‘Give HIV the Finger’

HIV is a virus that attacks the immune system, the body’s defence against infectious organisms and other invaders. If HIV is left untreated, a person’s immune system will get progressively weaker until it can no longer fight off life-threatening infections and diseases. However, the rate at which HIV progresses varies depending on age, general health and background. Testing regularly for HIV means you can get antiretroviral treatment if you need it and stay healthy.

The ‘give HIV the finger’ pun refers to the free postal finger-prick test that people can receive for testing without attending a clinic.

 

HIV in the United Kingdom

The United Kingdom (UK) has a relatively small HIV epidemic, with an estimated 101,200 people living with HIV in 2015. Just over 5,000 people were diagnosed with HIV in 2016, according to the data from Public Health England. This is an 18% decline from 2015.

The epidemic is largely concentrated among certain key populations, including men who have sex with men and black African populations. 54% of diagnoses were among gay and bisexual men; 19% and 22% among heterosexual men and women, respectively.

Late diagnosis is an important predictor of morbidity and premature death in people with HIV. In 2016, 42% diagnoses were made at a late stage of infection when treatment is less effective.

 

Current Screening Tests

HIV postal test kits allow people to take a finger-prick blood sample themselves. The samples are sent to a local laboratory for HIV testing. The test is highly accurate and can detect HIV within four weeks after infection.

These tests give a result of ‘reactive’ (positive) or ‘non-reactive’ (negative); reactive results are further classified into ‘high’ and ‘low’ reactive tests. A highly reactive result is suggestive of a HIV infection.

Patients providing a specimen reactive in the screening assay, but not confirmed to be consistent with HIV infection, should be retested using a fresh blood specimen collected at least two weeks later.

Ideally, a HIV antibody test should be performed on venous blood. Most laboratories in the UK use ‘fourth generation’ HIV screening tests. They detect anti-HIV (nearly all can detect the three main Ig classes: IgM, IgG and IgA) and p24 antigen. All patients whose first specimen indicates evidence of HIV infection must have their HIV status confirmed by tests on a second sample collected at another time.

HIV home sampling could potentially improve our ability to identify cases of HIV by targeting people at risk who do not use traditional testing venues such as sexual health clinics. The results data collected between 2015 and 2016 showed that 1.1% of tests submitted via the national postal testing scheme were ‘reactive’ and 0.7% were ‘high reactive’, compared to just 0.3% of tests finding HIV positive results from specialist sexual health clinics.

 

What is the difference between HIV and AIDS?

The definition of AIDS (acquired immune deficiency syndrome) is based on a potentially life-threatening infection or cancer seen in the immunosuppressed. Patients who have been diagnosed with AIDS have a greater risk of opportunistic infections. The most common AIDS-defining illnesses include:

  1. Tuberculosis
  2. Recurrent bacterial pneumonia
  3. Pneumocystis jiroveci pneumonia
  4. Kaposi’s sarcoma
  5. Lymphoma
  6. Cerebral toxoplasmosis
  7. Cryptococcal meningitis
  8. Intestinal cryptosporidiosis

Patients diagnosed late during HIV infection are at an increased risk of developing AIDS and are more likely to transmit HIV to others. This is one of the key challenges facing the UK, despite rates of late diagnosis being on the decline. In 2017, 428 people died from AIDS-related illnesses due to being diagnosed late. Nevertheless, the number of people diagnosed with AIDS-defining illnesses is declining and fell by 25% from 2015 to 2016.

 

Counselling

Patients identified as being at high-risk for HIV or those with concerns should be offered more in-depth discussion or counselling, in addition to a test. A brief pre-test discussion, explaining that routine HIV testing is recommended, is appropriate, with the aim of obtaining informed verbal consent.

 

Other methods to increase the uptake of testing

The Department of Health recommendation is that patients who come from countries where prevalence of HIV infection is high (>0.5%), all adults presenting to the emergency department in the UK should be tested (with consent). Also, all new patients registering at a GP should be tested. Testing in other outpatient departments, e.g. colposcopy and dermatology should also be carried out.

All patients attending sexual health clinics should be offered a HIV test on an ‘opt-out’ basis, and an information leaflet should be used to increase uptake of HIV antibody testing.

 

The future

Not too long ago, a diagnosis of HIV and AIDS was considered to be a death sentence. This has fortunately changed over the past decade, owing to significant progress made in the provision of antiretroviral treatment and gradual upliftment of the stigma that is attached to the condition.

Progress is still to be made, however, as late diagnosis rates continue to be high. People living with an undiagnosed infection have worse health outcomes and pose a public health risk as they are more likely to pass the virus on to others. Homosexual men and black Africans are still at a heightened risk of HIV. Further, the younger generation has lost some fear of HIV because of the success of treatment, causing them to engage in risky behaviours. These issues can be rectified by narrowing the gaps in HIV prevention and education schemes.

If you have any concerns or questions, you can get help from sexual health clinics, charities, or your GP.

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