When should I consider referring a patient to a specialist for HIV management?

Consider referring a patient to an HIV specialist promptly if they have a confirmed positive HIV test result. According to UK guidelines, people who test positive for HIV should be seen by an HIV specialist preferably within 48 hours and certainly within 2 weeks to ensure timely management and support ¹.

Referral is also indicated if the patient presents with symptoms suggestive of primary HIV infection or HIV-related illnesses, or if complex co-infections or comorbidities are suspected. This includes patients with indicator conditions such as infectious mononucleosis-like syndrome or those diagnosed with other sexually transmitted infections, as these may require specialist input for comprehensive care ¹.

Patients with HIV and coexisting chronic infections such as hepatitis B or C should be referred to specialists with expertise in infectious diseases or hepatology. For example, adults who are hepatitis B surface antigen positive should be referred to a hepatologist or infectious disease specialist with an interest in hepatology, as co-management is essential ².

Referral is also warranted for patients with advanced or decompensated liver disease or other complications related to HIV infection. This ensures access to specialist assessment and treatment options, including antiviral therapy and management of opportunistic infections ².

In adolescents or patients presenting with HIV-related emergencies, early specialist involvement is critical to address acute complications and optimise outcomes. Literature highlights the importance of specialist care in managing adolescent emergencies related to HIV, including opportunistic infections and immune reconstitution inflammatory syndrome (Salas-Humara et al., 2015).

Overall, referral should be considered immediately after diagnosis, when complex clinical features arise, or when co-infections and complications necessitate specialist expertise. Early specialist involvement improves patient outcomes through timely initiation of antiretroviral therapy, management of comorbidities, and provision of psychosocial support (Kasten, 2002; Salas-Humara et al., 2015) ¹.