Suspecting acute HIV infection: signs or symptoms of acute HIV infection with recent (within 2–6 wk) high HIV risk exposurea
Signs/symptoms/laboratory findings can include but are not limited to ≥1 of the following: fever, lymphadenopathy, skin rash, myalgia/arthralgia, headache, diarrhea, oral ulcers, leucopenia, thrombocytopenia, transaminase elevation, aseptic meningitis
High-risk exposures include sexual contact with a person infected with HIV or at risk of HIV, sharing of injection drug use paraphernalia, or contact of potentially infectious blood with mucous membranes or breaks in skina
↵a In some settings, behaviors conducive to acquisition of HIV infection might not be ascertained or might not be perceived as “high risk” by the health care provider, the patient, or both. Thus, symptoms and signs consistent with acute retroviral syndrome should motivate consideration of this diagnosis even in the absence of reported high-risk behaviors.
↵b p24 antigen or HIV RNA assay. The p24 antigen is less sensitive but more specific than HIV RNA tests; HIV RNA tests are generally preferred. HIV RNA tests include quantitative branched DNA (bDNA) or reverse-transcriptase polymerase chain reaction (RT-PCR) or qualitative transcription-mediated amplification (APTIMA [GenProbe, San Diego, CA]).
Data source: modified from Panel on Antiretroviral Guidelines for Adults and Adolescents. Department of Health and Human Services. Guidelines for the use of antiretroviral agents in HIV-1-infected adults and adolescents. Available at: www.aidsinfo.nih.gov/ContentFiles/AdultandAdolescentGL.pdf.
CDC Recommendations on Consent and Pretest Information
Screening should be voluntary and undertaken only with the patient's knowledge and understanding that HIV testing is planned
Patients should be informed verbally or in writing that HIV testing will be performed unless they decline (opt-out screening). Verbal or written information should include an explanation of HIV infection and the meanings of positive and negative test results, and the patient should be offered an opportunity to ask questions and to decline testing. With such notification, consent for HIV screening should be incorporated into the patient's general informed consent for medical care on the same basis as are other screening or diagnostic tests; a separate consent form for HIV testing is not recommended
Easily understood informational materials should be made available in the languages of the commonly encountered populations within the service area. The competence of interpreters and bilingual staff to provide language assistance to patients with limited English proficiency must be ensured
If a patient declines an HIV test, the decision should be documented in the medical record
Data source: Branson BM, Handsfield HH, Lampe MA, et al; Centers for Disease Control and Prevention. MMWR Recomm Rep. 2006;55(RR-14):1–17.4