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7b. HIV: When to recommend a test

During working hours, the duty clinician/clinical scientist can be contacted for advice on HIV testing on 38722 (external: 0141 201 8722). Outwith these times the duty clinical virologist is available via the Glasgow Royal Infirmary switchboard (0141 211 4000). There is a consultant available 24 hours a day.

Late diagnosis is the most important predictor of morbidity and mortality among those with HIV infection (with a CD4 cell count <350 cells/mm3 within three months of diagnosis).

In 2012, 47% (2,990) of HIV diagnoses in the UK were made at a late stage of infection including 28% (1,770) who were severely immunocompromised at diagnosis (CD4 cell count <200 cells/mm3).

In 2010, The overall one year mortality rate among people diagnosed late was 40 per 1,000 compared to 5.0 per 1,000 diagnosed promptly. This was particularly marked for people aged over 50 years where over 1 in 10 diagnosed late died within a year.  

Scotland had 140 diagnoses in men who have sex with men in 2012.

Scotland had 110 diagnoses in heterosexuals in 2012.

Please see the UK National Guidelines for HIV Testing 2008 or the clinical indicator diseases for adult HIV infection below.

UK National Guidelines for HIV Testing 2008: Clinical indicator diseases for adult HIV infection

Respiratory

AIDS-defining conditions:

Tuberculosis

Pneumocystis

Other conditions where HIV testing should be offered:

Bacterial pneumonia

Aspergillosis

Neurology


AIDS-defining conditions:

Cerebral toxoplasmosis

Primary cerebral lymphoma

Cryptococcal meningitis

Progressive multifocal leucoencephalopathy (PML)

Other conditions where HIV testing should be offered:

Aseptic meningitis / encephalitis

Cerebral abscess

Space occupying lesion of unknown cause

Guillain–Barré syndrome

Transverse myelitis

Peripheral neuropathy

Dementia

Leucoencephalopathy

Dermatology


AIDS-defining conditions:

Kaposi’s sarcoma

Other conditions where HIV testing should be offered:

Severe or recalcitrant seborrhoeic dermatitis

Severe or recalcitrant psoriasis

Multidermatomal or recurrent herpes zoster (shingles)

Gastroenterology


AIDS-defining conditions:

Persistent cryptosporidiosis

Other conditions where HIV testing should be offered:

Oral candidiasis

Oral hairy leukoplakia

Chronic diarrhoea of unknown cause

Weight loss of unknown cause

Salmonella, shigella or campylobacter

Hepatitis B infection

Hepatitis C infection

Oncology


AIDS-defining conditions:

Non-Hodgkin’s lymphoma

Other conditions where HIV testing should be offered:

Anal cancer or anal intraepithelial dysplasia

Lung cancer

Seminoma

Head and neck cancer

Hodgkin’s lymphoma

Castleman’s disease

Gynaecology


AIDS-defining conditions:

Cervical cancer

Other conditions where HIV testing should be offered:

Vaginal intraepithelial neoplasia

Cervical intraepithelial neoplasia Grade 2 or above

Haematology

Other conditions where HIV testing should be offered:

Any unexplained blood dyscrasia including:

• thrombocytopenia
• neutropenia
• lymphopenia

Ophthalmology

AIDS-defining conditions:

Cytomegalovirus retinitis

Other conditions where HIV testing should be offered:

Infective retinal diseases including herpesviruses and toxoplasma

Any unexplained retinopathy


ENT
Other conditions where HIV testing should be offered:

Lymphadenopathy of unknown cause

Chronic parotitis

Lymphoepithelial parotid cysts

General / Other

Other conditions where HIV testing should be offered:

Mononucleosis-like syndrome (primary HIV infection)

Pyrexia of unknown origin

Any lymphadenopathy of unknown cause

Any sexually transmitted infection