All Americans aged 15 to 65 should be screened for HIV at least once, even if they don’t appear to be at risk for the disease, an independent advisory panel said in draft recommendations released Monday.
The goal is to identify the more than 200,000 people who are unaware that they have HIV, as they can benefit from drug therapy, counseling and other interventions, as well as reduce their chances of infecting others, said the U.S. Preventive Services Task Force (USPSTF).
“The evidence is now clear that the benefits outweigh the harms,” said Dr. Douglas K. Owens, a member of the task force.
“This marks a monumental shift in how HIV in the United States can be prevented, diagnosed and treated,” said Carl Schmid, deputy executive director of the AIDS Institute.
Some 50,000 new HIV infections are diagnosed each year, according to the Centers for Disease Control and Prevention. This, however, doesn’t capture the full burden of the disease in the U.S., as about 20 percent to 25 percent of the estimated 1.2 million Americans living with HIV don’t know they have the disease.
The new USPSTF recommendation calls for “a one-time screening for everybody” — usually when they visit their pediatrician or primary care physician, Dr. Owens said.
Beyond that, more regular HIV testing is recommended for people who are at risk for acquiring AIDS, such as people who engage in unprotected sex, have multiple sex partners or inject drugs, he said, adding, “Much of the HIV transmission to women is from heterosexual sex.”
The policy change would impact insurance coverage, Mr. Schmid said.
Under the Affordable Care Act, President Obama’s health care law, private insurers are required to cover preventive services — without co-pays — that are recommended as Grade A and Grade B by the USPSTF, he said.
Under current USPSTF policy, giving HIV tests to all pregnant women and all patients who appear at-risk for HIV are Grade A recommendations, while routine HIV testing for other people is more optional, and merits a Grade C.
Under the new proposal, routine HIV screening for patients aged 15 to 65 would be elevated to Grade A.
Public comments are welcome until Dec. 17, said USPSTF, which is congressionally authorized and composed of 16 volunteer medical professionals. The task force receives staff support from the Agency for Healthcare Research and Quality in the Department of Health and Human Services, but it does not require department approval for its decisions.
In 2006, the CDC recommended routine HIV screenings for patients ages 13 to 64, all pregnant women, and all patients seeking treatment for tuberculosis and sexual diseases.
Most states have followed suit, including New York, which in 2010 changed its HIV-testing law to require health professionals to offer voluntary HIV tests to patients aged 13 to 64.
HIV screening has long been focused on people in high-risk groups, such as men who have sex with men and intravenous-drug users, as well as people living in big cities.
But this kind of focus has become ineffective because “increasing proportions of infected people” are women, teenagers, minority populations, people who live outside metropolitan areas, and “heterosexual men and women who frequently are unaware that they are at risk for HIV,” the CDC said.
Moreover, studies found that the costs of routinely testing most U.S. teens and adults would be offset by identifying and treating new infections. People who use antiretroviral drugs, especially soon after being infected, are less likely to transmit HIV.