Experts Urge Routine HIV Tests For
All
By Linda A. Johnson - Associated Press Writer - 10 February
2005
Urging a major shift in U.S. policy, some health experts are recommending
that virtually all Americans be tested routinely for the AIDS virus,
much as they are for cancer and other diseases.
Since the early years of the AIDS epidemic in the 1980s, the government
has recommended screening only in big cities, where AIDS rates are
high, and among members of high-risk groups, such as gay men and
drug addicts.
But two large, federally funded studies found that the cost of routinely
testing and treating nearly all adults would be outweighed by a
reduction in new infections and the opportunity to start patients
on drug cocktails early, when they work best.
"Given the availability of effective therapy and preventive
measures, it is possible to improve care and perhaps influence the
course of the epidemic through widespread, effective and cost-effective
screening," Dr. Samuel A. Bozzette wrote in an editorial accompanying
the studies, which appear in Thursday's New England Journal of Medicine.
A failure to institute such screening at doctors' offices and clinics
would be "a critical disservice" to patients with the
AIDS virus and "the future health of the nation," wrote
Bozzette, who is from the University of California at San Diego
and the Rand Corp. think tank in Santa Monica, Calif.
Dr. Robert Janssen, director of HIV-AIDS prevention at the Centers
for Disease Control and Prevention, said the CDC will re-evaluate
its guidelines over the next two years, and will consider the study's
findings as well as the availability of new, rapid HIV tests that
produce results in a half-hour instead of the usual week or two.
Who would bear the cost of expanded testing - and the cost of the
treatment, which runs to at least $15,000 a year - remains a sticky
question amid government cutbacks in health-care funding. However,
Janssen said the studies' findings could lead to some private insurers
to encourage more HIV testing.
One of the studies, by researchers at Duke and Stanford universities
and the Veterans Affairs Palo Alto Health Care System, estimated
that routine one-time testing of everyone would cut new infections
each year by just over 20 percent, and that every HIV-infected patient
identified would gain an average of 1 1/2 years of life.
The other study, by Yale and Harvard researchers, found that testing
people every three to five years would be cost-effective for all
but the lowest-risk people, such as those who are celibate or are
in monogamous heterosexual relationships. And even for those people,
one-time testing was found to be cost-effective.
Nationwide, about 40,000 new HIV infections occur each year. An
estimated 950,000 people are infected with the virus, but about
280,000 of them don't know it.
CDC guidelines recommend routine tests wherever the prevalence of
HIV infection is more than 1 percent - basically, cities and some
densely populated suburbs.
"If you need proof of the fact that it's not working, look
at all the people who have slipped through the cracks - 280,000,"
said A. David Paltiel of the Yale School of Medicine's division
of health policy, lead author of the second study.
The VA-funded study found that in areas where about 1 in 100 patients
has undiagnosed HIV - what the CDC calls high-risk settings - widespread
testing would cost about $15,100 for each year of good health gained
by people diagnosed with the virus, counting the benefits to their
sexual partners.
Even in areas with an undiagnosed HIV infection rate of only 1 in
2,000 - the rate in the general population - each healthy year gained
by newly diagnosed HIV patients and their partners would still cost
less than $50,000. That is the threshold at which health economists
generally consider treatments to be cost-effective.
Paltiel noted the two groups of researchers had very similar cost-benefit
results, even though they used different computer models.
"The cost-benefit to individuals and society is worth"
widespread screening, said Dr. Lawrence Deyton, chief of public
health in the Department of Veterans Affairs, which provides medical
care to about 5 million veterans.
In light of the findings, he said the VA is going to urge more patients
to get tested.
"We're going to take the ball and run with it," Deyton
said.
Copyright © 2005 The Associated Press. All rights reserved.
The information contained in the AP News report may not be published,
broadcast, rewritten or redistributed without the prior written
authority of The Associated Press.
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PS: More validation of the Sirian Revelations texts!
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