Improved prevention measures fail to reduce HIV levels in men who have sex with men in England and Wales
The rate of new HIV infections among men who have sex with men in England and Wales has remained unchanged over the past decade despite an almost four-fold increase in HIV testing, rising treatment coverage, and a 20 percent shortening of time-to-diagnosis, according to new research published Online First in the Lancet Infectious Diseases.
"Our findings highlight the limited effect of the national HIV strategy which aimed to reduce transmission by increasing the uptake of HIV testing in STI clinics, and suggest that high antiretroviral treatment (ART) coverage alone may not be enough to halt the spread of HIV among MSM", said lead investigator Daniela De Angelis from the UK Medical Research Council's Biostatistics Unit.
In England and Wales, MSM have the highest prevalence of HIV (9% in London and 3% elsewhere).
De Angelis and colleagues from the UK Medical Research Council's Biostatistics Unit developed a model for HIV incidence that, unlike previous models, allows for the estimation of both rates of infection and diagnosis by combining CD4 counts at diagnosis with information on the natural history of HIV infection. They applied the model to surveillance data on new HIV diagnoses in MSM, to estimate trends in time to diagnosis, rates of new infections and the number of undiagnosed infections among MSM between 2001 and 2010.
Over the decade, the estimated average time-to-diagnosis interval fell from 4 years to 3.2 years. However, the researchers noted no decline in HIV incidence, the number of new infections remaining at around 2300 a year, with little difference in the estimated number of undiagnosed MSM (7370 in 2001 and 7690 in 2010).
These results should be interpreted alongside a substantial increase in HIV testing in sexually transmitted infection clinics (16 000 men in 2001 to 59 300 in 2010), and a rise in ART uptake (from 69% in 2001 to 80% in 2010).
According to De Angelis, the most likely explanation for the continuing high level of HIV transmission in MSM is resurgence in unsafe sexual practices because of treatment optimism and insufficient coverage of HIV testing across the MSM population.
"We suggest that health-care services in England and Wales will need to improve targeting of testing to the most-at-risk groups and to initiate treatment earlier than currently recommended (irrespective of CD4 count), to bring about a drop in HIV incidence", she adds.
Writing in a linked Comment, Reuben Granich a senior advisor for care and treatment at UNAIDS in Geneva says, "the study findings regarding the flatlining HIV incidence, despite increased HIV testing and treatment rates, should be of considerable concern to men who have sex with men, their partners and families, the community, public health authorities, and policy makers."
"[The] call for earlier treatment initiation irrespective of CD4 cell count…is a bold conclusion—the conceptual shift to offering treatment initiation to all those with a positive diagnosis would be a significant innovation. [However], the analysis also clearly shows that increased testing and earlier treatment is no quick and easy solution. Given the complexity of the epidemic, a comprehensive response including the full range of societal and public health interventions will be necessary to reduce incidence", he adds.
More information: Study online: www.thelancet.com/… 1-9/abstract
Journal reference: Lancet Infectious Diseases
Provided by Lancet
- HIV racial disparities noted for men who have sex with men Jul 20, 2012 | not rated yet | 0
- HIV 'epidemics' emerging in MENA region: study Aug 03, 2011 | not rated yet | 0
- NIH-funded study finds high HIV infection rates among gay and bisexual black men in the US Jul 26, 2012 | not rated yet | 0
- Study finds HIV-infected men at risk for spreading HIV despite taking HAART Mar 27, 2012 | not rated yet | 0
- HPTN study finds greatly elevated HIV infection rates among young black MSM in the US Jul 23, 2012 | not rated yet | 0
- Motion perception revisited: High Phi effect challenges established motion perception assumptions Apr 23, 2013 | 3 / 5 (2) | 2
- Anything you can do I can do better: Neuromolecular foundations of the superiority illusion (Update) Apr 02, 2013 | 4.5 / 5 (11) | 5
- The visual system as economist: Neural resource allocation in visual adaptation Mar 30, 2013 | 5 / 5 (2) | 9
- Separate lives: Neuronal and organismal lifespans decoupled Mar 27, 2013 | 4.9 / 5 (8) | 0
- Sizing things up: The evolutionary neurobiology of scale invariance Feb 28, 2013 | 4.8 / 5 (10) | 14
Classical and Quantum Mechanics via Lie algebras
Apr 15, 2011 I'd like to open a discussion thread for version 2 of the draft of my book ''Classical and Quantum Mechanics via Lie algebras'', available online at http://lanl.arxiv.org/abs/0810.1019 , and for the...
- More from Physics Forums - Independent Research
More news stories
(HealthDay)—For HIV-infected individuals with recurrent Clostridium difficile infection, fecal microbiota therapy is feasible, according to a letter published in the May 21 issue of the Annals of Intern ...
HIV & AIDS 12 hours ago | not rated yet | 0
Canadian health authorities lifted Wednesday what was effectively a ban on gay men giving blood, announcing new rules making men who have not had sex with men in the past five years eligible.
HIV & AIDS 14 hours ago | not rated yet | 1
Top AIDS scientists were optimistic Wednesday of finding a cure for the disease that has claimed 30 million lives—but said it might not work for all people.
HIV & AIDS 17 hours ago | not rated yet | 0
The integration of mental health interventions into HIV prevention and treatment platforms can reduce the opportunity costs of care and improve treatment outcomes, argues a new Policy Forum article published in this week's ...
HIV & AIDS May 21, 2013 | not rated yet | 0
Swiss scientists reveal the mechanism responsible for aging hidden deep within mitochondria—and dramatically slow it down in worms by administering antibiotics to the young.
17 hours ago | 4.9 / 5 (9) | 1 |
Researchers from Queen Mary, University of London have led the largest sequencing study of human disease to date, investigating the genetic basis of six autoimmune diseases.
17 hours ago | 4.7 / 5 (3) | 0 |
Existing research shows that bicyclists who wear helmets have an 88 percent lower risk of brain injury, but researchers at Boston Children's Hospital found that simply having bicycle helmet laws in place showed a 20 percent ...
6 hours ago | not rated yet | 0
Until now, little was scientifically known about the human potential to cultivate compassion—the emotional state of caring for people who are suffering in a way that motivates altruistic behavior.
14 hours ago | 5 / 5 (2) | 2 |
(HealthDay)—Migraines and depression can each cause a great deal of suffering, but new research indicates the combination of the two may be linked to something else entirely—a smaller brain.
14 hours ago | 4 / 5 (2) | 0 |
A new approach for immunizing against influenza elicited a more potent immune response and broader protection than the currently licensed seasonal influenza vaccines when tested in mice and ferrets. The vaccine ...
14 hours ago | not rated yet | 0 |