The Challenge of HIV Testing

By Janssen, Robert S. | Clinical Psychiatry News, December 2004 | Go to article overview
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The Challenge of HIV Testing


Janssen, Robert S., Clinical Psychiatry News


Thanks to the advent of effective antiretroviral treatments, patients living with the human immunodeficiency virus in the United States can now expect to live nearly 2 decades from the day of becoming infected, and perhaps even to have a normal lifespan. That's great news for those of us who care for people living with HIV/AIDS and have lost too many patients to the disease.

But there's also bad news about AIDS in America: The downward trend in the rate of new HIV infections leveled off several years ago at about 40,000 per year. Perhaps most alarming, of the 850,000-950,000 Americans living with HIV today--the largest number since the epidemic began more than 20 years ago--one-fourth do not know they are infected. These individuals are not receiving care for their condition, and the effectiveness of their anti-retroviral therapy may be diminished when they do seek treatment. From a clinical and public health perspective, this trend is clearly unacceptable.

Recognizing the urgent need to ensure that those who are infected know their serostatus, and are linked to care and prevention services, the Centers for Disease Control and Prevention launched the Advancing HIV Prevention initiative in 2003. A major component of this effort is to make HIV antibody testing a routine part of patient care.

Our work is cut out for us. Current CDC estimates show that fewer than half of all U.S. adults between the ages of 18 and 64 years have ever been tested for HIV, and only 28% have been tested within the past 12 months. Of the people who do get tested, too many do not keep the appointment to learn their result. As a result, many people with HIV go undiagnosed, untreated, and unconnected to services.

In one CDC study, about 40% of AIDS patients developed the disease within 1 year of being diagnosed with HIV. The average time between infection and the appearance of symptoms (without treatment) is 10 years, so these individuals will start treatment late in the course of disease, when antiretroviral options are fewer and potentially less effective.

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