New draft recommendations for HIV testing

Teens, pregnant women included

Teens and adults aged 15 to 65, as well as all pregnant women, should be tested for HIV, according to new draft recommendations from the U.S. Preventive Services Task Force.

The new recommendations include pregnant women who show up at a hospital in labor but don't know their HIV status, and younger adolescents and older adults who are at increased risk of HIV.

In 2005, the task force recommended screening for all adolescents and adults at increased risk and all pregnant women. No recommendations were made regarding routine testing in that same population who were not at an increased risk.

Risk factors include having unprotected sex with more than one person or having sex with someone who is HIV positive, bisexual, an intravenous drug user or exchanging sex for drugs or money. Men who have sex with men and IV drug users are considered to be at very high risk.

According to the task force, children younger than 15 could be screened if they have risk factors for the disease. The USPSTF says screening after 64 is usually unnecessary unless there is a continuing risk of infection. The group says the new draft recommendations will allow for early detection and treatment. Early treatment with antiretroviral therapy reduces the risk of AIDS-related complications and the likelihood of transmission.

"Because HIV infection usually does not cause symptoms in the early stages, people need to be screened to learn if they are infected," said Dr. Douglas K. Owens, a member of the task force. "People who are feeling well and learn they are infected with HIV can begin treatment earlier, reduce their chances of developing AIDS and live longer and healthier lives."

One approach could be an initial screening to determine who already has the disease followed by repeat screenings every three to five years for those at increased risk and annually for those at very high risk, the task force says. Routine re-screenings might not be needed for those not at increased risk if they tested negative initially. Under the new recommendations, pregnant women would be retested during each pregnancy.

According to the Centers for Disease Control and Prevention, approximately 1.2 million people in the United States are living with HIV and there are about 50,000 new cases every year. About 25% of people living with HIV don't know they have the disease.

In 2006, the CDC updated its HIV testing guidelines, recommending routine screening for everyone between 13 and 64 years of age regardless of risk factors - but with the choice to "opt-out" or decline testing - and annual screenings for those at high risk of infection. For pregnant women, the recommendation was for HIV testing to be included in routine prenatal screening.

Dr. Carlos Del Rio, professor of medicine at Emory School of Medicine said the expanded recommendations are good news.

"I think when you have between 20 and 25% of people infected with HIV in this country that don't know it, we've got to do a better job of diagnosis ... many people who are diagnosed today with advanced HIV, they could have been screened and they were not screened, so those missed opportunities have consequences for both the individual and transmission."

Chris Collins, vice president and director of public policy for amfAR, The Foundation for AIDS Research, also welcomes the new changes. "Today's recommendation sends a clear message that screening for HIV should be a normal, routine part of appropriate health care," he says. "It's an important step forward in connecting people to the lifesaving care they need."

The task force is an independent group of experts that make "evidence based" recommendations on preventive services like screenings, preventive medications and counseling services. The HIV screening recommendations will be posted for public comment through December 17 on the task force website. There is no timeline on when final recommendations will be issued, but they will be published in the Annals of Internal Medicine.

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