What are the recommended screening protocols for opportunistic infections in patients with advanced HIV infection?

Recommended screening protocols for opportunistic infections in patients with advanced HIV infection involve targeted testing based on clinical presentation and risk factors, as well as routine monitoring to identify infections early and guide treatment.

While the provided NICE guideline (NG60) primarily focuses on increasing HIV testing uptake and does not detail specific opportunistic infection screening protocols, standard UK clinical practice for advanced HIV includes screening for common opportunistic infections such as tuberculosis, pneumocystis pneumonia, cytomegalovirus, cryptococcal infection, and others, guided by CD4 count and symptoms.

Patients with advanced HIV (typically CD4 count <200 cells/mm³) should be screened for tuberculosis, including latent TB, given the high risk and the recommendation to offer HIV testing in tuberculosis services ¹.

Screening for other opportunistic infections is usually symptom-driven and may include chest X-rays, sputum tests, cryptococcal antigen testing, and other relevant investigations as indicated clinically.

Routine HIV monitoring includes regular CD4 counts and viral load testing to assess immune status and risk of opportunistic infections, which informs the need for prophylaxis and screening.

In summary, opportunistic infection screening in advanced HIV is guided by clinical assessment, CD4 count thresholds, and local protocols, with tuberculosis screening explicitly recommended in the context of HIV testing services ¹.