Hospitals, GPs and GUM clinics are not testing for HIV despite obvious signs and symptoms, according to preliminary reports from the latest British HIV Association (BHIVA) national clinical audit of HIV diagnosis.
The audit reviewed new diagnoses of HIV at 98 participating centres in the UK, and found that 18 out of 75 individuals (24%) who had been admitted to hospital in the year prior to their HIV diagnosis did not have an HIV test offered to them as an inpatient or as follow-up, despite four cases whose admission was “very likely or definitely” HIV-related and seven that were “possibly” HIV-related, the majority of which were TB.
Similarly, out of 143 individuals who had visited their GP (n=71), hospital outpatients (n=37) or GUM clinic (n=20) in the year prior to their HIV diagnosis with symptoms ranging from STIs, opportunistic infections, symptomatic HIV disease or seroconversion, 42 (29%) were subsequently diagnosed during a routine screen, suggesting that in a significant minority of cases, HIV testing and diagnosis is being missed.
“I think that what is very important from this audit is that it highlights what those of us working in the field already know,” Dr. Margaret Johnson, chair of the BHIVA clinical audit committee told last week’s BHIVA conference in London, “which is that patients aren’t being offered HIV testing in situations where, very clearly, HIV is probably the underlying diagnosis.”
A total of 31% of diagnoses were made when CD4 counts were below 200 CD4 cells, the time by which people with HIV are recommended to have started treatment according to the current BHIVA guidelines. The BHIVA audit adds weight to Health Protection Agency (HPA) data presented last month, which found that 35% of HIV infections were diagnosed at this late stage in England and Wales last year.
The audit also presented information on the demographics of people being diagnosed with HIV in the first three months of this year. Out of 977 individuals newly diagnosed with HIV (and where information was available), 55% were male and 44% female; and 68% were infected heterosexually, 28% were infected through gay sex and 1% through injection drug use. The majority (45%) were aged between 30-39, although 2% were in the 15-19 age range and 1% over 60.
59% of new HIV diagnoses were made in people of African ethnicity, 33% white ethnicity, and 7% other ethnicity. 9% were known to be recent arrivals in the UK - defined as arriving in the UK within two months prior to diagnosis. A further 2% were returning UK nationals and only 1% were reported to be short term visitors.
Preliminary results of the audit are available for download at the BHIVA Clinical Audit Faculty
Further information on this website
New standards for England's HIV services published - news story, October 2003
35% of HIV infections diagnosed late in England and Wales last year - news story, September 2003
GPs missing signs of primary HIV infection in south London - news story, March 2003