HIV testing for the non-specialist

Since the introduction of highly active antiretroviral therapy the landscape of HIV has changed dramatically with greatly improved prognosis.1 The incidence of HIV infections continues to rise,2 with many patients undiagnosed until they present with a potentially preventable late complication or opportunistic infection. Current Health Protection Agency estimates are of 58 300 cases of HIV in the UK, a third of whom have not yet been diagnosed. Of these, 71% of infections are in adults aged 15-39 years.3 Many of those at risk of HIV will present to a variety of services—in particular accident and emergency, psychiatry, primary care, drug and alcohol services, genito-urinary medicine and other medical specialities. There are already examples of services where HIV testing is seen as a `routine' test (e.g. in obstetrics and genito-urinary medicine); this needs to be emulated and built upon (Box 1). The key to earlier diagnosis and treatment is to increase HIV testing uptake by the demystification of testing and a high clinical index of suspicion. This will involve consideration of testing of those not in the traditional high-risk groups. If HIV disease is not considered early then it may be overlooked until the patient presents with advanced disease or with an opportunistic infection. Late presenters, following multiple presentations to medical services, remain a common problem.4