title: Non-disclosure of HIV status in UK sexual health clinics--a pilot study to identify non-disclosure within a national unlinked anonymous seroprevalence survey.
abstract: OBJECTIVE
  To identify if HIV-infected individuals attending genitourinary clinics in the UK are not disclosing their HIV status, and to examine the potential utility of drug detection as a method to indicate non-disclosure.
  
  
  METHODS
  HIV-positive samples from the unlinked anonymous seroprevalence survey from one London centre in 2009 had viral load (VL) assays performed to identify samples with VL below the level of detection (50 copies/ml, VLBLD) or <1000 copies/ml. After data matching, known HIV positives were excluded and the remaining samples analysed for the presence of a panel of antiretroviral drugs.
  
  
  RESULTS
  Of 130 HIV-positive samples with sufficient clinical information and not undergoing an HIV test, 18 were classified as remaining undiagnosed after the clinic visit. Thirteen (72%, 95% CI: 47% to 90%) had a VLBLD (n=11) or VL <1000 copies/ml (n=2). Eight had sufficient volume to undergo ARV testing, and all were positive for the presence of drug; all with therapeutic levels of clinically appropriate combinations.
  
  
  CONCLUSIONS
  Non-disclosure of HIV status occurs among individuals attending sexual health services in the UK. This study demonstrates the feasibility and utility of using both VL and ARV assays in serum samples. Furthermore, the close correlation of detection of ARV with VLBLD suggests drug detection would be a useful tool to monitor non-disclosure prospectively, thus enabling the use of stored serum samples in future studies. The extent to which these findings can be extrapolated to other settings, and the potential impact of non-disclosure on undiagnosed estimates warrants urgent prospective study.
authors: John Hunter Clinic for Sexual Health, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK. Ann.Sullivan@Chelwest.nhs.uk
authors: Ann Kathleen
authors: AK
authors: Sullivan
authors: Emma J
authors: EJ
authors: Savage
authors: Catherine M
authors: CM
authors: Lowndes
authors: George
authors: G
authors: Paul
authors: Gary
authors: G
authors: Murphy
authors: Simon
authors: S
authors: Carne
authors: David J
authors: DJ
authors: Back
authors: O Noel
authors: ON
authors: Gill
mesh_terms: D019380:Anti-HIV Agents / Q000032:analysis; D030881:Disclosure / Q000706:statistics & numerical data*; D015658:HIV Infections / Q000175:diagnosis* / Q000453:epidemiology*; D015528:HIV Seroprevalence; D006801:Humans; D008297:Male; D010865:Pilot Projects; D044967:Serum / Q000737:chemistry / Q000821:virology; D006113:United Kingdom / Q000453:epidemiology; D019562:Viral Load
chemical_list: D019380:Anti-HIV Agents