Practical approaches to HIV testing in the intensive care unit

Diagnostic and ethical dilemmas around HIV testing are a common problem for the intensivist, whose patients may be unconscious. Emphasis on increased testing by the non-specialist sharpens the focus of this debate in the UK and raises specific questions around how this can be achieved within the current legal and ethical framework. In this article we outline the natural history of HIV for the non-specialist and discuss the legal and ethical interface with intensive care medicine through the use of specific clinical case studies. We argue that ICU clinicians should have a very low threshold

for offering HIV tests whenever clinical or epidemiological indicators are present. There is nothing ‘special’ about HIV testing except that specific consent still has to be obtained, in confidence, from conscious patients. Testing is indicated whenever it is in the clinical interests of the patient. The small proportion of situations that are less straightforward can be discussed with and/or be dealt with by the local HIV team.