Advances in HIV Testing

Jonathan Mermin, MD, MPH

Today is the 19th annual National HIV Testing Day (NHTD). HIV testing is the first critical step to ending the HIV epidemic in the United States, and testing and linkage to care continue to be the mainstay of our prevention efforts at the Center for Disease Control and Prevention. HIV testing is the only way to identify the nearly one in five Americans currently living with HIV who do not know they are infected and may be unknowingly transmitting the virus to others.

Since the last observance of NHTD, there are exciting HIV testing-related news and advances to share with you, from recently released testing recommendations and home test availability to fourth generation HIV testing and the launch of a new campaign to promote HIV testing in Latino gay and bisexual men.

HIV Testing Recommendations: In April, the U.S. Preventive Services Task ForceExit Disclaimer (USPSTF) announced a grade “A” recommendation for routine HIV screening. The USPSTF statement recommends clinicians screen for HIV in all adolescents and adults aged 15 to 65. It also recommends repeat HIV screenings for those who are at increased risk for HIV infection, including men who have sex with men (MSM) and people who inject drugs. These updated USPSTF recommendations align with CDC’s 2006 guidelines, which state that HIV testing should be a routine part of medical care for all American adults and adolescents. The USPSTF recommendations are incredibly important because under the Affordable Care Act, private health insurance policies must cover preventive services that have been give an “A” or a “B” grade at no cost to the consumer. This means more people than ever before will have access to HIV testing with no out-of-pocket expenses. See more at: New USPSTF HIV Testing Recommendation Paves the Way for Increased Testing and Timely HIV Diagnosis in the U.S.

Home Testing: Last July, the Food and Drug Administrations (FDA) approved the first over-the-counter home-use rapid HIV test, which has the potential to increase the number of people who know their status and decrease the overall rate of new HIV infections when those testing positive are linked to care and treatment. Rapid home HIV testing is likely to be a welcome opportunity for many who are unable or unwilling to be tested in other settings.

Making Diagnoses Earlier: For National HIV Testing Day, CDC released a study in its Morbidity and Mortality Weekly Report (MMWR) on the use of fourth generation HIV testing. Fourth generation assays can identify some HIV infections in the acute phase or during the "window period,” i.e., the time between HIV infection and the detection of HIV antibodies. This should lead to earlier diagnosis and earlier engagement in all stages of care. See more at: Detection of Acute HIV Infection in Two Evaluations of a New HIV Diagnostic Testing Algorithm — United States, 2011–2013

Promoting Testing through Campaigns: In early June, CDC launched a new campaign—called Reasons/Razones. The campaign aims to increase HIV testing among one of the hardest hit groups of men in the United States—Latino gay and bisexual men. A recent study in 20 U.S. cities found that more than a third (37 percent) of Latino gay and bisexual men living with HIV were unaware of their infection. Reasons/Razones encourages HIV testing through a compelling series of campaign ads that feature gay and bisexual Latinos sharing their reasons for getting tested for HIV, while encouraging others to get tested as well.

These are exciting new developments that we can utilize to help move us toward an AIDS-free generation and a healthier nation for all. Thank you for the work you do every day all year long.