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

Source
 

Nine standards for sexual health

posted: 21/01/2010

New standards for sexual health services aim to give everyone quality care wherever people live.
The launch of the new standards, including a leaflet version, “Standards for the management of sexually transmitted infections (STIs)” the first of their kind, come from the Medical Foundation for AIDS & Sexual Health (MedFash) and the British Association for Sexual Health and HIV (BASHH). Leading professional groups involved in STIs and the Health Protection Agency have given them support.

Patient service quality leaflet too
The nine standards - a guide for all health staff and NHS commissioners - cover all aspects of STI management, from diagnosis and treatment to infection control. Importantly there is a leaflet for patients, explaining the quality of care you have a right to expect, such as being offered an appointment within 48 hours, and ‘open access’ to services (meaning you can use the service without needing to see your GP first).

Dr Immy Ahmed, former president of BASHH and Project Clinical Lead for the standards said:
“Through increased investment and innovations, significant achievements in STI services have been realised in recent years. These new standards represent a consolidation of best practice and the challenge now is for commissioners and STI providers to focus all our efforts on working together and implementing these standards effectively.”

Nine standards
The nine standards have been drawn up to help with commissioning STI services within a clinical network – there are three sexual health networks in NW England. Networks support specialists and community and primary care healthcare staff to work well together. If you want consistent high quality services, this is how it has to be done.

“There is now increased patient choice and wider availability of testing and treatment for STIs, and the aim is to put patients at the centre of their care. However, as highlighted in the 2008 review of the sexual health strategy undertaken by MedFASH for the Independent Advisory Group on Sexual Health and HIV, local implementation of the strategy is very variable,” explains Ruth Lowbury, Chief Executive of MedFASH.
”The standards, which include key performance indicators, are an important tool for commissioners and providers to set measurable performance criteria and monitor outcomes for their services, whether in NHS acute, community or primary care settings, or commissioned from the independent or third sectors.”
 

Baroness Gould, Chair of the Independent Advisory Group on Sexual Health and HIV commented: “The high rates of sexual ill health in the UK means local leadership is required to ensure STI management is adopted and maintained as a public health priority. These standards, with universal implementation, can bring about significant cost savings for the NHS by preventing re-infection, reducing transmission, and making the very most of the resources available.”
The launch of the standards is also timely as it directly follows the 2010/11 NHS Operating Framework, which places quality as the organising principle of the NHS.

The standards and leaflet are available to download from MedFash

Source 
 

HIV and Hepatitis B or C

posted: 27/04/2009

BHIVA has written new guidelines for the management of co-infection with HIV and hepatitis B or C  and want people's comments. These guidelines replace the existing separate guidelines for HIV and Hepatitis B, and HIV and Hepatitis C. You can make your comments at the BHIVA website


These 2009 guidelines incorporate all new relevant information since the previous versions in 2005.

For 2009 we have decided to amalgamate the two guides for hepatitis coinfection into a single document. This avoids duplication, because general treatment for chronic liver disease is similar for both.

The translation of study data into clinical practice is often difficult, even with the best possible evidence, because of differences in factors such as trial design and inclusion criteria. Recommendations based upon expert opinion have the weakest evidence but provide an important reason for writing the guidelines – to produce a consensual opinion about current practice. The Writing Group seeks to provide guidelines that optimize treatment and management, but this needs to be tailored to fit the person - the draft is not suggesting a fixed standard for all.

Changes
The major changes/amendments include:

• More discussion on hepatitis screening and prevention;
• Clarification on the role of liver biopsy and non-invasive liver fibrosis assessment;
• More emphasis on screening for delta virus;
• More discussion on end-stage liver disease management and HCC screening;
• Molecular diagnostic tests used for the diagnosis and management of Hepatitis B and Hepatitis C;
• Revised CD4-based guidance on the management of chronic Hepatitis B;
• Management of acute Hepatitis B;
• Revised guidance on the management of chronic HCV, including ART interactions;
• Management of acute Hepatitis C
• Management of treatment non-responders and relapsers in both chronic Hepatitis B and C.

The consultation deadline is 5 June

BHIVA consultation page

Managing Coinfection with HIV and Hep B and C download the pdf

Online feedback form