U.S. Preventive Services Task Force
Screening for HIV: Recommendation Statement
Am Fam Physician. 2005 Dec 1;72(11):2287-2292.
This statement summarizes the U.S. Preventive Services Task Force (USPSTF) recommendations on screening for human immunodeficiency virus (HIV) infection and the supporting scientific evidence, and it updates the 1996 recommendations contained in the Guide to Clinical Preventive Services, 2d ed.1 Explanations of the ratings and of the strength of overall evidence are given in Tables 1 and 2, respectively. The complete information on which this statement is based, including evidence tables and references, is included in the summaries of evidence2,3 and evidence syntheses4,5 on this topic, available through the USPSTF Web site athttp://www.uspreventiveservicestaskforce.org. The recommendation also is posted on the Web site of the National Guideline Clearinghouse athttp://www.guideline.gov.
USPSTF Recommendations and Ratings
The USPSTF grades its recommendations according to one of five classifications (A, B, C, D, or I) reflecting the strength of evidence and magnitude of net benefit (benefits minus harms).
The USPSTF strongly recommends that clinicians provide [the service] to eligible patients. The USPSTF found good evidence that [the service] improves important health outcomes and concludes that benefits substantially outweigh harms.
The USPSTF recommends that clinicians provide [the service] to eligible patients. The USPSTF found at least fair evidence that [the service] improves important health outcomes and concludes that benefits outweigh harms.
The USPSTF makes no recommendation for or against routine provision of [the service]. The USPSTF found at least fair evidence that [the service] can improve health outcomes but concludes that the balance of benefits and harms is too close to justify a general recommendation.
The USPSTF recommends against routinely providing [the service] to asymptomatic patients. The USPSTF found at least fair evidence that [the service] is ineffective or that harms outweigh benefits.
The USPSTF concludes that the evidence is insufficient to recommend for or against routinely providing [the service]. Evidence that [the service] is effective is lacking, of poor quality, or conflicting, and the balance of benefits and harms cannot be determined.
USPSTF = U.S. Preventive Services Task Force.
USPSTF Recommendations and Ratings
USPSTF = U.S. Preventive Services Task Force.
USPSTF Strength of Overall Evidence
The USPSTF grades the quality of the overall evidence for a service on a three-point scale (good, fair, or poor).
Evidence includes consistent results from well-designed, well-conducted studies in representative populations that directly assess effects on health outcomes.
Evidence is sufficient to determine effects on health outcomes, but the strength of the evidence is limited by the number, quality, or consistency of the individual studies; generalizability to routine practice; or indirect nature of the evidence on health outcomes.
Evidence is insufficient to assess the effects on health outcomes because of limited number or power of studies, important flaws in their design or conduct, gaps in the chain of evidence, or lack of information on important health outcomes.
USPSTF = U.S. Preventive Services Task Force.
USPSTF Strength of Overall Evidence
USPSTF = U.S. Preventive Services Task Force.
Summary of Recommendations
The USPSTF strongly recommends that physicians screen for HIV infection in all adolescents and adults at increased risk of HIV infection (see Clinical Considerations for discussion of risk factors). A recommendation.
The USPSTF found good evidence that both standard and U.S. Food and Drug Administration (FDA)-approved rapid screening tests accurately detect HIV infection. The USPSTF also found good evidence that appropriately timed interventions, particularly highly active antiretroviral therapy (HAART), lead to improved health outcomes for many of those screened, including reduced risk of clinical progression and reduced mortality rates. Because false-positive test results are rare, harms associated with HIV screening are minimal. Potential harms of true-positive test results include increased anxiety, labeling, and effects on close relationships. Most adverse events associated with HAART, including metabolic disturbances associated with an increased risk of cardiovascular events, may be ameliorated by changes in regimen or appropriate treatment. The USPSTF concluded that the benefits of screening persons at increased risk substantially outweigh potential harms.
