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Originally published November 19, 2012 at 7:09 PM | Page modified November 20, 2012 at 6:03 AM

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Panel pushes for HIV screening for most in U.S.

Nearly everyone ages 15 to 64 should be screened for HIV even if they're not at great risk for contracting the virus, under guidelines proposed by a panel of medical experts.

Los Angeles Times

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Nearly everyone ages 15 to 64 should be screened for HIV even if they're not at great risk for contracting the virus, under guidelines proposed by a panel of medical experts. If the panel adopts the recommendation, Medicare and most private health insurers would be required to pay for the tests.

The proposal was written by the U.S. Preventive Services Task Force, an independent group that operates under the auspices of Department of Health and Human Services to advise the government and physicians on the medical evidence for preventive health measures.

Posted online Monday on the task-force website for four weeks of public comment, the guidelines also recommend that doctors offer HIV tests to people under 15 or over 64 if they are at high risk for contracting HIV and — in advice that has not changed — to all pregnant women.

The recommendations, which would apply to all but very low-risk populations, are a shift toward broader testing for the human immunodeficiency virus, which causes AIDS. The task force's 2005 guidelines suggested routine HIV screening only for adolescents and adults at increased risk, including men who have sex with men, injection drug users, people who trade sex for drugs and those who have multiple sexual partners.

But studies published since that time offer strong evidence that HIV-infected people, their intimate partners and the public are better served by near-universal screening, said task-force member Douglas Owens, a general internist and director of the Center for Primary Care and Outcomes Research in the School of Medicine at Stanford University.

Some of those reports found that people who were treated earlier for HIV infections fared better than those who started treatment later, and screening improved the chances that patients would learn of their infections sooner, Owens said. Studies also show that when people learn they are HIV-positive, they are more likely to adopt safe-sex behaviors.

Doctors have said that recommending the HIV test for all but the lowest-risk groups removes the stigma associated with getting a test and increases the likelihood of an early diagnosis. Conversations to assess a patient's risk status are time-consuming and awkward, and patients are often not truthful about their sexual behavior, they said.

A clinical trial last year involving 1,763 couples, most of them heterosexual, showed that when HIV-positive partners were treated early with antiretroviral medications, transmission of the virus to uninfected partners was reduced by 96 percent.

The 15-to-64 age range was suggested for such tests — which could be offered to patients visiting their doctors or hospitals for any reason — because government health statistics show this would capture the majority of Americans who contract the virus every year, Owens said.

About 50,000 new HIV infections occur in the United States each year. Because today's medications allow HIV-infected people to live longer, the number of people living with HIV will steadily increase unless ways are found to lower the rate of new infections, said Bernard Branson, an epidemiologist in the Center for Disease Control and Prevention's Division of HIV/AIDS Prevention. Every averted infection saves $367,000 in lifetime medical costs, he said.

The issue is especially complicated in the case of adolescents, said Patricia Emmanuel, a pediatric infectious-disease specialist at the University of South Florida in Tampa who co-wrote the 2011 American Academy of Pediatrics guidelines that recommend testing for teenagers ages 16 and older. When tests are done only for high-risk patients, the very fact someone had a test is a betrayal of confidentiality, she said.

A recommended HIV test "helps to create an environment where HIV testing is another medical screening test, not something so special," she said.

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