Article

Routine screening for chronic human immunodeficiency virus infection: why don't the guidelines agree?

Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Mail Code: BICC, Portland, OR 97239, USA.
Epidemiologic Reviews (Impact Factor: 7.33). 05/2011; 33(1):7-19. DOI: 10.1093/epirev/mxr001
Source: PubMed

ABSTRACT Infection with human immunodeficiency virus remains a major public health problem in the United States. Prominent guidelines from the U.S. Preventive Services Task Force and the Centers for Disease Control and Prevention differ in their recommendations on whether and how to screen adults and adolescents not known to be at higher risk. These discrepancies have led to controversy and debate as well as confusion among clinicians. This article reviews principles of screening, explains specific issues related to screening for human immunodeficiency virus, reviews the discrepancies between the US Preventive Services Task Force and the Centers for Disease Control and Prevention guidelines and the methods used in each guideline, and describes potential reasons for the discrepancies. The case of screening for human immunodeficiency virus illustrates how discrepancies between guidelines may be related to different guideline development methods as well as the different perspectives of the guideline development groups.

0 Followers
 · 
64 Views
  • [Show abstract] [Hide abstract]
    ABSTRACT: Human immunodeficiency virus (HIV)-positive patients treated with antiretroviral therapy now have increased life expectancy and develop chronic illnesses that are often seen in older HIV-negative patients. To address emerging issues related to aging with HIV. Screening older adults for HIV, diagnosis of concomitant diseases, management of multiple comorbid medical illnesses, social isolation, polypharmacy, and factors associated with end-of-life care are reviewed. Published guidelines and consensus statements were reviewed. PubMed and PsycINFO were searched between January 2000 and February 2013. Articles not appearing in the search that were referenced by reviewed articles were also evaluated. The population of older HIV-positive patients is rapidly expanding. It is estimated that by 2015 one-half of the individuals in the United States with HIV will be older than age 50. Older HIV-infected patients are prone to having similar chronic diseases as their HIV-negative counterparts, as well as illnesses associated with co-infections. Medical treatments associated with these conditions, when added to an antiretroviral regimen, increase risk for polypharmacy. Care of aging HIV-infected patients involves a need to balance a number of concurrent comorbid medical conditions. HIV is no longer a fatal disease. Management of multiple comorbid diseases is a common feature associated with longer life expectancy in HIV-positive patients. There is a need to better understand how to optimize the care of these patients.
    JAMA The Journal of the American Medical Association 04/2013; 309(13):1397-405. DOI:10.1001/jama.2013.2963 · 30.39 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Historians of nursing can inform and provide perspective and context to the discipline and to policy makers. This article provides several examples of the interplay of history and health policy debates across time and place. From issues of the nursing workforce to discussions about the skill level needed to safely care for patients and the issues of practice boundaries, history provides evidence for shaping our understanding of and engagement with health policy. History offers a way to understand the present and think about the future. It illustrates a critical perspective for both action and advocacy.
    Nursing outlook 09/2013; 61(5):346-52. DOI:10.1016/j.outlook.2013.07.001 · 1.83 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: We sought to evaluate the performance of an abbreviated version of the Denver HIV Risk Score in 2 urban emergency departments (ED) with known high undiagnosed HIV prevalence. We performed a secondary analysis of data collected prospectively between November 2005 and December 2009 as part of an ED-based nontargeted rapid HIV testing program from 2 sites. Demographics; HIV testing history; injection drug use; and select high-risk sexual behaviors, including men who have sex with men, were collected by standardized interview. Information regarding receptive anal intercourse and vaginal intercourse was either not collected or collected inconsistently and was thus omitted from the model to create its abbreviated version. The study cohort included 15184 patients with 114 (0.75%) newly diagnosed with HIV infection. HIV prevalence was 0.41% (95% confidence interval [CI], 0.21%-0.71%) for those with a score less than 20, 0.29% (95% CI, 0.14%-0.52%) for those with a score of 20 to 29, 0.65% (95% CI, 0.48%-0.87%) for those with a score of 30 to 39, 2.38% (95% CI, 1.68%-3.28%) for those with a score of 40 to 49, and 4.57% (95% CI, 2.09%-8.67%) for those with a score of 50 or higher. External validation resulted in good discrimination (area under the receiver operating characteristic curve, 0.75; 95% CI, 0.71-0.79). The calibration regression slope was 0.92 and its R(2) was 0.78. An abbreviated version of the Denver HIV Risk Score had comparable performance to that reported previously, offering a promising alternative strategy for HIV screening in the ED where limited sexual risk behavior information may be obtainable.
    The American journal of emergency medicine 03/2014; 32(7). DOI:10.1016/j.ajem.2014.02.043 · 1.15 Impact Factor