New HIV diagnoses among MSM in London fall by 25%

New HIV diagnoses among men who have sex with men in London fell by 25% over a recent period, including a 32% decline in five selected clinics, according to researchers from Public Health England.

Alison E. Brown, PhD, MSc, and colleagues said the drop between October 2015 and September 2016 coincided with high HIV testing volumes and rapid initiation of treatment among MSM. But they also urged “cautious interpretation” of their data, which they said were rapidly analyzed after sexual health clinics reported a drop in new HIV diagnoses among MSM last December.

“Conclusions could be affected by reporting delay (albeit minimal), incomplete data in relation to ART coverage, ART start date and CD4 count at HIV diagnosis, and neither the impact of partner notification nor the movement between clinics for HIV testing is measured,” they wrote in Eurosurveillance.

“The assumption that attendees of the same clinics are more likely to form part of the same sexual network compared with random sexual mixing is plausible but unsubstantiated,” they wrote. “Finally, while numbers of HIV diagnoses are not synonymous with HIV incidence, the rise in median CD4 count at HIV diagnosis suggests that the fall in diagnoses reflects a fall in incidence.”

According to Brown and colleagues, MSM account for half of all patients with HIV in England, with an estimated 5,000 to 8,000 infected MSM still undiagnosed. A national “treatment as prevention” strategy has been in place since 2012, recommending that MSM at high risk of HIV infection undergo frequent testing and start ART regardless of CD4 count if they test positive.

Pre-exposure prophylaxis (PrEP) for HIV prevention is not accessible through the National Health Service in England except through a clinical trial and use remains limited in the country, Brown and colleagues reported. It has been available since 2013 in some clinics as part of the PROUD trial and can be acquired through international purchasing online, Brown and colleagues said.

For their study, they analyzed public health data to examine HIV testing patterns and diagnoses among MSM who attended one of 200 free sexual health clinics in England between January 2013 and September 2016.

According to their results, new HIV diagnoses among MSM in England fell by 17% between October 2015 and September 2016 as compared with the previous 12-month period. In London, the decline was 25%, including a 32% drop in new HIV diagnoses among MSM at five selected “large-fall” clinics that coincided with a 50% increase in HIV tests at these locations, Brown and colleagues said. The decline was 8% at 30 other London clinics and 5% in 191 clinics in the rest of the country, they reported.

Brown and colleagues said the 50% increase in HIV tests at the “large-fall” clinics was coupled with a 51% decline in the number of MSM with HIV who were untreated at these locations. In other clinics, testing and treatment patterns either remained stable or increased less dramatically, Brown and colleagues reported. They also noted reduced time between diagnoses and the start of treatment among both London clinics and those outside the city.

Brown and colleagues concluded that increased testing and rapid treatment have reached levels sufficient to decrease the number of MSM with transmissible levels of virus, and that the use of PrEP among high-risk men also has contributed to the fall in diagnoses.

“If HIV testing of MSM at high risk of HIV is intensified, and wide-scale immediate ART, as observed within the London large-fall clinics, is replicated elsewhere, it is probable that a substantial reduction in HIV transmission among MSM could be achieved nationally,” they wrote. “Should the promise of the PrEP Impact Trial proposed in England be realized promptly, then a very large reduction in HIV transmission in MSM may be attained. The similarity of the MSM HIV epidemic in England to elsewhere in Western Europe suggests a similar approach in these countries might be equally successful.” – by Gerard Gallagher

Reference:

Brown AE, et al. Euro Surveill. 2017;doi:10.2807/1560-7917.ES.2017.22.25.30553.

Disclosure: The researchers report no relevant financial disclosures.

New HIV diagnoses among men who have sex with men in London fell by 25% over a recent period, including a 32% decline in five selected clinics, according to researchers from Public Health England.

Alison E. Brown, PhD, MSc, and colleagues said the drop between October 2015 and September 2016 coincided with high HIV testing volumes and rapid initiation of treatment among MSM. But they also urged “cautious interpretation” of their data, which they said were rapidly analyzed after sexual health clinics reported a drop in new HIV diagnoses among MSM last December.

“Conclusions could be affected by reporting delay (albeit minimal), incomplete data in relation to ART coverage, ART start date and CD4 count at HIV diagnosis, and neither the impact of partner notification nor the movement between clinics for HIV testing is measured,” they wrote in Eurosurveillance.

“The assumption that attendees of the same clinics are more likely to form part of the same sexual network compared with random sexual mixing is plausible but unsubstantiated,” they wrote. “Finally, while numbers of HIV diagnoses are not synonymous with HIV incidence, the rise in median CD4 count at HIV diagnosis suggests that the fall in diagnoses reflects a fall in incidence.”

According to Brown and colleagues, MSM account for half of all patients with HIV in England, with an estimated 5,000 to 8,000 infected MSM still undiagnosed. A national “treatment as prevention” strategy has been in place since 2012, recommending that MSM at high risk of HIV infection undergo frequent testing and start ART regardless of CD4 count if they test positive.

Pre-exposure prophylaxis (PrEP) for HIV prevention is not accessible through the National Health Service in England except through a clinical trial and use remains limited in the country, Brown and colleagues reported. It has been available since 2013 in some clinics as part of the PROUD trial and can be acquired through international purchasing online, Brown and colleagues said.

For their study, they analyzed public health data to examine HIV testing patterns and diagnoses among MSM who attended one of 200 free sexual health clinics in England between January 2013 and September 2016.

According to their results, new HIV diagnoses among MSM in England fell by 17% between October 2015 and September 2016 as compared with the previous 12-month period. In London, the decline was 25%, including a 32% drop in new HIV diagnoses among MSM at five selected “large-fall” clinics that coincided with a 50% increase in HIV tests at these locations, Brown and colleagues said. The decline was 8% at 30 other London clinics and 5% in 191 clinics in the rest of the country, they reported.

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Brown and colleagues said the 50% increase in HIV tests at the “large-fall” clinics was coupled with a 51% decline in the number of MSM with HIV who were untreated at these locations. In other clinics, testing and treatment patterns either remained stable or increased less dramatically, Brown and colleagues reported. They also noted reduced time between diagnoses and the start of treatment among both London clinics and those outside the city.

Brown and colleagues concluded that increased testing and rapid treatment have reached levels sufficient to decrease the number of MSM with transmissible levels of virus, and that the use of PrEP among high-risk men also has contributed to the fall in diagnoses.

“If HIV testing of MSM at high risk of HIV is intensified, and wide-scale immediate ART, as observed within the London large-fall clinics, is replicated elsewhere, it is probable that a substantial reduction in HIV transmission among MSM could be achieved nationally,” they wrote. “Should the promise of the PrEP Impact Trial proposed in England be realized promptly, then a very large reduction in HIV transmission in MSM may be attained. The similarity of the MSM HIV epidemic in England to elsewhere in Western Europe suggests a similar approach in these countries might be equally successful.” – by Gerard Gallagher

Reference:

Brown AE, et al. Euro Surveill. 2017;doi:10.2807/1560-7917.ES.2017.22.25.30553.

Disclosure: The researchers report no relevant financial disclosures.