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More Than A Quarter Of People With HIV In The UK Are 'Undiagnosed'

May 23, 2011

The number of people living with HIV in the UK reached an estimated 86,500 in 2009, but more than a quarter - almost 22,500 - were unaware of their infection, according to figures released by the Health Protection Agency (HPA) today.

A total of 6,630 people were newly diagnosed with HIV in 2009 - 4,400 men and 2,230 women. Although this represents the fourth year-on-year decline in the number of new diagnoses, evidence suggests that there has been no decline in the number of undiagnosed infections in the past decade.

The HPA's report also found that over half of people newly diagnosed in 2009 - 3,450 - were diagnosed late, after the stage when treatment should have started.

Dr Valerie Delpech, consultant epidemiologist and head of HIV surveillance at the HPA, said: "We're very concerned that a large number of people in the UK are unaware of their HIV status and that half of all newly diagnosed people are diagnosed late, meaning they may not benefit from very effective treatments.

"The HPA would like to see increased access to HIV testing in areas where rates of HIV infection are high. Pilot studies have shown that in these areas testing all adults registering at GPs or accessing certain hospital services can make an impact.

"The evidence shows that this testing is feasible to undertake and acceptable to patients. We would like to see this rolled out in areas where HIV infection is more common to reduce the number of people who are unaware of their HIV status and increase the chances of early diagnosis, when treatment is more successful."

Across the UK, 1.4 people per 1,000 of the population - both diagnosed and undiagnosed - were living with HIV in 2009. Expanded HIV testing is recommended in areas where the number of people diagnosed is greater than 2 per 1,000 population. Of the 37 PCTs in England with rates above this level, 26 of them were London boroughs. Overall in London, 5.24 per 1,000 people were living with a diagnosed HIV infection in 2009. Other areas with rates above 5 per 1,000 were Brighton and Hove City (7.57 per 1,000 people) and Manchester (5.22 per 1,000 people).

As well as monitoring early diagnosis, the HPA has developed measures to evaluate the quality of treatment and care HIV patients receive. Analysis of data across London in 2008 found that over 80 per cent of patients were seen for HIV care within one month of diagnosis. And a high level of care in the UK was also observed - close monitoring of those undergoing treatment found that over 90 per cent of patients had an undetectable viral load within a year as well as a restored immune system. This not only confirms that treatments are effective for the patient but that the chance of transmitting the virus is greatly reduced.

Dr Delpech added: "Thanks to the development of anti-retroviral treatments and universal access to world class health care through the NHS, HIV is a manageable illness for the vast majority of people in this country. We're very pleased that 8 out of 10 people in London newly diagnosed with HIV are receiving immediate access to care but we need to ensure this is maintained and improved upon across the UK."

Dr Paul Cosford, HPA's director of Health Protection Services, said: "Today's figures suggest that extra effort is needed to ensure more people are aware of their HIV status. This will enable faster access to treatment, improve survival and reduce the risk of transmission to partners.

"As well as widespread access to HIV testing, the HPA recommends that people who are at higher risk of HIV, such as men have sex with men and black Africans living in this country, should know their status and consider testing regularly. And it's crucial to remember that using a condom with all new or casual sexual partners is the best way to prevent sexually transmitted infections, including HIV."


1. HIV in the UK report - the Health Protection Agency's 'HIV in the United Kingdom: 2010 report' is available on the HPA's website.

2. Estimating undiagnosed HIV infections - statistical modelling frameworks and techniques are applied to combine different surveillance and survey data to obtain an estimate of the prevalence of HIV in the population. Further details of the methodology and data sources employed are available from Presanis et al Insights into the rise in HIV infections, 2001 to 2008: a Bayesian synthesis of prevalence evidence. AIDS 2010 24:2849-58. Or for more information about HIV prevalence visit here.

3. Late diagnosis - adults diagnosed with a CD4 cell count of less than 350 (within 91 days of diagnosis) are defined as diagnosed 'late', adults diagnosed with a CD4 cell count of less than 200 are defined as diagnosed 'very late'. For more information about late diagnosis, visit here.

