American College of Physicians Releases Guidelines on Routine HIV Screening
The American College of Physicians on Tuesday released guidelines urging physicians to begin routine HIV screening among patients at age 13, regardless of whether they engage in risky behaviors, the New York Times reports. Amir Qaseem, senior medical associate with ACP, said an upper age limit was not included in the recommendations because 20% of people living with HIV are older than age 50. He added that repeat screening should be determined by physicians on a case-by-case assessment. Qaseem said that about 24% to 27 % of the estimated one million to 1.2 million people currently living with HIV in the U.S. are unaware of their status and that ACP is "recommending clinicians just adopt routine screening in their patients."
According to the Times, ACP's guidelines differ from the U.S. Preventive Services Task Force's, which urge routine screening only for patients at high risk of the virus. However, many patients do not inform their physicians about their risky behaviors, Qaseem said. The American College of Obstetricians and Gynecologists also recommends routine HIV screening for all women between ages 19 and 64, regardless of their risk factors, the Times reports.
The Times also reports that the ACP guidelines differ from CDC's guidelines on routine HIV testing, which recommend routine screening until age 64 unless the HIV prevalence in the patient population is known to be less than 0.1%. According to Qaseem, it is difficult for physicians to know what the HIV prevalence rate is among certain patient populations.
According to the Times, hospitals and clinics have been slow to implement CDC recommendations on routine HIV screening. Richard Rothman, associate professor of emergency medicine at Johns Hopkins School of Medicine, said that a lack of funding has prevented the implementation and that only 50 to 100 of the country's 5,000 emergency departments routinely test for HIV. Rothman said, "The CDC's view was that you would get an HIV test just like you would have a complete blood count or any other test as part of your care. But right now in many states there is no mechanism for reimbursement, so emergency [departments] that try to do it have to foot the bill themselves or find creative ways of paying for it" (Rabin, New York Times, 12/2).
The ACP guidelines are available online.