The New York Times - December 1, 2008
Roni Caryn Rabin

The American College of Physicians is urging doctors to screen all patients for H.I.V. routinely beginning at age 13, whether or not they engage in risky behaviors.

The guidelines differ slightly from those of the federal Centers for Disease Control and Prevention, which recommends routine screening of patients until age 64 unless the prevalence of H.I.V. is known to be less than 0.1 percent in the patient population. The recommendations also differ from those put forth by the U.S. Preventive Services Task Force, which urges routine screening only of patients at increased risk for infection.

But most patients don't tell their doctors about their risky behaviors, said Dr. Amir Qaseem, senior medical associate with the American College of Physicians, a professional group that represents internists. Moreover, it is almost impossible for a physician to know what the H.I.V. prevalence rate is among certain patients, Dr. Qaseem added.

"Right now it's estimated 1 million to 1.2 million Americans have H.I.V., but 24 to 27 percent are undiagnosed or unaware of their infection," Dr. Qaseem said. "We're recommending clinicians just adopt routine screening in their patients."

The college set no upper age limit on testing because 20 percent of people with H.I.V. are over 50 years of age, Dr. Qaseem said. He said clinicians should decide whether repeat screening is required on a case-by-case basis.

Even though the C.D.C. recommended routine testing two years ago, hospitals and clinics have been slow to incorporate H.I.V. screening into daily care. Just 50 to 100 of the nation's 5,000 emergency rooms routinely test for H.I.V., said Dr. Richard Rothman, associate professor of emergency medicine at Johns Hopkins School of Medicine, in part because of a lack of funding.

"The C.D.C.'s view was that you would get an H.I.V. test just like you would have a complete blood count or any other test as part of your care," Dr. Rothman said. "But right now in many states there is no mechanism for reimbursement, so emergency rooms that try to do it have to foot the bill themselves or find creative ways of paying for it."

The American College of Obstetricians and Gynecologists also recommends routine screening of all women ages 19 to 64, regardless of their risk factors for H.I.V. infection. Early diagnosis maximizes the benefit from antiretroviral therapy and may also help contain the spread of the disease by decreasing inadvertent transmissions.

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