV infected people tested. Adherence to the complex drug regimes, which can be very demanding, appears to be important in reducing the risk of an individual developing resistance. Widespread resistance would lead to an increase in the number of AIDS cases. Although the new therapies have been able to bring about an improvement in the health of many infected people, it is most important to maintain efforts to control the spread of HIV.
Notifications of AIDS in New Zealand in the final quarter of 1998
Nine people, all male, were notified with AIDS in the final quarter of 1998. Six were men reported to have had sex with
other men, 2 were reported to have been infected through the sharing of equipment used for injecting drugs (one man had injected anabolic steroids and the other was from South East Asia), and the remaining man (who was from a high prevalence area) was reported to have been heterosexually infected.
People found to be infected with HIV in New Zealand in the final quarter of 1998
In the final quarter of 1998, 19 people were found to be infected with HIV.
Of these, 16 were male, and 3 were female Of the 16 males found to be infected, information has to date been obtained on 13. Of these 13, 7 were reported to have had sex with men, 5 were reported to have been heterosexually infected (all were from high prevalence areas), and one man was reported to have been infected through receiving a contaminated blood transfusion during a surgical operation in a high prevalence area in 1998.
Information has been obtained on all 3 females found to be infected. All were reported to have been heterosexually infected. Two of the women were from a high prevalence area, and the other was reported to have been infected in such an area.
Exposure categories and ethnicity of people notified with AIDS and found to be infected with HIV
Information on the categories of risk, sex and ethnicity, of the 669 people notified as having AIDS and the 1336 people diagnosed with HIV in New Zealand to the end of December 1998 is shown in Tables 2 and 3.
It is notable that the number of people found to be infected with HIV in 1998 was 105, the highest number since 1992. In addition nearly half of these people were reported to have been heterosexually infected, and a similar proportion were classified as of an ‘other’ ethnicity.
As was reported in our previous AIDS – New Zealand (Issue 39, November 1998), the vast majority of people diagnosed with HIV infection and reported to have been heterosexually infected have been infected outside New Zealand.
Information on the place where infected people were diagnosed has been collected since 1994, and gives insight into the reason for the rise in the total number of people found to be infected in 1998. Of the 105 people diagnosed in 1998, 43 (41%) were diagnosed as a result of the refugee health assessment which is offered to quota refugees
and asylum seekers. Although there has been some variation in the numbers diagnosed each year up to 1997, the marked increase in 1998 is likely to have been affected by this.
Of the 105 people diagnosed in 1998, 24 were reported to have been infected within New Zealand. Of these 24, 20 were men who had had sex with other men.
Table 2 Exposure category by time of notification of people with AIDS, and by time of diagnosis for those found to be infected with HIV
 NS = Not stated
* Includes people who have developed AIDS
‡ Acquired overseas
Table 3 Ethnicity by time of notification of people with AIDS, and by time of diagnosis for those found to be infected with HIV. Information on ethnicity of people found to be infected with HIV is only available since 1996
NS = Not stated
* Includes people who have developed AIDS
‡Includes people who belong to Maori and another ethnic group
For further information about the occurrence of AIDS in New Zealand contact:
Dr Nigel Dickson
AIDS Epidemiology Group
Department of Preventive and Social Medicine
University of Otago Medical School
PO Box 913
Dunedin
New Zealand
Tel: (03) 479 7211
Fax: (03) 479 7298
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