World Journal of AIDS, 2011, 1, 155-164
doi:10.4236/wja.2011.14023 Published Online December 2011 (http://www.SciRP.org/journal/wja)
155
Development of the Guideline for HIV Testing in
South Korea with Low Prevalence of HIV-1
Infection Based on the Expert Consensus*
Hee Jung Choi1, Kyoung Ae Kong2, Jung Won Min3, Hun-Jae Lee4, Hae-Sook Park3
1Department of Internal Medicine, School of Medicine, Ewha Womans University, Seoul, South Korea; 2Clinical Trial Center, Ewha
Womans University Medical Center, Seoul, South Korea; 3Department of Preventive Medicine, School of Medicine, Ewha Woma ns Uni-
versity, Seoul, South Korea; 4Department of Social and Preventive Medicine, College of Medicine, Inha University, Incheon, South Korea.
Received August 4th, 2011; revised October 27th, 2011; accepted N ovember 14th, 2011.
ABSTRACT
Purpose: This study was conducted to develop a guideline for HIV testing in South Korea where the HIV prevalence is
very low. It is necessary to make the recommendations presented here based on the epidemiology of opportunistic infec-
tion and cancer in the community. Methods: The development of a guideline for HIV testing was conducted using lit-
erature reviews and the agreement of Korean experts for HIV patients using a two-round Delphi consensus technique.
Each expert was asked to independently answer to each item related to HIV risk. Ten experts participated in the two-
round survey. Results: The individual items were determined based on the following categories: high risk behavior,
symptom and diseases, colo-rectal diseases, uro-genital diseases and gynecology, skin and oral diseases. The final
guideline consisted of 4-scale agreement rating (strongly recommended, recommended, not routin ely recommended, no
recommendation for routine provision). Discussion: We have developed the guideline for HIV testing in a country
where the HIV prevalence is low based on a systematic investigation and expert consensus.
Keywords: HIV, Testing, Guideline, Consensus, Delphi Studies
1. Introduction
The HIV prevalence of South Korea is still far less than
0.01% of its population, which is considered to be much
lower than that of other countries [1]. Recommendations
for HIV testing are already available from the Centers for
Disease Control and Prevention (CDC), which was de-
veloped by the United States, where there is greater than
1% HIV prevalence. According to a recent survey in
South Korea [2], compliance with HIV testing by Korean
physicians has been relatively poor due to the lo w preva-
lence of HIV infection and insufficient experience with
HIV patients in clinics in South Korea. Furthermore,
tuberculosis (TB) or viral hepatitis B of general popula-
tion is still more common, which are considered to be
indicative diseases for HIV testing, in Korea compared to
the United States statistics [3,4]. Therefore, previous
recommendations by the United States may be not appli-
cable to the country whose HIV prevalence is very low,
and a new guideline for HIV testing is required for the
use by primary physicians in the co mmun ity.
Although some individual guidelines for HIV testing
are currently available in Korea, these guidelines have
been developed by individual medical societies associ-
ated with HIV through the Kor ean NIH and CDC, which
had been recognized by only a few physicians in Korean
clinics. In addition, these are not new guidelines that
were systematically developed. However, It is required to
establish the recommendations that were made based on
agreements by experts treating HIV patients with consid-
eration of the Korean environment in terms of epidemi-
ology. Accordingly, they need to be appropriately revised
to reflect the current prevalence of HIV and other dis-
eases in Korea. Due to the increasing demand and as a
preparative measure, we have developed the guideline
for HIV testing in South Korea based on a systematic
investigation and expert consensus.
2. Methods
*This study was presented at the 57th Conference of the Korean Asso-
ciation of Internal Medicine, Seoul, Korea, October 28th, 2006. 1) Selection of items for the questionnaire for HIV test-

Development of the Guideline for HIV Testing in South Korea with Low Prevalence of HIV-1 Infection 156 Based on the Expert Consensus
ing.
