Nearly all adults and older teens should get tested for HIV at least once, a top group of experts says. The advice comes from the U.S. Preventive Services Task Force. Doctors and insurance companies often follow this group's advice on preventive care. The task force recommends that people ages 15 through 64 get the test as a routine part of a checkup. In the past, tests were recommended only for people at high risk of infection. But the new advice is based on growing evidence that treatment not only lengthens life but also greatly reduces the chance of spreading the virus to others. Experts estimate that 20% of those who are infected don't know it and therefore are not getting treatment. The U.S. Centers for Disease Control and Prevention has backed widespread HIV testing for some time. But most doctors still don't do the tests routinely. The task force is seeking public comments before publishing its final advice. Under the Affordable Care Act, insurance must cover preventive-care tests that the task force recommends at no charge. The Associated Press and USA Today wrote about the test advice November 20.

By Howard LeWine, M.D.
Harvard Medical School

What Is the Doctor's Reaction?

Every person between the ages of 15 and 64 should get tested for HIV at least once. That's now the formal recommendation of the United States Preventive Services Task Force. Doctors had been expecting this for some time.

The Centers for Disease Control and Prevention (CDC) has long advised that doctors ask all patients if they want HIV testing any time they visit a doctor's office or emergency room, or if they are admitted to a hospital. The new advice suggests that HIV testing should be a routine test, similar to testing for cholesterol.

The task force provides a grade along with any recommendation. The grade is based on how strongly the medical evidence supports the advice. Universal HIV testing gets an A grade. And an A grade means that health insurance pays for the service.

The task force is inviting public comment on the new advice before it crafts the final language.

Here are the main reasons that the task force recommends HIV testing for everyone:

• Testing for HIV is very accurate.
• There is excellent treatment available. And people with treated HIV have an average life expectancy close to what they would have if they did not have the virus.
• Treatment dramatically decreases a person's chance of spreading an infection to a sexual partner.

What Changes Can I Make Now?

As with any test or procedure, you always have the right to opt out. If you don't want HIV testing, your doctor may ask you why not. This is never meant to be intrusive. You may be reluctant to have the test for any number of reasons. The doctor is asking because some questions may have easy answers that relieve any anxiety you have about testing.

You don't need to explain why you don't want testing. But if you tell your doctor your reasons, he or she can provide more information about why the test is worthwhile for everyone.

You should always be tested for HIV if you:

• Have ever had unprotected sexual intercourse with anyone, man or woman, that causes you concern
• Want to know that you are not infected before starting a new sexual relationship, to avoid unknowingly infecting a partner
• Have ever used IV drugs, even once
• Are considering pregnancy

If you are worried that you might have contracted a sexually transmitted infection from a very recent sexual encounter, talk to your doctor.

This will require a discussion to determine the appropriate tests. The doctor might order a different test from the standard one used to screen for HIV. It depends upon how long ago you had the encounter.

The standard HIV blood test for the antibody to the virus may not become positive until three months after the exposure. Depending on your personal circumstances, your doctor may advise one of the following:

• Get the blood antibody test now. If it's negative, repeat in three months.
• Wait until three months after the exposure to test.
• Get a blood test now for HIV viral load. This test determines if you have active virus in your blood within days of exposure.

What Can I Expect Looking to the Future?

It will be interesting to see the final language of the recommendation.

Meanwhile, I will continue to ask patients if they have had an HIV test in the past. If the answer is no, then I will ask if they have ever donated blood. HIV testing is done on every unit of donated blood. If the answer again is no, I will say: "As I do for all my patients who have never been tested, I am ordering a routine HIV blood test."

Each person then has the choice to say "No, thank you."