The significance of early HIV testing (1)

Menezes et al present a salutary lesson of the month regarding the consideration of early HIV testing (Clin Med October 2008 pp 550–1). However the discussion around HIV risk factors is somewhat flawed. In their paper they refer to intimate family members as separate to sexual partners implying that HIV is transmitted by close family contact other than sexual intercourse. This is unlikely, for example once mother to child transmission during pregnancy has been ruled out we do not consider children to be at continued risk from normal day to day intimate contact with their infected parents. There have been isolated cases of transmission between siblings and non-sexual family members, but these are few and far between.¹ The authors suggest that the patient was infected during a period of time when she was caring for her sister who, unbeknown to her, was dying of an AIDS-related illness. This would be an unlikely method of HIV transmission. Acquisition of HIV by caring for a family member with the virus, even when not taking any precautions for intimate caring activities, is extremely rare.^2,3

In a significant minority of people diagnosed with HIV in the UK it is difficult to ascertain an obvious risk factor.⁴ It is most likely that a seemingly low-risk sexual partner did, in fact, have a high risk and was HIV positive. By incorrectly classifying this patient's risk for HIV the authors miss the real point about early HIV testing, which is that the decision whether to test should not be based on a history of risk factors but rather on whether the symptoms or condition being investigated could be HIV related. If one constantly asks oneself could this be HIV related and tests patients irrespective of the presence of risk factors (with their consent) then we will start to make some headway in the quest to diagnose HIV infection earlier.

• © 2009 Royal College of Physicians