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Routine HIV Screening in Health Care Settings

Routine HIV Screening in Health Care Settings. 2006 CDC HIV Screening Recommendations. David Spach, MD Clinical Director Northwest AIDS Education and Training Center Professor of Medicine, Division of Infectious Diseases University of Washington Seattle.

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Routine HIV Screening in Health Care Settings

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  1. Routine HIV Screening in Health Care Settings 2006 CDC HIV Screening Recommendations David Spach, MDClinical DirectorNorthwest AIDS Education and Training CenterProfessor of Medicine, Division of Infectious DiseasesUniversity of Washington Seattle This project was funded under cooperative agreement number U65/PS000821from the Centers for Disease Control and Prevention (CDC). 

  2. 2006 CDC HIV Screening RecommendationsSummary of Key Recommendations • Routine Screening for HIV Infection • Indications for Repeat HIV Screening • Consent and Pretest Information • Diagnostic Testing • Recommendations for Pregnant Women Source: CDC. MMWR 2006;55(no. RR-14):1-17.

  3. Source: CDC. MMWR 2006;55(no. RR-14):1-17.

  4. 2006 CDC HIV Screening RecommendationsSummary of Key Recommendations • Routine Screening for HIV Infection • Indications for Repeat HIV Screening • Consent and Pretest Information • Diagnostic Testing • Recommendations for Pregnant Women Source: CDC. MMWR 2006;55(no. RR-14):1-17.

  5. 2006 CDC HIV Screening RecommendationsOrganizations that Support CDC Recommendations • American Academy of HIV Medicine (AAHIVM) • American College of Obstetrics and Gynecology (ACOG) • American College of Physicians (ACP) • American Medical Association (AMA) • HIV Medicine Association (HIVMA) • National Association of Community Health Centers (NACHC) • National Medical Association (NMA)

  6. Routine Screening for HIV Infection • All patients aged 13-64 in all health care settings(Unless prevalence of undiagnosed HIV < 0.1%) Source: CDC. MMWR 2006;55(no. RR-14):1-17.

  7. Routine Screening for HIV Infection • All patients aged 13-64 in all health care settings(Unless prevalence of undiagnosed HIV < 0.1%) HIV Screening: performing an HIV test for all persons in a defined population Source: CDC. MMWR 2006;55(no. RR-14):1-17.

  8. Routine Screening for HIV Infection • All patients aged 13-64 in all health care settings(Unless prevalence of undiagnosed HIV < 0.1%) Screen Unless Yield of Screening is Less than 1 Infection per 1000 Patients Tested Source: CDC. MMWR 2006;55(no. RR-14):1-17.

  9. Source: Wilson JMG, Jungner G. Principles and Practice of Screening for Disease. WHO Public Health Paper. No.34. 1968. .

  10. WHO Criteria that Justify Routine Screening for a Medical Test • Serious health disorder that can be detected before symptoms develop • Treatment is more beneficial when begun before symptoms develop • Reliable, inexpensive, acceptable screening test • Costs of screening are reasonable in relation to anticipated benefits • Treatment must be accessible Source:Wilson JMG, Jungner G. Principles and Practice of Screening for Disease. WHO Public Health Paper. No.34. 1968.

  11. Routine Screening for HIV Infection • All patients aged 13-64 in all health care settings • Patients seeking treatment for STDs Gram’s Stain Gonorrhea Secondary Syphilis Source for Images: CDC/NCHSTP/Division of STD Prevention, STD Clinical Slides Source: CDC. MMWR 2006;55(no. RR-14):1-17.

  12. Routine Screening for HIV Infection • All patients aged 13-64 in all health care settings • Patients seeking treatment for STDs • Patients initiating tuberculosis treatment Image Source: HIV Web Study (www.HIVwebstudy.org) Source: CDC. MMWR 2006;55(no. RR-14):1-17.

  13. 2006 CDC HIV Screening RecommendationsSummary of Key Recommendations • Routine Screening for HIV Infection • Indications for Repeat HIV Screening • Consent and Pretest Information • Diagnostic Testing • Recommendations for Pregnant Women Source: CDC. MMWR 2006;55(no. RR-14):1-17.

  14. Indications for Repeat HIV Screening • Persons at high risk Injection-Drug Users & their Sex Partners Persons who Exchange Sex for Money or Drugs Sex Partners of HIV-Infected Persons Persons or their Partners with >1 Sex Partner Since their Most Recent HIV Test Source: CDC. MMWR 2006;55(no. RR-14):1-17.

  15. Indications for Repeat HIV Screening • Persons at high risk • Persons starting a new sexual relationship Source: CDC. MMWR 2006;55(no. RR-14):1-17.

