Friday, September 22, 2006

Routine HIV Testing Recommended by CDC
By Julie McKeel

Gillian Sanders, PhD

The HIV test should be given much like a cholesterol or blood-pressure test, but patients should the opportunity to refuse to take the HIV test if they don't want it, according to the statement released by the CDC during a press conference this week.

The recommendations also appear in the September 22 issue of the CDC's Morbidity and Mortality Weekly Report.

The DCRI's Gillian D. Sanders, an associate professor of medicine at Duke University Medical Center , thinks the new recommendations are an important step forward in HIV detection and prevention, and are a good allocation of public health-care time and dollars.

"I am very pleased to see that the CDC is now recommending routine voluntary HIV screening," Sanders told HealthDay.

"Our previous research has emphasized that the case for systematic voluntary HIV testing even in low prevalence health-care settings is compelling. Routine HIV screening is able both to prolong life of the infected individuals and their potential partners, and also is a good use of our resources," she said. And, the CDC's recommendation to streamline the pre- and post-counseling associated with HIV testing will considerably enhance the cost-effectiveness of routine HIV screening, added Sanders.

"Making voluntary HIV screening a routine part of health care will help to remove the stigma associated with testing while helping us to identify infected individuals early in their disease," Sanders said.

According to the CDC, more than 250,000 Americans are HIV-positive but don't know it. One of the goals of the new recommendations is to increase early detection of HIV, the virus that causes AIDS, and to simplify the HIV screening process.

The new recommendations are an attempt to increase the early diagnosis of HIV, so that people can get access to treatment sooner, know their HIV status, and get support as they learn to take care of themselves. Another goal of this early awareness campaign is to prevent transmission to other people, according to CDC Director Dr. Julie L. Gerberding.

Because previous screening approaches haven't been as effective in identifying people who are HIV-positive, "these new recommendations will help us reach our ultimate goal of no child with infection, no person untreated or undiagnosed, and no transmission of HIV among people in this country," Gerberding noted during the press conference on Thursday.

The recommendations also include new measures to improve diagnosis among pregnant women and further reduce mother-to-child HIV transmission. The recommendations aren't legally binding, but they are expected to influence doctors' practices and health insurance coverage.

Patients should be provided with information about HIV and the meaning of positive and negative test results, and should have the opportunity to ask questions. The CDC recommends that patient be told that HIV testing is part of routine care and then provide them with the opportunity to decline testing.

The recommendations are intended only for testing in health-care settings, and do not include community centers or other HIV- or health-care outreach programs. Patients who seek medical care should also have the opportunity to learn if they are infected with HIV.

The CDC recommends simplifying testing procedures to overcome obstacles to screening, such as pretest counseling and separate written consent. Both of these barriers should be removed. Rather, HIV testing should be incorporated into general consent for medical care, the agency said.

There should also be enhanced screening for pregnant women, the CDC said. The estimated number of infants born with HIV declined from about 1,650 in 1991 to less than 240 this year. The new recommendations are intended to help reduce this number even further.

SOURCES: Sept. 21, 2006, press conference with Julie L. Gerberding, M.D., M.P.H., director, U.S. Centers for Disease Control and Prevention, Atlanta; Gillian D. Sanders, Ph.D., associate professor, medicine, Duke Clinical Research Institute, Duke University, Durham, N.C.; Sept. 22, 2006, Morbidity and Mortality Weekly Report