Federal Task Force Now Advises More Screening for HIV and Hepatitis C

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January 4, 2013

The U.S. Preventive Services Task Force (USPSTF) has released draft guidelines to update their screening recommendations for human immunodeficiency virus (HIV), which can lead to AIDS, and to recommend, for the first time, screening guidelines for hepatitis C virus (HCV).

For HIV, the USPSTF's previous guidelines recommended testing only those at risk, but after reviewing more recent evidence, the Task Force now strongly recommends that clinicians screen all people ages 15 to 65 for HIV infection. The new Task Force recommendations are more in line with the current guidance from the Centers for Disease Control and Prevention (CDC), which began recommending screening for people ages 13 to 64 in 2006.

Nearly 1.2 million people in the United States are living with HIV, but 20-25% of them do not know that they are HIV-positive, notes the Task Force. "The draft recommendation reflects new evidence that demonstrates the benefits of both screening for and earlier treatment of HIV," says Dr. Douglas K. Owens, M.D., M.S, a professor of medicine at Stanford University and a member of the Task Force. Beginning drug treatment earlier reduces the risk of developing AIDS-related complications and has been shown to decrease the chance of transmission of HIV. "Because HIV infection usually does not cause symptoms in the early stages, people need to be screened to learn if they are infected," says Dr. Owens. "People who are feeling well and learn they are infected with HIV can begin treatment earlier, reduce their chances of developing AIDS and live longer and healthier lives."

Rapid screening tests that detect HIV antibodies are sensitive and can be done using blood or oral fluid samples. They provide results in 5 to 40 minutes with few false positives. However, screening tests must be confirmed using supplemental laboratory tests, and those results can take 1-2 weeks. (For more about screening options, see the article on HIV Antibody.)

As for how often to do HIV screening, the Task Force maintains that there is not sufficient evidence to say, but a "reasonable approach" would be:

  • One-time screening of teens and adults ages 15 to 64 to identify persons who are already HIV-positive.
  • Screen all pregnant women for HIV during each pregnancy, including women in labor whose HIV status isn't known. Pregnant women who have HIV and are treated during pregnancy rarely pass the virus to their babies, says the CDC. Drugs given to the mother during labor, and to the baby after birth, can reduce the risk of HIV transmission.
  • At least annual screenings for those at very high risk of HIV, such as men who have sex with men, IV drug users, and people living in a setting with a high HIV prevalence.
  • Screen people at increased risk less frequently than every year, such as every 3-5 years. People at increased risk include those who have unprotected sex with more than one partner, have a sexual partner who is HIV-infected, bisexual, or an IV drug user, those who exchange sex for drugs or money, and those who have or request testing for other sexually transmitted diseases (STDs).

The Task Force points out that risk is "on a continuum" and health professionals should use their own discretion in deciding how frequently to test people for HIV. Additionally, people with no identified risk factors may request testing.

The draft recommendations are especially critical now because a report released in November 2012 from the CDC found that about 50,000 people are infected with HIV each year and 1 in 4 is 13 to 24 years old. The CDC says that all young people should know how HIV is transmitted and prevented and should be tested. (For more, read the CDC's Vital Signs: HIV Among Youth in the U.S.)

Hepatitis C
The USPSTF has also released, for the first time, draft guidelines for hepatitis C screening in adults at high risk, including those with any history of IV drug use or a blood transfusion before 1992. The new guidelines also recommend routine testing for adults born between 1945 and 1965 because they may have received blood transfusions before screening of blood donations for hepatitis C began or have a history of other risk factors for exposure to the virus. Screening this group may help identify people who harbor the virus before they develop complications.

The CDC released its own recommendations for hepatitis C testing this past summer – a one-time screening for people born between 1945 and 1965. CDC's previous recommendations called for testing only people with certain known risk factors.

Hepatitis C infection, transmitted through infected blood or body fluids, is the most common blood-borne infection in the U.S. The most frequent way that people get infected today is by sharing needles or other equipment used to inject drugs. Rarely, hepatitis C can be transmitted during sex. Millions of Americans are infected with the hepatitis C virus, and prevalence is highest among people born 1945-1965. Many individuals who are infected don't know it because they may not have symptoms. About 75-85% of those with hepatitis C develop a chronic infection.

In the U.S., chronic hepatitis C is a leading cause of cirrhosis (scarring) of the liver, end-stage liver disease, liver cancer, and liver transplants. More than 15,000 people die of hepatitis C every year, according to the CDC.

