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"Establishment of routine testing for HIV infection is essential to reduce the number of persons...in the United States who are infected with HIV but are unaware of their HIV (status)," state Dr. Curt G. Beckwith from Brown Medical School in Providence, Rhode Island, and colleagues from Emory University School of Medicine in Atlanta, and Johns Hopkins School of Medicine in Baltimore.

The authors explain that significant numbers of persons with newly diagnosed HIV infection are diagnosed late in the course of the disease, not only worsening their prognosis but also increasing the likelihood of that they have transmitted HIV to others.

Moreover, the researchers write, current recommendations for testing are impractical, because few physicians working in the community can really know if they are working in a high-prevalence area or not.

Also, assessing patients' risk for infection is often hampered by inaccurate information supplied by patients, the physicians suggest.

Even without these factors, health-care providers may not offer HIV testing for a variety of reasons, ranging from failure to obtain informed consent from the patient to time constraints.

The authors propose instituting a new policy in which health-care providers routinely offer HIV testing, regardless of the patient's perceived risk. To make this workable, the authors say, counseling needs to be streamlined and rapid HIV testing implemented.

"Early diagnosis provides an opportunity for linkage to care, with the goal of preventing (AIDS-related) infections and the development of severe" immune deficiency, the researchers point out. "Early diagnosis also allows for risk-reduction counseling, which can reduce transmission of the...virus."

HIV testing "should be performed routinely for all sexually active persons, to diagnose HIV infection and to prevent AIDS," they conclude.

SOURCE: Clinical Infectious Diseases, April 1, 2005.

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