What is the significance of early Human Immunodeficiency Virus (HIV) screening in preventing the development of Acquired Immunodeficiency Syndrome (AIDS)?

From the Guidelines

Early Human Immunodeficiency Virus (HIV) screening is crucial in preventing the development of Acquired Immunodeficiency Syndrome (AIDS), as it enables timely treatment and reduces the risk of transmission to others.

Key Points

• The US Preventive Services Task Force (USPSTF) and the Centers for Disease Control and Prevention (CDC) recommend routine HIV screening for all adults and adolescents at increased risk for HIV infection, as well as all pregnant women 1.
• Risk-based screening has been shown to be ineffective in identifying a substantial proportion of people with HIV, as many individuals are unaware of their risk factors or do not disclose them 1.
• Routine opt-out screening has been widely implemented and highly successful in prenatal HIV screening, with high acceptance rates among women and significant reductions in mother-to-child transmission 1.
• Cost-effectiveness analyses have demonstrated that HIV screening is cost-effective, even at low prevalence rates, with a cost-effectiveness ratio of $50,000 per quality-adjusted life-year (QALY) gained 1.
• Early identification and treatment of HIV infection can substantially reduce the risk of AIDS-related clinical events and death, with a decrease in transmission to others through changes in risk behavior and suppression of viral load through treatment 1.

Screening Recommendations

• The CDC recommends routine screening of all adults unless the prevalence of undiagnosed HIV in the patient population or health care setting is less than 0.1% 1.
• High-risk patients, including men who have sex with men, injection drug users, and individuals with multiple sexual partners, should be screened at least annually 1.
• Pregnant women should be screened during each pregnancy, as recommended by the USPSTF, CDC, and American College of Obstetricians and Gynecologists 1.
• Older patients may also benefit from screening, particularly if they have ongoing risk factors for HIV infection, with a cost-effectiveness analysis suggesting that screening up to age 75 years may be cost-effective in certain populations 1.

From the Research

Importance of Early HIV Screening

• Early Human Immunodeficiency Virus (HIV) screening is crucial in preventing the development of Acquired Immunodeficiency Syndrome (AIDS) 2, 3.
• The first HIV antibody test was developed in 1985, and since then, there have been significant advancements in HIV diagnostic testing, reducing the test-negative window to approximately 2 weeks postexposure 2.
• Early detection of HIV infection enables timely initiation of antiretroviral therapy (ART), which can limit viral reservoirs, improve immune cell function, and reduce the chance of HIV transmission 3.

Benefits of Early ART Initiation

• Initiating ART in the early stage of HIV infection can improve treatment outcomes and reduce the AIDS-related disease burden 3.
• Early ART initiation can also reduce the viral load, making it easier to achieve viral suppression and prevent transmission to others 3, 4.
• Combining early ART initiation with other treatment strategies can help achieve a functional cure for HIV infection 3.

Challenges and Future Directions

• Despite the importance of early HIV screening and ART initiation, there are still challenges in implementing these strategies, including personal and social factors 3.
• Optimizing the implementation of existing interventions for HIV prevention and treatment, along with the development of new and innovative approaches, is necessary to end the HIV pandemic 4.
• Continued education of healthcare personnel and the public is essential to address the ongoing challenges in HIV prevention and treatment 5, 4.