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Massive scale-up of HIV testing, plus HIV treatment on diagnosis, needed to curtail UK gay epidemic
Roger Pebody, 2014-03-11 18:50:00

Increasing the proportion of HIV-positive gay men in the UK who have an undetectable viral load from the current figure of around 60% to 90% could result in a substantial drop in new HIV infections, a modelling study suggests. In order to achieve this, it wouldn’t be enough to change treatment guidelines – a substantial increase in HIV testing rates would also be required, Andrew Phillips of University College London told the 21st Conference on Retroviruses and Opportunistic Infections (CROI) in Boston last week.

However, Phillips noted that any decreases in current rates of retention in care, treatment adherence or condom use could have a negative impact on these predictions.

Reviewing the HIV epidemic among gay and other men who have sex with men (MSM) in the UK, Phillips said that there are approximately 600,000 MSM in the country, of whom around 45,000 are living with HIV. While approximately 20% are unaware of their infection, over 80% of diagnosed men are taking HIV treatment and 95% of those on treatment have an undetectable viral load. In all, approximately 60% of gay men living with HIV are virally suppressed.

It might therefore be expected that this high coverage of HIV treatment would have a substantial preventive effect, and that new infections would be falling. However, Phillips’ previously published modelling suggests that, in recent years, around 2500 men have newly acquired HIV each year, and this figure is either stable or increasing. Incidence is around 0.45% (in other words, each year around four in 1000 men become HIV positive).

His analyses suggest that while current provision of treatment has curbed infections, its impact has been undermined by an increase in the number of men having sex without a condom. Similar conclusions have been reached by researchers looking at the gay epidemics in the Netherlands and Switzerland. Moreover, epidemics of HIV in men who have sex with men continue to expand in most countries of the world.