All Adults, Adolescents, And Pregnant Women Should Be Screened For HIV

As adapted from the Annals of Internal Medicine (April 2013)

New recommendations from the United States Preventive Services Task Force (USPSTF) urge physicians to screen all adults and adolescents aged 15 – 65 for HIV. In addition, all pregnant women should receive screening, even those who are in labor but have not yet been screened. Rapid screening tests and conventional tests are considered equally accurate for screening.

In 2005, the Task Force recommended that doctors offer HIV screening to all adults and adolescents at increased risk for infection (men or women having a blood transfusion from 1978 to 1985; men or women having unprotected sex with multiple partners; men who have had sex with men after 1975; men and women who have exchanged sex for money or drugs, or who have sex partners who have done so; men or women whose past or present sex partners were HIV-infected, bisexual, or intravenous drug users; and men or women with other sexually transmitted diseases).

For patients with no risk factors, the Task Force recommended that doctors discuss the benefits and harms of testing. For pregnant women, the Task Force recommended HIV screening at their initial prenatal visit unless they specifically decline testing. Since then, the Task Force reviewed the literature for new studies, specifically those focusing on key research gaps identified in the earlier evidence review. A significant difference since 2005 is that researchers reviewed the data to assess the benefits and harms associated with universal screening. The research showed that screening for HIV infection improves clinical outcomes versus no screening, and is associated with very little risk for harm. In contrast, targeted screening misses a substantial number of HIV cases due to undisclosed or unknown risk factors. HIV screening in pregnant women dramatically reduces rates of mother-to-child transmission.