Late diagnosis of UK nationals at low risk of HIV

Most late HIV diagnoses in England, Wales and Northern Ireland are currently seen in black African heterosexuals. Late diagnosis is also a problem for a smaller number of mainly UK nationals who may have low risk for HIV, may not be aware of their partners´ risks or may not acknowledge their own high risk of infection. In many cases HIV diagnosis is only made after frequent attendances with a rnage of symptoms to primary care physicians (GPs).

Newly diagnosed and reported HIV infections in the UK are followed up if their exposure route requires clarification. In depth confidential interviews are conducted if both the clinician and patient agree.

During 2001, 265 interviews (155 men and 110 women) were conducted. Of these 84 had been reported with an undetermined risk for acquiring HIV infection, 134 with a heterosexual risk, but without additional information and 47 were believed to have acquired their infection in the UK from partners not known to have a risk factor for HIV infection.

Just under one quarter (23% or 62 individuals) were diagnosed because of the identification of an HIV-positive child or partner. In total 14% (37) were diagnosed because they were screened as a blood donor, at an antenatal or STI clinic, for insurance or for a visa. 8% (21 were tested of their own volition.

The majority of individuals reported frequent visits to their GP with a range of health concerns prior to diagnosis. For 213 of those interviewed, no risk factors for HIV were identified other than heterosexual contact, the majority of which occurred in the UK with partners believed not to be at any risk of HIV infection.

Almost all did not perceive themselves to be at risk of HIV infection and over half claimed little knowledge of HIV. A large proportion had been in a relationship for five years or more and this may have reinforced their sense that HIV was not of concern to them.

All those diagnosed late due to illness stated that no partners had contacted them to inform them of their possible HIV risk. In response to their own diagnosis, almost one third (of the 49 individuals asked) chose not to inform any of their partners. It is likely that some of the partners of those diagnosed late will also themselves be diagnosed late, as they will not perceive themselves to be at risk of HIV infection.

Primary care physicians should be encouraged to consider HIV testing as a possibility when patients “without risk” for HIV infection present with symptoms not responding to established treatments. The fact that these individuals presented to their GP on multiple occasions is particularly worrisome in light of Government plans to devolve HIV testing to primary care trusts.