Routine HIV Testing Recommended for all 15-64 by Federal Panel USPSTF
November 20, 2012, 6:00 AM|
"In an effort to curb HIV transmission and get treatment to those already infected, the U.S. Preventive Services Task Force has recommended that every American between the ages of 15 and 65 be tested for HIV.
"Hopefully, more people with HIV will be identified and treated earlier,"
"Experts hope that the new recommendations will encourage more Americans to get tested and, if necessary, get treated......"
"People are terrible at knowing their own risk," said Del Rio, adding that people may be unaware of the HIV status of their sexual partners. "And doctors are terrible at asking them about risk. It can be difficult to discuss sex and drugs with our patients."
"In order for the U.S. Preventive Services Task Force to make a testing recommendation, the test has to be accurate, treatment for the disease must be available and the benefits of the treatment outweigh the harms"
"Coupled with the fact that the benefits of HIV treatment are now known to outweigh the risks, screening now makes sense, according to the experts on the task force" ABCnews
Make HIV testing routine for all, not just those at high risk, panel urges
WASHINGTON There's a new push to make testing for the AIDS virus as common as cholesterol checks.
Americans ages 15-to-64 should get an HIV test at least once, not just people considered at high risk for the virus, an independent panel that sets screening guidelines proposed Monday.
The draft guidelines from the U.S. Preventive Services Task Force are the latest recommendations that aim to make HIV screening simply a routine part of a check-up, something a doctor can order with as little fuss as a cholesterol test or a mammogram.
Since 2006, the Centers for Disease Control and Prevention also has pushed for widespread, routine HIV screening.
Yet not nearly enough people have heeded that call: Of the more than 1.1 million Americans living with HIV, nearly 1 in 5 -- almost 240,000 people -- don't know it. Not only is their own health at risk without treatment, they could unwittingly be spreading the virus to others.
The updated guidelines will bring this long-simmering issue before doctors and their patients again, emphasizing that public health experts agree on how important it is to test even people who don't think they're at risk, because they could be.
"It allows you to say, "This is a recommended test that we believe everybody should have. We're not singling you out in any way,"' said task force member Dr. Douglas Owens, of Stanford University and the Veterans Affairs Palo Alto Health Care System.
And if finalized, the task force guidelines could extend the number of people eligible for an HIV screening without a copay in their doctor's office, as part of free preventive care under the Obama administration's health care law. Under the task force's previous guidelines, only people at increased risk for HIV, which includes gay and bisexual men and injecting drug users, were eligible for that no-copay screening.
There are a number of ways to get tested. If you're having blood drawn for other exams, the doctor can merely add HIV to the list, no extra pokes or swabs needed. Today's rapid tests can cost less than $20 and require just rubbing a swab over the gums, with results ready in as little as 20 minutes. Last summer, the government approved a do-it-yourself at-home version that's selling for about $40.
Free testing is available through various community programs around the country, including a CDC pilot program in drugstores in 24 cities and rural sites.
Monday's proposal also recommends:
-Testing people older and younger than 15-64 if they are at increased risk of HIV infection,
-People at very high risk for HIV infection should be tested at least annually.
-It's not clear how often to retest people at somewhat increased risk, but perhaps every three-to-five years.
-Women should be tested during each pregnancy, something the task force has long recommended.
The draft guidelines are open for public comment through Dec. 17.
Most of the 50,000 new HIV infections in the U.S. every year are among gay and bisexual men, followed by heterosexual black women.
"We are not doing as well in America with HIV testing as we would like," Dr. Jonathan Mermin, CDC's HIV prevention chief, said Monday.
The CDC recommends at least one routine test for everyone ages 13 to 64, starting two years younger than the task force recommended. That small difference aside, CDC data suggests fewer than half of adults under 65 have been tested.
"It can sometimes be awkward to ask your doctor for an HIV test," Mermin said - the reason making it routine during any health care encounter could help.
But even though nearly three-fourths of gay and bisexual men with undiagnosed HIV had visited some sort of health provider in the previous year, 48 percent weren't tested for HIV, a recent CDC survey found. Emergency rooms are considered a good spot to catch the undiagnosed, after their illnesses and injuries have been treated, but Mermin said only about 2 percent of ER patients known to be at increased risk were tested while there.
Mermin calls that "a tragedy. It's a missed opportunity."
Draft Recommendation Statements
· Screening for HIV
(November 20-December 17, 2012)
Summary of Recommendations and Evidence
The U.S. Preventive Services Task Force (USPSTF) recommends that clinicians screen adolescents and adults ages 15 to 65 years for HIV infection. Younger adolescents and older adults who are at increased risk should also be screened. See the Clinical Considerations for more information about screening intervals.
This is a grade A recommendation.
The USPSTF recommends that clinicians screen all pregnant women for HIV, including those who present in labor whose HIV status is unknown.
This is a grade A recommendation.
Table 1 describes the USPSTF grades, and Table 2 describes the USPSTF classification of levels of certainty about net benefit.