Expansion of HIV screening worthwhile

By Dr. Ananya Mandal, MDDec 21 2010

According to researchers, screening for the AIDS virus to include every American at least once and the highest-risk people once a year could prevent more than 80,000 infections over the next 20 years. The team from Yale University in Connecticut and Stanford University in California reported that if treatment for infected people were integrated into such a program, it would prevent an estimated 212,000 new infections.

At present the U.S. Centers for Disease Control and Prevention recommends universal screening, testing everyone at least once for the human immunodeficiency virus that causes AIDS. But little or no funding has gone to such a program. 600,000 Americans have died of AIDS, 1.1 million are infected and 21 percent of those infected do not know it because they have not been tested and more than 56,000 Americans get infected every year with HIV.

Researcher Elisa Long and colleagues at Stanford write, “Our model projects that approximately 1.23 million new HIV infections will occur over 20 years, with 74 percent occurring among high-risk persons.” The report is published in the Annals of Internal Medicine. High risk individuals are homo and bisexual men, blacks and injection drug users. They add, “One-time screening of low-risk persons combined with annual screening of high-risk persons prevents 81,991 infections (6.7 percent of the projected total).” However they say a strategy that includes screening everyone once in their lives and annual screening of the people at highest risk, plus treatment of 75 percent of those infected, would prevent more than 212,000 infections, or 17 percent of the total. The team also tried to find whether testing and treating nearly everyone could eliminate HIV in the United States. They write, “Such a strategy could prevent 24 percent of new infections but would not prevent more than 40,000 new infections each year.”

Stanford’s Dr. Owens said, “You do the most for health outcomes by scaling up these programs together. They are synergistic.” He adds that this type of program would cost $26.9 billion over 20 years, or about $22,000 per quality-adjusted life year saved, an accepted measure that reflects both how long people live and their quality of life. Long said, “We find that expanded screening and treatment could offer substantial health benefits, preventing 15 to 20 percent of new cases… And the strategy of one-time screening of low-risk individuals and annual screening of high-risk individuals is very cost-effective.”