Screening
HIV screening
HIV testing is indicated:
When someone requests a test
When someone has a condition that indicates possible HIV
When someone believes that they are at risk of infection through unprotected sexual activity, needle prick injury or unsafe injection drug use
In all pregnant women
For public health and infection control (e.g., blood product safety)
When required by, for example, life insurers.
The US Centers for Disease Control and Prevention (CDC) recommends that all people 13-64 years of age be routinely tested for HIV, including annual screening for those determined to be at high risk.[109] More frequent screening can be considered for some asymptomatic men who have sex with men, based on individual risk factors, local epidemiology, and local policies.[110] Despite this recommendation, 37% of transgender men and women have never been tested for HIV.[111] Also, national surveillance data indicate that people who are at high risk of HIV are not being retested as often as the CDC guidelines recommend.[112]
The US Preventive Services Task Force recommends screening in all people aged 15 to 65 years, younger and older adolescents and adults at increased risk of HIV, and all pregnant women (including those who present in labour or at delivery whose HIV status is unknown). Repeat screening is considered reasonable in patients at higher risk of HIV, but there is insufficient evidence to recommend specific screening intervals.[113]
The American Society of Obstetricians and Gynecologists (ACOG) recommends routine HIV screening for females aged 13-64 years (at least once in their lifetime and annually thereafter based on risk), and older women after age 64 years if there is an ongoing risk of HIV.[114]
HIV testing is key to both effective primary and secondary preventive strategies and critical for implementation of a management plan for those who test positive. Testing has been shown to reduce risk behaviour in people testing positive. Regular follow-up after positive test enables timely commencement of various prophylactic treatments to prevent opportunistic infections. In addition, timely testing before onset of advanced HIV enables adequate preparation for antiretroviral therapy (ART).
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