HIV coinfection with tuberculosis screening

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Screening

Importance of Screening

  • HIV infection is the most important known risk factor for progression from latent TB infection to TB disease.
  • Progression to TB disease is often rapid among HIV-infected persons and can be fatal.
  • In addition, TB outbreaks can rapidly expand in HIV-infected patient groups.
  • Targeted HIV testing based on provider assessment of patient risk behaviors fails to identify a substantial number of persons who are HIV infected. This is because many individuals may not perceive themselves to be at risk for HIV or do not disclose their risks.
  • Routine HIV testing also reduces the stigma associated with testing.
  • When HIV is diagnosed early, appropriately timed interventions can lead to improved health outcomes, including slower progression and reduced mortality.
  • Identifying TB patients, suspects, and contacts who are HIV infected allows for optimal TB testing of these groups and provides opportunities to prevent TB in those without disease.

Recommendations

  • CDC recommends HIV screening for all TB patients after the patient is notified that testing will be performed, unless the patient declines (i.e., opt-out screening).
  • Routine HIV testing is also recommended for persons suspected of having TB disease and contacts to TB patients.
  • Persons at high risk for HIV infection should be screened for HIV at least annually.
  • Prevention counseling and separate written consent for HIV testing should no longer be required.

What is Opt-Out Screening?

Opt-out screening is defined as performing HIV testing after notifying the patient that the test will be performed, and although the patient may decline or defer testing, it is strongly recommended.

References

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