Posted on Fri, Dec. 01, 2006

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WORLD AIDS DAY

Aids in South Carolina

HIV test delays slow diagnoses

By CZERNE M. REID

czreid@thestate.com

LINDSAY SEMPLE/LSEMPLE@THESTATE.COM

Mitch Journey, president of the AIDS Benefit Foundation in Columbia, participates in a World AIDS Day vigil Thursday.

More photos

Many South Carolinians who have HIV don’t get diagnosed until their disease is in advanced stages. And it’s not because they didn’t go to see a doctor.

Of more than 1,700 so-called “late testers” who were diagnosed between 2001 and 2005, almost three-quarters had visited a health care facility multiple times in preceding years, according to a study led by Dr. Wayne Duffus, director of HIV/STD medicine at the S.C. Department of Health and Environmental Control.

The report is published today, World AIDS Day, in the Centers for Disease Control’s Morbidity and Mortality Weekly Report.

On average, it takes 10 years from the contraction of HIV to the onset of AIDS. The study showed most “late testers” — which the CDC defines as people diagnosed with AIDS within a year of being diagnosed with HIV — had had up to five doctor visits within the previous year or longer before being tested for HIV.

Such missed chances for early diagnosis support new CDC recommendations that patients age 13-64 be tested for HIV as part of routine care in medical settings, unless they refuse.

“(The) recommendations ... help answer a need for new approaches to reach the quarter of a million HIV-positive Americans who are unaware of their infection,” CDC spokeswoman Jennifer Ruth said.

South Carolina has an estimated 15,000 cases of HIV and in 2004 had the 10th highest AIDS case rate among all states.

Nationally, 40 percent of people with HIV test late. The number is higher — 60 percent — in South Carolina.

Early diagnosis lets people start on life-saving medicines that lower their viral load and the risk of passing on the virus. People who test positive are likely to take precautions to protect their partners, studies show — those who don’t know they’re infected account for up to 70 percent of sexually transmitted infections.

In the South Carolina study of health care facility visits, more than 40 percent of people who tested HIV-positive were diagnosed with AIDS within a year of their initial diagnosis, and almost 17 percent within 30 days.

People diagnosed late don’t benefit as much from medications and are more likely to be hospitalized.

Most visits in the study were to emergency rooms, a setting where HIV-testing isn’t common.

Dr. Jay Taylor, medical director at Palmetto Baptist Emergency Department, points out that emergency department conditions and lack of resources make it hard to follow up with outpatients — phone numbers and addresses patients give often turn out to be wrong.

“The emergency department is kind of a tough place to institute all the public health measures,” Taylor said.

Despite difficulties, medical providers and advocates agree routine testing will help lessen HIV-related stigma.

Previous CDC recommendations called for routine testing only in settings where HIV prevalence is high, such as sexually transmitted disease clinics. In lower-prevalence settings, testing is offered to “high risk” patients.

But out of almost 8,000 doctor visits by late testers, 79 percent resulted in diagnoses for such conditions as diabetes and hypertension, which wouldn’t prompt doctors to recommend an HIV test. And only a third of late testers were injection drug users or men who had sex with men, categories considered to be at high risk of contracting HIV.

So testing based on HIV risk leads to later diagnoses than would routine screening of all patients, regardless of risk, said Duffus, who also is a clinical assistant professor at the University of South Carolina School of Medicine.

But many states might have to reform laws that could hinder implementation of the CDC’s new recommendations, Lawrence O. Gostin said in a recent commentary in the Journal of the American Medical Association. Such laws, put in place early in the AIDS epidemic, were meant to protect individuals during more hostile times. Changing those laws to ease routine testing will protect public health, he said.

Routine testing at health department STD and family planning clinics and among pregnant women has led to earlier HIV diagnoses among those groups than among the general population.

But the CDC’s recommendations for routine screening also raise financial concerns. Who will pay?

So far, health insurance companies haven’t said whether they will pay for testing. The other worry is about paying for medicine for the poor.

“It is important to keep in mind that once we make screening for HIV routine, it’s likely to lead to an increased number of people who are diagnosed with HIV,” Duffus said. “We have to think of how we’re going to be able to provide treatment for these (poor) people.”

The state’s AIDS Drug Assistance Program has run out of money, and as of Nov. 29 has a waiting list of 324 people.

Local health officials and advocates have asked the state Legislature to help.

“It is going to benefit all of us — infected or affected — in the long run,” Duffus said. “All of us are affected in some way, either through personal relationships or the increased cost of caring for someone who is diagnosed late with HIV infection.”

Reach Reid at (803) 771-8378.