Regular, routine HIV test for all between 13-64. CDC

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CDC: Regular, routine HIV test for all between 13-64. In a new

HIV/AIDS recommendation was published in the most recent issue of

the Morbidity and Mortality Weekly Report (MMWR) Reports and

Recommendations series, September 22, 2006.

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CDC backs HIV test for all between 13-64

By MIKE STOBBE, AP Medical Writer. ATLANTA - Federal health

officials Thursday recommended regular, routine testing for the AIDS

virus for all Americans ages 13 to 64, saying an Top of Form HIV

test should be as common as a cholesterol check.

The U.S. Centers for Disease Control and Prevention guidelines are

aimed at preventing the further spread of the disease and getting

needed care for an estimated 250,000 Americans who don't yet know

they have it.

" We simply must improve early diagnosis, " said CDC Director Dr.

Gerberding.

Nearly half of new HIV infections are discovered when doctors are

trying to diagnose a patient who has already grown sick with an HIV-

related illness, CDC officials said.

" By identifying people earlier through a screening program, we'll

allow them to access life-extending therapy, and also through

prevention services, learn how to avoid transmitting HIV infection

to others, " said Dr. Mastro, acting director of the CDC's

division of HIV/AIDS prevention.

Although some groups raised concerns, the announcement was mostly

embraced by health policy experts, doctors and patient advocates.

" I think it's an incredible advance. I think it's courageous on the

part of the CDC, " said A. Paltiel, a health policy expert at

the Yale University School of Medicine.

The recommendations aren't legally binding, but they influence what

doctors do and what health insurance programs cover.

However, some doctors' groups predict the recommendations will be

challenging to implement, requiring more money and time for testing,

counseling and revising consent procedures.

Some physicians also question whether there is enough evidence to

expand testing beyond high-risk groups, said Dr. Larry Fields, the

president of the American Academy of Family Physicians.

" Are doctors going to do it? Probably not, " Fields said.

But the recommendations were endorsed by the American Medical

Association, which urged doctors to comply. The CDC said it's

difficult to predict how many doctors will.

Previously, the CDC recommended routine testing for those at high-

risk for catching the virus, such as intravenous drug users and gay

men, and for hospitals and certain other institutions serving areas

where HIV is common. It also recommended testing for all pregnant

women.

Under the new guidelines, patients would be tested for the AIDS

virus as part of the standard tests they get when they go for urgent

or emergency care, or even during a routine physical.

The CDC recommends everyone get tested at least once, but annual

testing is urged only for people at high risk.

Consent for the test would be covered in a clinic or hospital's

standard care consent form. Patients would be allowed to decline the

testing. The CDC's guidelines say no one should be tested without

their knowledge.

An American Civil Liberties Union official protested the CDC's idea

of dealing with HIV on standard consent forms, and the agency's de-

emphasis of pre-test counseling.

" By eliminating these safeguards, what they're calling 'routine

testing' will in practice be mandatory testing, " said Rose Saxe, a

staff attorney with the ACLU AIDS Project.

The cost of the new policy is not clear. A standard HIV test can

cost between $2.50 and $8, public health experts say.

New rapid tests cost about $15. If an initial result is positive,

confirmatory tests can cost another $50 or more. Treatment for HIV

can cost more than $10,000 a year.

WellPoint, the Indianapolis company that owns 14 Blue Cross and Blue

Shield plans across the country, has not yet taken a position on the

CDC guidelines.

It also hasn't estimated what it will cost to expand HIV testing for

its 34 million members, but it traditionally covers tests

recommended by the CDC, said WellPoint spokeswoman

Troughton.

The recommendation, if fully implemented, could mean testing for to

100 to 200 million Americans, said Ron Spair, chief financial

officer of Pennsylvania-based OraSure Technologies, one of three

companies that sell rapid-result HIV tests in the United States.

The other companies are MedMira Inc. and Trinity Biotech. Standard

HIV tests are done through both public health labs and private and

commercial labs.

" This certainly expands the rapid HIV testing market, " Spair said.

Identifying more HIV patients will place an added burden on public

health programs that pay for such care, some of which are facing

potential cuts under a proposal before Congress. But more diagnoses

may help win bolstered funding, said Peebles, an assistant

branch chief over HIV programs at the North Carolina Department of

Health and Human Resources.

" If you don't know what you need, you can't make the argument for

resources, " Peebles said.

The CDC has been working on the guidelines for about three years,

and got input from more than 100 groups, including doctors'

associations and HIV patient support groups.

http://news./s/ap/20060921/ap_on_he_me/hiv_testing

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Moderators note: Revised Recommendations for HIV Testing of Adults,

Adolescents, and Pregnant Women in Health-Care Settings, can be

viewed on-line or downloaded at

http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5514a1.htm.

This report is also available in the Adobe Acrobat PDF file format

at http://www.cdc.gov/mmwr/PDF/rr/rr5514.pdf