STI Quarterly: You should screen for HIV from adolescence onward

The U.S. Preventive Services Task Force (USPSTF) has just released its final recommendation statement on screening for HIV, and it recommends that clinicians screen all people ages 15 to 65, as well as younger adolescents and older adults who are at an increased risk for HIV infection, such as those who engage in unprotected vaginal or anal intercourse, use injection drugs, or are men who have sex with men.1 It also recommends that all pregnant women, including those in labor whose HIV status is unknown, also be screened for HIV.

“HIV is a critical public health problem and, despite recent medical advances, still a devastating diagnosis for the 50,000 people in the United States who contract HIV each year” said Virginia Moyer, MD, MPH, chair of the task force and vice president for maintenance of certification and quality with the American Board of Pediatrics in Chapel Hill, NC. “In order to help reduce the suffering of those with HIV and their loved ones, we must continue finding better ways to prevent and treat this disease,”

In 2005, the task force called for HIV screening for adolescents and adults with risk factors, but it expressed concerns about the potential risk of harm associated with routinely screening low-risk individuals. With the new recommendation, the panel acknowledges that about one-quarter of HIV-infected individuals in the United States are unaware of their status. A 2012 report released by the Centers for Disease Control and Prevention (CDC) confirms this fact. It estimates 60% of U.S. youth living with the disease do not know they are infected.2 (Contraceptive Technology Update reported on the data; see “Time to up HIV testing in U.S. youth ages 13-24,” February 2013, p. 18.)

The task force recommendation falls in line with similar recommendations for HIV screening from the CDC, the American College of Physicians, and the American Academy of Pediatrics. The USPSTF recommends routine screening beginning at age 15, and the CDC recommends routine screening beginning at age 13.

“Primary care clinicians can play an important role in reducing HIV-related disease and death,” stated task force member Douglas Owens, MD, MS, Henry J. Kaiser, Jr. professor and director of the Center for Health Policy in the Freeman Spogli Institute for International Studies and of the Center for Primary Care and Outcomes Research in the Department of Medicine and School of Medicine at Stanford University. “That is why our recommendation, which closely aligns with the HIV screening guidelines from the CDC3, encourages clinicians to screen their patients for HIV.”

The American Academy of Family Physicians (AAFP) has just released its own guidance on HIV screening. It falls basically in line with the USPSTF guidance; however, it calls for HIV screening to begin at age 18.4

The prevalence of HIV infection and rate of new infection among 13-14 year olds and 15-17 year olds are very low, the AAFP guidance states. According to CDC data for the year 2010, there were 529 AIDS cases and 2,200 HIV cases in the age 15-19 group, it notes. Based on the most recent U.S. census, there are close to 4 million adolescents in each cohort year or a total of 20 million in the age 15-19 group, the guidance points out. “A rough calculation of (2729/20 million) provides a rate of 1.3/10,000,” the guidance states. “These data are not seroprevalence data, and the actual rates are likely higher.”

The CDC case numbers also include children known to be infected at birth and thus not all are infections contracted in the adolescent years, the AAFP guidance notes. In addition the rate calculated is for the five-year group and is likely skewed toward the older ages (18 and 19) and the rates in the 15-17 year olds probably are lower than that calculated, it states.4

Screening saves lives

While the best way to reduce HIV-related disease and death is to avoid getting infected, screening is also extremely important, noted Owens in a press statement issued at the publication of the USPSTF guidance.

“Nearly a quarter of people with HIV don’t know that they have it, and they’re missing out on a chance to take control of their disease,” Owens stated. “Universal screening will help identify more people with HIV, allowing them to start combined antiretroviral therapy earlier and live healthier and longer lives.”

While there is no cure for HIV infection, treating people with HIV earlier can not only reduce their risk of developing AIDS and delay its onset, but it also decreases the likelihood that they will pass on the infection to someone else, the USPSTF notes. Treating pregnant women also reduces the chances that the virus will be transmitted to their babies, the task force states.

References

1. Moyer VA, on behalf of the U.S. Preventive Services Task Force. Screening for HIV: U.S. Preventive Services Task Force Recommendation Statement. Ann Intern Med 2013; doi: 10.7326/0003-4819-159-1-201307020-00645.

2. Centers for Disease Control and Prevention (CDC). Vital signs: HIV infection, testing, and risk behaviors among youths -- United States. MMWR 2012; 61:971-976.

3. Branson BM, Handsfield HH, Lampe MA, et al; Centers for Disease Control and Prevention (CDC). Revised recommendations for HIV testing of adults, adolescents, and pregnant women in health-care settings. MMWR Recomm Rep 2006; 55(RR-14):1-17.

4. American Academy of Family Physicians. Human Immunodeficiency Virus (HIV). Accessed at http://bit.ly/11WbyFe.