The statements for the HIV testing survey were ex-
tracted from the CDC recommendations and individual
guidelines by Korean medical societies associated with
HIV [5-7]. The references that were recently developed
in Korea included the HIV/AIDS clinical guide that was
published by the Korean Society of Infectious Diseases
and the Korean Alliance to Defeat AIDS that focused on
Korean methods of HIV testin g, diagnosis and co nfirma-
tion, reporting, and therapy [7]. In the questionnaires,
each item was categorized into the following areas. The
HIV testing requirements in the questionnaires based on
high-risk behaviors were made from the CDC guideline
for HIV counseling. Other items for HIV testing re-
quested to special clinics were selected from each guide-
line developed by Korean Dermatological Association,
Korean society of Obstetrics and Gynecology, Korean
Society of Coloproctology, Korean Surgical Society,
Korean Urological Association, Korean Academy of
Dental Sciences, and Korean Society of Emergency
Medicine [7].
2) Expert panel selection and guideline development
using the two-round Delphi process
This study was conducted from January to February,
2006. Experts for the panel were composed of ten infec-
tious disease specialists in Korea who had AIDS research
experience at university hospitals and were also AIDS
advisory council in the Korean CDC. To request their
participation into the panel, experts were contacted by
electronic mail. All ten experts agreed to participate in
the survey. The questionnaires were sent to an expert
panel via an attached file in an electronic mail and re-
turned to the participants. In the first Delphi round, each
panelist was asked to independently respond on a scale
(Yes or No). In addition, they were asked to give com-
ments and to suggest new items. After responses were
received from the panel, their answers were collected,
and the revised questionnaires containing additional
items for HIV testing suggested by the panel were re-
turned to them in the second round of th e Delphi survey.
The newly added items for questionnaires were as fol-
lows: homosexual man; oral candidiasis and oral hairy
leukoplakia in dental clinic; syphilis; UTI due to rare
organisms; prostatitis or prostatic abscess; and any STD
in the uro-genital field.
After receiving the responses to the second survey
from the expert panel, the final items were categorized
into a 4-scale for agreement rating (strongly recom-
mended, seven or more of the ten experts agreed on the
need for an HIV screening test; recommended, four to six
out of the ten experts agreed; not routinely recommended,
one to three of the ten experts agreed; no recommenda-
tion for routine provi s ion, no one ag r e ed).
3. Results
1) Results of the survey of HIV testing requirement
based on hi gh-risk beha viors.
Out of the ten experts surveyed for this study, nine
have commonly conducted HIV tests for patients who
had unprotected intercourse with prostitutes. Addition-
ally, six have conducted HIV tests on patients who had
unprotected intercou rse with those who had unknown sex
partners. Although only two experts had experienced
HIV testing of IV drug abuser s who had shared injecting
needles, all of the panel members agreed to recommend
HIV testing to these individuals. In addition, all experts
agreed to recommend HIV testing to patients who had
unprotected intercourse with those who had multiple sex
partners and to any homosexual men. Although preg-
nancy is not compatible with HIV-high risk behavior, all
of the experts recommended HIV testing of pregnant
woman.
2) Survey results of the requirements of HIV testing
according to the AIDS case definition by the CDC.
These items are consistent with the opportunistic dis-
eases of HIV and most experts agreed with the necessity
of HIV testing of those items listed in Table 2. All ten
experts have performed HIV testing of patients with can-
didiasis of the esophagus, bron chus, and lung. Moreover,
nine of the ten experts agreed to recommend the HIV
testing to patients with extra-pulmonary cryptococcosis,
chronic fatigue, fever for more than 30 days, nonsponta-
neous weight loss, chronic diarrhea for more than 30
days, and pneumocystis carinii pneumonia. Although the
Korean panel has limited experience with chronic cry-
ptosporidiosis, extrapulmonary histoplasmosis, isosporo-
sis, Kaposi sarcoma in individuals younger than 60 years
old, progressive multifocal leukoencephalopathy, recur-
rent nontyphoid salmonellosis, and toxoplasmosis of
viscera, the experts accepted the recommendation of HIV
testing of patients with these d iseases. Only one member
of the panel had experience recommending HIV testing
to a cervical cancer patient, but six panelists agreed on
the need for HIV testing of individuals with invasive
cervical cancer. For TB, eight panelists had experience
with patients with military TB and four had experience
with pulmonary TB patients. However, only four experts
recommended HIV testing of patients with pulmonary
TB.
