Testing for the AIDS virus could become part of routine physical exams for adults and teens if doctors follow new U.S. guidelines expected to be issued by this summer.
Federal health officials say they would like HIV testing to be as common as a cholesterol check.
The guidelines for routine testing would apply to every American ages 13 to 64, according to the proposed plan by the U.S. Centers for Disease control and Prevention.
One-quarter of the 1 million Americans with the AIDS virus don't know they are infected, and that group is most responsible for HIV's spread, CDC officials said.
"We need to expand access to HIV testing dramatically by making it a routine part of medical care," said the agency's Dr. Kevin Fenton.
CDC officials presented the plans at a scientific conference in February. Last week, they said the guidelines should be released in June or July.
The recommendations are not legally binding, but they influence what doctors do and what health insurance programs cover.
Currently, the CDC recommends routine testing for those at high-risk for catching the virus, such as IV drug users and gay men, and for hospitals and certain other institutions serving areas where HIV is common. It also recommends testing for all pregnant women.
Under the new guidelines, patients would be tested for HIV as part of a standard battery of tests they receive when they go for urgent or emergency care, or even during a routine physical.
Patients would not get tested every year: Repeated, annual testing would only be recommended for those at high-risk.
There would be no consent form specifically for the HIV test; it would be covered in a clinic or hospital's standard care consent form. Patients would be allowed to decline the testing.
Standardizing HIV testing should reduce the stigma as well as transmission, CDC officials said. Nearly half of new HIV infections are discovered when doctors are trying to diagnose an illness in a patient who has come for care, they noted.
The American Medical Association supports the proposed recommendations, said Dr. Nancy Nielsen, a Buffalo, New York-based physician who is speaker of the AMA's House of Delegates.
Some doctor's offices will face challenges implementing the recommendations, she added. For example, they should not give a positive HIV test result over the phone and would have to provide or arrange for counseling.
But the benefits of reducing the spread of HIV far outweigh the logistical challenges, said Nielsen, an infectious disease specialist.
"I'm so happy the CDC is recommending this," she said. "HIV is an infectious disease and it should be treated like any other infectious disease. The fact that it has been treated so differently, I think, in some ways has contributed to the stigma."
Some patients' advocates have voiced concern that the recommendations do not include pre-test counseling and sufficient informed consent.
At many HIV testing sites, patients sit through a counseling session to explain the procedure before any blood is drawn. Many centers also require a patient to give "informed consent," indicating they understand the risks and benefits of the test.
The proposed recommendations do not require pre-test counseling in medical settings. They call for post-test counseling to be offered only to patients who test positive.
Pre-test counseling and informed consent ensure that patients are warned of possible mistakes in test results, said Catherine Christeller, executive director of the Chicago Women's AIDS Project.
They also can explain the implications of HIV testing, she added. For example, undocumented workers who test positive for the AIDS virus may be deported and need to understand that, Christeller said.
CDC officials say they understand advocates' concerns and are optimistic physicians will follow the recommendations carefully.
"Doctors should be explicit that 'You're going to be tested,"' said Dr. Tim Mastro, acting director of the CDC's division of HIV/AIDS prevention.