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Hot Topic: HIV Eradication

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Recently the UK government has set out an ambitious plan to entirely eliminate HIV/AIDS in the UK by 2030. This is a difficult process, which will first see a set of 2025 goals that need to be met, prior to the (planned) total elimination by 2030. This is a huge public health initiative, and one that is well-worth knowing about for your MMIs. Here we will work through some of the most pertinent parts of the strategy, as well as considering the current landscape.

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What is the current rate of HIV transmission?

The pledge to have zero new HIV infections, and zero AIDS or HIV related deaths in England by 2030 was made in 2019. It’s therefore important to consider recent rates of transmission and disease. As it stands, there has been a significant decline in new HIV diagnoses, driven by reductions in diagnoses in gay and bisexual men, who previously made up 41% of all new diagnoses in England in 2019. Typically, HIV is thought of as a disease that afflicts gay men, but the gap in new diagnoses between gay and heterosexual men versus the heterosexual population has narrowed in recent years – meaning that it’s now just as important to educate heterosexual people who are at a high risk of HIV as it is to focus on the gay and bisexual population. In fact, the rate of new HIV infections in England amongst heterosexual men and women has declined much less steeply than it has amongst gay and bisexual men – and there are additionally around 100 new HIV diagnoses per year amongst those who likely acquired HIV through injecting drug use.

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How can HIV be eradicated?

In order to achieve this ambitious goal, we need to both focus on prevention and early diagnosis, and the prompt care of those who are diagnosed with HIV. Through effective antiretroviral therapy (ART), HIV can be suppressed below detectable and transmittable levels. If it is undetectable, it is untransmittable. In other words, if we are able to suppress the virus, it cannot be passed on, thus reducing transmission.

As it stands, 11% of people with AIDS had transmissible levels of virus. Additional analysis by UKHSA has found that an estimated 18,160 people living with HIV in England had potentially transmissible levels of the virus, which is around 19% of people living with HIV. Some of these were undiagnosed – roughly a third it is thought – and around 21% were undiagnosed but had not been referred to specialist care or properly retained in care. 9% had attended the correct care pathway but were not receiving treatment, whilst 12% were not virally suppressed despite receiving treatment.

Specific steps that are being taken to reduce the rate of transmission to zero include preventing new infections by expanding and improving current HIV prevention activities, including investing in a national HIV prevention program and increasing access to PrEP; increasing the scale of HIV testing in high risk areas and populations, including further opt-out testing in A&Es, with significant investment in this area; ensuring that people receive rapid treatment as soon as they are diagnosed. The latter, of course, not only reduces transmission levels but also goes some way to ensuring that the patient is able to live as healthy a life as possible. Specific goals that are set for 2025 (an interim target to establish that the path is set for eradication by 2030) include:
– reducing the number of people first diagnosed in England from 2860 in 2019, to under 600 in 2025
– reducing the number of people diagnosed with AIDS within 3 months of HIV diagnosis from 219 to under 110
– reducing deaths from HIV/AIDS in England from 230 in 2019 to under 115

As it stands, significant progress has been made to increase diagnosis in gay and bisexual men, which in turn has led to new HIV diagnoses in these key groups falling from 2980 in 2014, down to 1890 in 2018, and further still to just 1580 in 2019. This represents real, positive change and is indicative that with continued work and investment the idea of England being entirely free of HIV/AIDS by 2030 is realistic and attainable.

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