9%) were identified. Thus, the overall prevalence of HIV infection in this patient group

was 1.3% (11 of 857), with 72.7% (eight of 11) cases missed at the initial GP consultation. Excluding the two patients found to be HIV positive following subsequent antenatal screening, four of the remaining nine patients (44.4%) were found to have evidence of recent acquisition based on the RITA testing algorithm, with three (75.0%) of these infections missed at the initial GP presentation. One further sample had an ‘invalid’ result because antibody levels were too low for the avidity test. Results indicate low levels of HIV testing in patients presenting in primary care with GF-like illness. Only 11.3% of patients presenting within our study period who received a GF screen also had a concomitant HIV test. As our study has demonstrated, this leads to a significant number of missed HIV diagnoses. Angiogenesis inhibitor It is estimated that 24% of people living with HIV in the UK remained undiagnosed in 2010 [10]. With a diagnosed prevalence in Lambeth and Southwark of 1.39 and 1.13%, respectively [11], the undiagnosed prevalence in the two local authorities can be estimated as 0.4%. The overall positivity of 1.3% in our group presenting with GF-like symptoms is substantially higher than the estimated undiagnosed prevalence in

the local population. The prevalence of recent infections within our cohort (0.5%; four selleck chemicals of 855) suggests a high prevalence of PHI within patients presenting with GF-like illness. The patient with an invalid RITA result because

of low levels of antibody may represent a case of very recent acquisition. Diagnosis in a significant proportion of patients with evidence of recent acquisition (75.0%) was missed at what, for most, may be the only symptomatic presentation second to healthcare services before more advanced disease years later. Our study had several limitations. In our anonymized study we could not verify whether the 694 samples without concomitant HIV test requests were known HIV positives as all identifying laboratory information was removed as a condition for ethics approval. However, as almost half of the cases had symptoms and laboratory results consistent with PHI, the contribution of previous known positive cases is unlikely to be significant. Furthermore, we do not have data on the number of individuals who declined the offer of an HIV test. Local experience suggests that this is a relatively rare occurrence. Recent studies conducted by the Department of Health found that the uptake rate by patients is generally high – between 75 and 91% in London [12] and Brighton [13]. Lack of patient demographic data meant we could not identify groups with particularly high HIV prevalence, or particularly low rates of primary care requested HIV tests.