This patient should be screened for HIV infection. The U.S. Preventive Services Task Force (USPSTF) recommends one-time HIV screening for all adults aged 15 to 65 years. Screening in adolescents younger than 15 years and adults older than 65 years may be indicated depending on individual risk factors. The currently recommended method for initial testing is a combination immunoassay that detects both HIV antibody and p24 antigen, a viral capsid protein that is elevated early in infection. This test replaces the previously used highly sensitive enzyme-linked immunosorbent assay (ELISA) for antibodies directed toward HIV. It is estimated that approximately 25% of persons with HIV infection are unaware of their diagnosis. Initiating antiretroviral therapy in asymptomatic patients compared with those who present clinically is associated with reduced risk for AIDS-related death.

Routine assessment of lipid levels from ages 40 to 75 years is necessary to identify dyslipidemia and calculate 10-year risk of atherosclerotic cardiovascular disease (ASCVD). The optimal screening frequency is unclear, but it is reasonable to measure lipid levels every 5 years in this age group. Asymptomatic persons aged 40 to 75 years without a history of ASCVD who have at least one ASCVD risk factor (dyslipidemia, diabetes, hypertension, or smoking) and a calculated 10-year ASCVD event risk of 10% or higher should be prescribed low- to moderate-intensity statin therapy for primary prevention, according to a 2016 USPSTF recommendation statement (Bibbins-Domingo K et al, 2016). The 2013 American College of Cardiology/American Heart Association cardiovascular risk guideline indicates that it is reasonable to assess traditional risk factors (including total and HDL cholesterol levels) every 4 to 6 years in adults between the ages of 20 and 79 years who are free from atherosclerotic cardiovascular disease. This patient's lipid levels were normal last year and she is otherwise at low risk for cardiovascular disease; therefore, she would not benefit from repeat lipid screening.

In 2015, the USPSTF issued an updated statement that recommends screening for abnormal blood glucose as part of a cardiovascular risk assessment in adults aged 40 to 70 years who are overweight or obese (Siu AL et al, 2015). According to the USPSTF, rescreening every 3 years is a reasonable approach, although evidence is limited. The American Diabetes Association, in its 2016 Standards of Medical Care in Diabetes, recommends screening for diabetes beginning at age 45 years, regardless of weight. Screening is also recommended in asymptomatic adults of any age who are overweight or obese and who have one or more additional risk factors for diabetes. The American Diabetes Association recommends repeat testing every 3 years if test results are normal. Because a normal fasting plasma glucose level was obtained in this patient last year, repeat testing is not necessary at this time.

In women aged 30 to 65 years in whom cytology (Pap smear) and human papillomavirus (HPV) testing are negative, repeat testing is recommended in 5 years. Because a Pap smear and HPV testing were performed in this patient 3 years ago, she should be screened again for cervical cancer in 2 years.