Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions
HIV Screening of Gay, Bisexual, and Other MSM
MMWR; ePub 2017 Aug 11; DiNenno, et al
There is insufficient evidence to warrant changing the current recommendation from the Centers for Disease Control and Prevention (CDC) regarding annual HIV screening for men who have sex with men (MSM) to more frequent screening of every 3 or 6 months. This according to a systematic review by a CDC workgroup that determined that the CDC’s 2006 recommendation for HIV screening of MSM is unchanged, in that all health care providers in clinical setting should offer HIV screening at least annually to all sexually active MSM. Other recommendations/observations:
- Clinicians can also consider the potential benefits of more frequent HIV screening (every 3 or 6 months) for some asymptomatic sexually active MSM based on their individual risk factors, local HIV epidemiology, and local policies.
- Additional research is needed to establish the individual- or community-level factors that might increase the risk for HIV acquisition for MSM and merit more frequent HIV screening.
- For MSM who are prescribed preexposure prophylaxis, HIV testing every 3 months and immediate testing whenever signs and symptoms of acute HIV infection are reported is indicated.
- MSM who experience a specific high-risk sexual exposure or have symptoms of recent HIV infection should seek immediate HIV testing, and clinicians should be alert for the symptoms of acute HIV infection and provide appropriate diagnostic testing.
DiNenno EA, Prejean J, Irwin K, et al. Recommendations for HIV screening of gay, bisexual, and other men who have sex with men—United States, 2017. MMWR Morb Mortal Wkly Rep 2017;66:830–832. doi:10.15585/mmwr.mm6631a3.
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In 2006, the CDC published guidelines recommending that all individuals aged 13-64 years of age should undergo routine screening for HIV in healthcare settings at least once regardless of risk for infection. Patients diagnosed with HIV would then be linked to care including antiretroviral therapy, resulting in decreased HIV-associated morbidity and mortality, as well as decreased transmission of HIV. These recommendations included rescreening “at least annually” for patients who were at increased risk for HIV infection, including men who have sex with men (MSM). Some experts have recommended that this latter group would benefit from more frequent screening because it is the group with the highest risk for infection. This rigorous study, however, concludes that annual screening is still recommended for asymptomatic MSM. More frequent screening considerations are listed in the summary above.
Despite insufficient evidence for recommending more frequent HIV screening in MSM, clinicians should recognize that MSM with substantial risk for HIV infection should receive pre-exposure prophylaxis (PrEP) with the antiretroviral combination pill consisting of tenofovir/emtricitabine. Identifying at-risk individuals for PrEP can decrease HIV transmission by greater than 90%. These at-risk MSM include those who have: a sexual partner with HIV, high number of sexual partners, a bacterial STD within prior 6 months, no or inconsistent use of condoms, or HIV-infected sexual partner. CDC recommendations include HIV screening every 3 months for patients receiving PrEP.
Recent data reported in CDC’s July 2017 Monitoring Report reveal that 85% of people with HIV living in the US know their status, including 83% of MSM. However, this still means that 166,000 individuals who are HIV-infected are not diagnosed. Any report on HIV screening such as this one can only continue to raise the awareness of its importance and any increases in screening should result in better health outcomes and decreased HIV transmission. In the interim, more research is needed to inform the frequency of HIV testing in increased risk groups such as MSM. —Fred A. Lopez, MD, MACP