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  3. Ask an expert: HIV in primary care
Practice Practice Pointer

Ask an expert: HIV in primary care

BMJ 2025; 388 doi: https://doi.org/10.1136/bmj.r129 (Published 03 February 2025) Cite this as: BMJ 2025;388:r129
  1. Surinder Singh, senior academic general practitioner (retired)1,
  2. Daniel Ivens, general practitioner (former consultant in genito-urinary medicine)2,
  3. Sophie Mylan, general practitioner3
  1. 1Research Dept of Primary Care and Population Health, University College London, UK
  2. 2Hampstead Group Practice, London
  3. 3City & Hackney Integrated Primary Care CIC, London
  1. Correspondence to S Singh s.singh2{at}ucl.ac.uk

What you need to know

  • Approach HIV as you would any other long term condition. People living with HIV appreciate empathy, access to a named doctor, continuity, and good communication with specialists

  • Knowing the prevalence of HIV in your area of practice will help determine your policy on testing

  • For those with a negative HIV test result and a high risk exposure, consider repeating the test 45 days after the exposure

BMJ Learning

To obtain accredited continuous professional development points, subscribers to BMJ Learning can complete the full module at https://new-learning.bmj.com/course/30000120. The module contains seven additional questions submitted by users of BMJ Learning, related to general considerations in primary care, addressing common concerns, pre- and post-exposure prophylaxis, and considerations for HIV in pregnancy, healthcare workers, and the ageing population.

General practitioners with a special interest in HIV Surinder Singh, Daniel Ivens, and Sophie Mylan provide expert answers to questions from general practitioners related to identifying, testing, and caring for patients with suspected or confirmed HIV infection, identifying seroconversion illness and patients who present late in their disease course, and the principles of antiretroviral therapy.

Test yourself

You see a new patient, a 31 year old woman, who tells you she was diagnosed with HIV infection two years ago. She has been seeing a specialist and is receiving antiretroviral therapy.

What do you need to consider?

  1. Recommend she has a cervical smear test every two years

  2. Recommend vaccination for hepatitis B, irrespective of her hepatitis B status

  3. Recommend she receives seasonal influenza vaccine and pneumococcal conjugated vaccine

  4. Find out her CD4 count, and if it is less than 200 cells×103/L recommend she receives the measles, mumps, rubella (MMR) vaccine.

What are the implications for primary care when you become aware of a patient being HIV positive?

In England, an estimated 4700 people are undiagnosed with HIV.1 Offer testing wherever an opportunity arises. In our experience, multiple steps can be taken in primary care services to become more “HIV friendly.” …

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