Routine HIV testing recommended by U.S. task force

More than 1.1 million residents living with HIV, nearly 1 in 5 don't know it 

A patient uses an oral test for HIV in 2012. A panel of government advisors released Monday their proposal that all Americans aged 15 to 64 should get an HIV test at least once. (Jacquelyn Martin/File/Associated Press)

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There's a new push to make testing for the AIDS virus as common as cholesterol checks.

People 15 to 64 years old who live in the U.S., and not just individuals considered at high risk for HIV, should get tested for the virus at least once, an independent panel that sets screening guidelines is proposing.

The draft guidelines from the U.S. Preventive Services Task Force are the latest recommendations that aim to make HIV screening simply a routine part of a checkup, something a doctor can order with as little fuss as a cholesterol test or a mammogram.

Since 2006, the Centers for Disease Control and Prevention also has pushed for widespread, routine HIV screening, yet not nearly enough people have needed that call.

'We are not doing as well in America with HIV testing as we would like.'—Dr. Jonathan Mermin, CDC's HIV prevention chief

Of the more than 1.1 million U.S. residents living with HIV, nearly one in five — almost 240,000 people — don't know it. Not only is their own health at risk without treatment, they could unwittingly be spreading the virus to others.

The updated guidelines would bring this long-simmering issue before doctors and their patients again — emphasizing that public health experts agree on how important it is to test even people who don't think they're at risk, because they could be.

"It allows you to say, 'This is a recommended test that we believe everybody should have. We're not singling you out in any way,"' said task force member Dr. Douglas Owens of Stanford University and the Veterans Affairs Palo Alto Health Care System.

HIV testing could be part of free preventive care

If finalized, the task force guidelines could extend the number of people eligible for an HIV screening in their doctor's office, as part of free preventive care under the Obama administration's health-care law. Under the task force's previous guidelines, only people at increased risk for HIV — which includes gay and bisexual men, and injecting drug users — were eligible for the no-copay screening.

There are a number of ways to get tested. If you're having blood drawn for other exams, the doctor can merely add HIV to the list, no extra pokes or swabs needed. Today's rapid tests can cost less than $20 US and require just rubbing a swab over the gums, with results ready in as little as 20 minutes. Last summer, the government approved a do-it-yourself at-home version that's selling for about $40.

Free testing is available through various community programs around the country, including a CDC pilot program in drugstores in 24 cities and rural sites.

Less than half of under-65s have been tested

Most of the 50,000 new HIV infections in the U.S. every year are among gay and bisexual men, followed by heterosexual black women.

Other recommendations from the proposal:

• Testing people older and younger than 15 to 64 if they are at increased risk of HIV infection.
• People at very high risk for HIV infection should be tested at least annually.
• It's not clear how often to retest people at somewhat increased risk, but perhaps every three to five years.
• Women should be tested during each pregnancy, something the task force has long recommended.

"We are not doing as well in America with HIV testing as we would like," Dr. Jonathan Mermin, CDC's HIV prevention chief, said Monday.

The CDC recommends at least one routine test for everyone ages 13 to 64, starting two years younger than the task force recommended. That small difference aside, CDC data suggests fewer than half of adults under 65 have been tested.

"It can sometimes be awkward to ask your doctor for an HIV test," Mermin said — the reason that making it routine during any health care encounter could help.

But even though nearly three-fourths of gay and bisexual men with undiagnosed HIV had visited some sort of health provider in the previous year, 48 per cent weren't tested for HIV, a recent CDC survey found. Emergency rooms are considered a good spot to catch the undiagnosed, after their illnesses and injuries have been treated, but Mermin said only about 2 per cent of ER patients known to be at increased risk were tested while there.

Mermin calls that "a tragedy. It's a missed opportunity."

The draft guidelines are open for public comment through Dec. 17.