The challenge of HIV testing.(Guest Editorial)

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.

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, one-fourth do not know they are infected. These individuals are not receiving care for their condition, and the effectiveness of their antiretroviral therapy may be diminished when they do seek treatment. They also may be unknowingly infecting their sex or needle-sharing partners.

Recognizing the urgent need to ensure that infected individuals 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. As primary care providers, we will play the leading role in ensuring that our patients receive voluntary HIV counseling and testing as regularly as they would screenings for other serious diseases.

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 individuals who do get tested, too many do not keep the appointment to learn their result. As a result, many people who have HIV go undiagnosed, untreated, and unconnected to prevention 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.

How can we ensure that a greater number of at-risk individuals are tested, get their results, and act upon them quickly? One way is to take time to talk regularly with patients about HIV testing and possible risk factors--something we are not doing frequently enough.