Testing

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Antiretroviral Postexposure Prophylaxis After Sexual, Injection-Drug Use, or Other Nonoccupational Exposure to HIV in the United States -- Recommendations from the U.S. Department of Health and Human Services , MMWR 54 (RR02); 1-20,

2005-January-21

Recommendations addressing administration, risk and effectiveness of antiretrovirals in preventing HIV infection when taken soon after a risky sexual or intravenous exposure. From the Division of HIV/AIDS Prevention, National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention; National Institutes of Health; Food and Drug Administration; and the Health Resources and Services Administration. In addition to offering guidance to those experiencing sexual or intravenous exposure to HIV with a real risk of transmission, these guidelines are relevant to policy proposals on testing of sexual assault defendants. In those situations where drug therapy is an option, the guidelines state that treatment should be started immediately after exposure, and is not believed to be effective if initiated more than 72 hours after the exposure. From the recommendations summary: For persons seeking care <72 hours after nonoccupational exposure to blood, genital secretions, or other potentially infectious body fluids of a person known to be HIV infected, when that exposure represents a substantial risk for transmission, a 28-day course of highly active antiretroviral therapy (HAART) is recommended. Antiretroviral medications should be initiated as soon as possible after exposure. For persons seeking care <72 hours after nonoccupational exposure to blood, genital secretions, or other potentially infectious body fluids of a person of unknown HIV status, when such exposure would represent a substantial risk for transmission if the source were HIV infected, no recommendations are made for the use of nPEP. Clinicians should evaluate risks and benefits of nPEP on a case-by-case basis. For persons with exposure histories that represent no substantial risk for HIV transmission or who seek care >72 hours after exposure, DHHS does not recommend the use of nPEP. Clinicians might consider prescribing nPEP for exposures conferring a serious risk for transmission, even if the person seeks care >72 hours after exposure if, in their judgment, the diminished potential benefit of nPEP outweighs the risks for transmission and adverse events. For all exposures, other health risks resulting from the exposure should be considered and prophylaxis administered when indicated. Risk-reduction counseling and indicated intervention services should be provided to reduce the risk for recurrent exposures.

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Expanding the Availability and Acceptance of Voluntary HIV Testing: Fundamental Principles to Guide Implementation, June 2007, The Centers for Disease Control and Prevention (CDC)

2007-October-03

The Centers for Disease Control and Prevention (CDC) has recommended that everyone between the ages of 13 and 64 get tested for HIV when they seek health care. In response to CDCs push for expanded rapid testing with decreased attention on counseling and informed consent, a group of HIV legal, medical and service organizations came together to endorse a set of fundamental principles to guide the implementation of expanded voluntary testing for HIV. The fundamental elementsthat HIV testing must always be informed, voluntary, confidential, and supported by health care and other services, and that it is always most effective when offered by someone trusted and trustworthyapply to all persons. The 15 guidelines include: People living with undiagnosed HIV infection must be reached and offered testing. Any HIV testing program must provide the highest standard of care. Everyone offered testing must be educated about HIV and the significance of positive and negative test results. People who test positive for HIV antibodies must be linked to care. Expanded HIV testing must be carefully planned, implemented and monitored. People with HIV/AIDS and other stakeholders must be included in formulating plans for expanded testing. Patients human rights and informed consent are consistent with, and not opposed to, the goal of expanded HIV testing. Expanded HIV testing must be tailored to different clinical settings, populations, and patient needs. Clinicians, medical directors and other providers must receive training and education in delivering high-quality testing programs. Clinicians, medical directors and other providers must receive training and education in making appropriate service referrals and linkages to care. Community-based HIV prevention interventions must be expanded in tandem with efforts to expand voluntary HIV testing in healthcare settings. Special attention must be paid to the prevention and care needs of at-risk populations. Expanded testing and the provision of care to all existing and new HIV cases require new and adequate funding. Testing protocols must address insurance issues. Efforts to assist those with undiagnosed and untreated or unmonitored HIV infection must be evaluated. The primary authors of the Principles are the AIDS Foundation of Chicago, The Center for HIV Law and Policy, and Lambda Legal.