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JAMA Patient Page
June 11, 2019

Who Should Be Screened for HIV Infection?

JAMA. 2019;321(23):2376. doi:10.1001/jama.2019.6919

The US Preventive Services Task Force (USPSTF) has recently published recommendations on screening for HIV infection in adults and adolescents.

What Is HIV?

Human immunodeficiency virus (HIV) is a virus that weakens the immune system and decreases the body’s ability to fight infections. It is mainly sexually transmitted but can also be spread via blood (sharing needles or syringes) or from mother to child during pregnancy, birth, or breastfeeding. It is estimated that nearly 15% of people in the United States who have HIV do not know that they have it, which increases the chance of spreading HIV infection to others. Infection with HIV produces a wide range of symptoms ranging from flu-like symptoms with initial infection to no symptoms in the early years following infection and to severe infections affecting all organs in the body in the late stage, when the immune system is at its weakest (progression to AIDS). Effective medications are available, but there is no cure for HIV infection, which is lifelong. Therefore, prevention of HIV infection is very important.

What Tests Are Used to Screen for HIV Infection?

HIV infection is detected by blood testing. A common screening test is the antigen/antibody test using blood drawn from a vein; results from this test become available in 1 to 2 days. Positive antigen/antibody tests are confirmed by viral load testing. Rapid HIV tests are also available. These are slightly less accurate than antigen/antibody tests but can be performed using saliva or capillary blood (from a fingerstick), and results are available in less than 20 minutes.

What Is the Patient Population Under Consideration for Screening for HIV Infection?

This USPSTF recommendation applies to adults and adolescents aged 15 to 65 years as well as all pregnant women. It also applies to people younger than 15 years or older than 65 years who have risk factors for HIV infection (eg, unprotected sex with new partners, injection drug use).

What Are the Potential Benefits and Harms of Screening for HIV Infection?

The benefit of screening for HIV infection is earlier treatment with antiviral medications. There is evidence that early detection and treatment decreases the chance of HIV transmission and the rate of AIDS-related illness or death. There is also evidence that treating pregnant women with HIV infection is very effective at preventing mother-to-child transmission. Potential harms of screening include side effects from antiviral medications, which are common but minor compared with potential benefits.

How Strong Is the Recommendation to Screen for HIV Infection?

Given the current evidence, the USPSTF concludes with high certainty that the benefits of screening for HIV infection substantially outweigh the potential harms. The optimal interval for screening is currently not well established.

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Article Information

Published Online: June 11, 2019. doi:10.1001/jama.2019.6919

Source: US Preventive Services Task Force. Screening for HIV infection: US Preventive Services Task Force recommendation statement [published online June 11, 2019]. JAMA. doi:10.1001/jama.2019.6587