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We review current recommendations on whom to test and how to test for HIV and hepatitis C virus in the United States and identify some remaining challenges.In the United States, of the 1.1 million persons infected with human immunodeficiency virus (HIV) and the 2.7 million infected with hepatitis C virus (HCV), approximately 16% and 50%, respectively, are unaware of their infection. Highly effective treatments have turned both diseases into manageable conditions, and in the case of hepatitis C, a disease that can be cured. Early diagnosis is imperative so that infected persons can take measures to stay healthy, get into care, benefit from therapy, and reduce the risk of transmission. In this report, we review current recommendations provided by the Centers for Disease Control and Prevention (CDC) and the United States Preventive Services Task Force on whom to screen for HIV and HCV infections, and recommendations from the CDC, the Association of Public Health Laboratories, and the Clinical and Laboratory Standards Institute on how to test for these infections. [ABSTRACT FROM AUTHOR]

We stress basing hepatitis C virus (HCV) virologic thresholds on the assays' lower limit of quantitation, allowing viral load to be recorded as quantifiable or unquantifiable. If unquantifiable, the result is classified as HCV RNA target detected or not detected, which are 2 clinically distinct populations.Retrospective analyses of the boceprevir and telaprevir phase 3 trial data demonstrate the clinical relevance of detected but not quantifiable hepatitis C virus (HCV) genotype 1 RNA during treatment. These analyses illustrate the importance of using precise and standard terminology in reporting low-level HCV RNA results for consistent data collection across clinical trials, and to ensure optimal virologic response-guided treatment decision making in clinical practice. In the context of currently available quantitative HCV RNA assays, we clarify that unquantifiable HCV RNA should be classified as target detected or target not detected, as both have been shown to reflect clinically different qualitative HCV RNA levels during treatment. Additionally, use of terms such as “undetectable” or “below limit of detection” should be avoided as such terms are imprecise, not consistently defined, and often misinterpreted. [ABSTRACT FROM AUTHOR]