HIV treatment as prevention among men who have sex with men in the UK: is transmission controlled by universal access to HIV treatment and care?
HIV Med
; 14(9): 563-70, 2013 Oct.
Article
en En
| MEDLINE
| ID: mdl-23890150
ABSTRACT
OBJECTIVES:
In the UK, free HIV care is provided through dedicated HIV clinics. Using the national cohort of men who have sex with men (MSM) with diagnosed HIV infection and estimates of the number of undiagnosed men, we assessed whether high retention in HIV care and treatment coverage is sufficient to reduce HIV transmission.METHODS:
Antiretroviral therapy (ART) uptake and viral load distribution among diagnosed men were analysed by treatment status and CD4 count for the period between 2006 and 2010. A multi-parameter evidence synthesis (MPES) method was used to estimate the size of the undiagnosed population. The viral load distribution among newly diagnosed untreated men was applied to the undiagnosed population. Infectivity was defined as a viral load > 1500 HIV-1 RNA copies/mL.RESULTS:
Between 2006 and 2010, ART coverage among all HIV-infected MSM (diagnosed and undiagnosed) increased from 49 to 60%, while the proportion of infectious men fell from 47 to 35%. Over the same period, the number of all HIV-infected MSM increased from 30,000 to 40,100 and the number of infectious MSM remained stable at 14,000. Of the 14,000 infectious MSM in 2010, 62% were undiagnosed, 33% were diagnosed but untreated, and 5% received ART. Extending ART to all diagnosed HIV-infected MSM with CD4 counts < 500 cells/µL in 2010 would have reduced the overall proportion of infectious men from 35 to 29% and halving the proportion who were undiagnosed would further have reduced this to 21%.CONCLUSIONS:
High ART coverage in the UK has reduced the infectivity of the HIV-diagnosed population. However, the effectiveness of treatment as prevention will be limited unless the undiagnosed population is reduced through frequent HIV testing and consistent condom use.Palabras clave
Texto completo:
1
Colección:
01-internacional
Base de datos:
MEDLINE
Asunto principal:
Infecciones por VIH
/
Transmisión de Enfermedad Infecciosa
/
Terapia Antirretroviral Altamente Activa
/
Accesibilidad a los Servicios de Salud
Tipo de estudio:
Etiology_studies
Aspecto:
Determinantes_sociais_saude
Límite:
Humans
/
Male
País/Región como asunto:
Europa
Idioma:
En
Revista:
HIV Med
Asunto de la revista:
SINDROME DA IMUNODEFICIENCIA ADQUIRIDA (AIDS)
Año:
2013
Tipo del documento:
Article
País de afiliación:
Reino Unido