The new face of HIV

Abstract

Human immunodeficiency virus (HIV) infection causes a treatable chronic condition that has no discernible impact on life expectancy when diagnosed and treated early. Screening and antiretroviral use in men who have sex with men has caused a decline in prevalence for this group in Western countries whereas the frequency of late diagnoses in white heterosexual adults has remained stable. These days no one should die from HIV, but late diagnoses are costing hundreds of lives in the UK every year – these are often people who do not consider themselves to be at risk of HIV. This article provides an update on our current understanding of HIV, to help GPs know when to offer HIV testing and support the thousands of patients living with HIV.

Get full access to this article

View all access options for this article.

References

Association of British Insurers (2016) HIV and life insurance. Available at: www.abi.org.uk/globalassets/sitecore/files/documents/publications/public/2016/hiv-and-insurance/hiv-and-insurance-guide.pdf (accessed 20 June 2018).

BASHH. Guidelines for the treatment of sexually transmitted infections. Available at: www.bashh.org/guidelines (accessed 4 September 2018).

BHIVA (2014) British HIV Association guidelines for the management of HIV infection in pregnant women 2012 (2014 interim review). HIV Medicine 15(S4): 1–77. DOI: 10.1111/hiv.12185.

BHIVA (2015) British HIV Association guidelines for the use of vaccines in HIV positive adults 2015. Available at: www.bhiva.org/file/NriBJHDVKGwzZ/2015-Vaccination-Guidelines.pdf (accessed 5 September 2018).

BHIVA (2016) British HIV Association guidelines for the treatment of HIV-1-positive adults with antiretroviral therapy 2015 (2016 interim update). Available at: www.bhiva.org/file/RVYKzFwyxpgiI/treatment-guidelines-2016-interim-update.pdf (accessed 4 September 2018)..

BHIVA (2018) Guidelines on the management of HIV in pregnancy and postpartum. Available at: www.bhiva.org/file/5bfd30be95deb/BHIVA-guidelines-for-the-management-of-HIV-in-pregnancy.pdf (accessed 6 February 2019).

BHIVA and BASHH (2018) BHIVA/BASHH guidelines on the use of HIV pre-exposure prophylaxis (PrEP) 2018. Available at www.bhiva.org/file/5b729cd592060/2018-PrEP-Guidelines.pdf (accessed 2 September 2018).

BHIVA, BASHH and BIS (2008) UK national guidelines for HIV testing 2008. Available at: www.bhiva.org/file/RHNUJgIseDaML/GlinesHIVTest08.pdf (accessed 3 September 2018).

Brown AE KP, Chau C, Khawam J, et al. (2017) Towards Elimination of HIV Transmission, AIDS and HIV-related Deaths in the UK- 2017 Report. London: Public Health England. Available at: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/675809/Towards_elimination_of_HIV_transmission_AIDS_and_HIV_related_deaths_in_the_UK.pdf (accessed 3 September 2018).

10.

Chowta

Kamath

Ramapuram

et al. (2018) Evaluation of adverse drug reaction profile of drugs used as first-line antiretroviral therapy. Interdisciplinary Perspectives on Infectious Diseases. DOI: 10.1155/2018/8095609. Available at: www.hindawi.com/journals/ipid/2018/8095609/ (accessed April 2019).

11.

Cresswell

Waters

Briggs

et al. (2016) UK national guideline for the use of HIV post-exposure prophylaxis following sexual exposure (PEPSE). International Journal of STD and AIDS 27(9): 713–738. DOI: 10.1177/0956462416641813.

12.

Department of Health (2008) HIV post-exposure prophylaxis. Guidance from the UK Chief Medical Officers' Expert Advisory Group on AIDS. Available at: http://webarchive.nationalarchives.gov.uk/20130105025754/http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_088185?ssSourceSiteId=ab (accessed 9 September 2018).

13.

Evans

Jones

Prendergast

(2016) HIV-exposed, uninfected infants: New global challenges in the era of paediatric HIV elimination. Lancet Infectious Diseases 16(6): e92–e107.

14.

