Hong Kong Advisory Council on AIDS concerned with rising situation of late presenters

The following is issued on behalf of the Hong Kong Advisory Council on AIDS:
 
     The Hong Kong Advisory Council on AIDS (ACA) convened a meeting today (November 15). The ACA members were briefed by the Department of Health (DH) on the latest situation of Human Immunodeficiency Virus (HIV) infection and recent trends in Hong Kong, particularly the rising proportion of late presenters among newly reported cases, and its impact on local HIV control efforts.

     Late presenters refer to individuals whose CD4 cells (one kind of immune cell) are being attacked by the virus and have decreased to a very low level (CD4 count of less than 200 cells/mm3) at the time of HIV diagnosis. Late presentation indicates that these individuals were not diagnosed and put on treatment in a timely way at an earlier stage of infection, resulting in a weakened immune system. Late presentation can lead to an increased risk of opportunistic infections and malignancies, leading to a higher mortality rate. In addition, as a result of an unsuppressed viral load, late presenters contribute to an increased risk of HIV transmission in the community, impacting the overall effectiveness of HIV control efforts and posing a significant burden to the healthcare system.  
      
     The ACA observed an increasing proportion of late presenters among newly reported cases in Hong Kong, rising from 28.5 per cent in 2014 to 47 per cent in 2023, similar to that observed overseas. An older age at diagnosis, and a heterosexual route of transmission are more commonly associated with late presentation. According to the Recommended HIV/AIDS Strategies for Hong Kong (2022-2027) published by the ACA in 2022, greater effort is needed to scale up testing and to promote universal testing to become a norm for the key communities, such as maintaining the conventional facility-based testing services and introducing new testing modalities including mobile testing and HIV self-testing. In view of the latest situation, the ACA recommends that normalisation of HIV testing among the non-key population, enabling people with HIV who are unaware of their status to receive a timely diagnosis and treatment, to be one of the crucial strategies to address the rising trend of late presentation.
      
     During the meeting, the DH briefed members on the newly published "Recommendations on HIV Testing in Hong Kong" (The Recommendations) by the Scientific Committee on AIDS and STI. Having taken into consideration the latest local epidemiology, scientific evidence, recommendations from the World Health Organization and overseas practices, the Recommendations serve to provide references and practical guidance to healthcare professionals and frontline service providers in the community. The Recommendations contain sections on who to get tested, how to test, consent, post-test care and referral pathway. Among them, it is recommended that people who have had sex should get HIV testing at least once to keep track of their health status, and that people with risk behaviours should undergo regular screenings. Members of the ACA support the Recommendations, agreeing that it would encourage HIV testing among non-key populations, help normalise HIV testing and facilitate destigmatisation of HIV infection and HIV testing among the general public.
      
     Details of the Recommendations are available on the CHP's website at www.chp.gov.hk/en/static/24003.html.

     Since its establishment in 1990, the ACA has been keeping in view local and international trends and developments relating to HIV infection and AIDS. It has also played a pivotal role in advising the Government on policies relating to the prevention, care and control of HIV/AIDS in Hong Kong. The ACA has published six sets of recommended HIV/AIDS strategies which have served as blueprints for the HIV response in Hong Kong.

     For more information on the previous and latest recommended HIV/AIDS strategies published by the ACA, please visit the ACA website (www.aca.gov.hk/english/index.html). For information about the local situation and programme on AIDS, please visit the website of the Virtual AIDS Office of the DH (www.aids.gov.hk).