September 16, 2016

Routine Testing for HIV: Ten Years On

This article originally appeared in the Health Affairs Blog.

Among the significant milestones in our ongoing effort to vanquish disease caused by the human immunodeficiency virus (HIV) was the development of a blood test, in 1985, that enabled the reliable diagnosis of those who’d been infected with the virus. That’s not to say that the test was universally acclaimed as a good thing. At that stage of our interaction with the HIV epidemic, the prognostic value of a positive test was uncertain, there were no effective treatments against the virus and opportunities for discrimination against those who were infected, or perceived to be infected, abounded. In fact, in the early years following the licensure of the HIV test, some advocacy groups cautioned at-risk persons to avoid—or at least be wary of—taking the test, given its uncertainties and the potential for discrimination based on HIV antibody serostatus. Readers who didn’t live through those days may find it hard to believe that there was more than one voice calling for widespread mandatory HIV testing and that even more extreme proponents dared to suggest isolation and quarantine measures for people who were found to have a positive HIV antibody test. Thankfully, mainstream public health leaders took the high road and made HIV testing services available on both a confidential and an “anonymous” basis so that those who did not wish to provide their names could still learn whether they’d been infected.

Time passed, hard-won knowledge accrued and legislation was enacted that provided stronger protections for those who were living with HIV disease. Not to say that fear and discrimination were eliminated, but that more powerful tools were made available to confront the irrational and harmful responses that often arose during those first, darkest years of the epidemic. The first treatment for HIV (AZT or zidovudine) was licensed in 1987 — six years after the Centers for Disease Control and Prevention’s (CDC) initial case reports of AIDS (acquired immune deficiency syndrome). But it wasn’t until the protease inhibitor Saquinavir was licensed in late 1995 that clinicians finally had an effective combination of drugs that could durably reduce circulating levels of virus and thereby interrupt the relentless destruction of the immune system that, before then, had resulted in hundreds of thousands of infected persons progressing to AIDS. So potent was the effect of these new drug combinations that decreases in national HIV-related mortality rates were observed a scant year after their licensure.

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