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1. HIV: When to test for HIV

Late diagnosis is the most important predictor of morbidity and mortality among those with HIV infection (with a CD4 cell count <350 cells/mm3 within three months of diagnosis).

Please see the HIV Indicator Conditions: Guidance for Implementing HIV Testing in Adults in Health Care Settings (coordinated by the HIV in Europe Secretariat) below:

1. Conditions which are AIDS defining = Strongly recommend testing:

Neoplasms

  • Cervical cancer
  • Non-Hodgkin lymphoma
  • Kaposi’s sarcoma

Bacterial infections

  • Mycobacterium Tuberculosis, pulmonary or extrapulmunary
  • Mycobacterium avium complex (MAC) or Mycobacterium kansasii, disseminated or extrapulmonary
  • Mycobacterium, other species or unidentified species, disseminated or extrapulmunary
  • Pneumonia, recurrent (2 or more episodes in 12 months)
  • Salmonella septicaemia, recurrent

Viral infections

  • Cytomegalovirus retinitis
  • Cytomegalovirus, other (except liver, spleen, glands)
  • Herpes simplex, ulcer(s) > I month/bronchitis/pneumonitis
  • Progressive multifocal leucoencephalopathy

Parasitic infections

  • Cerebral toxoplasmosis
  • Cryptosporidiosis diarrhoea, > 1 month
  • Isosporiasis, > 1 month
  • Atypical disseminated leismaniasis
  • Reactivation of American trypanosomiasis (meningoencephalitis or myocarditis)

Fungal infections

  • Pneumocystis carinii pneumonia
  • Candidiasis, oesophageal
  • Candidiasis, bronchial/ tracheal/ lungs
  • Cryptococcosis, extra-pulmonary
  • Histoplasmosis, disseminated/ extra pulmonary
  • Coccidiodomycosis, disseminated/ extra pulmonary
  • Penicilliosis, disseminated

Conditions associated with an undiagnosed HIV prevalence of >=0.1% = Strongly recommend testing:

  • Sexually transmitted infections
  • Malignant lymphoma
  • Anal cancer/dysplasia
  • Cervical dysplasia
  • Herpes zoster
  • Hepatitis B or C (acute or chronic)
  • Unexplained lymphadenopathy
  • Mononucleosis-like illness
  • Community-acquired pneumonia
  • Unexplained leukocytopenia/thrombocytopenia lasting >4 weeks
  • Seborrheic dermatitis/exanthema
  • Invasive pneumococcal disease
  • Unexplained fever
  • Candidaemia
  • Visceral leishmaniasis
  • Pregnancy (implications for the unborn child)

Other conditions considered likely to have an undiagnosed HIV prevalence of >0.1%= Recommend testing:

  • Primary lung cancer
  • Lymphocytic meningitis
  • Oral hairy leukoplakia
  • Severe or atypical psoriasis
  • Guillain–Barré syndrome
  • Mononeuritis
  • Subcortical dementia
  • Multiplesclerosis-like disease
  • Peripheral neuropathy
  • Unexplained weightloss
  • Unexplained oral candidiasis
  • Unexplained chronic diarrhoea
  • Unexplained chronic renal impairment
  • Hepatitis A 
  • Candidiasis

Conditions where not identifying the presence of HIV infection may have significant adverse implications for the individual’s clinical management = offer testing:

  • Conditions requiring aggressive immuno-suppressive therapy:
    • Cancer
    • Transplantation
    • Auto-immune disease treated with immunosuppressive therapy
  • Primary space occupying lesion of the brain.
  • Idiopatic/Thrombotic thrombocytopenic purpura