New draft recommendations(www.uspreventiveservicestaskforce.org) from the U.S. Preventive Services Task Force (USPSTF) encourage clinicians to screen all adolescents and adults, as well as all pregnant women, for HIV infection regardless of risk.
Photomicrograph of HIV-infected T cells
According to USPSTF Co-vice Chair Michael LeFevre, M.D., M.S.P.H., a family physician from Columbia, Mo., the update, which will be open for public comment until Dec. 17, 2012, expands the task force's 2005 recommendations for HIV screening for patients aged 15-65 years, as well as for all pregnant women.
The expanded recommendation are so physicians "don't have to go through the screening process of asking questions about the in-depth sexual history and so forth before making the decision that everyone should be screened," said LeFevre. "It simplifies the screening process because physicians can now say that the USPSTF recommends that everybody be screened irrespective of their perceived risk for having HIV. You can make decisions later about whether it needs to be repeated, but for people who have not been screened, we recommend that they get screened."
LeFevre said that although the update is part of the USPSTF's normal routine, it also is based on studies that have filled in the evidentiary gaps since 2005. The task force found that expanding HIV screening identifies a substantial number of persons with previously undiagnosed HIV infection, many of whom could benefit from early treatment.
"The motivation for (the expansion) came from new evidence that showed there really was substantial benefit to screening -- and then early treatment -- for HIV infection in all of these patients," he said. "I think that's the key right now -- that antiretroviral therapy has been demonstrated to be quite effective at earlier stages of infection and also reduces transmission at early stages of infection."
The task force also encourages physicians to screen younger adolescents and older adults who are at increased risk for HIV, as well as pregnant patients with an unknown HIV status who are in labor.
According to the recommendation, an estimated 1.2 million people in the United States currently live with HIV, a number that increases annually by about 50,000 cases. Approximately 20-25 percent of individuals living with HIV infection are unaware of their positive status.