Which preventive screening is recommended for a patient newly diagnosed with HIV?

• A. Fecal occult blood test
• B. Low-dose computed tomography of the chest
• C. Mammogram
• D. Tuberculin skin test

Answer: (D)

Screening for latent tuberculosis infection is essential when someone is newly diagnosed with HIV because HIV weakens the immune system and markedly increases the risk that latent TB will reactivate into active TB. The tuberculin skin test is used to detect latent TB infection; in people with HIV, a positive result is defined by an induration of 5 mm or more. If positive, treatment for latent TB is started to prevent progression to active disease. If the test is negative but there is ongoing risk or exposure, an interferon-gamma release assay can be considered, but the tuberculin skin test remains the standard initial screening in this setting. The other options (fecal occult blood test, low-dose CT chest, mammography) are cancer or general screening measures that aren’t specifically prompted by an HIV diagnosis.