13% of people living with HIV in the UK remain undiagnosed despite high standards of care

05 December 2016

The UK has exceeded UNAIDS Fast-Track targets of getting people on treatment and virally suppressed, but falls behind on reaching those who are undiagnosed.

An elderly hand holding pills

Standards of care for people living with HIV are very high and the vast majority of people receiving treatment in the UK have achieved an undetectable viral load – but 13% of infected people are thought to remain undiagnosed, Public Health England has warned.

Although the figure for undiagnosed cases has fallen by 11% from the government agency’s previous 2014 estimate, around 13,500 people remain unaware that they are living with HIV in 2015. Of this group, the highest proportion is among non-black African heterosexual men (21%) and women (20%) – two population groups considered at lower risk of contracting HIV.

Out of 101,200 people living with HIV in the UK in 2015, 69% were men and two in five lived in London. The annual number of new diagnoses – 6,095 people – represents a notably high rate of 11.3 per 100,000 people. Western Europe’s average is 6.3 per 100,000.

The annual HIV in the UK report shows that 96% of people living with HIV are receiving antiretroviral treatment (ART), but expresses concern about the number of late diagnoses carried out in 2015, with almost 2,000 people learning they were living with HIV after their CD4 count (a measure of the amount of white blood cells in the body) had decreased significantly. People who are diagnosed late face ten times the risk of death in the year which follows. The high numbers of late diagnoses emphasises the need to strengthen HIV testing policies.

Nearly all of the people who were newly diagnosed were linked to care within three months, and 94% of people living with HIV had rendered the virus undetectable in their blood through their use of ART, increasing their life expectancy and making them very unlikely to pass on the virus.

There was a noticeable difference between certain demographic groups, with some more likely to be diagnosed late. Gay and bisexual men were least likely to be diagnosed late, at 30%, compared with 55% of heterosexual men and 49% of heterosexual women. Geographically, 73% of heterosexual black African men living in the north had their status confirmed at a late stage – far higher than the overall figure of 39% among all newly-diagnosed patients, which British HIV Association (BHIVA) chair Dr Chloe Orkin described as “deeply troubling.”

“This phenomenon [late diagnosis] is most significant among heterosexual men and women who are not recognised as being at risk,” she observed, praising the “outstanding levels of care” for people accessing services.

The unemployment rate among the UK’s HIV population in care is almost three times the national rate of 6.4%, reflecting the problems reported in last year’s People Living with HIV Stigma Survey, when most participants backed an increase in education and awareness campaigns to counter discrimination.

In a 73% increase across the past decade, nearly 89,000 people living with HIV received HIV care in 2015, which the agency attributed to ongoing new infections and treatment which is improving life expectancies.

The promising figures for people who are receiving treatment or have a suppressed viral load mean the UK is surpassing two of the three critical Fast-Track 90-90-90 targets set by UNAIDS.

But it has fallen short in ensuring people living with HIV know their status, which the report says is at a level of 87%. Responding, Dr Orkin called for all doctors to be “adequately funded” and “fully empowered” to carry out testing.

Late HIV diagnosis is strongly linked to poorer outcomes for people living with HIV, including premature death. Since the vast majority of people diagnosed are effectively treated, most new HIV infections are passed on by people unaware of their status.

Among those with data available, 39% of adults living with HIV were diagnosed late – a high number, but a 17% decline from ten years ago.

Almost 7,000 people started antiretroviral therapy for the first time in 2015 – rising from 5,500 each year between 2010 and 2014. Two-thirds (66%) of people starting treatment had a CD4 count of above 350 350 cells/mm3 and 41% above 500 cells/mm3, compared with just 22% and 10% respectively just ten years ago.

Written by Caitlin Mahon

Content Specialist - HIV & Sexual Health