The USPSTF makes no recommendation for or against routinely screening for HIV infection in adolescents and adults who are not at increased risk of HIV infection (see Clinical Considerations for discussion of risk factors). C recommendation.
The USPSTF found fair evidence that screening adolescents and adults not known to be at increased risk of HIV infection can detect additional persons with HIV infection, and good evidence that appropriately timed interventions, especially HAART, lead to improved health outcomes for some of these persons. However, the yield of screening persons without risk factors would be low, and potential harms associated with screening have been noted (see above). The USPSTF concluded that the benefit of screening adolescents and adults without risk factors for HIV infection is too small relative to potential harms to justify a general recommendation.
The USPSTF recommends that physicians screen all pregnant women for HIV infection. A recommendation.
The USPSTF found good evidence that both standard and FDA-approved rapid screening tests accurately detect HIV infection in pregnant women and fair evidence that introduction of universal prenatal counseling and voluntary testing increases the proportion of HIV-infected women who are diagnosed and are treated before delivery. There is good evidence that recommended regimens of HAART are acceptable to pregnant women and lead to significantly reduced rates of mother-to-child transmission. Early detection of maternal HIV infection also allows for discussion of elective cesarean section and avoidance of breastfeeding, both of which are associated with lower HIV transmission rates. There is no evidence of an increase in fetal anomalies or other fetal harm associated with currently recommended antiretroviral regimens (with the exception of efavirenz; see below). Serious or fatal maternal events are rare using currently recommended combination therapies. The USPSTF concluded that the benefits of screening all pregnant women substantially outweigh potential harms.
In 1996, the USPSTF recommended routine counseling and screening for all persons at increased risk of HIV infection (A recommendation) and routine counseling and screening for high-risk pregnant women, as well as those residing in communities where the prevalence of seropositive newborns is increased (A recommendation).1 At that time, the USPSTF found insufficient evidence to recommend for or against routine HIV screening for persons without identified risk factors (C recommendation) and insufficient evidence to recommend for or against universal prenatal screening in low-prevalence communities (C recommendation). Testing infants born to high-risk mothers was recommended when the antibody status of the mother was unknown (B recommendation). Since then, the USPSTF approach to making recommendations has changed,6 and significant new evidence on screening for and treating HIV infection has been published in the medical literature. Therefore, this recommendation statement has been updated and revised based on a new review of the literature using the current USPSTF methodology.
• A person is considered at increased risk of HIV infection (and thus should be offered HIV testing) if he or she reports one or more individual risk factors or receives health care in a high-prevalence or high-risk clinical setting.
• Individual risk of HIV infection is assessed through a careful patient history. Those at increased risk (as determined by prevalence rates) include: men who have had sex with men after 1975; men and women having unprotected sex with multiple partners; past or present injection drug users; men and women who exchange sex for money or drugs or have sex partners who do; persons whose past or present sex partners were HIV-infected, bisexual, or injection drug users; persons being treated for sexually transmitted diseases (STDs); and persons with a history of blood transfusion between 1978 and 1985. Persons who request an HIV test despite reporting no individual risk factors also may be considered at increased risk, because this group is likely to include persons not willing to disclose high-risk behaviors.
• There is good evidence of increased yield from routine HIV screening of persons who report no individual risk factors but are seen in high-risk or high-prevalence clinical settings. High-risk settings include STD clinics, correctional facilities, homeless shelters, tuberculosis clinics, clinics serving men who have sex with men, and adolescent health clinics with a high prevalence of STDs. High-prevalence settings are defined by the Centers for Disease Control and Prevention (CDC) as those known to have a 1 percent or greater prevalence of HIV infection among the patient population being served. Where possible, physicians should consider the prevalence of HIV infection or the risk characteristics of the population they serve in determining an appropriate screening strategy. Data are currently lacking to guide clinical decisions about the optimal frequency of HIV screening.
