GPs urged to cut rates of late HIV diagnosis

One third of UK HIV patients present late despite the majority having received healthcare in the past year.

GPs have a key role to play in reducing rates of late diagnosis of HIV, experts have warned.

The increased mortality and morbidity rates and decreased quality of life associated with late presentation for HIV were discussed at a meeting in London last week.

Professor Margaret Johnson, medical director and consultant physician of general medicine, HIV/AIDS and thoracic medicine at the Royal Free Hospital, London, told GP that around a third of HIV patients in the UK present late.

'If we look at a CD4 cell counts below 200 or an AIDS-defining event, 30 per cent of UK patients are presenting at that stage,' she said. 'We should be treating patients much earlier than that.'

British HIV Association guidelines recommend that patients with established HIV infection and CD4 cell count of 201-350 should be treated 'as soon as possible'.

Patients with CD4 cell counts between 200 and 350 experience more AIDS-related events, Professor Johnson said.

'GPs need to raise the issue of HIV and do an HIV test if patients are in an at-risk group, such as gay men or individuals with a history of drug use, or if they have identifying symptoms, which would include a whole host of problems such as oral candidiasis, pneumonia, shingles or hepatitis B or C,' Professor Johnson added.

'If HIV could possibly be part of a differential diagnosis, HIV testing should be offered.'

'The majority of late presenters have been in touch with healthcare providers in the past year, whether that be hospital services or their GP,' she said.

A recent study of immigrants from Africa diagnosed with HIV in London showed more than three quarters had seen their GP in the previous 12 months but had not had an HIV test.

Professor Johnson added that patients who present late have higher viral loads and therefore a higher risk of onward transmission. Treating these patients earlier is therefore a public health issue, she argued.

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