Study Supports Routine HIV Tests for Fever Patients

American doctors could save hundreds of lives annually by giving HIV tests to patients with fevers and other signs of viral illness, suggests a new study published in the current issue of The Annals of Family Medicine.

While only a tiny percentage of the sick patients would actually be ill because they're in the early stages of HIV infection, identifying the disease in these individuals could prevent them from infecting others, according to the study findings.

There's no indication that the U.S. medical establishment is anywhere near making HIV tests routine for people with routine symptoms.

The tests themselves still carry a stigma, says study co-author Dr. Andrew Coco, head of the Healthcare Research Center at Lancaster General Hospital in Lancaster, Penn., and doctors themselves often don't think about the prospect that their patients may be ill with the virus that causes AIDS.

"This really isn't on their radar screen at all," he says.

Still, Coco says, changing the status quo could make a big difference, especially since "we're not cutting into the epidemic as we'd like to."

The study focused on patients with fever and other virus symptoms, because as many as 90 percent of people infected with HIV develop flu-like symptoms within days of being infected. The symptoms are a sign that the body has recognized the AIDS virus and is trying to kill it.

In some cases, the symptoms are so bad that patients go to a doctor. Coco estimates that routine testing of 3 million patients would turn up 17,054 new cases of HIV infection. According to his calculations, timely recognition of these infections could spare about 435 of those individuals' sex partners from getting infected too.

Based on an analysis of medical data from the year 2000, the calculations assumed that 0.66 percent -- or two-thirds of 1 percent -- of people with fever and related symptoms would be HIV-positive.

The tests would be cost-effective, Coco says, although he acknowledges that the study's most promising results regarding cost relied on a $24 HIV test. Since then tests have gone up in price.

"We spend a lot of money screening for a lot of other diseases, like breast cancer and colon cancer, and we do Pap smears," he says. "We wouldn't think of seeing patients and not screening for those."

By contrast, patients are typically screened for HIV only if they ask for a test or are identified as high risk and agree to be tested, says Gillian D. Sanders, an associate professor of medicine at Duke University in Durham, N.C.

In an accompanying commentary in the journal, Dr. Theodore G.

Ganiats of the Health Outcomes Assessment Program at the University of California in San Diego calls Coco's work "impressive." But he adds that questions still remain about the wisdom of making the HIV tests routine.

Even so, he says, doctors and researchers should take a close look at the study findings.

If so, Sanders says, perhaps HIV screening will become less stigmatized, with good results all around.

"We hope that, if HIV screening becomes more widespread in lower-risk populations, that there will be less of a stigma involved with requesting a test or being tested," she says.