Universal HIV Screening May Overload System: One Expert Says That the Current CDC Budget for HIV Prevention Is Already Short by $350 Million

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WASHINGTON -- New recommendations to test routinely for HIV in all patients aged 13-64 years would overburden the U.S. health care system with newly diagnosed patients unless additional funding is provided, experts said at a press briefing by the Centers for Disease Control and Prevention.

The CDC now recommends "opt-out" testing in which HIV screening is incorporated into routine health care unless the patient declines to be tested. Such an approach could identify 56,000 of the 250,000 U.S. residents who are unaware of their infection, generating a need for greater than $900 million in additional funding for counseling and treatment services, said Dr. Kevin Fenton, director of the CDC's National Center for HIV, Sexually Transmitted Diseases, and Tuberculosis Prevention.

He and others spoke at a briefing during a 2-day summit sponsored by the CDC aimed at exploring ways to expand HIV testing and the potential impact of increased numbers of patients diagnosed with HIV.

Approximately 25% of 1.2 million people thought to be living with HIV in the United States are unaware of their infections, the CDC estimates. Dr. Michael Saag, director of the Center for AIDS Research at the University of Alabama, Birmingham, said he believes that 25% may be a low estimate.

Three-quarters of patients diagnosed with HIV at his clinics have very low CD4 counts, indicating that they probably have been infected for 10-12 years.

Treating the infection early greatly improves survival at 8 years and reduces transmission of the virus.

"That screams at us that we should be testing earlier, but with that comes an obligation to provide access to care. At our clinic, we're already at capacity," Dr. Saag said.

Clinicians who provide HIV care are among the lowest paid health care providers, Dr. …