United Press International - September 21, 2006
Ed Susman

"We believe these new testing guidelines are the next step to reducing HIV infection in this country," Kevin Fenton, director of the National Center for HIV, STD (sexually transmitted diseases) and TB (tuberculosis) Prevention, part of the Centers for Disease Control and Prevention, said Thursday.

Fenton said the new recommendations are designed to overcome several barriers that hindered implementation of the earlier recommendations, which called for HIV testing for patients in healthcare settings with high HIV prevalence -- above 1 percent -- and for all high-risk individuals.

"Implementation of these recommendations was difficult because many healthcare facilities do not have information on HIV prevalence, and many providers report that they do not have sufficient time to conduct risk assessments," he said at a news briefing.

Physicians also report that the processes related to separate, written consent and pre-test counseling for HIV testing have posed significant hurdles, he said. In CDC surveys and consultations, healthcare providers consistently reported these time-consuming processes were not feasible in emergency rooms and other busy healthcare settings.

Under the new guidelines, said Daniel Kuritzkes, chairman of the Alexandria, Va.-based HIV Medicine Association, a person will visit a doctor who may order blood tests for cholesterol, liver function, and prostate cancer and would also now suggest an HIV test.

"We think this is how routine voluntary testing should be conducted," Kuritzkes, also director of AIDS research at Brigham and Women's Hospital in Boston, told United Press International.

"We are not trying to be deceptive or underhanded. If a person would object to HIV testing, opting out of the testing, we believe this would also give doctors the opportunity to start a dialogue about the patient's concerns," he said.

The major emphasis of the new testing guidelines, said Timothy Mastro, acting director of the CDC's Division of HIV/AIDS Prevention, includes:

-- HIV screening for all patients ages 13-64, regardless of risk: He noted that presently many persons with unrecognized HIV infection are never tested for HIV because their perceived risk is low.

-- Voluntary, "opt-out" approach, but patients should be provided basic information about HIV and the meanings of positive and negative test results, and should have the opportunity to ask questions.

-- Simplified testing procedures, specifically eliminating the need for pre-test counseling. Kuritzkes noted that the vast majority of the tests are going to be negative, so extensive counseling may have been an unnecessary time and cost barrier to getting the test.

Mastro said the CDC continues to encourage prevention counseling for all patients where feasible, especially when the healthcare visit is related to substance abuse, sexual health, family planning, or comprehensive health assessments.

-- Enhanced screening for pregnant women, with repeat HIV testing in the third trimester for women at risk or for women living in areas of high HIV prevalence. A rapid HIV test should be used during labor for all women with unknown HIV status at the time of delivery.

Fenton said the new guidelines will be published Friday in the CDC's Morbidity and Mortality Weekly Report and will go into effect immediately. Third party and government reimbursement for the tests are expected to follow, he said.

Kuritzkes said he expected that the new guidelines will come into use gradually as doctors hear about the new rules in the government documents and through news reports.

"We would expect that these guidelines will help reduce the number of people who become infected with HIV each year," he said. "We know that when people find out about their HIV status, they generally make an effort to protect their partners against transmission."

Julie Gerberding, director of the CDC, noted that 40 percent of people diagnosed with HIV today have been infected for more than 10 years without knowing it, and are in late stages of the disease when they are diagnosed. She said that earlier testing for the disease may find these patients earlier so they can be treated sooner.

"We urgently need new approaches to reach the quarter-million Americans with HIV who do not realize they are infected," said Gerberding. "People with HIV have a right to know that they are infected so they can seek treatment and take steps to protect themselves and their partners."

An estimated 1 million people in the United States are living with HIV infection. Worldwide, more than 38 million people have the disease, which is most often transmitted through sexual practices or intravenous drug use.

Kuritzkes said that one downside of expanded testing will be identifying more individuals who will require treatment. He said that he hopes that the Department of Health and Human Services will provide the necessary funding through state grants to pay for that treatment.

"Our goal is to ensure that everyone who receives medical care also has the opportunity to learn if they are infected with HIV," said Fenton. "These new recommendations will make routine HIV screening feasible in busy medical settings where it previously was impractical. Making the HIV test a normal part of care for all Americans is also an important step toward removing the stigma still associated with testing."
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