Dermatovenereologists can save lives by testing for HIV.
In the last 20 years since the advent of antiretroviral therapy, HIV has been transformed from a lethal infectious disease to a chronic condition where HIV-positive patients can expect almost normal life expectancy if they adhere to medication. This medication is also highly effective in preventing onward transmission of the virus, offering the potential to slow the epidemic significantly and potentially eliminate it in the long run.
In order to provide this life-saving therapy, the first step in the treatment cascade is to identify those who are infected. Yet in Europe a staggering one in four HIV-infected people are unaware of their condition. Many of these are not in specific risk groups and therefore may never consider getting tested for HIV. Others who might consider themselves at risk can erroneously assume that they have already been tested for HIV as part of routine blood tests for investigation of symptoms.
There have been several initiatives to raise health professionals’ awareness of the importance of testing for HIV when patients present with HIV indicator conditions. However, there is much still to be done if we are to have a significant impact on the undiagnosed rate. UN AIDS launched its 90-90-90 target in 2014 with the following goals:
– By 2020, 90% of all people living with HIV will know their HIV status.
– By 2020, 90% of all people with diagnosed HIV infection will receive sustained antiretroviral therapy.
– By 2020, 90% of all people receiving antiretroviral therapy will have viral suppression.
Through the Project Proposal Review Committee, EADV supported the development of www.hivindv.org to help dermatovenereologists and other clinicians managing skin conditions and sexually transmitted infections to diagnose HIV. Ultimately, more than 90% of patients will develop a skin disease as a manifestation of their HIV infection if the latter is undiagnosed and untreated. Dermatologists are key in identifying ‘late presenters’ but ideally should also be in a position to identify early signs of infection.
This online resource can be used by individual clinicians for self-directed learning. It covers background information and epidemiology of HIV, plus why, when and how to test for HIV, including information about use of rapid tests in a clinical setting. HIV indicator conditions are described, fully illustrated with colour photographs and demonstrated through case histories. These show how patients with HIV have failed to be diagnosed by a variety of clinicians. Case histories are useful for small group teaching as all relevant information is included in an easy-to-use format, providing trainers with a ready-made package to teach a variety of clinicians in the clinical setting. The resources and references list contains up-to-date and relevant policies and guidelines. Finaly, a knowledge test helps users to identify gaps in their learning and points them towards sections of the website providing information to address these. The website can be used as self-certified learning but other options are being explored for formalising CPD.
Pages from www.hivindv.org
The website was developed by a project team of experts including Professor Henry De Vries from Amsterdam as Chair of the EADV Sexually Transmitted Infections Task Force, Dr Angela Robinson as Project Lead, Professor Simon Barton and Mr Peter Greenhouse. Task Force members were consulted. The project co-ordinator and lead writer was Ruth Lowbury.
Meeting of the project team with the website designers, Fresh Lemon (left to right: Ruth Lowbury, Dr Angela Robinson, Jo Hobbs and Craig Heath of Fresh Lemon)
In future, we hope that the EADV website will have a direct link to the www.hivindv.org website, so that more dermatovenereologists will be made aware of it and be able to use it to improve their practice. This is a valuable resource which should help to increase diagnoses of HIV infection in dermatology and venereology, save lives and prevent further transmission of the virus.
Feedback is welcomed and can be sent to the Sexually Transmitted Infections Task Force at the following contact: marina@EADV.org
Dr Angela Robinson M.D. FRCP
Department of GUM/HIV
Mortimer Market Centre
Ruth Lowbury BA(Hons) HonFFSRH
Independent consultant specialising in HIV and sexual health