It's tough duty for Stuart Fisk, who must inform patients that they've tested positive for human immunodeficiency virus or the deadly disease that HIV causes -- acquired immune deficiency syndrome, known as AIDS.
"I've been telling people they have HIV for 20 years and the reactions range all over the place," he said. "As opposed to 1990, when you had to present it as a potential death sentence, now you can convince them they are not going to die. Now we can treat it."
The HIV and AIDS epidemic affects 1.2 million Americans, with about 25 percent unaware they're infected. It's a key reason Mr. Fisk, clinical manager of the Positive Health Clinic of the West Penn Allegheny Health System, says he endorses the U.S. Preventive Services Task Force draft recommendation that all people be tested for HIV, with people at high risk for the infection to be tested periodically.
Those not aware they have HIV "largely are responsible for perpetuating the epidemic in the United States," said Mr. Fisk, a nurse practitioner. "They are why we haven't seen any decrease in the annual diagnosis in the United States. There are fluctuations, but there has been no significant decline in HIV cases, and among men having sex with men, the numbers are going up."
The only notable decline is among injection drug abusers, due to such needle or syringe exchange programs as the Prevention Point Pittsburgh program.
The task force is an independent group of national experts in prevention and evidence-based medicine that works to improve the health of all Americans by making evidence-based recommendations about clinical preventive services such as screenings, counseling services and preventive medications.
The recommendations sometimes become part of medical practice or have an impact on health insurance policy.
The draft recommendation would advise clinicians to screen all people 15 to 65 for HIV and AIDS at least once, and also those older than 65 or younger than 15 if they have a higher risk for infection. The task force draft recommendation further encourages clinicians to screen all pregnant women for HIV, "including women in labor whose HIV status is unknown." An HIV positive mother can transmit the virus to her baby in three ways: during pregnancy, during vaginal childbirth and through breastfeeding. Treating the mother and recommending cesarean section are options.
The task force is seeking public comment on the draft recommendation until Dec. 17.
Task force member Douglas K. Owens said the recommendation "reflects new evidence that demonstrates the benefits of screening for earlier treatment of HIV." Once the task force approves a recommendation, it's circulated among clinicians nationwide. Dr. Owens said the recommendation involves a strategy to save lives with earlier diagnosis, then treatment with the proven battery of antiretroviral medications. Antiretroviral drugs can keep the virus at undetectable levels in the blood and prevent disease progression to AIDS, which cannot be controlled with drugs. AIDS destroys the immune system, making the body prone to various deadly infectious diseases.
Short of a cure, those with HIV must take the regimen of drugs the rest of their lives.
In Allegheny County, 2,500 people are HIV positive, with 2,300 having AIDS, the Allegheny County Health Department reports. Spokesman Guillermo Cole said the department is withholding comment on the draft recommendation, pending review.
Dr. Owens, an internist and professor of medicine at Stanford University, said people should take steps to avoid being infected with HIV. Screening is the best way to control disease and reduce AIDS deaths.
One problem to date is the stigma that HIV creates. It indicates that the person potentially was involved in men-with-men sex or injected drug use. Mr. Fisk said even doctors are reluctant to request that patients be tested or discuss the issue with patients.
"One reason you should want to be tested is that you want to be healthy and live a long life," he said. "If we test a majority of people and get people on treatment, only then will you see a slowing of the epidemic in this country."
The recommendation, he said, "is way overdue."