Screening

HIV screening

HIV testing is indicated:

  • When someone requests a test

  • When someone has a condition that indicates possible HIV infection

  • When someone believes that they are at risk of infection through unprotected sexual activity, needle stick injury, or unsafe injection drug use

  • In all pregnant women

  • For public health and infection control (e.g., blood product safety)

  • When required by, for example, life insurers.

The Centers for Disease Control and Prevention (CDC) recommends that all people 13-64 years of age be routinely tested for HIV, including annual screening for those determined to be at high risk.[73] More frequent screening can be considered for some asymptomatic men who have sex with men, based on individual risk factors, local epidemiology, and local policies.[74] Despite this recommendation, 37% of transgender men and women have never been tested for HIV.[75] Also, national surveillance data indicate that people who are at high risk of infection are not being retested as often as the CDC guidelines recommend.[76]

The US Preventive Services Task Force recommends screening in all people aged 15 to 65 years, younger and older adolescents and adults at increased risk of infection, and all pregnant women (including those who present in labor or at delivery whose HIV status is unknown). Repeat screening is considered reasonable in patients at higher risk of HIV infection, but there is insufficient evidence to recommend specific screening intervals.[77]

HIV testing is key to both effective primary and secondary preventive strategies and critical for implementation of a management plan for those who test positive. Testing has been shown to reduce risk behavior in people testing positive. Regular follow-up after positive test enables timely commencement of various prophylactic treatments to prevent opportunistic infections. In addition, timely testing before onset of advanced HIV enables adequate preparation for antiretroviral therapy.

Antibody-based tests or newer-generation HIV antibody/antigen combination assays are preferable as screening tests. Nucleic acid (HIV RNA) tests should be used if acute infection is suspected, or in neonates under 18 months of age (HIV DNA or RNA).

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