Scientists Advise Screening All Adults for HIV Infection
All adult Americans should be screened for HIV infections in an effort to prolong lives and reduce new infections, two groups of researchers urged today.
Everyone should be screened at least once, and the vast majority should be retested every three to five years in the same manner that physicians screen patients for colorectal cancer, diabetes, hypertension and other diseases, according to two independent reports published in the New England Journal of Medicine.
Such screening would reduce the rate of new infections in this country by about 20% and, on average, add 1 1/2 years of lifespan for each person found to be infected, researchers said.
The cost of the increased screening “would be money well spent,” said Dr. A. David Paltiel of Yale University, who led one of the studies.
“It’s a financial winner as well as a clinical winner and a societal winner,” said Dr. Samuel Bozzette of Rand Corp. and UC San Diego, author of an editorial about the reports in the same journal. “It’s very clear that people with HIV would benefit, as well as those at-risk, and even future generations.”
Guidelines issued by the Centers for Disease Control and Prevention call for screening people in groups with an HIV prevalence of 1% or higher -- a category that includes intravenous drug users, men who have sex with men, and people who have unprotected sex, among others.
Unfortunately, Paltiel said, the risk of HIV infection “has clearly expanded well beyond those stereotypical risk groups, while the mind-set for broadening screening has not changed.”
The CDC estimates that about 900,000 Americans are HIV-positive, and that about 280,000 of them do not know it. That number is growing each year, with about 40,000 new HIV infections.
About 40% of Americans had received an HIV test by the end of 2002, Bozzette said. Nonetheless, an estimated 40% of those diagnosed with the virus are not identified until they display AIDS symptoms.
“That tells us that the current system is not serving us well,” said Dr. Douglas K. Owens of Stanford University and the Veterans Affairs Palo Alto Health Care system, who led the second study.
The AIDS test is relatively cheap at about $2. It takes about 30 seconds to draw blood and a week to produce results. A rapid test that uses scrapings from the mouth and gives results in half an hour is about $7, while a confirmatory test is at least twice that amount. Add in necessary counseling, and the average cost rises to $40 to $60 per test, Owens said.
Over large populations that can add up, he said, but the benefits were worth it.
HIV tests are available to virtually anyone who wants one, experts said.
Insurance companies such as Kaiser will pay for the test if a client requests it, said Dr. Bill Towner of Kaiser Southern California. Also, the Department of Veterans Affairs will furnish a test to any veteran who is eligible for healthcare in the VA system. And the Los Angeles County Department of Public Health -- which tests about 80,000 people a year -- will provide a test to anyone who wants it.
In general, however, physicians in any of those groups do not encourage patients to have the test unless they fall into a risk group. In light of the new findings, they should recommend the test to everyone, Bozzette said.
Dr. Robert Janssen of the CDC said that the agency would probably revise its guidelines to reflect the new findings.
