December 29, 2010
Americans could avoid 15 percent to 20 percent of projected new HIV infections over the next 20 years by expanded screening and treatment for those found to be infected, a new study suggests.
Scientists from Yale University and Stanford University predicted how various screening efforts could affect the spread of HIV in the United States. They calculated that about 1.23 million new HIV infections are expected in the next 20 years, about three-fourths of them among those in high-risk groups such as gay and bisexual men, blacks, and injection drug users. CDC estimates that about 21 percent of those with HIV in the United States do not know they are infected, having not been tested.
One-time HIV screening for low-risk individuals and annual screening for those at high-risk would prevent 81,991 infections, or an estimated 6.7 percent of projected new cases over the next 20 years, the researchers wrote. Combining that screening with treatment of 75 percent of those infected pushes the number of infections avoided to more than 212,000, or about 17 percent of projected new infections.
"You do the most for health outcomes by scaling up these programs together. They are synergistic," said Dr. Douglas K. Owens, a Stanford professor of medicine.
Annual testing of everyone would be prohibitively expensive, at a cost of $750,000 per quality-adjusted life-year gained. Testing everyone and treating all those found to be HIV-positive "could prevent 24 percent of new infections but would not prevent more than 40,000 new infections each year," Owens and colleagues wrote.
Since 2006, CDC has recommended that persons ages 13 to 64 should be offered HIV testing as a part of routine medical care.
The study, "The Cost-Effectiveness and Population Outcomes of Expanded HIV Screening and Antiretroviral Treatment in the United States," was published in the Annals of Internal Medicine (2010;153(12):778-789).