More backing for broad, routine HIV testing

Experts view testing everyone as a possible means to get more people needed care and reduce the stigma about AIDS. Many doctors still aren't sure everyone needs it.

By Victoria Stagg Elliott, AMNews staff. March 28, 2005.

When Karla Demby, MD, sees patients, she takes a history and, on that basis, decides whether she should offer the patient an HIV test. In her opinion, offering it to everyone just doesn't make sense.

"There are fairly well-defined risk factors for HIV disease, and I don't think it's extremely difficult to delineate them in a primary care practice," said Dr. Demby, an internist from Cortez, Colo.

Still, the common practice of using a history as the initial screen for HIV is coming under scrutiny as routine screening is increasingly considered a possible strategy for diagnosing more people with the infection.

Most recently, two papers in the Feb. 10 New England Journal of Medicine used computer models to suggest that routinely screening every patient for HIV infection, at least once, and possibly as often as every three to five years, might be cost-effective.

"HIV testing turns out to be a comparatively good value, and as a society, we'd be better off," said A. David Paltiel, PhD, lead author of one of the papers and chair of the division of health policy and administration at the Yale School of Medicine in Connecticut.

Benefits include allowing more HIV-positive patients access to available medications sooner, which would likely lengthen their lives. On a populationwide basis, such screening could reduce spread, because medications suppress viral load and reduce the chance of transmission. Also, those who know they are positive tend to take more precautions.