HIV in the UK: diagnoses continued to fall during 2019 but 42% are still late

11 November 2020. Related: HIV prevention and transmission.

Simon Collins, HIV i-Base

On 3 November 2020, Public Health England (PHE) published the annual statistics from last year on HIV in the UK. [1, 2, 3]

The results showed a continued decline in diagnoses across all risk groups easily meeting overall aim for more that 73% of people to be virally suppressed. The UK now reports 94%, 92% and 89% for the UNAIDS targets of 90:90:90, for the percentage of HIV positive people overall who are diagnosed, on treatment, and virally suppressed respectively. See Figure 4.

However, late diagnoses continues to be a serious concern with 42% of people were diagnosed with a CD4 count <350 cell/mm³ – associated with an 8-fold higher risk of mortality.

A summary of findings are included below.

• 105,200 people are estimated to be HIV positive in the UK, with 6,600 undiagnosed (6%). About half are gay and bisexual men and half are heterosexual.
• During 2019 there were 4,139 new HIV diagnoses (1,139 women and 3,000 men). This was a 10% fall from 4,580 in 2018.
• The drop in gay and bisexual men was from 1,425 in 2018 to 1,107 in 2019.
• A total of 98,552 people (30,388 women and 68,088 men) accessed HIV care in the UK.
• 622 HIV positive people died (124 women and 498 men) which was similar to 2018. This represents a crude mortality rate of 631 per 100,000 population living.
• 1279 people were diagnosed late (42%) with a CD4 <350 cells/mm³), Late diagnosis was associated with 8-fold higher risk of mortality: 23 (95%CI: 17 to 32) vs 3 (95%CI: 1 to 7) per 1000.
• 65 cases of vertical transmission were reported, 5 of who (currently aged less than 15) were born in the UK.
• About 1 in 4 people (974) had been previously diagnosed outside the UK.

Gender is not recorded, so figures for transgender women and men is not available.

• White gay and bisexual men by –22% (from 1,425 to 1,107).
• People born in the UK by –25% (from 950 to 715).
• People aged 15 to 24 by –22% (from 299 to 222).
• People living in London by –15% (from 830 to 702).
• Heterosexual transmission by –6% (from 1,664 to 1,559).

Figure 3 from the report is included below to summarise declines in main risk groups since 2015.

The number of HIV tests in sexual health services increased by 6% to 1,310,731. Take up in sexual health clinics was 65%, with approximately half of the 550,000 people who were not tested were not offered a test and half declined. Just under 1 in 5 tests were postal kits via internet services (up by 68%).

Between April and December 2019, there were more than 51,000 tests in prisons (46% uptake) which included 401 diagnoses.

Out of more than 670,000 tests during pregnancy (>99% uptake), approximately 93 were positive.

Screening more than 1,500,000 blood donations (presumably for antibodies rather than PCR, though not specified), led to 9 HIV positive results.

The report includes a new analysis this year estimating approximately 14,600 to 19,200 people have a detectable viral load (14% to 18%). Of these, approximately 40% are undiagnosed, 20% are not engaged in care, 10% are not on treatment, 13% have a detectable viral load on ART, and 24% have no viral load result recorded for the previous two years.

• 12-page report from PHE.
• Tables on new HIV testing, diagnoses and on people accessing HIV care. 
• HIV slide set.