CDC Recommends Routine HIV Testing
CDC on Thursday released revised recommendations on HIV testing in the U.S. that say HIV tests should become a routine part of medical care for residents ages 13 to 64 and requirements for written consent and pretest counseling be dropped, the Washington Post reports (Brown, Washington Post, 9/22).
CDC estimates that about 25% of HIV-positive people in the U.S. do not know their status. Many physicians believe that routine testing could lead to an earlier diagnosis and earlier treatment (California Healthline, 5/8).
According to an agency release, the recommendations, published in the Sept. 22 edition of CDC's Morbidity and Mortality Weekly Report, were designed to "simplify the HIV testing process" and "overcome several barriers that hindered implementation" of the agency's previous guidelines -- released in 1993 -- calling for tests to be given to "high-risk individuals" and to all patients "in health care settings" with HIV prevalence of more than 1% (CDC release, 9/21).
According to the revised guidelines, health care providers should continue routine HIV testing unless they establish that less than one of every 1,000 patients tested is HIV-positive, "at which point such screening is no longer warranted" (Branson et al., MMWR, 9/22).
States can choose to adopt and modify the guidelines, the New York Times reports (McNeil, New York Times, 9/22). CDC has been working on the revised guidelines for about three years, receiving feedback from more than 100 groups, including HIV/AIDS patient advocacy groups and physician associations (Stobbe, AP/Forbes, 9/21).
According to the Los Angeles Times, the recommendations "carry no legal force," but now insurance companies are more likely to cover the cost of the tests (Maugh, Los Angeles Times, 9/21). If health care providers follow the guidelines, the number of HIV-positive people who are unaware of their status might be reduced by two-thirds, the Post reports (Washington Post, 9/22).
Lawrence Gostin, associate dean at the Georgetown University Law Center, said that a physician might incur legal issues if he or she does not at least tell a patient about the value of HIV testing and that patient has contracted HIV (Hendrick, Atlanta Journal-Constitution, 9/22).
CDC in the release said it will issue additional guidelines for physicians by early next year and provide "model approaches and practical tools" for implementing HIV testing (CDC release, 9/21).
Under current testing regulations, many states require individuals to participate in a 20-minute counseling session before obtaining an HIV test. In addition, people in some states must sign a separate informed-consent form, which details the risks and benefits of the test (California Healthline, 5/8).
The revised CDC guidelines say providers do not have to require patients to sign written consent forms or undergo counseling before receiving an HIV test, but physicians must allow patients to opt out of the test, USA Today reports (Sternberg, USA Today, 9/22).
"[P]atients should be informed orally or in writing that HIV testing will be performed unless they decline," the recommendations say, adding, "Information should include an explanation of HIV infection and the meanings of positive and negative test results, and the patient should be offered an opportunity to ask questions and to decline testing." The recommendations also say that it is "essential" that physicians make "[a]ctive efforts ... to ensure that HIV-infected patients receive their positive test results and linkage to clinical care, counseling, support and prevention services" (Washington Post, 9/22).
The agency "continues to encourage prevention counseling for all patients where feasible" and "intensive HIV prevention counseling for high-risk populations will remain a vital component of community-based HIV prevention interventions" (CDC fact sheet, 9/21).
The guidelines say that all pregnant women should be tested for the virus unless they opt out and that women who inject drugs, are commercial sex workers or who live in a higher prevalence region should be tested again in the third trimester of pregnancy, the New York Times reports (New York Times, 9/22). The guidelines also recommend that women in labor whose HIV status is unknown should be administered a rapid HIV test, and if a test cannot be administered before delivery, both the woman and the infant should immediately be given a rapid test postpartum (CDC fact sheet, 9/21).
According to the Houston Chronicle, the recommendations for expanded testing of pregnant women aim to reduce the number of mother-to-child HIV transmissions in the U.S. There were 240 cases of vertical HIV transmission in 2005, the Chronicle reports (Hopper, Houston Chronicle, 9/22).