An influential U.S. panel is calling for HIV screening for all Americans aged 15 to 65, regardless of whether they are considered to be at high risk, a change that may help lift some of the stigma associated with HIV testing.
The new guidelines from the U.S. Preventive Services Task Force (USPSTF), a government-backed panel of doctors and scientists, now align with longstanding recommendations by the U.S. Centers for Disease Control and Prevention for testing of all adults aged 15 to 65, regardless of their risk.
Guidelines issued by the USPSTF in 2005 had recommended HIV screening for high-risk individuals.
Experts said the change, published on Monday in the Annals of Internal Medicine, will likely trigger coverage for the tests as a preventive service under the Affordable Care Act. Under President Barack Obama’s healthcare law, insurers are required to cover preventive services that are recommended by the task force.
Currently, the healthcare law recommends coverage of HIV testing for adolescents and adults who are at high risk of infection.
“That was based on the 2005 USPSTF recommendations,” Dr. Jeffrey Lennox, a professor of medicine at Emory University School of Medicine and chief of infectious disease at Grady Memorial Hospital, an inner-city hospital in Atlanta.
“Now, hopefully they will go back and recategorize that and recommend that it will be covered for every adult.”
Joanne Peters, a spokeswoman for the U.S. Department of Health and Human Services, said the U.S. Preventive Services Task Force ranks preventive services based on the strength of the scientific evidence documenting their benefits.
“Preventive services with a ‘grade’ of A or B will be covered under these rules. This includes today’s HIV screening recommendations,” Peters said.
For doctors, the new recommendations should help clear up any confusion about testing among some primary-care doctors who have not been offering the test to all their adult patients. “Now, everybody agrees it should be done,” Lennox said.
Task force member Dr. Douglas Owens, a medical professor at Stanford University, said, “We do hope the fact that the guidelines are all very similar will provide an impetus for people to offer screening because it is a very critical public-health problem.”
50,000 NEW INFECTIONS A YEAR
Despite strides in reducing cases of HIV infection in the United States in the past three decades, as many as 50,000 Americans become infected with the virus each year.
The CDC estimates that almost 1.2 million people in the United States are infected with HIV, yet 20 percent to 25 percent of them do not know it.
“The Task Force’s new recommendations will expand the number of Americans who know their HIV status and can take action to protect themselves and their partners,” Dr. Jonathan Mermin, director of the CDC’s Division of HIV/AIDS Prevention, said in a statement.
The recommendations are based on evidence showing the benefits and risks of testing and treatment for HIV, the virus that causes AIDS. Recent studies have shown that HIV treatment can reduce transmission of the virus to an uninfected partner by as much as 96 percent but there is no cure for the disease.
The group also recommends that teens younger than 15 and adults older than 65 should be screened if they are at increased risk for HIV infection. And it recommends that all pregnant women - including those in labor - who do not know their HIV status should be tested.
The guidelines call for screening at least once for all adults, and it recommends periodic screening for individuals at higher risk of infection. But it does not specify how frequently people at high risk for infection should be tested.
High-risk groups include those who have sex with gay or bisexual men, illicit drug users and economically disadvantaged populations in which HIV rates are high.
Owens said testing all adults within a certain age range may help reduce any stigma associated with testing and encourage people to get tested.
According to the CDC, stigma has been a major stumbling block that keeps many from seeking out testing, and the hope is that the change will make HIV testing a common part of medical care.
“CDC believes HIV testing should be as routine as a cholesterol test or a blood pressure check - but so far fewer than half of Americans have ever been tested,” Mermin said.
As with the CDC recommendations, the USPSTF guidelines recommend that all individuals be offered the test as well as a chance to opt out of testing.
Lennox and others said it is too early to say whether the new guidelines will result in a significant increase in the number of tests, but the potential for insurance coverage may help.
Dr. Gerald Schochetman, senior director, infectious diseases and diagnostic research for Abbott Laboratories’ Abbott Diagnostics, which makes an HIV test, said the task force recommendation will put more emphasis on the need for all adults in the United States to be tested and should encourage more doctors to discuss the need for testing with their patients.
By Julie Steenhuysen