National HIV Testing Day: Take the Test, Take Control

Today is National HIV Testing Day in the US, where nearly 1.2 million people are living with HIV and almost 1 in 5 don’t know they’re infected. Here Martin S. Hirsch, MD, FIDSA, editor-in-chief of The Journal of Infectious Diseases, discusses the importance of HIV testing. Dr. Hirsch is also professor of medicine at Harvard Medical School, professor of infectious diseases and immunology at the Harvard School of Public Health, and a physician at Massachusetts General Hospital.

What role does HIV testing play in both the US and global response to the HIV/AIDS epidemic? Why is early diagnosis so important with this disease?
HIV testing is essential for effective control of the pandemic, both within the US and worldwide. Many persons who carry HIV are unaware of their infection and these individuals are a major source of virus transmission to others. Moreover, it is now clear that early antiretroviral drug therapy of infected individuals decreases long term morbidity and mortality. Since treatment is now recommended for nearly all HIV-infected individuals in the US, the earlier one knows he or she is infected, the better.

What recent research advances or findings have there been regarding HIV testing? What should we take away from these findings?
Diagnostic tests for HIV infection continue to improve, particularly with respect to being able to detect early infections, a time when the amount of virus in a person’s blood and secretions is high and the risk of transmission to others is greatest. Investigators have been able to reduce the “window period” where diagnostic tests cannot accurately detect virus from several weeks to 10-15 days, as a result of advances in diagnostic technology. Laboratories across the country are now implementing third and fourth generation tests to make reliable diagnoses early in the course of infection.

What do you see as the major barriers to implementing routine HIV testing in the US?
The major barriers to implementing routine HIV testing in the US are variations in health care infrastructures among our states, inadequate funding for such approaches, and the lack of knowledge regarding the benefits of routine HIV testing. It has been estimated that annual routine HIV testing worldwide, combined with antiretroviral treatment of those found to be infected, could reduce new HIV infections by over 90% within 10 years. However, inadequate health infrastructures and insufficient funding make this possibility unlikely.

What impact will greater access to HIV testing, such as the rapid at-home test now under regulatory review in the US for possible sale over the counter, have on HIV prevention and treatment efforts?
Over the counter, rapid, at-home tests will allow persons to test for HIV infection in the privacy of their homes. The sensitivity and specificity of some of these tests have improved considerably over the years. Although positive results on such at-home tests will still need confirmation by other tests at accredited laboratories, their increasing use will allow individuals to take their own first steps in determining whether or not they need medical attention.

To raise awareness of National HIV Testing Day, the Editors of the Journal of Infectious Diseases and the Journal of Clinical Infectious Diseases have highlighted recent, topical articles, which are freely available for the next two weeks. Both journals are publications of the HIV Medicine Association and the Infectious Diseases Society of America.