HIV

Background Increasing the uptake of HIV testing in people who may have undiagnosed HIV is essential to reduce the morbidity associated with late HIV diagnosis.

Methods We conducted a multicentre, longitudinal, mixed-methods study, surveying the attitudes, knowledge and practice of non-HIV specialist hospital physicians in South-East Scotland and North-East England with respect to HIV testing.

During the 1980s and 1990s, Edinburgh and the Lothians suffered significantly high rates of HIV infections, considered to be the result of a high proportion of intravenous drug users sharing injecting equipment. This young, sexually active cohort had the potential to pose a threat to the wider population via heterosexual spread, and hence measures were required to prevent, where possible, a second wave of the epidemic.

This story is of particular interest and importance to Edinburgh and Scottish medicine. It describes the events in one general medical practice in Edinburgh, the Muirhouse Medical Group, and their impact and relationship to the AIDS pandemic. For many, the origin of HIV in the UK is now history. Since the introduction of HIV/AIDS into the intravenous illegal drug using community, much has changed but problems remain that should concern policy makers and clinicians.

Since the introduction of highly active antiretroviral therapy (HAART) in 1996, mortality in patients with human immunodeficiency virus (HIV) infection has decreased markedly. As a result, morbidity from other chronic conditions  such as kidney, liver and heart disease is increasing. This is in part as a natural consequence of ageing, and in part due to the higher risk of solid organ failure in these individuals. This higher risk is related to the co-morbidities associated with HIV infection and to the metabolic consequences of drug therapy.

A 40-year-old heterosexual African man was admitted with fever, night sweats and lymphadenopathy. His human immunodeficiency virus antibody test was positive. Initial lymph node biopsy revealed reactive hyperplasia only. He was empirically treated for tuberculosis. However, symptoms persisted and a repeat lymph node biopsy was obtained, which confirmed Hodgkin’s disease. This emphasises the need to pursue histological diagnosis in such patients with persisting symptoms.

Keywords  HIV, Hodgkin’s disease, lymphadenopathy, tuberculosis

The latest UK national human immunodeficiency virus (HIV) testing guidelines, released in September 2008, state that HIV testing should be offered to all patients with indicator conditions and considered in all general medical admissions in high-prevalence areas. We audited testing rates at Blackpool Victoria Hospital, a high-prevalence area, one year before and one year after the publication of the new guidelines. In the year after publication the rate of HIV testing in patients with indicator diseases was as follows: hepatitis B 6%, hepatitis C 28%, tuberculosis 9% and lymphoma 14%.