A third of new HIV diagnoses in the UK in 2008 were made so late that the individuals had a significant risk of developing an AIDS-defining illness, new figures from the Health Protection Agency show.
Overall there were 7,298 new HIV diagnoses in the UK, a figure which is comparable to 2007. Gay men and Africans continue to be the focus of the UK’s HIV epidemic.
Concern is expressed by the HPA about the high proportion of patients who only have their HIV infection detected when their CD4 cell count is below 200 cells/mm3.
A total of 2,310 patients had a CD4 cell count below this level at the time of their diagnosis in 2008. Such a CD4 cell count indicates that these patients had been infected with HIV for a number of years and have sustained immune damage meaning that they are vulnerable to potentially life-threatening infections.
Late diagnosis of HIV is a problem across Europe. There were 525 HIV-related deaths in the UK last year, and the reason underlying many of these deaths will be late diagnosis of HIV.
UK HIV treatment guidelines now recommend that HIV treatment should be started before a patient’s CD4 cell count falls below 350 cells/mm3. Starting treatment at this time reduces the risk of developing not only HIV-related illnesses, but also others such as heart, kidney, and liver disease as well as some cancers. These are an increasingly important cause of illness and death in patients with HIV.
But the new HPA figures show that 55% of diagnoses were made in patients who had a CD4 cell count below this level.
It is now estimated that there are 83,000 individuals living with the HIV in the UK. However, anonymous HIV testing in sexual health clinics suggests that 27% of these infections remain undiagnosed.
Antiretroviral therapy means that most HIV-positive patients now have the chance to live a near normal lifespan. However, undiagnosed individuals are not able to take advantage of treatment than can mean a significantly longer and healthier life.
This point was made by Dr Valerie Delpech of the HPA: “HIV is a serious infection but if diagnosed early, there are very good treatment options. Of concern is that over 22,000 people remain unaware of their infection in the UK and cannot therefore benefit from effective treatment.”
There is increasing epidemiological data that the majority of new HIV transmissions involve individuals whose infection is undiagnosed.
Gay men remain a major focus of the HIV epidemic, accounting for 38% of new diagnoses. The 2,760 infections diagnosed amongst gay men in 2008 are due to continued HIV transmissions in this population and increased levels of testing.
However, 58% of new diagnoses were amongst heterosexuals. The majority of these 4,220 infections were acquired abroad.
Needle exchange programmes have helped control the HIV epidemic amongst injecting drug users in the UK, but there were nevertheless 170 new diagnoses amongst this population in 2008.
There were also cases 110 cases of mother-to-child transmission of HIV. Many of these infections will be due to late presentation.
But the report showed that levels of HIV testing in the UK are increasing. In 2008, 100,000 HIV tests were performed in sexual health clinics – a 50,000 increase on the year before. Overall, 93% of patients attending such clinics are now tested for HIV.
New UK HIV testing guidelines recommend wider screening for the infection in regions where its prevalence is above 2 per 1,000 amongst 15-59 year olds. The 2008 figures show that there are 42 local authorities in the UK where HIV prevalence is above this level. These are mainly located in London.
“It is in these areas that health professionals should routinely offer HIV testing to men and women aged 15 to 59 years who are registering in general practice”, said an HPA spokesperson.