Survey Results to the end of 2010
Graphs and tables
The CD4 surveillance scheme has monitored immunosuppression among adults living with a diagnosed HIV infection in England, Wales and Northern Ireland since 1995. A national resource for HIV surveillance, the CD4 surveillance scheme has driven public health policy and allowed auditing of national HIV testing, treatment and care guidelines. Examples include monitoring late HIV diagnoses (defined as having CD4 count under 350 cells/mm3) and associated short term mortality; these data inform the proposed Public Health Outcomes Frame work indicator for late HIV diagnoses. Additionally, the timing of first CD4 count indicates how quickly patients are integrated in HIV care following diagnosis. Similarly, monitoring the proportion of patients with CD4 counts <350 cells/mm3 receive anti-retroviral therapy (ARV) demonstrates the extent to which patients receiving treatment according to national guidelines. The monitoring of CD4 counts is a critical core function of HIV surveillance in the UK and outputs are available at the national and local authority level.
Suggested citation for reproduction of these graphs: CD4 Surveillance Scheme, Health Protection Services, Colindale, Health Protection Agency: 2011.
Late HIV Diagnosis
In 2010, an estimated 50% of adults (aged 15 or over) were diagnosed late (CD4 count <350 cells within 3 months of diagnosis) and 9% had AIDS at the time of HIV diagnosis in the UK (Figure 1). The proportion of adults diagnosed late was lower among MSM (39% with a low CD4 count and 6% with AIDS) compared with heterosexual women (58% and 10%), people who inject drugs (46% and 15%) and heterosexual men (63% and 14%) respectively.
Figure 1. Late diagnoses of HIV by exposure group: United Kingdom, 2010 (PDF, 167 KB)
Late HIV diagnoses and mortality
HIV-infected individuals diagnosed late may not fully benefit from therapy and are at an increased risk of early death. Late diagnosis also means that options for avoiding ongoing transmission through clinical and behavioural preventive measures are reduced. Prompt HIV diagnosis prevents further HIV transmission by ensuring that the patients’ viral load is low (through regular monitoring and/or administering antiretroviral therapy where clinically appropriate) and providing earlier opportunities for partner notification and behaviour change counselling.
In 2010, MSM diagnosed late were nine times more likely to die within a year of their HIV diagnosis than MSM diagnosed promptly (3.07% versus 0.33%) (Figure 2). For black African and Caribbean communities, HIV continues to cause serious illness and death due to late diagnosis. The proportion of black African and Caribbean adults (aged 15 and over) diagnosed late has fallen slowly in the last 10 years from 68% in 2001 to 62% in 2010. Black African and Caribbean adults diagnosed late were six times more likely to die within a year of their HIV diagnosis than those diagnosed with higher CD4 counts (3.20% compared to 0.54%)(Figure 3).
Median CD4 count at HIV diagnosis
The median CD4 count at HIV diagnosis has been consistently higher among women whose HIV infection was detected through antenatal screening compared to other women and heterosexual men (figure 4a and b). This indicates that the recommendation of testing during pregnancy provides an opportunity for women to be diagnosed earlier in the course of their infection, reducing their risk of developing opportunistic infections and potential early death.
However, the median CD4 count of women diagnosed via antenatal screening remains lower than that of men who have sex with men due to the relatively large number of women from abroad who are likely to have acquired their infection some years prior to arrival in the UK.
Figure 4a. Median CD4 count at diagnosis by exposure group: United Kingdom 2001 - 2010 (PDF, 157 KB)
Survey Results to the end of 2010
Survey Results to the end of 2010 (PowerPoint Presentation, 574 KB)
Last reviewed: 20 December 2011
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