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Objectives Prompt HIV diagnosis and treatment are associated with increased longevity and reduced transmission. The aim of the study was to examine late diagnoses and to assess the quality of care following diagnosis. Methods National surveillance and cohort data were used to examine late HIV diagnoses and to assess the quality of care received in the 12 months following HIV diagnosis. Results In 2011, 79% (4910/6219) of persons (15 years and over) diagnosed with HIV infection had CD4 counts reported within 3 months; of these, 49% were diagnosed late ( CD4 count < 350 cells/μL). Adults aged 50 years and over were more likely to be diagnosed late (67%) compared with those aged 15-24 years (31%). Sixty-four per cent of heterosexual men were diagnosed late compared with 46% of women and 36% of men who have sex with men ( MSM) ( P < 0.01). The percentage of late diagnoses was highest among black African adults (66%) compared with other ethnicities; 96% of black African adults diagnosed late were born abroad. Overall, 88% and 97% of patients were linked to care within 1 and 3 months of diagnosis, respectively, with little variation by demographics and exposure category. The crude 1-year mortality rate was 31.6 per 1000 persons diagnosed in 2010. It was highest among adults diagnosed late (40.3/1000 versus 5.2/1000 for prompt diagnoses) and particularly among those aged 50 years and over. Excluding deaths, 85% of the 5833 diagnosed in 2010 were retained in care in 2011; 92% of the 2264 adults diagnosed late in 2010 received antiretroviral therapy by the end of 2011. Conclusions The National Health Service provides high-quality care to persons newly diagnosed with HIV infection in the UK, with no evidence of health inequalities. Despite excellent care, half of adults are diagnosed late according to the threshold at which national guidelines recommend treatment should begin. Such patients have an 8-fold increased risk of 1-year mortality compared with those diagnosed promptly. Reducing late diagnosis of HIV infection remains a public health priority in the UK. [ABSTRACT FROM AUTHOR]

Objectives In the UK, free HIV care is provided through dedicated HIV clinics. Using the national cohort of men who have sex with men ( MSM) with diagnosed HIV infection and estimates of the number of undiagnosed men, we assessed whether high retention in HIV care and treatment coverage is sufficient to reduce HIV transmission. Methods Antiretroviral therapy ( ART) uptake and viral load distribution among diagnosed men were analysed by treatment status and CD4 count for the period between 2006 and 2010. A multi-parameter evidence synthesis ( MPES) method was used to estimate the size of the undiagnosed population. The viral load distribution among newly diagnosed untreated men was applied to the undiagnosed population. Infectivity was defined as a viral load > 1500 HIV-1 RNA copies/m L. Results Between 2006 and 2010, ART coverage among all HIV-infected MSM (diagnosed and undiagnosed) increased from 49 to 60%, while the proportion of infectious men fell from 47 to 35%. Over the same period, the number of all HIV-infected MSM increased from 30 000 to 40 100 and the number of infectious MSM remained stable at 14 000. Of the 14 000 infectious MSM in 2010, 62% were undiagnosed, 33% were diagnosed but untreated, and 5% received ART. Extending ART to all diagnosed HIV-infected MSM with CD4 counts < 500 cells/μ L in 2010 would have reduced the overall proportion of infectious men from 35 to 29% and halving the proportion who were undiagnosed would further have reduced this to 21%. Conclusions High ART coverage in the UK has reduced the infectivity of the HIV-diagnosed population. However, the effectiveness of treatment as prevention will be limited unless the undiagnosed population is reduced through frequent HIV testing and consistent condom use. [ABSTRACT FROM AUTHOR]

As part of the response of the Royal Thai Army to the outbreak of human immunodeficiency virus (HIV) in Thailand, a collaboration was established with the U.S. Army to jointly work toward the development of vaccines for the prevention of HIV infection. During the first decade of this collaboration, studies have been carried out in the diverse disciplines that are crucial to providing the foundations for efficacy trials of candidate HIV vaccines. Studies of host, pathogen, and vaccine interventions included studies of viral diversity, epidemiology, disease course, potential vaccine cohorts, and Phase I/II clinical trials. Collaborations were expanded to other Thai institutions and to overseas partners, resulting in the Thai AIDS Vaccine Evaluation Group. The efforts of these collaborations resulted in the development of candidate vaccines specifically designed for use in Thailand, and sequential evaluations that have lead to the threshold of the world's next and largest efficacy trial of HIV vaccines. [ABSTRACT FROM AUTHOR]