Screening for HIV Infection in Health Care Settings: A Guidance Statement from the American College of Physicians and HIV Medicine Association

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The full report is titled "Screening for HIV in Health Care Settings: A Guidance Statement from the American College of Physicians and HIV Medicine Association." It is in the 20 January 2009 issue of Annals of Internal Medicine (volume 150). The authors are A. Qaseem, V. Snow, P. Shekelle, R. Hopkins Jr., and D.K. Owens, for the Clinical Efficacy Assessment Subcommittee of the American College of Physicians.

Who developed these guidelines?

The American College of Physicians (ACP) developed these recommendations. Members of the ACP are internists, specialists in the care of adults. The recommendations were endorsed by the HIV Medicine Association.

What is the problem and what is known about it so far?

HIV is a virus that causes AIDS, an illness that interferes with the body's ability to fight infection and some types of cancer. Treatments containing multiple drugs have improved outcomes for HIV-infected patients. HIV passes from person to person through contact with blood or other body fluids that contain the virus. People can have HIV infection for years before becoming sick.

Testing for HIV infection involves a blood test. Screening means testing people who feel well rather than waiting until symptoms develop. Different organizations have different recommendations for HIV screening. The ACP wanted to review the recommendations of other organizations and recent research to guide doctors in light of differing recommendations from other organizations.

How did the ACP develop these recommendations?

The authors searched the National Guideline Clearinghouse to identify guidelines on screening for HIV infection in the United States. The authors then evaluated the guidelines by using a standard instrument that asks 23 questions related to the quality of the guideline. The authors also reviewed recent published research about the benefits, harms, and costs of HIV screening.

What did the authors find?

The authors identified 2 guidelines about screening for HIV infection. In 2005 (and updated in 2007), the U.S. Preventive Services Task Force (USPSTF) recommended that doctors routinely ask patients about HIV risk factors, patients tell their doctors if they have a risk factor, and doctors recommend HIV testing for all adolescents and adults with a risk factor. The USPSTF also recommends screening all pregnant women. In 2006, the Centers for Disease Control and Prevention (CDC) recommended routine screening for all patients 13 to 64 years of age unless they lived in an area where HIV infection occurs in fewer than 1 of every 1000 residents. The CDC also recommends screening pregnant women and patients with tuberculosis or sexually transmitted diseases.

Research shows that early diagnosis and treatment of HIV infection extends life and also decreases the spread of HIV infection to other people. Research also suggests that programs that screen only high-risk patients fail to identify substantial numbers of people with early HIV infection. Studies of screening in pregnant women suggest that acceptance of screening is high. Studies also suggest that the benefits of screening are worth the costs, especially if screening reduces the spread of HIV infection.

What does the ACP suggest that patients and doctors do?

The ACP recommends that doctors routinely encourage HIV screening for all patients older than 13 years regardless of whether HIV risk factors are present.

The ACP recommends that doctors determine the need for repeated screening on the basis of the individual patient's risk for infection.

What are the cautions related to these recommendations?

Recommendations may change as new studies become available. The authors did not examine guidelines from countries other than the United States.