Study Fuels Debate Over Widespread HIV Testing And Its Cost

By Christopher Weaver KHN

The wider use of a cheap blood test could
help cut the number of new HIV infections by more than 80,000 in the
United States over 20 years.

The test only costs a few dollars. But the researchers
say screening everyone at least once and people more likely to get the
disease, such as gay men, every year would be a cost-effective. Still,
even that considerable effort would cut the expected 1.23 million new
HIV infections over the next couple decades by a modest 7 percent.

The benefit would cost $27 billion, or $337,500 for each infection prevented, plus additional treatment costs. The study results appear in the latest Annals of Internal Medicine.

The study is part of a growing body of evidence that HIV
advocates say should buttress national guidelines recommending that
doctors screen all adults for the incurable virus. The federal Centers
for Disease Control and Prevention
backed that position.

But, another panel, the U.S. Preventive Services Task Force, a
behind-the-scenes government panel that evaluates medical evidence and
has a knack for arousing public outrage (see, mammography), hasn’t come around to that view, advising doctors only to screen ‘at-risk’ people.

And, their opinions matter: Insurers would have to pay for anything they recommend under the new health law.

The debate over how often to test for HIV is just one window into
the disputes that follow government plans to inject more evidence into
the practice of medicine, including the requirement that insurers pay
for recommendations of the preventive services panel.

Logo of the Centers for Disease Control and Pr...

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The group last reviewed evidence for broad HIV screening in 2005,
and it decided after the latest CDC recommendation not to update their
opinion. The panel plans to release, in a year or so, a review that
would include the Annals study, an official said. If they back the
suggestions outlined there, “it would be a good first start,” said
Andrea Weddle, executive director of the HIV Medicine Association, an advocacy group that represents doctors and researchers.

Weddle’s group and other HIV advocates have promoted broader
recommendations to the task force, according to the federal agency that
houses the panel. But, it’s unclear how the group will weigh in. Dr. Ned
Calonge, the panel’s departing chairman, told us over the summer that
“the bar for … doing something to a person who is already well needs to
be really high.”

Meanwhile, some states, such as Illinois, have moved to open to
the door to widespread HIV screening, said John Peller, government
relations director for the AIDS Foundation of Chicago.
Illinois once required special consent forms for HIV screening; now
doctors can add it to their usual battery of tests so long as they allow
patients to opt out, he said.

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