By Denise Mann
The updated recommendations, which are published in the April 30 issue of the journal Annals of Internal Medicine, suggest that pregnant women and all people aged 15 to 65 be screened for HIV. The guidelines are now more in line with screening recommendations from the U.S. Centers for Disease Control and Prevention, the American College of Physicians and the American Academy of Pediatrics.
"HIV is a critical public health problem. There are 50,000 new infections in the U.S. each year, and we need to find ways to prevent and treat it," said guideline author Dr. Douglas Owens, a professor of medicine at Stanford University and a senior investigator at the VA Palo Alto Health Care System, in California.
The guidelines, last updated in 2005, reflect new evidence about the effectiveness of treatment, especially when started early in the course of HIV infection.
"The best way to reduce HIV-related death and disability is to avoid getting infected," Owens said. "Should someone become infected, we want them to understand that there are very good treatments that will help them live longer and reduce transmission."
Experts agreed that such blanket screening is the best -- and possibly only -- way to stop the HIV epidemic in its tracks.
Knowing one's HIV status is "a first step for both prevention and needed medical services, yet the history of the epidemic has set up barriers such that, in some states, it is still not straightforward to access an HIV test without the need for written consent or a fee," said Dr. Sten Vermund, director of the Institute for Global Health at Vanderbilt University School of Medicine in Nashville. "Free, regular screening for HIV, much as we try to have regular blood pressure or breast cancer screening, is one of the best ways to start reducing the HIV epidemic in the U.S."
Another expert agreed.
"There is a growing -- and overdue -- realization that treating HIV infection has both a personal and public health benefit," said Dr. Paul Volberding, a professor of medicine at the University of California, San Francisco School of Medicine. He wrote an editorial accompanying the guidelines.
"We may have a chance to end the AIDS epidemic, but that all begins with diagnosing infection in the estimated 20 percent of cases in the U.S. [who are] unaware of their status and thus not in medical care," he said. "Finding infected persons, bringing them into care, suppressing their HIV levels and retaining them in that state are the overriding goals of HIV control. These guidelines, along with those of the CDC, can help in the first step in that care cascade."
"HIV therapy is the most effective means of preventing all forms of transmission," Volberding said. "The importance of treatment as prevention was underscored by the very recent failure of the only candidate HIV vaccine in large clinical trials. We may well have to treat our way out of the epidemic, and that process begins with diagnosis and ends with lifelong engagement in care."