Universal HIV Screening
In September 2006, the CDC issued new guidelines
recommending a wider screening of the general public for HIV.
This aggressive guideline resulted from the finding that of new HIV diagnosis, almost a half (over 40 percent) went on to develop AIDS in about a year after diagnosis. This suggests the initial diagnosis was made late--maybe as late as 10 years after infection. The CDC still recommends screening in high risk patients, but also suggested healthcare providers screen all patients in the age group 13-64. Those considered high risk or who engage in one episode of risky behavior should be screened annually.
While well-meaning, universal screening means that many smaller sites would have to provide the personnel, equipment to perform testing, arrange for confirmatory testing and to be prepared for test interpretation and patient counseling. I am not sure many sites such as rural sites or smaller physicians' offices are ready to do even rapid testing.
Widescale testing is bound to yield a higher level of false positives than would be seen when testing a high-risk population. I am not sure how many providers are prepared to understand and explain that nuance. Imagine the trauma of telling a young mother incorrectly after a single rapid test that she has HIV?
It's been almost 2 years since the CDC guideline was published. Have you noticed increased testing in your lab from outpatients, ED patients for example? What are the pros and cons of this CDC recommendation?