CDC Recommends Unviersal, Routine HIV Screening for Adults

CDC Recommends Universal, Routine HIV Screening for Adults
Revised recommendations call for integration of HIV testing into routine medical care. into routine medical care.
C_REMARK -->
The CDC recently published revised recommendations urging routine HIV screening in healthcare settings for individuals age 13 to 64, unless they opt out. This is not the first time that the CDC has made such a proposal. In 1992 and 2001, similar recommendations were made (e.g., see N Engl J Med 1992; 327:445) but unfortunately never implemented. Furthermore, the most recent U.S. Preventive Services Task Force (USPSTF) guidelines have endorsed previous CDC recommendations for screening only in areas where HIV prevalence is 1% or higher (ACC Jul 13 2005), a local statistic with which many physicians might not be familiar.
The major revisions to the previously published guidelines include:
Routine screening is recommended for everyone age 13 to 64 in healthcare settings, regardless of risk, with an opt-out rather than an opt-in approach.
Yearly screening is recommended for individuals at high risk.
Pretest counseling and separate, written consent for HIV testing should no longer be required (subject to state and local regulations).
Consent for HIV testing should be incorporated into general consent for medical care.
The guidelines for HIV testing of pregnant women were also revised from the 2001 recommendations. Repeat screening in the third trimester is now recommended not only for women at high risk for HIV but also for women in areas with high HIV prevalence.
Comment: These revised recommendations would make HIV testing a normal part of medical care, similar to screening for other treatable conditions (e.g., for cervical cancer or breast cancer). This will ensure that everyone who accesses the healthcare system has the opportunity to learn if they are HIV-positive, and we can hope that the change will also help to remove the stigma associated with HIV testing.
These guidelines are a significant improvement over current HIV testing practices in healthcare settings, although the devil will be in the details. It’s up to state and local governments to change the requirements for written consent for testing and for providing HIV pre- and post-test counseling. Furthermore, the recent USPSTF guidelines recommended against routine HIV screening, which might make financing of HIV testing difficult. Finally, clinicians will need to "think HIV" and incorporate testing into routine medical care — a change more easily said than done.
— Carlos del Rio, MD
Dr. del Rio served as a consultant in the development of these guidelines.
Published in AIDS Clinical Care October 6, 2006
Citation(s):
Branson BM et al. Revised recommendations for HIV testing of adults, adolescents, and pregnant women in health-care settings. MMWR Recomm Rep 2006 Sep 22; 55:1-17. [Medline abstract][Download citation]