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Textbook/Infectious diseases, microbiology and sexual health/New HIV diagnosis and baseline assessment/Rapid
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New HIV diagnosis and baseline assessment

Essential points for quick revision.

2 min synopsisUK scopeSources checked 27 Aug 2026Clinical review pending
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Advanced HIV with acute organ disease

Hypoxia, meningism, focal neurology, visual loss, shock, severe wasting, persistent diarrhoea, oesophageal symptoms or CD4 below 200 cells/µL with illness may indicate an opportunistic infection requiring urgent diagnosis before routine ART timing.

Action: Use ABCDE, involve HIV and infection specialists immediately, obtain syndrome-directed samples and imaging, start life-saving opportunistic-infection therapy and decide ART timing specifically, especially for cryptococcal or tuberculosis meningitis.

Synopsis

Confirm HIV sensitively and respectfully, recognise acute and advanced disease, complete the baseline resistance, coinfection and safety assessment and link rapidly to specialist treatment and prevention.

  • Use a laboratory fourth-generation HIV-1/2 antigen–antibody assay as the standard screening test and follow the national confirmatory algorithm after a reactive result.
  • During very early infection, antigen, antibody and rapid tests may be negative; request HIV RNA when acute HIV is strongly suspected.
  • Communicate a new diagnosis privately, non-judgmentally and with a clear same-day linkage plan; assess immediate mental-health and safeguarding needs.

Key red flags

Breathlessness, dry cough and hypoxia with advanced HIV suggests Pneumocystis pneumonia and needs urgent blood gas and imaging.

Acute retroviral syndrome

Fever, rash, sore throat, lymphadenopathy, myalgia, diarrhoea, headache or aseptic meningitis occurs weeks after some acquisitions.

Investigation priorities

01
Fourth-generation HIV antigen–antibody assayFirst step

Screen for established and many early HIV-1 or HIV-2 infections using venous laboratory testing.

Management branches

CONFIRMVerify and communicate diagnosis

An HIV screen is reactive or acute infection remains likely despite negative screening.

  1. Send the national confirmatory differentiation and nucleic-acid tests and urgently request HIV RNA when acute infection is suspected.
  2. Explain that a screening result needs confirmation, maintain privacy and assess immediate emotional safety and support preferences.

Key medicines

Rapid-start antiretroviral regimenUse the exact specialist-selected once-daily integrase-inhibitor-based combination after baseline specimens, adjusted for resistance, hepatitis B, pregnancy, kidney function and interactions.
Bictegravir, emtricitabine and tenofovir alafenamideGive one 50 mg/200 mg/25 mg tablet orally once daily when the HIV specialist selects this complete regimen.
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Sources and review status4 sources · checked 27 Aug 2026 · clinical review pending
Sources

Sources and review status

National guidance is shown before implementation-dependent detail. Typical adult dose examples remain subject to patient factors, contraindications and the live BNF or specialist protocol. Source check completed 27 Aug 2026; clinical approval remains outstanding.

Authoring stateRapid draftClinical stateAwaiting reviewJurisdictionUnited Kingdom