HIV in Primary Care Justin Walker November 2011

Learning Objectives Know when to consider testing for HIV in primary care Know when to consider testing for HIV in primary care To learn the best practice around testing To learn the best practice around testing To know what topics should be covered in counselling To know what topics should be covered in counselling Symptoms and signs of primary HIV Symptoms and signs of primary HIV Clinical conditions associated with long term HIV Clinical conditions associated with long term HIV

Programme Introduction - HPA Annual Report 2011 Introduction - HPA Annual Report 2011 Small group work Small group work Feedback within groups Feedback within groups Plenary Plenary Question and answer session Question and answer session Useful sources of information Useful sources of information

Introduction By the end of 2010, approximately 91,500 people were living with HIV in the UK, of whom about 24% are undiagnosed. By the end of 2010, approximately 91,500 people were living with HIV in the UK, of whom about 24% are undiagnosed. 6,600 people were newly diagnosed with HIV 6,600 people were newly diagnosed with HIV 50% of these were diagnosed late 50% of these were diagnosed late These individuals have a tenfold increased risk of dying within a year of diagnosis, compared to those diagnosed promptly (4.0 vs 0.4%). These individuals have a tenfold increased risk of dying within a year of diagnosis, compared to those diagnosed promptly (4.0 vs 0.4%).

Introduction People living with diagnosed HIV can expect a near-normal life expectancy People living with diagnosed HIV can expect a near-normal life expectancy An estimated 3000 new diagnoses in MSM, the highest ever An estimated 3000 new diagnoses in MSM, the highest ever In 2010 one in seven overall and one in four MSM had recently acquired infection. In 2010 one in seven overall and one in four MSM had recently acquired infection.

Introduction More than 2.1 million HIV tests were performed in 2010, most in STI clinic and antenatal settings. More than 2.1 million HIV tests were performed in 2010, most in STI clinic 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? Local AuthorityDiagnosed HIV prevalence per 1,000 (aged 15-59) Derby1.75 Nottingham2.33 Leicester3.38 South Derbyshire0.36 Amber Valley0.37 Derbyshire Dales0.43

Areas to Cover Primary HIV Infection and aetiology Primary HIV Infection and aetiology Testing - who and when Testing - who and when Testing - practicalities and counselling Testing - practicalities and counselling Clinical conditions associated with long term HIV. Clinical conditions associated with long term HIV.

Small Group Work Split into groups of four Split into groups of four Review resources (10-20 mins) Review resources (10-20 mins) Present summary to other members of the group. Note any questions. (30 mins) Present summary to other members of the group. Note any questions. (30 mins) Tea, coffee and lots of cake Tea, coffee and lots of cake Plenary, question and answer session. Plenary, question and answer session. Sources of information. Sources of information.

Herpes zoster

Rash in primary HIV infection

Kaposi’s sarcoma

Kaposi’s sarcoma II

Sebhorrhoeic dermatitis

Oral candida

Oral hairy leukoplakia

Palatal kaposi’s sarcoma

Plenary Primary HIV Infection and aetiology Primary HIV Infection and aetiology Testing - who and when Testing - who and when Testing - practicalities and counselling Testing - practicalities and counselling Clinical conditions associated with long term HIV. Clinical conditions associated with long term HIV.

Key Recommendations I In high HIV prevalence areas universal HIV testing should take place for all general medical admissions and new registrants in general practice. In high HIV prevalence areas universal HIV testing should take place for all general medical admissions and new registrants in general practice. HIV testing in STI clinics should be universal. HIV testing in STI clinics should be universal.

Key Recommendations II People most at risk of HIV infection (MSM, black Africans, IVDUs) should have an annual HIV test People most at risk of HIV infection (MSM, black Africans, IVDUs) should have an annual HIV test People with HIV should have PCV13 to decrease incidence of invasive pneumococcal disease. People with HIV should have PCV13 to decrease incidence of invasive pneumococcal disease.

Useful Sources of Information Managing HIV in Primary Care - MedFASH Managing HIV in Primary Care - MedFASH HIV Annual Report HPA HIV Annual Report HPA Recommendations for HIV testing 2008 BHIVA Recommendations for HIV testing 2008 BHIVA