Dr. Ronald ValdiserriThis week, the U.S. Preventive Services Task Force (USPSTF) released a new Recommendation Statement on screening for HIV, giving a “Grade A” recommendation for routine HIV screening for all people aged 15 to 65, as well as younger adolescents and older adults who are at an increased risk for HIV infection. It also gave a “Grade A” recommendation for HIV screening for all pregnant women, including those in labor whose HIV status is unknown. (Read a fact sheet about the new USPSTF HIV screening recommendations.)Implementation of these recommendations will aid substantially in efforts to improve the HIV treatment cascade and achieve the goals of the National HIV/AIDS Strategy.
The new Recommendation Statement aligns with the Centers for Disease Control and Prevention’s (CDC) Revised Recommendations for HIV Testing of Adults, Adolescents, and Pregnant Women in Health-Care Settings, issued in 2006. In that document, the CDC recommended that opt-out HIV screening be a part of routine clinical care for American adolescents and adults aged 13-64.
Grade A: Why Does It Matter?
USPSTF’s recommendations form the basis of the clinical standards for many professional societies, health organizations, and medical quality review groups. In addition, under the Affordable Care Act, at no extra cost to the consumer. The law also gives state Medicaid programs financial incentives to cover USPSTF-recommended preventive services for adults. Consequently, with these new USPSTF recommendations, more Americans will receive HIV screening with no out-of-pocket expenses.
This is critical because, according to the CDC , approximately 1.1 million Americans are living with HIV, yet one in five is unaware of their infection. Because HIV infection does not usually cause symptoms at the early stage, many people who are HIV-positive are unaware they are infected with the virus. So, implementation of the Task Force’s recommendations will help more people who do not necessarily suspect that they have HIV learn their status.
Once clinicians identify individuals who are infected through screening, they will be able to help link these individuals to HIV care, where they can begin antiretroviral therapy (ART) and—with the proper support systems in place—be retained in care, adhere to their treatment and achieve full viral load suppression, meaning no detectable HIV virus in the blood. A suppressed viral load results in improved health outcomes for infected persons and reduces the probability that they will transmit the infection to their partners.
Diagnosing the 240,000 Americans who are unaware of their infection is an important step in efforts to improve the HIV treatment cascade, have also provided evidence that people adherent to HIV treatment who achieve viral load suppression are less likely to transmit the virus to their partners.
This new Recommendation Statement will also make HIV screening easier for clinicians since they will no longer need to solicit patients' risk status before offering testing; HIV testing for all patients 15 to 65 years of age will become standard medical practice. And by making HIV testing a routine part of good medical practice, we will help reduce the stigma that prevents too many Americans from seeking HIV testing or treatment.
The Recommendation Statement will also help reduce the significant proportion of late HIV diagnoses. According to CDC, one third of people with HIV are diagnosed so long after they acquire their infection that they develop AIDS—the final stage of HIV disease—within one year. They may have been living with HIV for up to 10 years before being diagnosed and thus did not have the knowledge they needed to take advantage of HIV treatment. By making HIV screening a routine part of clinical preventive care, more individuals who are living with HIV will be diagnosed and linked into care in a timely manner.
By making HIV screening a routine part of clinical care and eliminating cost barriers, the USPSTF Recommendation Statement brings us closer to achieving all the goals of the National HIV/AIDS Strategy, beginning with increasing the proportion of people living with HIV who are aware of their serostatus.