A top group of experts may soon recommend HIV tests for all U.S. adults, Reuters news service said August 20. The U.S. Preventive Services Task Force now leaves the decision up to doctors. The task force is a group of experts on preventive care. It is appointed by the government but acts independently. The 2010 health care reform law requires that insurers cover preventive services that the task force recommends. Reuters said "health officials close to the panel" expect it to recommend routine HIV tests later this year. The task force's job is to weigh the harm of tests and procedures against their benefits. It last updated its advice on HIV tests in 2005. At that time, it did not find enough evidence to support routine tests. The Centers for Disease Control and Prevention already recommends one HIV test in a lifetime for people ages 13 to 64.

By Howard LeWine, M.D.
Harvard Medical School

What Is the Doctor's Reaction?

The U.S. Preventive Services Task Force is likely to decide in the next several months whether to recommend routine HIV testing. The task force is an independent group of experts appointed by the government. Its guidelines carry a lot of weight. In general, health insurance companies pay for services the task force recommends.

The U.S. Centers for Disease Control and Prevention (CDC) already recommends that everyone have a one-time HIV blood test. The CDC suggests that doctors order the test when a person makes a visit to a health facility. This could be a doctor's office, emergency room or walk-in clinic.

In the 1980s, when HIV tests first became available, there was such a fear of the stigma related to the diagnosis that most states required written informed consent for the test. Doctors might order the test based on a person's symptoms, or a higher than average risk of infection. But they had to ask permission. People had to sign a special form agreeing to have their blood tested for the antibody to the virus.

In those early days, HIV in the United States affected mainly men who had sex with men and IV drug users. Asking a patient for consent was uncomfortable at times. Some people took offense that the doctor was implying they were gay or using drugs. Doctors certainly didn't get training on how to handle this discussion well.

Today most states do not require consent. The few states that require any consent will accept a verbal OK to have the blood test. But many doctors remain uncomfortable ordering the test because a patient might ask why it was ordered.

If it's recommended that everyone get tested for HIV, no further explanation is needed.

It will be interesting to see what the task force recommends. Before making the guidelines official, the task force plans to release a statement for public comment.

What Changes Can I Make Now?

If you have even the slightest concern that you may have acquired an HIV infection, ask your doctor to order a blood HIV test. Just say that you heard everyone should get tested. No other explanation is needed.

Reasons for asking for an HIV test include:

• Prior or current unprotected sexual intercourse with anyone, man or woman, that causes you concern
• A precaution before starting a new sexual relationship, to be sure that you don't unknowingly infect a partner
• Having used IV drugs, even once
• 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 different ones depending on how long ago the encounter occurred.

For example, 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 and, if 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 what the U.S. Preventive Services Task Force first recommends for public comment. And will public comment influence the final advice?

I am not so sure that having everyone get an HIV test once in a lifetime makes sense. It seems more logical to have people at risk get tested more often and have no test for people at close to zero risk.

If the stigma of getting tested can be completely removed, we should be able to devise a more rational approach to HIV testing.