The Importance of Universal HIV Testing

HIV Testing Form
A form for ordering HIV testing and related bloodwork. Don Bayley / E+ / Getty Images

The Centers for Disease Control and Prevention (CDC) have been recommending routine, universal HIV testing since 2006. Unfortunately, many people still aren't being tested, and that's a real problem for both individual and public health. Individuals newly infected with HIV, in other words those with acute infections, are often highly contagious. Identifying them, and getting them on effective antiretroviral treatment (ART) is not only important for keeping them healthy for as long as possible, it also makes them less likely to transmit the virus to their sexual partners or those who they might expose through other means.

The recognition that maintaining an undetectable viral load can help reduce or even prevent HIV transmission is somewhat recent, a result of research on treatment as prevention. It has led to changes in policy about the prescription of antiretroviral drugs, so that treatment is now started earlier than it had been before. However, this understanding about the importance of early diagnosis and treatment has not yet trickled down to non-specialty providers.

An investigation of the state of the U.S. HIV epidemic that was published in April 2015 found that in 2009, 18 percent of people with HIV had never been diagnosed, 45 percent had been diagnosed but not retained in care (i.e. had not seen a doctor in the last year), 4 percent were in treatment but had not been prescribed ART, 7 percent had been prescribed ART but were not virally suppressed, and 25 percent were taking a medication regimen that was effective at achieving an undetectable viral load (Skarbinski et al., 2015).

This implies that nearly three quarters of Americans who are infected with HIV are being treated inefficiently or not treated at all, and as such are more likely to contribute to the continuance of the AIDS epidemic.

Undiagnosed HIV infections represent missed opportunities to both improve the long-term health of those living with HIV and to reduce the likelihood of future HIV transmissions, which is why universal HIV testing recommendations were initially introduced.

What keeps such recommendations from being put into practice effectively?

  1. Not all doctors know that they should be engaging in routine testing with all of their clients, not just those who they perceive (accurately or inaccurately) as high risk.
  2. Because many health centers use opt-in testing rather than opt-out testing, the stigma associated with HIV may lead to people refusing testing.

That's why, in the early spring of 2015, the CDC started up a new program called "HIV Screening. Standard  Care™." It provides resources for both patients and primary care providers in order to increase the prevalence of HIV screening among the general population. Hopefully it will help both patients and doctors recognize the importance of HIV testing for everyone, and make it just as much a part of standard care as a blood pressure or cholesterol check.

It's not enough, of course, to just test people on a regular basis. It's a good start, but the next step is to get those people who test positive into appropriate treatment.

Knowing you are infected with HIV reduces the likelihood that you will transmit it to someone else, but being effectively treated for the virus reduces it much, much more.

Next: Treatment as Prevention

Sources:

CDC (2015) "HIV screening. Standard of Care." http://www.cdc.gov/actagainstaids/campaigns/hssc/

Skarbinski J, Rosenberg E, Paz-Bailey G, et al (2015). Human Immunodeficiency Virus Transmission at Each Step of the Care Continuum in the United States. JAMA Intern Med. 175(4):588-596. doi:10.1001/jamainternmed.2014.8180.

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