• Current evidence supports the benefit of identifying and treating asymptomatic persons in immunologically advanced stages of HIV disease (i.e., CD4 cell count of less than 200 per mm3) with HAART. Appropriate prophylaxis and immunization against certain opportunistic infections also have been shown to be effective interventions in these persons. The use of HAART may be considered in asymptomatic patients who are in an earlier stage of disease but at high risk of disease progression (i.e., CD4 cell count less than 350 per mm3 or viral load greater than 100,000 copies per mL), although definitive evidence of a significant benefit of starting HAART at these counts is currently lacking.
• The standard test for diagnosing HIV infection, the repeatedly reactive enzyme immunoassay followed by confirmatory western blot or immunofluorescent assay, is highly accurate (sensitivity and specificity of at least 99 percent). Rapid HIV antibody testing also is highly accurate; can be performed in 10 to 30 minutes; and, when offered at the point of care, is useful for screening high-risk patients who do not receive regular medical care (e.g., those seen in emergency departments) as well as women with unknown HIV status who present in active labor.
• Early identification of maternal HIV seropositivity allows early antiretroviral treatment to prevent mother-to-child transmission, allows physicians to avoid obstetric practices that may increase the risk of transmission, and allows an opportunity to counsel the mother against breastfeeding (also known to increase the risk of transmission). There is evidence that the adoption of “opt-out” strategies to screen pregnant women (who are informed that an HIV test will be conducted as a standard part of prenatal care unless they decline it) has resulted in higher testing rates. However, ethical and legal concerns of not obtaining specific informed consent for an HIV test using the “opt-out” strategy have been raised. Although dramatic reductions in HIV transmission rates to neonates have been noted as a result of early prenatal detection and treatment, the extent to which detection of HIV infection and intervention during pregnancy may improve long-term maternal outcomes is unclear.
Of the estimated 850,000 to 950,000 persons in the United States infected with HIV-1, 25 percent are thought to be unaware of their status.7,8 If untreated, almost all infected persons eventually will develop acquired immunodeficiency syndrome (AIDS), defined by opportunistic infection or severe immune dysfunction. Despite significant recent advances in treatment, AIDS is the seventh leading cause of death in persons 15 to 24 years of age and the fifth leading cause of death in persons 25 to 44 years of age in the United States.9
HIV incidence rates (an estimated 40,000 new infections annually) have remained steady in the United States over the past decade.10 This figure includes infection via mother-to-child (vertical) transmission, with approximately 300 infants infected each year. Women are the fastest-growing group of persons with new HIV diagnoses, and an estimated 6,000 to 7,000 HIV-positive women give birth each year in the United States.11,12 Effective interventions are available to reduce rates of vertical transmission for women diagnosed with HIV infection. However, 40 percent of infected infants in 2000 were born to mothers not known to have HIV infection before delivery.13
To update its 1996 recommendations on HIV screening, the USPSTF examined the evidence from 1983 through June 2004 on the benefits and harms of screening and of currently available interventions for HIV infection in adults, adolescents, and pregnant women. Relevant studies on risk factor assessment and the accuracy and acceptability of testing also were reviewed.
The USPSTF review found that standard testing for HIV infection has a sensitivity and specificity greater than 99 percent and that false-positive test results are rare, even in low-risk settings.14,15 Although indeterminate results may occur slightly more commonly in parous and pregnant women, the diagnostic accuracy of standard HIV testing is thought to be similar for men and pregnant and nonpregnant women.16 Alternative FDA-approved screening technologies also are highly accurate and may increase testing acceptability. Compared with standard HIV testing, the reported sensitivities of rapid tests on blood specimens range from 96 to 100 percent, with specificities greater than 99.9 percent.17–19 Reported sensitivities and specificities of oral fluid HIV tests also are high (greater than 99 percent), although the diagnostic accuracy of urine tests appears lower than that of standard testing.20,21 One good-quality study22 of the only FDA-approved home collection kit, using finger-stick blood spot samples, found it to be highly accurate compared with standard testing.
