Amir Qaseem, MD, PhD, MHA; Vincenza Snow, MD; Paul Shekelle, MD; Robert Hopkins Jr., MD; Douglas K. Owens, MD, MS; Clinical Efficacy Assessment Subcommittee of the American College of Physicians
The American College of Physicians (ACP) developed this guidance statement to present the available evidence on screening for HIV in health care settings.
This guidance statement is derived from an appraisal of available guidelines on screening for HIV. Authors searched the National Guideline Clearinghouse to identify guidelines on screening for HIV in the United States and used the AGREE (Appraisal of Guidelines Research and Evaluation) instrument to evaluate guidelines from the U.S. Preventive Services Task Force and the Centers for Disease Control and Prevention.
ACP recommends that clinicians adopt routine screening for HIV and encourage patients to be tested.
ACP recommends that clinicians determine the need for repeat screening on an individual basis.
The U.S. Preventive Services Task Force (USPSTF) strongly recommends that clinicians screen for human immunodeficiency virus (HIV) all adolescents and adults at increased risk for HIV infection. (A recommendation).
The USPSTF makes no recommendation for or against routinely screening for HIV adolescents and adults who are not at increased risk for HIV infection. (C recommendation). [At the time this recommendation was made, a C recommendation from the USPSTF indicated that benefits and harms were such that the USPSTF made no recommendation for or against screening. This interpretation differs from the current use of C recommendation, which indicates a recommendation not to perform an intervention (16).]
The USPSTF recommends that clinicians screen all pregnant women for HIV. (A recommendation).
In all health-care settings, screening for HIV infection should be performed routinely for all patients aged 13 to 64 years. Health-care providers should initiate screening unless prevalence of undiagnosed HIV infection in their patients has been documented to be <0.1%. In the absence of existing data for HIV prevalence, health-care providers should initiate voluntary screening until they establish that the diagnostic yield is <1 per 1,000 patients screened, at which point such screening is no longer warranted.
All patients initiating treatment for TB should be screened routinely for HIV infection.
All patients seeking treatment for STDs, including all patients attending STD clinics, should be screened routinely for HIV during each visit for a new complaint, regardless of whether the patient is known or suspected to have specific behavior risks for HIV infection.
All pregnant women in the United States should be screened for HIV infection.
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New recommendations from ACP advocate HIV screening for all patients aged 13 and over, regardless of risk factors.
In support of World AIDS Day on December 1, ACP is reminding physicians to adopt routine screening for HIV and encourage patients to be tested. The recommendations are part of ACP's Screening for HIV in Health Care Settings guidance statement.
Qaseem A, Snow V, Shekelle P, Hopkins R, Owens DK, Clinical Efficacy Assessment Subcommittee of the American College of Physicians. Screening for HIV in Health Care Settings: A Guidance Statement From the American College of Physicians and HIV Medicine Association. Ann Intern Med. ;150:125–131. doi: 10.7326/0003-4819-150-2-200901200-00300
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Published: Ann Intern Med. 2009;150(2):125-131.
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