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Wall Street Journal
Health Panel Backs Broad HIV Tests

<p>Thomas M. Burton and Betsy McKay</p>


November 19, 2012

A government health panel on Monday for the first time recommended testing for the human immunodeficiency virus for all Americans aged 15 to 65, in an effort to slow its spread.

An estimated 200,000 people in the U.S. are infected with the virus that can cause AIDS and don't realize it. The U.S. Preventive Services Task Force said the new draft recommendation is aimed at preventing those people from infecting others or developing AIDS themselves.

The panel's recommendation is significant because, if finalized, private insurers would have to pay for the test. Past recommendations haven't always been embraced by doctors. But in this instance, the weight of medical evidence has already been trending in favor of screening and earlier treatment of people with HIV.

It is estimated that 1.1 million Americans have HIV, with about 50,000 new cases annually.

Focusing tests only on those at high risk hasn't been very effective, the panel said. "Targeted screening misses a substantial proportion of infected persons because of undisclosed or unknown risk factors," said an article in Annals of Internal Medicine published Monday to support the recommendation to support the task force's recommendation.

Until now, the task force had only recommended that doctors screen all pregnant women for HIV, and that younger adolescents and older adults who are at increased risk also be screened. Those at high risk include men who engage in sex with other men, people who take drugs by injection, and those who have sex with infected people, the task force has said.

Monday's recommendation doesn't say precisely how often people should get HIV screening. "One reasonable approach," the task force wrote, "would be onetime screening of adolescent and adult patients to identify persons who are already HIV positive, with repeat screening of persons who are known to be at risk for HIV infections."

Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases and a leading researcher and White House adviser on AIDS, said more than half of new HIV infections in the U.S. are a result of people who don't realize they have the virus. Testing and treating people, he said, "makes it highly unlikely that people with HIV will transmit their infection to their sexual partners."

Carl Schmid, deputy executive director of The AIDS Institute, a public-policy advocacy group, called the decision "a monumental shift in how HIV in the U.S. can be prevented, diagnosed and treated." He called the current risk-based approach "an ineffective screening strategy."

But there are many people who are skeptical about wider HIV testing, said Michael S. Lyons, an emergency room physician at the University of Cincinnati. "The benefits of diagnosing someone as early as possible are basically proven," he said, "but the difficulty is how do you do that?"

Mr. Lyons said many relatively poor people who show up at the emergency room may well be HIV-positive, "but emergency departments are very strained at this point. This is a compelling example of the tension between what would be good to do and what practically can be done."

The Centers for Disease Control and Prevention declined to comment on the significance of the recommendation because it is only in draft form and subject to public comment. Since 2006, the CDC has recommended routine HIV testing for everyone aged 13 to 64.

From here, the task force's draft would have to become a final recommendation. At an unspecified time after that, insurance plans would be obligated to pay for the test. Ultimately, it would be up to doctors to order the test.

Robert Zirkelbach, spokesman for America's Health Insurance Plans, said, "If a physician orders a test, the insurer will cover it, and that won't change." He noted that the Affordable Care Act requires insurers to pick up the costs.

The HIV tests are either blood or oral-swab tests, and the results of some are known in minutes. A 2010 study found that the quick test cost on average $48 for a negative test and $64 for a positive test, with the difference being the cost of counseling. Jonathan Mermin, director of the CDC's HIV/AIDS prevention program, has said HIV testing should be "as routine as cholesterol screening."

Chris Collins, vice president and director of public policy for amfAR, the Foundation for AIDS Research, said that despite the cost, it's useful to offer the HIV tests to everyone. "There's clear evidence that, absent routine testing, people simply aren't offered an HIV test," he said. "Lots of patients don't feel comfortable talking about this. This needn't be a highly charged issue."

Write to Thomas M. Burton at tom.burton@wsj.com and Betsy McKay at betsy.mckay@wsj.com



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