Thursday, May 24, 2018
Health

USF medical professor one of early proponents of new HIV testing guidelines

TAMPA — Nearly 25 years ago, Dr. Patricia Emmanuel treated the most fragile victims of the emerging AIDS epidemic: babies born to infected mothers.

But she doesn't see many young children any more.

"We've kind of put ourselves out of business when it comes to children with HIV (the virus that causes AIDS), which is fabulous," said Emmanuel, a University of South Florida professor and pediatric infectious disease specialist. "How have we eliminated it? We test every mother who's pregnant."

It was a significant and, at the time, controversial turning point in the history of the disease. The evolution continued earlier this month when the U.S. Preventive Services Task Force proposed all Americans ages 15 to 64 get an HIV test at least once — even if they aren't considered at high risk for the virus.

Last year, Emmanuel, 52, helped write similar guidelines for the American Academy of Pediatrics, recommending testing for teens ages 16 and older.

Emmanuel spoke with the Tampa Bay Times about the significance of the new proposed guidelines, particularly in adolescent care. What follows is an edited transcript.

How did you reach the recommendation to start with teens?

At least 25 percent, maybe upward of 50 percent, of new infections are in that younger age group, up to age 25. … So that's a really vulnerable population that doesn't access care and testing as much. Taking a test is also an opportunity to teach prevention. Many of (the tests) are going to be negative. But it's an opportunity to talk about sexual risk.

So when this recommendation came out, did you catch some flak for it?

We had to be very sure of the epidemiology, and there was a fair amount of controversy. First of all, there are so many recommendations for pediatricians that if you took all of them they would never get through a visit. Then also I think physicians feel like there are such differences based on where they practice. Say an area of very low prevalence, a state like Minnesota, or in rural areas, why should they be tested? So there was a lot of discussion about that because you're trying to make a recommendation across the board.

How do teens usually find out they have HIV?

In cities we have testing sites and outreach centers, like we have a clinic in Ybor that does testing. In rural areas, there's not as much access to testing. At least half of them get it at a health care provider.

There are studies that show people with HIV are usually seen in emergency rooms three or four times before they get tested. So we're trying to encourage routine testing in emergency room settings … because if you come for a reason to a doctor it usually means it's more advanced. And the more advanced, the longer it takes to respond to the medication.

One part is, obviously, to diagnose cases earlier. But is part of it also to reduce the stigma of HIV testing?

Absolutely. It's a test just like any other test, but because of the history of HIV, the way it started and how much stigma was associated with it 20 years ago, it has been treated differently. And it needs to stop getting treated differently.

The challenge for pediatricians, of course ... is healthy kids don't get a lot of blood work. But the idea is that it'd be a routine, "Today, we're going to check your hemoglobin and do your HIV test."

Do you ask them about their sexual activity at that point?

You really hope that's part of the discussion. ... I'd envision this as a test in the late teenage years, as they segue into adult care or go off to college. … One thing we don't do well as pediatricians is getting into issues of sexual orientation and that's where we're having the highest epidemic — young men who have sex with men, especially in our minority population, who may not identify as homosexual.

When the Centers for Disease Control and Prevention recommended young girls get the HPV vaccine, it became a political issue. Do you foresee anything similar with this?

We certainly worried about it with the (American Academy of Pediatrics)... But I think from a medical standpoint people are embracing, "Just get the test." The FDA just approved a 20-minute home test. It's $40 and at Walgreens. … Before, it had to be a trained counselor and you had to get the results in person, so that's really evolved. I think where the backlash will be is on the financial side. How much more can insurers pay? I think that's an issue.

Jodie Tillman can be reached at (813) 226-3374 or [email protected]

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