Should Healthy People be Screened for HIV Infection?

According to the Centers for Disease Control (CDC), 25% of people who are infected with HIV do not know they are infected. Apparently these people are causing 80% of all new HIV infections. The available research suggests that if they knew they were infected they would make healthier choices in order to maintain their own health and protect the health of those they love. In the long run, that would reduce the rate of new HIV infections and ultimately lower our national health care costs.

At least that’s the logic behind the idea that all adults should routinely be tested for HIV infection. The American College of Physicians and Surgeons currently recommends that all persons older than 13 years should be tested. The CDC largely agrees, but adds that testing is not warranted in persons older than 64 or in populations with an HIV prevalence of less than 0.1%. However, the U.S. Preventive Services Task Force (USPSTF) does not yet recommend routine HIV screening of all persons; it recommends screening only patients “at increased risk”. As a result, routine screening for HIV infection is not yet commonplace.   It boils down to money; without a recommendation by the USPSTF, insurance companies are unlikely to pay for HIV tests in healthy people. 

Physicians groups and the CDC argue that patients don’t necessarily tell their physicians if they are at increased risk of HIV infection, so it’s nearly impossible to tell who is at increased risk. In addition, it’s hard for a physician to know the actual percentage of HIV in the patient’s population.

But now it appears that the USPSTF is considering changing its recommendation. The Task Force issued a draft document on Nov. 20 that, if approved, will recommend that all persons aged 15-65 be routinely screened for HIV infection. The draft document is available for public comment until Dec. 17.

Would routine screening for HIV infection be a good idea? You decide. You can comment on the USPSTF’s draft recommendation if you wish by going to to the USPSTF’s web page on the subject.