GP Top Tips HIV Testing
Background:
Over the last 20 years, HIV infection has changed from an incurable lie shortening disease to a
treatable chronic disease. Many HIV infected people now live a normal life with HAART treatment
(nowadays often just one combination tablet a day) with little or no reduction in life span,and die of
causes other than opportunistic infections.
On the other hand, the pattern of new diagnoses in the UK, and particularly South Yorkshire, has
shifted from affecting typical “high risk” groups to older, white patients: 2010 was the first year
where the proportion of cases assigned to white ethnic groups was more than the proportion of
cases assigned to black ethnic groups. The disparity continues to widen in 2011.
More worryingly, a high proportion of cases are diagnosed late: Cases newly diagnosed with a CD4
<350 (late diagnosis) still account for over a third of new diagnoses in the region, cases newly
diagnosed with a CD4 <200 mm3 (very late diagnosis) accounts for almost a quarter of cases newly
diagnosed in 2011. Late or very late diagnosis is the single strongest risk factor for a poor outcome
and early death from AIDS.
Because of the shifting pattern of infection and better treatment, HIV testing should become routine
in patients presenting with any possible symptoms, or even a routine screening test. (Just as testing
for diabetes is routine.)
UK national guidelines for HIV testing 2008 state that: ‘It should be within the competence of any
doctor, midwife, nurse or trained healthcare worker to obtain consent for and conduct an HIV
test’
Apart from helping to reduce late diagnoses in individual patients, normalising HIV testing will
increase uptake and reduce stigma. Experience shows that many patients often assume that HIV
testing is part of routine panels of tests, and few are worried about the idea of being tested.
Clinicians in any speciality should move from pre-test “counselling” to informed consent; lengthy
pre-test HIV counselling is no longer a requirement, unless a patient requests or needs this. The
essential elements that the pre-test discussion should cover are:the benefits of testing to the
individual, details of how the result will be given.
So, who should be tested?
Testing should be driven by any of the following 1. Presence of indicator conditions, 2. Request by
patients, 3. Identifiable risk. The absence of any risk should NOT prevent testing.
Clinical indicator conditions include: Generalised lymphadenopathy / Acute generalised rash /
Glandular fever/ flu-like illnesses: Think about seroconversionsyndrome.Prolonged episodes of
herpes simplex; Shingles – extensive or multidermatomal; Persistent/recurrent candidiasis; Oral
candida with no other obvious cause; Indicators of immune dysfunction; Recently developed or
worsened seborrhoeic dermatitis or psoriasis; Molluscumcontagiosum on the face(particularly in
adults); Unusually troublesome genital conditions; ‘Odd’ looking mouth lesions; Unexplained weight
loss or night sweats; Persistent diarrhoea; Gradually increasing shortness of breath and dry cough;
Recurrent bacterial infections including pneumococcal pneumonia
Historical UK figures
80000
Numbers with diagnosed HIV infection
HIV diagnoses
AIDS diagnoses
Deaths
8000
70000
New HIV and AIDS diagnoses and deaths
7000
60000
6000
50000
5000
40000
4000
30000
3000
20000
2000
10000
1000
0
0
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
Ethnic Group Proportion of New Diagnoses, Yorkshire & the Humber, 2005-2011
100
90
Proportion of Cases
80
70
60
50
40
30
20
10
0
2005
2006
2007
Black
Source HPA New Diagnosis Data
2008
2009
Year of HIV Diagnosis
White
Other
2010
2011
People living with diagnosed HIV infection
9000
Age Distribution of New Diagnoses, Yorkshire & the Humber, 2011
Number of New Diagnoses
(2011)
140
120
100
80
60
40
20
0
<15
15-24
25-35
35-44
Age Group
Source HPA New Diagnosis Data
45-54
55-64
65+