Treatment News

Compiled by Gus Cairns

How do we get more Europeans to test for HIV?

Over Europe as a whole, probably 60% of people with HIV don’t know they have it, the 11th European AIDS Conference hard last month (see News). Professor Jens Lundgren of Copenhagen said: “This is the biggest unresolved public health problem in Europe.”

Given that early HIV testing both saves lives and reduces the infection rate, how do we increase the number of tests done? This question was debated at the conference and was also the subject of a special conference in Brussels on 26-27 November.

In the USA, the answer the Centres for Disease Control (CDC) has come up with is to recommend that HIV testing on an opt-out basis – meaning that “an HIV test is performed unless the patient specifically declines” – is performed in the majority of cases that patients seek a health checkup of turn up at hospital A&E departments.

This had run into problems, however, because the laws inn 33 out of 50 states specify that explicit consent, either written or verbal, must be obtained before an HIV test, and 11 states require pretest counselling. State legislatures have proven reluctant to change these laws, and law professor Leslie Wolf, based in the CDC’s home town of Atlanta, said that, given the continued stigma against HIV, a satisfactory standard for patient consent “would require more information about HIV testing than is currently contemplated under the CDC’s recommendations.”

Lundgren told the European Conference that universal testing on the CDC model was “not compatible with European philosophy.

“But,” he added, “We can identify patients with early signs of disease that should prompt testing.”

The European AIDS Clinical Society (EACS), who run the conference, is therefore proposing that the November Conference should hammer out a list of ‘indicator diseases’ the presence of which, in any patient in any healthcare setting, would trigger the offer of an HIV test.

As well as AIDS-defining conditions and other STIs they could include other indicators of risk behaviour or impaired immunity such as digestive diseases, fungal infections and shingles.

There were many questions to be answered, however. As Professor Nathan Clumeck of Belgium observed, ““We don’t want to put GPs into a position where they have to HIV-test almost everyone who has almost every disease.”

The EACS idea received some backing from a Danish study (referenced) that showed that patients who’d previously attended hospital with one or more of a list of non-HIV-related diseases were 37% more likely to subsequently catch HIV, and had a 21% greater death rate.

• Eleventh European AIDS Conference, abstract #P18.4/07.

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