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HIV testing should be offered to all who are sexually active, researchers say
  NEW YORK (Reuters Health) - Now is the time to implement routine, not risk-based, HIV testing, according to a viewpoint published in the April 1st issue of Clinical Infectious Diseases.
"Establishment of routine testing for HIV infection is essential to reduce the number of persons living in the United States who are infected with HIV but are unaware of their HIV serostatus," state Dr. Curt G. Beckwith from Brown Medical School in Providence, Rhode Island, and colleagues from Emory University School of Medicine in Atlanta, Georgia, and Johns Hopkins School of Medicine in Baltimore, Maryland.
The authors explain that significant numbers of persons with newly diagnosed HIV infection present late in the course of the disease, not only worsening their prognosis but also increasing the likelihood of their transmitting HIV to others.
Moreover, the researchers write, current prevalence-based recommendations for testing are impractical, because few physicians working in the community can really know whether they are working in a high-prevalence area or not.
Also, assessing patients' risk for infection is plagued by inaccurate information received from patients, the commentary suggests.
Even without these factors, health care providers may avoid offering HIV testing for a variety of reasons, ranging from informed consent to counseling issues to time constraints.
The essay proposes "a new policy whereby health care providers routinely offer HIV testing, irrespective of perceived risk." To make this workable, the authors say, counseling needs to be streamlined and rapid HIV testing implemented in the appropriate setting.
"Early diagnosis provides an opportunity for linkage to care, with the goal of preventing opportunistic infections and the development of severe immunosuppression," the researchers point out. "Early diagnosis also allows for risk-reduction counseling, which can reduce transmission of the HIV virus."
HIV testing "should be performed routinely for all sexually active persons, to diagnose HIV infection and to prevent AIDS," they conclude.
Clin Infect Dis 2005;40:1037-1040.
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