Making the Case: Public Health Benefit
Approximately one-fifth of the 1.1 million people infected with HIV are unaware of their infection.(2) Many learn of their HIV-positive serostatus only after it has progressed to AIDS.(3) Some estimate that those unaware of their HIV infection are 3.5 times more likely to transmit the virus to others.(4-6) In addition to preserving the health of those infected,(6, 7) early diagnosis of HIV infection can limit further transmission when those who are infected alter their risk behavior(8) and maintain sufficiently low viral loads.(9)
Analysts project that widespread use of HIV screening would be cost-effective(10-12) in all but the populations with lowest risk (<.02% HIV prevalence).(10, 11)
2. Glynn M, Rhodes P. Estimated HIV prevalence in the United States at the end of 2003. National HIV Prevention Conference. Atlanta, GA; 2005.
3. Centers for Disease Control and Prevention. HIV/AIDS surveillance report. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention; 2007. MMR. Oct 3, 2008; 57(3a): 1073-1076.
4. Centers for Disease Control and Prevention. Revised recommendations for HIV testing of adults, adolescents, and pregnant women in health-care settings. MMWR. Sept 22, 2006;55(RR-14):1-17.
5. Marks G, Crepaz N, Janssen R. Estimating sexual transmission of HIV from persons aware and unaware that they are infected with the virus in the USA. AIDS. June 26 2006;20(10):1447-1450.
6. Marks G, Crepaz N, Senterfitt J, Janssen R. Meta-analysis of high-risk sexual behavior in persons aware and unaware they are infected with HIV in the United States: implications for HIV prevention programs. J Acquir Immune Defic Syndr. 2005;39:446-453.
7. Palella F, Deloria-Knoll M, Chmiel J, et al. Survival benefit of initiating antiretroviral therapy in HIV-infected persons in different CD4+ cell strata. Ann Intern Med 2003;138:620-626.
8. Colfax GN, Buchbinder SP, Cornelisse PGA, Vittinghoff E, Mayer K, Celum C. Sexual risk behaviors and implications for secondary HIV transmission during and after HIV seroconversion. AIDS. Jul 26 2002;16(11):1529-1535.
9. Quinn TC, Wawer MJ, Sewankambo N, et al. Viral load and heterosexual transmission of human immunodeficiency virus type 1. Rakai Project Study Group. New England Journal of Medicine. Mar 30 2000;342(13):921-929.
10. Paltiel AD, Walensky RP, Schackman BR, et al. Expanded HIV screening in the United States: Effect on clinical outcomes, HIV transmission and costs. Annals of Internal Medicine. 2006;145:797-806.
11. Paltiel AD, Weinstein MC, Kimmel AD, et al. Expanded screening for HIV in the United States - an analysis of cost-effectiveness. New England Journal of Medicine. Feb 10 2005;352(6):586-595.
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