BHIVA: Opportunities for diagnosing HIV in primary care often missed

GPs may be missing primary infection in Africans

Africans present for HIV treatment and care in the United Kingdom significantly later than non-Africans, often when already ill with AIDS-defining illness.

Investigators from 15 HIV treatment centres in London conducted a survey between 2004 and early 2006 involving 236 Africans who had been recently diagnosed with HIV. They were asked about their use of primary care in the two years before their HIV diagnosis.

Almost three quarters of participants came from countries where the HIV prevalence is above 15%, and 52% had a CD4 cell count below 200 cells/mm³ at the time of their diagnosis, meaning that they had a significant risk of developing an opportunistic infection and were in need of immediate antiretroviral therapy.

There was a high degree of primary care utlisation in the period before HIV was diagnosed. The vast majority of individuals – 85% - were registered with a GP; 75% had seen their GP in the two years before their HIV diagnosis; and, 69% saw their GP within a year of HIV being diagnosed. Illnesses and symptoms that should alert a doctor to the possibility of HIV infection were often the reason for visits to a GP, with chest complaints, flu-like symptoms and skin problems the most common.

HIV testing was mentioned to 16% of individuals by their GP. A GP mentioning an HIV test was a powerful incentive for testing, with 55% of individuals recommended a test attending for one. What’s more, 56% of all individuals said that they would have attended for an HIV test if their GP had told them that they were at risk of the infection.

A previous HIV test was reported by a third of individuals, and a third of these said that this test had been in the UK. The investigators calculated that 20% of Africans recently diagnosed with HIV had been infected with the virus since their arrival in the UK.

Lack of trust in GP services emerged as a potential barrier to the accessing of primary care. Although 89% of individuals said that they trusted the staff at their HIV clinic, only 37% reported trusting their GP’s staff and, unsurprisingly, only 30% had disclosed their HIV status to their GP.

Three-quarters of Africans newly diagnosed with HIV in London visited their GP in the two years before their HIV was detected, often with symptoms suggestive of HIV infection, according to research presented to the Twelfth Annual Conference of the British HIV Association on March 31^st. Another study presented to the conference, this time involving HIV seroconverters in Brighton, also found that symptoms of primary HIV infection were often being overlooked by GPs.

Gay men in Brighton often have primary HIV infection missed by GPs

A study conducted in Brighton between 2003 and 2005, and largely involving gay men, has found that primary HIV is often missed by healthcare providers. The study involved 108 individuals, 88% of whom were gay men. Symptoms suggestive of primary HIV infection were recalled by 70% of patients, and 53% of these accessed healthcare because of these symptoms.

Primary HIV infection was diagnosed and HIV testing recommended for 52% of individuals, but eleven people attending their GP, four individuals attending accident and emergency, and one patient who went to a sexual health clinic, had their symptoms of primary HIV infection missed by healthcare staff.