When should screening for HIV be considered by the rheumatologist?
Traditionally, screening for HIV has been recommended in the following situations: 1) diagnosis of ReA with sexual or unknown mode of acquisition, 2) history of IVDAs or other potential exposures, 3) patients with septic arthritis/pyomyositis, 4) psoriatic arthritis with refractory or atypical rash subtypes, 5) atypical lupus or multiple unexplained autoantibodies, 6) sicca symptoms in the absence of SSA or SSB autoantibodies or 7) autoimmune disease refractory to typical therapy. Given the overwhelming benefit of early identification and initiation of ART therapy, the Center for Disease Control and Prevention recommends universal screening for HIV in all patients (if the patient consents to testing). As such, rheumatologists should have an extremely low threshold to screen for HIV in all patients.
