HIV treatment and care: welcome news as people living with HIV in Scotland continue to receive optimal treatment and care

On 27 August 2019, Health Protection Scotland (HPS) published the surveillance report ‘HIV infection and AIDS, HIV infection in Scotland: summary report of treatment and care to 31 December 2018’. 

The report shows that as at the end of December 2018, it is estimated that there are 5,881 individuals living with HIV in Scotland and, of these, 91% (5,352) have been diagnosed, of whom almost three quarters (73%, 3,916) are male and 1,436 are female. Of 5,352 diagnosed individuals, 92% (4,913) are attending specialist HIV services for treatment and care and, of these, 4,799 (98%) are receiving ART, of whom 94% (4,530) have achieved an undetectable viral load.

These figures highlight that Scotland has maintained the global UNAIDS ‘Fast Track’ HIV 90-90-90 targets set for 2020 first met in September 2018 (90% of HIV infected individuals will be diagnosed and, of these, 90% will be receiving antiretroviral therapy (ART) and, of these, 90% will achieve an undetectable viral load).

While it is welcome news that the numbers of diagnosed individuals attending for care, receiving ART and achieving viral suppression in Scotland are high, there is evidence that an appreciable proportion of first ever diagnoses are being made at a late, or very late, stage of infection each year (approximately one quarter (27%) of first ever diagnoses recorded in 2018 were made at a late stage of infection). Those individuals diagnosed late have an eight-fold higher risk of dying within one year of diagnosis.¹

Thus, while HIV treatment and care in Scotland is optimal, the main areas for public health action are:

• to reduce the number of HIV transmissions taking place (with HIV pre-exposure prophylaxis being a primary strategy among those at highest risk of sexual acquisition) and, where prevention fails, to diagnose these infections early (particularly focusing on key groups identified such as heterosexuals of White Scottish and Black African ethnicity), and
  
  
• to diagnose (or re-diagnose) early those infected individuals who come to Scotland already infected through earlier and more frequent testing with a view to improving their health outcomes.

1. Delpech, V., Brown, A.E., Croxford, S., Chau, C., Polavarapu, V., Cooper, N., et al. Quality of HIV care in the United Kingdom: key indicators for the first 12 months from HIV diagnosis. HIV Med 2019; 14(3): 19-24.