Clif Cleaveland: Making HIV/AIDS screening routine

Clif Cleaveland: Making HIV/AIDS screening routine

March 21st, 2013 by Clif Cleaveland in Life Entertainment

Dr. Clif Cleaveland

Dr. Clif Cleaveland

In 2006, the Centers for Disease Control and several physician organizations recommended routine testing of all adults for HIV infection, and an increasing numbers of states adopted the recommendation.

The influential U.S. Preventive Services Task Force, which analyzes evidence for screening for diseases, advised screening only for people with risky sexual or drug behaviors. But on March 7, the New England Journal of Medicine reported that the task force will soon advise routine screening of all adults for HIV infection.

The Affordable Care Act requires that all screening tests recommended by the task force be covered by public and private health plans without co-payments.

The implications of the new policy are huge. Persons with undiagnosed HIV infection pose a risk to their sexual partners. Young women with undiagnosed HIV infection may transmit the disease to their fetuses. These avenues for transmission will be progressively reduced, although a patient may still decline testing.

Years ago, routine testing for syphilis helped to reduce the incidence of that disease and its long-term consequences. Routine testing can achieve the same goals for HIV/AIDS.

HIV/AIDS is now an ingrained and frightening part of our world, yet it's important to note that the disease itself is relatively new and ways to treat it and prevent it are still being developed.

History of HIV/AIDS

Thirty years ago, in 1983, the viral cause of a devastating, new disease was established by the Pasteur Institute in Paris. The virus was subsequently named Human Immunodeficiency Virus (HIV).

Beginning in 1981, increasing outbreaks around the world of uncommon infections and a rare cancer had been linked to intimate sexual activity among gay males, illicit drug use with shared needles and transfusions with blood and blood products.

Common to these patients was a deficiency in a population of white blood cells (CD4). The term Acquired Immunodeficiency Syndrome (AIDS) was adopted in 1982 to categorize these patients.

AIDS was subsequently documented in babies born to infected mothers. Because pooled clotting factors were contaminated with HIV, many children who received these factors for treatment of inherited bleeding disorders were infected and subsequently developed AIDS.

Intensive research in many centers established a timeline for the development of AIDS. Infection with HIV causes a mild, flu-like illness which soon subsides. The virus selectively infects CD4 cells, slowly reducing their numbers. Eight to 10 years after initial infection with HIV, CD4 cells are no longer adequate to defend the body against a variety of chronic infections and malignancies. A progressive wasting illness may develop along with dementia. Think of HIV as a biologic time-bomb with a fuse set for years. An infected person may transmit HIV during this interval.

In 1985, the Food and Drug Administration licensed the first blood test for HIV. Studies on AZT, a drug initially developed as an anti-cancer agent, showed it to be effective in combatting HIV. An array of drug therapies followed. Intensive public education on safe sexual practices and cautions for all bodily fluids reduced the incidence of new cases of HIV. Improved therapies slashed the death rate. With carefully monitored, intensive therapy, patients with HIV/AIDS may live active lives for many years. The virus can only rarely be eradicated.

Currently, an estimated 35 million people worldwide live with HIV/AIDS. Two million die from AIDS yearly. Many developing countries lack financial and medical resources to diagnose and treat the disease.

Despite public health campaigns, an estimated 55,000 Americans acquire HIV infection yearly. AIDS kills at least 17,000 Americans each year. More than 1 million Americans are infected with HIV; at least one-fifth do not know that they are infected.

In the first years of the HIV/AIDS outbreak, patients were often stigmatized by a public that lacked understanding of the illness. Persons concerned that they might have been exposed to HIV infection were reluctant to undergo blood testing because of fear of discrimination or job loss should the result be positive. An individual desiring a test for HIV had to sign a special consent form and to be counseled by a physician about the significance of a possible positive test.

Postponement of testing, however, means that the immune system of an infected person will slowly erode until he or she develops AIDS. Earlier diagnosis means that effective treatment with medications can be launched before CD4 cell levels reach a critical point.

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