Don’t forget HIV testing in the over 60s

White reported routine offers of HIV tests at an accident and emergency department,1 while Das and colleagues discussed primary HIV infection as “easily missed.”2 Our recent experience with three older people suggests that opportunistic offers of HIV testing should be more widespread.

All three were repeat blood donors aged over 64 years who had seroconverted since their last donation. Careful history taking during discussion of the positive result uncovered an illness compatible with primary HIV infection. Two donors had visited their GP; the third was admitted to hospital for lymph node biopsy. The final diagnosis was “a viral infection” for two and gastrointestinal infection in the other. Two told us of a new sexual partner shortly before onset of illness—no sexual history had been taken in one, despite a history of sexually transmitted infection, and in the second a history had been taken but HIV testing was not suggested. The third donor had a clearly identifiable lifestyle risk.

None of our donors was recognised as having a primary HIV infection. Their infections would probably have gone unnoticed for years had they not been donors. They lived in different parts of England, outside London; two in rural areas. The two oldest had given multiple donations (77 and 92) and might have been considered “low risk.” They may also have considered themselves low risk.

Late diagnosis of HIV in the over 50s has recently been described,3 and our experience supports the concern that risk of HIV infection, and HIV seroconversion illness, is not being recognised or even considered in this age group. Lifestyle risks should be explored more readily and a high index of suspicion maintained in all cases of “non-specific viral infection.”