Universal AIDS tests will pay off, experts say
By Maggie Fox
Reuters Health
November 30, 2006
WASHINGTON (Reuters) - Routine, universal testing for the AIDS virus as recommended by a federal agency will likely cost the United States $900 million, but will pay off in terms of lives and money, experts said on Wednesday.
They said the federal government will need to allocate more money to programs that pay for treating uninsured HIV patients, and said cities, states and groups that run clinics will have to hire more staff.
Treatment must be available to everyone who is tested, or else much of the incentive to get the test is gone, the researchers told a conference on AIDS testing in Washington.
"We are talking about a little more than $900 million a year," said Dr. David Holtgrave of Johns Hopkins University in Baltimore.
But two experts said their experiences show the effort is worthwhile. "The data scream that we need to be doing this," said Dr. Michael Saag of the University of Alabama at Birmingham Center for AIDS Research.
In September the U.S. Centers for Disease Control and Prevention recommended near-universal testing for the AIDS virus, saying too many people are missed by the current practice of focusing on people who seem to be at high risk.
HIV infects more than 1 million people in the United States and the CDC estimates that 40,000 people become newly infected every year. But many do not know it because at first HIV causes mild symptoms, quietly destroying the immune system over time.
"When we have good therapy that works best when people start early, that is inappropriate," Dr. John Bartlett of Johns Hopkins University in Baltimore told a news conference.
The CDC estimates that between 16 million and 22 million HIV tests are conducted in the United States every year. President George W. Bush's 2007 budget request to Congress allocates $70 million for HIV testing.
ALREADY PAYING OFF
Dr. Marsha Martin of the Washington, D.C. HIV/AIDS Administration said the city began a universal testing policy last June that has already paid off.
"We have the highest AIDS rate in the country -- 179 per 100,000 (population)" she said.
"Since June we have screened more than 16,000 individuals," Martin added. Of these, 580 have been positive, giving an infection rate of 3.5 percent -- far above the estimated U.S. national rate of between 0.8 percent and 1.2 percent.
Tests are being given at student clinics at universities, in hospital emergency wards and hospital walk-in clinics, as well as at free clinics across the city, she said.
Saag said at his clinic, people who come in after their immune systems are already damaged -- as measured by a count of immune cells called CD4 T-cells -- die sooner.
Just 35 percent to 50 percent live eight years, as opposed to 75 percent of people who seek testing and treatment while their CD4 counts are above 350, a level considered fairly healthy.
Saag said to care for a person whose CD4 count is more than 350, it costs $12,000 a year but it costs $40,000 a year to treat someone whose CD4 count has fallen below 50.
Cocktails of HIV drugs can keep patients from developing AIDS, although there is no cure for the infection.
"They stay healthy. They stay active in society. It's a win-win-win proposition, well worth the investment," said Saag.
Churches, communities and organizations now have to encourage people to get tested, said Phill Wilson, chief executive officer of the Black AIDS Institute. An estimated 50 percent of all new HIV infections across the United States are in blacks.
"AIDS today is a black disease, plain and simple," Wilson said. "For me, the answer is simple -- marshal black folks."
Senator Tom Coburn
Subcommittee on Federal Financial Management, Government Information, and International Security
340 Dirksen Senate Office Building Washington, DC 20510
Phone: 202-224-2254 Fax: 202-228-3796
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