Why HIV screening should be routine for all

Written by Roger Chou, M.D.

About 20 percent of patients with HIV infection (equaling about 250,000 persons in the United States) are not aware that they are infected.

This means that their immune systems are slowly breaking down over time and they are a source of infection to others.  A new draft statement by the U.S. Preventive Services Task Force (USPSTF), based on a scientific review performed at the Pacific Northwest Evidence-based Practice Center here at OHSU, recommends that HIV screening be routinely offered to all persons between 15 and 65 years of age.

This is a shift from prior USPSTF recommendations, which focused on screening higher risk persons.  Why the change?

  • The HIV test is a simple blood test and is nearly 100 percent accurate—in fact it is one of the most accurate tests we have for any medical condition.
  • HIV treatments are very effective, with newer evidence confirming that early antiretroviral treatment, started when the immune system is still quite strong, improves mortality and prevents opportunistic infections.
  • We now have good evidence from within the last year that antiretroviral therapy reduces the risk of sexual transmission of HIV by over 90 percent.
  • Routine prenatal HIV testing has been a marked success, reducing the number of infected newborns from 1650 to around 200-300 per year.
  • Targeting testing to high risk patients misses a lot of cases, and has not reduced the approximately 56,000 new infections that occur annually. Some patients are uncomfortable disclosing their risk factors, and clinicians asking about them.  Some may not be aware that they are at risk. In women, for example, in whom heterosexual contact is the most common risk factor, it is often unclear who is “high risk” since it depends on the number of partners, their specific sexual practices and the risk of their partners—which they might not even be aware of.
  • Making HIV testing routine may help remove lingering stigma and barriers to testing. Many states, including Oregon, have already removed requirements for signed informed consent and detailed counseling prior to HIV testing. Under the Affordable Care Act, insurance companies are required to fully cover “A” and “B” recommendations from the USPSTF.

As noted by Hilary Clinton and the United Nations, this is an exciting time since the goal of an AIDS-free generation is finally within sight.

But to achieve this first requires that we identify and treat those currently affected, in order to eliminate the reservoirs of infection that allow HIV to persist.

The draft USPSTF recommendation is currently open for public comment through December 17, 2012.

Editor’s note: Dr. Chou also recently discussed this topic on OPB’s Think Out Loud.

***

Roger Chou, M.D. received his medical degree from Northwestern University Medical School and completed an internal medicine residency at OHSU. He is board certified in internal medicine. Chou’s research interests include development of evidence-based guidelines for health screening and management of pain conditions.

He has led research for the U.S. Preventive Services Task Force, the Drug Effectiveness Review Project, the American Pain Society and the Agency for Healthcare Research and Quality’s Comparative Effectiveness Program. In his free time, he enjoys rock climbing, mountaineering, hiking and photography.

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