Alison Brown , Valerie Delpech, Anne Presanis, Gary Murphy and Noel Gill.
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HIV and STI Department, Health Protection Agency - Colindale HIV and AIDS Reporting System The threshold for an ART secondary prevention effect on HIV transmission among MSM has not been reached despite high treatment uptake Alison Brown , Valerie Delpech, Anne Presanis, Gary Murphy and Noel Gill.
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The threshold for an ART secondary prevention effect on HIV transmission among MSM has not been reached despite high treatment uptake. Alison Brown , Valerie Delpech, Anne Presanis, Gary Murphy and Noel Gill. . Background :. - PowerPoint PPT Presentation
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HIV and STI Department, Health Protection Agency - Colindale
HIV and AIDS Reporting System
The threshold for an ART secondary prevention effect on HIV
transmission among MSM has not been reached despite high treatment
uptake
Alison Brown, Valerie Delpech, Anne Presanis, Gary Murphy and
Noel Gill.
HIV and STI Department, Health Protection Agency - Colindale
HIV and AIDS Reporting System
Background:
• Viral load established as key predictor for HIV transmission; ART effective at individual level
• From promise to programmes: the challenge of the treatment cascade
In the UK:• MSM HIV prevalence 5% and sustained number of
HIV diagnoses • HIV care provided free of charge • Nearly all diagnosed MSM are in HIV care • 82% of MSM in HIV care receive treatment
HIV and STI Department, Health Protection Agency - Colindale
HIV and AIDS Reporting System
Aims:
Assess the impact of high ART coverage on HIV transmission among MSM through:
•Community viral load •Number/proportion of population who are infective (viral load >1500 copies)•Markers of HIV incidence
HIV and STI Department, Health Protection Agency - Colindale
HIV and AIDS Reporting System
Methods:• Observational study of HIV-infected MSM
in the UK, 2006-2010• Comprehensive, national surveillance
data and modelling techniques determined:• Number HIV+ MSM (diagnosed and
undiagnosed)• ART coverage• Number & proportion of HIV-infected MSM who
were infective (viral load >1500 copies/mL)• HIV incidence indicators and the estimated
number of infective MSM
HIV and STI Department, Health Protection Agency - Colindale
HIV and AIDS Reporting System
Number of HIV positive MSM,and proportion
diagnosed and treated UK: 2006-10
.0005000.000
10000.00015000.00020000.00025000.00030000.00035000.00040000.00045000.000 Undiagnosed Diagnosed and untreated
Diagnosed and treated
Num
ber l
ivin
g wi
th H
IV
75%
77%
71%
80%
71%
HIV and STI Department, Health Protection Agency - Colindale
HIV and AIDS Reporting System
Number of HIV-infected MSM, and proportion infective (VL>1500
copies) by diagnostic and treatment status, UK: 2010
CD4<
350
CD4
350-
500
CD4
>50
0
Undi-ag-
nosed
Diagnosed
Diagnosed and untreated Treated
0tan28a5660280tan6a56736
0tan16a5687160tan25a570125
0tan6a571560tan15a5728150tan25a574225
Infective
Non-infective
Undiagnosed MSM assumed to have same distribution of viral load as untreated MSM in their first year of dia-gnosis
HIV and STI Department, Health Protection Agency - Colindale
HIV and AIDS Reporting System
Distribution of infective MSM * among HIV-infected MSM, UK:
2010
0tan29a5665290tan28a566028
0tan6a567360tan16a5687160tan25a570125
0tan6a571560tan15a5728150tan25a574225
0tan4a575640tan14a576914
35%
Infectious Non infectious
Num
ber o
f MSM
livi
ng w
ith
HIV
in
fect
ion
Breakdown of the infectious population
Undiagnosed MSM assumed to have same distribution of viral load as untreated MSM in their first year of dia-gnosis
Treated5%
Untreated >50016%
Untreated 350-50012%
Untreated <3505%
Undiagnosed62%
HIV and STI Department, Health Protection Agency - Colindale
HIV and AIDS Reporting System
Annual HIV incidence in MSM, England & Wales: 2001-2010 (Birrell
et al.)
HIV and STI Department, Health Protection Agency - Colindale
HIV and AIDS Reporting System
Annual HIV incidence in MSM, England & Wales: 2001-2010 (Birrell
et al.)
Also, between 2006-2010:- Number of new diagnoses increased- Median age & CD4 count at diagnosis stable - 25% of MSM newly diagnosed were recently infected (2009-10)
HIV and STI Department, Health Protection Agency - Colindale
HIV and AIDS Reporting System
Why is HIV transmission continuing?
.0005000.000
10000.00015000.00020000.00025000.00030000.00035000.00040000.00045000.000 Undiagnosed
Diagnosed and untreatedDiagnosed and treated
Num
ber l
ivin
g wi
th H
IV
Treated5%
Untreated >50016%
Untreated 350-50012%
Untreated <3505%
Undiagnosed62%
And…
And…in 2010 only 15-25% of MSM had an HIV test
HIV and STI Department, Health Protection Agency - Colindale
HIV and AIDS Reporting System
Conclusions:• UK access to HIV testing and treatment is excellent• Despite very high ART coverage, HIV
transmission has not decreased among MSM
• HIV incidence probably would have been much higher without extensive ART coverage
• Undiagnosed probable source of most new infections• Higher rates of testing are required to reduce late
diagnoses• Primary prevention remains key – Safer sex campaigns and behavioural interventions– Role of partner notification needs expanding
