Physicians’ Group Recommends Routine HIV Screening Starting at Age 14

Doctors should offer HIV screening to all patients older than 13, says a new guideline from the American College of Physicians (ACP) and HIV Medicine Association (HMA). The call for broad HIV screening echoes 2006 recommendations from the U.S. Centers for Disease Control and Prevention (CDC) that call for screening all adolescents and adults, except in communities with extremely low prevalence of the disease. Another prominent guideline from the U.S. Preventive Services Task Force (USPSTF) suggests screening members of at-risk populations, but neither recommends nor argues against screening others. The new ACP guideline appears in the January 20, 2009 issue of Annals of Internal Medicine.

"The intent of this (ACP) guideline is to help prevent the unwitting spread of HIV infection," said Vincenza Snow, MD, director of clinical programs and quality of care at ACP. "I would tell my patients that it's important to know your HIV status so that you do not risk infecting anyone else. Besides, an AIDS screen is very simple and quick, and can be performed during a routine exam."

It is important to remember that a screening test provides only a tentative result. A positive screening test needs a follow-up test to definitively diagnose HIV. A negative screening test means only that there is no evidence of disease right now. For patients at risk of HIV infection, it is important to repeat screening tests from time to time to monitor for possible exposure.

Strategies that target patients for screening based on risk factors – sexual behavior, injection drug use, treatment for other sexually transmitted diseases, and transfusions – have failed to identify a substantial proportion of HIV cases at their earlier and more treatable stages, say the guidelines. HIV affects more than one million people in the United States. Every year, about 20,000 new infections result from contact with individuals who are unaware that they are infected with HIV, according to ACP. CDC data show that 38% of patients with HIV infection develop AIDS within a year of diagnosis. Early diagnosis and treatment can greatly extend HIV-infected patients’ lives, ACP adds.

The recommendation for widespread, routine screening is based, in part, on successful large-scale screening of pregnant women. As a result, mother-to-child transmission of HIV has been nearly eliminated. Like the strategy advocated in the guideline, pregnant women may decline the screening test. The guideline also notes that screening is cost-effective, even in areas with low HIV infection rates.

In addition, many patients from groups at high risk for HIV infection have not been tested, the guideline notes, adding, “Efforts to reach these patients are especially important.” The guidelines suggest that while adopting a more universal approach to screening, efforts should also focus on settings with significant numbers of people at high risk for HIV, including homeless shelters, correctional facilities, and clinics for sexually transmitted diseases, tuberculosis, gay men, and adolescents.

ACP also recommends that physicians determine when to repeat HIV screening on a case-by-case basis. “The importance of repeated HIV screening depends on whether patients have ongoing risk for HIV infection,” the guidelines say. “Higher-risk patients should be retested more frequently than lower-risk patients.”

Sources

Qaseem, A. et al. Screening for HIV in Health Care Settings: A Guidance Statement from the American College of Physicians and HIV Medicine Association. Annals of Internal Medicine 2009; 150 (2): 1-6.

Fairchild, D. ACP Recommends Routine HIV Screening for All Patients over Age 13. Physician’s First Watch. December 1, 2008.

American College of Physicians Press Release: ACP Recommends Routine HIV Screening for All Patients. Issued December 1, 2008. Available online at http://www.acponline.org/pressroom/hiv_screen.htm through http://www.acponline.org. Accessed December 11, 2008.

Another Call for Routine HIV Screening. AIDS Clinical Care. December 8, 2008. Available online at http://aids-clinical-care.jwatch.org/cgi/content/full/2008/1208/1?q=etoc_jwgenmed through http://aids-clinical-care.jwatch.org. Accessed December 2008.

Tests: HIV Antibody
Condition: HIV