What are the recommendations for HIV screening?

Updated: Jul 27, 2020
  • Author: Shelley A Gilroy, MD, FACP, FIDSA; Chief Editor: Michael Stuart Bronze, MD  more...
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Answer

HIV screening recommendations include the following:

  • The US Preventive Services Task Force (USPSTF) recommends that clinicians screen for HIV in all adolescents and adults at increased risk for HIV infection, and all pregnant women [1]
  • The Centers for Disease Control and Prevention (CDC) recommends opt-out HIV screening for patients in all health-care settings; persons at high risk for HIV infection should be screened at least annually [2]
  • The American College of Physicians (ACP) recommends that clinicians adopt routine screening for HIV and encourage all patients to be tested [3]
  • Current CDC guidelines recommend testing for HIV infection with a US Food and Drug Administration (FDA)–approved antigen/antibody immunoassay that detects HIV-1 and HIV-2 antibodies and the HIV-1 p24 antigen, with supplemental testing following a reactive assay result to differentiate between HIV-1 and HIV-2 antibodies. If supplemental testing for HIV-1/HIV-2 antibodies shows nonreactive or indeterminant results (or if acute HIV infection or recent exposure is suspected or reported), an HIV-1 nucleic acid test is recommended to differentiate acute HIV-1 infection from a false-positive test result. [4]
  • The World Health Organization (WHO) recommends an HIV testing strategy/algorithm whereby a combination of rapid diagnostic tests (RDTs) and/or enzyme immunoassays (EIAs) are used to achieve at least a 99% positive predictive value (ie, < 1 false-positive result per 100 people diagnosed with HIV infection). [5]

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