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U.S. Poised to Normalize HIV Testing

March 14, 2013

In Canada and in most other high-income countries the cost of HIV treatment is subsidized for permanent residents and citizens. Such treatment, commonly called ART or HAART, helps to stabilize the immune system and reduces the amount of HIV in the blood and genital fluids. ART's power is so profound that an HIV-positive young adult who initiates therapy and takes his/her medicine every day exactly as directed and who has minimal pre-existing health conditions is expected to live for several decades.

ART also has another effect: Clinical trials in heterosexual couples where one partner has HIV and takes ART have found that effective treatment reduces the sexual spread of HIV. In these clinical trials, screening for and treatment of sexually transmitted infections, safer-sex counselling and condoms are all regularly provided. Clinical trials with same-sex couples are ongoing.

Faced with promising data from clinical trials performed so far, researchers, public health authorities, policy planners, doctors and nurses are increasingly looking toward the expansion of ART to more HIV-positive people as one means of helping to slow the HIV pandemic. This use of ART -- to help reduce the spread of HIV -- is called Treatment as Prevention (TasP). A key aspect of programs that focus on TasP is testing for HIV.

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Traditionally, HIV testing strategies have targeted specific populations who are at high risk for HIV transmission. In addition to diagnosing HIV in those who are unaware of their status and connecting them with care, targeted testing strategies provide opportunities for enhanced prevention counselling in high-risk populations. However, in Canada and other high income countries, a significant proportion of people living with HIV remain undiagnosed despite targeted testing strategies. Often these people access other health services but are not offered an HIV test because they are not identified as high-risk candidates.

In order to help uncover HIV, the U.S. Preventive Services Task Force (USPSTF) is now poised to endorse the routine testing of HIV in people aged 15 to 65 in medical settings, where HIV testing takes place just like any other test. This recommendation is very important because researchers estimate that between 20% and 25% of HIV-positive people in the U.S. do not know that they have this virus. Unaware that HIV is slowly degrading their immune system, such people may ignore warning signs of impending illnesses. This increases their risk of serious AIDS-related infections, which can be difficult to treat, are expensive for hospitals to manage and can lead to death. Furthermore, if someone does not know their HIV status, they may not take steps to help prevent its spread.

In the U.S. there are about 1.1 million HIV-positive people and 56,000 new HIV infections every year. Many public health officials hope that the looming USPSTF recommendations about HIV testing will be a very important step on the road to bringing the HIV epidemic under control.

The USPSTF recommendations will add to the growing consensus from leading public health, medical and scientific organizations in the U.S. that routine HIV testing is an important step forward in helping to reduce the spread of this virus and bring people into care. Such organizations include the following:

  • The Centers for Disease Control and Prevention (CDC)
  • The American College of Physicians
  • The Infectious Disease Society of America
  • The American College of Obstetricians and Gynecologists

Due to changes underway in the American healthcare system, routine HIV testing should increasingly become available at no additional cost to the person seeking it.

Hopefully, the USPSTF recommendations will help to uncover the 20% to 25% of Americans who researchers estimate are HIV positive but unaware of their infection and usher them into care and treatment.

In Canada there are approximately 71,000 HIV-positive people and about 3,200 new HIV infections per year. Public health authorities in British Columbia that have been working to expand opportunities for HIV testing in that province have recently called for the routine offer of an HIV test to be expanded across Canada. As in the U.S., Canada also has a large proportion (about 26%) of HIV-positive people who do not know their infection status.

AIDS was first recognized in 1981, and the cause, a virus we now call HIV, was discovered in 1983. Now, 30 years later, high hopes are being placed on the normalization and expansion of HIV testing and treatment so that the spread of the epidemic can be slowed, particularly in high-income countries such as Canada, France and the U.S.


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References

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  6. Martin EG, Schackman BR. Updating the HIV-Testing Guidelines -- A Modest Change with Major Consequences. New England Journal of Medicine. 2013; in press.
  7. Bayer R, Oppenheimer GM. Routine HIV Testing, Public Health, and the USPSTF -- An End to the Debate. New England Journal of Medicine. 2013; in press.
  8. Chou R, Selph S, Dana T, et al. Screening for HIV: systematic review to update the 2005 U.S. Preventive Services Task Force recommendation. Annals of Internal Medicine. 2012 Nov 20;157(10):706-18.
  9. Thompson MA, Aberg JA, Hoy JF, et al. Antiretroviral Treatment of Adult HIV Infection: 2012 Recommendations of the International Antiviral Society–USA Panel. JAMA. 2012;308(4):387-402.
  10. Centers for Disease Control. Kaposi's sarcoma and Pneumocystis pneumonia among homosexual men -- New York City and California. Morbidity and Mortality Weekly Report. 1981 Jul 3;30(25):305-8.
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  12. Gustafson R, Montaner J, Sibbald B. Seek and treat to optimize HIV and AIDS prevention. CMAJ. 2012 Dec 11;184(18):1971.


  
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This article was provided by Canadian AIDS Treatment Information Exchange. It is a part of the publication CATIE News. Visit CATIE's Web site to find out more about their activities, publications and services.
 
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