Denver HIV Risk Score

Age

Sex Assigned at Birth

Race / Ethnicity

Injection Drug Use

Sex with a Male Partner

Vaginal Sex

Score:–

–

Predicts probability of undiagnosed HIV infection.

Why Use

Helpful in settings where nontargeted testing is not feasible. Expedites confirmatory testing and treatment initiation by promptly identifying higher-risk patients who would benefit from screening.

When to Use

Use to identify patients (aged 13 years or older) with an increased probability of undiagnosed HIV infection. Useful for targeting HIV screening in primary care, urgent care, or emergency department settings.

Formula

Addition of the selected points: Variable Points Age, years <22 0 22–25 4 26–32 10 33–46 12 47–54 10 55–60 4 >60 0 Gender Female 0 Male 21 Sexual practices* Sex with a male 22 Receptive anal intercourse 8 Vaginal intercourse -10 None of the above 0 Other risk factors Injection drug use 9 Past HIV testing -4 Neither 0 Race/ethnicity** Black 9 Hispanic 3 American Indian, Alaska Native, Native Hawaiian, non-Hawaiian Pacific Islander, or other 0 White 0 *Choose practice that yields the highest score, e.g. if patient engages in both vaginal and receptive anal intercourse, choose the latter to assign 8 points. **Race may/may not provide better estimates of HIV prevalence; optional. See here for more on our approach to addressing race and bias on MDCalc.

Pearls / Pitfalls

A low score does not eliminate the possibility of HIV infection. Derived and validated in US clinical settings; its applicability to other patient populations may vary. The effectiveness of targeted HIV screening compared to nontargeted screening is mixed in the literature.

Management

A score ≥30 indicates an increased risk for undiagnosed HIV infection. Offer HIV testing, which may include nucleic acid, antibody, or antigen/antibody combination tests. For positive results, order confirmatory testing, provide education and counseling, and refer the patient for specialty HIV care and antiviral therapy. For negative results, provide prevention counseling and consider frequent rescreening if risk factors remain (e.g., injection drug use, men who have sex with men, or a sex partner with HIV).

Critical Actions

Be aware of HIV testing and reporting laws in your state. For detailed screening recommendations, visit the CDC .

Advice

The CDC recommends that all patients aged 13-64 be tested for HIV at least once as part of routine health care. This tool is meant to augment, not replace, existing HIV screening guidelines.

More Information

Interpretation: Score Risk HIV prevalence (95% CI) <20 Very low 0.31% (0.20-0.45) 20-29 Low 0.41% (0.29-0.57) 30-39 Moderate 0.99% (0.63-1.47) 40-49 High 1.59% (1.02-2.36) ≥50 Very high 3.59% (2.73-4.63)