Europe's HIV indicator conditions

Last edited 05/2019 and last reviewed 10/2020

HIV indicator conditions can be divided into 3 categories:

• 1. Conditions which are AIDS defining among PLHIV (people living with HIV);
  
  
• 2. Conditions associated with an undiagnosed HIV prevalence of >0.1%;
  
  
• 3. Conditions where not identifying the presence of HIV infection may have significant adverse implications for the individual's clinical management.

Routine testing for conditions with an HIV prevalence of >0.1% has been reported to be cost-effective and has the potential to increase earlier diagnosis of HIV, and thus lead to earlier opportunities for care and treatment (1).

Recommendations:

• any person (not already known to be HIV positive) presenting with potentially AIDS defining conditions should be strongly recommended HIV testing
  
  
• any person presenting with a condition with an undiagnosed HIV prevalence of >0.1% should be strongly recommended HIV testing
  
  
• for indicator conditions where expert opinion considers HIV prevalence likely to be >0.1%, but awaiting further evidence, it is recommended to offer testing
  
  
• for conditions where not identifying the presence of HIV infection may have significant adverse implications for the individual's clinical management, testing should be offered to avoid further immune suppression with potentially serious adverse outcomes for the individual, and to maximize the potential response to the treatment of the indicator condition (irrespective of whether the estimated prevalence is lower than 0.1% or not)

Conditions associated with an undiagnosed HIV prevalence of >0.1 - Strongly Recommend Testing

• sexually transmitted infections
• malignant lymphoma
• anal cancer/dysplasia
• cervical dysplasia
• herpes zoster
• hepatitis B or C (acute or chronic)
• unexplained lymphadenopathy
• mononucleosis-like illness
• community-acquired pneumonia
• unexplained leukocytopenia/thrombocytopenia lasting >4 weeks
• seborrheic dermatitis/exanthema
• invasive pneumococcal disease
• unexplained fever
• candidaemia
• visceral leishmaniasis
• pregnancy (implications for the unborn child)

Other conditions associated with an undiagnosed HIV prevalence of >0.1 - Offer Testing

• primary lung cancer
• lymphocytic meningitis
• oral hairy leukoplakia
• severe or atypical psoriasis
• Guillain-Barre syndrome
• mononeuritis
• subcortical dementia
• multiplesclerosis-like disease
• peripheral neuropathy
• unexplained weightloss
• unexplained oral candidiasis
• unexplained chronic diarrhoea
• unexplained chronic renal impairment
• Hepatitis A
• candidiasis

Conditions where not identifying the presence of HIV infection may have significant adverse implications for the individual's clinical management - Offer Testing

• conditions requiring aggressive immuno-suppressive therapy:
  • cancer
  • transplantation
  • auto-immune disease treated with immunosuppressive therapy
  • primary space occupying lesion of the brain
  • Idiopatic/Thrombotic thrombocytopenic purpura

Conditions which are AIDS defining among PLHIV* - Strongly Recommend Testing

• Neoplasms:
  • Cervical cancer
  • Non-Hodgkin lymphoma
  • Kaposi's sarcoma
• Bacterial infections
  • Mycobacterium Tuberculosis, pulmonary or extrapulmunary
  • Mycobacterium avium complex (MAC) or Mycobacterium kansasii, disseminated or extrapulmonary
  • Mycobacterium, other species or unidentified species, disseminated or extrapulmunary
  • Pneumonia, recurrent (2 or more episodes in 12 months)
  • Salmonella septicaemia, recurrent
• Viral infections
  • Cytomegalovirus retinitis
  • Cytomegalovirus, other (except liver, spleen, glands)
  • Herpes simplex, ulcer(s) > 1 month/bronchitis/pneumonitis
  • Progressive multifocal leucoencephalopathy
• Parasitic infections
  • Cerebral toxoplasmosis
  • Cryptosporidiosis diarrhoea, > 1 month
  • Isosporiasis, > 1 month
  • Atypical disseminated leismaniasis
  • Reactivation of American trypanosomiasis (meningoencephalitis or myocarditis)
• Fungal infections
  • Pneumocystis carinii pneumonia
  • Candidiasis, oesophageal
  • Candidiasis, bronchial/ tracheal/ lungs
  • Cryptococcosis, extra-pulmonary
  • Histoplasmosis, disseminated/ extra pulmonary
  • Coccidiodomycosis, disseminated/ extra pulmonary
  • Penicilliosis, disseminated

* Based on CDC and WHO classification system

Reference:

• EuroTEST - HIV Indicator Conditions: Guidance for Implementing HIV Testing in Adults in Health Care Settings (Accessed 3/5/2019)