BC Centre in HIV/AIDS Primary Care Guidelines

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1.4 Co-infection Screening

Tuberculosis TST using PPD; IGRA Check unless contraindicated (see comments) Annually for individuals with negative test results and more frequently if there is evidence of new exposure to TB. Individuals with advanced HIV and negative TST results should have repeat TST if their CD4 counts increase to >200 cells/mm³
  • Contraindications for TSTinclude:
    • documented history of a previous positive TST
    • documented TB
    • a previous severe reaction to PPD
  • Screening for TB also involves history of previous TB or exposure to TB, recent CXRs (≤3 months), and previous TST results and/or IGRA results.
  • Induration of ≥5 mm is considered a positive TST for HIV+ individuals
  • IGRA recommended if patient is TST–negative and either
    • CD4 <200/µL; or
    • history of contact with active TB
  • two IGRA assays are available: T-SPOT® and Quantiferon®-Gold-in-Tube; the T-SPOT® is preferred
Chest X-ray Chest X-ray As clinically indicated  
Toxoplasmosis Toxoplasma IgG Ab Check When indicated by CNS symptoms  
Hepatitis A Total Anti-HAV Ab Check unless there is documented evidence of prior HAV vaccination or prior HAV diagnosis Annually if negative at baseline, ongoing risk behaviours or unexplained elevated liver enzymes, and not immunized The value of post-immunization testing has not been established
Hepatitis B HBsAg, Anti-HBs, Anti-HBc Check Anti-HBs titres 1 – 6 months after completing immunization series. Annually if negative at baseline, ongoing risk behaviours or unexplained elevated liver enzymes, and not immunized. Isolated Anti-HBc+ (HBsAg and Anti-HBs, Anti-HBc+): do HBV-DNA to rule out occult HBV infection
Hepatitis C Anti-HCV Ab Check Annually if negative at baseline and ongoing HCV risk behaviours or unexplained elevated liver enzymes Confirm anti-HCV Ab+ with HCV RNA PCR
Syphilis EIA Check Annually, or every 3 – 6 months if ongoing risk behaviours or symptoms
  • Positive EIA will automatically be verified with confirmatory tests by the BC-PHMRL
  • Lumbar puncture should always be performed for patients with reactive syphilis serology who have neurologic or ocular symptoms/signs, irrespective of past syphilis treatment
Gonorrhea Men: Urine NAAT. Women: Cervical Swab, or Urine NAAT for women without a cervix or those who wish to avoid pelvic examination. Check  
Chlamydia Check  
Cervical Cancer Cervical Pap Smear Check 6 months after baseline; if normal, repeat annually  
Anal Cancer Anal Pap Smear    
  • Not considered standard of care at this time
  • Being performed in HIV+ women and MSM in some health centres

Other screening and health maintenance interventions may be indicated depending on the age and gender of the patient. See also: The Canadian Guide to Clinical Preventive Health Care

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