Screening for Human Immunodeficiency Virus Infection

U.S. Preventive Services Task Force

Release Date: July 2005

Summary of Recommendation / Supporting Documents

Summary of Recommendations

• The U.S. Preventive Services Task Force (USPSTF) strongly recommends that clinicians screen for human immunodeficiency virus (HIV) all adolescents and adults at increased risk for HIV infection (go to Clinical Considerations for discussion of risk factors).

  Rating: "A" recommendation.

  Rationale: The USPSTF found good evidence that both standard and U.S. Food and Drug Administration (FDA)-approved rapid screening tests accurately detect HIV infection. The USPSTF also found good evidence that appropriately timed interventions, particularly highly active antiretroviral therapy (HAART), lead to improved health outcomes for many of those screened, including reduced risk for clinical progression and reduced mortality. Since false-positive test results are rare, harms associated with HIV screening are minimal. Potential harms of true-positive test results include increased anxiety, labeling, and effects on close relationships. Most adverse events associated with HAART, including metabolic disturbances associated with an increased risk for cardiovascular events, may be ameliorated by changes in regimen or appropriate treatment. The USPSTF concluded that the benefits of screening individuals at increased risk substantially outweigh potential harms.

• The USPSTF makes no recommendation for or against routinely screening for HIV adolescents and adults who are not at increased risk for HIV infection (go to Clinical Considerations for discussion of risk factors).

  Rating: "C" recommendation.

  Rationale: The USPSTF found fair evidence that screening adolescents and adults not known to be at increased risk for HIV can detect additional individuals with HIV, and good evidence that appropriately timed interventions, especially HAART, lead to improved health outcomes for some of these individuals. However, the yield of screening persons without risk factors would be low, and potential harms associated with screening have been noted (above). The USPSTF concluded that the benefit of screening adolescents and adults without risk factors for HIV is too small relative to potential harms to justify a general recommendation.

Amendment April 2007 In September 2006, the Centers for Disease Control and Prevention (CDC) published revised guidelines recommending that all individuals between 13 and 64 yeas of age be screened for HIV regardless of recognized risk factors (1). In making this recommendation, the CDC considered a number of factors, including research published subsequent to the completion of the systematic evidence report on which the 2005 HIV screening recommendations of the USPSTF are based. In November 2006, the USPSTF assessed this new research using established methods for evaluating the quality and strength of the evidence (2). Based on this review (3), the USPSTF confirmed its "C" recommendation for screening non-pregnant adolescents and adults who are not at increased risk for HIV infection. Centers for Disease Control and Prevention. Revised recommendations for HIV testing of adults, adolescents, and pregnant women in health-care settings. MMWR 2006;55(RR-14):1-17 Harris RP, Helfand M, Woolf SH, et al. Current methods of the third U.S. Preventive Services Task Force. Am J Prev Med 2001;20(3S):21-35 Chou R, Huffman L. Screening for human immunodeficiency virus: focused update of 2005 systematic evidence review. April 2007.

 

• The USPSTF recommends that clinicians screen all pregnant women for HIV.

  Rating: "A" recommendation.

  Rationale: The USPSTF found good evidence that both standard and FDA-approved rapid screening tests accurately detect HIV infection in pregnant women and fair evidence that introduction of universal prenatal counseling and voluntary testing increases the proportion of HIV-infected women who are diagnosed and are treated before delivery. There is good evidence that 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. There is no evidence of an increase in fetal anomalies or other fetal harm associated with currently recommended antiretroviral regimens (with the exception of 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 potential harms.

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Supporting Documents

Screening for HIV, July 2005
Recommendation Statement (PDF File, 153 KB; PDF Help)
Screening for HIV in Adolescents and Adults: Review of the Evidence (PDF File, 876 KB; PDF Help)
Screening for HIV in Adolescents and Adults: Evidence Synthesis (PDF File Download, 1.6 MB; PDF Help)
       Focused Update, April 2007 (PDF File, 190 KB; PDF Help)
Prenatal Screening for HIV: Review of the Evidence (PDF File, 763 KB; PDF Help)
Screening for HIV in Pregnant Women: Evidence Synthesis (PDF File Download)

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Current as of April 2007

Internet Citation:

Human Immunodeficiency Virus Infection, Topic Page. April 2007. U.S. Preventive Services Task Force. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/clinic/uspstf/uspshivi.htm