3) Survey results of HIV testing of the items in colo-
rectal clinics.
The panel did not have experience with HIV testing of
colorectal diseases except for syphilis. However, all of
the panel members agreed to recommend HIV testing for

Development of the Guideline for HIV Testing in South Korea with Low Prevalence of HIV-1 Infection
Based on the Expert Consensus
157
Table 1. Agreement with items describing HIV testing requirement based on high-risk behaviors.
HIV testing
Questionnaire Items ExperiencedRequired (1st) Required (2nd)
A patient who had unprotected intercourse with someone that might be infected STD 5 9 10
A patient who had unprotected intercourse with someone that has had anonymous sex partners6 9 10
A patient who had unprotected intercourse with persons who exchange sex for money or drugs9 9 10
A patient who had unprotected intercourse with someone that has had multiple sex partner 3 9 10
A patient who had shared IV drugs or injecting needle 2 10 10
A patient who has been diagnosed for viral hepatitis B or C 2 3 1†
Any homosexual men* 1 1 7
All pregnant women 1 5 6
All items w ere evaluated by a panel of te n experts; *Added item following the 1st Survey; †required only for viral hepatitis C.
Table 2. Agreement with items describing the requirements for HIV testing according to the AIDS case definition by CDC.
HIV testing
AIDS Case Definition Items Experienced Required (1st) Requir ed (2nd)
Candidiasis of Eso phagus, Trachea, bronchus or lung 10 10 10
Invasive cervical cancer 1 6 6
Extrapulmonary cryptococcosis 9 10 10
Cryptosporidiosis, chronic diarrhea (greater than 1 mo) 2 10 10
Cytomegalovirus disease (other t han liver, spleen, or nodes) 7 10 10
Herpes simplex: chronic ulcer (greater than 1 month); or bronchitis, pneumonitis or esophagitis 4 10 10
Histoplasmosis, disseminated or extrapulmonary 0 9 9
Dementia of unknown cause 2 8 8
Chronic fatigue and unknown origin of fever more than 1 month 9 10 10
Involuntary weight loss of more than 10%, chronic diar rhea 9 10 10
Isosporiasis, chronic intestinal disease (greater than 1 month) 0 10 10
Kaposi's sarcoma developed in individuals less than 6 0 years old 2 10 10
Brain lymphoma developed in indivi duals less than 60 year s old 4 10 10
Non-Hodgkin's B cell lymphoma 3 8 6
Disseminated Mycobacterium avium or M. cansasii Infection 7 10 10
Disseminated tuberculosis 8 9 9
Pulmonary tuberculosis 4 6 4
Pneumocystis carinii pneumonia 9 10 10
Recurrent bacterial pneumonia 2 7 7
Progressive multifocal leukoencephalopathy 3 10 10
Recurrent salmonella septicemia 3 8 9
Toxoplasmosis, internal organ 3 9 10

Development of the Guideline for HIV Testing in South Korea with Low Prevalence of HIV-1 Infection 158 Based on the Expert Consensus
gonococcal infection of the lower rectum and anus,
Chlamydia, CMV colitis, Lymphogranuloma venereum,
Herpes simplex viral (HSV) infection, syphilis (Chancre,
condyloma lata), anal papilloma, anal dysplasia, squa-
mous carcinoma of anorectum, Non-Hodgkin’s B cell
lymphoma, and Kaposi’s sarcoma (Table 3).
4) Survey results of HIV testing of the items in uro-
genital fields.
All ten experts agreed on recommending HIV testing
to any patients with syphilis seen in urological or gyne-
cological exams, and of patients with recurrent genital
HSV, recurrent Herpes simplex genitalis, severe genital
Herpes or candidiasis, other genital ulcers, and refractory
or multiple condyloma accuminata. Eight of the ten ex-
perts agreed with HIV testing of patients with persistent
or recurrent candida vaginitis. In the first survey, HIV
testing of patients with pelvic inflammatory disease or
abnormal findings upon Pap smear was required by four
experts, but in the second survey testing of these indi-
viduals was not required by any of the experts. Urinary
tract infection and prostatitis or prostatic abscess by rare
organisms were newly posted after the first survey, but
only two experts agreed with HIV testing of individuals
with these items in the second survey.
