Screening for sexually transmitted and opportunistic infections in adolescents with HIV infection

Coinfection or comorbidity	Test(s) to perform	Timing and follow-up
CMV	Anti-CMV IgG for patients other than MSM and injection drug users (who may be assumed to be seropositive).	At initial diagnosis.
Gonorrhea, chlamydia*	NAAT testing (preferred) or culture with sites based on exposure history (eg, urine, urethral, vaginal, cervical, rectal, oropharyngeal).	At initial diagnosis and then at least every 6 months or more frequently if indicated. If positive, the patient should be treated and retested in 3 months because of high reinfection rates.
Syphilis	RPR or VDRL. Confirm reactive tests with treponemal-specific antibody tests.	At initial diagnosis and then at least yearly; in areas highly endemic for syphilis or with high-risk populations (ie, MSM), more frequently.
Latent Toxoplasma gondii	Anti-Toxoplasma IgG.	At initial diagnosis; also may be indicated in patients with initial negative serology if CD4 count drops below 100 cells/microL.
Latent Mycobacterium tuberculosis	Tuberculin skin test or IGRA. IGRA is preferred if history of BCG vaccination or in patients with a low likelihood of returning to have their test read.	At initial diagnosis and then annually. Those with positive test results should be treated for latent M. tuberculosis after active tuberculosis has been excluded.
Varicella virus	Anti-varicella IgG if no known history of chickenpox or shingles.	At initial diagnosis. If negative, then immunize if CD4 ≥200 cells/microL.
Viral hepatitis	HBsAg, HBsAb, anti-HBc, HCV antibody, HAV total or IgG antibody.	At initial diagnosis and annually. If HbsAg+, order HBV RNA level. If HCV Ab+, order HCV RNA level and HCV genotype. If HBsAb is negative, immunize for HBV. If HAV IgG is negative, immunize for HAV.
Cervical cancer, anal cancer	Cervical Pap test; anal Pap test if indicated^¶. Abnormal results require follow-up with colposcopy and high-resolution anoscopy, respectively.	At initial diagnosis^Δ, then 6 months later. If result negative, then annually.
Trichomoniasis	HIV+ women should be screened with NAAT (preferred), microscopy, rapid antigen testing, or culture.	At initial diagnosis and then annually; more frequently if patient infected with other STIs. If positive, patient should be treated and retested in 3 months because of high reinfection rates.

CMV: cytomegalovirus; IgG: immunoglobulin G; MSM: men who have sex with men; NAAT: nucleic acid amplification test; RPR: rapid plasma reagin; VDRL: Venereal Disease Research Laboratory; IGRA: interferon gamma release assay; BCG: Bacille Calmette-Guérin; HBsAg: hepatitis B surface antigen; HBsAb: hepatitis B surface antibody; anti-HBc: hepatitis B core antibody; HCV: hepatitis C virus; HAV: hepatitis A virus; HBV: hepatitis B virus; Pap test: Papanicolaou smear; STI: sexually transmitted infection.
* Testing should be performed among HIV-positive adolescents who are sexually active; it is not necessary among HIV-positive adolescents with vertical transmission until they become sexually active.
¶ Indicated in MSM, women with a history of receptive anal intercourse or abnormal cervical Pap test results, and patients with genital warts.
Δ In contrast with the recommendations for healthy adolescents, sexually active HIV-infected female adolescents should undergo cervical cancer screening after the onset of sexual activity rather than waiting until 21 years of age.

Adapted from: Aberg JA, Gallant JE, Ghanem KG, et al. Primary care guidelines for the management of persons infected with HIV: 2013 update by the HIV medicine association of the Infectious Diseases Society of America. Clin Infect Dis 2014; 58:e1.

Graphic 54700 Version 7.0

خرید پکیج

Screening for sexually transmitted and opportunistic infections in adolescents with HIV infection