1. The ageing HIV
population in Scotland:
adults and children
Lesley A Wallace
Health Protection Scotland
SHIVAG, Dunfermline, 26th
June 2015

2. HIV infection in Scotland
• Outline: Adults
• HIV landscape
• HIV diagnoses
• Treatment & Care
• Late diagnoses
• Combined with age information
• Data on paediatric infection

3. HIV Landscape:
Scotland 2014 Estimates
Annual Annual
Death & Chronically New transmissions (MSM)
Exported Infection Infected & Imported Infection
(High Prev. ountries)
?100 – 120 6450 ~350
Diagnosed Undiagnosed
4900 (76%) 1550 (24%)
In Specialist Care Not in Specialist Care
4100 (84%) 800 (16%)
Treated Untreated
3650 (89%) 450 (11%)
Optimal Response* Suboptimal Response
3500 (96%) 150 (4%)
*Cases recording HIV viral load of 400 copies/ml or less at latest attendance
34% >50
33% >50
35% >50

4. HIV infected persons by transmission
category and year of report, Scotland,
1981-2014
Data source: HIV diagnoses database, Health Protection Scotland
0
50
100
150
200
250
300
350
400
450
500
Number
Year
MSM
Heterosexual
PWID
Other/not known
Total

5. Reports of HIV infection – age at diagnosis,
2005-2014
• Most diagnoses in 25-49 age group
• Small increase in proportion of those aged 50+
0
20
40
60
80
100
120
140
160
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014
Number
Year
15-24 25-34 35-49 50+

6. Current ages of HIV cohort living in
Scotland
0
200
400
600
800
1000
1200
1400
1600
1800
2000
<20 20-29 30-39 40-49 50-59 60-69 >70
Number
Age group
• 36% of cohort aged 40-49
• 1.6% over 70 – this includes those >80
• 34% of cohort >50 years
• People living with HIV in Scotland for >30 years

7. Current ages of HIV cohort in Scotland
by transmission category
Data: HIV positive individuals alive and not known to have left Scotland at 31st
December 2014
0
250
500
750
1000
1250
1500
1750
2000
2250
Women Men Heterosexual
women
Heterosexual
men
PWID women PWID men MSM
Number
Exposurecategory
15-24 25-34
35-44 45+

8. Reports of heterosexually acquired HIV
infection, Scotland, 2000-2014
0
20
40
60
80
100
120
140
160
180
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014
Number
Year
Non-UK nationals infected outwith the UK Non-UK nationals infected within the UK
UK Nationals infected within the UK UK Nationals infected outwith the UK
50% attending services are >45years, of this group:
• 58% infected UK & 42% sub-Saharan Africa
• 59% White UK/Ireland ethnicity & 32% Black African
• 54% men

9. HIV reports among people who inject
drugs (PWID), Scotland 1984-2014
2015 Cluster in
Glasgow: 17 cases
• similar strain of
virus
• Evidence of recent
infection
• Many homeless
• Epidemiological
links between cases
• Public health
action70% attending services are >45years

10. HIV reports among MSM,
Scotland 1984-2014
53% attending services are >45years

11. HIV: Evidence of transmission
• Testing of new ‘first time’ reports in
Scotland
• Recency of infection
– Avidity test results
– Acquired infection within past 3-4m
MSM Other All
2012 17% 0% 11%
2013 21% 6% 14%
2014 30% 15% 21%
Most recent infections in MSM are aged 25-34y

12. HIV diagnoses, AIDS registrations and deaths
and individuals undergoing CD4 monitoring by
year of report/death in Scotland, 1992-2014
Deaths data 2011-2014: 102 of 145 (70%) are aged >45
- 1ry cause for all ages: 35% HIV related and15% malignancies
- 32% with AIDS registration at some time
0
500
1000
1500
2000
2500
3000
3500
4000
4500
0
50
100
150
200
250
300
350
400
450
500
NumberundergoingHIVmonitoring
Number
Year
HIV diagnoses AIDS registrations Deaths
AIDS deaths CD4 Persons monitored
Combination therapy
available 1996

13. HIV Landscape:
Scotland 2014 Estimates
Annual Annual
Death & Chronically New transmissions (MSM)
Exported Infection Infected & Imported Infection
(High Prev. ountries)
?100 – 120 6450 ~350
Diagnosed Undiagnosed
4900 (76%) 1550 (24%)
In Specialist Care Not in Specialist Care
4100 (84%) 800 (16%)
Treated Untreated
3650 (89%) 450 (11%)
Optimal Response* Suboptimal Response
3500 (96%) 150 (4%)
*Cases recording a “managable” HIV viral load of 400 copies/ml or less at latest attendance
34% >50
33% >50
35% >50

