HIV testing in Community Acquired Pneumonia: a local perspective (January 2020)

Why this topic?

• Community acquired pneumonia (CAP) is a common diagnosis in the AMU
• The World Health Organisation suggests that universal testing is recommended for all medically admitted patients in high risk areas
• In areas with lower risk (<2 in 1000 patients with HIV), it is suggested we opportunistically test for HIV in relation to certain clinical presentations
• CAP is one such presentation

What do we know about HIV?

Human immunodeficiency virus (HIV) can be associated with significant morbidity and mortality, especially in the context of Acquired Immunodeficiency Syndrome (AIDS)
HIV is readily treatable with antiviral drugs

1. Early identification of HIV has a number of benefits
2. Early initiation of treatment to avoid the complications of AIDS
3. Improved morbidity and mortality for the individual
4. Treatment significantly reduces the risk of transmission

Locally our prevalence of HIV in the Southwest of England is relatively low. Data from Public Health England calculated this to be 1.1 in 1000 people
As such, local testing is opportunistic, guided by WHO advice, rather than universal
It is acknowledged that testing rates may be lower than guidance might suggest

Who should be tested for HIV?

In a low prevalence area, we are encouraged to follow guidance available on the EuroTEST website

Facts about HIV screening

Patients do not need to be formally counselled prior testing, but should be advised of plans to undertake the test. This can be as simple as telling them “in patients with your condition, we will routinely undertake a HIV test – is that ok?”

You do not need to undertake a sexual health history – clear risk factors may be a helpful clue to testing but awkwardness associated with discussing sexual health should not preclude testing

HIV treatment is now available for nearly all patients and early treatment is associated with improved long term outcomes and prevention of complications, such as infection.  Treatment is now commenced for most patients irrespective of their CD4 count / viral load

Changing local practice

During a local quality improvement project, the microbiology/antibiotic guidelines for community acquired pneumonia in patients under 65 years of age was updated to include the following statement

Summary

HIV is a treatable condition with many positives associated with early identification and treatment
HIV testing should be considered for all patients diagnosed with community acquired pneumonia
Testing should not be considered taboo and simply seen as part of our usual practice