Study: Healthcare professionals ‘reluctant’ to offer HIV tests to older people

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Too many clinicians are failing to offer HIV tests to older people, resulting in late diagnosis and increased risk of mortality, research has found.

A study published in the British Geriatrics Society journal ‘Age and Ageing’ suggests that despite a year-on-year increase in the number of people over the age of 50 diagnosed with HIV, there is widespread reluctance of healthcare professionals to offer HIV tests to the group.

The most recent data from Public Health England (PHE) shows an estimated 73,660 people diagnosed as living with HIV.

In 2002, 12% (3,640) were aged over 50, while in 2011 that figure rose to 22% (16,550).

One in five of those with the virus is now aged over 50 – compared with one in ten a decade ago.

Co-author of the research, Professor Martin Fisher, of the Royal Sussex County Hospital in Brighton, warned that diagnosis among older people was often missed, resulting in high rates of “late presentation” and significantly increase mortality.

He said: “Even when HIV testing is introduced as a routine test, there is a reluctance of healthcare professionals to offer HIV tests to older persons. This is despite a year-on-year increase in the number of older individuals being diagnosed for the first time with HIV. Geriatricians need to enhance their diagnostic consideration of undiagnosed HIV infection and offer HIV testing to persons with clinical indicator diseases, irrespective of age.”

In Brighton, more than one in three people living with HIV is now aged over 50.

There have been substantial improvements in HIV management since the introduction of combination antiretroviral therapy (cART) in 1996.

Life expectancy has improved significantly, with many studies suggesting it to be near normal but as the population of older people living with HIV increases, new challenges continue to emerge.

Co-author of the research, Professor C Rajkumar said: “It is clear that the HIV cohort is ageing and that non-HIV physicians – including elderly care physicians – will be increasingly involved in the care of these patients. In the UK, the medical care of patients with HIV has historically been largely within either genitourinary medicine or infectious diseases clinics.

“As this relatively new chronic illness develops, HIV physicians could learn from the experience in management of other complex chronic diseases, incorporating an awareness of the need for a more comprehensive approach, taking account of the mental, functional, and social aspects, as well as medical issues. It is increasingly apparent that HIV specialists are less confident and less likely to treat significant co-morbidities such as diabetes and hypertension.”

Figures released in November last year by PHE showed HIV infections among gay and bisexual men at a record high.

In the same month the National AIDS Trust warned that too many doctors are failing to offer HIV tests to gay and bisexual men.