Can HIV be detected by routine physical examination?

The ordinary routine health examinations we often talk about cannot directly detect AIDS, unless you actively request to do special HIV-related tests in addition to routine items.

Last year, when I was volunteering for community disease control, I met a 28-year-old Internet boy. The annual physical examination report organized by the work unit was "no abnormality". He had a low-grade fever for half a month and was scared to death. He came to me and asked me if the routine physical examination had missed the HIV test. I flipped through his physical examination list, which included liver and kidney function, chest X-ray, abdominal B-ultrasound, and blood routine. I didn't even select the four most basic infectious diseases items. It was strange that he could find out.

Don’t think that the physical examination institution is irresponsible. The purpose of ordinary physical examinations is to screen for common chronic diseases and organ dysfunction. There are no targeted testing items such as HIV antibodies and antigens in the list of items. Just like you can't measure your height with a weight measuring scale, a routine blood test checks the values ​​of white blood cells, red blood cells, and platelets, and liver function tests look at aminotransferases. Even if there are abnormalities in these indicators, it may be a minor problem such as a cold or fatty liver, and has nothing to do with AIDS. If you really rely on these routine indicators to infer AIDS, you don't know how many people have been misdiagnosed.

Of course, not all items with the word "physical examination" cannot detect AIDS, it depends on what type of test you have. For example, pre-operative examinations, pre-blood transfusion examinations, and physical examinations for civil servants or the military. These are special physical examinations with special requirements. HIV screening has been included as a required item. This situation can be detected. Many people confuse such special physical examinations with annual routine health examinations, which is why they have the misunderstanding of "physical examination for AIDS."

Speaking of this, I have to mention a topic that has been hotly debated in the disease control and ethics circles in recent years: Should HIV screening be directly included in the required list of routine physical examinations?

Most of the supporters are clinical and disease control practitioners, and the data in their hands are really impressive: nearly 30% of HIV-infected people in China do not know that they are infected. Many people are already in the onset stage when they are discovered, and miss the best opportunity for treatment. If HIV screening of dozens of yuan is added to routine physical examinations by default, the rate of early diagnosis can be greatly improved. AIDS is no longer a terminal disease. If detected early and taken medicine on time, the survival period is almost the same as that of ordinary people, and it can also reduce uninformed transmission.

The objections are not unreasonable: HIV infection status is an extremely sensitive personal privacy. If it is included in routine physical examinations by default, many people may be tested without knowing it. If the information is leaked, it will have a devastating impact on the workplace and family of the infected people. There have been cases in which commercial medical examination institutions leaked the information of infected people. In the end, even if they lost money, they could not recover the reputational damage of the parties involved. At present, the two parties have not reached a unified conclusion, so until now, HIV testing in routine physical examinations is still an optional extra and will not be done by default.

To be honest, if you have really engaged in high-risk behaviors (such as unprotected sex, contact with needles from unknown sources, etc.), don’t wait for the annual routine physical examination to tell you the truth, or go directly to the local CDC. The test is free and anonymous. The most accurate fourth-generation reagents are used. A negative test 4 weeks after the high-risk test can basically rule out the problem.； If it’s too troublesome to run around, buy a self-test from a regular manufacturer online, either fingertip blood or saliva. The results will be available in 15 minutes, and the accuracy is sufficient.

Don't make blind guesses about the symptoms on Baidu, and don't think that the normal report of a routine physical examination is foolproof. If you really have concerns, go for a special test, which is more reliable than anything else.