HIV

Overview

If you are worried about doing an HIV test, giving a positive result or what to say to a patient either before or after a test, Unity Sexual Health and the Southmead HIV specialist nurses are very happy to support you- please see below for contact details.

Overview: HIV is now a chronic treatable condition. If tested and treated early in the course of their infection, people living with HIV (PLWHIV) have near normal life expectancy. Furthermore, those PLWHIV who have a fully suppressed virus on treatment CANNOT PASS ON THE VIRUS: ‘U=U; Undetectable means untransmittable’

However, those diagnosed late have a tenfold increased risk of death within the first year of diagnosis and those diagnosed very late have a 10 year reduction in life expectancy.

Who to test

All patients who are sexually active are at risk but those of African or Caribbean heritage or men who have, or have had, sex with men are particularly at risk. HIV in injecting drug users is less common in the United Kingdom.

In all areas, offer and recommend HIV testing to everyone who has not previously been diagnosed with HIV and who:

• Has symptoms that may indicate HIV or if HIV is part of the differential diagnosis (for example, infectious mononucleosis-like syndrome), in line with HIV in Europe's HIV indicator conditions
• Is known to be from a country or group with a high rate of HIV infection
• If male, discloses that they have sex with men, or is known to have sex with men, and has not had an HIV test in the previous year
• Is a trans woman who has sex with men and has not had an HIV test in the previous year
• Reports sexual contact (either abroad or in the UK) with someone from a country with a high rate of HIV
• Discloses high-risk sexual practices, for example the practice known as 'chemsex'
• Is diagnosed with, or requests testing for, a sexually transmitted infection
• Reports a history of injecting drug use
• Discloses that they are the sexual partner of someone known to be HIV positive, or of someone at high risk of HIV (for example, female sexual contacts of men who have sex with men)

In areas of high (>2/1000) and extremely high prevalence (>5/1000) (Bristol is high prevalence 2.7 cases/1000 population), also offer and recommend HIV testing to everyone who has not previously been diagnosed with HIV and who:

• Registers with the practice
• Is undergoing blood tests for another reason and has not had an HIV test in the previous year

 Additionally, in areas of extremely high prevalence, consider HIV testing opportunistically at each consultation (whether bloods are being taken for another reason or not), based on clinical judgement

National Guidance:  

NICE - Recommendations for HIV testing

BHIVA/BASHH/BIA - HIV testing guidelines 

Who to refer

Refer all patients with a positive HIV test result.

Call Southmead HIV Team Specialist Nurses on: 0117 414 6400 or email: Brecon.nurses@nhs.net

Red Flags

All patients with an ‘HIV indicator condition’ should be offered and recommended a blood test for HIV. See Guidance in short for HIV testing in health care settings

Testing

How to test: The patient can have a blood test in your practice or obtain a postal testing kit from the Unity Sexual Health website. Alternatively, if they have more complex sexual health needs, they can contact Unity Sexual Health for a telephone triage appointment. 

Before the test: There is no need for ‘pre-test counselling’. Tell the patient what they are being tested for, how they will get their results, that HIV is now a treatable disease with near normal life expectancy, on effective treatment it cannot be passed on (U=U) and that HIV testing is now considered part of routine care. Discuss the window period (45 days) as they might need to repeat the test in a few weeks. Making a simple risk assessment is useful as it enables you to provide advice about reducing subsequent risk. Having a negative HIV test has no effect on getting life insurance or a mortgage. Patients with a positive result should not have difficulty getting personal medical insurance, loans or mortgages.

After the test: The patient may need to repeat the HIV test after the window period. Don’t forget to advise the patient about safer sex including use of barrier protection (eg condoms), HIV post exposure prophylaxis (PEP) and HIV Pre-Exposure Prophylaxis (PrEP) if at ongoing risk of acquiring HIV (see resources below).

Support: If you require professional clinical advice please call Unity Sexual Health on 0117 3426913 (during Central Health Clinic opening hours- see website for details) or leave a message on 0117 3426944 (health advisers).

For support with giving a positive result call Unity Sexual Health Advisers on 0117 3426944 or contact Southmead HIV Team Specialist Nurses on 0117 414 6400 or email: Brecon.nurses@nhs.net

Resources

Local Unity Sexual Health information (including PEP/ PrEP): https://www.unitysexualhealth.co.uk/hiv-information-services-support-testing-treatments/

Unity Sexual Health postal testing kits: https://www.unitysexualhealth.co.uk/stis-and-testing/

Patient information is also available at: https://www.nhs.uk/conditions/hiv-and-aids/

NICE HIV testing guideline is found at: https://www.nice.org.uk/guidance/ng60/chapter/Recommendations#offering-and-recommending-hiv-testing-in-different-settings

National BHIVA/BASHH/BIA HIV testing guideline is found at: https://www.bashhguidelines.org/media/1067/1838.pdf

National statement on HIV window period: https://www.bashhguidelines.org/media/1069/bashh-eaga-statement-on-hiv-wp-nov-14.pdf

BASHH/ BHIVA HIV Post-exposure prophylaxis (PEP) guideline: https://www.bashhguidelines.org/media/1269/pep-2021.pdf

BASHH/ BHIVA HIV Pre Exposure Prophylaxis (PrEP) guideline: https://www.bashhguidelines.org/media/1189/prep-2018.pdf

Terrence Higgins Trust offers advice and support for those concerned about or living with HIV: https://www.tht.org.uk/

Efforts are made to ensure the accuracy and agreement of these guidelines, including any content uploaded, referred to or linked to from the system. However, BNSSG ICB cannot guarantee this. This guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer, in accordance with the mental capacity act, and informed by the summary of product characteristics of any drugs they are considering. Practitioners are required to perform their duties in accordance with the law and their regulators and nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties.

Information provided through Remedy is continually updated so please be aware any printed copies may quickly become out of date.