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Last Updated: 4/2/2015  

Screening for HIV

  • Perform HIV screening in all persons between the ages of 15 and 65.

  • Routinely offer opt-out HIV screening to all pregnant women.

  • Screen all newborns for HIV infection if the mother is known to be HIV positive, and consider recommending newborn screening if the serostatus of the mother is unknown during labor or at birth.

  • Perform annual HIV screening in high-risk persons including those with partners with known HIV infection, those undergoing dialysis, and those who are in correctional facilities, STD clinics, homeless shelters, clinics serving MSM, drug or alcohol prevention and treatment programs, acute care hospitals, emergency rooms, and other clinical settings where the seroprevalence is greater than 1% or the AIDS diagnosis rate is 1 per 1000 discharges or higher.

  • Perform HIV screening with a fourth-generation combination immunoassay that detects HIV-1 and HIV-2 antibodies and HIV p24 antigen.

    • A positive result should be confirmed by HIV1/HIV2 antibody differentiation immunoassay to identify the type of HIV.

    • If acute HIV is suspected or if differentiation immunoassay is indeterminate or negative, obtain HIV RNA (viral load).

  • Consider simple/rapid HIV screening antibody tests where rapid results are required, such as in the setting of occupational exposure from a source with unknown HIV serostatus, at the time of delivery when the serostatus of the pregnant mother is unknown, or in settings in which patient-return rates are poor.

  • Confirm all results from simple/rapid HIV screening tests.

  • Consider the use of in-home testing kits and home collection kits in populations who may otherwise be reluctant to be screened.

  • Retest individuals who have been exposed to HIV who are initially HIV seronegative at 3 and 6 months.

  • Retest pregnant women who continue to practice high-risk behaviors during their third trimesters if their initial HIV screens were negative.

  • When considering HIV screening, recognize that knowledge of HIV status and counseling regarding HIV risk reduction reduces high-risk behaviors.

  • Recognize that the rate of HIV screening is improved when testing is offered anonymously or via opt-out screening.

DOI: 10.7326/s377
The information included herein should never be used as a substitute for clinical judgment and does not represent an official position of ACP.
Author(s) and Disclosures:
Deborah Yamamura, MD has nothing to disclose. Erin Ney, MD, FACP has nothing to disclose.

One or more of the present or past ACP Smart Medicine physician editors worked on this module and had nothing to disclose: Davoren Chick, MD, FACP; Deborah Korenstein, MD, FACP; Marjorie Lazoff, MD, FACP; Richard Lynn, MD, FACP.

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