Screenings if you have HIV

Why some screenings change

NCI says people living with HIV have a higher risk of some types of cancer than the general population. During 2015 to 2019 they were more likely to be diagnosed with: (NCI)

Kaposi sarcoma (more than 200 times as likely);
anal cancer (nearly 20 times as likely);
Burkitt lymphoma (about 15 times as likely);
diffuse large B-cell lymphoma and Hodgkin lymphoma (each about 6 times as likely);
cervical cancer (3 to 4 times as likely);
liver cancer (twice as likely);
lung cancer (1.6 times as likely).

HIV.gov says long-lasting low-level inflammation puts people with HIV at greater risk for conditions such as heart disease, kidney disease, diabetes, bone disease, liver disease and some types of cancer. (HIV.gov, other health issues)

Cervical cancer screening

The USPSTF cervical screening schedule does not apply to people with a compromised immune system, such as women living with HIV; it says women with this risk factor should receive individualized follow-up. (USPSTF, 2018) The American Cancer Society also says a weakened immune system from HIV infection can mean a different screening plan, such as being screened more often, and to talk with your provider about the best plan. (ACS, cervical)

HIV.gov says NIH guidelines recommend that once a person over 21 is diagnosed with HIV, they have yearly cervical cancer screening, which can include an HPV test and a Pap test, and that screening may need to continue after 65. (HIV.gov, cervical) NCI summarizes national guidelines as a Pap test at the time of HIV diagnosis and throughout life, with co-testing (Pap plus HPV test) possible from age 30 and considered for ages 25 to 29. (NCI) See Pap and HPV test results and what to expect at a Pap smear.

Anal cancer screening

NCI says HHS recommends anal cancer screening for people living with HIV from age 35 for men who have sex with men and certain other high-risk groups, and from age 45 for all others. Methods include a digital anorectal exam, standard anoscopy and high-resolution anoscopy, with anal cytology alone or with HPV testing. (NCI) HIV.gov notes that abnormal anal cells are common in both men and women living with HIV. (HIV.gov, lab tests) The tests, schedules and symptoms are on anal cancer screening.

Hepatitis B and C

HIV.gov says everyone with HIV should be tested for hepatitis B and C when first diagnosed with HIV and beginning treatment, and people living with HIV who have ongoing risk factors should be tested every year. It says viral hepatitis progresses faster and causes more liver problems in people living with HIV. (HIV.gov, hepatitis) The USPSTF lists people with HIV among the groups who should be screened for hepatitis B, (USPSTF, 2020 hepatitis B) and recommends hepatitis C screening for all adults 18 to 79. (USPSTF, 2020 hepatitis C) See hepatitis B test results and hepatitis C test results.

Tuberculosis (TB)

HIV.gov says HIV weakens the immune system and increases the risk of TB, so it is important for people living with HIV to be tested for TB. (HIV.gov, other health issues) The USPSTF lists people living with HIV among those at increased risk for latent TB or progression to active disease, but its review did not include screening where it is part of managing a specific condition, such as HIV, and it points to the HHS opportunistic infection guidelines instead. (USPSTF, 2023) See latent TB test results.

Heart, bone and kidney checks

Heart

HIV.gov says people living with HIV can have a 50 to 100% increased risk for heart disease, and regular monitoring of heart health by your health care provider is an important part of ongoing care. (HIV.gov, other health issues) It says women living with HIV are three times more likely to have a heart attack than women without HIV. (HIV.gov, women) HIV.gov lists a fasting glucose (blood sugar) test and a fasting lipid panel (cholesterol and triglycerides) among the lab tests at the start of HIV care, and says repeat glucose tests watch for possible increases in blood sugar. (HIV.gov, lab tests) See heart screenings by age and cholesterol test by age.

Bone

HIV.gov says bone loss occurs faster in women and men living with HIV than in people who do not have HIV, and that osteoporosis is a concern for all older women but especially for women living with HIV. (HIV.gov, women) See how often to have a bone density test.

Kidney

HIV.gov lists kidney disease among the conditions people with HIV are at greater risk for. (HIV.gov, other health issues) It says blood chemistry tests in HIV care help monitor the health of your organs, especially the heart, liver and kidneys. (HIV.gov, lab tests) See kidney disease screening and kidney test results.

Other STIs

HIV.gov lists screening for syphilis, gonorrhea and chlamydia among the lab tests at the start of HIV care. (HIV.gov, lab tests) See sexual health screenings by age and STI test results.

When to talk to a doctor

HIV.gov says not all lab tests happen at every visit; some occur every few visits and others depend on whether you are stable on HIV treatment, so talk to your provider about the timing of tests and what is recommended for you. (HIV.gov, lab tests) For cervical screening, it says to talk with your health care provider about the right schedule for you, and to ask about it if you have not had one in a while or are not sure when you are due. (HIV.gov, cervical)

Where they differ:

Cervical screening. The USPSTF schedule (a Pap test every 3 years from 21 to 65, with HPV-based options every 5 years from 30) does not cover women living with HIV. (USPSTF, 2018) HIV.gov describes NIH guidelines as yearly screening after an HIV diagnosis over age 21, possibly continuing after 65, (HIV.gov, cervical) while NCI describes a Pap test at diagnosis and throughout life, with co-testing from 30. (NCI) ACS says to talk with your provider about the best screening plan. (ACS, cervical)
Hepatitis testing. The USPSTF recommends a one-time hepatitis C screen for adults 18 to 79, (USPSTF, 2020 hepatitis C) while HIV.gov says people living with HIV with ongoing risk factors should be tested for hepatitis B and C every year. (HIV.gov, hepatitis)
TB. The USPSTF latent TB recommendation covers adults in primary care and leaves screening of people living with HIV to HIV care guidelines. (USPSTF, 2023)

Your doctor decides what your result means for you.

Questions people ask

Does the usual cervical screening schedule apply if I have HIV?

No. The USPSTF recommendation does not apply to people with a compromised immune system, such as women living with HIV, who it says should receive individualized follow-up. HIV.gov says NIH guidelines recommend yearly cervical cancer screening once a person over 21 is diagnosed with HIV. (USPSTF, 2018) (HIV.gov, cervical)

When does anal cancer screening start for people with HIV?

NCI says HHS recommends anal cancer screening for people living with HIV from age 35 for men who have sex with men and certain other high-risk groups, and from age 45 for all others. (NCI)

Should people with HIV be tested for hepatitis B and C?

Yes. HIV.gov says everyone with HIV should be tested for hepatitis B and C when first diagnosed with HIV and beginning treatment, and people with ongoing risk factors should be tested every year. (HIV.gov, hepatitis)

Is TB testing part of HIV care?

HIV.gov says it is important for people living with HIV to be tested for TB. The USPSTF latent TB recommendation does not cover this, because it treats TB screening in people living with HIV as part of managing that condition. (HIV.gov, other health issues) (USPSTF, 2023)

Are heart and bone checks different with HIV?

HIV.gov says people living with HIV can have a 50 to 100% increased risk for heart disease, that regular monitoring of heart health is part of ongoing care, and that bone loss occurs faster in people living with HIV. (HIV.gov, other health issues) (HIV.gov, women)