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Special Communication
July 21, 2010

Time for Oncologists to Opt In for Routine Opt-Out HIV Testing?

Author Affiliations

Author Affiliations: Department of Medicine, Baylor College of Medicine, and Health Services Research and Development, Department of Veterans Affairs Medical Center, Houston, Texas (Drs Chiao and Giordano); Division of Hematology/Oncology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts (Dr Dezube); Memorial Sloan-Ketttering Cancer Center, New York, New York (Dr Krown); Research Service and Section of Hematology-Oncology, VA San Diego Healthcare System, and Division of Hematology-Oncology and Moores Cancer Center, University of California, San Diego, La Jolla (Dr Wachsman); Johns Hopkins Medical Center, Baltimore, Maryland (Dr Brock); University of California, Los Angeles Center for Clinical AIDS Research and Education, David Geffen School of Medicine at University of California, Los Angeles (Dr Mitsuyasu); and Department of Pathology, Baystate Medical Center, Tufts University School of Medicine, Springfield, Massachusetts (Dr Pantanowitz).

JAMA. 2010;304(3):334-339. doi:10.1001/jama.2010.752

Human immunodeficiency virus (HIV)–infected individuals are at high risk of malignancies. However, it is not currently the standard of care to routinely test cancer patients for HIV. In 2006, the Centers for Disease Control and Prevention recommended HIV testing in all health care settings, calling for standard nontargeted “opt-out” HIV screening. For a variety of reasons, routine opt-out HIV testing is still not widely used in the United States. Although many barriers to routine opt-out HIV testing have been addressed, such opt-out HIV testing continues to be conducted primarily in venues that target specific patient populations such as pregnant women. Although opt-out testing has been piloted in emergency departments, less emphasis has been placed on opt-out HIV testing in other clinical settings. In this article, the background, rationale, and evidence for supporting opt-out HIV testing as routine care for cancer patients are presented. In addition, evidence is discussed for the potential of opt-out HIV testing to improve clinical outcomes by facilitating appropriate HIV management during cancer treatment for individuals who are found to be HIV positive.