Epidemiology of HIV infection in Ontario: Update to 2007
Robert S. Remis MD, MPH, Juan Liu MScOntario HIV Epidemiologic Monitoring Unit
Department of Public Health Sciences, University of Toronto
HCV Task ForceOntario Advisory Committee on HIV/AIDS
Toronto, May 26, 2008
Background
• HIV epidemic in Ontario remains unstable and dynamic
• Many developments have influenced epidemiologic trends:
•Education, information and prevention activities
• Identification of virus, 1984
•HIV test October 1985
•Antiretroviral drugs 1987, HAART 1997
Number of HIV diagnoses by sexand proportion female, 1981-2007
0
400
800
1,200
1,600
2,000
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
Year
Num
ber
HIV
dia
gnos
es
0.0%
10.0%
20.0%
30.0%
40.0%
Pro
port
ion
fem
ale
(%)
MalesFemales% female
* Adjusted for unknown sex
Number of HIV diagnoses Toronto, 1996-2007
0
200
400
600
800
1,000
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007
Year
Num
ber
HIV
dia
gnos
es
Number of HIV diagnoses for other health regions, Ontario, 1996-2007
0
40
80
120
160
200
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007
Year
Num
ber
HIV
dia
gnos
es
Northern Eastern, otherOttawa Central East, otherSouthwest Central West
Number of HIV diagnoses by exposure category, Ontario, 1996-2007
0
100
200
300
400
500
600
700
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007
Year
Num
ber
HIV
dia
gnos
es
MSM MSM-IDUIDU HIV-endemicHR hetero LR hetero
* Adjusted for unknown sex, health region and exposure category
Number of reported AIDS cases by sexand proportion female, 1981-2006
0
200
400
600
800
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
Year
Num
ber
HIV
dia
gnos
es
0.0%
5.0%
10.0%
15.0%
20.0%
25.0%
30.0%
Pro
port
ion
fem
ale
(%)
MalesFemales% female
Modeled HIV prevalence and number diagnosed by exposure category, Ontario, 2006
HIV prevalence Proportion Ontario HIV diagnosed Proportion
diagnosed
MSM 15,656 59.4% 10,426 66.6%
MSM-IDU 712 2.7% 483 67.7%
IDU 1,935 7.3% 1,357 70.1%
HIV-endemic 4,181 15.9% 2,466 59.0%
Heterosexual 3,715 14.1% 1,790 48.2%
Clotting factor 127 0.5% 119 94.2%
Transfusion 30 0.1% 30 99.4%
Total 26,356 100% 16,671 63.3%
Modeled HIV incidence among MSMOntario, 1977-2006
0.0%
0.5%
1.0%
1.5%
2.0%
2.5%
3.0%
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
Year
Ann
ual i
ncid
ence
rat
e
0
200
400
600
800
1,000
1,200
1,400
1,600
1,800
Num
ber
of n
ew in
fect
ions
Incidence rate
Incidence number
Modeled HIV prevalence among MSMOntario, 1977-2006
0.0%
5.0%
10.0%
15.0%
20.0%
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
Year
Pre
vale
nce
%
0
2,000
4,000
6,000
8,000
10,000
12,000
14,000
16,000
18,000
Num
ber
infe
ctio
ns
Prevalence %
Prevalence number
Modeled MSM number, HIV prevalence and incidence by health region, Ontario, 2006
890
170
100
620
Annual HIVincidence
(No.)
17.2%
10.2%
11.9%
23.2%
Prevalence HIV
15,660
3,280
1,240
11,140
Number HIV
90,800
32,300
10,400
48,100
NumberMSM
1.2%Ontario, total
0.59%Rest of Ontario
1.1%Ottawa
1.7%Toronto
Annual HIVincidence
(%)Health region(aggregated)
MSM: Epidemiologic highlights
• 15,560 infected, of whom 67% diagnosed• New HIV diagnoses in 2006 up 26% over 2001• HIV prevalence 17.2%: Toronto 23.2%, Ottawa 11.9% and
other 10.2%• HIV prevalence up 31% 2001 to 2006, annual 5.5% • 888 new HIV infections in 2006 • HIV incidence 1.2%: Toronto 1.7%, Ottawa 1.1% and other
0.59%
Modeled HIV incidence among IDUOntario, 1977-2006
0.0%
0.2%
0.4%
0.6%
0.8%
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
Year
Ann
ual i
ncid
ence
rat
e
0
20
40
60
80
100
120
140
160
180
200
Num
ber
of n
ew in
fect
ions
Incidence rate
Incidence number
Modeled HIV prevalence among IDUOntario, 1977-2006
0.0%
1.0%
2.0%
3.0%
4.0%
5.0%
6.0%
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
Year
Pre
vale
nce
%
0
500
1,000
1,500
2,000
2,500
Num
ber
infe
ctio
ns
Prevalence %
Prevalence number
Modeled IDU number, HIV prevalence and incidence by health region, Ontario, 2006
80
30
20
30
Annual HIVincidence
(No.)
