AAFP Recommends Universal Screening for HIV Infection Beginning at 18 Years of Age
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Am Fam Physician. 2014 Apr 15;89(8):614-617.
Related U.S. Preventive Services Task Force Recommendation Statement: Screening for HIV
Related Putting Prevention into Practice: Screening for HIV
Related article: What Is New in HIV Infection?
Related letter: AAFP Should Support HIV Screening for All 15- to 17-Year-Olds
Human immunodeficiency virus (HIV) infection and AIDS are responsible for substantial morbidity and mortality in the United States. In 2011, there were nearly 50,000 HIV infection diagnoses, at a rate of 15.8 per 100,000 persons.1 In 2013, the U.S. Preventive Services Task Force (USPSTF) strongly recommended universal screening for HIV infection in all pregnant women, and in adolescents and adults 15 to 65 years of age.2 Screening for HIV infection meets many of the criteria of a worthwhile screening test, including earlier detection to improve morbidity and mortality, high sensitivity and specificity, and a testing method that is acceptable to most patients.
Although the American Academy of Family Physicians (AAFP) agrees with much of this recommendation, it recommends delaying the start of routine screening until 18 years of age, and screening all patients 18 to 65 years of age. The AAFP notes that screening younger patients may still be beneficial based on high-risk behaviors.3 The AAFP position differs from that of the USPSTF for the following reasons: the rate of HIV infection diagnosis is substantially lower in those 15 to 17 years of age; higher-risk adolescents can still be tested based on risk factors and regional prevalence; the positive predictive value of a test in a low-prevalence population is poor; a low-yield test would lead to potentially unnecessary, time-consuming interventions in the practice of a busy family physician; and the benefit of diagnosis
Address correspondence to Steven R. Brown, MD, FAAFP, at Steven.Brown@bannerhealth.com. Reprints are not available from the authors.
Author disclosure: No relevant financial affiliations.
EDITOR'S NOTE: Dr. Brown was the 2013 chair of the AAFP's Subcommittee on Clinical Preventive Services and is the 2014 chair of the Commission on Health of the Public and Science.
1. Centers for Disease Control and Prevention. HIV surveillance report, 2011; vol. 23. http://www.cdc.gov/hiv/topics/surveillance/resources/reports/. February 2013. Accessed November 18, 2013.
2. Moyer VA. Screening for HIV: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2013;159(1):51–60.
3. American Academy of Family Physicians. HIV infection, adolescents and adults. http://www.aafp.org/patient-care/clinical-recommendations/all/hiv.html. Accessed November 30, 2013.
4. Cornett JK, Kirn TJ. Laboratory diagnosis of HIV in adults: a review of current methods. Clin Infect Dis. 2013;57(5):712–718.
5. Centers for Disease Control and Prevention (CDC). Vital signs: HIV infection, testing, and risk behaviors among youths—United States. MMWR Morb Mortal Wkly Rep. 2012;61(47):971–976.
6. American Academy of Family Physicians. Adolescent health care, sexuality and contraception. http://www.aafp.org/about/policies/all/adolescent-sexuality.html. Accessed November 27, 2013.
7. Gigerenzer G. HIV screening: helping clinicians make sense of test results to patients. BMJ. 2013;347:f5151.
8. Biggs WS, Crosley PW, Kozakowski SM. Results of the 2013 National Resident Matching Program: family medicine. Fam Med. 2013;45(9):647–651.
9. Yarnell KS, Pollak KI, Østbye T, Krause KM, Michener JL. Primary care: is there enough time for prevention? Am J Public Health. 2003;93(4):635–641.
10. Howden LM, Meyer JA. Age and sex composition: 2010. 2010 Census Briefs. Washington, DC: U.S. Census Bureau; 2011.
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