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Case 8. 38 year-old man from Sub-Saharan Africa Came to UK in 2001 Living in London First wife died 10 years ago of TB Remarried for 7 years, wife currently pregnant (antenatal HIV screening negative). Case 8: PMH. 2001 Registered with GP 2004 Hypertensive – treatment started

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case 8
Case 8

38 year-old man from Sub-Saharan Africa

Came to UK in 2001

Living in London

First wife died 10 years ago of TB

Remarried for 7 years, wife currently pregnant (antenatal HIV screening negative)

case 8 pmh
Case 8: PMH

2001 Registered with GP

2004 Hypertensive – treatment started

Recurrent knee problems

2006 Arthroscopy - conservative treatment recommended

2007 PUO/suspected malaria

Admitted for 48 hours and found to be anaemic (Hb 9.8)

Treated with anti-malarials and antibiotics.

HIV test not offered

2008 >10 kg weight loss noted

Said he had been trying to lose weight as previously overweight

case 8 late july 2009
Case 8: late July 2009

Presented to GP with:

  • Flu-like illness

(presumed H1N1 treated with Tamiflu)

  • Herpes Zoster left trunk

Offered HIV test

      • HIV positive
      • CD4 189
      • Viral load 90,000
      • Hb 8.7
case 8 summary
Case 8: summary

2001 Registered with GP

From 2004 Seeing GP for hypertension

2006 Pre-op screening - arthroscopy

2007 Admitted for PUO/suspected malaria and anaemia

2008 GP notes >10 kg weight loss since Nov 2007

2009 Seen by GP for Herpes zoster

HIV diagnosed: CD4 189, VL 90,000

q at which of his healthcare interactions could hiv testing have been performed
Q: At which of his healthcare interactions could HIV testing have been performed?
  • When he first registered with his GP?
  • When he saw GP for hypertension?
  • When he was admitted by the orthopaedic team for arthroscopy?
  • When he was admitted for PUO/malaria and noted to have anaemia?
  • When his GP noted his >10kg weight loss?
  • Should he have been referred to GUM to see a trained counsellor before HIV testing?
who to test3
Who to test?

2008 Report on the

global AIDS epidemic

HIV prevalence (%) in adults (15–49) in Africa, 2007

slide12

Rates of HIV-infected persons accessing

HIV care by area of residence, 2007

Source: Health Protection Agency, www.hpa.org.uk

slide13

At least 5 missed opportunities!

If current guidelines used, HIV diagnosed 8 years earlier

2001 Registered with GP

From 2004 Seeing GP for hypertension

2006 Pre-op screening - arthroscopy

2007 Admitted for PUO/suspected malaria and anaemia

2008 GP notes >10 kg weight loss since Nov 2007

2009 Seen by GP for Herpes zoster

HIV diagnosed: CD4 189, VL 90,000

learning points
Learning Points
  • This patient came from an area of high HIV prevalence, but was not offered an HIV test in numerous contacts with healthcare services
  • His wife had tested HIV-negative, but this is no guarantee of his being HIV-negative
  • A perceived lack of risk should not deter you from offering a test when clinically indicated
  • HIV screening should be a routine test on presentation of a blood dyscrasia, PUO or weight loss of otherwise unknown cause
key messages
Key messages
  • Antiretroviral therapy (ART) has transformed treatment of HIV infection
  • The benefits of early diagnosis of HIV are well recognised - not offering HIV testing represents a missed opportunity
  • UK guidelines recommend universal HIV testing for patients from groups at higher risk of HIV infection
  • UK guidelines recommend screening for HIV in adult populations where undiagnosed prevalence >1/1000 as it has been shown to be cost-effective
slide16

Also contains

UK National Guidelines for HIV Testing 2008

from BASHH/BHIVA/BIS

Available from:

en[email protected] or 020 7383 6345

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