The case for wider use of testing for HIV infection

N Engl J Med. 1989 May 11;320(19):1248-54. doi: 10.1056/NEJM198905113201905.


PIP: There has been reluctance by the medical establishment and government to promote extensive human immunodeficiency virus (HIV) testing, even though it can be done economically and accurately. There are good arguments for more testing of 1 of the most serious epidemics of a infectious diseases in history. In 1987 there was estimated to be over 1 million people infected with HIV and most of them are unaware of the infection. The current methods to make people with HIV infection aware of the disease are not effective. Many people do not realize that early detection of HIV is important and that it is treatable. Where increased testing has been done there is evidence that unsafe sexual practices have been reduced by those with HIV. Another benefit of early detection of HIV is the identification of candidates for experimental therapies. There are reports that zidovudine is effective immediately after exposure to HIV, and hospitals should offer this treatment free to personnel exposed to blood or body fluids of an infected person. The effectiveness of hospital precautions should be evaluated and routine screening of patients can then be decided. Testing for HIV in the health care system could drive away those infected or who fear they are. Another argument against wider testing is false positive test results, but use of screening with sequential enzyme immunoassays followed by Western blot should rarely produce false positive results. It is a minimum requirement to test all patients that acknowledge sexual contact with homosexual men, any needle sharing, and any multiple unsafe heterosexual contacts. Also, testing of prenatal patients is strongly recommended, since early detection can allow abortion decision to be made, and also further pregnancies can be prevented.

MeSH terms

  • AIDS Serodiagnosis*
  • Acquired Immunodeficiency Syndrome / diagnosis
  • Acquired Immunodeficiency Syndrome / drug therapy
  • Acquired Immunodeficiency Syndrome / prevention & control
  • Discrimination, Psychological
  • False Positive Reactions
  • Female
  • Health Education
  • Homosexuality
  • Humans
  • Middle Aged
  • Pregnancy
  • Prenatal Diagnosis
  • Risk Factors
  • Substance-Related Disorders
  • United States