Screening for HIV and Treatment of Acquired Immunodeficiency

Board Approved: August 2007

Overall philosophy: Virtually every clinician has seen or will see patients who are infected with HIV. Family physicians should be prepared to provide screening, diagnosis, sources for consultation or referral, and education and counseling to patients and their families. The AAFP encourages its members to provide medical care to HIV-infected patients either through direct provision of care, in consultation with consultants, or by referral. The AAFP opposes any form of discrimination against individuals who are infected with HIV.

Medical education: All medical schools and family medicine residency programs should ensure that students and residents are educated about appropriate blood and body fluid precautions, and should have protocols in place that reduce exposure to HIV-infected body fluids. These protocols must include the availability of post-exposure prophylaxis.

Continuing medical education: The AAFP strongly encourages family physicians to participate in CME activities/programs that support their ability to skillfully diagnose, treat and coordinate the care of patients, and their families, who are HIV-positive, who are at risk for HIV infection, and/or who have AIDS.

Prevention strategies: The AAFP encourages the following strategies:

Reducing sexual transmission of HIV by encouraging abstinence, mutually monogamous relationships with an uninfected partner, use of condoms (either male or female), and/or practice of safe sex.
Reducing blood-borne transmission of HIV in medical settings by taking appropriate precautions with blood and body fluids, using safety needles, and screening all blood and organ donors.
Reducing parenteral transmission of HIV among injection drug users by promoting harm reduction techniques and appropriate treatment of infected individuals.
Reducing maternal to child transmission of HIV through universal screening of pregnant women as early as possible in the pregnancy and timely interventions for those who are positive including antiretroviral medications, scheduled caesarean delivery, avoidance of counsel against breast feeding, and providing treatment of the newborn at the time of delivery.
Reducing the transmission of HIV by screening for high-risk behaviors, communicating prevention messages, identifying and treating substance abuse and sexually transmitted diseases (STDs), and facilitating partner notification, counseling and testing.

HIV testing: The AAFP recommends the following groups be considered high priority for HIV testing:

Pregnant women: The AAFP recommends HIV testing for all pregnant women. Recognizing the patient’s right to refuse testing, the AAFP recommends an “opt out” approach. In the instance where a mother is not tested as part of prenatal care, rapid testing at the time of delivery should be offered. If the mother’s status is unknown postpartum, rapid testing of the newborn is recommended. (http://www.aafp.org/online/en/home/clinical/exam/f-j.html and http://www.cdc.gov/mmwr/PDF/rr/rr5514.pdf. (24-page PDF file; About PDFs)
Persons at high risk: The AAFP strongly recommends HIV testing in the following groups (http://www.aafp.org/online/en/home/clinical/exam/f-j.html):
1. Men who have had sex with men after 1975;
2. Men and women who have unprotected sex with multiple partners;
3. Past or present injection drug users;
4. Men and women who exchange sex for money or drugs, and their sex partners;
5. Persons whose past or present sex partners were HIV-positive, or who are or were injection drug users;
6. Persons who are entering or leaving the prison/correctional system;
7. Persons being treated for STDs;
8. Women who have sex with men who also are MSM;
9. Persons who request an HIV test despite reporting no individual risk factors may also be considered at increased risk, since this group is likely to include individuals who are not willing to disclose high-risk behaviors.
10. Persons who received a blood transfusion between 1978 and 1985.
The AAFP recommends that HIV testing should be done at periodic intervals, preferably annually, for those at increased risk (a-i above). (http://www.aafp.org/online/en/home/clinical/exam/f-j.html)
The AAFP recommends that routine (voluntary) HIV testing be offered in clinical settings where the prevalence of HIV infection is high, such as emergency rooms, STD clinics, acute care clinics, clinics in correctional facilities and homeless shelters, tuberculosis treatment clinics, drug treatment facilities, and family medicine clinics in high prevalence areas. (http://www.aafp.org/online/en/home/clinical/exam/f-j.html). In some of these settings the use of rapid tests may substantially decrease the number of persons who fail to learn their test results.
The AAFP also recommends the adoption in medical settings of HIV testing procedures that do not require special written informed consent or face–to-face prevention counseling before testing as well as procedures that allow HIV negative test results to be conveyed without direct personal contact between patient and physician. (http://www.cdc.gov/mmwr/PDF/rr/rr5514.pdf [24-page PDF file; About PDFs])

Treatment: The following are AAFP’s policies for treatment of patients who are infected with HIV and/or who have AIDS:

The allocation of governmental and other resources for HIV screening, counseling and treatment should recognize the need for persons of all backgrounds, ages, sexes, and ethnic and racial groups to receive compassionate and medically appropriate treatment, regardless of health insurance status. The allocation of resources for diagnosis and treatment should recognize rural and underserved areas as well as urban epicenters. The AAFP supports the compassionate use of anti-retroviral drugs still in research protocol and recognizes the importance of the use of these drugs by patients of family physicians.

These recommendations are provided only as assistance for physicians making clinical decisions regarding the care of their patients. As such, they cannot substitute for the individual judgment brought to each clinical situation by the patient’s family physician. As with all reference resources, they reflect the best understanding of the science of medicine at the time of publication, but they should be used with the clear understanding that continued research may result in new knowledge and recommendations.