All adult Americans should be screened for HIV infections in an effort to prolong lives and reduce new infections, two groups of researchers are urging.
Everyone should be screened at least once and the vast majority should be retested every three to five years in the same manner that physicians now screen patients for colorectal cancer, diabetes, hypertension and other diseases, according to two independent reports published today in the New England Journal of Medicine.
Such screening would reduce the rate of new infections in this country by about 20 percent and, on average, add 1 1/2 years of lifespan for each person found to be infected, researchers said.
The cost of the increased screening “would be money well spent,” said Dr. A. David Paltiel of Yale University, who led one of the studies.
“It’s a financial winner as well as a clinical winner and a societal winner,” said Dr. Samuel Bozzette of Rand Corp. and the University of California, San Diego, author of an editorial about the papers in the same journal. “It’s very clear that people with HIV would benefit, as well as those at risk, and even future generations.”
Current guidelines issued by the Centers for Disease Control and Prevention call for screening people in groups with an HIV prevalence of 1 percent or higher – a category that includes intravenous drug users, men who have sex with men, and people who have unprotected sex, among others.
Unfortunately, Paltiel said, the risk of HIV infection “has clearly expanded well beyond those stereotypical risk groups, while the mind-set for broadening screening has not changed.”
The CDC estimates about 900,000 Americans are HIV-positive and that about 280,000 of them do not know it. That number is growing each year, with about 40,000 new HIV infections.
About 40 percent of Americans had received an HIV test by the end of 2002, Bozzette said.
Nonetheless, an estimated 40 percent of those diagnosed with the virus are not identified until they display AIDS symptoms.
“That tells us that the current system is not serving us well,” said Dr. Douglas K. Owens of Stanford University and the Veterans Affairs Palo Alto Health Care system, who led the second study.
The AIDS test itself is relatively cheap, only about $2. It takes about 30 seconds to draw blood and a week to produce results. A rapid test that uses scrapings from the mouth and gives results in a half-hour is $7 or so, while a confirmatory test is at least twice that amount. Add in necessary counseling, and the average cost rises to $40 to $60 per test, according to Owens.
Over large populations, that can add up, Owens said, but the benefits are worth it.
HIV tests are available now to virtually anyone who wants one, experts said. Insurance companies like Kaiser will pay for the test if a client requests it, according to Dr. Bill Towner of Kaiser Southern California. The will furnish a test to any veteran who is eligible for healthcare in the VA system. And the Los Angeles County Department of Public Health – which tests about 80,000 people a year – will provide a test to anyone who wants it.
In general, however, physicians in any of those groups do not encourage patients to have the test unless they clearly fall into a risk group. In the light of the new findings, however, they should recommend the test to everyone, Bozzette said.
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