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Are Current HIV Screening Guidelines Too Conservative?

Authors question CDC recommendations (Mar. 13)

In a new study, researchers at Northwestern University report that current human immunodeficiency virus (HIV) screening guidelines from the Centers for Disease Control and Prevention (CDC) are too conservative and that more frequent testing would be cost-effective in the long run for both high- and low-risk groups.

The study was published in the March 13 issue of AIDS.

The researchers set out to determine whether HIV testing in health care settings should be more aggressive than is currently recommended. In their study, they performed a mathematical modeling analysis to determine “optimal testing frequencies” for HIV screening in different risk groups. They also modeled various scenarios in an attempt to “optimize the tradeoff” between the societal costs of testing versus the benefits of earlier HIV diagnosis over a patient's lifetime.

The investigators concluded that HIV screening should be performed every 2.4 years in low-risk individuals (0.01% annual incidence); every 9 months in moderate-risk individuals (0.1% incidence); and every 3 months in high-risk individuals (1.0% incidence). Further, they calculated that the incremental cost-effectiveness of this “optimal testing policy” is $36,342 per quality-adjusted life-year (QALY) for low-risk individuals and $45,074 per QALY for high-risk individuals compared with 20-year and annual testing, respectively.

The CDC currently recommends annual testing for high-risk groups — such as people with HIV-positive sexual partners, people with multiple sexual partners, injection drug users, and sex workers — and once-in-a-lifetime testing for low-risk groups (whose annual risk of acquiring HIV is 0.01%).

According to the authors, early detection of HIV infection through frequent testing would allow earlier initiation of highly active antiretroviral therapy (HAART), which substantially reduces HIV transmission and increases survival. Early detection would also promote risk reduction in previously undiagnosed HIV-positive patients by decreasing partnership acquisition rates and by increasing safe sex practices with perceived HIV-negative partners, the authors say.

Source: AIDS; March 13, 2013.

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