4. Access to HIV testing - the Department of Health has funded eight projects looking at the feasibility and acceptability of offering HIV testing in medical and community settings. The HPA has been tasked with analysing the results of these projects. An interim report entitled, 'Time to Test for HIV', will be presented at a conference being organised by the British Association for Sexual Health and HIV (BASHH) on Wednesday 1 December (World AIDS Day).

5. People with newly diagnosed HIV infection in 2009

- 3,560 (54 per cent) new HIV diagnoses were acquired heterosexually
- 2,760 (42 per cent) new HIV diagnoses were acquired by men who have sex with men
- 170 new diagnoses were acquired through injecting drug use
- Four out of five men who have sex with men acquired their infection in the UK
- A third of heterosexuals acquired their infection in the UK - the remaining two thirds are thought to have been acquired in sub-Saharan Africa

6. AIDS and deaths in people with HIV infection in 2009

- 547 people were diagnosed with AIDS in the UK, almost all of them at the time of their HIV diagnosis
- 516 people with HIV infection were reported to have died of any cause
- Of those who died, 73 per cent had been diagnosed late (with a CD4 cell count of less than 350)
- The number of HIV related deaths has remained stable over the past decade and the number of AIDS diagnoses has continued to decline

7. Accessing HIV care in the UK in 2009

- The number of people accessing care across the UK rose from 22,575 in 2000 to 65,319 in 2009 - including a seven per cent increase from 2008 when the figure was 61,110
- 78 per cent of diagnosed HIV cases in the UK were receiving anti-retroviral therapy in 2009, up from 76 per cent in 2008 and 70 per cent in 2000

Health Protection Agency

UK HIV Diagnoses - Still High, Still Late

May 19, 2011

New figures on HIV from the Health Protection Agency (HPA) reveal the number of diagnoses of HIV transmission occurring in the UK remain high, with no indication as yet of a decline.

Whilst overall diagnoses have declined for the fourth year running (going down to 6,630 in 2009 from 7,982 in 2005), this decrease is due to fewer diagnoses amongst those who were infected overseas. The 3,730 diagnoses of transmissions which occurred in the UK remain as high as previous years.

The report reveals that 1,000 heterosexuals were diagnosed with HIV and were infected in the UK. There were also 2,760 diagnoses amongst gay and bisexual men and, worryingly, one in six of those diagnosed appear to have been infected a few months prior to their test, suggesting high rates of ongoing HIV transmission in the gay community.

Not only is the number people being diagnosed with HIV still too high, just over half (52%) are being diagnosed after the point at which they should have started HIV treatment. In most instances this means they are likely to have had HIV for a number of years, with a high risk of transmission to sexual partners. Such late diagnosis can also reduce the effectiveness of treatment.

Deborah Jack, Chief Executive of NAT (National AIDS Trust), comments:

'The latest HIV figures underline the need for us to do more in both HIV prevention and HIV testing. As the Government prepares its Public Health White Paper, NAT is calling for commitment to reduce the continuing stubbornly high numbers of people getting HIV in the UK. Prevention is an immensely cost-effective activity given the financial implications of even one HIV transmission is up to £360,000 in direct costs to the NHS over a person's lifetime.

Another crucial step is for sexual health clinics to work on increasing the uptake of HIV tests amongst those who attend their services. The current uptake rate at 77% is still too low. But late diagnosis is a wider challenge to society - many people with HIV attend other NHS services repeatedly for years without being offered an HIV test and this neglect has to end. We need HIV testing to be normalised within our health system and people to be informed about the value of having an HIV test.'


HIV in the UK report - the Health Protection Agency's 'HIV in the United Kingdom: 2010 report' will be available on the HPA's website from Friday 26 November. Embargoed copies of the report and prevalence data by SHA and PCT will be available from the HPA press office in advance.

NAT (National AIDS Trust)

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