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screening for HIV1

Indications: 1) CDC, USPSTF & ACP recommend routine screening for all persons age 13-65 years at least once [2,3,5,7,10] 2) USPSTF recommends screening adults ages 15-65 years for HIV1; younger adolescents & older adults who are at increased risk should also be screened 3) all pregnant women [7] 4) no censensus on interval of screening - one time screening suggested for the general population - at least annual screening for those at high risk of HIV1 infection [5,7] * high risk [2,7] 1) men who have sex with men - screening once every 3 months per CDC guidelines [15] - no benefit in screening men who have sex with men > once a year [15] 2) unprotected sex with multiple partners 3) injection drug users 4) exchange sex for money or drugs, or sex with those that do 5) sex partners: HIV-positive, bisexual men, or IV drug abuse 6) sexually transmitted disease 7) blood transfusion 1978-1985 8) request for HIV testing 9) STD clinic, correctional facility, homeless shelter, tuberculosis clinic, area of HIV prevalence > 1% Laboratory: 1) specific HIV-1 antibodies* are not detectable until 4-12 weeks after initial infection a) screening with ELISA* for antibody to HIV-1 (99% sensitivity & specificity) b) Oraquick Rapid HIV-1 Antibody Test available 2003 c) 4th generation HIV Ag/Ab Combo assay to detect both HIV1 p24 antigen* & antibodies to HIV1 & HIV2 FDA-approved 6/21/2010 [5,6] - nearly 100% sensitivity & specificity for chronic HIV1 infection [5] - false positives & negatives occur [5] - if positive HIV1/HIV2 Ab differentiation assay - if inconclusive, obtain quantitative HIV-1 RNA levels* d) confirmatory HIV1 Western blot for antibodies to virus-specific proteins - no longer used e) HIV1 p24 antigen is generally positive just after onset of symptoms or seroconversion, before development of antibodies* 2) quantitative HIV-1 RNA levels* - HIV1 RNA levels generally high early in HIV1 infection, but may be low in a subset of patients [11] - identification of acute HIV infection with quantitative HIV-1 RNA levels combined with aggressive early treatment may [1] - reduce severity of chronic infection - prevent transmission to sexual contacts 3) self-testing & home testing may be an option for patients with recurrent HIV risk or difficulty with testing in a clinical environment [10] 4) WHO recommends self-testing be offered as another method to test for HIV1 [14] * follow-up of negative HIV1 serology with HIV1 p24 antigen & HIV1 RNA improves detection in high risk populations [13] Notes: - 10-25% of people who test HIV-positive report no high-risk behaviors. - nearly 50% of newly diagnosed patients are late stage - infected individuals unaware of their HIV status transmit ~ 20,000 infections per year - screening may be cost-effective even in low-risk communities - screening rates low among high-school students [12]

Related

HIV1 serology; HIV1 antibody (HIV1 EIA/ELISA, immunoblot) human immunodeficiency virus-1 (HIV-1)

