New UK draft guidelines on HIV testing urge a big expansion of the number of HIV tests done, the settings in which they’re done and the professionals who should do the test.

They also recommend new assays that should reduce the ‘window period’ (the lag between HIV infection and signs of it appearing in the blood) to 15 days.

The guidelines, co-written by the British HIV Association, the British Association for Sexual Health and HIV, and the British Infection Society, point out that 35% of AIDS-related deaths are directly due to too-late HIV diagnosis and that currently 47% of gay men who attend for STD checkups and have undiagnosed HIV still remain undiagnosed after their visit, despite the widespread adoption of ‘opt out’ testing.

The guidelines say that “all doctors, nurses and midwifes should be able to obtain informed consent for an HIV test in the same way they currently do for any other medical investigation.” They reject universal opt-out HIV screening as recommended in the USA and comment that it “‘may not be the most feasible approach…where there are pressures upon A&E departments to achieve 4-hour targets.” But it does recommend universal primary care and A&E testing in areas where more than one in a thousand of the local population has undiagnosed HIV – which, in practice, currently means Lambeth and Southwark in south London.

The guidelines say that any man who discloses gay sex, any women attending antenatal services ore for pregnancy termination, and anyone disclosing injecting drug use should be tested. Anyone ‘from a high prevalence country’ or their sexual partners should be tested, and all people diagnosed with TB, hepatitis B or C or lymphoma. The guidelines also include a list of ’indicator diseases’, only a minority directly AIDS-related, which should prompt the offer of a test. Gay men and injecting drug users should get an HIV test every year.
The Guidelines recommend that no one should have to wait more than three days for an HIV test result and all acute settings (i.e. hospitals) should have access to a service that can turn round a result “ideally within eight hours and certainly within 24 hours”.

The guidelines are not so keen on rapid HIV tests (‘Point of Care Tests’) that just require a pinprick or saliva sample rather than a full blood test. They don’t like them because rapid tests have reduced sensitivity and specificity, in other words produce too many false positive and negative results. They therefore only recommend them in community testing sites (without going into detail on what ‘community testing’ is), testing of the source partner in possible exposure incidents, and situations where people refuse a blood test, for example due to needle phobia.

The new testing guidelines can be read and commented on at
www.bhiva.org/cms1222489.asp.