3.0 Indications for HIV Testing

Posted in: HIV

HIV testing is indicated in a number of contexts:

  • clinical suspicion of HIV infection, a full list is available here:
    • an opportunistic infection (including tuberculosis)
    • HIV- linked malignancy
    • symptoms and signs consistent with primary HIV infection (e.g. mononucleosis-like syndrome)
    • other HIV indicator conditions (e.g. immune thrombocytopenia)
  • inclusion of HIV within the differential diagnosis
  • diagnosis of a condition with shared transmission route:
    • sexually transmitted infection (STI)
    • hepatitis B or C
  • reported high-risk exposure
  • unprotected sexual intercourse with a partner whose HIV status is unknown
  • reported reuse of equipment used for skin penetration
  • in the setting of contact tracing
  • as an early identification and/or prevention initiative e.g. tests based on epidemiological considerations or the opportunity to prevent vertical transmission
    • gay men and other men who have sex with men
    • people who inject drugs
    • people with multiple sex partners/recent partner change
    • people having travelled to countries of high prevalence and engaged in risk behaviour
    • people from high-prevalence countries
    • partners of the above
    • partners of PLHIV
    • pregnant women
    • people who have received a blood transfusion or blood products prior to 1985 in Australia, or from overseas
  • a patient-initiated request to a health care service for an HIV test (see Background Document to 2011 National HIV Testing Policy v1.2)
  • a patient who reports having a reactive result on an unlicensed HIV test
  • health care workers conducting exposure prone procedures. See infection control guidelines and the Communicable Diseases Network Australia (CDNA) policy on infected health care workers (see section 11.0 Post-Exposure Prophylaxis)
  • in the context of post-exposure prophylaxis which is subject of national and jurisdictional guidelines and policy (see section 11.0 Post-Exposure Prophylaxis)

Jurisdictions should develop guidelines and protocols, based on local epidemiology and demographic data to facilitate testing among populations at higher risk or requiring additional assistance to access testing and related services, for example Aboriginal and Torres Strait Islander communities, culturally and linguistically diverse (CALD) populations and people with cognitive or intellectual disabilities.

3.1 Clinical indications

HIV-related illness can affect any organ system, and the clinical features can overlap with a range of other potential diagnoses. HIV testing should be offered in any clinically indicated scenario. A list of clinically relevant conditions can be found here.

All people with HIV should be tested for tuberculosis, and all people with tuberculosis should be tested for HIV

3.2 Risk assessment and indications for testing

A sexual, drug use and past medical history should be conducted to assist in determining whether an HIV test is indicated. Epidemiology in Australia (and country of origin) and the identification of known risk factors will influence the decision to test. The absence of an identified epidemiological or behavioural risk factor should not preclude HIV testing in appropriate clinical circumstances.

3.3 Contact tracing

The practitioner organising HIV testing and/or conveying the result of testing has the responsibility to ensure that appropriate contact tracing is initiated.

3.4 Screening

Screening refers to performing an HIV test for all persons in a defined population.

There is evidence that significant numbers of people in higher-risk populations may be testing less frequently because of the need to return for their test results. The 2011 HIV Testing Policy allows negative test results to be delivered through non face-to-face communication under certain circumstances (see section 5.0 Conveying HIV Test Results) as well as the use of PoC testing for screening purposes (see section 13.0 Point of Care Tests for HIV in Community Settings).

3.5 Patient-initiated testing in the absence of indications

A small number of people will request a test but will not disclose risk factors. In this case, a person’s preference not to disclose risk factors should be recognised and HIV testing should be conducted.

3.6 Post-exposure prophylaxis (PEP)

Testing carried out as part of the process of PEP must comply with non-occupational and occupational PEP policies and any relevant state guidelines or operational directives. All testing conducted as part of a prophylaxis protocol should meet the principles and conditions of this policy.

3.7 Pre-operative testing

Routine pre-operative testing for HIV is not supported and should not be performed.

In a person with an identified risk of HIV infection and/or clinical indications of infection, pre-operative HIV testing should be performed only if it will benefit the patient and informed consent has been obtained.

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