Making the Case: Current Recommendations

HIV infection is consistent with all generally accepted criteria that justify screening:(4)

1. It is a serious health disorder that can be diagnosed before symptoms develop;
2. It is detectable by reliable, inexpensive, and noninvasive screening tests;
3. Infected patients can have years of life to gain if treatment is initiated early, before symptoms develop;
4. The costs of screening are reasonable in relation to the anticipated benefits.(43)

The U.S. Preventive Services Task Force recommends routine screening for patients at increased risk for HIV.(44) In 2006, the CDC expanded its recommendation for HIV screening in health care settings to include all patients ages 13 to 64, regardless of risk. The rationale for this new recommendation stems from evidence that people with HIV infection visit health-care settings years before receiving a diagnosis, but are not tested for HIV.(26, 45, 46) In addition, patients with unrecognized HIV often deny all risk factors, even when systematically assessed.(24, 26) An increasing number of new HIV infections are found among people younger than 20 years old, women, members of racial and ethnic minority groups, people who reside outside metropolitan areas, and heterosexual men and women who are often unaware that they are at increased risk for HIV.(4, 47) Missed diagnoses, denial of risk factors, and the changing demographics of HIV indicate that the effectiveness of risk-based testing may be diminishing.

Cited Sources

4. Centers for Disease Control and Prevention. Revised recommendations for HIV testing of adults, adolescents, and pregnant women in health-care settings. MMWR. Sept 22, 2006;55(RR-14):1-17.
24. Kelen GD, Hexter DA, Hansen KN, Tang N, Pretorius S, Quinn TC. Trends in human immunodeficiency virus (HIV) infection among a patient population of an inner-city emergency department: implications for emergency department-based screening programs for HIV infection. Clinical Infectious Diseases. Oct 1995;21(4):867-875.
26. Alpert PL, Shuter J, DeShaw MG, Webber MP, Klein RS. Factors associated with unrecognized HIV-1 infection in an inner-city emergency department. Annals of Emergency Medicine. Aug 1996;28(2):159-164.
43. Wilson JM, Jungner G. Principles and practice of screening for disease. Geneva, Switzerland: World Health Organization; 1968.
44. U.S. Preventive Services Task Force. Screening for HIV: Recommendation Statement. Accessed May 3, 2007.
45. Klein D, Hurley LB, Merrill D, Quesenberry CP Jr., Research Cf HIVAI. Review of medical encounters in the 5 years before a diagnosis of HIV-1 infection: implications for early detection. Journal of Acquired Immune Deficiency Syndromes. Feb 1 2003;32(2):143-152.
46. Liddicoat RV, Horton NJ, Urban R, Maier E, Christiansen D, Samet JH. Assessing missed opportunities for HIV testing in medical settings. Journal of General Internal Medicine. Apr 2004;19(4):349-356.
47. Institute of Medicine. No time to lose: getting more from HIV prevention. Washington, DC 2001.

<< Prev Page  |  Next Page >>