Promising trends continue in UK diagnosis and treatment rates

A ‘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 8 November.

Trends in diagnoses among heterosexual people continue downwards, but for the first time since the 1990s, the number of diagnoses among men who have sex with men (MSM) 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 that group.

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 make up 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 people who inject drugs. 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 diagnosed late with 55% in this category (down from two-thirds in 2006). In MSM, only 30% are now diagnosed late, and in London only 23%. Heterosexual Londoners were also somewhat less likely to be diagnosed late than in the rest of the country.

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 in 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 accessed HIV care was on treatment. This is a significant rise from 90% in 2014 and is likely to reflect the change in UK treatment guidelines last year to recommend 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 this corner.