A clinical opportunity for routine HIV testing
==============================================

* Richard Long
* Deanne Langlois-Klassen

Thank you for publishing the editorial “Seek and Treat to Optimize HIV and AIDS Prevention.”1 This article raises a number of important points about HIV screening but unfortunately contains a significant error. That “Canada has no recommendation for routine [HIV] testing outside of prenatal screening and screening of the blood supply.”1 is simply not the case. That routine HIV testing of patients with tuberculosis (TB) was overlooked must have been unintentional. The World Health Organization continues to recommend routine, universal HIV testing of patients with TB because much of the global resurgence of TB in recent years is attributable to HIV and the synergy between these diseases. In Canada, multiple official statements and peer-reviewed publications dating back to 1992, have recommended routine, universal HIV testing of patients with TB.2–7 In Alberta, where universal HIV testing of patients with TB has been applied since 2003, population and age groups with extraordinarily high rates of disease have been identified. In particular, Aboriginal people aged 15 to 64 and those from sub-Saharan Africa aged 15 to 64 have HIV coinfection rates of 14.7% and 20.9%, respectively.7 Nevertheless, national compliance with the recommendation to test patients with TB for HIV remains poor, as highlighted by the HIV status of only 41% of patients with TB being known in 2008.8

In Canada, “opt-out” HIV testing of patients with TB has been shown to be both feasible and acceptable.6,7 Not screening patients with HIV for TB or not offering to screen patients with TB for HIV may be considered a dereliction of our duty.

## References

1.  Gustafson R, Montaner J, Sibbald B. Seek and treat to optimize HIV and AIDS prevention. CMAJ 2012;184:1971.
    
    [FREE Full Text](http://www.cmaj.ca/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiRlVMTCI7czoxMToiam91cm5hbENvZGUiO3M6NDoiY21haiI7czo1OiJyZXNpZCI7czoxMToiMTg0LzE4LzE5NzEiO3M6NDoiYXRvbSI7czoyMjoiL2NtYWovMTg1LzcvNTg3LjEuYXRvbSI7fXM6ODoiZnJhZ21lbnQiO3M6MDoiIjt9) 

2.  Canadian Thoracic Society, Tuberculosis Directors of Canada, Department of National Health and Welfare in consultation with the provincial and territorial epidemiologists, AIDS coordinators and HIV caregivers. Guidelines for the identification, investigation and treatment of individuals with concomitant tuberculosis and HIV infection. CCDR 1992;18:155–60.
    
    

3.  The Canadian Tuberculosis Committee of the Centre for Infectious Disease Prevention and Control, Population and Public Health Branch, Health Canada. Recommendations for screening and prevention of tuberculosis in patients with HIV and for screening for HIV in patients with tuberculosis and their contacts. CCDR 2002; 28 (ACS-7): 1–6.
    
    

4.  Long R, Houston S, Hershfield E; Canadian Tuberculosis Committee of the Centre for Infectious Disease Prevention and Control, Population and Public Health Branch, Health Canada. Recommendations for screening and prevention of tuberculosis in patients with HIV and for screening for HIV in patients with tuberculosis and their contacts. CMAJ 2003;169:789–91.
    
    [FREE Full Text](http://www.cmaj.ca/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiRlVMTCI7czoxMToiam91cm5hbENvZGUiO3M6NDoiY21haiI7czo1OiJyZXNpZCI7czo5OiIxNjkvOC83ODkiO3M6NDoiYXRvbSI7czoyMjoiL2NtYWovMTg1LzcvNTg3LjEuYXRvbSI7fXM6ODoiZnJhZ21lbnQiO3M6MDoiIjt9) 

5.  The Canadian Tuberculosis Standards. 6th ed. Tuberculosis Prevention and Control, Public Health Agency of Canada, and the Canadian Lung Association/Canadian Thoracic; 2007.
    
    

6.  Sturtevant D, Preiksaitis J, Singh A, et al. The feasibility of using an ‘opt-out’ approach to achieve universal HIV testing of tuberculosis patients in Alberta. Can J Public Health 2009;100: 116–20.
    
    [PubMed](http://www.cmaj.ca/lookup/external-ref?access_num=19839287&link_type=MED&atom=%2Fcmaj%2F185%2F7%2F587.1.atom) 
    
    [Web of Science](http://www.cmaj.ca/lookup/external-ref?access_num=000265167800012&link_type=ISI) 

7.  Long R, Boffa J. High HIV-TB co-infection rates in marginalized populations: evidence from Alberta in support of screening TB patients for HIV. Can J Public Health 2010;101:202–4.
    
    [PubMed](http://www.cmaj.ca/lookup/external-ref?access_num=20737809&link_type=MED&atom=%2Fcmaj%2F185%2F7%2F587.1.atom) 

8.  Public Health Agency of Canada. Tuberculosis in Canada 2008. Ottawa (ON): The Agency; 2012.