ROUTINE HIV SCREENING RECOMMENDATIONS

Based on the lack of progress in preventing the transmission of HIV infection and the fact that early recognition and treatment of HIV disease keeps people healthy longer, slows the progression to AIDS, and may prevent the unknown transmission of the virus to others, the Centers for Disease Control (CDC) issued revised guidelines for routine screening for HIV infection in September, 2006. The new guidelines state that all patients ages 13-64 who present in any health care setting should have a baseline HIV test done as a part of normal preventive medical care. Testing should be voluntary; patients should be informed about HIV testing and given the choice to opt-out of it.

Repeat screening for persons determined not to be at high risk should be done based on clinical judgment, making it essential that healthcare providers incorporate a thorough assessment of lifestyle and sexual practices into annual healthcare for all patients in order to identify risk factors. Healthcare providers should encourage patients and any new prospective sexual partners to have HIV testing done prior to initiating a sexual relationship.

Persons considered to be at high risk should be screened at least annually; these people include injection drug users and their sexual partners, sexual partners of someone who is known to be HIV positive, persons who exchange sex for drugs or money, any male who has had sex with another male, anyone treated for a sexually transmitted disease, and anyone who has had unprotected sex or sex with more than one person since their last test.

Pregnant women should be tested during their first prenatal visit and then re-tested during the third trimester of pregnancy. This testing is voluntary, but if the woman refuses testing and her HIV status is unknown at the time of labor, the newborn should be screened immediately after birth; in the United States, screening of the newborn can be done without parental consent.

It goes without saying, of course, that prevention counselling and discussion of safe sexual practices should also be a part of the routine care of all patients, regardless of whether or not they admit to being sexually active. The hope is that this more aggressive approach to prevention of new HIV infections and early diagnosis will positively impact the transmission of HIV, thus decreasing the number of new infections.