Definitions of the levels of evidence (I-IV) and grades of recommendation (A-C) are provided at the end of the "Major Recommendations" field.
When to Consider Testing for Human Immunodeficiency Virus (HIV)
- Any patient presenting to a Genitourinary Medicine (GUM) clinic should be offered a human immunodeficiency virus (HIV) test regardless of signs or symptoms of disease or risk factors for infection. III B
- It is recommended that patients have a baseline HIV test done at presentation and if necessary this be repeated at 3 months from the time of any risk activity. IIb B
- People exposed to the risk of HIV should not be fully reassured until at least 3 months have passed during which they remain seronegative (the window period). IV C
How to Test for HIV
Please refer to the Health Protection Agency (HPA) laboratory testing guidelines (as prepared by the HIV Laboratory Diagnoses Forum) for comprehensive details on the testing recommendations and methodology.
- Screening for HIV infection on venous blood is recommended. IIa B
- A properly validated confirmatory testing algorithm must be used to confirm HIV infection. IV C
- All patients whose first specimen indicates evidence of HIV infection must have their HIV status confirmed by tests on a second sample collected at another time. IV C
Pre-test Discussion, Informed Consent, and Confidentiality
- Testing should be undertaken only with the individual's specific informed verbal consent which should be documented. IV C
- Patients must be given a clear indication why testing is being considered. IV C
- Provision of a leaflet about HIV testing can provide much of the information needed prior to obtaining consent. III B
- Patients identified as being at high risk for HIV or those with particular concerns should be offered more in depth discussion or counseling in addition to a test. IV C
- Pre-test discussion (PTD) is appropriate for the majority of patients being tested with the aim of obtaining informed verbal consent. IV C
Methods to Increase the Uptake of Testing
- An information leaflet should be used to increase uptake of HIV antibody testing. III B
- All patients attending GUM clinics should be offered an HIV test on an "opt-out" basis. III
- HIV prompts in case notes. IV C
Methods of Giving Results
- It is essential that procedures are established for how the patient will receive the result, with particular attention to the means by which a positive result will be delivered. IV C
- Arrangements for communicating the results should be discussed and agreed with the patient at the time of testing. IV C
Definitions:
Levels of Evidence
Ia Evidence obtained from meta-analysis of randomized controlled trials
Ib Evidence obtained from at least one randomized controlled trial
IIa Evidence obtained from at least one well-designed controlled study without randomization
IIb Evidence obtained from at least one type of well-designed quasi-experimental study
III Evidence obtained from well-designed, non-experimental descriptive studies, such as comparative studies, correlation studies, and case control studies
IV Evidence obtained from expert committee reports or opinions and/or clinical experience of respected authorities
Recommendation Grades
A (Evidence levels Ia, Ib)
Requires at least one randomized controlled trial as part of the body of literature of overall good quality and consistency addressing the specific recommendation
B (Evidence levels IIa, IIb, III)
Requires availability of well conducted clinical studies but no randomized clinical trials on the topic of recommendation
C (Evidence level IV)
Requires evidence from expert committee reports or opinions and/or clinical experience of respected authorities. Indicates absence of directly applicable studies of good quality
