Screening for HIV: a review of the evidence for the U.S. Preventive Services Task Force.
BACKGROUND
HIV infection affects 850,000 to 950,000 persons in the United States. The management and outcomes of HIV infection have changed substantially since the U.S. Preventive Services Task Force issued recommendations in 1996.


OBJECTIVE
To synthesize the evidence on risks and benefits of screening for HIV infection.


METHODS
MEDLINE, the Cochrane Library, reference lists, and experts.


METHODS
Studies of screening, risk factor assessment, accuracy of testing, follow-up testing, and efficacy of interventions.


METHODS
Data on settings, patients, interventions, and outcomes were abstracted for included studies; quality was graded according to criteria developed by the Task Force.


RESULTS
No trials directly link screening for HIV with clinical outcomes. Many HIV-infected persons in the United States currently receive diagnosis at advanced stages of disease, and almost all will progress to AIDS if untreated. Screening based on risk factors could identify persons at substantially higher risk but would miss a substantial proportion of those infected. Screening tests for HIV are extremely (>99%) accurate. Acceptance rates for screening and use of recommended interventions vary widely. Highly active antiretroviral therapy (HAART) substantially reduces the risk for clinical progression or death in patients with immunologically advanced disease. Along with other adverse events, HAART is associated with an increased risk for cardiovascular complications, although absolute rates are low after 3 to 4 years.


CONCLUSIONS
Data are insufficient to estimate the effects of screening and interventions on transmission rates or in patients with less immunologically advanced disease. Long-term data on adverse events associated with HAART are not yet available.


CONCLUSIONS
Benefits of HIV screening appear to outweigh harms. The yield from screening higher-prevalence populations would be substantially higher than that from screening the general population.
Oregon Evidence-based Practice Center, Oregon Health & Science University, Portland, Oregon 97239, USA. chour@ohsu.edu
Roger
R
Chou
Laurie Hoyt
LH
Huffman
Rongwei
R
Fu
Ariel K
AK
Smits
P Todd
PT
Korthuis
D017088:AIDS-Related Opportunistic Infections / Q000188:drug therapy / Q000517:prevention & control; D000293:Adolescent; D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use; D019317:Evidence-Based Medicine; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000401:mortality / Q000635:transmission; D006801:Humans; D008403:Mass Screening / Q000191:economics / Q000592:standards; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D015203:Reproducibility of Results; D018570:Risk Assessment; D012307:Risk Factors; D014481:United States / Q000453:epidemiology
D044966:Anti-Retroviral Agents