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Routine HIV Testing Advised for U.S. Adults

Routine HIV Testing and Treatment: A 1-2 Punch That Could Put AIDS on the Ropes
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WebMD Health News

Feb. 9, 2005 - Routine, voluntary HIV testing coupled with treatment could bring the U.S. AIDS epidemic to the brink of extinction.

That suggestion comes from respected AIDS researcher Samuel A. Bozzette, MD, PhD in a Feb. 10 New England Journal of Medicine (NEJM) editorial.

Bozzette's bold calculation is based on two independent NEJM studies showing that routine HIV testing would be far more helpful than previously thought. Using different techniques, the studies came up with nearly identical findings. They make a strong case for an aggressive attack on AIDS in the U.S., says Yale researcher A. David Paltiel, PhD, co-leader of one of the studies.

"We wired together all those forms of data that describe what this disease can do to people in order to find out what people can do to this disease," Paltiel tells WebMD. "A third of the people with HIV in this country -- fully 280,000 Americans -- are unidentified. They are not getting care. They are not getting counseling on how to prevent transmission. And we find that we can provide those things affordably and effectively."

Douglas K. Owens, MD, senior investigator at the VA Palo Alto Healthcare System, led the second study.

"We found that HIV screening provides a very substantial benefit, both for the infected person and for the community, because of decreased HIV transmission," Owens tells WebMD. "The benefit is so substantial that it makes economic sense -- more sense than we previously understood -- to screen for HIV in groups where HIV prevalence is low. And we are talking about voluntary screening."

Some 40% of the estimated 950,000 Americans with HIV get sick before they find out they're infected with the AIDS virus. By then, their bodies are crawling with infectious virus and their immune systems are badly damaged.

It's obvious that getting earlier testing and treatment would be a big help for these people. But it would also be a big help for the country at large. People who know they are infected aren't as likely to spread the infection. That's because they tend to get counseling on safer sex and drug-use behavior. It's also because they get treatment with AIDS drugs, which dramatically reduce the amount of infectious virus in the body.

Bozzette's calculation is that routine HIV testing and treatment can greatly slow the spread of AIDS. The effect can be great enough for a single medical advance - say, a vaccine that is only 50% effective - to wipe out AIDS in America.

"For any epidemic to perpetuate itself, each infected person has to infect at least one other. The closer you are to driving that number below 1, the closer you are to extinguishing the epidemic," Bozzette tells WebMD. "So if you can identify people who are transmitting HIV and reduce the probability they are going to transmit, it makes it easier to move to that point. Then let's say we get a partially effective HIV vaccine that cuts transmission by half. Well, if you have already reduced transmission substantially, that may be enough."

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