Ethics of HIV testing in general practice without informed consent: a case series.

Received 19 January 2005 Accepted for publication 23 March 2005 . . . . . . . . . . . . . . . . . . . . . . . C ase 1: A 40 year old man presented in 1990 for a life insurance medical and routine blood tests including HIV antibodies. The HIV test was refused. Despite prompting, the reasons for this were not volunteered. Several days later, I received the patient’s results. This included an HIV antibody test identifying the patient. This was in contravention of our practice policy which is to code HIV results. The pathology request form was reviewed. This showed an HIV test had been added in different handwriting. Practice and pathology staff could not explain the source of this writing. The patient returned for his results. Fortunately, the patient raised the issue of the HIV test himself. He had changed his mind and had himself written on the request form before delivering the request form to the pathologist. The implications of his negative result were explained after discussing the patient’s risk factors for HIV with him. Case 2: A 43 year old married clergyman presented in 2000 with a recurrent infection of his little toe. This developed into a pyodermic granuloma and was treated by curretage and diathermy. The preliminary pathology report queried Kaposi’s sarcoma and further staining was requested. The patient failed to call for his results. Based on my knowledge of this patient and his family, there were no risk factors for HIV infection. I considered whether to arrange an interview with this patient as soon as possible in order to take a detailed sexual history with a view to urgent HIV testing. I felt this course of action was likely to cause distress, that the risk of HIV in this patient was low, and that the delay in getting a final histological diagnosis was unlikely to alter the clinical course. The subsequent pathology report confirmed granulation tissue only.