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Eurosurveillance, Volume 7, Issue 20, 15 May 2003
Articles

Citation style for this article: Dougan S. Steady increase in HIV in the United Kingdom. Euro Surveill. 2003;7(20):pii=2230. Available online: http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=2230

Steady increase in HIV in the United Kingdom

Sarah Dougan (sarah.dougan@hpa.org.uk), Health Protection Agency Communicable Disease Surveillance Centre, London, England.

From 1990 to 1998, new diagnoses of HIV infection in the United Kingdom (UK) averaged 2675 per year, most among homosexual men. In 1999, however, a rapid increase in numbers of new diagnoses began (figure 1). By the end of March this year there were 5338 reports of new HIV diagnoses in 2002, representing a 28% increase on numbers of new diagnoses in 2001, reported by the same time last year. The number is predicted to rise to over 6000 new HIV diagnoses in 2002 as further reports are received. In contrast, the numbers of new AIDS diagnoses increased annually peaking in 1994 at 1854, until the widespread use of highly active antiretroviral therapy (HAART) in the mid nineties led to a fall, numbers stabilising in the late nineties, with 647 new AIDS diagnoses in 2002 reported so far.

Figure 1: HIV diagnoses and AIDS cases by year of first diagnosis in the United Kingdom:

(Data to end of March 2003)

Reports of new HIV diagnoses in the UK are received from laboratories and clinicians, the latter also reporting new AIDS diagnoses. Data presented are from reports received at the Communicable Disease Surveillance Centre by the end of March 2003.

Between 1999 and 2002, there were 17 188 new HIV diagnoses; 3058 in 1999, rising to 5338 in 2002, an increase of over 75%. Of those newly diagnosed with HIV during this period, where probable route of infection was reported, 9130 (57%) probably acquired infection heterosexually and 5985 (37%) through sex between men (table 1). Injecting drug use only accounted for 431 infections, and mother to child exposure for 358. One thousand one hundred and sixty nine (6.8%) of individuals do not yet have a probable route of infection assigned; this will decrease as follow up continues.

Table 1: New HIV diagnoses in the United Kingdom between 1999 and 2002, by sex and probable route of exposure
(Data to end of March 2003)

Exposure route
Male
Female
Total(%)
Sex between men*
5985
-
5985(35)
Heterosexual sex**
3472
5657
9130(53)
Injecting drug use
306
125
431(3)
Blood transfusion/products
41
48
89(1)
Mother to child
184
174
358(2)
Other
17
9
26(0.2)
Undetermined**
709
459
1169(7)
Total
10714
6472
17188
*includes 86 individuals who also injected drugs
**total includes 1 individual of unreported sex

Of the 9130 individuals who acquired infection heterosexually, 3472 (38%) were male and 5657 (62%) female. Where ethnicity was reported, 6095 (73%) were black African, 1410 (17%) white, and 407 black Caribbean (table 2). Where reported, 6686 (78%) were probably infected in Africa, 974 (11%) in the UK, and 374 in Asia (table 3). Heterosexual transmission within the UK is likely to be underestimated, because if an individual has been exposed to infection in more than one area of the world, probable country of infection is allocated to the area with the highest prevalence. In comparison, of the 5985 homosexual men, 3901 (88%) were white, with most (84%) for whom a likely country of infection has been recorded, probably infected in the UK.

Table 2: New HIV diagnoses in the United Kingdom between 1999 and 2002, by probable route of infection and ethnicity
(Data to end of March 2003)

Ethnic group
Men who have sex with men
Heterosexuals
Other/ Undetermined

Total (% of sub total)

White
3901
1410
593
5904(42)
Other/mixed
206
216
89
511(4)
Black Caribbean
165
407
41
613(4)
Black African
82
6095
564
6741(48)
Black other
51
91
11
153(1)
Indian/Pakistani/ Bangladeshi
51
130
29
210(2)
Sub total
4456
8349
1327
14132
Not reported
1529
781
746
3056
Total
5985
9130
2073
17188

 

Table 3: New HIV diagnoses in the United Kingdom between 1999 and 2002, by probable route of infection and probable region/country of infection
(Data to end of March 2003)

Probable country/region of infection*
Men who have sex with men
Heterosexuals
Other/ Undetermined
Total(% of sub total)
UK
2213
974
206
3393(28)
Africa
52
6686
397
7135(59)
Asia
42
374
42
458(4)
Australasia
32
16
5
53(0.4)
Europe
160
200
133
493(4)
Latin America/ Caribbean
75
299
13
387(3)
North America
60
24
7
91(1)
Sub total
2634
8573
803
12010
Not reported
3351
557
1270
5178
Total
5985
9130
2073
17188


There were 2867 new AIDS diagnoses between 1999 and 2002. As AIDS has become a poorer marker of infection progression since the introduction of HAART, reporting of AIDS, particularly when it is not present at HIV diagnosis, may have decreased, and this may underestimate the true number of new diagnoses over the period. Where probable route of infection was reported, 1524 (54%) of those diagnosed with AIDS probably acquired infection heterosexually and 998 (36%) through sex between men. An individual may have more than one AIDS defining illness at the time of first AIDS diagnosis. Pneumocystis carinii pneumonia (PCP) was the most frequently diagnosed AIDS defining condition among men who have sex with men, with 442 diagnoses. Among heterosexuals, tuberculosis was diagnosed in 565 individuals, reflecting the high numbers of black Africans in this exposure group, and PCP was diagnosed in 419 individuals (table 4).

Table 4: Initial AIDS defining illnesses and number new AIDS diagnoses by probable route of infection, United Kingdom 1999-2002
(Data to end of March 2003)

Probable route of infection
Initial AIDS defining illness
Men who have sex with men
Heterosexuals
Other
Total(%)
Kaposi's sarcoma
175
81
5
261(8)
Lymphoma
75
51
21
147(4)
Mycobacterium - other
42
57
8
107(3)
Mycobacterium tuberculosis
39
565
32
636(19)
Candidiasis
127
163
42
332(10)
Pneumocystis carinii pneumonia
442
419
112
973(28)
Other opportunistic infection
165
354
121
640(19)
Wasting
86
108
63
257(8)
Encephalopathy
31
26
25
82(2)
Total
1182
1824
429
3435
Total number of individuals*
998
1524
345
2867
*An individual may have more than one initial AIDS defining illness

The UK's HIV epidemic has changed substantially over the past decade, moving from one predominantly affecting white homosexual men, to one where HIV heterosexually acquired in Africa is driving significant rises in numbers of new HIV diagnoses here. Nevertheless, new diagnoses among white homosexual men continue. In sharp contrast, AIDS diagnoses have fallen since the introduction of HAART.

The need to recognise the diversity of the people affected has been acknowledged by the UK government's National Sexual Health Strategy (1), but effective action to reduce further spread of HIV within the UK will be hampered if resources are inadequate to meet the rapidly increasing prevention and care needs.

UK data from the Health Protection Agency Communicable Disease Surveillance Centre (CDSC), Scottish Centre for Infection and Environmental Health, and the Institute of Child Health, London.

References:
  1. Department of Health. The National Strategy for Sexual Health and HIV. London: Department of Health, 2001. (http://www.doh.gov.uk/nshs/bettersexualhealth.pdf).

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