In 2010, just under half of new HIV diagnoses in the UK were in men who have sex with men (MSM). This group are most at risk of acquiring and transmitting HIV in the UK. In March 2011, NICE published guidance specifically aimed at increasing uptake of HIV testing in MSM, because of the high levels of infection, high levels of recent acquisition of HIV infection and continued high-risk behaviour in this group. Delayed diagnosis of HIV confers a poor prognosis: 73% of the 516 patients with HIV who died in 2009 had been diagnosed late. An estimated 39% of MSM in 2009 were diagnosed when their immune system was below the threshold at which antiretroviral treatment should be commenced. Many of these men had seen their own GP with signs and symptoms of HIV and the opportunity to make the diagnosis had been missed. One of the most important indicators is primary HIV infection. This seroconversion illness presents with a flu-like illness often lasting more than two weeks with a rash, sore throat and lymphadenopathy. An HIV test should be performed straightaway on all MSM presenting with these features. The benefits of increased testing and early diagnosis include reduced mortality and morbidity related to HIV and the potential to reduce onward transmission. NICE recommends that MSM have HIV tests at least annually as part of routine care, and additionally if the patient: has a new sexual partner has high-risk sexual intercourse; is diagnosed with another STI; requests a sexual health screen; or presents with an HIV indicator disease.
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