A large, good-quality U.S. study found that risk factor assessment can identify persons at substantially higher risk of HIV infection but still misses a significant proportion (20 to 26 percent) of HIV-positive patients who report no risk factors23 (because some patients may choose not to disclose high-risk behaviors and others, especially women, unknowingly may be at risk from an infected sex partner24).There is fair evidence to indicate that a broader strategy, targeted to persons who report risk factors, combined with routine voluntary testing of those being seen in high-prevalence clinical settings, would result in substantially fewer missed diagnoses.25–27 In two good-quality studies, HIV screening in populations with a 1 percent prevalence rate was found to be cost-effective (in terms of acceptable cost per quality-adjusted life-year) compared with no screening.28,29 One study29 found that screening populations with even lower prevalence rates also is cost-effective if one assumes secondary transmission benefits. Neither study, however, reported on the incremental cost-effectiveness of screening lower-risk versus higher-risk patients.
The wide adoption in 1995 to 1997 of the use of HAART regimens with three or more antiretroviral agents has been associated with a marked decline in morbidity and mortality of HIV-infected patients in the United States.7 Good-quality evidence has shown HAART regimens to be consistently effective in reducing clinical progression and mortality rates in persons with CD4 cell counts of less than 200 per mm3,30,31 the percentage of patients found in studies to be candidates for HAART regimens at the time of HIV diagnosis has ranged from 12 to 43 percent.24,32 In addition, two good-quality systematic reviews33,34 found that the use of antibiotic medication to prevent opportunistic infections (e.g., Pneumocystis carinii pneumonia and disseminated Mycobacterium avium-intracellulare complex) is effective in persons with advanced disease. Theoretically, asymptomatic patients in an earlier stage of disease at the time of diagnosis (i.e., CD4 cell counts between 200 and 350 per mm3 or viral load greater than 100,000 copies per mL) also may benefit from HAART regimens. However, there are no completed trials showing clinical benefit from treatment versus no treatment in such patients. Data from the Strategies for Management of Anti-Retroviral Therapy trial, which focuses on this group, will not be available for a few more years.
The standard of care in the United States for preventing vertical HIV transmission in seropositive pregnant women has evolved from monotherapy (i.e., zidovudine [Retrovir]) to combination antiretroviral regimens, including HAART regimens, starting at 14 to 34 weeks’ gestation through labor and augmented with six weeks of neonatal prophylaxis with zidovudine.35 Avoidance of breastfeeding is recommended for seropositive women because observational studies have shown that breast-feeding increases transmission rates even when adjusted for other factors, including antiretroviral use. A good-quality, randomized clinical trial has demonstrated that, compared with other modes of delivery, elective cesarean delivery also reduces vertical transmission by minimizing contact between the fetus and infected maternal bodily fluids,36 although the benefit appears small in women with undetectable viral loads. There is fair to good evidence that the newer regimens, in combination with formula feeding and elective cesarean delivery, are associated with a reduction in perinatal transmission of 14 to 25 percent without interventions to 1 to 2 percent with interventions.
Information about the consequences of false-positive HIV test results (e.g., anxiety, labeling) is mostly anecdotal, although true-positive HIV test results have been shown to result in anxiety, depression, social stigmatization, changes in relationships with sex partners, and discrimination.37 Evidence suggests that persons who test positive for HIV (especially heterosexual serodiscordant couples) are more likely than others to avoid risky sexual behavior. On the other hand, optimistic beliefs about the effectiveness of HAART regimens have been shown to be associated with increased risky behaviors in persons known to be seropositive.38,39 All antiretroviral drugs and drug combinations are associated with specific harm profiles, although most harms are short term or self-limited, and effective alternatives often can be found.40 Metabolic disturbances (e.g., hyperlipidemia, diabetes) related to HAART regimens have been associated with an increased incidence of cardiovascular events, especially with longer exposure.41 However, the estimated three-year benefits of HAART regimens appear to greatly outweigh the cardiovascular complications.
