When should I consider referring a patient with HIV to a specialist for further management?

Guideline-aligned answer with reasoning, red flags and references. Clinically reviewed by Dr Kola Tytler MBBS CertHE MBA MRCGP.

Posted: 14 August 2025Updated: 14 August 2025 Guideline-Aligned (High Confidence) Clinically Reviewed
Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX

Consider referring a patient with HIV to a specialist for further management:

  • Immediately after a positive HIV test, refer urgently to a specialist HIV clinic to be seen preferably within 48 hours and at the latest within 2 weeks.
  • If the patient is well and there is no indication for urgent admission, ensure referral to specialist services for ongoing monitoring and management.
  • If non-adherence to antiretroviral therapy (ART) is suspected or identified, seek advice from the HIV specialist to manage treatment resistance and adherence issues.
  • Do not discontinue or adjust ART without specialist advice due to potential serious adverse effects and drug interactions.
  • Patients with CD4 counts below 200 cells/μL, indicating advanced immunosuppression and risk of opportunistic infections, require specialist management.
  • Any rising viral load suggesting treatment failure, resistance, or drug interactions should prompt specialist referral.
  • Patients with HIV-related problems, mental health issues, or end-stage advanced HIV disease should be managed in specialist services.

In summary, all patients diagnosed with HIV should be referred promptly to specialist HIV services for assessment and ongoing management, with urgent referral if there are complications, treatment issues, or advanced disease.

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