In 2005, the United States Preventive Services Task Force recommended that doctors offer HIV screening to all adults and adolescents at increased risk for infection.
Risk factors for HIV that were included in the 2005 recommendation include men or women having a blood transfusion from 1978 to 1985; men or women having unprotected sex with multiple partners; men who have had sex with men after 1975; men and women who have exchanged sex for money or drugs, or who have sex partners who have done so; men or women whose past or present sex partners were HIV-infected, bisexual, or intravenous drug users; and men or women with other sexually transmitted diseases.
For patients with no risk factors, the Task Force recommended that doctors discuss the benefits and harms of testing. Since then, the Task Force reviewed the literature for new studies, specifically those focusing on key research gaps identified in the earlier review. A key difference since 2005 is that researchers reviewed the data to assess the benefits and harms associated with universal screening.
The reviewers sought to determine the effect of screening, counseling, and antiretroviral therapy (ART) use on transmission risk; effectiveness of ART for HIV-infected persons with immunologically advanced disease; and long-term harms of ART. The Task Force found no direct evidence that screening for HIV infection improves clinical outcomes versus no screening, but found that targeted screening misses a substantial number of cases due to undisclosed or unknown risk factors.
They also found that HIV screening tests are accurate and that identifying undiagnosed HIV infection and treating immunologically advanced disease are associated with substantial clinical benefits. The evidence suggests that the use of ART reduces sexual transmission of HIV and the risk for AIDS-defining events and death in persons with less immunologically advanced stages of disease.
This evidence will inform an update to the Task Force's 2005 recommendations on HIV screening in adults and adolescents.