No significant increases in the rates of congenital anomalies, neonatal conditions, or other fetal harm have been associated with in utero exposure to FDA-approved regimens of antiretroviral drugs,42 with the exception of those including efavirenz. Efavirenz recently has been reclassified as Class D in pregnancy (i.e., positive evidence of human fetal risk). Although studies have demonstrated no ill effects of limited exposure to zidovudine monotherapy in women followed postpartum for as long as six years, no studies have evaluated the effects of limited exposure to combination antiretroviral drugs during pregnancy on the long-term clinical outcomes of HIV-infected women.
Recommendations of Others
Counseling and HIV testing of high-risk persons (as defined in the Clinical Considerations section) are recommended by the CDC,43 the Canadian Task Force on the Periodic Health Examination (now the Canadian Task Force on Preventive Health Care),44 and numerous professional organizations, including the American Medical Association (AMA),45 the American Academy of Family Physicians (AAFP),46 the American College of Obstetricians and Gynecologists (ACOG),47 the American College of Physicians,48 and the Infectious Diseases Society of America (IDSA).49 Also, the American Academy of Pediatrics (AAP)50 considers sexually active adolescents to be a high-risk group and recommends they be counseled and offered HIV testing. In addition, the CDC recommends that routine, voluntary testing be offered to all patients seen either in health care facilities where the prevalence of HIV infection is 1 percent or greater or in settings serving client populations at increased behavioral or clinical HIV risk.
The CDC, AMA, AAFP, ACOG,51 IDSA, AAP,52 and the American College of Nurse-Midwives53 recommend that all pregnant women be routinely counseled and encouraged to have HIV testing. ACOG, AAP, and the CDC go further in recommending that HIV testing be part of a routine battery of prenatal blood tests unless declined (i.e., an “opt-out” approach). The CDC and ACOG also recommend retesting in their third trimester of pregnancy women who are known to be at high risk of acquiring HIV, as well as rapid HIV testing during labor for women with undocumented HIV status.
REFERENCESshow all references
1. U.S. Preventive Services Task Force. Guide to clinical preventive services. 2d ed. Baltimore: Williams & Wilkins, 1996....
2. Chou R, Huffman LH, Fu R, Smits AK, Korthuis PT. Screening for human immunodeficiency virus: a review of the evidence for the U.S. Preventive Services Task Force. Ann Intern Med. 2005;143:55–73.
3. Chou R, Smits AK, Huffman LH, Fu R, Korthuis PT. Prenatal screening for human immunodeficiency virus: a review of the evidence for the U.S. Preventive Services Task Force. Ann Intern Med. 2005;143:38–54.
4. Chou R, Korthuis PT, Huffman LH, Smits AK. Screening for human immunodeficiency virus in adolescents and adults. Evidence synthesis No. 38. Rockville, Md.: Agency for Healthcare Research and Quality, 2005. Accessed online October 26, 2005, at: http://www.ahrq.gov/clinic/serfiles.htm.
5. Chou R, Smits AK, Huffman LH, Korthuis PT. Screening for human immunodeficiency virus in pregnant women. Evidence synthesis No. 39. Rockville, Md.: Agency for Healthcare Research and Quality, 2005. Accessed online October 26, 2005, at: http://www.ahrq.gov/clinic/serfiles.htm.
6. Harris RP, Helfand M, Woolf SH, Lohr KN, Mulrow CD, Teutsch SM, et al. Current methods of the U.S. Preventive Services Task Force: a review of the process. Am J Prev Med. 2001;20(suppl 3):21–35.
7. Centers for Disease Control and Prevention. Cases of HIV infection and Aids in the United States, 2002. HIV/AIDS Surveillance Report. Vol. 14. Accessed online March 23, 2005, at: http://www.cdc.gov/hiv/stats/hasr1402.htm.
