The Task Force reviewed new evidence, including findings from numerous scientific studies conducted between 1983 and 2004. It noted that since the last set of recommendations were made, drug treatments, such as HIV-suppressing combination therapies, that became available in the 1990s have improved survival rates and that HIV tests have become more accurate, minimizing the likelihood of a false positive result.

Most notable of its updated recommendations is that all pregnant women be screened for HIV infection. This was based on evidence that the HIV screening tests available are accurate in pregnant women and that universal prenatal counseling and testing can increase the number of women who are diagnosed and treated before delivery. Early detection and interventions, including the use of antiretroviral therapy, choice of cesarean section birth, and avoidance of breastfeeding, improve the chances that the virus won't be transmitted to the infant. Previously, the Task Force had found insufficient evidence to make this recommendation and advocated testing only for those pregnant women at high risk of infection and living in communities with high rates of newborn HIV infection.

Women are now the fastest-growing population of patients to be newly infected with HIV. These revised guidelines may help to detect HIV infection earlier so that treatment and counseling can occur at an earlier stage and help to reduce mother-to-child transmission. The American College of Obstetricians and Gynecologists, the Centers for Disease Control and Prevention (CDC), and several other organizations support making HIV screening part of usual prenatal care. In fact, several U.S. states have already made HIV testing of pregnant women or their newborns mandatory.

In addition, the Task Force reaffirmed its recommendation that all adolescents and adults at increased risk of HIV be tested based on evidence that both standard and U.S. Food and Drug Administration (FDA)-approved rapid screening tests accurately detect HIV infection. The Task Force also found good evidence that appropriately timed interventions, particularly highly active antiretroviral therapy, lead to improved health outcomes for many of those screened, including reduced risk for clinical progression and reduced mortality. Those at increased risk include: men who have had sex with men after 1975; men and women having unprotected sex with multiple partners; past or present injection drug users; men and women who exchange sex for money or drugs or have sex partners who do; individuals whose past or present sex partners were HIV-infected, bisexual, or injection drug users; persons being treated for sexually transmitted diseases; and persons with a history of blood transfusion between 1978 and 1985.

Although the CDC and others have advocated routine HIV screening of the general population, not just pregnant women or individuals at high risk, the Task Force did not find sufficient justification for supporting screening of the general population.

Sources
U.S. Preventive Services Task Force: Screening for Human Immunodeficiency Virus Infection. Release Date: July 2005. Available online: http://www.ahrq.gov/clinic/uspstf/uspshivi.htm

U.S. Preventive Services Task Force. Screening for HIV: Recommendation Statement. Annals of Internal Medicine. 143 (1): 32-37; 5 July 2005. Available online: http://www.annals.org/cgi/content/full/143/1/32

Mozes, A. Experts: Test All Pregnant Women for HIV. HealthDay Reporter. July 5, 2005. Available online: http://www.forbes.com/lifestyle/health/feeds/hscout/2005/07/05/hscout526659.html

Woznicki, K. All Pregnant Women Urged to Screen for HIV infection. MedPage Today. July 5, 2005. Available online: http://www.medpagetoday.com/InfectiousDisease/HIVAIDS/tb/1309

Pilcher, CD et al. Real-time, Universal Screening for Acute HIV Infection in a Routine HIV Counseling and Testing Population. JAMA. Volume 288 (2). July 10, 2002, pages 216-21.

CDC. Advancing HIV prevention: new strategies for a changing epidemic—United States, 2003. MMWR. 2003;52:329-32.