Late HIV Diagnosis Warning
posted: 23/04/2010
Far too many people in the UK with HIV are being diagnosed late, when they may have had the virus for as long as 10 years and are likely to have passed the infection to other people, sexual health experts warned. In Manchester, the British HIV Association (BHIVA) and British Association for Sexual Health and HIV (BASHH) conference is under way.
Urgent action is needed to make routine testing the norm in areas where HIV prevalence is high – and this includes Manchester, Salford and Blackpool in NW England. HIV rates in the UK are steadily rising, and delays in diagnosing infection increase deaths and onward transmission.
NW is late diagnosis hotspot
NW England has the worst rate of late diagnosis of all regions in England. Manchester last year had the largest number diagnosed late, 54 out of 142 people: 38% diagnosed late. But this is next door to Manchester's twin city Salford, where just 23.9% were late (11 out of 46). The national average rate for late diagnosis is a high 32%.
"It is in the interest of everyone for local health authorities and healthcare professionals to take a real stance on this issue," said Dr Keith Radcliffe, president of the British Association for Sexual Health and HIV.
1 in 3 diagnosed late
The conference heard that more than a third of HIV infections were still being diagnosed late. If infection is missed at an early stage there may be no symptoms for 10 years, until the patient falls seriously ill with a potentially fatal AIDS-related condition.
There is a window of opportunity to diagnose HIV early, during what is known as sero-conversion, when the body produces antibodies to the virus. It is also the time when people with HIV are the most infectious. The person is likely to have a flu-like illness including a rash and a sore throat.
Missed chances
But Dr Mark Pakianathan, a London-based HIV consultant, said GPs and A&E staff may not realise it could be HIV – or may not want to suggest a test.
Sometimes doctors are reluctant to raise the possibility because of their own assumptions about the person’s lifestyle. "They think it can't be HIV – it must be something else," said Pakianathan. The doctor may assume it is glandular fever or even swine flu. "An opportunity could be lost for 10 years," he added.
Later clues
There can be an intermediate phase, when patients may be diagnosed with illnesses such as fungal nail infection, related to the erosion of their immune system by the virus. But often patients are not diagnosed until they develop an AIDS-related illness such as a lymphoma or bacterial meningitis, which can be life threatening.
More than 7,000 new HIV diagnoses are made every year in England, Wales and Northern Ireland. At the end of 2008 there were an estimated 83,000 people infected, according to the Health Protection Agency.
Testing is a lottery
Studies presented at the conference showed what Radcliffe called the "lottery" in HIV testing. An investigation of HIV testing patterns in a large inner city hospital with high local prevalence found that 41% of HIV-positive patients had been in contact with a health professional, with a HIV-related symptom, in the last two years but had not been offered a HIV test.
A second study, lasting six months, of acute general medical admissions, found that only one third of undiagnosed HIV-positive patients were correctly advised to have a HIV test by clinicians. The two-thirds who were missed would have been identified if HIV testing was made routine for all general hospital admissions.
Testing urged because of treatment successes
Pakianathan said some clinicians seemed not to have caught up with the massive change in the prospects for people with HIV that has come about in the last decade with the availability of drugs that can keep people not only alive but well and active for the foreseeable future. He had visited GP surgeries in London to talk to them about de-stigmatising HIV testing.
"I still get [doctors and nurses] saying: 'When I offered a test, the patient got up and left the room'. It is about how you offer the test as well," he said.
Professor Ian Gilmore, president of the Royal College of Physicians, said: "Someone in their early 20s promptly diagnosed with HIV can today, with the current treatments available, look forward to a relatively normal life, whereas delayed diagnosis and treatment increase the rate of illness, premature death and the unknowing spread of the disease. Changing patterns of HIV transmission further underscore the need to raise awareness among physicians and make the test a standard first-line investigation in many secondary care settings."
BHIVA HIV Testing Guidelines
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