5
Syphilis
21. All patients should be screened for syphilis upon initiation of care.
22. A lumbar puncture should always be performed for patients with a
reactive syphilis serology who have neurologic or ocular symptoms or
signs, irrespective of past syphilis treatment history.
23. A lumbar puncture should be performed in patients who experience
serologic treatment failure (i.e., whose nontreponemal titers fail
to decline 4-fold after stage-appropriate therapy, or whose titers
increase 4-fold if reinfection is ruled out).
Latent Tuberculosis (TB)
24. Upon initiation of care, persons with HIV without a history of
tuberculosis or a prior positive tuberculosis screening test should be
screened for
M. tuberculosis infection by either a tuberculin skin test
(TST) or by an interferon-γ
release assay (IGRA). Those with positive
test results should be treated for latent
M. tuberculosis infection after
active tuberculosis has been excluded.
25. Persons with HIV who are close contacts of persons with infectious
tuberculosis should be treated for latent M. tuberculosis infection
regardless of their TST or IGRA results, age, or prior courses of
tuberculosis treatment. Active tuberculosis should be excluded first.
Hepatitis A, B, and C
26. Persons with HIV should be screened for evidence of hepatitis B
virus (HBV) infection upon initiation of care by detection of hepatitis
B surface antigen (HBsAg), hepatitis B surface antibody (HBsAb),
and antibody to hepatitis B total core antigen (anti-HBc or HBcAb). If
HBsAg is positive, HBV viral load should be ordered.
27. Persons with HIV should be screened for evidence of immunity to
hepatitis A virus (HAV) with HAV IgG.
28. Persons with HIV should be screened for HCV antibody upon initiation
of care. If positive, HCV RNA should be ordered to assess for active
HCV infection. Curative therapy should be offered to all who are
diagnosed with HCV.
29. Infants born to persons with HBV- and/or HCV should be tested for
HBV and HCV transmission, respectively.
30. Persons who are not immune to HAV and HBV should be immunized
according to Advisory Committee on Immunization Practices (ACIP)
guidelines. (See Section III for further discussion)
