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National Public Health Service for Wales Look Back Completion Questions and Answers Gwynedd Lookback completion Frequently asked Questions and Answers The Lookback What is a lookback? If a healthcare worker is diagnosed with specific notifiable communicable disease/s the NHS will, where appropriate, organise a Look Back of all his/her patients, contacting them to inform them of the risk and to offer advice and and testing. What is the lookback in this incident about? A healthcare worker in Gwynedd had been diagnosed to have carried hepatitis C. A lookback was organised for the patients with whom the healthcare worker has had contact. If the healthcare worker was diagnosed to have carried hepatitis C, why did you also look for hepatitis B and HIV? As part of its work to assess the risk involved, the management team set up to manage the lookback examined carefully the infection control procedures and records of the healthcare worker. This raised concerns and the incident management team sought advice from the United Kingdom Advisory Panel for Blood Boren Viruses (UKAP). On the basis of the concerns raised, the Panel advised that there was a very low risk of hepatitis B or HIV being passed on from one patient to another in the healthcare setting. The NHS therefore also offered patients advice, support and an opportunity to be tested for hepatitis B and HIV as well. The healthcare worker does not have hepatitis B or HIV. Version: 2 Author: Chris Lines and Teresa Owen Date: 19 March 2007 Page: - 1 -16 Status: Approved for publication National Public Health Service for Wales Look Back Completion Questions and Answers What did the NHS do about this? Officers of the Gwynedd LHB and the National Public Health Service for Wales met immediately on being notified of the healthcare worker’s diagnosis. The Incident Management Team was then convened in October 2005. It has met regularly since. Staff examined more than 5,000 patient records, checking the details on each, so that they could make contact with all the healthcare worker’s patients to explain the situation and offer a blood test. An advice line was set up to provide advice and support and to book appointments at a clinic for a blood test. The same line also provided negative test results to patients. Clinics were set up in North Wales and for patients further afield. GPs were contacted and asked to arrange tests. In total, 2,665 patients were tested. Epidemiological studies and further blood testing were then organised to see if the cases of hepatitis C found were beyond what would have been expected in a population of this size and whether the individuals concerned had other circumstances which could have explained their infection. This was an enormous piece of work involving more than 100 NHS staff. It was also a sensitive piece of work balancing the healthcare worker’s right to confidentiality with the health needs of his/her patients. The healthcare worker has not practised since the notification of infection so there was no additional risk at all to patients while the Incident Management Team was working. If the NHS knew about this in 2005 why did it take until the end of May 2006 for patients to be told? The NHS timeline for action was as follows: 2005 3rd October Gwynedd Local Health Board and the National Public Health Service for Wales (NPHS) were notified of the healthcare worker being diagnosed with hepatitis C. 3rd October The healthcare worker stopped working. 5th October The first Incident Management Team meeting was held. At this meeting, the need for further advice was discussed. Version: 2 Author: Chris Lines and Teresa Owen Date: 19 March 2007 Page: - 2 -16 Status: Approved for publication National Public Health Service for Wales Look Back Completion Questions and Answers 21st October Following further consideration, the Incident Management Team wrote to the United Kingdom Advisory Panel (UKAP) for Blood Borne Viruses formally seeking advice on action to take. 14th December UKAP responded to the Incident Management Team’s letter. 21st December The UKAP letter was received. It advised that the Incident Management Team should conduct a lookback of the healthcare worker’s patients. 29th December A meeting of the Incident Management Team was held and formally agreed to conduct the lookback 2006 11th January The Incident Management Team formally wrote to the healthcare worker requesting all patient notes. 8th March After ongoing discussions a second formal request for the patient notes was sent. 22nd March The first set of patient notes was received by the Incident Management Team. 6th April The final set of patient notes was received from the healthcare worker. 10th May BBC Wales contacted the LHB and NPHS with information on the lookback. 13th May Despite representations about the public concern that would be generated, BBC Wales broadcasts news of the lookback. 24th May Letter received from UKAP advising that the lookback should cover hepatitis B and HIV as well as hepatitis C. 26th May Gwynedd LHB asks the Healthcare Inspectorate Wales to investigate the response of health authorities to concerns raised with them in the past. 30th – 31st May Letters sent to patients notifying them of the risk and offering advice, support and a blood test. 5th June Version: 2 Author: Chris Lines and Teresa Owen First of the clinics to be held to take blood tests. Date: 19 March 2007 Status: Approved for Page: - 3 -16 publication National Public Health Service for Wales 17th July Look Back Completion Questions and Answers Last of the clinics to be held to take blood tests. 