 By LEE BOWMAN Scripps Howard News Service September 21, 2006
Until now, the federal Centers for Disease Control and Prevention had recommended routine screening for human immunodeficiency virus only in higher-risk populations, such as intravenous drug users and prostitutes.
The new guidelines also expand recommendations for testing all pregnant women to prevent transmission of the virus to infants. The recommendations are a bid to identify and treat an estimated 250,000 Americans who are HIV-positive but unaware of their infection, contributing to the spread of the virus and delaying life-extending therapies. "We urgently need new approaches to reach the quarter-million Americans with HIV who do not realize they are infected," said Dr. Julie Gerberding, director of the CDC. Nearly 40 percent of individuals who are diagnosed with HIV are detected within a year of their infection progressing to AIDS, when it may be too late for them to fully benefit from anti-retroviral drugs. Studies show that most people who learn they are infected take steps to protect their partners, while people who are unaware of their HIV status account for an estimated 50 percent to 70 percent of new sexually transmitted HIV infections, officials said. While health-care providers have no legal obligation to follow the recommendations, the agency's advice is influential and often weighs in what tests health insurers cover. The idea is to make an HIV test part of a standard kit of tests patients get when they go to a doctor or emergency room for care, including routine physicals. Pre-test counseling and specific written consent would not be required, but would be incorporated into standard consent forms. Patients would be advised that an HIV test was part of the package, be given basic information about what a positive or negative result means, and they would be allowed to opt out. "Recent surveys show that two-thirds of Americans agree that special procedures for HIV testing are not needed, and that they would be more comfortable with it if it was treated like other diagnostic tests," said Dr. Timothy Mastro, acting director of the CDC's division of HIV/AIDS prevention, which drafted the new guidelines. Doctors have often complained that the extra time and paperwork required for HIV testing is a major barrier to screening, even of patients diagnosed with other sexually transmitted diseases. Patients wouldn't necessarily be tested at every visit or even every year, unless they fall into a category of people at higher risk for infection. "These recommendations are important for early diagnosis and to reduce the stigma still associated with HIV testing. This is an important public-health strategy to stop the spread of HIV," said Dr. Nancy Nielsen, a trustee of the American Medical Association. "This is a golden opportunity to jump-start the expansion of HIV testing services in the U.S.," said Dr. David Paltiel, an associate professor of medicine at Yale University. Paltiel is lead author of a study published last year that concluded voluntary HIV screening would be cost-effective for all but very low-risk populations if it were done for everyone every three to five years.
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