Should primary care clinicians screen for HIV infection in adolescents and adults, including pregnant women?

In this updated 2019 review, the U.S. Preventive Services Task Force (USPSTF) recommends that clinicians screen for HIV infection in adolescents and adults aged 15 to 65 years. This recommendation also includes adolescents younger than 15 years and adults older than 65 years who are at increased risk of infection, and all pregnant women, including those who present in labor or at delivery with an unknown HIV status (A recommendation). Persons at increased risk of HIV infection include men who have sex with men, and heterosexually active women and men who have at least one of the following characteristics: having a sex partner with known HIV, inconsistently using condoms during sex with a high-risk partner whose HIV status is unknown, or having sexually transmitted syphilis or gonorrhea within the past 6 months. Other high-risk individuals include persons who inject drugs and share drug injection equipment, and persons who engage in sex for money, drugs, or housing, including commercial sex workers or persons trafficked for sex work. These recommendations are essentially unchanged from the 2013 USPSTF recommendations. (LOE = 2c)

US Preventive Services Task Force, Owens DK, Davidson KW, et al. Screening for HIV infection. US Preventive Services Task Force recommendation statement. JAMA 2019;321(23):2326-2336.  [PMID:31184701]

Practice guideline

Government

Population-based

The USPSTF found that currently available HIV tests are highly accurate in diagnosing HIV infection. Although no studies were found that direct evaluating HIV screening versus no screening, 2 recent randomized trials reported that initiating antiretroviral therapy (ART) to asymptomatic individuals with CD4 cell counts greater than 500/mm3 reduced the risk HIV transmission and AIDS-associated mortality and morbidity. The task force found additional evidence that ART is highly effective at reducing the risk of mother-to-child transmission. The task force found no evidence to determine an optimal screening interval for nonpregnant patients or an optimal repeat screening interval during pregnancy Several recent studies reported on potential long-term harms of ART, but the task force concluded the results are inconsistent and further studies are needed. The Centers for Disease Control and Prevention (CDC), American College of Obstetricians and Gynecologists (ACOG), American College of Physicians, American Academy of Pediatrics, and American Academy of Family Physicians recommend routine screening for HIV infection. The CDC and ACOG recommend screening all pregnant women with repeat testing during the third trimester in women with risk factors and those living in or receiving care in high-incidence settings.