US panel recommends HIV screening for everyone aged 15 to 64 years

BMJ 2013; 346 doi: (Published 03 May 2013) Cite this as: BMJ 2013;346:f2874
  1. Michael McCarthy
  1. 1Seattle

Everyone aged 15 to 64 years should be screened for HIV infection, according to new recommendations from the United States Preventive Services Task Force (USPSTF).1

Younger adolescents and older adults who have risk factors for HIV infection should also be screened, the task force said, as should all pregnant women, including those who present in labor and have not been tested and whose HIV status is unknown.

“The overall benefits of screening for HIV infection in adolescents, adults, and pregnant women are substantial,” the task force said.

USPSTF consists of independent experts in prevention and primary care appointed by the US Agency for Healthcare Research and Quality to evaluate the effectiveness of clinical preventive services. The task force’s new recommendations were published online in the Annals of Internal Medicine on April 30.

Since the first cases of AIDS in the US were reported in 1981, more than 1.1 million people in the country have been diagnosed with the disease, and nearly 595 000 have died from it.

Currently, an estimated 1.2 million people in the US are infected with HIV, of whom 20-25% are unaware that they carry the virus.

As for how often people should be tested for the virus, the task force found a “paucity of evidence” to support specific screening intervals.

“A reasonable approach may be to rescreen groups at very high risk . . . at least annually and individuals at increased risk at somewhat longer intervals (for example, three to five years),” the task force said.

Routine rescreening may not be necessary for individuals who have not engaged in activity that put them at increased risk since they were tested and found to be HIV negative, the task force said, but “women screened during a previous pregnancy should be rescreened in subsequent pregnancies.”

In an editorial accompanying the new recommendations, Moupali Das and Paul Volberding from the University of California, San Francisco, commented that the new USPSTF recommendations now align more closely with those of the US Centers for Disease Control and Prevention (CDC).2

But unlike the CDC guidelines, Das and Volberding noted, the new USPSTF recommendations “devote considerable effort” to the question of when antiretroviral therapy should be initiated.

“This is surprising,” they wrote, “as HIV clinicians now widely accept universal treatment for personal health and in light of data that persons who become aware of their infection reduce risk behaviors as outlined in the previous CDC guidelines.”

Das and Volberding also questioned the screening intervals suggested by both the USPSTF and the CDC for people engaging in high risk behaviors.

“Some advocate for more frequent testing, even every three months, to detect very recent infections, because newly infected persons are known to be substantial contributors to elevated community HIV incidence rates and may personally benefit from immediate antiretroviral therapy,” they wrote.


Cite this as: BMJ 2013;346:f2874