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.

TreatedTreatment naïve n=56,200n= copies/mL (IQR 39-49) 10,494 copies/mL (IQR 1,600-42,223) Results: In 2010, 68,600 adults accessed HIV care (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

Predictors for high viraemia: Risk factor % with viral load >40,000 copies Odds ratio95% CI Diagnosed during 2010 Recently infected41% Late diagnosis51% Other29% Diagnosed <201021%1.0- Age group % % % >5030% CD4 count % % %1.0- >50018% Exposure to HIV MSM29% Het men28% Het women17%1.0- PWID27%

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 you Particularly to Dr Zheng Yin and Cuong Chau