Intended for healthcare professionals


Test all patients in high prevalence areas for HIV, says NICE

BMJ 2011; 342 doi: (Published 23 March 2011) Cite this as: BMJ 2011;342:d1900
  1. Anne Gulland
  1. 1London

All patients living in areas in England where there is a high prevalence of HIV should be routinely offered tests for the virus, a government body has recommended.

The National Institute for Health and Clinical Excellence has recommended that patients living in areas where more than two in 1000 of the population have been diagnosed with HIV should be screened for the virus.

The guidance, which backs up recommendations made by the British HIV Association in 2008, says that doctors and other health professionals should consider offering and recommending an HIV test when registering and admitting new patients in high prevalence areas, and when they undergo a blood test, regardless of the reason.

The recommendations are included in guidance to increase the uptake of HIV testing among the black African community and men who have sex with men.

In 2009 there were 6630 people diagnosed with HIV in the UK, with around 2000 cases diagnosed in the black African community and 2500 among men who have sex with men. The Health Protection Agency estimates that around 9000 men are unaware that they are infected with HIV.

Jane Anderson, an HIV specialist at Homerton University Hospital NHS Foundation Trust, said it was important that people with HIV were diagnosed as early as possible so that they could benefit from improved treatments.

“If people are picked up late they do not do as well as people who come into therapy earlier. For many people with HIV they feel fine. Unless you can optimise testing across the board we’re missing opportunities to implement those significant treatment advances we’ve made in recent years,” she said.

She added that she hoped the new guidance would prompt doctors to offer HIV tests more widely.

“A significant number of people who present to my services have been somewhere in the medical system in the six to nine months before they come to me and HIV hasn’t been discussed.

“There are a whole variety of indicator conditions. If a clinician sees someone with shingles, Hepatitis B, tuberculosis—the sorts of infections that go with HIV—HIV should come on to their diagnostic list as a matter of absolute routine,” said Professor Anderson.

Matt Kearney, a GP in Runcorn and primary care adviser to the Department of Health, said, “Late diagnosis is after the point that the immune system has been damaged by the virus. The guidance will make testing routine and more accessible.”

According to the Health Protection Agency three out of five deaths are among people who were diagnosed late.

The agency released figures showing that the number of people infected with HIV almost doubled over the past decade, from 1950 in 2001 to 3780 in 2010.

Valerie Delpech, head of HIV surveillance at the agency, welcomed the NICE guidance.

“Testing new registrants in primary care should be implemented in high prevalence areas although the cost implications may be greater in this setting where there may be a greater reliance on point of care tests. These expanded HIV testing policies should be priorities for implementation as soon as possible,” she said.

The NICE guidance can be seen at and


Cite this as: BMJ 2011;342:d1900

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