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New Guidelines for Routine HIV Screening in Women

ACOG recommends test for females aged 13 to 64 years

According to a new “committee opinion” published in the May issue of Obstetrics & Gynecology, the American College of Obstetrics and Gynecology (ACOG) recommends human immunodeficiency virus (HIV) screening for females aged 13 to 64 years at least once in their lifetimes and annually thereafter, based on risk factors.

Screening is also indicated after the age of 64 years if there is an ongoing risk of HIV infection (e.g., new sexual partners), as indicated by a risk assessment.

In ACOG’s view, repeat HIV testing should be offered at least annually to women who:

  • are injection drug users
  • are sex partners of injection drug users
  • exchange sex for money or drugs
  • are sex partners of HIV-infected persons
  • have had sex with men who have sex with men since the most recent HIV test
  • have had more than one sex partner since their most recent HIV test

In addition, obstetrician–gynecologists should encourage women and their prospective sex partners to be tested before initiating a new sexual relationship.

ACOG has joined the Institute of Medicine and other leading professional organizations in support of “opt-out” HIV screening. With this testing approach, the patient is notified that HIV testing will be performed as a routine part of gynecologic and obstetric care, and written consent is not required. As part of this method, the patient is also given the opportunity to decline testing. According to ACOG, this approach helps to reduce barriers to testing that may result from extensive counseling or from perceptions of stigmatization associated with HIV status or at-risk groups.

The new guidelines also state that, because the recommended population for HIV testing includes adolescents, it is important to have practices in place to assist young patients. This includes a process of discussing safe-sex practices, risk factors, and behaviors that may lead to HIV exposure. Currently, some states allow minors to access HIV testing in a confidential fashion without disclosing testing or results to a parent or guardian.

The development of rapid HIV tests is another mechanism to support HIV testing and management, ACOG says. Until recently, HIV testing was performed using the repeatedly reactive enzyme immunoassay followed by a confirmatory Western blot or immunofluorescence assay. Although these tests are accurate, the results are not available for 24 to 48 hours after testing.

In contrast, the results of a rapid HIV screening test are available quickly, ideally within 1 hour. Rapid tests include point-of-care tests performed outside a laboratory (e.g., oral swab testing done in an outpatient setting) as well as testing performed in a laboratory. The tests currently approved by the FDA range in specificity from 93% to 100%, with a sensitivity of 98.6% to 100%. Therefore, ACOG considers rapid testing to be a feasible and acceptable approach for an HIV screening program in an obstetric–gynecologic practice.

Source: Obstetrics & Gynecology; May 2014.

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