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Integrating Routine HIV Screening Into Practice

From the September 2016 ACP Internist

Routine screening has 2 main benefits: diagnosing HIV infection before patients become symptomatic and have lost the bulk of their immune system and preventing HIV transmission.

HIV may be found in any health care setting, crossing boundaries of sexual orientation, gender, age and ethnicity. According to CDC statistics, more than 1.2 million people in the U.S. are living with HIV and 156,300, or about 1 in 8, are unaware of their status, which puts them at risk for the severest consequences of the disease. Undiagnosed, they may unintentionally transmit HIV to others. In fact, despite prevention efforts, the CDC calculates that the rate of new HIV infections has remained steady over the past decade at about 50,000 a year.

Routine screening has 2 main benefits: diagnosing HIV infection before patients become symptomatic and have lost the bulk of their immune system and preventing HIV transmission. Early diagnosis allows patients to be linked to care earlier, when they can benefit most from treatment. HIV-infected patients receiving early treatment have a good chance of nearly normal life spans.

An April 2015 study in JAMA Internal Medicine estimated that diagnosing unaware individuals and ensuring they receive prompt, ongoing care could avert more than 90% of new HIV infections in the U.S. Also, people who are aware of their HIV status modify their risk behavior. A 2005 meta-analysis in the Journal of Acquired Immune Deficiency Syndromes showed that people who know they are HIV-infected reduce their rate of unprotected sex with an uninfected partner by about 68%. An additional benefit is that as HIV screening becomes routine, the HIV test and the disease itself become destigmatized.

Unfortunately, in Kansas, my state, nearly one-third of patients infected with HIV meet the criteria for AIDS at the time of diagnosis. In our large general medical practice at the University of Kansas School of Medicine, it's not unusual to see patients present with advanced disease, coming in with symptoms of pneumocystis pneumonia or another opportunistic infection. Recently, a 56-year-old man, married and with grandchildren, came in with disseminated cryptococcal disease. He had never been tested for HIV. At this point, his immune system was down to 37 CD4 cells and he had an extremely high viral load.

Read the full article in ACP Internist.

ACP Internist provides news and information for internists about the practice of medicine and reports on the policies, products, and activities of ACP.

Back to the December 2017 issue of ACP IMpact