(RxWiki News) Should all people get an HIV test, or just people at high risk? These questions are at the heart of long debate about HIV testing. And the debate may be coming to an end.
A panel of experts whose recommendations guide clinical care and public policy said that all adults and teens over age 15 should have routine HIV tests. Some doctors think this marks the end of the debate about who should be tested and when.
Once the panel’s recommendations are final, HIV testing will be more accessible. The cost of HIV testing will be covered by healthcare plans as part of routine medical care.
"Ask your doctor about HIV testing."
The US Preventive Services Task Force (USPSTF) is a panel of independent doctors and experts. They review research about medical conditions and provide recommendations for doctors and policymakers about what the evidence says is best for a particular health condition.
The USPSTF recommendation is still in draft form and awaiting final edits. In its present form it says: “The US Preventive Services Task Force 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.”
Ronald Bayer, PhD, and Gerald M. Oppenheimer, PhD, MPH, presented their perspective on the new USPSTF recommendations about HIV testing.
They said that the new recommendation ends a long-standing debate about whether or not routine testing is helpful or harmful. They also said that they hope this is the first step toward making HIV testing more accessible for everyone and reducing the number of people who progress to acquired immune deficiency syndrome (AIDS) without ever knowing they were HIV positive.
In 2006, the USPSTF did not feel that the benefits outweighed the risks of routine HIV testing. Research at the time seemed to show that early detection of HIV meant that people were more likely to respond well to treatment – and live long, healthy lives.
But the stigma surrounding HIV infection meant that testing presented a psychological burden to patients and could impact their lives in various ways. So the USPSTF recommended that only people at risk for HIV infection should receive regular testing.
The USPSTF began reviewing all the research again in 2011. Now, after reviewing the research, the USPSTF has decided that the benefits of routine HIV testing outweigh the risks of testing.
The rationale they gave for the new recommendations is that starting antiretroviral drugs before symptoms appear has been shown to lower the risk of developing AIDS, AIDS-related complications and death. Also, using antiretroviral drugs is linked to lower risk of passing HIV to others.
Therefore, routine testing is likely to give more people the opportunity to start antiretroviral treatments early.
The new USPSTF recommendations mean that HIV testing will be available free-of-charge to anyone – regardless of risk. The Affordable Healthcare Act requires that health plans pay the cost of treatment and tests that are recommended by USPSTF without any copay by the patient.
Many people who are HIV positive don’t know it. An estimated 20 to 25 percent of Americans living with HIV are not aware they have the disease.
Many people do not get tested for HIV. As such, the infection is caught in later stages of the disease when people are sicker.
The Centers for Disease Control and Prevention (CDC) estimated that as many as 41 percent of people who tested positive for HIV had never had an HIV test before. And about a third of these people developed AIDS within the first year.
Overall, the USPSTF recommends that all adults should have regular screening for HIV. Catching it early can lead to early treatment. Early treatment can help people with HIV live longer, be healthier and protect their loved ones.
The opinions of Drs. Bayer and Oppenheimer were published February 20 in the New England Journal of Medicine. They report not conflicts of interest.