Urging amajor shift in U.S. policy, some health experts are recommending that virtuallyall Americans be tested routinely for the AIDS virus, much as they are forcancer and other diseases.
Since theearly years of the AIDS epidemic in the 1980s, the government has recommendedscreening only in big cities, where AIDS rates are high, and among members ofhigh-risk groups, such as gay men and drug addicts.
But twolarge, federally funded studies found that the cost of routinely testing andtreating nearly all adults would be outweighed by a reduction in new infectionsand the opportunity to start patients on drug cocktails early, when they workbest.
“Given theavailability of effective therapy and preventive measures, it is possible toimprove care and perhaps influence the course of the epidemic throughwidespread, effective and cost-effective screening,” Dr. Samuel A. Bozzettewrote in an editorial accompanying the studies, which appear in Thursday’s NewEngland Journal of Medicine.
A failureto institute such screening at doctors’ offices and clinics would be “acritical disservice” to patients with the AIDS virus and “the future health ofthe nation,” wrote Bozzette, who is from the University of California at SanDiego and the Rand Corp. think tank in Santa Monica, Calif.
Dr. RobertJanssen, director of HIV/AIDS prevention at the Centers for Disease Control andPrevention, said the CDC will re-evaluate its guidelines over the next twoyears, and will consider the study’s findings as well as the availability ofnew, rapid HIV tests that produce results in a half-hour instead of the usualweek or two.
Who wouldbear the cost of expanded testing — and the cost of the treatment, which runsto at least $15,000 a year — remains a sticky question amid government cutbacksin health-care funding.
However,Janssen said the studies’ findings could lead to some private insurers toencourage more HIV testing.
One of the studies, by researchers atDuke and Stanford universities and the Veterans Affairs Palo Alto Health CareSystem, estimated that routine one-time testing of everyone would cut newinfections each year by just over 20 percent, and that every HIV-infectedpatient identified would gain an average of 1 1/2 years of life.
The otherstudy, by Yale and Harvard researchers, found that testing people every threeto five years would be cost-effective for all but the lowest-risk people, suchas those who are celibate or are in monogamous heterosexual relationships. Andeven for those people, one-time testing was found to be cost-effective.
Nationwide,about 40,000 new HIV infections occur each year. An estimated 950,000 peopleare infected with the virus, but about 280,000 of them don’t know it.
CDCguidelines recommend routine tests wherever the prevalence of HIV infection ismore than 1 percent — basically, cities and some densely populated suburbs.
“If youneed proof of the fact that it’s not working, look at all the people who haveslipped through the cracks — 280,000,” said A. David Paltiel of the Yale Schoolof Medicine’s division of health policy, lead author of the second study.
TheVA-funded study found that in areas where about 1 in 100 patients hasundiagnosed HIV — what the CDC calls high-risk settings — widespread testingwould cost about $15,100 for each year of good health gained by peoplediagnosed with the virus, counting the benefits to their sexual partners.
Even inareas with an undiagnosed HIV infection rate of only 1 in 2,000_ the rate in thegeneral population — each healthy year gained by newly diagnosed HIV patientsand their partners would still cost less than $50,000. That is the threshold atwhich health economists generally consider treatments to be cost-effective.
Paltielnoted the two groups of researchers had very similar cost-benefit results, eventhough they used different computer models.
“Thecost-benefit to individuals and society is worth” widespread screening, saidDr. Lawrence Deyton, chief of public health in the Department of VeteransAffairs, which provides medical care to about 5 million veterans.
In light ofthe findings, he said the VA is going to urge more patients to get tested.