  16. Indications for Repeat HIV Screening • Persons at high risk • Persons starting a new sexual relationship • Clinical judgment Source: CDC. MMWR 2006;55(no. RR-14):1-17.

  17. 2006 CDC HIV Screening RecommendationsSummary of Key Recommendations • Routine Screening for HIV Infection • Indications for Repeat HIV Screening • Consent and Pretest Information • Diagnostic Testing • Recommendations for Pregnant Women Source: CDC. MMWR 2006;55(no. RR-14):1-17.

  18. Consent and Pretest Information • Voluntary testing Source: CDC. MMWR 2006;55(no. RR-14):1-17.

  19. Consent and Pretest Information • Voluntary testing • Permission from patient required Permission Required Source: CDC. MMWR 2006;55(no. RR-14):1-17.

  20. Consent and Pretest Information • Voluntary testing • Permission from patient required • Written consent should not be required Written Consent Should Not be Required Source: CDC. MMWR 2006;55(no. RR-14):1-17.

  21. Consent and Pretest Information • Voluntary testing • Permission from patient required • Written consent should not be required • Prevention counseling not required in conjunction with screening Prevention Counseling Not Required in Conjunction with HIV Screening Source: CDC. MMWR 2006;55(no. RR-14):1-17.

  22. 2006 CDC HIV Screening RecommendationsSummary of Key Recommendations • Routine Screening for HIV Infection • Indications for Repeat HIV Screening • Consent and Pretest Information • Diagnostic Testing • Recommendations for Pregnant Women Source: CDC. MMWR 2006;55(no. RR-14):1-17.

  23. Diagnostic Testing for HIV • Clinical manifestations of HIV/AIDS Oral Candidiasis Kaposi’s Sarcoma Oral Hairy Leukoplakia Pneumocystispneumonia Images Source: HIV Web Study (www.HIVwebstudy.org) Source: CDC. MMWR 2006;55(no. RR-14):1-17.

  24. Diagnostic Testing for HIV • Clinical manifestations of HIV/AIDS • Acute HIV (Recent high risk exposure + illness consistent with acute HIV) • High Risk Exposure Source: CDC. MMWR 2006;55(no. RR-14):1-17.

  25. Diagnostic Testing for HIV • Clinical manifestations of HIV/AIDS • Acute HIV (Recent high risk exposure + illness consistent with acute HIV) Signs and Symptoms of 160 Patients with Acute HIV Source: Vanhems P, et al. AIDS. 2000;14:375-81.

  26. Laboratory Studies with Initial HIV InfectionHigh Level Viremia HIV RNA Infection HIV RNA levels abruptly rise within several weeks after acute infection

  27. Laboratory Studies with Initial HIV InfectionHigh Level Viremia Precedes Detectable Antibodies Antibody Titer Antibody Titer HIV RNA Detectable Antibody Infection

  28. Laboratory Studies with Initial HIV Infection“Window Period” Window Period HIV RNA (copies/ml) Antibody Titer Detectable Antibody Detectable Antibody Infection

  29. Laboratory Studies with Acute HIV • Positive HIV-1 RNA Assay and Negative HIV Antibody Test Acute HIV Antibody Titer HIV RNA Antibody Titer Detectable Antibody Detectable Antibody Infection

  30. 2006 CDC HIV Screening RecommendationsSummary of Key Recommendations • Routine Screening for HIV Infection • Indications for Repeat HIV Screening • Consent and Pretest Information • Diagnostic Testing • Recommendations for Pregnant Women Source: CDC. MMWR 2006;55(no. RR-14):1-17.

  31. Recommendations for HIV Screening in Pregnancy • Recommendations • Universal Opt-Out Screening • Timing of HIV Testing • Rapid Testing During Labor • Address Reasons for Declining Test • Repeat Test in 3rd Trimester in Certain Circumstances Source: CDC. MMWR 2006;55(no. RR-14):1-17.

  32. Resources for HIV Testing in PregnancyCDC: One Test/Two Lives http://www.cdc.gov/hiv/topics/perinatal/1test2lives/

  33. Resources for HIV Testing in PregnancyACOG: Perinatal HIV Recommendations http://www.acog.org/departments/dept_notice.cfm?recno=39&bulletin=3527

  34. Resources for HIV Testing in PregnancyNational Clinicians Consultation Center: Perinatal HIV Hotline 1-888-448-8765 http://www.nccc.ucsf.edu/about_nccc/perinatal_hotline/

  35. Acknowledgement The project was funded under cooperative agreement number U65/PS000821 from the Centers for Disease Control and Prevention (CDC). 

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