5) Survey results regarding HIV testing requirements
for the items in dermatology and dental clinics
Herpes zoster was found to be the disease for which
HIV testing was most often recommended among der-
matology diseases, with all ten exp erts reportin g th ey had
performed testing on such individuals. This was followed
by recurrent oral candidiasis patients, who have been
tested for HIV by seven experts, and patients with anal or
genital ulcers, who were tested by six experts. It was also
suggested that HIV testing of herpes zoster patients be
limited to more specific subjects, such as those who are
younger than 50 years old. Some of the items in the den-
tal field overlapped with those in other fields that were
removed in the first survey. However, some experts pro-
posed that patients with oral hairy leukoplakia and oral
candidiasis be tested for HIV; therefore, they were in-
cluded in the second survey.
All ten experts agreed to test for HIV in herpes zoster
patients that were younger than 50 years old, as well as
in patients with anal or genital ulcer, Kaposi’s sarcoma,
genital warts, bacillary angiomatosis, and oral hairy leu-
koplakia. It was recommended that patients with mol-
luscum contagiosum of the face or genitalia be tested for
HIV by nine of the experts. Moreover, patients with per-
sistent generalized lymphadenopathy, which are lymph
nodes more than 1 cm in diameter that are located at
more than two sites excluding inguinal areas without
other distinct diseases and patients with recurrent oral
candidiasis were recommended for HIV testing by eight
experts. Six of the experts recommended that patients
with bartonellosis and severe eosinophilic purulent fol-
liculitis undergo HIV testing, while five experts recom-
mended that individuals with non-Hodgkin’s lymphoma
and four of the experts recommended that those with skin
T cell lymphoma and recurrent aphthous ulcer undergo
HIV testing. Five experts responded that severe gingivitis
Table 3. The requirements for HIV testing in colorectal clinics.
HIV testing
Diseases Items Experienced Required (1st) Required (2nd)
Gonorrhea 2 10 10
Chlamydial infection in recto-anal area 1 10 10
Nonspecific proctitis 2 7 6
CMV proctitis/colitis 4 10 10
Lymphogranuloma venereum 2 10 10
Herpes simplex infection 4 10 10
Syphilis 7 10 10
Idiopathic rectal-anal ulcer 3 8 9
Conlyloma 3 10 10
Anal dyspla s ia, squamous c ancer 1 10 10
Non-Hodgkin’s B cell lymphoma, Kaposi’ s s arcoma 0 10 10
Rare anal cancer; adenocarcinoma, basal cell carcinoma 0 8 7

Development of the Guideline for HIV Testing in South Korea with Low Prevalence of HIV-1 Infection 159
Based on the Expert Consensus
should lead to HIV testing in the first survey, but only
three experts agreed with this recommendation for the
second survey. Other items including squamous cell car-
cinoma of the skin, melanoma, refractory seborrheic
dermatitis, maculopapular rash, recurrent bacterial fol-
liculitis, and generalized Tinea corporis were considered
to necessitate HIV testing by four or five experts, but
only one or two experts recommended HIV testing of
individuals with those diseases in the second survey.
Moreover, none of the panel recommended HIV testing
of individuals with scabies, atopic dermatitis, drug erup-
tion, pyoderma, skin abscess, cellulitis, and necrotizing
fasciitis in the second survey. One expert pointed out that
HIV testing was required for patients older than 20 years
who developed atopic dermatitis for the first time and for
young males who developed maculo-papular rash.
6) Guideline endorsed by the expert panel for HIV
testing recommendation in Korea.
All of the questionnaire items considered by the ten
experts in Korea are shown in Tables 1-5. These items
were integrated and developed into a guideline (Table 6).
The recommendations were categorized into the follow-
ing four different levels as described in the methods:
Strongly-recommended, Recommended, Not routinely
recommended, and Not recomme n de d.
4. Discussion
The number of HIV-infected patients has been increasing
in South Korea since the first HIV-infected person was
confirmed in 1985. Indeed, the number of reported cases
was more than 6000 in 2009. However, the prevalence of
HIV in Korea is still only 0.01% of the national popula-
tion, which is lower than the average prevalence of the
world, whic h was 0. 8% i n 2 00 8 [ 1] .
