CDC recommends routine HIV testing

Published Thursday, September 21, 2006

ATLANTA (AP) - All Americans between the ages of 13 and 64 should be routinely tested for HIV to help catch infections earlier and stop the spread of the deadly virus, federal health recommendations announced today say.

The U.S. Centers for Disease Control and Prevention said HIV testing should become as common as a cholesterol check. Nearly half of new HIV infections are discovered when doctors are trying to diagnose a sick patient who has come for care, CDC officials said.

"We know that many HIV-infected people seek health care and they don’t get tested. And many people are not diagnosed until late in the course of their illness, when they’re already sick with HIV-related conditions," said Timothy Mastro, acting director of the CDC’s division of HIV/AIDS prevention.

"By identifying people earlier through a screening program, we’ll allow them to access life-extending therapy and also, through prevention services, learn how to avoid transmitting HIV infection to others," he said.

The announcement was hailed by some HIV patient advocates and health policy experts. They said the guidelines could help end the stigma of HIV testing and lead to needed care for an estimated 250,000 Americans who don’t yet know they have the disease.

"I think it’s an incredible advance. I think it’s courageous on the part of the CDC," said David Paltiel, a health-policy expert at the Yale University School of Medicine.

The recommendations aren’t legally binding, but they influence what doctors do and what health insurance programs cover.

Some physicians’ groups predict the recommendations will be challenging to implement, involving new expenditures of money and time for testing, counseling and revising consent procedures.

Some physicians also question whether there is enough evidence to expand testing beyond high-risk groups, said Larry Fields, president of the American Academy of Family Physicians.

"Are doctors going to do it? Probably not," Fields said.

But the recommendations were endorsed by the American Medical Association, which urged physicians to comply. "This is important public health strategy to stop the spread of HIV," said Nancy Nielsen, a Buffalo, a physician who sits on the AMA’s governing board.

Previously, the CDC recommended routine testing for those at high risk for catching the virus, such as intravenous drug users and gay men, and for hospitals and certain other institutions serving areas where HIV is common. It also recommends testing for all pregnant women. Under the new guidelines, patients would be tested for HIV as part of a standard battery of tests they receive when they go for urgent or emergency care, or even during a routine physical.

Patients wouldn’t get tested every year: Repeated, annual testing would only be recommended only for those at high risk.

There would be no consent form specifically for the HIV test; it would be covered in a standard care consent form. Patients would be allowed to decline the testing.

CDC officials have been working on revised recommendations for about three years and sought input from more than 100 organizations, including doctors’ associations and HIV patient advocacy groups. The CDC presented planned revisions at a scientific conference in February.

Since then, the CDC has strengthened language on informed consent to make sure that no one is tested without their knowledge and emphasized the need for doctors to provide information on HIV tests and the meaning of positive and negative results.