HIV and STI Department, Health Protection Agency - Colindale
HIV and AIDS Reporting System
Predictors for high viraemia among the treatment naïve population in the
United Kingdom.
Alison Brown, Adamma Aghaizu, Gary Murphy, Valerie Delpech
Background:• Viral load established as key predictor for HIV
transmission • More evidence needed for population effect
of Treatment as Prevention to reduce transmission
• Treatment based upon clinical guidelines• Quick win? Identify groups of untreated HIV
diagnosed people with elevated viraemia to target for prevention
Aims:
From a prevention perspective:• Describe distribution of viral load among the
treatment naïve HIV-diagnosed population• Identify predictors of high viraemia among the
untreated population• Discuss implications for prevention
The treatment cascade among HIV positive people in the UK:2010
* Numbers were adjusted by missing information and rounded to the nearest 100. § Viral load <50 copies/ml after HIV treatment initiation in the year of initiation.
The treatment cascade among HIV positive people in the UK:2010
* Numbers were adjusted by missing information and rounded to the nearest 100. § Viral load <50 copies/ml after HIV treatment initiation in the year of initiation.
87% of HIV diagnosed people with CD4 <350
receive treatment
Methods:
• Comprehensive, national HIV surveillance data• Treatment naïve adults (≥15 years) accessing
HIV care in the UK in 2010• Patients diagnosed during 2010 categorised
as: recently infected, late diagnosed & other• Most recent viral load in 2010; high viraemia
was defined as >40,000 copies.• Multivariate analysis was conducted to
identify predictors for high viraemia.
Treated Treatment naïve
n=56,200 n=8500
39 copies/mL (IQR 39-49)
10,494 copies/mL (IQR 1,600-42,223)
Results:
• In 2010, 68,600 adults accessed HIV care. • 8500 (12%) were treatment naïve and had
viraemia information available:Median viral load:
Elevated viral load
Number and proportion of treatment-naive HIV positive adults with a viral load
>40,000 copies/mL, UK, 2010
Recently infected Late diagnosis Other Diagnosed before 2010
Diagnosed during 2010
0tan28a566028
0tan24a566224
0tan19a566519
0tan15a566815
0tan12a567112
0tan6a56736
0tan3a56763
41% 51%
29%
21%
>40,000 <40,000
Num
ber o
f tre
atm
ent n
aive
adu
lts Viral load copies /mL
Number and proportion of treatment-naive HIV positive adults with a viral load
>40,000 copies/mL, UK, 20100-
200
201-
350
351-
500
>500
MSM
Het
men
Het
wom
en
PWID
15-2
4
25-3
4
35-4
9
>50
CD4 count /mm3* Exposure to HIV* Age group
0%
20%
40%
60%
80%
100%
>40,000<40,000
Num
ber o
f tre
atm
ent n
aive
adu
lts
Viral load copies /mL
Predictors for high viraemia:Risk factor % with viral load
>40,000 copies Odds ratio 95% CI
Diagnosed during 2010
Recently infected 41% 2.8 2.1-3.7Late diagnosis 51% 2.1 1.7-2.6
Other 29% 1.6 1.4-1.8 Diagnosed <2010 21% 1.0 -
Age group
15-24 23% 1.0 -25-34 26% 1.4 1.1-1.735-49 25% 1.3 1.1-1.6>50 30% 1.6 1.3-2.0
CD4 count
0-200 59% 3.1 2.4-4.0201-350 38% 1.4 1.2-1.6351-500 30% 1.0 ->500 18% 0.5 0.4-0.6
Exposure to HIV
MSM 29% 2.8 2.1-3.7Het men 28% 1.8 1.5-2.1Het women 17% 1.0 -PWID 27% 1.7 1.2-2.4
Discussion
• Predictors of high viraemia provide a useful tool to target secondary prevention.
• Need for rapid partner notification among the recently infected at diagnosis
• Rapid ARV critical for those diagnosed late for prevention as well as clinical purposes.
• The higher viraemia at older ages and among men requires further exploration.
HIV and STI Department, Health Protection Agency - Colindale
HIV and AIDS Reporting System
Thank youParticularly to Dr Zheng Yin and Cuong Chau
www.hpa.org.uk