Screening

In addition to screening for specific opportunistic infections, as detailed here, regular monitoring of CD4 counts allows for early diagnosis and prompt treatment of opportunistic infections.[206]​​​

Tuberculosis (TB)

All people living with HIV should be tested for latent TB infection (LTBI) regardless of their risk for TB.[1][207][208]​​​​​ Annual testing for latent infection is recommended for people living with HIV who are, or remain, at high risk for repeated or ongoing exposure to individuals with active TB.[1]​ Data from low TB incidence settings show that 12% of people living with HIV tested positive for LTBI, with a higher likelihood of positive results among those originating from TB-endemic countries or with prior exposure to TB.[209]

People with negative diagnostic tests for LTBI, advanced HIV infection (CD4 count <200 cells/microlitre), and without any indications for initiating empirical LTBI treatment, should be re-tested for LTBI once they start antiretroviral treatment and attain a CD4 count of 200 cells/microlitre or greater.[1]​ Data from low-incidence TB countries show that preventative treatment for LTBI reduced TB incidence, with 20 individuals needing preventative treatment to prevent one case of active TB.[209]

Toxoplasmosis

All people living with HIV should be tested for prior exposure to Toxoplasma gondii by measuring anti-Toxoplasma immunoglobulin G (IgG) upon initiation of care.[1]

If results are positive, primary prophylaxis should be provided when CD4 count is below 100 cells/microlitre.[1] If results are negative, the individual should be counselled on avoidance of infection (avoidance of under-cooked meat and avoidance or proper handling of cat faeces).[1]

Cryptococcosis

Routine testing for serum cryptococcal antigen in people newly diagnosed with HIV and no overt clinical signs of meningitis may be considered for individuals whose CD4 counts are ≤100 cells/microlitre, and particularly in those with CD4 counts ≤50 cells/microlitre. A positive test should prompt cerebrospinal fluid evaluation for meningitis.[1][76]

Coccidioidomycosis

Asymptomatic individuals who reside in areas where coccidioidomycosis is endemic and have a CD4 count ≤250 cells/microlitre should have annual IgM and IgG serological screening for Coccidioides species.[210]

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