• Screen for immunity to hepatitis A; vaccinate those not immune

• Negative

• Offer hepatitis A vaccine if indicated. (See chapter Immunizations for HIV-Infected Adults and Adolescents.)

• Positive

• Immune; no vaccine necessary.

• Indicates active hepatitis B

• sAg negative

• Most likely, no chronic infection (may be falsely negative).
• Vaccinate if HBsAb negative (not immune).

• sAg positive

• Indicates chronic or acute hepatitis B infection; requires further evaluation (check HBV DNA). (See chapter Hepatitis B Infection.)

• Indicates past infection or ongoing infection

• Anti-HBc negative

• The patient most likely has not been infected with hepatitis B; consider vaccination if HBsAb negative and HBsAg negative.

• Anti-HBc positive

• The patient most likely has been infected with hepatitis B; this test alone does not distinguish past exposure and active infection.
• In rare cases, may be falsely negative in some patients with chronic infection.
• If sAb negative and sAg negative, check HBV DNA to rule out active infection; vaccinate if HBV DNA is not detected.
• If sAb is positive, patient is immune.

• Indicates immunity status

• Anti-HBs negative

• The patient is not immune to hepatitis B; consider vaccination, unless patient has active hepatitis (sAg positive or HBV DNA positive).

• Anti-HBs positive

• The patient is immune to hepatitis B either by previous infection or by immunization; may be negative in acute hepatitis B infection.

• Hepatitis C status

• HCV negative

• Patient is not infected with hepatitis C.
• Screen at baseline; consider annual screening for high-risk patients, and if clinically indicated.

• HCV positive

• Patient has chronic hepatitis C infection or past infection with spontaneous clearance (no protective immunity); confirm positive results with HCV RNA.

• Detects past exposure; if positive, patient has increased risk of developing CNS toxoplasmosis if CD4 count <100 cells/µL

• Negative

• Repeat if patient becomes symptomatic or when CD4 count drops to ≤100 cells/µL.

• Positive

• Note as baseline information.
• Start toxoplasmosis prophylaxis if CD4 count drops to ≤100 cells/µ.

Tuberculosis (TB) Screening

TST (Tuberculin Skin Test) or IGRA (Interferon-Gamma Release Assay) (if no history of TB or positive TB screening test in the past)

• Detects latent TB infection (LTBI)

• Normal

• Repeat every 12 months if high risk of repeated or ongoing exposure.
• Repeat if CD4 count was <200 cells/µL on initial test but increases to >200 cells/µL on ART.

• Abnormal (TST induration ≥mm or positive IGRA)

• Evaluate for active TB. (See chapter Latent Tuberculosis Infection.)

• Detects latent or active diseases

• Normal

• Repeat as indicated for pulmonary symptoms or positive LTBI test.

• Abnormal

• Evaluate for TB, PCP, or other pathology.

• Detects abnormal cell changes, dysplasia

• Normal

• Cervical: Repeat in 6 months, then annually if negative on two tests and no ongoing risk factors.
• Anal: No national guidelines; consider screen at baseline. Follow-up interval has not been determined; consider same as in cervical Pap screening.

• Abnormal

• Perform workup, treat (see chapters Cervical Dysplasia and Anal Dysplasia) and follow up as indicated by condition.

• Indicates pregnancy status

• Positive/negative

• Perform before starting efavirenz (given risk of teratogenicity).
• If positive, consider ART initiation; avoid efavirenz in first trimester (see chapters Reducing Perinatal HIV Transmission and Care of HIV-Infected Pregnant Women).

Serum VDRL (Venereal Disease Research Laboratory) or RPR (Rapid Plasma Reagin)

(some centers screen using a treponemal test)

• Screen for syphilis at least annually in sexually active persons who are at risk; for men who have sex with men (MSM) with multiple partners: every 3-6 months

• Negative/nonreactive

• Counsel about safer sex and avoiding STDs.
• Repeat every 3-12 months, depending on risk factors.

• Positive/reactive: confirm with treponemal test

• Treat patient; refer partner(s) for evaluation and treatment; counsel about safer sex. (See chapter Syphilis.)
• Perform serial testing if monitoring active disease. (See chapter Syphilis.)

Screen all sites of possible exposures:

• Pharynx (recommended for GC screening)
• Cervix/vagina
• Rectum

• Negative

• Counsel about safer sex and avoiding STDs.
• Repeat every 6-12 months; more frequently if at high risk (e.g., adolescents).

• Positive

• Treat patient; refer partner(s) of previous 60 days for evaluation and treatment; counsel about safer sex.
• Retest at 3 months.

• Wet mount (insensitive), culture or nucleic acid amplification test (NAAT) of vaginal secretions
• Screen HIV-infected women annually

• Negative

• Counsel about safer sex and avoiding STDs.
• Repeat every 12 months.

• Positive

• Treat patient; refer partner(s) for evaluation and treatment; counsel about safer sex.
• Retest at 3 months.

• Screen for STDs in sexually active men who are at risk according to CDC guidelines, especially MSM
• Screen all MSM at baseline and at least annually; frequency of subsequent testing depends on risk factors
• Screen sites of possible exposures:
• Pharynx, if receptive oral sex (recommended for GC screening)
• Rectum, if receptive anal sex
• Urethra for MSM, if insertive oral or anal sex

• Negative

• Counsel about safer sex and avoiding STDs.
• Retest every 3-12 months, depending on risk factors.

• Positive

• Treat; refer partner(s) of previous 60 days for evaluation and treatment; counsel about safer sex.
• Retest at 3 months.

• Prevent hemolytic reactions to certain medications by screening higher-risk patients (African, Mediterranean, Asian, Sephardic Jewish descent); some would recommend screening all patients

• Normal range

• No intervention is necessary beyond documentation.

• Abnormal range

• Avoid oxidant drugs such as dapsone, primaquine, and sulfonamides, if possible.

• Detects exposure; may reveal future disease risk

• Negative

• Avoid exposure by practicing safer sex.
• If blood transfusion is required, use CMV-negative or leukocyte-reduced blood.

• Positive

• Be aware of disease risk in advanced HIV infection, when CD4 count is <50 cells/µL.

• Detects exposure

• Negative

• Consider vaccination, if CD4 count is >200 cells/µL.

• Positive

• No intervention is necessary.

• Detects CMV, ophthalmic toxoplasmosis, or HIV retinopathy

• Normal

• If CD4 count is >100 cells/µL, repeat annually.
• If CD4 count is <50 cells/µL or symptoms of retinal changes are present, repeat every 6 months.

• Abnormal

• Follow up immediately with ophthalmologist.