Since HIV positive status carries consequences for lifestyle and insurance, it should rarely be assessed without prior counselling and consent. The CD4 count may be used to assess the likelihood of symtomatology being AIDS-related, although this will fall further with acute critical illness; again, consent should usually be sought pre-testing. High risk patients should be considered for testing, e.g. homosexual males, intravenous drug abusers, haemophiliacs, Central African origin. In critically ill patients such consent can rarely be obtained and unconsented testing may be used where management may change significantly with knowledge of the HIV status, or where organ donation is being considered. Most AIDS-related infections can be adequately treated without knowledge of the HIV status. Patients or staff who are recipients of a needlestick injury can be treated with antiretroviral therapies if risk is high.

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