Screening

Tuberculosis (TB)

All people living with HIV (PLWH) should be tested for latent TB infection (LTBI) regardless of their risk for TB.[1][191][192]​​​ Annual testing for latent infection is recommended for PLWH who are, or remain, at high risk for repeated or on-going exposure to individuals with active TB.[1]

People with negative diagnostic tests for LTBI, advanced HIV infection (CD4 count <200 cells/microlitre), and without any indications for initiating empirical LTBI treatment, should be re-tested for LTBI once they start antiretroviral treatment and attain a CD4 count of 200 cells/microlitre or greater.[1]

Toxoplasmosis

All PLWH should be tested for prior exposure to Toxoplasma gondii by measuring anti-Toxoplasma immunoglobulin G (IgG) upon initiation of care.[1]

If results are positive, primary prophylaxis should be provided when CD4 count is below 100 cells/microlitre.[1] If results are negative, the patient should be counselled on avoidance of infection (avoidance of under-cooked meat and avoidance or proper handling of cat faeces).[1]

Cryptococcosis

Routine testing for serum cryptococcal antigen in people newly diagnosed with HIV and no overt clinical signs of meningitis may be considered for patients whose CD4 counts are ≤100 cells/microlitre, and particularly in those with CD4 counts ≤50 cells/microlitre. A positive test should prompt cerebrospinal fluid evaluation for meningitis.[1][70]

Coccidioidomycosis

Asymptomatic patients who reside in areas where coccidioidomycosis is endemic and have a CD4 count ≤250 cells/microlitre should have annual IgM and IgG serological screening for Coccidioides species.[193]

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