Off the Wires: Psychological Resources, Home HIV Screening

Directed by cognitive adaptation theory, a recent study assessed psychological resources as protection against HIV-related mortality and decline in CD4 lymphocyte counts among HIV-positive women (Ickovics JR, Milan S, Boland R, et al; the HIV Epidemiology Research Study [HERS] Group. AIDS. 2006;20:1851-1860).

The investigators employed the HIV Epidemiological Research Study, a longitudinal prospective cohort study, along with semiannual interview, physical examination, and laboratory assays. They recruited 773 HIV-positive women aged 16 to 55 years from 4 academic medical facilities in Baltimore; Bronx, New York; Providence, RI; and Detroit. The women were interviewed and underwent physical examination semiannually for up to 5 years. HIV-related mortality and CD4⁺ cell count decline over 5 years were included in the primary outcomes for these analyses.

Results showed that psychological resources were inversely associated with HIV-related mortality and time to death, beyond the effects of potential confounding variables including clinical status, sociodemographic characteristics, and depression at study entry (P < .05).

"Psychological resources may protect against HIV-related mortality and immune system decline," the investigators concluded. "Findings have implications for understanding individual variability in HIV disease progression . . . results can be applied to clinical interventions aimed at improving the health of women with HIV." [CDC HIV/STD/TB Prevention News Update, Wednesday, January 3, 2007]

HIV Home Screening Kit Launched
Persons seeking to test for HIV in the privacy of their own home can now do so, thanks to the launch of the United Kingdom's first home test kit, the Dr Thom test (BBC News. December 28, 2006).

An oral sample is sent from home to a laboratory, which looks for HIV antibodies in the saliva. If the results are negative, results are sent out via e-mail. If the £25 ($49) test detects signs of an immune response to HIV in the saliva, the service offers a phone call from a health professional. Patients are also advised to seek a formal diagnosis from a genitourinary clinic.

The Dr Thom test is unlikely to detect recent HIV infection because only persons who have been infected for approximately 14 weeks will have positive results. Also, the test is not as accurate as the standard blood test offered in clinics; this blood test will still be required in order to confirm infection.

Annabel Kanabus, director of the AIDS charity Avert, said the target audience for the test is the "worried well." "I would still recommend that if people are genuinely worried they may have HIV, they should go to a local [National Health Service] genitourinary clinic to be tested," she said. [CDC HIV/STD/TB Prevention News Update, Thursday, December 28, 2006]

Universal AIDS Testing Will Pay Off, Experts Say
A CDC recommendation to offer HIV testing to all Americans aged 13 to 64 years in routine health care settings would cost more than $900 million a year but is well worth the effort and expense, experts told a conference on HIV testing in Washington, DC. "The data scream that we need to be doing this," said Michael Saag of the Center for AIDS Research at the University of Alabama at Birmingham (Fox M. Reuters. November 29, 2006).

In September, the CDC called for near-universal HIV testing, saying too many people are missed by the current practice of focusing on high-risk groups. The agency estimates that many of the 40,000 Americans who become newly infected each year do not know it because the virus can first cause mild symptoms, compromising the immune system over time.

Treatment, however, must be available to all who are tested, otherwise the incentive for testing is diminished, researchers said. The federal government will need to allocate more funds for programs that pay for uninsured HIV patients, and cities, states, and organizations that offer testing and treatment services must hire more staff. According to the CDC, 16 million to 22 million HIV tests are performed each year in the United States. For the 2007 budget, President Bush requested $70 million for HIV testing.

Saag said that HIV patients who come to his clinic with low CD4⁺ cell counts die sooner. Just 35% to 50% of these patients will live 8 years, compared with 75% of persons who seek testing and treatment while their CD4⁺ cell counts are above 350/µL. The cost of treating a person with a CD4⁺ cell count above 350/µL is $12,000 annually; care for someone whose count has fallen below 50/µL is around $40,000 a year. Detecting HIV early allows people to "stay healthy," Saag said. "They stay active in society. It's a win-win proposition, well worth the investment." [CDC HIV/STD/TB Prevention News Update, Thursday, November 30, 2006]