February 2009: Volume 35, Number 2
ACP Recommends Broader HIV Screening
The American College of Physicians recently issued new practice guidelines calling for doctors to routinely screen for HIV in all patients older than age 13. ACP made the recommendation because more than one-third of new HIV cases each year—about 20,000—are caused by individuals who are unaware they are infected.
The guidelines are broader than those issued in 2007 by the U.S. Preventive Services Task Force and by CDC in 2006. Both agreed on the need for HIV screening in high-risk groups and settings, but the USPSTF concluded that there was no direct evidence about the benefits of screening in the general population. Meanwhile, CDC recommended routine screening for all patients ages 13 to 64 in any healthcare setting, in lieu of not screening in circumstances in which the prevalence of undiagnosed HIV is less than 0.1%, a rate typically not known by providers.
ACP based its recommendations on the benefits of identifying and treating HIV early in the disease process, the fact that risk-based screening has not identified “a substantial portion” of HIV-infected individuals early-on, that routine opt-out screening in which screening is performed unless the individual declines has been “highly successful” in prenatal HIV screening, and that screening is cost-effective, even when the prevalence of HIV is low.
The guidelines recommend offering screening to all patients, and determining the need for repeat testing on a case-by-case basis, with higher-risk patients retested more often than those at average-risk. Patients at increased risk include men who have sex with men, people of both sexes who have had unprotected sex with multiple partners, injection drug users and their sexual partners, individuals with STDs, and patients who received blood transfusions between 1978 and 1985. A copy of the guidelines is available online.