8. Fleming P, Byers RH, Sweeney PA, Daniels D, Karon JM, Janssen RS. HIV prevalence in the United States, 2000. In: Program and abstracts of the 9th Conference on Retroviruses and Opportunistic Infections. Seattle; February 24–28, 2002. Alexandria, Virginia: Foundation for Retrovirology and Human Health.
9. Kochanek KD, Smith BL. Deaths: preliminary data for 2002. Natl Vital Stat Rep. 2004;52:1–47.
10. Centers for Disease Control and Prevention. Increases in HIV diagnoses—29 states, 1999–2002. MMWR Morb Mortal Wkly Rep. 2003;52:1145–8.
11. Lee LM, Fleming PL. Trends in human immunodeficiency virus diagnoses among women in the United States, 1994–1998. J Am Med Womens Assoc. 2001;56:94–9.
12. Bulterys M, Nolan ML, Jamieson DJ, Dominguez K, Fowler MG. Advances in the prevention of mother-to-child HIV-1 transmission: current issues, future challenges. AIDScience. 2002. Accessed online October 26, 2005, at: http://aidscience.com/Articles/aidscience017.asp
13. Office of the Inspector General. Reducing obstetrician barriers to offering HIV testing. Washington, D.C.: Department of Health and Human Services, 2002. Accessed October 26, 2005, at: http://oig.hhs.gov/oei/reports/oei-05-01-00260.pdf.
14. Centers for Disease Control and Prevention. Update: serologic testing for HIV-1 antibody—United States, 1988 and 1989. MMWR Morb Mortal Wkly Rep. 1990;39:380–3.
15. Kleinman S, Busch MP, Hall L, Thomson R, Glynn S, Gallahan D, et al. False-positive HIV-1 test results in a low-risk screening setting of voluntary blood donation. Retrovirus Epidemiology Donor Study. JAMA. 1998;280:1080–5.
16. Celum CL, Coombs RW, Jones M, Murphy V, Fisher L, Grant C, et al. Risk factors for repeatedly reactive HIV-1 EIA and indeterminate western blots. Arch Intern Med. 1994;154:1129–37.
17. Butlerys M, Jamieson DJ, O’Sullivan MJ, Cohen MH, Maupin R, Nesheim S, et al. Rapid HIV-1 testing during labor: a multicenter study. JAMA. 2004;292:219–23.
18. O’Connell RJ, Merrit TM, Malia JA, VanCott TC, Dolan MJ, Zahwa H, et al. Performance of the OraQuick rapid antibody test for diagnosis of human immunodeficiency virus type 1 infection in patients with various levels of exposure to highly active antiretroviral therapy. J Clin Microbiol. 2003;41:2153–5.
19. Reynolds SJ, Ndongala LM, Luo CC, Mwandagalirwa K, Losoma AJ, Mwamba KJ, et al. Evaluation of a rapid test for the detection of antibodies to human immunodeficiency virus type 1 and 2 in the setting of multiple transmitted viral subtypes. Int J STD AIDS. 2002;13:171–3.
20. Gallo D, George JR, Fitchen JH, Goldstein AS, Hindahl MS. Evaluation of a system using oral mucosal transudate for HIV-1 antibody screening and confirmatory testing [published correction appears in JAMA 1997;227:792]. OrasSure HIV Clinical Trials Group. JAMA. 1997;2773:254–8.
21. Martinez PM, Torres AR, de Lejarazu R, Montoya A, Martin JF, Eiros JM. Human immunodeficiency virus antibody testing by enzyme-linked fluorescent and Western blot assays using serum, gingival-crevicular transudate, and urine samples. J Clin Microbiol. 1999;37:1100–6.
