Joseph Eron, MD: So David, talk about the guidelines. Talk about what we’re supposed to be doing in terms of screening people.
W. David Hardy, MD: The good news is the US Preventive Services Task Force many years ago gave HIV testing a very high recommendation, the highest recommendation, Grade A, and it’s been confirmed. So there’s really no scientific doubt that this was a good thing to do in terms of preventing longer-term HIV-related complications. And I think that’s what really makes it very clear. We’ve talked a little bit about how testing has been made better in many ways by taking over the consent form and the other things like that that used to get in the way.
But I think the thing that is tough is the stigma, because although we can persuade physicians to test people, and I think that’s great because it follows that guideline, whether or not people will consent to it is not always great. But the opt out, I think, has really helped when people get tested, are asked to be tested, or will be tested, and the wording can be as simple as, “I test all my patients for HIV. I’m going to test you today too, unless you say no.” So it assumes that it’s a good thing, and if presented in that light, it then goes on from there. Because, you know, for many years the CDC even recommended it, as the first with this epidemic, that we test people based upon their risk activities, or their risk factors, their percent, their perceived risk activities. And when you say that’s shown it’s not a good idea that everyone should be tested at least once after they become sexually active, after the age of 14 or so, up to the age of 65 at least, and that we do this on a regular basis if we detect that there are continuing risk factors going on. And the risk factors are very simple, including drugs.
Joseph Eron, MD: Sure, sex and drugs. Rock and roll.
Paul Sax, MD: I don’t know about that.
Ian Frank, MD: It leads to those 2 other behaviors.
Joseph Eron, MD: And so are there different recommendations for pregnant women?
W. David Hardy, MD: Definitely, because we can now prevent HIV infection and transmission of HIV infection from mother to child. Every woman should be tested at any time that she is going to get pregnant, if that’s a good idea, or after she’s pregnant. And certainly even up to the point of time of delivery. Because there are interventions that can be done all along that full continuum to be able to stop the transmission from mother to child. So testing there is really important.
Eric S. Daar, MD: Including late in pregnancy.
Ian Frank, MD: A second test late in pregnancy.
Joseph Eron, MD: Right, very important.
Paul Sax, MD: Exactly. The very few cases of HIV transmission in newborns; when you look back they often had a negative test early in pregnancy and then a positive one later on.
Joseph Eron, MD: Absolutely. Which gets back to that acute infection thing in which there are super-high viral loads with no antibody present. Which you know.