AEGiS-15IAC: HIV incidence remains constant in men who have sex with men (MSM) in UK despite widespread use of combination antiretroviral therapy.

15th International AIDS Conference

Bangkok, Thailand - July 11-16, 2004

HIV incidence remains constant in men who have sex with men (MSM) in UK despite widespread use of combination antiretroviral therapy.

Int Conf AIDS 2004 Jul 11-16; 15:(abstract no. WeOrC1336)

Parry JV, Murphy G, Charlett A, Osner N, Brown A, Gill ON
Sexually Transmitted & Bloodborne Virus Laboratory, Health Protection Agency, London, United Kingdom

BACKGROUND: The Serological Testing Algorithm for Recent HIV Seroconversion (STARHS) was applied to left over anti-HIV-1 positive serum specimens from MSM attending 15 Sexually transmitted infection clinics collaborating in a UK unlinked anonymous serosurvey (UAS).

METHODS: STARHS was performed on anti-HIV-1 positive specimens as previously described, and HIV incidence rates were determined. Specimens from those with previously diagnosed HIV infection or AIDS were excluded. National data on uptake of anti-retroviral therapy (ART), AIDS mortality and diagnoses of gonorrhoea in MSM were used to assist interpretation of the HIV incidence findings.

RESULTS: During 1995-2003 over 50,000 specimens were collected from MSM, of which over 4,000 were anti-HIV-1 positive. 1,977 serum specimens were from undiagnosed infections and available for STARHS testing, and 399 were determined to come from recently acquired infections. The overall estimated annual incidence ranged from 1.5% (1999) to 3.5% (2002). In 2002, incidence was 3.46% in London. Outside London it was 2.4%, a 2.5-fold increase since 2001.

CONCLUSIONS: Despite the increasingly effective use of ART to manage HIV infection by reducing viral load, we found no evidence of a significant decline in HIV incidence. Individuals whose HIV infection has been diagnosed should with treatment become less infectious but, in 2002, 22% of infections in MSM remain undiagnosed, many with acute STIs, and this may be an important driver of the ongoing epidemic. Initiatives to diagnose and treat a greater proportion of HIV infections, including those with a suspected seroconversion illness, may be critical to reducing HIV incidence in MSM.

Keywords: AEGIS, Acquired Immunodeficiency Syndrome, Incidence, HIV Seropositivity, HIV Infections, Coitus, Sex, London, Safe Sex, Humans, Male, epidemiology

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