22. Frank AP, Wandell MG, Headings MD, Conant MA, Woody GE, Michel C. Anonymous HIV testing using home collection and telemedicine counseling. A multicenter evaluation. Arch Intern Med. 1997;157:309–14.
23. Peterman TA, Todd KA, Mupanduki I. Opportunities for targeting publicly funded human immunodeficiency virus counseling and testing. J Acquir Immune Defic Syndr Hum Retrovirol. 1996;12:69–74.
24. Klein D, Hurley LB, Merrill D, Quescenberry CP Jr. Review of medical encounters in the 5 years before a diagnosis of HIV-1 infection: implications for early detection. J Acquir Immune Defic Syndr. 2003;32:143–52.
25. Centers for Disease Control and Prevention. Voluntary HIV testing as part of routine medical care—Massachusetts, 2002. MMWR Morb Mortal Wkly Rep. 2004;53:523–6.
26. Centers for Disease Control and Prevention. Routinely recommended HIV testing at an urban urgent-care clinic—Atlanta, Georgia, 2000. MMWR Morb Mortal Wkly Rep. 2001;50:538–41.
27. Walensky RP, Losina E, Steger-Craven KA, Freedberg KA. Identifying undiagnosed human immunodeficiency virus: the yield of routine, voluntary inpatient testing. Arch Intern Med. 2002;162:887–92.
28. Paltiel AD, Weinstein MC, Kimmel AD, Seage GR III, Losina E, Zhang H, et al. Expanded screening for HIV in the United States—an analysis of cost-effectiveness. N Engl J Med. 2005;352:586–95.
29. Sanders GD, Bayoumis AM, Sundaram V, Bilir SP, Neukermans CP, Rydzak CE, et al. Cost-effectiveness of screening for HIV in the era of highly active antiretroviral therapy. N Engl J Med. 2005;352:570–85.
30. McNaghten AD, Hanson DL, Jones JL, Dworkin MS, Ward JW. Effects of antiretroviral therapy and opportunistic illness primary chemoprophylaxis on survival after AIDS diagnosis [published correction appears in AIDS 2000;14:1877]. Adult/Adolescent Spectrum of Disease Group. AIDS. 1999;13:1687–95.
31. Palella FJ, Delaney KM, Moorman AC, Loveless MO, Fuhrer J, Satten GA, et al. Declining morbidity and mortality among patients with advanced human immunodeficiency virus infection. HIV Outpatient Study Investigators. N Engl J Med. 1998;338:853–60.
32. Dybul M, Bolan R, Condoluci D, Cox-lyamu R, Redfield R, Hallahan CW, et al. Evaluation of initial CD4+ T cell counts in individuals with newly diagnosed human immunodeficiency virus infection, by sex and race, in urban settings. J Infect Dis. 2002;185:1818–21.
33. Ioannidis JP, Cappelleri JC, Skolnik PR, Lau J, Sacks HS. A meta-analysis of the relative efficacy and toxicity of Pneumocystis carinii prophylactic regimens. Arch Intern Med. 1996;156:177–88.
34. Bucher HC, Griffith L, Guyatt GH, Opravil M. Meta-analysis of prophylactic treatments against Pneumocystic carinii pneumonia and toxoplasma encephalitis in HIV-infected patients. J Acquir Immune Defic Syndr Hum Retrovirol. 1997;15:104–14.
35. Centers for Disease Control and Prevention. Recommendations for use of antiretroviral drugs in pregnant HIV-1 infected women for maternal health and interventions to reduce perinatal HIV-1 transmission in the United States. Accessed October 25, 2005, at: http://aidsinfo.nih.gov/guidelines/perinatal/PER_022405.pdf.
36. Elective caesarean-section versus vaginal delivery in prevention of vertical HIV-1 transmission: a randomised clinical trial. The European Mode of Delivery Collaboration [published correction appears in Lancet 1999;353:1714]. Lancet. 1999;353:1035–9.
