Routine testing for HIV – Individuals presenting for care

Recommendation
Offer an HIV test for all individuals 18-70 years of age in your practice. For patients over 70 whose HIV status is not known, test once and then test if indicated by one of the considerations below.

Frequency
After an initial HIV test in all patients, repeat HIV test at a frequency of every five years, or earlier if another indication for HIV testing is identified. The optimum frequency of testing in British Columbia’s population is not yet determined, and the recommended frequency may change over time.

Some populations in BC are at increased vulnerability and experience a higher burden of HIV infection and morbidity.

Offer patients who are members of these populations HIV testing annually, or earlier if another indication for HIV testing is identified. These populations include:
- Gay men
- People who inject drugs
- People who work in the sex trade
- People from endemic countries*
- Aboriginal people**

In Practice
Offer an HIV test when doing blood work for another reason
Offer as part of new patient intake
Offer when you do not have an HIV result for your patient in
the past five years

* In 2014 countries where HIV is endemic include countries of the Caribbean and Sub-saharan Africa.
** BC’s Aboriginal population, like other populations with a higher burden of disease, is diverse and has a range of HIV prevalence. As with other populations having a higher burden, recommendations on testing frequency may be subject to change.

CHANGE IN HEALTH STATUS

Recommendation
Offer an HIV test to all patients, including those over 70 and youth, whenever ordering diagnostic blood-work for a new or worsening medical condition.

Frequency
As clinically indicated

In Practice
As HIV can have an array of nonspecific presentations, include HIV infection in the differential diagnosis for all patients, whether or not an individual risk for HIV acquisition has been identified. This includes when
a) a patient presents with symptoms that warrant laboratory investigation. Such conditions include but are not limited to; fever of unknown origin, mononucleosis-like syndrome, pneumonia, unexplained weight loss, unexplained hematological abnormality, and fatigue or failure to thrive.
b) a patient presents with symptoms associated with HIV infection or immune compromise. These symptoms include, but are not limited to lymphadenopathy, herpes zoster, recurrent and/or chronic herpes simplex infection, anogenital warts, anal cancer, cervical cancer, molluscum contagiosum, unexplained or recalcitrant prolonged diarrhea, unexplained peripheral neuropathy, Bell’s palsy, oral candidiasis, oral hairy leukoplakia, seborrheic dermatitis, fungal infections, recurrent bacterial infections (e.g. cellulitis, folliculitis, pneumonia, bronchitis), unexplained dementia, aseptic meningitis, B-cell lymphoma, Kaposi’s sarcoma or opportunistic infection indicative of immunodeficency.

Individual Risk Triggered Testing

Recommendation
Offer an HIV test to all patients, including youth and people over 70 years of age, when a risk for HIV infection is identified
Offer an HIV test every time you test for or diagnose:
- A sexually transmitted infection
- Hepatitis C
- Hepatitis B
- Tuberculosis

Frequency
As clinically indicated by an identified risk

If an ongoing risk is present, test every 3-6 months

After an incarceration

If a recent high-risk exposure has occurred, or acute HIV infection is suspected, repeat at 4 and 12 weeks

In Practice
If a recent high-risk exposure has occurred, or acute HIV infection (seroconversion) is suspected, indicate “query acute HIV” on the test requisition

Patient initiated testing

Recommendation
Order an HIV test whenever a patient requests it

Frequency
Whenever a patient asks

In Practice
Individuals may not disclose their reasons (or their risks) for testing for HIV. Eliciting these reasons or risks may be a barrier to testing

Antenatal screening for HIV

Recommendation
Offer an HIV test as part of routine antenatal care for all patients

Frequency
Once for every pregnancy
If at ongoing risk, repeat in the third trimester