2007 8th February Incident Management Team agrees conclusions of the lookback and agrees to write to UKAP. 8th March The Incident Management Team received a letter from UKAP to confirm that no further action is needed 20th March Incident Management Team writes to healthcare worker’s patients The lookback completion Can you be certain that the healthcare worker did not infect patients or that patients did not infect others in the healthcare worker’s setting? There is no evidence of any patients being infected by the Gwynedd healthcare worker. We have shared our findings with national experts at the UK Advisory Panel for blood-borne viruses. They agree that there is no evidence to justify any further action. It is very difficult to prove a negative so it is impossible to be absolutely certain. How can it be assumed that because people had other risk factors they did not get hepatitis C from the healthcare worker? All the evidence points to there being no causal connection between people with hepatitis C and the healthcare worker: The numbers of people infected is not higher than we would expect in a population of this size None of the patients where we were able to carry out further testing had the same type of hepatitis C as the healthcare worker Detailed interviewing showed that other risks were much more likely to have been the cause of infection. For example we know from experience and research studies that intravenous drug use is high risk and that exposure to a healthcare worker is low risk. Why has it taken so long to reach a conclusion to this lookback? A lookback of this magnitude takes time. The investigation involved patient identification, tracing patients resident in Wales and further a field, notifying GPs, the setting up of special clinics, operation of a helpline, the testing of 2,665 patients, the laboratory work to analyse the tests, and the enhanced work involved in the further testing of specimens and the undertaking of the epidemiological study. Version: 2 Author: Chris Lines and Teresa Owen Date: 19 March 2007 Page: - 4 -16 Status: Approved for publication National Public Health Service for Wales Look Back Completion Questions and Answers There were a number of parts of the investigation where the Incident Management Team could not control timescales: for example, the time needed by the United Kingdom Advisory Panel to consider issues and the availability of patients to take up tests and invitations for interview. What about the large number of patients who did not come forward for testing? Surely you haven’t tested enough patients to be sure of the conclusions? The number of patients tested - 2,665 patients – is very substantial. It is very reasonable to draw conclusions from such a large share of the total. Every patient identified had an opportunity of a test. It is a personal decision whether to accept or not. Can patients still ask for a test even if they haven’t taken up the previous offer? Yes. Anyone at anytime who is concerned that they may be at risk of hepatitis should speak to their GP. However, those who may be concerned because of this incident should be reassured. The investigation has concluded that the risk of infection to patients of this healthcare worker is no higher than the risk to the general population. What happened to the patient records of those people who say they were patients of the healthcare worker but were never contacted? We contacted every patient for whom we had a credible record. There were a few records which did not have full details. The healthcare worker said that some old records had been culled. This is legitimate. Patient records so not have to be passed on when a patient moves to a new healthcare worker when a healthcare worker practice closes. We can reassure those who self-identified that patients of the healthcare worker are not at any greater risk of infection than the wider population. Do you think the self identifiers were treated fairly? There are some people who identified themselves as patients for whom we did not have a credible record. The Incident Management Team decided that the results of the Look Back should be assessed before deciding whether these people should be offered a test. At all times, we considered carefully the actions which we took. We clearly stated at the beginning that we would review the investigation once we found out more about the level of risk to the public. We wrote to everyone who contacted us to explain this. Version: 2 Author: Chris Lines and Teresa Owen Date: 19 March 2007 Page: - 5 -16 Status: Approved for publication National Public Health Service for Wales Look Back Completion Questions and Answers We have now completed the investigation, and no evidence has been found that these patients were at an increased risk. There is no need for further investigation. We can reassure those who self-identified that patients of the healthcare worker are not at any greater risk of infection than the wider population. The Incident Management Team report Given the conclusions can the action and expense of the lookback be justified? Given the information available to the Incident Management Team at the start, the lookback was justified. There was a healthcare worker who had hepatitis C. The healthcare worker practised exposure prone procedures where blood to blood contact was a risk. Added to this, there were documented concerns about the healthcare worker’s infection control practices. These facts indicated that there was a very small risk of infection to patients. We emphasised at the time that there was no evidence of a patient being infected by the healthcare worker. However, we