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  Rapid HIV Testing Goes Mobile in Los Angeles
  http://www.msnbc.msn.com/id/6941258/

  David Mcnew / Getty Images file

  Routine HIV testing urged
  for nearly all Americans

  Early detection would cut rate
  of infection, AIDS experts say

  Joe Mendoza, manager of the AIDS Healthcare Foundation mobile
  testing program, pricks a volunteer's finger to demonstrate how a
  lancet from the OraQuick Rapid HIV-1 Antibody Test kit is used to
  obtain a blood sample, on April 28, 2004, in Los Angeles.

  The Associated Press
  Updated: 5:51 p.m. ET Feb. 9, 2005

  Urging a major shift in U.S. policy, some health experts are
  recommending that virtually all Americans be tested routinely for
  the AIDS virus, much as they are for cancer and other diseases.

  Since the early years of the AIDS epidemic in the 1980s, the
  government has recommended screening only in big cities, where AIDS
  rates are high, and among members of high-risk groups, such as gay
  men and drug addicts.

  But two large, federally funded studies found that the cost of
  routinely testing and treating nearly all adults would be
  outweighed by a reduction in new infections and the opportunity to
  start patients on drug cocktails early, when they work best.

  "Given the availability of effective therapy and preventive
  measures, it is possible to improve care and perhaps influence the
  course of the epidemic through widespread, effective and
  cost-effective screening," Dr. Samuel A.  Bozzette wrote in an
  editorial accompanying the studies, which appear in Thursday's New
  England Journal of Medicine.

    Tell us what you think

  Live vote: Should all Americans be tested for HIV?
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  A failure to institute such screening at doctors' offices and
  clinics would be "a critical disservice" to patients with the AIDS
  virus and "the future health of the nation," wrote Bozzette, who is
  from the University of California at San Diego and the Rand
  Corp. think tank in Santa Monica, Calif.

  CDC to re-evaluate screening guidelines

  Dr. Robert Janssen, director of HIV-AIDS prevention at the Centers
  for Disease Control and Prevention, said the CDC will re-evaluate
  its guidelines over the next two years, and will consider the
  study's findings as well as the availability of new, rapid HIV
  tests that produce results in a half-hour instead of the usual week
  or two.

  [Hmed_HIVScreen.jpg]
  Widespread screening for HIV beneficial
  Two studies conclude that routine testing of most Americans for
  the AIDS virus would reduce new infections.

  Current practice  Current   Testing  Every five  Testing
  vs. more testing  practice  once     years       annually

  Percentage of cases  37%    35%      21%          8%
  not detected before
  symptoms appear*

  Percentage           63%    61%      44%         19%
  currentlly detected

  Percentage that       -      3%      34%         73%
  would be detected
  in proposed testing

  * For high-risk groups including IV drug abusers, gay men
    and residents of major cities.

  SOURCE: New England Journal of Medicine           AP

  Who would bear the cost of expanded testing -- and the cost of the
  treatment, which runs to at least $15,000 a year -- remains a
  sticky question amid government cutbacks in health-care
  funding. However, Janssen said the studies' findings could lead to
  some private insurers to encourage more HIV testing.

  One of the studies, by researchers at Duke and Stanford
  universities and the Veterans Affairs Palo Alto Health Care System,
  estimated that routine one-time testing of everyone would cut new
  infections each year by just over 20 percent, and that every
  HIV-infected patient identified would gain an average of 1? years
  of life.

  The other study, by Yale and Harvard researchers, found that
  testing people every three to five years would be cost-effective
  for all but the lowest-risk people, such as those who are celibate
  or are in monogamous heterosexual relationships. And even for those
  people, one-time testing was found to be cost-effective.

  Nationwide, about 40,000 new HIV infections occur each year. An
  estimated 950,000 people are infected with the virus, but about
  280,000 of them don't know it.

  Benefits outweigh costs, experts say CDC guidelines recommend
  routine tests wherever the prevalence of HIV infection is more than
  1 percent -- basically, cities and some densely populated suburbs.

  "If you need proof of the fact that it's not working, look at all
  the people who have slipped through the cracks -- 280,000," said
  A. David Paltiel of the Yale School of Medicine's division of
  health policy, lead author of the second study.

  Fact File    HIV and AIDS
  http://www.msnbc.msn.com/id/6941258/
  . Introduction                  More than 830,000 cases of AIDS
  . What is HIV/AIDS              have been reported in the
  . How is it treated?            United States since 1981. And as
  . How is it spread?             many as 950,000 Americans may be
  . What are the symptoms         infected with HIV, one-quarter of
  . Access and cost of treatment  whom are unaware of their
  . U.S. statistics               infection. Every year there are an
  . Global statistics             estimated 40,000 new HIV/AIDS cases
                                  in the United States.
  Source: The Associated Press, CDC, NIH

  The VA-funded study found that in areas where about 1 in 100
  patients has undiagnosed HIV -- what the CDC calls high-risk
  settings -- widespread testing would cost about $15,100 for each
  year of good health gained by people diagnosed with the virus,
  counting the benefits to their sexual partners.

  Even in areas with an undiagnosed HIV infection rate of only 1 in
  2,000-- the rate in the general population -- each healthy year
  gained by newly diagnosed HIV patients and their partners would
  still cost less than $50,000. That is the threshold at which health
  economists generally consider treatments to be cost-effective.

  Paltiel noted the two groups of researchers had very similar
  cost-benefit results, even though they used different computer
  models.

  "The cost-benefit to individuals and society is worth" widespread
  screening, said Dr. Lawrence Deyton, chief of public health in the
  Department of Veterans Affairs, which provides medical care to
  about 5 million veterans.

  In light of the findings, he said the VA is going to urge more
  patients to get tested.

  "We're going to take the ball and run with it," Deyton said.
  http://www.msnbc.msn.com/id/6941258/

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