Bernard M. Branson, MD
Disclaimer: The findings and conclusions in this report are those of the author and do not necessarily represent the views of the Centers for Disease Control and Prevention.
Potential Financial Conflicts of Interest: None disclosed.
Requests for Single Reprints: Bernard M. Branson, MD, CDC–Division of HIV/AIDS Prevention, 1600 Clifton Road, MS D-21, Atlanta, GA 30333; e-mail, email@example.com.
The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.
Geneva University Hospital
December 13, 2006
Risk of HIV transmission with undetectable viral load
To quote the author:
"The unfavorable transmission scenario assumes that HIV screening and treatment increase HIV transmission by prolonging life (and therefore the duration of infectiousness) and that infected persons might increase sexual risk-taking because they mistakenly think that having an undetectable viral load means that they are not infectious."
Why "mistakenly"? HIV viral load is by far the most important determinant of infectiousness (1). Where is the evidence that transmission from persons with a undetectable viral load play a role in the HIV epidemic? Even isolated case reports are difficult to find.
(1) Quinn,T.C.; Wawer,M.J.; Sewankambo,N.; Serwadda,D.; Li,C.; Wabwire-Mangen,F.; Meehan,M.O.; Lutalo,T.; Gray,R.H. Viral load and heterosexual transmission of human immunodeficiency virus type 1. Rakai Project Study Group. N Engl J Med 2000;342:921-29.
Curt G Beckwith
Brown Medical School
January 5, 2007
Routine HIV Testing in Jails
We applaud Drs. Paltiel and co-authors and Dr. Branson for their recent articles [1-2] that support routine HIV testing. However, their recommendation for routine, voluntary HIV testing as part of primary medical care may miss most of the 750,000 individuals who are incarcerated in U.S. jails on any given day . Most of these individuals do not have primary care providers and are not clients of our nations' mainstream healthcare system. The prevalence of known HIV infection in U.S. jails is estimated to be 1.3 %  which is over 3 times greater than the prevalence rate for the general U.S. population however the true HIV prevalence in jails may be significantly higher. An estimated one-fourth of all people living with HIV in the U.S. each year are released from a correctional facility that same year . In particular, African-American men (the demographic group with the highest rate of HIV infection) are incarcerated in jail five times more frequently than White men . The Centers for Disease Control and Prevention recommend routine opt-out HIV testing in incarcerated settings but most jails have not yet implemented it. Focused advocacy is needed now by AIDS activists and the public health community to initiate routine HIV testing in jails with real possibility for opt-out voluntary testing, appropriate protection for confidentiality of results, and linkage to HIV care both within correctional facilities and in the community post-release.
1. Paltiel DA, Walensky RP, Schackman BR, Seage GR, Mercincavage LM, Weinstein MC, et al. Expanded HIV screening in the United States: Effect on clinical outcomes, HIV transmission, and costs. Ann Int Med. 2006; 145: 797-806.
2. Branson BM. To screen or not to screen: Is that really the question? Ann Intern Med. 2006; 145: 857-859.
3. Harrison PM, Beck AJ. Prison and jail inmates at midyear 2005. NCJ publication no. 213133. Bureau of Justice Statistics, US Department of Justice, Office of Justice Programs. Washington, DC, 2006.
4. Maruschak LM. HIV in prisons and jails, 2002. NCJ publication no. 205333. Bureau of Justice Statistics, US Department of Justice, Office of Justice Programs. Washington, DC, 2004.
5. Hammett TM, Harmon MP, Rhodes W. The burden of infectious disease among inmates of and releasees from U.S. correctional facilities, 1997. Am J Public Health. 2002; 92: 189-94.
Branson BM. To Screen or Not to Screen: Is That Really the Question?. Ann Intern Med. 2006;145:857–859. doi: 10.7326/0003-4819-145-11-200612050-00011
Download citation file:
Published: Ann Intern Med. 2006;145(11):857-859.
HIV, Infectious Disease.
Results provided by:
Copyright © 2019 American College of Physicians. All Rights Reserved.
Print ISSN: 0003-4819 | Online ISSN: 1539-3704
Conditions of Use