Please note: In 2003, the CTF updated its Grades of Recommendations to include an "I Recommendation" for situations where insufficient evidence exists to allow a recommendation to be made. (Formerly, these situations were captured under a "C Recommendation".) This change is not retroactive, and all "C Recommendations" made prior to 2003 have not been reevaluated in light of the new "I" recommendation grade. For a discussion of these recommendation grades, please link to the 2003 article in the Canadian Medical Association Journal here.
| MANEUVER | EFFECTIVENESS | LEVEL OF EVIDENCE <REF> | RECOMMENDATION |
| Obtaining history of sexual practices and injection drug use and counselling people in the general population. | Limited sensitivity for identifying HIV-positive people but may be offered for patient education; it is more sensitive than if history were not obtained. | Expert opinion <6,11,12> (III) | Poor evidence to include in or exclude from periodic health examination (PHE) of asymptomatic people. (C) |
| Reduces but does not eliminate high-risk activities in high-risk populations | Cohort studies <16-20,26-33> (II-2) | ||
| Voluntary screening with an enzyme-linked immunosorbent assay (ELISA) and confirmatory test; repeat test after 6 months for seronegative people at high-risk.* | Combination of ELISA and Western blot technique has almost 100% sensitivity and specificity | ||
| High-risk groups:* AIDS development was delayed with early treatment if CD4 count was less than 0.5x109/L; labelling is a problem. | Randomized controlled trials <21,25> (I) | Good evidence to include offer of screening in PHE of asymptomatic people at high risk. (A)* | |
| Pregnant women: Low rate of HIV infection in Canada raises concerns about poor positive predictive value; should be considered in large cities, where rate is highest. | Cohort studies <1-5,7-11> (II-2) | Poor evidence to include in or exclude from PHE of asymptomatic pregnant women. (C) | |
| Infants of HIV- positive women: Risk of vertical transmission is 20-50% but usual screening methods are not sensitive or specific enough. | Cohort studies <13-15> (II-2) | Fair evidence to include in PHE of children of HIV-positive women. (B) | |
| Voluntary screening with an enzyme-linked immunosorbent assay (ELISA) and confirmatory test. | People at low risk: False positive results may outweigh benefit of treating the few seropositive people identified. | Expert opinion (III) | Poor evidence to include in or exclude from PHE of asymptomatic people at low risk. (C) |