had reason to look for evidence, as a precaution. The Incident Management Team took advice from UK experts before going ahead. If we had known then what we know now, the lookback would not have been started. However, we only know what we know because of the action taken. Can such an incident be prevented from ever happening again? It is in fact very rare for a healthcare worker to have hepatitis C. The screening of new staff who undertake procedures prone to exposure to blood and rigorous infection control procedures across the NHS reduce the risk of infection so that it is very small indeed. Procedures worked well in this case in relation to the diagnosis of hepatitis C in the healthcare worker. The healthcare worker then stopped work immediately. The National Public Health Service for Wales was notified immediately. The public health response was also immediate. However, given the nature of the disease – people can have it for years without realising – and the number of people who use health services, it is impossible to say that such incidents will never happen again. What are the recommendations made as a result of the lookback?/ What have you learnt from the lookback? There are two principal public health issues raised by the lookback. Version: 2 Author: Chris Lines and Teresa Owen Date: 19 March 2007 Page: - 6 -16 Status: Approved for publication National Public Health Service for Wales Look Back Completion Questions and Answers There are issues around the inspection and regulation of healthcare workers in private practice and around the occupational health services available to such workers. In both cases there are gaps in the system which leave certain types of private healthcare beyond inspection and regulation and where there is no support to certain types of healthcare worker. The Incident Management Team has recommended that the Assembly should review these issues. In the case of inspection, this is already being considered. The report also provides a record which should be useful to the organisation of lookbacks in future. The National Public Health Service for Wales and Gwynedd LHB have learnt from the investigation so that operational procedures can be improved in future and appropriate resources allocated. While these lessons will help the organisations involved there would be little discernable difference to the decisions and actions taken or to the outcomes of any investigation. Do you think healthcare workers should be better regulated? The lookback has identified an issue in relation to the lack of inspection and regulation relating to some healthcare workers working in private practice. In this case, infection control concerns had been raised with a healthcare worker but the concerns could not be followed through after all NHS work was dropped. There is no inspection regime for the healthcare worker because it is a private practice. Are occupational health arrangements for staff stringent enough in the NHS? Occupational health arrangements are in place in the NHS and this lookback has not identified any issues for the NHS. However, some healthcare workers working in private practice fall outside the inspection and regulatory systems in place for their equivalents working in the NHS. This is an anomaly and, more importantly, a matter of public health concern. It needs to be addressed by Government and, in fact, is already under consideration. What actions should the Welsh Assembly Government consider as a result of the lookback? We have recommended that the Welsh Assembly Government should consider the Incident Management Team’s report in full. In particular there are issues around the inspection and regulation of healthcare workers in private practice and around the occupational health services available to such workers. Version: 2 Author: Chris Lines and Teresa Owen Date: 19 March 2007 Page: - 7 -16 Status: Approved for publication National Public Health Service for Wales Look Back Completion Questions and Answers The Welsh Assembly Government and the National Assembly is already considering matters of inspection which we welcome. The Healthcare Inspectorate Wales report What has happened to the Healthcare Inspectorate Wales report? Healthcare Inspectorate Wales have completed their investigations and are currently drafting a report for publication. The healthcare worker Who is the healthcare worker, where did they work, what type of work did they do and how long have they been working? The healthcare worker has the same rights to confidentiality as any patient seeking or receiving medical treatment. No personal information will be provided that might lead to the deductive disclosure of his/her identity. The NHS worked hard to identify all those patients that might have been put at risk of infection and every effort was made to contact both them and their GPs. The conclusions of the lookback support the need to have maintained confidentiality for the healthcare worker. The work has been completed successfully without the investigation team disclosing the name or the profession of the healthcare worker. How did the healthcare worker become infected? This information is not known. Many people with hepatitis C do not know how they were infected. When did the healthcare worker become infected? It is not always possible to tell when a patient with hepatitis C became infected. However as soon as the infection was diagnosed, the healthcare worker stopped working. How was the healthcare worker diagnosed? The healthcare worker took a test voluntarily. What is the risk to the healthcare worker’s patients? Advice from national experts was that the risk