“A doubling of new HIV infections in the UK in the past decade is leading experts to tell GPs to offer testing to all adult male patients in some areas,” reported BBC News.
The news report is based on the latest data, which showed that new diagnoses of HIV acquired in the UK have nearly doubled in 10 years, from 1,950 cases in 2001 to 3,780 in 2010. The figures, published today, have been released by the Health Protection Agency.
The data shows that men who have sex with men remain the group most at risk, with new cases rising by 70% (1,810 in 2001 to 3,080 in 2010).
The figures have been published in connection with new guidance by NICE. The guidance is aimed at increasing the uptake of HIV testing in this group.
The guidance suggests that regular, routine testing is offered to all men who register with a GP surgery in areas that have high levels of HIV. Routine testing will also be offered to men who live in areas that have a large community of men who have sex with men. It is also recommended that men in these areas are offered HIV tests when admitted to hospital.
What is the news based on?
The figures for the numbers of new HIV diagnoses have been released by the Health Protection Agency (HPA), an independent UK health watchdog set up to protect the public from threats to their health from infectious diseases and environmental hazards.
The guidance comes from the National Institute for Health and Clinical Excellence (NICE), which provides guidance, sets quality standards and manages a national database to improve people's health and prevent and treat ill-health.
What are the aims of the new NICE guidelines?
To increase HIV testing to help reduce undiagnosed infection and prevent transmission among men who have sex with men. The guidance suggests that healthcare professionals offer regular, routine testing to all men in high-prevalence areas, and to those who live in areas with large communities of men who have sex with men.
Why focus on men who have sex with men?
Men who have sex with men remain the group most at risk of becoming infected with HIV. In 2009, there were 6,630 people diagnosed with HIV in the UK. Over 40% of these new diagnoses were among men who have sex with men.
In total, there are about 30,800 men who have sex with men living with HIV in the UK. It is estimated that nearly 9,000 of these men are unaware that they are infected.
What areas have a high prevalence of HIV?
For these guidelines, high prevalence was defined as areas with more than two diagnosed cases per 1,000 people. The HPA has produced a table showing which primary care trusts fall within this definition.
Why increase testing?
Generally, the sooner a person with HIV is diagnosed the better their outcome. HIV can be successfully managed with antiretroviral therapies. However, if someone is diagnosed late it's more likely that the virus will have already seriously damaged their immune system. Late diagnosis is one of the biggest contributing factors to illness and death for people with HIV. Almost a third of people in the UK who are diagnosed as HIV positive are diagnosed late.
By getting an early diagnosis, people with HIV will have better health and a longer life expectancy.
Lack of a diagnosis also increases the likelihood that the virus will be passed onto other sexual partners.
What is the advice to GPs for routine HIV tests?
NICE advises that HIV testing should be offered and recommended to all men who:
- register with a practice in an area with a large community of men who have sex with men
- register with a practice in an area with a high HIV prevalence (high prevalence means more than two diagnosed cases per 1,000 people)
- disclose that they have sex with other men
- are known to have sex with men and have not had a HIV test in the previous year
- are known to have sex with men and disclose that they have changed sexual partner or engaged in high-risk sexual practices
- have symptoms that may either indicate HIV, or that HIV is part of the differential diagnosis
- are diagnosed with, or request screening for, a sexually transmitted infection
- live in a high-prevalence area and are undergoing blood tests for another reason
HIV testing should also be offered to men who are admitted to hospital with the following circumstances:
- are admitted in areas with a high prevalence of HIV
- disclose that they have sex with men
- have symptoms that may indicate HIV, or HIV is part of the differential diagnosis
What about repeat tests?
NICE recommends that repeat tests are offered annually to all men who have sex with men. More frequent testing is recommended for those at high risk of exposure (such as those with multiple partners or have unsafe sexual practices).
It also recommends repeat testing after the ‘window period’ for those who tested negative, but have possibly been exposed to the virus. The window period is the time between infection and when antibodies to the virus are detectable by a test. Depending on the type of test it can take up to 3 months, although fourth-generation testing can detect the virus much sooner.
Adapted from materials provided by NICE and the HPA.
Links to the headlines
BBC News, 23 March 2011
The Independent, 23 March 2011
The Guardian, 23 March 2011
Metro, 23 March 2011
Links to the science
NICE guidance; Issued: March 2011
HPA, March 23 2011