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Screening and diagnostic testing for HIV infection

John G Bartlett, MD
Paul E Sax, MD
Section Editor
Martin S Hirsch, MD
Deputy Editor
Howard Libman, MD, FACP


Nearly 15 percent of HIV-infected persons in the United States remain unaware of their HIV infection, leading to significant morbidity and the risk of further transmission to others. Improved access to HIV testing and new testing algorithms can decrease the number of individuals who present with advanced immunocompromise, enhance the detection of newly infected individuals, and reduce transmission to others.

This topic will address screening and diagnostic testing for HIV infection in adults in clinical care settings. Detailed information about screening for HIV in the blood supply, the diagnosis of HIV infection in children, and the diagnosis of HIV infections in patients presenting with symptoms of acute infection are found elsewhere. (See "Blood donor screening: Laboratory testing", section on 'Infectious disease screening' and "Diagnostic testing for HIV infection in infants and children younger than 18 months" and "Acute and early HIV infection: Clinical manifestations and diagnosis".)


HIV testing should be performed to diagnose HIV in patients with clinical signs and symptoms of acute or chronic infection as well as those with a possible exposure to HIV. HIV testing should also be incorporated into routine screening of healthy individuals, including pregnant women.

Symptoms of HIV infection — All patients with signs and symptoms of acute or chronic HIV infection should be tested. For patients presenting with clinical manifestations of acute HIV infection, testing for HIV RNA may be needed. A detailed discussion of the clinical manifestations of HIV infection is found elsewhere. (See "The natural history and clinical features of HIV infection in adults and adolescents".)

Possible HIV exposure — Patients who present after a known high-risk exposure to HIV (eg, sexual or percutaneous) should be tested for HIV infection and assessed for post-exposure antiretroviral therapy (ART). Such patients should then have follow-up testing over the course of four to six months (depending upon the type of test that is used). Topic reviews that discuss risk factors for HIV transmission and the use of post-exposure prophylaxis are found elsewhere. (See "HIV infection: Risk factors and prevention strategies", section on 'Risk factors for infection' and "Management of nonoccupational exposures to HIV and hepatitis B and C in adults" and "Management of healthcare personnel exposed to HIV".)

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Literature review current through: Nov 2017. | This topic last updated: Sep 05, 2017.
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