Routine HIV Screening in Health Care Settings David Spach, MD Clinical Director Northwest AIDS Education and Training Center Professor of Medicine, Division.

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Presentation transcript:

Routine HIV Screening in Health Care Settings David Spach, MD Clinical Director Northwest AIDS Education and Training Center Professor of Medicine, Division of Infectious Diseases University of Washington Seattle This project was funded under cooperative agreement number U65/PS from the Centers for Disease Control and Prevention (CDC) CDC HIV Screening Recommendations

2006 CDC HIV Screening Recommendations Summary 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.

2006 CDC HIV Screening Recommendations Summary 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.

2006 CDC HIV Screening Recommendations Organizations 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)

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

Routine Screening for HIV Infection Source: CDC. MMWR 2006;55(no. RR-14):1-17. All patients aged 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

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

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

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

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

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

2006 CDC HIV Screening Recommendations Summary 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.

Indications for Repeat HIV Screening Source: CDC. MMWR 2006;55(no. RR-14):1-17. 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 Persons at high risk

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

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

2006 CDC HIV Screening Recommendations Summary 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.

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

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

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

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

2006 CDC HIV Screening Recommendations Summary 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.

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

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

Diagnostic Testing for HIV Source: Vanhems P, et al. AIDS. 2000;14: Clinical manifestations of HIV/AIDS Acute HIV (Recent high risk exposure + illness consistent with acute 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

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

Laboratory Studies with Initial HIV Infection High Level Viremia Precedes Detectable Antibodies Antibody Titer Infection HIV RNA Antibody Titer Detectable Antibody

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

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

2006 CDC HIV Screening Recommendations Summary 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.

Recommendations for HIV Screening in Pregnancy Source: CDC. MMWR 2006;55(no. RR-14):1-17. 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 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

Resources for HIV Testing in Pregnancy CDC: One Test/Two Lives

Resources for HIV Testing in Pregnancy ACOG: Perinatal HIV Recommendations

Resources for HIV Testing in Pregnancy National Clinicians Consultation Center: Perinatal HIV Hotline

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