Antiretroviral therapy ART has transformed treatment of HIV infection

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Key messages

• Antiretroviral therapy (ART) has transformed
  treatment of HIV infection
• The benefits of early diagnosis of HIV are well
  recognised - not offering HIV testing represents
  a missed opportunity
• Over 25 of HIV-positive individuals remain
  undiagnosed, accounting for 54-70 of
  transmission
• 39 of HIV-positive heterosexuals are not
  diagnosed until their CD4 cell count falls below
  200
• In 2005, 24 of deaths in HIV-positive adults
  were attributable to late HIV diagnosis
• In one study, 62 of late diagnoses had been seen
  in secondary care in the previous 2 years, 26
  with an HIV related problem

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Key messages

• UK recommend screening for HIV in adult
  populations where undiagnosed prevalence is
  gt1/1000 as it has been shown to be cost-effective
• UK guidelines recommend routine opt-out HIV
  testing for patients with ltinsert relevant
  conditiongt
• UK guidelines recommend universal HIV testing for
  patients from groups at higher risk of HIV
  infection
• A perceived lack of risk should not deter you
  from offering a test when clinically indicated
• Some patients may not disclose that they have put
  themselves at risk of HIV infection in the past

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Tackling HIV TestingProject Advisory Group

• Dr Mary Armitage (Chair), Immediate Past Clinical
  Vice-President, Royal College of
  Physicians,Consultant Physician
  Endocrinologist, Royal Bournemouth Hospital
• Dr Nick Beeching, Clinical Lead, Tropical and
  Infectious Diseases Unit, Royal Liverpool
  University Hospital
• Dr Christine Blanshard, Consultant Physician and
  Gastroenterologist, Homerton Hospital, London
• Dr Gary Brook, Consultant in Genitourinary
  Medicine, Central Middlesex Hospital, London
• Professor Chris Bunker, Consultant Dermatologist,
  Chelsea Westminster and Royal Marsden
  Hospitals, Imperial College London
• Professor Jackie Cassell, Chair in Clinical
  Epidemiology, Brighton and Sussex Medical School
• Dr Martin Fisher, Consultant in HIV/Genitourinary
  Medicine, Brighton and Sussex University Hospital
• Dr Susie Forster, Consultant in Genitourinary
  Medicine and Clinical Lead for Sexual Health,
  Cambridgeshire Community Services
• Professor Margaret Johnson, Professor of HIV
  Medicine, Royal Free Hospital, London
• Ms Ruth Lowbury, Chief Executive, MedFASH
• Professor Rob Miller, Consultant Physician and
  Reader in Clinical Infection, University College
  Hospital, London
• Ms Angelina Namiba, Project Manager, Primary Care
  Access, Positively Women
• Mr Charles Oduka, Chair, African HIV Policy
  Network
• Dr Ed Ong, Consultant in Infectious Diseases,
  Newcastle General Hospital
• Ms Kay Orton, Policy Lead for HIV Services,
  Department of Health
• Dr Adrian Palfreeman, Consultant in Genitourinary
  Medicine, Leicester Royal Infirmary
• Dr Angela Robinson, Consultant in Genitourinary
  Medicine, University College Hospital, London
• Dr Murad Ruf, Assistant Director Health
  Protection, Consultant in Public Health Medicine,
  NHS Lambeth
• Ms Heather Wilson, Senior Health Adviser, Barnet
  Hospital, London

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Tackling HIV TestingProject Contributors

• MedFASH is grateful to the following colleagues
  who contributed cases and materials to the
  project
• Dr Rachel Baggaley, Dr Rachel Baggaley, Head of
  HIV and Health at Christian Aid, Honorary
  Research Fellow at the London School of Hygiene
  and Tropical Medicine and working in primary
  health care in Lambeth PCT
• Dr Nick Beeching, Clinical Lead, Tropical and
  Infectious Diseases Unit, Royal Liverpool
  University Hospital
• Dr Christine Blanshard, Consultant Physician and
  Gastroenterologist, Homerton Hospital, London
• Dr Gary Brook, Consultant in Genitourinary
  Medicine, Central Middlesex Hospital, London
• Professor Chris Bunker, Consultant Dermatologist,
  Chelsea Westminster and Royal Marsden
  Hospitals, Imperial College, London
• Dr Kate Cwynarski, Consultant Haematologist,
  Royal Free Hospital, London
• Dr Martin Fisher, Consultant in HIV/Genitourinary
  Medicine, Brighton and Sussex University Hospital
• Dr Susie Forster, Consultant in GUM and Clinical
  Lead for Sexual Health, Cambridgeshire Community
  Services
• Professor Rob Miller, Consultant Physician and
  Reader in Clinical Infection, University College
  Hospital, London
• Dr Adrian Palfreeman, Consultant in Genitourinary
  Medicine, Leicester Royal Infirmary
• Dr Conal Perrett, Dermatology Department, Chelsea
  Westminster Hospital, London
• Dr Alison Rodger, Department of Infection and
  Population Health, University College London and
  HIV Department, Royal Free Hospital, London

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Also contains UK National Guidelines for HIV
Testing 2008 from BASHH/BHIVA/BIS
Available from enquiries_at_medfash.bma.org.uk or
020 7383 6345 www.medfash.org.uk
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Available from enquiries_at_medfash.bma.org.uk, www.m
edfash.org.uk, or 020 7383 6345
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Who can test?
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Who to test?
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Who to test?
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Table PCTs in England in 2007 with diagnosed HIV
prevalence 2/1000 population (adults aged 15-59
years)
Source Health Protection Agency, www.hpa.org.uk
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Rates of HIV-infected persons accessing HIV care
by area of residence, 2007
Source Health Protection Agency, www.hpa.org.uk
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Who to test?
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Countries of higher HIV prevalence
Source UNAIDS Global Report 2008, www.unaids.org
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Countries of higher HIV prevalence
Source UNAIDS Global Report 2008, www.unaids.org
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Countries of higher HIV prevalence
Source UNAIDS Global Report 2008, www.unaids.org
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Who to test?
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Which test to use?
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Q What should be a reasonable time to receive an
HIV test result?
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