In 2001, the United States CDC recommended routine
HIV screening of persons aged 13 - 64 years in medical
settings in which the HIV sero-prevalence exceeds 1%
[5]. This recommendation was broadened in 2006 to in-
clude routine HIV testing for all persons aged 13 - 64
years in all healthcare settings [6]. However, the UK
guideline recommends that HIV testing should only be
conducted for high-risk group s and in medical settings in
local areas in which the prevalence exceeds 0.2% [8].
The European guideline for HIV testing was updated to
provide advice for sexu ally transmitted infection serv ices
in 2008 [9]. The WHO recommends HIV testing in
countries in which HIV is prevalent, but they clarified
that health care providers should not recommend HIV
testing to all persons attend ing health facilities in settin gs
with low-level epidemics [10]. Therefore, it is necessary
Table 4. Agreement with items describing HIV testing requirements in uro-genital field.
HIV testing
Diseases items Experienced Required (1st) Required (2nd)
Syphilis 2 2 10
Any STD 1 1 9
UTI due to rare organisms 0 1 2
Prostatitis or prostatic abscesses 0 1 2
Recurrent Herpes simplex genitalis* 3 8 10
Severe genital Herpes or candidiasis 1 9 10
Other genital ulcer 3 9 10
Refractory or multiple Condyloma accuminata 2 9 10
Abnormal findings in Pap smear 0 4 0
Any PID 1 4 0
Any STD 3 8 10
Persistent or re current candida vaginitis** 1 7 8
*Twice during six months or more than four times per year, the cases occurring two times in frequency though one year; **Persistent diseases after two rounds
of treatment, twice during six months or more than four times per year, the cases occurring two times in frequency through one year; †All items in the Urology
department were suggeste d by experts following the first survey.

Development of the Guideline for HIV Testing in South Korea with Low Prevalence of HIV-1 Infection 160 Based on the Expert Consensus
Table 5. Agreement with items describing HIV testing requirements in dermatology and dental clinics.
HIV testing
Items for D ermatology and Dental Clinic s Experienced Required (1st) Required (2nd)
Herpes zoster, age <50 years old 10 9 10
Ulcer of anal or genital area 6 10 10
Molluscum contagiosum in face, genitalia 2 8 9
Scabies 0 4 0
Bartonellosis 0 7 6
Kaposi’s sarcoma 4 10 10
Non-Hodgkins’s l ymphoma 1 6 5
Skin T cell lymphoma 0 6 4
Squamous cell ca r ci n oma 0 5 2
Melanoma 0 5 2
Severe eosinophilic purulent folliculitis 1 6 6
Psoriasis 1 2 0
Refractory seborrheic dermatitis 1 5 2
Atopic dermatitis 0 2 0
Drug eruption 1 1 0
Maculopapular rash 2 4 2
Persistent generalized lymphadenopathy* 2 9 8
Generalized Tinea corporis 2 4 1
Genital condyloma 2 7 10
Recurrent bacterial folliculitis 1 4 2
Pyoderma, abscess, cellulitis, necrotizing fasciitis 1 2 0
Bacillary angiomatosis 1 7 10
Recurrent oral candidiasis 7 10 8
Oral hairy leukoplakia 2 9 10
Recurrent aphthous ulcer 2 4 4
Severe gingivitis, periodontitis 3 5 3
*Lymph nodes more than 1 cm in diameter located in more than two sites except inguinal areas without other distinct diseases.
to establish a Korean national recommendation for HIV
testing that reflects the prevalence of infectious diseases
in Korea. This is the first study to integrate evidence
available in the literature, several recommendations for
other countries, and Korean expert consensus using a
Delphi survey [11].
The experts agreed on an HIV testing requirement for
all high-risk behaviors, except for viral hepatitis B or C.
