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USPSTF Recommends Screening for HIV in People at Increased Risk

The U.S. Preventive Services Task Force (USPSTF) has been releasing new and updated guidelines periodically (guidelines homepage).

The USPSTF concludes each of its guidelines with a recommendation, graded as follows:

A — The intervention is strongly recommended.

B — The intervention is recommended.

C — The USPSTF makes no recommendation for or against the intervention.

D — The intervention is not routinely recommended.

I — Evidence is insufficient to recommend for or against the intervention.

The USPSTF recommends that clinicians offer screening for HIV infection to all adolescents and adults at increased risk and to all pregnant women. (All pregnant women are included, even those not otherwise at increased risk, because antiretroviral treatment, formula feeding, and elective cesarean delivery reduce vertical transmission rates from mothers to neonates.) Groups at increased risk are defined as:

• men who have sex with men
  
• people who engage in unprotected sex with multiple partners
  
• injection drug users
  
• people who exchange sex for money or drugs, or have sex with those who do
  
• people whose sex partners are HIV-positive, bisexual men, or injection drug users
  
• people being treated for sexually transmitted diseases (STDs)
  
• people who received blood transfusions between 1978 and 1985
  
• people requesting HIV testing
  
• patients in STD clinics, correctional facilities, homeless shelters, tuberculosis clinics, clinics for men who have sex with men, adolescent clinics in areas with high prevalences of STDs, or any other setting where HIV prevalence is 1%
  

Recommendation: A

The USPSTF makes no recommendation for or against routine screening of adolescents and adults who aren’t at increased risk for HIV infection. The task force noted that screening would detect more cases and that treatment is effective. But it also noted that screening those at increased risk and in higher-prevalence clinical settings would result in very few missed cases and that screening those who aren’t at increased risk would have a low yield. Further, risk for harm (e.g., anxiety, stigmatization) is not zero. In addition, the task force identified no studies in which clinical outcomes were compared in low-risk people who were screened or not screened for HIV infections. In a low-prevalence population, 1210 to 13,800 people would have to be screened during 3 years to prevent 1 case of HIV clinical progression or death. Recommendation: C

Comment: Since 1996, the USPSTF has recommended that clinicians assess risk factors and screen patients who are at increased risk for HIV infection. The current updated recommendation includes screening people who are seen in high-prevalence clinical settings and all pregnant women. Although one might argue that universal screening makes sense from a public health perspective, the USPSTF takes stock of evidence that would be relevant from the perspective of an individual, asymptomatic, low-risk patient when it makes no recommendation for or against screening those who aren’t at increased risk. At the time of publication, the full text of the recommendation statement, the evidence review on risk-based screening, and the evidence review on prenatal screening was available free of charge.

— Richard Saitz, MD, MPH, FACP, FASAM

Published in Journal Watch General Medicine July 29, 2005

Citation(s):

U.S. Preventive Services Task Force. Screening for HIV: Recommendation statement. Ann Intern Med 2005 Jul 5; 143:32-7.

• Original article (Subscription may be required)
• Medline abstract (Free)

Chou R et al. Screening for HIV: A review of the evidence for the U.S. Preventive Services Task Force. Ann Intern Med 2005 Jul 5; 143:55-73.

• Original article (Subscription may be required)
• Medline abstract (Free)

Chou R et al. Prenatal screening for HIV: A review of the evidence for the U.S. Preventive Services Task Force. Ann Intern Med 2005 Jul 5; 143:38-54.

• Original article (Subscription may be required)
• Medline abstract (Free)