Guideline of the month - boosting HIV testing in those at increased risk

The guideline

NICE and Public Health England have updated their guidance for healthcare professionals on HIV testing in patients without a diagnosis of HIV. The new recommendations are designed to increase the numbers offered testing, especially in high-risk areas.

Key points for GPs

In areas of high or extremely high prevalence, GPs should offer HIV testing to everyone who registers with the practice, or is undergoing blood tests for another reason and who hasn’t had a test in the preceding 12 months.
Consider HIV testing opportunistically at each consultation in areas of extremely high prevalence.
The following are also indications for GPs to offer a HIV test:
- Symptoms suggestive of a HIV diagnosis.
- A patient who is from a country or group with a high HIV infection rate.
- A male patient who discloses he has sex with men.
- A history of injecting drug use.

Practical issues

Widening the number of patients who are supposed to be offered HIV testing has caused some debate over whether testing can be offered sensitively to patients who do not necessarily fit the high-risk groups identified by NICE. The British HIV Association has said that by ‘overstating the “ethical issue” of offending patients, GPs risk infections being missed or diagnosed too late’.

Expert comment

Dr Richard Ma, a GPSI in sexual health in London, said: ‘It is possible to offer testing sensitively. The offer might offend if it is unexpected or if the motive is not explained. While repeated offers during unrelated consultations might cause annoyance, it should be explained as part of a range of investigations when clinically appropriate, particularly if there are clinical indicators for HIV.

‘These new guidelines recommending testing in areas of high diagnosed prevalence might avoid such issues, particularly if this is promoted in the surgery and all new registrants are offered HIV tests regardless of sexuality or ethnicity, to make it part of the routine new patient check, for example.’