Latest figures published on HIV in the UK: 2023 report

1 December 2023. Related: Special reports, HIV prevention and transmission.

Simon Collins, HIV i-Base

On 6 October 2023, UKHSA published the latest annual report on HIV, together with the supporting data tables. [1, 2]

This essential resource is always an impressive achievement that provides the evidence to plan services by highlighting recent trends as well as current needs.

It includes data from 2022 on HIV testing, new diagnoses and access to ART together with other key measures including use of PrEP. Breakdowns by age, sex, gender, ethnicity, sexuality, geographic region and other related factors are included (mainly based on data for England). Results from 2022 are also compared to previous years.

Data for Scotland were published by Public Health Scotland in September 2023. [3]

Summary points are included below.

HIV testing

More than 1,155,000 people had an HIV test at a sexual health service (SHS) in England (rather than in other settings including pregnancy). This was 10% higher than in 2021 but still 16% lower than in 2019.

As in 2021, half of these were home tests ordered online.

Overall, approximately half the people who were eligible to need a test in a clinic took up this offer. Uptake was higher by gay and bisexual men (74% tested, 23% not offered, 3% declined) compared to straight and bisexual women (38% tested, 40% not offered, 22% declined).

HIV PrEP

The proportion of clinic visits from people who could benefit from PrEP increased to 9.7% in 2022 to over 121,000.

Uptake varied by risk group: 59% of straight and bisexual women (n=2,695), 63% of heterosexual men (n=2,607) and 84% of gay and bisexual men (n=83,223).

HIV diagnoses

Overall, HIV diagnoses in England rose by 22% from 3,118 in 2021 to 3,805 in 2022.

Of these, approximately one-third (1361/3805) were previously diagnosed outside the UK. Most were already on ART when they came to the UK, with an undetectable viral load (87%), and 96% were linked to UK care within three months.

New first-diagnoses in England increased by 6% from 2,313 in 2021 to 2,444 in 2022.

8% drop in gay and bisexual men to 724 in 2022, including a 3% drop in London (n=244),
14% increase in men and women in London identifying as straight to 325.
11% increase in men and women outside London identifying as straight to 651.
31% increase in women living outside London to 393. Of these, 77% (301) were born outside the UK.

Late and very late diagnosis

The report notes that almost half (44%) the new diagnoses in England were late, based on having a CD4 count <350 cells/mm³.

However, this 44% is based on only 865 people diagnosed in England and who had not been previously diagnosed in another country. This is because a significant percentage of other people diagnosed for the first time in the UK were originally diagnosed outside the UK and most had undetectable viral load on ART.

The data tables report the combined figures. Table 1b shows 608/1997 men (35%) are listed as being diagnosed late and 387/1154 women (33%). This shows 1080/3151 people were diagnosed with a CD4 count <350 cells/mm³ (roughly 34%),

The summary report also misses out information on very late diagnosis defined as having a CD4 <200 cells/mm³.

Table 1a7 shows that 1081 people (34%) were diagnosed late with a CD4 <350 and a further 624 people (20%) were diagnosed very late with a CD4 <200 cells/mm³.

Although this figure for late diagnosis should ideally be adjusted to exclude people diagnosed in acute infection, before the expected rebound, it isn’t clear whether this adjustment is included yet.

No data is provided for people with more serious immunosuppression, including those with a CD4 count <50 cells/mm³. People in this category are at the highest risk for all opportunistic infections, including mpox where cases can be fatal, and including active CMV which requires urgent monitoring. They also have more difficulty normalising their CD4 count on ART and are likely to have more complex risk of future complications.

Table 1a7 also includes that 4% of diagnoses (n=155) had symptoms of opportunistic infection that made these advanced HIV disease (the new WHO recommended term for the historical diagnosis of AIDS).

HIV-related deaths

During 2022, there were 603 deaths in 473 men and 130 women: 22 aged <35, 120 aged 35 to 49, 338 aged 50-69, 123 aged >70.

Of these, 261/603 were gay men, 143 straight men and 100 straight women.

Breakdowns are provided by sex for ethnicity, age, probable route of infection, country of birth and broad demographics of the epidemic in the UK.

Key points from Scotland (December 2022) include:

An estimated 6,600 people were living with HIV in Scotland, of whom 6,150 (93%) had been diagnosed.
Of those engaged with HIV services, 98% were on ART and 93% of those had undetectable viral load.
A continued decline in recently acquired HIV (within the previous 3-4 months).
In 2022, 24 of 108 (22%) first ever diagnoses were made at a late stage of infection, 16 (67%) of which were very late stage, with advanced HIV disease.

comment

These annual data sets and accompanying reports are always important and further analyses are still ongoing, including on mortality.

The impact of COVID, and to a lesser extent mpox, on social behaviour, testing and access to services still affects these figures, limiting the interpretation of trends.

A further report, not yet released will report on progress towards the 2025 target goals. [4]

This includes the commitment to achieving zero new HIV infections, zero cases of advanced HIV and HIV-related deaths in England by 2030.

Late diagnosis still accounts for a significant proportion of new diagnoses.

References

UKHSA. HIV testing, PrEP, new HIV diagnoses and care outcomes for people accessing HIV services: 2023 report. Publication number GOV-15487
https://www.gov.uk/government/statistics/hiv-annual-data-tables/hiv-testing-prep-new-hiv-diagnoses-and-care-outcomes-for-people-accessing-hiv-services-2023-report
HIV: annual data tables (October 2023).
https://www.gov.uk/government/statistics/hiv-annual-data-tables
Public Health Scotland. HIV in Scotland: update to 31 December 2022.
https://publichealthscotland.scot/publications/hiv-in-scotland/hiv-in-scotland-update-to-31-december-2022 (webpage)
https://publichealthscotland.scot/media/22243/hiv-infection-in-scotland-update-to-31-december-2022-finalised-main-report-2023_09_26.pdf (full report PDF)
UKHSA. Towards Zero: the HIV Action Plan for England – 2022 to 2025. (1 December 2021).
https://www.gov.uk/government/publications/towards-zero-the-hiv-action-plan-for-england-2022-to-2025