Human Immunodeficiency Virus Infection

The Women’s Preventive Services Initiative (WPSI) recommends all adolescent and adult women, ages 15 and older, receive a screening test for human immunodeficiency virus (HIV) at least once during their lifetime. Earlier or additional screening should be based on risk, and rescreening annually or more often may be appropriate beginning at age 13 for adolescent and adult women with an increased risk of HIV infection.

The WPSI recommends risk assessment and prevention education for HIV infection beginning at age 13 and continuing as determined by risk.

A screening test for HIV is recommended for all pregnant women upon initiation of prenatal care with rescreening during pregnancy based on risk factors. Rapid HIV testing is recommended for pregnant women who present in labor with an undocumented HIV status.

The WPSI recommends, as a preventive service for women, prevention education and risk assessment for HIV infection in adolescent and adult women at least annually throughout the life span. Clinicians should consider the cultural and linguistic needs of individual patients, and prevention education should be respectful, affirming, and non- stigmatizing.

This recommendation refers to routine HIV screening tests, which are different from incident-based or exposure-based HIV tests. More frequent testing for high-risk women, as determined by clinical judgment, is also recommended as a preventive service. Annual or more frequent HIV testing may be needed and is recommended as a preventive service for women who are identified or self-identify as high risk. Risk factors for HIV infection in women include, but are not limited to, being an active injection drug user; having unprotected vaginal or anal intercourse; patient or patient’s sex partner(s) having more than one sex partner since last HIV test; initiating a new sexual relationship; having sexual partners who are HIV-infected, bisexual, or injection drug users; exchanging sex for drugs or money; being a victim of sex trafficking; being incarcerated now or in the past; and having other sexually transmitted infections (STIs).

Approximately 20–26% of infected patients are not identified by risk-based screening. Early detection and treatment improve outcomes for patients and reduce transmission; therefore, based on clinical best practice, screening annually or more frequently may be reasonable.

Additional recommendations about STI prevention education, counseling, and testing, along with recommendations about HIV preexposure prophylaxis (PrEP) are provided in the WPSI Sexually Transmitted Infection (STI) Counseling recommendation, the Recommendations for Well-Woman Care: A Well-Woman Chart, and the Clinical Summary Tables.

• Studies of the effectiveness of optimal screening intervals for HIV at various ages and for different risk groups.
• Studies of the effectiveness of repeat or alternative screening strategies during pregnancy on mother-to-child HIV transmission or maternal and infant clinical outcomes and harms.
• Studies of the effectiveness of risk assessment strategies in predicting HIV incidence relevant to screening.
• Research on long-term adverse effects of antiretroviral therapy on adolescents and women including adverse effects of prenatal use.