Do not be surprised if a clinician asks about nonmedical drug use or discusses hepatitis C or HIV testing. Preventive screening recommendations broadened over time, but whether and when a test is appropriate still depends on age, pregnancy, previous results, health history and current risk.
Unhealthy drug use
In a recommendation statement published in 2020, the U.S. Preventive Services Task Force advised primary care clinicians to ask adults age 18 and older, including pregnant adults, about unhealthy drug use when services for accurate diagnosis, treatment and appropriate care are available.
The screening typically uses one or more questions about whether and how often someone uses particular substances. It can be completed verbally or through a questionnaire. A positive screen is not itself a diagnosis; it should lead to appropriate assessment and, when needed, treatment.
In this context, unhealthy drug use includes illegally obtained substances and prescription psychoactive medications used for nonmedical reasons, in different amounts than prescribed or by someone for whom they were not prescribed. Alcohol and tobacco screening are addressed separately. Readers looking for related context can review this article on alcohol and health.
Hepatitis C
The task force's 2020 recommendation supports hepatitis C screening for adults ages 18 to 79, with screening during pregnancy and periodic testing for people who have ongoing risk. Recommendations can be reassessed, so the current guidance and a person's previous tests should be checked with a clinician.
Hepatitis C can damage the liver while causing few or no early symptoms. Exposure through injection equipment is a major risk, and blood transfusion before routine screening of the blood supply began is an important historical consideration. Learn more in this overview of viral hepatitis.
Testing generally begins with an antibody blood test. A reactive result requires another test to determine whether an active infection is present. Effective direct-acting antiviral treatment is available, but diagnosis and treatment selection belong with a qualified professional.
HIV
The task force has advised screening adolescents and adults ages 15 to 65, screening younger or older people at increased risk, and screening during pregnancy. Its recommendation is based on evidence that tests are accurate and that identifying HIV allows treatment to begin earlier. See the evidence discussion in the published review.
HIV can be transmitted through sexual contact, shared injection equipment, and during pregnancy, birth or breastfeeding. Antiretroviral treatment protects health and can prevent sexual transmission when it produces and maintains an undetectable viral load. Our background explainer covers HIV infection and AIDS.
People with a substantial chance of acquiring HIV may also discuss pre-exposure prophylaxis, or PrEP, with a clinician. The task force has issued a separate recommendation about PrEP. The appropriate medication and follow-up plan depend on individual circumstances.
Questions for your next visit
- Which screenings are recommended for my age, history and current circumstances?
- Have I already had this test, and would repeating it add useful information?
- Is this routine screening or diagnostic testing for a symptom or exposure?
- What would a positive, negative or inconclusive result mean?
- How will results be confirmed, documented and followed up?
Bottom line: These three screening topics address different health concerns, and each has its own eligibility, testing and follow-up considerations. Use broad recommendations as a prompt for an individualized discussion—not as a reason to order or avoid a test on your own.
