Routine Screening for Chronic Human Immunodeficiency Virus Infection: Why Don't the Guidelines Agree?

Infection with human immunodeficiency virus remains a major public health problem in the United States. Prominent guidelines from the U.S. Preventive Services Task Force and the Centers for Disease Control and Prevention differ in their recommendations on whether and how to screen adults and adolescents not known to be at higher risk. These discrepancies have led to controversy and debate as well as confusion among clinicians. This article reviews principles of screening, explains specific issues related to screening for human immunodeficiency virus, reviews the discrepancies between the US Preventive Services Task Force and the Centers for Disease Control and Prevention guidelines and the methods used in each guideline, and describes potential reasons for the discrepancies. The case of screening for human immunodeficiency virus illustrates how discrepancies between guidelines may be related to different guideline development methods as well as the different perspectives of the guideline development groups.