Population‐based epidemiology of human immunodeficiency virus infection in Western Australia

Abstract

A total of 328 cases of infection with human immunodeficiency virus (HIV) in Western Australia in 1983‐1987 was studied with respect to demographic factors, the risk profile, the clinical progression of disease, the utilization of inpatient services and trends in incidence over time. The crude incidence rates were 8.8 cases/100 000 person‐years in men and 0.4 cases/100 000 person‐years in women. Age‐specific rates peaked at 25 to 29 years of age in men. The risk of HIV infection was associated with metropolitan residence, low socioeconomic level, and two specific occupational groups. Homosexual and bisexual men constituted 86% of all cases; the incidence rate of HIV infection in such men was approximately 1000‐times higher than was the incidence rate by apparent sexual transmission in heterosexual persons. However, the proportion of cases that occurred in women or that apparently was caused by heterosexual sexual transmission increased from zero in 1983‐1984 to 7.5% and 5.4%, respectively, in 1987. After two years of follow‐up, 71% of preclinical (category‐C) patients had developed signs, symptoms or evidence of immune dysfunction, and 12% of those patients with lymphadenopathy or with other early clinical features of disease (category‐B) had progressed to the acquired immunodeficiency syndrome (AIDS). At 21 months of follow‐up, the survival rate with AIDS was 9%. Patients with AIDS utilized an average of 68.9 short‐stay hospital bed‐days per person‐year, while category‐B patients used 11.5 hospital bed‐days per person‐year. Notifications of HIV infection increased each year from 1983 to 1986, but fell by 22% in 1987. The latter may have been as a result of chance, a screening artefact or a real reduction in the incidence rate. (Med J Aust 1989; 150: 362‐370)