One in three HIV positive patients diagnosed too late in UK

OnMedica Staff

Monday, 30 November 2009

One in three adults diagnosed with HIV in the UK last year were diagnosed late, show the latest annual figures issued by the Health Protection Agency (HPA).

Late diagnosis is defined as having evidence of substantially reduced immunity assessed by a CD4 count of <200cells/mm ³ or an AIDS diagnosis at the time of HIV detection.

In 2008 there were 7,298 new diagnoses of HIV in the UK, almost four out of 10 of which were among gay men, with and four out of every five probably acquiring their infections in the UK.

Over half (58%) of all infections were acquired through heterosexual contact. Total diagnoses among heterosexuals have fallen 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.

But an estimated 32% (2,310) of adults over 15 years being diagnosed at a point after which treatment should already have started, so potentially compromising life expectancy, the figures show.

British HIV Association guidelines introduced last year call for patients with HIV to be considered for treatment when their CD4 cell count reaches <350 per mm ³ rather than waiting until it falls further to <200 per mm ³ .

Three quarters of the 525 people with HIV who died in 2008 had been diagnosed after this point.

If these guidelines had been used when interpreting the latest figures, it would mean more than half (55%) of all individuals diagnosed last year would have been diagnosed late.

This highlights the importance of promoting testing to ensure early diagnosis and enable successful treatment, says the report.

The report also shows that the number of people living with HIV in the UK increased to 83,000 in 2008, equating to 1.3 per 1000 of the population. This number will continue to rise as people with HIV live longer on effective therapy, it says.

More people were tested for HIV at sexual health clinics, with 50,000 more tests carried out in 2008 than the previous year, when 950,000 were done. More than 9 out of 10 patients to sexual health clinics are now tested for HIV.

National HIV 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 accounting for 35 PCTs where the prevalence of HIV is above this threshold.

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, says the report.

Dr Valerie Delpech, an expert in HIV at the HPA 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,” she added.