of passing on the hepatitis C virus was very low indeed. It could only happen if the healthcare worker’s blood got into the patient’s bloodstream. The risk of patients getting hepatitis B or HIV in this healthcare setting were even smaller. It could only have happened if the blood of one patient got into the bloodstream of another patient. Version: 2 Author: Chris Lines and Teresa Owen Date: 19 March 2007 Page: - 8 -16 Status: Approved for publication National Public Health Service for Wales Look Back Completion Questions and Answers There is no evidence to suggest that any individual has suffered ill health as a consequence of having care provided by the healthcare worker. The contact programme was undertaken on a precautionary basis. As a precaution, we offered patients who had been cared for by the healthcare worker the opportunity to have a blood test for hepatitis C, hepatitis B and HIV. Why was this individual not screened before working in the health care setting?/ How can someone with hepatitis C be allowed to work in a health care setting? Hepatitis C testing of most health care workers is unnecessary as they do not carry out exposure prone procedures (EPPs) that pose a risk of infection to patients. The Advisory Group on hepatitis has advised the Department of Health that the low risk of transmission does not warrant testing all health care workers who carry out EPPs. In line with current guidance from the Department of Health and their professional duty of care, healthcare workers who perform EPPs and who believe that they may have been exposed to infection should promptly seek testing for hepatitis C. If they are found to be positive then as a precautionary measure they do not carry out EPPs. Was the healthcare worker allowed to continue working after they contracted hepatitis C, and if so, why? The healthcare worker stopped working as soon as s/he became aware of the infection. Most people who are infected with Hepatitis C often have no idea that they have caught it and will not have any symptoms at all. Did you contact all settings at which the healthcare worker was employed? Considerable efforts were made to establish the healthcare worker’s full employment history. If there were concerns about the healthcare worker’s infection control procedures before, why was the healthcare worker allowed to continue working? It is apparent from NHS records that concerns about infection control procedures had been raised with health authorities in the past. As a result, Gwynedd Local Health Board asked the Healthcare Inspectorate Wales to investigate the response by the NHS and other bodies to the concerns raised and how these were handled. Version: 2 Author: Chris Lines and Teresa Owen Date: 19 March 2007 Page: - 9 -16 Status: Approved for publication National Public Health Service for Wales Look Back Completion Questions and Answers Contacting patients If the personal details of the healthcare worker weren’t available, then how could someone find out if they had been affected? Gwynedd Local Health Board and the National Public Health Service for Wales made great efforts to ensure that everyone who may have been put at risk of infection was identified via their patient notes, so that they could be contacted and offered testing and support. We have a duty of confidentiality to the health care worker and we contacted patients potentially at risk without compromising that confidentiality. How were patients contacted to be informed of the risk? Patients were identified from the healthcare worker’s patient notes. They were sent a letter on Tuesday 30th and Wednesday 31st May 2006. The letter explained the low level of risk and provided a special helpline number for advice, support and to book an appointment for a blood test. Children and some patients – where their GP advised us to do so – were contacted directly in person by a member of NHS staff. Are you confident that you contacted all patients that may have been at risk? The Local Health Board (LHB) and National Public Health Service for Wales (NPHS) meticulously checked individual patient records to try to identify everyone who had been treated by the health care worker and may have been at risk of infection. There are some people who contacted the NHS because they believed that they were also patients of the healthcare worker even though the NHS did not have records for them. When these people contacted us, we explained that we would not be offering them blood tests. We emphasised that there was no evidence of anyone being infected by the healthcare worker or in the healthcare worker’s place of work. We wanted to analyse the results of the Look Back to see if there was evidence pointing to heightened risk which would justify contacting others and breaking the healthcare worker’s confidentiality. How many patients were contacted? Letters were sent out to approximately 4,786 people. Advice, support and a blood test What were patients asked to do? Version: 2 Author: Chris Lines and Teresa Owen Date: 19 March 2007 Page: - 10 -16 Status: Approved for publication National Public Health Service for Wales Look Back Completion Questions and Answers Having received a letter from Gwynedd Local Health Board, patients could ring the special helpline number, set up just for them. Lines were open: Monday – Friday Saturday – Sunday 7am – 8pm 7am – 4pm When patients rang this number and provided their contact details and the special identification number at the top of their letter, they were able to speak to a trained health information officer to discuss the option of receiving pretest counselling and a blood test. What was the