UK's failure to tackle undiagnosed HIV infections is 'appalling' says Lancet

The large number of undiagnosed HIV infections in the UK is “appalling”, a former government official is quoted as saying in an editorial published in the May 30^th edition of The Lancet.

“There is no credible strategy to diagnose and care for those living with, but unaware of HIV in Britain today”, writes the author of the editorial.

There are 77,000 people living with HIV in the UK. However, it is estimated that 21,000 of these individuals are unaware of their HIV infection.

Many of these undiagnosed individuals will only have their HIV detected when they are already seriously ill with an AIDS-defining illness. Late diagnosis of HIV is the underlying cause of the majority of HIV deaths still seen in the UK. With earlier diagnosis these individuals would have been able to take appropriate treatment for HIV and other infections meaning that these deaths are entirely avoidable.

Furthermore, there is accumulating evidence that the undiagnosed individuals are the principal source of new HIV infections in the UK. A presentation by Dr Valerie Delpech at a recent NAM symposium on the potential of HIV treatment to help control the spread of HIV emphasised the importance of undiagnosed HIV to the continued epidemiology of HIV. One of the event's take home messages was that reducing the number of undiagnosed HIV infections is essential to the control of the epidemic.

“It should be a matter of deep concern to the UK’s Department of Health that so many individuals are entirely unaware of their positive HIV status”, states the editorial. Recommendations from the Health Protection Agency that individuals with any risk or possible symptoms of HIV infection should be offered an HIV test “have largely been ignored”, write the author.

“No one is listening” to urgent pleas for action to reduce the high number of undiagnosed infections, continues the editorial. At a recent seminar on late diagnosis of HIV, a senior HIV consultant described the rejection by a specialist GP journal of a study showing that symptoms of primary HIV infection were often missed in general practice and the potentially serious consequences of this. Nor are hospitals paying adequate attention “to their public health responsibilities, of which HIV diagnosis is an important part.” Furthermore, primary care trusts have exhibited little interest in “this serious public health challenge.”

The Lancet editorial recommends that all patients registered with GPs and admitted to hospital who are aged between 15 and 59 should be offered an HIV test. It notes that routine antenatal HIV testing in the UK has a very high acceptance rate.

Failure to develop a strategy to deal with the high level of undiagnosed HIV infections in the UK “is an extraordinary failure of public health”, concludes the editorial, adding “this failure needs an urgent response.”