HIV in Primary CareHIV in Primary Care

Justin WalkerJustin Walker

November 2011November 2011

Learning ObjectivesLearning Objectives

• Know when to consider testing for HIV in Know when to consider testing for HIV in primary careprimary care

• To learn the best practice around testingTo learn the best practice around testing

• To know what topics should be covered To know what topics should be covered in counsellingin counselling

• Symptoms and signs of primary HIVSymptoms and signs of primary HIV

• Clinical conditions associated with long Clinical conditions associated with long term HIVterm HIV

ProgrammeProgramme

• Introduction - HPA Annual Report Introduction - HPA Annual Report 2011 2011

• Small group workSmall group work

• Feedback within groupsFeedback within groups

• PlenaryPlenary

• Question and answer sessionQuestion and answer session

• Useful sources of informationUseful sources of information

IntroductionIntroduction

• By the end of 2010, approximately 91,500 By the end of 2010, approximately 91,500 people were living with HIV in the UK, of people were living with HIV in the UK, of whom about 24% are undiagnosed.whom about 24% are undiagnosed.

• 6,600 people were newly diagnosed with HIV6,600 people were newly diagnosed with HIV

• 50% of these were diagnosed late50% of these were diagnosed late

• These individuals have a tenfold increased These individuals have a tenfold increased risk of dying within a year of diagnosis, risk of dying within a year of diagnosis, compared to those diagnosed promptly (4.0 compared to those diagnosed promptly (4.0 vs 0.4%). vs 0.4%).

IntroductionIntroduction

• People living with diagnosed HIV can People living with diagnosed HIV can expect a near-normal life expectancyexpect a near-normal life expectancy

• An estimated 3000 new diagnoses in An estimated 3000 new diagnoses in MSM, the highest everMSM, the highest ever

• In 2010 one in seven overall and one In 2010 one in seven overall and one in four MSM had recently acquired in four MSM had recently acquired infection.infection.

1 Data are adjusted for missing route of infection2 Includes Mother to child transmission and blood product recipient

0

500

1000

1500

2000

2500

3000

3500

4000

4500

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

New

HIV

dia

gnos

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MSMHeterosexual contact abroadHeterosexual contact in the UKIDUOther 2

Number of new HIV diagnoses1by prevention group, UK: 2000-2009

IntroductionIntroduction

• More than 2.1 million HIV tests were More than 2.1 million HIV tests were performed in 2010, most in STI clinic performed in 2010, most in STI clinic and antenatal settings.and antenatal settings.

• Coverage in STI clinics 69%Coverage in STI clinics 69%

• Coverage in antenatal care 96%Coverage in antenatal care 96%

What’s Happening Locally?What’s Happening Locally?

Local Authority Diagnosed HIV prevalence per 1,000 (aged 15-59)

Derby 1.75

Nottingham 2.33

Leicester 3.38

South Derbyshire 0.36

Amber Valley 0.37

Derbyshire Dales 0.43

Areas to CoverAreas to Cover

• Primary HIV Infection and aetiologyPrimary HIV Infection and aetiology

• Testing - who and whenTesting - who and when

• Testing - practicalities and Testing - practicalities and counselling counselling

• Clinical conditions associated with Clinical conditions associated with long term HIV.long term HIV.

Small Group WorkSmall Group Work

• Split into groups of fourSplit into groups of four

• Review resources (10-20 mins)Review resources (10-20 mins)

• Present summary to other members of Present summary to other members of the group. Note any questions. (30 the group. Note any questions. (30 mins)mins)

• Tea, coffee and lots of cakeTea, coffee and lots of cake

• Plenary, question and answer session.Plenary, question and answer session.

• Sources of information. Sources of information.

Herpes zosterHerpes zoster

Rash in primary HIV infectionRash in primary HIV infection

Kaposi’s sarcomaKaposi’s sarcoma

Kaposi’s sarcoma IIKaposi’s sarcoma II

Sebhorrhoeic dermatitisSebhorrhoeic dermatitis

Oral candidaOral candida

Oral hairy leukoplakiaOral hairy leukoplakia

Palatal kaposi’s sarcomaPalatal kaposi’s sarcoma

Plenary

• Primary HIV Infection and aetiologyPrimary HIV Infection and aetiology

• Testing - who and whenTesting - who and when

• Testing - practicalities and Testing - practicalities and counselling counselling

• Clinical conditions associated with Clinical conditions associated with long term HIV.long term HIV.

Key Recommendations IKey Recommendations I

• In high HIV prevalence areas In high HIV prevalence areas universal HIV testing should take universal HIV testing should take place for all general medical place for all general medical admissions and new registrants in admissions and new registrants in general practice.general practice.

• HIV testing in STI clinics should be HIV testing in STI clinics should be universal.universal.

Key Recommendations IIKey Recommendations II

• People most at risk of HIV infection People most at risk of HIV infection (MSM, black Africans, IVDUs) should (MSM, black Africans, IVDUs) should have an annual HIV testhave an annual HIV test

• People with HIV should have PCV13 People with HIV should have PCV13 to decrease incidence of invasive to decrease incidence of invasive pneumococcal disease. pneumococcal disease.

Useful Sources of Useful Sources of InformationInformation

• Managing HIV in Primary Care - Managing HIV in Primary Care - MedFASHMedFASH

• HIV Annual Report 2011 - HIV Annual Report 2011 - HPAHPA

• Recommendations for HIV testing Recommendations for HIV testing 2008 2008 BHIVABHIVA

• www.hiv-druginteractions.orgwww.hiv-druginteractions.org