HIV Specialist - June 2021 - 34

HIV IN JAPAN
Figure 1. Annually reported new HIV and AID patient from 19852019
in Japan.
In Japan, over 90 percent of PWH are
men who have sex with men (MSM). The
proportion of woman is less than fi ve percent
and pediatric cases are extremely rare. As a
cause of HIV transmission, intravenous drug
use (IDU) is also very rare, at two to three
cases per year. These values suggested that in
Japan the spread of HIV is limited mainly to
MSM, while heterosexual and IDU transmission
is less frequent. However, since IDU
is considered to be spreading among MSM
in Japan, IDU transmission of HIV may be
underestimated.
Drug-Resistant HIV Strains
Among over 500 newly diagnosed PWH in
2019, 6.4 percent were infected with HIV harboring
major drug resistance mutations. By
antiretroviral therapy (ART) class, 3.7 percent
of nucleoside reverse-transcriptase inhibitors
(NRTI), 3.7 percent of non-NRTIs, 1.8 percent
of protease inhibitors (PI) and 0.2 percent of
integrase strand transfer inhibitors (INSTI)
were reported.4 This is low compared to the
resistance rate reported from other countries,
including the United States which reports 31
percent resistance to at least one drug and
INSTI resistance at 8 percent.5 In the era of
INSTI-based regimens as a fi rst choice in
treatment naïve patients, this class of medications
can safely be selected for patients in
Japan without concern for HIV resistance.
The Joint United Nations Programme on
HIV/AIDS (UNAIDS) has set the goal of " 9090-90 " --
90 percent of all people living with
HIV will know their HIV status, 90 percent of
all people with diagnosed HIV infection will
receive sustained treatment, and 90 percent
of all people receiving treatment will have
viral load suppression. In Japan, the numbers
are close to hitting this target. According to
the recent study, 85.6 percent of PWH knew
their HIV status, 82.8 percent of those were on
antiretroviral therapy (ART) and 99.1 percent
of PWH on ART achieved viral suppression at
the end of 2015 (85.6-82.8-99.1)6 (Fig.2).
The results suggest that one of the characteristics
of HIV care in Japan is that once PWH
initiate ART, a high rate of are retained in care,
leading to excellent outcomes. The success rate
is unbelievably high. This including high rates
of viral suppression. These data are consistent
with my own clinical experience.
34 JUNE 2021 HIVSPECIALIST WWW.AAHIVM.ORG
Figure 2. HIV care cascade in Japan. From reference 8.
Columns in blue and the numbers and percentages above them show the care using the number of PLWHA
(26,670) as the denominator. The lines and percentages above them show the cascade calculated between the
columns indicated by the lines
Since 2008, the number of newly diagnosed
HIV/AIDS cases has been decreasing
and the number of HIV-positive samples
detected through blood donation in Japan
has been decreasing (Fig.1). This downward
trend has continued for more than 10 years.
This trend may refl ect a potential eff ect of
treatment as prevention within the localized
MSM population given the high success rate.
Life expectancy of PWH has signifi cantly
increased due to the development of ART,
especially in high income countries such as
Japan and the U.S. However, regarding the
mortality in PWH, AIDS-related death and
non-AIDS-defi ning malignancy contributed
to 39 percent and 47 percent of death from
2005-2016 in Japan respectively.7 Moreover,
in this same study by Nishijima, mortality
of PWH on ART, even with early diagnosis
or without history of AIDS, was four times
higher than the general population.
Similar to other countries around the
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