Key US public health leaders have coalesced around an aggressive screening strategy for HIV: making HIV screening a routine part of care for US adolescents and adults, regardless of whether they are at increased risk for the infection.
New recommendations by the US Preventive Services Task Force (USPSTF) in today’s Annals of Internal Medicine suggest growing support for routine HIV screening as a means to prevent transmission and to provide infected individuals with better care. The recommendation calls for screening all individuals aged 15 to 65 years for HIV, regardless of risk factors, and for screening of individuals younger than 15 years or older than 65 years if they are at increased risk. Additionally, the recommendation calls for screening of all pregnant women.
Previously in 2005, the USPSTF had recommended HIV screening for adolescents and adults with risk factors but had expressed concerns about the potential risk of harm associated with routinely screening low-risk individuals. In the new recommendation, the USPSTF acknowledges that about 20% to 25% of HIV-infected individuals in the United States are unaware of their infection status, a circumstance that increases the risk of HIV spread and denies such individuals the opportunity to receive potentially life-extending HIV treatments. Moreover, the task force concluded that overall, the potential harms of screening are small.
The new recommendation is similar to one issued by the US Centers for Disease Control and Prevention in 2006, which called for routine HIV screening of all individuals between the ages of 13 and 64 years, regardless of risk factors, and for all pregnant women. This suggests that a consensus about HIV screening is forming among leading public health authorities.
The USPSTF cited convincing evidence that identification and treatment of HIV reduced risk of progression to AIDS, AIDS-related events, and death in individuals with a CD4 count less than 0.2 × 109 cells/L. They found adequate evidence that initiating combined antiretroviral therapy (ART) even earlier in the course of disease may also decrease the risk of death and AIDS-related events. Additionally, they cited evidence that ART substantially reduced the risk that an infected individual would spread infection to an uninfected partner. The task force did note some concern about the potential cardiovascular risks of treatment but found the overall benefits of treatment for the individual and for public health to be compelling.
In an editorial accompanying the recommendation, Moupali Das, MD, MPH, and Paul Volberding, MD, both of the University of California, San Francisco, argued that this growing consensus on population-wide screening and the benefits of treatment, as well as better access to care under the Affordable Care Act, is critical to reducing the HIV epidemic.
“Ending the epidemic will be very difficult, and only effective screening can make it remotely possible,” they wrote in the editorial.