In an article on page 295, Joel E. Gallant, M.D., M.P.H., John Hopkins University School of Medicine, provides a review of counseling, testing, and referral of patients with human immunodeficiency virus (HIV) infection. In an effort to reduce the annual number of new cases of HIV infection, the Centers for Disease Control and Prevention (CDC) has updated its guidelines on counseling, testing, and referral. Dr. Gallant points out that, over the past decade, the annual number of new cases of HIV infection has remained relatively stable but high, with an estimated 40,000 new cases each year. While the rate of new infections is declining in newborns, older men who have sex with men, and whites, it is increasing in young persons, women, Hispanics, and blacks.
CDC guidelines issued in 2001 focused on the reduction of barriers to testing, voluntary routine testing of high-risk populations and persons with risk factors, case management and partner tracing for infected persons, and universal testing of pregnant women. Effective strategies for reducing HIV infection include behavioral interventions, comprehensive school-based HIV and sex education, access to sterile drug equipment, screening of the blood supply, and postexposure prophylaxis for health care workers.
An accompanying editorial, entitled “Preventing HIV—A Primary Care Imperative,” by Ronald H. Goldschmidt, M.D., San Francisco General Hospital, University of California, and Rebecca E. Poage, M.D., Georgetown University Medical Center, Washington, D.C., appears on page 246. Dr. Goldschmidt is director of the Family Practice Inpatient Service at San Francisco Hospital. Dr. Poage recently served as assistant professor in the Department of Family Medicine at Georgetown University School of Medicine and also served as an editing fellow for AFP. Dr. Poage has finished this one-year fellowship and will begin working at the National Clinicians’ Counseling Center for HIV/AIDS at the University of California at San Francisco.
The authors of the editorial note that improved rapid tests for HIV represent a promising new tool to make HIV prevention efforts easier and more effective. Current rapid HIV tests have near-zero false-positive and false-negative rates. Although confirmation is required to establish a final diagnosis, these tests are nevertheless sufficiently accurate to both guide clinical decisions and inform patients of the results with near complete confidence. They also point out that the Institute of Medicine has recommended that HIV testing be a routine part of prenatal care so that all pregnant women are tested for HIV. By integrating HIV counseling and rapid and standard HIV testing into their routine clinical practice, family physicians can take a leading role in HIV prevention.