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 considered a common critical risk factor for progression from latent TB infection to active TB disease.
- Progression to TB disease is often rapid among HIV-infected persons and can be fatal.
- Rapid progressive expansion of TB outbreaks can occur in HIV-infected patient groups.
- Because many individuals do not perceive themselves to be at risk for HIV or do not disclose their risks, the targeted HIV testing based on physician assessment of patient risk behaviors fails to detect a large number of individuals who have HIV infection.
- Routine HIV testing may decrease the stigma linked to testing.
- With early diagnosis of HIV, appropriately timed interventions can slow the disease progression, reduce the mortality rate, and improve the outcome and quality of life.
- 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
- According to CDC, HIV screening is recommended for all TB patients after the patient is notified that testing will be done, 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.
- Individuals who are at high risk for HIV infection should perform at least annual HIV screening.
- Prevention counseling and separate written consent for HIV testing are no longer be necessary.
What is Opt-Out Screening?
Opt-out screening refers to HIV testing after patient notification that the test will be done, and although the patient may decline or defer testing, it is highly recommended.