Studies Call for HIV Screen

Offering routine HIV screenings to an increased number of Americans—rather than screening only those who are in high risk groups—is a cost effective way of dealing with the high number of undiagnosed cases of HIV in the United States, according to two new studies released by researchers at a number of institutions, including Harvard.

Of the 950,000 HIV-positive individuals in the United States, approximately 280,000 of them are unaware they are infected, according to Center for Disease Control (CDC) estimates.

Current CDC guidelines issued in 2001 recommend testing individuals from populations that have a relatively high risk of HIV, defined as a prevalence of at least 1 percent.

However, both studies found that current testing practices do not go nearly far enough to ensure that HIV-positive individuals find out about and treat their illness in a timely manner.

“What we have done so far in terms of case detection has been completely inadequate,” said Dr. Rochelle P. Walensky an assistant professor at Harvard Medical School who co-authored one of the studies.

“It’s not enough to ask if you are an injection drug user,” she said. “We should be testing everybody.”

The studies found that while increased screenings can be expensive, their overall cost effectiveness is similar to that of other medical screenings that are commonly performed.

“It’s certainly comparable in terms of other things we screen for like colon cancer, breast cancer, and hypertension,” said Dr. Gillian Sanders, an author of the other study.

While previous studies in the 1990s have examined the cost effectiveness of HIV screenings, these two are the first to consider the effects of new treatments, said Dr. Douglas K. Owens, who co-authored the study with Sanders.

“Treatment certainly prolongs peoples’ lives,” said Owens, who estimated that beginning treatment with new medicines early instead of “getting treatment when you’re sick and show up at your doctor’s office” allows HIV-positive individuals to live about a year and a half longer.

Now that the results of the studies, which were conducted separately, have been released, the authors said they hope their work will spur changes in the way screenings occur.

“I think what we hope is that the CDC reopens the discussion of who they should be screening,” said Sanders.

One problem, the authors said, is money.

“The CDC has the ability to make recommendations, but ultimately the barrier to more widespread use is who’s going to pay for it,” said Milton C. Weinstein, the Kaiser professor of health policy and management at Harvard, who co-authored the study with Walensky

Walensky said she hopes that health care providers will realize the effectiveness of the screening relative to other treatments they already provide.

“Compared to a mammography for breast cancer,” she said, “this is an efficient test.”

—Staff writer Evan H. Jacobs can be reached at ehjacobs@fas.harvard.edu.