Should Everyone Be Tested for HIV?


How would you feel about a policy that required everyone to be tested for HIV? That’s a proposal discussed at the American Association for the Advancement of Science meeting in San Diego and being considered by health officials, as reported in the Guardian.

According to Brian Williams, professor of epidemiology at the South African Centre for Epidemiological Modelling and Analysis in Stellenbosch, it is possible to stop the transmission of HIV within five years with the use of antiretroviral drugs (ARVs). To be effective, however, it is necessary to identify everyone who has HIV so they can be treated.

In the United States, approximately 1.1 million adults and adolescents are living with HIV, according to the Centers for Disease Control and Prevention. This includes those not yet diagnosed and those who have already progressed to AIDS. At the end of 2007, an estimated 455,636 people were living with AIDS in the United States.

The 2009 AIDS Epidemic Update released in November 2009 by the World Health Organization and UNAIDS (WHO/UNAIDS) reported that new HIV infections have been reduced by 17 percent over the past eight years. While the number of new infections in sub-Saharan Africa is about 15 percent lower and those in East Asia have declined by nearly 25 percent, in some countries there are signs that HIV incidence is rising again. Overall, the AIDS Epidemic Update shows that there are 31.1 to 35.8 million people living with HIV. The number of AIDS-related deaths has decline by more than 10 percent over the past five years as more people have had access to life-saving treatment.


Testing Everyone
The goal of the proposed new strategy to fight HIV and AIDS is to reduce the transmission of the virus that causes AIDS so that it dies out completely over the next 40 years. To achieve that goal, officials believe it would be necessary to test most of the world’s population for HIV and to put anyone who tests positive for the disease on a lifetime course of antiretroviral drugs.

Major trials of the strategy are planned in the United States and Africa and the results will help experts decide whether to adopt the measure as public health policy in the next two years. In these trials, individuals will be offered HIV tests once a year as part of their routine visit to their doctor or through mobile clinics in more remote areas. People who test positive will be put on ARVs for the rest of their lives.

Research indicates that mass prescribing of ARVs could stop the transmission of HIV and reduce the number of AIDS-related tuberculosis by 50 percent within ten years. An individual who has HIV generally infects five to 10 other people before succumbing to the complications of AIDS. Experts believe that if people are treated with ARVs within a year of becoming infected, transmission of the disease can be reduced tenfold, which is sufficient to cause the epidemic to die out.

What about Cost?
Scientists estimate that the cost of putting this strategy into practice in South Africa alone will cost $3 to $4 billion a year. Currently the world spends $30 billion a year on AIDS research and treatment, and it is believed this figure will double over the next ten years. Williams believes that when all the factors are brought into play, this strategy will begin saving money from day one, “because the cost of the drugs would be more than balanced by the cost of treating people for all of these other diseases and then letting them die.”

Should everyone be tested for HIV? It is a public health issue that is being tested. Last year, a large scale trial in Thailand in which HIV vaccines were administered benefited only 31 percent of those who received it. A vaccine is generally not considered to be worthwhile unless it protects more than 70 percent of those who are treated. Scientists hope the trials to be conducted in the United States and Africa will help them answer the question about whether everyone should be tested for HIV and ultimately treated if positive.

Centers for Disease Control and Prevention
The Guardian, Feb. 22, 2010
The World Health Organization