The United States guideline recommends HIV testing of
hepatitis B positive patients, but the Korean guidelines
do not consistently adopt this recommendation. This is
likely due to the difference in the prevalence of viral he-
patitis B. The sero-prevalence of chronic hepatitis B was
about 3.7% in South Korea in 2005 [3]. In contrast, the
prevalence of hepatitis B in the United States was about
0.3% - 0.5% in 2006 [12]. The physicians who partici-
pated in the present survey con sidered viral hepatitis B to
be too common to recommend HIV testing in

Development of the Guideline for HIV Testing in South Korea with Low Prevalence of HIV-1 Infection 161
Based on the Expert Consensus
Table 6. The guideline endorsed by the expert panel for HIV testing recommendation in Korea.
Strongly recommended
A. High risk behaviors
A patient who had unprotected intercourse with someone that might be infected with an STD
A patient who had unprotected intercourse with som eone that has had an anonymous sex partner
A patient who had unprotected intercourse with someone that has exchanged sex for money
A patient who had unprotected intercourse with someone that has had multiple sex partners
A patient who has shared IV drug or injecting needle
Any homosexual men
B. Symptom and Diseases
Candidiasis in esophagus, trachea, bronchus or lung
Extrapulmonary cryptococcosis
Cryptosporidiosis accompanying chronic diarrhea for more than 1 month
Cytomegalovirus disease (other than liver, spleen, or nodes)
Herpes simplex viral infections: chronic ulcer (s) (duration greater than 1 month)
HSV bronchitis, pneumonitis, or esophagitis
Extrapulmonary Histoplasmosis
Dementia, unkno wn origin
Involuntary weight loss greater than 10% and unknown fever for greater than 30 d ays
Isosporiasis, chronic intestinal (duration greater than 1 month)
Kaposi's sarcoma in individual less than 60 years old
Brain lymphoma in individual less than 60 years old
Disseminated Mycobacterium avium or M. cansasii
Disseminated tuberculosis
Pneumocystis carinii pneumonia
Recurrent bacte rial pneumonia
Progressive multifocal leukoencephalopathy
Recurrent salmonella bacteremia
Toxoplasmosis of internal organ
C. Colo-rectal Diseases
Gonorrheal diseases in rectum and anal canal
Chlamydial infection, CMV colitis in rectum and anal canal
Lymphogranuloma venereum
Herpes simplex infection
Syphilis
Idiopathic rectal ulcer
Condyloma
Dysplasia
Non-Hodgkin's B cell lymphoma, Kaposi samcoma
Rare anal cancer; adenocarcinoma, small cell cancer, basal cell carcinoma
D. Uro-genital Diseases/Gynecology
Syphilis
Sexually Transmitted Diseases
Recurrent Herpes simplex genitalis (Twice during six mo n th s o r more than four times per
year,
Severe genital Herpes or candidiasis

Development of the Guideline for HIV Testing in South Korea with Low Prevalence of HIV-1 Infection 162 Based on the Expert Consensus
Other genital ulcer
Refractory or multiple Condyloma accuminata
Persistent or recurrent candida vaginitis (Occurring after two rounds of treatment, twice during six months or more than four times per year)
E. Skin and Oral Diseases
Herpes zoster in individuals less than 50 years old
Ano-genital ulcer
Molluscum contagiosum on face, genitalia
Generalized persistent lymphadenopathy (Lymph nodes greater than 1 cm in diameter
located in more than two sites except inguinal areas without other distinct diseases)
Genital warts
Bacillary angiomatosis
Recurrent oral candidiasis
Oral hairy leuko plakia
Recommended
A. High-risk Behavior
Pregnancy
B. Symptom and Diseases
Invasive cervical cancer
Non-Hodgkin’s B cell lymphoma
Pulmonary tuberculosis
C. Colorectal Diseases
Nonspecific proctitis
D. Skin and Oral Diseases
Bartonellosis
Non-Hodkin's lymphoma
Skin T cell lymphoma
Severe eosinophilic pustular folliculitis
Recurrent aphthous ulcer
Not routinely recommended
A. Symptom and Diseases
Viral Hepatitis C
B. Uro-genital Diseases
Urinary Tract Infection by rare organisms
Prostatitis or prostatic abscess
C. Skin and Oral Diseases
Squamous cell carcinoma
Melanoma
Refractory seborrheic dermatitis
Maculopapular rash
Generalized Tinea corporis
Recurrent bacterial folliculitis
Severe periodontitis, gingivitis
No recommendation for routine provision
A. Symptom and Diseases
Viral hepatitis B
B. Uro-genital Diseases
Abnormal Pap smear findings
Pelvic inflammatory diseases
C. Skin & Oral Diseases
Scabies
Psoriasis
Atopic Dermatitis
Drug eruption
Pyoderma, abscess, cellulitis, necrotizing fasciitis

Development of the Guideline for HIV Testing in South Korea with Low Prevalence of HIV-1 Infection
Based on the Expert Consensus
163
Korea.
