HIV – Warning signs, and where medical negligence can occur

‘Red Flag’ Blog Series

HIV/AIDS is one of the most devastating pandemics recorded in human history and continues to be a global burden. Despite advances in knowledge and treatment, there is no vaccine and drugs are not curative.

It is estimated that 100,000 people in the UK are infected with HIV, but a quarter do not know that they are carrying the virus. Reassuringly, the proportion of people being diagnosed late (when HIV has already caused substantial damage to their immune system) has gone down in recent years.

As a medical negligence solicitor, I wanted to cover both the medical and legal aspects of HIV including examples of clinical negligence claims involving HIV/AIDS.

How is HIV passed on?

HIV (Human Immunodeficiency Virus) can be passed onto another person in the following ways:

• unprotected sexual intercourse
• sharing injecting equipment
• virus transmission from a mother to her baby during pregnancy, birth or when breastfeeding
• receiving blood transfusions or other blood-related products from someone living with HIV, artificial insemination, skin grafts and organ transplants. In UK, blood, sperm and organ donations are now screened for HIV.

Symptoms

A person infected with HIV may or may not have any symptoms. This can lead to delay in diagnosis and treatment. Symptoms vary depending on the stage of HIV infection.

In the acute stage of HIV infection (first 2-6 weeks after being infected), the symptoms may include fever, a blotchy red rash, diarrhoea, headache, nausea/ vomiting, fatigue, aching muscles, sore throat and weight loss.

The symptoms of acute infection are similar to those of other viral illnesses and are often compared to getting the flu. The symptoms may last up to two weeks and then completely go away as the virus goes into a non-symptomatic phase.

The second, chronic stage of HIV infection is usually asymptomatic. However, some HIV sufferers may present with conditions/symptoms such as the thrush, shingles, thrombocytopenia, anemia, seborrhoeic dermatitis and weight loss.

This period can last for over 10 years. It is during this period of time that HIV can be passed on to others as people may not know that they are infected.

During this often asymptomatic phase, HIV is slowly destroying the body’s immune system. A healthy person has a CD4 T-cell count between 450 and 1,400 cells per microlitre. For an HIV-infected person, the number of CD4 T-cells steadily drops, putting them at a very high risk of developing other infections and AIDS which is the advanced stage of HIV infection. When the CD4 T-cell count drops to below 200, people are diagnosed with AIDS (Acquired Immune Deficiency Syndrome).

Diagnosis

There are two types of blood tests which can detect HIV. One type looks for the antibodies the immune system produces to fight HIV infection. Another type looks for the virus itself (known as an antigen test or a p24 test).

Most clinics use a test kit which includes both of these – an antibody test and an antigen test. This means that HIV can be found sooner after infection than it would be by using an antibody test on its own.

There may still be a short period of time after exposure where HIV may not be detected with the above tests. Therefore the official recommendation is that anyone at increased risk of HIV infection should be tested three months after possible exposure to HIV and then re-tested at six months.

Treatment

Without treatment, HIV sufferers are highly likely to develop AIDS. Modern HIV treatment means that many people with HIV are living long and healthy lives. HIV is treated with different types of anti-retroviral medication (ARVs). Additional protection against other types of viral infection is also recommended (such as annual flu jabs).

Clinical negligence claims involving HIV

I have come across the following cases involving HIV:-

1. Failure or delay in diagnosing and treating HIV

Early diagnosis and treatment can substantially increase the life expectancy and improve quality of life of HIV sufferers. Patients should also be provided with on-going support and HIV treatment for the remainder of their life which, sadly, is not always the case.

2. Failures in management of pregnancy and labour of HIV infected mothers resulting in a baby contracting HIV

It is possible for an HIV infected woman to give birth to HIV-negative child as long as the necessary precautions are followed by her, her midwives and doctors. The precautions include: taking anti-HIV drugs during pregnancy, carefully managed delivery (being offered a planned caesarean section if the mother’s viral load is above 400), not breastfeeding and giving the new baby an anti-HIV drug for a few weeks after being born. Failure to follow one or more of these precautions can have life-changing implications for the mother and her baby.

3. Receiving HIV infected blood, semen or organ

As mentioned above, HIV screening of blood, semen and organ donations is mandatory in UK. However, errors occasionally occur particularly as tests can never be 100% accurate as if a donor has only very recently been infected with a disease it may not show up as part of the screening; therefore it is possible for infected blood to enter the system in a small number of cases.

4. Receiving medical treatment from an HIV-infected person which leads to the infection of the patient

A recent change in the legislation means that HIV positive staff can carry out surgery and dentistry.  The risk of being infected in this way is said to be extremely low and there are no reported cases of such occurrence in UK.

5. Errors resulting in incorrect positive HIV test results being given, with significant psychological consequences

6. Issues of confidentiality involving HIV patients and the use of their medical records which can have psychological consequences

A compensation claim can assist those who contracted the virus or have not received treatment as a result of clinical negligence by improving their quality of life. It is important that anyone who wants to pursue a compensation claim relating to HIV instructs a specialist clinical negligence solicitor with knowledge of this condition and experience of cases involving HIV.

Alex Dabek is a solicitor at Bolt Burdon Kemp specialising in clinical negligence claims. She has an interest in HIV and HIV related claims. She can be contacted on 020 7288 4812 or by email on alexdabek@boltburdonkemp.co.uk