The USPSTF is updating their recommendations because of new research and because there are newer, more effective medicines, with fewer side effects, available to treat hepatitis C. The CDC has estimated that one-time hepatitis C screening of people born between 1945 and 1965 could identify more than 800,000 additional people, and that that the newly available drugs can cure up to 75% of infections. Expanded testing and treatment could save more than 120,000 lives.

"The treatment of hepatitis C is advancing rapidly," says Kirsten Bibbins-Domingo, M.D., PhD, an Associate Professor of Medicine and of Epidemiology and Biostatistics at the University of California/San Francisco and a member of the Task Force. "Based on what we know today, the Task Force concluded that screening provides substantial benefits for people at high risk. We also found that screening people from the baby boomer generation also provides real, although smaller, benefits. People at high risk have about a 50 percent chance of being infected with hepatitis C [;] people born between 1945 and 1965 have a three to four percent chance of being infected."

HCV antibody testing with confirmatory testing for the virus using molecular methods (polymerase chain reaction, PCR) has been shown to be accurate for identifying patients with hepatitis C, according to the Task Force. However, the Task Force found no evidence, and made no recommendation, for how often people should be screened.

The public comment period for the USPSTF recommendations on HIV and hepatitis C screening ended in late December. Final recommendations are expected during 2013, according to Ana Fullmer, a spokesperson for the Task Force.

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NOTE: This article is based on research that utilizes the sources cited here as well as the collective experience of the Lab Tests Online Editorial Review Board. This article is periodically reviewed by the Editorial Board and may be updated as a result of the review. Any new sources cited will be added to the list and distinguished from the original sources used.

Screening for HIV: U.S. Preventive Services Task Force Recommendation Statement, DRAFT. Available online at http://www.uspreventiveservicestaskforce.org/draftrec.htm#consider through http://www.uspreventiveservicestaskforce.org. Accessed December 20, 2012.

U.S. Preventive Services Task Force Issues Draft Recommendation on Screening for Human Immunodeficiency Virus (HIV) (News Release). PDF available for download at http://www.uspreventiveservicestaskforce.org/bulletins/hivbulletin.pdf through http://www.uspreventiveservicestaskforce.org. Accessed December 20, 2012.

Centers for Disease Control and Prevention. Basic Information about HIV and AIDS. Available online at http://www.cdc.gov/hiv/topics/basic/index.htm#hiv through http://www.cdc.gov. Accessed December 20, 2012.

Centers for Disease Control and Prevention. One Test. Two Lives. HIV Screening for Prenatal Care. Available online at http://www.cdc.gov/Features/1Test2Lives/http://www.cdc.gov/Features/1Test2Lives/ through http://www.cdc.gov. Accessed December 20, 2012.

CDC Vital Signs. HIV Among Youth in the US. Available online at http://www.cdc.gov/vitalsigns/HIVAmongYouth/index.html through http://www.cdc.gov. Accessed December 20, 2012.

U.S. Preventive Services Task Force Issues Draft Recommendation on Screening for Hepatitis C Virus Infection in Adults. PDF available for download at http://www.uspreventiveservicestaskforce.org/bulletins/hepcbulletin.pdf through http://www.uspreventiveservicestaskforce.org. Accessed December 20, 2012.

U.S. Preventive Services Task Force. Screening for Hepatitis C Infection in Adults. PDF available for download at http://www.uspreventiveservicestaskforce.org/uspstf12/hepc/hepcfact.pdf through http://www.uspreventiveservicestaskforce.org. Accessed December 20, 2012.

Screening for Hepatitis C Virus Infection in Adults: U.S. Preventive Services Task Force Recommendation Statement, DRAFT. Available online at http://www.uspreventiveservicestaskforce.org/draftrec2.htm through http://www.uspreventiveservicestaskforce.org. Accessed December 20, 2012.

Hepatitis C Testing for Anyone Born During 1945-1965: New CDC Recommendations. Available online at http://www.cdc.gov/features/hepatitisctesting/ through http://www.cdc.gov. Accessed December 20, 2012.

CDC Now Recommends All Baby Boomers Receive One-Time Hepatitis C Test. Available online at http://www.cdc.gov/nchhstp/newsroom/2012/HCV-Testing-Recs-PressRelease.html through http://www.cdc.gov. Accessed December 20, 2012.

Centers for Disease Control and Prevention. Hepatitis C Overview and Statistics. Available online at http://www.cdc.gov/hepatitis/HCV/HCVfaq.htm#section1 through http://www.cdc.gov. Accessed December 26, 2012.

Ana Fullmer, spokesperson for the U.S. Preventive Services Task Force. Phone interview December 19, 2012.