A third of HIV patients diagnosed late

27 November 2009

A third of adults diagnosed with HIV in the UK last year were diagnosed late, according to figures released today by the Health Protection Agency.

In 2008 there were 7,298 new diagnoses of HIV in the UK with an estimated 32% (2,310) of adults over 15 years being diagnosed at a point after which treatment should already have begun (CD4 cell count <200 per mm3). This results in patients missing out on the benefits that come from early diagnosis, including improved life expectancy.

According to British HIV Association guidelines introduced last year, patients with HIV should now be considered for treatment when their CD4 cell count reaches <350 per mm3 rather than waiting until it falls further to <200 per mm3. If these guidelines were used when interpreting the latest figures, it would mean more than half (55%) of all individuals diagnosed last year would have been diagnosed late.

The number of deaths among HIV-infected people has remained stable over the past decade. However, three quarters of the 525 people with HIV who died in 2008 had been diagnosed at a point after which treatment should have begun according to the latest treatment guidelines (i.e. a CD4 cell count <350 per mm3). This highlights the importance of promoting testing to ensure early diagnosis and enable successful treatment.

The agency's annual HIV report also shows that the number of people living with HIV in the UK increased to 83,000 in 2008.  This number will continue to rise as people with HIV live longer on effective therapy.

Improvements have been made in the number of people testing for HIV - 100,000 more tests were performed at GUM (genitor-urinary medicine) clinics in 2008 than the previous year (950,000 up from 850,000 in 2007). 93% of people attending GUM clinics are now tested for HIV. This has continued to increase steadily since 2004 when 23% of visitors to a GUM clinic were not being tested for the infection.

National HIV testing guidelines recommend wider HIV testing in those areas of the country where the prevalence of diagnosed HIV infection is greater than 2 per 1,000 population aged 15 to 59 years. There are 43 local authorities in England (35 Primary Care Trusts) where the prevalence of HIV is above this threshold. It is in these areas that health professionals should routinely offer HIV testing to all men and women aged 15 to 59 years who are registering in general practice or admitted for medical care.

Dr Valerie Delpech, an expert in HIV from the Health Protection Agency said: "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.

"It is encouraging to see the increased numbers of HIV tests being performed in STI clinics.  However, we must reduce the number of people presenting late with their infection by increasing awareness of the importance of testing, improving access and de-stigmatising the HIV test.

"We need to continually reinforce the safe sex message - using a condom with all new or casual sexual partners is the surest way to ensure you do not become infected with a serious sexually transmitted infection such as HIV.

"People need to know that testing for HIV and all sexually transmitted infections is both free and confidential at sexual health clinics across the UK. If you have had unprotected sex with a new or casual partner you should go and get tested.

 "Medical guidelines published last year have encouraged more widespread testing in areas where there is a high prevalence of diagnosed HIV and we hope this will contribute to improving awareness of the infection in this community and therefore increase testing."

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2008 in numbers

Living with HIV

• An estimated 83,000 people are living with HIV in the UK (both diagnosed and undiagnosed).
• This equates to a rate of 1.3 people per 1,000 population.
• Among the 83,000 HIV infected individuals, 27 per cent (22,400) remain unaware of their infection.

Accessing care

• 61,213 people diagnosed with HIV were accessing care in the UK last year - this represents and eight per cent increase in 2007 (56,433) and more than 3x the number in1999 (20,009).

New diagnoses

• 2008 saw 7,298 new diagnoses of HIV, a similarly high figure to recent years, although a decline on the peak observed in 2005 (7,975).
  • 38% (2,760) were among gay men and four out of every five probably acquired their infections in the UK.
  • 58% (4,220) were acquired through heterosexual contact - with the majority of cases probably infected abroad. Total diagnoses among heterosexuals have declined from their peak in 2004 (5,020) although those acquired within the UK are increasing from an estimated 740 in 2004 to 1,130 in 2008.
  • 170 infections were acquired through injecting drug use.
  • 110 were acquired through mother-to-child transmission.

Late diagnoses

• An estimated 32% (2,310/7,218) of adults aged over 15 years were diagnosed with a CD4 cell count <200 per mm3 within three months of diagnosis. The proportion diagnosed with a CD4 cell count <350 per mm3 (the threshold at which treatment should be considered according to 2008 British HIV Association guidelines) was 55% (3,970/ 7,218).

Death

• 525 deaths (387 men and 138 women) were recorded among HIV-infected people in 2008.

* Adjustments have been made to some of the detailed figures provided above to take into account missing information relating to the cases reported

Notes to editors
To view HPA's annual HIV report - HIV in the United Kingdom: 2009 Report visit the agency's website at http://www.hpa.org.uk/HPA/Publications/InfectiousDiseases/HIVAndSTIs/

Late diagnosis is defined as having evidence of substantially reduced immunity assessed by a laboratory measure of a CD4 count of <200cells/mm3 or an AIDS diagnosis at the time of an HIV diagnosis. For more information about this visit http://www.hpa.org.uk/webw/HPAweb&HPAwebStandard/Page/1201094588994?p=1201094588994

A high prevalence of HIV is considered to be areas where diagnosed HIV prevalence in the local population exceeds 2 in 1,000. The Map below shows the prevalence of HIV infection across the UK in 2008.

For further information on this press release please contact the Health Protection Agency's Centre for Infections press office on:

Georgina Fletcher 020 8327 6690
David Daley  020 8327 6647
Alexandra Baker  020 8327 7098
Eleanor Bunch  020 8327 7751
Louise Brown  020 8327 7080
Kate Swan  020 8327 7097

Last reviewed: 27 November 2009