UK HIV diagnoses fall - because fewer people infected abroad

With 6630 people newly diagnosed in 2009, this is the fourth year in a row in which the UK has seen a fall in the number diagnosed with HIV, the Health Protection Agency announced today. However, the decline has been driven by falls in the number of people who acquired their infection abroad, whereas diagnoses of gay men and other people who acquired HIV in the UK remain stubbornly high.

Moreover, the HPA says that there has been no decline in the number of undiagnosed infections over the past decade.

New diagnoses

Whereas almost 8000 people were diagnosed with HIV in 2005, the figure in 2009 was 6630.

The fall in diagnoses has been driven by reductions in the number of heterosexuals who acquired their infection abroad, especially in sub-Saharan Africa. In 2005, 3115 of those diagnosed were in this group, but in 2009 the figure had dropped to 2430.

At the same time, the numbers of new diagnoses in other groups have remained broadly stable: 2760 gay and bisexual men were diagnosed in 2009, as were 1130 heterosexual people who acquired HIV in the UK and 170 injecting drug users.

Fifty-four per cent of newly diagnosed people acquired their infection through heterosexual sex. Just under two-thirds of this group were black African.

Forty-two per cent of newly diagnosed people were infected during sex between men.

Recent infection

The report also presents data from new systems of detecting how recently a person acquired HIV. The procedure, known as RITA (Recent Infection Testing Algorithm) identifies newly diagnosed individuals who were probably infected in the past four or five months.

One-in-six (17%) newly diagnosed gay or bisexual men were infected recently, and similar proportions of recent infections were seen across all age ranges.

Among heterosexual people, one-in-16 (7%) had recent infection. By age, the highest proportions were in women aged 15 to 24 (16%) and men aged 25 to 34 (12%).

Undiagnosed infection

Of the total 86,500 people estimated to be living with HIV in the UK, one quarter remain undiagnosed (22,200 or 26%).

A recent study, looking at HPA data between 2001 and 2008, found that the proportion of undiagnosed HIV infections has dropped over the decade. Nonetheless, because the total number of people with HIV has risen, the actual number of people with undiagnosed HIV has remained stable. To put this in other terms, the proportion of the general population who have undiagnosed HIV has remained stable.

Late diagnosis

In the past, figures for the number of people diagnosed ‘late’ were based on the proportion who had a CD4 cell count below 200 cells/mm³ at the time of diagnosis. However, now that HIV treatment is recommended for everyone with a CD4 cell count below 350 cells/mm³, the new cut-off point is 350 cells/mm³.

In 2009, 52% of people were diagnosed late. The proportion was lower among gay and bisexual men (39%) compared with heterosexual women (59%) and heterosexual men (66%).

Moreover, 30% were diagnosed ‘very late’ (with a CD4 cell count below 200 cells/mm³).

Three-quarters of the 516 HIV-positive people who died in 2009 had been diagnosed late.

Accessing HIV care

In 2009, a total of 65,319 people used HIV clinics, which represents a 7% increase in a single year.

Seventy-eight per cent of people with diagnosed HIV took antiretroviral therapy in 2009 (up from 70% in 2000). Nonetheless, 17% of those with a CD4 cell count below 350 cells/mm³ did not take treatment.

Older adults

The HPA report highlights the ageing population of people with HIV in the UK, an issue previously reported on aidsmap.com (here and here). In 2009, people aged 50 or over represented one-in-five of adults accessing HIV care and 13% of all new HIV diagnoses. Two-thirds of this age group were diagnosed late.

Comments

Commenting on the report, Dr Valerie Delpech of the HPA drew attention to the data on undiagnosed infection and late diagnosis, which suggest problems with the provision of HIV testing.

“The HPA would like to see increased access to HIV testing in areas where rates of HIV infection are high,” she said. “Pilot studies have shown that in these areas testing all adults registering at GPs or accessing certain hospital services can make an impact. The evidence shows that this testing is feasible to undertake and acceptable to patients.”

Deborah Jack of the National AIDS Trust (NAT) added: “The latest HIV figures underline the need for us to do more in both HIV prevention and HIV testing.  As the Government prepares its Public Health White Paper, NAT is calling for commitment to reduce the continuing stubbornly high numbers of people getting HIV in the UK.”