CLINICAL SUMMARY OF U.S. PREVENTIVE SERVICES TASK FORCE RECOMMENDATION

PopulationAdolescents and adults at increased risk for HIV infectionAdolescents and adults who are not at increased risk for HIV infectionPregnant women
RecommendationScreen for HIV.
Grade: A
No recommendation for or against screening.
Grade: C
Screen for HIV.
Grade: A
Risk AssessmentA person is considered at increased risk for HIV infection if he/she reports one or more individual risk factors or receives health care in a high-prevalence or high-risk clinical setting. High-risk settings include sexually transmitted infection (STI) clinics, correctional facilities, homeless shelters, tuberculosis clinics, clinics serving men who have sex with men, and adolescent health clinics with a high prevalence of STIs. High-prevalence settings are defined as those known to have a 1% or greater prevalence of infection among the patient population being served.
Individual risk for HIV infection is assessed through a careful patient history. Individuals at increased risk include:
  • Men who have had sex with men after 1975
  • Persons having unprotected sex with multiple partners
  • Persons who are past or present injection drug users
  • Persons who exchange sex for money or drugs or have sex partners who do
  • Persons whose past or present sex partners are HIV-infected, bisexual, or injection drug users
  • Persons being treated for sexually transmitted diseases
  • Persons with a history of blood transfusion between 1978 and 1985
  • Persons who request an HIV test despite reporting no risk factors (since this group is likely to include individuals not willing to disclose high risk behaviors)
Screening TestsThe standard test for diagnosing HIV infection is the repeatedly reactive enzyme immunoassay, followed by confirmatory western blot or immunofluorescent assay. Rapid HIV antibody testing is also highly accurate, can be performed in 10 to 30 minutes, and when offered at the point of care, is useful for screening high-risk patients who do not receive regular medical care (e.g., those seen in emergency departments), as well as women with unknown HIV status who present in active labor.
InterventionsEvidence supports the benefit of identifying and treating asymptomatic individuals in immunologically advanced stages of HIV disease (i.e., CD4 cell counts <200 cells/mm3) with highly active antiretroviral therapy (HAART). Appropriate prophylaxis and immunization against certain opportunistic infections have also been shown to be effective interventions for these individuals. Use of HAART can be considered for asymptomatic individuals who are in an earlier stage of disease but at high risk for disease progression (i.e., CD4 cell count <350 cells/mm3 or viral load >100,000 copies/mL.
Recommended regimens of HAART are acceptable to pregnant women and lead to significantly reduced rates of mother-to-child transmission. Early detection of maternal HIV infection also allows for discussion of elective cesarean section and avoidance of breastfeeding, both of which are associated with lower HIV transmission rates.
Balance of Benefits and HarmsThe USPSTF found good evidence that screening accurately detects HIV infection and that appropriately timed interventions, particularly HAART, lead to improved health outcomes for many of those screened. False-positive test results are rare, and most adverse events associated with treatment, including metabolic disturbances with an increased risk for cardiovascular events, may be ameliorated by changes in regimen.
The USPSTF concluded that the benefits of screening individuals at increased risk substantially outweigh potential harms.
The USPSTF found fair evidence that screening individuals who are not known to be at increased risk for HIV can detect additional individuals with HIV, and good evidence that appropriately timed interventions lead to improved health outcomes for some of these individuals. However, the yield of screening persons without risk factors would be low, and there are potential harms of screening.
The USPSTF concluded that the benefit of screening individuals without risk factors for HIV is too small relative to the potential harms to justify a general recommendation.
The USPSTF found good evidence that screening accurately detects HIV infection in pregnant women, and fair evidence that prenatal counseling and voluntary testing increases the proportion of HIV-infected women who are diagnosed and treated before delivery. There is no evidence of fetal anomalies or other clinically important fetal harm associated with currently recommended antiretroviral regimens (except for efavirenz). Serious or fatal maternal events are rare using currently recommended combination therapies.
The USPSTF concluded that the benefits of screening all pregnant women substantially outweigh the potential harms.
Other Relevant USPSTF RecommendationsThe USPSTF has made recommendations on screening and counseling for other sexually transmitted infections. These recommendations are available at http://www‚Äč.uspreventiveservicestaskforce.org/.

From: Recommendations for Adults

Cover of The Guide to Clinical Preventive Services 2012
The Guide to Clinical Preventive Services 2012: Recommendations of the U.S. Preventive Services Task Force.

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