title: Diagnosing HIV infection in patients presenting with glandular fever-like illness in primary care: are we missing primary HIV infection?
abstract: OBJECTIVE
  The aim of the study was to examine the prevalence of HIV infection in patients presenting in primary care with glandular fever (GF)-like illness.
  
  
  METHODS
  Samples from primary care submitted for a GF screen between April 2009 and June 2010 were identified. Samples without an HIV request were anonymized and retrospectively tested using a 4th-generation HIV antigen/antibody screening test. Reactive samples were further confirmed by an HIV antibody only test, with or without a p24 antigen assay. Antibody avidity testing based on the Recent HIV Infection Testing Algorithm (RITA) was used to identify individuals with evidence of recent acquisition (within 4-5 months).
  
  
  RESULTS
  Of 1046 GF screening requests, concomitant HIV requests were made in 119 patients. Excluding one known positive patient, 2.5% (three of 118) tested HIV positive. Forty-five (4.3%) had a subsequent HIV test through another consultation within 1 year; of these, 4.4% (two of 45) tested positive. Of the remaining 882 patients, 694 (78.7%) had samples available for unlinked anonymous HIV testing, of which six (0.9%) tested positive. The overall HIV prevalence was 1.3% (11 of 857), with 72.7% (eight of 11) of cases missed at initial primary care presentation. Four of the nine (44.4%) available positive samples had evidence of recent acquisition, with three (75.0%) missed at initial primary care presentation.
  
  
  CONCLUSIONS
  Low levels of HIV testing in patients presenting in primary care with GF-like illness are resulting in a significant number of missed HIV and seroconversion diagnoses. Local policy should consider adopting an opt-out strategy to include HIV testing routinely within the GF-screening investigation panel.
authors.affiliation: Department of Public Health, NHS Lambeth, London, UK.
authors.forename: D T S
authors.initials: DT
authors.lastname: Hsu
authors.forename: M
authors.initials: M
authors.lastname: Ruf
authors.forename: S
authors.initials: S
authors.lastname: O'Shea
authors.forename: S
authors.initials: S
authors.lastname: Costelloe
authors.forename: J
authors.initials: J
authors.lastname: Peck
authors.forename: C Y W
authors.initials: CY
authors.lastname: Tong
mesh_terms: D003937:Diagnosis, Differential; D004739:England / Q000453:epidemiology; D015658:HIV Infections / Q000175:diagnosis* / Q000453:epidemiology; D006801:Humans; D007244:Infectious Mononucleosis / Q000188:drug therapy*; D008403:Mass Screening / Q000592:standards; D012189:Retrospective Studies