Intended for healthcare professionals

Clinical Review

HIV testing and management of newly diagnosed HIV

BMJ 2014; 349 doi: (Published 08 July 2014) Cite this as: BMJ 2014;349:g4275
  1. Michael Rayment, consultant1,
  2. David Asboe, consultant2,
  3. Ann K Sullivan, consultant2
  1. 1Homerton Sexual Health Services, Homerton University Hospital NHS Foundation Trust, London E9 6SR, UK
  2. 2Directorate of HIV/GU Medicine, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
  1. Correspondence to: M Rayment michaelrayment{at}

Summary points

  • HIV testing is the gateway to both HIV treatment and HIV prevention

  • Patients with a diagnosis of HIV infection before moderate to severe immunosuppression occurs should plan for a normal life expectancy with effective access to antiretroviral therapy

  • The UK HIV epidemic continues to grow and remains marred by a high proportion of cases (50%) diagnosed at a late stage in the clinical course of the infection, and a persistent undiagnosed fraction (22% of patients living with HIV are unaware of their status)

  • Every clinician can, and should, offer patients an HIV test in line with national guidelines

  • Primary HIV infection should be considered, and an HIV test offered to all patients with a mononucleosis-like illness

  • All patients living with HIV infection should be encouraged to disclose their HIV status to other healthcare providers, especially their general practitioner

HIV infection in the United Kingdom remains a public health challenge; in 2012 an estimated 98 400 people were living with HIV infection, with 1 in 5 cases undiagnosed. The prognosis for those with a diagnosis of HIV is broadly excellent. Most patients with newly diagnosed HIV infection should prepare for a normal, healthy, and productive lifespan.

UK guidance on HIV testing,1 published in 2008, encouraged the normalisation and expansion of HIV testing. As a result more testing is now being undertaken in non-specialist settings, with an increase now being seen in the number of cases being diagnosed outside specialist services.

The purpose of this review is to provide an evidence based summary to support primary and secondary care clinicians in delivering HIV testing and to guide them in the initial management of patients with newly diagnosed HIV infection. Although we focus on the situation in the UK, many of the principles apply to populations worldwide. Globally, undiagnosed and late stage diagnosed …

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