European guidance on HIV testing in healthcare settings strongly recommends offering an HIV test to patients routinely when they present with an HIV indicator condition (indicator condition-guided testing). 18 It is considered that this universal approach is cost effective where at least one person in a thousand with the condition has undiagnosed HIV. Recent pan-European research identified conditions in which HIV prevalence was over this 0.1% threshold, even exceeding 2.5% in a number of these conditions. 19
Other research has shown that a routine offer of HIV testing is effective and highly acceptable to patients presenting with an HIV indicator condition. One study found that uptake was high when testing was routinely offered, but overall testing rates were lower because healthcare professionals did not always routinely offer the test. 20
Some conditions, which are common in the general population (for example psoriasis), can become severe, persistent or recurrent when there is underlying HIV infection. In such developing presentations, an HIV test should be offered. When these conditions have a normal presentation, the patient’s medical, sexual and drug-taking history should help inform whether to offer a test, but if in doubt it is safer to offer a test than to ignore the possibility of HIV.
It is basic good clinical practice to offer an HIV test to any patient presenting with symptoms which could be HIV-related. Failure to do so could be deemed medically negligent.