14. Number predicted to be receiving HIV
treatment and care,Scotland,2020
S. Corson et al, BASHH, Glasgow 2015
Model predicts:
- 40% increase in those in care
- 50% increase in those receiving treatment

15. START – Scotland perspective
• 1539 individuals attending for the first time AND starting
treatment for the first time between 2000 -2011
• CD4 count up to 90 days before first recorded treatment
– 19% started treatment CD4 >350
• Outcome: proportion of deaths
– 6.6% in those treated at CD4 <350
– 3.7% in those treated at CD4 >350
CD4 count pre
treatment
Number
Number of
deaths
Proportion
(%)
<200 739 70 9.5
201-350 503 12 2.4
350-500 192 8 4.2
>500 105 3 2.9

16. HIV - late diagnosis
• Late diagnosis:
CD4 count <350*
* CD4 cell count <350 within 30 days of earliest positive HIV diagnosis , excludes those known to be previously infected
0
10
20
30
40
50
60
70
80
90
100
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014
Proportion(%)
Year
% 201-350
% <200
0
10
20
30
40
50
60
70
80
90
100
2012 2013 2014 2012 2013 2014
Proportion%
Year
<30 years 31-50 years >50 years
Heterosexual MSM
• Age comparisons: no
evidence that more late
diagnoses are made in
older people

17. HIV infection among
children in Scotland

18. HIV infection among children
•126 paediatric HIV infections notified to HPS
•73 males and 53 females
• 58% UK born
• 39% Black African ethnicity
• Transmission routes:
96
22
6 2
Mother-to-child
transmission
Blood factor
treatment
Blood/tissue transfer
Other/undetermined
Data source: Laboratory reports of newly diagnosed HIV positive individuals aged > 18m and
*NSHPC- National Study of HIV in Pregnancy and Childhood
UK*: ~2570
• 84% MTCT
• 40% UK born
•15% died

19. HIV diagnoses among children by year of
report and transmission category, Scotland,
1982-2014
Data source: Integrated HIV & AIDS Diagnoses Surveillance System
0
1
2
3
4
5
6
7
8
9
10
11
12
1982 1984 1986 1989 1991 1994 1998 2001 2003 2005 2007 2009 2011 2013
Number
Year
Blood/Tissue transfer Bloodfactor treatment Mothertochild Other/Unknown
HIV antibody test available
Antenatal screening

20. HIV diagnoses among children by
ethnicity and year of report,Scotland,
1982-2014
Data source: Integrated HIV & AIDS Diagnoses Surveillance System
0
2
4
6
8
10
12
14
16
1982 1984 1986 1988 1990 1992 1994 1996 1998 2000 2002 2004 2006 2008 2010 2012 2014
Number
Year
Black-African Mixed White-Scottish
White-Other White-OtherBritish Other/Unk
Antenatal
screening

21. Outcomes among paediatric HIV
diagnoses
• Of 126 paediatric diagnoses:
• 29 (23%) have died
• median survival 5years (range 0-20years)
• 21 (72%) of these registered as having AIDS
• Of 97 HIV infected children alive at end 2014
• 43 attending for treatment and care
• 30 are <15 years
• 18 lost to follow up
• 6 left Scotland
Data source: Integrated HIV & AIDS Diagnoses Surveillance System

22. Access to specialist care and therapy
• Of 43 paediatric HIV infections now attending
for treatment and care:
- aged 16-46years (median 24y)
- 93% (40) on antiviral therapy
- 93% (37) achieved viral suppression
- 67% UK born
- 26% Black African
UK*: 1037 in treatment and care
• 48% UK born
• 79% Black African
• 97% Mother to child transmission
• 84% on ART (11% naive and 5% off ART)
* CHIPS data to end March 2014

23. Summary
• Estimated 6450 living with HIV in Scotland
– 4900 diagnosed
• Ongoing HIV transmission
• Late diagnosis
• High proportion of cohort accessing specialist care
and responding to treatment
• Diagnosis of HIV among children in Scotland is
rare event - mostly imported infection
• Ageing cohort
– further analyses?
– use morbidity data?
– survival analyses?

24. Acknowledgements
with thanks to data suppliers…
AIDS & HIV Clinicians, Nurses,
GUM clinic staff, Co-ordinators,
and Collaborators
& Laboratory staff throughout
Scotland
& Colleagues at HPS