New guidelines from the US Preventive Services Task Force call for virtually
every adult to be routinely screened for HIV, the virus that causes AIDS.
The updated recommendations, which are published in the issue of the journal
Annals of Internal Medicine, suggest that pregnant women and all people
aged 15 to 65 be screened for HIV.
The guidelines are now more in line with screening recommendations from the
US Centers for Disease Control and Prevention, the American College of
Physicians and the American Academy of Pediatrics.
"HIV is a critical public health problem. There are 50 000 new infections in
the US each year, and we need to find ways to prevent and treat it," said
guideline author Dr Douglas Owens, a professor of medicine at Stanford
University and a senior investigator at the VA Palo Alto Health Care System, in
The guidelines, last updated in 2005, reflect new evidence about the
effectiveness of treatment, especially when started early in the course of HIV
"The best way to reduce HIV-related death and disability is to avoid getting
infected," Owens said.
"Should someone become infected, we want them to understand that there are
very good treatments that will help them live longer and reduce
Experts agreed that such blanket screening is the best - and possibly only -
way to stop the HIV epidemic in its tracks.
Knowing one's HIV status is "a first step for both prevention and needed
medical services, yet the history of the epidemic has set up barriers such that,
in some states, it is still not straightforward to access an HIV test without
the need for written consent or a fee," said Dr Sten Vermund, director of the
Institute for Global Health at Vanderbilt University School of Medicine in
Chance to end epidemic
"Free, regular screening for HIV, much as we try to have regular blood
pressure or breast cancer screening, is one of the best ways to start reducing
the HIV epidemic in the US."
Another expert agreed.
"There is a growing - and overdue - realisation that treating HIV infection
has both a personal and public health benefit," said Dr Paul Volberding, a
professor of medicine at the University of California, San Francisco School of
Medicine. He wrote an editorial accompanying the guidelines.
"We may have a chance to end the AIDS epidemic, but that all begins with
diagnosing infection in the estimated 20% of cases in the US [who are] unaware
of their status and thus not in medical care," he said.
"Finding infected persons, bringing them into care, suppressing their HIV
levels and retaining them in that state are the overriding goals of HIV control.
These guidelines, along with those of the CDC, can help in the first step in
that care cascade."
"HIV therapy is the most effective means of preventing all forms of
transmission," Volberding said.
"The importance of treatment as prevention was underscored by the very recent
failure of the only candidate HIV vaccine in large clinical trials. We may well
have to treat our way out of the epidemic, and that process begins with
diagnosis and ends with lifelong engagement in care."
Learn more about risks for HIV transmission at the US Centers for Disease
Control and Prevention.