November 20, 2012
The U.S. Preventive Services Task Force, an independent group that operates under the sponsorship of the U.S. Department of Health and Human Services to advise the U.S. government and physicians on the medical evidence for preventive health measures, has recommended HIV tests for everyone aged 15 to 64. The guidelines also recommend that doctors offer HIV testing to people under 15 or over 64 if they are at high risk for contracting HIV and that they offer HIV testing to all pregnant women. On November 19, the task force posted its recommended guidelines to its website for a four-week period of public comment. The task force conducted two reviews of the science done by independent groups of scientists: one focused on pregnant women and one focused on HIV screening for the population at large. Annals of Internal Medicine published the two reviews on November 19.
The recommendations would apply to all but very-low-risk populations. In their 2005 guidelines, the task force suggested routine HIV screening only for adolescents and adults at increased risk. Since then, however, studies have been published that offer sound evidence that HIV-infected individuals, as well as their intimate partners and the public, are better served by near-universal screening.
Dr. Bernard M. Branson, an epidemiologist at the Centers for Disease Control and Prevention (CDC) and a co-writer of the CDC's 2006 guidelines, states that every HIV infection that is prevented saves $367,000 in lifetime medical costs. CDC's guidelines are mainly in agreement with the task force's current ones, differing only in that CDC recommends that testing begin at age 13 instead of 15. Other groups such as the American Congress of Obstetricians and Gynecologists, the American College of Physicians, and the American Academy of Pediatrics also recommend widespread HIV testing, with slight differences. Dr. Jeffrey D. Klausner, a professor of medicine and infectious diseases at UCLA, notes that regardless of the increasing endorsements, surveys show that many doctors are not performing the tests routinely.
The panel listed its recommendations as Grade A, meaning that there is high certainty of substantial benefit. If the panel ultimately adopts those recommendations, Medicare and most private health insurers would be required to pay for the tests.