35% of HIV infections diagnosed late in England and Wales last year

Over one-third of all new HIV diagnoses last year in England and Wales were made when the CD4 count was below 200 cells/mm³: the time by which people with HIV are recommended to have started treatment in current British HIV Association (BHIVA) guidelines. Response to treatment is significantly poorer in people who start after this point, and people with CD4 cell counts below 200 cells/mm³ are at much greater risk of developing AIDS-related illnesses.

The latest HIV infection data for 2002 (based on reports to the end of March 2003), released at the Health Protection Agency’s First Annual Conference, indicate that late HIV diagnosis continues to late HIV diagnosis continues to contribute substantially to the late initiation of HAART in the UK. In 2001, BHIVA found that almost 60% of those with CD4 counts below 200 were not receiving HAART, largely due to late HIV diagnosis.

However half as many people (10.4% of all new HIV infections in 2002) are being newly diagnosed with an AIDS-defining illness at the same time as being newly diagnosed with HIV as in 1997 - when the rate was 20% - implying that HIV testing campaigns have had some success, particularly amongst gay/bisexual men and pregnant women.

Who is being diagnosed late?

Late HIV diagnosis can be defined in two ways: either being diagnosed with both HIV and an AIDS-defining illness within 30 days of each other, or being diagnosed with a CD4 count

Using either definition, heterosexual males - the vast majority of whom were black Africans who acquired their HIV infection outside of the UK - were almost twice as likely as all other at-risk groups to be diagnosed with an AIDS-defining illness at the time of their HIV diagnosis, and two-and-a-half times more likely than gay/bisexual men to present for HIV diagnosis with a CD4 count below 200.

It is not clear from the data, however, how many black African males were aware of their HIV infection prior to testing HIV-positive for the first time at a UK clinic. Crucially, a presentation from the North West region found that asylum seekers were more likely to have voluntary HIV tests than the population at large, although another presentation reporting on anonymous HIV seroprevalence data from GUM clinics found that HIV prevalence was three times higher amongst people born in sub-Saharan Africa not accepting a voluntary HIV test, compared with those accepting one. That particularly study concluded: “Those at the highest risk of HIV infection are less likely to accept voluntary confidential HIV tests.”

Overall 35% of new HIV diagnoses were made when CD4 counts were already 200 or below. Specifically, 27% of gay/bisexual men, 37% of IDUs, 40% of female heterosexuals and 49% of male heterosexuals were diagnosed when their immune systems were already severely immunosuppressed. Heterosexual women were more than twice as likely, and injection drug users more than one and a half times likely as gay/bisexual men to have a CD4 cell count below 200 at HIV diagnosis.

A total of 4248 new HIV infections in the UK have been reported so far for 2002, however this number will in all probability rise to a number substantially higher than the 2001 final figure of 4909 once all reporting is tallied. The latest data will be released by the HPA in October. As the figures currently stand, 54% of new HIV infections were attributed to heterosexual sex (33% in females, 21% in males), 42% due to gay/bisexual sex, 3% due to injection drug use and 1% due to mother-to-infant transmission.

Further information on this website

Counting the cost of late presentation for HIV care - news story

Late diagnosis of UK nationals at low risk of HIV - news story

BHIVA audits adherence to UK treatment guidelines - news story