CDC Advises Routine HIV Screening of Patients

The CDC has called for routine, voluntary HIV screening of all patients aged 13-64 in all health care settings. The agency issued "Revised Recommendations for HIV Testing of Adults, Adolescents and Pregnant Women in Health Care Settings"
in the Sept. 22 issue of Morbidity and Mortality Weekly Report.

The AAFP Commission on Science will review the CDC's recommendations, says AAFP President Larry Fields, M.D., of Ashland, Ky. "I'm happy the CDC has brought HIV back to the public's attention," he adds.

The AAFP, in shaping its own policy, built on decisions of the U.S. Preventive Services Task Force that call for testing adults and adolescents at high risk for HIV and for testing all pregnant women, says Fields. The USPSTF found insufficient evidence to recommend routine testing of people who are not at high risk for HIV.

"We're not telling physicians not to follow the CDC's new recommendations," says Fields. "However, our commission needs to study the evidence basis for the new CDC report. If we need to change our recommendations, we will."

The CDC, listing major revisions to its earlier HIV/AIDS statements, says, "HIV screening is recommended for patients in all health care settings after the patient is notified that testing will be performed unless the patient declines (opt-out screening)." Other major revisions include recommending screening persons at high risk for HIV at least annually and making HIV screening part of "the routine panel of prenatal screening tests for all pregnant women."

"Adolescents aged 13-19 years represent new cohorts of persons at risk," the CDC says in its report. "The 2005 Youth Risk Behavior Survey indicated that 47 percent of high-school students reported that they had had sexual intercourse at least once, and 37 percent of sexually active students had not used a condom during their most recent act of sexual intercourse. More than half of all HIV-infected adolescents are estimated not to have been tested and are unaware of their infection."

Health care professionals should initiate screening, says the CDC, unless the prevalence of undiagnosed HIV infection in their patients has been documented to be less than 0.1 percent. "In the absence of existing data for HIV prevalence, health care providers should initiate voluntary HIV screening" until they establish that fewer than one patient per 1,000 patients screened had HIV, "at which point such screening is no longer warranted," says the CDC.

The Academy's policy notes, "Virtually every clinician has seen or will see patients who are infected with HIV." The AAFP policy lists strategies to prevent HIV transmission and describes high-priority groups for HIV testing. The policy also notes, "The AAFP recommends that HIV testing be offered in clinical settings where the prevalence of HIV infection is high, such as STD clinics, tuberculosis treatment clinics and drug treatment facilities."

The AAFP Board of Directors approved the policy in July, and the AAFP Congress of Delegates is reviewing it during the delegates' meeting Sept. 26-28 in Washington, D.C.