Use and Effectiveness of HIV Indicator Conditions in Guiding HIV testing: A Review of the Evidence

Aims: To identify the most commonly reported HIV indicator conditions (HIV ICs) found in or associated with HIV infection and to review interventions incorporating HIV ICs to aid or guide offering of an HIV test and discuss their effectiveness in increasing HIV testing rates and diagnosing new cases of HIV-infection.

Methodology: The following electronic databases were searched; OVID Medline, Google, Web of Science and PubMed. We included studies conducted in high income countries within the adult population (>18yrs of age) that were published in the era of combination antiretroviral therapy between 1996 and 2016. We excluded studies relating to HIV testing or screening of pregnant women.

Results: We identified 42 studies investigating ICs associated with HIV infection either prior to or after diagnosis within primary, secondary and tertiary care settings. The most common ICs and symptoms associated with HIV infection were; sexually transmitted infections (syphilis, chlamydia, gonorrhoea and condyloma acuminata) and blood borne viruses (Hepatitis C and Hepatitis B), pneumonia, tuberculosis, blood dyscrasia, thrombocytopenia, oral and oesophageal candidiasis, seborrhoeic dermatitis, herpes zoster, Kaposi sarcoma, fever, weight loss, diarrhoea and lymphadenopathy. Twelve intervention studies that used HIV prediction tools and computer prompts based on HIV ICs demonstrated that these are effective in helping healthcare professionals to offer more targeted approaches to HIV testing.

Conclusion: Our review may aid policy makers and healthcare professionals in developing strategies to improve and increase HIV testing in individuals that present with defined HIV ICs. ICs have the potential to be used more effectively as triggers for earlier HIV testing and importantly for patients to receive a more timely diagnosis.