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The threshold for an ART secondary prevention effect on HIV transmission among MSM has not been reached despite high treatment uptake. Alison Brown , Valerie Delpech, Anne Presanis, Gary Murphy and Noel Gill. . Background :.

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The threshold for an ART secondary prevention effect on HIV transmission among MSM has not been reached despite high treatment uptake

Alison Brown, Valerie Delpech,

Anne Presanis, Gary Murphy and Noel Gill.


Background
Background transmission among MSM has not been reached despite high treatment uptake:

  • Viral load established as key predictor for HIV transmission; ART effective at individual level

  • From promise to programmes: the challenge of the treatment cascade

    In the UK:

  • MSM HIV prevalence 5% and sustained number of HIV diagnoses

  • HIV care provided free of charge

  • Nearly all diagnosed MSM are in HIV care

  • 82% of MSM in HIV care receive treatment


Aims: transmission among MSM has not been reached despite high treatment uptake

Assess the impact of high ART coverage on HIV transmission among MSM through:

  • Community viral load

  • Number/proportion of population who are infective (viral load >1500 copies)

  • Markers of HIV incidence


Methods
Methods transmission among MSM has not been reached despite high treatment uptake:

  • Observational study of HIV-infected MSM in the UK, 2006-2010

  • Comprehensive, national surveillance data and modelling techniques determined:

    • Number HIV+ MSM (diagnosed and undiagnosed)

    • ART coverage

    • Number & proportion of HIV-infected MSM who were infective (viral load >1500 copies/mL)

    • HIV incidence indicators and the estimated number of infective MSM



Number of HIV-infected MSM, and proportion treated UK: 2006-10infective (VL>1500 copies) by diagnostic and treatment status, UK: 2010




Annual hiv incidence in msm england wales 2001 2010 birrell et al1
Annual HIV incidence in MSM, England & Wales: 2001-2010 2010(Birrell et al.)

Also, between 2006-2010:

- Number of new diagnoses increased

- Median age & CD4 count at diagnosis stable

- 25% of MSM newly diagnosed were recently infected (2009-10)


Why is hiv transmission continuing
Why is HIV 2010transmission continuing?

And…

And…

in 2010 only 15-25% of MSM had an HIV test


Conclusions
Conclusions: 2010

  • UK access to HIV testing and treatment is excellent

  • Despite very high ART coverage, HIV transmission has not decreased among MSM

  • HIV incidence probably would have been much higher without extensive ART coverage

  • Undiagnosed probable source of most new infections

  • Higher rates of testing are required to reduce late diagnoses

  • Primary prevention remains key

    • Safer sex campaigns and behavioural interventions

    • Role of partner notification needs expanding


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