4.9%
4.0%
14.5%
4.1%
Prevalence HIV
1,930
790
480
660
Number HIV
39,100
19,800
3,300
16,100
NumberIDU
0.22%Ontario, total
0.16%Rest of Ontario
0.71%Ottawa
0.19%Toronto
Annual HIVincidence
(%)Health region(aggregated)
IDU: Epidemiologic highlights
• 1,940 infected, of whom 70.1% diagnosed• New HIV diagnoses in 2006 down 32% over 2001• HIV prevalence 4.9%: Ottawa 14.5%, Toronto 4.1% and
other 4.0%• HIV prevalence up 10% from 2001 to 2006, annual 1.9%• 82 new HIV infections in 2006 • HIV incidence 0.22%: Ottawa 0.71%, Toronto 0.19% and
other 0.16%
Modeled HIV incidence among persons from HIV-endemic regions, Ontario, 1977-2006
0
100
200
300
400
500
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
Year
Num
ber
of n
ew in
fect
ions
Incidence number
Modeled HIV prevalence among persons from HIV-endemic regions, Ontario, 1977-2006
0.0%
0.2%
0.4%
0.6%
0.8%
1.0%
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
Year
Pre
vale
nce
%
0
500
1,000
1,500
2,000
2,500
3,000
3,500
4,000
4,500
Num
ber
infe
ctio
ns
Prevalence %
Prevalence number
Modeled population, HIV prevalence and incidence among persons from HIV-endemic regions by health region, Ontario, 2006
425
80
85
260
Annual HIVincidence
(No.)
0.94%
0.49%
2.8%
1.1%
Prevalence HIV
4,180
960
770
2,450
Number HIV
447,000
195,400
29,900
223,800
Population
0.10%Ontario, total
0.04%Rest of Ontario
0.31%Ottawa
0.12%Toronto
Annual HIVincidence
(%)Health region(aggregated)
HIV-endemic: Epidemiologic highlights
• 4,180 HIV infected, of whom 59% diagnosed• New HIV diagnoses in 2006 up 31% over 2001• HIV prevalence 0.94%: Toronto 1.1%, Ottawa 2.8% and
other 0.49%• HIV prevalence up 72% from 2001 to 2006, annual 11.5%• 430 new HIV infections in 2006
• Includes imported and acquired in Canada
• HIV incidence 0.10%: Toronto 0.12%, Ottawa 0.31% and other 0.04%
Modeled HIV incidence among persons atheterosexual risk, Ontario, 1977-2006
0.0%
0.0%
0.0%
0.0%
0.0%
0.1%
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
Year
Ann
ual i
ncid
ence
rat
e
0
50
100
150
200
250
300
350
400
Num
ber
of n
ew in
fect
ions
Incidence rate
Incidence number
Modeled HIV prevalence among persons atheterosexual risk, Ontario, 1977-2006
0.0%
0.1%
0.2%
0.3%
0.4%
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
Year
Pre
vale
nce
%
0
500
1,000
1,500
2,000
2,500
3,000
3,500
4,000
Num
ber
infe
ctio
ns
Prevalence %
Prevalence number
Modeled population, HIV prevalence and incidence among persons at heterosexual risk by health region, Ontario, 2006
355
130
45
180
Annual HIVincidence
(No.)
0.040%
0.020%
0.080%
0.105%
Prevalence HIV
3,710
1,400
480
1,830
Number HIV
9,203,000
6,855,000
602,000
1,748,000
Population
0.0039%Ontario, total
0.0019%Rest of Ontario
0.0075%Ottawa
0.0103%Toronto
Annual HIVincidence
(%)Health region(aggregated)
Heterosexual: Epidemiologic highlights
• 3,720 HIV-infected, of whom 48% diagnosed• New HIV diagnoses in 2006 up 31% over 2001• HIV prevalence 0.040%: Toronto 0.105%, Ottawa 0.080%,
and other 0.020%• HIV prevalence up 70% from 2001 to 2006, annual 11.2%• 360 new HIV infections in 2006 • HIV incidence 0.004%: Toronto 0.010%, Ottawa 0.08% and
other 0.002%
HIV diagnoses highlights: 2007
• 1,076 new HIV diagnoses in 2007• Decrease of 7% (82 cases) compared to 2006, mainly due to a
decrease among females (27% decrease, 96 cases) • Compared to 2006
• Decreases: HIV-endemic 40% (115 cases), LH hetero 16% (30 cases), HR hetero 21% (11 cases)
• Increases: IDU 71% (42 cases), MSM-IDU 29% (8 cases), MSM 1.8% (9 cases)
• Decreases: Toronto 10% (72 cases), Eastern, other 53% (18 cases), Central West 8% (10 cases), Ottawa 5% (8 cases), Southwest 5% (3cases)
• Increases: Northern 53% (14 cases) and Central East, other 23% (16 cases)
Conclusions
• HIV epidemic in Ontario is not yet under control• Good news:
• AIDS incidence and mortality decreasing• HIV infection among IDUs relatively stable
• However. . . . . • Continued HIV incidence in MSM, with high prevalence in
Toronto• Overall, HIV prevalence increased from 2001 to 2006 by
38% (19,000 to 26,400)• HIV prevalence increased markedly in HIV-endemic and
other heterosexual exposure categories
Acknowledgements
• Frank McGee, Coordinator, AIDS Bureau, Ontario Ministry of Health and Long Term Care (MOHLTC)
• Carol Swantee, HIV Laboratory, MOHLTC • Maraki Fikre Merid, University of Toronto• Ontario HIV Treatment Network and Public Health Agency of
Canada for funding Laboratory Enhancement Study
