Screening for HIV: U.S. Preventive Services Task Force Recommendation Statement,Annals of Internal Medicine

Who developed these guidelines?

The U.S. Preventive Services Task Force (USPSTF) developed these recommendations. The USPSTF is a group of health experts that reviews published research and makes recommendations about preventive health care.

What is the problem and what is known about it so far?

HIV is the cause of AIDS, an illness that interferes with the body's ability to fight infection and some types of cancer. Treatments containing multiple drugs have improved outcomes for HIV-infected patients. The virus passes from person to person through contact with blood or other bodily fluids that contain it. People can have HIV infection for years before becoming sick.

Men who have sex with men and active users of injected recreational drugs are at very high risk for HIV infection. Other risk factors include unprotected vaginal or anal intercourse; having sexual partners who are HIV-positive, bisexual, or injection drug users; exchanging sex for drugs or money; and having other sexually transmitted infections. Research also shows that people who request HIV testing despite reporting no risk factors are at increased risk for HIV infection, possibly because of risk factors that they do not report.

Conventional tests for HIV infection are blood tests that usually provide results in 1 to 2 days. Rapid tests that provide results in 5 to 40 minutes involve testing blood or saliva, but positive results must be confirmed with conventional blood tests.

In 2005, the USPSTF recommended that physicians ask patients about HIV risk factors, advise HIV testing for all adolescents and adults with a risk factor for HIV, and screen all pregnant women regardless of whether they have risk factors. Screening means testing people who feel well rather than waiting until symptoms develop. The USPSTF wanted to update these recommendations.

How did the USPSTF develop these recommendations?

The USPSTF reviewed published research to evaluate the benefits and harms of HIV screening.

What did the authors find?

Conventional and rapid HIV tests are highly accurate in diagnosing infection. Research shows that identification and treatment of HIV infection greatly reduce the progression to AIDS. Early initiation of treatment is associated with fewer AIDS-related complications or deaths. Treatment reduces the transmission of HIV to uninfected heterosexual partners. The identification and treatment of HIV infection in pregnant women greatly reduces the passage of infection from mother to child. The harms of screening for and treating HIV infection in adolescents, adults, and pregnant women are probably small.

What does the USPSTF recommend that patients and doctors do?

All adolescents and adults aged 15 to 65 years should have HIV screening. Younger adolescents and older adults who have risk factors for HIV infection should also be screened.

All pregnant women should receive screening for HIV infection, including those who present in labor whose status is unknown.

What are the cautions related to these recommendations?

Patients with signs or symptoms of HIV infection should be tested regardless of whether they are in the aforementioned age and risk groups.

问题是什么，到目前为止对此有什么了解？

HIV是AIDS的病因，AIDS是一种疾病，会干扰人体抵抗感染和某些类型癌症的能力。含有多种药物的治疗对感染HIV的患者的结局有所改善。病毒通过与血液或其他含有病毒的体液接触而在人与人之间传播。人们在生病之前可能会感染艾滋病毒多年。

与男性发生性关系的男性以及积极注射消遣性毒品的男性感染艾滋病毒的风险非常高。其他危险因素包括未保护的阴道或肛门性交；拥有HIV阳性，双性恋或注射吸毒者的性伴侣；用性来交换毒品或金钱；以及其他性传播感染。研究还表明，尽管未报告任何危险因素但仍要求进行HIV检测的人感染HIV的风险增加，这可能是由于他们未报告危险因素所致。

HIV感染的常规检查是血液检查，通常会在1-2天内提供结果。在5到40分钟内提供结果的快速测试涉及对血液或唾液的测试，但是必须通过常规血液测试确认阳性结果。

在2005年，USPSTF建议医生向患者询问有关HIV的危险因素，为所有具有HIV危险因素的青少年和成年人提供HIV检测建议，并对所有孕妇进行筛查，无论他们是否具有危险因素。筛查意味着测试感觉良好的人，而不是等到症状出现。USPSTF希望更新这些建议。

作者发现了什么？

常规和快速的HIV检测在诊断感染方面非常准确。研究表明，鉴定和治疗艾滋病毒感染可以大大减少艾滋病的发展。尽早开始治疗可减少与艾滋病相关的并发症或死亡。治疗可以减少艾滋病毒向未感染的异性伴侣的传播。孕妇中HIV感染的识别和治疗大大减少了感染从母婴传播的机会。在青少年，成人和孕妇中筛查和治疗HIV感染的危害可能很小。