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HIV testing as a normal diagnostic procedure

Abstract:

Since improved antiretroviral therapy has normalised the life expectancy of HIV-infected individuals, HIV is no longer considered an important medical problem in the Netherlands. This is not only the feeling of the general public, but unfortunately also of doctors working outside the HIV field. The cases described by Hermans et al. in this journal1 are no exception: we often encounter patients with clear symptomatic clues for an HIV infection, who have been through several expensive and invasive diagnostic procedures, before an HIV test is considered. The unfortunate result is that in the Netherlands, even in 2010, 56% of patients were diagnosed as so-called late presenters: individuals either presenting for care with a CD4-cell count below 350 cells/mm3 (normally between 800-1200 cells/mm3) or presenting with an AIDS-defining event regardless of the CD4 count. 2 Late diagnoses are associated with poorer prognoses and increased medical costs. 3 Furthermore, when individuals are unaware of their HIV status, they cannot take preventive measures against transmitting the virus to other people. 4 Hermans et al. discuss the reluctant attitude of both doctors and patients towards HIV testing in the Netherlands. 1 As a result, the percentage of persons living in the Netherlands with an HIV infection, who have not been diagnosed yet, is estimated to be around 40%, with a regional difference of 25% in the Amsterdam area and 45% in the rest of the country. 5 This percentage is one of the highest in Europe, a fact not to be proud of. Much more effort has to be made to lower both the percentage of undiagnosed individuals as well as the number of late …