A Once-in-a-Lifetime HIV Test Isn’t Enough
If you happened to be a young adult in the 1980s and 1990s, getting an HIV test was something you probably did if you had any reason to think you might be at risk of infection (e.g., you were having sex). And if you didn’t get tested (and even if you did), you probably worried.
These days, though, getting an HIV test isn’t something most people talk (or seem to worry) much about anymore. But it’s something we should be doing much more often, says new research out of Northwestern University. The team of researchers, led by Aaron Lucas, a graduate researcher, and Benjamin Armbruster, an assistant professor of industrial engineering and management sciences at Northwestern’s McCormick School of Engineering and Applied Science, found that the current HIV screening recommendations from the Centers for Disease Control (CDC)—put in place in 2006—are too conservative. The CDC currently recommends that people at low risk of HIV should be tested only once in their lifetime, and that those at highest-risk—people with multiple sex partners, IV drug users, and sex workers—should be tested every three years.
Men who have sex with men have the highest rate of new HIV infections; the CDC recommends that this group be tested every three to six months. The CDC says that in 2009, about two in five of all new HIV infections were in people ages 13 to 29.
The researchers did a mathematical model to figure out the ideal frequency of testing, balancing the health trade-off of delaying diagnosis with the financial cost of testing. The goal: to capture more people with the infection earlier (so they could be treated sooner and would stay in better health) and that would also be worth the money. Their conclusion? Those at the highest risk of being infected with HIV should be screened every three months, and even those at low risk should get the test every three years. People at moderate risk should be tested every nine months. They published their finding in AIDS, the journal of the International AIDS Society.
Right now, recommendations for when to start treatment for those who have HIV are based on their counts of a specific type of white blood cell, called CD4+, which helps to fight infection. But more research is showing that the sooner treatment is started, the better patients do. More frequent screening would aim to capture more people earlier in their infection and start them on treatment right away, says Aaron Lucas. This would mean a great number of people in better health and lower healthcare costs down the road.
In fact, even factoring in all the negative tests (in which people are tested and find out they do not have the virus), it still makes sense to test much more frequently, says Lucas. “Those lost costs from testing negative are still cheap compared to the risk of forgoing an HIV test,” he says. “We would like to see an update of [the CDC’s] current testing recommendations, but we would also like to see physicians and care providers more engaged in recommending their patient test for HIV even for low-risk or moderate-risk groups.”
Others agree that HIV testing should be done more often. “The AIDS Healthcare Foundation is strongly in favor of more aggressive HIV testing efforts,” says Lori Yeghiayan Friedman, associate director of communications for the global organization, which has its headquarters in Los Angeles. “We believe that everyone should get tested and know their status,” she says, adding that the group supports efforts to increase recommended frequency of testing for everyone.
Like others, Friedman links more testing to helping to end the AIDS epidemic: “The best way to…reduce the number of infections is to identify people who are positive and link them to treatment,” she says. “The earlier one is diagnosed with HIV, the better the health outcome. Too many people are being diagnosed late and are therefore not receiving the full benefit of lifesaving HIV/AIDS treatment.” Especially hard-hit when it comes to early diagnosis are people who don’t have ready access to good-quality care, including people of color and those living in rural and poorer areas.
Friedman notes that when someone is diagnosed soon after exposure to the infection, they respond better to treatment and are likelier to protect their partner(s) from infection, which further helps eradicate the disease. “It’s estimated that 25 percent of people who are positive are unaware of their HIV-positive status,” says Friedman. “This 25 percent are the unwitting source of the majority of new infections…At an estimated $600,000 lifetime cost for treatment for one person in the U.S., every infection averted equals thousands of dollars saved.” Treatment makes someone less infectious too.
Like Lucas, Friedman thinks more testing is a crucial step: “Increased HIV testing will lead to a reduction in new infections and, therefore, is a cost-effective strategy in fighting HIV in the U.S.—and will save lives.”
What do you think the best ideas are for stopping HIV infections? Have you ever been tested for HIV?