However, HIV testing is not always requested as part of the GF investigation panel [2]. UK HIV testing guidelines state that an HIV test should be considered in the investigation of patients with a mononucleosis syndrome [1]. Despite these guidelines, recent research highlights missed opportunities for offering HIV testing outside traditional genitourinary medicine (GUM) and antenatal settings [3-5]. Rates of general practitioner (GP)-offered testing, in particular, remain low [6, 7]. Missed opportunities for diagnosis of PHI are well recognized [5, 8]. Despite an increased awareness among the medical profession,

a recent 24-year retrospective study found Regorafenib datasheet no significant improvement in the time delay in diagnosis of PHI [9]. The objective of this study was to examine the prevalence of HIV infection in patients presenting in primary care with GF-like illness to inform local health policy in incorporating HIV in the routine GF testing algorithm. Guy’s and St Thomas’ Pathology Laboratories (GSTS) are part

of the Guy’s and St Thomas’ Hospitals NHS Foundation Trust (GSTT), and provide virological testing for two teaching hospitals Venetoclax datasheet as well as primary care services within the inner London boroughs of Lambeth and Southwark Primary Care Trust. Following local research ethics committee approval, samples from primary care submitted to GSTT for a GF screen between April 2009 and June 2010, with and without a concomitant HIV request, 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. In conjunction with the HIV Reference laboratory at the Centre for Infection, Health Protection Agency, Colindale, antibody Sirolimus 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). A total of 72 GP practices submitted GF screening requests during the study period. The average number of GF screen requests per practice was 15, with a median of 9 (and a range of 1–85). Thirty-two practices submitted 10 or more requests, and 18 practices submitted 20 or more requests. Of 1046 primary care patients with GF screening requests, a concomitant HIV request was made in 119 patients (Fig. 1). One patient was known to be positive at the time of request and was excluded from the study results. Of the remaining 118 (118 of 1045; 11.3%), 2.5% (three of 118) were HIV positive. A further 45 (4.3%) had an HIV test requested subsequently through another consultation within 1 year; of these, 4.4% (two of 45) were HIV positive, and both were diagnosed through routine antenatal screening 6 and 8 months after the initial GF investigation. Of the 882 patients with unknown HIV status, 694 (78.