Important note: Information in this article was accurate in 2006. The state of the art may have changed since the publication date.
Los Angeles Times - September 21, 2006
Thomas H. Maugh II, Times Staff Writer, thomas.maugh@latimes.com
The Centers for Disease Control and Prevention also recommended increased testing for pregnant women to further reduce the already low transmission of the virus from mothers to infants.
The testing would be voluntary and would be offered on an "opt-out" basis in which patients would receive the test unless they explicitly refused it. The guidelines would also no longer require written consent for the test and pretest counseling ù requirements that now provide a major impediment to widespread testing.
"By identifying people earlier through a screening program, we'll allow them to access life-extending therapy and also, through prevention services, learn how to avoid transmitting HIV infection to others," Dr. Timothy Mastro, acting director of the CDC's division of HIV/AIDS prevention, said in a press conference.
Most physicians and activist groups were pleased with the recommendations, which CDC has spent three years refining.
"We see far too many patients who were never tested for HIV before they became sick with AIDS," said Dr. Daniel R. Kuritzkes, chair of the HIV Medicine Assn.
Early detection, moreover, halves the cost of providing care, said Dr. Michael S. Sang, director of the AIDS Center at the University of Alabama at Birmingham.
The new guidelines, published today in CDC's Morbidity and Mortality Weekly Report, were endorsed by the American Medical Assn., which urged physicians to adopt them.
Dr. Larry Fields, president of the American Academy of Family Physicians, said that many doctors would not do the test because of the increased time that would be required and the lack of evidence that expanding testing would be beneficial.
The new recommendations carry no legal force. But the government's endorsement means that insurance companies are more likely to cover the tests. The costs range from about $9 for a negative test to about $80 for a positive test, confirmation and post-test counseling.
Current guidelines, which have been in effect since 1993, call for testing only individuals at high risk and those visiting hospitals where the HIV prevalence is at least 1%. Physicians have argued that they don't have the time to assess risk for every patient and most hospitals do not know the HIV prevalence among their clients.
The guidelines also require written consent for the test and pre-test counseling. Eliminating those requirements, officials say, will make it much easier to administer the tests.
"No one signs a form to get a prostate exam" and it should not be any different for HIV testing, Sang said. "We need to make sure patients are informed about the HIV test, but we should not put obstacles in the way of testing."
Current guidelines for pregnant women call for testing upon confirmation of pregnancy and repeat testing in the third trimester for women at high risk. The new guidelines recommend repeat testing for women in areas with high prevalence and those who deliver in facilities where the rate is one HIV diagnosis per 1,000 women screened.
For pregnant women whose HIV status is unknown, the guidelines call for a rapid HIV test during labor.
An estimated 1 million Americans are HIV positive, according to the CDC, and 40,000 more are newly infected each year.
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