HIV screening

USPSTF2019Grade A

Screen all adolescents and adults aged 15 to 65 at least once. Screen younger adolescents and older adults at increased risk. Screen all pregnant persons, including those presenting in labor or at delivery with unknown HIV status; repeat third-trimester screening for those at increased risk or in high-incidence settings. No optimal rescreening interval established; repeat screening reasonable for those at increased risk.

CDC2024

Test all patients aged 13 to 64 at least once as part of routine care using an opt-out approach, and document a decision to decline. Rescreen at least annually those with ongoing risk; for sexually active gay, bisexual, and other men who have sex with men, more frequent testing (for example every 3 to 6 months) may be beneficial. Use a laboratory antigen/antibody combination test.

USPSTF2023Grade A

Prescribe preexposure prophylaxis (PrEP) with effective antiretroviral therapy to adolescents and adults at increased risk of HIV acquisition: for example, a partner with HIV and unknown or detectable viral load, a recent bacterial STI, inconsistent condom use with partners of unknown status, injection drug use with shared equipment, or transactional sex. Options include oral TDF/FTC, oral TAF/FTC, or injectable cabotegravir.

CDC2025Grade Strong recommendation, high-certainty evidence

Lenacapavir by subcutaneous injection every 6 months is now a recommended PrEP option for adults and adolescents weighing ≥35 kg who would benefit from PrEP, alongside the 2021 CDC options of two oral tenofovir-based regimens and injectable cabotegravir. Twice-yearly dosing may help people who struggle with daily pills or frequent visits.