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HIV testing: Should it be routine?

People who know sooner that they have the virus can prevent the damage to their immune systems, officials say.

By LISA GREENE
Published August 19, 2006



These patients shouldn’t keep showing up, not now, not with infections that should have become rare.

But Dr. Jeffrey Levenson, a St. Petersburg infectious disease specialist, still sees them in local hospitals as often as once a week.

They’re patients ravaged by infections with names that ring of the ugly first years of the AIDS epidemic. It happens even though these days, better drugs mean that many HIV-positive people have never had such an infection and hope never to develop AIDS.

But Levenson keeps seeing them.

They are patients who don’t know they’re infected with HIV, the virus that causes AIDS. The virus quietly tears down their immune systems, and diseases rush in. Pneumocystic pneumonia. Esophageal candidiasis.

But Levenson isn’t surprised. He knows that about one-fourth of the 1-million Americans believed to be infected with HIV don’t know it. Now, federal scientists have proposed guidelines to try to identify those people by expanding HIV testing.

They want HIV testing to become part of everyday medical care, as routine as a cholesterol check or a pregnancy test.

“There’s a hidden pool of patients out there who don’t know they have HIV,” Levenson said.

The Centers for Disease Control and Prevention’s draft proposal calls for routine HIV testing for all patients between ages 13 and 64, while allowing people to refuse. The agency is expected to make final recommendations next month.

“If we can just incorporate it into medical care services, as we test for diabetes and cholesterol, it will pull the disease out of the shadows,” said Steve Huard, a spokesman for the Hillsborough County Health Department. “It will help eliminate the stigma.”

The centers had recommended HIV testing for high-risk individuals, patients in health-care settings with high HIV levels and early in pregnancy. The proposal also calls for repeat testing of women at higher risk.

Scientists believe broader testing could do more than make people think of HIV as just another disease. It could help those who are HIV-positive and shrink their numbers.

In the past several years, medicine has made tremendous strides in treating HIV. A diagnosis is no longer a death sentence.

“If you don’t get tested, you’re not going to seek medical treatment, and then you’re going to die,” said David Karst, project coordinator for AIDS Services Association of Pinellas.

Karst should know. A longtime survivor, he tested positive in 1989, but believes he may have been infected as early as 1982. He escaped his own brushes with death before the development of better HIV drugs. He’s also gone from taking 50 pills a day to 10. He’s hoping for one.

“The object of the game is to screen and diagnose patients before they end up with a major illness,” Levenson said.

Advocates also hope broader testing could reduce the rate of HIV infection. Since 1998, about 40,000 people have become infected in the United States each year, a number that has stubbornly refused to drop.

But if people know they are HIV-positive, studies have shown they are less likely to practice risky sexual behavior that could infect others.

“Information is the best weapon against HIV,” said David Konnerth, a contract specialist with AIDS Services Association of Pinellas. “If you know your status, that brings with it a responsibility to act. Hopefully it would be the driving force to change behavior.”

The proposal has won widespread praise from AIDS advocates and care providers. Frank Oldham Jr., executive director of the National Association of People With AIDS, touted the “enormous courage and vision” of federal officials proposing the change, and said his group fully supports it.

Still, there are concerns. Discussion of broader HIV testing drew a few dozen protesters in Canada last week, at the 16th International AIDS Conference, according to news reports. A sudden increase in the number of HIV-positive patients will present challenges, Oldham said.

“If 100,000 people suddenly know their (HIV-positive) status, what happens to the health care system?” he asked. “We don’t have universal health care. There’s an overall safety net that I think has been eroded.’’