June 27 Is National HIV Testing Day

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June 27 is National HIV Testing Day (NHTD), an annual opportunity to promote HIV screening and awareness. The U.S. Centers for Disease Control and Prevention estimates that 1 in 6 people with HIV do not know they are infected, and therefore are not receiving the care and treatment that could improve their own health and prevent transmission. The CDC this week issued new recommendations using modern technology to facilitate earlier diagnosis.

"National HIV Testing Day offers an opportunity to reflect on the pivotal role that HIV testing plays in our nation’s ever-expanding prevention toolkit," said Jonathan Mermin, director of the CDC's National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention. "HIV testing is the linchpin for prevention and treatment. For people who test HIV positive, diagnosis opens the door to life-saving treatment, which also reduces the risk of transmitting HIV to others. For those who test negative, knowing their status empowers them to remain HIV-free."

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In 2006, the CDC recommended that all U.S. adults (age 13-64) should undergo HIV testing at least once, yet the agency estimates that more than half of American adults have never been tested. Nearly one-third of newly diagnosed individuals develop AIDS (CD4 count below 200 cells/mm3 or opportunistic illnesses) within 12 months, indicating that they have probably been infected for years. The good news is that the number of HIV positive people who do not know their status has fallen in recent years from 1 in 5 to 1 in 6, or from 20% to 16%.

In advance of NHTD, the CDC has released new recommendations outlining the approach U.S. laboratories should use for HIV testing. The latest screening technologies can diagnose infection up to 4 weeks sooner than current standard tests. In advance of NHTD, the CDC has released new recommendations outlining the approach U.S. laboratories should use for HIV testing. Instead of the familiar immunofluorescence assay and Western blot test, the new algorithm recommends a fourth-generation assay that measures both HIV-1/HIV-2 antibodies and p24 antigen. The latest screening technology can diagnose infection up to 4 weeks sooner than the old standard tests, and returns results in a few hours. Initial positive tests will still be confirmed, but the new assay has a much lower chance of a false negative because the body has not yet produced enough antibodies. The full recommendations and a step-by-step flowchart are available online.The full recommendations and a step-by-step flowchart are available online.

Early detection is important because people in the acute stage of infection typically have a high viral load and therefore are more likely to transmit the virus. Experts estimate that as many as half of the 50,000 annual new infections are transmitted by people who do not know they have HIV. In addition, some research suggests that very early treatment may facilitate an eventual "functional cure" that could allow some HIV positive people to stop antiretroviral therapy without disease progression.

"Identifying acute infections has long been one of our nation’s biggest HIV prevention challenges, since these infections eluded traditional testing technologies," according to Mermin. "But with consistent and widespread use of this new testing method, we can diagnose people several weeks earlier than before."

"Our national response to HIV is focused on improving outcomes for people living with HIV along all steps in the HIV care continuum -- from diagnosis to viral suppression -- so that those who are infected with the virus can successfully navigate the HIV care continuum and realize the life-extending benefits of HIVcare and treatment," wrote Deputy Assistant Secretary for Health Ronald Valdiserri.

"Both CDC and the U.S. Preventive Services Task Force recommend that all adolescents and adults be screened at least once for HIV as part of their routine healthcare," he continued. "CDC further recommends HIV testing at least once a year for people at increased risk of HIV infection, such as gay and bisexual men, people who inject drugs, or people with multiple sex partners."

Thanks to the Affordable Care Act -- better known as Obamacare -- many more people have gotten coverage and are seeking medical care, which offers new opportunities for HIV testing and treatment.

"Because of the ACA, providers can expect to see new patients coming into their offices," said James Friedman, executive director of the American Academy of HIV Medicine. "They should apply the principles of routine HIV testing to all of those patients. This is an amazing opportunity to test patients who have never been tested before, and to facilitate regular testing with those who would benefit from it."

6/27/14

Sources

Centers for Disease Control and Prevention. Laboratory Testing for the Diagnosis of HIV Infection: Updated Recommendations. June 27, 2014.

J Mermin. CDC Recommends New HIV Testing Approach to Diagnose Infection Earlier. National HIV Testing Day Statement. June 27, 2014.

R Valdiserri. National HIV Testing Day 2014: HIV Testing Saves Lives. Blog.AIDS.gov. June 26, 2014.

American Academy of HIV Medicine. New Patients Bring New HIV Testing Opportunities: How the Affordable Care Act Is Increasing the Need for Providers to Implement Routine HIV Testing. Press release. June 27, 2014.