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With cases of HIV now at a record high in the UK, we investigate what is being done to reduce infection and how pharmacies can help to improve the public's understanding of the virus

Human immunodeficiency virus (HIV) is the world's leading infectious killer, with 38 million people estimated to have died worldwide since the infection's discovery in 1981. Our understanding of the virus has improved dramatically in the last 30 years €“ long gone are the scaremongering days of the 1980s when it was widely believed that HIV was a death sentence and no one was safe from infection. It is now known to be easily preventable, yet cases of HIV in the UK remain stubbornly high.

In 2013, an estimated 108,000 people were living with HIV in the UK, 6,000 of whom were newly diagnosed. Some 26,100 people €“ a quarter of those infected €“ were unaware that they had HIV at all. Put simply, HIV attacks thecells of the immune system, weakening its ability to fight infections and diseases. The virus lives in the blood and some body fluids and is most commonly transmitted through unprotected oral, anal or vaginal sex €“ 95 per cent of people diagnosed with HIV acquire the virus through sexual contact.

Up to 80 per cent of people with HIV experience a short, flu-like illness two to six weeks after infection, but it can then take up to 10 years for any further symptoms to appear. Despite this, the virus continues to be active and causes progressive damage to the immune system.

Innovations in testing

Early diagnosis of HIV is crucial in ensuring positive treatment outcomes and reducing the risk of spreading the infection. If diagnosed in the late stages, there is a 10 times increased risk of death in the following year compared to those who are diagnosed early. As symptoms often don't appear straight away, people should be vigilant if they think they've been exposed to HIV and get tested as soon as possible €“ reliable results can be obtained from four weeks after exposure.

HIV testing is free of charge on the NHS and is most commonly done via a blood test. Considerable advancements in HIV testing have been made in the UK in recent years and this has contributed to the increased number of HIV cases reported. More than one million HIV tests were carried out by sexual health services in 2013 €“ a five per cent increase on the previous year.

And the proportion of people diagnosed in the late stages of HIV fell from 57 per cent in 2004 to 42 per cent in 2013. Revolutionary HIV home test kits were made available online in April 2015, enabling people who are worried about having contracted HIV to get results in just 15 minutes. Working in a similar way to a pregnancy test, they detect levels of proteins created by the virus in a drop of blood.

HIV charities hope these kits will reduce the number of undiagnosed cases in the UK. In July this year, St Thomas' Hospital in south London became the first hospital to test all A&E patients over the age of 16 for HIV as part of routine blood tests, unless they opt out. 

Prevalence of HIV in the area served by the hospital is the highest in the UK, with 10 out of every 1,000 people being infected. Nationally, this figure is three in 1,000.

In 2014, an estimated 68,000 patients received blood tests at the A&E, and it is expected that this routine testing will identify 150 additional HIV cases a year, helping to achieve earlier diagnosis, prevent transmission and save lives, says the hospital. The hospital believes that normalising testing and assuming everyone may have been at risk of infection are important steps in challenging the stigma surrounding HIV.

No longer a death sentence

There is no known cure for HIV. However, treatment options are improving for patients diagnosed early and it's now considered a chronic condition rather than fatal. In 2013, 81,512 people received HIV care €“ a five per cent increase on the previous year and almost double the number of people accessing care a decade ago.

Of those people, 90 per cent were given antiretroviral drugs (ARVs). ARVs are taken daily and lower the amount and activity of the virus, allowing the immune system to repair itself. The drugs also make the virus less infectious, reducing the risk of onward transmission.

People living with HIV tend to take a combination of three or more ARVs, known as antiretroviral therapy (ART), as HIV can quickly adapt and become resistant to just one single drug. Although ART is effective, a holistic approach to HIV treatment is considered most beneficial and this includes the improvement not only of a patient's health but also their physical and mental wellbeing.

Exercising regularly, eating a balanced diet, getting enough sleep and stopping or not taking up smoking are all crucial in keeping the immune system strong and preventing opportunistic infections from attacking. Improved understanding and treatment of HIV means one in four people living with HIV are now over 50 years of age. Indeed, for those diagnosed promptly, life expectancy now almost matches that of people without HIV.

New approaches

Treatment as Prevention (TasP) has recently been approved by NHS England and ensures immediate access to ART for people who are diagnosed with HIV and are at risk of passing on the infection to sexual partners. Public Health England estimates that 1,800 HIV infections could be prevented over a six-year period alone with TasP.

Pre-exposure prophylaxis (PrEP) is the use of ARV drugs by people without HIV to avoid acquiring the virus. Research known as the PROUD study found that when taken properly each day, PrEP reduced the risk of HIV infection in men engaging in unprotected sex with men by 86 per cent. The NHS England HIV Clinical Reference Group is currently working to resolve issues of eligibility and cost-effectiveness for a nationwide PrEP programme.

Condoms are an effective and cheap way to prevent HIV

These new prevention strategies cannot be relied upon individually and a combined approach to HIV prevention is a priority. Correct and consistent condom use has always been a highly effective and relatively cheap method of reducing HIV transmission. To limit the risk of exposure, injecting drug users should also be urged not to share needles or syringes.

How can pharmacy help?

While medical understanding of HIV is good, there are still wide gaps in knowledge among much of the general public. For example, figures from the National Aids Trust show that 16 per cent of the public incorrectly think HIV can be transmitted through kissing.

Cary James, head of programmes at Terrence Higgins Trust, explains: €Fear is a major cause of stigma and much of the fear surrounding HIV is caused by incorrect or out-dated beliefs about HIV. At every opportunity, it's important to communicate the truth about HIV today.€

He adds: €Most people do not regularly access sexual health clinics or community HIV organisations, so primary care can be the most efficient route to make people aware of the issue.€ Pharmacies can therefore improve the general public's knowledge of HIV, dispel myths and encourage testing.

Pharmacy staff are also well placed to offer advice and reassurance to people living with the virus to help them stay as healthy as possible after diagnosis. This includes discussing over-the-counter medicines that can be taken to relieve the side effects of ARVs, such as diarrhoea, nausea, vomiting and headaches, as well as raising awareness of safe sex and the importance of condom use and STI testing. 

With a weakened immune system, contracting STIs such as syphilis and chlamydia can lead to HIV treatment complications. Not only this, but having HIV as well as an untreated STI increases the likelihood of passing on HIV during unprotected sex.

Pharmacies can also provide advice on healthy lifestyles. If people living with HIV smoke, their risk of death doubles, so pharmacies should promote smoking cessation services and nicotine replacement therapy products. Encouraging people living with HIV to get the annual flu vaccine should also be a priority as their weakened immune systems mean there is an increased risk of flu leading to serious complications such as pneumonia.

For those diagnosed promptly, life expectancy now almost matches that of people without HIV