A Complex Picture

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A Complex Picture

• HIV other Sexually Transmitted Infections in
  the United Kingdom 2006

Dr Valerie Delpech
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Outline of presentation

• Context
• HIV
• Total number of individuals living with HIV
• Groups requiring targeted interventions
• Late diagnoses
• HIV testing
• Sexually transmitted infections
• Young people
• Conclusions

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Context

• 25 years of HIV
• global impact
• HIV/AIDS is the worst pandemic the world has ever
  faced (UNAIDS)
• UK response
• a decade of effective anti-retroviral treatments
• National roll out of National Chlamydia Screening
  Program (NCSP) in England
• Complex and changing picture of HIV/STIs

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HIV
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Overview of HIV epidemic in the UK

• 63 000 people living with HIV infection in the UK
  
• One third unaware of their infection
• Deaths has decreased from peak of 1726 in 1996 to
  approx 500 per year since 1998
• HIV disproportionately affects specific groups of
  the population. Targeted interventions are key to
  reducing HIV transmission in the UK
• HIV infected individuals continue to die of AIDS,
  most because they are diagnosed too late
• Early testing of HIV and access to treatment
  remains crucial in reducing ill health and the
  transmission of HIV

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Number of adults with HIV in the UK
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Adults living with HIV in the UK (aged 15-59)
2005
Multi-parameter Evidence Synthesis method -
Goubar A et al. 2005, United Kingdom.
SOPHID, Health Protection Scotland, Natsal 2000,
Unlinked Anonymous Programme, ICH National Study
of HIV in Pregnancy Childhood.
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New diagnoses
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HIV and AIDS diagnoses and deaths, UK
Numbers will rise, for recent years, as further
reports are received. Clinician reports of new
HIV/AIDS diagnosis
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HIV diagnoses by exposure category, UK
Numbers will rise, for recent years, as further
reports are received. Clinician reports of new
HIV/AIDS diagnosis
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Men who have Sex with Men (MSM)
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Men who have Sex with Men (MSM)

• MSM remain the behavioural group at greatest risk
  of acquiring HIV within in the UK
• New diagnoses among MSM are the highest on record
  since the start of the epidemic
• Incidence of HIV remains high (an estimated 3 of
  MSM attending sentinel GUM clinics have recently
  acquired their infection)
• High risk behaviour for HIV continue to be
  reported
• Co-infection with other STIs are common

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Annual HIV incidence among MSM attending GUM
clinics
Estimated using the Serological Testing Algorithm
for Recent HIV Seroconversion (STARHS). Trend not
significant.
Unlinked anonymous testing of GUM clinic
attendees
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Diagnoses of selected STIs among MSM
Routine GUM clinic returns
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Ciprofloxacin resistance in Gonorrhoea
Prevalence estimates for ciprofloxacin resistant
(gt1mg/l) N.gonorrhoeae in England Wales, by
gender and sexual orientation 2001 to 2005
Gonococcol Resistance to Antimicrobials
Surveillance Programme
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HIV contracted heterosexually within the UK
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HIV contracted heterosexually within the UK
Numbers will rise, for recent years, as further
reports are received. Clinician reports of new
HIV/AIDS diagnosis
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HIV contracted heterosexually within the UK
sexual partners place of infection 2000 to 2005
Clinical reports of HIV/AIDS diagnosis
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Persons who present late in the course of their
HIV infection
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Late diagnosis of HIV infection
n2356 n156
n2571 n1478
n7450
Reports of HIV/AIDS diagnosis and CD4
Surveillance
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HIV drug resistance
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HIV drug resistance in patients who have never
received treatment, UK
NRTI nucleoside reverse transcriptase
inhibitors PI protease inhibitors nNRTI
non-nucleoside reverse transcriptase
inhibitors. UK HIV Drug Resistance Database
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Other sexually transmitted infections
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Sexually Transmitted Infections in young people
UK
Chlamydia and gonorrhoea are uncomplicated
episodes and genital warts and herpes are first
attack only
Routine GUM returns
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Syphilis (primary secondary) in women by age
group
Routine GUM clinic returns
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Chlamydia screening - infection rate in young
adults by sex 2005
National Chlamydia Screening Programme
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HIV prevalence among current injecting drug users
in England and Wales
Current IDU is defined as someone who reports
injecting in the previous 28 days. Unlinked
anonymous testing of injecting drug users
attending services
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HIV testing
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Uptake of Voluntary and confidential HIV test in
GUM clinics
VCT excludes those previously diagnosed
Unlinked anonymous testing of GUM clinic
attendees
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Pregnant women and newborn infants HIV
diagnosis and transmission rates
Assumes a vertical transmission rate of 26.5 in
undiagnosed women and 2.2 in diagnosed
women. Unlinked anonymous testing of
newborn infant dried blood spots and NSHPC
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Recommendations

• Invest in targeted behaviour modification and
  intervention strategies for MSM and black-African
  and black-Caribbean heterosexuals
• Targeted HIV testing, and HIV tests as part of
  Health Checks
• Maintain high antenatal screening
• Develop improved Needle Exchange services
• Accelerate roll-out of chlamydia screening
• Strengthen surveillance and monitoring systems
• Progress microbiological R D

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HIV and STIs in the UK other parts of the
picture