The annual report on the UK HIV epidemic from the Health Protection Agency (HPA) reveals that the number of new HIV diagnoses declined last year for the fourth year in a row.¹ So far 6630 new diagnoses were logged in 2009 (more may be added as records come in), a decline from a peak of 8000 in 2005.

This is entirely explained by a decline in the number of HIV infections acquired abroad. For the first time since 1999, the number of diagnoses in gay men (2760) exceeded the number in heterosexual people infected abroad (2240), and diagnoses in gay men have been at the same level for three years. Gay men represent 40% of the UK’s positive population but, for the first time in ten years, a slightly higher proportion of new diagnoses (42%).

A higher proportion of heterosexual infections, about a third, took place in the UK - far more than ten years ago, when it was about one in ten.

The HPA estimates that there are now 86,500 people living with HIV in the UK: three times as many as ten years ago. A quarter of these are undiagnosed: the number accessing care is 65,000. The HIV-positive population is ageing: one in five is now over 50.

People are still being tested far too late. Half of adults were diagnosed with HIV with CD4 counts of below 350 cells/mm³, which is when treatment is recommended to start. A quarter of gay men and half of heterosexual men are diagnosed with CD4 counts below 200, meaning they are at substantially greater risk of illness and death, and a much higher proportion of people over 50 are diagnosed late.

Once people are in care, the UK has an excellent record of treatment efficacy: 90% of people on treatment have an undetectable viral load.

Researchers have found that HIV infection still cuts 13 years off the average person’s life expectancy amongst patients in the UK. Ten of those years are due to people coming forward late for testing, with CD4 counts already under 200 cells/mm³, a recent HIV conference in Glasgow heard.²

The impact of HIV is disproportionately felt by men, whose deficit in life expectancy relative to the HIV-negative population is twice that of HIV-positive women.

Figures from the UK Collaborative HIV Cohort (UK CHIC) study, a database of 18,000 patients from 30 HIV clinics, were used to compute life expectancy at age 20: the additional extra years a person could be expected to live when they reached their 20th birthday. Figures for people who, at some point in their lives, were diagnosed with HIV were compared with those from the general UK population.

The researchers found that, in the most recent time period, the life expectancy for HIV-positive people at 20 was 46 years: in other words, the average HIV-positive person could have been expected, at their 20th birthday, to survive till 66. (Note that this does not mean that HIV-positive 65-year-olds are going to die next year: life expectancy increases as you get older, as the fact that you have survived and others have died makes it more likely you will continue to live.) 

Men had a considerably lower life expectancy than women – 40 versus 50 years. Why this is the case is not clear. 

These life expectancies are, on average, 13 years lower than in the UK population and 20 years lower for men.

However, many of the excess deaths were in people diagnosed with low CD4 counts who died in the first year after presenting for an HIV test. The life-expectancy deficit for people who maintained a CD4 count over 200 was 6.5 years post-2000 and in the last two years has become near-normal, presenter Margaret May said.

We are turning the corner in the HIV epidemic, the director of UNAIDS says in the organisation’s annual report on the global epidemic.³

The estimated number of people living with HIV worldwide has fallen by 20% since 2000 and - thanks to increasing access to antiretroviral therapy - AIDS-related mortality has also fallen significantly. There are now an estimated 33.3 million people living with HIV around the world, and there were 2.6 million new HIV infections in 2009.

UNAIDS estimates that 5.2 million individuals are now receiving therapy with anti-HIV drugs, of whom 1.2 million started in 2009.

However, the report also describes funding for prevention and care falling in 2009. “Many countries are under-investing and need to increase their domestic commitments to sustain and scale-up the AIDS response.”