* Experts hope move will encourage more testing
* Guidelines may trigger insurance coverage for tests
By Julie Steenhuysen
CHICAGO, April 29 An influential U.S. panel is
calling for HIV screening for all Americans aged 15 to 65,
regardless of whether they are considered to be at high risk, a
change that may help lift some of the stigma associated with HIV
The new guidelines from the U.S. Preventive Services Task
Force (USPSTF), a government-backed panel of doctors and
scientists, now align with longstanding recommendations by the
U.S. Centers for Disease Control and Prevention for testing of
all adults aged 15 to 65, regardless of their risk.
Guidelines issued by the USPSTF in 2005 had recommended HIV
screening for high-risk individuals.
Experts said the change, published on Monday in the Annals
of Internal Medicine, will likely trigger coverage for the tests
as a preventive service under the Affordable Care Act. Under
President Barack Obama's healthcare law, insurers are required
to cover preventive services that are recommended by the task
Currently, the healthcare law recommends coverage of HIV
testing for adolescents and adults who are at high risk of
"That was based on the 2005 USPSTF recommendations," Dr.
Jeffrey Lennox, a professor of medicine at Emory University
School of Medicine and chief of infectious disease at Grady
Memorial Hospital, an inner-city hospital in Atlanta.
"Now, hopefully they will go back and recategorize that and
recommend that it will be covered for every adult."
Joanne Peters, a spokeswoman for the U.S. Department of
Health and Human Services, said the U.S. Preventive Services
Task Force ranks preventive services based on the strength of
the scientific evidence documenting their benefits.
"Preventive services with a 'grade' of A or B will be
covered under these rules. This includes today's HIV screening
recommendations," Peters said.
For doctors, the new recommendations should help clear up
any confusion about testing among some primary-care doctors who
have not been offering the test to all their adult patients.
"Now, everybody agrees it should be done," Lennox said.
Task force member Dr. Douglas Owens, a medical professor at
Stanford University, said, "We do hope the fact that the
guidelines are all very similar will provide an impetus for
people to offer screening because it is a very critical
50,000 NEW INFECTIONS A YEAR
Despite strides in reducing cases of HIV infection in the
United States in the past three decades, as many as 50,000
Americans become infected with the virus each year.
The CDC estimates that almost 1.2 million people in the
United States are infected with HIV, yet 20 percent to 25
percent of them do not know it.
"The Task Force's new recommendations will expand the number
of Americans who know their HIV status and can take action to
protect themselves and their partners," Dr. Jonathan Mermin,
director of the CDC's Division of HIV/AIDS Prevention, said in a
The recommendations are based on evidence showing the
benefits and risks of testing and treatment for HIV, the virus
that causes AIDS. Recent studies have shown that HIV treatment
can reduce transmission of the virus to an uninfected partner by
as much as 96 percent but there is no cure for the disease.
The group also recommends that teens younger than 15 and
adults older than 65 should be screened if they are at increased
risk for HIV infection. And it recommends that all pregnant
women - including those in labor - who do not know their HIV
status should be tested.
The guidelines call for screening at least once for all
adults, and it recommends periodic screening for individuals at
higher risk of infection. But it does not specify how frequently
people at high risk for infection should be tested.
High-risk groups include those who have sex with gay or
bisexual men, illicit drug users and economically disadvantaged
populations in which HIV rates are high.
Owens said testing all adults within a certain age range may
help reduce any stigma associated with testing and encourage
people to get tested.
According to the CDC, stigma has been a major stumbling
block that keeps many from seeking out testing, and the hope is
that the change will make HIV testing a common part of medical
"CDC believes HIV testing should be as routine as a
cholesterol test or a blood pressure check - but so far fewer
than half of Americans have ever been tested," Mermin said.
As with the CDC recommendations, the USPSTF guidelines
recommend that all individuals be offered the test as well as a
chance to opt out of testing.
Lennox and others said it is too early to say whether the
new guidelines will result in a significant increase in the
number of tests, but the potential for insurance coverage may
Dr. Gerald Schochetman, senior director, infectious diseases
and diagnostic research for Abbott Laboratories' Abbott
Diagnostics, which makes an HIV test, said the task force
recommendation will put more emphasis on the need for all adults
in the United States to be tested and should encourage more
doctors to discuss the need for testing with their patients.