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^CDC Supports Broader Testing for AIDS (Washn)<

^By Marlene Cimons=

^(c) 1991, Los Angeles Times=

WASHINGTON _ Federal health officials, advocating a significant expansion of

AIDS testing policy, proposed Wednesday that all patients entering hospitals be

routinely encouraged to undergo screening for infection with the human

immunodeficiency virus.

The proposed guidelines, which are certain to be controversial, mark the

first time that the federal government formally has moved to urge testing among

hospital patients not necessarily considered at risk for AIDS infection. A

similar suggestion by several public health officials in 1987 was abandoned,

along with a proposal to test all applicants for marriage licenses.

The guidelines, which were drafted and released by the federal Centers for

Disease Control in Atlanta, would not be mandatory. Even so, they are expected

to have a major impact on the practices of public and private hospitals and on

state and local health departments across the country.

``We are not recommending mandatory testing, but we are suggesting that we

treat HIV today the way syphilis was treated in the past,'' said Dr. James O.

Mason, assistant secretary for health, in an interview. ``Years ago, patients

were routinely tested for syphilis as part of a hospital workup.''

The guidelines stressed, however, that HIV testing should be conducted only

with the informed consent of the patient, and would be accompanied by

counseling so that patients fully understand the implications of the results.

Even with those precautions, Mason said he expected the recommendations

would evoke considerable opposition from ``people who don't like testing and

who want as little testing as possible.''

Health officials said they hoped such testing would enable infected patients

to receive early medical intervention, and would protect health care workers

who might be exposed to infected patients. Recently, the CDC also issued

guidelines recommending testing of health professionals who perform surgery.

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Although the Public Health Service has for some years recommended testing of

individuals who engage in high-risk activities known to transmit the AIDS

virus, they said Wednesday that many people are likely to be unknowingly

infected and would benefit from screening.

In addition, a number of treatments are now available that have proved

successful in slowing the onset of fully developed AIDS in infected

individuals, such as therapy with the antiviral drug AZT, also known as

zidovudine. Treatment with several other drugs is known to prevent episodes of

pneumocystis carinii pneumonia, a life-threatening respiratory ailment that is

common to AIDS patients and often signifies the onset of the disease.

``So many people test positive and it comes as a total surprise to them,''

Mason said. ``If we really have 1 million people out there who are infected,

these people ought to be identified for their own good. This is the overriding

consideration that is driving this. If I were HIV positive, I would want to

know.''

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The guidelines recommend that hospitals and their associated health-care

providers routinely offer and encourage HIV testing for all patients.

Such services ``are especially indicated for patient populations with an HIV

(prevalence) of greater than 1 percent.'' In hospitals where AIDS prevalence is

very low, ``services could be provided to patients within a defined age

range,'' in other words, those patients whose age puts them at greater risk for

infection.

``The results should be provided in a confidential manner,'' the proposed

guidelines state. ``HIV-infected persons should receive medical evaluation for

their HIV infection and specific therapies and prevention services as needed.''

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