Late diagnosis means higher risk of poor response to treatment and increased mortality [14]. Onward transmission of HIV from infected individuals is more likely if the infected individual is unaware of their own infection [15]. The public health and clinical benefits are particularly relevant for diagnosis during PHI where viral load and thus infectivity are highest. Early diagnosis also provides an opportunity for maximizing the impact of recent partner notification. We believe our results provide a strong economic case for including

HIV in the standard GF screening tests. In our study, we carried out 694 additional HIV tests, and found three seropositive patients with evidence of recent acquisition (PHI). Assuming each test costs £10, the cost per diagnosis of PHI is £2310. The lifetime treatment cost of one patient is estimated to be around £280 000 ICG-001 in vivo to £360 000 [10]. Diagnosis of PHI represents a compelling economic argument for universal HIV testing in people presenting with GF-like illness. Formal cost-effectiveness studies have been conducted in the USA and France. In the USA, universal HIV testing is considered cost-effective check details if the positivity rate is greater than 1/1000 [16]. In France, a once-a-lifetime HIV test in the general

population, and annual HIV tests in high-risk populations are considered cost-effective [17]. The UK national guidelines also recommend screening if diagnosed HIV prevalence exceeds 2 per 1000 population [18]. A prevalence of 1.3% in our GF cohort is well above the recommended threshold for routine screening. Local policy should consider adopting the same opt-out strategy as in antenatal screening and include an HIV test routinely within the GF screening investigation panel. We are grateful to Gary Murphy at

the HIV Reference laboratory in the Centre for Infection, Health Protection Agency, Colindale for help with the RITA analysis. “
“3.1 We recommend patients are given the opportunity to be involved in making decisions about their treatment. GPP 4.1 We recommend patients with chronic infection start second ART if the CD4 cell count is ≤350 cells/μL: it is important not to delay treatment initiation if the CD4 cell count is close to this threshold. 1A   We recommend patients with the following conditions start ART:   • AIDS diagnosis [e.g. Kaposi sarcoma (KS)] irrespective of CD4 cell count. 1A • HIV-related co-morbidity, including HIV-associated nephropathy (HIVAN), idiopathic thrombocytopenic purpura, symptomatic HIV-associated neurocognitive (NC) disorders irrespective of CD4 cell count. 1C • Coinfection with hepatitis B virus (HBV) if the CD4 cell count is ≤500 cells/μL (see Section 8.2.2 Hepatitis B). 1B • Coinfection with hepatitis C virus (HCV) if the CD4 cell count is ≤500 cells/μL (Section 8.2.3 Hepatitis C). 1C • Non-AIDS-defining malignancies requiring immunosuppressive radiotherapy or chemotherapy (Section 8.3.2 When to start ART: non-AIDS-defining malignancies).