Annual trends update: HIV, Hepatitis and STIs among MSM in Ireland (to the end of 2017) June 2018

Note: 2017 data are provisional Acknowledgements We would like to sincerely thank all who provided data for this update; The National MSM Outbreak Response group and Epidemiology subgroup The National Virus Reference Laboratory (NVRL) Microbiology Laboratories Departments of Public Health Consultants in Infectious Disease/Genitourinary Medicine STI clinics GPs and all other clinicians involved More detailed reports on HIV and STIs in Ireland can be found at http://www.hpsc.ie/a-z/hivstis/ Note: 2017 data are provisional

Overall trends in HIV Notifications stable between 2015 and 2017

HIV trends by risk group MSM account for approximately half of new notifications

HIV: Previously diagnosed abroad Proportion diagnosed abroad increasing (2017 incomplete)

HIV trends by region of birth Number of notifications stable in Irish born MSM

Summary of HIV Overall number of HIV notifications stable since 2015 MSM the group most affected by HIV in Ireland Large proportion of MSM diagnosed with HIV in Ireland were previously diagnosed abroad (40% in 2017) Majority are transferring their care and are virally suppressed at time of diagnosis in Ireland Majority of MSM diagnosed with HIV are born abroad

Hepatitis A among MSM Reports of increased numbers of hepatitis A cases in MSM in a number of European countries since mid-2016 No cases of hepatitis A in MSM in Ireland in 2016 20 cases (30% of all hepatitis A cases) identified in 2017

Hepatitis A among MSM

Hepatitis C among MSM Reports of increased numbers of MSM being diagnosed with hepatitis C since late 2015 67% HIV positive at time of HCV diagnosis Number of cases among MSM decreased in 2017

Hepatitis C among MSM *Gonorrhoea, syphilis, chlamydia, lymphogranuloma venereum or genital herpes simplex in the same year as hepatitis C notification or in the year prior to hepatitis C notification 2016 provisional data

Early infectious syphilis (EIS): Summary 2017 2017 provisional data Early infectious syphilis (EIS): Summary 2017 Increase in EIS notifications during 2017 (n=401) versus 2016 (n=305), however data are not comparable as the sensitivity of reporting increased in July 2016 MSM continue to be the group most affected, accounting for 88% of EIS notifications in 2017 (similar to 2016) 2017 provisional data

Recent trends in EIS among males 2017 provisional data Recent trends in EIS among males *Laboratory criteria for notifying EIS were updated, increasing the sensitivity of reporting, from 01st July 2016 onwards 2017 provisional data

2017 provisional data EIS: Summary 2017 Large proportion (34%) of MSM diagnosed with EIS are HIV positive (similar to 2016) Majority (51%) of MSM diagnosed with EIS were born in Ireland (25% originate from Latin America; 18% from Eastern, Central or Western Europe and 6% from other regions) 2017 provisional data

Overall trends in gonorrhoea Rates of gonorrhoea notifications increasing in recent years

Trends in gonorrhoea by risk group Proportion of cases among MSM stabilising

Summary of gonorrhoea Overall number of gonorrhoea notifications is increasing Number of gonorrhoea notifications among MSM is high but remained stable in 2017 Antibiotic resistant gonorrhoea is an international concern - Establishment of Irish committee to monitor situation

Overall trends in LGV 128 cases notified 96% notified as MSM Where known, 72% of patients were HIV positive

Trends in LGV by region of birth Over 50% of cases among Irish-born MSM

Summary of LGV Overall low number of cases -Mainly HIV positive MSM -Number of notifications decreased in 2017 The majority of cases were among Irish-born MSM, followed by those born in Latin America and Central/Eastern Europe

STEI among MSM Sexually transmitted enteric infections are an emerging issue among MSM Shigella was historically travel-associated and food/water-borne Sexually transmitted Shigellosis among MSM has been reported in recent years - Outbreaks/clusters associated with HIV+ MSM in Ireland

Overall trends in Shigellosis

Summary: HIV and STIs among MSM Overall HIV notifications remaining stable High proportion previously diagnosed abroad and majority of previously positive group are virally suppressed Hepatitis A among MSM decreased at end of 2017 Hepatitis C among MSM decreased in 2017 Syphilis proportion of MSM unchanged in 2017 compared to 2016 Gonorrhoea numbers among MSM remain high but did not increase in 2017 LGV decreased in 2017 STEIs like Shigellosis are an emerging issue among MSM