This article is more than 5 years old. Information may no longer be current.
No changes in HIV infection rate among MSM in UK
Despite increases in HIV testing, rising treatment coverage and shorter times to diagnosis, the rate of new HIV infections among men who have sex with men in England and Wales has not changed during the past decade, according to a new report in The Lancet Infectious Diseases.
“Our findings highlight the limited effect of the national HIV strategy, which aimed to reduce transmission by increasing the uptake of HIV testing in STI clinics,” Daniela De Angelis, PhD, of the UK Medical Research Council, Biostatistics Unit, said in a press release. “They also suggest that ART coverage alone may not be enough to halt the spread of HIV among MSM.”
De Angelis and colleagues developed a model that was able to estimate rates for infection and diagnosis using CD4 counts at diagnosis and the natural history of HIV infection. They used the model on surveillance data to estimate trends in time to diagnosis, rates for new infections and the number of undiagnosed infections among MSM between 2001 and 2010.
The estimated time to diagnosis decreased from 4 years to 3.2 years during the 10-year timeframe. However, the researchers found no decline in HIV incidence: the number of new infections remained at approximately 2,300 to 2,500 infections per year. There was no change in the number of undiagnosed MSM, despite an increase in ART uptake from 69% to 80% and an almost four-fold increase in HIV testing.
“We suggest that health care services in England and Wales improve targeting of testing to the most at-risk groups and initiate treatment earlier than currently recommended (irrespective of CD4 count), to bring about a drop in HIV incidence,” De Angelis said.
In an accompanying editorial, Reuben Granich, MD, of the Joint United Nations Programme on HIV/AIDS (UNAIDS), said that the study should be very concerning to MSM and their partners and communities. He said that the researchers’ call for earlier treatment initiation is a “bold conclusion.”
“The conceptual shift to offering treatment initiation to all those with a positive diagnosis would be a significant innovation,” Granich wrote. “This also makes sense, since turning someone away who has carefully considered the risks and benefits and is eager to start treatment could represent a lost individual and public health opportunity.”
For more information:
Birrell P. Lancet Infect Dis. 2013;doi:10.1016/S1473-3099(12)70341-9
Granich R. Lancet Infect Dis. 2013;doi:10.1016/S1473-3099(13)70035-5