US health providers should have a policy of routine HIV testing, according to a letter published in the 15th March 2003 edition of the Journal of Infectious Diseases.
Such a policy would mean a shift in emphasis from the current risk-based approach to HIV testing in the US (and for most people in the UK).
The letter’s authors, from Brown University, Providence, Rhode Island, point out that the average heterosexual women testing HIV-positive in Rhode Island would be traditionally considered “low risk” for HIV, as her median number of sexual partners in the last ten years was less than three.
Routine testing for HIV would also be advantageous as it would eliminate the need to obtain sexual and risk histories prior to taking blood samples, which both health provider and patients can find embarrassing. Indeed, the authors suggest that embarrassment may cause some people seeking HIV testing to lie about their HIV risk behaviour.
A knock-on advantage of routine testing would be the destigmatisation of HIV testing, and the authors suggest “offering routine HIV testing would be analogous to the current standard of care that indicates routine offering of Pap smear tests to women between the ages of 18 and 65 years, irrespective of risk.” All sexually active people aged 18-65 would be tested for HIV as a matter of course under the authors' proposals.
Cost effectiveness of routine testing has been demonstrated, say the Brown University investigators. Routine testing would also lead to the early detection of undiagnosed HIV infections, enabling anti-HIV therapy to be offered before CD4 cell count falls below 200 cells/mm3. A third of cases of HIV in the US and UK are estimated to be undiagnosed and late presentation often occurs, frequently in an in-patient setting when a person may already have become severely ill with HIV, and may not be able to fully benefit from anti-HIV treatments.
Reduced rates of HIV transmission could also be a desirable consequence of routine testing, add the authors.
Routine testing should, the authors recommend, consist of brief pre and post-test counseling, with patients required to positively opt out. They also suggest that reduced rates of HIV transmission could also be a desirable consequence of routine testing.
In the UK most pregnant women are offered an antenatal HIV test as part of their routine care.
Further information on this website
Simmons E et al. Routine, not risk-based, human immunodeficiency virus testing is the way to go. Journal of Infectious Diseases, 187: 1024, 2003.