In 2001, the CDC recommended all pregnant women
undergo an HIV test as part of routine screening for pre-
natal care [13]. The universal HIV screening for the pre-
natal period and HAART therapy demonstrated that 20%
of the perinatal transmission cases decreased to less than
2% due to the recommendation for HIV testing [14,15].
Therefore, despite the low HIV prevalence among Ko-
rean women, experts recommended routine screening of
pregnant women for HIV based on evidence for the re-
duction of perinatal HIV transmission when it was de-
tected early.
As shown in Table 2, most of the panel members
agreed to the recommendation for screening of individu-
als with the opportunistic diseases mentioned in the
AIDS-surveillance case definition [16]. The prevalence
of TB is relatively high in Korea, with 18,000 (0.039%)
smear positive and 224,000 (0.32%) radiologically activ e
TB patients being present in 2006 [4]. In contrast, the
United States reported only 4.2 cases of TB per 100,000
in 2008, which was 10-f old lower than that of the Kor ean
smear-positive cases [17]. TB prevalence is also de-
creasing in Korea, but it is an important opportunistic
infection of HIV patients. Therefore, although TB is still
prevalent in Korea, our expert panel recommended HIV
testing of individuals diagnosed with TB. Meanwhile, in
the uogenital and anorectal field, most experts in this
study agreed to recommend HIV testing of individuals
with well-known AIDS defining opportunistic infections
or cancer. However, it was not recommended that indi-
viduals with nonspecific diseases of the skin such as sca-
bies, atopic dermatitis, drug eruption, and psoriasis un-
dergo HIV testing. All the recommendations were inte-
grated, scaled and completed to a guideline.
Since 2006, the CDC has recommended universal HIV
testing at hospitals, but it was reported that many physi-
cians did not routinely provide HIV tests [18], and only
35.8% of residents of internal medicine in New York
administered HIV tests [19]. The CDC recommends HIV
testing of newly diagnosed TB patients. In the United
States, 63% of TB patients were tested for HIV in 1993,
but only 37% of such patients were tested in Singapore in
2006 [20,21]. This discrepancy suggests that the guide-
line should be publicized to practicing doctors. This
guideline could help Korean physicians properly apply
HIV testing to their patients.
In summary, this literature review and Korean expert
consensus condu cted through the Delphi process re sulted
in the development of guideline for HIV testing reflect-
ing national epidemiology of HIV-indicating diseases,
which were different points compared with both CDC in
US recommending universal HIV testing at ho spital. The
guideline presented here should be revised again accord-
ing to the change of HIV-prevalence.
5. Acknowledgments
This study was funded by Korean CDC grant 2005-
E31003-00.
We thank the ten experts who participated in the Del-
phi survey: Nam Joong Kim, Seoul National University
School of Medicine; Yang-Ri Kim, Catholic University
School of Medicine, Department of Internal Medicine,
Division of Infectious Diseases; Woo Joo Kim, Korea
University School of Medicine; June Myung Kim, Yon-
sei University College of Medicine; Sun-Hee Lee, Busan
National University School of Medicine; Hong-Bin Kim;
Seoul National University College of Medicine; Hyo-
Yeul Kim, Yousei University College of Medicine;
Hyunjoo Pai; Hanyang University College of Medicine;
Myoung-don Oh, Seoul National University College of
Medicine; Jun Yong Choi, Yousei University College of
Medicine.
6. Author Disclosure Statement
Hee Jung Choi, Kyoung Ae Kong, Jung Won Min,
Hun-Jae Lee and Hae-Sook Park have no potential con-
flicts of interest to disclose.
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