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HIV infection missed by clinicians

Quarter of people with HIV could have been diagnosed earlier

Adrian O'Dowd

Thursday, 04 October 2012

Doctors are too often missing the signs that patients may be infected with HIV and should be tested sooner, according to a new audit published today.

The British HIV Association (BHIVA), the association that represents professionals in HIV care, has revealed its latest audit of HIV testing and diagnosis in the UK in a study published in the RCP journals Clinical Medicine.

For the audit, the authors examined the records of more than a thousand patients attending HIV treatment centres across the UK.

Analysis found that 52.2% of patients were diagnosed HIV positive after they had already shown evidence of a damaged immune system, and were suffering physical symptoms such as weight loss or chronic diarrhoea.  

Overall, 25% of patients missed an opportunity for their HIV infection to be detected earlier because they were not offered an HIV test, despite being seen by an NHS clinician in the years prior to their diagnosis.

It is estimated that the number of people living with HIV in the UK will exceed 100,000 this year and late diagnosis of the condition is a concern.

The Health Protection Agency has said that people diagnosed with more advanced HIV have a tenfold increased risk of death in the first year after they are diagnosed when compared to those diagnosed with earlier stages of infection.

The BHIVA commissioned study was designed to audit how the NHS was reacting to the 2008 national recommendations for HIV testing, endorsed by the chief medical and chief nursing officers.

They called for widespread HIV testing to be carried out in situations where people had illnesses associated with HIV and in locations where the number of people known to be living with HIV exceeded 2 per 1,000 people.

One of the report authors, Dr Edmund Ong said: “Our data shows one in four people living with HIV could have had their condition diagnosed earlier. This is a serious wake-up call, and shows we need a proactive and widespread testing programme which is tailored to those people who are most at risk.”

Professor Jane Anderson, BHIVA chair, said: “Late diagnosis is the single biggest cause of death from HIV in the UK. It increases the risk of HIV related ill health, of HIV being acquired by others, and significantly increases the costs of treatment.

“HIV is treatable, and if diagnosed in time, people with HIV can expect to have long and healthy lives. Sadly, opportunities for longer life expectancy for people with HIV are being thrown away by late diagnosis.”

The government should invest in HIV testing, she added, saying: “Increased testing for HIV by GPs and in acute medical settings in areas of high risk would save a great deal of HIV related ill-health, as well as reducing the costs of expensive treatments further down the track.”

Lisa Power, policy director at charity the Terrence Higgins Trust, said: “We support BHIVA’s call for better diagnosis of HIV. Every doctor should know how to offer an HIV test and when to offer it appropriately.

"It’s entirely possible to live well with HIV, but your chances are greatly improved by early diagnosis and prompt treatment."

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