[Viva] Fwd: CATIE-News - Editorial in Canada's leading medical journal calls for routine HIV testing
Tami Starlight
tamistarlight at gmail.com
Fri Nov 30 14:00:48 PST 2012
**
CATIE-News - Bite-sized HIV/AIDS news bulletins
CATIE-News - Editorial in Canada's leading medical journal calls for
routine HIV testing
The widespread availability of potent combination anti-HIV therapy
(commonly called ART or HAART) has greatly decreased deaths from
AIDS-related complications in Canada and other high-income countries. The
benefits of ART are so profound that doctors estimate that a 20-year-old
diagnosed with HIV today who takes his or her medicine exactly as
prescribed and who does not have other pre-existing health issues will
likely have a near-normal life expectancy.
Unfortunately, not all HIV-positive people in Canada are benefitting from
ART in a timely manner. According to the Public Health Agency of Canada,
researchers estimate that about 25% of 71,300 HIV-positive people alive in
Canada today are not aware of their HIV status. Moreover, a large fraction
of such people, because they are unaware of their HIV status, only receives
care and treatment when their immune systems are very weak.
There are many disadvantages, at both a personal and societal level, to a
late HIV diagnosis, including the following:
- because the immune system is weak, improvement in overall health may
be delayed despite the use of ART
- such people are prone to life-threatening infections
- the cost of care is much greater
- a person who does not know his or her status may not take steps to
prevent further spread of HIV
Canada
Routine HIV testing is recommended in Canada in cases of pregnancy and
blood donations. Otherwise, HIV testing is primarily done in people who are
at or are perceived to be at high risk for this infection. In an editorial
for an upcoming issue of the *Canadian Medical Association
Journal,*Vancouver doctors Réka Gustafson and Julio Montaner note that
risk-based
testing is likely to miss “a substantial proportion of [hidden HIV
infections].”
Uncovering HIV
The Vancouver Coastal Health authority conducted a pilot study and found
that 60% of HIV-positive people diagnosed late in the course of infection
had previously encountered the health care system, as they had at least one
of the following experiences three years prior to their diagnosis or last
negative test:
- one lab test
- a visit to the emergency department of a hospital
- been admitted to a hospital for care
Drs. Gustafason and Montaner note that according to recommendations in
other high-income countries, such as France and the U.K. and U.S., “these
patients should have been offered an HIV test at these earlier encounters,
without needing to raise or acknowledge a specific risk.” Moreover, public
health authorities in these countries now encourage health care
professionals to offer HIV testing to a broad age range of people, from
teenagers to senior citizens, without taking into account risk factors.
The pilot study
As part of Vancouver Coastal Health’s pilot project, hospital
administrators recommend HIV testing “as part of all medical admissions and
emergency department visits,” stated Gustafason and Montaner. Preliminary
analysis of the pilot project found that 43% of hospital doctors offered
the test and 92% of participants consented to be tested for HIV. This
project uncovered six new cases of HIV infection per 1,000 tests. Other
research has found that even one new case of HIV per 1,000 tests is cost
effective. Based on the results from the pilot study, Dr. Gustafason, who
is the Medical Health Officer for Vancouver Coastal Health, now recommends
offering routine screening for HIV in hospitals and doctors’ offices.
Editorial in Canada’s medical journal
In an upcoming issue of the *Canadian Medical Association Journal*, based
on the success of the BC pilot study, Drs. Gustafason and Montaner
encourage other provinces and territories to “implement and evaluate
routine HIV testing across Canada.” Hopefully such testing will be
accompanied by supportive counselling both before and after testing.
This recommendation seeks to normalize HIV testing so that it is routinely
done in hospitals and clinics so that undiagnosed cases of HIV can be
caught early. Such normalization can help reduce costs, improve personal
health and reduce the transmission of HIV.
*—Sean R. Hosein*
REFERENCES:
1. Gustafason R, Montaner J, Sibbald B, et al. Seek and treat to
optimize HIV and AIDS prevention. *Canadian Medical Association Journal*.
2012; *in press*.
2. Sabin C. Review of life expectancy in people with HIV in settings
with optimal ART access: what we know and what we don’t. In: Program and
abstracts of the *11th International Congress on Drug Therapy in HIV
Infection*, 11–15 November 2012, Glasgow, UK. Abstract O131.
3. May M, Gomples M, Sabin C, et al. Impact on life expectancy of late
diagnosis and treatment of HIV-1 infected individuals: UK Collaborative HIV
Cohort Study. In: Program and abstracts of the *11th International
Congress on Drug Therapy in HIV Infection*, 11–15 November 2012,
Glasgow, UK. Abstract O133.
4. Lohse N, Hansen AB, Pedersen G, et al. Survival of persons with and
without HIV infection in Denmark, 1995-2005. *Annals of Internal Medicine
*. 2007 Jan 16;146(2):87-95.
5. Lohse N, Hansen AB, Gerstoft J, et al. Improved survival in
HIV-infected persons: consequences and perspectives. *Journal of
Antimicrobial Chemotherapy*. 2007 Sep;60(3):461-3.
6. Søgaard OS, Lohse N, Østergaard L, et al. Morbidity and risk of
subsequent diagnosis of HIV: a population based case control study
identifying indicator diseases for HIV infection. *PLoS
One**.*2012;7(3):e32538.
7. Krentz HB, Gill MJ. Cost of medical care for HIV-infected patients
within a regional population from 1997 to 2006. *HIV Medicine*. 2008
Oct;9(9):721-30.
8. Haukoos JS, Hopkins E, Conroy AA, et al. Routine opt-out rapid HIV
screening and detection of HIV infection in emergency department patients.
*JAMA*. 2010 Jul 21;304(3):284-92.
9. Palfreeman A, Nyatsanza F, Farn H, et al. HIV testing for acute
medical admissions: evaluation of a pilot study in Leicester,
England. *Sexually
Transmitted Infections*. 2012; *in press*.
10. Casalino E, Bernot B, Bouchaud O, et al. Twelve Months of Routine
HIV Screening in 6 Emergency Departments in the Paris Area: Results from
the ANRS URDEP Study. *PLoS One*. 2012;7(10):e46437.
11. Bezemer D, de Wolf F, Boerlijst MC, et al. 27 years of the HIV
epidemic amongst men having sex with men in the Netherlands: an in depth
mathematical model-based analysis. *Epidemics*. 2010 Jun;2(2):66-79.
12. Audelin AM, Cowan SA, Obel N, et al. Phylogenetics of the Danish HIV
epidemic: the role of very late presenters in sustaining the
epidemic. *Journal
of Acquired Immune Deficiency Syndromes*. 2012; *in press*.
13. Wilson DP, Jin F, Jansson J, et al. Infectiousness of HIV-infected
men who have sex with men in the era of highly active antiretroviral
therapy. *AIDS*. 2010 Sep 24;24(15):2420-1.
14. Krentz HB, Gill MJ. Impact of expanded HIV screening. *Annals of
Internal Medicine*. 2007 Jul 17;147(2):146.
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