Routine HIV Screening For All Patients, American College of Physicians Recommends

This new practice guideline appears on the Annals of Internal Medicine Web site at http://www.annals.org.

HIV affects more than one million people in the United States. Every year, about 20,000 new infections are caused by individuals who are unaware that they are infected with HIV. Timely identification of undiagnosed cases of HIV can help prevent further transmission.

"The purpose of the guideline is to present the available evidence to physicians as a way to help guide their decisions around screening for HIV in their practice," said Amir Qaseem, MD, PhD, MHA, senior medical associate in ACP's Clinical Programs and Quality of Care Department and the lead author of the guideline. "ACP recommends that physicians adopt a routine screening policy for HIV and encourage their patients to get tested, regardless of their risk factors."

According to the guideline, physicians should offer screening to all patients, and should determine the need for repeat screening intervals on a case-by-case basis. Higher risk patients should be retested more frequently than patients who are at average risk.

Patients are considered "at risk" for HIV if they have shared injection drug needles, or if they have had a blood transfusion between 1978 and 1985. Sexual practices that put patients at risk include having unprotected sex with multiple partners; having an STD; or engaging in unprotected sex with anyone who falls into any of those risk categories. Patients should talk to their doctors about their individual risk of HIV.

Vincenza Snow, MD, FACP, is the director of clinical programs and quality of care at ACP. Also a general internist at a free clinic in Philadelphia, Dr. Snow sees both at-risk patients and patients who are at average risk for HIV infection. Under the new guidelines, she would be offering HIV testing to all of her patients.

"The intent of this guideline is to help prevent the unwitting spread of HIV infection," said Dr. Snow. "I would tell my patients that it's important to know your HIV status so that you do not risk infecting anyone else. Besides, an AIDS test is very simple and quick, and can be performed during a routine exam."