II. History
III. Epidemiology
- Increasing risk in age under 20 years and rural communities
IV. Indications: Screening (USPTF, 2013)
- Screen all patients ages 15 to 65 years (unless patient opts out, refuses)
- Screen up to annually depending on risk
- CDC recommends starting screening at age 13 years
- High risk indications (more frequent screening, at least annually, and regardless of age)
- See risk factors below
- Other indications
- New diagnosis of Tuberculosis at onset of treatment
- All patients presenting with possible Sexually Transmitted Disease related concerns
- All pregnant patients with Prenatal Labs (and again in third trimester in high risk patients and communities)
V. Risk Factors
- Sexual contact (primary mode of transmission)
- Men who have Sex with Men (most common risk)
- High risk heterosexual contact
- Intravenous Drug Abuse (Injection Drug Abuse)
- Unprotected vaginal or anal intercourse
- High-risk sexual partners or behaviors
- Sex Workers
- History of Sexually Transmitted Disease
VI. Background: Medicolegal recommendations by CDC
- Routine HIV Screening falls under consent for general medical care and should not require additional consent
- Opt-out screening is typical policy where patient specifically declines HIV Screening
- In contrast, opt-in only screening misses 25% of HIV cases
- Walensky (2002) Arch Intern Med 162(8): 887-92 [PubMed]