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