HIV Screening and Diagnosis
- Clinicians should use a 4th-generation (HIV-1/2 Ag/Ab combination) immunoassay to screen patients for HIV infection. (A1)
- Clinicians must perform diagnostic HIV laboratory tests in full compliance with New York State HIV/AIDS Laws and Regulations. Additional information regarding testing procedures and regulations is available from the Wadsworth Center (518-474-2163). Report confirmed cases of HIV according to New York State Law (see NYSDOH Provider Reporting and Partner Services).
- Clinicians should offer assistance with notifying partners or should refer patients to other sources for partner notification assistance (see Partner Services in New York State or the Contact Notification Assistance Program in New York City).
- When immediate results are necessary, such as in the labor/delivery, newborn, or post-exposure settings, or when the person receiving testing is unlikely to return for a follow-up visit, clinicians should use a Food and Drug Administration (FDA)-approved screening test that produces results within 60 minutes. (A2)
- Clinicians should not wait for serologic confirmation of HIV to initiate antiretroviral therapy (ART) when pregnant individuals are diagnosed with acute HIV infection by HIV RNA testing. Initiation of ART is strongly recommended for pregnant individuals. (A2)
- Because all screening tests are subject to false-positive results, clinicians should consider all reactive screening test results preliminary; reactive specimens require further testing with appropriate tests to determine the final result. (A1)
- For all individuals who test negative and have recent or ongoing high-risk behavior, clinicians should discuss goal-oriented, harm-reduction strategies such as PrEP and the emergency availability of post-exposure prophylaxis (PEP). Clinicians should refer these patients as appropriate for counseling services and should offer repeat testing every 3 months, or sooner if acute HIV infection is suspected, for as long as high-risk behavior continues. (A3)
- See the NYSDOH AI guidelines PEP to Prevent HIV Infection and PrEP to Prevent HIV and Promote Sexual Health.
- Clinicians should not delay initiation of ART pending results of repeat testing (see the NYSDOH AI guideline When to Initiate ART, With Protocol for Rapid Initiation).
NOTE: Recommendations for management when acute HIV is suspected are available in the NYSDOH AI guideline Diagnosis and Management of Acute HIV.
