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Barriers in HIV-testing oncology patients may be physician-led

Swiss study reveals younger, non-migrant men with cancer more likely to be offered HIV testing

The success of modern pharmacological antiretroviral management means that many people are living now with HIV.

The changing epidemiology, ageing population and association of the disease with co-infection with oncogenic viruses, immunosuppression and other cancer-risk behaviours such as smoking, mean that non-AIDS-defining cancers are now the leading cause of non-AIDS death in people living with HIV.

Low uptake

Though the acceptance of HIV testing has previously been shown to be high in the oncology patient population, the actual uptake of HIV testing remains low.

Researchers from Lausanne, Switzerland, examined the inclination and disposition of patients and staff to HIV testing as part of the initial diagnostic work-up, and the rationale for not offering such testing.

Over a four-month period, of 239

...

The success of modern pharmacological antiretroviral management means that many people are living now with HIV.


Only 43 out of 239 patients of unknown HIV status diagnosed with solid organ 
non-AIDS-defining cancers were offered HIV testing

The changing epidemiology, ageing population and association of the disease with co-infection with oncogenic viruses, immunosuppression and other cancer-risk behaviours such as smoking, mean that non-AIDS-defining cancers are now the leading cause of non-AIDS death in people living with HIV.

Low uptake

Though the acceptance of HIV testing has previously been shown to be high in the oncology patient population, the actual uptake of HIV testing remains low.

Researchers from Lausanne, Switzerland, examined the inclination and disposition of patients and staff to HIV testing as part of the initial diagnostic work-up, and the rationale for not offering such testing.

Over a four-month period, of 239 patients of unknown HIV status newly diagnosed with solid organ non-AIDS-defining cancers, only 43 (18%) were offered HIV testing, with a 91% (39/43) acceptance rate for the procedure.

Risk of exposure

Those who declined testing did not consider themselves to be in a population at risk of exposure. Testing tended to be offered to the younger and non-migrant population.

The rationale for not offering a test was not proffered by the majority of clinicians. However, of the 16% of the physician sample who did put forward a reason, lack of time, the patient’s cognitive difficulties or follow up being conducted elsewhere predominated.

Just under 2% of the population were found to be HIV positive, which exceeded the threshold prevalence for cost-effectiveness of the intervention, where it is recognised that positive disease affects medical management.

Merz L, Zimmermann S, Peters S et al (2016) Investigating barriers in HIV-testing oncology patients: the IBITOP study, phase 1. The Oncologist. 21, 10, 1176-1182.

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