Canada should adopt routine HIV testing

Offering routine HIV testing to the general population rather than only to high-risk individuals will significantly reduce illness and death, argues Dr. Julio Montaner and coauthors in an editorial in CMAJ (Canadian Medical Association Journal).

"A proactively deployed 'seek and treat' strategy will dramatically reduce AIDS-related morbidity and death, as well as HIV transmission, and as such provide the road map for an AIDS-free generation," writes Dr. Montaner, Director, BC Centre for Excellence in HIV/AIDS, Vancouver, BC.

Highly active antiretroviral therapy (HAART), in use since 1996, has greatly extended the lifespan of people living with HIV, making the disease a manageable chronic condition. HAART has been shown to be effective in preventing transmission of the virus. However, in Canada more than 50% of people with HIV receive the diagnosis after immunodeficiency is established, making treatment less effective and increasing the likelihood of HIV transmission.

It is estimated that at least 25% of people with HIV are unaware that they are infected.

The United States recommends routine screening of all patients in health care environments between 13 and 64 years of age. France recommends screening of the entire population aged 15 to 70 years and targeted screening of at-risk groups.

"It is now evident that HIV testing, based only on perceived risk, misses multiple opportunities for earlier diagnosis," writes coauthor Dr. Réka Gustafson, Medical Health Officer and Medical Director, Communicable Disease Control, Vancouver Coastal Health. "Routine HIV testing, on the other hand, has been shown to be acceptable and highly cost-effective. It is therefore imperative to implement and evaluate routine HIV testing across Canada."