CDC recommends routine HIV testing during visits to doctor, ER

CDC recommends routine HIV testing during visits to doctor, ER
By Jeremy Manier
Copyright © 2006, Chicago Tribune
Published September 22, 2006


Testing for HIV should be a routine part of doctor appointments and emergency-room visits for all patients between ages 13 and 64, according to new federal guidelines designed to identify AIDS patients before they develop life-threatening symptoms.

The policy may be difficult to implement, especially in Illinois, where the law sets tight standards for how doctors must obtain consent for HIV tests and how they can inform patients of the results.

Supporters of the new recommendations, released Thursday by the federal Centers for Disease Control and Prevention, said more widespread testing would improve care for the estimated 250,000 Americans who don't know they're infected. It also could help reduce the spread of the disease by up to 30 percent, since studies show that carriers of HIV cut back on high-risk behavior, such as unprotected sex, once they learn of the infection.

"People with HIV have a right to know that they are infected," said CDC director Dr. Julie Gerberding.

In essence, the non-binding guidelines would have health-care providers test for HIV much as they already screen routinely for conditions such as diabetes or high blood pressure.

But the effort to treat HIV as just another disease may collide with entrenched cultural attitudes and laws that have set the ailment apart.

The special handling of AIDS emerged in an era when the disease was a virtual death sentence and an intense stigma around the virus inspired efforts to protect patients' privacy. Experts believed then that testing everyone would yield little benefit, since there was no good treatment. Until now, recommendations have called for testing people at high risk for HIV, such as drug users, health-care workers and homosexual men.

But attitudes about whom to test changed starting in the mid-1990s, when new treatments made the disease manageable, though still potentially deadly. Tests also have fallen in price, to about $8 for an ordinary test or up to $20 for a rapid test. Now, the CDC believes, the benefits of early treatment make routine testing imperative.

Implementing all of the CDC's recommendations may be nearly impossible under Illinois law. Illinois requires that patients be informed of HIV test results face-to-face, which can be difficult to accommodate with patients' work schedules. The law also prescribes pre-test counseling, which the CDC wants to keep to a minimum to allow the widest possible use of tests.

"Illinois has some of the more restrictive laws in the country," Bernard Branson, lead author of the CDC recommendations, said in an interview.

Many advocates for privacy and patients' rights say Illinois' restrictions are necessary. Ann Fisher, executive director of the AIDS Legal Council of Chicago, said her group has "grave reservations" about the policy, mostly because of its recommendation that doctors and states loosen their standards of informed consent for HIV tests.

"What they really want is not so much routine testing as what I call stealth testing," Fisher said.

The CDC guidelines propose testing patients on an "opt out" basis, meaning it would be a routine part of a typical medical visit, but patients could choose not to have the test. That's a change from current practices, in which patients often must sign a form giving specific consent for an HIV test. Illinois requires written consent for any HIV test.

Advocates of the revised approach say it would make testing patients easier and remove any stigma of being singled out for an HIV test.

Fisher agreed with Branson about the legal problems the CDC rules would face here. "These guidelines cannot currently be implemented in Illinois," she said.

Illinois health officials will take the new guidelines under review, said Melaney Arnold, a spokeswoman for the Illinois Department of Public Health. The agency could change its regulations or recommend a change in law by the state legislature, depending on input from the community and medical experts, Arnold said.

Testing all patients could have a pronounced effect in Chicago and other urban areas, which tend to have the highest concentration of HIV patients and undiagnosed carriers of the virus.

Branson of the CDC said some of the inspiration for the new recommendations came from recent studies of routine HIV testing at Stroger Hospital of Cook County and other public health-care centers. Those studies have found that about half of the patients who tested positive had no risk factors that would have prompted doctors to give them HIV tests under the old guidelines.

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jmanier@tribune.com

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The new guidelines

- All patients between ages 13 and 64 should be screened for HIV routinely when they visit hospitals or doctors' offices. People at high risk for HIV should be tested at least once a year.

- Testing should be done on a "voluntary, opt-out" basis--meaning that it's routine, but patients can choose not to be tested. The U.S. Centers for Disease Control and Prevention recommends that HIV screening be incorporated into general consent forms for medical care; separate written consent is not recommended.

- Prevention counseling should not be required with HIV diagnostic testing or as part of HIV screening programs. CDC officials said such counseling might discourage doctors or patients from making the tests routine.

For more information, visit the CDC's Web site at www.cdc.gov/hiv/topics/testing/resources/factsheets/healthcare.htm