Kaiser Permanente Research: Routine HIV Testing Necessary to Avoid Late Diagnosis

OAKLAND, Calif. -- "HIV testing must become more routine if we're going to treat the infection effectively," say researchers with Kaiser Permanente in a study published in the February issue of the Journal of Acquired Immune Deficiency Syndromes (JAIDS). The possible benefits of earlier detection include improved survival, fewer complications, and reduced spread of HIV.

Daniel Klein, MD, working with investigators in Kaiser Permanente's eight regions nationwide, studied the medical records of 440 HIV-infected patients to see when they were diagnosed and what led to the testing that confirmed infection.

What they found was that waiting for symptoms to prompt initial testing meant patients usually had reached advanced stages of immune suppression.

"The basic message is that we all need to talk about and test for HIV more often than we do," says Daniel Klein, infectious disease chief at Kaiser Permanente's Hayward, CA, medical center, and the principal investigator of the study. "HIV and other STDs need to become part of the standard set of issues patients and their care providers talk about."

The Centers for Disease Control and Prevention (CDC) has long supported routine testing, and at Kaiser Permanente pregnant women are routinely tested. "We need to see more of this in the entire sexually active population and among individuals with histories of substance abuse, particularly intravenous drug abuse" suggests Klein.

Klein et al found that more than 40 percent of HIV cases are diagnosed with CD4 counts lower than 200. The lower the count, the greater the likelihood that problems will develop.

Although 26 percent of the patients studied had documented risk factors reported in the years prior to diagnosis, in reality more than 80 percent admitted to prior risky behaviors prior to diagnosis. Only 22 percent of patients had any of the eight clinical indicators currently listed in medical literature as reasons to prompt HIV testing.

The authors emphasize that more attention to in-depth risk assessment (sexual behaviors, current or prior STDs, and/or intravenous drug use) -- with more frequent recommendations for testing -- would identify patients in earlier stages of disease. Waiting for the presence of HIV-associated signs or symptoms gives the infection more time to progress.

Source: Kaiser Permanente