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Promising trends continue in UK diagnosis and treatment rates
Gus Cairns, 2016-10-07 07:50:00
‘mini report’ of the latest figures on HIV diagnoses, late diagnosis, and
treatment uptake in the UK reports generally good results, with downward trends
in infections, the proportion of people diagnosed late, and the proportion both
on treatment and virally suppressed.
The report is a nine-page summary of Public Health England’s
HIV statistics up to the end of 2015. A fuller report is due to be published on
Trends in diagnoses among heterosexuals continue downwards,
but for the first time since the 1990s, the number of diagnoses among men who
have sex with men also went down slightly.
The report also shows that the UK has now easily reached the WHO/UNAIDS target of 72.9% of all people with HIV having undetectable viral loads.
Long term trends show that the peak year for HIV diagnoses
in the UK was 2005, when 7887 people were diagnosed; last year it was 6095.
This is largely driven by a decline in new arrivals into the UK of people from
high-prevalence countries in Africa; the peak year for diagnosis in people of
sub-Saharan origin was 2003, with 3957 diagnoses; last year there were 1148 in
In contrast diagnoses among MSM have increased every year
this century – until last year. In 2000, there were 1541 new diagnoses in gay
men. In 2014, that figure had more than doubled to 3360. In 2015, there were
only 40 fewer (3320) and MSM form 54% of all HIV diagnoses, but although this
1% decrease may only be a statistical blip, it may also be a significant event.
The only group in which HIV infections increased last year was
in injecting drug users. These still form only 2% of diagnoses, but those
increased from 160 in 2014 to 210 in 2015. This was mainly due to a localised outbreak in Glasgow.
If HIV diagnoses are decreasing generally, this may be
because people are getting diagnosed and therefore treated and virally
suppressed earlier. The proportion of people diagnosed with a CD4 count below
350 cells/mm3 (‘late diagnosis’) is still 39% but has declined from
56% in 2006.
Heterosexual men remain the group most likely to be late
diagnosed with 55% in this category (down from two-thirds in 2006). In MSM,
only 30% are now late-diagnosed, and in London only 23%. Heterosexual Londoners
were also somewhat less likely to be diagnosed late than in the rest of the
In 2015 88,769 people accessed HIV care, a 73% increase from
2006, and a 4% increase from last year, even with fewer diagnoses. The
population on care continues to age; one in three is now over 50, though by
no means all of these are long-term diagnosed (one in six people diagnosed last
year was over 50).
If the proportion of people with HIV who are undiagnosed has
not increased from last
year’s 17% estimate (this figure is not given in the mini-report), then the
UK has easily achieved the UNAIDS/WHO
‘90/90/90’ target of having 72.9% of its entire HIV-positive population
virally suppressed (equivalent to 90% diagnosed, 90% of those on treatment, and
90% of them virally suppressed).
Last year 96% of people who access HIV care was on treatment.
This is a significant rise from 90% in 2014 and is likely to reflect the change
treatment guidelines last year to treatment for all on diagnosis. Of those,
94% were virally suppressed (89% of all in care). This implies that an
estimated 74.9% of all people with HIV living in the UK are now virally
suppressed. Interestingly, a model discussed
by Kimberly Powers at
the 2014 HIV Research for Prevention Conference suggested that in an HIV epidemic
where most infections are recent, 70% suppression might be the threshold above
which one could expect to see HIV incidence starting to go down because so many
people were virally suppressed. It remains to be seen whether 2015 has turned