Clinical Preventive Service Recommendation
Human Immunodeficiency Virus (HIV)
HIV Infection, Adolescents and Adults
Grade: A recommendation
The AAFP recommends that clinicians screen adolescents and adults ages 18 to 65 years for HIV infection. Younger adolescents and older adults who are at increased risk should also be screened. See the Clinical Considerations for more information about screening intervals. (2013)
Note: The AAFP’s recommendation differs from the U.S. Preventive Services Task Force (USPSTF) only on the age to initiate routine screening for HIV. The USPSTF(www.uspreventiveservicestaskforce.org) recommends routine screening beginning at age 15 years and the Centers for Disease Control and Prevention (CDC) recommends routine screening beginning at age 13 years.
- The evidence base for the new recommendations for HIV screening for adults is solid. The one difference between the AAFP recommendations and those of the CDC and USPSTF pertains to what age to initiate routine screening. The CDC states age 13 years and the USPSTF recommendation states age 15 years. The AAFP recommends routine screening starting at age 18 years.
- The prevalence of HIV infection and rate of new infection among 13-14 year olds and 15-17 year olds are very low. CDC data show for the year 2010 there were 529 AIDS cases and 2,200 HIV cases in the age group 15-19 years. Based on the most recent US census there are close to 4 million adolescents in each cohort year or a total of 20 million in the ages 15-19. A rough calculation of (2729/ 20 million) provides a rate of 1.3/10,000. These data are not seroprevalence data and the actual rates are likely higher. However, these case numbers also include children known to be infected at birth and thus not all are infections contracted in the adolescent years. In addition the rate calculated is for the 5 year group and is likely skewed toward the older ages (18 and 19) and the rates in the 15-17 year olds are probably lower than that calculated.
- The benefits of detecting HIV in a low risk 15-17 year old versus detecting the infection in the same adolescent at age 18 is unknown.
HIV Infection, Pregnant Women
Grade: A recommendation
The AAFP recommends that clinicians screen all pregnant women for HIV, including those who present in labor whose HIV status is unknown. See the Clinical Considerations for more information about screening intervals. (2013)
These recommendations are provided only as assistance for physicians making clinical decisions regarding the care of their patients. As such, they cannot substitute for the individual judgment brought to each clinical situation by the patient's family physician. As with all clinical reference resources, they reflect the best understanding of the science of medicine at the time of publication, but they should be used with the clear understanding that continued research may result in new knowledge and recommendations. These recommendations are only one element in the complex process of improving the health of America. To be effective, the recommendations must be implemented.