HIV Screening and Treatment Guidelines

HIV Screening Recommendations

The Centers for Disease Control and Prevention recommends that all persons aged 15-65 years should be screened for HIV at least once in their lifetime using routine opt-out screening in primary care settings, emergency departments, and for all pregnant women 1
The American College of Physicians recommends that adolescents and adults aged 15-65 years should undergo routine HIV screening regardless of perceived risk, with younger adolescents and older adults screened if at increased risk 1
The Infectious Diseases Society of America recommends that all pregnant persons must be screened for HIV, including those who present in labor or delivery with unknown HIV status 1

The Centers for Disease Control and Prevention recommends that screening should use fourth-generation HIV antigen/antibody combination assays that detect both HIV antibodies and p24 antigen, allowing detection of acute infection approximately 2 weeks earlier than antibody-only tests 1
The American College of Physicians recommends that if initial fourth-generation assay is reactive, perform HIV-1/HIV-2 antibody differentiation immunoassay 1

The Infectious Diseases Society of America recommends that before starting antiretroviral therapy (ART), patients should undergo comprehensive baseline testing, including HIV RNA (viral load) level, CD4 cell count with percentage, genotypic resistance testing, HLA-B*5701 testing, and tropism testing 1, 5

The World Health Organization recommends that all persons diagnosed with HIV should be offered ART immediately upon diagnosis, regardless of CD4 count or viral load 1, 5
The International AIDS Society recommends that preferred regimens include an integrase strand transfer inhibitor (INSTI) plus two nucleoside reverse transcriptase inhibitors (NRTIs) 5

The Centers for Disease Control and Prevention recommends that viral load should be measured 4-6 weeks after starting or changing ART regimen to assess initial response 1, 5
The American College of Physicians recommends that CD4 counts should be measured every 6 months until counts are >250/μL for at least 1 year with concomitant viral suppression 1, 5

The Infectious Diseases Society of America recommends that if adherence appears sufficient but viral suppression is not achieved, genotypic resistance testing is recommended 5

The World Health Organization recommends that systematic monitoring of ART adherence is essential for successful treatment 5
The International AIDS Society recommends that self-reported adherence should be obtained routinely from all patients, and pharmacy refill data are recommended for objective adherence monitoring 5

The Centers for Disease Control and Prevention recommends that each visit of an HIV-infected person should include screening for high-risk behavior to assess transmission risk to others 4
The American College of Physicians recommends that PrEP should be offered to HIV-negative persons with ongoing high risk for HIV infection 1, 5

The Infectious Diseases Society of America recommends that behavioral and psychosocial services are integral to HIV care and should be available on-site or through referral 1, 2
The International AIDS Society recommends that routine screening and treatment for depression is recommended for all HIV-infected patients 1

The Centers for Disease Control and Prevention recommends that persons with HIV and altered immune function are at increased risk for infections requiring preventive measures, including tuberculosis, pneumocystis jirovecii pneumonia (PCP), and bacterial pneumonia 3