Screening for HIV Infection

Abstract

IMPORTANCE Approximately 1.1 million persons in the United States are currently living with HIV, and more than 700 000 persons have died of AIDS since the first cases were reported in 1981. There were approximately 38 300 new diagnoses of HIV infection in 2017. The estimated prevalence of HIV infection among persons 13 years and older in the United States is 0.4%, and data from the Centers for Disease Control and Prevention show a significant increase in HIV diagnoses starting at age 15 years. An estimated 8700 women living with HIV give birth each year in the United States. HIV can be transmitted from mother to child during pregnancy, labor, delivery, and breastfeeding. The incidence of perinatal HIV infection in the United States peaked in 1992 and has declined significantly following the implementation of routine prenatal HIV screening and the use of effective therapies and precautions to prevent mother-to-child transmission. OBJECTIVE To update the 2013 US Preventive Services Task Force (USPSTF) recommendation on screening for HIV infection in adolescents, adults, and pregnant women. EVIDENCE REVIEW The USPSTF reviewed the evidence on the benefits and harms of screening for HIV infection in nonpregnant adolescents and adults, the yield of screening for HIV infection at different intervals, the effects of initiating antiretroviral therapy (ART) at a higher vs lower CD4 cell count, and the longer-term harms associated with currently recommended ART regimens. The USPSTF also reviewed the evidence on the benefits (specifically, reduced risk of mother-to-child transmission of HIV infection) and harms of screening for HIV infection in pregnant persons, the yield of repeat screening for HIV at different intervals during pregnancy, the effectiveness of currently recommended ART regimens for reducing mother-to-child transmission of HIV infection, and the harms of ART during pregnancy to the mother and infant. FINDINGS The USPSTF found convincing evidence that currently recommended HIV tests are highly accurate in diagnosing HIV infection. The USPSTF found convincing evidence that identification and early treatment of HIV infection is of substantial benefit in reducing the risk of AIDS-related events or death. The USPSTF found convincing evidence that the use of ART is of substantial benefit in decreasing the risk of HIV transmission to uninfected sex partners. The USPSTF also found convincing evidence that identification and treatment of pregnant women living with HIV infection is of substantial benefit in reducing the rate of mother-to-child transmission. The USPSTF found adequate evidence that ART is associated with some harms, including neuropsychiatric, renal, and hepatic harms, and an increased risk of preterm birth in pregnant women. The USPSTF concludes with high certainty that the net benefit of screening for HIV infection in adolescents, adults, and pregnant women is substantial. CONCLUSIONS AND RECOMMENDATION The USPSTF recommends screening for HIV infection in adolescents and adults aged 15 to 65 years. You...

Social Media Use and HIV Screening Uptake Among Deaf Adults in the United States: Cross-Sectional Survey Study

“…The United States Department of Health and Human Services and the Centers for Disease Control and Prevention (CDC) prioritize HIV screening tests as a cornerstone of the national HIV prevention strategy [1,2]. The United States Preventive Services Task Force (USPSTF) recommends all adults 15-65 be screened for HIV at least once, with increased frequency of screening among men who have sex with men (MSM), injection drug users, and high-prevalence settings, including sexually transmitted disease (STD) clinics, homeless shelters, tuberculosis clinics, and correctional settings [3]. However, data from the Behavioral Risk Factor Surveillance System (BRFSS) shows that only 36.1% of all adults, and 46% of adults ages 18-64, have reported ever being tested for HIV [4,5].…”

Using a report card to increase HIV screening in a large primary care group practice

“…Recently, the USPSTF reaffirmed the importance of universal HIV screening in adolescents and adults in their recent guidelines. 3 Our quality improvement study shows that an intervention consisting of brief review of HIV screening guidelines and quarterly performancerelated report cards is associated with an increased rate of HIV screening and can help motivate PCPs to screen their patient population for HIV.…”

Reducing False-Positive Results With Fourth-Generation HIV Testing at a Veterans Affairs Medical Center

“…Current practice guidelines from the CDC and the US Preventive Services Task Force recommend universal screening of the population for HIV infection. 5,6 As the general population to be screened would normally have a low prevalence of HIV infection, the risk of a false positive on the initial screen False Positive Positive Results, % ■ Third generation ■ Fourth generation is significant. 17 Indeed, the CMJCVAMC experience has been that with the thirdgeneration screening assay, the number of false-positive test results outnumbered the number of true-positive test results.…”

“…[1][2][3] Given that there are both public health and clinical benefits in earlier diagnosis and treatment of patients with available antiretroviral therapies, universal screening with opt-out consent has been a standard of practice recommendation by the Centers of Disease Control and Prevention (CDC) since 2006; universal screening with opt-out consent also has been recommended by the US Preventative Task Force and has been widely implemented. [4][5][6][7] HIV SCREENING While HIV screening assays have evolved to be accurate with very high sensitivities and specificities, false-positive results are a significant issue both currently and historically. [8][9][10][11][12][13][14][15][16] The use of an HIV assay on a low prevalence population predictably reduces the positive predictive value (PPV) of even an otherwise accurate assay.…”