PMID- 23165662
OWN - NLM
STAT- MEDLINE
DCOM- 20130128
LR  - 20220321
IS  - 1539-3704 (Electronic)
IS  - 0003-4819 (Linking)
VI  - 157
IP  - 10
DP  - 2012 Nov 20
TI  - Screening for HIV: systematic review to update the 2005 U.S. Preventive Services 
      Task Force recommendation.
PG  - 706-18
LID - 10.7326/0003-4819-157-10-201211200-00007 [doi]
AB  - BACKGROUND: A 2005 U.S. Preventive Services Task Force (USPSTF) review found good 
      evidence that HIV screening is accurate and that antiretroviral therapy (ART) for 
      immunologically advanced disease is associated with substantial clinical 
      benefits, but insufficient evidence to determine the effects on transmission or 
      in less immunologically advanced disease. PURPOSE: To update the 2005 USPSTF 
      review on benefits and harms of HIV screening in adolescents and adults, focusing 
      on research gaps identified in the prior review. DATA SOURCES: MEDLINE (2004 to 
      June 2012) and the Cochrane Library (through the second quarter of 2012). STUDY 
      SELECTION: Randomized trials and observational studies that compared HIV 
      screening strategies and reported clinical outcomes, evaluated the effects of 
      starting ART at different CD4 cell count thresholds and long-term harms, or 
      reported the effects of interventions on transmission risk. DATA EXTRACTION: 2 
      authors abstracted and checked study details and quality using predefined 
      criteria. DATA SYNTHESIS: No study directly evaluated the effects on clinical 
      outcomes of screening versus no screening for HIV infection. A randomized trial 
      and a subgroup analysis from a randomized trial found that ART initiation at CD4 
      counts less than 0.250 x 109 cells/L was associated with a higher risk for death 
      or AIDS-defining events than initiation at CD4 counts greater than 0.350 x 109 
      cells/L (hazard ratios, 1.7 [95% CI, 1.1 to 2.5] and 5.3 [CI, 1.3 to 9.6]). 
      Large, fair-quality cohort studies also consistently found that ART initiation at 
      CD4 counts of 0.350 to 0.500 x 109 cells/L was associated with lower risk for 
      death or AIDS-defining events than delayed initiation. New evidence from 
      good-quality cohorts with longer-term follow-up confirms a previously observed 
      small increased risk for cardiovascular events associated with certain 
      antiretrovirals. Strong evidence from 1 good-quality randomized trial and 7 
      observational studies found that ART was associated with a 10- to 20-fold 
      reduction in risk for sexual transmission of HIV. LIMITATIONS: Only 
      English-language articles were included. Observational studies were included. 
      Studies done in resource-poor or high-prevalence settings were included but might 
      have limited applicability to general screening in the United States. CONCLUSION: 
      Previous studies have shown that HIV screening is accurate, targeted screening 
      misses a substantial proportion of cases, and treatments are effective in 
      patients with advanced immunodeficiency. New evidence indicates that ART reduces 
      risk for AIDS-defining events and death in persons with less advanced 
      immunodeficiency and reduces sexual transmission of HIV. PRIMARY FUNDING SOURCE: 
      Agency for Healthcare Research and Quality.
FAU - Chou, Roger
AU  - Chou R
AD  - Oregon Health & Science University, 3181 Southwest Sam Jackson Park Road, Mail 
      Code BICC, Portland, OR 97239, USA. chour@ohsu.edu
FAU - Selph, Shelley
AU  - Selph S
FAU - Dana, Tracy
AU  - Dana T
FAU - Bougatsos, Christina
AU  - Bougatsos C
FAU - Zakher, Bernadette
AU  - Zakher B
FAU - Blazina, Ian
AU  - Blazina I
FAU - Korthuis, P Todd
AU  - Korthuis PT
LA  - eng
GR  - 290-2007-10057-I/PHS HHS/United States
PT  - Journal Article
PT  - Research Support, U.S. Gov't, P.H.S.
PT  - Review
PT  - Systematic Review
PL  - United States
TA  - Ann Intern Med
JT  - Annals of internal medicine
JID - 0372351
RN  - 0 (Anti-Retroviral Agents)
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Anti-Retroviral Agents/adverse effects/therapeutic use
MH  - CD4 Lymphocyte Count
MH  - Counseling
MH  - HIV Infections/drug therapy/immunology/*prevention & control/*transmission
MH  - Humans
MH  - *Mass Screening
MH  - Risk Assessment
MH  - Safe Sex
EDAT- 2012/11/21 06:00
MHDA- 2013/01/29 06:00
CRDT- 2012/11/21 06:00
PHST- 2012/11/21 06:00 [entrez]
PHST- 2012/11/21 06:00 [pubmed]
PHST- 2013/01/29 06:00 [medline]
AID - 1392192 [pii]
AID - 10.7326/0003-4819-157-10-201211200-00007 [doi]
PST - ppublish
SO  - Ann Intern Med. 2012 Nov 20;157(10):706-18. doi: 
      10.7326/0003-4819-157-10-201211200-00007.