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Another Call for Routine HIV Screening

The American College of Physicians adds its support to a policy of HIV testing for all adolescents and adults, regardless of perceived risk.

Currently, the two most prominent sets of guidelines for HIV testing differ on target populations for routine screening: The U.S. Preventive Services Task Force calls for screening at-risk populations and neither recommends nor argues against screening other individuals. In contrast, the CDC calls for screening all adolescents and adults except in communities of exceedingly low prevalence. The influential American College of Physicians (ACP) has now endorsed a policy of broad screening as well. Among the considerations cited in support of its decision were the following:

• 10% to 25% of people who test HIV-positive report no high-risk behaviors.
  
• Almost half of all newly diagnosed patients are identified late in their illness, when they might not reap full benefit from antiretroviral treatment.
  
• People unaware of their infection status transmit an estimated 20,000 or more infections per year.
  
• Strong evidence indicates that, because of this ongoing transmission, screening is cost-effective even in low-risk communities.
  

Comment: These guidelines mark one more step toward what seems the inevitable endpoint: universal HIV screening. Of note, all guidelines still leave many details to the individual practitioner’s judgment, including optimal frequency of testing in both high- and low-risk individuals. However, the ACP has provided one helpful tip for practitioners in low-risk communities: If 4000 consecutive, routine HIV tests are negative, your community prevalence is probably <0.1%, and you are justified in reassessing the need for further testing of low-risk individuals.

— Abigail Zuger, MD

Published in Journal Watch HIV/AIDS Clinical Care December 8, 2008

Citation(s):

Qaseem A et al. Screening for HIV in health care settings: A guidance statement from the American College of Physicians and HIV Medicine Association. Ann Intern Med 2009 Jan 20; [e-pub ahead of print]. (http://www.annals.org/cgi/content/full/0000605-200901200-00300v1)

Reader Remarks:

Review and add to remarks on this article

• US Preventive Services Task Force
  Patrick R Carrington, 30 Mar 2009 5:30 PM EST
  This useless task force paid for by taxpayer monies is also the group that says routine generalized skin checks (BY... [more]

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