General

screening

References

  1. Journal Watch 25(11):88, 2005 Pilcher CD, Fiscus SA, Nguyen TQ, Foust E, Wolf L, Williams D, Ashby R, O'Dowd JO, McPherson JT, Stalzer B, Hightow L, Miller WC, Eron JJ Jr, Cohen MS, Leone PA. Detection of acute infections during HIV testing in North Carolina. N Engl J Med. 2005 May 5;352(18):1873-83. PMID: 15872202
  2. Journal Watch 25(16):131, 2005 US Preventive Services Task Force. Screening for HIV: recommendation statement. Ann Intern Med. 2005 Jul 5;143(1):32-7. No abstract available. PMID: 15998753 http://www.ahrq.gov/clinic/uspstf05/hiv/hivrs.htm Corresponding NGC guideline withdrawn Jan 2011 - Chou R, Huffman LH, Fu R, Smits AK, Korthuis PT; US Preventive Services Task Force. Screening for HIV: a review of the evidence for the U.S. Preventive Services Task Force. Ann Intern Med. 2005 Jul 5;143(1):55-73. Review. PMID: 15998755 http://www.ahrq.gov/clinic/uspstf05/hiv/hivreview.htm - Chou R, Smits AK, Huffman LH, Fu R, Korthuis PT; US Preventive Services Task Force. Prenatal screening for HIV: A review of the evidence for the U.S. Preventive Services Task Force. Ann Intern Med. 2005 Jul 5;143(1):38-54. Review. PMID: 15998754 http://www.ahrq.gov/clinic/uspstf05/hiv/hivprenat.htm
  3. Centers for Disease Control and Prevention; Workowski KA, Berman SM. Sexually transmitted diseases treatment guidelines, 2006. MMWR Recomm Rep. 2006 Aug 4;55(RR-11):1-94. Erratum in: MMWR Recomm Rep. 2006 Sep 15;55(36):997. PMID: 16888612
  4. Qaseem A et al. Screening for HIV in health care settings: A guidance statement from the American College of Physicians and HIV Medicine Association. Ann Intern Med. 2009 Jan 20;150(2):125-31. Epub 2008 Nov 30 PMID: 19047022 http://www.annals.org/content/150/2/125.full (corresponding NGC guideline withdrawn Jan 2015)
  5. Medical Knowledge Self Assessment Program (MKSAP) 14, 15, 16, 17, 19. American College of Physicians, Philadelphia 2006, 2009, 2012, 2015, 2021. - Medical Knowledge Self Assessment Program (MKSAP) 19 Board Basics. An Enhancement to MKSAP19. American College of Physicians, Philadelphia 2022
  6. FDA NEWS RELEASE: June 21, 2010 FDA Approves First Diagnostic Assay to detect both HIV Antigen and Antibodies http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm216375.htm
  7. US Preventive Services Task Force Screening for HIV: U.S. Preventive Services Task Force Recommendation Statement Draft Recommendation Statement http://www.uspreventiveservicestaskforce.org/draftrec.htm - Moyer VA et al Screening for HIV: U.S. Preventive Services Task Force Recommendation Statement. Ann Intern Med. Published online 30 April 2013 PMID: 23698354 http://annals.org/article.aspx?articleid=1682314 - Das M and Volberding P Bringing the End in Sight: Consensus Regarding HIV Screening Strategies. Ann Intern Med. Published online 30 April 2013 PMID: 23698261 http://annals.org/article.aspx?articleid=1682313
  8. Long EF, Brandeau ML, Owens DK. The cost-effectiveness and population outcomes of expanded HIV screening and antiretroviral treatment in the United States. Ann Intern Med. 2010 Dec 21;153(12):778-89 PMID: 21173412
  9. Lin X, Dietx PM, Rodriguez V et al Routine HIV Screening in Two Health-Care Settings - New York City and New Orleans, 2011-2013. MMWR. Weekly June 27, 2014 / 63(25);537-541 http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6325a2.htm
  10. Marrazzo JM et al HIV Prevention in Clinical Care Settings. 2014 Recommendations of the International Antiviral Society - USA Panel JAMA. 2014;312(4):390-409 PMID: 25038358 http://jama.jamanetwork.com/article.aspx?articleid=1889145
  11. Chen I et al. Low-level viremia early in HIV infection. J Acquir Immune Defic Syndr 2014 Dec 1; 67:405 PMID: 25140905
  12. Van Handel M et al. HIV testing among US high school students and young adults. Pediatrics 2016 Jan 18; PMID: 26787047
  13. Peters PJ, Westheimer E, Cohen S et al. Screening yield of HIV antigen/antibody combination and pooled HIV RNA testing for acute HIV infection in a high- prevalence population. JAMA 2016 Feb 16; 315:682 PMID: 26881371
  14. World Health Organization (WHO) WHO issues new guidance on HIV self-testing ahead of World AIDS Day. News release. Nov 29, 2016 http://www.who.int/mediacentre/news/releases/2016/world-aids-day/en/
  15. DiNenno EA, Prejean J, Irwin K, et al. Recommendations for HIV Screening of Gay, Bisexual, and Other Men Who Have Sex with Men - United States, 2017. MMWR Morb Mortal Wkly Rep 2017;66:830-832 https://www.cdc.gov/mmwr/volumes/66/wr/mm6631a3.htm
  16. US Preventive Services Task Force. Screening for HIV Infection: US Preventive Services Task Force recommendation statement. JAMA 2019 Jun 11; PMID: 31184701 https://jamanetwork.com/journals/jama/fullarticle/2735345 - Chou R, Dana T, Grusing S, Bougatsos C Screening for HIV infection in asymptomatic, nonpregnant adolescents and adults: Updated evidence report and systematic review for the US Preventive Services Task Force. JAMA 2019; Jun 11 PMID: 31184705 https://jamanetwork.com/journals/jama/fullarticle/2735508 - Havlir DV, Buchbinder SP. Ending AIDS in the United States - If not now, when? JAMA Intern Med 2019 Jun 11; PMID: 31184750 https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2735516
  17. Pitasi MA, Delaney KP, Brooks JT, DiNenno EA, Johnson SD, Prejean J. HIV Testing in 50 Local Jurisdictions Accounting for the Majority of New HIV Diagnoses and Seven States with Disproportionate Occurrence of HIV in Rural Areas, 2016-2017. MMWR Morb Mortal Wkly Rep 2019;68:561-567 https://www.cdc.gov/mmwr/volumes/68/wr/mm6825a2.htm