When is the ideal age to go for HIV screening? 18? 25? or 30? That is the question was explored by a study published recently in the Journal of Adolescent Health. According to the authors, the ideal age for persons who are not at risk to go for HIV screening is 25 years. Why? This is because most new HIV infections occur before an individual turns 25. During teenage years and early adulthood, people are more likely to experiment with drugs and behave in a way that puts them at risk. Although everyone is encouraged to get tested, knowing when to go for HIV screening in the absence of symptoms may be a dilemma for some. Furthermore, if a person gets screened too early, the infection may be missed if it is still within the window period.
In a statement by Massachusetts General Hospital (MGH), the authors provided more information on why they embarked on the study and what were their main findings:
“We began by thinking that, if people are screened only once, it makes sense to get screened after the age when the most new HIV infections occur. We also thought that, if we accounted for all of the HIV testing that is already taking place in the U.S., an additional screening test for youth without known risk factors would be most useful at some point after age 18.”
HIV screening refers to testing of individuals who do not have symptoms of the infection. Many youth may be at higher risk than they, their parents or their health care providers believe, so offering a one-time screening HIV test could identify infections that would otherwise be missed
“It can be hard to talk to teens about their risk for HIV,” says study co-author Commander Richard Dunville, MPH, epidemiologist at CDC. “However, it is important that parents, health care providers and teens themselves have more information to decide if and when HIV screening is appropriate. Studies like this one and data about high-risk youth can help guide these informed decisions.”
Andrea Ciaranello, MD, MPH, of the MGH Division of Infectious Disease, senior author of the study, says, “For at-risk groups, HIV screening should occur much more frequently than once in a lifetime, since a single screen will only capture a very small proportion of the population with HIV. However, for young people who become infected by age 25, the gains in life expectancy and improvements in health outcomes, including viral suppression, from that one-time screening test would be substantial.”
From 2009 to 2013, HIV diagnoses among those aged 13 to 29 were highest in ages 22 to 25. “There is often a delay between when someone becomes infected with HIV and when they are diagnosed, so we cannot be certain at what age most infections are occurring,” says Dunville. “Still, this study leads us to doubt that screening teens 18 and younger without risk factors would be a good use of limited resources.”
Neilan adds, “About half of all young people ages 13 to 24 with HIV have no idea they are infected, but fewer than 15 percent of adults with HIV are unaware. HIV screening is an important component of addressing this disparity. 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.”
What is the current recommendation on HIV screening? According to the CDC, people should be tested for HIV infection at least once between ages 13 and 64. However, this recommendation is based on data from United States and may not apply to individuals in Nigeria and other developing countries.
Nevertheless, getting HIV screening at least once has often been advocated by other international bodies too. This may potentially reduce the risk of new infections.
In 2016, the number of individuals that became infected with HIV in Nigeria was 220 000. Sadly, out of the 3.2 million persons living with HIV/AIDS, 160 000 died from AIDS-related deaths in 2016. One of the main challenges is the low levels of infected persons that get treated. According to UNAIDS, about 7 out of every 10 persons living with AIDS did not receive treatment. Could this be partly because of knowing when to go when for HIV screening? Perhaps. People may stay away from screening centres on account of low level of awareness, lack of symptoms and stigma.
It is important to note that this recommendation does not apply to persons who engage in risky behaviour or are vulnerable to HIV. These includes gay and bisexual males, people who inject drugs and their sex partners, people who exchange sex for money or drugs, and sex partners of HIV-infected people.
Should there a national approved ideal age for HIV screening? Please leave your comments below!