Dr. Ron’s Research Review – August 9, 2017

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This week’s research review focuses on HIV Screening

A 19-year-old woman presents to the university health clinic for a well-woman examination. She reports no problems and mentions that she is sexually active with one male partner, who usually uses condoms. She has never been screened for a sexually transmitted infection. (Lee, 2014)

Case Study Questions

1. Based on the recommendations of the U.S. Preventive Services Task Force (USPSTF), what additional information about this patient is needed to determine whether she should be screened for human immunodeficiency virus (HIV) infection?

A. She has volunteered at a homeless shelter for the past year.
B. She reports marijuana use in the previous month.
C. Her mother was recently diagnosed with tuberculosis.
D. Her sex partner was recently diagnosed with chlamydial infection.
E. No additional information is needed; the patient should be screened.

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2. The patient asks whether her older sister, who is pregnant with her second child, should be screened for HIV infection. According to the USPSTF’s recommendations, which one of the following statements is correct?

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A. She does not need to be screened if she was tested during her first pregnancy and was found to be HIV-negative.
B. She does not need to be screened if she was already tested during her second pregnancy and was found to be HIV-negative, and if she has not been at increased risk since the screening test.
C. She does not need to be screened if she has no current risk factors for HIV infection.
D. She does not need to be screened if her husband was recently found to be HIV- negative.

 

3. A medical student who is present during the examination later asks about the benefits and harms of antiretroviral therapy. According to the USPSTF’s recommendations, which one of the following is true?

A. Antiretroviral therapy can cure chronic HIV infection.
B. Antiretroviral therapy can reduce the risk of HIV transmission among men who have sex with men.
C. In patients with HIV infection who have immunologically advanced disease, antiretroviral therapy can reduce risk of progression to AIDS, AIDS-related events, and death.
D. Antiretroviral therapy has no adverse effects.

Answers

1. E. The USPSTF recommends that clinicians screen for HIV infection in all adolescents and adults 15 to 65 years of age.
2. B. The USPSTF recommends that clinicians screen all pregnant women for HIV infection
3. C. The USPSTF found convincing evidence that identification and treatment of HIV infection are associated with a markedly reduced risk of progression to AIDS, AIDS-related events, and death in persons with HIV infection who have immunologically advanced disease.

Primary HIV infection should be considered, and an HIV test offered to all patients with a mononucleosis-like illness, according to the UK Guidelines. (Rayment et al., 2014)
Twelve of the 37 non-AIDS indicator conditions were significantly associated with subsequent HIV diagnosis; most strongly were bacterial pneumonia (odds ratio 47.7, 95% confidence interval 5.6 to 404.0), oral candidiasis (29.4, 6.9 to 125.5), and herpes zoster (25.4, 8.4 to 76.1). Signs and symptoms most associated with HIV were weight loss (13.4, 5.0 to 36.0), pyrexia of unknown origin (7.2, 2.8 to 18.7), and diarrhea (one or two consultations). Notably, 74.2% of HIV cases (n=697) presented with none of the HIV indicator conditions before diagnosis. (Rayment et al., 2014)
The most important predictor of primary HIV infection being diagnosed is suspicion by the patient or clinician. (Rayment et al., 2014)

 

Dr. Ron

 


Articles

 

Screening for HIV.
            (Lee, 2014) Download
Case Study A 19-year-old woman presents to the university health clinic for a well-woman examination. She reports no problems and mentions that she is sexually active with one male partner, who usually uses condoms. She has never been screened for a sexually transmitted infection.

Screening for HIV: U.S. Preventive Services Task Force Recommendation Statement.
            (Moyer and U.S., 2013) Download
DESCRIPTION:  Update of the 2005 U.S. Preventive Services Task Force (USPSTF) recommendation statement on screening for HIV. METHODS:  The USPSTF reviewed new evidence on the effectiveness of treatments in HIV-infected persons with CD4 counts greater than 0.200 × 109 cells/L; effects of screening, counseling, and antiretroviral therapy (ART) use on risky behaviors and HIV transmission risk; and long-term cardiovascular harms of ART. POPULATION:  These recommendations apply to adolescents, adults, and pregnant women. RECOMMENDATION:  The USPSTF recommends that clinicians screen adolescents and adults aged 15 to 65 years for HIV infection. Younger adolescents and older adults who are at increased risk should also be screened. (Grade A recommendation)The USPSTF recommends that clinicians screen all pregnant women for HIV, including those who present in labor who are untested and whose HIV status is unknown. (Grade A recommendation).

HIV testing and management of newly diagnosed HIV.
            (Rayment et al., 2014) Download
The purpose of this review is to provide an evidence based summary to support primary and secondary care clinicians in delivering HIV testing and to guide them in the initial management of patients with newly diagnosed HIV infection. Routine testing is recommended for all patients presenting to any healthcare service if they belong to a higher risk group, have certain medical conditions (known as HIV indicator conditions), or are accessing care in certain clinical and geographical settings.

 


References

Lee, KC (2014), ‘Screening for HIV.’, Am Fam Physician, 89 (8), 665-66. PubMed: 24784126
Moyer, VA and Preventive Services Task Force U.S. (2013), ‘Screening for HIV: U.S. Preventive Services Task Force Recommendation Statement.’, Ann Intern Med, 159 (1), 51-60. PubMed: 23698354
Rayment, M, D Asboe, and AK Sullivan (2014), ‘HIV testing and management of newly diagnosed HIV.’, BMJ, 349 g4275. PubMed: 25005147