HIV

• People living with HIV who are started on treatment in a timely fashion have a normal life expectancy.​
• There is NO risk of HIV transmission from patients whose viral load is undetectable (<40 copies/mL) and who take their HIV medications. Undetectable=Untransmissible (U=U).​
• There are a range of HIV treatments available including combination once-a-day tablets and injectable therapies. Most regimens consist of between 2 and 4 anti-retroviral medications. Medications are prescribed via secondary care and the current regimen is usually listed on their last HIV clinic letter. 

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• People living with HIV can self-refer by attending RIDU reception​
• GPs can refer patients via SCI-Gateway​
• For new ward diagnoses of HIV please page the ID registrar on #8161 0900-1900​
• If a person living with HIV is admitted under your care and management advice is not required, please inform the HIV specialist nurses
• If HIV specific management advice is required please contact the ID registrar in the first instance​

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RIDU

• 01315372959​
• 07769932053​
• 07769931376​

Chalmers

• 07580852672 ​

• ​Late diagnosis is the leading cause of HIV related morbidity and mortality.​
• All healthcare workers should be able to offer an HIV test in their setting. ​
• Consent requirements:​ no special consent is required beyond that required for any routine blood test, as outlined by the GMC guidance. 
• Individuals should be made aware that they will be tested for HIV and informed how they will receive their result.
• Lengthy pre-test discussion is not required however, if there is a high pre-test probability then individuals should be counselled on the implications of a positive result. 
• The screening test is a combined HIV Ag/Ab, details on requesting here
• HIV viral load and CD4 should only be performed after specialist advice (see section below)

Who is HIV testing recommended for?

• People belonging to a group at increased risk of testing HIV positive (e.g. gay, bisexual and other men who have sex with men, people who inject drugs, people from countries with high HIV seroprevalence and trans women)​
• People attending health services associated with increased risk of HIV (e.g. sexual health, tuberculosis, lymphoma and addiction and substance use services)​.
• All people presenting with symptoms and/or signs consistent with an HIV indicator condition, regardless of the presence or absence of identifiable risk factors​.

Clinical guidelines on HIV testing and treatment, and a full list of indicator conditions can be found at British HIV Association (BHIVA).​

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HIV indicator conditions 

• Community acquired pneumonia​
• Herpes zoster​
• Hepatitis B or C (acute or chronic)​
• Unexplained lymphadenopathy​
• Mononucleosis-like illness​
• Unexplained leucopenia/thrombocytopenia​
• Peripheral neuropathy or mononeuritis​
• Unexplained weight loss​
• Unexplained chronic diarrhoea​
• Severe or atypical psoriasis​
• Seborrhoeic dermatitis​
• Lymphocytic meningitis​

​As routes of acquisition are similar, we recommend offering testing for HBV and HCV in all individuals identified as being at risk of HIV infection.

Potentially AIDS defining conditions

Most people living with HIV will be on anti-retrovirals with undetectable viral loads, and will be admitted with non-HIV related issues.​

Checklist​

• Ensure the correct anti-retrovirals are prescribed following medicines reconciliation. As these medications are prescribed via secondary care, do not rely on ECS alone - check the most recent HIV clinic letter. If there is any uncertainty about the current antiretroviral prescription, please contact the HIV pharmacy team on RIDUpharmacists@nhs.scot or liaise with the ward pharmacist.
• Check interactions for any newly started medications (including inhaled and injected medications) using the HIV drug interactions checker​.
• If you suspect the individual is presenting with a condition related to HIV then contact the on-call RIDU registrar for advice 0900-1900 page 8161. There is a consultant available 1900-0900 for emergency advice.
• If the patient has been lost to HIV follow up (not attended services within the last 6-12 months) then please contact the HIV specialist nurses (01315372959​), leaving a message if there is no answer. 

• We do not recommend ordering HIV viral load and CD4 counts unless recommended by an HIV specialist.
• ​We no longer routinely check CD4 cell counts if an individual has been undetectable on therapy with a CD4 count over 350 cells/uL for at least one year. A repeat CD4 count is not required unless there is a concern regarding treatment failure (detectable viral load) or new onset of HIV related symptoms. In these instances, please contact the ID registrar on-call for advice.
• Viral load determines effectiveness of anti-retrovirals and if the person can transmit HIV (undetectable = untransmissible).​
• CD4 is a measure of the degree of immunosuppression​
• If you are asked to order CD4 or HIV viral load see further information here: ​
  • CD4/8 request details​
  • HIV viral load request details

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When prescribing a new medication for a PLWHIV please use the ​HIV drug interaction checker 

1. Terrence Higgins Trust: PrEP
2. NHS Lothian RefHelp: HIV PrEP and PEPSE​
3. British HIV Association (BHIVA): Current guidelines

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