Routine HIV Testing Urged for All Patients Aged 13 to 64, Regardless of Risk Factors
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Reviewed By Louise Chang, MD
Dec. 1, 2008 -- Doctors should routinely offer all their patients over age 13 a blood test to screen for the HIV virus, which causes AIDS, the American College of Physicians (ACP) urges in new guidelines.
The organization, which represents more than 126,000 internists, internal medicine subspecialists, residents, and medical students, says it is issuing the new guideline on World AIDS Day, which is Dec. 1, to raise awareness that the disease and virus that causes it are still wreaking havoc across the globe.
"The purpose of the guideline is to present the available evidence to physicians as a way to help guide their decisions around screening for HIV in their practice," says Amir Qaseem, MD, PhD, senior medical associate in the ACP's Clinical Programs and Quality of Care Department. "ACP recommends that physicians adopt a routine screening policy for HIV and encourage their patients to get tested, regardless of risk factors."
The ACP also recommends that doctors assess the need for repeat screening on an individual patient basis.
Higher-risk patients should be tested more often than people at lower risk. Higher-risk groups include men who have had sex with men, men and women who've had unprotected sex with multiple partners, past or present injection drug users, and men and women who trade sex for money or drugs or have sexual partners who do.
Persons at risk also include people whose past or present sexual partners were infected with HIV, were bisexual, or were injection drug users; people treated for STDs, and those with a history of blood transfusion between 1978 and 1985.
The ACP identifies patients who received care in high-risk health care settings which would also warrant priority in screening. These include STD clinics, correctional facilities, homeless shelters, tuberculosis clinics, substance abuse clinics, and clinics serving men who have had sex with men. Adolescent health clinics with a high prevalence of STDs also are considered high-risk settings.
"The intent of this guideline is to help prevent the unwitting spread of HIV infection,'' says Vincenza Snow, MD, director of clinical programs and quality of care at the ACP. She sees both at-risk and average-risk patients at her free clinic in Philadelphia and says all of them should be offered HIV testing. Snow says she tells patients that HIV screening is important so that people will be aware of risks; and that the tests are easy, quick, and can be performed during a routine exam.
The new suggestion, "Screening for HIV in Health Care Settings: A Guidance Statement from the American College of Physicians and HIV Medicine Association," says HIV is major public health problem worldwide and that at least 1 million people in the United States are infected.
However, up to 27% of them haven't been diagnosed, the ACP says. And it says at least 20,000 new infections a year in the U.S. are because of transmission of the virus from people who don't know they are infected.
In 2005, the latest year for which statistics are available, at least 17,011 Americans with AIDS died, raising the total number of deaths from the virus to 550,394, the ACP says, quoting statistics from the CDC.
The ACP indicates it didn't decide to issue the new guideline lightly, but only after study of other guidance statements from the CDC and the U.S. Preventive Services Task Force. Its new guideline also has been endorsed by HIV Medicine Association.
Early detection of the virus is critical so that patients can get the maximum benefits from existing therapies, the ACP says.
"The evidence also showed that most adults discuss and disclose high-risk behaviors when the issue is brought up by their physician," the ACP says. But 10% to 25% of people who test positive for HIV report no risky behaviors.
The ACP's guideline notes that the CDC in 2006 said screening for HIV should be performed routinely for all patients 13 to 64. It also says all pregnant women in the U.S. should be tested for HIV infection.
Early detection is important, the ACP says, because it can increase life span. Also, there's evidence that people with HIV likely change risky behaviors that could spread the virus. It says doctors should talk to patients to get them to reduce risky behaviors.
The guideline notes that according to the CDC, 20% of people with HIV are older than 50.
SOURCES: News release, American College of Physicians. Qaseem, A. Annals of Internal Medicine, Jan. 20, 2009; vol 150(2).
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