Wood Hayley, Colver Helen, Stewart Ewen, Palfreeman Adrian
University Hospitals of Leicester.
Practitioner. 2011 Apr;255(1739):25-8, 3.
In 2010, just under half of new HIV diagnoses in the UK were in men who have sex with men (MSM). This group are most at risk of acquiring and transmitting HIV in the UK. In March 2011, NICE published guidance specifically aimed at increasing uptake of HIV testing in MSM, because of the high levels of infection, high levels of recent acquisition of HIV infection and continued high-risk behaviour in this group. Delayed diagnosis of HIV confers a poor prognosis: 73% of the 516 patients with HIV who died in 2009 had been diagnosed late. An estimated 39% of MSM in 2009 were diagnosed when their immune system was below the threshold at which antiretroviral treatment should be commenced. Many of these men had seen their own GP with signs and symptoms of HIV and the opportunity to make the diagnosis had been missed. One of the most important indicators is primary HIV infection. This seroconversion illness presents with a flu-like illness often lasting more than two weeks with a rash, sore throat and lymphadenopathy. An HIV test should be performed straightaway on all MSM presenting with these features. The benefits of increased testing and early diagnosis include reduced mortality and morbidity related to HIV and the potential to reduce onward transmission. NICE recommends that MSM have HIV tests at least annually as part of routine care, and additionally if the patient: has a new sexual partner has high-risk sexual intercourse; is diagnosed with another STI; requests a sexual health screen; or presents with an HIV indicator disease.
2010年，英国新增的艾滋病病毒确诊病例中，刚好不到一半是男男性行为者（MSM）。在英国，这一群体感染和传播艾滋病病毒的风险最高。2011年3月，英国国家卫生与临床优化研究所（NICE）发布了专门针对提高男男性行为者艾滋病病毒检测率的指南，因为该群体感染率高、近期艾滋病病毒感染率高且持续存在高危行为。艾滋病病毒诊断延迟会导致预后不良：2009年死亡的516例艾滋病病毒感染者中，73%被诊断得较晚。据估计，2009年39%的男男性行为者在免疫系统低于应开始抗逆转录病毒治疗的阈值时才被诊断出来。这些男性中有许多人曾因艾滋病病毒的症状和体征去看过自己的全科医生，但却错过了诊断的机会。最重要的指标之一是原发性艾滋病病毒感染。这种血清转化疾病表现为类似流感的疾病，通常持续两周以上，伴有皮疹、喉咙痛和淋巴结病。所有出现这些症状的男男性行为者都应立即进行艾滋病病毒检测。增加检测和早期诊断的益处包括降低与艾滋病病毒相关的死亡率和发病率，以及减少进一步传播的可能性。NICE建议，男男性行为者应至少每年进行一次艾滋病病毒检测，作为常规护理的一部分，此外，如果患者：有新的性伴侣；有高危性行为；被诊断出患有另一种性传播感染；要求进行性健康筛查；或出现艾滋病病毒指示性疾病，也应进行检测。