process for offering testing to exposed patients? The staff on the helpline offered advice and pre-test counselling and assisted in making arrangements for testing. How long did patients wait to be tested? Patients in the South Gwynedd area were invited to attend especially arranged local clinics set up by the NHS. There were 47 clinics set up in the morning, afternoon and evenings and at weekends. (Due to the volume of patients, GPs were not able to do blood tests in South Gwynedd.) Patients from other areas of North Wales, or elsewhere in Gwynedd were able to arrange their blood tests via their GP. However they were also able to attend one of the clinics if they wished to do so. The appointments were co-ordinated through the special Help Line. It took six weeks to complete the clinics. There were a small number of patients coming forward for tests several months later How were patients informed of the result? The results were available in three weeks after the test. The patients received the results of the blood test by telephone using their name and special identification number on the assumption that they did not have the infection. A copy of the results were sent to the patient’s GP unless a patient specifically requested otherwise. How were patients informed of positive results? Patients with positive results were contacted individually by their GP to arrange for them to have further tests. Patients were offered assessment, advice and support for a specialist team. Version: 2 Author: Chris Lines and Teresa Owen Date: 19 March 2007 Page: - 11 -16 Status: Approved for publication National Public Health Service for Wales Look Back Completion Questions and Answers Advice for pregnant women Should pregnant women be concerned? All pregnant women are routinely offered a HIV test and a hepatitis B test as part of the antenatal screening programme – this has been UK policy since 2000. There is no evidence of any patient acquiring any of the viruses in the healthcare worker’s place of work. Advice for women who are breast feeding Should women who have been patients of the healthcare worker continue to breast feed? There is no evidence of any patient acquiring any of the viruses in the healthcare worker’s place of work so we strongly recommend that all women continue to breastfeed. Advice on sexual relationships Should patients abstain from sex? There is no need for any patient of the healthcare worker to abstain from sexual intercourse.. General advice on safe sex applies here as with the wider population. Insurance, mortgages and employment Would the offer of a test affect a patient’s insurance or mortgage? Since publication of the first version of the Association of British Insurers Statement of Best Practice on Underwriting Life Insurance for HIV in July 1994, insurers have not asked whether an applicant has undergone counselling about HIV, or have taken an HIV test. Instead, insurers have been expected only to ask whether the applicant has tested positive for HIV, or was awaiting the results of an HIV test. If the result is negative, the fact of having an HIV test will not, of itself, have any effect on your acceptance terms for insurance The Association of British Insurers (www.abi.org.uk) advises that insurance companies will not ask whether an applicant for life or health protection insurance has taken a Hepatitis C test, had counselling in connection with such test or received a negative test result. Insurers have been expected only to ask whether the applicant had tested positive for Hepatitis C, or was awaiting the results of an Hepatitis C test. Version: 2 Author: Chris Lines and Teresa Owen Date: 19 March 2007 Page: - 12 -16 Status: Approved for publication National Public Health Service for Wales Look Back Completion Questions and Answers ABI members are instructed to use the following question: “Have you ever tested positive for HIV, Hepatitis B or C or are you awaiting the results of such a test? Note: If the result is negative, the fact of having a Hepatitis C test will not, of itself, have any effect on your acceptance terms for insurance.” Would the offer of a test affect a patient’s employment? There is no need to tell your employer that you have had these tests as part of a look back. Patients who had a positive test result were advised what if anything their employer needs to know. Outside the medical/dental profession individuals would not normally impart this information to their employer. Hepatitis C What is hepatitis C? Hepatitis C infection is a virus that can cause long-lasting infection and can lead to liver disease. What are the symptoms of hepatitis C? Hepatitis C infection affects different people in different ways; many experience no symptoms at all while others experience extreme tiredness and can feel very unwell. Reported symptoms include fatigue, weight loss, nausea, 'flu like symptoms, problems concentrating, abdominal pain and jaundice. It is estimated that around 15-30% of infected people clear their infections naturally within the first 6 months of infection. For the remainder, hepatitis C is a chronic infection that can span several decades and can be life-long. Diagnosis is made by a blood test. As many people do not have any symptoms, it is important to have a blood test if you feel you have been put at risk. How common is hepatitis C? Hepatitis C is a rare infection – there is an estimated 1 in 200 people carrying this virus in Wales. How do you catch hepatitis C? Infection occurs through: Infected blood entering the bloodstream of another person sex with an infected person although this is extremely rare The virus can pass from