For the first time, a federally convened panel of experts is recommending HIV testing for all adults based on evidence that early detection of the virus could lead to more effective treatment of infection.
Nearly 1.2 million Americans are living with HIV and about 5o,000 become newly infected with the virus every year, according to the latest statistics from the Centers for Disease Control and Prevention (CDC). And an estimated 20% to 25% of HIV-positive individuals are not aware they are infected.
That could change if HIV testing became more routine, which is the intent of the latest recommendation from the U.S. Preventive Services Task Force (USPSTF), which calls for HIV testing of everyone aged 15 to 65, including pregnant women, during regular checkups. The CDC already calls for testing of all adults, regardless of their risk status.
In 2005, the panel reviewed the latest studies at the time and advised that only those at highest risk of being exposed to HIV– including people who received blood transfusions before banks began screening for the virus, people who used intravenous drugs and those who had unprotected sex with multiple partners — be screened.
But in the intervening years, new studies on anti-HIV drugs showed that the medications could keep the virus at bay and possibly even prevent infections from progressing. The drugs were most effective, however, if patients took them soon after becoming exposed, so regular HIV screening could help more people to become aware of their status and take advantage of the therapies. The task force is recommending that those younger than 15 or older than 65 be screened only if they are at increased risk getting infected. All pregnant women should be screened, including women in labor who are unaware of their HIV status, since administering anti-HIV medications can significantly lower the risk of transmitting the virus from mother to child. Researchers even reported success in functionally curing a newborn of HIV infection after the infant, which contracted HIV from the mother, was given a combination of drugs within hours of birth.
In coming to its conclusion, which were published in the Annals of Internal Medicine, the USPSTF considered both the benefits and harms of screening and determined that widespread testing would identify the disease in more people and at its earliest stages, so patients can start therapy and improve their chances of keeping their HIV levels low and not passing the virus on to others. Those benefits, the panel concluded, outweighed the potential harms from screening, such as false-positive results or the side effects associated with the anti-HIV therapies, including heart problems and lipid abnormalities.
The task force members hope that universal screening will make more individuals aware of their HIV status, and place much-needed emphasis on preventing infections in the first place. Previous prevention campaigns that focused on safe sex, condom use and abstinence have only been marginally effective in reducing new infection rates. “The fact is that the best way to deal with HIV is don’t get it in the first place,” Dr. Virginia Moyer, the chair of the task force and professor of pediatrics at Baylor College of Medicine told TIME in November, when a draft of the current recommendations was released for public comment. “Yes, we can screen and treat, and it makes a difference, but it still involves treatment that if you could avoid it, you wouldn’t want to have. If we can really focus on prevention, that would be great.”
The USPSTF’s guidelines are not binding, but the group’s advice is often followed by doctors and adopted by professional medical groups. The task force says screening should be voluntary and only done with a patient’s consent. “That was always the intent of the guidelines, but people had questions about it so we put that in explicitly to make sure it was clear. In other words, people should not be screened without their knowledge,” says task force member Dr. Douglas K Owens, a professor of medicine at Stanford University who is also with the VA Palo Alto Health Care System.
“HIV is a very critical public health problem and we need a better way to prevent infections and treat people who have HIV. Of course the best way to reduce HIV disease and deaths is to not become infected and our hope is that message will get out and people will take steps to reduce their risk,” says Owens. “We hope this will provide more impetus for people to provide screening and that more people will learn about their status and that’s important because treatment for HIV is very good and treatment early in disease is important. Often people are asymptotic and they wouldn’t know they have HIV or that they are candidates for treatment. That’s why screening is important.”
Read the full recommendation statement here.