Indications for HIV testing

Indications for HIV testing, including behavioural and epidemiological indicators, are set out in the National HIV Testing Policy developed by the Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine (ASHM).

In Australia, up to one-third of new cases of HIV infection are diagnosed late, once significant immunodeficiency has occurredCroxford, 2022 Lin, 2019. Late HIV diagnosis is associated with poorer outcomes (poorer response to treatment, and increased morbidity and mortality), a higher likelihood of HIV transmission and increased healthcare costsHIV in Europe., 2012 Lin, 2019. Although late diagnosis may be a result of individuals not presenting for healthcare, it can also be associated with a lack of recognition of specific indicator conditions for HIV testing.

Indicator conditions for HIV testing are defined as conditionsNational HIV Testing Policy Expert Reference Committee, 2020:

associated with HIV, including AIDS-defining conditions (ie conditions that, when they occur in a patient with HIV infection, indicate that the patient has advanced HIV)
for which concomitant HIV infection would impact disease management (eg tuberculosis)
that share a transmission route with HIV (eg sexually transmissible infections, hepatitis B or C).

Note: All patients with indicator conditions should be offered HIV testing, regardless of behavioural and epidemiological risk factors.

All patients with indicator conditions should be offered HIV testing, regardless of the presence of behavioural and epidemiological risk factors for HIV infection. This creates opportunities for earlier HIV diagnosis and initiation of antiretroviral treatment, and improves patient outcomes.

In these guidelines, the requirement of HIV testing for indicator conditions is addressed, when appropriate, in the relevant clinical topics.