37. Gielen AC, O’Campo P, Faden RR, Eke A. Women’s disclosure of HIV status: experiences of mistreatment and violence in an urban setting. Women Health. 1997;25:19–31.
38. Centers for Disease Control and Prevention. Adoption of protective behaviors among persons with recent HIV infection and diagnosis—Alabama, New Jersey, and Tennessee, 1997–1998. MMWR Morb Mortal Wkly Rep. 2000;49:512–5.
39. Crepaz N, Hart TA, Marks G. Highly active antiretroviral therapy and sexual risk behavior: a meta-analytic review. JAMA. 2004;292:224–36.
40. Department of Health and Human Services. Guidelines for the use of antiretroviral agents in HIV-1 infected adults and adolescents. Accessed October 25, 2005, at: http://aidsinfo.nih.gov/guidelines/adult/AA_100605.pdf.
41. Friis-Moller N, Sabin CA, Weber R, d’Arminio MA, El-Sadr WM, Reiss P, et al. Combination antiretroviral therapy and the risk of myocardial infarction [published correction appears in N Engl J Med 2004;350:955]. N Engl J Med. 2003;349:1993–2003.
42. Tuomala RE, Shapiro DE, Mofenson LM, Bryson Y, Culnane M, Hughes MD, et al. Antiretroviral therapy during pregnancy and the risk of an adverse outcome. N Engl J Med. 2002;346:1863–70.
43. Centers for Disease Control and Prevention. Revised guidelines for HIV counseling, testing, and referral and revised recommendations for HIV screening of pregnant women. MMWR Morb Mortal Wkly Rep. 2001;50:1–57.
44. Periodic health examination, 1992 update: 3. HIV antibody screening. Canadian Task Force on the Periodic Health Examination. CMAJ. 1992;147:867–76.
45. American Medical Association. Universal, routine screening of pregnant women for HIV infection. Accessed October 25, 2005, at: http://www.ama-assn.org/ama/pub/category/13548.html.
46. American Academy of Family Physicians. HIV Infection Statements and Policies. Accessed July 1, 2005, at: https://www.aafp.org/x1586.xml.
47. ACOG Committee on Obstetric Practice. ACOG committee opinion number 304, November 2004. Prenatal and perinatal human immunodeficiency virus testing: expanded recommendations. Obstet Gynecol. 2004;104(pt 1):1119–24.
48. Human immunodeficiency virus (HIV) infection. American College of Physicians and Infectious Diseases Society of America. Ann Intern Med. 1994;120:310–9.
49. Aberg JA, Gallant JE, Anderson J, Oleske JM, Libman H, Currier JS, et al. Primary care guidelines for the management of persons infected with human immunodeficiency virus: recommendations of the HIV Medicine Association of the Infectious Diseases Society of America. Clin Infect Dis. 2004;39:609–29.
50. American Academy of Pediatrics, Committee on Pediatric AIDS and Committee on Adolescents. Adolescents and human immunodeficiency virus: the role of the pediatrician in prevention and intervention. Pediatrics. 2001;107:188–90.
51. ACOG Committee opinion number 304, November 2004. Prenatal and perinatal human immunodeficiency virus testing: expanded recommen dations. Obstet Gynecol. 2004;104:1119–24.
52. Human immunodeficiency virus screening. Joint statement of the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists. Pediatrics. 1999;104(pt 1):128
53. American College of Nurse-Midwives. Position statement: Human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS). 2003. Accessed online March 24, 2005, at: http://www.midwife.org/prof/display.cfm?id=403.
This is one in a series excerpted from the Recommendation Statements released by the U.S. Preventive Services Task Force (USPSTF). These statements address preventive health services for use in primary care clinical settings, including screening tests, counseling, and chemoprevention. This statement is part of AFP’s CME. See “Clinical Quiz” on page 2173.
The series coordinator is Charles Carter, M.D., University of South Carolina Family Medicine Residency, Columbia, S.C.
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