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Routine HIV screening at age 25 improves clinical outcomes

Anne M. Neilan

A one-time routine HIV screening at 25 years of age was cost-effective and led to better clinical outcomes among teenagers and young adults without identified HIV risk factors, according to findings published in the Journal of Adolescent Health.

Current CDC guidelines recommend one-time HIV screening for everyone between the ages of 13 to 64 years.

“About half of all young people aged 13 to 24 years with HIV have no idea they are infected, but fewer than 15% of adults with HIV are unaware. HIV screening is an important component of addressing this disparity,” Anne M. Neilan, MD, MPH, division of infectious diseases at Massachusetts General Hospital, told Healio Family Medicine. “We were hoping to provide evidence which would allow future guidelines to be more specific, and therefore more helpful for clinicians.”

Researchers created a model simulating 12-year-olds in the U.S. without HIV and without identified risk factors, but who had the potential for age-specific risks of HIV infection. The model evaluated a one-time screen that cost $36 for patients aged 15, 18, 21, 25, or 30 years alongside a screen conducted at age 13 years to draw the parallel between the current CDC guidelines.

Neilan and colleagues found that when analyzed alongside the present CDC guidelines, screening at aged 25 years resulted in favorable care continuum outcomes in the following areas: virologic suppression (49% vs. 32%), retention in care (68% vs. 44%), linkage to care (71% vs. 51%), and proportion diagnosed (77% vs. 51%). Screening at age 25 years also led to the greatest gains in undiscounted HIV-infected life expectancy from age 12 (589.82 months, an increase of 4.8 months vs. using current guidelines). Further, HIV screening at age 25 was cost-effective ($96,000/year-of-life saved) by U.S. standards (less than $100,000/year-of-life-saved) and provided the greatest clinical benefit vs. the next most effective screen.

“Our results indicate that focusing screening on teens 18 or younger without risk factors would be a less efficient use of a one-time screen than screening at a later age.” Neilan said in the interview.

She also provided suggestions for primary care physicians to consider when broaching the subject of HIV and AIDS with their younger patients.

“When a health care provider makes a recommendation for a screening test, it can be an opportunity to have a conversation about risk factors, then tailor recommendations based on the conversation,” Neilan said. “Talking about social and sexual relationships is challenging at any age, but particularly for adolescents and young adults who are just starting to have these experiences. There are also confidentiality concerns for those younger than 18 [years] or who still have health insurance through their parents. Approaching these issues in a nonjudgmental, developmentally appropriate, and open-ended way is key.” - by Janel Miller

Disclosure: The authors report no relevant financial disclosures.