WEDNESDAY, Feb. 9, 2005 (HealthDay News) -- Offering HIV testing to all Americans as part of their routine health care could reduce AIDS-related deaths, fight the spread of new infections and save the health-care system precious dollars over the long-term, two new studies claim.
Both studies, published in the Feb. 10 issue of the New England Journal of Medicine, found the cost-effectiveness payback from routine testing is equal to, or exceeds, that of other common health screens such as cancer detection or blood pressure monitoring.
"Given the benefit to both the HIV patient and the community, it really makes sense to screen in populations we haven't been considering in the past," said Gillian D. Sanders, a co-author of one of the studies and an associate professor of medicine at Duke University.
That might mean encouraging the average, low-risk American to get an HIV test alongside the list of routine blood tests he receives during an annual check-up, for example.
With new advances in HIV treatment, "I think there's a real argument for routine screening in all medical settings," agreed Dr. Samuel A. Bozzette, a senior natural scientist at the nonprofit Rand Corp who wrote a commentary accompanying the studies in the journal.
Bozzette, an infectious diseases expert, hopes the new research will prompt "a debate about making HIV screening routinely offered to everybody."
For her study, Sanders and researchers from the Palo Alto Veterans Affairs Health Care System, Stanford University and the University of Toronto constructed a detailed cost-effectiveness computer model, plugging in such factors as the cost of HIV testing, estimated infection rates in specific populations and the cost of treating HIV/AIDS at various stages in infection.
"We found that HIV screening both prolongs life and is also a cost-effective use of resources," she said, even among low-risk populations where the prevalence of HIV infection is less than 1 percent.
In terms of money spent in testing versus money saved in health care and other costs, one-time HIV testing compared favorably to such routine health interventions as regular mammograms, colon cancer screening or routine high blood pressure testing, she added.
A second study, conducted by researchers at Yale and Harvard Universities, came to much the same conclusion.
While researchers have conducted studies on the cost-effectiveness of HIV screening in the past, the two studies published this week are the first done since the powerful, HIV-suppressing highly active antiretroviral therapies (HAART) were introduced 10 years ago.
"Things have really changed since then," Sanders said. "HIV is now considered more [a] chronic viral infection, a disease with effective treatments. This emphasizes the importance of finding infected people and getting them on these treatments."
HAART needs to be administered relatively soon after infection for optimal effect, however. According to Bozzette, too many Americans are still finding out they are infected far too late.
"Most people who die of HIV in the United States are people presenting late in the course of disease -- they get very little care before they die," he said. Routine testing would have caught more of those people, earlier, he added.
Testing may also help prevent infected individuals from passing the virus on to others. "Being on HAART lowers viral load, and that lowers transmission [risk]," Sanders said. "Also, patients who are identified undergo mandatory risk counseling, and we believe there would be some [risk] behavior modification based on that, too."
If HIV testing became universal, increased detection and heightened awareness might even cause the epidemic to finally subside, at least in affluent countries like the United States, Bozzette said.
"The way you get rid of epidemics is to drive the transmission rate down such that a typical infected person infects less than one other person, on average," he explained. "So, even with one-time HIV screening, you start to draw a kind of 'circle' around the epidemic."
Hurdles remain, however, including the still-widespread stigma surrounding HIV and HIV testing. Still, the California expert remains hopeful: "Education is part of fixing that. Remember, if everybody were to get these tests, there wouldn't be as much stigma, either," Bozzette said.
More information
To find out more about HIV and HIV testing, head to the National Institute of Allergy and Infectious Diseases.
