Always test for HIV as part of investigation of recurrent respiratory infection
We welcomed the reminder to include HIV testing as part of the
investigation of recurrent respiratory infection in primary care by Wood
and Peckham (1). The report recommended HIV testing be considered only in
those disclosing risk behaviours; we suggest current guidance indicates
that all cases should be offered testing.
Approximately one third of people living with HIV in the UK remain
undiagnosed and 25% of newly diagnosed individuals have a CD4 count of
less than 200 (an accepted marker of “late diagnosis”). Late diagnosis is
associated with considerable morbidity and mortality and unwitting
transmission of infection. Guidelines(2) to encourage wider screening and
testing for HIV recognise a range of indicator diseases for HIV infection
that should prompt testing; bacterial pneumonia tops the list in adults.
It should also be remembered that HIV infection is much more common than
combined variable immunedeficiency (CvD). The authors quote an incidence
for CvD of 1.7 per 100,000. HIV incidence in the UK in 2007 was estimated
at 127 per 100,000 (170 per 100,000 for men)(3).
HIV testing should, therefore, be routine in severe, persistent, unusual,
or recurrent presentations of any kind; this should include recurrent
respiratory infections.
(1) Wood P, Peckham D. Investigating recurrent respiratory infections
in primary care BMJ 2009;339:b4118 (12th November 2009)
(2) British HIV Association, British Association of Sexual Health and HIV,
British Infection Society. UK national guidelines for HIV testing 2008.
BHIVA, 2008 . www.bhiva.org/cms1222621.asp
Rapid Response:
Always test for HIV as part of investigation of recurrent respiratory infection
We welcomed the reminder to include HIV testing as part of the
investigation of recurrent respiratory infection in primary care by Wood
and Peckham (1). The report recommended HIV testing be considered only in
those disclosing risk behaviours; we suggest current guidance indicates
that all cases should be offered testing.
Approximately one third of people living with HIV in the UK remain
undiagnosed and 25% of newly diagnosed individuals have a CD4 count of
less than 200 (an accepted marker of “late diagnosis”). Late diagnosis is
associated with considerable morbidity and mortality and unwitting
transmission of infection. Guidelines(2) to encourage wider screening and
testing for HIV recognise a range of indicator diseases for HIV infection
that should prompt testing; bacterial pneumonia tops the list in adults.
It should also be remembered that HIV infection is much more common than
combined variable immunedeficiency (CvD). The authors quote an incidence
for CvD of 1.7 per 100,000. HIV incidence in the UK in 2007 was estimated
at 127 per 100,000 (170 per 100,000 for men)(3).
HIV testing should, therefore, be routine in severe, persistent, unusual,
or recurrent presentations of any kind; this should include recurrent
respiratory infections.
(1) Wood P, Peckham D. Investigating recurrent respiratory infections
in primary care BMJ 2009;339:b4118 (12th November 2009)
(2) British HIV Association, British Association of Sexual Health and HIV,
British Infection Society. UK national guidelines for HIV testing 2008.
BHIVA, 2008 . www.bhiva.org/cms1222621.asp
(3) Health Protection Agency. HIV in the United Kingdom: 2008. HPA 2008
http://www.hpa.org.uk/web/HPAwebFile/HPAweb_C/1227515298354
Competing interests:
None declared
Competing interests: No competing interests