May 1, 2013
Federal Task Force Calls For HIV Testing For All Adults Aged 15-65
redOrbit Staff & Wire Reports - Your Universe Online
Every American between the ages of 15 and 65 should be screened for HIV, even those not at high risk, said the influential US Preventive Services Task Force on Tuesday.
Citing recent evidence that HIV infections are best managed when caught and treated early, the panel of medical experts made its recommendation as part of its final statement on HIV screening.
The new guidelines seeks to address one of the most important challenges in the battle against HIV/AIDS — the time during which patients best respond to treatment is also when symptoms are least apparent.
“HIV is a critical public health problem and, despite recent medical advances, still a devastating diagnosis for the 50,000 people in the United States who contract HIV each year,” said Task Force chairwoman and pediatrician Virginia Moyer.
“In order to help reduce the suffering of those with HIV and their loved ones, we must continue finding better ways to prevent and treat this disease,”
The panel´s recommendations are being released after a number of well-publicized cases in which early treatment with a combination of antiretroviral drugs has dramatically improved patient survival rates.
In one case reported in March, a Mississippi infant who began aggressive drug treatment immediately after birth has been "functionally cured" of HIV, according to experts.
“There's very good evidence that treatment is effective when given earlier, at a time when people are often asymptomatic. So the only way they would know that they had HIV, or that they needed treatment, is to be screened,” said Dr. Doug Owens, a task force member and professor of medicine at Stanford University, in an interview with the Los Angeles Times.
The new guidelines, which were published Monday in the Annals of Internal Medicine, represent a shift from the recommendations the task force made in 2005 but align with other medical groups that recommend routine HIV screening for adolescents and adults.
"We hope that now, with all groups recommending really similar things, the message will get out," Owens said.
HIV, the virus that causes AIDS, attacks the cells that protect the body from disease. It can take years or even decades for serious symptoms to appear.
The virus is most commonly transmitted through blood and semen, and intravenous drug users and men who have sex with men are considered to be at highest risk of infection.
Other groups at risk include those who have unprotected vaginal or anal intercourse, and people who have sex with a partner who is either HIV-positive, bisexual, an IV drug user or who sells sex for money or drugs.
The previous task force recommendations called for HIV screening only for these risk groups, and for pregnant women. When making their earlier guidance, task force members expressed concern that widespread testing might result in false-positive results, or cause depression and social stigma for those who tested positive.
Some panel members also noted that long-term treatment could result in deleterious side effects, such as cardiovascular disease.
However, a review of more recent data — including evidence that as many as one-quarter of US HIV carriers have no idea they are infected — convinced task force members that early detection would result in “substantial public health benefits" that outweighed the risks of widespread screening.
The task force "found convincing evidence that conventional and rapid HIV antibody tests are highly accurate in diagnosing HIV infection," Moyer said.
"Although long-term use of certain antiretroviral drugs may be associated with increased risk for cardiovascular and other adverse events, the magnitude of risk seems to be small."
The new guidelines urge everyone aged 15 to 65 to undergo a one-time HIV screening, and advise people in risk groups who are older or younger to also undergo screening.
Women should also be tested during each pregnancy, the task force said. The task force also recommends at least annual screenings for people in known high-risk groups.
"The question is, 'Do you have ongoing risk, like new sexual partners?'" Owens said. "If you do, then it makes sense to screen periodically."
Patients should also have the ability to ask questions and to decline testing altogether, the panel said.