HIV Infection and AIDS Guidelines

Updated: Oct 08, 2019
  • Author: Nicholas John Bennett, MBBCh, PhD, MA(Cantab), FAAP; Chief Editor: Michael Stuart Bronze, MD  more...
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CDC Guidelines on HIV Screening in Men Who Have Sex with Men

The following are guidelines on HIV screening among men who have sex with men (MSM) [157]

  • The CDC concludes that the evidence, programmatic experience, and expert opinions are insufficient to warrant changing the current recommendation of annual screening for men who have sex with men (MSM) to more frequent screening (every 3 or 6 months).
  • Providers in clinical settings should offer HIV screening at least annually to all sexually active MSM.
  • Clinicians can also consider the potential benefits of more frequent HIV screening (eg, every 3 or 6 months) for some asymptomatic sexually active MSM based on their individual risk factors, local HIV epidemiology, and local policies.
  • Among 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.

European AIDS Clinical Society Guidelines on Antiretroviral Therapy and Chronic HIV Infection

Antiretroviral therapy (ART) is recommended in all adults with chronic HIV infection, irrespective of CD4 counts.

Human papillomavirus (HPV) vaccination is now recommended for all HIV-positive persons up to 26 years of age and up to 40 years of age for men who have sex with men (MSM).

All HIV-positive women of reproductive age should have a pregnancy test.

Screen for sexually transmitted infections (STIs) not only for those at risk, but also during pregnancy.

Pre-exposure prophylaxis (PrEP) should be used in adults at high risk of acquiring HIV infection when condoms are not used consistently.

Before PrEP is initiated, HBV serology status should be documented.

Intermittent tuberculosis (TB) regimens (2 or 3 times per week) are contraindicated in HIV-positive persons.

PrEP is recommended in HIV-negative MSM and transgender individuals when condoms are not used consistently with casual partners or with HIV-positive partners who are not on treatment. A recent STI, use of post-exposure prophylaxis, or chemsex may be markers of increased risk for HIV acquisition.

PrEP may be considered in HIV-negative heterosexual women and men who are inconsistent in their use of condoms and have multiple sexual partners, some of whom are likely to have HIV infection and not being on treatment.

Documented negative fourth-generation HIV test is recommended prior to starting PrEP. During PrEP, this test should be repeated every 3 months, and PrEP should be stopped immediately in case of early clinical signs of HIV seroconversion or a positive HIV diagnostic test and the person referred for evaluation to an HIV unit.