GPs are not testing for HIV when individuals who think they are at low risk of HIV infection present with symptoms indicative of immune suppression, according to a presentation by the Health Protection Agency (HPA) at the 10th Anniversary Conference of the British HIV Association (BHIVA) in Cardiff on the late diagnosis of HIV infection in people with a perceived low HIV risk.
Researchers at the HPA’s Communicable Disease Surveillance Centre (CDSC) identified 286 UK nationals who were diagnosed with HIV/AIDS between 1990-2003 despite believing they had a low risk of contracting the virus. In many cases, HIV diagnosis was only made after frequent attendance at a GP’s surgery.
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. Those who were diagnosed due to HIV-related symptoms – which the CDSC classifies as late diagnosis – were compared with those diagnosed due to other reasons (e.g. they had had a routine HIV test during a medical).
Just over half of the 286 ‘low risk’ individuals (157 or 55%) had HIV-related symptoms at the time of diagnosis. Those diagnosed late were significantly more likely to be male (71%), older (median age = 39 years) and in a steady, long-term relationship of five years or more (72%; p=0.0001 for each), all of which may have reinforced their belief that HIV infection was not likely to happen to them.
During their in-depth follow-up interviews, 95 of the 157 (60%) presumed their most likely route of infection to be through heterosexual sex with a partner they believed also to be of low risk; 74 of whom felt they were most likely to have been infected in the UK, and 21 abroad. A further sixteen individuals were identified as having been infected through ‘high risk’ behaviours – e.g. men who have sex with men (MSM), or injecting drug use (IDU)) – and another sixteen believed they were infected heterosexually, but that their partner was a member of a ‘high risk’ group (e.g. MSM, IDU, or from an area of high HIV prevalence). The remaining 19% were unable to identify any risk factor for acquiring HIV, and were classified as having been infected through an unusual, other or unknown route.
None of the late presenters had been notified by the partners who may have infected them, and, in turn, about one third of these late presenters did not notify their own partners of their own HIV status.
Last Autumn, BHIVA presented their own figures on late diagnosis in the UK and found that about a third of people who visit their GP with symptoms ranging from STIs, opportunistic infections, symptomatic HIV disease or seroconversion illness in the year prior to their HIV diagnosis were subsequently diagnosed during a routine HIV test.
The HPA have also previously reported that 35% of HIV infections were diagnosed late in England and Wales in 2002.
Further information on this website
One in four UK HIV diagnoses are missed says BHIVA - 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
Gilbart VL et al. Late diagnosis of HIV infection among individuals with low or unacknowledged risks in England, Wales and Northern Ireland 10th Anniversary BHIVA Conference, Cardiff, abstract 015, 2004.