CDC Considers HIV Screening for All Americans

The majority of Americans are aware that health and longevity are a matter of good nutrition, exercise and avoidance of bad habits, as well as following the recommendations for screening tests to detect early signs of various illnesses. Mammograms, colonoscopies, Pap smears and prostate exams have become accepted aspects of good health maintenance, along with timely vaccinations. The recommendations for these early detection screenings come from the Centers for Disease Control, the American Medical Association, the American Cancer Society and other groups and are intended as general guidelines, to be followed in combination with the counsel of one’s personal physician. Regular, timely screenings can be life saving, allowing doctors to catch diseases such as cancer in time for early, effective intervention.

Now, a new study has found that there is one more screening test that could make a life prolonging difference for millions of Americans. A recent study published in February 2005 in the New England Journal of Medicine recommends the routine screening of all Americans – adults and children – for the HIV virus. In response to the federally funded study, the CDC is reviewing its’ current guidelines for HIV testing and will formulate new recommendations over the next two years.

Many experts in infectious disease and AIDS treatment believe that widespread screening for the virus that causes AIDS would result in a decrease in new infections, faster access to care and an improved prognosis for those who are infected and receive early treatment. Treatment of HIV-infected individuals, using “drug cocktails” and immunity-strengthening nutrition, is most effective in the early stages of the disease. Too often, however, persons who are unknowingly HIV-positive do not seek medical attention until they present with serious symptoms – symptoms that may not immediately suggest a diagnosis of HIV infection.

Sheri Kaplan is the Executive Director and Founder of The Center for Positive Connections in North Miami, a non-profit that provides peer counseling, social support, education, referrals and holistic services to HIV-infected persons, with an emphasis on heterosexuals. Kaplan herself is HIV-positive and has been so for 17 years – living proof that early diagnosis can mean a life of greater length and quality.

“How can you care for yourself if you don’t know that you are infected?” she asks. “Early diagnosis means less likelihood of opportunistic infections, less medical care and less cost. More emphasis can be placed on monitoring and sustaining your immune system. It is possible to be pro-active, to stay ahead of it and use alternative treatments and good nutrition to boost your immune system. And when you don’t know you are infected, there is more risk that you will infect others. I encourage people to get tested – it is always better to know.”

Since the onset of the AIDS epidemic in the early 80’s, the recommendations for HIV screening have been limited primarily to high-risk groups, particularly homosexual males and IV drug users. But screening of the entire population could mean early detection for hundreds of thousands of people. Nearly one million Americans are infected with the HIV virus – but some experts believe that 30% of those people are not aware of it. Thus, they may well be infecting others, spreading the infection exponentially. Every year, 40,000 new infections occur in the United States and that number has remained consistent for the past few years.

Routine testing for HIV could reduce that number significantly.

According to Samuel A. Bozzette, MD, principal author of the study, “Given the availability of effective therapy and preventive measures, it is possible to improve care and perhaps influence the course of the epidemic through widespread, effective and cost-effective screening.”

One concern about such an ambitious screening program is cost, but the study indicated that the cost of routine screening for all adults would be outweighed by the benefit of a decreased number of cases. Still, Kaplan has concerns about how small agencies such as hers will be able to handle the increased client volume. “There will be a need for increased resources – financial and human resources. Even now, we have to fight to find the resources that we need. There will also need to be a major public education effort, because people are still so afraid and think that there is no help available.”

Margaret Palumbo, MPH, Administrative Director of the University of Pittsburgh Medical Center HIV Program, favors widespread screening. “We believe that everyone should know his or her HIV status,” she says. “The earlier you know your status, the earlier you can get life-sustaining medical care, improving your chances for a better outcome and a better quality of life.”

Delayed diagnosis and treatment can have tragic consequences. In the autumn of 2001, Michael G., a 41 year-old Chicago man, began seeing physicians for weight loss, memory loss, weak muscle tone and gait disturbance. He was given numerous diagnostic tests, but those tests did not include screening for HIV. Because he is heterosexual and has no history of drug use, he did not fit the profile of the “typical” HIV-infected person – and although he eventually developed thrush, an oral infection that is associated with AIDS, was not correctly diagnosed until three years later. By that time, he was gravely ill. He finally received appropriate treatment and responded well to the drug cocktails, but has brain atrophy and irreversible dementia as a result of the delay in diagnosis and treatment. As a result, he cannot work or live independently. For Michael G., a routine HIV test may have made a critical difference.

Another study, published in the same February issue of NEJM, indicated that testing people every three to five years would be cost-effective for all but the lowest-risk categories, such as persons who are in monogamous heterosexual relationships or live a celibate lifestyle. But the study recommends one-time testing even for those groups.

If the recommendations from the studies are implemented, then HIV screening may well become a standard aspect of preventive care for everyone, just like screening for cancer or diabetes. The HIV test is a painless test that utilizes an oral swab to obtain a saliva sample and takes under 30 minutes to process.