an infected mother to child during pregnancy, when giving birth or after birth (6% risk). Unprotected Hepatitis C is an occupational hazard in the dental and medical professions. Version: 2 Date: 19 March 2007 Status: Approved for Author: Chris Lines and Page: - 13 -16 publication Teresa Owen National Public Health Service for Wales Look Back Completion Questions and Answers How long does it take to become ill? It takes between 6 weeks and 6 months to show that the virus is present from when it was picked up, although it is usually many years before symptoms develop. Is there treatment available? There is no vaccination available to prevent hepatitis C. There is effective treatment available to patients with hepatitis C. What is the long-term outlook for a patient with hepatitis C? About 70% to 85% of people who acquire infection become chronically infected. The rest clear the infection spontaneously. Most people who are chronically infected live out a normal lifespan; others develop symptoms of chronic liver disease many years after the initial infection; 5-20% may develop serious liver disease (cirrhosis) after 20 years. A small proportion of these (12%) develop liver cancer. How is hepatitis C diagnosed? Hepatitis C antibodies are detected by a blood test. The test, called an antiHCV test, looks for antibodies to Hepatitis C produced by the body’s immune system in response to the virus. Detecting antibodies to Hepatitis C shows evidence of exposure to the virus rather than necessarily infection with the Hepatitis C virus. If someone has a positive antibody test this need not mean that they are still infected, further tests will then be required. Hepatitis B What is hepatitis B? The hepatitis B virus causes hepatitis (inflammation of the liver) and can also cause long term liver damage. What are the symptoms of hepatitis B? Many people have no symptoms while others experience a flu-like illness including a sore throat, tiredness, joint pains, and a loss of appetite. Other symptoms may include nausea and vomiting. Acute infection can be severe causing abdominal discomfort and jaundice. 90% of people will clear the virus after infection in adult life. For the remainder, hepatitis B is a chronic infection that can span several decades and can be life-long. Diagnosis is made by a blood test. As many people do not have any symptoms, it is important to have a blood test if you feel you have been put at risk. How common is hepatitis B? It is estimated that in Wales 1 in 300 people have had the virus. Version: 2 Author: Chris Lines and Teresa Owen Date: 19 March 2007 Page: - 14 -16 Status: Approved for publication National Public Health Service for Wales Look Back Completion Questions and Answers How do patients get infected? Infection occurs through: Infected blood entering the bloodstream of another person sex with an infected person Unprotected The virus can pass from an infected mother to child during pregnancy, when giving birth or after birth. Since April 2000, all pregnant women in the UK are offered testing for hepatitis B. How long does it take to become ill? Children may often present with no symptoms. Adults who pick up the virus are usually ill within 6 months. What is chronic hepatitis B infection? The failure to clear hepatitis B infection after six months leads to the chronic carrier state. Many people who become chronic carriers have no symptoms and are unaware that they are infected. These individuals will remain infectious and will be at risk of developing cirrhosis and primary liver cancer. Is there treatment for chronic hepatitis B infection? There is a vaccination available to prevent people getting hepatitis B. There is effective treatment available for someone with hepatitis B. Human Immunodeficiency Virus (HIV) What is HIV? HIV stands for Human Immunodeficiency Virus and is a blood borne virus that attacks the immune system. How do you catch HIV? Infection occurs through: The transfer of body fluids (such as blood, semen, fluid from the woman’s cervix and breast milk) from an infected person to an uninfected person. Unprotected sexual intercourse with an infected partner. The virus can pass from an infected mother to child during pregnancy, when giving birth or after birth. Since April 2001, all pregnant women in the UK are offered tested for HIV. How common is HIV? This is the least common of these viruses – there is an estimated 1 in 4000 people in Wales being cared for HIV. What are the symptoms of HIV? Version: 2 Author: Chris Lines and Teresa Owen Date: 19 March 2007 Page: - 15 -16 Status: Approved for publication National Public Health Service for Wales Look Back Completion Questions and Answers People with HIV usually have no symptoms for a prolonged period of time, while the virus acts slowly to weaken the body’s immune system. When a person’s immune system has been broken down, he or she is susceptible to other illnesses, especially infections (e.g tuberculosis and pneumonia) and cancers, many of which are not normally a threat to a healthy person. How long does it take to become ill? It takes between 6 weeks and 3 months to show that the virus is present from when it was picked up, although it is usually many years before symptoms develop. How is HIV diagnosed? Diagnosis is made by a blood test. As many people do not have any symptoms in the early stages of infection it is important to have a blood test if you feel you have been put at risk. Is there any treatment available for HIV infection? There is effective treatment for HIV. Version: 2 Author: Chris Lines and Teresa Owen Date: 19 March 2007 Page: - 16 -16 Status: Approved for publication