Hashemi

Ghassemi

Faro

et al. (2000) Induction of human immunodeficiency virus type 1 expression by anaerobes associated with bacterial vaginosis. The Journal of Infectious Diseases 181(5): 1574–1580. DOI: 10.1086/315455.

15.

Kapetanovic

Dass-Brailsford

Nora

et al. (2014) Mental health of HIV-seropositive women during pregnancy and postpartum period: A comprehensive literature review. AIDS Behaviour 18(6): 1152–1173. DOI: 10.1007/s10461-014-0728-9.

16.

McCormack

Dunn

Desai

et al. (2016) Pre-exposure prophylaxis to prevent the acquisition of HIV-1 infection (PROUD): Effectiveness results from the pilot phase of a pragmatic open-label randomised trial. The Lancet 387(10013): 53–60. DOI: 10.1016/S0140-6736(15)00056-2.

17.

Mellins

Chu

Malee

et al. (2008) Adherence to antiretroviral treatment among pregnant and postpartum HIV-infected women. AIDS Care 20(8): 958–968. DOI: 10.1080/09540120701767208.

18.

Mentor Mothers Scheme and HIV support. Available at positivelyuk.org. (accessed 5 September 2018).

19.

Nakagawa

Miners

Smith

et al. (2015) Projected lifetime healthcare costs associated with HIV infection. PLOS One 10(4): 125018 DOI: 10.1371/journal.pone.0125018.

20.

NICE (2017) HIV testing: Increasing uptake among people who may have undiagnosed HIV (Joint NICE and Public Health England guideline) Available at: www.nice.org.uk/guidance/NG60 (accessed 4 September 2018).

21.

PrEP Impact Trial. PrEP impact trial. Available at: www.prepimpacttrial.org.uk/ (accessed 9 September 2018).

22.

Public Health England (2016) Annual epidemiological spotlight on HIV in the East of England. Available at: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/712722/spotlight_on_hiv_in_the_east_of_england_2016_data.pdf (accessed 1 September 2018).

23.

Public Health England (2017) Trends in new HIV diagnoses and people receiving HIV-related care in the UK: Data to end of December 2017. Available at: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/738222/hpr3218_hiv17_v2.pdf (accessed 5 September2018).

24.

RCGP. Professional module 2.01: The GP consultation in practice. Available at: www.rcgp.org.uk/training-exams/training/gp-curriculum-overview/online-curriculum/knowing-yourself-and-relating-to-others/2-01-the-gp-consultation-in-practice.aspx (accessed 1 September 2018).

25.

RCGP. Clinical module 3.01: Healthy people: Promoting health and preventing disease. Available at: www.rcgp.org.uk/training-exams/training/gp-curriculum-overview/online-curriculum/working-in-systems-of-care/3-01-healthy-people.aspx (accessed 1 September 2018).

26.

RCGP. Clinical module 3.08: Sexual health. Available at: www.rcgp.org.uk/training-exams/training/gp-curriculum-overview/online-curriculum/applying-clinical-knowledge-section-1/3-08-sexual-health.aspx (accessed 1 September 2018).

27.

RCGP. Clinical module 3.14: Care of people who misuse drugs and alcohol. Available at: www.rcgp.org.uk/training-exams/training/gp-curriculum-overview/online-curriculum/managing-complex-care/3-14-drugs-and-alcohol-misuse.aspx (accessed 1 September 2018).

28.

Stohr

Dunn

Porter

et al. (2007) CD4 cell count and initiation of antiretroviral therapy: Trends in seven UK centres, 1997-2003. HIV Medicine 8(3): 135–141. DOI: 10.1111/j.1468-1293.2007.00443.x.

29.

Sullivan

Curtis

Sabin

et al. (2005) Newly diagnosed HIV infections: Review in UK and Ireland. British Medical Journal 330: 1301–1302. DOI: 10.1136/bmj.38398.590602.E0.

30.

The UK Collaborative Group for HIV and STI Surveillance (2007) Testing times. HIV and Other Sexually Transmitted Infections in the United Kingdom: 2007, London: Health Protection Agency, Centre for Infections.

31.

UNAIDS. AIDSinfo map. Available at: http://aidsinfo.unaids.org/ (accessed 2 September 2018).