Volume 5 No 35; 2 September 2011
Diagnosed HIV infection in the UK: 2010 update
Almost 70,000 persons accessed HIV-related care at the end of 2010, an increase of 4,100 (6%) compared to 2009. In 2010, nearly half (34,312) of diagnosed HIV-infected individuals were men and women infected via heterosexual contact and 43% (29,647) were men infected through sex between men.
The age distribution of people living with diagnosed HIV infection is changing as older age-groups increase both in number and proportion. In 2010, 21% of adults were aged 50 years or older, compared with 13% in 2005 and 11% in 2000. This increase is due to effective antiretroviral therapy (ART) improving survival among the diagnosed HIV-infected population, and continued transmission at older ages .
The number and proportion of patients receiving ART has increased over the past decade. In 2010, 82% (56,071/68,683) of individuals seen for HIV care were prescribed ART compared with 69% (14,051/20,373) in 2000. The 2008 British HIV Association (BHIVA) guidelines recommend that treatment discussions commence when a patient's CD4 cell count falls to <350 cells/µl , (previous guidelines recommended treatment should start when CD4 cell counts reached below 200 cells/µl). The proportion of patients whose CD4 cell count was <350 cells/µl and who were prescribed ART has increased from 76% (12,759/16,875) in 2007 to 87% (12,675/14,638) in 2010 (figure 1). Previous analyses have shown that 60% of patients not receiving ART, despite being eligible (ie CD4 <350 cells/µl), are treated by the next survey period; if these individuals are included, an estimated 90% were being treated as indicated under the current national guidelines in 2010.
The total number of persons newly diagnosed in the UK in 2010 was 6,658. These data are close to the previously produced estimate of 6,750 new diagnoses released in March 2011. Half of people (3,350) newly diagnosed in 2010 acquired their infection through heterosexual contact, followed by 45% (3,000) through sex between men (figure 2); these are similar proportions to 2009.
The year-on-year decline in the number of new diagnoses since the peak observed in 2005 (7,844), has plateaued following 6,625 new diagnoses in 2009. This decline has been due to the number of new diagnoses among those infected through heterosexual contact abroad falling from 4,155 in 2004 to 2,260 in 2010.
As a result, the proportion of new HIV diagnoses acquired through heterosexual contact in the UK has increased from 24% in 2007 to 33% in 2010, despite little variation in the annual number of these infections (990/4,100 versus 1,090/3,350).
In 2010, after adjusting for missing data, the largest ever annual number of new HIV diagnoses was recorded among men who have sex with men (MSM) (3,000). The majority were born in the UK (67%), had acquired their infection in this country (81%) and were white (83%).
Detailed tables on the UK HIV data for 2010, by geographic region and prevention groups, can be accessed on the HIV section of the HPA website at: http://www.hpa.org.uk/Topics/InfectiousDiseases/InfectionsAZ/HIV/.
Figure 1. HIV-diagnosed persons seen for care with CD4 <350 cells/µl and on treatment, by exposure group 2007-2010
Figure 2. New HIV diagnoses in the UK by exposure category, UK: 2000 - 2010
1. Smith R, Delpech VC, Brown AE et al. HIV transmission and high rates of late diagnoses among adults aged 50 years and over. AIDS 2010 24:2109-15.
2. Gazzard, B.G & BHIVA Treatment Guidelines Writing Group. British HIV Association Guidelines for the treatment of HIV-1-infected adults with antiretroviral therapy 2008. HIV Medicine 2008; 9(8): 563-608.
On 6 April 2010, three new sets of regulations came into force as part of the modernisation of the legal framework for health protection in England [1,2]. They complement the updated Public Health (Control of Disease) Act 1984 which was substantially amended by the Health and Social Care Act 2008. The new regulations improve and extend the previous arrangements for statutory notification of infectious diseases in England. They also set out the powers and duties of local authorities and justices of the peace to take action to protect public health from a risk of significant harm from infection or contamination if voluntary cooperation cannot be secured. In general, they provide a wider and more flexible set of powers than previously existed.
In July this year, a new suite of documents for use by authorised officers dealing with practical situations arising from the application of the current statutory provisions was published on the Chartered Institute of Environmental Health and the HPA websites . The resource is "a grab-and-go toolkit" likely to be particularly useful in urgent and emergency situations, providing checklists and template letters/notices that can be downloaded* and adapted for local use. It was produced through a partnership between Environmental Health at Lewes District Council and the HPA's Surrey and Sussex Health Protection Unit
The toolkit complements the official Department of Health (DH) guidance on the regulations that was published last year  and includes cross-references to relevant algorithms of the DH guidance. It is intended to be used in conjunction with the official DH guidance and not as a substitute for it. The toolkit may be useful to authorised officers in carrying out their statutory duties but at all times relevant local authority procedures, communications and documentation need to be scrutinised by legal advisors.
1. The Health Protection (Local Authority Powers) Regulations 2010 (SI 2010/657); the Health Protection (Part 2A orders) Regulations 2010 (SI 2010/658); and the Health Protection (Notification) Regulations 2010 (SI 2010/659). Downloadable at: Office of Public Sector Information, http://www.opsi.gov.uk/si/si-2010-index.
2. DH guidance on new health protection legislation, HPR 4(12): news, 26 March 2010.
3. Health Protection Regulations 2010 Toolkit, July 2011 [3.3 KB PDF]. Downloadable from: the CIEH website (www.cieh.org); also from the HPA website, at: Topics › Infectious Diseases › Infections A-Z › Health Protection Regulations 2010.
4. HPA/CIEH/NHS. Health Protection Legislation (England) Guidance 2010 (in electronic PDF format only), produced by the HPA and the Department of Health in consultation with the Chartered Institute of Environmental Health, 25 March 2010. Downloadable at: http://www.dh.gov.uk/en/
Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_114510 [2.35 MB PDF].