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One in six HIV-infected people in UK is aged over 55

PHE calls for better-integrated care to cope with multimorbidity, and earlier diagnosis

Louise Prime

Tuesday, 20 October 2015

More people than ever in the UK are now living with human immunodeficiency virus (HIV) infection and almost a sixth of these are over the age of 55, according to the latest official figures. The authors of Public Health England’s report called this morning for better integrated care pathways to manage co-morbidities and other complications, as life expectancy increases for HIV-infected people.

They also reported that although the UK provides excellent care for people diagnosed with HIV, an “unacceptably high” two-fifths of new diagnoses are still being made in people with late-stage disease, both delaying the start of treatment and jeopardising efforts to reduce transmission – and they called for urgent action to increase testing opportunities and uptake in the worst-affected areas.

HIV new diagnoses, treatment and care in the UK: 2015 report shows that during 2014 there were 6,151 new HIV diagnoses in the UK and by the end of the year, a total of 85,489 people were being seen for HIV care across the UK. PHE said that this was partly down to the life-prolonging effect of antiretroviral therapy (ART), but also a result of ongoing HIV transmission and new diagnoses. Of all those living with diagnosed HIV, 15% are aged 55 or more and 4% are over 65. The report’s authors said: “The ageing cohort of people living with HIV emphasises the importance of integrated care pathways to manage co-morbidities and other complications.”

They reported that the UK is ahead of time when it comes to meeting two out of the three UNAIDS 90/90/90 goals; these are that globally, by 2020, 90% of people living with HIV will have been diagnosed, of whom 90% are on ART, of whom 90% have achieved viral suppression. In the UK, 91% of those diagnosed are on ART of whom 95% are virally suppressed, making them very unlikely to be infectious to others. They said: “HIV specialist treatment in the UK remains excellent.”

However, they found that the UK still faces a major challenge in meeting targets for timely diagnosis, which enables lifesaving ART to start and prevents onwards transmission of infection. In 2014, two in every five people newly diagnosed with HIV already had a CD4 count below 350 cells/mm3, classified as late-stage HIV; a drop from 56% in 2005, but still, they said, an “unacceptably high” proportion. They pointed out that late diagnosis is associated with a tenfold rise in the risk of dying within a year, and in the UK most of the 613 people who died last year from HIV had been diagnosed late.

The report showed a decline last year in the number of new HIV infections acquired through heterosexual sex, and a further rise in the number of new cases among men who have sex with men. It also showed that of all those accessing HIV care in the UK last year, 41% lived in London, and 21% of English local authorities (including all but one London borough) had a diagnosed HIV prevalence of at least two per 1,000 population, which is the threshold for expanded testing into general practice new registrants and hospital admissions.

PHE said: “There is an urgent need to increase HIV testing opportunities and uptake for people living in these areas, in line with national HIV testing guidelines.”

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