35% of cases too advanced for treatment

SCOTLAND'S top doctor has issued a plea to health staff to offer more patients HIV tests amid concerns that many are still dying from the disease because they were diagnosed too late.

While there have been great advances in the treatment of the condition, a recent audit has revealed that late diagnoses account for at least 35% of HIV-related deaths among adults in the UK.

The survey, carried out by the British HIV Association, also found that in around a quarter of cases, diagnosis came too late for effective treatment. Yet separate research has noted that a "significant" proportion of people who are diagnosed late with HIV had been in contact with health care professionals in the preceding year, presenting with symptoms that were likely to be related to HIV.

The findings have prompted chief medical officer Dr Harry Burns to write last week to all doctors and nurses asking for a "special effort" to help combat the condition by offering a test when appropriate. This includes where a patient has been at an identifiable risk of being exposed to HIV or has signs and symptoms potentially associated with the illness, ranging from malaise and weight loss to pneumonia and tuberculosis.

The letter also seeks to dispel some misconceptions surrounding HIV tests, such as the issue of counselling, which is not necessarily required unless a patient requests it. And patients with negative HIV tests do not need to disclose this on insurance application forms.

In the letter, Dr Burns said: "The introduction 10 years ago of highly active antiretroviral therapy has transformed HIV services and health outcomes, and today most people are living with HIV as a chronic long-term condition instead of an acute fatal illness.

"However, HIV remains a serious and stigmatised health condition which may deter individuals from actively seeking or being offered an HIV test The risks of remaining undiagnosed are clear."

Susan Macdonald, national director of the Terrence Higgins Trust Scotland, agreed it was vital that awareness was raised among medical professionals, particularly those outwith specialist HIV services. "A lot of the time it is being missed because people haven't gone to an HIV specialist service, where it is more apparent that it is an HIV infection," she said.

"We are very clear from our work that early diagnosis has clear medical benefits in being able to undertake treatment and provide appropriate support. The earlier you find out about it and the earlier you get treatment, the more likely you are to have a successful outcome."

She added: "It is now really a chronic long-term condition, rather than people dying of HIV or presenting with Aids. But if you don't get them the treatment when they need it, that is when it becomes problematic."

David Johnson, director of Scottish HIV charity the Waverley Care Trust, said people could be more likely to initially present with symptoms at their GP's surgery, rather than an HIV specialist.

"There are still people who die from HIV, and many of those are people who have tested very late," he said. "So they test not just with an HIV diagnosis, but with an Aids diagnosis, and are therefore seriously ill.

"Because HIV is not that common - a lot of GPs don't see it very often - there may be either a lack of expert knowledge at that level or perhaps an unwillingness to really think about it."

A spokeswoman for the Scottish government said the Expert Advisory Group on Aids, a UK body, had recognised a need to reduce late diagnosis of HIV, particularly in non-specialist settings. "Chief medical officers throughout Britain have recognised this as an important issue and an area where there is room to make improvement," she added.