Characteristics of heterosexually-acquired compared to homosexually-acquired HIV and implications for clinical practice: results from the Australian HIV Observational Database

ABSTRACT

Heterosexuals living with HIV report feeling additional HIV stigma compared to homosexual men, which may affect clinical outcomes. Yet, beyond routinely collected surveillance data, little is known about the characteristics of individuals who acquire HIV heterosexually and clinical outcomes by mode of sexual acquisition have not been directly compared. Using data from the Australian HIV Observational Database, we compared clinical characteristics of those with heterosexually-acquired (Het-HIV) to homosexually-acquired HIV (Hom-HIV) to investigate any differences and their implications for clinical management. 513 Het-HIV and 1467 Hom-HIV patients were included and contributed 3,127 and 9,457 person-years of follow-up, respectively. Compared with Hom-HIV, Het-HIV were more often born outside Australia (62.5% vs 39.9%, p<0.001), less likely to have Hepatitis C (4.8% vs 7.8%, p=0.029) and had lower median CD4 counts at diagnosis (292 vs 450 cells/µL, p<0.001) and cART initiation (270 vs 340 cells/µL, p<0.001). Despite these lower CD4 counts, there were no significant differences between groups for time to the major clinical endpoints of cART initiation, viral suppression, virological failure or all-cause mortality. Het-HIV had a lower risk of loss-to-follow-up than Hom-HIV (aHR 0.78; 95% CI 0.64-0.95). Further studies examining factors associated with, and interventions to inform retention in care are required.

KEYWORDS:

• HIV/AIDS
• heterosexual
• mode of transmission
• loss to follow up
• outcome

Acknowledgements

The Australian HIV Observational Database is funded as part of the Asia Pacific HIV Observational Database, a program of The Foundation for AIDS Research, amfAR, and is supported in part by grant number U01-AI069907 from the U.S. National Institutes of Health with funding provided by the National Institute of Allergy and Infectious Diseases, Eunice Kennedy Shriver National Institute of Child Health and Human Development and the National Cancer Institute, and by unconditional grants from Merck Sharp & Dohme, ViiV Healthcare and Janssen-Cilag and previously from Gilead Sciences, Bristol-Myers Squibb and Boehringer Ingelheim.

The Kirby Institute is funded by the Australian Government Department of Health, and is affiliated with the Faculty of Medicine, UNSW Sydney. The Funders had no role in the study design, data collection and analysis, decision to publish or preparation of the manuscript.

The Authors acknowledge all AHOD participants and participating sites: New South Wales: D Ellis, Plaza Medical Centre, Coffs Harbour; M Bloch, T Vincent, Holdsworth House Medical Practice, Sydney; D Allen, Holden Street Clinic, Gosford; D Smith, A Rankin, Lismore Sexual Health & AIDS Services, Lismore; D Baker*, East Sydney Doctors, Surry Hills; DJ Templeton*, Niveditha Manokaran, R Jackson, RPA Sexual Health, Camperdown; Eva Jackson, K McCallum, Nepean and Blue Mountains Sexual Health and HIV Clinic, Penrith; N Ryder, G Sweeney, B Moran, Clinic 468, HNE Sexual Health, Tamworth; A Carr, K Hesse, T Chronopoulos, F Bascombe, St Vincent’s Hospital, Darlinghurst; R Finlayson, C Tan, J Le, Taylor Square Private Clinic, Darlinghurst; K Brown, V Aldous, JL Little, Illawarra Sexual Health Service, Warrawong; R Varma, H Lu, Sydney Sexual Health Centre, Sydney; D Couldwell, J Walsh, Western Sydney Sexual Health Clinic; DE Smith*, V Furner, D Smith, Albion Street Centre; S Fernando, Clinic 16 – Royal North Shore Hospital; A Cogle*, National Association of People living with HIV/AIDS; C Lawrence*, National Aboriginal Community Controlled Health Organisation; B Mulhall*, Department of Public Health and Community Medicine, University of Sydney; M Boyd*, University of Adelaide; M Law*, K Petoumenos*, R Puhr*, J Hutchinson*, T Dougherty, The Kirby Institute, University of NSW. Northern Territory: M Gunathilake, K Jackson, Centre for Disease Control, Darwin. Queensland: M O’Sullivan, S White, Gold Coast Sexual Health Clinic, Southport; D Russell, F Bassett, M Rodriguez, Cairns Sexual Health Service, Cairns; D Sowden, K Taing, P Smith, Clinic 87, Sunshine Coast Hospital and Health Service, Nambour; D Orth, D Youds, Gladstone Road Medical Centre, Highgate Hill; D Rowling, J Langton-Lockton, N Latch, F Taylor, Sexual Health and HIV Service in Metro North, Brisbane; B Dickson*, CaraData. South Australia: W Donohue, O’Brien Street General Practice, Adelaide. Victoria: R Moore, S Edwards, S Boyd, Northside Clinic, North Fitzroy; NJ Roth*, H Lau, Prahran Market Clinic, South Yarra; T Read, J Silvers*, W Zeng, Melbourne Sexual Health Centre, Melbourne; J Hoy*, M Giles*, K Watson*, M Bryant, S Price, The Alfred Hospital, Melbourne; I Woolley, T Korman, J O’Bryan, K Cisera, Monash Medical Centre, Clayton. Western Australia: D Nolan, A Allen, G Guelfi. Department of Clinical Immunology, Royal Perth Hospital, Perth. New Zealand: G Mills, C Wharry, Waikato District Hospital Hamilton; N Raymond, K Bargh, Wellington Hospital, Wellington.

Disclosure statement

No potential conflict of interest was reported by the author(s).