hiv testing in primary care (who, when, and how to interpret results)

Earlier HIV diagnosis improves outcomes and reduces transmission. In primary care, offer testing where (1) there is risk, (2) there are indicator conditions, or (3) the patient requests it. Routine, normalised testing reduces stigma and missed diagnoses.

• Request-based: patient asks, or wants reassurance after a risk event.
• Risk-based: MSM, condomless sex with new/multiple partners, sex work, PEP use, PrEP assessment, people from high-prevalence settings, IVDU.
• Indicator conditions (examples): recurrent/severe shingles, persistent lymphadenopathy, unexplained weight loss, chronic diarrhoea, recurrent bacterial infections, atypical pneumonia, oral candidiasis, thrombocytopenia, and many STI presentations.

Practical: if you’re ordering tests for an STI screen, consider HIV testing as part of the package (with appropriate consent and local arrangements).

• Laboratory 4th generation (Ag/Ab) test is standard in the UK. Many services consider it conclusive by around 6 weeks (≈45 days) post-exposure (check local lab guidance).
• Point-of-care antibody tests generally have a longer window period; use local sexual health service advice for timing and confirmatory testing.
• Reactive/screen positive results require confirmatory testing and urgent linkage to care (sexual health / HIV specialist team).

Acute HIV can present with a glandular-fever-like illness (fever, rash, sore throat) days–weeks after exposure; discuss urgent testing with specialist services if suspected.

• Before testing: document consent, explain the window period, and discuss how results will be communicated.
• After a negative test: advise repeat testing if within window period; discuss risk reduction and consider PrEP for ongoing risk.
• After a reactive test: contact the patient promptly, arrange confirmatory testing per local protocol, and refer/hand over to specialist HIV services the same day where possible.