Abstract
In 2009, Public Health England (PHE) introduced the routine application of a recent infection testing algorithm (RITA) to new HIV diagnoses, where a positive RITA result indicates likely acquisition of infection in the previous six months. Laboratories submit serum specimens to PHE for testing using the HIV 1/2gO AxSYM assay modified for the determination of HIV antibody avidity. Results are classified according to avidity index and data on CD₄ count, antiretroviral treatment and the presence of an AIDS-defining illness. Between 2009 and 2011, 38.4% (6,966/18,134) of new HIV diagnoses in England, Wales and Northern Ireland were tested. Demographic characteristics of those tested were similar to all persons with diagnosed HIV. Overall, recent infection was 14.7% (1,022/6,966) and higher among men who have sex with men (MSM) (22.3%, 720/3,223) compared with heterosexual men and women (7.8%, 247/3,164). Higher proportions were among persons aged 15-24 years compared with those ≥50 years (MSM 31.2% (139/445) vs 13.6% (42/308); heterosexual men and women 17.3% (43/249) vs 6.2% (31/501)). Among heterosexual men and women, black Africans were least likely to have recent infection compared with whites (4.8%, 90/1,892 vs 13.3%, 97/728; adjusted odds ratio: 0.6; 95% CI: 0.4-0.9). Our results indicate evidence of ongoing HIV transmission during the study period, particularly among MSM.
Highlights
With over 6,000 new human immunodeficiency virus (HIV) diagnoses in 2011 in the United Kingdom (UK) [1] and a steady increase in the number and proportion of new diagnoses among men who have sex with men (MSM), as well as an increase among UK-acquired infections among heterosexual men and women [2], controlling the HIV epidemic continues to be a public health priority
We review the implementation of the first three years of the programme and examine factors associated with biomarker test results indicative of recent infection among persons newly diagnosed with HIV infection
Coverage was broadly similar across subpopulations apart from slightly more testing among individuals from London and individuals of black Caribbean and other black ethnicity, and less testing among people who inject drugs (PWID); numbers were small among PWID (Table 1)
Summary
With over 6,000 new human immunodeficiency virus (HIV) diagnoses in 2011 in the United Kingdom (UK) [1] and a steady increase in the number and proportion of new diagnoses among men who have sex with men (MSM), as well as an increase among UK-acquired infections among heterosexual men and women [2], controlling the HIV epidemic continues to be a public health priority. HIV incidence, the rate of new infections, is considered to be the most valuable measure for describing the current dynamics of the epidemic. One approach is to use positivity for biomarkers to distinguish recently acquired from longstanding HIV infections from a single sample [3]. A technical guide on how to implement testing for recent infection has been developed by the European Centre for Disease Prevention and Control [7]
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