One-Time Routine HIV Screening at Age 25 Optimal With No Risk Factors

HIV blood test sample
HIV blood test sample
Using adult quality-of-life weights for adolescents and young adults increased the incremental cost-effectiveness ratios of screen at 25 compared to screen at age 30 to $115,900/quality-adjusted life-year.

HealthDay News — For young adults without known risk factors, a one-time routine HIV screen at 25 years would optimize clinical outcomes and be cost-effective, according to a study published in the Journal of Adolescent Health.

Anne M. Neilan, MD, MPH, from Massachusetts General Hospital in Boston, and colleagues simulated HIV-uninfected 12-year-olds without identified risk factors who faced age-specific HIV infection risks. The authors modeled a one-time HIV screen ($36) at age 15, 18, 21, 25, or 30 years, each in addition to current US screening practices (30% screened by age 24).

The researchers found that all one-time screens detected a small proportion of lifetime infections (0.1% to 10.3%). 

A screen at 25 years led to the most favorable care continuum outcomes at age 25 compared to current screening practices, with a higher proportion diagnosed (77% vs 51%), linked to care (71% vs 51%), retained in care (68% vs 44%), and virologically suppressed (49% vs 32%). A screen at age 25 years not only provided the greatest clinical benefit but also was cost-effective ($96,000/year-of-life saved [YLS]) by US standards of <$100,000/YLS compared with the next most effective screen.

“Focusing screening on adolescents and young adults ages 18 or younger is a less efficient use of a one-time screen among AYA than screening at a later age,” the authors write.

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Neilan Am, Dunville R, Ocfemia MCB, et al. The optimal age for screening adolescents and young adults without identified risk factors for HIV. J Adolesc Health. 2018 Jan;62(1):22-28.