Research Article: Late HIV Diagnosis: Bad Medicine and Worse Public Health

Date Published: June 12, 2007

Publisher: Public Library of Science

Author(s): Ronald O Valdiserri

Abstract: The author discusses a new study that models the impact of the CDC’s new recommendation of opt-out HIV testing in all health care encounters in the US for persons 13-64 years old.

Partial Text: It is estimated that there are some 252,000–312,000 Americans living with HIV yet unaware that they carry this deadly virus [1]. Once they develop symptoms of HIV disease, most will be diagnosed. But by then, their immune systems will have experienced permanent damage, and thousands will have inadvertently infected their partners. One analysis reckons that annual HIV transmission rates in the United States are some 3.5 times higher among people with undiagnosed HIV infection compared to those who are diagnosed [2], due to the fact that knowledge of positive HIV serostatus is associated with substantial decreases in high-risk sexual behaviors among those so diagnosed [3].

Arguably, addressing the persistent problem of late HIV diagnosis was the major driver in the recent push by the Centers for Disease Control and Prevention (CDC) for routine, opt-out testing in health-care settings, i.e., informing patients of the intent to perform HIV testing and inferring consent unless the patient declines [8]. Citing the time constraints of risk-assessment and counseling, CDC’s 2006 guidelines also note that “prevention counseling should not be required with HIV diagnostic testing or as part of HIV screening in health care settings” [8].

Perspectives on how best to encourage early diagnosis of HIV infection will continue to evolve as additional program implementation data and improved input parameters become available to further refine cost-effectiveness analyses. But it would be a serious mistake to narrow this multifaceted discussion to an artificial dichotomy of opt-out routine testing versus targeted HIV testing.

Source:

http://doi.org/10.1371/journal.pmed.0040200

 

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