Abstract:
Introduction National UK policy for HIV testing1 recommends
offering an HIV test to all patients with HIV indicator diseases such
as tuberculosis (TB), Pneumocystis pneumonia, aspergillosis and
bacterial pneumonia. Universal testing is advocated for all adults
registering with a GP and all general medical hospital admissions in
regions where HIV prevalence is >2/1000 population. Although ’opt
out’ HIV testing is a standard practice for patients with TB, testing
falls far short in other clinical settings.
Method A large number of community-acquired pneumonia (CAP)
cases across three south London boroughs where HIV prevalence
exceeds 2/10002 are managed at our institution. All cases of CAP in
2008 (with one or more of: radiographic consolidation, CAP clinical
case definition fulfilment, positive microbiology or pneumococcal
urinary antigenaemia) were included in the present analysis.
Demographic, HIV sampling and outcome data were collected.
Results 618 patients (325 or 53% male, 293 female) with a diagnosis of
CAP were identified. The majority (500, 81%) were aged >50. Of the
total, only 23 (3.7%) patients underwent HIV testing, of whom 1 in 4
(26%) tested positive. Half represented new diagnoses while the
remainder had prior documentation of HIV positivity. Overall, 9/60
(15%) of ethnically black (African-Caribbean) patients were tested,
A180
compared to only 6/429 (1.4%) of White British patients. The rate of
testing varied between age groups: 16% (19/118) of those aged 15e50
were tested, in contrast to only 0.8% (4/500) of patients aged over 50.
Information regarding patients were declined testing was not available.
Discussion Of individuals diagnosed with CAP who were HIV-
tested, the proportion of ’incident’ positive testing (13%) is
approximately 5 times higher than expected if a policy of universal
testing was practised. HIV testing was more often performed on
younger or black patients. Despite serving a high prevalence popu-
lation, HIV testing at this and likely many other institutions is
under-utilised by medical teams even for patients with an HIV
indicator pathology. Management of CAP in secondary care repre-
sents an opportunity to prevent a delayed diagnosis of HIV. Barriers
to HIV testing need to be identified to reduce HIV mortality asso-
ciated with late diagnosis.
REFERENCES
1.
2.
UK National Guidelines for HIV Testing (http://www.bhiva.org).
HIV in the United Kingdom: 2009 report. Health Protection Agency published
November 2009.
2010
abstract No:
P246
Full conference title:
British Thorasic Society Winter Meeting 2010
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- BTSWM 2010