UK 2015 HIV statistics: high engagement with ART but new infections in gay men and late diagnosis overall still high

29 November 2016. Related: HIV prevention and transmission, Other news.

Simon Collins, HIV i-Base

On 20 October 2016, an early summary of latest annual HIV statistics (for the year 2015) were released from Public Health England. [1]

The report shows that HIV continues to be an epidemic that disproportionately affects gay men (54% of all diagnoses) and that current prevention options are failing to reduce these rates.

In terms of the 90-90-90 global targets, the percentage of people who are undiagnosed will not be published until November, but this is likely to fall short of 90%. However, 96% of people who are diagnosed overall in the UK are receiving antiretroviral treatment (ART) and 94% of those on ART have undetectable viral load.

New diagnoses

In 2015, 6095 people (4551 men and 1537 women) were diagnosed with HIV in the UK. This included 65 children, 5012 adults aged 15-49 years and 1018 adults aged 50 years or over.

After adjusting for missing exposure information, 3320 diagnoses (54%) were reported among gay, bisexual and other men who have sex with men. Although a slight decline on 2014 (3,360), new HIV diagnoses among MSM remained high. This reflects an increase in levels of HIV testing as well as ongoing transmission in this group.

A total of 2360 new diagnoses were reported in heterosexual men (1010) and women (1350).

Late diagnosis also remains a significant concern with 39% (2350/6028) of adults diagnosed late stage (defined as CD4 counts < 350 cells/mm3). This proportion was higher among heterosexuals, with 55% (490/890) of men and 49% (536/1,094) of women diagnosed late. Rates were lower in MSM (30%; 877/2923). A total of 305 people were diagnosed with AIDS at their HIV diagnosis (CD4 <200) cells/mm3).

For geographic differences, late diagnosis was 50% in the Midlands and East of England, 47% in the North of England, 41% in the South of England and 32 % in London. MSM in London had a lower rate of late HIV diagnosis (23%; 296/1287) compared to those living outside London (36%; 554/1539). This geographical difference was also observed among heterosexual men outside London (men 57%; 315/552 and women 51%; 361/708) compared to London (men: 52%; 158/303 and women: 47%; 163/346).”

Effectiveness and use of ART

In 2015, 88,769 people were living with diagnosed HIV and accessed HIV care (61,097 men and 27,672 women). The average age of people accessing care is now 45 and one in three (29,960; 34%) people are now aged 50 years or over.

Of these, 96% are on ART – a rise from 90% in 2014. Estimated rates of viral suppression are also good at 94% of those on ART. The report notes that this will dramatically reduce the likelihood for further HIV transmission even without condoms.

Mortality rates

Mortality rates were similar to previous years: 613 people with HIV died in 2015, but less than half of these were likely to be AIDS related.

Comment

Two years ago, an estimated 103,700 people (95% credible interval (CrI) 97,500-112,700) were HIV positive in the UK. A conservative increase of 4% would make this number close to 108,000 for 2015.

The UK therefore only diagnoses around 80% of people with HIV, falling short of the 90% global target for this critical first step to ending AIDS. In contrast, Sweden recently reported that at the end of 2015, 90% of HIV positive people were diagnosed, 99.8% of these people were linked to care and 95% of people on ART had undetectable viral load. [2]

Health prevention in the UK needs to define targets to reduce HIV incidence. As with many other countries and included in WHO guidelines, we need PrEP to play a key role.

The NHS needs to recognise this urgency and provide PrEP as part of an ambitious target to dramatically reduce HIV incidence.

References:

1. Public Health England. HIV diagnoses, late diagnoses and numbers accessing treatment and care. HIV official statistics overview: 2016. PHE publications gateway number: 2016349.
   https://www.gov.uk/government/statistics/hiv-annual-data-tables
2. Gisslén M et al. Sweden, the first country to achieve the Joint United Nations Programme on HIV/AIDS (UNAIDS)/World Health Organization (WHO) 90-90-90 continuum of HIV care targets. HIV Medicine, online edition. DOI: 10.1111/hiv.12431 (2016).
   https://www.ncbi.nlm.nih.gov/pubmed/27535540